#Kathmandu University
BIRAT MEDICAL COLLEGE
Budhiganga-02, Tankisinuwari, Morang
Level: Final MBBS (Batch: 2021)
Semester: 8th
Examination: End-Semester
Subject: Surgery & Allied Subject (Paper-I)
Time: 2 hrs. 30 mins.
Date: March 15, 2026
Marks: 50
#INSTRUCTION TO THE CANDIDATE
Answer each section in a separate answer book.
Write brief, relevant and legible answers.
Illustrate your answer with well labeled diagrams where required.
All questions are compulsory.
#SECTION ‘B’
#Short Answer Questions [5Q × 6 = 30 marks]
Define near-total thyroidectomy. Enumerate at least four complications of the surgery. Enlist the treatment of thyrotoxic crisis (thyroid storm). [1+2+3=6]
Enlist four important causes of lower G.I. bleeding. What are the key components of management of this condition? Enumerate the options of surgical procedures? [2+2+2=6]
Define lymphoma. Enumerate the differences between Hodgkin’s and Non-Hodgkin’s lymphoma. Write complications of Hodgkin’s lymphoma. [1+3+2=6]
What are the indications of splenectomy? Define overwhelming post-splenectomy infection (OPSI). Enlist its prevention strategies. [3+1+2=6]
What are the common presenting complaints of peripheral arterial disease? What are the investigations to be done for the disease? How do you treat chronic limb threatening ischemia? [2+2+2=6]
#SECTION ‘C’
#Problem Based Questions / Modified Essay Questions [2Q × 10 = 20 marks]
#Problem I
A 35-year male comes to BMCTH emergency with alleged history of road traffic accident on left lower chest. He complains of dizziness, pain in left upper abdomen and tip of left shoulder. His pulse is 102 beats/minute and blood pressure is 80/60 mm of Hg, respiratory rate is 30/min. On chest examination, chest compression test is positive, left side of chest is dull on percussion and breath sounds are absent. On abdominal examination, left upper abdomen is tendered, distension of the abdomen is present with fluid thrill and liver dullness is present.
a. State your most probable complete clinical diagnosis. [2]
b. How will you resuscitate this patient in emergency? [5]
c. How will you manage him further, after he becomes hemodynamically stable? [3]
#Problem II
A 40-year premenopausal female presented to BMCTH Surgery OPD with painless lump in right breast for 6 months. On examination, a 2.5 × 1 cm² lump was present in right upper quadrant which was hard, non-tender, not fixed to skin or underlying structure and no axillary lymph node were palpable.
a. What important further history you would like to ask from her? [2]
b. Mention the focused clinical examination to be done. [2]
c. How will you investigate her? [3]
d. Mention the staging of the disease and further treatment according to the stage. [3]
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