Question: Treatment of Congenital Hydrocephalus is

Ans. (d) VP shuntRef: Bailey and Love 27th edition Page 655Treatment of Congenital Hydrocephalus:* Temporary CSF diversion by External Ventricular Drain* Ventriculo peritoneal shunt is long term mainstay management* Endoscopic Third Ventriculostomy* Lumbar Puncture is also a temporary measure until VP shunt is made.


Question: 'Liver shrinkage diet' is advised before

In bariatric surgery, 'liver shrinkage diet' for at least 2 weeks before surgery is advised, especially when there is central obesity, as this is associated with large livers that can make surgery impossible.Ref: Bailey and love 27e pg: 1146


Question: Entonox is combination of

B. i.e. (50% oxygen : 50% N2O) (132 - Lee s synopsis of anaesthesia 13th )ENTONOX - is the trade name for a 50 - 50 mixture of gaseous N2O and O2* The cylinder shoulder is painted white and blue in quarters and body is blueUses include - obstetric analgesia, and analgesia for dressed wounds, coronary infarction and dental surgery**PIN number for oxygen - 2, 5 for Entonox- 7. Nitrous oxide 3, 5, air 1, 5


Question: Gate control theory of pain is due to


Question: Aerial enhancement and venous phase washout in a liver mass larger than 2 cm is diagnostic for


Question: Mild head injury is having glassgow coma scale of

There are a number of schemes to stratify the severity of head injury. Any such categorization isarbitrary and will be imperfect. A simple system based only on GCS score is as follows:* GCS 14-15 =mild* GCS 9-13 =moderate* GCS<=8 =severe ref; handbook of neurosurgery, Mark S.Greenberg P-825 glasgow coma scale EYE OPENING spontaneous -4 to speech -3 to pain -2 no response -1. VERBAL RESPONSE oriented -5 confused conversation -4 inappropriate words -3 incomprehensible sounds -2 no verbal response at all -1 MOTOR RESPONSE obeys commands -6 localises pain -5 withdrawal response -4 abnormal flexion -3 extension -2 no response -1


Question: BRCA 2 gene is associated with carcinoma of

The genes associated with breast cancers are p53, BRCA1 and BRCA2. BRCA2 is located on chromosome 13q and there is an association with male breast cancer. While BRCA1 gene has been associated with an increased incidence of breast and ovarian cancer and is located on the long arm of chromosome 17(17q). Reference : Bailey & Love, 27th Edition, page no =880.


Question: The commonest site of lodgement of a pulmonary embolus is in the territory of


Question: Preferred time for cleft lip repair surgery is

U/L cleft lip : 5 - 6 months.
Bilateral cleft lip : 4 - 5 months.


Question: Most common site of instrumentation perforation in oesophagus is

Ans) a (Cervical) Ref sabiston 18th ed pi 110Endoscopic procedures are the most common cause of iatrogenic esophageal perforation, with the cricopharyngeal area most commonly injured.


Question: "Figure of Eight" bandage used commonly in the fracture of


Question: Tumor seen in Barret's Esophagus

Ans. (a) AdenocarcinomaRef: Surgery Sixer 3rd Edition Page 330Predisposing factors of Esophageal Adenocarcinoma:* GERD* Barret's Esophagus* Obesity* Scleroderma* High Protein Diet and Fat Diet* SmokingNote: H. pylori producing cag -A toxin is protective against Adenocarcinoma of Esophagus


Question: Full thickness graft is indicated in

(C) Fascial regions for cosmetic effect # Whole Thickness (Wolfe's) Skin Graft# Full-thickness skin graft is a free graft including the entire epidermis and dermis.> Disadvantages of these grafts include> Better blood supply for their survival> Limited area that can be covered> The need to surgically close the donor site> The poor resistance to infection, which generally precludes use of these grafts on contaminated wounds.> Full thickness skin is best taken from locations where the skin is thin such as postauricular area, supraclavicular are and eyelids or where skin is loose and redundant such as flexor creases of the elbow, buttock and groin.> A pressure dressing of the 'tie over' variety is advisable.> The dressing should not be removed before 7 to 10 days


Question: Alvarado score is used in the diagnosis of

The most widely used is the Alvarado score A score of 7 or more is strongly predictive of acute appendicitis. The Alvarado (MANTRELS) score Symptoms Score Migratory RIF pain 1 Anorexia 1 Nausea and vomiting 1 Signs Tenderness (RIF) 2 Rebound tenderness 1 Elevated temperature 1 Laboratory Leucocytosis 2 Shift to left 1 Total 10 Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1211


Question: A Bennett's fracture is difficult to maintain in a reduced position mainly because of the pull of the


Question: The most common bone fractured during bih


Question: Ohobaric oxygen is used in

.HYPERBARIC OXYGEN It is administration of oxygen 1 or 2 atmospheres above the atmospheric pressure in a compression chamber. It increases the aerial oxygen saturation so that oxygen perfusion of tissues will be increased.Indications 1. Carbon monoxide poisoning. 2. Tetanus, gas gangrene infections. 3. Bedsores, frostbites, necrotising fasciitis. 4. Drenching in paralytic ileus to reduce the nitrogen gas in distended bowel. 5. As a radiosensitizer in the treatment of cancer. ref:SRB&;s manual of surgery,ed 3,pg no 98


Question: Pringle's Manuever is used to stop the bleeding from

Ans. (c) LiverRef: Bailey and Love 27th Edition Page 1162* Occlusion of Inflow vessels at epiploic Foramen by Soft Clamp is known as Pringle Manuever.* This is done during Elective Surgery and in cases of Trauma.


Question: Most common type of mesenteric cyst

Cysts may occur in the mesentery of either the small intestine (60%) or the colon (40%). Types include ChylolymphaticEnterogenousUrogenital remnant (actually retroperitoneal but project into peritoneum)DermoidAlthough all mesenteric cysts are rare, chylolymphatic is the most common variety, arises in a congenitally misplaced lymphatic tissue.Ref: Bailey and love 27e pg: 1063


Question: The earliest manifestation of increase intracranial pressure following head injury is

Early signs of elevated ICP includes drowsiness and a diminished level of consciousness Coma and unilateral papillary changes are late signs and require immediate intervention Ref : Harrison's 19th edition Pgno :1779


Question: The following metabolic anomaly is seen in cases of hemorrhagic shock.

Ans. (a) Metabolic acidosisRef: "Anion Gap: Acid Base Tutorial". University of Connecticut Health Centre* Lactic acidosis is seen in hemorrhagic shock.* Lactic acidosis causes increase anion gap metabolic acidosis.


Question: Most common bone secondaries from

(B) (Carcinoma breast) (1085-CSDT 13th)METASTATIC BONE TUMORS:* 80% of these metastatic lesions are from primary carcinoma-particularly of the Breast, Prostate, lung, kidney, thyroid, pancreas or stomach in that order of frequency (1202-CSDT 12th).* Most common primary source of solitary skeletal metastasis at the time of first diagnosis is carcinoma of the kidney (1202 CSDT 12,h).* Most common site of bony metastasis in carcinoma breast goes to - Lumber vertebra**.* Most common quadrant site in carcinoma breast is - upper outer quadrant***.A) MOST COMMON CAUSE OF OSTEOBLASTIC SECONDARY* In males - Prostate cancer* In females - Breast cancerB) MOST COMMON CAUSE OF OSTEOLYTIC METASTASIS* In males - Lung cancers* In females - Breast cancersC) LYTIC EXPANSILE METASTASIS* Thyroid* Renal carcinoma


Question: Long term complication of live kidney donors are

Answer- A. HypeensionHypeentionCardiovascular risksPreoteinuriaEnd stage renal disease


Question: Treatment of carcinoma left colon with acute obstruction

.Obstruction due to rectosigmoid growth with patient being severely ill--Hamann's operation can be done to save the life of the patient wherein distal stump after removal of the growth is closed, proximal colon is brought out as end colostomy. ref:SRB&;s manual of surgery,ed 3,pg no 857

Extended . colectomy with ileoanal anastomosis


Question: FNAC needle size

Fine needle aspiration cytology (FNAC) is cytological study of tumour cells to find out the disease and also to confirm whether it is malignant or not. It is done using 23 or 24 gauge needle(22-26 G) fixed to specialised syringes which creates negative pressure for aspiration and contents are smeared on the slides. It is done in parotid, thyroid, lymph node, breast and all other surface lesions. Reference : page 278 SRB's manual of surgery 5th edition


Question: A pregnant female presents with pain in abdomen on examination, tenderness is found in right lumbar region. TLC is 12000/cmm. and urine examination is normal. For diagnosis fuher test done is

Ans is 'b' ultrasound abdomen Ultrasound is a useful diagnostic method in a pregnant female presenting with right iliac fossa pain to exclude tubal or ovarian disease. CT and X-ray should not be done for fear of radiation to the fetus.


Question: Syndrome of internal iliac aery occlusion manifested by

Aerial pulses It is standard practice to examine the femoral, popliteal, posterior tibial and dorsalis pedis aeries together with the abdomen for an aoic aneurysm or renal aery bruit, which may coexist with lower limb occlusive disease. Diminution of a femoral and/or popliteal pulse can often be appreciated by comparing it with its opposite number; however, pedal pulses are either clinically palpable or absent. Popliteal pulses are often difficult to feel; a popliteal aery aneurysm should be suspected if the popliteal pulse is prominent with concomitant loss of the natural concavity of the popliteal fossa. Pulsation distal to an aerial occlusion is usually absent although the presence of a highly developed collateral circulation may allow distal pulses to be palpable - this is most likely to occur with an iliac stenosis. In this case, exercise (walking until claudication develops) usually causes the pulse to disappear as vasodilation occurs below the obstruction, causing the pulse pressure to reduce. An aerial bruit, heard on auscultation over the pulse, indicates turbulent flow and suggests a stenosis. It is an unreliable clinical sign as tight stenoses often do not have bruits. A continuous 'machinery' murmur over an aery usually indicates an aeriovenous fistula. Iliac obstruction Unilateral claudication in the thigh and calf and sometimes the buttock Bruit over the iliac region Unilateral absence of femoral and distal pulses Ref: Bailey and love 27th edition Pgno : 944


Question: The earliest manifestation of increased intracranial pressure following head injury is

• Early signs of elevated ICP includes drowsiness and a diminished level of consciousness.
• Coma and unilateral papillary changes are late signs and require immediate intervention.


Question: Numbness of cheek following fracture of zygomatic complex is due to

Tears of the antral mucosa may lead to epistaxis on the affected side, and damage to the infraorbital nerve may cause paraesthesia in its sensory distribution.


Question: Commonest complication of Zenker&;s diveiculum is

Commonest complications are lung abcess and pneumonia. It occurs because of Regurgitation during night while turning neck. Othercomplications are abscess in the neck due to infection in the pouch, Carcinoma, Weight loss and cachexia. Reference: SRB's Manual of Surgery, 6th Edition, page no=422


Question: The diagnostic method of submandibular sialolithiasis is

Ans. (c) Plain X-rayRef: Bailey and Love 27th Edition Page 780* MC cause of Submandibular duct obstruction is Stones in Gland and Duct.* 80% stones are radio opaque and hence X ray is diagnostic.* 80% of salivary stones are seen in Submandibular duct.* Stones distal to Lingual nerve (Beyond 2nd Molar) - Duct lay opening and stone removal is enough


Question: Dumbell tumour is seen in


Question: Most common neuroendocrine tumour of pancreas is

TumourIncidence%Insulinoma70-80Gastrinoma20-25Non-functional tumours30-50VIPoma4Glucagonoma4Somatostatinoma<5Carcinoid<1ACTHoma<1GRFoma<1Ref: Bailey and Love 27e pg: 846


Question:
Reactionary hemorrhage occurs after extraction
because of


Question: Working end of cryer elevator is placed at

Junction of interseptal bone and mesiobuccal portion of root


Question: Most common site of chronic gastric ulcer

Ans. b. Lesser curve near incisuraRef: Essential Surgery E-Book: Problemsy Diagnosis and Management: With Student by Clive R. G. Quick; Page No- 296PEPTIC ULCER DISEASEResults from damage to the gastric or duodenal mucosa caused by impaired mucosal defense and/or | acidic gastric contents.Risk factors: H. pylori (>90% of duodenal ulcers and 70% of gastric ulcers), NSAIDs, alcohol, and tobacco use; concomitant use of corticosteroids and NSAIDs; gender (males>females).HISTORY/PEPresentation: Chronic or periodic dull, burning epigastric pain that is often related to meals and can radiate to the back; nausea; hematemesis ("coffee-ground" emesis); or hematochezia (blood in the stool).Examination: Usually normal but may reveal epigastric tenderness and stool guaiac.Risks: Acute perforation (rigid abdomen, rebound tenderness, and/or guarding).Most common sites:The most common sire for chronic peptic ulcers are in the first part of the duodenum or the gastric antrum, particularly along the lesser curvature.A chronic stomal ulcer may also appear at the margin of a surgical created communication between stomach and intestine (Gastroenterostomy).


Question: Most common cyst of the spleen are

Pseudocyst or secondary cyst is the common cause for the development of cyst in the spleen ( constitutes 80% ). true cyst and parasitic cyst constitute 20% Reference: SRB 5th edition page no. 679


Question: The best prognosis in carcinoma stomach is with

Ca stomach may be divided into 5 morphological subtypes, that correlates loosely with the natural history and outcome.

Ulcerating Ca
Polypoidal Ca
Superficial spreading Ca

also known as early gastric cancer, superficial ca is confined to mucosa and submucosa.
these cancers have excellent prognosis (-90% 5 year survival rate) after resection

Linitis plastica or Scirrhous Ca

these tumors infiltrate the entire thickness of the stomach and cover a very large surface area, commonly involve the entire stomach. Marked desmoplastic reaction is noted, the stomach loses its pliability.
it has the worst prognosis of all types as spread is early.

Advanced carcinoma

this largest category contains the big tumors that are found partly within and partly outside the stomach. They may originally have qualified for inclusion in one of the preceding groups but have outgrown that early stage.


Question: Omphalocele is caused by

There are two abdominal wall defects due to failure of development of abdominal musculature:- Ref:- Sabiston 20th edition; Pg num:- 1071

Abnormal rotation of the intestinal loop

Failure of GUT to return to the body cavity from its physiological herniation


Question: Sister Mary Joseph nodule is most commonly seen with

Carcinoma of stomach may spread the abdominal cavity to the umbilicus ( Sister Joseph's nodule) Bailey & Love,26th,1050.


Question: Classic symptom of ectopic ureter in females

ECTOPIC URETERAL ORIFICE * Around 80% is associated with a duplication collecting system. * More common in females. Location * Males: Prostatic or posterior urethra (MC), lateral in bladder. * Females: Anterior urethra (MC), vestibule, vagina. Clinical Features * Females: continuous incontinence with an otherwise normal voiding . * Males: MC presentation Is UTI, no urinary incontinence . Diagnosis * IVP: Drooping Lily sign Treatment * Mainly expectant, Ureteric reimplantation or pole nephrectomy depending on moiety function.

Ureteral incontinence with otherwise normal voiding


Question: Mondor's disease is

Ans. a (Superficial thrombophlebitis of breast) (Ref. Bailey and Love 25th/833)Mondor's disease is thrombophlebitis of the superficial veins of the breast and anterior chest wall although it has also been encountered in the arm.MONDOR'S DISEASEIn the absence of injury or infection, the cause of thrombophlebitis - like that of spontaneous thrombophlebitis in other sites - is obscure. The pathognomonic feature is a thrombosed subcutaneous cord, usually attached to skin. When the skin over the breast is stretched by raising the arm, a narrow, shallow subcutaneous groove alongside the cord becomes apparent. The differential diagnosis is lymphatic permeation from an occult carcinoma of the breast. The only Rx required is restricted arm movements, and it subsides within a few months without recurrence, complications or deformity.


Question: Ankle sprain due to forced inversion of a plantar flexed foot is due to injury to


Question: The Most common complication following splenectomy is

(A) Left lower lobe atelectasis # Postoperative Complications after Splenectomy:> Immediate complications specific to splenectomy include haemorrhage resulting from a slipped ligature from the splenic artery.> Haematemesis from gastric mucosal damage and gastric dilatation are uncommon.> Left basal atelectasis is common and a pleural effusion may be present.> Adjacent structures at risk during the procedure include the stomach and pancreas.> A fistula may result from damage to the greater curvature of the stomach during ligation of the short gastric vessels.> Damage to the tail of the pancreas may result in pancreatitis, a localized abscess or a pancreatic fistula.> The blood platelet count may rise, and if this exceeds one million per milli litre prophylactic aspirin is recommended to prevent axillary or other venous thrombosis.> Post-splenectomy septicaemia may result from Streptococcus pneumonia, Neisseria meningitides, Haemophilus influenzae and Escherichia coli.> Opportunist Post-Splenectomy Infection (OPSI) is a major concern.> The benefit of prophylactic antibiotics in this setting is controversial.


Question: Saint Antony's Fire is a description given for


Question: Complication of TPN is

Complications : Related to nutrient deficiency- Hypoglycaemia/hypocalcaemia/hypophosphataemia/hypomagnesaemia(refeeding syndrome) Related to overfeeding: Excess glucose-hyperglycaemia, hyperosmolar dehydration. Hepatic steatosis, hypercapnia, increased sympathetic activity, fluid retention, electrolyte abnormalities. Excess fat-hypercholesterolaemia and formation of lipoprotein X, hyperiglyceridaemia, hypersensitivity reactions. Excess aminoacids: hyperchloraemic metabolic acidosis, hypercalcaemia, aminoacidaemia, uraemia. Related to sepsis: Catheter related sepsis Possible increased predisposition to systemic sepsis Related to line : On inseion : pneumothorax, damage to adjacent aery, air embolism, thoracic duct damage, cardiac perforation or tamponade, pleural effusion, hydromediastinum. Long term use: occlusion, venous thrombosis. Ref: Bailey and love 27th edition Pg no : 288


Question: Best investigation to diagnose hemorrhoids is


Question: Investigation to diagnose the Laryngo pharyngeal reflux

Ans. (b) Dual Probe Impedance pH MonitoringRef: Shackelford Page 222/8th Edition* pH monitoring at the level of Pharynx is not helpful because the acid refluxed is neutralized by the Pharyngeal secretions.* Hence a Dual (Bifurcated) catheter measuring both pH and Impedance is used across Upper esophageal sphincter, thereby permitting detection of Pharyngeal reflux


Question: In hypovolemic shock % of fluid depletion should be

(B) 15-45% # Treatment should be aggressive and directed more by response to therapy than by initial classification.> Class I hemorrhage (loss of 0-15%):* In the absence of complications, only minimal tachycardia is seen.* Usually, no changes in BP, pulse pressure, or respiratory rate occur.* A delay in capillary refill of longer than 3 seconds corresponds to a volume loss of approximately 10%.> Class II hemorrhage (loss of 15-30%):* Clinical symptoms include tachycardia (rate >100 beats per minute), tachypnea, decrease in pulse pressure, cool clammy skin, delayed capillary refill, and slight anxiety.* The decrease in pulse pressure is a result of increased catecholamine levels, which causes an increase in peripheral vascular resistance and a subsequent increase in the diastolic BP.> Class III hemorrhage (loss of 30-40%):* By this point, patients usually have marked tachypnea and tachycardia, decreased systolic BP, oliguria, and significant changes in mental status, such as confusion or agitation.* In patients without other injuries or fluid losses, 30-40% is the smallest amount of blood loss that consistently causes a decrease in systolic BP.* Most of these patients require blood transfusions, but the decision to administer blood should be based on the initial response to fluids.> Class IV hemorrhage (loss of >40%):* Symptoms include the following: Marked tachycardia, decreased systolic BP, narrowed pulse pressure (or immeasurable diastolic pressure), markedly decreased (or no) urinary output, depressed mental status (or loss of consciousness), and cold and pale skin.


Question: Lower leg perforator is between

Lower leg perforator is between posterior tibial vein and posterior arch vein (a tributary of GSV).

Posterior tibial vein and saphenous veiin

Posterior tibial vein and posterior arch vein


Question:
One of the following is considered as best imaging
modality for detecting sequestra in osteomyelitis


Question: Most common cause of acquired AV fistula is

. Ans : (d) Penetrating Trauma Penetrating injuries are the most common cause , but fistulas are sometimes seen after blunt trauma . Fungal and bacterial infections are not much common as penetrating trauma in acquired AV fistula.


Question: The treatment of choice in Cushing's disease is

The treatment of choice in Cushing's disease is transsphenoidal excision of the pituitary adenoma, which is successful in 80% of patients. Pituitary irradiation has been used for patients with persistent or recurrent disease after surgery. However, it is associated with a high rate of panhypopituitarism, and some patients develop visual deficits. This has led to increased use of stereotactic radiosurgery, which uses CT guidance to deliver high doses of radiotherapy to the tumour (photon or gamma knife) and also bilateral laparoscopic adrenalectomy. Patients who fail to respond to either treatment are candidates for pharmacologic therapy with adrenal inhibitors (medical adrenalectomy) such as ketoconazole, metyrapone, or aminoglutethimide

Transsphenoidal excision of the pituitary adenoma


Question: Dietle's crises, are seen in

Ans. b (Pelviureteric junction obstruction). (Ref. Bailey & Love, Surgery, 25th ed., 1293).Intermittent hydronephrosis (Dietl's crisis): A swelling in the loin is associated with acute renal pain. Some hours later the pain is relieved and the swelling disappears when a large volume of urine is passed.TERMMeaningDietl's crisesAfter an attack of acute renal pain a swelling in loin is found.Some hours later, following the passage of a large volume of urine, the pain is relieved and swelling disappears, known as Dietl's crises.It is seen in intermittent hydronephrosis, for e.g. due to PUJ obstruction.MengenblaseAcute abdominal pain due to gaseous distention of splenic flexureMittelschmerzMidcycle rupture of a follicular cyst with bleeding produces lower abdominal and pelvic pain, typically midcycle. Systemic upset rare, pregnancy test negative, symptoms subside within hours.Occasionally, diagnostic laparoscopy required.Retrograde menstruation cause similar symptoms.MeteorismThe gas filled, slightly dilated loops of bowel produce pain anywhere in body, or when respiration is laboured as in asthma or pneumonia, the amount of air swallowed is increased, thus containing relatively little fluid and term meteorism is applied to this appearance.StranguryBladder pain is felt as a suprapubic discomfort made worse by bladder filling. In men, a sharp pain misleadingly referred to the tip of the penis may be the result of irritation of the trigone of the bladder. Severe inflammation of the bladder can cause an extreme wrenching discomfort at the end of micturition.


Question: Crohn's disease is best diagnosed by

Diagnosis CT Enteroclysis: IOC for diagnosis of Crohn's disease Earliest radiographic findings in enteroclysis are aphthous ulceration, a coarse villous pattern of the mucosa, and thickened folds Ulcerations on the mesenteric aspect with sacculation on the antimesenteric surface. Serology : Anti-Saccharomyces cerevisiae (ASCA) autoantibodies have specificity of 92% for Crohn's disease.


Question: Gail model of risk assessment is used for

Gail risk assessment model is used for CA breast. It includes (modified):  *Age, age at menarche, age at 1st live child bih, race.  *Number of 1st degree female relatives having breast cancer.  *Number of previous breast biopsies. * Proliferative lesion with atypia. These risk factors are translated into risk scores by specified calculations. But model does not include genetic factor. Reference : page 530 SRB's manual of surgery 5th edition


Question: A 30 year old male, labourer, chronic smoker, alcoholic, presents with acute chest pain, severe back pain, radiation to interscapular area. The diagnosis is

(B) Ruptured aortic aneurysm> Dilatations of localised segments of the arterial system are called aneurysms.> They can either be true aneurysms, containing the three layers of the arterial wall in the aneurysm sac, or false aneurysms, having a single layer of fibrous tissue as the wall of the sac, e.g. aneurysm following trauma and as a mycotic aneurysm. ('Mycotic' is a misnomer, as the cause is not due to a fungus but to bacterial infection).


Question: OPSI is related to

Overwhelming post splenectomized infection (OPSI) is seen in patient&;s who have undergone splenectomy. post splenectomized patients are more prone to infections with pneumococcal septicaemia, Neisseria meningitides, H influenza, Babesia microfti And can occur any time after splenectomy SRB 5 the edition page no.677


Question: Milian's ear sign is seen is

Erysipelas being a cutaneous condition can spread to ear lobule = Milian's ear sign.


Question: Most common cause of abdominal aoic aneurysm is

. Aoic wall contain smooth muscle cell matrix,elastin(in tunica media),collagen (in adventitia) as safe net in the wall to provide tensile strength prevent aneurysms formation.Elastin in tunica media is degraded and reduced significantly in infrarenal aoa in relation to collagen,abscence or less vasa vasorum in infrarenal aoa and atherosclerotic ubstability of the medial wall of aoa cause infrarenal aoa and more prone to develop aneurysms.Increased proteolytic matrix metalloproteinase(MMP) which is derived from aoic smooth muscle cells and macropgages cause elastin and collagen degradation and increase in the diameter of aneurysms. Refer; SRB's manual of Surgery page no:198.


Question:
A 32 year old male patient complains of swelling in left maxillary region with heaviness in the maxillary sinus following tooth extraction of maxillary first molar. Patient gives a history of tooth extraction one week before with transalveolar type of extraction.

The average mucociliary air flow transport in the maxillary sinus is


Question: In a case of hyperophic pyloric stenosis, the metabolic disturbance is

Hyperophic metabolic acidosis Clinical features Infant is normal at bih, symptomatic between ages of 3-6 weeks Infants with HPS typically present with projectile nonbilious vomiting Visible gastric peristalsis may be seen as a wave of contraction from the upper left quadrant to the epigastrium The infants usually feed vigorously between episodes of vomiting Typical electrolyte abnormalities Hypochloremia Hypokalemia Metabolic acidosis with paradoxical aciduria Ref: Sabiston 20th edition Pgno : 1869

Metabolic alkalosis with paradoxical aciduria


Question:
Best surgical approach in accessing retrosternal
goitre is

For retrosternal goitre cervical route is preferred.


Question: Fournier's gangrene occurs in the


Question: Most common histological type of the thyroid carcinoma is

Papillary thyroid cancer is the most common cancer. Occurs in 70-80% of patients diagnosed with thyroid cancer. Common in females and younger age group. According to Woolner's Classification there are 3 types. 1)Occult primary(less than 1.5cm) 2) Intrathyroidal 3) Extrathyroidal Reference: SRB's Manual of Surgery, 6th Edition, page no = 468.


Question: CBD microliths are diagnosed by

CBD stones IOC is MRCP
Micro stones are detected by EUS.


Question: Most common nerve to get entrapped during open inguinal hernia surgery


Question: The Sagittal split mandibular operation

is a good operation for closing an anterior open bite.

Has a very low incidence of inferior dental nerve anaesthesia or paraesthesia with a skilled operator.

Has a lower morbidity when used for pushing back a mandible than an intra oral vertical subsigmoid osteotomy.

Rarely leads to a non union of the osteotomy site


Question: Cause of hydrocoele in infants is


Question: Gompezian curve is used to describe

Gompezian curve: In its early stages, growth is exponential but, as the tumour grows, the growth rate slows. This decrease in growth rate probably arises because of difficulties with nutrition and oxygenation. The tumour cells are in competition: not only with the tissues of the host but also with each other.Ref: Bailey and Love 27e pg: 143

Nutritional requirements in surgical patients


Question: Treatment of choice for TURP syndrome

Furosamide is used to treat the dilutional hyponatremia. If not controlled 3% NaCl is used.


Question:
The distinguishing feature of masticatory space
infection is


Question: Ivor Lewis operation is done for

In carcinoma surgery alone is best suited to patients with disease confined to the oesophagus (T1b, T2)The most widely practiced oesophagotomy approach is the two-phase Ivor Lewis operation, especially distal tumors.Three-phase oesophagectomy (McKeown) may be more appropriate for more proximal tumours in order to achieve better longitudinal clearance,Ref: Bailey and Love 27e pg: 1092


Question: A Toddler has few drops of blood coming out of rectum. Probable diagnosis is

Ans is 'a' i.e. Juvenile Rectal Polyp "The aetiology and management of rectal bleeding depends on the age of the child, the type and quantity of bleeding and the associated symptoms. Unlike adults, malignancy is exceptionally rare. In infants, an anal fissure, necrotizing enterocolitis, intussusception and allergic enterocolitis are possible causes. In older children, more common causes include an anal fissure, a juvenile polyp and certain gastroenteritides (e.g. Campylobacter infection); Meckel's diverticulum, duplication cyst and inflammatory bowel disease are less common. Bailey and LoveJuvenile polyps are the most common type of childhood polyp, occurring in up to 1% of preschool children. They are usually solitary polyps found in the rectum which most commonly present with rectal bleeding.These are hamartomatous polyps, which are usually pedunculated but can be sessile. "The typical child with a juvenile polyp is 4 to 6 years of age, presents with intermittent painless rectal bleeding with bowel movements. Rudolph's PediatricsJuvenile polyps are usually are not premalignant.Because the gross appearance of these polyps is identical to adenomatous polyps, these lesions should also be treated by polypectomy.Juvenile polyposis is a term used when more than 5 to 10 juvenile polyps develop.Juvenile polyposis coli applies if the polyps are limited to the colon, whereas generalized juvenile polyposis describes the presence of polyps throughout the GI tract. Both have a significant malignant potential.Other mentioned options are rare in children.Familial Adenomatous Polyposis (FAP) patients present in Td to 3rd decade.Rectal ulcer (solitary rectal ulcer) is commonly seen in 20 to 40 yrs age group.Piles are rare in children. (Ref: Rudolph's Pediatrics, 21/e Chapter 17.22)


Question: Takayasu's arteritis most commonly affects

Subclavian artery is most commonly involved in Takayasu's arteritis.


Question: Management of a case of iliac aery embolism requires


Question:
Suture least adherent to tissue and have a property of
plasticity


Question: A new bom presents with discharge of urine from the umbilicus for 3 days. Diagnosis is

(Urachal fistula) (211,1289- B & L 24th) (776- Nelson 18th) (986-Baily 25th)A persistent urachus (Urachal cyst, sinus, patient urachus or diverticulum) is due to failure of closure of the allantoic duct and is associated with bladder outlet obstruction* Patency should be suspected if a clear, light, yellow urine- like fluid is being discharged from the umbilicus* Symptoms include drainage, a mass or cyst, abdominal pain, local erythema or infectionCongenital Omphalocele - is a herniation or protrusion of the abdominal contents into the base of the umbilical cord, the sac is covered with peritoneum without overlying skin.Bleeding from umbilical stump suggests - factor XIII deficiency** (AIIMS - May - 2007)


Question: Daily requirement of sodium in an adult is

The following are the approximate daily requirements of some electrolytes in adults:sodium: 50-90 mM/daypotassium: 50 mM/daycalcium: 5 mM/daymagnesium: 1 mM/dayRef: Bailey and Love 27e pg: 281


Question: Brilliantly translucent swelling in the neck region in a 2 year old child, diagnosis is

CYSTIC HYGROMA:
• Cystic hygromas are multiloculated cystic spaces lined by endothelial cells.
• It results due to sequestration of a portion of the jugular lymph sac from the lymphatic system.
• Cysts are filled with clear lymph and are lined by endothelium.
• Turner's syndrome is associated with cystic hygroma.
• Most cystic hygromas involve the lymphatic jugular sacs.
• MC site: Posterior neck region.
• Other common sites: Axilla, mediastinum, inguinal and retroperitoneal regions.
• Approximately 50% of them are present at birth.
• It may show spontaneous regression.
Clinical Features
• Usually present as soft cystic masses. that distort the surrounding anatomy, can result in acute airway obstruction.
• Usually manifests in the neonates or in early infancy (50% present at birth).
• Prone to infection and hemorrhage within the mass.
• Swelling is soft and partially compressible and invariably increases in size, when the child coughs or cries.
• Characteristic features: Brilliantly translucent.
Diagnosis
• MRI play a crucial role in preoperative planning.
Treatment
• Complete surgical excision is the preferred treatment.
• Injection of sclerosing agents, such as bleomycin or OK-432 (Picibanil), derived from Streptococcus pyogenes may eradicate the cystic hygroma.


Question: Abbe estlandec flap is used for

.abbe flap is used for lip reconstruction surgeries


Question: During exploration, a patient is found to have a tumor in the thymus that is invading the pericardium and surrounding the left and right phrenic nerves. The pathologist says that appears on frozen section to be a benign thymoma. The surgeon now should

Ans. b. Attempt as complete a resection as possibleThymomas usually appear histologically benign even though they may be grossly invasive.Thymectomies are necessary when a thymoma is present to prevent the spread of malignant thymic disease.

Close the chest and plan irradiation therapy

Close the chest and await permanent sections


Question: Inferior alveolar nerve block is given in


Question: Drug of Choice for Severe Mastitis

* MC organism causing Mastitis- Staphylococcus aureus * Drug of Choice is- Cloxacillin Ref:- Surgery Sixer 3rd Edition; Pg num:- 268


Question: Sentinel lymph node biopsy in carcinoma breast is done if

Sentinel lymph node is the first axillary lymph node draining the breast. SLNB is done in all cases of early breast cancers ,T1 and T2 without clinically palpable nodes. It is not done in clinically palpable axillary nodes as tgere is already distoion of lymphatic flow due to tumour. SRB's Manual of Surgery.Edition -5. Pg no:543


Question: Persistent foetal lobulation of adult kidney is due to

In humans, embryologically, the kidneys originate as distinct lobules that fuse as they develop and grow. The lobulation of the fetal kidney is usually lost as the lobules become bonded together by the growth of new coex and the renal capsule. Persistent fetal lobulation is a normal variant seen occasionally in adult kidneys . It occurs when there is incomplete fusion of the developing renal lobules.It is often seen on ultrasound, CT or MRI as smooth indentations of the renal outline in between renal pyramids. They should be distinguished from renal coical scarring , which generally overlie the pyramids. Reference : radiopaedia.org/aicles/persistent-fetal-lobulation-of-the-kidneys


Question: Odontogenic infections are mostly caused by


Question: Glod standard test for insulinoma

A fasting test that may last for up to 72 hrs is regarded as the most sensitive test.Usually , insulin, pro insulin, C-peptide and blood glucose are measured in 1- to 2-hr intervals to demonstrate inappropriately high secretion of insulin on relation to blood glucose. About 80% of insulinomas are diagnosed by this test,most of them in first 24 hrs . Bailey & Love ,26th,788


Question: Predisposing factors of Ca esophagus

PREDISPOSING FACTORS OF SCC- 1.SEX -4 TIMES MORE IN MALE 2.ETHINICITY-AFRICAN AMERICANS, CENTRAL ASIA, MIDDLE EAST 3.ALCOHOLISM AND TOBACCO CHEWING 4.INTRINSIC DEFECTS-PLUMMER VINSON SYNDROME, ACHALASIA 5.HEREDITARY CANCER SYNDROME - TYLOSIS, FANCONI ANEMIA 6.HPV 7.H/O CAUSTIC INGESTION ADENO CARCINOMA 1.SEX -MALE 2.ETHINICITY- WHITE 3.BARRETT&;S OESOPHAGUS 4.SMOKING 5.OBESITY (SABISTON TEXTBOOK OF SURGERY 20TH EDITION)


Question: Revised trauma score is

Glasgow coma scale : Total score = 13-15 Mild head injury = 9-12 Mild = 3-8 Ref : SRB&;s 4thE pg:1175


Question: Day care surgery uses

i.e. (Propofol): (81-A-Yadav 4th)Propofol is the IV agent of choice for day care surgeryBecause-(i) Early induction(ii) Early and smooth recovery(iii) Inactive metabolites(iv) Antiemetic antipruritic* Along with opioids (alfntanil or renifentanil) propofol is the agent of choice for total intravenous anaesthesia (TIVA)* Propofol infusion is used to produce sedation in ICU* Agent of choice for induction in susceptible individuals for malignant hyperthermia* *** Propofol is safe in porphyria (373- Wylie Anaesthesia)PROPOFOL (2mg/kg)It is oil based preparation containing soya bean oil egg lecithin and glycerol, so injection is painful and should be preceded by lignocaine injection. The colour of solution is milky white and used within 6 hour after opening the vial because there have been death reports following the use of contaminated solution ofpropofol (as egg lecithin is good media for bacterial growth) and to prevent this problem recently available propofol formulations have disodium edate or sodium metabisulfite as anti microbial agents* Mechanism of action is mainly GABA mediated* Most common side effect during induction of anesthesia is hypotension. Which is augmented by concomitant administration of opioids


Question: Most common type of hernia in females

Ans. (b) IndirectRef: Bailey and Love 27th edition Page 1035* MC hernia in females - Indirect Inguinal* Femoral hernia: Most common in Females than Males.* Direct hernias are very rare in Females.* Incisional Hernia is more common in Females.


Question: Most common site of aoic aneurysm rupture is

Answer- D. Infrarenal aoaRuptured aneurysm is the most common cause of aoic rupture and they are most common in the abdomen.


Question: Paucity of pus is seen in


Question: Type of anaemia caused by pulmonary TB

Microcytie hypochromic anaemia Tuberculosis is a chronic inflammatory disorder. It is associated with anemia of chronic disease Anemia that is often observed in patients with infectious inflammatory or neoplastic disease that persists for more than 1 or 2 months is called anemia of chronic disease. - The characteristic feature of this group is occurrence of anemia in the presence of ample storage iron. The erythrocytes in anemia of chronic disease are usually normocytic and nonnochronic, however hypochromia and microcytosis may also be observed. The morphological features are determined by the primary disease. - "For instance many patients with cancer have anemia that is typically normocytic and normochromic. In contrast patients with long standing active rheumatoid ahritis or chronic infections such as tuberculosis will have a microc tic hypochromic anemia". The key pathological feature in anemia of chronic disease is failure to mobilize stored irony (ferritin). Ferritin is present in the macrophages of bone marrow and reticuloendothelial system. Under normal circumstances, iron can be mobilized back from the ferritin into the circulation. When developing erythrocytes require iron, the iron stored as ferritin is presented to the plasma from where it is carried to the developing erythrocytes. Why there is failure of iron mobilization in anemia of chronic disease? Anemia of chronic disease occurs in ceain inflammatory conditions or chronic disease. In these conditions macrophages are activated and they release ceain cytokines e.g. IF, IL-1, TNF. These cytokines stimulate synthesis of hepcidin in the liver. Increased hepcidin synthesis inhibits release of iron from the storage pool. Thus in anemia of chronic diseases, the macrophages, despite being rich in stored iron cannot provide iron to developing erythrocyte. The other impoant effect of cytokines released by rnacrophages in chronic inflammatory disorders is inhibition of CFUE (colony forming units erythroid). The inhibition leads to decreased synthesis of erythropoletin which in turn decreases erythropoiesis and produces anemia. The Hematological Parameters in Anemia of Chronic disease Serum iron --> Normal to decreased Serum ferritin --> Normal to increased TIBC --> Decreased % saturation Normal to increase Bone marrow iron stores --> Normal to increase MCV (MCH) --> Decreased


Question: Orphan Annie eyed nuclei is the characteristic histologic appearance is seen in


Question: Dohlman's procedure is used in

Zenker's diveiculum is a protrusion of mucosa through killian's dehiscence, a weak area of the posterior pharyngeal wall between thyropharyngeus (oblique fibres) and cricopharyngeus (transverse fibres ) of the inferior constrictor muscle of the pharynx. It is a pulsion diveiculum. Dohlman's approach is minially invasive endoscopic technique wherein pouch is excised using double lipped endoscopy. Cautery or laser is used. It is a quicker procedure with shoer duration of anaesthesia and faster recovery. Reference : page 433-34 SRB's manual of surgery 5th edition


Question: 70 years old lady underwent Right Radical mastectomy 10 years back, now presents with multiple subcutaneous nodules in right upper limb. Most probable diagnosis is

Ans. (a) Lymphangiosarcoma(Ref Bailey and Love 27h edition page 879)Lymphangiosarcoma (Stewart Treves Syndrome)* It is a complication of Lymphedema which develops after mastectomy.* It takes the form of multiple nodules in upperlimb.* Differentiate from recurrent breast cancer.* Poor prognosis* Inter scapulothoracic (Forequarter Amputation) is rarely indicated


Question: Complication of total paranternal nutrition is

.Complications OF TPN includes Technical - 1. Air embolism. 2. Pneumothorax. 3. Bleeding. 4. Catheter displacement, sepsis, blockage. 5. Infection, thrombosis. Biochemical- 1. Electrolyte imbalance: Hyponatraemia, hypokalaemia, hypophosphataemia. 2. Hyperosmolarity. 3. Hyperglycaemia. - common. 4. Dehydration. 5. Altered immunological and reticuloendothelial function. 6. Azotaemia. Others- 1. Dermatitis. 2. Anaemia and increased capillary permeability. 3. Cholestatic jaundice: It is common. 4. Severe hepatic steatosis. 5. Metabolic acidosis. 6. Candida infection (candidiasis), staphylococcal infection. (10-15%). ref:SRB&;s manual of surgery,ed 3,pg no 89


Question: Serum amylase is NOT raised in

(D) Ruptured ovarian cyst > Appendicitis alone does not cause increased amylase. Perforated appendix, may be associated with increased amylase.> Abdominal disorders associated with increased amylase levels include> Biliary tract disease: Cholecystitis Choledocholithiasis> Intra-abdominal disease: Perforating or penetrating peptic ulcer Intestinal obstruction or infarction Ruptured ectopic pregnancy Peritonitis Aortic aneurysm Chronic liver disease Postoperative


Question: In a highly selective vagotomy, the vagal supply is severed to

Done in cases of uncomplicated duodenal ulcer wherein the fibres entering the stomach is divided both anteriorly as well as posteriorly, Nerve of Latarjet is retained to supply the tantrum. Reference: SRB 5th edition page no. 861


Question: Metabolic abnormality seen in congenital hypertrophic pyloric stenosis is

Ans. is 'a' i.e. Hypochloremic hypokalemic metabolic alkalosis * Repeated vomiting leads to hypochloremic, hypokalemic metabolic alkalosis. The urine is alkaline initially but eventually it becomes acidic {paradoxical aciduria)Cause of paradoxical aciduria - Initially the kidney compensate for metabolic alkalosis by reabsorbing hydrogen and chloride ions in exchange for sodium, potassium and bicarbonate. But gradually as the body stores of sodium and especially potassium become depleted, kidney starts retaining these ions in exchange of hydrogen ions, thus the urine becomes acidic and metabolic alkaline state is further aggravated

Hyperchlonemic hypokalemic metabolic alkalosis

Hypochloremic hypokalemic metabolic acidosis

Hyperchloremic hypokalemic metabolic acidosis


Question:
Retropharyngeal space infection is mainly due to
spread of


Question: The operation that precipitates portosystemic encephalopathy is

Portosystemic encephalopathy is a neuropsychiatric syndrome, It most often results from high gut protein or acute metabolic stress
(eg, GI bleeding, infection, electrolyte abnormality) in a patient with portosystemic shunting.
In portosystemic shunting, absorbed products that would otherwise be detoxified by the liver enter the systemic circulation and reach the brain, causing toxicity, particularly to the cerebral cortex.


Question: Most common early complication of end ileostomy is

Early commplication - necrosis.
Late commplication - prolapse.


Question: Pus in burns forms in


Question: Duct ectasia, treatment of choice is

Duct ectasia is the dilatation of breast ducts with periductal inflammation.Dilatation of one or more large lactiferous duct with stagnant brown or green secretion.Fibrosis devolop with slit like nipple retraction. Treatment:Stop smoking -antibiotics like flucloxacillin -microdochectomy- surgical excision of lactiferous ducts (Hadfield's operation.) Bailey and Love'sSho practice of surgery.Edition 23.Pg no:757


Question: Investigation of choice for choledochal cyst is

The investigation of choice for Choledochal cyst is MRCP-to see the status of pancreatic & biliary system and pancreaticobiliary maljunction. Reference:SRB's manual of surgery,5th edition,page no:638.


Question: A person was presented with swelling of the salivary gland. Mild pain was felt by him.Investigation of choice.

Here the most accurate answer is FNAC. The first investigation which is done is FNAC. It can be guided by ultrasound as it demonstrates if the lump is intrinsic to parotid or not. Open surgical biopsy is contraindicated unless evidence of gross malignancy is present. Reference : Bailey & love, 27th Edition, page no = 789.


Question: Squamous cell carcinomas of the esophagus most commonly occur

- MC type of CA Esophagus World Wide - Squamous cell carcinoma- MC type of CA in western countries - Adenocarcinoma- MC site of Squamous cell carcinoma - Middle 1/3rd- MC site of Adenocarcinoma - Lower 1/3rd- MC site of CA Esophagus overall - Middle 1/3rd- SCC - more common in low socio-economic status- Adenocarcinoma - more common in high socio-economic status

Evenly distributed throughout the esophagus


Question: Best management for a contaminated wound with necrotic material

Necrotic tissue acts as foci of infection and slows down healing. So Debridement is neccesary after initial assessment. Debridement : A wound should be explored and debrided to the limit of blood staining. Devitalized tissue must be excised until bleeding occurs with obvious exceptions of nerves, vessels and tendons.


Question: Anatomical structure injured in excision of ranula


Question: To differentiate between stress incontinence and detrusor instability investigation done is

Ans is 'b' ie Urodynamic study Genuine stress incontinence is defined as urinary leakage occuring during increased bladder pressure when this is solely due to increased abdominal pressure and not due to increased true detrusor pressure. - It is caused by sphincter weakness. Detrusor instability - this is phasic increase in detrusor pressure (due to phasic contraction of detrusor muscle) giving rise to sensation of urgency of micturition and urge incontinence. It is found in pts with several types of neurogenic bladder dysfunction such as multiple sclerosis (MS) Parkinson disease or following a stroke or ceain types of spinal injury when it is known as detrusor hyperreflexia. Usefulness of Urodynamic testing: 1) Distinguishing genuine stress incontinence from detrusor instability in women. 2) Classification of neurogenic bladder dysfunction 3) Distinguishing bladder outflow obstruction from idiopathic detrusor instability in men. 4) Investigation of incontinence.


Question: Renal calculus seen in proteus infection is

Urease producing organisms eg :- proteus ,psuedomonas , and staphylococcus , break down urea to produce ammonia and co2.The urine becomes alkaline which promotes formation of struvite calculi ( magnesium ammonium phosphate ) which grow to become staghorn calculi.E coli never forms struvite stones ref :- Bailey and Love 27th edition .chapter 72 . pg no 1406


Question: Ecchymosis and hematoma are treated with


Question: Galeazzi fracture is

B i.e. Fracture of the distal radius with inferior radio ulnar joint dislocation Fractures of Forearm (Single Bone Fracture) Monteggia Fracture Dislocation Fracture of proximal third of ulna with dislocation of proximal radioulnar jointQ. Essex - Lopresti Fracture Dislocation - Fracture of radial head or neck, disruption of distal radial ulnar joint & tearing of interosseous membrane for a considerable distance proximally - Tethering effect of interosseous membrane is lost; if the radial head is resected, rapid proximal migration of the radius can occur, resulting in wrist pain from ulnar carpal impingment & elbow pain from radiocapitellar impingment. Galeazzi Fracture Dislocation Fracture of the distal third of radius and dislocation of the distal radio - ulnar jointQ. Galeazzi fracture is called the "fracture of necessity". Like monteggia fracture dislocation, it often go unrecognized. And a treatment regimen of closed reduction & cast immobilization has a high rate of unsatisfactory results. Rigid anatomical fixation by plating (DCP/ LC - DCP) is the treatment of choice in adultsQ.

Fracture of radius in the proximal site and dislocation of the elbow


Question: Prostatic cancer mostly seen in

- MC site of CA Prostate - Posterior lobe - MC site of BPH - Median lobe - On DRE - Posterior lobe is felt and medial lobe is felt when enlarged. - MC site of BPH - Transition zone - MC site of CA Prostate - Peripheral zone


Question: Testicular tumour most sensitive to radiation is

Seminomas are most radiosensitive. So after orchidectomy radiotherapy is given to increase the cure rate and also to reduce relapse(excellent results in stage 1 and 2 seminomas). Radiotherapy is not beneficial in teratomas as they are less radiosensitive. Other radiosensitive tumours are squamoua cell carcinoma, basal cell carcinoma, hodgkin's lymphoma.Reference : page 1087 and1143 SRB's manual of surgery 5th edition


Question: Disadvantage of Somatic stem cells is

Somatic stem cells are easily available, have good expansion in vitro, low risk of malignancyNo ethical concerns (not taken from foetus, embryo and mostly used for autologus tissues)Main disadvantage is limited pluripotencyRef: Bailey and Love 27e pg: 34


Question: Signature fracture of skull is seen in

DEPRESSED SKULL FRACTURE It is a common neurosurgical problem among the head injuries. It means fracture depression is more than the depth of inner table of the skull. Investigations: CT scan. Problems in depressed fracture Tear in the dura beneath Haematoma in the deeper plane Injury to the cerebrum Injury to the venous sinuses--may cause life-threatening haemorrhage. Fracture should not be elevated in such occasion, as it itself can precipitate bleeding Convulsions Meningitis Treatment Antibiotics, anticonvulsants. Elevation of the depressed fracture: Burr holes are made in the adjacent normal skull. Fracture is elevated. Bony fragments and necrotic materials are removed. Dural tear is closed with interrupted sutures. Ref: SRB's Manual of Surgery 5th edition Pgno : 1099


Question: In performing a tracheostomy, authorities agree that

Although tracheostomy is occasionally an emergency procedure, it can be more effectively performed in an operating room where hemostasis and antisepsis are readily achieved. Most authorities recommend a horizontal incision; however, limited direct midline incisions have the advantage of not opening any unnecessary tissue planes and perhaps reducing the incidence of bleeding complications. Both approaches have advocates. In either case, the skin incision is made just below the cricoid cartilage, the strap muscles are spared and retracted, the thyroid isthmus is divided if necessary, and the trachea is entered at the second tracheal ring. The second and third tracheal rings are incised vertically, allowing placement of the tracheostomy tube. The first tracheal ring and the cricoid cartilage must be left intact.

The trachea should be entered at the second or third cartilaginous ring

Only horizontal incisions should be used


Question: Diverticulosis is most common in

Ans) a (Sigmoid colon) Ref: Sabiston's 18th editionA diverticulum is an abnormal sac or pouch protruding from the wall of a hollow organ, which is, for the purposes of this discussion, the colon. A due diverticulum is composed of all layers of the intestinal wall, whereas a false diverticulum, or pseudodiverticulum, lacks a portion of the normal bowel wall. The diverticula that commonly occur in the human colon are pseudodiverticula.Diverticula most commonly affect the sigmoid colon and are confined to the sigmoid in about half of patients with diverticulosis. The next most common area involved is the descending colon (?40% of affected individuals), and the entire colon has diverticula in 5% to 10% of patients with diverticulosis.


Question: A patient presents with sudden headache and vomiting and unconsciousness. The diagnosis is

• MC cause: Trauma >Spontaneous rupture of Berry aneurysm
Clinical Features
• Sudden transient loss of consciousness (occurs in nearly half of the patients)
• Excruciating severe headache: presenting complaint in 45% of cases (worst headache of patients life) more common upon regaining consciousness when loss of consciousness is associated
• Neck stiffness and vomiting: are common associations
• Focal neurological deficit: uncommon.
• Sudden headache in the absence of focal neurological deficit is the hallmark of aneurysmal rupture.
• Associated prodromal symptoms (suggest location of progressively enlarging unruptured aneurysm):
−− Third cranial nerve palsy: Aneurysm at junction of PCA and ICA
−− Sixth nerve palsy: Aneurysm in cavernous sinus
−− Occipital and posterior cervical pain: Inferior cerebellar artery aneurysm
−− Pain in or behind the eye: MCA aneurysm
Diagnosis
• Non contrast CT scan: Investigation of choice (Lumbar puncture is not indicated prior to an imaging procedure)
• CSF picture: Hallmark of aneurysmal rupture is blood in CSF (Xanthochromic spinal fluid)


Question: A 3 cm size stone in CBD near the ampulla of Vater is removed by

Ans. (a) Transduodenal ApproachRef: Sabiston 20th edition Page 1501Impacted stones at the ampulla that cannot be removed through choledochotomy or several stones in a nondilated tree can be addressed by a transduodenal sphincteroplastySteps:* Kocher maneuver,* Longitudinal duodenotomy is made on the lateral wall* Palpation of the ampulla to plan placement of the duodenotomy* After identifying ampulla- an incision made at 11' O clock* Avoid 5'O clock as pancreatic duct enters there.* The duodenal mucosa is sewn to the bile duct mucosa with absorbable 4-0 sutures.* A 1.5cm sphincterotomy is usually sufficient to allow stone removal and subsequent drainage.* Closure of the longitudinal duodenotomy in transverse fashion to avoid future duodenal stricture.


Question: Duhamel procedure is done for

Answer- A. Hirschsprung's diseaseSurgery in Hirschsprung's discase aims to remove the aganglionic segment and'pull-through'ganglionic bowel to the anus (e.9. Swenson, Duhamel, Soave and transanal procedures) and can be done in a single stage or in several stages after first establishing a proximal stoma in normally innervated bowel.


Question: Investigation of choice for spinal tuberculosis

Ans. is 'd' i.e., MRI Investigations in musculoskeletal system Investigation of choice for AVN Hip MR1 Best initial test for osteomyelitis -9 Plain x-ray Best second line test for osteomyelitis (if there is high clinical suspician and x-ray is negative) --> MRI Most accurate diagnostic test for osteomyelitis Bone biopsy and culture. Best view for scaphoid fracture --> Oblique (scaphoid) view of wrist. Best view for C1-C2 veebrae & junction -* Open mouth odontoid (Pegs) view. Investigation of choice for ACL & PCL injury MRI Investigation of choice to detect calcification --> CT scan Investigation of choice for prolapsed interveebral disc --> MRI Investigation of choice for spinal tuberculosis -4 MRI Investigation of choice for traumatic paraplagia --> MRI Gold standard and investigation of choice for osteoporosis --> Dual energy x-ray absorptiometry (DEXA).


Question: The ganglion to be avoided while doing cervical sympathectomy to avoid Horner syndrome

Cervical sympathectomy Open cervical sympathectomy was previously performed for vasospastic conditions affecting the hands and to treat palmar (sometimes axillary) hyperhidrosis. The operation is now obsolete, having been replaced by endoscopic transthoracic sympathectomy. Fuhermore, it has been increasingly recognised that the vasospastic conditions do not respond to this form of treatment, rendering the endoscopic intervention a therapy that is suitable solely for hyperhidrosis. Ref: Bailey and love 27th edition Pgno : 968


Question: "Double bubble sign" seen in

(Annular pancreas) (1120, 1198-LB) (1137-B & L 25th)Annular pancreas - in which a ring of pancreatic tissue from the head of the pancreas surrounds the descending duodenum X-ray shows a dilated stomach and proximal duodenum (double bubble sign) and little or no air in the rest of the small bowel.Congenital duodenal obstruction - causes of duodenal obstruction are atresia, mucosal web, annular pancreas, preduodenal portal vein and peritoneal bands {Ladd's bands) from malrotations - shows - "double bubble sign" (1316-CSDT 11th)


Question: Biological oxygen demand (BOD) measures the total organic content of water based on the consumption of oxygen in a sample at 20deg C Celsius over five days. A consumption of 10 to 20 mg of O2 per liter most likely represents a sample from

Biological oxygen demand is a measure of organic content in water. The greater the demand, the greater the load of organic content that can be broken down, reflecting a high bac-terial load. Untreated freshwater has a BOD of 25 mg/l, treated sewage, 10-20, domestic sewage, 200-500, and industrial sewage, >2000.


Question: Most useful investigation in sliding hernia in female

(Barium meal) (1281 -B&L 24th) (771-CSDT 12th) (977-Baily & Love 25th)* Finding a segment of colon in the scrotum on barium enema strongly suggests a sliding hernia (771-CSDT 12th)SLIDING -HERNIA (hernia - en-glissade) is a type of indirect inguinal hernia* Almost exclusively in men* It should be suspected in a very large globular inguinal hernia descending well into the scrotum* Right side the caecum is most commonly involved* Left side the sigmoid colon is most commonly involved* The surgical complication most often encountered following sliding hernia repair is bowel injury**


Question: Helicobacter pylori is implicated as causative agent in

Helicobacter pylori infection is causative agent in MALT Lymphoma.


Question: Traetment of Medullary Carcinoma thyroid

In medullary carcinoma thyroid , total thyroidectomy is treatment of choice. Radiotherapy can be considered in unresectable cases or after complete surgical resection in few cases. Note : Since medullary thyroid cancer doesnot arise from follicular cells, TSH suppression and RAI (radio active iodine) therapy have no role. Source : Sabiston 20th edition pg 910


Question: The procedure of choice for elective removal of CBD stones for most patient is

The procedure of choice for elective removal of CBD stones is Endoscopic choledocholithotomy.i.e.,endoscopic papillotomy(sphincterotomy)and stone extraction through Dormia basket or balloon catheter.CBD stent is placed in situ.Once the CBD stones are extracted,laparoscopic cholecystectomy is done. Reference:SRB's manual of surgery,5th edition,page no:651.


Question: Crohn&;s disease can be seen in

.crohn&;s disease is a granulomatous, noncaseating inflammatory condition of the ileum commonly and of the colon often. * It is independent of age, sex, socioeconomic status and geographic areas. Main features of Crohn's disease * Ileum--most common site of occurrence--60% * Rectal sparing is usual and common * Skip lesion * Hose-pipe pattern * Linear ulcers and cobble stone appearance of mucosa * Transmural ref:SRB&;s manual of surgery,ed 3,pg no 801


Question: Triangle of doom is associated with

Ans. (b) Laparoscopic hernia surgeryRef Palanivel Laparosopic Surgery* The following triangles are related to Laparoscopic hernia repair:# Triangle of Doom# Triangle of Pain


Question: Auto nephrectomy is seen in


Question: Position that is least likely possible by means of bilateral saggital split osteotomy is


Question: Most common cause of acute mesenteric ischemia is

.Superior mesenteric aery is commonly involved than inferior mesenteric aery. Often superior mesenteric vein can also get involved. Causes * Embolism (50%)--Sources - From left auricle, as seen in atrial fibrillation. - A mural infarct. - Atheroma from aoa or aneurysm. - Endocarditis vegetations. - Left atrial myxoma. * Thrombosis--may block the origin of the superior mesenteric aery and can cause ischaemia of full length of small bowel. It is life threatening. ref:SRB&;s manual of surgery,ed 3,pg no 806


Question: Hypoparathyroidism following thyroid surgery occurs within

Parathyroid insufficiency is due to the removal of the parathyroid glands or infarction through damage to the parathyroid end aeries; often both factors occur together. Vascular injury is probably far more impoant than inadveent removal. The incidence of permanent hypoparathyroidism should be less than 1% and most cases present dramatically 2-5 days after an operation but, very rarely, the onset is delayed for 2-3 weeks or a patient with marked hypocalcemia may be asymptomatic.Ref: Bailey and Love, page no: 815


Question: Carcinoma of pancreas associated with

.Ampullary tumours mainly present with jaundice and weight loss.b. Carcinoma of head and neck region present with weight loss and jaundice. c. Cystadenocarcinoma of pancreas present with pain, weight loss . * Silvery stool (due to mixing of undigested fat with metabolised blood derived from the ooze of periampullary growth). * Loss of appetite and weight. * Scratch marks on the back. * Migratory superficial thrombophlebitis--Trousseau's sign (10%) is due to release of platelet aggregating factors from the tumour or its necrotic material. (Trousseau himself died of carcinoma pancreas who had migrating thrombophlebitis.) * Ascites. * Left supraclavicular palpable lymph node. * Secondaries in rectovesical pouch (Blumer's shelf). * Gall bladder may be palpable which is nontender, soft, globular, smooth, moving with respiration, mobile horizontally, dull on percussion. (30% in carcinoma head of pancreas; 50% in periampullary carcinoma). Courvoisier law ours gall bladder enlargement. * Liver is enlarged, smooth, firm, nontender, due to dilated bile filled biliary radicles--Hydrohepatosis. Liver can show multiple hard nodules due to secondaries. * Cystadenocarcinoma of pancreas can present with mass in epigastric region, which is nonmobile, not moving with respiration, smooth, soft, nontender. * Splenic vein thrombosis with splenomegaly (10%) can occur. ref:SRB&;S manual of surgery,ed 3,pg no 632

Syndrome of inappropriate secretion of ADH


Question: Most common cause of bacterial peritonitis is

Peritonitis secondary to any bowel or other visceral pathology eg. perforation, appendicitis is termed as secondary peritonitis, E-Coli is the commonest organism causing this. Primary peritonitis - there is no documented infection, it&;s monomicrobial, extraperitoneal postoperative leak after surgery for gallbladder, CBD, ERCP, duodenum, pyloroplasty Reference: SRB 5th edition page no.566,573


Question: In nonunion of scaphoid vescularized muscle pedicle graft is taken from.

C i.e. Pronator quadrates Blood supply of scaphoid enters distally mainly through the dorsal ridge (spiral groove, narrow non aicular region in the waist) and proximal segment is supplied by retrograde intraosseous blood flow from distal to proximal. This unusual pattern of vascularity is responsible for higher probability of nonunion & avascular necrosis of proximal fragment in fractures of scaphoid. Therefore 0-1% of distal third, 20% of middle third, 40% of proximal third and 100% of proximal pole fractures result in AVN and nonunion. Scaphoid Fracture Functional Anatomy & Epidemiology Scaphoid is the most commonly fractured bone in the - carpusQ, in adult as well as children. However unlike in adults and adolescents, the fracture is rare in young children. (d/t cailagenous nature of carpal bones in children) Scaphoid fracture is seen most commonly in males between the ages of 15 and 30. (adolscents & adults)Q - Scaphoid may be divided into proximal, middle and distal thirds. The middle third is termed the waist. The scaphoid tubercle forms the distal volar prominence. Middle third (Waist) fractures are most commonQ accounting for - 70% of scaphoid fractures > proximal pole fracture (20%) > distal pole fracture (10%), in adults & adolescents. Investigation Distal pole avulsion type fracture is most common fracture type in children Q. Anteroposterior, lateral and oblique views are all essential; often a recent fracture shown only in the oblique viewQ. So a routine scaphoid x- ray series must include:- Radial and ulnar deton PA views with the wrist in about 30deg of extension (by asking to make a fist gently) True lateral view Radial oblique (supinated PA) view and ulnar oblique (pronated PA) view. Comparison view of opposite wrist. However it is common for the fracture not to be visible on the initial films. If doubt exists, the scaphoid should be immobilized in plaster and repeat radiograph obtained in 1421 days as the late films are usually positiveQ. Bone scan, trispiral tomography are other investigations ; occult scaphoid fractures can be reliably diagnosed by MRI & nucleotide scan. Vascularity, Nonunion & AVN Blood supply of scaphoid is precarious. It receives most of its blood supply from two major vascular pedicles (dorsal & volar branches) from the radial aery, both entering distallyQ. Volar (palmar) scaphoid branch of radial aery enters the scaphoid tubercle and supplies its distal 20-30%. Dorsal scaphoid branch of radial aery enters through numerous small foramina along the spiral groove & dorsal ridge and account for 80% of its blood supply. There is usually no or rarely a single perforater proximal to the waist of scaphoid. Hence vascularity of proximal fragment is maintained by retrograde intraosseous blood flow from distal to proximal; 7080% of which is provided by dorsal branch. The distal scaphoid has a dense vascular network whereas intraosseous vascular density declines proximally, leaving the proximal pole with sparse blood supply. Because of this unusual retrograde vascular supply to proximal segment, the scaphoid has a high risk of nonunion and AVN after fracture through waist and proximal pole. Because the scaphoid aiculates with four carpal bones & radius, most of its surface is composed of aicular cailage. Therefore, the vascular supply comes through -a narrow non aicular region in the waist. Most of the blood supply to the scaphoid enters distally, so blood supply of scaphoid diminishes proximallyQ. This accounts for the fact that 1% of distal third, 20% of middle third, 40% of proximal third and 100% of proximal pole fractures result in avascular necrosis or non union of the proximal fragment2. -Because it aiculates with distal radius, and with 4 of remaining 7 carpal bones, the scaphoid moves with nearly all carpal motions, especially volar flexion. Any alteration of its aicular surface through fracture, dislocation, or subluxation or any change of its stability by ligamentous rupture can cause severe secondary changes throughout the entire carpus. Management Stable and undisplaced fractures are treated by scaphoid cast immobilization (glass holding dorsal and radial flexion positionQ impacts the scaphoid fragments and minimises the shearing effects), for 4 - 8 weeks in distal third, 6 - 12 weeks in middle third and 12- 20 weeks in proximal third fractures. Scaphoid cast is applied from the upper forearm to just sho of meta carpophalyngeal joints of fingers, but incorporating proximal phalynx of thumb. The wrist is held dorsiflexed and the thumb forwards in "glass holding position" - A displaced fracture, by definition, is one with > 1 mm of step-off or >60degof scapholunate or >15deg of lunato- capitate angulation. The subtle signs of displacement or instability are - opening & obliquity of fracture line, angulation of distal fragment, and fore shoening of scaphoid image. Displaced- unstable fractures are treated by percutaneous screw fixation or OR & IF by k - wires, compression screw or Herbe screw. - Undisplaced ununited (nonunion) fractures may be treated by excavation of the scaphoid & placement of volar inlay coicocancellous bone graft (Matti Russe procedure). In most cases of stable nonunion cancellous bone graft from either the distal radius (for small defects) or the iliac crest (preferable because of its superior osteogenic and mechanical propeies) is packed into the defect. Dorsal cailage is not disturbed. This provides a hinge and facilitates assessment of scaphoid length. If fracture site is angulated or collapsed coico cancellous volar graft is employed to correct the deformity. If the proximal pole is avascular and no significant radiocarpal ahritis is present, revascularization of the scaphoid with a vascularized bone graft from dorsal radius or preferably pronator quadratus graftQ should be performed. Paial radial stylodectomy should be performed in all patients with radiological signs of stage I radioscaphoid ahritis limited to scaphoid and radial styloid. - Once degenerative ahritis is evident at the radio -carpal joint, salvage procedures includes proximal row carpectomy, scaphoid excision and mid carpal ahodesis or total wrist ahrodesis. Clinical Presentation - The patient is usually and adolescent boy or young adult who gives a h/o falling on outstretched hand usually during active spos. Commonly the injury is misinterpreted as "just a sprain". Like colle's it is a supination - dorsiflexion injury. - Fullness & tenderness in anatomical snuff boxQ. Radial side wrist pain; passive dorsiflexion to the radial side is painful, grip is weak and release of grip gives transitory pain, resisted pinch between the thumb and index finger is uncomfoable. Proximal pressure along the axis of the thumb may be painfulQ.


Question: Most common tumour occurring in appendix includes

Carcinoid tumours arise in argentaffin tissue (Kulchitsky cells of the crypts of Lieberkuhn) and are most common in the vermiform appendix.The tumour can occur in any pa of the appendix, but it is frequently found in the distal third Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1217


Question: Drug used for Buerger's disease is

Thromboangiitis obliterans (Buerger's disease) This is characterised by occlusive disease of small- and medium-sized aeries (plantar, tibial, radial, etc.), thrombophlebitis of the superficial or deep veins and Raynaud's syndrome; it occurs in male smokers, usually under the age of 30 years. Often, only one or two of the three manifestations are present. Histologically, there are inflammatory changes in the walls of aeries and veins, leading to thrombosis. Treatment is total abstinence from smoking, which arrests, but does not reverse, the disease. Established aerial occlusions are treated as for atheromatous disease, but amputations may eventually be required. Ref : Bailey and love 27th edition Pgno : 967 Xanthinol Nicotinate Xanthinol Nicotinate (or xanthinol niacinate or complamina) is a vasodilator It is combination of xanthinol and niacin (nicotinic acid) This vasodilator is used in the treatment of Raynaud's phenomenon or Buerger's disease Ref: Wikipedia


Question: M. C. anterior mediastinum tumor is

Ans is 'a' ie Thymoma RememberMost common mediastinal mass-Neurogenic tumorsMost common Ant. mediastinal mass-ThymomaMost common Middle mediastinal mass-Bronchogenic & pleuropericardial cystsMost common Posterior mediastinal mass-Neurogenic tumorMost common malignant mass of mediastinum-LymphomasMost common mediastinal mass in children-Neurogenic tumor


Question: Compound fracture is


Question: Gold standard investigation for recurrent gastrointestinal stromal tumor is

.Investigation: - Mainly CT scan - Tumour / molecular marker to differentiate it from sarcomas (immunohistochemistry). - Endosonography guided biopsy/guided FNAC are impoant to get histological confirmation. - 18 FDG PET scan is very useful adjunct to CT but reserved for difficult/equivocal cases. ref:SRB&;S manual of surgery,ed 3,pg no 792


Question:
The most likely cause of intermittent jaundice in elderly
man is

Periampullary carcinoma causes intermittent jaundice (waxing and waning of jaundice).


Question: Hernia with hydrocele is .... hernia


Question: Paralytic ileus caused by

Hypokalemia leads to decreased smooth muscle contraction leading to decreased peristalsis and thus paralytic ileus. Pg NO.1296 BAILEY 27TH EDITION


Question: Excision of head of radius in a child should not be done because

C i.e. It causes subluxation of inferior radioulnar joint

It leads to secondary Osteo ahritis of elbow

It causes subluxation of inferior radio-ulnar joint


Question: 28 year old male met with an accident and sustained severe crush injury. He is most likely develop aEUR'

Acute renal failure Crush Syndrome Severe systemic manifestation of trauma and ischaemia involving soft tissues, principally skeletal muscle, due to prolonged severe crushing. - It leads to increased permeability of the cell membrane and to the release of potassium, enzymes, and myoglobin from within cells. Ischaemic renal dysfunction secondary to hypotension and diminished renal perfusion results in acute tubular necrosis and uraemia." Pathophysiology Crush injury can follow prolonged continuous pressure on muscle tissue. Crush injury can lead to crush syndrome. Ischaemia reperfusion (when the pressure is released. from the crushed limb) is the main mechanism of muscle injury in crush syndrome. There is traumatic rhabdomyolysis. Rhabdomyolysis is the breakdown of muscle fibres with the leakage of potentially toxic cellular contents into the systemic circulation. Muscle injury causes large quantities of potassium, phosphate, myoglobin, creatine kinase and urate to leak into the circulation. Myoglobin levels in the plasma are normally very low. If a significant amount of skeletal muscle is damaged (>100 g) excess myoglobin is .filtered by the kidneys and can cause renal tubular obstruction and renal damage: the excess myoglobin is nephrotoxic. intravascular volume depletion and renal hypoperfusion, combined with myoglobinuria, result in renal dysfunction.2 Crush syndrome is characterised by Hypovolaemic shock (due to sequestration of water in the injured muscle cells). Hyperkalaemia (release of cellular potassium by the injured muscle cells). This can also lead to: - Metabolic acidosis (release of cellular phosphate and sulphate by the injured muscle cells) - Acute renal failure - Disseminated intravascular coagulation (DIC) The key clinical_ features of crush syndrome are : Crushing injury to a large mass of skeletal muscle. Sensory and motor disturbances in the compressed limbs, which subsequently become tense and swollen Myoglobinuria and/or haemoglobinuria Raised creatine kinase There may be oliguria Elevated levels of urea, creatinine, uric acid, potassium, phosphate Thpocalcaemia


Question: Screening will be significantly improve life span in

Schwaz says "Because the majority of Colorectal cancers are thought to arise from Adenomatous polyps, preventive measures focus upon identification and removal of these premalignant lesions. In addition, many cancers are asymptomatic and screening may detect these tumors at an early and curable stage American cancer society Recommendations for early detection of cancer in Average - Risk, Asymptomatic individuals Cancer site - Colorectal Population to be screened - Men and women aged >= 50 years Test or procedure - Fecal occult blood test(FOBT( or fecal immunochemical test (FIT( Flexible sigmoidoscopy FOBT and Flexible sigmoidoscopy Double - Contrast barium enema (DCBE( Colonoscopy Frequency Annual, staing at age 50 Every 5 years, staing at age 50 Annual FOBT, (or FIT) and flexible sigmoidoscopy every 5 years, staing at age 50 DCBE every 5 years, staing at age 50 Colonoscopy every 10 years, staing at age 50 Ref: Harrison's 19th edition Pgno : 481 Schwaz 10th edition Pgno : 298


Question: Radiolucent stone is

(Uric acid calculus) (1317-LB) (1296-B &L 25th)* About 90% of calculi are radiopaque (calcium, phosphate oxalates, cystine)* Uric acid stones are radiolucent and appear on an excretion urogram as a filling defect* Spiral CT has become the study of choice in emergent situations, as the entire urinary tract can be scanned rapidly and without contrast injection. (1042-CSDT 11th)


Question: Patient is placed in trendelenburg position in air embolism in order to

Trendelenberg position keeps left ventricular air bubble away from coronary ostia, so that air bubbles do not enter and occlude coronary arteries.

Keep left ventricular air bubble away from coronary artery ostia

Prevent air from passing through foramen ovale

Prevent air from entering left ventricle


Question: Mammography is performed in

Mammography is preferred in first of the menstrual cycle.
Usually two views are taken craniocaudal and mediolateral oblique.


Question: Thunderclap headache is a feature of

Ans. (d) SAHRef: Sabiston 20th Page 1904* Subarachnoid hemorrhage usually results in a sudden severe thunderclap headache. A patients describes the worst headache of my life.


Question: Hadfield operation is done for

Ans. (a) Duct Ectasia(Ref. Bailey and Love 27th Edition Page 868)* Hadfield operation of resection of all ducts conically with apex at the nipple and base at pectoralis fascia level. Done for periductal mastitis (Duct Ectasia) and Duct papilloma of unknown duct origin.


Question: Acinic cell carcinoma is found in

Acinic cell tumour is a rare,slow growing tumour that occurs almost always in parotid and is composed of cells like serous acini.It is more common in women.It occurs in adults and elderly.It can involve facial nerve or neck lymph nodes.Clinically,it is of variable consistency with soft and cystic areas.Microscopically, it can be micro cystic,papillary,follicular, medullary,etc SRB,5th,417.


Question: Tube (Cylinder) cast is applied for the fracture of

D i.e. Knee Cylinder (tube) cast is used in undisplaced transverse fracture of patellaQ.


Question: Tarsometatarsal amputation is also known as

B i.e. Lisfranc amputation Tarsometatarsal joint is known as Lisfranc joint and amputation through this joint is k/a Lisfranc amputationQ.


Question: Following are features of Barrett&;s oesophagus

Histologic changes of the distal oesophagal mucosa from its normal squamous epithelium to a columnar configuration (intestinal metaplasia). Barrett oesophagus in endoscopy appears as velvety-red "tongues" of mucosa that extend cephalad from the GEJ. These patients carry a higher risk to Adenocarcinoma oesophagus compared to normal population. Reference: Sabiston 20th edition page: 1074


Question: Saw tooth appearance in abdominal barium enema X ray is seen in

Diveicula These are abnormal outpouchings or sacs of colon wall that occur due to interactions of high intraluminal pressures, disordered motility and low diet in fiber Formed on mesenteric side of antimesenteric taenia coli Results in protrusion of mucosa and submucosa through layers of muscle It is Pseudodiveiculum or False diveiculum Radiological evidence in prediveicular disease Saw tooth appearance of colon Shoening of bowel Crowding of haustra Picket fencing of folds Ischemic colitis- Ba. Enema - Thumb print sign Ulcerative colitis


Question: Management of stage 2 pressure sore, clean ulcer without cellulitis is


Question: "Seat belt syndrome" is

(Sudden deceleration can result in a torn mesentery) (1147-48-LB) (1003-4-B &L 25th)SEAT-BELT SYNDROME - If a car accident occurs when a seat belt is worn, sudden deceleration can result in a tom mesentery. This possibility should be borne in mind, particularly as multiple injuries may distract attention from this injury. If there is any bruishing of the abdominal wall or even marks of clothing impressed into the skin, laparotomy may be indicated.* Diagnostic peritoneal lavage may be helpful in this situation.

Sudden deceleration can result in a tom mesentery

Fracture shaft of the femur with testicular swelling


Question: Treatment of choice for simple cyst of liver

Deroofing is the treatment of choice for simple cyst of liver.


Question: Best test to differentiative between medical and surgical jaundice is

Investigations for Obstructive Jaundice 1. Serum bilirubin. A normal value is less than 1.0 mg%. Both direct and indirect bilirubin are assessed. Direct is increased in obstructive jaundice, i.e. conjugated hyperbilirubinaemia. van den Bergh's test is done. 2. Serum albumin, globulin and A: G ratio. Normal S. albumin is more than 3.5 gm%. 3. Prothrombin time. A normal value is 12-16 seconds. It is significant if it is more than 4 from the control or more than one and half times the control. It is corrected by injection vitamin K, 10 mg IM OD for 5 days or by FFP--5-10 units. 4. Serum alkaline phosphatase, SGPT, SGOT, 5' nucleotidase. 5. U/S abdomen. 6. ERCP to visualise the site of obstruction, brush biopsy, bile sample for analysis. 7. MRCP--Non-invasive diagnostic tool. Ref: SRB&;s manual of surgery,3 rd ed, pg no 588


Question: Screening of prostate Ca is done by

Screening for malignancy according to America cancer society Recommendations for early detection of cancer in Average - Risk, Asymptomatic individuals Cancer site : Prostate Population : Men aged >= 50 years Test or procedure : Digital rectal examination (DRE) and prostate specific antigen (PSA) test. Frequency : Offer PSA test and DRE annually, staing at age 50,for men who have life expectancy of atleast 10 years Ref: Harrison's 19th edition Pgno : 481


Question: Injection sclerotherapy for varicose veins is by usinga) Phenolb) Absolute alcoholc) 70% alcohold) Ethanolamine oleate

Sclerosing agents mentioned in the latest editions of Schwartz, CSDT and Bailey are:
- hypertonic saline,
- sodium tetradecyl sulfate, and
- polidocanol
2 other sclerosants are mentioned in KDT 6/e p597

Ethanolamine oleate
Phenol in almond oil or Peanut oil


Question: In treatment of papillary carcinomas thyroid, radioiodine destroys the neoplastic cells predominantly by

I131 is treated by the body just like the ordinary nonradioactive isotope, so that when swallowed it is concentrated in the thyroid gland.
It emits mainly β radiation (90%) which penetrates only 0.5 mm of the tissue and thus allows therapeutic effects on the thyroid without any damage to the surrounding structures, particularly the parathyroids.
It also emits gamma rays, which are more penetrating.

Uses

I131is the preferred initial t/t for hyperthyroidism caused by Grave's disease.
It is used in combination with surgery in some cases of thyroid carcinoma, especially those in which metastases are sufficiently differentiated to take up iodides selectively.

Also know,

It is contraindicated in children and pregnant or breastfeeding women, and can induce or worsen ophthalmopathy.


Question: A cell cycle specific anticancer drug that acts mainly in the M phase of the cell cycle is

Paclitaxel The taxanes, paclitaxel and docetaxel, interfere with the separation of chromosomes during mitosis because of their effects on micro tubules.


Question: Most common site of metastasis of carcinoma bronchi


Question:
In the extraoral technique for mandibular nerve
block the needle after contacting the pterygoid plate is directed


Question: Decision regarding surgery in a case of hemothorax due to blunt trauma chest should be based on

Decision regarding surgery for haemothorax due to blunt trauma chest is based on the hemodynamic status of the patient & whether features of shock present or not.Treatment usually consists of ICT placement in the mid -axillary line in the 6th intercoastal space.Thoracotomy is done when ICT shows persistent drainage /hourly collection of 200-300 ml or initial chest tube output of 1500 ml of blood .


Question: Subcapsular orchiectomy is done for

Orchidectomy Orchidectomy is performed in advanced disease. In 1941, prostate cancer was shown to be responsive to such treatment by Charles Huggins, the only urologist to win a Nobel Prize. Bilateral orchidectomy, whether total or subcapsular, will eliminate the major source of testosterone production. Ref: Bailey and love 27th edition Pgno : 1474


Question: Pseudocyst of pancreas is

Ans. b (Post-inflammation cyst). (Ref. Bailey & Love, 25th/1138.)PSEUDOCYST OF PANCREAS# A pseudocyst of pancreas is a collection of pancreatic juice enclosed in a wall of fibrous or granulomatous tissue that is usually located in lesser sac region and follows an attack of acute pancreatitis/trauma.# It is not lined by epithelium in contrast to true pancreatic cyst.# A pseudocyst with wall thickness more than 5 mm or size more than 6 cm is a mature pseudocyst and surgical treatment (cystogastrostomy) is indicated.


Question: Seminoma correspond to

Seminoma corresponds to dysgerminoma in ovaries.


Question: Pronator quadratus has the same innervation as the following muscl

Flexor pollicis longus The most appropriate answer to this question is flexor pollicis longus. Anterior interosseous nerve (AIN) is the deep branch of median nerve and takes care of three muscles...namely flexor pollicis longus, pronator quadratus and the radial half of flexor digitorum profundus (for the index and middle finger) in the anterior forearm. Flexor digitorum profundus is a hybrid muscle...being supplied by two nerves....ulnar nerve supplying its medial half (ring and little finger). The middle finger can have overlap of nerve supply...and could be getting supply from ulnar nerve in paial or total entirely. Hence FPL is first option and FDP is second in preferential order..

Flexor digitorum profundus of middle finger


Question: Most common site of lymphangiosarcoma is

Most common site of lymphangiosarcoma is arm following mastectomy, Occurs commonly after radical lymph nodes dissection- stewa treves syndrome Reference- SRB - 5th edition, sarcoma, page 311.


Question: The commonest thyroid malignancy is


Question: Indication for surgery in a case of adrenal incidentaloma is

Any non-functioning adrenal tumour greater than 4 cm in diameter and smaller tumours that increase in size over time should undergo surgical resection. Non-functioning tumours smaller than 4 cm should be followed-up after 6, 12 and 24 months by imaging (MRI) and hormonal evaluationRef: Bailey and Love 27e pg: 840


Question: HIPEC is used for

Hypehermic intraperitoneal chemotherapy (HIPEC) is used for peritoneal metastases.Other treatment modalities are cytoreductive surgery, intraperitoneal chemotherapy.Ref: Bailey and love 27e pg: 1059


Question: A 18 year old male presents with a draining sinus on his left leg with pus discharge and discharge of bony pieces since in 3 months. The diagnosis

Answer- A. Chronic osteomyelitisA history of bone piece discharge from the chronic sinusis considered diagnostic of chronic osteomyelitis.


Question: Decision analyses often include a patient's utilities in the determination of the best decision. These utilities measure

The relative value a patient places on a paicular outcome In decision analysis, utilities refer to the relative values placed on various outcomes.

Whether a patient ors one decision over another

Whether a physician ors one decision over another

The difference between a patient's decision and the physician's decision


Question: Thyroid storm after operation is due to

Thyroid strom is acute exacerbation of hypehyroidism. It occurs if a thyrotoxic patient has been inadequately prepared for thyroidectomy. It is characterized by a high fever, fast and often irregular hea beat, vomiting, diarrhea, and agitation. Treatment include administration of intravenous fluids for dehydration, cooling the patient with ice packs for hyperpyrexia, administration of oxygen, diuretics for cardiac failure, digoxin for uncontrolled atrial fibrillation, sedation and intravenous hydrocoisone . Specific treatment is by carbimazole 10-20 mg 6-hourly, Lugol's iodine 10 drops 8-hourly by mouth or sodium iodide 1 g i.v. Propranolol intravenously (1-2 mg) or orally (40 mg 6-hourly) will block beta-adrenergic effects. Source : Bailey and Love 26th edition Pg : 762


Question: Most common renal stone is

Calcium oxalate stones - 60% Phosphate stones( hydroxyapatite and brushite) - 22% Uric acid stones -7 % ,struvite 7%.Cystine stones - 2% Reference : Campbell and Walsh urology 11th edition , chapter 51 , pg no 1181


Question: Initial treatment of the patients with growth hormone secreting pituitary adenoma

Ans. (a) Transphenoidal Surgical resection* Treatment of Choice for Pituitary tumors is initially and always is by Transsphenoidal Resection.* Preferred for both micro and macro adenomas


Question: Oschner Sherren regimen is for

Ans. b (Appendicular mass). (Ref. Bailey & Love, 25th ed., 1215)APPENDICULAR MASS# Following an attack of acute appendicitis infection is sealed off by greater omentum, caecum, terminal ileum, etc resulting in a tender, soft to firm appendicular mass.# Presence of appendicular mass is a contraindication for appendicectomy due to risk of faecal fistulae.# It is treated by Oschner & Sherren's regime, which includes:1. Aspiration with Ryle's tube to give rest to GIT.2. Bowel care (avoid purgatives).3. Charts--temperature, pulse, respiration, diameter of mass.4. Drugs--to cover all organisms.5. Exploratory laparotomy contraindicated.6. Fluid-IV (patient kept nil orally for few days).7. Swinging temperature & increased in size of mass indicate abscess.Criteria for stopping conservative treatment of an appendix mass include A rising pulse rate , Increasing or spreading abdominal pain and Increasing size of the mass


Question: Mondors disease is

Mondor's disease is thrombophlebitis of superficial veins of the breast and anterior chest wall. The pathogonomic feature is the thrombosed subcutaneous cord,usually attached to skin.Thevtreatment is restricted arm movements ,and in any case the condition subsides withina few months without recurrence,complications or deformity. Bailey and Love'sSho practice of surgery.Edition 23.Pg no:756


Question: Degloving injury is characterised by

Degloving Injury is defined as an Avulsion injury including the following layers:- * Skin * Subcutaneous Tissue with intact fascia Ref:- Bailey and Love 27th Edition; Pg num:- 27

Loss of Skin and Subcutaneous tissue along with Fascia

Loss of Skin and Subcutaneous tissue with intact fascia

Loss of Skin, Subcutaneous Tissue and Muscle


Question: Thrombophlebitis extending from thigh to involve iliofemoral vein causes

Answer- D. White legWhite leg (Phlegmasia alba dolens)- seen in ileofemoral thrombophlebitis.Phlegmasia alba dolens (white leg): This is characterised by aerial spasm resulting in pale, cold leg with diminished pulses, with blanching of the limb, more often seen in iliofemoral thrombophlebitis and is called milk leg of pregnancy.


Question: The best dressing for open wounds is


Question: Grey Turner's sign (flank discoloration) is seen in

Sign seen due to enzyme seep across etroperitoneum causing hemorrhagic spots and ecchymosis in the flanks SRB,5th,683.


Question: Dumping syndrome can occur after

Billroth ii is an operation wherein the greater curvature of the stomach is attached to 1st pa of jejunum in end to side anastomosis It occurs due to rapid delivery of osmotically active solid and liquid into jejunum due to alteration in the storage function of the stomach resulting in increased intestinal activity leading to diarrhoea and fall in blood volume. Reference SRB 5th edition page no.839


Question: Most common cause of esophagitis is

Ans is 'd' i.e. Esophageal reflux "Reflux esophagitis is the most common type of esophagitis. It occurs in patients with gastroesophageal reflux disease (GERD) secondary to dysfunction of the lower esophageal sphincter. " "Candidal esophagitis is the most common form of infectious esophagitis."-The Washington manual of surgical pathology pi 65

Esophageal Diseases - Gastroesophageal Reflux Disease, Carcinoma


Question: Most common complication of acute and chronic pancreatitis is

.Complications of acute pancreatitis * Shock-hypovolaemic and septic * Respiratory failure and ARDS--Common in 7 days * Septicaemia--Common after 7 days * Hypocalcaemia * Disseminated intravascular coagulation (DIC) * Acute renal failure * Pancreatic pleural--effusion (left sided 20%) * Pancreatic pseudo aneurysm * Pancreatic ascites * Colonic stricture * Pseudocyst of pancreas * Chronic pancreatitis * Splenic vein thrombosis * Pancreatic abscess. ref:SRB&;S manual of surgery,ed 5,pg no 618


Question: Hemangioma of the rectuma) Common tumourb) Fatal haemorrhage seenc) Ulcerative colitis like symptoms seend) Acute anal fissure

Hemangioma of the rectum is an uncommon cause of serious hemorrhage.
When localized in the lower part of the rectum or anal canal, a hemangioma can be excised.
When the lesion is diffuse, or lying in the upper part of the rectum, the symptoms simulate ulcerative colitis.
Diagnosis is often missed for a long period, or it is mistakenly thought to be a carcinoma.
Selective angiography and embolization may be helpful, but excision of the rectum is sometimes required.


Question: Growth disturbance, nonunion, elbow instability & late ulnar nerve palsy is commonly seen in

C i.e. Fracture lateral condyle Milch Classification of Fracture Lateral Condyle Humerus Mitch type I (Salter Harris type IV) - Less common type - Fracture running through the secondary ossification centre of capitullum and entering the joint lateral to capitulotrochlear groove Cause growth defectQ Mitch type II (Salter Harris type II (?) IV (?)) - Commonest - Fracture staing in metaphysis and running along the physis of lateral condyle into trochlear i.e. fracture extends medial to capitulotrochlear groove. - Make ulnar - humeral (elbow) joint unstableQ. * If the lateral condyle is left capsized nonunion is inevitableQ : with growth elbow becomes increasingly valgus and tardy ulnar nerve palsyQ is then likely to develop.


Question: Familial polysosis coli is associated with

.HNCC (hereditary nonpolyposis colonic cancer) * No polyps. Autosomal dominant* Three members of the family have colonic cancers * Lynch syndrome I is site specific - commonly right sided, occurs in early age group, 40% are metachronous * Lynch syndrome II has other malignancy in, stomach, breast, ovary, endometrium and urinary bladder. It is cancer family syndrome * Microsatellite instability (MSI) at DNA level occurs in HNCC * Accounts for 3-5% of colonic cancers * Amsterdam criteria I (1990); Amsterdam criteria II (1999) and revised Bethesda guidelines (2002) are used to diagnose HNCC ref:SRB&;S manual of surgery,ed 3,pg no 835


Question: A man presented with fractures of 4th to 10 th ribs and paradoxical respiration after RTA. He is diagnosed to have flail chest and a PaO2 of <70%. Management is

Flail chest in fracture of 3 or more continuous ribs.
Paradoxical respiration is when during inspiration chest moves inwards and vice versa.


Question: Nerve compressed by aneurysm of posterior communicating aery is

Occulomotor nerve Most unruptured intracranial aneurysms are completely asymptomatic. Symptoms are usually due to rupture and resultant subarachnoid hemorrhage. Occasionally neurological symptoms may arise due to mass effect of the aneurysm. Progressively enlarging unruptured aneurysm most commonly involves the occulomotor nerve. This usually occurs .from an expanding aneurysm at junction of post communicating aery and internal carotid aery. Other neuropathies due to intracranial aneurysms are Cavernous sinus aneurysm can produce sixth nerve palsy. Supraclinoid carotid or anterior cerebral aery aneurysm can produce visual field defects. Posterior inferior cerebellar aery or anterior inferior cerebellar aery aneurysm may present as occipital & posterior cervical pain. An expanding middle cerebral aery aneurysm can produce pain in or behind the eye & in the low temple. Ophthalmic aery aneurysm can cause visual loss by compressing optic nerve.


Question: Safest contrast in esophageal perforation

Ans. (a) IohexolRef: Shackelford, 7th Edition, Page 86Contrasts to detect leak and perforation:Two contrasts are commonly used to detect perforation* Barium* Water soluble contrasts:# Low osmolar: Iohexol, Metrizamide# High Osmolar: Diatrazoate (Gastrograffin)* High osmolar Gastrograffin (Diatrozoate meglumine): has more chances of pulmonary edema than low osmolar contrasts like Iohexol (Omnipaque) and metrizamide (Amnipaque).In conclusion:* Best to diagnose perforations - High density Barium* Safest in usage: Low osmolar Water soluble contrasts like Iohexol and Metrizamide