Question: Priapism in a young male could occur because of

Priapism is persistent ( more than 4 hours) painful erection of penis. Usually seen as a compilcation of blood disorders like leukemia, sickle cell disease. Other causes include following therapeutic injection of papaverine, abnormally prolonged bout of otherwise normal sexual activity, idiopathic thrombosis of corpora cavernosa or prostatic venous plexus, malignant disease in the corpora cavernosa or the pelvis, rarely as a consequence of spinal cord disease. Reference : page 1063 SRB's manual of surgery 5th edition and page 1374 Bailey and Love's sho practice of surgery 25th edition


Question: Following an oral surgical procedure, the surgical site is covered with a gauze wetted with saline because

Saline promotes local haemostasis at the site

Saline decreases the tendency of the clot to get embedded in gauze mesh

Saline has localized anti-inflammatory action

Saline accelerates the healing of the wound


Question: Dimpling in cancer breast happens due to

Ans. (b) Infiltration of Cooper's Ligament(Ref. Bailey 26th edition Page 798)* Infiltration of Suspensory ligament of breast (Cooper's) results in Dimpling of breast in cancer


Question: Elevators should not be used to remove the palatal root of an


Question: Dysphagia mainly for liquids is seen with

Ans. (a) Achalasia Cardia* Achalasia is a rare disease caused by loss of inhibitory ganglion cells within the esophageal myenteric plexus* It leads to a hypertensive lower oesophageal sphincter (LOS) which fails to relax on swallowing, and by aperistalsis of the body of the oesophagus.* Long-standing achalasia is characterized by progressive dilatation and sigmoid deformity of the esophagus with hypertrophy of the LES.Clinical Presentation* Progressive dysphagia is the most common presenting symptom. It generally concerns initially liquids and later both liquids and solids from the outset.# Dysphagia: Liquids > Solid* The second most common symptom is the regurgitation of undigested food during or shortly after a meal.Investigation* Screening: Barium study- Bird beak appearance* IOC: ManometryTreatment* Medical management:# Calcium channel blockers# Nitrates# Botulinum toxin (injected into the LES under endoscopic guidance)* Surgical management:# Harrison states: "The only durable therapies for achalasia are pneumatic dilatation and Heller myotomy"# Surgery of choice: Heller's myotomy


Question: Hilton method is best used in

Answer- B. Axillary abscessHilton's method of abscess drainage is chosen when there are plenty of impoant structures like nerves and yessels around the abscess caity, like axilla. In this method incision is made only through the skin and subcutaneous tissue. The deep fascia is not incised.


Question: The surgery for hyperophic pyloric stenosis of infancy is

After laparotomy hyperophied muscle is cut along the whole length adequately until mucosa bulges out, then pyloromyotomy is done. in Heller&;s operation muscle of the cardiac are cut to allow passage of food ,and is done in achalasia cardia Truncal vagotomyis done by denervating the main branch which is supply in pylorus as in cases like peptic ulcerarltion Delorme&;s operation is done for repairing a external rectal prolapse Reference: SRB 5th edition page no. 821 & internet


Question: In testicular tumours

(Maldescent of testis leads to malignancy) (1411-LB) (1385-B & L 25th)Tumours of the Testes* About 99% of testicular neoplasm are malignant and although they make up only about 1 -2% of malignant tumours (MC tumours in young males)* **Maldescent undoubtedly predisposes to malignancy.* Tumours of testis = Seminoma (40%) Teratoma (32%) combined (14%) interstitial tumours (1.5%) lymphoma (71%).* Malignant teratoma intermediate teratocarcinoma is the most common histologic variants of teratoma.* Clinical features(i) First noticing that he has a testicular lump. A sensation of heaviness.(ii) Only 30% of patients experience pain (Normally painless)(iii) There is a history of trauma to the affected side in over 10%(iv) 10% of patients have lax secondary hydroceleEssentials of Diagnosis (1070-CSDT 11th)* Painless firm mass within the testicle in a man aged 18-40* Elevated serum levels of the beta subunit of(i) Human chorionic gonadotropin (P-hCG) (ii) Alpha fetoprotein (AFP) (iii) Lactic dehydrogenase (LDH) or all three* Enlarged retroperitoneal nodes on abdominal CT scan* Palpable abdominal mass in advanced cases.

Maldescent of testes leads to malignancy


Question: Confirmation of appendicitis

The classical features of acute appendicitis begin with poorly localised colicky abdominal pain.Central abdominal pain is associated with anorexia, nausea and usually one or two episodes of vomiting that follow the onset of pain (Murphy). Anorexia is a useful and constant clinical feature, paicularly in children. The patient often gives a history of similar discomfo that settled spontaneously. Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1207,1208


Question: Clostridium difficile infection risk increases on use of

Ciprofloxacin increases risk of C.difficile enterocolitis.Metronidazole, vancomycin, teicoplanin are effective agaist C. difficile in cases of pseudomembranous colitis.Ref: Bailey and Love 27e pg: 56


Question: Posterior communicating aery arises from

Internal carotid Internal carotid aery has five main branches to the brain: anterior cerebral, middle cerebral, ophthalmic, anterior choroidal and posterior communicating aery.


Question: Lumbar sympathectomy is of value in the management of

. Ans: b (Distal ischemia affecting the skin of toes) (Ref. Textbook of surgery by S. Das-3rd ) - Indications for sympathectomy: 1. Circulatory insufficiency of the limbs (Limb warms, pain reduces and ulcers may show signs of regression) o Atherosclerosis (with rest pain, impending gangrene of toes) o Raynaud's Syndrome (temporary relief) o Buerger's disease 2. Hyperhidrosis 3. Causalgia

Distal ischaemia affecting the skin of the toes


Question: Open fracture is treated by


Question: Mark the Nerve (Arrow) to be identified during surgeryr of overlying organ

Recurrent laryngeal (Identified during Thyroid surgery)


Question: management of an open wound seen 12 hours after the injury


Question: . Hirschprung's disease is treated by


Question: "Cobblestone" appearance seen on colonoscope is cheracteristic of the following disease

.in crohn&;s disease,Fibrosis, stricture formation, deep ulcers, oedema of mucosa between ulcer areas which looks like 'cobble stone', skipped normal areas in between, serosal opacity, mesen-teric fat stranding, enlarged mesenteric lymph nodes, abscesses in the mesentery, fistula are the pathology. Small mucosal aphthous ulcers are earliest gross feature. ref:SRB&;s manual of surgery,ed 3,pg no 800


Question: Most common location of anorectal fistula

Park classification of anorectal fistula is
Type 1. Intersphincteric - most common
Type 2. Transsphincteric
Type 3. Suprasphincteric
Type 4. Extrasphincteric


Question: Ureteric colic due to stone is caused by

(Increased peristalsis of the ureter to overcome obstruction) (31-Smith Urology 17th,1274-Baily & Love 25th)The severity and colicky nature of ureteric colic pain are caused by the hyper peristalsis and spasm of smooth muscles of the ureter as it attempts to rid itself of a foreign body or to overcome obstruction (smith urology 17th)Pain from acute obstruction of ureter(Stone or Blood clot)|| |Back Pain Severe colicky painThis results from capsular distensionThis results from renal, pelvic and ureteral muscle spasm. The severity and colicky pain are caused by the hyperperistalsis and spasm of this smooth muscle organ (Ureter) as it attempts to rid itself of a foreign body or to overcome obstruction* Pain classically radiates from costovertebral angle down towards the lower anterior abdominal quadrant* In Men - It may also be felt in the bladder, scrotum or testicle* In women - it may also be felt in the vulvaLocation of Ureteric Pain Stone in upper ureter - Pain radiates to testicles (T11T12) Nerve supply of testicles is similar to that of kidney & upper ureter Stone in the midportion of ureter(i) Right side - Pain referred to Me Burney's point and stimulates appendicitis (T12L1)(ii) Left side - Pain referred to left lower quadrant and stimulates diverticulitis or other disease of the descending or sigmoid colon (T12-L1) Stone in the lower portion(i) Proximal to orifice - Pain is referred to inner side of thigh or groin (L1 L2)(ii) At the level of orifice or orifice involved due to edema symptoms of vesical irritability such as frequency and urgency may occur* Ureteric peristalsis is due to intact supply of - Intrinsic smooth muscle pacemaker activity of renal calyces**** The narrowest part of ureter is at the - uretero-vesical junction*** Highest incidence of ureteric injury in- Wertheim's hysterectomyUreteric Constriction - Sitesi. Ureteropelvic junctionii. Crossing of the iliac arteryiii. Juxta position of the vas deferens or broad ligamentiv. Uretero vesical junctionv. Ureteric orifice* Phosphate stones (Staghorn calculi)Excess alkali consumption, Alkali urine*Infection with urease splitting organism eg Proteus, kleibsella, Pseudomonas* Cystine stoneForm in acidic urine*, Extremely hard stone,Relatively resistant to fragmentation with ESWL**The most sensitive imaging modality for diagnosis ureteric stone in a patient with acute colic is - Non contrastCT scan of the abdomenArterial supply of ureter are as follows(a) upper end(b) Middle portion(c) PelvisRenal arteryTesticular or ovarian arterySuperior vesical artery

Stretching of renal capsule due to back pressure

Increased peristalsis of ureter to overcome the obstruction


Question: Dry socket

Results from loss of blood clot in the socket

Is treated with reinducing bleeding into the socket

Is common in extraction of anterior teeth


Question: Adson test used for determining vascular sufficiency is useful in

SRB Manual of Surgery 4th edition, Pg 458 Adson's test :
The hand is raised above after feeling the radial pulse.
The patient is asked to take a deep breath and turn the same side. Any change in pulse, i.e. either becoming feeble or absent is noted. Adson's test is done in case of the Cervical rib.
It is not useful in varicose veins, PVD or AV fistula.


Question: Ainhum is seen in

Ainhum : is a condition usually affecting Negro males (but some females) who have run barefoot in child hood.
Clinical Features : A fissure appears at interphalangeal joint of toe -usually the fifth. This fissure becomes a fibrous band, encircles the digit and causes necrosis.


Question: Most common cause of hypovolemic hyponatremia in hospitalized patient is

(B) Diuretics induced > Hypervolemic hyponatremia cirrhosis congestive heart failure nephrotic syndrome massive edema of any cause> Euvolemic hyponatremia states of severe pain or nausea in the setting of trauma or other damage to the brain SIADH (and its many causes)Hypovolemic hyponatremia any cause of hypovolemia such as prolonged vomiting, decreased oral intake, severe diarrhea diuretic use (due to the diuretic causing a volume depleted state and thence ADH release, and not a direct result of diuretic-induced urine sodium loss)


Question: For a 8 year old child with TMJ ankylosis, the treatment of choice is

Gap arthroplasty with costochondral grafting


Question: Linguine sign is Seen in

It is a sign seen in intracapsular rupture of breast implant on MRI.


Question: Complication of fracture scaphoid is


Question: Content of staghorn calculus is

Ans. is 'a' i.e., Phosphate Types of renal calculusOxalate calculus (calcium oxalate)* Oxalate stones are irregular in shape and covered with sharp projections, which tend to cause bleeding.* The surface of the calculus is discoloured by altered blood. A calcium oxalate monohydrate stone is hard and radiodense.Phosphate calculus* A phosphate calculus is smooth and dirty white.* It tends to grow in alkaline urine, especially when urea-splitting Proteus organisms are present. As a result, the calculus may enlarge to fill most of the collecting system, forming a staghorn calculus.* Even a very large staghorn calculus may be clinically silent for years until it signals its presence by haematuria, urinary infection or renal failure.* Because they are large, phosphate calculi are usually easy to see on radiographic films.Uric acid and urate calculi* These are hard, smooth and often multiple.* They vary from yellow to reddish brown and sometimes have an attractive, multi- faceted appearance.* Pure uric acid stones are radiolucent and appear on an excretion urogram as a filling defect, which can be mistaken for a transitional tumour of the upper urinary tract.* The presence of uric acid stones is confirmed by CT. Most uric acid stones contain some calcium, so they cast a faint radiological shadow.* In children, mixed stones of ammonium and sodium urate are sometimes found. They are yellow, soft and friable. They are radiolucent unless they are contaminated with calcium salts.Cystine calculus* These uncommon stones appear in the urinary tract of patients with a congenital error of metabolism that leads to cystinuria.* Hexagonal, translucent, white crystals of cystine appear only in acid urine. They are often multiple and may grow to form a cast of the collecting system.* Pink or yellow when first removed, they change to a greenish colour when exposed to air.* Cystine stones are radioopaque because they contain sulphur, and they are very hard.Xanthine calculus* These are extremely rare. They are smooth and round, brick-red in colour, and show lamellation on cross-section. These stones are radiolucent.


Question: Graft Survival in first 48 hours depends on

Ans. is 'a' ie. Plasma imbibition (Ref. Sabiston, 18/e p2135 (17/e p2185); Schwartz 9/e p165))" Skin grafts to survive in the recipient bed, have to become revascularized. This takes place in three distinct phases":Imbibition: refers to absorption of nutrients into the graft, which serves to feed the graft for the first 24 to 48 hrs.Inosculation: is the process whereby donor and recipient capillaries become aligned. During the first two phases, the graft becomes adhered to the recipient bed by fibrous deposition at the interface.Revascularization : is completed by differentiation of the connecting vessels into arterioles and venules.

Connection between donor and recipient capillaries.


Question: Metastasis in thyroid gland come most commonly from carcinoma of

The above-mentioned book is solely dedicated to surgery and diseases of thyroid & parathyroid gland.

It writes -
"Metastatic disease to the thyroid may occur as a consequence of direct extension from upper aerodigestive malignancies, i.e., squamous cell Ca, or by hematogenous spread. Evidence at autopsy has demonstrated upto 20% of patients exhibiting distant metastasis to the thyroid gland from breast, lung, kidney, & melanoma skin most commonly."


Question: After the first postoperative year of cardiac transplantation, the most common cause of death is

Chronic graft rejection is manifested in cardiac allografts as chronic vascular rejection of main and intramuscular coronary arteries. Myointimal proliferation and medial scarring result in diffuse and eccentric arterial narrowing referred to as accelerated graft atherosclerosis. Infection remains the primary cause of death within the first year of cardiac transplant, but accelerated graft arteriosclerosis is the most common cause of mortality thereafter. Percutaneous transluminal coronary angioplasty, coronary artery bypass grafting, and re-transplantation are the current options for combating this problem.


Question: Harder stone with less satisfactory result in ESWL is

Ans. (d) Cystine StonesRef Bailey and Love 27th Edition, Page 1408Extra Corporeal Shock Wave Lithotripsy:* Shock waves generated and focused on the stones.* Methods of Shock Wave Generation:# Spark Gap# Electromagnetic# Piezo Electric# Micro Expulsive* Cardiac arrhythmias can happen in cases of Spark Gap generated waves* ESWL is indicated for stones upto 1.5cm in kidney* Prophylactic antibiotics are advised.* Relatively resistant stone is CYSTINE due to its hardness.* Contraindications: Pregnancy and Oral Anticoagulant drug consuming patients* Steinstrasse - Stone street is collection of stone fragments in distal ureter after breaking by ESWL.


Question: Characteristic of H. Pylori is

Normal duodenum cannot harbour H pylori, duodenum with gastric metaplasia can very well get infected by H pylori which explains why it is involved in duodenal ulcer. It is a gram-negative spiral like flagellated organism, it is most common cause of duodenal ulcer (95%), triple regime including clarithromycin - metronidazole - omeprazole is used for its treatment Reference SRB edition :5 page : 819, 820


Question: Margin of normal tissue margin taken in excision of melanoma

For in situ melanoma a wide excision of 5 mm is sufficient; for melanoma <1 mm deep, a 1 cm margin is sufficient; and for deeper lesions, a 2 cm only margin is recommended, as there is no evidence that wider margins make a difference.Ref: Bailey and Love, 27e, page: 611


Question: The blood product of choice for treatment of hemophilics is


Question: Most common testicular tumor in Pre pubertal age

Yolk sac tumors are most commonly found in pre pubertal age group.


Question: Poor prognostic indicator of Pott's paraplegia

Ans. is 'c' i.e., Healed disease Prognosis of Pott's paraplegia Good Poor Degree Paial (only sensory or motor) Complete paraplegia (grade IV) Duration Shoer Longer (> 12 months) Type Early (acute) onset Late (chronic) onset Speed of onset Slow (insidious) Rapid (sudden) Age Younger Old General condition Good Poor Veebral disease Active Healed Kyphotic deformity < 600 > 60deg Cord on MRI Normal Myelomalacia or syringomyelia Preoperative Wet lesion Dry lesion


Question: Bariatric surgical procedures include

Treatment for Obesity includes * Dieting. * Exercise.and also the various modalities of surgery indicated is the following, * Veical banded gastroplasty. * Gastric bypass. * Laparoscopic gastroplasty or gastric bypass. * Jaw wiring. * Biliopancreatic diversion. * Jejuno-ileal bypass ref: SRB&;s manual of surgery, ed 3, pg no 90


Question: Tibial Fracture with > 1 cm wound, slight comminution and moderate crushing is


Question: In newborn the most common cause of intestinal obstruction is


Question: The gold standard for diagnosing acid reflux is

The gold standard for diagnosing and quantifying acid reflux is the 24-hour pH test.Sabiston 20th edition Pg: 1070


Question: Abdominal pain, fever and jaundice. This triad is known as;

- Charcot's triad - abdominal pain + jaundice + fever. - Seen in Cholangitis. - For cholangitis to occur, the 2 essential factors are obstruction & infection. Predisposing factors for cholangitis: CBD stones (M.C) Stricture Cholangiocarcinoma Choledochal cyst Worms M.C organism responsible for CBD is E. coli > Klebsiella. M.C symptom - fever + chills. Inadequate treatment causes Reynold's pentad - Charcot's triad + shock + mental status changes.


Question: Masaoka staging is used in

The staging system for thymoma was developed by Masaoka and colleagues. It is an anatomic system in which the stage is increased on the basis of the degree of invasiveness. Diagnostic criteriaIMasaoka Staging System for ThymomasStageMacroscopiccriteriamicroscopically completely encapsulated; noinvasion through capsuleIIIIAMicroscopic invasion outside the capsuleIIBMacroscopic invasion into surrounding fat or grossly adherent to pleura or pericardiumIIIIIIAMacroscopic invasion into neighboring organs, pericardium, or pleura but not great vesselsIIIBMacroscopic invasion into neighboring organs that includesgreat vesselsIVIVAPleural or pericardial disseminationIVBLymphatic or hematogenous metastasesRef: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 123e Thymoma; Page no: 123e-1


Question: Most common site for salivary gland tumors is

The parotid gland is the most common site for salivary tumors. Most commonly seen in the superficial lobe of parotid gland.


Question: Most common abdominal tumor in children is

MCC of abdominal tumor in children is neuroblastoma. It crosses midline
2nd MCC of abdominal tumor in children is wilms tumor it doesnt cross midline


Question: Trastuzumab is directed against

Trastuzumab is a humanized monoclonal antibody directed against the extracellular domain of the (human epidermal growth factor receptor -2) HER-2 surface receptor and is effective treatment for HER-2-positive breast cancer Ref: Sabiston 20e, page: 840

Human epidermal growth factor receptor 2


Question: Pseudopolyps are common with

Ans. (a) Ulcerative colitisRef: Sabiston 20th edition, Page 1260* Pseudo polyps are uninvolved areas in colon in ulcerative colitis.* If cancer arises in ulcerative colitis it arises from intervening areas of pseudo polyps.


Question: Oblique view is required to diagnose fracture of


Question: Most common site of development of carcinoma of prostate is

For BPH - transitional zone is most commonly involved
For carcinomma - peripheral zone is most commonly involved.


Question: Gases for Pneumoperitoneum

CO2 is commonly used to create pneumoperitoneum as it is readily available, is cheaper, suppresses the combustion, is easily absorbed by tissues, has a high diffusion coefficient and is quickly released respiration. Other gases used are: Air, nitrous oxide, helium, argon. Reference : page 1183 SRB's manual of surgery 5th edition


Question: Amputated digits are preserved in

The amputated digits are cleansed under saline solution, wrapped in saline moistened gauze, and placed in a plastic bag The plastic bag containing the pa is then placed on (not packed in) a bed of ice in a suitable container The amputated pa should never be immersed in Non-physiological solution such as antiseptics or alcohol Ref: Sabiston 20th edition Pgno :1996


Question: Ethyl alcohol is effective (against spores)


Question: Screening of prostate CA is best done by

DRE + PSA is the best way to screen prostate Ca.


Question: Commonly seen Pancreatic endocrinal tumour

Insulinoma Definition This is an insulin-producing tumour of the pancreas causing the clinical scenario know as Whipple's triad, i.e. symptoms of hypoglycaemia after fasting or exercise, plasma glucose levels <2.8 mmol/L and relief of symptoms on intravenous adminis- tration of glucose. Incidence Insulinomas are the most frequent of all the functioning PETs with a repoed incidence of 2-4 cases per million population per year. Insulinomas have been diagnosed in all age groups, with the highest incidence found in the fouh to the sixth decades. Women seem to be slightly more frequently affected. Pathology The aetiology and pathogenesis of insulinomas are unknown. No risk factors have been associated with these tumours. Viually all insulinomas are located in the pancreas and tumours are equally distributed within the gland. Approximately 90% are solitary and about 10% are multiple and associated with MEN 1 syndrome. Prognosis and predictive factors No markers are available that reliably predict the biological behaviour of an insulinoma. Approximately 10% are malignant. Insulinomas of <2 cm in diameter without signs of vascular invasion or metastases are considered benign. Clinical features Insulinomas are characterised by fasting hypoglycaemia and neuroglycopenic symptoms. The episodic nature of the hypoglycaemic attacks is caused by intermittent insulin secretion by the tumour. This leads to central nervous system symptoms such as diplopia, blurred vision, confusion, abnormal behaviour and amnesia. Some patients develop loss of consciousness and coma. The release of catecholamines produces symptoms such as sweating, weakness, hunger, tremor, nausea, anxiety and palpitations. Biochemical diagnosis A fasting test that may last for up to 72 hours is regarded as the most sensitive test. Usually, insulin, proinsulin, C- peptide and blood glucose are measured in 1- to 2-hour intervals to demonstrate inappropriately high secretion of insulin in relation to blood glucose. About 80% of insulinomas are diagnosed by this test, most of them in the first 24 hours. Elevated C-peptide levels demonstrate the endogenous secretion of insulin and exclude factitious hypoglycaemia caused by insulin injection. Ref: Bailey and love 27th edition Pgno : 849


Question: Contrast media used in ultrasound is

D. i.e. (Echovist) (39- 42 - Textbook of colour Doppler Imaging S.K. Bhargava)* Iohexol used in Myelography*** Contrast agent (ECHOVIST) have been used to evaluate tubal potency in infertility and ureteric reflux in children with renal tract infectionsContrast agents in Ultrasound* Contrast agents increases shift frequency and echo strength determines the visualization hence act as echoenhancers* Echo- enhancers are microbubbles - levovist, optisan, sonovue* Range of ultrasound frequencies that are used for clinical diagnosis microbubbles at(1 - 7 m diameter) do not diffuse across the endothelium


Question: The most common location of hypeensive intracranial haemorrhage is

Most common locations of hypeensive intraparenchymal hemorrhage are basal ganglia (especially the putamen) thalamus cerebellum pos It usually results from spontaneous rupture of small penetrating aery deep in the brain. Ref : Harrison, 17/e p2531


Question: Recurrent dislocation of shoulder occurs, because of


Question: Empyma is a term given for

Collection of blood in the tissue spaces

Collection of serous fluid in the tissue spaces


Question: Pattern theory of pain control was given by


Question: Cerebral perfusion pressure is measured as

(A) MAP (mean arterial pressure) - ICP (intracranial pressure)# CEREBRAL PERFUSION PRESSURE, or CPP, is the net pressure gradient causing cerebral blood flow to the brain (brain perfusion).> It must be maintained within narrow limits because too little pressure could cause brain tissue to become ischemic (having inad-Equate blood flow), and too much could raise intracranial pressure (ICP).> Every increase of ICP can cause a change in tissue perfusion and an increase in stroke events.> From resistance: CPP can be defined as the pressure gradient causing cerebral blood flow (CBF) such that CBF = CPP / CVR CBF = CPP/CVRwhere: CVR is cerebrovascular resistanceBy intracranial pressure> An alternative definition of CPP is: CPP = MAP-ICP CPP=MAP-ICPwhere: MAP is mean arterial pressure ICP is intracranial pressure JVP is jugular venous pressure> More specifically, cerebral perfusion pressure can be defined as: CPP = MAP-ICP CPP = MAP - ICP (if ICP is higher than JVP)or CPP = MAP-JVP CPP = MAP - JVP (If JVP is higher than ICP).> Physiologically, increased ICP causes decreased blood perfusion of brain cells by mainly two mechanisms: Increased ICP constitutes an increased interstitial hydrostatic pressure that, in turn, causes a decreased driving force for capillary filtration from intracerebral blood vessels. Increased ICP compresses cerebral arteries, causing increased cerebrovascular resistance (CVR). FLOW Ranging from 20ml 100g-1 min-1 in white matter to 70ml 100g-1 min-1 in grey matter.> Autoregulation: Under normal circumstances a MAP between 60 to 160 mmHg and ICP about 10 mmHg (CPP of 50-150 mmHg) sufficient blood flow can be maintained with autoregulation. Although the classic 'autoregulation curve' suggests that CBF is fully stable between these blood pressure values (known also as the limits of autoregulation), CBF may vary as much as 10% below and above its average within this range. Outside of the limits of autoregulation, raising MAP raises CPP and raising ICP lowers it (this is one reason that increasing ICP in traumatic brain injury is potentially deadly). In trauma some recommend CPP not go below 70 mmHg. Recommendations in children is at least 60 mmHg. Within the autoregulatory range, as CPP falls there is, within seconds, vasodilatation of the cerebral resistance vessels, a fall in cerebrovascular resistance and a rise in cerebral-blood volume (CBV), and therefore CBF will return to baseline value within seconds. These adaptations to rapid changes in blood pressure (in contrast with changes that occur over periods of hours or days) are known as dynamic cerebral autoregulation.

ICP (intracranial pressure) - MAP (mean arterial pressure)

CPP (cerebral perfusion pressure)/CVR (cerebrovasular resistance)

MAP (mean arterial pressure) + JVP (jugular ve nous pressure)


Question: Most common vessel affected in acute Limb ischaemia is

Superficial femoral artery is most commonly affected artery in acute Limb ischaemia.


Question: Tenesmus occurs in lesions of


Question: Calculate GCS of 25 old head injury patient with following parameters confused,opening eyes in response to pain ,localising pain response to pain

Glasgow coma scale: Eye opening Best verbal response Best motor response Response Score Response Score Response Score Spontaneously 4 Oriented and Converses 5 Obeys commands 6 To verbal stimuli 3 Disoriented and converses 4 Localises pain 5 To pain 2 Inappropriate words 3 Flexion- withdrawal to pain 4 Never 1 Incomprehensible words 2 Abnormal flexion (decoicate rigidity) 3 No response I Abnormal extensive obsturing 2 No response 1 Maximum score is : 15 Minimum score is :03 RE: BAILEY AND LOVE 27TH ED


Question: Most common Complication of TIPSS procedure

Since systemic blood is shunted toxins ( NH3) travel to brain
causing encephalopathy. Hence TIPSS is contra indicated in
encephalopathy patients.


Question: Normal cerebral blood flow is

Normal cerebral bloodflow (CBF) is about 55 mL per minute for every 100 gramsof brain tissue. Ischaemia results when this rate drops below20 mL per minute, and even lower levels will result in infarctionunless promptly corrected.Flow depends on cerebral perfusion pressure (CPP), the difference between mean aerial pressure (MAP) and intracranial pressure (ICP).CPP (75-105 mmHg) = MAP (90-110 mmHg) - ICP(5-15 mmHg)Bailey and love 27e 328

45 ml/min for every 100gm of brain tissue

55 ml/min for every 100gm of brain tissue

65 ml/min for every 100gm of brain tissue

75 ml/min for every 100gm of brain tissue


Question: Yellow nodules over palm diagnosis

Answer- C. CornA corn is a localized keratosis of the skin. Histologically a corn is composed of keratin masse with intact basal layer.It usually occurs at the sites of frictional pressure on the sole, foot and toes. This often occurs due to ill fitting or tight shoes.Corn is thicker than callosity and causes more cofloent to the patient.


Question: Treatment of choice for transverse cell carcinoma in renal pelvis is

Upper tract transitional cell carcinoma Accounts for 5-10% of urothelial carcinomas . Often presents late with advanced disease In the absence of metastatic disease, standard treatment is nephroureterectomy ref : Bailey and Love 27th ed , chapter 76 , pg no 1421


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


Question: Thoracic outlet syndrome is primarily diagnosed by

The initial presentation of thoracic outlet syndrome(eg.,in cervical rib)is dependent on whether the compression is primarily vascular,neurogenic or a combination of both.Vascular thoracic outlet syndrome can involve subclan aery or vein presenting with colour changes of affected upper extremity,claudication,or diffuse pain.Neurogenic syndrome involves brachial plexus presenting as sensory loss,pain or paraesthesia. Reference:Bailey & Love's sho practise of surgery,25th edition,pageno:895.


Question: Best marker for prediction of coronary aery disease aEUR'

LDL/HDL Risk factors for atherosclerosis and cardiovascular complications (Braunwald) Abnormalities in plasma lipoproteins and derangement in lipid metabolism rank as the most firmly established risk factors for atherosclerosis. Adjusted relative risk for future cardiovascular events for selected lipid fractions and lipid rations in decreasing order are given in the following table Relative risk for future Lipid Fractions and lipid Cardiovascular events Ratios cardio * Total chotesterol : HDL Cholestrol Ratio (TC : HDLC) * Apopratein B100: HDL Cholesterol Ratio (APo B100: HDLC) * LDL Cholesterol : HDL Cholesterol Ratio (LDLC: HDLC) * Apoprotein 8100: Apoprotein A -1 (APO B100: APO Al) * Non HDL Cholesterol fraction * Apolipoprotein B -1 Fraction * * HDL cholesterol Fraction * Total cholesterol Fraction Decreasing Predictivity * Apolipoprotein Al Fraction of Risk * LDL cholesterol Fraction


Question: Amyand's hernia is


Question: Secondary deposits form prostatic carcinoma is commonest in

Secondary deposits form prostatic carcinoma is commonest in boneThe prostate is the most common site of origin for skeletal metastases, followed in turn by the breast, the kidney, the bronchus and the thyroid gland. The bones involved most frequently are the pelvic bones and the lower lumbar veebrae. The femoral head, rib cage and skull are other common sites


Question: During splenectomy in ITP, platelet infusion is given

Indications for splenectomy: 1. Relapsed severe cases after treatment with steroids - for 6 weeks 2. Girls attaining menarche 3. ITP persisting even after 6-9 months refractory to treatment 4. In 2nd trimester pregnancy, with platelet count <10000/mm3 and severe bleeding problems 5. Recurrence after stopping/tapering steroids 6. Profound GI bleed and intracranial bleed Surgery * During surgery and in emergency, fresh blood transfusions or platelet transfusions are required. Sometimes the anti-platelet immune response is temporarily blocked by IgG transfusion so to allow the platelet count to rise at the time of surgery or in cases of severe bleeding or in pregnancy. * Accessory spleen should be identified and removed. * In 7 days platelet count raises to more than 100000/ cu mm. * Laparoscopic approach is ideal in elective splenectomy for ITP. Ref: SRB&;s manual of surgery,3 rd ed, pg no 607


Question: Contraindication of local anaesthesia is

(Clotting disorders): Ref: 50. LB (199-B &L 25th)* Contraindication of LA are local infection and clotting disorders, Not only does local infiltration spread the infection, but local anaesthetic drugs are ineffective in condition of acidity as produced by infection. Local infiltration in the presence of a clotting disorder may result in haemorrhage or may produce haematoma, which is potentially fatal in the airway, as may occure in dental surgery.


Question: Shagreen patch is seen in

(A) Tuberous sclerosis # TUBEROUS SCLEROSIS is a genetic disorder affecting cellular differentiation and proliferation, which results in hamartoma formation in many organs (eg, skin, brain, eye, kidney, and heart).> Skin lesions (found in 70-80% of cases)> Characteristic lesions are angiofibromas, previously known by a misnomer, adenoma sebaceum.> These are pink or skin-colored telangiectatic papules commonly observed in the nasolabial folds and on the cheeks and chin. They usually appear in children younger than 10 years and increase in size and number until adolescence, remaining unchanged thereafter. Other areas in which they may be observed include in and around nails (ungual fibromas), scalp, and forehead, in the latter location reaching sizes up to several centimeters. In the oral mucosa, they may be observed in the lips, dorsa of tongue, and palate. Dental pitting occurs in about 90% of patients. A hand lens examination aids detection of these pits, which are less obvious in deciduous teeth.> Periungual fibromas (Koenen tumors) are smooth, firm, flesh-colored papules emerging from the nail folds. They can be the only manifestation in some individuals. These are noted around puberty and may increase in frequency as the patient ages.> Shagreen patches Are flesh-colored soft plaques that are frequently found in the lumbosacral area but may occur anywhere on the trunk. Surface may be pebbly (resembling pigskin or untanned leather) with prominent follicular openings. Are usually noticed during the first decade.> White macules Are ovoid, hypopigmented, ash leaf-shaped macules that can be found on the trunks or limbs. White macules offer an excellent opportunity for early diagnosis because they may be found at birth or early infancy. The use of Wood lamp accentuates these macules. Color, even though described as white, lacks the depigmented white appearance of vitiligo. Careful examination is necessary before making any firm diagnosis because hypopigmented macules may be a normal finding in newborn babies. 3 or more white macules at birth should alert the clinician regarding the possibility of tuberous sclerosis. Other skin signs include guttate leukoderma, cafe-au-lait macules, and poliosis.


Question: Surgical treatment (ligation or stripping) is preferred for GSV diameter equal to or greater than

SAPHENOFEMORAL LIGATION AND GREAT SAPHENOUS STRIPPING An oblique groin incision is made at the level of, and lateral to, the pubic tubercle, ideally above the groin crease. The GSV is identified and dissected to the SFJ, which should be clearly established before the vein is divided to avoid disastrous inadveent transection of the superficial femoral vein. The anatomy is often variable but six GSV tributaries may be encountered close to the SFJ: Laterally: * superficial inferior epigastric vein; * superficial circumflex iliac vein; Medially: * superficial external pudendal vein; * deep external pudendal vein; Distally: * anterior accessory saphenous vein; * posteriomedial thigh vein. Classically, these are ligated distal to their divisions. A flush SFJ ligation is then performed and the GSV retrogradely stripped to around the knee. Phlebectomy is performed as discussed above. Closure of the cribriform fascia, with sutures or synthetic patches over the ligated SFJ, does not reduce groin recurrence. Stripping to the lowest point of reflux may improve results, but at a cost of increased saphenous nerve complications and is not widely performed. More recently, some surgeons argue that surgical trauma and subsequent inflammation in the groin is associated with neovascularisation, which in turn may lead to recurrence. Fuhermore, others hypothesise that it is the loss of the normal groin tributaries that may be responsible for driving the process of neovascularisation. These concepts have led some to believe that ligation of the refluxing vein should be distal to the tributaries and that the junction itself should be left untouched. There is no clear clinical evidence to suppo these hypotheses. Ref: Bailey and love 27th edition Pgno : 981


Question: Apa from Escherichia coli, the other most common organism implicated in acute suppurative bacterial peritonitis is

Bacteroides are commonly found in peritonitis. These Gram-negative, non-sporing organisms, although predominant in the lower intestine, often escape detection because they are strictly anaerobic and slow to grow on culture media unless there is an adequate carbon dioxide tension in the anaerobic apparatus (Gillespie). In many laboratories, the culture is discarded if there is no growth in 48 hours. These organisms are resistant to penicillin and streptomycin but sensitive to metronidazole, clindamycin, lincomycin and cephalosporin compounds. Since the widespread use of metronidazole (Flagyl), Bacteroides infections have greatly diminished. When bacteria contaminate the peritoneum as a result of spillage from an intra-abdominal viscus.* Infection in secondary bacterial peritonitis is polymicrobial* E. coli and Bacteroides are MC organisms.* The species of organism isolated vary with the source of the initial process and the normal flora present at the site. * Peritonitis is one of the MC complications of CAPDQ, occurring with an incidence of approximately one episode every 1 to 3 years.* Refractory or recurrent peritonitis is MC cause of technical failure of CAPD.* MC organism: Staphylococcus epidermidis (30-50%). Clinical Features* Patients present with abdominal pain, fever, and cloudy peritoneal dialysate containing >100 WBC/mm3, with >50% of the cells being neutrophils.* Gram staining detects organisms only in 10-40% of cases. Treatment* CAPD associated peritonitis is treated by the intraperitoneal administration of antibiotics, usually a first-generation cephalosporin.* Overall, 75% of infections are cured by culture-directed antibiotic therapy.* Recurrent or persistent peritonitis requires removal of the dialysis catheter and resumption of hemodialysis Reference:Bailey & Love's sho practise of surgery,25th edition,page no:992


Question: Duret haemorrhage is/are seen in

Duret Hemorrhage In case of increased ICP downward herniation of brainstem occur, which cause stretching of perforators of basilar aery and may result in bleed (Duret hemorrhage) Duret hemorrhage is a small area of bleeding in ventral and paramedian pa of upper brainstem (midbrain and pons). It usually indicates a fatal outcome, however survival has been repoed Diagnosis is made on CT or MRI Ref: Robbins 9th edition Pgno :1255


Question: A young patient presents with a massive injury to proximal duodenum, head of pancreas and distal common bile duct. The procedure of choice in this patient should be

.whipple&;s operation is done by removing (tumor with) head and neck of pancreas , c loop of duodenum, 40% distal stomach, 10cm proximal jejenum, lower end of common bile duct,gall bladder, peripancreatic,pericholedochal, paraduodenal and perihepatic nodes. continuity is maintained by choledochojejunostomy, pancreaticojejunostomy, and gastrojejunostomy. few advocate pancreaticogastrostomy into posterior wall of stomach. moality in whipple&;s operation is 2-8% (Ref: SRB&;s Manual of Surgery, 5th edition, pg no. 706)


Question: Most common cause of hydronephrosis in children

Congenital PUJ obstruction is MCC for hydronephrosis in children.


Question: Site of IM injection without injuring any vessels or nerves


Question: Seat belt injury is


Question: MC type of carcinoma anal canal


Question: Child pug score is used to assess severity of


Question: A pt. with Ca tongue is found to have lymph nodes in the lower neck. The t/t of choice for the lymph nodes is

Surgical management can be of 3 types: Radical neck dissection (RND), Modified radical neck dissection (MRND) & Selective neck dissection (SND) Radical neck dissection - is the traditional gold standard for control of cervical metastasis. - RND involves removal of levels I to V of the cervical lymph nodes + Sternocleidomastoid, IJV and the spinal accessory nerve (CN XI). Modified radical neck dissection is modification of RND that preserves nonlymphatic structures i.e. CN XI, SCM and IJV. MRND has been found to be equally effective in controlling neck disease as RND with superior functional outcome. Selective neck dissection Preservation of any of the levels I through V during neck dissection is known as Selective neck dissection. The principle behind preservation of ceain nodal groups is that specific primary sites preferentially drain their lymphatics in a predictable pattern. Types of SND include the supraomohyoid neck dissection, the lateral neck dissection, and the posterolateral neck dissection.


Question: Lymph node first involved in Ca breast is/are

.Levels of the axillary nodes *Level I : Below and lateral to the pectoralis minor muscle--anterior, lateral, posterior *Level II : Behind the pectoralis minor muscle--central *Level III : Above and medial to pectoralis minor muscle-- apical Note in carcinoma breast * Spread restricted to level I nodes carries better prognosis * Spread to level II has poor prognosis * Spread to level III indicates worst prognosis. ref:SRB&;s manual of surgery,ed 3,pg no 455


Question:
Absolute contraindication of conservative breast cancer therapy isa) Large pendulous breastb) History of previous radiationc) Axillary node involvementd) Subareolar lump presente) 1
st
 trimester pregnancy


Question: A 45 year old patient is suffering from diffuse toxic goiter, Therapy of choice will be

Antithyroid drugs first	followed by surgery


Question: Delayed prolonged bleeding after a minor surgery is caused by defect in

Defect in capillary bed to support the clot.

Defect in connective tissue to support capillaries


Question: The most common type of intussuception is

.It is telescoping or invagination of one poion (segment) of bowel into the adjacent segment. Types 1. Antegrade--Most common. 2. Retrograde--Rare (jejunogastric in gastrojejunostomy stoma). In elderly intussusception: * Colocolic is most common type * Apex is formed usually by growth * No role of hydrostatic reduction * It can be single or multiple (rare). * It can be ileo-colic (most common type, 75%), colocolic, ileoileocolic, colocolic. *It is common in weaning period of a child (common in male), between the period of 6-9 months. ref:SRB&;S manual of surgery,ed 3,pg no 863


Question: Crohn&;s disease

.Medical therapy for crohn&;s disease includes * To induce remission - steroids * For maintenance - immunomodulating drugs like azathioprine * Antibiotics, metronidazole (as immunomodulator) * Monoclonal antibody - infliximab * Nutritional suppo Note: Patients with Crohn's disease should avoid NSAIDs ref:SRB&;s manual of surgery ,ed 3,pg no 802

Has no increased risk for colonic cancer

Medical management includes antibiotics, immunosuppressive agents and biologic agents

Associated enteroenteric fistula is an indication for urgent surgery


Question:
A 72 year old male presented with complete rectal prolapse with
history of constipation from the last 10 years. Management for this
patient Is

For young pts - Abdominal rectopexy is preferred.
For old pts - perineal rectopexy is preferred (delormes, altamaier).
Underlying cause must be treated.


Question: Dysphagia in Plummer Vinson syndrome is due to

Ans. is 'a' i.e. Post cricoid region commonly involved in web formation


Question: Treatment for superficial bladder carcinoma with single papillary lesion is

For low grade tumor of pTa stage only TUR (Transurethral resection of
bladder) is done.


Question: Most common site for colorectal cancer is

Ans is 'a' i.e., Rectum * Following image demonstrates the distribution of colorectal adenocarcinoma:* Thus the most common site is Rectum. (rectum> sigmoid colon> caecum).


Question: Dupuytren's contracture is seen in

Dupuytren's contracture refers to localised thickening of palmar aponeurosis and later formation of nodules with severe permanent changes in metacarpophalangeal and proximal interphalangeal joints. It is often associated with the following conditions : * Plantar fasciitis 5%-Ledderhose's disease * Mediastinal and retroperitoneal fibrosis * Peyronie's disease of penis 3% * Nodules in the face and ear * Pellegrini-Stieda's disease. Reference : page 163 SRB's manual of surgery 5th edition


Question: Most common cause of urinary retention in children includes

(A) Posterior urethral valves # Posterior urethral valves: These constitute an important cause of distal urinary tract obstruction in boys.> Dribbling, abnormal urinary stream, palpable bladder and recurrent UTI are the usual presenting features.> The presence of severe obstruction in the urinary tract in utero may lead to renal dysplasia.> Mild to moderate impairment of renal function may be present at birth.> The diagnosis is made on MCU, which shows dilated posterior urethra and valves at its junction with anterior urethra.


Question: Tumor marker for seminoma testis is

Ans. (d) Lactate DehydrogenaseRef Surgery Sixer 3rd Edition Page 795Tumor markers in testicular cancers:* Beta HCG - Concentration is increased in Both Seminoma and Non Seminoma.* AFP - Concentration is increased in only non seminoma.* LDH - It is increased in both seminoma and non seminoma, but not specific.


Question: The expression of the following oncogene is associated with a high incidence of medullary carcinoma of the thyroid

MTC occurs most commonly in a sporadic form (80%); it occurs less commonly as an autosomal dominant inherited disorder such as MEN2A, MEN2B, and familial medullary thyroid carcinoma (FMTC).The MEN2 and FMTC syndromes involve different germline activating mutations in the RET proto-oncogene. Additionally, 40% to 50% of sporadic MTC specimens have acquired RET mutations.Ref: Sabiston 20e, page no: 932


Question: Gastric irritation is not caused by

Ans. c (Paracetamol). (Ref. KD Tripathi, 5th/pg. 181)PARACETAMOL AS COMPARED TO ASPIRIN:# Does not stimulate respiration or affect acid-base balance# Causes insignificant gastric irritation# Has no cardiovascular effect# Does not affect platelet function# Is not uricosuricRemaining all above drugs can cause significant gastritis


Question: Pseudoclaudication is caused by

Pseudoclaudication is the term used for neurogenic claudication caused due to lumbar canal stenosis. Its symptoms mimic intermittent claudication of PVD. Neurogenic claudication, consists of back and buttock or leg pain induced by walking or standing and relieved by sitting or changing posture. Symptoms in the legs are usually bilateral. Unlike vascular claudication, symptoms are often provoked by standing without walking. Spinal stenosis can be acquired, congenital, or due to a combination of these factors. Congenital causes include achondroplasia, idiopathic. Acquired causes are degenerative diseases (spondylosis, spondylolisthesis, scoliosis), trauma, spine surgery, metabolic or endocrine disorders (epidural lipomatosis, osteoporosis, acromegaly, renal osteodystrophy, hypoparathyroidism), and Paget&;s disease. Ref : Bailey and love surgery text book 27th Ed.


Question: The most frequently used procedure for diagnosing palpable breast masses is

Fine needle aspiration cytology FNAC, is very useful in breast carcinoma advantages; least painful, can be done in OP basis, reliable and cheaper malignant deposit will not occur along the track of FNAC ref ;(page no;542) 5th edition of SRB&;S Manual of SURGERY


Question: Name the wiring technique


Question: Scissors gait is seen in

Scissor gait is a form of gait abnormality primarily associated with spastic cerebral palsy rigidity and excessive adduction of the leg in swing plantar flexion of the ankle flexion at the knee adduction and internal rotation at the hip progressive contractures of all spastic muscles complicated assisting movements of the upper limbs when walking


Question: The parotid duct is known as

ParotidStenson's ductOpens at upper 2nd molar toothSubmandibular glandWhaon's ductOpens into the papilla just lateral to the frenulumSublingual glandDucts of RiviniusNumerous excretory ducts(Ducts of Rivinus), directly into the oral cavityDuct of Wirsung is major pancreatic ductDuct of Santorini is accessory pancreatic ductRef: Bailey and love, page no: 779


Question: Most common electrolyte imbalance that causes paralytic ileus is

In paralytic ileus uraemia and hypokalemia are the most common contributory factors. Paralytic ileus is defined as a state in which there is failure of transmission of peristaltic waves secondary to neuromuscular failure. Reference : Bailey & Love, 27th Edition, page no = 1297.


Question: Colonic diveiculosis is best diagnosed by

Investigations * Barium enema (best method to diagnose) shows 'sawteeth' appearance. Champagne glass sign--Paial filling of diveicula by barium with stercolith inside-- seen in sigmoid diveicula. * Sigmoidoscopy is useful but should not be done in acute stage. Once acute stage subsides, barium enema, sigmoidoscopy, colonoscopy can be done (To rule out associated malignancy). * CT scan in acute phase to see pericolic abscess. CT scan shows thickening of muscle layer, abscess, perforation, fistula, involvement of organs like urinary bladder and associated pathology. CT is the ideal investigation. ref:SRB &;s manual of surgery,ed 3,pg no-822


Question: Headache, apathy and deteriorating level of consciousness occurring weeks after head injury suggests;


Question: Middle segment pancrectomy avoided in

.95% subtotal pancreatectomy. * Distal pancreatectomy--Spleen, body and tail of the pancreas are removed--Child's operation. * Puestow's operation--As the duct is dilated more than 8 mm, duct can easily be opened longitudinally. After removing all stones from the duct, it is anastomosed to the jejunum as Roux-en-Y anastomosis. In Puestow's operation spleen is removed. * Paington - Rochelle operation: Here longitudinal pancreaticojejunostomy is done using almost entire laid open pancreatic duct. Spleen is retained in this procedure. This is now commonly done procedure. * Total pancreatectomy is indicated when entire gland is diseased. It relieves the pain and also prevents the diseased pancreas from turning into malignancy. Patient has to take insulin and oral pancreatic enzymes permanently (brittle diabetes). * The cause is treated like cholecystectomy for gall stones. ref:SRB&;S manual of surgery,ed 3,pg no 629


Question: Ponsetti technique failure in children should be managed with

Answer- A. Posteromedial soft tissue releaseIf treatment by manipulation and retention fails, operation should usually be undeaken before 9 months of age, mostly at 4- 6 months.The idea behind early operation is to set the tarsal bones in normal relationship to one another and to remove deforming forces, thus allowing the bones to develop in their normal shape from an early age. The procedure used is soft tissue release, i.e. postero-medial release (PMR).

Lateral closing wedge osteotomy of calcaneum


Question: T/t of CBD stone includes

ERCP-therapeutic,i.e.,Endoscopic papillotomy (sphincterotomy) and stone extraction through Dormia basket or balloon catheter is the treatment of choice for CBD stones.It has a success rate of around 95%.Other methods include mechanical/extracorporeal shock (ESW)lithotripsy and extraction;or removal through baby endoscope.CBD stent is placed insitu.Once stones are removed,laparoscopic cholecystectomy can be done. Reference:SRB's manual of surgery,5th edition,page no:651.


Question: The most important prognostic factor in breast carcinoma is

Stage of the tumour at the time of diagnosis

Status of estrogen and progesterone receptors

Over expression of p53 tumor suppressor gene.


Question: In congenital hyperophic pyloric stenosis, the defect is in

Infantile Hyperophic Pyloric stenosis In HPS, hyperophy of circular muscle of pylorus results in constriction & obstruction of gastric outlet Accquired condition Incidence of 1 in 3000 to 4000 live bihs This condition is most common between the ages of 3-6 weeks Associated anomalies in 6-20% cases : Esophageal atresia, Hirschprung's disease, ARM and malrotation Ref: Sabiston 20th edition Pgno : 1869


Question: Lucid interval is a characteristic pathognomonic feature of\

(A) Extradural haemorrhage # Extradural haemorrhage.> It is a period in which person is liable for acts> Lucid interval is a period occurring in insanity, during which all the symptoms of insanity disappear completely. The individual is able to judge his acts soundly and he becomes liable for his acts.> If he commits an offense, he can be held completely responsible.> Because it is very difficult to whether he was suffering from mental aberration at the time of commit the offence.


Question: Best approach for thoracic trauma is

Here best option is anterolateral thoracotomy. Different approaches to the contents of the chest cavity are.. Left anterolateral thoracotomy : left lung and lung hilum, Thoracic aoa, left side of hea, origin of left subclan aery and lower oesophagus. Right anterolateral thoracotomy : Right lung and lung hilum, Azygos vein, Superior vena cava, Infracardiac inferior vena cava, Upper oesophagus, Thoracic trachea. Median sternotomy : Anterior aspect of the hea, Anterior Mediastinum, Ascending aoa and arch of aoa, pulmonary aeries and Carina of trachea. Indications for thoracotomy: 1.1000ml drained at inseion of chest drain. 2.Continued brisk bleeding >100ml per 15 min. 3.Continued bleeding >200ml per hr. for 3 or 4 more hrs . 4.Rupture of bronchus, aoa, oesophagus, diaphragm. 5.Cardiac tamponade. Reference : Bailey & love, 27th Edition, page no = 371.


Question: Most common impacted foreign body in esophagus in children is

Ans. is 'a' i.e., Coin Foreign body impaction* Most impacted foreign bodies do not get impacted in the oropharynx. The most common exceptions are fish and chick bones.* These objects most often lodge in the soft tissues at the base of tongue, but they can also lodge in the tonsil or the pyriform fossa.* Coins are the most commonly impacted foreign bodies in children in esophagus and oropharynx followed by the food products.


Question: A young male presented with dyspnea, bleeding and petechial hemorrhage in the chest after 2 days following fracture shaft of the femur right side. Most likely cause is

(Fat -embolism) (855-56-CSDT 12th) (178-Anaesthesia- A. yadav 3rd)FAT-EMBOLISM - Fracture through a large marrow filled cavity almost inevitably results in small showers of fat emboli being swept to the lungs. This can usually be accommodated without serious consequences, but in some cases (and especially in those with multiple injuries and severe shock or in patients with associated chest injuries) it results in progressive respiratory distress and multi - organ failure (ARDS)* Blood gases should be measured soon after admission, and may suspicious signs such as shortness of breath, restless ness or a rise in temperature or pulse rate should prompt a search for petechal hemorrhages over the upper body axillae and conjunctivae* TRIAD of fat embolism - Dyspnea, confusion and petechial haemorrhage.* Capnography show fall in endtidal CO2 (ETCO2 may become zero if embolus is large enough to block the main pulmonary artery* Coagulation abnormalities like increased clotting time and decreased platelets* Serum lipase is increased* Air embolism - occure during the placement or removal of central venous catheters* Amniotic fluid-embolism - occur during active labour* Fat embolism - occur from long bones fractures- Characterised by respiratory insufficiency, Coagulopathy, encephalopathy and an upper body petechial rash* Pulmonary embolism - results from septic emboli, tumour emboli from atrial myxoma or IVC extension of renal cell carcinoma and parasitic emboli**DVT remains the most common source of pulmonary thromboembolism


Question:
Inhaled general anaesthetic with low blood gas
partial coefficient are characterized by

Rapid induction and quick recovery from anaesthesia

Rapid induction and slow recovery from anaesthesia

Slow induction and slow recovery from anaesthesia

Slow induction and quick recovery from anaesthesia


Question: Most common presenting symptom of benign breast disease

Ans) a (Pain) Ref: Ref: Bailer & Love's short practice of surgery 25th editionBenign breast disease(BBD) is the most common cause of breast prob-lems. 30% of the women suffer fromBBD. Most common symptoms include pain & lumpiness. The symptoms of ANDI (Abnormalities of normal development & involution) often include lumpiness (seldom a discrete lump) and/or breast pain.


Question: Minimum amount of GI bleed to cause melena is


Question: H. pylori infection is associated with increased risk of

Ans. b (Carcinoma of body and pylorus of stomach) (Ref. LB 25th/1067)Helicobacter seems to he principally associated with carcinoma of the body and distal stomach rather than theproximal stomach. As Helicobacter is associated with gastritis, gastric atrophy and intestinal metaplasia, theassociation with malignancy is perhaps not surprising.Risk factors for the development of stomach/gastric carcinoma are:1. Male > Female2. Age > 40 years3. Chronic H. pylori infection4. Chronic atrophic gastritis with intestinal metaplasia5. History of partial gastric resection6. Pernicious anemia7. Blood group A8. Race: Asians especially Japanese9. Gastric ulcer and polyps10. Menetrier's disease: extreme hypertrophy of gastric rugal folds11. Cigarette smoking12. Dust ingestion13. Ingestion of spirits14. Genetic factors15. Long-term ingestion of high concentration of nitrates in dried smoke and salted foods. (Charred or burnt foods).

Carcinoma involving gastroesophageal junction


Question: Hinchey classification is used for perforations of colon secondary to

Answer-C. DiveiculitisHinchey Classification is used to describe perforations of the colon due to diveiculitis.Hinchey I - localised abscess (para-colonic)Hinchey II - pelvic abscessHinchey III - purulent peritonitis (the presence of pus in the abdominal cavity)Hinchey IV - feculent peritonitis. (Intestinal perforation allowing feces into abdominal cavity)


Question: Treatment of choice for phylloides tumor

Treatment of choice for phylloides tumor is excision or subcutaneous mastectomy is done if malignant, total mastectomy is done phylloides tumor also known as cystosarcoma phylloides/ serocystic disease of broide they are simply giant fibroadenoma ref ;(page no;521) 5th edition of SRB&;S Manual of SURGERY


Question: Symbolic stripped 'Y' classification for cleft Lip and palate was given by


Question: Intra abdominal pressure maintained during laparoscopy is

Ans. (b) 12-15 mm Hg(Ref: Textbook of Laparoscopic surgery by R K Mishra, 3rd ed p-74-78)* Intra abdominal operation is maintained between 12-15mm of hg for avoiding any hemodynamic derangements during laparoscopy.


Question:
On thyroid function test, TSH value is raised and
t4 value is decreased. Referred diagnosis is

IF TSH raised ans T4 is decreased then its primary.
IF both are decreased then its secondary.


Question: Most common site for extra mammary Paget&;s disease is

.It is superficial manifestation of an intraductal carcinoma. The malignancy spreads within the duct up to the skin of the nipple and down into the substance of the breast. It mimics eczema of nipple and areola.most commonly extra mammary manifestations of paget&;s disease is seen in the vulva. * Paget's disease of penis (Erythroplasia of Querat is persistent rawness of glans penis). ref:SRB&;s manual of surgery,ed 3,pg no 1009,473


Question: Commonest injury in blunt abdominal trauma

Splenic injury can be a subcapsular hematoma, laceration or hilar injury. It can be associated with other organ injuries It can cause torrential hemorrhage and shock. It is the most common organ injured in blunt injury abdomen (Ref; SRB,s Manual of Surgery,5th edition, pg no. 149)


Question: In erect posture commonest site of foreign body in bronchus

(A) (Right posterior basal) (Pretest physical diagnosis)* The most common anatomic location for a foreign body in the right main stem bronchus or the right lower lobe.* The right main stem bronchus is wider, shorter and vertically placed, and therefore the posterior segment of the right upper lobe (If the patient aspirated while supine) are anatomically susceptible to aspiration pneumonia. The superior segment of the right lower lobe and left lower lobe (If the patient supine) are also susceptible to aspiration pneumonia. These three segments are often referred to on the aspiration segments of the long the basilar segments of both lungs are susceptible to aspiration if the patients aspirates while erect or sitting up.Aspiration in supine position* Right upper lobe - posterior segment* Right lower lobe - superior segment* Left lower lobe - superior segmentAspiration in sitting position* Right basilar segments of lower lobes **


Question: Neurogenic shock in acute spinal injury is due to

Neurogenic shock presents with hypotension, anormal hea rate or bradycardia and warm peripheries.This is due to unopposed vagal tone resulting from cervical spinal cord injury at or above the level of sympathetic outflow (T1/T5). It should be treated with inotropic suppo,and care should be taken to avoid fluid overloadBailey and love 27e pg: 352


Question: 'N3' in Head & Neck cancer TNM staging refers to

Answer- D. Contralateral lymph node > 6 cmN3- Metastasis in a lymph node > 6 cm in greatest dimension


Question: In surgical patient malnutrition is best assessed by

.* Weight loss more than 10% of individual's weight in 6 months is called as significant weight loss. * Body Mass Index (BMI) is body weight in kilograms divided by height in meters squared. BMI less than 18.5 signifies nutritional impairment and below 15 signifies severe malnutrition.in surgical patients malnutrition is best assessed by mid arm circumference. ref:SRB&;s manual of surgery,ed 3,pg no 86


Question: Glasgow coma scale motor score 4 is

Glasgow coma scale Motor response score: 6= obeys command 5= localised to pain 4= Withdraws from pain 3= Flexion in response to pain 2= Extension to pain 1= No motor response Reference : Bailey & Love, 27th Edition, page no = 325.


Question: An 18 year old patient presents with acute abdominal pain, vomiting and on clinical examination loin tenderness is present. History of pyrexia is absent. The diagnosis is

(A) Acute testicular torsion# TESTICULAR TORSION Usually presents with sudden, severe, testicular pain (in groin and lower abdomen) and tenderness. There is often associated nausea and vomiting. Testis may be higher than its normal position. Mild pyrexia and redness of overlying area may be found. Presentation of acute appendicitis includes abdominal pain, nausea, vomiting, and fever. Appendix becomes more swollen and inflamed, it begins to irritate the adjoining abdominal wall. Leads to the localization of the pain to the right lower quadrant. Classic migration of pain may not be seen in children under three years. Pain can be elicited through signs and can be severe. Signs include localized findings in the right iliac fossa. Abdominal wall becomes very sensitive to gentle pressure (palpation). There is severe pain on sudden release of deep pressure in the lower abdomen (rebound tenderness). If appendix is retrocecal (localized behind the cecum), even deep pressure in the right lower quadrant may fail to elicit tenderness (silent appendix). This is because the cecum, distended with gas, protects the inflamed appendix from pressure. Similarly, if the appendix lies entirely within the pelvis, there is usually complete absence of abdominal rigidity. Digital rectal examination elicits tenderness in the rectovesical pouch. Coughing causes point tenderness in this area (McBurney's point).> Acute pyelonephritis develop rapidly over a few hours or a day & it can cause high fever, pain on passing urine, and abdominal pain that radiates along the flank towards the back. There is often associated vomiting.> Chronic pyelonephritis causes persistent flank or abdominal pain, signs of infection (fever, unintentional weight loss, malaise, decreased appetite), lower urinary tract symptoms and blood in the urine.> Diverticulitis symptoms may include: Tenderness, cramps, or pain in the abdomen (usually in the lower left side but may occur on the right) that is sometimes worse with movement. Fever and chills. Bloated feeling, abdominal swelling, or gas. Diarrhea or constipation. Nausea and sometimes vomiting. Loss of appetite.


Question: Most common site of urethral carcinoma is men is

There is a high prevalence of primary urethral cancer in the bulbomembranous urethra, which is also the most common location of urethral strictures. Squamous carcinoma can develop in an area of squamous metaplasia sometimes seen with a urethral stricture. Reference : page 1370 Bailey and Love's sho practice of surgery 25th edition


Question: Hutch diveiculum is seen in

Hutch diveiculum is a congenital type of bladder diveiculum characterised by herniation of bladder mucosa through a weak point in the wall near the ureterovesical junction, often caused by chronically high intravesical pressure.


Question: Killians incision is used for

Ans. is 'a' i.e., Submucous resection of nasal septum Killians incision* It is used for submucous resection (SMR) of the nasal septum.* It is used to address the septal deviations posterior to the nasal septum.* It is made usually along the convex side of the deviation from superiorly along the mucocutaneous junction of the nasal septum to the nasal floor and can be modified to extend laterally along the floor of the nose, so that tunneling under the submucoperichondrial flap can proceed without tearing the mucosa.* One should be mindful that the tearing of the submucoperichondrial flaps on the apposing sides can result in septal perforations which are especially symptomatic at the anterior inferior aspect of nasal septum.


Question: Commonest organ injured in blast injury is

Ans. is 'a' i.e. Lung The structures injured by the primary blast wave, in order of prevalence, are the middle ear, the lungs and the bowel" - Love & BaileyThe hollow organs containing gas or air are most readily damaged by blast waves. The homogenous tissues like liver and muscle are least likely injured.In underwater blast, injuries occur mostly in gastrointestinal tract and less commonly in lungs.The lung injury can introduce air into the circulatory system. Death may occur from systemic air embolism.Tympanic membrane rupture is a sensitive marker for primary blast injury.


Question: The score in Glasgow coma scale of conscious person is


Question: A.M.L. with worst prognosis

Monsomy 7 [Ref Harrison 17th/e p 680 & leh/e p 6341 There are number of factors which determine the prognosis in A.M.L. In a number of studies in last 2 decades it has been observed that cytogenetic markers are major determinants in assessment of prognosis. Prognosis of Acute Myeloid leukemia . t (8 ; 21),Q * Good prognosis * inv (16) ordeg . t (15 ; 17)Q * Moderately ourable outome . No cytogenetic abnormalitydeg . inv (3),deg * Monosomy 7 presence deg of PTD of MLL or 1TD of FLT 3 * Poor prognosis . Uq 23,deg . 3q21,deg . 3q26deg Prognostic factors in Acute Myeloid leukenia Factors Favorable Unorable . Age <45 years < 2 year, > 60 years . Leucocytosis 25 x RP/LQ > 100 x lOYL . CNS involvement AbsentQ Present . Response to therapy Rape& Delayed/incomplete . Auer rods Present Absent . FAR type M2, B3 M4E0 M5, M6, M7 . Cell markers CD2or CD19 CD13, CD14, CD33 . Cytogenetics t (15:17)Q in M3 -7; del (7q), -50 t (8:21) in M2 del (sq)Q, 11q23 inv( 16) del(16q) abnormalities 3q21 and 3q26 abnormalities complex karyotypic abnormalities


Question: During an operation for presumed appendicitis, the patient appendix is found to be markedly thickened and feels rubbery to firm. The serosa is edematous and inflamed and the mesentery is thickened with fat growing about the bowel circumference. Most likely diagnosis

Crohn's disease can present acutely, and when it involves the terminal ileum may clinically resemble appendicitis. The bowel in this patient has the characteristic gross findings and inflammatory changes of Crohn's disease including the "creeping fat" within the mesentery. Meckel's diveiculitis can mimic appendicitis but it presents as an inflammatory phlegmon located approximately 50 cm (2 feet) from the ileocecal varve and does not have the bowel changes seen in this patient. Ulcerative colitis is usually confined to the large bowel and, although it may occasionally be associated with inflammatory changes of the ileal mucosa (backwash ieitis), it is generally not associated with full- thickness changes described above. Ileal carcinoid would present as a mass in the ileum and would not be associated the inflammatory changes seen in this patient.


Question: Commonest site of ischemic colitis


Question: Buerger's Disease is

Buerger's Disease is non atherosclerotic inflammatory disorder involving medium sized and distal vessels. It is segmental, progressive , occlusive, inflammatory disease.


Question: Most common form of actinomycosis

Actinomycosis is caused by Actinomyces israelii. Facio-cervical is the most common type. Infection spreads either from tonsil or from adjacent tooth. Actinomyces israelii is an anaerobic gram - positive fungal like bacterium. It is called as Ray fungus. Reference : SRB's Manual of Surgery, 6th Edition, page no = 54.


Question: Gastric malignancy is predisposed with


Question: Radiological Contrast to be preferred for demonstrating TO fistula


Question: Most common clinical presentation of idiopathic retroperitoneal fibrosis is

Idiopathic retroperitoneal fibrosis also called Ormond's disease is nonspecific inflammation of fibrofatty tissue in the retroperitoneum. It results in extensive collagen deposition surrounding the ureters, mostly at the level of the pelvic brim or below- Most patients present with ureteric obstruction, often with renal failure Reference : page 1007 Bailey and Love's sho practice of surgery 25th edition


Question: Keloid scar is

An atrophic scar is a pale, flat and stretched in appearance, often appearing on the back and in areas of tension. A hyperophic scar is defined as excessive scar tissue that does not extend beyond the boundary of the original incision or wound. A keloid scar is defined as excessive scar tissue that extends beyond the boundaries of the original incision or wound Bailey and Love 27e pg: 30

Excessive scar tissue that does not extend beyond the boundary of the original incision or wound.

Excessive scar tissue that extends beyond the boundaries of the original incision or wound

Pale, flat and stretched in appearance, often appearing on the back and in areas of tension.

Pale, flat and stretched in appearance, often appearing on the chest and sternum and in areas of no tension.


Question: Nexus criteria in trauma is used for


Question: Bent inner tube sign is seen in

Ans. (a) VolvulusRef: Manipal Manual of surgery, 4th ed./739* In sigmoid volvulus, the X ray abdomen erect shows hugely dilated sigmoid loop called bent inner tube sign.* Acute sigmoid volvulus presents as intestinal obstruction and starts after straining at stool. It occurs in anti-clockwise direction and after one and a half turns, the entire loop becomes gangrenous.* The percussion note on the abdomen shall be tympanitic note.


Question: Sequence of colour changes observed in Raynaud's disease.

Triphasic Color Response Include Three Stages Blanching (stage of local syncope) With exposure to cold, digital aerioles goes into spasm Decreased flow is evidenced by pallor or blanching Digits may appear white Cyanosis (stage of local asphyxia) Capillaries and venules dilate Red Engorgement (stage of recovery) With rewarming or passing of attack, the digital vasospasm resolves Blood flow into dilated aeries and capillaries increases dramatically Reactive hyperemia impas bright red color to the digits


Question: Life span of microfilaria in human blood is

Life span of micro filaria in human blood is 3 Months.


Question: Major complication of cysto gastrostomy for pseudo pancreatic cyst is

.Cysto-gastrostomy: At laparotomy, anterior wall andvposterior wall of the stomach is opened. Brownish fluidvis aspirated. The thick capsule of pseudocyst isbopened. All fluid with necrotic material are sucked.bFluid should be sent for cytology, culture and sensitivity and amylase estimation. Cyst wall always should be biopsied. Cyst cavity should be washed with normal saline after breaking septae. Pseudocapsule is anastomosed to posterior wall of the stomach--Jurasz operation. Complications of pseudocyst * Rupture--3% - into bowel or peritoneum * Infection, commonest--20% * Bleeding from the splenic vessels--7% * Cholangitis * Duodenal obstruction * Poal/splenic vein thrombosis and segmental poal hypeension * Cholestasis due to CBD block ref:SRB&;S manual of surgery,ed 3,pg no 623


Question: Circumcision is contraindicated in

Circumcision is not done in patients with hypospadias as the prepuce can later be used in surgical repair. Circumcision is mostly done for cultural reasons. The medical indications for circumcision are: Phimosis & Paraphimosis Recurrent balanoposthitis. (i.e. inflammation of the foreskin) Recurrent urinary tract infection. (Circumcision is occasionally justified in boys with an abnormal upper urinary tract and recurrent urinary infection. It may also help boys with spina bifida who need to perform clean intermittent urethral catheterization.) An emerging and still controversial indication for circumcision is in the prevention of sexually acquired human immunodeficiency virus (REV) infection in communities where this disease is common; large clinical trials have recently shown that circumcision reduces the risk of HIV transmission. Circumcision for medical reasons is best performed under general anesthesia. Reference : page 1056 SRB's manual of surgery 5th edition and page1371 Bailey and Love's sho practice of surgery 25th edition


Question: Paget's disease of the nipple is treated by

Ans. is 'c' i.e., Biopsy and Simple mastectomy Paget's disease of nipple is a chronic eczematous eruption of nipple which may progress to an ulcerated weeping lesion. It is almost always associated with an underlying ductal carcinoma (may be in situ Ca or invasive). The underlying lesion may be palpable or not. A complete mammographic workup and biopsy of the nipple and underlying mass if present is done. Pathognomonic histological feature is presence of Paget's cells in the epithelium. A skin specimen containing cells confirms the diagnosis and can be obtained by nipple scrape cytology or biopsy. Paget's disease may be confused with superficial spreading melanoma. Differentiation from pagetoid intraepithelial melanoma is based on the presence of S-100 antigen immunostaining in melanoma and carcinoembryonic antigen immunostaining in Paget's disease. Treatment of Paget's disease includes : - mastectomy + axillary staging (axillary dissection or sentinel node biopsy) wide excision of the nipple and areola to achieve clear margins + radiation + axillary staging, or lumpectomy + radiation therapy + axillary lymph node procedure


Question: Hematemesis is not the most common symptom of

Clinical features of Carcinoma esophagus Early stage cancers: Asymptomatic or mimic symptoms of GERD MC symptom : Dysphagia >Weight loss Most patients with esophageal cancer present with dysphagia and weight loss, symptoms that usually indicate advanced disease Choking, coughing and aspiration from a tracheoesophageal fistula (In advanced cases) Hoarseness and vocal cord paralysis from direct invasion into the recurrent laryngeal nerve (In advanced cases) MC site of metastasis : Liver>lung>bone Paraneoplastic manifestation associated with adenocarcinoma : Motor neuropathy Ref: Sabiston 20th edition Pgno : 1038


Question: Most common site of metastasis for Breast Carcinoma is

1) Bone(most common) (70%) - in order -lumbar veebrae, femur, ends of long bone, thoracic veebrae, ribs, skull 2)Liver 3)Lung- causes malignant pleural effusion and cannon ball secondaries. 4)Brain- causes increased ICP 5)Adrenals and ovaries Reference: SRB's Manual of Surgery, 6th Edition, page no = 530.


Question: Shoulder pain post laparoscopy is due to

Laparoscopy Needle used for pneumoperitoneum : Veress needle Most commonly used gas: CO2 Flow of gas : 1L/min Intra abdominal pressure : 12-15mmHg Trocar is inseed at or just below the umbilicus penetrating skin, superficial & deep fascia, fascia transversalis & parietal peritoneum Post-laparoscopy shoulder pain is due a to CO2 retention causing irritation of diaphragm & referred pain to the shoulder through phrenic nerve Ref: Sabiston 20th edition Pgno : 394-396


Question: Laser used in the treatment of ureteric calculi is

The Ho:YAG laser is a 2140-nm pulsed laser that is used for soft-tissue and lithotripsy applications in urology. The 2140-nm wavelength is strongly absorbed in water, traveling only about 0.5 mm in the fluid medium, making it ideal for the urologicenvironment. In the prostate, the absorption depth is about 0.4 mm resulting in a high-energy density that leads to the rapid vaporization of tissue. In the 1980s, lasers first became of interest to researchers and clinicians in urology, and at the present time a wide range of lasers are employed to treat various soft-tissue and stone conditions. Although the holmium:yttrium-aluminum-garnet (Ho:YAG) laser has become the accepted gold standard for the treatment of urinary calculi at this time, various wavelengths of lasers are employed to treat soft-tissue conditions such as stricture disease, benign prostatic hyperplasia (BPH), urothelial cell cancer, and genital skin lesions ref : Campbell - Walsh urology 11th edition , chapter 11 , pg no :- 228


Question: In LAHSHAL terminology for cleft lip & cleft palate, LAHSHAL denotes

Ref: Bailey and love 27th edition Pgno :637 LAHSAL system of Classification LAHSAL system is a diagrammatic classification of cleft lip & cleft palate In this classification system, mouth is divided into 6 pas. I.e., LAHSAL Right Lip; right Alveolus ; Hard palate ; Soft palate ; Left Alveolus ; Left lip First character is for patients right lip & last character for patients left lip Complete cleft is indicated with a capital letter & an incomplete cleft with small letter No cleft is represented with a dot Examples of LAHSAL system of Classification Bilateral complete cleft lip & palate LAHSAL Left complete cleft lip ..... L Right Incomplete cleft lip & Alveolus la.... Incomplete hard palate, complete soft palate defect .. hS..


Question: A patient presented with episodes of flushing and hypotension. His urinary 5HIAA levels were found to be increased. The diagnosis is

(B) Carcinoid syndrome # Carcinoid syndrome-Clinical findings include:> Flushing of the skin> Diarrhea and abdominal cramps> Right sided heart disease> Bronchoconstriction> Abdominal pain due to desmoplastic reaction of the mesentery in most patients, increased urinary excretion of 5-HIAA (5-hydroxy-indoleacetic acid), a degradation product of serotonin> Serotonin causes fibrosis of the tricuspid valve and pulmonary valve> "TIPS" - Tricuspid Insufficiency, Pulmonic Stenosis (fibrosis of tricuspid and pulmonary valves)


Question: Petersen hernia is

Peterson Hernia Petersen hernias are internal hernias which occur in the potential space posterior to a gastrojejunostomy. This hernia is caused by the herniation of intestinal loops through the defect between the small bowel limbs, the transverse mesocolon and the retroperitoneum, after any type of gastrojejunostomy. The laparoscopic approach facilitates the occurrence of this type of hernia, due to the lack of post-operative adhesions which prevent bowel motility and hence, herniation. These hernias occur in patients with a Roux-en-Y gastric bypass Clinical presentation usually presents with diffuse abdominal pain (could be caused by bowel obstruction with spontaneous reduction) may present as intestinal obstruction late postoperative obstruction may be due to adhesions, fibrotic stenosis, intussusception or more often, internal hernias Ref: internet sources


Question: Indication of Sentinel node Biopsy in cancer breast

Ans. (c) Breast Mass without palpable axillary node(Ref. Bailey and love 27th edition Page 877)* Sentinel node biopsy is indicated only for Node non palpable cases.* Palpable node always Cytology (FNAC) Done

Breast mass without Palpable Axillary node


Question: A 60 yr old smoker came with a history of painless gross hematuria for one day. Most logical investigation would be

In this case, we should suspect bladder carcinoma ( transitional cell carcinoma ) . Smokers are at a higher risk of developing TCC.Other risk factors being chemical .industry workers in western countries and schistosomiasis in endemic regions . It is more common in males -3:1. They usually presents with painless gross hematuria. Thus the best option here is urine microsopy for RBC's and malignant cells.urine cytology even though not a good screening test because of lack of sensitivity is highly specific . Mainstay of diagnosis is cystourethroscopy. investigations include imaging ( CT , MRI ,USG ,IVU ) and blood investigations for HB , electrolytes and urea . Bailey and Love 27th edition.chapter 77.pg no 1449.


Question: The most common cause of non union is


Question: Foaming liver seen with infection by

Foaming Liver is characteristic of gas gangrene.


Question: Most common extra intestinal manifestation of amoebiasisis

Ans. is 'a' i.e., Amoebic liver abscess * Amoebic Ever abscess is the most common extraintestinal manifestation of amebiasis. Disease begins when E. histolytica trophozoites penetrate through the colonic mucosa, travel through the portal circulation, and reach the liver.* Most individuals with amebic liver abscess do not have concurrent signs or symptoms of colitis, and most do not have E. histolytica trophozoites in their stools.* The classic presentations of amebic liver abscess are right-upper-quadrant pain, fever, and hepatic tenderness.* The most common laboratory findings are leukocytosis (without eosinophilia), an elevated alkaline phosphatase level, mild anemia, and an elevated erythrocyte sedimentation rate.


Question: The most common organism that causes the following condition is

The above image is that of cellulitis of the leg.Cellulitis is a non-suppurative, invasive infection of tissues, which is usually related to the point of injury.Typically caused by B haemolytic streptococci, staphylococci and Clostridium perfringens. Streptococci being the commonest.Necrotising fasciitis is mostly polymicrobialGas gangrene is caused by Clostridium perfringens.Ref: Bailey and love 27th edition PG: 48


Question: Membranous urethral rupture causes collection of blood in


Question: 'Tennis elbow' is characterized by

Tennis Elbow (Lateral Epicondylitis) This is the most common cause of elbow pain excluding traumatic conditions Usually occur in patients of 30-40 years, etiology is unknown in most cases Strenous or over activity may precede spymptoms Anterodistal lateral epicondyle tenderness Diagnosis Resisted wrist extension is a reliable diagnostic test Local anaesthetic injection is diagnostically helpful Treatment Vast majority improve with supervised Conservative management Open or ahroscopic release yields good results in recalcitrant cases Ahroscopic release also identifies associated pathology Ref: Bailey and love 27th edition Pgno : 448


Question: MANTREL score is done for

Ans. (a) Acute appendicitisCharacteristicScoreM = Migration of pain to the RLQ1A = Anorexia1N = Nausea and vomiting1T = Tenderness in RLQ2R = Rebound pain1E = Elevated temperature1L = Leukocytosis2S = Shift of WBCs to the left1Total10RLQ = right lower quadrant; WBCs = white blood cells


Question: Incision used for modified Radical neck dissection

Mac fee incision & Modified schobinger incision are the incisions used for MRND.


Question: The intense pain associated with a felon occurs because of

A closed space infection : A felon is an infection of the distal pulp space of a digit, usually secondary to a puncture wound. This is a closed space at the level of the distal interphalangeal joint. Since the infection cannot spread proximal to this point, pain is throbbing and intense. Late osteomyelitis may develop in the distal phalanx if the felon is not opened appropriately.


Question: The most common location of hypertensive intracranial haemorrhage is

Most common locations of hypertensive intraparenchymal hemorrhage are

basal ganglia (especially the putamen)

thalamus
cerebellum
ports

It usually results from spontaneous rupture of small penetrating artery deep in the brain.


Question: Thierch graft consists of

Thiersch graft is a split thickness skin graft and therefore consists of epidermis and variable portion of dermis.

Epidermis and variable portion of dermis


Question: French in Foley's Catheter refers to

Ans. (c) Diameter of catheterRef Internet Sources, Wikipedia* The French scale or French gauge system (most correctly abbreviated as Fr, but also often abbreviated as FR or F) is commonly used to measure the size (diameter) of a catheter.* 1Fr=0.33mm, and therefore, the diameter of the catheter in millimeters can be determined by dividing the French size by 3:# D(mm)=Fr/3 or# Fr = D (mm) x3For example, if the French size is 9, the diameter is 3mm.Note that the French scale is a measurement of the diameter, not the circumference (diameter xp).* An increasing French size corresponds to a larger diameter catheter. This is contrary to needle-gauge size, where the diameter is 1/gauge, and where the larger the gauge the narrower the bore of the needle.


Question: A 16 years old female patient has abdominal lump that is movable and painless, upon exploratory laparotomy a cystic lump is found arising from mesentery, diagnosis is

Answer- B. Mesenteric cystMesentric cyst present asA painless abdominal swellingThe swelling moves freely in a plane at right angles to the attachment of the mesentry.Recurrent attacks of abdominal pain with or without vomiting due to obstructive symptoms.


Question: Day care surgery can be done in

.* Lateral anal sphincterotomy - Here internal sphincter is divided paially away from the fissure either in right or left lateral positions (also gives a good result). - Here closed or open methods (Notaras) are used. Sphincterotomy is done below the dentate line. In closed method no 11 blade is inseed into the intersphincteric groove to pass upwards. Blade is moved medially to cut lower 1/3 or 1/2 of the internal sphincter. In open method skin is incised laterally, external to anal verge. Hyperophied band of lower pa of internal sphincter is dissected and divided. Wound is left open. - Haematoma, perianal abscess, bruising, fistula, incontinence are the complications of lateral sphincterotomy. ref:SRB&;s manual of surgery,ed 3,pg no 913


Question: Eburnation is seen in


Question: In BPH most common lobe involved is

Ans is 'c' ie Median Anatomical division of ProstateProstate has 5 lobes :Anterior lobeis a small isthmus connecting the two lateral lobes in front of the urethra.Posterior lobeit connect the two lateral lobes behind the urethra. It lies behind the median lobe and the ejaculatory ducts. Carcinomas are most common in this lobe*.Median lobelies behind the upper part of the urethra, in front of the ejaculatory ducts just below the neck of the bladder.BHP arises in this lobe*.Lateral lobeslie one on each side of the urethra.Zonal or surgical division of ProstateProstate has 3 distinct zonesThe peripheral zone (PZ) - accounts for 70% of volume of young adult prostateThe Central zone (CZ) - accounts for 25%The transition zone (TZ) - accounts for 5%Carcinoma of prostate arises most commonly in -the peripheral zoneBenign prostatic hyperplasia originates in - the transition zone


Question: For Ca breast best chemotherapeutic regimen

Chemotherapy using first generation regime such as 6-monthly cycle of cyclophosphamide, methotrexate and 5- fluorouracil(CMF) will achieve a 25% reduction in the risk of relapse over a 10-15 year peroid. Reference: Bailey and Love, 27th Edition, page no : 878.


Question: Initial emergency reduction of intracranial pressure is most rapidly accomplished by

Closed head injuries may result in cerebral concussion from depression of the reticular formation of the brainstem. This type of injury is usually reversible. Local bleeding and swelling (intracranial or extracranial) produce an increase in the intracranial pressure. A characteristic symptom pattern occurs initiated by progressive depression of mental status. Increasing intracranial pressure tends to displace brain tissue away from the source of the pressure; if the pressure is sufficient, herniation of the uncal process through the tentorium cerebri occurs. Pupillary dilation is caused by compression of the ipsilateral oculomotor nerve and its parasympathetic fibers. If the pressure is not relieved, the contralateral oculomotor nerve will become involved and, ultimately, the brainstem will herniate through the foramen magnum and cause death. Hypeension and bradycardia are preterminal events. Emergency measures to reduce intracranial pressure while preparing for localization of the clot or for a craniotomy or both include hyperventilation, dexamethasone (Decadron), and mannitol infusion. Of these, hyperventilation produces the most rapid decrease in brain swelling.


Question: Best prognostic factor for head injury is

The severity of head injury is classified according to glassglow coma scale(GCS) as it is the best predictor of neurological outcome. Mode of injury and age of the patient help in initial evaluation and management, CT helps in confirmation of the diagnosis. Their prognostic value is less when compared to GCS. Reference: Bailey and Love's Sho Practice of Surgery, 26th edition, Pg no:313


Question: Radiolucent renal stone

Ans. (a) Uric acidRadiolucent kidney stones are-L.U.XRadio Lucent stones are Uric acid and Xanthine stones


Question: Advantage of Minimal access surgery

The core principles of minimal access surgery (independent of procedure or device) can be summarized by the acronym I-VITROS: * Insufflate/create space - to allow surgery to take place in the minimal access setting * Visualise - the tissues, anatomical landmarks and the environment for the surgery to take place * Identify - the specific structures for surgery * Triangulate - surgical tools (such as po placement) to optimise the efficiency of their action, and ergonomics by minimising overlap and clashing of instruments * Retract - and manipulate local tissues to improve access and gain entry into the correct tissue planes * Operate - incise, suture, anastomose, fuse * Seal/haemostasis. Ref: Bailey and love 27th edition Pgno : 105


Question: Aims of abbreviated laparotomy


Question: Most common differential diagnosis for appendicitis in children is

Differential diagnosis of acute appendicitis in children Gastroenteritis Mesenteric adenitis Meckel's diveiculitis Intussusception Henoch-Schonlein purpura Lobar pneumonia Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1209


Question: Triple ahrodesis does not involve September 2010

Ans. D: Tibiotalar Joint A triple ahrodesis consists of the surgical fusion of the talocalcaneal (TC), talonavicular (TN), and calcaneocuboid (CC) joints in the foot.


Question: An absent kidney is found in

About 1 in 1400 people have a single kidney. Sometimes a ureter and renal pelvis are present with no kidney. The contralateral kidney is typically hyperophied. Reference: page 1282 Bailey and Love's sho practice of surgery 26th edition ( note : according to 27th edition Complete absence of one kidney occurs in 1 in 500-1000 bihs )


Question: From the surgery done below name the scoring used to diagnose this

Ans. (a) ALVARDORef: Surgery Sixer 3rd Edition Page 442ALVARDO score is done to diagnose Acute appendicitis by clinical and Lab values.The mnemonic for this score is - MANTRELS* M- Migratory Pain (1 Score)* A- Anorexia* N- Nausea (1 Score)* T- Tenderness (2 Score)* E- Elevated Temperature (1 Score)* L- Leucocytosis (2 Score)* S- Shift of Neutrophils to left (1 Score)A value of > 7 is strongly suggestive of Appendicitis


Question: Milroy's disease is

Congenital lymphedema or Milroy disease (10%), that is present at bih and associated with an autosomal dominant familial history


Question: Most common site for squamous cell ca. esophagus is

Ans. is 'b' i.e., Middle third Distribution of Squamous cell Ca Upper 1/3 10% Middle 1/3 60% Lower 1/3 30% (Values according to Sabiston 17/e, may be different in other texts but are approx. the same)


Question: Entrance into the sinus in a Caldwell procedure is made through the


Question: In a patient of acute cholecystitis, referred pain to the shoulder is k/a

Boa's sign is the area of hyperaesthesia between 9th and 11th ribs posteriorly on the right side,i.e.,below the right scapula,sign of acute cholecystitis. Murphy's sign is right upper quadrant tenderness that is exacerbated during inspiration by the examiner's right subcostal palpation.It's also a sign of acute cholecystitis. Grey turner sign is the skin discolouration in the left flank in cases of acute hemorrhagic pancreatitis. Cullen's sign is the discolouration of umbilicus and surrounding skin(umbilical black eye).It's due to hemoperitoneum & seen in conditions like ruptured ectopic pregnancy,acute hemorrhagic pancreatitis. Reference:SRB's manual of surgery,5th edition,page no:644;Bailey & Love's manual of surgery,25th edition,page no:1121.


Question: Lipodermatosclerosis is most commonly seen at

Lipodermatosclerosis Lipodermatosclerosis is the name given to skin changes seen in chronic venous insufficiency Components of lipodermatosclerosis Pigmented skin Inflammed Subcutaneous tissue Elevated venous pressure facilitates the Extravasation of the RBC'S and fluid leaking to inflammation The pigmentation is due to fixation of hemosiderin in the tissue It is most commonly seen in gaiter area (above medial malleous) Ref: Sabiston 20th edition Pgno : 1832


Question: Idea of adrenal biopsy should be made after ruling out

Ans. (c) PheochromocytomaRef: Bailey and love, 26th ed; pg. 779Adrenal gland biopsy* Never biopsy an adrenal mass until pheochromocytoma has been biochemically excluded* The indication for adrenal gland biopsy is to confirm adrenal gland metastasis


Question: Treatment of SNT with Lymph node involvement

Ans. (d) Total thyroidectomy + MRNDRef: Page 1537/ Schwartz 10th edition* A solitary nodule with Lymph node involvement is suggestive of Papillary cancer. So Total thyroidectomy + MRND on that side is must.


Question: Investigation of choice for submandibular sialolithiasis is

X ray is IOC for submandibular sialolithiasis as most of the stones are radio-opaque.


Question: A 25 year old female complains of discharge of blood from a single duct in her breast. The appropriate treatment is

.DUCT PAPILLOMA - * Commonest cause of bloody discharge from nipple * It is usually single, from a single lactiferous duct * It blocks the duct causing ductal dilatation * Papilliferous swelling (projection), usually seen near the nipple orifice. * Blood stained discharge from the nipple is common. * But serous or serosanguinous discharge can also occur. * Single papilloma is not premalignant. * But multiple papillomas in many ducts can be premalignant. Treatment -Microdochectomy: Probed lactiferous duct is opened, and the papilloma is excised using tennis racquet incision ref:SRB&;s manual of surgery,ed 3,pg no 467.


Question: Compament syndrome is treated by


Question: The mechel&;s diveiculum is situated within about .............. cm from the ileocecal valve

.It is a congenital diveiculum arising from the terminal ileum and is pa of the unobliterated proximal poion of the vitello intestinal duct. It is- * 2% common. * 2 feet from the ileo-caecal valve. * 2 inch in length. * It is congenital, results from incomplete closure of vitello-intestinal duct. * It is the most common congenital anomaly of small intestine. * Arises from the antimesenteric border of the ileum, containing all three layers of the bowel with independent blood supply. ref:SRB&;s manual of surgery,ed 3,pg no 798


Question: Most common site of chronic fissure in ano

Chronic fissure in ano will present as skin tags in posterior anal canal.


Question: Consider the following


Question: Boyd's classification is with regard to

Boyd's classification is with regard to claudication.