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AMC RECALL PAPERS: SURGERY

2005
Snake bite: A middle-aged man is brought to your surgery with a history of being bitten by a black snake. On examination there are scratch marks on the lower leg and no other symptoms. What is your management? a) Reassure and send him home b) Excise wound c) Administer antivenin immediately d) Apply Tourniquet e) Observation and antivenom if necessary Ans: e. Apply bandage immediately on the bite site firmly but not very firmly, extend 15 cm above (JM p.1345). Trauma: Photograph 3: X-ray showing an open fracture of the fibula & tibia. A young man, after an accident on his motorcycle, presented with 3 cm of bone protruding through the skin of his leg. What is your next line of management? a) Internal fixation of the fracture immediately b) Skin closure of the wound immediately to prevent infection c) Reduce the fracture and apply plaster of paris d) Give tetanus toxoid IM & antibiotics iv e) Debridement is only indicated when the wound is severely contaminated Ans: D. But debridement is to be done.

2|Page Guide for tetanus prophylaxis: JM p.1385 Endocrinology: Photograph 5: Shows the head & neck of a female. There is a large swelling at the center of the neck and no exophthalmos of the eyes. What is the most likely diagnosis? *** a) Multinodular goiter b) Ca thyroid c) Sub acute thyroiditis d) Thyroid cyst e) Graves disease Ans: Large diffuse non tender swelling: 1. Graves disease 2. Hashimotos thyroiditis (Dj p.133). Graves ds and Sud acute thyroiditis (transient phase) can present with hyperthyroidism. Multinodualr Goitre: Benign Thyroid nodules (Tjendra p.294).

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Skin: Photograph 6: Shows a red hemispherical lesion on the back of a hand. Some brownish/necrotic tissue present at the border of the lesion, no visible punctum. What is the diagnosis?

a) Malignant Skin Lesion b) Inflamed keratoacanthoma c) Infected lipoma d) Lichen planus e) Solar Keratosis Ans: E. Solar keratosis has potential has malignant change (JM p.1206). Ortho: Photograph 7: X-ray showing Colles fracture. An elderly person sustained a fall on an outstretched hand. What is true? a) Median nerve function should be assessed

3|Page b) The plaster cast is not suitable to correct the fracture in the elderly c) Immediate internal fixation d) Plaster cast from below elbow to MCP joint, for at least 10 weeks Ans: E. JM p.1399. Rh: Photograph 8: showing a deformed hand (swan neck deformity). Which of the following is true? a) It is due to erosion & rupture of the flexor tendons b) It is more common in rheumatoid arthritis than oseoarthritis c) It is due to Ulner nerve compression Ans: B Skin: Photograph 9: A young child with a patch of hair loss on the scalp. Some small flakes of skin are present. What is your diagnosis? a) Tinea b) Psoriasis c) Alopecia areata d) Trichotillomania e) SLE Ans: Tinea capitis JM p.1231, look 1230 for Trichotillomania. Skin: Photograph 10: A man came with his wife. A slow growing soft large lump on his back in between the scapulae remains in that position for last 10 years. WOF is your MX a) Observation and reassurance b) Opinion from specialist c) Radiotherapy Ans: A.

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4|Page Lipoma/dermoid / sebaceous cyst.

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Ortho: A man is suffering from back pain, so he is sleeping on a hard wooden bed for last three weeks. Now he complains of pain in his right elbow. WOF is the cause of the pain in elbowa) Olecranon bursitis b) Injury to the insertion of flexor muscles c) Injury to the insertion of extensor muscles Ans: Olecranon Bursistis (JM p.685). Ethics: During an operation spleen was accidentally injured and splenectomy was done to minimize the complications. Next morning the patient asked you about the success & progress of that operation. As an intern you will tell him---a) Everything has gone smoothly b) Your spleen has been removed c) During the operation procedure complication aroused and to minimize further complication it was necessary to remove your spleen. d) Only the surgeon could tell you about your operation. Ans: D. Trauma: A young man injured in a road traffic accident (RTA) has fractures of three ribs anteriorly on the left and a minimal left pneumothorax. Peritoneal lavage is positive for blood, and laparotomy is planned for intraperitoeal hemorrhage. The most important step prior to laparotomy is a) Insertion of a naso-gastric tube. b) Insertion of intercostals drainage tube c) Determination of PaO2 and PaCO2 d) Insertion of a central venous pressure line on the right side. e) Delay surgery until BP comes to normal Ans: D. Abdominal bleeding may cause hemorrhagic shock thus CVP

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CVS: After an operation for aortic aneurysm/aortography, there is uncontrollable bleeding from the site of the grafting. WOF is best to transfusea) Fresh blood b) Desmopressin c) Fresh frozen plasma d) Cryosipitate e) Factor VIII Ans: A. Fresh blood.

CVS: A man came to you complaining of pain in the leg. O/E you could not find pulse in his leg. You clinically become sure that there is atherosclerasis or atheroma in the peripheral artery. This is due to a) Stenosis of femoral artery b) Thrombosis of Femoral artery c) Polyarteritis nodosa(PAN) d) Rupture aneurysm

Ans: b.

CVS: A 42-years old man complaint of pain in his right hand. He tells you that the previous day he used a chainsaw for long hours to cut trees. O/E you found his right arm is slightly swollen than other arm, and there is pain too. WOF is most appropriate investigation--*** a) Venogram b) Lymphanogram (Dx: Raynauds phenomenon; due to use of vibratory tools) c) CT Scan d) MRI e) Arteriogram Ans: Arteriogram is only indicated in before surgery.

6|Page AA p.445

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GUT: Regarding unilateral undescended testis, which of the following is most commonly associated? *** a) Malignancy b) Varicocele c) Ingiunal hernia(Indirect) d) Hydrocele e) Torsion of the testis f) Direct Ingunal hernia Ans: Indirect inguinal hernia 80 to 90% Sterility Pain Torsion Epididymo orchitis Malignancy 5times risk increased.

GIT: A 64-years old man presents with profuse bright red bleeding per rectum. What is the most likely cause? *** a) Ca colon b) Polyp c) Diverticulosis d) Duodenal ulcer e) Haemorrhoids Ans: C. JM p.362

A 50-year old man presents with sudden onset of severe abdominal pain. Which of the following is least likely to be the cause?

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a) Acute appendicitis b) Perforated peptic ulcer c) Acute pancreatitis d) Ruptured abdominal aortic aneurysm e) Renal colic Ans: A. JM p.321

Malignancy: Which of the following disseminated malignancies has the worst prognosis? *** a) Metastatic breast cancer b) Metastatic choriocarcinoma c) Metastatic seminoma d) Hodgkins lymphoma e) Non-Hodgkins lymphoma Ans: E. No reference

Breast: Which of the following is the most common cause of bloody discharge from the nipple? a) Intraductal carcinoma b) Intraductal papilloma c) Pagets disease of the braest d) Fibroadenoma e) Duct ectasia Ans: A.

12. Hutchinsons melanotic freckle. Which of the following is not correct? a) Mostly occurs in the elderly b) Mainly occurs in covered parts of the body c) Malignant

8|Page d) Irregular border e) Irregular colour (from black to brown) Ans: B. JM p.1220.

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Ulcer: A diabetic patient with an ulcer at the head of the 2nd metatarsal on the sole of the foot, which of the following would be the most likely cause? a) Macrovasclar disease b) Diabetic neuropathy c) Infection d) Varicose venis e) Hyperglycaemia Ans: B. Harrison p.2168 GIT: A 60-year old man presents with 3 days vomiting and loss of weight (3 kg.). Six years ago he was treated with Cimetidine. Over the last 3 months he has had epigastric pain intermittently, for which he takes aspirin. Vomitus is clear in colour with identifiable food particles. The likely diagnosis is? a) Drug induced gastritis b) Chronic duodenal ulcer disease c) Ca pancreas d) Cancer of the cardia of the stomach e) Pyloric stenosis Ans: E. GOO: Bailey p.1048.

GIT: The most common cause of diarrhoea in bedridden elderly patients is?

9|Page a) Ca colon b) Crohns disease c) Ulserative colitis d) Diverticulosis e) Faecal impaction Ans: E. Spurious diarrhoea (JM p.)

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Breast: A female had mastalgia for the last 1 year. Conservative treatment has not worked. How would you manage this patient? a) Bromocriptine b) Danazole c) Clomiphene d) OCP e) NSAIDs Ans: Danazol JM p.969

CVS: With fat embolism, petechiae are most to be seen where? a) All over the body b) Pressure dependent areas c) Subungual d) Upper part of the body e) Lower body Ans: D. Maheshwari p.34 GIT: A 65-year old woman develops acute abdominal pain with distension. There is a history of 12 hours of vomiting and cramping pain. On examination, irregular pulse 120/min, BP-

10 | P a g e 100/60 mmHg, abdomen is tender with guarding and bowel sounds are absent. Rectal examination reveals a dark bloodstone on the finger. Which of the following is most likely? a) Perforated peptic ulcer b) Messenteric arterial occlusion c) Diverticulosis d) Perforated appendicitis e) Ca colon Ans: B. Atrial fibrillation. Trauma: A 21-year old man presents with increasing dysponea, tachypnoea a hyperinflated left hemithorax with evidence of a mediastinal shift. Your immediate management would be? a) Insert a water sealed chest drain b) Intubate c) Insert a venflon into 4th intercostals space midaxillary line d) Insert a wide bore needle into the 2nd intercostals space, midclavicular line Ans: D.

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ENT: Which of the following is most likely to be associated with otosclerosis? a) Normal tympanic membrane b) Red & inflamed tympanic membrane c) Tense & transparent tympanic membrane with fluid level behind d) Blue gray sclera e) Obstruction of the Eustachian tube Ans: A.

ENT: Which of the following is true regarding carcinoma of the nasopharynx?

11 | P a g e a) Arises from the lymphatics b) Not sensitive to radiotherapy c) Responds well to chemotherapy d) Caused by EBV e) Locally destructive lesion Ans: D.

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All are seen in ischaemia of the leg, except? a) Claudication b) Pallor c) Pain on walking d) Shooting pain down the posterior aspect of the thigh Ans: D.

Malignancy: Which of the following is least likely to cause metastasis to the brain? a) Prostate cancer b) Melanoma c) Small cell carcinoma of the lung d) Breast cancer e) Renal carcinoma

Ans: prostate.

GIT: Which of the following is not a feature of uncomplicated haemorrhoids? a) Bright red bleeding b) Prolapse of mucosa c) Purities d) Pain e) Mucous

12 | P a g e Ans: Pain Ortho: Which of the following nerves would be damaged in a mid-humerus fracture? a) Axillary nerve b) Radial nerve c) Musculocutaneous nerve d) Ulner nerve e) Median nerve Ans: radial nerve.

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GIT: A female complaints of bloating & belching. She is found to have gallstones, which is subsequently treated by cholecystectomy. Cholangiogram was done during the operation and was clear (nothing was found). She was symptom free for 1 week, but then the same symptoms returned. What is the most likely? *** a) Pancreatities b) Cystic duct stump syndrome c) Stone left in the common bile duct d) Symptoms are not related to the gallstones e) Post cholecystectomy syndrome Ans:

All are true about gallstones, except? a) Usually asymptomatic b) Stone in the bile duct presents with clinical sepsis c) Ususally radiolucent d) Ans: http://emedicine.medscape.com/article/175667-overview
Bailey p.1109.

Breast:

13 | P a g e Which of the following is true regarding mammography? a) More sensitive in premenoposal than postmanuposal women b) Painless c) Most useful in woman with a palpable breast lump d) It has a better pick up rate than self examination e) Can differentiate between a solid & cystic tumour Ans: GIT: All of the following would be expected after splenectomy for spherocytosis, except? *** a) Transient leucocytis b) Persistence of anaemia c) Same osmotic fragility d) Persistence of spherocytosis e) Normal life span of the erythrocytes Ans: E.

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Ortho: What is the most important aspect in managemant of an open fracture? a) Antibiotics b) Intenal fixation c) Debridement d) Tetanus toxoid e) Immobilisation Ans: Debridement.

GIT: A 35-years-old woman having severe sudden abdominal pain throughout the night wakes up and passes dark urine in the bathroom. She immediately goes to see the doctor. Investigations showed: - bilirubin 5 times normal - Alkaline phosphatase 3 times normal - AST & ALT 4 times normal - S.amylase 2 times normal What is the most likely diagnosis?

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a) Acute cholelithiasis b) Acute cholecystitis c) Ca gallbladder d) Acute choledocholithiasis e) Ans: D. GIT: What is true about fistulas? a) It is a communicating track between 2 epithelial surfaces b) It is lined by granulation tissue c) It is a blind track leading from the surface down to the tissue d) A kind of ulcer e) ? Ans: a.

Pain: What is true regarding pain management? a) Pethidine is best given by calculating mg/kg body weight b) Pethdine is better than morphine c) Pethidine should not be repeated within 4 hours d) Older patients require less, because they tolerate pain better e) ? Ans: C. Potential accumulation of norpethidine limits its utility for repeated dosing (KDT p.459).

Trauma: You are performing external cardiac massage on a patient who has just suffered a cardiac. Which of the following provides best indication that resuscitation is effective? a) ECG

15 | P a g e b) Palpation of the radial pulse c) Color of skin & mucous membranes d) Size & reaction of the pupils e) Response to stimuli Ans: D. Radial: 80mmHg, Femoral: 70mmHg, Carotid: 60mmHg. JMp.1352

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Breast: All of the following are risk factors for breast cancer, except? a) Early artificial menopause b) First pregnancy after 35 years of age c) Early menarche d) No breast feeding e) Cancer of the other breast f) age - peak incidence 45-75 years but any age postmenarche >> 4x g) country of residence - high in West > 4x e.g. UK, low in East e.g. Japan h) previous breast cancer > 4x i) irradiation of chest - shows a linear dose-response relationship 2-4x j) social class (I vs. V) 2-4x k) race - more common in Caucasians < 2x l) previous ovarian or endometrial cancer < 2x m) early menarche or late menopause < 2x n) nulliparity or older than 30 years before first child < 2x o) hormonal supplementation < 2x p) obesity - oestrogen synthesis in adipose tissue q) alcohol consumption In the male, Klinefelter's syndrome is a risk factor for breast cancer. Ans: a. CNS: A 32-years old man felt pain in the maxillary area at night, which radiates to the side of his head. There was water inside his nostrils during the attack. WOF is your diagnosisa) Migraine

16 | P a g e b) Cluster headache for female Hemicrnia.... c) Maxillary sinusitis Ans: b. Ortho: A 35-years old female came with complaints of wake up during the night with pain in her right hand & a shooting pain up the arm. She has difficulty using her right hand when carrying a shopping bag. Examination shows slight thenar wasting. What is your diagnosis? a) Brachial neuritis b) Thoracic outlet obstruction c) Cervical spondylosis d) Carpal tunnel syndrome e) Cervical rib Ans: CTS JMp. 678, p.685.

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GIT: A man presents with history of an inguino-scrotal swelling, which disappears on lying down. What is the most probable diagnosis? a) Hydrocele b) Saphena varix c) Femoral hernia d) Varicocele e) Direct inguinal hernia Ans: B. A saphena varix is a dilatation at the top of the long saphenous vein due to valvular incompetence. It may reach the size of a golf ball or larger. The varix is:

* soft and compressible * disappears immediately on lying down * exhibits an expansile cough impulse

17 | P a g e * demonstrates a fluid thrill

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GUT: A 25 years old man is awakened during night very severe pain in his right loin. He notices bright blood in his urine. Next morning he comes to you- you found him a febrile and plain X ray shows calcium oxalate stone in his bladder. WOF you will advice -a) Not to take calcium containing food b) Avoid red meat c) Avoid all kind of drinks, tea, coffee Ans: c. Bailey 1321 Burns: Most common cause of death in severe burns, in Australia is? a) Irreversible shock b) Septicaemia c) Respiratory failure due to respiratory tract burns d) Unable to maintain positive nitrogen balance Ans: b.

GIT: All of the following cause acute pancreatitis, except-a) Alcohol ( Note: Dr. SusanGET SMASHED) b) Mumps virus infection 1. gall stones c) Diabetes Mellitus 2.ethanol d) Gall stone 3.trauma e) Pancreatic islet cell tumour 4.steroids 5.mumps 7.autoimmune 8.scorpion venom 9.hyperlipidaemia 10.ERCP 11.DM/drugs: azathioprine,pentamdine Ans: e. Preop:

18 | P a g e When is the best time to administer prophylactic antibiotics? a) 1 day before operation b) 1 hour before operation c) At the time of incision d) After the infection Ans: b. GIT: A female pt. Complaints of fullness fat indigestion after fatly meals. In an ultrasound stones seen in gallbladder, but there is no sepsis. After surgery no stone left in the gall bladder and free of symptoms for few weeks, then symptoms recur. What is the explanation-*** a) Pancreatitis after cholecystitis b) Stone was left in CBD c) It is a result of removal of gall bladder-Fat indigestion d) Gall stones were not her symptoms e) Cystic duct stump syndrome f) Recurrence of stone formation after cholecyctectomy Ans: D. There is no sepsis: No choledocholithiasis.

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GIT: A middle aged female complaints of morning diarrhoea and cramps. On examination there are no remarkable findings. Which is the most likely diagnosis? a) Irritable bowel disease b) Ca Colon c) Crohns disease d) Ulcerative colitis Ans: A. 45.A patient came with weakness in extension of hand and pronation. On examination there is no wasting of hand muscles. Flexion normal, Biceps & Triceps reflexes also normal. No Brachioradialis jerk. Where is the lesion?

19 | P a g e a) Median nerve b) Radial nerve c) Ulner nerve d) Nerve to Posterior interoseus e) Nerve to Anterior interoseus Ans: d. Maheshwari p.53

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1. A couple came to your GP surgery to know about the mode of inheritance/number of incidence of cystic fibrosis in the population. Your answer will be a) 1 in 2 b) 1 in 4- mode of inheritance c) 1 in 25 d) 1 in 100 e) 1 in 2500- number of incidence Ans: e.

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2006
Picture: Dark discolouration on the side of the nose. After excision report shows it as a Nodular malignant malanoma.WOF is next Mx- (Antho-397 picture on the Sole) a.Observe b.Do nothing c. Wider local excision d. Radiotherapy e. Excision

Picture: A child with rash on the buttocks and legs .Both ankles swollen and tender, also abdominal pain, but no fever. No neck stiffness.WOF is most common major complication(Dx:HS purpura ;AMC-286) a.Nephritis Picture: One X-ray and one Mammogram of Breast (Anthology-104). Dx: a.Breast Cyst 4.Photo:Lipoma on the neck of a man.H/O soft swelling present for last 3 yrs, never had any trouble for that swelling.But now he came to you for your opinion.WOF you will doa.Reassure, nothing need to do ( Anthology-399) b.Refer for specialist opinion c.FNAC Picture: X-ray chest of a 8 months old infant with opacity in Rt lower zone and pneumatoceles(Staph. Pneumonia). Rx- (AMC: Fig-119) I/V Flucloxacillin Picture: Eye and dilated pupil.Man came to you with h/o pain in the eye, also has headache and vomiting. Mxa.Tropical Acetazolamide b.Patch the eye to look for FB cAtropine eye drops d. Topical Pilocarpine Picture: A growth in the palm;developed over 2 weeks in a manual labour.Dx-

21 | P a g e Pyogenic granuloma (Anthology-398) Picture: A man came with a soft swelling in groin for last 2 years.It is soft, slowly growing over inguinal ligament & lateral to pubic tubercle.WOF is your Dxa. Lipoma b. Inguinal Hernia (May-2005) c. Femoral Hernia

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Picture: X-ray chest of a 9 months old infant as shown in AMC book(page-119). What is the Dx? Staph. Pneumonia( But most common in this age group is Streptococcus pneumonia) 11.Photo: CT Scan. A lady complains that she feels her left side of body she feels heavy. She also has paralysis & weakness of left side. WOF is your Dxa. Cerebral Tumour b. Cerebral Haemorrhage c. Cerebral Infarction d. SAH

A pt. present with ptosis of left eye, left side sensory loss of face. Left side gag reflex was absent, Rt. Sided hemiparesis and incoordination of Rt. Upper and lower limb.Where is the lesion? a.Middle Cerebral Artery b.Internal Carotid Artery c. Vertebral Artery d. Multiple Sclerosis e.Post. Cerebral Artery Apparent shortening due to severe osteoarthritis of the hip is due to: a.Fixed adduction b.Fixed flexion c.Degeneration of head of femur Median nerve injury above the wrist.WOF is trueparalysis of abductor pollicis brevis with inability to abduct the thumb (LOAF)

In pt. with pancreatitis for purpose of statistical studies ,AOF are useful EXCEPTa.Case control b.Cohort c.Case report/case study(one study)

22 | P a g e d.Double blind study e.Systemic review

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WOF is a feature of Parkinsonisma..Loss of postural reflex b.Hyperreflexia c.Hypotonia d Wide based gait. WOF is not a feature of Lacunar Infarct? a.Fascicultion b.Spasticity c.Face weakness(sensory loss of face) d.Difficulty in walking e.Increase Reflexes

Tennis elbow,cause isOverstretch of the common extensor tendons origin at elbow A pt. complains of severe pain on pressing on nail of thumb.WOF is most likely the causea.Fibrosarcoma b.Osteosarcoma c.Glomus tumour GIT: On 10th day after appendectomy apatient presents with diarrhoea with fever and difficulty in passing urine, what is the most likely cause? Pelvic abscess

GIT: After screening with faecal blood test WOF is the correct percentage of detection of Duke A1 colonic carcinoma: Scott-323 a.<3% b.15% ( Duke A-tumour confined to bowel wall-survival 90%) c.25% d.50% e.75%

23 | P a g e 40.WOF is a feature of Thyrotoxicosis? a.Fine tremor b. Distal myopathy c.Small muscle weakness.

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GIT: After screening with faecal blood test WOF is the correct percentage of detection of Duke A1 colonic carcinoma: Scott-323 a.<3% b.15% ( Duke A-tumour confined to bowel wall-survival 90%) c.25% d.50% e.75%

WOF is a feature of Thyrotoxicosis? a.Fine tremor b. Distal myopathy c.Small muscle weakness. A 62 yr old man presents with tiredness ,weight loss,anemia and fatigability. What is the Ix you will do first? a.Barium meal Oct.92 b.Sigmoidoscopy c.Colonoscopy d.Fecal occult blood test

A patient has hammered his nail and came to you with Subungual haematoma under his nail.WOF is your Mxa.Oral Trebinafine b.Oral Griseoflvin OHCS-738 c.Remove the nail d.Expressing the blood through a hole trephined in the nail

A 43 yr old man came to your surgery as he is worried about his chances of getting of colon cancer.He told you that his father and elder brother had died of colon cancer. What you will advice him? a.Sigmoidoscopy b.Colonoscopy

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Supra condylar fracture of Humerus:structure most likely to be damageda.Radial nerve b.Brachial artery c.Median nerve GIT: A 33 yr old man came in ER with H/O 3 days vomiting followed by mid abdominal pain.O/E abdomen is rigid, distended absent bowel sound on auscultation.Plain X-ray shows multiple air fluid level.WOF is the appropriate fluid therapy for the patient: a.2000ml of dextrose in 4.5% NaCl preoperatively b.2000 ml of Hartmanns solution preoperatively c.2000ml of Hartmanns solution during the operation What is true about SCOLIOSIS ? Congenital and more common among girls than boys .

A 22 yr old football player during a game fell down in awkward position, and developed pain and rapidly increasing swelling of the knee. Anterior, posterior and lateral X-rays are normal.WOF injuries you expect to finda.Tear of Medial Meniscus b.Rupture of Anterior Cruciate Ligament Leg ulcer due to peripheral neuropathy commonly located ina.Medial malleolus b.Sole of the foot A patient came with weakness in extension of hand and of pronation.O/E there is no wasting of hand muscles. Flexion normal, Biceps and Triceps reflexes also normal,No Brachioradialis jerk.Where is the lesion? a.Median nerve July-2005 b.Radial nerve c.Ulner nerve d.Nerve to Postrior Interoseus e.Nerve to Anterior Interoseus

What is the priority in a Motor Vehicle Accident(MVA): a.Stop bleeding b. Clear the airway @ A-B-C

25 | P a g e c.Shine a torch in the pupils

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Function of Adductor Pollicis is lost.Which nerve is affected? a. Median nerve b. Radial nerve c. Ulner nerve

Patient with ileal resection causing increased INR.WOF is correcta.Non absorption of Vit. K (Normal INR 0.9-1.2) b.Bleeding disorder

A patient with INR 2.1: An old man is on Warfarin and now he is discovered with a resectable colon cancer.Management: Stop Warfarin and start low dose Heparin; operate when INR is normal

WOF doesnt produce keratotic scale? a. Basal cell carcinoma b.Squamous cell carcinoma c.Pityriasis versicolor d.Keratoacanthoma e.Psoriasis

Hutchisons Melanotic Freckle,WOF is not correct? a.Mainly occurs in the covered parts of body b.Irregular border c.Malignant d.Mostly occurs in the elderly

Q. on Submandibular Gland:Still to be recalled

A man presents with sudden onset of Horners syndrome, 9 & 10 nerves palsy and loss of touch and temperarure sensation on the opposite side of the body.Where is the site of lesion? a.Vertebrobasilar artery b.Basilar artery c.middle cerebral artery

26 | P a g e d.Vertebral artery e.Carotid artery GIT: A lady undergone surgery for gallstones.She developed fever and tachycardia after 6 hrs.Oral Cholangiogram was done; findindings were normal.Dxa.Atelectesis b.Wound infection c.Allergy to dye

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A 63 yr old man presents with 3 days vomiting and has lost 3 kilos.Five years ago he was treated with cimetidine.Over the last two months he has epigastric pain and has been treated with aspirin.Vomitus is clear in colour with identifiable food paticles.The Dx is: a.Drug induced gastritis b.Chronic duodenal ulcer c.Cancer of duodenum d.Pyloric stenosis e.Cancer of cardia A 45 yr old lady complains of irregular menstrual bleeding.She has been treated for CIN-II previously and a Pap smear done 6 months ago was fond normal.WOF is the most appropriate investigation for her? a.Colposcopy Repeat: March06 b.USG to detect endometrial thickness c.Cone biopsy (see the difference: Q-40/oct04) d.Endometrial curettage e.Repeat Papsmear

A labourer who is a heavy smoker find difficult to perform his duties and worried about his physical conditions.On examination there is ankle oedema, raised JVP, huge hepatosplenomegaly and ascitisWOF is likely- (May05) a.Cirrhosis b.Costrictive pericarditis due to previous tuberculosis c.SVC obstruction d.Budd Chiari Syndrome

A foot ball player while playing got injury in his Rt.Knee.The knee is locked.Dx: [Outline of fractures-224:Locking is common & important Tear of Medial Meniscus feature of torn medial meniscus.Knee suddenly gives way]

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A 57 yr old lady develops sudden onset of left sided weakness and right eye blindness.This is most likely due toa.Vertebro-basilar insufficy b.Pituitary tumour c.Carotid artery stenosis d.Cerebellar lesion e.Retinal detachment

Pleural Effusion: Typical presention.Stony dull on percussions,bronchial breath sound above the area, restricted movements on the affected side. A patient presents with impaired sensation on medial aspect of the hand, 4th and 5th fingers of the hand are flexed.Where is the lesion? Ulner nerve at elbow

GIT: A pt. was on warfarin, he developed haematemesis and melena.His INR is 10 times normal.WOF should be the management? (Sept.05) a.Fresh plasma infusion b.I/V Fluids c. Oral Vit-K d.Transfuse blood e.Intra muscular Vit-K

GIT: Pain in epigastrium which does not releifs by eating or any effort.Has no relation with food.DxHiatus hernia

Question on Basal cell carcinoma

Rx of ADHD: Dexa amphetamine

Management of Supracodyler # of Humerus(Anthology book)

28 | P a g e A boxer comes to the ED after a fight in which he was knocked out.His left pupil is dilated, but otherwise he is normal and he feels ok.WOF would you doa.Give Manitol b.CT Scan of head A man presents with pain over the L4 region.His X-ray shows multiple metastatic lesions in the spine.WOF investigations is most appropriate: a. Prostate specific antigen b. CT Scan c. MRI

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A 12 yr old boy presented with painless lump in the scrotum for the last 6 months.He is otherwise healthy grown up.What is the most likely Dx? a.Hernia b.Seminoma c.Encysted hydrocelc of the cord d.Saphena varix e.Haematocele

A mother of a 4 yr old child noticed that there is a solid mass in the Rt. Loin area of her child which she noticed for the first time with occasional blood in urine.WOF is your initial Dx: OHCS-220 a.Neuroblastoma Wilms tumour:Commonest intraabdominal tumour of b.Wilms tumour childhood.Haematuria not common,but fever,flank pain c c.Hydronephrosis abdominal mass found. US-pelvicdisortion,hydronephrosis d.Plycystic kidney disease .

Two months old childs mother noticed a firm lump in her baby in the left side of upper abdomen while bathing.Child has bilateral periorbital ecchymosis.what is the most likely cause? a.Neuroblastoma May-2000 b.Wilms tumour Mother of a 3 year old child noticed a mass in the abdomen on the left side.AOF could be the cause,excepta.Hydronephrosis October96 b.Neuroblastoma c.Nephroblastoma(Wilms tumour) d.Poly cystic kidneys(Die before 1 year of age )

29 | P a g e e.Chr. constipation

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An 8 yr old girl presents with abdominal protusion,anaemia and tenderness.O/E there is a big irregular and mobile mass crossing the midline.DxNeuroblastoma Derived from sympathetic neuroblasts,most common solid tumour in children<5yr.Likely to present with abdominal swelling and urinary catecholamines (vanillylmandelic& homovanillic acids) raised in 92% cases.

Hypospadias: incidence of 1:350 male birth.

All are autosomal recessive , Excepta.Neurofibroblastoma b.Phenylketonuria c.Galactossemia d.Cystic fibrosis e.Sickle cell anaemia

A 23 yr old man limped into ED and stated that he was kicked in the post. Aspect of the leg during a game of foot ball.He experienced immediate sharp pain which subsided.O/E there is decreased planter flexion.What is the DxRupture of achillis tendon

Peritonsilar abscess(Quinsy): Caused by Streptococcus& Trismus seen.

Zygomatic bone (maxillo facial) fractures characterized bya. Involvement of infraorbital nerve b. Subconjuctival hge. with no definitive posterior limit c. Loss of senstion over canine & first premolars d. Partial trismus e. All of the above

WOF is most likely to be damaged during carotid endarterectomy: a .Vagus nerve b.Hypoglossal nerve NMS-132 c.Facial nerve ( 1.vagus 2.hypoglossal 3.Recurrent laryngeal 4.Marginal mandibular) d.Laryngeal nerv

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2007
Ortho: A piicture of Dupuytren contracture. Cause: A. Use of chronic vibrating tools B. Chronic alcoholism

ans: B. Maheshwari p.255 Hereditary predisposition Cirrhosis Anti epileptic drugs: Phenytoin and phenobarbitone.

Picture of Bowen disease from Anthology. Dx?

GIT: Picture of perianal haematoma. Mn?

Ans: Incision and drainage. Ortho: A boy came with fever and pain in the right leg. He hardly moves the leg and does not allow you to move it either. He refuses to carry weight on that leg. What could be the dx? A. Septic arthritis of hip B. OM of femur C. D. E. could be excluded easily

31 | P a g e Ans: A

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What will be the first S/S when a plaster is too tight? A. Pain B. Change of colour C. Swelling D. Stiffness Ans: Pain Ortho: Which nerve regenerates most after taumatic laceration? A. ulnar n. B. Median n. C. Digital n. D. sciatic n E. Common peroneal n.

Ans: Ulner.

GIT: A patient came with 12 hr H/O severe vomiting. Pain in upper abdomen which is now constant in the epigastrium. There is rigity and guarding in the abdomen. Dx? A. ac. pancreatitis B. Perforated DU C. perforated GU Ans: Anterior duodenal ulcer more likely to perforate. GIT:

32 | P a g e A pt came with an ill defined mass in the RIF and loose watery stools. He has fever and has lost 6 kgs of weight recently. Dx? A. Crohn disease B. Meckel diverticulitis C. UC D. Ca large gut Ans: A. Dj p.41 Git: Most common S/S assoc. with ca rectum? Rectal bleeding (Bailey p.1233). GIT: A patient came with a pus discharging bead at 5 o'clock position at the anal verge. on probing there was a track discovered which extended in the rectum for 15 cm. (these were the exact words). DX? A. Crohn dis B. Ankylostomiasis C. Ca rectum D. Haemorrhoids Ans: a.

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GCS: A patient opens his eyes to pain, withdraws to painful stimulus ans is unable to answer any questions. What is his GCS? A. 7-9 B. 10-12 C. 3-5 C. 13-15 Ortho:

33 | P a g e Pic of anterior dislocation of shoulder. Where will be the cutaneous anaesthesia? On the lateral aspect of deltoid (I think the one who was the least serious about the exam, could even manage to get this one pinned.)

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GIT: What is the lymphatic drainage of anal canal below dentate line? A. Sup. ing. nodes B. deep ing. nodes Ans: A. A typical CXR of lobar consolidation. What is the org? A. strep pneumoniae

Burns: Another old authentic typical ques.: A burn patient with soot in the throat and singening of nasal hair etc etc. Mn? Ans: intubate CNS: A man came with ipsilateral horner's syn., cerebellar S/S, dissociated sensory loss. (I could diagnose the case as having lateral medullary syndrome). which artery is involved? A. Ant communicating artery B. Post. cerebral artery C. Post inf. cerebellar artery d. ant. spinal artery Ans: PICA CNS: What is the mechanism of TIA when there is carotid stenosis?

34 | P a g e A. Embolim from the artery B, transient spasmodic occlusion of the artery C. Transient hge following increase in carotid artery pressure ans: A.

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CHEST: Another repeated ques. (and confusing as well!!): Which org does not cause lung abscess" A. Staph aureus B. P. carinii C. M. pneuminiae D. M. TB Ans: C Ortho: A man fell from height and was complaining low back pain. No other abnormality. What is the inv you do? A. X ray spine B. MRI spine C. CT spine D. Nothing needed Ans: A.

GIT: Most commomn cause of intestinal obstruction in Australian community? (I think this was the only ques I found from the AMCQ book that everybody reads so intently!!) Ans: Adhesion GIT: A child came with pain and redness and swelling of one eye. He had fever and was (probably) vomiting. i could diagnosis it as orbital cellulitis. Mn? A. Ceftriaxon IV

35 | P a g e B. Ampi + Genta IV C. Cefurixime + metro Ans: A. RHP p.264 Endo: An incidentaloma was found on one of the adrenals which measured 5 mm. What do you do? A. ignore B. ask to come 6 wk later c. ask to come 6 months later Ans: Tjendra p.306 CNS: A picture of a man protruding his tongue. It showed wasting on the right side. What will be correct for this. A. Left sided lesion and tongue veers to left B. left lesion-tongue veers to right C. right lesion and tongue veers to right D. right lesion and tongue veers to left Ans: C. Hypoglossal nerve palsy.

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GIT: An x-ray of large gut showing obstruction. Cause? Trauma: When two rescuers available, what is true regarding CPR? A. 15:2 should be the compression rate B. response should be checked evey 2 min C. chest compression should be on mid chest D. There should be 2.5 cm chest compression each time. Ans: GIT: An infant was brought who was vomiting from birth. He was pale, dehydrated and not gainig weight. What is most likely to find? A. Lump B. Distension C. Anuria

37 | P a g e Ans: b.
Duodenal atresia is a disease of newborn infants. Cases of duodenal stenosis or perforated duodenal web (diaphragm) rarely remain undiagnosed until childhood or adulthood; these cases represent the exception rather than the rule. Duodenal atresia appears to be equally distributed between infants of both sexes, with no reported predilection for one race. The use of modern ultrasonography has allowed many infants with duodenal obstruction to be identified prenatally. In a large cohort study of 18 different congenital malformation registries from 11 European countries, 52% of infants with duodenal obstruction were identified in utero.5 Duodenal obstruction is characterized by a double-bubble sign on prenatal ultrasonography. The first bubble corresponds to the stomach and the second to the postpyloric and prestenotic dilated duodenal loop. Prenatal diagnosis allows the mother the opportunity to receive prenatal counseling and to consider delivery at or near a tertiary care facility that is able to care for infants with GI anomalies. 5,6 Presenting symptoms and signs are the result of high intestinal obstruction. Duodenal atresia is typically characterized by onset of vomiting within hours of birth. While vomitus is most often bilious, it may be nonbilious because 15% of defects occur proximal to the ampulla of Vater. Occasionally, infants with duodenal stenosis escape detection of an abnormality and proceed into childhood or, rarely, into adulthood before a partial obstruction is noted. Nevertheless, one should assume any child with bilious vomiting has a proximal GI obstruction until proven otherwise, and further workup should be begun expeditiously. Once delivered, an infant with duodenal atresia typically has a scaphoid abdomen. One may occasionally note epigastric fullness from dilation of the stomach and proximal duodenum. Passing meconium within the first 24 hours of life is not usually altered. Dehydration, weight loss, and electrolyte imbalance soon follow unless fluid and electrolyte losses are adequately replaced. If intravenous (IV) hydration is not begun, a hypokalemic/hypochloremic metabolic alkalosis with paradoxical aciduria develops, as with other high GI obstruction. An orogastric (OG) tube in an infant with suspected duodenal obstruction typically yields a significant amount of bile-stained fluid.

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HEAD and Neck: A patient with parotid carcinoma will have which of the following a.drooping of lower eyelid b.drooping of the angle of mouth c ? d? Ans: b.

CNS: A picture of a man with the tongue deviated to right. The question was which side is the lesion and to which side is the tongue deviated. Ans: Rt side.

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CNS: A man with difficulty in extending the wrist and fingers. All other movement and sensations are normal. Reflexes normal. What is the lesion? 1. radial n 2. ulnar n 3. median n 4. posterior interroseous nerve Ans: 4.

GIT: Condition which typically produce profuse watery discharge per rectum to the level to produce electrolyte imbalance. a.colonic polyp b. pelvic abscess c.carcinoma. Ans: Villous Adenoma ( colonic Polyp). CNS: Coma scale

Ortho: A lady with history of pain and stiffness of joints for a few weeks. While playing golf she had sudden onset of pain and swelling in calf. What is the diagnosis a.ruptured popliteal bursa b.spontaneous haematoma c.achilles tendonitis Ans: Maheshwari p.275

RH:

39 | P a g e which is not a feature of temporal arthritis. a.amarosis fugax b.headache c.iritis d.shoulder muscle pain Ans: Iritis

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CVS: Cause of TIA in carotid stenosis? Ans: Embolism

CNS: Cause of amaurosis fugax a.temporal arteritis b.carotid stenosis c.infarct Ans: Carotid Stenosis. JM p.842

Ophthal: Picture. fundoscopy .which is the likely lesion

GUT: A child presented with undescended testis at 6 weeks. What will you do a.do an immediate orchidopexy b. wait till 4 years and then do orchidopexy c. encourage the mother to massage the inguinal region to milk down the testis and review after 2 months d. review after 6 months Ans: D.

40 | P a g e Wait till one year, if not descended by one year surgery.

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GUT: Undescended testis is most frequently associated with a.neoplasm b.inguinal hernia c.tortion Ans: 80% cases associated with inguinal hernia. Malignancy chances increase by 5 times. [10:28:28 PM] dr_gauravsuneja: An ectopic testis has deviated from the normal path of descent after it has emerged through the external inguinal ring.

In order of frequency, it may be found:

* in the superficial inguinal pouch which lies anterior to the external oblique aponeurosis * in the perineum * at the root of the penis * in the femoral canal

The ectopic testis cannot be pushed down into the scrotum. Unlike an incompletely descended testis, the ectopic one is usually well developed and histologically normal.

The main hazard is that it is liable to injury.

Treatment is by orchidopexy. [10:28:45 PM] dr_gauravsuneja: The undescended testis lies along the correct path of descent but outside the scrotum. It may be abdominal, inguinal or retractile.

41 | P a g e The incidence of testicular undescent is:

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* 20% in premature boys (100% in male neonates of 32 weeks gestation) * 2% in boys born at full term boys * 1% at l year

There is little evidence that testes descend spontaneously after the first year.

The right testis is affected alone in 50% of cases and the left alone in 30%. The condition is bilateral in 20%.

The scrotum is often underdeveloped and flattened. At operation, the testis often appears grossly abnormal. It is small and soft, and has a dissociated epididymis. It is accompanied by a hernial sac.

Absence of testicular tissue suggests intrauterine torsion or true testicular agenesis. If the latter is suspected, than an abdominal ultrasound should be performed to check for renal agenesis. [10:29:55 PM] dr_gauravsuneja: Complications include:

* infertility in bilateral undescent; no more common in unilateral cases * associated indirect inguinal or interstitial hernia * increased risk of malignancy, particularly seminomas in the late second or third decade * increased risk of testicular torsion * increased risk of trauma to the testis * atrophy from recurrent trauma

42 | P a g e Infection: Picture of cellulites of leg. Treatment Ans: JMp. 722 Bed rest Elevate limb Pain control: paracetamol, aspirin, Wound cleansing and dressing Antibiotic: Flucloxaciliin 2gm 6hrly Penicillin sens: Cephalexin

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Infection: A man was treated for cellulites of leg with antibiotics. After few days he presented with hypotention and tachycardia. his leg was dusky in colour and crepitus was present.what is the immediate management. a.continue antibiotics b.wound debridement c.hyperbarric oxygen d.antitoxin Ans: b.

Picture of chronic venous ulcer. Management.

Immunization: A 4 year old child with lacerated wound after falling on garden bed. He has taken dtpa at 2 and 4 months. After that no vaccination was given. What will you do a.give antibiotics b.give immunoglobulins cgive dtpa and Ig d.dtpa and booster after 2 months e.give dtpa Ans: JM p.1385

43 | P a g e Ortho: Management of severe compound fracture of tibia and fibula. Ans: Wound debridement.

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RH: A woman with pain and stiffnes of metacarpophalangeal and pip joints. She has malar rash. What is the initial management a.NSAID b.steroids c.methotrexate Ans: Tor. Rh p.17.

RH: A patient with pain and swelling around the knee. Aspirated fluid (microscopy) contains neutrophils. No organisms or crystal found. Diagnosis? a. septic arthritis b. gout c.rheumatoid arthritis d? e? Ans: C. Septic arthritis: gram stain and culture positive (Tor p.Rh31, Tor p.Rh8).

Skin: Two darkish brown spots was found on the leg of a lady on examination. She did not notice any change in appearance of those spots for the past years. What is the diagnosis a.benign junctional naevi b.melanoma c.???spots d? Ans:

Head and Neck:

44 | P a g e A smoker with and indurated ulcer on the tongue. The ulcer margins are white. He has caries tooth. a.sq carcinoma of the tongue b syphilitic ulcer Ans: A.

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Rh: Typical presentation of reiters syn. Ans:

Drug: Which of the following drug combinations are contraindicated? Ans: Varapamil/diltiazem and B blockers: Heart block TCA and SSRIS NSAIDS, Diuertics, ACE inhibitors: Acute renal failure Clozapine and lithium: malignant Hyperthermia GIT: A patient with anal fistula. Internal opening in rectum and external opening at 5 oclock position.what is the most common underlying lesion a.crohns disease b.anal gland infection GIT: A patient given radiotherapy for ca cervix. Now presents with bloody diarrhea. a.proctitis b.rectovaginal fistula c.metastatic carcinoma Ans: Proctatits

GIT: Lower part of the anal canal drains into which lymph nodes a.superficial inguinal b.deep inguinal c.paraaortic

Ans: Superficial

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GIT: A patient presents with severe epigastric pain, vomiting and hypotention. a.pancreatitis b.cholecystitis c.perforated duodenal ulcer Ans: Pancreatitis, DU perforation: Gurding

GIT: Ultrasonography is best used for the diagnosis of which condition in a jaundiced patient. a.gall stones b dilated bileduct c.cholecystitis d.ca liver Ans; Gall stones

Breast: Treatment for mastalgia a.danasol b. progesterone c.ocp Ans: B. Jmp.969

Womens health: Which if the most important factor for osteoporosis in women a. menopause in 40 years b.BMI <20 C.? Ans: B. JM p.1015

Chest: Most common site of insertion of intercostals tube in pneumothorax Ans: 2nd intercostals place.

46 | P a g e GIT: Most important diagnostic feature of achalasia Ans: Both solid and liquid.

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GIT: The most common presenting feature of a patient with duodenal stricture secondary to duodenal ulcer. a.vomting one hour after each meal b.vomioting of large amounts 2-3 times a day c.? d? Ans: A Nausea and vomiting are the cardinal symptoms of GOO. Vomiting usually is described as nonbilious, and it characteristically contains undigested food particles. In the early stages of obstruction, vomiting may be intermittent and usually occurs within 1 hour of a meal.

CNS: Which of the following conditions doesnot cause neck stiffness a.meningitis b.pneumonia c.tetanus d.botulism e.SAH Neck stiffness often makes the investigator think of meningitis. However, it may also be caused by:

* subarachnoid haemorrhage * tetanus * upper lobe pneumonia * tender posterior cervical adenopathy * retropharyngeal abscess * rheumatoid arthritis Infection: PICTURE of an adult man. Center of the umbilicus is red. Erythema of the surrounding skin. A.omphalitis B.obstructed paraumbilical hernia c.necrotising faciitis d.herpes zoster e.?

47 | P a g e Ans: A. Epidemiology: A drug was introduced which decreased the fatality of the disease but doesnot bring about complete cure of the disease. This means a. incidence of the disease decrease. B.prevalence decrease incidence increase prevalence increase. Both increase. Ans: prevalence increase and incidence remains same.

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