Kathmandu University
BIRAT MEDICAL COLLEGE
Budhiganga-02, Tankisinuwari, Morang
Level: III MBBS (Batch: 2023)
Semester: 5th
Examination: End-Semester
Subject: Surgery
Time: 2 hrs. 30 mins.
Marks: 50
Date: February 13, 2026
#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 [6Q × 5 = 30 marks]
What is Pseudo-obstruction? What are the factors associated with Pseudo-obstruction. How do you differentiate pseudo-obstruction with acute bowel obstruction?
[1+2+2=5]What are metabolic responses to starvation? What are the three stages of starvation? Enumerate indications and contraindications of enteral feeding?
[1+1+3=5]What are various positions of appendix? Write about sign and symptoms of acute appendicitis.
[2+3=5]What are the causes of bleeding per rectum? Define hemorrhoids. How do you manage hemorrhoids according to its grade?
[1+1+3=5]Define ulcer. What are the parts of ulcer? Classify ulcer according to margin with examples.
[5]Define burn. What is Parkland formula. Draw a diagram regarding Wallace rule of 9 in burn.
[1+2+2=5]
#SECTION ‘C’
Problem Based Questions / Modified Essay Questions [2Q × 10 = 20 marks]
#Problem–I
A 45-year-old male presents to the emergency department with sudden onset severe generalized abdominal pain, abdominal distension, non-bilious vomiting and inability to pass stool and flatus for 24 hours. On examination he is ill looking, tachycardia with pulse rate 105 beats per minute, BP 85/50 mm Hg. On per abdomen examination bowel sound was absent.
Questions:
a. What is the most likely diagnosis? [1]
b. Enumerate causes of this condition. [3]
c. What are the investigations to be sent? [2]
d. Outline principles of management. [4]
#Problem–II
A 35-year-old male presents to OPD with swelling in the right groin that increases on coughing for last 6 months. His bowel and bladder habits are normal. On examination of inguinal region cough impulse is present with reducible swelling.
Questions:
a. What is the most likely diagnosis? [1]
b. Write about difference between direct and indirect inguinal hernia. [2]
c. Write about types of hernia by complexity. [2]
d. List the investigations required in this case? [3]
e. Write about role of laparoscopy in management of inguinal hernia. [2]