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Important Questions Systemic Surgery
For Professional Exams
According to Table of Specifications
Compiled by Muhammad Mohsin Ali Dynamo (Batch
‘18)
Table of Specifications for Systemic Surgery (Surgery B)
Seria Topic SEQ MCQs
l No s
1 Breast and Endocrine 2 6
2 GIT 2 6
3 Hernia 1 3
4 Hepatobiliary 1 4
5 Vascular 1 4
6 Genitourinary 1 2
7 Miscellaneous (Cardiothoracic, Spleen, Surgical Anatomy, Gynecology) 2 5
Section 1: Breast and Endocrine
1. Enlist the causes of hypercalcemia. How will you investigate a case of hypercalcemia?
2. A 35 year old female presents with 2 cm in upper outer quadrant of left breast. Trucut biopsy
revealed intraductal carcinoma of breast. On examination of axilla no lump is palpable.
a. How will you evaluate axilla of this patient definitely?
b. How and what surgical procedure will you carry out.
c. What will be the benefit of this procedure.
3. A 15 year old boy presented with diarrhea and a swelling in the nexk which moved on
swallowing. On examination there is a 2 x 2 cm nodule in right lobe of thyroid and neck is
unremarkable. FNAC revealed cells with characteristic Orphan Annie nuclei.
a. Write down the most likely diagnosis.
b. Write down treatment options.
4. A 52 years old female presented with painless lump in left breast for past 6 months, with
gradual change in size. On examination lump is located in upper outer quadrant, non tender,
approximately 2 x 5 cm with skin ulceration. Her ipsilateral axillary lymph nodes are palpable
and mobile.
a. How will you diagnose this case?
b. What is clinical stage of disease?
c. How will you treat this case?
5. Enumerate complications of thyroidectomy.
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6. What is incidentaloma? Enlist its causes. Mention investigations to determine exact cause.
7. A 40 year old perimenopausal patient presents in OPD. On examination she has a 3 cm mobile
mass in upper outer quadrant of left breast with tethering of overlying skin. There are palpable
mobile lymph nodes in left axilla.
a. Give diagnosis with stage of disease.
b. How will you investigate the patient?
c. How will you manage?
8. Write short notes on:
a. Carcinoid syndrome
b. Surgical hypertension
Section 2: GIT
1. Write a detailed account of gastric cancer, emphasizing its epidemiology, etiology, pathological
types, early and advanced disease classification, clinical features, diagnosis, and treatment
options available for curable disease.
2. A 60 year old man has pain over RIF along with non tender mass for 4 months. He has also lost
15 kg body weight. There have been few episodes of melena. Clinical examination reveals a pale
looking, weak patient with irregular mobile lump in RIF.
a. Write down most likely diagnosis and list differential diagnosis for this patient.
b. How will you investigate this case?
3. What are the complications of peptic ulcers? How will you treat a case of perforated duodenal
ulcer?
4. An elderly man with long standing history of constipation has presented in A&E department
with history of discomfort in left iliac fossa and profuse fresh rectal bleed. In ER he is clinically in
shock and abdominal examination reveals mild tenderness and fulness in LIF.
a. Write down two probable diagnosis.
b. How can this case be investigated?
c. List steps of treatment in ER.
5. A 24 year old male presented with perianal discharge for last 6 months. On examination a
diagnosis of perianal fistula was made.
a. Classify perianal fistula.
b. Write down causes of anal fistula.
c. Enlist treatment options for complex anal fistula.
6.
a. Write down malignant tumors of stomach. What are the various predisposing factors?
b. How will you investigate and palliate locally advanced gastric cancer.
7. What are the clinical manifestations of achalasia cardia? How will you investigate and treat this
condition?
8. What is Meckel’s diverticulum? What are its various presentations and complications? How will
you treat?
9. What are the causes of diffuse peritonitis? How will you treat a case of peritonitis due to
perforated appendix?
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10. What are the clinical features of lower rectal carcinoma? Describe investigations and
management of a 57 year old female who presents with lower rectal CA 7 cm from anal verge.
11. Write a short note on post-gastrectomy syndromes.
12. Write down TNM classification of colorectal cancer.
Section 3: Hernia
1. A 35 year old male presented in emergency with irreducible right inguinoscrotal swelling for last
12 hours. He is having colicky pain in abdomen and vomiting.
a. What is the most likely diagnosis and how will you confirm it?
b. How will you initially manage this patient?
c. Enlist the steps of definitive treatment plan.
2. A 40 year old male patient is planned for left Lichtenstein repair for left indirect inguinal hernia.
a. Enlist structures encountered from skin incision to bed of mesh placement.
b. Name structure to which the mesh will be anchored.
3. A 45 year old male presented in ER with painful swelling in Right inguinoscrotal region. It is
associated with pain in abdomen, vomiting, abdominal distension, and absolute constipation for
three days. On examination the swelling is tense, tender and irreducible.
a. What is your diagnosis?
b. How will you manage this case?
4. A young school boy has presented with sudden, severe pain and swelling of right hemi-scrotum.
He is vomiting and tachypneic. Scrotum is discolored and tender.
a. Write down most probable differential diagnosis.
b. What investigations will you advise to confirm your diagnosis?
c. Write down treatment in ER for this patient.
Section 4: Hepatobiliary
1. A 48 year old laborer male presents with right sided upper abdominal pain and fever two weeks
after an attack of diarrhea. He gives history of frequent intake of meals from hotels.
Examination: Pulse 110 bpm, BP 120/80 mmHg, Temp 38 degrees, RR 16/min. abdominal
examination reveals tender hepatomegaly. Chest examination reveals right lower intercostal
tenderness, vocal fremitus and breath sounds are decreased in right lower chest posteriorly.
a. What is the most likely diagnosis? Justify.
b. Enlist at least 2 differential diagnosis.
c. How relevant laboratory, serology and imaging investigations will help in reaching a
diagnosis? OR Write three investigations that will help you confirm the diagnosis.
d. Briefly outline management plan for this patient.
2. A 35 year old female is presented in emergency with severe epigastric localized pain, vomiting,
and abdominal distension. On examination, she is dehydrated with pulse 112 bpm, BP 90/70
mmHg, RR 36/min, with severe epigastric tenderness. 8 months ago she was diagnosed to be
suffering from multiple tiny gallstones.
a. What is your most likely clinical diagnosis?
b. What investigations will you advise in this patient?
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c. Enlist the severity assessment scores used to assess severity and treatment plan for this
patient.
3. How will you investigate a case of acute pancreatitis?
4. Describe various treatment options for hepatocellular carcinoma.
5. Write a short note on palliative management of pancreatic carcinoma.
6. A young man is brought in surgical emergency following blunt abdominal trauma in an RTA. He
complains of severe pain in LHC radiating to shoulder. He is pale looking with tenderness in left
half of abdomen. Pulse is 88/min and BP 100/70 mmHg.
a. How will you evaluate this patient?
b. What are the possible injuries in this case?
c. What are the indications for exploration of abdomen?
Section 5: Vascular
1. A 45 year old female patient presented in the ER with sudden onset of pain and swelling of her
left leg. She has undergone major pelvic surgery last week. On examination her left leg is swollen
and tender to touch and on dorsiflexion of foot.
a. What is the most likely diagnosis?
b. How will you investigate this patient to confirm the diagnosis?
c. Outline treatment plan of the patient.
2. A female patient 60 years of age suffered an acute attack of MI along with atrial fibrillation. Four
hours later, she complains of severe pain in right calf along with numbness.
a. Write down the most likely clinical diagnosis with justification.
b. What other clinical examination will you perform to confirm the diagnosis?
c. Briefly outline treatment plan.
3. What are the causes of acute limb ischemia? How will you clinically confirm it?
4. Write down steps to treat a 50 year old patient who has developed sudden acute limb ischemia
of right leg after AMI.
Section 6: Genitourinary
1. A 70 year old man presented in OPD with symptoms of bladder outflow obstruction. On DRE his
prostate is enlarged, smooth and rubbery.
a. How will you investigate patients?
b. What can be the long term consequences of this condition?
c. Enumerate various medical and surgical treatment options to treat this condition.
2. A 35 year old male presented with right testicular swelling for last 6 months. On examination it
is firm to hard in consistency.
a. Enlist the differential diagnosis of the pathology.
b. List classification of testicular tumors.
c. Outline investigation plan for the patient.
3. Give a brief account of urinary bladder stones, emphasizing types, composition, clinical features,
and treatment options available.
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4. What are the causes of stricture of urethra in a male patient? How will you diagnose and treat
it?
Section 7: Miscellaneous
Spleen
1. Enlist indications of splenectomy. Enumerate methods of splenic conservation in children. What
are the complications of splenectomy?
2. A 37 year old female patient presented with menorrhagia and easy bruisability. Abdominal USG
revealed splenomegaly.
a. Enumerate causes of splenomegaly.
b. How will you prepare a patient with hypersplenism for splenectomy? OR How will you
prepare a patient for splenectomy due to ITP?
3. A 12 year old boy has presented with grade II splenic injury after blunt abdominal trauma. He
has been advised conservative management by a surgeon.
a. What is grade II splenic injury?
b. What are components of conservative management of splenic injury?
c. When will you decide to stop conservative management and explore this boy?
Cardiothoracic
1. A 24 year old male presented to A&E department after a RTA. He is severely dyspneic. Breath
sounds are diminished on right side of chest and percussion note is resonant. Trachea is shifted
to left side.
a. Write down most likely diagnosis.
b. Enlist treatment plan in ER.
Pediatric Surgery
1. What in infantile hypertrophic pyloric stenosis? Give clinical features and principles of
management of this condition.
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