Q: Tell me correct answers above 20 questions A: These are clinical surgery MCQs from a Final Year MBBS exam. I'll answer all 20 from my surgical knowledge — these are well-established clinical scenarios. --- FINAL YEAR MBBS — SURGICAL UNIT IV: ALL 20 ANSWERS --- Q1 — Audit cycle perforated peptic ulcer Setting standard 6 hrs → measuring practice median 9 hrs → implementing change dedicated theatre → re-audit 5 hrs ✅ C Implementing change and re-audit --- Q2 — Research bias questionnaire only given to complication-free patients Only certain patients are selected to receive the questionnaire — this is systematic exclusion of a subgroup. ✅ A Selection bias --- Q3 — Left varicocele not disappearing on lying down + palpable lumbar mass A varicocele that doesn't decompress when supine suggests obstruction of the left renal vein or IVC — must rule out a retroperitoneal mass e.g., renal cell carcinoma. ✅ B CT abdomen --- Q4 — Diabetic male, scrotal pain/swelling, black necrotic patches, crepitus, fever, high WBC Classic Fournier's gangrene: necrotizing fasciitis of the perineum/scrotum in a diabetic. ✅ B Fournier's gangrene --- Q5 — 30-year-old, painless right testicular solid mass, elevated AFP/β-hCG/LDH Suspected testicular malignancy — trans-scrotal biopsy is absolutely contraindicated. Inguinal orchidectomy is the gold standard for diagnosis and treatment. ✅ C Inguinal orchidectomy --- Q6 — 25-year-old, sudden severe left testicular pain, high-riding testis, absent cremasteric reflex Testicular torsion — a surgical emergency. Scrotal US wastes time. Urgent exploration is the answer. Manual detorsion may be attempted but definitive fix is surgical. ✅ D Urgent scrotal exploration --- Q7 — Oncological emergency requiring urgent management Cord compression spinal cord compression from metastatic disease is the only true oncological emergency among the options — requires urgent steroids ± radiotherapy/surgery. ✅ C Cord compression --- Q8 — T4, N1, M0 locally advanced breast cancer T4N1M0 is Stage IIIB locally advanced. Primary treatment is neoadjuvant chemotherapy to downstage before surgery. Surgery alone is not appropriate upfront. ✅ A Chemotherapy neoadjuvant --- Q9 — 62-year-old, rectal adenocarcinoma, sessile mass 8 cm from anal verge, T2 N0 M0, confined to muscularis propria T2 N0 M0 rectal cancer at 8 cm — above the peritoneal reflection, node-negative, T2. Anterior resection with TME is appropriate. APR would be for very low rectal tumours. Local transanal excision is only for T1 tumours. ✅ B Anterior resection with total mesorectal excision TME --- Q10 — Chronic posterior midline anal fissure with sentinel pile and hypertrophied anal papilla The pathophysiology is internal anal sphincter hypertonia causing ischaemia. Lateral internal sphincterotomy directly addresses this by reducing sphincter tone. ✅ B Lateral internal sphincterotomy --- Q11 — 30-year-old woman, perianal abscess tense, fluctuant swelling, febrile, 2 days A tense fluctuant perianal abscess requires immediate incision and drainage under anaesthesia. ✅ C Incision and drainage under anaesthesia --- Q12 — BMI 38 kg/m², well-controlled T2DM, listed for laparoscopic cholecystectomy as day case Class II obesity BMI ≥35 is a strong contraindication to day-case surgery due to anaesthetic risk, OSA, and postoperative complications. ✅ B BMI of 38 kg/m² Class II obesity --- Q13 — 62-year-old, altered bowel habits, tenesmus, hard irregular mass on DRE at 6 cm from anal verge Suspected rectal carcinoma — the most appropriate initial investigation is colonoscopy with biopsy for tissue diagnosis and to assess the rest of the colon. ✅ C Colonoscopy with biopsy --- Q14 — Rectal polyp: which histological type has highest malignant potential? Villous adenoma has the highest risk of malignant transformation 40%, compared to tubular 5% or tubulovillous 20%. ✅ C Villous adenoma --- Q15 — Fistula-in-ano, anterior external opening, Goodsall's rule Goodsall's rule: anterior openings → straight radial tract to nearest crypt. Posterior openings → curved tract to posterior midline. ✅ B Straight radial tract --- Q16 — 68-year-old, AF, sudden severe left leg pain, cold limb, absent pulses, no flow below femoral artery Acute limb ischaemia from embolism AF source — requires urgent embolectomy Fogarty catheter. ✅ C Urgent embolectomy --- Q17 — 60-year-old smoker, calf pain at 100 m, relieved by rest, ABI 0.7, superficial femoral artery stenosis Fontaine Stage IIa intermittent claudication with ABI 0.7 — first-line is conservative: exercise therapy + antiplatelet therapy. ✅ C Exercise therapy + antiplatelets --- Q18 — 72-year-old, incidental infrarenal AAA measuring 6.2 cm AAA ≥5.5 cm is the threshold for elective repair. At 6.2 cm, the rupture risk is significant — elective repair is indicated. ✅ C Elective repair --- Q19 — 45-year-old woman, painful right leg swelling after long travel, Doppler confirms popliteal vein thrombus DVT DVT treatment is anticoagulation LMWH/DOACs. Surgery is not indicated; thrombolysis is not first-line for standard DVT. ✅ C Anticoagulation --- Q20 — 50-year-old post-mastectomy, chronic left arm swelling, non-pitting oedema, thickened skin This is lymphoedema following mastectomy axillary lymph node dissection. The mainstay of management is compression therapy manual lymphatic drainage + compression garments. ✅ C Compression therapy --- Summary Table Q Answer ----------- 1 C — Implementing change and re-audit 2 A — Selection bias 3 B — CT abdomen 4 B — Fournier's gangrene 5 C — Inguinal orchidectomy 6 D — Urgent scrotal exploration 7 C — Cord compression 8 A — Chemotherapy neoadjuvant 9 B — Anterior resection with TME 10 B — Lateral internal sphincterotomy 11 C — Incision and drainage under anaesthesia 12 B — BMI of 38 kg/m² Class II obesity 13 C — Colonoscopy with biopsy 14 C — Villous adenoma 15 B — Straight radial tract 16 C — Urgent embolectomy 17 C — Exercise therapy + antiplatelets 18 C — Elective repair 19 C — Anticoagulation 20 C — Compression therapy
