REVISION 2023

FREE CLASSES

TRUE / FALSE
BREAST
1. Regarding fat necrosis of the breast,
a. Occurs following mastitis
b. Due to necrosis of the adipocytes
c. Involves inflammation and fibrosis
d. Can cause puckering
e. Cause of nipple retraction

2. The following conditions have an increased risk of developing breast cancer,

a. Chronic breast abscess
b. Papilloma
c. Periductal mastitis
d. Mondoor’s disease
e. Apocrine metaplasia

3. Regarding pathogenesis of breast cancer

a. Arises from glandular epithelial cells
b. Ductal type is commoner than lobular type
c. Has a preclinical in-situ stage
d. In-situ to invasive change takes 2 years
e. In-situ carcinoma is managed with close follow up looking for malignant change

4. The following are true/false regarding nipple discharge in women,

a. The majority are due to benign conditions
b. The commonest cause of blood-stained nipple discharge is a duct papilloma
c. Galactorrhoea is a manifestation of pituitary tumour
d. All patients with nipple discharge above age of 40 should have mammography
e. Any nipple discharge is pathological

5. Which of the follow are classified as a T3 breast lesion?

a. A lump in the upper outer quadrant with 2.6cm in the widest diameter
b. A 6cm Lump in the upper inner quadrant with slight puckering of the skin on elevation of the arms
c. A 3cm lump in the upper inner quadrant with ulceration of skin over the lump
d. 4cm lump with core biopsy report of inflammatory carcinoma
e. A 6cm lump with Peau d' orange changes of the skin over it

6. A 20 year old female presenting with a breast lump was diagnosed to have fibroadenoma. WOTF are T/F
regarding this,
a. It occurs due to excess oestrogen
b. May have a lobulated surface
c. Has ill defined margins
d. Highly mobile
e. Soft and fluctuant because of glandular tissue component
7. Regarding investigations of the breast
a. Use of contrast in mammography improves sensitivity
b. Mammogram has 2 views
c. MRI is the best for local spread
d. Core biopsy is indicated in inconclusive cases
e. FNAC is more sensitive than core biopsy

8. Mastalgia
a. Differential diagnosis includes costochondritis
b. Evening primrose oil helps to minimize cyclical mastalgia
c. Cyclical mastalgia can be treated with cyst aspiration.
d. Is the presenting feature of upto 5% of breast cancer
e. Common in fibroadenoma

9. Regarding pathogenesis of breast cancer,

a. BRCA 1 has higher risk of malignancy than BRCA 2
b. BRCA 2 is responsible for male breast cancer
c. BRCA 1 also increases risk of ovarian cancer
d. In those with BRCA gene positive prophylactic mastectomy is indicated
e. Up to 50% of cancers have familial origin

10. Regarding the anatomy of breast

a. Blood supply is by axillary and internal mammary arteries
b. Lymphatic drainage is into the axillary nodes
c. Most lymph drain into the anterior nodes
d. Ipsilateral supraclavicular nodal spread indicates N3 spread
e. Up to 15% lymph drains into internal mammary nodes

11. Breast reconstruction surgery

a. Immediate reconstruction requires skin sparing mastectomy
b. Saline prosthesis require perioperative antibiotics
c. Latissimus dorsi is used as a flap
d. Is always done
e. Increases the risk of recurrence

12. Regarding fibroadenosis

a. Nipple discharge is a feature
b. It occurs due to excess oestrogen
c. Increases in size following menopause
d. It is a premalignant condition
e. Always needs surgery

13. Regarding investigations of the breast

a. USS is better than mammogram in a 36 year old woman
b. Mammogram showing calcification is a definite sign of malignancy
c. Dermal oedema indicates malignancy in mammogram
d. Core biopsy enables immunohistochemistry and special stains
e. FNAC can be used in diagnosing metastasis
14. Regarding treatment of breast cancer
a. Radical mastectomy is the only curative option
b. Breast conservative surgery has unacceptably higher risk of recurrence
c. Modified radical mastectomy involves removal of pectoralis major muscle
d. If sentinel node biopsy comes positive axillary clearance is done
e. T4 lesions need neoadjuvant chemotherapy

15. Following are known causes of gynaecomastia

a. Klinfeter’s syndrome
b. Testicular atrophy
c. Testicular malignancy
d. Torsion of the testis
e. Cimetidine

16. A 32 year old woman diagnosed with breast carcinoma requests conservative surgery. Which of the
following are contraindications for BCS?
a. Past BCS
b. Poorly differentiated lesion
c. Ill-defined margins
d. Lesion in retro-areolar region
e. Multi-centric lesio

17. Causes of nipple discharge,

a. Fibroadenosis
b. Fibrocystic disease
c. Pagets disease
d. Lactation
e. Malignancy

18. A 38 year old mother of 3 month old child undergoes mastectomy and axillary clearance for T2N2
malignant breast lesion. Which of the following are T/F regarding her follow up
a. Needs radiotherapy of chestwall
b. Yearly mammogram should be done
c. 5 yearly MRI should be done
d. Gene testing should be offered
e. Monthly clinic follow up at CIM
 THYROID

19. A 26-year old man presented with a 5 cm solitary thyroid nodule. Which of the following indicates
malignancy?
a. Male sex
b. Hoarseness of voice
c. Multinodularity of the goiter
d. Horner’s syndrome
e. Nodule occurring in a child

20. Symptoms of thyrotoxicosis include

a. angina
b. Restlessness
c. Nervousness
d. Insomnia
e. Loss of appetite

21. Which of the following are signs of hyperthyroidism,

a. Muscle wasting of cheek muscles: Hollow cheeks
b. Tremors of the tongue
c. Receding eye brows
d. Peri-orbital puffiness
e. Lid lag

22. Which of the following are signs of Hyperthyroidism,

a. Ophthalmoplegia: Diplopia
b. Bradycardia
c. Thyroid acropachy
d. Reduced pulse rate
e. Delayed ankle jerk

23. Symptoms of thyrotoxicosis include,

a. Weight loss
b. Nausea/Vomiting
c. Constipation
d. Menorrhagia
e. Loss of libido

24. Which of the following statements regarding medullary thyroid cancers are true?
a. Of medullary type usually presents with episodic flushing &diarrhea
b. Amyloid is present in medullary carcinoma.
c. It can present as multiple endocrine neoplasia
d. It is not TSH-dependent
e. It is associated with a poor prognosis

25. The thyroglossal tract

a. Usually persists as a small fistula
b. Causes a small dimple in the tongue called the foramen caecum
c. May persist in parts as a throglossal cyst
d. Is continuous with the pyramidal lobe of the thyroid
e. Bifurcates around the hyoid bon
26. Which of the following suggest a biochemical diagnosis of primary hyperparathyroidism?
a. Raised ionised calcium and suppressed PTH levels
b. Raised total calcium and elevated PTH levels
c. Low serum phosphate levels
d. Low urine calcium level
e. Raised ionised calcium and elevated PTH

27. In thyroid cancer

a. A follicular carcinoma is usually treated with lobectomy alone
b. Of follicular type is best treated by I131 therapy alone
c. Of papillary type should be treated with total thyroidectomy
d. Treatment with high dose thyroxine is effective in reducing recurrence
e. Chemotherapy is effective

28. True or false regarding medical treatment of thyroid disease

a. Lugol’s iodine is given for long term treatment of thyrotoxicosis
b. Beta blockers reduce thyroxine production
c. Steroids are used in thyrotoxic crisis
d. Glad may initially enlarge after starting Cabimazole
e. Beta blockers are contraindicated in asthmatics

29. Regarding post-operative1st 24 hours after thyroidectomy

a. Serum calcium levels should be done without applying a tourniquet
b. Do not prop up the patient if a drain is in situ
c. Routine steam inhalation done
d. Hypocalcemia is common
e. Hypocalcemia should not be corrected in this period

30. Regarding the thyroid gland

a. Embryologically thyroid gland is originated from the thymus
b. Develop from a down growth of foramen caecum
c. Parafollicular cells develops under the influence of neural crest cells
d. Lateral aberrant thyroid is a developmental abnormality
e. Isthmus overlies first tracheal ring

31. Regarding Reidel’s thyroiditis

a. Thyroid tissue is replaced by fibrous tissue
b. Potentially malignant
c. Infiltrates adjacent muscles
d. Associated with mediastinal fibrosis
e. Soft thyroid is a typical feature

32. T/F regarding assessment of thyroid enlargement

a. Fine needle aspiration cytology (FNAC) can accurately diagnose a colloid nodule
b. FNAC can accurately diagnose follicular carcinoma
c. I123 can diagnose metastatic thyroid carcinoma
d. USS can confidently discriminate benign from malignant disease
e. FNAC done under general anaesthesia
33. Anaplastic CA
a. Anaplastic CA has the best prognosis among thyroid CA
b. Occurs following multinodular goiter
c. Biopsy indicated
d. Radical surgery is main mode of treatment
e. Tracheostomy is done palliatively

34. TSH,
a. glycoprotein
b. increases in primary hypothyroidism
c. reduces vascularity of thyroid gland
d. increases synthesis of thyroglobulin
e. Stimulates the growth of malignancy

35. Which of the following regarding thyroglobulin are true?

a. It is a part of normal thyroid function tests
b. It is secreted only by cancerous cells
c. Autoantibodies may interfere with its levels
d. It is a sensitive marker of recurrent thyroid cancer
e. Radioiodine affects its concentration

36. True or false regarding medical treatment of thyroid disease

a. Thyroxine when given in excess for a prolonged period is known to cause osteoporosis
b. Thyroxine treatment for congenital hypothyroidism is stopped at puberty
c. Thyroxine 300mg/day is the initial dose in elderly
d. Carbimazole inhibits iodine uptake by thyroid follicular cells
e. Carbimazole is known to cause agranulocytosis

37. T/F regarding thyroidectomy

a. Complete recurrent laryngeal nerve division is more compromising than partial
b. Cricothyroid muscle is supplied by RLN
c. Hypocalcaemia occurs due to ischaemia of the parathyroid glands
d. Prophythiouracil is safe in pregnancy
e. Unilateral RLN damage cause respiratory distress

38. Symptoms of thyrotoxicosis include,

a. Hyperkinesias
b. Heart failure
c. Vitiligo
d. Heat intolerance
e. Sweating

39. True or false regarding chronic autoimmune thyroiditis,

a. More common in males more than females
b. Patients present with smooth enlargement of the thyroid gland
c. It is known to be associated with other autoimmune diseases of the body
d. On histological examination colloid filled cysts are seen
e. About 80% of the patients develop follicular carcinoma
 UROLOGY
40. Ureteric colic
a. Due to peristalsis of ureter
b. Sometimes associated with fever and chills
c. USS is not indicated in the acute phase
d. Contrast spiral CT is the method of choice for investigation
e. IVU is preferred over USS if available

41. Benign prostatic hyperplasia

a. Peripheral zone shows changes in early stages
b. rarely produces an abnormality on intravenous urogram
c. 5 alpha reductase inhibitors are started as a medical treatment
d. PSA is very significant in differentiating from malignancy
e. Has 5% mortality risk

42. Regarding complications of urolithiasis

a. Renal failure
b. Bladder squamous cell carcinoma
c. Rupture of bladder
d. Impaction and perforation of the ureter is common
e. Bladder diverticuli

43. Causes for painless haematuria

a. Bladder carcinoma
b. Bladder diverticuli
c. Hypernephroma
d. Wilms tumour
e. Cystitis

44. Clinical features of renal cell CA

a. Can present with right sided varicocele
b. Presents with haematuria, loin mass and pain in 10% of cases
c. Presents with paraneoplastic syndrome
d. Fever
e. Hyperviscosity syndrome

45. Acceptable treatment options of 1 cm stone at the renal pelvis in 40 year-old man include
a. Conservative management
b. Diuretic challenge
c. ECSWL
d. PCNL is the first line treatment
e. Dormia basket extraction

46. Urine full report

a. Dysmorphic red cells seen in glomerular damage
b. Oxalate crystals if present, an x-ray KUB is indicated
c. 5-10 pus cells can be seen in acute appendicitis
d. Is one of the basic investigations
e. Not necessary in macroscopic haematuria
47. Regarding UTI
a. Antibiotics are indicated if culture shows >105/ml colony forming units
b. Cystitis needs urgent IV antibiotics
c. Gram negative sepsis is a major cause of death
d. Asymptomatic bacteriuria needs prompt treatment in all cases
e. Sepsis can be ruled out if urine culture negative

48. Renal calculi

a. Staghorn calculus maybe clinically silent
b. Causes loin pain
c. Are the only cause of ureteric colic
d. May present with uremia
e. Haematuria common with xanthine stones than oxalate stones

49. Regarding treatment of prostatic carcinoma,

a. Histologically graded by Gleason’s
b. Always serum PSA elevated
c. PSA >35 ng/ml suggests advanced disease
d. 5 alpha reductase is an option
e. Enucleation of prostate is a choice of therapy

50. Regarding the management of urolithiasis

a. Most are radio-opaque
b. Uric acid stones are easy to detect in X-ray KUB
c. Cystine stones are radiolucent
d. Are usually identified on plain x-ray
e. Can exclude stones in the absence of crystals in urine

51. Regarding ESWL

a. ESWL will be better responsive if stone >2cm in size
b. ESWL cannot be done if unfit for general anesthesia
c. ESWL freely available in teaching hospitals
d. Those in the upper ureter maybe treated by ESWL
e. Can be used in obstructed kidney

VASCULAR
52. Post-operative pulmonary embolism
a. Presents as haemoptysis
b. Can exclude if chest X-ray is normal
c. Is confirmed by CT angiography
d. Can be excluded if there is no DVT in calf veins
e. e.Can be prevented by early mobilization

53. In compartment syndrome

a. Absent pulse in the distal limb is an early feature
b. Increased pain during passive flexion and extension rules it out
c. Monitoring absolute pressure values are unreliable
d. Lower limbs are commonly affected
e. Expansion of the compartment as a result of haemorrhage is a causative factor
54. A 54 y old man has his femoro-popliteal segment affected by atherosclerosis
a. He will have pain in the calf while standing for a long time
b. He may have intermittent claudication when walking for 100 m
c. If surgery is indicated femoro-femoral bypass should be done
d. There is 10% amputation risk after 10 y
e. Graded exercises will have beneficial effect

55. The following are true concerning aneurysms

a. Measurement of AP diameter is important in the management
b. Easily found on careful clinical examination
c. Plain X-ray is not helpful in diagnosis
d. USS is useful for diameter assessment
e. >80% of patients die from an unrelated cause

56. Regarding peripheral vascular disease

a. At the stage of tissue loss nothing can be done
b. Bypass is always better than angioplasty
c. Short term outcomes better with angioplasty
d. Aspirin increases claudication distance
e. Proper foot care is essential

57. Regarding varicose veins of the lower limbs,

a. Tourniquet test to indicate perforator incompetence
b. Perthes test to confirm superficial venous thrombosis
c. Venogram is first line investigation
d. Progesterone is a risk factor
e. Seen during pregnancy

58. Acute arterial occlusion

a. Fixed skin staining is an early sign
b. Should be treated conservatively if the site of the occlusion is above the linguinal ligament
c. Demands the urgent use of vasodilator drugs
d. Of a limb is usually painless due to the anoxic damage produced in the peripheral nerves
e. May produce irreversible muscle necrosis after 6 hours

59. A 50 year old woman is diagnosed with ileo-femoral deep vein thrombosis following anterior resection. In
this patient
a. Early mobilization is associated with a greater risk of pulmonary embolism
b. Treatment is initiated with heparin
c. A caval filter is not recommended at this stage
d. Warfarin therapy should be continued for up to six months
e. Long term aspirin is recommended

60. Calf claudication

a. Is usually associated with an ABPI <0.7
b. False normal in DM due to calcified vessel
c. Is associated with fall in ABPI on exercise with delayed recovery
d. May be present in the absence of significant atherosclerosis
61. DVT in post-op patient
a. Occurs in <5% of patients undergoing total knee replacement
b. Usually begins to form in the early post op period
c. May lead to venous ulcer
d. Usually of little clinical significance
e. Initial treatment with subcutaneous enoxaparin better than unfractionated heparin

62. 32 year old man presents with chronic occlusive arterial disease. WOTF needs urgent surgical intervention
a. Painful ulcer at the tip of the toe
b. Rest pain
c. Presence of DM
d. Presence of varicose veins
e. Claudication distance of 200 m

63. Acute arterial occlusion

a. Immediate heparin infusion can reduce amputation rates
b. Should operate within 6 hours for better results
c. Intra-arterial thrombolysis is invariably successful
d. Reperfusion injury can lead to compartment syndrome
e. Trauma causes acute limb ischemia only in high risk people

64. 55 year old diabetic man presents to the hospital with a painless heel ulcer of 3 months duration. He does
not claudicate and all the peripheral pulses are present. The ulcer is clean and there is no cellulitis. His
HbA1c is 8.5 (non diabetic <6.7). he uses regular foot wear at all times. The factors that contribute to non-
healing of this man are,
a. Wound infection:
b. Weight bearing on the ulcer
c. Ischaemia is a contributing factor
d. Peripheral neuropathy
e. Poor sugar control

65. Features differentiating arterial intermittent claudication from venous claudication

a. Calf pain
b. No pain on standing
c. Cramping type pain
d. Relief by raising the leg
e. Reproducible

66. Regarding atheroma of aorto-iliac segment

a. Commonly presents with impotence
b. Intermittent claudication occurs only in gluteal segment
c. Intermittent claudication pain does not occur in calf
d. Numbness is not a feature
e. Endarterectomy is better than bypass

67. False aneurysm of femoral artery

a. May follow angiogram
b. Is most often due to atherosclerosis
c. Will thrombose spontaneously in most cases
d. Maybe mistaken for haematoma
e. Is treated by ligation of femoral artery
68. Ischemic ulcers
a. Most common in anterior aspect of leg
b. Are painful
c. Have a punched out edge
d. The base is filled with granulation tissue
e. Only rarely coexist with neuropathy

69. Routine clinical investigations in a patient with peripheral vascular disease are
a. Serum cholesterol
b. Serum autoantibodies
c. ESR
d. Echocardiogram
e. ABPI

70. Regarding varicose veins of the lower limbs

a. Affects 20% of the population
b. >20% are recurrent varicosities
c. Secondary varicose veins occur following venous thrombosis
d. All skin changes are reversible
e. Brodies test is done for SFI

TRAUMA AND ORTHOPAEDICS

71. Which of the following are immediate life threatening conditions in trauma
a. Cardiac tamponade
b. Open pneumothorax
c. cervical spine at C1 and C2 level
d. EDH with GCS 13
e. Penetrating injury to colon

72. Regarding missile injuries

a. Extent of internal tissue damage can be associated with the size of skin wound
b. Exit wound is larger than entry wound
c. Penetration injury to the abdomen is an indication for exploratory laparotomy
d. Primary suturing can be done for upper arm wounds
e. High dose of penicillin is indicated

73. Which of the following is/are complications of the POP casts

a. Sudeck’s atrophy
b. Ulceration
c. Neuropraxia
d. DVT
e. Compartment syndrome

74. Regarding immediate management of a patient who comes with facial and chest burns
a. High flow O2 via face mask
b. Fluid requirement is indicated from the time the patient is admitted to the emergency ward
c. Hartmann's solution given in doses of 0.5ml / kg / burn surface area
d. Management of pain is easier in superficial burns as compared to patient with deep burn
e. TPN is preferred to enteral nutrition
75. Regarding fractures of the vertebral column,
a. Hypotension is a feature
b. There should be a minimum of 3 persons for log-rolling
c. Open mouth-view is taken to assess fracture of the 1st cervical vertebra
d. CT is performed to confirm fractures of cervical spine
e. Skull traction is used in atlanto-axial fractures

76. T/F regarding pelvic fractures

a. Pelvic fractures are usually detectable by clinical examination
b. External fixation can often reduce pelvic haemorrhage
c. Cause rectal injury
d. Anterior urethral damage in male is an associated feature
e. Blood at urethral meatus is an indication for urethral catheterization

77. Following are true/false regarding IC tubes in chest trauma

a. 2nd ICS in the midclavicular line is the preferred site for insertion
b. It is usually inserted under local anaesthesia
c. It is the only form of treatment required in over 50% of those with pneumothorax
d. It is mandatory in the management of flail chest
e. Drainage of 100ml of blood in the first hour after insertion is an indicator for emergency
thoracotomy

78. T/F regarding dislocation of the hip joint

a. It is usually anterior
b. Can be associated with acetabular fracture
c. Reduction done under GA
d. Commonly occurs at adducted leg
e. Need urgent reduction

79. Regarding blunt trauma to abdomen,

a. Common site of rupture of small intestine is mid jejunum
b. Acute pancreatitis is a sequale
c. Peritoneal lavage is used to diagnose visceral perforations
d. Absent haematuria excludes urinary injury
e. Subcapsular haematoma in spleen is managed non-surgically

80. Features of EDH

a. Low BP
b. Lucid interval
c. Tachycardia
d. Headache
e. Reduced urine outpu

81. Which of the following are T/F regarding nerve injuries

a. Median nerve at wrist cause wrist drop
b. Ulnar nerve damage at wrist causes claw hand more markedly than damaged at elbow
c. Common peroneal nerve is damaged by fracture of tibia
d. Popliteal artery may be damaged by fracture of the tibia
e. Ulnar nerve is damaged by shoulder dislocation
82. Which of the following are T/F regarding nerve injuries
a. Median nerve at wrist cause wrist drop
b. Ulnar nerve damage at wrist causes claw hand more markedly than damaged at elbow
c. Common peroneal nerve is damaged by fracture of tibia
d. Popliteal artery may be damaged by fracture of the tibia
e. Ulnar nerve is damaged by shoulder dislocation

83. T/F regarding chest trauma

a. Haemothorax may be difficult to diagnose on CXR
b. The main effect of tension pneumothorax is respiratory
c. Massive hemothorax needs immediate surgical exploration
d. A widened mediastinum suggests aortic rupture
e. IC tube inserted at 2nd intercoastal space at mid clavicular line

84. Regarding GCS

a. A GCS 10 indicates severe head injury
b. A GCS 7 requires intubation
c. 3 components are assessed
d. A GCS of 15 exlude head injury
e. A GCS 3 indicates brain death

85. Regarding extra-capsular fracture of neck of the femur

a. Common in elderly
b. Leg is externally rotated
c. Blood supply to femoral head is compromised
d. Hemi-arthroplasty is indicated
e. Internal fixation is done in all age groups

86. Recognized cause of shock include

a. Hypothyroidism
b. Acute pancreatitis
c. Tension pneumothorax
d. Pulmonary embolism
e. Infected hydronephrosis

87. In a patient with 35% superficial thermal burns

a. Urethral catheterisation is indicated
b. NG insertion is indicated
c. Crystalloids are preferred in fluid resuscitation
d. Fluid requirement is indicated from the time the patient is admitted to the emergency ward
e. Fluid requirement is calculated from Parkland’s formula

88. Early feature of septic shock include

a. Rapid thready pulse
b. Low cardiac output
c. A fall in urine output
d. Cold clammy periphery
e. Decreased respiratory rate
89. Regarding intercostals tubes,
a. It is usually inserted under local anaesthesia
b. Drainage of 100ml of blood in the first hour after insertion is an indication for thoracotomy
c. It is the only form of treatment required in over 50% of those with pneumothorax
d. Inserted in the 2nd intercostals space
e. Essential for flail chest

90. T/F regarding chronic SDH

a. Common in young people
b. Associated with cerebral atrophy
c. Can present with confusion
d. Is having a bad prognosis than acute SDH
e. Can be treated with Burr hole

91. Used for fluid management in the first 24 hours

a. Copious water irrigation is needed in acid/alkali burns
b. Circumferential burn can cause compartment syndrome
c. Escharotomy is usually done on second day of the burn after adequate hydration is given
d. Consider non accidental injury in burns of children
e. Parkland formula is used to measure the burn surface area

92. T/F regarding osteosarcoma

a. Less commoner than chondrosarcoma
b. More common in young people
c. Cause secondary deposits at the lungs
d. Lymphatic spread is commoner than blood stream
e. Resistant to chemotherapy

93. The osteoclastoma (giant cell tumour of bone)

a. characteristically occurs in the shaft of a long bone
b. usually occurs before fusion of the epiphyseal plate
c. may be recognized by the subperiosteal new bone
d. may be malignant
e. characteristically presents as a pathological fracture

94. WOTF are T/F regarding SUFE,

a. Is a recognized cause of AVN of the femoral head
b. Is best diagnosed by USS of the hip
c. Require internal fixation
d. Is due to a hormonal imbalance
e. Common during puberty

95. Slipped upper femoral epiphysis (SUFE)

a. Has a peak incidence between 5-10 years
b. Is often unilateral
c. Is a recognized cause of AVN of the femoral head
d. Is best diagnosed by USS of the hip
e. Require internal fixation
 LUMPS AND NECK LUMPS
96. WOTF are midline swellings in the neck,
a. Thyroglossal cyst
b. Branchial cyst
c. Laryngocele
d. Submental lymphadenopathy
e. Dermoid cyst

97. Pleomorphic adenoma of the parotid gland

a. Completely capsulated
b. Fluctuant lump
c. Can undergo malignant transformation
d. Is the least common neoplasm in the salivary glands
e. Can be diagnosed by FNAC

98. The following is/are true of salivary glands

a. Acute parotitis is commonly caused by Staphylococcus aureus
b. The most common cause of post-operative parotitis is streptococcal species
c. Mumps may affect submandibular as well as sublingual glands
d. Recurrent parotitis of childhood often has no identifiable aetiology
e. Calculi are most common in the submandibular gland

99. Which of the following is correct regarding salivary duct calculi?

a. Doesn’t produce pain when eating
b. Can be treated by excision of the affected gland
c. Are associated with hypercalcaemic status
d. Are a common cause of acute parotitis
e. Are commonest in the parotid duct

100. The differential diagnosis of a thyroglossal cyst includes

a. Sub-hyoid bursa
b. Thyroid swelling
c. Epidermoid cyst
d. Pharyngeal pouch
e. Cystic hygroma

101. Which of the following lumps has transillumination as a feature?

a. Sebaceous cyst
b. Ganglion
c. Hydrocele in young males
d. Hydrocephalus in new born
e. Cystic hygroma

102. Which of the following lumps can occur in anterior triangle of the neck
a. Dermoid cyst
b. Cystic hygroma
c. Carotid body tumors
d. Branchial cyst
e. TB abscess
 HERNIA
103. Regarding inguinal canal
a. Deep inguinal ring is at mid-inguinal point
b. conjoint tendon forms medial part of posterior wall
c. ilio-inguinal nerve goes through the deep inguinal ring
d. External oblique forms the roof
e. Internal oblique contributes both to anterior and posterior walls

104. Regarding inguinal canal

a. Inguinal canal is longer in children
b. Fascia transversalis forms the anterior wall of inguinal canal
c. neck of hernia present lateral to inferior epigastric artery in direct hernia
d. deep opening is midway between anterior superior iliac spine & symphysis pubis

105. Femoral Hernia

a. Occurs between femoral artery and vein
b. Hernia below and lateral to pubic tubercle
c. Obstruction is rare
d. More in women
e. May strangulate without obstruction

106. Differences between direct and indirect inguinal hernia,

a. Patients age
b. the shape
c. position of cough impluse
d. extension in to scrotum
e. Compressibility by deep ring occlusion test

107. DD for inguinal hernia

a. Femoral hernia
b. Vaginal hydrocele
c. Undescended testis
d. Ectopic testis
e. Hydrocele of cord

108. Swelling below & lateral to the pubic tubercle may be

a. Femoral hernia
b. Saphinavarix
c. Femoral artery aneurysm
d. Psoas abscess
e. Lymphadenopathy
 MISCELLANEOUS
109. These suture materials are absorbable
a. Catgut
b. Polypropylene
c. Black silk
d. Polyglactine
e. Polyamide

110. Methods used in sterilization of surgical instruments

a. Ethylene oxide
b. Para-acetic acid
c. Chlorhexidine
d. Gamma-rays
e. High pressure steam

111. Smoking is a predisposing factor for the development of

a. Lung carcinoma
b. Peptic ulcer disease
c. Thromanbangitis obliterans
d. Buergers disease
e. Cirrhosis

112. Regarding epistaxis

a. Impacted foreign body is a cause
b. If severe, posterior nasal pack may be required
c. Anticoagulant therapy should be discontinued in the management
d. In the elderly, hypertension should be excluded
e. Embolization of bleeding vessels using radiological technique is indicated in refractory cases

113. To be suitable for day-case surgery under general anesthesia, the patient,
a. Should have a friend or relative to stay with them on the first night
b. Could be undergoing haemorrhoidectomy
c. May have a body mass index (BMI) of 44
d. Could be undergoing a laparoscopic cholecystectomy
e. Could have insulin-controlled diabetes mellitus

114. Regarding maxillary sinusitis

a. H. influnzae is one of the commonest causative organism
b. Antral lavage is contraindicated
c. Inhalation of steroids is useful
d. Plain X-ray has minimal use in diagnosis
e. Occurs secondary to dental sepsis

115. Drugs that should be stopped before a major surgery

a. Clopidogrel
b. Warfarin
c. Prednisolone
d. Losartan
e. Thyroxine
116. The following statements are true regarding infections of the hand
a. Passive motion is painful in flexor tendon sheath infections
b. Pulp space infection results in avascular necrosis of the distal phalanx
c. Incision and drainage is best done under local anaesthesia
d. Early mobilization of the finger is not advisable
e. Swelling is more in the dorsum than the palmar aspect

117. Thoracic outlet syndrome

a. Is more common in men than women
b. Vascular symptoms commoner than neurologic or venous symptoms
c. Symptoms are worsened by carrying weights or lifting the arms above head height
d. Diagnostic tests include Adson’s manouvre
e. Onset of symptoms is precipitated by trauma in about one third of patients

118. True/False regarding local anesthetic agents

a. Bupivacaine is used in spinal anesthesia
b. Duration of action of lignocaine is longer than that of bupivacaine
c. Convulsions are a feature of local anesthetic toxicity
d. Addition of adrenaline to lignocaine will increase it's duration of action
e. Maximum safe dose of lignocaine without adrenaline is 3mg/kg

119. Which of the following are True/False regarding pre-operative preparation?

a. Everyone undergoing surgery need 2D echo
b. Before oesophageal surgery blood gas analysis should be done
c. Warfarin should be stopped 48hrs before surgery
d. Atenolol should be stopped 1 week prior to the surgery
e. Anxiolytics are indicated for hypertensive patient prior to surgery

120. Blood loss during surgery can be assessed by,

a. Weight measurement before and after surgery
b. Weight of soaked swabs
c. ECG monitoring
d. Central venous pressure (CVP)
e. Intraoperative Hb level

121. Which of the following are T/F

a. Tonsillar enlargement indicates infection
b. Peritonsillar abscess has highest incidence in children
c. Eustachian tube opens to nasopharynx
d. Cholesteatoma is pre malignant
e. Antral washout is indicated in Chronic maxillary sinusitis

122. T/F regarding kidney transplantation

a. Cadaveric donors are the commonest variety in Sri Lanka
b. Is an example for allograft
c. Bilateral nephrectomy done at recipient during transplantation
d. Kidney is transplanted into the abdominal cavity
e. Renal artery and vein are anastomosed to the aorta and IVC
123. Which of the following can be given in an adult patient with heamorrhage for resuscitation?
a. Dextrose 10%
b. 0.45% saline
c. Hartmann’s solution
d. Albumin
e. FFP

124. T/F regarding acute otitis media

a. Commonest presentation is pain
b. Commonest in the 4th decade
c. May need to do a myringotomy
d. Cause permanent deafness
e. Associated with mastoiditi

125. True/False regarding complications of contrast angiography

a. Anaphylaxis
b. Renal failure
c. Cerebral oedema
d. Urinary retention
e. Arterial dissection

126. T/F following are the associations of dupuytren's disease

a. Liver diseases
b. Flexion contractures of the MCP joints
c. The use is vibrating tools
d. Skin pits and nodules
e. Anti-epileptic medications

127. Middle ear infections

a. Vertigo is a feature
b. Common in children
c. Majority are haematogenous
d. Pain is a prominent feature in chronic otitis media
e. Is a cause of meningitis

128. Regarding IV infusion/injection

a. Hartman’s solution contains 10mmol of K+ per liter
b. One litre of normal saline contain 300 calories
c. KCL is preferably given by IV infusion
d. Darrow’s solution contains more K+ than Hartman’s
e. Colloids are used to expand the intravascular volume

129. The following statements are True regarding IV fluids

a. Insensible losses replaced with 5% dextrose
b. 1000 ml Hartmann supply adequate K+ for adult male per day
c. Normal saline supplies energy
d. 1000 ml normal saline supplies daily Na+ required for males
e. 5% dextrose is a colloid
130. In a diabetic patient undergoing surgery
a. The dose of insulin should be halved on the day of surgery
b. Morning dose of insulin should be given on the day of the surgery
c. An IV infusion of 5% Dextrose should be started on the morning of surgery
d. Insulin requirements may increase after a major surgery
e. The majority of diabetic patient undergoing surgery have type I diabetes

131. Following are indicated in post op analgesia

a. Morphine
b. Ephedrine
c. 0.5% bupivacaine
d. GTN
e. Tramadol

132. Surgical Site Infection can be reduced by

a. Hand washing
b. Prophylactic antibiotics
c. Peri-operative warming of the patient
d. Minimizing blood transfusion
e. Using topical antibiotics

133. Complication of chronic suppurative otitis media include

a. Facial nerve palsy
b. Mastoiditis
c. Sinusitis
d. Intra-cranial abscess
e. Deafness

134. Hypokalemia occurs with

a. Spironolactone
b. Acute renal failure
c. Villous adenoma of Rectum
d. Intestinal obstruction
e. Mannitol

135. Conduction deafness is caused by

a. Glue ear
b. Wax in the external auditory canal
c. Osteosclerosis
d. Presbyacusis
e. Labyrinthitis

136. Regarding USS

a. Combined with a Doppler & used to assess vascularity
b. Endosonography is helpful in staging oesophageal neoplasia
c. Is useful in the evaluation of suspected malignancies
d. Useful in differentiating solid from cystic lesions
e. Wave travels better through air than through solid media
137. True/False regarding the incidence of post- operative infection in clean surgery
a. Reduced by skin preparation with local antiseptic
b. Reduce by shaving 24 hours before the surgery
c. Minimized by shortening the pre-operative hospital stay
d. Approximately 10%
e. Reduced by prophylactic antibiotics

138. Regarding Tetanus

a. caused by gram -ve bacilli
b. needs ICU care
c. battle injuries are a cause
d. Incubation period is 7 days Is treated by penicillin

139. Which of the following can be given in an adult patient with heamorrhage for resuscitation?
a. Dextrose 10%
b. 0.45% saline
c. Hartmann’s solution
d. Albumin
e. FFP

140. Components of systemic inflammatory response syndrome

a. Pulse rate >80/min
b. Respiratory rate >20/min
c. Temperature <36?C or >38?C
d. WBC count <4×109 or >12×109
e. Evidence of infection

141. Regarding neonatal surgical conditions

a. In gastroschisis bowel herniated through the umbilical cord
b. Associated anomalies are common in exomphalos
c. Duodenal atresia is associated with down syndrome
d. Duodenal atresia is associated with polyhydramnios
e. Duodenal atresia neonates can develop bilious vomiting

142. These suture materials are absorbable

a. catgut
b. Polypropylene
c. Black silk
d. Polyglactine
e. Polyamide

143. True/False regarding complications of contrast angiography

a. Anaphylaxis
b. Renal failure
c. Cerebral oedema
d. Urinary retention
e. Arterial dissection
144. Pulmonary atelectasis (partial or complete collapse of the lung)
a. Impairs gas change
b. Predisposes to infection
c. Is a cause of post-operative fever
d. Is prevented with appropriate antibiotics
e. Is unlikely if the CXR is normal

145. Regarding acute tonsillitis

a. Ear ache is a symptom
b. The commonest bacterial cause is hemolytic streptococcus
c. Enlargement of the jugulodigastric lymph node is a feature
d. A reduction in the absolute lymphocytic count is a feature when it's due to infectious
mononucleosis (IMN)

146. Proptosis is associated with,

a. Acromegaly
b. Horner’s syndrome
c. Primary thyrotoxicosis
d. Retinoblastoma
e. Cavernous sinus thrombosis