FMGE 2018 - Surgery PYQs Practice Questions

Q: Time cut-off for diagnosis of Priapism is?

4 hours. ***4 hours*** - A penile erection lasting longer than **4 hours** is the established cut-off for the diagnosis of **priapism**. - Prolonged erection beyond this duration can lead to **ischemia** and permanent cavernosal damage. *2 hours* - While concerning, an erection lasting 2 hours is typically not classified as priapism, which requires a longer duration to meet diagnostic criteria. - At this stage, the risk of significant ischemic injury is lower compared to longer durations. *3 hours* - An erection lasting 3 hours is still below the clinically defined threshold for priapism. - Although it warrants close monitoring, intervention is usually recommended once the 4-hour mark is reached. *1 hour* - An erection of 1 hour is generally considered a normal physiological response and does not meet the criteria for priapism. - This duration is insufficient to cause the microvascular damage and cellular changes associated with priapism. [Practice more Surgery PYQs on OnCourse]

Q: Most common immediate complication after splenectomy?

Hemorrhage. **Hemorrhage** - **Hemorrhage** is the most common immediate complication due to the spleen's rich blood supply and its close proximity to major vessels such as the **splenic artery and vein**. - Surgical trauma, inadequate ligation, or dislodgment of ligatures can lead to significant blood loss post-splenectomy. *Fistula* - Fistula formation, such as a **pancreatic fistula**, can occur but is less common immediately post-splenectomy compared to hemorrhage. - This complication typically develops due to injury to the **pancreatic tail** during splenic dissection, leading to leakage of pancreatic enzymes. *Bleeding from gastric mucosa* - Bleeding from the **gastric mucosa** (e.g., from stress ulcers or gastritis) is a potential complication after any major surgery but is not the most common immediate complication specific to splenectomy. - While the stomach is in close proximity, direct injury to the gastric mucosa causing significant bleeding is less frequent than hemorrhage from the splenic bed. *Pancreatitis* - **Pancreatitis** can be a severe complication of splenectomy, resulting from injury to the **pancreatic tail** during the procedure. - While it can manifest immediately, its incidence is generally lower than that of hemorrhage. [Practice more Surgery PYQs on OnCourse]

Q: In gastric outlet obstruction in a peptic ulcer patient, the site of obstruction is most likely to be:

Pylorus. ***Pylorus*** - The **pylorus** is the most common site of obstruction in gastric outlet obstruction caused by **peptic ulcer disease**. This is due to **scarring** and **inflammation** from chronic ulcers in or near this region. - Obstruction at the pylorus impedes the normal flow of digested food from the stomach into the **duodenum**. *Duodenum* - While ulcers can occur in the **duodenum** (specifically the duodenal bulb), they are less likely to cause a complete obstruction of the gastric outlet. - **Duodenal ulcers** are more common than gastric ulcers, but rarely lead to severe narrowing causing outlet obstruction. *Antrum* - The **gastric antrum** is part of the stomach leading up to the pylorus. Although ulcers can occur here, obstruction is less common compared to the **pylorus** itself. - Obstruction due to antral pathology typically occurs closer to the **pyloric sphincter**. *Fundus* - The **fundus** is the upper, dome-shaped part of the stomach. It is very rarely the site of obstruction in the context of gastric outlet obstruction from peptic ulcer disease. - Obstructions in the fundus are usually associated with other pathologies, such as **tumors** or **gastric volvulus**, not peptic ulcers causing outlet obstruction. [Practice more Surgery PYQs on OnCourse]

Q: Which of the following is FALSE regarding deep second-degree burns?

Show blanching response. ***Show blanching response (FALSE - Correct Answer)*** - This is the **FALSE statement**. Deep second-degree burns typically show **absent or diminished blanching response**, not a positive blanching response. - A **blanching response** indicates intact blood flow to the capillaries, which is typical of **superficial partial-thickness burns** only. - In **deep second-degree burns**, the damage extends deeper into the reticular dermis, involving the **dermal capillary plexus**, leading to loss of the blanching response. *Heal by scar deposition (TRUE)* - **Deep second-degree burns** damage the dermal elements responsible for regeneration, necessitating significant **scar deposition** for healing. - Due to destruction of many **dermal appendages** (hair follicles, sebaceous glands), complete regeneration without scarring is unlikely. *Painless (TRUE)* - While superficial burns are very painful, **deep second-degree burns** can be relatively **painless** due to destruction of **nerve endings** in the deeper dermis. - The variable destruction of **nociceptors** means patients may experience both painful areas and areas of reduced sensation or numbness. *Damage to deeper dermis (TRUE)* - **Deep second-degree burns** are characterized by injury extending into the **reticular dermis** (deeper layer), which lies beneath the papillary dermis. - This level of damage affects significant **dermal structures** including hair follicles, sweat glands, and nerve endings. [Practice more Surgery PYQs on OnCourse]

Q: Patient with history of blunt trauma to face presents with enophthalmos, diplopia on upward gaze and loss of sensitivity over cheek. True statement about this is:

It is a blow out fracture. ***It is a blow out fracture*** - The combination of **enophthalmos** (sunken eye), **diplopia on upward gaze** (due to **inferior rectus muscle entrapment**), and **loss of sensitivity over the cheek** (indicating infraorbital nerve involvement) are classic signs of an **orbital blowout fracture**. - These fractures typically involve the **orbital floor** or medial wall, caused by a direct impact to the orbit, which transmits force to the thin bony walls causing them to fracture while the orbital rim remains intact. *Maxillary fracture* - While the **infraorbital nerve** passes through the maxilla, a general maxillary fracture typically presents with broader symptoms such as **midfacial pain**, **swelling**, and **malocclusion**, which are not specified here. - Maxillary fractures often involve the **zygomaticomaxillary complex** or Le Fort patterns, which usually lead to more extensive facial abnormalities. *Zygomatic bone is most likely injured* - A **zygomatic arch fracture** would primarily cause **flattening of the cheek** and pain upon opening the mouth, not enophthalmos or diplopia on upward gaze. - While the zygoma forms part of the orbit, isolated zygomatic fractures rarely cause these specific orbital findings. *Frontal bone fracture* - **Frontal bone fractures** typically result from **high-impact trauma** and can involve the **frontal sinus**, leading to **forehead swelling**, **CSF rhinorrhea**, or **periorbital ecchymosis** (raccoon eyes). - The symptoms described are not characteristic of a frontal bone fracture. [Practice more Surgery PYQs on OnCourse]

Question 1

Time cut-off for diagnosis of Priapism is?

Accepted Answer

4 hours

Answer

2 hours

Answer

3 hours

Answer

1 hour

Question 2

Most common immediate complication after splenectomy?

Accepted Answer

Hemorrhage

Answer

Fistula

Answer

Bleeding from gastric mucosa

Answer

Pancreatitis

Question 3

In gastric outlet obstruction in a peptic ulcer patient, the site of obstruction is most likely to be:

Accepted Answer

Pylorus

Answer

Duodenum

Answer

Antrum

Answer

Fundus

Question 4

Which of the following is FALSE regarding deep second-degree burns?

Accepted Answer

Show blanching response

Answer

Heal by scar deposition

Answer

Painless

Answer

Damage to deeper dermis

Question 5

Patient with history of blunt trauma to face presents with enophthalmos, diplopia on upward gaze and loss of sensitivity over cheek. True statement about this is:

Accepted Answer

It is a blow out fracture

Answer

Maxillary fracture

Answer

Zygomatic bone is most likely injured

Answer

Frontal bone fracture

Question 6

Best treatment strategy for carcinoma of the anal canal:

Accepted Answer

Chemoradiation

Answer

Radiation

Answer

Surgery

Answer

Chemotherapy

Question 7

Surgery is indicated in Ulcerative Colitis in all except?

Accepted Answer

Colonic polyp

Answer

Toxic megacolon

Answer

Colonic obstruction

Answer

Failure of medical management

Question 8

Which of these is the best for management of a 3 cm stone in renal pelvis without evidence of hydronephrosis?

Accepted Answer

PCNL

Answer

Retrograde pyeloplasty

Answer

ESWL

Answer

Antegrade pyeloplasty

Question 9

Marjolin's ulcer is:-

Accepted Answer

Squamous cell carcinoma from scar

Answer

Adenoma of scar

Answer

Amoebic ulcer

Answer

Tubercular ulcer

Question 10

Dye for Sentinel Lymph Node Biopsy is injected in which of the following sites?

Accepted Answer

Areola

Answer

Nipple

Answer

Axilla

Answer

Tail of spence

FMGE 2018 — Surgery