SURGERY END POSTING EXAM

YEAR 5 BATCH 3: GROUP 2

MCQ
1. Regarding consent
TRUE A. Must explain diagnosis
TRUE B. Must explain other successful treatment options
TRUE C. Side effects of 1 % or less should be explained.
TRUE D. Consent can be taken by junior doctor in surgical department.
TRUE E. Must explain the procedure of choose surgery

2. Regarding urinary tract infection (UTI)

TRUE A. More common in female
TRUE B. E.coli common cause
FALSE C. In female due to bladder stone
TRUE D. Prostatitis due to retrograde infection
TRUE E. Pyelonephritis gives positive renal punch

3. Bladder cancer
TRUE A. Bladder cancer cause is aniline dye
FALSE B. Happens in young adults
FALSE C. Squamous cell carcinoma most common The most common type is transitional cell carcinoma
TRUE D. Intermittent haematuria common
TRUE E. Intravesical Bacillus Calmette–Guerin (BCG) in early CA

4. Regarding wound healing after surgery

TRUE A. Slower healing in diabetic patients
TRUE B. Slower healing in children than adults Wounds in children normally heal faster than in adults
TRUE C. Shave 2 days before to decrease likelihood of SSI
FALSE D. Prophylactic antibiotics given 1 day prior to surgery Prophylactic antibiotics should be initiated
within one hour before surgical incision,
E. Anti-tetanus is not needed in 30 years old man who has completed his immunisation during childhood
9. Varicose vein
FALSE A. Pain when walking Walking can help treat varicose veins and spider veins
TRUE B. Perforators carry blood flow from deep to superficial
TRUE D. Trendelenburg test for saphenous-femoral junction incompetence
E. Secondary varicose vein best treated surgically

SINGLE BASED ANSWER (SBA)

11. 52 y/o male, MVA Resuscitate with 2 ltrs, BP 73/52 mmhg, 123 pulse
Multiple laceration at face. Ecchymosis left lower chest & abdomen
Chest clear, mild tender abdomen
A. Ascites
B. Bladder Rupture
C. Descending Aorta Tear
D. Splenic Rupture
E. Bowel perforated

12. Patient with inhalational injury, erythema and blisters on oropharynx and 2nd n 3rd degree burn of 15%.
Carboxyhaemoglobin level of 20%. What’s your immediate management?
A. Fluid restriction
B. Endotracheal intubation
C. High dose corticosteroid
D. Acetylcysteine

13. Male 53 years old 30 years smoking history, post op day 2, tachypneic after cholecystectomy due to biliary
pancreatitis spO2 90%
A. Aspiration
B. Bronchial oedema and bronchospasm
C. Pulmonary atelectasis due to impaired secretion/ shallow breathing
D. Ventilator-associated pneumonia
17. 55 years old patient with leg pain after walking 100m. Also associated with rest pain. Popliteal and pedal
not palpable. Good femoral pulse.
A. Common iliac obstruction
B. Internal iliac stenosis
C. Posterior popliteal obstruction
D. Profunda femoral stenosis
E. Superficial femoral artery obstruction

18: A 54 years old male with 12 years history of GERD. Previous GI endoscopy 10 years ago revealed mild
Barret oesophagus and since then was started on PPI. Recent follow up he started having dysphagia to solid
foods. What is most probable diagnosis?
A. Squamous cell carcinoma of oesophagus.
B. Esophageal stricture.
C. Adenocarcinoma of oesophagus.
MEQ
40 years old lady presented with breast lump.

1. 10 risk factors of malignancy.

2. What are the early assessment for this patient?

She has moderate risk factor. Examination revealed mobile ipsilateral axillary node. Mammography revealed
3.6 cm mass on the breast.
3. What is your next step?
Fine needle aspiration cytology
4. Laboratory, imaging investigations, indications of bone scan?
5. Clinical staging of this patient?
Biopsy revealed differentiated Invasive ductal carcinoma (IDC)
6. What are tumour receptors?
7. Significance of tumour receptors?

8. Features of metastatic lymph node in ultrasound

Normal aspect on ultrasound
A normal sized lymph node is less than 10 mm with a thin cortex of less than 3 mm. A normal node has an
oval shape. Its cortex is thin and of uniform thickness. The cortex is hypoechoic. The contours are well
delineated. The hilum, consisting mostly of fat, is wide .The hilar fat is usually hyperechoic but can also take
on a non-suspicious hypoechoic aspect. Doppler analysis shows vascularization in the hilum exclusively.

Cortical abnormalities include a focal or diffuse thickening of > 3 mm, the presence of focal bulges and a
peripheral vascularization with the color Doppler.
Late morphological abnormalities due to metastatic lymph node infiltration. After infiltrating the cortex, the
tumor invades the lymph node hilum. Diffuse tumoral infiltration cause loss of normal oval shape and lymph
node takes a round shape. Finally, the tumor invades the perinodal fat, making the contours of the node blurry.
9. She has DM and on Metformin OD. How do we manage?
10. Definitive treatment.
There are two main types of local treatments for IDC: surgery and radiation therapy.
Systemic treatments for IDC include:
 chemotherapy
 hormonal therapy
 targeted therapies

Feedback from Prof. Walid

Regarding OSCEs:
1- 1st OSCE: was on a case of small intestinal obstruction due to obstructed umbilical hernia
Although the scenario was very suggestive, all symptoms started suddenly after a cough, you did not
spot the umbilical hernia on the CT which was very clearly visible.

Some students are unfortunately still unable to distinguish SB from LB on plain abdo. X-ray.
You need to improve on this by looking at textbooks pictures and some radiology demonstration, there
are thousands online. You just need the motivation to look.
I am happy with your management plan, this compensated well on your final scores .

2- The 2nd OSCE, was on a victim of stab wound of the abdomen.

You need to be accurate with descriptive abilities
When the case on male patient do not say ovary and Fallopian tubes can be injured in female, OSCE
is usually about the given case, not a theory question.
Many organs can be injured from this location such as (Ileum, Caecum, appendix, lower pole of kidney,
full bladder, ureter, iliac vessels) there is no need to mention ovary or uterus in female.

Your management outline was satisfactory, but remember to cover the exposed loop in sterile moist
dressing or a plastic sheet. Antibiotics are essential here.
Since the question says isolated injury, it means that no other regions injured although I consider it
right to follow standard systemic approach.

FAST is an adjunct investigation in blunt trauma cases but not usually for penetrating trauma where
laparotomy or laparoscopy is clearly indicated.

3. The 3rd OSCE was on a case of ulcerated rectal carcinoma

Majority of you did very well with this question, and you impressed me.