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: Comment on the diagnosis of a film shown of a 65-year-old man with acute abdomen:

Colocolic intussusception. ***Colocolic intussusception*** - This is a rare form of intussusception where a **proximal segment of the colon telescopes into a distal segment** within the colon itself. - In adults, it is often associated with a **lead point**, such as a tumor, polyp, or lipoma, which can be visualized on imaging. *Sigmoid volvulus* - Characterized by the **twisting of the sigmoid colon** around its mesentery, often presenting with a characteristic "coffee bean" sign on abdominal X-ray. - While it causes acute abdomen, it is distinguishable from intussusception by its specific radiological appearance and underlying mechanism of obstruction. *Ileocolic intussusception* - This involves the **terminal ileum telescoping into the cecum**, and it is the most common type of intussusception in children. - In adults, it is also typically associated with a lead point but the segment of bowel involved is different from colocolic intussusception. *Toxic megacolon* - This is a severe complication of inflammatory bowel disease or infectious colitis, characterized by **non-obstructive colonic dilation** and signs of systemic toxicity. - Imaging would reveal a dilated colon, often with loss of haustra, but without the specific "target sign" or "pseudokidney sign" indicative of intussusception. [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

Comment on the diagnosis of a film shown of a 65-year-old man with acute abdomen:

Accepted Answer

Colocolic intussusception

Answer

Sigmoid volvulus

Answer

Toxic megacolon

Answer

Ileocolic intussusception

Question 6

What is the most likely diagnosis for this 60-year-old man with the lesion shown in the image?

Accepted Answer

SCC of lip

Answer

Plunging Ranula

Answer

Basal cell carcinoma

Answer

Epulis

Question 7

Bleeding vessel in hemorrhoids is

Accepted Answer

Superior rectal artery

Answer

Superior rectal vein

Answer

Middle rectal vein

Answer

Middle rectal artery

Question 8

Best treatment strategy for carcinoma of the anal canal:

Accepted Answer

Chemoradiation

Answer

Radiation

Answer

Surgery

Answer

Chemotherapy

Question 9

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 10

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

FMGE 2018 — Surgery