SEQs for BDS

1. SURGICAL ANATOMY

1.1 Submandibular Gland

Q1. A surgeon has to operate on a right submandibular gland. Excision of gland for benign disease is planned.

1. What are important anatomical relationships of submandibular gland?
2. To what group of lymph nodes does the submandibular gland drain? (Annual 2017)

1.2 Thyroid Gland

Q1. A 45-year-old euthyroid female with multinodular goitre is listed for total thyroidectomy.

1. Describe the anatomical structures encountered before reaching the thyroid gland.
2. Which two nerves must you save during the procedure? (Annual 2020)

Q2. A 30-year-old secretary is undergoing thyroidectomy for multinodular goitre.

1. Name the structures the surgeon incises/dissects to expose the thyroid gland.
2. Enlist five structures to be saved during thyroid dissection. (Supple 2011)

Q3. A 45-year-old with a large multinodular goitre underwent bilateral subtotal thyroidectomy through a Kocher incision. To expose each lobe the surgeon decided to divide the muscle covering the lobes.

1. Name the muscle covering the thyroid lobes.
2. Should these muscles be divided in the lower part of the neck near the manubrium or in the upper part, and why?

Q4. A 40-year-old housewife with multinodular goitre is planned for total thyroidectomy through a collar incision. What anatomical structures are encountered in this incision before reaching the thyroid gland? (Annual 2007)

Q5. A 35-year-old woman with multinodular goitre is undergoing total thyroidectomy.

1. Enumerate the arteries divided to free the lobes of the thyroid.
2. Name one nerve, one large artery and one associated gland to be preserved. (Model paper 2007)

Q6. A 35-year-old female with multinodular goitre is listed for subtotal thyroidectomy.

1. What is the appropriate incision and its anatomical level?
2. Which thyroid pedicles will the surgeon ligate? Name the structures crossed to reach them.
3. What special precautions avoid neurological injury? (Annual 2022)

1.3 Breast

Q1.

1. Describe the lymphatic drainage of the breast.
2. What are the ligaments of Cooper?
3. What is the significance of these ligaments? (Annual 2018)

Q2. During modified radical mastectomy the surgeon approaches the axilla by lifting a thick muscle anteriorly.

1. Which is the muscle and its function?
2. Which deeper structure is divided to expose the axillary nodes, and the importance of its relations?
3. Name at least three structures preserved while working in the axilla. (Annual 2012)

Q3. A 40-year-old with carcinoma of the left breast (upper outer quadrant) is planned for modified radical mastectomy.

1. Give the lymphatic drainage of this area and the important structures in axillary dissection.
2. What is a sentinel lymph node? (Annual 2009)

1.4 Abdomen

Q1.

1. Draw and label the surface anatomy of the anterior abdomen divided into nine regions.
2. Name two horizontal and two vertical lines responsible for this division. (Supple 2014)

1.5 Stomach

Q1.

1. Which arteries supply the stomach, and their parent arteries?
2. Give four posterior relations of the stomach. (Supple 2016)

Q2. A young man has carcinoma of the body and antrum of the stomach; subtotal gastrectomy with gastrojejunostomy is planned.

1. What blood vessels are divided during this operation?
2. What group of lymph nodes should be looked for? (Annual 2010)

Q3. In a patient with carcinoma of the stomach, total gastrectomy is being performed. Name the arteries that need to be ligated. (Supple 2008)

1.6 Hepatobiliary System

Q1. A 45-year-old with chronic cholelithiasis is listed for laparoscopic cholecystectomy.

1. What is Calot’s triangle? Draw and label it.
2. Enumerate four surgical anomalies encountered during laparoscopic cholecystectomy. (Supple 2020)

Q2.

1. Draw and label the surgical anatomy of the gallbladder with special reference to Calot’s triangle.
2. Name four important structures related to the common bile duct. (Annual 2016)

Q3. During laparoscopic cholecystectomy the surgeon dissects Calot’s triangle.

1. What is Calot’s triangle?
2. Why is it important during laparoscopic cholecystectomy? (Supple 2015)

Q4.

1. Draw and label the anatomy of the gallbladder and Calot’s triangle.
2. Name four anatomical parts of the common bile duct. (Supple 2013)

Q5. A 40-year-old with chronic cholecystitis is to undergo cholecystectomy through a subcostal incision. Which anatomical structures are encountered before reaching the gallbladder? (Annual 2008)

Q6. A 46-year-old is undergoing laparoscopic cholecystectomy for gallstones.

1. What is the main content of Calot’s triangle?
2. Describe the three steps of the critical view of safety. (Annual 2021)

1.7 Spleen

Q1. A 20-year-old with ITP is planned for elective splenectomy.

1. What are the different incisions used?
2. What are the splenic pedicles and the structures dissected to reach them?
3. Briefly describe splenunculi.

1.8 Appendix

Q1. A 20-year-old with acute appendicitis.

1. What should guide the surgeon’s choice of incision, based on anatomy?
2. Enumerate the structures incised/retracted to reach a retrocaecal appendix. (Annual 2011)

1.9 Kidney

Q1. A 25-year-old with left pyelolithiasis is planned for pyelolithotomy through a left lumbar subcostal incision. Which structures are encountered before reaching the kidney? (Annual 2008)

1.10 Inguinal Hernia

Q1. A 25-year-old with a right inguinoscrotal swelling; provisional diagnosis right inguinal hernia.

1. Describe the surgical anatomy of the inguinal canal.
2. Give three differences between direct and indirect inguinal hernia.

Q2. Describe the boundaries of the inguinal canal. How do you clinically locate the deep inguinal ring? (Supple 2017)

Q3.

1. Draw and label the anatomy of the inguinal canal and Hesselbach’s triangle.
2. Name four contents of the inguinal canal in the male. (Annual 2015)

Q4. A patient with an indirect right inguinal hernia is planned for mesh hernioplasty.

1. Give the boundaries of the inguinal canal.
2. Name the structures cut from outside in until the sac is reached.
3. Name one nerve at risk during hernia surgery. (Annual 2014)

1.11 Femoral Hernia

Q1. A 60-year-old with a painful left groin swelling of one hour; suspected strangulated femoral hernia.

1. Name the anatomical boundaries occupied by this hernia.
2. Which structure impedes reduction of the hernia?
3. Which vessel is prone to injury during the procedure? (Annual 2019)

1.12 Blood Vessels

Q1.

1. What are the anatomical relations of the right femoral vein?
2. Draw and label the termination of the long saphenous vein in the right groin.

1.13 Testis

Q1. A mother brings her 4-year-old boy with an impalpable, undescended right testis.

1. How will you counsel the mother about the surgical outcome?
2. How will you investigate?
3. Mention the steps of surgery from skin onward. (Supple 2018)

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2. A&E SURGERY; TISSUE REPAIR

2.1 Pre-Op Evaluation & Management

Q1. A 30-year-old lactating diabetic mother with a left breast abscess; fasting blood sugar 230 mg/dl on oral agents, with pain, swelling and fever with rigors.

1. How will you prepare the patient for surgery?
2. What are the steps of management of the abscess?
3. Give the post-op care. (Supple 2018)

Q2. A 45-year-old man on warfarin after prosthetic mitral valve replacement is listed for elective laparoscopic cholecystectomy. How will you manage him in the perioperative period?

Q3. A 45-year-old diabetic with gallstones and chronic cholecystitis is planned for laparoscopic cholecystectomy.

1. How will you evaluate her preoperatively?
2. What are the principles of creating pneumoperitoneum?
3. What intraoperative complications can occur? (Annual 2015)

Q4. A malnourished 35-year-old (20% underweight) with an incisional hernia has surgery postponed for one month.

1. Why was the operation delayed, and how should the problem be assessed?
2. What advice should be given to achieve the objective? (Annual 2012)

2.2 Wound Complication

Q1.

1. What is wound dehiscence?
2. Write the factors involved.
3. What suture material closes the abdomen after laparotomy and its rationale? (Annual 2016)

Q2. A 60-year-old, 5 days after laparotomy for perforated duodenal ulcer, develops fever and tachypnoea with a healthy wound. What is the differential diagnosis? (Supple 2007)

2.3 Advanced Trauma Life Support

Q1. After crossfire, a conscious 30-year-old driver has a bleeding wound on the left leg.

1. What will be your first step at reception?
2. Give four steps of management.
3. Outline the final treatment. (Annual 2011)

Q2. A 17-year-old after an RTA has multiple lacerations of the forearm soiled with mud and sand, with marked hand swelling. How will you manage this patient?

Q3. A 15-year-old motorcyclist with multiple injuries is dyspnoeic, tachycardic and hypotensive. How would you manage him using the ATLS approach? (Annual 2008)

Q4. A 54-year-old with a profusely bleeding penetrating temporal wound arrives not breathing, with no recordable pulse or BP, and cannot be revived. What pre-hospital management could have saved her life? (Annual 2007)

2.4 Primary Survey

Q1. A couple after an RTA — the husband dead, the wife with depressed consciousness; primary and secondary surveys were done.

1. Discuss the trimodal distribution of death with the cause in each group.
2. Enlist four adjuncts to the primary survey. (Annual 2014)

Q2. What do you understand by the term “primary survey”? (Annual 2021)

2.5 Definitive Care Plan (Tertiary Care)

Q1.

1. What is FAST?
2. Write down its uses and limitations. (Supple 2015)

2.6 Triage

Q1. In a suicide bomb attack, 50 died and 150 were injured and rushed to a district hospital. As the medical officer on duty, how would you manage these casualties? (Supple 2007)

2.7 Tension Pneumothorax

Q1. A 16-year-old after a motorbike accident has absent breath sounds and hyper-resonance on the left with the trachea deviated to the right.

1. What is the diagnosis?
2. What measures would you take? (Supple 2015)

Q2. A 40-year-old motorcyclist after an RTA is restless with tachypnoea, distended neck veins, tracheal deviation, hyper-resonance and decreased breath sounds over one hemithorax.

1. What is your diagnosis?
2. What immediate radiological investigation and management are needed?
3. What are the “deadly dozen” threats to life? (Supple 2018)

Q3. A 34-year-old after a motorbike accident is restless, pulse 140, BP 80/50, RR 30, with distended neck veins, absent breath sounds and a hyper-resonant left chest.

1. What is the most likely diagnosis?
2. How will you manage this patient? (Annual 2011)

2.8 Brain Injury

Q1. A 20-year-old motorcyclist after an RTA had a brief loss of consciousness and has been resuscitated per ATLS.

1. Write the guidelines for obtaining a CT brain in head injury.
2. Write the management plan if the CT shows an acute extradural haematoma.
3. Write the motor response part of the Glasgow Coma Scale. (Supple 2014)

2.9 Spinal Injury

Q1. A 60-year-old after a fall from stairs has severe back pain; she is conscious, can walk a few steps with pain, and has normal vitals.

1. What is the most reliable investigation to confirm the injury?
2. Enlist five steps of management with precautions.

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3. SURGICAL NUTRITION

3.1 Nutritional Assessment

Q1. A 60-year-old man with dysphagia is not taking proper food. How will you assess his nutritional status? (Supple 2019)

Q2. A 50-year-old with multiple enterocutaneous fistulae after a tuberculous perforation lost 10 kg in a week.

1. What clinical parameters assess malnutrition?
2. What nutritional therapy is needed and why? (Annual 2017)

Q3.

1. How will you calculate BMI?
2. How will you clinically assess the nutritional status of a surgical patient? (Supple 2016)

Q4. A 50-year-old with unresectable carcinoma of the oesophagus is emaciated with significant weight loss. How can you assess his nutritional status? (Supple 2015)

Q5. A 20-year-old lost ~20 kg after caustic-soda ingestion six months ago and needs corrective surgery. Which baseline investigations evaluate her nutritional status? (Annual 2015)

Q6. A 16-year-old with a 3-month history of dysphagia (solids and liquids) after corrosive intake.

1. How will you assess her nutritional status?
2. What is the best method of replenishing her nutritional requirements?

Q7. A 35-year-old develops a jejunal fistula after an anastomotic leak and is managed conservatively. How would you look after her nutritional requirements? (Supple 2007)

Q8. A 21-year-old with dysphagia for solids and vomiting, 4 months after bleach ingestion; emaciated, abdominal distension with a positive succussion splash.

1. Give the most likely diagnosis.
2. How will you assess her nutritional status?
3. How will you build her up for surgery via the enteral route? (Annual 2021)

Q9. A 23-year-old with 3 months’ dysphagia after corrosive intake, now with non-bilious projectile vomiting and 10 kg loss.

1. Describe different methods for nutritional assessment.
2. What regular biochemical monitoring is mandatory during nutritional support? (Supple 2021)

Q10. A 50-year-old smoker with 2 months’ dysphagia for solids and liquids, anaemia and weight loss is diagnosed with upper-GI malignancy.

1. How will you assess his nutritional status?
2. What is the most appropriate route for nutritional build-up? (Annual 2022)

3.2 Calculation of Nutritional Requirements

Q1. For a 20-year-old who lost ~20 kg after caustic-soda ingestion and needs corrective surgery, what is the average 24-hour energy, carbohydrate, fat and protein requirement? (Annual 2015)

3.3 Enteral Feeding

Q1. A 60-year-old with oropharyngeal cancer cannot take orally before surgery. (Supple 2021)

1. What clinical methods and investigations assess nutritional status?
2. Which route of nutrition is preferred and why?
3. What average 24-hour energy is required from carbohydrate, fat and protein?

Q2. A 70-year-old with advanced carcinoma of the oesophagus needs total enteral nutrition. Which methods are available, and enlist tube-related, gastrointestinal, metabolic and infective complications. (Annual 2020)

Q3.

1. Name various methods of enteral nutrition.
2. What are the complications of enteral nutrition? (Supple 2019)

Q4. A 20-year-old with corrosive oesophageal burns is unable to take orally; enteral nutrition is planned.

1. What are the common enteral nutrition techniques?
2. What metabolic and tube-related complications can occur? (Annual 2019)

Q5.

1. What is enteral nutrition?
2. What are various methods of enteral nutrition?
3. Enumerate the complications. (Annual 2018)

Q6.

1. How will you define enteral nutrition?
2. Enlist different methods of enteral nutrition.

Q7. A 50-year-old with unresectable carcinoma of the oesophagus, emaciated. Write three different ways to give him enteral nutrition. (Supple 2015)

Q8. Write down at least three ways of enteral nutrition. (Supple 2014)

Q9. A 65-year-old with 6 months’ dysphagia has lost ~20% of body weight and needs major surgery soon.

1. For a better surgical result, what is your point of focus at this stage?
2. How will you execute your strategy? (Supple 2011)

Q10. A 60-year-old with a malignant oesophageal stricture 35 cm from the incisors, Hb 9 g%, albumin 2 g%, tumour not involving adjacent structures; nutrition to be improved before surgery.

1. How can he be provided with adequate enteral nutrition?
2. Enumerate five tube-related complications. (Supple 2010)

Q11. A 70-year-old with advanced carcinoma of the oesophagus needs total enteral nutrition.

1. Which methods of total nutrition are available?
2. Write two merits and two demerits of total enteral nutrition. (Annual 2008)

Q12. What are the complications of enteral nutrition? (Annual 2022)

3.4 Total Parenteral Nutrition (TPN)

Q1. Enumerate the complications of total parenteral nutrition. (Supple 2018)

Q2. Give the indications of total parenteral nutrition. (Supple 2016)

Q3. A 34-year-old presents with a high-output intestinal fistula after abdominal surgery.

1. Write the ideal route of nutritional supplementation.
2. Write the metabolic complications relating to the feeding regimen. (Supple 2014)

Q4. After laparotomy for acute abdomen, almost all the small gut was gangrenous and resected, leaving only 20 cm of jejunum.

1. Which routes of nutrition will you choose?
2. What are the effects of massive small-bowel resection?
3. Name four complications of parenteral nutrition. (Annual 2014)

Q5. A 25-year-old with a high-output enteric fistula after laparotomy for typhoid perforation.

1. Name the nutritional fluids to be given and their caloric values.
2. Enumerate ten complications of parenteral nutrition. (Supple 2013)

Q6. A young woman with oesophageal and gastric scarring after corrosive ingestion cannot tolerate oral intake and is advised TPN.

1. What routes are available for this procedure?
2. What are its complications? (Annual 2010)

Q7. A patient with advanced carcinoma of the oesophagus and severe malnutrition is planned for oesophagectomy.

1. What combination of fluids will you use for parenteral nutrition preoperatively?
2. Enumerate the complications of parenteral nutrition. (Annual 2009)

Q8. A 35-year-old with a jejunal fistula from an anastomotic leak is on TPN through a central line. How would you perform biochemical monitoring? (Annual 2007)

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4. ACID BASE BALANCE

4.1 Gastric Outlet Obstruction

Q1. A 50-year-old woman with gastric outlet obstruction is vomiting profusely.

1. Name the fluid and electrolyte disturbance.
2. Name the acid-base imbalance.
3. What is paradoxical aciduria?
4. How will you correct it?

Q2. A 60-year-old with gastric outlet obstruction and repeated vomiting.

1. What is the electrolyte imbalance and its physiological basis?
2. Mention two fluids and one investigation used to treat and monitor. (Annual 2013)

Q3. A 4-week-old baby with non-bilious vomiting, abdominal distension and a positive succussion splash.

1. Enlist the metabolic complications.
2. How will you treat this child? (Supple 2008)

Q4. A 45-year-old with vomiting, absolute constipation, abdominal pain and distension for 12 hours. What fluid, electrolyte and acid-base balance would be present? (Annual 2007)

Q5. A 20-year-old with vomiting, absolute constipation, pain and distension for 3 days, having received 3 L of 5% dextrose in the last day. What fluid, electrolyte and acid-base disturbance would be present? (Model paper 2007)

Q6. A 50-year-old smoker with 3 months of non-bilious post-meal vomiting is diagnosed with peptic ulcer disease.

1. What metabolic derangements can occur?
2. How will you correct them?
3. What is the primary metabolic abnormality? Describe the mechanism. (Supple 2021)

4.2 Fluid Therapy

Q1. A 40-year-old recovered from earthquake debris after five days is semi-conscious after airway control in a camp hospital.

1. Fluid and electrolyte replacement strategy when there is no obvious/concealed haemorrhage?
2. How will you monitor the efficacy of therapy?
3. How long will you continue it? (Annual 2011)

4.3 Shock

Q1. A 35-year-old after a road accident is in shock.

1. Define shock.
2. Classify shock. (Supple 2019)

Q2. Define and classify shock. (Supple 2010)

Q3. A 19-year-old struck by a car has pulse 120, BP 100/60 and cold clammy skin.

1. Define shock.
2. What are the types of shock?
3. What are two cardinal principles of managing bleeding in trauma?

Q4. A 25-year-old motorcyclist with multiple injuries — pulse 125, BP 70/50, RR 32. Define shock. (Annual 2022)

4.4 Severity of Shock

Q1. A 30-year-old, 4 hours after a fall, is well-oriented with a deformed right upper limb, cold peripheries, pulse 100, BP 110/70.

1. Is it compensated or decompensated shock?
2. Enumerate the factors placing the patient in that category. (Annual 2017)

Q2. A patient run over by a speeding truck has polytrauma and shock.

1. What are the parameters of severe shock?
2. What are the consequences of irreversible shock? (Annual 2010)

Q3. A 25-year-old motorcyclist — pulse 125, BP 70/50, RR 32.

1. Classify shock according to severity.
2. Compare the clinical features of each type in tabulated form. (Annual 2022)

4.5 Haemorrhage and its Management

Q1. A 45-year-old had above-knee amputation for gas gangrene; on the 7th postoperative day massive bleeding starts from the wound.

1. What type of haemorrhage is it?
2. What factors are responsible?
3. What are the principles of management?

Q2. A 30-year-old with severe abdominal and chest trauma after an RTA presents in haemorrhagic shock and is taken to theatre.

1. What are the two main goals of damage control surgery?
2. What are the stages of damage control surgery?
3. What is the role of interventional radiology in torso trauma? (Annual 2022)

4.6 Hypovolaemic (Haemorrhagic) Shock

Q1. A 35-year-old after multiple injuries — pulse 140, BP 80/60, tense tender abdomen.

1. What is the type of shock?
2. How do you quickly assess for abdominal visceral injury?

Q2. A 25-year-old with blunt abdominal trauma is shocked (BP 70/40, pulse 124), abdomen tender in the left upper quadrant.

1. Which solid organ is most likely injured?
2. Write the grading of injury of this organ.
3. What management if you find > grade 4 injury? (Annual 2020)

Q3. A 30-year-old semi-conscious man with an incised neck wound — pulse 115, systolic BP 50 mmHg. What is the traditional classification of haemorrhagic shock? (Supple 2018)

Q4. A 40-year-old bank cashier in shock had 10 days of high fever, severe bone pain and haemorrhagic spots, used NSAIDs at home, and bled on brushing his teeth.

1. What is your suspicion and three first-line measures?
2. How will you manage him after the first hour? (Supple 2011)

Q5. A 45-year-old mother with dengue fever — temperature 100°F, pulse 110, platelets 70 × 10⁹. Enlist five management steps. (Annual 2011)

Q6. A 20-year-old with multiple injuries after an RTA — pulse 120 and thready, BP 90/60, difficult respiration and sweating.

1. What is the diagnosis?
2. How would you treat this case? (Supple 2007)

4.7 Septic Shock

Q1. What are the clinical features of septic shock? (Supple 2017)

Q2. A 50-year-old after laparotomy for typhoid perforation develops tachycardia, hypotension and oliguria on day 3; Hb 12 g/dl, WCC 22,000/dl.

1. What is the probable cause?
2. Outline the principles of management. (Annual 2013)

4.8 Obstructive Shock

Q1. How would you resuscitate a 20-year-old who has gone into shock after blunt chest and abdominal trauma? (Supple 2013)

Q2. A 50-year-old struck on the right chest develops rapidly progressive dyspnoea; extremities cold and clammy, pulse 110, BP 90/60, with tracheal and apex-beat shift to the left.

1. What type of shock has developed and why?
2. What other conditions can cause the same category of shock? (Supple 2010)

4.9 Shock Monitoring

Q1. A 35-year-old after an RTA is in shock. How will you monitor him? (Supple 2019)

Q2. A 30-year-old with an incised neck wound — pulse 115, systolic BP 50. What are the minimum and additional modalities to monitor a shocked patient? (Supple 2018)

Q3. A 21-year-old with a right-chest stab wound (pulse 120, BP 90/60, pallor) is given crystalloids; 30 minutes later pulse is 90 and BP 105/70.

1. What is the dynamic fluid response and its interpretation?
2. How will you monitor perfusion? Give four points. (Annual 2014)

4.10 Indications of Blood Transfusion

Q1. Give three indications of blood transfusion. (Supple 2015)

4.11 Complications of Blood Transfusion

Q1. A 35-year-old after multiple injuries — pulse 140, BP 80/60, tense tender abdomen.

1. Enumerate three complications with a single transfusion.
2. Enumerate four complications of massive transfusion.

Q2. A patient after cholecystectomy is started on a transfusion; you notice mismatched/incompatible blood.

1. What is the management?
2. What measures prevent this in future? (Annual 2018)

Q3. A 65-year-old with O-positive blood is to undergo a Whipple’s operation needing multiple transfusions. What complications of blood transfusion can occur? (Supple 2015)

Q4. A 40-year-old with intra-abdominal bleeding received five pints of blood during and after liver-injury repair. Mention any three complications of a single transfusion. (Annual 2015)

Q5. An ABO-incompatible transfusion was given to a young man by clerical error (~10 ml before it was stopped); he is shivering, febrile and has loin pain.

1. How would you deal with this in the immediate phase?
2. Enlist the infectious complications of blood transfusion. (Supple 2014)

Q6. An 8-year-old given whole blood after major abdominal surgery develops severe headache, fever and a rapidly spreading urticarial rash 5 minutes into transfusion.

1. What is the most likely diagnosis?
2. Enumerate the initial treatment steps.
3. How can this be prevented? (Annual 2012)

Q7. A 65-year-old with O-positive blood is to undergo a Whipple’s operation with multiple transfusions. Which infectious complications can occur? (Annual 2008)

4.12 Disseminated Intravascular Coagulation

Q1. What treatment steps are suitable for coagulopathy after massive blood transfusion? (Annual 2015)

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5. ANAESTHESIA & PAIN MANAGEMENT

5.1 General Anaesthesia (GA)

Q1. A 50-year-old with a left parotid swelling; FNAC shows pleomorphic adenoma.

1. Which anaesthesia is suitable, and its steps?
2. Give two common complications. (Supple 2020)

Q2. What are the techniques for maintaining the airway during general anaesthesia? (Supple 2016)

Q3. A 35-year-old fit woman with acute cholecystitis is planned for early laparoscopic cholecystectomy.

1. What type of anaesthesia is preferred?
2. Name the triad of this anaesthesia.
3. Name the layers a spinal needle passes through. (Annual 2014)

Q4. A 25-year-old teacher is undergoing subtotal thyroidectomy for primary thyrotoxicosis (Graves’ disease).

1. What anaesthesia is necessary for a safe procedure?
2. What measures ensure a better outcome (as anaesthetist)?
3. Give the steps you would take during the procedure. (Annual 2011)

Q5. A 40-year-old with an acute abdomen is planned for laparotomy.

1. What are the objectives of the anaesthetist to facilitate surgery?
2. Give the advantages of general anaesthesia. (Annual 2010)

Q6. What is the general anaesthesia triad? (Supple 2018)

5.2 Local & Regional Anaesthesia

Q1. A 70-year-old man, fit for surgery, presents with a left inguinal hernia.

1. Which anaesthesia is most suitable and commonly used for hernioplasty?
2. Enumerate four complications of this technique.
3. What measures avoid the common complications? (Annual 2020)

Q2. A 40-year-old with a right wrist ganglion is to be operated under Bier’s block.

1. Write a brief note on intravenous regional anaesthesia (Bier’s block).
2. What are the common techniques for local anaesthesia? (Supple 2019)

Q3. A 25-year-old is to have varicose-vein surgery of the left lower limb under spinal anaesthesia.

1. What are the complications of this procedure?
2. How does spinal differ from epidural anaesthesia? (Annual 2018)

Q4. A 30-year-old in labour requests epidural anaesthesia.

1. Describe the method of giving epidural analgesia.
2. Mention three complications. (Supple 2017)

Q5. What is spinal headache? (Supple 2016)

Q6. Mention three indications of epidural anaesthesia. (Supple 2016)

Q7.

1. Name the different types of regional anaesthesia.
2. Name three complications of spinal anaesthesia.
3. Write the steps in treating spinal headache. (Annual 2016)

Q8. A young woman with a 2×2 cm swelling on the flexor forearm needs excision biopsy but refuses all forms of general anaesthesia.

1. What is the most suitable regional anaesthesia?
2. Name two drugs used and their maximum safe dose.
3. Enlist at least four complications. (Supple 2014)

Q9. A 60-kg woman is to have a forearm lipoma removed under local anaesthesia.

1. Name two local anaesthetic agents and their doses for her.
2. Mention five important complications of local anaesthetics. (Supple 2013)

Q10. A 70-year-old man, unfit for GA, is to have a right inguinal herniorrhaphy under regional anaesthesia.

1. What is regional anaesthesia, and two advantages over GA?
2. Mention two types with their complications. (Annual 2013)

Q11. A 65-year-old, hypertensive (controlled) and diet-controlled diabetic with a reducible right inguinal hernia is planned for repair.

1. What anaesthetic techniques can be used?
2. Which one is preferred, briefly?

Q12. A 25-year-old is planned for anorectal surgery under spinal anaesthesia.

1. What is the most appropriate site for injection and why?
2. Enlist the complications of spinal anaesthesia. (Annual 2009)

Q13. A 20-year-old is to undergo right herniorrhaphy.

1. What anaesthetic techniques can be employed?
2. Write one merit and one demerit of each. (Supple 2008)

Q14. A 20-year-old is to have a left inguinal herniorrhaphy under regional anaesthesia.

1. What regional techniques are available?
2. Describe any one of them. (Annual 2008)

Q15. A 25-year-old is to undergo elective right inguinal hernioplasty.

1. What are the different options for anaesthesia?
2. Describe the complications of local anaesthesia. (Supple 2021)

5.3 Pain

Q1. A 60-year-old, 6 hours after TURP for carcinoma of the prostate, complains of pain.

1. Name the different types of chronic pain.
2. Briefly mention the options for controlling pain in malignant disease. (Supple 2018)

Q2. What are the options for controlling severe pain in malignant disease?

Q3. A middle-aged woman with locally advanced right breast carcinoma is in agony from severe intractable pain.

1. What is the WHO pain step-ladder?
2. Which painkiller should be selected for this patient?

Q4. A 40-year-old with severe pain after radical gastrectomy is put on patient-controlled analgesia.

1. What is patient-controlled analgesia?
2. How is it administered?
3. What are its advantages?

Q5. A 66-year-old with unresectable carcinoma of the body of the pancreas has severe abdominal pain.

1. What is the most likely cause of this pain?
2. What percutaneous neurolytic technique can relieve it?
3. Describe the WHO pain management ladder. (Annual 2021)

Q6. A 65-year-old with haematuria, generalized bone pain and anaemia is diagnosed with advanced carcinoma of the prostate.

1. What are the different methods to control severe pain in this malignant disease?
2. What is the WHO analgesic ladder?

↑ Back to topics

6. SURGICAL & SPECIAL INFECTIONS

6.1 Aseptic Techniques & Sterilization

Q1.

1. What is the difference between sterilization and disinfection?
2. Enlist four common methods of sterilization with an example of each.
3. How are disposable articles sterilized? (Supple 2017)

Q2. The hospital infection-control team is concerned about increased infection in the main operating theatre and asks for your recommendations. Enlist 10 points of concern. (Supple 2011)

Q3. After surgery on an infected case, how will you ensure the safe reuse of the instruments for the next operation? (Supple 2008)

6.2 Surgical Site Infections (SSI)

Q1. A 30-year-old, otherwise healthy, after open cholecystectomy develops severe induration on day 4 with pus pouring out; the wound is opened and repeatedly debrided.

1. Can you name this infection?
2. Name the simple steps to avoid such infections. (Annual 2017)

Q2. Various methods are used to avoid wound infection.

1. Classify wounds according to the risk of infection.
2. Give an example of each type and the risk with or without antibiotic prophylaxis. (Supple 2016)

Q3.

1. Name the factors that determine whether a wound gets infected.
2. How will you treat a 20-year-old with wound infection after appendectomy? (Supple 2016)

Q4.

1. What factors increase the risk of surgical site infection?
2. What preoperative measures minimize SSI? (Annual 2016)

Q5. What scoring system(s) are used for wound-infection classification? (Annual 2015)

Q6.

1. Describe surgical site infections.
2. Write four ways to avoid SSI. (Annual 2014)

Q7. A 15-year-old develops wound infection on day 5 after appendectomy.

1. What type of wound is it?
2. Classify the surgical wounds and give examples. (Supple 2013)

Q8. On the 4th day after surgery for a perforated appendix, a 30-year-old has increasing wound pain, with redness and swelling, pulse 100, temperature 100°F, BP 130/70.

1. What is the doctor’s first step, with the suspected diagnosis?
2. How should he subsequently manage this patient? (Annual 2011)

↑ Back to topics

7. SOLVED UNIVERSITY SEQs — GENERAL SURGERY

Solved SEQ bank for MBBS & BDS — answers as provided in the source compilation.

SEQ 1. A 25 years old poultry farm worker is brought with inability to open his mouth for last three days. He had injury on his right foot ten days ago but kept working bare footed in farm without treatment.

1. What is the diagnosis on high index of suspicion?
2. Outline the management plan with prognosis?

SEQ 2. A 15 years old school girl presents with 2×2 cm nodule on her left supraclavicular region for the last four months. She is having sweats at night and her sputum contains blood. She has lost about 10% of her body weight meanwhile.

1. What is the likely disease causing swelling in her neck?
2. How will you investigate her problem? Enumerate the necessary ones only.
3. Name three components of management?

SEQ 3. A 40 years old garment factory worker reports with 1×1 cm ulcer on right side of her oral cavity since two months. She is a habitual of pan eater. She also notices a 0 .5xo.5 cm nodule on upper part of neck on same side. The surgeon examines and advises.

1. What is his main suspicion
2. Why has he come to this conclusion
3. How should he proceed scientifically for the best results of treatment

SEQ 4. Six days after exploratory laparotomy for perforated appendix, 50 years old diabetic lady with moon face, looks toxic and has gangrene developing around her abdominal wound. As attending surgeon

1. What is your main concern regarding the illness
2. Your diagnosis is further strengthened by the presence of which specific features
3. In few words outline the management

SEQ 5. A 77 years old house wife presents with 5×5 cm swelling on right side of neck which moves with deglutition .she has a normal voice and some difficulty in swallowing. Her pulse is 78 per minutes. She is not using any drugs.

1. What investigations you will ask for in this patient
2. What diagnosis on one investigation can lead to suggestion of an operation
3. Name three complications which can result from operation for this problem

SEQ 6. for reducing the infection rate in Operation Theater, the hospital infection control committee has given six point instructions for all to observe. Please reproduce them here

SEQ 7. A 35 years old school teacher comes to surgical outpatient department with a uniform swelling of 6×6 cm in front of neck. She has prominent eyes. Her pulse is 120/min. she is not using any medications.

1. Enumerate the clinical tests to complete your evaluation
2. Enlist the investigations in order of priority
3. Give immediate management in maximum of six lines

SEQ 8. A 12 years old school boy comes with a bluish swelling 2×2 cm in size lifting his tongue upward and on left side. On examination it feels soft.

1. What is your likely diagnosis with closest differential diagnosis with some points
2. How will you treat this case

SEQ 9. A 35 year old shopkeeper’s presents with discharging point on his right cheek

1. What will be essential clinical examination in this case
2. How will you proceed with the most appropriate treatment

SEQ 10. A 13 years old school boy brought after a highway traffic accident three hours ago. He bears an abrasion and bruise on right upper quadrant of abdomen. He has a pulse of 100/min and blood pressure of 100/60 mm Hg, complains of pain in abdomen. He narrates the whole story of accident

1. What will you immediately do
2. What will be your next step
3. Outline the subsequent management plan

SEQ 11. In May, A 20 year old student complains of pain in his right axilla for five days. On examination his axilla shows redness and is tender over 3x3cm area.

1. What is your suspicion
2. Give a sketch to manage his problem

SEQ 12. A 24 years old newlywed woman comes with a firm swelling on her left supraclavicular fossa. She complains of numbness and weakness during washing of clothes. On examination this side pulse is weaker than on right side. On x-Rays chest, surgeon has discovered the cause of her problem and advised treatment.

1. what the surgeon has discovered on x-rays
2. What is the treatment advised and how should he proceed

SEQ 13. A 55 years old farmer comes with history of swelling around left ear for the last ten years. It has recently increased in size up to 8×8 cm and he is unable to close his left eye

1. What is your spot diagnosis
2. What will you do to complete your clinical examination
3. Outline the management plan in six lines

SEQ 14. In September there is new epidemic of disease characterized by patients complaining of fever with rigors, headache and body aches. On examination, many patient show hemorrhagic small spots on their body.

1. What is your most likely diagnosis
2. Name two pathogenic elements in spread of this illness
3. Suggest in few lines measures limit the spread of this disease

SEQ 15. A 70 years old elder from tribal areas of Pakistan has a non-healing 1.5×1.5 cm ulcer on his right cheek for the last one year. On examination, the ulcer has rolled up margins with no evidence of any swelling in rest of his head and neck.

1. Name two main suspicions keeping a high index
2. Give management plan of diseases you favor with reference to any latest development in this field

SEQ 16. A 12 years old school boy is brought to emergency after a road traffic accident twenty minutes earlier. He has a laceration on his forehead, bleeding. He is fully conscience.

1. What will be your first step
2. In three lines give next plan
3. Enlist definite management plan

SEQ 17. A six years old girl is in outpatient department with discharging sinus of right side of neck just anterior to anterior border of sternocleidomastoid muscle since birth

1. What is the most likely diagnosis
2. Name most relevant investigation
3. Suggest appropriate definite treatment

SEQ 18. A 60 years old farmer complains of non-healing ulcer on his lower lip for the last four months. He has also observed 1×1 cm swelling on left side of neck.

1. What is the most likely diagnosis with high index of suspicion
2. Give two necessary investigation to reach diagnosis and design management
3. Enumerate management options

SEQ 19. Give a brief account of risk factors which make a wound more prone to infection.

SEQ 20. A 18 years old club cricketer is disturbed by slowing increasing swelling under his tongue. On examination this looks blue and more prominent on right side and is fluctuant with little displacement of his tongue. This problem is observed for the last six months.

1. What is the most likely diagnosis with one differential diagnosis
2. Give four lines on management options

SEQ 21. A 25 years old house wife has noticed a 1×1.5 cm swelling on back of her neck for last one week. This is painful to touch. She also complains of discomfort during combing of her hair.

1. What is the diagnosis
2. How will you manage

SEQ 22. A 70 years old diabetic lady has presented with swelling of her right arm after an act of prolonged itching. Her arm is red and painful. She has fever with chills.

1. What is the diagnosis
2. What are the components of management? Enumerate

SEQ 23. A 30 years old motor mechanic is worried by weight loss for last ten months. He has increased appetite, anxious and disturbed by hand tremors. On examination his pulse is 115/min. There is visible prominence in front of neck with staring gaze.

1. What is the diagnosis
2. Enlist necessary investigations
3. Give three management options

SEQ 24. After getting a multivitamin injection on her left upper arm, this 40 year old house maid comes with painful swelling of left upper arm for last two weeks. She has fever with rigors. The swelling is 8×8 cm red hot, tender and fluctuant.

1. What is the clinical diagnosis
2. Outline the best option to manage
3. Name important investigation which can bring complete resolution of problem

SEQ 25. A 25 years old office clerk complains of pain and fatigue of his right hand after a prolonged desk work. On examination his right radial pulse is weaker than left. There is firm prominence on right supraclavicular fossa.

1. What is the most likely clinical diagnosis
2. Which simple routine investigation can give support to your diagnosis
3. Outline the treatment

SEQ 26. A 60 years old shopkeeper comes to outpatient department with 10×10 cm swelling of left side of face below and in front of left ear for last 15 years. There has been recent increase in size.

1. What is the clinical diagnosis
2. Which clinical examination is mandatory in this case
3. Give few line on management

SEQ 27. A 65 years old bus accident victim is brought to emergency one week after the accident. His initial care was done by family at home. He is toxic looking with temperature 101F. His injured right leg is swollen, tender and discolored. On examination a crepitus is discovered.

1. What is your clinical diagnosis
2. Which simple investigation will clinch the diagnosis
3. Enlist the treatment options in three lines

SEQ 28. Grandfather of 75 years is losing weight over the past four months due to increasing difficulty to swallow solid food. He has noticed a small 1x1cm firm swelling in his left supraclavicular fossa.

1. What is your suspicion on priory and its basis
2. Which investigation specific to problem will be your choice? name three only
3. How will you counsel the patient and family about management options

SEQ 29. A 14 years old swimmer attends clinic with headache, fever and nose block. Headache is dull and changes with different postures

1. What is the likely diagnosis
2. Which imaging technique will be useful to support your diagnosis
3. Outline the management

SEQ 30. Three days after tooth extraction this 50 years old teacher comes to emergency with a swelling of floor of mouth displacing her tongue upward. She looks toxic and finding difficulty in teaching due to voice limitation. Her breathing is also uncomfortable while she lies in bed

1. What is your most likely suspicion
2. Which serious problem can occur if untreated
3. Give steps of management

SEQ 31. A young female patients from low socioeconomic class presents with a pus discharging sinus in the lower part of the posterior triangle of the neck. Chest X-Rays reported tubercular lesion at the apex of right lung.

1. What other investigation are required to confirm the diagnosis
2. What is your plan of treatment in this case

SEQ 32. A 5 years old male child presents with soft cystic swelling about 12 cm in diameter in the lower part of anterior triangle of neck. It has been present since birth and increasing in size. on transillumination it is brilliantly translucent.

1. What is the differential diagnosis
2. What complication may arise if not treated now
3. What advise will you give to parents regarding treatment of this patient

SEQ 33. while eating food a young male gets severe colicky pain in the right submandibular salivary gland which becomes enlarged and painful. Patient also gets fever

1. How will you investigate this problem
2. What is the treatment of this condition
3. What are the complications of stone in submandibular salivary gland duct

SEQ 34. A 50 years old lady who been eating betel (pan) for the last 15 years, develops a painless ulcer in the middle of the right lateral border of her tongue. It is gradually increasing in size and has everted margins and its base is hard to touch

1. Clinically what is your diagnosis
2. How will you investigate this case
3. What methods of treatment are available for this condition

SEQ 35. a young boy of eighteen years met with an accident, while driving a motor cycle. He sustained blunt injury to his abdomen. in the emergency room his blood pressure was 80mm Hg, and pulse rate was 120/minute, he was pale

1. Which is the most common solid intra-abdominal organ to rupture in blunt abdominal trauma
2. What investigations are required to confirm the diagnosis
3. How will you resuscitate and prepare this patient for operation

SEQ 36. seven years old diabetic female patient developed right ischiorectal abscess. It was rapidly enlarging in size and patient was very septic. At places the skin was gangrenous. The wound was foul smelling. It was clinically diagnosed as synergistic gangrene (necrotizing fascitis)

1. Which micro bacteria are involved in this infection
2. What other investigations are to be carried out in this case
3. What is the treatment of this condition

SEQ 37. Fifty five years old patient had a soft, compressible swelling on the left side of neck for the last 8 years, it was gradually increasing in size and would further enlarge with taking food and reduce in size after regurgitation of food, he also complained of difficulty in swallowing

1. Describe the investigations to confirm the diagnosis
2. What plan would you suggest for treatment

SEQ 38. twenty five years old male patient sustained open wound to his right thigh in a factory. The wound was heavily contaminated with dirt. on third day of injury he developed full-blown tetanus

1. How will you manage this case
2. What is the prognosis

SEQ 39. A 60 years old man presents with progressive dysphagia for solids. He gives history of weight loss. He has been smoking for the last 30 years .on examination he looks wasted. Barium swallow study showed stricture at the mid esophagus.

1. How will you assess the nutrition status of this patient?
2. What is the next step to confirm the diagnosis?
3. How will you treat this patient?

SEQ 40. A 25 years old female presented with multiple swellings in front of neck. She gives history of palpation, weight loss and disturbance of menses. On examination, the swellings are firm in consistency and move with swallowing. Radiograph neck shows deviation of trachea.

1. What is the most likely diagnosis?
2. How will you confirm the diagnosis?
3. How will you manage this case?

SEQ 41. A 60 years old male smoker presented with non-healing ulcer on the left lateral side of tongue. On examination, 2×2 cm ulcer present over the posterior third part of the left lateral side of tongue. Submandibular lymph node hard in consistency is also palpable.

1. What are differential diagnoses
2. How will confirm your diagnosis
3. What are the principles of management

SEQ 42. A 20 years old male got trauma to face in road traffic accident. He complains of pain neck. On examination the left cheek is depressed and there is parasthesia over the cheek

1. How will you assess the patient in emergency room?
2. What is le Fort classification?
3. What is the possibly of neck pain in the patient?

SEQ 43. A 35 years old male presented with submandibular swelling which increase in size after meal. He also complains of pain in the swelling after taking lemon drinks. On examination, the swelling is bimanually palpable.

1. What is the most likely diagnosis?
2. How will you investigate this case?
3. How will you treat this patient?

SEQ 44. A 20 years old female presented with swelling in the right side of neck. She also gives history of low-grade fever and weight loss. On examination, the swelling is soft, nontender and fluctuant. Her ESR is 90 mm/HG.

1. Give three differential diagnoses.
2. How will you investigate this patient?
3. How will you treat this patient?

SEQ 45. A 30 years old man got blunt trauma abdomen in road traffic accident. In the emergency room, he is received in semiconscious stat. His pulse is 120/min and blood pressure is 90/60 mm/Hg. His abdomen is gradually distending.

1. What is the possible cause of hypotension
2. What is this type of shock?
3. How will you manage this patient

SEQ 46. . A 25-year-old female presented with swelling in front of neck, palpitation and tremor of hands. On examination the swelling is diffuse, non-tender and moves with swallowing .USG neck shows no nodularity.

1. Justify your diagnosis.
2. Write three appropriate investigations, which are helpful in making diagnosis.
3. Write three options to treat this patient

SEQ 47. . A 60-year-old farmer presented with non- healing ulcer on the right cheek. On examination, it has pearly rolled edge and telangiectatic vessels. No cervical lymph node palpable.

1. What is the most probable diagnosis?
2. How will you confirm your diagnosis?
3. Enlist the treatment options in this patient

SEQ 48. . A 50-year-old male presented with non-healing ulcer on the right lateral side of tongue. On examination, the edge of ulcer is everted and base is indurated. A 3cm hard lymph node is palpable in right side of neck.

1. How will you confirm the diagnosis?
2. How will you treat this patient?
3. Name the different types of neck dissections

SEQ 49. Bomb Blast occurred near your hospital and you are expected to receive 20 casualties.

1. What is the common scheme of assessment for these patients?
2. What are the commonest steps of ATLS (Advanced Trauma Life Support)?

SEQ 50. An elderly man had a hard lymph node palpable in the upper part of the right side of the neck, anterior to the sternomastoid muscle. FNAC confirmed metastatic carcinoma, probably from a primary in the oropharynx.

1. Where would you look for the primary focus
2. What other investigations would you do for management of the case

SEQ 51. A 45 years old female patient from Gilgit had multinodular goiter for the last 15 years. One year ago she developed tachycardia, weight loss, tremors in hands and sweating of palms

1. What is the diagnosis
2. What investigations are required to confirm the diagnosis

SEQ 52. A thirty five years old female patient had history of recurrent stone in both kidneys for which she lithotripsy done in Past. Now she had developed another stone in the right kidney. She also suffers from peptic ulcer diseases and radiological examination reveals multiple cysts in the limb bones.

1. Clinically what is your diagnosis
2. What investigations are required for confirmation
3. How will you manage this case

SEQ 53. A 45 years old patient developed an ulcerating lesion 1cm in diameter on the neck just below her right eye. The biopsy of the ulcer revealed basal cell carcinoma.

1. Clinically how does basal cell carcinoma present
2. What are the different types of treatment available? In your opinion what is the best treatment

SEQ 54. A dentist notices a shaggy white mass in gingivobuccal recess of a 68 years old man. It has been increasing in size and bleeds occasionally.

1. What investigations for the confirmation of diagnosis and plan of treatment are required
2. What treatment would you suggest if it turns out to be cancerous

SEQ 55. Mother of five years old child brought her son to you with complaint of that her son has a midline painless, cystic swelling in front of neck just below the hyoid bone. It has recently become red, painful and child has fever.

1. What is the differential diagnosis
2. How will you confirm the diagnosis
3. What is the treatment of this condition

SEQ 56. A diabetic patients developed multiple discharging sinus on the right side of the neck near the right angle of mandible with fever. Pus was sent for culture and it reported as actinomycosis

1. What is the differential diagnosis
2. What are the complications of this infection if not treated in time
3. What is the best treatment for this condition

SEQ 57. A 26 years old psychiatric patient presents with brawny swelling in the right submandibular region and odynophagia. Examination reveals trismus, edema of the tongue and floor of mouth along with putrid halitosis.

1. What is the most likely diagnosis
2. What are various complications of the untreated condition
3. Outline a treatment plan for this patient

SEQ 58. A 28 years old male presented with enlarged cervical lymph nodes. Enumerates various causes of cervical lymphadenopathy

SEQ 59. A 35 years old female presents with non-healing ulcerative lesion in the right submandibular region following the extraction of a carious tooth. On examination there is brawny edema and purulent discharge from the lesion which contains yellowish granules

1. What is the most likely diagnosis
2. What is the causative organism of this condition
3. How will you confirm the diagnosis
4. What is the treatment of this condition

SEQ 60. A 38 years laborer presents with a painless swelling in the left cervical region. There is history of evening rise of fever and generalized malaise. the swelling is 3×4 cm, soft, nontender and fluctuant with normal local temperature. there are matted cervical lymph nodes on the same side.

1. What is the most likely diagnosis
2. What investigations will you suggest to reach the diagnosis
3. Briefly outline the treatment of this condition

SEQ 61.

1. Define the terms “ cellulitis “ and “Lymphangitis “
2. What are the common organisms responsible for these lesions
3. What is the clinical presentation of these conditions

SEQ 62. A 47 years old intravenous drug abuser who is suspected to have HIV infection presented with right sided parotid abscess requiring incision and drainage. as a surgeon, what precautions will you take to protect yourself during parotid surgery

SEQ 63. A 46 years old man presents with an irregular bright red lesion on the mucosal aspect of right cheek, diagnosed as “ Erythroplakia “

1. Define Erythroplakia
2. Enumerate the pathological features of this lesion
3. Outline the treatment of this lesion

SEQ 64. enumerates various lesions and conditions of oral mucosa associated with increased risk of malignancy

SEQ 65. An eight year old child has presented with delayed eruption of primary teeth.

1. Enumerate the local factors related to delayed eruption
2. Enumerate the systemic factors related to delayed eruption

SEQ 66. A 45 years old female has been diagnosed as a case of “Sjogren Syndrome “

1. What is “ Sjogren Syndrome”
2. How will you diagnose this condition
3. How will you treat this patient

SEQ 67. A 35 years old female presents with an enlarged thyroid gland. while considering the appropriate management of this patient, how are various thyroid swelling classified

SEQ 68. A 40 years old male presents with history of upper abdominal pain aches and pain various bones, frequent passage of gravels in the urine and variable mode changes during the past 2 years. Clinical examination is unremarkable. His serum calcium is 3 mmol/L and BUN and creatinine are within normal range.

1. What is the most likely diagnosis
2. Enumerate various investigations to confirm the diagnosis
3. Enumerate various investigations to localize the causative lesion
4. What is the treatment of this condition

SEQ 69. A mother brings her 3 months old son with complains of gradually enlarging swelling on the right upper neck which increases in size when the child cries. on examination the swelling is 6×8 cm in size, non-tender, soft to cystic and brilliantly trans illuminant. The temperature overlying skin is normal and fluctuation test is positive

1. What is the most likely diagnosis
2. What is the pathology of this lesion
3. What are the various complications if the condition is left untreated
4. What is the treatment

SEQ 70. What do you understand by the term “ Radical Neck Dissection “ enumerate various types of radical neck dissections mentioning the various structures removed in every type

SEQ 71. A 35 years old motorcyclist met a road traffic accident and sustained abrasions and lacerations of the face. A deep lacerations on the right side causes complete transection of ipsilateral facial nerve and parotid duct

1. Enumerate the basic steps while examine a patient for faciomaxillary trauma
2. Outline the principles of management of facial soft tissue injuries
3. What is the treatment of transected facial nerve
4. What is the treatment of transected parotid duct

SEQ 72. 35 years old lady presents with solitary nodule in front of neck which moves on deglutition with recent change in voice

1. What is the diagnosis
2. What important relevant investigations are required
3. What are the treatment options in papillary carcinoma

SEQ 73. Painful red looking swelling in right submandibular region in 20 years old boy with following findings and complaints, difficulty on swallowing, throbbing pain, tender and fluctuant swelling

1. What are the possible diagnosis
2. What is the treatment

SEQ 74.

1. define bacteremia and septicemia
2. what precaution would you take in extraction of tooth in a patient who has mitral valve replacement

SEQ 75. what do you know by term

1. healing by first intention
2. healing by second intention give two examples of each

SEQ 76. A patients has undergone subtotal thyroidectomy for toxic goitre

1. enumerate various post-operative complications
2. how will you manage postoperative hemorrhage in such case

SEQ 77. A 60 years old man presents with I cm ulcer on lateral side of tongue with rolled margins and a lymph node in submandibular region

1. what is the diagnosis
2. what investigations are required to confirm the diagnosis
3. what are the treatment options

SEQ 78. A young patients has been brought to emergency room with facial trauma and difficulty in breathing:

1. what steps you will take to restore breathing
2. what is the cricothyroidotomy

SEQ 79.

1. what is the classification of maxillofacial injury
2. What is management of LeFort 1 type of fracture

SEQ 80. A patients with hepatitis C infection has come to you for dental treatment

1. What precautions you will take to avoid transmission to other patients and yourself
2. How will you sterilize, used instruments
3. What is the rout of infection in hepatitis C

SEQ 81. A 60 KG patient with 30% burn and coughing has been admitted in the ward

1. What are the important steps in treatment
2. What is his fluid requirement
3. How would you assess percentage of burn and depth of burn

SEQ 82. A fifty years old man presents with gradual dysphagia to solid

1. What are the relevant investigations
2. What is the most probable diagnosis

SEQ 83. A patients presents with painless swelling in lateral side of neck, firm consistency, six month duration

1. What are the important points in history that you will ask
2. What investigations are required to make diagnosis
3. What is FNAC

SEQ 84.

1. what are the various varieties of shock
2. Enumerate the clinical features of hypovolemic shock
3. Attendant of patient, while witnessing a dental procedure collapse with following finding Pulse 50/ minute, thready Blood pressure 70/40 mmHg Beads of sweat on forehead (what type of shock she has suffered)

SEQ 85. A child five months old has presented with unilateral cleft lip and palate

1. How would you classify his deformity? what is your management plan
2. Pre-operative preparation
3. Timing of surgery
4. Objectives of good repair

SEQ 86. A 20 years old female underwent appendectomy for perforated acute appendicitis. On 5th post-operative day she complains of diarrhoea and passage of mucous discharge per rectum. Rectal examination revealed bulging of the anterior rectal wall.

1. What is the most likely diagnosis?
2. How will you confirm the diagnosis?
3. What are the treatment options?

SEQ 87. A 30 years old married female presented with pain abdomen and vomiting. Pain is worsened by movement or breathing. She also gives history of vaginal discharge. On examination, her pulse is 100/min and temperature is 102F. There is tenderness and guarding in the abdomen. On vaginal examination she has tenderness on the movement of cervix.

1. What is the differential diagnosis?
2. How will you investigate this patient?
3. How will you treat this patient?

SEQ 88. A 40-year-old bankers is suffering from duodenal ulcer for last 10 years. He is not properly taking medication for this problem. He presented with projectile non-bilious vomiting. On examination, he looks dehydrate and peristalsis is visible in the upper abdomen.

1. What is the most likely diagnosis?
2. How will you confirm your diagnosis?
3. How will you manage this patient?

SEQ 89. A 60 years old man presented with mass in the upper abdomen. There is history of anorexia, dyspepsia and weight loss. He is chain smoker for last 30 years. On examination, he is wasted and looks pale .A hard mass palpable in the epigastrium. Hematology investigation shows iron deficiency anaemia

1. what investigations are required to make diagnosis?
2. What are the principles of treatment in this patient?

SEQ 90. A 55-year-old obese woman presents with a painful, irreducible swelling in the right groin for the last 12 hours. She has nausea, vomiting, and abdominal distension. On examination, the swelling lies below and lateral to the pubic tubercle.

1. What is the most likely diagnosis and which hernia is most prone to strangulation?
2. Outline the immediate management of this patient.

SEQ 91. A 40-year-old male presents with a swelling in the right groin extending into the scrotum. The swelling is reducible, has an expansile cough impulse, and lies above and medial to the pubic tubercle.

1. Differentiate between direct and indirect inguinal hernia on the basis of anatomy and examination.
2. Discuss the preferred surgical management for primary inguinal hernia in adults.

SEQ 92. A 3-year-old child is brought by his mother with a small swelling at the umbilicus, which becomes prominent on crying. The swelling is soft, reducible, and 1.5 cm in size.

1. What is the most likely diagnosis? How is it different from a paraumbilical hernia?
2. Outline the management of this condition in children.

SEQ 93. A 60-year-old obese man presents with a bulge at the site of a previous midline laparotomy scar done 2 years ago for a perforated appendix. The swelling is large, reducible, and increases on coughing.

1. What are the risk factors for incisional hernia development?
2. Discuss the surgical management options for incisional hernia.