Rmu Surgery Ospes

MBBS Third Year Ward Test
Surgery
Objectively Structured Performance Evaluation (OSPE)
Static Station 1
Candidate
Time Allowed: 4 minutes
Task:
Carefully observe the photograph and answer the following questions:
A
B
14
a. Name the object provided and give its parts? 1

b. What are possible complications of its early and long term use? 2
c. What are the indications of its use? 1
d. How this object is sterilized? 0.5
e. What is the difference when it is used in infants and in adults? 0.5
MBBS Final Year Ward Test
Surgery
Static Station 1
Examiner
Key
a. Endotracheal tube
b. Trauma/ dislocation/ obstruction/ improper
ventilation – pressure necrosis vocal cords
tracheo oesophagus fistula/ bleeding / chest
infection
c. General anasthesia/ trauma patient with
inadequate breathing/ chest trauma ventilatory
support.
Shocked patient.
d. Enthylene oxide gas.
e. Uncuffed / cuffed – small size
16
Surgery
Static Station 3
Candidate
Marks: 5 Time Allowed: 4 minutes
Task:
23
a. Name the object and its usage. 1

b. Which object is used to remove clot from vessels? 1
c. Write four common causes of gangrene in lower limbs. 1
d. Write three important causative factors in diabetic gangrene. 1
e. Write three important investigations for arterial stenosis/ occlusion. 1
Surgery
Static Station 3
Examiner
Marks: 5
Key
a. Bull dog vascular clamp
b. Fogarty catheter
c. Secondary arterial occlusion, infective,
traumatic, venous.
d. Peripheral neuritis
Ischaemia
excess sugar – ↑ risk infection
e. Arteriography
MRA
Dupplex scan
25
Surgery
Static Station 4
Candidate
Task:
1. Name this item. 1
2. Name two veins through which it can be inserted? 0.5, 0.5
3. What is the physiologic range of the parameter measured? 1
4. Name two indications for its insertion. 0.5, 0.5
5. Name two complications of its insertion. 0.5, 0.5

Surgery
Static Station 4
Examiner
Marks: 5
1. Central Venous Pressure Line. 1
2. Subclavian, Internal jugular veins. 0.5, 0.5
3. 5-10 cm of water 1
4. Resuscitation, Monitoring of CVP. 0.5, 0.5
5. Any two of: Hemothorax, Pneumothorax, air embolism, arterial

puncture. 0.5, 0.5
Surgery
Static Station 5
Candidate
Carefully observe the photograph and answer the following questions.
1. Identify the pathology. 1
2. What is the investigation of choice to make the diagnosis

preoperatively? 1
3. Enumerate four complications that may develop in this condition? 2
4. What is the standard operative treatment if the patient becomes

symptomatic? 1
Surgery
Static Station 5
Examiner
Marks: 5
1. Cholelithiasis . 1
2. Abdominal Ultrasonography 1
3. Acute cholecystitis, cholangitis, Hydrops of gall bladder, empyema

gall bladder, mucocoele, perforation, peritonitis, fistula to
duodenum and colon, biliary ileus, pancreatitis
1
any 4, marks 0.5 each
4. Laparoscopic cholecystectomy
Surgery
Static Station 2
Candidate
Task:
1. Identify the object. 1
2. Name two structures that can be held with this instrument.0.5, 0.5
3. Is it traumatizing to the tissues? 1
4. Name two operations in which this instrument can be used. 1, 1

Surgery
Static Station 8
Candidate
1. What is the most likely diagnosis? 1
2. What signs if present, indicate malignancy? 0.5, 0.5
3. Which investigation may be used to exclude malignancy

preoperatively? 1
4. What would be the treatment if the lesion is:
i. Benign 1
ii. Malignant 1
Surgery
Static Station 8
Examiner
Marks: 5
1. Parotid swelling/ pleomorphic adenoma 1
2. Facial nerve paralysis 0.5
Lymph node enlargement 0.5
3. FNAC 1
4.
i. Superficial conservative parotidectomy 1
ii. Total conservative parotidectomy 1

Surgery
Static Station 7
Candidate
This 52 years old male gives H/O burns and a non-healing ulcer for 20 years.
1. What is the most likely diagnosis? 1
2. Are inguinal lymph nodes likely to be enlarged? 1
3. How will you confirm the diagnosis? 1
4. What is the most appropriate treatment? 2

Surgery
Static Station 7
Examiner
Marks: 5
1. Rodent ulcer (basal Cell carcinoma) 1
2. No 1
3. Local invasion 1
4. Surgical excision (and/ skin grafting) 1
Radiotherapy 1
Surgery
Static Station 1
Candidate
Task:
A
B
2. Name the function of parts labelled A and B. 0.5, 0.5
3. Give two indications for its use. 0.5, 0.5
4. Name two complications of its insertion. 1, 1

Surgery
Static Station 1
Candidate
Marks: 5
1. Foley’s two way catheter. 1
2. Port A for urinary drainage and port B for inflatting the ballon.
0.5, 0.5
3. Acute/ chronic retention of urine, operations on urinay tracts,

monitoring urinr output 0.5, 0.5
4. Infection, trauma to urethra, urethral stricture 1, 1

Surgery
Static Station 10
Candidate
Task:
1. What is this investigation? 1
2. What is diagnosis? 1
3. Name the vessel most commonly involved. 1
4. What is lucid interval? 1
5. Give management of this disease. 1

Surgery
Static Station 10
Examiner
Marks: 5
1. CT scan of the head. 1
2. Exradural hematoma. 1
3. Middle meningeal artery. 1
4. Period of consciosness before deterioration in level of

cosciousness in head injury 1
5. Craniotom, evacuationof hematoma, hemostasis. 1

Surgery
Interactive Station 11
Candidate
Task
This patient presented with swelling in neck.
Perform the relevant physical examination.
You are not allowed to ask questions from the patient.

Surgery
Examiner
Marks: 5
Examine for neck swelling
Roll Numbers
1 Introduction & consent
2 Position and exposure
3 Inspection
4 Palpation from front
5 Palpation from behind
6 Trachea & carotids
7 Pamberton sign
8 percussion
9 Auscultation
10 Eye signs, ankle jerk,
tremors
Total
Surgery
Station 12
Examiner:
Questions related to Station 11
1. What is your provisional diagnosis? 1
2. How will you confirm your diagnosis? 2
3. Treatment options 2
Surgery
Candidate
Task
This patient C/O pain in right calf that is brought on after walking about 200 meters
and relieved on resting for 10 minutes.
Examine him for peripheral vascular disease.
You are not allowed to ask questions from the patient.

Surgery
Examiner
Marks: 5
Examine for peripheral vascular disease
Roll Numbers
1 Introduction
2 Informed consent
4 Inspection
5 Burger’s angle
6 Local temperature
7 Capillary refill
8 Palpation of pulses
right leg
9 Palpation of rest of
pulses
10 Auscultation
Total
Surgery
Static Station 14
Examiner
Marks: 5
Questions related to station 13 by the examiner.
1. What investigations you will do for peripheral vascular disease.

2. What life style modifications you will ask the patients.
3. What are the indications of amputation?
Surgery
Static Station 2
Candidate
Task:
2. Indications 2
3. Care 2
Surgery
Static Station 2
Examiner
Marks: 5
1. Tracheostomy Tube. 1
2. a. Fascial Injuries 2
b. emergency air Way access
3. a.Wet Guaze Application
b. Suctioning
Surgery
Static Station 11
Organizer
Instructions for the Organizer:

Logistics:
STATION NUMBER printed on a paper
A table
A chair for the candidate
Question paper (Candidate’s sheet) to be pasted on the table
Pen
Answer sheet
Surgery
Static Station 3
Candidate
Task:
2. Indications of use. 2
3. Contra indications of use 2

Surgery
Static Station 3
Examiner
Marks: 5
1. Proctoscope 1
2. a.Bleeding PR 2
b. Haemorrhoids
3. a. Anal Fissure 2
b. Childrens
Surgery
Static Station 4
Candidate
Task:
1. Radiological Findings. 1
2. Two diffrentials 2
3. Treatment 2
Surgery
Static Station 4
Examiner
Marks: 5
1. Gas under Diaphragm 1

2. a.Perforated Duodenal Ulcer 2
b. Enteric Perforation Treatment
3. Exploratory Laparotomy & Repair
Surgery
Static Station 5
Candidate
Task
A 55 year old man increase history of Urinary frequency, hesitancy and

nocturia for the last 6 month.
Question
1. Most likely diagnosis 1
2. Relevant investigations 2
3. Treatment Plan 2
Surgery
Static Station 5
Examiner
Marks: 5
Marks: 5
1. BPH 1
2. a.USG Abdomen & Pelvis 2
b. Urine R/E
c. PSA
3. TURP 2
Surgery
Static Station 6
Candidate
Task
Counseling for below knee amputation
Surgery
Static Station 6
Examiner
Marks: 5
Examine for neck swelling
Roll Numbers
1 Introduction
2 Informed consent
3 Procedure
4 Alternate Options
5
6
7
8
9
10
Total
Surgery
Candidate
Task
Examination
Abdomen / Hernia
Surgery
Examiner Key
Marks: 5
Roll Numbers
1 Introduction
2 Informed consent
4 Inspection
5 Palpation
6 percussion
7 Auscultation
8 DRE
9 Hernial orifices
10 Thanks
Total
Surgery
Candidate
20 year old male met an RTA and his x-ray shows
1.x-ray Finding
2.Treatment
3.complications
Surgery
Examiner
Marks: 5
1. Mid Shaft Humerus Fracture

2. ORIF (Open Reduction Internal Fixation)
3. a. Brachial Artery Injury
b. Wrist drop/ Radial Nerve Injury
Surgery
Candidate Station 15
Task
A 35 year old male has history of on and off pain in lumber region for the past 3 months. His
investigation is done.
1. What is the radiological investigation shown above?
2. What is radiological finding?
3. Indications for above mentioned radiological investigation.

Surgery
Examiner
1. IVU
2. Renal Stone.
3. Ureteric Stone / Vasical Stone/ Renal Stone.
Station no 1
1. Name, the procedure in the picture?
2. Name structures marked (Blue arrow and

yellow arrow) in this image.
3. Enlist three most likely complications after

this surgery.
Station no. 2
This middle-aged patient developed this huge

abdominal mass on his right lower abdomen along
with hematochezia.
1. What is most likely diagnosis?
2. How would you investigate this patient?
3. What is the best treatment options?

Station no 5
1. Name this instrument.

1. When the instrument is used
2. What surgeries can be performed by this instrument?
Station no 6
Patient developed swelling in front of

abdomen two years after cholecystectomy.
Swelling was reducible and cough impulse
was positive.
Q no 1. What is the diagnosis?

Q no 2. How would you manage this patient?
Q no 3. what complications can occur if patient is
left untreated.
Q no 4; what are the complications of surgery
Station no 7
A) What is the diagnosis?
B) Describe the treatment of this condition?
C) What are the complications of

treatment of this condition?
Station no 8
1.What is most likely diagnosis

2. Name two important investigations for
confirmation of diagnosis?
3. What is best treatment for this condition
provided it has not spread elsewhere?
Station no 9
This small child presented with soft cystic

swelling in right neck.
1) What is most likely diagnosis.
2) What is the most appropriate treatment?
3) Name two specific complication of this disease.

Station no 10
This is ultrasound of a thirty year old lady with

pain right hypochondrium.
1) What is most likely diagnosis?

2) What is the best treatment option?
3) What are complications of this disease?
Station no 11
This patient had arthritis of his wrist, and

developed pain and weakness in his hand for
last three-years. ·
1. What is the most likely diagnosis?

2. Which structure is likely to be injured in this
lesion?
3. Give two more tests to check for this lesion?
Station no.12
A 34-year-old women with history of palpitations

and termers had this neck swelling.
1. What is most likely diagnosis?
2. How would you prepare patient for surgery?
3. What is the best treatment options?

Station no 13
A 30 year old multiparous lady had this image on
Laparoscopy (anterior abdominal wall)
1. Name the disease in the picture?
2. Which procedure is likely to be performed ?
3. Enlist three most likely complications after

this surgery?
Station no 14
This patient was not able to extend his two

fingers
2. Which structure is likely to be injured in this

lesion?
3. Give two more tests to check for this lesion?

Stat ion no. 16
Patient developed swelling in back of neck which

is soft in consistency.
Q no 1. What is the most likely diagnosis?
Q no 2. How would you manage this patient?
Q no 3. what are the complications of surgery?

Station no. 15
Instrument
1. Name this instrument.
2.What is use of this instrument?
3.Name two procedures in which this

instrument is used.
Station no. 17
1. What is the diagnosis?
2. Describe the treatment of this condition?
3. What are the complications of treatment

of this condition?
Station no. 18
A diabetic patient developed this lesion on back

of neck
A) What is most likely diagnosis
B) What is immediate treatment for this

condition?
C) What treatment
- will patient take when
he is discharged home.?
. -
Station no. 19
This is CT image of chest of a patient.
X ray chest of a 60 Year old farmer with history

of fresh bleeding per rectum for last 1 year had
this chest x ray with dyspnoea.
1. What is most likely diagnosis
2. What are important questions in history

and physical exam?
3. What is the most appropriate treatment?

Station no. 20
The patient was deeply jaundiced and having this

investigation performed
· 1. What is this investigation?

2. What are the indications?
3. What are complications of this procedure?
OSPE
3RD YEAR WARD TEST

STATION 1
• TAKE HISTORY OF PATIENT WITH RIGHT ILIAC

FOSSA PAIN? 5
STATION 2
• TAKE HISTORY OF PATIENT WITH RIGHT

HYPOCHONDRIUM PAIN 5
STATION 3
• TAKE HISTORY OF PATIENT WITH FRESH

PERRECTAL BLEED 5
8
STATION 5
Time allowed: 05 minutes

Static Station
Instruction to Candidates:
Carefully observe the provided object and answer
the following questions.
a. Name the object provided? 1
b.Give three important indications of its use.
2
c. Write two methods of confirmation of correct
placement of this object?
0.5
d.Write three complications of its long term usage?
1.5
9
Key
a. NG tube
b. Intestinal decompression/ feeding/ gastric levage
c. Pushing air into stomach/ contrast injection abd. X-ray
d. Aspiration pneumonia/ trauma/ gastro oesophageal
reflux/ perforation of viscera.
Nasal skin necrosis
10
11
STATION 6
Time allowed: 05 minutes

Static Station
Instruction to Candidates:
Carefully observe the object provided and answer
the following questions.
a. Name the object provided and its types?
0.5
b.What are its indications for long term usage?
2
c. What are the contraindications of its usage?
2
12
Key
a. Three ways Foley’s catheter

b.Urinary incontinence/ comatosed patients, unfit
patient with BOO (Bladder Outlet Obstruction)
c. Urethral trauma/stricture stenosis/ local
infection
STATION 7
• DO ABDOMINAL EXAMINATION OF PATIENT ?

5
STATION 8
• EXAMINE THE NECK OF PATIENT? 5

STATION 9
• DO GERENAL PHYSICAL EXAMINATION OF

PATIENT ? 5
STATION 10
• LOG BOOK/HISTORY MANUALS /VIVA 5

STATION 1
A 58-year-old woman presents to Accident and Emergency with pain and swelling
in her wrist following a fall.
1. What is the clinical diagnosis?
Colle’s fracture
2. What initial important clinical examination should be performed
3. List the common complications of this injury.
i. Median nerve injury
ii. Malunion
iii. Rupture of extensor pollicis longus tendon
iv. Sudeck’s atrophy
v. Joint stiffness
STATION 2.
A 55-year-old woman presents with a lump in the breast.

1. What does the mammogram show?
Breast Carcinoma
2. What is meant by triple assessment?
i. clinical assessment
ii. radiological imaging
iii. either cytological or histological analysis
3. What are the predisposing risk factors?
STATION 3
Identify the instruements.

What are uses?
STATION 4
A 34yrs farmer presented with c/o pain RHC for 2months, his CT scan is
given.
1. What are the findings?
2. What is cause of disease?
3. What are different treatment options?
STATION 5
A young male presented to OPD with c/o left sided testicular swelling for 2yrs, O/E
swelling is soft, non reducible, you can get above swelling, cough impulse-ve,
transillumination is positive.
1. What is your diagnosis?
Hydrocele
2. What are its types?
 Primary
i. Congenital
ii. Infantile
iii. Encysted hydrocele of the cord
iv. Vaginal hydrocele
 Secondary
3. What are treatment options?
i. Jaboulay’s repair
ii. Lord’s Plication
iii. Hydrocelectomy
STATION 6
1. What is the investigation shown?

Barium swallow
2. What is probable diagnosis?
Bird Beak sign: Achalasia
3. What are treatment options?
 Medical
i. Calcium channel blockers and Nitrates
 Laproscopic
i. Botulinum Toxin
ii. Pneumatic Dilation
 Surgical
i. Heller’s Myotomy
STAION 7
1. what is triangle of safety?
The safest site for insertion of a drain is in the triangle that lies:
• anterior to the mid-axillary line;
• above the level of the nipple;
• below and lateral to the pectoralis major muscle.
This will ideally find the fifth space.
2. Name the stages of empyema thoracis. (p 856)

STATION 8
A 63yrs male presented with 2months h/o rest pain with 2weeks h/o dry gangrene
of left 4th toe.
1. identify the instrument given.
hand held doppler ultrasound
2. What is intermittent claudication?
Intermittent claudication is a cramp-like pain felt in the muscles that is:
• brought on by walking;
• not present on taking the first step (unlike osteoarthritis);
• relieved by standing still
3. What is ABPI?
The ankle–brachial pressure index (ABPI) is the ratio of systolic pressure at the
ankle to that in the arm. The highest pressure in the dorsalis pedis, posterior tibial
or peroneal artery serves as the numerator, with the highest brachial systolic
pressure being the denominator. Resting ABPI is normally about 1.0; values below
0.9 indicate some degree of arterial obstruction (claudication), less than 0.5
suggests rest pain and less than 0.3 indicates imminent necrosis.
STATION 9
A 16yrs old motorcyclist presents to ER with h/o RTA ½ hr back, on arrival GCS
14/15, with h/o LOC (loss of consciousness) at the scene. BP=110/70, Pulse=
88/min, R/R= 18/min. after sometime patient became unresponsive with a GCS of
3/15.
1. What is the probable diagnosis?

Extradural haematoma
2. Describe common site of injury?
Linear squamous temporal bone fracture of skull with laceration of a branch of
middle meningeal artery
3. What is the management?
i. Follow ATLS
ii. Open craniotomy for clot evacuation
iii. Mannitol should be avoided
STATION 10
Name the procedure being done.

CVP line insertion
What are the possible complications?
i. Pneumothorax
ii. Pleural complication
iii. Hemothorax
iv. Thrombosis
v. Air embolism
vi. Cardiac tamponade
vii. chylothorax
Benazir Bhutto Hospital, Surgical Unit II
Final year ward test
Station 6
A 20 year old male patient presented in the emergency room with complaints of
pain in right iliac fossa for past 3 days. When inquired he also complains of Nausea,
febrile feeling and anorexia. The pain is non radiating but had initially started in
peri-umbilical region. On examination patient exhibits guarding in Rt iliac fossa.
In light of the above history answer the following questions:
1. What is the most likely diagnosis of this patient? (2)
Acute appendicitis
2. What sings would you like to elicit in this patient? (1)
i. Rovsing sign
ii. Pointing
iii. Psoas/ Obturator
3. What are various components of Alvarado’s scoring system and how would
you interpret it? (2)
Station 2
A 30 year old male patient, known smoker, presented in the emergency room with
complaints of severe, excruciating pain in chest following an episode of dyspnea. A
radiograph was taken in the ER which is as follows.
1. What are the x-ray findings in favor of the diagnosis? (2)

Left sided mediastinal shift.
Right lung collapse
Secondary spontaneous pneumothorax
2. What is the immediate management? (2)
Chest intubation in the 5th intercostal space using under water seal.
3. What is the definitive surgical procedure required in this patient? (1)
i. Partial pleurectomy
ii. Complete partial pleurectomy
iii. Apical bullectomy
Station 9
A 55 year old, diabetic and hypertensive, patient presents in the Emergency room
with severe generalized abdominal pain, there is evident guarding on examination.
The patient also has had vague generalized body pains for which he has been self
medicating for several years. Following radiograph was obtained.
1. What is the most likely diagnosis? (2)
Free air under the right hemidiaphragm indicating perforated duodenal ulcer.
2. What steps would you take in initial management of this patient?
i. IV fluid
ii. NG aspiration
iii. Monitor urine output
iv. IV antibiotics
v. Analgesics
vi. Arrangement of blood
vii. Carry out all investigations required for anesthesia
3. What would be the definitive surgical procedure this patient would undergo? (1)
Exploratory laparotomy and repair.

Station 4
a 13 year old male child presents in the emergency room after recieveing blunt
trauma to abdomen by being crushed between two heavy logs. On arriving, the
child is pale with a distended abdomen and is disorientated. He has a blood
pressure of 110/70 and a pulse of 140bpm. There are no open wounds on the
patient.
1. What will be the single most important investigation for diagnosing this
patient readily available in our emergency? (2)
Focused assessment with sonography for trauma
2. Enumerate the steps of management in this patient. (2)
3. What could be the most likely injury in this patient and what would be its
definitive management? (1)

Station 8
Please differentiate following sutures as being organic or synthetic, absorbable or
non absorbable, mono-filament or poly-filament.
1. Catgut chromic (organic, absorbable, mono-filament)

2. Vicryl (synthetic, absorbable, poly-filament)
3. Silk (organic, non-absorbable, polyfilament)
4. Prolene (synthetic, non-absorbable, mono)
Station6
Please examine the abdomen of this patient and answer questions of your
examiner. (6)
Station 7
A 50 year old female patient presents in the surgical OPD with complaint of a 5 X 5
cm lump in right breast for past 1 year. She has noticed that it was increasing in
size but the recent blood discharge from the nipple has made her seek medical
help now.
1. How will you proceed in investigating this patient? (2)
Triple assessment
2. what points would you like to inquire in patients history? (2)
3. what are the differences between modified radical mastectomy and classical
radical mastectomy (Halsted)? (1)
modified radical mastectomy: pec major and minor are
Station8
1. Identify the medical apparatus. (2)

2. Define the purpose/use of points “D” and “E”. (2)
3. Enlist the immediate and late complications associated with use of this
medical apparatus. (1)
Station9
Above image was taken of a patient who presented in the ER after road traffic
accident with a GCS of 8/15. Regarding this image.
1. What is the name of this investigation? (2)
2. What is the condition evident in this investigation? (2)
3. What is the definitive surgical management of this patient? (1)
Station10
Please produce your ward card and answer the questions of the examiner. (5)
STATION 1
Examine the X-Ray and answer following questions

2. What is pre-operative management?
3. What is the definitive treatment?
STATION 2
A 64yrs male presented with 2months h/o repeated episodes of
non bilious vomiting, shortly after taking meals, containing
undigested food particles. O/E there is fullness in left
hypochondrium with visible peristalsis from left to right.
1. What is the most probable diagnosis?

2. Name the possible metabolic abnormality.
STATION 3
A 16yrs old motorcyclist presents to ER with h/o RTA ½ hr back,

on arrival GCS 14/15, with h/o LOC at the scene. BP=110/70,
Pulse= 88/min, R/R= 18/min. after sometime patient became
unresponsive with a GCS of 3/15.

2. Describe common site of injury?
3. What is the management?
STATION 4
A 48yrs female presents with multiple episodes of vomiting upper

abdominal pain, and jaundice.
1. What is the above mentioned pic and what does it show?
Choledocolithiasis
3. What is the treatment?
i. ERCP
ii. Cholecystectomy
STATION 5
1. Identify the instruement.
2. What are the indications?
3. What are the contraindications?
STATION 6
1. Identify the suture.

2. After how many days it is absorbed?
3. What are its uses?
4. Is it monofilament or braided?
STATION 7
An 18month old baby presents to ER with deformed arm

1. What is the diagnosis?
Supracondylar fracture of humerus
2. What important initial clinical examination must be performed?
3. what structures are prone to injury?
STATION 8
A 30yrs old lactating female came to ER with complaints of painful

lump on right breast that is hot and tender.
1.what is most probable diagnosis?

Mastitis
2.which organism is most common?
S. aureus
3.what is the management?
Antibiotics
Antipyretic
Analgesics
Continue breast feeding
STATION 9
A young male came to OPD with h/o repeated fractures after minor
trauma, also complains of lumbar pain. His serum Ca and PTH were
ordered that also came to be raised.
1.what is your diagnosis?

Hyperparathyroidism
2.what investigations are needed?
Urine Ca excretion
Alkaline phosphatase level (^)
Serum phosphate level (decreased)
Bone scan
3.what is MEN 1 syndrome?

i. Pituitary adenoma
ii. Parathyroid hyperplasia
iii. Pancreatic tumors
STATION 10
A 26yrsmale presented with h/o blunt trauma to chest, followed by
decreased breath sounds on right side of chest with dull percussion,
patient’s BP=90/60, pulse= 120/min, R/R= 28/min. X ray chest shows air
fluid level.
1.what is most likely diagnosis?
Hemothorax
2.how will you manage this patient?
i. follow ATLS
ii. physical examination and CXR for diagnosis
iii. chest intubation for drainage of blood
3.what are the indications of thoracotomy?
BENAZIR BHUTTO HOSPITAL, Surgical Unit-II
Final Year Ward TEST
Station 1
A 30 year old male patient presented in the emergency with a fire arm injury to the abdomen
in the Lt hypochorndrium. 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)
2. On subsequent laparatomy 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 year 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)

2) What is the management of this patient? (2)
3) What is the most useful diagnostic tool that can be used in this patient? (2)
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 criteria to label the patient or arise suspicion of hyperthyroidism?
If not what other CLINICAL TEST would you like to perform that is more reliable? (2)
2. What investigation/imaging would you like to order to rule out the possibility of
retrosternal extension of this goiter? (2)
CXR and thoracic inlet
3. What drugs can be used to render a thyrotoxic patient euthyroid? Name at least three
drugs. (2)
Carbimazole
Propyl thio uracil
Propanolol
Station 3
A 22 year 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)
2. How would you clinically differentiate between the two possible diagnoses? (1)
3. What are the possible management options? (3)
i. Compression garments
ii. Silicone gel sheets and cream
iii. Corticosteroids injections
iv. Surgery and post-operative interstitial radiotherapy
v. Radiotherapy
vi. Cryotherapy
vii. Laser therapy
Station 4
1. Name the above instrument (2)

Allis forceps
2. Is this instrument tissue damaging? (2)
Yes
3. On which tissues can this instrument be applied? (2)
i. Deep fascia
ii. Skin
iii. Aponeurosis
Station 6
1. Name this instrument. (2)

Artery foreceps
2. Can this instrument be used in a vascular anastamosis? If not why? (2)
No.
3. What is the main use of this instrument? (2)
Hemostasis achievement.
Station 5
A 60 year old female patient presented in the ER with complaints of pain in Rt
hypochrondrium and jaundice (bil- 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)

Acute cholecystitis
2. How will you manage this patient? (2)
Conservative
i. IV fluids
ii. Antibiotics
iii. Analgesics
iv. NPO
v. BP
vi. Temp
vii. Pulse
Investigations
i. HIDA scan
ii. USD
iii. Leukocytosis
Surgery:
i. Cholecystectomy
3. What options are available to bring down this patient’s bilirubin levels? (2)
Cholecystectomy.
Phototherapy

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MBBS Third Year Ward Test

Carefully observe the photograph and answer the following questions:

a. Name the object provided and give its parts? 1

Carefully observe the photograph and answer the following questions:

a. Name the object and its usage. 1

Marks: 5 Time Allowed: 4 minutes

Carefully observe the photograph and answer the following questions:

1. Name this item. 1

2. Name two veins through which it can be inserted? 0.5, 0.5

3. What is the physiologic range of the parameter measured? 1

4. Name two indications for its insertion. 0.5, 0.5

5. Name two complications of its insertion. 0.5, 0.5

1. Central Venous Pressure Line. 1

2. Subclavian, Internal jugular veins. 0.5, 0.5

4. Resuscitation, Monitoring of CVP. 0.5, 0.5

5. Any two of: Hemothorax, Pneumothorax, air embolism, arterial

Carefully observe the photograph and answer the following questions.

1. Identify the pathology. 1

2. What is the investigation of choice to make the diagnosis

3. Enumerate four complications that may develop in this condition? 2

4. What is the standard operative treatment if the patient becomes

3. Acute cholecystitis, cholangitis, Hydrops of gall bladder, empyema

Carefully observe the photograph and answer the following questions:

1. Identify the object. 1

3. Is it traumatizing to the tissues? 1

4. Name two operations in which this instrument can be used. 1, 1

Carefully observe the photograph and answer the following questions:

1. What is the most likely diagnosis? 1

2. What signs if present, indicate malignancy? 0.5, 0.5

3. Which investigation may be used to exclude malignancy

4. What would be the treatment if the lesion is:

1. Parotid swelling/ pleomorphic adenoma 1

2. Facial nerve paralysis 0.5

Lymph node enlargement 0.5

i. Superficial conservative parotidectomy 1

ii. Total conservative parotidectomy 1

Carefully observe the photograph and answer the following questions:

1. What is the most likely diagnosis? 1

2. Are inguinal lymph nodes likely to be enlarged? 1

3. How will you confirm the diagnosis? 1

4. What is the most appropriate treatment? 2

1. Rodent ulcer (basal Cell carcinoma) 1

4. Surgical excision (and/ skin grafting) 1

Carefully observe the photograph and answer the following questions:

1. Identify the object. 1

2. Name the function of parts labelled A and B. 0.5, 0.5

3. Give two indications for its use. 0.5, 0.5

4. Name two complications of its insertion. 1, 1

1. Foley’s two way catheter. 1

3. Acute/ chronic retention of urine, operations on urinay tracts,

4. Infection, trauma to urethra, urethral stricture 1, 1

Carefully observe the photograph and answer the following questions:

1. What is this investigation? 1

3. Name the vessel most commonly involved. 1

4. What is lucid interval? 1

5. Give management of this disease. 1

1. CT scan of the head. 1

3. Middle meningeal artery. 1

4. Period of consciosness before deterioration in level of

5. Craniotom, evacuationof hematoma, hemostasis. 1

Marks: 5 Time Allowed: 4 minutes

This patient presented with swelling in neck.