Question: Diversion of urinary bladder is best done at

Permanent urinary tract diversion is most commonly performed by conduit diversion. The ureters are implanted into a sho, isolated segment of ileum or, less commonly, colon. The conduit dives the urine onwards to a cutaneous stoma for collection in an ileostomy bag. Ileal segment is the best for urinary diversion after cystectomy. Still better method is "Continent cutaneous diversion" method. But the best method is "Ohotopic neobladders". "Incontinent cutaneous urinary diversion" by ileal conduit: a segment of ileum is exteriorized in the form of a stoma through the abdominal wall, around which an appliance is secured and into which urine continuously drains. "Continent cutaneous diversions" -- All continent cutaneous reservoirs rely upon a low-pressure pouch constructed of various detubularized bowel segments and a functional mechanism that connects the reservoir to the skin, designed to prevent involuntary urine flow. The most obvious advantages of this type of diversion are the ability to avoid continuous urine drainage and the need for an external appliance. These continent cutaneous diversions require intermittent clean self-catheterization through the stoma both to empty the reservoir and to irrigate mucous. No stomal appliance is usually required. Although continent cutaneous diversions have been largely supplanted by the ohotopic neobladder, this procedure is used when the urethra or bladder neck is non-functional or involved by tumor, and avoidance of an external appliance is desired. "Ohotropic neobladders"-- Ohotropic neobladders are internal reservoirs that are connected to the native urethra and rely upon the external striated sphincter for continence. These reservoirs are constructed from a segment of detubularized intestine (usually ileum) anastomosed to the native urinary outflow tract. Because this approach facilitates the restoration of normal self-image by approximating normal voiding, construction of an ohotropic neobladder has become the procedure of choice for most patients following cystectomy for bladder cancer in both men and women. It is contraindicated if the urethra is nonfunctional or involved with tumor. Bailey and Love Pg : 1336


Question: Carcinoma tongue is most common at

Carcinoma Tongue Most common site is middle of lateral border or ventral aspect of the tongue Most common histological type is squamous cell carcinoma Most common associated risk factors are tobacco and alcohol Most common variety is ulcerative 30% patients presents with cervical node metastasis Ref: Bailey and love 27th edition Pgno : 616


Question: Sudden loud sound is more likely to damage the cochlea than prolonged sounds because

Basilar fibers are sensitive to sudden sounds but adapt to prolonged sounds

Tympanic membrane becomes flaccid during prolonged loud sounds

There is a latent period before the attenuation reflex can occur


Question: Lithotripsy is the equipment used to crush the stones

.Cystoscopic litholapaxy Under GA, cystoscope is passed and the stone is visualized. It is fragmented by pneumatic, laser, electromagnetic waves or mechano-hydraulic lithotripsy. The bladder is flushed using an irrigator (Freyer's evacuator or irrigator or Ellik's evacuator).in extracopreal shock wave lithotripsy (ESWL)Piezo-Ceramic or Electromagnetic shock waves are passed to the stone through water bath or water cushion which acts as a media. Shocks are produced at 2/sec. 1000-4000 shocks are required for each stone. * Dornier Lithotripter is used for fragmenting stones. * Stone is located and observed through fluoroscope (C-ARM) or ultrasound. Shock waves are triggered to create compressive waves over the stone, to fragment it. These fragments are flushed out later. ref:SRB&;s manual of surgery,ed 3,pg no 957

Medium range (2.5 MHz) pulsed wave are used


Question: The organism most frequently related to mediastina fibrosis is

Fibrosing mediastinitis or mediastinal fibrosis is the least common,but the most severe ,late complication of histoplasmosis.It is due to an abnormal immunological response to antigens released by the soil based fungus Histoplasma capsulatum.It is characterised by invasive calcified fibrosis centered at locations of lymph nodes,which occludes major vessels & airways.


Question: Most common site of basal cell carcinoma is

Basal cell carcinoma is usually a slow-growing, locally-invasive, malignant tumour of pluripotential epithelial cells arising from basal epidermis and hair follicles; hence, it affects the pilosebaceous skinThe strongest predisposing factor to BCC is UVR.Ref: Bailey and Love, 27e, page: 605


Question: Cock’s peculiar tumour is


Question: Distance from Olecranon in amputation should be

C i.e. 15 - 20 cm Type of Amputation Traditional Length of StumpAbove knee 12 cmBelow knee 14 cmBelow Elbow 18 cmQAbove Elbow 20 cm


Question: MC duct stones involved is in


Question: Nerves of latarjet are spared in

Types of vagotomy

Highly selective vagotomy (HSV)
Vagotomy and drainage (V+D)
Vagotomy and antrectomy (V+A)

Vagotomy is a component of each of these procedures. It decreases the acid secretion by stopping cholinergic input into the stomach.
But since vagus nerve is also the motor supply of stomach and the antropyloroduodenal segment a truncal vagotomy leads to gastric stasis.
Gastric stasis is prevented by adding a drainage procedure to the truncal vagotomy (Vagotomy & drainage - V+ D).
Drainage procedure used are :

Gastrojejunostomy
Pyloroplasty

In Highly selective vagotomy (also known as parietal cell vagotomy or proximal gastric vagotomy) the vagal innervation to the antrum and pylorus (nerves of Latarjet) are preserved, only the vagal supply to the proximal two- thirds of the stomach (where essentially all the parietal cells are located) is cut.

This preserves gastric motility
Advantages

Technical simplicity & preservation of entire gastric reservoir capacity.
Lowest mortality and side effects
Minimal chances of dumping syndrome

Disadvantage

Recurrence rates are higher than V + D or V + A.

Vagotomy plus antrectomy

In this operation, a distal gastrectomy (about 50% of the stomach) is done. This removes almost all the gastrin-producing mucosa, thus acid reduction is maximum in this operation.

Advantages - lowest recurrence rate
Disadvantage - high mortality & morbidity


Question:
Features of right side carcinoma colon are
I. Obstruction
II. Altered bowel habit
III. Anemia
IV. Melena

Right sided Ca. Bleeds ( melena) causing anemia.


Question: Risdon wiring is indicated for


Question: Diffuse peritonitis in acute appendicitis is caused due to

Diffuse peritonitis can develop rapidly because of the underdeveloped greater omentum, which is unable to give much assistance in localising the infection. Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1209


Question: Chvostek's and Trousseau's signs are related to

Chvostek's and Trousseau's signs are related to hypocalcemia.Chvostek's sign refers to contraction of the ipsilateral facial muscles on percussion of the facial nerve below the zygoma. Trousseau's sign refers to the development of carpopedal spasm secondary to occlusion of the arm (usually with a blood pressure cuff).Ref: Bailey and Love 27e pg: 831


Question:
A 36 year old male patient has reported to you with swelling in the submandibular region. His tongue is elevated and he complains of dysphagia. He has high fever. Intra oral examination reveals grossly destructed lower first molar.

CST (culture sensitivity test) is carried out to evaluate

Whether the antibiotic dosage is adequate

Antibiotic is most sensitive or least resistant


Question: In hand injury first structure to be repaired should be

For musculoskeletal injuries, early total care allows definitive fixation of all unstable long bone, spinal and pelvic fractures within 36 hours of injury. This facilitates nursing care, allows early mobilisation of the patient and reduces pulmonary complications and length of stay on intensive care. If a sequence of fracture fixations is required, at the conclusion of each procedure the surgeon and anaesthetist should determine whether the patient's physiological status has been maintained sufficiently to allow the next procedure, or whether the patient should return to critical care for a fuher period of resuscitation. Ref: Bailey and love 27th edition Pgno : 326 Sequence of repair in Hand injuries Bone shoening and stabilization/Fixation Extensor tendon repair Flexor tendon repair Aerial anastomosis Nerve repair Venous anastomosis Skin/Wound closure Pneumonic: BE FAN of VeinS Ref: Master techniques in ohopaedic surgery series by Morgan and cooney (2008) Pgno : 487


Question: Most commonest bladder stone is

MC primary bladder stone - ammonium urate
MC secondary bladder stone - uric acid (MC overall).


Question: Cause of nephrocalcinosis in granulomatous ds aEUR'

Increased calcium absorption [Ref: Robbin's 7/e p. 2387; Harrison 17/e p. 23871 Hypercalcemia associated with sarcoidosis The predominant mechanism for the development of hypercalcemia and hypercalciuria is the increased intestinal absorption of calcium induced by elevated calcitriol (1,25 hydroxyvitamin D). Sarcoidosis is associated with ectopic and unregulated synthesis of calcitriol by steroid tissue in response to sunlight or ingestion of vitamin D. The macrophage monocyte line of immune cells express the enzyme la hydroxylase which is identical to the I a hydroxylase present in kidney. - 1 a hydroxylase conves 25 hydroxyvitamin D to 1,25 hydroxy vitamin D. (calcitriol) la hydroxylase 25 hydroxy vitamin D > 1,25 dihydroxy vitamin D (Calcitriol) - (Normally this conversion takes place in kidney) 1,25 hydoxyvitamin D in turn causes increased absorption of calcium in intestine. Activity of I a hydroxylase enzyme is under negative feedback control in normal tissues. - However, in granulomatous disorder normal feed hack inhibition is abolished, probably by the effects of interferon gamma. - Interferon gamma induces the activity of la hydroxylase this leads to increased production of calcitriol (1,25 hydroxyvitamin D). - Increased production of calcitriol causes augumented intestinal absorption of calcium. Hypersensitivity to vitamin D remains despite b/I nephrectomy indicating that increase in serum calcitriol is not mediated by renal I a hydroxylase.


Question: Pain in endometrium is closely associated with

Ans B Ref: Williams gynaec page 230Underlying cause of pain is unclear: proinflammatory cytokines (PGF2alpha) released by the endometriotic implants into peritoneal fluidEvidence to suggest that pain from endometrium correlate to depth of invasion and site of pain- many indicate lesion location.Recent data suggest pain result from neuronal invasionRef: Sheila Balakrishnan, gynaec page 143Severe endometriosis can produce pain by peritoneal inflammation, deep infiltration and scarring, invasion of nerve endings, adhesions, collection of menstrual blood.


Question: In triage green colour indicates

Triage consists of rapidly classifying the injured on the basis of the severity of their injuries and the likelihood of their survival with prompt medical intervention. The most common classification uses the internationally accepted 4 colour code system. RED indicates high priority treatment or transfer, YELLOW signals medium priority, GREEN indicates ambulatory patients and BLACK for dead or moribund patients. Reference : page 796 Park's textbook of Preventive and Social Medicine 23rd edition


Question: Least malignant thyroid cancer is


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

Sub Arachnoid Hemorrhage Most common 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 neurologicalal 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 nerve cranial nerve palsy :Aneurysm at junction of PCS and ICA Sixth nerve palsy :Aneurysm in cavernous sinus Occipital and posterior cervical pain: Inferior cerebellar aery aneurysm Pain in or behind the eye :MICA aneurysm Ref: Sabiston 20th edition Pgno :1918


Question: Highest incidence of acute appendicitis occurs in

(B) 2nd decade # Peak incidence of acute appendicitis is in the 2nd & 3rd decades of life.> It is relatively rare at the extreams of age.> Apendicular perforation is more common in infancy & in the elderly, during which periods mortality rates are highest.


Question: Commando's operation is for

It is en-bloc removal ,which includes wide excision of primary tumour with hemimandibulectomy and neck block dissection,examples : it is done usually in carcinoma of tongue or floor of the mouth ;it is a composite resection of primary tumour ,mandible and radical neck dissection(RND) SRB,5th,451.


Question: Painless Breast lump in a young female

Ans. (a) Fibroadenoma(Ref. Bailey and Love 27th edition Page 870)* Fibroadenoma (Breast mouse) is mc in young females, painless and freely mobile with Firm Indian rubbery consistency


Question: Commonest cause of blood discharge from the nipple is

Duct papilloma is the Commonest cause of blood discharge from the nipple Duct papilloma are epithelium lined true polyps of breast lactiferous ducts it is usually single,from a single lactiferous duct it blocks the duct causing ductal dialatation ref ;(page no;528) 5th edition of SRB&;S Manual of SURGERY


Question: The commonest site for extra gonadal germ cell tumour

Anterior Mediastinal Masses Thymoma (MC in anterior mediastinum) Lymphoma Germ cell tumors. Thyroid and parathyroid masses Bronchogenic cyst Aneurysm Germ cell tumors constitute 11% of Total tumors in anterior mediastinum Ref: Sabiston 20th edition Pgno : 1608


Question: The most useful investigation for profuse lower gastrointestinal bleeding is

.Indications for colonoscopy includes * Bleeding per rectum, resistant anaemia. * To take biopsies from different pas of the bowel. * To identify synchronous growths, ulcerative colitis. * To remove polyps. * When barium enema shows irregularity. * For therapy--colonoscopic polypectomy, dilatation of stricture colon, fulgaration. Contraindicated in Acute ulcerative colitis. ref:SRB&;s manual of surgery,ed 3,pg no 891


Question: Ideal age for PMSTR is

Answer- B. 1 - 3 yearsPMSTR: Posteromedial Soft tissue release:It is the soft tissue surgical treatment for congenitaltalipesEquinovarus.The results of early operation for treatment of congentialtalipesequino varus, in paicular neonatal surgery have not been shown to be better than those of late surgeryDelaying surgery until the child is near walking age has the advantage of operating of larger foot (making surgery easier)Posteromedial soft tissue release (PMSTR), (Turcos) is best done at young age (l-3 years)


Question: A 20 year old male come to causality with head injury. Examination reveals normal consciousness and blood in the tympanic membrane. Most likely cause is


Question: &;SEPS&; is a procedure used for

<p> SEPS:- Subfascial endoscopic perforator ligation surgery A special telescope is introduced deep to deep fascia through a single small veical incision at proximal leg selecting healthy skin. Potential space between muscle and deep fascia with loose areolar tissue us easy to dissect using endoscope. Endoscope is advanced down along the medial border of tibia. Perforators travelling in subfascial plane are identified and fulgurated using bipolar cautery or clips can be applied into the perforators. It is recommended in Chronic venous insufficiency. {Reference: SRB&;s manual of surgery, 5th edition , page no. 237}


Question: Staghorn calculus is made of


Question: Treatment of Medullary carcinoma of thyroid is

Management Total thyroidectomy + Routine central lymph node dissection + ipsilateral modified radical node dissection (Tumor > 1cm) +- Bilateral modified Radical neck dissection (if any lymph node is positive) MCT - Poor prognosis (because it does not respond to radioactive iodine ablation) Vandetanib - Only FDA approved drug in advanced progressive medullary thyroid cancer.


Question: The drug of choice to prevent graft rejection in recipient is


Question: During renal rupture the nephrectomy is NOT attempted until

(Contra-lateral renal function is scertain)Nephrectomy is a possibility so it is important to establish that the contralateral kidney is functioning (1291- Bally & Love 25th)Injury to the Kideny * Haematuria is a cardinal sign of a damaged kidney *** Meterorism - abdominal distension comes on about 24-48 hours after the accident (retroperitoneal haematoma implicating splanchnic nerves)* An Intravenous urogram (IVP) should be obtained urgently to show that the other kidney is normal. A leak of urine on the damaged side is often demonstrated* Before proceeding to surgical procedure for bleeding a renal arteriogram should be performed if possible. If the bleeding vessel is visualized it may be embolised with small starch microspheres to stop bleeding* Should the necessity for a urgent operation arise and facilities for urography not be available, the presence of a functioning kidney on the contralateral side can often be confirmed by chromo- cystoscopyTREATMENT1. Nephrectomy - Kidney is found to rupture in several places or kidney pedicle is damaged2. Small tear can be sutured over oxycel or a piece of detached muscle3. Nephrostomy - Larger single rents in the middle of the kidney4. Partial Nephrectomy - laceration is confined to one pole of the kidney

Contralateral renal function is ascertain


Question: The most popular incision for open general thoracic surgical procedure is

For open general thoracic surgery,the most popular incision is median sternotomy.Here,an incision is made from the jugular or suprasternal notch to the lower end of the xiphisternum.The sternum is divided & retracted to expose the thymus superiorly & the pericardium inferiorly. Reference:Bailey & Love's sho practise of surgery,25 th edition,page no:851


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 most common microbial population found in a infected maxillary sinus are


Question: Most common location of posterior urethral value is


Question: The preferred initial treatment for carcinoma of the anal canal is

#Treatment is by chemoradiotherapy in the first instance # Associated with HPV # More prevalent in patients with HIV infection # May affect the anal verge or anal canal # Lymphatic spread is to the inguinal lymph nodes # Uncommon tumour, which is usually a squamous cell carcinoma # Major ablative surgery is required if the above fails Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1269

Abdominoperineal resection followed by radiotherapy


Question:
Posterior mandible resorbs at a rate approximately
times faster than the anterior mandible


Question: Secondary deposits from carcinoma breast are commonest in

Bone metastasis is commonest. In order of frequency the lumbar veebrae, femur, thoracic veebrae, rib and skull are affected and these deposits are generally osteolytic.Metastases may also commonly occur in the liver, lungs and brain and, occasionally, the adrenal glands and ovaries.Ref: Bailey and Love, 27e, page: 873


Question:
A fracture mandible should be immobilized for an
average of


Question: Seton used in fistula in anosurgery is draining seton and

Setons (Latin: seta = bristle) have been used in a variety of ways in fistula surgery and it is impoant for surgeons to be clear about what they are trying to achieve in a paicular situation. Loose setons are tied such that there is no tension upon the encircled tissue; there is no intent to cut the tissue. A variety of materials have been used but the seton should be non-absorbable, nondegenerative and comfoable. Tight or cutting setons are placed with the intention of cutting through the enclosed muscle. Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1264,1265


Question: Screening of prostate Ca commonly done by

Screening for carcinoma prostate is done by measurement of PSA (prostate specific antigen ). It is a organ specific protease produced from the prostatic epithelium, secreted in the semen to cleave and liquefy the seminal coagulum formed after ejaculation. It is sensitive for carcinoma prostate but not specific. Normal value is 4 ng/ml of plasma. Value >10 ng/ml is significant. Cancer detection rate is 2-4%. About 30% of men with elevated PSA will have prostate cancer confirmed by biopsy. But about 20% of those with clinically significant prostate cancer have PSA level within normal range. Reference : page 1043, 1044 SRB's manual of surgery 5th edition and page 1354 Bailey and Love's sho practice of surgery 25th edition


Question: Cottons fracture is fracture of


Question: The best cosmetics results for large capillary (po wine) hemangiomas are achieved by

Po wine stain treatment is with intense pulsed light and pulse dye laser . PWS may be associated with various syndroms Sturge-Weber syndrome Klippel-Trenaunay syndrome Proteus syndrome: Bailey and love 26th edition pg 599


Question: Meckel&;s diveiculum is remnant of

It is a congenital diveiculum arising from the terminal ileum and is pa of the unobliterated proximal poion of the vitello intestinal duct..Intestinal endof the vitelline duct may remain patent forming Meckel's diveiculum, which may be attached to umbilicus with a fibrous band. Meckel's diveiculum itself can cause diveiculitis, obstruction. ref:SRB&;S manual of surgery,ed 3,pg no 798


Question: Most common type of shock in emergency room is

Hypovolaemic shock is the most common form of shock


Question: Tardy ulnar nerve palsy occur as a delayed sequele of

Fracture of lateral condyle of humerus in children


Question: Avascular necrosis of bone is most commonly seen in


Question: Parastomal hernia is most frequently seen with

end colostomy is always permanent colostomy,which is done 6 cm above and medial to the anterior superior iliac spine in the left iliac fossa.it is also done as bringing out of proximal colon as in Haman's procedure. Ref:SRB's manual of surgery,ed,3,pg no 839


Question: Most common tumour of the pancreas is

Exocrine tumors are mostly Solid tumors (75%) among which main is Ductal adenocarcinoma(85%).


Question: &;Cystosarcoma phyllodes&; is best treated by

Cystosarcoma phylloides are not simply giant fibroadenoma. They show a wide spectrum of activity, varying from almost a benign condition (85%) to a locally aggressive and sometimes metastatic tumour (15%). Depending on mitotic index and degree of pleomorphism they are graded as low grade to high grade tumours. Treatment; Excision or subcutaneous or simple mastectomy is done. If malignant (sarcoma), total mastectomy is indicated Ref; (page no; 520) 5th edition of SRB&;S manual of Surgery


Question: Potter syndrome is not assoiated with

Since there is b/l kidney agenesis or cystic disease there is no urine production
leading to oligohydromnios


Question: Carcinoma tongue less than 2 cm is treated by


Question: The expression of the following oncogene is associated with a high incidence of Medullary carcinomas of thyroid


Question: A person present in Emergency. On examination he is found to open eyes only on painful stimuli, he says inappropriate words and moves his limbs on commands. His GCS is

Ans. (a) 11Ref Surgery Sixer 2nd edition Page 109Based on GCS table* Eye opening on painful stimuli - 2 points* Inappropriate words - 3 points* Obeys commands to motor response - 6 points


Question: Treatment of choice for medullary carcinoma thyroid

Ans) a (Total thyroidectomy) Ref Bailey 25th ed 797Medullary carcinomaTumors of parafollicular cells derived from the neural crest. Amyloid stroma is characteristic.High levels of CEA & calcitonin (useful for follow up)Diarrhoea 30% (due to 5 - hydroxy tryptamine or PG)10 - 20% case familialMEN 2A - Med carcinoma thyroid hyperparathyroidism phaeochromocytoma (adrenal)MEN 2B - MEN 2A +mucosal neuromas +marfanoid habitusLymphnode involvement in 50 - 60% casesBlood bom mets commonTumor is not TSH dependent and do not take radioactive iodine.TreatmentTotal thyroidectomy & either prophylactic or therapeutic resection of the central & bilateral cervical nodes.Familial casesGenetically screened for RET proto oncogene along with S.calcitonin levels.Prophylactic surgery is now recommended for infants with genetic traits.Surgical cases should exclude phaeochromocytoma with urinary catecholamine levelsMost common thyroid cancer - Papillary CaBest prognosis is for Papillary CaClassification of thyroid neoplasmBenignFollicular adenomaMalignantPrimaryFollicular epithelial differentiated - follicular & papillaryFollicular epithelial undifferentiated - AnaplasticParafollicular cells - MedullaryLymphoid cells - LymphomaSecondaryMetastaticLocal infiltration


Question: Best investigation for carcinoma colon


Question: In Forrest classification visible clot at ulcer base is

FORREST - Classification of upper gastrointestinal hemorrhage
Acute hemorrhage
Forrest IA - Active spurting hemorrhage
Forrest IB - Oozing hemorrhage
Signs of recent hemorrhage
Forrest IIA - Non-bleeding visible vessel
Forrest IIB - Adherent clot
Forrest IIC - Hematin on ulcer base
Lesions without active bleeding
Forrest III - Clean-base ulcers.


Question: 75% Lymph from breast goes to

Answer- A. Axillary L.N.Lymphatic drainage of Breast is as follows : -Axillary nodes (75%)Internal mammary or Paresternal nodes (20%)Posterior intercostal lymph nodes (5%)


Question: Amide type of local anesthetic agents undergo bio transformation primarily in the


Question: Recurrent fibroma refers to Desmoid tumor arising in


Question: Modified amstredam criteria is used for diagnosis of

HNPCC / lynch is diagnosed bt modified emstredam eciteria.


Question: A full thickness wound having length greater than the depth caused by a sharp object is described as


Question: Ormond's disease is

In 70% cases of Ormond's disease Idiopathic retro peritoneal fibrosis is seen.

Idiopathic retro peritoneal lymphadenopathy


Question: Battle's sign is

(B) Ecchymosis around mastoid area # Battle's sign, or mastoid ecchymosis, is an indication of fracture of posterior cranial fossa of the skull, and may suggest underlying brain trauma.> Battle's sign (named after William Henry Battle) consists of bruising over the mastoid process, as a result of extravasation of blood along the path of the posterior auricular artery.> Note well that this sign will take at least one day to appear after the initial traumatic basilar skull fracture, similar to Raccoon eyes.> It is usually seen after head injuries resulting in injury to mastoid process leading to bruising.> Battle's sign may be confused with a spreading hematoma from a fracture of the mandibular condyle (less serious injury).


Question: Most common nerve injured during thyroidectomy

MC injured nerve - External branch of superior laryngeal nerve (aka External laryngeal nerve)


Question: The commonest anterior mediastinal tumour is

Thymomas are the most common anterosuperior mediastinal tumors accounting for 25% of the total.They are commonly associated with myasthenia gravis.Diagnosis and treatment is best achieved by complete thymectomy. Reference:SRB's manual of surgery,5th edition,page no:1127.


Question: Normal CVP is

.CENTRAL VENOUS PRESSURE (CVP) It is a method to measure the right atrial pressure by placing a venous catheter (20 cm) into the SVC. Commonly for CVP monitoring, a venous catheter is passed through internal jugular vein or infraclavicular subclan vein to the SVC (used for TPN purpose).Normal value is 2-10 cm of saline. If less than 2 cm, more fluid is infused. If more than 10 cm, fluid infusion should be restricted. ref:SRB&;s manual of surgery,ed 3,pg no 96


Question: Carcinoma of the prostate arise from

(Peripheral zone) (1045-CSDT 12th) (1354-B &L 25th)CARCINOMA OF PROSTATE - 90% of tumours are adenocarcinoma the tumour arises primarily in the peripheral zone (70%) an area that differs in embryoic derivation from the periurethral (transition) zone which is the site of formation of benign prostatic hyperplasiaScreening - by transrectal ultrasound (TRUS/and prostate specific antigen (PSA)* PSA = (under age 55 years) normal > 2.5 ng/ml= over age 65 years/ normal > 6.5 ng/ml.* PSA density (PSA divided by prostate volume) >0.15 suggest cancer* Percent free PSA (Total PSA minus complexed PSA) where when < 10% the risk of prostate cancer is 60% (only useful with total PSA 2-10 mg/ml)* Newer methods for measuring unbound (free) PSA have substantial promise for differentiating benign from malignant disease


Question: Le dance sign is seen in

Le dance sign is empty right iliac fossa, seen in Intussusception.


Question: Lower lip paresthesia occurs in


Question: Sentinal lymph node for carcinoma penis is know as

Cabana Node ⇒ Superficial injuinal node is the sentinal lymph node for carcinoma penis.


Question: Reperfusion is useful for aEUR'

Hibernating Myocardium "Hibernating myocardium" is a state of persistently impaired myocar- dial and left ventricular function at rest due to reduced coronary blood flow that can be paially or completely restored to normal if the myocardial oxygen supply demand relationship is ourably allered either by improving blood flow and/ or by reducing demand - Hibernation is a response to chronic reduction in resting coronary blood flow, leading to a new equilibrium where myocardial metabolism was altered with a subsequent reduction in energy production and myocardial contractility The initial triggering event i.e., reduction the blood flow was followed by a downregulation in cardiac function to a point at which the limited Oxygen supply enabled the maintenance of biochemical functions that sustained cell integrity - If the myocardial oxygen supply/demand was subsequently altered either temporarily or permanently then symptoms or signs of ischemia and/or necrosis might- occur - The hibernating response of the hea, namely a reduction of cardiac .function to cope with a reduced myocardial blood flow was considered an act of self preservation (Little blood, Little work) This chronic adaption occurs in the absence of angina (the lack of resting pain is a unique sign of chronic hibernation) or electrocardiographic evidence of ischemia and was thought to be a protective mechanism reducing the oxygen demand of hypoperfused myocardium and preserving long term bility On imaging, the hea is presented as area of left ventricular wall that could have been hypokinetic, akinetic dyskinetic Myocardial stunning This describes a clinical state where after a period of "transient ischemia" the hea goes into period of "Persistent dysfunction" even after the flow is reversed The impoant point to note in myocardial stunning is that the left ventricular dysfunction persisted after reperfusion despite the absence of irreversible damage and despite the restoration of normal or near normal coronary blood flow. It is believed or proposed that due to ischemia the hea is stunned .for a period of time. So even after the blood flow is restored the hea will not regain its function immediately. It will remain in its dysfunctional state for a ceain period of time and then resumes its normal activity. Its should be noted that myocardial stunning is a fully reversible abnormally, provided of course that sufficient time is allowed for myocardiunt to recover. Hibernating and stunned myocardium are clinically very impoant conditions of contractile asynergy, since they are potentially reversible Hibernating myocardium is similar to stunned myocardium in that both are characterized by ble myocardial cell with depressed function. When ischemia is relieved the hibernating myocardium exhibits nearly "immediate return" of function where as stunned myocardium exhibit "gradual recovery"


Question: Treatment of choice for annular pancreas is

Ans. is 'a' i.e., Duodenoduodenostomy "The usual treatment is bypass (duodenoduodenostomy)" -- Bailey and Love"Retrocolicduodenojejunostomy is the procedure of choice." -- Harrison"Treatment usually involves bypass, through duodenojejunostomy, rather than resection." -- Sabiston"The surgical treatment of choice for duodenal obstruction due to duodenal stenosis or atresia or annularpancreas is a duodenoduodenostomy." -- Schwartz 9/e


Question: Compament syndrome is commonly seen in

Answer-A. Fracture of proximal tibiaHigh-risk injuries for development of compament syndrome are fractures of the elbow, forearm bones, proximal third of the tibia, and also multiple fractures of the hand or foot, crush iniuries and circumferentialburns.


Question: Consider the following with reference to the management of poal hypeension surgery

Surgeries for poal hypeension * Devascularisation surgeries * Decompression surgeries * Ohotopic liver transplant (OLT) Surgeries for oesophageal varices and poal hypeension Nonselective shunts * End to side poa caval shunt (ECK fistula) * Side to side poa caval shunt * Mesenteric-caval shunt * Mesenteric-caval shunt with graft * Proximal splenorenal shunt--Linton's shunt * TIPSS Selective shunts * Distal splenorenal shunt--Warren's shunt * Inokuchi shunt between left gastric vein and IVC through a graft. Poa azygos disconnection * Oesophageal stapler transection of Johnston * Boerema--Crile operation--thoracic approach * Milnes--Walker thoracic oesophageal transection * Tanner's abdominal oesophagogastric transection * Hassab operation. Devascularisation and splenectomy. * Sugiura--Futagawa operation--vagotomy, pyloroplasty, devascularisation, splenectomy. * Splenectomy *Liver transplant Ref: SRB&;s manual of surgery,3 rd ed, pg no 555


Question: Fever in burnt patient is cause by

Fever in burn patients Many of the physiological criteria that has been claimed to reflect sepsis are non-infectious manifestations of post injury hypermetabolism Hypehermia (39degC or greater) is occasionally a febrile a response to infection, paicularly in children, but episodic elevation in temperature are common in uninfected burn patients The hypermetabolism phase mediated by greatly increased levels of catecholamines, prostaglandins, glucagon and coisol occurs after the acute phase and also produces pathophysiological changes Burn patients exhibit increased blood flow to organs and tissues, an increased internal core temperature, hypoproteinaemia and edema formation Ref: Sabiston 20th edition Pgno :516


Question: Healing below knee joint is slow because of


Question: Crush syndrome is managed by

C i.e. Maintaining high Crush Syndrome It is seen when a limb is compressed for many hours in a vehicle, rubble or pneumatic antishock garment, resulting in massive crushing of musclesQ and release of large amounts of myohaemoglobinQ


Question: Most common type of sarcoma of breast

Ans. (a) Angioarcoma(Ref. Sabiston page 842,20th edition)* Angiosarcoma most commonly follows RT to the axilla.* Characterized by Bluish purple nodule clinically


Question: The symptom that doesn&;t improve with TURP is

Post-micturition dribble will not improve with TURP. It can be related to weak sphincter or other causes which may not improve with TURPBailey and Love 27e pg: 1459


Question: Investigation of choice in the early phase of renal transplant

• Vascular complications after renal transplantation are low, presents during the first week after transplantation with sudden pain and swelling at the site of the graft.
• Diagnosis is confirmed by Doppler ultrasonography.
• Urgent surgical exploration is indicated and, in most cases, transplant nephrectomy is required.


Question: Hose pipe appearance of intestine is a feature of

.Pathology of crohn&;s disease, Transmural inflammation >>Granuloma formation with linear snake like ulcers>>Cicatrisation>> Thickening of the bowel wall (Hose pipe pattern)>>Adhesions>> Fistula formation.Barium enema--shows loss of haustrations, narrow contracted colon (hose pipe colon), mucosal changes, pseudo polyps. It is avoided in fulminant cases. ref:SRB&;s manual of surgery ,ed 3,pg no 825


Question: The causal mechanism in carcinoid syndrome is due to

Carcinoid syndrome develops (in 10% of carcinoid tumours) due to release of 5-HT (serotonin), kinins, prostaglandins, histamine and indoles causing flushing, diarrhoea, cyanosis, asthmatic attacks, hepatomegaly, cardiac lesion on right side.. Reference : page 878 SRB's manual of surgery 5th edition


Question: The commonest site of an intraperitoneal abscess

Pelvis is the most common intraperitoneal abscess.(50-60%).It is the collection of pus in rectovesical or rectouterine pouch(pouch of Douglas). The pelvis is the commonest site of an intraperitoneal abscess because the vermiform appendix is often pelvic in position and the fallopian tubes are frequent sites of infection. Reference:Bailey & Love's sho practise of surgery,25th edition,page no:996;SRB's manual of surgery,5th edition,page no:576.


Question: Prevention of human brucellosis depends primarily on

Prevention of human brucellosis depends on pasteurization of dairy products from cows, goats, and sheep; education of farmers and workers in the livestock industry as to the dangers of infected animals; and care in handling products from aboed animals. There is no insect vector. No vaccine for human use is available. Since person-to-person transmission does not occur, treatment of individual cases will not control spread of brucellosis. Destruction of infected animals will prevent transmission to other animals and is a method to control an outbreak in animals. Vaccine is available for livestock, for prevention but not control of outbreak. Immunity from the vaccine lasts only two years.

Pasteurization of dairy products derived from goats, sheep, or cows

Immunization of farmers and slaughterhouse workers.


Question: The term Bennett's fracture is used to describe

D i.e. Fracture dislocation of trapezometacarpal joint

Fracture-dislocation of metacarpophalangeal joint of thumb

Interphalangeal fracture dislocation of thumb

Anterior marginal fracture of distal end of radius


Question: Cavity formation in bronchogenic carcinoma occurs in


Question: A 10 month old infant presents with intussesception, likely cause is

Most common cause of intussusception in children is hypertrophy of Peyer's patches due to Rotavirus infection.


Question: Fluid levels are not visible in

In meconium ileus meconium is so thick that it is unable to form air-fluid level despite complete small intestinal obstruction (Note the multiple air-fluid level is a feature of mechanical small bowel obstruction & paralytic ileus).


Question: Duga's test is helpful in

Di.e. Anterior Dislocation of shoulder Anterior Dislocation of ShoulderShoulder is the commonest joint to undergo recurrent & /or nonrecurrent (traumatic) dislocationQ.Anterior dislocation is the commonest type of shoulder dislocationQ accounting for - 97% of cases.


Question: The most common neoplasm of kidney is


Question: Treatment of choice of flail chest is

.It is fracture of two or more consecutive ribs, with each rib having two or more fracture sites. Such segment is called as flail segment. Treatment  Intercostal tube drainage.  Applying clips to fracture ribs and fi xing above and below to normal ribs.  Antibiotics like penicillins, cefotaxime.  Blood transfusion, IV fluids.  Bronchodilators, steroids.  Ventilator suppo with IPPV--IPPV is treatment of choice. Assisted ventilation is required for several days until the chest wall stabilises. If ventilator suppo is required for more than 10 days, then tracheo stomy is done to prevent laryngeal stenosis which can occur due to prolonged endotracheal intubation.  Thoracotomy--when required only. Ref: SRB's Manual of Surgery, 4th Edition, pg. no. 1196

Ext. fixation of flail segment & mech ventilation


Question: Nipple retraction in Ca breast due to infiltration of

Answer- B. Lactiferous ductsIt is seen in breast carcinoma due to infltration of the lactiferous ducts by carcinoma.It is due to extention of the growth along the lactiferous ducts and subsequent fibrosis.Nipple retraction is circumferential in carcinoma and slit like in periductal mastitis.


Question: Liver donor healthy person

(D) Mortality for donor is 0.5 %# DEATH AFTER LIVING DONOR LIVER TRANSPLANTATION (LDLT) has been reported at 0% (Japan), 0.3% (USA) and <1% (Europe), with risks likely to decrease further as surgeons gain more experience in this procedure.> Risk of dying from living liver donor surgery may be as high as 0.5% when donating the right lobe. If ail complications are included, 1 of every 3 donors will experience a complication; most are considered minor or have no permanent sequelae. Thus, centers must carefully weigh the risks against the benefits.> Likewise, potential living liver donors should balance the decision to donate with the advice of family, friends, an independent conor advocate, and the medical/surgical team.> As stated by Marsh and colleagues, "no matter how carefully right lobar living donor transplantation is applied, the historical verdict on the ethics of this procedure may be harsh."


Question: A Sentinel pile indicates

Ans. c (Fissure in ano) (Ref. Bailey and Love Surgery 26th/1250; Ref. Q. 216 of MH-2007).SENTINEL PILE- This misnomer is given to a skin tag marking--and often containing within it--the distal end of an anal fissure, found usually in the posterior midline.


Question: Earliest method of diagnosing pituitary tumour


Question: Fogarty,s catheter used for

Removal of blood clots from the arteries


Question: 80 kg male with bilateral upper limb, right lower limb with perineum burns 3rd degree, amount of fluid required in first 8 hours is

Answer- D. 6560 mlThe amount of fluid required fot the above patient = 4ml x 80 x 41 = 13120 ml.Half of the calculated fluid is gtum in first 8 hrs and half in next 76 hrs.So the amount of fluid to be given in the first hrs = total fluid required/ 2 = 1312O/ 2 = 6560ml


Question: Most common type of carcinoma of thyroid

Papillary carcinoma
Papillary carcinoma is the most common thyroid malignancy.
Nonetheless, when papillary cancer is diagnosed most patients will be  offered  treatment.  The  disease  is  known  for  its  propensity for lymph node metastases. These are more common in younger patients, in whom they do not affect the otherwise excellent survival.
Reference: Bailey & Love’s short practice of surgery , 27th  ed page no 818


Question: Triple assessment for CA Breast includes

Triple assessment: In any patient who presents with a breast lump or other symptoms suspicious of carcinoma, the diagnosis should be made by a combination of clinical assessment, radiological imaging and a tissue sample taken for either cytological or histological analysis the so-called triple assessment. Ref : Bailey and love 26thE pg 818

History, Clinical examination and mammogram

Clinical examination, Mammogram and FNAC


Question: Paresthesia over nasal and upper lip following fractured zygoma is because of involvement of


Question: Hypoparathyroidism after thyroidectomy commonly manifests in

Parathyroid insufficiency after thyroidectomyThis is due to removal of the parathyroid glands or infarction through damage to the parathyroid end aery; 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 per cent and most cases present dramatically 2-5 days after operation but, veryrarely, the onset is delayed for 2-3 weeks or if a patient with marked hypocalcaemia is asymptomatic.


Question: Bag of worms in scrotum is seen in

Ans. is 'a' i.e.,Varicocele Varicocele* A varicocele is a varicose dilatation of the veins draining the testis.* Most varicoceles present in adolescence or early adulthood, usually on the left.* In many cases the dilated vessels are cremasteric veins and not part of the pampiniform plexus.* Obstruction of the left testicular vein by a renal tumour or after nephrectomy is a cause of varicocele in later life; characteristically, the varicocele does not decompress in the supine position.* Varicocele is usually symptomless but there may be an annoying dragging discomfort that is worse if the testis is unsupported.* The scrotum on the affected side hangs lower than normal, and on palpation, with the patient standing, the varicose plexus feels like a bag of worms.* There may be a cough impulse.* If the patient lies down the veins empty by gravity and this provides an opportunity to ensure that the underlying testis is normal to palpation.* In longstanding cases the affected testis is smaller and softer than its fellow owing to a minor degree of atrophy.* It is widely believed that varicocele causes infertility but the evidence is inconclusive.


Question: A person has been brought in casualty with history of road accident. He had lost consciousness transiently and gained consciousness but again became unconscious. Most likely, he is having brain hemorrhage of

Lucid interval' is a classical feature of extradural hemorrhage. Ref : Sabiston, 17/e p755


Question:
A morbid patient unlikely to survive 24 hours with or
without surgery is classified as


Question: Xanthogranulomatous pyelonephritis is often associated with infection by


Question: Most common cause of death in Crohn&;s disease is due to

.Complications of Crohn's * Intestinal obstruction * Stricture * Bleeding * Fistula formation * Carcinoma * Perianal abscess * Peritonitis * Pericolic abscess. ref:SRB&;s manual of surgery,ed 3,pg no 802


Question: Long term complication of a liver kidney donor is


Question: T/t used for lower ureteric stone is

Ans is 'a' ie Endoscopic removal Best modality of t/t for ureteric stone is - Ureteroscopic removal.There are other methods alsoEndoscopic Dormia basket - can only be used for small stones that are within 5-6 cm of the orifice.This has been replaced by ureteroscopic technique.Endoscopic Meatotomy - this is for removal of stones lodged in the intramural part of the ureter.Push bang method - If the stone is lying in the upper or middle part of the ureter; it can be pushed into the kidney pelvis using a ureteral catheter. The pt. can then be referred for ESWL (Extracorporeal shock wave lithotripsy)Lithotripsy in situ


Question: The most common cause of shock of children is

Hypovolemic shock is the most common cause of shock in children and adults.


Question: Trendelenberg test is positive in palsy of

Ans. is 'b' i.e., Gluteus medius Trendelenberg test : It tests the stability of the hip and paicularly of the abductor mechanism of the limb on which the patient is standing. Principle of the test : Normally when one leg is raised from the ground the pelvis tilts upwaras on that side, through the action of the hip abductors of the standing limb. If the abductors are inefficient they are unable to sustain the pelvis against the body weight and it tilts downwards instead of rising up on the side of the lifted leg. Note that the test is performed with the patients standing on the affected leg. Abductor mechanism : It can be compared with the lever, with the body weight being trying to tilt the pelvis down; the hip joint being the fulcrum and the abductor muscles being the power acting throught the lever arm (from the head of the femur to attachment of the abductor muscles on the greater trochanter - the neck of the femur). Causes of positive trendelenberg test : Any failure of abductor mechanism causes dipping of the pelvic (ASIS) on the normal side. There are three fundamental causes : 1) Paralysis of the abductor muscles (Supplies gluteus medius & minimus) eg. Polio. Paralysis of superior gluteral nerve 2) Marked approximation of the inseion of the abductor muscles to their origin by upward displacement of the greater trochanter ; so that the muscles are slack. eg. Severe coxa vara, dislocation of hip 3) Absence of stable fulcrum & lever arm about which the abductor muscles can act Neck femur fracture Dislocation of hip, Destructruction of head as in Pehe's diseases.


Question: Increased risk factor for carcinoma breast is

Risk factors of breast carcinoma Mutation of tumour suppressor genes BRCA1/BRCA2 is thought to be involved with high-risk of breast carcinoma Diet low with phytoestrogens and high alcohol intake have high-risk of breast cancer. Vitamin C reduces the risk. It is more common in nulliparous woman. Attaining early menarche and late menopause have high-risk of breast malignancy. Early child-bearing and breastfeeding reduces the chances of malignancy. Early 1st child bih reduces the risk; late first child bih after 35 years increases the risk. It is more common in obese individuals Ref; (page no;530 ) 5th edition of SRB&;S manual of Surgery.


Question: Most common oral cancer;

MC histological type- Squamous cell ca MC type of cancer in India - CA oral cavity MC site of CA Oral cavity - Tongue > lip IOC for Dx - Edge Biopsy


Question: Aims of abbreted laparotomy

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


Question: Most common cause of a Krukenberg tumour is

A Krukenberg tumor refers to a malignancy in the ovary that metastasized from a primary site, classically the gastrointestinal tract, although it can arise in other tissues such as the breast. Gastric adenocarcinoma, especially at the pylorus, is the most common source.Krukenberg tumors are often (over 80%) found in both ovaries, consistent with its metastatic nature. Krukenberg tumors can be seen in all age groups, with an average age of 45 years. In most countries, cancer that has metastasized to the ovary accounts for only about 1 to 2% of ovarian cancer; in the remainder, the ovary itself is the primary cancer site. However, in Japan they represent a much higher percentage of malignancies in the ovary (almost 20%) due to the increased prevalence of gastric cancer. Ref: Internet sources (Wiki)


Question: Incision used in thyroidectomy


Question: Best prognosis among RCC is

Chromophobe has best prognosis
Collecting duct has the worst prognosis.


Question: Fracture shaft of femur in adult unites by

C i.e. 3-4 months It is said that a fractured shaft femur should unite in 100 days, plus minus 20 (3 - 4 rnonths)Q. But nonunion is probably best defined by a lack of progression of healing combined with clinical symptoms of discomfo at a minimum of 6 months from the time of treatment. Fuher, a nonunion implies that healing is considered unlikely without fuher intervention.


Question: Preferred time for prophylactic antibiotic administration for surgery

Prophylactic Antibiotics Antibiotics should be used when local wound defences are not established (the decisive period) Ideally, maximal blood and tissue levels should be present at the time at which the first incision is made and before contamination occurs. IV administration at induction of anaesthesia is optimal If induction is not mentioned in the option go for 30 minutes to 1 hour before surgery. In long operations, those involving the inseion of a prosthesis, when there is excessive blood loss or when unexpected contamination occurs, Antibiotics may be repeated 8 to 16 hours later. The use of the newer, broad spectrum antibiotics for prophylaxis should be avoided. Benzylpenicillin should be used if clostridium gas gangrene infection is a possibility Patients with hea valve disease or a prosthesis should be protected from bacteraemia caused by dental work, urethral instrumentation or visceral surgery Ref: Sabiston 20th edition Pgno :224


Question: Massive edema in body in a patients of burns is due to

Massive edema in burns is due to altered pressure gradient because of injury to basement membrane.

Cardiac dysfunction due to release of cardiac depressants

Basement membrane injury causing altered pressure gradient


Question: A 50 Yr. old male presents with obstructive symptoms. Biopsy of stomach reveals Gastrointestinal stromal tumor (GIST). Most appropriate marker for GIST is

.* GIST arises from interstitial cell of Cajal (pacemaker cell which intercalates between smooth muscle cells and intramural neurons). Mutation of tyrosine kinase and platelet derived growth factor alpha (PDGFa) are the newer pathogenetic theories. * GIST is classified as very low risk (2 cm); low risk (2-5 cm); intermediate risk (5-10 cm) and high risk (> 10 cm) based on tumour size and mitotic activity of cells. * 95% of GISTS express c-kit - CD117 mutations - a specific molecular marker. ref:SRB&;s manual of surgery ,ed 3,pg no 791


Question: The Gold standard investigation for GERD is

(A) 24 hr pH monitoring > Useful investigations may include barium swallow X-rays, esophageal manometry, 24 hour esophageal pH monitoring and Esophagogastroduodenoscopy (EGD). In general, an EGD is done when the patient does not respond well to treatment, or has alarm symptoms including: dysphagia, anemia, blood in the stool (detected chemically), wheezing, weight loss, or voice changes. Some physicians advocate once-in-a-lifetime endoscopy for patients with longstanding GERD, to evaluate the possible presence of Barrett's esophagus, a precursor lesion for esophageal adenocarcinoma.> Esophagogastroduodenoscopy (EGD) (a form of endoscopy) involves insertion of a thin scope through the mouth and throat into the esophagus and stomach (often while the patient is sedated) in order to assess the internal surfaces of the esophagus, stomach, and duodenum.> Esophageal manometry is a test that measures the function of the lower esophageal sphincter and the motor function of the esophagus. A tube is passed down your throat until it reaches the esophagus. It is often performed along with 24-hour pH probe study.> In a 24-hour pH probe study, a thin tube is placed down into your esophagus for 24 hours.


Question: The prognosis of rhabdomyosarcoma is likely to be poor if the site of the tumour is

Rhandomyosarcoma Rhabdomyosarcoma Arises from Mesenchymal tissues MC sites of origin : Head and neck (Parameningeal) > Extremities > Genitourinary tract > Trunk MC pediatric soft tissue sarcoma : Rhabdomyosarcoma Associated with : NF, Beckwith- Weidman syndrome, Li-Fraumeni and fetal alcohol syndrome Prognosis of Rhabdomyosarcoma Favourable primary sites Unourable primary sites Orbit Nonparameningeal head and neck Paratestis Vagina Extremity Parameningeal Ref: Devita 9th edition Pgno : 1780-1784


Question: Best investigation to diagnose colonic diveiculosis

Investigation of choice for colonic diveiculosis: Barium enema Investigation of choice for diveiculitis: CT scan


Question: Water content in infant

Ans. is 'b' i.e., 75-80% Schwaz writes - "the highest percentage of Total Body Water is found in newborns, with approximately 80% of their total body weight comrpised of water. This decreases to about 65% by 1 year of age and therafter remains fairly constant through childhood".


Question: 26 year old man died while playing. His autopsy of the hea revealed myocyte hyperophy. Diagnosis is aEUR'

HOCM Sudden death associated with spos or vigorous exeion along with the presence of hyperophied septum suggests the diagnosis of HOCM. Remember HOCM does not give specific symptoms. This disorder has variable presentation. Most patients are asymptomatic, and unfounately the .first clinical manifestation of the disease in such individuals may be death. M.C. manifestation of H.O.C.M. in symptomatic patients Dyspnea The essential feature of HOCM is massive myocardial hyperophyQ without ventricular dilatation. - The impoant feature of hyperophy is that it is asymmetricalQ, the ventricular septum is characteristically involved but ventricular wall is spared.


Question: Pierre Robin Sequence includes

Pierre robin syndrome includes cleft palate retrognathia posteriorly displaced tongue(glossoptosis) early respiratory and feeding difficulties SRB ,5th,347.


Question: Injury around the ankle joint occur at


Question: Osteomyelitis of the jaw can be cured by

Sequestrectomy with antibiotic treatment


Question: In Budd Chiari syndrome, the occlusion is at the

Budd chiari syndrome occurs when venous drainage of the liver is occluded by hepatic venous thrombosis or obstruction from a venous web Reference Bailey and love&;s 24 the edition page no.1074


Question: Carcinoma sigmoid colon with obstruction Management includes

- 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.Resection of the gangrenous sigmoid done; proximal cut is brought out as end colostomy: distal end closed - Hamann's operation. Later in 6-12 weeks colorectal anastomosis is maintained. ref:SRB&;s manual of surgery,ed 3,pg no 856

Resection and end to end anastomosis with proximal colostomy


Question: Mets form prostatic carcinoma are common in

Through batson plexus cancer spreads through bone.


Question: Verres needle is used for

Verres needle is used for creation of a pneumoperitoneum in closed method.Although this method is fast and relatively safe, there is a small but significant potential for intestinal or vascular injury on introduction of the needleRef: Bailey and Love 27e pg: 108


Question: Catgut suture is packed in


Question: The most posterior teeth are removed


Question: In order to activate helper/inducer T (CD41) lymphocytes, macrophages release

Interleukin 1 (IL-1) is a thymocyte mitogen produced by activated macrophages as well as many other types of cells (e.g., monocytes, dendritic cells, Langerhans cells, neutrophils, microglial cells). It induces interleukin 2 production by the helper T cell, which initiates a cascade of immunoregulatory and inflammatory functions.


Question: The etiologic factor implicated in the development of pulmonary insufficiency following major nonthoracic trauma is

Posttraumatic pulmonary insufficiency in the absence of significant thoracic trauma has been attributed to a wide variety of etiologic agents, including aspiration, simple atelectasis, lung contusion, fat embolism, pneumonia, pneumothorax, pulmonary edema, and pulmonary thromboembolism. In a landmark monograph entitled Respiratory Distress Syndrome of Shock and Trauma, Blaisdell and Lewis identified fat embolism syndrome as the etiologic factor. The mechanism of this condition appears to be pulmonary alveolar injury due to the mobilization of free fatty acids in the blood as an adrenergic response to trauma, rather than pulmonary injury from embolization of fat globules from fractured bones, as was originally thought.


Question: The first to appear in a cause of acute intestinal obstruction is

Symptoms of intestinal obstruction Symptoms of intestinal obstruction : Pain, vomiting, distension and constipation Pain is the first symptom encountered ; it occurs suddenly and is usually severe Pain in intestinal obstruction It is colicky in nature and is usually centered on the umbilicus(small bowel) or lower abdomen (large bowel) The pain coincides with increased peristaltic activity With increasing distension, the colicky pain is replaced by a mild constant diffuse pain The development of severe pain is indicative of the presence of strangulation Pain may not be a significant feature in post operative simple mechanical obstruction and does not usually occur in paralytic ileus Ref: Bailey and love 27th edition Pgno : 1285


Question: 26 yr old female came for the first time in OPD with lump in breast first investigation

Answer- B. MammogramRadiological investigations for the initial assessment for breast lump are either USG or Mammography.Since the patient given in the question is a young female. Ultrasonography is a preferred first investigation for evaluation of breast lump.ultrasound is paicularly useful in young women with dense breasts in whom mammograms are difficult to interpret, and in distinguishing cysts from solid lesions.


Question: Nelson syndrome is seen following

Nelson's syndrome also referred to as post adrenalectomy syndrome occurs following bilateral adrenalectomy in patients with pituitary dependant Cushing's syndrome. The common symptoms include: hyper-pigmentation of the skin, visual disturbances, headaches, abnormal high levels of beta-MSH and ACTH, abnormal enlargements of the pituitary gland(invasive pituitary macroadenoma), interruption of menstrual cycles in women.Reference : page 776 Davidson's principles and practice of Medicine 22nd edition


Question: Treatment of Papillary Ca of Thyroid with bony metastasis

Ans. is 'd' i.e. Near total thyroidectomy with radioiodine & radiotherapy As already mentioned in previous question, Total or Near total thyroidectomy is t/t of choice in PTC and also FTC (except minimally invasive cancer). Radioactive iodine '3'1is used post-operatively to detect and destroy any metastatic disease. It is also advised by some expes to do a routine 1311scan and therapy for all patients of differentiated thyroid cancer, postoperatively (except those with occult or minimally invasive disease). Screening with RAI is more sensitive than chest x-ray or CT scanning for detecting metastases; however, it is less sensitive than Tg measurements for detecting metastatic disease in most differentiated thyroid cancers except Huhle cell tumors. External beam radiotherapy is used to treat bone metastasis (to prevent fracture or to control pain). It is also occasionally used to control unresectable, locally invasive or recurrent thyroid carcinoma. There is no role for routine chemotherapy in differentiated thyroid cancers. Other Postop management in differentiated thyroid cancers Thyroid Hormone T4 is given as replacement therapy in patients after total or near-total thyroidectomy, and has the additional effect of suppressing TSH and reducing the growth stimulus for any possible residual thyroid cancer cells. TSH suppression reduces tumor recurrence rates. Thyroglobulin measurement Thyroglobulin (Tg) is produced only by thyroid follicular cells. Following total thyroidectomy, it should be undetectable in serum and any detectable level then indicates the persistence or recurrence of neoplastic disease. This is the basis for the use of Tg as a post-operative tumor marker in the follow-up of thyroid cancer patients Tg levels in patients who have undergone total thyroidectomy should be <2 ng/mL when the patient is taking T4 , and <5 ng/mL when the patient is hypothyroid.

Near total thyroidectomy with radiotherapy


Question: Treatment for achalasia associated with high rate of recurrence

Treatment of choice in case of high chance of recurrence is Endoscopic injection of botulinum toxin to sphincter. Botulinum toxin is neurotoxic protein derived from Clostridium botulinum is highly toxic poisonous substance. Very small amount is used for therapeutic purpose. 7 types of toxins are found. It blocks cholinergic nerve ends reducing the cholinergic acetylcholine release causing flaccid paralysis of muscles. Reference: SRB's Manual of Surgery, 6th Edition, page no= 791.


Question: Standard views for mammography are

Mammography views : Craniocaudal from above downward. Mediolateral from side to side. Ref : SRB&;s 4thE pg:547


Question: Wilm' s tumor associated with A/E

The genitourinary anomalies most commonly associated with Wilms tumor are

hypoplasia,
fusion and ectopia of the kidney,
duplications of the collecting systems,
hypospadias, and
cryptorchidism
(Bilateral polycystic kidney disease is not associated with the Wilm's tumor)

Syndromes Associated with Wilms Tumor

Several syndromes and congenital abnormalities commonly are reported in patients with Wilms tumor.
WAGR syndrome (contiguous gene deletion of WT1 & PAX6 on 11P13)
It consists of
Wilms tumor,
Aniridia,
Genitourinary abnormalities (cryptorchidism, streak ovaries, bicornuate uterus, ambiguous genitalia), and
Mental retardation.
Patients with this syndrome have a constitutional deletion of chromosome 11p13 where the Wilms tumor gene,
WT1, and the aniridia gene, PAX6, are located.
Denys- Drash syndrome(missense mutation in WT1 gene)
It is characterized by
Male pseudohermaphrodism,
Early-onset renal failure characterized by mesangial sclerosis and
Increased risk of Wilms tumor.
Patients with this syndrome typically carry a missense mutation in the WT1 gene.
Beckwith-Wiedemann syndrome (WT2 gene abnormality on chromosome 11P15.5)
It is characterized by
Hemihypertrophy,
Macroglossia,
Visceromegaly,
Omphalocele
Risk of developing Wilms tumor (3-5%)
A variety of 11p15.5 abnormalities have been reported in patients with this syndrome, and it is postulated that a second Wilms tumor gene, WT2, is located in this region. Loss of imprinting of the insulin-like growth factor 2 gene, an epigenetic process, also is associated with Wilms tumor.

Other syndromes or conditions with an increased risk of Wilms tumor include:

Hemihypertrophy,
Sporadic aniridia,
Genitourinary anomalies,
Pearlman syndrome,
Sotos syndrome,
Neurofibromatosis (von Recklinghausen disease), and Von Willebrand disease.

About option 'c' Hypertension.
"Hypertension also has been described and probably is due to renal ischemia."- Nelson
More about Wilm's tumor (also k/a nephroblastoma):

Wilm's tumor is the most common renal neoplasm & 2nd most common malignant abdominal tumor, in children (Most common abdominal malignant tumor is neuroblastoma)
Peak incidence is between 2 and 5 yrs of age.
5-10% are bilateral; either both kidneys are involved simultaneously (synchronous) or one after the other (metachronous)

Clinical features of W.T.

Abdominal lump (most common presenting feature)
Abdominal pain
Vomiting
Hematuria
Hypertension

Treatment:

High cure rates of 80-90% can be achieved with multimodality treatment using surgery, chemotherapy & radiotherapy
Surgical resection is done in all stages followed by chemotherapy (stage I&II) or chemotherapy + radiotherapy (stage III, IV, V)
Pre op chemotherapy is given in inoperable & bilateral cases

Chemotherapeutic agents used are Vincristine, Dactinomycin, Doxorubicin & Cyclophosphamide.


Question: Most common sarcoma in a child is


Question: Hippocrates facies is seen in

Most cases of peritonitis are caused by an invasion of the peritoneal cavity by bacteria, so that when the term 'peritonitis' is used without qualification, bacterial peritonitis is implied.When the peritoneum becomes inflamed, the temperature, and especially the pulse rate, rise. Abdominal pain increases and usually there is associated vomiting. The most impoant sign is guarding and rigidity of the abdominal wall over the area of the abdomen that is involved, with a positive 'release' sign (rebound tenderness). Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-992,993


Question: Most common location of Subdural hematoma is

Overall 85% of subdural haematomas are unilateral in adults. However, 75-85% are bilateral in infants. Common sites for subdural hematomas are frontoparietal convexities and the middle cranial fossa Reference: Textbook of Adult Emergency Medicine by Peter Cameron, 4th edition, page no: 78 :.


Question: In thyroid, the bruit is heard in

Ans. (b) Upper pole.Ref: Rajamahendran Long Cases In Surgery- Page 32 2nd Edition* Systolic bruit may be heard in superior pole outwards due to increased vascularity.


Question: Physiologic jaundice in term newborns is best characterized by

A rise in serum bilirubin concentration of less... Physiologic jaundice in term newborns is characterized by the appearance of clinical jaundice after 24 hours, an increase in bilirubin concentration of less than 5 mg/dl/day, total serum bilirubin concentrations of less than 13 mg/dl, direct serum bilinibin levels of less than 1.5-2 mg/dl, and the resolution of jaundice by the age of 1 week. Jaundice related to breast-feeding is termed breastfeeding jaundice, which typically responds to temporary discontinuation of breast-feeding.

The onset of clinical jaundice by 12 hours of age.

Persistence of clinical jaundice for at least 1 week.

Equal elevation of direct and indirect serum bilirubin values

A rise in serum bilirubin concentration of less than 5 mg/dllday


Question: Gene therapy is given in aEUR'

Severe combined immunodeficiency [Ref KDT 6m/e p. 843, 8441 Gene therapy Gene therapy refers to introduction of functional genetic material usually D.N.A. into target cells to replace or supplement defective genetic material. In contrast to all other therapies or drugs, gene therapy impas, new functions to a cell. Gene defects result in.fallure to synthesize a functional protein or in the synthesis of a dysfunctional protein. Equipping the cell with a normal copy of the defective gene would overcome the deficieny at the site where it is needed on a long term. Approaches in gene therapy :? Gene therapy tries to either modify or transfer the genes. Gene modification This involves correction of the defective poion of a genomic sequence or removal of the whole defective gene and its replacement by a normal copy. Gene transfer This involves introduction of genes without removing or altering the existing ones. Gene transfer is carried out in the following ways? i) Injection of naked D.N.A. ii) Transfer of generic material using virus as a carrier with D.N.A. incorporated into its genome. iii) Transfer of D.N.A. encapsulated within a liposome Applications of Gene therapy (where genetherapy is being considered) :? Cystic fibrosis (inseion of CFTR gene into respiratory epithelial cells) Severe combined immunodeficiency disease (introducing genes for adenosine deaminase) Growth hormone deficiency Familial hypercholesterelimia Lysch Nyhan syndrome Parkinsonism Alzhiemer's disease, Huntington's chorea. Familial amyotrophic lateral sclerosis, Gaucher's disease Stroke, head injury, multiple sclerosis Duchenne muscular dystrophy Prevention of restenosis of grafted coronary vessel Anemia Sickle cell anemia Haemophilia HIV infection Cancers Current status of Gene therapy (www.Fda.gov/Biologic.s bloodvaccines/cellular gene therapy) The food and drug administration has not yet approved any human gene therapy product for sale. - Current gene therapy is experimental and has not proven very successful in clinical trials. - Clear cut success in gene therapy has been achieved in Severe combined immunodeficiency (adenosine deaminase deficiency). - But there were repos that children treated with gene therapy in severe combined immunodeficiency developed leukemia. - Based on current data, the efficacy of gene transfer, .for severe combined immunodeficiency is convincing there have been no complications in the six children treated on this protocol, but longer term follow up will be required to determine whether this approach is sufficiency safe to he used in place of pegylated form of the enzyme adenosine deaminase.


Question: The most common cause of Superficial Thrombophlebitis is

Ans is A i.e. Intravenous catheters/infusion


Question: Old male came with jaundice, palpable mass in the right hypochondrium not associated with pain.

Ans. (a) Carcinoma Ampulla of VaterRef: Long cases surgery RRM* As per Courvoisier law"GB palpable is due to cancer-Distal CBD or Periampullary cancer"


Question: Most common complication of Giant cell aeritis

GIANT CELL AERITIS (TEMPORAL AERITIS) Superficial temporal, veebral & major aoic arch branches may be involved. Ischemic symptoms are common, including claudication of facial or extremity muscles & retinal ischemia Blindness, usually irreversible, is a dreaded complicated.


Question: Intermittent claudication

(A) Most common in calf region# INTERMITTENT CLAUDICATION:> Cramp like pain felt in the muscles that is brought on by walking, not present on taking the first step (OA) relieved by standing still (IVD)> The distance walked is called the claudication distance.> Most commonly felt in the CALF, but can affect the thigh or the buttock.> Less common in the upper limb (writhing or manual labor).CLINICAL SPECTRUM OF CLAUDICATIONIntermittent(Atherosclerosis)Neurogenic(Lumbar Spinal Stenosis)Venous(Deep Vein Thrombosis)* Pain is in the muscle of the calf, thigh or buttock* Pain is in whole leg can be associated with tingling and numbness* Involvement of whole leg* Unilateral in femoropopliteal disease* Bilateral (Can also be less commonly unilateral)* Patient may describe feeling their "leg is going to burst"* Bilateral in aorto-iliac disease* Comes on suddenly on standing up or walking* Most commonly unilateral* Gradual onset after walking "claudication distance"* Relieved by sitting down, bending over and stop walking* Gradual onset after beginning to walk* Pain is relieved by rest* Unable to straighten legs* Relief on elevating the leg* Absent/reduced pulses * Cyanosed* Varicose veins* edematousNB, The claudication distance is a constant distance the patient was able to walk before the onset of symptoms

Claudication distance is not consistent for an individual


Question: Post gonococcal stricture urethra is most commonly situated in the


Question: Alpha feto protein is increased in

Alpha fetoprotein AFP is a normal component of plasma protein of the fetus secreted by yolk sac and embryonal hepatocytes(fetal liver) which usually reduces after bih and persists as a low value level. Normal value is upto 10 ng/ml. It is an impoant tumour marker for hepatocellular carcinoma (100-1000 ng/ml). It also increases in non seminomatous testicular tumours, hepatoblastoma and some ovarian tumours(yolk sac tumours). It also increases in benign conditions (<100 ng/ml). It is useful in diagnosing omphalocele, ataxia telengiectasia, neural tube defects. Reference : page 594 SRB's manual of surgery 5th edition


Question: The most common cause of pathological fracture is


Question: A chronic alcoholic presents with abdominal pain radiating to the back that responds to analgesics. At evaluation the pancreatic duct was found to be dilated and stones were noted in the tail of pancreas. The most appropriate management is

conservative (70-90%) is first to be done in acute pancreatitis due to any cause SRB,5th,686.


Question: IOC for acute appendicitis in children


Question: Congenital hyperophic pyloric stenosis associated with

Due to electrolyte changes because of vomiting, hypochloremic, hyponatremic, hypokalemic, hypocalcemic, hypomagnesemic alkalosis occurs with paradoxical aciduria. Reference: SRB 5th edition page no. 829


Question: Investigation of choice to diagnose hyperophic pyloric Stenosis in infants is

Ultrasonography is recommended because its sensitivity and specificity are close to 100% for this disease. Ultrasound is reliable and easily performed and has replaced barium studies as the main investigation.There is a normal variation of pylorus muscle measurements with age and gestation but ultrasound has a very high sensitivity and specificity.


Question: In triage green color indicates


Question: Mikulicz's disease is


Question: Treatment of Choice for Annular Pancreas

Ans. (a) Duodeno duodenostomyRef: Bailey And Love 27th edition Page 1219* Annular Pancreas is the result of failure of complete rotation of ventral pancreatic bud during development, so that the ring of pancreatic tissue is surrounding the 2nd or 3rd part of pancreas.* Most common in down syndrome cases.* Presents with Vomiting in neonatal age.* Treatment is Duodeno Duodenostomy* In late cases presenting with pancreatitis - resection of head of pancreas is preferable to a lesser procedure than resection.


Question: Treatment of choice for cystic hygroma is

Definitive treatment for Cystic hygroma is complete excision of the cyst at an early stage if possible. Injection of a sclerosing agent is an alternative strategy and may reduce the size of the cyst, however they are usually multicystic and therefore complete resolution is a challenge. Reference : Bailey & Love, 27th Edition, page no = 754.


Question: IV formula for Bum is

A. i.e. (Total % body surface area x weight (kg) x 4 = volume (ml)) (384 -B &L 25th)* Simplest and most widely used formula is the Parkland formulaTotal % body surface area x weight (kg) x 4 = Volume (ml)* Half this volume is given in the first 8 hours and second half is given in the subsequent 16 hours* In children with bum over 10% TBS A and adults with bums over 15% TBSA, consider the need for intravenous fluid resuscitation* The key is to monitor urine output* The commonest colloid - based formula is the Muir and Barclay formula0.5 x % body surface area burnt x weight = one portion* * Ringer lactate is the most commonly used crystalloid

Total % body surface area x weight (kg) x 5 = volumc/ml)

Total % body surface area x weight (kg) x 6 = volume /ml)

Total % body surface area x weight (kg) x 7 = volume (ml)


Question: Volkmann's ischaemic contracture mostly involves


Question: Treatment of choice for squamous anal carcinoma is

Radiotherapy with concurrent chemotherapy (Chemoradiotherapy) is the standard of care for patients with nonmetastatic squamous cell anal cancer. Most patients treated with chemoradiotherapy have an excellent prognosis. Nigro Regime :Initial radiotherapy for 3 weeks 3000 rads (30 Gy total) to perineum and pelvis. Then chemotherapy--5 FU, for 4-5 days; is a radiosensitizer, staed on 1st day of as 1000 mg/m2 continuous infusion. Mitomycin C is 15 mg/m2 as single dose on 1st day of . Reference : page 987 SRB's manual of surgery 5th edition


Question: Most common Site of tongue Cancer

Ans. (c) Lateral margin of tongueRef.: SRB Manual of Surgery 4th ed. /1310Squamous cell cancer of the tongue is the commonest cancer. The location is at the following sites* Lateral margin -50%* Posterior 1/3 rd tongue-20%* Dorsum-6.5%* Ventral surface- 6%* Tip-10%


Question: Burns with vesiculation, destruction of the epidermis and upper dermis is


Question: According to Rule of Nine , burns involving perineum are

BURNS in % BSA

Determination of burn size estimates the extent of injury.
Burn size is assessed by Wallace rule of nines (By Alfred Russel Wallace)

Wallace Rule of Nines

In adults:

- Each upper extremity: 9%
- Head and neck: 9%
- Lower extremities: 18%
- Anterior and posterior aspects of the trunk: 18%
- Perineum and genitalia: 1%

Children have a relatively larger proportion of body surface area in their head and neck, which is compensated by a relatively smaller surface area in the lower extremities.

- In infants: Head and neck- 21%; Each leg-13%

Berkow formula is used to accurately determine burn size in children.
For estimating smaller burns: Area of open hand (including palm and extended fingers) of the patient is approximately 1% of TBSA.
This method is helpful in evaluating splash burns and burns of mixed distribution.


Question: Sensitive most investigation to detect minimal intraperitoneal free air

Although as little as 1 ml of free gas can be demonstrated radiographically, either in chest PA or a left lateral decubitus abdominal film, CT is superior to plain radiographs in detecting minute quantities of pneumoperitoneum. Chest PA view is more sensitive than even a left lateral decubitus abdominal film.


Question: A Poly A base sequence would be most likely found at the

The addition of a poly A tail to the 3' end is one of the post-transcriptional modifications that occurs in the processing of eukaryotic messenger RNA (mRNA). A cap consisting of a guanosine derivative is attached to the 5' end. Intervening sequences (introns) are removed by splicing. All of these processing events occur in the nucleus of eukaryotes. Prokaryotic mRNA undergoes none of these modifications.

5' end of a prokaryotic messenger RNA (mRNA)


Question: Radioiodine is preferred for the treatment of

Ans. (d) Diffuse toxic goiter in > 45 years old.Ref: Schwartz 10th edition, Page 1533Contraindications for RAI ablation in Graves' disease* Pregnancy* Lactation* Young (Children and adolescents)* Nodules in thyroid gland* Ophthalmopathy (Progression of Graves ophthalmopathy happens)


Question: Hyperkalemia with no ECG finding. The drug that should not be used isaEUR'

Calcium gluconate (Also see AIIMS May 2010) . Calcium gluconate is the fastest acting agent used in t/t of hyperkalemia. . In acts within nzinutes but an impoant point to note is that it does not cause transcellular movement of potassium, instead it acts on cell membrane. - It stabilizes the cardiac cell membrane and reduces chances of cardiac arryhthmia. - Thus it has no use when there are no E.C.G. features. NaHCO3 NaHCO3 has been routinely used in the treatment of hyperkalemia. It was believed that NaHCO3 caused movement of potassium inside the cells by causing alkalosis. But studies do not suppo this - They claim that NaHCO3 do not cause movement of potassium inside the cells in acute cases of hyperkalemia. - It only decreases potassium when there is coexisting acidosis. - NaHCO3 can decrease potassium level in chronic hyperkalemia. It increases potassium delivery to the kidney. But the use of NaHCO3 still continues in most hospitals and institutes across the world. - It is now hypothesized that NaHCO3 does not cause IC* entry inside the cell by mechanism earlier believed to be, but by another mechanism. The question does not say anything about acidosis. Don't think that acidosis occurs only in severe hyperkalemia. Most patients with C.R. F. present with acidosis and mild moderate hyperkalemia. In hyperkalemia with no E.C.G. feature, calcium prophylaxis is not indicated - Calcium gluconate is administered to stabilize the cardiac membrane - Instability of the cardiac membrane is indicated by E.C.G. changes - Absence of E.C.G. changes suggest that the cardiac membrane is stable. In these cases there is no use of calcium administration. Prophylactic calcium gluconate is of no use.


Question: Commonest cause of non traumatic subarachnoid hemorrhage

Ans. (b) Berry aneurysm ruptureRef: Bailey 26th 320 Schwartz 10th 1730* Most common cause of SAH - TRAUMA* Most common cause of non traumatic subarachnoid hemorrhage - BERRY ANEURYSM RUPTURE


Question: The Father of Modern Surgery is

Though it may seem ridiculous to remember the names of innumerable scientists and personalities it assumes great impoance in view of the current trend of AIPGME and AIIMS exams which contain at least 1 persona based question each time. Here is a comprehensive list of all the FATHERS of all our SUBJECTS : Father of Anatomy Herophilus of Chalcedon Father of Physiology Claude Bernard Father of Microbiology Louis Pasteur Father of Bacteriology Sir Robe Koch Father of Chemotherapy Paul Ehrlich Father of Pharmacology Oswald Schmiedberg Father of Modern Pathology Rudolf Virchow Father of Forensic Medicine Bernard Spillsbury Father of Modern Epidemiology John Snow Father of Occupational Health Ramazzini Father of Modern Medicine Hippocrates Father of Indian Medicine Charaka Father of American Medicine William Osler Father of Modern Surgery Ambroise Pare Father of Indian Surgery Sushruta Father of Antiseptic Surgery Joseph Lister Father of Modern Inguinal Hernia Surgery Edoardo Bassini Father of Thyroid Surgery Emil Kocher Father of Genetics Gregor Mendel Father of Modern Human Genetics Dr Victor A. McKusick Father of Psychoanalysis Sigmund Fruend Father of Porphyrin chemistry Hans Fischer Father of PTCA Andreas Gruntzig Father of Modern Psychiatry Johann Weyer Father of American Psychiatry Benjamin Rush Father of Biology Aristotle Father of Diagnostic Imaging Roentgen


Question: Treatment of malignant hyperthermia is


Question: The most common complication of ERCP

ERCP carries additional risks. Pancreatitis occurs in about 5% of patients undergoing ERCP and is seen in up to 25% of patients with sphincter of Oddi dysfunction. Young anicteric patients with normal ducts are at increased risk. Post-ERCP pancreatitis is usually mild and self-limited but may infrequently result in prolonged hospitalization, surgery, diabetes, or death. Bleeding occurs after 1 % of endoscopic phincterotomies. Ascending cholangitis, pseudocyst infection, and retroperitoneal perforation and abscess may all occur as a result of ERCP. Common cause of pancreatitis 1. Gallstones (including microlithiasis) 2. Alcohol (acute and chronic alcoholism) 3. Hyperiglyceridemia 4. Endoscopic retrograde Cholangiopancreatography (ERCP), especially after biliary manometry 5. Trauma (especially blunt abdominal trauma) 6. Postoperative (abdominal and non abdominal operations) 7. Drugs (azathioprine, 6-mercaptopurine, sulfonarnides, estrogens, tetracycline, valproic acid, anti-HIV medications) 8. Sphincter of Oddi dysfunction.


Question: In Recurrent Anterior dislocation of shoulder, the movements that causes dislocation is


Question: Looser's zone is present in September 2010 March 2013 (a, f)

Ans. B: Osteomalacia Pseudo-fracture (Looser zone): A lucent band of decreased coical density Perpendicular to bone surface Often multiple, +/- symmetrical +/- callus formation "Pathognomonic" of osteomalacia and seen on compressive (concave) side (eg, prox femur) Also seen in Paget dz on tensile (convex) side


Question:
Maastricht classification of category 3 stands for DCD donor
stands for

Cardiac arrest and unsuccessful resuscitation in hospital

Awaiting cardiac arrest after withdrawl of life support


Question: An ulcer that may develop in burn tissue is

Marjolin's ulcer is the name given to a malignancy (usually sq cell ca) which arises in a:

any long-standing wound or
a scar: eg scar of an old burn

It presents the following characteristics
It grows slowly as the scar is relatively avascular
It is painless as scar tissue contains no nerves.


Question: Charcot's/neuropathic joint are most commonly seen in


Question: A patient was operated 2 months back and at that time a midline incision was used. Now he requires a second operation and this the ideal incision to be used now is

(B) The scar of the previous incision is excised and the same incision is used # Scar of the previous incision is excised and the same incision is used .> We should not create more scars on patient body unnecessarily.> If it is possible we have use the same scar.

The same incision used without excision of old scar


Question: Adson test is used for determining vascular suffiency. It is useful in


Question: Human papillomavirus is most commonly associated with

Papillomavirus infects the skin or mucosa and causes benign tumors. The lesion is termed condyloma acuminatum. These tumors may undergo malignant conversion and become squamous cell carcinomas. Classification of the human papillomavirus is done by DNA hybridization, and to date 46 types have been recognized. Some types, such as 16 and 18 are more frequently associated with carcinoma, while others, such as 6 and 11, are associated with benign tumors or was.


Question: Spigelian hernia occurs through

Ans) b (Aponeurotic ....) Ref Sabiston 18th ed pg 1214Spigelian herniaOccurs through the spigelian fascia which is composed of the aponeurotic layer between the rectus muscle medially and the semilunar line laterally. Small -1 -2cm in diameter.Develop during the fourth to seventh decades of life.Localised pain in the area without a bulge (beneath the intact external oblique aponeurosis.)USG or CT abdomen confirms diagnosis.Risk for incarceration due to its relatively narrow neck.Obturator herniaWeakening of obturator membrane covering obturator canal. Obturator canal is formed by union of the pubic bone and ischium.Causes intestinal incarceration & strangulation.Howship-Romberg sign - compression of the obturator nerve which causes pain in the medial aspect of thigh.One half of patients present with complete or partial bowel obstruction.CT abdomen confirms diagnosis.Lumbar herniaEither congenital or acquired & occur in the lumbar region of the posterior abdominal wall. Hernias through superior lumbar triangle are more common.Superior lumbar triangle (Grynfeltt's triangle)- bounded by the 12,h rib, paraspinal, and internal oblique muscle.Inferior lumbar triangle (Petit's triangle)- bounded by the iliac crest, latissimus dorsi muscle, & external oblique muscle.Lumbar hernias are not prone to incarceration.Some named hernias1) Richter's hernia -Hernia in which the sac contains only a portion of the circumference of the intestine (usually small intestine). It usually complicate femoral & rarely Obturator hernia.2) Laugier's femoral hernia -This is a hernia through a gap in the lacunar (Gimbernat's) ligament. The hernia commonly strangulates.3) Narath's femoral hernia -Occurs only in patients with congenital dislocation of the hip & is due to lateral displacement of psoas muscle. Hernia is hidden behind the femoral vessels4) Cloquet's hernia -Sac lies under the fascia covering the pectineus muscle. Sac may co exist with the usual type femoral hernia sac5) Spigelian hernia -Hernia occurs through the linea semilunaris at the level of arcuate line i.e, a few centimeters above the inguinal ligament. Victims are above 50 years of age.6) Lumbar hernia -Occurs through Petit's triangle bounded below by crest of the ilium, laterally by the external oblique & medially by latissimus dorsi7) Hernia-en-glissade or Sliding hernia -A piece of extraperitoneal bowel, usually the caecum on the right side or the pelvic colon on the left side or the urinary bladder on either sides slides down out side the hernial sac forming a part of its wall being covered by the peritoneum on the hernial aspect only. Since left side is much more common than right side Sigmoid is the most common content of sliding hernia8) Littre'shernia -Hernia which contains Meckel's diverticulum9) Maydl's hernia or Hernia-en-w or Retrograde strangulation -Two loops of bowels remains in the sac & the connecting loop remains within the abdomen and be- comes strangulated.10) Gibbon's hernia - it is hernia with hydrocele11) Berger's hernia - Hernia in pouch of Douglas

Aponeurotic layer between rectus muscle and semilunar line

Membrane covering canal between pubic bone & ischium


Question: Most common cause of urethral stricture is

Urethral stricture CAUSES The common causes of urethral stricture are: * Inflammatory * Secondary to urethritis * Secondary to balanitis xerotica obliterans (BXO) * Traumatic (MC) * Bulbar urethral injury * Pelvic fracture urethral disruption injury * Iatrogenic * Secondary to urethral instrumentation including cath- eterisation and transurethral prostatectomy * Secondary to radical prostatectomy * Secondary to radiotherapy for prostate cancer * Idiopathic CLINICAL FEATURES Symptoms are usually hesitancy of micturition, straining to void and a poor urinary stream. The relative youthfulness of the patient often rules out prostatic enlargement, which characteristically occurs after the age of 50. As the stream becomes narrower, micturition is prolonged and is followed by postmicturition dribbling as a result of urine trickling from the dilated urethra proximal to the stricture. Urinary frequency by day and night is common and is due to incomplete bladder emptying, coexisting detrusor overactivity or urinary infection. If the stricture is tight enough, the patient will go into acute retention, although this is rare. If this happens, there is a danger that clumsy attempts to pass a urethral catheter will result in a false passage. If a patient has gone into retention because of a urethral stricture, its lumen will be too narrow to pass even a tiny catheter and suprapubic catheterisation is required. Investigation involves uroflowmetry, urethroscopy, urethrography and ultrasound scanning to assess bladder emptying and to detect any upper tract dilatation. The urinary flow rate is typically prolonged and plateau shaped while urethroscopy allows the stricture to be viewedas a circumferential scar. Openings of false passages commemorate previous misguided attempts to pass a urethral catheter. Urethrography using a water-soluble contrast medium will show the extent and severity of the stricture Ref: Bailey and love 27th edition Pgno : 1482


Question: The best treatment for the following skin lesion is

This is a case of basal cell carcinoma of skin. The most frequently occurring form of skin cancer BCCs are abnormal, uncontrolled growths or lesions that arise in the skin's basal cells, which line the deepest layer of the epidermis (the outermost layer of the skin). BCCs often look like open sores, red patches, pink growths, shiny bumps, or scars. Usually caused by a combination of cumulative UV exposure and intense, occasional UV exposure, BCC can be highly disfiguring if allowed to grow, but almost never spreads (metastasizes) beyond the original tumor site.


Question: Long standing goitre leads to

Long standing goitre leads to cancer, usually follicular. Dominant or rapidly growing nodules in longstanding goitres should always be subjected to aspiration cytology. Reference: Bailey & Love's Sho Practice of Surgery, 27th Edition, page no= 807.


Question: Tumor with perineural invasion

.SRB&;S Manual of Surgery 4th edition pg Adenoid cystic carcinoma has got high affinity for perineural spread both axially and circumferentially, antegrade and retrograde fashion along mandibular and maxillary divisions of trigeminal nerve and facial nerve. It infiltrates nerve more proximally for long distance. Tumor may reach Gasserion ganglion, pterygopalatine ganglion and cavernous sinus.


Question: Seabrocks operation is done for

Ans. (a) Parotid FistulaRef: SRB Manual of surgery, 4th ed p-438-39* Parotid fistula usually results following surgery or Trauma or infection* Fistulas from Parotid gland usually heals* Fistulas from duct wont heal and will need Newman and Seabrook operation - reconstruction of duct by double cannulation.


Question: Most common renal tumour is

(Renal cell carcinoma) (1329-30-LB) (1309-B &L 25th)Renal neoplasmBenignMalignant neoplasms* Adenoma* Wilm's tumour (Nephroblastoma in children)* Angioma* Grawitz tumour (Adenocarcinoma, hypernephroma)* Angiomyolipoma* Transitional cell carcinoma of the renal pelvis and collecting system* Squamous carcinoma of the renal pelvis* Renal cell carcinoma (Hypernephroma, Grawitz tumour). This is adenocarcinoma and is the most common neoplasm (75%) of the kidney.

Squamous cell carcinoma of the renal pelvis


Question: Moon's molars seen with

Moon's- or Mulberry Molar is a condition where the first lower molar tooth has become dome-shaped due to malformation by congenital syphilis.


Question: Earliest tumor to appear after birth is


Question: Commonest treatment of Branchial cyst

A branchial cyst probably develops from the vestigial remnants of the second branchial cleft, is usually lined by squamous epithelium, and contains thick, turbid fluid full of cholesterol crystals. The cyst usually presents in the upper neck in early or middle adulthood and is found at the junction of the upper third and middle third of the sternomastoid muscle at its anterior border. It is a fluctuant swelling that may transilluminate and is often soft in its early stages so that it may be difficult to palpate. If the cyst becomes infected it becomes erythematous and tender and, on occasions, it may be difficult to differentiate from a tuberculous abscess. Ultrasound and fine-needle aspiration both aid diagnosis and treatment is by complete excision, which is best undeaken when the lesion is quiescent. Although the anterior aspect of the cyst is easy to dissect, it may pass backwards and upwards through the bifurcation of the common carotid. Bailey & Love,5th,727