SURGERY

FMG DECEMBER - 2021

1.A 20-year-old boy joins a gym and tries
weightlifting on first day despite instructor warning
him not to do so. Post dead weight lift he develops
severe peri-anal pain that makes him seek your
consultation. Local examination shows an olive
shaped painful subcutaneous swelling at anal
margin. What will we your advice to the patient?
a. Laxatives and Topical nitroglycerin for a week
b. Orchidectomy
c. Schedule Lateral internal sphincterotomy
d. Diosmin and hesperidin orally
2.A person has presented with inability to pass
urine after sustaining fall as shown in the image.
Vitals are stable but bladder is not palpable. Which
is first differential diagnosis?
a.Bladder rupture
b.Penile avulsion
c.Anterior urethra rupture
d.Posterior urethra rupture
3.Which of the following is not correct about the
stoma shown?
a.Effluent is smelly
b.Spout must be at skin level
c.Loop ileostomy
d.Watch for potassium level
4.A known case of P.U.D has presented with severe
abdominal pain and rebound tenderness. Bowel
sounds are reduced. Vitals are Pulse rate of
130/min with BP = 100/ 70 mm Hg. Which of the
following is the expected X ray finding of this
patient?
a.Step ladder pattern of air fluid levels
b.Gas above diaphragm
c.Multiple air fluid levels
d.Ground glass appearance
5.18-year-old girl is having discharge from this
fistulous tract which is present at junction of lower
and middle one third of sternocleidomastoid.
Comment on the internal location of this fistula?
a.Foramen caecum
b.Tonsillar fossa
c.Hypo-phyranx
d.Killian dehiscence
6.Esophagogram showing shaggy contour with irregular
plaque like filling defects will be seen in?

a.Candida esophagitis
b.HSV esophagitis
c.CMV esophagitis
d.Esophageal varices
7.In which of the following clinical situations
Mackler’ triad is seen?
a.Forceful vomiting against a closed gottis leading to
superficial tear at OG junction
b.Forceful vomiting against a closed glottis leading to
deep tear and perforation at lower one third of
esophagus
c.Forceful vomiting against increased LES tone leading
to vertical split in cardia
d.Forceful vomiting during attempted instrumentation of
esophagus leading to aspiration of stomach contents
8.Brachytherapy with I-125 radiation seeds
implantation is done for?
a.Carcinoma Cervix
b.Carcinoma breast
c.Carcinoma thyroid
d.Carcinoma prostate
9.A 60-year-old patient is having severe colicky
abdominal pain with distention of abdomen and
obstipation. Bowel sounds in Right iliac fossa are
exaggerated. AXR is shown below. Comment on
diagnosis?
a.High small bowel obstruction
b.Large bowel obstruction
c.Pseudo-obstruction
d.Low small bowel obstruction
10.57 years old woman came to the hospital with
the following presentation. On examination stony
hard breast mass 5 X 8 cm is adherent to chest wall
and overlying skin which shows discoloration. She
says that she has been using topical emollients over
what she perceives as eczema. Surgeon checks
other flexural sites for eczema but finds no lesions.
What is the T- staging of the cancer?
a.T4a
b.T4b
c.T4c
d.T4d
11.A patient with hypertriglyceridemia has mid
epigastric pain which radiates to back and is
relieved on sitting up/leaning forwards. Bowel
sounds are reduced and resident on duty has made
provisional diagnosis of acute pancreatitis. Which
of the following is used for CT based severity of
acute pancreatitis?
a.Glasgow score
b.Atlanta scoring
c.Balthazar score
d.Ranson imrie scoring
12.Which of the following is incorrect about the
following bosselated lesion over the right breast of
this 60-year-old lady?
a.Phyllodes tumor
b.Fixed to chest wall
c.Can metastasize to lungs
d.Treatment is subcutaneous mastectomy
13.Which of the following is not a feature of
Dieulafoy’s triad?
a.Tenderness
b.Skin Hyperaesthesia
c.Muscle contraction locally
d.GI bleeding
14.Comment on diagnosis of this 30-year-old lady who
has a cord like structure palpated on breast with
retraction of lateral part of breast. She says the lesion
was painful earlier but now is painless.
a.Mondor disease
b.Galactocele
c.Duct ectasia
d.Ductal carcinoma in situ
15.Intern was asked to remove foley’s catheter of
female patient at time of discharge. The catheter
however is stuck and he is not able to remove it.
What is best step for management of this case?
a.Cut of side arm and clear the channel with wire
b.Inflate balloon with more saline and under
sonographic guidance and burst the balloon
c.Plan suprapubic cystostomy
d.Deflate balloon with 50 ml syringe as smaller
syringe may not generate sufficient suction
16. 50-year-old patient presents with severe acute
non remitting abdominal pain with vomiting
episodes and blood in stools. On admission BP is
80/60 mm Hg , pulse 120/min and is febrile. Bowel
sounds are reduced. He is known case of atrial
fibrillation. Doppler shows high peak velocity of
flow in superior mesenteric artery. Which is the
likely event that triggered this presentation?
a.Embolic event
b.Thrombosis of mesenteric veins
c.Aortic Aneurysm rupture
d.Aortic dissection
17.A 65-year-old lady presents with neck mass and
swelling on forehead which has been increasing in
size for past one month. It is warm to touch, and she
says she has taken some herbal medicines but it is
not improving. The X ray skull shows lytic lesion.
Comment of first differential diagnosis?
a.Multiple myeloma
b.Follicular cancer of thyroid
c.Potts puffy tumor
d.Histiocytosis-X
18.The following foley catheter packet insert says
16F. The no 16 indicates
a.16 mm diameter of catheter
b.16 mm circumference of catheter
c.16 mm3 volume of retaining balloon
d.16 mm length of tip of catheter
19.Which is not Correct about luminal type A breast
cancer?
a.HER2 negative
b.High ER expression
c.low grade tumor
d.Responds best to chemo-therapy
20.A 30-year-old alcoholic is having multiple
episodes of vomiting and noticed blood in vomiting.
On examination the abdominal wall is soft in all the
quadrants and normal bowel sounds are present.
Vitals are HR=100/min with BP= 120/ 80 mm Hg,
RR= 14/min. X ray abdomen was done. What is the
diagnosis?
a.Boerhaave syndrome
b.Perforation peritonitis
c.Mallory Weiss Syndrome
d.Intestinal obstruction
21.Esophagogram performed in this young female
with complaints of non-progressive dysphagia is
suggestive of?
a.Plummer Vinson syndrome
b.Schtazki ring
c.Pulsion diverticula
d.Achalasia cardia
22.Which is correct about the malignancy of thyroid
gland shown below?
a.Leads to Hurthle cell neoplasms
b.Spreads by transcelomic spread
c.Associated with A-Cal Deposits
d.Post operative use of thyroxine
23.An alcoholic has recurrent episodes of
epigastric pain He is currently on PPI and Tramadol
for past 6 weeks. CT abdomen is shown which
shows evidence of focal calcification. Which of the
following is most likely to be seen in this patient?
a.High serum amylase
b.Sentinel loop sign
c.Surgical drainage
d.Steatorrhea and diabetes
24.Colon cut off sign is?
a.Absence of colon visualization in acute
pancreatitis
b.Absence of colonic gas shadow beyond
splenic flexure in acute pancreatitis
c.Absence of colonic gas shadow beyond
rectosigmoid junction in chronic pancreatitis
d.Absence of colonic gas shadow beyond
hepatic flexure in chronic pancreatitis
25.A 35-year-old patient presented with a one-year
history of diarrhea, abdominal pain off and on and
weight loss. During investigation with a contrast
evaluation of the bowel, following images were
seen. Possible diagnosis?
a.Cancer colon
b.Diverticulosis of colon
c.Ileo-caecal tuberculosis
d.Volvulus
26.In an asymptomatic patient, on routine
screening a small mass was detected in the rectum.
Carcinoma rectum was suspected. What is the next
step in the management?

a.CT pelvis
b.Barium enema
c.Colonoscopy with lesion biopsy
d.Sigmoidoscopy with lesion biopsy
27.70-year-old man presenting with fever, anorexia,
left lower quadrant pain and obstipation. He claims
to have constipation for as long as he can
remember in his life-time but these complaints are
of recent onset. Which of the following
investigations is first line for diagnosis of this
patient?
a.CT abdomen
b.Barium enema
c.Air enema
d.Laparotomy
28.A 25-year-old male presents with following
lesions in intergluteal cleft. The diagnosis is?
a.Fistula in ano
b.Anal fissure
c.Post anal dimple
d.Pilonidal sinus
29.A 34-year-old female presented with a mass in
the inguinal region which produced gurgling sound
on reduction. The mass reduced completely on
pressing it through the deep inguinal ring. Possible
diagnosis in this lady?

a.Femoral hernia
b.Pantaloon hernia
c.Indirect inguinal hernia
d.Direct inguinal hernia
30.70-year-old male presented with a ballotable
mass in the left flank region. On examination
painless hematuria, RBCs were found in urine,
while there were no WBCs in urine. Most probable
diagnosis in this patient?
a.Renal cell carcinoma
b.Polycystic kidney disease
c.Hydronephrosis
d.Pyelonephritis
31.To prevent development of post-operative
hypoparathyroidism, Parathyroid glands are
reimplanted in following site following Total
thyroidectomy procedure?
a.Sternocleidomastoid
b.Scalaneus anticus
c.Scalaneus medius
d.Brachioradialis
32.Bird beak sign on barium enema is seen in?

a.Achalasia cardia
b.Sigmoid volvulus
c.Cancer Oesophagus
d.Barret Oesophagus
33.A 28-year-old construction worker presented
with complaints of groin swelling that increases on
standing and reduces on supine position. On
attempted reduction, initially it reduces easily but
last part is impossible to reduce. No gurgling sound
is heard during reduction. Diagnosis is?
a.Omentocele
b.Enterocele
c.Bubonocele
d.Hydrocele
34.30-year-old nulliparous woman was diagnosed
as having Femoral hernia. Which is the surgery
performed for this condition?
a.Lord’s plication
b.Jaboulay procedure
c.Lockwood operation
d.Delorme procedure
35.Malignancy on thyroid scan in a solitary nodule
appears as?
a.Hot nodule
b.Warm nodule
c.Cold nodule
d.Cannot differentiate malignancy from autonomous nodule
36.Murphy’s triad is used for diagnosis of?
a.Appendicitis
b.Cholecystitis
c.Diverticulitis
d.Pancreatitis
37.A patient is having primary piles of second
degree. Best treatment is?
a.Sitz bath
b.Sclerosant injection
c.Barron banding
d.Cryosurgery
38.Correct about nigro regimen?
a.Radiotherapy for 3 weeks 3000 rads
b.5 fluro-uracil
c.Mitomycin C
d.All of the above
39.Diarrhea and persistent retching will be noticed
in which position of appendix in a case of
appendicitis diagnosed on CT abdomen?
a.Retrocecal
b.Post ileal
c.Pelvic
d.Subcecal
40.During inguinal hernia surgery, resident notes
two hernial sacs straddling the inferior epigastric
artery. He is asking the assisting intern to name this
presentation.
a.Maydl hernia
b.Ritcher hernia
c.Pantaloon hernia
d.Sliding hernia
41.A 40-year-old alcoholic went for binge drinking
with his friends and had multiple episodes of
retching and vomiting. Later he developed severe
chest pain followed by prostration. On examination
Crepitus is noted in anterior chest wall and face
with vitals of PR=120/min, BP= 100/78 mm Hg and
RR= 30/min. Diagnosis is?
a.Mallory Weiss syndrome
b.Rupture of Esophageal varices
c.Boerrhave syndrome
d.Pneumothorax
42.Cameron ulcer is found in?
a.Sliding hernia
b.Rolling hernia
c.Amyand hernia
d.Ritcher hernia
43.Which of the following is not seen in Menetrier’s
disease?
a.Low albumin
b. Foveolar cell hyperplasia
c.Chronic blood loss
d.Non beta cell tumor
44.A 40-year-old female smoker presents with
tender indurated mass under the areola of left side
with a creamy discharge. Tender axillary lymph
nodes are palpable. First differential Diagnosis?
a.Mondor disease
b.Duct ectasia
c.Carcinoma breast
d.Fibroadenoma
45.Which of the following is correct about Sentinel
lymph node biopsy in carcinoma breast?
a.Done in case of clinically palpable node
b.Injection of radio-labelled albumin
c.Injected into axilla
d.Identifies multi centric breast tumor
46.Van Nuys prognostic index is used for?
a.LCIS
b.DCIS
c.Inflammatory carcinoma
d.Triple negative breast cancer
47. A person was struck on helmet by cricket ball after
which he fell on the pitch and became unconscious. After 5
minutes he regained consciousness and played an
excellent innings. But after reaching dressing room on
match completion he became unconscious and started
having decerebrate posturing. Which is correct score of
Motor response component of GCS for this patient?
a. 1
b. 2
c. 3
d. 4
48.The y prefix in TNM staging indicates?
a.Stage assessed after neoadjuvant therapy
b.Stage assessed after clinical examination
c.Stage assessed after pathological examination of specimen
d.Stage assessed for recurrence of tumour
49.Which of the following is most common non-
epithelial neoplasm of breast?

a.Fibroadenoma
b.Serocystic disease of brodie
c.Duct papilloma
d.Carcinoma breast
50.A 25-year-old female presents with a smooth soft
swelling in umbilical area. It is freely mobile in
direction perpendicular to mesentery. First
differential Diagnosis is?
a.Desmoid tumour
b.Mesenteric Lymphadenitis
c.Mesenteric Cyst
d.Peritoneal carcinomatosis
51.Appendiectomy through Mcburney’s incision
leads to development of?
a.Direct inguinal hernia
b.Indirect inguinal hernia
c.Amyand hernia
d.Ritcher hernia
52.Extra mammary Paget’s disease is seen at?
a.Vulva
b.Vagina
c.Skull
d.Vertebra
53.Sideropenic dysphagia is seen with?
a.Schtazaki’s ring
b. Post cricoid web
c.Pseudo-achalasia
d.Nutcracker oesophagus
54.24 hour urinary 5-HIAA Is used for diagnosis of?

a.Extra nodal lymphoma

b.Argentaffinoma
c.Gastrointestinal stomal tumour
d.Periampullary carcinoma
55.Modified Amsterdam criteria are used for
diagnosis of?

a.Carcinoma anus
b.Hereditary non polyposis colonic cancer
c.Renal cell cancer
d.Gastrointestinal stomal tumour
56.Folinic acid with 5-FU and oxaliplatin is used for
management of?

a.Anal cancer
b.Metastatic Colonic cancer
c.Renal cell carcinoma
d.Oesophageal carcinoma
57.Barium meal showing niche and notch
appearance is a feature of?

a.ZES
b.Colonic diverticulosis
c.Peptic ulcer disease
d.Bilroth procedure
58.Paradoxical aciduria is a feature of?

a.Pyloric stenosis
b.Duodenal fistula
c.Fistula in ano
d.Renal tubular acidosis
59.Post bulbar ulcers are seen in?

a.ZES
b.Type A gastritis
c.Type B gastritis
d.Zollinger Ellison syndrome
60.Which is called as incarcerated hernia?

a.Non reducible hernia

b.Non reducible hernia with ischemic contents
c.Bubonocele
d.Omentocele
61.First choice drug for metastatic breast cancer?

a.Tamoxifen
b.Anastrazole
c.Goserelin
d.Lapatinib
62.Nurse reports to you that meniscus of fluid in
chest drain is not swinging. This implies that?

a.Empyema is fully drained

b.Patient has developed iatrogenic pneumothorax
c.Chest drain is blocked
d.Patient has develop bronchopleural fistula
63.Prehn sign is used for differentiating?

a.Varicocele from hydrocele

b.Epididymitis from epididymal cyst
c.Fournier gangrene from torsion testis
d.Torsion testis from epididymitis
64.Elephantiasis chirugens is a feature of?

a.Radical mastectomy
b.Lymphogranuloma Venerum
c.Wucheria Bancrofti infection
d.Radical Prostatectomy
65.Bilateral mastectomy is done for?

a.Stage 0- LCIS
b.Stage I
c.Stage II
d.Stage III
66.Peritonitis developing after any abdominal
surgery is called as?

a.Primary Peritonitis
b.Secondary Peritonitis
c.Tertiary Peritonitis
d.Spontaneous Bacterial peritonitis
67.Which of the following is not a feature of
Carcinoma prostate?

a.Bladder outlet obstruction

b.Osteosclerotic secondaries
c.TURP is protective against Carcinoma prostate
d.Loss of median groove on PR examination
68.Hippocratic facies is seen in?

a.Chronic Renal failure

b.Depression
c.End stage peritonitis
d.Paralytic ileus
69.Most common intra-peritoneal abscess?

a.Pelvic abscess
b.Right Sub-phrenic abscess
c.Left sub-phrenic space
d.Right sub-hepatic space
70.Obtuse ileo-caecal angle is a feature of?

a.Appendicular abscess
b.Appendicular mass
c.Ileo-caecal TB
d.Amoeboma
71.All are true about Fournier gangrene except?

a.Caused by haemolytic streptococci

b.Idiopathic gangrene of testis
c.Common in immunosuppressed patients
d.Skin grafting is done
72.Middle aged man presents with dragging
sensation in scrotum for 2 years. On examination
fluctuant mass is felt in right scrotal with ability to
get above the swelling. Cough impulse is negative.
Diagnosis is?
a.Right direct inguinal hernia
b.Right indirect inguinal hernia
c.Right varicocele
d.Right hydrocele
73.“Bag of worms feeling” with positive cough
impulse in a testicular lump is diagnostic of?

a.Varicocele
b.Inguinal hernia
c.Lipoma of cord
d.Hydrocele
74.Dough-nut Sign on USG abdomen is seen in?

a.Intussception
b.Stomach volvulus
c.Caecal volvulus
d.Infantile Hypertrophic pyloric stenosis
75.“Absence of duodenal cap” on barium meal
follow through is a feature of?
a.Duodenal atresia
b.CHPS
c.PUD
d.Duodenal polyps
76.Most common non epithelial tumor of GIT is?
a.MALTOMA
b.GIST
c.Carcinoid
d.Leiomyoma
77.Bent inner tube sign is a feature of?
a.Gastric cancer
b.Volvulus of pelvic colon
c.Colorectal cancer
d.Appendicular carcinoid
78.Kehr sign is diagnostic of?
a.Acute diverticulitis
b.Ruptured Amoebic liver abscess
c.Splenic rupture
d.Rupture of oesophagus
79.IVU of the patient is diagnostic of?

a.Duplication of renal collecting system

b.Hydronephrosis
c.Papillary necrosis
d.Vesico-ureteric reflux
80.The following image shows?

a. Duplication of renal collecting system

b. Posterior urethral valves
c. Ureterocele
d. Bladder exostrophy