Index No.
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UNIVERSITY OF JAFFNA, SRI LANKA
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FINAL EXAMINATION FOR MEDICAL DEGREES (2nd) — July 2021
SURGERY — PAPER II
Date: 29.07.2021 Time: 03 hours
1.30 p.m. — 4.30 p.m.
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Answer all TEN questions
Please answer the questions in the given space.
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A 50-year-old man who is a known patient with diabetes mellitus was admitted to the hospital with high fever, confusion and low urine output. He had dysuria and left loin pain for 3 days. His blood pressure; 80/60 mmHg, pulse rate: 122 bpm, respiratory rate: 24 pm. He was clinically diagnosed as having Urosepsis.
- Define the term Sepsis. (10 marks)
- List three (3) possible micro-organisms responsible for urosepsis in this patient. (10 marks)
- Explain the patho-physiology for above clinical findings. (30 marks)
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Surgery - Final MBBS July 2 021 Page 1 of 20
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UNIVERSITY OF JAFFNA, SRI LANKA FINAL EXAMINATION FOR MEDICAL DEGREES (2nd) — July 2021 SURGERY PAPER II
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- Briefly describe the management of this patient during the next hour. (40 marks)
On further evaluation of this patient, US/KUB revealed left pyonephrosis and 1 cm obstructing stone at left proximal ureter.
- What is the next important step in the management after initial resuscitation? (10 marks)
Surgery. Final MBBS July 2021 Page 2 of 20
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A 30-year-old man is brought to the Accident and Emergency department by ambulance after he sustained injuries in a road traffic accident. The ambulance driver said that a witness to the accident reported that the patient was the driver of a car that struck an electricity post head on and was not wearing a seat belt. The patient was brought immobilized with a cervical collar and on a spinal board. He is conscious and complains of right sided chest pain.
- How will you carry out the immediate assessment of this patient? (30 marks)
During your assessment you observe that his breathing suddenly gets worse and he is struggling to talk. Pulse rate is 110/min, respirations are 40/min, and systolic blood pressure is 80 mmHg. The neck veins are distended. the trachea is displaced to the left, and the right side of the chest is hyper resonant to percussion with muffled breath sounds.
- What is the most likely cause for these findings and describe how you will manage it? (30 marks)
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UNIVERSITY OF JAFFNA, SRI LANKA FINAL EXAMINATION FOR MEDICAL DEGREES (2nd) July 2021 SURGERY PAPER II
- What type of intravenous fluid should be administered initially in this patient and why? (10 marks)
- What would be the indications for blood transfusion in a trauma patient? (10 marks)
He was brought in wearing a cervical collar.
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- How will you decide if it needs to be kept on? (20 marks).
Surgery Final MBBS July 2021 Page 4 of 20
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A 30-year-old toddy tapper was brought to Accident & Emergency following fall from 20 feet high palmyrah tree. On admission he was conscious and able to talk rationally without any noisy breathing. He complains of neck pain and unable to move all four limbs.
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- What is the diagnosis of his condition? (10 marks)
- List the initial management during your primary survey. (20 marks)
- What imaging would help in management of this patient? (20 marks)
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UNIVERSITY OF JAFFNA, SRI LANKA FINAL EXAMINATION FOR MEDICAL DEGREES (2nd) July 2021 SURGERY PAPER II
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- Outline the long term management (50 marks)
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A 56-year-old man presented with bleeding per rectum for three months. He was found to have rectal carcinoma with a synchronous lesion in the sigmoid colon
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- What is synchronous lesion? (05 marks)
- Mention the investigations used to stage clinical condition of this patient. (20 marks)
At the MDT meeting, it was decided to give neo adjuvant chemo-radiation to this patient
- Mention the possible reason for the above decision (15 marks)
- What would be the likely surgical treatment after chemo-radiation? (10 marks)
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Surgery - Final MBBS July 2021 Page 7 of 20
Index No ....................................
UNIVERSITY OF JAFFNA, SRI LANKA FINAL EXAMINATION FOR MEDICAL DEGREES (2 nd) — July 2021 SURGERY — PAPER II
- Mention the important aspects of taking consent for the above operation. (10 marks)
- Outline the pre-operative preparation of this patient (30 marks)
- Mention the likely postoperative complications of surgery mentioned above in 4.4. (10 marks)
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Surgery - Final MBBS July 2021 Page 8 of 20
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A 72-year-old man referred to surgical clinic for worsening lower urinary tract symptoms (LUTS).
- What do you understand by lower urinary tract (10 marks)
- List five (5) voiding LUTS and five (5) storage LUTS. (20 marks)
Voiding LUTS:
Storage LUTS:
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- Explain the following; "LUTS is neither gender specific nor organ specific" (10 marks)
Surgery - Final MBBS July 2021 Page 9 of 20
UNIVERSITY OF JAFFNA, SRI LANKA FINAL
- List five (5) common causes for LUTS in this man. (10 marks)
- Briefly describe how will you assess him (History and Examination) in ward? (35 marks)
- How will you investigate him? (15 marks)
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Surgery - Final MBBS July 2021 Page 10 of 20
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A 28-year-old woman presented with a solitary nodule on the left lobe of thyroid gland. She had enlarged cervical lymph nodes at level II on the ipsilateral side.
- What do you understand by solitary nodule of thyroid? (10 marks)
- Mention three likely causes for the clinical presentation of this patient. (15 marks)
- Outline the important investigations to arrive at a diagnosis. (25 marks)
On further evaluation it was found to be malignant thyroid lesion.
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- What is the most likely malignancy in this patient? (10 marks)
Surgery - Final MBBS July 2021 Page 11 of 20
UNIVERSITY OF JAFFNA, SRI LANKA FINAL EXAMINATION FOR MEDICAL
- Mention the reason for your answer you mentioned above in 6.4. (10 marks)
- What is the management of the condition mentioned above in 6.4? (20 marks)
- Mention the immediate postoperative complications if she underwent total thyroidectomy with bilateral cervical node dissection. (10 marks)
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A 55-year-old school teacher was admitted to the surgical emergency with a history of yellowish discolouration of sclera of five weeks duration.
- What are the features in the history and physical examination suggestive that the jaundice is the obstructive type? (30 marks)
History:
Physical Examination:
- Mention five (5) causes for the obstructive jaundice. (20 marks)
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Surgery - Final MBBS July 2021 Page 13 of 20
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UNIVERSITY OF JAFFNA, SRI LANKA FINAL EXAMINATION FOR MEDICAL DEGREES (2") — July 2021 SURGERY PAPER II
- List five (5) laboratory tests you would do in this patient? (15 marks)
- Mention three (3) imaging you would do in this patient to identify the cause for the obstructive jaundice. (15 marks)
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On the 2nd day of admission she developed the clinical features of ascending cholangitis.
- Outline the management of ascending cholangitis (20 marks)
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A 65-year-old man presented with right leg and foot swelling for 5-years duration. Intermittently he develops worsening of swelling with fever. He did not have other comorbid diseases. He was diagnosed to have lymphoedema,
- Define the term lymphoedema. (10 marks)
- Mention five (5) causes of Lymphoedema. (15 marks)
- Mention five (5) clinical features of Lymphoedema. (10 marks)
- List five (5) protective measures to prevent Lymphoedema in a vulnerable limb. (15 marks)
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Surgery Final MBBS July 2021 Page 15 of 20
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UNIVERSITY OF JAFFNA, SRI LANKA FINAL EXAMINATION FOR MEDICAL DEGREES (2nd) — July 2021 SURGERY
- List two (2) complications of Lymphoedema. (10 marks)
- List the investigations which help in the management of the lymphedema. (10 marks)
- Briefly describe the management of a patient with Lymphoedema. (30 marks)
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A 70-year-old woman presented with melena for two weeks duration. She has upper abdominal pain for the last one-year. She takes diclofenac sodium on and off for her lower back pain for past two years.
- List five (5) pathological conditions cause melena. (15 marks)
- What could be a possible cause for melena in this lady? (10 marks)
- Mention five (5) etiological factors responsible (15 marks)
- Mention the complications of the condition mentioned above in 9.2. (15 marks)
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Surgery Final MBBS July 2021 Page 17 of 20
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UNIVERSITY OF JAFFNA, SRI LANKA FINAL EXAMINATION FOR MEDICAL DEGREES (2nd) — July 2021 SURGERY
- Briefly describe the management of this woman after admitting to the surgical emergency. (45 marks)
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Surgery - Final MBBS July 2021 Page 18 of 20
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UNIVERSITY OF JAFFNA, SRI LANKA FINAL EXAMINATION FOR MEDICAL DEGREES (2nd) - July 2021 SURGERY PAPER II
- A 55-year-old man presented with a painful lump in his left breast for one year duration. Radiological and histopathological investigations revealed that the lump as Gynaecomastia. How history and physical examination would help to find the cause for the gynaecomastia in this patient? (35 marks)
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History:
Examination:
- A 40-year-old lactating mother presented with a painful lump in her right breast of five days duration.
- Mention two (2) clinical diagnoses for her presentation. (06 marks)
- Mention three (3) relevant investigations with interpretation to arrive the diagnosis. (15 marks)
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UNIVERSITY OF JAFFNA, SRI LANKA FINAL EXAMINATION FOR MEDICAL DEGREES (2nd) — July 2021 SURGERY — PAPER II
- Enumerate the management of each condition mentioned above in 10.2.1. (14 marks)
- A 23-year-old woman attended the outpatient surgical clinic with a lump in her right breast of two years duration.
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- What is the most probable diagnosis? (03 marks)
- What findings in the physical examination of this patient support the above diagnosis? (15 marks)
- Mention the advice with explanation you would suggest for her condition, (12 marks)
Surgery - Final MBBS July 2021 Page 20 of 20
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