Station No.

Instruction to Candidates:

You are provided with a photograph. Please observe it carefully. You are supposed to answer
questions on the answer sheet provided

Q1 What does this photo shows?

Q2 Name the procedure in which this complication occurs?
Q3 What are other complications of this procedure?
Q4 How can the condition shown in the photo be managed ?
Station No. 1

Instruction for examiner:

You are provided with a photograph. Please observe it carefully. You are supposed to answer
questions on the answer sheet provided

KEY
Q1 Prolapsed ileostomy with ulceration & midline laparotomy 3.0
scar
Q2 End ileostomy with ulceration 2.0
Q3 Fluid and electrolyte imbalance 3
Parastomal hernia
Retraction
Bleeding
Q4 Needs refashioning as it is and end ileostomy 2
Station No. 2

Instruction to Candidates:

A 30 year old lady has undergone laparoscopic cholecystectomy. In the immediate post
operative period she shows pain abdomen, nausea and vomiting. She was discharged on medication.
She presented 3 months later with jaundice and pruritis all over the body. Look at the investigation
provided and answer the following question.

Q1 Name the Investigation?

Q2 What are the findings?
Q3 How do you classify this complication?
Q4 What is the definitive management?
Station No. 2

Instruction for examiner:

A 30 year old lady has undergone laparoscopic cholecystectomy. In the immediate post
operative period she shows pain abdomen, nausea and vomiting. She was discharged on medication.
She presented 3 months later with jaundice and pruritis all over the body. Look at the investigation
provided and answer the following question.

KEY
Q1 PTC 2
Q2 Stricture at confluence of right & left hepatic ducts. 3
Dilated intrahepatic biliary channels
Visible LIGA clips
No extravasation of dye.
Q3 Bismuth classification 3
Q4 Conservative management. 2
End to side Roux-En-Y hepaticojejunostomy
Station No. 3

Instruction to Candidates:

A 30 year old male has presented with the history of something coming out of anus for the last 3 years.
To start with it was only on defecation but now it is also present at cough. There is history of blood and
mucus discharge with stools off and on. Look at the photograph of the patient and answer the following
questions ?

Q1 What is the diagnosis?

Q2 What are the different types of this condition?
Q3 How would you confirm your diagnosis clinically?
Q4 What are the different modalities of management of this condition?
Station No. 3

Instruction for examiner:

A 30 year old male has presented with the history of something coming out of anus for the last 3 years.
To start with it was only on defecation but now it is also present at cough. There is history of blood and
mucus discharge with stools off and on. Look at the photograph of the patient and answer the following
questions?

KEY
Q1 Complete rectal prolapse 1.5
Q2 Complete and partial rectal prolapse 1.5
Q3 DRE & Proctoscopy 2
Sphincter tone and pelvic floor
Q4 General measures 5
Pelvic floor exercises
Thiersch wire
Ripstein
Goldberg
Various rectopexy techniques
Delorme’s procedure
Station No. 4

Instruction to Candidates:

Look at the record of elective procedure.

KEY
Q1 Presentation skills 2
Q2 Correct sequence of steps of procedure 4
Q3 Complication during surgery & their management 2
Q4 Does he /she observes his/her limitations 2
Station No. 5

Instruction to Candidates:

Look at the log book for any emergency procedure .

KEY
Q1 Presentation skills 2
Q2 Correct sequence of steps of procedure 4
Q3 Complication during surgery & their management 2
Q4 Does he /she observes his/her limitations 2
Station No. 6

Instruction to Candidates:

A 22 Year old man has presented with progressive generalized muscular weakness, respiratory distress
and drooping of eyes. He has been taking psychotic treatment also. Look at the radiograph of the
patient and answer the following questions.

Q1 What are the radiological findings on the xray ?

Q2 What is the diagnosis ?
Q3 How would you confirm the diagnosis ?
Q4 How would you manage this patient.
Station No. 6

Instruction for examiner:

A 22 Year old man has presented with progressive generalized muscular weakness, respiratory distress
and drooping of eyes. He has been taking psychotic treatment also. Look at the radiograph of the
patient and answer the following questions.

KEY
Q1 Radiopaque shadow in the superior mediastinum and 2
thoracic inlet with smooth definite borders.
Q2 Thymoma 2
Q3 Lateral Xray chest 3
CT scan chest including the neck
Short acting I/V anticholinestrase
Q4 Median sternotomy and thymectomy 3
Azathioprine
Prednisolone
Station No. 7

Instruction for examiner:

A patient with enlarged benign parotid gland has been presented to you for surgery. Take
informed consent for superficial parotidectomy

KEY
Q1 Introduces himself and greets the patient 1
Q2 Is polite and gentle ? 1
Q3 Explains the procedure and complications especially facial 3
nerve damage.
Q4 Tells the patient the pros and cons of this surgery 3
Q5 Listens to patient’s queries and responds to them in an 2
appropriate scientific manner.
Station No. 8

Instruction to Candidates: the accompanying

A 55 years old male has presented with painless hematuria off and on for one month and C/O fullness of
left lumbar region. Look at the accompanying investigation and assess following questions

Q1 Name the investigation?

Q2 What are the positive findings?
Q3 What is the diagnosis ?
Q4 How will you stage the condition?
Q5 What is the definitive management?
Station No. 8

Instruction for examiner:

A 55 years old male has presented with painless hematuria off and on for one month and C/O fullness of
left lumbar region. Look at the accompanying investigation and assess following questions

KEY
Q1 Double contrast CT Scan 1
Q2 Liver, stomach, Gallbladder, Right kidney, Aorta & IVC+ 2
vertebrae visible. Left kidney’s shadow is replaced by a mixed
echogenicity mass.
Q3 Renal cell carcinoma ( Renal mass) 2
Q4 Staging of renal cell carcinoma 2
Q5 According to stage 3
Radical nephrectomy
Chemotherapy
Radiotherapy.
Station No. 9 basic surgical skills

Instruction to Candidates:

Apply one horizontal and vertical mattress suture.

KEY
Q1 Where gloves 1
Q2 Doesn’t touch the sharps with hands 1
Q3 Holds the needle holder and forceps properly 1
Q4 Holds the needle properly in a needle holder. 1
Inserts the needle at 90o 1
Reverses the needle with instruments 1
Ties a proper reef knot 1
Proper horizontal mattress suture is applied 1.5
Proper vertical mattress suture is applied 1.5
Station No. 10

Instruction to Candidates:

A 23 years old college student was involved in a fight in college. He was stabbed in the abdomen about
30 minutes ago and has presented in A & E department.

Q1 What should be your initial management?

Q2 What does the photograph show?
Q3 How would you assess the fluid requirement of his patient?
Q4 After initial resuscitation what other steps you must take?
Station No. 10 stab abdomen

Instruction for examiner:

A 23 years old college student was involved in a fight in college. He was stabbed in the abdomen about
30 minutes ago and has presented in A & E department.

KEY
Q1 ABCDE primary and secondary survey 2
Q2 Omentum coming out of anterior abdominal wall, blood 2
soaked clothes, I/V line and Foley catheter
Q3 By pulse, BP, urine output and history 3
Q4 Complete secondary survey including examination of the
back and body from head to toe.
Station No. 11 proctoscope

Instruction to Candidates:

You are provided with an instrument. Please observe it carefully. You are supposed to answer
questions on the answer sheet provided

n Name the instrument and its parts ?

Q2 How is this instrument sterilized?
Q3 What are its diagnostic indications?
Q4 What is its therapeutic indications?

KEY
Q1 Proctoscope A) Obturator, (B) sheath. 2
Q2 Autoclave 121oC for 15 min at 15 lb/inch2 2
Q3 Uncomplicated hemorrhoids. Rectal polyp, rectal ulcer; rectal 3
carcinoma, any problem with biopsy needle needed.
Q4 Injection schlerotherapy 1st degree hemorrhoids. 3
Band ligation for 2nd degree hemorrhoids
Injection schlerotherapy for internal hemorrhoids’.
Examination of rectal polyp.
Station No. 12

Instruction to Candidates:

An 18 year old emaciated male has presented in emergency with severe abdominal pain and
recurrent episodes of vomiting. He has a strong family history of tuberculosis. Look at his chest
X-ray and answer the following question.

Q1 What does the radiograph shows?

Q2 What is the initial management?
Q3 What are the likely complications of this condition?
Q4 What would be the definitive management of this case?
Station No. 12

Instruction for examiner:

An 18 year old emaciated male has presented in emergency with severe abdominal pain and
recurrent episodes of vomiting. He has a strong family history of tuberculosis. Look at his chest
X-ray and answer the following question.

KEY
Q1 Air under the right dome of diaphragm 2.5
Pneumothorax on the left side.
Left lung also shows cavitation
Bilateral miliary shadowing of lungs
Q2 Resuscitation which includes fluids and electrolyte 2.5
replacements, NG tube, Foley catheter, Labs for CBC,
electrolyte, ABG’s, Blood group for cross match
Q3 Fecal peritonitis with attending sequelae . 2
ARDS and ALI
MODS
Q4 After stabilizing the patient exploratory laparotomy and left 3
tube thoracostomy.
Oxygen inhalation and respiratory support if required.
Station No. 13

Instruction to Candidates:

You are provided with an investigation. Please observe it carefully. You are supposed to answer
questions on the answer sheet provided

Q1 What is this investigation?

Q2 What are the positive findings?
Q3 What would be your next step in management?
Q4 What is the definitive management?
Station No. 13

Instruction for examiner:

You are provided with an investigation. Please observe it carefully. You are supposed to answer
questions on the answer sheet provided

KEY
Q1 Barium swallow 1
Q2 An irregular stricture at the lower end of esophagus 2
Q3 Upper GI endoscopy with biopsy 3
Q4 After staging the disease surgical resection if possible 4
Or intubation with palliative intent
Station No. 14

Instruction to Candidates:

A patient with respiratory embarrassment has been brought to emergency after doing initial
resuscitation you receive the ABG analysis that was requested by you. Look at the ABG report provided
and answer the following questions;

pH 7.3

pCO2 40mmHg

pO2 89 mmHg

HCO3 21.3

O2 sat 94%

B.E. - 2.7

Q1 How would you send a sample for ABG analysis?

Q2 What does this report indicate?
Q3 How would you correct this imbalance?
Q4 Name 3 common causes of this condition?
Station No. 14

Instruction for examiner:

A patient with respiratory embarrassment has been brought to emergency after doing initial
resuscitation you receive the ABG analysis that was requested by you. Look at the ABG report provided
and answer the following questions;

pH 7.3

pCO2 40mmHg

pO2 89 mmHg

HCO3 21.3

O2 sat 94%

B.E - 2.7

KEY
Q1 An arterial puncture is done and sample taken in a 2
heparinized syringe in ice and quickly analyzed.
Q2 Metabolic acidosis 2
Q3 Correction of the underlying cause 3
Oxygen supplementation
Q4 Diabetes ketoacidosis 3
Pancreatitis
Chronic renal failure
Station No. 15

Instruction to Candidates:

You are provided with a photograph / radiograph. Please observe it carefully. You are supposed
to answer questions on the answer sheet provided

Q1 What is this investigation?

Q2 What are the pre-requisites of this investigation and how do we prepare for it?
Q3 What are the positive findings?
Q4 What are the indications of this procedure?
Station No. 15 36

Instruction for examiner:

You are provided with a photograph / radiograph. Please observe it carefully. You are supposed
to answer questions on the answer sheet provided

KEY
Q1 An Intravenous urogram 2
Q2 Normal urea creatinine, 2
Patient not allergic to iodine based dye
Bowel has been cleared
All precautions for hypersensitivity reaction has been taken
Q3 Right sided hydronephrosis with DJ stent in place 3
Dye also showing the left renal pelvis and bladder
Q4 Ureteric repair 3
ESWL
As a precaution in surgeries where ureteric involvement is
anticipated.