General Surgery Past Papers by Dr Zeashan

New One

1. S u r g e ry P a s t Paper s D r Z e a s han A h m a d

2. Q : 1 A 50-year-old patient has been taking NSAIDs for knee arthritis. He presented in surgical emergency with sudden onset of severe upper abdominal pain. On examination pulse 120/min, BP 100/70, abdomen is tense & tender all over, bowel sounds are absent. a ) What are the two radiological investigations which are most likely to give you the diagnosis? Which one of the two is more accurate? b) Describe his early management in emergency ward. c) What is the significance of NSAID intake for arthritis in the patient? d) Is measurement of serum amylase indicated in this patient? Give reason for your answer. [Annual 2017]

3. Q : 2 40-year-old female presents with severe colicky pain in epigastrium radiating to right hypochondrium present for last 2 hours. There is associated retching and vomiting. She also gives history of similar episodic pain in past. On examination, abdomen is soft and non-tender. Her pulse is 86/min, BP is 130/80 mm Hg, temperature is normal. a) What is the most likely diagnosis? b) How would you manage this case? c) What investigations would you advise? [Supple 2010 held in 2011]

4. Q : 3 A 35-year-old female is presented in emergency room with severe epigastric localized pain, vomiting and abdominal distension. On examination, she is dehydrated with pulse 112/min & BP 90/70 mm Hg. RR is 35/min along with severe epigastric tenderness. Eight months back she was diagnosed to be suffering from multiple tiny gallstones. a) What is your most likely clinical diagnosis? b) What investigations you will advise in this patient? [Annual 2013 ]

5. Q : 4 A 65-year-old male presented with three months history of progressively worsening jaundice with dark colored urine and clay-colored stools. He has anorexia, weight loss of 10 kg over one month. Examination reveals deep jaundice and palpable gallbladder. a) What is your clinical diagnosis? b) What is the underlying pathology? c) How will you manage him? [Annual 2016]

6. Q : 5 A 56-year-old female has presented with bleeding per rectum for last 3 months. On proctoscopy she has a mass 2 cm in size, 5 cm from the anal verge. a) What is your suspected diagnosis? b) What further investigations will you advise? c) How will you stage the disease? [Annual 2019 ]

7. Q : 6 A 15-year-old male presented with pain in right iliac fossa for one day associated with nausea and anorexia. He has two episodes of vomiting. On examination, pulse is 90/min, BP is 120/80 mm Hg, temperature is 99 F and abdomen is tender. A diagnosis of acute appendicitis is made. During surgery, his vermiform appendix looked normal. a) What would be the cause of his clinical picture? b) How would you proceed in this patient on seeing a normal appendix? c) Name two commonly performed incisions for appendectomy. d) What complications can occur in the incision made for appendectomy? [ A n n u a l 2 1 4 ]

8. Q : 7 A 25-year-old male presents with severe excruciating pain during defecation with b l e eding. On physical examination of anal canal, a fissure is noticed at the 6 o’clock position. a) Define fissure. b) What are the other painful conditions of anorectal region? c) What is the management of this patient? [Supple 2019 held in 2020 ]

9. Q : 8 A 45-year-old male presents with history of mucus and blood discharge per rectally for the past 5 months on and off associated with something coming out of the r ectum and reduces spontaneously. a) What is the most likely diagnosis? b) How would you classify different severity/degrees of this condition? c ) Enumerate two complications of stapled hemorrhoidectomy? [Supple 2017 held in 2018 ]

10. Q : 9 A 60-year-old male presented with an irreducible swelling in the right groin. Patient gives history of reducibility in the same swelling. There is history of worsening pain in t he swelling and vomiting. a) What is the most probable diagnosis? b) What critical step in the operation is different from an elective case of hernia repair? [Supple 2017 held in 2018]

11. Q : 1 A 30-year-old female is known case of ulcerative colitis for 12 years presented in emergency ward with complaints of severe abdominal pain, distension and loose motions. a) What is your diagnosis? b) How will you manage? c) Write two indications for surgical intervention. [Annual 2018]

12. Q : 1 1 : A 60-year-old male presents in the OPD with symptoms of frequency, nocturia urgency and poor urine stream. A provisional diagnosis of Benign Prostatic Hyperplasia is made. a) Enlist urodynamic criteria used to select best treatment options for symptomatic patients. b) Name various drugs and operative treatment options available for the disease. c) What is TUR (Transurethral Resection) syndrome? [Supple 2016 held in 2017]

13. Q : 1 2 A 65-year-old male presented with lumbar spine, pain and pelvic bone pain. He also gave history of difficulty in passing urine and hematuria. X-ray lumbar spine and pelvis showed the bone to be dense and coarse. Digital Rectal Examination revealed large hard irregular prostate. a) How would you explain the appearance in x-ray of lumbar spine? b) How would you confirm your diagnosis? c) How would you manage this particular patient? d) What are the tumor markers of this disease?

14. Q : 1 3 A 15-year-old boy complains of sudden agonizing pain in the right groin while playing a match of hockey. He is feeling nausea. On examination of inguinoscrotal region, skin of scrotum is inflamed. a) What is the provisional diagnosis? b) What is differential diagnosis? c) What is the management? [Supple 2019 held in 2020]

15. Q : 1 4 A 26-year-old breastfeeding mother presented with fever and pain in right breast. she has a temperature of 37.9 C and a pulse rate of 92/min. on examination, there is a localized, tender area adjacent to areola of the right breast. There is surrounding erythema and tender lymphadenopathy in the right axilla. a) What is the likely diagnosis? b) What other investigations would you order? c) What are the treatment options? [Annual 2015]

16. Q : 1 5 A 65-year-old female presents with dry and cracked nipples of her right breast. Her left breast is normal. She has been treated by dermatologist who gave her treatment for eczema but there was no improvement. Clinical examination shows partial erosion of the nipple of right breast. a) What is your clinical diagnosis? b) How would you confirm your diagnosis? c) What further examination and investigation you will perform before definite treatment of this patient? d) Enumerate the different treatment modalities in this disease. [Annual 2014]