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Final Exam – Paper II

General Surgery 2012 Time: 3hrs

1. Persistent spiking fevers and diarrhea on post-operative day 8 after sigmoid

resection for colon cancer.
a. What is the most likely cause of this patient’s fever and its management?
b. Explain why left sided colon cancer is detected more earlier than the right?

2. A patient is admitted for a one day procedure to surgically repair an inguinal

hernia using tension free technique. After the surgery, the scrotal area is swollen
and erythematous. The following week, the patient develops pain, swelling and
erythema to the area and has to be readmitted.
a. What are the factors that delay wound healing?
b. What parameters are used to ensure healing?
c. What is meant by prophylactic antibiotics?
d. Describe the correct application of prophylactic antibiotics and give two

3. Write short notes on

a. Carcinoma of the larynx – classification, staging and treatment
b. Otitis media – clinical features, complications and treatment

4. Most patients in surgery develop hypokalemia and not hyperkalemia

a. Give examples of 4 conditions that cause hypokalemia
b. Discuss the mechanism of developing hypokalemia
c. What are the signs and diagnosis of hypokalemia

5. Write short notes on

a. Epidural hematoma
b. Cushing’s Triad
c. Anisocoria

a. Compare and contrast the clinical presentation, laboratory studies and
treatment of Biliary Colic and Acute cholecystitis
b. Discuss the development of peri-umbilical pain in acute appendicitis and
its progression to perforation and gangrene.

7. Explain
a. Pathogensis of Anal fistula.
b. Diverticular disease and management of one of it’s complication

8. Write short notes on

a. Conservative management of BPH
b. Management of an acute scrotum in a 16years old patient
a. What are the benefits of splinting and the principles used in splinting?
b. What is non-union? What are the causes of non-union

10. Fill in the blanks

a. Osteochondrosis
 Perthes disease affects the femoral capital epiphysis.
 Osgood-Schlatter disease affects the tibial tuberosity
 Johannson Lander diease affects the infrapatellar tendon.
 Kienbock affects the lunate.
 _______________affects the calcanium
 Scheuermann's Disease affects the vertebra
b. Write one primary bone tumor for each of the following categories
 Osteogenic
 Chondrogenic
 Fibro histiocyto
 Myelonic
 Osteoclastoma

11. A 22year old is brought into the emergency unit with a gunshot would to the
thigh. He is hemodynamically stable, distal pulses are palpable and he has no foot
drop. Outline the steps in your management of this patient.

12. A 44 year old man with DM and hypertensive presents with an above knee
amputation. He also has Chronic renal failure. The surgeon explains that he will
need a hindleg amputation with removal of the left pelvis.
a. What is his ASA physical status?
b. Which type of anesthetic technique would you use and why?
The patient refuses surgery despite the surgeon’s saying he would die without it
c. As the anesthesiologist, what would be your recommendations to the
patient, his relatives and surgeon.
Anal fissures vs Hemorroids
Anal Fistula & Abscess
Acute Scrotum