MCQ General Surgery DR Zahid

MCQ for Final Professional MBBS
Author:
DR. Zahid Mahmood
Associate Professor
LMDC Lahore
Q.1. A 25 year old male got crush injury to lower leg. On 5th day he has severe pain in the leg and skin
became discolored. On examination crepitus is felt. Radiograph leg shows gas in the subcutaneous
tissue. The following is the most appropriate step:
a. Give antibiotic and send home

b. Give hyperbaric oxygen
c. Transfuse blood
d. Make long incision and debride dead tissue *
e. Give antiserum to cure this problem
Q.2. A 40 year old female underwent laparoscopic cholecystectomy for cholelithiasis. Prophylactic 2nd
generation cephalosporin was administrated during the induction of general anaesthesia as this
operation is:
a. Clean
b. Clean contaminated *
c. Contaminated
d. Dirty
e. Untidy
Q.3. A 40 year old female scheduled for total thyroidectomy for papillary carcinoma thyroid. You have
advised to give preoperative shot of 1st generation cephalosporin just prior to induction of
anesthesia. Your aim is:
a. To treat wound infection with gm +ve organism

b. To treat wound infection with gm -ve organism
c. To augment the effect of cellular immune response
d. To cover the decisive period *
e. To augment the effect of humeral immune response
Q.4. A 40 year old diabetic male got blunt injury abdomen. Colostomy was made due to perforation of
sigmoid colon in exploratory laparotomy. On 6th post-operative day skin around the stoma site
became brownish black and foul smelling discharge noted. Crepitus was also palpated. The following
is the most likely organism responsible:
a. Clostridium septicum
b. Gram negative organism
c. Clostridium welchii *
d. Clostridium novyi
e. Anaerobic
Q. 5. All of the following are benign Neoplasia except:
a. Papilloma
b. Adenoma
c. Melanoma *
d. Lipoma
e. Fibroma
Q.6. A 5 year old child got 4cm incised wound on the right cheek while playing with shaving blade. He
presented in the emergency with bleeding. Which of the following step is appropriate?
a. Apply pressure dressing and send home
b. Do primary suturing *
c. Do delayed primary suturing
d. Do secondary suturing
e. Only give analgesia and send home
Q.7. A 25 year old male reports 5th day after primary suturing of lacerated wound lower leg in a road
traffic accident. He complains of severe pain at wound site and fever. On examination the wound
edges are swollen and red. His temp is 102 which of the following statement concerning the condition
are true?
a. Remove the stitches and drain pus *

b. Chang the antibiotic and send home
c. Irrigate the wound and apply stitches to close it
d. This is type of tidy injury
e. All tidy injuries should close secondarily
Q.8. An 8 year old child fell down from running motorcycle. He dragged over the road and his back skin
rubbed off. Keeping in mind the mechanism of injury the following is the type of wound:
a. Lacerated
b. Traction
c. Avulsion
d. Abrasion *
e. Contusion
Q.9.In the above child the following is the appropriate management:
a. Primary suturing of wound

b. Gently brush the wound and irrigate with normal saline *
c. Partial thickness grafting
d. Full thickness grafting
e. Flap rotation
Q.10. A 20 year old female presented with keloid scar in ear lobule after ear piercing. Regarding this
lesion which statement is correct?
a. More in white races

b. More in males
c. More occur in children
d. Common sites are sternum , shoulder and face *
e. Clinically these are red, raised, itchy and tender
Q.11. A 70 year old man presented with 2 cm ulcer on right pinna with palpable neck lymph nodes. The
edges are everted. He is a weed farmer and does not smoke or drink. He has no recent history of any
other ENT problems. The lesion is most likely:
a. Syphilitic
b. Squamous cell carcinoma *
c. Basal cell carcinoma
d. Tuberculosis
e. Melanoma
Q.12. While you are on duty in the emergency room, 12-year-old boy arrives with pain and inflammation
over the ball of his left foot and red streaks extending up the inner aspect of his leg. He remembers
removing a wood splinter from the sole of his foot on the previous day. The most likely infecting
organism is:
a. Clostridium perfringens
b. Clostridium tetani
c. Staphylococcus
d. Escherichia coli
e. Streptococcus *
Q.13. A cirrhotic patient with abnormal coagulation studies due to hepatic synthetic dysfunction requires
an urgent cholecystectomy. A transfusion of fresh frozen plasma is planned to minimize the risk of
bleeding due to surgery. The optimal timing of this transfusion would be:
a. The day before surgery

b. The night before surgery
c. On call to surgery *
d. One week before surgery
e. In the recovery room
Q.14. A 27-year-old man sustains a single gunshot wound to the left thigh. In the emergency room he is
noted to have a large hematoma of his medial thigh. He complains of paresthesias in his foot. On
examination there are weak pulses palpable distal to the injury and the patient is unable to move his foot.
The appropriate initial management of this patient would be:
a. Angiography
b. Immediate exploration and repair *
c. Fasciotomy of anterior compartment
d. Observation for resolution of spasm
e. Local wound exploration
Q.15. A 30 year old male presented with severe facial trauma in the emergency. He is bleeding from the
oral cavity. His airway is compromised. The following is the best way to maintain air way in this
patient:
a. Chin lift
b. Cricothyroidotomy *
c. Endotracheal intubation
d. Nasotracheal intubation
e. Oropharyngeal air way
Q.16. A 55 year old farmer gives history of change in size, shape and color of a long standing mole at the
back. On examination there is crusting and bleeding in the lesion. Axillary lymph nodes are
enlarged. The most likely diagnosis is:
a. Basal cell carcinoma

b. Melanoma *
c. Keratoacanthoma
d. Squamous cell carcinoma
e. Verrucous carcinoma
Q.17. A 40 year old female having carcinoma breast undergone modified radical mastectomy. One of the
following statements is true regarding the surgical anatomy of breast.
a. The blood supply of breast is only internal thoracic artery
b. Sub mammary space is well vascularized area
c. The lymphatics of the breast only drain into the axillary lymphonods
d. The areola contains involuntary muscles *
e. Peau d’orange is due to ulceration of the skin
Q.18 Boundaries of calot’s triangle are
a. CHD, cystic duct and liver *

b. CBD, cystic artery and gallbladder
c. Right and left hepatic ducts and porta hepatic
d. infundibulum of gallbladder, cystic artery and cystic duct
e. None of the above
Q.19. A 35 year old man presented carcinoma parotid gland. Total parotidectomy was planned. Regarding
the surgical anatomy the following statement is true:
a. The facial nerve passes posterior to the deep lobe

b. Parotid gland lies on the carotid sheath, xi and xii cranial nerves *
c. Only retromandibular vein passes through the gland
d. The gland is divided into superficial and deep separated by external carotid artery
e. An accessory lobe is always present
Q.20. A pregnant woman in her 32ndwk of gestation is given magnesium sulfate for preeclampsia. The
earliest clinical indication of hypermagnesemia is:
a. Loss of deep tendon reflexes *

b. Flaccid paralysis
c. Respiratory arrest
d. Hypotension
e. Stupor
Q.21. Five days after an uneventful cholecystectomy, an asymptomatic middle-aged woman is found to
have a serum sodium level of 120 meq/L. Proper management would be:
a. Administration of hypertonic saline solution

b. Restriction of free water *
c. Plasma ultra-filtration
d. Hemodialysis
e. Aggressive diuresis with furosemide
Q.22. A 30-year-old woman in the last trimester of pregnancy suddenly develops massive swelling of the
left lower extremity from the inguinal ligament to the ankle. The correct sequence of workup and
treatment should be
a. Venogram, bed rest, heparin

b. Duplex Scan, bedrest, heparin *
c. Impedance plethysmography, bed rest, vena caval filter
d. Impedance plethysmography, bed rest, heparin, warfarin (Coumadin)
e. Clinical evaluation, bed rest, warfarin
Q.23. A 23-year-old woman undergoes total thyroidectomy for carcinoma of the thyroid gland. On the
second postoperative day, she begins to complain of tingling sensation in her hands. She appears
quite anxious and later complains of muscle cramps. Initial therapy should consist of:
a. 10 mL of 10% magnesium sulfate intravenously

b. Oral vitamin D
c. 100 µg of oral Synthroid
d. Infusion of calcium gluconate *
e. Oral calcium gluconate
Q.24. Prophylactic regimens of documented benefit in decreasing the risk of postoperative

thromboembolism include all except.
a. Early ambulation
b. External pneumatic compression devices placed on the upper extremities
c. Elastic stockings
d. Leg elevation for 24 h postoperatively*
e. Dipyridamole therapy for 48 h postoperatively
Q.25. Which one of the following inhalation anesthetics accumulates in air-filled cavities during general
anesthesia?
a. Diethyl ether
b. Nitrous oxide*
c. Halothane
d. Methoxyflurane
e. Trichloroethylene
Q.26. Which one of the following cases is considered a clean contaminated wound?
a. Open cholecystectomy for cholelithiasis*

b. Herniorrhaphy with mesh repair
c. Lumpectomy with axillary node dissection
d. Appendectomy with walled-off abscess
e. Gunshot wound to the abdomen with injuries to the small bowel and sigmoid colon
Q.27. Blunt trauma to the abdomen most commonly injures which of the following organs?
a. Liver
b. Kidney
c. Spleen*
d. Intestine
e. Pancreas
Q.28. A 25-year-old woman arrives in the emergency room following an automobile accident. She is
acutely dyspneic with a respiratory rate of 60 breaths/min breath sounds are markedly diminished
on the right side. The first step in managing the patient should be to:
a. Take a chest x-ray

b. Draw arterial blood for blood gas determination
c. Decompress the right pleural space *
d. Perform pericardiocentesis
e. Administer intravenous fluids
Q.29. All of the following are the complications of the radiotherapy except:
a. Bone marrow suppression

b. Drug resistance *
c. Avascular necrosis of bone
d. Malignant transformation
e. Radiation enteritis
Q.30. A 65 years old patient develops gangrene of big toe. The local treatment of choice is:
a. Daily foot bath

b. Heat by heat pad
c. Cooling by ice
d. Topical antibiotics
e. Ray amputation *
Q.31 In gridiron incision which nerve is vulnerable to injury?
a) Femoral nerve
b) Subcostal nerve
c) Hypogastric nerve
d) Ilio inguinal nerve *
e) Lateral cutaneous nerve of the thigh
Q. 32 Boundaries of calot’s triangle are

a) CHD, cystic duct and liver*
b) CBD, cystic artery and gallbladder
c) Right and left hepatic ducts and porta hepatic
d) lnfundiblim of gallbladder, cystic artery and cystic duct
e) None of the above
Q. 33 The anatomical structures encountered during thyroidectomy before reaching the thyroid gland
include.
a) Skin, superficial fascia, deep fascia and pretracheal fascia *
b) Skin, subcutaneous fat, deep fascia and thyroid capsules
c) Skin, Subcutaneous fat, platysma muscle, investing layer of deep cervical fascia
d) Skin, subcutaneous fat, platysma muscle, inversing layer of deep cervical fascia and capsule of thyroid
Q. 34 In the ideal immediate management of clean incised wound

a) Local anaesthesia includes the global use of 1; 10000 adrenaline *
b) Debridement is employed for every layer
c) Divided structures should not be repaired at this stage
d) Wound drainage is not necessary
e) The wound should not be closed
Q.35 In the healing of a wound the normal tensile strength of the tissues is generally regained in
a) Two weeks
b) Six weeks
c) Six months *
d) One year
e) Two years
Q.36 The true keloid scar

a) Is the normal pattern of scar formations?
b) Is synonymous with hypertrophic scar
c) Is common among white skinned individual
d) Tends to get worse even after one year *
e) Can only be treated by complete excision
Q.37 In the pre-hospital management of an accident victim, effective care includes

a) Nursing the patient in supine position
b) Nursing the patient in propped up position
c) Cleaning the mouth and pharynx of blood, debris etc *
d) Fixing the fractured bones
e) Administration of CO2
Q.38 The best site for an intramuscular injection is the

a) Abdomen
b) Forearm
c) Neck
d) Inner lower quadrant of the buttock
e) Outer upper quadrant of the buttock *
Q.39 In road traffic accidents there is a tendency for one type of injury to be associated with another such
as
a) Pott's fracture with ruptured spleen
b) Fracture of lower ribs with rupture of liver or spleen *
c) Le Fort's fractures with dislocation of hip
d) Mid shaft fractures of femur with head injury
e) Seat belt injury with collie’s fracture
Q.40 Insensible loss of fluid from skin and lungs over 24 hours, in a temperate climate is normally in
the range
a) 100-250 ml
b) 250-500 ml
c) 500-750 ml *
d) 750-1000 ml
e) 1000-1500 ml
Q.41 Sodium depletion (Hyponatremia)
a) Can be caused by increased secretion of aldosterone

b) Occurs during the first 48 hours after major operation
c) Can follow prolonged gastric aspiration combined with replacement by IV infusion of 5 % Dextrose water
*
d) Results in urine containing excess of chloride
e) Leads to anaemia
Q.42 Clinical features associated with hemorrhagic shock include EXCEPT
a) Pallor
b) Cold and clammy extremities
c) Air hunger
d) Restlessness
e) Hyperthermia *
Q.43 The complications of blood transfusion include all of the following EXCEPT.
a) Transmission of viral infection

b) Anaphylactic shock
c) Sensitization of leukocytes
d) Hemolysis
e) Christmas disease *
Q.44 Blood for transfusion should be stored at

a) 20°c
b) 4 to 0°c *
c) + 2°c to + 6°c
d) + 10°c to + 14°c
e) 30°c
Q.45 The methods used to assess malnutrition in a surgical patient include all of the following
EXCEPT
a) Lymphocyte count
b) Triceps skin-fold thickness
c) Candida skin test
d) Serum albumin
e) Serum fibrinogen *
Q.46 The fat soluble vitamins include all of the following EXCEPT vitamin
a) Vitamin -C *
b) Vitamin -A
c) Vitamin -D
d) Vitamin -E
e) Vitamin -K
Q.47 The recognized unwanted effects of nasogastric tube feeding include all of the following
EXCEPT
a) Pulmonary aspiration
b) Nausea
c) Diarrhea
d) Disturbed liver function
e) Hyponatremia *
Q.48 A cachectic patient is brought for palliative treatment. His nutritional status can be assessed
all parameters EXCEPT.
a) Upper arm circumference

b) Body mass index
c) Leukocyte count
d) Candida test
e) Mid-calf circumference *
Q.50 Parenteral and enteral nutrition can be best given to a patient by all means EXCEPT
a) Central venous line

b) Peripheral venous line
c) Nasogastric tube
d) Gastrostomy
e) Subcutaneously *
Q.51 Clinical indications of nutritional support are all EXCEPT
a) Preoperative nutritional depletion

b) Proximal bowel fistula
c) Malabsorption syndrome
d) Acute appendicitis *
e) Massive bowel resection
Q.52 A sequestration epithelial dermoid cyst is
a) Due to squamous cells being driven in by a needle

b) Due to cells being buried during development
c) An example of parthenogenesis
d) A sebaceous cyst
e) A sarcoma
\
Q.53 A 50 years old patient has persistent sinus on buttock for last 3 months. All of the following are
possible reasons EXCEPT
a) A foreign body
b) Mycobacteria
c) Malnutrition
d) Malignant change
e) Low serum cholesterol level
Q.54 All are the types of basal cell carcinoma EXCEPT
a) Cystic
b) Pigmented
c) Morphoeic
d) Field fire
e) Pyogenic granuloma
Q.55 A port wine stain (nervous flammus) is a
a) Premalignant lesion of skin

b) Type of melanoma
c) Type of bruising of skin
d) Type of hemangioma
e) Tattoo
Q.56 A 15 years old boy is brought in emergency after sustaining burn trauma. The admission criterion
for a burn patient includes all EXCPT
a) Circumferential bum of extremities

b) Bum more than 20% of surface area
c) Bum involving genitalia
d) Bum associated with rib fracture
e) Bum on chest 5%
Q.57 A 40 years old man has multiple inguinal lymph node enlargement and skin lesion on penis.
The lymph nodes draining a syphilitic lesion of genitalia area are felt as
a) Bulky
b) Soft
c) Firm
d) Cystic
e) Matted
Q.58 A young boy develops progressive swelling of left leg after sustaining trauma on foot. On
examination crepitus is felt, the gas gangrene is caused by
a) Clostridium welchii
b) Clostridium tetani
c) Hemophilus influenza
d) Gonococci
e) Trepinoma pallidum
Q.59 An autograft is one where
a) Skin graft taken from one species and applied to other species
b) Skin graft taken from one individual and applied 10 another individual or same species
c) Skin graft taken from one individual and applied to another individual or different sex
d) Skin graft taken from one individual and applied to another individual or same blood group
e) Skin graft taken from one individual and applied to same individual
Q.60 A full thickness burn
a) Is painless
b) Is painful
c) Usually does not require skin graft
d) Is created by loss of a few layers of epidermis
e) Is pre-malignant condition
Q.61 A squamous cell carcinoma has
a) Undermined edges
b) Everted edges
c) Rounded edges
d) Sloping edges
e) Blue edges
Q.62 Factors which does not favour wound healing include all EXCEPT
.
a) Diabetes
Infection
b) Malnutrition
c) Rest
d) Foreign body
Q.63 An antibioma is
a) Type of antibiotic
b) Malignant tumor caused by antibiotics
c) An excess mass of fibrous tissue around an abscess, persistently treated by antibiotics
d) Benign tumor
e) Expired antibiotic
Q.64 All of the followings are features of chronic limb ischemia EXCEPT
a) Claudication pain
b) Rest pain
c) Engorgement of veins
d) Ischemic ulcers
e) Atrophy of muscles
Q. 65 A 50 years old man presents with claudication pain in left calf. All of the following investigations are
used to diagnose arterial diseases
A. Doppler studies
B. Duplex scan
C. Myelography
D. Conventional angiography
E. Digital subtraction angiography
Q.66 All of the followings are features of buergers’s disease EXCEPT

A. Mostly male patients
B. Usually middle aged
C. Smoker
D. Thrombophlebitis of superficial veins
E. Positive family history
Q.67 All of the followings disorders are associated with secondary Raynaud’s phenomena EXCEPT
A. Systemic lupus erythematosus (SLE)
B. Cold injury
C. Hyperparathyroidism
D. Polyarteritis nodosa
E. Cervical rib
Q.68 A 65 years old patient develops gangrene of big toe. The local treatment of choice for this patient is
A. Daily foot bath
B. Heat by heat pad
C. Cooling by ice
D. Topical antibiotics
E. Ray amputation of the toe
Q.69 All of the following are characteristics of venous ulcers EXCEPT.

A. Occur over medial malleolus
B. Non healing ulcers
C. Deep ulcer with slough on the floor
D. Usually associated with deep vein in sufficiency
E. Non healing ulcers associated with surrounding pigmentation and edema
Q.70 All of the following treatment options for varicose veins EXCEPT.
A. Compression bandage
B. Injections sclerotherapy
C. Repair of defective valves
D. Multiple ligations
E. Multiple ligations and striping
Q.71 All of the following are clinical features of deep vein thrombosis of leg (DVT)
A. Calf swelling
B. Pain
C. Calf tenderness
D. Absent limb pulses
E. Dilated superficial veins
Q.72 All of the following are causes of lymphedema EXCEPT.

A. Filariasis
B. Primary lymphatic malignancy
C. Matastatic spread to lymph nodes
D. Morbid obesity
E. Radiotherapy to lymph nodes
Q.73 A 40 years old male patient is to be operated under general anaesthesia. All of the following
parameters are included in routine monitoring during Anaesthesia EXCEPT.
A. Pulse rate
B. Blood pressure
C. Continuous monitoring of ECG
D. Spirometery
E. Pulse oximetery
Q.74 All of the following drugs are used as local anaesthetic agent EXCEPT.
A. Lignocaine 2%
B. Lignocaine with adrenalin
C. Bupivacaine 0.5%
D. Prilocaine 1%
E. Halothane
Q.75 All of the following are verities of regional anaesthesia EXCEPT

A. Lumber symphathectomy
B. Intratheical anaesthesia
C. Epidural anaesthesia
D. Caudal epidural block
E. Brachial plexus block
Q.76 All of the following investigations can be used as diagnostic as well as therapeutic purpose EXCEPT.
A. Ultrasonography
B. CT scan
C. Chest x-ray
D. MRI
E. ERCP
Q.77 Interventional radiology is helpful in following diagnostic and therapeutic procedures EXCEPT.
A. Percutaneous biopsy
B. Drainage of abscess
C. Laparoscopy
D. Percutaneous biliary procedures
E. Percutaneous biliary procedures and stenting
Q.78 All of the following malignant tumors are radiosensitive EXCEPT.

A. Seminoma
B. Carcinoma stomach
C. Squamous cell carcinoma
D. Lymphoma
E. Breast cancer
Q.79 All of the following are the complications of the radiotherapy EXCEPT
A. Bone marrow suppression
B. Drug resistance
C. Avascular necrosis of bone
D. Malignant transformation
E. Radiation enteritis
Q.80 A 40 year old female having carcinoma breast undergone modified radical mastectomy.
One of the following statements is true regarding the surgical anatomy of breast.
A. The blood supply of breast is only internal thoracic artery
B. Submammary space is well vascularized area
C. The lymphatics of the breast only drain into the axillary lymphnodes
D. The areola contains involuntary muscles
E. Peau d’orange is due to ulceration of the skin
Q. 81 Boundaries of calot’s triangle are

f) CHD, cystic duct and liver
g) CBD, cystic artery and gallbladder
h) Right and left hepatic ducts and porta hepatic
i) infundibulum of gallbladder, cystic artery and cystic duct
j) None of the above
Q.82 A 35 year old man presented carcinoma parotid gland. Total parotidectomy was planned.
Regarding the surgical anatomy the following statement is true
A. The facial nerve passes posterior to the deep lobe
B. Parotid gland lies on the carotid sheath, xi and xii cranial nerves
C. Only retromandibular vein passes through the gland
D. The gland is divided into superficial and deep separated by external carotid artery
E. An accessory lobe is always present
Q.83 A pregnant woman in her 32ndwk of gestation is given magnesium sulfate for preeclampsia.
The earliest clinical indication of hypermagnesemia is
A. Loss of deep tendon reflexes
B. Flaccid paralysis
C. Respiratory arrest
D. Hypotension
E. Stupor
Q.84 Five days after an uneventful cholecystectomy, an asymptomatic middle-aged woman is

found to have a serum sodium level of 120 meq/L. Proper management would be
A. Administration of hypertonic saline solution
B. Restriction of free water
C. Plasma ultra-filtration
D. Hemodialysis
E. Aggressive diuresis with furosemide
Q.85 A 30-year-old woman in the last trimester of pregnancy suddenly develops massive swelling
of the left lower extremity from the inguinal ligament to the ankle. The correct sequence of
workup and treatment should be
A. Venogram, bed rest, heparin
B. Duplex Scan, bedrest, heparin
C. Impedance plethysmography, bed rest, vena caval filter
D. Impedance plethysmography, bed rest, heparin, warfarin (Coumadin)
E. Clinical evaluation, bed rest, warfarin
Q.86 A cirrhotic patient with abnormal coagulation studies due to hepatic synthetic dysfunction
requires an urgent cholecystectomy. A transfusion of fresh frozen plasma is planned to minimize
the risk of bleeding due to surgery. The optimal timing of this transfusion would be
A. The day before surgery
B. The night before surgery
C. On call to surgery
D. One week before surgery
E. In the recovery room
Q.87 Signs and symptoms of hemolytic transfusion reactions include all accept.
A. Hypothermia
B. Hypertension
C. Polyuria
D. Abnormal bleeding
E. Hyperesthesia at the transfusion site
Q.88 A 23-year-old woman undergoes total thyroidectomy for carcinoma of the thyroid gland. On
the second postoperative day, she begins to complain of tingling sensation in her hands. She
appears quite anxious and later complains of muscle cramps. Initial therapy should consist
of
A. 10 mL of 10% magnesium sulfate intravenously
B. Oral vitamin D
C. 100 µg of oral Synthroid
D. Infusion of calcium gluconate
E. Oral calcium gluconate
Q.89 Prophylactic regimens of documented benefit in decreasing the risk of postoperative

A. Early ambulation
B. External pneumatic compression devices placed on the upper extremities
C. Elastic stockings
D. Leg elevation for 24 h postoperatively
E. Dipyridamole therapy for 48 h postoperatively
Q.90 Which one of the following inhalation anesthetics accumulates in air-filled cavities during
general anesthesia?
A. Diethyl ether
B. Nitrous oxide
C. Halothane
D. Methoxyflurane
E. Trichloroethylene
Q.91 Compensatory mechanisms during acute hemorrhage include except.

A. Decreased cerebral and coronary blood flow
B. Decreased myocardial contractility
C. Renal and splanchnic vasodilatations
D. Increased respiratory rate
E. Decreased renal sodium resorption
Q.92 Among patients who require nutritional resuscitation in an intensive care unit, the best
evidence that nutritional support is adequate is
A. Urinary nitrogen excretion levels
B. Total serum protein level
C. Serum albumin level
D. Serum transferrin levels
E. Respiratory quotient
Q.93 While you are on duty in the emergency room, a 12-year-old boy arrives with pain and
inflammation over the ball of his left foot and red streaks extending up the inner aspect of his leg.
He remembers removing a wood splinter from the sole of his foot on the previous day. The most
likely infecting organism is
A. Clostridium perfringens
B. Clostridium tetani
C. Staphylococcus
D. Escherichia coli
E. Streptococcus
Q.94 Which one of the following cases is considered a clean contaminated wound?
A. Open cholecystectomy for cholelithiasis
B. Herniorrhaphy with mesh repair
C. Lumpectomy with axillary node dissection
D. Appendectomy with walled-off abscess
E. Gunshot wound to the abdomen with injuries to the small bowel and sigmoid colon
Q.95 Blunt trauma to the abdomen most commonly injures which of the following organs?
A. Liver
B. Kidney
C. Spleen
D. Intestine
E. Pancreas
Q.96 A 27-year-old man sustains a single gunshot wound to the left thigh. In the emergency room
he is noted to have a large hematoma of his medial thigh. He complains of paresthesias in his
foot. On examination there are weak pulses palpable distal to the injury and the patient is
unable to move his foot. The appropriate initial management of this patient would be
A. Angiography
B. Immediate exploration and repair
C. Fasciotomy of anterior compartment
D. Observation for resolution of spasm
E. Local wound exploration
Q.97 A 25-year-old woman arrives in the emergency room following an automobile accident. She
is acutely dyspneic with a respiratory rate of 60 breaths/min. Breath sounds are markedly
diminished on the right side. The first step in managing the patient should be to
A. Take a chest x-ray
B. Draw arterial blood for blood gas determination
C. Decompress the right pleural space
D. Perform pericardiocentesis
E. Administer intravenous fluids
Q.98 A 28-year-old man is brought to the emergency room for a severe head injury after a fall.
Initially lethargic, he becomes comatose and does not move his right side. His left pupil is
dilated and responds only sluggishly.
The most common initial manifestation of increasing intra cranial pressure in the victim of
head trauma is.
A. Change in level of consciousness
B. Ipsilateral (side of hemorrhage) pupillary dilation
C. Contralateral pupillary dilation
D. Hemiparesis
E. Hypertension
Q.99All of the following are the complication of the radiotherapy except

A. Bone marrow suppression
B. Drug resistance
C. Avascular necrosis of bone
D. Malignant transformation
E. Radiation enteritis
Q.100 All of the following malignant tumors are radiosensitive except

A. Seminoma
B. Carcinoma stomach
C. Squamous cell carcinoma
D. Lymphoma
E. Breast cancer
Q.101 All of the following are varieties of regional anesthesia except

A. Lumber sympathectomy
B. Intrathecal anesthesia
C. Epidural anesthesia
D. Caudal epidural block
E. Brachial plexus block
Q.102 A 40 year old male patient is to be operated under general anesthesia. All of the following
parameters are included in routine monitoring during anesthesia except
A. Pulse rate
B. Blood pressure
C. Continuous monitoring of ECG
D. Spirometery
E. Pulse oximetery
Q.103 All of the following are causes of lymph edema except

A. filariasis
B. Primary lymphatic malignancy
C. Metastatic spread to lymph nodes
D. Morbid obesity
E. Radiotherapy to lymph nodes
Q.104 A 65 years old patient develops gangrene of big toe. The local treatment of choice is
A. Daily foot bath
B. Heat by heat pad
C. Cooling by ice
D. Topical antibiotics
E. Ray amputation
Q.105 All of the following are the features of buergers’s disease except
A. Mostly male
B. Usually middle age
C. Smoker
D. Thrombophlebitis of superficial vein
E. Positive family history
Q.106 All of the following are the features of chronic limb ischemia except
A. Claudication pain
B. Rest pain
C. Engorgement of veins
D. Ischemic ulcers
E. Atrophy of muscles
Q.107 All are types of the basal cell carcinoma except

A. Cystic
B. Sigmoid
C. Morphoeic
D. Field fire
E. Pyogenic granuloma
Q.108 Clinical indications of nutritional support are all except

A. Preoperative nutritional depletion
B. Proximal bowel fistula
C. Malabsorption syndrome
D. Chronic pancreatitis
E. Massive bowel resection
Q.109 Nutritional status of cachectic patient can be assessed by all parameters except
A. Upper arm circumference
B. Body mass index
C. Leukocyte count
D. Candida test
E. Mid-calf circumference
Q.110 The true keloid scar

A. Is the normal pattern of scar formation
B. Is synonymous with hypertrophic scar
C. Is common among white skinned
D. Tends to get worse even after one year
E. Can only be treated by complete excision
Q.111 The response to shock includes which of the following metabolic effects except.
A. Increase in sodium and water excretion
B. Increase in renal perfusion
C. Decrease in cortisol levels
D. Hyperkalemia
E. Hypoglycemia
Q.112 A 26-year-old man sustains a gunshot wound to the left thigh. Exploration reveals that a 5-
cm portion of superficial femoral artery is destroyed. Appropriate management includes
A. Debridement and end-to-end anastomosis
B. Debridement and repair with an interposition prosthetic graft
C. Debridement and repair with an interposition arterial graft
D. Debridement and repair with an interposition vein graft
E. Ligation and observation
Q.113 What is the most common cause of cancer death among women?
A. Breast cancer
B. Ovarian cancer
C. Colon cancer
D. Endometrial cancer
E. Lung cancer
Q.114 Complications of blood transfusion include all of the following except

A. Transmission of viral infection
B. Anaphylactic shock
C. Sensitization of leukocytes
D. Hemolysis
E. Christmas disease
Q.115 A port wine stain is a

A. Premalignant lesion of skin
B. Type of melanoma
C. Type of bruising of skin
D. Type of hemangioma
E. Tattoo
Q.116 A sequestration epithelial dermoid cyst is

A. Due to squamous cell being driven in by a needle
B. Due to cells being buried during development
C. An example of parthenogenesis
D. A sebaceous cyst
E. A sarcoma
Q.117 A full thickness burn

A. Is painless
B. Is painful
C. Usually does not require skin graft
D. Is created by loss of a few layers of epidermis
E. Is premalignant condition
Q.118 An antibioma is
A. Type of antibiotic
B. Malignant tumor caused by antibiotics
C. An excess mass of fibrous tissue around an abscess persistently treated by antibiotics
D. Benign tumor
E. Expired antibiotic
Q.119 The best site for an intramuscular injection is the
f) Abdomen
g) Forearm
h) Neck
i) Inner lower quadrant of the buttock
j) Outer upper quadrant of the buttock
Q.120 In road traffic accidents there is a tendency for one type of injury to be associated with another such
as
k) Pott's fracture with ruptured spleen

l) Fracture of lower ribs with rupture of liver or spleen
m) Le Fort's fractures with dislocation of hip
n) Mid shaft fractures of femur with head injury
o) Seat belt injury with collie’s fracture
Q.121 Blood for transfusion should be stored at

f) 20°c
g) 4 to 0°c
h) + 2°c to + 6°c
i) + 10°c to + 14°c
j) 30°c
Q.122 The methods used to assess malnutrition in a surgical patient include all of the following
EXCEPT
f) Lymphocyte count
g) Triceps skin-fold thickness
h) Candida skin test
i) Serum albumin
j) Serum fibrinogen
Q.123 A 20 years old female presented in OPD with pain right lower quadrant for last 7 days, she is
anorexic. On examination there is mass palpable in the right iliac fossa & it is tender. Bowel sounds
audible. The next common appropriate investigation is
a) Total leucocyte count
b) ESR
c) Ultrasonography
d) C.T Scan
e) MRI
Q.124 A 22 years old man underwent appendectomy for acute appendicitis but he is unwell after operation.
The followings should be checked except.
a) Examine the wound & abdomen for abscess
b) Perform Rectal examination
c) Examine the liver for pylephlebitis
d) Examine the stool for blood
e) Examine the urine for pyelonephritis
Q.125 The criteria for stopping conservative treatment of appendicular mass is except
a) Rising pulse rate
b) Increasing abdominal pain

c) Low grade fever
d) Increasing size of mass
e) Vomiting or copious gastric aspirate
Q.126 A 30 years old person underwent appendicectomy for perforated appendix. The most common
postoperative complication may be
a) Postoperative ileus
b) Intra-abdominal abscess
c) Wound infection
d) Pylephlebitis
e) Fecal fistula
Q.127 The followings are the appropriate incisions for appendicectomy except
a) Grid iron incision
b) Lanz incision
c) Right paramedian incision
d) Pfannenstiel incision
e) Lower midline incision
Q128 A 5 years old child presented with pain in the right lower quadrant & vomiting for 6 hours. The
following differential diagnosis should be suspected except
a) Gastroenteritis
b) Mesenteric
c) Intussusception
d) Perforated duodenal ulcer
e) Lobar Pneumonia
Q.129 The followings are the clinical sign in acute appendicitis except.
a) Pyrexia
b) Rebound tenderness
c) Absent bowel sounds
d) Rovsing sign
e) Pointing signs
Q.130 The followings are the most common risk factors for perforation of appendix except
a) Extreme of age
b) Diabetes mellitus
c) Fecalith obstruction
d) Hepatitis C patients
e) Pelvic appendix
Q.131 The rarest position of the appendix is
a) Post ileal
b) Retrocaecal
c) Preileal
d) Pelvic
e) Paracaecal
Q.132 The mesoappendix contains the appendicular artery which arises from
a) Superior mesenteric artery
b) Ileocolic artery
c) Anterior caecal artery
d) Posterior caecal artery
e) Accessory appendicular artery
Q.133 A 9 month old boy presented with right inguinoscrotal swelling since birth. He also vomited twice.
On examination the swelling is tense and tender. Right testes are not present in the right scrotum. The next
best step is
a) To get ultrasound of scrotum
b) X-ray plain abdomen
c) CT scan abdomen
d) Explore the right inguinal region
e) MRI of scrotum
Q.134 A 40 year old multipara presented with swelling in the lower abdomen. On examination it becomes
more prominent on standing position. The most likely it is
a) Fatty linea Alba
b) Spigelian hernia
c) Divarication of recti
d) Paraumbilical hernia
e) Umbilical hernia
Q.135 A 65 year old smoker presents with swelling in the right inguinoscrotal region. On
examination the swelling is only reduced manually. The percussion note over swelling is tympanitic.
The following factor is less likely contraindicated for hernioplasty
a) Chronic cough
b) Benign prostatic hypertrophy
c) Stricture urethra
d) Ascites abdomen
e) Bladder out let obstruction

Q.136 A 2 month old baby presented with bloody discharge from umbilicus. On examination there is small
red nodule which bleeds on touch. The most likely diagnosis is
a) Adenoma
b) Granuloma
c) Sister Joseph nodule
d) Pilonidal sinus
e) Patent ductus urachus
Q.137 A 45 year old diabetic patients underwent Exploratory Laparotomy for doudenal perforation. On 7th
post-operative day there is serosanguinous discharge from the wound. The most likely it is
a) Wound infection
b) Seroma formation
c) Wound dehiscence
d) Synergistic gangrene
e) Incisional hernia
MCQ.138 An Endoscopy is being performed for the evaluation of acid peptic disease. At the level of 15cm from
incisor teeth gastroenterologist has difficulty to pass the endoscope. The following constriction may encounter
a) Aortic
b) Bronchial
c) Cricopharyngeal
d) Atrial
e) Diaphragmatic
MCQ.139 The following factors influence the lower esophageal sphincter tone EXCEPT
a) Food
b) Gastric distension
c) Exercise
d) Gastrointestinal hormones
e) Smoking
MCQ. 140 The parents of 5year old child give history of swallowing coin by the child. The child is crying and
breathing normally. The following is the first line investigation
a) Barium swallow
b) Bronchoscopy
c) Radiograph chest and abdomen
d) Flexible endoscopy
e) Rigid endoscopy
MCQ.141 A 24 year old full term pregnant female experienced severe pain in chest and upper abdomen
following the delivery of child in obstructed labor. She is shortness of breath. The first line investigation is
a) Barium swallow
b) Barium meal
c) Contrast CT chest and abdomen
d) Radiograph chest
e) Endoscopy
MCQ.142 A 16 year old girl swallowed alkali in suicide attempt. She has severe burning in the chest. The
following effect is less likely produced by this agent
a) Liquefaction
b) Saponification of fat
c) Coagulative necrosis
d) Fibrous scarring
e) Thrombosis of blood vessels
MCQ.143 A 60 year old male smoker presented with progressive dysphagia for solids. Endoscopy revealed a
fungating growth in mid esophagus. Biopsy was taken for histopathology. The following is the next investigation
to further evaluate the patient.
a) Radiograph chest
b) Endoluminal USG
c) CT scan
d) MRI
e) Laparoscopy
MCQ. 144 A 64 year old male is being evaluated for dysphagia. Endoscopy and biopsy of the growth confirmed
squamous cell carcinoma esophagus. CT scan showed metastasis in the liver and mediastinal lymph adenopathy.
Endoluminal USG showed tumor invading the muscularis propria. This patient has following stage of tumor
a) T1N1M1
b) T2N1M1
c) T3N1M1
d) T4N1M1
e) T4N2M1
MCQ.145 The following is the less likely palliative treatment of carcinoma esophagus
a) Intubation
b) Brachytherapy
c) Endoscopic laser
d) Radical esophagectomy
e) Metallic stents
MCQ.146 A 60 year old male underwent esophagectomy for carcinoma esophagus. The following is the most
common post-operative complication
a) Respiratory
b) Anastomotic stricture
c) Anastomotic leakage
d) Injury to recurrent laryngeal nerve
e) Chylothorax
MCQ. 147 A 40 year old female underwent laparoscopic cholecystectomy. During the procedure the surgeon
identify the calot’s triangle for safe dissection. The following structures form the boundaries of this triangle
a) Liver, common bile duct ,cystic duct

b) Liver, common hepatic duct , cystic artery
c) Liver, common hepatic duct , cystic duct
d) Liver, common bile duct ,duodenum
e) Liver , common hepatic duct , Pancreases
MCQ.148 The porcelain gall bladder is best diagnosed on
a) Plain radiograph of gall bladder

b) USG abdomen
c) Cholangiogram
d) HIDA scan
e) Oral cholecystography
MCQ.149 A 40 year old female presented with pain right upper quadrant of abdomen and fatty meal intolerance.
USG shows multiple tiny stones in the gall bladder. CBD is of normal diameter. The following is the gold standard
treatment
a) Laparoscopic cholecystectomy
b) ERCP followed by lithotripsy
c) Open cholecystectomy
d) Cholecystectomy
e) Dissolution of stones with chenodeoxycholic acid
MCQ.150 The following is the less likely normal function of gall bladder
a) Reservoir for bile

b) Secretion of mucous
c) Formation of bile
d) Concentration of bile
e) Contraction in response of hormone
MCQ.151 A 55 year old female presented with jaundice, pain abdomen, early satiety and weight loss. USG shows
dilated intrahepatic ducts but normal common bile duct. The following is the best investigation for further
evaluation of this patient
a) PTC
b) MRCP
c) ERCP
d) CT scan
e) I/V Cholangiogram
MCQ.152 The following risk factor is less likely responsible for the development of Cholangiocarcinoma
a) Ulcerative colitis
b) Hepatolithiasis
c) Choledochal cyst
d) Amoebiasis
e) Liver flukes
MCQ. 153 A 60 year old male presented with pain right upper quadrant of abdomen, anorexia and weight loss. On
examination mass is palpable in the right hypochondrium. His serum level Ca19-9 is elevated. The following
investigation is best for staging the disease
a) C-reactive protein
b) USG
c) CT Scan
d) Laparoscopy
e) MRI
MCQ.154 A 10 year old child presented with jaundice, fever, abdominalpain. Onexamination mass is palpable in
the right hypochondrium. The most likely diagnosis is
a) Carcinoma gall bladder

b) Mucocele of gall bladder
c) Empyema gall bladder
d) Choledochal cyst
e) Cholangiocarcinoma
MCQ. 155 A 45 years old diabetic male presented with pain in the upper outer quadrant of abdomen, bilious
vomiting and high grade fever. On examination right hypochondrium and epigastrium is tender and guarding
present. USG shows distended gall bladder and multiple stones. The most likely diagnosis is
a) Mucocele of gallbladder
b) Carcinoma gall bladder
c) Empyema gall bladder
d) Liver abscess
e) Porcelain gall bladder
MCQ.156 A40 year old female underwent opencholecystectomy and choledochotomy for choledocholithiasis
and T tube was inserted. Post-operatively the T tube cholangiogram was planned. Which time period is suitable for
this procedure?
a) 3-5 post-operative days

b) 7-10 post-operative days
c) 12-15 post-operative days
d) 17- 20 post-operative days
e) 22- 24 post-operative days
MCQ.157 A 45 year old female presented withjaundice, pale stool and dark color urine. There is history of
laparoscopic cholecystotomy 2 years ago. USG shows extra and intrahepatic bile ducts are dilated. The next best
investigation is
a) Cholangiogram
b) HIDA Scan
c) ERCP
d) MRCP
e) CT scan
Q.158 A 60 years old male presented with periodic pain in the epigastrium since the past 02 months and
a single episode of vomitius containing fresh blood 02 days back. Patient is taking enteric coated Aspirin
tablet 75 mg every day before going to bed as prescribed by his cardiologist and is a smoker since his
teens. What is the single best investigation you will perform in a patient with these symptoms?
a) Colonoscopy
b) X-ray Chest
c) Gastro duodenoscopy
d) Ultrasound abdomen
e) Doppler Scan
Q.159 A 42 years old woman presented with haemetemesis. She also C/O Epigastric pain which usually
occurs at night and is relieved by antacids while getting worse when she is hungry. What is the most
likely diagnosis?
a) Duodenal ulcers
b) Gastric Ulcers
c) Hepatitis-A
d) Gastric Carcinoma
e) Cholecystitis
Q.160 A 30 years old female under treatment for gastric ulcers since 12 weeks presented with abdominal
pan and distention. Her pulse is 110/min and B.P is 110/80 mmHg. On examination abdomen shows
board like rigidity. As effect plain chest radiograph reveal free air under diaphragm. What next step will
you consider in treating perforated gastric ulcer?
a) Conservative
b) Gastroscopy
c) Antacids
d) Resuscitation & Exploratory Laparotomy
Q.161 Symptomatic treatment In case of extensive recurrent perforated duodenal ulcers the surgeon
decided upon a rather aggressive mode of treatment. He mobilized the atrium and distal body of stomach
and removed 2/3rd of stomach, closed duodenal stamp by suturing and created an anastomosis between
stomach and jejunum. What is this age-old procedure called?
a) Billroth II Gastrostomy
b) Billroth I Gastrostomy
c) Gastrojejunostomy
d) Truneal Vagotomy & Anrectomy
e) Anterior Resection
Q.162 A 50 years old female underwent highly selective vagotomy for treatment of recurrent duodenal
ulcers. On her 2nd follow-up visit she complains of early satiety leading to decreased diet and hence
weight loss. What complication of the previous surgery is he experiencing?
a) Early dumping
b) Late dumping
c) Small stomach syndrome
d) Recurrent ulceration
e) Anorexia nervosa
Q.163 The fat soluble vitamins include all of the following EXCEPT vitamin
a) Vitamin -C
b) Vitamin -A
c) Vitamin -D
d) Vitamin -E
e) Vitamin –K
Q.164 The recognized unwanted effects of nasogastric tube feeding include all of the following
EXCEPT
a) Pulmonary aspiration
b) Nausea
c) Diarrhea
d) Disturbed liver function
e) Hyponatremia
Q.165 A 50 years old patient has persistent sinus on buttock for last 3 months. All of the following are
possible reasons EXCEPT.
a) A foreign body
b) Mycobacteria
c) Malnutrition
d) Malignant change
e) Low serum cholesterol level
Q.166 A 15 years old boy is brought in emergency after sustaining burn trauma. The admission criterion
for a burn patient includes all EXCPT.
a) Circumferential burn of extremities

b) Bum more than 20% of surface area
c) Bum involving genitalia
d) Bum associated with rib fracture
e) Bum on chest 5%
Q.167 A 40 years old man has multiple inguinal lymph node enlargement and skin lesion on penis.
The lymph nodes draining a syphilitic lesion of genitalia area are felt as
a) Bulky
b) Soft
c) Firm
d) Cystic
e) Matted
Q.168 All of the following treatment options for varicose veins EXCEPT.
a) Compression bandage
b) Injections sclerotherapy
c) Repair of defective valves
d) Multiple ligations
e) Multiple ligations and striping
Q.169 Factors which does not favor wound healing include all EXCEPT.
a) Diabetes
b) Infection
c) Malnutrition
d) Rest
e) Foreign body
Q.170 A 25 year old male got crush injury to lower leg. On 5th day he has severe pain in the leg and skin
became discolored. On examination crepitus is felt. Radiograph leg shows gas in the subcutaneous
tissue. The following is the most appropriate step:
a) Give antibiotic and send home

b) Give hyperbaric oxygen
c) Transfuse blood
d) Make long incision and debride dead tissue
e) Give antiserum to cure this problem
Q.171 A 40 year old female underwent laparoscopic cholecystectomy for cholelithiasis. This operation is:
a) Clean
b) Clean contaminated
c) Contaminated
d) Dirty
e) Untidy
Q.172 A 40 year old female scheduled for total thyroidectomy for papillary carcinoma thyroid. You have
advised to give preoperative shot of 1st generation cephalosporin just prior to induction of
anesthesia. Your aim is:
a) To treat wound infection with gm +ve organism

b) To treat wound infection with gm -ve organism
c) To augment the effect of cellular immune response
d) To cover the decisive period
e) To augment the effect of humeral immune response
Q.173 A 40 year old diabetic male got blunt injury abdomen. Colostomy was made due to perforation of
sigmoid colon in exploratory laparotomy. On 6th post-operative day skin around the stoma site
became brownish black and foul smelling discharge noted. Crepitus was also palpated. The following
is the most likely organism responsible:
a) Clostridium septicum
b) Gram negative organism
c) Clostridium welchi
d) Clostridium novyi
e) Anerobic
Q. 174 All of the following are benign neoplasia except:
a) Papilloma
b) Adenoma
c) Melanoma
d) Lipoma
e) Fibroma
Q.175 A 5 year old child got 4cm incised wound on the right cheek while playing with shaving blade. He
presented in the emergency with bleeding. Which of the following step is appropriate?
a) Apply pressure dressing and send home

b) Do primary suturing
c) Do delayed primary suturing
d) Do secondary suturing
e) Only give analgesia and send home
Q.176 A 25 year old male reports 5th day after primary suturing of lacerated wound lower leg in a road
traffic accident. He complains of severe pain at wound site and fever. On examination the wound
edges are swollen and red. His temp is 102 F. Which of the following statement concerning the
condition is true?
a) Remove the stitches and drain pus

b) Chang the antibiotic and send home
c) Irrigate the wound and apply stitches to close it
d) This is type of tidy injury
e) All tidy injuries should close secondarily
Q.177 A 8 year old child fell down from running motorcycle. He dragged over the road and his back skin
rubbed off. Keeping in mind the mechanism of injury the following is the type of wound:
a) Lacerated
b) Traction
c) Avulsion
d) Abrasion
e) Contusion
Q.178 In the above child the following is the appropriate management:
a) Primary suturing of wound

b) Gently brush the wound and irrigate with normal saline
c) Partial thickness grafting
d) Full thickness grafting
e) Flap rotation
Q.180 A 20 year old female presented with keloid scar in ear lobule after ear piercing. Regarding this
lesion which statement is correct?
a) More in white races

b) More in males
c) More occur in children
d) Common sites are sternum , shoulder and face
e) Clinically these are red, raised, itchy and tender
Q.181 A 70 year old man presented with 2 cm ulcer on right pinna with palpable neck lymph nodes. The
a) Syphilitic
b) Squamous cell carcinoma
c) Basal cell carcinoma
d) Tuberculosis
e) Melanoma
Q.182 While you are on duty in the emergency room, a 12-year-old boy arrives with pain and inflammation
organism is:
a) Clostridium perfringens
b) Clostridium tetani
c) Staphylococcus
d) Escherichia coli
e) Streptococcus
Q.183 A cirrhotic patient with abnormal coagulation studies due to hepatic synthetic dysfunction requires
bleeding due to surgery. The optimal timing of this transfusion would be:
a) The day before surgery

b) The night before surgery
c) On call to surgery
d) One week before surgery
e) In the recovery room
Q.184 A 27-year-old man sustains a single gunshot wound to the left thigh. In the emergency room he is
examination there are weak pulses palpable distal to the injury and the patient is unable to move his foot.
The appropriate initial management of this patient would be:
a) Angiography
b) Immediate exploration and repair
c) Fasciotomy of anterior compartment
d) Observation for resolution of spasm
e) Local wound exploration
Q.185 A 30 year old male presented with severe facial trauma in the emergency. He is bleeding from the
patient:
a) Chin lift
b) Cricothyroidotomy
c) Endotracheal intubation
d) Nasotracheal intubation
e) Oropharyngeal air way
Q.186 A 55 year old farmer gives history of change in size, shape and color of a long standing mole at the
back. On examination there is crusting and bleeding in the lesion. Axillary lymph nodes are
enlarged. The most likely diagnosis is:
a) Basal cell carcinoma

b) Melanoma
c) Keratoacanthoma
d) Squamous cell carcinoma
e) Verrucous carcinoma
Q.187 A 40 year old female having carcinoma breast undergone modified radical mastectomy. One of the
following statements is true regarding the surgical anatomy of breast.
a) The blood supply of breast is only internal thoracic artery
b) Submammary space is well vascularized area
c) The lymphatics of the breast only drain into the axillary lymphnodes
d) The areola contains involuntary muscles
e) Peau d’orange is due to ulceration of the skin
Q.188 Boundaries of callot's triangle are
a) CHD, cystic duct and liver

b) CBD, cystic artery and gallbladder
c) Right and left hepatic ducts and porta hepatic
d) infundibulum of gallbladder, cystic artery and cystic duct
Q.189 A 35 year old man presented carcinoma parotid gland. Total parotidectomy was planned. Regarding
the surgical anatomy the following statement is true:
a) The facial nerve passes posterior to the deep lobe

b) Parotid gland lies on the carotid sheath, xi and xii cranial nerves
c) Only retromandibular vein passes through the gland
d) The gland is divided into superficial and deep separated by external carotid artery
e) An accessory lobe is always present
Q.190 A pregnant woman in her 32ndwk of gestation is given magnesium sulfate for preeclampsia. The
earliest clinical indication of hypermag-nesemia is:
a) Loss of deep tendon reflexes

b) Flaccid paralysis
c) Respiratory arrest
d) Hypotension
e) Stupor
Q.191 Five days after an uneventful cholecystectomy, an asymptomatic middle-aged woman is found to
have a serum sodium level of 120 meq/L. Proper management would be:
a) Administration of hypertonic saline solution

b) Restriction of free water
c) Plasma ultra filtration
d) Hemodialysis
e) Aggressive diuresis with furosemide
Q.192 A 30-year-old woman in the last trimester of pregnancy suddenly develops massive swelling of the left
lower extremity from the inguinal ligament to the ankle. The correct sequence of workup and
treatment should be
a) Venogram, bed rest, heparin

b) Duplex Scan, bedrest, heparin
c) Impedance plethysmography, bed rest, vena caval filter
d) Impedance plethysmography, bed rest, heparin, warfarin (Coumadin)
e) Clinical evaluation, bed rest, warfarin
Q.193 A 23-year-old woman undergoes total thyroidectomy for carcinoma of the thyroid gland. On the
quite anxious and later complains of muscle cramps. Initial therapy should consist of:
a)10 mL of 10% magnesium sulfate intravenously

b)Oral vitamin D
c)100 µg of oral Synthroid
d)Infusion of calcium gluconate
e)Oral calcium gluconate
Q.194 Prophylactic regimens of documented benefit in decreasing the risk of postoperative
a) Early ambulation
b) External pneumatic compression devices placed on the upper extremities
c) Elastic stockings
d) Leg elevation for 24 h postoperatively
e) Dipyridamole therapy for 48 h postoperatively
Q.195 Which one of the following inhalation anesthetics accumulates in air-filled cavities during general
anesthesia?
a) Diethyl ether
b) Nitrous oxide
c) Halothane
d) Methoxyflurane
e) Trichloroethylene
Q.196 Which one of the following cases is considered a clean contaminated wound?
a) Open cholecystectomy for cholelithiasis

b) Herniorrhaphy with mesh repair
c) Lumpectomy with axillary node dissection
d) Appendectomy with walled-off abscess
e) Gunshot wound to the abdomen with injuries to the small bowel and sigmoid colon
Q.197 Blunt trauma to the abdomen most commonly injures which of the following organs?
a) Liver
b) Kidney
c) Spleen
d) Intestine
e) Pancreas
Q.198 A 25-year-old woman arrives in the emergency room following an automobile accident. She is acutely
dyspneic with a respiratory rate of 60 breaths/min breath sounds are markedly diminished on the
right side. The first step in managing the patient should be to:
a) Take a chest x-ray

b) Draw arterial blood for blood gas determination
c) Decompress the right pleural space
d) Perform pericardiocentesis
e) Administer intravenous fluids
Q.199 All of the following are the complication of the radiotherapy except:
a) Bone marrow suppression

b) Drug resistance
c) Avascular necrosis of bone
d) Malignant transformation
e) Radiation enteritis
Q.200 A 65 years old patient develops gangrene of big toe. The local treatment of choice is:
a) Daily foot bath

b) Heat by heat pad
c) Cooling by ice
d) Topical antibiotics
e) Ray amputation
Q.201 A 23 years old house wife has noticed a swelling in the right axilla for last 8 months. It used to
increase in size premenstrualy. On examination it is firm, mobile and non- tender. The following one is the
most likely diagnosis
a) Axillary tail
b) Carcinoma breast
c) Lipoma
d) Lymph node
e) Sebaceous cyst
Q.202. A 55 years old teacher presented with lump in the right breast for 6 months. On examination it is hard
and fix to overlying skin .There is skin tethering present. The most likely cause of this tethering is
a) Fibrosis of lobule
b) Shortening of cooper’s ligament
c) Obstruction of lymphatics
d) Fibrosis of lactiferous ducts
e) Venous obstruction
Q.203. A 42 years old lady doctor presented with lump in the right breast. She also complains bloody
discharge from the nipple. On examination there is about 1.5X 2cm swelling palpable in the sub areolar region.
FNAC of lump is inconclusive. Mammography revealed microcalcification. what is your next step
a) Excisional biopsy
b) Incisional biopsy
c) Tru cut biopsy
d) Lumpectomy
e) Mastectomy
Q.204. A 48 years old singer presented with mastalgia. Her mother died due to carcinoma of breast. On
examination the breast is lumpy and no definite swelling is palpable in the breast. The following one is
appropriate investigation to assess the patient
a) FNAC
b) Tru Cut Biopsy
c) Mammography
d) Ultrasonography
e) MRI
Q.205. A 29 years old married school teacher presented with lump in the breast. On examination it is firm in
consistency. Ultrasonography of breast shows 3X2cm cyst in the upper outer quadrant of breast. what is the
next step
a) FNAC
b) Aspiration of cyst
c) Tru cut biopsy
d) Excision of cyst
e) Just observation
Q.206. A 26 years old female presented with mastalgia. On examination no abnormality found in the breast but
she is worried as her mother and grandmother died due to carcinoma breast. The following one is the best
investigation for screening
a) Mammography
b) CT scan Breast
c) Ultrasonography
d) MRI Breast
e) Digital mammography
Q.207. A 34 years old lady presented with nipple discharge and pain in the breast. On examination the
yellowish discharge is expressed when areola is pressed at 3 and 5 clock positions. Cytology of discharge has
no malignant cells. The following is the most suitable treatment
a) Microdochectomy
b) Hadfield’s operation
c) Antibiotics & analgesia
d) Simple Mastectomy
e) Excision of areola and nipple complex
Q.208. Middle aged women developed a lump in the breast after a blow to breast 6 months ago. On
examination there is smooth, non-tender swelling in the breast. FNAC is unremarkable The following is the
most likely diagnosis
a) Fat necrosis
b) Hematoma
c) Breast abscess
d) Lipoma
e) Fibro adenoma
Q.209. A 40 years old lady presented with lump in the breast. On examination it is hard in consistency and
about 5cm in size near the nipple .Axillary lymph nodes are also palpable. Tru cut biopsy shows infiltrating
ductal carcinoma. The following one is the most appropriate 1st step in management
a) Simple Mastectomy
b) Radical Mastectomy
c) Modified radical Mastectomy
d) Wide local excision
e) Neo-adjuvant chemotherapy
Q.210. A 25 years old lady presented with lump in the left breast. On examination the swelling is firm in
consistency. Ultrasonography of breast shows solid swelling. The fine needle aspiration cytology was
performed. The following pathological examination will be moderately increased risk for malignancy
a) Adenosis
b) Atypical hyperplasia
c) Fibrosis
d) Papilloma
e) Squamous metaplasia
Q.211 A 50 years old male presented with jaundice & pain right upper quadrant of abdomen.
Ultrasonography Abdomen revealed dilated biliary system with gallstones & impacted stone lower
end of CBD. ERCP failed to remove stone. The appropriate treatment is
A. PTC & removal of stone
B. Lap cholecystectomy + Laparoscopic CBD exploration

C. Open cholecystectomy + Trans duodenal sphincterotomy
D. Cholecystojejunostomy
E. Cholecystostomy
Q.212 A 30 years old female presented with pain right upper quadrant of abdomen and bilious vomiting
.on examination there is tenderness in right hypochondrium. USG revealed multiplegallstones. The
most appropriate treatment.
A. Lithotripsy
B. Conservative treatment
C. Laparoscopic cholecystectomy
D. Open cholecystectomy + CBD exploration
E. ERCP + Sphincterotomy
Q.213 A 60 years old male presented with jaundice, clay stool & dark urine.On examination the gall
bladder is palpable. His fasting blood sugar is 160mg/dl. USG showed dilated intra and extra
hepatic ducts and distended gall bladder. The most likely diagnosis is.
A. Stricture of CBD
B. CA head of pancreas
C. Stone CBD
D. Chronic pancreatitis
E. CA gall bladder
Q.214. A 75 years old male patient having coronary artery disease was found to have Gall bladder stones
while undergoing a routine USG of the abdomen. There was no history of biliary colic or jaundice at
any time. What is the treatment of choice for such a patient for his Gallstones.
A. Open cholecystectomy
B. Laparoscopic cholecystectomy
C. Observation and follow up only
D. ERCP and removal of stones
E. ESWL
Q.215. A 50-year-old man presented with a right cheek swelling that is discharging malodorous cheesy
discharge. Chest x-ray shows patchy shadows in the left apex. The most appropriate management strategy
for this patient is
A. Incision and drainage
B. Intravenous antibiotics
C. Sistrunk operation
D. Antituberculous chemotherapy
E. CT scan
Q.216. A 60 year old smoker presented with 2 cm neck lump in the posterior triangle .The FNAC is
inconclusive. What is your most appropriate next step in his management.
A. Counselling
B. CT scan of head, neck, thorax
C. Excisional biopsy
D. Radical neck dissection
E. Endoscopy of stomach
Q.217 A 70 year old man presented with 2 cm ulcer on right pinna with palpable neck lymph nodes. The
A. Syphilitic
B. Squamous cell carcinoma
C. Basal cell carcinoma
D. Tuberculosis
E. Melanoma
Q.218 A 14-year-old black girl had her right breast removed because of a large mass. The tumor weighed
1400 g and was found to have a bulging, very firm, lobulated surface with a whorl-like pattern. This
neoplasm is most likely
A. Cystosarcoma phylloides
B. Fibroadenoma
C. Intraductal carcinoma
D. Juvenile hypertrophy
E. Malignant lymphoma
Q.219 A 50 year female patient presented to you in the OPD with complaint of right breast lump FNAC
was done on this patient and it was found to be an intraductal carcinoma. Tumor is 5cm in size
mobile with palpable and mobile ipsilateral lymph nodes. However there is no other metastasis.
What is the stage of carcinoma in this patient.
A. Stage 1
B. Stage 2a
C. Stage 2b
D. Stage 3
E. Stage 4
Q.220 A 30-year-old female underwent total thyroidectomy necessitated by diagnosis of papillary

carcinoma. What would be the immediate management if this patient had a severe respiratory
embarrassment along with mass at operative site
A. Open stitches in OT
B. Tracheostomy
C. Pass Endotracheal tube

D. Conservative
E. Transfuse blood
Q.221 A 20 years old female presented in OPD with pain right lower quadrant for last 7 days, she is
anorexic. On examination there is mass palpable in the right iliac fossa & it is tender. Bowel sounds
audible. The next common appropriate investigation is.
A. Total leucocyte count
B. ESR
C. Ultrasonography
D. CT Scan
E. MRI
Q.222 A 70 year old man is diagnosed with carcinoma lip, his lesion is on middle one third of lower lip, 1x1
cm in size without any node involvement. The ideal management for this patient is
A. Chemo-radiotherapy
B. Local resection followed by radiotherapy
C. Excision with primary repair
D. Primary irradiation
E. Neoadjuvent chemotherapy
Q.223 A 26 year old man following a trip to dentist for a toothache presents with a tender neck swelling,
pyrexia and pain on swallowing .His tonsils are normal. The diagnosis for this patient is
A. Ludwig’s angina
B. Reactive lymphadenitis
C. Parapharyngeal abscess
D. Infected branchial cyst
E. Thyroiditis
Q.224 A 70-year-old woman has nausea, vomiting, abdominal distention, and episodic, crampy
midabdominal pain. She has no history of previous surgery but has a long history of cholelithiasis
for which she has refused surgery. Her abdominal radiograph reveals a spherical density in the right
lower quadrant.
Correct treatment should consist of
A. Ileocolectomy
B. Cholecystectomy
C. Ileotomy and extraction
D. Nasogastric tube decompression
E. Intravenous antibiotics
Q.225 A cirrhotic patient with abnormal coagulation studies due to hepatic synthetic dysfunction requires
bleeding due to surgery. The optimal timing of this transfusion would be
A. The day before surgery
B. The night before surgery
C. On call to surgery
D. One week before surgery
E. In the recovery room
Q.226 A 23-year-old woman undergoes total thyroidectomy for carcinoma of the thyroid gland. On the
quite anxious and later complains of muscle cramps. Initial therapy should consist of
A. 10 mL of 10% magnesium sulfate intravenously
B. Oral vitamin D
C. 100 µg of oral Synthroid
D. Infusion of calcium gluconate
E. Oral calcium gluconate
Q.227 While you are on duty in the emergency room, a 12-year-old boy arrives with pain and inflammation
organism is
A. Clostridium perfringens
B. Clostridium tetani
C. Staphylococcus
D. Escherichia coli
E. Streptococcus
Q.228 A 27-year-old man sustains a single gunshot wound to the left thigh. In the emergency room he is
examination there are weak pulses palpable distal to the injury and the patient is unable to move his
foot. The appropriate initial management of this patient would be
A. Angiography
B. Immediate exploration and repair
C. Fasciotomy of anterior compartment
D. Observation for resolution of spasm
E. Local wound exploration
Q.229 A 25 year old female presented with swelling in the right upper lateral side of neck, low grade fever
and night sweats. She looks pale. On examination the swelling is firm, non-tender and feels as matted
lymph nodes. The most appropriate investigation to confirm the diagnosis is
A. DLC
B. ESR
C. Excision Biopsy
D. FNAC
E. USG Neck
Q.230 A 20 year old male presented with swelling in the submandibular region and dysphagia. On
examination the swelling is hot and tender. There is edema floor of mouth. The most likely diagnosis is
A. Cold abscess
B. Ludwig angina
C. Submandibular lymphadenitis
D. Subhyoid dermoid cyst
E. Thyroglossal cyst
Q.231 A 30 year old male presented with severe facial trauma in the emergency. He is bleeding from the
patient
A. Chin lift
B. Cricothyroidotomy
C. Endotracheal intubation
D. Nasotracheal intubation
E. Oropharyngeal air way
Q.232 A 45 year old female presented with huge swelling in front of neck and difficulty in swallowing. On
examination the swelling is non-tender and firm in consistency. One nodule is palpable over the
swelling. The thyroid function test is within normal range. The most likely diagnosis is
A. Dominant nodule
B. Grave’s disease
C. Multinodular nodular goiter
D. Simple diffuse goiter
E. Solitary nodule
Q.233 A 20 year old female presented with swelling in the upper part of neck in the midline .On
examination the swelling moves with swallowing and tongue profuse it is firm in consistency. The
following is the most important investigation before proceeding for treatment
A. ESR
B. FNAC
C. Thyroid Scan
D. Thyroid function test
E. USG neck
Q.234 A 55 year old farmer gives history of change in size, shape and color of a long standing mole at the
back. On examination there is crusting and bleeding in the lesion .Axillary lymph nodes are
enlarged. The most likely diagnosis is
A. Basal cell carcinoma
B. Melanoma
C. Keratoacanthoma
D. Squamous cell carcinoma
E. Verrucous carcinoma
Q.235 A 40 year old male presented with solitary swelling in the right lobe of thyroid. The swelling
is hard in consistency and one lymph node is palpable in the neck. Thyroid function test is normal. The
next step to investigate this patient is
A. CT scan
B. FNAC
C. True cut biopsy
D. Thyroid Scan
E. USG neck
Q.236 A 50-year-old man presented with a right cheek swelling that is discharging malodorous cheesy
material. Chest x-ray shows patchy shadows in the left apex. The most appropriate management
strategy for this patient is
A. Incision and drainage
B. Intravenous antibiotics
C. Sistrunk operation
D. Antituberculous chemotherapy
E. CT scan
Q.237 A 60-year-old smoker presented with 2 cm neck lump in the posterior triangle .The FNAC is
inconclusive. What is your most appropriate next step in his management?
A. Counseling
B. CT scan of head, neck, thorax
C. Excisional biopsy
D. Radical neck dissection
E. Endoscopy of stomach
Q.238 A 70-year-old man presented with 2 cm ulcer on right pinna with palpable neck lymph nodes. The
A. Syphilitic
B. Squamous cell carcinoma
C. Basal cell carcinoma

D. Tuberculosis
E. Melanoma
Q.239 A 30-year-old female underwent total thyroidectomy necessitated by diagnosis of papillary

carcinoma. What would be the immediate management if this patient had a severe respiratory
embarrassment along with mass at operative site?
A. Open stitches in OT
B. Tracheostomy
C. Pass Endotracheal tube
D. Conservative
E. Transfuse blood
Q.240 A 70-year-old man is diagnosed with carcinoma lip. His lesion is on middle one third of lower lip.
1x1 cm in size without any node involvement. The ideal management for this patient is
A. Chemo-radiotherapy
B. Local resection followed by radiotherapy
C. Excision with primary repair
D. Primary irradiation
E. Neo-adjuvant chemotherapy
Q.241 A 42 years old man sustained gun shot wound to the abdomen and presented in shock. During his
management multiple units of packed red cewlls were transfused to resuscitate him. He complains of numbness
around his mouth and facial twitching on pre-auricular tapping. His ECG showed prolonged QT interval. The
treatment of choice in this patient is intravenous administration of
a) sodium bicarbonate
b) potassium chloride
c) calcium gluconate *
d) parathormone
e) magnesium Sulphate
Q.242 which of the following is associated with metabolic acidosis
a) Gastric aspiration
b) Diuretic therapy
c) Cushing syndrome
d) Primary aldosterone
e) Starvation
Q. 243 A 25 year old male was buried under the collapsed roof during earth quake. He was evacuated after 36
hours. On examination he was fully conscious and there was marked bruising of his both thigh with swelling.
Which of the following abnormalities this patient is likely to have
a) hypernatremia
b) hypercalcemia
c) hyperkalemia *
d) hyperglycemia
e) hyperchloremia
244. A 45 years school teacher presented with cystic swelling in the right scrotum. He has mild
discomfort in the swelling. On examination there are multiple grapes like swelling at the
epididymis. Testes is separately palpable and it is trans illuminable. The following is the
appropriate next step to make the diagnosis
a) Aspiration of cyst
b) Ultrasonography
c) Radiography
d) MRI
e) Vasography
245. A 51 years old postman presented with multiple cystic swellings in the scrotum which have
recurred after excision 6 months ago. The following one is the best management
a) Multiple aspirations
b) Inject Tetracycline in swelling
c) Partial epididymectomy
d) Inject steroids in it
e) Radiotherapy
246. A 40 years old shopkeeper presented with large cystic swelling in the scrotum. On examination
it is lax and present in the head of epididymis. It is nontender and transilluminable. On
aspiration the fluid is like barley water. It is most probably
a) Epididymal cyst
b) Spermatocele
c) Cyst of testicular appendages
d) Vaginal hydrocele
e) Testicular tumor
247. A 5 years old child presented with absence of right testes in the scrotum since birth. On
examination the testes is palpable in the inguinal canal. The right side of scrotum is not well
developed. The following one is the most likely factor for this condition.
a) Maternal ovarian hormone
b) Maternal Progesterone hormone
c) Maternal chorionic gonadotropin
d) Maternal prolactin
e) Follicle stimulating hormone
248. A 7 years old child presented with absence of both testes in the scrotum. On examination the
scrotum is not well formed. Testes are not palpable in the course of descent. USG is advised to
locate the testes. The following one is the most common site for the arrest of testes.
a) Inguinal canal
b) Above the internal ring
c) Superficial inguinal pouch
d) Base of penis
e) Femoral triangle
249. A 30 years old male presented with painless swelling in the right testes. He has feeling of
heaviness in the testes. On examination the swelling is hard like cricket ball. Testicular
sensation is lost. Rectal examination is normal. The following is the investigation to confirm the
diagnosis
a) CT scan
b) MRI
c) USG
d) FNAC
e) True cut biopsy
250. A 45 years old male presented with swelling in the left scrotum for 5 years. On examination the
swelling is about 8x6cm, firm and upper limit is reachable. It is fluctuant and transillumination
test is positive. The following one is the best option for its management
a) Aspiration of the swelling
b) Sclerotherapy
c) Subtotal excision of sac
d) Eversion of sac
e) Just watch it
251. 34 years old married male presented with pain in the right scrotum and dysuria for 3 days. On
examination the swelling is very tender and further examination is abandoned. He has relief of
pain while keep it elevated by wearing underwear. USG scrotum shows epididymis and testes
are edematous. The following one organism is most likely responsible for this condition.
a) Chlamydia
b) Gonococcus
c) Escherichia coli
d) Streptococcal
e) Proteus
252. A 20 years old male presented with hanging of right scrotum more then left side. He also
complains dragging discomfort. On examination the swelling feels like bag of worms. The test is
softer and smaller than other side. the treatment of choice is
a) Embolization of testicular vein
b) Low ligation
c) Middle ligation
d) High ligation
e) laparoscopic ligation of the testicular vein
253. A 12 years old child presented with sudden severe pain in the left testes for 3 hours. On
examination the left testes is lying transversally and pain is aggravated on lifting the testes.
The clinical diagnosis of torsion of testes is established. What is the next step in management?
a) Get USG to confirm the diagnosis
b) Get duplex scan to check viability of testes
c) Urgent exploration & orhiopexy affected side
d) Urgent exploration & bilateral orhiopexy
e) Detort the testes & give antibiotics
254. A 54 year old diabetic male suffering from acute intestinal obstruction for the last four days is
brought to the emergency in a semi conscious state. He has a 130/min feeble pulse and B.P. is
55/30 mm Hg. Respiratory rate is 45/min with coarse crepitations and he is anuric. On
examination the patient has cold and clammy skin and ankle oedema. At the moment the patient
is exhibiting which of the following complications?
a. Bactermia.
b. Septicemia.
c. Systemic inflammatory response syndrome (SIRS).
d. Multiple organ dysfunction syndrome (MODS).
e. Diabetic ketoacidosis.
255. A 40 year old chronic alcoholic is admitted in the intensive care unit with acute pancreatitis. His
parameters reveal decreased cardiac output, mixed venous saturation and venous pressure.
Vascular resistance and base deficit are raised. He is exhibiting which form of shock?
a. Hypovolaemic shock
b. Cardiogenic shock
c. Obstructive shock
d. Distributive shock
e. Endocrine shock
256. A 40 year old chronic alcoholic is admitted in the intensive care unit with acute pancreatitis. He
is conscious and has pulse of 84/min. his B.P. is 130/85 mmHg and respiratory rate is 16/min.
His urine output is 45 ml/Kg/ hr. The arterial blood gas analysis shows a pH of 7.38. This patient
is in
a. Compensated form of shock
b. Mild form of shock

c. Moderate form of shock
d. Severe form of shock
e. Multiple organ failure
257. A 45 year old female suffering from severe puerperal sepsis is brought to the emergency in semi
conscious state. Her vitals indicate pulse 136/min B.P. 60/30 mm Hg. She has tachypnnea and
severe oliguria. Despite adequate fluid resuscitation her blood pressure has not improved so you
intend to start inotropic support. The agent of first choice for this purpose will be
a. Dopamine
b. Dobutamine
c. Digoxin
d. Digitoxin
e. Beta blocker
258. Ten hours after an open cholecystectomy a patient suddenly develops generalized pain in the
abdomen. Clinically she is very pale and has cool extremities. Her blood pressure is 90/50 mm
Hg and the drainage bottle has suddenly filled. This is a typical example of
a. Concealed hemorrhage
b. Covert hemorrhage
c. Primary hemorrhage
d. Secondary hemorrhage
e. Reactionary hemorrhage
259. You are performing laparotomy on a 60 year old male with congestive heart failure who has
suffered from a road traffic accident. At laparotomy the liver was found to be shattered. During
surgery the patient went into cardiac arrest. What would be your course of action concerning
control of hemorrhage?
a. Arrest hemorrhage by suturing the liver and close the abdomen
b. Ligate the hepatic artery and close the abdomen
c. Perform immediate total hepatectomy and close the abdomen
d. Perform partial hepatectomy and close the abdomen
e. Pack the liver and close the abdomen and plan a second look after 48 hours
260. A thirty year old female suffered from post partum hemorrhage and had to be transfused eight
pints of blood during resuscitation. Concerned about post transfusion coagulopathy you need
which of the following investigations?
a. Serum electrolytes.
b. Blood grouping.
c. Activated partial thromboplastin time.
d. Complete blood count.
e. Urinary myoglobin levels

261. A 40 year old cirrhotic male presents to the emergency department with severe bleeding per
rectum. Two weeks ago he underwent band ligation for grade II hemorrhoids. What is the most
likely cause for this bleeding?
a. Ischemia of the vascular stump
b. Portal hypertension
c. Slipping of the ligature
d. Infection of the vascular stump
e. Defective coagulation
262. While performing a laparotomy for a shattered liver injury after a road traffic accident on a 60
year old male your patient goes into cardiac arrest. He is a known case of congestive heart
failure. At that moment one of your resident suggested performing damage control surgery.
What is the idea behind this?
a. Limit to the minimum necessary to arrest bleeding and control sepsis.
b. Control hemorrhage from the damaged tissue first.
c. Perform a definitive surgery to arrest hemorrhage.
d. Wait till the anaesthetist stabilizes the patient.
e. Avoid further damage by performing meticulous surgery.
263. A 35 year old female of average build underwent exploratory laparotomy for perforated
duodenal ulcer. On the 5th post operative day you have removed the drain and nasogastric tube.
His bowel sounds are audible. Serum electrolytes reveal Na+ = 141meq/L and K+= 4.3meq/L. To
maintain the daily sodium balance what should be his requirement for the next 24 hours?
a. 1 liter of 0.9% saline
b. 500 ml of 4.5% saline.
c. 500 ml of 0.9% saline.
d. 500 ml of1.8% saline.
e. 1 liter of 1.8% saline.
264. A 30 year old female presents to the emergency with abdominal distention and vomiting. On
examination the abdomen is distended tense and slightly tender. Bowel sounds are absent. The
patient had severe diarrhea 2 days ago. Her serum electrolyte shows Na+= 138mmol/L and K+=
3.1mmol/L. What should be the plan for replacement of potassium?
a. 40 mmol of KCl injection given directly I/V at 8 hourly interval.
b. 40 mmol of KCl diluted in 200 ml of fluid I/V at 8 hourly interval.
c. 20 mmol of KCl diluted in 100 cc of fluid I/V at 8 hourly interval.
d. 40 mmol of KCl diluted in 1 liter of fluid I/V at 8 hourly interval.
e. 20 mmol of KCl diluted in 50 cc of fluid I/V at 8 hourly interval.
265. A 16 year old female was found semi conscious in her room 1 hour after being scolded by her
parents for some misbehavior. On examination her pulse is 84/min, respiratory rate is 28/min,
B.P. is 110/70 mmHg and temperature is 98.8o F. Her hands were semi-flexed, flexion at MP
joint and extension at IP joints. What treatment would you suggest?
a. 100% O2 inhalation.
b. Breathing in a paper bag.
c. Place the patient on the ventilator.
d. Resuscitate the patient with ringer lactate.
e. Give O2 at 4 liters.
266. A 60 year old diabetic female is brought to the emergency in unconscious state. Her pulse is
115/min; B.P. is 90/60 mmHg. Her temperature is 98.4oF and Resp. Rate is 30/ min. Her
respiration is rapid and shallow with a fruity odor in the breath. Her ABG reveals
PH=7.31 PaO2=68mmHg PCO2=30mmhg HCO3─ =16 BE= -7.5
Na+=139mmol. K+=4.2mmol. CI─ =99mmol.
Which statement concerning the condition of the patient is TRUE?
a. There is an increase in the number of unmeasured cations.
b. There is an increase in the number of unmeasured anions.
c. The patient is exhibiting respiratory acidosis.─
d. The condition mandates assisted ventilation.
e. There is an increase in the number of measured anions.
267. A 30 year old female is brought to the emergency in severe respiratory distress. On
examination her pulse is 115/min and B.P is 80/40 mmHg. The extremities of the patient are
cold. Chest auscultation reveals both crepitations and ronchi. The symptoms began after eating
shell fish and rapidly worsened. This allergic condition is thought to be the result an antigen
combining with
a. IgE on the eosinophils.
b. IgE on the mast cells and basophils.
c. IgE on the monocytes and phagocytes.
d. IgE on the neutrophils and eosinophils.
e. IgE on the lymphocytes and target cells.
268. A 46 year old male suffering from perforated duodenal ulcer is referred to the emergency in
a comatose state. On examination his pulse is 130/min, B.P 70/nil, temp. is 99.6oF and
respiratory rate is 38/min and shallow. There is generalized edema of the face, hands and feet
present. Auscultation of the chest reveals fine crepitations. Which of the following statements
concerning the condition is TRUE?
a. Endotoxin mediated capillary leakage is the cause of fluid loss.
b. Endotoxin-IgE complex mediated immune is the cause of symptoms.
c. The condition is a typical example of warm endotoxin shock.

d. Mast cell degranulation is the cause of the symptoms.
e. Hemorrhage due to perforated duodenal ulcer is the cause of symptoms.
269. A 15 years old school boy presented with a small opening in the lower one third of left
sternocleidomastoid muscle since birth. He gives H/O discharge off and on. The following is the
most appropriate and cheap investigation to confirm the diagnosis.
a) Cytology of discharge
b) Culture of the discharge
c) CT scan
d) Fistulogram
e) MRI
270. A 30 year old teacher is going for excision of the branchial cyst on the left side of neck. The
following structure is less likely injured during procedure
a) Accessory Nerve
b) Glossopharyngeal nerve
c) Hypoglossal nerve
d) Recurrent laryngeal nerve
e) Vagus nerve
271. A 20 years old university student presented with soft swelling on the right side of neck. On
examination it is fluctuant, transilluminal and non-compressible .Aspiration cytology of swelling
shows granulomatous caseation. The following is the most likely diagnosis.
a) Branchial cyst
b) Cold abscess
c) Cystic hygroma
d) Pharyngeal pouch
e) Sebaceous cyst
272. A 30 years old bank manager presented with soft swelling on the right side of neck. On
examination, it is situated at the junction of upper and middle third of sternocleidomastoid
muscle. It is fluctuant, non-tender and non-compressible. The following is the best investigation
to confirm the diagnosis.
a) Excision biopsy
b) CT Scan
c) FNAC
d) MRI
e) USG
273. A 25 years old actress presented with swelling in front of neck. On examination it moves on
tongue protrusion. It is tense, non-tender and non-trans illuminable. The following is the best
investigation to rule out ectopic thyroid gland.
a) CT scan
b) MRI
c) Thyroid function test
d) Thyroid Scan
e) USG
274. An infant was born with obstructed labour due to large neck swelling. On examination, the
swelling is soft, compressible and brilliantly transilluminal. The following is the best treatment
option while counselling his mother.
a) Aspiration of the swelling
b) Excision of the swelling
c) Incision & drainage
d) Marsupialization of swelling
e) Picibanil (OK-432) should injected
275. A 2 years old child presented with neck swelling since birth. On examination, there is about
10x8cm soft, compressible, non-tender and brilliantly transilluminal swelling present in the
right posterior triangle of neck. The following one is the best investigation to confirm the
diagnosis.
a) X-Rays
b) USG
c) FNAC
d) MRI
e) Excision Biopsy
276. A 20 years old medical student present in emergency room with painful swelling in the
submandibular region .on examination he has strider . This swelling is brawny, tender and
lifting the tongue upward. He looks cyanosed. The following is the best next step to manage the
patient
a) Give narcotic analgesia
b) Do incision & drainage
c) Pass endotracheal tube
d) Give 3rd generation cephalosporin
e) Cricothyroidotomy
277. A 50 years old farmer from northern area presented with slowly enlarging painless swelling
neck. On examination it is firm, rubbery, pulsatile, mobile from side to side present at the side
of the thyroid cartilage. The following is the next step to investigate this patient.
a) Angiogram
b) CT scan
c) Duplex scan
d) FNAC
e) MRI
278. A 55 years old man underwent hemiglossectomy & radical neck dissection for squamous cell
carcinoma tongue left side. The following are the structures which removed during this
procedure.
a) All lymphatic tissue, sternocleidomastoid muscle, accessory nerve
b) All lymphatic tissue, sternocleidomastoid muscle, accessory nerve ,internal jugular vein
c) sternocleidomastoid muscle, accessory nerve ,internal jugular vein
d) All lymphatic tissue, sternocleidomastoid muscle, accessory nerve ,internal jugular vein
submandibular gland
e) sternocleidomastoid muscle, accessory nerve ,internal jugular vein ,submandibular gland
279. A 62 years old retired teacher presented with swelling left side of neck .she notices gurgling
noise from neck on swallowing and sometime experience fit of coughing. The following
investigation is helpful in making diagnosis.
a) CT scan
b) Endoscopy
c) MRI
d) Videofluroscopy
e) X-Rays
280. A 15 year old student presented with swelling in the midline. On examination, it is firm, on-
tender and mobile .After excision of swelling the wall contains epidermal appendages. The most
likely diagnosis is
a) Branchial cyst
b) Cold abscess
c) Dermoid cyst
d) Epidermoid cyst
e) Thyroglossal cyst
281. A neonate presented with painful swelling of middle third of sternocleidomastoid muscle after
birth trauma. On examination there is torticollis. The following is the most likely diagnosis.
a) Branchial cyst
b) Carotid body tumor
c) Cystic hygroma
d) Mastoid tumor
e) Thyroglossal cyst
282. A 30 years old house wife presented with hard swelling right supraclavicular region. She also
complains of pain in the right arm. On examination there is wasting and weakness of the small
muscles in the right hand. The following is the first line investigation to make diagnosis
a) Angiography
b) Duplex scan
c) MRI
d) Nerve conduction study
e) Radiography
283. A 17 years old student presented with multiple swelling in the neck. On examination the
swelling are discrete, rubbery and non-tender. Axillary lymph nodes are also palpable. Spleen is
enlarged .Radiograph chest shows hilar lymphadenopathy. The most likely diagnosis is
a) Tuberculosis lymphadenopathy
b) Hodgkin Lymphoma
c) Metastatic lymphadenopathy
d) Infectious mononucleosis
e) Toxoplasmosis

MCQ General Surgery DR Zahid

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MCQ for Final Professional MBBS

DR. Zahid Mahmood

a. Give antibiotic and send home

a. To treat wound infection with gm +ve organism

a. Remove the stitches and drain pus *

Q.9.In the above child the following is the appropriate management:

a. Primary suturing of wound

a. More in white races

a. The day before surgery

a. Basal cell carcinoma

Q.18 Boundaries of calot’s triangle are

a. CHD, cystic duct and liver *

a. The facial nerve passes posterior to the deep lobe

a. Loss of deep tendon reflexes *

a. Administration of hypertonic saline solution

a. Venogram, bed rest, heparin

a. 10 mL of 10% magnesium sulfate intravenously

Q.24. Prophylactic regimens of documented benefit in decreasing the risk of postoperative

a. Open cholecystectomy for cholelithiasis*

a. Take a chest x-ray

a. Bone marrow suppression

a. Daily foot bath

Q.31 In gridiron incision which nerve is vulnerable to injury?

Q. 32 Boundaries of calot’s triangle are

Q. 34 In the ideal immediate management of clean incised wound

Q.36 The true keloid scar

Q.37 In the pre-hospital management of an accident victim, effective care includes

Q.38 The best site for an intramuscular injection is the

Q.41 Sodium depletion (Hyponatremia)

a) Can be caused by increased secretion of aldosterone

Q.42 Clinical features associated with hemorrhagic shock include EXCEPT

a) Transmission of viral infection

Q.44 Blood for transfusion should be stored at

a) Upper arm circumference

a) Central venous line

Q.51 Clinical indications of nutritional support are all EXCEPT

a) Preoperative nutritional depletion

Q.52 A sequestration epithelial dermoid cyst is

a) Due to squamous cells being driven in by a needle

Q.54 All are the types of basal cell carcinoma EXCEPT

Q.55 A port wine stain (nervous flammus) is a

a) Premalignant lesion of skin

a) Circumferential bum of extremities

Q.59 An autograft is one where

Q.60 A full thickness burn

Q.61 A squamous cell carcinoma has

Q.66 All of the followings are features of buergers’s disease EXCEPT

Q.69 All of the following are characteristics of venous ulcers EXCEPT.

Q.72 All of the following are causes of lymphedema EXCEPT.

Q.75 All of the following are verities of regional anaesthesia EXCEPT

Q.78 All of the following malignant tumors are radiosensitive EXCEPT.

Q. 81 Boundaries of calot’s triangle are

Q.84 Five days after an uneventful cholecystectomy, an asymptomatic middle-aged woman is

Q.89 Prophylactic regimens of documented benefit in decreasing the risk of postoperative

Q.91 Compensatory mechanisms during acute hemorrhage include except.

Q.99All of the following are the complication of the radiotherapy except

Q.100 All of the following malignant tumors are radiosensitive except

Q.101 All of the following are varieties of regional anesthesia except

Q.103 All of the following are causes of lymph edema except