SURGERY PAPER 2 SEMESTER 10 2016

1. Ca of the head of pancreas encroaching on the duodenum. Procedure of choice:

a) PPPD
b) Whipple
c) Distal pancreatectomy
d) Triple bypass

2. Pt with bruises, spleen not enlarged, low platelets. Rx:

a) Give platelets

3. ITP Treatment:
a) Steroids

4. Appendicitis:
b) Leukocyte shift to the left

5. Mass in RIF:
c) Caecal Ca
d) Appendix Ca
e) Appendix Mass

6. Ranson score 7, seen 48 hours later.

b) Base deficit > 4

7. TB:
a Adhesion
b Stricture

8. Transverse ulcer is a feature of:

a) Typhoid
b) TB
c) Malignancy

9. Pt with night sweets & symptoms of intestinal obstruction. Inv:

a) X-ray Abdomen
b) X-ray Chest

10. 1 day history of guarding and signs of shock. Dx:

e) Appendicitis
f) Pancreatitis
g) Ectopic pregnancy

11. Case: Inc ALP, Amylase normal. Dx:

 a) Biliary Pancreatitis
b) Nighat said obstructive jaundice

12. Bile duct stone. Next step:

c) ERCP
d) Explore bile duct

13. Intestinal metaplasia diagnosis:

a) Barrets

14. 40 yrs old pt with crohn’s disease. Follow up investigation:

a) Flexible sigmoidoscopy
b) Colonoscopy

15. Breast infiltrating cancer, spread to lymph nodes and legs. Rx:
a) Palliative chemotherapy

16. Right Hepatic flexure mass found during operation. Mgmt:

a) Remove nodule
b) Take biopsy
c) Wedge resection (hemorroidectomy if given as option, not then wedge)

17. In a pt of pancreatic ca, during pancreatic head removal, liver node found. Mgmt:
a) Intrahepatic ablation
b) Chemo

18. Expanding subscapular hematoma of liver. Mgmt:

a) Ligate the artery (nighat said it should be 3P’s Packing, Push, Pile)

19. Cause of incisional hernia & burst abdomen:

20. Investigation for dysphagia:

a) Barium Enema (nighat said it should be upper GI endoscopy and biopsy)

21. Smoker c/o cough, sputum discharge & dysphagia. Dx:

a) Ca Lung (it should be Ca of Esophagus)

22. Irreducible hernia with pain. Dx:

a) Strangulation

23. 25 yrs old male, discharge from umbilical (NOT Remembered).

a) Umbilical sinus (also called a pilonidal sinus)

24. Pain within 6 hours of appendicectomy. Reason:

a) Poor pain management
b) Poor nutrition
 c) IV something
d) Sutures not good

25. Infant had umbilical hernia. Mgmt:

a) Parental reassurance

26. Correct regarding Epigastric Hernia:

a) Protrusion of fat through the linea alba

27. Pt has massive splenomegaly, fever, rigors, chills. Recent hx of anti-malarial drugs. Mgmt:
b) Long term medical management for Malaria
c) Splenectomy

28. Umbilical hernia is prone to obstruction:

a) Pregnancy
b) Obesity
c) When gut is in its contents

29. Thoracic trauma, frank pus in chest tube. Mgmt:

a) Tube thoracostomy

30. 15 year old child, sudden onset of abd. pain and rigidity. Dx:
a) Entero-perfusion

31. Case of Strangulated paraumbilical hernia (NOT Remembered).

32. Aortoenteric fistula results in:

a) Melena and hematemesis

33. In intestinal obstruction, step ladder pattern is seen in which view?

a) Erect X-Ray (it should be spine xray)

34. CBD stones:

a) Exploration
b) ERCP

35. Grade B Carcinoma in pelvic colon, stoma site will be:

a) Colostomy
b) Jejunostomy
c) Illeostomy

36. Duodenal adenocarcinoma. Rx:

a) Whipples

37. Best initial imaging modality for liver:

a) U/S
 b) C/T

38. Correct regarding courvoisier sign:

a) Palpable gallbladder secondary to CBD cancer + jaundice

39. Incontinence due to vaginal delivery is because of:

b) Pudendal nerve damage by instruments

40. Risk factor for Sigmoid volvulus:

a) High residual diet
b) Enlarged mesocolon

41. Treatment of umbilical hernia:

a) Surgery after 2 years

42. Which of the following is associated with gastric cancer:

b) H.Pylori

43. Case: Fever, RUQ pain & Jaundice. Dx:

a) Ascending cholangitis

44. Acute small intestinal obstruction exam finding:

a) Hyper-resonant bowel sounds

45. Pt. Had UC, after 10 years he came for follow up. What will you do?
a) Colonoscopy

46. Case: Abdominal pain, distention, vomiting & absolute constipation. Dx:
a) Acute intestinal obstruction
b) Acute small intestinal obstruction
c) Acute on chronic intestinal obstruction

47. Imaging in intestinal obstruction:

a) Supine X-Ray

48. Pt. with history of taking ATT now present with abdominal pain. Dx:
a) Peritonitis due to TB ulcer

49. Girl, c/o menorraghia, On Exam, liver & spleen palpable, next investigation?
a) BM biopsy
b) Electrophoresis

50. 8 months old child presented with rectal bleed. Dx:

a) Juvenile polyp

51. Ca involving the upper rectum. Procedure of choice:

 a) ABPR
b) Ant. Resection
0 0
52. On proctoscopy, lady is found to have some pathology b/w 6 clock & 7 clock positions. She
has hx of multiple vaginal deliveries. Dx:
a) Perianal hematoma
b) Anal fissure
c) Hemorrhoid

53. High fistula investigation:

a) Fistulogram
b) MRI

54. Case of anal fissure (NOT Remembered)

55. Male pt, constipation and plum like mass at anal margin. Dx:
a) Prolapsed hemorrhoid

56. Thrombosed external piles treatment:

conservative mngt (IM)

57. BPH most common treatment:

a) TURP

58. Kidney hematoma; after resuscitation what will you do?

a) Simple suturing of laceration
b) partial nephrectomy
c) Tube nephrostomy
d) Conservative Rx

59. Most common congenital disease of kidney:

a) Horseshoe
b) Simple cystic kidney
c) Polycystic kidney

60. How to check renal azotemia?

a) MAG - 3

61. Bladder outflow obstruction after anesthesia is because of:

a) Reflux spasm

62. Correct regarding Bladder Ca:

a) SCC
b) Mimics UTI in initiation & present with hematuria
c) Partial cystectomy is Rx
d) Radiation is Rx
63. Case (Signs of bulbar urethral rupture given). Dx:
a) Urethral Rupture

64. External meatus opening on underside of penis. Dx:

a) Hypospadiasis

65. Pt c/o urinary retention. Hx of RTA. Dx:

a) Urethral stricture

66. Pt. with urinary complaints & having family history of prostate Ca. Inv:
a) PSA

67. False impression of calculi. What will you do?

a) repeat q. 12th rib etc (NOT Remembered exactly)

68. Case of Prostate ca. Next step:

b) TURP
c) Hormone ablation
d) Biopsy for staging

69. Bladder diverticula:

a) Cystoscopy

70. Acute obstruction of renal collecting system. Inv:

a) CT pyelogram

71. Pt with bag of worms appearance of the scrotum. Next Investigation:

a) U/S Testis
b) U/S Kidney

72. Tender, red testis, pain on the elevation of testis. Dx:

a) Testicular torsion (IM)
b) Epididymo-orchitis
c) Varicocele

73. 60 years old pt with scrotal gangrene. Mgmt:

a) Bilateral orchidectomy (Nighat said extensive surgical debridement - IM)

74. Inv for Seminoma:

a) TruCut Biopsy
b) FNAC
75. Upper pole testis cyst treatment:
a) Excision

76. Non-transilluminant & Non-fluctuant swelling of testis:

a) Testicular tumor
77. Epididymo-orchitis treatment:
a) Antibiotics & Analgesics

78. Which approach is preferred during for the surgery of testicular tumor?
b) Inguinal approach
c) Abdominal approach

79. Bleeding site can’t be found: (NOT Remembered)

a) Subtotal colectomy + ileostomy

80. Cholangiocarcinoma: (NOT Remembered)

a) MDR CT

QUESTIONS 81 & 82
CASE: Female presented with lower abdominal pain, vaginal discharge, adnexal & vaginal
tenderness.
81. Dx:
a) PID

82. Rx:
b) Conservative
c) Antibiotics

QUESTIONS 83 to 85
CASE: Married girl presented with pain in the right iliac fossa.

83. Next Investigation:

a) Beta HCG

84. Imaging modality:

b) U/S

85. Dx:
a) Ruptured Ectopic Pregnancy

QUESTIONS 86 to 88
CASE: Pt with c/o dysphagia & weight loss.
86. Inv:
a) Endoscopy

87. Dx:
b) SCC

88. Rx: Mckeown operation (better for SCC)

QUESTIONS 89 to 91
CASE: Dilated CBD (NOT Remembered Exactly).
89. ER mgmt:
a) NPO + IV Antibiotics

90. Inv:
a) ERCP

91. If pain persists after ERCP, check amylase for:

b) Post ERCP pancreatitis

QUESTIONS 92 to 94
CASE: Pt with tetany. On abdominal exam, succussion splash is present.
92. Dx:
a) Gastric outlet obstruction

93. Procedure of choice:

b) Gastroenterostomy
c) Pyloroplasty

94. Cause of tetany in this pt?

a) Hypocalcemia due to alkalosis (hypochloraemic hypokalemic metabolic alkalosis)

QUESTIONS 95 & 96
CASE: 15year old girl; stones, splenomegaly. (hereditary spherocytosis)
95. Inv:
a) Bone marrow biopsy
b) Osmotic fragility test

96. Above condition occur because of the mutation in:

c) Spectrin

QUESTIONS 97 & 98
CASE: Painful black currant like swelling around anus.
97. Dx:
a) Perianal hematoma

98. Rx:
b) Stool softeners
c) Antibiotics and analgesics
d) Incision and drainage

QUESTIONS 99 & 100

CASE: Case of a 60 year old female on NSAIDs for osteoarthritis (Not remembered).
99. Dx:
 a) Perforated peptic ulcer

100. Inv:
a) C/T Abdomen

SURGERY PAPER 2 SEMESTER 9 2016

2. In a patient with acute cholecystitis if inflammation is subsiding he should be treated with:
a) Immediate open cholecystectomy as soon as patient is resuscitated.
b) Conservative management followed by surgery. (B here but C if inflammation has
already subsided)
c) Immediate laparoscopic cholecystectomy as soon as patient is resuscitated.
d) Routine cholecystectomy.
e) Partial cholecystectomy.

3. In small bowel obstruction, the plain x-ray abdomen will show:

a) Straight segments lying transversely at the periphery of the film.
b) Straight segments generally central and lying transversely with haustral folds.
c) Centrally placed transversely segments along with irregularly placed induration on the
periphery of the film.
d) Irregularly placed induration with haustral folds.
e) Straight segments generally central and lying transversely with valvulae conniventes
visible. (BAILEY pg 1189)

4. Constipation, band adhesions, high residual diet and long pelvic mesocolon are
predisposing cause for:
a) Compound volvulus.
b) Volvulus neonatorum.
c) Caecal volvulus.
d) Sigmoid volvulus. (BAILEY pg 1185)
e) Idiopathic megacolon.

5. The main cause for transudative ascites is:

a) Tuberculous peritonitis.
b) Meig’s syndrome.
c) Pancreatitis.
d) Cirrhosis.
e) Peritoneal metastasis.

6. Hydatid cyst of the liver does not warrant any intervention if it is:
a) Uni-loculated.
b) Located deep in the substance of the organ.
c) Less than 5 cm in diameter.
d) Calcified. (BAILEY pg 1081)
 e) Not compressing the biliary channels.

7. The preferred safe treatment of high complex fistula in ano remains:

b) Advancement flaps.
c) External fistulotomy.
d) Internal opening closure and extrasphincteric tract drainage.
e) Seton placement
f) Fistulectomy (IM)

8. Regarding small bowel diverticulum:

a) Contrast radiology may be used to detect Meckel’s diverticulum.
b) Primary duodenal diverticulum is located on the outer wall of second and third
part of duodenum. (IM pg 291)
c) Meckel’s diverticulum may be a cause of severe hemorrhage.
d) Meckel’s diverticulum should be resected if found incidentally during appendicectomy
when wide mouthed and not thickened.
e) Jejunal diverticula are usually solitary.

9. The best diagnostic modality for locating an undescended testis:

a) MRI
b) Ultrasound
c) CT scan
d) Laparoscopy (BAILEY pg 1378)
e) Clinical examination.

10. Which of the following is not a recognized cause of epididymo-orchitis:

a) Mycobacterium TB
b) Citrobacter. (BAILEY pg 1384)
c) Chlamydia trachomatis.
d) N. gonorrhoeae.
e) E-coli.

11. An arterial pile:

a) Is bright red in color
b) Is hemangiomatous malformation casing furious bleeding
c) Is diagnosed during surgery.
d) Pulsatile swelling during the proctoscopy. (odd one out)
e) Usually presents as an internal hemorrhoids.

12. Pancreatitis is primarily due to intracellular activation of enzyme:

a) Amylase.
b) Pancretozymin.
c) Trypsinogen. (BAILEY pg 1127)
 d) Lipase.
e) Cholecystokinin.

13. Richter’s hernia is a hernia in which the sac contain:

a) A portion of the omentum with vessels in it.
b) Peritoneum only.
c) A portion of the circumference of the intestine. (BAILEY pg 950)
d) Extra peritoneal fat.
e) A complete small bowel loop with mesentry.

14. A donor with blood group O can donate organs to recipient with:
a) Group B
c) Group O
d) Group A
e) Group AB
f) Group O, A, B OR AB

15. 20 year old I/V drug abuser presents with 5 day history of vomiting. Abdominal pain and
several
episodes of diarrhea per day. O/E he is found to be grossly emaciated and having palpable
inguinal lymph nodes. He is diagnosed by infections disease team as having infective colitis.
The commonest cause in such an immunocompromised patient would be.
d) Clostridum difficle.
e) Campylobacter.
f) Cytomegalo virus.
g) Ameobiasis.
h) Shigella.

16. The most important investigations to diagnose the cause of diffuse peritonitis is:
a) CBC.
b) Erect abdominal radiography in unconscious patients.
c) Peritoneal diagnostic aspiration.
d) Serum amylase.
e) Ultrasound / CT scanning.

17. 6 month old child brought to ER crying and vomiting (there was long scenario of
intestinal obstruction).what would be finding on ultrasound:
a) Rat tail appearance
b) Doughnut appearance/sign (BAILEY pg 1190)
c) Claw sign

18. While performing appendectomy, appendiceal stump is neither crushed nor ligated,
instead two stitches are placed in cecal wall close to base of appendix and tied in case of:
 a) Perforated base of appendix
b) Retrocecal appendix
c) Gangrenous appendiceal base (BAILEY pg 1209)
d) Inflamed base of appendix
e) Oedematous cecal wall

19. Male diagnosed case of carcinoma of head of pancreas. Metastatic work up is negative.
During surgery a nodule is noticed on right quadrant of liver. What action you would
further take:
a) Whipple's procedure
b) Excise nodule and get fresh frozen biopsy before proceeding
c) Close abdomen without any intervention
d) Palliative bypass
e) Whipple's operation and liver resection

20. What is the 1 year graft survival following living - donor kidney transplantation:
a) 95% (BAILEY pg 1426)
b) 80%
c) 65%
d) 90%
h) 70%
21. Young male present with complain of upper abdominal pain for 2 days. he also has hx of
acid peptic disease. TLC is 8000. x ray reveals gas under diaphragm. most accurate clinical
dx is:
a) TB ileum
b) Malignant perforation
c) Duodenal perforation
d) Ileocecal TB
e) Typhoid illeal perforation
22. Male presents has a post anal discharging sinus and a cystic swelling with a painful area
palpable on rectal examination . what is the likely diagnosis:
a) Anal carcinoma
b) Postanal dermoid
c) Thrombosed pile
d) Abscess
e) Gastrointestinal Stromal tumor
23. Accurate assessment of differential renal function is performed by:
a) MSA scan
b) Serum urea
c) Serum creatinine
d) (MAG-3) Mercaptoacetyl glycine scan (BAILEY pg 1277)
 e) I.V.U
24. 75 year old male bed ridden with history of Cerebrovascular accident is brought to emergency
with complaint of abdominal distention and inability to pass stool and flatus. On examination
abdomen is distended with mild tenderneness on palpation. On DRE hard faeces felt in
rectum. X-ray abdomen reveals dilated bowel with marked cecal distention. What is the most
likely diagnosis:
a) Colonic pseudo-obstruction
b) Sigmoid volvulus
c) Stricture large bowel
d) Sigmoid cancer
e) Cholelithiasis
25. Male presents in emergency room with a tender palpable right lower abdomen. Previous
history of colicky pain and black outs. He had barium studies show narrowing of terminal
ileum. Colonoscopy shows skip lesions. What is the best treatment option?
a) Steroids
b) Immunomodulatory drugs
c) Antibiotics
d) Monoclonal antibodies
26. Male presented with 2 month history of pain in epigastrium and burning on food intake. On
examination epigastric tenderness was present. Investigation revealed Antral gastritis and
biopsy for H.pylori was positive. Best treatment in this case?
a) H2 inhibitors + Metronidazole + Amoxicillin (BAILEY pg 1031)
b) H2 inhibitors + Metronidazole + Clarithomycin
e) H2 inhibitors + Sucralfate

26. 30 year old male presented with 4 months history of dysphagia following by suicidal
ingestion of alkali. His endoscopy revealed multiple strictures starting from middle
esophagus. Treatment is?
a) Placement of Stents (endoscopic)
b) Esophageal replacement (BAILEY pg 995)

27. Male presented with acute complains of tenesmus, diarrhea, blood and mucus discharge.
also complains of fever, with local tenderness. malaise and pyrexia. On sigmoidoscopy
hyperaemic areas and pus noticed. What is your provisional diagnosis?
a) Acute non-specific proctitis
b) Acute specific proctitis
c) Chronic pancreatitis
d) Ulcerative colitis/ Crohn’s
e) Carcinoma of sigmoid colon

28. Patient with history of empyema 8 weeks back. Now his lung is not expanding.
Investigation revealed white fibrous membrane surrounding lung. Treatment is?
 a) Urgent thoracotomy
b) Pneumonectomy
She said it should be decortication
29. Laparoscopic cholecystectomy was done for mucocele, can’t grasp, next step?
a) Convert to open cholecystectomy
b) Leave the operation
c) Open the cystic duct

30. History of diarrhea, Extrasphicteric fistula in ano, cause?

a) Cryptoglandular disease
b) Intersphincteric abscess
c) PID (BAILEY pg 1260)
d) Trauma(BAILEY pg 1260)

31. Patient after 5 days of anterior resection develop mild fever and pain in lower abdomen,
Diagnosis:
a) Wound infection
b) Leaking anastomosis (GOOGLE)
c) Pelvic abscess

32. Mortality rate in patients using IVU contrast:

a) 1/10000
b) 1/25000
c) 1/100000
d) 1/50000

33. Trauma, hemoperitoneum, 50% liver shattered, control bleeding by:

a) Transfuse FFP
b) Pack liver
c) Ligate arteries

34. 30 year old man with large cyst on upper pole of testis , management:
a) Lords
b) Excision
c) Jaboleys

35. Acute obstruction of Renal collecting system, Investigation?

b) CT pyelogram
c) IVU
d) US KUB
e) XRAY KUB
SBL for Questions 36 & 37

37. H. Pylori causes peptic ulcer as it:

a) Reduces arterial perfusion of stomach
b) Causes vagal stimulation
c) Decreases prostaglandin
d) Damages mucosal barrier
e) Produces antibodies to parietal cells
38. Urea breath test for H. Pylori detection utilizes?
a) Urease produced by the organism
b) Cytotoxin produced by the organism
c) Hyper secretion of gastric acid
d) Protease activity of organism
e) Chronic inflammation produced by infestation

SBL for Questions 38 & 39

(30 year old female presents in opd with urinary frequency which has increased progressively.
Urine culture is negative but has numerous white cells on urine analysis. X-ray shows calcified
lesions in left kidney.)

39. What is the most likely diagnosis?

a) Malignant tumor of kidney
b) Renal calcinosis
c) Renal calculi
d) Tuberculosis of kidneys (BAILEY pg 1302)
e) Hyper parathyroidism
40. What is most appropriate management?
a) Nephrectomy
b) Removal of parathyroid
c) Anti tuberculous therapy
d) Vitamin D replacement
e) Conservative management and observation

SBL for Questions 40 to 42

(60 year old man with bleeding PR. On DRE there is a palpable mass. The is a strong???)
40. Laboratory tests are likely to show:
a) Decreased Mean Corpuscular Volume
b) increased hemoglobin
c) Increased carcino-embryonic antigen
d) Decreased albumin concentration
 e) Increased total lecocyte
41. Which of the following investigation is the most appropriate?
a) X-ray chest and abdomen
b) U/S pelvis
c) Sigmoidoscopy with biopsy
d) Fecal occult blood
e) Contrast barium enema
42. Examination revealed a nearly obstructing annular growth 5mm from anal verge.
Following procedure is most appropriate?
a) Neoadjuvant chemoradiation
b) Anterior resection
c) Anterior resection with diverting ileostomy
d) Diverting stoma and referral for neo-adjuvant treatment

SBL for Questions 43 to 45

(Old man having difficulty micturition. He is complaining of dribbling of urine. He has to wake up
many times at night for urine)
44. What is most likely diagnosis?
a) Urinary Tract Infection
b) Bladder outflow disorder
45. What investigation would you order to confirm diagnosis?
a) PSA
46. What would be management for mild to moderate symptoms?
a) TURP
b) Watchful waiting
c) Medical treatment (IM)

SURGERY PAPER 2 2016 SMBBC

1. Case picture of upper GI endoscopy was given and patient had dysphagia
a. Next investigation A. biopsy of man
2. On CT, blurring of fat planes, aorta 180’, patient has dysphagia only for semi-solid, what
treatment?
a. Endoluminal stenting
b. Esophagectomy
3. Case picture given of gastric outlet obstruction
4. Appropriate method of staging for TNM classification
a. Staging laparoscopy
b. CT
c. MRI
5. On staging laparoscopy, patient ..can’t read the rest at all!
a. Metallic stenting
 b. Bypass gastrojujenostomy
c. Gastrectomy
6. Case 5 days ago patient had an anterior resection and now patient presents with low
grade fever and pain
a. Cause wound infection or anastomotic complication
b. Tx of above complication? Antibiotics?
7. Case Simple Renal Cyst
a. Simple renal cyst should be differentiated from? Hydatid cyst of kidney or complex
renal cyst?
b. Treatment of simple renal cyst? Excision or observation?
8. Case Patient has yellow sclera and soft abdomen
a. Dx > Cholangiocarinoma
b. U/S, histobiopsy, CT
c. Tumor marker > CA 19-9
9. Sclerotherapy preferred in?
a. Elderly
b. Infant + children
c. Young patient
d. Recurrent prolapse
e. Full thicken prolapse
10. Case Patient came in ER and generalized abdominal pain + continued vomiting, tender
rigid abdomen
a. DX sigmoid volvulus
b. Cause chronic constipation
c. DX Erect Abdomen X-ray
11. Suspected case of acute appendicitis on adult general examination, appendicular
something found on laprostomy?
a. Revise g/a
b. Appendictomy
12. Patient came in ER, cod 20hrs, sudden severe pain in RUQ, few bouts of vomiting, and
epigastric tenderness.
a. Dx, acute cholangitis or pancreatitis?
b. Investigation U/S (CT)
c. What complication could occur in above condition if not treated right?
i. Perforation
ii. Fistula
13. Case CA rectum
14. Regarding Barret Esophagus?
a. Easy to differentiate…
b. Occurs in upper 1/3 of esophagus
c. Every case is necessary for endoscopy and biopsy
d. Columnar cells esophagus
15. What can be used to treat barret esophagus?
16. Most common cause of mesenteric lymphadenitis?
a. Non specific lymphadenitis
17. Unit of absorbed dose of radiation?
 a. RAD..
18. Frequent complication of prostectomy?
a. Retrograde ejaculation
b. Erectile dysfunction
c. Incontinence
19. Female and pancreatitis mcc?
a. Gallstone
20. Testicular tumor most common?
a. Malignant
b. Teratoma
21. Testis not descended upto 3 months of age?
a. Unlikely to descend fully (IM)
b. Increased risk of malignancy
22. Swollen scrotum, feels like bag of worms?
a. U/S of testis
23. Treatment of perianal abscess
a. Incisions and drainage and deroofing
24. Retention of urine
a. Stricture
25. Mcc of stricture of urethra
a. Trauma
26. Widely used investigation for pancreas?
a. Amylase
27. D/D of inguinal hernia in man
a. Vaginal hydrocele
28. D/D of diverticular disease
a. U/S
b. CT
29. Femoral hernia D/D
a. Inguinal hernia
30. Which score system use to have appendectomy
a. Alvarado
31. Patient complain of R upper quadrant pain, leaning toward to relieve the pain, LFTs are
normally raised, serum amylase normal, lipase 2 ½ times normal
a. Acute pancreatitis
b. Cholecytitis
c. Mucocele
d. Empyema of gallbladder
32. Something about multiple cyst lesions of liver
a. Albendazole intial tx
b. CT ordered for further evaluation
33. Anal incontinence in young adult
a. Child birth trauma
b. Divided sphincter
34. In graft rejection following cell?
a. Mononuclear cell infiltration
 b. Macrophage
c. Neutrophil
35. Regarding hereditary spherocytosis?
a. Increased permeability to Na
36. Urinary retention, diverticular and groin
a. Cystoscopy
37. Not a cause of upper GI CA
a. H. Pylori
38. In tropical countries, rupture of spleen?
a. Malaria
39. M-C kidney tumor in adult?
a. Hypernephroma (RCC)
40. 45 year old female case of anal ca, 6cm from anal verge, no distant metastasis but 1.2
pararectal lymph node involved?
a. Anterior resection
b. Anterior resection + lymphadenctomy
41. Most common presentation of hemorrhoids
a. Tender to touch (on DRE)
42. Juvenile polyp?
a. Polypectomy
b. Endomucosal resection
43. Flexible endoscopy for upper GI bleed
44. Torsion of omentum > mimic as appendicitis
45. Salient spread of penile CA
a. Inguinal node (IM)
b. Pararectal node
46. Appropriate investigation to find cause of diffuse peritonitis
a. Peritoneal diagnostic investigation
b. U/S + CT
47. In university hospital, 27 yrs old man develop acute cholecystitis tx?
a. Lap chole
b. Open
48. Appropriate tx of 3rd degree hemorrhoid? (hemorrhoidectomy in IM)
a. Photocoagulation
b. Diathermy
c. Cryotherapy
49. Case figure esophagoscopy pt with progressive dysphagia
a. What should be done next? Biopsy of the man
b. For dysphagia (don’t remember the question) metallic stent
50. Figure endoscopy of pylorus
a. What should be done for T and N staging = EUS
b. Peritoneal multiple metastasis present what should be done in this lady to relieve
pyloric obstruction = gastrectomy,
51. Pt 35 years right iliac fossa, colicky abdominal pain and diarrhea. Barium shows narrow
ileum endoscopy shows inflammation and ulcer = u/c, crohn’s ?
52. Patient with right iliac fossa pain unequal vocal decide to to appendectomy Alvarado
53. Patient with h/o of acute pancreatitis now vague man and pain in abdomen CT shows
cyst in pancreas how will you do dx amylase
54. Diff diverticular disease from = carcinoma
55. Hemorrohoid = bleeding during defecation
56. Patient obese, pain in right hypochondrium, dyspepsia. Investigation = U/S abdomen
57. Diabetes mellitus causing drug = tacrolimus
58. Renal injury = CT wala option
59. Urethral stricture mcc = post gonoccal (in young ppl)
60. 18 months old per rectal bleeding painless cause = juvenile polyposis
61. Treatment of juvenile polyp = polypectomy, polypectomy + surveillance
62. Case = patient after 5 days of anterior resection develop mild fever and pain in lower
abdomen
a. Dx = wound infection,
b. Rx = antibiotic
63. Case = 70 year old man no known comorbid present in ER with generalized abdominal
pain and vomiting for 12 hours has passed flatus 1 day before on examination abdomen is
distended with rigidity.
a. Dx = sigmoid volvulus
b. Next investigation = X-ray (erect)
c. Which is most important/common predisposing factor in the above condition?
Previous surgery
64. Case = 35 year old married lady presents in ER with pain in right hypochondrium and
continuous vomiting for 20 hours O/E tenderness in epigastrium
a. Dx = acute cholecystitis
b. Complication most likely to occur if not treated = empyema, perforation,
pancreatitis, ?
c. Unit of absorbed radiation = Gray
65. 70 years old BPH prostectomy advised what is most common complication?
Retrograde ejaculation
66. Case (symptoms of intestinal obstruction) which is not systemic complication = renal
failure
67. Radio opaque stone = Ca oxalate
68. Lung embryology = primitive foregut 4th week
69. Bleeding PR proctoscopy normal do sigmoidoscopy
70. Strawberry gallbladder inside of gallbladder cholesterol crystals
71. Ascites TB color of fluid = hemmorhagic
72. On laparotomy greenish fluid = duodenal perforation due to acid disease
73. Extremes of age, faecolith, immunosuppress etc = appendiceal perforaton
74. Pain in right hypochondrium and epigastrium, relived by leaning forward, came to hospital
after 5 days….acute pancreatitis
75. Meckels diverticulum = remnant of vitelline duct
76. Desmoid tumor = 2.5 cm wide excision
77. Laparotomy gastric ulcer perforated most appropriate treatment?
a. Biopsy then wide excision of margin, 2 layer closure?
78. Sigmoid volvulus, gut viable on laparotomy what next?
a. Resection and anastomosis? Deflating by sigmoidoscope if viable, attach the
 sigmoid to the posterior abdominal wall, not viable than do Mickulz procedure.
79. Epidymo-orchitis and torsion of testis differentiated = elevation of testis relieve pain in
epidymo-orchitis.
80. Left varicocele which investigation = U/S
81. Undescended testis = laproscopy
82. Most common kidney tumor = hypernephroma (Renal cell carcinoma)
83. Unilateral undescended testis = sterility
84. If the testis does not descend in 3 months it is unlikely to descend
85. Case Pain right lumber region Dx as simple renal cyst
a. Rx observation
86. Differentiate from Hydatid cyst of kidney
87. Liver transplant acute rejection mononuclear cell infiltrate
88. Multilocular cyst on liver U/S what next? CT scan, Albendazole is the intial treatment.
89. The ring occlusion test = indirect inguinal hernia
90. MC o/d of femoral hernia = inguinal hernia
91. Young male inguinal hernia d/d = vaginal hydrocele
92. Case = 70 year old full thick prolapse 4 length
a. Preferred operation? Perineal approach delromes opertion
93. Sclerotherapy done in = infants and children
35 years old hematemesis most commonly caused by = duodenal ulcer
101.burns patient in icu, hematemesis diagnosed as stern ulcer what rx?
a. Sucralfate
94. Uncomplicated H. pylori rx = eradication
95. Common used factor for adenocarcinoma = FAP
96. Patient with rectal CA 6cm above anal verge…RX = neoadjuvant chemoradio
97. Rectum relations in female
a. Pouch of douglas
98. H/o of diarrhea, extrasphincteric anal fistula, what will be the cause intrasphincteric
abscess, trauma, cyptoglandular disease??
99. Appendicectomy is planned in GA in a patient with acute appendicitis on examination
man is found what should be done?
100.Ulcerative Colitis = sigmoidoscopy + biopsy
101.Mediastinal tumor thymoma
102.Testicular tumor most are malignant
103.Acute pancreatitis in elderly gallstone
104.Anal continence in young = sphincter division due to trauma
105.Hydatid cyst no treatment = when calcified
106.ERCP = urine retention wala option
107.Injury blood at meatus perineal swelling what dx
a. Urethral injury
108.Diffuse peritonitis = CT and U/S, diagnostic peritoneal aspiration
109.A 5 days after cholecystectomy fever, rigors…ascending cholangitis
110.3rd degree hemmorhoid
a. hemoridectomy
111.10 years old 4 hrs pain scrotum and swelling = testicular torsion
112.Adenocarcinoma = begin as benign polyp
113.Hereditary spherocytosis = Na permeability
114.Case Pt had pain in epigastrium, for ---- hours, yellow sclera and itching 2 weeks mass
palpable in epigastrium in upper abdomen + weight loss
a. Dx = cholangiocarcinoma
b. Investigation = Ct scan, Mrcp
c. Marker = CA 19-9, CEA
115.Female with mass at external anal verge between 3 & 7 degree clock most likely this pt,
due to HPV, SCC
116.Torsion of omentum = mistaken for appendicitis
117.Perianal abscess incision drainage and deroofing
118.Long pelvic mesocolon, residual diet etc = sigmoid volvulus
119.Proximal gastric cancer not associated with = H. pylori
120.In a uni, treatment of 29 year old lady with recurrent biliary colic
a. Laproscopic chole + open
121.Ileal atresia = abdominal distention
122.BPH differentiated from cancer = rectal mucosa
a. Moves freely
123.Therapeutic endoscopy = upper GI bleeding
124.What is measured in acute appendicitis amylase Alvarado score
125.Regarding esophageal disease = wrong one?

SURGERY PAPER 2 2015

1. Procedure done for infantile hydrocele? A. Jabouley’s procedure if acquired hydrocele
2. Features of strangulation?
a. Sudden colicky pain and tenderness over hernia site
3. Regarding antibiotic coverage in acute appendicitis
a. Metronidazole and third gen cephalosporins
4. A male neonate who hasn’t passed meconium, diagnostic modality:
a. Sweat test (diagnostic for cystic fibrosis)
5. Most important step in investigation of tense hydrocele (U/S > Jabolueys)
6. Treatment for Warts:
a. Podophyllin
7. Most common cause of urinary retention after 70 years of age?
a. BPH
8. Regarding peri uretheral transitonal zone
a. BPH in submucosal glands
9. Commonest cause of urethral strictures in young people?
a. Post gonorrhea , (trauma overall, post gon. in sexually active)
10. Ranson criteria:
a. Age > 55, WBC > 16000, LDH >700
11. In a specialized biliary unit, most common cause of biliary duct strictures?
a. Post choledochotomy
12. For P/V and proctoscopy, what is most important?
a. Consent
13. A patient with renal transplant 6 months back, comes with renal failure?
 a. Early rejection
14. Treatment of anal fissure?
a. Forceful manual 4-8 digit sphincter dilation in young patients (conservative > GTN,
Ditiazam)
15. Important factor related to burst abdominal and incisional hernia?
a. Improper suture material , suture technique (both in IM)
16. Which of the growth factor is over expressed in gastric ca?
a. ERBB2, VGEF
17. Regarding hereditary spherocytosis?
a. Most common cause spectrin deficiency
18. Most common cause of acute pancreatitis?
a. Gallstones
19. What will be the case of obstructive acute pancreatitis related to age?
a. Hyperlipidemia
20. Complication of hemoridectomy ?
a. Acute urine retention (early complication)
21. What will be the differentials for an obstructed inguinal hernia?
a. Testicular torsion , epididimitis
22. Most common site for upper GI cancers
a. Stomach
23. A Balochi guy comes with severe abdominal pain and distention
24. A patient treated with seminoma, but some remnants remained in intestine
a. Start salvage chemotherapy
25. Sebaceous cyst of testis:
26. A patient comes with abdominal mass, hypertension, and hematuria
a. Polycystic kidney disease
27. Familial adenomatous polyposis:
a. Mutation of APC gene on short arm of chromosome 5
28. CAD test
29. Diagnostic and therapeutic investigation in fistula? MRI is gold standard for fistula
imaging
30. A patient with dilated bowel loops, wbc > 20000, amylase of 100
31. A patient who is on table for hepatic flexure cancer, incidentally you find a 3x3 hepatic
metastasis, next step
a. Remove the portion of liver
32. A patient comes with dyspnea, flushing, and hypo echoic liver on sonography
a. Perform a biopsy
33. Splenic artery aneurysm has a strong association with?
a. Arteriosclerosis (atherosclerosis) (female sex)
34. A 60 years old male came with profuse bleeding per rectum, suspected case of colonic
diverticulitis, bleeding site couldn’t be established, next step in management?
a. Hartman’s Procedure
35. Frequency of transducer used in trans rectal ultrasound
a. 6.5
36. A 25 years old maid slipped and fell on upturned leg, sustaining perineal injuries, initial
question in ER?
 a. Does she pass urine
37. Commonest testicular tumor:
a. Seminoma
38. Pancreatic Pseudocyst
a. Encapsulated collection of amylase rich pancreatic fluid, develops 4 weeks after
pancreatitis.
39. A patient with squamous cell carcinoma of esophagus, T3M0N0, operation in this case
a. Mckeon Procedure
40. A Vietnam girl presents with gallstones?
a. Alcohol
41. Regarding prostatic venous plexus
a. A capsule sheath
42. Hyposapidias surgery
a. Performed between 9-18 months of age
43. Vagus
44. Complication of pneumoectomy
a. Bronchopleural fistula
45. OSPE UNDESCENDED TESTES
46. Regarding pancreatic pseudocyst
a. Encapsulated collection of amylase rich pancreatic fluid develops after 4 weeks of
pancreatitis
47. Regarding treatment of fourniere’s gangrene
a. High dose penicillin G or ceftriaxone IV and surgical debridement
48. Most common tumor mediatizing to lungs
a. Bladder (it should be prostate)
49. Regarding dentate line
a. Represents hindgut-proctodeum junction
50. Most common cause of acute abdomen
a. Acute appendicitis
51. Which cells are seen predominantly in graft rejection
a. Neutrophils (mononuclear cells IM)
52. Regarding adynamic obstruction:
a. Peristalsis may be present in non propulsive form
53. Etiology of achalasia
a. Dysfunction of inhibitory neurons in lower esophagus due to loss of ganglion cells
54. A 25 year old comes with a history of weak urinary stream, prolonged micturition time, and
dribbling of urine? Stricture
55. What are the therapeutic indications of flexible endoscopy?
a. Upper GI bleed
56. Most dangerous variation of cystic artery
a. Tortuous hepatic artery on front of origin of cystic duct.
57. A patient comes with his labs, PSA significantly raised, DX?
a. Prostatic CA
58. Regarding Hydatid cyst, no need of treatment if?
59. Phosphate stones:
a. Grows in alkaline medium
60. Cysteine stones (acidic)
a. Radio-opaque, hexagonal translucent
61. Which of the following are the most common bladder stones?
a. Calcium oxalate
b. Mixed stone (IM)
62. Regarding painless tuberculosis peritonitis (ascitc - IM)
63. Procedure of hernia repair with least recurrence
a. Hernioraphhy
64. Procedure resulting in least recurrence of peptic ulcer:
a. Highly selective vagotomy
65. A patient has a cyst in head of pancreas, next investigation?
a. CT Scan
66. Most common cause fistula in ano in our setup?
a. Intersphinteric gland infection
67. A patient known case of crohn’s disease, comes with multiple ano:
a. Seton placement
68. Recurrent fistula in ano, most important factor to look for: ?
69. A 12 years old boy has pain in scrotum for 3 hours, his both testicles higher than normal:
a. Prompt exploration for testicular torsion
70. Abdominal pain, early vomiting and absolute constipation:
a. Intestinal obstruction
71. Most important investigation for biliary cancer:
a. CA19-9
72. Treatment for femoral hernia:
a. Lockwood operation in elective cases
73. Regarding treatment for gastric lymphoma:
a. Associated with h.pylori

SURGERY PAPER 2 2015 SEMESTER 10

1. pancreatic pseudocyst with normal duct, tx?
a. Percutaneous aspiration
2. Pseudocyst takes weeks to develop
a. 4 weeks
3. During splenectomy, oversight mistake by surgeon
a. Panc fistula??
4. Hernia which is medial to inferior epigastric artery
a. Direct hernia
5. Recurrence of epigastric hernia, most common cause
a. Failure to find 2nd lesion during surgery
6. Main principle of doing surgery of colorectal ca ?
7. Sliding hernia definition hernia in which the posterior wall of sac is partially formed by
the wall of viscera (IM)
8. Hernia in children
a. Due to patent processes vaginalis
9. If > 1800 ml fluid in chest tube drain
 a. Prepare for thoracostomy
10. Simple test for pancreatic function
a. Fecal elastase
11. To check azotemia
a. MAP 3?
12. Chemotherapy for gastric Ca
a. ECF (epirastian cisplastin + flouroucaicil)
13. GERD symptoms
a. Heart burn + epigastric pain + regurgitation
14. Case of patient, diagnosis > perforated duodenal ulcer
15. Alcoholic patient, varices, t/m > endoscopic ligation ?
16. Emergency t/m for varices > octreotide?
17. t/m for early dumping > small meals + somatostatin
18. recurrence of ulcer mostly in > gastroenterostomy alone
19. least recurrence of hernia in >linchstein repair
20. Case of patient, diagnosis > strangulated paraumblical hernia
21. Hirschsprung dx, diagnosis, > rectal biopsy
22. Male patient, not passing meconium > Rectal biopsy
23. Most common atresia in neonate > duodenal
24. Most common organism in liver abscess > E. Coli
25. Case of patient, diagnosis > non specific proctitis
26. >6cm colon > toxic megacolon
27. more fistula in Pakistan due to > TB
28. fistula and abscess due to > intersphincteric gland infection
29. lumbar spine tender, vauge pain in RIF and fluctuant mass, DX? Prostatic abscess maybe
30. Counsel mother of a child having undescended testes > counsel for malignancy?
31. 12 year old boy with undescended testis do orchidopexy for > reduce risk of malignancy or
for psychological etc?
32. Necrosis in scrotum, tx? Surgical debridement
33. Gangrene in duodenojejunal junction > extensive enterectomy
34. Ca in pelvic colon, stoma site will be in ?
35. Ca 5 mm of anal verge > lower anterior resection
36. Most important etiology of perianal warts > anal intercourse or HPV
37. t/m of BPH > transurethral resection
38. MC injury of urethra > bulbar or membranous
39. When to do surgery in BPH > when flow is < 10
40. Hemothorax than becomes empyema, t/m > thoracotomy
41. Rectosigmoid obstruction > hartmann procedure
42. CVA patient, symptoms, Dx > pseudocolonic obstruction
43. Hirschsprung disease include > rectum and lower sigmoid colon
44. Child has foregin body in resp. tract > do flexible bronchoscopy
45. Pt has P/R bleed, suspected Ca, investigation > colonoscopy + biopsy
46. Pt and U.C after 10 years should have > colonoscopy
47. MC extra intestinal feature of U.C > arthritis
48. MC hematuria causing stone > oxalate
49. Most important step in management of cholangitis & obstructive jaundice > drainage of
 biliary tree?
50. Pt and recurrent stones check 3 times serum Ca + and 24 hour urinary urate?
51. Uric acid stone, correct > smooth, hard, multiple, radiolucent
52. 3 year old child, hematuria, mass in abdomen > Wilms tumor
53. feature of pelvic abscess > diarrhea with mucus, spiking pyrexia
54. Pt and something external piles, management > pain killers, cold/hot compress, rest or
surgery?
55. Mesenteric cyst, correct > more right angles to mesentery
56. Prostatic venous plexus > b/w autonomic capsule and prostatic sheath
57. For graft rejection, which cells > lymphocytes
58. For high risk fistula, t/m > fistulectomy
59. In appendix mass, stop conservative t/m, when > pulse rising
60. MC cause of perforation of appendix > fecolith
61. Widal test postivie, distended abdomen , no bowel sounds > paralytic ileus
62. Skene tubercles > homologus of prostate
63. 2 score of ranson in pancreatitis, mortality rate > 5%
64. Case: young female and pain in RIF and collapsing
a. Investigation > B-hcg
b. For confirmation > U/S abdomen
c. Suspected diagnosis > ruptured ectopic pregnancy
65. Case of peptic ulcer
a. Mc site of peptic ulcer > first part of duodenum
b. Urea breath test check what > urease
66. Case of men having LUTS (lower urinary tract symptoms)
a. Dx? BPH
b. Investigation > urodynamic studies or PSA?
c. For mild to moderate > drugs (alpha blockers and finistride)
67. Case: Esophageal CA
a. Investigation: upper GI endoscopy
b. T/m of squamous > chemoradiotherapy
c. Of recurrence > esophageal stent
68. Case: RTA
a. DX: flail chest
b. First abnormality > increased PCO2? (Hypoxia)
c. Thoracostomy when chest tube drain 300 ml/hr for 3 hrs (200ml/hr for 2-4hrs)
69. Case: dilated CBD…
a. Emergency management > NPO + IV antibiotics
b. Investigation > ERCP
c. If pain after ERCP > check amylase for post ERCP pancreatitis

SURGERY PAPER 2 2015 SEMESTER 10

1. pregnant lady in 3rd trimester presents with pain radiating to back, generalized tenderness
and rigidity, she has suffered the pain for last 3 weeks, diagnosis:
a. splenic artery rupture
b. aortic aneurysm
 c. acute cholecystitis
d. perforated appendix
e. acute pancreatitis
2. A lady presents with high grade fever, bilateral adnexal tenderness and vaginal discharge,
most likely diagnosis
a. PID
b. Acute diverticulitis
c. Acute appendicitis
d. Pyelonephritis
e. None of the above
3. Most common cause of esophageal perforation
a. Instruments
b. Drugs
c. Boerhaave syndrome
d. Infections
e. Gerd
4. Most common cause of perianal fistula
a. Infections
b. Surgery
c. Anal cancer
d. Crohn’s disease
e. Anal intercourse
5. A patient 3 days after cholecystectomy develops high grade fever, jaundice and rigors.
What is the cause?
a. Aseptic peritonitis
b. Leaking bile duct
c. Liver abscess
d. Ascending cholangitis
e. Chemical peritonitis
6. A patient presents with acute abdominal pain, tenderness and guarding in LIF. Sigmoid
volvulus is diagnosed, what will be the treatment if it is viable on laparotomy
a. Decompression per anum
b. Resection and anastomosis
c. Leave intervention and close abdomen
d. Barium enema
e. Stoma formation
7. Long mesentery, narrow attachment of pelvic colon, band of adhesions and overloaded
pelvic colon of descending colon predisposes to (sigmoidopexy)
a. Ileal volvulus
b. Cecal volvulus
c. Transverse colon volvulus
d. Sigmoid volvulus
e. Sigmoid infarction
8. Acalculous cholecystitis is found in
a. Burns
b. Fever
 c. Infections
d. Hemolytic anemia
e. Choledocholithiasis
9. GIST treatment
a. Gemcitabine
b. Methotrexate
c. Cisplatin
d. Imitanib
e. Ru-486
10. Regarding desmoid tumor
a. Arises from musculo-aponeurotic structures of abdominal wall
b. Is an encapsulated tumor
c. Is treated by wide excision of 2.4cm around it
d. Is more common in female
e. Sarcomatous change never occurs
st
11. 1 line of therapy for anal canal cancer
a. local wide excision
b. abdomino perineal resection of rectum
c. chemo radiotherapy
d. surgery and post op
e. neo-adjuvant chemotherapy
12. A thin lean man presents with high grade fever, rigors chills and palpable splenomegaly,
Treatment
a. Partial splenectomy
b. Anti malarial
c. Antibiotics
d. Total splenectomy
e. Anti cancer agents
13. Regarding dynamic obstruction
a. Altered motility of proximal gut, normal peristalsis and absorption of distal gut with
gas formation and fluid accumulation in proximal part
b. Altered motility of proximal part, distal gut collapsed with anti-peristalsis
c. Altered motility of distal part and proximally gut dilated
d. Altered motility of proximal part with distal gut distended with gas and fluid
e. Altered motility in whole gut irrespective of segment of gut involved
14. Symptoms of acute appendicitis occur in following sequence
a. Periumblicial pain shifting to RIF, anorexia, nausea and low grade fever
b. Nausea, vomiting, RIF pain and diarrhea
c. Fever, lower abdominal pain, nausea and vomiting
d. High grade fever, periumblicial pain shifting to RIF and absolute constipation.
e. Generalized abdominal pain, high grade fever, nausea and constipation
15. A patient presents with fever, pain in rt. Lumbar region, he is unable to walk as it
aggravates on walking extension to groin is also seen
a. Pelvic abscess
b. Peri-nephric abscess
c. Psoas abscess
 d. Obturator obscess
e. Mycotic aneurysm
16. Feature of aorto-enteric fistula
a. Bright red bleeding PR
b. Bright red hematemesis
c. Chocolate brown stools
d. Melena
e. All of above
17. Regarding diagnosis of hirschsprung disease
a. Sigmoidoscopy and rectal biopsy
b. Sigmoidoscopy
c. Rectal biopsy only
d. Coloncoscopy and rectal biopsy
e. Manometry, sigmoidoscopy and rectal biopsy
18. A patient presents with symptoms of intestinal obstruction. Imaging shows many
strictures and transverse ulcers. Diagnosis
a. Mesenteric adenitis
b. Tuberculosis
c. Ulcerative colitis
d. Crohn’s disease
e. Pseudo membranous colitis
19. An IV drug abuser presents with fever, mediastinal pain and signs/symptoms of shock. He
has history AIDS. X-ray shows air in mediastinum. What might be the cause of it?
a. Instruments
b. CMV infectioin
c. Candida infection
d. Toxoplasmosis infection
e. Drugs
20. Best treatment for controlling Varices
a. TIPSS
b. Liver transplantation
c. Banding
d. Balloon tamponade
e. Sclerotherapy
21. A 76 year old patient presents with acute abdominal pain, generalized rigidity and shock.
He had an MI 6 days back, he is hypertensive and diabetic. An urgent laparotomy is done
and extensive gangrene from duodeno-jejunal flexure to upto sigmoid colon is seen. What
is the appropriate treatment?
a. Resection and anastomosis
b. Massive enterectomy
c. Anticoagulation
d. Resection and permanent jejuna stoma formation
e. Resection and temporary stoma formation
22. Liver transplant in acute liver failure is indicated when
a. pH < 7.30
b. PT > 100s
 c. Serum creatinine > 300 umol
d. Age < 10 years or > 40 years
e. Bilirubin > 300 umol
23. A girl aged 20 is being operated for stones in cystic duct via laparoscopy. The stone slips
back into gall bladder. What will be the Rx now?
a. Choledochotomy
b. Laparoscopic cholecystectomy
c. Open cholecystectomy
d. Leave surgery and close the ports
e. None of above
24. Feature of budd chiari syndrome
a. Thrombosis of intra hepatic vein with no residual change
b. Thrombosis of both intra and extra hepatic veins
c. Presents with ascites, portal hypertension and hepatomegaly
d. Ivc compression occurs early
e. Is a surgical emergency
25. Fistula in ano Rx
a. Setons
b. Advancement flaps
c. Fisulotomy
d. Fistulectomy
e. Marsupialization
26. Obstructive appendicitis presents as
a. Generalized pain from start (IM)
b. Anorexia and nausea
c. Genrelized abdominal pain, tenderness and diarrhea
d. Periumblicial pain and constipation
e. All of above
27. A middle aged man develops fever, diarrhea after appendectomy. Which drugs should be
given
a. Ciprofloxacin
b. Ceftriaxone
c. Clindamycin + metronidazole
d. Amoxil + metronidazole
e. Ciprofloxacin + metronidazole
28. Pelvic abscess feature is
a. Spiking pyrexia, tenesmus, frequent stools
b. Spiking pyrexia and diarrhea
c. Low grade fever and elevated lymphocytes
d. High grade fever and chills, rigors.
e. High grade fever, tenesmus and constipation
29. A women gave birth of baby 1 day ago, presents with complains of something coming out.
Cause is:
a. Instrumental injury
b. Vaginal trauma due to birth
c. Weakend pelvic floor
 d. Stretched or torn pelvic ligaments
e. All of above
30. A 10 year old child gas got trauma to testes, best management in this age group is
a. Incision and drainage
b. Evacuation of blood and repair of tunica albuginea
c. Conservative management is required
d. Aspiration by needle
e. None of above
31. A patient operated for cholecystitis develops low grade fever, discharge form wound what
is the cause?
a. Leaking anastomosis
b. Wound infection
c. Atelectasis
d. Aseptic peritonitis
e. None of above
32. Early dumping is best treated by
a. Frequent small meals + somatostatin
b. Somatostatin
c. Antacids
d. H2 antagonists
e. PPI
33. Late dumping is relieved by
a. Food (and octreotide)
b. Lying down
c. Exercise
d. Alcohol
e. PPI
34. Testicular CA spreads with
a. Lymphatics
b. Blood
c. Both blood and lymphatics
d. Local spread
e. All of above
35. Hepatic metastasis and response to treatment is assessed by
a. CT scan
b. MIR scan
c. PET scan
d. Biopsy
e. All of above
36. Indication of bronchoscopy
a. Confirmation of carcinoma lung
b. Tissue biopsy
c. Removal of foreign bodies
d. Evaluation of hemoptysis
e. In cardiac surgery (odd one out)
37. Skenes Tubercles
 a. Female homologue of seminal vesicles
b. Female homologue of prostate
c. Female homologue of cowpers gland
d. Male homologue of labia majora
e. Male homologue of bartholin’s gland
38. Most common extra intestinal complication of UC
a. Biliary cirrhosis
b. Primary sclerosing cholangitis
c. Secondary sclerosing cholangitis
d. Arthritis (migratory polyarthritis IM)
e. Episcleritis
39. Most common cause of mesenteric cyst
a. Infections
b. Trauma
c. Surgery
d. Congenital
e. Ileal perforation
40. Most common complication of cyst
a. Infection
b. Erosion into adjacent structures
c. Resolution
d. Bursting into peritoneum
e. Hemorrhage
41. Perianal hematoma is diagnosed in a patient, his age is 50, and he is hypertensive. What
should be the management?
a. Marsupilization
b. Banding
c. Sclerotherapy
d. Evacuation of clot under local anesthesia
e. Pain killers
42. Most common DD of femoral hernia
a. Direct inguinal hernia
b. Saphena varix
c. Femoral artery aneurysm
d. Indirect inguinal hernia
e. Littre’s hernia
43. Most common cause of acute pancreatitis in young men is
a. Gall stones
b. Alcohol
c. Infected bile
d. Hemolytic anemia
e. Solitary life style
44. Most common symptom of meckel diverticula
a. Asymptomatic
b. Hemorrhage
c. Pain
 d. Nausea
e. Diarrhea
45. Para umblical hernia best treatment
a. Shouldice method
b. Lylte’s method
c. Umblical herniorraghy
d. Paraumblical hernioplasty
e. Lipectomy
46. Regarding epigastic hernia
a. Occurs through triangle of petit
b. Occurs through linea alba
c. Has a small sac
d. Comprises of omentum/extra peritoneal fat only
e. Majority of these hernia’s are asymptomatic
47. Regarding post thoracotomy pain
a. Is because of intercostal nerve entrapment
b. Is treated by PCA
c. Relieved by local anesthetic into wound and beneath pleura
d. Alters the breathing pattern and gas exchange
e. Maybe due to rib fracture during surgery (odd one out)
48. Laparoscopic herniorraphy
a. Done in inguinal hernia
b. Done in femoral hernia
c. Is commonly associated with increased mortality
d. Is done in recurrent bilateral hernia
e. Mesh repair is not necessary
49. Regarding peutz jeugar syndrome
a. Is an autosomal dominant tract
b. Multiple hamartomas affecting whole small and large bowel are present
c. Melanosis of lips and buccal mucosa is present
d. Associated with colorectal, breast, ovarian, cervical, breast carcinoma
e. All of above
50. Genital warts is caused by
a. Condyloma accuimnata
b. HPV
c. HBV
d. Syphilis
e. Birds flu
51. Most common cause of duodenal obstruction
a. Cancer of duodenum
b. Cancer of pylorus
c. Annular pancreas
d. Duodenal atresia
e. Carcinoma of head of pancreas
52. Most important question after female perineal injury
a. Passage of urine after trauma or not
 b. Bleeding
c. Type of trauma
d. Position at time of impact
e. None of above
53. A patient presents with worsening discoloration of skin, pale stools and itching.
Abdominal is soft and non tender. He lost 10kg in past 4 months
a. Gall bladder Carcinoma
b. Cholangiocarinoma
c. Carcinoma of head of pancreas
d. Hepatoma
e. Obstructive jaundice
54. Location of peptic ulcer most commonly is
a. Body
b. Fundus
c. Pylorus
d. Antrum
e. Lesser sac
55. Intestinal obstruction in surgery is mainly due to surgery of
a. Cecum
b. Appendix
c. Ileum
d. Duodenal
e. Jejunum
56. Most common DD of appendicitis in children is
a. Gastroenteritis
b. Mesenteric lymph adenitis
c. Yersinia infections
d. TB
e. Ileal crohns disease
57. Best operation of hernia with least recurrence rates
a. Mcewen
b. Lichtenstein
c. Shouldice
d. Lytle’s hernia
e. Herniotomy
58. Best investigation in undescended testes
a. X-ray KUB
b. US KUB
c. CT scan KUB
d. MRI KUB
e. Nuclear imaging
59. Eitology of UC
a. Smoking has not a protective effect
b. Is an autosomal dominant tract
c. Smoking has a protective effect
d. Is an environmental disease
 e. HLA B27 predisposes to UC
60. Gold standard treatment of BPH
a. Radical prostatectomy
b. Modified radical prostatectomy
c. NOTES
d. TURP
e. Medical management
61. Dangerous complication of UC
a. Primary sclerosing cholangitis
b. Episcleritis
c. Toxic mega colon
d. Erosive arthritis
e. Anterior uveitits
62. Level of obstruction in infants is clinically assessed by
a. Color of vomitus
b. Diarrhea
c. Abdominals distention
d. Visible peristalsis
e. Color of stools
63. Commonest cause for perforation of appendix
a. Extremes of ages
b. Fecolith obstruction
c. Immunosuppression
d. Diabetes
e. Pelvic appendix
64. A patient presents with bleeding PR, nothing seen on proctoscopy. Next inv.
a. Sigmoidoscopy
b. Colonoscopy
c. MRI
d. CT scan + colonoscopy
e. Capsule endoscopy
65. Best inv. For ulcerative colitis
a. Barium enema
b. CT scan
c. Colonscopy and biopsy
d. Sigmodoscopy
e. X-ray
66. No. of calyces in kidney
a. 4
b. 6
c. 7
d. 9
e. 5
67. Regarding hereditary spherocytosis
a. Presents late
b. Is due to defective Na channel (increased permeability)
 c. Is autosomal recessive disease
d. Repeated blood transfusions is necessary (Medscape)
e. Aggravates in summer
68. Dangerous variation of cystic artery
a. Short cystic artery
b. Tortuous hepatic artery taking course on sort cystic artery
c. Hepatic artery is short and cystic is long
d. Tortuous and short hepatic artery
e. No one of above
69. Pancreatitis occurs due to enzyme
a. CCK
b. Pancreoezymin
c. Typsin
d. Secretin
e. VIP
70. Most common site for ectopic testes
a. Intra abdominal
b. Intra scrotal
c. Deep inguinal ring
d. Root of penis
e. Superficial inguinal ring
71. Case: a patient is diagnosed having simple cyst. It should be differentiated from?
a. Renal cell carcinoma
b. Hydatid cyst
c. Neuro endocrine tumor
d. Polycystic kidney
e. Wegeners granulomatosis
72. Treatment should be
a. Observe
b. Excise the cyst
c. Partial nephrectomy
d. Total nephrectomy
e. Enucleation of cyst
73. Case: a patient presents with low grade fever, lumbar pain, increased urinary frequency
and on urine c/s no organism is found. Urine DR shows sterile pyuria. Diagnosis
a. Renal cell carcinoma
b. Renal TB
c. UTI
d. Hemorrhagic cystitis
e. Polycystic kidney
74. Treatment should be
a. ATT
b. Cystectomy
c. Cisplatin
d. Antibiotics partial nephrectomy
75. Case: middle aged patient presents with acute onset of pain in loin region which is
 radiating to groin. He has a past history of similar attacks. His labs shows Ca 13mg/dl,
PTH 20 U, Na 139, Cl 103, K 3.1 Dx?
a. Primary hyperparathyroidism
b. Secondary hyperparathyroidism
c. Renal failure
d. Malignancy
e. Idiopathic
76. Treatment will be
a. Conservative management
b. ESWL
c. Pyellithotomy
d. Nephrolithtomy
e. Dormia basket
77. Case: A patient presents with something coming out from anal canal. It goes back by
manipulation. A diagnosis of full thickness prolapsed is made. Tx? (full thick is 6 x more in
females)
a. Delromes operation eldery and young males
b. Abdominal rectopexy females
c. Sacro rectopexy
d. Perineal rectosigmoidectomy
e. Rectopexy with resection
78. Case: a patient operated for appendix 5 days ago now presents with pain, erythema
around wound and discharge from wound. Treatment?
a. Saline irrigation and antibiotics
b. Antibiotics and anti pyretics
c. Saline irrigation, antibiotics and pain killers
d. Remove sutures and leave wound open
e. Antibiotics only

SURGERY PAPER 2 2014

1. Most common cause of rectal prolapse in children is: Diarrhea

2. Most common location of appendix is: Retrocecal

3. Commonest complication of urethral stricture: Urinary retention

4. Most common testicular tumor: Seminoma

5. Regarding early dumping: A complication of gastric bypass surgery

6. Anorectal carcinoma is mostly associated with: HPV

7. Investigation of diffuse peritonitis: Diagnostic peritoneal lavage (DPL is done in Trauma)

8. Gold standard treatment for BPH: TURP

9. In case of obstructive jaundice, the first investigation: Ultrasound scan (LFT’s 1st, Investigation
of choice U/S)

10. Most common predisposing cause of testicular torsion: Inversion of testis

11. In upper GI Bleeding, investigation of choice is: Endoscopy

12. Peutz Jeghers Syndrome: Hamartomatous lesions

13. Not a complication of ulcerative colitis: Diarrhea

14. Regarding meckel's diverticulum: If narrow mouthed, remove it

15. Condition that does not present with respiratory distress in infants: Pulmonary sequestration

16. Normal pressure of lower esophageal sphincter: 30 - 50 cmH2O

18. Most common intussusception in children is: Ileocolic

19. Most common cause of epididymitis in young adult men: Chlamydia

20. First line investigation for liver disease: Ultrasound (LFT’s 1st, Investigation of choice U/S)

21. Most common post operative complication after appendicectomy: Wound infection

22. Uric acid stones: Hard, smooth, multiple and radiolucent

24. Treatment of acute colitis in ulcerative colitis: Steroids

26. 27 year old patient complains of bloody episodic diarrhea for 3-4 weeks, malaise, weight
loss. On colonoscopy there is loss of vascular pattern and granularity, Diagnosis: Ulcerative
colitis

27. Most common complication of hemorrhoids: Strangulation and thrombosis

28. Commonest position of ectopic testis: Superficial inguinal pouch

30. Association of gastritis and H. pylori in: Type B gastritis

31. Operation of choice in infantile hernia: Herniotomy

32. Most dangerous variation during open cholecystectomy: Short cystic artery arising from
tortuous artery in front of cystic artery hepatic artery

33. Recurrent stones common in: Hyperparathyroidism

34. Patient with abdominal distension, vomiting and absolute constipation, most appropriate
early investigation: X Ray

35. Condition that should be differentiated from appendicitis: Mesentric adenitis

36. Gastric carcinoma common at: Esophagogastric junction

37. Most common site for Crohn's Disease: Ileum

38. Initial imaging modality for gall stones: Ultrasound

39. For dysphagia, first investigation: Barium study of esophagus

40. Testicular tumor would involve which nodes first: Para-aortic

42. Most common cause of acute pancreatitis in our country: Gall stones

43. Regarding direct inguinal hernia: Repaired by mesh implant

44. Most common cause of gastric mucosal barrier breakdown: NSAIDs

46. Pancreatitis is primarily due to activation of: Trypsinogen

48. Teratoma marker: AFP

49. For hydatid cyst, most common scolicidal fluid injected is: 20% saline

50. Most common complication of typhoid: Paralytic ileus (IM)

51. Obstructive acute appendicitis presents with: Generalized pain from start (IM)

52. Commonest cause of bilious vomiting in infants: Duodenal atresia

54. Most common bacteria from GI tract causing peritonitis: E. coli (IM)

55. Aetiological factor most related to ulcerative colitis: Genetic predisposition

56. Best statement about intussusception: Proximal into distal part

57. Treatment of choice in 3rd degree hemorrhoids: Hemorrhoidectomy

58. Regarding testicular tumours, correct statement is: All are malignant??? (wrong)

59. Ectopia vesicae is associated with: Epispadias

60. Commonest abdominal complication of peritonitis: Adhesional small bowel obstruction (IM)

61. In case of hypospadias, always avoid: Circumcision

62. Femoral hernia best statement: Most liable to become strangulated

63. Most severe form of hypospadias: Perineal

64. Most common site of GISTs: Stomach and duodenum

66. A highly mobile lump in the breast is: Fibroadenoma

67. The preferred treatment of a pelvic abscess is: Rectal drainage

68. Regarding duodenal ulcers: Anterior ulcers cause perforation

69. Most common cause of ascites: CHF (CLD - Cirrhosis)

70. Most useful clinical sign of CLD: Flapping tremors

71. Cystine calculi: Change color from yellow to green when exposed to air

72. In small bowel obstruction: Pain is predominant with central distension

73. Regarding intestinal diverticulae: Duodenal diverticulae mostly occur on inner wall of 2nd and
3rd part of duodenum

74. Peyronie's disease is treated by: Nesbit’s operation

75. Incomplete descent of testis is commonly associated with: Indirect inguinal hernia

76. Predisposing causes of sigmoid volvulus include all except: Sigmoid more than 25cm

77. Possible complications of pancreatic pseudocysts include all except: Carcinomatous

changes

78. Morbid obesity BMI greater than: 35 (40)

79. Operative procedure with least long term recurrence rate in adult inguinal hernia: Lichenstein
Hernioplasty

81. Commonest type of esophageal atresia and TEF: Type C

83. Adenocarcinoma of colon: Columnar cell in origin

84. Incidence of recurrence following duodenal ulcer operation is higher in: Gastroenterostomy
alone (if option for gastroenterostomy + vagotomy choose that)

85. Most common surgical complication of peptic ulcer: Perforation

86. Fistula in ano: Track between anal canal and perineal skin

87. Acute hepatocellular damage is confirmed by measuring: ALT

88. Initial treatment of ascites in liver disease: Salt restriction

89. 90 year old woman found to have gall stones on routine testing. Further course of
management: Leave alone

90. In which liver tumor biopsy is contraindicated: Hemangioma

91. High intestinal loop syndrome usually causes: Fat malabsorption

92. Which of the following stimulates motility: Histamine (via H2 and H3 receptors)

93. Staging of hepatocellular carcinoma does not include: Cirrhosis

94. Traditional treatment of urethral stricture: Intermittent self dilatation

96. After injury to pancreas. pseudocyst develops. If the main duct is intact, most appropriate
management would be: Percutaneous aspiration

97. Hernia commencing as a protrusion of fat through linea alba: Epigastric hernia

98. Which part of urethra is most liable to injury: Membranous urethra

99. Urinary diverticulae are most frequently diagnosed incidentally on: Cystoscopy

SURGERY PAPER 2 2014

Q. Hyatid cyst can be managed conservatively when?
Calcified
Less than 5cm
Unilocular

Q. Fournier gangrene treated by?

Wide surgical debridment of necrotic area and antibiotics (my answer)

Q. Cannonball lesion of X-ray in a 20 year old guy (picture question tha) .... which organ to be
investigated?
Kidney (IM)
Testis
Liver

Q. Patient develops mass in the epigastrium after an acute attack of pancreatitis. Can be best
treated by? (I assumed it was a pseudocyst)
Percutaneus drainage
Endoscopic drainage
Laproscopic resection

Q. A 17 year old guy develops a painless swelling in the abdomen measuring 10x12cm. Most
appropriate management?
Observation - hematoma
Laprotomy and excision - tumor
Laprotomy and marsupilization hydatid cyst

Q. A patient has had 5 surgeries for fistula and presents to the clinic for another one. Best
managed by.
Search for underlying malignancy or cause (my answer) (MRI is best investigation)
Use of setons
Can't remember more

Q. Best imaging modality in elderly patients presenting with right hypochondriac pain?
CT scan abdomen
U/S followed by CT abdomen
MRI
Some Technetium scan

Q. A 52 year old gentleman presents with an acute attack of pancreatitis, ranson score of 7. On
4th admission day (or post-op) he develops hypotension and tachycardia. An abdominal X-ray
showed multiple air fluid levels, U/S showed cholecystitis, his amylase levels are 100U and his
abdomen shows rigidity and tenderness. What is the most likely diagnosis? (possibily the best qs
of the paper)
Perforated peptic ulcer
Acid peptic disease
Acute cholecystitis
Intestinal obstruction
Pancreatitis

Q. Imaging modality for fistula (can't remember the exact qs)

MRI

Q.Etiology of burst abdomen and incisional hernia?

Superficial wound infection
Wound infection (it should be wound dehiscence)

Q. Most common d/d of obstructed inguinal hernia

Vaginal hydrocele
Femoral hernia

Q. Femoral hernia repaired by?

Some answer of closure of femoral canal (Lockwood operation)

Q. Cysteine stones are radio-opaque, hexagonal translucent

Q. Phosphate stones are radio-opaque

Q. In adynamic obstruction?
In paralytic ileus there is no peristalsis
In all of these there is no mechanical obstruction

Q. was a picture of 12 year boy who had a proper penis but no scrotum. He presented to the OPD.
His condition can be best described as.
Atresia of testis
Undescended testis
Retractile testis
Post Orchydectomy (my answer, since no testis would mean no penis)

Q. HPV is treated by?

Podophyllin
Q. Regarding mesenteric injury?
Is caused by decelerating car injury (IM)
Transverse laceration is treated by resection of affected intestine. (IM)

Q. Painless form of TB peritonitis

Ascitic form

Q. Operation done for squamous cell carcinoma of esophagus?

McKeown.

Q. Patient ingested caustic soda. Develops multiple strictures in the esopagus. Best treated by?
Resection of affected segment and placement of esophagus tube.

Q. Transition (peri urethral) zone of prostate is a site for ?

BPH

SURGERY PAPER 2 2014

anal cancer asociation: hiv/ hpv

3. Sacrococcygeal teratoma - arises from cocyx

4.nesbit operation : peyronie’s disease

8. rectal drainage

9.per-rectal drainge

10.cortocosteroids: severe UC

11. commonest site for GI tumour GE junction

12.Hydatid cyst: albendazole

13.adhesion

14.non op cause: inflammatory

15.pseudocyst definition

17.hemorrhoidectomy complication - retention of urine (early)

19.biliary pancreatitis/ pancreatic pseudocyst

20.ulcerative colitis scenario

21.hernia diaphragmatic: (incorrect) immediately after operation

22.pancreatitis-trypsinogen

23.antireflux surgery n PPI

24. H.pylori eradication therapy - ppi+metro+amox bailey

25.ritcher hernia (portion of intestine)

26.appendix perforation (symptoms)

27. finger tip - (hernia exam).

28 picture - sliding hernia/richter hernia/ interstitial

29.observation (mucosa of gall bladder)

30.hernia 6 month child(longest option)

31.convince mother(it will reduce chance of malignancy)

32. 12yr child come after orchidopexy decrease risk of malignancy

33.testis will not descend fully after 3 month

34.CBD stone- ERCP +laprascopic cholecystectomy

39. Cyst with renal failure - renal transplantation

40.femoral hernia - operate urgent in the groin

41.Torsion testic - inversion of testis

42.comonly associated with inguinal hernia

43.meckel cause of hemorrhage

44.direct hernia - mesh repair

45.type B gasritis/ type A gastritis

47. nsaid ulcers perforated ulcer first treatment if resuscitate and analgesic for the first 48
hours perforated ulcer

48. cholangiocarcinome(stenting)
49.vietnamiese woman - Worm infection

50. splenic artery aneurysm -more in female

51.splenic rupture -splenectomy

52. appendicitis(extremes of ages)

53. Appendix most commonly retrocecal

54.diverticulum of bladder: cystoscopy

55.jj stent: decrease intra renal pressure or nephrostomy is preferred in infection / stent is used
to maintain patentcy of the renal parenchyma something

57.int obstruction- vomiting, absolute constipation, pain, distension

58. UC (serosa clear, colon involved)

59.diffuse peritonitis: diagnostic peritoneal lavage/ US-CT

60.ectopic vesicae associated with epispadiasis

61. Chordee - bending fwd

62.citrobacter (not a cause of epididymo-orchitis)

63.prostate ca (psa high)

64.dna testing (cystic fibrosis)

66.early dumping (vasomotor symptoms)

67.upper GI endoscopy (endoscopy)

68.graft rejection: hla antigen

69.dentate line white, morpho plus surgical importance

70. Anterior duodenal ulcer perforates

72. esophageal tef with distal tef

73. Pyelonephritis Urine DR and Culture / urea

74. Lung tumour - pancoast

75. colostomy with large bowel obstruction

76. Biopsy contraindicated in hemanigioma

77.post cholecystectomy: pre-op symptoms

78. Sigmoid volvulus (band adhesion, pelvic mesocolon

79.anal fissure- child birth trauma

80.budd chiari- hepatic venous thromobosis?

81.stomach n duodenum (gist)

82. prostate plexus between capsule etc

83. endocrine neoplasm of pancreas seen on CT

84. UC associated with sclerosing cholangitis

85. ascites CHF

86. sickle cell elongated and disrupted cell

87. receptor Dr adhesin, type 1 mannose sensitive/ resistant ?

88. enterochromaffin cells in stomach histamine has major role

89. post thoracotomy pan injected between the plueral space

90. Mesentric infarction presents as ?

91. definition of apoptosis

92.patient with left chect trauma

93. suture used to close cystic duct Prolene ?

SURGERY PAPER 2 2014

1. Treatment for Warts:
a. Podophyllin
2. Commonest cause of urethral strictures in young people?
a. Post gonorrhea
3. Ranson criteria:
a. Age > 55, WBC > 16000, LDH >700
4. In an specialized biliary unit, most common cause of biliary duct strictures?
a. Post choledochotomy
5. For P/V and proctoscopy, what is most important?
a. Consent
6. Important factor related to burst abdominal and incisional hernia?
a. Improper suture material, improper technique (both in IM)
7. Which of the growth factor is over expressed in gastric ca?
a. ERBB2, VGEF
8. Regarding hereditary spherocytosis?
a. Most common cause spectrin deficiency
9. Complication of hemoridectomy?
a. Acute urine retention
10. What will be the differentials for an obstructed inguinal hernia?
a. Testicular torsion , epididimitis
11. Most common site for upper GI cancers
a. Stomach
12. A patient has a cyst in head of pancreas, next investigation?
a. CT Scan
13. Most common cause fistula in ano in our setup?
a. Intersphinteric gland infection
14. A patient known case of crohn’s disease, comes with multiple ano:
a. Seton placement (do resection)
15. Recurrent fistula in ano, most important factor to look for:
16. A 12 years old boy has pain in scrotum for 3 hours, his both testicles higher than normal:
a. Prompt exploration for testicular torsion
17. Most important investigation for biliary cancer:
a. CA19-9
18. Treatment for femoral hernia:
a. Lockwood operation in elective cases
19. Regarding treatment for gastric lymphoma:
a. Associated with h.pylori (do chemotherapy)
20. Sliding hernia:
a. Exclusively in men
21. Most dangerous variation of cystic artery
a. Tortuous hepatic artery on front of origin of cystic duct.
22. A patient comes with his labs, PSA significantly raised, DX?
a. Prostatic CA
23. Regarding Hydatid cyst, no need of treatment if?
24. Phosphate stones:
a. Grows in alkaline medium
25. Cysteine stones (acidic)
a. Radio-opaque, hexagonal translucent
26. Regarding painless tuberculosis peritonitis (ascitic form)
27. Procedure of hernia repair with least recurrence
 a. Hernioraphhy (Lichtenstein)
28. Procedure resulting in least recurrence of peptic ulcer:
a. Highly selective vagotomy
29. Couldn’t read it
30. Arterial piles
31. Regarding dentate line
a. Represents hindgut-proctodeum junction
32. Most common cause of acute abdomen
a. Acute appendicitis
33. Which cells are seen predominantly in graft rejection
a. Neutrophils (mononuclear)
34. Regarding adynamic obstruction:
a. Peristalsis may be present in non propulsive form (IM)
35. Etiology of achalasia
a. Dysfunction of inhibitory neurons in lower esophagus due to loss of ganglion cells
36. A 25 year old comes with a history of weak urinary stream, prolonged micturition time, and
dribbling of urine? Stricture
37. What are the therapeutic indications of flexible endoscopy?
a. Upper GI bleed
38. A Vietnam girl presents with gallstones?
a. Alcohol
39. Regarding prostatic venous plexus
a. A capsule sheath
40. Hyposapidias surgery
a. Performed between 9-18 months of age
41. Vagus
42. Complication of pneumoectomy
a. Bronchopleural fistula
43. A Balochi guy comes with severe abdominal pain and distention
44. A patient treated with seminoma, but some remnants remained in intestine
a. Start salvage chemotherapy
45. Sebaceous cyst of testis:
46. A patient comes with abdominal mass, hypertension, and hematuria
a. Polycystic kidney disease
47. Familial adenomatous polyposis:
a. Mutation of APC gene on short arm of chromosome 5
48. A 60 year old male patient presents with tenesmus, bleeding PR, and mucous discharge
from rectum ?
a. Diverticular disease
49. A female presents with tenesmus, bleeding PR, fever, anorexia, pus, and hyperemia, dx?
a. Ulcerative colitis
50. A patient with dilated bowel loops, wbc > 20000, amylase of 100 (if amylase is 1000 than
its perforation)
51. A patient who is on table for hepatic flexure cancer, incidentally you find a 3x3 hepatic
metastasis, next step
a. Remove the portion of liver
 52. A patient comes with dyspnea, flushing, and hypo echoic liver on sonography
a. Perform a biopsy
53. A 72 year old male comes with complains of back pain and urinary tract obstruction,
investigation?
a. PSA
54. Investigation done for motor neuron disease
a. EMG
55. Regarding acuoustic neuroma,
a. Hearing loss is invariable
56. Young patient comes with lymphoadenopathy, fever, splenomegaly and abdominal pain,
Hb is 11 dx?
a. MP
57. A patient with aplastic anemia, bone marrow aspiration = dry tap. Next investigation
trephine biopsy.
58. A female develops fever, rash and desquamation of hands after she delivered a baby. Her
blood pressure is 80/50. Dx?
a. Toxic shock syndrome
59. A male taking some drugs for congestive heat failure, develops breast enlargement :
spironolactone

SURGERY PAPER 2 2013

1. Differential Diagnosis for obstructive testis is?
A. Vaginal hydrocele
B. Testicular hematoma
C. testicular cancer
D. Spermatocele
E. All of the above

2. Regarding mesenteric arterial occlusion?

A. Most commonly occur in children
B. Surgical treatment is the only option
C. 60% occur in ileum
D. Associated with major trauma
E. most common presentation is abdominal pain

3. For the management of perianal hematoma?

A. Non ER management
B. Conservative treatment is only reqd
C. Sclerotherapy
D. Surgical evacuation
E. Banding

4. The preferred treatment of a pelvic abscess is:

A. laparotomy
B. US guided aspiration
C. antibiotics
D. Rectal drainage
E. suprapubic drainage

5. Most common cause of appendiceal perforation?

A. Immunocompromised
B. Extreme of ages
C. Fecolith
D. Diabetic patient
E. Pelvic position of appendix

6. A woman para 6 developed anal incontinence, most common inciting factor would be?
A. Constipation
B. Caesserian section
C. Vaginal delivery
D. Appendicitis
E. Hemorrhoids

7. A woman has a normal vaginal delivery, after a few days she developed pain on defecation
which was relieved by defecation. What is the most likely diagnosis?
A. Fissure in ano
B. Fistula in ano
C. Perianal abscess
D. Perianal hematoma
E. Haemorrhoids

8. A young male patient presented with vomiting and acute abdominal pain radiating to back
since 3 days. His Ranson score was 2. What is the mortality rate
A. 5%
B. 40%
C. 60%
D. 80%
E. 90%

9. Regarding Ranson score, on admission:

A. Age above 65
B. Blood glucose above 5mmol/l
C. LDH > 700 U/L
D. WBC count > 20x10^6 /L
E. All of the above

10. Villous adenoma :

A. Hypokalemia
B. Hyperkalemia
C. Characteristic Frond like appearance
D. Occurs in jejunum
E. Of unknown etiology

11. The time span for the development of pseudocyst :

A. 4 weeks
B. 6 weeks
C. 8 weeks
D. 1 week
E. 1 day

12. The location of pseudocyst :

A. It lies in the sub hepatic space
B. it lies in the left paracolic gutter
C lies below and behind the stomach
D. Occupies the whole lesser sac (google)
E. Lies above and behind the stomach

13. A patient in A and E presented with acute appendicitis, after 4 days he develops low bp and
high heart rate, what would be the most appropriate investigation
A. MRI
B. Xray
C. ERCP
D MRCP
E.CT Scan

14. What is the most common complication after 1 week of appendicectomy

A. pelvic abscess
B. Enteritis
C. pyrexia
D. adhesions
E. paralytic ileus

15. Treatment of direct hernia?

A. Open laparotomy
B. Mesh repair
C. Shouldice
D. Mcevedy
E. None of the above

16. 20 years old female developed lower abdominal pain, her pregnancy test was negative.
What would be the most appropriate management?
A. Appendicectomy
B. Exploratory laparotomy
C. Repeat pregnancy test.
D. Repeat biochemical test
E. Repeat pregnancy test, biochemical test and TLC
17. Phosphate stones develop in?
A. Renal pelvis
B. Acidic urine
C. Alkaline urine
D. Patient with high diet of vitamin A
E. obese patient

19. A patient undergoes ECSW for renal stones after few days he again develops stones, how will
we investigate
A. repeat ECSW
B. Fasting Ca
C. urine DR
D. Fasting Ca 3 times, phosphate, magnesium, Urine DR
E. A and B are correct

20. Post surgical diagnosis is obtained by which surgical procedure?

A. Appendicectomy
B. thyroidectomy
C. Hepatictomy
D. Adrenalectomy
E. Orchidectomy

21. Dentate line is

A. Represents the fusion of proctodeum and postallantoic gut
B. Represents the fusion of midgut and hindgut
C. Is a surgically important landmark
D. Contains anal glands
E. None of the above

22. What is the most effective application of fresh frozen biopsy:

A. intraoperative diagnosis
B. quick diagnosis
C. More reliable than conventional histopathology
D. Clear margins
E. can be used as permanent section

23. A 4 years old child presented with severe constipation and abdominal distention from 2 years
, on xray abdomen distal Colon was massively enlarged with normal proximal colon . How will
you confirm your diagnosis
A. Ct-scan
B. Rectal biopsy
C. Barium enema
D. laparoscopy
E. MRI

24. Most common presentation of meckel’s diverticulum?

A. abdominal pain
B. bleeding per rectum
C. Vomiting
D. Sign and symptoms of intestinal obstruction
E. peptic ulcer

25. Management of congenital hydrocele:

A. Conservative treatment
B. Herniotomy
C. Jobs procedure
D. Jaboulay’s procedure
E. Orchidectomy

26. Regarding the content of hernia, if meckels diverticulum is herniated then it is said:
A. Omentocele
B. Epiplocele
C. Littre’s hernia
D. Richter’s hernia
E. Both A and B

27. A child presented with a small cyst at the lumbosacral region , what is the most probable
diagnosis
A. Sacrococcygeal teratoma
B. Post anal dermoid
C. pilonidal sinus
D. Jeeps disease
E. none of the above

28. Most common cause of urine retention in males above 60 years?

A. BOO
B. BPH
C. Prostatic carcinoma
D. urethral stricture
E. posterior urethral valves

29. Most common cause of esophageal rupture?

A. Instrumental injury
B. Boerhave syndrome
C. Mallory weis tears
D. Achalasia
E. Bulemia nervosa

30. A 65 years old male presented with bleeding per rectum. On multiple examinations no
apparent bleeding sign was found, what would be the safest course?
A. subtotal colectomy
B. Restorative proctocolectomy
C. proctcolectomy with ileoanal anastomosis
D.Subtotal colectomy with permanent ileostomy
E. ileostomy

31. Regarding BPH?

A. Nodularity on DRE
B. Hard mass on DRE
C. Rectal mucosa can be moved easily
D. Blood on DRE
E. None of the above

32. A house officer was appointed to perform a colorectal surgery. He had to review the basic
principle for this particular intervention. What would be the important principle to review?
A. Removal of the tumor
B. Removal of the lymph node
C. Complete removal of the colon
D. determination of stoma site
E. Removal of the tumor plus the removal of locoregional lymph nodes

33. Most accurate renal function test ?

A. MRA scan
B. Creatinine clearance test
C. Urea clearance test
D. MAG 3 test
E. IVP

34. Most common cause of enterocutaneous fistula?

A. Major trauma
B. Crohn’s disease
C. Post surgical
D. Ulcerative colitis

35. Simple test for pancreatic function ?

A. Fecal elastase
B. IV secretin test
C.Lund Test
D. PABA test
E. serum amylase

36. What is the physiologic function of Cholecystokinin

A. Increases the secretion of bicarbonate ions
B. Increases the enzyme secretion
C. Increases the Fluid secretion
D. increasese the secretion of bicarbonate ions, enzymes and fluids
E. None of the above
37. In our country most common cause of pancreatitis ?
A. trauma
B. Gallstones
C. Ampullary tumors
D. Alcohol
E. Autoimmune

38. A young patient developed carcinoma of lung, what would be the initial investigation?
A. CT- scan
B. MRI
C. Anteroposterior and lateral Xrays
D. Sputum microscopy
E. Biopsy

39. Surgery for uncomplicated duodenal ulcer?

A. Billroth
B. Hepaticojejunostomy (odd one out)
C. Truncal vagotomy
D. Antrectomy
E. Highly selective Vagotomy

40. A 44 years old patient presented in emergency dept with complain of vomiting distention
and abdominal pain. What would be the most appropriate investigation?
A. Supine Xray
B. Decubitus Xray
C. Ct-scan
D MRi
E. Barium enema

41. Regarding undescended testis?

A. They descend by first month of life
B. They descend by 2nd month of life
C. They descend by 3rd month of life
D. They descend by 2nd week
E. They descend by 5th month

42. For femoral hernia the best management is?

A. lichtenstein operation
B. McEvedy operation (most useful and safest IM)
C. shouldice operation
D. BAssini operation
E. surgical closure

43. Acute appendicitis?

A. It needs to be differentiated from mesenteric adenitis
 B. Wbc count increases by 20,000
C. It most commonly occurs in age group of 35-45
D. Conservative treatment is not necessary
E. Ct-scan is used for diagnosis

44. Regarding sliding hernia?

A. occurs in male above 40 years
B. Occurs in female below 40 years
C. Associated with tractional hernia
D. Commonly strangulates
E. none of the above

45. Immunosuppressive drugs?

A. Maximize graft acceptance
2. Do not include steroids
C. Reduce CMV infection
D. Cause GVH disorder
E, B&C are correct

46. Mr Fazal has a history of peptic ulcer since 3 years , What would be the appropriate
treatment?
A. Antibiotics
B. PPI
C. PPI + metronidazole + 400 mg amoxicillin (bailey)
D.Omeprazole +metronidazole + 400 mg clarithromycin
E. PPI + metronidazole

47. Most common types of intussusception in children?

A. Colocolic
B. Ileocolic
C. Ileoiliac
D. Ileocecal
E. Multiple

48. Regarding dilatation of esophageal stricture

A. Balloon dilatation is most commonly used
B. Effective dilatation diameter should be of 16 mm
C. Balloon dilatation causes perforation in most cases
D. Risk factors of esophageal trauma is increased
E. B&C are correct

49. Flexible endoscopy is therapeutic for?

A. esophageal perforation
B. carcinoma esophagus
C. Boerhave syndrome
D. Upper GI bleed
E. Hiatus hernia

50. Which of the following is the most common cause of ascites?

A. Chronic liver disease (Cirrhosis)
B. Hypoproteinemia
C. nephrotic syndrome
D. malabsorption syndrome
E. Congestive heart failure

51. Non painful type of abdominal TB?

A. fibrotic
B. Ascitic
C. localised
D. Purulent
E. All of the above

52. Which type of intestinal TB causes perforation of intestine?

A. Hyperplastic
B. Ulcerative
C. Ascitic
D. Purulent
E. Localised

53. Most appropriate surgery for duodenal ulcer ?

A. Billroth 1
B. billroth 2
C. Antrectomy
D. Highly selective Vagotomy
E. Pyloroplasty

54 . Vagus is/does not

A. Negative role
B. Inhibition of receptive relaxation
C. Causes enzyme release
D. Not involved in vagotomy
E. None of the above

55. A 45 years old lady Anum was living at Vietnam and developed abdominal pain localized to
the right hypochondrium and she develops jaundice. What is the most likely cause
A. PSC
B. Acute cholangitis
C. Klaskin tumors
D. Hereditary spherocytoses
E. Worm infestation
56. Most common complication of undescended testis
A. infertility
B. Malignancy
C. torsion
D trauma
E. Vaginal hydrocele

57. Characteristic feature of late dumping is ?

A. Aggrevated by food
B. relieved by food (and octreotide)
C. Relieved by exercise
D.Develops in 10 mins
E. relieved by lying down

58. Significant raised level of PSA

A. Prostatic cancer
B. BPH.
C. Prostatitis
D. Epididymoorchitis
E. Prostatic calculi

59. Regarding carcinoid tumor?

A. Neuroendocrine tumor
B. Produces serotonin
C. It causes facial flushing
D. It metastasizes to the brain
E. it more commonly occurs in the intestine

60. Regarding omental torsion?

F. It occurs in infants
G. It occurs in obese patients
H. It occurs in immunocompromised patient
I. It mimics acute appendicitis
J. It occurs most commonly in women

61. Most appropriate surgery for anal fissure.

A. Fistulotomy
B. Lateral sphincterotomy
C. Anal Advancement flap
D. Setons
E. Reconstructive surgery

62. Regarding umbilical hernia?

A. Should be repaired after 2 years (IM)
B. Can be managed conservatively
C. Immediate closure is required
D. More common in white patients
E. Carnet sign is not always positive

63. Most common type of Anal cancer?

A. Adenocarcinoma
B. Squamous cell carcinoma
C. Basal cell Carcinoma
D. Adenosquamous cell carcinoma
E. Malignant melanoma

64. Which of the following is the most common sequelae of incisional hernia?
A. Wound dehiscence
B. Wound infection
C. Use of continuous suture
D. Obesity
E. none of the above

66. What is the most common extra intestinal manifestation of UC

A. PSC
B. Arthtritis (IM)
C. uveitis
D. Ankylosing spondylosum
E. Erytherma nodosum
67. What is the most appropriate management of pelvic abscess
A. Conservative
B. Antibiotics
C. Percutaneous drainage
D. Per rectal/ Vaginal drainage
E. Incision and aspiration

69. What is the most common site of intestinal atresia in children?

A. Duodenum
B. Ileum
C. jejunum
D. Colon
E. Rectum

70. Which of the following presents most commonly with ileal atresia?
A. Abdominal pain
B. Abdominal distention
C. Ileus
D. Billious vomiting
E. All of the above

72. Incase of marked loss of ureter?

A. Pigtail end-to-end anastomosis
 B. Kidney mobilization
C. Transureteroureterostomy
D. Percutaneous nephrostomy
E. All of the above

73. Radiographic sign of small bowel obstruction:

A. featureless radiographic sign
B. Rounded gap shadow in the right iliac fossa
C. Irregularly placed haustral folds
D. Hosepipe ileum
E. Segments lie centrally in the transverse plane and show valvulae connivtantes

74. Prostatic plexus lies :

A. Periprostatic fascia
B. Prostatic capsule
C. Between capsule and sheath
D. Between fascia and capsule
E. In the sheath

75. Most common types of intussusception in adults?

A. Colocolic
B. Ileocolic
C. ileoiliac
D. ileocecal
E. multiple

76. Allograft:
A. One species to another
B. One individual to another
C. Graft placed in its normal anatomic position
D. Graft between twins
e. A type of transplantation

77. A 75 years patient had LUTS, On transrectal US the tumor was fixed on the rectal mucosa.
What is the likely stage of this tumor
A.T0N1M0
B.T2N2M0
C. T3N3M0
D.T4N0M0
E.T4N4M0

78. A 65 years old male patient presented with history of progressive dysphagia on EUS a tumor
was found invading muscularis propria and 2 loco regional lymph node were involved as
well . On CT scan there was no hepatic metastasis. What is the stage of this tumor
A. T1N3M1
B. T2N1M0
C. T3N1M0
D.T3N2M1
E.T4aN1M0

79. Gold standard investigation for liver is?

A. Erect Xray
B. US
C. Plain CT.
D. ERCP
E. Spiral CT

80. Anorectal ring comprises of?

A. Puborectalis
B. Puborectalis + External anal sphincter
C. External anal sphincter + Internal anal sphincter
D. Puborectalis + External anal sphincter + internal anal Sphincter + longitudinal muscles
E. External anal sphincter + longitudinal muscles

81. Gold standard for the treatment of BPH

A. TURP
B. Retroperitoneal
C. Through perineum
D. TVP
E. None of the above

82. Which of the following is most commonly confused with renal stone?
A. Calcified mesenteric lymph nodes
B. Gall stones
C. Cacified mesenteric lymph nodes, Gall stones, phleboliths, calcified adrenal gland
D. Cacified mesenteric lymph nodes, Gall stones, phleboliths, calcified adrenal gland, ossified tip
of twelfth rib,
E. Ossified tip of twelfth rib

83. Which surgery most commonly leads to the adhesion formation

A. Cholecystectomy
B. Laparoscopic Cholecystectomy
C. Colectomy
D. Talc
E. Appendicectomy

84. Most common complication of prostatectomy?

A. Hemorrhage
B. Water intoxication
C. Impotence
D. Retrograde ejaculation
 E. Secondary hemorrhage

85. Most common Inciting factor for Torsion of testis?

A. Inversion of testis
B. Short vas deferens
C. Patent processus vaginalis
D. Seperation of epididymis from the body of testis
E. Weight lifting

86. Carcinoma of the body of stomach has multifactorial risk factors. What is the most
formidable risk factor of its development?
A. Cigarette smoking
B. H. pylori
C. Japanese descent
D. Alcohol
E. Both B and C are correct

87. Patient with recurrent hematemasis , Upper Gi endoscopic finds gastric ulcer
with rolled edges , what would be the most appropriate next step of investigation?
A. CT scan
B. repeat endoscopy
C. Transbronchial lavage
D. Endoscopic biopsy of ulcer
E. Barium meal

88. Regarding Ectopic vesicae

A. There is separation of pubic bones
B. The bladder should be closed in the first six month of life
C. It is most commonly found in females
D. Conservative management is most appropriate
E. A&C are correct

89. A 34 years old male patient presented with abdominal pain and distention for 4 weeks. On
ultrasound the lily sign was found. How will you confirm your diagnosis?
A. MRI
B. Xray
C. CT-scan
D. ERCP
E. MRCP

90. A male patient presented in A&E Dept with rectal pain and bleed. He has previous history of
heavy weight lifting. Which of the following complication of external pile has occurred
A. Thrombosed
B. Fibrosed
C. Strangulated
D. prolapsed
E. ulcerated

91. Most common site of hypospadiasis is?

A. Glanular
B. penile
C. Perineal
D. coronal
E. penoscrotal

92. What is the tumor marker of HCC

A. CA-125
B. CA 19-9
C. LDH
D. AFP
E. B-HCG

93. Regarding adult polycystic kidney disease?

A. Autosomal recessive disease
B. manifest before 30 years of age
C. Autosomal dominant disorder
D. X-linked disorder
E. doesnot present with htn

94. Regarding chordee?

A. Cosmetic surgery is always necessary
B. Dorsal bending of penis
C. Ventral bending of penis
D. Doesnot interfere with sexual function
E. Sideways bending of penis

95. Regarding mixed hernia?

A. Cardia above hiatus hernia in mixed type
B. Increased chances of stomach volvulus
C. Dyspnoea on exertion
D. More common in young patient

96. A 50 years old Faizan Wallam presented with an obstructing lesion at rectosigmoid
junction. Most appropriate treatment would be?
A. Hartmann procedure
B. Colectomy
C. Ileostomy
D. Proctocolectomy
E. Proctocolectomy + ileostomy

97. Most appropriate investigation for UC

A. Proctoscopy
B. Barium enema
C. Sigmoidoscopy + biopsy
D. Barium follow through
E. Laparoscopy

98. A young patient Hassan farooqui has a history of recurrent hernia. On investigation he is
found to have bilateral inguinal hernia what would be most appropriate treatment options.
A. Herniotomy
B. Open surgical closure
C. laparoscopic herniorrhaphy
D. Lichtenstein Hernioplasty
E. Conservative surgery

100. A patient with 1st degree piles, what would be the management?
A. Sclerotherapy
B. Banding
C. Hemorrhoidectomy
D. Hemorrhoidopexy
E. Both banding and sclerotherapy

SURGERY PAPER 2 2013

1. The most important factor for developing wound infection after colonic surgery is:
a. Corhn’s disease
b. Peroperative stoma
c. Blood loss of greater than 2 units
d. Serum albumin less than 2.9
e. Preoperative irradiation
2. Peutz Jegher’s polyps
a. Have a malignant potential
b. Are haramtomatous
c. Are associated with meckel’s diverticulum
d. Cause haemorrhage
e. Occur as multiple lesions
3. The most important aspect to be noted in managing a patient with gastric lymphoma is
a. Early gastric lymphomas may regress and disappear when H pylori is treated
b. Distinguish between primary gastric lymphoma and generalized lymphomatous
process/disease
c. Chemotherapy is appropriate for systemic disease only
d. It remains in stomach for a long time before involving lymph nodes
e. Presentatioin is not different from gastric cancer
4. Regarding skene’s tubules
a. Are the homologue of the prostate in female
b. Develop from surrounding mesenchyme
c. Canalize in 6 week of development
d. Have a major role in differentiation
e. Are a series of solid epithelial buds
5. Which statement best describes the management of a 12 years old boy with swelling and
severe pain after scrotal trauma:
a. Ultrasound guided drainage of hematocele
b. Emergency drainage of hematocele
c. Orchidectomy
d. Repair of tunica albuginea after evacuation of hematoma
e. Open drainage of hematocele and inspection of testis
6. A person with history of blunt pancreatic injury six months back. Has pseudo pancreatic
cyst with normal main pancreatic duct. The preferred treatment will be
a. Excision of the cyst
b. Endoscopic drainage
c. Conservative
d. Percutaneous drainage
e. Cystogastrostomy
7. The classic clinical findings found in dynamic low small bowel obstruction are
a. Distention with constipation is the primary presenting feature with no associated
pain or vomiting
b. Pain is predominant with distention and no associated vomiting or constipation
c. Vomiting occurs early with rapid dehydration followed by pain, distention and
constipation
d. Pain with central abdominal distention are predominant followed by vomiting and
constipation
e. Distention is early and pronounced with mild pain and vomiting
8. Key to successful cholecystectomy is:
a. meticulous dissection
b. saline wash of the operative field
c. blood less field
d. defining calot’s triangle properly
e. using diathermy with care
9. A 50 year old man with history of jaundice presenting with massive haematemsis should
be treated with:
a. Esophageal transaction and re anastomosis
b. Correction of coagulopathy
c. Vasopressin or octreotide
d. Porta systemic shunt
e. Upper GI endoscopy and sclerotherapy/band ligation of esophageal varices
10. In tropical countries, rupture of spleen following trivial injuries is seen in splenic disease
due to:
a. Filariasis
b. Trypanosomiasis
c. Amebiases
d. Schistosomiasis
e. Malaria
11. A 29 year male is anorexic and malnourished presented with vague tenderness RIF and
pain lumbar spine O/E there is fluctuant lump in groin on same side. Most likely he has
a. Diverticulum
 b. Psoas abscess
c. Lymphoma
d. Tabes Dorsalis
e. Rectus sheath haematoma
12. Following investigation is best for detecting metastases and response to treatment:
a. Hida scan
b. CT scan
c. Alkaline phosphatase level
d. PET scan
e. Ultrasound
13. The most common mesenteric cyst is
a. Teratoma cyst
b. Urogenital remant
c. Chylolymphatic cyst
d. Meothelial cyst
e. Enterogenous cyst
14. Traditional treatment of stricture urethra is:
a. Uretheroplasty
b. Supra pubic catheterization
c. Intermittent urethral dilation
d. Urethrotomy
e. Urethral catheterization
15. The major cause of acute pancreatitis in the elderly lady is
a. Hypocalcemia
b. Alcoholism
c. Gall stone
d. Ischemia
e. Drug induced
16. Regarding small bowel diverticulum
a. Contrast radiology may be used to detect meckel’s diverticulum
b. Primary duodenal diverticulum is located on outer wall of second and third part of
duodenum
c. Meckel’s diverticulum may be a cause of severe hemorrhage
d. Meckel’s diverticulum should be resected if found incidentally during
appendectomy when wide mouthed and not thickened
e. Jejunal diverticula are usually solitary
17. The treatment options for acute proctitis are as follows
a. No further treatment is required
b. Surgery is done to obtain early relief
c. Only symptomatic treatment advised
d. Relief obtained by 5 amniosalicylcic acid compounds and predisnolone enemas
e. Oral steroids are necessary
18. Soon after cholecystectomy a patient develops jaundice and high grade fever with rigors.
The first step in management is:
a. Liver function tests
b. MRCP
 c. US scan
d. Exploratory laparotomy
e. ERCP
19. The operative procedure with the least long term recurrence in adult inguinal hernias is:
a. Lichtenstein hernioplasty
b. Herniotomy
c. Bassini’s repair
d. Lylte method
e. Shouldice method
20. A 35 years old female presents with history of jaundice and massive ascites. She should
be managed with:
a. Salt restriction and diuretics
b. TIPPS
c. Porta caval shunting
d. Abdominal paracentesis
e. Liver transplant
21. In a young male the most common cause of epidiymo-orchitis is
a. Outflow obstuctions
b. Blood borne infections
c. Urethral catheterization
d. Secondary to urinary infection
e. Sexually transmitted chlamydia
22. Which of the following is not a recognized cause of epdidymo-orchitis
a. Mycobacterium TB
b. Citrobacter
c. Chlamydia trachomatis
d. N. gonorrhea
e. E coli
23. The best medical treatment of acute severe ulcerative colitis is
a. Mesalazine
b. Corticosteroids
c. Olsalazine
d. Sulphasalizine
e. Metronidazole
24. In small bowel obstruction, the plain xray abdomen will show:
a. Straight segments generally central and lying transversely with haustral folds
b. Straight segments generally central and lying transversely with valvulae
conniventes visible
c. Straight segment lying transversely at the periphery of the film
d. Irregularly placed indurations with haustral folds
e. Centrally placed transverse segments along with irregularly placed induration on
the periphery of film
25. Per operative viability of the gut is best assessed by which of following feature’s:
a. Peristalsis may be observed
b. Intestinal musculature, firm
c. Pressure ring may or may not disappear
 d. Peritoneum, shiny
e. Good circulation, dark colour become lighter, and mesentery bleeds if pricked.
26. The commonest feature of chronic TB peritonitis is:
a. ascites
b. recurrent abdominal pain
c. loss of weight
d. fever
e. night sweats
27. Accurate investigation in diagnosis of perforated peptic ulcer is:
a. plain xray abdomen
b. CT imaging
c. Blood urea, serum creatinine, serum electrolyte
d. Ultrasound of abdomen
e. Serum amylase
28. A rectal growth at the middle third of rectum can be assessed by:
a. Digital rectal examination and proctoscopy
b. Digital rectal examination and flexible sigmoidoscopy
c. Digital rectal examination and sigmoidoscopy
d. Digital rectal examination and colonscopy
e. Digital rectal examination only
29. Injury to male urethra most common part that is injured: scenario incomplete?
a. Rupture of bulbar urethra is common (blow to perineum, due to a fall)
b. Rupture above of all three parts
c. Penile urethra
d. Rupture of membranous urethra is common (pelvic fracture, RTA, crush injuries)
e. Rupture of prostatic urethra is common
30. The strongest association of splenic artery aneurysm is with:
a. Presence of aneurysms in other vessels
b. Female sex
c. Third trimester of pregnancy
d. Age above 60 years
e. Acute pancreatitis
31. In gall stone formation:
a. Abnormal gall bladder maybe an intitating factor
b. Nucleation of cholesterol monohydrate crystal from multilamellar vesicles is a
crucial step
c. Bile acids and phospholipids play main role
d. Insoluble cholesterol is main culprit
e. Infection provides a nidus
32. Which of the following is the most common type of intussusception
a. ileo-ileo-colic
b. ileocolic (most common and in children)
c. colocolic (common in adults)
d. multiple
e. ileoileal
33. A 14 day old newborn presents with projectile vomiting. The clinical feature that will help
 diagnose level of obstruction is
a. Color of vomitus
b. Consistency of vomitus
c. Presence of fever
d. Amount of vomitus
e. Presence of abdominal signs
34. Which one of the following is not true about hypospadias
a. Other genitourinary abnormalities should be excluded
b. Circumcision must be avoided
c. Is mainly a cosmetic problem
d. Usually operated before 2 years of age
e. Is usually coronal
35. Adeno carcinoma of colon
a. Is a sequelae of juvenile polyps
b. Non annular varieties present with hemorrhage (IM)
c. Progresses slowly
d. Leads to carinomtosis peritonei
e. Originates as a benign adenoma (IM)
36. An arterial pile
a. Is bright red in color
b. Is hemangiomatous malformation causing furious bleeding
c. Is diagnosed during surgery pulsatile swelling on proctoscopy
d. Pulsatile swelling on proctosopy (odd one out)
e. Usually presents as an internal haemorrhoid
37. Laparoscopic herniorrhaphy is best indicated in:
a. Incisional hernia
b. Oburator hernia
c. Bilateral or recurrent inguinal hernias
d. Only direct inguinal hernia
e. Infantile hernia
38. As regards the origin of pilonidal sinus, the following is the most widely accepted
statement:
a. It occurs secondary to a post anal dermoid
b. It occurs secondary to collection of broken hair due to friction and sitting on hard
surfaces
c. Toilet paper use is the intiating factor
d. It is the persistent caudal remnant of orginial neual canal
e. It develops from hair follicles in the wall of the sinus
39. Commonest type of esophageal atresia and tracheoesophegeal fistula is:
a. Esophageal atresia with no TEF
b. Esophageal atresia with proximal and distal TEF
c. Esophageal atresia with distal TEF
d. Esophageal atresia with proximal TEF
e. H-type TEF
40. ERCP of the patient shows CBD obstruction and narrowed main pancreatic duct with
dilation upstream and normal distally. Patient is most probably suffering from
 a. Carcinoma head of pancreas
b. Acute pancreatitis
c. Chronic pancreatits
d. Stone impacted at the ampulla
e. Cholangicarinoma
41. In a 17 yr old boy, most likely history for diagnosis of acute appendicitis is
a. Nausa
b. Anorexia
c. Vomiting
d. Peri umblical pain shift to the right iliac fossa
e. Peri umblical pain
42. Clinical features of strangulation consist of
a. Constant pain with pyrexia and abdominal rigidity
b. Dehydration and constant pain in the abdomen
c. Constant pain in the abdomen, rigidity of abdomen and features of shock
d. Constant pain in the abdomen with tenderness in abdomen
e. Constant pain in the abdomen with shock
43. 60 yrs old renal transplant patient presents with pain and bleeding per anal canal. O/E an
irregular indurated ulcer is seen in the anal canal. Biopsy reveals squamous cell
carcinoma. Best tx?
a. Local excision
b. Chemo-radiation
c. Abdominal resection
d. Chemotherapy
e. Radiotherapy
44. A 52 yr old lady with history of prolonged NSAID usage presents with severe abdominal
pain for 9 hrs. Her chest xray shows free gas under the diaphragm. Her most appropriate
management will be
a. Exploratory laporatomy
b. Upper GI endoscopy
c. Ultrasound guided drainage
d. Ct guided drainage
e. Nasogastric drainange, I/V fluids and antibiotics for first 48 hours
45. Diagnosis of renal injury is mostly on:
a. Severe abdominal pain
b. Bruises on the abdomen and in renal areas
c. Surgical exploration
d. The fracture of the 9th rib
e. Frank hematuria
46. 65 yr old male presented in OPd with multiple episodes of rectal bleeding. He gives history
of similar episodes of painless bleeding for last 8 months with several episodes of
diahorrhea. The commonest cause of bleeding in his case would be
a. UC
b. Angiodysplasia
c. Colonic polyps
d. Colorectal carcinoma
 e. Diverticulutis
47. Which of the following complications after splenectomy is due to technical oversight by
the operating surgeon
a. Gastric dilation
b. Opportunist post splenectomy infection
c. Left basal atlelectasis
d. Left pleural effusion
e. Pancreatic fistula
48. The following best describes the thin descending limb of the loop of henle
a. Permeable to water and less permeable to sodium, chloride and urea
b. Impermeable to water
c. Impermeable to water, highly permeable to sodium an chloride and slightly
permeable to urea
d. Impermeable to water an urea with sodium and chloride actively reabsorbed
e. Permeable to water, sodium, chloride and urea
49. Pancreatitis is primarily due to intracellular activation of enzyme?
a. Amylase
b. Pancreozymin
c. Trypsinogen
d. Lipase
e. Cholecystokinin
50. Richters hernia is a hernia in which the sac contain
a. A portion of the omentum with vessels in it
b. Peritoneum only
c. A portion of the circumference of the intestine
d. Extra peritoneal fat
e. A complete small bowel loop with mesentery
51. In case of acute appendicitis the therapeutic antibiotic should cover the following
organisms?
a. Anaerobes
b. Gram positive bacilli and anaerobic cocci
c. Aerobes
d. Gram positive polymicrobials
e. Gram positive and gram negative bacilli
52. Vaginal hydrocele means
a. The collection of fluid in tunica vaginalis which extends upto the deep ring
b. Smooth oval swelling near the spearmatic cord which may be mistaken for inguinal
hernia
c. Smooth rounded oval swelling in the cananl of nuck in females
d. The collection of fluid in the tunica vaginalis with patent processes vaginalis and
communication with peritonieum
e. The collection of fluid in tunica vaginalis with the swelling confined to scrotum
53. The etiological factor according to patients age for obstructive acute appendicitis can be
a. Aerobic bacterial infection in child hood
b. Viral infection in child hood
c. Intestinal parasites in infant below 2 years
 d. Anaerobic bacterial infection in child hood
e. Carcinoma of caecum in middle age and elderly
54. Regarding duodenal ulceration
a. Duodenal ulcers tend to be larger than gastric ulcers
b. Anterior ulcers tend to bleed
c. Fibrosis may cause pyloric stenoisis
d. Kissing ulcers are two adjacent posterior ulcers
e. Posterior ulcers tend to perforate
55. Incidence of recurrence following duodenal ulcer operations is higher in
a. Gastro enterosotomy alone
b. Gastrectomy
c. Highly selective vagotomy
d. Selective vagotomy and drainage
e. Truncal vagotomy and drainage
56. In acalculus cholecystitis most common cause is:
a. Bacteria’s are found in bile obatained from affected gallbladder
b. Is responsible for 5% of cases of cholecystitis
c. In association with cholecystones
d. It is seen in patient recovering from major surgery, trauma and burns
e. Gall bladder ileus
57. Cystine stone are
a. Single hard stone which changes color from green to pink or yellow on exposure to
air and in radio-opaque
b. Multiple soft stones kidneys which are radio-lucent on plain x-ray KUB
c. Multiple soft stones in kidneys which are radio-opaque on plain xray KUB
d. Single soft stones which are radio lucent on plain xray KUB
e. Multiple hard stones which changes color from pink to green on exposure to air and
are radio-opaque on plain xray KUB
58. A donor with blood group O can donate organs to recipient with
a. Group B
b. Group A
c. Group O
d. Group AB
e. Group O, A, B, or AB
59. The hormone neuropeptide having the characteristics of endocrine, paracrine and
neurocrine function simultaneously is secreted by
a. Gastric mucosal cells
b. Parietal cell
c. Enterochromaffin like cells
d. Gastric neuronal cells
e. Chief cells
60. Treatment recommended for perianal abscess is
a. Incision and drainage of abscess cavity and suturing the incision with interrupted
sutures
b. Drainage of the abscess by wide bore cannula and irrigation with antibiotic solution
for 5 days
 c. Analgesia and antibiotics for 5 days
d. Incision and drainage of abscess with de-roofing of the abscess cavity
e. Application of poultice and wait for the abscess to burst and drain spontaneously
61. Regarding periurethral transitional zone TZ
a. Lies above the ejaculatory ducts
b. Most benign prostatic hyperplasia arise in this zone
c. Lies mainly posteriorly
d. Most carcinoma arise from this zone
e. Lies posterior to urethral lumen
62. 20 year old I/V drug abuser presents with 5 day history of vomiting, abdominal pain and
several episodes of diarrhea per day. O/E he is found to be grossly emaciated and having
palpable inguinal lymph nodes. He is diagnosed by infections disease team as having
infective colitis. The commonest cause in such a immune compromised patient would be
a. clostridium difficile
b. campylabactar
c. cytomegalo virus (2ndary to HIV (drug iv abuser)
d. amebiasis
e. shigella
63. The most important investigations to diagnose the cause of diffuse peritonitis is:
a. CBC
b. Erect abdominal radiography in unconscious patients
c. Peritoneal diagnostic aspiration
d. Serum amylase
e. US/CT scanning
64. Regarding adynamic form of intestinal obstruction
a. In paralytic ileus peristalsis is absent
b. In pseudo-obstruction there is non-propulsive peristalsis
c. In all these conditions mechanical obstruction is absent
d. In paralytic ileus mechanical obstruction is absent
e. In mesenteric vascular occlusion peristalsis is present
65. Obstructive acute appendicitis presents with:
a. Vomiting
b. Generalized pain from the start
c. Anorexia
d. Pain at umblicial area, which shifts to right iliac fossa
66. Pancreatitis is primarily due to intracellular activation of enzyme:
a. Pancreyozymin
b. Cholecystokinin
c. Lipase
d. Amylase
e. Typsinogen
67. The most common organism involved in causing pyogenic liver abscess is
a. E. coli
b. Proteus vulgaris (hydatid cyst echinococcus)
c. Klebsiella (amoebic liver abscess entamoeba)
d. Streptococcus faecalis
 e. Staphlycoccurs aureus
68. The most important condition in the differential diagnosis of diverticular disease is:
a. Crohn’s disease
b. UC
c. Polyps
d. Carcinoma
e. Ischemic colitis
69. Commonest complication of prostatectomy is:
a. Urethral stricture
b. Bladder neck contracture
c. In continence of urine
d. Haemorrhage ( if option for retrograde ejac. If not than hemorrhage)
e. Perforation of bladder
70. Which one of the following is not a hereditary cause of splenomegaly:
a. Spherocytosis
b. G6PD deficiency
c. Sickle cell disease
d. Autoimmune haemolytic anaemia
e. Thalassemia
71. Which of the following is the most common type of intussusception
a. Ileocolic (children)
b. Colocolic (adults)
c. Ileoileal
d. Ileo-ileal colic
e. Multiple
72. Acute intussusception
a. Leads to gangrene
b. Occurs in children
c. Occurs due to hypertophic peyer’s patches
d. Proximal part of gut enters into the distal part
e. Is idiopathic
73. 22 year girl, 4 days after appendicetomy complains of fever, abdominal pain, diarrhea and
passage of mucus in stool. On DRE there is a soft bulge anteriorly. Her most appropriate
management is:
a. laparoscopy and drainage
b. CT guided drainage
c. Laparotomy and drainage
d. US guided perabdominal drainage
e. Per rectal drainage
74. A young man with history of road accident is brought to emergency in shock. O/E he has
bruising of left lower chest. He should be managed with:
a. Fluid resuscitation and US
b. Thoracocentesis of left chest
c. Surgical treatment for splenic rupture is splenectomy
d. Evaluation for injury to gut
e. Confirmation of splenic rupture is an indication for surgery
 75. Most important serum markers in Teratoma of testis is
a. Alpha Feto Protein
b. LDH
c. Beta HCG
d. CEA
e. CA 125
76. The best intial peroperative manoeuvre in a case of intestinal obstruction is:
a. Assessment of sigmoid colon
b. Assessment of jejenum
c. Assessment of duodenum
d. Assessment of ileum
e. Assessment of caecum
77. Carcinoma of prostate:
a. Can be detected early by elevated levels of PSA
b. May occur after prostatectomy for BPH
c. Is common malignant tumor in males over the age of 65 yrs
d. Is the common site of origin of skeletal metastases
e. When symptomatic, is usually not curable

SURGERY PAPER 2 2013

1. PSA prostate
2. on X-ray ... valvulea conventis shown
3. symtoms of left colon Ca....? bleeding ???
4. hartman procedure
5. cholecystokinin for stimulation of....
6. BPH... age 60... urinary symtoms
7. pseudocyst form in 4 week
8. for hydatid cyst... liver CT
9. hepatoma .... hep B
10. testes malignancy... Rx orchidectomy
11. helicobactor plyro ... Rx.... PPI+clarthromycin+ampicillin
12. post thoractomy pain.. relived by????
13. most common cause of fistulae... crohns or post-operative... ???
14. 1 que of hypospadias ... glandular
15. epispadias.... ectopic vesicae
16. chordea.... Rx?????
20. lung Ca.... X-ray
21. constipation plain X-rays supine
22. femoral hernia... hernitomy
23. dirty white stones of - PO4 stones
25. adhesions ... post appendicectomy
26. therapeutic.......... upper GIT bleeding
27. renal function ..... creatinine
28. inversion testes (2 ques)
30. diabetes... risk factor malignancy
31. fecal elastase for pancreatic functions
32. CHF.......... ascites
33. Principle of Graft
34. allograft
35. amyalse >4000 ... Diagnosis.... Pancreatitis
36. while surgery for quick diagnosis... frozen section is taken to diagnose on the spot
37. procedure.... billroth-II
38. BPH.... on DRE .. move freely
39. trans-uretro-uretrostomy.... procedure for ??????????
40. anatomy of esophagus.... ans was 16 mm somewhat
41. anorectal ring anatomy...
42. mesh repair in hernia'
43. strawberry gall bladder
44. please read Ranson scale for pancreatitis... que exactly not remembered, bt difficult
45. UC... sclerosing cholangitis
46. rectal bleeding ...meckels diverticulum
47. adults ... colo-colic
48. ileocolic in children
49. one que of Littre's hernia
50. scelrothearpy for bleeding 2nd degree pile....

SURGERY PAPER 2 2012

1. Treatment of choice in case of splenic abscess is:
a. Drainage of splenic abscess by percutaneous route under radiological guidance.
b. Splenectomy
c. Laparoscopic aspiration
d. Antibiotics only
e. Open laparotomy and drainage of abscess
2. The following best describes the thin descending limb of the loop of henle
a. Permeable to water, sodium, chloride and urea
b. Impermeable to water and urea with sodium and chloride actively reabsorbed
c. Permeable to water and less permeable to sodium, chloride and urea
d. Impermeable to water, highly permeable to sodium and chloride and slightly
permeable to urea
e. Impermeable to water
3. 25 year old male on high dose of analgesics after upper limb amputation 1 year back
presented with 6 months history of progressive vomiting 12 hrs after taking meals and
weight loss. OGF revealed narrowing at the pylorus. Best Tx?
a. Billroth II surgery
b. Highly selective vagotomy and gastrojejunostomy
c. Truncal vagotomy and gastrojejunostomy
d. Truncal vagotomy and pyloroplasty
e. Billroth I surgery
4. In a patient with acute cholecystitis if inflammation is subsiding he should be treated with
a. Immeadiate open cholecystectomy as soon as patient is resuscitated
b. Conservative management followed by surgery
 c. Immediate laprascopic cholecystectomy as soon as patient is resuscitated
d. Routine choleystostomy
e. Partial cholecystectomy
5. A middle aged man presents with painless jaundice. US shows dilated CBD and a
distended gallbladder with normal wall thickness. He is most likely suffering from:
a. Stricture of bile duct
b. Choledocolithiasis
c. Chronic pancreatitis
d. Carcinoma head of pancreas
e. Choledocal cyst
6. The operation of choice in infantile hydrocele is:
a. Herniotomy
b. Herniotomy & herniorrhaphy
c. Hernioplasty
d. Aspiration of hydrocele
e. herniorrpaphy
7. Regarding perineal haematoma, the best statement is that
a. It is not an emergency and conservative treatment should be opted
b. It is an emergency and incison and drainage should be doe under GA
c. It is an emergency and blood should be transfused
d. It is not an emergency but patient admitted and kept under observation
e. It is an emergency and incision and drainage should be done
8. Acute intussusception
a. Proximal part of gut enters into the distal part
b. Occurs due to hypertrophic peyer’s patches
c. Leads to gangrene
d. Occurs in children
e. Is idiopathic
9. In small bowel obstruction, the plain x-ray abdomen will show:
a. Straight segments generally central and lying transversely with valvuale
conniventes visible
b. Straight segment lying transversely at the periphery of the film
c. Straight segments generally central and lying transversely with haustral folds
d. Irregularly placed induration with haustral folds
e. Centrally placed transverse segments along with irregularly placed induration on
the periphery of film
10. Gold standard treatment of Benign prostatic hypertrophy is
a. Transurethral resection of prostate
b. Wait and watch
c. Open prostactectomy
d. Drugs
e. Catheterization
11. In the differential diagnosis of femoral hernia the commonest condition is:
a. Inguinal hernia
b. Femoral artery aneurysm
c. Saphena varix
 d. Burst psoas abscess
e. Rupture of adductor longus muscle with haematoma formation
12. In the occurrence of peptic ulcer, the most important finding is:
a. H. Pylori is the cause of 90% cases
b. Mucus is abnormal
c. Cigarette smoking increases the relapse rate
d. Milk lowers the acidity
e. pH of stomach is low because of increase in acid uptake
13. Extra intestinal manifestation of ulcerative colitis in majority of cases
a. Sclerosing cholangitis
b. Iritis
c. Arthritis (IM)
d. Pyodermal gangrenousus
e. Bile duct carcinoma
14. In case of acute appendicitis the therapeutic antibiotic should cover the following:
a. Gram negative bacilli and anaerobic cocci
b. Gram positive polymicrobes
c. Aerobes
d. Gram positive and gram negative bacilli
e. Anaerobes
15. The most important investigation for the diagnosis of Hirschsprung’s disease
a. Rectal biopsy
b. Plain xray abdomen erect
c. Water soluable contrast enema
d. Plain xray abdomen supine
e. Anorectal manometry
16. A male neonate presents with failure to pass meconium. Plain x-ray of abdomen shows
dilated colon. Dx modality?
a. Rectal biopsy
b. CT scan abdomen
c. Anorectal manometry
d. Gastregrafin enema
e. Barium enema
17. Which of the following is commonly associated with anal carcinoma?
a. HPV
b. Crohn’s disease
c. Perianal skin dermatitis after radiation therapy
d. HIV
e. Ulcerative Colitis
18. Constipation, band adhesions, high residual diet and long pelvic meso colon are
predisposing cause for
a. Sigmoid volvulus
b. Compound volvulus
c. Volvulus neonatrum
d. Caecal volvulus
e. Idiopathic mega colon
19. Regarding duodenal ulcer
a. Anterior ulcers tend to perforate
b. Two anterior placed ulcers are known as kissing ulcers
c. Posterior ulcer tend to bleed commonly by eroding splenic artery
d. Most occur in 2nd part of duodenum
e. Anterior ulcers tend to bleed
20. Commonest complication of stricture urethra is:
a. Retention of urine
b. Urethral fistula
c. Periurethral fistula
d. Urethral fibrosis
e. Urethral diverticulum
21. In majority of cases of acute obstructing lesion of rectosigmoid junction, emergency
surgical option is
a. Hartmann’s procedure
b. Colorectal anastomosis, after on table lavage
c. Caecostomy
d. Loop ileostomy
e. Paul mikulicz procedure
22. Preferred surgical procedure for duodenal ulceration is
a. Highly selective vagotomy
b. Billroth II gastrectomy
c. Truncal vagotomy
d. Selective vagotomy and drainage
e. gastrojejunostomy
23. Parenchyma of each kidney usually drain in to:
a. Seven calyces
b. Five calyces
c. Four calyces
d. Two calyces
e. Six calyces
24. The most important step in investigatin a patient with tense hydrocele:
a. U/S to visuzlize testis
b. Examine for associated hernia
c. History of trauma to testis
d. Rule out epidiymo orchitis
e. Congenital swelling
25. Direct inguinal hernias:
a. Are repaired by implanting a mesh
b. Often strangulate
c. Are treated by Bassini or darn operation
d. Are congenital
e. Are complete
26. Fissure in ano at an ectopic site or with atypical feature (not in IM)?
a. Heals after treating the cause
b. Raises the suspicion of malignancy
 c. Is commonly seen in patient with STD
d. Is usually associated with specific etiology
e. Requires adequate clinical examination under anesthesia with biopsy and culture
27. The strongest associate of splenic artery aneurysm is with:
a. Female sex
b. Age above 60 years
c. Presence of aneurysms in other vessels
d. Acute pancreatitis
e. Third trimester of pregnancy
28. Following type of gastric polyps commonly regress after medical therapy
a. Familial polyposis
b. Fundic gland polyps due to PPI
c. Inflammatory polyps
d. Metaplastic polyps associated with H. pylori
e. Very early gastric cancer polyps
29. Urate calculi present as
a. Hard, smooth often multiple stones in the kidney which are radio-lucent on plain
xray KUB
b. Soft, smooth, single stones which are radio-opaque on plain xray KUB
c. Solitary hard, irregular stone in the kidney, which are radio-lucent on plain xray KUB
and causes hematuria
d. Plain irregular often multiple stones in the kidney which are radio-opaque on plain
xray KUB and cause hematuria
e. Soft, smooth, often single stone in the kidney which are radio-lucent on plain xray
KUB
30. Following surgical procedure is an example in which surgery is central to the diagnosis of
cancer:
a. Oesophagectomy
b. Mastectomy
c. Orchidectomy (IM)
d. Left hemicolectomy
e. Right hemicolectomy
31. Regarding skene’s tubules
a. Are the homologue of the prostate in female
b. Canalize in 6 week of development
c. Develop from surrounding mesenchyme
d. Are a series of solid epithelial buds
e. Have a major role in differentiation
32. 40 year old male patient presented with painless haematuria and a palpable mass in right
region, dx ?
a. Renal CA
33. Stress urinary incontinence:
a. Occurs only in males
b. Is associated with urinary frequency and urgency
c. Is a disease of aging produced by shorting of the urethra
d. May be corrected by surgically increasing the volume of the bladder.
 e. Is principally a disease of young females
34. Regarding treatment of haemorrids:
a. Banding is suitable for second degree haemorrhoids (IM)
b. Haemoroidectomy is indicated for 3rd degree haemorrhoids (IM)
c. Cryosurgery with liquid nitrogen is an alternative to surgery
d. Injection treatment alone is best for 1st degress haemorrhoids (IM)
e. Endostaping technique is less painful and less traumatic
35. Despite of best supportive care the overall mortality from acute liver failure is:
a. 50%
b. 70%
c. 80%
d. 10%
e. 25%
36. Definite diagnostic tool for carcinoma of esophagus is:
a. Endoscopy and biopsy
b. Laparoscopy
c. Barium swallow
d. CT scan
e. U/S
37. Post thoracotomy pain
a. Is relieved by local anesthetic into wound and beneath pleura
b. Alters the breathing pattern and gas exchange
c. May be due to rib fracture during surgery (odd one out)
d. Is because of intercostal nerve entrapment
e. Is best treated by patient-controlled analgesia
38. In a case of intestinal obstruction of unknown etiology, the most suitable incision is:
a. Midline incision (IM)
b. Mini-laparatomy incison
c. Pfannenstiel incision
d. Kocher’s incision
e. Transverse incison
39. What frequency of transducer is used during transrectal ultrasound?
a. 5.5 mhz
b. 4.5 mhz
c. 3.5 mhz
d. 7.5 mhz
e. 6.5 mhz
40. Uric acid and urate stones are:
a. Hard, smooth, multiple stones which are radio lucent in plain x-ray abdomen
b. Hard, dirty white in color with multiple projections
c. Hard smooth and single stones
d. Smooth, hard single stone which are radio-lucent on xray abdomen
e. Hard, smooth, multiple stones which are radio-opaque on plain x-ray abdomen
41. The main cause of transudative ascites is
a. Cirrhosis
b. TB peritonitis
 c. Meig’s syndrome
d. Pancreatitis
e. Peritoneal metastasis
42. 25 years house maid slipped and fell on upturned leg of a chair sustaining injuries to the
perinrum. What is the initial vital question for the doctor in ER to enquire?
a. Had the patient passed urine after the incident
b. Is there any discharge
c. Was the injury with sharp or blunt object
d. Has the patient passed clotted blood per rectum
e. Has the patient moved her bowels after the incident
43. Renal calculi which commonly cause hematuria are:
a. Calcium Oxalate
44. Most common presentation of pelvic abscess developing about a week following
appendicectomy is:
a. Spiking pyrexia
b. Pain in suprapubic region
c. Boggy mass in pelvis
d. Pelvic pressure and discomfort
e. Loose stool with tenesmus
45. The commonest abnormality of female urethra is:
a. Prolapse
b. Carcinoma
c. Urethrocele
d. Stricture
e. Carbuncle
46. 25 year old female is diagnosed as a case of ulcerative colitis. What extra intestinal
manifestation will occur commonly?
a. Sclerosing cholangitis
b. Arthritis (IM)
c. Uveitis
d. Erythema nodosum
e. Ankylosing sponydylitis
47. The commonest testicular tumor is:
a. Seminoma
b. Teratoma
c. Interstial tumor
d. Lymphoma
e. Semino teratoma
48. Acute pseudocyst of pancreas is:
a. Formation requires 4 weeks or more
b. Encapsulated collection of fluid in greater sac
c. Collection of degenerated fluid enclosed in a wall of granulation tissue in the lesser
sac
d. A collection of pancreatic juice enclosed in a wall with epithelial lining
e. A collection of circumscribed intra abdominal pus in proximity to pancreas
49. In hereditary spherocytosis
 a. Red cell membrane permeability increases to sodium ion
b. Abnormal hemoglobin is present in abundance
c. Lipids are stored in red cells in large amounts
d. The causative factor in malrarial parasite
e. Anti bodies are formed which damage patients own platelets
50. Pancreatitis is primarily due to intracellular activation of enzyme:
a. Pancreozymin
b. Choleycystokinin
c. Amylase
d. Trypsinogen
e. Lipase
51. In adults the commonest cause of intussusception is:
a. A polyp (peutz-jegers)
b. A small bowel tumor
c. A meckel’s diverticulum
d. A large bowel tumor
e. A submucosal lipoma
52. A 30 years old male sustains a penetrating gunshot injury to the buttock with signs of
peritonitis. At laparotomy intraperitoneal perforation of rectum is found. Surgical
management includes:
a. Hartmann’s procedure
b. Rectal washout with wide drainage from below
c. Perforation closed with defunctioning ileostomy
d. Perforation closed with proximal defunctioning colostomy
e. Rectal washout wash out and defunctioning colostomy
53. A 25 years old male is diagnosed with 2nd degree hemorrhoids that come out of anus
during defection and retrieves themselves. Treatment of choice for her?
a. Band ligation (prolapse)
b. Open hemorhoidectomy
c. Injection sclerotherapy (bleeding)
d. Stapled hemorhoidectomy
e. Diet change and laxatives
54. Anal fissure:
a. Results from incorrectly performed haemorrhoidectomy
b. Contains tag of skin at distal end known as sentinel pile
c. Is treated by gentle dilatation of sphincter
d. In acute form is painful because it occurs in stratified epithelium
e. Is an elongated ulcer in long axis of anal canal
55. 17 year old female belly dancer presents with non obstructing common bile duct stones.
Best investigaton?
a. ERCP
b. CT scan is most helpful
c. Radio-nuclide scan is method of choice
d. Laparoscopic ultrasound is useful
e. Lymph node biopsy is central
f. Laparotomy is tool of choice
56. The normal amount of protein excreted by the kidney is
a. 230-250 mg/day
b. 80-150 mg/day
c. 50-80 mg/day
d. 200-230 mg/day
e. 150-200 mg/day
57. The carcinoma of prostate:
a. Is the common site of origin of skeletal metastases
b. May occur after prostatectomy for BPH
c. When symptomatic is usually not curable
d. Can be dectected early by elevated levels of prostatic specific antigens
e. Is the common site of origin of skeletal metastases
58. In spherocytosis the fragility of red cell membrane is due to increased permeability of
following ion into the cell:
a. Calcium
b. Lithium
c. Magnesium
d. Sodium
e. Potassium
59. In paraumbical hernia of <2 cms size
a. A primary fascial herniorrhapy is usually done
b. Transverse double breasting repair is commonly done
c. Laparascopic repair is preferable
d. Paraumblical hernipolasty with mesh is gold standard (>2 cms)
e. Repair and lipectomy is commonly done.
60. In Mallory Weiss syndrome the bleeding occurs due to
a. Longitudinal tear below the gastro esophageal junction
b. Tear of the stomach
c. A tear of the gastro esophageal junction
d. Longitudinal tear of the esophagus
e. Longitudinal tear above the gastroesophgeal junction
61. Hydatid cyst of the liver does not warrant any intervention if it is:
a. Uni-loculated
b. Located deep in the substance of the organ
c. Less than 5cms in diameter
d. Calcified
e. Not compressing the biliary channels
62. The preferred safe treatment of high complex fistula in ano remains:
a. Fistulectomy
b. Seton placement
c. Internal opening closure and extrasphincteric tract drainage
d. Extensive fistulotomy
e. Advancement flaps
63. In a patient with history of pain in right upper abdomen, high grade fever, fat intolerance
and a palpable mass in Rt hypochondrium the most probable cause is:
a. Empyema gall bladder
 b. Acute on chronic cholecystits
c. Mucocele of gall bladder
d. Carcinoma head of pancreas
e. Viral hepatitis
64. The best surgical treatment option to treat duodenal adenocarcinoma is:
a. Radio therapy
b. Chemo therapy
c. Segmental resection
d. Excision of a tumor
e. Whipple procedure
65. In small bowel obstruction, the plain x ray will show
a. Straight segments generally central and lying transversely with vallae conniventes
visible
b. Irregularly placed indurations with haustral folds
c. Straight segment lying transversely at the periphery of the film
d. Straight segments generally central and lying transversely with haustral folds
e. Centrally placed transverse segments along with irregularly placed induration on
the periphery of film
66. Preferable treatment of femoral hernia is:
a. Surgical closure of femoral canal
b. Laparoscopic repair
c. Closure of saphenous opening
d. Use of a Truss
e. Femoral herniotomy
67. Acute intussusception
a. Proximal part of guy enters into the distal part
b. Is idiopathic
c. Occurs in children
d. Leads to gangrene
e. Occurs due to hypertrophic peyer’s patches
68. The most frequent complaint of patients with colonic carcinoma is:
a. Change in bowel habits (IM)
b. Bleeding per rectum (IM)
c. Pain in abdomen
d. Mucus per rectum
e. Mass in abdomen
69. Which of the following is the most common type of intussusception
a. Ileocolic
b. Colocolic
c. Multiple
d. Ileoileal
e. Ileo-ileo colic
70. A 50 year old male presents with bleeding per rectum and tenesmus. Proctoscopy is
normal. The next line of investigation is:
a. Sigmoidoscopy
b. CT scan of abdomen
 c. Colonscooy
d. Single contrast barium enema
e. Double contrast barium enema
71. The following is the commonest presenting feature of carcinoma of head of pancreas:
a. Painless jaundice
b. Change in bowel habits
c. Palpable liver
d. Anorexia and weight loss
e. Metastatic lymph node in the neck
72. A 30 year old man develops upper abdominal pain with radiaton to back after a week of
non stop alcohol consumption. Which lab test among the following suggests a most
probable diagnosis?
a. Elevated blood alcohol level
b. Raised serum amylase
c. Raised white cell count
d. Elevated bilirubin level
e. Elevate prothrombin time
73. The radiological findings in case of intestinal obstruction due to gall stones are
a. Multiple air fluid levels in small bowel in erect x ray abdomen
b. Multiple gas filled bowel loops with radio opaque stone at ilecoecal junction
c. Multiple air fluid levels in small bowel and air in biliary tree
d. Step- ladder pattern of fluid level in small and large bowel
e. One or three air fluid levels at ileocecal junction and impacted stone
74. The cause of strangulation in closed bowel loop obstruction is due to
a. Increased intraluminal pressure with obstruction at proximal and distal ends
b. Interrupted blood flow from complete volvulus or intussusception
c. External obstruction from adhesions or hands
d. Mesenteric infarction primary to arterial emboli
e. Significant aerobic and an aerobic bacterial over growth
75. Type of intussusception common in adults:
a. Colo-colic
b. Ileo-colic
c. Ileo ileal
d. Ileo-ileo-colic
e. multiple
76. A 45 years old male presented with haemetemesis. His upper GI endoscopy revealed a
2x2 cm ulcer in the body of the stomach. He has previous history of dyspepsia since last 1
year. The most important strategy in his management is
a. Endoscopic ablation of bleeding
b. Endoscopic biopsy
c. H. pylori eradication
d. Blood transfusion
e. Early institution of PPI’s
77. The ideal treatment for an established acquired hydrocele is
a. Jaboulay’s procedure (thick)
b. Lords plication (thin)
 c. Canula drainage
d. Injectioin of sclerosants
e. Conservative for unfit patients
78. Regarding sliding hernia:
a. Patient is nearly always over 40 years of age
b. May be found in females
c. Is controlled with truss
d. Is treated by herniotomy
e. Mostly found on right side
79. High incidence of upper GI bleeding from duodenal ulcer is from
a. Posterior duodenal ulcer
b. Anterior duodenal ulcer
c. Erosions
d. Associtated angio dysplasia
e. Ulcer more than 2 cm in size
80. Condylomata acuminate (Genital warts) is caused by:
a. Human papilloma virus
b. Candidiasis
c. Gonococcus
d. Trichomonas
e. Treponema pallidum (syphilis)
81. Proliferation and clonal expansion of following cells is an integral part of the immune
response to allograft
a. Lymphocytes
b. Basophils
c. Platelets
d. Neutrophils
e. Eosinophils
82. Most common complication of urethral injury is:
a. Stricture of urethra
b. Impotence
c. Hemorrahage
d. Urinary incontinence
e. False passage
83. Etiological factor for ulcerative colitis is
a. Genetic predisposition
b. Milk ingestion
c. A weakened mucosal barrier
d. Bacterial dysentery
e. Abstincence from smoking

SURGERY PAPER 2 2012

1. A 25 years old female is diagnosed with 2nd degree hemorrhoids that come out of anus
during defecation and retrieves back themselves. The treatment of choice for her
condition is:
a. Band ligation
 b. Open hemmorhoidectomy
c. Injection sclerothrapy
d. Stapld hemmorhoidectomy
e. Diet change and laxatives
2. Regarding internal hemorrhoids
a. Treated by band ligation
b. Represented dilated internal venous plexus with prolapsed anal cushions
c. Diagnosed on proctoscopy
d. They are primary heamorrhhoids
e. Usually occurs below the anorectal ring
3. Opacities on plain xray abdomen radiography that may give false impression of renal
calculus
a. Calcified mesenteric lymph nodes and phlebolith
b. Calcified mesenteric lymph nodes, phlebolith, gallstones, concretion in in appendix,
ossified tip of ribs, calcified TB lesions of kidney
c. Gall stones, ossified tip of the 12th rib, foreign body in the alimentary tract and
calcified mesenteric lymph nodes
d. Calcified TB lesion in the kidney, calcified adrenal gland and gall stones
e. Gall stone, calcified mesenteric lymph nodes and concretion in the appendix
4. Tumors associated with environmental exposure of ionizing radiation
a. Melanoma, cervix, endometrial cancer
b. Leukemia, cervix, stomach
c. Breast, hepatoma, mesothelioma
d. Lung, cancer, esophageal cancer, gastric cancer
e. Thyroid, lymphoma, leukemia
5. Which one of the following is not true about Hypospadias
a. Is usually coronal
b. Usually operated before 2 years of age
c. Is mainly a cosmetic problem
d. Circumcision must be avoided
e. Other genotiurinary abnormalities should be excluded
6. Regarding surgical anatomy of esophagus
a. It is lined columnar epithelium
b. Meissener’s plexus is abundant in esopohagus
c. Two centimeter or less lies below the diaphragm
d. It is 25 cm in length
e. It occupies posterior mediastinum
7. Best diagnostic modality for esophageal perforation is
a. Xray chest and abdomen
b. MRI
c. Contrast esophagus
d. Chest and abdomen
e. Upper GI endoscopy
8. If confirmation of acute pancreatitis is required then the investigation of great importance
a. CT scan of abdomen
b. Serum amylase
 c. Serum lipase
d. Urinary amylase
e. Serum chymotrypsin
9. 50 year old female diagnosed case of GERD had been on a H2 receptor antagonist. She
had been to various doctors for treatment of anxiety and depression. Her GERD symptoms
have exaggerated in the last 18 months. The best treatment modality in her case is
a. fundoplication
b. endoscopic treatment
c. antipsychotic drugs and anxiolytics
d. PPI’s
e. Dietary modification
10. Regarding duodenal ulcer:
a. Anterior ulcers tend to bleed
b. Two anterior placed ulcers are known as kissing ulcers
c. Most occur in 2nd part of duodenum
d. Anterior stores tend to perforate
e. Posterior ulcer tend to bleed commonly by ending splenic artery
11. Gold standard treatment of benign prostatic hypertrophy is
a. Transurethral resection of prostate
b. Wait and watch
c. Catheterization
d. Open prostectomy
e. Drugs
12. Treatment of choice for varicocele when available is
a. Open surgical procedure
b. High ligation
c. Embolization of testicular veins under radiographic control (IM)
d. Laparoscopic ligation
e. Low ligation
13. The typical symptoms of acute appendicitis are in following sequence
a. Fever, lower abdominal pain, nausea and vomiting
b. Generalized abdominal pain, absolute constipation fever and vomiting
c. Periumblical pain, which shifts to right iliac fossa anorexia, nausea and low grade
fever
d. Nausea, vomiting, right iliac fossa pain and diarrhea
e. High grade fever, periumblical pain which shafts to right iliac fossa, nausea and
absolute constipation
14. The operative procedure preferred for complicated large duodenal ulcer perforation is
a. Truncal vagotomy and antrectomy
b. Billroth I gastrectomy
c. Truncal vagotomy an pyloroplasty
d. Billroth II gastrectomy
e. Gastro jejunostomy rouxen y
15. The most important investigation to diagnose the cause of diffuse peritonitis is:
a. CBC
b. Erect abdominal radiography in unconscious patients
 c. Peritoneal diagnostic aspiration
d. Ultrasound/CT scanning
e. Serum amylase
16. Most testicular tumors
a. Metastasize via lymphatics
b. Often come into notice after trauma
c. Seen in undescended testis
d. Are teratoma
e. Are malignant
17. A T2N1M? colorectal cancer is
a. Intraepithelial tumor, metastasis 1-3 regional lympoh nodes so distant metastasis
b. Tumor invades submucose, metastasis in 1-3 regional lymph nodes, no distant
metastasis
c. Tumor invades submucosa, no metastasis in regional lymph nodes, distant
metastasis present
d. Tumor directly invades beyond bowel, metastasis, 4 regional lymph nodes, no
distant metastasis
e. Tumor invades muscularis propria, metastasis 1-3 regional lymph nodes, no distant
metastasis
18. The vessels responsible for bleeding from esophagus/stomach in portal hypertension are
a. Inferior pancreatoduodenal artery
b. Gastroduodenal artery
c. Coronary vein
d. Short gastric artery
e. Superior pancreatoduodenal artery
19. In the differential diagnosis of femoral hernia the commonest condition is:
a. Rupture of adductor longus muscle with haemotoma formation
b. Femoral artery aneurysm
c. Saphena varix
d. Burst psoas abscess
e. Inguinal hernia
20. 30 years old male sustains a penetrating gunshot injury to the buttock with signs of
peritonitis. At laparotomy intraperitoneal perforation rectum is found. Surgical
management includes
a. perforation closed with proximal defunctionig colostomy
b. rectal washout with wide draninage from below
c. rectal wash out and defuntioning colostomy
d. harmtmann’s procedure
e. perforation closed with defunctioning ileostomy
21. Treatment recommended for perianal abscess is
a. Drainage of the abscess by wide bore cannula and irrigation with antibiotic solution
for 5 days
b. Incison and drainage of abscess with de-roofing of the abscess cavity
c. Application of poultice and wait for the abscess to burst and drain spontaneously
d. Incison and drainage of abscess cavity and suturing the incision with interrupted
sutures
 e. Analgesia and antibiotics for 5 days
22. Vaginal hydrocele means
a. Smooth rounded oval swelling in the canal of nuck in females
b. The collection of fluid in tunica vaginalis with swelling confined to scrotum
c. The collection of fluid in the tunica vaginalis with patent processes vaginalis and
communication with peritoneum
d. The collection of fluid in tunica vaginalis which extends upto to the deep ring
e. A smooth oval swellin near the spermatic cord which may be mistaken for inguinal
hernia
23. While performing appendectomy, appendiceal stump is neither crushed nor ligated.
Instead two stiches are placed in cecal wall close to base of appendix and tied in case of:
a. Retrocecal appendix
b. Inflamed base of appendix
c. Perforated base of appendix
d. Edematous cecal wall
e. Gangrenous appendiceal base
24. 55 years male presented in surgical emergency with the history of gastric outlet
obstruction the most common cause of this obstruction
a. gastric ulcer
b. duodenal ulcer
c. pyloric mucosal diphragram
d. gastric cancer
e. adult pyloric stenosis

25. In hypospadias:
a. Chordee is upward bending of penis
b. Absent urethral strictures are represented
c. Perineal variety is the commonest
d. Glandular variety usually does not need treatment
e. Circumcision should be done as soon as possible.
26. 50 year old female presents with a year long history of rectal bleeding. She is sent to the
surgeon with a suspicion of malignancy. The most efficient initial diagnostic investigation
for colorectal carcinoma is:
a. spiral CT scan
b. U/S abdomen
c. Double contrast barium enema
d. Colonscopy
e. Flexible sigmoidoscopy
27. A 25 year old male diagnosed case of ulcerative colitis presented with high grade fever >
38 C, 100 b/min and a history of passage of eight to ten bloody stools per day, his
immediate treatment is
a. Topical 5 aminosalicytic acid
b. Antidiarrheals
c. Systemic steroids
d. Topical steroids
e. Systemic 5 aminosalicylic acid
28. After penumonectomy the most serious complication is
a. Respiratory infection
b. Broncho pleural fistula
c. Persistent air leak
d. Wound infection
e. Post operative bleeding
29. Acute pancreatitis should be highly suspected in a patient who presents with
a. Acute onset of right sided upper abdominal pain with radiation to back
b. Clinical feautres suggesting myocardial infarction with abdominal distention
c. Acute onset of left sided upper abdominal pain radiation to back
d. Acute non specific abdominal pain with shock
e. Shock following abdominal surgery
30. Proximal gastric cancer is not associated with:
a. H. pylori
b. Genetic factors
c. Gastric polyp
d. Obesity
e. Higher socioeconomic status
31. Incidence of recurrence following duodenal ulcer operations is higer in
a. Gastro enterostomy alone
b. Gastrectomy
c. Selective vagotomy and drainage
d. Truncal vagotomy and drainage
e. Hghly selective vagotomy
32. Regarding blunt renal trauma
a. Blunt renal trauma requires exploration only when the patient exhibits
hemodynamic instability.
b. Blunt renal trauma must be evaluated by contrast studies using either IVP or CT
c. Blunt renal trauma with urinary extravastation always requires surgical exploration
d. Blunt renal trauma and penetrating renal injuries are managed similary.
e. Any kidney fractured by blunt renal trauma must be explored.
33. After trauma bulbar urethral injury should be suspected when examination findings are
a. Rentention of urine perineal haematoma and fracture pelvis
b. Rentention of urine, perineal haematoma and bleeding from external meauts
c. External meatus bleeding and rentention of urine
d. External meatus bleeding along with pelvic fracture
e. Perineal haematoma and retention of urine
34. Features of late dumping syndrome
a. Relived by taking food
b. Major symptoms is epigastric fullness
c. Aggravated by taking food
d. Major symptoms is abdominal colic
e. Major symtoms is sweating
35. The cause of strangulation in closed bowel loop obstruction is due to
a. Siginificant aerobic and an aerobic bacterial over growth
b. External obstruction from adhesions or bands
 c. Mesenteric infarction primary to arterial emboli
d. Interrupted blood flow from complete volvulus or intussusception
e. Increased intraluminal pressure with obstruction at proximal and distal ends
36. Most common cause of rentention of urine beyond 60 years of age is
a. Benign prostate hyperplasia
b. Stricture urethra
c. Constipation
d. Carcinoma of prostate
e. Urethral stone
37. After common bile duct exploration for stones, CBD is most commonly
a. Closed with continuous sutures with T-tube
b. Anastomosed to duodenum
c. Closed with sutures without T-tube
d. Closed with interrupted sutures with out T-tube
e. Closed with continuous or interrupted sutures with T-tube
38. 25 year old female is diagnosed as a case of ulcerative colitis. What extra intestinal
manifestation will occur commonly?
a. Uveitis
b. Sclerosing cholangitis
c. Arthritis (IM)
d. Erythema nodosum
e. Ankylosing spondylitis
39. In small bowel obstruction, the plain xray abdomen will show
a. Straight segments generally central and lying transversely with haustral folds
b. Centrally placed transversely segments along with irregularly placed induration on
the periphery of film
c. Straight segments generally central and lying transversely with valvulae
conniventes visisble
d. Irregularly placed induration with haustral folds
e. Straight segment lying transversely at the periphery of the film
40. Discrete nodules of carcinoma peritoneal closely resemble
a. Peritoneal hydatids
b. Fat necrosis
c. Fibrotic bands
d. TB peritonitis
e. Pancreatic neurosis
41. The potential source of anal sepsis resulting in an abscess and fistula is
a. Immunocomprimised patient
b. Systemic infection
c. Infection of intersphincteric anal gland
d. Hygiene of perianal region
e. Diabetes
42. A 30 year old lady with pregnancy of 6 months present with bilateral lumbar pain and
fever. U/S KUB is normal. To establish diagnosis of pyelonephritits the most suitable
investigatioin is
a. Urine DR and C/S
 b. X ray IVP
c. Blood urea
d. Blood CP and ESR
e. X-ray KUB
43. Therapeutic bronchoscopy is most commonly done for
a. removal of mucus plugs
b. stent placement
c. aspiration of blood
d. removal of foreign body
e. endobronchial resection
44. The migrating motor complex of gastro intestinal tract moves distally at rate of 5-10
cm/min reaching the teriminal ileum in 1.5 hours. It starts
a. In phase III after a meal
b. In phase I of quiescence period
c. In phase II of propagation in stomach
d. In the slow wave phase of duodenum
e. In the waves propagated from fundus of stomach
45. According to TNM classification for Carcinoma of prostate if the tumor is fixed and
invading adjacent rectum or pelvic side wall it is
a. T2b,N0,M0
b. T3a,N0,M1
c. T4,N0,M0
d. T1c,N0,M0
e. T4,N0,M0
46. Carcinoid tumor of appendix commonly occurs in:
a. Retrocaecal appendix
b. Pelvic appendix
c. Proximal third of appendix
d. Base of appendix
e. Distal third of appendix
47. 65 year old male presented in OPD with multiple episodes of rectal bleeding. He gives
history of similar episodes of paniless bleeding for last 8 months with several episodesd
of diahorrhea. The commonest cause of bleeding in his case would be
a. colorectal carcinoma
b. colonic polyps
c. ulcerative colitis
d. diverticulitis
e. angiodysplasia
48. The characteristic feature of a pelvic abscess is
a. septic shock
b. intestinal obstruction
c. a lump in hypogastrium
d. exaggerated sounds
e. diarrhaea and passage of mucus in stools
49. the most widely used scolicidal agent during open hepatic hydatids cyst surgery in
Pakistan is:
 a. 0.5% silver nitrate
b. fermaldehyde
c. 20% hypertonic saline
d. 95% sterile ethanol
e. absolute alcohol
50. 55 years old female was diagnosed as having squamous cell carcinoma at 28 cms of
esophagus on endoscopy. Best modality for staging this patient is
a. PET scan
b. MRI scan
c. CT chest with contrast
d. Bronchoscopy
e. Endoscopic ultrasound
51. Regarding strawberry gall bladder
a. Interior of the gall bladder looks like strawberry due to submucosal deposition of
cholesterol crystal and cholesterol esters
b. Patient presents with dyspepsia
c. The gall bladder has chronic inflammation
d. It is a variety of cholestasis
e. Associated with cholesterol stones
52. Which of the following best describes the thin descending limb of the loop of Henle?
a. Impermeable to water, highly permeable to sodium and choride and slightly to urea
b. Impermeable to water and urea with sodium and chloride actively reasbsorbed
c. Impermeable to water
d. Permeable to water and less permeable to sodium, chloride and urea
e. Permeable to water, sodium, chloride and urea
53. Key to successful cholecystectomy is:
a. Blood less field
b. Using diathermy with care
c. Saline wash of the operative field
d. Meticulous dissection
e. Defining calot’s triangle properly
54. A 55 years old male presents in OPD with 1 day history of perianal pain after lifting heavy
load. O/E a painful swelling at the perianal verge is seen. What is your diagnosis?
a. A sentinel pile with fissure
b. Strangulated external haemorhoids
c. Intero-external haemorrhoids
d. A thrombosed external pile
e. A perianal haematoma
55. The most common reason for enterocutaneous fistula is
a. Crohn’s diseae
b. Malignancy
c. Postoperative
d. Radiation
e. Ulcerative Colitits
56. A 14 day old newborn presents with projectile vomiting. The clinical feature that will help
diagnose level of obstruction is:
 a. Amount of vomitus
b. Presence of abdominal signs
c. Color of vomitus
d. Consistency of vomitus
e. Presence of fever
57. The pathophysiology of dynamic obstruction depends upon ?
a. Irrespective of etiology and acuteness a dilated proximal bowel and contracted
distal bowel
b. Increased proximal peristalsis continuously with dilated distal bowel
c. Altered proximal bowel motility leading to distal bowel dilation
d. Mesenteric vascular occlusion leading to bowel obstruction
e. Acuteness of onset and etiology followed by proximal bowel dilation empty distal
loop
58. 45 year old lady para 5 case of severe pain on defecation and rectal bleeding last 2 years
is seen in the opd. O/E longititudinal split seen in endoderm of distal canal at 12 o clock
position. Etiology in her case?
a. Surgery
b. Trauma
c. Diarrhea
d. Vaginal delivery
e. Hard stool
59. Which symptom is likely to be predictor of strangulation in patients of acute intestinal
obstruction
a. Constipation
b. Abdominal tenderness
c. Sudden and severe abdominal pain with early and profuse vomiting
d. Hypovolemic shock
e. Distention of abdomen
60. A 43 yr old gentleman present with backache and on working is found to retroperitoneal
fibrosis affecting the right ureter. His intial management will be:
a. Ureteric stenting & steroids
b. Renal transplant
c. Nephron ureterectomy
d. Percutaneous nephrosotomy
e. Excision of diseased ureter and reimplantation
61. Differentiating point for undescended and retractile testis is that in undescended tesits,
a. Scrotum is empty
b. Scrotum on affected side is under developed
c. Associated with hernia
d. Loss of cremester reflex
e. Small size of testis
62. The most important predisposing factor for causation of pilonidal sinus is
a. hairy maile
b. prolonged sitting
c. profession
d. buttock friction and shearing forces in natal left
 e. infection
63. The treatment options for acute proctitis are as follows
a. Only symptomatic treatment advised
b. No further treatment is required
c. Relief obtained by 5 aminosalicyclic acid compounds and predisnolone enemas
d. Oral steroids are necessary
e. Surgery is done to obtain early relief
64. Anal incontinence in young adults:
a. Results from childbirth trauma
b. Is due to irraditation
c. Is due to perineal descent
d. Due to patulous sphincter after diarrhea
e. Due to divided sphincter after injury
65. Condylomata acumnata (genital warts) are caused by
a. Candidiasis
b. Trichomonas
c. Gonococcus
d. Terponema pallidum
e. HPV
66. A Vietnamese woman had pigment stones removed at cholecystectomy. Which of the
following could be more likely cause of stones?
a. Bile duct strictures
b. Hereditary spherocytosis
c. Thalesemia
d. Worm infestation
e. Sickle cell anemia
67. Urate calculi present as:
a. Soft smooth often single stone in the kidney which are radio-lucent on the plain
x-ray KUB
b. Plain irregular often multiple stones in the kidney which are radio-opaque on plain
xray KUB and cause hematuria
c. Soft smooth single stones which are radio-opaque on plain xray KUB
d. Hard smooth often multiple stones in the kidney which are radio lucent on plain
xray KUB
e. Solitary hard, irregular stone in the kidney, which are radio-lucent on plain xray KUB
and causes hematuria
68. Pancreatitis is primarily due to intracellular activation of enzyme:
a. Pancreozymin
b. Cholecystokinin
c. Lipase
d. Amylase
e. Typsoinogen
69. The most common organisms involved in causing pyogenic liver abscess
a. E.coli
b. Proteus vulgaris
c. Klebsiella
 d. Streptococcus faecalis
e. Staphlyoccossu aureus
70. The most important condition in the differential diagnosis of diverticular disease is:
a. Crohns disease
b. Ulcerative colitis
c. Polyps
d. Carcinoma
e. Ischemic colitis
71. Which of the following is the most common type of intussusception
a. Ileocolic
b. Colocolic
c. Ileoileal
d. Ileo-ileo-colic
e. Multiple
72. 22 year old girl, a day after appendicectomy complains of fever, abdominal pain, diarrhea
and passage of mucus in stools. On digital rectal examination, there is a soft bulge
anteriorly. Her most appropriate management is:
a. laparoscopy and drainage
b. CT guided drainage
c. Laparaotmy and drainage
d. Ultrasound guided perabdominal drainage
e. Per rectal drainage
73. A young man with history of road accident is brought to emergency in shock..O/E he has
bruising of left lower chest, management?
a. Fludid recuscitation and ultrasound
b. Thoracocentesis of left chest
c. Surgical treatment for splenic rupture is an indication for surgery
d. Evaluation for injury to gut
e. Confirmation of splenic rupture is an indication for surgery
74. Acute intussception
a. Leads to gangrene
b. Occurs in children
c. Occurs due to hypertophic peyer’s patches
d. Proximal part of gut enters into distal part
e. Is idiopathic
75. Most important serum markers in teratoma of testis is
a. Alpha feto protein
b. LDH
c. Beta HCG
d. CFA
e. CA 125
76. Carcinoma of prostate:
a. Can be detected early by elevated levels of prostatic specific antigen
b. May occur after prostatectomy for BPH
c. Is common malignant tumor in males over the age of 65 years
d. Is the common site of origin of skeletal metastases
 e. When symptomatic , is usually not curable.
77. For staging and clinical assessment of hepatocellular carcinoma the following are not
imporatnat:
a. CT scan for assessment of intraperitoneal disease
b. Child grading
c. CT and MRI 2 weeks after injecting lipoidal
d. Chest CT and bone scan
e. Is the liver cirrhotic
78. 25 years old female presents with acute upper abdominal pain radiating to the back. Her
serum amylase is 4000 iu/dl (upper limit 170 iu/dl) ransons score on admission is 2.
Predicted mortality?
a. 20%
b. 75%
c. 5% (ranson score 0-2 is 2% mortality)
d. 50%
e. 90%
79. 35 years old female with past history of acute pancreatitis presents with persistent
abdominal pain a vague mass in epigastrium. US shows a cystic lesion in the head of
pancreas. The diagnostic laboratory investigation of choice is:
a. serum insulin level
b. hydrogen breath test
c. fecal fat analysis
d. serum amylase
e. serum lipase
80. A trainee surgeon operates on a gallstone patient laparoscopically. Postop patient
develops biliary peritonitis. Which is the most likely cause?
a. Liver laceration
b. Oozing of bile from liver bed
c. Duodenal injury
d. Common bile duct injury
e. Portal vein injury
81. 35 year old male presented with six months of rectal bleeding. His colonoscopy revelaed a
circumferential growth and 10cms from anal verge. Biopsy revealed adenocarcinoma
rectum. The next investigation of choice to determine local spread would be
a. U/S abdomen
b. MRI
c. Endoluminal U/S
d. PET
e. Ct scan
82. The main cause of transudative ascites is
a. TB peritonitis
b. Peritoneal metastasis
c. Cirrhosis
d. Pancreatitis
e. Meig’s syndrome
83. Regarding mesenteric cysts:
 a. Enterogenous cyst has same blood supply as bowel from which it originates
b. Enterogenous cyst is filled with milky fluid
c. Cysts from urogenital remnant are essentially intraperitoneal
d. Dermoid cyst is commonest variety among all mesenteric cysts
e. Chylolymphatic cyst requires resection of bowel
84. Post cholecystectomy syndrome reflects as:
a. Persistence of pre-operative symptoms
b. A retained stone in cystic duct stump
c. Post op jaundice
d. Injury to common bile duct
e. Stone in common bile duct
85. The growth and descent of testis through the abdominal wall into the scrotum is
dependent upon
a. Maternal chorionic gonadotropins
b. Fold of peritoneum
c. Gubernaculum
d. Processes vaginalis
e. Normal development of testis
86. For histological diagnosis of lymphoma
a. Lymph node biopsy is central
b. Laparaotmy is tool of choice
c. Laparoscopic ultrasound is useful
d. Radio nuclide scan is method of choice
e. CT scan is most helpful
87. 40 year old male patient presented with painless haematuria and palpable mass in right
region DX?
a. Right sided hypernephroma
b. Right renal calculus
c. Right ureteric calculus
d. Rifht sided hydronephrosis
e. Pyelonephritis

SURGERY PAPER 2 2012

1. Regarding principles of immunosuppression:
a. The aim is to maximize graft protection and minimize side effects (IM)
b. Need for immunosuppression is maximum in the 1st 9 months after organ
transplant
c. Principles vary according to the organ transplanted
d. Immunosuppression increases the risk of infections and malignancies
e. All regimens are based on calcineurin blockade and steroids
2. Side effects of non specific immunosuppression
a. CMV is a major problem
b. Transplant receipients are at high risk of cadidial infections
c. Risk of infections is highest in the 1st year after transplant
d. Chemoprohylaxis is important during first 3 months after transplant (IM)
3. Which of the following is not a feature of brain death
 a. Absence of pupillary eye response
b. Straight line on ecg (IM)
c. Absence of gag/cough reflex
d. Absence of corneal reflex
e. Absence of caloric reflex
4. Best investigation to diagnose site of intestinal obstruction is
a. Erect abdominal x-ray
b. Supine abdominal x-ray
c. CT abdomen
d. Barium follow through
e. Erect chest x-ray
5. Which anatomical variation of the cystic artery is the most dangerous
a. Tortuous cystic artery
b. Short cystic artery
c. Behind the cystic duct
d. Below the cystic duct
e. In front of the cystic duct
6. Regarding bladder stones
a. Cysteine stones are multiple, change color from green to pink and are hard and
radio-opaque
b. Cysteine stones are usually single, change color from pink to green and are soft
and radiolucent
c. Cysteine stones are multiple, change color from pink to green and are very hard and
radio-opaque
d. Cysteine stone occur as a solitary stone is usually huge, soft and radio-lucent and
changes color from pink to green when exposed to air.
e. Cysteine stones are hexagonal, translucent and very hard in consistency and
appear as white crystals only in alkaline urine
7. Calots triangle is identified to prevent injury to which structure
a. Hepatic vein
b. Cystic artery
c. Gall bladder
d. Cystic duct
e. Common bile duct
8. Safest scollicidal agent used in PAIR procedure is
a. 95% etanol
b. hypertonic saline 20%
c. normal saline
d. albendazole
e. mebendazole
9. step ladder pattern in intestinal obstruction is seen in
a. erect abdominal x-ray
b. supine abdominal x-ray
c. erect chest x-ray
d. barium studies of the intestines
e. sigmoidoscopy
10. How will you manage a 28yr old otherwise healthy man coming to you with the complain
of something coming out of his anus while defecation and going back spontaneously
a. Banding and laxatives
b. Sclerotherapy
c. Haemorrhoidectomy
d. Conservatively
e. Avoiding stress
11. Prostate venous plexus is situated
a. Within the anatomical capsule
b. In between the prostate and bladder base
c. Within the false capsule
d. Within the endopelvic facia
e. In between the anatomical capsule and the prostatic sheath
12. After common bile duct exploration for stones, CBD is:
a. Closed with continuous sutures or intermittent sutures with t-tube
b. Closed with continuous sutures with t-tube
c. Closed with sutures without the t-tube
d. Closed with intermittent sutures without t-tube
e. Anastomosed with duodenum
13. A patient of gastric cancer (with no evidence of metastasis on imaging) was
coincidentally found to have a mass in the liver during surgery, what should be done about
the mass during the surgery?
a. Take a frozen section for cytology and wait for the report before closing the
abdomen
b. Leave it as it is and investigate further at a later date
c. Inject 90% ethanaol solution into the mass
d. Resect the mass
e. Perform lobectomy of the effected lobe
14. Pipe-like appearance on radiograph
a. Ileum
b. Jejunum
c. Duodenum
d. Transverse colon
e. Toxic mega colon
15. To label imperforate anus as high or low the best investigation done is
a. Lateral prone radiograph (invertogram IM)
b. Ct scan abdomen
c. Supine abdominal radiograph
d. Erect chest x-ray
e. Barium enema
16. What is implicated in etiology of ulcerative colitis
a. HLA related
b. Abstinence from smoking
c. Consumption of milk
d. Steroids
e. Mycoplasma
17. Gold standard treatment for bilateral direct inguinal hernia’s (laproscopoic hernioraphy
repair)
a. Herniotomy with mesh repair
b. Bassini’s repair
c. Herniotraphy ?
d. Trus
e. Darning repair
18. The hernia in which the content of the sac is mekel’s diverticulum is known as
a. Richter’s hernia
b. Femoral hernia
c. Littre’s hernia
d. Incisional hernia
e. Salpegian herna
19. Commonest cause of intussception in a child is
a. Idiopathic (IM)
b. Hypertrophy of peyer’s patches
c. Mesenteric adenitis
d. Diarrhea
e. Polyps
20. 60 years old patient complaining of rt. Iliac fossa pain, which investigation will help you in
making the diagnosis
a. CT scan
b. Barium follow through
c. Colonscopy
d. X-ray abdomen
e. Sigmoidoscopy and biopsy
21. A 60 yr old pt. comes to you with profuse bleeding could not be determined, what is the
treatment for this pt.
a. Sub total colectomy with ileostomy
b. Pan colectomy with permanent ileostomy
c. Right hemicolectomy with colostomy
d. Right hemicolectomy with ileostomy
e. Extended left hemicolectomy
22. Which investigation should be done for diagnosing a bladder diverticulum
a. X-ray pelvis
b. X-ray abdomen
c. Mri abdomen and pelvis
d. Cystourethroscopy
e. Suprapubic puncture
23. Commonest site of carcinoid tumor is
a. Distal 1/3rd of the appendix
b. Ampulla of vater
c. Periampullary region
d. Apex of lung
e. Base of appendix
24. Most common location of the appendix
 a. Post ileal
b. Pelvic
c. Paraileal
d. Sub ceacal
e. Retroceacal
25. What is the frequency used for rectal u/s
a. 4.5 hz
b. 6.5 hz
c. 7.0 hz
d. 6.0 hz
e. 9 hz
26. a 60 yr old pt. comes to you with recurrent hematemesis and as a house officer you need
to counsel the patient’s attendant, what will you tell the attendant to the be the most likely
cause of this:
a. duodenal ulcer
b. gastric erosion
c. esopophageal varices
d. gastric carcinoma
27. An alcoholic with esophageal varices is brought to you, what is the best management of
this pt.
a. Blackmore gastric ballon is inserted for temporary hemostasis and the ballon
deflated after ever 12 hrs
b. Urgent endoscopy and liagation
c. Emergency esophagectomy
d. Endoscopic sclerotherapy
e. TIPSS
28. Best statement regarding para esophageal hiatal hernia/ rolling hernia is
a. Cardia remains in its normal anatomical position
b. Cardia is displaced into the chest (IM)
c. Greater curvature of stomach rolls into the mediastinum (IM)
d. Stomach undergoes volvulus
e. Mixed variety is never found
29. Femoral hernia is best treated by
a. Tuss
b. Herniotomy
c. Herniotomy and mesh repair
d. Herniotomy and closure of the canal
30. Gold standard investigation for GERD is
a. Endoscopy and biopsy
b. 24 hr ph monitoring
c. urea breath test
d. barium studies
e. manometry
31. most common cause of upper GI bleeding
a. ulcer
b. erosion
 c. malignancy
d. portal HTN
e. Mallory Weiss syndrome
32. Risk of malignant change is associated with which type of gastritis?
a. Type a
b. Type b (due to h.pylori for distal ca)
c. Pangrastritis
d. Auto immune gastritis
e. ? ( if option given, it should be all of above)
33. For defining endocrine tumors of pancreas
a. CT and SRS
b. PET
c. Stool elastase
d. ERCP
e. U/S
34. Exocrine function of pancreas is most conveniently judged by
a. Stool elastase
b. CT scan
c. U/S
d. Serum amylase
e. Blood sugar levels
35. Resectibility of carcinoma of biliary tree is best judged by
a. CT scan
b. MRCP
c. ERCP
d. U/S
e. PTC
36. The complication of splenectomy which is induced by the doctor
a. Sepsis
b. Gastric dialation
c. Infecton
d. Heamorrhage
e. Pancreatic fistula
37. Commonest cause of adhesions during surgery is
a. Appendix
b. Talc
c. TB
d. Previous intestinal surgery
e. Typhoid
38. Commonest cause of pancreatitis in our country
a. Gall stones
b. Alcohol
c. Nsaids
d. ERCP
39. Villous adenoma
a. Fond like appearance
 b. Always causes tremendous water and electrolyte disturbance
c. Losses K ions in large amounts
d. Looses NA ions in huge quantities
e. Are purely benign in nature
40. Secondary hydrocele is most commonly associated with
a. Injury
b. Acute infection
c. Malignancy
d. Epidiymo-orchitis
e. Torsioin of testes
41. Commonest type of intussuception
a. Ilecolic
b. Colocolic
c. Distal part into the proximal
d. Does not cause intestinal obstruction
e. Intitiaed by hyperplasia of peyer’s patches
42. Commonest complication of prostatectomy
a. Retrograde ejaculation
b. Heamorrhage
c. Sepsis
d. Fluid overload
e. Impotence
43. Regarding Ca prostate, best statement
a. Most common malignancy in men over 60 yrs
b. Becomes incurable once symptoms appear
c. Most are squamous cell carcinoma
d. PSA level above 10 is diagnostic
e. Usually originates in the transitional zone
44. Metastasis from all of the following malignancies go to the brain except
a. Liver
b. GIT
c. Breast
d. Kidney
e. Thyroid
45. Splenic aneurism in a 40 yr old female is best treated by
a. Spleenectomy and resection of the aneurism
b. Ligation
c. Observation
d. Resection of the aneurism
e. Therapeuritc embolization of the artery
46. With the ALVARADO score of 5, how you further reach the diagnosis
a. U/S or CT scan
b. Treat as acute appendicitis
c. Response to conservative treatment would help in diagnosis
d. X-ray abdomen
e. MRI
47. Peutz jegherz polyp
a. Are hamartomatous
b. Pre malignant
c. Sporadic
d. Result from long standing inflammation
e. Freq site for development of carcincoid
48. Definitive investigation for perforated gastric ulcer is
a. Plain erect x-ray chest
b. Erect x-ray abdomen
c. Contrast studies
d. MRI
e. Peritoneal lavage
49. Most common risk factor for torsion of the testes is
a. Inversion of testes
b. High investment of testes
c. Epdidymal cyst
d. Trauma
e. Separation of epididymis from testes
50. A patient has been admitted in your ward for the past 3 days and now he has a silent
abdomen, his tests reports showed him to be WIDAL positive. What is the most likely
diagnosis?
a. Typhoid perforation
b. Peritonitis
c. Intestinal obstruction
d. Intussusception
e. borborygmus
51. which is the surest indication for laparotomy
a. gas under the diaphragm
b. blood stained aspirate on DPL
c. peritonitis
d. failed intestinal anastomoses
e. heamoperitoneum
52. which is not an indication for circumcision
a. hypo spadiasis
b. phimosis
c. recurrent balanopsthitis
d. recurrent UTI
e. ethinicity and religious background
53. meckel’s diverticulum
a. 60cm proximal to the ileoceacala valve (2ft)
b. represents the remanent of yolk sac
c. is present in 20% of the population
d. is situated on the mesenteric border of the intestines
e. situated near the ampulla of vater
54. commonest cause of fecal incontinence in adults
 a. lateral sphincterectomy
b. heamorrhoidectomy
c. hirschsprung diseae
d. collagen disorders
e. hyperthyrioidsm

55. treatment for infantile hydrocele is

a. herniotomy
b. herniotomy with hernioraphy
c. herniotomy with mesh implant
d. truss
e. lichenstiene repair
56. Most common cause of perforation of appendix
a. Immunosuppression
b. Fecolith obstruction (IM)
c. Exremes of ages (IM)
d. Pelvic appendix
e. Diabetes
57. Criterion to stop conservative management of appendicular lump includes
a. Rising pulse rate
b. Vomiting
c. Severe right iliac fossa pain
d. Anorexia
e. Elevated temperature
58. The best investigation to determine the extent of abdominal aortic aneurysm is
a. CT
b. MRI
c. MRA
d. Abdominal x-ray
e. Angiongraphy
59. Duodenal carcinoma
a. Arises in the peri ampullary region
b. Arises from the columnar cells of intestines
c. Involvement of ampulla leads to indirect hyperbiliruibinemia
d. Regional lymph node metastasis are rare
e. Commonly arises in the pre existing peutz jegher’s polyps
60. Common inflammation of glans penis is
a. Prostatitis
b. Cystitis
c. Balanopshtitis
d. Epididymitis
e. Orchitis
61. Most common congential malformation of urethra is
a. Epispdadisis
b. Meatal stenosis
c. Congenital urethral valves at the posterior urethra
 d. Congenital urethral stricture
e. Hypospadiasis
62. Regarding PSA, it is a marker for the progress of advanced disease
a. It is glycoprotein which is a glutamine protease
b. It is highly specific for prostatic cancer
c. It is highly sensitive for BPH
d. Values above 10mmol/ml indicate malignancy (IM)
e. Neither sensitive nor specific (IM)
63. The most important landmark both morphologically and surgically in the anal canal is
a. Dentate line
b. Intersphincteric plane
c. Anorectal ring
d. Anal valves of ball
e. Pubertalis ring
64. Rectal carcinoma with secondary deposits in the regional lymph nodes (50%) is calssified
as DUKE staging of
a. Type a
b. Type b
c. Type c (IM)
d. Type d
e. Type c1 and c2
65. In infants partial rectal prolapse is simply managed by
a. Phenol injections
b. Surgery
c. Wait and see
d. Digital repositioning
e. Treating the cause
66. Septic shock occurs in patient with serious gram ve infection mainly due to:
a. Fecal peritonitis
b. Leaking intestinal anastomosis
c. Strangulated hernia
d. Suppurative hernia
e. Strangulated intestines
67. Commonest cause of rectal prolapsed in children is
a. Cough
b. Diarrhea (recurrent)
c. Congenital anal sphincter anomalies
d. Flat sacrum
e. Deformed pelvis
68. After an accident a 35 year old male presents to you rentention of urine and O/E you see
blood at the meatus, per rectal examination reveals a prostate that is high. The most likely
injury is
a. To the membranous urethra
b. To the bulbar urethra
c. Baldder rupture
d. Injury to the prostate
 e. Fracture of the pelvis
69. The commonest site for genital syphilis is (Glans penis Medscape)
a. Testes
b. Epididymis
c. Scrotum
d. Vas deferens
e. Prostate
70. In case of transitional cell carcinoma of the bladder the main etiological factor is
(smoking - IM)
a. Infection by schistosoma hematobium
b. Infection by schistosoma japancium
c. Exposure to radiations
d. Family history
e. Exposure to choestyraminos
71. Poly cystic kidney disease
a. Deroofing of the cyst is the most valuable intervention
b. Unipolar cysts
c. Autosomal dominant trait
d. Unilateral
e. Presents early in adolescence with HTN and hematuria
72. A patient comes with recurrent UTI and on investigation he is found to have 3 kidney
stones about 4-5 mm in diameter, the patient can best managed by
a. ECSWL
b. Antibitotics
c. Adequate hydration and input/output charting (IM)
d. Sympotomatic treatment
e. Diuretics
73. A 45 yrs old female, case of anal carcinoma 6cm from the anal verge with no distant mets
but 3 para rectal L.nodes involved is best treated by
a. Anterior resection
b. Abdomino perineal resection
c. Radiotherapy
d. Combined chemo and radio
e. Pan colectomy with permanent ileostomy
74. HPV subtypes known to have a malignant potential are (6, 18, 31, 33)
a. 6 & 8
b. 16 & 8
c. 32 & 12
d. 11 & 34
e. 16 & 33
75. Cutting tight setons are used
a. To gradually cut through the fistula and allow it to heat by granulation alongside
b. For long term palliation to avoid septic and painful exacerbations
c. For establishing effective drainage
d. Before the advanced techniques
e. To preserve the external sphincter in trans sphincter fistulas
76. Goodsall’s rule implies that
a. All fistulas opening in the perianal region are low lying
b. Openings in the posterior half have a straight path
c. Intersphincteric fisutlas open in the pen anal region
d. High fistulas open at a distance from the anal verge
e. Low lying fistulas open above the dentate line
77. Three days after hemorrhoidectomy a patient presents with spiking fever and chills but no
other finding on examination, the complication he has most likely developed is
a. Pelvic abscess
b. Perianal abscess
c. Intersphincteric abscess
d. Pararectal abscess
e. Post traumatic stress response
78. Gold standard investigation for for fistula imaging is
a. Barium enemas
b. Laproscopy
c. MRI
d. Ultrasound
e. Setons
79. A blood picture showing spherical RBC’s with increased fragility and permeability of the
membranes, is due to which of the following abnormality
a. Defects of the sodium channels leading to increased permeability to sodium (IM)
b. Defects of the sodium channels leading to decreased permeablitiy to sodium
c. Defect of the sodium potassium ATPase pump
d. Defect in the hemoglobin chain
e. Defect in the membrane cholesterol
80. Commonest abnormality of the female urethra is
a. Prolapse
b. Stricture
c. Carcinoma
d. Abnormal valves
e. Diverticulums
81. In a patient with cholangiocarcinoma involving the CBD upto 0.5cm from the confluence,
with no nodal or distant mets, the best treatment option would be
a. Hepaticojejunojejunostomy with jejunojenostomy
b. Roux en Y choledochojejunosotomy
c. Roux en Y hepaticoduodenostomy
d. Hepaticojejunosotomy with jejunojejunostomy
e. Duodenoduodenostoomy
82. Eradication therapy
a. H2 blockers + PPI + clindamycin
b. H2 blockers/PPI + metronidazole + azithromycin
c. PPI + azithromycin + H2 blockers
d. PPI + metronidazole + omeprazole
e. H2 blockers + azithromycin + clindamycin
83. Most common surgical complication for gastrectomy is
 a. Recurrent ulceration
b. Malignant transformation
c. Diarrhea
d. Gall stones
e. Early and late dumping
84. A patient who has previously undergone intestinal resection has now come with a
complain of recurrent UTI. What is the most likely reason for his complain
a. Infection
b. Dehydration
c. Urate stones
d. Oxalate stones
e. Calcium stones
85. If the neck of the gall bladder is obstructed by a stone, which is the most likely
complication develop
a. Mucocele
b. Obstructive jaundice
c. Chlangiocarcinoma
d. Carcinoma of the gall bladder
e. Strawberry gallbladder
86. Treatment of choice for duodenal ulcer is
a. Highly selective vagotomy
b. Truncal vagotomy
c. PPI’s
d. Eradication therapy
e. NSAID’s
87. Longitudinal split in the anoderm at 6’o clock position is
a. Anal fissure
b. Anal fistula
c. Carcinoma
d. Tubercluous ulcer
e. Para rectal abscess
88. A patient comes with a subcutaneous lump at the anal verge and bags of bluish masses
coming out at 7 & 11 o’clock positions. He has most likely presented with
a. Internal and external hemorrhoids
b. Peri anal abscess
c. Rectal polyps
d. Thrombosed external hemorrhoids
e. Anal carcinoma
89. Most dreaded complication of plummer vinson’s syndrome
a. Iron deficiency anemia
b. Hypopharyngeal cancer (Medscape)
c. Dysphagia
d. Achalasia
e. Oropharyngeal cancer
90. A 27 old female comes with right iliac fossa pain, which investigation is most helpful in
reaching a diagnosis
 a. Beta HCH
b. Ultrasound abdomen
c. X-ray abdomen supine
d. Erect chest x-ray
e. Barium enema
91. A patient comes with severe pain in the abdomen, he has a history of arrythmia, what is
most likely to be seen in this patient
a. ECG showing ST depressions
b. Gas bubble in the mesenteric vein is pathognomic
c. Gas under the diaphragm is diagnostic
d. DPL would reveal blood stained fluid
e. Examination would reveal a silent abdomen
92. Treatment of seminoma with spread to regional and retroperitoneal lymph nodes is
a. Excision and retroperitoneal node dissection
b. Radio and chemo therapy
c. Radiotherapy alone
d. Chemo therapy alone
e. Excision and dissection followed by radio
93. Young girl known case of crohn’s disease and previously on topical steroids now comes
with a relapse, her management would include
a. I.V steroids
b. Antibiotics and infliximab
c. 5 ASA and oral steroids
d. continue topical steroids with some precautions
e. wait and observe
94. which investigation modality would help u best diagnose a hernia where the sac is in
between the muscle layers
a. CT or U/S
b. Laparotomy
c. X-ray abdomen
d. MRI
e. Barium studies
95. 52 yr old male patient with squamous cell carcinoma of the middle 1/3rd of the esophagus
and LN involvement along the right sided main brochus, the treatment most suitable for
this patient is by which of the following procedures
a. ivor lewis
b. mckeown (better for SCC)
c. transhiatal esophagectomy
d. sistrunks operation
e. lichenstein repair

SURGERY PAPER 2 2011

1. common cause of perforation of acute appendicitis is:
a. faecolith obstruction
b. diabetes mellitus
c. pelvic appendix
 d. immunosuppression
e. previous abdominal surgery
2. if confirmation of acute pancreatitis is req. then the investigation of great importance is
a. serum amylase
b. serum chymotrypsin
c. urinary amylase
d. serum lipase (IM)
e. ct scan of abdomen
3. the investigation of choice for the diagnosis of a subphrenic abscess is
a. ultrasound of abdomen
b. a plain x-ray abdomen
c. leukocyte count
d. radiolabelled white cells
e. upper GH endoscopy
4. pilonidial sinus at coccygeal region
a. is more common in males
b. present as tender swelling at bottom of spine
c. is commonly treated by excision and packing
d. is practically confined to white races
e. is confused with sinus in anoccygeal area
5. principles of surgical treatment for carcinoma of lower third of rectum with distal margin
of tumor 5cm above anal canal include:
a. with stapling gun excision and anastomosis is possible
b. abdomino-perineal excision with permanent colostomy
c. in presence of distant metastases rectal excision should not be considered for
palliation
d. complete removal of rectum along with mesorectum is not required
e. siphincter saving surgery is not possible
6. maximum safe cold storage time for kidney for transplantation is
a. 48 hours
b. 72 hours
c. 12 hours
d. 36 hours
e. 24 hours
7. most common cause of death in immediate period following pancreatic injury is:
a. bleeding
b. hyperglycemia
c. hypoxia
d. sepsis
e. hyocalcemia
8. Gastric cancer is a multifactorial disease. Epidemiological studies point to following to be
principally associated with carcinoma of body of stomach:
a. H. pylori
b. Obesity
c. Gastric atrophy
d. Cigarette smoking
 e. Bilroth II gastrectomy
9. In the differential diagnosis of femoral hernia the commonest condition is:
a. Inguinal hernia
b. Rupture of adductor longus muscle with haemotoma formatioin
c. Saphena varix
d. Burst psoas abscess
e. Femoral artery aneurysm
10. What is the French or charriere gauge equal to
a. Diameter multiplied by 3 in mm
b. Circumference in mm
c. Diameter in mm
d. Diameter multiplied by 3 in mm
e. Circumference in cm
11. The most common cause of chronic pancreatitis in a young male is
a. Alcohol consumption
b. Hereditary pancreatitis
c. Pancreatic duct obstruction due to gall stones
d. Pancreatic duct stricture
e. Idiopathic pancreatitis
12. In case of hypospadias always avoid:
a. Circumcision
b. Cathererization
c. Dilatation
d. Pyelography
e. Urinary diversion
13. A primary hydrocele is a
a. Collection of abnormal serous fluid in the adventitia
b. Collection of fluid in the tunica albgenia
c. Collection of abnormal serous fluid fluid in tunica vaginalis
d. Collecton serous fluid in tunia vaginalis
e. Transilluminable negative swelling
14. The indication of urgent endoscopic intervention in acute pancreatitis is:
a. Gallstone pancreatitis
b. Cholangitis with abnormal LFt’s
c. Severe pancreaitis
d. Multi organ failure
e. all patients with raised serum amylase levels
15. Regarding duodenal ulceration
a. Fibrosis may cause pyloric stenosis
b. Kissing ulcers are two adjacent posteriror ulcers
c. Anterior ulcers tend to bleed
d. Posterior ulcers tend to perforate
e. Duodenal ulcers tend to be larger than gastric ulcers
16. First line recommended treatment of anal carcinoma is:
a. Chemo-radiotherapy
b. Abdomino-peineal excision and permanent colostomy
 c. Radiotherapy alone
d. Wide local excision and dissection of inguinal lymph nodes
e. Wide local excision followed by radiotherapy
17. A 40 year old obese woman presents with right upper quadrant pain which is colicky in
nature. She also has post prandial dyspepsia frequently since 2 years. The best
investigation to be done is:
a. Ultrasound of abdomen
b. Endoscopic retrograde cholangiopancreatography
c. Computerized tomography
d. Intravenous cholangiography
e. Magnetic resonance cholangiopancreatography
18. What was Kass’s proposed criteria for urinary tract infection?
a. > 105 bacteria/ml
b. > 103 bacteria/ml
c. >101 bacteria/ml
d. > 102 bacteria/ml
e. > 104 bacteria/ml
19. The most common benign tumor of spleen is
a. Hemangioma
b. Lymphoma
c. Hemangiosarcoma
d. Adenoma
e. hamartoma
20. The commonest consequence of bile duct stones are
a. Obstruction and cholangitis
b. Obstruction and cholangiocarinoma
c. Obstruction and liver abscess
d. Obstruction and perforation of bile duct
e. Obstruction and sub hepatic abscess
21. Most common cause of intestinal obstruction globally is
a. Adhesions
b. Obstructed hernias
c. Carcinoma of large bowel
d. Faecal implation
e. Inflammatory bowel disease
22. An ectopic testis
a. Develops on sites away from the normal pathway
b. Is atrophic
c. Usually subjected to trauma
d. Normal in size
e. May undergo torsion
23. The most common cause of perforation of esophagus is
a. instrumental perforation (IM)
b. barotrauma
c. bullet injuries
d. corrosive ingestion
 e. tumor perforation
24. A 55 years old male presents in opd with 1 day history of perinanal pain after lifting heavy
load…O/E a painful swelling at the perianal verge is seen. Dx?
a. A perianal haematoma
b. Intero-external haemorrhoids
c. A thrombosed external pile
d. Strangulated external haemorrhoids
e. A sentinel pile with fissure
25. Regarding familial adenomatous polyposis:
a. Develop multiple rectal and colonic polys around puberty
b. Pan proctocolectomy with permanent ileostomy is necessary in majority of cases
c. Autosomal recessive inherited condition
d. Responsible gene isolated on chromosome # 8
26. The least common type of testicular tumors are:
a. Interstial tumors
b. Teratomas
c. Semino teratomas
d. Lymphomas
e. seminomas
27. Torsion of omentum:
a. Is usually mistaken for appendicitis
b. May be due to adhesion of omentum to infective focus
c. Could be due to herniation of portion of omentum into hernia sac
d. Is most frequently found in middle aged obese male
e. If becomes gangrenous may give rise to bacterial peritonitis ?
28. A 25 years old female presents with history of painful defecation, bleeding with passage
of stool and constipation since 5 days. O/E puckered, tightly closed anus was observed
with skin tag at 6’oclock position. Dx?
a. Fissure in ano
b. External hemorrhoids
c. Fistula in ano
d. Stenosis of anus
e. Perianal abscess
29. Non gonococcal urethritis is caused by:
a. Chlamydia trachomatis
b. E-coli
c. Streptococcus
d. Klebsella
e. Peneumococcus
f. Chlamydia trachomatis
30. Goodsall’s rule is best related to fistula in ano of the following varieties
a. Low level fistula’s opening on the skin in relation to the anterior or posterior half of
the anus (IM)
b. Low level fistulas opening on the skin in the relation to the lateral halves of the
anus
c. Traumatic fistulas
 d. High level fistulas opening on the skin in relation to the anterior or posteriror half of
the anus
e. Malignant fistulas
31. Lymphatic spread of testicular tumor, most commonly occurs to
a. Para aortic lymph node
b. Skin
c. Inguinal lymph node
d. Nodes along common iliac artery
e. Contra lateral testis
32. A 45 year old male presents with bilateral lumbar pain and haematuria. On examination
his BP is 180/110 mmHg and both kidneys are palpable, he is suffering from
a. Polycystic kidneys
b. Renal tuberculosis
c. Renal stones
d. Hypernephroma
e. Horse shoe kidneys
33. Meckels diverticulum
a. Is a remnant of vitellointestinal duct
b. Should be left alone if found incidently
c. Is seldom a cause of symptoms
d. Is found in an inguinal hernia
e. Should be removed if it is narrow mouthed
34. Which statement best describes the management of 12 years old boy with swelling and
severe pain after scrotal trauma:
a. Repair of tunica albuginea after evacuation of hematoma
b. Emergency drainage of hematocolle
c. Orchidectomy
d. Ultrasound guided drainage of hematocolle
e. Open drainage of hematocolle and inspection of testis
35. A 35 year old had right upper quadrant colicky pain lasting 30 minute. She gets it every 2-3
weeks. Her wbc count is 5000 and normal bilirubin. No fever. Ultrasound abdomen shows
gallstones. Dx?
a. Common bile duct stones
b. Acute cholecystitis
c. Chronic choleycystits
d. Carcinoma gall bladder
e. Biliary colic
36. An allograft
a. An organ or tissue transplanted from one individual to another
b. A graft placed in its normal position
c. Is taken from same individual
d. Is a graft performed between different species
e. A graft placed in a site different from that where the organ is normally located
37. The most important investigation for the diagnosis of hirschsprung’s disease is:
a. Rectal biopsy
b. Plain x-ray abdomen in erect posture
 c. Anorectal manometry
d. Plain x ray abdomen in supine posture
e. Water soluble contrast enema
38. When referring to adrenaline what does a 1 in 10,000 solution equate to
a. 0.1mg per ml
b. 10 mg per ml
c. 1 mg per ml
d. 10 mg per 10 ml
e. 1 mg per 100 ml
39. Meaningful investigation for ulcerative colitis is
a. sigmoidoscopy with biopsy
b. plain xray abdomen
c. stool D/R
d. barium enema
e. proctoscopy
40. A 17 old boy presents with a painless abdominal swelling. 10 x 12 cms which moves
freely in a plane at right angles to the attachment of mesentery. The most appropriate
management is:
a. Ultrasound guided aspiration
b. Laparotomy and excision of swelling
c. CT guided aspiration
d. Laparotomy and marsuplistion
e. observation
41. Regarding carcinoma anus:
a. Squamous cell carcinoma is the commonest tumor
b. In old age abdomino perineal excision is advised
c. Chemo-radiation is first line treatment
d. It involves people of all ages
e. It presents as a mass in inguinal region due to metastic lymph nodes
42. A 45 years old diabetic male has been diagnosed to have chronic pancreatitis and referred
for surgical opinion. The most important indication for surgical intervention is:
a. Risk of malignancy
b. Steatorrhea
c. Weight loss
d. Uncontrolled diabetes
e. Refractory pain
43. Accurate assessment of differential renal function is performed by
a. Serum creatinine
b. Serum urea
c. (MAG-3) mercaptoacetyl glycine scan (Bailey)
d. I.V.U
e. MSA scan
44. For a tumor to grow larger, it has to acquire the characteristic of
a. Angiogenic competence
b. Immortality
c. Genomic instability
 d. Ability to disseminate
e. Ability to invade
45. Most common reason for congenital/childhood causes of constipation include:
a. Hirschsprung’s disease
b. Myotonic dystrophy
c. Multiple sclerosis
d. Amyloid neuropathy
e. rectocele
46. Important component for Alvarado score to diagnose acute appendicitis is:
a. Nausea & vomiting
b. Leukocytosis
c. Rebound tenderness
d. Anorexia
e. Elevated temperature
47. Seminoma spread
a. To inguinal lymph nodes
b. By blood stream
c. By lymphatic to lung
d. By local in skin
e. Both lymphatics and blood stream
48. Treatment of choice in case of splenic abscess is:
a. Drainage of splenic abscess by percutaneous route under radiological guidance
b. Laparascopic aspiration
c. Splenectomy
d. Antibitotics only
e. Open laparotomy and drainage of abscess
49. Regarding gastric acid secretion
a. Histamine is a key factor in gastric acid production
b. Peptide hormones and secretin increase acid secreation
c. H2-receptor antagonist can abolish acid production
d. Proton pump inhibitors reduce acid production upto 50%
e. Neuropeptides and secretin increase acid secretion
50. A 42 old man presents with abdominal pain starting in epigastrium and spreading all over
the abdomen. Pulse is 110 and on examination has board like rigidity, the most
appropriate imaging?
a. Ultrasound of abdomen
b. CT scan abdomen
c. Barium meal study
d. Chest xray in erect posture
e. Abdominal xray erect posture
51. The typical symptoms of acute appendicitis are in following sequences:
a. Periumblical pain, which shifts to right iliac fossa, anorexia, nausea and low grade
fever
b. Nausea, vomiting, right iliac fossa pain and diarrhea
c. Generalized abdominal pain, absolute constipation fever and vomiting
d. High grade fever, periumblical pain which shifts to right iliac fossa, nausea and
 absolute constipation
e. Fever, lower abdominal pain, nausea and vomiting
52. Which of the following complications after splenectomy is due to a technical oversight by
the operating surgeon:
a. Left basal atelectasis
b. Gastric dilation
c. Left pleural effusion
d. Opportunist post-splecnectomy infection
e. Pancreatic fistulas
53. Which of the following is not a recognized cause of epididymo-orchitis?
a. Citrobacter
b. Chlamydia trachomatis
c. Mycobacterium TB
d. N. gonorrhea
e. E.coli
54. 25 years patient comes in A&E with complain of vomiting and constipation. On
examination his abdomen was distended but non tender, bowel sounds were not audible.
Blood CP was normal. Widal test was positive. What complication can be responsible for
these symptoms in widal positive patient?
a. Paralytic ileus
b. Typhoid ulcer
c. Choleycystitis
d. Peritonitis
e. Arthritis
55. Richter’s hernia is a hernia in which the sac contain
a. A portion of the circumference of the intestine
b. Extra peritoneal fat
c. Peritoneum only
d. A complete small bowel loop mesentery
e. A portion of the omenturm with vessels in it
56. 45 year old male with biopsy proven squamous cell CA and CT staging of T3N3M? is
scheduled for surgery. His tumor is 2cm at 35cms. Which surgical approach would be
best suited for the patient
a. Mckeown’s esophagectomy
b. Thoracoscopic assisted transhiatal oesophagectomy
c. Ivor lewis esophagectomy
d. Thoracoabdominal esophagectomy
e. Transhiatal esophagectomy
57. Bleeding after percutaneous biopsy of liver contraindicates its uses in suspected case of:
a. Haemongioma of liver
b. Hepatic adenoma
c. Liver metastases
d. Focal nodular hyperplasia
e. cirrhosis
58. 25 year old man undergone ERCP with removal of common bile duct stones. Two days
later he develops severe abdominal pain. Most likely diagnosis?
 a. Pancreatitis
b. Damage to ampulla of vater
c. Common bile duct injury
d. Duodenal injury
e. Gastric perforation
59. During liver resection bleeding from liver can best be reduced by using:
a. Ultrasonic (CUSA) dissector
b. Reducing CVP
c. Aprotonin
d. TEG
e. Fibrin glue
60. 35 years old male presents in ER with abdominal pain, distention, vomiting. The diagnostic
modality of choice is:
a. abdominal film supine
b. ultrasound whole abdomen
c. abdominal film erect
d. diagnostic laparoscopy
e. CT scan whole abdomen
61. Condylomata acuminate (genital warts) are caused by:
a. HPV
b. Gonococcus
c. Trichomonas
d. Candida
e. Trepnoema pallidum
62. The commonest cause of enlarged ileocaecal mesenteric lymph nodes is
a. Nonspecific mesenteric lymphadenitis
b. Yersinia ileitis
c. Tubercluous lymphadenitis
d. Metastatic lymphadenopathy
e. Typhoid enteritis
63. Childs classification of hepatocellular function in cirrhosis is based on all the following
except:
a. SGPT
b. Nutrition
c. Ascites
d. Albumin
e. bilirubin
64. A five year old child with C/O screaming and pulling at the penis with the hand during
micturition is most likely suffering from
a. Bladder stone
b. Phimosis
c. Pin hole meatus
d. Paraphimosis
e. Posterior urethral valrum
65. Zollinger Ellision syndrome is confirmed by :
a. Hypergastrinemia and concurrent gastric acidity
 b. Unexplained diarrhea
c. Peptic ulcer occurring at a very young age
d. Presence of hyperparathyroidism
e. Presence of family history of endocrinopathy
66. 55 years male presented in surgical emergency with the history of gastric outlet
obstruction most common cause of this obstruction?
a. Gastric cancer
b. Pyloric mucosal diaphrgram
c. Duodenal ulcer
d. Adult pyloric stenosis
e. Gastric ulcer
67. The operative procedure preferred for complicated large duodenal ulcer perforation?
a. Bilroth II Gastrectomy
b. Truncal vagotomy and antrectomy
c. Truncal vagotomy and pylorolasty
d. Gastro jejunostomy roux-en-Y
e. Billroth I gastrectomy
68. In paraumblical hernia of <2 cms size:
a. A primary fascial herniorrhaphy is usually done
b. Paraumbliical hernioplasty with mesh is gold standard
c. Laparoscopic repair is preferable
d. Transverse double breasting repair is commonly done
e. Repair and lipectomy is commonly done
69. A haematoma should always be evacuated by open surgery if:
a. It is large and causing pressure effects
b. It is in a cosmetically sensitive area
c. It does not resolve after several days
d. It is in extracranial position
e. It requires repeated aspirations
70. Regarding TB mesenteric lymph adenitis
a. Calcified nodes are usually seen on plain X-ray adomen (IM)
b. It is easy to differentiae from acute appendicitis
c. Feautres of intestinal obstruction are commonly present
d. Lymphocytosis is seen in most cases
e. The noes are always palpable
71. 60 years old female presented with 2 days history of projectile vomiting. O/E she was
dehydrated, anaemic along with succession splash. Her pulse was 100 b/min, bp 90/40,
immediate management would include:
a. Pass nasogastric tube and normal saline with potassium
b. Nasogastric tube with dextrose water with potassium
c. Nasogastric tube with ringer’s lactate
d. Nasogastric tube with blood transfusion
e. Nasogastric tube with normal saline and calcium
72. Common cause of perforation of acute appendicitis is:
a. Faecolith obstruction
b. Previous abdominal surgery
 c. Immunosuppression
d. Pelvic appendix
e. Diabetes mellitus
73. Mesenteric injury:
a. May be diagnosed by diagnostic peritoneal lavage (odd one out)
b. Can be caused by sudden deceleration during car accident
c. Can follow severe abdominal confusion contusion
d. With transverse tear makes resection of intestine necessary
e. Is assoicitaed with rupture of intestine in 60% of cases
74. iLeal atresia:
a. has four main types
b. is the commonest anatomical site of congenital neonatal intestinal atresia
c. is associated with Down syndrome
d. radiography shows classical double bubble sign
e. bile stained vomiting is diagnostic
75. The pathophysiology of intestinal obstruction consists of:
a. Altered motility of the gut proximally, normal peristalsis and absorption distal to
obstruction
b. Altered motility in the segment of the gut, proximal to the site of obstruction
c. Altered motility of the gut proximally and normal peristaltic activity distal to
obstruction
d. Altered motility in the whole gut irrespective to the site of obstructin.

SURGERY PAPER 2 2011

3.Sacrococcygealteratoma - arises from cocyx

8. rectal drainage

9.per-rectal drainge

10.cortocosteroids:severe UC

11. commonest site for GI tumour GE junction

12.Hydatid cyst: albendazole

13.adhesion

14.non op cause: inflamotory

15.pseudocyst definiton

17.hemorrhoidectomy complication - retention of urine

19.biliary pancreatitis/ pancreatic pseudocyst

21.hernia diaphragmatic: (incorrect) immediately after operation

22.pancreatitis-trypsinogen

23.antireflux surgery n PPI

24. H.pylori eradication therapy - ppi+metro+amox/ clarithro+ppi+amox

25.ritcher hernia (portion of intestine)

26.appendix perforation (symptoms)

27. finger tip - (hernia exam).

28 picture - sliding hernia/richter hernia/ interstitial

29.observation (mucosa of gall bladder)

30.hernia 6 month child(longest option)

31.convince mother(it will reduce chance of malignancy)

32. 12yr child come after orchidopexy decrease risk of malignancy

33.testis will not descend fully after 3 month

35.melanoma/ basaloid (radio-resistant)

38.Descent of testis maternal gonadotrophins

40.femoral hernia - operate urgent in the groin

41.Torsion testic - inversion of testis

42.comonly associated with inguinal hernia

43.meckel cause of hemorrhage

44.direct hernia - mesh repair

45.type B gasritis/ type A gastritis

47. nsaid ulcers perforated ulcer first treatment if resuscitate and analgesic for the first 48
hours perforated ulcer

48. cholangiocarcinome(stenting)
49.vietnamiese woman - Worm infection

50. splenic artery aneurysm -more in female

51.splenic ruptur -splenectomy

52. apendicitis(extremes of ages)

53. Appendix most commonly retrocecal

54.diverticulum of blader: cystoscopy

55.jj stent: decrease intra renal pressure or nephrostomy is preferred in infection / stent is used
to maintain patentcy of the renal parenchyma something

56.acute non specificproctitis/ ulcerative colitis ?

57.int obstruction- vomiting, constipation, pain, distension

58. UC (serosa clear,colon involved)

59.diffuse peritonits: diagnostic peritoneal lavage/ US-CT

60.ectopic vesicae associated with epispadiasis

61. Chordee - bending fwd

62.citrobacter (not a cause of epididymo-orchitis)

63.prostate ca (psa high)

64.dna testing(cystic fibrosis)

65. Hypospadiasis glandular type

66.early dumping(vasomotor symptoms)

67.upper GI endoscopy(endoscopy)

68.graft rejection: hla antigen

69.dentate line white, morpho plus surgical importance

70. Anterior duodenal ulcer perforates

72.esophagealtef with distal tef

73. Pyelonephritis Urine DR and Culture / urea

74. Lung tumour - pancoast

75.colostomy with large bowel obstruction

76. Biopsy contraindicated in hemanigiomas

77.post cholecystectomy: pre-op symptoms

78. Sigmoid volvulus (band adhesion, pelvic mesocolon

80.budd chiari- hepatic venous thromobosis?

81.stomach n duodenum(gist)

82. prostate plexus between capsule etc

83. endocrine neoplasm of pancreas seen on CT

84. UC associated with sclerosing cholangitis

85. ascites CHF

86. sicklecel elongated and disrupted cell

87. receptor Dradhesin, type 1 mannose sensitive/ resistant ?

89. post thoracotomy pan injected between the plueral space

90. Mesentric infarction presents as ?

91. definition of apoptosis

92.patient with left chect trauma

94 use of Ercp justified when therapeutic intent

95. Radiographic feature of small bowel obstruction valvulae convintes

SURGERY PAPER 2 2010

1. Dysphagia lusoria is due to
a. carcinoma esophagus
b. compression of esophagus by aberrant vessel (right subclavian artery acc. to
google)
 c. barret’s esophagus
d. achalasia
e. esophageal stenosis
2. Most common disease prone to malignancy is:
a. Duodenal diverticulum
b. Duodenal ulcer
c. Genetic factor
d. Gastritis
e. Esophagitis
3. Endoscopic history is necessary to confirm the diagnosis of:
a. Duodenal ulcer
b. Gastric carcinoma
c. Gastritirs
d. Mallory Weiss syndrome
e. Achalasia esophagus
4. ERCP is better option for the removal of:
a. CBD stone with malignant stricture
b. CBD stone
c. Pancreatic stone
d. Gallstone
e. Stone in the cystic duct
5. The best treatment option for gall bladder cancer is:
a. Medical treatment
b. Surgery
c. Radiotherapy
d. Chemotherapy
e. A combination of all of the above
6. Biopsy is necessary to diagnose:
a. Hepatocellular carcinoma
b. Hemangioma
c. Hydatid cyst
d. Hepatitis
e. Ascending cholangitis
7. The diagnosis of a direct inguinal hernia can be confidently made in which of the following
tests:
a. Finger invaginatioin test
b. Ring occlusion test
c. Obturator test
d. Cough impulse
e. Irreducibility
8. A 25 yr old man presents with history of RTA. He has bruise on the left side of lower chest
and is pale and hypotensive with tender abdomen. Which of the organs most likely to have
damaged?
a. Left kidney
b. Right lung
c. Spleen
 d. Liver
e. Left rib fracture
9. A 95 yr old insulin dependent man, with history of uncontrolled hypertension and severe
angina comes to OPD with a reducible left direct inguinal hernia that has been there for 5
years. Which of the following is the best course of treatment?
a. Bassini’s repair
b. Shouldice repair
c. Laparoscopic repair
d. Damine
e. Conservative management
10. Acute hepatocellular damage can be assessed best by:
a. Albumin level - chronic
b. Bilirubin level
c. AST /SGOT
d. Ultrasound
e. Prothrombin time -chronic
11. Regarding umbilical hernia in infants:
a. Presents with pain and other GI symptoms
b. Incidence is same in blacks and whites
c. With increase in size with time
d. Early surgery is recommended due to chances of obstruction
e. Surgery is indicated after 2 years of age
12. 45 year old lady Para 6 case of severe pain on defectation and bleeding P/R last 2 years.
O/E longitudinal split seen in endoderm of distal anal canal at 12 o clock position.
Etiology?
a. Hard stool
b. Vaginal delivery
c. Surgery
d. Trauma
e. Diarrhea
13. The low fistula in ano:
a. Is defined as track between anal canal and perianal skin
b. Open into anal canal below the anorectal ring
c. Results from anorectal abscess which bursts spontaneously
d. Has internal opening which is felt as nodule on digital rectal examination
e. Open into the anal canal below the dentate line
14. The most common operative procedure performed for the treatment of anal fissure is:
a. Anal dilatation
b. Crytherapy of fissure
c. Lateral sphincterotomy
d. Anal advancement flap
e. Posterior sphincterotomy
15. Highest incidence of congenital atresia in new born is seen in:
a. Jejunum
b. Duodenum (& Down syndrome)
c. Ascending colon
 d. Ileum
e. Multiple sites
16. Important factor related to burst abdomen and incisional hernia is:
a. Interrupted suturing
b. Transverse incision
c. Use of nylon as suturing material
d. Superficial wound infection
e. Infected wound (IM)
17. In gall stone formation:
a. Nucleation of cholesterol monohydrate crystal from multicellular vesicles in a
crucial step
b. Insoluable cholesterol is main culprit
c. Abnormal gall bladder may be an imitating factor
d. Infection provides a nidus
e. Bile acids and phospholipids play main role
18. Among the following is the growth factor receptor over expressed/amplified in gastric
cancer:
a. Epidermal growth factor
b. Endothelial growth factor
c. Erb B-2 (IM)
d. All of these
e. Vascular endothelial growth factor
19. Investigation of choice with diagnosis of structure urethra is a
a. IV
b. Urethiragram (ascending/retrograde)
c. US
d. Xray KUB
e. Urine for DR
20. Definitive investigation to suggest perforated peptic ulcer is:
a. Serum amylase
b. Leucocyte count
c. A water soluble contrast swallow
d. An erect plain chest xray
e. Diagnostic peritoneal lavage
21. The investigation of choice for the diagnosis of a subphrenic abscess is:
a. U/S abdomen
b. Upper GI endoscopy
c. Radiolabelled white cells
d. A plain xray abdomen
e. Leukocyte count
22. The cause of strangulation in closed bowel loop obstruction is due to
a. Interrupted blood flow from complete volvulus or intussusceptions
b. Significant aerobic and an aerobic bacterial growth
c. Mesenteric infarction primary to arterial emboli
d. External obstruction from adhesions or bands
e. Increased intraluminal pressure with obstruction at proximal and distal ends
23. Commonest position of ectopic testis is the
a. Superficial inguinal ring
b. Deep inguinal ring
c. Root of penis
d. Femoral triangle
e. Perineum
24. Typhoid perforation most commonly occur in:
a. Ileum (distal)
b. Caecum
c. Jejunum
d. Rectum
e. Stomach
25. Most typical point in the history of a patient with severe appendicitis is
a. Fever
b. Painful flexion at hip joint
c. Dyuria
d. Difficulty in movement
e. Periumblicical pain shifting to RQ
26. Most common and dreaded complication of laparoscopic cholecystectomy is:
a. Pain in right shoulder
b. Acute pancreatitis
c. Paralytic ileus
d. Iatrogenic injury to the bile duct
e. Ulcerative obstruction
27. Most important indication for surgical laparotomy is:
a. Hemoperitoneum
b. Peritonitis
c. Adhesive obstruction
d. Failed intestinal anastomosis
e. Ileal perforation due to tyhoid
28. In a child, scrotal swelling that dissappers in the morning and becomes prominent in the
evening is most likely due to
a. Inguinal hernia
b. Testicular torsion
c. Epididymo-orchitis
d. Scrotal sebaceous cyst
e. Patent processus vaginalis
29. The most reliable investigation in a suspected case of acute pancreatitis is: (most specific
is lipase)
a. LFT
b. Serum electrolytes
c. Prothrombin time
d. Bleeding time
e. Serum amylase
30. The commonly used therapeutic plan in prolapsed piles is:
a. Conservative treatment
 b. Urgent hemorrhoidectomy
c. Barrons banding
d. Injection sclerotherapy
e. Cryotherapy
31. In trying to assess the position of stone in renal colic, the best investigation is:
a. Xray KUB
b. Ultrasound abdomen (IM)
c. CT scan (pylogram)
d. MRI
e. IVP
32. Sebaceous cysts:
a. Have tenderness
b. Are foul smelling
c. Have a punctum
d. Are filled with clear fluid
e. Arise from the subcutaneous fat
33. Most common cause of gastric mucosal barrier injury?
a. NSAID , Alcohol, Stress
34. Peutz jeghers’s polyps
a. Occur as multiple lesions
b. Have malignant potential
c. Are associated with meckel’s diverticulum
d. Cause haemorrhage
e. Are hamartomatous
35. Simple test to measure the pancreatic exocrine in sufficiency is
a. Lundh test
b. Secretin and CCK I/V administration
c. Faecal elastase level
d. Nitroblue terazolium-para amino-benzoid acid (NBT_PABA test)
e. Serum elastase
36. Regarding surgical anatomy of esophagus
a. It is lined by columnar epithelium
b. Meissner’s plexus is abundant in esophagus
c. Two centimeter or less lies below the diaphragm
d. It is 25 cm in length
37. Carcinoid tumor of appendix commonly occurs in:
a. Pelvic appendix
b. Retrocaecal appendix
c. Proximal third of appendix
d. Base of appendix
e. Distal third of appendix
38. The operative procedure with the least long term recurrence in adult inguinal hernias is:
a. Herniotomy
b. Shouldice method
c. Bassini’s repair
d. Lylte method
 e. Lichtenstein hernioplasty
39. Commonest type of intussusception is:
a. Colocolic
b. Multiple
c. Ileoileal
d. Ileo-ileo-colic
e. Ileocolic
40. Regarding skene’s tubules
a. Are a series of solid epithelial buds
b. Develop from surrounding mesenchyme
c. Are the homologue of the prostate in female
d. Have a major role in differentiation
e. Canalize in 6 week of development
41. The typical symptoms of acute appendicitis are in following sequence
a. Fever, lower abdominal pain nausea and vomiting
b. Nausea, vomiting, right iliac fossa pain and diarrhea
c. High grade fever, periumblical pain which shifts to right, iliac fossa, nausea and
absolute constipation
d. Periumblical pain, which shifts to right iliac fossa anorexia, nausea, low grade fever
e. Generalized abdominal pain, absolute constipation fever and vomiting
42. The commonest testicular tumor are:
a. seminoma
b. teratoma
c. lymphoma
d. semino teratomas
e. interstitial tumors
43. Treatment of choice for varicocele when available is:
a. Open surgical coagulation
b. High ligation
c. Embolization of testicular veins under radiographic control
d. Laparoscopic ligation
e. Low ligation
44. Recommended optimum treatment of third degree piles in a fit and healty 27 yrs old man
includes the following:
a. Diathermy coagulation
b. Photocoagulation
c. Treatment with rubber band ligation
d. Cryosurgery
e. Surgical haemorrhoidectomy
45. Preferable treatment of femoral hernia is:
a. Use of a Truss
b. Femoral herniotomy
c. Closure of saphenous opening
d. Laparoscopic repair
e. Surgical closure of femoral canal
46. Pseudo pancreatic cysts develops commonly
 a. Behind and below the stomach
b. Behind urinary bladder
c. Tail of pancreas
d. In right paracolic gutter
e. Around the duodenum
47. Gastric cancer is most prone to develop in:
a. Menetriers disease
b. Pangastritis
c. Phlegmonous gastritis
d. Granulomatous gastritis
e. Type A gastritis (IM)

1. Commonest cause of stricture urethra in young adult is:

a. congenital
b. traumatic
c. urethral condoscopy
d. post gonorrheal infection
e. catheterization
2. Strawberry gall bladder:
a. Associated with cholesterol stones
b. The gall bladder has chronic inflammation
c. Anterior of the gall bladder looks like straw berry due to submucosal
desposition of cholesterol crystal
d. Cholesteroal esters
e. Patient presents with dyspepsia
f. Is a variety of cholestasis
3. Which one of the following is not a hereditary cause of splenomegaly:
a. G6PD deficiency
b. Autoimmune haemolytic anaemia
c. Thalassaemia
d. Sickle cell disease
e. Spherocytosis
4. The commonest abnormality of female urethra is:
a. Carcinoma
b. Prolapse
c. Urethrocele
d. Stricture
e. Carbuncle
5. Lymphatic spread of testicular tumor, most commonly occurs to
a. Skin
b. Para-aortic lymph node
c. Contra lateral testis
d. Inguinal lymph node
e. Nodes along common iliac artery
6. Differentiating point for undescended and retractile testis is that in undescended
testis:
 a. Associated with hernia
b. Less of cremester reflex
c. Undeveloped scrotum on affected side
d. Scrotum is empty
e. Small size of testis
7. Etiological factor for UC is
a. Milk ingestion
b. Weakened mucosal barrier
c. Genetic predisposition
d. Abstinence from smoking
e. Bacterial dysentery
8. Incidence of recurrence following duodenal ulcer operation is higher in
a. Highy selective vagotomy
b. Truncal vagotomy and drainage
c. Gastro enterostomy alone
d. Selective vagotomy and drainage
e. Gastrectomy
9. Among the following which fits into ranson’s criteria at admission for assessment of
severity acute pancreatitis
a. Age > 40 yrs
b. Fluid sequestered > 3 liters
c. Arterial oxygen saturation < 80 mmHg
d. WBC count > 20 x 10 / deciliter
e. LDH > 700 units/litre
10. In a specialized biliary unit, which of the following is the most common cause of
benign bile duct strictures
a. operative trauma
b. sclerosing cholangitis (Medscape)
c. recurrent cholangitis
d. chronic duodenal ulcer
e. chronic pancreatitis
11. ominous feature of primary lung cancer is:
a. myopathies
b. dyspnea due to loss of lung tissue
c. blood stained fluid in the pleural space
d. haemoptysis
e. severe localized chest pain
12. In benign prostatic hyperplasia on DRE
a. Rectal mucosa can be moved over freely
b. Finger installed is blood stained
c. It is tender to touch
d. The posterior surface is firm to hard
e. Residual urine can be felt
13. Investigation of choice in the diagnosis of carcinoma stomach is:
a. US of abdomen
b. Tumor marker
 c. Endoscopy and biopsy
d. Barium meal
e. CT scan of abdomen
14. A 50 year old male presents with bleeding per rectum,tenesmus proctoscopy is
normal. The next line investigation?
a. Single contrast barium enema
b. CT scan of abdomen
c. Sigmoidoscopy
d. Double contrast barium enema
e. Flexible colonoscopy
15. The commonest clinical features of hemorrhoids is:
a. Bleeding, which occurs during defecation
b. Pain when haemorrhoids are complicated
c. Anaemia due to profuse bleeding
d. Mucoid discharge, which lead to pruitis ani
e. Prolapse
16. 5 year old child with C/O screaming and pulling at the penis with the hand during
urination is suffering from?
a. Bladder stone
b. Pin hole meatus
c. Paraphismotosi
d. Posterior urethra valrum
e. Phimosis
17. The duodenal adenocarcinoma:
a. Is treated by pancreatico duodenectomy
b. May arise in pre-exisitng villous adenoma
c. Mostly originate in periampullary region
d. Results in obstructive jaundice due to involvement of ampulla
e. Causes anaemia due to ulceration of tumor
18. Acute intussusception
a. Proximal part of gut enters into distal part
b. Occurs in children
c. Is idiopathic
d. Leads to gangrene
e. Occurs due to hypertophic peyer’s patches
19. The commonest feature of chronic TB peritonitis is:
a. Night sweats
b. Fever
c. Recurrent abdominal pain
d. Loss of weight
e. Ascites
20. In spherocytosis the fragility of red cell membrane is due to increased permeability of
which ion into the cell?
a. Potassium
b. Sodium
c. Magnesium
 d. Lithium
e. Calcium
21. Obese female patient presented in OPD with complaints of flatuant dyspepsia,
retrosternal heart burn off and on Rt upper abdominal pain and irregular bowel habits.
Probable dx?
a. Chronic appendicitis
b. Chronic cholecytitis
c. Hiatal hernia
d. Acid peptic disease
e. Saints triad
22. The radiological findings in case of intestinal obstruction due to gall stone are
a. Multiple gas filled bowel loops with radio-opaque stone at iliocecal junction
b. One or three air fluid levels of ileocecal junction and impacted stone
c. Multiple air fluid levels in small bowel in erect xray abdomen
d. Multiple air fluid levels in small bowel and air fluid level in biliary tree
e. Step ladder pattern of fluid level in small and large bowel
23. 60 years old renal transplant patient presents with pain and bleeding per anal canal.
O/E irregular indurated ulcer seen in the anal canal biopsy reveals squamous cell
carcinoma. Best treatment option is this case is
a. chemotherapy
b. radiotherapy
c. chemoradiation
d. local excision
e. abdominalperineal resection
24. In case of hypospadias always avoid:
a. Pyelography
b. Circumcision
c. Dilatatioin
d. Urinary diversion
e. Cathereization
25. Pilonidal sinus at coccygeal region
a. Present as tender at bottom or spine
b. Is practically confined to white races
c. Is commonly treated by excision and packing
d. Is confused with sinus in anococcygeal area
e. Is more common in males.
26. Which is the commonest DD in a child bearing female with right iliac fossa pain and
amonerrhea
a. Torsion of ovarian cyst
b. Pelvic inflammatory disease
c. Mittzelshmerz
d. Haemmorhage of ovarian tumor
e. Ectopic tubal pregnancy
27. A male patient who has undergone open cholecystectomy 2 week ago presented with
complain of bouts of pain, jaundice and high grade fever. The probable cause is:
a. Ligation of CBD (common bile duct)
 b. Retained stone
c. Ascending cholangitis
d. Liver abscess (swinging fever)
e. Injury to common bile duct
28. A 30 year old male patient presenting with severe colicky pain in the left loin with
radiation to groin and root of penis is most likely to suffer from
a. Horse shoe kidney
b. Hydronephrotic left kidney
c. Left ureteric stone
d. Polycystic kidney
e. Pylelonephritis
29. 25 years patient comes in A&E with complain of vomiting and constipation. On
examination his abdomen was distended but non tender, bowel sounds were not
audible. Blood CP was normal, widal test positive. Whats the most common
complication that can occur? (the case is paralytic ileus)
a. Arthritis
b. Typhoid ulcer
c. Paralytic ileus
d. Choecysytitis
e. Peritonitis
30. Proliferatioin and clonal expansion of following cells is an integral part of the immune
response to allograft
a. Platelets
b. Basinophills
c. Lymphocytes
d. Neutrophils
e. Basophils
31. Most common surgical complication of peptic ulcer is
a. Stricture
b. Abdominal pain
c. Bleeding
d. Intestinal obstruction
e. Perforation of ulcer
32. Treatment of choice in case of splenic abscess is:
a. Open laparotomy and drainage of abscess
b. Splecnectomy
c. Antibiotcs only
d. Laparoscope aspiration
e. Drainage of splenic abscess by percutaneous route under radiological guidance
33. Commonest presentation of meckels diverticulum is:
a. Pain around the umbilicus
b. Band obstruction
c. Bleeding per rectum
d. Symptoms like acute appendicitis
e. Sign & symptoms of intestinal obstruction
34. Regarding duodenal atresia
 a. Child vomits at birth without bile staining
b. Complete disphragm lies near in vicinity of ampulla of vater
c. Antenatal U/S characteristaclly shows dilated duodenum
d. Diaphragm has near duoedeno-jejunal junction
e. Antenatal U/S characteristically shows dilated stomach
35. 25 yrs female undergone IVP for right renal stone, becomes breathless her pulse is
120/min and B.P 80/50 immediately after injection of contrast medium, she is likely to
have developed
a. anaphylactic shock
b. renal failure
c. hepatic failure
d. respiratory failure
e. cardiac failure
36. After common bile duct exploration for stones CBD is
a. Closed with interrupted sutures without T-tube
b. Closed with continuous or interrupted sutures with T-tube
c. Closed with sutures without T-tube
d. Closed with continuous sutures with T-tube
e. Anastomosed to duodenum
37. In majority of cases of acute obstructing lesion of rectosigmoid junction, emergency
surgical option is
a. Loop ileostomy
b. Caecostomy
c. Hartmann’s procedure
d. Paul mikulicz procedure
e. Colorectal anastomosis after on table lavage
38. During liver resection bleeding from liver can best be reduced by using:
a. Aprotonin
b. Reducing CVP
c. Fibrin glue
d. TEG
e. Ultrasonic something
39. Therapeutic bronchoscopy is most commonly done for
a. Removal of secretions
b. Aspiration of blood
c. Removal of foreign body (Rigid)
d. Endobronchial resection
e. Stent placement
40. Commonest mediastinal tumor are:
a. Mesenchymal tumors
b. Neurofibromas
c. Thymomas
d. Secondaries
e. Germ cell tumor
41. Laparoscopic herniorrhaphy is best indicated in:
a. Bilateral and recurrent inguinal hernias
 b. Obturator hernia
c. Incisonal hernia
d. Infantile hernia
e. Only direct inguinal hernia
42. Polycystic diseases of kidneys are
a. Detected before 30 years of life
b. Localized to one pole of the kidneys
c. Treated surgically by deroofing
d. Hereditary and the disease is transmitted as an autosomal dominant trait
e. Associated with cysts of other organs in 50% of cases
43. The gold standard method of prostatectomy is:
a. Transurethrally (TURP)
b. Retoperitially
c. Through perineum
d. Retropubically (RPP)
e. Transvesical prostatectomy (TVP)
44. First line recommended treatment of anal carcinoma is:
a. Abdomino-perineal excision and permanent colostomy
b. Wide local excision and dissection of inguinal lymph nodes
c. Chemo-radiotherapy ( & 5FU)
d. Wide local excision followed by radiotherapy
e. Radiotherapy alone
45. The most common cause of graft rejection is
a. Metabolic disease
b. Malnutrition
c. Technique of graft application
d. HLA antigens
e. Infection
46. In adult the commonest cause of intussusception is
a. A small bowel tumor
b. A submucosal lipoma
c. A meckels diverticulum
d. A large bowel tumor
e. A polyp
47. The commonest cause of enlarged ileocaecal mesenteric lymph nodes is
a. Yersinia ileitis
b. Typhoid enteritis
c. Metastatic lymphadenopathy
d. Nonspecific mesenteric lymphadenitis
e. TB lymphadenitis

SURGERY PAPER 2 QUESTIONS

1. migratory motor complex > starts with phase I
2. the most common DD for diverticular disease > Carcinoma
3. patient diagnosed case of UC now had bloody stools per day with signs of systemic upset,
treatment will be > systemic steroids
4. extra intestinal manifestation of UC > sclerosing cholangitis
5. most common cause of enterocutaneous fistula > post operation
6. widal test positive patients complication? > paralytic ileus
7. T2, N, M0, give histologic stage? Colorectal Ca
8. 60 year old patient with bleeding per rectum what investigation should be done > flexible
sigmoidoscopy or colonoscopy??
9. Urate calculi: they are hard, smooth multiple and radio-?
10. Regarding descending loop of henle > permeable to water and impermeable to Na and Cl
11. Pregnant lady , what should be the investigation to diagnose pylonephreitis? KUB shows
no stone..> Urine D/R and C/S
12. Patient with age 40 years, with painless hematuria and mass in right flank Dx? Right
hypernephroma
13. Most common indication for therapeutic bronchoscopy > removal of foreign body
14. Prostactic venous plexus (anatomy)
15. Gold standard method for prostactectomy > Turp
16. Closed loop obstruction > definition..
17. X-ray features of gallstone obstruction > multiple airfluid levels in level in biliary tree
18. Acute intussusception > perianal into distal
19. Most common intussusception? > ileocolic
20. Regarding intestinal obstruction > irrespective of etiology or occurrence in onset in
dynamic obstruction, presumed bowel dilation & distal becomes empty.
21. Anal sepsis & abscess are due to: infection of intersphincteric anal gland
22. Investigation for detecting low or high imperfect anus is…> lateral prone radiographic
(invertogram)
23. A woman para 6 having breach is cranial, most common cause is > vaginal delivery
24. Definition of hemmorhoids?
25. A woman with prolapsed something that reduces itself. Treatment > band ligation
26. A woman lifted weight had peri-anal swelling + diagnosis ? - peri-anal hematoma
27. Warts (HPV)
28. 25 years old female presents with history of painful defecation, bleeding with stool and
constipation since 5 days. On examination puckered, tightly observed with skin tag at 6’o
clock position. Most likely diagnosis is:
a. stenosis of anus
b. fissure in anus
c. fistula in anus
d. perianal abscess
e. external hemorrhoids
29. The preferred treatment options for second degree hemorrhoids is:
a. Closed hemorroidectomy
b. Banding (for prolapse)
c. Sclerotherapy
d. Cryotherapy
30. Brown pigment stones:
a. Are primary bile duct stones
b. Contains calcium bicarbonate and calcium phosphate
c. Is associated with infected bile
 d. Related to deconunjagtion of bilirubin glucronide
31. Pinidal sinus at coccygeal region
a. Is more common in males
b. Is practically confined to white races
c. Present as tender swelling at bottom of spine
d. Is commonly created by exclusion and packing
e. Is confused with sinus in anococcygeal area
32. Most common cause of bladder outflow obstruction in 60 year > BPH
33. Commonest complication of prostatectomy > hemorrhage if retrograde ejaculation than
choose that
34. Regarding Ca-prostate > Mc malignant tumor over 65 year
35. Regarding hypospadias > closure is a upward bend
36. Symptoms of bulbar urethra rupture > urinary rentention

SURGERY PAPER 2 QUICK POINTS

∙ Ninety-nine percent of patients have metastatic disease at the
time of diagnosis, and only 5 20% will be alive at 5 years following a
pancreaticoduodenectomy.
∙ Hirschsprung’s disease, which is the congenital absence of ganglion cells in the rectum or
rectosigmoid colon, is definitively diagnosed by rectal biopsy. Treatment colostomy
∙ Congenital anorectal anomalies are frequently associated with other congenital
anomalies including heart disease
∙ Hematomas of the rectus sheath are more common in women and present most often in
the fifth decade. A history of trauma, sudden muscular exertion, or anticoagulation can
usually be elicited
∙ A bypass procedure is the operation of choice for obstruction secondary to an annular
pancreas.A Whipple procedure is too radical a therapy for this benign disease, and a
partial resection of the annular pancreas often is complicated by fistula.
Duodenojejunostomy is much more physiologic than gastrojejunostomy and does not
require a vagotomy to prevent marginal ulceration; it is therefore the procedure of choice.
∙ Carcinoma esophagous a high incidence is reported in patients with corrosive esophagitis
∙ Appendicitis is is the most prevalent extrauterine indication for laparotomy in pregnancy
∙ The classic Quincke triad of abdominal pain in the right upper quadrant, jaundice,
and gastrointestinal bleeding is present in 30 40% of patients with hemobilia
∙ Intussusception is the result of invagination of a segment of bowel into distal bowel
lumen. The most common type is ileocolic, which typically appears as a coiled spring on
barium enema. Ileoileal and colocolic intussusceptions occur less commonly and are not
easily diagnosed on barium enema. If bloody mucus, peritonitis, or systemic toxicity have
not developed, hydrostatic reduction by barium enema is the appropriate initial treatment
Most patients are successfully managed this way and do not require surgical intervention.
Immediate treatment should be instituted to avert the danger.
∙ Cholangitis is suggested by the presence of the Charcot triad: fever, jaundice, and pain in
the right upper quadrant
∙ Rectal carcinoids are slowly growing tumors, but they can be locally invasive and
metastasize in up to 15% of patients. Local recurrence is rare
∙ Esophagous is fibromuscular coat c6-t11 & 25 cm long its in the superior and posterior
mediastinum. Lined by squmaous epithelium and lower 3cm is columnar.15cm,25 cm
impression made by it aortic and bronchial constriction in endoscopy and
radiography.40cm diaphragmatic sphincter constriction. Upper one third is striated,
Congenital 85% cases lower esophagous open in trachea new born baby regurgitate all its
first , saliva pours and attacks of coughing and cyanosis on feeding. Mother of neonate
will be polyhydromnios
∙ Conservative management perforation confined to mediastineum , cervical oesophagous,
flexible endoscope
∙ Operative perforation of abdominal esophagous , breech in pleura
∙ PPI is the most effective drug GERD
∙ Fundus of stomach wrapped completely around lower 5cm of esophagous - NISSEN
FUNDOPLICATION
∙ Sliding hernia present with GERD in 85%
∙ Paraesophagous rolling hernia 5% present with cardic symptoms and chest pain. It’s a
true hernia
∙ Achalasia uncommon and due to loss of inhibitarory neurons. Respond well to the
treatment. Loss of ganglion in auerbach’s plexsuses and dilated loop of esophagous
contain few ganglions
∙ Carcinoma stomach tobacco use, alcohol, china etiology unknow
∙ Dysphagia is the most common presenting complain but its late symptoms
∙ Preexisting condition achalaisa, esophagitis, and barret esophagous
∙ Dysphagia initially to solids. Hoarsness of voice due to recurrent laryngeal nerve
∙ Endoscopy U/S is best best for preoperative staging
∙ Radiotherapy for adenocarcinoma of esophagous
∙ Fatty dyspepsia is due to gord
∙ Symptoms of rolling hernia is due to twisting and distortion of esophagous
∙ Heller + fundoplication=heller’s dor’s operation
∙ Collis nissen is used for short esophagous
∙ Nissen fundoplication & toupet fundoplication
∙ GORD d/d Achlasia
∙ Saint traid hiatus hernia , cholilithiaisa & diverticulosis coli
∙ Hypertropic pyloric stenosis 5/1000
∙ 4 times boys are likely affected
∙ u/s investigation of choice for hypertrophic pyloric stenosis
∙ duodenum atrasia is diagnosed antenatally by u/s
∙ gastric ulcer produce normal acid level,mainly lowered mucosal resistance. Acid pepsin
level normal.chronic duodenum ulcer are not associated with malignancy but gastric
ulcers are. Chronic duodenum ulcer are more common. Peptic ulcer more common in
duodenum on anterior surface
∙ carcinoma of stomach 22% gastroesophageal junction s/s vague but persistent
indigestion or epigastric pain. On gastroscopy multiple biopsies are taken
∙ trouser sign
∙ hpylori type b gastritis
∙ nsaid and alcohol Errosive gastritis
∙ type a gastritis is autoimmune
∙ reflux gastritis Although commonly seen after gastric surgery, it is occasionally found in
patients with no previous surgical intervention or who have had a cholecystectomy.
∙ Stress gastritis The condition also sometimes follows cardiopulmonary bypass.
∙ The patient, who may have a history of peptic ulceration, develops sudden onset severe
generalised abdominal pain due to the irritant effect of gastric acid on the
peritoneum.often elderly.treatment is surgical
∙ Upper gastrointestinal bleeding is a coomon emergency and mortality is 5%.common
cause of gastrointestinal bleeding ulcers 60%
∙ Upper class proximal gastric cancers
∙ The features of advanced gastric cancer are usually obvious. However, curable gastric
cancer has no specific features to distinguish it symptomatically from benign dyspepsia.
In advanced cancer early satiety, bloating.

∙ Primary gastric lymphoma accounts for approximately 5 per cent of all gastric neoplasms.
Gastric lymphoma is the most common in the sixth decade. Following diagnosis adequate
staging is necessary, primarily to establish whether the lesion is a primary gastric
lymphoma or part of more generalised process. Although the treatment of primary gastric
lymphoma is somewhat controversial, it seems most appropriate to use surgery alone for
the localised disease process. No benefit has been shown from adjuvant chemotherapy,

∙ Polya gastrectomy is modification of bilroth II = retrocolic anastomsis

∙ Vagotomy and drainage The most popular drainage procedure is the Heineke Mikulicz
pyloroplasty
∙ Perforated peptic ulcer CT scan is diagnostic
∙ Lauren classification 1)intestinal gastric cancer 2)diffuse gastric cancer
∙ Gastric cancers are chemosensitive
∙ Plain radiography is sufficient for forigen body of stomach and esophagous
∙ Horizontal rotation of stomach is common
∙ Advanced gastric cancer involves the muscularis. Its macroscopic appearances have
been classified by Bormann into four types
∙ Liver trauma this may be facilitated by producing vascular inflow occlusion by placing an
atraumatic clamp across the foramen of Winslow (the Pringle manoeuvre)
∙ Common cause of acute liver failure 1) viral hepatitis ABCDE 2)mushrooms 3)Wilson’s
disease
∙ Treatment of acities: paracentisis abdominal , tips , peritonieum venous shunt liver
transplantation
∙ Heptacellular carcinoma alpha fetoprotein
∙ Contrast MRI most sensitive investigation currently avialabe in staging of HCC
∙ Right and left hepatic ducts KLATSKIN TUMORS.
∙ The main current indication for a surgical shunt is a patient with Child’s grade A cirrhosis
in whom the initial bleed has been controlled by sclerotherapy.
∙ Felty syndrome= R.A+spleenomegaly+leucopenia
∙ Splenic Pain referred to the left shoulder is known as Kehr’s sign. There may be
hyperaesthesia in this area. The sign can often be demonstrated 15 minutes after
elevation of the foot of the bed
Rupture of a malarial spleen
∙ As has been mentioned, in tropical countries this is not an infrequent catastrophe. The
delayed type of rupture (following trivial’ injury) is also very common and the patient is
admitted with a perisplenic haematoma. If splenectomy can be performed before the
haematoma bursts into the general peritoneal cavity, the prognosis is less grave
∙ Post splenectomy haemorrhage common
∙ Post splenectomy result in pneumonia , nesseria meningitides, h-influenza and ecoli &
OPSI
∙ Some killers have pretty nice capsule
∙ H-influenza type b vaccination
∙ Rupture spleen xray: obliteration of spleenic outline, obliteration psoas shadow,
indentation left gastric air bubble, fracture lower left ribs & elevation of left diaphragm
∙ Spleenectomy indication: trauma most common , radical gastrectomy , Idiopathic
thrombocytopenic purpura, in association with shunt in portal hypertension
∙ Postoperative complication: gastric dilation and rise in wbc and platelets count

The inflammatory destruction of the bile ducts has been classified into three main types
type I atresia restricted to the common bile duct;
type II atresia of the common hepatic duct;
type III atresia of the right and left hepatic ducts.
 Associated anomalies include, in about 20 per cent of cases, cardiac lesions, polysplenia, situs
inversus, absent vena cava and a pre duodenal portal vein.
Clinical features
About one-third of cases are jaundiced at birth. In all, however, jaundice is present by the
end of the first week and deepens progressively. The meconium may be a little bile
stained but later the stools are pale and the urine is dark. Prolonged steatorrhoea gives
rise to osteomalacia (biliary rickets). Pruritis is severe. Clubbing and skin xanthomas,
probably related to a raised serum

Limey bile
Lime-water’ bile is revealed on a plain radiograph (Fig. 54.5)more clearly than if the gall bladder
has been visualised by cholecystography. The opacity is the result of the gall bladder becoming
filled with a mixture of calcium carbonate and calcium phosphate, usually the consistency of
toothpaste. The condition tends to occur when there is a gradual obstruction of the cystic or
common bile duct, for example due to chronic pancreatitis or carcinoma of the pancreas.
Organisms are rarely grown from the emulsion.
Gas in gallstones
Rarely the centre of a stone may contain radiolucent gas in a triradiate or biradiate fissure and
this gives rise to characteristic dark shapes on a radiograph the Mercedes Benz’ or seagull’
signs.
Cystic duct is 2.5cm. common hepatic duct is less than 2.5cm. gall bladder capacity 20ml. u/s is
the gold standard for the gall stone. peroperative cholangiography will define anatomy and
confirm presence or absence of stones. Chledochal cyst appear at 6month of age.mixed stone
calcium bilirubinate, ca phosphate, ca carbonate, ca palmitate and protein.typhoid calculus and
acalculus. 90% respond to conservative treatment.conservative treatment must be abondaned if
pain and tenderness increase.percutaneous cholecystectomy is performed.gall bladder
concentrate 5-10times
Clinical presentation of postoperative stricture: 15% cases bile duct injury recognized at the
time of surgery.85% cases postoperatively. Carcinoma of gall bladder in 70yrs common in
females 5:1. Very poor prognosis closely linked to that of gall bladder.5% 5 year survival rate.
MRCP not for strictures
ERCP identify leak and temporary stenting will ensure adequate biliary drain. Usually
percutaneous drain are placed
The most dangerous anomalies are where the hepatic artery takes a torturous course on the
front of the origin of the cystic duct, or the right hepatic artery is torturous and the cystic artery
short. The tortuosity is known as the caterpillar turn’ or Moynihan’s hump’
Investigation of the biliary tract
Plain radiograph
The skilfully taken plain X-ray of the gall bladder will show radio-opaque gallstones in 10 per cent
of patients (Fig. 54.3). It will also show the rare cases of calcification of the gall bladder, a
so-called porcelain’ gall bladder (Fig. 54.4).The importance of this appearance is that it is
premalignant and an indication for cholecystectomy. Limey bile is a curiosity and is frequently
related to multiple small stones (Fig. 54.5).This lesion is not a premalignant lesion.
Oral cholecystography (Graham Cole test) (Figs 54.6 and 54.7)
Iopanoic acid BP is taken as tablets on the night before the examination. A control radiograph is
taken before the tablets are given and a series of X-rays is taken on the following day, with
further films after a fatty meal. The fatty meal stimulates gall-bladder contraction and reveals the
adequacy of gallbladder function.
This investigation has been discarded by most hospitals because of its inaccuracy except to
show diverticulae and polyps, and to assess function; adequate films depend on the patient
taking the tablets, and the tablets being absorbed,secreted by the liver and concentrated in the
gall bladder after passing into the gall bladder through an unobstructed cystic duct. Thus, a
cholecystogram which shows no concentration of contrast can result from many causes and it
not diagnostic of gallstone disease
Radioisotope scanning
Technetium-99m (99mTc)~labelled derivatives of iminodiacetic 
 acid (HIDA, PIPIDA) are excreted in the bile and ate used to visualise the biliary tree. In acute
cholecystitis the gall bladder is not seen. The technique is used when biliary enteric
anastomoses are functioning inadequately as it will show the extent of obstruction at the
anastomosis and indicate the delay inexcretion.

PTC: Addition to this technique enables placement of a catheter into the bile ducts to provide
external biliary drainage or the insertion of indwelling stents. The scope of this procedure can be
further extended by leaving the drainage catheter in situ for a number of days and then dilating
the track sufficiently for a fine flexible choledochoscope to be passed into the intrahepatic biliary
tree in order to diagnose strictures, take biopsies and remove stones.
Operative biliary endoscopy (choledochoscopy)
At operation a flexible fibre-optic endoscope can be passed down the cystic duct into the
common bile duct enabling stone identification and removal under direct vision.
Mucocele of the gall bladder
This occurs when the neck of the gall bladder becomes obstructed by a stone but the contents
remain sterile. The bile is absorbed and replaced by mucous secreted by the gall bladder
epithelium. The gall bladder may be palpable
Cholesterosis ( strawberry gall bladder’)
In the fresh state the interior of the gall bladder looks something like a strawberry; the yellow
specks (submucous aggregations of cholesterol crystals and cholesterol esters) correspond to
the seeds (Fig. 54.34).It may be associated with cholesterol stones.
Diverticulosis of the gall bladder
Diverticulosis of the gall bladder is usually manifest as black pigment stones impacted in the
out-pouchings of the lacunae of Luschka. Diverticulosis of the gall bladder may be demonstrated
by cholecystography, especially when the gall bladder contracts after a fatty meal. There are
small dots of contrast medium just outside the gall bladder (Fig. 54.36).A septum may also be
present (to be distinguished from the Phrygian cap Fig. 54.26) and the treatment is
cholecystectomy.

Symptoms persisting after cholecystectomy

In 15 per cent of patients cholecystectomy fails to relieve the symptoms for which the operation
was performed. Such patients may be considered to have a postcholecystectomy’ syndrome.
However, such problems are usually related to the preoperative symptoms and are merely a
continuation of those symptoms. Full investigation should be undertaken to exclude the
presence of a stone in the bile duct, a stone in the cystic duct stump or operative damage to the
biliary tree. This is best performed by an MRCP or an ERCP which has the added advantage that
if a stone remains it can be removed.

Cholangitis immediate relief of obstruction by drainage endoscopic or transhepatic. If cbd is

obstructed there is leakage of biliary tree due to cystic duct leak then a drain should be placed in
the subhepatic space percutaneously and reconstruction of the duct

∙ Beger procedure is duodenum preserving procedure

∙ Frey’s pancreatojejunostomy
∙ Sphincter of oddi is 6-10mm long
∙ Gastrinoma is passaro triangle.
∙ A desmoid tumour is a tumour arising in the musculoaponeurotic structures of the
abdominal wall, especially below the level of the umbilicus.