SURGERY COMMON MCQ PAPER - 2024

Faculty of Medicine, Ragama

19th Jan 2024

TRUE/ FALSE QUESTIONS (1-30)

01. Regarding Barre>’s oesophagus,

A. Achalasia cardia is a predisposing factor
B. Barium swallow shows bird’s beak appearance
C. Histology shows intesQnal metaplasia
D. It is a malignant condiQon of lower oesophagus
E. Radio frequency ablaQon is a treatment opQon

02. Treatment modaliQes of achalasia cardia,

A. Botulinum toxin injecQon
B. Heller's myotomy
C. Nissen fundoplicaQon
D. Oesophageal dilataQon
E. Peroral endoscopic myotomy

03. Regarding diverQcular disease of the colon,

A. Majority are asymptomaQc
B. Predisposes to colonic cancer
C. Causes colo-vesical fistula
D. Associated with massive PR bleeding
E. Complicated with colonic strictures
04.⁠ ⁠Regarding large bowel obstrucQon,
A. Erect abdominal X-ray is used to detect the site of obstrucQon
B. Barium enema is contraindicated
C. Tenderness in the right iliac fossa is suggesQve of impending perforaQon
D. Colonic stenQng can be used to relieve obstrucQon
E. Hartmann’s procedure can be used in treatment

05. Treatment of the following condiQons is facilitated by a defuncQoning stoma,

A. 3rd degree vaginal tear
B. High fistula-in-ano
C. Prolapsed thrombosed haemorrhoids
D. Grade 4 sacral pressure sore
E. Perineal necroQsing fasciiQs

06.⁠ ⁠Painful perianal condiQons include,

A.⁠ ⁠2nd degree haemorrhoids
B.⁠ ⁠Acute fissure-in ano
C.⁠ ⁠Perianal abscess
D.⁠ ⁠Anal warts
E.⁠ ⁠Perianal haematoma

07.⁠ ⁠Causes for high swinging fever, right upper quadrant pain and tenderness include,
A. Biliary colic
B. Acute cholangiQs
C. Liver abscess
D. Mucocele of the gall bladder
E. Right renal abscess

08.⁠ ⁠Reasons for weight loss in a paQent with chronic pancreaQQs include,
A. Fear of food ingesQon
B. Exocrine failure
C. PancreaQc ductal stones
D. PancreaQc carcinoma
E. Poorly controlled diabetes
09.⁠ ⁠A 25-year-old lactaQng mother presents with fever and pain in the led breast for 2 days duraQon.
The breast is warm, red and tender at 2 o’clock posiQon. Regarding this paQent,
A. Ultrasound scan of the breast is indicated
B. Breaseeeding should be stopped
C. Incision and drainage is the treatment modality of choice
D. Anaerobes are the most likely causaQve organisms
E. Flucloxacillin is indicated

10.⁠ ⁠Regarding fibroadenoma,

A.⁠ ⁠Can transform into a malignancy
B.⁠ ⁠Increases in size ader menopause
C.⁠ ⁠USS adds contribuQon for the diagnosis
D.⁠ ⁠Common in adolescent girls
E.⁠ ⁠ObservaQon is a management opQon

11.⁠ ⁠Regarding thyroid carcinoma,

A. Thyroglobulin is used to follow-up ader surgery
B. DifferenQated thyroid carcinomas have a good prognosis
C. Papillary thyroid carcinoma spread predominantly via lymphaQcs.
D. Psammoma bodies are found in medullary thyroid carcinoma
E. Medullary thyroid carcinoma responds well to radioiodine therapy.

12.⁠ ⁠Regarding Graves’ disease,

A. Presents as a mulQnodular goitre
B. Chemosis is an eye sign
C. AnQ-microsomal anQbodies are posiQve
D. Relapses in toxicity following pharmacotherapy is more with Graves’ than with a mulQnodular
goitre
E. Total thyroidectomy is a treatment modality.

13. 25-year-old male presented to A & E following head trauma. Airway, breathing and circulaQon
was normal. Eye opening to pain, localize to the pain and speech is confused. His breath smells
alcohol and has a bleeding scalp laceraQon. Which of the following is true regarding the management
of this paQent?
A. CT scan of the head is indicated
B. Pupillary response is assessed in primary survey
C. DeterioraQon of GCS is an indicator of exacerbaQon of primary brain injury
D. Immediate intubaQon is indicated
E. Suturing is the best method to manage the scalp haemorrhage

14.⁠ ⁠Regarding spine and spinal cord injuries,

A. Spinal injuries are assessed in the secondary survey.
B. Neurogenic shock occur in cord injury below T6
C. HypovenQlaQon occurs in spinal cord lesions below C6.
D. Absent bulbocavernosus reflex is a feature of spinal shock.
E. The features of abdomino pelvic injuries are masked by upper thoracic cord injuries.

15. Regarding injuries to extremiQes,

A. Severed finger needs to be transported in a 0.9% saline soluQon
B. IV broad-spectrum anQbioQcs should be started as soon as possible in an open fracture
C. Supracondylar fracture with an absent radial pulse requires emergency closed reducQon
D. Gas gangrene is a complicaQon of primarily sutured farm injury
E. Palpable pedal pulse excludes compartment syndrome in a Qbial shad fracture

16. ComplicaQons of unilateral undescended tesQs,

A. ErecQle dysfuncQon
B. InferQlity
C. Inguinal hernia
D. Malignancy
E. TesQcular torsion

17. Regarding paroQd gland,

A. Malignant neoplasms are commoner than benign ones
B. Mumps cause bilateral paroQQs
C. Calculi disease is commoner than in submandibular gland
D. Duct opens into floor of mouth
E. Pleomorphic adenomas have a risk of malignant transformaQon

18.⁠ ⁠Regarding parathyroid adenoma,

A. Serum phosphate is low in primary hyperparathyroidism
B. Serum calcium is high in secondary hyperparathyroidism
C. Adenoma is commoner than carcinoma
D. Osteoporosis is common in primary hyperparathyroidism
E. Hungry bone syndrome is a complicaQon following removal of parathyroid adenoma
19. Regarding skin cancers,
A. AcQnic keratosis is premalignant
B. Basal cell cancer has a poor prognosis
C. Human papilloma virus (HPV) is an aeQological factor
D. SenQnel node biopsy is indicated in malignant melanoma
E. UV radiaQon is a risk factor

20.⁠ ⁠Regarding hernia management,

A. Herniotomy done in indirect inguinal hernia
B. Genitofemoral nerve damage is a complicaQon
C. Right sided sliding hernia contains caecum
D. Laparoscopic repair is contraindicated in recurrence
E. Mesh repair is done in infants

21. ComplicaQons of chronic suppuraQve oQQs media,

A. Facial nerve palsy
B. Ramsay Hunt syndrome
C. Intracranial abscess
D. Hearing loss
E. Maxillary sinusiQs

22. Regarding thyrotoxic eye disease,

A. Diplopia
B. Pterygium
C. Lid lag
D. Chemosis
E. -

23. Following disease condiQons compared with image modality of choice,

A. Gallstones - X-ray
B. Hydronephrosis - Ultrasound scan
C. Renal scarring - DTPA
D. PUV - MicturaQng cystourethrogram
E. Renal calculi - Non-contrast CT

24.⁠ ⁠Spinal anaesthesia is used for,

A. Abdominal perineal resecQon
B. LigaQon of processus vaginalis
C. Haemorrhoidectomy
D. Varicose vein surgery
E. Inguinal hernia repair

25.⁠ ⁠AnQbioQc prophylaxis is given in,

A. Right hemicolectomy
B. Inguinal hernia mesh repair
C. Total hip replacement
D. Cardiac surgery
E. Excision of breast lump

26. Which of the following are correctly matched with regards to the suture removal Qme of a healthy
adult?
A. Carpal tunnel surgery - 5 days
B. Facial laceraQon - 3 days
C. Fibroadenoma removal of breast - 7 days
D. Midline laparotomy incision - 10 days
E. Scalp lump excision - 5 days

27. In obstrucQve jaundice coagulopathy is due to,

A. Abnormality in the common pathway
B. Abnormality in the extrinsic pathway
C. Abnormality in the intrinsic pathway
D. Thrombasthenia
E. Thrombocytopenia

28. An 8-year-old boy presented with joint swelling, erythema and fever. Regarding sepQc arthriQs,
A.⁠ ⁠High ESR confirms the diagnosis
B.⁠ ⁠Knee joint is the commonest affected joint
C.⁠ ⁠Staphylococcus aureus is responsible
D.⁠ ⁠Irreversible joint destrucQon occurs
E.⁠ ⁠Joint wash out should be done
29. Regarding abdominal aorQc aneurysm,
A. Severe backache due to retroperitoneal bleeding
B. Anteroposterior diameter of 6 cm is an indicaQon for intervenQon
C. Ischemic coliQs is a known complicaQon
D. Mostly seen in aorQc segments below the renal artery
E. Commonest aeQology is atheroscleroQc disease

30. 50-year-old male smoker presents with intermi>ent claudicaQon and a claudicaQon distance of
150 m. Regarding management of this paQent,
A. DSA is indicated to idenQfy the occlusion
B. Hb needs to be opQmized
C. StaQn is indicated
D. Aspirin is effecQve in increasing the claudicaQon distance
E. Graded exercise should be encouraged

SINGLE BEST ANSWER QUESTIONS (31-70)

31.⁠ ⁠35 years old man is presented to the A & E with one episode of haematemesis preceded by
several bouts of vomiQng. What is the mostly likely diagnosis?
A. GORD
B.⁠ ⁠Mallory Weiss syndrome
C.⁠ ⁠Oesophageal carcinoma
D. ⁠Oesophageal varices
E.⁠ ⁠OesophagiQs

32. 60-year-old women is on treatment for rheumatoid arthriQs presents with sudden severe
abdominal pain. She looks ill, is tachycardic and has generalized abdominal tenderness and guarding.
Which is the most possible clinical diagnosis?
A. Acute cholecysQQs
B. Acute diverQculiQs
C. Acute pancreaQQs
D. Perforated pepQc ulcer
E. Ruptured aorQc aneurysm
33. 60-year-old man presents with non-bilious vomiQng. He is dehydrated. There's visible peristalsis
with succussion splash. What is the metabolic derangement in him?
A. Hyperchloremic hyperkalemic acidosis
B. Hyperchloremic hyperkalemic alkalosis
C. Hypochloremic hypokalemic acidosis
D. Hypochloremic hypokalemic alkalosis
E. Hypochloremic normokalemic alkalosis

34. A 35-year-old man presented with intermi>ent loose stools with blood and mucous for 12 months
duraQon. He had loss of weight and a lower back pain. Abdominal examinaQon is unremarkable.
What’s the most likely diagnosis?
A. UlceraQve coliQs
B. Rectal cancer
C. Solitary rectal ulcer
D. DiverQculiQs
E. Benign rectal polyp

35. A 52-year-old man with DM presented with led lower limb pain with fever for 5 days. There is
localized tenderness over his L/iliac fossa. His WBC 200/mm3 and CRP 160mg/L. CT abdomen
revealed large pericolic diverQcular abscess of sigmoid colon. What is the next step in the
management?
A. ConservaQve management with IV anQbioQcs
B. Emergency laparotomy and drain
C. HydraQon with N/S
D. Laparoscopic drainage of abscess
E. USS guided inserQon of a drain

36. 53-year-old male presented with per rectal bleeding. His MRI pelvis showed a locally advanced
(T3N1) lower rectal carcinoma which is 5 cm away from anal verge was detected. What is the most
appropriate next step in management?
A. Chemotherapy
B. Radiotherapy
C. Neoadjuvant chemoradiaQon
D. Anterior resecQon
E. Abdominal perineal resecQon
37.⁠ ⁠Best invesQgaQon to access loco-regional spread of distal rectal carcinoma,
A.⁠ ⁠CECT abdomen pelvis
B.⁠ ⁠EUS
C.⁠ ⁠PET
D.⁠ ⁠MRI
E. USS abdomen pelvis

38. 30-year-old man presented with one episode of painless, fresh rectal bleeding. Drops/ spurts of
blood visible at the end of passing stools. No lump at anus. Digital rectal examinaQon is normal. What
is the next step in the management?
A. Band ligaQon
B. Flexible sigmoidoscopy
C. Haemorrhoidectomy
D. Lifestyle modificaQon
E. Sclerotherapy

39. A 2.5 cm lesion was detected in a cirrhoQc liver on a rouQne follow-up USS abdomen. What is the
next step of management?
A. Fibroscan
B. CECT
C. Core biopsy of lesion
D. FNAC of lesion
E. Radiofrequency ablaQon

40.⁠ ⁠A 40-year-old female presented with fever and right upper quadrant pain. Which of the following
would be most helpful to disQnguish acute cholangiQs from acute cholecysQQs?
A. Family history of haemolyQc anemia
B. Loss of weight
C. Passing of tea coloured urine
D. Pain radiaQng to back
E. Biliary colic
41. 56-year-old male presented with painless jaundice associated with loss of weight and loss of
appeQte. USS shows a gallbladder with gallstones and dilated intrahepaQc and extrahepaQc bile ducts
upto the ampulla. What is the most appropriate next step of management?
A. Contrast-enhanced computer tomography
B. MagneQc resonance cholangiopancreatography
C. Endoscopic resonance cholangiopancreatography
D. Percutaneous transhepaQc cholangiogram
E. Endoscopic ultrasound scan

42. 55-year-old woman comes with right upper outer quadrant 3 cm breast lump for 1 month
duraQon. Next best management?
A. Core biopsy
B. FNAC
C. Mammogram and USS
D. Mammogram and MRI
E. MRI and USS

43. 26-year-old woman presenQng with progressively worsening scaly lesion in the nipple areola
complex for 3 months which had not resolved despite treatment. What is the most likely diagnosis?
A. Fungal infecQon
B. Invasive ductal carcinoma
C. Nipple eczema
D. Paget’s disease of the breast
E. Periductal masQQs

44.⁠ ⁠A 29-year-old pregnant women (POA 20 weeks) presents with toxic adenoma of the led lobe of
the thyroid gland. She is clinically and biochemically hyperthyroid. Which of the following is the most
appropriate treatment?
A. Carbimazole
B. Lugol’s iodine
C. Methimazole
D. Radioiodine therapy
E. Propylthiouracil
45.⁠ ⁠A 34-year-old woman underwent total thyroidectomy for organ-confined papillary thyroid
carcinoma. What is the best next step in management?
A.⁠ ⁠Assess serum thyroglobulin levels
B.⁠ ⁠Cervical block dissecQon
C.⁠ ⁠High dose thyroxine to supress TSH
D.⁠ ⁠Maintain normal levels of thyroxin
E.⁠ ⁠Radioiodine therapy

46.⁠ ⁠A 40-year-old woman presented with right solitary nodule of the thyroid. Ultrasound scan showed
a 2 cm solitary nodule on the right thyroid. She has no family history of thyroid cancer. Which is the
best recommended management?
A. Core biopsy
B. Follow-up USS in 3 months
C. Right hemithyroidectomy
D. Total thyroidectomy
E. USS guided FNAC

47.⁠ ⁠A 45-year-old man was brought to the A & E ader a high velocity following a road traffic accident.
He is on a spinal board with a semi-rigid collar. He is restless and his breathing is noisy. SpO₂ 88%. BP
80/50 mmHg. PR 136 bpm. GCS 8/15. Which of the following is the most appropriate method to
secure his airway?
A. Bag and mask venQlaQon
B. Endotracheal intubaQon
C. Cricothyroidotomy
D. Laryngeal mask airway
E. Oropharyngeal airway

48.⁠ ⁠A 40-year-old farmer presented to the A & E ader sustaining an injury to his right leg while
working in the field. Ader iniQal infiltraQon with local anaesthesia, examinaQon of the wound
revealed a superficial laceraQon with contaminaQon. Which of the following is the best soluQon to
clean the wound?
A. 0.9% saline
B. 10% povidone iodine
C. 2% chlorhexidine
D. 70% alcohol
E. Hydrogen peroxide
49. 60-year-old man has a radial nerve injury secondary to a humeral shad fracture. The humerus is
internally fixed with a plate. What is the most appropriate orthosis to be used unQl recovery of the
nerve injury?
A. Below-elbow dorsal back slab
B. Below-elbow palmar back slab
C. Collar and cuff
D. Dynamic wrist splint
E. U-slab

50.⁠ ⁠45-year-old motorcycle rider brought to the A & E ader a high velocity RTA. He is on a spinal board
and shouQng in pain. There is a large pulsaQle bleed from the lower part of the right thigh. What is
the most appropriate iniQal step to prevent bleeding?
A. Clamping and haemostat
B. Direct pressure
C. ExploraQon and packing
D. Tourniquet applicaQon
E. TracQon splint

51. Front seat passenger in a motor car who faced a head-on collision RTA. He is stable ader the
primary survey. On secondary survey, shortening of led lower limb and foot drop was detected. What
is the most likely reason?
A. Femur shad fracture
B. Intracapsular neck of femur fracture
C. Posterior dislocaQon of hip
D. Supracondylar fracture of femur
E. VerQcal shear fracture of pelvis

52.⁠ ⁠A 19-year-old man presents with increasing nocturnal pain and swelling of right knee joint for one
month duraQon. He a>ributes it to a minor twisQng injury that happened 2 months ago. X-ray of the
joint shows bone destrucQon and bone formaQon in the proximal Qbia. What is the most likely
diagnosis?
⁠A. Chronic osteomyeliQs
B. Fracture of proximal Qbia
C. HaemarthrosIs of knee joint
D. Osteosarcoma
E. Chondrosarcoma
53. A 23-year-old boy presented with recent-onset led scrotal swelling. On examinaQon there was an
irregular, hard mass in the led scrotum. What is the next invesQgaQon to aid in the diagnosis?
A. Fine needle aspiraQon cytology
B. Serum alfa fetoprotein levels
C. Serum beta hCG levels
D. Core biopsy of the tesQs
E. USS of tesQs

54.⁠ ⁠A 60-year-old male presented due to recent-onset poor urinary stream, dysuria and increased
urinary frequency. His system examinaQon is normal and prostate is clinically benign on digital rectal
examinaQon. UFR showed 10-15/ hpf red cells. PSA is elevated 8 ng/mL (normal <4 ng/mL). What is
the next most appropriate management for him?
A. MRI of prostate
B. Tamsulosin for 2 weeks and repeat PSA
C. Trans rectal USS guided biopsy of prostate
D. Urine culture followed by anQbioQc and repeat PSA
E. Watchful waiQng and PSA repeated in 3 months

55 A healthy man with 1 cm stone in renal pelvis with episodic pain and haematuria. Renal funcQons
are normal. No signs of infecQon. Density of stone 900 HU on CT. Most appropriate treatment?
A. Extracorporeal shockwave lithotripsy
B. Medical dissoluQon therapy
C. Medical expulsion therapy
D. Percutaneous nephrolithotomy
E. Pyelolithotomy

56.⁠ ⁠60-year-old man presenQng with drooping of mouth ader submandibular sialoadenectomy. What
is the most likely nerve injury?
A.⁠ ⁠Glossopharyngeal nerve
B.⁠ ⁠Hypoglossal nerve
C.⁠ ⁠Lingual nerve
D.⁠ ⁠Mandibular branch of trigeminal nerve
E.⁠ ⁠Marginal mandibular branch of facial nerve
57.⁠ ⁠23-year-old women presented with painless progressive enlargement of neck lump over 2 months
duraQon. It's firm to hard . 5 x 4 cm and areas of fluctuaQons present. Overlying skin is erythematous
but not warm. What is the most likely condiQon?
A. Branchial cyst
B. Glandular fever
C. Lymphoma
D. MetastaQc deposit of carcinoma
E. Tuberculous adeniQs

58. A 53-year-old man presents with a hyperpigmented lesion in the lower groin, which has irregular
margins and a diameter of 1 cm. Which is the most appropriate management?
A. Excision and flap cover
B. Immunotherapy
C. Neoadjuvant chemotherapy + wide local excision
D. Systemic chemotherapy
E. Wide local excision

59. A 60-year-old man presents with pain, erythema and swelling around the surgical site ader
inguinal hernia mesh repair. There is neither fluctuaQon nor discharge. He is known paQent with
diabetes mellitus and is on oral hypoglycaemic drugs. What is the most appropriate management
opQon?
A. AnQbioQcs
B. Change to insulin
C. Remove suture
D. Remove mesh
E. USS of groin

60. 40-year-old female diagnosed with paraumbilical hernia (defect 2 cm) presents with intermi>ent
pain without any other symptoms. Which of the following is the most likely content in the hernial
sac?
A. Peritoneal fat
B. Omentum
C. Jejunum
D. Peritoneal fluid
E. Transverse colon
61.⁠ ⁠A 40-year-old male who undergone anterior resecQon develop sudden-onset SOB on post-op day
five. He was conscious with RR 32/min, BP 100/70 mmHg, PR 120 bpm. His SpO₂ was 88% despite on
100% O₂. What is the most appropriate next step in the management?
A. CT chest and abdomen
B. Blood culture and give anQbioQcs.
C. Fluid resuscitaQon.
D. Laparotomy repair
E. VenQlatory support

62. A 40-year-old man was admi>ed to ICU ader a major trauma. He was restless, tachypnoeic and
his spO2 was 88%. Which of the following best indicates ARDS?
A. Led side opaciQes in chest X-ray
B. P/F raQo <100
C. PaO2 60 mmHg on room air
D. Respiratory rate 32/min
E. SpO2 88%

63. 65-year-old male admi>ed to ICU with sepsis ader a laparotomy following gangrenous bowel. No
improvement of MAP or CVP ader 3 boluses of 20 ml/kg crystalloids. What is the next best
intravenous fluid?
A. 0.9% NaCl
B. 3% NaCl
C. Albumin
D. Hartmann’s
E. Tetrastarch
64. Newly-developed COVID rapid anQgen test for COVID-19 disease was assessed by comparing its
performance against viral culture (gold-standard) using specimens from 300 paQents. The results are
given in the table.
Viral culture (+)ve Viral culture (-)ve
COVID rapid an7gen
test (+)ve 79 11 90
COVID rapid an7gen
test (-)ve 21 189 210
100 200 300
[79/100=79%, 79/90=87.8%, 189/200=94.5%, 189/210=90%.]
Which is the sensiQvity and specificity of the COVID rapid anQgen test?
A. 79% and 90%
B. 79% and 94.5%
C. 87.8% and 90%
D. 87.8% and 94.5%
E. 94.5% and 87.8%

65.⁠ ⁠Following surgeries are scheduled to be performed tomorrow.

A - 35-year-old male - Wound debridement
B - 4-year-old boy - Inguinal hernia repair
C - 40-year-old female - Total thyroidectomy
Select the most appropriate order in which the surgeries should be performed.
A.⁠ ⁠ABC
B.⁠ ⁠BAC
C.⁠ ⁠ACB
D.⁠ ⁠BCA
E.⁠ ⁠CAB

66. A 3-year-old child presented with epigastric pain, PR bleeding for 3 months and there was no
colic, diarrhoea or consQpaQon. Hb - 10 g/dL. Platelets - 25000 x 109 /L. What is the most likely
diagnosis?
A. HaemolyQc uremic syndrome
B. intussuscepQon
C. Merkel diverQculum
D. UlceraQve coliQs
E. Rectal carcinoma
67. 20-year-old women diagnosed paQent with rheumatoid heart disease presented to the A & E with
acute lower limb pain in right side of the leg. On examinaQon, the limb is cold and the popliteal and
dorsalis pedis pulses are absent. She can move her big toe. Led lower limb is normal in examinaQon.
What is the best treatment opQon?
A. DSA followed by thrombolysis
B. IV Heparin
C. Saphenofemoral bypass
D. Four-compartment fasciotomy
E. Transfemoral embolectomy

68. 50-year-old diabeQc male present with non-healing ulcer in the plantar surface of his foot. He is
afebrile. Both pedal pulses are absent and there is numbness of foot. What is the best step of
management?
A.⁠ ⁠AnQbioQcs and revascularizaQon
B.⁠ ⁠AnQbioQcs and wound off-loading
C.⁠ ⁠Wound excision and anQbioQcs
D.⁠ ⁠Wound excision and revascularizaQon
E.⁠ ⁠Wound off-loading and revascularizaQon

69. PaQent with DM, HTN and history of smoking, presented with two episodes of intermi>ent
headache and light-headedness that lasted for less than 6 hours. CaroQd artery duplex shows 75%
narrowing. Most appropriate management,
A. Aspirin
B. CaroQd bypass
C. CaroQd endarterectomy
D. ConservaQve management with lifestyle modificaQon
E. AnQcoagulant therapy

70.⁠ ⁠40-year-old female presents 6 months ader renal transplant with rising serum creaQnine level.
What would be the cause?
A. Drug toxicity
B. Grad rejecQon
C. Malignancy
D. Technical problem with ureteric replacement
E. Technical problem of vascular anastomosis