Y4 - CA 2025 - Sample 1- Q

 Subject: Y4 Surgery

Y4 CA 2025 – Sample 1

Time: 1hr 30min                               

 (Section A: MCQ-1 mark (20)

1	Which of the following features characterize secondary hyperparathyroidism?
	A	Hypercalcemia associated with elevated parathyroid hormone
	B	Hypocalcaemia associated with elevated parathyroid hormone
	C	Hypocalcaemia associated with decreased parathyroid hormone
	D	Hypercalcemia associated with decreased parathyroid hormone

 

2	The most common cause of groin swelling is
	A	Enlarged Lymph node
	B	Inguinal hernia
	C	Strangulated femoral hernia
	D	Saphena varix

 

3	A nodule in the thyroid gland
	A	May be presentation of a multinodular goitre
	B	Is unlikely to be cyst if painful
	C	Usually requires excision
	D	Will require radio-isotope scanning to help distinguish between a benign and malignant nodule

 

4	Haemorrhoids
	A	Most haemorrhoids are congenital
	B	Pain is rare in uncomplicated grade I haemorrhoids
	C	Piles which remain permanently prolapsed are called grade 3 haemorrhoids
	D	Profuse bleeding is never seen in haemorrhoids

 

5	Necrotizing soft tissue infections (NSTI)
	A	They are usually polymicrobial infections
	B	The onset is usually gradual as run a chronic course
	C	Clostridium species commonly cause toxic shock symptoms
	D	Treatment is essentially medical using antibiotics

 

6	The following are true of Basal cell carcinoma except
	A	Slow growing
	B	Ultraviolet radiation is a strong risk factor
	C	Occurs in the covered parts of the body like chest and abdomen
	D	Treatment includes wide excision aboot 2cm margin

 

 

7	Complications of a liver abscess
	A	Malignant change
	B	Obstructive jaundice
	C	Right pleural effusion
	D	Liver cirrhosis

 

8	Which of the following is accurate about the workup of patient suspected acute pancreatitis?
	A	Aggressive hydration is rarely required
	B	Contrast-enhanced CT scanning and/or MRI should be performed in all cases
	C	Routine use prophylactic antibiotic is indicated
	D	Intervention in patients with infected necrosis may be delayed through the use of antibiotics that do not penetrate the necrotic tissue

 

9	Which of the following statements regarding H. pylori are true?
	A	The organism is round in shape.
	B	It has the ability to hydrolyse urea with the production of ammonia
	C	Some strains produce the cytokinins cagA and vacA, which are associated with the ability to cause gastritis, ulceration and cancer
	D	Treatment is recommended for infected patients who are asymptomatic

 

10	Which of the following are more common in multiparous women?
	A	Indirect inguinal hernia
	B	Lumbar hernia
	C	Umbilical
	D	Direct inguinal hernia

 

11	Which is not a complication of colostomy
	A	Bleeding
	B	Retraction
	C	Malignant change
	D	Parastomal hernia

 

12	The following is not a complication of gallstones
	A	Biliary colic
	B	Acute cholecystitis
	C	Acute pancreatitis
	D	Pancreatic carcinoma

 

 

13	Fistula-in ano
	A	It may be found in association with ulcerative colitis
	B	Trans-sphincteric fistulae usually have an external opening close to the anal verge
	C	Posterior fistulae are more likely to have a curved track and a horseshoe communication
	D	Fistulotomy is the treatment of choice in trans-sphincteric fistula involving more than 30 per cent of the external sphincter

 

14	Which is not a clinical sign of inoperability in stomach cancer
	A	Gastric outlet obstruction
	B	Free fluid in the peritoneal cavity
	C	Blumer’s shelf—deposits in the rectovesical area, rectouterine pouch—made out by PR
	D	Virchow’s node

 

15	Which of the following are indications for surgery in varicose veins?
	A	Recurrent bleeding
	B	Skin changes such as lipodermatosclerosis without ulceration
	C	Itching
	D	Cosmesis

 

16	Pnemoperitoneum
	A	In the presence of free air within the lumen of the intestine
	B	Is commonly caused by perforated duodenal ulcer
	C	AXR is far superior to CT scan in detecting it
	D	Always seen as air under the diaphragm

 

17	Abdominal aortic aneurysms (AAA)
	A	Abdominal aortic aneurysms (AAA) are usually symptomatic.
	B	Ultrasound has a high degree of sensitivity and specificity for AAA
	C	The size of the aneurysm is best assessed by angiography
	D	Most AAAs will eventually rupture,resulting in the patient’s death.

 

18	Which of the following regarding diagnosis of deep vein thrombosis (DVT) are true?
	A	Clinical findings are a reliable way of establishing the diagnosis
	B	A raised D-dimer level is high specific for venous thrombosis
	C	Duplex scanning is the investigation of choice for DVT
	D	Radioiodine-labelled fibrinogen is commonly used in the diagnosis of DVT.

 

 

 

19	The following statements are true about a hydrocele except
	A	A hydrocele is a collection of fluid within the tunica vaginalis
	B	A congenital hydrocele causes an intermittent swelling.
	C	Testicular pathology may cause a hydrocele.
	D	Drainage is an effective treatment

 

20	In a patient with multiple trauma
	A	The FAST scan is the most useful initial investigation
	B	Best managed by a surgeon
	C	CT scan is not useful as a diagnostic tool
	D	Diagnostic peritoneal lavage is always necessary to diagnose intra-abdominal bleeding

 

Section B: SAQ (5)

1	A	List four (4) main symptoms of mechanical intestinal obstruction	[ 2 Marks]
	B	Outline the management of a strangulated inguinal hernia	[ 3 Marks]

 

2	A	List the 3 main features of cholangitis	[ 2 Marks]
	B	Outline the management of ascending cholangitis	[ 3 Marks]

 

3	A	Name 3 common causes of hematemesis	[ 2 Marks]
	B	Describe the management of a patient with hematemesis	[ 3 Marks]

 

4	A	List 3 common causes of blood-stained stools	[ 2 Marks]
	B	Outline the management of bleeding haemorrhoids	[ 3 Marks]

 

 

5	A	Name 3 causes of a mass in the RIF	[ 2 Marks]
	B	How will you manage a patient with carcinoma cecum stage Duke’s B	[ 3 Marks]

 

 

 

 

Section C: Case Scenarios—PMP (5)

( Patient Management problem ) Based

1a	A 62 year old lady presents with a lump in the upper outer quadrant of left breast.
	Which of the following is the most appropriate next step in the management of this patient?
	A		Ultrasonography of the breast and fine needle aspiration cytology
	B		Mammography and fine needle aspiration cytology
	C		Mammography and core needle biopsy
	D		Ultrasonography and core needle biopsy
1b		The above patient is diagnosed to have Invasive Ductal Carcinoma of Left Breast staged as T4N3M0
		Which of the following is most appropriate next step in the management of this patient?
		A		Mastectomy
		B		Radiotherapy
		C		Breast Conserving Surgery
		D		Neoadjuvant Chemotherapy

 

2a	A 41 year old woman presents with a one week history of fever,jaundice and RUQ pain.Which of the following is most useful next step in the diagnosis
	A	Ultrasound abdomen
	B	Abdominal X-ray
	C	Contrast enhanced CT scan
	D	Serum amylase
2b	The ultrasound showed 2 stones in the lower CBD.What is the preferred treatment
	A		Laparoscopic cholecystectomy
	B		Endoscopic sphincterotomy and stone extraction
	C		Open exploration of CBD and stone removal
	D		Choledochojeunostomy

 

3a	A 22year old man complaints of RIF pain and vomiting for 1 day. What are investigations needed for the patient.
	A	FBC + urinalysis + ultrasound scan
	B	Ultrasound and CT scans
	C	Upper and lower GI Endoscopy
	D	AXR and CT scan
3b	He has been diagnosed as acute appendicitis. Outline the subsequent management of the patient
	A		Antibiotics and elective appendicectomy
	B		Open appendicectomy is preferable to laparoscopic
	C		Prophylactic antibiotics is always used
	D		IV fluids + antibiotics + urgent appendicectomy

 

 

4a	A 50-year-old man, a chronic alcoholic, is referred to the surgical outpatients with a 6-month history of epigastric pain, weight loss and altered bowel habit.  What is the most useful investigation needed for the patient
	A	Ultrasound abdomen
	B	AXR
	C	Faecal fat estimation
	D	Abdominal CT scan
4b	These are the AXR and CT scan films of the patient. What is your diagnosis?
	A	Acute intestinal obstruction
	B	Carcinoma of pancreas
	C	Chronic pancreatitis
	D	Acute pancreatitis

 

5a	A 42year old man complained of epigastric pain and passing blackish stools. The next step the management of the patient
	A	IV fluids + GXM blood + Upper GI endoscopy
	B	IV fluids + Ultrasound abdomen + Upper GI endoscopy
	C	Immediate blood transfusion + Upper Gi endoscopy
	D	Urgent CT scan and blood transfusion
5b	On upper GI endoscopy, there was a duodenal ulcer at D1with no active bleeding. What is the next line of treatment?
	A		Partial gastrectomy
	B		Highly selective vagotomy
	C		PPI + H. pylori eradication
	D		Endoscopic injection of adrenaline

 

 

Section D: EMI (1-4)

Theme : Types of shock
Option List
	A	Septic shock	B	Carcinogenic shock
	C	Hypovolemic shock - haemorrhagic	D	Neurogenic shock
	E	Anaphylactic shock	F	Endocrinal shock
	G	Hypovolemic – non- hemorrhagic shock	H	Idiopathic shock
	I	Irreversible shock	J	Reversible shock

 

Choose and match the correct diagnosis with each of the scenarios given below:

 Each option may be used once, more than once or not at all.

1

G

A 76-year-old male is brought to the hospital with persistent diarrhoea and vomiting for the past 4 days. He has been unable to keep his food down and feels very tired. On examination, he is very dehydrated. His pulse is 128/min and his BP is 88/52 mmHg

 

2

A

An 83-year-old male has been complaining of increasing lower abdominal pain for the past week. On examination he looks very unwell with warm peripheries. He has signs of generalised peritonitis. His pulse is 130/min and his BP 84/50 mmHg.

 

3

D

A 28-year-old motorist is brought to the A&E after a road traffic accident (RTA). He has sustained an isolated injury to his back and has motor and sensory deficits in both lower limbs. His pulse is 122/min and his BP 100/62 mmHg.

 

4

C

A 19-year-old male is brought to the hospital after sustaining an abdominal injury while playing rugby. He is complaining of left upper abdominal pain and has some bruising over the same area. His pulse is 140/min and his BP is 100/82 mmHg

 

 

 

Section E: MEQ – Modified Essay Questions

1	A 2-year-old male child is brought with 1 day history of severe crampy abdominal pain, alternating with periods of no pain, nausea, vomiting and red jelly-like stools mixed with mucus, tenderness and guarding in the Right Upper Quadrant and a sausage-shaped mass palpable in the Right Upper Quadrant.
	A	What is the most likely diagnosis?	[1 Mark]
	B	What is the most appropriate first step in the management of this child?	[ 1 Mark]
	C	In this case what is the most appropriate first diagnostic investigation?	[ 1 Mark]
	D	Which other investigation is helpful for diagnosis and treatment of this condition?	[ 1 Mark]
	E	List two conditions which are risk factors for the development of this condition?	[  1 Mark]

 

2	A 65-year-old man complaints of anorexia and weight loss for 3 months. He has intermittent vomiting associated with malaise. On examination he looks anaemic, and has a firm mobile mass in the epigastrium and RUQ regions.
	A	What is the most likely diagnosis?	[  1Mark]
	B	What is the most appropriate first step in the management of this child?	[  1 Mark]
	C	In this case what is the most appropriate first diagnostic investigation?	[  1 Mark]
	D	Which other investigation is helpful for diagnosis and treatment of this condition?	[  1 Mark]
	E	List two conditions which are risk factors for the development of this condition? Family history, pernicious anaemia, smoking	[  1 Mark]

 

3	A 36-year-old woman was involved in a motor vehicle accident in a head on collision. She gives a history of LOC for few minutes and complained of giddiness, headache, and vomiting. Two hours later she was brought into the ED unconscious. Her GCS score was 10/15.There was a swelling over her right parietal region.
	A	What is the most likely diagnosis?	[  1Mark]
	B	What emergency investigation will you do?	[  1 Mark]
	C	This is a CT scan of the brain. What is the definitive diagnosis?	[  1 Mark]
	D	What are the complications of this condition?	[  1 Mark]
	E	What the surgical treatment	[  1 Mark]

 

4	A 69-year-old man attends the vascular clinic complaining of a cramping pain in the right calf on walking about 250 meters. The pain is worse on an incline and is quickly relieved by rest. The pain is then reproduced after walking the same distance.
	A	What is the most likely diagnosis?	[  1Mark]
	B	What is patent’s symptom called?	[  1 Mark]
	C	What clinical test is required on the patient?	[  1 Mark]
	D	What other investigations are required?	[  1 Mark]
	E	Outline the treatment	[  1 Mark]

 

 

5	A 56-year-old woman was admitted for 2 episodes of vomiting fresh blood with clots. The bleeding was sudden, and the blood was bright red. There was no pain. After the second episode, she felt dizzy and lethargic. She was slightly emaciated mildly jaundiced and pale. She had bilateral pedal oedema. The abdomen was markedly distended with positive fluid thrill and shifting dullness.
	A	What are the possible diagnoses?	[  1Mark]
	B		[  1 Mark]
	C	This is an image taken on OGDS. What does it show?	[  1 Mark]
	D	What is the definitive treatment for the patient?	[  1 Mark]
	E	What is long term management pf the patient?	[  1 Mark]