Question: Hypertrophic pyloric stenosis is characterized by

Ans. b (Metabolic alkalosis). (Ref. LB, 25th/79)Hypertrophic pyloric stenosis of infancy (CHPS)Aetiology# The incidence of this condition is approximately three cases per 1000 births.# In some cases there seems to be a familial association.# The mucosa is compressed such that only a probe can be inserted.Clinical features# Characteristically it is a first-born male child that is most commonly affected.# The condition is most commonly seen at 4 weeks after birth ranging from the third week to, on rare occasions, the seventh. Most commonly affects boys aged 2-8 weeks.# Characterised by projectile vomiting after feeds and Gastric peristalsis can be seen and a lump felt# Weight loss is a striking feature and rapidly the infant becomes emaciated and dehydrated.Imaging# Ultrasonography is the investigation of choice. Contrast radiology is not now necessary.Treatment# Following diagnosis the first concern is to correct the metabolic abnormalities. Essentially this is the same situation that pertains in adults with the patient being dehydrated, with low sodium, chloride and potassium, and a metabolic alkalosis. The child should be rehydrated with dextrose--saline and potassium (2.5 per cent dextrose plus 0.45 percent sodium chloride plus 1 g of potassium chloride per 500 ml of fluid). This will restore the infant's clinical condition and electrolytes to normal. Following this operation is required.# Ramstedt's operation is surgery of choice.


Question: Surgical ciliated cyst is often associated with surgeries of the


Question: The Most common cause of bleeding from nipple is


Question: Erythroplasia of Quegrat occurs in

Erythroplasia of Queyrat is Premalignant condition of Penile cancer.


Question: Secondary deposits from prostatic carcinoma is commonest in


Question: Hippocratic facies is seen in

Hippocratic facies--bright, hollow eyes; pale, pinched face; cold perspiration in eye brows; dry, fissured tongue; blue lips. Patient will be in severe shock. It signifies terminal status with high moality rate. It is a typical facial sign of severe end stage peritonitis.Reference : page 572 SRB's manual of surgery 5th edition


Question: Gardener&;s syndrome is a rare hereditary disorder involving the colon. It is characterized by

.GARDNER'S SYNDROME * It is commonly associated with FAP - 10%. * Presents with bone, skin, soft tissue and dental abnormalities. Jaw osteomas are very common. Other features are epidermoid cysts (50%), exostoses, fibromas, lipomas. * Associated with desmoid tumours seen in the scar, abdomen, intraabdominal region and mesenteric fibromatosis. * Congenital hyperophy of pigment layer of retina (seen as pigment spots)--commonly seen. * Often associated with MEN IIb syndrome. ref:SRB&;s manual of surgery,ed 3,pg no 834

Polyposis colon, Cancer thyroid, skin tumours

Polyposis is jejunum, pituaitary adenoma and skin tumours

Polyposis colon, osteomas, epidermal inclusion cysts and fibrous tumours in the skin

Polyposis of gastrointestinal tract, cholangiocarcinoma and skin tumours


Question: Best diagnosis of the ectopic gastric mucosa of Meckel's diveiculum is by

Plain abdominal radiography, CT, and ultrasonography are rarely helpful.In children, the single most accurate diagnostic test for Meckel's diveicula is scintigraphy with sodium 99mTc-peechnetate. The 99mTc-peechnetate is preferentially taken up by the mucus-secreting cells of gastric mucosa and ectopic gastric tissue in the diveiculum. The diagnostic sensitivity of this scan has been repoed as high as 85%, with a specificity of 95% and an accuracy of 90% in the pediatric age group.In adults, however, the sensitivity of 99mTc-peechnetate scan falls to 63% because of the presence of less gastric mucosa in the diveiculum compared with that noted in the pediatric age group.Sabiston 20e pg:1310


Question: The preferred bypass procedure in case of non resectable carcinoma of head of pancreas is

It is preferable to use bile duct rather than the gall bladder.Cholecystojejunostomy is easier to perform,but the bile must then drain through the cystic duct,which is narrow and ,if the cystic duct is inseed low into the bile duct,it is vulnerable to occlusion by tumour growth. Bailey & Love 26th edition ,page no.1140 .


Question: Murmur increasing with valsalva maneouvre aEUR'

HOCM EFFECT OF VARIOUS INTERVENTIONS ON SYSTOLIC MURMURS


Question: Most common presentation of peutz jegher syndrome is

Most common presentation of peutz jegher syndrome is intussusception. Mutation is STK 11 mutation.


Question: Catgut is preserved in

The catgut suture is supplied sterile in "pre-cut" lengths or non-needled or attached to various needle in packing fluid containing: o 90% Isopropyl Alcohol, o 0.5% Sodium Benzoate, o 0.5% Diethylethanolamine and o water q.s. ad 100%.


Question: Proteus organisms cause

(A) Struvite stones # STRUVITE STONE: A phosphate calculus is smooth and dirty white. It tends to grow in alkaline urine, especially when urea splitting Proteus organisms are present. As a result, the calculus may enlarge to fill most of the collecting system, forming a staghorn calculus.# TYPES OF RENAL CALCULUS:> Calcium oxalate calculus: Most common; they have hard, small and jagged surface> Uric acid and urate calculus: these are radiolucent> Cystine stones: uncommon, seen in cystinuria; appear only in acid urine; they are pink to yellow when first removed but they change colour to a greenish hue when exposed to air.> Xanthine calculi: are radiolucent; Most common symptom of renal calculi is Pain.


Question: Malignant cell in Hodgkin's lymphoma is

Reed-Sternberg cells (also known as lacunar histiocytes for ceain types) are distinctive, giant cells found with light microscopy in biopsies from individuals with Hodgkin's lymphoma (a.k.a. Hodgkin's disease, a type of lymphoma). They are usually derived from ,B lymphocytes classically considered crippled germinal center B cells, meaning they have not undergone hypermutation to express their antibody. Seen against a sea of B cells, they give the tissue a moth-eaten appearance. Reed-Sternberg cells are large (30-50 microns) and are either multinucleated or have a bilobed nucleus with prominent eosinophilic inclusion-like nucleoli (thus resembling an "owl's eye" appearance)


Question: The most malignant brain tumour is

(D) Glioblastoma multiforme # Glioblastoma multiforme (GBM), WHO classification name "glioblastoma", also known as Grade IV Astrocytoma, is the most common and most aggressive malignant primary brain tumor in humans, involving glial cells and accounting for 52% of all functional tissue brain tumor cases and 20% of all intracranial tumors.


Question: Most common presentation of trichobezoar is

Ans) a (Obstruction) Ref: Sabiston's textbook of surgery 18th editionTrichobezoars are concretions of hair, generally found in long-haired girls or women who often deny eating their own hair (trichophagy). Symptoms include pain from gastric ulceration and fullness from gastric outlet obstruction & occasional gastric perforation


Question: Fogay catheter is used for

Fogay catheter is used to remove thrombus in acute limb ischaemiaThe aery (usually the femoral), bulging with clot, is exposed and held in silastic vessel loops. Through a transverse incision, the clot begins to extrude and is removed, together with the embolus, with the help of a Fogay balloon catheter. The catheter, with its balloon tip, is introduced both proximally and distally until it is deemed to have passed the limit of the clot.The balloon is inflated and the catheter withdrawn slowly, together with any obstructing material. The procedure is repeated until bleeding occurs.Ref: Bailey and love pg: 955


Question: Reparative granuloma of jaw is treated by

Reparative granuloma of jaw is treated by curettage Giant Cell Reparative Granuloma Giant cell reparative granuloma is an apparently Reactive intraosseous lesion of the mandible and maxilla following trauma induced intraosseous hemorrhage and containing prominent giant cells Also known as central giant cell granuloma MC site : Anterior pa of mandible (2/3rd of cases) between the 2nd premolar and 2nd molar with extension across the midline 2nd MC site : Small bones of hands and feet Clinical features It is a disease of the young presenting as a painless swelling in the anterior jaw and Radiographically appearing as a lytic expansile lesion with a characteristic Tendency of reabsorbing the root of tips of adjacent unerupted teeth Treatment Curettage or local excision Recurrence rate : 22-50% Lesion Eradication typically does not require >2 excision Chemical cautery, electrocautery, cryotherapy, calcitonin, Interferon alpha and intralesional steroids are used for more aggressive and recurrent lesions Ref: medind.nic.in/ibn/t06/i4/ibnt06i4p677


Question: Little old lady's hernia is also know as


Question: Commonest site of a rodent ulcer is

Rodent ulcer is synonymous with basal cell carcinoma.
90% of basal cell carcinomas are seen in the face, above a line from the corner of mouth to the lobule of ear. The commonest site is around the inner canthus of the eye (also k/a Tear cancer).


Question: The most common complication seen in hiatus hernia is

Ans. is 'a' i.e. Esophagitis There are 4 types of hiatal herniaType I : Sliding hernia (most common type -- 70 - 80%)Type II : Paraesophageal or rolling herniaType III : MixedType IV : these hernias are distinguished by the presence of other abdominal viscera wihin the defect i.e. omentum, transverse colon.Type I or Sliding hiatal hernia- this is characterized by upward dislocation of the cardioesophageal junction into the posterior mediastinum.Type II or Rolling Paraesophageal hernia- the cardioesophageal junction is undisplaced the whole or pa of stomach herniates into the thorax immediately adjacent and to the left of the undisplaced cardioesophageal junction.- since the normally located gastroesophageal junction functions normally in most of these hernias, reflux is uncommon


Question: Pancreatitis caused bya) Ascending cholangitisb) ↑ed PTHc) CBD stoned) Alcohole) Starvation

Increased parathormone leads to hypercalcemia which can cause pancreatitis.


Question: Persistent urachus is a risk factor for

Sepsis, tuberculosis, adenocarcinoma of bladder can occur in patients with patent urachus. Patent urachus with urine leak signifies obstruction distal to bladder. Reference : page 1029 SRB's manual of surgery 5th edition


Question: Pseudoeschar formation is seen with

Pseudoeschar is thickened burnt skin due to repeated silver sulphadiazine application.


Question: Superolateral boundary of axillary dissection is

Lateral group of axillary nodes are present along axillary vein. Axillary dissection is the removal of fat, fascia, nodes in the axilla. Usually level 1 and level 2 nodes are removed. Nodes below the axillary vein are usually removed. so the superolateral boundary of axillary dissection is axillary vein. Dissection is done through an individual crease transverse inciaion in the axilla. Reference :SRB's Manual of Surgery, 6th Edition, page no = 543, 529.


Question: Alagille syndrome is

Alagille syndrome is an autosomal dominant genetic disorder affecting liver,hea,kidney,etc.Liver biopsy in Alagille syndrome shows too few bile ducts(bile duct paucity) or in some cases,the complete absence of bile ducts(biliary atresia).Bile duct paucity results in reduced absorption of fat & vitamins(A,D,E,K) which may lead to rickets/a failure to thrive in children.


Question: The posture associated with the greatest lumbar intradiscal pressure is

Nachemson's studies showed the lowest intradiskal pressure occurred with the patient supine, followed by the lateral decubitus position. Sitting produced higher intradiskal pressures than standing, and pressures were increased in both positions by flexion of the trunk. The highest pressures encountered were with the patient sitting with the trunk flexed.


Question: Watson criteria is used for


Question: Percentage of malignancy in duct ectasia is

Ans. (a) No risk(Ref. Schwartz 10th edition Page 511, Bailey 26th edition page 806)* The periductal mastitis mimics like cancer and hence mammography must be done.* Otherwise there is no risk of cancer in Duct ectasia


Question: The earliest manifestation seen after Gastrectomy


Question: Tensile strength of wound after laparoscopic cholecytectomy in a 30 years old Woman depends upon

"Covalent cross linking of the lysine residues provides tensile strength. The extent and type of cross linking vary from tissue to tissue. In tissues such as tendons, in which tensile strength is crucial, collagen cross linking is extremely high." Sabiston 26th edition Pg: 139


Question: A chronic wound may be defined as one that fails to heal by

A chronic wound may be defined as one that fails to heal in the expected time for a wound of that type, which is usually less than 3 weeks. Delays in healing can occur at any phase but most often occur in the inflammatory phase.Bailey and love 27e pg: 29


Question: The most common complication of intracapsular fracture neck of femur is


Question: Most common site for carcinoid tumor is

Carcinoid tumour 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 amines like 5- HT, 5-HIAA, 5-HTP; tachykinins, peptides (chromogranins)and PGs. It commonly occurs in appendix (45%), ileum (25%) and rectum (15%). Other (15%) sites are--other pas of GIT (including pancreas and biliary tract), bronchus and testis. Reference: page 877 SRB's manual of surgery 5th edition.


Question: In carcinoma of anus distal margin of clearance of anal canal of at least


Question: Saccular diveiculum of extrahepatic bile duct in choledochal cyst is classified as

Type 1b -saccular dilatation of extrahepatic biliary tree, Type 2-diveiculum of extrahepatic biliary tree Type 3-cystic dilatation of intraduodenal pa of CBD Type 4- dilatation of multiple pas of an extrahepatic biliary tree, dilatation of intrahepatic and extrahepatic biliary tree. Reference SRB edition 5. page637


Question: Ileocecal tuberculosis is associated with

.* Abdominal pain is the most common symptom (90%). It is dull in mesenteric type; colicky in intestinal type. * Common in 25-50 years age group. Equal in both sexes. * Anaemia,megaloblastic type , loss of weight and appetite (80%). * Diarrhoea--10-20%. * Fever--50-70%. ref:SRB&;s manual of surgery,ed 3,pg no 514


Question: The commonest cause of acute pancreatitis is

Major cause of acute pancreatitis is biliary calculi(50-70% of patients) A careful search of aetiology is must before labelling idiopathic and no more than 20% cases should fall into this category. Bailey & Love 26th edition,1127,1128.


Question: Treatment for benign tumor of superficial lobe is

All tumors of the superficial lobe of the parotid gland are treated by superficial parotidectomy.


Question: Treatment of anaplastic carcinoma of thyroid

Ans. (d) Total thyroidectomyRef: Bailey and Love page 770/ 26th editionManagement of Anaplastic Carcinoma Thyroid:* This tumor is one of the most aggressive thyroid malignancies, with few patients surviving 6 months beyond diagnosis.* All forms of treatment have been disappointing. If anaplastic carcinoma presents as a resectable mass, thyroidectomy may lead to a small improvement in survival, especially in younger individuals.* Combined radiation and chemotherapy in an adjuvant setting in patients with resectable disease has been associated with prolonged survival, although these agents are also being used in a neoadjuvant fashion.* Isthmectomy and Tracheostomy may be needed to alleviate airway obstruction.


Question: Most pathognomic in pelvic abscess is

Pelvic abscess is the most common intraperitoneal abscess(50-60%).It is the collection of pus in rectovesical / rectouterine poch (pouch of Douglas).The most characteristic features are diarrhoea & passage of mucopurulent discharge per rectum.Per rectal examination shows a soft,tender,boggy swelling in the anterior rectal wall which may burst into the rectum. Reference:Bailey & Love 's sho practise of surgery,25th edition,page no:996;SRB's manual of surgery,5th edition,page no:574


Question: Best diagnostic procedure for ant. Cruciate ligament injury is


Question: Normal value of ankle branchial index is

Ankle Brachial Index ABI= Systolic BP at the ankle/systolic BP in the arms Compared to the arm, lower blood pressure in the leg is an indication of blocked aeries (peripheral vascular disease) ABI is calculated by dividing the systolic blood pressure at the ankle by the systolic blood pressures in the arm ABI is calculated by dividing the systolic blood pressure at the ankle by the systolic blood pressures in the arm ABI Interpretation >1.2 Non-compressible, severely calcified vessel (in DM & ESRD) 1.0-1.2 Normal vessels 0.5-0.9 Intermittent claudication 0.1-0.4 Critical limb ischaemia( Ischaemic ulceration, gangrene) Ref: Sabiston 20th edition Pgno :1758


Question: Difficulty score for a mesioangular class II position C mandibular third molar is


Question: A patient with anterior dislocation of shoulder will most likely give a history of


Question: The substrate depleted earliest in the postoperative period is

The metabolic response to surgery (and other trauma) is a result of neuroendocrine stimulation that sharply accelerates protein breakdown, stimulates gluconeogenesis, and produces glucose intolerance. The glycogen stores are rapidly depleted because of a fall in insulin and a rise in glucagon levels in the plasma. The peripheral effects of the neuroendocrine secretion result in an increase in plasma levels of amino acids, free fatty acids, lactate, glucose, and glycerol. In the liver, the coisol and glucagon stimulate glycogenolysis, gluconeogenesis, and increased substrate uptake.


Question: Wolfe Graft is

Split-thickness skin graftsCalled Thiersch grafts. They are used to cover all sizes of wound, are of limited durability and will contract.Full-thickness skin grafts Called Wolfe graftsUsed for smaller areas of skin replacement where good elastic skin that will not contract is required (such as fingers, eyelids, facial pas).Ref: Bailey and love 27e pg: 636


Question: A patient with a non obstructing carcinoma of the sigmoid colon is being prepared for elective resection. To minimize the risk of postoperative infectious complications, your planning should include

Many clinical and experimental studies have looked at the optimum bowel preparation and preoperative regimen for elective colonic surgery to reduce the postoperative infectious complications of wound infection, intra-abdominal abscess, and anastomotic leakage. Currently a postoperative rate of wound infection of only 5% can be attained by combining mechanical cleansing, oral antibiotics, and perioperative parenteral antibiotics. Oral antibiotics may be administered one hour prior to surgery and should cover all anaerobes (e.g., neomycin-erythromycin), antibiotics effective against aerobes (e.g., cefoxitin) should be administered in the operating room as a single dose and not postoperatively. Both antibiotic regimens are for prophylaxis without fostering resistant against microbes.

A single preoperative parenteral dose of antibiotic effective against aerobes and anaerobes.

Avoidance of oral antibiotics to prevent emergence of clostridium difficile

Postoperative administration for 2 to 4 days of parenteral antibiotics effective against aerobes and anaerobes

Postoperative administration for 5 to 7 days of parenteral antibiotics effective against aerobes and anaerobes


Question: During insipiration the main current of airflow in a normal nasal cavity is through

* During quite respiration inspiratory air current pass through middle pa of the nose between the turbinatcs and nasal septum. * Very little air passes through inferior meatus or olfactory region of the nose. * Therefore weak odorous substances have to be sniffed before they reach olfactory area. * During expiration air current follows the same course as during inspiration but the entire air current is not expelled directly through the nares. * Friction offered at lumen nasi conves it into eddies under cover of inferior and middle turbinates and this ventilates the sinuses through the Ostia

Middle pa of the cavity in middle meatus in a parabolic curve

Lower pa of the cavity in the inferior meatus in a parabolic curve

Superior pa of the cavity in the superior meatus


Question: Gene responsible for FAP is located at

Familial adenomatous polyp(FAP) is inherited as an autosomal dominant neoplastic condition (chromosome 5q21). It has a high potential for malignant transformation. It presents in younger age group- 15-20 yrs; equal in both sexes. It commonly involves the large intestine but can also occur in stomach, duodenum and small intestine. Reference : page 899 SRB's manual of surgery 5th edition


Question: For extra oral maxillary nerve block the target area is


Question: Indications for fine needle aspiration in liver abscess are

Indications of fine needle aspiration in liver abscess are - in case of large abscess (>10cm), infected abscess, failure of drug therapy, large left lobe abscess, seronegative, abscess in pregnancy where drug therapy cannot be used. Reference :SRB edition 5 ,page no.599


Question: In cryptorchism histological changes appear in testis


Question: Splenosis means

• Splenosis or regeneration of miniscule splenic remnants in the peritoneal cavity
• May be encountered in cases of traumatic rupture where splenic tissue disseminates throughout the peritoneal cavity.

Rupture of spleen and distribution of its tissue on peritoneum


Question: A female is presented with a breast lump of size 20 cm with no lymphadenopathy no metastasis. Her TNM staging would be

T0 - No evidence of primary T1 - Tumor less than 2cm T2 - Tumor of size 2-5cm T3 - Tumor greater than 5cm in greater dimention. T4 - Any tumor with direct extension to chest wall or skin or both. T4a is tumor extending to chest wall while T4b is tumor infiltrating the skin and T4c is tumor showing both chest wall and skin extensions. T4d is inflammatory carcinoma. N0 means no regional lymph nodes. M0 means no metastasis So here the staging is T3N0M0. Reference : SRB's Manual of Surgery, 6th Edition, page no = 532.


Question: Peaud' orange develops due to

(Lymphatic obstruction) (837-LB) (839-B & L 25th)Phenomena resulting from lymphatic obstruction In advanced breast cancer(i) Peaud's orange (ii) Cancer-en-cuirasse (iii) LymphangiosarcomaPeaud' orange - is due to cutaneous lymphatic oedema, where the infiltrate skin is fethered by the sweat ducts, it cannot swell leading to an appearance like orange skin. Occasionally the same phenomenon is seen over a chronic abscess


Question: Dye used in chromoendoscopy for detection of cancer

Chromoendoscopy is an endoscopic technique that uses stains during endoscopy to highlight differences in mucosa, as well as dysplastic and malignant changes that are not apparent in white light. Chromoendoscopy has been used in the evaluation of Barrett esophagus, esophageal adenocarcinoma, gastric metaplasia and adenocarcinoma, colon polyps , colon cancer, and surveillance in inflammatory bowel disease. Common staining agents used are Lugol solution, methylene blue (gastric metaplasia & carcinoma ), toluidine blue, crystal violet, indigo carmine, congo red, and phenol red.


Question: A tumor arising in a burns scar is likely to be

Tumor rising from burns scar is marjolins ulcer Marjolin&;s ulcer refers to an aggressive ulcerating squamous cell carcinoma presenting in an areas of previously traumatized,chronically inflamed, or scarred skin.


Question: Tensile strength of wound becomes normal after

Scar will continue to mature for one to two years. The maturation of collagen(TYPE III to TYPE I) leads to increase in tensile strength in the wound which is maximal at 12th week post injury and represents approximately 80% of uninjured skin strength. Bailey and Love 27th edition Pg: 25


Question: Leriche syndrome is caused in

Leriche&;s syndrome involves the blockage of the abdominal aoa as it transitions into the common iliac aeries.Aooiliac obstruction is characterized byClaudication in buttocks, thighs and calvesFemoral and distal pulses absent in both limbsBruit over aooiliac regionImpotence (Leriche)Ref: Bailey and love pg: 944


Question: A patient is presented with a gunshot wound on 4th intercostal space producing pneumothorax. The suction pressure needed for drainage is

Traumatic Pneumothorax Traumatic pneumothoraces can result from penetrating injuries and non penetrating chest trauma. Traumatic pneumothoraces should be treated with tube thoracotomy unless they are very small Iatrogenic pneumothorax is a type of traumatic pneumothorax that is becoming more common Leading cause are transthoracic needle aspiration,thoracocentesis and the inseion of central intravenous catheters Most can be managed with supplemental oxygen or aspiration (presure should be about 20 cmH2O), but if these measures are unsuccessful, a tube thoracostomy should be performed. Ref: Bailey and love 27th edition Pgno : 366


Question: Lady with recent delivery engorged shiny mass on breast under nipple fever

Answer- A. Breast abscessFeaturesouringbreastabscess :Lactating womanTender swellingPyreiaTense shiny overlying skin


Question: Rigler's triad doesn't include

Rigler's triad is a combination of findings on an abdominal radiograph of people with gallstone ileus, a condition where a large gallstone causes bowel obstruction.it consists of
(a) Small bowel obstruction,
(b) a gallstone outside the gallbladder
(c) air in the bile ducts(pneumobilia).


Question: Infection in burns is most commonly due to

Infection in burns is most commonly due to Beta - hemolytic streptococci.


Question: Carcinoma that doesnot arise from thyroid follicles

Medullary carcinoma thyroid arise from parafollicular &;C&; cells. 20-30% of these occur in familial basis as pa of MEN 2A and MEN 2B syndromes Papillary, follicular and anaplastic carcinomas arise from follicular cells Huhle cell crcinoma is a subtype of follicular carcinoma and has more aggresive biological behaviour, compared to other follicular carcinomas of thyroid.


Question: Inflammatory bowel disease found in children

.ULCERATIVE COLITIS * It is an inflammatory condition of rectum and colon of unknown aetiology perhaps related to stress, westernized diet, autoimmune factor, familial tendency, allergic factor. * Disease commonly stas in the rectum, spreads proximally to the colon and often into the ileum as back wash ileitis (5%). * More common in females (2:1), begins in 3rd decade. Watery diarrhoea, mucus or blood stained discharge per rectum. * Colicky pain, spasms. * Decreased appetite and loss of weight. * Relapses and remissions at regular intervals. ref:SRB&;s manual of surgery,ed 3,pg no 824


Question: Etiology of bloody discharge from nipple

blood stained nipple discharge is obtained in case of duct ectasia,duct papilloma,or carcinomaother nipple discharges of pathological impoance are clear serous discharge and black,greenish discharge. Bailey and Love'sSho practice of surgery.Edition 23.Pg no:753


Question: Variant of papillary carcinoma thyroida) Medullaryb) Warthinc) Columnar celld) Insulare) Diffuse sclerosing


Question: Adult polycystic kidney is inherited as


Question: The water shed area in the marginal aery of Drummond is at

Answer- C. Splenic flexureThe blood supply of colon is derived from the marginal aery of Drummond.It is a paracolic anastomotic aery formed by anastomosis between colic branches of superior mesentric aery ileocolic, right colic, middle colic) and colic branches of inferior muentetic aety (left colic and sigmoidal aeries),

Junction of proximal 2/3rd and distal 1/3' of transverse colon

Junction of Ascending and transverse colon


Question: The Reynoldis pentad of fever, jaundice, right upper quadrant pain, septic shock and mental status change in typical of

Reynold's pentad of acute obstructive cholangitis (suppurative cholangitis-5%)include persistent pain,persistent fever,persistent jaundice,shock(toxicity) & altered mental status.Here,biliary tree contains pus.It usually develop secondary to choledocholithiasis. Reference :SRB's manual of surgery,5th edition,page no:651.


Question: As the thickness of split skin graft increases

The thicker the dermis that is taken -Fewer but brisker bleeding points on the donor site The more durable will be the graft once healed (although it might take longer and require more care), Also more difficult will be donor site healingThicker grafts heal with less contracture Bailey and love 26e pg: 403

More the wound contracture at recipient site


Question: Most common cause of bleeding for massive hemothorax in blunt trauma to chest is from

Answer- A. Intercostal vesselsThe most common cause of massive haemothorax in blunt injury to chest is continuing bleeding from torn intercostal vexels or occasionallyfrom the internal mammary aety.


Question: Most common biochemical abnormality in congenital pyloric stenosis.

Ans. is 'd' i.e. Hypokalemic metabolic alkalosis Repeated vomiting leads to hypochloremic, hypokalemic metabolic alkalosis. The urine is alkaline initially but eventually it becomes acidic (paradoxical aciduria)


Question: Most specific antibody seen in RA

Answer- A. Anti CCPThe presence of serum anti-CCP antibodies has about the same sensitivity as serum RF for the diagnosis of RA.However, its diagnostic specificity approaches 95% (most specific for RA), so a positive test for anti-CCP antibodies in the setting of an early inflammatory ahritis is usefrrlfor distinguishing RA from other forms of ahritis.


Question: Fracture of femur at the level of isthmus is best treated by


Question: Follicular carcinoma of thyroid is best treated by


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

Examination of CTEV(Clubfoot) Normally the foot of a newborn child can be Dorsi flexed until the dorsum touches the anterior aspect of the shin of the tibia. This is a good screening test for detecting milder variety of club foot. Classic findings Bilateral foot deformity in 60% cases Size of the foot smaller Foot is in equinis, varus and adduction. This can be judged by the Inability to bring the foot in the opposite direction. In late cases in addition cavus of the foot may also be present Heel is small in size, the calcaneum may be felt with great difficulty Deep skin creases on the back of the heel and on the medial side of the sole Bony prominences felt on the lateral side of the foot, the head of the talus and lateral malleolus Outer side of the foot is gently convex. There are dimples on the outer aspect of the ankle. Ref: Textbook of ohopaedics, Maheshwari and Mhaskar 6th edition pgno:212


Question: Sialosis refers to

Sialosis refers to enlargement of salivary gland due to fatty infiltration, as a result of various metabolic causes like diabetes, acromegaly,obesity,liver disease,alcoholism,bulimia,idiopathic,drug induced(sympathomimetics,carbimazole,thiouracil) SRB,5th,409


Question: In fracture of femur popliteal aery is commonly damaged by

B i.e. Distal fragment lit fracture supracondylar femur, the distal fragmentQ is markedly displaced by gastrocnemius, thus risking to the popliteal aery.


Question: Two most important clinical features of primary biliary cirrhosisa) Generalized pruritusb) Jaundicec) Fatigued) Clubbinge) Hematemesis

• MC indication for LT: Cirrhosis from Hepatitis C (HCV)
• 2nd MC indication for LT: Alcoholic liver disease
• MC indication for LT in children: Biliary atresia
• MC metabolic disorder requiring LT: Alpha-1 antitrypsin deficiency
• MC indication for LT following acute liver failure: Acetaminophen toxicity
• Sepsis and sepsis-induced multiple organ failure are the MC causes of death in liver transplantation.


Question: Site of transplantation in Islet cell transplant for diabetes mellitus

• The islets are then purified from the dispersed tissue by density-gradient centrifugation and can be delivered into the recipient liver (the preferred site for transplantation) by injection into the portal vein.


Question: Drug approved for advanced prostate cancer

Drugs used in advanced prostate cancer are : *LHRH agonists ( medical castration ) - leuprolide, goserelin *Phosphorylated diethylstilbestrol *Androgen receptor blocking agents like flutamide, bicalutamide *Cyproterone acetate (also has progestogenic effect ) Ganirelix, cetrorelix and abarelix are GnRH antagonists Reference : page 1050 SRB's manual of surgery 5th edition


Question: Psuedoaneurysm in I.V.drug abusers is commonly found in

Pseudoaneurys Most common cause : Trauma (penetrating trauma or iotrogenic by catheterization) MC aery involved : Radial aery Treatment Ligation is the optimal treatment for infected pseudoaneurysm because it is easy, safe and cost effective (in IV drug abuser there is high chance of infection) RReconstruction is not recommended because of extension of infection at location of pseudoaneurysm and at aificial graft site Ref: Rutherford vascular surgery 6th edition pvolume II Pgno : 248-249


Question: An itching wound suggests a


Question: Posterior right subhepatic intraperitoneal space is

Posterior right subhepatic intraperitoneal space is called morrison&;s pouch. Morison&;s pouch is the space that separates the liver from the right kidney. As a potential space, the recess is not filled with fluid under normal conditions. However, fluid can collect in this space in circumstances where the abdomen fills with fluid, such as hemoperitoneum Its one of the four regions seen in FAST scan


Question: This has increased risk of

This is a cutaneous horn. Actinic (solar) keratoses (AK), i.e. cutaneous horns and keratoacanthomas, were considered to be premalignant lesions leading to SCC. Ref: Bailey and Love, 27e, page: 606


Question: Best treatment of 3 weeks old, fracture shaft femur with nonunion is

A i.e. Bone grafting with internal fixation


Question: Mechanical bowel obstruction is differentiated from paralytic ileus in X rays by

Answer: a) Absence of rectal gas shadow (BAILEY 26th ED, P-1189)INTESTINAL OBSTRUCTIONProximal small bowelDistal small bowelLarge bowel* Vomiting early and profuse* Minimal distension* Colicky pain* Peristalsis not seen* Little evidence of air fluid levels in X-ray* Pain - intermittent, colicky* Central distension* Vomiting delayed (bilious)* Step ladder peristalsis* Multiple air fluid levels* Pronounced early distension* Pain is mild* Vomiting (faeculent) and dehydration are late* Right to left peristalsis may be seen* Proximal colon and caecum are distended on X-rayJejunum - Concertina or ladder effect due to valvulae conniventes (Herring bone pattern)Fluid levels appear later than gas shadowThree inconstant fluid levels in adults (considered normal)Fundus of stomachDuodenal capTerminal ileumFew fluid levels in the small intestine may be physiological in infants less than 1 yearFluid levels in non obstructive conditions (Inflammatory bowel disease, Acute pancreatitis, Intraabdominal sepsis)PARALYTIC ILEUSFailure of transmission of peristaltic waves secondary to neuromuscular failureIntestinal obstruction/slowing/absence of passage of luminal contents without a demonstrable mechanical obstructionEtiologyPost operativeA degree of ileus usually occurs after any abdominal procedureSelf-limiting (24-72 hours)May be prolonged in Hypoproteinemia or metabolic abnormalityIntra-abdominal inflammation(peritonitis, abscess, retroperitoneal hemorrhage)Reflex ileus: following fractures of spine/ribs, retroperitoneal hemorrhage or application of a plaster jacketMetabolic & electrolyte derangements (uremia, hypokalemia, hyponatremia, hypo and hypomagnesemia, diabetic coma, hypoparathyroidism, hypothyroidism)Drugs (opiates, psychotropic agents, anticholinergic agents, calcium channel blockers)Intestinal ischemia; Myocardial infarction; Ureteric colicClinical featuresAbdominal distension usually without colicky abdominal painNausea, vomiting, absent bowel sounds and absolute constipationNo passage of flatusIn the absence of gastric aspiration, effortless vomiting may occur X-Ray: gas filled small and large bowel loops with multiple air fluid levelsTreatmentNasogastric decompression, IV fluids, electrolyte managementTreat the underlying causeCatchpole regime: adrenergic blocking agent + cholinergic stimulant (neostigmine) used in resistant casesParalytic ileusMechanical Obstruction* Generalized, uniform, gaseous distension of the large and small bowel* Diffuse air fluid levels* Involvement of large bowel and lack of a transition point* Quiet abdomen* Dilated loops of small bowel proximal to the obstruction; no air in colon* Step ladder air/fluid levels* Transition point seen* Valvulae conniventes are visible in jejunum (concertina or ladder effect)* Featureless ileum* Initially active peristalsis; later quite


Question: Luxatio erecta

B i.e. Inferior dislocation of shoulder Inferior (downward/ sub- glenoid) dislocation of shoulder is known as luxatio erectaQ.Inferior Dislocation of Shoulder* It is caused by severe hyper abduction force. With the humerus as the lever and acromian as fulcrum, the humeral head is lifted across the inferior rim of glenoid socket and pokes into axilla (subglenoid position).* It is rare and also called luxatio erecta because the humeral head is subluxated (dislocated inferiorly and humerus shaft points upwards (erected).* The staling picture of a patient with his / her arm locked in almost full abduction/ elevation(2, should make diagnosis quite easy. The patient comes with his arm fixed almost by the side of his head.* Potentially serious consequences eg neurovascular damage is quite common.* Reduced by pulling upwards in the line of abducted arm with counteraction downwards.


Question: A cold nodule in thyroid scintiscan mean

Nodule which is nonfunctioning & malignant

Nodule which has no signs of inflammation


Question: The common presentation of duct papilloma of the breast is

True polyps of epithelium lined breast ducts Benign and not precancerous Solitary and located under areola Less than 1 cm in size and can grow up to 4-5 cms Most common presentation is bloody nipple discharge
Treatment - excision of duct along with tumor known as duct excision


Question: Commonest symptom of pheochromocytoma is

Ans. is 'b' i.e., Headache Hypeension is the most common symptom of pheochromocytoma followed by headache > Sweating > Palpitation.


Question: The most common type of supracondylar fracture is


Question: Characteristic feature of malignant gastric ulcer seen on Barium meal

Radiological features of Benign gastric ulcer Collection of barium on dependent wall Round, oval, linear in shape with a ring shadow May project beyond the gastric lumen Hampton's line- a thin lucent line crossing the ulcer base Ulcer collar- thicker smooth rim of lucency at the ulcer base Ulcer mound- with increasing edema, symmetrically gently sloping mass can be seen. Features suspicious for malignancy Location within fundus or proximal half of greater curvature Incomplete healing Loss of mucosal pattern Carmen meniscus sign- characterized by lentiform shaped appearance of inner margin.


Question: Ileal obstruction due to round worm obstruction treatment is

If the bowel wall is healthy, enterotomy and removal of the worms may be performed Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-53

Enterotomy, removal of worms and primary closure


Question: Treatment of Anal canal stage 2 is

AJCC staging for anal canal cancers is based on the size of the tumor and local invasion of adjacent organs or structures.A tumor that is 2 cm or smaller is designated T1, larger than 2 cm but not more than 5 cm is T2, and larger than 5 cm is T3. Any size tumor that invades a local structure is designated T4. Staging of disease includes CT of the chest, abdomen, and pelvis and pelvic MRI. Positron emission tomography scanning should be considered for larger (T2 or greater) tumors or any node-positive disease. HIV testing and checking a CD4 count should also be considered if indicated. Historically, treatment consisted of surgery alone or radiation therapy alone. Epithelial or subepithelial tumors were locally excised, and more advanced lesions underwent APR. The introduction of multimodality therapy combining chemotherapy andradiation therapy promised to preserve continence, to avoid colostomy, and to offer similar or improved survival. Nigro was the first to promote radiation therapy with chemotherapy as definitive treatment for squamous cell cancers of the anal canal. The current protocol includes infusional 5-FU with mitomycin C and external beam radiation to the pelvis with a minimum dose of 45Gy. The inguinal nodes, pelvis, anus, and perineum should be included in the radiation fields. Patients with T2 lesions and residual disease after 45 Gy, T3 or T4 tumors, or node-positive disease are usually treated with an additional 9 to 14 Gy for a total dose of 54 to 59 Gy. In patients treated with APR for persistent or locally recurrent disease, 5-year actuarial survival is repoed at 57%.46 Despite high success rates with definitive chemoradiotherapy, 15% to 30% of patients will have recurrence or fail to respondcompletely.47 Patients with persistent disease up to 6 months after treatment generally require APR. Those who have local recurrence are also recommended for APR. In the setting of isolated inguinal node recurrence, groin dissection is generally required with consideration for radiation therapy to the inguinal node basins if no prior radiotherapy was given. Up to 50% of patients treated with salvage APR can expect a 5-year cure. This is compared with approximately 27% of patients treated with salvage radiation and concurrent cisplatin-based chemotherapy who can expect cure. In those patients presenting with anal squamous cell carcinoma in the setting of HIV infection, disease severity (CD4 count and use of antiretroviral therapy) has a significant impact on success of standard chemoradiation. The current consensus is that standard protocols for chemoradiotherapy should be attempted, regardless of HIV status, and that medical management of the patient's HIV infection be optimized. The 2-year survival rates for HIV-positive patients have been repoed to be the same as for HIV-negative patients, 77% and 75%, respectively Ref: Sabiston 20th edition Pg no : 1415


Question: Degree of burns in a patient with blister formation is

Blisters are formed when only papillary dermis is destroyed.


Question: Burkitt's Lymphoma commonly affects


Question: Best surgery for grade IV hemorroids

Stapled hemorroidopexy is surgery of choice for grade IV hemorrhoids.


Question: The Least common quadrant in cancer breast is

Ans. (d) Lower inner(Ref: Bailey and Love Principles and Practice of Surgery, 26th ed p-811)* MC site - Upper outer* Least Common - Lower Inner


Question: Most common cause of hemobilia is

Hemobilia is bleeding commonly from the liver or occasionally from the gallbladder into the biliary tract.Accidental trauma,iatrogenic trauma (50%) is the most common cause.In accidents,Hemobilia is more commonly caused by blunt trauma than penetrating one.Other causes include Vascular diseases of hepatic aery,malignant and benign liver diseases,poal hypeension,parasitic liver diseases,etc. Reference:SRB's manual of surgery,5th edition,page no:662


Question: The most common malignancy found in Marjolin&;s ulcer is

Marjolin's Ulcer Low grade SCC, which develops on a chronic benign ulcer or a long standing scar tissue Arises from the edge of the ulcer. Marjolin's ulcer may develop in Post burn scar Long standing venous ulcer Chronic ulcer due to trauma. Chronically discharging osteomyelitis sinus Post - radiation ulcer Ref: schwaz's principle of surgery 10th edition Pgno :259


Question: The most common dislocation of TM] is


Question: Treatment with herceptin in breast cancer is indicated for

Treatment with herceptin in breast cancer is indicated for Tumours with over-expressed C-erb B-2 protein it is a inhibitor of C-erb B-2 protein, which is a growth factor receptor also known as Transtuzumab it is currently approved by FDA for use only in metastatic disease ref ;(page no;551) 5th edition of SRB&;S Manual of SURGERY


Question: Mainstay treatment of primary hyperparathyroidism is

The mainstay of treatment for PHPT is surgery. All symptomatic patients and asymptomatic patients with bone resorption or hypercalcemia are offered surgical intervention.Where a single adenoma ie one gland) has been confidently identified by radiological means, a minimally invasive parathyroidectomy may be offered. Else a three and a half-gland parathyroidectomy or a four gland parathyroidectomy and autotransplantation should be performed.All other options are pa of medical management.Medical management is warranted in patients who are deemed unfit or who have contraindications to surgical intervention, in patients with failed surgical intervention or in the long-term management of parathyroid carcinoma.Ref: Bailey and Love 27e pg: 829


Question: Reactionary hemorrhage is hemorrhage after surgery that occurs


Question: Gold standand for diagnosis of carotid body tumour is


Question: Blunt injuries to the abdomen

Ans. is 'b' i.e., Rarely need urgent laparotomy Non operative treatment is the rule rather than exception Schwaz writes- "Over the past 20 years there has been a remarkable change in management practices and operative approach for the injured patient. With the advent of CT scanning, nonoperative management of solid organ injuries has replaced routine operative exploration. Those patients who do require operation may be treated with less radical resection techniques such as splenorrhaphy or paial nephrectomy. Colonic injuries, previously mandating colostomy, are now repaired primarily in viually all cases. Additionally, the type of anastomosis has shifted from a double-layer closure to a continuous running single-layer closure; this method is technically equivalent to and faster than the interrupted multilayer techniques. Adoption of damage control surgical techniques in physiologically deranged patients has resulted in limited initial operative time, with definitive injury repair delayed until after resuscitation in the surgical intensive care unit (SICU) with physiologic restoration. Abdominal drains, once considered mandatory for parenchymal injuries and some anastomoses, have disappeared; fluid collections are managed by percutaneous techniques."


Question: Treatment of choice of flail chest chest is

External fixation of flail segment and mechanical ventilation


Question: Transitional cell carcinoma is seen in

Ans. (d) Urinary bladderRef: Bailey & Love 26th ed. /1330-35* Transitional cell epithelium lines -> the urinary tract from the renal pelvis to the ureter, urinary bladder, and the proximal two-thirds of the urethra.* Transitional cell carcinoma-Cancers can occur at any point mentioned above:# 90% of malignancies develop in the bladder# 8% in the renal pelvis# 2% in the ureter or urethra.Salient features about urothelial tumors* Bladder cancer is the fourth (4th) most common cancer in men and the thirteenth (1 +3=4) in women.* Among urothelial tumors-95% are transitional cell in origin.* Others are- Pure squamous cancers with keratinisation constitute 3%, adenocarcinomas 2%, and small cell tumors (often with paraneoplastic syndromes) <1%. Adenocarcinomas* Polychronotropism -urothelial tumors exhibit polychronotropism, which is the tendency to recur over time in new locations in the urothelial tract.* Most imp risk factor- Cigarette smoking* Other- aniline dyes, drugs phenacetin and chlornaphazine, external beam radiation. Chronic cyclophosphamide ,Schistosoma haematobium(a parasite-cause both see and tcc)* Vitamin A - protective.* 3 clinical subtypes-# Superficial (75%)# Invade muscle (20% )# Metastatic (5%)* Clinical presentation# Hematuria (painless)- Most common presentation (80-90% of cases)# Irritative bladder symptoms such as dysuria, urgency, or frequency of urination occur in 20-30% of patients with bladder cancer.* The bladder is the most common source of gross hematuria (40%),* Among bladder causes benign cystitis (22%) > bladder cancer (15%) as a cause of hematuria* Microscopic hematuria- is more commonly of prostate origin (25%)* MC site of lymphatic metastasis: -pelvic lymph nodes (obturator MC)* MC site of hematogenous spread- LIVER > LUNG* Diagnosis- diagnosis and initial staging is made by cystoscopy and TUR.# Newer; voided urine assays (i.e., bladder tumor antigen , NMP-22, fibrin/fibrinogen degradation products ) are being used for the detection and surveillance of urothelial carcinoma.* Management-cystoscopy and TUR or biopsy* Further management depends on stage, grade, size, multiplicity, recurrecnce pattern* Drugs for intravesical chemo- Mitomycin,Thiotepa, Epirubicin,BCG (most effective)


Question: Gold standard test for for insulinoma

72 hr fasting test [Ref: Harrison 17/e p23541 "The most reliable test to diagnose insulinonza is a fast up to 72 h with serum glucose, C-peptide, and insulin measurements every 4-8 h." -Harrison An insulinoma is an endocrine tumor of the pancreas derived from beta cells that ectopically secretes insulin, which results in hypoglycemia. The clinical symptoms are because of the effects of hypoglycaemia (sweating, tremor, palpitations, confusion, headache, disorientation, visual difficulties, irrational behavior, or even coma) The diagnosis of insulinoma requires the demonstration of an elevated plasma insulin level at the time of hypoglycemia. This is because insulinomas do not reduce the secretion of insulin in the presence of hypoglycaemia. Whereas in a normal person, insulin levels would decrease with decrease in blood glucose levels. The most reliable test to diagnose insulinoma is a fast up to 72 h with serum glucose, and insulin measurements every 4-8 h. The test is terminated if the the patient becomes symptomatic or glucose levels are <40 mg/dL (2.2 mmol/L). Diagnosis of insulinoma is made if: - A serum insulin level of 6 microunit/mL or more in the presence of blood glucose values below 40 mg/dL - ratio of plasma insulin to glucose is > 0.3 In addition to the above criteria, some other measurements are also required before making the diagnosis of insulinoma - C-peptide level - serum proinsulin level, - serum sulfonylurea levels These additional tests are used because any hidden use of insulin or oral hypoglycemics taken by the patient would resemble insulinoma causing high levels of insulin in presence of hypoglycaemia. The combination of elevated proinsulin levels (normal in exogenous insulin/hypoglycemic agent users), elevated C-peptide levels (low in exogenous insulin users), antibodies to insulin (positive in exogenous insulin users), and measurement of sulfonylurea levels in serum or plasma will allow the correct diagnosis to be made.


Question: Investigation of choice for vesicoureteric reflex


Question: During appendectomy if it is noticed that base of appendix is inflamed then further line of treatment is

The following steps are usually followed in appendectomy

The base of the appendix is crushed with an artery forceps (No longer recommended).
The base is then ligated with an absorbable suture.
Distal to the ligature the appendix is divided.
A purse string suture is applied in the cecal wall around the base of the appendix. The purse string suture is tightened and the appendix stump is invaginated into the cecum. (This step has also lost its popularity and there are surgeons who are in favour of simple ligation and amputation only).

Methods adopted in special circumstances

When the cecal wall is edematous & inflamed

→ purse string suture is not applied and the stump is not invaginated.

When the base of the appendix is inflamed

→ the base is not crushed for the fear of the spread of infection by way of lymphatics and bloodstream. It is ligated close to the cecum, after which the appendix is amputated and the stump invaginated.

If the base is gangrenous

→it is neither crushed nor ligated. Two stitches are placed through the cecal wall close to the base of the appendix, which is amputated flush with the cecal wall after which these stitches are tied. Further closure is effected by means of the second layer of interrupted sutures.


Question: Borchardt's triad of acute epigastric pain, violent retching and inability to pass a nsogastric tube is seen in patients with

A volvulus is a twisting or axial rotation of a portion of bowel about its mesentery.
When complete it forms a closed loop of obstruction with resultant ischaemia secondary to vascular occlusion.


Question: Serum calcitonin is a marker for


Question: The commonest cancer of oral cavity is

Ans. (d) Squamous cell carcinomaRef: Devita 9th edition, page 729* Most common site oral Cancer: Carcinoma Tongue > Carcinoma Lip* Most common histological type: Squamous Cell Cancer* Most common site of oral Cancer in India: Cancer of Buccal Mucosa* Max Risk of L.N. Metastasis: Carcinoma Tongue* Min Risk of L.N Metastasis: Carcinoma lip > hard palate* Most common age: 50-60 years


Question: Cocket & Dodd's operation is for


Question: A patient presented with local gigantism of the leg and increased pulsations of the lower limb veins. Most probable diagnosis is

The patient is having congenital AV fistula which has caused overgrowth of the leg. Aeriovenous fistula (AVF) AVF may be congenital or acquired (by the trauma of a penetrating wound, or surgically created for renal dialysis) Structural effect on veins - Veins are aerialised*, they become dilated touous and thick walled. Physiological effects of fistula - Increased pulse pressure (Increased systolic & decreased diastolic) Enhanced venous return result in Increased HR* and Increased CO*. Left ventricular enlargement and later cardiac failure may occur A congenital fistula in the young may cause overgrowth of limb*. In the leg, indolent ulcers may result* from relative ischemia below the sho circuit. Clinical signs A pulsatile swelling* A thrill on palpation* Continuous bruit on auscultation* Nicoladonis sign' or Branham sign* - Pressure on the aery proximal to fistula causes the swelling to diminish in size, a thrill or bruit to cease, the pulse rate to fall and the pulse pressure return to normal. Ref : Bailey & Love 25/e p923


Question: During blood transfusion, clotting of transfused blood is associated with

Most transfusion reactions are hemolytic and are due to clerical errors that result in administration of blood with major (ABO) and minor antigen incompatibility. Interestingly, Rh incompatibility is not associated with intravascular hemolysis. Administration of blood through hypotonic solutions such as 5% dextrose and water results in swelling of the erythrocytes and hemolysis. Calcium-containing solutions such as Ringer's lactate cause clotting within the intravenous line rather than hemolysis and may lead to pulmonary embolism. Delayed transfusion reactions, caused by a presumed anamnestic immune response that occurs 3-21 days after blood is infused, result in a hemolytic anemia.


Question: Low and fixed specific gravity of urine is seen in

Normal specific gravity of urine is 1.015 - 1.025. Theoretical extremes are 1.003 to 1.032. The specific gravity will be decreased(hyposthenuria) in excessive water intake, in chronic nephritis, in acute glomerulonephritis, in pyelonephritis and in diabetes insipidus. It is increased(hypersthenuria) in diabetes mellitus, in nephrosis and in excessive perspiration. In chronic renal failure, the specific gravity of urine is low and fixed at 1.010 (isosthenuria). The earliest manifestation of renal damage may be the inability to produce concentrated urine. Reference : page 317-18 Textbook of Biochemistry D M Vasudevan 6th edition


Question: Main cause of congestive splenomegaly.

Ans. (d) Banti syndromeRef: Internet sourcesBanti syndrome:* Congestive splenomegaly caused by obstruction of Portal veins, Splenic Veins, Hepatic veins resulting in Portal hypertension, Ascites, Thrombocytopenia, Leukopenia and Upper GI haemorrhage.


Question: Pelvi ureteric junction obstruction in hydronephrosis. Best diagnosis with

[Cl i.e. (Nuclear imaging): (1294-Bailey & Love 25th)Isotope renography (Diuretic nuclear renal scan) is the best test to establish that dilatation of the renal collecting system is caused by obstruction 99m Tc labelled DTPA or MAG-3 passage through the kidneys can be tracked using a gamma camera 99mTc DTPA is quickly clearedfrom a normal kidney but is trapped in the renal pelvis on the obstructed side and will not be washed out even if the flow of urine is increased by administering furosemide* USG - regularly used to diagnose PUJ obstruction in utero* Excretion urography is only helpful if there is significant function in the obstructed kidney* Retrograde pyelography is rarely indicated but will confirm the site of obstruction immediately before corrective surgeryCongenital PUJ obstruction* Cong PUJ obstruction is the most common cause of significant dilatation of the collecting system in the fetal kidney* More common in boys (2:1)* Usually unilateral but bilateral in 10-40%*** More common in left side** Associated anomaliesa. Renal dysplasiab. Multicystic dysplastic kidneyc. Renal agenesis**d. Vesico-ureteric refluxe. PUJ obstruction was noted in 21% of children with the VATER group of anomalies* Most common presentation of cong PUJ obstruction is asymptomatic* Whitaker test (pressure flow studies) can be used to find out obstruction to flow of urineIn whitaker test catheters are placed in renal pelvis and bladder. Fluid is infused in to the kidney and the pressures are measures. A differential pressure between kidney and bladder could then be indicative of obstruction to the flow* Anderson Hynes Dismembered Pyeloplasty is the most Commonly employed technique


Question: Traumatic dislocation of hip is characterized by

A i.e. Adduction internal rotation deformity


Question: Pseudoarterial aneurysm in drug abuser's seen in

Pseudoaneurysm is a rare condition arising from disruption in the arterial wall with blood dissecting into the tissues around the damaged artery creating a perfused sac that communicates with the arterial lumen. Its incidence is on rising due to the increase in endovascular procedures, hemodialysis and intravenous drug abuse.
Here we report a young male who was found by an NGO worker, lying on the roadside near a Mandir with a pulsatile inguinal swelling and blood oozing out from it. He was taken immediately to the emergency department of LN Hospital. He was a rickshaw puller and known drug addict.
The swelling was diagnosed as pseudo-aneurysm of common femoral artery on clinical examination and by Doppler ultrasonography. He was referred to CTVS department and admitted there for surgery.
In the meanwhile, he collapsed in the hospital toilet and died due to hemorrhagic shock consequent upon rupture of pseudoaneurysm of the femoral artery.


Question: Y.V plasty procedure is used for


Question: Patey's mastectomy is a type of

Ans. (c) Modified radical mastectomy(Ref. Bailey and Love 26th edition Page 813)* In Patey's type of MRM- Pectoralis Minor muscle removed.


Question: The most common nerve involved in Volkamann's ischaemic contracture of forearm includes

C i.e. Median nerve Volkman's ischemic contracture most commonly involve flexor digitorum profundus muscleQ & median nerveQ.


Question: Diameter of varicose veins is

Varicose veins are dilated tortuous subcutaneous veins ≥ 3mm in diameter.


Question: Highest percentage of MUFA are seen in;

fats Saturated FA MUFA PUFA coconut oil 92 0 2 balm oil 4.6 44 10 Ground nut oil 19 50 31 safflower oil 10 15 75 sunflower oil 8 27 65 Com oil 8 27 65 Soya bean oil 14 24 62 Butter 60 37 3 margarine 25 25 50


Question: Emergency management of Ulcerative colitis is by

(D) Total Proctocolectomy with end ileostomy# OPERATIVE MANAGEMENT OF ULCERATIVE COLITIS:> Emergent Operation:- In a patient with fulminant colitis or toxic megacolon, total abdominal colectomy with end ileostomy, rather than total proctocolectomy, is recommended.> Although the rectum is invariably diseased, most patients improve dramatically after an abdominal colectomy, and this operation avoids a difficult and time-consuming pelvic dis- section in a critically ill patient. Rarely, a loop ileostomy and decompressing colostomy may be necessary if the patient is too unstable to withstand colectomy.> Definitive surgery may then be undertaken at a later date once the patient has recovered.> Complex techniques such as an ileal pouch anal reconstruction generally are contraindicated in the emergent setting.> However, massive hemorrhage that includes bleeding from the rectum may necessitate proctectomy and either a permanent ileostomy or ileal pouch anal anastomosis.> Elective Operation:- In the past, abdominal colectomy with ileorectal anastomosis often was recommended for patients with relatively quiescent rectal disease.> Risk of ongoing inflammation, the risk of malignancy, and the availability of restorative proctocolectomy have led most surgeons to now recommend elective operations that include resection of the rectum.> Abdominal colectomy with ileorectal anastomosis is still an appropriate operation for a patient with indeterminate colitis and rectal sparing.> Total proctocolectomy with end ileostomy has been the "gold standard" for patients with chronic ulcerative colitis.> This operation removes the entire affected intestine and avoids the functional disturbances associated with ileal pouch-anal reconstruction.> Most patients function well physically and psychologically after this operation.> Total proctocolectomy with continent ileostomy (Kock's pouch) was developed to improve function and quality of life after total proctocolectomy, but morbidity is significant and restorative proctocolectomy generally is preferred today.> Since its re introduction in 1980, restorative proctocolectomy with ileal pouch-anal anastomosis has become the procedund of choice for most patients who require total proctocolectomy but wish to avoid a permanent ileostomy.


Question: Normal pressure in superficial venous system of leg while walking is

Pressure in superficial venous system decreases to 30 mmHg while walking as blood flows from superficial to deep veins.


Question: Cystic hygroma is

CYSTIC HYGROMA (Cavernous Lymphangioma)

It is a cystic swelling due to sequestration of a portion of jugular lymph sac from the lymphatic system, during the developmental period in utero.
Present at birth and so may cause obstructed labour. Occasionally present in early infancy.
Lymphatics fail to communicate to venous system; abnormal budding of lymphatics is seen.
Often it is associated with Turner’s, Down’s, Klinefelter syndromes and trisomy 18 and 13.
It is also called as hydrocoele of the neck.
Lymphatic malformation (LM) type can be microcystic (lymphangioma) or macrocystic (cystic hygroma). It can cause lymphoedema, soft tissue and bony hypertrophy, asymmetry (face), macrochelia, macroglossia, macrotia, cellulitis.

Key Concept:
 It is a type of congenital lymphangioma and the common victims are infants and children.
Reference: SRB's Manual of Surgery, 5th ed, page no 86, 216, 435


Question: Increased risk of gastric carcinomas associated with

Chronic dysplasia - chronic gastritis leads to gastric atrophy leads to intestinal metaplasia leads to dysplasia which fuher leads to carcinoma in-situ and carcinoma- this cycle is most commonly seen in body and distal stomach and is often called as Correa cycle. Reference SRB edition 5 page no.845


Question: The best scars are seen in


Question: A major indication for orthognathic surgery before puberty is

Hyperdivergent facial pattern with anterior open bite


Question: While performing a submandibular sialography the cannula is inserted in the following direction to prevent damage to Wharton's duct.


Question: Disseminated seminoma is treated by


Question: MC germ cell tumor is

Seminoma Testicular seminoma originates in the germinal epithelium of the seminiferous tubules. About half of germ cell tumors of the testicles are seminomas.Treatment usually requires removal of one testicle. However, feility usually isn't affected. All other sexual functions will remain intact. Signs and symptoms The average age of diagnosis is between 15 and 35 years. This is about 5 to 10 years older than men with other germ cell tumors of the testes. In most cases, they produce masses that are readily felt on testicular self-examination; however, in up to 11 percent of cases, there may be no mass able to be felt, or there may be testicular atrophy. Testicular pain is repoed in up to one fifth of cases. Low back pain may occur after metastasis to the retroperitoneum. Some cases of seminoma can present as a primary tumour outside the testis, most commonly in the mediastinum. In the ovary, the tumor is called a dysgerminoma, and in non-gonadal sites, paicularly the central nervous system, it is called a germinoma. Ref: https://en.m.wikipedia.org/wiki/Seminoma


Question: Dacron vascular graft is

.Aneurysm is excised and the aerial graft either PTFE (Polytetrafluoroethylene), knitted dacron graft, or woven dacron graft is placed. The graft is sutured to the vessel above and below using monofilament, nonabsorbable suture material, polypropylene 5-zero. ref:SRB;s manual of surgery,ed 3,pg no 170


Question: . Treatment of choice in cold nodule of thyroid


Question: Thyroglossal cyst can increase the risk for

Thyroglossal cyst can increase the risk for papillary carcinoma of thyroid.


Question: Most common route of infection of Kidneys in T.B. is


Question: Most common complication of surgery in lithotomy position

Ans) a (Damage to low...) Ref: Complications of Urologic Surgery, style="font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif; margin: 0 0 0 8px; text-indent: 0">Standard lithotomy position requires the patients' legs to be separated from the midline into 30 to 45 degrees of abduction, with the hips flexed until the thighs are angled between 80 and 100 degrees. The patient's legs are placed into stirrups, with the knees bent such that the lower legs are parallel to the plane of the torso. The lithotomy position is used for a variety of open and endoscopic urologic procedures. Therefore, an under- standing of potential postoperative complications related to this position is essential to the care of these patients. In addition to neurologic complications, which are discussed here, other complications that have been reported after procedures in the lithotomy position include lower extremity compartment syndrome, venous thrombosis, and rhabdomyolysis.


Question: Not a treatment for phyllodes tumour

Treatment for Phyllodes tumour is enucleation in young women or wide local excision. Massive tumors, recurrent tumors will require mastectomy. Reference: Bailey & Love, 27th Edition, page no = 870.


Question: Most common complication of acute pancreatitis is

Most common complication of acute pancreatitis is hypoxemia.


Question: Tillaux's sign is seen in

Tillaux's sign: In mesenteric cyst, the swelling moves freely in a plane at right angles to the attachment of the mesenteryRef: Bailey and love 27e pg: 1063


Question: A patient having Glasgow score of 12 is suffering from

Severity of head injury is classified according to the Glasgow Coma Score (GCS), as the GCS – and in particular the motor score – is the best predictor of neurological outcome:
- Minor head injury: GCS 15 with no loss of consciousness (LOC);
- Mild head injury: GCS 14 or 15 with LOC;
- Moderate head injury: GCS 9–13;
- Severe head injury: GCS 3–8.


Question: The most impoant indication for surgical repair of a double uterus, such as a septate or bicornuate uterus, is

Habitual aboion is the most impoant indication for surgical treatment of women who have a double uterus. The aboion rate in women who have a double uterus is to three times greater than that of the general population. Therefore, women who present with habitual aboion should be evaluated to detect a possible double uterus. Hysterosalpingography, hysteroscopy, ultrasound, CT, and magnetic resonance imaging (MRI) are all potentially useful imaging modalities in this investigation. Dysmenorrhea, premature delivery, dyspareunia, and menometrorrhagia are other, less impoant indicators for surgical intervention.


Question: Recording of data of bihs and deaths in a community continuously after 6 months survey is known as

Sample registration system Sample Registration system (SRS) - staed in 1960 * SRS provide reliable estimated of bih rate at national and state levels. * It is dual record system Enumerator : Continuous enumeration of bih and death rate. - Independent survey : Survey every 6 month by investigator supervisor. * It cover entire country major source of death information. Census : It taken usually at intervals of 10 year Civil Registration system : It is deficient in India. * Estimation to missing event by enumerator and supervisor using well defined technique know as "CHANDRASEKHARAN DEMMY FORMULA"


Question: Absolute contraindication for endovenous abalation in varicose veins

An acute occlusive DVT is an absolute contraindication to endovenous thermal ablation, whereas a chronically recanalized deep venous system in the extremity to be treated is a relative contraindication. Care must be taken to ensure that superficial venous ablation will not compromise the venous outflow of the post-thrombotic limb.Ref: Sabiston 20e pg: 1866


Question: Gastrointestinal stromal tumours arise form

Gastrointestinal stromal tumours (GISTs) may arise in anypa of the gastrointestinal tract but 50% will be found inthe stomach.They are now known to be a distinct tumor derived from the interstitial cells of Cajal,The tumours are universally associated with a mutation in thetyrosine kinase c-kit oncogene (CD 117). These tumours are sensitive to the tyrosine kinase antagonist imatinibBailey and Love 27e pg: 1139


Question: The common organism isolated in Emphysematous pyeloneohritis is

Emphysematous pyelonephritis (EPN) is a severe, necrotizing infection of the renal parenchyma causing gas formation within the collecting system, renal parenchyma, and/or perirenal tissues. Also called renal emphysema and pneumonephritis. Gas in the renal pelvis alone, without parenchymal gas, is often referred to as emphysematous pyelitis.EPN most often occurs in persons with diabetes mellitus, especially women.Among the bacteria associated with emphysematous pyelonephritis (EPN), Escherichia coli is isolated in 66% of patients, and Klebsiella species are repoed in 26% of patients. Proteus,Pseudomonas, and Streptococcus species are other organisms found in patients with EPN, and Entamoeba histolytica and Aspergillus fumigatus also have been repoed to cause the disease. Mixed organisms are observed in 10% of patients. Rare organisms such as Clostridium and Candida species have also been isolated in patients with EPN.


Question: A patient came with lower chest trauma with pain in abdomen. His BP is 60/40 pulse 120 next best investigation

Answer- B. USG FASTUSG is the investigation of choice in both stable as well as unstable patients."Blunt abdominal trauma initially is evaluated by FAST examination in most major trauma centers"


Question: Investigation of choice for posterior urethral value is

Micturating cystourethrogram is investigation of choice for posterior urethral value.


Question: Next Investigation to be done for painful breast lump in a lactating woman

Ans. (b) USGRef: Bailey & Love 26th ed. / 527* Breast abscess is highly probable in this lactating patient. Ultrasonography is used to distinguish solid from cystic structures and to direct needle aspiration for abscess drainage.* Ultrasound is the imaging method of choice for the majority of women aged < 40 years and during pregnancy and lactation.* Breast MRI does not form part of the initial imaging assessment of patients in the symptomatic breast clinic. It may, however, be useful in the further investigation of some breast lesions and in the evaluation of patients with confirmed breast cancer.


Question: A patient is diagnosed with gas gangrene of the foot. Best management would be

All the above are pa of gasgangrene management, the main stay is debridment and antibiotics Treatment for gas gangrene includes, Inj. Benzyl penicillin 20 lacs 4th hourly. + Inj. metronidazole 500 mg 8th hourly + Inj. aminoglycosides (if blood urea is normal) or third generation cephalosporins. Polyvalent antiserum 25,000 units given intravenously after a test dose and repeated after 6 hours. Liberal incisions are given. All dead tissues are excised and debridement is done until healthy tissue bleeds. * Hyperbaric oxygen is very useful. Rehydration and maintaining optimum urine output (30 ml/hour) (0.5 ml/kg/hour). Electrolyte management. In severe cases amputation has to be done as a lifesaving procedure - stump should never be closed. Often ventilator suppo is required. ref:SRB;s manual of surgery,ed 3,pg no 46


Question: Mc. Murray's sign is seen in injury to


Question: Most common type of oral carcinoma is


Question: Keloid is differentiating with hypertrophic scar

i.e. (Increased growth beyond size): (30-Bailey & Love 25th) (52, 1103-5-CSDT 13th) (152. S-Das 6th)KELOID SCAR is defined as excessive scar tissue that extends beyond the boundaries of the original incision or wound (As a true tumour arising from the connective tissue elements of the dermis)Keloids by definition extend beyond the border of the wounds and are most common in pigmented skin xiphisternum and each shoulder tipupregulation offibroplastic growth factors like TGF-b is implicated during hypertrophic or keloid scar formation (52 CSDT 13th)In the case of keloids, the over reactive proliferation of fibroblasts continues for weeks or months. By the time it ceases. Maturation with spontaneous improvement does not usually occursThe histology of both hypertrophic and keloid scars shows excess collagen with hypervascularityRadiographic Features:Spider leg aooearancePolycystic kidneySandy patchesSchistosmiasis of bladderCobra head appearanceUreteroceleDrooping flower appearanceEctopic ureterFlower vase appearanceHorse shoe kidneySoap bubble appearanceHydronephrosisRim or crescent signHydronephrosis* Familial condition, more common in women, Tuberculosis plays a role in aetiology* Claw like processess, pink and raised patch, unsighty often tender to touch and always itch, Recurs even when it is excisedHYPERTROPHIC SCAR is defined an excessive scar tissue that does not extend beyond inflammatory phase of wound healing and from unfavourable scar siting i.e. across the line of skin tension In the face, these are known as the lines of facial expression* Generally self limited** (Regresses after 6 months)* The last areas of a bum to heal are the most often hypertrophic* Usually no claw-like processes, no itching.* There is no sign of increased vascularity and the hypertrophic scar is never reddish in colour* It does not recur after excision. If the causative factors are eliminatedTreatment of choice for keloids and intractable hypertrophic scar is still injection of triamcinolone acetonide (1105-CSDT 13th)Comparison of Hypertrophic and Keloid scar (206-207 Sabiston 18th)FeaturesHypertrophic ScarKeloid ScarGeneticNot familialMay be familialRaceNot race relatedBlack > WhiteSexFemale = maleFemale > maleAgeChildren10-30 yearsBorderRemains within woundOutgrows wound areaNatural historySubsides with timeRarely subsidesSiteFlexor surfaceSternum, shoulder, faceAetiologyRelated to tensionUnknown


Question: Best test to diagnose gastroesophageal reflux disease and quantity acid output is

.for GERD, THE INVESTIGATIONS can be, *24 hours oesophageal pH monitoring is regarded as the gold standard.PPI should be stopped for 3 weeks prior to pH monitoring. *barium study in head down position. *endoscopy to exclude other diseases. *oesophagal manometry to assess the state of lower oesophagal sphincter. Ref: SRB&;s manual of surgery,5th ed, pg no 792


Question: Initial treatment of keloid

Answer- B. Intralesional steroidIntralesional injection of steroid (Triamcinolone acetate) is now recommended as the first line of t/t for keloid.


Question: Traetment for periductal mastitis

Duct cectasia is the dilatation of lactiferous ducts due to muscular relaxation of duvt wall with periductal mastitis. C/f: greenish dicharge from nipple. Slit like retraction of nipple due to fibdosis can occur May form abcess and fistula Treatment : To stop smoking Antibiotics Cone excision of major ducts-Hadfield operation. SRB's Manual of Surgery.Edition -5. Pg no:525


Question: Lehriche syndrome is characterized by presence of aerial insufficiency in

Answer- A. Aoo- iliac aeryBrought on by walkingNot present on taking the first step (unlike osteoahritis)Relieved by standing stillThe pain of claudication is usually felt in the calf because the superficial femoral aery is the most commonly affected.Aooiliac disease (30 per cent of cases) may cause thigh or buttock claudication.Buttock claudication in association with sexual impotence resulting from aerial insufficiency is eponymously called Leriche's syndrome. It is very rare.


Question: The difficulty score for an mesioangutar impacted mandibular 3rd molar, Class II and level II is


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

In general, symptoms and signs that suggest a rise in ICP include altered level of consciousness, headache, vomitingwithout nausea, ocular palcies, back pain and papilledema. If papilledema is protracted, it may lead to visual disturbances, optic atrophy, and eventually blindness. The headache is classically a morning headache which may wake them from sleep. The brain is relatively poorly supplied by oxygen as a result of mild hypoventilation during the sleeping hours and also cerebral edema may worsen during the night due to the lying position. ref-Graham, D. I.; Gennarelli, T. A. (2000). "Pathology of Brain Damage After Head Injury". In Cooper, Paul Richard; Golfinos, John (eds.). Head Injury (4th ed.). McGraw-Hill. pp. 133-54


Question: Testicular tumor with best prognosis is

Seminomas are radiosensitive tumors so prognosis is good.


Question: Pehes affects age group

Ans. B. 4 - 8 yrsPehe's disease is also known as osteochondritis deformans juvenilis or Coxa plana or Pseudocoxalgia.Pehe's disease is an osteochondritis of the epiphysis of the femoral head (capital femoral epiphysis).The disease occurs commonly in males in the age group of 5-10 years.


Question: Epulis arises from

Epulis literally means 'upon the gum'. Thus it is a swelling situated on the gum.
It can originate from the mucous membrane, the periosteum or the bone giving rise to different varieties of Epulis.


Question: Mammography radiation used is

Ans. (b) Bremsstrahlung Xray(Ref Internet Source)* Mammography is a Low voltage and High Amperage X ray* Mammography is a type of X ray known as Bremsstrahlung/Braking X-ray generation (It is not a classical X ray)


Question: Enucleation of palatal tumor results in

Excessive bleeding from nasopalatine vessels


Question: Down fracture of zygomatic arch is done in the treatment of


Question: Treatment of leukoplakia

• In most cases, lesions regress spontaneously after stopping alcohol or tobacco consumption or correction of underlying cause.


Question: Avascular necrosis of bone is most common in


Question:
Best time for surgery in case of combined unilateral cleft lip
and hard palate is

If cleft is in hard palate surgery is done between 15-18 months.


Question: A lady with a long stading thyroid nodule is planned for a subtotoal thyroidectomy. Before the surgery the surgeon must check/ do

Answer- C. Indirect LarngoscopyNerve Damage to recurrent / superior laryngeal nerve is a known complication of thyroidectomy.Hence it is impoant to document the state ofthe vocal cords before surgery to prevent litigation liability.


Question: Features(s) of jejunal diveicula is/are

.Jejunal diveicula are rare. Often can cause obstruction, haemorrhage. It needs surgical resection.in case of jejunal diveicula,the absorption of nutients such as vitamin B12 ar seriuosly affected. ref:SRB&;s manual of surgery,ed 3,pg no 800


Question: 25 year old male with head injury comes walking, conscious oriented and then becomes unconsious. Diagnosis

.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 becomes normal. later after 6-12hours , he again falls ill and the condition deteriorates. this is the time taken to increase the 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: Most common site of BCC (Basal cell carcinoma) is

Ans. a (Face) (Ref. Bailey and Love, 25th /609)Basal cell carcinoma# Basal cell carcinoma is the most common eyelid tumor.# These are locally malignant lesions (rodent ulcer) with rare chances of distant metastasis and are most common malignant tumors of eyelid, more common in lower eye lid.# Most common site of BCC is face.# In fact the rodent ulcer may be seen more commonly in places of face over which tear rolls down so it's aptly called tear cancer.# Though no site is exempted, yet 90% of basal cell carcinomas are seen on face above the line drawn from the angle of the mouth to the louble of the ear.# It may also occur in the scalp, neck, arm & hands.# The common sites on face are- Around inner and outer canthus of the eye.- Nose and On & around nasolobial fold- On the forehead - more common in female# Treatment: Excision with care not to deform lid (.Mohys surgical excision).


Question: Most common catheter induced blood infection is due to

Coagulase negative staphylococci fRef. Harrison 17th /e p 839 & 16th/e. p 777. 778] Intravascular catheter related infections Indwelling vascular catheters are a leading source of bloodstream infections. Amongst indwelling vascular catheters, central venous catheters are the most common culprits. Pathogenesis There are four potential sources for catheter related infections ? 1) The skin inseion site 2) The catheter hub 3) Hematogenous seeding from a distant infection 4) Contaminated infilsate The skin inseion site and the catheter hub are by for the two most impoant sources. Approximately 65% of catheter related infections originate from the skin flora, 30% from the contaminated hub and 5% from other pathways. For sho term catheters, skin contamination is the most likely mechani.sm of pathogenesis. On the other hand, for long term catheters, hub contamination is more frequent because such catheters often have to be intercepted and manipulated. Skin organisms migrate from the skin inseion site along the external surface of catheter, colonizing the distal intravascular tip of the catheter, and ultimately causing blood-stream infection. On the other hand, in hub related infections, organisms are usually introduced into the hub from the hands of medical personnel and the organisms migrate along the internal surface of the catheter, where they can cause a bloodstream infection. Microbiology Most of the micro-organisms implicated in CRIs arise from the skin flora. Staphylococci are the most frequently isolated pathogens, paricularly coagulase-negative staphylococci. Etiology of catheter related infection Microorganism Percentage * Coagulase negative staphylococci 30 - 40 * Staph aureus 5-10 * Enterococci 4 - 6 * Candida spp. 3 - 6 * Pseudonzonas aeruginosa 2 - 5 * Enterobacter spp 1 - 4 * Acinetobacter spp. 1 - 2 * Serratia spp. <1 * Others < 1 - 5


Question: 20 yr old female diagnosed previously with adenocarcinoma stomach and on examination following is seen;

Sister Mary joseph nodule - Cutaneous metastatic deposit around umbilicus (Not Lymph node) Lymph Node involvement in Ca stomach - Involvement of left supraclavicular LN - Virchow's Node (Aka Troisier's Sign) - Involvement of Axillary LN - Irish nodes - Palpable intraperitoneal metastasis on digital rectal examination - Blummer's shelf


Question: Recently delivered female with a shiny mass in the breast with fever

Ans. (a) Breast Abscess(Ref Bailey and Love 866)* MC organism causing breast abscess - Staphylococcus aureus* It is due to ascending infection of a sucking Baby* Treatment is by Antibiotics and I/D if not resolved in 48 hours


Question: The best guide to adequate tissue perfusion in the fluid management of a patient with burns, is to ensure a minimum hourly urine output of

0.5 - 1 ml / kg / hour is the urine output maintained in burns.


Question: Obstruction of the hepatic vein by thrombosis or a web is

Budd Chiari syndrome is a syndrome or group of disorders caused by occlusion of major hepatic veins or IVC or both at or near the level of the hepatic vein, usually three main major hepatic veins are involved by thrombosis or block. Reference: SRB 5th edition page no 626


Question: Nicoldoni sign is also known as

Branham sign (or Nicoladoni sign): This sign is elicited when aeriovenous fistula is suspected. A pressure on the aery proximal to the fistula will cause: a. Reduction in size of the swelling. b. Disappearance of bruit. c. Fall in pulse rate. d. Pulse pressure returns to normal. Reference : page 1193 SRB's manual of surgery 5th edition


Question: Verrucaous carcinoma of penis is causes by

Verrucous carcinoma of penis, also called Buschke-Lowenstein tumour, is caused by HPV 6 and 11. It is a curable malignancy but is locally destructive and locally invasive. It neither spreads through lymphatics nor blood. Surgical excision or paial amputation is the treatment of choice.Reference : page 1067 SRB's manual of surgery 5th edition


Question: Adamantinoma arises from

Adamantinoma arises from odontogenic tissue which can be probably from enamel or dental lamina.So the most correct option,since it is classified under odontogenic tumours, is that it arises from odontogenic tissue SRB,5th,359.


Question: Foreign body the common passage is

A. i.e. (Right main bronchus) (297 -Dhingra 4th)Foreign bodies* Children - seeds, beans, tiny toys* Adult - meat is the most common cause of obstruction* Most common route by which a foreign body enters the nose is the anterior nares (179 - Maqbool 11th)* Commonest site of foreign bodies of food passage is at or just below the cricopharyngeal sphincter. (311 - Dhingra 4th)Most foreign bodies enter the right bronchus because it is wider and more in line with tracheal lumen causes - atelectasis or check valve obstruction* Double density sign of chest x-ray is a feature of left atrial dilatation*** Fish bone, chicken bone, needle or a denture may lodge in the pyriform fossa


Question: Most common complication of chronic gastric ulcer is

Gastric ulcers like duodenal ulcers cause pain, bleeding, and obstruction and can perforate.The most frequent complication of gastric ulceration is a perforation. Most perforations occur along the anterior aspect of the lesser curvatureHaemorrhage occurs in approximately 35% to 40% of patients.The incidence of malignancy ranges from 6% to 30% and increases with the size of the ulcer.Sabiston 20e pg: 1233


Question: A patient is brought to the emergency as a case of head injury, following a head on collision road traffic accident. His BP is 90/60 mmHg. Tachycardia is present. Most likely diagnosis is

Due to cushings reflex HR is decreased in brain injury.


Question: Raynauds phenomenon is commonly seen in

. It is an episodic vasospasam,especially aeriolar spasam usually bilateral more often seen in upperlimb of females as a result of abnormal sensitivity to cold.Patient develops blanching,cyanosis qnd later flushing .usually medial four digits and palm are involved.Thumb is spared.If vasospasam becomes longer,gangrene or ischemic ulceration supervenes along the tips of fingers. Refer page no 183 of SRB's manual of surgery5th edition.


Question: Whitehead's varnish in gauze is used to arrest bleeding from


Question: The intercostal drainage tube is inseed in the

Answer- A. 5th intercostal space in the midaxillary lineSafe triangle of icd inseionAnterior border of latissimus dorsi.Lateral border ofpectoralis major.Horizontal line superior to the nipple.Horizontal line inferior to axilla.More specifcally, the tube is inseed into the 46 or 5th intercostal space slightly anterior to the mid axillary line

3rd intercostal space in the midaxillary line

4th intercostal space in the anterior axillary line

9th intercostal space in the midclavicular line


Question: Poal triad is not formed by

Poal triad relation CBD laterally Poal vein posteriorly Hepatic aery medially Mickey mouse view: Ultrasound image of hepatic aery, bile duct and poal vein is in a configuration, referred as Mickey Mouse View Ref: Sabiston 20th edition Pgno : 1421-1422


Question: Condition not associated with Pancreatic Panniculitis is

Panniculitis is a group of disease whose hallmark is inflammation of subcutaneous adipose tissue. Symptoms- Tender skin nodules, Fatigue, Weight loss. Acute or chronic pancreatitis and pancreatic carcinoma (usually of acinar cells) are the most common pancreatic diseases associated with pancreatic panniculitis. However, pancreatic pseudocyst, post-traumatic pancreatitis, pancreas divisum and pancreatic vascular fistulas have also been repoed.


Question: Treatment of choice for medullary carcinoma of thyroid is

Most patients with MTC should undergo at least total thyroidectomy The presence of clinically detectable or ultrasound-detectable disease in the lateral neck warrants total thyroidectomy and level VI and lateral compament nodal dissection. Because MTC is not of follicular cell origin, TSH suppression and RAI scanning and therapy have no role in MTC. Source : Sabiston 20th edition Pg : 910


Question: The one most consistent sign of fresh fracture is


Question: Endoscopic stapling procedure would be ideal in

Stappling of diveicula is done as a treatment procedure for pharyngeal pouch(Zenker's diveiculum). Other method is Dohlman's procedure. In this Pouch is excised using double lipped endoscopy. Cautery or laser is used. It is quicker procedure with sho duration of anaesthesia, with fast recovery. Other treatment option is Diveiculectomy with cricopharyngeal myotomy. Reference: SRB's Manual of Surgery, 6th Edition, page no= 422.


Question: Plunging ranula is a type of


Question: Beevor sign is seen in aEUR'

Abdominal muscle Beevor's Sign Movement of the umbilicus towards the head on flexing the neck. It is caused by weakness of the lower abdominal muscles. Physiology Beevor's sign is characteristic of spinal cord injury b/w T6-T10levels. This occurs because the upper abdominal muscles such as rectus abdominus are intact at the top of the abdomen but weak at the lower poion. Thus when the patient is asked to do a sit up only the upper muscles contract pulling the umbilicus towards the head in patients who are abnormal. It has also been described in amyotrophic lateral sclerosis and fascioscapulohunzeral muscular dystrophy.


Question: Fibroblast in healing wound is derived from

Fibroblasts are specialized cells that differentiate from resting mesenchymal cells in connective tissue The primary function of fibroblasts is to synthesize collagen. Sabiston 20th edition Pg 137


Question: Post spinal headache is due to

A. i.e. (CSF leaks in the dura) (517- Lee's synopsis of anaesthesia 13th)* It is low pressure headache due to seepage of CSF from dural rent (hole) created by spinal needle. The loss may be around 10 ml /hrPost spinal headache - is due to seepage of CSF. Can be minimized by using smaller bore needle (360-KDT 6th)* More common in young pregnant patients and with accidental dural puncture rate during epidural anaesthesia using Touhy needle (60 - 80%). Reduced by the introduction of size 25 G and 27G whitacre pencil point needles. Which replaced cutting needles* Typical location is bifrontal and /or occipital* CSF leakage results in changes in hydrodynamics of brain causing traction on pain sensitive structures like dura, vessels and tentorium producing painTreatment - Caffeine, sumatriptan and adreocorticotropic hormoe, "epidural blood patch"* Related to a reduction in CSF volume due to leakage through the dura (300 - Current. Diagnosis and treatment - pain)


Question: Pseudomembranous colitis is caused by


Question: Acinic cell tumor is most commonly seen in

Ans. (a) Parotid glandRef: Stell and Maran's Head and Neck Surgery, p-719* Acinic cell tumor is low grade tumor* Most common site of Acinic cell tumor is Parotid gland


Question: Investigation of choice for CHPS

Ans. (a) USGRef: Bailey and Love page 113-114/26th edition* IOC for Congenital Hypertrophic Pyloric stenosis - USG* Palpated as a Olive tumor in right Upper quadrant.* If the history and clinical mass is there - no need of USG - directly we can do Ramstedt's pylromyotomy


Question: Severe disease involves


Question: A pt presented with pulsating varicose veins of the lower limb. Most probable diagnosis is

Ans. is 'a' ie Klippel-Trenaunay Syndrome Klippel- Trenaunay Syndrome :is characterized byCongenital AV fistulasCutaneous hemangiomasVaricose veinsHyperophy of involved extremityAbsence of deep venous system (so pathological superficial veins should not be removed without evidence of an intact deep system)*Another syndrome closely associated with A-V malformations is:Kasabach-Merritt syndrome characterised by:- thrombocytopenia* and- hemorrhagic manifestation *- d/t trapping & destruction of platelets* within the AV malformations*.


Question: The most important prognostic factor in carcinoma breast is

The Nottingham prognostic index (NPI) is used to determine prognosis following surgery for breast cancer.
Its value is calculated using three pathological criteria: the size of the lesion; the number of involved lymph nodes; and the grade of a tumour.
Size of the lesion is least important.
The extent of axillary lymph node involvement by breast cancer—is the most established and reliable prognostic factor for subsequent metastatic disease and survival


Question: Most common site of bleeding diveicula

Diveicula most commonly affect the sigmoid colon and are confined to sigmoid colon in approximately 50% of patients with diveiculosis. Segment of sigoid colon is having smallest luminal diameter, and so colonic pressure as high as 90mm Hg can be generated. Reference : Sabiston, Textbook of Suregery, 19th Edition, page no = 1310.


Question: Thyroid carcinoma with pulsating vascular, skeletal metastasis is


Question: Name the pathology seen in scalp

Ans. (b) Sebaceous cyst* MC site of Sebaceous cyst is scalp.* Never seen in palms, soles, mucosa.* Ulcerated Sebaceous cyst of scalp is Cock's peculiar tumor.


Question: Malignant cells in urine cytology are most commonly seen in

Ans. c (Urothelial carcinoma). (Ref. Harrison's Medicine 17th ed. 555)# Urothelial malignancy classically shows polychronotropism & multicentricity.# In urothelial or transitional carcinoma of renal pelvis or ureter, the examination of urine for malignant cells is positive and even may indicate whether tumor is well or poorly differentiated.# There is evidence that those with poorly differentited tumors do better if they have a short course of radiotherapy before surgery.# It is hence useful to obtain cells from tumor/urine by sampling a brush or catheter passes up the ureter under radiological control.


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

.Po wine stain (Naevus flammeus): It presents at bih and persists throughout life without any change. Spontaneous regression will not occur. It presents as smooth, flat, reddish blue/intensely purple area; common in head, neck and face; often with maxillary and mandibular dermatomes of 5th cranial nerve. Eventually surface becomes nodular and keratotic. * It persists throughout life. * It is actually a capillary malformation even though considered under haemangioma. It results from defect in maturation of sympathetic innervation of skin causing localised vasodilatation of intradermal capillaries. * It is often associated with Sturge-Weber syndrome, Klippel - Trenaunay-Weber syndrome and Proteusnsyndrome. * It needs treatment - laser (pulsed dye/diode); excision and grafting; cosmetic coverage. Expected result by treatment is not possible many times. ref:SRB&;s manual of surgery,ed 3,pg no 180


Question: The most common intraperitoneal abscess following peritonitis