Question: Relation of hernial sac to spermatic cord in direct inguinal hernia is

Ans. b (Sac is posterior to cord). (Ref. B & L, Surgery, 25th/pg. 70, 971)INGUINAL HERNIAS# Indirect inguinal hernia:- It is the remains of the processus vaginalis and therefore is congenital in origin.-It is more common than a direct inguinal hernia.- It is much more common in males than in females.- It is more common on the right side.- It is most common in children and young adults.- The hernial sac enters the inguinal canal through the deep inguinal ring and lateral to the inferior epigastric vessels.- An indirect inguinal hernial sac travels down the canal on anterolateral aspect of spermatic cord.- The neck of the sac is narrow.- The hernial sac may extend through the superficial inguinal- ring above and medial to the pubic tubercle. (Femoral hernia is located below and lateral to the pubic tubercle).- The hernial sac may extend down into the scrotum or labium majus.# Indirect inguinal hernia:- While a direct inguinal hernial sac comes out directly forwards through posterior wall of inguinal canal, Neck of indirect hernial sac is lateral to inferior epigastric vessels, while direct emerges medial to it.- An inguinal hernia can be differentiated from femoral by sac neck relation to medial end of inguinal ligament and pubic tubercle i.e. in inguinal hernia neck is above and medial while in femoral it is below and lateral to medial end of inguinal ligament and pubic tubercle.- So, direct hernia = sac is posterior, Indirect hernia = sac anterolateral.- Direct hernias do not often attain a large size or descend into scrotum.- In contrast to an indirect inguinal hernia, a direct inguinal hernia lies behind the spermatic cord.- As neck of the sac is wide, direct hernia s do not often strangulate.- A direct inguinal hernia is always acquired (Smoking, occupation that involve straining & heavy lifting & damage to ILIOINGUINAL NERVE)- Women practically never develop a direct inguinal hernia (It is common in old men with weak abdominal muscles and is rare in women).


Question: Laproscopic procedure patient develops shoulder pain due to

Ans. (c) Sub diaphragmatic migration of gas(Ref: Bailey 26th 100-101)* Shoulder pain after laparoscopy is due to pain referred from diaphragm and due to subdiaphragmatic migration of gas


Question: In a child with a cavovarus foot deformity, the standing lateral block test assesses the flexibility of the

The standing lateral block test is used to evaluate hind foot flexibility. It is performed by placingthe heel and lateral border of the patient's foot on a wooden block 2 to 4 cm thick, while the medial border of the foot is allowed to hang freely. This test negates any effect the forefoot may have on the hindfoot in stance. If the heel varus corrects with the patient standing on the block, the hindfoot is considered flexible.


Question: Pneumatosis intestinalis is diagnostic of

.Necrotising enterocolitis is an acquired inflammatory disease commonly seen in infants and newborn but occasionally can occur in children and adults. It ismore commonly seen in premature babies. It is more common in formula fed babies than breast bed babies. Reduced gut flora make virulent pathogens to act and cause sepsis. * Common site is terminal ileum, caecum and ascending colon. Often it can involve entire small bowel. * Gas in the bowel wall and often in poal vein is typical. ref:SRB&;s manual of surgery ,ed 3,pg no 810


Question: Earliest Sign/Symptom of Compartment Syndrome of Leg is

Ans. (B) Pain on Passive flexion of FingersRef: Surgery Sixer 3rd Edition Page 103Repeated question so many times,Compartment syndrome of Lower leg is associated with* Early Sign- Pain on Passive stretching* Late Sign- Absent Pulses* Fasciotomy done Longitudinally at 2 sides of Tibia, at pressure >30mmHg.* Delayed Fasciotomy may result in Myoglobinuria and Renal Failure.


Question: In doing phrenic nerve block, it is best to infiltrate

Phrenic nerve is blocked 3 cm above the clavicle at the posterior border of sternomastoid.


Question: Best test for oesophageal varices is

B. i.e. (Gastro - oesophagoscopy) (1089 - B &L) (897 - S. Das 5th)Endoscopy - upper GI endoscopy represents the most reliable single technique as it shows the oesophageal varix and bleeding point* Dilated longitudinal veins running a Zig- Zag course*** Diffuse esophageal spasm is best diagnosed by Manometry**Management of bleeding oesophageal varices* Blood transfusion* Correct coagulopathy* Oesopageal balloon tamponade (Sengstaken - Blakemore tube)*** Drug therapy (Vasopressin /Octreotide)* Endoscopic sclerotherapy or banding* Assess portal vein potency (Doppler USG or CT)* Transjugular intrahepatic portosystemic stent shunts (TIPSS) (Contraindicated in portal vein occlusion)* Surgery- Portosystemic shunts- Oesophageal transaction- Splenectomy and gastric devascularisation* Commonest cause of acute upper GI haemorrhage - Peptic ulcer**


Question: Tennis Racquet cells

Rhabdomyosarcoma An adjectival description for a relatively elongated cell, lesion, structure or radiological density that is globose at one end and elongated at the other, alike to the device used in game of tennis. Tennis racquet cell: A tennis-racquet-shaped variant of rhabdomyoblast seen in sarcoma botryoides, a form of rhabdomyosarcoma affecting children. The key cell to recognize by routine microscopy is the rhabdomyoblast, a cell with an eccentric round nucleus and variable amounts of brightly eosinophilic cytoplasm. 'Tennis racquet' appearance: A descriptive term for the ping-pong paddle-like thickening of the mesangium in glomeruli affected by Kimmelstiel Wilson disease. Tennis racquet granule: Birbeck granule; Langerhans' granule. A subcellular paicle with a pentilaminar 'handle' and bulbous terminal dilation of unceain significance that is seen by electron microscopy in the antigen-presenting Langerhans cell and in histiocytes. 'Tennis racquet sign (radiology): The description for a finding in a 'blighted ovum' in which the ultrasonically empty gestational sac is compressed (the racquet's 'handle') and adjacent to a surrounding decidual reaction (the 'paddle'); aka Tadpole sign. 'Tennis racquet' spore (microbiology): A descriptive term for the morphology of the subterminal spores in the gram positive Clostridium tetani, as well as in C. diphtheriae.


Question: According to Borrman's classification, Linnitis plastica is

Classification of advanced gastric cancer according to Borrmann: Type Ipolypoid fungating Type IIulcerative with elevated distinct borders,Type IIIulcerative with indistinct bordersType IVdiffuse, indistinct borders (linitis plastica)Sabiston 20e pg: 1241


Question: The renal cell carcinoma having worst prognosis is

Collecting duct/ bellini has the worst prognosis.


Question: "Apple core" sign seen in

i.e. (Carcinoma descending colon): (1181-Love & Bailly 25th)* Barium enema showing a carcinoma of the sigmoid colon. It may have a 'apple core' appearance i.e. a short irregular stenosis with sharp shoulders at each end.* Carcinoma of the left colon appears as a fixed filling defect with an annular "apple core" configuration lesion of the right colon may appears as - constriction or an intraluminal mass (663 - CSDT13th)CEA levels are high in 70% of patients with cancer of large intestine but less than half of patients with localize disease are CEA positive. CEA does not therefore serve as a useful screening procedure, nor is it an accurate diagnostic test for colorectal cancer in a curable stage. CEA is helpfid in detecting recurrence after curative surgical resection; if high CEA levels return to normal after operation and then rise progressively during the follow up period, recurrence of cancer is likely (663-CSDT 13th)* Apple jelly nodules are seen in Lupus vulgaris*** Claw appearance on barium enema - Intussusception* Napkin - Ring sign - carcinoma colonRisk Factors for the Development of Colorectal cancer* Diet: Animal fat, High caloric diet, High saturated fat consumption* Hereditary syndromes (Autosomal dominant inheritance* Polyposis coli* Nonpolyposis syndrome (Lynch syndrome)* Inflammatory bowel syndrome (UC & CD)* Streptococcus bovis bacteremia* Uretero sigmoidostomy* DM and obesity* Tobacco use* Sedentary life style* High red meat consumption* High content of refined carbohydrate* There is narrowing of terminal ileum due to irritability This along with shortened rigid caecum is called as "Sterilin sign" seen in Crohn's disease and Ileocaecal TuberculosisCROHN'S DISEASE or REGIONAL ENTERITISULCERATIVE COLITIS* Terminal ileum is the Most common site*** Granularity & asymmetrical involvement with skip lesion* Ulcer - Apthous ulcer and fissure ulcer* Cobblestone pattern** (Serpiginous transverse ulcer seperated by areas of edema)* Rigidity of mesenteric border and pseudosacculation of anti mesenteric border (Omega sign)* Wide gapping of bowel loops due to thickening of bowel wall* Stricture : long segment (String sign of cantor)*** Collar button ulcer* Double Tracking (longitudinal submucosal ulceration over several centimeter)* Symmetrical involvement of colon* Rectum involvement in 95% of cases*** Thumbprinting** due to mucosal oedema* Blunting of haustral fold (Pipestem appearance)*** Inflammatory polyp*** Back wash ileitis. In UG when whole colon involved, the inflammation extends 1-2 cm into terminal ileum in 10-20% cases called Backwash ilitis* Gaseless abdomen in X-ray***


Question: Parotid gland contains

Parotid glands - Contain serous acini
Sub lingual glands - Contain mucious acini
Minor salivary glands - Contain mucious acini
Submandibular glands - Contain both serous and mucinous acini

Serous and mucinous acini with equal proportion

75 % serous acini and 25 % mucinous acini


Question: Most common cause of upper GI bleed is

Most common cause of upper GI bleed is duodenal ulcer-33%. Other causes are gastric ulcer-21%, erosions-26%, mallery weis tears-4%, oesophageal varices-4%, tumours-0.5%, vascular lesions eg. Dieulafoy's disease-0.5% and others-5%. Reference : page 1063 Bailey and Love's sho practice of surgery 25th edition


Question: A surgeon excises a poion of the liver to the left to the attachment of the falciform ligament. The segments that have been resected are

Segments II and III are to the left of the left hepatic vein and falciform ligament with II superior and III inferior to the poal plane.


Question: Lachman test is positive in


Question: Recovery is complete in the following injury

Seddon's Classification Neuropraxia: It is temporary physiological paralysis of nerve conduction. Here recovery is complete. There is no reaction of degeneration. Axonotmesis: It is division of nerve fibres or axons with intact nerve sheath. There is reaction of degeneration distally with near complete recovery. Patient can present with sensory loss, paralysis of muscles or causalgia. Neurotmesis: Here complete division of nerve fibres with sheath occurs . Degeneration occurs proximally up to the first node of Ranvier as well as distal to the injury. Recovery is incomplete even after nerve suturing. There is complete loss of motor and sensory functions with loss of reflexes. If the nerve is mixed type other than pure motor or sensory recovery is still poorer. Injuries may be incised or lacerated or crushed one. Cut end of the nerve forms proximally neuroma and distally glioma. Ref: SRB's Manual of Surgery 5th edition Pgno : 264


Question: Platelets can be stored at

. Shelf-life 5 days Storage temperature range 20-24 oC Comments Platelets components must be agitated gently and continuously in a single layer on a platelet agitator.


Question: Treatment for stage T3N1 of carcinoma maxilla is

Maxillary carcinoma is of two types Squamous cell carcinoma -- (MC. type of carcinoma) Adenocarcinoma T/T of maxillary carcinoma Squamous cell carcinoma - Combination of Surgery and radiotherapy gives better res is than either alone. Radiotherapy can be given before or after surgery (The t/t is same in every stage of maxillary carcinoma) Adenocarcinoma - Radiotherapy is ineffective, so only surgery is done.


Question: Metabolic abnormality is seen in large colorectal villous adenoma

Villous adenomas causing profuse watery diarrhoea and hypokalemia is known as the McKittrick Wheelock syndrome after it was first described in 1954.
Metabolic abnormalities seen are hyponatraemia, hypokalaemic, and hypochloraemic metabolic acidosis.
Severe volume loss may cause acute renal failure and cardiovascular collapse.
The mechanism of fluid and electrolyte loss is unclear. Locally released prostaglandin E2 has been suggested as the secretagogue responsible for salt wasting, as has a cyclic AMP.

Treatment:

Reversal of the biochemical derangement is the cornerstone of successful management. Once resuscitated, immediate surgical resection of the tumor, is the treatment of choice.


Question: Commonest site of meningocele is

• Herniation of meninges through a defect in the posterior vertebral arches.
• Spinal cord is usually normal and assumes a normal position in the spinal canal
• There may be tethering, syringomyelia, or diastematomyelia.
Clinical Features
• A fluctuant midline mass, that may transilluminate occurs along the vertebral column, in the lower back.
• Most meningoceles are well covered with skin and pose no threat to the patient.
• Anterior meningocele: Projects into pelvis through a defect in the sacrum.
• Symptoms of constipation and bladder dysfunction develop due to the increasing size of the lesion.
Diagnosis
• Plain roentgenograms demonstrate a defect.
Treatment
• Asymptomatic children with normal neurologic findings and full-thickness skin covering the meningocele may have surgery delayed.
• Patients with leaking CSF or a thin skin covering should undergo immediate surgical treatment to prevent meningitis.


Question: In a sutured surgical wound, the process of epithelialization is completed within

Epithelialization is defined as a process of covering the denuded epithelial surface. In a sutured surgical wounds are epithelialized within 24-48 hours. Hence Post op dressing is done only after 48 hrs.


Question: Negative pressure dressing is used for

Answer- B. Chronic non-healing diabetic ulcerNegative-pressure wound therapy (NPWT) is a therapeutic technique using a vacuum dressing to promote healing in acute or chronic wounds and enhance healing ofsecond and third degree burns.Use in the treatment of diabetes-associated chronic leg wounds.


Question: Treatment of choice of cystic hygroma

Surgical excision is most definitive treatment of cystic hygroma. Other treatments include Sclerotherapy and cautery etc.


Question: Ectopic uretor opening is not located in

Ectopic ureters are almost always associated with ureteric duplication and 10% are bilateral. There is a female:male ratio of 7:1. The ectopic ureter drains the upper pole of the kidney and inses into the bladder more distally than normal and towards the bladder neck. In females, the ectopic ureter opens either into the urethra below the sphincter or into the vagina. A female who voids normally but who has dribbled urine for as long as she can remember is typical of the patient with an ectopic ureter. In the male, the opening of the ureter is above the external urethral sphincter so the patient is continent. An ectopic ureteric orifice in a male at the apex of the trigone, in the posterior urethra, in a seminal vesicle or in an ejaculatory duct is likely to be functionally abnormal and infection is common. A severely diseased or atrophic moiety is effectively treated by paial nephrectomy. A refluxing ureter may need re-implanting. An ectopic ureter in a female often drains hydronephrotic and chronically infected renal tissue and is best excised. Rarely, the incontinence can be cured and renal function preserved by re-implanting the ureter into the bladder. ( ref : Bailey 27 th ed , chapter 76 , pg 1401 )


Question: Salivary calculus is more common in


Question: A young male presents with leg swelling and recurrent aphthous ulcers of his lips and tongue. He has also recently noted painful genital ulcers. There is no urethritis or conjunctivitis. On exam, he has evidence of deep vein thrombophlebitis. (SELECT 1 DIAGNOSIS)

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


Question: Drug of choice for Her 2 Neu positive Breast cancer

Ans. (a) Trastuzumab(Ref. Bailey and Love 27th Edition Page 878)* Drug of choice for Tumors containing Growth Factor receptor positive for C- erb B2 is Trastuzumab (Herceptin)* Other agents currently available are:# Lapitinib- Oral Combined Tyrosine Kinase Inhibitor# Pertuzumab- Tyrosine Kinase inhibitor# T-DM1- A drug which has emestane is bound to Anti Her 2 agent to allow targeted delivery of Chemotherapy for HER-2 Positive cases.


Question: EDH least common possibility is in

(D) Saccular aneurysm # Extradural hemorrhage is most commonly due to middle meningeal artery.> Saccular aneurysm rupture is associated with subarachnoid hemorrhage.


Question: Most common site of salivary gland stone

Stones are common in submandibular gland due to thick secretions.


Question: Jack stone calculi are made up of

Jack stone calculi are seen in bladder formed by calcium oxalate.


Question: Noble laurate among the following

(Theodor kocher) (Internet)Theodor kocher was the first Nobel prize winner in the surgical speciality in 1909 for this work in surgery of the thyroid glandWillian Stewart Halsted* In 1882 Halsted was researching breast cancer a disorder that was becoming better understood by the time. He decided that the best way to prevent the spread of the cancerous cells was to simply remove them surgically known as radical mastectomy*** Between 1883 and 1886 Halsted published many papers on* Usuage of blood transfusion during surgery* Injection of a saline solution in to the blood to dilute it can treat shock* In 1884 a physician named Karl Koller demonstrated the use of cocaine for LA* Rubber gloves for medical purposes & its importance** in preventing infection and the spread of pathogene* Method for repair of inguinal hernia that had a lower mortality rate than other previous methods* The noble prize in physiology or medicine for 2007 was jointly awarded to Mario R. capecchi, Martin J. Evans J and Oliver Smithies for their discoveries of - Principles for introducing specific gene modification in mice by the use of embryonic stem cells**


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

.extradural haematoma is the collection of blood in the extradural space between the dura and skull. most common site is the temporoparietal region.usually it is associated with fracture of temporoparietal region. immediately after injury , there is transient loss of consciousness and the patient soon become normal. later after 6-12 hours , he again falls ill and the condition deteriorates. this is the time taken to develop raised intracranial pressure,coning and its effects. this crucial time gap is called lucid interval. (Ref : SRB&;s Manual of Surgery, 5th editin , pg no.1095)


Question: Gold standard test for insulinoma is

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: Treatment of choice for Wahin's Tumor

Ans is 'a' i.e. Superficial parotidectomy The treatment of all benign tumors of the parotid gland is superficial parotidectomy


Question: Branchial cyst is found in

A branchial cyst probably develops from the vestigial remnants of the second branchial cleft, is usually lined by squamous epithelium, and contains thick, turbid fluid full of cholesterol crystals. The cyst usually presents in the upper neck in early or middle adulthood and is found at the junction of the upper third and middle third of the sternomastoid muscle at its anterior border. It is a fluctuant swelling that may transilluminate and is often soft in its early stages so that it may be difficult to palpate. If the cyst becomes infected it becomes erythematous and tender and, on occasions, it may be difficult to differentiate from a tuberculous abscess. Ultrasound and fine-needle aspiration both aid diagnosis and treatment is by complete excision, which is best undeaken when the lesion is quiescent. Although the anterior aspect of the cyst is easy to dissect, it may pass backwards and upwards through the bifurcation of the common carotid Bailey & Love ,25th,727.

Upper and middle third of the sternomastoid muscle at its anterior border

Upper one-third along anterior tender of trapezius


Question: Investigation of choice for parotid fistula

Starch iodine Test is used for Frey's Syndrome.


Question: Management of 5 cm size renal struvite calculus

For stones which are

>2cm size
Hydronephrosis
Obstructed

PCNL is performed


Question: Painless gross hematuria occurs in


Question: Cause of Failure to thrive include (s)

.* Mesenteric tuberculous adenitis is more common in children. Present with anaemia, fever, loss of appetite and reduced weight, failure to thrive, palpable mass in right iliac fossa which is firm and nodular.failure to thrive as also in choledochal cysts. ref:SRB&;s manual of surgery,ed 3,pg no 522


Question: Most common cause of acute epididymitis in young males

Young males most common organism is chlamydia
Age > 40 most common organism is E Coli


Question: Water soluble contrast made up of

There are two types of Water soluble contrast:- Ref:- Surgery Sixer 3rd Edition; Pg num:- 327


Question: Dimpling in carcinoma breast is due to

Answer- C. Subdermal lymphangitisPeaud's orange is produced due to obstruction of superficial lymph vessels by cancer cell.This causes edema of the skin giving rise to an appearance like that ofthe skin of an orange (Peau'd orange appearance).


Question: In majority of patient with esophageal leaks in thoracic cavity of less than 12 hours duration, the treatment of choice is

Primary closure, drainage and antibiotics


Question: After extraction of upper central incisor, patient develops ophthalmoplegia, meningitis and lateral rectus paralysis. The diagnosis is


Question: Testis tumor is associated with secondary hydrocele in

• Approximately 5-10% of testicular tumors may be associated with hydroceles.


Question: Sphincterotomy of sphincter of Oddi is performed at

This cut is made superiorly (at the 11 o'clock position) for 4 to 5 mm The sphincter is incised at the 11-O'clock position to avoid injury to the pancreatic duct


Question: Curling's ulcer is seen if burns area is more than


Question: Patient is on autocoids for 1 year complains of severe pain epigasrium relieved iv antacids now complains of pain in right iliac fossa and epigastrium with fever and loss of liver dullness diagnosis

Answer- A. Duodenal perforationLong term therapy with autocoids led to an ulcer that eventually perforated and now the patient has presented early signs of peritonitis.Clinical features of perfontion of duodenal ulcerPerforated duodenal ulcer is characterized by sever constant onset epogastric painPatient looks ill and lies unusually stillTachycardiaShallow respirationTender with intense guarding and rigidityIf the air has escaped into peritoneal cavity then liver dullness may be absentPeptic ulcer perforation leads to chemical peritonitis initially.


Question: In cholecystectomy, fresh frozen plasma should be given


Question: Banka's lesion involves the of the glenoid labrum.


Question: Treatment of squamous cell carcinoma of anal canal not involving the deeper structures include

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


Question: The most common cause of epididymitis is

Epididymitis is most common in young men ages 19 to 35. Chlamydia is the most common cause in sexually active men younger than 35 years (accounting for up to 50% of cases). Infections with urinary coliforms (eg, E coli, Pseudomonas species, Proteus species, Klebsiella species) are the most common cause in children and in men older than 35 years. Reference : page 1383 Bailey and Love's sho practice of surgery 25th edition


Question: Palpable plaque with curved penis pointing to the side of plaque is a feature of

Ans. is 'a' i.e., Peyronies disease * Unyielding palpable plaque in penis with erect penis bent, often dramatically, towards the side of the plaque is a feature of peyronies disease.Peyronie's disease* Peyronie's disease is a common cause of deformity of the erect penis.* Hard plaques of fibrosis can usually be palpated in the tunica of one or both corpora cavernosa. The plaques may be calcified.* The presence of the unyielding plaque tissue within the normally elastic wall of the corpus cavernosum causes the erect penis to bend, often dramatically, towards the side of the plaque.* The aetiology is uncertain but it may be a result of past trauma - there is an association with Dupuytren's contracture.* Disease may continue to progress or remit after 3-5 years.* When the deformity of the penis is causing distress, it may be possible to straighten it by placing non- absorbable sutures in the corpus cavernosum opposite the plaque. This reduces the elasticity in this region to balance that caused by the plaque (Nesbitt's operation).


Question: Vasodilation in spider naevi is due to aEUR'


Question: A 21 years old woman has 3 cm node in the lower deep cervical chain on the left. The biopsy is interpreted as revealing normal thyroid tissue in a lymph node. The most likely diagnosis is

. Thyroid tissue present in cervical lymph nodes in the face of a clinically normal thyroid gland is a metastasis from an occult primary thyroid carcinoma Occasionally, a metastatic papillary thyroid cancer manifests as a painless lateral neck mass that is clinically detected before detecting the primary thyroid lesion. Sabiston 20th edition pg 926


Question: Pringle maneuvar to arrest hehemorrhage is

Pringle manoeuvre is used to control hemorrhage by clamping the hepatoduodenal ligament and compressing the poal triad,thereby reducing aerial and venous inflow into the liver.But it doesn't control the backflow from inferior vena cava and hepatic veins. Reference: Bailey & Love's sho practise of surgery,25 th edition,page no348.


Question: Radiographic appearance of the inferior dental canal and roots of the mandibular third molar

Radiolucent band evident in relation to root of third molar which is grooved tunneled


Question: 'Rubber band' extraction is a method of extraction in patients having

Myocardial infarction and angina pectoris


Question: The role of Tamoxifen in the reduction of breast cancer is

(A) Competes with estrogen receptor in breast # Tamoxifen is a hormone treatment developed over twenty years ago. It lowers the risk of breast cancer coming back (recurring) or developing in the other breast.> Tamoxifen prevents oestrogen from going into breast cancer cells> Oestrogen can stimulate breast cancer cells to divide and grow.> The oestrogen receptor is a part of the cell that oestrogen can lock into and encourage the cell to multiply to make more breast cancer cells.> Tamoxifen locks into the oestrogen receptor and stops the oestrogen from getting to the cell. Progesterone receptors are similar 'locks' on the cell surface for progesterone, the other female sex hormone.> Breast cancers are divided into oestrogen receptor and progesterone receptor positive and Tamoxifen is given to oestrogen receptor positive patients


Question:
30 yrs female presented with unilateral breast cancer associated with axillary lymph node enlargement. Modified
radical
mastectomy was done, a further treatment plan will be

Stage I & II breast cancers (Early invasive breast cancers ) are managed by
1. Primary therapy for local management
2. Adjuvant therapy Primary therapy consists of:
Mastectomy with an assessment of axillary lymph node status (or modified radical mastectomy) or Breast conservation (lumpectomy, wide local excision or quadrantectomy) with an assessment of axillary lymph node status + radiotherapy.
Various trials have found both these methods to be equally effective. Breast conservation is the preferred form of treatment because of cosmetic advantages. However, there are certain contraindications for conservative surgery (described in subsequent question) Management of axillary lymph nodes Earlier dissection of axillary lymph nodes (level I and II) was performed to assess the lymph node status (i.e. presence or absence of occult metastasis). Now Sentinel lymph node biopsy is considered the standard for evaluation of the axillary lymph nodes for metastasis in women who have clinically negative lymph nodes, (the sentinel lymph node is thirst regional lymph node to receive tumor cells that metastasize along the lymphatic pathway from the primary breast cancer). Axillary Lymph node dissection is performed for clinically palpable axillary lymph nodes or metastatic disease detected in sentinel lymph node biopsy. Adjuvant chemotherapy is given to all node-positive cancers node-negative cancers if > 1 cm in size.

Node-negative cancer > .5 cm in size with adverse prognostic factors such as blood vessel or lymph vessel invasion high nuclear grade high histological grade HER 2/neuoverexpression negative hormone receptor status Adjuvant hormone therapy (tamoxifen) is added to all those with estrogen receptor positive tumors. HER-2/neu expression is determined for all patients with newly diagnosed breast cancer and may be used to provide prognostic information in patients with node-negative breast cancer and predict the relative efficacy of various chemotherapy regimens. Trastuzumab is the HER-2/neu-targeted agent that is added to the adjuvant therapy is the tumor shows overexpression of HER-2/neu receptors. Advanced Local-Regional Breast Cancer (Stage III ) (Neoadjuvant chemotherapy + MRM + adjuvant radiation therapy + chemotherapy + antiestrogen therapy)

Here the disease is advanced on the chest wall or in regional lymph nodes (or both), with no evidence of metastasis to distant sites.
Such patients are recognized to be at significant risk for the development of subsequent metastases, and treatment addresses the risk for both local and systemic relapse. In an effort to provide optimal local-regional disease-free survival as well as distant disease-free survival for these women, surgery is integrated with radiation therapy and chemotherapy.
Neoadjuvant chemotherapy (administration of therapeutic agents prior to the main treatment) should be considered in the initial management of all patients with locally advanced stage III breast cancer. Surgical therapy for women with stage III disease is usually a modified radical mastectomy, followed by adjuvant radiation therapy and chemotherapy. Antiestrogen therapy (tamoxifen) is added for hormone receptor-positive tumors.
Chemotherapy is used to maximize distant disease-free survival, whereas radiation therapy is used to maximize local-regional disease-free survival.
In selected patients with stage IIIA cancer, neoadjuvant (preoperative) chemotherapy can reduce the size of primary cancer and permit breast-conserving surgery.
Distant Metastases (Stage IV ) (mainly palliative treatment) Treatment for stage IV breast cancer is not curative but may prolong survival and enhance a woman’s quality of life.
Hormonal therapies that are associated with minimal toxicity are preferred to cytotoxic chemotherapy.
Appropriate candidates for initial hormonal therapy include women with hormone receptor-positive cancers; women with bone or soft tissue metastases only; and women with limited and asymptomatic visceral metastases.
Systemic chemotherapy is indicated for women with hormone receptor-negative cancers, symptomatic visceral metastases, and hormone-refractory metastases. Bisphosphonates, which may be given in addition to chemotherapy or hormone therapy, should be considered in women with bone metastases. About Adjuvant Therapy, Adjuvant therapy is the use of systemic therapy (chemotherapy or/and hormone therapy) in patients who have received local therapy but are at risk of relapse.
The objective is to eliminate the occult metastasis responsible for late recurrences while they are microscopic and theoretically most vulnerable to anticancer agents. Adjuvant chemotherapy is given to all node-positive cancers node-negative cancers if > 1 cm in size node-negative cancer > .5 cm in size with adverse prognostic factors such as blood vessel or lymph vessel invasion high nuclear grade high histological grade HER 2/neuover expression negative hormone receptor status Adjuvant hormone therapy (tamoxifen) is added to all those with estrogen receptor positive.

The use of chemotherapy in postmenopausal women is controversial. In postmenopausal women, chemotherapy is frequently used upto age 70 yrs, if she can tolerate it. In older women, chemotherapy is performed less frequently.

 In estrogen-positive tumors, in postmenopausal women, antiestrogen (tamoxifen / aromatase inhibitors)
Therapy is the preferred form of adjuvant systemic treatment. Neoadjuvant chemotherapy it involves the administration of adjuvant therapy before primary therapy (surgery & radiation therapy) it has shown to down-stage the tumor. Previously CMF (cyclophosphamide, methotrexate & 5 - fluorouracil) was the chemotherapeutic regimen of choice. “CMF is no longer considered adequate adjuvant chemotherapy and modem regimens include an anthracycline (doxorubicin or epirubicin) and the newer agents such as the taxanes (paclitaxel and docetaxel)”- Bailey and Love 25/e p844 Anti-HER-2/neu antibody therapy.
(Trastuzumab) HER-2/neu expression for all newly diagnosed patients with breast cancer is now recommended. Trastuzumab is added to the chemotherapy for tumors overexpressing HER-2/neu receptors (Trastuzumab is added along with taxanes).

Adriamycin based chemotherapy followed by tamoxifen depending on estrogen/progesterone receptor status


Question: . Internal fistulas with colonic diverticulitis are most often


Question: Elephant foot deformity is indicative of

Non-union of fractured edentulous mandible

Unilateral Le Fort I fracture of maxilla


Question: The Best investigation to visualize posterior urethra is

Ans. (d) Ascending urethrogramRef: Campbell Urology 11th Edition, Page 3257* Best Investigation to visualize posterior urethra is micturiting cystourethrogram or ascending urethrogram


Question: Pseudomyxoma peritonei arises from

Pseudomyxoma peritonei occurs more commonly in women.It is associated with mucinous cystic tumours of ovary and appendix. Reference:Bailey & Love's sho practise of surgery,25 th edition,page no:1003.


Question: Primary anatomic structure of concern in posterior mandible periradicular surgery

Neurovascular bundle coursing through infraorbital canal.

Neurovascular bundle near incisive foramen

NeurovascuLar bundle near palatine foramen

Neurovascular bundle coursing through mandibular canal.


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

In clinical cases of thyroid nodule, Thyroid profile (T3 T4 TSH) is done. If TSH is low, thyroid scan is done to see if nodule is hot or cold. If TSH is low or normal, ultrasound followed by FNAC is done Source :Sabiston 20 th edition Pg 890


Question: The initial investigation of choice for a postcholecystectomy biliary stricture is

The first step in the management of a postcholecystectomy biliary stricture is to undeake an immediate ultrasound scan of the abdomen.This will demonstrate whether there is intrahepatic /extrahepatic dilatation secondary to strictures. After that, the anatomy needs to be defined by either an ERCP or MRCP. Reference: Bailey & Love&;s sho practise of surgery,25th edition, page no:1125.


Question: Brilliantly translucent swelling in the neck region in a 2 years child. Diagnosis is

C. i.e. (Cystic hygroma) (729 B & L 25th) (625-S. Das 5th)CYSTIC HYGROMA - swelling consists of aggregation of cysts which contain clear lymph** (multilocular).Each locule is lined by a single layer of endothelium that is why this swelling is a Brilliantly Translucent swelling* ' Sequestration of a portion of the jugular lymph sac** from the lymphatic system accounts for the appearance of these swelling* Benign multilobular, multinodular cystic masses lined by a endothelial cells (mosaic appearance)* Posterior triangle of the neck is commonest site * * ** Soft, fluctuation test is positive, impulse on coughing presents regional lyrnphnode are not enlarged* Excision is the treatment of choice** and sclerotherapy with picibanil (OK- 432)


Question: Physiological locking involves

A i.e. Internal rotation of femur over stabilized tibia Physiological locking occurs in last 30 degree of extension, when femur rotates medially (internally) over stabilized tibiaQ. This very stable position is caused by quadriceps femoris muscle. Unlocking needed to initiate flexion is carried out by popliteus muscle, which moves femur laterally on stabilized tibia.

Internal rotation of tibia over stabilized femur

External rotation of tibia over stabilized femur

External rotation of femur over stabilized tibia


Question: Involucrum is


Question: Lalita, a female pt. presents with pigmentation of the lips and oral mucosa and intestinal polyps. Her sister also gives the same history. Most probable diagnosis


Question: A part of adjacent intestine will be removed in

Treatment of Enterogenous cyst is bowel resection fillowed by intestinal anastomosis.


Question: A patient died after a blunt trauma to chest, most common cause of death in blunt trauma to chest is

Answer is pneumothorax. The common life threatening conditions due to blunt trauma are Tension pneumothorax, Massive haemothorax, Flail chest etc, out of which Tension pneumothorax is most common cause. Pericardial tamponade needs to be differentiated from a tension pneumothorax. It is most commonly the result of penetrating trauma. Reference: Bailey & love, 27th Edition, page no = 367


Question: Atkin's diet is

Carbohydrate restricted low calorie diet Traditionally, fat restricted, low calorie diet has been used for weight loss. Atkin's proposed a new theorey for weight loss based on carbohydrate restricted low calorie diet


Question: Double Bubble sign is seen with

It&;s a radiological sign described in cases of duodenal obstructive. A plain abdominal X-ray reveals 2 foci of gas, one in the stomach and other in the duodenum = a sign of duodenal atresia Reference bailey and love&;s edition 5 th page no.1195


Question: Features of fracture neck of femur includes

C i.e. Shoening & Lateral rotation Fracture neck femur and inter trochanteric femur present with - lateral rotation and shoingQ. The only difference is in the amount i.e. * Less lateral rotation deformity in fracture neck femur is due to attachment of capsule to the distal fracture fragment which prevents excessive rotation in acute cases. But gradually the deformity increases d/t stretching of hip joint capsule by the weight of limb.


Question: A man presented with fractures of 4th to 10th ribs and respiratory distress after a Road Traffic Accident (A). He is diagnosed to have flail chest and a PaO2, of

Flail chest occurs when three or more contiguous ribs are fractured in at least two locations. Paradoxical movement of this free-floating segment of chest wall may be evident in patients with spontaneous ventilation, due to the negative intrapleural pressure of inspiration. The decreased compliance and increased shunt fraction caused by the associated pulmonary contusion that is typically the source of postinjury pulmonary dysfunction. Pulmonary contusion often progresses during the first 12 hours. Resultant hypoventilation and hypoxemia may require presumptive intubation and mechanical ventilation. Ref: Cothren C., Biffl W.L., Moore E.E. (2010). Chapter 7. Trauma. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e.


Question: Peripheral aneurysm most commonly located at

. Ans : (b) Popliteal aery - Popliteal aery aneurysm accounts for 70% of all peripheral aneurysms ; two- thirds are bilateral. - Almost all patients (97%) with Popliteal aery aneurysms are male.


Question: Absorbable suture material is

(A) Polyglactin) (38- Bailey & Love 26th)Absorbable suture material Absorption rateNon absorpable suture material* Catgut (plain)}Natural 7-10 days* Silk}Natural* Catgut (chromic)within 90 days* Linen* Polyglactin (Vicryl) 60-90 days* Polyglyconate (Maxon) 180 day* Polyglycolic acid 60-90 days* Polydiaxanone (PDS) 180 days* Polyglycaprone (Monocryl) 90-120 days* Surgical steel* Nylon (Ethilon/Nurolon)* Polyester (Mersilene/Ethibond)* Poly butester* Polypropylene (Proline)


Question: Sho 4th metacarpal is a feature of

Ans. is `c' i.e., Pseudohypoparathyroidism Sho 41kmetacarpal/metatassal (metacarpal sign) Post - traumatic Post infection (from sickle cell anemia) Turner's syndrome Pseudohypoparathyroidism Pseudopseudohypoparathyroidism Hereditary multiple exostosis Chondroectodermal dysplasia (Ellis-vanCreveld syndrome)


Question: Name of the procedure

This is V-to-Y advancement. Commonly used for fingeips and extremities.Ref: Bailey and love, 27e, page: 641


Question: Thomas test is used for testing


Question: Non progressive contraction of esophagus are

Three types of contractions in the oesophagus, they are *primary -progressive, triggered by swallowing *secondary-progressive,generated by distension,or irritation *teiary -non-progressive Ref: SRB&;s manual of surgery,5th ed, pg no 788


Question: Inversion of nipple occures due to involvement of

.* Breast carcinoma arising from lactiferous ducts is called as ductal carcinoma. * Breast carcinoma arising from lobules is called as lobular carcinoma. It is 10% common. Cutaneous Manifestations of Carcinoma Breast * Peau d'orange: Due to obstruction of dermal lymphatics, openings of the sebaceous glands and hair follicles get buried in the oedema giving rise to orange peel appearance. * Dimpling of skin due to infiltration of ligament of Cooper. * Retraction of nipple due to infiltration of lactiferous duct. * Ulceration, discharge from the nipple and areola. * Skin ulceration and fungation. * Cancer-en-cuirasse: Skin over the chest wall and breast is studded with cancer nodules appearing like an armour coat. ref:SRB&;s manual of surgery,ed 3,pg no 472


Question: A 60 years old male alcoholic presents with acute upper GI bleeding following bouts of vigrous vomiting. Most probable diagnosis is

Answer- C. Mucosal and submucosal tear at cardiac orifice of stomachMallory - Weiss syndromeIs characterized by mucosal tear at the gastroesophageal junction following a bout of forceful retching (or vomiting, coughing or straining.The clinical picture consists of acute upper gastrointestinal bleeding following bouts of retching or vomitting.Other frequent associations with Mallory-Weiss tears areHiatal herniaNSAIDs abuseDisease related bleeding diathesis.


Question:
Pseudocyst of pancreas develops after attack of acute
pancreatitis

It usually devolops at 6 weeks after acute pancreatitis.


Question: Most common complication following haemorrhoidectomy is

MC Most Common complication following haemorrhoidectomy is Pain.
2nd Common complication following haemorrhoidectomy is urinary retension.


Question: The most common facial abnormality seen in Gardener&;s syndrome is

.desmoid tumor is often associated with the familial polyposis colon (FAP), osteomas, odontomes epidermal cysts-- Gardner's syndrome. Gardner's syndrome 1. Familial polyposis colon 2. Osteomas 3. Odontomes 4. Epidermal cyst - 20% ref:SRB &;s manual of surgery,ed 3,pg no-672


Question: Cricothyroidotomy is contraindicated in


Question: Wahins tumour is

Wahin's tumor, or papillary cystadenoma lymphomatosum, is the second most common benign parotid tumor and occurs most often in older white men. Because of the high mitochondrial content within oncocytes, the oncocyte-rich Wahin tumor and oncocytomas will incorporate technetium Tc 99m and appear as hot spots on radionuclide scans. If fine-needle aspiration suggests a slow-growing Wahin tumor with confirmatory technetium scanning in a patient with contraindications to surgery, the tumor may be closely monitored because it has no malignant potential.


Question: Lesser curvature anterior seromyotomy is indicated in

.Surgery for Uncomplicated DU * Highly Selective Vagotomy (HSV). * Selective vagotomy with pyloroplasty (SV + P). * Truncal vagotomy with gastrojejunostomy (TV + GJ). In HSV, only fibres supplying the parietal cells are ligated. The nerve of Latarjet which supplies the antrum pump is retained and so no drainage procedure is required in HSV. HSV is also called as parietal cell vagotomy or super selective vagotomy. Here nerve fibres in 6 cm of the stomach, just proximal to pylorus are preserved.(Crow's foot). Vagotomy reduces acid secretion, hence ulcer heals. No acid, No ulcer. * Posterior truncal vagotomy with anterior seromyotomy-- Taylor's operation. It can be done through laparoscopy. Note: Presently, there is no role of gastrectomy or gastrojejunostomy (Just GJ) for uncomplicated DU. Ref: SRB&;s manual of surgery,3 rd ed, pg no 760


Question: Splenunculi are commonly seen in

A. (Hilum of spleen) (1103-B & L 25th)ACCESSORY SPLEEN (Splenunculi) - probably results from a failure of infusion of splenic embryonic tissues* They are located near the hilum of the spleen in 50% of cases and related to the splenic vessels or behind the tail of pancreas in 30%. The remainder are located in the mesocolon or the splenic ligaments* These are functionally similar to the spleen and while performing splenectomy for blood dyscrasias removal of these accessory spleens are obligatory, otherwise there always remains a chance of recurrence* Axis of spleen enlargement projects into- Greater sac**


Question: Aromatase inhibitors in Ca breast

letrozole is nonsteroidal competitive inhibitor of enzyme aromatase this enzyme conves adrenal androgen to oestrogens it is used an adjuvant endocrine therapy in post menopausal women with hormone sensitive breast carcinoma ref ;(page no;551) 5th edition of SRB&;S Manual of SURGERY


Question: TIPSS involves percutaneous creation of a shunt between

It&;s a nonsurgical interventional radiological method wherein stent is placed in the liver between hepatic venule and poal venule through a guidewire, used in reducing poal pressure before doing an ohotopic liver transplantation in cirrhotic patients. Reference SRB edition 5 page:622


Question: Most common site for carcinoid tumor in the abdomen

.CARCINOID TUMOUR It commonly occurs in appendix (65%), ileum (25%), other pas of GIT and rarely bronchus, testis, ovary. In the small intestine, carcinoids are most often seen within the terminal 2 feet of the ileum. * They arise from the enterochromaffin cells (Kulchitsky cells) found in the crypts of Lieberkuhn. * These cells are capable of APUD (Amine precursor uptake and Decarboxylation) and can secrete vasoactive peptides. * Carcinoid syndrome is seen in 40% of patients. * Carcinoid in appendix is usually single. But commonly it causes luminal obstruction and so presents with features of appendicitis. Common site is at tip/distal 2/3. ref:SRB&;s manual of surgery ,ed 3,pg no 812


Question: The degective migration of neural crest cells results in

Hirschsprung's disease (congenital mega colon) Hirschsprung's disease is characterised by the congenital absence of intramural ganglion cells (aganglionosis) and the presence of hyperophic nerves in the distal large bowel. The absence of ganglion cells is due to a failure of migration of vagal neural crest cells into the developing gut. The affected gut is in spasm, causing a functional bowel obstruction. The aganglionosis is restricted to the rectum and sigmoid colon in 75% of patients (sho segment), involves the proximal colon in 15% (long segment) and affects the entire colon and a poion of terminal ileum in 10% (total colonic aganglionosis) . A transition zone exists between the dilated, proximal, normally innervated bowel and the narrow, distal aganglionic segment.Hirschsprung's disease may be familial or associated with Down syndrome or other genetic disorders. Gene mutations have been identified on chromosome 10 (involving the RET proto-oncogene) and on chromosome 13 in some patients. Hirschsprung's disease typically presents in the neonatal period with delayed passage of meconium, abdominal distension and bilious vomiting but it may not be diagnosed until later in childhood or even adult life, when it manifests as severe chronic constipation. Enterocolitis is a potentially fatal complication. The diagnosis requires an adequate rectal biopsy and an experienced pathologist. A contrast enema may show the narrow aganglionic segment, a cone and the dilated proximal bowel. Surgery aims to remove the aganglionic segment and 'pull-through' ganglionic bowel to the anus (e.g. Swenson, Duhamel, Soave and transanal procedures), and can be done in a single stage or in stages after first establishing a proximal stoma in normally innervated bowel. Most patients achieve good bowel control but a significant minority experience residual constipation and/or faecal incontinence or fuher enterocolitis. Ref: Bailey and love 27th edition Pgno : 136


Question: Treatment of submandibular salivary gland ductcalculi is

Opening the duct and removal of calculus


Question: Most common benign mesenchymal tumour of the stomach

Abdominal leiomyosarcoma Leiomyosarcoma describes a type of soft tissue cancer that occurs within smooth muscle cells Gastrointestinal stromal tumors (GISTs) are the MC mesenchymal tumors of the GIT Formerly GISTs were commonly classified as Leiomyosarcomas ;however they are noe known to arise from the interstitial cells of cajal This kind of cancer can be difficult to detect as it often causes no organ dysfunction until the tumor had gotten to be large in size Most common locations : Uterus & stomach Clinical features Asymptomatic in initial stage Earliest symptom : Noticeable lump or swelling within the abdomen The sign most often cited is bleeding. These tumors sometimes ne rose and bleed into the bowel Leiomyosarcomas that occur in the digestive tract can also cause GI Blockage or bleeding, which can manifest as blood in the stool Uterine Leiomyosarcomas can cause vagibal bleeding Ref: www.ncbi.nlm.gov


Question: Success rate for intraligamentary anaesthesia


Question: Most serious injury is at

Answer- A. open pneumothoraxThis is a large open defect in the chest (> 3 cm), leading to equilibration between intrathoracic and atmospheric pressure.Air accumulates in the hemithorax (rather than in the lung) with each inspiration, leading to profound hypoventilation on the affected side and hypoxia.


Question: Most common carcinoma after burns is


Question: Subcapsular nephrectomy is indicated is


Question: Aseptic peritonitis is seen in

Aseptic peritonitis -peritonitis in which inflammation of the peritoneum is caused by chemicals, radiation, or injury, rather than by an infectious agent. secondary peritonitis secondary to disruption of the abdominal cavity or a hollow viscus, paicularly leakage from the gastrointestinal tract. teiary peritonitis- peritonitis which occurs after any abdominal surgeries Reference SRB edition 5 page 566,567

Irritation due to abnormal physiological fluid in peritoneum


Question: Increased gastric acid secretion occurs in

Gastric ulcersTYPELOCATIONACID LEVELI60%Lesser curve at incisuraLow to normalII15%Gastric body with duodenal ulcerIncreasedIII20%Prepyloric IncreasedIVLess than 10%High on lesser curveNormalVAnywhereNormal, NSAID-inducedSome ulcers may appear on the greater curvature of the stomach,but the incidence is less than 5%Sabiston 20e pg: 1233


Question: Most common cause of acute RVF aEUR'

Massive pulmonary embolism Acute right ventricular failure is usually caused by acute cor pulmonales. Most common cause of acute cor pulmonale is pulmonary embolism. M.C. cause of chronic cor pulmonale is pulmonary embolism Causes of acute right hea failure Pulmonary embolism (M.C.) Acute respiratory failure (especially in broncho pulmonary disease with hypoxic / hypercapnic pulmonary vasoconstrictions. ARDS Sepsis Acutely exacerbated chronic (left / biventricular) hea failure Acute inferior myocardial infarction involving the R.V.


Question: Skip lesions with tuberculoid granulomas is characteristic of


Question: Commonest site for ischemic colitis is

Ans is 'b' ie. Splenic flexure "Although splenic flexure is the most common site of ischemic colitis, any segment of colon may be affected. The rectum is relatively spared because of its rich collateral circulation." - Schwartz 9/eOther Commonly asked Commonest Sites*Crohn's ds* -Terminal ileum*Amoebic colitis* -Sigmoid colon*Typhoid ulcer* -Terminal ileum*Tuberculous ulcer* -Terminal ileum*Ulcerative colitis* -Rectum*Colonic diverticula* -Descending & Sigmoid colon*Gall stone ileus -Terminal ileum*Volvulus* -Sigmoid colon*Polyps in Peutz-Jeghers synd* -Jejunum*Peptic ulcer* -1st part of duodenum*Gastric ulcer* -Lesser curvature (Just beyond the junction of body & antrum)*Hirschsprung ds* -Rectum*Obstruction in meconium ileus* -Distal ileum*Bleeding in angiodysplasia* -Right colon*Colon Ca -Rectosigmoid (more specifically rectum)


Question: The most impoant single special investigation in lumbar disc prolapse is


Question: Best approach in thoracic trauma is

.Indications for thoracotomy * Haemothorax more than 1500 ml found when ICT is placed or hourly collection in ICT is 200- 300 ml * ICT placed shows persistent drainage of blood * Diaphragmatic injury * When associated with liver and spleen injuries * Bronchus and major vessel injuries * Haemopericardium * Oesophageal and thoracic duct injuries. ref:SRB&;s manual of surgery,ed 3,pg no 1061


Question: Gastrojejernostomy surgery belongs to

Clean contaminated surgery :

Wound is exposed to not only skin but also GI tract / Respiratory tract / Urinary tract organism in controlled enviroment.
Hence Gastrojejunostomy surjery belongs to this category.


Question: Nerve involvement in Frey&;s syndrome is

Auriculotemporal nerve. Frey's syndrome(gustatory sweating) results from damage to the autonomic innervation of the salivary gland with inappropriate regeneration of the postganglionic parasympathetic nerve fibres of the auriculotemporal nerve that aberrantly stimulate the sweat glands of the overlying skin. Reference : Bailey & love, 27th Edition, page no = 794


Question: Gleasons score is used for

Ans. is 'a' i.e., Prostate carcinoma Gleason score and grading system* Gleason score is the most commonly used histological grading system for prostate cancer.* The two most predominant histological patterns of the prostate cancer are assigned a Gleason grade ranging from 1-5.* Primary grade is assigned to the pattern of cancer that is most commonly observed in the histological slides of the specimen.* Secondary grade is assigned to the second most commonly observed pattern in the specimen.* Gleason score is the sum of the two grades. Thus it is also known as Gleason sum.* If the entire specimen has only one pattern present, then both the primary and sencondary grades are reported as the same grade.* As Gleason grades range from 1 to 5, Gleason score thus range from 2 to 10* The Gleason score is used to help evaluate the prognosis of men with prostate cancer. Together with other parameters, the Gleason score is incorporated into a strategy of prostate cancer staging which predicts prognosis and helps guide therapy.* A point of importance is that the primary Gleason grade is most important with respect to placing patients in prognostic groups. For example in patients with a Gleason score 7, a Gleason 4+3 is a more aggressive cancer than a Gleason 3+4.


Question: Actinomycosis most commonly affects

Facio - cervical Actinomycosis is most common type.


Question: Cock's peculiar tumour is

(Secondary to infected sebaceous cyst) (594-BaiIy & Love 25th)Cock's peculiar tumour - (Infected ulcerated sebaceous cyst)An infected cyst may discharge its contents. If an ulcerated surface remains, it can resemble an epithelioma, and to which the term 'Cock's peculiar tumour may be appliedALSO - REMEMBERS* MoIIuscum fibrosum - are polypoid or filiform soft flashy skin tags which occur on the neck trunk andface* Cylindroma (syn 'turban' tumour) - extensive turban like swelling over the scalp, relatively benign* Glomus tumour is seen in fingers (Subungual) role - thermal regulation* RANULA is a retension cyst of minor salivary glands transluscent bluish swelling in the floor of the mouth** Treatment - complete excision or marsupialization for large cystGLOMANGIOMA or Glomovenous malformation* Typical glomus tumour are sub categorized as solid glomus tumour, glomangioma & glomangiomyoma* Solid glomus tumour is the most common variety of glomus tumour* Glomangioma, comprises approximately 20% of glomus tumour are characterized by dilated veins surrounded by small clusters of glomus cells* Glomangioma occure more often during childhood are rarely subungual & are less likely to be painful or symptomatic* Most predominate on the hand and forearm*** Histologically they are usually poorly circumscribed, occasionally plaque like lesion that resemble cavernous hemangioma* Secondary thrombosis & phlebolith formation may occur in these lesions just as they would in an ordinary hemangioma* Hidradentitis suppurativa - is a chronic suppurative condition of apocrine gland (Modified sweat gland**) bearing skin which is found in the axillae, sub mammary regions, nape of the neck, groin, mons pubis, inner thigh & sides of the scrotum as well as the perineum & buttocks* Fordyce's spot's - are ectopic sebaceous glands*, which has no erythcmous halos & are found in the mouth of healthy individuals**. It is not a sign of internal malignancy* Miliaria - is a disorder that occurs as a result of either obliteration or disruption of the Eccrine sweat gland*** Milium - is a small sub epidermal keratin cyst that occurs in under developed sebaceous glandDercum's disease (Adiposis Dolarosa) - It is characterized by the presence of multiple circumscribed or diffuse painful sub cutaneous fat depositions on the trunk and limbs**, particularly near the kneeAcute Febrile Neutrophilic Dermatosis (SWEET'S SYNDROME)Characterized by, fever, neutrophilia, erythematous, tender papulo- nodulo- plaques and targetoid lesions with pseudo vesiculation. Common women following RTIAssociated with malignancy, AML, lymphoma, myeloma, myelodysplastic syndromes and solid tumours (primarily of the genitor-urinary tract) as well as drugs (cg-all- transretinoic acid)

Secondary to osteomyelitis of skull bones

Secondaries in skull bones from carcinoma thyroid


Question: A patient with distal gastric carcinoma, following procedure, is done. Name the procedure

In the above image, after distal gastrectomy Roux-en-Y reconstruction is done.In this anastomosis, the Roux limb is the efferent or antegrade limb that serves as the primary recipient of food after the surgery (Gastro-jejunostomy), while the hepatobiliary or afferent limb that anastomoses with the biliary system serves as the recipient for biliary secretions, which then travel through the excluded small bowel to the distal anastomosis at the mid-jejunum (Jejuno-jejunostomy)In Billroth I technique gastroduodenal anastomosis after distal gastrectomyIn Billroth II technique gastrojejunal anastomosis is donebailey and love 27e pg: 1136


Question: According to the Bismuth/Strasberg classification &; Cystic blow out&; is classified as

Strasberg classification  Class A: Bile leak from the cystic duct or an accessory duct showing continuity with the common bile duct  Class B: Section/injury of an accessory duct/sectorial ducts aberrant right hepatic duct with no continuity with the common bile duct with occlusion  Class C: Leak/open drainage from a sectorial duct/aberrant right hepatic duct with no continuity with the common bile duct  Class D: Paial section/lateral injury of an extrahepatric duct bile duct with no complete loss of continuity with the rest of the bile duct system  Class E: Complete section/circumferential injury of the bile duct with subtypes according to the length of the stump at various levels - E1- Stricture/injury at more than 2 cm distal to bifurcation. - E2 - Stricture/injury less than 2 cm distal to bifurcation. - E3 - Stricture/injury at bifurcation - E4 - Stricture/injury involving right and left hepatic ducts - E5 - Complete obstruction of entire bile duct Note: Only right and left paial injuries are not included in this classification SRB's Manual of Surgery, 4th Edition, pg. no. 708


Question: Abbey estender flap is based on

.abbey flap is used for lip reconstruction so it is based on labial aery


Question: Non absorbable suture material is


Question: Meniere's disease is characterized by

(Veigo, tinnitus and hearing loss) Ref: Dhingra, 5th edition,Page 51,111 Meniere's disease (Endolymphatic hydrops) Characterized by tetrad of symptoms Episodic veigo 2.Flactuating sensorineural hearing loss (more severe in lower frequencies) A sensation of aural fullness Tinnitus (low- pitched and roaring) Hennebe's sign and Tulio's phenomenon is present Diagnosis Normal intact tympanic membrance with negative fistula test Recruitment is frequently present Impedence auidiometry is normal and there is no tone decay Sensory neural hearing loss , Rinne test is positive ,ABC is reduced in affected ear and Weber's is Lateralized to the better ear Radiography of the mastoid will be normal as views of the internal audiotry meati BERA - reduced latency of wave V Most sensitive and diagnostic is Electrochochleography Treatment Medicaltreatment Surgicaltreatment . Reassurance,bedrest,salt restriction,a lowcaffinediet avoidanceof nicotine. . Diuretics,labyrinthinesedative . Vasodilators . Streptomycintherapyisgivenin bilateralcasesto inducethe labyrinthinedamage Indicationsevereincapacitatingveigooinnitusoo preventfuher deteriorationofhearing (i)Decompressionofendolymphaticsacandinseionofa shuntbetween themembranouslabyrinthandsubarachnoidspace (ii)Vestibularneurectomy (iii)Totaltransmastoidlabyrinthectomy-whichrelievesveigoinover90% ofpatients (iv)Sacculotomy(Fick'soperation) Medicaltreatment Surgicaltreatment . Reassurance,bedrest,salt restriction,a lowcaffinediet avoidanceof nicotine. . Diuretics,labyrinthinesedative . Vasodilators . Streptomycintherapyisgivenin bilateralcasesto inducethe labyrinthinedamage Indicationsevereincapacitatingveigooinnitusoo preventfuher

Veigo ear discharge, tinnitus and headache


Question: Most common complication of central venous line is catheterisation is

Central Venous Catheterisation:
Most common complication - Catheter related sepsis
Most dangerous complication - Pneumothorax


Question: A most common site for squamous cell ca. esophagus is

Distribution of Squamous cell Ca

Upper 1/3 - 10%
Middle 1/3 - 60%
Lower 1/3 - 30%


Question: Adder head appearance on I.V.P is seen in

Ans. (b) UreteroceleRef.: Bailey & Love 26th ed. /1285A ureterocele is a congenital saccular dilatation of terminal portion of the ureter. The most common presentation is that of urinary tract infection or uro-sepsis in children. Stasis of urine can lead to calculus formation. Some children may present with palpable mass due to hydro nephritic kidney .Cyst may prolapse into internal urethral opening causing obstruction to bladder outflow. This condition may remain unrecognized until adult life. Ureterocele is usually discovered on radiological examination or during endoscopy.


Question: Treatment of mucocele on lower lip


Question: Bilateral vestibular Schwannomas are associated with

(D) Neurofibromatosis Type 2# Central neurofibromatosis, or Neurofibromatosis type 2 (NF2), is a multisystem genetic disorder associated with bilateral vestibular schwannomas, spinal cord schwannomas, meningiomas, gliomas, and juvenile cataracts, with a paucity of cutaneous features (which are seen more consistently in neurofibromatosis type 1 ).> Although quite variable in its age of onset and severity of symptoms in affected individuals, NF2 is associated with significant morbidity and decreased life span. Furthermore, diagnosis in childhood is often difficult because of the absence of central nervous system (CNS) involvement at a young age.> Complications of NF2 may include the following: Unilateral or, frequently, bilateral vestibular schwannomas leading to tinnitus, hearing loss, and/or problems with balance Meningiomas, gliomas, ependymomas, and other cerebral, cerebellar, or spinal cord lesions that may result in neurologic deficits, seizures, and/or hydrocephalus Peripheral nerve schwannomas, mixed tumors, and, occasionally, neurofibromas Peripheral neuropathies Visually significant juvenile cataracts


Question: Earliest symptom of carcinoma rectum is

Early symptoms of rectal cancer # Bleeding per rectum # Tenesmus # Early morning diarrhoea Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1231


Question: Rodent ulcer is

Basal cell cancer Aka Rodent ulcer Locally invasive Destruction of surrounding tissues - Aka Tear Cancer Seen in face above the line joining ear lobule to angle or corner of mouth - Arises from Basal layer of epidermis - Most common site - Nose > Inner canthus Types of BCC (based on pathology) - Nodular MC type Classical sign- Central depression with umbilication - Pigmented - Cystic - Superficial Diagnosis - IOC for Dx - Wedge Biopsy Management - Wide Local Excision- If tumor is non-aggressive involving trunk or extremities - MOH'S micrographic surgery- If tumor is aggressive involving vital areas, cosmetic areas and recurrent


Question: The Most common type of imperforate anus is

(C) Anorectal agenesis # Imperforate anus> (The term is used as a well-recognised description. Strictly it should be 'agenesis' and 'atresia' of the rectum and anus.)> One infant in 4500 is born with an imperforate anus, or with imperfect fusion of the post-allantoic gut with the proctodaeum.> The condition is divided into two main groups: the high and the low, depending on whether the termination of the bowel is above or below the pelvic floor.> Low varieties are easy to diagnose and relatively simple to treat, and the outlook is good.> High varieties often have a fistula into the urinary tract together with a deficient pelvic floor, and are difficult to treat.# Low abnormalities:> Covered anus. The underlying anal canal is covered by a bar of skin with atrack running forwards to the perineal raphe. The track should be opened with scissors, followed by routine dilatation of the anus.> Ectopic anus. The anus is situated anteriorly and may open in the perineum in boys, or more commonly in the vulva in girls, or rarely into thevagina. A plastic 'cut back' operation isrequired (Pena).> Stenosed anus. The anus is microscopic, but careful examination usually reveals a minute opening which responds to regular dilatation.> Membranous stenosis. Here the anus is normally sited, but is covered with a thin membrane which bulges with retained meconium. It is rare, and an incision will cure the condition.# High abnormalities:> These are often associated with a fistulous connection between the blind rectal stump and the bladder, or other abnormalities of the pelvic structures.> Anorectai agnesis. A blind rectal pouch lies just above the pelvic floor -- its anterior aspect in the male is attached to the bladder and often there is a rectovesical fistula manifested by the passage of gas or meconium in the urine. In the female, the fistula is usually into the posterior fornix.> Rectal atresia. The anal canal is normal but ends blindly at the level of the pelvic floor. The bowel also ends blindly above the pelvic floor without a fistulous opening. This anomaly is rare but must be treated by mobilisation of the rectum and excision of the stricture. After that, end-to-end anastomosis of the anus and rectum must be attempted.> More conservative measures are followed by an intractable stricture.> Cloaca. This occurs only in females and here the bowel, urinary and genital tracts all open into a common wide cavity. Commonly severe malformations of the area are associated with other developmental abnormalities, e.g. tracheobronchial fistula.


Question: Sistrunk operation is preferred treatment for

Thyroglossal Cyst Congenital Age of presentation - 15-30 years Location Most common location- Subhyoid C/F Midline swelling in anterior pa of neck Thyroglossal cyst moves with deglutination Moves up on protrusion of tongue. Complications of Thyroglossal cyst- Infection - Abscess - if Incision and Drainage|Thyroglossal fistula (acquired condition due to I & D of abscess of thyroglossal cyst)- Increased risk of papillary carcinoma of thyroid Rx TOC - Sistrunk operation. The cyst passes body of hyoid bone - so excision is made Enbloc removal of central pa or body of hyoid bone + cyst.


Question: Structures pierced during pleural tapping are a/e


Question: Early postoperative complication of ileostomy

Ans. is 'd' i.e. Necrosis "Stoma necrosis may occur in the early postoperative period and usually is caused by skeletonizing the distal small bowel and/or creating an overly tight fascial defect. Schwartz 9/e pl031Stomal ComplicationsCategoryComplication EarlyLateStomaPoor locationProlapse RetractionStenosis Ischemic necrosisParastomal hernia DetachmentFistula formation Abscess formationGas Opening wrong endOffensive OdourPeristomal skinExcoriationParastomal varices DermatitisDermatoses Cancer Skin manifestations of inflammatory bowel diseaseSystemicHigh outputBowel obstruction NonclosureMay also develop as a late complication.Other complications are:DiarrheaUrinary tract calculiGallstonesImportant points about OstomiesAn intestinal stoma is an opening of the bowel onto the surface of the abdomen.Depending upon the clinical situation, a stoma may be temporary or permanent. It may be end-on or a loop.A temporary ileostomy often is used to "protect" an anastomosis that is at risk for leakage (low in the rectum, in an irradiated field, in an immunocompromised or malnourished patient, and in some emergency operations). In this setting, the stoma often is constructed as a loop ileostomy.A permanent ileostomy sometimes is required after total proctocolectomy or in patients with obstruction. An end ileostomy is the preferred configuration for a permanent ileostomy.Most colostomies are created as end colostomies rather than loop colostomies. The bulkiness of the colon makes a loop colostomy awkward for an appliance, and prolapse is more likely with this configuration.However, regardless of the indication for a stoma, placement and construction are crucial for function.A stoma should be located within the rectus muscle to minimize the risk of a postoperative parastomal hernia.It also should be placed where the patient can see it and easily manipulate the appliance.The surrounding abdominal soft tissue should be as flat as possible to ensure a tight seal and prevent leakage.The optimal position for an ileostomy is in the right lower quadrant.The most desirable position for a sigmoid or descending colostomy is usually in the left lower quadrant of the abdomen. However, if the patient is obese, it may be preferable to site the colostomy in the left upper quadrant so that it is visible to the patient and not trapped on the undersurface of a panniculus. If a distal transverse colostomy is planned, the left upper quadrant is usually the preferable site.The left colon should be used for a colostomy if possible; the distal transverse colon is also a reasonable choice. Proximal colostomies should be avoided, as they will combine the worst features of both a colostomy and an ileostomy: liquid, high-volume, foul-smelling effluent.Parastomal hernia is the most common late complication of a colostomy.Parastomal hernia is less common after an ileostomy than after a colostomy.Most common indication:According to Maingot's Abdominal Operations, the most common indication for an ostomy is Ulcerative colitis, followed by Colorectal cancer.Most common indication for ileostomy is Inflammatory bowel disease (Ulcerative colitis).The most common indication for a colostomy is colorectal cancer.


Question: Indication of liver transplantation

.In cirrhotic patients with HCC, total hepatectomy with ohotopic liver transplantation is required. Now it is found that even resection candidates will do better by transplantation than resection. But waiting period for transplantation is long. To bridge this waiting period for transplantation radiofrequency ablation, transaerial embolization, ethanol/acetic acid injections are used. Liver transplantation is the good surgical option for hepatocellular carcinoma. Liver transplantation may be beneficial for ascites in liver diseases. Ref: SRB&;s manual of surgery,3 rd ed, pg no 557


Question: Sistrunk operation used for

Ans. (a) Thyroglossal CystRef Sabiston 20th edition Page 1861* Sistrunk operation involves complete excision of the cyst in continuity with its tract, the central portion of the hyoid bone, and the tract interior to the hyoid bone extending to the base of the tongue


Question: Treatment of choice for pleomorphic adenoma

Treatment of Pleomorphic adenoma (or any benign lession of Salivary gland)

in Parotid → Superficial protidectomy
in other salivary glands → Excision of the affected gland.


Question: Recurrent prolapse of the rectum in children is treated by


Question: CSF otorrhoea is caused by

Ans is 'c' ie Fracture of petrous temporal boneC.S.F. otorrhea is seen in fracture (longitudinale) of temporal bone C.S.F. is seen in external and middle ears T/T -It usually ceases spontaneously surgical intervention is rarely needed. Antibiotics (Co-trimoxazole) is given as it us sensitive to bacter ious causing URTI and it can cross blood brain barrier.


Question: The most common cyst of the oral region is


Question: Veins involve in stomach varices are

The left gastric vein(or coronary vein) carries blood low in oxygen, tributaries derived from both surfaces of the stomach; it runs from right to left along the lesser curvature of the stomach, between the two layers of the lesser omentum, to the esophageal opening of the stomach, where it receives some esophageal veins ..so the coronary veins are involved in gastric varices.


Question: Best indication for testicular biopsy in a male is

"The testis biopsy is a useful adjunct in the infertility evaluation because it provides direct information regarding the state of spermatogenesis.............. This procedure is most useful in the azoospermic patient, in which it is often difficult to distinguish between a failure of sperm production and obstruction within the reproductive tract ducts. A testis biopsy allows definitive delineation between these 2 conditions and can guide further treatment options in azoospermic men " - Smith's Urology


Question: A 25 year old man presents with 3 days history of pain in the right lower abdomen and vomitings. patient's general condition is satisfactory and clinical examination reveals a tender lump in right iliac fossa. The most appropriate management in this case would be

Ans. is 'c' i.e., Oschner Sherren regimen


Question:
In case of sub condylar fracture, the condyle move
in


Question: Runt's disease is associated with

GVHD Robbins, 7 edition, Page 222 * Runt's disease: is a pathological condition in which cells from the transplanted tissue of a donor initiate an immunologic attack on the cells and tissue of the recipient Complications of small bowel transplantation: * Most of the moality after bowel transplantation is due to sepsis and multiorgan failure. * The risk of infection after small bowel transplantation is heightened by the additional requirements for immunosuppression in order to control graft rejection. * This accounts for the relatively high incidence of Lymphoproliferative disease (around 10%) observed in patients who have undergone small bowel transplantation. * Because of the large amount of donor lymphoid tissue transplanted Graft- Versus-Host Disease (GVHD) may occasionally be an added complication


Question: Most common cause of clicking


Question: Most reliable investigation in bladder rupture is


Question: Reduction of size and vascularity prior to thyroidectomy is done by

Ans. (a) Lugol iodineRef: Bailey and Love 26th edition Page 760* Lugol's Iodine: 10% Potassium Iodine+ 5% Iodide is used on last 10 days before surgery to make the gland firm and stronger and decreases the vascularity of gland


Question: In an emergency room an alcoholic patient enters with hematemesis. On examination he has ascites with splenomegaly and gynecomastia. Etiology is

Ans. (b) Portal hypertension due to alcholic cirrhosisRef: Sabiston 20th edition Page 1437* Clinical features and findings suggest that the patient is a known case of Alcoholic cirrhosis with portal hypertension.* So most common cause in him is Varices bleeding

Portal hypertension secondary to viral hepatitis

Portal hypertension due to Alcoholic cirrhosis


Question: Major mineral of the bone is

Hydroxyapatite Hydroxyapatite crystals are the major mineral of bone Hydroxyapatite (also k/a bone mineral) is the salt of calcium and phosphorus with the formula Calc(PO4)6(01)2. Structural composition of bone : Also know Bone has to be 50% mineralised to be visible on radiographs.


Question: Commonest cause of moality in Ivor Lewis operation

Ivor Lewis operation is done for esophageal carcinoma. It is a 2 stage operation, in which abdomen is opened first, closed and then thoracotomy is performed. As it involves esophago- gastric anastomosis, Major complication causing moality is anastomotic leak. Aggressive investigation for leak is mandatory in case of unexplained fever or clinical event. Reference: Bailey and love, 27th edition, page 1092,1093


Question: Colonoscopy as a part of screening is not needed in.

Ans. (a) MEN 2 syndromeRef Bailey and Love 27th edition, Page 1259* MEN2B syndrome is not associated with colorectal cancers.; FAR HNPCC, Cronkhite, Banayan, all these syndromes; have associated colorectal cancers.


Question: Feline Esophagus is

(A) Eosinophilic Esophagitis[?]Feline Oesophagus:Feline oesophagus also known as Oesophageal shiver, refers to the transient transverse bands seen in the mid and lower oesophagus on a double contrast barium swallow.The appearance is almost always associated with active gastro oesophageal reflux and is thought to be due to contraction of the muscularis mucosae with resultant shortening of the oesophagus and 'bunching up' of the mucosa in the lumen. In given image, there are numerous 1-2 mm radiolucent folds across the oesophagus. The folds are angled with respect to the center of the oesophagus in a "herringbone" pattern.The folds occur transiently:Feline oesophagus also known as oesophageal shiver, refers to the transient transverse bands seen in the mid and lower oesophagus on a double contrast barium swallow.The appearance is almost always associated with active gastro-oesophageal reflux and is thought to be due to contraction of the muscularis mucosae with resultant shortening of the oesophagus and 'bunching up' of the mucosa in the lumen.Radiographic features:The folds are 1-2 mm thick and run horizontally around the entire circumference of the oseophageal lumen. The findings are transient, seen following reflux and not during swallowing. The appearance is confined to the distal two-thirds of the thoracic oesophagus.Other Options[?]Diffuse Esophageal Spasm:Unknown etiologyNon-progressive dysphagia with solids & liquids & non-exertional chest pain that responds to nitroglycerin.Corkscrew on barium.Diagnosis by Manometry:Periodic occurrence of simultaneous high-amplitude contractions with intervening periods of normal peristalsis.Therapy transplant treatment: Rule out CAD, then medical management of reassurance, nitrates & CCBs.Botulinum toxin injection, surgery does not have an established role.[?]Radiation-Induced Esophagitis:Seen in up to 80% of patients receiving XRT to the chest.Use of cytotoxic chemo has an additive effect.Typically chest pain, dysphagia & odynophagia occur shortly after the initiation of therapy.Late stricture formation is a common complication.Usually self-limited, treatment is symptomatic.[?]Diagnostic Criteria for Eosinophilic Esophagitis:Esophageal dysfunction (clinical symptoms)>15 eosinophils in 1 high power field of 1 or more esophageal specimens.No response to proton pump inhibitor therapy up to 2 mg/kg/day or normal pH monitoring seen in the distal esophagus.


Question: Post operatively wound dehiscence occurs between

Wound dehiscence is disruption of any or all of the layers in a wound. Wound dehiscence most commonly occurs from the fifth to the eighth postoperative day when the strength of the wound is at its weakest.Risk factors in wound dehiscenceGeneralLocal MalnourishmentDiabetesObesityRenal failureJaundiceSepsisCancerTreatment with steroidsInadequate or poor closure of woundPoor local wound healing, e.g. because of infection, haematoma or seromaIncreased intra-abdominal pressure, e.g. in postoperative patients suffering from chronic obstructive airway disease, during excessive coughingRef: Bailey and love 27e pg: 297


Question: Bochdalek hernia occurs through

A hernia through foramen Bochdalek (through the pleuroperitoneal canal) (95% left-sided, only 5% right sided) * It is a commonest congenital diaphragmatic hernia. * This is a developmental defective condition, due to a failure of fusion of pleuroperitoneal canal leaving a direct communication between pleura and peritoneum on left side. This allows herniation of contents of the abdomen into the left side thorax. * Common content is a colon. Occasionally small bowel, stomach is the contents. * 80% cases do not have a hernial sac. Only 20% cases have got sac. Ref: SRB&;s manual of surgery,3 rd ed, pg no 1078


Question: Most radiosensitive testicular tumor is

Ans. a (Seminoma). (Ref. LB, 25th/1384)Radiosensitive tumors are seminoma, Ewing's sarcoma, Hodgkin's lymphoma, few gynaecological malignancies and medulloblastoma.Radiotherapy -is the treatment of choice for# Oral cavity, lip, tongue, cheek# Nasopharynx, Oropharynx and hypopharynx# Nasal cavity# Larynx# Skin cancers (except melanoma)# Cervix# Bladder (except Tl)# Testis - Seminoma# Hodgkin's disease - early disease# NHL - early disease# Medulloblastoma (following surgery)# Retinoblastoma# Astrocytomas (grade 3 and 4)Radiosensitivity of different tumorsHighly radiosensitiveModerately radiosensitiveRelatively resistantHighly resistantLymphomaSeminomaMyelomaEwing's sarcomaWilm's tumorsSmall cell lung cancerBreast cancerBasal cell carcinomaMedulloblastomaTeratomaOvarian cancerSquamous cell lung cancerRCCRectal carcinomaBladder carcinomaSoft tissue sarcomaCervical cancerMelanomaOsteosarcomaPancreatic Ca


Question: Most common nerve injured in face lift surgery is

Ans. is 'd' i.e., Frontal branch of facial nerve Nerve injury during facelift surgery Some sensory reduction after facelift surgery is considered a consequence and not a complication of facelift surgery. Care must be taken to avoid injury to the greater auricular nerve. The most commonly injured nerve is the frontal branch of the facial nerve.


Question: Induration of seminal vesicle is seen most oftenly in

TUBERCULOSIS OF THE PROSTATE AND SEMINAL VESICLES Tuberculosis of the prostate and seminal vesicles is rare and associated with renal tuberculosis. In 30% of cases, there is a history of pulmonary tuberculosis within 5 years of the onset of genital tuberculosis. Tuberculosis of one or both seminal vesicles may be found when examining a patient with chronic tuberculous epididymitis, no symptoms being referable to the internal genitalia. On rectal examination, the affected vesicle is found to be nodular. When the prostate is involved, rectal examination reveals nodules in one or both lateral lobes. Patients with tuberculous prostatitis usually present with the following: * urethral discharge; * painful, sometimes blood-stained, ejaculation; * mild ache in the perineum; * infeility; * dysuria; * abscess formation. Special forms of investigation Radiography sometimes displays areas of calcification in the prostate and/or the seminal vesicles. Bacteriological examina tion of the seminal fluid yields positive cultures for tubercle bacilli. Treatment The general treatment is that for tuberculosis. If a prostatic abscess forms, it should be drained transurethrally. Ref: 1475


Question: Traetment of breast cancer with pregnant lady in first trimester

1st trimester MRM (modified radical mastectomy) If axillary node is +ve then pregnancy is terminated; (MTP), chemotherapy is given Second trimester; MRM,Chemotherapy carefully Third trimester; MRM, After delivery, chemotherapy with suppression of lactation Ref; (page no; 561) 5th edition of SRB&;S manual of Surgery.

MTP followed by treatment according to protocol


Question: Commonly done treatment of single perforation of typhoid in ileum.

Ans. (a) Direct closureRef: Sabiston 20th edition, Page 1267Typhoid intestinal perforation:* Intestinal perforation occurs in 2% cases.* Typically, it is usually a single perforation in Peyer's patch areas* Simple closure is the treatment of choice* Multiple perforation occurs in 25% cases* In such cases of multiple perforations resection is done followed by anastomosis or exteriorization depending upon the case


Question: Surgical treatment of parotid tumor involving the deep lobe is

Answer- A. Total parotidectomy with facial nerve preservationThe primary treatment of salivary malignancies is surgical excision.For parotid tumors that arise in the lateral lobe, superficial parotidectomy with preservation of CN VII is indicated

Total parotidectomy with facial nerve sacrifise

Subtotal parotidectomy with facial nerve sacrifice


Question: The most common mechanism of perforation in appendix is

Appendicular Perforation Immediate appendectomy has long been the recommended treatment for acute appendicitis because of the presumed risk of progression to rupture The overall rate of perforated appendicitis is 25.8% Children <5 years of age and patients >65 years of age have the highest rates of perforation (45 & 51% respectively) Risk factors for Appendicular Perforation Fecolith Diabetes mellitus Immunosuppression Extremes of age Pelvic appendix Previous abdominal surgery It has been suggested that delays in presentation are responsible for the majority of perforated Appendices Appendiceal rupture occurs most frequently distal to the point of luminal obstruction along the anti mesenteric border of the appendix Rupture should be suspected in the presence of fever with a temperature of < 39% (102degF) and a WBC count of >18000 cells/mm3 MC bacteria isolated in perforated appendicitis : Bacteroides fragilis (80%) > E.coli (77%) Ref: Sabiston 20th edition Pgno : 1297


Question: Head & neck burn in children is

Berkow formula to estimate Burn size Body pa 0-1 year 1-4 years 5-9 years Head 19 17 13 Neck 2 2 2 Anterior trunk 13 13 13 Posterior trunk 13 13 13 Ref: Sabiston 20th edition Pgno :508


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

RADIOACTIVE IODINE (I131) THERAPY:

I131 is an effective agent for delivering high radiation doses to the thyroid tissue
It emits mainly beta radiation (90%), which penetrates only 0.5 mm of the tissue and thus allow therapeutic effects on the thyroid without any damage to the surrounding structures, particularly the parathyroids.

Mechanism of Action:

I131 emits beta particles and X-rays.
Beta rays are utilized for their destructive effects on thyroid cells.
X-rays are useful for tracer studies.


Question: Gold standard investigation for chronic pancreatitis

ERCP(Endoscopic retrograde cholangiopancreatography) is the most accurate way of elucidating the anatomy of duct and, in conjunction with the whole organ morphology, can help to determine the type of operation required. Reference : Bailey & Love, 27th Edition, page no = 1231


Question: A 40 year old female presents with fever, faigue, diffuse painful swelling in the midline of the neck, FNAC of the same reveals epithelioid cells and giant cells, the likely diagnosis is

Painful midline diffuse swelling in neck with fever and fatigue points to thyroiditis. In sub acute granulomatous thyroiditis (De Quervain&;s thyroiditis) there is the presence of multinucleated giant cells composed of epitheloid cells. De Quervain&;s thyroiditis : May follow a viral infection. In a typical subacute presentation, there is pain in the neck, fever, malaise and a firm, irregular enlargement of one or both thyroid lobes. Note : Gaint cells and epithelioid cells are seen in any granulomas, not just tuberculosis. Caseation is hall mark of TB granulomas. Source : Bailey and Love 26th edition Pg : 771


Question: Cavernous sinus thrombosis following infection of anterior maxillary teeth most often from spread of infection along


Question: Most common organ involved in blunt abdominal trauma is


Question: Moneteggia fracture is fracture of


Question: According to Johnson's classification prepyloric Plus duodenal ulcers is

TYPE
LOCATION

I
Lesser curve at incisura

II
Gastric body with duodenal ulcer

III
Prepyloric

IV
High on lesser curve

V
Anywhere


Question: Fibroadenoma of the breast are


Question: Most common cause of Foley catheter induced UTI

Ans. (a) E. coliRef Bailey and Love 26th Edition, Page 276* Urinary infection is the most commonly associated infection in postoperative period* Most common organism isolated in catheter related Infections: E. coli


Question: Typhoid ulcer ruptures at

C. i.e. (3rd week) (69- 5 B & L 25th) (995- S. Das 5th)* After the second week, signs of peritonitis usually denotes perforation, which is confirmed by the presence of free.gas seen on x-ray (69-.B & L 25th)* Perforation usually occurs during the third week it occurs through ulcerated peyer's patches in the terminal ileum (commonest site)** (995 - S-Das 5th)* Typhoid ulcer are longitudinal (Tuberculous ulcers are transverse)**** Treatment - laparotomy - close the peritoneum and leave the wound open for secondary closure* In typhoid, chronic carriers are those - Urinary carriers with anomaly*** Chronic burrowing ulcer is caused by - Microaerophilic streptococci**


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

.Treatment for abdominal injury includes, Emergency laparotomy. Indications includes * Frank haemoperitoneum * Significant diagnostic peritoneal lavage * Haemodynamically unstable patient * U/S or CT scan shows significant intra-abdominal injuries ref:SRB&;s manual of surgery,ed 3,pg no 124

Exploratory Laparotomy under general anesthesia

Inseion of abdominal drain followed by laparotomy


Question: Cleft lip surgery is earliest done at

Ref: Sabiston 20th edition Pgno : 1947 "Rule of 10s" by surgeon Wilhelmmensen and Musgrave Surgery is done in cleft lip in a child when Age >= 10 weeks Weight >= 10 pounds Hemoglobin >= 10 gm Management of cleft lip and cleft palate Surgical techniques are aimed at restoring normal anatomy Cleft lip Repaired between 3 and 6 months of age Cleft palate Repaired between 6 and 18 months


Question: A 35 year female comes with Size 5 cm tumour of the oral cavity + single lymph node of 2 cm diameter on the same side in the neck is staged as

TNM staging of oral cancer :
Tx : Cannot be assessed e.g. already excised.
T0 : No evidence of primary tumor (occult primary).
Tis : Carcinoma in - situ.
T1 : Equal to or less than 2 cm in greatest dimension.
T2 : More than 2 cm. bul less than or equal to 4 cm.
T3 : More than 4 cm.
T4a : Moderately advanced local disease :
Lip and check - involvement of cortical bone, skin, inferior alveolar nerve.
Tongue - extrinsic muscles, skin.
T4b : Very advanced local disease :
Check - involvement of masticatory space, base of skull, internal carotid artery.
Internal carotid artery.
TNM staging of cavity tumors. Status of lymph nodes 'N' :


Question: Metabolic abnormality seen in congenital hyperophic pyloric stenosis is

To control alkalosis, kidney secretes excess bicarbonate. Due to hyponatremia, body conserves sodium and so bicarbonate is secreted along with the hydrogen in. Urine becomes acidic and called as paradoxical aciduria Reference: SRB edition: 5th page no:830

Hypochloremic hypokalemic metabolic alkalosis

Hyperchlonemic hypokalemic metabolic alkalosis

Hypochloremic hypokalemic metabolic acidosis

Hyperchoremic hypokalemic metabolic acidosis


Question: Carcinoma thyroid localized and well differentiated, treatment consists of

The primary treatment of DTC (differentiated thyroid cancer) , is surgical ablation. The other mainstays of therapy are RAI ablation and TSH suppression. A patient diagnosed with PTC will undergo either total or near-total thyroidectomy as the preferred initial treatment. Therapeutic neck dissection is performed with initial thyroidectomy for patients with PTC with neck node metastasis. Adjuvant therapy includes postoperative TSH suppression with thyroxine therapy. If the patient is considered low risk, TSH levels are acceptable into the low range of normal. High-risk patients are often maintained at <=0.1 mIU/L. Postoperative radioactive abalation is reserved for patients with high-risk PTC or patients with a diagnosis of follicular or HCC (huhle cell cancer). External beam radiation therapy is used in patients with reccurrence or metastasis that is not amenable to surgery. Also is tried in patients with anaplastic carcinoma. Source : Devita Principles of Oncology 10th edition : Pg 1182

Subtotal thyroidectomy with external beam irradiation

Near total thyroidectomy, iodine, external beam irradiation

Total thyroidectomy, external beam radiation, life long eltroxin


Question: McNeal's peripheral Zone in prostate gland is the seat of

Carcinoma prostate arises from the peripheral zone in prostatic gland proper, commonly in posterior lobe. BPH arises from the submucosal glands of periurethral transitional zone. Reference : page 1044 and1048 SRB's manual of surgery 5th edition


Question: Best indicator to determine fluid required in hypovolemic patient is

Best Indicator to determine fluid required is PCWP


Question: Normal poal vein pressure is

Poal veins carries approximately 75% of blood supply to the liver, formed by the junction of the superior mesenteric and splenic veins behind neck of pancreas&;s Normal poal vein pressure is 5-10mmHg if there is sustained elevation in the poal venous pressure more than 10mmHg. Reference SRB edition :5 page:614