LUMIERE SELANJAR 5 : Surgery
1. Q: 56 y/o man, surgery for internal obstruction, ileus but comfortable.
A- Perforated peptic ulcer
B- Normal in 3 days post laparaotomy
C- Anastomotic breakdown
3 Q: 25 y/o lady , practise OCP for 3 months, come with breast lump for 1 month, mobile
. unilateral, non tender, no lymphadenopathy, DX?
A- Breast cyst
B- Breast Ca
C- Fibroadenoma
4 Q: A 35 y/o professional weightlifter present with a red and swollen lump in left groin. An
. inguinal hernia is suspected and at the time of operation, lump is found contain small
loop of necrotic bowel.
A- Irreducible
B- Strangulated
C- Ritcher’s
5 Q: 55 y/o women complaint of central abdominal pain and 2 episodes of vomiting. She
. last open her bowel 4 hours ago. On examination, patient was dehydrated and in pain.
There was tenderness and distension of abdomen, and increased bowel sound. Your
provisional diagnosis is bowel obstruction. What is the most appropriate initial
investigation would you like to order?
A- Colonoscopy
B- CT abdomen
C- Plain radiograph of abdomen
6 Q: 62 y/o, jaundice, pale stool, dark red urine, palpable gallbladder.
. Most likely cause
A- Hepatocelullar ca
B- Impacted stone in CBD
C- Tumor head of pancreas
7 Q: 55 years old man with positive history of smoking come with complaint of pain at
. lower left leg. He felt pain at left calf during walking and relieve by rest. The pain is
localized at left calf only. His walking distance has been decreased due to the pain the he
felt. What is the best investigation need to be done?
A- Ankle brachial index (ABI)
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B- Angiography
C- Ultrasound
NO. QUESTIONS
1) 62 y/o man presented to OPD with 7 weeks of loose passing stool, three times per day.
Previously, he was passing stool with normal consistency. No history of bleeding per
rectum. He had constipation preceding change of consistency. What is the most likely the
diagnosis?
A- irritable bowel syndrome
B- ischemic colitis
C- colorectal cancer – altered bowel habit
2) 65 y/o man recently increased a significant amount of weight. His hair became dry and
brittle, he was low in mood. He had round face with prominent fat pad along his back.
What is the best initial investigation for him?
A- early morning cortisol level
B- dexamethasone suppression test
C- pituitary MRI
3) 65 y/o man recently increased a significant amount of weight. His hair became dry and
brittle, he was low in mood. He had round face with prominent fat pad along his back.
What is the best initial investigation for him?
A- early morning cortisol level
B- dexamethasone suppression test
C- pituitary MRI
4) A 90 years old woman has a neck swelling which increases in size from last 2 weeks. She
has difficulty in swallowing, shortness of breath, cough and hoarseness. The large fixed
mass is located at anterior triangle of nec & there is present of cervical lympadenopathy.
A-Papillary Thyroid Carcinoma
B-Anaplastic Thyroid Carcinoma
C-Lymphoma
5) A 60 years old man with previous history of ischaemic heart disease is scheduled for
lower anterior resection for rectal cancer. In anaesthetic room he is to be put on arterial
line before administration of anesthesia.
Which test is best should be done before inserting the arterial line
A - Coombs test
B-
C - Allen test
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NO. QUESTION
1) A 45 years old lady presented with right hypochondriac pain with positive Murphy’s
sign for 3 days duration. Abdominal radiograph showed radiopaque shadow at the
right subcostal region.
The main component contributing to the radiograph finding is
A- Bile salt
B- Calcium carbonate
C- Calcium bilirubinate
2) 60 years old man admitted to emergency department with severe epigastric pain for
1 day. He was on regular NSAIDs for gouty arthritis for past 1 year. Clinical
examination revealed upper abdominal tenderness with guarding.
What immediate investigation required in this scenario?
A- Abdominal erect X-ray
B- Chest erect X-ray – Air under right hemidiaphragm
C- Ultrasound abdomen
3) 45 years old man complaining of not passing flatus with abdominal distention 6
months after large bowel resection for perforated sigmoid diverticulum. He
experienced 3 episodes of colicky abdominal pain prior to the admission.
What is the most probable cause of the above scenario?
A- Bowel adhesion
B- Internal bowel herniation
C- Paralytic ileus
4) A 30 years old lady presented with anterior neck swelling for 5 years duration. The
swelling move with deglutition. On examination, there was a single nodule
measuring 4cm in diameter and located at right anterior neck.
The most likely pathology of the swelling is
A- Thyroid cyst
B- Thyroid carcinoma
C- Colloid nodule
5) 35 years old female presented with painless right breast lump for 6 months. On
Examination, it was 2 cm in diameter at the right upper outer quadrant. FNAC
Revealed invasive carcinoma.
What is the best treatment?
A- Excision of lump with axillary clearance
B- Modified radical mastectomy
C- Wide local excision of lump with axillary clearance
6) 70 years old chronic smoker came to the hospital with complaint of intermittent
claudication. He is a known case of hypercholesterolemia.
What is the best bedside examination to assess severity of the disease?
A- Ankle brachial systolic index
B- Buerger’s angle
C- Peripheral arterial pulse examination
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7) A 70 years old man presented to emergency department with 1 day history of
inability to pass urine. he also had history of poor stream urination and dysuria for
past 2 years.
The commonest cause of this problem
A- Benign prostatic hyperplasia
B- Prostate carcinoma
C- Urethral stone
8) 8. 25 years old construction worker presented with haematuria for 1 say duration. He
had frequent history of painful micturition and colicky lower abdominal pain for past
1 year.
Most probable diagnosis is
A- Recurrent UTI
B- Urolithiasis
C- CA urinary bladder
NO. QUESTIONS
1) A 60 years old male presented with sudden onset of unable to pass urine for
1 day. He had been having slow urine stream, frequency and urgency for the
past 5 years. Per abdomen examination revealed distended bladder. Per rectal
revealed enlarged prostate with smooth surface. 500 ml of clear urine is drained
after CBD insertion. What is the most likely diagnosis?
A- Benign prostate hyperplasia
B- Bladder calculi
C- Prostate carcinom
2) A 30 years old male smoker presented with history of 1 episode of
hematemesis for 1 day. The vomitus was coffee ground in appearance and about
1 cup in amount. He claimed to have intermittent abdominal pain 1 month prior
to admission. On abdominal examination revealed tenderness at the epigastric
region. Which of the following is most appropriate investigation to confirm the
diagnosis?
A- CLO test
B- Oesophagogastroduodenoscopy
C- Ultrasound of abdome
3) 40 years old lady presented with gradually enlarging neck lump for the past 3
months. She denied having dysphagia or hoarseness of the voice. On
examination, there was a single large nodule at the anterior part of the neck
which moves with deglutition. It was firm in consistency. The cervical lymph
nodes were palpable.. Which of the following is the most likely diagnosis?
A- Anaplastic carcinoma
B- Dominant nodule of multinodular goiter
C- Papillary thyroid carcinom
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4) A 30 years old woman presented with right upper quadrant abdominal pain
associated with fever, nausea and anorexia for 10 days duration. The abdominal
pain was dull in nature and radiated t the right shoulder. There was no history
of blood transfusion. Clinically she was obese. Her temperature was 38°C and
other vital signs were stable. She was jaundiced but not pale. Abdomen
examination revealed tenderness and guarding over the right hypochondriac
region with tenderness during deep inspiration. There was no
hepatosplenomegaly. Which of the following is the most likely diagnosis?
A- Acute cholecystitis + Mirizzi syndrome
B- Acute hepatitis
C- Acute pancreatitis
5) 5. A 55 years old lady came with a right breast lump. On examination, there
was a 4 cm irregular lump at 3 o’clock of the right breast associated with
palpable axillary lymph nodes. Which of the following is the most appropriate
management?
A- CT scan
B- Mastectomy with axillary clearance
C- Triple assessment
6) A 40 years old man has history 10 days of high grade fever with chills and
rigor. It was followed by right hypochondriac pain and jaundice 1 day prior to
admission. On examination, he is conscious, febrile and tender hepatomegaly.
What is your diagnosis?
A- Acute cholangitis
B- Acute hepatitis
C- Liver abscess
7) A 35 years year soldier presented with gross haematuria associated with right
loin pain since 1 month. The pain was colicky in nature. He has 1 episode of
passing out sandy urine for 1 week but he did not seek treatment at that time.
Examination is unremarkable. Most appropriate investigation is
A- Flexible cystoscopy
B- Ultrasound of KUB
C- Urine FEME
8) A 70 years old man, chronic smoker presented with non-healing ulcer for the
past 1 month at the right big toe. He had underlying diabetes mellitus and
hypertension with good compliance. Further questioning, revealed history of
intermittent claudication for 1 year followed by rest pain 2 months prior to this
presentation. Examination revealed presence of ulcer with necrotic floor at the
right big toe. Which of the following is the most likely diagnosis?
A- Diabetic ulcer
B- Ischaemic ulcer
C- Neuropathic ulcer
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9) A 50 years old man presented with 3 months history of jaundice and 1 week
history of pruritus. Upon examination, a painless globular mass was palpable at
the right hypochondrium. Which of the following is the most likely diagnosis?
A- Head of pancreas tumour
B- Choledocholithiasis
C- Hilar cholangiocarcinom
10) A 60 years old man presented with per rectal bleeding with tenesmus and
spurious diarrhoea for 2 months duration. What is the most probable diagnosis?
A- Colonic diverticular disease
B- Rectal carcinoma
C- Solitary rectal ulcer syndrome
11) A 50 years old fisherman presented with a painless crusty lesion over his lower
lip with everted edges, central ulceration which easily bled. Further examination
revealed a palpable lump over his submandibular region. Which of the following
is the most likely diagnosis?
A- Basal cell carcinoma
B- Squamous cell carcinoma
C- Submandibular gland tumour
NO. QUESTIONS
1) A 27 years old man presented with 3 days right iliac fossa pain with low grade fever . On
examination, temperature is 37.8 C with no septic looking.Abdominal examination
revealed right iliac fossa mass measuring 5 x 5 cm . What is the probable diagnosis
A- Acute divertivulitis
B- Appendicular mass
C- Caecal tumour
2) 60 years old man with past history of laparoscopy for bleeding duodenal ulcer and
perforated appendicitis presented with 3 days colicky abdominal pain,vomiting and
inability to pass motion .Upon examination, he was afebrile . Abdominal examination
revealed abdominal distension with hyperactive bowel sounds . Which of the following
is the most likely diagnosis?
A- Acute volvulus
B- Colorectal Carcinoma
C- Intestinal adhesion
3) A 20 years old man visited OPD with complained of neck swelling since childhood.
Swelling is painless and not increase in size.On examination, anterior neck swelling is
2x3cm . Provisonal diagnosis is thyroglossal cyst. Which of the following is significant
clinical sign to support above diagnosis?
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2. Centrally located swelling
3. Swelling move with protrusion of tongue
4. Swelling move with swallowing.
4) A 66 years old man , a chronic smoker complained of leg pain upon walking for long
distance for the past one week. Before this, he needed to take a rest after walking from
his house to the mosque which was about 200m distance. Which of the following is the
most accurate lower limb assessment for this patient?
A- Ankle brachial Systolic Index (ABSI)
B- Handheld Doppler
C- Peripheral pulse examination
5) 40 years old labour complained of 6 hours inability to pass urine. He mentioned of
having painful hematuria for 1 week. On examination, there is suprapubic bulge.
A- Cystitis
B- Prostate cancer
C- Urethral calculi
6) A 65 years old man presented to Emergency Department with history of painless
hematuria for past 1 week.It was the 2nd episode within 1 month and associated with
lethargy. Upon examination, he was pale, not in pain and afebrile. A hard suprapubic
mass was palpable.
5. Prostate cancer
6. Urinary bladder calculi
7. Urinary bladder Carcinoma
7) A 35 years old pregnant lady presented with bleeding per rectum since 1 day .It was
painless and during defecation. She noted that the blood dropped out after passing
stool. She had history of constipation during early pregnancy.
A- Anorectal prolapse
B- Internal haemorrhoid
C- Rectal abscess
8) A 70 years old man underwent emergency laparotomy for perforated sigmoid
diverticulum .During surgery, gross faecal contamination and some spill over the skin
noted. After resection, the abdominal cavity was washed with 5L of water .Linea alba
closed.Which was the best method of skin closure for this patient?
A- Delayed skin closure after adequate dressing and wound granulation.
B- Primary skin closure with suture
C- Skin and subcutaneous layer left open.
9) A 45 years old teacher presented with right ankle ulcer for past 1week. It was
associated with on and off bleeding which was controlled by compression. She also
complained of heaviness of affected limb. ON examination, there was 3x3 cm ulcer
above medial malleolus of granulation tissue at floor.Which is the most expected
clinical finding to support the diagnosis in this patient?
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A- Brittle nails
B- Muscle wasting
C- Tortuous and dilated vein
10) A 56 years old lady came with severe itchiness for 3 days. She noticed of yellow skin
since 1 moth before admission. No abdominal pain and fever. Abdominal examination
revealed painless globular mass at right hypochondrium. What is the probable
diagnosis?
A- Cholelithiasis
B- Gall bladder Carcinoma
C- Periampullary tumor
