UNIVERSITY OF DUBLIN

TRINITY COLLEGE

Faculty of Health Sciences

School of Medicine
Final Medicine (Surgery) 2020

2019- 2020

Paper 2: MCQ Paper

Date: 7th April 2019 Blackboard: Online Time: 1 : -1 : 0

Examiners:

Professor KCP Conlon Professor Ajith Siriwardena

Professor JV Reynolds. Mr Declan Carey

Instructions to candidates:

This paper comprises three sections (A-C): two multiple choice question sections (A and B) and one
short answer questions (section C)

All sections are to be attempted (Section A , B and C)

Section A: 30 questions (5 answers per question); Answers to marked True or False

o Please note that negative marking will be in place for this section, as follows
+1 for a correct answer

-1 for an incorrect answer

Section B: 50 questions; Please select the single best answer from A-E

o There will be no negative marking for this section

Section C: 6 short answer questions, please answer all questions

 SECTION A - TRUE/FALSE

1. Concerning Sarcoma:
• Osteosarcoma represents approximately 80% of all sarcomas
• The commonest form of soft tissue sarcoma is liposarcoma
• Is associated with a 76% five year survival
• Is relatively insensitive to chemotherapy
• Represents approximately 10% of all cancers

2. A 55-year-old falls from a roof 5 meters high that he was fixing. Which of the following
are reasonable first line trauma series investigations?
• Lateral Cervical Spine X-ray
• Lateral Chest X-ray
• AP X-ray of Pelvis
• MRI of calcaneous
• Skull X-ray

3. In Gastric Cancer:
• E-Cadherin mutation is a risk factor
• Helicobacter pylori is implicated in many cases
• Always requires an Endoscopic Ultrasound (EUS) for staging
• Is associated with 74% five year survivals
• Is associated with high smoked food diets

4. In Traumatic Brain Injury:

• Subdural haematomas may expand over weeks
• Depressed skull fracture is the most common type
• Basal skull fracture often presents with bilateral ecchymoses around the orbits
• Epidural haematomas are commonly associated with the subgaleal artery tearing
• Diffuse Axonal Injury is associated with penetrating trauma
5. A 43-year-old man with a history of a previous laparotomy presents to the ED with
colicky central abdominal pain, obstipation and vomiting. Plain film of the abdomen
shows dilated loops of small bowel.
• The likely diagnosis is small bowel obstruction
• The likely cause are adhesions
• Treatment is with intravenous fluids and a nasogastric tube
• Operations to resolve the condition are required in majority of cases
• Gallstones are a rare cause of this presentation

6. Concerning Gallstones in the Gallbladder:

• The most common situation is asymptomatic status
• Empyema is more common than Mirrizzi syndrome type 1
• Biliary colic requires admission for IV analgesia
• Cholecystitis may occur without gallstones
• The most common stones in Europe are mixed stones

7. In perianal haemorrhoids:
• First degree types can be seen just at the external aspect of the anal canal
• Usually present with blood and pain on defaecation
• Can be treated with a high fibre diet
• Require surgery in 4 out of 5 cases
• Are rare in pregnancy

8. Anal fissure
• Is an abnormal connection between 2 epithelial lined surfaces
• Is treated with anal stretch
• Presents with blood and pain on defaecation
• Only requires treatment if becomes chronic
• Can be associated with Crohn's disease
9. A 43-year-old who has a 6 month history of alcohol abuse presents with melaena.
• Bleeding duodenal ulcer is the likely cause
• Initial treatment is wide bore IV access and intravenous fluids
• Endoscopy should be performed within the first 24 hours
• IV proton pump infusion for 140 hours is usually the treatment
• It may take 6 hours for the actual haemoglobin drop to become apparent on tests

10. An 87 year old presents with early stage rectal cancer (T1)
• Local excision is reasonable
• If anterior resection is considered the patient would be advised of a 30 day mortality
rate approximating 1%
• Local arterial infusion of chemotherapy is a standard therapy
• Has a 100% five year survival
• Radiotherapy is an option, if bleeding occurs

11. Chronic Gastroparesis

• Is a condition where effortless vomiting occurs
• Is common
• Can be treated with low dose erythromycin
• Can be treated with a laparoscopically placed gastric pacer
• Can be associated with diabetes

12. Regarding visceral (autonomic) abdominal pain, which of the following are paired
correctly?
• Early appendicitis and periumbilical pain
• Pancreatitis and periumbilical pain
• Distal oesophagitis and epigastric pain
• Hindgut pain and supra pubic pain
• The visceral afferents for foregut return to the spinal cord via the coeliac artery
plexus
13. Key features of Cauda Equina Syndrome include:
• Unilateral or bilateral leg pain
• Bowel and bladder dysfunction
• Saddle anaesthesia
• Fever
• Lower extremity sensorimotor changes

14. Which of the following management steps should be taken whenever a non-
ambulatory infant presents to the ER with a diaphyseal long bone fracture?
• Immediate consultation with child protective services and possible admission to the
hospital
• Order serum vitamin D levels
• Order serum calcium and phosphorus level
• Temporary immobilisation of fracture with splint
• Adequate analgesia

15. In Inflammatory Bowel Disease:

• Bowel resection is usually curative in Crohn’s Disease
• Ileal-pouch anal anastomosis (IPAA) is an option for patients with Ulcerative Colitis
who do not want a permanent stoma
• IPAA is a good option for Crohn’s Disease
• A seton is often used in Ulcerative Colitis
• The long term risk of colon cancer is higher in Crohn’s Disease than in UC

16. In inguinal hernia:

• Inguinal hernia repair has a rate of chronic pain of 1 in 1000
• The superior epigastric artery is at risk during laparoscopic hernia repair
• Spighelian herniae occur at the linea alba at the arcuate line 1/3 below the
umbilicus
• Direct inguinal herniae are often found extending into the scrotum
• The medial border of Hesselbach’s triangle is the rectus abdominis
17. In regard to stomas:
• Domperidone is often used to manage a high output stoma
• Stoma prolapse is common with loop transverse colostomies
• Skin excoriation is a common feature of all stomas
• Monitoring electrolytes and stoma output is important in calculating fluid
requirements
• Loperamide can be useful in high output stomas

18. In colorectal cancer:

• Locally advanced colon cancer usually receive neoadjuvant chemoradiotherapy
• Liver metastases preclude surgery in colon cancer
• Tumours with microsatellite instability are classically in older ladies on the right side
if they are sporadic, or on the left side in younger patients with Lynch syndrome
• Stage III colon cancer involves the regional lymph nodes
• Low anterior resection results in an irreversible stoma

19. In upper gastrointestinal bleeding:

• The Rockall Score helps to predict the risk for rebleed and mortality
• In 25% of cases, upper GI bleedings are caused by neoplasms
• A low BUN (blood urea nitrogen) to creatinine ratio indicates an upper GI bleed
• IV Terlipressin is used in variceal haemorrhage as it decreases the portal-venous
pressure
• A Sengstaken-Blakemore tube is the treatment option of choice in an otherwise
uncontrollable haemorrhage from gastric varices

20. In acute pancreatitis:

• A CT scan is often necessary to confirm the diagnosis
• A Glasgow-Imrie score of 2 indicates a low risk for severe pancreatitis
• An empiric broad band antibiotic treatment is the standard treatment and should be
started immediately after the diagnosis has been confirmed
• In patient with biliary pancreatitis, the gall bladder should be removed on the same
admission
• Gall stones and hypertriglyceridemia are the two most common causes for acute
pancreatitis
21. In peptic ulcer disease (PUD):
• The lifetime prevalence of perforation in patients with PUD is about 30%
• A barium meal can be used to diagnose a perforated peptic ulcer (PPU)
• The classic triad of sudden onset of upper abdominal pain, tachycardia and
abdominal rigidity is missing in many patients with PPU
• The prevalence of H. pylori in patients with perforated duodenal ulcers ranges from
50%-80%
• Patients with clinical suspicion of PPU and no free air under the diaphragm on an
erect chest X-ray should receive an emergency MRI abdomen

22. In acute mesenteric ischaemia:

• Pain out of proportion to physical examination is a characteristic feature of acute
mesenteric ischemia
• Patients with atrial fibrillation and abdominal pain should be treated as mesenteric
ischemia until proven otherwise
• Abdominal angina usually describes a chronic form of mesenteric ischaemia
• NOMI refers to a thrombotic occlusion of the superior mesenteric artery
• Patients with a thrombosis of the superior mesenteric vein are at risk of developing
an acute mesenteric ischemia

23. In regard to enteral/parenteral feeding:

• Abnormal LFT’s can regularly be observed in patients receiving TPN
• Patients undergoing colon surgery should receive TPN until postoperative day 5 to
minimize the risk for an anastomotic leak
• Patients with severe pancreatitis and gastroparesis should be fed via an open
feeding jejunostomy
• A refeeding syndrome is characterized by high phosphate, magnesium, and
potassium levels
• A short bowel syndrome is a contraindication for enteral feeding
24. Colorectal cancer:
• Is the most common GI malignancy
• Tumour markers can be used for diagnosis
• 3% to 5% of patients will have a synchronous carcinoma at time of diagnosis
• Iron deficiency anaemia may be the only presenting symptom
• The predominant type is anaplastic

25. Regarding Carpal tunnel syndrome

• Clinical feature include numbness in little finger
• Atrophy of hypothenar musculature
• Positive Tinel sign of Ulnar Nerve at wrist
• Nocturnal pain and numbness in affected fingers
• Treatment include median nerve decompression at wrist

26. Pheochromocytoma
• 10% occur unilateral
• 10% occur extra-adrenal
• 10% have malignant potential
• Can be diagnosed with MIBG scan
• Associated in MEN type 1

27. An 18-year-old male college student presents with a right ankle injury two weeks after
slipping on a soccer ball. The skin is intact and tender anterior talofibular ligament
with no instability. X-rays show no bony injury. Which of the following non operative
treatment modalities have been shown to minimize recurrence of his injury?
• Immobilization in a non-weight-bearing cast
• Immobilization in a weight-bearing boot
• Immobilization in a splint
• Functional bracing with early proprioceptive training
• Neuromuscular training alone
28. Ruptured Abdominal Aortic Aneurysms (AAA):
• CT Aortogram is mandatory in all patients with ruptured AAAs.
• Fluid resuscitation is maintained till a normal blood pressure is achieved.
• Severe abdominal pain, radiating to the back, associated with collapse is the classic
presentation of ruptured AAA.
• The annual risk of rupture of a 6 cm AAA is 10%.
• Up to 75% of patients with ruptured AAA die before reaching the hospital.

29. Regarding surgical site infections:

• Staphylococcus aureus is found in the nasopharynx of 15% of the population
• Streptococcus viridians is associated with infections after bowel surgery
• Streptococcus faecalis is the most pathogenic of the Streptococcus group
• Clostridium difficile is the pathogen responsible for pseudomembranous colitis
• Pseudomonas species can colonise burns and tracheostomy sites

30. DVT Prophylaxis in surgical patients routinely involves the following

• Direct oral anti-coagulants after hip replacement
• Sequential compression devices intra-operatively
• Low-molecular weight heparin injections
• Aspirin
• Physiotherapy
 SECTION B - PLEASE SELECT THE SINGLE BEST ANSWER

31. A 64-year-old male presents with left iliac fossa pain and tenderness. He is diagnosed
Hinchey Acute Diverticulitis on clinical exam and CT scan. Which of the following
statements is true?
A. Requires a colonoscopy at 6 weeks after this episode
B. Flucloxacillin and Benzylpenicillin are the best combination IV antibiotics
C. He is likely to need interval (elective) resection of his sigmoid if he avoid acutes
resection
D. He is very likely to need acute surgical resection of his sigmoid diverticular segment
E. Can be treated conservatively at home

32. The following are types of appendicitis EXCEPT:

A. Acute inflammatory appendicitis
B. Chronic myeloid appendicitis
C. Acute gangrenous appendicitis
D. Acute suppurative appendicitis
E. Appendix mass

33. A 78 year old presents with acute pancreatitis for the second time. He had a
cholecystectomy 2 years ago after his first episode. Which of the following statement
is true?
A. Requires a CT on day 1
B. Is best treated with IV spironolactone and bed rest
C. In the presence of a recent trip to Cork, scorpion bite should be in the differential
aetiology list
D. This could still be gallstone pancreatitis
E. Salivary amylase level is diagnostic

34. Meckel’s Diverticulum is

A. Is a pseudodiverticulum
B. Present in 20% of the population
C. Is present within 2 feet (circa 60cm) from the duodenojejunal flexure (DJ)
D. Can cause fat embolus
E. Unless has ectopic gastric or pancreatic mucosa, rarely causes clinical problems
35. Pancreas pseudocysts
A. Can be drained by endoscopic stent
B. Cyst fluid is low in amylase
C. Are acquired usually after a bout of mild pancreatitis
D. Have an epithelial lining
E. Always require drainage

36. For bariatric surgery

A. Body mass index (BMI) should be below 30
B. A gastric bypass is the always necessary
C. Is generally not reversible
D. Is mostly open (not laparoscopic)
E. Can reverse the onset of diabetes

37. For Gastro-oesophageal reflux

A. Weight loss can be associated with improved symptoms
B. Nissen Fundoplication is where a pyloromyotomy is performed
C. is best treated with SSRIs
D. pH and manometry is rarely helpful in determining therapy
E. Surgery is usually indicated

38. A 67 year old presents with a microcytic anaemia requires the following as a minimum
work up EXCEPT:
A. A dietary history
B. Gastroscopy and D2 biopsy
C. A PET scan
D. Serum Iron studies
E. Colonoscopy
39. Laparoscopic cholecystectomy
A. The gallbladder is usually removed via the suprapubic port
B. Involves 7 small incisions
C. Allows the gallbladder to be preserved while removing all the stones
D. The right upper quadrant port is where the camera is placed
E. Takes usually a 40 minutes to 1 hour

40. The incidence of superficial surgical site infection after open appendicectomy (clean-
contaminated) is
A. 0%
B. 20%
C. 5%
D. 40%
E. 60%

41. Total Parenteral Nutrition is indicated in a patient who can’t support enteral feeding
for an estimated
A. 4 days
B. 5 days
C. 2 days
D. 3 days
E. 1 day

42. A midline neck lump which moves on tongue protrusion is likely a

A. Lymph node
B. Submandibular gland tumour
C. Brachial cyst
D. Thyroglossal cyst
E. Carotid body tumour
43. Which on the list below is the earliest step on the plastic surgery reconstruction
ladder?
A. Free flap
B. Primary suture repair
C. Split skin graft
D. Full thickness graft
E. Local flap

44. A 28 year old man is involved in a road traffic accident and sustains a flail chest injury.
On arrival in the emergency department he is hypotensive. On examination he has an
elevated jugular venous pulse and auscultation of the heart reveals quiet heard
sounds. What is the most likely diagnosis?
A. Pneumothorax
B. Myocardial contusion
C. Cardiac tamponade
D. Ventricular septal defect
E. Haemothorax

45. Which nerve innervates the rectus femoris muscle?

A. Femoral
B. Peroneal
C. Sartorial
D. Tibial
E. Obturator

46. A young man has a tibia-fibula fracture following a fall from a wall. The fracture is
grossly aligned and placed in a long leg splint in the emergency room. What is
considered the earliest sign or symptom of a developing compartment syndrome of
the leg?
A. Pain out of proportion to injury
B. Decreased pulses in the foot
C. Loss of the ability to move the toes
D. Decreased sensation in the foot
E. Pale appearance of the foot
47. A 34-year-old man sustained a gunshot wound to the knee 18 months ago and was
treated with bullet removal and a 10 day course of oral antibiotics. He now complains
of 12 months duration of pain in the thigh and recent ulceration and drainage of the
skin near the site of his gunshot wound. Physical exam is notable for a draining sinus
tract, erythema and tenderness of the mid-thigh. He is afebrile. An MRI revealed
abnormal signals in the distal femur. Which of the following is the most appropriate
management?
A. Core needle biopsy, chest CT scan, and bone scan
B. Surgical debridement, culture, and intravenous antibiotics
C. Neoadjuvant chemotherapy and wide resection followed by adjuvant chemotherapy
D. Core needle bone culture followed by intravenous antibiotics
E. Two week course of oral cephalosporin

48. A 75 year old man presents to the surgical department with increasing yellow
discoloration of the skin and sclera. He has had significant weight loss in the past three
months. On examination a globular mass is palpable in the right upper quadrant. What
is the most likely diagnosis?
A. Acute cholecystitis
B. Liver abscess
C. Acute hepatitis
D. Periampullary tumour
E. Gallbladder mucocele

49. A 27-year-old man sustains a Gustilo and Anderson type II open tibia fracture during a
motorcycle accident. He had a full course of tetanus vaccination as an infant and child.
He also had a tetanus booster vaccination 12 months ago when he began a new job. In
addition to intravenous antibiotics, what tetanus prophylaxis should be administered?
A. Tetanus vaccine and immunoglobulins
B. Tetanus vaccine and tetanus immune globulin with a booster vaccine required 6
months from now
C. Tetanus Immunoglobin
D. No prophylaxis required
E. Tetanus vaccine
50. A 55 year old lady presents to the emergency department with severe right upper
quadrant pain, jaundice, fevers and rigors. On abdominal examination she has right
upper quadrant tenderness. Ultrasound abdomen confirms gallstones with intra and
extrahepatic biliary dilatation. What is the definitive management for her presenting
condition?
A. MRCP
B. Tube cholecystostomy
C. PTC
D. Hepatico-jejunostomy
E. ERCP

51. A 65 year old man presents to the surgical department with worsening dysphagia and
weight loss. What initial investigation would you request for him?
A. Ultrasound abdomen
B. OGD
C. MRI abdomen
D. Laryngoscopy
E. ERCP

52. A 35 year old man presents to the emergency department with left sided loin to groin
pain. His urine analysis reveals microscopic haematuria. What would be most
appropriate radiological investigation for him?
A. MRI kidney
B. US abdomen
C. DMSA scan
D. CT KUB
E. X ray Chest

53. A 16 year old boy presents to the emergency department with complaint of right sided
testicular pain after playing a football match. On examination his right testes is higher
than the left one and extremely tender. What is the most likely diagnosis?
A. Testicular torsion
B. Testicular trauma
C. Spermatocele
D. Testicular cancer
E. Varicocele
54. The most common cause of bright red bleeding in a young otherwise healthy 20 year
old:
A. Haemorrhoids
B. Rectal tumour
C. Infective colitis
D. Ulcerative colitis
E. Juvenile polyps

55. Hereditary non polyposis colorectal cancer is caused by:

A. Mutation in CFTR gene
B. Mutation in SPINK1 gene
C. Mutation in BRCA gene
D. Mutation in mismatch repair genes
E. Mutation in APC gene

56. About femoral hernia

A. Is associated with a defect in Linea Alba
B. The femoral vein lies medial to the hernia
C. Has a low incidence of incarceration
D. More common in men than women
E. More common in women than men

57. A 75 year old male presented with acute pain, pallor, and absent pulses in his left leg.
Investigations revealed an embolus in his femoral artery. What is the most likely
source of this embolus?
A. Paradoxical emboli
B. Endocarditis
C. Thrombus from an atheroma in the aorta.
D. Right ventricular thrombi
E. Rheumatic endocardial vegetations
58. A 19 year old male presents with vomiting fresh blood following a 48 hours drinking
binge. He denies regular alcohol abuse. He is vitally stable. What is the most likely
diagnosis:
A. Peptic ulcer
B. Aorto-duodenal fistula
C. Mallory-Weiss tear
D. Meckel’s diverticulum
E. Oesophageal varices

59. Most common type of thyroid cancer

A. Lymphoma
B. Follicular carcinoma
C. Papillary carcinoma
D. Anaplastic carcinoma
E. Medullary carcinoma

60. A 72-year-old female presents with vomiting and colicky abdominal pain and absence
of flatus. On examination her abdomen is distended, nontender and tympanic to
percussion. There is a mid-line laparotomy incision with no evidence of an incisional
hernia. Plain film of the abdomen demonstrates a small bowel obstruction. What is
the most likely cause of the small bowel obstruction in this case?
A. Adhesions
B. Duodenal carcinoma
C. Volvulus
D. Epigastric hernia
E. Metastatic disease

61. A 50-year-old man returns to outpatient clinic following an open mesh repair of a right
inguinal hernia. He complains of some pain and numbness in his right hemi-scrotum.
What structure has most likely been injured during his operation?
A. Pubic symphysis
B. Femoral nerve
C. Ilioinguinal nerve
D. Testicular artery
E. Round ligament
62. Day 4 following a 2-stage oesophagectomy, an otherwise healthy 58 year old male
develops a high grade temperature of 39. He is most likely to have
A. Anastomotic leak
B. Wound infection
C. Drug induced pyrexia
D. Pulmonary embolism
E. Urinary tract infection

63. Which is the most important criteria used for determining prognosis of malignant
melanoma
A. Type of melanoma
B. Borders of the lesion
C. Breslow thickness
D. Large lesion
E. Bleeding lesion

64. Which of the following is not well absorbed following a gastrectomy?

A. Vitamin C
B. Zinc
C. Vitamin B12
D. Copper
E. Molybdenum

65. A surgical team wish to conduct a meta-analysis of randomised controlled trials of the
use of low molecular weight heparins in the prevention of post-operative deep vein
thrombosis. How would these results be best displayed graphically?
A. Forest plot
B. Box Whisker plot
C. Violin plot
D. Kaplan Meier graph
E. None of the above
66. Adrenal Medulla is derived from
A. Endoderm
B. Ectoderm
C. Neural Crest
D. Mesoderm
E. None of the above

67. Best test to diagnose Achalasia is

A. CT thorax
B. 24 hour pH monitoring
C. Oesophageal Manometry
D. OGD
E. Barium meal

68. Which of the following is not a predisposing factor for a hernia?

A. Obesity
B. Chronic obstructive pulmonary disease
C. Pregnancy
D. Urinary stones
E. Peritoneal dialysis

69. In germ cell testicular tumours lymph node metastases spread to:
A. Femoral nodes
B. Para-aortic nodes
C. Inguinal nodes
D. Axillary nodes
E. Mesenteric nodes

70. Which one the following levels indicates the oesophageal aperture in the diaphragm?
A. 11th thoracic vertebra
B. 8th thoracic vertebra
C. 12th thoracic vertebra
D. 9th thoracic vertebra
E. 10th thoracic vertebra
71. A 72-year-old lady presents to A&E with sudden onset of severe epigastric pain and
vomiting. On examination her abdomen is tender with guarding in the epigastrium and
RUQ. She tells you she has been taking some pain relief for her osteoarthritis but is
unsure of the name. Which of the following investigations would you request first for
this patient?
A. Erect chest x-ray
B. Plain film of the abdomen
C. CT scan of the abdomen and pelvis
D. Echocardiogram
E. Oesophago-gastro-duodenoscopy (OGD)

72. The most common injury following pelvic ring fracture is of :

A. Bladder
B. Colon
C. Rectum
D. Vagina
E. Urethra

73. Vasoconstrictor in Local Anaesthetic Solution:

A. Reduces systemic toxic effects of LA solution
B. Increases bleeding
C. Increases toxic effect of LA Solution
D. Has NO effect of efficacy of the LA solution
E. All of the Above

74. A 21-year-old man fractures his ulna and radius. He is treated by means of a plaster
cast, which is removed after four weeks. What pathological process is most likely to
have affected the immobilized muscles?
A. Hypertrophy
B. Atrophy
C. Hyperplasia
D. Aplasia
E. Neoplasia
75. A 45 year old male, known case of ulcerative colitis, has not responded to maximal
medical therapy. A plain AXR shows colonic diameter of 7 cm with generalised
guarding and tenderness. He has 5 days history of bloody diarrhoea. What is the most
appropriate operation for this patient in emergency setting
A. Sigmoid colectomy and primary anastomosis
B. Subtotal colectomy with ileostomy
C. Hartmann’s procedure
D. Anterior resection
E. Transverse loop colostomy

76. A 69 year old male presents to the A & E with sudden severe onset of epigastric
abdominal pain radiating to back. He is nauseous, sweating and feels faint. On
examination, he is hypotensive and tachycardiac. What is the most appropriate
diagnosis:
A. Ruptured abdominal aortic aneurysm
B. Myocardial infarction
C. Gastritis
D. Chronic pancreatitis
E. Biliary colic

77. A 55 year old lady presented with a wrist drop and loss of sensation over the lateral
aspect of the hand following a fall. X-ray shows fracture of mid-shaft of humerus. The
most likely nerve injured is ?
A. Ulnar nerve
B. Suprascapular nerve
C. Median nerve
D. Radial nerve
E. Axillary nerve

78. Magnesium is usually absorbed in:

A. Proximal jejunum
B. Proximal ileum
C. Duodenum and jejunum
D. Ascending colon
E. Distal jejunum and ileum
79. The most distensible part of the large bowel is:
A. Caecum
B. Sigmoid colon
C. Descending colon
D. Rectum
E. Transverse colon

80. Which of the following is considered a major risk factor in the development of AAA?
A. Diabetes mellitus
B. Smoking
C. Collagen vascular disease
D. Hypertension
E. Obesity

SECTION C - SHORT ANSWER QUESTIONS, PLEASE ANSWER ALL QUESTIONS

1. What is surgical site infection?

Discuss the methods to reduce surgical site infection.
Describe the factors responsible for surgical site infection.

2. Write a note on hiatus hernia.

Discuss their classification, investigation and management

3. Enumerate the causes of lower GI bleeding and discuss its management in brief.

4. Write a note on classification of thyroid carcinoma.

List the complications of thyroidectomy.

5. Write a short note on diagnosis and management of Colles’ fracture.

6. Discuss management of an infrarenal abdominal aortic aneurysm.