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OSPE Past Papers – BDS & MBBS

OSPE Past Papers – BDS & MBBS

A collection of OSPE (Objective Structured Practical Examination) papers in General Surgery by Prof. Dr. Zahid Mahmood, for BDS and MBBS Final Year students. Each paper can be viewed online or downloaded.

BDS OSPE Papers

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OSPE for 3rd Year BDS

BDS OSPE Paper

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OSPE – 3rd Professional BDS, UHS 2018

BDS OSPE Paper

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OSPE – BDS Annual 2019

BDS OSPE Paper

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OSPE for BDS (New Set)

BDS OSPE Paper

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OSPE – 3rd Professional BDS, UHS Annual 2023 (General Surgery)

BDS OSPE Paper

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OSPE – BDS Static Station 1

BDS OSPE Station Paper

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OSPE – BDS Static Station 2

BDS OSPE Station Paper

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OSPE – BDS Static Station 3

BDS OSPE Station Paper

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OSPE – BDS Static Station 4

BDS OSPE Station Paper

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OSPE – BDS Static Station 5

BDS OSPE Station Paper

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OSPE – BDS Static Station 6

BDS OSPE Station Paper

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OSPE – BDS Static Station 7

BDS OSPE Station Paper

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OSPE – BDS Static Station 8 (General Surgery)

BDS OSPE Station Paper

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OSPE – BDS Static Station 9

BDS OSPE Station Paper

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MBBS Final Year OSPE Papers

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OSPE – Final Year MBBS Surgery, Surgical Unit-II

MBBS OSPE Paper

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BDS OSPE Practice Stations (50)

Text-based practice stations (3 marks · 3 minutes each) covering general surgery topics relevant to BDS 3rd Professional. Attempt the tasks, then tap Show Key to reveal the model answer.

Station 1 · Hernia Marks: 3  |  Time: 3 min
A 55-year-old man presents with a swelling in the right groin that appears on standing and coughing, and disappears on lying down.
  1. What is the most likely diagnosis? (1)
  2. Name one clinical test to differentiate a direct from an indirect inguinal hernia. (1)
  3. What is the definitive treatment? (1)
Show Key
1. Inguinal hernia (1)
2. Deep ring occlusion test — occlude the deep inguinal ring with a finger and ask the patient to cough; an indirect hernia stays controlled, a direct hernia still bulges (1)
3. Hernia repair (mesh hernioplasty, e.g. Lichtenstein repair) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.64, The Abdominal Wall, Hernia
Station 2 · Wound Healing Marks: 3  |  Time: 3 min
A clean surgical incision is closed primarily with sutures and heals within days, leaving a fine linear scar.
  1. What type of wound healing is this? (1)
  2. Name one clinical example of the other type of healing. (1)
  3. Give one factor that delays wound healing. (1)
Show Key
1. Healing by primary intention (1)
2. Healing by secondary intention — e.g. an open, infected wound or a pressure sore healing by granulation (1)
3. Diabetes mellitus / infection / poor nutrition / steroid use / smoking (any one) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.3, Wound Healing and Tissue Repair
Station 3 · Surgical Incisions Marks: 3  |  Time: 3 min
A surgeon plans a gridiron (McBurney's) incision for an open appendicectomy.
  1. Name the layers split (not cut) in this muscle-splitting incision. (1.5)
  2. Give one advantage of a muscle-splitting incision over a muscle-cutting incision. (1.5)
Show Key
1. External oblique aponeurosis, internal oblique, and transversus abdominis — each split along its fibres (1.5)
2. Stronger wound with lower risk of incisional hernia; less bleeding (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.7, Basic Surgical Skills
Station 4 · Local Anaesthesia Marks: 3  |  Time: 3 min
A dental surgeon is about to infiltrate lignocaine with adrenaline before a minor oral procedure.
  1. What is the maximum safe dose of plain lignocaine (mg/kg)? (1)
  2. Why is adrenaline added to local anaesthetic solutions? (1)
  3. Name one early symptom of local anaesthetic toxicity. (1)
Show Key
1. 3 mg/kg (up to 7 mg/kg with adrenaline) (1)
2. Causes local vasoconstriction, reducing systemic absorption and prolonging the duration of action (1)
3. Perioral tingling / tinnitus / light-headedness / metallic taste (any one) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.23, Anaesthesia and Pain Relief
Station 5 · Sterilization Marks: 3  |  Time: 3 min
Surgical instruments are being prepared for reuse in the minor operating theatre.
  1. Name the most reliable method used to sterilize heat-stable surgical instruments. (1)
  2. What temperature and pressure combination is typically used? (1)
  3. How is successful sterilization confirmed? (1)
Show Key
1. Autoclaving (steam under pressure) (1)
2. 121°C at 15 psi for about 15–20 minutes (or 134°C for shorter cycles) (1)
3. Biological indicator (spore test) or autoclave/chemical indicator strip (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.7, Basic Surgical Skills
Station 6 · Surgical Drains Marks: 3  |  Time: 3 min
A closed suction drain is placed in a large wound cavity after breast surgery to prevent fluid collection.
  1. Name one other common indication for a surgical drain. (1)
  2. Differentiate an open drain from a closed drain. (1)
  3. Name one complication of leaving a drain in too long. (1)
Show Key
1. To drain an abscess, control a fistula, or monitor a suture line for leakage/bleeding (any one) (1)
2. Open drains (e.g. corrugated) drain onto a dressing; closed drains (e.g. Redivac) drain into a sealed collection system, reducing infection risk (1)
3. Ascending infection along the drain tract (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.7, Basic Surgical Skills
Station 7 · Wound Dehiscence Marks: 3  |  Time: 3 min
On the 6th postoperative day after a laparotomy, a patient coughs and notices pink serous fluid soaking through the dressing.
  1. What complication does this "pink fluid sign" suggest? (1)
  2. Name one local risk factor for this complication. (1)
  3. What is the immediate management? (1)
Show Key
1. Wound dehiscence (impending burst abdomen) (1)
2. Wound infection, poor surgical technique, obesity, raised intra-abdominal pressure (any one) (1)
3. Cover the wound with a sterile saline-soaked dressing and arrange emergency return to theatre for re-closure (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.24, Postoperative Care
Station 8 · Scarring Marks: 3  |  Time: 3 min
A young patient develops a raised, itchy scar after an ear-piercing wound that extends beyond the original wound margins.
  1. What is this type of scar called? (1)
  2. How does it differ from a hypertrophic scar? (1)
  3. Name one treatment option. (1)
Show Key
1. Keloid scar (1)
2. A keloid extends beyond the original wound margins and rarely regresses; a hypertrophic scar stays within the wound margins and often regresses with time (1)
3. Intralesional steroid injection, silicone sheeting, or pressure therapy (any one) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.3, Wound Healing and Tissue Repair
Station 9 · Surgical Site Infection Marks: 3  |  Time: 3 min
A patient develops fever, wound redness, and purulent discharge on the 4th postoperative day after an abdominal operation.
  1. Name two patient-related risk factors for surgical site infection. (1)
  2. Name one operative measure that reduces this risk. (1)
  3. What is the initial management? (1)
Show Key
1. Diabetes mellitus, obesity, smoking, immunosuppression, malnutrition (any two) (1)
2. Prophylactic antibiotics at induction, good aseptic technique, hair clipping instead of shaving (any one) (1)
3. Open and drain the wound, send pus for culture, and give appropriate antibiotics (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.5, Surgical Infection
Station 10 · Lipoma Marks: 3  |  Time: 3 min
A 40-year-old man notices a soft, painless, mobile lump on his back that has slowly enlarged over two years.
  1. What is the most likely diagnosis? (1)
  2. Name one clinical feature that would help confirm this diagnosis on examination. (1)
  3. What is the treatment if the lump is symptomatic? (1)
Show Key
1. Lipoma (1)
2. Soft, lobulated, fluctuant, with a slippage sign at the edge; skin moves freely over it (1)
3. Simple surgical excision (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.45, Skin and Subcutaneous Tissue
Station 11 · Sebaceous Cyst Marks: 3  |  Time: 3 min
A patient has a smooth, round swelling on the scalp with a visible central punctum, which is mobile over deeper structures but the skin cannot be pinched off it.
  1. What is the most likely diagnosis? (1)
  2. Why can the overlying skin not be moved separately from the swelling? (1)
  3. What is the definitive treatment? (1)
Show Key
1. Epidermoid (sebaceous) cyst (1)
2. Because the cyst arises from a blocked hair follicle/sebaceous gland duct within the dermis, so it is attached to the skin at the punctum (1)
3. Complete surgical excision of the cyst wall, including the punctum (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.45, Skin and Subcutaneous Tissue
Station 12 · Ganglion Marks: 3  |  Time: 3 min
A young woman presents with a smooth, cystic, non-tender swelling on the dorsum of her wrist that transilluminates.
  1. What is the most likely diagnosis? (1)
  2. What does it arise from? (1)
  3. Name one treatment option. (1)
Show Key
1. Ganglion cyst (1)
2. A myxoid degeneration of a joint capsule or tendon sheath containing thick, jelly-like fluid (1)
3. Aspiration or surgical excision (recurrence is common with aspiration alone) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.38, The Upper Limb
Station 13 · Abscess Marks: 3  |  Time: 3 min
A patient presents with a painful, tender, fluctuant swelling on the buttock with overlying erythema.
  1. What is the most likely diagnosis? (1)
  2. What is the principle of management? (1)
  3. Why are antibiotics alone usually insufficient? (1)
Show Key
1. Abscess (likely a boil/skin abscess) (1)
2. Incision and drainage — "where there is pus, let it out" (1)
3. Poor antibiotic penetration into the avascular pus-filled cavity (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.5, Surgical Infection
Station 14 · Cellulitis Marks: 3  |  Time: 3 min
A diabetic patient presents with a diffusely red, warm, tender area on the leg with no fluctuance or discharge.
  1. What is the most likely diagnosis? (1)
  2. How does this differ from an abscess on examination? (1)
  3. What is the mainstay of treatment? (1)
Show Key
1. Cellulitis (1)
2. Cellulitis is a diffuse spreading infection of skin and subcutaneous tissue with no localized collection or fluctuance, unlike an abscess (1)
3. Systemic antibiotics (surgical drainage is not required unless an abscess develops) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.5, Surgical Infection
Station 15 · Cervical Lymph Nodes Marks: 3  |  Time: 3 min
A patient presents with a firm, non-tender, enlarged lymph node in the anterior triangle of the neck.
  1. Name two groups of cervical lymph nodes you would examine. (1)
  2. Name one investigation to determine the cause of the lymphadenopathy. (1)
  3. Name one important malignant cause of a persistent neck node in an adult. (1)
Show Key
1. Submandibular, submental, jugulodigastric, posterior triangle, supraclavicular (any two) (1)
2. Fine needle aspiration cytology (FNAC) (1)
3. Metastatic squamous cell carcinoma from the oral cavity/pharynx, or lymphoma (any one) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.52, The Pharynx, Larynx and Neck
Station 16 · Tuberculous Lymphadenitis Marks: 3  |  Time: 3 min
A young patient presents with multiple matted, non-tender cervical lymph nodes and low-grade evening fever with weight loss.
  1. What is the most likely diagnosis? (1)
  2. Name one investigation to confirm it. (1)
  3. What is the mainstay of treatment? (1)
Show Key
1. Tuberculous cervical lymphadenitis (scrofula) (1)
2. FNAC showing caseating granulomas, or Gene Xpert/AFB stain of aspirate (1)
3. Anti-tuberculous therapy (standard 6-month ATT regimen) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.6, Tropical Infections and Infestations
Station 17 · Thyroglossal Cyst Marks: 3  |  Time: 3 min
A 10-year-old child has a midline neck swelling below the hyoid bone that moves upward on protruding the tongue.
  1. What is the most likely diagnosis? (1)
  2. Why does it move on tongue protrusion? (1)
  3. What is the operation of choice? (1)
Show Key
1. Thyroglossal cyst (1)
2. Because it is attached to the foramen caecum of the tongue via the thyroglossal tract, a remnant of thyroid gland descent (1)
3. Sistrunk's operation (excision of the cyst, tract, and central part of the hyoid bone) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.52, The Pharynx, Larynx and Neck
Station 18 · Branchial Cyst Marks: 3  |  Time: 3 min
A young adult presents with a smooth, fluctuant swelling at the anterior border of the upper third of sternocleidomastoid.
  1. What is the most likely diagnosis? (1)
  2. What is its embryological origin? (1)
  3. What is the treatment? (1)
Show Key
1. Branchial cyst (1)
2. A remnant of the second branchial cleft that fails to obliterate (1)
3. Complete surgical excision (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.52, The Pharynx, Larynx and Neck
Station 19 · Ludwig's Angina Marks: 3  |  Time: 3 min
A patient with a recent lower molar tooth infection develops rapidly progressive, painful swelling of the floor of the mouth with tongue elevation and difficulty breathing.
  1. What is this life-threatening condition called? (1)
  2. Which spaces are typically involved? (1)
  3. Name the most urgent step in management. (1)
Show Key
1. Ludwig's angina (1)
2. Submandibular, sublingual, and submental spaces, bilaterally (1)
3. Secure the airway first (may need urgent tracheostomy), then IV antibiotics and surgical drainage (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.5, Surgical Infection
Station 20 · Odontogenic Infection Spread Marks: 3  |  Time: 3 min
An untreated dental abscess of an upper canine tooth spreads infection into the surrounding soft tissue of the face.
  1. Name the facial space most likely to be involved from an upper canine infection. (1)
  2. Name one dangerous route of further spread from the face. (1)
  3. Why is this spread dangerous? (1)
Show Key
1. Canine (infraorbital) space (1)
2. Via the angular vein/ophthalmic veins into the cavernous sinus (1)
3. The facial vein has no valves, so infection can spread directly to the cavernous sinus, causing cavernous sinus thrombosis (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.5, Surgical Infection
Station 21 · Osteomyelitis of the Mandible Marks: 3  |  Time: 3 min
A patient presents with persistent jaw pain, swelling, and pus discharge weeks after a tooth extraction, with a loose sequestrum on X-ray.
  1. What is the most likely diagnosis? (1)
  2. Name the most common causative organism. (1)
  3. What is the principle of treatment? (1)
Show Key
1. Osteomyelitis of the mandible (1)
2. Staphylococcus aureus (1)
3. Prolonged appropriate antibiotics with surgical debridement/removal of the sequestrum (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.43, Infection of the Bones and Joints
Station 22 · Cleft Lip and Palate Marks: 3  |  Time: 3 min
A newborn is found to have a unilateral cleft lip and palate on routine examination.
  1. At what approximate age is cleft lip repair usually performed? (1)
  2. At what approximate age is cleft palate repair usually performed? (1)
  3. Name one functional problem this condition can cause before repair. (1)
Show Key
1. Around 3 months of age ("rule of 10s": weight >10 lb, Hb >10 g/dL, age >10 weeks) (1)
2. Around 6–12 months of age (1)
3. Feeding difficulty, speech problems, or recurrent otitis media (any one) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.50, Developmental Abnormalities of the Face
Station 23 · Sialolithiasis Marks: 3  |  Time: 3 min
A patient develops painful swelling of the floor of the mouth and submandibular region that worsens while eating.
  1. What is the most likely diagnosis? (1)
  2. Why does the swelling and pain worsen with eating? (1)
  3. Name one investigation to confirm the diagnosis. (1)
Show Key
1. Submandibular duct (Wharton's duct) stone — sialolithiasis (1)
2. Eating stimulates saliva production, which cannot drain past the obstructing stone, causing the gland to distend (1)
3. Plain X-ray (most submandibular stones are radio-opaque), or ultrasound/sialography (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.54, Disorders of the Salivary Glands
Station 24 · Mucocele Marks: 3  |  Time: 3 min
A patient has a small, painless, bluish, fluctuant swelling on the inner aspect of the lower lip after accidentally biting it.
  1. What is the most likely diagnosis? (1)
  2. What causes it? (1)
  3. What is the treatment? (1)
Show Key
1. Mucocele (mucous extravasation cyst) (1)
2. Trauma to a minor salivary gland duct causing leakage of mucus into the surrounding soft tissue (1)
3. Surgical excision of the lesion along with the associated minor salivary gland (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.54, Disorders of the Salivary Glands
Station 25 · Breast Lump Assessment Marks: 3  |  Time: 3 min
A 30-year-old woman presents with a palpable breast lump found on self-examination.
  1. Name the three components of "triple assessment" used to evaluate a breast lump. (1.5)
  2. Why is triple assessment used rather than a single test? (1.5)
Show Key
1. Clinical examination, imaging (ultrasound/mammography), and pathology (FNAC or core biopsy) (1.5)
2. Combining all three gives the highest diagnostic accuracy; any single test alone can miss a cancer (false negative) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.58, The Breast
Station 26 · Varicose Veins Marks: 3  |  Time: 3 min
A 45-year-old woman with a standing occupation presents with dilated, tortuous veins along the medial side of her leg.
  1. Name one special clinical test used to assess valve competence in varicose veins. (1)
  2. What does a positive cough impulse over the saphenofemoral junction suggest? (1)
  3. Name one conservative measure of management. (1)
Show Key
1. Trendelenburg test (or tourniquet test) (1)
2. Saphenofemoral junction incompetence (1)
3. Leg elevation, compression stockings, weight loss, regular exercise (any one) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.62, Venous Disorders
Station 27 · Intermittent Claudication Marks: 3  |  Time: 3 min
A 60-year-old smoker complains of cramping calf pain after walking a fixed distance, relieved by rest.
  1. What is this symptom called? (1)
  2. Name one bedside test/sign used to assess peripheral arterial disease. (1)
  3. Name one modifiable risk factor to address first. (1)
Show Key
1. Intermittent claudication (1)
2. Ankle–brachial pressure index (ABPI), or absent peripheral pulses (1)
3. Smoking cessation (also: diabetes/hypertension/hyperlipidaemia control) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.61, Arterial Disorders
Station 28 · Diabetic Foot Marks: 3  |  Time: 3 min
A diabetic patient presents with a painless, punched-out ulcer over the plantar aspect of the foot.
  1. Name one reason diabetic foot ulcers are typically painless. (1)
  2. Name one investigation to assess for underlying bone infection. (1)
  3. Name one general principle of management. (1)
Show Key
1. Peripheral neuropathy reduces protective sensation (1)
2. X-ray of the foot (or MRI) to look for osteomyelitis (1)
3. Good glycaemic control, wound debridement, off-loading pressure, and treating any infection (any one) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.61, Arterial Disorders
Station 29 · Burns Marks: 3  |  Time: 3 min
A patient sustains a scald injury with a red, blistered, painful wound that blanches on pressure.
  1. What depth of burn does this describe? (1)
  2. Name one different clinical feature of a full-thickness burn. (1)
  3. Name one immediate first-aid measure for a fresh burn. (1)
Show Key
1. Superficial partial-thickness (second-degree) burn (1)
2. Full-thickness burns are painless (nerve endings destroyed), leathery/waxy, and do not blanch (1)
3. Cool the burn with running water for 20 minutes (avoid ice) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.46, Burns
Station 30 · Fracture Types Marks: 3  |  Time: 3 min
An X-ray shows a broken bone with the skin intact over the fracture site.
  1. What is this type of fracture called? (1)
  2. What term describes a fracture with an overlying skin wound communicating with the bone? (1)
  3. Why is the second type considered a surgical emergency? (1)
Show Key
1. Closed (simple) fracture (1)
2. Open (compound) fracture (1)
3. High risk of contamination and osteomyelitis, requiring urgent wound debridement and antibiotics (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.7, Basic Surgical Skills
Station 31 · Gangrene Marks: 3  |  Time: 3 min
A diabetic patient's toe is black, shrivelled, and mummified, with a clear line of demarcation from healthy tissue and no signs of infection.
  1. What type of gangrene is this? (1)
  2. What feature would suggest wet gangrene instead? (1)
  3. Why is wet gangrene more dangerous? (1)
Show Key
1. Dry gangrene (1)
2. Swelling, foul-smelling discharge, and spreading infection/toxicity (1)
3. Bacterial infection and toxin absorption can rapidly cause sepsis and is limb/life-threatening, requiring urgent debridement or amputation (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.61, Arterial Disorders
Station 32 · Haemorrhage Control Marks: 3  |  Time: 3 min
A patient has brisk bleeding from a deep laceration of the forearm in the emergency room.
  1. What is the first-line method to control this bleeding? (1)
  2. If direct pressure fails, name one further measure. (1)
  3. Why should blind clamping of bleeding vessels be avoided? (1)
Show Key
1. Direct firm pressure over the wound with a sterile dressing (1)
2. Elevation of the limb, or a proximal tourniquet if life-threatening and uncontrolled (1)
3. Risk of injury to adjacent nerves and vessels; vessels should be clamped under direct vision (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.2, Shock, Haemorrhage and Transfusion
Station 33 · Blood Transfusion Marks: 3  |  Time: 3 min
A patient requires an urgent blood transfusion before surgery.
  1. Name the test performed before transfusion to check compatibility. (1)
  2. Which blood group is the universal donor? (1)
  3. Name one early sign of an acute haemolytic transfusion reaction. (1)
Show Key
1. Cross-matching (and ABO/Rh grouping) (1)
2. O negative (1)
3. Fever, chills, loin pain, or hypotension (any one) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.2, Shock, Haemorrhage and Transfusion
Station 34 · Shock Marks: 3  |  Time: 3 min
A trauma patient is cold, clammy, tachycardic, and hypotensive after a road traffic accident with an obvious limb deformity.
  1. What is the most likely type of shock? (1)
  2. Name one other major class of shock. (1)
  3. What is the first step in initial management? (1)
Show Key
1. Hypovolaemic (haemorrhagic) shock (1)
2. Cardiogenic, septic, neurogenic, or anaphylactic shock (any one) (1)
3. Secure airway and breathing, then gain IV access and start fluid resuscitation while controlling the source of bleeding (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.2, Shock, Haemorrhage and Transfusion
Station 35 · Preoperative Fasting Marks: 3  |  Time: 3 min
A patient is scheduled for elective surgery under general anaesthesia the next morning.
  1. Why is preoperative fasting required? (1)
  2. What is the standard minimum fasting time for solid food before elective surgery? (1)
  3. What is the standard minimum fasting time for clear fluids? (1)
Show Key
1. To reduce the risk of pulmonary aspiration of gastric contents during induction of anaesthesia (1)
2. 6 hours (1)
3. 2 hours (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.21, Preoperative Care
Station 36 · Informed Consent Marks: 3  |  Time: 3 min
A surgeon explains a planned operation, its risks, benefits, and alternatives to a patient before obtaining a signature on the consent form.
  1. Name the three key elements that make consent legally and ethically valid. (1.5)
  2. Who is the most appropriate person to take consent for an operation? (1.5)
Show Key
1. The patient must have capacity, be given adequate information, and consent voluntarily (without coercion) (1.5)
2. The operating surgeon (or a suitably trained member of the surgical team who understands the procedure) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.14, Ethics and Law in Surgical Practice
Station 37 · Biopsy Types Marks: 3  |  Time: 3 min
A surgeon needs tissue from a suspicious skin lesion to reach a diagnosis before planning definitive treatment.
  1. Name the type of biopsy that removes the entire lesion with a margin of normal tissue. (1)
  2. Name the type of biopsy that removes only a representative part of a large lesion. (1)
  3. Name a needle-based technique used to sample cells from a lump. (1)
Show Key
1. Excisional biopsy (1)
2. Incisional biopsy (1)
3. Fine needle aspiration cytology (FNAC), or core needle biopsy (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.11, Tissue and Molecular Diagnosis
Station 38 · Basal Cell Carcinoma Marks: 3  |  Time: 3 min
An elderly farmer presents with a slow-growing, pearly nodule with a rolled edge and central ulceration on the nose.
  1. What is the most likely diagnosis? (1)
  2. What is the main risk factor for this condition? (1)
  3. What is the treatment of choice? (1)
Show Key
1. Basal cell carcinoma (rodent ulcer) (1)
2. Chronic sun (UV) exposure (1)
3. Surgical excision with clear margins (Mohs surgery in cosmetically sensitive areas) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.45, Skin and Subcutaneous Tissue
Station 39 · Squamous Cell Carcinoma of the Lip Marks: 3  |  Time: 3 min
An elderly pipe-smoker presents with a non-healing, indurated ulcer with everted edges on the lower lip.
  1. What is the most likely diagnosis? (1)
  2. Name one major risk factor. (1)
  3. Where does this lesion most commonly spread first? (1)
Show Key
1. Squamous cell carcinoma of the lip (1)
2. Tobacco use (smoking or chewing), or chronic sun exposure (1)
3. Submental and submandibular lymph nodes (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.53, Oral Cavity Cancer
Station 40 · Oral Cancer Risk Factors Marks: 3  |  Time: 3 min
A patient who regularly chews betel nut (paan) with tobacco presents with a non-healing oral ulcer.
  1. Name two risk factors for oral cavity cancer relevant to this history. (1.5)
  2. Name one premalignant oral condition associated with chronic betel/tobacco use. (1.5)
Show Key
1. Betel nut (areca nut) chewing and tobacco use (smoking or smokeless); also alcohol (any two) (1.5)
2. Leukoplakia, erythroplakia, or oral submucous fibrosis (any one) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.53, Oral Cavity Cancer
Station 41 · Leukoplakia Marks: 3  |  Time: 3 min
A patient has a white patch on the buccal mucosa that cannot be scraped off.
  1. What is this lesion called? (1)
  2. Why is it clinically significant? (1)
  3. What is the next step in management? (1)
Show Key
1. Leukoplakia (1)
2. It is a premalignant condition with a risk of malignant transformation to squamous cell carcinoma (1)
3. Biopsy to assess for dysplasia, and removal of the causative irritant (e.g. stop tobacco/betel use) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.53, Oral Cavity Cancer
Station 42 · Parotid Abscess Marks: 3  |  Time: 3 min
An elderly, dehydrated postoperative patient develops painful swelling and redness over the parotid region with trismus.
  1. What is the most likely diagnosis? (1)
  2. Name one predisposing factor seen in this patient. (1)
  3. What is the principle of treatment? (1)
Show Key
1. Acute suppurative parotitis / parotid abscess (1)
2. Dehydration and poor oral hygiene reducing salivary flow, allowing ascending bacterial infection (1)
3. IV antibiotics, rehydration, and surgical drainage if an abscess has formed (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.54, Disorders of the Salivary Glands
Station 43 · Peritonsillar Abscess Marks: 3  |  Time: 3 min
A young adult presents with severe sore throat, trismus, drooling, and a muffled "hot potato" voice, with the uvula deviated away from the swollen tonsil.
  1. What is this condition called? (1)
  2. Name one investigation/procedure that is both diagnostic and therapeutic. (1)
  3. Name one serious potential complication if untreated. (1)
Show Key
1. Peritonsillar abscess (quinsy) (1)
2. Needle aspiration of the abscess (1)
3. Airway obstruction, or spread to the parapharyngeal space/mediastinum (any one) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.51, The Ear, Nose and Sinuses
Station 44 · Epistaxis Marks: 3  |  Time: 3 min
A patient presents to the emergency department with active bleeding from the nose.
  1. What is the most common site of bleeding in anterior epistaxis? (1)
  2. What is the first-line first-aid measure? (1)
  3. Name one method used if simple measures fail to stop the bleeding. (1)
Show Key
1. Little's area (Kiesselbach's plexus) on the anterior nasal septum (1)
2. Pinch the soft part of the nose firmly and lean forward for 10–15 minutes (1)
3. Anterior nasal packing, or cautery (silver nitrate/electrocautery) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.51, The Ear, Nose and Sinuses
Station 45 · Foreign Body Ingestion Marks: 3  |  Time: 3 min
A child presents after accidentally swallowing a coin, with mild drooling but no respiratory distress.
  1. Name the first investigation to localize the foreign body. (1)
  2. Where do sharp/impacted foreign bodies most commonly lodge in the oesophagus? (1)
  3. When is urgent endoscopic removal indicated? (1)
Show Key
1. Plain X-ray of the neck, chest and abdomen (1)
2. At the physiological narrowings, most commonly the cricopharyngeus (upper oesophageal sphincter) (1)
3. If there is respiratory distress, complete obstruction, a sharp object, or a button battery (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.9, Gastrointestinal Endoscopy
Station 46 · Hydrocele Marks: 3  |  Time: 3 min
A middle-aged man presents with a painless, smooth, cystic swelling of the scrotum that transilluminates and in which the testis cannot be felt separately.
  1. What is the most likely diagnosis? (1)
  2. Why does it transilluminate? (1)
  3. What is the treatment for a large symptomatic hydrocele? (1)
Show Key
1. Hydrocele (1)
2. It contains clear serous fluid within the tunica vaginalis, which readily transmits light (1)
3. Surgical repair (e.g. Jaboulay's or Lord's procedure) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.86, The Testis and Scrotum
Station 47 · Umbilical Hernia in Adults Marks: 3  |  Time: 3 min
An obese adult presents with a reducible swelling at the umbilicus that increases with straining.
  1. What is the most likely diagnosis? (1)
  2. Name one risk factor for this condition in adults. (1)
  3. Why is surgical repair generally advised in adults, unlike in infants? (1)
Show Key
1. Umbilical hernia (1)
2. Obesity, pregnancy, ascites, or chronic cough/constipation (any one) (1)
3. Adult umbilical hernias rarely close spontaneously and carry a risk of incarceration/strangulation, unlike most infantile umbilical hernias which often close by age 2–4 (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.64, The Abdominal Wall, Hernia
Station 48 · Boils and Carbuncles Marks: 3  |  Time: 3 min
A patient presents with a tender, red nodule around a hair follicle on the back of the neck, and another patient has a larger, deeper swelling with multiple discharging sinuses in the same area.
  1. What is the name of the smaller, single-follicle lesion (furuncle)? (1)
  2. What is the name of the larger, multi-loculated lesion with several sinuses? (1)
  3. Name the most common causative organism for both. (1)
Show Key
1. Boil (furuncle) — infection of a single hair follicle (1)
2. Carbuncle — infection of a group of adjacent hair follicles with multiple discharging sinuses (1)
3. Staphylococcus aureus (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.5, Surgical Infection
Station 49 · Necrotizing Fasciitis Marks: 3  |  Time: 3 min
A diabetic patient presents with rapidly spreading skin discolouration, severe pain out of proportion to visible signs, and crepitus over the affected limb.
  1. What is the most likely diagnosis? (1)
  2. Why is pain "out of proportion" to clinical signs a key warning feature? (1)
  3. What is the definitive management? (1)
Show Key
1. Necrotizing fasciitis (1)
2. It reflects rapid destruction of deep soft tissue and nerves along fascial planes, often before obvious skin changes appear — a red flag for this surgical emergency (1)
3. Urgent, aggressive surgical debridement of all necrotic tissue, along with broad-spectrum IV antibiotics (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.5, Surgical Infection
Station 50 · Surgical Hand Scrubbing Marks: 3  |  Time: 3 min
A surgeon prepares to enter the operating theatre for a clean elective procedure.
  1. Name the purpose of surgical hand scrubbing before an operation. (1)
  2. Name one commonly used antiseptic agent for surgical scrub. (1)
  3. How should hands be held after scrubbing and before gowning? (1)
Show Key
1. To reduce the resident and transient microbial flora on the hands and forearms, minimizing the risk of surgical site infection (1)
2. Chlorhexidine gluconate, or povidone-iodine (any one) (1)
3. Hands held up and away from the body, above elbow level, allowing water to drip from the elbows and not the fingertips (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.7, Basic Surgical Skills

MBBS Final Year OSPE Practice Stations (50)

Text-based practice stations (5 marks · 5 minutes each) covering major general surgery topics for Final Year MBBS. Attempt the tasks, then tap Show Key to reveal the model answer.

Station 1 · Acute Appendicitis Marks: 5  |  Time: 5 min
A 22-year-old woman presents with 18 hours of periumbilical pain that has now localized to the right iliac fossa, with anorexia, low-grade fever, and tenderness at McBurney's point.
  1. What is the most likely diagnosis? (1)
  2. Name two clinical signs that support this diagnosis. (1.5)
  3. What is the investigation of choice in an equivocal case, especially in a young woman? (1)
  4. What is the definitive management? (1.5)
Show Key
1. Acute appendicitis (1)
2. Rovsing's sign, psoas sign, obturator sign (any two) (1.5)
3. Ultrasound abdomen/pelvis (to exclude gynaecological causes); CT abdomen if still equivocal (1)
4. Appendicectomy — laparoscopic or open (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.76, The Vermiform Appendix
Station 2 · Gallstone Disease Marks: 5  |  Time: 5 min
A 48-year-old obese woman presents with colicky right upper quadrant pain radiating to the back, worse after fatty meals, with associated nausea.
  1. What is the most likely diagnosis? (1)
  2. What is the investigation of choice to confirm this? (1)
  3. Name Charcot's triad and the condition it suggests if all three are present. (1.5)
  4. What is the definitive treatment for symptomatic gallstones? (1.5)
Show Key
1. Biliary colic due to gallstones / cholelithiasis (1)
2. Ultrasound abdomen (1)
3. Fever with rigors, jaundice, RUQ pain — suggests ascending cholangitis (1.5)
4. Laparoscopic cholecystectomy (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.71, The Gallbladder and Bile Ducts
Station 3 · Perforated Peptic Ulcer Marks: 5  |  Time: 5 min
A 50-year-old man with a history of peptic ulcer disease presents with sudden-onset severe generalized abdominal pain, a rigid "board-like" abdomen, and absent bowel sounds.
  1. What is the most likely diagnosis? (1)
  2. Which imaging finding on an erect chest X-ray would support this diagnosis? (1)
  3. What is the definitive surgical management? (1.5)
  4. Name one supportive measure started before surgery. (1.5)
Show Key
1. Perforated peptic ulcer with generalized peritonitis (1)
2. Free gas (pneumoperitoneum) under the diaphragm (1)
3. Emergency laparotomy with Graham's omental patch repair of the perforation, and peritoneal lavage (1.5)
4. IV fluids, nasogastric decompression, broad-spectrum IV antibiotics, and analgesia (any one) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.67, The Stomach and Duodenum
Station 4 · Intestinal Obstruction Marks: 5  |  Time: 5 min
A patient with a previous laparotomy presents with colicky abdominal pain, distension, absolute constipation, and vomiting.
  1. What is the most likely underlying cause given the surgical history? (1)
  2. Name one classical clinical/radiological sign of small bowel obstruction on an erect abdominal X-ray. (1.5)
  3. What is the initial (conservative) management? (1)
  4. Name one indication for surgical intervention. (1.5)
Show Key
1. Adhesive intestinal obstruction (from the previous surgery) (1)
2. Multiple air–fluid levels ("step-ladder" pattern) with dilated central small bowel loops (1.5)
3. "Drip and suck" — IV fluid resuscitation, nasogastric tube decompression, and correction of electrolytes (1)
4. Signs of strangulation (peritonism, fever, tachycardia), or failure of conservative management (any one) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.78, Intestinal Obstruction
Station 5 · Acute Pancreatitis Marks: 5  |  Time: 5 min
A 45-year-old man with a history of alcohol use presents with severe epigastric pain radiating to the back, associated with vomiting and a serum amylase five times the upper limit of normal.
  1. What is the most likely diagnosis? (1)
  2. Name the two most common causes of this condition. (1)
  3. Name one severity scoring system used in this condition. (1)
  4. What is the initial management principle? (2)
Show Key
1. Acute pancreatitis (1)
2. Gallstones and alcohol (1)
3. Modified Glasgow (Imrie) score, Ranson's criteria, or APACHE II (any one) (1)
4. Aggressive IV fluid resuscitation, analgesia, nil by mouth initially, and close monitoring; treat the underlying cause once stable (2)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.72, The Pancreas
Station 6 · Acute Cholecystitis Marks: 5  |  Time: 5 min
A 40-year-old woman presents with continuous right upper quadrant pain, fever, and tenderness with a positive Murphy's sign.
  1. What is the most likely diagnosis? (1)
  2. What does a positive Murphy's sign indicate? (1)
  3. What is the investigation of choice? (1)
  4. What is the recommended timing of surgery? (2)
Show Key
1. Acute cholecystitis (1)
2. Arrest of inspiration on palpation of the RUQ due to pain — suggests an inflamed gallbladder (1)
3. Ultrasound abdomen (gallstones, wall thickening, pericholecystic fluid) (1)
4. Early laparoscopic cholecystectomy, ideally within 72 hours (1 week) of symptom onset (2)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.71, The Gallbladder and Bile Ducts
Station 7 · Ascending Cholangitis Marks: 5  |  Time: 5 min
A 60-year-old man presents with fever with rigors, jaundice, right upper quadrant pain, confusion, and hypotension.
  1. What is the most likely diagnosis? (1)
  2. Name the five features of Reynold's pentad seen in severe cases. (2)
  3. What is the first-line treatment? (1)
  4. Name one definitive procedure to relieve the obstruction. (1)
Show Key
1. Acute (ascending) cholangitis (1)
2. Fever with rigors, jaundice, RUQ pain, hypotension, and altered mental status (2)
3. IV fluids and broad-spectrum antibiotics (1)
4. Endoscopic retrograde cholangiopancreatography (ERCP) with biliary drainage/stenting (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.71, The Gallbladder and Bile Ducts
Station 8 · Amoebic Liver Abscess Marks: 5  |  Time: 5 min
A young man from an endemic area presents with fever, right upper quadrant pain, and tender hepatomegaly, with a hypoechoic lesion on ultrasound.
  1. What is the most likely diagnosis? (1)
  2. Name the most common causative organism. (1)
  3. What is the first-line drug treatment? (1.5)
  4. Name one indication for percutaneous aspiration. (1.5)
Show Key
1. Amoebic liver abscess (1)
2. Entamoeba histolytica (1)
3. Metronidazole (1.5)
4. Large abscess (>5 cm), left lobe abscess (risk of pericardial rupture), or failure to respond to drug therapy after 72 hours (any one) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.69, The Liver
Station 9 · Splenic Trauma Marks: 5  |  Time: 5 min
A young man involved in a road traffic accident presents with left upper quadrant pain, left shoulder tip pain, and hypotension.
  1. What is the most likely diagnosis? (1)
  2. Name the referred pain sign described and its cause. (1)
  3. Name the initial bedside investigation of choice in a haemodynamically unstable trauma patient. (1.5)
  4. What is the management principle in a haemodynamically stable patient with a minor splenic injury? (1.5)
Show Key
1. Splenic injury/rupture (1)
2. Kehr's sign — referred pain to the left shoulder due to diaphragmatic irritation from blood (1)
3. FAST (Focused Assessment with Sonography for Trauma) scan (1.5)
4. Non-operative management with close monitoring (splenic conservation) if stable; splenectomy if unstable or high-grade injury (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.70, The Spleen
Station 10 · Upper GI Bleeding Marks: 5  |  Time: 5 min
A patient with known liver cirrhosis presents with sudden-onset large-volume haematemesis and hypotension.
  1. What is the most likely source of bleeding in this patient? (1)
  2. Name the initial resuscitation priority. (1)
  3. Name one drug used to reduce portal pressure acutely. (1)
  4. Name the definitive endoscopic treatment. (2)
Show Key
1. Bleeding oesophageal varices (due to portal hypertension from cirrhosis) (1)
2. Airway protection, IV access with fluid/blood resuscitation, and correction of coagulopathy (1)
3. Terlipressin (or octreotide) (1)
4. Endoscopic variceal band ligation (or sclerotherapy) (2)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.66, The Oesophagus
Station 11 · Lower GI Bleeding Marks: 5  |  Time: 5 min
An elderly patient presents with painless, bright red bleeding per rectum mixed with stool over the past week.
  1. Name two common causes of lower GI bleeding in this age group. (1.5)
  2. What is the investigation of choice to localize the source? (1.5)
  3. Name one red flag symptom that would raise suspicion of malignancy. (2)
Show Key
1. Diverticular disease and colorectal carcinoma (also haemorrhoids, angiodysplasia) (1.5)
2. Colonoscopy (1.5)
3. Weight loss, change in bowel habit, or iron deficiency anaemia (any one) (2)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.77, The Large Intestine
Station 12 · Carcinoma of the Colon Marks: 5  |  Time: 5 min
A 65-year-old man presents with altered bowel habit, weight loss, and iron deficiency anaemia, with a mass palpable in the right iliac fossa.
  1. What is the most likely diagnosis? (1)
  2. What is the investigation of choice to confirm and biopsy the lesion? (1)
  3. Name the tumour marker used to monitor this condition. (1)
  4. What staging system is commonly used? (2)
Show Key
1. Carcinoma of the caecum/ascending colon (1)
2. Colonoscopy with biopsy (1)
3. CEA (carcinoembryonic antigen) (1)
4. TNM staging (or Dukes' staging) (2)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.77, The Large Intestine
Station 13 · Carcinoma of the Rectum Marks: 5  |  Time: 5 min
A 58-year-old man presents with tenesmus and blood mixed with stool, and a hard, irregular mass is felt on digital rectal examination.
  1. What is the most likely diagnosis? (1)
  2. Name the imaging modality used for local staging of this tumour. (1)
  3. Name one treatment option used before surgery for locally advanced rectal cancer. (1.5)
  4. What is the surgical procedure for a low rectal tumour close to the anal sphincter? (1.5)
Show Key
1. Carcinoma of the rectum (1)
2. MRI pelvis (for local staging) (1)
3. Neoadjuvant chemoradiotherapy (1.5)
4. Abdominoperineal resection (APR) with permanent colostomy (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.79, The Rectum
Station 14 · Inflammatory Bowel Disease Marks: 5  |  Time: 5 min
A young adult presents with chronic bloody diarrhoea, abdominal pain, and weight loss, with colonoscopy showing continuous mucosal inflammation starting from the rectum.
  1. What is the most likely diagnosis? (1)
  2. Name the other major inflammatory bowel disease and one feature that distinguishes it. (1.5)
  3. Name one extra-intestinal manifestation of inflammatory bowel disease. (1)
  4. Name the surgical procedure of choice for medically refractory disease confined to the colon. (1.5)
Show Key
1. Ulcerative colitis (1)
2. Crohn's disease — causes skip lesions and can affect any part of the GI tract (mouth to anus) with transmural inflammation, unlike the continuous, mucosa-limited, rectum-starting pattern of ulcerative colitis (1.5)
3. Erythema nodosum, pyoderma gangrenosum, uveitis, or ankylosing spondylitis (any one) (1)
4. Total proctocolectomy with ileal pouch–anal anastomosis (IPAA) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.75, Inflammatory Bowel Disease
Station 15 · Anal Fissure Marks: 5  |  Time: 5 min
A young patient complains of severe, sharp pain during and after defecation, with a small amount of bright red blood on the toilet paper.
  1. What is the most likely diagnosis? (1)
  2. Where is the fissure most commonly located? (1)
  3. What is the first-line medical treatment? (1.5)
  4. Name one surgical option for chronic, refractory cases. (1.5)
Show Key
1. Anal fissure (1)
2. Posterior midline (relatively avascular watershed area) (1)
3. Topical glyceryl trinitrate (GTN) or diltiazem ointment, with stool softeners and increased fibre/fluid intake (1.5)
4. Lateral internal sphincterotomy, or botulinum toxin injection (any one) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.80, The Anus and Anal Canal
Station 16 · Fistula-in-Ano Marks: 5  |  Time: 5 min
A patient presents with a recurrent, intermittently discharging opening near the anus, with a history of a previously drained perianal abscess.
  1. What is the most likely diagnosis? (1)
  2. Name the rule used to predict the internal opening based on the external opening's position. (1)
  3. Name one investigation used to delineate the fistula tract before surgery. (1.5)
  4. Why must the relationship of the tract to the anal sphincters be carefully assessed before surgery? (1.5)
Show Key
1. Fistula-in-ano (1)
2. Goodsall's rule (1)
3. MRI pelvis, or examination under anaesthesia with probing (any one) (1.5)
4. Because dividing too much sphincter muscle during fistulotomy risks faecal incontinence (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.80, The Anus and Anal Canal
Station 17 · Haemorrhoids Marks: 5  |  Time: 5 min
A patient presents with painless, bright red bleeding per rectum after defecation and a swelling that reduces spontaneously.
  1. What is the most likely diagnosis? (1)
  2. What grade of haemorrhoids does spontaneous reduction after prolapse represent? (1)
  3. Name one non-surgical outpatient treatment option. (1.5)
  4. Name the surgical procedure of choice for large, grade IV haemorrhoids. (1.5)
Show Key
1. Internal haemorrhoids (1)
2. Grade III (prolapses with straining/defecation and reduces spontaneously) (1)
3. Rubber band ligation, sclerotherapy, or infrared coagulation (any one) (1.5)
4. Open (Milligan–Morgan) or closed (Ferguson) haemorrhoidectomy; stapled haemorrhoidopexy is an alternative (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.80, The Anus and Anal Canal
Station 18 · Pilonidal Sinus Marks: 5  |  Time: 5 min
A young, hirsute man presents with recurrent painful discharging swelling in the natal cleft over the sacrococcygeal region.
  1. What is the most likely diagnosis? (1)
  2. Name one predisposing factor for this condition. (1)
  3. What is the definitive treatment for chronic disease? (1.5)
  4. Name one measure to prevent recurrence after healing. (1.5)
Show Key
1. Pilonidal sinus disease (1)
2. Excess body hair, obesity, prolonged sitting, or poor hygiene (any one) (1)
3. Surgical excision of the sinus tract(s), with primary closure or healing by secondary intention/flap reconstruction (1.5)
4. Regular hair removal/shaving of the natal cleft and good hygiene (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.45, Skin and Subcutaneous Tissue
Station 19 · Rectal Prolapse Marks: 5  |  Time: 5 min
An elderly woman presents with a mass protruding from the anus on straining, which appears as concentric mucosal folds.
  1. What is the most likely diagnosis? (1)
  2. How would you differentiate a full-thickness rectal prolapse from prolapsed haemorrhoids on examination? (1.5)
  3. Name one predisposing factor. (1)
  4. Name one surgical treatment option. (1.5)
Show Key
1. Rectal prolapse (procidentia) (1)
2. A full-thickness prolapse shows concentric mucosal folds/rings, while prolapsed haemorrhoids show radial grooves between individual haemorrhoidal cushions (1.5)
3. Chronic straining/constipation, multiparity, or pelvic floor weakness (any one) (1)
4. Abdominal rectopexy (or perineal procedure such as Delorme's/Altemeier's in frail patients) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.79, The Rectum
Station 20 · Sigmoid Volvulus Marks: 5  |  Time: 5 min
An elderly, chronically constipated patient presents with gross abdominal distension and a coffee-bean-shaped loop of bowel on abdominal X-ray.
  1. What is the most likely diagnosis? (1)
  2. What is the first-line management if there are no signs of peritonism? (1.5)
  3. Name one indication for emergency surgery in this condition. (1.5)
  4. Name the definitive surgical procedure to prevent recurrence. (1)
Show Key
1. Sigmoid volvulus (1)
2. Endoscopic (sigmoidoscopic) decompression and flatus tube insertion (1.5)
3. Signs of peritonitis, bowel gangrene, or failed endoscopic decompression (any one) (1.5)
4. Sigmoid colectomy (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.78, Intestinal Obstruction
Station 21 · Intussusception Marks: 5  |  Time: 5 min
A well-nourished infant presents with episodic colicky abdominal pain, drawing up of the legs, vomiting, and "redcurrant jelly" stool.
  1. What is the most likely diagnosis? (1)
  2. Name the most common site. (1)
  3. What is the investigation of choice, which can also be therapeutic? (1.5)
  4. Name one indication for surgery rather than non-operative reduction. (1.5)
Show Key
1. Intussusception (1)
2. Ileocaecal (ileocolic) region (1)
3. Air or hydrostatic (contrast/ultrasound-guided saline) enema reduction (1.5)
4. Peritonitis, perforation, failed enema reduction, or a pathological lead point (any one) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.17, Paediatric Surgery
Station 22 · Strangulated Hernia Marks: 5  |  Time: 5 min
A patient with a known inguinal hernia presents with a tender, irreducible, erythematous groin swelling associated with vomiting and absolute constipation.
  1. What complication of the hernia does this presentation suggest? (1)
  2. What is the underlying pathophysiology causing pain and tenderness? (1.5)
  3. Why is this a surgical emergency? (1)
  4. What is the definitive management? (1.5)
Show Key
1. Strangulation of the hernia (with obstruction) (1)
2. The neck of the hernial sac compromises the blood supply to the contained bowel, causing ischaemia (1.5)
3. Ischaemic bowel can rapidly become gangrenous and perforate, causing peritonitis and sepsis (1)
4. Emergency surgery to reduce/resect any non-viable bowel and repair the hernia (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.64, The Abdominal Wall, Hernia
Station 23 · Femoral Hernia Marks: 5  |  Time: 5 min
A middle-aged woman presents with a small, tender lump below and lateral to the pubic tubercle.
  1. What is the most likely diagnosis? (1)
  2. Name the borders of the femoral canal through which this hernia passes. (1.5)
  3. Why does this type of hernia carry a higher risk of strangulation than an inguinal hernia? (1)
  4. What is the treatment? (1.5)
Show Key
1. Femoral hernia (1)
2. Anteriorly the inguinal ligament, posteriorly the pectineal ligament, medially the lacunar ligament, and laterally the femoral vein (1.5)
3. The femoral canal is a narrow, rigid space, so the hernia is more likely to become tightly constricted (1)
4. Surgical repair (e.g. Lockwood's low approach, or laparoscopic repair) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.64, The Abdominal Wall, Hernia
Station 24 · Incisional Hernia Marks: 5  |  Time: 5 min
A patient who underwent a laparotomy 6 months ago presents with a bulge at the site of the old surgical scar that increases with straining.
  1. What is the most likely diagnosis? (1)
  2. Name two risk factors for this condition. (1.5)
  3. What is the principle of surgical repair? (1.5)
  4. Name one measure to reduce the risk of this complication after future surgeries. (1)
Show Key
1. Incisional hernia (1)
2. Wound infection, obesity, poor nutrition, smoking, or emergency surgery (any two) (1.5)
3. Repair with mesh reinforcement (open or laparoscopic) to reduce recurrence (1.5)
4. Meticulous closure technique, using appropriate suture material, and optimizing risk factors before elective surgery (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.64, The Abdominal Wall, Hernia
Station 25 · Breast Carcinoma Marks: 5  |  Time: 5 min
A 55-year-old woman presents with a hard, irregular, painless breast lump fixed to the skin, with dimpling over it.
  1. What is the most likely diagnosis? (1)
  2. What causes the skin dimpling seen in this condition? (1)
  3. Name the staging system used for breast cancer. (1)
  4. Name one component of modern multidisciplinary treatment. (2)
Show Key
1. Carcinoma of the breast (1)
2. Infiltration of the suspensory (Cooper's) ligaments by tumour, causing traction on the overlying skin (1)
3. TNM staging (1)
4. Surgery (breast-conserving or mastectomy), with adjuvant chemotherapy, radiotherapy, hormonal therapy, or targeted therapy as indicated (any one) (2)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.58, The Breast
Station 26 · Fibroadenoma Marks: 5  |  Time: 5 min
An 18-year-old woman presents with a firm, smooth, highly mobile breast lump that does not change with the menstrual cycle.
  1. What is the most likely diagnosis? (1)
  2. Why is this lump often called a "breast mouse"? (1)
  3. What is the investigation of choice in this age group? (1.5)
  4. What is the management if the lump is small and clinically/radiologically benign? (1.5)
Show Key
1. Fibroadenoma (1)
2. Because of its marked mobility under the examining fingers (1)
3. Ultrasound of the breast (preferred over mammography in young women with dense breast tissue) (1.5)
4. Reassurance and conservative follow-up (excision only if large, symptomatic, or patient preference) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.58, The Breast
Station 27 · Breast Abscess Marks: 5  |  Time: 5 min
A breastfeeding mother presents with a painful, red, fluctuant swelling in the breast with fever.
  1. What is the most likely diagnosis? (1)
  2. Name the most common causative organism. (1)
  3. What is the preferred initial treatment for a small collection? (1.5)
  4. Should breastfeeding be stopped on the affected side? (1.5)
Show Key
1. Lactational breast abscess (1)
2. Staphylococcus aureus (1)
3. Ultrasound-guided needle aspiration with antibiotics (surgical drainage reserved for large/multiloculated abscesses) (1.5)
4. No — continued breastfeeding/expression is encouraged from both sides to aid drainage and prevent milk stasis (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.58, The Breast
Station 28 · Papillary Thyroid Carcinoma Marks: 5  |  Time: 5 min
A young woman presents with a painless thyroid nodule and a firm cervical lymph node, with FNAC showing Orphan Annie eye nuclei.
  1. What is the most likely diagnosis? (1)
  2. What is the most common route of spread of this cancer? (1)
  3. What is the surgical treatment of choice? (1.5)
  4. What is the overall prognosis of this type of thyroid cancer? (1.5)
Show Key
1. Papillary thyroid carcinoma (1)
2. Lymphatic spread to cervical lymph nodes (1)
3. Total thyroidectomy (with central/lateral neck dissection if nodes are involved) (1.5)
4. Excellent prognosis — it is the most common and least aggressive type of thyroid cancer (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.55, The Thyroid Gland
Station 29 · Multinodular Goitre Marks: 5  |  Time: 5 min
An elderly woman with a long-standing multinodular goitre presents with progressive difficulty breathing, worse on lying flat.
  1. What complication of the goitre is likely causing these symptoms? (1)
  2. Name the sign elicited by asking the patient to raise both arms above the head, which becomes positive in this complication. (1.5)
  3. Which imaging investigation best delineates the extent of this complication? (1)
  4. What is the definitive treatment? (1.5)
Show Key
1. Retrosternal extension of the goitre causing tracheal compression (1)
2. Pemberton's sign — facial congestion/plethora and respiratory distress on raising both arms, due to thoracic inlet obstruction (1.5)
3. CT scan of the neck and thorax (1)
4. Total thyroidectomy (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.55, The Thyroid Gland
Station 30 · Primary Hyperparathyroidism Marks: 5  |  Time: 5 min
A patient presents with recurrent renal stones, bone pain, and abdominal pain, and blood tests show raised serum calcium with raised parathyroid hormone.
  1. What is the most likely diagnosis? (1)
  2. Name the classic mnemonic used to remember its clinical features. (1)
  3. Name the most common cause of this condition. (1.5)
  4. What is the definitive treatment? (1.5)
Show Key
1. Primary hyperparathyroidism (1)
2. "Bones, stones, abdominal groans, and psychiatric moans" (1)
3. A solitary parathyroid adenoma (1.5)
4. Surgical parathyroidectomy (removal of the adenoma) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.56, The Parathyroid Glands
Station 31 · Phaeochromocytoma Marks: 5  |  Time: 5 min
A patient presents with episodic severe headache, palpitations, sweating, and hypertension, and is found to have an adrenal mass on CT.
  1. What is the most likely diagnosis? (1)
  2. Name the biochemical test used to confirm the diagnosis. (1)
  3. Why must alpha-blockade be started before beta-blockade in preoperative preparation? (1.5)
  4. What is the definitive treatment? (1.5)
Show Key
1. Phaeochromocytoma (1)
2. 24-hour urinary (or plasma) fractionated metanephrines/catecholamines (1)
3. Starting a beta-blocker first can cause unopposed alpha-adrenergic vasoconstriction, precipitating a severe hypertensive crisis (1.5)
4. Surgical adrenalectomy after adequate alpha- (then beta-) blockade (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.57, The Adrenal Glands
Station 32 · Carotid Body Tumour Marks: 5  |  Time: 5 min
A patient presents with a slow-growing, pulsatile, painless neck mass at the level of the carotid bifurcation that moves side-to-side but not vertically.
  1. What is the most likely diagnosis? (1)
  2. What is this characteristic mobility finding called? (1)
  3. Name the investigation of choice to confirm the diagnosis and delineate its blood supply. (1.5)
  4. What is the definitive treatment? (1.5)
Show Key
1. Carotid body tumour (paraganglioma) (1)
2. Fontaine's sign (1)
3. CT or MR angiography ("lyre sign" — splaying of the internal and external carotid arteries) (1.5)
4. Surgical excision (with preoperative embolization in selected large tumours) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.52, The Pharynx, Larynx and Neck
Station 33 · Varicose Vein Management Marks: 5  |  Time: 5 min
A patient with symptomatic, ultrasound-confirmed great saphenous vein reflux and skin changes requests definitive treatment.
  1. Name one investigation used to map venous reflux before intervention. (1)
  2. Name one minimally invasive endovenous treatment option. (1.5)
  3. Name one indication for compression stockings as sole management. (1)
  4. Name one complication of untreated long-standing varicose veins. (1.5)
Show Key
1. Duplex ultrasound of the lower limb venous system (1)
2. Endovenous laser ablation (EVLA), or radiofrequency ablation (any one) (1.5)
3. Patient unfit for or declining intervention, or mild disease without complications (any one) (1)
4. Venous ulceration, lipodermatosclerosis, or superficial thrombophlebitis (any one) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.62, Venous Disorders
Station 34 · Deep Vein Thrombosis Marks: 5  |  Time: 5 min
A postoperative patient develops a painful, swollen, warm left calf on the third postoperative day.
  1. What is the most likely diagnosis? (1)
  2. Name the scoring system used to assess pretest clinical probability. (1)
  3. What is the investigation of choice to confirm the diagnosis? (1.5)
  4. Name the most feared acute complication of this condition. (1.5)
Show Key
1. Deep vein thrombosis (DVT) (1)
2. Wells score (1)
3. Duplex (compression) ultrasound of the leg veins (1.5)
4. Pulmonary embolism (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.62, Venous Disorders
Station 35 · Critical Limb Ischaemia Marks: 5  |  Time: 5 min
A diabetic smoker presents with rest pain in the foot at night, relieved by hanging the leg over the side of the bed, with absent pedal pulses.
  1. What is the most likely diagnosis? (1)
  2. Why is the pain relieved by dependency? (1)
  3. Name the first-line non-invasive investigation to assess arterial supply. (1.5)
  4. Name the definitive investigation before planning revascularization. (1.5)
Show Key
1. Critical limb ischaemia (1)
2. Gravity increases arterial perfusion pressure to the ischaemic foot, temporarily improving blood flow and reducing pain (1)
3. Ankle–brachial pressure index (ABPI) (1.5)
4. CT angiography (or conventional/digital subtraction angiography) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.61, Arterial Disorders
Station 36 · Abdominal Aortic Aneurysm Marks: 5  |  Time: 5 min
A 70-year-old male smoker is found to have an incidental pulsatile, expansile mass in the abdomen on examination.
  1. What is the most likely diagnosis? (1)
  2. What is the first-line screening/diagnostic investigation? (1)
  3. At what approximate diameter is elective repair generally recommended? (1.5)
  4. How does a patient with a ruptured aneurysm of this type typically present? (1.5)
Show Key
1. Abdominal aortic aneurysm (AAA) (1)
2. Abdominal ultrasound (1)
3. Around 5.5 cm (or rapid growth >1 cm/year, or symptomatic aneurysm) (1.5)
4. Sudden severe abdominal/back pain, a pulsatile abdominal mass, and hypotension/shock (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.61, Arterial Disorders
Station 37 · Fluid Resuscitation in Burns Marks: 5  |  Time: 5 min
An adult patient weighing 70 kg sustains 30% total body surface area burns and requires fluid resuscitation.
  1. Name the formula commonly used to calculate initial fluid requirements in burns. (1)
  2. What type of fluid is typically used? (1)
  3. Over what time period is the calculated first-24-hour volume given, and how is it distributed? (1.5)
  4. Name one parameter used to monitor adequacy of resuscitation. (1.5)
Show Key
1. Parkland formula (1)
2. Crystalloid, usually Ringer's lactate/Hartmann's solution (1)
3. Total volume = 4 mL × body weight (kg) × %TBSA burn; half given in the first 8 hours from the time of injury, the remaining half over the next 16 hours (1.5)
4. Urine output (target ~0.5–1 mL/kg/hr), heart rate, or blood pressure (any one) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.46, Burns
Station 38 · Traumatic Brain Injury Marks: 5  |  Time: 5 min
A patient brought after a road traffic accident opens eyes to pain, makes incomprehensible sounds, and withdraws from painful stimuli.
  1. Calculate this patient's Glasgow Coma Scale score, showing the breakdown. (2)
  2. How would you classify the severity of head injury based on this score? (1)
  3. Name one early sign of raised intracranial pressure to monitor for. (1)
  4. Name the initial imaging investigation of choice. (1)
Show Key
1. E2 + V2 + M4 = GCS 8 (2)
2. Severe head injury (GCS ≤ 8) (1)
3. Deteriorating consciousness, unequal/non-reactive pupils, bradycardia with hypertension (Cushing's reflex), or vomiting (any one) (1)
4. CT scan of the head (non-contrast) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.28, Traumatic Brain Injury
Station 39 · Blunt Abdominal Trauma Marks: 5  |  Time: 5 min
A patient involved in a road traffic accident presents with abdominal tenderness and hypotension not responding to initial fluid boluses.
  1. Name the bedside investigation used to rapidly detect free intra-abdominal fluid in trauma. (1)
  2. Name one solid organ commonly injured in blunt abdominal trauma. (1)
  3. What is the management if the patient remains haemodynamically unstable despite resuscitation with a positive scan? (1.5)
  4. What is the management approach if the patient is haemodynamically stable? (1.5)
Show Key
1. FAST (Focused Assessment with Sonography for Trauma) scan (1)
2. Spleen, or liver (any one) (1)
3. Emergency laparotomy (1.5)
4. CT abdomen with contrast for further evaluation, with non-operative management and close monitoring if appropriate (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.29, Torso and Pelvic Trauma
Station 40 · Tension Pneumothorax Marks: 5  |  Time: 5 min
A trauma patient develops sudden respiratory distress, absent breath sounds on one side, tracheal deviation away from that side, and hypotension.
  1. What is the most likely diagnosis? (1)
  2. Is imaging required before treatment in this situation? (1)
  3. What is the immediate life-saving intervention? (1.5)
  4. What is the definitive treatment after initial decompression? (1.5)
Show Key
1. Tension pneumothorax (1)
2. No — this is a clinical diagnosis requiring immediate treatment; imaging should not delay life-saving intervention (1)
3. Needle decompression (large-bore cannula in the 2nd intercostal space, midclavicular line — or 4th/5th space, anterior axillary line) (1.5)
4. Insertion of an intercostal (tube) chest drain (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.29, Torso and Pelvic Trauma
Station 41 · Benign Prostatic Hyperplasia Marks: 5  |  Time: 5 min
An elderly man presents with hesitancy, poor stream, nocturia, and a smooth, firm, enlarged prostate on digital rectal examination.
  1. What is the most likely diagnosis? (1)
  2. Name one investigation to exclude prostate cancer as a differential. (1)
  3. Name the first-line class of drug used for symptomatic relief. (1.5)
  4. What is the surgical treatment of choice for refractory cases? (1.5)
Show Key
1. Benign prostatic hyperplasia (BPH) (1)
2. Serum PSA (prostate-specific antigen) (1)
3. Alpha-blockers (e.g. tamsulosin); 5-alpha-reductase inhibitors are also used (1.5)
4. Transurethral resection of the prostate (TURP) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.84, The Prostate and Seminal Vesicles
Station 42 · Renal Colic Marks: 5  |  Time: 5 min
A patient presents with sudden-onset severe colicky loin-to-groin pain, restlessness, and microscopic haematuria.
  1. What is the most likely diagnosis? (1)
  2. Name the imaging investigation of choice to confirm this. (1)
  3. Name one factor that would favour conservative management over intervention. (1.5)
  4. Name one minimally invasive treatment option for a larger stone that fails to pass spontaneously. (1.5)
Show Key
1. Renal/ureteric colic due to a ureteric stone (1)
2. Non-contrast CT KUB (kidney, ureter, bladder) (1)
3. Small stone size (<5–6 mm) with no signs of infection/obstruction, likely to pass spontaneously (1.5)
4. Extracorporeal shock wave lithotripsy (ESWL), or ureteroscopy with laser lithotripsy (any one) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.82, The Kidney and Ureter
Station 43 · Testicular Torsion Marks: 5  |  Time: 5 min
A 15-year-old boy presents with sudden-onset severe unilateral scrotal pain, with the affected testis high-riding and horizontally placed, and an absent cremasteric reflex.
  1. What is the most likely diagnosis? (1)
  2. Why is this considered a surgical emergency? (1)
  3. Within what approximate time frame from symptom onset should surgery ideally occur to preserve testicular viability? (1.5)
  4. What is the surgical procedure performed, including on the unaffected side? (1.5)
Show Key
1. Testicular torsion (1)
2. Twisting of the spermatic cord cuts off the testicular blood supply, and delay risks irreversible testicular infarction (1)
3. Within 6 hours of symptom onset (1.5)
4. Surgical exploration with detorsion and fixation (orchidopexy) of the affected testis, and prophylactic fixation of the contralateral testis (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.86, The Testis and Scrotum
Station 44 · Varicocele Marks: 5  |  Time: 5 min
A young man presents with a dull, dragging scrotal ache and a scrotal swelling described as feeling like "a bag of worms", which decreases on lying down.
  1. What is the most likely diagnosis? (1)
  2. Why does a left-sided varicocele occur more commonly than a right-sided one? (1.5)
  3. Name one reason surgical treatment may be indicated in a young man. (1)
  4. Name the surgical procedure used to treat this condition. (1.5)
Show Key
1. Varicocele (1)
2. The left testicular vein drains into the left renal vein at a right angle (rather than directly into the IVC as on the right), causing higher venous pressure and reflux (1.5)
3. Impaired fertility/abnormal semen analysis, or persistent pain (any one) (1)
4. Varicocelectomy (surgical ligation of the dilated veins), or radiological embolization (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.86, The Testis and Scrotum
Station 45 · Undescended Testis Marks: 5  |  Time: 5 min
A 2-year-old boy is brought with an empty right hemiscrotum, and the testis cannot be palpated in the inguinal canal or scrotum.
  1. What is the most likely diagnosis? (1)
  2. Name the recommended age range for surgical correction. (1)
  3. Name the surgical procedure performed. (1.5)
  4. Name one long-term risk if this condition is left uncorrected. (1.5)
Show Key
1. Undescended testis (cryptorchidism) (1)
2. Between 6 and 18 months of age (ideally before 12–18 months) (1)
3. Orchidopexy (1.5)
4. Infertility, or increased risk of testicular malignancy (any one) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.20, Paediatric Urology
Station 46 · Carcinoma of the Oesophagus Marks: 5  |  Time: 5 min
A 60-year-old man presents with progressive dysphagia, first to solids and then to liquids, along with significant weight loss.
  1. What is the most likely diagnosis? (1)
  2. Name the investigation of choice for diagnosis and biopsy. (1)
  3. Name the investigation used for local staging (depth of invasion and nodal status). (1.5)
  4. Name one risk factor for the squamous cell subtype of this cancer. (1.5)
Show Key
1. Carcinoma of the oesophagus (1)
2. Upper GI endoscopy with biopsy (1)
3. Endoscopic ultrasound (EUS) (1.5)
4. Smoking, alcohol use, or chronic hot beverage/food intake (any one) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.66, The Oesophagus
Station 47 · GERD and Hiatus Hernia Marks: 5  |  Time: 5 min
A patient presents with chronic heartburn and regurgitation, worse on lying flat, with endoscopy showing a sliding hiatus hernia.
  1. What is the most likely diagnosis explaining the symptoms? (1)
  2. Differentiate a sliding hiatus hernia from a rolling (para-oesophageal) hiatus hernia. (1.5)
  3. Name the first-line medical treatment. (1)
  4. Name the surgical procedure used for refractory or complicated disease. (1.5)
Show Key
1. Gastro-oesophageal reflux disease (GERD) due to a sliding hiatus hernia (1)
2. In a sliding hernia the gastro-oesophageal junction slides above the diaphragm; in a rolling hernia the junction stays in place but the fundus herniates alongside the oesophagus (1.5)
3. Proton pump inhibitors, along with lifestyle modification (1)
4. Laparoscopic Nissen fundoplication (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.66, The Oesophagus
Station 48 · Bariatric Surgery Marks: 5  |  Time: 5 min
A 35-year-old woman with a BMI of 42 kg/m² and poorly controlled type 2 diabetes is being evaluated for surgical weight loss treatment.
  1. Name the general BMI threshold at which bariatric surgery is typically considered. (1)
  2. Name one restrictive and one malabsorptive/combined bariatric procedure. (1.5)
  3. Name one metabolic benefit of bariatric surgery beyond weight loss, relevant to this patient. (1.5)
  4. Name one long-term nutritional complication that must be monitored after these procedures. (1)
Show Key
1. BMI ≥ 40 kg/m² (or ≥ 35 kg/m² with obesity-related comorbidities such as diabetes) (1)
2. Sleeve gastrectomy (restrictive); Roux-en-Y gastric bypass (combined restrictive/malabsorptive) (1.5)
3. Significant improvement or remission of type 2 diabetes mellitus (1.5)
4. Vitamin/mineral deficiency (e.g. B12, iron, calcium) due to reduced absorption (any one) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.68, Bariatric and Metabolic Surgery
Station 49 · Carcinoma of the Stomach Marks: 5  |  Time: 5 min
A 60-year-old man presents with epigastric pain, early satiety, weight loss, and coffee-ground vomiting, with a palpable left supraclavicular lymph node.
  1. What is the most likely diagnosis? (1)
  2. What is the eponymous name for the palpable supraclavicular node described, and what does it signify? (1.5)
  3. Name the investigation of choice for diagnosis and biopsy. (1)
  4. Name the surgical procedure for a resectable distal gastric tumour. (1.5)
Show Key
1. Carcinoma of the stomach (1)
2. Virchow's node (Troisier's sign) — signifies metastatic spread via the thoracic duct, indicating advanced/incurable disease (1.5)
3. Upper GI endoscopy with biopsy (1)
4. Subtotal (distal) gastrectomy with D2 lymphadenectomy (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.67, The Stomach and Duodenum
Station 50 · Acute Mesenteric Ischaemia Marks: 5  |  Time: 5 min
An elderly patient with atrial fibrillation presents with sudden-onset severe abdominal pain that is out of proportion to the mild tenderness found on examination.
  1. What is the most likely diagnosis? (1)
  2. Why is pain "out of proportion to findings" a classic warning sign here? (1)
  3. Name the investigation of choice to confirm the diagnosis. (1.5)
  4. What is the definitive management if bowel is non-viable? (1.5)
Show Key
1. Acute mesenteric ischaemia (likely embolic, given atrial fibrillation) (1)
2. Early ischaemia causes severe visceral pain before peritoneal signs develop, since peritonism only appears once the bowel becomes necrotic — a classic red flag for this diagnosis (1)
3. CT angiography of the mesenteric vessels (1.5)
4. Emergency laparotomy with resection of non-viable bowel (and embolectomy/revascularization where possible) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.74, The Small Intestine

BDS OSPE Practice Stations — Head & Neck / Salivary Glands (25)

Station 51 · Mumps Marks: 3  |  Time: 3 min
A 7-year-old child presents with bilateral painful parotid swelling, fever, and malaise, with no prior vaccination history.
  1. What is the most likely diagnosis? (1)
  2. What is the causative organism? (1)
  3. Name one complication of this condition in a post-pubertal male. (1)
Show Key
1. Mumps (viral parotitis) (1)
2. Mumps virus (a paramyxovirus) (1)
3. Orchitis (also: pancreatitis, meningitis, or sensorineural hearing loss) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.54, Disorders of the Salivary Glands
Station 52 · Acute Suppurative Sialadenitis Marks: 3  |  Time: 3 min
An elderly, dehydrated bedridden patient develops a painful, red, tender swelling over the parotid region with pus discharge from Stensen's duct.
  1. What is the most likely diagnosis? (1)
  2. Name one predisposing factor seen in this patient. (1)
  3. What is the principle of treatment? (1)
Show Key
1. Acute suppurative (bacterial) sialadenitis of the parotid gland (1)
2. Dehydration and reduced salivary flow allowing ascending infection (also poor oral hygiene) (1)
3. Rehydration, good oral hygiene, antibiotics, and drainage if an abscess has formed (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.54, Disorders of the Salivary Glands
Station 53 · Xerostomia Marks: 3  |  Time: 3 min
A patient complains of persistent dry mouth, difficulty chewing dry food, and increased dental caries.
  1. What is this symptom called? (1)
  2. Name one common drug-related cause. (1)
  3. Name one autoimmune condition that can cause this. (1)
Show Key
1. Xerostomia (1)
2. Anticholinergics, antihistamines, or antidepressants (any one) (1)
3. Sjögren's syndrome (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.54, Disorders of the Salivary Glands
Station 54 · Sialography Marks: 3  |  Time: 3 min
A patient with recurrent painful swelling of the submandibular gland during meals is being investigated for a suspected duct stone.
  1. What is this contrast-based imaging investigation called? (1)
  2. What does it directly visualize? (1)
  3. Name one contraindication to performing this test. (1)
Show Key
1. Sialography (1)
2. The salivary ductal system, showing strictures, stones (filling defects), or dilatation (1)
3. Acute sialadenitis/active infection, or known iodine/contrast allergy (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.54, Disorders of the Salivary Glands
Station 55 · Neck Triangles Marks: 3  |  Time: 3 min
A student is asked to localize a swelling described as lying within the anterior triangle of the neck.
  1. Name the boundaries of the anterior triangle of the neck. (1.5)
  2. Name one structure/swelling typically found within this triangle. (1.5)
Show Key
1. Anteriorly the midline of the neck, posteriorly the anterior border of sternocleidomastoid, superiorly the lower border of the mandible (1.5)
2. Thyroid gland/goitre, submandibular gland, or carotid body tumour (any one) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.52, The Pharynx, Larynx and Neck
Station 56 · Dermoid Cyst of the Neck Marks: 3  |  Time: 3 min
An infant presents with a painless, soft, midline neck swelling that does not move with tongue protrusion or swallowing.
  1. What is the most likely diagnosis? (1)
  2. How does this help differentiate it from a thyroglossal cyst? (1)
  3. What is the treatment? (1)
Show Key
1. Dermoid cyst (1)
2. A thyroglossal cyst characteristically moves upward on tongue protrusion (attached to the foramen caecum), while a dermoid cyst does not (1)
3. Surgical excision (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.52, The Pharynx, Larynx and Neck
Station 57 · Cystic Hygroma Marks: 3  |  Time: 3 min
A newborn presents with a large, soft, brilliantly transilluminant swelling in the posterior triangle of the neck.
  1. What is the most likely diagnosis? (1)
  2. What is its embryological origin? (1)
  3. Name one treatment option. (1)
Show Key
1. Cystic hygroma (lymphangioma) (1)
2. A congenital malformation of the lymphatic system (sequestered lymph sac that fails to connect with the venous system) (1)
3. Sclerotherapy (e.g. OK-432/bleomycin), or surgical excision (any one) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.17, Paediatric Surgery
Station 58 · Indications for Tracheostomy Marks: 3  |  Time: 3 min
A patient requiring prolonged mechanical ventilation is being considered for an elective tracheostomy.
  1. Name two indications for tracheostomy. (1.5)
  2. Name one advantage of tracheostomy over prolonged endotracheal intubation. (1.5)
Show Key
1. Prolonged ventilatory support, upper airway obstruction, or to protect the airway/aid tracheal toilet in reduced consciousness (any two) (1.5)
2. Reduces laryngeal/tracheal injury from a long-term tube, reduces dead space, improves patient comfort and allows easier weaning/nursing care (any one) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.52, The Pharynx, Larynx and Neck
Station 59 · Nasal Polyps Marks: 3  |  Time: 3 min
A patient presents with bilateral nasal obstruction, loss of smell, and pale, grape-like swellings seen on anterior rhinoscopy.
  1. What is the most likely diagnosis? (1)
  2. Name one condition commonly associated with nasal polyps. (1)
  3. Name the first-line medical treatment. (1)
Show Key
1. Nasal polyps (1)
2. Chronic rhinosinusitis, allergic rhinitis, aspirin sensitivity/asthma (Samter's triad), or cystic fibrosis (any one) (1)
3. Intranasal corticosteroids (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.51, The Ear, Nose and Sinuses
Station 60 · Sinusitis Marks: 3  |  Time: 3 min
A patient presents with facial pain, nasal discharge, and tenderness over the cheeks for the past 2 weeks.
  1. What is the most likely diagnosis? (1)
  2. Which sinus is most commonly involved? (1)
  3. At what duration would this be classified as chronic rather than acute sinusitis? (1)
Show Key
1. Acute sinusitis (rhinosinusitis) (1)
2. Maxillary sinus (1)
3. Symptoms persisting beyond 12 weeks (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.51, The Ear, Nose and Sinuses
Station 61 · Tonsillitis Marks: 3  |  Time: 3 min
A child has recurrent episodes of severe sore throat with enlarged, inflamed tonsils, occurring 6 times in the past year.
  1. What is the most likely diagnosis? (1)
  2. Name one indication for tonsillectomy in recurrent tonsillitis. (1)
  3. Name one early postoperative complication of tonsillectomy. (1)
Show Key
1. Recurrent acute tonsillitis (1)
2. Seven or more episodes in one year (or 5/year for 2 years, or 3/year for 3 years) meeting criteria for surgery (1)
3. Haemorrhage (reactionary or secondary), or pain/poor oral intake (any one) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.52, The Pharynx, Larynx and Neck
Station 62 · Adenoid Hypertrophy Marks: 3  |  Time: 3 min
A young child presents with mouth breathing, snoring, and recurrent ear infections, with a nasal, hyponasal voice.
  1. What is the most likely diagnosis? (1)
  2. Name one complication involving the middle ear. (1)
  3. What is the surgical treatment? (1)
Show Key
1. Adenoid hypertrophy (1)
2. Otitis media with effusion (glue ear), from Eustachian tube obstruction (1)
3. Adenoidectomy (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.51, The Ear, Nose and Sinuses
Station 63 · Otitis Media Marks: 3  |  Time: 3 min
A child presents with ear pain, fever, and a bulging, red tympanic membrane on otoscopy.
  1. What is the most likely diagnosis? (1)
  2. Name one complication if this is left untreated. (1)
  3. What is the first-line treatment? (1)
Show Key
1. Acute otitis media (1)
2. Tympanic membrane perforation, mastoiditis, or chronic otitis media (any one) (1)
3. Analgesia, with antibiotics (e.g. amoxicillin) if indicated (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.51, The Ear, Nose and Sinuses
Station 64 · TMJ Dislocation Marks: 3  |  Time: 3 min
A patient presents unable to close the mouth after a wide yawn, with the jaw locked open and pain in front of the ear.
  1. What is the most likely diagnosis? (1)
  2. In which direction does the mandibular condyle typically dislocate? (1)
  3. What is the immediate management? (1)
Show Key
1. Temporomandibular joint (TMJ) dislocation (1)
2. Anteriorly, out of the glenoid fossa, in front of the articular eminence (1)
3. Manual reduction (Hippocratic method) — downward and backward pressure on the molars with thumbs while guiding the chin (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.31, Maxillofacial Trauma
Station 65 · Mandible Fracture Marks: 3  |  Time: 3 min
A patient presents after facial trauma with pain, malocclusion of the teeth, and a step deformity felt along the lower jaw.
  1. What is the most likely diagnosis? (1)
  2. Name one common site of mandibular fracture. (1)
  3. Name one clinical sign that suggests a fracture rather than a soft tissue injury alone. (1)
Show Key
1. Mandibular fracture (1)
2. Angle of the mandible, condyle, symphysis, or body (any one) (1)
3. Malocclusion, step deformity, abnormal mobility of fragments, or numbness of the lower lip (any one) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.31, Maxillofacial Trauma
Station 66 · Oral Submucous Fibrosis Marks: 3  |  Time: 3 min
A patient with a long history of chewing areca (betel) nut presents with progressive difficulty opening the mouth and a burning sensation with spicy food.
  1. What is the most likely diagnosis? (1)
  2. What is the main causative agent? (1)
  3. Why is this condition clinically significant beyond causing trismus? (1)
Show Key
1. Oral submucous fibrosis (1)
2. Areca (betel) nut chewing (1)
3. It is a premalignant condition with an increased risk of oral squamous cell carcinoma (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.53, Oral Cavity Cancer
Station 67 · Ameloblastoma Marks: 3  |  Time: 3 min
A young adult presents with painless, progressive swelling of the mandible, and an X-ray shows a multilocular "soap-bubble" radiolucent lesion.
  1. What is the most likely diagnosis? (1)
  2. What is the tissue of origin of this tumour? (1)
  3. What is the treatment? (1)
Show Key
1. Ameloblastoma (1)
2. Odontogenic epithelium (remnants of the dental lamina/enamel organ) (1)
3. Wide surgical excision with a margin of normal bone (simple enucleation has a high recurrence rate) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.53, Oral Cavity Cancer
Station 68 · Dentigerous Cyst Marks: 3  |  Time: 3 min
A routine dental X-ray of a teenager shows a well-defined radiolucent lesion surrounding the crown of an unerupted molar tooth.
  1. What is the most likely diagnosis? (1)
  2. Which tooth is most commonly involved? (1)
  3. What is the treatment? (1)
Show Key
1. Dentigerous cyst (1)
2. Mandibular third molar (wisdom tooth) (1)
3. Enucleation of the cyst along with the associated unerupted tooth (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.53, Oral Cavity Cancer
Station 69 · Radicular Cyst Marks: 3  |  Time: 3 min
A patient with a long-standing carious, non-vital tooth is found to have a well-defined periapical radiolucency on dental X-ray.
  1. What is the most likely diagnosis? (1)
  2. What is its cause? (1)
  3. What is the treatment? (1)
Show Key
1. Radicular (periapical) cyst (1)
2. Chronic periapical inflammation from a non-vital/infected tooth, stimulating cyst formation from epithelial rests of Malassez (1)
3. Root canal treatment or extraction of the causative tooth, with enucleation/curettage of the cyst (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.53, Oral Cavity Cancer
Station 70 · Vocal Nodules Marks: 3  |  Time: 3 min
A teacher who uses her voice heavily presents with chronic hoarseness, and laryngoscopy shows small, symmetrical, bilateral swellings at the junction of the anterior and middle third of the vocal cords.
  1. What is the most likely diagnosis? (1)
  2. What is the main cause? (1)
  3. What is the first-line treatment? (1)
Show Key
1. Vocal (singer's) nodules (1)
2. Chronic vocal abuse/misuse (1)
3. Voice rest and speech therapy (surgery only if conservative measures fail) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.52, The Pharynx, Larynx and Neck
Station 71 · Epiglottitis Marks: 3  |  Time: 3 min
A young child presents acutely unwell with high fever, drooling, stridor, and a preference for sitting forward (tripod position).
  1. What is the most likely diagnosis? (1)
  2. Name the classic causative organism. (1)
  3. What is the most important initial step in management? (1)
Show Key
1. Acute epiglottitis (1)
2. Haemophilus influenzae type b (1)
3. Avoid distressing the child or examining the throat with a spatula; urgently secure the airway in a controlled setting (e.g. operating theatre) — do not attempt to lay the child flat (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.51, The Ear, Nose and Sinuses
Station 72 · Nasal Foreign Body Marks: 3  |  Time: 3 min
A 3-year-old presents with unilateral foul-smelling nasal discharge after playing with small beads.
  1. What is the most likely diagnosis? (1)
  2. Why does a foreign body typically cause unilateral symptoms? (1)
  3. What is the management? (1)
Show Key
1. Nasal foreign body (1)
2. Because it is usually lodged in only one nostril, causing localized obstruction and secondary infection on that side (1)
3. Removal under direct vision (e.g. with a hook or forceps), with sedation/general anaesthesia in an uncooperative child (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.51, The Ear, Nose and Sinuses
Station 73 · Sialorrhoea Marks: 3  |  Time: 3 min
A child with cerebral palsy has persistent drooling of saliva, causing perioral skin irritation and social embarrassment.
  1. What is this symptom called? (1)
  2. Name one conservative management option. (1)
  3. Name one surgical option for severe, refractory cases. (1)
Show Key
1. Sialorrhoea (drooling) (1)
2. Speech/oromotor therapy, or anticholinergic medication (e.g. glycopyrrolate) (any one) (1)
3. Botulinum toxin injection into the salivary glands, or submandibular duct relocation/gland excision (any one) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.54, Disorders of the Salivary Glands
Station 74 · Ankyloglossia Marks: 3  |  Time: 3 min
A newborn is noted to have a short, tight lingual frenulum restricting tongue movement, with the mother reporting difficulty breastfeeding.
  1. What is this condition called? (1)
  2. Name one functional problem it can cause later in childhood. (1)
  3. What is the simple surgical treatment? (1)
Show Key
1. Ankyloglossia (tongue-tie) (1)
2. Speech articulation difficulty, or feeding/breastfeeding difficulty (any one) (1)
3. Frenotomy/frenectomy (division of the lingual frenulum) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.50, Developmental Abnormalities of the Face
Station 75 · Impacted Ear Wax Marks: 3  |  Time: 3 min
An elderly patient complains of gradual hearing loss and ear fullness, with a dark brown mass seen occluding the ear canal on otoscopy.
  1. What is the most likely diagnosis? (1)
  2. Name one method used to remove it. (1)
  3. Name one situation in which syringing should be avoided. (1)
Show Key
1. Impacted cerumen (ear wax) (1)
2. Ear syringing/irrigation, microsuction, or manual removal with instruments (any one) (1)
3. Known tympanic membrane perforation, previous ear surgery, or active ear infection (any one) (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.51, The Ear, Nose and Sinuses

MBBS Final Year OSPE Practice Stations — Head & Neck / Salivary Glands (25)

Station 51 · Sjögren's Syndrome Marks: 5  |  Time: 5 min
A middle-aged woman presents with dry eyes, dry mouth, and bilateral parotid gland swelling, with positive anti-Ro/anti-La antibodies.
  1. What is the most likely diagnosis? (1)
  2. Differentiate primary from secondary Sjögren's syndrome. (1.5)
  3. Name one investigation used to support the diagnosis. (1)
  4. Name one long-term malignant complication to monitor for. (1.5)
Show Key
1. Sjögren's syndrome (1)
2. Primary Sjögren's occurs in isolation; secondary Sjögren's occurs in association with another autoimmune disease, e.g. rheumatoid arthritis or SLE (1.5)
3. Anti-Ro (SSA)/anti-La (SSB) antibodies, Schirmer's test, or minor salivary gland (lip) biopsy (any one) (1)
4. Non-Hodgkin's lymphoma (MALT lymphoma of the salivary gland) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.54, Disorders of the Salivary Glands
Station 52 · Warthin's Tumour Marks: 5  |  Time: 5 min
A 60-year-old male smoker presents with a soft, painless, cystic swelling in the tail of the parotid gland, and FNAC shows papillary cystic structures with lymphoid stroma.
  1. What is the most likely diagnosis? (1)
  2. Name a key risk factor for this tumour. (1)
  3. Is this tumour more often benign or malignant? (1)
  4. What is the treatment? (2)
Show Key
1. Warthin's tumour (papillary cystadenoma lymphomatosum) (1)
2. Smoking (strongly associated) (1)
3. Benign — it very rarely undergoes malignant transformation (1)
4. Superficial parotidectomy (conservative excision, preserving the facial nerve) (2)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.54, Disorders of the Salivary Glands
Station 53 · Pleomorphic Adenoma — Recurrence Marks: 5  |  Time: 5 min
A patient who had a pleomorphic adenoma of the parotid "shelled out" (simple enucleation) years ago now presents with multiple small nodules at the surgical site.
  1. What has most likely happened? (1)
  2. Why does simple enucleation of this tumour carry a high recurrence risk? (1.5)
  3. What is the correct primary surgical procedure to prevent this? (1)
  4. Name one long-term risk of a longstanding or recurrent pleomorphic adenoma. (1.5)
Show Key
1. Recurrent pleomorphic adenoma (multinodular recurrence) (1)
2. The tumour has a pseudocapsule with microscopic extensions/pseudopodia; enucleation leaves tumour cells behind and can seed the field (1.5)
3. Superficial (or total) parotidectomy with a cuff of normal tissue, preserving the facial nerve (1)
4. Malignant transformation to carcinoma ex-pleomorphic adenoma (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.54, Disorders of the Salivary Glands
Station 54 · Mucoepidermoid Carcinoma Marks: 5  |  Time: 5 min
A 45-year-old presents with a firm, slowly enlarging parotid mass with recent-onset facial nerve weakness.
  1. What does the new facial nerve weakness suggest about this parotid mass? (1)
  2. What is the most likely diagnosis given this history? (1)
  3. Name the most common malignant salivary gland tumour overall. (1)
  4. What is the treatment? (2)
Show Key
1. Facial nerve involvement strongly suggests malignancy rather than a benign tumour (1)
2. Malignant parotid tumour, most likely mucoepidermoid carcinoma (1)
3. Mucoepidermoid carcinoma (1)
4. Total parotidectomy (sacrificing the facial nerve only if directly infiltrated), with neck dissection if nodes are involved, and adjuvant radiotherapy for high-grade tumours (2)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.54, Disorders of the Salivary Glands
Station 55 · Adenoid Cystic Carcinoma Marks: 5  |  Time: 5 min
A patient with a submandibular gland tumour reports persistent deep-seated pain and later develops facial numbness, out of proportion to the tumour's size.
  1. What histological feature of this tumour explains the pain and numbness? (1.5)
  2. What is the most likely diagnosis? (1)
  3. What is the characteristic pattern of spread of this tumour? (1)
  4. What is the long-term prognosis, despite often being slow-growing? (1.5)
Show Key
1. Perineural invasion — the tumour tracks along nerve sheaths (1.5)
2. Adenoid cystic carcinoma (1)
3. Perineural spread, with a tendency for late haematogenous (especially pulmonary) metastasis (1)
4. Poor long-term prognosis despite an indolent course, due to a high rate of late local recurrence and distant metastasis (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.54, Disorders of the Salivary Glands
Station 56 · Frey's Syndrome Marks: 5  |  Time: 5 min
Several months after a parotidectomy, a patient notices sweating and flushing over the cheek whenever eating.
  1. What is this condition called? (1)
  2. Explain the underlying mechanism. (1.5)
  3. Name one investigation that can confirm it. (1)
  4. Name one treatment option. (1.5)
Show Key
1. Frey's syndrome (gustatory sweating) (1)
2. Aberrant regeneration of severed parasympathetic secretomotor fibres (originally destined for the parotid gland) into the sympathetic fibres supplying the overlying skin's sweat glands (1.5)
3. Minor's starch-iodine test (1)
4. Botulinum toxin injection into the affected skin (also: antiperspirants, or an interposition graft/fascial barrier at the time of original surgery to prevent it) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.54, Disorders of the Salivary Glands
Station 57 · Plunging Ranula Marks: 5  |  Time: 5 min
A patient presents with a soft, painless swelling in the submandibular/neck region, with a history of a similar swelling in the floor of the mouth.
  1. What is the most likely diagnosis? (1)
  2. How does it differ from a simple (oral) ranula? (1.5)
  3. Which gland does it usually arise from? (1)
  4. What is the treatment? (1.5)
Show Key
1. Plunging (cervical) ranula (1)
2. A plunging ranula extends/herniates through the mylohyoid muscle into the neck, unlike a simple ranula which remains confined to the floor of the mouth (1.5)
3. Sublingual gland (1)
4. Excision of the sublingual gland along with the ranula (marsupialization alone has a high recurrence rate for the plunging type) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.54, Disorders of the Salivary Glands
Station 58 · Parotid Fistula Marks: 5  |  Time: 5 min
A patient develops persistent clear fluid discharge from a wound over the cheek following facial trauma, which increases with eating.
  1. What is the most likely diagnosis? (1)
  2. What is the most useful test to confirm the fluid is saliva? (1)
  3. Name one conservative management option. (1.5)
  4. Name one indication for surgical intervention. (1.5)
Show Key
1. Parotid (salivary) fistula, from injury to the gland or Stensen's duct (1)
2. Fluid amylase level (raised in saliva) (1)
3. Pressure dressing, antisialogogue medication (e.g. anticholinergics), and repeated aspiration (any one) (1.5)
4. Persistent high-output fistula failing conservative treatment, or ductal injury requiring repair/ligation (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.54, Disorders of the Salivary Glands
Station 59 · Submandibular Gland Excision Marks: 5  |  Time: 5 min
A patient with recurrent submandibular gland swelling due to multiple duct stones and chronic sialadenitis is planned for gland excision.
  1. Name one indication for submandibular gland excision. (1)
  2. Name one important structure at risk during this operation, and the resulting deficit if injured. (2)
  3. Name a second nerve also at risk during this surgery. (1)
  4. What is the approach used for this operation? (1)
Show Key
1. Recurrent sialadenitis with stones, a suspected tumour, or chronic duct obstruction (any one) (1)
2. Marginal mandibular branch of the facial nerve — injury causes weakness of the lower lip depressors (asymmetric smile) (2)
3. Lingual nerve (also hypoglossal nerve) — injury causes tongue numbness/taste loss or tongue weakness (1)
4. A transcervical (external) incision approach, about 4 cm below the mandible (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.54, Disorders of the Salivary Glands
Station 60 · Retropharyngeal Abscess Marks: 5  |  Time: 5 min
A young child presents with fever, neck stiffness, drooling, and reluctance to extend the neck, with widening of the prevertebral soft tissue shadow on a lateral neck X-ray.
  1. What is the most likely diagnosis? (1)
  2. What is the usual source of infection in a child? (1)
  3. Name the imaging investigation of choice to confirm and delineate the abscess. (1.5)
  4. Name one life-threatening complication if untreated. (1.5)
Show Key
1. Retropharyngeal abscess (1)
2. Suppuration of retropharyngeal lymph nodes secondary to a nasopharyngeal, adenoidal, or upper respiratory tract infection (1)
3. Contrast-enhanced CT scan of the neck (1.5)
4. Airway obstruction, mediastinitis (via spread along the prevertebral space), or rupture with aspiration (any one) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.52, The Pharynx, Larynx and Neck
Station 61 · Parapharyngeal Abscess Marks: 5  |  Time: 5 min
A patient with recent tonsillitis develops trismus, unilateral neck swelling, and medial displacement of the tonsil and lateral pharyngeal wall.
  1. What is the most likely diagnosis? (1)
  2. Name one major vascular structure at risk within this space. (1.5)
  3. What is the initial management? (1)
  4. Name one serious complication involving this vascular structure. (1.5)
Show Key
1. Parapharyngeal abscess (1)
2. Internal carotid artery (the parapharyngeal space contains the carotid sheath) (1.5)
3. IV antibiotics with surgical drainage of the abscess (1)
4. Internal jugular vein thrombosis (Lemierre's syndrome), or carotid artery erosion/haemorrhage (any one) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.52, The Pharynx, Larynx and Neck
Station 62 · Laryngeal Carcinoma Marks: 5  |  Time: 5 min
A 65-year-old male smoker with heavy alcohol use presents with progressive hoarseness of voice for 3 months.
  1. What is the most likely diagnosis until proven otherwise? (1)
  2. What is the investigation of choice for direct visualization and biopsy? (1)
  3. Why does a glottic (vocal cord) tumour tend to present earlier than a supraglottic tumour? (1.5)
  4. Name one treatment option for early-stage disease. (1.5)
Show Key
1. Carcinoma of the larynx (1)
2. Direct laryngoscopy with biopsy (1)
3. A glottic tumour causes hoarseness early due to its effect on vocal cord vibration, prompting early presentation; supraglottic tumours are often asymptomatic until more advanced and may present with metastatic neck nodes first (1.5)
4. Radiotherapy, or transoral laser surgery/partial laryngectomy (any one) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.52, The Pharynx, Larynx and Neck
Station 63 · Recurrent Laryngeal Nerve Injury Marks: 5  |  Time: 5 min
A patient develops a hoarse, breathy voice immediately after undergoing a total thyroidectomy.
  1. What is the most likely cause? (1)
  2. What muscle group does this nerve supply that explains the voice change? (1.5)
  3. If both recurrent laryngeal nerves were injured, what life-threatening complication could result? (1.5)
  4. What is the emergency management of that complication? (1)
Show Key
1. Recurrent laryngeal nerve injury/palsy (1)
2. It supplies all the intrinsic muscles of the larynx except cricothyroid, controlling vocal cord movement/abduction (1.5)
3. Bilateral vocal cord paralysis causing acute airway obstruction (cords lie close to the midline) (1.5)
4. Urgent reintubation or emergency tracheostomy to secure the airway (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.55, The Thyroid Gland
Station 64 · Maxillary Sinus Carcinoma Marks: 5  |  Time: 5 min
An elderly patient presents with unilateral nasal obstruction, blood-stained nasal discharge, facial swelling, and loosening of the upper molar teeth.
  1. What is the most likely diagnosis? (1)
  2. Why does this tumour often present late? (1)
  3. Name the imaging investigation of choice for staging. (1.5)
  4. Name one treatment modality used. (1.5)
Show Key
1. Carcinoma of the maxillary sinus (1)
2. The sinus is a hidden air-filled cavity, so tumours grow silently until they erode into the nose, orbit, palate, or cheek (1)
3. CT or MRI of the paranasal sinuses (1.5)
4. Surgical resection (maxillectomy), often combined with radiotherapy (any one) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.51, The Ear, Nose and Sinuses
Station 65 · Mastoiditis Marks: 5  |  Time: 5 min
A child with untreated acute otitis media develops postauricular swelling, redness, and the pinna pushed forward and downward.
  1. What is the most likely diagnosis? (1)
  2. What is the underlying pathophysiology? (1)
  3. Name one serious intracranial complication if untreated. (1.5)
  4. What is the management? (1.5)
Show Key
1. Acute mastoiditis (1)
2. Extension of middle ear infection into the mastoid air cells, causing periostitis and abscess formation (1)
3. Meningitis, brain abscess, or lateral (sigmoid) sinus thrombosis (any one) (1.5)
4. IV antibiotics, with myringotomy/cortical mastoidectomy if there is abscess formation or failure to respond (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.51, The Ear, Nose and Sinuses
Station 66 · Cholesteatoma Marks: 5  |  Time: 5 min
A patient with chronic, foul-smelling ear discharge is found to have an attic perforation with white, keratinous debris on otoscopy.
  1. What is the most likely diagnosis? (1)
  2. Why is this condition potentially dangerous even though it is not a tumour? (1.5)
  3. Name one complication of erosion into the inner ear. (1)
  4. What is the definitive treatment? (1.5)
Show Key
1. Cholesteatoma (1)
2. It is a locally destructive mass of keratinizing squamous epithelium that can erode adjacent bone, including the ossicles, labyrinth, facial nerve canal, and skull base (1.5)
3. Vertigo/labyrinthitis (erosion into the labyrinth), or sensorineural hearing loss (any one) (1)
4. Surgical excision (mastoidectomy) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.51, The Ear, Nose and Sinuses
Station 67 · Facial Nerve Palsy Marks: 5  |  Time: 5 min
A patient presents with sudden-onset unilateral facial weakness involving the forehead (unable to raise the eyebrow), with no other neurological deficit and no history of trauma.
  1. What is the most likely diagnosis? (1)
  2. Why does forehead involvement suggest a lower motor neurone lesion rather than a stroke? (1.5)
  3. Name one investigation to exclude a structural cause such as a parotid tumour. (1)
  4. Name the first-line treatment. (1.5)
Show Key
1. Bell's palsy (idiopathic facial nerve palsy) (1)
2. The forehead has bilateral cortical representation, so an upper motor neurone lesion (e.g. stroke) spares the forehead; sparing does not occur here, indicating a lower motor neurone (peripheral) lesion (1.5)
3. Examination of the parotid gland, or MRI if a structural lesion is suspected (1)
4. Oral corticosteroids started early (within 72 hours), with eye protection to prevent exposure keratitis (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.54, Disorders of the Salivary Glands
Station 68 · Le Fort Fractures Marks: 5  |  Time: 5 min
A patient involved in high-impact facial trauma presents with a mobile midface that moves as a single block with the nasal bridge, but the orbits are stable.
  1. Which Le Fort fracture classification does this best describe? (1.5)
  2. Name the classic clinical sign used to detect a Le Fort fracture. (1)
  3. Which Le Fort fracture is most likely to cause CSF rhinorrhoea? (1)
  4. What is the general principle of surgical management for Le Fort fractures? (1.5)
Show Key
1. Le Fort II (pyramidal fracture) — involves the nasal bridge and maxilla but spares the zygomatic arches (1.5)
2. Grasping the anterior maxillary teeth/hard palate and gently rocking to feel abnormal midface mobility (1)
3. Le Fort III (craniofacial disjunction), as the fracture line passes through the base of the skull/cribriform plate (1)
4. Open reduction and internal fixation (ORIF) with plates/screws to restore facial height, width, and occlusion (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.31, Maxillofacial Trauma
Station 69 · Orbital Blowout Fracture Marks: 5  |  Time: 5 min
A patient struck in the eye by a fist presents with double vision on upward gaze and numbness over the cheek and upper lip.
  1. What is the most likely diagnosis? (1)
  2. Which nerve is responsible for the sensory loss described? (1)
  3. Why does the patient have diplopia on upward gaze? (1.5)
  4. Name one imaging investigation used to confirm the diagnosis. (1.5)
Show Key
1. Orbital (floor) blowout fracture (1)
2. Infraorbital nerve (1)
3. Entrapment of the inferior rectus (or orbital fat) in the fractured orbital floor restricts upward movement of the eye (1.5)
4. CT scan of the orbits/facial bones (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.31, Maxillofacial Trauma
Station 70 · Hypopharyngeal Carcinoma Marks: 5  |  Time: 5 min
An elderly smoker presents with progressive dysphagia, referred otalgia, and a neck mass, and endoscopy reveals a tumour in the pyriform fossa.
  1. What is the most likely diagnosis? (1)
  2. Why does the patient experience ear pain despite the tumour being in the throat? (1.5)
  3. Why does hypopharyngeal cancer often present late with nodal metastasis? (1)
  4. Name one treatment modality used. (1.5)
Show Key
1. Carcinoma of the hypopharynx (pyriform fossa) (1)
2. Referred otalgia via the vagus nerve, which supplies sensation to both the hypopharynx/larynx and (via its auricular branch) part of the ear (1.5)
3. The pyriform fossa is a relatively silent, expandable space, so tumours can grow large and spread to lymph nodes before causing significant symptoms (1)
4. Combined chemoradiotherapy, or surgery (pharyngolaryngectomy) with reconstruction for advanced disease (any one) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.52, The Pharynx, Larynx and Neck
Station 71 · Nasopharyngeal Carcinoma Marks: 5  |  Time: 5 min
A patient from an endemic region presents with unilateral conductive hearing loss, nasal obstruction, and a painless neck mass, with biopsy showing undifferentiated carcinoma.
  1. What is the most likely diagnosis? (1)
  2. Name the virus strongly associated with this cancer. (1)
  3. Why does the patient have unilateral hearing loss? (1.5)
  4. Name the primary treatment modality, given the tumour's radiosensitivity and deep location. (1.5)
Show Key
1. Nasopharyngeal carcinoma (1)
2. Epstein–Barr virus (EBV) (1)
3. The tumour obstructs the Eustachian tube opening in the nasopharynx, causing a middle ear effusion (otitis media with effusion) (1.5)
4. Radiotherapy (often combined with chemotherapy), as the nasopharynx is surgically inaccessible and the tumour is highly radiosensitive (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.52, The Pharynx, Larynx and Neck
Station 72 · Juvenile Nasopharyngeal Angiofibroma Marks: 5  |  Time: 5 min
An adolescent male presents with recurrent severe unilateral epistaxis and progressive nasal obstruction, and imaging shows a vascular mass in the nasopharynx.
  1. What is the most likely diagnosis? (1)
  2. In which demographic does this tumour classically occur? (1)
  3. Why is biopsy in the clinic contraindicated? (1.5)
  4. Name one measure taken before surgical excision to reduce intraoperative bleeding. (1.5)
Show Key
1. Juvenile nasopharyngeal angiofibroma (1)
2. Adolescent/teenage males (it is a benign but highly vascular tumour) (1)
3. It is highly vascular, and clinic biopsy risks severe, potentially life-threatening haemorrhage (1.5)
4. Preoperative embolization of its feeding vessels (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.51, The Ear, Nose and Sinuses
Station 73 · Cervical Lymphadenopathy — Unknown Primary Marks: 5  |  Time: 5 min
A 55-year-old smoker presents with a firm, enlarged cervical lymph node, and biopsy confirms metastatic squamous cell carcinoma, but no obvious primary tumour is found on examination.
  1. What is this clinical scenario called? (1)
  2. Name one investigation used to search for an occult primary tumour. (1.5)
  3. Name the sites most commonly harbouring an occult primary in this scenario. (1)
  4. What is the general management approach? (1.5)
Show Key
1. Metastatic cervical lymphadenopathy from an unknown (occult) primary (1)
2. PET-CT scan, or panendoscopy with directed biopsies (tonsil, tongue base, nasopharynx, pyriform fossa) (any one) (1.5)
3. Tonsil, tongue base, nasopharynx, or pyriform fossa (the "mucosal head and neck" sites) (1)
4. Neck dissection with (chemo)radiotherapy to the neck and the likely mucosal sites (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.52, The Pharynx, Larynx and Neck
Station 74 · Parotid Tumour — Benign vs Malignant Marks: 5  |  Time: 5 min
Two patients present with parotid masses: one has a slow-growing, painless, mobile swelling with normal facial movement; the other has a rapidly growing, painful swelling with facial weakness.
  1. Which clinical features favour a benign parotid tumour? (1.5)
  2. Which clinical features favour a malignant parotid tumour? (1.5)
  3. What is the first-line investigation for any parotid mass? (1)
  4. Why must facial nerve function always be assessed and documented before parotid surgery? (1)
Show Key
1. Slow growth, painless, mobile, and normal facial nerve function (1.5)
2. Rapid growth, pain, fixation to skin/deep structures, and facial nerve weakness (suggesting nerve infiltration) (1.5)
3. Ultrasound-guided FNAC (1)
4. Because pre-existing facial weakness from tumour infiltration must be distinguished from nerve injury during surgery, both clinically and for medico-legal documentation (1)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.54, Disorders of the Salivary Glands
Station 75 · Cervical Rib Marks: 5  |  Time: 5 min
A young woman presents with pain, tingling, and weakness in the hand, worse with overhead arm activity, and a palpable bony prominence in the supraclavicular fossa.
  1. What is the most likely underlying cause? (1)
  2. What is the resulting clinical syndrome called? (1)
  3. Which part of the brachial plexus is most commonly compressed? (1.5)
  4. Name one clinical test used to help diagnose this condition. (1.5)
Show Key
1. Cervical rib (an extra rib arising from the 7th cervical vertebra) (1)
2. Thoracic outlet syndrome (1)
3. The lower trunk of the brachial plexus (C8–T1) (1.5)
4. Adson's test (or Roos test/EAST) (1.5)
Source: Bailey & Love’s Short Practice of Surgery, 28th Ed. — Ch.61, Arterial Disorders