FMGE 2019 - Surgery Practice Questions

Q: What is the most common anterior mediastinal tumor?

Thymoma. ***Thymoma*** - **Thymomas** are the most common primary tumor of the **anterior mediastinum** in adults. - They originate from the epithelial cells of the **thymus gland**, which is located in the anterior mediastinum. *Bronchogenic cyst* - **Bronchogenic cysts** are typically found in the **middle mediastinum**, although they can occasionally occur in the anterior or posterior mediastinum. - They are congenital anomalies resulting from abnormal budding of the **tracheobronchial tree**. *Neurofibroma* - **Neurofibromas** are nerve sheath tumors that typically occur in the **posterior mediastinum**, arising from spinal nerves. - They are often associated with **neurofibromatosis type 1**. *Pericardial cyst* - **Pericardial cysts** are benign, fluid-filled sacs most commonly found in the **middle mediastinum**, specifically in the cardiophrenic angle. - They are usually asymptomatic and are often discovered incidentally.

Q: 20 yr old female diagnosed previously with adenocarcinoma stomach and on examination following is seen;

Sister Mary joseph nodule. ***Sister Mary Joseph nodule*** - A **Sister Mary Joseph nodule** is a **metastatic lesion** to the umbilicus, often originating from an intra-abdominal malignancy such as **gastric adenocarcinoma**. - Its presence in a patient with a known history of **adenocarcinoma of the stomach** strongly suggests metastatic spread. *Infected umbilical hernia* - An **infected umbilical hernia** would typically present with signs of local infection such as **erythema**, **pain**, **tenderness**, and possibly **purulent discharge**. - While it might cause a lump, it does not explain the association with a prior diagnosis of gastric adenocarcinoma. *Umbilical granuloma* - An **umbilical granuloma** is a benign, inflamed overgrowth of tissue that presents as a **red, moist lump** at the umbilicus, often seen in infants. - It is not associated with malignancy and would not typically be found in a 20-year-old female in the context of gastric cancer. *Irish node* - An **Irish node** refers to a **left axillary lymph node metastasis** from gastric cancer. - While it signifies metastatic gastric cancer, it is distinct from an umbilical metastasis.

Q: In which location is a transplanted kidney typically placed?

Iliac fossa. ***Iliac fossa*** - The **iliac fossa** is the standard site for kidney transplantation due to its accessibility and the proximity of suitable blood vessels (iliac artery and vein) for anastomosis. [1] - Placing the kidney here allows for easier access for potential biopsies and monitoring. *Retroperitoneal space* - The patient's native kidneys are located in the **retroperitoneal space**, but a transplanted kidney is typically placed in a more accessible anterior location. - Transplanting a kidney into the retroperitoneal space would be a more complex and invasive procedure due to the depth and surrounding structures. *Hypogastric region* - While the iliac fossa is part of the broader hypogastric region, the term **hypogastric region** is less specific for the precise anatomical location of kidney transplantation. - The iliac fossa specifically refers to the concave surface of the ilium, which provides a suitable bed for the donated kidney. *Kidney fossa* - **Kidney fossa** is not a formally recognized anatomical term for a specific site of kidney transplantation. - The term "fossa" describes a depression or hollow, but in the context of transplantation, the iliac fossa is the correct anatomical landmark used.

Q: A lady comes to OPD after fall from scooty. Her vitals are stable. She is having continuous, clear watery discharge from nose after 2 days. This is most likely a feature of?

CSF rhinorrhoea. ***CSF rhinorrhoea*** - **Clear watery discharge** appearing **two days after head trauma** (fall from scooty) is highly suggestive of **cerebrospinal fluid (CSF) rhinorrhoea**. - This occurs due to a breach in the **skull base**, allowing CSF to leak from the subarachnoid space into the nasal cavity. *Acute respiratory infection* - An acute respiratory infection typically presents with symptoms like **fever, cough**, and **nasal discharge** that is often thicker and discolored, not clear and watery. - The onset of discharge two days after trauma without other signs of infection also makes this less likely. *Rhinitis* - Rhinitis involves inflammation of the nasal mucosa, leading to watery discharge, sneezing, and congestion. - However, the traumatic etiology and the specific timing of the discharge make **CSF leak** a more pertinent diagnosis than simple rhinitis. *Middle cranial fossa fracture* - While a **middle cranial fossa fracture** can cause CSF leakage, the discharge from the nose (rhinorrhoea) typically originates from an **anterior cranial fossa fracture**. - A middle cranial fossa fracture is more commonly associated with **otorrhoea** (CSF leakage from the ear) if the temporal bone is involved.

Q: 32-year-old man presented with fever and pain in upper right hypochondrium after food intake. Investigation of choice?

Ultrasound. ***Ultrasound*** - **Ultrasound** is the initial and often definitive investigation for suspected **gallbladder pathology** like cholecystitis, especially given the symptoms of fever and **right upper quadrant pain post-meals**. - It effectively visualizes **gallstones**, gallbladder wall thickening, and **pericholecystic fluid**, which are key indicators of cholecystitis. *CT scan* - A **CT scan** is generally not the first-line investigation for acute cholecystitis due to **radiation exposure** and its **lower sensitivity** for gallstones compared to ultrasound. - While it can identify complications like abscesses or perforations, it is usually reserved for **ambiguous ultrasound findings** or suspected complications. *ERCP (Endoscopic Retrograde Cholangiopancreatography)* - **ERCP** is an **invasive procedure** primarily used therapeutically for the removal of **bile duct stones** or for stent placement in cases of obstruction. - It carries risks of **pancreatitis** and perforation, making it unsuitable as an initial diagnostic tool for simple cholecystitis. *MRCP (Magnetic Resonance Cholangiopancreatography)* - **MRCP** is a **non-invasive imaging technique** that provides detailed images of the **biliary and pancreatic ducts** without radiation, primarily useful for confirming suspected bile duct stones or strictures. - While excellent for ductal anatomy, it is **not typically the first choice** for acute cholecystitis, as ultrasound is quicker, cheaper, and sufficient for initial diagnosis.

Q: The complication which will not occur after PCNL surgery:

Urethral stricture. ***Urethral stricture*** - **Urethral stricture** is a complication typically associated with transurethral procedures involving instrumentation through the urethra, such as a **Transurethral Resection of the Prostate (TURP)** or repeated urethral catheterisation. - **PCNL (Percutaneous Nephrolithotomy)** involves direct access to the kidney through the skin in the flank, bypassing the urethra entirely, therefore, making urethral stricture not a direct complication of this procedure. *Organ injury* - **Organ injury**, particularly to adjacent organs like the **colon**, **pleura**, or **spleen/liver**, can occur during PCNL if the access tract is misdirected or during instrumentation. - This is a well-recognised but infrequent complication requiring careful pre-operative planning and imaging guidance. *Bleeding* - **Bleeding** is a common complication of PCNL due to the invasive nature of the procedure, involving puncture of the kidney and fragmentation of stones. - It can range from minor self-limiting bleeding to significant haemorrhage requiring transfusion or further intervention such as **angiography** and **embolization**. *Sepsis* - **Sepsis** is a serious potential complication, particularly if the patient has pre-existing urinary tract infection or if bacteria are dislodged during stone fragmentation. - **Infection** can disseminate into the bloodstream, leading to severe systemic inflammatory response syndrome and septic shock.

Q: A lady with 50% TBSA burn with involvement of dermis and subcutaneous tissue came to the emergency department. The burns will be classified as:

3rd degree burn. ***3rd degree burn*** - **Third-degree burns** involve the entire thickness of the skin (dermis and epidermis) and often extend into the **subcutaneous tissue**, muscle, or bone. - These burns typically appear dry, leathery, and often lack pain sensation due to nerve destruction. *2nd degree superficial* - **Superficial second-degree burns** involve the epidermis and the superficial part of the dermis, often presenting with **blisters** and painful, red, moist skin. - They do not extend to the subcutaneous tissue, which is a key feature of the burn described. *2nd degree deep* - **Deep second-degree burns** involve the epidermis and deeper layers of the dermis, but not the entire dermis or subcutaneous tissue. - While they can be less painful and appear dry, the involvement of **subcutaneous tissue** pushes the classification to third-degree. *1st degree* - **First-degree burns** only affect the epidermis, causing redness and pain but **no blistering** or damage to deeper layers. - These are typically sunburns or minor scalds and do not involve the dermis or subcutaneous tissue.

Question 1

What is the most common anterior mediastinal tumor?

Accepted Answer

Thymoma

Answer

Bronchogenic cyst

Answer

Neurofibroma

Answer

Pericardial cyst

Question 2

In an accident case, after the arrival of medical team, all should be done in early management except;

Accepted Answer

Check BP

Answer

Glasgow coma scale

Answer

Stabilization of cervical vertebrae

Answer

Check Respiration

Question 3

20 yr old female diagnosed previously with adenocarcinoma stomach and on examination following is seen;

Accepted Answer

Sister Mary joseph nodule

Answer

Infected umbilical hernia

Answer

Umbilical granuloma

Answer

Irish node

Question 4

In which location is a transplanted kidney typically placed?

Accepted Answer

Iliac fossa

Answer

Retroperitoneal space

Answer

Hypogastric region

Answer

Kidney fossa

Question 5

A 27-year-old woman presents with 26 weeks of gestation with a thyroid lesion which is found to be papillary carcinoma of thyroid. Which is the best treatment for this patient?

Accepted Answer

Observation

Answer

Hemi-thyroidectomy

Answer

Total thyroidectomy

Answer

Thyroid ablation using radioactive Iodine

Question 6

A lady comes to OPD after fall from scooty. Her vitals are stable. She is having continuous, clear watery discharge from nose after 2 days. This is most likely a feature of?

Accepted Answer

CSF rhinorrhoea

Answer

Acute respiratory infection

Answer

Rhinitis

Answer

Middle cranial fossa fracture

Question 7

A young male patient presents with dyspnea; auscultation reveals absent breath sounds on the right side, and he has hypotension. What is the immediate next step?

Accepted Answer

Needle insertion in 2nd intercostal space, midclavicular line

Answer

Chest X-ray

Answer

Intubate the patient

Answer

Urgent IV fluid administration

Question 8

32-year-old man presented with fever and pain in upper right hypochondrium after food intake. Investigation of choice?

Accepted Answer

Ultrasound

Answer

CT scan

Answer

ERCP (Endoscopic Retrograde Cholangiopancreatography)

Answer

MRCP (Magnetic Resonance Cholangiopancreatography)

Question 9

The complication which will not occur after PCNL surgery:

Accepted Answer

Urethral stricture

Answer

Organ injury

Answer

Bleeding

Answer

Sepsis

Question 10

A lady with 50% TBSA burn with involvement of dermis and subcutaneous tissue came to the emergency department. The burns will be classified as:

Accepted Answer

3rd degree burn

Answer

2nd degree superficial

Answer

2nd degree deep

Answer

1st degree

FMGE 2019 — Surgery