FMGE 2026 - Surgery PYQs Practice Questions

Q: What is CEAP staging of the given image?

C1. ***C1*** - Represents **telangiectasias** (spider veins) or **reticular veins**, which are the hallmark clinical finding for this stage. - These are typically defined as venous dilations measuring less than **3 mm** in diameter. *C2* - Characterized by the presence of **varicose veins**, which are defined as subcutaneous dilated veins measuring greater than **3 mm**. - Unlike C1, these veins are often palpable and visible as tortuous, bulging vessels. *C3* - Defined by the presence of venous-related **edema**, representing a more advanced stage of venous insufficiency. - The edema is typically **pitting** and worsens at the end of the day or after prolonged standing. *C4c* - Refers to **lipodermatosclerosis** or atrophie blanche, which are severe skin changes indicative of chronic venous disease. - This stage indicates significant **dermal fibrosis** and tissue remodeling, unlike the earlier stages of simple venous dilation. [Practice more Surgery PYQs on OnCourse]

Q: A lady got a stab wound on thyroid region, which zone and management?

Zone 2, surgical exploration. ***Zone 2, surgical exploration*** - **Zone 2** of the neck extends from the **cricoid cartilage** to the **angle of the mandible**, where the thyroid gland is located. - Penetrating trauma in Zone 2 is historically managed with **mandatory surgical exploration** due to the high density of critical structures, including the **carotid arteries**, **jugular veins**, and the **larynx/trachea**, which are easily damaged. *Zone 1 , surgical exploration* - **Zone 1** represents the area from the **clavicles** to the **cricoid cartilage**, containing the **great vessels** of the thoracic inlet. - While serious, modern management for Zone 1 often favors less invasive diagnostics like **CT angiography** or **endoscopy** rather than immediate mandatory neck exploration compared to the traditional approach. *Zone 1, conservative* - Management for neck injuries is rarely purely [Practice more Surgery PYQs on OnCourse]

Q: The given image is of right superficial parotidectomy to identify the marked structure?

External jugular vein. ### ***External jugular vein*** - In the context of a superficial parotidectomy, the **external jugular vein** is a critical landmark often identified crossing the **sternocleidomastoid muscle**. - Its position relative to the **parotid gland** and the **greater auricular nerve** helps surgeons orient themselves before dissecting deeper structures. *Facial nerve* - The **facial nerve** lies much deeper than the surface landmarks usually highlighted in initial superficial dissections; it is located within the **parotid parenchyma**. - It emerges from the **stylomastoid foramen** and divides within the substance of the parotid gland, requiring meticulous dissection to preserve. *Parotid gland* - While the procedure is a parotidectomy, the parotid gland is the target organ being resected, not the specific structure marked for identification. - In a superficial parotidectomy, the **superficial lobe** is removed, but the gland itself is the volume of tissue rather than a single distinct landmark structure. *Digastric muscle* - The **posterior belly of the digastric muscle** is a vital deep landmark for locating the **facial nerve** trunk, but it is situated deeper than the superficial plane. - It serves as a superior boundary for the **carotid triangle** and is key for surgical orientation, but is not the superficial vessel commonly identified at this stage. [Practice more Surgery PYQs on OnCourse]

Q: During a laparoscopic cholecystectomy, a lateral injury to the Common Bile Duct is identified. What is the most appropriate next step in management?

Convert to open procedure with T -tube drainage. ***Convert to open procedure with T-tube drainage*** - Recognizing a common bile duct (CBD) injury intraoperatively requires immediate conversion to an **open procedure** to ensure adequate visualization and repair. - A **T-tube** is placed to provide biliary decompression and allow for healing across the primary repair or reconstruction, minimizing the risk of a post-operative **bile leak** or **stricture**. *Continue the laparoscopic procedure and place a drain* - Continuing laparoscopically after recognizing a major **CBD injury** is dangerous as it prevents adequate surgical exploration and repair of the ductal structure. - Placing a **drain** alone does not repair the duct; it only manages extravasated bile, leading to high morbidity and potentially life-threatening **biliary peritonitis**. *Ligate the duct proximal to the injury* - Simple ligation of the CBD will result in immediate **extrahepatic biliary obstruction**, causing obstructive **jaundice** and subsequent liver injury. - This approach is never acceptable; the integrity of the biliary tract must be maintained via **biliary reconstruction** (e.g., end-to-end anastomosis or hepaticojejunostomy). *Close the abdomen and refer for ERCP* - Closing the abdomen without addressing a known intraoperative iatrogenic injury is considered malpractice, as it leads to **peritonitis** and sepsis. - **ERCP** is reserved for postoperative management or diagnosis of leak/stricture; it cannot repair an acute, complete, or severe lateral injury identified during the original surgery. [Practice more Surgery PYQs on OnCourse]

Q: Ductal carcinoma in situ treated with lumpectomy, and was found to have margins of 2mm, what is the next best management ?

Radiotherapy. ***Radiotherapy*** - Following **lumpectomy** (breast-conserving surgery) for **ductal carcinoma in situ (DCIS)**, adjuvant **whole-breast radiotherapy** is standard of care to significantly reduce the risk of **local recurrence**. - Even with clear margins (defined as ≥2mm in most modern guidelines), radiotherapy is recommended for patients undergoing breast-conserving therapy to improve long-term outcomes. *Mastectomy* - **Mastectomy** is generally reserved for extensive disease, multifocal or multicentric disease, or cases where clear margins cannot be achieved with breast-conserving surgery. - Since clear margins (2mm) were achieved in this case, proceeding directly to a major surgical procedure like mastectomy is overtreatment and not indicated. *BCT* - While **breast-conserving therapy (BCT)** refers to the combination of surgery (lumpectomy) and **adjuvant radiotherapy**, stating [Practice more Surgery PYQs on OnCourse]

Question 1

What is CEAP staging of the given image?

Accepted Answer

C1

Answer

C2

Answer

C3

Answer

C4c

Question 2

A lady got a stab wound on thyroid region, which zone and management?

Accepted Answer

Zone 2, surgical exploration

Answer

Zone 1 , surgical exploration

Answer

Zone 1, conservative

Answer

Zone 2, conservative

Question 3

The given image is of right superficial parotidectomy to identify the marked structure?

Accepted Answer

External jugular vein

Answer

Facial nerve

Answer

Parotid gland

Answer

Digastric muscle

Question 4

During a laparoscopic cholecystectomy, a lateral injury to the Common Bile Duct is identified. What is the most appropriate next step in management?

Accepted Answer

Convert to open procedure with T -tube drainage

Answer

Continue the laparoscopic procedure and place a drain

Answer

Ligate the duct proximal to the injury

Answer

Close the abdomen and refer for ERCP

Question 5

Ductal carcinoma in situ treated with lumpectomy, and was found to have margins of 2mm, what is the next best management ?

Accepted Answer

Radiotherapy

Answer

Mastectomy

Answer

BCT

Answer

Regular follow up

Question 6

A 43 years presented with 4.6cm breast lump with ipsilateral mobility present, Axillary LN without distant metastasis, which stage does it belongs to?

Accepted Answer

Stage 2b

Answer

Stage 2a

Answer

Stage 3c

Answer

Stage 4

Question 7

An adult trauma patient presents with severe respiratory distress, hypotension (BP 80/50), and distended neck veins. X given below. What is the immediate next step in management

Accepted Answer

Needle decompression at 2nd intercostal space

Answer

Needle decompression at 7th intercostal space

Answer

Intubation

Answer

100% O2 at 8 liters /Min

Question 8

What is the most common cause of posterior duodenal ulcer bleeding name the artery involved?

Accepted Answer

Gastroduodenal artery

Answer

Left epiploic artery

Answer

Right epiploic artery

Answer

Intercostal artery

Question 9

A 60 year traffic police presented with dull pain in the both lower limb with tortuous vein as shown in the image. Which of the following structure is involved?

Accepted Answer

Great saphenous vein

Answer

Short saphenous vein

Answer

Popliteal vein

Answer

Femoral vein

Question 10

A patient with a malignant lesion involving the posterior one -third of the tongue is being evaluated for regional lymph node metastasis. Which lymph nodes are most commonly involved in the lymphatic drainage of this region?

Accepted Answer

Deep cervical lymphnodes

Answer

Submental lymphnodes

Answer

Submandibular lymphnodes

Answer

Periauricular lymphnodes

FMGE 2026 — Surgery