Asmall contribution from the May 2023 group for our future colleagues. © A big thanks to my mentors Dr Bishoy who made us come together. Like this we became like a small family. Thanks to Dr Reda who has always been my support system ee Studying in the group made our journey very much fun and memorable and | encourage all of our future colleagues to study the same way. Enjoy the journey! Share. Care. Love. Together We Did it!MAY 2023 Recalls 1) Patient after RTA, you are waiting with the patient for CT protocol and you notice that the patient got perioral oedema and respiratory distress. His saturation started to drop (72%). What should be the initial management? a. Adrenaline IM Hydrocotisone IV Endotracheal intubation Emergency surgery salbutamol pans 2) Massive blood transfusion. Hypocalcemia. Ca level mentioned 2.01. Other electrolytes given normal. a. Citrate toxicity b. latrogenic hypoparathyroidism c. Hypothermia 3) Patient comes to you after a fall. After examination he is unable to internally rotate and adduct his shoulder. Which rotator cuff muscle responsible for internal rotation of shoulder? a. Supraspinatous b. Subscapularis c. Teres minor d. Teres major e. Deltoid 4) 70 year old patient was undergoing routine checkup when the radiologist reported an abdominal aortic aneurysm of 4.7cm size. What is the most appropriate treatment plan? a. Surveillance with US serial Open AAA repair Endovascular AAA repair Endovascular embolization .. Arrange urgent CT 5) Which of the following substances is released from the sympathetic nervous system to stimulate the adrenal medulla? a. Noradrenaline b. Acetylcholine Substance P Tyrosine Adrenaline pao peo6) Premature Baby Presented With Abdominal Distention and Billious vomiting from NG Tube with bloody rectal bleeding ? a. Meconium Ileus Meckle's Diverticulum Necrotizing Enteroco Duodenal Atresia Intussusuption pags 7) Patient first had a perianal discharge for 3 months and now since 2 weeks abdominal pain, diarrhea and accounted some weight loss. There was a tender mass in right iliac fossa, What is the diagnosis? a. Right colon cancer b. Toxic megacolon c. Crohns 8) Patient with cardiogenic shock what to give have marked heart contractility and low vascular contractility effect? a) Adrenaline b) Noradrenaline ¢) Dobutamine d) Dopamine 9) Not a risk factor of aortic dissection — a. Atherosclerosis b. Hypertension c. Marfan d, Diabetes mellitus e. Smoking 10) _ Little girl recently well from fever, keeps pulling her ear, mother notices yellow pus from ear a) Streptococcus intermedius b) Staph aureus c) Moraxella cateralis 11) _ Sepsis scenario, what to give that has less beta 1 activity, mainly Alfa 1 activity a) Adrenaline b) Noradrenaline c) Dopamine d) Dobutamine12) Aortic dissection due to - a) Adventitia Collagen b) Adventitia elastin c) Intima elastin d) Media collagen e) Media elastin 13) What is the diagnosis? ee Tee “ret pa hely | eee oe ee: |. Massive PTE . Myocardial infarction . Pulmonary oedema . Cardiac failure 14) Which receptors does dobutamine act on ,to reduce BP a, Beta 1 b. Beta 2 c. Alpha 1 d. Alpha 2 15) Patient with positive tinels sign. Pain at night. Median nerve injury, which muscle affected — a. Abductor pollicis brevis b. 3, 4th lumbrical c. Flexor digitirum profundus d. Flexor digitorum superficialis 16) Smoker, ischemic heart disease history of evar repair of aortic aneurysm now developed trash foot. pulses papable cause of trash foot? a. thrombosed evar b. popliteal aneurysm c. atril fibrillation eopoed. abdominal aortic aneurysm 17) Painful thyroid swelling with defective epithelial cells and siderophages a. Medullary carcinoma b. Papillary carcinoma c. folicular carcinoma d. simple thyroid cyst 18) _ First structure pierced by needle during CSF collection in vertebral canal a. Ligamentum flavum b. Epidural fat c. Dura d. Posterior ligament e. Arachnoid 19) Prolapsed disc asking about cause deficiency of which structure? a. Nucleus pulposus b. Annulous fibrosus c. Posterior longitudinal ligament d. Ligamentum flavum 20) Patient with Chronic Pancreatitis presents with pain in the back. What will be appropriate management? a. Nsaids b. Nerve block c. Opiods 21) Fecal immunochemical test (biochemical test) related question is: a. Sensitive b. Specific c. Specific not sensitive d. Specific and sensitive e. Sensitive not specific 22) Multiple recent RCts used, level of evidence asked a1 b.2 Can) d. 4 e5 23) Burn including both forearms and both anterior [Link] wt 80 kg. Fluid required in 24 hrs ?? a. 2-34 b. 4-51 ce. 3-4L d. 6-7LTiny explanation = both forearms i.e. 4.5+4.5 + both anterior thighs ie. 4.5 +4.5 = total 18 18 x 2.x 80 kg = 2880 = approx. 2-31 in 24 hours 24) For scalp wound Adr plus lignocaine 1% .pt wt 50 kg. Amount of adr a. 25 b. 35 c. 45 d. 55 Tiny explanation: Lignocaine + adr max dosage 7 mg/kg = 7 x 50 kg = 350. 1% lignocaine = 10 ml, therefore 350 / 10 = 35 25) Sudden severe tender abdominal pain, CT showed enlarged left colon, little fluid in the peritoneum. Bloody plum coloured stool. Tachypnoea, tachycardia, Raising lactate. No signs of obstruction a. Ischaemic colitis b. Toxic megacolon 26) 55 year old patient. Head injury patient, lost consciousness for 15 secs. Then GCS 15 a. Give instructions and accompany and discharge b. CTin 1 hour c. CT in 8 hours 27) Patient came with DVT. What's the body physiological mechanism of keeping thrombosis in control: a. Plasmin b. Protein C c. TNF d. Heparin e. antithrombin 28) During major trauma what important factor that is increased and important in coagulopathy + hyperfibrinolysis? a. TNF b. Plasmin activator inhibitor c. Activated protein C d. Tissue plasminogen NOTE: During your prep, pay attention to the coagulation pathway. It will help you decipher tricky questions like these.29) 30) 31) 32) 33) 34) 35) Twenty — four hours after a routine aortic valve replacement for a heavily calcified valve the patient's heart rate abruptly falls to 40 beats/minute. The systolic pressure was 140 mmHg and become 110 mmHg and right atrial pressure was 7mmHg and become 15 mmHg. which of the following is the most likely diagnosis? a. Atrial fibrillation b. Cardiac tamponade c. Digoxin toxicity d. Heart block e. Left ventricular failure Nerve injured in supracondylar fracture of humerus - a. Median b. Radial c. PIN d. Ulnar Tiny Tip: Remember AIN > Median nerve Nerve passing posterior then lateral to humerus, then anteriorly at the lateral condyle Radial Median Ulnar AIN e. PIN Injury to parietal lobe will result in lesion at ~ a. Optic nerve b. Optic radiation c. Optic chiasm d. Lateral geniculate body Alcoholic pt, history of fall , lateralising signs present. Injury ? a. EDH b. SDH c. SAH d. ICH Sciatic nerve path - a. Single trunk above piriformis b. Single trunk below piriformis c. One trunk above & 2 trunks below piriformis d. One trunk below & 2 trunks above piriformis Inguinal Ligament forms superior border of - ao.Femoral triangle Femoral canal Inguinal canal Subsartorial canal e. Popliteal fossa 36) Impact at temporal bone injury medial meningeal artery causing EDH. Location of injury? a. Pterion b. Vertex c. Glabella d. Nasion 37) Picture with incision at lateral side of foot. Nerve injured — -) =a gogo a. Sural b. Saphenous c. Tibial d. Superficial peroneal e. Deep peroneal 38) _ Sinus tarsi between - a. Calcaneum and talus b. Talus and navicular c. Navicular and calcaneum d. Cuboid and calcaneum 39) Mesothelioma is a a. Vascular tumor b. Primary tumor of lung c. Epithelial tumor and tubular cells 40) Female who is noticing intermittent discharge since 6 months. History of nipple piercing. No lump on physical examination and USG. Diagnosis? a, Mammary fistula b, Breast abscess41) Anulliparous 30-year-old Woman presents with a recurrent painful red area in the areola. She gives a history of smoking cigarettes. The lesion is excised, and the histology shows squamous metaplasia of lactiferous ducts with greenish discharge . Microbiological culture does not grow any organism. Which of the following is the most likely diagnosis? a. Breast abcess b. Ductal carcinoma c. Fibroadenoma d. Periductal mastitis 42) _ Patient with history of breast surgery while she was abroad, now presented with red erythrmatous lesion and 3 lumps over the site. a. Fibroadenoma b. Phylloides c. Breast sarcoma OR the scenario was.. 35 year old lady presents with breast mass. Had biopsy 10 years ago, which was fine. Now shows 3 areas of calcification. What is it? i. fibroadenoma ii. cyst ili. phyloid iv. Inflammatory cancer v. Fat necrosis 43) A female with mammo showing no lesion. Mammo 2 Years back normal. Targeted usg shows breast tissue abnormality a. Fat necrosis b. Ductal CA c. Lobular CA 44) Which antibody is a pentamer that doesn't cross the placenta? a. IgG b. IgA c. IgD d. IgM e. IgE 45) Child with mass in the right abdomen. Haematuria, What will be the initial investigation? a. Usg abdomen b. Xray abdomen c. CT d. MRINote: Usg will be initial . CT would be definitive 46) 55 year old man on Rivoroxaban falls on his back of the head. Feels completely fine. What would be your next step? a. (Tin 1 hour b. CT in 8 hours c. Discharge d. Xray skull Note : Patient is on anticoagulant. Read the head injury guidelines for adults and children thoroughly. 47) _ Patient was on morphine. You notice he has pinpoint pupils and respiratory depression. You prescribe him naloxone. What is the mechanism of action of naloxone? a. Competitive antagonism b. Non competitive antagonism c. Synergism 48) Morphine acts on which receptors? a. Mu b. Kappa c. Alpha d. Beta 49) Mechanism of action of Tranexamic acid? a. Plasmin Inhibitor b. Thromboxane inhibition 50) 56 year old male presents to the acute surgical take with severe abdominal pain. He is normally fit and well. He has no malignancy. The biochemistry laboratory contacts the ward urgently, his corrected calcium result is 3.6 mmol/l. What is the initial management? a. IV Pamidronate Oral Alendronate Dexamethasone Calcitonin 0.9% Normal Saline peo Note:Here INITIAL, if definitive management of scenario then IV Pamidronate. If malignancy - IV Zolendronate The actual scenario was like this 8 cm stone, Ca 3.5, management? = ECG + IV NS + Bisphosphonate51) _ Post renal transplant patient with high ALP. Just an example: 165. A 45 years old woman is investigated after two episodes of renal colic. A plain abdominal X-ray reveals small opacities in both kidneys. No abnormalities are found on physical examination. Biochemical investigations show: Findings Normal ‘Adjusted (corrected) Calcium | 2.85 mmol/L | 2.25-2.55 mmol/L Phosphate __|o.7ommoi_| 0.6-.25 ‘Alkaline phosphatase 295 1U/L 20-420 Creatinine TavmoliL | 35-220 PTH 32.7pmol/i_| 0.95-5.7 Which, of the following is the most likely cause? A. Primary hyperparathyroidism B. Primary typoparathyroidts C_ Pseudohyperparathyroidism D. Secondary hyperparathyroid sm E. Tertiary hyperparathyroidism Tip: Be welll versed with all Primary, Secondary , Tertiary hyperparathyroidism. You may find confusing recalls out there with not accurate values. Just know your basics and move forward. 52) Post renal transplant. Double DR matched. Become anuric in ward, bladder irrigation done free flow of urine drainage noted. Likely cause? a. Renal artery thrombosis b. Uretheral blockage c. Bladder outlet obstruction d. Renal vein thrombosis 53) _Rivoroxaban (DOAC) Mechanism of action? a. Direct factor Xa Inhibitor b. Thrombin inhibitior c. Plasmin d. Prekallikerin 54) 70 year old active man, fit, no comorbidities. Subcapital fracture. How would you manage this fracture? a. Cemented hemiarthroplasty b. Cemented total hip replacement c. Intramedullary nailing d. Orif 55) Patient with oliguria was prescribed thiazide + loop diuretic. His urine output improved. What is this Mechanism of action? a. Antagonism b. Synergism 56) 14 years old Child with left knee pain and xray knee were normal. What next step?Xray left Hip AP Xray pelvis AP and lateral MRI cr Xray frog view eoaoce Not always obese will be mentioned incase of SUFE. Know the basic differences in presentation of Perthes, DDH, SUFE = 2 questions do come. 57) _ Patient with RTA, suffered aortic disruption. Which part of aorta affected? a. Ascending aorta b. Pulmonary trunk c. Pulmonary veins d. Superior vena cava e. Descending aorta 58) Post open midline appendectomy after 6 days you notice serosanguinous discharge from the wound. What is the cause? a. Wound dehisensce b. Haematoma c. Wound infection 59) Colles fracture managed by cast, pt presented after 3 months with wrist pain and inability to extend thumb - ? a. avascular necrosis b. Malunion ¢. non union d. osteoarthritis e. further displacement 60) After colle's fracture, cast removed .Now pt can't extend thumb. This is due to injury to tendon of - / can't lift his thumb off the table and cannot fully move his interphalangeal joint a. Extensor pollicis longus tear b. Abductor pollicis cc. Opponens pollicis d. 4th lumbricals 61) Which tendon lies in the third compartment of extensor retinaculum? a. EPL b. EPB cc. Abductor pollicis brevisTip: come up with a mnemonic to remember all that passes through the extensior compartments. Will help. 62) Median nerve supplys to - a. Abductor pollicis brevis b. Flexor digitirum profundus c. 4th lumbrical 63) Apixiban when to stop before surgery a. 24hr b. 2-3days c. Tdays d. 12hr 64) 41 old age patient presented with back pain on xray there were narrowing of joint space and subchondral cyst what is the likely cause? a. Rheumatoid arthritis b. Osteoarthritis c. Radiculopathy d. Ankylosing spondylitis 65) Needle aspiration in second intercostal space , midclavicular line what structure is likely demaged ? a. 2nd intercostal nerve b. 3rd intercostal nerve c. Internal thoracic artery 66) There's some scenario of internal iliac artery getting compressed by some external structure. Then - Which is the correct anatomical relation? a. Vein is anterior to artery b. Vein is lateral to artery c. Ureter is anterior to artery d. Artery is anterior to vein e. Artery is posterior to vein 67) A 29 year old woman presents to the emergency department with thirst and polyuria. She does not smoke and has rash that resolved three months prior to her presentation. Her history is otherwise unremarkable. her lung Xray shows hilar shadowing Serum biochemistry is performed and this reveals: Finding ‘Normal ‘Adjusted (corrected) calcium 3.45 mmol/L 2.15~ 255 Phosphate T 1.20mmol/L 0.6= 125 Creatinine 150 Mmol/L 35-110 ‘Alkaline phosphatase 3510 20-120She was treated with normal saline and started on a course of hydrocortisone. A week later, her corrected calcium is within normal range, but her para thyroid hormone is 0.4 pmolL/L (normal 1.0—6.5) which of the following is most likely cause? a. Carcinoma of the lung b. Hypercalcemic hypocalciuric . Primary hyperparathyroidism . Sarcoidosis e. Secondary hyperparathyroidism ao Note: Very important to remember here 3 scenarios : Hyperparathyroidism scenarios , Sarcoidosis and Sojgrens scenario. 68) Most likely amyloid composition in heart - a. AA b. AL c. Attr d. Beta 2 69) Patient noticed a discharge from anus with fissure , plus abdominal pain what will be next best step? a. Drain abscess with seton b. USG c. CT d. Colonoscopy 70) History of thornprick. Looking like this . Organism causing this ? a. Staph aureus b. Strep pyogenes 71) Bifurcation of Carotid arteries? a. C2 b. C3 c C4 d. cS e. C6 72) A 23 year old lady presents with a posteriorly sited fissure in ano. Which of the following would be the most appropriate next management step ?Lords procedure Injection of botulinum toxin Lateral internal sphincterotomy Endoanal advancement flap e. GTNO0.4 topical 73) A53years old female developed pain, stitches in her hands especially at night. Her mother had history of autoimmune disease. What will be the expected histological finding of this condition? a. Rhomboid crystals b. Needle-shaped crystals c. Necrobiotic granuloma d. Sulfur granules e. None of the above 74) After cholecystectomy, minor blood loss, no biliary slippage, no leakage how to describe the wound? a. Clean b. Clean contaminated c. Contaminated 75) Which are the major cells in a granuloma? a. Macrophage b. Neutrophil c. Eosinophil 76) Noncaseating granuloma in Duodenal biopsy a. Crohns b. Sarcoidosis c. Celiac disease 77) One patient's blood transfusion line was connected with another patient's IV line. However, it was recognised and corrected before the transfusion started. What's this in medicolegal terms a. Harm No harm Near miss Low harm Others aooe pao78) Which blood test should you do for a 14 year old undergoing elective [Noharm (mpc prevented) - Any patent safety ineson hat hac he potent to caste ham but war prover. est no harm © peepereotng NHS fond care This ‘may be localy tamed 2 near miss "No harm (impact not prevented) - Any patent salty incient at ant competion bt ‘no haem occed o people feng NHS tnded Cre Tie has no mapping, Ensure that eco 1 Wo) porto upoad otherwise the nc ponding PDIG (Was he patent harmed) = ib reece {Tedunenand coud minmal ham i one o more persons recaving NAS faded care, Moderate ‘Any urexpectad or uitended incident at esuted na moderate crease trenmant possbie suet nieventon. cncehng of veament orate another ston and which caused spc! bt na pemanentharm, one f move porsons ‘ecehng NMS tended care ‘Any urexpecas ot uitonded eset tat appears to have rested in permanent ham {lone or mare porns Death ‘Any urexpecns ot unietended incerta drety rested inthe death of one or more tonsillectomy? a. FBC, b, . Clotting, c. URE d. e, 73) Pylo a b. . All of the above, . None of the above ric stenosis symptoms given , asked initial management - . Pyloromyotomy . Iv fluid rehydration c. Fluoroscopic reduction d. 80) Patient post trauma, can't abduct his should , parenthesis over lateral |. Others: arm and forearm , nerve involved » b. c. . Suprascapular Upper thoracic . Axillary d. Radial81) Patient has tibial and fibula fracture . Pt operated, shifted to ward . Has severe pain . Next management? a. Release 4 compartment b. Measure icp c. Puloximeter on great toe 82) Froment test for ? a. Abductor pollicis b. Adductor pollicis c. Lumbricals 83) Child post lung surgery can't push himself from crawling to standing position due to rt arm weakness injury to? a. Thoracodorsal nerve b. Long thoracic nerve c. Intercostobrachialis 84) _ Loss of sensation on the lateral part of arm? a. C5C6 b. C5C7 c. C8T1 85) Post laparoscopic appendectomy, patient feels shoulder tip pain. The referred shoulder pain is due to? a. C3C4 b. C5C6 c. C8T1 86) A 3-week-old baby exhibits projectile vomiting shortly after feeding, and failure to thrive. On examination, an olive-shaped mass is palpable in the right upper quadrant of the abdomen. Clinical diagnosis? a. Oesophageal atresia b. Malrotation c. Hypertrophic pyloric stenosis d. GERD e. Duodenal atresia 87) 1 month old child, feeds on milk and vomits after sometime. Gains weight. pH, electrolytes table was provided, all under normal range. Whats the diagnosis? a. GERD b. Hypertrophic pyloric stenosis c. Pyloric atresia d. Duodenal webs e. Intussusception 88) Which of the following is depolarising anaesthetic agent -a. Suxamethonium b. Vecuronium c. Atracurium 89) Antibiotic for bacteroides - a. Metronidazole b. Clindamycin c. Ciprofloxacin d. Penicillin 90) A biker fell of his bike and injured his leg. In AE department, he was examined and found that there was laceration over the leg exposing Tibia. What is the management? a. Conservative dressing b, STSG . Debridement and closure . Local flap e. Full Thickness graft ao Similar scenario 30 years old suffers from deep burn to his leg after rood traffic collision and vehicle. Three weeks later he has 7 X 5 cm area of ulceration exposing the tibia. Which of the following is appropriate management? A. Conservative management B. Free flap reconstruction C. Primary direct closure D. Split thickness graft E. Surgical debridement and delayed primary closure 91) Male patient with longstanding asthma. Takes 15mg prednisone daily and needs to undergo an operation. Most appropriate changes to be made to his steroid dosage? a. Increase steroid on day of op and continue for three days post op .. Increase steroid on day of op and continue for one month post op . Decrease dose on day of op |. Stop steroid preop e. Continue normal dose of steroid peri-operatively 92) True about complement - a. C3 for mast cells b. Cb for opsonization ¢. 5a6789 can lyse cell membranes aon93) Site of tracheostomy: a. Jem above sternal notch b. Midway between sternal notch and cricoid c. Between thyroid and cricoid 94) Patient has raised icp . Which is NOT a measure to decrease ICP? a. Raise head by 15-30° b. Hypothermia c. Manitol d. Hypocapnia 95) Ct shows bilateral EDH . On OT table anaesthetist notes that one pupil is dilated. Where should be the site for first burr hole? a. Ipsilateral side b. Contralateral side c. Vertex 96) Post cholecystectomy , patient comes with pain in right hypochondric region. 5x5 cm collection seen. What will be the management? a. Percutaneous drain b. Ercp+stent c. Mrep 97) 11years old girl, unwell, pyrexia, 38 kg in weight. Initial fluid management? a. 380 cc glucose 5% STAT b. 640 cc glucose 5% STAT c. 640 ce saline 0.9% STAT d. 1000 cc glucose over an hour e. 1000 cc saline over an hour 98) Patient had gastrectomy and was on fluid therapy, there was a delay for 10 days before insertion of TPN. What is the expected electrolyte abnormality? a. Hypercalcaemia b. Hyperkalemia c. Hypoglycaemia d. Hypophosphatemia e. Hypermagnesemia 99) Post colonoscopy for snare polypectomy in ther rt colon, after the endosopy the pt had abd. Pain. A ct scan done ther was small volume air leak below diaphragm. What is the most appropriate management? a. Emergency laparoscopic repair and wash b. Conservative and antibiotics c. Endoscopic clippingd. Right hemicolectomy Explanation by our colleague — According to baileys, if the perforation noticed during the endoscpoy and it is minimal then clipping is done. If a delayed perforation is noticed with abd. Pain, then the patient should be nill by mouth with antibiotics and conservative measures 100) Patient has pain on ipsilateral side of face. Frontal area not spared. Opthalmoplegia seen. Nerves passing through? a. Superior oribital fissure b. Foramen ovale c. Foramen rotundum d. Foramen magnum 101) Tourniquet using in operation Inflation of cuff above diastolic after exsanguination b. Inflation of cuff above mean pressure before exsanguination c. Inflation of cuff above mean pressure before exsanguination d e » |. Inflation of cuff above systolic before exsanguination . Inflation of cuff above systolic after exsanguination 102) A lump was noticed in a patient after physical examination and was visualised on Mammography. What will be the next best step? a. FNAC b. Core biopsy c. Trucut biopsy d. Excision biopsy 103) Patient with epigastric pain. A table was given in which Serum Amylase 900 , Normal GGT, Alp normal, Slightly elevated bilirubin. This picture is due to? a. Alcohol b. Choledocolithiasis c. Biliary colic 104) A patient with Malignant melanoma. what is the best prognostic factor ? a. Breslow thickness b. Free margins c. Completeness of excision d. Lymphovascular invasion e. None of the above 105) Some question on breast cancer prognosis = Breast cancer management of patient in the future, what will be useful? HER 2 +ve Status similar to thisA 62-Year Old Woman Presents With A Firm Irregular Mass In The Upper Outer Quadrant Of The Right Breast. This Is Shown To Be Malignant On Mammography And Fine Needle Aspiration Cytology. She Is Treated With Wide Local Excision And Axillary Clearance. Which Of The Following Histopathological Findings Would Imply A Better Prognosis ? a. Absence Of Her2 Amplification b. Bloom And Richardson Grade III c. More Than Three Positive Axillary Nodes d. Presence Of Lymphovascular Invasion e. Presence Of Estrogen Receptors 106) DJ flexure location in normal condition? a. On the left at transpyloric b, On the right at transpyloric 107) 80 years alcoholic 7 units per week,, history of few times previous confusion & patient is taking thiazides diuretics for HTN. preop Na 130 post op confused which one more risk for confusion? a. Age b. Previous confusion c. Sodium d. Alcohol e. Hypertension 108) 85 year old man presents with nocturnal enuresis, GP did PSA which is 8.7. US scan shows bilateral hydronephrosis; Sclerotic bony lesion. U&Es elevated. Cause? a. High pressure retention of urine . Bladder cancer . Bladder outlet obstruction |. Metastatic prostate cancer e. Retroperitoneal fibrosis 109) Patient has a fibrotic mass on the plantar surface of his feet that pains. On excision there was tissue and in the centre bony calcification was present. What is this.? a. Atrophy b. Dysplasia c. Metaplasia d. Hypertrophy eos Similar 35 year old patient has previous scar his big toe with underneath the scar developed swelling. Histopathology of this swelling showsdense fibrous tissue with bone elements and calcification. what is the pathological process? A. Neoplasia B. Metaplasia C. Hyperplasia D. Dysplasia E. Anaplsia 110) After oesophagectomy, blood supply of upper oesophagus a. Inferior thyroid artery Tip : Remember all the constrictions and all the arterial supply to oesophagus. 111) Laryngeal abduction muscle? a. Posterior cricoarytenoid b. Lateral cricoarytenoid c. Cricothyroid 112) After resection of d rectal tumor a patient experiences erectile dysfunction. Which of the 113) following nerves is most likely to have been damaged in surgery? a. Genitofemoral Nerve b. Lumbosacral Plexus ¢. Pelvic Splanchnic Nerves d. Perineal Branch Of S4 e. Pudendal Nerve 114) 92 old women with many risk factors presented with bilateral whole lower limbs ischemia a. Above knee amputation b. Aortofemoral c. Pallitive 115) Patient with hypothermia 35C, going to elective hernia repair, how will you deal with? a. critical incident report b. IVwarm saline c. Make Ambient temperature 19 d. Warm by bur huger and do the operation under general anesthesia e. Do the operation under local anesthesia 116) QSofa score includes?a. Resp rate < 20 b. Sbp <90 c. Altered mental status 117) Vancomycin type of antibiotic a. Blactam b. Quinolone ¢. Glycopeptide d. Carbapenem 118) Tranexamic acid mechanism of action a. Inhibits thrombin b. Inhibits factor x c. Inhibits plasmin 119) During laprotomy, jejunum is distinguished from ileum on basis of? a. narrow lumen Longer vasa recta. more lymphoid tissue less peritoneum more arterial arcade in mesentry — Jejunum and ileum a peor Jejunum Meum pou = > Forms the proximal 2/5 of (2) > Forms the dita 3/5 of (7. > Occupies the et side of abdomen + > Oceuples hypogastric region + righ ae fossa ‘umbilical region > Narrow and thin wall ‘Wide and thick walled > mesentery here e > Mesentory contains less ft (2), wlth ‘complicated arterial arcades (2) + short vasa simple arterial arcades (2) + long vasa recta (less vascula recta (more vascular) > Mucosa contains less nd smaller circu folds > The mucosa has large circular folds and ‘and vi, but more lymphatic follicles elther large numerous vil ‘oltary or agrezated (Peyer's patch). Cr 90 120) Superior gluteal nerve passes over which muscle into the thigh above which structure? a. Piriformis b. Gluteus medius121) What did two Lateral ligaments passing from umbilicus carry during fetal period Deoxygenated blood from placenta to fetus Deoxygenated blood from fetus to placenta oxygenated blood from fetus to placenta d. oxygenated blood from placenta to fetus 122) Ligament from umbilical to right upper quadrant carried which vessel in fetal life a. Ductus venous b. Umbilical artery c. Umbilical vein 123) What drains in to superior meatus a. Anterior ethmoid b. posterior ethmoid sinus c. frontal sinus d. maxillary sinus 124) Tricuspid stenosis. In which wave of jvp do we see the findings av bY cA d. X 125) Most dangerous valvular disease in intra op period a. AS b. AR c. MS d. MR 126) 9 year old patient. Testicular cancer with high Beta-HCG a. Embryonal carcinoma b. Seminoma c. Differentiated Teratoma d. Leydig cell tumor 127) Patient 15 years old with undecended testis, which is most likely a. choriocarcinoma b. seminoma c. teratoma 128) Patient presents with left varicocele vein. What is the initial investigation to order? a. CT abdomen b. Ultrasound c. MRI ore129) Indicator for CSF leak a. Beta 2 transferrin b. Beta protein trace c. Dye test 130) vitally stable pt, exp lap done, liver grade 3 non bleeding laceration. a. Conservative b. Transfer to high dependency for strict care c. Wash out and close drain monitoring d. Laprotomy and packing e. Refer to hepatobilliary centre 131) RTA scenario, patient with BP 70/30, HR 145, RR 30, which class of hypovolaemic shock? a. Class 1 b.2 «3 a4 132) Bradycardia after failed balloon valvuloplasty to the mitral valve, now will be undergoing surgical repair, what can be a complication a. Left Circumflex injury b. Bundle branch block c. Posterior descending artery 133) 55 year old man is found to have an anal cancer. His staging investigations show no metastatic disease. What is the most appropriate treatment? a. Radical abdominoperineal excision of the anus and rectum b. Radical chemoradiotherapy c. Excision proctectomy d. External beam irradiation alone e. Chemotherapy alone 134) Female RA, BA on 10 mg bid steroid and sulbutamole, Rt iliac fossa pain vomiting, fever, k high, wbcs 15 Na low, BP 80/50, pulse 80 what to do? a. 250 ml colloid and reassess b. 100 ml prednisolone c. 1.2 gmiv co-amoxiclav d. 1V 100 mg Hydrocortisone e. Ca resonium per rectal 135) What is the best investigation for solitary parathyroid adenoma? a. Sestamibi scan b. CT c. MRId. USG 136) Hit in the knee by a hockey stick. On examination, his knee is tense and swollen. X-ray shows no [Link] next definitive investigation? a. CT b. MRI c. Bone scan d. Aspiration e. Arthroscopic 137) Posterior gastric perforation. Initial site of collection a. Hepatorenal pouch b. Greater sac. c. Omental bursa 138) Patient presenting with swollen knee, what to do for DEFINITIVE diagnosis. No history of trauma. Non pyrexic. WBC normal. a. Aspirate joint b. Arthroscopy c. Aspiration and culture 139) Types of stones seen in patients with hereditary spherocytosis? a. Pigment b. Calciuim oxalate 140) Polytrauma patient, Saturation decreasing, on the basis of the given Xray what is the diagnosis? a. Massive pulmonary embolism b. Myocardial infarction cc. ARDS d. Pulmonary oedema141) A 23 year old man sustains a severe facial fracture and reconstruction is planned. Best imaging study? a. Mandibular tomography Magnetic resonance scan of face Skull X-ray Computerised tomography of the head e. Orthopantomogram 142) Some young guy comes into A&E after self-inflicted injury to neck with a knife. Patient is breathing and talking fine, BP 80/40, but severe bleeding from [Link] initial course of action? a. Pressure on wound b. Explore wound to find bleeding point to ligate c. Transfuse blood 143) During a game of football, Andrew experienced a twisted injury. The next day emergency house officer found a positive patellar tap. He cannot extend his knee. What is your diagnosis? a. Anterior cruciate ligament injury b. Knee Dislocation c. Dislocated patella d. Bucket handle meniscal tear e. lateral collateral ligament injury 144) A footballer sustains a knee injury in a match and is being assessed in the outpatient department. On examination, he has a positive valgus stress test and minimal joint effusion. What is the most likely underlying injury? Injury to the lateral collateral ligament b. Injury to the medial collateral ligament c. Injury to the anterior cruciate ligament Injury to the posterior cruciate ligament. . Injury to the patellar tendon 145) A 25 years old man sustains a twisting injury while playing football. He develops immediate swelling of the knee and he cannot continue the game. Six months later, he Is still not able to play football. His knee feels unsteady and tends to give way. On examination, he has a full range of knee motion. There is a positive anterior draw test and a small effusion. What is the most likely structure damaged? a. Anterior cruciate ligament b. Lateral collateral ligament Medial collateral ligament Oblique popliteal ligament Posterior cruciate ligament goo » oo e290146) Girl goes skiing, crashed into soft [Link] swelling knee with positive patellar tap. Difficulty extending knee. Knee aspiration showed hemarthrosis. What happened? ? a. Patellar rupture b. meniscal damage cc. Acl rupture 147) Patient has RTA. Secondary survey clear. Patient has trismus. Suspected mandibular fracture. Ix? a. OPG b. Occulomental in 0 degree c. Occulomental in 30 degree d. CT Head 148) Superior gluteal nerve relation to piriformis? Runs a. superior to piriformis b. Posterior c. inferior d. anterior 149) .A35-year-old man presents with hematemesis (did not mention how many m1), sudden pain and a prolonged bout of vomiting Which of the follow the mostly likely diagnosis. Right now conscious. a. Candida esophagitis b. Carcinoma of the esophagus ¢. Mallory-Weiss tear d. Esophageal varices e. Peptic esophagitis 150) A 70-year-old ex-sailor presents with an crusty exophytic ulcer over his left cheek since 6 months . On examination, the ulcer has got an everted edge with basloid features . A few enlarged lymph nodes are palpable in his neck Sce Bec Keratocnathoma Malignant melanoma e. Merkel cell tumour 151) A60-year»old man presents to the-Emergency Department with epistaxis. The source Of the bleeding is identified as Little's area and resolves with direct cautery. Which vessel is most likely responsible for the bleeding? a. Anterior ethmoidal artery b. Infraorbital artery gorec. Middle meningeal artery d. Sphenopalatine artery e. Supratrochlear artery 152) A 54-year-old female is admitted one week following a cholecystectomy with profuse diarrhoea. Apart from a minor intra-operative bile spillage incurred during removal of the gallbladder, the procedure was uncomplicated. What is the most likely diagnosis? a. Giardia lamblia b. [Link] infection ¢. Clostridium diffici d. Salmonella infection e. Pelvic abscess Note: There was a Q. in which Patient presented with diarrhea, had a history of using antibiotics - Colonoscopy shows White Coat = [Link] 153) A 25 years-old man has multiple episodes of diarrhea with joint pain, CRYPT ABSCESSES on colonoscopy. What is the diagnosis? a. Rectal ulcer b. Crohns disease c. Ulcerative colitis d. AVM e. RA 154) Patient admitted with a penicillin sensitive bacterial infection (scenario of endocarditis). Has a history of rash when previously took penicillin. What would be the appropriate medication? a. Amoxycillin b. Linezolid c. Cefiroxime d. Gentamicin e. Metronidazole 155) Following a Heart transplant surgery 20 days ago, a 52-year-old patient presented with pneumonia not responding to treatment. What is the most likely causative organism? a. Pseudomonas b. Cytomegalovirus cc. Streptococcus pneumonia d. Staphylococcus aureus e. Clostridium Perfringens 156) During a liver resection a surgeon performs a pringles manoeuvre to control bleeding. Which of the following structures will lie posterior to the epiploic foramen at this level? infectionHepatic artery Cystic duct Greater omentum Superior mesenteric artery e. Inferior vena cava 157) Which of the structures listed below is a content of the carotid sheath along with JV and Carotid arteries? a. External jugular vein Phrenic nerve Hypoglossal nerve Vagus nerve Recurrent laryngeal nerve aooe pao Maybe also a scenario of Phrenic nerve lying anterior to scalene muscle? 158) Which is more severe prostate ca? a. Gleason score 345 b. Gleason score 4+ 5 c. Gleason score 443 ( tertiary pattern) d. Intraepithelial neoplasia (PIN) e. Gleason score 245 159) A scenario of EDH was given + lucid interval. And then asked the artery involved in this is a branch of? : Maxillary artery Note: asking = Middle meningeal artery is a branch of = Maxillary artery 160) What is Reciprocal of absolute risk reduction? a. Number needed to treat b. Relative risk reduction. c. Odds ratio. d. Sensitivity e. Probability 161) A 45-year-old woman feels a sudden pain in her left leg and feels as if she has been hit in the back of the ankle as was playing tennis. Which of the following is the most appropriate test? a. An impingement sign b. Apley's grinding test c. Phalen's manoeuvre d. Simmonds' squeeze test e. Thomas test 162) During hip surgery ,surgeon release ilioposas muscle near its insertion near to lesser trochanter which structure is at risk?Femoral nerve Femoral artery Femoral vein Sciatic nerve e. Medial circumflex artery 163) A57-Year-Old Heart Transplant Recipient Is Keen To Join The Cardiac Rehabilitation Programme Which Of The Following Factors Is Most Likely To Increase Cardiac Output In This Patient During Moderate Exercise ? a. Decreased Negative Intrathoracic Pressure b. Decreased Venous Tone c. Decreased Ventricular Compliance d. Increased Atrial Filling 164) Patient with post gastrectomy what would cause delayed gastric emptying? a. Increase cck b. Vagotomised c. Sympathetic loss d. loss of parasympathetic 165) What is the enzyme responsible for auto digestion in acute pancreatitis? a. Lipase b. Elastase c. Trypsin d. Amylase e. None of the above 166) Patient with refractory hypertension and diagnosed of Conn's what you think the cause of hypertension? a. Increase plasma volume b. Increase renin c. Increase ACTH d. Decrease aldosterone e. Increase cortisol 167) A 23-year-old asthmatic man is admitted with a bilateral fracture of fibula and tibia following a road traffic accident. He is on 15 mg of prednisolone daily and is to undergo surgery the following day, which of the following regimes should be implemented? a. Continue normal steroids in the perioperative period b. Omit steroids on day of surgery then continue normal steroids c. Reduce steroids on day of surgery then continue normal steroids d. Increase steroids on day of surgery and for three days postoperatively aooee. Increase steroids on day of surgery and for one month following surgery 168) Which of these factors is intrinsic factor? a. factor IXa b. factor VII a c. factorVI a d. factor Ia e. factor Ta 169) A 34 years old patient was in operation with tourniquet. After release of ‘tourniquet, what is the substance released causing VD? a. Noradrenaline b. Vasopressin c. Histamine d. Serotonin 170) AV septal defect. Defect in which? a. Endocardial cushion b. Sinus venosus c. Bulbus cordis d. Truncus Arteriosus 171) Klumpkes palsy scenario = Claw hand will be seen 172) Motor and sensory loss, patient unable to abduct shoulder, C3C4 anaesthesia = Axillary nerve 173) Post parotidectomy patient received radiation treatment, followed by presentation with dryness of eyes, which ganglion involved? a. Pterygopalatine b. Otic c. Ciliary d. Submandibular Tip = Remember all three for dry eyes = Sphenopalatine / Pterygopalatine / Greater petrosal. 174) Post parotidectomy patient developed gustatory sweating during meals, what is the mechanism? a. Regeneration of the parasympathetic fibers of auriculotemporal nerve into sympathetic b. Fibers innervating the sweat gland c. Regeneration of sympathetic fibers on the parasympathetic of auriculotemporal nerve d. Regeneration of facial nerve after its injurye. Regeneration of great auricular nerve on sympathetic fibers innervating the sweat gland f. None of the above 175) Patient with spontaneous splenic rupture, denies any trauma, no bruise , no signs of injury, on body. Which infection can cause splenic rupture? a. Spontaneous splenic rupture (EBV) b. Mumps c. Measles 176) What is affected gland in this disease? |. Minor salivary gland . Submandibular gland . Sublingual gland . Parotid gland e. Sweat gland 177) A 23 year old man undergoes an orchidectomy. The right testicular vein is ligated; into which structure does it drain? a. Right renal vein b. Inferior vena cava ¢. Common iliac vein d. Internal iliac vein e. External iliac vein 178) A'53 year old man with a chronically infected right kidney is due to undergo a nephrectomy. Which of the following structures would be encountered first during a posterior approach to the hilum of the right kidney? a. Right renal artery b. Ureter . Right renal vein |. Inferior vena cava . Right testicular vein enon paoSimilar scenario like this was mentioned in which the relation of Renal vein to IVC was asked = Renal vein passes posterior to IVC 179) 74-year-old man, who has undergone emergency major abdominal surgery two days previously, is noted to be confused. He has been on furosemide for mild heart failure. The plasma sodium is 122 mmol/L. Inspection of the fluid chart shows that he has been written up for four- hourly I.V. 5% glucose infusions. What is the most likely cause for the hyponatremia? a. An ACTH (Adrenocorticotrophic hormone) response to surgery b. Excessive intravenous fluid administration c. Osmotic effect of hyperglycemia induced by glucose infusions d. Syndrome of inappropriate antidiuretic hormone e. Use of loop diuretic in the long term 180) GCS question = Patient opens eye to pain, tries to speak but makes incomprehensible sounds, makes abnormal flextion. What is the score? a8 b. 9 7 6 10 181) A 1 day old infant is born with severe respiratory compromise. On examination, he has a scaphoid abdomen, stomach is in abdomen and an absent apex beat. Which of the following anomalies is most likely? a. Situs inversus b. Septum transversum defect c. Pleuriperitoneal membrane defect d. Cystic fibrosis 182) 3% burn in forearm with crusting, dry and loss of sensation, management post debridement? a. Split thickness skin graft b. Full thickness skin graft c. Occlusive dressing 183) Aman suffered a gunshot through the intersection between the right 9th intercostal cartilage and the lateral margin of rectus abdominis, the most likely organ to be injured is: a. Liver b. Fundus of gall bladder . Body of gall bladder . Left Kidney . Pancreas ea @ao184) 45 years old woman developed a thyroid swelling. Her blood investigations showed normal thyroid profile with CD20 cells and empty pale nuclei with atypical lymphocytic cells. What is the cause? a. Papillary thyroid carcinoma b. Hashimoto thyroiditis c. Lymphoma d. Follicular thyroid carcinoma e. None of the above 185) Another scenario: Patient , young lady , with left thyroid lump, oncocytic cells, mature lymphocytes on histology a. Papillary thyroid carcinoma b. Hashimotos c. Follicular thyroid carcinoma d. Medullary thyroid carcinoma e. None of the above 186) Follow up in medullary thyroid cancer following thyroidectomy {Calcitonin not an option) a. Thyroglobulin b. CEA c. TSH d. TRH e. 14 187) A50-Year-Old Woman Presents With A History Of Faecal Incontinence Over The Past Few Years She Had A Prolonged And Difficult First Stage Of Labor 20 Years Previously. Physical Examination Reveals A Relatively Lax Anal Sphincter. Which Nerve Is Likely To Have Been Damaged In Labour ? a. Autonomic Nerves To The Rectum b. Genitofemoralnerve c. Lumbosacral Trunk d. Pudendal Nerve e. Obturator Nerve 188) A54 years old man undergone hip replacement for fractured neck femur. During follow up, the man walks with the Trendelenburg gait. What is the most likely cause? a. Sciatic nerve injury b. femoral nerve injury . Superior gluteal nerve injury . Gluteus maximus muscle paralysis . Inferior gluteal nerve injury peo189) A 67 year old man is undergoing a transurethral resection of a bladder tumour using diathermy. Suddenly during the procedure the patients leg begins to twitch. Stimulation of which of the following nerves is the most likely cause? a. b. cs d. e Femoral Pudendal Sciatic Obturator Glueteal 190) A 65 year old man with long standing atrial fibrillation develops an embolus to the lower leg. The decision is made to perform an embolectomy, utilising a trans popliteal approach. After incising the deep fascia, which of the following structures will the surgeons encounter first on exploring the central region of the popliteal fossa? . Popliteal vein . Common peroneal nerve Popliteal artery Tibial nerve . None of the above 191) Posterior compartment of leg deepest structure? b. c. d. jal artery Fibular artery Tibial nerve Saphenous nerve 192) Posteromedial approach to Baker's cyst, which part of neurovascular bundle is most superficial and susceptible to damage? a. b. « d. e Sciatic Saphenous vein Tibial Sural CPN 193) Patient with back pain, blood test shows high ESR and abnormal electrophoresis. CT scan shows lesions in sacrum. If you take biopsy from the sacrum, what would you see? a. b. c Plasma cells Reed sternburg cells Oxyphil cells Tip = Multiple myeloma scenario 194) IVDU presents with groin swelling, what is found?Mast cells Sequestrum Eosinophils Fibrous wall . None of the above 195) Tall 180cm man is in a sports physiology lab which is most likely a. Vital capacity 2L b. Peak expiratory flow in 1 second of 500m! c. Forced vital capacity 4 times in 1st second d. Resting respiratory rate 10 e. None of the above 196) In how many weeks does intestine go back into abdominal cavity of fetus? a. 8 weeks b. 12 weeks c. 24weeks 197) Patient with recently diagnosed pancreatitis who suffered from seizures. Muscle weakness, hyperreflexia. ECG shows prolonged QT?? and T-wave version, which electrolyte? a. Hypocalcaemia b. Hypercalcaemia c. Hypernatraemia d. Hypokalaemia 198) Pt already came with urine retention and cauda equina syndrome what will not present?. a. Urine retention b. Knee hyperreflexia c. Overflow incontinence d. Saddle anaesthesia 199) A 21 year old man undergoes surgical removal of an impacted 3rd molar. Post operatively, he isnoted to have anaesthesia on the anterolateral aspect of the tongue. What is the most likely explanation? a. Injury to the hypoglossal nerve b. Injury to the inferior alveolar nerve ¢. Injury to the lingual nerve d. Injury to the mandibular branch of the facial nerve . Injury to the glossopharyngeal nerve 200) Myotome for ankle dorsiflexion = LALS Ora scenario like this eoanre 2A 45-Year-Old Man Presented With Backache And Leg Pain Due To Prolapsed Lumbar Intervertebral Disc. The Pain, Which Is Aggravated By Coughing And Sneezing Radiates To The Dorsum Of The Foot On Examination There Is Weakness Of The Dorsiflexion Of The Foot. Which Nerve Root Is Most Likely To Be Involved ? T12 13 LS $1 E52 201) During Recovery From Varicose Veins Surgery 35 Years Old Woman Complains Of Weakness Of Dorsiflexion and Eversion Of The Ankle Physical Examination Reveals Absent Sensation over The Dorsum Of The Foot. Which Of The Following Nerves Is Most Likely Injured? a. Deep Peroneal Nerve b. Saphenous Nerve c. Superficial Peroneal Nerve d. Sural Nerve 202) Patient in Lloyd Davies position underwent a perianal surgery, after surgery complained of foot drop. Which nerve injured? a. CPN b. DPN c. Tibial nerve d. Sural nerve oo> 9 Similar scenario A patient undergone an operation in Lloyd Davis position. Subsequently, he developed parathesia over dorsum of the foot with loss of eversion. What is the most likely nerve injury? A. Sural nerve B, Superficial peroneal nerve C. Deep peroneal nerve D. tibial nerve E, Saphenous nerve 203) LN drainage of glans penis? a. Deep inguinal LN b. Sup inguinal LN c. Paraaortic d. External iliac e. Internal iliac204) 56 year old lady is referred to the colorectal clinic with symptoms of pruritus ani. On examination a polypoidal mass is identified inferior to the dentate line. A biopsy confirms squamous cell carcinoma. To which of the following lymph node groups will the lesion potentially metastasise? a. Internal iliac b. External iliac c. Mesorectal d. Inguinal e. None of the above 205) Boy has bleeding tendencies mother said his two sisters never had the issue and suspects its from her divorced husband a. Factor 8 b, Factor 11 c. Factor 13 206) Nerve injured in Cavernous sinus thrombosis, did not mention lateral wall component. a. Optic nerve b. Oculomotor c. Abducens d. Ophthalmic 207) An 21 year old man undergoes an uncomplicated tonsillectomy for recurrent attacks of tonsilitis. Post operatively he complains of otalgia. The nerve affected originates from which arch? al apo RWN e. 208) Afferent of Gag reflex? a. Trigeminal b. Hypoglossal ¢. Glossopharyngeal d. Facial e. Vagus 209) A 23 year old lady with sialolithiasis of the submandibular gland is undergoing excision of the gland. Which of the following nerves is at risk as the duct is mobilised? a. Lingual nerve b. Facial nerve c. Hypoglossal nerved. Facial artery 210) Muscles of mastication belong to which pharyngeal arch? a1 b. 2 3 d. 4 2 6 211) Which nerve belongs to the 2" pharyngeal arch? a. Facial nerve b. Trigeminal ¢. Glossopharyngeal d. Vagus 212) Why to remove thyroglossal cyst? a. Recurrent inflammation b. Malignancy c. Aberrant tissues 213) Thoracic duct damage. Where to ligate the thoracic duct? a. Aortic hiatus on left b. Oesophageal opening c. Vena caval hiatus d. At its crossing infront of carotid sheath e. At pleural relfection Superior mediastinum 214) Numbness of cheek and upper frontal teeth after trauma to face, anesthesia on that side of the nose a. Supratrochlear nerve b. Infraorbital nerve c. Infratrochlear nerve 215) Stellate ganglion forms from? a. C7T1 b, T172 c. C6C7 d. 7273 216) A 45 year old man undergoes an upper gastrointestinal endoscopy for a benign oesophageal stricture. This is dilated and he suffers an iatrogenic perforation at the site. His imaging shows a small contained leak and a small amount of surgical emphysema. What is the most appropriate nutritional option? a. Nil by mouth and intravenous fluids alone b. Intravenous fluids and sips orally c. Total parenteral nutritiond. Nasogastric feeding e. PEG tube feeding 217) CABG performed, patient has sternal dehiscence, there was wound debridement and muscle repair. Now sternum blood supply depends on? a. Thoracoacromial artery b. Internal thoracic artery c. Intercostal arteries 218) A42 year old woman is admitted to surgery with acute cholecystitis. She is known to have hypertension, rheumatoid arthritis and polymyalgia [Link] are called by the CT1 to assess this lady as she has become delirious and hypotensive 2 hours after surgery. Her blood results reveal: i, Na+ 132 mmol/I ii, K+ 5.3mmol/I ili, Urea 7 mmol/| iv. Creatinine 108 umol/! v. Hb 12.4 ¢/dl vi. Platelets 178 * 109/1 vil. WBC 15.4 * 109/I What is the diagnosis? a) Addisons disease b) Conns c) Phaeochromocytoma d) Graves e) None of the above 219) Medial border of anatomical snuff box? a. Abductor pollicis brevis b. Extensor pollicis longus c. Extensor pollicis brevis d. Flexor digitorum longus e. Flexor digitorum brevis 220) Patient with urinary bladder cancer and made an operation for resection of urinary bladder and then new bladder is formed from small intestine mainly ileum, creatinine is high. What is the electrolyte disturbance a. Hyperkalemia b. Hypokalemia c. Hyperchloremia d. Hypochloremia e. Hypocalcemia 221) In hypotension, first baroreceptor response would be at?Carotid sinus Aortic arch Superior vena cava External carotid artery e. Carotid body 222) Patient with haemothorax after road traffic accident = Place chest drain in the safe triangle 223) Urethral injury in trauma + Pelvic injury , did not mention high riding prostate. Bruising of anterior abdominal wall. a. Membranous urethra rupture b. Bulbar urethra rupture c. Prostatic urethra rupture 224) ERCP is done in patient with benign CBD stricture , after 12 hours of procedure, fever and abdominal pain? a. Gall stone b. Cholangitis c. Bilary duct injury d. Duodenum rupture 225) A 33 year old lady presented with jaundice secondary to common bile duct stones. A cholecystectomy and common bile duct exploration is performed and the bile duct closed over a T tube. Six weeks post operatively a T tube cholangiogram is performed and shows no residual stones. The T tube is removed and five hours after removal a small amount of bile is noted to be draining from the T tube site. What is the best course of action? a. Await spontaneous resolution b. Arrange an MRCP c. Arrange an ERCP d. Return to theatre for CBD exploration e. Re-insert the T tube 226) 45 years old woman presents with cough and weight loss over three months. she also complains of recent onset of polyuria. On examination her pulse rate was 90 and her blood pressure is 100/85 mmHg. Her BMI is 211 and she has reduced breath sounds in the right upper zone. Her chest X- ray shows an irregular mass lesion in the right upper lobe. Her calcium serum corrected 3.52mmol/L (normal <2.70) which of the following assays would be the most informative? a. 1.2 dihydroxycholecalcifrol b. 2 hydroxycholecalcalifrol c. Glucose aoe