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SEQs for BDS

1. SURGICAL ANATOMY

1.1 Submandibular Gland

  1. 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, the submandibular gland drains? (Annual 2017)

1.2 Thyroid Gland

  1. A 45 year old female with multinodular goiter presented in outpatient department. She is euthyroid both clinically and biochemically. She is on next operative list for total thyroidectomy.
    1. Describe the anatomical structures that would be encountered before reaching the thyroid gland
    2. Which two nerves will you have to save during procedure? (Annual 2020)
  2. A 30 year old office secretary is undergoing thyroidectomy for multinodular goiter.
    1. Name anatomical structures the surgeon will incise/dissect to expose thyroid gland with precision from start
    2. Enlist Five Structures Required To Be Saved During Thyroid Gland Dissection. (Supple 2011)
  3. A 45 year old female presented with large multinodular goiter for10 years. She underwent bilateral subtotal thyroidectomy. During surgery, Kocher incision was made. Upper & lower skin flaps were raised, cervical fascia incised radically in midline. For adequate exposure of each lobe of thyroid, surgeon decided to divide the muscle covering thyroid lobes.
    1. Name the muscle covering thyroid lobes.
    2. Surgeon should divide these muscles in lower part of neck near manubrium sterni or in upper part of neck and why?
  4. A 40 year old housewife presents with a swelling in front of neck, which on examination is found to be of thyroid gland. Diagnosis of multinodular goiter is made and total thyroidectomy is planned trough collar incision. What anatomical structures would be encountered in this incision before reaching thyroid gland? (annual 2007)
  5. A 35 year old woman suffering from multinodular goiter is undergoing total thyroidectomy
    1. Enumerate the arteries that need to be divided in order to free the lobes of thyroid gland.
    2. Name one nerve, one large artery and one associated gland that need to be preserved. (Model paper 2007)
  6. A 35 year old female presented in surgical OPD with multinodular goiter. Her subtotal thyroidectomy has been planned elective operation list.
    1. What is the appropriate incision and its anatomical level?
    2. What thyroid pedicles surgeon will ligate? Name anatomical structures to reach these pedicles.
    3. What special precautions are required to avoid neurological injuries? (Annual 2022)

1.3 Breast

    1. Describe the lymphatic drainage of breast
    2. What are ligaments of Cooper?
    3. What is the significant of these ligaments? (Annual 2018)
  2. During modified radical mastectomy, the surgeon approaches the patient's axilla by lifting the fiber of thick muscle anteriority.
    1. Which is the muscle and its function?
    2. Which other structure the surgeon has divided deeper to the lifted muscle to expose axillary lymph nodes with importance of its relations?
    3. What are the structures that the surgeon will preserve while working in axilla? Name at least three (Annual 2012)
  3. A lady 40 year old diagnosed as a case of carcinoma left breast upper outer quadrant is planned for modified radical mastectomy.
    1. Give lymphatic drainage of this area and important structures encountered in axillary dissection.
    2. What is sentinel lymph node? (Annual 2009)

1.4 Abdomen

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

1.5 Stomach

    1. Which arteries supply the stomach? Also name the parent arteries from which these arise.
    2. Give four posterior relations of stomach. (Supple 2016)
  2. A young man with dyspeptic syndrome was found to have carcinoma of body and antrum of stomach on endoscopy and biopsy for surgical treatment. He has to undergo subtotal gastrectomy and gastro-jejunostomy.
    1. What blood vessels have to be divided during this operation?
    2. What group of lymph nodes should be looked for in this patient? (Annual 2010)
  3. In a patient with carcinoma of stomach, total gastrectomy is being performed. Name the arteries which need to be ligated during this operation. (Supple 2008)

1.6 Hepatobiliary system

  1. A 45 year old female presented in OPD with complaint of pain right hypochondrium. On ultrasound abdomen, she was diagnosed as a case chronic cholelithiasis. So, she was put on elective list for laparoscopic cholecystectomy. You are working as house surgeon going to assist this case.
    1. What is Calot's triangle? Draw and label it.
    2. Enumerate four surgical anomalies which you come across during laparoscopic cholecystectomy. (Supple 2020)
    1. Draw and label surgical anatomy of Gallbladder with special reference of Calot's triangle
    2. Name four important structures in relation of common bile duct. (annual 2016)
  3. A surgeon has planned a laparoscopic cholecystectomy of a patient with cholelithiasis. After insertion of the ports, he has to do dissection in the Calot's triangle.
    1. What is the Calot's triangle?
    2. Why is it important during laparoscopic cholecystectomy? (Supple 2015)
    1. Draw and label the anatomy of gallbladder and Calot's triangle.
    2. Name four anatomical parts of common bile duct (CBD) (Supple 2013)
  5. A 40 year old Qaria is diagnosed as suffering from chronic cholecystitis and has to undergo cholecystectomy through subcostal incision. Which anatomical structures would be encountered in this incision before reaching the gallbladder? (Annual 2008)
  6. A 46 year old female is undergoing laparoscopic cholecystectomy for gallstone disease.
    1. What is main content of Calot's triangle?
    2. Describe three steps of critical view of safety in cholecystectomy. (Annual 2021)

1.7 Spleen

  1. A 20 year old female is suffering from idiopathic thrombocytopenic purpura for which she has been under treatment of physician for last 02 years. Now her elective splenectomy is planned.
    1. What are the different incisions in this surgery?
    2. What are the splenic pedicles? Which anatomical structures surgeon will dissect to reach these pedicles?
    3. Briefly describe splenunculi.

1.8 Appendix

  1. A 20 year old college girl is diagnosed to have acute appendicitis.
    1. While selecting a more appropriate incision what should be surgeon's selection criteria based on anatomical facts.
    2. Enumerate with precision the structures incised and/or retracted to reach inflamed appendix in retrocecal position. (Annual 2011)

1.9 Kidney

  1. A 25 year old laborer presented with pain in his left lumber region. Excretory urography reveals left pyelolithiasis. Pyelolithotomy is planned through left lumbar subcostal incision. Which structure will be encountered in this incision before reaching kidney? (Annual 2008)

1.10 Inguinal Hernia

  1. A 25 years old person presents with a swelling in the right inguinoscrotal region. The provisional diagnosis is right inguinal hernia.
    1. Describe the surgical anatomy of inguinal canal.
    2. Describe three differences between direct & indirect inguinal hernia to confirm the diagnosis.
  2. Describe the boundaries of inguinal canal. How do you clinically locate the deep inguinal ring? (Supple 2017)
    1. Draw and label the anatomy of inguinal canal and Hesselbach's triangle.
    2. Name four contents in inguinal canal in male. (Annual 2015)
  4. A patient presents with history of right sided reducible swelling in groin which reappears on coughing. The diagnosis of indirect inguinal hernia is made and inguinal mesh Hernioplasty is planned.
    1. Give the boundaries of inguinal canal.
    2. Name the structures being cut from outside in, till you reach the contents of the sac.
    3. Name one nerve that is at risk of injury during hernia surgery (Annual 2014)

1.11 Femoral Hernia

  1. A 60 year old female presented with swelling and severe pain in the left inguinal region for one hour. On clinical examination, it is suspected strangulated femoral hernia.
    1. Name the anatomical boundaries occupied by this hernia.
    2. Which structure impedes the reduction of hernia?
    3. Which vessel is prone to injury during procedure? (Annual 2019)

1.12 Blood Vessels

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

1.13 Testis

  1. A mother examined her 4 years old boy with missing of right testis which is also not palpable in the groin.
    1. How will you counsel her mother about surgical outcome?
    2. How will you investigate?
    3. Mention steps of surgery from skin onward in this particular child. (Supple 2018)

2. A&E SURGERY; TISSUE REPAIR

2.1 Pre-Op Evaluation & Management

  1. A 30 year old lactating diabetic mother developed left breast abscess. Her blood sugar (F) is 230 mg/dl with oral anti-diabetic drugs. She presented with H/O sever pain, swelling and fever with rigors.
    1. How will you prepare the patient for surgery?
    2. What are the steps of management of abscess?
    3. Give post-op care of this patient. (Supple 2018)
  2. A 45 year old male is on warfarin after prosthetic mitral valve replacement. He is planned for laparoscopic cholecystectomy on elective list. How will you manage him in perioperative period?
  3. A 45 year-old female with gallstone & chronic cholecystitis is admitted from OPD. She is known case of diabetes mellitus. She is planned for laparoscopic cholecystectomy.
    1. How will you evaluate her preoperatively?
    2. What are the principles of creating pneumoperitoneum?
    3. What type of intraoperative complications can occur in this operation? (Annual 2015)
  4. A 35 year old mother of eight children is brought from flood affected area of the country. She has reducible swelling in area of cesarean section scar. She is pale looking and weighs 20% less weight for her age and height. The surgeon has postponed the operation for one month to improve the final results.
    1. Why did the doctor delay the operation? How should he assess the problem?
    2. What advice should be given to patient to achieve his objective? (Annual 2012)

2.2 Wound Complication

    1. What is wound dehiscence?
    2. Write the factors involved in this process.
    3. What type of suture material is used to close the abdomen after laparotomy and what is the rationale of its use? (Annual 2016)
  2. A 60 year old retired clerk has undergone laparotomy for perforated duodenal ulcer general anaesthesia. On 5th post-operative day, he develops fever and tachypnea. Examination reveals a healthy wound. What is the differential diagnosis in this case? (Supple 2007)

2.3 Advance Trauma Life Support

  1. After crossfire, a 30 year old driver is brought to emergency with bleeding wound on left leg. He is conscious.
    1. What will be your first step at reception?
    2. Give four steps of management.
    3. Outline the final treatment. (Annual 2011)
  2. A 17 year old young man was brought to emergency with history of road traffic accident (RTA) and injury to left arm. On examination, multiple lacerations of the forearm and marked swelling of the hand and fingers were noted. Lacerations were soiled with mud and sand and the margins had some blackish discoloration. How will you manage this patient?
  3. A 15 year old motorcyclist meets a road accident and presents to Accidents & emergency department with multiple injuries. He is dyspneic, tachycardiac & hypertensive. How would you manage this patient using ATLS approach? (Annual 2008)
  4. A 54 year old working woman got a penetrating wound on her right temporal region which was bleeding profusely. On reaching Accident & emergency Department 30 minutes later, she was not breathing, her pulse & BP were not recordable. Inspite of all resuscitation efforts, she could not be revived. What pre-hospital management could have saved her life? (Annual 2007)

2.4 Primary survey

  1. A couple was brought in emergency room after Road Traffic Accident. The husband was received dead while the wife had depressed conscious level. Primary & Secondary surveys were done and she was managed conservatively.
    1. Discuss Trimodal distribution of death along with the cause in each group.
    2. Enlist four adjuncts to the primary survey. (Annual 2014)
  2. What do you understand by term primary survey? (Annual 2021)

2.5 Definitive care Plan (Tertiary Care)

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

2.6 Triage

  1. In a suicide bomb attack 50 people died and 150 were injured, which were rushed to local district hospital. Suppose you were medical officer on duty in emergency ward. How would you manage these casualties? (Supple 2007)

2.7 Tension Pneumothorax

  1. A 16 year old boy is brought to surgical emergency room after a motor bike accident. On primary survey and resuscitation, he has absent breath sounds on the left side of the chest and hyper resonance on percussion. Trachea is deviated to right side.
    1. What is the diagnosis?
    2. What measures would you take to deal with this emergency? (Supple 2015)
  2. A 40 year old motorcyclist brought to emergency with history of RTA. He was becoming increasingly restless with tachypnea, dyspnea and distended neck veins. Examination revealed tracheal deviation, hyper-resonance and decreased breath sound over the affected hemithorax.
    1. What is your diagnosis?
    2. What immediate radiological investigations and management should be taken?
    3. What are the deadly dozen threats to life from injury? (Supple 2018)
  3. A 34 year old male has presented after a motor bike accident with restlessness and shouting, he is going to die. On examination he has a pulse of 140, BP 80/50 and a respiratory rate of 30. He has distended neck veins and absent breath sound and hyper-resonant note percussion on left chest.
    1. What is most likely diagnosis?
    2. How will you manage this patient? (Annual 2011)

2.8 Brain Injury

  1. A 20 year old motorcyclist is brought to accident & emergency department of tertiary care hospital after a road traffic accident. There is history of brief period of unconsciousness. He has been resuscitated with ATLS protocol.
    1. Write down the guidelines to obtain CT brain plain in patient with head injury.
    2. Write down the specific management plan if this patient's CT scan is showing an acute extradural hematoma.
    3. Write down motor response part of Glasgow Coma Scale. (Supple 2014)

2.9 Spinal injury

  1. A 60 year old household had a fall from stairs. She is complaining of severe pain in her back. She is conscious, can walk 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 of the most likely diagnosis with important precautionary measures.

3. SURGICAL NUTRITION

3.1 Nutritional Assessment

  1. A 60 year old man is suffering from dysphagia and is not taking proper food. How will you do nutritional assessment of this patient? (Supple 2019)
  2. A 50 year old female has been operated for a tuberculous perforation. Postoperatively, she developed multiple Enterocutaneous fistulae. She lost 10 kg weight in the last one week.
    1. What are the clinical parameters on which this patient has to be assessed for malnutrition?
    2. What type of nutritional therapy this patient needs and why? (Annual 2017)
    1. How will you calculate BMI?
    2. How will you clinically assess the nutritional status of a surgical patient? (Supple 2016)
  4. A 50 year old street bowler has been diagnosed as a case of un-resectable carcinoma of oesophagus. He is emaciated with significant weight loss. How can you assess his nutritional status? (Supple 2015)
  5. A 20 year old female had difficulty in swallowing after accidental ingestion of caustic soda six months ago. She has lost about 20 kg weight and needs corrective surgery. She is being admitted for surgery. Which baseline investigations are necessary to evaluate her nutritional status? (Annual 2015)
  6. A 16 year old girl after corrosive intake presents with three months history of dysphagia both for solids and liquids.
    1. How will you assess her nutritional status?
    2. What is the best method of replenishing her nutritional requirements?
  7. A 35 year old housewife develops jejunal fistula after leakage of an anastomosis. She is put on conservative treatment. How would you look after nutritional requirements of this patient? (Supple 2007)
  8. A 21 year old female has presented with dysphagia for solids only and vomiting for last two months. There is history of bleach intake for suicidal intention four months back. On examination, she is emaciated and has abdominal distention with a positive succession splash.
    1. Give the most likely diagnosis.
    2. How will you assess her nutritional status?
    3. How will you build her up nutritionally for surgery through enteral route? (Annual 2021)
  9. A 23 year old female has history of dysphagia following corrosive intake for 03 months. Now she has developed non-bilious projectile vomiting and lost 10 kg weight in last 03 months.
    1. Describe different methods for nutritional assessment.
    2. What regular biochemical monitoring is mandatory during nutritional support of this patient? (Supple 2021)
  10. A 50 year old male smoker has history of dysphagia for solids and liquids for two months. He is anemic, loss of appetite and significant weight loss. He was diagnosed as a case of upper GI malignancy.
    1. How will assess his nutritional status?
    2. What is the most appropriate route for nutritional build-up for him? (Annual 2022)

3.2 Calculation of Nutritional Requirements

  1. A 20 year old female had difficulty in swallowing after accidental ingestion of caustic soda six months ago. She lost about 20 kg weight and needs corrective surgery. She is being admitted for surgery. What is average amount of energy, carbohydrate, fat and protein requirement for 24 hours? (Annual 2015)

3.3 Enteral Feeding

  1. A 60 year old male diagnosed as a case of oropharyngeal cancer. Patient is unable to take orally before surgery because of this growth. (Supple 2021)
    1. What are clinical methods and investigations to assess nutritional status?
    2. Which route of nutrition is preferred and why?
    3. What is average amount of energy required from carbohydrate, fat and protein for 24 hours?
  2. A 70 year old male suffering from advanced carcinoma of esophagus. He has to be put on total enteral nutrition, which methods of total enteral nutrition are available for this patient? Enlist tube related, gastrointestinal, metabolic and infective complications related to total enteral nutrition. (Annual 2020)
    1. Name various methods of enteral nutrition.
    2. What are the complications of enteral nutrition? (Supple 2019)
  4. A 20 year old female got corrosive burns to esophagus. In emergency room, resuscitation of patient is done. She is unable to take by mouth. Enteral nutrition planned.
    1. What are common enteral nutrition techniques?
    2. What metabolic and tube related complications can occur during enteral nutrition? (Annual 2019)
    1. What is enteral nutrition?
    2. What are various methods of enteral nutrition?
    3. Enumerate the complications of enteral nutrition. (Annual 2018)
    1. How will you define enteral nutrition?
    2. Enlist different methods of enteral nutrition.
  7. A 50 year old street bowler has been diagnosed as a case of un-resectable carcinoma of esophagus. He is emaciated with significant weight loss. Write down three different ways to give him enteral nutrition. (Supple 2015)
  8. Write down at least three ways of enteral nutrition. (Supple 2014)
  9. A 65 year old man with dysphagia for six months is being prepared for a major surgical procedure in next few days. He has lost about 20% of his body weight in this period.
    1. For a better result of surgical intervention, what is your point of focus at this stage?
    2. How will you execute your strategy? (Supple 2011)
  10. A 60 year old patient presents with dysphagia and significant weight loss. His upper GI endoscopy showed a malignant stricture 35 cm from incisors. Investigations: Hb 9 gm% & serum albumin was 2 gm%. CT scan showed growth which is not involving adjacent structures. It was decided to improve his nutritional status before surgery.
    1. Discuss how he can be provided with adequate nutrition enterally?
    2. Enumerate 5 tube-related complications of enteral nutrition. (Supple 2010)
  11. A 70 year old butler is suffering from advanced carcinoma of the esophagus for which he has to be put on total enteral nutrition.
    1. Which methods of total nutrition are available for this patient?
    2. Write two merits and two demerits of total enteral nutrition. (Annual 2008)
  12. What are complications of enteral nutrition? (Annual 2022)

3.4 Total Parenteral Nutrition (TPN)

  1. Enumerate the complications of total parenteral nutrition. (Supple 2018)
  2. Give indications of total parenteral nutrition. (Supple 2016)
  3. A 34 year old male from peripheral area presents after some abdominal operation to a tertiary care hospital. He has been diagnosed as a case of high output intestinal fistula.
    1. Write down the ideal route of nutritional supplementation in this case.
    2. Write down metabolic complications he can encounter with this supplementation relating to feeding regimen. (Supple 2014)
  4. A patient presented in surgical emergency with signs and symptoms of acute abdomen. His exploratory laparotomy was done. Almost whole of small gut was found to be gangrenous and it was resected. Only 20 cm of jejunum was left behind.
    1. Which routes of nutrition will you chose in this patient?
    2. What are the effects of resection of small intestine on him?
    3. Name four complications of parenteral nutrition. (Annual 2014)
  5. A 25 year old boy presents with high output enteric fistula after laparotomy for typhoid perforation.
    1. Name nutritional fluids that should be given to him with their caloric values.
    2. Enumerate ten complications of parenteral nutrition. (Supple 2013)
  6. A young lady attempted suicide by drinking a corrosive solution. She developed ulceration and scarring of the esophagus and stomach due to which she is unable to tolerate orally. She is advised total parenteral nutrition.
    1. What are the routes available for this procedure?
    2. What are its complications? (Annual 2010)
  7. A patient with advanced carcinoma of esophagus with severe malnourishment has been planned for Esophagectomy.
    1. What combinations of fluids will you use to improve nutrition of this patient prior to surgery by parenteral nutrition?
    2. Enumerate the complications of parenteral nutrition. (Annual 2009)
  8. A 35 year old clerk develops jejunal fistula due to leakage of anastomosis. He is put on total parenteral nutrition through a central venous line. How would you perform biochemical monitoring of this case? (Annual 2007)

4. ACID BASE BALANCE

4.1 Gastric Outlet Obstruction

  1. A 50 year old woman has presented with gastric outlet obstruction. She is vomiting profusely.
    1. Name the fluid and electrolyte disturbance that can occur.
    2. Name type of acid base imbalance can be seen in her case.
    3. What is paradoxical aciduria?
    4. How will you correct it?
  2. A 60 year old lady presents in emergency with gastric outlet obstruction resulting in repeated vomiting.
    1. What is the electrolyte imbalance & give its physiological basis?
    2. Mention two important fluids & one important investigation used to treat & monitor this patient. (Annual 2013)
  3. A four week baby presented with non-bilious vomiting, distention of abdomen and succession splash positive.
    1. Enlist the metabolic complications you will consider in this case.
    2. How will you treat this child? (Supple 2008)
  4. A 45 year old laborer presents with vomiting, absolute constipation, abdominal pain and distention for last 12 hours. What fluid, electrolyte and acid base balance would be present in him? (Annual 2007)
  5. A 20 year old man presented with vomiting, absolute constipation, abdominal pain and distention for previous 03 days. He has received 03 liters of 5% D/W in previous one day. What fluid, electrolyte and acid base disturbance would be present in this case? (Model paper 2007)
  6. A 50 year old male smoker came with history of non-bilious vomiting after meal for last 03 months. He was diagnosed as a case of peptic ulcer disease.
    1. What metabolic derangements can occur in this condition?
    2. How will you correct these metabolic abnormalities?
    3. What is the primary metabolic abnormality? Describe the mechanism. (Supple 2021)

4.2 Fluid Therapy

  1. A 40 year old woman recovered from the debris of an earthquake in October, five days after incident. She is semi-conscious, responding to loud verbal commands after adequate airway control in a camp hospital.
    1. What will be your fluid & electrolyte replacement strategy when there is no obvious or concealed hemorrhage?
    2. How will you monitor the efficacy of designed therapy?
    3. How long will you continue with this fluid and electrolyte support? (Annual 2011)

4.3 Shock

  1. A 35 year old person is brought to emergency with history of road side accident. On examination, he is found to be in shock.
    1. Define shock
    2. Classify shock (Supple 2019)
  2. Define and classify shock. (Supple 2010)
  3. A 19 year old boy is struck by a car while crossing the road. He is brought to emergency with pulse of 120, BP 100/60 and cold clammy skin.
    1. Define shock
    2. What are types of shock?
    3. What are two cardinal principles of management of bleeding in a trauma patient?
  4. A 25 year old motorcyclist has presented in accident and emergency department with multiple injuries. On examination, his pulse is 125/min, BP 70/50 mmHg, with R/R 32/min. Define shock. (Annual 2022)

4.4 Severity of Shock

  1. A 30 year old patient has brought to emergency with history of fall before 04 hours. On examination, he is well-oriented; there is deformity of right upper limb, cold peripheries. Pulse 100/min, BP 110/70 mmHg.
    1. Is it compensated or decompensated shock?
    2. Enumerate the factors to place the patient in the above category. (Annual 2017)
  2. In a patient run over by a speeding truck, polytrauma has resulted in shock.
    1. What are parameters of patient in the stage of severe shock?
    2. What are consequences of irreversible shock? (Annual 2010)
  3. A 25 year old motorcyclist has presented in accident and emergency department with multiple injuries. On examination, his pulse is 125/min, BP 70/50 mmHg, with R/R 32/min.
    1. Classify shock according to severity.
    2. Compare clinical features of each type in tabulated form. (Annual 2022)

4.5 Hemorrhage and its Management

  1. A 45 year old man underwent above knee amputation for gas gangrene of the lower limb. On 7th postoperative day, massive bleeding started from the wound site.
    1. What is the type of haemorrhage?
    2. What are the factors responsible for bleeding?
    3. What are the principles of management?
  2. A 30 year old male has got severe trauma of abdomen and chest during RTA. He has presented with haemorrhagic shock. He was shifted to operating room.
    1. What are the two main goals of damage control surgery?
    2. What are stages of damage control surgery?
    3. What is role of interventional radiology in torso-trauma? (Annual 2022)

4.6 Hypovolemic (Haemorrhagic) Shock

  1. A 35 year old brought to an emergency room after multiple injuries. On examination, his pulse is 140, BP 80/60, abdomen is tense and tender.
    1. What is the type of shock in this patient?
    2. How you quickly assess this patient regarding abdominal visceral injuries?
  2. A 25 year old young male presented to emergency with blunt trauma abdomen. He is in shock with blood pressure 70/40; pulse 124/min. On examination abdomen is tense and tender more on left upper abdomen.
    1. Which solid organ is most likely to be injured in this case?
    2. Write down grading of injury of this organ?
    3. What would be the steps of management if you found more than grade 04 injury of this organ? (Annual 2020)
  3. A 30 year old semi-conscious man brought to the emergency with incised wound on the neck. His pulse is 115/min, systolic BP is 50 mmHg. What is traditional classification of haemorrhagic shock? (Supple 2018)
  4. A 40 year old bank cashier is brought to emergency in shock. He had suffered from high-grade fever, severe bone pain and haemorrhagic spots on his body since last 10 days. He has stayed at home and was using NSAIDs for symptomatic control. On brushing of teeth, he was bleeding but ignored.
    1. What is your suspicion and enumerate three 1st line measures?
    2. How will you subsequently manage him after initial one hour of admission? (Supple 2011)
  5. From the rural health center, a 45 year old mother of six children is referred with the diagnosis of Dengue fever. She has a body temperature of 100°F, pulse rate 110/min. She has a platelet count of 70 x10^9. Enlist five management steps for her care in our ward. (Annual 2011)
  6. A 20 year old college student sustains multiple injuries in a road traffic accident. His pulse is 120/min & thready, blood pressure 90/60 mmHg. He has difficult respiration and sweat on his forehead.
    1. What is the diagnosis?
    2. How would you treat this case? (Supple 2007)

4.7 Septic Shock

  1. What are the clinical features of septic shock? (Supple 2017)
  2. A 50 year old man after laparotomy for typhoid perforation develops tachycardia, low blood pressure & oliguria on 3rd postoperative day. His Hb is 12 gm/dl & leukocyte count is 22,000/dl.
    1. What is the probable cause?
    2. Outline the principles of management of the patient. (Annual 2013)

4.8 Obstructive Shock

  1. How would you resuscitate a 20 year old boy who has gone into shock after blunt trauma injury to chest and abdomen? (Supple 2013)
  2. A 50 year old male was struck on right side of chest during a quarrel. He develops rapidly progressive dyspnea. On examination, his extremities are cold and clammy. Pulse 110, BP 90/60. There is tracheal and apex beat shift to left side.
    1. What type of shock has this patient developed and why?
    2. What are other clinical conditions which can lead to same category of shock? (Supple 2010)

4.9 Shock Monitoring

  1. A 35 year old person is brought to emergency with history of road traffic accident. On examination, he is found to be in shock. How will you monitor this patient who is in shock? (Supple 2019)
  2. A 30 year old semi-conscious man brought to the emergency with incised wound on the neck. His pulse is 115/min, systolic BP is 50 mmHg. What are the minimum and additional modalities to monitor the patient in shock? (Supple 2018)
  3. A 21 year old boy presents in emergency room with stab injury in right chest. On examination, his pulse is 120/min, BP 90/60 mmHg and pallor is positive. Two wide bore I/V lines are taken & I/V crystalloids are administered. Half hour later, his pulse becomes 90/min and BP 105/70 mmHg.
    1. What are dynamic fluid response and its interpretation?
    2. How will you monitor patient in shock for organ/system perfusion? Give four points. (Annual 2014)

4.10 Indications of Blood Transfusion

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

4.11 Complications of Blood Transfusion

  1. A 35 year old brought to an emergency room after multiple injuries. On examination, his pulse is 140, BP 80/60, abdomen is tense and tender.
    1. Enumerate three complications with single transfusion.
    2. Enumerate four complications of massive transfusion.
  2. A 40 year old male who has been operated for cholecystectomy is started on blood transfusion. You notice the mistake of mismatched or incompatible blood.
    1. What will be the management of this patient?
    2. What measures will you take to prevent the catastrophe in future? (Annual 2018)
  3. A 65 year old carpenter with O positive blood group has to undergo Whipple's operation for which multiple blood transfusions would be required. What complications of blood transfusion can occur in this patient? (Supple 2015)
  4. A 40 year old male is brought to emergency room after multiple injuries. He is in shock. Initial management has been done, now he is in the ward. He is found to have intra-abdominal bleeding. He was transfused with five pints of blood during and after repair of liver injuries. Mention any three complications with single transfusion. (Annual 2015)
  5. In a surgical ward, nurse on duty has called the duty doctor announcing ABO incompatible blood transfusion to a young male patient due to clerical mistake and told him only 10 ml blood was transfused when she stopped the transfusion. Patient is shivering, running fever and complaining of pain in loin area.
    1. How would you deal with this condition in the immediate phase if you are the attending doctor?
    2. Enlist the infectious complications of blood transfusion. (Supple 2014)
  6. An 8 year old male has been advised whole blood transfusion after a major abdominal surgery. He complains of severe headache & develops fever & rapidly appearing urticarial rash all over the body 5 minutes after initiation of transfusion.
    1. What is the most likely diagnosis?
    2. Enumerate initial treatment steps in management of this patient.
    3. How can this complication be prevented? (Annual 2012)
  7. A 65 year old carpenter with O+ve blood group has to undergo Whipple's operation for which multiple blood transfusions would be required. Which infectious complications of blood transfusion can occur in this patient? (Annual 2008)

4.12 Disseminated Intravascular Coagulation

  1. What treatment steps are suitable to treat coagulopathy after massive blood transfusion? (Annual 2015)

5. ANAESTHESIA & PAIN MANAGEMENT

5.1 General Anaesthesia (GA)

  1. A 50 year old man presented in OPD with swelling in left-sided parotid region. On FNAC, it turned out to be pleomorphic adenoma.
    1. Which type of anaesthesia is suitable for this patient? Give the steps of this anaesthesia.
    2. Give two most common complications of this anaesthesia. (Supple 2020)
  2. What are techniques for maintaining airway during General Anaesthesia? (Supple 2016)
  3. A 35 year old female is admitted with acute cholecystitis secondary to gallstones. She is otherwise fit and early laparoscopic cholecystectomy is planned.
    1. What type of anesthesia is preferred for this patient?
    2. Name the triad of this anesthesia.
    3. Name the layers through which spinal needle passes. (Annual 2014)
  4. A 25 year old school teacher is undergoing subtotal thyroidectomy for primary thyrotoxicosis (Grave's disease).
    1. What type of anaesthesia will be necessary for a safe surgical procedure?
    2. What measures will you take to ensure the better outcome in the capacity of anesthetist?
    3. In five lines, give the steps you will take during the procedure. (Annual 2011)
  5. A 40 year old man with acute abdomen is planned for laparotomy.
    1. What are objectives of the anesthetist to facilitate the surgery?
    2. Give the advantages of general anesthesia in this patient. (Annual 2010)
  6. What is general anaesthesia triad? (Supple 2018)

5.2 Local & Regional Anaesthesia

  1. A 70 year old male presented in outpatient department with left sided inguinal hernia. He was fit for surgery by cardiology and anaesthesia department.
    1. Which type of anaesthesia is more suitable and commonly used in the surgery of Hernioplasty?
    2. Enumerate four complications of this technique.
    3. What measures can be taken to avoid common complications of this anaesthesia? (Annual 2020)
  2. A 40 year old woman presents with ganglion of right wrist. The surgeon decides to operate her under Bier's block.
    1. Write a brief note on intravenous regional anesthesia (Bier's block)
    2. What are the common techniques for local anaesthesia? (Supple 2019)
  3. A 25 year old man is going to be operated for varicose veins of left lower limb under spinal anaesthesia.
    1. What are the complications of this procedure?
    2. How does spinal anesthesia differ from epidural anaesthesia? (Annual 2018)
  4. A 30 year old lady undergoing labor; she requests for epidural anesthesia during delivery.
    1. Describe the method of giving epidural analgesia.
    2. Mention its three complications. (Supple 2017)
  5. What is spinal headache? (Supple 2016)
  6. Mention three indications of Epidural Anaesthesia. (Supple 2016)
    1. Name different types of regional Anaesthesia.
    2. Name three complications of spinal anaesthesia.
    3. Write the steps in the treatment of spinal headache. (Annual 2016)
  8. A young female has presented with 2×2 cm swelling on the flexor aspect of her right forearm. Surgical excision biopsy has been planned. She is reluctant to all types of general anaesthesia.
    1. What is the most suitable regional anaesthesia you will plan for this patient?
    2. Name any two drugs frequently used for this anaesthesia along with their maximum safe dose in most cases.
    3. Enlist at least four complications of this form of anaesthesia. (Supple 2014)
  9. A 40 year old lady who weighs 60 kg has come for removal of lipoma on her right forearm. You plan to remove it under local anaesthesia.
    1. Name two important local anaesthetic agents and their doses which can be used in her case.
    2. Mention five important complications of local anesthetics. (Supple 2013)
  10. A 70 year old man has to undergo right inguinal herniorraphy. He is not fit for general anaesthesia. Anesthetist decides that this procedure should be done under regional anaesthesia.
    1. What do you mean by regional anaesthesia? Mention its two advantages over GA.
    2. Mention two of its types with their complications. (Annual 2013)
  11. A 65 year old male presents with reducible RIH. He is hypertensive, well controlled on medication, ECG is normal. There is history of diet controlled diabetes. He is planned for repair of RIH.
    1. What are various types of anesthetic techniques which can be used in this patient?
    2. Briefly discuss which one type of anaesthesia is preferred for this patient.
  12. A 25 year old man is planned for anorectal surgery under spinal anaesthesia.
    1. What is the most appropriate site for injection and why?
    2. Enlist complications of spinal anaesthesia. (Annual 2009)
  13. A 20 year old college student has to undergo right herniorraphy.
    1. What anesthetic techniques can be employed in this case?
    2. Write 1 merit & 1 demerit of each. (Supple 2008)
  14. A 20 year old university student has to undergo left inguinal herniorraphy under regional anaesthesia.
    1. What regional techniques are available for this patient?
    2. Describe any one of them. (Annual 2008)
  15. A 25 year old male has to undergo right inguinal Hernioplasty as elective surgery.
    1. What are different options for anesthesia administration in this surgery?
    2. Describe complications of local anesthesia. (Supple 2021)

5.3 Pain

  1. A 60 year old man has been operated for TURP for carcinoma of prostate 06 hours ago and is now complaining of pain.
    1. Name the different types of chronic pain.
    2. Briefly mention the different options for controlling pain in malignant disease. (Supple 2018)
  2. What are the options for controlling severe pain in malignant disease?
  3. A middle aged lady presents with locally advanced carcinoma of right breast. Patient is in agony because of severe intractable pain.
    1. What is WHO pain step ladder?
    2. Which painkiller is to be selected for this patient?
  4. A 40 year old male underwent radical gastrectomy for carcinoma stomach. In the post-operative period, he was feeling severe pain for which the doctor advised patient controlled analgesia.
    1. What is patient controlled analgesia?
    2. How is it administered?
    3. What are advantages of patient controlled analgesia?
  5. A 66 year old male has an unresectable carcinoma of body of pancreas. He is complaining of severe abdominal pain.
    1. What is most likely cause of this pain?
    2. What percutaneous neurolytic technique can help relieve this pain?
    3. Describe WHO pain management ladder. (Annual 2021)
  6. A 65 year old male presented with haematuria and generalized bone pain and anemia. He was diagnosed as advanced CA prostate.
    1. What are different methods to control severe pain in this malignant disease?
    2. What is WHO analgesic ladder?

6. SURGICAL & SPECIAL INFECTIONS

6.1 Aseptic Techniques & Sterilization

    1. What is the difference between sterilization and disinfection?
    2. Enlist four common methods of sterilization with an example for each one of them.
    3. How disposable articles are sterilized? (Supple 2017)
  2. Hospital infection control team is concerned about increased incidence of infection in main operation theatre. They have asked for your recommendation based on scientific knowledge. Enlist 10 points of your concern. (Supple 2011)
  3. After a surgery on an infected case, how will you ensure the safe reuse of these instruments in next operation? (Supple 2008)

6.2 Surgical Site Infections (SSI)

  1. A 30 year old male has been operated for open cholecystectomy on elective list. He is not a diabetic, hypertensive or on any drug. On 4th post-operative day, patient develops severe induration and pus started pouring out of wound. Wound was opened and multiple debridements were carried out.
    1. Can you enumerate the scientific name of such infection?
    2. Name the simple steps to avoid such infections. (Annual 2017)
  2. In surgical practice various methods are used to avoid wound infection.
    1. Classify wounds according to the risk of infection.
    2. Also give example of each type of wound as well as risk of infection with or without antibiotics prophylaxis. (Supple 2016)
    1. Name the factors that determine whether a wound will get infected or not.
    2. How will you treat a 20 year old boy who has developed wound infection after appendectomy? (Supple 2016)
    1. What are different factors that increase the risk of surgical site infection?
    2. What pre-operative measures should be taken to minimize surgical site infections? (Annual 2016)
  5. What scoring system/systems are used for wound infection classification? (Annual 2015)
    1. Describe surgical site infections.
    2. Write four ways to avoid SSI. (Annual 2014)
  7. A 15 year old boy has undergone appendectomy. On 5th post-operative day, he develops wound infection.
    1. What type of wound is it?
    2. Classify the surgical wounds and give examples. (Supple 2013)
  8. On fourth day of operation done for perforated appendix, the 30 year old man is complaining of increased pain at wound site. On examination, the doctor finds redness and swelling at wound. Patient has pulse of 100/min and temperature 100°F. His BP is 130/70 mmHg.
    1. What should be the doctor's first step in this case with suspected diagnosis?
    2. How should he subsequently manage this patient? (Annual 2011)