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Surgery and Post Op

1. An elderly postoperative patient became agitated with low oxygen saturation. CT pulmonary angiogram (CTPA) is the next best investigation to evaluate for possible pulmonary embolism given the clinical context. 2. A man with abdominal pain and findings on ultrasound of dilated bowel loops and air in the biliary tree likely has gallstone ileus, a mechanical bowel obstruction caused by a gallstone that has eroded into the bowel. 3. For an obese patient with an epigastric hernia, weight loss through diet and exercise represents the most appropriate initial management approach given the absence of complications requiring surgical intervention.
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0% found this document useful (0 votes)
153 views96 pages

Surgery and Post Op

1. An elderly postoperative patient became agitated with low oxygen saturation. CT pulmonary angiogram (CTPA) is the next best investigation to evaluate for possible pulmonary embolism given the clinical context. 2. A man with abdominal pain and findings on ultrasound of dilated bowel loops and air in the biliary tree likely has gallstone ileus, a mechanical bowel obstruction caused by a gallstone that has eroded into the bowel. 3. For an obese patient with an epigastric hernia, weight loss through diet and exercise represents the most appropriate initial management approach given the absence of complications requiring surgical intervention.
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Surgery and Post Op

1.Post-op day 3, old lady, agitated, pulled out IV cannula, SpO2 not given. Invx asked.
A) CTPA
B) D-dimer
C)Blood Glucose
D)Alcohol level
E) Pulse Oximetry

ANS: E. (if spO2 decreased, CTPA)


Kaplan epg 105
2.A 50 years old man came with loin to groin pain and u/a shows hematuria in CT we see a 2cm
stone in calyx?
1. laser lithotripsy **
2. per cutaneous lithotripsy
3.open surgery
4.further f/u
Best choice ESWL
Text book of surgery 543,544, genitourinary notes epg 23
Renal stones

Location of stone Conservative Rx ESWL Surgery or scopic removal


Renal pelvis < 5mm90% 0.5-2cm > 2cm (percutaneous nephrolithotomy:
pass. PCNL)
5-7mm:
tamsulosin or
nifedipine
Ureteric stone < 5mm, f/by serial 0.5-1cm > 1cm  ureteroscopic laser
(Gold standard test AXR every 1-2 lithotripsy for stones up to 2cm in
for both renal & weeks middle portion after fragmentation of
ureteric stones is stones > 6mm; distal ureter 
non-contrast CT cystoscopic removal using basket;
scan.) Initial: upper ureteric stone pushed bang if
AXR 80% is <2cm
radioopaque, lucent
stones: MUX
mat-rix, urate,
xanthine

3. pt after trauma ,presented with hypotension ,BP 90/60 , glucose 2.2 , ask which fluid
will use?
a) glucose 5% normal saline 500 ml ***
b) glucose 50% 50ml
c)glucagon

4. motor vehicle collision complains chest pain most suspicious of an aortic injury
A multiple rib fractures--
B a left pulmonary contusion

5. 50 years old male patient has sudden retrosternal chest pain and severe vomiting proceed
by pain. He has hypertension and controlled with thiazide. On examination, dullness lower left
lung and reduced breath sound on left lower zone of lung. Which of the following investigations
to reach diagnosis?
A. CT chest
B. Gastrografin swallow
C. Ultrasound
D. Echo
E. Chest X-ray
E. CT scan
Kaplan epg 128
Boerhaave’s syndrome is rupture (perforation) of the esophagus that results from
prolonged, forceful vomiting. There is continuous, severe, wrenching epigastric and low
sternal pain of sudden onset, soon followed by fever, leukocytosis, and a very sicklooking
patient. Contrast swallow with a water-soluble agent (Gastrografin) is
diagnostic and emergency surgical repair should follow. Delay in diagnosis and
treatment has grave consequences due to the morbidity of mediastinitis.
Mallory-Weiss tear is a mucosal laceration at the junction of the esophagus and
stomach. It occurs after prolonged, forceful vomiting and presents with bright red
hematemesis. Endoscopy establishes diagnosis, and allows treatment with endoscopic
clipping or coagulation.
6.post operative patient, oliguric with indwelling catheter, fever 38.5, what is ur most appropriate
management?
1.abd x ray
2. blood culture
3.serum electrolytes and Cr
4. abd us
Dx bacteraemia

7.case with paralytic ileus, post-operative, patient stable, present of few abdomen sound ,
presented with pic ,ask next in management?
a) IV fluids and conservative **
b) CT
In normal, post op ileus –few days after surgery
If the patient is unstable or peritonitis, do CT abdomen

8. The diverification of recti scenario with picture. management?


a) physiotherapy **
b) open mash repair
c) lap mash repair
d) weight loss
e) gastric optication
baley and love epg 949
dx; false herniation – physiotherapy and weight loss

9. another question post op patient, no catheter, present with oliguria, ask treatment?
OHCm epg 576
Urine output (oliguria) Aim for output of >30mL/h in adults (or >0.5mL/kg/h).
Anuria may reflect a blocked or malsited catheter (see p763) rather than AKI. Flush
or replace catheter. Oliguria is usually due to too little replacement of lost fluid. Treat
by increasing fluid input. Acute kidney injury may follow shock, drugs, transfusion,
pancreatitis, or trauma (see p300 for classification and management of AKI).
• Review fluid chart and examine for signs of volume depletion.
• Urinary retention is also common, so examine for a palpable bladder.
• Establish normovolaemia (a CVP line may help); you may need 1L/h IVI for 2–3h. A
‘fluid challenge’ of 250–500mL over 30min may also help.
• Catheterize bladder (for accurate monitoring)—see p762; check U&E.
• If intrinsic renal failure is suspected, stop nephrotoxic drugs (eg NSAIDS, ACE-i) and
refer to a nephrologist early.

10.Asking for appropriate advice for the patient. The diverification of recti scenario with picture.
management
A. Weight loss therapy **
B. Abdominal binder
C. herniorraphy with mesh repair
D Hernioplasty
E Observation

11. I got X-Ray Caecal Volvulus (Ask Diagnosis) I forgot the detail of scenario.
Text book of surgery epg 288
12. 11. Another question is same but ask for treatment??

13. 75 years old man present with severe retrosternal chest pain. pain is preceded by
vomiting. with BP 100/70 mmHg, dull on percussion and reduced breath sound at base of the
lung. he has HTN DM asking most diagnostic test?
1. non-contrast CT
2. electrocardiogram
3. chest X-ray
4. Gastrograffin swallow **
Dx :
HB 2.116, S169
13.The patient with history of claudication, smoke 30 pack cigarette per day, drink alcohol,
obese with diabetic history. he refuses surgery although he was fit for it. He asked you for the
appropriate advice that will improve his symptoms of claudication?

A-Reduce smoking
B-reduce alcohol drinking
C-supervised exercise *
D-control his hypercholesterolemia
Therapeutic guide line epg 369
14)flail chest Q,CT given(hemopneumothorax) , MVA, #rib, painful shallow breathing ,O2 given
by face mask, what’s next?
a. morphin*
b.intubate
c. drain

15.Patient 6 hrs after hemicolectomy 110/75, pulse: 85/min. fluids given at 125ml/hr. urine
output only 80 ml. mild abdominal tenderness also present. catheter already inserted. what
should be the next most appropriate investigation:
Bladder scan
Serum urea and creatinine
Blood cultures

16)Post op oliguria in a patient with cholecystectomy 12 hours before. fever 37.9, BP and pulse
normal, fluid running at 80 ml/hr but urine output only 100 ml. no mention of catheterization.
what to do next:
Usg bladder**
Ct scan
Serum urea creatinine
blood culture ( bacteremia due to catheterization )
urine output post op 30ml/hr
Auria due to catheter malposition or obstruction or bladder retention (catheterization)
17.Women feels pain in abdomen during gardening. pain settles down but happens again and
again for half hour episodes. On USG examination dilated small bowel loops and air in biliary
tree. What is the most likely diagnosis?
a) Cholelithiasis
b) Pancreatitis
c) Crohns ileitis
d) Mesenteric ischemia
Causes- ERCP during procedure, recent surgery, gall stone ileus –splinter of oddi incompetent

18. Epigastric hernia scenario. Most appropriate management?


a) physiotherapy
b) open mash repair
c) lap mash repair
d) weight loss
textbook of surgery epg 381,336, barley and love epg 335
19.Epigastric hernia scenario. asking advice?
a) physiotherapy
b) open mash repair
c) lap mash repair
d) weight loss

20. left leg scc of handbook q recall

21.post op pt oliguria but no fever and no mention of the catheter , what is your most
appropriate management ?
1.abd x ray
2. blood culture
3.serum electrolytes and Cr
4-abd us*

ANS: 4 (No bladder distension —> oliguria is confirmed)


Post-op oliguria
Bladder distension- suprapubic examination (to rule out AROU following lower abdominal
surgery)
If (+), insert Catheter. If (-), U & E.
USG.
Pre-renal: Fluid challenge
Established ATN- Treatment of Renal Failure
22. old patient who drinks about 10-12 standard drinks per day and also smoker, underwent some
surgery. on 3rd post op day he developed agitation, O2 saturation 88%.no fever. what next?
a) blood alcohol
b) blood glucose
c) CTPA
d) XRAY CHEST
e) urine culture
Dx ; PE
23.Patient on post-operative day 3 started becoming agitated, irritable and had Shortness of
breath.
What is the next and best appropriate investigation?
a. CTPA *
b. D-Dimer
c. Chest x-ray
d. Blood gases
e. Blood sugar level

24.I got 3 hernia cases - asking advice, treatment and diagnosis. i opted for watchful observation
- as patient was asymptomatic and there was no underlying disease.

Epigastric hernia picture of a 56


yearoldmanwhichextendsfrom umbilicus to
xiphisternum. He looked morbidly obese and had a
waistcircumferenceof 110 cm
26.Patient after surgery present with agitation, tremor, restless. Previous medication contains
oxycodone and others drugs. HT + and history of drinking one glass of wine every day before.
Current medication list mention and didn’t contain oxycodone.
a) Benzodiazepam withdrawal
b) Alcohol withdrawal*

27.1st POD after surgery for incarcerated hernia. Patient irritable agitated has fever O2 sat 88%
what next appropriate after giving O2
A. IV antibiotic
B. heparin
C. thrombolysis
D. droperidol***

OHCM epg 576


Confusion may manifest as agitation, disorientation, and attempts to leave hospital,
especially at night. Gently reassure the patient in well-lit surroundings. See p484 for
a full work-up. Common causes are:
• hypoxia (pneumonia, atelectasis, LVF, PE) • infection (see earlier)
• drugs (opiates, sedatives, and many others) • alcohol withdrawal (p280)
• urinary retention • liver/renal failure.
• MI or stroke
Occasionally, sedation is necessary to examine the patient; consider lorazepam 1mg
PO/IM (antidote: fl umazenil) or haloperidol 0.5–2mg IM. Reassure relatives that postop
confusion is common (seen in up to 40%) and reversible

28 RTA patient with SEVERAL (question said several. no. of ribs not given) front ribs
fracture. in pain which is radiated to back side with sob. no vitals given...what will you
do next. (scenario seemed like flail chest or aortic rupture)
a) Echo
b) CXR***
c) USG
d) intubation
e) Ecg
Explanation: C X ray --fail chest or pneumothorax or aortic rupture rib fracture
ECG – myocardial contusion
USG (focus assement ) to exclude haemothorax –splenic rupture
Intubation ---for respiratory depression
29. The old patient who drinks about 10-12 standard drinks per day and also smoker, underwent
some surgery. on 3rd post op day he developed agitation, O2 saturation 88%.no fever. what
next?
a) blood alcohol
b) blood glucose
c) CTPA **
d) XRAY CHEST
e) urine culture
Dx PE
well score
respi notes
30.Young male complaining of pain in groin after lifting a heavy object, by exam no lump but
US revealed 1 cm defect in inguinal ring with fat herniation but no visible lump, next;
a) Open laparotomy,
b) mesh
c) Laparoscopic repair **
treatment –reassure
Textbook of surgery epg 378
(BAILEY & LOVE) epg 354,957
OHCM epg 612
Check again if lump appears
31 75-year-old (I forgot man or woman) complaint of having difficulties with swallowing
solid food. The patient also got food being regurgitated. What is the most likely
Diagnosis.?
A. Pouch Pharyngeal **
B. Achalasia
C. Stricture esophagus (something like that., I forgot)
HB 3.099 OHCS pg epg 583,584 B&l epg 1018
Pharyngeal pouch The pharyngeal mucosa herniates through an area of
weakness known as ‘Killian’s dehiscence’, possibly due to incoordiation of swallowing and
increased pressure above the closed upper oesophageal sphincter.
Signs: Dysphagia with gurgling, and regurgitation of undigested food; halitosis; a lump in the
neck; aspiration/pneumonia. Often seen in elderly men. Imaging: Barium swallow (fig 7.42).
Endoscopy must also be performed to exclude
malignancy within the pouch. Treatment: (if symptomatic), endoscopic stapling of the wall that
divides the pouch from the oesophagus.
Zenker’s diverticulum (pharyngeal pouch) is not really an oesophageal diverticulum as it
protrudes posteriorly above the cricopharyngeal sphincter through the natural weak point (the
dehiscence of Killian) between the oblique and horizontal (cricopharyngeus) fibres of the inferior
pharyngeal constrictor (Figures 62.64 and 62.65). The exact mechanism that leads to its
formation is unknown, but it involves loss of the coordination between pharyngeal contraction
and opening of the upper sphincter. When the diverticulum is small, symptoms largely reflect
this incoordination with predominantly pharyngeal dysphagia. As the pouch enlarges, it tends to
fill with food on eating, and the fundus descends into the mediastinum. This leads to halitosis
and oesophageal dysphagia. Treatment can be undertaken endoscopically with a linear cutting
stapler to divide the septum between the diverticulum and the upper oesophagus, producing a
diverticulo-oesophagostomy, or can be done by open surgery involving pouch excision, pouch
suspension (diverticulopexy) and/or myotomy of the cricopharyngeus. All techniques have good
results.
Gp epg 2310
A pharyngeal pouch usually causes regurgitation of undigested food and
gurgling may be audible over the side of the neck.
Neurological disorders typically result in difficulty swallowing or
coughing or choking due to food spillover, especially with liquids.
Dysphagia for solids only indicates a structural lesion, such as a
stricture or tumour.
Dysphagia for liquids and solids is typical of an oesophageal motility
disorder, namely achalasia.
Achalasia: Coordinated peristalsis is lost and the lower oesophageal sphincter
fails to relax (due to degeneration of the myenteric plexus), causing dysphagia, regurgitation, and
weight. Characteristic findings on manometry or contrast swallow
showing dilated tapering oesophagus. Treatment: endoscopic balloon dilatation, or
Heller’s cardiomyotomy—then proton pump inhibitors (PPIS, p254). Botulinum toxin injection
if a non-invasive procedure is needed (repeat every few months). Calcium channel blockers and
nitrates may also relax the sphincter
32. Mild cystocele patient, with 39 BMI does not like to do surgery, what is next
appropriate advice:
a) weight reduction 10 kg
b) surgery
c) pelvic floor exercise ( first choice )
d) oestrogen ( if post menopause )
FOG pg 334
e) Ca sigmoid scenario. DX
34.Differentiate between hydrocele and varicocele
Gp pg 4739
35. What is the emergency case?
a) hepatic injury
b) fluid in the peritoneum
c)intra vascular splenic injury
36.Femoral hernia: inv:
a) USG
b) MRi
c) CT
gp 4734 and textbook of surgery pg 379
37.A well circumscribed mass in liver, dx:
a) Hepatoma
b) Malignant melanoma of skin

38. The flial chest Trauma to chest by MVA and flail chest and open chest wound ,important
step to be done at scene(accident site)
A-Morphine IV
B_pressure by gauze to close the wound
C_chest tube
D_chest strapping
Securely taping all edges of the dressing can
cause air to accumulate in the thoracic cavity, resulting in a tension pneumothorax unless a
chest tube is in
place. Any occlusive dressing (e.g., plastic wrap or pet

wrap or pet
A

DLS pg 105
39.Patient who became agitated and irritable after sustaining head injury. Na+ =123 K+=4.8.
What is the reason for his symptoms?
a) SIADH
b) physiological response to injury
c) acute renal failure

40.Last night girl was in a dance party, now came with agitation, 40c
temp, jerky movement, asking Mx>>
a. IV N/S fluid,
b. cooling N/S
c. cooling blanket **
gp e pg 2534, OHCM e pg 778, 843

Ecstasy poisoning Ecstasy is a semi-synthetic, hallucinogenic substance (MDMA,


3,4-methylenedioxymethamphetamine). Its effects range from nausea, muscle pain,
blurred vision, amnesia, fever, confusion, and ataxia to tachyarrhythmias, hyperthermia,
hyper/hypotension, water intoxication, DIC, K+, acute kidney injury (AKI),
hepatocellular and muscle necrosis, cardiovascular collapse, and ARDS. There is no
antidote and treatment is supportive. Management depends on clinical and lab findings, but may
include:
• Administration of activated charcoal and monitoring of BP, ECG, and temperature
for at least 12h (rapid cooling may be needed).
• Monitor urine output and U&E (AKI pp298–9), LFT, CK, FBC, and coagulation (DIC p352).
Metabolic acidosis may benefit from treatment with bicarbonate.
• Anxiety: lorazepam 1-2mg IV as a slow bolus into a large vein. Repeat doses may be
administered until agitation is controlled (see p826).
• Narrow complex tachycardias (p806) in adults: consider metoprolol 5mg IV.
• Hypertension can be treated with nifedipine 5–10mg PO or phentolamine 2–5mg IV.
Treat hypotension conventionally (p790).
• Hyperthermia: attempt to cool, if rectal T° >39°C consider dantrolene 1mg/kg IV
(may need repeating: discuss with your senior and a poisons unit). Hyperthermia
with ecstasy is akin to serotonin syndrome, and propranolol, muscle relaxation, and
ventilation may be needed.

41. The 40-year-old male with a history of fall on an outstretched hand with pain and swelling.
XRay was given, (showed scaphoid fracture. Very clear fracture line throught the middle)
gp 5614
42.What is the best treatment option for this patient
a. Crepe bandage
b. Plaster cast *
c. Analgesics
d. Compression screw
e. Platefixation

43. History of appendicetomy& cholecystectomy presented with 3 wk history of abd pain,


distension. X-ray shows dilated ascending colon, transverse colon & descending colon, no air.
Rectum is empty.
A. Sigmoid volvulous
B. Adhesive IO
C. CA Sigmoid*

44. Man comes to ED with severe chest pain which occur after a bout of vomiting, on
examination, there is dullness over left lower lobe of lung, what is investigation?
a. CT chest

b. Gastrografin swallow

c. Oesophagoscopy

d. CXR

e. USG

45.Woman trauma injury, small pneumothorax, saturation


98% in room air, what to do before she’s transported to
hospital?
B. Chest tube
C. intubate
D.give oxygen
46.Men 5 days post injury after falling from motorcycle, wounds over body, didn’t go to hospital
on the day of accident, develops high fever, what to do after administering antibiotics?
a) Debridement*
b)biopsy

47.Diabetic ulcer on foot with erythema:


a)Cover
b)bed rest
c) antibiotics*
d) skip insulin
48.Patient post op hemicolectomy for caecal carcinoma, low Cl, K, Na, reason?
a) Hyperaldosteronism ( salt and water retention –Na increased )
b) SIADH
c) too much glucose administration **
causes of SIADH
C-cigarrete, cisplatin, cyclophosphamide, Ca lung, encephalitis

49.A cyclist fall on the ground with obvious deformity of the tibia
his leg is pale and pulseless
what is the most essential first treatment for this boy ?
a)surgical debridement
b) lavage
c)reduction * ( closed reduction )
open reduction for open fracture and neurovascular involvement, displacement of joints

50.A 35 year-old woman is brought to the Emergency department after she had sustained a motor
vehicle accident as a front seat passenger and had her right ankle injured. On examination, her
vital signs are stable. However her left ankle joint is displaced laterally and there is a 13-cm
laceration over the joint. The dorsalis pedis pulse of the left foot is barely felt and the foot is
rather cold and pale. You have discussed the case with the orthopaedic on-call and he has
diagnosed an open fracture/dislocation of the ankle joint. Which of the following is the most
appropriate step in preventing wound infection?
A. Intravenous antibiotics
B. Wound debridement
C. Tetanus prophylaxis
D. Reduction of the displacement
E. X-ray of the joint
Ans: B
First step- IV A/B
OHCS Lowe limbs

51. A lady was in Operation for hours and stayed in lithotomy position (mentioned exactly)
After that she suffered of foot drop
where the lesion
a) S 1
b) neck of fibula *
c) L 5
Vagina hysterectomy, lithotomy position—common peritoneal nerve

52. A man with pain on the right side of the abdomen which radiates to the groin which is
colicky in nature. He also had haematuria in his urine. What will you do next?
a) Right abdominal USG
b) Plain X ray abdomen *
c) CT urogram
53.Patient was just shifted from ICU after pacemaker insertion. patient suddenly complains of
chest pain and difficult breathing. Pulse 88 Beats/min Oxygen 98% heart sound faint Next?
A.CXR * ( Dx: tension pneumothorax )
B.CTPA
C.CT
D.Troponin
E.Echo ( cardiac tamponade )

54.One Xray with Left side has no diaphragm outline like paraoesophageal hernia p/t has abd
pain no guarding, nausea, vomiting, only GI symptom
on auscultation, Chest is clear on both side. no Resp symptom
p/t post of 3days I think

 CTPA
 CXR

 Abd USG

 Stool for ova and cysts???

55.Alcoholic patient history of surgery for perforated diverticulum disease, post op 3 day, get
agitation, confused and oxygen 88%(exact) chest examination normal. Most appropriate next
invx?
A. chest x ray
B. CTPA *
C. blood glucose
D. Blood alcohol level
E. Urine creatine and electrolyte
Well score –Dx PE
56.A patient came with confusion. Was on multiple drugs. Known case of DM and HTN. Serum
sodium was low. Glucose was 8. It was mentioned that urine specific gravity was normal.
Asking for cause of confusion? (Lab values given) sodium- reduced, potassium- increased,
Chloride- normal.
a) Hyponatremia***
b) Hyperosmolar syndrome
c) Hyperkalemia
Hyperosmolar syndrome or diabetic hyperosmolar syndrome is a medical emergency
caused by a very high blood glucose level. The prefix "hyper" means high, and
"osmolarity" is a measure of the concentration of active particles in a solution, so the
name of the syndrome simply refers to the high concentration of glucose in the blood.
SURGERY

17/4/2018

57. patient had surgery, after 12 hours got chest pain. What to do?

A) chest physiotherapy

b) echo

c) ecg**

58. patient had injury to tibia, 5 cm clean, what to do next?

A) clean the wound***


b) give tetanus toxoid (no thing mentioned about tetanus history or anything)

59. patient had injury to tibia,6 cm lacerated wound, what to do next?

A) wound debridement

B) give tetanus toxoid (nothing mention about tetanus history)

60. women has 4 days’ history of constipation progressing, no history of any surgery before, x-
ray findings written, ask cause?

a) ca colon

b) adhesion

c) stool impaction ***

no sigmoid in option

61. xray given of ceacalvolvulas.


62. The male came with scrotal swelling. you diagnose this as varicocele. How u will find on
exam?
A)the mass is around the testis and positive transillumintaion test
b)mass is above the testis and negative tranillumination test***
c) the mass is soft and can get above the swelling
63. History of appendectomy & cholecystectomy presented with 3-week history of abdomen
pain, distension, Bowel Sound exaggerated, CT abdomen image given. Asking the cause
A- Sigmoid volvulous
B- Adhesive IO
C- CA Sigmoid *
D- Pseudo obstruction

64 the case with sigmoid carcinoma


patient came to ER. he has accident crush injury
asked what is the most appropriate indication for laparotomy
a.gas in retroperitoneal cavity (if gas in the peritoneal cavity –first choice )
b. free blood in peritoneum cavity**( shoulder tip pain )
c.10 c hematoma in the right hypochondria
d. something was about spleen also

65. What is the U/S benefit used as abdominal diagnostic measure


a. injury to solid organs
b. to Dx fluid filled cyst ***
c. To Dx ruptured viscus

66.A man involved in a MVA observed in the hospital for possibility of concussion, I forget
exact scenario they asked for immediate action but something made me choose a as an answer
a. I v dexamethasone
b. Intubate
c. wait and watch(I/V Mannitol for Cerebral Edema in Head Injury)
ANS: c
Explanation: GP 3497 find concussion and paedtric pg 155 and 156 find head injury
67. There is a photo of leg ulcer medial side of the leg with dark discoloration blue color
extending to a large area of the leg, I saw some yellow crusts surrounding the ulcer, the ulcer
itself was above the medial malleolus, pt has Hx of DVT, DM long standing, peripheral pulses
absent, asking about the cause of discoloration
a. diabetic ulcer (neuropathy)
b. venous ulcer (increase venous pressure)
c. arterial ulcer (arterial narrowing)
d. hemosiderin deposition
e. bleeding into the muscle layers
ANS: D
Dx venous ulcer (increase venous pressure)

Explanation: Gp find venous ulcer pg ---5180,5172

68. same scenario of progressive constipation through 3 weeks in old age (3 questions)
one with empty rectum and no gases in x ray just distention of ascending, transverse, descending
colon with progressive abdominal distention and constipation
(the three questions the same ..progressive ,3 weeks ,no fever )
Diagnosis:
A. cecal volvolus
B. sigmoid volvolus
C. cancer sigmoid
ANS: C
69.Old age ,felt 4 hour retrosternal chest pain ,the pain was proceeded by aggressive
vomiting ,left lower lung dullness ..invx:
Troponin
Gastrographin **
Irrelevant
Explanation: GP find mallaior and bohaeve
70.Old age female, heavy smoker, complaining of painless lump in her neck by examination you
found a lump supraclavicular region. Subcutaneous plane.
What will lead to diagnosis?
a) Bronchoscope
b) Gasteroscope
c) MRI neck
d) Mammography
e) FNAC***
Posterior- lymph nodes
Posterior triangle Below clavicular –80 % from tumour
Anterior triangle- 20 % above clavicular –tumour

71.Young male complaining of pain in groin after lifting a heavy object, by exam no lump but
US revealed 1 cm defect in inguinal ring with fat herniation but no visible lump, next;
Open laparotomy, mesh
Laparoscopic repair ***
Check again if lump appears

72.Regarding unilateral undescended testis, which of the following is most commonly


associated?
a) Malignancy
b) Varicocele
c) Inguinal hernia(Indirect) ***
d) Hydrocele
e) Torsion of the testis
Explanation Gp 4754 …find ectopic testes and 4710—bell clapper

73.75-year-old man comes to you with progressive constipation for last 3 weeks with absence of
flatus. Abdominal distension is becoming worse. Mild tenderness is present. He had history of
cholecystectomy 25 years ago. Dilated bowel loops along ascending transverse and descending
colon. Rectal examination is empty. What is the diagnosis?
Adhesion obstruction
Sigmoid volvulus
Cancer of Sigmoid colon***
Ceacal volvulus

74.X-ray showing distended bowel I think small bowel obstruction? patient vomiting, abdominal
distension present for 3 days??? (no acute presentation and no pain mention in my exam
question) Rectal exam normal. Patient had AF. Next step?
A. Endoscopy or colonoscopy (forgot)
B. microlax enema
C. ct scan
D. air enema
E. nasogastric tube insertion***
OHCM 620
75. Testicular swelling likely hydrocele??? scenario, testes are soft and asking what investigation
to do?
a. Ultrasound***
b. AFP and beta HCG
Explanation Scott clinical surgery find primary hydrocele pg 350,362
76. A woman after removal of central venous line lady developed facial swelling and swelling
around the neck. What’s the most appropriate investigation?
a. CT chest
b. CT neck angiogram ( to detect the arterial occlusion )
c. Chest x-ray
d. Neck USG Doppler***
e. Echo
superior venaca syndrome –USG neck easier imaging

77.Farmer came with left swelling in a groin. U did FNAC and it shows squamous cells.
Where is the lesion?
A. Left leg ***
B. Anus -----complete mass ----to internal iliac
C. Rectum-----ingino, external iliac
D. testis-----ingino?,Para aortic
E. penis----external iliac ?, inguinal
Drainage of LN in CA
Anus : Below pectinate deep inguinal LN Above pectinate internal iliac LN
Testes + ov para aortic Lower limb inguinal Tongue submental LN (scott)
Cervical LN ENT notes

78.CT scan given, chest MVA with severe chest pain and difficulty breathing due to pain.
Tenderness present on both side of chest. Decreased breath sounds bilaterally and dullness to
percussion. Asked about the cause of pain. Diagnosis?
a) Fractured ribs***
b) Hemothorax
c) Pneumothorax
d) Pneumo mediastinum
79.History of appendectomy & cholecystectomy presented with 3-week history of abdomen pain,
distension, Bowel Sound exaggerated, CT abdomen image given. Asking the cause
A- Sigmoid volvulous
B- Adhesive IO
C- CA Sigmoid------old age
D- Pseudo obstruction-------ileus
80.picture of abdominal aortic aneurysm abdominal pain and mass palpable pulse 100 bp
100/70; next appropiate step?
A. FAST USG
B. aortogram
C. repair n grafting
JM 342

81.Old age, History of appendicetomy & cholecystectomy presented with 3 weeks history of
abdominal distension on ascending colon, transverse colon, descending colon, rectum is empty.
There is mild tenderness of the abdomen and loud borborygmi. What is the diagnosis? (CT was
given-clear apple core)
A- Sigmoid volvulus
B- Adhesive IO
C- CA Sigmoid
D- Fecal impaction
82)X ray abdomen given with pin inside
OHCS foreign body
Treatment observation
Lithium battery –endoscopic emoval
. 83. Old man 75 years of age has 3-week history of constipation. He presents with mild
abdominal tenderness and on rectal examination there is no faces in the rectum. On CT
there is cut off at the sigmoid colon and dilation of the ascending, transverse and
descending colon. Which of the following is the most likely diagnosis? (no ct given)
a. Sigmoid volvulus
b. Colon cancer
c. Caecal volvulus
84. A man comes to the ER with sudden severe chest pain which he developed after an acute
bout of vomiting. On examination there is dullness to percussion on the left lower lobe. Which of
the following will help you identify the diagnosois?
a. Gastrograffin swallow
b. CT scan non contrast
c. oesophagoscopy

85. A man in brought to the ER after he received a kick to the side of his face. On examination
you have found an orbital floor fracture. Which of the following is the accurate predictor of this
diagnosis?
a. Inablity to open the mouth
b. Subconjunctival haemorrhage
c. Anesthesia on cheek*
upward grade anathesia ,enothomos ,diplopia , Anesthesia on cheek

86.Australian farmer with painless mass on the right groin. On biopsy it shows squamous
cell cancer. What is the likely site of primary cancer?
a. Leg
b. Penis
c. anus
d. Testes

87.Post op oliguria in a patient with cholecystectomy 12 hourrs before. fever 37.9, BP and
pulse normal, fluid running at 80 ml/hr but urine output only 100 ml. no mention of
catheterization.{Stone} what to do next:
a. Bladder scan
b. Ct scan
c. Serum urea creatinine

88.Oliguria in patient post-surgery with FC, IVF given = S/Urea, Creat

89.Oliguria in pt post-surgery with FC, IVF given, asso with diffuse abdominal tenderness =
USG Abd
90.Post laparotomy opt patient oliguria with indwelling catheter. fever 38.5.There was
generalized abdominal pain. most appropriate mx?
A. And xray
B.Blood culture *
C. S electrolyte and creatinine
D. abd usg

91. 55 yrs old male, K/C/O Hep C, not using IV Drugs since last 5 yrs. Alcoholic. On
presentation, he is drowsy but answers /obeys commands. O/E gynecomastia, flapping
tremors, fever 38’C, mild ascites, spider nevi, parotid gland enlargement. What is the
most initial investigtion?
A. FBC
B. Ammonia (Fever is not there, its hepatic encephalopathy)
C. Abd. Paracentesis
D. LFT
GI note pg 14
SBP (E. coli is MCC; 20% mortality rate) IV a/b such as cefotaxime or piperacillin +
tarzobactam & albumin infusion to ↓ risk of HRS before paracentesis for cell count
(neutrophils ≥250 x 106/L) & culture (don’t wait for result); stop propranolol if already on it.
Indefinite primary a/b proph-ylaxis with ciprofloxacin in patients at high risk for SBP: ascitic
fluid total protein < 15g/L + any of the following:
- serum Na ≤ 130mEq/L
- serum Cr ≥ 1.2mg/dL (106.1)
- BUN ≥ 25mg/L (8.9mmol/L)
- bilirubin ≥ 3mg/dL (51.3)
- Child-Puch class B or C
A bout of SBP lifelong A/b s/b given as 2nd*prophylaxis.

92. Young boy, post MVA, c/o pain, O2 sat 96%, other vitals normal, CT given, showed
mild Hemothorax. After giving O2, What next?
Similar pic
A. Morphine *
B. Intubate
C. chest drain
D. Observe
E. needle thoracostomy

Dx ; haemo pneumothorax

92. Hernia pic from Xiphisternum to Umbilicus-


Huge epigastric hernia picture of a 56-year-old man which extends from umbilicus
to xiphisternum. He looked morbidly obese and had a waist circumference of 110 cm
Asking for appropriate management for the patient.
A. Weight loss therapy
B. Abdominal binder
C. Herniorraphy with mesh repair *
D. Hernioplasty
E. Observation and Reassurance

similar pic
93. Same question as above however patient was told to be overweight.
Hernia- 110 cms waist circumference, what advice?

A. Weight loss therapy *


B. Abdominal binder
C. Herniorraphy with mesh repair
D. Hernioplasty
E. Observation and Reassurance

94. Young man about 30-34 years old, presented with this condition as shown in the pic, he is
a smoker, drinks alcohol daily, on ranitidine for dyspepsia. O/E parotid enlargement,
Testicular swelling U/L – can’t get above the swelling. What is the most likely diagnosis?

Similar pic
A. Teratoma
B. Leydig cell tumour
C. Alcoholic liver disease *
D. Ranitidine
Gp pg 4740,4745
A varicocele is a varicosity of the veins of the pampiniform plexus (see
FIG. 112.6 ). It is seen in 8–10% of normal males and occurs on the left
side in 98% of affected patients, due to a mechanical problem in drainage
of the left kidney vein. A relationship with infertility has been observed
but its nature is controversial, as is whether repairing varicoceles in
subfertile men improves fertility chances.
Most varicoceles are asymptomatic and incidental findings. They can
cause a dragging discomfort in the scrotum. Investigation is usually not
necessary but an ultrasound is useful where the diagnosis is doubtful or a
neoplasm is suspected. Treatment is indicated if it is symptomatic or for
infertility. Firm-fitting underpants may relieve discomfort. Surgical
treatment is by venous ligation, above the deep inguinal ring. Ligation is
indicated if there is any reduction in the size of the left testis
95. patient with history of claudication, smoke 30 pack cigarette per day, drink alcohol, obese
with diabetic history. he is not fit for surgery. He asked you for the appropriate advice
that will improve his symptoms of claudication?
A. Reduce smoking
B. reduce alcohol drinking
C. supervised exercise (JM 752) *
D. control his hypercholesterolemia

96. pt was going to stent operation. After 4/5 days got a swelling in the right groin 6 cm
painful, pulsatile, what to do? -
a) antithrombin inj to the mass
b) Compress by probe
c) manual pressure

Ans: compress by probe or USG


Dx ; pseudo aneurysm after cardiac operation
97. patient has repetitive previous Hx of colicky abdominal pain description fits with renal
stones, he came with SOB and cough. CXR given lots of haziness bilateral no mass, no
cardiomegaly, investigation asked to reach to a diagnosis.
a. Ca level
b. CT chest
c. CT abdomen * ( without contrast )
d. echo
e. forget
Dx: sarcoidosis with renal stone

98. Hutchinson's freckle ( superficial ) - local excision

99.enlarged gall bladder with multiple stones, found dilated bile duct and stone obstruction
in common bile duct, patient developed toxic shock, what to do after fluid resuscitation?
a. laparotomy cholecystectomy
b. laparoscopic bile duct explores
c. percutaneous bile drainage
d. endoscopic decompression****(for drainage of intra peritoneal fluid) + injection Antibiosis
_----laparotomy cholecystectomy)
100.post op hemicolectomy patient labs Na 110 K 3.5 CL low as well. osmolality not given
cause ?
A. SIADH *
B. Over infusion
http://teachmesurgery.com/perioperative/endocrine/hyponatraemia/

Explanation: Harrison pg 3
Explanation: Harrison pg 3
+ 25. Post-op oliguria- with catheter and without catheter.

101. Post abdominal surgery a patient with catheter inserted has urine output of 100 ml in 24 hrs.
He started on IV fluids at 80 ml/hr. Fever 38.5. What is the next appropriate investigation?
A. Serum Creatinine and electrolytes
B. Pulse oximetry
C. Bladder scan
D. CT scan
E. Blood culture *

102. History of appendectomy & cholecystectomy presented with 3 weeks’ history of abdominal
distension on ascending colon, transverse colon, descending colon, rectum is empty. There is
mild tenderness of the abdomen and loud borborygmi. What is the diagnosis? (CT was given) Ca
sigmoid with CT picture  not apple core deformity
A. Sigmoid volvulous
B- Adhesive IO
C- CA Sigmoid
D- Fecal impaction
E- Caecal volvulus

103. 75 yrs old man with 3 weeks’ h/o of abdominal pain and distension, had h/o of
appendectomy and cholecystectomy, X ray (not given) shows dilated ascending, transverse and
descending colon, on examination, rectum is empty, what Dx?
a. Sigmoid volvulus
b. Ca sigmoid
c. Adhesive IO
d. Caecal volvulus

104.A man presents with black lesion in his cheek which lasts for 6 years, now size is increasing.
What is the next step of management? (Given picture)
A. Local excision * (Hutchinson's freckle ( superficial ))
B. Excision with a 2 cm margin.
C. Fluorouracil cream
D. Review in 12 months
E. Shave biopsy

JM1383

105. 54yrs old male patient has sudden retrosternal chest pain. Severe vomiting proceed by pain.
He has HT and controlled with Thiazide. On examination, dullness lower left lung and reduce
breath sound on left lower zone of lungs. Which of the following Investigation to reach
diagnose?
A) CT chest
B) Gastrograffin swallow
C) USG
D) CXR
E) Echo

106. Farmer came with left swelling in a groin. U did fnac and it shows sqaumous cells. Where is
the lesion
A.Left leg
B.Anus
C.Rectum.
D.testis.
E.penis

107.a 56 year old man which extends from umbilicus to xiphisternum. He looked morbidly obese
and had a waist circumference of 110 cm. Asking for most appropriate advice for the patient?
A. Weight loss therapy***( for diverifiction OF RECTI)
B. Abdominal binder
C. Mesh herniorrhaphy
D. Hernioplasty
E. Observation
Explanation : Baley and Love ..page find divarification

108. Old man present with large abdominal swelling from umbilicus to epigastric for 3 months ,
no pain, pic given, Swelling is most prominent when his head raise or his leg raise, and also in
most prominent with coughing, what is your most appropriate management?
A. Open mesh herniorraphy (epigastric hernia)
B. Hernioplasty (epigastric hernia)
C. Laparoscopic repair (epigastric hernia)
D. Physiotherapy***
E. Reassurance
(Photo was given here.)
Dx: for diverifiction OF RECTI
Explanation: DDx: epigastric hernia – Baley and love find epigastric hernia

109. patient with history of claudication, smoke 30 pack cigarette per day, drink alcohol, obese
with diabetic history. he refuses surgery although he was fit for it. He asked you for the
appropriate advice that will improve his symptoms of claudication?
A-Reduce smoking
B-reduce alcohol drinking
C-supervised exercise***
D-control his hypercholesterolemia

110. A lady with BMI of 35. How will you manage her in addition to exercise for long term
management?
A. Low Carbohydrate food
B. Lipase inhibitor
C. Diuretics
D. Surgery
E. 4000 kJ/day*** ( 946 kcal /day )

Therapeutic guideline 340,749,


OHCm 34

To measure waist circumference, place a stretch-resistant measuring tape midway


between the lower rib margin and the top of the iliac crest. Ask the patient to stand with
arms relaxed by their side, and take the measurement at the end of a normal exhalation.
Waist circumference at which cardiometabolic risk is
increased (Table 3.2) [NB1]
Substantially increased risk Substantially
Increased risk Increased risk
increased risk
Caucasian: 94 cm
men South Asian, Chinese or 102 cm
Japanese: 90 cm
women 80 cm 88 cm
NB1: Except where otherwise specified, these figures are for a population of European origin.
Higher
cut-off values may be considered in Pacific Islanders and lower cut-offs may be considered for
Aboriginal Australian males.
The BMI is a measure of general adiposity. It is calculated using the following formula:
Obesity is classified according to the BMI (see Table 3.3). The BMI should be interpreted
with caution in groups where muscle or fat mass varies significantly (eg very muscular
people, older people).
Classification of weight according to body mass index (Table
3.3)
Body mass index (kg/m Body mass Risk of obesity-related Risk of obesity-
Classification
index (kg/m )) related
Classification
[NB1] [NB1] comorbidities comorbidities
low (but the risk of other clinical
underweight less than 18.5
problems is increased)
healthy 18.5 to 24.9 average
overweight 25 to 29.9 increased
greatly increased, particularly in
obese 30 or more association with central fat
deposition
class I 30 to 34.9 high
class II 35 to 39.9 very high
class III 40 or more extremely high

Obesity
Defined by the World Health Organization as a BMI of over 30kg/m2. A higher waist
to hip ratio, indicating central fat distribution, is commoner in  and is associated
with greater health risks, which include type 2 diabetes mellitus, IHD, dyslipidaemia,
BP, osteoarthritis of weight-bearing joints, and cancer (breast and bowel); see p206.
The majority of cases are not due to specific metabolic disorders. Lifestyle change is
key to treatment, to increase energy expenditure and reduce intake (p244). Medication ±
surgery may be considered if the patient fulfi ls strict criteria (BMI of 40 kg/m2
or more, or between 35 kg/m2 and 40 kg/m2 and other significant disease that could
improve with weight loss, non-surgical measures have been tried and failed, patient
receives intensive management in a tier 3 service, and fit for anaesthesia and surgery).
Conditions associated with obesity include: genetic (Prader–Willi syndrome,
Lawrence–Moon syndrome), hypothyroidism, Cushing’s syndrome, and hypothalamic
damage (eg tumour or trauma  damage to satiety regions).
111.Old patient with ischiorectal abscess, has this problem recurrent many times, what’s the
cause?
A. Anal fistula***
B. Diverticular disease
C. Crohn’s disease
D. Diabetic
Gp 1693
Ischiorectal abscess
An ischiorectal abscess presents as a larger, more diffuse, tender, dusky red swelling in the
buttock. The presence of an abscess is usually very obvious but the precise focus is not
always obvious on inspection. Antibiotics are of little help and surgical incision and drainage
as soon as possible is necessary. A deep general anaesthetic is necessary
112. Patient with perianal pain with h/o of constipation, examination not possible d/t
pain, treatment asked?
Glyceryl trinitrate cream (anal fissure) **
Gp 1689

113. Women feels pain in abdomen during gardening. pain settles down but happens
again and again for half hour episodes. On USG examination dilated small bowel loops
and air in biliary tree ( pneumobilia). What is the most likely diagnosis?
a. Cholelithiasis ****
b. Pancreatitis
c. Crohn’s ileitis
d. Mesenteric ischemia
common –anaerobic organism –produce gases,
other causes – sphinter of oddi obstruction
gall stone ileus
Explanation: Gall stone ileus ---terminal ileum ----obstruction ---air in biliary tree
Mesenteric ischemia ---common in old age--- thrombus in superior mesenteric arteries—
pain in abdomen---acute abdomen, seen in AF – silent thrombus, hypotension

114. A pt with h/o hemicolectomy for diverticulitis and colostomy done since 5 days,
now there is serosanguinous discharge (key word) came around the colostomy, the
wound edges are hyperaemic , erythematous asking for diagnosis :
a-wound dehiscence ***
b-wound haematoma
c-small intestinal fistula
first sign of wound gaping - serosanguinous discharge
scotts aid to surgery pg 84
Clinical features
Symptoms. There may be no warning of an impending
wound dehiscence. Altem:u.iveJy. mere may be nausea.
fever. and local pain or discomfort. Occasionally the
patient describes a 'tearing' or 'ripping' sensation in the
wound after a bout of coughing or su:lin..ing.
Signs. These include serosanguineous or thin purulent
discharge from the wound: and bowel or omenrum protruding through. the wound
sponmneousJy or after
removal of skin sutures
115. Lady comes on 10th post-partum day with pain in perineum tear. History of perineum
laceration during delivery which was sutured. Now on examination there is a perineum wound 2
cm long 1 cm wide and 1 mm deep. Clean with no discharge. What is next?
A. Apply local antibiotics
B. Put on oral antibiotics
C. Simply keep the wound clean ****
D. Suture the wound under LA
E. Suture the wound after cutting the edges
FOG pg 94 to 96
116.Recall on mass on the left side of scrotum, cannot get above the mass. Asking for
management
A) usg***
B) surgical exploration
C) Orchidectomy
D) FNAC

(Scott

117.A old patient went through roux en y gastric bypass surgery after 6 days she had a
constant epigastric pain after vomiting.in examination abdominal tenderness but no guarding
in epigastrium.
A. thrombose of afferent
B. stomach perforation (guarding?)
C. small bowel obstruction
D. esophageal rupture (guarding?)
E. pancreatitis
(other question -> Cx of this operation)
Ans: (C)
afferent loop $isn’t likely as the symptom is pain after vomiting; otherwise, it should be
“pain relieved after vomiting”
( thrombosis common in liver transplant )
Risk of afferent loop syndrome  Billroth II (Polia?) >>>> Roux en Y
Afferent loop syndrome  Pain is relieved by vomiting
Scott pg 260,266
AFFERENT LOOP SYNDROME
This condition is generaJed by mechanical obsauction
aftei a Polya type reconstruction. H it occurs in the early
postopenirive phase. catasuopbic complications, including blow-Qut of the duodenal swmp, may
occur. It can.
bowever. become evident as a chronic problem and gen·
era..I.Iy arises because of a poorly CODSUUCted afferent
loop with angulation at the anastomosis or with excessive length or by obstruction from
extrinsic bands. The
clinical syndrome is of postprandial abdominal pain and
nausea foDowed later. at a variable time. by vomiting of
food mixed wilh bile and immediate relief. This specific
sequence is diagnostic and signals drainage of me distended afferent loop.

118. After MVA, hoarseness of voice, wide mediastinum on cxr. What is the most appropriate
next step in management of this patient?
A. Echo
B. CTPA
C. Doppler neck
D. Intubation and ventilate
E. MRI
ANS: (A) (transoesophageal Echo) (the better one will be spiral CT, chest CT)
Dissection of aorta compresses the left recurrent laryngeal nerve which causes hoarseness of
voice.
Ascending – echo ( TTE )
Descending - TOE

119. female hernia Sx,12hrs later becomes restless, confuse and remove IV access.
SpO2 89%? BP 90/60 PR increased, RR increased. X ray was given ( bad looking lung
(not quality) increase radio opacity at right mid zone from hilar to periphery and same but
less extant from left hilar).next management
A)intubation
B)IV anticoagulation (if IV, unfractionated heparin for pul embolism)
C)antibiotic

ANS: A
(post-op atelectasis likely…and if ventilation is not efficient, oxygen will a bit useless too…)
(triangular white area in chest Xray — atelectasis; A-Z 72)
120. CT chest pic MVA with severe pain and difficulty breath due to pain. Decreased breath
sounds bilaterally and dullness to percussion. Asks about the cause of pain?
a) Hemothorax
b) Pneumothorax
c) Pneomediastinum
d) Fractured ribs

ANS: D
121. A post-operative case after 12 hrs patient ,cxr looks like atelectasis, asked mx after
oxygen
Chest physiotherapy

122. Fluid calculation in surgery? Postoperative in 24 h. Input output given.

123.MVA open wound with tibia shaft fracture. Analgesia given to the patient and resuscitation
done next immediate step?
a. Open reduction
b. Iv antibiotics and Tetanus
c. Dressing
d. Reduction

ANS: B (OHCS 721)

123. Young man transferred to hospital after MVA. BP: 120/70 HR: 90 RR: 18, conscious
and communication CT given ( I think it was splenic sub capsular hematoma) what to
do :
like this pic but hematoma was less
a) Laparotomy
b) Keep him under close observation
c) Splenic artery embolization

Dx  perisplenic haematoma

If the haemotoma is as large as the photo  Do Laparotomy (BP-65)


124.50 y female with dizzy and faint after eating.... Have a gastric surgery past.... Now is dizzy
blood sugar 2.5
Dumping syndrome
GI + notes pg 6
Post-gastrectomy or Early dumping Late dumping Treatment
bypass surgery syndrome syndrome
Onset Within 30 min of a 2-3hr after a meal Supportive mainly.
meal (esp. carbohydrate
meal)
GI symptoms: Present early; Not generally seen Eat multiple & small
nausea, bloating, frequent meals
vomiting, watery
diarrhea [explosive/
osmotic], epigastric
fullness, crampy
abd. pain
Vasomotor Present later due to More prominent d/t
symptoms: sweating, dehydration & hypoglycemia
tremors, palpita-tion, hypovolemia
weakness, dizziness,
strong desire to lie
down
Mechanism Rapid & Rapid digestion &
unreglulated gastric absorption in the
emptying into small small bowel evoke
bowel osmotic excessive release of
diarrhea leading to insulin (may involve
dehydration GIP & GLP)
rebound
hypoglycemia

125.MRI after whipple procedure. Which complication caused pain in epigastric region,
tenderness (3 day)? No rigidity. Options
a)- SBO
b)- leaking of anastomosis *
c)- paralytic ileus
Scotts pg 210,213
The most feared complication after Whipple
pancreaticoduodenectomy is clinically relevant
postoperative pancreatic fistula (CR‐POPF). Risk
factors include a soft pancreas, narrow pancreatic
duct (without chronic obstruction) and significant
blood loss during the resection. With these factors
present, the risk of CR‐POPF can be as high as
Other complications include exocrine pancreatic failure, worsening diabetes, impaired gastric
emptying or ‘dumping syndrome’.

126.Woman fell over the edge of bath tub asking most important investigation before surgery :

A. Usg pelvis * ( dx valval haematoma )

B.Ct ( to rule out internal injuries)


C.PT
D. Complete blood count

127. Mva scenario : person with bp of 90/70


Jvp raised
It’s difficult to auscultate cardiac sounds: no deviation of trachea:
What u will choose:
a) (tension) pneumothorax
b) Simple
c) Cardiac tamponade *
Tension pneumothorax trachea away from affected side, hyper resonance, decreased breath
sounds

128. Post MI on enoxaparin develop left abdominal pain (CT scan given: looks like
hematoma?) Management?
a) Laparotomy
b) platelet transfusion
depend on CT
no answer for this question
peritoneal haematoma – protamine sulphate followed laparotomy
retroperitoneal bleeding –observe or drain
corrected by coagulation factor transfusion
129. Post trauma patient now got deviation of trachea to the right with reduced breath sound over
left lung. Diagnosis?

Tension pneumothorax

130. Patient with flail chest after chest tube insertion. Next plan?

Positive pressure ventilation (intubation)

131.Middle age lady with fever 12 hours post laparascopic cholecystectomy. What to do?

a) Chest physiotherapy *
b) Give antibiotic

132.Obese man with underlying hypertension, diabetes and gastric reflux. HbA1c is 9.1 and
already on insulin. How to best manage his diabetes, obesity and gastric reflux?
a) Surgery gastric banding
b) Lifestyle modification and aggressive medical therapy *
c) Roux en y op.
d) Increase insulin
133. Scenario of trauma patient, cervical collar on, now 2 days passed patient still has some
tenderness in neck. asking what is clinical sign ... indication to investigate
a) tenderness of neck (ATLS)
OHCS pg 794

134. x-ray of clavicle dislocation after a 35-year-old fell on outstretched hand to catch. a running
tram . now 1 week he cannot lift his shoulder up above his head asking management
a) shoulder sling
b) screw fixation of clavicle to coracoid
c) 2 more option don’t know

135. in a scenario of dialysis pt post dialysis he developed this


136. pulse oximetry as initial step in dyspneic patient.
137. post op pt, input 600 mL oral, 2000mL IV, urinary catheter inserted, output - 3.1L,
mx? →
a) 4L of ???
b) NS, 2L DS

c) 2L NS + 2L D
d) ?2L NS in 4/5 DS
138. MVA, massive haemothorax, with flail chest, 1.8L drained, what is the factor
indication for thoracotomy? →

a) volume of blood loss *


b) flail chest

139. prep for GERD surgery? BMI~30, …, best? →


a) J-roux en roulex

b) life style modification *


if drug choose that

140. 40M, prep for GERD surgery, treated for DVT years ago, mx? →
· enoxaparin before surgery & continue until discharge
· enoxaparin after surgery & continue until discharge

· enoxaparin after surgery for 10 day *


therapeutic guide line pg 367 table 3.1

141. post op day-1 , oliguria after #FNOF, on aspirin, allopurinol, diclofenac,


simvastatin, slow vit-K, furosemide, one more drug I don't remember, which 3 of these
drugs likely cause the oliguria?

Maybe triple whammy gp pg 539


142 . post op <24hr, SOB, fever(?), (seemed like atelectasis) mx? →

· physiotherapy *
· drainage
· Ab

143 . MVA, X-ray neck given, C2 is # or something, patient saying he can't breathe,
mx? →

· ET tube * ( first choice )


· Tracheostomy (third choice )
· Cricothyroidotomy ( second choice )
· PPV
OHCS pg 674
144 . child right scrotum inflamed for days (I think 2-4d), no fever, no tender, palpable
testes, also redness on(along?) the penis, dx? →
a) Epididymitis ( old age –UTI, in middle age –reproductive age )
b) testicular torsion
c) hydrocele
d) allergy *
gp pg4722
Problems of scrotal skin
Sebaceous cysts are common and may be infected and require drainage.
Less commonly, idiopathic scrotal oedema can present, usually in boys
aged 5–10 years. With this condition, scrotal swelling and mild redness
and tenderness begin gradually and spread, often across the midline and
also possibly beyond the scrotum. Palpation reveals normal, non-tender
testes but torsion needs to be excluded in some instances of the swollen
red scrotum. Idiopathic scrotal oedema is believed to be allergic in origin,
either localised (e.g. insect bite) or globalised as part of urticaria. It
sometimes results from exposure to cold water. There may be a tender
enlarged draining inguinal lymph node near the external ring. Treatment
includes scrotal support, analgesics and antihistamines.

145. MVA long case then asked about what will make you decide to go for surgery immediately
a) Sub capsular hematoma of the spleen
b) Sub capsular hematoma of liver
c)Free peritoneal blood (solid organ damage) FAST
d) Free peritoneal air (hollow viscus damage)CXR

Ans: (d) Free peritoneal air (GUD) (if no option for D, choose C; intraperitoneal bleeding)

146. MVA scenario of young male who was sitting beside the driver before an accident, he has
transient unconsciousness but he described what happened and knew where he is, BP 70/40 then
measure again after resuscitation was the same 70/40 what next:
CT abdomen
Laparotomy
FAST
Request blood products

Ans: (D) (both C and D) (OHCS 785 - FAST)


147. A man appears with small bowel obstrtucion symptoms, has previously
undergone an appendectomy done and some other surgery related to the pancreas. What
is your diagnosis?

Note: Ct was given but I was unable to recognize the Dx so I solved it according to the
stem.
a) Adehsional Intestinal obstruction
b) Carcinoma of the sigmoid
c) Sigmoid volvulous
Ans-A
148. MVA scenario of young male who was sitting beside the driver before an
accident, he has transient unconsciousness but he decribed what happened and 0knew
where he is, BP 70/40 then measure again after resuscitation was the same 70/40 what is
next?

a) FAST USG
b) CT abdomen
c) Laparotomy
d) Request blood products
Ans-A or D

149. Pancreatic pseudo cyst 10 cm after some an episode of pancreatitis, what is your
management?

a) endoscopic cystogastrostomy
b)Laparotomy with drainage
c) ERCP with pancreatic duct drainage
Ans-A
Scott pg 284

150. Patient presents with a breast lump, it was suspicious on Mammography and
biopsy shows atypical ductal hyperplasia
a) wide local excision
b)Watchful waiting
c) radiotherapy
Ans-A
Fibrocystic changes (Non proliferative breast changes)
1. Fibrosis
2. Adenosis (increase number of acini per lobule)
3. Apocrine metaplasia cysts
4. Ductal hyperplasia without atypia

151. Patient has undergone uneventful laparoscopic cholecystectomy. 3 days later she
comes with complain of shoulder tip pain and dyspnoea. What to do next?
A. d dimer
B. CTPA
C. troponin
D. usg abdomen
E Chest xray
Ans-D
152. lump in outer upper quadrant.
A. Core biopsy
b. FNAC
c. Mammography
Ans-C

Gp pg 4421

153. A man was brought to the ED after being involved in an MVA. He initially lost
consciousness but regained it and was well until he started having seizures. Some labs given.
What is the cause of the presentation?
a. Epilepsy
b. Intracranial hemorrhage
c. Inappropriate secretion of Antidiuretic hormone
Ans EDH ??? B
Lucid interval
154. A 42-year-old woman presented with breast
lump which is diagnosed as intra-ductal
carcinoma (?? Biopsy dx). What is your next step
in management?
a. Core biopsy
b. Hook wire excision
c. USG
Ans hookwire excision scott 226 for
localization of breast lump
155.patient had cholecystectomy 2 days back and transferred to medical word, you were called
because he became unresponsive, on examinassions: Bp: 130/85 HR: 75. RR: 12 SO2: 88 %
what next:
A. put him on nasal cannula
B. start face mask
C. call the rapid response team
D. Jaw thrust chin left and ampu
No option for intubation

Ans: (C) call the rapid response team (if not, intubation?? because unresponsive)
OHCM pg

156.post operative parotitis investigation


a. u/s
b. parotid duct content culture

Ans: b (S 67, epg 79; Antibiotics {first choice} and drain the area early). USG isn’t usually
required. seen usually in post op pts (esp when the pt is dehydrated and oral hygiene is bad)

157. Looked like cholangitis pt... fluids given usg shows stones in gall bladder and ducts. Next
step in immediate Mx?
A. Endoscopic decompression of bile ducts *
B. Trans hepatic drainage of common bile duct
C. Lap Cholecystectomy
D. Laparotomy and bile duct exploration
158. Neck trauma...soft tissue injury...O2 given by Hudson mask. What to do?
A. Give thiopentone and suxa and intubate *
B. Take to ot and give Anesthesia induction
C. Circothyroidotomy

D. Neck lateral xray


OHCS pg rpg 642
159. On CT superficial parotid involvement facial nerve spared. Next step?

A. Core biopsy
E. Superficial parotidectomy(done during intra operation – did frozen section of biopsy
followed by surgery because it is benign –pleomorphic adenoma )
160. An 18 years old boy with pelvic fracture after a motor accident wants to pass urine, but
can’t and there is also bleeding from urethra, what to do:
1- suprapubic catheter *
2- cystoscopy
3- intra urethral catheter
4- U/S ( to detect the bladder distention )

161. H/o MVA with cervical vertebral fracture and having stridor. X-ray shows narrowing of
airway with cervical vertebrae fracture. immediate management
a) endotracheal intubation *
a) tracheostomy
b) cricothyroidectomy
c) continue o2

162. Patient is after resuscitation his urine output is 50ml/hr. What will you do next?

a. No kcl
b. 25 ml Kcl
c. 50 ml Kcl
Myoglobin -300ml/hr of fluid given
Normally, fluid 125ml/hr of fluid given
urine output is 80ml/hr
OHCM 319
163. June woman came with her 18-month old child anxious about pus surrounding
the meatus and the foreskin is partially retractable, what’s your next step?

a. Circumcision

b. Betamethasone cream **

c. Mipurocin cream

d. Oral phenoxymethyle penicillin

e. I.V benzathyne penicillin

gp epg 4763

CI of Circumcision gp pg
164. Man underwent for gastric bypass surgery complaint of dizziness,
bloating and diarrhoea after eating meals. How will you give treatment?
A) Dietary Adjustment***

B) Metoclopramide

C) other drugs, don’t remember Dx-


Dumping $

165. MVA accident, man came here with lacerated wound with open # tibia & fibula. He has
been fully immunized. After given antibiotic, what would be your next step to prevent
further infection?
A) Wound debridement***

B) Internal fixation

C) External fixation

D) Tetanus vaccination

E) Dislocation correction

166. The man underwent for surgery for colectomy. After 12 hours, he developed
shortness of breath, abdominal pain and can’t breathe properly. You give O2 and what is your
next step in management?
A) Intensive chest physiotherapy
B) Give antibiotics
C) Laprotomy
D) CXR*** (to rule out postop pulmonary atelectasis)
E) CT abdomen

167. Neck trauma...soft tissue injury...o2 given by Hudson mask. What to do?
• A. Give thiopentone and suxa and intubate

• B. Take toot and give Anesthesia induction

• C. Circothyroidotomy
• D. Neck lateral xray

168. H/o mva with cervical vertebral fracture and having strider. X-ray shows
narrowing go fair way with cervical vertebrae fracture. immediate management?
• a) endotracheal intubation

• b) tracheostomy

• c)cricothyroidectomy

• d)continue O2
ANS: a
Explanation: OHCM Pg 772

169.Young boy is brought to the rural hospital ER after trauma to the head. He was in a motor
vehicle accident. After that he developed extreme unconsciousness with GCS of 6/15… pupil
dilated. You have intubated the patient. The Neurosurgery unit is 3 hours from the rural ER.
What is the next appropriate plan for this patient?
A. Transfer to neurosurgery unit
B. Do a CT scan
C. Temporary Burr hole
D. Craniotomy
Ans: A
First intubation and then refer to NSU

170.Patient with a trauma you want to give him blood transfusion what will you choose?
A) O group blood
B) O negative low titer whole blood
C) O negative low titer packed RBC units
D) Give blood without cross matching
Ans C (universal blood transfusion )

171. The flail chest injury, management?


A. Morphine***** (scott 136)
B. needle thoracotomy,
C. cover wound
Ans A
Mild to moderate (scott 136)
characterised by a small fail segment with respiratory movement maintained. Treatment is by:
• adequate analgesia
• adequate sedation
• prophylactic antibiotics
• posturing and physiotherapy
• intranasal oxygen
• respirator with mouth piece.

Severe
In severe cases of flail chest. int~nent positive pressure
respiration is required for at least lO days in addition
to the simple tne3.Sures above. The flail segment may
rarely require surgical fixation.

172. Case scenario of crush trauma, dark urine. What to give:


A. IV NS , UOP>=1ml/kg
B. IV NS , UOP>=2 ml/kg
C. IV Dextrose UOP>=1ml/kg
D. IV Dextrose UOP>=2ml/kg
E. IV Colloid
Ans B

173.Chest trauma with multiple stab wounds all over the nipple. Saturation is 93%. Bp is 90/50.
He has been started on saline infusion with 2 wide bored iv lines. Chest drain also placed which
has given 1500 ml of blood. Next step
a. bedside usg
b. 1 l bolus NS
c. thoracotomy **** Continued bleeding of 300-500 ml/hour requires thoracotomy (Scott
137)
Ans C

174.xray of # cervical vertebra. suicidal attempt by hanging. Bp 80/55.what to do? (Nerve 1)


a. ETT **** (ABC of emergency)
b. cricothyrodotomy
c. tracheostomy
Ans A

175.Pt with sudden headache but improved in 2 hours with neurological deficit, no history of
trauma, afebrile and what is the diagnosis?
A-subarachnoid he (OHCM 478)
B-cerebral abscess (fever, headache)
C-extradural hemorrhage
D-subdural he
Ans A

176. young male with knife in his back mid scapula, can’t speak full sentences, air entry bilateral
but reduced, BP 80/50, pulse 120, spo2 85% after 15 l o2 what next?
a. cross match
b. intubation (A, B, C of emergency)
c. remove knife
Ans B

177. Q. man after trauma came for blood in urethra. What to do next?
A. Cystoscopy
B. CT scan
C. USG
Ans B
Retroograde uretbrography. should be performed to assess
the damage. If the urethra is intact, then a catheter C!U1 be
passed ;md the decision 10 repair the bladder depends
upon me extent of the injury. Partial rupture of the urethra
is managed by suprapubic catheterisation alone:
complete rupture may be suitable for repair by an experienced
urologisl. (Scott 133)
178. Trauma patient left side if chest injured, no breath sounds on left trachea to the right.
Oxygen sat 80% next?
A) Underwater seal drainage ***** (secondary p’thorax 815)
B) thoracotomy
C) ETT
Ans A
As it is open pneumothorax
Needle decompression if tension pneumothorax
(tension p’thorax - OHCM 814)

179. MVA patient with 96% saturation on room air, finding it hard to breath b/c of intractable
pain and taking shallow breaths due to pain, multiple bilateral rib injuries, ct provided showing
small hemothorax on rt side what is the immediate treatment to help him breath

 Intubation
 Morphine
 Chest strapping
 Underwater seal

Ans B

180.patient with chest trauma + flail chest what to do at accident scene


A. Opioid
B. chest tube
C. Mouth to mouth resuscitation
D. Cover open chest wound with a dressing
Ans D
181. A patient with trauma. flail chest again x-ray neck was given with vertebral fracture.
Collar was fixed ...chest dull on percussion. spo2 85% what is most appropriate step in
management
A intubation (ABCD of emergency)
B tracheostomy
Ans A

182. one trauma patient with oxygen 95%...bp 80/50..pulse 110bpm what is ur initial
management?
1. Oxygen
2. chest xray
3. ct scan
4. iv colloids
Ans 4

183.Trauma to chest by MVA and flail chest and open chest wound, important step to be done
at scene (accident site)
A. Morphine IV
B. pressure by gauze to close the wound
C.IM ATT
D. chest tube
E. chest strapping
Ans B

184- Knife in back of chest BP 85/50 HR 110 SPO2 98% after starting iv and 02 by mask what
next
a. urgent CT
b. Intubate
c. cross match "new option was not in recalls"
d. remove knife
ans C

185-man with stab injury, with knife in the chest, posteriorly in the 4-5 ics, in mid clavicular
line after stabilizing vitals in ED, what is the next most appropriate step-
a. remove knife
b. intubates
c. drain
d. fast usg
e. ct
Ans E

186-same scenario, with knife stabbed in chest. they haven’t mentioned the area of chest. After
stabilizing the patient, what is the most appropriate next step
a. ct chest
b. intubates
c. remove knife under GA
d. usg
ans A

187.CT abdomen (given) showing liver after trauma, conscious, stable vital signs asking
diagnosis?
- sub capsular hematoma
- intrahepatic hemorrhage
- splenic tear
Ans A

188.man after trauma came for blood in urethra . What to do next?


A. Cystoscopy
B. CT scan
C. USG
Ans B

189.a man with penetrating chest trauma on left has now developed SOB his breathing has
become laboured no x-ray… he has got tachypnea n tachycardia…. And there is also
subcutaneous emphysema in neck, on physical exam there is dull breath sounds plus
mediastinum shift towards left side, what’s the diagnosis?
a- tension pneumothorax
b- hemopneumothorax
c- aortic dissection
d- cardiac tamponade
e- aortic rupture
Ans B

190.MVA & chest trauma. Haematoma on sternal area, subcutaneous emphysema on


suprasternal area. What would u suspect?
a. Rupture Trachea
b. Rupture Larynx
c. Haematoma
ans A

191.Patient comes with abdominal trauma and pain. Vitals are stable. What’s the most
important finding on imaging?
A. Intraperitoneal hematoma
B. Sub capsular hematoma of spleen
C. Liver hematoma
D. Air under diaphragm
Ans D

192.45-yound adult while playing football he has a trauma to his right hypochondrium and
chest , bp is 120/80 , p 115 , spo2 90% , pain in right hypochondrium and flank and tenderness
over the lower rips , decrease breath sound on the lower right side what is your most
appropriate next step
a-oxygen
b-chest tube
no analgesic, no iv fluid.
Ans A
193. patient presents after trauma to the lower left chest, now presents with bl. pressure 90/60,
pulse 100 and tender upper left quadrant. paramedics have already started fluid
resuscitations. what next?
• a- 2L normal saline bolus
• b- abdominal US
• c- CT abdomen (FAST is better – pericardium, liver, spleen, pelvic organs)
• d- laparotomy
Ans A

194.After MVA what is the most important finding leading to immediate surgery.
A. Retroperitoneal hematoma
B. Retroperitoneal Gas (duodenum, ascending & descending colon are retroperitoneal structures)
C. Intraperitoneal bleeding**** (air > bleeding)
195.CT scan after trauma, tenderness in ribs, ct shows a broken rib too, bp 100/70, breathing
in room air, spo2 ok, ct looks like aortic rupture, but scenario was dullness in right lung base,
after o2 what will u do?
a) intubate
b) pericardiocentesis
c) under water seal drainage*****
ans C

196.main causes of wide mediastinum after trauma……


1- aortic rupture *** (in mediastinal from front to back  trachea, esophagus, artery)
2- esophageal rupture
Ans A

197.Which of the following is the most common pathological condition associated with Aortic
aneurysm:
a. Atherosclerosis,
b. Syphilitic aortitis,
c. Trauma,
d. Rheumatic aortitis,
c. Cystic medial necrosis
Ans A
198.Guy after trauma left side of abdomen 80/50 conscious sats normal now in ER just started on
iv

normal saline next step in management


Saline bolus
Laparotomy
Ct scan shift to icu
Abdominal usg
Ans A

199.A preterm baby born 33 week had respiratory problem due to hyaline disease and need
40percent O2 in a tube. O2 requirement is need to increase till 80percent of O2 .to let o2
saturation 90percent.cause if deterioration?

Congenital heart disease


Pneumonia
Septicemia
Pneumothorax
Ans D ??
pic of lower lobe consolidation.
200.man comes with breathlessness, cough and chest pain for 1 week. auscultation no breath
sound heard, dullness to percussion and trachea seems to be shifted to right management?
-confused between pneumonia or pneumothorax-!
Ans A
201-young male with knife in his back mid scapula, can’t speak full sentences, air entry bilateral
but reduced, BP 80/50, pulse 120, spO2 85% after 15 l o2 what next?
a. cross match
b. intubation
c. remove knife
Ans B
202.with MVA with flail chest and severe painful respiration. dyspnea. cyanosis, what is your
best management at EMERGENCY SCENE (this is the exact scenario very short)
A) strap the chest
B) analgesia
C)cover the open wound
D)needle thoracotomy
Ans B
203. a patient with spontaneous pneumothorax (25%) n no symptoms. He has history of asthma.
Next?
A admission for observation
B aspiration under Ct
C aspiration and recheck Xray
D.give oxygen

ans aspiration and recheck n x ray


ref up-to-date: for SSP.

204.A patient comes with RTA. CT scan given. BP 120/70, pulse 80/min. what’s the diagnosis?
A. Liver haematoma
B. Pericardial effusion
C. Pneumothorax
D. Splenic laceration
E. Splenic haematoma

205. A severe RTA occurs. He got heart in front of his chest. what organ can be affected in the
body likely.
A. Diaghram paralysis
B. Abdominal aorta
C. Lungs
D. Spleen
E. Kidneys
Ans C otherwise thoracic aorta
206.Patient with dyspnea with pneumothorax and trachea shifted. What’s next?
• Chest X-ray
• Needle thoracotomy
• Under water seal drain
Ans B
207. one ques about sucking chest wound, ribs are fractured after RTA next step of
management asked?
A. O2
B. Morphine
C. Thoracotomy
D. Incubation
E. Chest drain
Ans A
OHCM pg
Gp pg 132 OHCS 716

208. Young boy is brought to the rural hospital ER after trauma to the head. He was in a motor
vehicle accident. After that he developed extreme unconsciousness with GCS of 6/15. You have
intubated the patient. The Neurosurgery unit is 3 hours from the rural ER. What is the next
appropriate plan for this patient?
a. Transfer to neurosurgery unit
b. Do a ct scan
c. Burr hole
d. Craniectomy
Ans transfer to neurosurgery unit
209.A young boy is brought to you in the rural ER. Neurosurgery unit is 1 hours away. Earlier
today he was hit during football where he lost consciousness and fell to the ground. A few
minutes he regained his consciousness and walked out of the field. His family brought him to
you complaining that he has developed headache after the incident. His GCS is 10/15. What is
the next plan for him?
a. Do a ct scan
b. Transfer to neurosurgery unit
c. Hyperventilation and mannitol infusion
d. Burr hole
e. Craniectomy
Anstransfer

210.Man with penetrating chest trauma on left has now developed SOB his breathing has
become laboured. No x-ray given. He has got tachypnoea and tachycardia. And there is also
subcutaneous emphysema in neck, on physical exam there is dull breath sounds plus
mediastinum shift towards left side, what’s the diagnosis?

a- Tension pneumothorax
b- Hemopneumothorax

c- Aortic dissection

d- Cardiac temponade

e- Aortic rupture

ans B haemopneumothorax

211.After MVA what is the most important finding leading to immediate surgery.

A. Retroperitoneal hematoma

B. Retroperitoneal Gas

C. Intraperitoneal bleeding

D. Gas in the stomach

E. Forgot last option

Ans C If there is no option for intraperitoneal gas = GUD  laparotomy and proceed

. young man with 25% of pneumothorax following knife stab. vitals stable, no resp. distress but
reduced entry of air in the same side. mx?
A- admit and observe
b- do cxr
c- thoracotomy
d- removal of knife under GA followed by underwater drain *
e. removal of knife only

the patient in emergency room with a knife in lt chest, what will u do? (condition stable except
HR:100)
remove the knife and deep suture
remove the knife after chest x-ray * (next step)
send to OR and remove the knife and then insert chest tube
insert chest tube in ER and then remove the knife

Knife in back of chest BP 85/50 HR 110 SPO2 98% after starting iv and 02 by mask what next
1.urgent CT
2. Intubate
3. cross match *
4. remove knife.

2-man with stab injury, with knife in the chest, posteriorly in the 4-5 ics, in midclavicular line.
After stabilizing vitals in ed, what is the next most appropriate step-
a. remove knife
b. intubates
c. drain
d. fas tusg.
e. ct *
patient was brought to emergency room after a fight causing a stab with a knife in the chest
patient BP is normal but his O2sat is mildly decreased he is calm, he only has mild dyspnea, on
examination he has dullness to percussion, decreased air entry on left side with trachea deviated
to the side of the injury (not the opposite)
what should you do?
a- Give O2* (next)
b- Chest tube (second next)
c- Thoracentesis
d- IV fluids
e- Just cover the wound and send him home
Excised BCC send to patho lab. what is the most prognosis value for this??
A. thickness of the lesion…. for melanoma
B. no cancer cell all around the margin*
C. inflammation of the lesion
D. amt Solar keratosis
Margins for bcc. Thickness for melanoma.

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