2021 Surgery Past Paper PDF

Final Professional Exam:Single Best Answers (MBBS Batch 8) SURGERY - (2 Hours 15 Min) Year 5 MBBS Batch 8 (5th November 2021) 1)35 year old lady presents with left thyroid swelling measuring 4x3.5cm , painless on palpation. Positive family history of thyroid disease.USG shows hypoechoic lesion with...

Final Professional Exam:Single Best Answers (MBBS Batch 8) SURGERY - (2 Hours 15 Min) Year 5 MBBS Batch 8 (5th November 2021) 1)35 year old lady presents with left thyroid swelling measuring 4x3.5cm , painless on palpation. Positive family history of thyroid disease.USG shows hypoechoic lesion with no microcalcification. Most likely diagnosis; A)thyroid cyst B)subacute thyroditis C)thyroid adenoma D)autoimmune thyroditis 2) Mr Lim, 65 years old had an attack of sigmoid diverticulitis diagnosed by CT scan and successfully treated by IV antibiotics and he is asymptomatic. What is the best next management? A)Colonoscopy B)Barium Enema C)Water soluble contrast edema D)Repeat CT scan of abdomen and pelvis 3) Madam Aisyah, a 67 years old retiree with underlying rheumatoid arthritis has epigastric pain and fever for 24 hours. She has been taking regular ibuprofen and recently on oral steroids. Erect chest X ray in the ED shown subdiaphragmatic free air. What is the most likely clinical diagnosis? A) acute pancreatitis B) perforated peptic ulcer C) bleeding duodenal ulcer D) incarcerated hiatus hernia 4) A) B) C) D) 5) A) B) C) D) 6)35yo woman, painless swelling right breast, no skin dimpling or lymphadenopathy, FNAC reveals malignant cells. What is the best management? A)Total Mastectomy B)Trucut biopsy of the mass C)Partial Mastectomy and Radiotherapy D)MRI of breast 7) is A) B) C) D) 8) Ms Janet, 28 yrs old, has low retrosternal 'sticking' sensation and choking sensation. Barium swallow showed bird beak appearance. Dx? A)Esophageal adenocarcinoma B)Diffuse esophageal spasm C)Achalasia cardia D)Schatzki ring 9) KUB Xray shows 5mm stone at uretrovesical junction. What is the appropriate treatment? A) adequate fluid B) Analgesia C) Percutaneous Nephrolithotomy D) ESWL 10) Most common location for urinary stone to get lodged A)renal pelvis B)mid ureter C)ureteropelvic junction D)vesicoureteric junction 11) A 65 year old male presented with severe back pain which lasted for 20 minutes. On examination, He was in shock and a palpable pulsatile 8cm was found on the epigastric region. A) Acute cholecystitis B) Acute pancreatitis C) Herniated lumbar disc D) Ruptured abdominal aorta aneurysm 12)40 years old women presented to ED due to heaviness on the left leg, she was awakened by leg pain in the night. on examination,there is superficial variscoses, and painful ulcer at 5cm above left medial melleolous. A)arterious insufficiency B)deep vein insufficiency C)incompetent perforation vein D) Isolated symptomatic varicose vein 13) Miss Laila , 50 year old developed tingling sensation and muscular irritability in the upper limbs 8 he’s after thyroidectomy. What is the immediate investigation you will do for her? A) Serum calcitonin level B) Serum TSH level C) Serum free thyroxine level D) Serum calcium level 14)76yo with bph present with difficulty in urinating after taking oral nasal congestion. Which of the following are responsible for it: A)Alpha 1 adrenergic B)Beta2 adrenergic C)Ganglionic nicotinic D)Sertoligenic 15) Mrs Lim, 60 years old lorry driver admit to hospital due to severe hematemesis. NSAID for joint point for 2 years. A. Esophagitis B. Esophageal varices C. Mallory weis tear D. Peptic ulcer 16) MSam, a 55 year old man with a history of drug and alcohol abuse undergoes a surgical replacement of a portosystemic shunt for portal hypertension. Which of the following is the most appropriate vein to anastomose the major tributary of the portal vein? A) Left gastric vein B) Left renal vein C) Splenic vein* D) Superior mesenteric vein 17) Management after TURBT A) BCG infusion B) Radiotherapy C) Chemotherapy D) Surgical Resection 18) Mrs siti, 35 years old, present with abdominal distension, with TABHSO, most likely diagnosis A) colon ca B) adhesion band C) incarcerated hernia D) sigmoid vulvulus 19) Infant was born with abnormal urethra opening at the ventral surface of penis at 0.3cm from corona of glans. What is the clinical diagnosis. A. Exstrophy B. Crryptochidism C. Hypospadias D. Epispadias 20) Mrs Thong, 70 years old, rectal bleeding start 4 days ago, with mild abdominal pain. Hypotension. What is the initial management? A) Colonoscopy B) Analgesics C) Catheterisation D) MR angiography 21) a 43 year old man came to the hospital with complaints of abdominal pain and vomiting for several weeks after an episode of acute pancreatitis. On examination. There is a palpable mass at the epigastric region. What is the most likely diagnosis A) pancreatic carcinoma B) pseudo cyst of lesser sac C) empyema of gallbladder D)abdominal aortic aneurysm 22) A) B) C) D) 23) A) B) C) D) 24) A) B) C) D) 25) A) B) C) D) 26) A) B) C) D) 27) A) B) C) D) 28)Ms Azleen, 26yr old lady came to the ED with a chief complaint of redness and swelling of the right breath. The swelling is 6cm in size. What Advice would you give her as she is breastfeeding now? A) breastfeed with both breast* B) breastfeed with the affected breast C) breastfeed using the unaffected breast D) stop breastfeeding 29) 53yo headmistress, p/w early satiety and abdominal fullness for 3/12. CT scan showed fluid filled cyst at tail of pancreas. CEA elevated. Next appropriate management: A) distal pancreatectomy B) percutaneous drainage of fluid filled cyst C) internal drainage with roux en Y cyst jejunostomy D) repeat CT and resection if lesion increase in size 30) pt having pheochromocytoma. Urine abnormality noted: A) methanephrine B) DHEA C) preganedione D) 5HIAA 31) scrotal sac has ‘bag of worm’ appearance A) torsion of testis B) spermatocele. C) hydrocele D) varicocele 32) lady after forcep delivery. Developed bluish mass at right labia? How would you manage? A) exploration laparotomy B) vaginal packing C) incision and drainage D) compression, ice pack & analgesics 33) sexually active ,had a unprotected sex 2 days ago. LMP 18days ago, cycle 30 days with 5 days flow. What is the contraception method can used now ? A)check pregnancy B)levonorgestrel C)ulipristal D)insert copper IUD 34) non malignant adnexal mass. Meigs syndrome. A) teratoma B) hydrosalpinx C) ovarian fibroma * D) Endometrioma 35) The best management for a woman with 42 weeks of gestation, favourable cervix, vertex presentation, and estimated fetal weight of 3800 gm. A) induction of labor B) start fetal surveillance C) cesarean section D) amniocentesis for fetal lung maturity study 36) partogram can pick up this finding: A)obstructed labour B) abruptio placentae C) placenta praevia D)hemorrhage 37) primigravida, OGTT done at 20w because of her AGE. Results shown below, what’s the mx Fasting: 5.2 2 hours pp: 7.2 A) repeat ogtt at 24w or 28w B)start 7 point glucose profile and start treatment C) diagnose as GDM and initiate treatment D)discharge and go to clinic for routine follow up 38)o&g A) B) C) D) 39)[O&G] A) B) C) D) 40)[O&G] A) B) C) D) 41)[O&G] A) B) C) D) 42)[O&G] A) B) C) D) 43)[O&G] A) B) C) D) 44)28yo, G3P2, postdate 5 days ago, complaint of reduced fetal movement for 1 day,maternal vital sign normal, USG normal and AFI 8. CTG show normal fetal heart rate. What is the most likely cause of reduce fetal movement? A) cord compression B)head engaged C)reduced amniotic fluid D)fetal distress due to postdate 45) 25yo, primigravida, came antenatal checkup, with spontaneous pain labour, moderate and regular uterine contraction, no progress of labour after 2 hr, membrane intact, cervix fully effaced, dilated 5cm, vertex 0 station, what is appropriate next action? A)induction with oxytocin B)amniotomy C) Arrange for Emergency LSCS D) ? 46)G2P1, 37weeks of gestation, singleton pregnancy breech presentation, had previous LSCS due to fetal distress,which is the best management? A)induction at 38 weeks B)spontaneous labour C)elective LSCS at 38 weeks D) ECV 47)28 weeks gestation, came with abdominal pain and vomiting, usg fetal normal, placenta location normal, maternal HR 110bpm, BP?, WBC 13,000(High). Usg show well encapsulated mass at fundus. What is dx? A) B) UTI C)chorionitis D)red degeneration of fibroid 48) Para 5, just give birth to large baby weight 3.8kg with vacuum extraction. Two hour post placental delivery, uterus well contracted however there is brisk vaginal bleeding, what is next action? A) check placental membrane B)inspect vagina and cervix for lacerations. C) repair episiotomy wound D)? 49)[O&G] A) B) C) D) 50)24y/o, sexually active lady present with dyspareunia. Temperature 38.5c, Have unilateral tense, tender, fluctuant swelling at right lower part of introitus, in relation to Bartholin gland.[O&G] A) incision & drainage B) marsupialization C) aspiration D) surgical resection 51) Pap smear shows HSIL what is the next step A) cone biopsy B)colposcopy guided biopsy C) D) 52)Which is the smallest diameter of the foetal skull. A) sub-occipitofrontal B) Occipitobregnamtic C) Sub-mento vertical D) sub-mento bregmatic 53) Strawberry cervix case (trichomonas vaginalis), treatment: A) Metronidazole B) Metronidazole + doxycycline C) Azithromycin D) Azithromycin with contact tracing 54)[O&G] A) B)7 C) D) 55)[O&G] Bulky uterus, bilateral adnexal mass, UPT positive A)Trophoblastic disease B) Ectopic pregnancy C) D) 56)[O&G] A) B) C) D) 57)[O&G] A) B) C) D) 58) [Ortho] A) Trigger finger B) C) D) 59) [Ortho] A) SSG (split skin graft) B) Give antibiotics C) Remove external fixator and POP D) Intramedullary nail and manage wound later 60) [Ortho] Codman triangle, sunburst appearance A) Osteosarcoma B) C) D) 61)[Ortho] Crescent sign on femoral head A) Avascular necrosis B) SUFE C) Giant cell tumour (osteoclastoma) D) Osteosarcoma 62)[Ortho] A)Genu valgus B) C) D) 63)[Ortho] A) Fasciotomy B) C) D) 64)[Ortho]Club foot A) Ponseti brace B)Surgery C)Release of soft tissue D) 65)[Ortho] A) B) C) D) 66)[Ortho] A) B) C) D) 67)[Ortho] A) B) C) D) 68)[Ortho] A) B) C) D) 69)[Ortho] A) B) C) D) 70)[Ortho] A) B) C) D) 71)[Ortho] A) B) C) D) 72) [Anaesthesiology] A) B) C) D) 73) A 2 year old boy was brought to the emergency department for sudden episode of coughing, dyspnoea and stridor. He was at 90% SpO2. Examination shows an apparent hyperinflation of the right chest. What is the likely diagnosis? A) acute severe asthma B) Acute epiglottitis C) Foreign body aspiration. D) aspiration pneumonia 74) Mr.Helmi, 70 year old man presented with severe gastroenteritis and was given fluid resuscitation. He was given a large volume of normal saline. What acid base complication that he can have? A) No acid based complication. B) Hyperchloremia with metabolic acidosis C) Hypochloremia with metabolic alkalosis D) Hyperchloremia with metabolic alkalosis 75) John, a 5 y/o child, came for elective circumcision. Put under GA. What is the use of Laryngeal Mask Airway in this case? A) Maintain airway B) Absorb saliva C) For laryngeal surgery D) prevent aspiration 76) 7 years old boy undergo operation. But he is crying and unable to do venepuncture. What is the best for him? A) Inhalation Sevoflurane B) Inhalation Isoflurane C) Inhalation Nitrous Oxide D) Inhalation Desflurane 77) Mr Chong, young patient with sudden painless loss vision with systolic murmur, cherry red spot A) CRAO B) CRVO C) DM Retinopathy D) Branch retinal vein occlusion 78) 9 year old female, comes to ED, pain at right eye after hit by shuttlecock. What is the presentation? A) Blood stain cornea B) Hyphaema C) Hypopyon D) Glaucoma 79)Aisyah a 10 year old student is diagnosed with acute conjunctivitis with right eye redness and swelling Which of the following is correct about conjunctivitis A)Bacterial conjunctivitis cause mucopurulent secretions B)Missed C)Viral conjunctivitis shud be treated with antibiotics D)Vernal conjunctivitis is caused by adenovirus 80) A 10 year old boy attending to hospital with a small circular swelling at his left upper eyelid. There is no difficulty in vision or redness. Physical examination shows no tenderness. What is the most likely cause? A) Stye B) chalazion C) meibomitis D) Entropion 81) Mr Tan, 45 year old Chinese man presented with left ptosis and left abduction deficit. He also have left sided facial hyperaesthesia and keratoconjunctivitis sicca. What is the clinical diagnosis? A) Meningioma B) Chondroma C) Nasopharyngeal carcinoma D) Diabetic vascular neuropathy 82) [ENT] Nasal polyp associated with A)penicillin allergy B)chronic bronchitis C) aspirin allergy D) gastric polyps 83) What investigation is done to confirm nasal discharge as CSF leakage rather than nasal mucus? A) CT scan B) glucose stick test C) MRI D) endocscopy 84) [ENT] A) B) C) D) 85)50 yes old man presented with lateral neck swelling and fever 2 weeks. What is the best management A)block neck dissection B)fine needle aspiration C)incisional biopsy D)excisional biopsy 86)Which of the following describes the best Management of acoustic neuroma A)Hearing loss in treatment B)Predictable tumour growth allows appropriate time for treatment C)Treatment factors include tumor size abd hearing level D)CT scan is investigation of choice 87)Patient is able to open eyes to command, disoriented but able to converse, moves his limbs on command. What’s his gcs score? A)12 B)13 C)14 D)15 88) A 47y/o man was brought to Ed due to wandering in street mumbling. His BP 150/74,HR 110 beats/min, temperature 38 degree Celsius, RR 16, SPO2 99% in room air, finger stick glucose 98mg/dL. PE: patient confused with mumbling speech, dilated pupil, flushed face, mucosa membrane and skin were dry. What is the toxidrome mentioned above? A) opiate syndrome B)anticholinergic syndrome C)cholinergic syndrome D)sympathomimetic syndrome 89) Mrs Chong, a 75 year old woman presented to emergency with rapid, irregular palpitations with fatigue. What is the cause of the palpitations? A) Atrial premature beat B) Atrial fibrillation C) Supraventricular tachycardia D)Ventricular tachycardia 90) Mr.Bala a 26 year old motorist brought into ED after being involved in an Road traffic accident, he is in respiratory distress and only able to speak in a few words, he also has paradoxical breathing, pulse 120bpm. SPO2 80% and air entry equal bilaterally A) open pneumothorax B) massive hemothorax C) tension pneumothorax D) flail chest MISSED QUESTIONS: 1. Knocked knee, knocking knees when running resulting in falls: Genu Valgus 2. Insulin resistance, which hormone?- HPL 3. 12 week of amenorrhea, Rh - mother. Next plan - determine the father blood group 4. Hypertensive, with liver tenderness HELLP syndrome (isnt it liver congestion?) 5. Patient with PSA elevated- do a transrectal ultrasound 6. Fnac of breast report reveal abnormal cell - do MRI of breast, trucut core bioy, partial mastectomy, total mastectomy 7. Alcoholic 10 years, Crescent sign: Avascular necrosis of femoral head 8. Minimal urine flow rate to maintain to avjoid kidney injury: 30ml 9. Lachman test positive: ACL 10. In between Subscapular swelling, fluctuant, edge slipped when palpated: Lipoma 11. Osteosarcoma- sunburst, codman 12. 16 yo, hips movement restriction: SUFE 13. Compression #, xray shows vertebrae with thin cortex - osteoporosis 14. Clubfoot- ponsetti method and bracing 15. Ascending cholangitis common organism: ecoli, yersinia, aspergillus. 16. Petechial rash after trauma: Fat embolism 17. Fracture of ulnar and radius, compartment pressure high: Fasciotomy 18. CTG abnormal in? Baseline heart rate: 110-160bpm Variability >10 Present of deceleration Absent of acceleration 19. 70 year old lady, Fall down in toilet, external rotation with shortening of limb. What #? (Hip, femur neck, intertrochanteric fracture) 20. ENT- ASOM true statement Common in adult Pain increases after perforated tympanic membrane Most commonly caused by Streptococcus Pneumoniae 21. Bulky uterus, bilateral adnexal mass, UPT positive (incomplete miscarriage, ectopic pregnancy, molar pregnancy, ovarian..?) 22. Post vacuum delivery, after 30 mins no signs of placenta separation (IV syntocinon and control cord traction, push to OT for manual removal of placenta (confirmed by prof nanda), wait and observe..(?)) 23. Nipple bloody discharge (Nipple biopsy,..) 24. Inoperable.. dilated bile ducts...Jaundice, how to treat? Percutaneous transhepatic biliary drainage, ERCP with stenting 25. Trauma, hemodynamic instability: FAST Scan 26. Typist, difficulty in typing, locked finger (trigger finger) 27. Open fracture, done external fixation, wound healed with clean granulation measuring 5x6cm, what to do next? (Intramedullary nail and manage wound later, Skin graft, antibiotics, remove of external fixator and POP) 28. Back pain after fall from (1 floor) significant height, xray shows anterior column fracture of lumbar vertebrae, what is the mechanism of injury? (Compression #, burst #, chance #, dislocation) 29. Epidural anaesthesia in pregnancy, presented with tingling sensation and carpo-pedal spasm that resolves by itself. Cause? (Hypokalemia, hypocalcemia, anesthesia-induced sth sth,...) 30. Preceded by URTI, young boy presents with knee pain, tenderness and swelling. What is the next mx? (FBC, arthrocentesis, …??) 31. Man with hyperlipidemia. Cyanotic 4th toe, dorsalis pedis and posterior tibial artery palpable (Digital atherosclerosis, lupus vasculitis, peripheral arterial disease, thromboembolism) 32. Mastectomy done for breast ca with axillary lymphadenopathy, then presents with jaundice with hard, nodular liver. (Secondary to liver, …) 33. Acute pancreatitis, serum amylase dropped on 3rd day. On 8th day, develops fever… Management (IV amphotericin B, …) 34. Severe atherosclerosis, done cardiac catheterization and started on aspirin. 1 day after develops abdominal pain and pr bleed. (Mesenteric ischaemia, NSAID enteropathy, …) 35. Acute limb ischemia? What is the best investigation to assess vascular status? (Angiography, ECG, …) 36. Patient early pregnancy 2 months of amenorrhea unsure of the date, what to do to confirm the EDD? (Ultrasound for Crown rump length, ultrasound for gestational sac) 37. Patient at 42 week, no sign of labour, what to do? (Review back the last menstrual history……) NOTE 1: THIS EXAMINATION FORMAT WAS CREATED TO ADAPT TO THE COVID-19 PANDEMIC UNDER RECOMMENDATIONS FROM THE MQA & MMC. NOTE 2: ALL IMAGES / CHARTS / GRAPHS / SCENARIOS PROVIDED ARE CLOSE TO THE ACTUAL ONES USED IN THE EXAMINATION. COMPILED BY BATCH 8 Analysis of Questions / Postings: 32 Surgery 25 O&G 14 Orthopaedics 5 Anaesthesiology 4 Ophthalmology 6 Otorhinolaryngology (ENT) 4 Emergency Medicine Total: 90 Questions.