SURGERY PROF 2021

PAPER 1

10. 12 yo girl fell in school. Lat 1/3 clavicle fracture.

A pop cast
B arm sling
Idr the other options
Q. 33) Person had appendix surgery; got post-op antibiotics for 3 days before discharge. 5
days after discharge came with fever and diarrhea. Most likely diagnosis?

A. Colitis
B. Gastroenteritis
C. Pseudomembranous colitis
D. Pelvic abscess
E. UTI
6. 72 y/o male with complains of difficulty swallowing since 6 months. And regurgitation of
undigested food at night. He also woke up at night from suffocation. What is the likely
diagnosis?

Esophageal stricture
Esophageal carcinoma
Esophageal spasm
40 year old male came with bilateral inguinal hernia. Had repair for right sided hernia 2 years
ago. Which procedure should be done now:
A. Bilateral Shouldice
B. Bilateral Litchenstein
C. Bilateral Laparoscopic repair
D Laparoscopic for Right and shouldice for left
- Question about finkelstein test positive
Answer : Dequervain tensynovitis
26. Patient had some specific surgery (don't remember the name .-.) at 5 PM and at 2 AM the
nurse tells you that patient is irritable, pulse is above normal (110 maybe) and BP cannot be
measured. What would you do next?
A. Tell nurse to start IV Salfucrat something
B. Tell nurse to keep repeating vitals every hour and updating
C. Measure vitals yourself before taking a decision
D. Check vitals again a while later (I think)
E. Some other option
Most common hernia in females- inguinal, umbilical
Paraumbilical, femoral
2cm solitary nodule in upper lobe of lung.
Diagnosis
-solitary lung nodule
Other options if someone rmr
Shortening of leg with external rotation after fall.

Hip posterior dislocation

Hip fracture
Femur fracture

Q)Lauge hansen classification

Transverse fracture of fibula below syndesmosis with vertical medial malleolus fracture
- Pronation abduction
-pronation Adduction
-supination adduction
-pronation external rotation
-supination external rotation
Q12.old lady with osteoporosis,fell in the washroom,shortened and externally rotated limb?
Fracture around the hip joint
Dislocation of hip joint
Teenage girl. Pain and fracture of left pinky finger, undisplaced. How will you manage?

-Pop cast till below knee

-Reassure, rest or something and pop backslap
-reduction and k-wire
-Open fixation
Fracture of clavicle in young girl
Treatment?
- POP
- reassurance/no treatment
- arm sling
I think there was open reduction also, not sure
Dinner fork deformity
- colles
- smith
- Barton’s
Lady with thyroid nodule on lateral side of neck that moved with deglutition. Radioactive iodine
revealed a cold nodule. Most likely diagnosis:

- follicular carcinoma
- thyroiditis
- thyroglossal cyst
- thyroid adenoma
45 year old bilateral thin serous discharge. No mass:

-Physiological discharge
-Galactorrea
-pyogenic something
-carcinoma
-Pappiloma
Bosselated mobile mass in breast:

-Phylloedes (don’t remember other options)

-Fibroademona
Q10) A girl presented with pain in her neck and right side x ray showed fracture of the lateral
1/3rd clavicle what will you do?
Do nothing
Pop and immobilise
Put arm in sling
Start physiotherapy
Fibula transverse facture below syndysmosis and medial maleolus displaced
- abduction, pronation
- external rotation and pronation
- external rotation and abduction
- pronation and adduction
- supine, external rotation
Q. 45 year old bilateral thin serous discharge. No mass.
What is the diagnosis
A. Galactorrea
B. Physiological discharge
C. Pyogenic abscess
D. Carcinoma
26. Patient had some specific surgery (don't remember the name .-.) at 5 PM and at 2 AM the
nurse tells you that patient is irritable, pulse is above normal (110 maybe) and BP cannot be
measured. What would you do next?
A. Tell nurse to start IV Solucortif
B. Tell nurse to keep repeating vitals every hour and updating
C. Measure vitals yourself before taking a decision
D. Take patient to the OR
E. Call the surgeon
2cm solitary nodule in upper lobe of lung.
Diagnosis
-solitary lung nodule
- hamartoma
- infectious nodule
25 year old male undergoing preop assessment. He doesn’t smoke and has no comorbids.
Which investigations should be done?
A. hb, rbs, uce
B. Hb,rbs, urine dr
C. hb, rbs, xray chest and smth
Diabetic patient on oral anti diabetics being prepped for surgery. What is the recommendation?
A. Stop taking medicine one week back (either one week or two weeks)
B. Don’t take morning dose of medicine
C. Switch to sliding scale
You were called to evaluate a patient post elective hysterectomy. She had abdominal pain,
blood pressure was 100/60 and she was tachycardiac. What will you do next
A. Nothing because it’s a gynae case
B. Two Large IV bore cannulae
You were called to evaluate a patient post elective hysterectomy. She had abdominal
distention, blood pressure was 100/60 and she was tachycardiac and respiratory rate was fast,
was also a little disoriented. What is the most likely underlying cause
A. Electrolyte imbalance post op
B. Not enough IV fluids being given
Prego hypothyroid lady with pain in R thumb whaz the condition
Lauge Hansen classification question
Phelon sign and tinel sign positive what’s the procedure to perform
There was one with post op complication which had generalised rash I think. Options were
- Toxic Epidermal Necrolysiw
- Toxic Shock Syndrome
- cellulitis
- necrotising Fasciitis
Guy with vomiting, abdominal pain. Na: 151, K:4.8, HCO3-:18 or 15. Creatinine was 1.6. RBS:
super duper high. Whcih fluid therapy will you give?
- Normal Saline and Insulin
- Half saline and insulin
- Dextrose and Insulin

Gastric outlet obstruction. Which type of fluid therapy should be given

40 year old female with lump. On examination, it’s cystic. What is the next step:
A. Check when postmenopausal
B. Core cut biopsy
C. Drainage
D. Mammogram
48 year old female whos younger sister died due to breast cancer. She is concerned about
herself. In examination, there is no significant finding.

A. Do a mammogram
B. Genetic testing
posterior wall of inguinal canal made of?

transversalis fascia
Conjoint tendon
Single solitary nodule in the upper lobe of right lung. 2*2 cm/mm

Infectious granuloma
Lung nodule
Cancer
Patient admitted, post-op. Pulse increased. Nurse is saying she was unable to take the BP.
What will you do.

-tell nurse to do hourly monitoring and get back to you

-take the vitals yourself and then decide
-call your consultant (it’s night shift btw)
-Take for surgery
Iatrogenic esophageal trauma mana garment
Management*
What has the highest chance of decreasing also infection:

Monofilament suture
Antibiotic prophylaxis five days after surgery
Antibiotics before surgery
One dose of Antibiotics at induction
Pt had ileotransvese anastomoses and then had Fever, abd rigidity.

-Anastamotic leak
-Biliary peritonitis

48 year old female has severe anxiety

Her sister died of breast cancer
She wants to know her risk of developing breast cancer
On examination no masses or Axillary nodes were palpable
What should she do next ?
Ultrasound
Genetic testing
Mammogram
There’s another one I’m really sad about and I can’t stop crying because I changed it last
minute idk if it’s from the same question or I mixed it up

Small ? Mobile lump bosselated surface with dilated veins on the breast
Fibroadenoma
Breast cancer
Phylloides tumor
What’s the earliest complication of wound healing
Tattooing
Hypertrophic scar
Keloid
Haematoma

SEQs
Q2: Patient was being transfused 12 units of blood after some major trauma

Which blood is being used?

What are the biochemical abnormalities associated with transfusion?
After a while the patient starts bleeding from nose and has hematuria, what blood products will
you give the patient?

Q3: Patient had an RTA and suffered injury to left lower thorax.

Describe what you will do in primary survey

List 5 other injuries this person can have

Q4: Patient has stones in gallbladder. Bilirubin increase, ALP significantly increased

Diagnosis:
Complications of this condition:
What is charcots triad.
Q1: Patient has tenesmus (they don’t use the word they describe it) and per rectal bleeding
with weight loss and constipation.

Diagnosis?
What 3 investigations you will do to stage this?
What surgery will you do when?

Seqs

Patient had cholilithiasis.

What type of jaundice is this?
What are the complications associated with it?
What is charcot triad?

PAPER 2

Rectal cancer spread to pararectal tissue but not involving lymph nodes. What stage of DUKES
is this?

A
B
C1
C2
D
Q- 24 year old female, acute appendicitis, what investigation will you do to rule out other pelvic
pathologies.
- pregnancy test
-U/s
- Ct abdomen
Diffuse swelling on neck
A, 3 D/d
B, what test will you do
C, criteria for thyroidectomy
35 yr old Female PT. Hematuria. No other symptoms
A, d/d for her age
B, tests with justification
What test helps in diagnoses of bph
-prostate smear
-psa
-ultrasound
Cholelithiasi and choledocholitheiais leads to
- progressive painless
-progressive
Painful
-intermittenr painless

Q- 24 year old female, acute appendicitis, what investigation will you do to rule out other pelvic
pathologies.
- pregnancy test
-pelvic U/s
- Ct abdomen
- pelvic MRI
Q. 34 week pregnant female came with complaints of painful defecation with blood mixed with
stool. Anal tag at 6 o clock. What is the treatment
A. Lateral sphincterotomy
B. Conservative management
C. Hemmoridectomy
D. Fistulectomy
26. 42 year old female, complaints of RUQ pain, vomiting, jaundice, fever & chills. Most
probable diagnosis:
• acute cholecystitis
• acute pancreatitis
• gall bladder carcinoma
• gall bladder empyema
• some other pathology of the gall bladder
Q10. 30yo female presents to ED with complaints of rif abdominal pain for 3 days. Pulse 100
BP 130/80 temp 101.5 rr 18. Mild leukocytes. Tenderness in RIF and right rectal wall on DRE.
D/d cannot be
A duodenal perforation
B sigmoid volvulus
C pelvic abscess
D right ovarian cyst
E acute appendicitis
RUQ pain with fever etc (indicating cholecystitis). US done but no stone in GB. What is the next
investigation you will do to come to your diagnosis

A. Radioactive isotope scan

Patient had elevated PSA. what will you ask in history?
A) if patient had DRE
b) has had previous nephropathy
30 year old male with heamturia. Mass in lower pole of the kidney. Most likely diagnosis

A. Renal cell carcinoma

B. Renal hemangioma
2 year old boy will flank mass moves on respirstion
-wilms
-RCC
-neuroblastoma
Criteria to diagnose prognosis of pancreatitis
-apache I
-Ranson criteria
30 year old came with fever rigors and chills after trauma. U/S show 10×6 hypoechoic mass.
Dxis
-liver abscess
-acute pancreatitis
18 year old female came with pain in right iliac fossa for 72 hours. Increase WBC.
Mass palpable in right iliac fossa. Dxis
-appendicualr abscess
-acute appendicitis
There was grade III spleen injury also. What treatment will be done?

- Splenectomy
Don’t rmr other options
2 year old came with a mass coming out of rectum. Which goes inside.
Dxis
-rectal prolapse
-hemorrhoids
1 month old baby with vomiting after feed and visible peristalsis on taking feed. Sunken eyes
etc.
- duodenal atresia
- hypertrophic pyloric stenosis
- gastroenteritis
 Little boy came with diarrhea and blood in stool since 1 week.fever,pain on defecation. You did
dre but nothing. As soon as removed hand blood came out. Dxis
-rectal polyp

Dont know other options

65 year old man with epigastric pain, postprandial vomiting for five months. Most likely cause?
- Gastric outlet obstruction
Treatment of stage III recatl cancer
Treatment of mets recatl cancer
-surhery
-chemo
-radio
Perforated peptic ulcer. Patient with unstable vitals. Which procedure will you do
- Partial Vagotomy
- selective vagotomy
- Graham’s patch
After TURP biopsy turned out positive for malignancy. What to do next?
- Radical Prostatectomy
- Radiation
- Chemotherapy and Radiation
Patent with massive hematamesis. History of H. Pylori and partially treated ulcer. Vitals are
unstable. What will be the next step in management?
A. Urgent endoscopy
B. Arrange blood
C. IV 0.9% NS
D. Was it vasopressin?
Man with History of peptic ulcer disease. Came with hematamesis. Most likely source of
bleeding:
A. Gastric Ulcer
B. Anterior Duodenal Ulcer
C. Posterior Duodenal ulcer
30 yr old female came with pain in rt Iliac fossa since 3 days. Bp= 130/90, R/R= 22, pulse
=100. On DRE there was right rectal wall tenderness. Which could NOT be a possible
diagnosis:
Duodenal perforation
Sigmoid volvulus
Ovarian torsion
Abscess
Acute appendicitis
29 year old male with gas under diaphragm on XRay. History of fever for two weeks. Most likely
diagnosis
- enteric perforation
- gastroenteritis
- bowel obstruction
 Patient with stone in CBD. Most likely symptoms are
- painless progressive jaundice
- painful progressive jaundice
- painful fluctuating jaundice
- painless fluctuating jaundice
Q10) 30 year old woman presents with vomiting RIF pain, tenderness in RIF and tender rectal
wall on dre. What is not part of the differential?
Torsion of ovarian cyst
Sigmoid volvulus
Duodenal perforation
Appendicitis
Little boy came with diarrhea and blood in stool since 1 week.fever,sever abdominal pain on
defecation. You did dre but nothing. As soon as removed hand blood and mucus came out. Dxis
-rectal polyp
- intussusception

Dont know other options

29 year old male with gas under diaphragm on XRay. History of fever for two weeks. Most likely
diagnosis
- enteric perforation
- Acute gastroenteritis
65-70 year old Patient I think with Hb 5.8 or smth. What’s the best investigation
- Colonoscopy
Whcih one of the following polyps is most likely to become malignant:
- adenomatous
- hamartomatous

60 year old male with bowel obstruction. History of appendectomy years ago. What is the most
likely cause:
- Adhesive obstruction
- paralytic ileus
60 year old with 10-12 episodes of diarrhea and 2 episodes of vomiting for 1-2 days, abdominal
pain and distention. Intestinal obstruction due to:
- Phytobezoar
-
Patient with RUQ pain, fever with rigours and jaundice. Most likely diagnosis:
- Empyema
- Mucocele
- Ascending Cholangitis
- Acute Cholecystitis
Post pregnancy. Female had pain on defecation. Couldn’t even sit. Bleeding PR. Whag is the
best treatment for her
- GTN
- manual dilatation
- lateral anal sphincter print
Sphincterotomg*
Pregnant patient. Bleeding PR. Pain with defecation. Om DRE very tight anal sphincter. I think
there was a sentinel tag too. Treatment option:
A. Conservative
B. Lateral sphincterotomg
Dissection of puborectalis can result in:
A. Complete incontinence of flatus and stool
B. Partial incontinence of flatus and stool
C. Complete incontinence to loose stools
I think there was one with just fecal as well
There was one with continent patient and another with incontinent to flatus
Young Boy has painful micturition and pulls at penis

- vesical stone
Dissection of puborectalis can result in:
A. Complete incontinence of flatus and stool
B. Partial incontinence of flatus and stool
C. Complete incontinence to loose stools
D. Incontinence to flatus
E. Fecal incontinence
Young Boy has painful micturition and pulls at penis

- vesical calculus
- posterior urethral valves
Man with firm discrete swelling and there is beading of vas . There is no history of fever or any
other associated symptoms.
Most likely diagnosis:
- epididymitis
- Genital TB
- Varicocele
Whcih one of the following does not help in staging of prostate cancer
- DRE
- TRUS with biopsy
- radioiodine scan
- MRI

SEQs

Q1: burn around 34%. Patient came in and needs fluids:

-how will you give fluids in this patient in first 24 hours

-what is criteria for admission in a Burns patient
-Complications of Burns

Q2: 30 year old woman with hematuria. No other symptoms

-what are the 3 most common causes for this patient/ in this age group
-what investigations will you use to make your diagnosis? Justify each?
-can’t remember last one

Q3: 30-ish patient from Gilgit with swelling in neck

-3 differential
-how will you investigate a neck swelling
-what are the indications of surgery in a thyroid patient

Q4: 50 year old diabetic male, wt: 100 kg had an emergency laparotomy and ileocecal
something. On 5th post operative day had fever and erythema and pus in wound.

Diagnosis?
What are his risk factors for this condition?
How can you prevent this condition?

Burns saq: 35% body burnt, 65kg weight of female

A, how will you calculate the fault requirement and how will you give in the the first 24hrs
B , criteria for hospital admission
C, complications associated with burns

TABLE VIVA

External:
-Ulcerated gastric cancer
-Thyroid adenoma (Radioiodine uptake scan)
-Prolene suture
-Catpaw retractor

Arsalan:
-Counselling of a 70y woman with IHD & Diabetes for high risk surgery for intestinal obstruction
-Neck of femur fracture
-Bladder stone
Internal
Shoulder dislocation
Counseling for perforation
Intracranial hemorrhage- epidural
External:
Woman with Right lilac fossa pain: differentials, investigations,txt
Intrument:
Babcock, Catheter - indications contraindications
Internal
Diabetic foot
Counseling for mastectomy
Renal Stone

External:
Woman with Right lilac fossa pain: acute appendicitis
Intrument: Babcock
Foleys Catheter
Internal
Counselling for below knee amputation
Cystoscopy showing bladder stones

External:
T tube cholangiogran
Paraumb hernia
Allis forcep
NG tube
Internal also showed hydrocephalus CT picture and asked causes and treatment
• Internal, Dr. Arsalan
1. Counselling for breast malignancy & mastectomy.
Also asked me about types of reconstruction surgeries lolspols
2. X-ray KUB of a renal staghorn calculi
3. Diabetic foot picture

• External, Dr. Asif Qureshi - v chill and helpful

1. Right illiac fossa pain in a young female - case: appendicitis; differentials, investigations,
treatment
2. Foley's catheter, indications
3. Bobcat (?) forceps, uses
4. Liver abscess CT, patient also had fever and diarrhea, differentials, organism causing
amoebic liver abscess, treatment
Internal Dr. Zubia
- Counselling for reducible inguinoscrotal hernia
- Ureteral stone on CT KUB
- Colles fracture on x ray

External
- Tension pneumothorax xray
- ERCP
- Instruments (tooth forcep and Langenbeck retractor)
Internal
Stoma and rectal carcinoma counselling
Subdural hematoma
Renal carcinoma

External
Fibroadenoma
Kidney tray, deavers retractor
Gastric carcinoma
Stoma counselling
Fibroadenoma - mamogram show, d/d, tests, treatment, identify what you can see
Rcc- PT with gross hematuria and lump in flank. Diagnosis, treatment
Kidney tray and dealers retractors
Gastric outlet obstruction- identify, causes, tests
Chronic subdural hematoma, treatment and what will you counsel/tell patient
Allis forcep, what is it used for + also asked about how to sterilise equipment for use in surgery.

T tube cholangiogram, indications, procedure, etc. Within this she also asked a bit about
anaesthesia, how do you give GA, which drugs do you give.
Internal:
- MRI lumbar spine L5 disc herniation
- Re-exploration counselling
- Open fracture Type 3

External:
- IV cannula
- Needle holder forcep
- Paralytic ileus abdominal x ray (air in rectum)
Dr Arsalan: orchidectomy counseling, Head trauma ATLS, Fornier gangre
External: Morrisons retractor and rediveric drain, solitary thyroid nodule and tension
pneumothorax
Internal:
-Inguinal hernia (reducible) counselling
-Colles fracture: diagnosis, complications
-Uretric Stone in proximal ureter with hydronephrosis: diagnosis? Investigations? Treatment?
Something happening in other kidney also, how will you check for it?

External:
-ERCP image showing stones in CBD: what is seen? Diagnosis? Complications of ERCP.
-Pneumothorax (location and gauge of needle thoracostomy, why not in 1st intercoastal space,
location of chest tube, what will happen if not fixed quickly?)
-Right angle retractors: full name? Purpose
Also why do we Attach an under water drain to the chest tube?

Also shoed toothed forceps + uses

Surgery viva:
Dr nadeem khursheedi (v sweet just having a good time)
-Thyroid lump on R side
-Pneumothorax, chest tube
-instruments: Morris retractor, redivac drain

Dr Naeem: (also v nice will lead you to answers if you’re confused)

Counselling of orchidectomy
Depressed skull fracture, atls
Fourniers gangrene
Internal
-Counselling of anastomotic leak.
-Open fracture
-Cauda Equina Syndrome

External
-Condyloma acuminatum
-Cannula and needle holding forcep
-intestinal obstruction sec to paralytic ileus
Internal:
-Inguinal hernia (reducible) counselling
-Colles fracture

External:
-ERCP image showing stones in CBD
-Pneumothorax
-Right angle retractors
Same including ureteric calcus and tooth forceps
Internal:
Intestinal obstruction worsening (counsel for explorative laprotomy)
Epidural hematoma
Ant shoulder dislocation

External
Gallstones due to hemolytic anemia (findings on peripheral smear, mx. Etc)
Pancreatic pseudo cyst CT
guedels airway
Curved artery forceps
Morris*
BEDSIDE cases

Day 1 cases:
1. Obstructive jaundice post Whipples
2. Incisional hernia with history of previously operated hernia and cholecystectomy
3. Colostomy post colorectal Tumors
Ulcerative colitis + proctocolectomy and ileostomy
Lumbar hernia
Papillary carcinoma thyroid
*DAY 2 *
1. Pancolectomy with ileostomy
Hx of ibd + stoma
Only inspection of abdomen and stoma
UC vs crohns (symptoms, investigations, management)
Extra intestinal manifestations

2. Indirect inguinal hernia

Hx and limited examination
Management
Open vs laparoscopic

3. Neck swelling
Hx and examination
DDs
Investigation
Fnac shows lipoma. How would you manage? What if he doesn't want a surgery?
Complications?

Ulcerative colitis + proctocolectomy and ileostomy

Lumbar hernia
Papillary carcinoma thyroid
*DAY 2 *
1. Pancolectomy with ileostomy
Hx of ibd + stoma
Only inspection of abdomen and stoma
UC vs crohns (symptoms, investigations, management)
Extra intestinal manifestations

2. Indirect inguinal hernia

Hx and limited examination
Management
Open vs laparoscopic
3. Neck swelling
Hx and examination
DDs
Investigation
Fnac shows lipoma. How would you manage? What if he doesn't want a surgery?
Complications?

Ulcerative colitis + proctocolectomy and ileostomy

Lumbar hernia
Papillary carcinoma thyroid

*DAY 2 *
1. Pancolectomy with ileostomy
Hx of ibd + stoma
Only inspection of abdomen and stoma
UC vs crohns (symptoms, investigations, management)
Extra intestinal manifestations

2. Indirect inguinal hernia

Hx and limited examination
Management
Open vs laparoscopic

3. Neck swelling
Hx and examination
DDs
Investigation
Fnac shows lipoma. How would you manage? What if he doesn't want a surgery?
Complications?

Ductal carcinoma
Goiter
Incisional Hernia

Lumbar hernia
Stoma

Inguinal hernia ( hx, exam, easy questions)

Submandibular gland swelling( Hx, exam, dds, investigations, treatment, counselling)

Proctocolectomy + end ileostomy due to UC (grades of uc disease/ extra intestinal
manifestations/ tx dds name of surgeries ) + anal fistula (classification/treatment all of it )

Breast Ca
Multinodular goitre
Incisional hernia
DAY 2: ZONE 1

Thyroid (diffuse goiter) (external)

-Hx and examination
-hypo/hyper/euthyroid?
-What investigations will you do?
-What will you see on US
-How will you treat the patient?
-Complications of thyroidectomy

STOMA: ileostomy post pancolectomy (external)

-Causes: UC and FAP
-early and late stoma complications
-How will you manage a patient with high output? What fluid will you give in this patient?
-How will you manage a patient with retracted stoma.
-Why is there skin irritation in ileostomy
-Why is colostomy stump flat

IRREDUCIBLE HERNIA (Lumbar): Dr Harris

-Hx and exam
-Present findings
-D/D’s
-Incestigations
-Treatments
-Risks in this patient: obstruction, strangulation
-What is strangulation?
-What are the most common places where hernias may get strangulated
-what exactly strangulates: the neck
-laparoscopic techniques? Why is it better?
-Who does laparoscopic hernia repair in ziauddin 🙈