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MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER,

ELDERLY AND CHILDREN
TANGANYIKA MEDICAL TRAINING BOARD
ST. JOHN COLLEGE OF HEALTH SCIENCES
DEPARTMENT OF CLINICAL MEDICINE
NTA LEVEL 5 SEMESTER 2
CAT 1 EXAMINATION
MODULE CODE: CMT 05209
MODULE NAME: SURGERY
EXAMINATION NUMBER __________________ DATE;

TIME: 2:00 HRS

INSTRUCTIONS
1. Read all the instructions carefully
2. Answer all questions as per instructions
3. Write your examination number on every sheet of paper you
use
4. Cell phones and any other unauthorized materials are
strictly prohibited in examination room
5. Each essay question to be answered on not more than three
(3) hand written paper
6. This examination paper consists of five sections.
7. The table below is for OFFICIAL USE ONLY

INITIAL INITIAL
MARKS SIGNATURE SIGNATURE
SCORED
SECTION TYPE OF QUESTIONS ALLOCATIO OF OF
MARKS
N EXAMINATIO EXAMINATION
N MARKER VERIFIER
A MULTIPLE CHOICE 10
B MULTIPLE TRUE FALSE 10
C MATCHING 10
D SHORT ANSWER 40
E GUIDED ESSAY 30

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TOTAL 100

SECTION A: MULTIPLE CHOICE QUESTIONS (10 Marks)

 Circe the best response among the five given
 Attempt all questions
1. Regarding intussusceptions in children:
A. Presents with abdominal pain and constipation
B. Is most common in the 6 – 12 years age group
C. Meckel’s diverculum can induce intussusception
D. Characterized by invagination of the stomach into the duodenum
E. Abdominal radiography reveals air under the right hemi-diaphragm.

2. In a patient presenting with signs and symptoms of intestinal obstruction:

A. In small bowel obstruction, vomiting occurs late while constipation occurs early
B. Dehydration is more in large bowel obstruction rather than small bowel obstruction
C. In large bowel obstruction, both vomiting and constipation occur early
D. Abdominal pain is usually localized at the hypogastric area
E. Distention is greater the more distal the lesion.

3. A 34 yrs old patient presents with fresh painless rectal bleeding. He also suffers from
constipation. His weight is steady and his appetite normal. There is no family history of
bowel cancer. The most likely diagnosis is:
A. Thrombosed piles
B. Colorectal cancer
C. Haemorrhoids
D. Diverticulitis
E. Anal fissure

4. What should be done to a patient with mastatis which is not responding to antibiotics:
A. Surgical excision.
B. Needle aspiration
C. Mastectomy
D. Incision and drainage
E. Marsupilization

5. A 20 years old boy brought to the hospital with painful swollen scrotum relieved by elevating
testes. On examination, febrile at 390C, no history of trauma. The most likely diagnosis is;
A. Varicocele
B. Hydrocoral
C. Haematocoele
D. Epididymo cyst
E. Epididymo-orchitis
6. A patient presents with a history of right scrotal swelling for 5 years now, no history of
trauma. On examination has a swelling on the right scrotum that you cannot go above it and
it can be reduced but recurs when the patient cough. What is the most likely diagnosis?

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A. Right Hydrocele
B. Right epididymo – orchitis
C. Right scrotal tumour (teratoma)
D. Right direct reducible inguinal hernia
E. Right indirect reducible inguinal hernia

7. A man was cut on his forearm by a rusting wreck while working in the garage. 1 hour later he
arrived to the hospital. On examination; the wound was about 5cm long, highly contaminated
and the bone was exposed. One of the following will be the mode of wound closure method:
A. Primary wound closure
B. Secondary wound closure
C. Tertiary wound closure
D. Delayed primary wound closure
E. Delayed secondary wound closure

8. A 40 years old boy brought to the hospital with history of motor cycle accident and sustained
injured on the chest. On examination; he was dyspnoeic, cyanotic; pale; BP=90/50,
PR=110beats/minute. On respiratory examination; bilateral bulging of the chest, reduced vocal
flemitus and breath sound. The most likely diagnosis is;
A. Pneumohaemothorax
B. Painful fractured ribs
C. Thoracic Empyema
D. Pneumothorax
E. Haemothorax

9.Blunt abdominal injury associated with features of shock will indicate;

A. Ruptured urinary bladder
B. Confusion of the intestine
C. Ruptured spleen
D. Pelvic fracture
E. Compensatory shock

10. Ligamentous injuries associated with the overextension of a joint is called:-

A. Sprain

B. Strain

C. Soft tissue injury

D. Green stick fracture

E. Myositis ossificans

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SECTION B: MULTIPLE TRUE FALSE QUESTIONS (10 MARKS)

Instructions:
 This section consists of four (4) questions with five (5) options each
 Write the word TRUE and NOT letter ‘T’ for a correct statement and
FALSE,NOT letter ‘F’ for incorrect statement in the space provided for each
option
 All responses should be in CAPITAL letters
 Half (½) will be awarded for each correct response
 Responses with T’ and ‘F’ will not be awarded any mark
1. Regarding testicular torsion:
A. The highest incidence is in the neonatal and peripubertal periods………………………………..
B. May present with abdominal pain and vomiting and few testicular
symptoms………………………..
C. Radiological investigation with 2D ultra sound is invariably indicated………………………………..
D. Testicular viability is reduced when surgery is delayed more than 6 hrs……………………………..
E. Contralateral fixation (oorchidopexy) of the tests should be performed……………………………
2. Indications of wound closure are;
A. Primary for clean post operative wounds…………………………………………
B. Delayed for surgical clean wounds…………………………………………………
C. Secondary for contaminated wounds……………………………………….
D. Delayed secondary for obviously infected wounds………………………………………
E. Secondary for obviously infected wounds……………………………………………

3. The following are the pathological classifications of ulcers;

A. Traumatic are non specific……………………………………………
B. Tropical ulcers are specific…………………………………………
C. Trophic ulcers are non specific ………………………………………..
D. Buruli ulcer is non-specific…………………………………………..
E. Syphilitic ulcer is non-specific…………………………………….

4. The Mechanical causes of intestinal obstruction includes:-

A. Medication, especially narcotics……………………………………….
B. Post-operative adhesions………………………………………………...
C. Worm infestation like ascariasis……………………………………..
D. Obstructed hernia………………………………………….
E. Intraperitoneal infection e.g. peritonitis………………………………………….

SECTION C: MATCHING QUESTIONS

Instructions:
 This section consists of two (2) questions of matching with five (5) options each
 Match the items in column B with those in column A by writing the letter of the

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correct response in the space provided on each option. USE CAPITAL

LETTERS
 Each correct response is awarded one (1) mark
Each item from column b is used only once
1. Match the breast diseases from column B with the characteristic features in column A

COLUMN A COLUMN B

Clinical feature Breast Diseases

1 Blood nipple discharge A. Fibroadenosis or mammary duct ectasia

2 Pus nipple discharge B. Underlying benign condition of the breast

3 Milk nipple discharge C. Galactocele or mammary fistula

4 Serous/Greenish nipple discharge D. Papilloma or carcinoma

5 Retraction of nipples E. Phyllodes tumour

F. Breast Cyst

G. Underlying carcinoma of the breast

H. Mammary abscess

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2. Match the following characteristics of an ulcer in column A with corresponding diagnosis

from column B.

COLUMN A COLUMN B
CONDITION CLINICAL FEATURES
1. Undermined edge A. Squamous cell carcinoma

2. Punched out edge B. Healing ulcer

3. Slopping edge C. Basal cell carcinoma

4. Rolled out edge D. Venous ulcer

5. Raised and pearly beaded edge E. Granomous ulcer

F. Gummatous ulcer

G. Buruli ulcers

H. Medulla foot

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SECTION” D” SHORT ANSWER QUESTIONS (40 MARKS)

Instruction:

 This section consists of eight (8) questions.

 Write your answers in the space provided for each question
 Write in a readable handwriting. DIRTY WORK IS NOT ALLOWED
(1) A.What are the six (6) indications for admission of a burn patient? (3 Marks)
i. ….…………………………………………………………………………………………………………………………………..
ii. ….……………………………………………………………………………………………………………………………………
iii. ….……………………………………………………………………………………………………………………………………..
iv. ….………………………………………………………………………………………………………………………………………
v. ….……………………………………………………………………………………………………………………………………..
vi. ….…………………………………………………………………………………………………………………………………….

B. List four (4) late complication of burn injury (2

Marks)
i. ….…………………………………………………………………………………………………………………………………….
ii. ….……………………………………………………………………………………………………………………………………
iii. ….……………………………………………………………………………………………………………………………………..
iv. ….………………………………………………………………………………………………………………………………………
(2) A 19 years old female, present with a laceration on the right palm during gardening. The
wound is covered with a cloth that was applied at home. How will you manage this patient?
(5 Marks)
i. ….
……………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………….
ii. ….
……………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………
iii. ….
……………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………..
iv. ….
……………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………..
v. ….
……………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………

(3) A 45 years present to hospital with a history of protrusion of mass through the anus. Initially it
was occurring during defecation and now protrudes even when walking or coughing. No
history of bleeding. (5 Marks)

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A. From the history what is most likely diagnosis?

….…………………………………………………………………………………… (1 Mark)
B. Mention possible causes of above condition. (4 Marks)
i. ….
………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………
ii. ….
………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………
iii. ….
………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………
iv. ….
………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………
(4) A 25 years old young man sustained injured on the scrotum while playing football 4 days ago,
he used paracetamol for pain relief at home. Yesterday he started to experience painful
swelling on the scrotum and decided to come to dispensary. On examination; swollen tender
scrotum with hotness and redness. 5 Marks
A. What is the most likely diagnosis? (1 Mark)
….……………………………………………………………………………………………………………………………………..
B. Mention one differential diagnosis? (1 Mark)
….…………………………………………………………………………………………………………………………………..

C. How will you treat the patient? (3 Marks)

i. ….
………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………..
ii. ….
………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………….
iii. ….
………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………

(5). A 22 yrs old man come to the dispensary with history of right groin swelling for 4yrs.
Abdominal distention and vomiting for 2 days. The swelling was on on and off till 3 days ago

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when it fall and disappear. On examination distended abdomen, hyper tympanic with
reduced bowel sound. Local examination scrotal mass which cannot get above it with negative
cough impulse

A. What is the diagnosis (1 Mark)

….
…………………………………………………………………………………………………………………………………………….

B. Outline management plan for this patient (4 Marks)

i. ….
……………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………
ii. ….
……………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………….
iii. ….
……………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………..
iv. ….
……………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………..

6. Differentiate hydrocele from Inguinal scrotal hernia (5 Marks)

i. ….
………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………
ii. ….
………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………….
iii. ….
………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………….
iv. ….
………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………..
v. ….
………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………

7. Write a short note on:-

A. Surgical anatomy of the inguinal hernia (3 Marks)

……………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………

B. Why Inguinal hernia is more common on right side(2 Marks)

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….
……………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………….

8. List five (5) congenital surgical problems in children (5 Marks)

i. ….………………………………………………………………………………………………………………………………………………

ii. ….……………………………………………………………………………………………………………………………………………….

iii. ….………………………………………………………………………………………………………………………………………………..

iv. ….………………………………………………………………………………………………………………………………………………..

v. ….
………………………………………………………………………………………………………………………………………………….

SECTION E: ESSAY QUESTIONS

INSTRUCTIONS
 This section consists of two (2) questions which are supposed to be answered in
narrative way
 Write your answer on the papers provided. Each question should start on a new page
 Write a readable handwriting. DIRTY WORK IS NOT ALLOWED.

1. A 50 years old man with 70 Kgs, was brought to you with history of thermal injury 3 hours
ago. On examination you find that the anterior chest, abdomen and both upper limbs are
affected with huge blisters and wounds. He is conscious but in severe pains. Explain the
management of this patient based on estimation of percentage of burnt area, investigation,
treatment and immediately complications. (15
Marks)

2. Mr Toturo is building contractor where he used to carry building brick past five years he
experience a protruding mass at left inguinal which is sometime painless and subsides
spontaneously today when at work he experience very severe pain at protruding mass site,

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swelling, tender and tried to reduce all attempt failed, discuss based on diagnosis,
investigation, treatment and prevention (15 Marks)

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