FMGE 2019 - Surgery PYQs Practice Questions

Q: Which finding is assigned 2 points in the Alvarado scoring system for appendicitis assessment?

Leukocytosis. **Leukocytosis** - An elevated **white blood cell count** (typically greater than 10,000 cells/mm³) is a significant indicator of inflammation, assigned **2 points** in the Alvarado score. - This finding reflects the body's systemic response to the infection and inflammation associated with **appendicitis**. *Low-grade fever* - A low-grade fever (oral temperature of 37.3-38.0°C) is assigned **1 point** in the Alvarado score. - While indicative of inflammation, it is less specific and less weighted than leukocytosis. *Nausea and vomiting* - These gastrointestinal symptoms are common in appendicitis and are assigned **1 point** in the Alvarado score. - They are non-specific and can be present in many other abdominal conditions. *Rebound tenderness* - This clinical sign, indicating **peritoneal irritation**, is assigned **1 point** in the Alvarado score. - It is a physical exam finding, not a laboratory finding, and suggests localized inflammation. [Practice more Surgery PYQs on OnCourse]

Q: Bell clapper deformity (abnormal testicular fixation) predisposes to which of the following conditions?

Testicular torsion. ***Testicular torsion*** - The **bell clapper deformity** describes an abnormally high attachment of the tunica vaginalis, leaving the testis and epididymis free to rotate within the scrotal sac. - This anatomical variation allows the spermatic cord to twist, cutting off blood supply to the testis, which is the mechanism of **testicular torsion**. *Hydrocele* - A **hydrocele** is a collection of fluid in the tunica vaginalis, resulting from an imbalance in fluid production and absorption, or a patent processus vaginalis. - It is not directly caused by abnormal testicular fixation. *Testicular atrophy* - **Testicular atrophy** is a reduction in testicular size, often due to conditions like cryptorchidism, mumps orchitis, or prolonged testicular torsion, but not predisposed by the bell clapper deformity itself unless torsion occurs. - While torsion can lead to atrophy if not promptly treated, the deformity directly predisposes to the torsion event, rather than atrophy itself. *Varicocele* - A **varicocele** is an abnormal dilation of the veins of the pampiniform plexus within the scrotum, usually due to incompetent valves or venous obstruction. - This condition is not associated with testicular fixation abnormalities. [Practice more Surgery PYQs on OnCourse]

Q: A 62-year-old female had a kidney stone and was treated with PCNL. After 2 days, she comes to the OPD with chills and fever. What is the complication?

Bacterial sepsis. ***Bacterial sepsis*** - **Chills and fever** two days after a **Percutaneous Nephrolithotomy (PCNL)** are highly suggestive of a systemic infection, specifically **bacterial sepsis**, as this procedure carries a risk of introducing bacteria into the bloodstream. - Urinary tract manipulation, especially in a patient with a potentially *infected kidney stone*, can lead to bacteremia and subsequent **sepsis** if not properly managed. *Acute pancreatitis* - **Acute pancreatitis** is not a common complication of PCNL. It typically presents with severe **epigastric pain** radiating to the back, often with nausea and vomiting, and is usually associated with gallstones or alcohol abuse. - While it can cause fever, the clinical presentation and context do not strongly support **pancreatitis** as the primary issue following a PCNL. *Ureteric stricture* - A **ureteric stricture** is a *late complication* of kidney stone treatment and typically leads to symptoms of **urinary obstruction**, such as flank pain, rather than acute fever and chills two days post-procedure. - It would not cause acute systemic signs like **chills and fever** within such a short timeframe after PCNL. *Splenic injury* - **Splenic injury** is a rare but possible complication of procedures around the left kidney; however, it would typically present with **abdominal pain**, signs of **hemorrhage** (e.g., hypotension), and sometimes shoulder pain, not primarily with fever and chills as the immediate post-operative concern. - While fever can occur with internal injuries, the primary and most immediate concern with fever and chills after a urological procedure is **infection**. [Practice more Surgery PYQs on OnCourse]

Q: What is the most common tumor of the mediastinum?

Neurogenic tumor. ***Neurogenic tumor*** - **Neurogenic tumors** are the **most common primary tumors of the mediastinum** overall, accounting for approximately **35-40%** of all mediastinal masses. - They are the most common tumors of the **posterior mediastinum** and arise from nerve sheaths (e.g., **schwannomas, neurofibromas**) or sympathetic ganglia. - These tumors occur across all age groups, with higher prevalence when including both pediatric and adult populations. *Thymoma* - **Thymomas** are the most common primary tumor of the **anterior mediastinum** in adults, accounting for about **40-50%** of anterior mediastinal masses. - However, they represent only about **20-25%** of all mediastinal tumors overall. - Often associated with paraneoplastic syndromes like **myasthenia gravis** (30-50% of cases). *Lymphoma* - **Lymphoma** is a common mediastinal tumor, particularly **Hodgkin lymphoma** in young adults, accounting for approximately **15-20%** of mediastinal masses. - It often presents with bulky mediastinal masses and symptoms like **dyspnea, cough, or superior vena cava syndrome**. - While very common, it ranks second or third overall after neurogenic tumors. *Neuroblastic tumor* - **Neuroblastic tumors** (e.g., neuroblastoma, ganglioneuroblastoma) are a subset of neurogenic tumors more common in **children**. - They arise from the sympathetic nervous system and typically occur in the posterior mediastinum. - While important in pediatric populations, they are less common than all neurogenic tumors combined. [Practice more Surgery PYQs on OnCourse]

Question 1

Which finding is assigned 2 points in the Alvarado scoring system for appendicitis assessment?

Accepted Answer

Leukocytosis

Answer

Low-grade fever

Answer

Nausea and vomiting

Answer

Rebound tenderness

Question 2

Bell clapper deformity (abnormal testicular fixation) predisposes to which of the following conditions?

Accepted Answer

Testicular torsion

Answer

Hydrocele

Answer

Testicular atrophy

Answer

Varicocele

Question 3

A 62-year-old female had a kidney stone and was treated with PCNL. After 2 days, she comes to the OPD with chills and fever. What is the complication?

Accepted Answer

Bacterial sepsis

Answer

Acute pancreatitis

Answer

Ureteric stricture

Answer

Splenic injury

Question 4

A 6-month-old child presents with an umbilical hernia measuring 3 cm in diameter. What is the management protocol?

Accepted Answer

Observation until 2 years of age, then surgery if unresolved

Answer

Immediate surgical repair

Answer

Elective surgery at 5 years of age

Answer

Hernioplasty for repair

Question 5

What is the most common tumor of the mediastinum?

Accepted Answer

Neurogenic tumor

Answer

Thymoma

Answer

Lymphoma

Answer

Neuroblastic tumor

Question 6

Investigations used for CSF rhinorrhea are all except:

Accepted Answer

Skull X-ray

Answer

CT cisternogram

Answer

Beta-2 transferrin

Answer

Nasal endoscopy

Question 7

A patient who underwent gastrectomy develops sweating and diarrhea within 20 minutes after eating. What could be the cause?

Accepted Answer

Early dumping syndrome

Answer

Late dumping syndrome

Answer

Hyperglycemia

Answer

Hypoglycemia

Question 8

A patient with varicose veins came to the hospital; an intern was on duty. Which test should he perform to assess the competency of deep veins?

Accepted Answer

Perthes test

Answer

Ober test

Answer

Thomas test

Answer

Brodie Trendelenburg test

Question 9

Prostatic cancer mostly seen in

Accepted Answer

Posterior

Answer

Lateral

Answer

Answer

Medial

Question 10

Abdominal pain, fever and jaundice. This triad is known as;

Accepted Answer

Charcot's triad

Answer

Renault's triad

Answer

Virchow triad

Answer

Saint's triad

FMGE 2019 — Surgery