FMGE Surgery Simplified

Dr. Rohan Khandelwal

@lefthandedsurgeon
Which type of graft has been depicted in the image?
a. Allograft
b. Autograft
c. Xenograft
d. isograft
• Autograft – same person
• Isograft – identical twins
• Allograft – same species
• Xenograft – different species
Which of the following feature is seen in all types of shock?
a. Decrease in RR
b. Cold clammy skin
c. Increased peripheral resistance
d. Decrease in tissue perfusion
A patient is brought to the ER after a RTA. Vital point towards shock
and the urine output is decreased. Patient appears confused. From
which stage of shock does urine output start reducing?
a. Mild
b. Moderate
c. severe
d. Decompensated
Key points
• Class 1 – all parameters remain normal
• Class 2 –compensated phase – Tachycardia is the earliest
manifestation
- Systolic bp remain normal
- Anxious patient
Class 3 – decompensated phase – SBP starts falling
- Confused patient
Class 4 – comatose patient; vitals not recordable
1. A 34-year-old female presents with a lump in her left breast for 2 years. On
examination, a 6 x 4 cm mass is palpated. Dimpling of the skin and bloody
discharge from the nipple is present. The lesion is invading the pectoralis
major muscle. Ipsilateral Level I and Level II matted axillary lymph nodes
present. There was no distant metastasis. What is the TNM staging (AJCC
8th)? (Clinical / Application)
a. T4bN1M0
b. T3N2M0
c. T4aN1M0
d. T2N1M1
2. A 25-year-old male with a history of a road traffic accident is brought to the
emergency department. His GCS is 8/15, oxygen saturation is 85%, BP is 100/ 60
mmHg, and heart rate is 60 beats per minute. On auscultation his right side breath
sounds were absent. What is the next step in management? (Clinical / Application)
a. Secure airway, give oxygen, insert ICD, secure IV line
b. Administer IV dextrose followed by NCCT head
c. Start IV fluids, give atropine and secure airway
d. Evaluate for head injury and do CT-head
NEXUS Criteria
Airway
9. An 84-year-old man with a history of stroke 2 years ago, who is on prolonged bed rest, develops a pressure ulcer with partial
thickness skin loss and a clean base. What is the grade of his pressure sore? (Clinical / Application)
a. Grade 1
b. Grade 2
c. Grade 3
d. Grade 4
Bed sores
10. A chronic smoker comes with complaints of pain in his legs after walking 100 metres. On examination, he has an absent
pulse in the bilateral dorsalis pedis, anterior tibial, and posterior tibial arteries, but no gangrene is present. Intermittent
claudication is implicated. Which of the following statements is true regarding this condition? (Clinical / Application)
a. Pain is more at night and sleep
b. Development of pain on the 1st step of walking
c. Pain aggravated by standing and relieved by bending forward
d. Pain develops after walking some distance and relieved by rest
Clinical scenarios
Intermittent claudication Osteoarthritis Neurogenic
claudication

Cramping pain after Maximum pain Pain varies with

walking a certain on first step posture
distance
Pain is usually in one Pain in affected
muscle group lower than joint
block
Progresses to rest pain
11. An elderly male patient comes with foul smelling breath and dysphagia. A barium swallow X-ray is attached. What is the
most likely diagnosis?
(IMAGE: Anterior view with Lateral swelling - BARIUM SWALLOW image
https://www.researchgate.net/figure/Barium-swallow-AP-view-left-and-lateral-view-right_fig1_321071064) (Image based)
a. Achalasia cardia
b. Zenker's diverticulum
c. Tracheoesophageal fistula
d. Carcinoma esophagus
14. A 35-year-old male underwent surgery for an ileal perforation. Due to heavy contamination, only the sheath was closed, and
the wound was left open. Daily wound washing was performed, and the wound was closed on postoperative day 5. By which
mechanism does wound healing occur in this case? (Clinical / Application)
a. Primary intention
b. Secondary intention
c. Tertiary intention
d. Quarternary intention
Wound healing

24
Which of the following is the cause of the condition shown in the
image of a breast cancer patient
a) Superficial lymphatics
b) Deep lymphatics
c) Skin
d) Chest wall
Peau d’ orange - involvement of subdermal
lymphatics
51 year old female presented with complaints of a mass in the right
breast. On examination mass was more than 2 cm and enlarged
axillary lymph nodes were present. Mass was not fixed to the skin.
What is the stage considering the mass is malignant?
a. Ct4n1m0
b. Yt4n1m0
c. Ct3n1mo
d. yt3n1m0
In a patient with recurrent kidney stones and psychiatric symptoms
with fatigue, which investigation will be used for diagnosis?
a. Tc 99 sestamibi scan
b. Usg neck
c. Ct
d. mri
Hyperparathyroidism
Osteitis fibrosa cystica
32 year old male patient presents with episodic hypertension,
headache, sweating and palpitations. What is the most likely
diagnosis
a. Carcinoid tumor
b. Phaeochromocytoma
c. Adrenal carcinoma
d. Neuroblastoma
Which of the following are the correct components of the child
pugh score?
a. Total bilirubin, creatinine
b. Serum albumin, bilirubin, pt/inr, ascites, encephalopathy
c. Ascites, globulin
d. Albumin, globulin, creatinine
A child is brought to the emergency after ingestion of a coin. Which
of the following interventions would be used in the management of
this patient?
a) Bronchoscopy
b) Esophagoscopy
c) Heimlich manuver
d) tracheostomy
Foreign body esophagus
• Beyond C6 – ______
• Impacted at C6 – _______
• Button batteries – _______
Foreign body - lateral x ray
A patient presented to the surgery opd with complaints of pus
discharge per anum. Patient was diagnosed with a fistula in ano.
Which is the gold standard investigation in this patient
a. Cect
b. Mri
c. Fistulogram
d. usg
Park’s classification – perianal sinus
Which of the following is not true about CHPS?
a. Presents with non bilious vomiting
b. Caused by hypertrophy of longitudinal muscles
c. Usg is very sensitive in diagnosing the condition
d. Hypokalemic metabolic alkalosis is seen
Congenital Hypertrophic Pyloric stenosis
Investigations
• IOC – USG

- Thickness more than 4 mm

- Length of pyloric channel more than 16 mm

• X ray – Single bubble sign

• Contrast study

- String sign

- Double track sign

- Mushroom sign
Contrast study
CHPS
CHPS
Which of the following is not true regarding the condition shown in
the image?
a. Testis are preserved
b. Common in diabetic patients
c. Staph aureus is the causative organism
d. High mortality
44 year olf female with a flank mass which is ballotable and the
mass measures 4 cm on CT. Urine shows malignant cells. What is
the management
a. Chemo radiation
b. Radical nephrectomy
c. Partial nephrectomy
d. DTPA scan
55 year old male is diagnosed with left testicular carcinoma. Which
of the following lymph nodes is the first to be involved?
a. Inguinal
b. Iliac
c. Para aortic
d. Pre caval
79 year old chronic smoker with coronary artery disease presents
with foot pain. Image of foot with blackening of toes. What is the
diagnosis?
a. Atherosclerosis
b. Beurgers disease
c. Raynaud’s disease
d. Giant cell arteritis
Buerger’s vs Atherosclerosis
32 year old lady sustains a fall from a flight of stairs and is brought
to the ER in an unconscious state. NCCT is done and image is
shown below. What is the diagnosis?
a. SDH
b. SAH
c. EDH
d. Contusion
Contusion
Extradural hematoma
Pterion
Subdural hematoma
50 year old lady complains of the worst headache of life. She has
not experienced this kind of headache in the past. What is the most
likely cause
a. EDH
b. SDH
c. SAH
d. Contusion
• 6. An MRCP image is shown below. Which among the following is the most likely diagnosis?

• Choledocholithiasis
1. Cholecystitis
2. Pancreatic duct stricture
3. Common bile duct obstruction
A patient underwent laparoscopic cholecystectomy for cholelithiasis,
and the histopathology report of the resected gall bladder indicates
Stage T1a of gallbladder cancer. What is the appropriate next step in
the management of this pateint?

A) No further treatment
B) Perform extended cholecystectomy
C) Adjuvant chemotherapy
D) Palliative nonsurgical therapy
Answer: A) No further treatment

Explanation: In cases of Stage T1a gallbladder cancer, which is

confined to the mucosa, the appropriate management may involve no
further treatment after laparoscopic cholecystectomy.
Q. A patient with multiple gallstones undergoes a USG, which reveals
the CBD diameter to be 12 mm. Serum bilirubin is 0.8. ALP is 380
and GGT is raised 5 times. What is the next step in the
management of this patient?
A. MRCP

B. ERCP

C. Cholecystectomy

D. CECT abdomen
Q. A patient undergoes a lap cholecystectomy and is discharged the
next day. She comes back after 2 days with pain in the right
hypochondrium. LFT is normal but TLC is raised (13,000). What is
the most likely problem?
A. Cbd stone

B. Bile duct leak

C. Acute pancreatitis

D. Right lobar pneumonia

 Origin of the
bile leak

Subhepatic
collection
Q. 28 year old lady is diagnosed with an incidental GB polyp
which measures 5mm. Patient is asymptomatic. What is the
most appropriate treatment for this patient?
A. Observation

B. Lap cholecystectomy

C. Open cholecystectomy

D. CECT abdomen
Q. A 50-year-old diabetic man presents with a progressive
increase in pain in his calf, initially after walking a
distance of 400m later 200m over the last 6 months. He
now prefers to sleep in a seated position by hanging
his leg to alleviate pain. Which of the following is the
most likely cause?
A. Rest pain
B. Sciatica
C. Neurological claudication
D. Venous claudication
Clinical scenarios
Intermittent claudication Osteoarthritis Neurogenic
claudication

Cramping pain after Maximum pain Pain varies with

walking a certain on first step posture
distance
Pain is usually in one Pain in affected
muscle group lower than joint
block
Progresses to rest pain
Symptoms depending on site