INI-CET 2017 - Surgery PYQs Practice Questions

Q: A car accident patient complains of breathlessness. On examination BP is $110 / 70 \mathrm{mmHg}$ with GCS of 15/15. On examination, trachea is deviated to the right side, with reduced breath sounds in left infra-axillary area and inframammary areas. $S_{1}$ and $S_{2}$ are normal in intensity and splitting. CXR is shown below. What is the best step in management of the patient?

Chest tube insertion. ***Chest tube insertion*** - The patient's symptoms (breathlessness, tracheal deviation to the right, reduced breath sounds in the left infra-axillary and inframammary areas) combined with the CXR findings indicate a **left-sided hemothorax or pneumothorax** causing mediastinal shift. - A chest tube will **drain the accumulated air or fluid**, re-expand the lung, and relieve the mediastinal shift, thereby improving breathing. - This is **NOT a tension pneumothorax** (patient is hemodynamically stable with BP 110/70 mmHg), so definitive chest tube insertion is preferred over needle decompression. *Needle aspiration* - Needle thoracostomy is indicated for **tension pneumothorax**, which presents with hemodynamic instability, severe respiratory distress, and requires immediate decompression. - This patient is **hemodynamically stable** (normal BP, GCS 15/15), indicating a simple pneumothorax or hemothorax that requires **chest tube** for definitive drainage rather than temporary needle aspiration. *Pericardiocentesis* - **Pericardiocentesis** is indicated for **cardiac tamponade**, which presents with muffled heart sounds, hypotension, and distended neck veins (Beck's triad). - The patient's **normal blood pressure, normal heart sounds** (S₁ and S₂ normal), and clinical findings pointing to pleural pathology rule out cardiac tamponade. *Immediate thoracotomy* - **Immediate thoracotomy** is reserved for massive hemothorax with **>1500 mL initial drainage** or **>200 mL/hour persistent bleeding** after chest tube insertion, or for major vessel/cardiac injuries. - Initial management should be **chest tube insertion** for drainage and assessment before proceeding to thoracotomy. [Practice more Surgery PYQs on OnCourse]

Q: You are asked to put a 22-gauge cannula in a patient. Which of the following cannula will you put?

C. ***C*** - This cannula is blue, which correlates to a **22-gauge** size according to standard color-coding for IV cannulas. - A **22-gauge** cannula matches the specific requirement in the question and is generally used for patients with fragile veins, pediatric patients, or for slow infusions. *A* - This cannula is green, typically indicating an **18-gauge** size. - An 18-gauge cannula provides a larger bore for faster fluid administration but is **too large** for the 22-gauge requirement specified. *B* - This cannula is pink, which corresponds to a **20-gauge** size according to standard color-coding. - A 20-gauge cannula is commonly used for routine infusions but is **larger than the requested 22-gauge** size. *D* - This cannula is yellow, indicating a **24-gauge** size, the smallest common size. - A 24-gauge cannula is **smaller than the requested 22-gauge** and is primarily reserved for very fragile veins and infants. [Practice more Surgery PYQs on OnCourse]

Q: Identify the instrument shown in the image:

Asepto syringe. ***Asepto syringe*** - The image displays a **red rubber bulb** attached to a glass or plastic barrel ending in a nozzle, which is characteristic of an **Asepto syringe**. - Asepto syringes are commonly used for **irrigation** of wounds or surgical sites, and for various procedures where precise suction or fluid delivery is needed without a needle. *Trocar for tapping hydrocele* - A **trocar** is a pointed medical instrument with a sharp tip, typically used with a cannula to introduce instruments or drain fluids from a body cavity. - Trocars for hydrocele tapping would differ significantly in appearance, featuring a pointed tip and often a stylet, which are absent here. *Czerny retractor* - A **Czerny retractor** is a surgical instrument with two blades, used primarily to hold back tissue during surgery to provide a clear view of the surgical field. - The instrument shown here is focused on fluid suction/delivery, not on tissue retraction. *Malecot catheter* - A **Malecot catheter** is a type of self-retaining catheter, typically made from soft, flexible material, with a distinctive mushroom-shaped tip that helps anchor it within a viscus. - This image clearly depicts a syringe-like device with a bulb, not a flexible catheter with a four-winged tip. [Practice more Surgery PYQs on OnCourse]

Q: Which is correct about hematemesis (upper GI bleeding) in this patient?

Rockall scoring is used for risk stratification. ***Rockall scoring is used for risk stratification*** - The image shows a patient with significant **hematemesis**, indicating an upper gastrointestinal bleed. The **Rockall score** is a validated tool used to assess the risk of rebleeding and mortality in patients with upper GI bleeding. - This scoring system considers factors such as **age**, **shock**, **comorbidity**, and endoscopic findings to guide management. *Most common is variceal bleeding* - While variceal bleeding is a serious cause of upper GI hemorrhage, **peptic ulcer disease** (gastric or duodenal ulcers) is the most common cause of non-variceal upper GI bleeding, accounting for 40-50% of cases. - Variceal bleeding is common in patients with **portal hypertension**, often due to liver cirrhosis. *Occurs only if bleeding occurs proximal to ampulla of Vater* - **Hematemesis** (vomiting blood) specifically indicates bleeding **proximal to the ligament of Treitz**, which is superior to the ampulla of Vater. - Bleeding from the small intestine distal to the ligament of Treitz or the colon typically results in **melena** or **hematochezia**, not hematemesis. *MC management is endoscopic banding* - **Endoscopic banding** is the primary treatment for **esophageal variceal bleeding**. - For non-variceal bleeding, such as from **peptic ulcers**, the most common endoscopic management is **epinephrine injection** followed by **thermal coagulation** or **clip placement**. [Practice more Surgery PYQs on OnCourse]

Question 1

A car accident patient complains of breathlessness. On examination BP is $110 / 70 \mathrm{mmHg}$ with GCS of 15/15. On examination, trachea is deviated to the right side, with reduced breath sounds in left infra-axillary area and inframammary areas. $S_{1}$ and $S_{2}$ are normal in intensity and splitting. CXR is shown below. What is the best step in management of the patient?

Accepted Answer

Chest tube insertion

Answer

Needle aspiration

Answer

Pericardiocentesis

Answer

Immediate thoracotomy

Question 2

You are asked to put a 22-gauge cannula in a patient. Which of the following cannula will you put?

Accepted Answer

C

Answer

A

Answer

D

Answer

B

Question 3

Which is incorrect about the procedure shown in the patient with right flank pain?

Accepted Answer

No anesthesia is required

Answer

Done as outpatient procedure

Answer

Contraindicated in hard stones

Answer

Shockwaves pass through a water bath

Question 4

Identify the instrument shown in the image:

Accepted Answer

Asepto syringe

Answer

Trocar for tapping hydrocele

Answer

Czerny retractor

Answer

Malecot catheter

Question 5

Which is correct about hematemesis (upper GI bleeding) in this patient?

Accepted Answer

Rockall scoring is used for risk stratification

Answer

Most common is variceal bleeding

Answer

Occurs only if bleeding occurs proximal to ligament of Treitz

Answer

MC management is endoscopic banding

Question 6

What type of choledochal cyst is shown in the image?

Accepted Answer

2

Answer

1

Answer

3

Answer

4

Question 7

Which classification is used to evaluate the condition shown in the image below?

Accepted Answer

Todani classification

Answer

Bismuth classification

Answer

Johnson classification

Answer

Maastricht classification

Question 8

A 30-year-old construction worker had a partial traumatic nail avulsion. 3 weeks later he presents with the presentation shown below. What is the diagnosis?

Accepted Answer

Pyogenic granuloma

Answer

Pyoderma gangrenosum

Answer

Pott's puffy tumor

Answer

Acute paronychia

Question 9

An HIV positive patient presents with symptoms of toxemia and foul smelling discharge from the lesion shown below. What is the diagnosis?

Accepted Answer

Necrotizing fasciitis

Answer

Trophic ulcer

Answer

Pyogenic granuloma

Answer

Martorell ulcer

INI-CET 2017 — Surgery