Question: Arsenic is used in treatment of

Acute promyelocytic leukemia /Ref Harrison 16th/e p 636] Arsenic trioxide is used in the treatment of Acute promyelocytic leukemia Treatment of Acute promyelocytic leukemia Usually all the cases of AML other than acute promyelocytic leukemia are treated with cytarabine + Anthracycline. But in case of Acute promyelocytic leukemia, these drugs are not used, instead Tretinoin is used for induction. It is a well known fact that acute promyelocytic leukemia may lead to D.I.C. When acute promyelocytic leukemia is treated with anthracycline and cytarabine, DIC is induced by the release of granule components of dying tumour cells. Tretinoin does not produce D.I.C., instead it may produces another complication known as retinoic acid syndrome, which occurs in the first 3 weeks of treatment and is characterized by fever, dyspnoea, chest pain, pulmonary infiltrates, pleural and pericardial effusions. If the patient is refractory to tretinoin therapy, Arsenic trioxide is used : "Arsenic trioxide produces, meaningful response in upto 85% of patients refractory to tretinoin"


Question: Plasma expanders are used in

During endotoxic shock,the amount of blood that can be delivered to the tissues get reduced due to loss of RBC's and decrease in blood volume which causes a decrease in blood pressure. Therefore,plasma expanders are used for the maintanence of blood volume in the body.They act by increasing osmotic pressure. Ref : SRB's manual of surgery 6th edition


Question: "String sign of Kantor" is seen in

(Crohn's disease) (1170-LB) (1171-B & L 25th)* Crohn's disease - The principal findings include thickened bowel wall with stricture ("String sign of kantor")* Rovsing's sign - A sharp pressure over the left iliac fossa produces pain in the right iliac fossa in Acute Appendicitis* Murphy's sign - The patient experiences pain and "Catches the breath" just before the zenith of respiration when the gall bladder area is gently pressed in acute cholecystitis* Boas sign - There may be an area of hyperaesthesia between the ninth and eleventh ribs posteriorly on the right side in Acute cholecystitis.


Question: Treatment of choice for ureterocele

Ureteric reimplantation or endoscopic incision is the treatment of option for
ureterocoele.


Question: A robust male baby with vigorous feeding and immediate vomiting at 2 months of age. Most probable diagnosis is

Congenital hyperophic pyloric stenosis is seen between 3 rd and 6 the week of age of an infant because the time taken by the hyperophied muscle to cause complete obstruction is between 3rd and 6 the week, as well as the congenital hyperophic pyloric stenosis is most commonly seen in firstborn males. Reference: SRB 5 the edition page no. 821


Question: Congenital hypertrophic pyloric stenosis associated with

Ans is 'b' i.e. Hypokalemic alkalosis Repeat from Nov 09Repetitive vomiting leads to hypochloremic, hypokalemic metabolic alkalosis. The urine is alkaline initially but eventually it becomes acidic (paradoxical aciduria)Cause of paradoxical aciduriaInitially the kidney compensate for metabolic alkalosis by reabsorbing hydrogen and chloride ions in exchange for sodium, potassium and bicarbonate. But gradually as the body stores of sodium and especially potassium become depleted, kidney starts retaining these ions in exchange of hydrogen ions, thus the urine becomes acidic and metabolic alkaline state is further aggravated.Hypertrophic Pyloric Stenosis (HPS)The musculature of the pylorus and adjacent antrum is grossly hypertrophied, the hypertrophy being maximum in the pylorus itself.It occurs in approximately 3 in 1000 live birth and is the most common surgical cause of vomitting in infancy.M > F (4 : 1)*Characteristically the first born male child is affected.The condition is most commonly seen at 4 wks. after birth ranging from the 3rd wk. to on rare occasion, the 7th. However, 20% of infants are symptomatic from birth, and most are symptomatic within the first 2 months after birth.Non-bilious vomiting, becoming increasingly projectile, occurs over several days to weeks. Eventually the infant will develop a nearly complete obstruction by the second to fourth week of life and will not be able to hold down even clear liquids. This invariably proceeds to severe dehydration if not t/t.These infants develop a metabolic alkalosis with severe depletion of potassium and chloride ions."The diagnosis of pyloric stenosis usually can be made on physical examination by palpation of the typical 'olive' in the right upper quadrant and the presence of visible gastric waves on the abdomen.When the olive cannot be palpated, ultrasound in experienced hands will diagnose the condition accurately in 95 percent of pts. " - Schwartz.TreatmentPyloric stenosis is never a surgical emergency although dehydration and electrolyte abnormalities may present a medical emergencyFluid resuscitation and correction of electrolyte abnormalities and metabolic alkalosis is essential before surgery.Surgery: Fredet-Ramstedt pyloromyotomy. (In it the pyloric mass is split without cutting the mucosa)Also knowAdministration of erythromycin in early infancy has been linked to the subsequent development of HPS.Jaundice may be seen in HPS, although cause is not clear.


Question: Remodelling phase (maturing phase) is characterized by

Normal wound healing have 3 or 4 phases, most commonly agreed to be 1 the inflammatory phase (2-3 days) 2 the proliferative phase (3 days - 3 weeks) 3 the remodelling phase (maturing phase) (stas on day 6-7and may extend up to a year) In the remodelling phase is characterised by the maturation of collagen (type I replacing type III until a ratio of 4:1 is achieved). There is a realignment of collagen fibres along the lines of tension, decreased wound vascularity, and wound contraction due to fibroblast and myofibroblast activity. Bailey and Love 27e pg: 25


Question: Moures sign is seen in

Moure's sign: in normal persons, there is a click felt when the larynx is moved from side to side over the veebral column. This sign is absent in patients with post-cricoid carcinoma (Moure's sig n positive).


Question: Milan Criteria is used for

Ans. (a) Liver transplantRef: Bailey and Love 27th edition, Page 1555Milan criteria is for liver transplant in HCC patients:* Single nodule <5cm or less than 3 nodules, the largest of which is <3cm* Those who meet these criteria - recurrence rate less than 20%* Those who fall outside, recurrence rate 60%


Question: Buschke Lowentein tumour is

Buschke Lowentein tumour :

it is locally invasive cancer.
Histological pattern is similar to verrucous cancer.


Question: Most common type of mesentric cyst is

Chelolymphalic cyst :

It is commonest type of mesentric cyst.
It has congenital misplaced lymphatic tissue.


Question: Lord's and Jaboulay's operation is done for

These operations are done for hydrocele .Lord's operation or plication is suitable when the sac is small, thin walled and contains clear fluid. Here tunica is bunched into a 'ruff' at its attachment to the testis by using a series of multiple interrupted chromic catgut sutures to plicate the redundant tunica vaginalis, so as to make the sac to form fibrous tissue. Jaboulay's procedure - Eversion of the sac following paial excision with placement of the testis in a pouch prepared by dissection in the fascial planes of the scrotum.Reference : page 1072 SRB's manual of surgery 5th edition and page 1382 Bailey and Love's sho practice of surgery 25th edition


Question: Breast cancer is conservatively treated by following methods

Breast conservation surgery The amount of breast tissue excised with the lesion may vary with the clinical situation, but is typically 5mm to 10mm in all directions BCS may consist of removal of tumor with 1 cm margin of normal tissue (wide local excision) or a more extensive excision of a whole quadrant of breast (Quandrantectomy) Ref: Mastery of Surgery 5th edition Pgno : 525

It is based on relative size of breast tumor


Question: 50 year old male with positive family history of prostate cancer has come to you for a screening test. The screening test done to pickup prostate cancer is

Prostate-specific antigen (PSA) and Digital rectal examination (DRE) Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years. Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65). Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).

Endorectal coil MRI with T1 and T2 W images


Question: Most common malignant lesion of the eyelid is

Basal cell carcinoma This is usually a slow-growing, locally-invasive, malignant tumour of pluripotential epithelial cells arising from basal epidermis and hair follicles; hence, it affects the pilo-sebaceous skin. EPIDEMIOLOGY The strongest predisposing factor to BCC is UVR. It occurs in the elderly or the middle-aged after excessive sun exposure, with 95% occurring between the ages of 40 and 80 years. The incidence of BCC rises with proximity to the equator, although 33% arise in pas of the body not usually sunexposed. Other predisposing factors include exposure to arsenical compounds, coal tar, aromatic hydrocarbons, ionising radiation and genetic skin cancer syndromes. White- skinned people are almost exclusively affected. BCC is more common in men than women. PATHOGENESIS BCCs have no apparent precursor lesions and their development is propoional to the initial dose of the carcinogen, but not duration of exposure. The most likely model of pathogenesis for BCCs involves mesodermal factors as intrinsic promoters coupled with an initiation step. BCCs metastasise extremely rarely. MACROSCOPIC BCC can be divided into localised (nodular; nodulocystic; cystic; pigmented and naevoid) and generalised (superficial: multifocal and superficial spreading; or infiltrative: morphoeic, ice pick and cicatrizing). Nodular and nodulocystic variants account for 90% of BCC. MICROSCOPIC Twenty-six histological subtypes have been described. The characteristic finding is of ovoid cells in nests with a single 'palisading' layer. It is only the outer layer of cells that actively divide, explaining why tumour growth rates are slower thantheir cell cycle speed would suggest, and why incompletely excised lesions are more aggressive. Morphoeic BCCs synthesize type 4 collagenase and so spread rapidly Ref: Bailey and love 27th edition Pgno : 604


Question: Typhoid perforation occurs during

• Enteric fever is a potentially life - threatening systemic disease characterized by fever and abdominal pain.
• It is caused by Salmonella typhi or paratyphi.
• Typhoid is the MC cause of ileal perforation in tropical countries (India).
Pathology :
• Ulceration and necrosis of ileocecal Peyer’s patches.
• The ulcer is parallel to the long axis of the gut and is usually situated in the lower ileum (longitudinal ulcers).
• Perforation of a typhoid ulcer usually occurs during the third week and is occasionally the first sign of the disease.
Clinical Features :
• Fever and abdominal pain are hallmark symptoms.
• Non-specific symptoms : Headache, cough, sweating, myalgia, arthralgia, fatigue.
• Paralytic ileus is the MC complication of typhoid.
• Intestinal hemorrhage (2nd MC) may be the leading symptom.


Question: A patient with long standing multinodular goitre develops hoarseness of voice; also, the swelling undergoes sudden increase in size. Likely diagnosis is

Ans. is 'a' i.e., Follicular Ca History of sudden growth in a long standing goiter and hoarseness are suggestive of malignant change. Most common carcinoma to develop in developing in long standing multinodular goiter is Follicular carcinoma.


Question: The Most common complication in varicose vein surgery is

(A) Ecchymosis # Complications of varicose vein surgery: Bruising and discomfort are common following removal of varices, especially where the veins were of very large diameter. However, the pain usually requires only mild analgesics.


Question: The sequence of symptoms in pulmonary embolism is


Question: The best predictor of prognosis in congenital diaphragmatic hernia

Pulmonary hypoplasia and immaturity of the lungs remain the leaden cause of death, from pulmonary hypeension (right-to-left shunting) with resultant hypoxemia. The best predictor of prognosis in congenital diaphragmatic hernia Pulmonary hypeension.


Question: Most common cause of unilateral diaphragmatic paralysis is

(A) Surgical trauma # UNILATERAL DIAPHRAGMATIC PARALYSIS may be idiopathicl or secondary to multiple causes, among which the most common is a tumour with phrenic nerve involvement or surgical trauma,> Causes of unilateral paralysis are diseases of the cervical spinal cord affecting the anterior horn cells of the fourth segment, such as poliomyelitis, tumour, progressive muscular atrophy, myelitis, haemorrhage, and injuries and caries of the cervical vertebrae.> Peripheral lesions of the phrenic nerve or its roots include neck wounds, polyneuritis (usually diphtheritic), destruction by neoplastic masses (usually near the hilum of the lung), and avulsion from birth injury as an extension of Erb's palsy.> Unilateral diaphragmatic paralysis is often discovered incidentally in patients undergoing chest radiography for some other reason Patients usually are asymptomatic at rest but experience dyspnea upon exertion and have a decrease in exercise performance.> If the patient has an underlying lung disease, dyspnea may occur at rest.> Some patients may develop orthopnea, which is less intense than bilateral diaphragmatic paralysis.


Question: Most common type of cyst in jaw

Radicular Radicular Cyst 1. Also known as dental cyst or periodontal cyst or periapical granulomaQ 2 Most common cyst of jaw 3 It usually develops due to continuous irritation of infected tooth which stimulate the nests of cell to proliferate. 4 Occur more frequently in upper jaw. Presentation * Cyst present at the apexQ of the affected tooth * Expansion of jaw * Painless (unless infected) * Bone in thinned out with eggshell crackling. X- ray- well circumscribed radiolucency at the apex of the affected tooth. The margin of the cyst may be sclerosed. Treatment- Extraction of the carious tooth with curettage (intra oral approach)


Question: A 60 year old male was diagnosed as carcinoma right lung. On CECT chest there was tumour of 5 x 5 cm in upper lobe and another 2 x 2 cm size tumour nodule in middle lobe. The primary modality of treatment is

Refer above table Treatment of operable NSCCL Stage IA, IB, IIA, IIB : Surgical resection Adjuvant chemotherapy is given in stage II Stage IIIA with minimal N2 involvement : Neoadjuvant chemotherapy followed by surgical resection with complete Mediastinal LN dissection Postoperative radiotherapy for patients found to have N2 disease Ref : Sabiston 20th edition Pgno : 1591


Question: 'Gold standard' in diagnosis of GERD is

24-hour pH recording is the 'gold standard' for diagnosis of GORDNormally endoscopy with biopsy is done. If the typical appearance of reflux oesophagitis, peptic stricture or Barrett's oesophagus is seen, the diagnosis is clinched,In patients with atypical or persistent symptoms despite therapy, oesophageal manometry and 24-hour oesophageal pH recording (ideally with impedance measurement) is done.Manometry and pH recording are essential in patients being considered for antireflux surgery.A CT scan gives the best appreciation of gastro-oesophageal anatomy. This may be impoant in the context of surgery for rolling or mixed hiatus hernias,Ref: Bailey and Love 27e pg: 1078


Question: Among the given populations risk of hernia is least in

Inguinal hernia is less common in obese patients, with hernia risk being negatively related to body mass index (BMI). Hernia is more common in smokers.Hernia development is more common in pregnancy due to hormonally induced laxity of pelvic ligaments. It is also more common in elderly people due to degenerative weakness of muscles and fibrous tissue. Ref: Bailey and love 27e pg: 1024


Question: High incidence of oral malignancies is attributed to

In the Indian subcontinent, the use of 'pan' (a combination of betel nut, areca nut, lime and tobacco), as well as reverse smoking (smoking a cheroot with the burning end inside the mouth), are responsible for the high incidence of oral cancer. Betel quid appears to be the major carcinogen, although there is also a relationship between slaked lime and the areca nut and cancer.Ref: Bailey and love pg: 760


Question: In an adult, % of total body surface required to be involved in a burn injury to cause shock

As the size approaches 10-15% of total body surface area (TBSA), the loss of intravascular fluid can cause a level of circulatory shock. Fuhermore, once the area increases to 25% of TBSA, the inflammatory reaction causes fluid loss in vessels remote from the burn injury.Ref: Bailey and love 27e pg: 619


Question: Ductopenia seen in

Ans. (b) Alagille syndromeRef: Internet Sources* Alagille syndrome is an autosomal dominant genetic disorder affecting liver and heart commonly.* Bile duct paucity is the common manifestation which results in Cirrhosis and Liver failure


Question: Per rectum examination is not a useful test for diagnosis of

PILONIDAL SINUS/DISEASE (Jeep Bottom; Driver's Bottom) Pilus--hair; Nidus--nest It is epithelium lined tract, situated sho distance behind the anus, containing hairs and unhealthy diseased granula- tion tissue. It is due to penetration of hairs through the skin into subcutaneous tissue. It forms granuloma/unhealthy granulation tissue in the deeper plane. It is of infective origin and occurs in sacral region between the buttocks, umbilicus, axilla. Other indications of per rectal examination are:Carcinoma rectum, Stricture rectum, Polyps, BPH and carcinoma prostate, Secondaries in the rectovesical pouch (Blumer shelf), Sphincter tone, Pelvic abscess (is felt as boggy swelling), to feel the internal opening of anal fistulas, in bimanual palpation of the bladder or pelvic tumours, in acute abdominal conditions--it reveals dilated empty rectum with tenderness.Reference : page 967 and 952 SRB's manual of surgery 5th edition


Question: The technique of laparoscopic cholecystectomy was first described by.

Ans. (b) Erich MuheRef Blumgart 5/e p 512* 1st Lap Cholecystectomy was done by ERIC MUHE in 1982.* 1st Lap Appendectomy was done by KURT SEMM in 1980


Question: Most frequent site of mandibular fracture is

Most common site of fracture is in the neck of condyles( 35%) as it is the weakest point, condyle is displaced in front and medially often with dislocation. Reference SRB edition:5 page :355


Question: Renal trauma is best treated by


Question: Ultrasound is investigation of choice for

Focused abdominal sonogram for trauma (FAST) Focused assessment with sonography for trauma (FAST) examination is a bedside screening tool to identify free intra peritoneal, pleural and pericardial fluid. It is limited ultrasound examination with 6 views. The average time to perform a complete FAST examination is 2-4 minutes.


Question: A newborn child presents with inveed foot and the dorsum of the foot cannot touch the anterior tibia. The most probable diagnosis is

CTEV [Ref: Maheshwari Ohopaedics 3/e p195; Ebnezar 3/e p454J In a new born child it is possible to dorsiflex and eve the foot till the dorsum of foot touches anterior surface of tibia.This is not possible in CTEV. This is known as 'clorsillexion test' and can be used as a screening test. Ahrogryposis Multiplex Congenita is a rare congenital disorder that is characterized by multiple joint contractures and muscle atrophy and fibrosis. It is a non-progressive disease. CTEV can be seen as one of the components of AMC. So AMC can also be the answer but since it's much rarer than CTEV and in the question other joints involvement is not mentioned, answer would be `CTEV'. Congenital veical talus is a'rare disease usually affecting both feet, characterized by rigid flatfoot deformity, with the plantar aspect of the foot having a convex contour. The heel is in valgus, and the forefoot is abducted and dorsiflexed. In the newborn having this condition, the dorsal aspect of the foot may be in close approximation to the distal aspect of tibia. Flat foot or Pes planus is a condition characterized by varying degrees of loss of the longitudinal arch of the foot. This condition can be normal which usually disappears as the child grows, or can be pathological as seen in Congenital veical talus, tarsal coalition, inflammatory joint disorder or a neurological disorder. Congenital Talipes Equinovarus (Idiopathic club-food -Talipes is a term for any foot deformity that centres around the talus. - Equinus implies that the foot is flexed in the plantar direction. - Varus implies that the foot is inveed and adducted so that the sole faces inwards. CTEV is a complex deformity of the foot where the foot is both turned and twisted inwards so that the sole faces posteromedially. Deformities noted are: - plantar flexion (equines) - in version - adduction - supination - sometimes cavus (high medial arch) The involved foot is generally smaller than the opposite side with varying amounts of calf atrophy. More common in boys (2:1) Bilateral in 1/3 cases.(Ret Apley's Ohopaedics 11/e 591) Clinical tests in CTEV: 1)Dorsiflexion test: described above. 2)Plumbline test: This test helps to detect the tibial torsion. The child is made to sit on a table with both the lower limbs hanging from the edge. A line drawn from the centre of the patella to the tibial tubercle when extended down, should cut the foot at the first or second intermetatarsal space normally. This is called the pulmline. In CTEV, with medial rotation of the tibia. the plumbline cuts the zith or 5th intermetatarsal space. 3)Scratch test: This test is performed to detect muscle imbalance in an infant who cannot obey commands. - Medial scratch test- In a normal child when the medial sole is scratched, the foot eves. The tests the peroneals. - Lateral scratch test- When the lateral sole is scratched, the child inves the foot. This tests the inveors. X-ray: Radiographs AP and Lateral are obtained in maximally corrected position. The talo-calcaneal angle (Kite's angle) obtained in both AP and lateral views is reduced in CTEV.


Question: Not classified as untidy wound is

Answer- B. Incised woundUsually involves crushing and tearing and contain devitalized tissues.Needs conversion to tidy wound before closure is considered.These wounds result from crushing, avulsion or burns. Fractures are common and may be multifragmentary.Treatment - Once the untidy wound is convereted to a didy one by wound excision, it can be saiely closed or allowed to heal by second intention.


Question: Most common cause of brain metastases

Origin PercentageLung 40Breast 15Melanoma 10Renal/genitourinary 10Other/unknown 25Ref: Bailey and love 27e pg: 664


Question: Posterior triangle lymph nodes are

ISub mandibulaeIIUpper deep cervicalIIIMid-cervicalIVLower cervicalVPosterior triangleVIPre laryngeal/pre trachealVIIMediastinalRef: Bailey and love pg: 764


Question: Bile strictures are seen in

Biliary strictures are most commonly present post operatively(80%),especially following laparoscopic cholecystectomy.It can also occur following open cholecystectomy,biliary surgery,gastrectomy,liver surgery,duodenal and pancreatic surgery. Choledocholithiasis(CBD stones) can lead to recurrent attacks of cholangitis and thereby biliary structures.But cholelithiasis cannot usually lead to CBD strictures. Biliary strictures can also occur following malignancy(cholangiocarcinoma) & worm infestations like Ascaris lumbricoides,Clonorchis sinensis. Reference:SRB's manual of surgery,5th edition,page no:657.


Question: A women noticed mass in her left breast with bloody discharge. Histopathology revealed duct ectasia. Traetment is

Duct ectasia is the dilatation of lactiferous duct due to muscukar relaxation of duct wall with periductal mstitis. C/f:greenish discharge from nippleindurated mass under areolaslit like retravtion of nipple,may present as mastalgia. Treatment is cessation of smokingantibioticscone excisionof invilved duct-Hadfields operation. SRB's Manual of Surgery.Edition -5. Pg no:525


Question: After bilateral adrenalectomy, patient developed gradual loss of vision, with hyperpigmentation of skin, and headache. Likely cause is

In 10% of patients with Cushing's disease who undergo a bilateral adrenalectomy after failed pituitary surgery, the pituitary adenoma causes Nelson's syndrome due to continued ACTH secretion at high levels, causing hyperpigmentation as a result of chemical synergies between ACTH and melanocyte-stimulating hormoneRef: Bailey and Love 27e pg: 842


Question: Orchidopexy is done in cases of undescended testes at the age of

Ans. is 'a' i.e. Infancy Campbell's Urology writes - "Definitive treatment of an undescended testis should take place between 6 and 12 months of age. Because spontaneous descent occurs in most boys by 3 months of age and uncommonly thereafter, earlier interventions should be considered in order to theoretically prevent the complication of cryptorchidism that may be manifested before 1 yr. of age".


Question: After Cleft lip operation sutures are removed on

Guidelines go rday of suture removal by Area Body region Removal Eyelid 3-4 days Eyebrow 3-5 days Nose 3-5 days Lip 3-4 days Face(other) 3-4 days Scalp 6-8 days Chest, abdomen 8-10 days Ear 10-14 days Back 12-14 days Extremities 12-14 days Hand 10-14 days Foot, sole 12-14 days Ref: Sabiston 18th edition Pgno :2134


Question: The "Van Nuys grading" is used for

Ans. (b) DCIS(Ref: Sabistons Textbook of Surgery, 20th ed p-853)* DCIS prognosis is based on Van Nuy's Grading* Van Nuys Grading is used to decide whether RT can be avoided in selective cases after Lumpectomy* Van Nuys favorable cases for whom RT can be avoided are - Low and Intermediate grade, DCIS <2.5cm size and Margin minimum 1cm after excision


Question: Dacron vascular, graft is

Textile synthetic graft → Dacron
Nontextile synthetic graft → PTFE (polytetra fluoro ethylene)


Question: The most common cause of acute sciatica is due to


Question: In CPR the sternum should be depressed at a rate of


Question: Keloid formulation is not seen over


Question: The most common type of mode of meniscal injury is

C i.e. Flexion & rotation movement The twisting force (rotation) in a weight bearing flexed knee is the commonest mode of meniscal (semilunar cailage) injuryQ. Menisci follow the tibial condyles during flexion & extension, but during rotation, they follow the femur and move on the tibia; consequently the medial meniscus becomes distoed. Its anterior and posterior attachments follow the tibia, but its intervening pa follows the femur, thus it is likely to be injured during rotation. However, the lateral meniscus b/o firm attachment to popliteus muscle, ligament of Wrisberg or Humphry, follows the lateral femoral condyle during rotation and therefore is less likely to be injured. In addition popliteus muscle, by way of arcuate ligament, draws the posterior segment of lateral meniscus backward there by preventing it from being caught between the condyles of femur & plateau of tibia when tibia is rotated internally and knee is flexed(2.


Question: Insensible daily water loss is


Question: Most common complication after ERCP is

Complication perforation(1.3%)/hemorrhage (1.4%),pancreatitis (4.3%) and sepsis (3-30%). Bailey & Love 26th, 208


Question: The following is ideal for the treatment with injection of sclerosing agents

It is ideal for first-degree internal hemorrhoids which bleed and for early second-degree internal hemorrhoids, injecting sclerosant will produce fibrosis in the submucosal region (sclerosis leading to mucosal fixation on to deeper planes and occlusion of lakes) thereby fixes the cushion which does not prolapse, causes strengthening of the vessel wall and obliteration of the vessel lumen it is done on op basis and gives 95% cure rate in the first-degree prolapse , it&;s a painless procedure and results are quick for prolapsed piles stapled haemorrhoidectomy is preferred, for external piles excision is done, for strangulated haemorrhoidectomy conservative management by sitz bath after 5days haemorrhoidectomy is done Reference SRB edition 5 page no. 972,974,976


Question: Murphy's sign is seen in

In the acute cholecystitis, the patient may have right upper quadrant tenderness that is exacerbated during inspiration by the examiner's right subcostal palpation (Murphy's sign). A positive Murphy's sign suggests acute inflammation and may be associated with a leukocytosis and moderately elevated liver function tests.Ref: Bailey and love 27e pg: 1199


Question: Serum marker used after surgery for differentiated thyroid cancer is

Measurement of peripheral Thyroglobulin has predictive value for the recurrence of differentiated thyroid cancer (ie papillary and follicular thyroid cancers),locally or in metastatic deposits after initial total thyroidectomy . Basal or stimulated calcitonin levels are sensitive markers for primary or recurrent medullary thyroid cancer. Source : Sabiston 20th edition Pg : 886


Question: Most common infections after splenectomy are

Oppounist post-splenectomy infection is caused by capsulated bacteria.Post-splenectomy septicaemia may result from Streptococcus pneumoniae, Neisseria meningitides, Haemophilus influenzae and Escherichia coli.Bailey and love 26th edition pg: 1096


Question: Most common site of oesophageal rupture in rigid bronchoscopy

Rigid bronchoscopy--It is used for removal of the foreign body and bronchial wash. It reaches up to third generation bronchioles. It is used to take the biopsy from carcinoma of proximal divisions but not from carcinoma of the peripheral lung. The rigid scope has got multiple holes to allow ventilation during the procedure (Oesophagoscope does not have side holes). It is done under general anaesthesia. Ref: SRB&;s manual of surgery,3 rd ed, pg no 1079


Question: Dentigerous cyst arises from

Dentigerous cyst is a unilocular cystic swelling arising in relation to the dental epithelium from an unerupted tooth SRB,5th edition,360.

The periosteum of the fractured mandible

The sequenstrum of osteomyelitis of mandible


Question: A vibration perceptile on palpation is


Question: Amyl nitrate inhalation test is used to detect

Amyl nitrate inhalation (useful adjunct to the radiographic examination)seems to distinguish patients with pseudoachalasia from those with idiopathic achalasia. *In pseudoachalasia patients with tumour infiltration of the distal oesophagus, the narrow lower oesophagal sphincter segment was unaffected by the smooth-muscle relaxant effect of amyl nitrite. *amyl nitrate caused a measurable increase of 2 mm or more in sphincter diameter in patients with idiopathic achalasia ( smooth-muscle relaxant effect of amyl nitrite).


Question: Use of an acrylated arch bars for closed reduction of mandible was described by


Question: Cause for nipple retraction in breast carcinoma is

Infiltration of the Cooper’s ligament will give rise to dimpling of skin.
Blocking of subcutaneous lymph nodes will give rise to peau d'orange appearance.


Question: Most common type of appendix is

Ans. a (Retrocecal). (Ref. Bailey and Love, 25th/pg.l205)Vermiform appendix is a muscular tubular structure arising from caecum.Its various positions include:Retrocaecal74%Pelvic21%Paraceacal2%Sub-caecal1.5%Preileal1%Postileal0.5%The appendicular artery is branch of lower division of iliocolic artery.


Question: A 50 year old male known case of ulcerative colitis presents with distention of the abdomen of acute onset with vomiting. The next investigation would be

Answer- A. Abdominal X rayToxic megacolon is defined as a transverse colon with a diameter of more than 5.0 to 6.0 cm with loss ofhaustration.Although usually associated with ulcerative colitis, toxic megacolon can also be seen in Crohn's disease.Plain abdominal railiographs are essmtial for the iliagnosk and management of toxic megacolon (toxic colitis)


Question: While treating benign prostatic hyperplasia with finasteride the period of trial required for maximum response

Minimum time to act - 1 month
Maximum response around 6 months.


Question: Most common cancer in men is

Answer- C. Prostate cancerCancers in males in India: Lip / oralcavity > Prostate > Colorectum > Pharynx (other than nssopharynx) > Larytx


Question: A fracture of the mandible in the canine region in a 6 year old child should be managed by


Question: Increased incidence of reaction to L.A will occur by

Addition of vaso constrictor to the solution


Question: Hyperthyroidism is diagnosed by

Ans. (b) T3, T4 and TSHRef: Bailey and Love page 751/26th editionNormal Values:* TSH: 0.5 to 5 Micro Units/ml* Total T3: 1.5-3.5nmol/l* Total T4: 55-150nmol/l* Free T3: 3-9pmol/l* Free T4: 12-28pmol/l* Radioactive Iodine Uptake Study is useful to diagnose the activity in nodules but not to diagnose Hyperthyroidism as such.


Question: Minimum amount of GI bleed to cause malena is

Melaena refers to the passage of typical black, tarry coloured foul smelling stool. It signifies upper GI bleed. At least 50-60 ml bleeding should be there to cause melaena. Reference : page 834 SRB's manual of surgery 5th edition


Question: Cabitus varus is most commonly seen in


Question: Most common syndrome associated with cleft palate

Although most clefts of the lip and palate occur as an isolated deformity, Pierre Robin sequence is an impoant association. This sequence comprises isolated cleft palate, retrognathia and a posteriorly displaced tongue (glossoptosis), which is associated with early respiratory and feeding difficulties. Stickler (ophthalmic and musculoskeletal abnormalities), Shprintzen (cardiac anomalies), Down, Ape and Treacher Collins syndromes are other common syndromes where cleft lip and palate are frequently encountered.Ref: Bailey and love pg: 689


Question: Extradural haemorrhage is caused by

(A) Rupture of Middle meningeal artery # Extradural haematoma (EDH), also known as an Epidural haematoma, is a collection of blood that forms between the inner surface of the skull and outer layer of the dura, which is called the periosteal layer.> They are commonly associated with a history of trauma and associated skull fracture.> The source of bleeding is usually a torn meningeal artery (most commonly, the middle meningeal artery).> EDHs are typically biconvex in shape and can cause a mass effect with herniation.> They are usually limited by cranial sutures, but not by venous sinuses.> Both CT and MRI are suitable to evaluate EDHs.> When the blood clot is evacuated promptly (or treated conservatively when small), the prognosis of EDHs is generally good.


Question: Pain at left shoulder tip in a patient with splenic trauma is known as

Referred pain is due to irritation of the diaphragm and phrenic nerves by the blood in the peritoneal cavity (hemoperitoneum). Reference SRB edition 5 page no.1196


Question: A 20 yr old girl presents with 9 month history of neck swelling with thyrotoxic symptoms. On investigation increased T4 and decreased TSH with palpable 2 cm nodule was found. Next investigation will be


Question: Secondary vesical calculus refers to stones formed due to

Secondary vesical calculus - occurs in the presence of infection. E.coli is the common organism. Usually phosphate stone. Occurs in bladder only. Primary vesical calculus - occurs in sterile urine. Usually oxalate stone(Jack stone). Usually comes down from kidney through ureter into the bladder and enlarges here. Most vesical calculi are formed de novo within the bladder, but some initially may have formed within the kidneys as a dissociated Randall plaque or on a sloughed papilla and subsequently may have passed into the bladder, where additional deposition of crystals cause the stone to grow. * Most renal stones that are small enough to pass through the ureters are also small enough to pass through a normally functioning bladder and an unobstructed urethra. * In older men with bladder stones composed of uric acid, the stone most likely formed in the bladder.* Stones composed of calcium oxalate are usually initially formed in the kidney.* In adults, MC type of vesical stone (seen in >50% of cases) is composed of uric acid. * Less frequently, bladder calculi are composed of calcium oxalate, calcium phosphate, ammonium urate, cystine, or magnesium ammonium phosphate (when associated with infection). Endemic Bladder Calculi * In children, stones are composed mainly of ammonium acid urate, calcium oxalate, or an impure mixture of ammonium acid urate and calcium oxalate with calcium phosphate.* The common link among endemic areas relates to feeding infants human breast milk and polished rice.* These foods are low in phosphorus, ultimately leading to high ammonia excretion.* These children also usually have a high intake of oxalate-rich vegetables (increased oxalate crystalluria) and animal protein (low dietary citrate). * Vesical calculi may be single or multiple, especially in the presence of bladder diveicula, and can be small or large enough to occupy the entire bladder. They range from soft to extremely hard, with surfaces ranging from smooth and faceted to jagged and spiculated ("jack" stones). * Most bladder stones are secondary, more common in older males (>50 years), usually because of bladder outlet obstruction.* MC type: Uric acid (sterile urine) > Struvite stones (Infected urine)* Bladder stones are usually solitary, multiple in 25% patients.Etiology* Bladder outlet obstruction (MC cause)* Neurogenic bladder* Foreign body (Foley's catheter, forgotten DJ stents)* Bladder diveiculaClinical Features* Typical symptoms are intermittent, painful voiding and terminal hematuria with severe pain at the end of micturition.* Pain may be referred to the tip of the penis or to the labia majora.Diagnosis* A large percentage of bladder stones are radiolucent (uric acid).* USG bladder: Identifies the stone with its characteristic shadowing and stone moves with changing body position.Treatment* Small stones: Removed or crushed transurethrally (Cystolitholapexy)* Larger stones: Disintegrated by transurethral electrohydraulic lithotripsy or Cystolithotomy Stones of Genitourinary Tract * MC renal stone: Calcium oxalate* MC primary bladder stone: Ammonium urate* MC bladder stone: Uric acid >Struvite* MC prostate stone: Calcium phosphate Ref : Bailey and Love 25/e p1323


Question: Most common cause of upper GI bleed

Answer- C. Duodenal ulcersCauses ofupper GI bleeding (in descending order)Peptic ulcer - Duodenal ulcer - gastric ulcerOesophageal varicesGastritis erosionsMallory-Weiss tearsUncommon causes - Gastric carcinoma, esophagitis, pancreatits.


Question: Absent parathyroid, thymic aplasia with immunodeficiency and heart defects are features of

Ans. c (Di george syndrome) (Ref. Harrison's medicine 17th ed., Ch. 310)22q11 deletion syndromes:# DiGeorge syndrome --thymic, parathyroid, and cardiac defects. Occurs Due to aberrant development of 3rd and 4th branchial pouches. Cleft palate, Abnormal facies, Thymic aplasia T-cell deficiency, Cardiac defects, Hypocalcemia 2deg to parathyroid aplasia, due to microdeletion at chromosome 22q11.# Velocardiofacial syndrome-palate, facial, and cardiac defects.THE DIGEORGE SYNDROME# classic example of isolated T cell deficiency# results from maldevelopment of thymic epithelial elements derived from the 3rd and 4th pharyngeal pouches.# The gene defect is on chromosomal position 22q11 in most patients with the DiGeorge syndrome.# Defective development of organs dependent on cells of embryonic neural crest origin includes:- Congenital cardiac defects, particularly those involving the great vessels;- Hypocalcemic tetany, due to failure of parathyroid development; and- Absence of a normal thymus.# Facial abnormalities may include abnormal ears, shortened philtrum, micrognathia, and hypertelorism.# Serum immunoglobulin concentrations are frequently normal, but antibody responses, particularly of IgG and IgA isotypes, are usually impaired. T cell levels are |, whereas B cell levels are normal.Pendred syndromeAn autosomal-recessive syndrome consisting of a bilateral congenital sensorineural hearing loss and goiter years later in mid-childhood. T4 levels are usually low to absent, and a perchlorate test is diagnostic. The hearing loss is nonreversible.Also Know:Features of Polyglandular Autoimmune (PGA) syndromesPGA IPGA IIAutosomal recessivePolygenic inheritanceMutations in APECED geneHLA-DR3 and HLA-DR4 associatedChildhood onsetAdult onsetEqual male:female ratioFemale predominanceDisease Associations Mucocutaneous candidiasisAdrenal insufficiencyHypoparathyroidismHypogonadismAdrenal insufficiencyGraves' diseaseHypogonadismType 1 diabetesAlopeciaHypothyroidismDental enamel hypoplasiaMyasthenia gravisMalabsorptionVitiligoChronic active hepatitisAlopeciaVitiligoPernicious anemiaPernicious anemiaCeliac disease


Question: Dukes classification is used for

Dukes' classification was originally described for rectal tumours but has been adopted for histopathological repoing of colon cancer as well. Dukes' classification for colon cancer is as follows: A: confined to the bowel wall; B: through the bowel wall but not involving the free peritoneal serosal surface; C: lymph nodes involved.Dukes himself never described a D stage, but this is often used to describe either advanced local disease or metastases to the liver.Dukes classified carcinoma of the rectum into three stages: A: The growth is limited to the rectal wall (15%); prognosis excellent. B: The growth is extended to the extrarectal tissues, but no metastasis to the regional lymph nodes (35%): prognosis reasonable. C: Secondary deposits in the regional lymph nodes (50%); prognosis is poor. These are subdivided into C1, in which the local pararectal lymph nodes alone are involved, and C2, in which the nodes accompanying the supplying blood vessels are implicated up to the point of division.A stage D is often included, which was not described by Dukes which signifies the presence of widespread metastases, usually hepatic.Reference : page 1180 and 1230 Bailey and Love's sho practice of surgery 25th edition


Question: Test used for presence of residual helicobacter pylori infection

Urease breath test is used for both diagnosis and eradication.


Question: Most common tumour of pancreas is

Pathology of carcinoma pancreas More than 85% of pancreatic cancers are ductal adenocarcinomas. The remaining tumours constitute a variety of pathologies with individual characteristics. Endocrine tumours of the pancreas are rare. Ductal adenocarcinomas arise most commonly in the head of the gland. They are solid, scirrhous tumours, characterised by neoplastic tubular glands within a markedly desmoplastic fibrous stroma. Fibrosis is also a characteristic of chronic pancreatitis, and histological differentiation between tumour and pancreatitis can cause diagnostic difficulties. Ductal adenocarcinomas infiltrate locally, typically along nerve sheaths, along lymphatics and into blood vessels. Liver and peritoneal metastases are common. Proliferative lesions in the pancreatic ducts can precede invasive ductal adenocarcinoma. These are termed pancreatic intraepithelial neoplasia or PanIN, and can demonstrate a range of structural complexity and cellular atypia. Cystic tumours of the pancreas may be serous or mucinous. Serous cystadenomas are typically found in older women, and are large aggregations of multiple small cysts, almost like bubblewrap. They are benign. Mucinous tumours, on the other hand, have the potential for malignant transformation. They include mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms (IPMNs). MCNs are seen in perimenopausal women, show up as multilocular thick-walled cysts in the pancreatic body or tail, and, histologically, contain an ovarian-type stroma. IPMNs are more common in the pancreatic head and in older men, but an IPMN arising from a branch duct can be difficult to distinguish from an MCN. IPMNs arising within the main duct are often multifocal and have a greater tendency to prove malignant. Thick mucus seen extruding from the ampulla at ERCP is diagnostic of a main duct IPMN. Mucinous tumours can be confused with pseudocysts. Occasionally, lympho epithelial cysts, lymphangiomas, dermoid cysts and intestinal duplication cysts can show up in the pancreas. Solid pseudopapillary tumour is a rare, slowly progressive but malignant tumour, seen in women of childbearing age, and manifests as a large, pa-solid, pa-cystic tumour. Tumours arising from the ampulla or from the distal common bile duct can present as a mass in the head of the pancreas, and constitute around a third of all tumours in that area. Adenomas of the ampulla of Vater are diagnosed at endoscopy as polypoid submucosal masses covered by a smooth epithelium. They can harbour foci of invasive carcinoma; the larger the adenoma, the greater the risk. Biopsies taken at endoscopy may not always include the malignant focus. Endoscopic surveillance, endoscopic resection or even surgical transduodenal ampullary excision should be considered . Patients with familial adenomatous polyposis (FAP) can present with multiple duodenal polyps. Malignant transformation in a duodenal polyp is a significant cause of moality in these patients, mandating endoscopic follow-up and pancreatoduodenectomy in selected patients with high- grade dysplasia within the polyp. Ampullary adenocarcinomas often present early with biliary obstruction. Their natural history is distinctly more ourable compared with pancreatic ductal adenocarcinoma. Ampullary carcinomas are relatively small when diagnosed, which may account for their better prognosis. Occasionally, other malignant neoplasms can arise at the ampulla, such as carcinoid tumours and high-grade neuroendocrine carcinomas. Ref: Bailey and love 27th edition Pgno : 1234


Question: Paralytic ileus is caused by


Question: Slit shaped nipple seen in

Answer- A. Duct ectasiaDuct ectasia is dilatation of lactiferous ducts associated with periductal inflammation.Chronic inflammation and scarring will lead to indrawing and slit-shaped inversion of the nipple.If secondary infection supervenes, a mammary duct fistula can also develop.


Question: Intussusceptions frequently associated with


Question: If a patient with Raynaud’s disease immersed his hand in cold water, the hand will


Question: Number of liver segment marked 'F" as per Couinaud

F is segment IV In diagram G, H are II and III, E is I (caudate lobe) D, C, A, B are V, VI, VII, VIIIThe Couinaud classification of liver anatomy divides the liver into eight functionally indepedent segments.Each segment has its own vascular inflow, outflow and biliary drainage.In the centre of each segment there is a branch of the poal vein, hepatic aery and bile duct.In the periphery of each segment there is vascular outflow through the hepatic veins.Right hepatic vein divides the right lobe into anterior and posterior segments.Middle hepatic vein divides the liver into right and left lobes (or right and left hemiliver). This plane runs from the inferior vena cava to the gallbladder fossa.The Falciform ligament divides the left lobe into a medial- segment IV and a lateral pa - segment II and III.The poal vein divides the liver into upper and lower segments.The left and right poal veins branch superiorly and inferiorly to project into the center of each segment.


Question: Upper dose limit of lignocaine in a 70 kg adult is

Few common local anaesthetic drugs Name Maximum dose Comments Lignocaine 3 mg/kg (7 mg/kg with adrenaline) Early onset, sho acting, good sensory block Bupivacaine 2 mg/kg Long lasting, more cardio toxic, must never be used intravenously Prilocaine 6mg/kg (9 mg/kg with adrenaline) Least systemic toxicity, causes methemoglobinemia) Ropivacaine 3-4 mg/kg Less cardio toxic, greater sensory-motor seperation Levobupivacaine 2mg/kg Isomer of Bupivacaine with fewer cardio toxic propeies Ref: Bailey and love 27th edition Pgno : 273


Question: Sensitivity to local anaesthetics is greater in


Question: Treatment of Medullary Carcinoma thyroid

. A total thyroidectomy with bilateral neck dissection is the gold standard for treating medullary thyroid cancer, and is the most definitive means of achieving a cure in patients without distant metastases or extensive nodal involvement. Due to the extreme level of difficulty in successfully performing the neck dissection without extensive morbidity, it is very impoant for patients to seek care under an experienced surgeon at a Center of Excellence who operates on MTC patients at least several times a year. Risks of surgery include loss of vocal control, irreparable nerve damage, death or the need for second operation to clean out residual diseased lymph nodes left behind if the sentinel node biopsy was positive for cancerous spread. Extensive surgery can be effective when the condition is detected early, but a risk for recurrence remains, paicularly in patients with multiple positive lymph nodes or extracapsular invasion. About half of patients have metastasis to regional lymph nodes at the time of diagnosis.


Question: A 6 year old child has an accident and had elbow, after 4 years presented with tingling and numbness in the ulnar side of finger, fracture is


Question: Anomaly associated with duodenal atresia is

Duodenal atresia (DA) is thought to occur as a result of the failure of vacuolization of the duodenum from its solid cord stage.
The range of anatomic variants includes duodenal stenosis causing constipation, mucosal web with the intact muscular wall (so-called windsock deformity); two ends separated by a fibrous cord, or complete separation with a gap within the duodenum.
Associated Anomalies: DA is associated with several conditions, including prematurity, Down syndrome, maternal polyhydramnios, malrotation, annular pancreas, and biliary atresia.
Other anomalies, such as cardiac, renal, esophageal, and anorectal anomalies, are also common.
In most cases, the duodenal obstruction is distal to the ampulla of Vater, and infants present with bilious emesis in the neonatal period.
In patients with a mucosal web, the symptoms of postprandial emesis may occur later in life. Diagnosis:
The classic plain abdominal radiograph of DA is termed the double-bubble sign (air-filled stomach and duodenal bulb, In cases in which there is no distal air, the diagnosis is secured, and no further studies are necessary. On the other hand, if the distal air is present, an upper gastrointestinal contrast study is performed fairly rapidly.
This study is important not only to confirm the diagnosis of duodenal stenosis or atresia but also to exclude midgut volvulus, which would constitute a surgical emergency.
Treatment: The management of DA is by surgical bypass of the duodenal obstruction as either a side-to-side or proximal transverse-to-distal longitudinal (diamond-shaped) duodenoduodenostomy.


Question: Most common testicular tumor in prepubeal adults is

.Seminoma Testis * Stas in the mediastinum of testis. * Grossly it is lobulated, fleshy, homogenous, creamy or pinkish in colour and it compresses adjacent testicular tissue. * Histologically, malignant cells resemble spermatocytes which are cells containing clear cytoplasm with large nucleus, and are arranged in sheets with fibrous stroma in between which is in turn infiltrated by lymphocytes. * It spreads through testicular lymphatics into the paraaoic lymph nodes and then to left supra-clavicular lymph node. Through blood, it spreads to lungs, bone, brain, liver. Histological Classification * Germ cell tumour. - Seminomatous - classic; spermatocytic; anaplastic. - Nonseminomatous type - embryonal carcinoma; teratomas; choriocarcinoma; yolk sac tumour (endodermal sinus tumour contains Schiller Duval bodies). * Sex cord stromal tumours - Leydig cell tumour; Seoli cell tumour; granulosa cell tumour. * Combined germ cell and gonadal stromal tumour - Gonadoblastoma. * Adnexal and paratesticular tumours - mesothelioma; sarcomas. * Others - carcinoids; lymphomas. * Secondaries. ref:SRB&;s manual of surgery,ed 3,pg no 1032


Question: Commonest benign tumour of the esophagus

Benign tumours of the oesophagus are unusual and constitute less than 1% of all oesophagal neoplasms. Approximately 60% of benign oesophagal lesions are leiomyomas, 20% are cysts, 5% are polyps, and the remaining 5% are other neoplasms.Ref: Sabiston 2oth edition pg:1047


Question: A useful though temporary improvement in a patient's ischaemic foot can be attained by giving intravenously


Question: BIRAD's Score is designed to

Answer- A. Maintain uniformity in the repoing of imaging findings of various breast diseasesBIRADS stands for Breast Imaging-Repoing and Data System. It's a quality assurance tool developed by American college of Radiology.The system is designed to standardize both the repoing of imaging findings and the recommendations for fuher management.

Evaluate the effect of brachial aery thrombosis

Clinicoradiological association of breast malignancy


Question: Lymph nodes involved in anal Ca. Is

Inguinal lymph nodes are involved in anal ca.


Question: This develops along lines of embryological fusion in the floor of the mouth. SELECT ONE.

Dermoid cysts arise along line of fusion of embryonic parts. In the floor of the mouth, the swelling forces the tongue upward. Alternatively, the swelling may occur below the mylohyoid muscle, where it gives the impression of a double chin. It is not a premalignant lesion. It has an epithelial lining and may contain secretions, sloughed-off cells, and hair.


Question: Commonest cause of lung abscess is

Lung abscess Lung abscess refers to a microbial infection of the lung that results in necrosis of the pulmonary parenchyma MC cause of primary lung abscess : Anaerobic bacteria Etiology of anaerobic lung abscess : Aspiration Routes of infection Aspiration of organisms that colonize oropharynx (MC) Inhalation of infection or aerosols Hematogenous dissemination from extrapulmonary site Direct inoculation (as in tracheal intubation or stab wounds) Contiguous spread from an adjacent site of infection Ref: schwaz's principle of surgery 10th edition Pgno : 650


Question: Most common cause of lower gastro intestinal bleeding is

.Diveiculitis is the second stage due to inflammation of one or more diveicula with pericolitis.It presents with persistent pain in left iliac fossa, fever, loose stool, recurrent constipation, tenderness in right iliac fossa, palpable and thickened sigmoid colon. P/R may reveal a tender mass. Features of diveiculitis - Pain in left iliac fossa which is constant radiates to back and groin, tenderness, bloody stool, often massive haemorrhage, fever, rigidity and mass in left iliac fossa. Mass is usually tender, firm, resonant, nonmobile. ref:SRB&;s manual of surgery,ed 3,pg no 821


Question: Burst abdomen most commonly occurs on the


Question: Gastrointestinal secretion with highest amount of carbohydrate

NaKClHCO3Saliva10251030Stomach5015110-Duodenum1405100-Ileum 140510030Pancreas140575115Bile140510035Ref: Bailey and Love 27e pg: 281


Question: Snow storm ascites is seen in

.meconium is neonatal manifestation of fibrocystic disease of the pancreas, wherein thick meconium which is viscid and paste like, gets collected in the terminal ileum. Because of inspissation it forms a firm bolus leading to obstruction of the ileum Meconium ileus- * Commonly associated with cystic disease of pancreas but not necessarily always * Respiratory dysfunction * Exocrine pancreatic insufficiency * High salt in the sweat > 90 mmol/L * Ileal obstruction * Soap bubble appearance in X-ray * Gelatin in X-ray film will not get digested by patient's vomitus * Bishop-Koop operation, ileostomy, dissolving ileal meconium pellets are required. ref:SRB&;s manual of surgery,ed 3,pg no 862


Question: In fracture neck of fibula, the following nerve is involved

A i.e. Common peroneal nerve Smallar terminal branch of sciatic nerve, the common peroneal (lateral popliteal) nerve arises in the lower third of thigh. It runs down ward through the popliteal fossa (lateral side) closely following the medial border of biceps femoris muscle. It leaves the fossa by crossing superficially the lateral head of the gastrocnemius muscle. It then passes behind the head of the fibula, winds laterally around the neckQ of the bone, pierces the peroneus longus muscle, and divides into two terminal branches superficial and deep peroneal nerve. The common peroneal nerve is extremely vulnerable to injury as it winds around the neck of fibulaQ by direct trauma and fractures. Injury to common peroneal nerve causes foot dropQ. Beware : an isolated fracture of proximal fibula is rare : it may be merely the most visible pa of a more extensive rotational injury of leg involving a serious fracture or ligament injury of the ankle (the Misonneuve fracture). So alsways X - ray the ankle !


Question: GCS minimum value

Answer- A. 3Glasgow coma scale is used to determine the conscious level of the patient.Ranges from 3 to 15.


Question: Marsupialization is the procedure done in


Question: A 40 years old male with CA descending colon presents with acute intestinal obstruction. Emergency treatment of choice is


Question: Vocal cord palsy in thyroid surgery is due to injury to

Reccurent laryngeal nerve injury is classically described as a paralyzed vocal cord with loss of movement from the midline (supplies all the intrinsic muscles of the larynx, except cricothyroid muscles). Injury to the external branch of the superior laryngeal nerve leads to loss of tension in the vocal cord (supplies cricothyroid) with diminished power and range in the voice Source : Bailey and Love 26th edition Pg: 762


Question: This appearance of mammary skin is due to

Ans. (c) Lymphatic penetration.Observe the dotted dimpling on the skin which resembles orange peel, hence the name peau-d-orange.Peau-d-orange is due to cutaneous lymphatic blockage, leading to an appearance like orange skin, this condition is due to lymphatic penetration by tumor cells.Image source- style="font-family: Times New Roman, Times, serif">


Question: Spermatocoeles are most commonly found at

Answer- A. The Head of epidydimisSpermatoceles typically arise from the caput (head) of the epididymis, which is located on the superior aspect of the testicle.


Question: Chylothorax means pleural cavity containing

(A) Lymph # CHYLOTHORAX OR CHYLE LEAK is a type of pleural effusion &results from lymph formed in the digestive system called chyle accumulating in the pleural cavity due to either disruption or obstruction of the thoracic duct.> Causes: It is rare but serious, and It results from leakage of lymph fluid from the thoracic duct (or one of its tributaries). This can result from direct laceration (e.g., from surgery) or from nontraumatic causes. The most common nontraumatic cause is malignancy, especially lymphoma. Less common is left-heart failure, infections, and developmental abnormalities such as Down syndrome and Noonan syndrome.> Treatment of Chylothorax: Drainage of the fluid out of the pleural space is essential to obviate damage to organs, especially the inhibition of lung function by the counter pressure of the chyle. Pleuroperitoneal shunting (creating a communication channel between pleural space and peritoneal cavity). Loss of essential triglycerides that escape the thoracic duct can be prevented. Omitting fat (in particular FFA) from the diet is essential. Surgical or chemical pleurodesis: leaking of lymphatic fluids is stopped by irritating the lungs and chest wall, resulting in a sterile inflammation. Llung and the chest wall to be fused together which prevents the leaking of lymphatic fluids into the pleural space. Octreotide has been shown to be beneficial and in some cases will stop the chylothorax after a few weeks.


Question: Charcots/neuropathic joints are most commonly seen in September 2007

Ans. A: DM Any condition that causes sensory or autonomic neuropathy can lead to a Charcot joint. Charcot ahropathy occurs as a complication of diabetes, syphilis, chronic alcoholism, leprosy, meningomyelocele, spinal cord injury, syringomyelia, renal dialysis, and congenital insensitivity to pain. Diabetes is considered to be the most common cause of Charcot ahropathy Acute Charcot ahropathy almost always presents with signs of inflammation. Profound unilateral swelling, an increase in local skin temperature (generally, an increase of 3-7 degrees above the nonaffected foot's skin temperature), erythema, joint effusion, and bone resorption in an insensate foot are present. These characteristics, in the presence of intact skin and a loss of protective sensation, are often pathognomonic of acute Charcot ahropathy. Pain can occur in more than 75% of patients; however, the pain's severity is significantly less than would be expected based on the severity of the clinical and/or radiographic findings. Instability and loss of joint function also may be present. Passive movement of the joint may reveal a "loose bag of bones." Approximately 40% of patients with acute Charcot ahropathy have concomitant ulceration, which complicates the diagnosis and raises concerns that osteomyelitis is present.


Question: Blisters are seen in

Superficial second degree burns Involve upper layer of dermis (papillary dermis) Erythematous Blisters are seen Blanch to touch Painful Heals without scarring in 7-14 days Ref: Sabiston 20th edition Pgno :506-507


Question: Not used for intravascular volume maintainence is

Answer- C. ErythropoetinErytheropoetin InjectionsErythropoietins available for use as therapeutic agents are produced by recombinant DNA technology in cell culture, They are used in treating anemia resulting from chronic kidney disease, chemotherapy induced anemia in patients with cancer, inflammatory bowel disease (Crohn's disease and ulcerative colitis).


Question: Ulcerative colitis starts in

(A) Rectum # Pathology of ulcerative colitis: In 95%t of cases the disease starts in the rectum and spreads proximally.> When the ileocaecal valve is incompetent, retrograde (backwash) ileitis involving the last 30 cm of the ileum is likely to occur.> It is a nonspecific inflammatory disease, primarily affecting the mucosa and superficial submucosa, and only in severe disease are the deeper layers of the intestinal wall affected> There are multiple minute ulcers, and microscopic evidence proves that the ulceration is almost always more severe and extensive than the gross appearance indicates.> When the disease is chronic, inflammatory polyps (pseudopolyps) occur in up to 20 per cent of cases and may be numerous.> They result from previous episodes of ulceration heaving islands of spared mucosa which will remain prominent when the adjacent mucosa heals.> In severe fulminant colitis a section cf the colon, usually the transverse colon, may become acutely dilated and the intestinal wall then becomes extremely thin and may perforate ('toxic megacolon').> On microscopic investigation there is an increase of inflammatory cells in the lamina propia, the walls of crypts are infiltrated by inflammatory cells and there are crypt abscesses.> There is depletion of goblet cell mucin. The crypts are reduced in number and appear to be atrophic and irregularly spaced. With time these changes become severe and precancerous changes can develop (severe dysplasia or carcinoma in situ).


Question: Bassini's repair for hernia is done for


Question: The use of medical history in extraction patients is


Question: Amount of thyroid tissue left after subtotal thyroidectomy is

Total thyroidectomy involves excision of all visible thyroid tissue. Near-total thyroidectomy is complete resection on one side while leaving a remnant of thyroid tissue on the contralateral side, leaving less than 1 g of tissue adjacent to the RLN at the ligament of Berry. Subtotal thyroidectomy leaves a remnant of thyroid tissue bilaterally. Subtotal resection of each lobe is carried out, leaving a remnant of 4-5 g on each side. Thyroid lobectomy typically includes removal of the thyroid isthmus and pyramidal lobe (if present). Source : Sabiston 20th edition Pg : 912 Bailey and Love 26th edition Pg : 761


Question: Partial thickness graft is

Ans. b (Thierch graft) (Ref. Bailey and Love 26th/pg.402)SKIN GRAFTSSplit Thickness (Therisch)Full Thickness (Wolfe)Donor site factor# Large area available# Smaller area# Donor site heals spontaneously# Donor site must be closed# Reusable donor site# Donor site scarsRecipient site factors# Poor color match# Good color match# Easily abraded# Abrasion resistant# inferior cosmetic results# Good cosmetic results# More reliable take# Less reliable take# Shiny texture, inelastic# Normal texture, elastic(Note: Wolfe's graft is a Whole (Full) thick-ness graft)


Question: A metastatic carcinoma in the brain of an adult, most often comes from primary in the


Question: In the immediate post operative period, body potassium is

There is increased Adreno cortical activity which causes Na+ retention & K+ excretion.


Question: Most appropriate management of advanced stage rectal carcinoma

(B) Abdominoperineal resection # 'RECTAL CARCINOMA' located at 5 cm from the anal verge lies in the lower rectum.> Considering the conventional methods of treatments Anterior resection is possible for tumors of upper 2/3rd of rectum Abdominoperineal resection is indicated for tumors of lower 1/3rd of rectum> General site specific plan> Upper Rectum (> 11 cm) Anterior Resection , Mid Rectum (6-11 cm) Low Anterior resection , Lower Rectum (< 6 cm) Abdominal- perineal resection> Note: Length of rectum is about 12 to 15 cm and the anal canal is about 4 cm, any tumor 5 cm from anal verge would thus lie at lower rectum.> General considerations for tumors in lower Rectum: Abdominoperineal Resection (APR) is the gold standard for the treatment of distal rectal cancer. 'APR' involves complete excision of rectum and anus, by concomitant dissection through abdomen and perineum, with permanent closure of perineal rafe and creation of an end colostomy. The most significant disadvantage of this procedure is that it sacrifices the sphincter mechanism and hence now focus is shifting towards a number of sphincter sparing procedures.> It is important however to note here that the information provided is too limited to comment upon the possibility of performing sphincter saving procedures such as local resection or a posterior proctotomy.> Sphincter sparing procedures may be carried out for Young patients who have a favourable body habitus Patients with good preoperative sphincter function Lack of sphincter involvement by tumor Limited extension of tumor into rectal wall (T1 or T2 lesions) Low grade tumors> Sphincter sparing procedures include: Colonal anastomosis Local excision Transanal excision Trans sphincteric excision Posterior proctotomy (Kraske procedure)


Question: HLA B27 is seen associated with aEUR'

Ankylosing spondylitis HLA B27 is associated with: Ankylosing spondylitisQ Reiter's syndromeQ Reactive ahritis (yersinia, salmonella, shigella, Chlamydia) Psoriatic spondylitisQ


Question: Gas most commonly used to create pneumoperitonium is

Ans) a (CO2) Ref:hnp:/Avww.researchgate.net/pubHcation/6252R23_Pathophysiologic effects of CO2-pneiimopentoneum in lupanmnpic surgeryLaparoscopic surgery is one of the most important diagnostic and therapeutic tools in general surgery. This minimally invasive procedure requires pneumoperitoneum for adequate visualization and operative ma-nipulation.Carbon dioxide is the most commonly used gas for creating pneumoperitoneum, because of its high diffusibility and rapid rate of absorption and excretion.Certain specific surgeries that in the past required long hospitalization and were associated with severe post- operative pain and frequent compli-cations are today performed laparoscopically. This minimally invasive technique potentially offers reduced operative time and morbidity, decreased hospital stay and earlier return to normal activities, less pain and less post-operative ileus compared with the traditional open surgical procedures.Because the postoperative benefits are superior to open surgical pro-cedures, laparoscopy is today also used in many high risk patients in ad-vanced age and pre-existent cardiopulmonary and respiratory diseases.However, insufflations of carbon dioxide into the peritoneum may lead to alteration in the acid-base balance, cardiovascular and pulmonary physiology. Although these changes may be well tolerated in healthy pa-tients, in high risk patients they may increase the rate of perioperative complications.


Question: A 12 year old girl presents with a 0.4 cm slightly raised strawberry coloured nodule in the skin of the abdomen below the umbilicus. It is present for many years and not changed in color or size. Diagnosis

Answer: c) Hemangioma (ROBBINS 9th ED, P-516)HEMANGIOMAHemangiomas are very common tumors characterized by increased numbers of normal or abnormal vessels filled with bloodMost are present from birth and initially increase in size, but many eventually regress spontaneouslyWhile hemangiomas typically are localized lesions confined to the head and neck, they can occasionally be more extensive (angiomatosis) and can occur internally.Nearly one third of these internal lesions are found in the liverMalignant transformation is rare.Capillary hemangiomasMost common typeOccur in the skin, subcutaneous tissues, and mucous membranes of the oral cavities and lips, as well as in the liver, spleen, and kidneysJuvenile hemangiomas (strawberry type hemangiomas)Juvenile hemangiomas of the newborn are extremely common and can be multiple.These arise in the skin and grow rapidly for a few months, but then fade by 1 to 3 years of age and completely regress by age 7 in the vast majority of cases.Cavernous hemangiomasComposed of large, dilated vascular channelsAs compared to capillary hemangiomas, cavernous hemangiomas are more infiltrative, frequently involve deep structures, and do not spontaneously regress.Intravascular thrombosis and associated dystrophic calcification are common.They can be locally destructive, and as a result some may require surgery.Cavernous hemangiomas are one component of von Hippel-Lindau diseasePyogenic granulomasCapillary hemangiomas that present as rapidly growing red pedunculated lesions on the skin, gingival, or oral mucosa.They bleed easily and are often ulceratedRoughly a quarter of lesions develop after trauma, reaching a size of 1 to 2 cm within a few weeks.Curettage and cautery is usually curative.Pregnancy tumor (granuloma gravidarum) is a pyogenic granuloma that occurs infrequently (1% of patients) in the gingiva of pregnant women.These lesions may spontaneously regress (especially after pregnancy), or undergo fibrosis, but occasionally require surgical excision


Question: The most common facial abnormality in Gardener's syndrome

Ans. is 'c' i.e. Multiple osteomas Osteomas is mandible and skull are the most common facial lesions in Gardner syndrome. Gardner syndrome is a variant of FAP characterized by: - Colorectal polyposis - Epidermoid cysts - Desmoid tumors - Osteomas - Thyroid neoplasms, and - Congenital hyperophy of the retinal pigment epithelium


Question: Commonest cause of cellulitis is

Ans. (b) Streptococcus(Ref: Bailey 26th 55)* Most common cause of cellulitis is Streptococci. Other causes include Staphylococci, and C.Perfringens


Question: The advantage of bladder drainage over enteric drainage after pancreatic transplantation is better monitoring of

The specific complications of enteric drainage include intra-abdominal sepsis and adhesive small intestinal obstruction.Bladder drainage of the exocrine pancreas may result in the following complications:* bladder/duodenal anastomotic leaks;* cystitis (owing to effect of pancreatic enzymes);* urethritis/urethral stricture;* reflux pancreatitis;* urinary tract infection;* haematuria;* metabolic acidosis (due to loss of bicarbonate in the urine).Urinary drainage of the pancreas has the advantage that urinary amylase levels can be used to monitor for graft rejection. However, after bladder drainage, urinary complications are commonBailey and Love 26th edition pg: 1427


Question: "Doughnut" sign is seen in

.CONGENITAL HYPEROPHIC PYLORIC STENOSIS is hyperophy of musculature of pyloric antrum, especially the circular muscle fibres, causing primary failure of pylorus to relax. Duodenum is normal. Clinical features of congenital pyloric stenosis 1. Vomiting 2. VGP 3. Palpable mass 4. Constipation and dehydration Diagnosis is established by -- Clinical examination. -- U/S abdomen (very useful)--Doughnut sign. * Pyloric muscle 4 mm or more in thickness. * Length of pyloric canal > 1.8 cm. -- Barium meal shows obstruction. ref:SRB&;S manual of surgery,ed 3,pg no 752


Question: CT severity index is a measure of

Ans. (b) PancreatitisRef: Sabiston 20th ed; pg. 1528* Balthazar scoring is a CT scoring system* CTSI is one of the best system used to classify the severity of pancreatitis.


Question: Lumbar sympathectomy is the treatment for

(B) Distal ischaemia affecting the skin of the toes with rest pain


Question: The facial space that is divided by styloid process into an anterior and posterior compartment is


Question: Earliest sign of deep vein thrombosis is


Question: Treatment of choice for Tension pneumothroax is

tension pneumothorax must be treated as a medical emergency. If the tension in the pleural space is not relieved, the patient is likely to die from the inadequate cardiac output or marked hypoxemia. A large-bore needle should be inseed into the pleural space through the second anterior intercostal space. If large amounts of gas escape from the needle after inseion, the diagnosis is confirmed. The needle should be left in place until a thoracostomy tube can be inseed. Ref : Harrison 17/e p1660; Bailey & Love 25/e p879


Question: Skip lesions are seen in

in ileocaecal tuberculosis,.Ulcerative--commonest 60%. Circumferential transverse often multiple 'girdle' ulcers - with skip lesions. It i common in old, malnourished people. skip lesions are typical in the case of crohn&;s diseaseskip lesions are also observed in wet gangrene and necrotizing enterocolitis . ref:SRB&;s manual of surgery,ed 3,pg no 513


Question: The colour of a nitrous oxide cylinder is


Question: The occurrence of hyperthyroidism following administration of supplemental iodine to subject with endemic iodine deficiency goitre is known as


Question: Most common ovarian malignancy in post menopausal period is

Ans a Ref: Sheila balakrishnan page 256Epithelial tumor: Majority are seen in post menopausal woman, peak incidence between 50-60.30-40:peak incidence of borderline tumorsLess common under 40 yrsMost common epithelial tumor is serous cystadenoma followed by mucinous.Sex cord stromal tumors: can occur at all ages Germ cell tumors: common among children, young adults


Question: Most common cause of lymphedema  of upper limb is


Question: Nodular regenerating hyperplasia is associated with aEUR'

Drug [Ref: www.ijpmonline.org; Depament of Pathology AFMC Pune D.shelly, MS Tevetial Nodular regenerative hvperplasia Nodular regenerative hyperplasia of the liver is an uncommon condition characterized by diffuse benign transformation of the hepatic parenchyma into small regenerative nodules with minimal or no fibrous septa i.e., "unlike cirrhosis there is absence of fibrosis". It is also known as :? - Nodular transformation - Noncirrhotic nodules - Paial nodular transformation Nodular regenerative hyperplasia belongs to a group of liver diseases that causes an intrahepatic noncirrhotic poal hypeension (NCPHP. In addition to nodular regenerative hyperplasia this group includes incomplete septal cirrhosis and hepatopoal sclerosis. Nodular regenerative hyperplasia is the most common cause of noncirrhotic poal hypeension in the western world and is responsible for 14-27% of cases of NCPH. Conditions associated with nodular regenerative hyperplasia Nodular regenerative hyperplasia has been described in association with a variety of conditions. Most of them are systemic autoimmune diseases or hematological disorders and less frequently solid neoplasms, drugs. Connective tissue disease associated with nodular regenerative hyperplasia Antiphospholipid syndromeQ Felty's syndrome Lupus erythematosis Sjogren's syndrome Systemic sclerosis Hematological disorders associated with Nodular regenerative hyperplasia Usually myeloproliferative disorders Drugs associated with nodular regenerative hyperplasia AzathioprineQ Pathogenesis of nodular regenerative hyperplasia:- Pathogenesis is unceain but seems to be related to abnormalities of hepatic blood flow. The vascular lesions in nodular regenerative hyperplasia could be due to recurrent entbolization of the poal vein radicals by platelet aggregates and thrombi originating in the poal venous system.


Question: A man takes peanut and develop stridor, neck swelling, tongue swelling and hoarseness of voice. Most probable diagnosis is

Angioneuritic edema (Ref. Harrison 17th/e p 2066 & 16riVe p 52, 1952] Angioedema is essentially an anaphylaxis limited to the skin and subcutaneous tissues and can be due to drug allergy, insect stings or bites, desensitization injections or ingestion of ceain foods (paicularly eggs, shellfish or nuts) Sometimes reactions occur explosively after ingestion of minute amounts. Others (e.g. reactions to strawberries), may occur only after overindulgence and possibly result from direct (toxic) mediator liberation. It is characterized by a diffuse and painful swelling of loose subcutaneous tissue, e.g. dorsum of hands or feet, eyelids, lips, genitalia and mucous membrane. Edema of the upper airways may produce respiratory distress and the stridor may be mistaken for asthma. Treatment Epinephrine should be the first treatment for acute pharyngeal or laryngeal angioedema. This may be supplemented, by a nebulized agonist (e.g. albuterol) and an I.V. antihistamine (diphenhydramine). This is usually sufficient to prevent airway obstruction hut intubating or performing a tracheostomy and administering 0, might be necessary. Also know Uicaria This is also an anaphylaxis reaction, but in uicarias the disease is limited to the superficial tissues. Uicaria is characterized by local wheals and erythema in the superficial dermis whereas angioedema is a deeper swelling due to edematous areas in the deep dermis and subcutaneous tissue. Generally, pruritus is the first symptom, which is followed sholy by the appearance of wheals that may remain small (1-5 mm) or enlarge. The larger ones tend to be clear in the centre and may be noticed, first as large rings (> 20 cm across) of erythema and edema. Also know If acute angioedema is recurrent progressive, painful rather than pruritic and not associated with uicaria a hereditary enzyme deficiency should be considerd. Hereditary angioneurotic edema occurs due to loss of C1 inhibitor (regulatory protein) CIF of hereditary angioneuroedema - Episodes of laryngeal edema - Prominence of recurrent gastrointestinal attacks - lack of pruritus and of uicarial lesions Laboratory diagnosis of hereditary angioneuroedema - It depends upon demonstrating the deficiency of C1 inhibitor


Question: Most common thyroid malignancy is

Malignancy Relative incidencePapillary carcinoma 80%Follicular carcinoma 10%Poorly differentiated/anaplastic carcinoma 5%Medullary carcinoma 2.5%Lymphoma 2.5%Ref: Bailey and love, page no: 816


Question: Bleeding from externaJ auditory meatus in a case of head injury is suggestive of

(B) Middle cranial fossa fracture > 'Panda' sign': Bilateral periorbital haematoma in a patient with a fracture of the anterior cranial fossa.# Base of skull fractures :-> Anterior cranial fossa fracture (involves frontal or ethmoid sinuses) Sub conjunctival hematomas (extending to posterior limits of sclera) Anosmia, epistaxis, Nasal tip paraesthesia, CSF rhinorhoea, caroticocavernous fistula, causes rupture of anterior inferior cerebral artery> Middle cranial fossa fracture (involves petrous temporal bone) - CSF otorrhoea or rhinorrhoea through Eustachian tube, hemotympanum, ossicular disruption, Battle sign, VII and VIII cranial nerve palsies. Battle sign- Bruising behind ear after 36 hours of head injury involving petrous temporal bone


Question: Forceps used for maxillary fracture disimpaction


Question: Most common presenting symptom of fibroadenosis is

.Tamoxifen used in- * Carcinoma breast * Benign diseases of the breast like fibroadenosis * Infeility in males * Desmoid tumour. Differential diagnosis for carcinoma breast * Fibroadenosis * Traumatic fat necrosis * Tuberculosis of breast * Blood good cyst * Filariasis breast * Mastitis etc. usually ibroadenosis presents with pain. ref:SRB&;s manual of surgery,ed 3,pg no 456


Question: Most commonly used local anesthesia


Question: Pulled elbow is


Question: Latest method "Gail model'' of risk assessment is for

Ans. (c) Breast cancer.(Ref Schwartz principles of surgery, 10th ed p-512)Because of the increased risk of breast cancer in US - Gail developed a most commonly used model to predict the cumulative risk of breast cancer. It includes the following factors# Age# Age at menarche# Age at 1st child birth# Number of breast biopsy specimens# History of atypical hyperplasia# Number of 1st degree relatives with breast cancer* A scoring is calculated by a software based on these and predicts the 5 year risk and life time risk of breast cancerFor Extra Edge - Know the other similar models used for cancer breast:# Clauss model# BRCAPRO model# Tyrer-Cuzick model


Question: Commonest cause of Ludwig's Angina is

Commonest cause of Ludwig's angina is dental infection of 2nd and 3rd molar teeth.


Question: Improper direction of the needle insertion during inferior alveolar nerve block results in


Question: A ranula is a

Cystic swelling in the floor of the mouth


Question: Nerve supply of the skeletal muscles element of diaphragm is

Phrenic nerve Phrenic nerve is the sole motor nerve supply to diaphragm. Under the influence of phrenic nerve input, the diaphragm contributes more than any other muscle to inspiration. With deeper respiration, there is more extensive descent of the domes which brings them inferior to the central tendon.


Question: Not preserved in modified radical mastectomy is

Ans. (d) Branches of Inter costobrachial Nerve(Ref. Bailey and Love 6th Edition Page 813)Structures preserved in MRM:* Axillary Vessels* Bells nerve* Cephalic vein* Nerve to Latissmus dorsi* Pectoralis Major


Question: Perirectal abscess drainage belongs to

Contaminated surgery :

Wound is exposed to any organism in uncontrolled environment.
Perisectal abscess drainage belongs to this category.


Question: Optimal timing of administration of prophylactic antibiotic for surgical patients is

one hour prior to induction of anesthesia


Question: Fundoplication is used in treatment of

Ans. a (Hiatus hernia). (Ref. LB 25th ed., 1024)PARAOESOPHAGEAL ('ROLLING') HIATUS HERNIA# Rolling hiatus hernias are dangerous# Unlike sliding hiatus hernia a rolling hiatus hernia is a true hernia that is prone to complications. True paraoesophageal hernias in which the cardia remains in its normal anatomical position are very rare and confined to museum exhibits and personal collections of interesting cases. The hernia is commonest in the elderly, but may occur in young fit people.# The symptoms of rolling hernia are mostly due to twisting and distortion of the oesophagus and stomach. Dysphagia is common. Chest pain may occur due to distension of an obstructed stomach. Classically the pain is relieved by a loud belch. Symptoms of GORD are variable.# The hernia may be visible on a plain X-ray of the chest as a gas bubble, often with a fluid level behind the heart. Fluid levels are not seen in sliding hernias. A barium meal is the best method of diagnosis. Endoscopic look may be confusing, especially in large hernias endoscopist feels as if have lost sense of direction.# Rolling hernias always require surgical repair as they are potentially dangerous. However, major surgery may not be an attractive prospect in frail elderly patients or in someone who has few symptoms. The essential part of the operation is reduction of the hernia and some form of gastropexy. Some surgeons perform a fundoplication arguing that this is a very effective means of maintaining reduction and that it deals with the associated GORD.# Laparosopic repair has recently become popular. Full anatomical repair of a large rolling hernia can be tedious and difficult by the laparoscopic approach and it is more common simply to reduce the hernia and perform a gastropexy. Some surgeons lay a sheet of prosthetic mesh across the hiatal opening to stop the bowel entering it.# Total or partial fundoplication? The disadvantage of the Nissen fundoplication is that it can produce an overcompetent cardia resulting in dysphagia or the gas bloat syndrome in which belching is prevented. As a result the stomach fills with air and the patient feels very full after meals and passes excessive flatus. The problem of the overcompetent cardia has been largely overcome by the floppy Nissen in which the fundoplication is made very loose around oesophagus and also by making a short fundoplication of 1 cm or so.


Question: Sign of lymphatic spread in carcinoma stomach is

Troisier's sign : tumour appearing in the supraclavicular nodes, it is by lyphatic spreadBlumer's shelf (pouch of Douglas), Krukenberg's (ovaries) and Sister Josephs's (umbilicus) are by transperitoneal spreadTrousseau sign of malignancy is migratory thrombophlebitis a Non-metastatic effect of malignancyTrousseau sign of latent tetany: In hypocalcemia, a blood pressure cuff is placed around the arm and inflated to a pressure greater than the systolic blood pressure and held in place for 3 minutes. This will induce spasm of the muscles of the hand and forearm.Bailey and love 27e pg: 1133


Question: A female post open cholecystectomy through general Anesthesia after 12 hours she is dyspneic. Right lower lobe crepitations present. Probable cause is

Ans. (b) AtelectasisRef: Bailey and Love 26th edition Page 273Post op complications - Respiratory:* MC post operative complications are - Hypoxemia, Hypercarbia and Aspiration in recovery room* Hypoxia reasons:# Upper airway obstruction due to secretion# Laryngeal edema# Recurrent laryngeal nerve injury after thyroid surgery# Hypoventilation related to anesthesia# Atelectasis# Pneumonia# Pulmonary edema of cardiac origin# Pulmonary embolism


Question: Principles of treatment of Pyogenic infection of skeletal system are

. Treatment is antibiotics,radical wound excision with removal of pus and all necrosed muscle and compament release haemodialysis is needed until recovery if there is renal failure later secondary suturing or skin grafting is needed. (Ref: SRB's Manual of surgery,5th edition,pg no.65)


Question: Most common cause of death in burns patients is

Septic shock is most common cause of death.
Asphyxia is MCC death in immediate phase of burns.


Question: Causes of oesophagal carcinoma

.common causes of developing oesophageal carcinoma include cardiac achalasia, Plummer Vinson syndrome, oesophageal websBarrett&;ss oesophagus, corrosive strictures and also TYLOSIS.Tylosis is an inherited disorder in which there is thickening of the skin of palm and sole, also known by the name Hovels Evans syndrome. Ref: SRB&;s manual of surgery,5th ed, pg no 804


Question:
The fracture of the tooth bearing segment of the
mandible is


Question: Emergency operation done in cases of

Surgery is required to prevent or relieve ischaemia.When a removable lesion is found in the caecum, ascending colon, hepatic flexure or proximal transverse colon, an emergency right hemicolectomy should be performed. Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1191,1200

Appendicular perforation with paralytic ileus


Question: SEPS is used for

. SEPS-Subfascial Endoscopic Perforator Ligation Surgery,it us recommended in chronic venous insufficiency. procedure: 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 is easy to detect using endscope.Technique is done under torniquet 300 mm hg pressure.Endoscope is advanced down along the medial border of tibia.Perforators travelling in subfascial plane are identified and fulgurated using bipolar cauery or clips can be applied into the perforators.It is recommended in chronic venous insufficiency.But its limitation is difficuilty in getting "lift off" skin in cases with severe lipodermatosclerosis to identify the perforators. Refer page no 237 of SRB's manual of surgery 5 th edition.


Question: Most common tumor of eyelid is

Ans. a (Basal cell carcinoma). (Ref. Baily & Love, 25th/pg. 609)BASAL CELL CARCINOMA (BCC, rodent ulcer)# Basal cell carcinoma is the commonest form of skin cancer and typically affects individuals between the ages of 40 and 79 years; 50 percent are male.85 percent occur in the head and neck region.# Are thought to originate from pluripoten epithelial cells of the epidermis and hair follicles.# BCCs grow slowly, but locally invasive and penetrate deeper tissues -- hence the term rodent ulcer,# Metastasis is rare.# Typically these tumours have a nodular appearance with a pearly rolled edge (which is apparent on stretching the skin) and telangiectatic vessels.# Clinically types in order of frequency:- Nodular: 50-54%; (90% nodular/nodular cystic). Superficial : 9-11%;- Cystic: 4-8%; Pigmented: 6%; Morpheic : 2%.# Treatment:- Surgical excision -- the treatment of choice with cure rates between 85 and 95%.- Electrodessication and curettage -- commonly used for small superficial lesions (2--5 mm in diameter) gives cure rates between 85 and 100%.- Radiotherapy -- BCC is very radiosensitive and has an overall response of 92 % in selected patients. This is reserved for elderly patients who are not suitable for surgery or for specialised anatomical sites.- Moh's micrographic surgery (chemosurgery) --involving serial horizontal excision and mapping of the tumour. Usually reserved for recurrent lesions, tumours in difficult areas or those with indistinct borders (morphea-form).- Following complete excision it is unnecessary routinely to follow-up these patients unless they have a familial disposition for BCC formation (Gorlin's syndrome).


Question: Cyst around crown of uninterrupted tooth is

Dentigerous cyst is a unilocular cystic swelling arising in relation to the dental epithelium from an unerupted tooth SRB,5th edition,360 .


Question: Hirschsprung&;s disease is due to

.* It is a congenital, familial condition, occurring in newborn due to the absence of ganglion cells-- Auerbach's and Meissner's plexus in anorectum, which may extend proximally either a pa or full length of the colon. ref:SRB&;s manual of surgery,ed 3,pg no 818

Loss of ganglion cells in the sympathetic chain

Failure of migration of neural crest cells from cranial to caudal direction


Question: Screening of prostate CA is commonly done by

Screening of prostate cancerPSAIn general, one would advise men aged50-69 years to undergo prostate biopsy if the PSA was more than ~3 ng/mL. The threshold would be lower in younger men with a strong family history.DREIrregular induration, characteristically stony hard in pa or in the whole of the gland (with obliteration of the median sulcus), suggests carcinomaBailey and love 27 e pg: 1458


Question: A lady with 50% TBSA burn with involvement of dermis & subcutaneous tissue came to emergency depament. Burns will be classified as;

Third degree burns - Aka full thickness burn - Involvement of Epidermis + dermis + Subcutaneous fat - Burn Surface has Black coloured leathery eschar - Escharotomy is done to prevent compament syndrome - Characteristic features No pain, No blister, No pin prick sensation Healing occurs with contracture - To prevent contracture - Excision of burned skin with skin grafting


Question: Surgical blade number useful for aeriotomy is

Surgical blade for aeriotomy is 11 Minor surgical procedures- 15 Abdominal incisions- 22 Reference: Bailey and love, 27th edition, page:85


Question: The origin of thyroglossal duct is


Question: Most common cause of umbilicus does not separate at age of 2 years

Ans. is 'b' i.e., Leukocyte adhesion deficiency


Question: Male patient with EHL weakness

(A) L4-L5 slip disc CLINICAL FEATURES OF LUMBAR DISC PROLAPSENerve Root CompressedL1L2L3L4L5S1Level of Disc ProlapseT12-L1L1-L2L2-L3L3-L4L4-L5L5-S1PainThoraco lumbar junction groin, proximal part of thighThoracolumbar junction, groin, proximal part of thighUpper lumbar spine, atnerior aspect of proximal thighLower back, hip, posterolateral thigh, anterior legSacroiliac joint, hip, lateral thigh & lateral legSacroiliac joint, hip, posteriolateral leg to heelParesthesiaOblique band proximal 3rd of thigh anteriorly just below inguinal ligamentOblique band mid 3rd of thigh anteriorlyOblique band lower part of thigh anteriorly just above the kneeMedial to shin of tibia, medial aspect of the footLateral leg, dorsum of foot, 1st web spacePosterior aspec: of thigh, back of calf lateral side & sole of footMuscle Affected MainlyIliopsoas (Hip flexion)Iliopsoas (Hip flexion), Quadriceps (Knee extension), adductor brevis, longus magnus (Hip adduction)Iliopsoas (HIP flexion), Quadriceps (knee extension), adductor brevis, longus, magnus (Hip adduction)Tibialis anterior (foot inversion), Quadriceps (knee extension), adductor brevis, longus magnus (Hip)Extensor Hallucis Longus (Dorsiflexion of great toe), Extensors brevis (Dorsiflexion of foot), GluteusPeroneus Longus & Brevis (Foot eversion), Flexor hallucis longus (Plantar flexion of great toe), Flexor digitorum longus & brevis> Extensor hallucis longus is a thin muscle, situated between Tibialis anterior and Extensor digitorum longus, functions to extend big toe and dorsiflex foot, & assists with foot eversion and inversion.> Innervation: Deep peroneal (fibular) nerve, branch of common peroneal (fibular) nerve (L4, L5, S1).


Question: Common bule duct injuries are most commonly seen in

Bile duct injuries are most common in laparoscopic cholecystectomy(0.8 %),i.e.,around 3 times more than that of an open cholecystectomy.BDI can lead to bile leak,fistula formation,biliary strictures and lately biliary cirrhosis and poal hypeension. Reference:SRB's manual of surgery,5th edition,page no:666


Question: A blood stained discharge from the nipple indicates

(Duct papilloma) (831 - Baity & Love 25th, 281- CSDT 13th)Blood discharge from nipple caused by benign papilloma in the ductCauses of blood stained discharge from nippleBlood stained discharge from a single ductMore than one duct,* Intraductal carcinoma* Intraductal papilloma*** Duct ectasia* Carcinoma* Ectasia* Fibrocystic diseaseCauses of other tvpe of discharge from nippleSerous (any colour)Grumous/GramPurulentMilk* Fibrocystic disease* Duct ectasia* Carcinoma* Duct ectasiaInfections* Lactation* OCP users* Estrogen replacement therapyGreenish discharge is seen in fibroadenosis and mammary duct ectasia* Treatment of ductal papilloma (<40 years) - Michrodochectomy*** Lobular carcinoma are associated with bilaterality, A biopsy of the contralateral breast is therefore requiredCEA is a marker of Paget's disease of the mammary gland (Infiltratina ductal carcinoma)Post radical neck dissection syndrome - arising from denervation and atrophy of the trapezius muscle due to sacrifice of the spinal accessory nerve (SAN)- Inability to abduct the shoulder beyond 90deg cephalad- Long standing pain in the shoulder- Deformity of the shoulder girdle- Drooping of the shoulder, shoulder abduction and external rotationCauses of Fat necrosis1. After surgery / surgical trauma -* Wide local excision* Reduction mammoplsty*** Breat reconstruction* Breast biopsy2. Following radiotherapy* including iridium implant3. following trauma4. Autologous fat injection using the liposuction* technique to fill in irregular contours & small soft tissue defects in the breast may lead to fat necrosis secondary to poor blood supply in the injected fat5. Conservative treatment of breast cancer with lumpectomy & radiation therapy may also result in fat necrosis* Phenomena resulting from lymphatic obstruction in advanced breast cancer(i) Peaud's orange (due to cutaneous lymphatic oedema)(ii) Cancer-en-cuirasse(iii) Lymphangiosarcoma* Aromatase Inhibitors are used in Breast carcinoma are - Letrozole, Anastrozole, Exemestane, Aminoglutethimide


Question: Blumberg's sign is

Positive Blumberg's sign or rebound tenderness or Release sign is indicative of peritonitis which can occur in diseases like appendicitis, perforated peptic ulcer and may occur in ulcerative colitis with rebound tenderness in the right lower quadrant etc. Rebound tenderness on abdominal palpation is d/t the fact that the parietal peritoneum which has already been inflamed due to the presence of underlying inflamed organ also springs back along with the abdominal muscles. < p> Reference : page 458 A manual on clinical surgery Das 10th edition

Rebound tenderness during abdominal palpation

Pressure over left iliac fossa causing pain in right iliac fossa

Pressure over right iliac fossa causing pain in left iliac fossa


Question: The commonest gastric polyp is

.Metaplastic/hyperplastic Polyp -* Metaplastic- indicates a difference in appearance from normal mucosa. * Very minute in size- 1-2 mm. Multiple. * Common in rectum. Also occurs in other pas of colon. * Contains columnar epithelium, cystic dilatation, goblet cells, and lymphocytes. * Not a pre-malignant entity. ref:SRB&;s manual of surgery,ed 3,pg no 831


Question: In a healthy adult scheduled for an elective operation, solid food shoulder be withheld for at least .......... hours before surgery

Nil by mouth and regular medications Patients are advised not to take solids within 6 hours and clear fluids (isotonic drinks and water) within 2 hours before anaesthesia to avoid the risk of acid aspiration syndrome. These restrictions are fuher reduced in infants, as keeping hydrated reduces discomfo and is known to improve post- operative outcomes. If the surgery is delayed, oral intake of clear fluids should be allowed until 2 hours before surgery or intravenous fluids should be staed, especially in vulnerable groups of patients, e.g. children, the elderly and diabetics. Patients can continue to take their specified routine medications with sips of water in the NBM period. Ref: Bailey and love 27th edition Pgno : 259