MCQ SURGERY

MCQ (True /False)

1.

For malignant lesions of the stomach:

T
A.
T
B.
the stage.
F
C.
F
D.
T
E.
2.

Symptoms and signs manifest very late.

Penetration of tumors through the stomach wall helps to determine
All metastasis past first through the pulmonary circulation.
Most lesions start initially as benign polyps.
Endoscopy and biopsy are the main diagnostic tools.

In cases of Bleeding Peptic Ulcer with shock:

F
A.
T
B.
F
C.
capacity.
T
D.
perfusion.
F
E.

Blood pressure improves only with blood transfusion.

The pulse rate is useful for monitoring hypovolaemia.
The Central Venous Pressure measures the oxygen carrying

3.

The following parameters are essential in trauma to the chest:

T
A.
T
B.
F
C.
F
D.
T
E.
suspected.

Measurement of oxygen saturation.

Plain chest X-ray.
Full white blood cell count.
Blood urea and serum electrolytes.
Echocardiogram (Cardiac ultrasound) if cardiac temponade is

4.

The Pulse Oxymeter reading increases with improving tissue

Endoscopy is used on for clarifying the diagnosis.

The following features occur in acute appendicitis:

T
A.
Nausea is common but vomiting is infrequent.
F
B.
When an abscess is formed, the bacteria often involved belong to
the Staphylococcus group.
T
C.
Diarrhea is not a presenting symptom
F
D.
Pain and tenderness may start at the right iliac fossa and then
become generalized.
T
E.
Severity of illness usually correspond with the duration of illness.
5.

In carbuncles:

F
A.
T
B.
T
C.
response.
T
D.
F
E.

It can heal spontaneously.

Diabetes mellitus is a predisposing factor.
The symptoms and sign are attributable to an acute inflammatory
It is caused by Staphylococcus aureus which may be MRSA.
Haematogenous spread of infection to other organs.

6.

Factors that delay wound healing include:

T
T

A.
B.

Infarction.
Excessive mobility of affected part.

T
T
F
7.

C.
Zinc deficiency.
D.
Diabetes mellitus.
E.
Aldosterone.
Mammary duct fistula is associated with:

F
F
T
F
F

A.
B.
C.
D.
E.

8.

Regarding septic shock

T
A.
F
B.
F
C.
T
D.
T
E.
compilation.

Lobular carcinoma in situ.

Duct papilloma.
Duct ectasia.
Galactocele.
Fat necrosis.

Passes in two stages, the first is warm hyperdynamic.

Mostly is due to gram positive septicaemia.
Hypovolaemia is due to external fluid loss.
Nitric Oxide antagonists in animals improve survival.
DIC (Disseminated intravascular Coagulopathy) is possible

9.

Pulmonary embolism

T
F
T
T
F

A.
B.
C.
D.
E.

10.

Critical limb ischemia:

F
T
T
T
T

A.
B.
C.
D.
E.

11.

The following drugs should be discontinued prior to surgery:

T
T
F
F
F

A.
B.
C.
D.
E.

12.
T
T
T

Commonly caused by thrombi from calf, thighs or pelvic veins.

Recurrent small emboli need only follow up.
Medium sized emboli causes pulmonary infarction.
Intravenous and oral anticoagulants must be started immediately.
Heparin and Streptkinase should be given together.

Usually is arterial only.

Causes loss of pulses, sensations and function.
Leads to cold limb with colour change.
Needs urgent duplex scan.
Can be treated and limb is saved in some cases.

Warfarin.
Aspirin.
Nifedipine.
Corticosteroid.
Thiazide diuretics.
Regarding the administration of the banked whole blood:

A.
B.
C.

Banked blood is a poor source of platelets.

The levels of intracellular adenosine triphosphate drops.
Oxygen transport function of blood falls during storage.

F
F

D.
E.

pH of banked blood rises slowly during storage.

Significant haemolysis occurs during storage.

13.

Regarding acute abdomen:

F
T
F
T
F
fever.

A.
B.
C.
D.
E.

14.

For a thyroid adenoma:

F
T
T
T
F

A.
B.
C.
D.
E.

15.

Cancer stomach:

T
T
F
T
F

A.
B.
C.
D.
E.

16.

Risk factors for post-operative wound infection in bowel surgery include:

T
F
T
T
T

A.
B.
C.
D.
E.

17.

Acute increase of intracranial pressure is accompanied by

T
T
F
F
F

A.
B.
C.
D.
E.

18.

Regarding prophylaxis against deep vein thrombosis

A plain abdominal X-ray is diagnostic in all cases.

Laparoscopy is a useful diagnostic tool.
Meckels diverticulitis is a common cause.
Murphys sign is diagnosticof acute cholecystitis.
Appendicular abscess presents with moderate tachycardia and mild

FNAC is diagnostic.
It is a benign swelling.
Is treated by hemi-thyroidectomy if confined to the same lobe.
Can appear as a cold, hot or iso-nodule.
It invades its capsule.

Is reduced by vitamin C, milk, vegetables.

Is increased by smoked, picked, or salted food.
Is more in females than males.
Is treated mainly by surgery.
Radiotherapy alone is an effective treatment option.

Lung atelectasis and/or collapse.

Early mobilization of operated patient.
Anastomotic leakage.
Unprepared bowel preoperatively.
Jaundice.

Papilloedema.
Raised blood pressure (Kuching reflex).
Hyporthermia.
Tachycardia.
Erosion of dorsum sellae.

F
A.
Middle aged man for truncal vgotomy and gastric drainage falls into
high risk category.

T
B.
Combination of heparin and stockings is cost effective in moderate
risk group.
T
C.
Low molecular heparin (LMWH) has a lower risk of bleeding than
LDUH(Low dose unfractionated Heparin).
T
D.
Intraoperative pneumatic keg compressions beneficial in high rish
patients.
F
E.
Prophylactic heparin in lap. Choelcystectomy is injected during the
operation.
19.

Post-operative wound infections

F
A.
T
B.
T
C.
F
D.
T
E.
operation

In clean-contaminated operations is 30%

Coliforms are frequently responsible
Are minimized with antibiotic prophylaxis
Lipoma excision is a clean-contaminated operation
Appendicectomy with inflamed appendix is a clean-contaminated

20.

Regarding phylloides tumour of the breast, it:

F
T
T
T
F

A.
B.
C.
D.
E.

21.

In breast cancer:

F
T
T
F
F

A.
B.
C.
D.
E.

22.

Haemorrhoids

F
T
F
T
T

A.
B.
C.
D.
E.

23.

Barrets esophagus

Is a malignant tumour in women above 40 years.

Reaches a huge size and is bosselated.
Can ulcerate by pressure atrophy on skin.
Remains mobile on chest wall.
Is treated by mastectomy and axillary clearance.

Lobular carcinoma is situ can be seen in mammogram.

Atypical ductal hyperplasia is a risk factor for breast cancer.
Breast cancer rarely presents with mastalgia.
Pagets disease of breast is associated with diseases of the bone.
Inflammatory breast cancer is staged as T3.

Internal means it is lying in the upper 1/3 of the anal canal.

More common in males than females.
Pain is in almost all patient.
May be associated with cancer of rectum.
Injection with sclerotherapy is a method of treatment.

F
A.
Is a painful; condition.
F
B.
Is metaplastic replacement of normar columnar ephitelium to
squamous ephitelium.
T
C.
Causes dhysphagia.
F
D.
Is a recursor for squamous cell carcinoma.
F
E.
Is treated by surgical resection.

24.

Regarding pre-operative preparation of a patient:

T
A.
Informed consent should only be provided by member of the
operating team.
F
B.
Pre-operative preparation does not depeng upon urgency of
operation.
T
C.
In cardiac risk index, S 3 gallop is a risk factors.
T
D.
Estimation of fasting blood sugar is recommen ded in all patient.
F
E.
ECG should be done in every patient.
25.

Correct answer about acute intestinal ischemia:

T
T
F
T
F

A.
B.
C.
D.
E.

26.

Regarding thyroid tumours

Abdominal pain is out of proportion to physical findings.

Metabolic acidosis is present.
Multiple dilated small bowel loops are there in abdominal X-ray.
Occult blood in stool is a late sign.
Relief of symptoms is obtained by intravenous morphine.

F
A.
Majority of thyroid nodules are malignant.
F
B.
Ultrasound is a reliable investigation to differentiate benign from
malignant tumours.
T
C.
Neck irradiation is a cause of thyroid cancer.
T
D.
Papillary thyroid cancer forms 60% of thyroid cancers.
T
E.
Medullary carcinoma arises from parafollicular C cells.
27.

Regarding Hernia:

F
T
T
T
F

A.
B.
C.
D.
E.

28.

Raynauds disease:

T
F
T
T
F

A.
B.
C.
D.
E.

29.

In lymphatic spread of malignant celles:

F
A.
F
B.
T
C.
Trousseaus
F
D.
T
E.
30.

Femoral hernia is common in males than females.

Irreducibility of inguinal hernia is the early complication.
Femoral hernia is liable for complications more than inguinal type.
Indirect inguinal hernia tends to come down into the scrotum.
Direct inguinal hernia is due to wide deep ring.

Primary one has a genetic predisposition.

It occurs in young males more than females.
Treated by calcium antagonists or sympathectomy.
It is an abnormal response to cold.
It occurs in three stages end by dusky cyanosed fingers.

It is exclusively antegrade.
Troisiers sign represents antegrade extension.
Deep seated abdominal cancer shows both Troisiers and
signs.
Extension is by permeation only.
Final station is the lung and liver.

In peptic ulcer disease :

F
F
F
F
T

A.
B.
C.
D.
E.

Type 1 gastric ulcer is at fundus.

Duodenal ulcer has risk or malignancy.
Curlings ulcer occurs in head injury patients.
Bismuth is an antisecretory drug.
Antibiotic therapy has become more significant.

1.

Regarding inguinal hernia?

F
T
T
F
T

A.
B.
C.
D.
E.

2.

Regarding appendicitis?

All inguinal hernia pass through the deep inguinal ring.

An indirect hernia passes lateral to the inferior epigastric artery.
A large indirect hernia reaches the scrotum.
A direct hernia is within the coverings of the spermatic cord.
Congenital hernia is of an indirect type.

T
A.
Tenderness at McBurneys point is a clinical sign.
T
B.
The blood supply of the appendix are branches of appendicular
branch of ileocolic artery.
T
C.
In female, torsion of the ovarian cyst should be considered as a
differential diagnosis.
T
D.
Tachycardia and mild pyrexia are typical presentations.
F
E.
Abdominal radiograph is mandatory for diagnosis.
3.

Regarding malignancies of the skin:

T
A.
Malignant melanoma most often arises from preexisting naevus.
F
B.
Satellite lesions appearing around the primary malignancy is a
feature of squamous cell carcinoma.
T
C.
Basal cell carcinoma has a raised and rolled edge.
F
D.
Squamous cell carcinoma is also referred to as rodent ulcer.
T
E.
Marjolins ulcer is associated with squamous cell carcinoma.

4.

Carcinoma of the oesophagus:

T
T
F
T
T

A.
B.
C.
D.
E.

5.

The following occur/s with gastro-oesophageal reflux:

A.

Consumption of salted fish is a risk factor.

Achalasia is a predisposing condition.
Adenocarcinoma type is radio-sensitive.
Dysphagia is a presenting complaint.
Spreads to the liver and lungs.

Pneumonia.

T
T
F
F

B.
C.
D.
E.

Oesophageal stricture.
Barrett's esophagus.
Squamous cell carcinoma of the oesophagus.
Pernicious anaemia.

6.

Carcinoma of the stomach?

T
A.
Is commonly a complication of atrophic gastris.
F
B.
Causes pre-hepatic type of jaundice.
T
C.
The infiltrating carcinomas results in linitis plastica (leather bottle
appearance).
T
D.
Produces Krukenberg tumour.
T
E.
Endoscopic biopsy is the definitive diagnostic aid.
7.

The following colorectal polyp are pre malignant:

T
F
F
T
F

A.
B.
C.
D.
E.

8.

Regarding colorectal cancer:

T
A.
F
B.
T
C.
T
D.
enema.
F
E.

9.

Adenoma.
Hamartoma.
Metaplastic polys.
Familial polyposis coli.
Juvenile polyp.

Adenomas are precursors.

It is commoner in the transverse colon than in the rectum.
Pericolic abscess is a presentation.
Annular carcinoma produces "Apple core" appearance in barium
Intestinal obstruction is common in the right sided cancer.

In intraabdominal abscess:

F
A.
Colicky pain which increase inexorably is a feature.
T
B.
There is usually a marked leuccocytosis.
T
C.
Appendicular perforation is one of the causes.
T
D.
Tender abdominal mass is palpable.
F
E.
Abdominal Radiograph is most helpful in demonstrating the site and
size of the abscess.
10.

In patients admitted with acute abdomen:

F
A.
T
B.
peritonitis.
T
C.
F
D.
T
E.

Acute appendicitis could be confirmed by abdominal X-ray.

Exploratory laparotomy is indicated in patients with generalised
Leaking Abdominal aortic aneurysm should be excluded.
Hard board rigidity occur in perforated gastric ulcer.
High serum amylase level is suggestive of the cause.

11.

Regarding haematemesis:

T
T
F
T
T

A.
B.
C.
D.
E.

12.

Concerning the sources of radiation hazards:

T
T
T
F
T

A.
B.
C.
D.
E.

It could be associated with hypovolaemic shock.

It could arise as a complication of peptic ulcer disease.
It consists of tarry black blood.
The condition could be fatal.
Endoscopy is a useful investigative tool.

Aging X-ray tube leakage.

Radio-isotopes administration during HIDA scanning examination.
Cosmic rays.
Electric generator.
Computed tomographic- fluoroscopic examination.

13.
A supine plain abdominal radiograph often provides useful diagnostic
information in the following conditions:
T
F
F
T
T

A.
B.
C.
D.
E.

Abdominal aortic aneurysm.

Perforated peptic ulcer.
Acute appendicitis.
Acute cholycystitis.
Large bowel obstruction.

14.
The following radiological features suggest Crohns disease rather than
ulcerative colitis:
T
F
F
F
F

A.
B.
C.
D.
E.

Pseudosacculation.
Involvement of the rectum.
shortening of the colon.
lead pipe appearance of the colon.
lesions in continuity.

15.

Regarding ultrasound examination?

F
F
F
T
T

A.
B.
C.
D.
E.

Cannot be used to assess biliary obstruction.

Is used to evaluate pneumothorax.
Is contraindicated in patients with acute abdomen.
Is the examination of choice in suspected liver abscess.
Detect minimal ascites.

16.

Regarding Graves disease:

T
A.
T
B.
of Graves.
F
C.
F
D.
T
E.

Is one of the common causes of thyrotoxicosis.

Long acting Thyroid-stimulating hormone (LATS) level is a diagnostic
The thyroid gland is of normal size.
Ophthalmopathy is seen in all cases.
It is associated with pretibial myxoedema.

17.

Regarding gallstones:

F
T
T
F
T

A.
B.
C.
D.
E.

18.

Regarding thyroid malignancies?

F
T
T
T
T

A.
B.
C.
D.
E.

19.

During the initial evaluation and resuscitation in multiple trauma patient:

F
A.
T
B.
F
C.
first hour.
T
D.
T
E.
20.

Most of them are visible on plain abdominal X-ray.

Pure cholesterol stones form less than 10% of stones.
Oestrogen facilitates stone formation.
Bile stones are formed from conjugated bilirubin.
Laparascopic cholecystectomy is a mode of treatment.

Collar-stud appearance is a characteristic feature.

Papillary carcinoma contains psammoma bodies.
Follicular carcinoma is associated with severe back-ache.
Anaplastic carcinoma is associated with Kocher sign.
Medullary carcinomas arise from APUD C-cells.

A very complete and detailed history is the first priority.

Must address airway, breathing and circulation immediately.
Patient who has alcohol intoxication can be discharged after the
It is important to rule out hypoglycaemia.
Glasgow Coma Scale is useful to assess conscious level.

Regarding the thyroid gland:

T
A.
The recurrent laryngeal nerve can be injured during
thyroidectomies.
T
B.
Total thyroidectomy can lead to tetany.
F
C.
It moves with protrusion of tongue.
T
D.
Colloid carcinoma is a rare form of malignancy.
F
E.
Hot spots on thyroid scan suggest malignancy.
21.

Regarding galactorrhoea?

T
T
F
T
T
22.

A.
Is due to pituitary tumour.
B.
Is associated with visual disturbance.
C.
Only happen in females.
D.
medication such as metocloprimide (maxolon) as a cause.
E.
one of the main investigations is serum prolactin.
The following are regarded as immediate postoperative complications:

T
T
T
F
F

A.
B.
C.
D.
E.

23.

Breast cancer is more common in patients with:

T
F
T
F
T

A.
B.
C.
D.
E.

24.

Clinical features of acute pancreatitis include:

T
T
T
T
T

A.
B.
C.
D.
E.

25.

Regarding deep vein thrombosis:

T
A.
T
B.
group.
T
C.
T
D.
F
E.

Atelectasis.
Deep Vein Thrombosis.
Paralytic ileus.
Incisional herni.
Dumping syndrom.

A family history of breast cancer.

History of bilateral oophorectomy.
Endometrial cancer.
Chronic smoking habit.
Late first pregnancy.

Tetany.
Paralytic ileus.
Vomiting.
Jaundice.
Pleural effusion.

It occurs in patients who has prolonged immobilization.

Combination of heparin and stockings is effective in moderate risk
Lung infarction is a complication of moderate sized emboli.
The patho physiology is based on the Virchows triad.
It is treated by oral anticoagulants.

26.

Risk factors for post-operative wound infection include:

T
F
T
T
T

A.
B.
C.
D.
E.

27.

Regarding skin infections and abscesses:

atelectasis.
early mobilization in patient with laparotomy scar.
anastomotic leakage.
unprepared bowel.
Jaundice.

F
A.
epidermidis.
T
B.
T
C.
T
D.
F
E.

28.
T
T
F
T
T

29.
T
F
F
T
T

30.

Organisms can spread via the bloodstream.

Furuncle is due to infection of a hair follicle.
Erysipelas is caused by Streptococcus pyogenes.
Carbuncles are best treated with oral antibiotics.

Regarding varicose veins:

A.
B.
C.
D.
E.

they are more common in woman.

the saphenofemoral junction is initially affected.
haemosiderin deposition causes hypopigmentation.
lipodermatosclerosis is a feature.
intake of oral contraception is a predisposing factor.

First degree haemorrhoids are a cause of:

A.
B.
C.
D.
E.

Fresh rectal bleeding.

Anal pain.
Rectal mucosal prolapse.
Anaemia.
Pruritis ani.

Regarding mechanical disorders of the oesophagus:

F
A.
F
B.
thorax.
T
C.
T
D.
sphincter.
T
E.
1.

Breasts abscesses are commonly caused by Staphylococcus

Sliding hernias are less common than rolling hernia.

In rolling hernia, the cardio-oesophageal junction is lifted up into the
Barium swallow in achalasia typically shows Rat-tail appearance.
In achalasia. Auerbach's plexus is absent above the oesophageal
Dysphagia in achalasia is affected for solids and liquids.

The natural history of a disease refers to:

T
F
T
of the
F
used.
F

A.
The progression of the disease over time.
B.
The most common symptoms.
C.
The description of the onset, spectrum of presentation and outcome
disease.
D.
Differences in progression of illness when different treatments are

2.

Carcinoma of the oesophagus:

T
T

A.
B.

E.

The findings from the clinical examination.

occur most commonly in the middle third of the oesophagus.

is predominantly squamous in type.

F
T
T

C.
D.
E.

Commonly spread to the vertebral column.

is a complication of oesophagitis.
is associated with alcohol intake.

3.

Regarding appendicitis:

F
T
T
T
F

A.
B.
C.
D.
E.

4.

Regarding the Parotid Gland:

Blood supply to the appendix is gastroduodenal artery.

Can be caused by a faecolith or foreign body obstruction.
Appendicectomy can be performed laparoscopically.
Psoas sign is positive in retroperitoneal type.
Essentially is managed as an outpatient basis.

F
A.
It is mainly a mucous gland.
T
B.
The Stensens duct opens into the oral cavity opposite the upper
2nd molar.
F
C.
Parotid duct calculi is more common than submandibular duct
stones.
T
D.
Surgical intervention could lead to facial nerve palsy.
T
E.
Sialogram is diagnostic for parotid duct stones.
5.
Regarding the Thyroid Gland tumour:
F
A.
F
B.
T
C.
nodule.
T
D.
F
E.

Are the commonest cause of posterior neck swelling.

More common in adult males than females.
Sudden change in size with pain indicates haemorrhage into the
Papillary Carcinoma is the commonest type of malignancy.
Radioisotope scan is confirmatory of malignancy.

6.

Regarding Keloid:

F
T
F
F
T

A.
B.
C.
D.
E.

7.

The following are regarded as immediate postoperative complications:

T
T
T
F
F

A.
B.
C.
D.
E.

8.

Regarding Basal Cell Carcinoma:

A.

Hypertrophy of mature fibroblasts is a feature.

Intralesional triamcinolone is one mode of treatment.
Continues to grow larger without spreading to the normal tissues.
Is common in areas of skin exposed to sunlight.
Mostly recurs after excision.

Pulmonary embolism.
Deep Vein Thrombosis.
Paralytic ileus.
Incisional hernia.
Dumping syndrome.

It is the commonest type of skin malignancy.

F
F
F
T

B.
C.
D.
E.

Usually occurs in the area between the lower lip and chin.
Is known as Bowens disease.
Rodent ulcer has raised everted edges.
It is locally invading and rarely metastasize.

9.

In bowel obstruction:

T
A.
Colicky abdominal pain is characteristically the earliest symptom.
F
B.
Passing flatus after the onset of pain excludes the diagnosis.
T
C.
If the site of obstruction is in the distal large bowel, vomiting is a
late feature.
T
D.
Visible peristalsis supports the diagnosis of obstruction.
T
E.
Air fluid level in abdominal X-ray is a feature.
10.
Acute pancreatitis is associated with:
T
T
T
T
F

A.
B.
C.
D.
E.

11.

Pure water depletion occurs in the following circumstances:

T
T
T
T
F

A.
B.
C.
D.
E.

12.

Hypokalemia:

F
T
T
F
T

A.
B.
C.
D.
E.

13.

In a normal 70-kg adult:

T
T
T
T
T

A.
B.
C.
D.
E.

14.

Regarding prophylaxis against deep vein thrombosis

F
A.
category.

Gall stones.
Hyperlipidaemia.
Mumps infection.
Prolonged ingestion of oral contraceptive pills.
Hypothyroidism.

Diminished intake.
Inability to swallow due to painful conditions of the pharynx.
Obstruction in the oesophagus.
Increased loss from lungs after tracheostomy.
Syndrome of Inappropriate Anti Diuretic Hormone secretion (SIADH).

Is seen in renal failure.

Is seen in cases of paralytic ileus.
Manifests as intermittent periodic paralysis.
Causes peaking of T wave in an ECG.
Potassium should be given by controlled infusion .

Urine output is 1.5 liter/day.

Insensible water loss is 700-1000ml/day.
Sodium requirement is 2mmol/kg.
Random serum blood glucose ranges 5 10 mmol/L.
Water requirement is 30 mL/kg/day.

Middle aged man undergoing hernioraphy falls into high risk

T
B.
Combination of heparin and stockings is cost effective in moderate
risk group.
T
C.
Low molecular heparin (LMWH) has a lower risk of bleeding than
LDUH (Low dose unfractionated Heparin).
T
D.
Intraoperative pneumatic leg compression is beneficial in high risk
patients.
F
E.
Prophylactic heparin in laparoscopic cholecystectomy is injected
during the operation.
15.

In patients with acute cholecystitis:

T
F
T
F
T

A.
B.
C.
D.
E.

16.

The following features are characteristic of venous ulcers:

F
T
T
hose.
F
T

A.
B.
C.

They are never painful.

They are usually found on the medial aspect of the lower leg.
They are can be treated with high compression (class III) support

D.
E.

They usually require immediate surgical excision.

They are more common than arterial ulcers.

17.

In breast cancer:

F
T
T
F
F

A.
B.
C.
D.
E.

18.

The growth of the following tumors is hormone dependent:

T
T
T
F
F

A.
B.
C.
D.
E.

19.

Raised intracranial pressure may produce:

T
T
T
F
T

A.
B.
C.
D.
E.

Gall stones are not always present.

Common organism is Staphylococcus sp.
Empyema is a common complication.
Murphys sign is always present.
Complications are more likely in diabetic patients.

Lobular carcinoma in situ can be found on mammography.

Atypical ductal hyperplasia is a risk factor for breast cancer.
Breast cancer rarely presents with mastalgia.
Paget's disease of breast is associated with Paget's disease of bone.
Inflammatory breast cancer is staged as T3.

lobular carcinoma of breast.

follicular carcinoma of thyroid.
carcinoma of prostate.
small cell carcinoma of lung.
colorectal carcinoma.

diminished consciousness.
erosion of the posterior clinoid processes.
Papilloedema.
lowered systolic blood pressure with a rapid pulse.
tonsillar herniation.

20.

Healing of the surgical wound is impaired;

T
T
F
F
T

A.
B.
C.
D.
E.

in the presence of infection to the wound.

by poor selection of suture material used in suturing the wound.
following gentle tissue handling of the wound.
following accurately opposing the wound edges.
in patient with diabetes mellitus.

21.
During the initial evaluation/resuscitation in head injury and polytrauma
patient:
F
A.
a very complete history and detailed physical examination is the
first priority.
T
B.
must address airway, breathing and circulation immediately.
F
C.
patient who has alcohol intoxication can be discharged after the
first hour.
T
D.
important to rule out concomitant injury to the cervical spine.
T
E.
Glasgow Coma Scale is useful to assess conscious level.
22.

Protective factors for breast cancer include;

T
F
T
T
F

A.
B.
C.
D.
E.

23.

A conventional X- ray of the abdomen is useful in detecting:

T
T
F
T
T

A.
B.
C.
D.
E.

24.

Minimally invasive surgery

T
F
T
T
T

A.
B.
C.
D.
E.

Breastfeeding.
High intake of alcohol.
Late menarche.
Early menopause.
Nulliparous.

Teratoma.
intestinal obstruction.
liver laceration.
radio opaque renal calculi.
perforated bowel.

is used for cholecystectomy.

means minimal skill is required.
makes use of carbon dioxide for insufflation.
is contraindicated in patients with coagulopathy.
affords a quicker recovery than open procedures.

25.

In abscesses involving the skin:

F
A.
The most common bacteria involved is methicillin resistant
Staphylococcus aureus (MRSA).
T
B.
Diabetes mellitus is a predisposing factor.
T
C.
The symptoms and signs are attributable to an acute inflammatory
response.
F
D.
Histopathological examination is mandatory to achieve diagnosis.
T
E.
A serious complication is haematogenous spread of infection to
other organs.
26.

In patients with inguinal hernias:

F
A.
If the onset is in infancy, complications are rare and therefore
surgical treatment should be deferred.
T
B.
It is more common in males than females.
F
C.
Intestinal obstruction is more likely to occur in the direct hernia
rather than the indirect hernia.
T
D.
It can be differentiated from a femoral hernia because in inguinal
hernia the swelling appears above the inguinal ligament; whereas in femoral
hernia the swelling is below the inguinal ligament.
T
E.
Pain is more likely to be felt at the mid-abdomen rather than at the
site of swelling.
27.

Varicose veins:

T
T
T
F
F

A.
B.
C.
D.
E.

28.

Is more common in elderly group of the population.

Usually are asymptomatic.
Sapheno-femoral ligation is a common surgical intervention.
Are commonly due to deep venous thrombosis (DVT).
Commonly cause gangrene of the limbs.

The following is/are expected complications of inguinal hernia:

T
T
T
F
T

A.
B.
C.
D.
E.

29.

Regarding jaundice:

T
A.
T
B.
F
C.
jaundice.
F
D.
T
E.

Obstruction.
Incarceration.
Strangulation.
Malignant changes.
Gangrene of the bowel.

pruritus a feature in obstructive type.

can also be caused by incompatible blood transfusion.
reticulocyte count is usually increased in post hepatic
Urobilinogen is routinely detected in obstructive jaundice.
could occur in sepsis.

30.
F
T
F
T
T

Regarding haemorrhoids:
A.
Internal haemorrhoids lie distal to the pectineal line.
B.
1st degree haemorrhoid is reducible.
C.
pain is in almost all patient.
D.
may be associated with cancer of rectum.
E.
rubber banding of the pedicle is a method of treatment.

MEQ 1

Part 1 (15 minutes)

Mr Chong is a 45-years-old Chinese male who was brought to the

hospital with a sudden severe epigastric pain with abdominal
distension, vomiting.

He has a history of recurrent attacks of epigastric pain which was

aggrevated by food intake and relieved by ante acid drugs.

QUESTION 1

Mention THREE possible differential diagnoses.

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________
(3 marks)

123456-

Perforated Gastric Ulcer

Perforated duodenal ulcer
Mallory Weiss Syndrome
Acute pancreatitis
Small bowel obstruction
Gastric outlet obstruction

QUESTION 2

What questions you want to further ask the patient or relatives Give important
THREE questions

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________
(3 marks)
1234-

Type and quality of pain

Relation of pain to meals.
history of peptic ulcer medical treatment
History of previous endoscopy

QUESTION 3

Mention FOUR essential signs you want to look for

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________
(2 marks)
1234-

low blood pressure

rapid weak pulse
pale toxic face
hard rigid abdomen

56-

tender whole abdomen

absent bowel sounds
QUESTION 4

Mention FOUR important investigations and aim of it

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________
(2
marks)

Investigation
1- Plain X- ray erect and supine or lateral
film
2- Ultrasound abdomen
3- CBC
4- Serum amylase

Aim
Gas under diaphragm
Fluid in abdomen
Svere leukocystosis
Acute pancreatitis

MEQ 1

Part II (15 minutes)

Mr Chong is a 45-years-old Chinese male who was brought to the

hospital with a sudden severe epigastric pain with abdominal
distension, vomiting.
He has a history of recurrent attacks of epigastric pain which was
aggrevated by food intake and relieved by ante acid drugs.

Patient gave a history of having medication for a peptic ulcer since two
years.
Examination showed rapid pulse and low blood pressure. Abdomen was
tnder all over and rigid with no bowel sounds.
Abdominal X-ray was shown

QUESTION 5

Describe the X-ray film and findings

__________________________________________________________________________________
_

__________________________________________________________________________________
_
(2 marks)

1
2
3

Erect film
Well centralized patient
Air under both copulae of diaphragm

Pneumoperito
neum

QUESTION 6

What is the next step for management of this patient?

__________________________________________________________________________________

__________________________________________________________________________________
(2 marks)

Exploration laparotomy

QUESTION 7

Mention FOUR steps to prepare this patient for surgery.

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________
(2
marks)

12345-

Naso gastric tube aspiration

Correct Fluids
Correct Electrolytes
Cross matching for blood
Coagulation profile

MEQ 1

Part III (15 minutes)

Mr Chong is a 45-years-old Chinese male who was brought to the

hospital with a sudden severe epigastric pain with abdominal
distension, vomiting.
He has a history of recurrent attacks of epigastric pain which was
aggrevated by food intake and relieved by ante acid drugs.
Patient has a peptic ulcer since two years. Examination showed rapid
pulse and low blood pressure. Abdomen was tnder all over and rigid
with no bowel sounds.
Abdominal X-ray showed gas under diaphragm

Patient was taken to the operation theatre after preparation,

laparotomy was done and showed perforated anterior gastric ulcer.

QUESTION 8

What is the management of this condition?

__________________________________________________________________________________
_

__________________________________________________________________________________
_
(2 marks)

1-Closure with omental patch

2- or definitive treatment by vagotomy and drainage or partial gastric
resection
and anastomosis to jejunum

QUESTION 9

What are the possible complications of surgery? Mention THREE

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________
(3 marks)

1234-

Re-perforation
Abscess (Sub-diaphragmatic)
Upper GIT Fistula
Post gastrectomy syndromes

QUESTION 10

What are the post operative medications should be given?

marks)

(2

__________________________________________________________________________________
_

__________________________________________________________________________________
_

1- Peptic ulcer regime ( Metronidazole, antibiotic, proton pump

inhibitors)
2- Antibiotics
3- Pain control

4- Avoid food and give IV feeding for a week

MEQ 1

Part 4 (15 minutes)

Mr Chong is a 45-years-old Chinese male who was brought to the

hospital with a sudden severe epigastric pain with abdominal
distension, vomiting.
He has a history of recurrent attacks of epigastric pain which was
aggrevated by food intake and relieved by ante acid drugs.
Patient has a peptic ulcer since two years. Examination showed rapid
pulse and low blood pressure. Abdomen was tnder all over and rigid
with no bowel sounds.
Abdominal X-ray showed gas under diaphragm
Patient was taken to the operation theatre after preparation,
laparotomy was done and showed perforated anterior gastric ulcer.

Closure of the ulcer with omental patch was done and patient was done
and patient was discharged but one week later he came back with right
tender huge hypochondrial swelling. Ultra sound showed an abscess
under diaphragm.

1- How can you manage the case?

marks)
_______________________________________________________________________

(2

_______________________________________________________________________

2- What is the sequlae of this abscess?

marks)

(2

_______________________________________________________________________

_______________________________________________________________________

3- How are you going to manage this sequalae

marks)

(3

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

MEQ
Part 1 (10 minutes)

Madam T, a 38 year-old single lady, noted a palpable mass in her right

breast 3 weeks previously which warranted her to seek medical opinion.

Question:

1.

List FIVE (5) points that you would ask the patient in the history.
(5 marks)

....

loss of weight, appetite

history of menarche and menstrual cycle
Number of children
lactation history
History of OCP intake
Family history of underlying breast Ca.
Nipple discharge
difficulty in breathing
History of fever

Question:

2. List FIVE (5) other clinical signs that could assist you in making
the diagnosis?
(5 marks)

..

General examination;

pallor, cyanosis, cachexia

Upper limb: lymphoedema
Lungs: Dullness to percussion over the costal angle suggest pleural
effusion
Bone: tenderness
Liver: enlargement
Palpable axillary lymph nodes
o Ipsilateral and contralateral sites
o single / multiple nodules

Local examination;

Features of the lump (size, shape, surface, mobility, consistency, number,

transillumination)
peau d orange sign

Retracted nipple
Discharge from the nipple

MEQ

Part 2 (8 minutes)

Madam T, a 38 year-old single lady, noted a palpable mass in her right

breast 3 weeks previously which warranted her to seek medical opinion.

On examination, there is a 4 x 4 cm hard mass with tethering of the skin of the

right breast associated with mobile enlarged right axillary lymph nodes.

3.
Mention THREE (3) possible causes for the breast lump in this
patient.
(3 marks)
.

.
i.
ii.
iii.
iv.
v.
vi.

Breast carcinoma
Tuberculous mass
Sarcoids
Traumatic fat necrosis
Actinomycosis
Chronic breast abscess

Matric No: __________________

4.

Outline FIVE (5) investigations you would do for this patient and
state the findings that you would expect from each investigation?
(5

marks)

No.

Investigation

Findings

No.
Investigation
1. Blood:
HB, TWDC,
Liver
Lung
2. mammography

Findings

1.
2.
3.
4.
5.

Answer

3. Ultrasound of the lump

4. FNAC
5. Chest x-ray

Spiculated mass with architectural

distortion microcalcification
Mass lesion which has either well
demarcated edges or indistinct outline
solid or cystic lesion
rib secondaries,
pleural effusion
lung secondaries

Part 3 (12 minutes)

Madam T, a 38 year-old single lady, noted a palpable mass in her right

breast 3 weeks previously which warranted her to seek medical opinion.

On examination, there is a 4 x 4 cm hard mass with tethering of the skin of the

right breast associated with mobile enlarged right axillary lymph nodes.
The chest X-Ray and ultrasound of the abdomen were normal. Tru-cut
biopsy confirmed infiltrative intra ductal carcinoma.

5.

Describe with the aid of an anatomical diagram, the lymphatic

drainage of the breast.
(6 marks)

To include;
The anterior, medial, central, posterior, apical, lateral, internal thoracic
nodes, infradiaphragmatic and supraclavicular nodes

Matric No: __________________

6.
What is the stage of this tumour?
(1 mark)


Answer
T2N1M0

7.
Outline the definitive management plan for this patient.
marks)

(3

..

Breaking news of malignancy and counseling

Mastectomy
Adjuvant: Radiotherapy / Chemotherapy/ Hormonal

8.
Outline the assessment methods for the surveillance of her left
breast in the future.
(2
marks)

..

..

..

Assessment of the symptoms and signs

Breast self examination regularly
Periodic and regular follow-up with the surgical or oncology clinic
Yearly mammogram

MEQ
Part 1 (10 minutes)

Mrs. KM, a 60-year-old lady presented with vomiting out blood and
passing out tarry black stool for more than 2 days and was admitted
to the surgical ward.
She also mentioned to the doctor that she has
been having upper abdominal discomfort and joint pains for a year of
which she has seen a doctor and is on regular follow-up.

Question 1

Mention FIVE (5) questions that you would ask in the history to suggest
the
possible
causes
of
his
problem:
(5 marks)

1.
2.
3.
4.
5.

____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

Matric No: __________________

LOA /LOW
Symptoms of anaemia
Past Medical history: Past history of Peptic Ulcer Disease and its
symptoms
And having Blood dyscrasia, Blood group A

Drug history: NSAIDS and steroids

Social history: Alcohol intake, smoking
Diet history: spicy food

On examination, she was found to be a medium-sized lady, lying supine on the

bed. She was pale with an intravenous drip on her left forearm.

Question 2

List FIVE (5) findings that you would expect in the general physical
examination of
this
patient:
(2.5 marks)
1.
2.
3.
4.

____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
5. ____________________________________________________________________

i.
ii.
iii.
iv.
v.
vi.
vii.
viii.

pulse: Weak/thready volume and tachycardia from the

BP: Hypotensive
RR: tachycardic
Pallor
Jaundice
hydrational status, skin turgor
Signs of heart failure: crepts in the lungs, pedal oedema etc
Body Weight

Matric No: __________________

Question 3:

List FIVE (5) findings you would look for to assist in making the
differential diagnoses:
(2.5 marks)
1.
2.
3.
4.

____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
5. ____________________________________________________________________

Guidefor examiner: DDx:

vii.
viii.
ix.
x.
xi.
xii.
xiii.

Peptic ulcer disease

Oesophageal varices
Erosive gastritis secondary to the NSAID (non steroidal antiinflammatory tablets)
Gastric carcinoma
Blood dyscrasia
Mallory Weiss syndrome
Deulafoys lesion
Stigmata of chronic liver disease
o clubbing, palmar erythema, spider naevi, gynaecomastia, testicular
atrophy)
Abdominal exam:
o mass on deep palpation at the Epigastrium or Left Hypochondrium
o Signs of portal hypertension such as ascites, hepatomegaly and
caput medusae
Palpable supraclavicular lymph nodes
Signs of inflammation in both knee joints
Malaenic stool upon per rectal examination

MEQ
Part 2 (10 minutes)

Mrs. KM, a 60-year-old lady presented with vomiting out blood and
passing out tarry black stool for more than 2 days and was admitted
to the surgical ward.
She also mentioned to the doctor that she has
been having upper abdominal discomfort and joint pains for a year of
which she has seen a doctor and is on regular follow-up.

Following physical examination performed, a provisional

upper gastro-intestinal bleed was made.

diagnosis of

Question 1

List FIVE (5) possible causes of bleeding in this patient:

(5 marks)

1.

____________________________________________________________________

2.

____________________________________________________________________

3.

____________________________________________________________________

4.

____________________________________________________________________
5. ____________________________________________________________________

Matric No: __________________

i.
ii.
iii.
iv.
v.
vi.
vii.

Gastritis / Peptic ulcer disease

Oesophageal varices
Erosive gastritis secondary to the NSAID (non steroidal antiinflammatory tablets)
Gastric carcinoma
Blood dyscrasia
Mallory Weiss syndrome
Deulafoys lesion

Question 2

List FIVE (5) investigations you would do in the management of this

patient and state the
findings that you would expect from each investigation that you have
performed.
(2.5 marks)

No.

Investigation

Findings

1.

2.

3.

4.

5.

No
.

Investigation

Findings

1.

Haematological
investigation

Low haemoglobin (anaemia)

Low haematocrit count ( Low PCV)
High urea

2
3.

Bleeding profile
Oesophagoscope
(including taking
biopsy)
Erect plain abdominal
x-ray
Ultrasound ABDOMEN
Barium swallow and
meal
CT scan Abdomen

Raised PT and PTT level

OGDS findings such as oesophageal
varices, erosive gastritis, ulcers and
abnormal masses, & take biopsy
Gas under the diaphragm

4.
5.
6.
7.
8

Radioisotope RBC tag

masses arising from THE VISCUS

Abnormalities in the oesophagus and
gastric mucosa
Further delineation of the abdominal
viscus
Localized hot spot at the site of bleeding
Matric No: __________________

Question 3

With the aid of a diagram, describe the anatomy of the

gastric junction,

oesophago-

stomach, duodenum including the blood supply and lymphatic drainage

of these organs.
(2.5 marks)

To include;

Oesophagus
Left gastric vein (portal)
Accessory hemiazygos vein (systemic)
The cardio-oesophageal junction
Stomach
Pylorus
Duodenum
Arterial supply
Venous drainage
lymphatics

Part 3 (10 minutes)

Mrs. KM, a 60-year-old lady presented with vomiting out blood and
passing out tarry black stool for more than 2 days and was admitted
to the surgical ward.
She also mentioned to the doctor that she has
been having upper abdominal discomfort and joint pains for a year of
which she has seen a doctor and is on regular follow-up.

Following physical examination performed, a provisional diagnosis of

upper gastro-intestinal
bleed
was
made.
Subsequently
investigations revealed
Very Low haemoglobin (anaemia
and
oesophagogastroduodenoscopes revealed an actively oozing duodenal
ulcer.

Question 1:

Describe the pathogenesis of gastric ulcer, duodenal ulcer and

bleeding peptic ulcer:
(4 marks)

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Matric No: __________________

Mismatch of the production of acid in the stomach

Decreasing integrity of the duodenal mucosa
Formation of either the gastric or duodenal ulcer (the bleeding ulcer is
usually on the posterior surface of the duodenal bulb)
Development of the bleeding area when the mucosal wall is breached,
ulcer penetrates, the gastroduadenal artery is exposed and eroded
Punctate erosion over the ulcerative region

Question 2:

Outline the plan of management (general and specific) for this patient:
(6 marks)

General:

Admit patient to the ward; put in large bore cannula and start analgesics
and oxygen
Resuscitation: with intravenous fluid, blood and blood products
If indicated.
rest the gut: nasogastric tube to decompress gut, assess bleeding and to
commence cold water lavage if indicated
Specific:

Minimally invasive procedures such as OGDS and use of

electrocautery, sclerosant or Adrenaline to stop local bleeding points
and to take biopsy if indicated

To start definitive intervention such as Medical management once

the diagnosis of peptic ulcer is made; Anti H2 antagonist, Proton pump
inhibitor, triple therapy for helocobacter pylori infection

If scope and adrenaline injection failed to control the bleeding

peptic ulcer, take consent for laparotomy and subsequent definitive
surgical intervention such as Emergency laparotomy, pyloroplasty,
underrunning of the affected vessels and classically the Billroth
procedure or highly selective vagotomy.

The specimen was excised from a 60 year-old lady who came to the
hospital with a complaint of a neck swelling for the past one year and
normal vital signs.

Question:

1.

List FOUR (4) investigations to diagnose this condition prior to surgery.

____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
(
4 marks)
Answer:

2.

Serum T3/T4/TSH
FNAC
USG
CT neck

Describe the specimen (Pot A).

____________________________________________________________________

____________________________________________________________________
(2 marks)
Answer:

Thyroid gland
Multinodular mass
Matric No: __________________

3.

Describe the histopathological findings (in Picture B).

_____________________________________________________________________

_____________________________________________________________________
(2
marks)
Answer:

4.

Columnar cells lining the follicle

minimal colloid

List TWO (2) differential diagnoses.

_____________________________________________________________________

_____________________________________________________________________
(2
marks)

Answer

MNG
Ca thyroid

OSCE 2

A 20 year-old Mat Rempit came

casualty with the problems shown
He
was
given
immediate

1.

to
the
in the picture.
treatment.

Name the instrument in the set.

____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
(
4 marks)
Answer:

Needle holder
Forceps
Kidney dish
Gallipots

Matric No: __________________

2.

Name solutions used to clean the wound?

__________________________________________________________________
__________________________________________________________________
(
2 marks)
Answer:

NS
Povidone iodine

3.

What immediate treatment would you institute for this patient?

__________________________________________________________________
__________________________________________________________________
(
2 marks)
Answer:

4.

ATT
T&S
Analgesics

This patient came back one week after being discharged from the hospital
with purulent discharge from the wound. Name ONE (1) common causative
organism and its treatment.

__________________________________________________________________

__________________________________________________________________
(
2 marks)

Staphylococcus aureus
Dressing with antiseptics such as povidone iodine, acriflavine and
administration of antibiotic, Cloxacillin

OSCE 3

Mr F, a 55-year old presented to the hospital with a history of long

standing on and off pain in right hypochondrium, referred to his back.
Examination showed a large palpable mass in right hypochondrium and
an ill defined mass left to the epigastrium.

1.

List FOUR (4) other important points in the history you would elicit from
this patient.
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
(
4 marks)
Answer:

Loss of appetite / LOW

Pruritus
Tea coloured urine
Pale stool

Bleeding tendencies
Drugs intake
Alcohol ingestion
Drug abuse

Matric No: __________________

2.

Name important FOUR (4) laboratory investigations you would perform for
this patient.
__________________________________________________________________
__________________________________________________________________
(
2 marks)

serum bilirubin
serum alkaline phosphatase
serum amylase
Coagulation profile tests
Serum globulin titres
Autoantibodies
Tumour markers

3.

What other FOUR (4) diagnostic investigations needed?

__________________________________________________________________
__________________________________________________________________
(
2 marks)

Ultrasound hepato-biliary
CT scan
Endoscopic ultrasound
ERCP
MRI cholangiopancreatography
Liver biopsy , Pancreatic biopsy

4.

What are the differential diagnoses?

__________________________________________________________________
__________________________________________________________________
(
2 marks)

Choledocholithiasis
CholangioCa
Ca Head of pancreas
Malignant LNS in porta hepatic
Peri ampullary carcinoma

OSCE 4

A 42-year-old man presented with a short history of upper abdominal

pain which radiates to his right shoulder associated with vomiting and
shortness of breath. The surgeon wishes to perform a surgery.

Past medical history

On examination

Peptic ulcer disease

Sweaty, cyanosed
Temperature 39.5 C
Heart rate 140 Sinus Rhythm
Blood Pressure 90/45 mmHg
Respiratory rate 25/minute
Reduced air entry at the right base with
bronchial breathing
Presence of hard board rigidity of the abdomen

Investigations

Hb

6 g/dl
14 x 109/L

WBC

380x 109/L

Platelet

Na

149 mmol/L

4.5 mmol/L

Urea

11 mmol/L

Creatinine

124 mmol/L

Blood gas on 40% Oxygen

pH

7.28

pCO2 31 mmHg
pO2

63 mmHg

HCO3 19 mmol/L
BE

-5 mmol/L

LFT is normal

Matric No: __________________

1.

List the significant findings in the clinical examination.

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
(
4 marks)
Answer:
pyrexic

hypotensive
tachycardia
tachypnoeic

2.

Interpret the laboratory results.

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
(
4 marks)
anaemia
sepsis: elevated WBC,
dehydration: elevated urea, creatinine
hypoxia
metabolic acidosis

3.

This patient was started on intravenous fluid regimen as shown.

State TWO (2) disadvantages of the fluid.

(a)

____________________________________________________ (1 mark)

(b)

____________________________________________________ (1 mark)

HARTMANS SOLUTION
Large sodium and water load (1:3@1:4)
Potential for over infusion, pulmonary oedema, subsequent ARDS.
Minimal effect on intravascular volume (duration in circulation is very
short (20 minutes).
No oxygen carrying capacity.

OSCE 5

A 60 year old man complained of loss of weight and appetite for the
past four months with altered bowel habits. Initial investigations
revealed a hemoglobin level of 7.2 g/dL. The investigation shown in the
picture was carried out.

1.

Name the investigation.

__________________________________________________________________
(
1 mark)
Answer:
Double contrast barium enema

2.

Describe the findings.

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
(3
marks)
Answer:
Irregular narrowing / stricture or apple-core appearance (1 mark)
at the transverse colon (1 mark)
OR

filling defect at mid transverse colon in keeping with mass lesion

Matric No: __________________

3.

List THREE (3) contraindications for the above procedure.

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
(3
marks)
Answers:
Toxic megacolon
Complete intestinal obstruction
Bowel perforations
Recent rectal biopsy
Pseudomembranous colitis
No bowel preparation
Recent barium meal

4.

What is your diagnosis?

__________________________________________________________________
(1
mark)

Answers:
Carcinoma of colon

5.
List TWO (2) other investigations/procedure needed to confirm the
diagnosis.

__________________________________________________________________
__________________________________________________________________
(2
marks)
Answers:
Colonoscopy and biopsy
CT abdomen

OSCE 1

Mr CKL a 62-year-old Chinese gentleman, underwent resection of his

left colon. The specimen is shown in Picture A, while Picture B shows
the histopathology.

1.
Describe the macroscopic and microscopic appearance of the lesion in
Picture A and
Picture B respectively

a
b

Macroscopic :
Microscopic:.

(2marks)

Answers:

Ulcerated lesion with heaped up edges

Gland have lost its polarity, appaer disorganized and adhere to each
other
Epithelial cells tightly packet, hyperchromatic with hich nucleus to
cytoplasm ratio
Tumour invades deeply into colonic mucosa

List
two
(1marks)

predisposing

factors

for

this

disease

a
b

Answers:

Familial polyposis coli

Chronic ulcerative colitis

List four (4) questions you would ask the patient in the history (2marks)
a
b
c
d

..
..
..
.

Answers:

Dietary history
Family history of colon Ca
Altered bowel habits
Blood mixed with stools
Symptoms of anaemia
Symptoms of obstruction

What investigations would Mr CKL have undergone to confirm the

diagnosis prior to surgery
(3marks)
a
b
c

..
..
..

Answers

Rigid or flexible sigmoidoscopy

Double contrast barium enema
Colonoscopy

List two other investigations with reasons that should be done for Mr CKL
a
b

..
..

(2marks)

Answers

USG abdomen-metastasis to liver and lymph nodes

CXR -Metastasis
CT/MRI Metastasis to liver and LN

List 3 preoperative preparation that would have been undertaken for Mr

CKL

(3marks)
a..
b..
c..

Answers

Mechanical bowel preparation

Counselling for stomas and complication
Correction of anaemia and electrolyte disturbance
DVT prophylactic
Insertion of catheter
Prophylatic antibiotics

OSCE 2
Mr KBM has problems with his left leg for several years as seen in Picture A. He
has just undergone surgery 2 months ago which the result was shown in Picture
B.

(Picture A)

(Picture B)

1. Describe the findings in Picture A

(2 marks)

Answers:

Tortousity and dilatation of the superficial vein of the (left) leg

The mass is compressible to digital pressure

2. List 2 (TWO) symptoms that you would like to elicit from the patient (2marks)
Answers:

Dragging pain on walking and long standing (due to

thrombophlebitis)
Lump in the leg; Tortousity and dilatation of the superficial vein
Eczema gives rise to itching

3. Name 2 examinations that you will perform for this patient

Answers:

Trendelenburg test
[Explanation]

(2marks)

To distinguish patients with superficial venous reflux from those with

incompetent deep venous valves
Elevate the leg until the congested superficial veins have all collapsed. Direct
pressure is used to occlude a varicose vein just below the SFJ (Sapheno
Femoral Junction) or at another point of possible reflux from the deep system
into the superficial varicosity. The patient stands with the occlusion still in
place
If the distal varicosity remains empty or fills very slowly, the principal entry
point of high pressure into the superficial system has been identified.
Rapid filling despite manual occlusion of the possible high point of reflux
means that some other reflux pathway is involved.

Perthes manouvre
[Explanation]
To distinguish antegrade flow from retrograde flow in superficial varices.
a Penrose tourniquet is placed over the proximal part of the varicose leg in
such a way as to compress any superficial varicose veins while leaving deep
veins unaffected
The patient walks or performs toe-stands to activate the calf-muscle pump
This normally causes varicose veins to be emptied, but if deep system
obstruction exists, then activating the calf-muscle pump causes paradoxical
congestion of the superficial venous system and engorgement of varicose
veins.
Antegrade flow in a variceal system indicates that the system is a bypass
pathway around a deep venous obstruction

4. List 4 (Four) complications that can occur in this condition

marks)

(2

Answer:

Bleeding from rupture of a varix

Ulceration
Thrombophlebitis
Lipodermatosclerosis
5. Name 2 specific investigations for this problem?
marks)
Answer:

(2

Duplex ultrasound
Contrast venography
MRI / MRV (Magnetic Resonance Imaging on vein / MR Venography)
OSCE 3

[item: chest XR]

Mrs TSA, 45-year-old lady complained of epigastric pain on and off for several
years. She was brought to A & E Department yesterday. This investigation was
done immediately.

1. What imaging modality is this?

mark)

(1

Answer: Plain Chest X-ray / Plain chest radiograph

2. Describe the abnormality found in the picture shown.

mark)

(1

Answer: There is free air under both the hemidiaphragms

3. What are the symptoms (two) do you expect in this patient?

marks)
a) ________________________

b) ________________________

Answer:
a. Sudden onset of severe abdominal pain; aggravated by
coughing or straining

(2

b. Nature of the pain is dull and is associated with loss of

appetite, nausea,
vomiting and the feeling of lassitude.

4. What are the physical signs of this patient ?

a). General

(2 marks)

1. _______________________

2. _______________________

b) Abdomen

(2 marks)

1. _______________________

2. ________________________

Answers;

General
Patient is in severe distress and is lying very quietly
Breathing is shallow to minimize abdominal movement
Patient might lie down with his knees drawn up to

minimize
intraabdominal pressure

Abdomen
There is a board-like rigidity of the a

bdomen

The dullness over the liver space is tympanitic

Reduced or absent bowel sound

5. List 4 causes for this problem.

marks)

1.
2.
3.
4.

(2

________________________
________________________
_________________________
_________________________

Answers:

Perforated gastric/duodenal ulcer

Perforated ileum
Perforated gall bladder
Perforation of colonic diverticulum

OSCE 4

[item: Radivac and Drainage bag]

Question 3.

1. What is the medical devices shown on this table?

1. ________________________

(2 marks)

2. ________________________

Answers;

a. Vacuum/Redivac tube
b.

Drainage bag

2. What are the uses of these devices?

marks)
1. ______________________
2. ______________________

(2

Answers;
a.
promote healing

drain out the residual blood or blood product to

b. as a mean to check whether haemostasis of the

cut/incised/excised area is intact or not

How do you determine whether the instrument is functioning;

(2 marks)

Answers:
a. the rabbit ear/lateral projection is activated (bag under
vacuum)
b. the effluent in the tube is still flowing continuously to the
drainage bag
What are the complications that may arise from using these devices? (2 marks)
3. ______________________
4. ______________________
Answers:
the patient

a.

Introducing infection from the environment to

b. Migration of the tube to the surrounding area

c. Iatrogenically could cause bleeding over the blood
vessels of surgical area and damage the nearby
nerve
3. Name TWO operation in which this instrument is used;
marks)
Answer:

a. Thyroidectomy
b

Mastectomy

Gastrectomy

Resection of colon

e
almost all surgical operation where there is no
susceptible sensitive
structures such as the brain, bleeding vessels and
nerves

(2

OSCE 5

This is a Pulse Oxymeter

You are on-call in the surgical ward. The staff nurse in-charge called you
to see a patient who has had an emergency surgery the night before,
with the above device attached to him.

1. Interpret the findings shown above and give the name of the condition
(a) _______________________________________________________________
(b) _______________________________________________________________
(2 marks)

Answers;

A. low SaO2 (and tachycardia)

B. Hypoxia / Hypoxemia
2. List THREE causes of post operative oxygen desaturation?
(a) _______________________________________________________________
(b) _______________________________________________________________
(c) _______________________________________________________________
(3marks)

Answers;

C. Airway obstruction/ bronchospasm

D. Preexisting lung disease
E. Impaired gas exchange due to reduce FRC, increased shunt and
increased V/Q mismatch
F. Abolition of hypoxic pulmonary vasoconstriction by anaesthetic
agents
G. Diffusion hypoxia
H. Impaired ventilatory response
I. Residual muscle paralysis
J. Myocardial depression
K. Inadequate replacement of blood loss
L. Wound pain/ supine position/ restrictive bandaging, reducing
alveolar ventilation
3. Outline THREE principles in managing the patient?
(a) _______________________________________________________________
_______________________________________________________________
(b) _______________________________________________________________
_______________________________________________________________
(c) _______________________________________________________________
_______________________________________________________________
(5 marks)

M. Airway
Ensure the airway is patent

N. Breathing
Observes the respiratory pattern and auscultate the chest.
Clear the oropharynx of secretions
Optimize the airway by chin lift/jaw thrust/head tilt menoeuvres
Use an oropharyngeal or nasopharyngeal airway if required
Oxygen therapy via face mask should continue throughout the
recovery period
O. Circulation
Ensure that blood loss has been adequately replaced and the
patient is haemodynamically stable( Oxygen carrying capacity)
P. Drug
Assess level of residual neuromuscular blockade. If significant,
this may necessitate continuation of mechanical ventilation until
muscle relaxant wears off, or further doses of reversal agent.
Hypoventilation
from opioid-induced central
respiratory
depression may treated with Naloxone
Q. Other
Relieve mechanical factors that cause hypoventilation
Nurse the patient in the recovery position to minimize the risk of
aspiration.
Post-operative chest physiotherapy will help improve lung
volume
OSCE

50 years old Malay man was admitted from A & E department after
complaining for recent 3 days. He was operated for irreducible inguinal
hernia. This picture was taken during surgery.

Q1.
Describe the abnormality in this picture.
mark)

(1

Q2.
Mention in a chronological manner the complications of inguinal hernia.(2
marks)
Q3.

Describe causes (Underlying risk factors) of inguinal hernias.

(2.5 marks)

Q4.

Describe the preoperative clinical picture in this patient.

(2 marks)

Q5.

Mention THREE investigations, and cause of selection.

(1.5 marks)

Q6.
How can we manage this patient?
mark)

(1

OSCE 2

35 years old military Malay man was seen in the clinic with this picture
in the right lower limb.

Q1.

Describe the abnormality in this picture.

marks)

(2

Q2.
What are the possible symptoms in this case? Mention FOUR
marks)

(2

Q3.
How can you examine this patient?
marks)

(3

a)

Mention FOUR diagnostic investigations.

marks)

(2

_________________________________________________________________

b)

How can you treat this condition?

mark)

OSCE 3

(1

Mr Hashim (A) is a 35 years old Malay male who was presented to

surgery clinic with this swelling. He used to have pain on taking any
sour food. This investigation (B) was done for him.
Q1.
Describe the abnormality in the figure A, and in the figure B.
marks)

(2

Q2.
Mention possible THREE causes of this abnormality.
marks)

(3

Q3.
Mention TWO differential diagnoses.
marks)

(2

Q4.
Describe FOUR diagnostic investigations.
marks)

(2

________________________________________________________________________

Q5.

What is the treatment?

(1 mark)

OSCE 4
Q1.

Describe the instrument.

(2 marks)

________________________________________________________________________

Q2.

What are the uses?

Q3.
Describe the technique of having a biopsy.
marks)

(2 marks)
(2

Q4.
Mention TWO complications.
marks)

(2

Q5.
What are the precautions for parotid tumour biopsy?
marks)

(2

OSCE 5

56-years-old female was presented with left breast two lumps.

This investigation was done. She has a family history of breast

cancer,
and hysterectomy for cervical cancer.
She felt swellings in both breasts.
This
investigation was done for the left breast.
Q1.

What is the name of this investigation?

Q2.
What are the positive findings? Mention THREE.
marks)

(1 mark))

(3

Q3.
What is the other investigations required for this patient? Mention threeand significance of each.
(3 marks)

Q4.
How can complete examination of this patient?
marks)

(2

Q5.
What is the line of treatment in this case?
mark)

(1

OSCE 1st rotation

1. Normal Saline
- Name 1 of the substance in the solution and what is its concentration
- What is the indication to give the solution to a patient
- What is the complication of given solution to a patient
- How many kcal?
2. Nasogastric tube
- Name the equipment
- Indication of the equipment
3. Chest Xray (air under diaphragm)
- Identify the xray (not sure but maybe diorg tanya like erect or supine,
chest xray or abdominal xray)
- Identify the abnormality in the chest xray
- Give 1 example of patient that have the same findings with the
abnormality in the xray given
4. Active station (Inserting branula)
- Demonstrate the branula insertion and give comments as you go along
with the procedure
5. Active station (Per Rectal Examination)
- Basically, active station ni based on demonstration but questions
totally depends on examiners
- Example of questions from Prof G.
a) Position of the patient? Other than left lateral side?
b) Indication
c) Contraindication
d) Details of the steps- inspect, insert, take out, inspect once more