KAMPALA INTERNATIONAL

UNIVERSITY
DEPARTMENT OF SURGERY

3rd YEAR 2009

THIS PAPER HAS TWO PARTS, A & B

PART A, has 50 MCQ questions: attempt all &

indicate the correct answer by circling on the

answer sheet given

PART B has two sections, I and II: Attempt all 4

questions (short notes) from section I and one from

section II

USE THE ANSWER SHEET

PROVIDED
 DO NOT WRITE OR MARK ANYTHING ON THIS

QUESTION PAPER WHICH SHOULD BE

HANDED IN AT THE END OF THE EXAMINATION

SACTION A

1 The following are absorbable sutures EXCEPT

a) Catgut
b) Silk
c) Chromic catgut
 d) polyglyconate (Maxon)
e) Polyglactin (Vicryl)

2 The following are wound complications except

a) Seroma
b) Subphrenic abscess
c) Haematoma
d) Hernia
e) Infection
3 Regarding peptic ulceration
a) H. pylori is a gram negative bacillus
b) Duodenal is more common than gastric
ulceration
c) Zollinger-Ellision syndrome is associated
with gastrin hyposecretion
d) H2 blockers will heal 85-95% of duodenal
ulcers in 8weeks
e) a, b, & d are correct

4. Which treatment after human bite of the hand is

inappropriate?
A) Surgical debridement
B) Wide spectrum iv antibiotics
C) Irrigation of the wound
D) Elevation of the arm
E) Primary closure after debridement

5 On examining Tuberculous ulcer, the following

signs are (is) present
a) AAFBS
b) Rolling margins
c) Sloping margins
d) Undermining margins
 e) A & c

6 Gaitano 15yrs old came with an ulcer on the lower

limb which had sloping margins, red colour and
bleeds easily no discharge. What would you do?
a) admitted, debride and do daily dressing
b) dress with honey gauze, debride, antibiotics
c) amputate, debridment, antibiotics
d) biopsy, excise widely and graft
e) non of the above

7 The above boy who had Hb of 12g/dl was

operated by a 3rd year medical student and lost
about 1litre of blood. What were the signs on
examination?
a) collapsed
b) reduced BP
c) reduced urine out put
d) rise pulse
e) cardiac arrest

8 In pyogenic arthritis of the shoulder

a) is very common
b) May spread from a focus of acute
osteomyelitis in upper humeral metaphysis
c) is usually insidious in onset
 d) present always late due to heavy
musculature over it
e) arthrotomy should never be done before x-
ray

9 In metabolic response to trauma, aldosterone is

secreted by
a) juxta-glomerular apparatus
b) Zona glomerulosa
c) Zona falculata
d) Renin-angiotensin apparatus
e) Pituitary gland

10 A teacher was sitting in his office when a

kerosene lamp exploded. He tried to extinguish the
flames. On admission both hands and face show
superficial burns. He is coughing, cyanotic,
respiratory rate over 40.Which is the adequate
management?
A) Administer oxygen
B) Incubation
C) Ventilation
D) Endotracheal lavage
E) All of the above

11 Abdominal Distension in mechanical intestinal

obstruction is contributed to in part by all the
following except:-
A Swallowed air
A) Carbon dioxide produced in the bowel
B) Increased intestinal secretions
proximal to the obstruction
 C) Decreased intestinal absorption in the
proximal segment
D) Failure to pass a nasogastric tube

12 Nasogastric tube
a) best passed in extended head
b) must have only 4 holes on the distal end
c) its passed retrograde to avoid complications
d) can cause cicatrisation of oesophagus
e) it’s a rectal tube

13 Joan was admitted following road accident. What

would be the best way to approach her in terms of
management?
a) score her using GSC
b) score her using Injury severity score
c) give IV fluids and take BP
d) do primary survey
e) a & b

14 Carcinoma of the colon characteristically

A) Causes anaemia
B) Spread of the inguinal lymph nodes
C) Present early when on the right side
 D) Is transitional celled in nature?
E) Is markedly radiosensitive

15 Complications of colostomy include

A) Stenosis
B) Prolapse
C) Herniation
D) Necrosis
E) All the above

16 You were called to examine a patient who was

opening eyes to speech, confused, and localizes
pain. What was his GCS?
a) 14
b) 13
c) 12
d) 11
e) 10

17 The following is a recognised feature of

onchocerciasis:
a. keratitis
b. diarrhoea
c. "hanging groin"
d. Calabar swelling
e. eosinophilia
18 Regarding body water, the following are true
except
a. in a healthy 65 Kg male, it is about 40
Liters in amount
b. 70 % of total body water is intracellular
c. 70 % of extra cellular water is in the
interstitium
d. water moves between different body
compartments by an active process
e. whole body extra cellular water is
about 12 liters

19 Superficial partial thickness burns

a) heal by primary intension
b) Re-epithelialize within 3weeks from the
remaining dermis
c) Re-epithelialize within 3weeks from lining of
sweet ducts & hair follicles
d) Must excise and graft
e) non of the above

20 Typical finding in burns of IV degree are

Which is false?
a) Involvement of fascia
b) Involvement of bone
c) Involvement of muscle
d) myoglobinuria
e) hypokalaemia

21 The best way of assessing fluid replacement in

burn patients is
a) calculate fluids needed within 24hrs
b) monitoring of vital signs
 c) Re-covers from shock
d) Urine output of 5ml/min
e) b and d

22 Succussion splash is diagnostic of:

a. perforated peptic ulcer
b. duodenal ulcer
c. acute pancreatitis
d. acute cholecystitis
e. gastric outlet obstruction

23 Characteristically in acute appendicitis:

f. the tongue is clean
g. rigidity can be absent if the appendix is
pelvic in position
h. vomiting always precedes pain
i. true pain begins in epigastric region and
shifting to right iliac fossa
j. conservative treatment is the choice
24 Filling and emptying sign is a typical of
a) Lymphangioma
b) Tense ganglion
c) Squamous cell carcinoma
d) Keloid
e) Haemangioma

25 Kaposi’s sarcoma is
a) malignant tumour only involving skin
b) multifocal angiolymposarcoma
c) Neoplasm found only in HIV
d) angiosarcoma
e) Multi-focal angiosarcoma

a) 26 Pyomyositis : All is true except:

a. is a disease of disadvantaged tropical
communities
b. it is common between the ages of 5 and
25 years
c. one or more of the patients muscles
become exquisitely painful, tender and
swollen
d. staphylococcus is usually responsible
e. septicaemia associated with
pyomyositis is seldom beneficial

27 Brachial cyst:
k. is the most common congenital anomaly
seen in the lateral neck
l. patients often present at the age of ten
years
 m. represent ruminants of the lymphatic
system
n. the presence of a sinus tract contradicts its
origin
a) all the above

28 Thyroid gland is supplied by the following blood

vessels:
a) superior thyroid artery branch of internal
carotid
b) inferior thyroid branch of external carotid
c) vertebral artery
d) a & b
e) thyroidea ima branch of brachio cephalic
artery

29 Neck swelling in the midline may be one of the

following except
a) Diffuse toxic
b) Toxic nodule
c) Toxic nodular
d) Toxic thyroiditis
e) Non of the above

30 A patient presents with, preference for cold

weather, excessive sweating
Regular pulse over 90/min, weight loss & palpable
small neck midline swelling most diagnosis is
a) shock
 b) Auto-immune disease
c) Thyrotoxicosis thyrodia
d) Anxiety neurosis
e) Thyrotoxicosis

31 The following operation(s) may be performed on

goitre
a) cervical thyroidectomy
b) open thyroidectomy
c) near total thyroidectomy
d) trans-tracheal thyroidectomy
e) all the above

32 What is typical clinical feature of Grave’s

disease?
a) tachycardia
b) dry skin
c) constipation
d) bradycardia
e) Graves symptom-c

33 The goal of caring for any wound is:

a. stop bleeding
b. prevent infection
c. asses drainage to underlying structures
d. promote wound healing
e. all the above are true
34 Childhood intussusception:
a. usually presents in children <2 years of
age
b. mostly occurs at the ilieo-ceacal junction
c. barium enema is not allowed to be used
d. only a and b are correct
e. none of the above

35 In acute head injury the following is not likely to

influence the outcome
a) Age
b) Sex
c) Morphology
d) Mechanism of injury
e) Open injury

36 An adult man of 30yrs was involved in road

accident with GCS of 12, dilated right pupil and left
hemiparesis. His management should be?
a) craniotomy on the left side
b) craniectomy on the right side
c) craniotomy on right side
d) conservative management
e) non of the above
37 Surgical techniques have an influence on wound
healing. Which technique is not adequate?
a) using cutting needle for skin closure
b) gentle tissue handling
c) using scissors for skin incision
d) using diathermy to avoid haematoma
e) a & d

38 Which of the following cannot be a content of a

hernia?
a) urinary bladder
b) ileum
c) sigmoid
d) caecum
e) psoas muscle
39 Which hernia is the commonest in female?
a) direct inguinal hernia
b) indirect inguinal hernia
c) femoral hernia
d) umbilical hernia
e) internal hernia

40 What is the meaning of herniorraphy?

a) Herniotomy
b) Herniotomy and sac separation
c) Incision and drainage
 d) Separation of the sac from the cord
e) Herniotomy and repair of the defect

41 What is true with surgical jaundice?

a) conjugated bilirubin is raised in extra-hepatic
cause
b) conjugated bilirubin is raised in intra-hepatic
cause
c) ALP is decreased in the serum
d) Unconjugated bile is present
e) ALP is increased in the serum

42 Post operatively, what urine would you expect?

a) 1ml/kg/hr
b) 50ml/kg/hr
c) 3ml/kg/min
d) 500mi/hr
e) 1liter in 24hrs

43 A condition caused by severe neural, humoral

and metabolic disorders and results in reflex
inhibition of intestinal mortality is:
a) Mechanical intestinal motility
b) Intestinal volvulus
c) intussusception
d) Redundant loop of gut
d) Paralytic ileus

44 The following are causes of closed loop

obstruction except
a) Intra-luminal tumour
b) Small intestinal volvulus
c) Sigmoid volvulus
 d) Colonic obstruction with competent ileo-ceacal
valve
e) A and d

45 The presence of colic pain, early vomiting, and

absence of gross abdominal distension suggest:
a) Paralytic ileus
b) Lower intestinal obstruction
c) High intestinal obstruction
d) Volvulus
e) perforation

46 In examining the abdomen,

a) jaundice can be detected in sclera
b) palpation of the liver should start at the right
costal margin and move to right iliac fossa
c) The normal sized spleen is felt in adults
d) The bladder is always palpable
e) Shifting dullness indicates fluid in the abdomen

47 Which is the commonest malignant tumour of the

colon?
a) squamous cell carcinoma
b) Adenocarcinoma
c) melanoma
d) fibrosarcoma
e) colorectal mass
48 In examining the breast:
a) retraction of the nipple is always pathological
b) palpation of axillae can give clues as to the
extent of the disease
c) its only necessary to examine the
symptomatic breast
d) its best examine from the behind patient
e) all the above

49 What are the most common causes of

pyomyositis?
a) Staphylococus pyogenes, streptococcus
pyogenes and E-coli
b) Staphylococus pyogenes, candida albicans,
TB
c) E-coli, strep, candida alb
d) Staph, TB, candida alb
e) AIDS, TB & Ebola

50 acute post traumatic renal failure

a) is usually the result of direct crush injuries to
the kidney
b) may be due to hypovolaemia and poor tissue
perfusion
c) is particularly associated with crush injuries
d) both b & c
e) all the above
 PART A
SECTION I

Write short notes on:

1) Plaster of Paris
2) Burst abdomen
3) Treatment of septic wound
4) Pathophysiology of osteomyelitis

SECTION II

1. O. G of KIU (60yrs) who had stayed in USA for

long, presented on surgical ward with history of
repeated constipation, passing gaseous-mucus
stools with dark stools, weight loss and abdominal
mass in the right iliac fossa. The mass is mobile in
transverse direction constipation and weight loss.
 a) What are the most likely differentional
diagnose(s)?
b) How could you investigate this patient?
c) How would you prepare her for surgery?
b) mention the treatment of the most likely
diagnosis this patient

2. Give differential diagnosis of neck swellings

A third year medical student after a bout of alcohol

from tank hill hostel was stabbed with a pocket knife
in the right 3rd intercostal space. His main complaint
in emergency ward is pain and laboured breathing.
1. What are the most complications of his injury?
2. Describe how you would manage this patient?

MERRY CHRISTMAS & HAPPY

NEW YEAR
Keep away from HIV