PRE PROFF 2024

SURGERY 1 + 2

1. 58 year old known case of hypertension underwent explorative laparotomy for perforated sigmoid
tumor. Post operatively patient was kept in high dependency unit, his urine output decreased on first
post operative day. Which of the following is regarding injury.
A.
B.
C.
D.
2. 30 year old male addicted to mawa presented with oral cavity ulcer histopathology revealed it to
squamous cell carcinoma, he also has submucosal fibrosis with reduced mouth opening only soft and
hard palate is visible according to modified mallampati score what is the grade in this patient?
A1

B ⁠2
C3
D4
3. 36 year old female under went paraumbilical hernia mesh repair, per operatively defect size 5*7 cm it
was repaired primarily onlay poly propylene mesh was placed, drain was also placed: On out patient
follow up visit patient inquires when will we removed her drain.
A no output in drain
B daily output reduces to 40ml
C Daily drain output of less than 5 ml
D daily drain output of less than 25 ml
4. 30 year old female underwent laparoscopic cholecystectomy under general anesthesia, in recovery
room patient suddenly become hypoxic and hypotensive. Select the correct conditions which can lead to
hypoxia in this patient
A no effect of muscle relaxant and pain
B. high dose of analgesics
C high flow oxygen
D. bleeding
5. 32 year old male had road traffic accident, pedestrian versus troller He suffered from multiple
fractures in bilateral lower limb bruising was also noted in periumbilical region, in emergency room he
was agitated his blood pressure was 90/60 mmhg pulse 120 beats/minute he is in hypovolemic shock
class?
A. 1
B2
C3
D. 4
6. 45 year female presented with diffuse abdominal pain associated with fever for 2 days, on
examination abdomen diffusely tender, underwent laparotomy and repair of peptic ulcer, which of
following is most useful clinical parameter to monitor the patient in septic shock?
A pulse
B. urine output
C. blood pressure
D. mean arterial pressure
7. Baby boy was delivered at 32 weeks of gestation, on initial evaluation it was noted that there was sac
at umbilical region containing bowel loops covered by thin membranous sac, the child likely has?
A- gastroschisis
B. Exomphalos
C. umbilical hernia
D. bladder exstrophy
8. 4 year old child suffered from blunt trauma abdomen resulted in splenic injury plan was to manage
patient conservatively, non operative management is considered successful with hemodynamic stability
with no more than mi/kg fluid resuscitation.
A. SO
B. 70
С. 60
D. 40
9. 37 year old female presented in outpatient department with complaints of right breast swelling
associated with discharging sinuses, she has history of similar complain on and off for 1 year Her under
excision of sinus tracts but symptoms persisted, she needs
a. Currettege with long course iv penicillin
b. Currettege with long course of oral penicillin
c. Long course iv penicillin
d. Currettge with oral penicillin
10. 70 year old male undergoing surgery for aortic aneurysm referred to cardiologist for optimization of
hypertension, the process of improving functional capacity of patient prior to major surgery in order to
improve functional outcome of the patient is?
a. Prehabilitation
b. Rehabilition
C Optimization
d. Assessment
11. 50 year old female planned for incisional hernia mesh repair under general anesthesia, commonly
used intravenous drug for induction of general anesthesia is
a. Propanol
b. benzodiazepine
c. Propofol
d. Nitrous oxide
12. A 17 years old boy suffers RIA referred from ortho atter fracture fixation of left tibia, there is a clean
granulating wound on the posterior aspect of calf, 10-15 cm in dimensions and no vital structures
exposed.
The best coverage options:
a) STSG
b) DFG
c) Free flap
d) Pedicled flap
13. A young mate with history of chemical burn 2hrs back comes to you in ER after receiving local wound
care from local hospital. Your team leader instructs you to begin with fluid resuscitation. Which of the
following formula is used commonly
a) Hasselback
b) Cureri
c) Parkland
d) Brookes
14. 31 year old male underwent exploratory laparotomy for perforated appendix, peropertaively 900ml
of purulent fluid was removed from abdominal cavity, skin was not approximated at the end of surgery,
this wound closure is said to be
A healing by primary intention
B. healing by secondary intention
C. healing by tertiary intention
D. primary closure
15. 32 year old female underwent total thyroidectomy for multinodular non toxic goiter how would you
classify the surgery?
A. Clean surgery
b. Clean contaminated surgery
C. Contaminated surgery
d. Dirty surgery
16. 20 year old male had road traffic accident in emergency room he underwent evaluation extended
focused assessment with sonar for trauma was done, which of the following area in not assessed?
A paracolic gutters
B. pericardium
C pleural cavity
D. neck
17. 28 year old female suffered from penetration trauma to upper abdomen, diaphragmatic injury is
suspected, what should operative approach in this patient?
A. chest
B. thoracoabdominal
C abdomen
D. VATS
18. 65 year old female suffered from pathological fracture of femoral shaft, since bone tumors are most
commonly metastatic in origin most common cause of primary tumor in this patient is
A breast cancer
B. prostrate cancer
C Liver cancer
D. colon cancer
19. 3o year old male with painful swelling on his right tibia, he also has pyrexia and anemia, xray of right
tibia showed onion skin periosteal reaction, he likely has
a. Chondrosarcoma
b. Ewings sarcoma
c. Osteoblastoma
d. rhabdomyosarcoma
20) 60 year old male known case of hypertension presented in emergency with acute onset of right sided
weakness first investigation of choice would be
a. Ct scan
b. Duplex scan carotids
C MRI
d. Lumber puncture
21. 55 year old female surgery from….
a. anterior fossa
b. posterior fossa
c. cerebrum
d. ventricles

22.
23. 20 year old female presented in breast clinic with complaint of right breast swelling, on examination
swelling is nontender, mobile measures 2*3cm located upper outer quadrant overlying skin is normal,
there is no associated axillary lymphadenopathy, she is most likely having?
a. Phyllodes
b. Carcinoma
c. Fibroadenoma
d. abscess
24. 33 year old female with body mass index of 30kg/m2 has developed varicose veins in both lower
limb, on examination in right lower limb skin pigmentation was also noted she would classify clinically
as?
*A c3
8. c2
C. c4
D. 65
25. 36 year old male developed malignant melanoma of left lower limb he also had lymphedema in
affected extremity, which of the following malignancy is associated with lymphedema?
A. Colon cancer
B. Basal cell carcinoma
C. Thyroid cancer
D. Prostrate cancer
26. Following surgical resection of a large thyroid mass, a patient complains of persistent hoarseness and
a weak voice. What is the most likely cause of these symptoms?
A. Traumatic intubation
B. Prolonged intubation
C. Injury to the recurrent laryngeal nerve
D. Injury to the superior laryngeal nerve
E. Scar tissue extending to the vocal cords
27. A 15-year-old patient presents with chronic abdominal pain, alternating diarrhea and constipation,
multiple perianal fistulas, and rectal strictures. Which condition is most likely indicated by these
findings?
A Tuberculosis of the intestine
8. Crohn's disease
C. Ulcerative colitis
D. Colon cancer
E Imitable bowel syndrome (IBS)
28: A 65-year-old male experiencing obstructive lower urinary tract symptoms (LUTS) may find relief
with which of the following medications?
A. Anti-muscarinic drugs
8. Sympathomimetics
C. Alpha-adrenergic blockers
D. Anti-cholinergic drugs
E. None of the above
29.30 years old male presented in ER half hour after RIA where he sustained injuries to his chest. On
examination, his airway is intact, breathing is laboured, asymmetrical chest wall movements and absent
breath sounds over the right lung field. The immediate next step in management would be
A. Tube thoracostomy
8. Wide bore canula in 2% intercostal space for immediate
decompression of pleural cavity
C. 3-way occlusive dressing
D. Urgent CT chest
30. A 52-year-old obese female presents with pain in the right hypochondrium, fever, and jaundice for
the last 5 days. What is the
likely diagnosis?
A. Ascending cholangitis
B. Acute pancreatitis
C. Acute cholecystitis
D. Choledocholithiasis
E Obstructive jaundice
31. What perioperative care is indicated for a 2-year-old boy following emergency splenectomy after a
fall?
A. She requires platelets
B. There is a higher chance of malignancy.
C. Vaccination must be administered after two weeks of surgery
D. Vaccination should include polyvalent pneumococcus, H, Infiuenza 8, and Meningococcus
E. Give broad-spectrum antibiotics
32. 3 year old male presents with complaints of constipation on and off for last one year. Rectal biopsy
done shows absence of ganglion cells in the submucosal and myenteric plexus of the distal intestine. This
condition is known as:
A. Congenital hypertrophic pyloric stenosis
B. Hirschsprung's disease
C. Turner syndrome
D. Gastroesophageal reflux
E Achalasia
33. A 29 years old female came via outpatient clinic with complain of bleeding per rectum for the last 3
months, associated with constipation, painful defecation and pruritis. What is the most likely diagnosis?
A. Internal Haemorrhaids
B. External Haemorrhoids
C Fistula in Ano
D. Fissure in Ano
E. Adenocarcinoma of anal canal
34. A patient is admitted from the emergency department following a large-volume hematemesis,
Endoscopy is performed, which identifies a posteriorly positioned duodenal ulcer that is actively
bleeding. The vessel responsible is
A. Gastroduodenal artery
B. Abdominal aorta
C. Right gastric artery
D. Left gastric artery
E. Right gastroepiploic artery
35. A patient with a previous anal abscess presents with persistent. discharge from the anus and perianal
discomfort On examination a sinus is identifiable at the 6 o'clock position with the patient in the
lithotomy position. A fistula is diagnosed and the patient is booked lor theatre. What procedure is the
surgeon most Likely to perform?
A. Diversion loop colostomy
B. Plug insertion
C. Open exploration of trad
D. Endoanal ultrasound
E. Examination under anesthetic +/- proceed
36. All of the following may cause a right iliac fossa mass that is palpable on abdominal examination,
except
A. Mucocele
B. Ulcerative colitis
C. Tuberculosis
D. Appendicitis
E. Ovarian cancer
37. A 59-year-old patient presents with a 6-week history of increasing difficulty swallowing, He first
noticed problems when eating meat which became stuck "behind his heart, but this gradually began to
include other foods. The patient is currently worried because he is now struggling with thick fluids and
has noticed some involuntary weight loss. What is the most appropriate investigation?
A. Staging computed tomography
B. Barium meal
C Upper gastrointestinal endoscopy
D. Barium swallow
E. Electrocardiography
38. A 45-year-old female business executive presents with a swelling in the midline of the neck and
features of hyperthyroidism secondary to Graves' disease. Following a course of antithyroid medication,
a subtotal thyroidectomy is performed. Raised titers of which immunoglobulin would be expected in this
individual?
A. Anti-thyroglobulin antibody
B. Rheumatoid factor
C. Antinuclear antibody
D Antineutrophil cytoplasmic antibody
E. Anti-thyroid stimulating hormone receptor antibody
39. 50y old male patient presented in OPD with complain of increase frequency, poor stream,
intermittency incomplete emptying of bladder for 6 months, His BP 110/60, Pulse 80bpm, Temp A/F.
What is the most likely diagnosis?
A. Urinary tract infection
B. Bladder stone
C Ureteric colic
D. Benign prostate hyperplasia
40. A 35-year-old professional weightlifter presents with a red and swollen lump in the left groin. An
inguinal hernia is suspected and, at the time of operation, the lump is found to contain a small loop of
necrotic bowel. This type of hernia is best described as
A Irreducible
B. Strangulated
C. Obstructed
D. Sliding
E Richter's
41. A 32-year-old male presents with a swollen right scrotum which has developed over 3 weeks after
being kicked in the groin area. There is a non-tense swelling of the right scrotum and the underlying
testis cannot be easily palpated. A dipstick is positive for nitrates only What is the most likely diagnosis?
A) Epididymo-orchitis
B) Testicular torsion
C) Torsion of testicular appendage
D) Hydrocele
E) Hematocele
42. - 65 years old male smoker came with complaint of painless hematuria on and off for 1 year, What is
the most probable cause
A) UTI
8) Ca Bladder
C) Ca Prostate
D) Bladder stone
E) Renal calculus
43. A 17 year old female patient presents in the emergency room with complaints of pain in the right
iliac fossa for the past day. The pain is accompanied by vomiting and fever, Upon examination, rebound
tenderness and a positive psoas sign are noted. A complete blood count reveals a hemoglobin level of 11
g/dl, and a leukocyte count of 15000/mm3 Urine analysis shows no significant findings. What is the most
likely diagnosis for this patient?
A) Acute appendicitis
B) Acute cholecystitis
C) Acute hepatitis
D) Pancreatitis
E) Urinary infection
44. Which type of hernia follows the path of the spermatic cord within the cremaster muscle?
A) Femoral
B) Direct inguinal
C) Indirect inguinal
D) Spigelian
E) Sliding
45. As the emergency department doctor on call, you are asked to perform a lumbar puncture. The mid-
point at the level of the iliac crests is identified as your point of insertion of the puncture needle Which
intervertebral space does this represent?
A. L1/L2
B. L2/13
C. L3/L4
D. L4/L5
E. L5/S1
46. A 78-year-old lady presents with colicky abdominal pain and a tender mass in her groin. On
examination; there is a small firm mass below and lateral to the pubic tubercle. Which of the following is
the most likely underlying diagnosis?
A) Incarcerated inguinal hernia
B) Thrombophlebitis of a saphena varix
C) Incarcerated femoral hernia
D) Incarcerated obturator hernia
E) Deep vein thrombosis
47. A patient presents with history of jaundice for 2 months. The consultant in OPD suspects pancreatic
cancer. Which of the following tumor markers are most commonly associated with this cancer?
A. Carcinoembryonic antigen
B. Cancer antigen (CA) 125
C. CA19-9
D. a-fetoprotein (AFP)
E B-human chorionic gonadotrophin
48. Which one of the following is not an independent risk factor for the development of pilonidal sinus?
A. Family history
B. Poor personal hygiene
C. Obesity
D. Male sex
E Professional driver
49.
50. A patient is sent for emergency laparoscopic cholecystectomy after being diagnosed with acute
cholecystitis, which failed to resolve after 48 hours. One step of this procedure entails camping and
dividing the arterial blood supply to the gallbladder to facilitate its resection. From the list of answers
below, select the artery that supplies the gallbladder.
A Cystic artery
B. Right hepatic artery
C. Common hepatic artery
D. Left hepatic artery
E. Gastroduodenal artery

OSCE