MCQ SURGERY MCQ (True /False) 1.
For malignant lesions of the stomah!
T T
". '.
the stage. F C. F +. T E. -.
S#m$toms an% signs manifest &er# late. enetration of tumors through the stomah all hel$s to %etermine "ll metastasis $ast *rst through the $ulmonar# irulation. Most lesions start initiall# as ,enign $ol#$s. En%oso$# an% ,io$s# are the main %iagnosti tools.
n ases of 'lee%ing e$ti Uler ith sho!
F ". T '. F C. a$ait#. T +. $erfusion. F E.
'loo% $ressure im$ro&es onl# ith ,loo% transfusion. The $ulse rate is useful for monitoring h#$o&olaemia. The Central 0enous ressure measures the o#gen arr#ing
3.
The folloing $arameters are essential in trauma to the hest!
T ". T '. F C. F +. T E. sus$ete%.
Measurement of o#gen saturation. lain hest 45ra#. Full hite ,loo% ell ount. 'loo% urea an% serum eletrol#tes. Ehoar%iogram (Car%ia ultrasoun%) if ar%ia tem$ona%e is
6.
The ulse 2#meter rea%ing inreases ith im$ro&ing tissue En%oso$# is use% on for larif#ing the %iagnosis.
The folloing features our in aute a$$en%iitis!
T ". 7ausea is ommon ,ut &omiting is infre8uent. F '. 9hen an a,sess is forme%: the ,ateria often in&ol&e% ,elong to the Sta$h#loous grou$. T C. +iarrhea is not a $resenting s#m$tom F +. ain an% ten%erness ma# start at the right ilia fossa an% then ,eome generali;e%. T E. Se&erit# of illness usuall# orres$on% ith the %uration of illness. <.
n ar,unles!
F ". T '. T C. res$onse. T +.
t an heal s$ontaneousl#. +ia,etes mellitus is a $re%is$osing fator. The s#m$toms an% sign are attri,uta,le to an aute in=ammator#
F
E.
>aematogenous s$rea% of infetion to other organs.
?.
Fators that %ela# oun% healing inlu%e!
T T
". '.
t is ause% ,# Sta$h#loous aureus hih ma# ,e MRS".
nfartion. Eessi&e mo,ilit# of a@ete% $art.
T T F B.
C. Ain %e*ien#. +. +ia,etes mellitus. E. "l%osterone. Mammar# %ut *stula is assoiate% ith!
F F
". '.
o,ular arinoma in situ. +ut$a$illoma.
T F F
C. +. E.
+ut etasia. Galatoele. Fatnerosis.
D.
Regar%ing se$ti sho
T ". F '. F C. T +. T E. om$ilation.
asses in to stages: the *rst is arm h#$er%#nami. Mostl# is %ue to gram $ositi&e se$tiaemia. >#$o&olaemia is %ue to eternal =ui% loss. 7itri 2i%e antagonists in animals im$ro&e sur&i&al. +C (+isseminate% intra&asular Coagulo$ath#) is $ossi,le
.
ulmonar# em,olism
T F T T F
". '. C. +. E.
1.
Critial lim, ishemia!
F T T T T
". '. C. +. E.
11.
The folloing %rugs shoul% ,e %isontinue% $rior to surger#!
T T F F F
". '. C. +. E.
1-. T T T
Commonl# ause% ,# throm,i from alf: thighs or $el&i &eins. Reurrent small em,oli nee% onl# follo u$. Me%ium si;e% em,oli auses $ulmonar# infartion. ntra&enous an% oral antioagulants must ,e starte% imme%iatel#. >e$arin an% Stre$tinase shoul% ,e gi&en together.
Usuall# is arterial onl#. Causes loss of $ulses: sensations an% funtion. ea%s to ol% lim, ith olour hange. 7ee%s urgent %u$le san. Can ,e treate% an% lim, is sa&e% in some ases.
9arfarin. "s$irin. 7ife%i$ine. Cortiosteroi%. Thia;i%e %iuretis. Regar%ing the a%ministration of the ,ane% hole ,loo%!
". '. C.
'ane% ,loo% is a $oor soure of $latelets. The le&els of intraellular a%enosine tri$hos$hate %ro$s. 2#gen trans$ort funtion of ,loo% falls %uring storage.
F F
+. E.
13.
Regar%ing aute a,%omen!
F
".
T '. F C. T +. F E. fe&er.
$> of ,ane% ,loo% rises slol# %uring storage. Signi*ant haemol#sis ours %uring storage.
" $lain a,%ominal 45ra# is %iagnosti in all ases. a$aroso$# is a useful tool. Meels %i&ertiulitis is a%iagnosti ommon ause. Mur$h#s sign is %iagnostiof aute hole#stitis. "$$en%iular a,sess $resents ith mo%erate tah#ar%ia an% mil%
16.
For a th#roi% a%enoma!
F T T T F
". '. C. +. E.
1<.
Caner stomah!
T T F T F
". '. C. +. E.
1?.
Ris fators for $ost5o$erati&e oun% infetion in ,oel surger# inlu%e!
T F T T T
". '. C. +. E.
1B.
"ute inrease of intraranial $ressure is aom$anie% ,#
T T F F F
". '. C. +. E.
1D.
Regar%ing $ro$h#lais against %ee$ &ein throm,osis
F7"C is %iagnosti. t is a ,enign selling. s treate% ,# hemi5th#roi%etom# if on*ne% to the same lo,e. Can a$$ear as a ol%: hot or iso5no%ule. t in&a%es its a$sule.
s re%ue% ,# &itamin C: mil: &egeta,les. s inrease% ,# smoe%: $ie%: or salte% foo%. s more in females than males. s treate% mainl# ,# surger#. Ra%iothera$# alone is an e@eti&e treatment o$tion.
ung ateletasis an%/or olla$se. Earl# mo,ili;ation of o$erate% $atient. "nastomoti leaage. Un$re$are% ,oel $reo$erati&el#. Haun%ie.
a$illoe%ema. Raise% ,loo% $ressure (Iuhing re=e). >#$orthermia. Tah#ar%ia. Erosion of %orsum sellae.
F ". Mi%%le age% man for trunal &gotom# an% gastri %rainage falls into high ris ategor#.
T '. Com,ination of he$arin an% stoings is ost e@eti&e in mo%erate ris grou$. T C. o moleular he$arin (M9>) has a loer ris of ,lee%ing than +U>(o %ose unfrationate% >e$arin). T +. ntrao$erati&e $neumati eg om$ressions ,ene*ial in high rish $atients. F E. ro$h#lati he$arin in la$. Choel#stetom# is inJete% %uring the o$eration. 1.
ost5o$erati&e oun% infetions
F ". T '. T C. F +. T E. o$eration
n lean5ontaminate% o$erations is 3K Coliforms are fre8uentl# res$onsi,le "re minimi;e% ith anti,ioti $ro$h#lais i$oma eision is a lean5ontaminate% o$eration "$$en%ietom# ith in=ame% a$$en%i is a lean5ontaminate%
-.
Regar%ing $h#lloi%es tumour of the ,reast: it!
F T T T F
". '. C. +. E.
-1.
n ,reast aner!
F T T F F
". '. C. +. E.
--.
>aemorrhoi%s
F T F T T
". '. C. +. E.
-3.
'arrets eso$hagus
F
".
s a malignant tumour in omen a,o&e 6 #ears. Reahes a huge si;e an% is ,osselate%. Can ulerate ,# $ressure atro$h# on sin. Remains mo,ile on hest all. s treate% ,# mastetom# an% aillar# learane.
o,ular arinoma is situ an ,e seen in mammogram. "t#$ial %utal h#$er$lasia is a ris fator for ,reast aner. 'reast aner rarel# $resents ith mastalgia. agets %isease of ,reast is assoiate% ith %iseases of the ,one. n=ammator# ,reast aner is stage% as T3.
nternal means it is l#ing in the u$$er 1/3 of the anal anal. More ommon in males than females. ain is in almost all $atient. Ma# ,e assoiate% ith aner of retum. nJetion ith slerothera$# is a metho% of treatment.
s a $ainfulL on%ition.
F '. e$hitelium. s meta$lasti re$laement of normar olumnar e$hitelium to s8uamous T C. Causes %h#s$hagia. F +. s a reursor for s8uamous ell arinoma. F E. s treate% ,# surgial resetion.
-6.
Regar%ing $re5o$erati&e $re$aration of a $atient!
T ". nforme% onsent shoul% onl# ,e $ro&i%e% ,# mem,er of the o$erating team. F '. re5o$erati&e $re$aration %oes not %e$eng u$on urgen# of o$eration. T F
C. +. E.
n ar%ia ris in%e: S 3 gallo$ is is a ris fators.%e% in all $atient. Estimation of fasting ,loo% sugar reommen ECG shoul% ,e %one in e&er# $atient.
-<.
Corret anser a,out aute intestinal ishemia!
T T F T F
". '. C. +. E.
-?.
Regar%ing th#roi% tumours
",%ominal $ain is out of $ro$ortion to $h#sial *n%ings. Meta,oli ai%osis is $resent. Multi$le %ilate% small ,oel loo$s are there in a,%ominal 45ra#. 2ult ,loo% in stool is a late sign. Relief of s#m$toms is o,taine% ,# intra&enous mor$hine.
F ". MaJorit# of th#roi% no%ules are malignant. F '. Ultrasoun% is a relia,le in&estigation to %i@erentiate ,enign from malignant tumours. T C. 7e irra%iation is a ause of th#roi% aner. T +. a$illar# th#roi% aner forms ?K of th#roi% aners. T E. Me%ullar# arinoma arises from $arafolliular C ells. -B.
Regar%ing >ernia!
F T T T F
". '. C. +. E.
-D.
Ra#nau%s %isease!
T F T T F
". '. C. +. E.
-.
n l#m$hati s$rea% of malignant elles!
F F
". '.
T C. Trousseaus F +. T E. 3.
Femoral hernia is ommon in males than females. rre%ui,ilit# of inguinal hernia is the earl# om$liation. Femoral hernia is lia,le for om$liations more than inguinal t#$e. n%iret inguinal hernia ten%s to ome %on into the srotum. +iret inguinal hernia is %ue to i%e %ee$ ring.
rimar# one has a geneti $re%is$osition. t ours in #oung males more than females. Treate% ,# alium antagonists or s#m$athetom#. t is an a,normal res$onse to ol%. t ours in three stages en% ,# %us# #anose% *ngers.
t is elusi&el# antegra%e. Troisiers sign re$resents antegra%e etension. +ee$ seate% a,%ominal aner shos ,oth Troisiers an% signs. Etension is ,# $ermeation onl#. Final station is the lung an% li&er.
n $e$ti uler %isease !
F F F F T
". '. C. +. E.
T#$e 1 gastri uler is at fun%us. +uo%enal uler has ris or malignan#. Curlings uler ours in hea% inJur# $atients. 'ismuth is an antiseretor# %rug. "nti,ioti thera$# has ,eome more signi*ant.
1. F T T F T
Regar%ing inguinal hernia ". "ll inguinal hernia $ass through the %ee$ inguinal ring. '. "n in%iret hernia $asses lateral to the inferior e$igastri arter#. C. " large in%iret hernia reahes the srotum. +. " %iret hernia is ithin the o&erings of the s$ermati or%. E. Congenital hernia is of an in%iret t#$e.
-.
Regar%ing a$$en%iitis
T ". Ten%erness at M'urne#s $oint is a linial sign. T '. The ,loo% su$$l# of the a$$en%i are ,ranhes of a$$en%iular ,ranh of ileooli arter#. T C. n female: torsion of the o&arian #st shoul% ,e onsi%ere% as a %i@erential %iagnosis. T +. Tah#ar%ia an% mil% $#reia are t#$ial $resentations. F E. ",%ominal ra%iogra$h is man%ator# for %iagnosis. 3.
Regar%ing malignanies of the sin!
T ". Malignant melanoma most often arises from $reeisting nae&us. F '. Satellite lesions a$$earing aroun% the $rimar# malignan# is a feature of s8uamous ell arinoma. T C. 'asal ell arinoma has a raise% an% rolle% e%ge. F +. S8uamous ell arinoma is also referre% to as ro%ent uler. T E. MarJolins uler is assoiate% ith s8uamous ell arinoma.
6.
Carinoma of the oeso$hagus!
T T F T
". '. C. +.
Consum$tion of salte% *sh is a ris fator. "halasia is a $re%is$osing on%ition. "%enoarinoma t#$e is ra%io5sensiti&e. +#s$hagia is a $resenting om$laint.
T
E.
S$rea%s to the li&er an% lungs.
<.
The folloing our/s ith gastro5oeso$hageal re=u!
T
".
neumonia.
T T F F
'. C. +. E.
2eso$hageal striture. 'arrettNs eso$hagus. S8uamous ell arinoma of the oeso$hagus. erniious anaemia.
?.
Carinoma of the stomah
T ". s ommonl# a om$liation of atro$hi gastris. F '. Causes $re5he$ati t#$e of Jaun%ie. T C. The in*ltrating arinomas results in linitis $lastia (Oleather ,ottle a$$earane). T +. ro%ues Iruen,erg tumour. T E. En%oso$i ,io$s# is the %e*niti&e %iagnosti ai%. B.
The folloing oloretal $ol#$ are $re malignant!
T F F
". '. C.
"%enoma. >amartoma. Meta$lasti $ol#s.
T F
+. E.
Familial $ol#$osis oli. Hu&enile$ol#$.
D.
Regar%ing oloretal aner!
T ". F '. T C. T +. enema. F E.
.
"%enomas are $reursors. t is ommoner in the trans&erse olon than in the retum. erioli a,sess is a $resentation. "nnular arinoma $ro%ues P"$$le oreP a$$earane in ,arium ntestinal o,strution is ommon in the right si%e% aner.
n intraa,%ominal a,sess!
F ". Coli# $ain hih inrease ineora,l# is a feature. T '. There is usuall# a mare% leuo#tosis. T C. "$$en%iular $erforation is one of the auses. T +. Ten%er a,%ominal mass is $al$a,le. F E. ",%ominal Ra%iogra$h is most hel$ful in %emonstrating the site an% si;e of the a,sess. 1.
n $atients a%mitte% ith aute a,%omen!
F ". T '. $eritonitis. T C. F +. T E.
"ute a$$en%iitis oul% is ,ein%iate% on*rme% a,%ominal E$lorator# la$arotom# in,# $atients ith 45ra#. generalise% eaing ",%ominal aorti aneur#sm shoul% ,e elu%e%. >ar% ,oar% rigi%it# our in $erforate% gastri uler. >igh serum am#lase le&el is suggesti&e of the ause.
11.
Regar%ing haematemesis!
T T F
". '. C.
t oul% ,e assoiate% ith h#$o&olaemi sho. t oul% arise as a om$liation of $e$ti uler %isease. t onsists of t arr# ,la , loo%.
T
+. E.
The on%ition ,e in&estigati&e fatal. En%oso$# is aoul% useful tool.
1-.
Conerning the soures of ra%iation ha;ar%s!
T T T F T
". '. C. +. E.
"ging 45ra# tu,e leaage. Ra%io5isoto$es a%ministration %uring >+" sanning eamination. Cosmi ra#s. Eletri generator. Com$ute% tomogra$hi5 =uoroso$i eamination.
13. " su$ine $lain a,%ominal ra%iogra$h often $ro&i%es useful %iagnosti information in the folloing on%itions! T F F T T
". '. C. +. E.
",%ominal aorti aneur#sm. erforate% $e$ti uler. "ute a$$en%iitis. "ute hol##stitis. arge ,oel o,strution.
16. The folloing ra%iologial features suggest Crohns %isease rather than ulerati&e olitis! T F F F F
". '. C. +. E.
seu%osaulation. n&ol&ement of the retum. shortening of the olon. lea% $i$e a$$earane of the olon. lesions in ontinuit#.
1<.
Regar%ing ultrasoun% eamination
F F F T T
". '. C. +. E.
Cannot ,e use% to assess ,iliar# o,strution. s use% to e&aluate $neumothora. s ontrain%iate% in $atients ith aute a,%omen. s the eamination of hoie in sus$ete% li&er a,sess. +etet minimal asites.
1?.
Regar%ing Gra&es %isease!
T T
". '.
s one of the ommon auses of th#rotoiosis. ong ating Th#roi%5stimulating hormone ("TS) le&el is a %iagnosti
of Gra&es. F C. The th#roi% glan% is of normal si;e. F +. 2$hthalmo$ath# is seen in all ases. T E. t is assoiate% ith $reti,ial m#oe%ema.
1B.
Regar%ing gallstones!
F T T F
". '. C. +.
Most of them are &isi,le on $lain a,%ominal 45ra#. ure holesterol stones form less than 1K of stones. 2estrogen failitates stone formation. 'ile stones are forme% from onJugate% ,iliru,in.
T
E.
a$araso$i hole#stetom# is a mo%e of treatment.
1D.
Regar%ing th#roi% malignanies
F T T T T
". '. C. +. E.
1.
+uring the initial e&aluation an% resusitation in multi$le trauma $atient!
F ". T '. F C. *rst hour. T +. T E. -.
Collar5stu% a$$earane is a harateristi feature. a$illar# arinoma ontains O$sammoma ,o%ies. Folliular arinoma is assoiate% ith se&ere ,a5ahe. "na$lasti arinoma is assoiate% ith Ioher sign. Me%ullar# arinomas arise from "U+ C5ells.
" &er# om$lete an% %etaile% histor# is the *rst $riorit#. Must a%%ress aira#: ,reathing an% irulation imme%iatel#. atient ho has alohol intoiation an ,e %isharge% after the t is im$ortant to rule out h#$ogl#aemia. Glasgo Coma Sale is useful to assess onsious le&el.
Regar%ing the th#roi% glan%!
T ". The reurrent lar#ngeal ner&e an ,e inJure% %uring th#roi%etomies. T '. Total th#roi%etom# an lea% to tetan#. F T F
C. +. E.
t mo&esarinoma ith $rotrusion of tongue. Colloi% is a rare form of malignan#. >ot s$ots on th#roi% san suggest malignan#.
-1.
Regar%ing ga latorrhoea
T T F T T --.
". s %ue to $ituitar# tumour. '. s assoiate% ith &isual %istur,ane. C. 2nl# ha$$en in females. +. me%iation suh as metolo$rimi%e (maolon) as a ause. E. one of the main in&estigations is serum $rolatin. The folloing are regar%e% as imme%iate $osto$erati&e om$liations!
T T T F F
". '. C. +. E.
-3.
'reast aner is more ommon in $atients ith!
T F T F
". '. C. +.
" famil# histor# of ,reast aner. >istor# of ,ilateral oo$horetom#. En%ometrial aner. Chroni smoing ha,it.
T
E.
ate *rst $regnan#.
-6.
Clinial features of aute $anreatitis inlu%e!
T T T T T
". '. C. +. E.
-<.
Regar%ing %ee$ &ein throm,osis!
T ". T '. grou$. T C. T +. F E.
"teletasis. +ee$ 0ein Throm,osis. aral#ti ileus. nisional herni. +um$ings#n%rom.
Tetan#. aral#ti ileus. 0omiting. Haun%ie. leural e@usion.
t ours in $atients ho has $rolonge% immo,ili;ation. Com,ination of he$arin an% stoings is e@eti&e in mo%erate ris ung infartion is a om$liation of mo%erate si;e% em,oli. The $atho $h#siolog# is ,ase% on the 0irhos tria%. t is treate% ,# oral antioagulants.
-?.
Ris fators for $ost5o$erati&e oun% infetion inlu%e!
T F T
". '. C.
ateletasis. earl# mo,ili;ation in $atient ith la$arotom# sar. anastomoti leaage.
T T
+. E.
un$re$are% Haun%ie. ,oel.
-B.
Regar%ing sin infetions an% a,sesses!
F ". e$i%ermi%is. T '. T C. T +. F E.
'reasts a,sesses are ommonl# ause% ,# Sta$h#loous 2rganisms an s$rea% &ia the ,loo%stream. Furunle is %ue to infetion of a hair follile. Er#si$elas is ause% ,# Stre$toous $#ogenes. Car,unles are ,est treate% ith oral anti,iotis.
-D.
Regar%ing &ariose &eins!
T T F T T
". '. C. +. E.
-.
First %egree haemorrhoi%s are a ause of!
T F F T T
". '. C. +. E.
3.
Regar%ing mehanial %isor%ers of the oeso$hagus!
F ". F '. thora. T C. T +. s$hinter. T E. 1.
the# are more ommon in oman. the sa$henofemoral Juntion is initiall# a@ete%. haemosi%erin %e$osition auses h#$o$igmentation. li$o%ermatoslerosis is a feature. intae of oral ontrae$tion is a $re%is$osing fator.
Fresh retal ,lee%ing. "nal$ain. Retal muosal $rola$se. "naemia. ruritis ani.
Sli%ing hernias are less ommon than rolling hernia. n rolling hernia: the ar%io5oeso$hageal Juntion is lifte% u$ into the 'arium sallo in ahalasia t#$iall# shos Rat5tail a$$earane. n ahalasia. "uer,ahNs $leus is a,sent a,o&e the oeso$hageal +#s$hagia in ahalasia is a@ete% for soli%s an% li8ui%s.
The natural histor# of a %isease refers to!
T ". The $rogression of the %isease o&er time. F '. The most ommon s#m$toms. T C. The %esri$tion of the onset: s$etrum of $resentation an% outome of the %isease. F +. +i@erenes in $rogression of illness hen %i@erent treatments are use%. F E. The *n%ings from the linial eamination. -.
Carinoma of the oeso$hagus!
T T
". '.
our most ommonl# in the mi%%le thir% of the oeso$hagus. is $re%ominantl# s8uamous in t#$e.
F T T
C. +. E.
3.
Regar%ing a$$en%iitis!
F T T T F
". '. C. +. E.
6.
Regar%ing the aroti% Glan%!
F ". T '. -n% molar. F C. stones. T T <.
Commonl# s$rea% to the &erte,ral olumn. is a om$liation of oeso$hagitis. is assoiate% ith alohol intae.
'loo% su$$l# to ,# theaa$$en%i arter#. Can ,e ause% faeolithisorgastro%uo%enal foreign ,o%# o,strution. "$$en%ietom# an ,e $erforme% la$aroso$iall#. soas sign is $ositi&e in retro$eritoneal t#$e. Essentiall# is manage% as an out$atient ,asis.
t is mainl# a muous glan%. The Stensens %ut o$ens into the oral a&it# o$$osite the u$$er aroti% %ut aluli is more ommon than su,man%i,ular %ut
+. Surgial inter&ention oul% lea% to faial ner&e $als#. E. Sialogram is %iagnosti for $aroti% %ut stones. Regar%ing the Th#roi% Glan% tumour!
F ". F '. T C. no%ule. T +. F E.
"re the ommonest ause of $osterior ne selling. More ommon in a%ult males than females. Su%%en hange in si;e ith $ain in%iates haemorrhage into the a$illar# Carinoma is the ommonest t#$e of malignan#. Ra%ioisoto$e san is on*rmator# of malignan#.
?.
Regar%ing Ieloi%!
F T F F T
". '. C. +. E.
B.
The folloing are regar%e% as imme%iate $osto$erati&e om$liations!
T T T F
". '. C. +.
ulmonar# em,olism. +ee$ 0ein Throm,osis. aral#ti ileus. nisional hernia.
F
E.
+um$ing s#n%rome.
D.
Regar%ing 'asal Cell Carinoma!
T
".
>#$ertro$h# of mature *,ro,lasts is a feature. ntralesional triaminolone is one mo%e of treatment. Continues to gro larger ithout s$rea%ing to the normal tissues. s ommon in areas of sin e$ose% to sunlight. Mostl# reurs after eision.
t is the ommonest t#$e of sin malignan#.
F F F T
'. C. +. E.
Usuall# ours in the area ,eteen the loer li$ an% hin. s non as 'oens %isease. Ro%ent uler has raise% e&erte% e%ges. t is loall# in&a%ing an% rarel# metastasi;e.
.
n ,oel o,strution!
T ". Coli# a,%ominal $ain is harateristiall# the earliest s#m$tom. F '. assing =atus after the onset of $ain elu%es the %iagnosis. T C. f the site of o,strution is in the %istal large ,oel: &omiting is a late feature. T +. 0isi,le $eristalsis su$$orts the %iagnosis of o,strution. T E. "ir =ui% le&el in a,%ominal 45ra# is a feature. 1. "ute $anreatitis is assoiate% ith! T T T T F
". '. C. +. E.
11.
ure ater %e$letion ours in the folloing irumstanes!
T T T T F
". '. C. +. E.
1-.
>#$oalemia!
F T T F T
". '. C. +. E.
13.
n a normal B5g a%ult!
T T T T T
". '. C. +. E.
16.
Regar%ing $ro$h#lais against %ee$ &ein throm,osis
F ". ategor#.
Gall stones. >#$erli$i%aemia. Mum$s infetion. rolonge% ingestion of oral ontrae$ti&e $ills. >#$oth#roi%ism.
+iminishe% intae. na,ilit# to sallo %ue to $ainful on%itions of the $har#n. 2,strution in the oeso$hagus. nrease% loss from lungs after traheostom#. S#n%rome of na$$ro$riate "nti +iureti >ormone seretion (S"+>).
s seen in renal failure. s seen in ases of $aral#ti ileus. Manifests as intermittent $erio%i $aral#sis. Causes $eaing of T a&e in an ECG. otassium shoul% ,e gi&en ,# ontrolle% infusion .
Urine out$ut is 1.< liter/%a#. nsensi,le ater loss is B51ml/%a#. So%ium re8uirement is -mmol/g. Ran%om serum ,loo% gluose ranges < 1 mmol/. 9ater re8uirement is 3 m/g/%a#.
Mi%%le age% man un%ergoing herniora$h# falls into high ris
T '. ris grou$. T C. +U> (o T +. $atients. F E.
Com,ination of he$arin an% stoings is ost e@eti&e in mo%erate o moleular he$arin (M9>) has a loer ris of ,lee%ing than %ose unfrationate% >e$arin). ntrao$erati&e $neumati leg om$ression is ,ene*ial in high ris ro$h#lati he$arin in la$aroso$i hole#stetom# is inJete%
%uring the o$eration. 1<. n $atients ith aute hole#stitis! T F T F T
". '. C. +. E.
Gall stones are not ala#s $resent. Common organism is Sta$h#loous s$. Em$#ema is a ommon om$liation. Mur$h#s sign is ala#s $resent. Com$liations are more liel# in %ia,eti $atients.
1?.
The folloing features are harateristi of &enous ulers!
F
".
The# are ne&er $ainful.
T T hose. F T
'. C.
The# are usuall# foun% on the me%ial as$et of the loer leg. The# are an ,e treate% ith high om$ression (lass ) su$$ort
+. E.
The# usuall# re8uire imme%iate surgial eision. The# are more ommon than arterial ulers.
1B.
n ,reast aner!
F T T F F
". '. C. +. E.
1D.
The groth of the folloing tumors is hormone %e$en%ent!
T T T F F
". '. C. +. E.
1.
Raise% intraranial $ressure ma# $ro%ue!
T T T F T
". '. C. +. E.
o,ular arinoma in situ an ,e foun% on mammogra$h#. "t#$ial %utal h#$er$lasia is a ris fator for ,reast aner. 'reast aner rarel# $resents ith mastalgia. agetNs %isease of ,reast is assoiate% ith agetNs %isease of ,one. n=ammator# ,reast aner is stage% as T3.
lo,ular arinoma of ,reast. folliular arinoma of th#roi%. arinoma of $rostate. small ell arinoma of lung. oloretal arinoma.
%iminishe% onsiousness. erosion of the $osterior linoi% $roesses. a$illoe%ema. loere% s#stoli ,loo% $ressure ith a ra$i% $ulse. tonsillar herniation.
-.
>ealing of the surgial oun% is im$aire%L
T T F F T
". '. C. +. E.
in the $resene of infetion to the oun%. ,# $oor seletion of suture material use% in suturing the oun%. folloing gentle tissue han%ling of the oun%. folloing auratel# o$$osing the oun% e%ges. in $atient ith %ia,etes mellitus.
-1. +uring the initial e&aluation/resusitation in hea% inJur# an% $ol#trauma $atient! F ". *rst $riorit#. T '. F C. *rst hour. T +. T E.
a &er# om$lete histor# an% %etaile% $h#sial eamination is the must a%%ress aira#: ,reathing an% irulation imme%iatel#. $atient ho has alohol intoiation an ,e %isharge% after the im$ortant to rule out onomitant inJur# to the er&ial s$ine. Glasgo Coma Sale is useful to assess onsious le&el.
--.
roteti&e fators for ,reast aner inlu%eL
T F T T F
". '. C. +. E.
-3.
" on&entional 45 ra# of the a,%omen is useful in %eteting!
T T F T T
". '. C. +. E.
-6.
Minimall# in&asi&e surger#
T F T T T
". '. C. +. E.
'reastfee%ing. >igh intae of alohol. ate menarhe. Earl# meno$ause. 7ulli$arous.
Teratoma. intestinal o,strution. li&er laeration. ra%io o$a8ue renal aluli. $erforate% ,oel.
is use%minimal for hole#stetom#. means sill is re8uire%. maes use of ar,on %ioi%e for insuation. is ontrain%iate% in $atients ith oagulo$ath#. a@or%s a 8uier reo&er# than o$en $roe%ures.
-<.
n a,sesses in&ol&ing the sin!
F ". The most ommon ,ateria in&ol&e% is methiillin resistant Sta$h#loous aureus (MRS"). T '. +ia,etes mellitus is a $re%is$osing fator. T C. The s#m$toms an% signs are attri,uta,le to an aute in=ammator# res$onse. F +. >isto$athologial eamination is man%ator# to ahie&e %iagnosis. T E. " serious om$liation is haematogenous s$rea% of infetion to other organs. -?.
n $atients ith inguinal hernias!
F ". f the onset is in infan#: om$liations are rare an% therefore surgial treatment shoul% ,e %eferre%. T '. t is more ommon in males than females. F C. ntestinal o,strution is more liel# to our in the %iret hernia rather than the in%iret hernia. T +. t an ,e %i@erentiate% from a femoral hernia ,eause in inguinal hernia the selling a$$ears a,o&e the inguinal ligamentL hereas in femoral hernia the selling is ,elo the inguinal ligament. T E. ain is more liel# to ,e felt at the mi%5a,%omen rather than at the site of selling. -B.
0ariose &eins!
T T T F F
". '. C. +. E.
-D.
s more ommon in el%erl# grou$ of the $o$ulation. Usuall# are as#m$tomati. Sa$heno5femoral ligation is a ommon surgial inter&ention. "re ommonl# %ue to %ee$ &enous throm,osis (+0T). Commonl# ause gangrene of the lim,s.
The folloing is/are e$ete% om$liations of inguinal hernia!
T T T F T
". '. C. +. E.
-.
Regar%ing Jaun%ie!
T
".
T '. F C. Jaun%ie. F +. T E.
2,strution. nareration. Strangulation. Malignant hanges. Gangrene of the ,oel.
$ruritus a feature in o,struti&e t#$e. an also ,e ause% inom$ati,le transfusion. retiulo#te ount is,# usuall# inrease%,loo% in $ost he$ati Uro,ilinogen is routinel# %etete% in o,struti&e Jaun%ie. oul% our in se$sis.
3. F T F T T
Regar%ing haemorrhoi%s! ". nternal haemorrhoi%s lie %istal to the $etineal line. '. 1st %egree haemorrhoi% is re%ui,le. C. $ain is in almost all $atient. +. ma# ,e assoiate% ith aner of retum. E. ru,,er ,an%ing of the $e%ile is a metho% of treatment.
MEQ 1
Part 1 (15 minutes)
Mr Chong is a 45-years-old Chinese male who was brought to the hospital with a sudden severe epigastri pain with abdominal distension! vomiting"
#e has a history o$ reurrent atta%s o$ epigastri pain whih was aggrevated by $ood inta%e and relieved by ante aid drugs"
Q&E'*+ 1
Mention #,EE $ossi,le %i@erential %iagnoses.
(3 mars)
1/04-
Per$orated .astri &ler Per$orated duodenal uler Mallory eiss 'yndrome 2ute panreatitis
5bowe obstr uti on 3- 'ma .astll ri outllet obstr uti on
Q&E'*+ /
9hat 8uestions #ou ant to further as the $atient or relati&es Gi&e im$ortant #,EE 8uestions
(3 mars) 1/04-
ype a nd uality o $ pain ,elation o$ pain to meals" history o$ pepti uler medial treatment #istory o$ previous endosopy
Q&E'*+ 0
Mention *&, essential signs #ou ant to loo for
1/04-
(- mars) low blood pressure rapid wea% pulse pale to6i $ae hard rigid abdomen
53-
tender whole abdomen absent bowel sounds Q&E'*+ 4
Mention *&, im$ortant in&estigations an% aim of it
(mars)
nvestigation 1- Plain 7- ray eret and supine or lateral 8lm /- <rasound abdomen 0- C9C 4- 'erum am ylase
2im .as under diaphragm luid in abdomen 'vere leu%oystosis 2ute panreatitis
MEQ 1
Part (15 minutes)
Mr Chong is a 45-years-old Chinese male who was brought to the hospital with a sudden severe epigastric pain with abdominal distension, vomiting. He has a history of recurrent attacks of epigastric pain which was aggrevated by food intake and relieved by ante acid drugs.
Patient gave a history o$ having mediation $or a pepti uler sine two years" E6amination showed rapid pulse and low blood pressure" 2bdomen was tnder all over and rigid with no bowel sounds" 2bdominal 7-ray was shown
Q&E'*+ 5
+esri,e the 45ra# *lm an% *n%ings
(- mars)
1 / 0
Eret8lm ell entrali:ed patient 2ir under both opulae o$ diaphragm
Pneumoperito neum
Q&E'*+ 3
9hat is the net ste$ for management of this $atient
(- mars)
E6ploration laparotomy
Q&E'*+ ;
Mention *&, ste$s to $re$are this $atient for surger#.
mars)
1/045-
+aso gastri tube aspiration Corret luids Corret Eletrolytes Cross m athing $ or blood Coagulation pro8le
MEQ 1
Part (15 minutes)
(-
Mr Chong is a 45-years-old Chinese male who was brought to the hospital with a sudden severe epigastric pain with abdominal distension, vomiting. He has a history of recurrent attacks of epigastric pain which was aggrevated by food intake and relieved by ante acid drugs. atient has a peptic ulcer since two years. !"amination showed rapid pulse and low blood pressure. #bdomen was tnder all over and rigid with no bowel sounds. #bdominal $-ray showed gas under diaphragm
Patient was ta%en to the operation theatre a$ter preparation! laparotomy was done and showed per$orated anterior gastri uler "
Q&E'*+ <
9hat is the management of this on%ition
(- mars)
1-Closure with omental path /- or de8nitive treatment by vagotomy and drainage or partial gastri resetion
Q&E'*+ >
and anastomosis to =e=unum
9hat are the $ossi,le om$liations of surger# Mention#,EE
(3 mars)
1/04-
,e-per$oration 2bsess ('ub-diaphragmati) &pper . istula Post gastretomy syndromes
Q&E'*+ 1?
9hat are the $ost o$erati&e me%iations shoul% ,e gi&en mar%s)
(/
1- Pepti uler regime ( Metronida:ole! antibioti! proton pump inhibitors) /- 2ntibiotis 0- Pain ontrol
4- 2void $ood and give @ $eeding $or a wee%
MEQ 1
Part 4 (15 minutes)
Mr Chong is a 45-years-old Chinese male who was brought to the hospital with a sudden severe epigastri pain with abdominal distension! vomiting" #e has a history o$ reurrent atta%s o$ epigastri pain whih was aggrevated by $ood inta%e and relieved by ante aid drugs" Patient has a pepti uler sine two years" E6amination showed rapid pulse and low blood pressure" 2bdomen was tnder all over and rigid with no bowel sounds" 2bdominal 7-ray showed gas under diaphragm Patient was ta%en to the operation theatre a$ter preparation! laparotomy was done and showed per$orated anterior gastri uler "
Closure o$ the uler with omental path was done and patient was done and patient was disharged but one wee% later he ame ba% with right tender huge hypohondrial swelling" <ra sound showed an absess under diaphragm"
1- #owanyoumanagetheaseA mar%s)
(/
/- hatistheseulaeo$thisabsessA mar%s)
(/
0- #owareyougoingtomanagethisseualae mar%s)
(0
M!% Part 1 (1? minutes)
Madam ! a 0< year-old single lady! noted a palpable mass in her right breast 0 wee%s previously whih warranted her to see% medial opinion"
Question!
1"
Bist @E (5) points that you would as% the patient in the history" (< mars)
.... • • • • • • • • •
loss of weight, appetite history of menarche and menstrual cycle Number of children lactation history History of OCP intake Family history of underlying breast Ca. Nipple discharge diculty in breathing History of feer
Question!
/" Bist @E (5) oth er lin ial signs that oul d assist you in ma%ing the diagnosisA (< mars)
.
.
.
.
.
.
.
..
.
!eneral e"amination# • • •
• • •
pallor, cyanosis, cache"ia $pper limb% lymphoedema &ungs% 'ullness to percussion oer the costal angle suggest pleural e(usion )one% tenderness &ier% enlargement Palpable a"illary lymph nodes o *psilateral and contralateral sites o single + multiple nodules
&ocal e"amination# •
•
Features of the lump si-e, shape, surface, mobility, consistency, number, transillumination peau d/ orange sign
• •
0etracted nipple 'ischarge from the nipple
M!%
Part / (< minutes)
Madam ! a 0< year-old single lady! noted a palpable mass in her right breast 0 wee%s previously whih warranted her to see% medial opinion"
2n eamination: there is a 6 6 m har% mass ith tethering of the sin of the right ,reast assoiate% ith mo,ile enlarge% right aillar# l#m$h no%es.
0" Mention #,EE (0) possible auses $or the breast lump in this patient"
(3 mars) .
.
.
.
. i.
)reast carcinoma
ii. iii. i. . i.
1uberculous mass 2arcoids 1raumatic fat necrosis 3ctinomycosis Chronic breast abscess
Matri +o
4"
*utline @E (5) investigations you would do $ or this patient and state the 8ndings that you would e6pet $rom eah investigation (<
mars)
7o.
n&estigation
Fin%ings
n&estigation
Fin%ings
1. 2. 3. 4. 5.
"nser
7o. 1. )lood%
H), 14'C, &ier &ung 2. mammography 3. $ltrasound of the lump 4. FN3C 5. Chest"6ray
S$iulate% mass ith arhitetural %istortion miroali*ation 5ass lesion which has either well demarcated edges or indistinct outline solidorcysticlesion ribsecondaries, pleural e(usion lung secondaries
Part 0 (1/ minutes)
Madam ! a 0< year-old single lady! noted a palpable mass in her right breast 0 wee%s previously whih warranted her to see% medial opinion"
2n eamination: there is a 6 6 m har% mass ith tethering of the sin of the right ,reast assoiate% ith mo,ile enlarge% right aillar# l#m$h no%es. he hest 7-,ay and ultrasound o$ the abdomen were normal" ru-ut biopsy on8rmed in8ltrative intra dutal arinoma"
5"
Desribe with the aid o$ an anatomial diagram! the lymphati drainage o$ the breast" (? mars)
1o include# 1he anterior, medial, central, posterior, apical, lateral, internal thoracic nodes, infradiaphragmatic and supraclaicular nodes
Matri +o
3" hat is the stage o$ this tumourA (1 mar)
3nswer 17N859
;. *utline the de8nitive management plan $or this patient" mars)
(3
.
..
.
• • •
)reaking news of malignancy and counseling 5astectomy 3d:uant% 0adiotherapy + Chemotherapy+ Hormonal
<" *utline the assessment methods $or the surveillane o$ her le$t breast in the $uture" (mars)
..
..
..
• • • •
3ssessment of the symptoms and signs )reast self e"amination regularly Periodic and regular follow6up with the surgical or oncology clinic ;early mammogram
M!% Part 1 (1? minutes)
Mrs" M! a 3?-year-old lady presented with vomiting out blood and passing out tarry bla% stool $or more than / days and was admitted to the surgial ward" 'he also mentioned to the dotor that she has been having upper abdominal disom$ort and =oint pains $or a year o$ whih she has seen a dotor and is on regular $ollow-up"
Question 1
Mention @E (5) uestions that you would as% in the history to suggest the possible auses o$ his problem (< mars)
1"
/" 0" 4" 5"
Matri +o
&'# (&') *ymptoms of anaemia ast Medical history+ ast history of eptic lcer isease and its symptoms #nd having lood dyscrasia, lood group # rug history+ /*#0* and steroids *ocial history+ #lcohol intake, smoking iet history+ spicy food
2n eamination: she as foun% to ,e a me%ium5si;e% la%#: l#ing su$ine on the ,e%. She as $ale ith an intra&enous %ri$ onher left forearm.
Question -
Bist @E (5) 8ndings that you would e6pet in the general physial e6amination o$ this patient (-.< mars) 1" /" 0" 4"
5"
i. ii. iii. i. . i. ii. iii.
pulse% 4eak+thready o lume and tachycardia from the )P% Hypotensie 00% tachycardic Pallor
Matri +o
Question 3!
Bist @E (5) 8ndings you would loo% $or to assist in ma%ing the diFerential diagnoses (-.< mars) 1" /" 0" 4"
5"
!uidefor e"aminer% ''"% ii. iii. i". ". "i. "ii. "iii.
•
•
• • •
Peptic ulcer disease Oesophageal arices =rosie tablets gastritis secondary to the N23*' non steroidal anti6 in>ammatory !astric carcinoma )lood dyscrasia 5allory ?4eiss syndrome 'eulafoy/s lesion
2tigmata of chronic lier disease o clubbing, palmar erythema, spider naei, gynaecomastia, testicular atrophy 3bdominal e"am% o mass on deep palpation at the =pigastrium or &eft Hypochondrium o 2igns of portal hypertension such as ascites, hepatomegaly and caput medusae Palpable supraclaicular lymph nodes 2igns of in>ammation in both knee :oints 5alaenic stool upon per rectal e"amination
M!% Part / (1? minutes)
Mrs" M! a 3?-year-old lady presented with vomiting out blood and passing out tarry bla% stool $or more than / days and was admitted to the surgial ward" 'he also mentioned to the dotor that she has been having upper abdominal disom$ort and =oint pains $or a year o$ whih she has seen a dotor and is on regular $ollow-up"
ollowing physial e6amination per$ormed! a provisional upper gastro-intestinal bleed was made"
diagnosis o$
Question 1
Bist @E (5) possible auses o$ bleeding in this patient (< mars)
1"
/"
0"
4"
5"
Matri +o
i. ii. iii. iv. v. vi. vii.
1astritis ( eptic ulcer disease 'esophageal v arices !rosive gastritis secondary to the /*#0 2non steroidal antiin3ammatory tablets 1astric carcinoma lood dyscrasia Mallory )eiss syndrome eulafoy6s lesion
Question -
Bist @E (5) investigations you would do in the management o$ this patient and state the 8ndings that you would e6pet $rom eah investigation that you have per$ormed"
(-.< mars)
No.
Investigation
Findings
1.
2.
3.
4.
5.
/o .
0nvestigation
7indings
8.
Haematological investigation
&ow haemoglobin 2anaemia &ow haematocrit count 2 &ow C9 High urea
: >.
leeding pro;le 'esophagoscope 2including taking
4.
abnormal ? take biopsy 1as undermasses, the diaphragm
A.
biopsy !rect plain abdominal "-ray ltrasound # 'M!/ arium sw allow and meal C= scan #bdomen
B
5. @.
masses arising fr om =H ! 90*C* #bnormalities in the oesophagus and gastric mucosa 7urther delineation of the abdominal viscus &ocalied hot spot at the site of bleeding Matri +o
Question 3
ith the ai d o$ a diagram! desribe the anato my o$ the gastri =untion!
oesophago-
stomah! duodenum inluding the blood supply and lymphati drainage o$ these organs" (-.< mars)
1o include# • • • • • • • • • •
Oesophagus &eft gastric ein portal 3ccessory hemia-ygos ein systemic 1he cardio6oesophageal :unction 2tomach Pylorus 'uodenum 3rterial supply @enous drainage lymphatics
Part 0 (1? minutes)
Mrs" M! a 3?-year-old lady presented with vomiting out blood and passing out tarry bla% stool $or more than / days and was admitted to the surgial ward" 'he also mentioned to the dotor that she has been having upper abdominal disom$ort and =oint pains $or a year o$ whih she has seen a dotor and is on regular $ollow-up"
ollowing physial e6amination per$ormed! a provisional diagnosis o$ upper gastro-intestinal bleed was made" 'ubseuently and investigations revealed @ery &ow haemoglobin 2anaemia oesophagogastroduodenoscopes revealed an actively ooing duodenal ulcer.
Question 1!
Desribe the pathogenesis o$ gastri uler! duodenal uler and bleeding pepti uler (6 mars)
Matri +o
• • •
•
•
5ismatch of the production of acid in the stomach 'ecreasing integrity of the duodenal mucosa Formation of either the gastric or duodenal ulcer the bleeding ulcer is usually on the posterior surface of the duodenal bulb 'eelopment of the bleeding area when the mucosal wall is breached, ulcer penetrates, the gastroduadenal artery is e"posed and eroded Punctate erosion oer the ulceratie region
Question /
*utline the plan o$ management (general and spei8) $or this patient (? mars)
!eneral% •
•
•
"%mit $atient to the ar%L $ut in large ,ore annula an% start analgesis an% o#gen 0esuscitation% ith intra&enous =ui%: ,loo% an% ,loo% $ro%uts f in%iate%. rest the gut! nasogastri tu,e to %eom$ress gut: assess ,lee%ing an% to ommene ol% ater la&age if in%iate% S$ei*!
•
•
Minimall# in&asi&e $roe%ures suh as 2G+S an% use of eletroauter#: slerosant or "%renaline to sto$ loal ,lee%ing $oints an% to tae ,io$s# if in%iate% To start %e*niti&e inter&ention suh as Me%ial management one the %iagnosis of $e$ti uler is ma%eL "nti >- antagonist: roton $um$ inhi,itor: tri$le thera$# for heloo,ater $#lori infetion
•
f so$e an% a%renaline inJetion faile% to ontrol the ,lee%ing $e$ti uler: tae onsent for la$arotom# an% su,se8uent %e*niti&e surgial inter&ention suh as Emergen# la$arotom#: $#loro$last#: un%errunning of the a@ete% &essels an% lassiall# the 'illroth $roe%ure or highl# seleti&e &agotom#.
he speimen was e6ised $rom a 3? year-old lady who ame to the hospital with a omplaint o$ a ne% swelling $or the past one year and normal vital signs"
Question!
1.
ist *&, (6) in&estigations to %iagnose this on%ition $rior to surger#. ( 6 mars) "nser! • • • •
:.
Serum T3/T6/TS> F7"C USG CT ne
+esri,e the s$eimen (ot ").
(- mars) "nser! • •
Th#roi% glan% Multino%ular mass Matri +o
3.
+esri,e the histo$athologial *n%ings (in Piture 9).
(mars) "nser! • •
6.
Columnar ells lining the follile minimal olloi%
ist * (-) %i@erential %iagnoses.
(mars)
"nser • •
M7G Ca th#roi%
*'CE /
2 /? year-old GMat ,empitH ame asualty with the problems shown #e was given immediate
1.
to
the in the piture" treatment"
7ame the instrument in the set.
( 6 mars) "nser! • • •
7ee%le hol%er Fore$s Ii%ne# %ish Galli$ots
Matri +o
-.
7amesolutionsuse%toleantheoun%
( - mars) "nser! 7S o&i%one io%ine
• •
3.
9hat imme%iate treatment oul% #ou institute for this $atient
( - mars) "nser!
• • •
6.
"TT TS "nalgesis
This $atient ame ,a one ee after ,eing %isharge% from the hos$ital ith $urulent %isharge from the oun%. 7ame *+E (1) ommon ausati&e organism an% its treatment.
( - mars) • •
Sta$h#loous aureus +ressing ith antise$tis suh as $o&i%one io%ine: ari=a&ine an% a%ministration of anti,ioti: Cloaillin
2SCE 3
Mr ! a 55-year old presented to the hospital with a history o$ long standing on and oF pain in right hypohondrium! re$erred to his ba%" E6amination showed a large palpable mass in right hypohondrium and an ill de8ned mass le$t to the epigastrium"
1.
ist *&, (6) other im$ortant $oints in the histor# #ou oul% eliit from this $atient. ( 6 mars) "nser!
• • • •
oss of a$$etite / 29 ruritus Tea oloure% urine ale stool
• • • •
'lee%ing ten%enies +rugs intae "lohol ingestion +rug a,use
Matri +o
-.
7ame im$ortant *&, (6) la,orator# in&estigations #ou oul% $erform for this $atient. ( - mars)
•
serum ,iliru,in serum alaline $hos$hatase serum am#lase Coagulation $ro*le tests Serum glo,ulin titres "utoanti,o%ies Tumour marers
3.
9hat other *&, (6) %iagnosti in&estigations nee%e%
• • • • • •
( - mars) • • • • • •
Ultrasoun% he$ato5,iliar# CT san En%oso$i ultrasoun% ERC MR holangio$anreatogra$h# i&er ,io$s# : anreati ,io$s#
6.
9hat are the %i@erential %iagnoses ( - mars)
• • • • •
Chole%oholithiasis CholangioCa Ca >ea% of $anreas Malignant 7S in $orta he$ati eri am$ullar# arinoma
*'CE 4
2 4/-year-old man presented with a short history o$ upper abdominal pain whih radiates to his right shoulder assoiated with vomiting and shortness o$ breath" he surgeon wishes to per$orm a surgery"
Past medial history
*n e6amination
Pepti uler disease
'weaty! yanosed emperature 0>"5 IC #eart rate 14? 'inus ,hythm 9lood Pressure >?J45 mm#g ,espiratory rate /5Jminute ,edued air entry at the right base with bronhial breathing Presene o$ hard board rigidity o$ the abdomen
nvestigations
#b
3gJdl
9C
11 4 6?
Platelet
>
JB
0
+a
14>mmolJB
4"5 mmolJB
&rea
11mmolJB
Creatinine
1/4 mmolJB
9lood gas on 4?K *6ygen
p#
>
JB
;"/<
pC*/ 01 mm#g p*/
30 mm#g
#C*0 1> mmolJB 9E
-5 mmolJB
B is normal
Matri +o
1.
ist the signi*ant *n%ings in the linial eamination. ( 6 mars) "nser! $#rei
h#$otensi&e tah#ar%ia tah#$noei
-.
nter$ret the la,orator# results. ( 6 mars) anaemia se$sis! ele&ate% 9'C: %eh#%ration! ele&ate% urea: reatinine h#$oia meta,oli ai%osis
3.
This $atient as starte% on intra&enous =ui% regimen as shon. State * (-) %isa%&antages of the =ui%.
(a)
(1 mar)
(,)
(1 mar)
>"RTM"7S S2UT27 arge so%ium an% ater loa% (1!3V1!6) otential for o&er infusion: $ulmonar# oe%ema: su,se8uent "R+S. Minimal e@et on intra&asular &olume (%uration in irulation is &er# short (- minutes). 7o o#gen arr#ing a$ait#.
*'CE 5
2 3? year old man omplained o$ loss o$ weight and appetite $or the past $our months with altered bowel habits" nitial investigations revealed a hemoglobin level o$ ;"/ gJdB" he investigation shown in the piture was arried out"
1.
7ame the in&estigation. ( 1 mar) "nser! +ou,le ontrast ,arium enema
-.
+esri,e the *n%ings. (3 mars) "nser! rregular narroing / striture or Oa$$le5ore a$$earane (1 mar) at the trans&erse olon (1 mar) 2R
*lling %efet at mi% trans&erse olon in ee$ing ith mass lesion
Matri +o
3.
ist #,EE (3) ontrain%iations for the a,o&e $roe%ure.
(3 mars) "nsers! Toi megaolon Com$lete intestinal o,strution 'oel $erforations Reent retal ,io$s# seu%omem,ranous olitis 7o ,oel $re$aration Reent ,arium meal
6.
9hat is #our %iagnosis
(1 mar)
"nsers! Carinoma of olon
<. ist * (-) other in&estigations/$roe%ure nee%e% to on*rm the %iagnosis.
(mars) "nsers! Colonoso$# an% ,io$s# CT a,%omen
*'CE 1
Mr CB a 3/-year-old Chinese gentleman! underwent resetion o$ his le$t olon" he speimen is shown in Piture 2! while Piture 9 shows the histopathology"
1. +esri,e the maroso$i an% miroso$i a$$earane of the lesion in iture " an% iture ' res$eti&el#
a
Maroso$i !
,
Miroso$i!.
(-mars)
#nswers+
• •
•
•
-
$lcerated lesion with heaped up edges !land hae lost its polarity, appaer disorgani-ed and adhere to each other =pithelial cells tightly packet, hyperchromatic with hich nucleus to cytoplasm ratio 1umour inades deeply into colonic mucosa
ist to (1mars)
$re%is$osing
fators
for
this
%isease
a ,
.
#nswers+ • •
3
Familial polyposis coli Chronic ulceratie colitis
ist four (6) 8uestions #ou oul% as the $atient in the histor# (-mars) a , %
.. .. .. .
#nswers+ • • • • • •
6
'ietary history Family history of colon Ca 3ltered bowel habits )lood mi"ed with stools 2ymptoms of anaemia 2ymptoms of obstruction
9hat in&estigations oul% Mr CI ha&e un%ergone to on*rm the %iagnosis$riortosurger# (3mars) a ,
.. .. ..
#nswers • • •
0igid or >e"ible sigmoidoscopy 'ouble contrast barium enema Colonoscopy
<
ist to other in&estigations ith reasons that shoul% ,e %one for Mr CI a ,
.. ..
(-mars)
#nswers • • •
?
$2! abdomen6metastasis to lier and lymph nodes CA0 65etastasis C1+50* ?5etastasis to lier and &N
ist 3 $r eo$erati&e $re$aration that oul% ha&e ,een un%ertaen for Mr CI
(3mars) a.. ,.. ..
#nswers
• • • • • •
5echanical bowel preparation Counselling for stomas and complication Correction of anaemia and electrolyte disturbance '@1 prophylactic *nsertion of catheter Prophylatic antibiotics
*'CE / Mr I'M has $ro,lems ith his left leg for se&eral #ears as seen in iture ". >e has Just un%ergone surger# - months ago hih the result as shon in iture '.
(iture ")
(iture ')
1. +esri,e the *n%ings in iture "
(- mars)
#nswers+ =ortousity and dilatation of the super;cial vein of the 2left leg =he mass is compressible to digital pressure -. ist - (T92) s#m$toms that #ou oul% lie to eliit from the $atient (-mars)
#nswers+ ragging pain on walking and long standing 2due to thrombophlebitis &ump in the legD =ortousity and dilatation of the super;cial vein !cema gives rise to itching
3. 7ame - eaminations that #ou ill $erform for this $atient "nsers!
=rendelenburg test WE$lanationX
(-mars)
To %istinguish $atients ith su$er*ial &enous re=u from those ith inom$etent %ee$ &enous &al&es Ele&ate the leg until the ongeste% su$er*ial &eins ha&e all olla$se%. +iret $ressure is use% to olu%e a &ariose &ein Just ,elo the SFH (Sa$heno Femoral Huntion) or at another $oint of $ossi,le re=u from the %ee$ s#stem into the su$er*ial &ariosit#. The $atient stan%s ith the olusion still in $lae f the %istal &ariosit# remains em$t# or *lls &er# slol#: the $rini$al entr# $oint of high $ressure into the su$er*ial s#stem has ,een i%enti*e%. Ra$i% *lling %es$ite manual olusion of the $ossi,le high $oint of re=u means that some other re=u $atha# is in&ol&e%.
erthes manouvre WE$lanationX To %istinguish antegra%e =o from retrogra%e =o in su$er*ial &aries. a enrose tourni8uet is $lae% o&er the $roimal $art of the &ariose leg in suh a a# as to om$ress an# su$er*ial &ariose &eins hile lea&ing %ee$ &eins una@ete% The $atient als or $erforms toe5stan%s to ati&ate the alf5musle $um$ This normall# auses &ariose &eins to ,e em$tie%: ,ut if %ee$ s#stem o,strution eists: then ati&ating the alf5musle $um$ auses $ara%oial ongestion of the su$er*ial &enous s#stem an% engorgement of &ariose &eins. "ntegra%e =o in a &arieal s#stem in%iates that the s#stem is a ,#$ass $atha# aroun% a %ee$ &enous o,strution
6. ist 6 (Four) om$liations that an our in this on%ition mars)
(-
#nswer+ leeding from rupture of a vari" lceration =hrombophlebitis &ipodermatosclerosis <. 7ame - s$ei* in&estigations for this $ro,lem mars)
#nswer+
(-
uple" ultrasound Contrast venography M<0 ( M<9 2Magnetic
Witem! hest 4RX Mrs TS": 6<5#ear5ol% la%# om$laine% of e$igastri $ain on an% o@ for se&eral #ears. She as ,rought to " E +e$artment #ester%a#. This in&estigation as %one imme%iatel#.
1. 9hat imaging mo%alit# is this mar)
(1
#nswer+ lain Chest $-ray ( lain chest radiograph
-. +esri,e the a,normalit# foun% in the $iture shon. mar)
(1
#nswer+ =here is free air under both the hemidiaphragms
3. 9hat are the s#m$toms (to) %o #ou e$et in this $atient mars) a)
,)
#nswer+ a. 'udden onset o$ severe abdominal painL aggravated by oughing or straining
(-
b" +ature o$ the pain is dull and is assoiated with loss o$ appetite! nausea! vomiting and the $eeling o$ lassitude"
6. 9hat are the $h#sial signs of this $atient a). General
mars) (-
1.
-.
",%omen ,)
mars) (-
1.
-.
"nsersL
.eneral Patient is in severe distress and is lying very uietly 9reathing is shallow to minimi:e abdominal movement Patient might lie down with his %nees drawn up to
minimi:e intraabdominal pressure
2bdomen here is a board-li%e rigidity o$ the a
bdomen
he dullness over the liver spae is tympaniti ,edued or absent bowel sound
<.ist6ausesforthis$ro,lem. mars)
(-
1. -. 3. 6. "nsers
Per$orated gastriJduodenal uler
Per$orated ileum Per$orated gall bladder Per$oration o$ oloni divertiulum
2SCE 6
Witem! Ra%i&a an% +rainage ,agX
Question 3.
1. 9hat is the me%ial %e&ies shon on this ta,le 1.
(- mars)
-.
"nsersL b"
a. @auumJ,ediva tube Drainage bag
-. 9hat are the uses of these %e&ies mars) 1. -.
(-
"nsersL a. promote healing
drain out the residual blood or blood produt to
b" as a mean to he% whether haemostasis o$ the utJinisedJe6ised area is intat or not
How do you determine whether the instrument is functioning# (- mars)
"nsers! a" the rabbit earJlateral pro=etion is ativated (bag under vauum) b" the euent in the tube is still Nowing ontinuously to the drainage bag 9hat are the om$liations that ma# arise from using these %e&ies (- mars) 3. 6. "nsers! the patient
a"
ntroduing in$etion $rom the environment to
b" Migration o$ the tube to the surrounding area " atrogenially ould ause bleeding over the blood vessels o$ surgial area and damage the nearby nerve 3. 7ame T92 o$eration in hih this instrument is use%L mars) "nser!
a.
hyroidetomy b
Mastetomy
.astretomy d
,esetion o$ olon
e almost all surgial operation where there is no suseptible sensitive strutures suh as the brain! bleeding vessels and nerves
(-
2SCE <
his is a Pulse *6ymeter
Oou are on-all in the surgial ward" he staF nurse in-harge alled you to see a patient who has had an emergeny surgery the night be$ore! with the above devie attahed to him"
1. nter$ret the *n%ings shon a,o&e an% gi&e the name of the on%ition (a) (,) (- mars)
"nsersL
". lo Sa2- (an% tah#ar%ia) '. >#$oia / >#$oemia -. ist #,EE auses of $ost o$erati&e o#gen %esaturation (a) (,) () (3mars)
"nsersL
C. "ira# o,strution/ ,ronhos$asm +. reeisting lung %isease E. m$aire% gas ehange %ue to re%ue FRC: inrease% shunt an% inrease% 0/Q mismath F. ",olition of h#$oi $ulmonar# &asoonstrition ,# anaestheti agents G. +i@usion h#$oia >. m$aire% &entilator# res$onse . Resi%ual musle $aral#sis H. M#oar%ial %e$ression I. na%e8uate re$laement of ,loo% loss . 9oun% $ain/ su$ine $osition/ restriti&e ,an%aging: re%uing al&eolar &entilation
3. 2utline #,EE $rini$les in managing the $atient (a) (,) () (< mars)
M. "ira# Ensure the aira# is $atent
7. 'reathing 2,ser&es the res$irator# $attern an% ausultate the hest. Clear the oro$har#n of seretions 2$timi;e the aira# ,# hin lift/Ja thrust/hea% tilt menoeu&res Use an oro$har#ngeal or naso$har#ngeal aira# if re8uire% 2#gen thera$# &ia fae mas shoul% ontinue throughout the reo&er# $erio% 2. Cirulation Ensure that ,loo% loss has ,een a%e8uatel# re$lae% an% the $atient is haemo%#namiall# sta,le( 2#gen arr#ing a$ait#) . +rug "ssess le&el of resi%ual neuromusular ,loa%e. f signi*ant: this ma# neessitate ontinuation of mehanial &entilation until musle relaant ears o@: or further %oses of re&ersal agent. >#$o&entilation from o$ioi%5in%ue% entral res$irator# %e$ression ma# treate% ith 7aloone Q. 2ther Relie&e mehanial fators that ause h#$o&entilation 7urse the $atient in the reo&er# $osition to minimi;e the ris of as$iration.
ost5o$erati&e hest $h#siothera$# ill hel$ im$ro&e lung &olume
*'CE
5? years old Malay man was admitted $rom 2 E department a$ter omplaining $or reent 0 days" #e was operated $or irreduible inguinal hernia" his piture was ta%en during surgery"
Q1. +esri,ethea,normalit#inthis$iture. mar)
(1
Q-. Mention in a hronologial manner the om$liations of inguinal hernia.(mars) Q3.
+esri,e auses (Un%erl#ing ris fators) of inguinal hernias. (-.< mars)
Q6.
+esri,e the $reo$erati&e linial $iture in this $atient. (- mars)
Q<.
Mention #,EE in&estigations: an% ause of seletion. (1.< mars)
Q?. >oanemanagethis$atient mar)
(1
*'CE /
05 years old military Malay man was seen in the lini with this piture in the right lower limb"
Q1.
+esri,ethea,normalit#inthis$iture. mars)
(-
Q-. 9hat are the $ossi,le s#m$toms in this ase Mention *&, mars)
Q3. >oan#oueaminethis$atient mars)
a)
(-
(3
Mention *&,% iagnostiin&estigations. mars)
(-
,)
>o an #ou treat this on%ition mar)
*'CE 0
2
9
(1
Mr #ashim (2) is a 05 years old Malay male who was presented to surgery lini with this swelling" #e used to have pain on ta%ing any sour $ood" his investigation (9) was done $or him" Q1. +esri,e the a,normalit# in the *gure ": an% in the *gure '. mars)
(-
Q-. Mention $ossi,le #,EE ausesofthisa,normalit#. mars)
(3
Q3. Mention * %i@erential%iagnoses. mars)
(-
Q6. +esri,e *&, %iagnostiin&estigations. mars)
(-
Q<.
9hatisthetreatment
(1mar)
*'CE 4 Q1.
+esri,etheinstrument.
(-mars)
Q-.
9hat are the uses
Q3. +esri,ethetehni8ueofha&inga,io$s#. mars)
(mars) (-
Q6. Mention * om$liations. mars) Q<. 9hat are the $reautions for $aroti% tumour ,io$s# mars)
(-
(-
*'CE 5
53-years-old $emale was presented with le$t breast two lumps"
his investigation was done" 'he has a $amily history o$ breast aner! and hysteretomy $or ervial aner" 'he $elt swellings in both breasts" his investigation was done $or the le$t breast" Q1.
9hatisthenameofthisin&estigation
Q-. 9hat are the $ositi&e *n%ings Mention #,EE" mars)
(1mar))
(3
Q3. 9hat is the other in&estigations re8uire% for this $atient Mention three5 an% signi*ane of eah. (3 mars)
Q6. >oanom$leteeaminationofthis$atient mars)
Q<. 9hatisthelineoftreatmentinthisase mar)
(-
(1
2SCE 1st rotation 1. 7ormal Saline 5 7ame 1 of the su,stane in the solution an% hat is its onentration 5 9hat is the in%iation to gi&e the solution to a $atient 5 9hat is the om$liation of gi&en solution to a $atient 5 >o man# al -. 7asogastri tu,e 5 7ame the e8ui$ment 5 n%iation of the e8ui$ment 3. Chest 4ra# (air un%er %ia$hragm) 5 %entif# the ra# (not sure ,ut ma#,e %iorg tan#a lie eret or su$ine: hest ra# or a,%ominal ra#) 5 %entif# the a,normalit# in the hest ra# 5 Gi&e 1 eam$le of $atient that ha&e the same *n%ings ith the a,normalit# in the ra# gi&en 6. "ti&e station (nserting ,ranula) 5 +emonstrate the ,ranula insertion an% gi&e omments as #ou go along ith the $roe%ure <. "ti&e station (er Retal Eamination) 5 'asiall#: ati&e station ni ,ase% on %emonstration ,ut 8uestions totall# %e$en%s on eaminers 5 Eam$le of 8uestions from rof G. a) osition of the $atient 2ther than left lateral si%e ,) n%iation ) Contrain%iation %) +etails of the ste$s5 ins$et: insert: tae out: ins$et one more
