Question: A 20 years male patients following road traffic accident presented with pulse 100/minute, BP 100/70 mmHg and Respiratory rate 21/minute. The chest move in inspiration and move out in expiration. Diagnosis is

i.e. (Flail chest): (689-Schwartz 7th) (161, 179-190- CSDT 13th)FLAIL CHEST - Massive trauma to the chest with multiple fracture of multiple ribs or bilateral disruption of the costo chondral junctions can result in free floating segment of chest wall may produce a paradoxical motion that impairs lung expansion.Flail chest is characterized by paradoxical motion of the chest wall (inward with inspiration and outward with expiration) The chances of having an intra thoracic injury in this situation increases several folds PaCO2 increases. In addition hypoventilation leads to progressive atelectasis and hypoxemia (and most important consequence of flail chest is respiratory failure).* PaO2: FiO2 ratio yields an estimate of the extent of intrapulmonary shunt and may be used as a parameter to determine the need for mechanical ventilationTreatment* Analgesia intercostal nerve block, epidural anaesthesia* Endotracheal intubation and mechanical ventilation with peak end expiratory pressure are usually indicated provided that pain control is adequate* Intubation is delayed until clear evidence of a need of ventilator suport develops; a respiratory rate of 40/min, a falling PaCO2 (evidence of excessive work of breathing) or a PaO2 below 60 torr or inspired O2 fraction of over 0.5 (689-Schwartz 7th)* Suggested parameters for instituting ventilator support are respiratory rate >30 breaths per minute PaO2 <60 mmHg or PaCO2 >45 mmHg (894-W.Shields 7th)* Open reduction plus internal fixation of sternal or rib fractures is rarely neededTENSION PNEUMOTHORAX - develops when a flap valve leak allows air to enter the pleural space but prevents its escape, intrapleural pressure rises, causing total collapse of the lung and a shift of the mediastinal viscera to the opposite side interfering with venous return to the heart It must be relieved immediately to avoid impairment of cardiac functionsCP- hypotension in the presence of distended neck veins, decreased or absent breath sounds of the affected side hyper resonance to percussion and tracheal shift away from the affected side, cyanosis (late manifestation)Treatment - Insertion of a large bore needle or plastic IV cannula (angiocath) through the chest wall into the pleural space in the second intercostal space in the second intercostal space along the mid clavicular line to relieve pressure. Tension pneumothorax should be treated definitively by tube thoracostomy.Suckling chest wound - which allow air to pass in and out of the pleural cavity should be promptly treated by a three sided occlusive dressing and tube thoracostomy


Question: Terminal heamaturia occurs in

(Prostatic urethra) (411, 434. S. Das-clinical surgery 7th)* Most common cause of haematuria is cystitis**Bladder stone - Heamaturia is characterised by the passage of a few drops of bright-red blood at the end of micturition and is due to the stone abrading the vascular trigone-a fact that also accounts for the pain (1348-LB)* Blood appears at the beginning of the act (urethral) towards the end of the act (vesical) or is intimately mixed throught the process (prerenal, renal or vesical). S. Das* Painless, profuse and paroxysmal heamaturia is the main and only symptom of Papilloma* Common cause of isolated heamaturia includes - stones, neoplasms, TB, trauma, and prostatitis* * Urogenital neoplasms in patients with isolated painless heamaturia (non dysmorphic RJBCs) increases with age (251-H)* Best answers is urinary bladder (vesical) (1286 -B &L 25th)


Question: IV fluid replacement in a trauma patient is determined by

Adequacy of fluid replacement should be checked with hemodynamic stability and urine output. When very large fluid shifts are expected and the patient has compromised renal insufficiency it is necessary to monitor fluid status using central venous pressure(CVP). Manipal manual of surgery-Shenoy,4th edition,pg


Question: Commonest presentation of Hodgkin's lymphoma is

Most patients present with palpable lymphadenopathy that is nontender; in most patients, these lymph nodes are in the neck, supraclavicular area, and axilla. More than half the patients will have mediastinal adenopathy at diagnosis, and this is sometimes the initial manifestation. Subdiaphragmatic presentation of Hodgkin's disease is unusual and more common in older males.


Question: Reconstruction surgery in breast carcinoma, Best myocutaneous flap is

D. i.e. (Transverse rectus abdominis) (1241 - CSDT 12th) (845 -B&L 25th) (737 - S. Das 5th)* Majority surgeons now prefer to use transverse rectus abdominis (TRAM-flap) - TRAM- flap reconstruction results in a soft natural and ptotic breast and avoids the need for additional prosthetic volume replacement. Excellent cosmetic results are achieved at the expanse of 5 -7 days hospital stay, a 4 to 6 weeks convalescent period and an overall complication rate of 16% to 28%BREAST - RECONSTRUCTION is new regarded as an integral part of breast cancer management and is requested with increasing frequency by informed women at the time of mastectomy* The easiest type of reconstruction is using a silicone gel implant under the pectoralis major muscle* The latissimus dorsi myocutaneous flap is used most often for reconstruction of breast with an implant* Abbey - Estlander flap used for lip* ** that may be used to correct a tight upper lip due to severe tissue deficiency (1238 - CSDT 12th)* Abbey estlendes flap is based on Labial artery*** Lingual nerve block is given in neck of mandible**


Question: Seabrooks operation is done for

Parotid Fistula Internal fistula opens inside the mouth and doesn't give rise to symptoms External fistula : Gland fistula or duct fistula Causes Rupture of parotid abscess Inadveent incision during drainage of parotid abscess Penetrating injury After superficial parotidectomy Clinical presentation When the external fistula is connected to the gland, external opening is pinpoint, though discharge is present for several months, usually closes spontaneously When external fistula is connected with major duct, there is outpouring of parotid secretions onto cheek during meals with excoriation of surrounding skin Diagnosis Sialography or sialogram Treatment Newman and Seabrock's operation (in case of fistula connected with main duct, this operation reconstructs the duct) Ref: Bailey and love 27th edition Pgno : 778


Question: The treatment of annular pancreas is

Duodenal obstruction typically causes vomiting in neonate.The usual treatment is bypass(duodenoduodenostomy) Bailey & Love ,26th,1125.


Question: Age for regular mammography is

Screening mammography: For screening purpose it is done after 40 years. Early screening is indicated when there is family history of carcinoma breast or histological risk factor. Mammography before 35 years of age is usually not done unless there is a suspicious lump or a strong family history. Screening is done in asymptomatic female where even cancer is suspected. Ref; (page no; 515) 5th edition of SRB&;S manual of Surgery.


Question: The following can lead to increased Intra cranial pressure accept

Ans. (d) MigraineRef: Sabiston 20th Page 1934* Hemorrhage within the cranium cause a rise in ICP* Meningitis causes fever malaria altered mental status and increase in ICP.


Question: Thyroid carcinoma with pulsating vascular skeletal metastasis is

In Follicular carcinoma the Blood-borne metastases are more common and the eventual moality rate is twice that of pappillary cancer. bone secondaries are typically vascular ,warm pulsatile, localised,commonly in skull,longbones, ribst. ref ;(page no;794)25th edition of Bailey and love&;s sho practice of surgery


Question: Most common site of lentigo maligna melanoma is


Question: The compression fracture is commonest in

C i.e. Lower thoracic spine - Aproximately 90% of all spinal fractures occur in the thoracic and lumbar spines. Infact, the majority of thoracic and lumbar injuries occur with in the region between T11 & L1, commonly referred as thoraco- lumbar junction. - Compression/ wedge fractures involves bucking , or fracture of anterior and middle aspect of veebral body (unlike burst , there is no involvement of posterior veebral body). Axial loading with a flexion movement is the mechanism of injury. - Osteoporosis is the most common cause of multiple compression fractures - Compression fractures are most common in thoracolumbar spineQ (lower dorsal > upper lumbar)Q.


Question: The normal ankle brachial pressure index (ABPI) is 1.0.A value of 0.8 suggests

. The normal value of Ankle Brachial Pressure index (ABPI) will be less than 0.3.one should check blood pressure in all the 4 limbs.ABPI is checked in supine position;systolic blood pressure in upper and lower limbs is checked and higher value of each extremities is taken;ABPI is calculated.Results->0.9 is normal ;.70-0.89 is mild disease; 0.50-0.69 is moderate;< 0.50 is severe. Refer page no 171 of SRB's manual of surgery 5 th edition.


Question: Investigation of choice in appendicitis in adults


Question: Pheochromocytomas if extra adrenal are most commonly located in

Ans. (a) Posterior mediastinumRef: Bailey and love, 26th ed; pg. 869* Neurogenic tumors derived from the sympathetic nervous system or the peripheral nerves, more common in posterior mediastinum.* Mostly incidental findings in Chest radiograph* May be painful also* Includes neuroblastoma in childhood* Schwannomas and neurofibromas in adults, which are usually benign.* Pheochromocytoma arises from the sympathetic chain and produces the characteristic endocrine syndrome.* Excision of neurogenic tumors by thoracotomy, for smaller tumors a VATS approach done.


Question: Controlled hyperventilation (induced hypocapnia) is frequently recommended following head trauma. The therapeutic consequences of this therapy include

Controlled hyperventilation to a PaCO2 of 25 kPa raises tissue pH, increases cerebrovascular resistance, decreases cerebral blood flow, and consequently reduces intracerebral pressure (ICP). In the effort to avoid brain swelling by lowering cerebral blood flow and ICP, the clinician must be wary of causing ischemic brain damage through hypoperfusion. The metabolic compensation to induced hypocapnia leads to normalization of the pH by loss of bicarbonate (metabolic acidosis), and over 8-24 h the beneficial effects of the hypocapnia will have been lost. The partial pressures of carbon dioxide should be allowed to slowly return to normal and should be held in reserve in case unanticipated increases in ICP require another pulse of short-term reduction. It is important to monitor the patient while the PaCO2 is rising because untoward or rapid increases in ICP may occur in response to the rising cerebral blood flow.

Reduction of intracellular potassium levels

Induction of compensatory metabolic alkalosis


Question: Death in Ludwig's angina occurs due to


Question: Imaging IOC for acute pancreatitis

Ans. (a) CT ScanRef: Sabiston Page 1530/ 20th edition* The imaging investigation of choice for acute pancreatitis is CECT scan.* CECT scan is done after 72 hours of onset- ideally on the 7th day.


Question: Glomus tumor is seen in

GLOMUS TUMOUR, also called as glomangioma, arises from the cutaneous glomus composed of a touous aeriole which communicates directly into the venule (Sucquet-Hoyer canal) and these vessels being surrounded by network of small nerves making this lesion very painful. It consists of a mixture of blood spaces, nonmedullated nerve tissue, muscle fibres derived from the wall of the aeriole, with large cuboidal glomus cells--angiomyoneuroma. They are often seen in limbs and common in nail-beds near the finger tips, as purple red swelling. Excision cures the condition. Reference : page 81 SRB'S manual of surgery 5th edition


Question: Excision of the hyoid bone is done in


Question: A person might become quadriplegic if injury to spine is at level of

Expected outcomes in spinal injuriesIf an injury at the level of C3-C4: Power wheelchair with mouth or chin control. Verbalise care, communicate through adaptive equipment. Maybe ventilatordependent.If an injury at the level of C5: Power wheelchair, dress upper body, self-feed with aids, wash face with assistanceIf an injury at the level of C6: Propel power wheelchair, possibly push a manual wheelchair, transfer with assistance, dress upper body (lower body with assistance), self-groom with aids, bladder/bowel care with assistance, self-feed with splints, able to driveIf an injury at the level of C7: Manual wheelchair, independent transfer, dressing (with aids), feeding, bathing, self-care. Bladder and bowel care withassistanceIf an injury at the level of C8-T4: Independent with most activities of daily living, and bowel and bladder careBailey and Love 26e PG: 340


Question: The long acting analgesic used in post operative pain is

.Bupivacaine (Marcaine): It has got prolonged action. It is a vasodilator also. Dose: 3 mg/kg. Epidural block: 0.5% Spinal 0.5% 3 ml.* An epidural catheter is placed in the space and fixed. 2% xylocaine with adrenaline or 0.5% bupivacaine is injected into the space to achieve anaesthesia up to the desired level. ref:SRB&;s manual of surgery,ed 3,pg no 1105


Question: The ideal replacement for the oesophagus after oesophagus after esophagectomy is

.Only 20% of oesophageal cancers present early and becomes curable. In such early growths confirmed with an absence of nodal spread, curative surgery is the main approach - radical oesophagectomy. Proximal extent of resection should be 10 cm above a macroscopic tumour and distal extent of resection is 5 cm from the macroscopic distal end of a tumour. Proximal stomach has to be removed commonly especially in lower 1/3 a tumour. Sufficient removal of contiguous structures may be needed in the curative resection. Orringer approach, i.e. Trans hiatal blind total oesophagectomy with anastomosis in the left side of the neck. Through laparotomy, stomach and lower pa of the oesophagus are mobilised. Through left-sided neck approach, the upper pa of the oesophagus is mobilised using a finger. Ref: SRB&;s manual of surgery,3 rd ed, pg no 740


Question: Medial meniscus of knee joint is injured more often than the lateral meniscus because the medial meniscus is relatively

B i.e. Less mobile Medial meniscus is more frequently torn than the lateral because the medial meniscus is securely attached around the entire peripheryQ of the joint capsule, which makes it less mobileQ. - where as the lateral meniscus is more mobile and has no weak point between a movable and relatively fixed point. popliteus muscle sends few fibers into the posterior margin of lateral meniscus. Thus muscle contraction withdraws & protects the lateral meniscus by drawing it posterolaterally during flexion of the knee and medial rotation of the tibia.


Question: Percentage of cold nodules that become malignant are

About 80% of discrete swellings are cold. The risk of malignancy is higher in "cold" lesions (20%) compared to "hot" or "warm" lesions (<5%) Ref: Bailey and love 27th edition Pgno :804


Question: Peritoneal metastasis in colon cancer is staged as

T1 Invades submucosaT2Invades muscularis propriaT3Invades through the muscularis propria into perirectal tissuesT4aInvades through the visceral peritoneumT4bDirectly invades to adjacent organs or structuresN1aOne node positiveN1b2-3 nodes positiveN1cNo regional lymph nodes positive, but there are tumour deposits in the subserosa, Mesentery or non-peritonealized pericolic/ perirectal/ mesorectal tissues N2a4-6 lymph nodes positiveN2b7 or more lymph nodes positiveM1aMetastasis to one site or organ, without peritoneal metastasisM1bMetastasis to 2 or more sites or organs without peritoneal metastasisM1c Metastasis tothe peritoneal surface (alone or along with other site/organ)Ref: AJCC 8e


Question: Treatment of choice for pleomorphic adenoma is

Superficial parotidectomy is the most common procedure for parotid gland pathology and procedure of choice for pleomorphic adenoma.A superficial parotidectomy is when the pa of the gland superficial to the facial nerve has removed The aim of superficial parotidectomy is to remove the tumour with a cuff of normal surrounding tissue.A deep lobe parotidectomy is when the pa of the gland beneath the nerve is removed and total parotidectomy is when both are dissected and removed.Radical parotidectomy involves removal of all parotid gland tissue and elective division of the facial nerve, usually through the main trunk. Radical parotidectomy is performed for patients in whom there is clear histological evidence of a high-grade malignant tumourRef: Bailey and love, page no: 791


Question: Jeep&;s disease is

The term pilonidal sinus describes a condition found in the natal cleft overlying the coccyx, consisting of one or more, usually non-infected, midline openings, which communicate with a fibrous tract lined by granulation tissue and containing hair lying loosely within the lumen. A common affliction amongst the military, it has been referred to as Jeep disease. Reference : Bailey & Love, 27th Edition, page no = 1347.


Question:
Most common complication of condylar injuries in
children


Question: Nipple inversion occurs due to involvement of

Mastitis in many cases the lactiferous ducts will first become blocked by epithelial debris leading to stasis; this theory is suppoed by the relatively high incidence of mastitis in women with a retracted nipple.Periductal fibrosis is a sequela of periductal mastitis and may result in nipple retraction.Schwaz surgery 15th edition pg: 509


Question: Features of pyloric stenosis

Because of vomiting-hypochloremia hyponatremia, hypocalcemia, hypomagnesemia alkalosis occurs. Reference: SRB edition:5th page no: 829


Question: Wolf Chaikoff effect is due to excess

Ans. (a) IodidesRef: Schwartz 9th Edition Page2599/E book* Excessively large doses of iodide may lead to initial increased organification, followed by suppression, a phenomenon called the Wolff-Chaikoff effect


Question: In triage &;red&; denotes

First priority: Red - Critical, but likely to survive if treatment given earlySecond priority: Yellow - Critical, likely to survive if treatment given within hoursThird priority: Green - Stable, likely to survive even if treatment is delayed for hours to daysLast priority: Black - Not breathing, pulseless, so severely injured that no medical care is likely to helpBailey and love 26e pg: 422


Question: In primary pulmonary hypeension basic abnormality in gene lies in

Bone morphogenetic protein receptor II Mutation in the bone morphogenetic protein receptor-2 (BMPR-II) cause pulmonary aerial hypeension. The BMPR-II gene plays a role in regulating the number of cells in ceain tissues. Researchers suggest that a mutation in this gene promotes cell division or prevents cell death, resulting in an overgrowth of cells in small aeries throughout the lungs. As a result, these aeries narrow in diameter which increases the resistance to blood flow. The blood pressure in the pulmonary aery and the right ventricle of the hea increases to overcome the increased resistance to blood flow resulting in pulmonary hypeension.


Question: Most common complication of TURP

Retrograde ejaculation is MC complication of TURP due to injuiry to openings of ejaculatory ducts.


Question: Male patient with euthyroid state presents with the following condition

Ans. (b) Multiple nodular goiterRef.: Bailey & Love 26th ed. / 749* Notice the multiple enlarged lobes of this multiple nodular goiter which represents a spectrum of disease ranging from a single hyper-functioning nodule (toxic adenoma) within a multi-nodular thyroid to a gland with multiple areas of hyper function.* Thyroglossal cyst is ruled out as it is present in midline.* The answer should not be given as toxic nodular goiter because we cannot comment on thyrotoxicosis status of patient as eye signs etc. are not visible or given and the question also mentions a EUTHYROID status of the patient.* Autonomous hyperactivity is conferred by somatic mutations of the thyrotropin, or thyroid-stimulating hormone (TSH), receptor in 20-80% of toxic adenomas and some nodules of multinodular goiters. Autonomously functioning nodules may become toxic in 10% of patients.* Hyperthyroidism predominantly occurs when single nodules are larger than 2.5 cm in diameter. Signs and symptoms of TNG are similar to those of other types of hyperthyroidism.


Question: The maximum dose of lignocaine without adrenaline that can be admitted to a patient is


Question: Mainly elevators in exodontia works on the principle of


Question: Treatment for brown tumor is


Question: Features of left side Ca colon are

. Patient can have de novo multiple primary carcinomas in different pas of the colon at the same time, i.e. synchronous (5-10%), or can present with growth in different pas of the colon in different periods, i.e. metachronous (10-20%). Gross types: Annular, tubular, ulcerative, cauliflower like. Annular (stenosing) type: * It is more common on left side. * Here the growth spreads round the internal wall and so it often presents with intestinal obstruction. * Left sided growth presents with colicky pain, altered bowel habits (alternating constipation and diarrhoea), palpable lump, distension of abdomen due subacute/ chronic obstruction. Later may present like complete colonic obstruction. Tenesmus, with passage of blood and mucus, with alternate constipation and diarrhoea, is common. Bladder symptoms may warn colovesical fistula. ref:SRB&;s manual of surgery,ed 3,pg no 838


Question: Hunt Hess scale is used to grade manifestations of

Answer-A. Subarachnoid hemorrhageThe initial clinical manifestations of SAH are graded using the Hunt-Hess or World Federation of Neurosurgical Societies classification schemes.A grading system has therefore been developed to document the severity of patient's disease in order to guide therapy and prognostication.


Question: Best treatment protocol of a Enterogenic cyst

Ans. (b) Resection with intestine partRef: Bailey & Love 2&h ed. / 903* Enterogenous cyst arises from either a diverticulum of the mesentric border of the intestine that has become sequestrated from the intestinal canal during embryonic life or from a duplication of the intestine.* An enterogenous cyst has a thicker wall than a chylolymphatic cyst and is lined by mucous membrane, sometimes ciliated.* The content is mucinous and is either colourless or yellowish brown as a result of past haemorrhage. The muscle in the wall of an entric duplication cyst and the bowl with which it is in contact have a common blood supply, consequently removal of the cyst always entails resection of the related portion of intestine.


Question: Most common malignancy found in Marjolins ulcer is

Marjolin&;s ulcer is a well-differentiated squamous cell carcinoma which occurs in chronic scars like burn scar, scar of venous ulcer. It is relatively avascular and hence grows slowly. As scar tissue does not contain lymphatics and nerves, it will not spread to lymph nodes and it is painless respectively. Once it reaches the normal skin it behave like any other SCC, it will spread to lymph nodes. Wide excision is treatment of choice. Radiotherapy should not be given as it may turn into poorly differentiated squamous cell carcinoma. Reference : page 290 SRB&;s manual of surgery 5th edition


Question: Commonest salivary gland to get stones

Eighty per cent of all salivary stones occur in the submandibular glands because their secretions are relatively viscous. Eighty per cent of submandibular stones are radio-opaque and can be identified on plain radiography. Stones are mainly composed of phosphate and oxalate salts.Ref: Bailey and love, 27e, page no: 780


Question: 50 year tobacco chewer comes with chief complaints of a mass in the oral cavity of 1.5 cm with a single lymph node size <3 cm on ipsilateral neck. TNM stage is.......

Ans. (d) T1 N1Ref: Bailey and Love Page 709Staging of Oral cavity Cancer:* T1 - <2cm* T2- 2-4cm* T3 - 4-6cm* T4 - adjacent structure involvement* N1-Ipsilateral single node <3cm* N2 a- Ipsilateral single node 3-6cm* N2 b- Ipsilateral multiple nodes all <6cm* N2 c- Contralateral nodes<6cm* N3- any node >6cm size* M1-metastasis


Question: A GCS of an intubated person with abdominal flexion attitude and eye opening only to pain is

Glasgow Coma Scale score for head injury. Eyes open Spontaneously 4 To verbal command 3 To painful stimulus 2 Do not open 1 Verbal Normal oriented conversation 5 Confused 4 Inappropriate/words only 3 Sounds only 2 No sounds 1 Intubated patient T Motor Obeys commands 6 Localises to pain 5 Withdrawal/flexion 4 Abnormal flexion 3 Extension 2 No motor response 1 Ref: Bailey and love 27th edition Pgno: 331


Question: Most common cause of hyperparathyroidism is

Most common cause of hypoparathyroidism is iatrogenic cause that is accidental removal of parathyroid glands during thyroidectomy.


Question: Metabolic disorder leading to acute pancreatitis

(B) Hyperparathyroidism# Causes of Acute Pancreatitis> Common Causes Gallstones (including microlithiasis) Alcohol (acute and chronic alcoholism); Hypertriglyceridemia Endoscopic retrograde cholangiopancreatography (ERCP), especially after biliary manometry Trauma (especially blunt abdominal trauma) Postoperative (abdominal and non-abdominal operations) Drugs (azathioprine, 6-mercaptopurine, sulfonamides, estrogens, tetracycline, valproic acid, anti-HIV medications) Sphincter of Oddi dysfunction> Uncommon causes Vascular causes and vasculitis (ischemic-hypoperfusion states after cardiac surgery) Connective tissue disorders and thrombotic thrombocytopenic purpura (TTP) Cancer of the pancreas Hypercalcemia Periampullary diverticulum Pancreas divisum Hereditary pancreatitis Cystic fibrosis Renal failure> Rare causes Infections (mumps, coxsackievirus, cytomegalovirus, echovirus, parasites) Autoimmune (e.g., Sjogren's syndrome)> Causes to consider in patients with recurrent bouts of acute pancreatitis without an obvious etiology Occult disease of the biliary tree or pancreatic ducts, especially microlithiasis, sludge Drugs Hypertriglyceridemia Pancreas divisum Pancreatic cancer Sphincter of Oddi dysfunction Cystic fibrosis Idiopathic


Question: The pivot test is for


Question: Surgery is not useful in


Question: Protein content of <4mg/ml is seen in


Question: The commonly inured carpal bone next to scaphoid is


Question: "adder head" appearance on excretory urography is seen in

(Ureterocele) (1310-LB) (1290-B & L 25th)Ureterocele is a cystic enlargement of the intramural portion of the ureter thought to result from congenital atresia of the ureteric orifice.* The "adder-head' on excretory urography is typical* Usually the cyst wall is composed of urothelium only and the diagnosis is confirmed by the cystoscopic appearance of a translucent cyst enlarging and collapsing as urine flows in from the upper ureter.


Question: Clinical scenario with bag of worms

Answer- A. VaricoceleA varicocele is a varicose (touous) dilatation of the vein draining the testis.C/FOn palpation, testicules may feels like a bag of wormsvaricocele is painless and the only complaint of the patient is swelling.


Question: Pringle manoeuvre may be required for treatment of

In case of liver lacerations, the inflow from the poal triad is controlled by a Pringle's manoeuvre, with direct compression of poal triad, either digitally or using a clamp. This has the effect of reducing aerial and poal venous inflow into the liver, although it doesn't control the back flow from inferior vena cava and hepatic veins. Reference : Bailey & Love, 27th Edition, page no = 374.


Question: BASDAI criteria is indicated in

BASDAI(Bath Ankylosing Spondylitis disease activity index) Used to know effectiveness of drug therapy On a scale of 1-10 it is measured by various factors like discomfo, pain, morning stiffness etc If the value is >4 there is suboptimal control of disease


Question: Most common carcinoma caused by Cirrhosis.

Ans. (a) HCCRef: Sabiston 20th edition Page 1458* Cirrhosis leads to HCC.* High rate of HCC formation is seen in - HBV infection, Hemochromatosis* Low rate of HCC formation is seen in - Alcohol, Primary Biliary Cirrhosis* Cirrhosis with high DNA replication rates have increased risk of cancer liver


Question: This thyroiditis is also known as "Painless Thyroiditis.

. Subacute lymphocytic thyroiditis is a form of thyroiditis that is also known as silent thyroiditis or painless thyroiditis. Subacute lymphocytic thyroiditis may occur at any age and is more common in females. A variant of subacute lymphocytic thyroiditis occurs postpaum, postpaum thyroiditis. Both of these entities can be considered subtypes of Hashimoto&;s thyroiditis and have an autoimmune basis. Anti-thyroid antibodies are common in all three and the underlying histology is similar. This disorder should not be confused with de Quervain&;s thyroiditis which is another form of subacute thyroiditis.


Question: High or low fistula is ano is termed according to its internal opening present with reference to

The anorectal ring marks the junction between the rectum and the anal canal. It is formed by the joining of the puborectalis muscle. the deep external sphincter, conjoined longitudinal muscle and the highest pa of the internal sphincter. The anorectal ring can be clearly felt digitally, especially on its posterior and lateral aspects. Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1240


Question: Intestinal polyps that have highest potential to grow into cancer

Classification of intestinal polypsInflammatory Inflammatory polyps (pseudopolyps in UC)Metaplastic Metaplastic or hyperplastic polypsHamaomatous Peutz-Jeghers polypJuvenile polypNeoplastic AdenomaTubularTubulovillousVillousAdenocarcinomaCarcinoid tumourRef: Bailey and Love, 27e, page: 1259


Question: For vascular anastomosis sutures of choice

Answer- A. PolypropyleneVascular anastomoses require an extremely accurate closure as they must be immediately wateight at the end of the operation when the vascular clamps are removed.In many cases, some form of prosthetic material or graft may be used which will never be integrated into the body tissues and so the integrity of the suture line needs to be permanent.For this reason, polypropylene is one of the best sutures as it is not biodegradable. It is used in its monofilament form,mounted on an atraumatic, curved, round bodied needle.


Question: Structures not removed in radical neck dissection

The classic operation involves resection of the cervical lymphatics and lymph nodes and those structures closely associated: the internal jugular vein, the accessory nerve, the submandibular gland and the sternocleidomastoid muscle. These structures are all removed en blocand in continuity with the primary disease if possible. The main disability that follows the operation is weakness and drooping of the shoulder due to paralysis of the trapezius muscle as a consequence of excision of the accessory nerve Bailey & Love ,25th,733.


Question: Most common posterior mediastinal tumour is

The most common tumour of posterior mediastinum is neurofibromas,which constitutes around 75% of the total.Other tumors include ganglioneuromas,aneurysm of descending aoa,lymph node mass. Reference:SRB's manual of surgery,5th edition,page no:1126.


Question: The flap not used to reconstruct Breast is

Ans. (c) Pectoralis major myocutaneous flap(Ref: Bailey 26th /e p. 816, Sabiston 20th edition 867)Flaps used to reconstruct Breast:* Transverse rectum abdominis flap (Pedicled or Free flaps)* Latissimus Dorsi flap* Gluteal flap* Ruben's flap* Thoraco epigastric flap* Lateral thigh flap

Transverse rectus abdominis myocutaneous flap


Question: Treatment of stage I bladder cancer is

Answer- B. Endoscopic removal with intravesical chemotherapy


Question: Flask shaped undermined ulcers in rectosigmoid area are seen in

Most amoebic ulcers occur in the rectosigmoid. On sigmoidoscopy shallow skip lesions and 'flaskshaped' or 'collar-stud' undermined ulcers may be seen and can be biopsied or scrapings can be taken along with mucus for immediate microscopic examination. The presence of trophozoites distinguishes the condition from ulcerative colitis.Ref: Bailey and Love 27e pg: 58


Question: Subperiosteal abscess, penetrating deep is seen after extraction of


Question: Familial polyposis coli is due to

.desmoid tumour is often associated with the familial polyposis colon (FAP), osteomas, odontomes epidermal cysts-- Gardner's syndrome.it is usually due to genetic abnormality involving chromosome 5. ref:SRB&;s manual of surgery ,ed 3,pg no 776


Question: Absolute indication for surgery in hyperparathyroidism is


Question: Uterine artery is a branch of

Ans C Ref: Williams Obstetrics page 26Vascular supply of uterus is derived principally from uterine artery which is amain branch of internal iliac artery. Sheila Balakrishnan (Ob-stetric) page 16Internal iliac artery is the feeding vessel of pelvis Anterior division:Parietal branches- ObturatorPosterior division-has only parietal branchesDiolumbar Inferior glutealInternal pudendalVisceral branches- Superior vesical Lateral Sacral Obliterated umbilicalInferior vesicalMiddle rectalUterine & vaginal Superior gluteal


Question: Man comes with head injury investigation of choice

Answer- D. Plain CTInvestigation of choice for head trauma patient is CT scan.


Question: Most common Cause of pseudaneurysm of aoa is

Answer- B. TraumaAoic pseudoaneurysms are contained ruptures of the aoa in which the majority of the aoic wall has been breached, and luminal blood is held in only by a thin rim of the remaining wall or adventitia.They typically occur from focal aoic transection-penetrating traumaBlunt trauma


Question: Latency period in distraction osteosynthesis is defined as

Time period between surgical osteotomy and starting of distraction

Time period between starting of distraction to the completion of distraction

Time period for completion of distraction process

Time period between distraction and functional Loading of the area


Question: Inosculation refers to

Inosculation is alignment of donor and recipient capillaries for graft uptake.

Alignment of donor and recipient capillaries


Question: Alpha feto protein is a marker of

(Yolk sac carcinoma): (999-CSTD 13th edition; 424-Shaw's 15th)MARKERS1. Endodermal sinus (Yolk sac) tumour* Alpha-fetoprotein and alpha-1 antitrypsin2. Choriocarcinoma - hCG3. Embryonal cell carcinoma - AFP & hCG4. Dysgerminoma and pure germinomas do not secrete these markers but secretes lactose dehydrogenase


Question: Pheochromocytoma with malignant potential exclusively secretes


Question: Hand joining sign is characteristic of

Both kidneys meet in midline seen has hand joining sign.


Question: Cleft palate should be repaired

Cleft palate is usually repaired in 12–18 months. Early repair causes retarded maxillary growth (probably due to trauma to growth center and periosteum of the maxilla during surgery if done early). Late repair causes speech defect.
Abnormal insertion of tensor palati is released.
Wardill- Kilner push back operation—by raising mucoperiosteum flaps based on greater palatine vessels.
The exact timing of repair of a palate cleft is controversial. In general, the velum must be closed before the development  of  speech  sounds  that  require  an  intact  palate.

Reference: SRB's Manual of Surgery, 5th ed, page no 350, Fonseca 4th ed page no 503


Question: Treatment for fibrous dysplasia in a young 25 yrs old patient involving maxilla is best treated by


Question: List the following pediatric parotid neoplasms in order from most frequent to least frequent

Parotid tumours incidence: Common parotid tumors Histopadiology Incidence Pleomorphic adenoma 59% Mucoepidermoid carcinoma 7.9% Wahin's tumor 7.3% Carcinoma Ex-Pleomorphic adenoma 4.4% Acinic cell carcinoma 3.5% Adenoid cystic carcinoma 3.1% Squamous cell carcinoma 2.0%

Pleomorphic adenoma > acinic cell > mucoepidermoid > adenoid cystic

Pleomorphic adenoma > mucoepidermoid > acinic cell > adenoid cystic

Pleomorphic adenoma > adenoid cystic > mucoepidermoid > acinic cell

Mucoepidermoid > pleomorphic adenoma > acinic cell > adenoid cystic


Question: Tom smith's ahritis is due to

Answer- A. Pyogenic infection in infancyTom smith ahritis is the sepfic ahritis of hip joint, occurs in infancy. At this stage head of the femur is cailaginous and is rapidly and completely destroyed by the pyogenic process.


Question: Osteotomies

of the Le Fort III type, like the Le Fort III fracture, are not associated with great blood loss and therefore the patient rarely needs more than 2 pints of blood transfused.

of the Le Fort III type, if done with the use of a bicoronal flap are not followed by nerve paraesthesias postoperatively

of the Le Fort III type are most commonly indicated in syndromes associated with the early closure of cranial sutures

of the Le Fort II type produce maxillary necrosis in the cleft palate patient


Question: The disadvantage of elemental include diets in childrena) Hypertonic dehydrationb) Lower caloric inputc) Dumping syndromed) High nitrogen input


Question:
A known patient with renal stone disease developed pathological fracture along with abdominal pain and certain psychiatric symptoms.
He should be investigated for


Question: A new born boy is having lumbosacral meningomyelocele and awaiting the surgical repair. The sac is best protected with sterile gauze piece soaked with

Ans. (d) Normal salineRef: Bailey & Love 26th ed. / 482-83The first step in the management of a newborn with myelomeningocele is a careful clinical assessment followed by open defects which should be covered with a saline-moistened non-adherent dressing to prevent injury to and dessication of the neural placode.


Question: Golf hole ureter is seen in

Tb will cause golf hole ureter causing reflex. TB will also give rise to cement kidney , thimble bladder , watermelon prostate.


Question: Symptoms of hyperthyroidism include


Question: Massive colonic bleeding in a patient of diverticulosis is from

Although diverticulosis involves mainly the left side of colon, bleeding occurs mostly from right side of colon. Right side is supplied by superior mesentric artery.
"Hemorrhage from a colonic diverticula is the most common cause of hematochezia in patients over the age of 60." - Harrison 16/e, p 1796


Question: Commonly encountered complication during extraction of maxillary third molar is


Question: Most frequent tooth to be impacted is

Impacted tooth Is the tooth that has failed to erupt completely or paially to its correct position in the dental arch and its eruption potential has been lost. Order of frequency Mandibular 3rd molar (i.e. Lower 3rd molar) Maxillary 3rd molar (Upper 3rd molar) Maxillary canine


Question: Not a complication of Colles' fracture


Question: Tumor arsing from Olfactory nasal mucosa

Esthesioneuroblastoma (Olfactory Neuroblastoma) Esthesioneuroblastoma is a rare unique tumor of neural crest origin Arises from the basal neural cells of the olfactory mucosa of the cribriform plate, upper nasal wall and superior turbinate. Seen in either sex and most common in 3rd and 4th decade Clinical Features: Presents as unilateral polypoidal mass in the upper third of the nasal cavity with symptoms of nasal obstruction, epistaxis and anosmia. It is a vascular tummor that bleeds profusely on biopsy. LN and systemic metastases can occur. Treatment: Favored treatment is surgical excision followed by radiation Ref: Dhingra 5th edition Pgno: 217


Question: Contra indication for nasotracheal intubation

In anterior cranial fossa # and maxillo facial injuries it is avoided.


Question: Tensile strength in the wound scar is

This maturation of collagen leads to increased tensile strength in the wound which is maximal at the 12th-week post-injury and represents approximately 80% of the uninjured skin strength. Bailey and love 27e pg: 25


Question: Tip of nose reconstruction is done by

Local flaps A local flap is raised next to a tissue defect in order to reconstruct it Basic patterns of local flaps Transposition flap Most basic design, leaving a graftable donor site Z-plasty For lengthening scars or tissues Rhomboid flap For cheek, temple, back and flat surface defects Rotation flap For convex surfaces Advancement flap For flexor surfaces, may need triangles excised at the base to make it work (commonly called Burrow's triangles) V-to-Y advancement Commonly used for fingeips and extremities Bilobed flap For convex surfaces, especially the nose Bipedicle flap For eyelids, rarely elsewhere Ref: Sabiston 20th edition Pgno :836


Question: Most common tumor of anterior mediastimum is

Thymomas are the most common tumours of anterosuperior mediastinum in the adult,accounting for 25% of the total.They are most common in the 5th and 6th decades of life.Both sexes are equally affected.They vary in behaviour from benign to aggressively invasive.Diagnosis and treatment are best achieved by complete thymectomy.


Question: Wilm's tumor associated with A/E

Wilm's tumour ( nephroblastoma ) is a mixed tumour containing blastemal, stromal and epithelial elements arising from embryonic nephrogenic tissue. It is the most common primary tumour of kidney in children . Most commonly between 2 and 5 years of age . It is associated with three congenital malformation syndromes 1) WAGR SYNDROME . wilms tumour , ANIRIDIA , mental retardation 2 ) DENYS - DRASH SYNDROME . gonadal dysgenesis and renal abnormalities. These two syndromes are associated with WT1 mutations. 3) BECKWITH-WIDEMANN SYNDROME is associated with Macroglossia,Visceromegaly, enlargement of entire segment (HEMI HYPEROPHY) , enlargement of adrenal coical cells ( adrenal cytomegaly ) is charecteristic microscopic feature.Midline abdominal wall defect .BWS is an example of disorder of genomic imprinting. CLINICL FEATURES :- 1.Flank mass M/C clinical presentation 2.Hematuria(Extension into renal pelvis) 3.HTN 4.Weight loss. 5.Pain (least common) IOC:CT scan (CECT) CXR (lung metastasis M/C) ref : - Robbins basic pathology . 9th edition .chapter 6 .pg no :- 262 Bailey and Love 27th edition . chapter 76 .pg no 1421.0


Question: Early stage of trauma is characterized by

Injury Phase (Phase of catabolism):-- Begins at the time of injury and lasts for 2-5 days-- Phase of hypermetabolism-- Stress hormones (coisol, catecholamines and glucagon) and volume control hormones (renin-angiotensin, aldosterone and ADH) are increased. This leads to proteolysis, lipolysis, hyperglycemia and wound healing despite of negative nitrogen balance.* Turning Point:-- Transient period marked physiologically by turning off of the neuroendocrine response and clinically by the appearance of getting well. * Early Anabolic Phase:-- Marked by gain in muscular strength or positive nitrogen balance.* Late Anabolic Phase:-- Marked by gain in weight and body fat or positive caloric balance


Question: The propensity of recurrence after surgical intervention is the least in


Question: Most important prognostic factor for colorectal carcinoma is

"The number of positive nodes appeared to be the single most important prognostic factor."-DeVita


Question: A driver wearing seat belt applied brake suddenly to avoid accident. Most common organ injured in seat belt injury

Most common seat belt injury is mesentery


Question: Minimum nitrogen required for an adult with dynamic tissue turnover to maintain a positive nitrogen balance is

.minimum nitrogen required for an adult with dynamic tissue turnover to maintain a positive nitrogen balance is about 5.5 to 6.5 g.* Glucose requirement is 200 g per day; fat requirement is 200 g per week; nitrogen (protein) requirement is 0.15 g/kg per day. Nitrogen need increases to 0.25 g/kg/day in hyper catabolic status. ref:SRB&;s manual of surgery,ed 3,pg no 86


Question: Total parenteral nutrition should have

.Components used in TPN * Carbohydrates. * Fat and amino acids. * Vitamins and trace elements. Monitoring the patient by body weight, fluid balance, blood glucose, electrolytes, blood urea, LFT serum calcium, magnesium, phosphate should be done at regular intervals. A weight gain more than one kg/day signifies fluid overload. ref:SRB&;s manual of surgery,ed 3,pg no 89

10% of total calories is provided as lipids


Question: Symmetrical areflexic bladder bowel & lower limb occur in


Question: Mucocele of the appendix isa) Benign tumourb) Low grade malignancyc) Retention cystd) Infective process

Mucocele of appendix:
A mucocele of the appendix is an obstructive dilatation by intraluminal accumulation of mucoid material.
Mucoceles may be caused by one of four processes: retention cysts, mucosal hyperplasia, cystadenomas, and cystadenocarcinomas.
The clinical presentation of a mucocele is nonspecific, and often it is an incidental finding at operation for acute appendicitis.
An intact mucocele presents no future risk for the patient; however, rupture may lead to pseudomyxoma peritonei or mucinous carcinomatosis of appendiceal origin
Every effort is made to keep the mucocele intact during extraction, including placing the specimen in a bag and converting a laparoscopic procedure to open.
Management of Mucocele:
Includes resection of the appendix, plus wide resection of the mesoappendix to include all the appendiceal lymph nodes, collection and cytologic examination of all intraperitoneal mucus, and careful inspection of the base of the appendix.
Right hemicolectomy is done for patients with a positive margin at the base of the appendix or positive periappendiceal lymph nodes.


Question: The most common cause of acquired aeriovenous fistula is

. Trauma is the most common cause of accquired atreiovenous fistula(AV fistula).most common sites involved are femoral region,brachial region,popliteal region,wrist,aoa-vena canal,abdomen.It may be following road traffic accidents,penetrating wounds,cock fight injury(common in south india).Other causes includes after surgical intervention of major vessels,cimino fistula(AVF created for renal dialysis). Refer page no 219 of SRB's manual of surgery 5th edition.


Question: Not a component of Glasgow coma scale

GLASGOW COMA SCALE EYE OPENING VERBAL RESPONSE MOTOR RESPONSE spontaneous -4 oriented -5 obeys commands -6 to speech -3 confused -4 localises pain -5 to pain -2 inappropriate words -3 flexion to pain -4 none -1 incomprehensible words -2 abnormal flexion -3 none -1 extension to pain -2 none -1 .TOTAL SCORE :15 MILD HEAD INJURY:13-15 MODERATE HEAD INJURY: 9-12 SEVERE HEAD INJURY: less than 8(3-8)


Question: Commonest cause of acute folliculitis (hair follicle infection) is

Acute folliculitis are of two types: superficial and deep. The most common causative organism is Staphylococcus aureus. Superficial folliculitis is also caused by Pseudomonas aeruginosa.Reference : page 41 IADVL's Concise Textbook of Dermatology


Question: In Couinaud classification, segment IV of liver is

Segment 1 - caudate lobe, segment 4 - quadrate lobe ,.segments( 1,2,3,4) left lobe, segments (5,6,7,8)- right lobe Reference SRB edition :5 page:593 and internet


Question: Garden's classification is applicable to


Question: Most common cause of lower gastro intestinal bleeding is;

(Colo.rectal carcioma) (1310-CSDT 12th) (1160-B &L 25th)* Although diverticulitis, cancer and / angiodysplasia are the most common cause of lower GI bleeding in adults (1310-CSDT 12th)* Diverticular diseases (Very common in western countries, though it is quite rare in this country (1104. S.Das 5th)Diverticulitis (1161-B&L)Symptoms and signs of colorectal cancer (1178-B & L)Complications1. Recurrent periodic abscess2. Perforation leading to general peritonitis3. Intestinal obstruction4. Haemorrhage - profuse colonic haemorrhage5. Fistula formation Diverticulitis is not a precancerous conditions but cancer may coexist* Right sided tumour - Iron deficiency anemia, abdominal mass* Left sided tumours - rectal bleeding alteration in bowel habit, tenesmus obstruction* Metastatic disease - Jaundice, ascitis, hepatomegaly, other symptoms and sign from rarer sites of metastasis.* In Infants - anal fissures continue to be the most common cause of rectal bleeding.* Juvenile polyps - are the single most common cause of lower GI bleeding in children (20-30%)


Question: Inguinal hernia with hydrococle is know as


Question: For lacerated wound, delayed primary suturing is done within

For clean wound, primary suturing done within 6 hr.
For locerated wound, delayed primary suturing is done within 48 hrs.
For infected wound, secandary suturing done within 10 - 14 days.


Question: Most common cause of AVN of the hip is

Answer- A. IdiopathicCauses ofAVN hipldiopathic (most common)Infection- septic ahritis, osteomyelitisHematological malignancies- leukemia, lymphomaAlcohol,coicosteroidsSLEPregnancyCassions diseaseHyperlipidemiaPehes diseasIonising radiation


Question: The effect of local anesthesia can be increased by the addition of


Question: Testicular cancer is common in


Question: Omental bursa (lesser sac)A posteriorly perforating ulcer in the pyloric antrum of the stomach is most likely to produce initial localized peritonitis or abscess formation in the following

Ans. is 'a' i.e., Omental bursa BDC writes - "The posterior surface of the stomach is related to structures forming the stomach bed, all of which are separated from the stomach by the cavity of the lesser sac." Thus an ulcer on the posterior wall of stomach would perforate into the lesser sac. Also remember Most perforated ulcers are located on the anterior wall. The moality rate for perforated gastric ulcer is higher than that for duodenal ulcer. This is generally due to the gastric ulcer patients' more advanced age, increased medical comorbidities, delay in seeking medical attention, and the larger size of gastric ulcers.


Question: A patient with abdominal injury presents to the emergency department with signs of signs of peritonitis and shock. Airway and breathing were secured and IV fluids were started with 2 large bore cannulas. The next line of management should be

Treatment for abdominal injury includes Emergency laparotomy.
Indications include

Frank haemoperitoneum
Significant diagnostic peritoneal lavage
Haemodynamically unstable patient
U/S or CT scan shows significant intra-abdominal injuries

Exploratory Laparotomy under general anesthesia

Insertion of abdominal drain followed by laparotomy


Question: Tension pneumothorax due to fracture rib is treated by


Question: Least glycemic index is seen in

* Glycemic index is a measure of a foods' ability to elevate blood sugar level. * The indexing is done by comparing a food stuffs digestion rate to that of glucose, with a glycemic index of 100. * The higher the glycemic index, the faster will it enter the blood and increase the blood sugar level. * Glycemic index is used to label the food as good and evil. Food with a high glycemic index of 60 and above is considered unhealthy as they break down quickly and spike blood sugar level. Low glycemic foods enter the blood stream slowly and provide sustain long term energy (maintain stable blood sugar levels). High glycemic index Glucose 100 Baked potato 85 Corn flakes 84 Honey 73 Watermelon 72 White bread 70 -72 Table sugar 65 Ice-cream 61 Moderately glycemic food Orange papaya 58 White rice 58 Brown rice 55 Pop corn 55 Sweet potato 54 Mango 55 Banana 50 Carrots 49 Orange 44 Low glycemic food Apple 37 Yoghu 33 Skimmed milk 32 Kidney beans 27 Peanuts 14


Question: Commando’s operation is for


Question: The most commonly practiced operative procedure for a perforated duodenal ulcer is

Here perforation is identified and an omental patch is placed & closed with interrupted, horizontal sutures. Because of its adhesion propey, it seals perforation, maintain good vascularity, and promote lymphatic drainage Reference: SRB 5th edition, page no: 832


Question: Tamsulosin belongs to

The mainstay of treatment for LUTS due to BPH is a1-adrenergic receptor blockers.a-adrenergic receptors are the most common adrenergic receptors in the bladder, and a1 is the most common subtype in the lower urinary system, prostate, and urethra. The action of a1 blockers is to relax the smooth muscle in the bladder neck and prostate and to reduce outflow resistance. (Prazosin)This class of drugs has become progressively more selective to the a1 subtypes, and many now target the a1asubtype receptor specifically. (Tamsulosin, Alfuzosin)The most common side effects of these drugs are dizziness related to ohostasis, retrograde ejaculation, and rhinitis.The second category of pharmacologic therapy is the 5a-reductase inhibitors that target the glandular component of the prostate. These drugs block the conversion of testosterone to dihydrotestosterone in the prostate and subsequently reduce the prostate volume, thereby reducing outflow resistance. (Finasteride, Dutasteride)Sabiston 20e pg: 2108


Question: Indications of percutaneous nephrostomy

Nephrostomy is the term used to describe a passageway maintained by tube , stent or catheter that perforates the skin , passes to abdominal wall and renal paranchyma and terminates in renal pelvis or calyx . Access to kidney inferior calyx. Exception -Horseshoe kidney superior pole. Indications :- 1) when upper urinary tract drainage is desired and retrograde ureteral stent placement is not feasible 2) instillation of chemotherapeutic agents for malignancy ( mitomycin c and BCG ) and dissolution of stones COMPLICATIONS:- Heamtoma, Hematuria,Colonic perforation. ref :- Campbell - walsh urology 11th ed , chapter no 6 , pg no 133. , Medscape " NEPHROSTOMY" aicle


Question: Treatment of Hormone dependent fungating carcinoma of breast with secondaries in the lung in a female patient aged 30 years is

Hormonal therapy in Carcinoma Breast Ovarian suppression or ablation Bilateral oophorectomy. Medically by LHRH agonist (Goserelin, leuprolide) SERM: Tamoxifen and Raloxifen Aromatase Inhibitors Non-steroidal : Letrozole & Anastrazole Steroidal : Exmestane Anti-Estrogens Fulvestrant Progestins Megesterol & Medroxyprogesterone acetate Ref: schwaz's principle of surgery 10th edition Pgno : 552-553

Simple mastectomy followed by oophorectomy

Radical mastectomy followed by oophorectomy


Question: Circumcision cannot be used in management of

Answer- D. Penile CancerPhimosisBalanitis PosthitisParaphimosisSevere UTIs


Question: Hot flush is not associated with

Hot flashes Hot flashes (also called hot flushes, vasomotor symptoms) have been recognized as a side effect of androgen ablation (medical or surgical) Described as a subjective feeling of warmth in the upper torso and head followed by objective perspiration Are among the most common side effects of androgen ablation, affecting between 50% and 80% of patients Treatment of hot flushes should be reserved for those who find them bothersome Drugs used for treatment : DES, oral progestogen, cyproterone acetate, clonidine, seraline, venlafaxine Ref: Bailey and love 27th edition Pgno : 1473


Question: Central dot sign is seen in

"central dot" sign: enhancing dots within the dilated intrahepatic bile ducts, representing poal radicles (seen in CT).


Question: Bilateral pulseless disease in upper limbs is caused by

Aooaeritis or Takayasu's ds. is an inflammatory & stenotic disease of the medium and large-sized aeries with a strong predilection for the aoic arch and its branches (therefore also k/a aoic arch syndrome). Narrowing of the lumen of the involved vessels occur with or without thrombosis, leading to symptoms of vascular compromise. Subclan aery is the most commonly involved vessel, leading to loss or weakening of pulses (thus also k/a pulseless ds.) It is mostly seen in adolescent girls and young women. It is more common in Asia.


Question: Most common bladder tumor is


Question: Most common cause of death after anaesthesia

(C) (Cardiac arrest) (131- Ajay Yadav 5th)More than 80% of cardiac arrest occurs at the time of inductionHypotension -may occurs in intraoperative and post ooperatve period due to effect of anaesthatic drugs, inadequate fluid infusion, excessive loss, cardiac arrhythmiasHypothermia - is the most common thermal pertubation seen in anaesthesia.* Heat loss during general anaesthosia may be as high as 30 kcal /hr* Shivering occurs as a protective mechanism to hypothermia, 02 consumption may increase to 4 times (400%)* Shivering can be abolished by inhibition of hypothalamus* Most common shivering is seen after halothane* Pethidine is drug of choice. Tramodol is 2nd drug of choiceAtelectasis is the MC pulmonary complications of GA in post operative period and the MC cause of at electasis is bronchial obstruction by secretions leading to lobar or segmental collapse (V/Q mismatch).Post operative respiratory depression has been cited as the most common cause of anaesthesia related death in perioperative period.


Question: During an attempted extraction of upper posterior teeth, to determine the position of the roots displaced into antrum, ideal radiograph would be

Bitewing radiography of maxillary posteriors

Lateral oblique view of mandibular posteriors


Question: IOC for polyscystic kidney disease


Question: Investigation of choice for DVT is

. Duplex scanning shows noncompressible vein which is wider than normal.On compression over calf muscles,it does not show any augmentation of flow.Normal venous sound atg the area of femoral vein which disappears during inspiration is conspicuously absent in DVT. Refer page no 224 of SRB's manual of surgery 5 th edition.


Question: Not a complication of total parenteral nutrition

.Biochemical COMPLICATIONS OF TOTAL PARENTERAL NUTRITON INCLUDES 1. Electrolyte imbalance: Hyponatraemia, hypokalaemia, hypophosphataemia. 2. Hyperosmolarity. 3. Hyperglycaemia. - common. 4. Dehydration. 5. Altered immunological and reticuloendothelial function. 6. Azotaemia. ref:SRB&;s manual of surgery,ed 3,pg no 89


Question: Action of intramedullary 'K' nail is


Question: Normal capacity of renal pelvis is

The renal pelvis is roughly pyramidal, with the base facing the parenchyma and the apex funneling down into the ureter. It usually has a capacity of 3 to 10 mL of urine. ref : campbell - walsh urology 11th ed , chapter 42 , pg no : 973


Question: Cock's peculiar tumor is

Ans is 'c' i.e. Ulcerated sebaceous cyst Repeat from May 04Cocks peculiar tumor is actually a complication of sebaceous cyst.- When the sebaceous cyst of the scalp ulcerates excessive granulation tissue forms resembling fungating epithelioma. This is called cock's peculiar tumor.Also know these termsCylindroma-A malignant epithelial tumour also k/a Turban tumorKnown as cylindroma because of histological appearancePilomatrixoma (Calcifying epithelioma of Malherbe) -It is a benign hair follicle derived tumour.Pott's puffy tumour -It is osteomyelitis of the skull associated with subperiosteal swelling and edema.


Question: Earliest symptom of Wilm's tumour


Question: Most common cause of bowel obstruction is

.ADHESIONS AND BANDS - Adhesions and bands are the commonest causes of intestinal obstruction in Western countries. In India, hernia and then adhesions are the two common causes of intestinal obstruction. Causes- * Infection due to peritonitis, appendicitis, postlaparotomy, and other acute infective abdominal conditions. Type I--Fibrinous adhesions occur during 5-10th postsurgical period. It usually gets resolved completely. It is avascular and flimsy. Type II--Fibrous adhesions. Due to lack/poor blood supply, bowel gets attached to pa of peritoneum or omentum or other pas of the bowel with dense vascular adhesions to maintain blood supply. It will persist and precipitate intestinal obstruction, often-subacute and recurrent type. Adhesions due to tuberculosis are severe, dense and difficult to separate. ref:SRB&;s manual of surgery ,ed 3,pg no 870


Question: Commonest type of cleft lip is

Distribution of Cleft types Cleft lip alone - 15% Cleft lip & palate - 45% Isolated cleft palate - 40% Ref : Bailey & Love 25/e p657


Question: Parkland formula is amount of RL given in 24 hrs is calculated as

Parklands regime: 4 * %burn * weight (kg) for 24hoursMaximum percentage of burns considered is 15%Half of the volume is given in first 8hours , Rest given in 16hours


Question: It is difficult to obtain local infiltration anesthesia in the presence of inflammation because of


Question: Dysphagia caused by in Plummer Vinson Syndrome is due to

(Web) (1024-25-LB) (737, 1043-B &L 25th)Plummer-Vinson Syndrome (Brown-Kelly Paterson syndrome or sideropenic dysphagia)* Young women with iron deficiency anaemia and dysphagia referred high in the neck.* The dysphagia was said to be caused by spasm or a web in the post-cricoid area. The patients were said to have an increased tendency to post-cricoid cancer.* Web certainly occurs in the upper oesophagus. More recently it has been noted that there is often a patch of heterotopic gastric mucosa in the upper oesophagus (probably congenital)* Complications - ulceration, stricture and adenocarcinoma


Question: 22 Gauge iv cannula colour is

Orange : 14G
Gray : 16G
Green : 18G
Pink : 20G
Blue : 22G
Yellow : 24G


Question: Management of rectosigmoid obstructive carcinoma in elderly frail

Colostomy MC indication for fashioning a colostomy : CA rectum. Colostomies are also constructed as treatment for Obstructing lesions of the distal large intestine and for actual or potential perforation. Type by Anatomic Location End-sigmoid colostomy (MC) End-descending colostomy Transverse colostomy Cecostomy Decompressing Colostomy Diveing colostomy Indications Distal obstructive lesions causing massive dilation of the proximal colon without ischaemic necrosis Severe sigmoid diveiculitis with phlegmon Selected patients with toxic mega colon Types of Decompressing stomas Blow-hole Cecostomy Blow-hole transverse colostomy Tube type of Cecostomy Loop-tramsverse colostomy Indications When distal segment of bowel has been completely resected (as during APR) Known or suspected perforation or obstruction of the distal bowel (e.g., Obstructing carcinoma, diveiculitis, leaking anastomosis or trauma) Destruction or infection of the distal colon, rectum, or a us (eg: Crohn's disease or failed anal sphincter reconstruction) Type of Diveing Stomas Loop-tramsverse colostomy Loop sigmoid colostomy Ref: Sabiston 20th edition Pgno : 1326-1330


Question: Metastasis of ca buccal mucosa goes to

Tumors in this area have a propensity to spread locally and to metastasize to regional lymphatics . Lymphatic metastasis of Buccal ca go to submandibular and later upper jugular nodes. MC type of Buccal ca - Squamous cell ca Commonest site of origin - angle of mouth or the line of occlusion of upper and lower teeth


Question: Abscess that arise from the tuberculous origin is


Question: Cisterna chyli lies in front of vertebrae

Cisterna chyli is a lymph sac lying in front of L1 and L2 vertebrae between aorta and crus of diaphragm.


Question: &;Tennis elbow&; is characterized by

.tennis elbow(lateral epicondylitis) characterised by pain and tenderness at the lateral epicondyle of the humerus due to non-specific inflammation of the origin of extensor muscle of the forearm. clinical features-tenderness ,precisely localized to the lateral epicondyle of the humerus.pain is aggravated by putting the extensor tendons to a stretch (Ref: Essential ohopaedics, Maheshwari and Mhaskar,5th edition,pg no. 302)


Question: The most common complication of supracondylar fracture is


Question: Osteoblastic secondaries occurs with

(Carcinoma prostate) (1086-CSDT 13th)* Although some tumours may produce mainly osteolytic lesions (eg Kidney cancers) and others mainly osteoblastic lesions (eg prostate cancers), most metastatic lesion produce both types of lesion and may go through stages where one or the other predominates - 613- Harrison 17th* Osteolytic lesions are associated with hypercalcemia* and hydroxyproline - containing peptides* Osteoblastic lesions are associated with increased levels of serum alkaline phosphatase** Most common cause of osteolytic metastasis- In males - lung cancer- In female - Breast cancer Most common cause of Osteoblastic metastasis- In male - Prostate cancer- In female - Breast cancer* Lytic expansile metastasis seen in Thyroid, Renal carcinomaCarcinoma of prostate - 90% tumours are adeno carcinoma the tumour arises primarily in the peripheral zone (70%)**Periurethral (Tansition) zone - site for benign prostatic hyperplasia**Screening by transrectal Ultrasound TRUS / and PSATRUS - most useful for Taking guided biopsy*** Most common cause of sclerotic skeletal metastasis in a female patients is - Carcinoma breast


Question: Banka's lesion involves

B i.e. Anterior aspect of glenoid labrum


Question: Punched out Ulcer in Esophagus on Endoscopy in a Immunocompromised patient is seen in

Herpes Simplex Esophagitis: - * Common in Immunocompromised patients. * Characterised by small raised herpetic vesicles few days before on the lips. * Endoscopy reveals- Vesicles and small ulcers with raised margins (Punched out) usually in upper half of esophagus. Ref:- Bailey and Love 27th Edition; Pg num:- 1104


Question: Selective toxicity of zindovudine for HIV is based on inhibition of

HIV binds to a surface molecule on CD4 lymphocytes and enters the cell, where viral RNA serves as a template for both positive and negative strands of complementary DNA. Reverse transcriptase (RNA-dependent DNA polymerase) transcribes the viral RNA. The double- stranded complementary DNA is then spliced into the host cell genome by a virus-encoded integrase. The mtegrated complementary DNA is then transcribed and translated into viral proteins. The dideoxy nucleosides including zidovudine, selectively inhibit revers transcriptase. Host cell DNA polymerase is more than 100 times less sensitive than the HIV polymerase to zidovudine.

Incorporation of complementary DNA into the host genome

Transcription of viral DNA by host RNA polymerase


Question: Hinge fracture is seen in

Skull base fractures Anteruor cranial fossa Subconjunctival hematoma CSF Rhinorrhea Carotico-cavernous fistula Periorbital hematoma or "Raccoon eyes" Middle cranial fossa fracture CSF otorrhea Hemotympanum Ossicular disruption Battle sign : Bruising behind the ear 7th and 8th cranial nerve palsies Ref: Bailey and love 27th edition Pgno : 333


Question: CSF rhinorrhoea is diagnosed by

(B) Beta 2 transferrin # investigations:> CSF as compare to nasal secretion has a central area of blood with outer ring or halo (Halo sign)> Glucose testing: CSF glucose is low compared to serum glucose.> Beta 2 transferring assay: This marker is very specific to CSF. However, the test is expensive & results may take several days to a few weeks to receive. Most leaks will have closed before the results are available, making this a poor test> Protein used in iron transport> Beta 1 - Serum, nasal secretions, tears, saliva> Beta 2 - CSF, perilymph and aqueous humor.> Diagnosis: History - surgeries, accident, unilateral, watery, intermittent, assocaited features like headache, positional variation, associated with anosmia or hyposmia etc.,> Laboratory Tests: Glucose oxidase test: Glucose oxidase strips show color change on detection of glucose (high false negative so abondoned) b2 transferring in the nasal secretions. In CSF Beta 2 transferring is present, and it is absent in normal nasal secretions. (100%sensitivity and 95% specificity. b Trace protection: 100% sensitive and specific Intrathecal radionucleotide test: Most specific Test that help to localise the CSF leak MR cysternography, CT Cysternography (Contraindicated in active meningitis or High ICP) Intrathecal administration of non-ionic contrast with high resolution CT scan. Intrathecal administration of low quantities of Fluorescein can also be used. If the leak is present it can be seen in the nasal cavity with a 490 nm light generated by a special optical filter. Dye injection is done using Barbolage technique in which 1-2 drops of 5% Fluorescein is diluted with the patients own CSF, and then injected partially, then CSF is withdrawn further diluting the dye and then reinjecting the dye.# CSF contains glucose which can be demonstrated by oxidase peroxidase paper strip or biochemical tests. Beta 2 transferrin is specific for CSF.> Analysis of the collected nasal fluid can be both problematic and useful. Analysis of nasal fluid is problematic because simple testing such as observing how the drainage dries on paper (Ring sign) or measuring the sugar content (reflecting the elevated glucose content of CSF) may not be valid.> Presence of the enzyme Beta2-transferrinase is only found in CSF, but requires the collection of several milliliters of fluid to be sent for highly specialized laboratory testing.> To confirm or further identify the route of CSF rhinorrhea, three forms of imaging are available.> Isotope cisternogram is the most sensitive, but least specific form of imaging. Nuclear medicine study consists of placing a low yield radioactive isotope in the subarachnoid space via a lumber puncture or spinal tap. Presence of isotope containing CSF in the nose is confirmed by measuring radioactivity within the nasal cavity or on cotton pledgets placed at probable sites of cerebral spinal fluid drainage from the cranial cavity. Contrast CT cisternography is a more specific, but a less sensitive form of imaging for CSF rhinorrhea. Requires an active leakage of CSF to the nose and involves the placement of an agent opaque to CT imaging within the subarachnoid space. Coronal CT scan is then performed to image the defect within the floor of the anterior or middle cranial fossa, and the route of drainage into the nose.> Magnetic resonance imaging is a non-radiographic procedure utilizing the detection of electromagnetic energy released from the hydrogen atom as the electron circling the nucleus descends to a lower energy level. Soft tissue contains various amounts of water and the physics of detecting changes in energy rather than density (as in the case of CT) significantly favor the former. MR imaging is the examination of choice tor visualizing potential brain anomalies, such as encephaloceles (herniation of brain into the nose or ear). MR also permits the identification of CSF draining into the nose without the use of contract, but does not visualize well bony detect in the skull base or currently lacks the detail provided by CT cisternography.


Question: The recent treatment of sho bridle passable stricture of urethra in the penile and bulbous urethra is

Endoscopic (internal) urethrotomy Internal urethrotomy is performed using the optical urethrotome. The stricture is cut under visual control using a knife passed through the sheath of a rigid urethroscope. The stricture is usually cut at the 12 o'clock position, taking care not to cut too deeply into the vascular spaces of the corpus spongiosum that surrounds the urethra. It is possible to get lost when trying to cut a way through a very tight stricture, and this is especially true when there are false passages because of previous dilatation attempts. Accordingly, a guidewire should be passed through to the bladder prior to incision of the stricture in order to establish the true lumen of the urethra. Following urethrotomy a catheter should be left in situ for 1-3 days afterwards. A single urethrotomy seems to give a permanent cure of an uncomplicated stricture in about 50% of patients. Success rates are highest when the stricture is sho and when it is present within the bulbar urethra. In contrast, failure rates are highest in long strictures, strictures within the penile urethra and in recurrent strictures. The main complications are infection and bleeding. Ref: Bailey and love 27th edition Pgno : 1484

Internal urethrotomy with Thompson-Walker's urethrotome


Question: Earliest manifestation of increased intracranial pressure following head injury is

Ans. (c) Altered mental statusRef: Bailey 26th 310Altered mental status is the earliest manifestation of increased intracranial pressure.Cushing's triad of increased ICP* Intracranial hypertension* Brady cardia* Irregualr respiration


Question: Ascites with SAAG < 1 is seen in

SAAG is calculated by subtracting ascitic fluid from serum albumin level, if swag is less than 1.1 then it is called low gradient SAAG which suggests an absence of poal hypeension and is seen in a condition like nephritic syndrome. SAAG more than 1.1 suggest presence of poal hypeension, it is called high gradient SAAG is seen in cirrhosis, Budd Chiari syndrome, cardiac ascites Reference : SRB edition : 5 page: 625


Question: Acute urinary retention in a male child may be due to

Acute urinary retention in a male child may be due to local inflammatory causes like meatal ulcer with scabbing.


Question: Retractile mesenteis may be seen in


Question: Investigation of choice for spinal TB

Answer- C. MRIBest view for Cl-C2 veebrae & junction - open mouth odontoid (pegs) view.Investigation of choice for spinal tuberculosis - MRIInvestigation of choice for traumatic paraplagia - MRI


Question: A patient presents with bilateral proptosis, heat intolerance and palpitations. Most unlikely diagnosis here would be


Question: Most common paraneoplastic syndrome in HCC is

Paraneoplastic syndromes on HCC Hypercholesterolemia Hypoglycemia Erythrocytosis Hypercalcemia Hypercholesterolemia > Hypoglycemia > Erythrocytosis > Hypercalcemia Ref: Sabiston 20th edition Pgno : 1459


Question: MTC associated with MEN 3 syndrome has

MITC associated with MEN 3 syndrome is very aggressive.
Chromosome 10 ( RET) mutation is present.


Question: A new born presented with bloated abdomen sholy after bih with passing of less meconium. A full thickness biopsy rectal biopsy finding is most likely to be present.

.hirschsprung disease is a congenital, familial condition, occurring in newborn due to the absence of ganglion cells-- Auerbach's and Meissner's plexus in anorectum, which may extend proximally either a pa or full length of the colon. * It always involves the anus, internal sphincter and rectum (paly or entirely). * There is narrow, spasmodic, non relaxing pathological segment. * Transitional zone proximal to it contains only few ganglion cells with formation of cone. ref:SRB&;s manual of surgery,ed 3,pg no 818


Question: This surgical blade is used for

This is Number 12 surgical blade. It is used for suture removal.


Question: Best treatment modality for SCC of bladder

SCC of bladder is treated by radical cystectomy.


Question: It can be stated that the superior haemorrhoidal veins —a) Drain into the inferior mesentric veinb) Have no valvec) Leave the anal canal at the pactinate lined) Cause external haemorrhoids


Question: The earliest symptom in primary biliary cirrhosis is

Pruritis occurs because of deposition of bile salts in the skin, this clinical symptom occurs before the development of jaundice.


Question: Most common type of malignant melanoma is

A. i.e. (Superficial spreading melanoma) (613 -B & L 25th) (111- 13 S. Das 5th)MALIGNANT MELANOMA* Commonest type is superficial spreading melanoma (70%) and Least is acral lentiginous melanoma (2 - 8%)* Nodular melanoma is the most malignant form*** The presence of lymph node metastasis is the single most important prognostic index in melanoma* Skin is the most common site of malignant melanoma (palms, soles and external genitalia are the common site)* Cardinal symptoms of malignant change in a mole or naevus1. Increase in size2. Change in colour3. Bleeding4. Evidence of local spread5. Enlarged regional lymph nodes


Question: Most common nutritional deficiency seen after gastrectomy

Most common complication is violin deficiency.


Question: Least common quadrant in cancer breast is

Most malignant type of CA breast : Inflammatory breast cancer Best prognosis is seen in : Tubular MC site of CA breast : Upper outer quadrant (left breast >right) Least common site of CA breast lower inner quadrant MC site of metastasis is Bone (osteolytic deposits in lumbar veebrae >Femur >Thoracic veebrae >Rib > Skull Ref: Sabiston 20th edition Pgno :837


Question: Sequence of colour changes observed in Raynaud’s disease


Question: Pain and ahritis of distal interphalangeal joint is seen in


Question: In reduction genioplasty

Parasymphysis part of the mandible is reduced

Parasymphysis part of the mandible is advanced


Question: Cullen Sign is a feature of

Ans. (a) hemorrhagic pancreatitisRef: Bailey and Love 27th edition Page 1222* Cullen sign: Hemorrhagic Pancreatitis causing Pigmentation in Umbilicus* Grey turner sign: Hemorrhagic Pancreatitis causing Pigmentation at Loin* Fox sign: Hemorrhagic pancreatitis causing pigmentation in Inguinal region.


Question: 30 year old patient with pain in right hypochondrium for 5 days with soft and tender liver and intercostal tenderness. He complains of catch in breath on inspiration and has a non productive cough. On examination the lung fields are clear, patient looks pale and emaciated. Probable diagnosis is

Ans. (a) Ameobic liver abscessRef:Manipal Manual of surgery, 4th ed./521Refer to the above explanationHydatid cystUsually clinically silentEnlarged liver with smooth surface and is non tender.Pyogenic liver abscessMultiple abscess leading to spiky fever and enlarged liver.Hepatic adenomaPresents in young women on OCP and is solitary. Liver enlargement may or may not be seen.


Question: Standard treatment of appendicular mass is

[Cl (Ochsner: sherren regimen) (1216-LB) (1215-B &L 25th)Management of a appendix mass* If an appendix mass is present and the condition of the patients is satisfactory, the standard treatment is the conservative Ochsner-Sherren regimen* It is advisable to remove the appendix after an interval of 6-8 weeksAppendicitis During Pregnancy - Appendicitis is the most common non-obstetric surgical disease of the abdomen during pregnancy.* Laparoscopic appendectomy (specifically the pneumoperitoneum) is well tolerated by the mother and fetus (669-CSDT IT)


Question: A child is passing blood with act of defecation. The probable diagnosis is

Ans. (a) Juvenile rectal polypRef : Bailey & Love 26th ed. /1224The most common cause of bleeding per rectum in children is juvenile rectal polyp up to adolescence age. Though in infants and young children (up to 1 yrs) the cause is anal fissure.


Question: Most common site of metastasis in Ca colon is

One-third of patients will have liver metastases at the time of diagnosis and 50% will develop them at some point, accounting for the majority of deaths. The lung is the next most common site; metastasis to ovary, brain, kidney, and bone is less common.Ref: Bailey and love, page: 1262


Question: As per CEAP classification healed venous ulcer is

CEAP (Clinical-aEtiology-Anatomy-Pathophysiology) classification for chronic venous disorders Clinical classificationC0: no signs of venous disease;C1: telangectasia or reticular veins;C2: varicose veins;C3: oedema;C4a: pigmentation or eczema (some include malleolar flare in this category);C4b: lipodermatosclerosis or atrophie blanche;C5: healed venous ulcer;C6: active venous ulcer.Etiological classificationEc: congenitalEp: primaryEs: secondary (post-thrombotic)En: no venous cause identified.Anatomical classificationAs: superficial veinsAp: perforator veinsAd: deep veinsAn: no venous location identified.Pathophysiological classificationPr: refluxPo: obstructionPr,o: reflux and obstructionPn: no venous pathophysiology identifiable.Ref: Bailey and love pg: 974


Question: In prostate Ca. metastasis, lymph nodes most commonly affected are

Obturator LN are first nodes involved in prostate Ca.


Question: In general commonest hemorrhage following head injury is

SUBDURAL HAEMATOMA Types Acute Chronic Acute Subdural Haematoma It is a collection of blood between the brain and dura. It is due to injury to the coical veins and often due to laceration of coex of brain which bleeds and blood gets collected in the subdural space forming a haematoma. Here haematoma is extensive and diffuse. There is no lucid interval. There is severe primary brain damage. Haematoma may be of coup and contre-coup type. Loss of consciousness occurs immediately after trauma and Is progressive. Convulsion is common. Features of raised intracranial pressure is obviously seen high BP, bradycardia, vomiting. Focal neurological deficits or hemiparesis can occur. CT scan shows concavo-convex lesion. Treatment Antibiotics, anticonvulsants. Surgical decompression is done by craniotomy. Chronic Subdural Haematoma It is due to the rupture of veins between dura and brain (cerebral hemispheres), causing gradual collection of blood in subdural space. It is commonly seen in elderly people following any minor trauma like fall, slipping (which might have gone unnoticed). In elderly people, brain atrophies and even minor injuries can cause shearing and bleeding from these veins. Blood collects gradually over 2-6 weeks. Plasma and cellular components get separated. Eventually cellular pa gets absorbed leaving only fluid component. It is called as chronic subdural hygroma. Usual haematoma collection is 60-120 ml. Often in 50% of cases, it is bilateral. Clinical Features Common in old age, with history of minor trauma. Patient presents with confusion, disorientation, gradually with altered level of consciousness and drowsiness. Later convulsions, features of intracranial hypeension, features of coning develops. Extensor plantar response and pupillary changes develop eventually. Investigations CT scan (shows concavo-convex lesion). Serum electrolytes. Blood grouping and cross matching. Differential Diagnosis Electrolyte imbalance. Intracranial space occupying lesion. Treatment Craniotomy and evacuation of clot is done when required on both sides. Antibiotics. Anticonvulsants for 3 years. Complications Epilepsy Meningitis Coning Neurological deficits Ref: SRB's Manual of Surgery 5th edition Pgno : 1096


Question: Buerger's angle that indicates severe ischaemia is

If Buerger's angle is < 30°, it indicates severe ischaemia.


Question: Most common site of carcinoma of stomach in developed countries is

The proximal stomach is now the most common site for gastriccancer in resource-rich western countriesIt can be seen that just under 60% of all of the malignancies occurring in the oesophagus and stomach occur in proximity to the oesophago-gastric junction.This high prevalence of proximal gastric cancer is not seen in Japan, where distal cancer still predominates, as it does in most of the rest of the world.Bailey and Love 27e pg: 1132


Question: Thoracic duct can be identified by

Thoracic duct is identified within Poirier's triangle which is formed by arch of aorta, left subclavian artery & vertebral column.


Question: The commonest earliest complication of TV and GJ is


Question: Pseudo obstruction of intestine is also known as

Ans. (c) Ogilvie's syndromeRef.: Bailey & Love 26th ed. /1198* Pseudo-obstruction of the colon is called as ogilvie's syndrome which is characterized by distention of the colon, with signs and symptoms of colonic obstruction, in the absence of an actual physical cause of the obstruction. The cause of the dilation was attributed to the malignant infiltration of the sympathetic ganglia.* Mirizzi syndrome is a gallstone becoming impacted in cystic duct or neck of gall bladder causing compression of CBD and resultant obstructive Jaundice.


Question: The following is the commonest site for venous ulcer

Venous ulcers usually lie just proximal to the medial or lateral malleolus. Venous ulcers are accompanied by lipodermatosclerosis and hemosiderosis (if these are not present then the ulcer is probably not of venous origin). Ref : Bailey & Love 25/e p937


Question: An elderly male presents with pain in his shoulders and hands. ESR is 105 mm/L. History includes transient blindness and unilateral headache. (SELECT 1 DIAGNOSIS)

Behcet syndrome is a multisystem disorder that usually presents with recurrent oral and genital ulcers. Onefouh of patients develop superficial or deep vein thrombophlebitis. Iritis, uveitis, and nondeforming ahritis may also occur. The 50-year-old drug abuser also has a multisystem disease, including systemic complaints, hypeension, skin lesions, neuropathy, and an abnormal urine sediment. This complex suggests a vasculitis, paicularly polyaeritis nodosa. The disease is a necrotizing vasculitis of small and medium muscular aeries. The pathology of the kidney includes an aeritis and, in some cases, a glomerulitis. Nodular skin lesions show vasculitis on biopsy. The 19-year-old with low back pain, morning stiffness, and eye pain has complaints that suggest ankylosing spondylitis. This is an inflammatory disorder that affects the axial skeleton. It is an autoimmune disorder that has a close association with HLA-B27 histocompatibility antigen. Anterior uveitis is the most common extraaicular complaint. Aoic regurgitation occurs in a few percent of patients. The elderly male presents with nonspecific joint complaints typical of polymyalgia rheumatica. The high erythrocyte sedimentation rate is characteristic. The transient loss of vision suggests concomitant temporal aeritis, an impoant association seen paicularly.


Question: Aim of damage control laparatomy are

DAMAGE CONTROL SURGERY (Abbreted laparotomy) Following major injury, protracted surgery in the physiologically unstable patient can in itself prove fatal. Patients with the 'deadly triad' (hypothermia, acidosis and coagulopathy) are those at highest risk. 'Damage control' or 'damage limitation surgery' is a concept that originated from naval ship- building strategy, whereby ships were designed so that the damage was kept 'local' and which allowed only the minimal repairs needed to prevent it from sinking, while definitive repairs waited until it had reached po. The technique has been adopted following major trauma, and includes initial care and resuscitation (damage control resuscitation) and the surgical correction of the injury (damage control surgery). The minimum amount of surgery needed to stabilise the patient's condition may be the safest course until the physiological derangement can be corrected. Damage control surgery is restricted to only two goals: * stopping any active surgical bleeding; * controlling any contamination. Once these goals have been achieved then the operation is suspended and the abdomen temporarily closed. The patient's resuscitation then continues in the intensive care unit, where other therapeutic interventions can take place.Once the physiology has been corrected, the patient warmed and the coagulopathy corrected, the patient is returned to the operating theatre for any definitive surgery. Indications for Damage control surgery Anatomical Inability to achieve haemostasis Complex abdominal injury, e.g. liver and pancreas Combined vascular, solid and hollow organ injury, e.g. aoic or caval injury Inaccessible major venous injury, e.g. retrohepatic vena cava Demand for non-operative control of other injuries, e.g. fractured pelvis Anticipated need for a time-consuming procedure Physiological (decline of physiological reserve) Temperature <34oC pH <7.2 Serum lactate >5 mmol/L (normal: <2.5 mmol/L) Prothrombin time (PT) >16 s Paial thromboplastin time (PTT) >60 s >10 units blood transfused Systolic blood pressure <90 mmHg for >60 min Environmental Operating time >60 min (core temperature loss in usually 2degC/h) Inability to approximate the abdominal incision Desire to reassess the intra-abdominal contents (directed relook) Ref: Bailey and love 27th edition Pgno : 379


Question: The initial pharmacologic therapy of choice in this stable patient (refer to Q 87) is

Vagotonic maneuvers such as carotid massage or the Valsalva maneuver could ceainly be tried first. If these are unsuccessful, adenosine, with its excellent safety profile and extremely sho half-life, is the drug of choice for supraventricular tachycardia at an initial dose of 6 mg. Dosage can be repeated if necessary a few minutes later at 12 mg. Verapamil is the next alternative; if the initial dose of 2.5 to 5 mg does not yield conversion, one or two additional boluses 10 min apa can be used. Diltiazem and digoxin may be useful in rate control and conversion, but have a much slower onset of action.

Verapamil 2.5 to 5 mg IV over 1 to 2 min


Question: Most common variant of carcinoma breast among the following is

Invasive Epithelial Cancers (Percentage of Total)Invasive lobular carcinoma (10%)Invasive ductal carcinomaInvasive ductal carcinoma, not otherwise specified (50%-70%)Tubular carcinoma (2%-3%)Mucinous or colloid carcinoma (2%-3%)Medullary carcinoma (5%)Invasive cribriform carcinoma (1%-3%)Invasive papillary carcinoma (1%-2%)Adenoid cystic carcinoma (1%)Metaplastic carcinoma (1%)Ref: Sabiston 20e, page: 837


Question: Purely radilucent renal stones are

Ans. is 'c' i.e., Xanthine Renal stone disease* Routine use of noncontast CT Scan has completely revolutionized te imaging evaluation of renal stone disease, nearly completely replacing plain radigrpahs and X urography for diagnosis of acute ureteral obstruction by renal stones.* Nephrolithiasis refers to the presence of calculi in the renal collecting system.* Nearly 10 % of the population will form a renal stone in their lifetime.* Sufficient calcium oxalate and phosphate is present in 80 % of the renal calculi for them to be radio-opaque on the plain radiographs.* Struvite (magnesium ammonium phosphate stones formed in the presence of alkaline urine and infection make up 15% of the renal calculi and also radio opaque on radiographs.* Cysteine stones make up 1 - 2% of the renal stones, and are mildly radio opaque. They are found in patients with congenital cystinuria.* The remaining 3 - 4% of the renal stones are composed of urate or xanthiene and are radiolucent on radiographs.


Question: Protein metabolism after trauma is characterized by

Injury and sepsis result in accelerated protein breakdown with increased urinary nitrogen loss and increased peripheral release of amino acids. The negative nitrogen balance represents the net result of breakdown and synthesis (with breakdown increased and synthesis increased or diminished). Amino acids such as alanine are released by muscle and transported to the liver for incorporation into acute-phase proteins including fibrinogen, complement, haptoglobin, and ferritin. The amino acids also undergo gluconeogenesis to glucose, which is utilized primarily by the brain and other glycolytic tissues such as peripheral nerves, erythrocytes, and bone marrow. Other tissues receive energy from fat in the form of fatty acids or ketone bodies during starvation following major trauma; this helps to conserve body protein. Glutamine is the most abundant amino acid in the blood, and its levels in muscle and blood decrease following injury and sepsis as it is consumed rapidly by replicating fibroblasts, lymphocytes, and intestinal endothelial cells. The use of glutamine may decrease protein catabolism in the intestine and may help prevent atrophy of the gastrointestinal tract in starved and parenterally nourished patients. Along with the counterregulatory hormones (glucagon, epinephrine, cortisol), interleukin 1 appears to mediate muscle breakdown. Recent studies have indicated that TNF (also called cachectin because of the role it plays in muscle wasting in septic or oncologic patients) also may be a principal catabolic cytokine in the traumatized patient. This protein is secreted by macrophages and further affects metabolism by inducing secretion of interleukin 1 and inhibiting synthesis and activity of lipogenic enzymes.

Inhibition of skeletal muscle breakdown by interleukin 1 and tumor necrosis factor (TNF, cachectin)

Hepatic synthesis of acute-phase reactants


Question: Initial investigation of choice in obstructive jaundice is

Transabdominal ultrasound scan is universally established as the most useful first line imaging study in the jaundiced adult.It provides an excellent evaluation of liver parenchyma & assessment of the presence/absence of bile duct dilatation. Reference:SRB's manual of surgery,5th edition,page no:656.


Question: Ectopic ureter in females of ectopic pelvis opens into

According to weger meyert rule ectopic urethra opens into urethra in males and
vagina in females.


Question: Very commonly used suture material in oral surgical procedures


Question: Infectionrate without antibiotic prophylaxis for clean contaminated surgery is

Type of surgery
Infection rate with prophylaxis
Infection rate without prophyloxis

Clean surgery
1 - 2 %
1 - 2 %

Clean contaminated surgery
3%
6 - 9 %

Contaminated surgery
6 %
13 - 20%

Dirty surgery
7%
40%


Question: This is a specimen of

This is a specimen of familial adenomatous polyposis with multiple polyps.Polyps are usually visible on sigmoidoscopy by the age of 15 years and will almost always be visible by the age of 30 years.Carcinoma of the large bowel develops 10-20 years after the onset of the polyposis.If over 100 adenomas are present at colonoscopy, the diagnosis can be made confidently.Ref: Bailey and love, 27e, page: 1260


Question: Meckel's derived from;

Ans. (a) Proximal part of VIDRef: Sabiston 20th edition, Page 1284* Meckel's diverticulum results from incomplete closure of proximal VID* Raspberry tumor (Umbilical adenoma) is persistence of distal VID


Question: In obstruction of the large gut rupture occurs at the


Question: Diverticular disease is not common in

• Most common sites of diverticula: CMD PES JAI (Colon >Meckel’s >Duodenum >Pharynx >Esophagus >Stomach >Jejunum >Appendix >Ileum)


Question: Hyperacute rejection is due to

Hyperacute rejection occurs when preformed anti-donor antibodies are present in the circulation of the recipient. Such antibodies may be present in a recipient who has previously rejected kidney transplant, Multiparous women, Prior blood transfusionsHyperacute Rejection occurs within minutes or hours after transplantation.Robbins pathology 9e Pg: 233


Question: Carcinoma testis, the lymphatic metastasis goes to the first site seen in

(Para-aortic lymph node) (1386-Baily & Love 25th)Metastasis first develop in the retroperitoneal nodes; right sided tumours metastasize primarily to the inner aortocaval region just below the renal vessels and left sided tumours primarily to the left para-aortic area at the same level (953-CSDT 13th)Lymphatics of the Testis - runs upwards in the spermatic cord and passing through the internal inguinal rings.They branch fountain- wise (behind and adherent to the posterior peritoneum) towards the para-aortic lymphnodes in the region of the origin of spermatic vessels. Above this level the lymph drains into thoracic duct which extends through the mediastinum to the left supraclavicular fossa where it drains into the left innominate vein. Lymphatics from the medial side of the testis may run with the artery to the vas and drain into lymph node at the bifurcation of the common iliac arteryInguinal lymphnodes are only affected if the scrotum in involved.ALSO - REMEMBER* Most common tumour above 50 years of age - Lymphoma* Most common testicular tumour in prepubertal adults (Infant and children) is Yolk sac tumour* Seminoma are most common testicular tumours, better prognosis, most radiosensitive tumours* Non seminoma are more malignant than seminoma* Seminomas as well as nonseminomas typically metastasize through- lymphatics*** a- feto protein is elevated in 70% of patients with non seminomatous testicular cancer but is not elevated in seminoma* Markers {LDH, fihCG, a-fetoprotieri) are used mainly to follow tumour regression or predict recrudescence as even minute amounts of tumour may cause serum elevations however tumour may be present without elevation of serum markers* Most common germ cell tumour is - Seminoma


Question: Initial periumbilical pain shifting to right iliac fossa is symptoms suggestive of

In acute appendicitis, visceral pain stas around the umbilicus d/t distension of appendix, later after few hours somatic pain occurs in the right iliac fossa d/t irritation of parietal peritoneum by inflamed appendix.In mesenteric ischemia, abdominal pain is out of propoion in relation to tenderness; pain is around umbilicus to begin with which later becomes diffuse. Right ureteric colic pain is colicky in type and radiates from right loin to groin often to the tip of genitalia, testis in males, labia majora in females.The abdomen is moderately-to-severely tender in a diffuse or localized pattern, usually on the right side in case of abdominal worms. Reference : page 940, 871, 1019SRB's manual of surgery 5th edition


Question: Commonest complication of Zenker's diverticulum is

"Pulmonary infection is the most frequent serious complication, and many patients are first seen after experiencing repeated episodes of pneumonia."-CSDT

Aspiration pneumonia & Lung abscess are the most frequent complications of Zenker's diverticulum.
Other rare complications are:
Perforation
Bleeding
Carcinoma