Clincal Sciences Major Rotation Senior Clerkship Surgery MCQ Self Assessment * Required Roll Number: * 1.445 year old man came to surgical OPD with complain of progressive painless jaundice for two months & nausea for one month. On examination patient is dehydrated, deeply icteric & globular lump at right hypochondriac region. * What is most likely diagnosis? D a. Acute cholecystitis © b. Carcinoma of head of pancreas © c.Hydatid eyst liver © 4.Pseudocyst pancreas 2.420 year old male patient having a appendicular lump under non operative management developed fever, tachycardia and increased lump size & tenderness on 3rd day of admission. What is next appropriate investigation? © a. Abdominal X ray © b.Colonoscopy © &.Chest X ray erect © 4.USG of abdomen 3. A gentleman of 63 presents with severe upper abdominal pain for two days associated with bilious vomiting twice. Pain radiated to back. Pain got less after stooping forward. Examination showed pulse 114/min, temp 38 C, BP 118/70. Abdomen was tender in epigastric region. WCC was 11,000/cu mm. USG showed tiny Gall bladder calculi. Chest X-ray was normal. * Whatis the diagnosis? a. Acute pancreatitis, © b. Appendicular perforation © c. Duodenal ulcer perforation O d.Enteric perforation 4. A55-year-old man complains of chronic intermittent epigastric pain, and gastroscopy demonstrates a 2-cm ulcer of the distal lesser curvature. Endoscopic biopsy yields nomalignant tissue. Even after repeated six weeks trial of H2 blockade and antacid therapy, the ulcer remained unchanged. * What would be the proper treatment now? © 2 Billroth | partial gastrectomy ) b. Billroth | partial gastrectomy with vagotomy © Local excision of the ulcer © 4 Repeat trial of medical therapy 5. A47 year old lady presented with small amount of greenish discharge from right nipp| She is worried whether she has cancer. She has no pain. Examination shows multi-duct discharge with no other abnormality in the breast. Mammogram is normal. * What will you advise for her? a. Antibiotics for at least six weeks © b. Major duct excision (Hadfield operation) c. Microdochectomy 6. A52 year old lady is brought to Patan hospital emergency with a history of burn occurring © 4 Reassurance due to explosion of gas cylinder in a closed room while cooking. She has 40% burn mostly second and third degree affecting the lower half of the body. Her weight is 60 kg. * How much fluid will you give her in first eight hours? ) a. 3200 ) b. 4000 © &.4800 © 4.5600 7. A47 year old lady with breast carcinoma (Invasive ductal carcinoma, ER /PR negative (Estrogen/Progesterone receptor). HER 2 negative) who has had surgery followed by chemotherapy four years back suddenly developed severe back pain and weakness of both legs. Examination showed tenderness at mid lumbar region with power 3/ 5 both limbs. X ~ spine shows metastasis at L2 region. * Which is the most appropriate management at this stage? © a.Higher chemotherapy © b. Hormonal therapy c. Radiotherapy to spine © 4 Surgical fixation of spine 8. 50 year male patient known to have chronic liver disease with gross ascites & oesophageal varices presented in ER with massive upper GI bleeding. Patient remained hemodynamically unstable even after initial resuscitation and continued to bleed. * What is immediate appropriate management? © a Endoscopic Variceal Ligation © b Endoscopic sclerotherapy© c.Sengstaken Blakemore Tube © 4. Transjugular intrahepatic portosystemic shunt (TIPS) 9. A57 year old Hepatitis B positive gentleman presents with vomiting of large amount of fresh blood. USG done one month back has shown shrunken nodular liver with splenomegaly. Abdominal examination shows splenomegaly 4 cm below left costal margi ‘ing duliness is positive. * Which drug will be most useful for the treatment of bleeding? © a.lV Octreotide ) b.1V Pantoprazole c.1V Tranexamic acid © 4.Vitamin k 10. A50 year old lady is brought by ambulance with history of haematemesis and maelena. She has very feeble pulse with blood pressure 70/? and looks very pale. She has been given 3 litres of Normal saline on the way. Itis decided to give her blood without cross-matching. Her blood group is A+ve. * Which will be appropriate step for transfusion of blood in this dire emergency situation? ) a. Ask for 0 —ve blood. © b. Transfuse AB -ve blood. © c. Transfuse A +ve blood. © 4.Transfuse AB #ve blood 11. A32 year old lady presented with pain anal region during defection associated with small amount of fresh bleeding for 3 months. Pain is severe and lasts for about half an hour after defecation. At other times she is pain free. * What is the most likely diagnosis? © a Anal fissure © b.Perianal abscess © c. Sentinel pile d. Thrombosed haemorrhoids 12. AT year old boy presents with history of fresh bleeding per rectum for six months. Sigmoidoscopy showed a pedenculated polyp of 2cm which was removed and sent for istology. * What is the histology report most likely to show? © a. Adenomatous polyp © b. Hamartomatous polyp © ¢. Hyperplastic polyp © 4.inflammatory polyp 13. A45 years old lady presented with fresh bleeding per rectum for last 2 months. She has. no pain but complains of something coming out per rectum during defecation reduced spontaneously. She looks pale. Digital rectal examination is normal but proctoscopy revealed