Download University of Jaffna (University of Sri Lanka) MBBS (Bachelor of Medicine and Bachelor of Surgery) 2021 July Surgery Paper II Previous Question Paper
UNIVERSITY OF JAFFNA, SRI LANKA
FINAL EXAMINATION FOR MEDICAL DEGREES (2 nd) -- July 2021
SURGERY -- PAPER II
Date: 29.07.2021
Time: 03 hours
1.30 p.m. -- 4.30 p.m.
Answer all TEN questions
Please answer the questions in the given space.
1. A 50-year-old man who is a known patient with diabetes mellitus was admitted to the hospital with
high fever, confusion and Iow 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.
I .1. Define the term Sepsis.
(10 marks)
1.2. List three (3) possible micro-organisms responsible for urosepsis in this patient.
(10 marks)
1.3_ Explain the patho-physiology for above clinical findings.
(30 marks)
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UNIVERSITY OF JAFFNA, SRI LANKA FINAL EXAMINATION FOR
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1.4. 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 crn obstructing
stone at left proximal ureter.
1.5. What is the next important step in the management after initial resuscitation? (10 marks)
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UNIVERSITY OF JAFFNA, SRI LANKA
FINAL EXAMLNATION FOR MEDICAL DEGREES (2nd) -- July 2021
SURGERY -- PAPER II
2.
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.
2.1. 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.
2.2. 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
2.3. What type of intravenous fluid should be administered initially in this patient and why?
(10 marks)
2.4.What would be the indications for giving blood transfusion in a trauma patient?
(10 marks )
He was brought in wearing a cervical collar.
2.5.How will you decide if it needs to be kept on?
(20 marks).
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UNIVERSITY OF JAFFNA, SRI LANKA FINAL EXAMINATION
FOR MEDICAL DEGREES (2 nd) -- July 2021 SURGERY -- PAPER
II
3. A 30-year-old toddy tapper was brought to Accident & Emergency following fall from 20 feet
high palrnyrah 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.
3.1. What is the diagnosis or his condition?
(10 marks)
3.2.List the initial management during your primary survey.
(20 marks)
3.3.What imaging would help in management of this patient?
(20 marks)
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UNIVERSITY OF JAFFNA, SRI LANKA FL AL EXAMINATION FOR MEDICAL
DEGREES (2nd) -- July 2021 SURGERY -- PAPER II
3.4.0utline the long term management
(50 marks)
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4. A 56-year-old man presented with bleeding per rectum for three months. fle was found to have
rectal carcinoma with a synchronous lesion in the sigmoid colon
4.1.What is synchronous lesion?
(05 marks)
4.2.Mention the investigations used to stage clinical condition of this patient. (20 marks)
At the MDT meeting, it was decided to give neo adjuvant cherno-radiation to this patient_
4,3.1VIention the possible reason for the above decision_
(15 marks)
4.4. hat would be the likely surgical treatment after chemo-radiation?
(10 marks)
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UNIVERSITY OF JAFFNA, SRI LANKA FINAL EXAMINATION
FOR MEDICAL DEGREES (2 nd) -- July 2021 SURGERY --
PAPER II
4.5.Mention the important aspects of taking consent for the above operation. (10 marks)
4.6.()utline the pre-operative preparation of this patient
(30 marks)
4.7.Mention the likely postoperative complications of surgery mentioned above in 4.4.
(I. 0 marks)
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UNIVERSITY OF JAFFNA, SRI LANKA FINAL EXAMINATION
FOR MEDICAL DEGREES (2nd) -- July 2021 SURGERY --
PAPER II
5. A 72-year-old man referred to surgical clinic for worsening lower urinary tract symptoms
(LUTS).
(10 marks)
5.1. hat do you understand by lower urinary tract
(20 marks)
5.2.List five (5) voiding LUTS and five (5) storage LUTS.
Voiding LUTS:
Storage LUTS:
5. .Explain the following;
"LUTS is neither gender specific nor organ specific"
(10 marks)
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UNIVERSITY OF JAFFNA, SRI LANKA FINAL EXAMINATION
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SURGERY -- PAPER II
5.4.List five (5) common causes for LUTS in this man.
(10 marks)
5.5.Brietly describe how will you assess him (History and Examination) in ward?
(35 marks)
5.6.How will you investigate him?
(15 marks)
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UNIVERSITY OF JAFFNA, SRI LANKA. FINAL EXAMINATION
FOR MEDICAL DEGREES (2nd) - July 2021
SURGERY -- PAPER II
6. 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.
6.1. What do you understand by solitary nodule of thyroid?
(10 marks)
62.Mention three likely causes for the clinical presentation of this patient.
(15 marks)
6.3.Outline the important investigations to arrive at a diagnosis.
(25 marks)
On further evaluation it was found to be malignant thyroid lesion.
6.4.What is the most likely malignancy in this patient?
(10 marks)
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DEGREES (2 nd) -- July 2021 SURGERY -- PAPER II
6.5.Mention the reason for your answer you mentioned above in 6.4.
(10 marks)
6.6.What is the management of the condition mentioned above in 6.4?
(20 marks)
6.7.Mention the immediate postoperative complications if she underwent total thyroidectomy
with bilateral cervical node dissection.
(10 marks)
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UNIVERSITY OF JAFFNA, SRI LANKA FINAL EXAMINATION FOR MEDICAL
DEGREES (2nd) -- July 2021 SURGERY -- PAPER II
7. A 55-year-old school teacher was admitted to the surgical emergency with a history of
yellowish discolouration of sclera of five weeks duration.
7. 1 . What are the features in the history and physical examination suggestive that the jaundice
is the obstructive type?
(30 marks)
History:
Physical Examination:
7. .Mention five (5) causes for the obstructive jaundice.
(20 marks)
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UNIVERSITY OF JAFFNA, SRI LANKA FINAL EXAMINATION
FOR MEDICAL DEGREES (2") -- July 2021
SURGERY -- PAPER II
7.3.List five (5) laboratory tests you would do in this patient?
(15 marks)
7.4 Mention three (3) imaging you would do in this patient to identify the cause for the
obstructive jaundice.
(15 marks)
On the 2'd day of admission she developed the clinical features of ascending cholangitis.
7. 5. Outline the management of ascending cholangitis
(20 marks)
UNIVERSITY OF JAFFNA, SRI LANKA FINAL EXAMINATION FOR MEDICAL
DEGREES (2 nd) -- July 2021 SURGERY -- PAPER II
8. 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 comorhid
diseases. He was diagnosed to have lymphoedema,
8.1.Define the term lymphoedem a.
(10 marks)
8.2.Mention five (5) causes of Lymphoedema.
(15 marks)
8.3 . Mention five (5) clinical features of Lymphoedema.
(10 marks)
8.4.List five (5) protective measures to prevent Lymphoedema in a vulnerable limb.
(15 marks)
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SURGERY -- PAPER H
8.5. List two (2) complications of Lymphoedema.
(10 marks)
8.6 List the investigations which help in the management of the lymphedema.
(10 marks)
8.7. Briefly describe the management of a patient with Lymphoedema.
(30 marks)
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UNIVERSITY OF JAFFNA, SRI LANKA FINAL EXAMINATION FOR MEDICAL
DEGREES (2nd) -- July 2021 SURGERY -- PAPER II
9. 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.
9A. List five (5) pathological conditions cause melena.
(15 marks)
9.2.What could be a possible cause for melena in this lady?
(10 marks)
9.3.Mention five (5) etiological factors responsible for the above condition mentioned in 9.2.
(15 marks)
9.4.Mention the complications of the condition mentioned above in 9.2.
(15 marks)
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DEGREES (2nd) -- July 2021 SURGERY -- PAPER II
9.5.Briefly describe the management of this woman after admitting to the surgical
emergency.
(45 marks)
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DEGREES (2nd) -- July 2021 SURGERY -- PAPER II
10.
10.1. 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)
History:
Examination:
10.2. A 40-year-old lactating mother presented with a painful lump in her right breast of five
days duration.
10.2.1. Mention two (2) clinical diagnoses for her presentation.
(06 marks)
10.2.2. Mention three (3) relevant investigations with interpretation to arrive the diagnosis.
(15 marks)
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10.2.3. Enumerate the management of each condition mentioned above in 10.2.1.
(14 marks)
10.3. A 23-year-old woman attended the outpatient surgical clinic with a Jump in her right
breast of two years duration.
10.3.1. What is the most probable diagnosis?
(03 marks)
10,3,2. What findings in the physical examination of this
patient support the above
diagnosis?
(15 marks)
10.3.3. Mention the advice with explanation you would suggest for her condition,
(12 marks)
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This post was last modified on 19 October 2021