FMGE 2025 - Surgery PYQs Practice Questions

Q: A 3-year-old child presented with multiple burn injuries involving the entire head, neck & one upper limb. What is the percentage of burn?

25-30%. ***Correct Answer: 25-30%*** Using the **Modified Rule of Nines for Pediatric Burns** (for children aged 1-4 years): **Calculation:** - **Head & Neck:** ~18% (children have proportionally larger heads compared to adults) - **One Upper Limb:** ~9% - **Total TBSA (Total Body Surface Area):** 18% + 9% = **27%** This falls within the range of **25-30%**, making this the correct answer. **Why Other Options are Incorrect:** *Incorrect: 5-10%* - This significantly underestimates the burn area. Head and neck alone account for ~18% in young children. *Incorrect: 18-20%* - This would represent only the head and neck, failing to account for the upper limb involvement. *Incorrect: 40-44%* - This overestimates the burn area. Even if both upper limbs were involved (18%), the total would be ~36%, not 40-44%. **Clinical Pearl:** In pediatric burns, remember that children have different body surface area proportions than adults - the head is proportionally larger (18% vs 9% in adults), while the lower limbs are proportionally smaller. Always use age-appropriate burn assessment charts. [Practice more Surgery PYQs on OnCourse]

Q: A patient presents with a transverse fracture at the skull base, described as splitting it and creating a 'hinge' with a 'nodding face sign.' This fracture extends from one petrous ridge across the sella turcica to the other petrous ridge. Which type of fracture is this?

Motorcyclist Fracture (Hinge Fracture). ***Motorcyclist Fracture (Hinge Fracture)*** - This is a descriptive term for a high-energy **transverse skull base fracture** that typically runs through the middle cranial fossa, traversing the skull base from one **petrous ridge** across the **sella turcica** to the opposite petrous ridge. - The fracture creates a 'hinge' mechanism that physically separates the facial skeleton from the calvarium, resulting in instability often described clinically as the **'nodding face sign'**. *Depressed Fracture* - A depressed fracture is characterized by bone fragments driven inwards, below the level of the surrounding skull, often leading to potential injury to the underlying **dura mater** and brain parenchyma. - These fractures result from blunt force trauma focused on a small area, and their primary feature is **inward displacement**, not the transverse splitting and hinge mechanism described. *Comminuted Fracture* - A comminuted fracture involves the bone being broken into **multiple pieces** (three or more separate fragments) at the fracture site. - While hinge fractures are often complex, the defining feature of this clinical presentation is the **transverse path** across the sella and the resulting hinge-like instability, which is a structural description differentiating it from a general comminution. *Ring Fracture* - A ring fracture occurs around the **foramen magnum** and is caused by significant axial loading (e.g., severe fall onto the feet or buttocks). - This fracture causes instability at the **craniocervical junction** and is localized to the posterior cranial fossa, not the extensive transverse fracture across the middle cranial fossa described. [Practice more Surgery PYQs on OnCourse]

Q: A fracture caused by falls landing on feet/buttocks (force transmitted through the spine), heavy blows to the top of the skull/vertex, twisting of the head on the spine, or blows to the occiput or chin. Which type of fracture is this?

Fissured Fracture (Linear Fracture). ***Fissured Fracture (Linear Fracture)*** - This type of fracture, also known as a **linear fracture**, results from forces that cause a simple, nondisplaced crack in the skull vault. - The mechanisms described—such as forces transmitted through the spine (falls on feet/buttocks) or blows to the vertex, chin, or occiput—are classic causes of **linear skull fractures** because the force is typically dispersed over a wide area, rather than focused enough to cause depression. *Depressed Fracture* - These fractures occur due to high-velocity **localized impact**, where the outer table of the skull is driven inward below the level of the inner table, posing a high risk of **dural tear** and underlying brain injury. - The mechanisms listed in the question involve generalized force transmission or twisting, which are inconsistent with the **inward comminution** required for a depressed fracture. *Gutter Fracture* - This term is specifically associated with **penetrating missile injuries**, like low-velocity bullet wounds, where bone fragments are typically driven inward, creating a characteristic groove or channel. - The mechanisms listed in the prompt are **blunt force** injuries or transmission of force, not penetrating trauma that creates a 'gutter.' *Diastatic Fracture (Sutural Fracture)* - This fracture involves the **separation of cranial sutures** due to a fracture line extending into them, primarily observed in infants and young children before the sutures are fully fused. - The forces described result in a break *through* the bone of the vault (a fissure) rather than primarily causing the **separation of existing, fused sutures** in an adult skull. [Practice more Surgery PYQs on OnCourse]

Q: A 4-year-old boy was brought to the emergency department with complaints of melena and acute intermittent pain in the right iliac region. On surgical exploration, a diverticulum containing gastric mucosa was found. What is the diagnosis? ![img-71.jpeg](img-71.jpeg)

Meckel's diverticulum. ***Meckel's diverticulum*** - This is a remnant of the **vitelline duct** and is the most common congenital anomaly of the gastrointestinal tract, classically presenting with painless rectal bleeding in a young child. - The symptoms of **melena** and right iliac fossa pain are due to ulceration caused by acid secretion from ectopic **gastric mucosa**, which is found in about 50% of symptomatic cases. *Appendicular lump* - An appendicular lump is an inflammatory mass formed by the inflamed appendix and adjacent structures, typically presenting with fever, pain, and a palpable mass in the right iliac fossa. - It does not contain ectopic gastric mucosa and would not be the primary cause of melena; the image shows a distinct diverticulum, not an inflammatory phlegmon. *Carcinoid* - A carcinoid is a **neuroendocrine tumor** that can occur in the GI tract, but it appears as a solid, yellowish tumor, which is different from the structure shown in the image. - While it can cause bleeding or obstruction, the classic history of bleeding from ectopic gastric mucosa is not associated with carcinoid tumors. *Obstructed bowel loops* - This is a clinical finding rather than a specific diagnosis. While a Meckel's diverticulum can cause bowel obstruction (e.g., through **intussusception** or volvulus), the image and history point to the diverticulum as the primary pathology. - The image shows a specific anatomical structure (the diverticulum), not the general appearance of dilated, obstructed bowel loops proximal to a blockage. [Practice more Surgery PYQs on OnCourse]

Q: A 26 year old female was brought to ER post fire incidence. Her face and lower limbs were spared. Based on the burn distribution shown, calculate the percentage of body surface area affected.

40-50%. ***40-50%*** - The **Rule of Nines** is used to estimate the Total Body Surface Area (TBSA) of burns in adults. According to this rule, the anterior trunk is 18%, each upper limb is 9%, and the posterior trunk is 18%. - In this patient, burns cover the entire anterior trunk (18%), both upper limbs (9% + 9% = 18%), and likely the upper posterior trunk (approx. 9%), totaling around **45%**, which falls in this range. This calculation is critical for fluid resuscitation. *5-10%* - This percentage represents a much smaller burn area, equivalent to approximately one full arm (9%) or the head (9%). - The visual evidence clearly shows extensive burns involving the entire torso and both arms, far exceeding this estimation. *20-30%* - This TBSA would typically represent burns covering the entire anterior trunk (18%) plus one arm (9%), totaling 27%. - This estimate is incorrect as it fails to account for the burns on the second upper limb and the likely involvement of the back. *10-15%* - A burn of this size would involve an area such as the anterior chest (9%) or one leg from the knee down. - This option significantly underestimates the burn severity, as the anterior trunk alone accounts for 18% of the TBSA. [Practice more Surgery PYQs on OnCourse]

Question 1

A 3-year-old child presented with multiple burn injuries involving the entire head, neck & one upper limb. What is the percentage of burn?

Accepted Answer

25-30%

Answer

5-10%

Answer

40-44%

Answer

18-20%

Question 2

A patient presents with a transverse fracture at the skull base, described as splitting it and creating a 'hinge' with a 'nodding face sign.' This fracture extends from one petrous ridge across the sella turcica to the other petrous ridge. Which type of fracture is this?

Accepted Answer

Motorcyclist Fracture (Hinge Fracture)

Answer

Comminuted Fracture

Answer

Depressed Fracture

Answer

Ring Fracture

Question 3

A fracture caused by falls landing on feet/buttocks (force transmitted through the spine), heavy blows to the top of the skull/vertex, twisting of the head on the spine, or blows to the occiput or chin. Which type of fracture is this?

Accepted Answer

Fissured Fracture (Linear Fracture)

Answer

Diastatic Fracture (Sutural Fracture)

Answer

Depressed Fracture

Answer

Gutter Fracture

Question 4

A 4-year-old boy was brought to the emergency department with complaints of melena and acute intermittent pain in the right iliac region. On surgical exploration, a diverticulum containing gastric mucosa was found. What is the diagnosis? ![img-71.jpeg](img-71.jpeg)

Accepted Answer

Meckel's diverticulum

Answer

Appendicular lump

Answer

Obstructed bowel loops

Answer

Carcinoid

Question 5

A 26 year old female was brought to ER post fire incidence. Her face and lower limbs were spared. Based on the burn distribution shown, calculate the percentage of body surface area affected.

Accepted Answer

40-50%

Answer

20-30%

Answer

5-10%

Answer

10-15%

Question 6

A patient with grade 2 hemorrhoids underwent surgery, identify the instrument.

Accepted Answer

Haemorrhoids band kit

Answer

Stapler kit

Answer

CO2 laser

Answer

Haemorrhoids resection kit

Question 7

A 45-year-old man is found unconscious after a fall from a ladder. In the emergency department, his eyes do not open even in response to pain; he is making incomprehensible sounds, and he exhibits abnormal flexion in response to painful stimuli. What is his Glasgow Coma Scale (GCS) score?

Accepted Answer

6

Answer

7

Answer

8

Answer

5

Question 8

Which of the following is the classical triad of acute cholangitis?

Accepted Answer

Pain, jaundice, fever

Answer

Pain, $\uparrow$ WBC, $\uparrow$ Bilirubin

Answer

Fever, jaundice, $\uparrow$ WBC

Answer

Pain, jaundice, shock

Question 9

A 22-year-old male presents to the emergency department with a strong urge to urinate but is unable to do so. He has a history of perineal trauma. On examination, blood is noted at the external urethral meatus. Which structure is most likely injured?

Accepted Answer

Bulbar urethra

Answer

Intraperitoneal Bladder rupture

Answer

Posterior urethral valve

Answer

Membranous urethra

Question 10

Spread of prostate cancer to lumbar vertebra is via?

Accepted Answer

Venous spread

Answer

Local spread

Answer

Arterial spread

Answer

Lymphatic spread

FMGE 2025 — Surgery