Professional Documents
Culture Documents
Virumandi
Virumandi
Virumandi
B Trypnosomiasis
C Strongyloidosis
D Clonorchis sinensis
B usually malignant.
B tachypnoea.
C peripheral cyanosis.
B Rebound tenderness.
C Guarding.
B Acute hepatitis.
C Idiopathic pancreatitis.
D Mesenteric ischaemia.
C In transverse incisions.
C Lacerations in hand due to broken glass or a knife are rarely associated with nerve or
tendon injuries.
D Haematoma should generally be left alone.
13 Regarding gangrene
A Gangrenous tissue appears black owing to accumulation of melanin.
B It involves mainly the skin, subcutaneous tissue and the deep fascia.
16 A sebaceous cyst:
A Is occasionally seen in sole of the palm.
B Is an exudation cyst.
17 In undescended testis:
A The operation is recommended at the age of 5 years.
20 The followings are problem associated with surgery in a jaundiced patient EXCEPT:
A Myocardial infarction.
B Hepatorenal syndrome.
C Clotting disorders.
D Infection.
1 A 76-year-old gentleman has passed only a small quantity of urine 24 hours after an inguinal
hernia surgery. He has a tender suprapubic mass on abdominal examination. The most
appropriate management will be:
A intravenous frusemide.
D urinary catheterisation.
2 A 25-year-old male who is 15 hours’ post-laparotomy for a perforated chronic duodenal ulcer is
found to have a respiratory rate of 9 breaths/min. Physical examination shows neurological
poor response and reduced air entry in both lung fields. The likely diagnosis is:
A aspiration pneumonia.
C narcotic overdose.
D pulmonary atelectasis.
3 On the fifth post-operative day after an emergency laparotomy, a patient was noted to have
serosanguineous discharge from the abdominal incision. The most appropriate treatment for the
problem is:
A Emergency re-exploration.
C Intravenous antibiotics.
4 A debilitated patient has undergone major upper gastrointestinal surgery. The most appropriate
postoperative nutritional support for him is:
A nasogastric feeding
5 A 45-year-old man was admitted to general surgical ward with severe exacerbation of
ulcerative colitis. All necessary assessment was done and put up in next week operation list for
total colectomy. The BESTchoice of pre-operative nutritional support for him would be:
A nasojejunal feeding.
B nasogastric feeding.
2 In determining the outcome of a patient with malignant melanoma the most important factor is:
A a history of pre-existing pigmented lesion.
1 A 38-year old man presenting with a left parotid tumour was explained about the complications
of surgery. All of the following are complications EXCEPT:
A great auricular nerve neuroma.
B gustatory sweating.
C cutaneous fistulae.
1) 30 year old lady comes with pain upper abdomen, fever, chills and rigors and with
icterus - what should be the first line of investigation ? :
A ) liver function test
B ) total haemogram
C ) ultrasound of hepato-biliary region
D ) CT scan of abdomen
2) 50 year old alcoholic, suddenly after meal, develops acute pain in abdomen with
fever, tachycardia, hypotension – likely diagnosis should be ? :
A ) acute gastro-enteritis
B ) acute pancreatitis
C ) acute cholecystitis
D ) acute mesenteric vascular ischaemia
3) 25 year old male reports with complaints of feeling heaviness of this right testis.
On examination, the testis is found to be hard in consistency with mild hydrocoele of
right scrotum. No inguinal lymphadenopathy and no history of trauma.
The preferred management should be :
A ) fine needle aspiration cytology (FNAC) of right testis
C ) open biopsy of right testis
D ) scrotal incision and removal of right testis
E ) inguinal incision and removal of right testis
1) Mammogram
A) detects breast carcinoma in young ladies less than 35 years old,
B) differentiates between solid lumps and cysts,
C) shows clustered microcalcifications in carcinoma breast,
E) is a painless procedure and can be repeated often.
2) Radiotherapy in carcinoma of breast
A) is routinely given after simple mastectomy for Paget’s disease,
B) can be given to contralateral breast as prophylaxis,
C) must be given after breast conserving surgery,
D) is safely given in pregnant ladies.
1. A ranula :
A is a malignant tumour of the oral cavity.
2. Carcinoma of tongue :
A is usually an adenocarcinoma.
D cystic artery.
B bile salts.
C bile pigments.
D cholesterol.
6. Choledochal cyst :
A is dilatation of the cystic duct.
B is caused by gall-stones.
C is treated by cholecystectomy.
B hepatitis B infection.
C liver adenoma.
B intravenous 5-fluorouracil.
C transarterial chemoembolisation.
B liver cirrhosis.
C Budd-Chiari Syndrome.
D chronic pancreatitis.
B tuberculous lymphadenitis.
C goiter.
D branchial cyst.
17. The most appropriate approach for a patient who has an enlarged prostate with a 5 cm diameter
bladder stone is :
A transurethral.
B transvesical.
C transperineal.
D retropubic.
18. Digital per rectal examination of a benign prostatic enlargement will reveal :
A obliteration of the median groove.
B perforation.
C malignant change.
D polyps formation.
20. Injury to the ilio-inguinal nerve from abdominal incisions may result in :
A inguinal hernia.
B femoral henia.
C lumbar hernia.
D paraumbilical hernia.
1. A 55 year old diabetic man had Mayo’s repair of his paraumbilical hernia 4 days ago,
developed fever with redness, swelling and tenderness in an area surrounding the wound.
What would be the most appropriate treatment ?
A Continue oral antibiotics and observe.
2. A 50 year old lady presented with an acute onset of high fever, jaundice and right
hypochondrial pain and tenderness but no palpable abdominal mass.
What is the most likely diagnosis ?
A Carcinoma head of pancreas.
B Acute pancreatitis.
D Acute cholangitis.
3. A 45 year old man with a history of peptic ulcer presented with acute severe upper abdominal
pain, tenderness and board-like rigidity of whole abdomen with decreased bowel sounds.
What is the first immediate investigations to be ordered ?
A Plain X-ray abdomen in supine position.
4. A 25 year old lady presented with a painless freely-movable 2 cm lump in her right breast.
The rest of the breast, the contralateral breast and axillae were normal.
What is the most appropriate management ?
A Excision biopsy of the lump.
B Right mastectomy.
5. A 55 year old farmer noticed a hyperpigmented 1 cm diameter mole on his face increased in
size recently with itching. What is the most appropriate management ?
A Topical antifungal ointment.
6. A 37 year old lady presented with a progressively enlarging hard lump in her left breast with no
nipple or skin changes. Fine Needle Aspiration Cytology confirmed a breast malignancy.
What is the most likely type of breast cancer ?
A Infiltrating ductal carcinoma.
B radiotherapy.
C chemotherapy.
B anti-oestrogen drugs.
D chemotherapy.
D brachytherapy.
C Ascites.
B parathyroid adenoma.
C gastric adenoma.
B Liver.
C Stomach.
D Kidney.
B oesophageal varices.
D Mallory-Weis tear.
5. Which of the following blood groups is a risk factor for carcinoma of stomach ?
A A.
B B
C AB.
D O.
B lymphatic embolisation.
C peritoneal seedlings.
D direct spread.
B 25 cm.
C 30 cm.
D 35 cm.
8. All the following are removed in Patey’s modified radical mastectomy, EXCEPT :
A pectoralis major.
D clavi-pectoral fascia.
4 Parathyroid glands :
A. are normally palpable in the neck.
B. are exocrine glands.
C. can occasionally be found in the superior mediastinum.
D. produces calcitonin.
6 Sistrunk operation :
A. is surgical excision of a ranula.
B. is done through intraoral approach without a neck incision.
C. involves removal of part of hyoid bone.
D. involves removal of anterior half of the tongue.
4 A ranula :
A. is a tumour of the mucosa.
B. is malignant.
C. presents as a swelling under the tongue.
D. is treated with radiotherapy.
8 Malignant melanoma :
A. is the commonest skin malignancy.
B. is more commonly found in dark-skinned people.
C. always arises from pre-existing naevus.
D. carries poorer prognosis than basal cell carcinoma.
14 Amoeboma :
A. is caused by Entamoeba coli.
B. is treated with metronidazole.
C. is most likely to affect the left lobe of liver.
D. is potentially malignant.
15 A 55 year old lady presents with a painless mobile lump in the upper outer quadrant of
her left breast for the past 1 month.
What would be the next appropriate step ?
A. Reassure her that the lump will resolve spontaneously with time.
B. Send her home with a course of antibiotics.
C. Do mammogram then needle aspiration for cytology.
D. Admit her for simple mastectomy.
16 A 7 month old baby had been crying on and off the whole day, then passed sticky dark
red stools. What is a likely diagnosis ?
A. Acute gastroenteritis.
B. Acute anal fissure.
C. Acute haemorrhoids.
D. Acute intussusception.
17 A 10 year old boy presents in the Emergency Department with acute severe painful
swelling of left scrotum. What is the likely diagnosis ?
A. Mumps orchitis.
B. Acute epididymoorchitis.
C. Acute testicular torsion.
D. Fournier’s gangrene.
19 A 27 year old man presents with a progressively enlarging hard swollen left testis of 2
months duration. What would be the most appropriate treatment ?
A. Fine needle aspiration cytology (FNAC) of right testis.
B. Open biopsy of right testis
C. Scrotal incision and removal of right testis..
D. Inguinal incision and removal of right testis.
1 Marjolin ulcer is
2 Dermoid cyst is
D transillumination postive.
A
3 Sebaceous gland is
A apocrine type.
B holocrine type.
C merocrine type.
D endocrine type.
4 A 38 year-old lady presents to the emergency department with pain on defaecation lasting
about one hour. She also has noted some bright red blood on the tissue paper. The most
likely diagnosis is:
C Proctitis
D Anal fissure
A Crohn’s disease.
C Perianal abscess.
D Tuberculosis
A retention cyst.
B exudation cyst.
C cystic tumour.
D degenerative cyst.
B
A Exomphalos minor
B Exomphalos major
C Umbilical hernia
D Ectopia Vesicae
A gravitational ulcer.
B syphilitic ulcer.
C tuberculous ulcer.
D trophic ulcer.
9 Major cause regarding the mortality in congenital diaphragmatic hernia is due to:
B lung hypoplasia.
D polyhydramnios.
10 62-year-old man with a history of smoking presents with hematuria. He has owned and
operated a chain of dry cleaners for over 30 years. The most likely diagnosis is:
A Prostate cancer
C Bladder cancer
D Carcinoma of the ureter
C
1. Severe head injury is considered to be having Glasgow Coma Scale (GSC) score of :
A. more than 12.
B. less than 10.
C. more than 10.
D. less than 8.
25 Wilm’s tumour :
A. is seen in children.
B. is benign in origin.
C. initially presents with haematuria.
D. is treated conservatively.
26. Mammogram :
A. diffentiates between solid lumps and cysts.
B. is not a screening procedure.
C. showing clustered microcalcifications needs biopsy for carcinoma.
D. is painless and has bad effects of irradiation to breasts.
27. Amoeboma is :
A. a chronic amoebic liver abscess.
B. a malignant tumour associated with chronic amoebiasis.
C. a chronic granuloma arising mainly in the colon from amoebiasis.
D. mesenteric lymphadenitis resulting from intestinal amoebiasis.
32. A 32 year old truck driver presents with a painful fluctuant swelling in his gluteal cleft
for 2 days. What is the most likely diagnosis ?
A. Ischiorectal abscess.
B. Pilonidal abscess.
C. Crohn’s disease of anus.
D. tuberculous ulcer.
1. Severe head injury is considered to be having Glasgow Coma Scale (GSC) score of :
A. more than 12.
B. less than 10.
C. more than 10.
D. less than 8.
25 Wilm’s tumour :
A. is seen in children.
B. is benign in origin.
C. presents initially with haematuria.
D. is treated conservatively.
26. Mammogram :
A. diffentiates between solid lumps and cysts.
B. is not a screening procedure.
C. showing clustered microcalcifications needs biopsy for carcinoma.
D. has bad effects of irradiation on the breasts.
27. Amoeboma is :
A. a chronic amoebic liver abscess.
B. a malignant tumour associated with chronic amoebiasis.
C. a chronic granuloma arising mainly in the colon from amoebiasis.
D. mesenteric lymphadenitis resulting from intestinal amoebiasis.
29. A 32 year old truck driver presents with a painful fluctuant swelling in his gluteal cleft
for 2 days. What is the most likely diagnosis ?
A. Ischiorectal abscess.
B. Pilonidal abscess.
C. Crohn’s disease of anus.
D. Prolapsed haemorrhoids.
30. A 25 year old motorcyclist involved in an accident, sustained severe facial jnjuries with
deformity and bleeding . Which of the following measures is correct ?
A. evaluation of cervical spine should precede the facial injuries management.
B. direct oral or nasotracheal intubation should performed promptly to prevent airway
obstruction.
C. standard facial X-ray series are preferable to CT scan to evaluate facial fractures.
D. definitive management of fractures of facial bones should not be delayed.
7 Grave’s Disease :
A. is associated with multinodular goiter.
B. is treated by total thyroidectomy.
C. is commonly seen in young ladies.
D. is best investigated by radioisotope scan.
9 The gallbladder :
A. concentrates bile.
B. conjugates bilirubin
C. converts bilirubin to biliverdin.
D. produces bile.
9 An ulcer by definition is :
A. a defect caused by infection.
B. a bleeding malignant lesion.
C. an abrasion of the skin.
D. a breach in the continuity of an epithelial surface.
10 Barrett’s oesophagus is :
A. a premalignant lesion of the oesophagus.
B. is a frank malignant lesion of the oesophagus
C. is due to a viral infection.
D. is due to duodenal ulceration.
14 Sebaceous cyst :
A. has a punctum.
B. is found on palms of hands.
C. is found in the oral mucosa.
D. will turn malignant.
2 Femoral hernias :
A. are more common in men.
B. are less likely to strangulate than inguinal hernias.
C. are found medial to the femoral vein.
D. occur as a result of infection.
3 Choledochal cyst :
A. is dilatation of the cystic duct.
B. is caused by gall-stones.
C. is treated by cholecystectomy.
D. has increased risk of developing cholangiocarcinoma.
5 Kehr’s sign is :
A. ecchymoses around umbilicus in ruptured ectopic pregnancy.
B. pain at right iliac fossa on pressing the left iliac fossa in acute appendicitis.
C. pain referred to left shoulder tip in ruptured spleen.
D. tenderness at hypochondrium in acute cholecystitis
MCQ :
1: B 2 : C 3: D 4: A 5: C
6 : A 7 : C 8 : D 9 : B 10 : C
11 : B 12 : A 13 : C 14 : D 15 : B
4. All of the following statements are true regarding bladder calculi EXCEPT
a. The incidence has fallen markedly in this country since the late 19th century
b. They may be totally asymptomatic
c. They are more prevalent in patients with chronic urinary sepsis
d. They increase the risk of transitional cell carcinoma
1. A 28 year old man is brought to the Emergency Department with a history of skidding and
falling off his motorcycle 30 minutes ago. He complains of severe breathlessness and chest
pain. There is no history of loss of consciousness. On examination, the respiratory rate is 38/
minute, pulse rate is 110 per minute and BP is 90/60mmHg. The JVP is raised. The right
chest seems to be moving less than the left and there is no air entry on the right chest on
auscultation.. There is no obvious rib fracture clinically. The SpO2 reading is 88%. The
immediate step to be taken to save life is
a. Ambu bag ventilation
b. Intubation and ventilation
c. Needle thoracostomy
d. Cricothyroidotomy
e. Colloid infusion
2. A 30-year old motorcyclist was admitted to the ward after a closed reduction and above knee
plaster cast for fracture shaft of tibia. 12 hours after admission you were called to see him
for severe unceasing pain in his injured leg. You would
a. elevate his leg in a Braun’s frame
b. prescribe him pethidine injection to relieve the pain
c. split the plaster cast completely
d. send him for a check x-ray to see if there is any re-displacement of the fracture
e. reassure him
3. A 38 year old lady had undergone hysterectomy for menorrhagia. In the post-operative period
her paO2 level was found to be decreasing in spite of delivering oxygen through high flow
nasal mask. Her ventilation/perfusion ratio was found to be abnormal. The probable cause
would be
a. lower abdominal surgery
b. starvation
c. increased cardiac output
d. upright position in bed
e. pulmonary embolism
4. A man had a cerebral concussion after an accident. A few days later he complained of vertigo
whenever he turned his head. It was very short lived but at times associated with nausea and
vomiting. His hearing was normal. What is the diagnosis ?
a. Acute vestibular failure
b. Vestibular neuronitis
c. Benign paroxysmal positional vertigo
d. Labyrinthitis
e. Endolymphatic hydrops
5. A 25-year old farmer presents with a painful red eye. He had sustained injury to the eye with
plant material while working in his field a week ago. Eye examination shows conjunctival
discharge and ciliary congestion. There is a 3-mm sized hazy lesion in the cornea which
stains with fluorescein. Pupil is 3 mm and reacting. Vision is 6/18. The most probable
diagnosis is
a. acute iridocyclitis
b. acute congestive glaucoma
c. muco purulent conjunctivitis
d. Corneal ulcer
e. Interstitial keratitis
A 4-year-old boy is referred by his general practitioner with an enlarged left kidney. He is otherwise
asymptomatic and completely well. He is afebrile. Urinalysis reveals microscopic haematuria. Urine
cultures are negative. The most likely diagnosis is
(a) nephroblastoma
(b) renal cell carcinoma
(c) transitional cell carcinoma
(d) adenoma Kidney
One of the following is strong indication for prostatectomy in benign prostatic hyperplasia.
(a) very large prostate on PR examination
(b) acute retention of urine with raised urea in blood
(c) frequency
(d) difficult to initiate micturition
Which one of the following mechanisms is associated with posterior urethral rupture?
(a) forceful catheterization
(b) fall astride on the projecting object
(c) pubic bone fracture
(d) iatrogenic injury during anterior resection of rectum
Amoeboma is
(a) a chronic granuloma arising mainly in the colon
(b) a chronic amoebic liver abscess
(c) mesenteric lymphadenitis resulting from intestinal amoebiasis
(d) a malignant tumour associated with chronic amoebiasis
Which area of the breast is least likely to be affected by breast cancer?
(a) Upper inner quadrant.
(b) Lower outer quadrant.
(c) Lower inner quadrant.
(d) Upper outer quadrant.
A 13-year-old student presents with bilateral tender and swollen breasts. He has become increasingly
self-conscious of late and has been absent in physical education classes. On examination there are
tender soft masses in the lower
quadrants of both breasts. What is the likely diagnosis?
(a) Acute mastitis.
(b) Fibroadenoma.
(c) Lymphoma.
(d) Gynaecomastia
Out of the followings, which carcinoma of breast usually carry poorer prognosis?
(a) Colloid carcinoma
(b) Tubular carcinoma
(c) Inflammatory carcinoma
(d) Medullary carcinoma
A 23-year-old pregnant woman presents with constipation and bright red blood
coating her stools. On examination, two bluish tender spongy masses are found
protruding from the anus. These do not reduce spontaneously and require digital
reduction. The most likely diagnosis is:
(a) anal carcinoma
(b) rectal prolapse
(c) haemorrhoids
(d) peri-anal warts
All cause the bloody discharge from the nipple of the breast except:
(a) Intraductal papilloma.
(b) Paget’s disease of the breast.
(c) Intraductal carcinoma of the breast.
(d) Duct ectasia.
Malignant tumour arising from the kidney and bladder could be:
(a) Squamous cell carcinoma.
(b) Transitional cell carcinoma.
(c) Adenocarcinoma.
(d) All of the above.
Palliative surgery done for inoperable peri-ampullary carcinoma of the pancreas is:
(a) Stenting.
(b) Cholecysto-jejunostomy.
(c) Choledocho-jejunostomy.
(d) All of the above.
Regarding the Glasgow Coma Scale, the followings are true except:
(a) It is used to assess the severity of head injury.
(b) A high score correlates with high mortality.
(c) It measures the motor response.
(d) It measures verbal response.
The most common initial manifestation of increasing intra-cranial pressure in a victim of head
trauma is:
(a) Change in level of consciousness.
(b) Ipsilateral pupillary dilatation.
(c) Contralateral pupillary dilatation.
(d) Hemiparesis.
A man was brought to the emergency department of a local hospital with a painful swelling in his left
scrotum following an injury while playing baseball. The treatment of choice is:
(a) Rest and icebag application.
(b) Rest and hot water bag application.
(c) Scrotal support and analgesic.
(d) Surgical exploration.
In colorectal cancers:
(a) At least 50% are in the rectum and sigmoid colon.
(b) Low anterior resection is easier in males than in females.
(c) Most 1cm polyps contain a focus of cancer.
(d) Alteration in bowel habit is common in right sided cancers.
A 43-year-old policeman presents with a painless ulcer over the left medial malleoli with
surrounding pigmentation. The ulcer is likely to be:
(a) Ischaemic ulcer
(b) Venous stasis ulcer
(c) Marjolin’s ulcer
(d) Diabetic ulcer
In hypothyroidism:
(a) pre-tibial myxoedema is present.
(b) it is associated with low serum Thyroid Stimulating Hormone levels.
(a) it occurs immediately after total thyroidectomy.
(b) it occurs immediately after radioiodine therapy
Papillary carcinoma of thyroid with lymph node involvement is best treated with :
(a) total thyroidectomy with cervical lymph node dissection.
(b) radio iodine ablation of remnant thyroid tissue.
(c) long-term TSH suppression with oral thyroxine.
(d) all of the above.
A 70 year old lady presents with a progressive enlarging painless hard thyroid nodule, hoarseness of
voice and weight loss. What is the likely diagnosis?
(a) multinodular goitre.
(b) anaplastic carcinoma of thyroid.
(c) follicular adenoma.
(d) de Quervain’s thyroiditis.
1 Gas gangrene :
A. is seen in traumatic wounds of head and neck.
B. is caused by gram negative bacilli.
C. can be prevented by active immunization.
D. may present with crepitus in the wound.
7 All of the following factors have increased risk of surgical site infection, EXCEPT :
A. positive pressure airflow in the operating theatre.
B. hypothermia during surgery.
C. skin shaving.
D. perioperative poor blood glucose control.
8 All the following have high risk of developing malignancy by tobacco, EXCEPT :
A. urinary bladder.
B. oesophagus.
C. lungs.
D. liver.
15 A 45-year-old female presents with a painful and red perianal swelling at 9 o’clock
position with fever for 3 days. The best option of treatment is:
A. systemic antibiotics and analgesics.
B. Sitz baths.
C. emergency surgery.
D. topical application of antibiotics and local analgesics.
In fibreoptic colonoscopy the following cannot be visualized :
A : lumen of appendix .
B : ileocaecal junction.
C : lumen of Meckel’s diverticulum.
D : diverticulum of colon.
Ranula :
A : is a malignant tumour of the tongue.
B : is palpable as a hard lump in the posterior triangle of neck.
C : require post-operative radiotherapy to control spread.
D : is none of the above.
A 70 year old lady presents with a progressive enlarging painless hard thyroid nodule,
hoarseness of voice and weight loss. What is the likely diagnosis ?
A) diffuse toxic goiter.
B) anaplastic carcinoma of thyroid.
C) follicular adenoma.
D) de Quervain’s thyroiditis.
1. A 75 year old man presents with persistent right upper quadrant pain.
He is a known case of advanced carcinoma caecum with secondaries in the liver.
He is in atrial fibrillation and on Warfarin treatment.
What would be your strategy for symptom relief ?
A) Liver transplantation.
B) Chemotherapy with cis-platinum.
C) Radiofrequency ablation.
D) Radiotherapy to the liver.
2. A 75 year old man presents with watery diarrhoea and evidence of multiple
metastases in the liver.
He is cachexic, hyokalaemic with hypochlorhydria.
The level of vasoactive intestinal polypeptide is very high and a tumour of
the pancreas is suspected. cachetic.
What is your management?
A) Codeine phosphate.
B) Pancreatectomy
C) Radiofrequency ablation of liver lesions.
D) Somatostatin treatment
8 In a 18 year old male was in a car crash and found to have no respiration may be due to
A. Fracture of 6th cervical spine
B. Fracture of 2nd cervical spine
C. Fracture of 7th cervical spine
D. Depressed fracture of the skull
9. In a 46 year old male involved in a auto mobile accident, has on chest X-ray widened
mediastinum with indistinct aortic knob. The diagnosis is
A. Pneumo thorax
B. Ruputured aorta
C. Rib fractures
D. Right pleural effusion
10. A patient who is 25 year old fell from a height 20feet c/o pain abdomen. Indication for
Laprotomy is
A. DPLReveals100,000 RBC/ml or WBC7,500
B. Laceration of abdominal wall 2inches
C. No rebound tenderness of abdomen
D. Bowel sounds present
11. A 15year old male with gun shot wound to abdomen on laprotomy has a hole in sigmoid
colon. Best choice of treatment is
A. Suture the hole in colon with non absorbable suture
B. Segmental resection of colon with end to end anastomosis
C. Exteriorization of colon with repair after 6weeks
D. Primary repair and give antibiotics.
20. A patient in coma following a car crash has a distended abdomen. The evaluation of the
abdominal trauma is by
A. Ultra sound
B. CT scan
C. DPL ( diagnostic peritoneal lavage)
D. Rectal exam
13. A14 year old boy is hit over the side of the head with a base ball bat. He loses
consciousness for a few minutes and recovers promptly and continues to play. He is
found in the locker room unconscious. Right pupil is dilated and fixed.
A. Sub arachnoid hemorrhage
B. Acute epidural hematoma
C. Basal skull fracture
D. Subdural hematoma
14. If a patient sustains a penetrating wound in the middle of neck. The management is
A. Pressure dressing over the wound
B. Immediate surgical exploration
C. angiography
D. CT scan of the neck
15. A four year old child had a gun shot injury to the arm. He is hypotensive with
tachycardia. Three attempts to start peripheral IV have failed. What is the next step
A. Central line
B. Interaosseous cannulation
C. IV cut down
D. Subcutaneous injection of saline
16. A 22year old boy brought to the ER following a gun shot wound to the chest. He is pale
diaphoretic, cold and shivering with a BP 60/40. Pulse 150/mt. Distended neck veins and
there is no breath sounds on the right chest. The diagnosis is
A. Tension pneumothorax
B. Cardiac tamponade
C. Hemo pneumothorax D.flail chest
17. A 67 year old male fell of a horse a month ago, prior to which he was active. At present
he stares at the wall, barely talks and has altered sensorium. The diagnosis is
A. Stroke (CVA)
B. Chronic sub dural hematoma
C. Depressed skull fracture
D. Intra cerebral hemorrhage
18. A 55 year old man involved in a car crash. Examination reveals no breath sounds in the
left side of the chest. Percussion is unremarkable. Chest X- ray shows multiple fluid
levels in the left chest. The diagnosis is
A. Hemo pneumothroax
B. Gastric rupture
C. Diaphragmatic rupture
D. Liver laceration
19. A 27 year old intoxicated man crashes against a tree. He has tenderness in the left chest
wall. X-ray reveals fracture ribs 89 and 10. BP is 80/60. Pulse 128/mt. The diagnosis is
A. Small bowel rupture
B. Splenic rupture
C. Pancreatic injury
D. Rupture of the left kidney
20. A 25 year old man involved in high speed auto collision has pelvic fracture with fresh
blood at the urethral meatus. The initial evaluation of the patient includes
A. Ultra sound
B. CT scan
C. Retrograde urethrogram
D. Rectal exam
1. A 8. B 15. B
2. A 9. B 16. A
3. A 10. A 17. B
4. B 11. C 18. C
5. A 12. C 19. B
6. B 13. B 20.
7. B 14. B
1. Right gastric artery is normally a branch of
A. Celiac axis artery
B. Common hepatic artery
C. Gastroduodenal artery
D. Superior mesenteric artery
1. A 60 year old man is admitted with abdominal pain, vomiting, distention and constipation for the
past one week. He gives a history of appendicectomy done 2 years ago. Provisionally he is diagnosed
to have “intestinal obstruction”. Which one of the following is the initial investigation of choice?
A. CT scan
B. MRI
C. Plain X-ray
D. Barium enema.
2. A 25 year old woman suffers impact injuries following a car accident. She is apparently doing well
till the 2nd day when she begins to vomit and complains of shortness of breath. Plain Xray taken in
the Emergency room shows loss of diaphragmatic contour. What is the most likely cause?
A. Ruptured Gallbladder.
B. Ruptured Liver
C. Ruptured Spleen
D. Ruptured Diaphragm.
3. A 60 year old male who is chronic smoker is diagnosed recently suffering from bronchogenic
carcinoma. He is found to be very irritable, tired and confused. He has lost his appetite. He also
states that he is breathless and feels thirsty and wakes up several times at night to pass urine. The
most underlying cause is
A. Lung collapse
B. Cerebral hypoxia
C. Para neoplastic syndrome
D. Acute glomerulonephitis.
A 70-year old lady, known hypertensive complains of sudden loss of vision in left eye since
morning; he was apparently normal till yesterday. The eye is quiet. Pupil shows RAPD. Fundus
exam shows normal optic disc; retinal arteries are markedly narrowed; retina is milky-white but
fovea shines as a bright red spot. Veins show 'cattle-truck' appearance. What is your diagnosis ?
A) Central Retinal vein occlusion
B) Papilloedema
C) Central Retinal artery occlusion
D) Hypertensive retinopathy Ans : C
A 4-year-old boy is referred by his general practitioner with an enlarged left kidney. He is otherwise
asymptomatic and completely well. He is afebrile. Urinalysis reveals microscopic haematuria. Urine
cultures are negative. The most likely diagnosis is
(e) nephroblastoma
(f) renal cell carcinoma
(g) transitional cell carcinoma
(h) adenoma Kidney
One of the following is strong indication for prostatectomy in benign prostatic hyperplasia.
(e) very large prostate on PR examination
(f) acute retention of urine with raised urea in blood
(g) frequency
(h) difficult to initiate micturition
Which one of the following mechanisms is associated with posterior urethral rupture?
(e) forceful catheterization
(f) fall astride on the projecting object
(g) pubic bone fracture
(h) iatrogenic injury during anterior resection of rectum
Amoeboma is
(e) a chronic granuloma arising mainly in the colon
(f) a chronic amoebic liver abscess
(g) mesenteric lymphadenitis resulting from intestinal amoebiasis
(h) a malignant tumour associated with chronic amoebiasis
A 13-year-old student presents with bilateral tender and swollen breasts. He has become increasingly
self-conscious of late and has been absent in physical education classes. On examination there are
tender soft masses in the lower
quadrants of both breasts. What is the likely diagnosis?
(e) Acute mastitis.
(f) Fibroadenoma.
(g) Lymphoma.
(h) Gynaecomastia
Out of the followings, which carcinoma of breast usually carry poorer prognosis?
(e) Colloid carcinoma
(f) Tubular carcinoma
(g) Inflammatory carcinoma
(h) Medullary carcinoma
A 23-year-old pregnant woman presents with constipation and bright red blood
coating her stools. On examination, two bluish tender spongy masses are found
protruding from the anus. These do not reduce spontaneously and require digital
reduction. The most likely diagnosis is:
(e) anal carcinoma
(f) rectal prolapse
(g) haemorrhoids
(h) peri-anal warts
All cause the bloody discharge from the nipple of the breast except:
(e) Intraductal papilloma.
(f) Paget’s disease of the breast.
(g) Intraductal carcinoma of the breast.
(h) Duct ectasia.
Palliative surgery done for inoperable peri-ampullary carcinoma of the pancreas is:
(e) Stenting.
(f) Cholecysto-jejunostomy.
(g) Choledocho-jejunostomy.
(h) All of the above.
Regarding the Glasgow Coma Scale, the followings are true except:
(e) It is used to assess the severity of head injury.
(f) A high score correlates with high mortality.
(g) It measures the motor response.
(h) It measures verbal response.
The most common initial manifestation of increasing intra-cranial pressure in a victim of head
trauma is:
(e) Change in level of consciousness.
(f) Ipsilateral pupillary dilatation.
(g) Contralateral pupillary dilatation.
(h) Hemiparesis.
A man was brought to the emergency department of a local hospital with a painful swelling in his left
scrotum following an injury while playing baseball. The treatment of choice is:
(e) Rest and icebag application.
(f) Rest and hot water bag application.
(g) Scrotal support and analgesic.
(h) Surgical exploration.
In colorectal cancers:
(e) At least 50% are in the rectum and sigmoid colon.
(f) Low anterior resection is easier in males than in females.
(g) Most 1cm polyps contain a focus of cancer.
(h) Alteration in bowel habit is common in right sided cancers.
The normal ankle brachial pressure index (ABPI) is:
(e) 0.5
(f) 1
(g) 1.5
(h) 2
A 43-year-old policeman presents with a painless ulcer over the left medial malleoli with
surrounding pigmentation. The ulcer is likely to be:
(e) Ischaemic ulcer
(f) Venous stasis ulcer
(g) Marjolin’s ulcer
(h) Diabetic ulcer
In hypothyroidism:
(c) pre-tibial myxoedema is present.
(d) it is associated with low serum Thyroid Stimulating Hormone levels.
(c) it occurs immediately after total thyroidectomy.
(d) it occurs immediately after radioiodine therapy
Papillary carcinoma of thyroid with lymph node involvement is best treated with :
(e) total thyroidectomy with cervical lymph node dissection.
(f) radio iodine ablation of remnant thyroid tissue.
(g) long-term TSH suppression with oral thyroxine.
(h) all of the above.
A 70 year old lady presents with a progressive enlarging painless hard thyroid nodule, hoarseness of
voice and weight loss. What is the likely diagnosis?
(e) multinodular goitre.
(f) anaplastic carcinoma of thyroid.
(g) follicular adenoma.
(h) de Quervain’s thyroiditis.
1. Severe head injury is considered to be having Glasgow Coma Scale (GSC) score of :
A. more than 12.
B. less than 10.
C. more than 10.
D. less than 8.
25 Wilm’s tumour :
A. is seen in children.
B. is benign in origin.
C. initially presents with haematuria.
D. is treated conservatively.
26. Mammogram :
A. diffentiates between solid lumps and cysts.
B. is not a screening procedure.
C. showing clustered microcalcifications needs biopsy for carcinoma.
D. is painless and has bad effects of irradiation to breasts.
27. Amoeboma is :
A. a chronic amoebic liver abscess.
B. a malignant tumour associated with chronic amoebiasis.
C. a chronic granuloma arising mainly in the colon from amoebiasis.
D. mesenteric lymphadenitis resulting from intestinal amoebiasis.
32. A 32 year old truck driver presents with a painful fluctuant swelling in his gluteal cleft
for 2 days. What is the most likely diagnosis ?
A. Ischiorectal abscess.
B. Pilonidal abscess.
C. Crohn’s disease of anus.
D. tuberculous ulcer.
34. A 25 year old motorcyclist involved in an accident, sustained severe facial jnjuries with
deformity and bleeding . Which of the following measures is correct ?
A. Evaluation of cervical spine should precede the facial injuries management.
B. Direct oral or nasotracheal intubation should performed promptly to prevent airway
obstruction.
C. Standard facial X-ray series are preferable to CT scan to evaluate facial fractures.
D. Definitive management of fractures of facial bones should not be delayed.
1. A young motorcyclist is thrown against a concrete bridge abutment and sustains severe
trauma to his face with marked deformity and bleeding. Regarding these injuries, which
of the following statements is true ?
A. Evaluation of the cervical spine should precede the management of the facial
injuries.
B. Direct oral or nasotracheal intubation should be performed prompty to prevent
airway obstruction.
C. Standard facial X-rays are preferable to CT scan to assess facial fractures.
D. Definitive management of fractures of facial bones should not be delayed.
2. A 21 year old lady presents with a small painless lump in the midline of her neck which
moves up with swallowing. A clinical diagnosis of thyroglossal cyst was made.
Which of the following statement regarding symptomatic thyroglossal duct cyst is true ?
A. Over 90% manifest itself before age 12.
B. Treatment includes resection of the hyoid bone.
C. They usually present as a painful swelling in the lateral neck.
D. They rarely become infected.
3. A 60 year old smoker presents with an ulcerating mass on his tongue, which on biopsy
was found to be a squamous cell carcinoma. He declines surgical intervention.
Which of the following statements regarding his cancer is true ?
A. Carcinoma of the tongue is best treated by irradiation alone rather than by surgery.
B. Metastases to the pre-auricular lymph nodes is common.
C. Cancer of the tongue most commonly occurs near the frenulum.
D. Local invasion may result in hypoglossal or lingual nerve dysfunction.
4. A 32 year old truck driver presents with a painful fluctuant mass in between gluteal folds
of 2 days duration. Which of the following is the most likely diagnosis ?
A. Fistula in ano.
B. Ischiorectal abscess.
C. Pilonidal abscess.
D. Crohn’s disease of anus.
5. A 47 year old asymptomatic woman was incidentally found to have a 5 mm polyp and no
stones in her gallbladder on ultrasonography scan. Which of the following is the best
management option ?
A. Laparoscopic cholecystectomy.
B. Open cholecystectomy with frozen section biopsy.
C. Observation with repeat ultrasonography scan – to evaluate for increase in
polyp size.
D. En block resection of the gallbladder with wedge resection of liver and portal
lymphadenectomy.
6. Femoral hernias :
A. are more common in men.
B. are found medial to the femoral vein.
C. occur as a result of infection.
D. are less likely to present with incarceration than inguinal hernias.
9. Following a stab injury to the middle of the upper arm, a 30 year old man cannot flex his
three radial digitals. Which of the following structures has he most likely injured ?
A. Flexor pollicis longus and flexor digitorum longus tendons.
B. Radial nerve.
C. Medial nerve.
D. Ulnar nerve.
10. A 26 year old man presents with urinary burning, frequency and urgency. His external
urinary meatus is inferiorly displaced on his glans. Which of the following statements
about his hypospadias is correct ?
A. It is often associated with cordee.
B. It is often associated with undescended testis (in more than 50% of cases)
C. It is rare fusion defect of the male posterior urethra.
D. The most common location is penoscrotal.
1) Mammogram
A) detects breast carcinoma in young ladies less than 35 years old,
B) differentiates between solid lumps and cysts,
C) shows clustered microcalcifications in carcinoma breast,
E) is a painless procedure and can be repeated often.
2) Warthin’s Tumour :
A) is a common tumour in the submandibular gland.
B) is also called adenolymphoma.
C) is often seen in children.
D) invades the facial nerve causing facial palsy.
3) Mumps :
A) is an acute viral infection.
B) affects the elderly more often than children.
C) recurrent parotitis in childhood is an important complication.
D) require antibiotics to treat.
4) Mondor’s disease of breast :
A) is an important pre-requisite to carcinoma.
B) is superficial thrombophlebitis.
C) requires surgery and biopsy.
D) causes nipple discharge.
5) Superficial parotidectomy :
A) usually performed under local anaesthesia.
B) starts with dissection of the anterior border of the parotid gland.
C) location of facial nerve trunk is important.
D) is treatment of choice for high-grade malignant tumours.
2 Which transfusion has been notably associated with the transmission of Human
Deficiency Virus (HIV) ?
A. Whole blood.
B. Iron infusion.
C. Packed cells.
D. Anti-haemophilic globulin.
7 Hyperaldosteronism is diagnosed by :
A. a reduced ratio between renin and aldosterone.
B. a high blood pressure reduced by alpha-blockers (phenoxybenzamine).
C. base excess of minus 10.
D. sudden increases of blood pressure.
9 Persistent duodenal ulceration even after vagotomy and partial gastrectomy is a feature
of :
A. Zollinger-Ellison Syndrome (primary hypergastrinaemia)
B. a Vipoma.
C. Conn’s Syndrome.
D. acromegaly.
24 Keratoacanthoma is :
A. a self-limiting condition.
B. usually takes six months to develop.
C. locally invasive.
D. caused by a Streptococcal viridians infection.
28 Malignant melanoma.
A. is common in Africans.
B. becomes more frequent after exposure to sunlight.
C. Clark’s level 5 is associated with 30% five-year survival.
D. Clark’s level 1 is associated with 60% five-year survival.
29 Kaposi’s sarcoma :
A. is only seen in patients with Acquired Immune Deficiency Syndrome (AIDS)
B. is a tumour of smooth muscle.
C. is caused by Herpes virus 8.
D. is best treated by radiotherapy.
1 Marjolin ulcer is
2 Dermoid cyst is
D transillumination postive.
3 Sebaceous gland is
A apocrine type.
B holocrine type.
C merocrine type.
D endocrine type.
B
4 A 38 year-old lady presents to the emergency department with pain on defaecation lasting
about one hour. She also has noted some bright red blood on the tissue paper. The most
likely diagnosis is:
C Proctitis
D Anal fissure
A Crohn’s disease.
C Perianal abscess.
D Tuberculosis
A retention cyst.
B exudation cyst.
C cystic tumour.
D degenerative cyst.
A Exomphalos minor
B Exomphalos major
C Umbilical hernia
D Ectopia Vesicae
A gravitational ulcer.
B syphilitic ulcer.
C tuberculous ulcer.
D trophic ulcer.
9 Major cause regarding the mortality in congenital diaphragmatic hernia is due to:
B lung hypoplasia.
D polyhydramnios.
10 62-year-old man with a history of smoking presents with hematuria. He has owned and
operated a chain of dry cleaners for over 30 years. The most likely diagnosis is:
A Prostate cancer
C Bladder cancer
A
B Pallor of disease.
Bowen’s the lesion.
B
C Irregularity
early of surface.
circiumcision.
C
D Bleeding
penile on touch.
warts.
12 Marginal ulcer is :
A sublingual.
B suprahyoid.
D subhyoid.
A serosa..
B mucosa.
C submucosa.
D muscularis mucosa.
16 A 68 yer old lady who had been treated for a static leg ulcer for the past 5 years developed a
noduleat one side of the ulcer over 2 weeks which started to bleed intermittently and then
ulcerate itself.The most likely diagnosis is :
B rodent ulcer.
C diabetic ulcer.
D Marjolin’s ulcer.
1) 30 year old lady comes with pain upper abdomen, fever, chills and rigors and with
icterus - what should be the first line of investigation ? :
A ) liver function test
B ) total haemogram
C ) ultrasound of hepato-biliary region
D ) CT scan of abdomen
2) 50 year old alcoholic, suddenly after meal, develops acute pain in abdomen with
fever, tachycardia, hypotension – likely diagnosis should be ? :
A ) acute gastro-enteritis
B ) acute pancreatitis
C ) acute cholecystitis
D ) acute mesenteric vascular ischaemia
3) 25 year old male reports with complaints of feeling heaviness of this right testis.
On examination, the testis is found to be hard in consistency with mild hydrocoele of
right scrotum. No inguinal lymphadenopathy and no history of trauma.
The preferred management should be :
A ) fine needle aspiration cytology (FNAC) of right testis
C ) open biopsy of right testis
D ) scrotal incision and removal of right testis
E ) inguinal incision and removal of right testis
1 Sentinel node biopsy in carcinoma of breast usually involves biopsy of lymph node in :
A. ipsilateral axilla..
B. contralateral axilla.
C. the supraclavicular region.
D. the internal mammary area.
2 When a clinical diagnosis of acute intestinal obstruction is made, the next appropriate
imaging procedure is ?
A. Barium contrast studies of upper gastrointestinal tract.
B. Plain supine and erect views of abdomen.
C. Computerized tomography of abdomen and pelvis.
D. Magnetic resonance imaging of abdomen.
3 Fournier’s gangrene :
A. is cused by thrombosis of spermatic arteries.
B. is a dry gangrene.
C. is often associated with diabetes mellitus.
D. will heal well with antibiotic therapy alone.
4 Bilateral gynaecomastia :
A. is a premalignant condition.
B. will always show lactation.
C. can be seen in chronic liver disease.
D. presents with bloody nipple discharge.
5 Intestinal amoebiasis :
A. is caused by Entamoeba coli.
B. causes carcinoma of colon.
C. can lead to liver abscess.
D. causes intestinal obstruction.
9 An ulcer by definition is :
A. an abrasion of the skin.
B. a breach in the continuity of an epithelial surface.
C. a defect caused by infection.
D. a bleeding malignant lesion.
10 Ludwig’s angina :
A. is an infection of closed fascial space in the neck.
B. is a form of oesophageal motility disorder.
C. is an abscess above the palatine tonsil.
D. is associated with coronary artery spasm.
33 ERCP usually :
A. requires general anaesthesia.
B. can diagnose strictures of the pancreatic duct.
C. is contra-indicated in jaundice.
D. gives same information as obtained in Percutaneous transhepatic cholangiography
(PTC).
35 A 45 year old lady presented with bloody discharge from left nipple for 3 weeks with a
small non-tender firm lump in her left breast. What is a possible diagnosis ?
A. galactocoele.
B. duct papilloma.
C. acute breast abscess.
D. fibroadenoma breast.
36 A 53 year old lady who was diagnosed with early stage carcinoma of caecum.
During operation the following structures that were removed included
A. distal 20 cm of ileum.
B. lymph nodes along left colic artery.
C. whole descending colon
D. right ovary and Fallopian tube.
37 A 55 year old lady sustained extensive full-thickness burns to her right leg 5 years ago
was left with an ulcer on her right leg just above the ankle which seemed to be larger
recently. Which of the following procedures should be undertaken ?
A. Continue with Eusol dressings and wearing of compression stockings.
B. Take edge biopsy for the possibility of Marjolin’s ulcer.
C. Give a combination of wide spectrum antibiotics for 2 weeks.
D. Perform split skin grafting on ulcer.
38 A baby was born with complete cleft lip and cleft palate.
Appropriate management of this case would be :
A. CT scan done to assess other skull abnormalities.
B. Primary closure of cleft palate is done first before closure of cleft lip.
C. Primary closure of cleft palate is done by 2 months old.
D. Primary closure of cleft lip is done at 3 months old.
2) Barrett’s oesophagus is :
A) a premalignant lesion of the oesophagus.
B) is a frank malignant lesion of the oesophagus.
C) is due to a viral infection.
D) is due to duodenal ulceration.
D light skinned men have a higher risk than dark skinned women.
B hypercalcaemia.
D thrombocytosis.
B phaechromocytoma.
D craniopharyngioma.
6 In hepatocellular carcinoma (HCC), which factor is most commonly present ?
A A preceding Hepatitis A infection.
C cirrhosis of liver.
D gallstones.
B Transverse colon.
C Sigmoid colon.
D Rectum.
8 Xerostomia is caused by :
A post-irradiation to head and neck.
D ranula.
9 Of the matching pairs of tumour marker to malignancy, which of the following is TRUE :
A serum prostatic specific antigen – carcinoma bladder.
B total oesophago-gastrectomy.
C radiotheraphy.
D chemotherapy.
B. analgesia.
C. Muscle relaxation
D. apnoea
B. a receding mandible.
A. anxiolysis.
B. basal narcosis.
C. anti-emesis.
D. anti-tussive.
B. hyperglycemia.
D. laryngeal spasm.
C. haemodynamic stability.
A. severe coagulopathy.
A. Naloxone.
B. Flumazenil.
C. Naltrexone.
D. Morphine sulphate.
A. sleep
B. sedation
C. depth of anaesthesia
D. pain intensity
1 Regarding morphine
2 Regarding propofol
A. Visual Analogue Scale (VAS) is widely used to assess the severity of pain. (T)