SURGERY T & D QUESTIONS

1. All of the following are means of enteral nutrition except:

A: PEG
B: PICC
C: Nasojejunal tube
D: Sip feeding

2. A 55 year old diabetic patient with a frail build comes to the OPD. His daughter is concerned about his recent
weight loss and lack of appetite. Which parameters will you consider while assessing his malnutrition using MUST?
A: Age
B: Recent weight loss
C: Current nutritional intake
D: Acute illness

3. A 30 year old patient presented after 30% loss of blood volume in a road traffic accident. What next
management is to be given-
A: i.v. fluid with cardiac stimulant
B: i.v. fluid only
C: Dopamine
D: Vasopressor Drug

4. Identify the surgical knot in the given image

A: Surgeon’s Knot
B: Granny Knot
C: Reef Knot
D: Half Hitch Knot

5. What is the below given instrument?

A: Veress needle
B: Micropoint needle
C: Dolphin nose needle
D: Port closure needle

6. Name the instrument given below :

A: Artery forcep
B: Kocher’s forceps
C: Needle holder
D: Tissue holding forceps

7. A four-week-old male infant presents to the surgery OPD with nonbilious projectile vomiting. An olive-shaped
mass is palpable in the right upper quadrant of the infant which contracts from the left to right direction. On
conducting an ultrasound examination which of the following signs is not seen in this condition?
A: Target sign
B: Cervix sign
C: Nipple sign
D: Rat-tail sign

8. A newborn who was delivered at full term by normal vaginal delivery presented with respiratory distress
immediately after birth. On examination, the neonate was found to have a scaphoid abdomen. An X-ray was
performed that showed the following:
A: Congenital diaphragmatic hernia
B: Transient tachypnea of the newborn
C: Meconium Aspiration Syndrome
D: Acute Respiratory Distress Syndrome

9. A 22 year old woman delivered a premature neonate who showed the following defect. Which of the following
statements regarding it is false?

A: The defect size can range from 6 to 15 centimeters

B: The herniated viscera generally contains stomach, small bowel and colon
C: The herniated viscera can undergo malrotation
D: In order to decompress the stomach, an orogastric tube is placed

10. Which of the following is the most common location for the condition shown below?
A: Posterior triangle of neck
B: Axilla
C: Anterior triangle of neck
D: Carotid triangle

11. A 3 month old baby is brought to the OPD for a facial defect. On examination, the following findings were
noticed. The soft and hard palate are intact. Out of the following options, which is the most appropriate management
for this child?

A: Cleft lip repair immediately

B: Cleft lip repair at 4-6 months
C: Cleft lip repair at 9-12 months
D: Cleft lip repair at 12-15 months

12. The Trauma and Injury Severity Score (TRISS) includes the following components:
A: GCS + BP + RR
B: RTS + ISS + age
C: RTS + ISS + GCS
D: RTS + GCS + BP

13. A 14 year old healthy girl of normal height and weight for age, complains that her right breast has developed
twice the size of her left breast since the onset of puberty at the age of 12. Both breasts have a similar consistency on
palpation with normal nipples areolae. The most likely cause for these findings is :
A: Cystosarcoma phyllodes
B: Virginal hypertrophy
C: Fibrocystic disease
D: Early state of carcinoma
14. Which of the given axillary match correctly according to their anatomic relationship to pectoralis minor muscle?
A: Level 1 - Below edge of pectoralis minor muscle
B: Level 2 - Above / medial to pectoralis muscle
C: Level 3 - Posterior to pectoralis muscle
D: Level 4 - Above edge of pectoralis muscle

15. Which surgery is performed for Periductal Mastitis :

A: Hadfield’s operation
B: Patey’s mastectomy
C: Modified radical mastectomy
D: None of the above

16. A 60 year old patient presents with lump in right breast on evaluation carcinoma breast was detected, which of
the following breast carcinoma has high incidence of involving opposite breast :
A: Lobular Carcinoma
B: Atrophic scirrhous carcinoma
C: Medullary carcinoma
D: Scirrhous carcinoma

17. A postmenopausal 48-year-old woman appears with an 7-cm breast lump that is adherent to the skin, one hard
apical lymph node in the axilla, and one additional node in the ipsilateral supraclavicular region. There is no clinical
signs of distant metastases.The staging is
A: T3 N2 M1
B T4 N2c M1
C: T4 N3c M0
D: T3 N3 M0

18. Breast cancer patients have a favorable prognosis except:

A: Positive estrogen progesterone hormone receptor
B: High HER-2-neu oncogene
C: Node negative status.
D: DNA flow cytometry shows-diploidy

19. You are posted in Surgery OPD. A patient comes to you with the below depicted swelling. You examine it and
find that it moves on tongue protrusion. Which of the following is the most common site for it to occur?
A: Region of the thyroid cartilage
B: Suprahyoid
C: At the level of hyoid
D: Infrahyoid

20. A 30 year old man presents to the surgery OPD with a nodule over the neck area. You are an intern and are
instructed to palpate the nodule. Which of the following is not a method of thyroid palpation?
A: Kocher’s method
B: Crile’s method
C: Griffith’s method
D: Lahey’s method

21. You are posted as an intern in the Surgery OPD. A patient with complaint of thyroid swelling comes with an
FNAC report showing Thy4 lesion. The senior resident asks you to interpret the report. What is your inference?
A: Malignant
B: Suspicious for malignancy
C: Follicular
D: Non-diagnostic cystic

22. A 50 year old woman presents to the Surgery OPD with painless enlargement of the thyroid gland. On
conducting proper investigations, she has been diagnosed with Hashimoto’s thyroiditis. Which of the following
statements is false regarding the condition?
A: TSH levels are low and T3 and T4 levels are high.
B: On histopathological examination, follicular destruction along with Hurthle cells are seen.
C: There are antibodies present against thyroid receptors, thyroglobulin and thyroid peroxidase.
D: In long-standing disease, there is a risk of developing compressive features and thyroid lymphoma.

23. A patient presnts to the emergency department with fever, tremor, tachycardia, nausea and vomiting, diarrhea
and dehydration. On detailed evaluation, the doctor-on-duty diagnoses it as thyroid storm. Which of the following is
not a cause of thyroid storm?
A: Gradual cessation of anti-thyroid medications
B: Trauma in patient with untreated thyrotoxicosis
C: Amiodarone administration
D: Inadequate preparation for thyroidectomy

24. A patient is being operated for thyroid surgery. The surgeon identifies the recurrent laryngeal nerve using the
Beahrs’ triangle. Beahrs’s triangle is not formed by which of the following structures?
A:External Carotid artery
B: Common Carotid artery
C: Inferior thyroid artery
D: Recurrent Laryngeal nerve

25. A patient with solitary, firm nodular thyroid swelling came to the surgery OPD with a recent report of thyroid
hormone levels which showed normal TSH but elevated T4 levels. He was advised to get an ultrasound done. Which
of the following findings on sonography are suggestive of malignancy except ?
A:Microcalcifications
B: Hypovascularity
C: Infiltrative margins
D:Hypoechoic compared with surrounding parenchyma

26. A man aged 54 years is diagnosed with follicular cancer of the thyroid gland with no lymph node involvement and
is admitted in the surgery ward for treatment. On histopathological examination of the thyroid gland, capsular
invasion and lymphovascular invasion was seen. How will he be managed?
A:Total thyroidectomy with central neck dissection
B: Total thyroidectomy
C: Hemi-thyroidectomy
D: Total thyroidectomy with modified neck dissection

27. A 45 year old woman was diagnosed with medullary thyroid carcinoma with Level 6 lymph node involvement.
Which of the following statements is correct regarding management of her condition?
A: Total thyroidectomy with prophylactic central neck dissection
B: Total thyroidectomy with therapeutic central neck dissection and prophylactic modified radical neck dissection
C: Total thyroidectomy with central neck dissection and therapeutic modified radical neck dissection
D: Hemithyroidectomy with radio-iodine ablation

28. When performing a parathyroidectomy, the surgeon measures PTH levels. Pre-incision, pre-removal, 5 and 10
minutes post-removal assessments were completed.The surgeon noticed a specific level and chose to explore it
further.Which of the following statements best supports the decision of the surgeon?
A: The percentage decline won't exceed 50% of PTH
B: The percentage decline exceeds 50% of PTH
C: The percentage decline exceeds 60% of PTH
D: The percentage reduction exceeds 75% of the PTH

29. A 29 -years- old alcoholic male comes to the emergency department with acute onset of chest pain,dyspnea,
crunching sound on auscultation, and crepitus in the neck. Her symptoms started immediately after vomiting. What
is the most likely diagnosis?
A: Mallory weiss syndrome
B: Corrosive injury
C: Iatrogenic perforation
D: Boerhaave’s syndrome

30. What is the earliest change noted in GERD?

A: Increase in transient LOS relaxations
B: Decrease in transient LOS relaxations
C: Persistent Increase pressure in LOS
D: Persistent Decrease pressure in LOS

31. A 55-year-old male was diagnosed with Esophageal adenocarcinoma. He underwent a surgical procedure which
involves two surgical incisions, one in midline abdomen and other in the neck. With this approach lower esophageal
tumor and Lymph nodes were removed but lymph nodes in middle mediastinum and upper mediastinum were
inaccessible. Identify the described procedure ?
A: Iwor lewis
B: Orringer’s
C: McKeown
D: Debacky

32. A 52-year-old man is taken to the hospital emergency room because of acute-onset, excessive vomiting of bright
red blood. A large peptic ulcer located proximally on the stomach's lesser curvature is visible during an endoscopy.
Which of the following arteries is the most likely source of bleeding?
A: Gastroduodenal
B: Inferior pancreaticoduodenal
C: Left gastric
D: Right gastroepiploic
33. A 56-year-old healthy male seeks medical attention for a 2-year history of recurrent upper abdomen pain and
fullness that gets worse after meals. The urea breath test is successful. An endoscopy reveals patchy erythema and
widespread mucosal atrophy but no ulcer. Which of the following places is most likely to produce an accurate biopsy
result?
A: Fundus of stomach
B:1st Part of Duodenum
C:Pylorus of stomach
D: Gastric antrum

34. A 55-year-old man seeks medical attention after experiencing increasing episodes of upper abdominal pain,
nausea, vomiting, and diarrhea over the past six months. During this time, he has lost 5 kg weight. Bilateral pitting
pedal edema is visible and conjunctival pallor on physical examination. A stomach fundus endoscopy reveals
prominent rugae. Which of the following is the most likely condition ?
A: Carcinoid syndrome
B: Menetrer’s disease
C: H.Pylori Infection
D: Gastrinoma

35. A 53- Year-old male underwent gastric resection for malignancy. He reports diarrhea, bloating and dizziness and
syncope after food intake. Diagnosis of dumping syndrome was made. Which of the following suggest late dumping
syndrome?
A: Hypoglycemia
B: Epigastric fullness
C: Diarrhea
D: Associated with food

36. Which of the following is not a boundary for Passaro’s triangle?

A: Junction of the cystic duct and common bile duct
B: Junction of the second and third parts of the duodenum
C: Junction of the neck and body of the pancreas
D: Junction of Body and Tail of the pancreas

37. 7-day- old baby is brought in with billowing vomiting, severe abdominal distension, and no bowel noises. Multiple
gas filled loops can be seen in X-ray abdomen. What is the most probable diagnosis?
A: Hirschsprung disease
B: Congenital Hypertrophic Pyloric Stenosis
C: Malrotation of Gut
D: Duodenal Atresia
38. A 40 years old male underwent superficial parotidectomy 3 months ago and presents with non specific symptoms
(not related to parotid gland or wound ) fow which we decided to go ahead with the test shown in the image. Which of
the following statement regarding the image is FALSE?

A: This is the investigation of choice

B: Injection of botulinum toxin in the white areas and sparing discolored area is the treatment of choice
C: Jacobson’s tympanic neurectomy can be performed
D: Parasympathetic innervation is sacrificed in surgery for treating this condition

39. Match the following

A: 240ml/min

B: 92ml/min

2
C: 180ml/min

3
D: 62ml/min

4
A: 1-b, 2-a, 3-c, 4-d
B: 1-b, 2-c, 3-a, 4-d
C: 1-a, 2-d, 3-b, 4-c
D: 1-d, 2-c, 3-a, 4-a
40. A 76years old male patient who is chronic bed ridden was admitted to the hospital for a pre existing medical
condition, while examining there an ulcer over the sacral region which has been there for over 6 weeks, what will be
your option for the following case?

A: Stage IV pressure sore, C&D with VAC dressing

B: Stage III pressure sore , C&D with VAC dressing
C: Stage IV pressure ulcer, C&D with frequent change of position
D: Unstageable

41. A 55-year-old emaciated alcoholic male presents with a 2-day history of chest pain after forceful vomiting. He is
taken to the OR for a thoracotomy after he is found to have an esophageal rupture. A jejunal feeding tube is placed
and he is started on tube feeds on POD 1, when he develops confusion, shallow breathing, and pulmonary edema.
What electrolyte abnormalities do you expect to see?
A: Hypophosphatemia, hypokalemia, hypomagnesemia
B: Hyperphosphatemia, hypokalemia, hypomagnesemia
C: Hypernatremia, hyperkalemia, hyperphosphatemia
D: Hypernatremia, hypokalemia, hypophosphatemia

42. Match the following

1. Pig tail

a
2. Penrose

b
 3. corrugated

c
4. T- Tube

A: A-1, B-2, C-3, D-4

B: A-2, B-1, C-4, D-3
C: A-3, B-4, C-1, D-2
D: A-4, B3, C-2, D-1

43. Day care surgery is defined as

A: Admission and discharge with 24 hours
B: Admission and discharge with in 12 hours
C: Admission and discharge with in 8 hours
D: Admission and discharge within 6 hours

44. Which of the following is not a criteria for acute admission to a burns unit
A: Suspected airway injury
B: Any suspicion of accidental injury
C: Psychiatric patient with 10% BSA burnt
D: 5 years old with 5% BSA burnt

45. A 32 years old male was admitted in burns ward with 15% of TBSA burnt, patient was stabilized and vitals are
maintained. Patient was under burn ward care where regular dressings were done, after 2 dressings patient
complained of palpitations, headache, altered mental status such as severe anxiety due to hypoxia, decreased visual
acuity, nausea, vomiting, abdominal pain. Which of the following agent could trigger that?
A: Silver sulphadiazine cream
B: Silver nitrate solution
C: Mafenide acetate cream
D: Silver sulphadiazine and cerium nitrate

46. Which is true regarding the flap shown in the image?

A: AB = DE
B: BD = DE
C: AC = EF
D: All should be equal

47. Match the following

Organ Cold storage time
1. Kidney a. 36 hours maximum
2. Liver b. 12 hours optimum
3. Pancreas c. 18 hours maximum
4. Heart d. 3 hours optimum
A: 1D, 2B, 3C, 4A
B: 1A, 2B, 3C, 4D
C: 1C, 2A, 3D, 4B
D: 1B, 2A, 3C, 4D

48. A 13 years old child presented with electrical burns involving 20% TBSA, which of the following statements
regarding the management is TRUE regarding fluid resuscitation and urine output according ATLS guidelines
A: 4 ml/Kg/%TBSA of RL for 24 hrs; 1-1.5ml/Kg/hr urine out put
B: 4 ml/Kg/%TBSA of RL till urine clears out ; 1-1.5ml/Kg/hr urine out put
C: 2 ml/Kg/%TBSA of RL for 24 hrs; 0.5 ml/Kg/hr urine out put
D: 2 ml/Kg/%TBSA of RL till urine clears out; 0.5ml/Kg/hr urine out put

49. Identify the structure marked in the image of laparoscopic inguinal hernia repair

A: Gonodal vessel
B: Vas deferens
C: Inferior epigastric artery
D: Peritoneal reflection

50. Which of the following statements regarding the device shown is NOT TRUE?

A: Used in esophago-jejunostomy
B: Used for hemorrhoidectomy
C: Completeness of procedure is conformed via DOUGHNUTS of excised tissue
D: Its can be used for end to side anastomosis
51. The CEAP classification is a formal system for classifying venous disease based on the Clinical picture, Etiology of
the disease, Anatomic distribution, and Pathophysiology of venous disease. A patient with telangiectasias on physical
examination of the lower extremity would be classified with which clinical stage?
A: 0
B: 1
C: 3
D: 5

52. Which of the following is the most common sclerosing agent used in foam sclerotherapy for treating varicose
veins?
A: Sodium tetradecyl sulphate
B: Sodium morrhuate
C: Polidocanol
D: Ethanolamine oleate

53. 26 yr male presents to the ER with periumbilical pain and vomiting.On palpation there is tenderness in the right
iliac fossa.Which of the following is not a risk factor for perforation of appendix?
A:Diabetes mellitus
B:Extremes of age
C:Preileal appendix
D:Faecolith obstruction

54. 28 yr female model was admitted in emergency with acute abdominal pain and vomiting.On exam she was febrile
and investigations revealed leucocytosis.She was diagnosed as a case of acute appendicitis.What would be the
preferred incision in this patient?
A:Mc Arthur incision
B:Lanz incision
C:Rutherford Morrision incision
D:Grid iron incision

55. A screening colonoscopy was performed on a 50-year-old female. A solitary polyp is discovered, removed, and
given to a histopathologist for analysis. Which of the following biopsy results has the greatest risk of cancer?
A: Villous adenoma
B: Hyperstalic polyps
C: Inflammatory polyps
D: Tubular adenoma
56. A polyp biopsy revealed dysplasia that extended to the colonic submucosa. Determine this lesion's classification
using Haggitt's system:
A: Level 1
B: Level 2
C: Level 3
D: Level 4

57. A 12-year-old with symptoms of intestinal obstruction is brought to the emergency room. A target sign seen on an
ultrasonography suggests intussusception. Her palm and oral mucosa both exhibit numerous 1-2 mm blue-gray
macules upon closer inspection. Which diagnosis is more likely?

A:Turcot syndrome
B: Lynch syndrome
C: Peutz - Jeghers syndrome
D: Cowden syndrome

58. A 35-year-old man's colonoscopy and biopsy found hundreds of adenomatous polyps throughout the entire
descending and sigmoid colon. The possibilities for preventative surgery are examined. Which of the following
treatments will most effectively lower the likelihood of cancer?
A: Ileorectal anastomosis with total colectomy
B: Ileal pouch-anal anastomosis with total colectomy
C: Total proctocolectomy with ileal pouch-anal anastomosis
D: Total proctocolectomy with end ileostomy

59. 25-year-old man with numerous tiny bumps on his forehead showed up at the dermatologist's office. The results
of the excisional biopsy point to the presence of several tiny sebaceous adenomas. His grandfather and brother both
have colon cancer, according to a thorough family history, while his aunt has rectal cancer. Which syndrome needs to
be taken seriously?
A: Gardner's Syndrome
B: Cowden's Syndrome
C: Muir- Torre Syndrome
D: Turcot Syndrome
60. A 60-year-old man rushed to ER who had been experiencing obstipation, abdominal pain, and a change in mental
status for the previous two days. Perforated intestinal blockage with peritonitis is suspected based on physical
examination and imaging results. A worrisome ascending colon mass is discovered in the operating room after he has
been stabilized. Which of the following best fits this patient's needs in terms of management?
A: Right hemicolectomy with ileocolostomy
B: Resection and anastomosis
C: Hartmann's procedure
D: Endoluminal stent placement

61. A 45-year-old male patient complained to the OPD that he was bleeding while defecating without any pain. When
the patient is requested to exert strain during an examination, a pinkish mass is visible at the anal orifice. As soon as
the patient unwinds, it naturally decreases. What grade does this haemorrhoid have?
A: First-degree
B: Second-degree
C: Third-degree
D: Fourth- degree

62. A 40-year-old male patient presents to the clinic with a history of discharge from the perianal region for the past 1
week. On examination, an external opening was seen at 2 o'clock position around the anal orifice. On per rectal
examination, an opening was palpable at 3 o'clock position at the dentate line. What is the preffered investigation for
assessing this patient?
A: CT
B: MRI
C: Endoanal USG
D: Fistulogram

63. A patient complained of a serous discharge coming from a perianal region opening. Upon closer inspection, it was
discovered that the external opening was at the 8 ‘o’ clock position. What distance from the dentate line would the
internal opening be palpated in this patient in accordance with Goodsall's rule?
A: 8'o clock
B: 4'o clock
C: 1'o clock
D: 6’o clock
64. Which of the following features would be less ideal for mesh?
A: Lightweight
B: Big Pore
C: Artificial
D: Absorbable

65. Low approach surgery for femoral hernia is called as ?

A:Mckevedy
B: Lothesiam
C:Lockwood
D:None of the above

66. A 35-year-old man arrived with the chief complaint of a 5×4 cm swelling at the right back, 1 cm above the iliac
crest. Which Hernia Occurs Through the Petit Triangle?
A:Spigelian hernia
B:Obturator Hernia
C:Lumbar hernia
D:Sciatic hernia

67. A 28 year old male with chief complain of swelling of size 4×4cm at umbilicus.Operation was done and mesh was
placed as described below. Putting a mesh underneath rectus muscle and above posterior rectus sheath is known as ?
A: ONLAY
B: SUBLAY
C: INLAY
D: UNDERLAY

68. A 5-year-old male kid arrived with the main complaint of a 4-3 cm enlargement near the umbilicus. Which of the
following statements about a child's umbilical hernia is true?
A: Boys are more impacted than girls are.
B: Strangulation and blockage are frequent injuries in children under 3 years old.
C: Surgery is necessary in most cases.
D: Surgery is necessary if a hernia lasts longer than two years.
69. A 63-year-old woman with unresectable cholangiocarcinoma undergoing palliative therapy presents with fever,
right upper quadrant pain, jaundice, and cough for 1 day. Temperature was 101.7°F, pulse 93 beats/min, blood
pressure 112/65 mmHg, respiratory rate 20 breaths/min, and saturation 98% on room air. Physical examination
shows a soft and non distended abdomen with tenderness in the right upper quadrant and hepatomegaly. Lab results
include a white blood cell count of 14,000/mm3 and alkaline phosphatase level of 215 IU/L. Chest x-ray shows an
elevated right hemi-diaphragmand right lower lobe atelectasis. Ultrasound is performed showing a round hypoechoic
lesion within the liver, with well-defined borders and several internal echoes, mildly dilated intrahepatic bile ducts,
and no cholelithiasis or pericholecystic fluid. In addition to further imaging, what is the most appropriate
management?
A. Antibiotics for 10 to 14 days
B. Percutaneous drainage and intravenous (IV) antibiotics
C. Endoscopic retrograde cholangiopancreatography
D. Laparoscopic cholecystectomy

70. A 30-year-old man visiting from Mexico comes to the emergency department with a history of 2 weeks of right
upper quadrant pain and tenderness, fevers, chills, and diarrhea. He is febrile to 102.9°F. His heart rate and blood
pressure are 120 beats/min and 100/75 mmHg, respectively. Laboratory results include a white blood cell count of
16,000/mm3, aspartate aminotransferase (AST) level of 50 IU/L, and alanine aminotransferase (ALT) level of 93
IU/L. Ultrasound of the abdomen shows a 4 × 7-cm2 round, hypoechoic, nonhomogeneous lesion abutting the liver
capsule without rim echoes. Subsequent CT also demonstrates a non–rim-enhancing hypoechoic lesion with a smaller
adjacent lesion measuring 2 × 2 cm2. Which of the following is the most appropriate course of action?
A. Observation
B. Open surgical drainage
C. Broad-spectrum antibiotics and percutaneous drainage
D. Serologic testing for Entamoeba histolytica and oral metronidazole

71. A 55-year-old woman with a history of colorectal cancer 10 years ago, treated with right hemicolectomy and
chemotherapy and with no evidence of disease since then, presents with vague abdominal pain. Temperature is
98.7°F, pulse 67 beats/min, blood pressure 132/78 mmHg, and saturation 99% on room air. Labs are remarkable for
AST 67 IU/L, ALT 83 IU/L, and carcinoembryonic antigen (CEA)-27 ng/mL. Triple-phase contrast CT shows a new
peripheral liver mass that slightly enhances on arterial phase. She has hypertension that is well controlled with
medications. What are the most likely diagnosis and most appropriate management of her liver lesion?
A. FNH; observation
B. Primary liver cancer; resection
C. Primary liver cancer; chemotherapy
D. Metastatic colorectal cancer; resection
72. A 55-year-old woman with a history of ulcerative colitis presents to your office with a new onset of vague
epigastric pain and jaundice. She denies any weight loss. To her knowledge, this has not happened before. Lab results
are significant for a WBC of 12,000 cells per MCL and a total bilirubin of 2.0 mg/dL. You send her to the emergency
room for a CT scan Subsequent ERCP showed areas of irregular narrowing throughout the intrapancreatic common
bile duct. No masses are identified on EUS. What is the initial treatment of choice for this patient?

A. Puestow procedure
B. Total pancreatectomy
C. Whipple procedure
D. Steroids

73. Which among the following pancreatic cystic lesion has maximum concentration of amylase
A: Pseudocyst of pancreas
B: Serous cyst adenoma
C: Mucinous cyst adenoma
D: Intraductal papillary mucinous neoplasm

74. What is demonstrated in the image shown during laproscopic cholecystectomy

A: Critical view
B: Calot’s view
C: Hepatocystic view
D: Fundus first view

75. On HIDA scan acute cholecystitis is suspected when gallbladder fails to fill in
A: 30 mins
B: 1 hr
C: 2 hr
D: 3 hr

76. Which is false regarding fibrolamellar hepatocellular carcinoma

A: Seen in younger patient
B: Male and female are equally affected
C: AFP is positive in >80%
D: >50% of the patients have resectable tumour

77. A 28 years old female who underwent total thyrodectomy with post operative RAI for papillary cancer thyroid 6
months ago plans for pregnancy, what will be your advice
A: Not a contraindication, can plan for pregnancy
B: Minimum of 6-12 months wait is required after treatment
C: Pregnancy is contra indicated
D: Minimum of 12-18 months wait is required after treatment

78. Which among the following statement is false regarding prevention of Freys syndrome secondary to
parotidectomy ?
A: Frey’s syndrome is minimal when extracapsular dissection is performed
B: sternomastoid muscle flap is used to prevent frey’s syndrome
C: temporalis fascial flap is used to prevent frey’s syndrome
D: tympanic neurectomy is done to prevent frey’s syndrome

79. Which of the following is a non selective end to side porto-caval shunt
A: ECK fistula
B: SSPC
C: PSRS
D: DSRS

80. A 54-year-old man is being assessed for colicky abdominal pain and occasional nonbilious emesis. He denies fevers
and does not have leukocytosis. He has a history of melanoma that was resected from his arm 5 years earlier. His
radiograph is shown, What is the next best step in this patient’s management?

A. Barium enema with pneumatic decompression

B. Exploratory laparotomy and manual reduction
C. Exploratory laparotomy, manual reduction, and resection of the involved segment
D. Nasogastric tube placement, intravenous fluid, and a trial of nonoperative management

81. An 85-year-old woman has severe abdominal pain and distention. She is tachycardic, oliguric, and acidotic.
Abdominal radiographs show pneumobilia and a mass. What is the best surgical management for this patient during
an exploratory laparotomy?

A. Resection of the mass

B. Hepaticojejunostomy
C. Cholecystectomy, enterotomy, and removal of the mass
D. Enterotomy and removal of the mass
82. Match the following

1. Calcium oxalate monohydrate a. hexagon

2. Brushite b. Amorphous
3. Cystine c. hour glass
4. Uric acid d. needle
A: 1-a; 2-b; 3-c, 4-d
B: 1-b; 2-c; 3-d, 4-a
C: 1-c; 2-d; 3-a, 4-b
D: 1-d; 2-b; 3-c, 4-a

83. A 45 years old male patient presented with intermittent, painless, terminal hematuria with history of high grade
fever with sweating. Patient was planned for cystoscopy and based on cystoscoopy CT was also performed. Which of
the following statements regarding this condition is false?

A: adenocarcinoma of bladder
B: Praziquantel 60 mg/kg
C: Katayama fever
D: Swimmers itch

84. An upper Gl endoscopy was performed on an elderly patient who had chronic black, tarry stools. The gastric
mucosa was visible, as seen below. What is the likely diagnosis?
A: Watermelon Stomach
B: Portal hypertensive gastropathy
C: Menetrier's disease
D: Dieulafoy lesion

85. A laparotomy for a perforated appendix is planned for a patient with liver cirrhosis. Which of the following
parameters will you not utilize for this patient based on the Child-Turcotte-Pugh score?
A: Ascites
B: INR
C: Encephalopathy
D: Creatinine

86. Most common type of choledochal cyst?

A: Type 1
B: Type 2
C: Type 3
D: Type 5
87. The most effective way to localize an insulinoma:
A: EUS(endoscopic USG) with intraoperative palpation
B: MRI with dynamic CT
C: SRS
D: CECT

88. Which among the given signs is not seen in the condition of acute pancreatitis?
A: Grey-Turner’s sign
B: Cullen’s sign
C: Fox sign
D: Hook Sign

89. A 45 year old lady presents with pain in upper abdomen which is radiating to the back accompanied with
vomiting and fever. She also states that the pain is relieved by leaning forward. On physical examination, tenderness
is present in the upper abdomen. Laboratory examination revealed high serum amylase and serum lipase levels. X-
ray shows distension of transverse colon with collapse of descending colon. What is the most likely diagnosis?
A: Acute pancreatitis
B: Chronic pancreatitis
C: Acute Cholecystitis
D: Right sided acute pyelonephritis

90. Which among the given statements is not true about mucinous cystadenoma of the pancreas?
A: It is lined by columnar epithelium
B: Commonly seen in peri-menopausal women
C: Identified histologically by the presence of ovarian-like stroma
D: It is not premalignant

91. Cyst fluid aspiration was performed in a patient with pancreatic neoplasm. The aspirated fluid stains positive for
mucin and shows elevated levels of amylase and CEA. What is the most probable diagnosis?
A: Serous cystadenoma of pancreas
B: Mucinous cystadenoma of pancreas
C: Intraductal papillary mucinous neoplasm
D: Mature cystic teratoma
92. A 1 month old child came to the clinic for the evaluation of recurrent urinary tract infection. USG was performed
which showed dilated inner pelvis. Intravenous urogram is shown below. What is the likely diagnosis?

A: Retrocaval ureter.
B: Duplicated ureter.
C: Polycystic kidney disease.
D: Horseshoe kidney.

93. A patient came with the complaint of severe right-sided abdominal pain. Abdominal X-ray appears normal, USG
was done which showed the presence of a 6mm renal stone. Which of the following stones is most likely to be seen in
this patient?
A: Uric acid stone
B: Cystine stone
C: Oxalate stone
D: Struvite stone

94. A patient who is diabetic presents with fever and right flank pain. Clinical examination was done in which
Murphy’s punch sign is positive. CECT abdomen done is given below. What is the most likely causative organism in
this condition?

A: E.coli
B: Proteus
C: Clostridium
D: Staphylococcus aureus

95. A patient presented with flank pain, hematuria and sterile pyuria . Which of the following findings are associated
with this condition?
1. Papillary ulcer
2. Pyonephrosis
3. Pseudo Calculi
4. Putty kidney
5. Thimble bladder
6. Golf hole ureteral orifice
A: Only 1
B: 1&4
C: 1,2,3&4
D: All of the above

96. Which of the following is false in case of renal cell carcinoma ?

A: Flank pain is the most common presentation
B: It is most commonly associated with left sided varicoceles
C: It may be associated with pulsatile bony metastasis
D: Palpable abdominal mass is part of the classic triad seen in RCC

97. You are asked to remove a Foley's catheter after a procedure but you are unable to deflate the balloon. The
surgeon himself tries to remove it after cutting the sidearm but is unsuccessful as well. What should be the next step
of management?
A: CT-guided rupture of bulb of Foley’s
B: Inject ether to dissolve the balloon and pull it out
C: Inject water to over inflate the balloon until it bursts and remove the catheter
D: Inflate with 20 ml of water and under USG guidance, locate and prick the balloon

98. Which statement is true regarding the condition given below ?

A: Bilateral in more than 50% of the cases.
B: Associated with dysplastic renal tissue.
C: Children usually present with stones.
D: Affects male more often than females.

99. A man was brought to the emergency department after he fell into a manhole and injured his perineum. He gets
an urge to micturate but is unable to urinate. On examination, blood was seen at the tip of the urethra, and swelling
of the penis and scrotum was seen. What is the site of injury?
A: Membranous urethra rupture
B: Bulbar urethra injury
C: Prostatic urethra injury
D: Urinary bladder rupture

100. A newborn was found to have a following anomaly of the penile urethra while being examined by a pediatrician.
Identify the incorrect statement regarding the condition?

A:It is the most common congenital abnormality of the urethra

B: Circumcision should be dorne to remove the excess skin
C: It does not cause urinary obstruction
D: Ventral chordee is a common association
101. A 52-year-old man came to the urology OPD with complaints of a slow-growing ulcerative lesion in the penis for
the past few months. On examination, a fungating mass in his glans penis was seen and lymph nodes were not
palpable. He was suspected to have penile carcinoma. Which of the following statements is false regarding the
management of the patient?
A: MRI is the investigation of choice for staging
B: 1 cm margin of normal tissue must be removed
C: Sentinel lymph node biopsy should be done.
D: If stump is <3 cm, total amputation of the penis is done

102. The mother of a 1-year-old boy brought him to the OPD after seeing that he had only one testicle in his scrotum.
The testis cannot be felt in the belly or inguinal region during inspection. Abdominal testes are seen during a
diagnostic laparoscopy, and orchiopexy is performed. Which of the following tumours is the one that this patient is
most likely to develop?
A: Seminoma
B: Yolk sac tumor
C: Mature teratoma
D: Choriocarcinoma