IMM Orthopaedic Guess Paper — Paper 1 (General Surgery)
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Section 1: Trauma & ATLS Principles
(Ref: Syllabus “Trauma (Initial Assessment and Resuscitation on ATLS Principles)” )
- A 25-year-old male is brought to the ER after a road traffic accident. He is confused, pale, and has a heart rate of 130 bpm. His blood pressure is 80/50 mmHg, and respiratory rate is 35/min. According to ATLS guidelines, which class of hemorrhagic shock does this represent?
- A) Class I
- B) Class II
- C) Class III
- D) Class IV
- E) Class V
- Correct Answer: D (Class IV implies >40% blood loss, significant tachycardia, and hypotension)
- During the primary survey of a polytrauma patient, you identify a tension pneumothorax. What is the immediate management step?
- A) Chest X-ray
- B) Needle decompression
- C) Tube thoracostomy
- D) CT Scan Chest
- E) Intubation
- Correct Answer: B (Needle decompression is immediate; tube thoracostomy follows)
- A patient with blunt abdominal trauma is hemodynamically unstable. The FAST scan is positive for free fluid. What is the most appropriate next step?
- A) Contrast CT Abdomen
- B) Diagnostic Peritoneal Lavage (DPL)
- C) Urgent Exploratory Laparotomy
- D) Blood transfusion and observation
- E) Angiography
- Correct Answer: C
- Which of the following is the most sensitive clinical sign of developing compartment syndrome in a patient with a tibial fracture?
- A) Pallor
- B) Pulselessness
- C) Paralysis
- D) Pain out of proportion to injury
- E) Paresthesia
- Correct Answer: D
- A 30-year-old male sustains a head injury. His eyes open to pain, he speaks incomprehensible sounds, and withdraws from pain. What is his GCS score?
- A) 6
- B) 7
- C) 8
- D) 9
- E) 10
- Correct Answer: C (E2 + V2 + M4 = 8)
- In a patient with neurogenic shock following a high cervical spine injury, which clinical finding is characteristic?
- A) Tachycardia and Hypotension
- B) Bradycardia and Hypotension
- C) Tachycardia and Hypertension
- D) Cool, clammy skin
- E) Narrow pulse pressure
- Correct Answer: B (Loss of sympathetic tone leads to bradycardia and hypotension)
- What is the preferred site for diagnostic peritoneal lavage (DPL) in a patient with a suspected pelvic fracture?
- A) Infra-umbilical open technique
- B) Infra-umbilical closed technique
- C) Supra-umbilical open technique
- D) Left iliac fossa
- E) Right iliac fossa
- Correct Answer: C (Supra-umbilical prevents entering a pelvic hematoma)
- A trauma patient arrives with a sucking chest wound. The immediate management is:
- A) Intubation
- B) Occlusive dressing taped on three sides
- C) Occlusive dressing taped on four sides
- D) Thoracotomy
- E) Positive pressure ventilation
- Correct Answer: B
- Which fluid is the initial crystalloid of choice for resuscitation in burn patients according to the Parkland formula?
- A) 5% Dextrose
- B) 0.9% Normal Saline
- C) Ringer’s Lactate
- D) 0.45% Saline
- E) Dextrose Saline
- Correct Answer: C
- In a patient with flail chest, the primary cause of hypoxia is:
- A) Rib fractures
- B) Pain
- C) Pulmonary contusion
- D) Paradoxical chest movement
- E) Hemothorax
- Correct Answer: C
- The “lethal triad” of trauma consists of:
- A) Hypothermia, Acidosis, Coagulopathy
- B) Hyperthermia, Alkalosis, Coagulopathy
- C) Hypertension, Bradycardia, Irregular respiration
- D) Hypoxia, Hypercapnia, Acidosis
- E) Hypotension, Tachycardia, Tachypnea
- Correct Answer: A
- A patient falls from a height and lands on his feet. He complains of back pain. Which spinal fracture is most commonly associated with a calcaneal fracture?
- A) Cervical
- B) Thoracolumbar junction (T12-L1)
- C) Sacral
- D) Mid-thoracic
- E) High lumbar
- Correct Answer: B
- According to ATLS, what is the first priority in the management of a trauma patient?
- A) Circulation with hemorrhage control
- B) Airway maintenance with C-spine protection
- C) Breathing and ventilation
- D) Disability assessment
- E) Exposure and environmental control
- Correct Answer: B
- Which organ is most commonly injured in blunt abdominal trauma?
- A) Liver
- B) Kidney
- C) Spleen
- D) Pancreas
- E) Intestine
- Correct Answer: C
- Massive blood transfusion is defined as the replacement of a patient’s total blood volume within:
- A) 12 hours
- B) 24 hours
- C) 36 hours
- D) 48 hours
- E) 6 hours
- Correct Answer: B
Section 2: Fluid, Electrolytes & Acid-Base Balance
(Ref: Syllabus “Fluid & electrolytes”, “Acid base balance” )
- A post-operative patient has a serum potassium level of 6.5 mEq/L and ECG changes (peaked T waves). What is the immediate first-line treatment to stabilize the cardiac membrane?
- A) IV Sodium Bicarbonate
- B) IV Calcium Gluconate
- C) Insulin and Glucose
- D) Nebulized Salbutamol
- E) Loop Diuretics
- Correct Answer: B
- A patient with pyloric stenosis presents with persistent vomiting. Which metabolic abnormality is most likely?
- A) Metabolic Acidosis
- B) Hypochloremic Metabolic Alkalosis
- C) Respiratory Acidosis
- D) Respiratory Alkalosis
- E) Hyperkalemic Metabolic Acidosis
- Correct Answer: B
- The daily maintenance fluid requirement for a healthy 70kg adult is approximately:
- A) 15-20 ml/kg/day
- B) 25-30 ml/kg/day
- C) 40-50 ml/kg/day
- D) 10-15 ml/kg/day
- E) 60 ml/kg/day
- Correct Answer: B (approx. 2000-2500ml)
- ECG changes associated with Hypokalemia include:
- A) Peaked T waves
- B) U waves and flattened T waves
- C) Shortened QT interval
- D) Widened QRS complex
- E) Prolonged PR interval only
- Correct Answer: B
- “Third space” fluid loss refers to:
- A) Fluid loss via urine
- B) Fluid loss via sweat
- C) Sequestration of fluid into the interstitial space or body cavities
- D) Intracellular dehydration
- E) Blood loss during surgery
- Correct Answer: C
- Hypernatremia in a surgical patient is most commonly caused by:
- A) Excess Sodium intake
- B) Free water deficit
- C) Syndrome of Inappropriate ADH (SIADH)
- D) Renal failure
- E) Adrenal insufficiency
- Correct Answer: B
- Which solution is considered isotonic to plasma?
- A) 0.45% Saline
- B) 3% Saline
- C) 0.9% Saline
- D) 10% Dextrose
- E) 5% Dextrose in 0.45% Saline
- Correct Answer: C
- Refeeding syndrome in a malnourished patient can precipitate a life-threatening drop in which electrolyte?
- A) Sodium
- B) Chloride
- C) Phosphate
- D) Calcium
- E) Bicarbonate
- Correct Answer: C
- In metabolic acidosis, the compensatory mechanism is:
- A) Hypoventilation
- B) Hyperventilation (Kussmaul breathing)
- C) Renal excretion of bicarbonate
- D) Renal retention of hydrogen ions
- E) Hepatic metabolism of lactate
- Correct Answer: B
- The most common cause of hypocalcemia in the immediate post-thyroidectomy period is:
- A) Bone hunger
- B) Parathyroid vascular compromise or removal
- C) Renal failure
- D) Vitamin D deficiency
- E) Calcitonin release
- Correct Answer: B
Section 3: Surgical Infection & Sterilization
(Ref: Syllabus “Surgical infections”, “Sterilization and disinfection” )
- Which of the following is an example of a “Clean-Contaminated” wound?
- A) Hernia repair
- B) Elective Cholecystectomy
- C) Perforated diverticulitis
- D) Traumatic wound > 4 hours old
- E) Breast biopsy
- Correct Answer: B (Controlled entry into hollow viscus)
- Gas gangrene is most commonly caused by:
- A) Staphylococcus aureus
- B) Streptococcus pyogenes
- C) Clostridium perfringens
- D) Pseudomonas aeruginosa
- E) Escherichia coli
- Correct Answer: C
- The most effective method for sterilization of surgical instruments is:
- A) Boiling water
- B) Autoclaving (Moist heat under pressure)
- C) Glutaraldehyde
- D) Alcohol
- E) Povidone-iodine
- Correct Answer: B
- Which feature best distinguishes a carbuncle from a furuncle?
- A) Caused by Streptococcus
- B) Involves subcutaneous tissue with multiple discharging sinuses
- C) Occurs only on the face
- D) Less painful
- E) Responds to topical antibiotics alone
- Correct Answer: B
- Prophylactic antibiotics for elective surgery should ideally be administered:
- A) 24 hours before surgery
- B) Within 60 minutes prior to incision
- C) Immediately after skin closure
- D) Only if pus is encountered
- E) For 5 days post-operatively
- Correct Answer: B
- Which organism is the most common cause of Surgical Site Infection (SSI)?
- A) E. Coli
- B) Staphylococcus aureus
- C) Klebsiella
- D) Bacteroides
- E) Pseudomonas
- Correct Answer: B
- Tetanus toxin acts by:
- A) Blocking release of acetylcholine
- B) Blocking release of inhibitory neurotransmitters (GABA/Glycine)
- C) Direct muscle necrosis
- D) Causing hemolysis
- E) Inhibiting protein synthesis
- Correct Answer: B
- Synergistic gangrene (Meleney’s gangrene) typically involves:
- A) Only aerobic bacteria
- B) Only anaerobic bacteria
- C) A combination of microaerophilic streptococci and Staph aureus
- D) Clostridium tetani
- E) Fungal infection
- Correct Answer: C
- Standard precautions (Universal Precautions) primarily aim to prevent transmission of:
- A) Airborne diseases
- B) Blood-borne pathogens (HIV, HBV, HCV)
- C) Fecal-oral diseases
- D) Vector-borne diseases
- E) Droplet infections
- Correct Answer: B
- The definition of SIRS (Systemic Inflammatory Response Syndrome) includes all EXCEPT:
- A) Temperature >38°C or <36°C
- B) Heart rate >90 bpm
- C) Respiratory rate >20/min or PaCO2 <32 mmHg
- D) WBC >12,000 or <4,000
- E) Hypotension (SBP <90 mmHg)
- Correct Answer: E (SIRS criteria are clinical/lab; Hypotension defines sepsis/shock)
Section 4: Wound Healing & Management
(Ref: Syllabus “Principles of wound healing” )
- Which cell is central to wound healing, responsible for collagen production and contraction?
- A) Macrophage
- B) Neutrophil
- C) Fibroblast
- D) Lymphocyte
- E) Platelet
- Correct Answer: C
- A Keloid scar differs from a Hypertrophic scar because a Keloid:
- A) Remained confined to the wound margins
- B) Extends beyond the original wound margins
- C) Improves spontaneously over time
- D) Occurs mainly on the face
- E) Has a low recurrence rate after excision
- Correct Answer: B
- The phase of wound healing characterized by angiogenesis and collagen deposition is:
- A) Hemostasis
- B) Inflammation
- C) Proliferation
- D) Remodeling
- E) Maturation
- Correct Answer: C
- Delayed primary closure is indicated for:
- A) Clean surgical incisions
- B) Heavily contaminated or infected wounds
- C) Small lacerations on the face
- D) Skin grafts
- E) Biopsy sites
- Correct Answer: B
- Vitamin C is essential for wound healing because it is required for:
- A) Epithelialization
- B) Hydroxylation of proline and lysine in collagen synthesis
- C) Coagulation cascade
- D) Prevention of infection
- E) Muscle contraction
- Correct Answer: B
- Which factor is the most potent inhibitor of wound healing?
- A) Anemia (mild)
- B) Infection
- C) Old age
- D) Vitamin C deficiency
- E) Hypothyroidism
- Correct Answer: B
- Marjolin’s ulcer refers to:
- A) A pressure sore
- B) Squamous cell carcinoma arising in a chronic wound/scar
- C) A venous ulcer
- D) A diabetic foot ulcer
- E) A rodent ulcer
- Correct Answer: B
- Vacuum Assisted Closure (VAC) therapy promotes healing by:
- A) Increasing bacterial load
- B) Removing edema fluid and promoting granulation tissue
- C) Delivering antibiotics locally
- D) Preventing scab formation
- E) Cooling the wound
- Correct Answer: B
- The tensile strength of a healed wound eventually reaches approximately what percentage of uninjured skin?
- A) 100%
- B) 80%
- C) 50%
- D) 30%
- E) 10%
- Correct Answer: B
- Which suture material is non-absorbable?
- A) Catgut
- B) Vicryl (Polyglactin)
- C) Monocryl (Poliglecaprone)
- D) Prolene (Polypropylene)
- E) PDS (Polydioxanone)
- Correct Answer: D
Section 5: Perioperative Care & Complications
(Ref: Syllabus “Perioperative care”, “Postop complications” )
- The most common cause of fever in the first 24 hours post-operatively is:
- A) Wound infection
- B) Atelectasis
- C) Deep Vein Thrombosis (DVT)
- D) Urinary Tract Infection (UTI)
- E) Anastomotic leak
- Correct Answer: B
- Virchow’s triad for the pathogenesis of DVT includes:
- A) Stasis, Hypercoagulability, Endothelial injury
- B) Hypertension, Hyperglycemia, Hyperlipidemia
- C) Age, Obesity, Immobility
- D) Pain, Pallor, Pulselessness
- E) Infection, Inflammation, Ischemia
- Correct Answer: A
- Which of the following suggests a diagnosis of Pulmonary Embolism (PE)?
- A) Bradycardia and Bradypnea
- B) Sudden onset dyspnea, pleuritic chest pain, and tachycardia
- C) Productive cough with fever
- D) Gradual onset of leg swelling
- E) Hypertension and headache
- Correct Answer: B
- Burst abdomen (wound dehiscence) is most often associated with:
- A) Use of non-absorbable sutures
- B) Skin clips
- C) Deep wound infection and increased intra-abdominal pressure
- D) Early mobilization
- E) Young age
- Correct Answer: C
- When is the optimal time to stop smoking before elective surgery to reduce pulmonary complications?
- A) 12 hours
- B) 1 week
- C) 2 weeks
- D) 4-8 weeks
- E) 6 months
- Correct Answer: D
- The ASA (American Society of Anesthesiologists) classification for a patient with severe systemic disease that is a constant threat to life is:
- A) ASA I
- B) ASA II
- C) ASA III
- D) ASA IV
- E) ASA V
- Correct Answer: D
- Malignant Hyperthermia is triggered by:
- A) Propofol
- B) Suxamethonium (Succinylcholine) and volatile agents
- C) Fentanyl
- D) Ketamine
- E) Local anesthetics
- Correct Answer: B
- The most reliable test to confirm proper endotracheal tube placement is:
- A) Chest movement
- B) Auscultation of breath sounds
- C) Capnography (End-tidal CO2)
- D) Pulse oximetry
- E) Mist in the tube
- Correct Answer: C
- Post-spinal anesthesia headache is caused by:
- A) Meningitis
- B) CSF leakage through the dural puncture site
- C) Hypertension
- D) Drug reaction
- E) High spinal block
- Correct Answer: B
- Pre-operative fasting guidelines for clear fluids allow intake up to:
- A) 6 hours before surgery
- B) 4 hours before surgery
- C) 2 hours before surgery
- D) 8 hours before surgery
- E) Midnight before surgery
- Correct Answer: C
Section 6: Critical Care (ICU) & Nutrition
(Ref: Syllabus “Critical Care”, “Nutrition in ICU” )
- Adult Respiratory Distress Syndrome (ARDS) is characterized by:
- A) Left heart failure
- B) High pulmonary capillary wedge pressure
- C) Bilateral pulmonary infiltrates and Hypoxemia (PaO2/FiO2 < 300)
- D) Hypercapnia alone
- E) Pneumothorax
- Correct Answer: C
- The preferred route of nutrition in a critically ill patient with a functional gut is:
- A) Total Parenteral Nutrition (TPN) via central line
- B) Peripheral Parenteral Nutrition (PPN)
- C) Enteral Nutrition
- D) Oral glucose only
- E) NPO for 7 days
- Correct Answer: C
- Central Venous Pressure (CVP) mainly reflects:
- A) Left ventricular function
- B) Right ventricular filling pressure (Preload)
- C) Cardiac output
- D) Systemic vascular resistance
- E) Aortic pressure
- Correct Answer: B
- Dopamine at low doses (renal dose) primarily stimulates:
- A) Alpha receptors
- B) Beta-1 receptors
- C) Dopaminergic receptors
- D) Beta-2 receptors
- E) Muscarinic receptors
- Correct Answer: C
- A patient in septic shock remains hypotensive despite adequate fluid resuscitation. The next step is:
- A) More crystalloids
- B) Blood transfusion
- C) Start Vasopressors (e.g., Noradrenaline)
- D) Give Steroids
- E) Give Diuretics
- Correct Answer: C
- Which parameter is best for monitoring oxygen delivery to tissues?
- A) Pulse oximetry
- B) Mixed venous oxygen saturation (SvO2) or Lactate levels
- C) Hemoglobin
- D) Blood pressure
- E) Urine output
- Correct Answer: B
- The caloric density of fat in TPN is approximately:
- A) 4 kcal/g
- B) 6 kcal/g
- C) 9 kcal/g
- D) 3.4 kcal/g
- E) 2 kcal/g
- Correct Answer: C
- Criteria for brain death include all EXCEPT:
- A) Deep coma (GCS 3)
- B) Absent brainstem reflexes
- C) Apnea test positive
- D) Spinal reflexes (e.g., knee jerk)
- E) Known irreversible cause
- Correct Answer: D (Spinal reflexes may remain intact in brain death)
- The most common complication of central venous catheterization is:
- A) Pneumothorax
- B) Air embolism
- C) Arterial puncture
- D) Catheter related sepsis
- E) Arrhythmia
- Correct Answer: A (during insertion), D (long term) – Usually “Pneumothorax” is the acute answer for insertion risks.
- Disseminated Intravascular Coagulation (DIC) is characterized by:
- A) High platelets, Low PT/APTT
- B) Low platelets, Prolonged PT/APTT, Low Fibrinogen
- C) Normal platelets, Prolonged Bleeding time
- D) Thrombocytosis
- E) High Fibrinogen
- Correct Answer: B
Section 7: General Surgical Conditions & Competencies
(Ref: Mini-CEX topics “Breast, Thyroid, Hernia”, Syllabus “Specific infection”, “Hemorrhage” )
- A 45-year-old female presents with a painless, hard breast lump. The most appropriate initial investigation triad (Triple Assessment) includes:
- A) Clinical exam, Ultrasound, MRI
- B) Clinical exam, Imaging (Mammogram/US), Pathology (Core biopsy/FNAC)
- C) MRI, CT Scan, PET Scan
- D) Clinical exam, Tumor markers, Reassurance
- E) Excision biopsy directly
- Correct Answer: B
- The most common type of hernia in females is:
- A) Direct Inguinal Hernia
- B) Indirect Inguinal Hernia
- C) Femoral Hernia
- D) Umbilical Hernia
- E) Incisional Hernia
- Correct Answer: B (Although femoral hernias are more common in women than men, Indirect Inguinal is still the most common hernia overall in women). Note: If the question asks “Which hernia has the highest risk of strangulation in females?” -> Femoral.
- Which nerve is at risk during a submandibular gland excision?
- A) Marginal mandibular branch of Facial nerve
- B) Recurrent laryngeal nerve
- C) Spinal accessory nerve
- D) Vagus nerve
- E) Phrenic nerve
- Correct Answer: A
- A patient presents with a midline neck swelling that moves up with swallowing and tongue protrusion. The diagnosis is:
- A) Thyroid nodule
- B) Thyroglossal cyst
- C) Branchial cyst
- D) Dermoid cyst
- E) Lipoma
- Correct Answer: B
- In acute appendicitis, the pain typically shifts from:
- A) Right iliac fossa to Umbilicus
- B) Umbilicus to Right iliac fossa
- C) Epigastrium to Left iliac fossa
- D) Back to Groin
- E) Right hypochondrium to Scapula
- Correct Answer: B
- Murphy’s sign is specific for:
- A) Acute Appendicitis
- B) Acute Cholecystitis
- C) Acute Pancreatitis
- D) Pyelonephritis
- E) Diverticulitis
- Correct Answer: B
- A “Sentinel Loop” on abdominal X-ray suggests:
- A) Intestinal Obstruction
- B) Localized paralytic ileus due to adjacent inflammation (e.g., Pancreatitis)
- C) Sigmoid Volvulus
- D) Pneumoperitoneum
- E) Gallstone ileus
- Correct Answer: B
- The most common cause of small bowel obstruction in adults is:
- A) Hernias
- B) Adhesions
- C) Malignancy
- D) Volvulus
- E) Intussusception
- Correct Answer: B
- Which triangle is the anatomical landmark for inguinal hernia repair?
- A) Femoral Triangle
- B) Hesselbach’s Triangle
- C) Calot’s Triangle
- D) Posterior Triangle
- E) Suboccipital Triangle
- Correct Answer: B
- The definitive treatment for a tension hydrocele in an adult is:
- A) Aspiration
- B) Lord’s plication or Jaboulay procedure
- C) Antibiotics
- D) Scrotal support
- E) Orchidectomy
- Correct Answer: B
- A fistula-in-ano most commonly originates from:
- A) Diverticulitis
- B) Crohn’s disease
- C) Cryptoglandular infection (Infected anal gland)
- D) Trauma
- E) Tuberculosis
- Correct Answer: C
- The investigation of choice for a patient with obstructive jaundice is:
- A) Plain X-ray abdomen
- B) Ultrasound Abdomen
- C) HIDA Scan
- D) Laparoscopy
- E) Barium swallow
- Correct Answer: B (First line). MRCP/ERCP may follow.
- Which of the following thyroid carcinomas has the best prognosis?
- A) Papillary carcinoma
- B) Follicular carcinoma
- C) Medullary carcinoma
- D) Anaplastic carcinoma
- E) Lymphoma
- Correct Answer: A
- Fine Needle Aspiration Cytology (FNAC) cannot distinguish between:
- A) Papillary carcinoma and Normal thyroid
- B) Follicular adenoma and Follicular carcinoma
- C) Medullary carcinoma and Colloid nodule
- D) Thyroiditis and Carcinoma
- E) Lymphoma and Cyst
- Correct Answer: B (Requires histological evidence of capsular/vascular invasion)
- In a patient with Acute Pancreatitis, which enzyme is specific for diagnosis?
- A) ALP
- B) ALT
- C) Serum Amylase and Lipase
- D) GGT
- E) CPK
- Correct Answer: C (Lipase is more specific)
- “Coffee bean sign” on abdominal X-ray is characteristic of:
- A) Cecal Volvulus
- B) Sigmoid Volvulus
- C) Small bowel obstruction
- D) Intussusception
- E) Perforation
- Correct Answer: B
- The most common complication of ERCP is:
- A) Bleeding
- B) Perforation
- C) Pancreatitis
- D) Cholangitis
- E) Cholecystitis
- Correct Answer: C
- A diabetic patient presents with a foot ulcer and cellulitis. The most likely organisms are:
- A) Staphylococcus aureus only
- B) Pseudomonas only
- C) Polymicrobial (Gram +ve, Gram -ve, and Anaerobes)
- D) Fungal
- E) Mycobacterial
- Correct Answer: C
- For a dog bite, the wound should be:
- A) Sutured immediately
- B) Left open and irrigated copiously
- C) Treated with topical steroids
- D) Cauterized
- E) Grafted immediately
- Correct Answer: B (To prevent infection; never suture bite wounds immediately)
- The primary treatment for primary varicose veins with sapheno-femoral incompetence is:
- A) Compression stockings only
- B) Antibiotics
- C) Trendelenburg operation (Ligation) + Stripping or Endovenous ablation
- D) Skin grafting
- E) Femoral popliteal bypass
- Correct Answer: C
- Pain in the right hypochondrium radiating to the right scapula/shoulder is typical of:
- A) Gastritis
- B) Renal colic
- C) Biliary colic (Gallbladder pathology)
- D) Splenic rupture
- E) Appendicitis
- Correct Answer: C
- In a patient with upper GI bleeding, the most common cause is:
- A) Esophageal varices
- B) Peptic Ulcer Disease
- C) Mallory-Weiss tear
- D) Gastric cancer
- E) Dieulafoy’s lesion
- Correct Answer: B
- Which artery is the primary blood supply to the breast?
- A) Lateral thoracic
- B) Internal Mammary (Internal Thoracic)
- C) Thoracoacromial
- D) Intercostal arteries
- E) Subscapular
- Correct Answer: B (Internal Mammary provides ~60%)
- An anal fissure is most commonly located at:
- A) 12 o’clock (Anterior midline)
- B) 6 o’clock (Posterior midline)
- C) 3 o’clock (Left lateral)
- D) 9 o’clock (Right lateral)
- E) Multiple positions
- Correct Answer: B
- Courvoisier’s Law states that a palpable, non-tender gallbladder in a jaundiced patient suggests:
- A) Gallstones
- B) Acute cholecystitis
- C) Malignancy of the pancreas or biliary tree
- D) Hepatitis
- E) Hemolytic anemia
- Correct Answer: C
Section 8: Miscellaneous & Basic Skills
(Ref: Syllabus “Biopsy techniques”, “Chest tube”, “Energy devices” )
- When inserting a chest tube, the safe triangle is bounded by:
- A) Pectoralis major, Latissimus dorsi, 5th intercostal space
- B) Sternum, Clavicle, Nipple
- C) Rectus abdominis, Inguinal ligament, Iliac crest
- D) Trapezius, Scapula, Spine
- E) Deltoid, Pectoralis minor, 2nd rib
- Correct Answer: A
- Monopolar diathermy should be avoided or used with caution in patients with:
- A) Metal implants (e.g., hip prosthesis)
- B) Cardiac Pacemakers
- C) Diabetes
- D) Hypertension
- E) Obesity
- Correct Answer: B (Interference; Bipolar is preferred)
- Which local anesthetic has the highest risk of cardiotoxicity?
- A) Lidocaine
- B) Bupivacaine
- C) Prilocaine
- D) Procaine
- E) Ropivacaine
- Correct Answer: B
- The maximum safe dose of Lidocaine with Adrenaline is:
- A) 3 mg/kg
- B) 5 mg/kg
- C) 7 mg/kg
- D) 10 mg/kg
- E) 15 mg/kg
- Correct Answer: C (Without adrenaline is usually 3-4.5 mg/kg)
- In which part of the body is the use of Adrenaline with local anesthetic contraindicated?
- A) Scalp
- B) Back
- C) Digits (Fingers/Toes), Penis, Ear lobule
- D) Abdomen
- E) Thigh
- Correct Answer: C (End arteries – risk of ischemia)
- During Trucut biopsy of a breast lump, the needle should pass through:
- A) The nipple
- B) The areola
- C) Normal skin directly over the lump
- D) The axilla
- E) The inframammary fold
- Correct Answer: C
- The correct position for a patient undergoing Digital Rectal Examination (DRE) is:
- A) Supine
- B) Left Lateral (Sims) position
- C) Trendelenburg
- D) Prone
- E) Sitting
- Correct Answer: B
- Which of the following is an absorbable suture material?
- A) Silk
- B) Nylon (Ethilon)
- C) Polypropylene (Prolene)
- D) Polyglactin (Vicryl)
- E) Steel wire
- Correct Answer: D
- A “Time-out” in surgery refers to:
- A) Coffee break for the surgeon
- B) Anesthesia induction time
- C) Final verification of correct patient, site, and procedure before incision
- D) Post-op recovery period
- E) Sterilization cycle
- Correct Answer: C
- The half-life of albumin is approximately:
- A) 2 hours
- B) 2 days
- C) 7 days
- D) 20 days
- E) 3 months
- Correct Answer: D (Hence not a good marker for acute nutritional change)
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