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FMGE 2013 — Surgery

Q: A patient presented with bleeding from thigh and broken 5th rib on right side. What should be done first:

Control bleeding. ***Control bleeding*** - In trauma cases, **hemorrhage control** is the immediate priority to prevent exsanguination and hypovolemic shock, which can be rapidly fatal. - The **ABCDE approach** in trauma management (Airway, Breathing, Circulation, Disability, Exposure) dictates that controlling life-threatening bleeding falls under "Circulation" and often takes precedence over other injuries once the airway is secured. *Strapping of chest* - While a fractured rib can cause pain and impair breathing, **chest strapping** is generally not recommended as it restricts chest wall movement, potentially leading to **atelectasis** and **pneumonia**. - Furthermore, it does not address the immediate life threat of uncontrolled bleeding from the thigh. *Internal fixation of rib* - **Internal fixation** of a broken rib is an advanced and elective surgical procedure, typically performed significantly later for specific indications such as flail chest or non-union. - It is not an emergent intervention and would be performed only after the patient is stable and all life-threatening conditions, including active bleeding, have been addressed. *Wait & watch* - A "wait and watch" approach is inappropriate for a patient with active bleeding and a fractured rib, as it delays critical interventions and can lead to **deterioration** of the patient's condition. - Immediate assessment and intervention are required to manage both the bleeding and the potential respiratory compromise from the rib fracture. [Practice more Surgery PYQs on OnCourse]

Q: Curling ulcer is seen in:

Burn. ***Burn*** - **Curling's ulcer** is a type of acute peptic ulcer that can develop in the **duodenum** in patients suffering from severe burns. - It is believed to be caused by **ischemia** due to reduced plasma volume and systemic vasoconstriction following the burn injury, leading to decreased blood flow to the gastrointestinal tract. *Corticosteroids* - Corticosteroid use can increase the risk of **peptic ulcer disease** by impairing mucosal defense and inhibiting prostaglandin synthesis. - However, the ulcers associated with corticosteroids are not specifically termed Curling's ulcers; this term is reserved for ulcers caused by severe burns. *TPN* - Total Parenteral Nutrition (TPN) itself does not directly cause specific ulcers like Curling's ulcers. - Complications of TPN can include issues like **cholestasis** or **catheter-related infections**, but not acute stress ulcers. *Head injury* - Acute gastric ulcers that can develop after a severe head injury or other central nervous system trauma are known as **Cushing's ulcers**. - These ulcers are thought to be caused by **increased vagal stimulation** and excessive gastric acid secretion. [Practice more Surgery PYQs on OnCourse]

2 Previous Year Questions with Answers & Explanations

Questions

All Subjects Anatomy (1)Forensic Medicine (1)Microbiology (1)Pharmacology (3)Surgery (2)

A patient presented with bleeding from thigh and broken 5th rib on right side. What should be done first:

Curling ulcer is seen in: