Common Surgical Presentations — Practice Questions
Surgery — Common Surgical Presentations, NMC MBBS licence examination syllabus (Nepal Medical Council).
Common surgical presentations — NMC-style practice questions
Practice questions written for this chapter. These are not past NMC papers.
📋 About these questions: These are practice questions written to test the reasoning in this chapter. They are NOT reproduced from any past Nepal Medical Council examination, and no verified past NMC questions were supplied for this chapter.
Level 1–2 — recall and understanding
Q1. A femoral hernia lies:
A. Above and medial to the pubic tubercle
B. BELOW and LATERAL to the pubic tubercle
C. In the midline
D. Above and lateral to the anterior superior iliac spine
ANSWER: B — below and lateral.
Why: an inguinal hernia lies above and medial to the tubercle.
The distinction matters because the femoral canal is narrow
and rigid, so femoral hernias strangulate far more often and
are repaired promptly.
LEARNING POINT: find the pubic tubercle first, then locate the
lump relative to it.
Q2. Charcot's triad in ascending cholangitis consists of:
A. Fever, jaundice and right upper quadrant pain
B. Pain, vomiting and distension
C. Jaundice, pale stools and dark urine
D. Fever, rash and arthralgia
ANSWER: A.
Why: fever with rigors, jaundice and right upper quadrant pain
indicate infected bile behind an obstruction. Confusion and
hypotension mark severe disease.
LEARNING POINT: cholangitis requires antibiotics AND biliary
drainage.
Level 3–4 — application and clinical reasoning
Q3. A groin hernia is now tender, tense and irreducible with
NO cough impulse, and the patient is vomiting and unwell.
The correct action is:
A. Firm manual reduction
B. URGENT SURGICAL REFERRAL for operative repair
C. Reassure and review in clinic
D. Apply a truss
ANSWER: B.
Why: these features indicate STRANGULATION — the blood supply
is compromised and the bowel is dying. Reducing it pushes
necrotic bowel into the abdomen, where perforation goes
unrecognised.
LEARNING POINT: never force a tender irreducible hernia back.
Q4. A 57-year-old has a hard breast lump with skin dimpling.
Mammography is normal. The correct next step is:
A. Reassure and discharge
B. Complete the TRIPLE ASSESSMENT with tissue sampling
C. Repeat mammography in one year
D. Start antibiotics
ANSWER: B.
Why: triple assessment requires all three components, and a
normal result in one does not exclude cancer. Discordance
between suspicious clinical findings and normal imaging is a
reason to proceed, not to reassure.
LEARNING POINT: a discrete new lump in an older woman is
cancer until proven otherwise.
Q5. A patient with cholangitis remains febrile and unwell
after 48 hours of appropriate antibiotics. The next step
is:
A. Change to a broader-spectrum antibiotic
B. Arrange BILIARY DRAINAGE
C. Continue and observe
D. Add an antifungal
ANSWER: B — drainage.
Why: infected bile behind an obstruction is a closed infected
space that antibiotics cannot sterilise. This is the same
source-control logic as an undrained abscess.
LEARNING POINT: if there is pus under pressure, it has to come
out.
Level 5 — exception-based
Q6. A midline neck lump moves upwards when the patient
protrudes her tongue. This indicates:
A. Thyroid nodule
B. THYROGLOSSAL CYST
C. Lymph node
D. Branchial cyst
ANSWER: B — thyroglossal cyst.
Why: thyroid lumps move on SWALLOWING because the gland is
attached to the larynx. Movement on TONGUE PROTRUSION
indicates attachment along the thyroglossal tract.
LEARNING POINT: confirm normal thyroid tissue is present
before excision.
Q7. Which groin swelling disappears on lying down and has a
cough impulse, mimicking a hernia?
A. Femoral aneurysm
B. SAPHENA VARIX
C. Lymph node
D. Undescended testis
ANSWER: B — saphena varix.
Why: it is a soft compressible venous swelling with a cough
impulse that empties when the patient lies flat. A femoral
aneurysm is pulsatile and expansile.
LEARNING POINT: a cough impulse alone does not make a lump a
hernia.
Syllabus points
Recall and understanding questions
Application and clinical reasoning questions
Exception-based questions
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