BENAZIR BHUTTO HOSPITAL, Surgical Unit-II

Final Year Ward TEST

Station 1
A 30 years old male patient presented in the emergency with a fire arm injury to
the abdomen in the Left hypochondrium. The blood pressure on presentation is
100/70 mm of Hg and pulse is 110/min.

1. Enlist your priorities in management of this patient. (3)

 Airway
 breathing
 circulation
 assessment of hemoperitoneum
 assessment of splenic rupture
 splenectomy

2. On subsequent laparotomy the patient is found to be having a 2X2 cm rent

in the proximal jejunum. What management option do you have regarding this
injury? (3)

Station 2
A 14 years old boy presents in the ER with complaints of severe pain in the Rt
testis radiating towards the upper abdomen. On examination the testis is found to
be retracted and with an abnormal lie. On inquiry pain was sudden in onset and is
persistent for last one hour.

1) What is the most likely diagnosis? (2)

Testicular torsion
 2) What is the management of this patient? (2)
 relieve pain
 give IV fluids
 prepare for surgery
 counsel about orchiectomy
 ORCHIDECTOMY
3) What is the most useful diagnostic tool that can be used in this patient?
(2)
clinical diagnosis
ultrasound may show reduced blood flow

Station 3
A patient presents in the OPD with a large swelling in front of neck which is
mobile with deglutition. The patient has a heart rate of 110/min and complains of
difficulty in swallowing and orthopnea which has progressively worsened over
time.

1. Is this pulse a reliable criterion to label the patient or arise suspicion of

hyperthyroidism? If not, what another CLINICAL TEST would you like to
perform that is more reliable? (2)

Pulse alone is not a reliable criterion to raise suspicion of hyperthyroidism

lid lag, lid retraction, proptosis.
 2. What investigation/imaging would you like to order to rule out the
possibility of retrosternal extension of this goiter? (2)
chest X ray
AP and Lat views

3. What drugs can be used to render a thyrotoxic patient euthyroid? Name

at least three drugs. (2)
 PTU
 Carbimazole
 Methimazole
 Propranolol
 iodides

Station 4
A 22 years old African patient has a history of excision of a sebaceous cyst from
the anterior wall of chest just in front of the sternum a few months ago. Now he
has presented with a raised unsightly scar at the site of this surgery.

1. What are the two possible diagnoses, assuming that this is an abnormal
scar? (2)
keloid formation
hematoma formation
recurrence
2. How would you clinically differentiate between the two possible
diagnoses? (1)

3. What are the possible management options? (3)

 Station 5

1. Name the above instrument (2)

Allis tissue forceps (clamp)
2. Is this instrument tissue damaging? (2)
Allis clamps can cause damage, so they are often used in tissue about to be removed.
3. On which tissues can this instrument be applied? (2)
 used to hold or grasp heavy tissue.
 It is also used to grasp fascia and soft tissues such as breast or bowel tissue.
 Allis clamps can cause damage, so they are often used in tissue about to be
removed.
 Station 6

1. Name this instrument. (2)

Artery forceps
A hemostat (also called a hemostatic clamp, arterial forceps)
2. Can this instrument be used in a vascular anastomosis? If not why? (2)
because it crushes the vessels and can induce permanent hemostasis
instead
3. What is the main use of this instrument? (2)
it is common in the initial phases of surgery for initial incision to be lined with hemostats
which close blood vessels awaiting ligation.

Station 7
A 60 years old female patient presented in the ER with complaints of pain in Rt
hypochondrium and jaundice (bilirubin- 15mg/dl). She had been experiencing
multiple episodes of vomiting and a fever of 103-degree Fahrenheit. She is a
known case of cholelithiasis which was diagnosed on ultrasound 6 months back.
Fresh USG scan shows cholelithiasis and a dilated CBD. CT Scan was performed in
the emergency and pancreas is normal as well as the serum amylase.
1. What is the diagnosis of this patient? (2)
Obstructed jaundice due to choledocholithiasis
2. How will you manage this patient? (2)
A. relieve pain
B. Anti-emetics if vomiting
C. adequate hydration
D. ERCP for removal of gallstones from CBD
E. choledochotomy via laparoscopy if ERCP fails.

interval cholecystectomy.

3. What options are available to bring down this patient’s bilirubin levels?
(2)
 Phototherapy
 albumin infusion
 Clofibrate