Question: Not a pa of personal protective kit

Universal Precautions kit National Health Service UK Guidelines: - * Use face full mask ideally with Protective spectacles. * Use of waterproof, disposable gowns and drapes. * Avoid Clogs and wear Boots to prevent sharp injuring leg. * Double Glove is needed ( with large size on inside is more comfoable) * Allow only essential personal in theatre * Avoid unnecessary movement in theatre. * Meticulous technique needed. Bailey and Love, 27th edition; pg num:- 52


Question: Lord's plication is done for

Lord's plication is done for hydrocele. It is suitable when the sac is small, thin walled and contains clear fluid. Here tunica is bunched into a 'ruff' at its attachment to the testis by using a series of multiple interrupted chromic catgut sutures to plicate the redundant tunica vaginalis, so as to make the sac to form fibrous tissue. Reference : page1072 SRB's manual of surgery 5th edition


Question: Treatment of Medullary Ca of thyroid with lymph node metastasis

.In medullary carcinoma thyroid , total thyroidectomy is treatment of choice. Radiotherapy can be considered in unresectable cases or after complete surgical resection in few cases. Note : Since medullary thyroid cancer doesnot arise from follicular cells, TSH suppression and RAI (radio active iodine) therapy have no role. Source : Sabiston 20th edition pg 910

Sub total thyroidectomy + Radioiodine + TSH supression


Question: Prophylactic antibiotics are most effective during

In the first 4 hours, after a breach in an epithelial surface and underlying connective tissues, there is delay in the mobilisation of host defences. This period is called 'decisive period' and during this period, bacterial colonisation and established infection can begin. It is logical that prophylactic antibiotics will be most effective during this time.


Question: 1 month later injury presents with irritability altered sensorium

Chronic subdural Hematoma Chronic SDH: Collection of blood breakdown products that is atleast 2-3 weeks old Chronic SDH: SDH often occurs in patients without a clear history of head trauma, as they may arise from minor trauma Clinical features Alcoholics, the elderly, and patients on anticoagulants are at higher risk for developing chronic SDH Patients may present with head ache, seizures, confusion, contralateral hemiparesis or Coma Ref:Sabiston 20th edition Pgno :439-441


Question: Gastro jejunostomy is an example of

Ans. is 'a' i.e., Clean contaminated wound Surgical wounds are classified based on the presumed magnitude of the bacterial load at the time of surgery. Classification of Surgical Wounds Clean Wound (Class D include those in which no infection is present; only skin micro flora potentially contaminate the wound. No hollow viscus is entered. No inflammation examples : Hernia repair, breast biopsy Clean/contaminated wounds (Class II) include those in which a hollow viscus such as the respiratory, alimentary or genitourinary tracts with indigenous bacterial flora is opened, but under controlled circumstances without significant spillage of contents. No inflammation. examples : Cholecystectomy, elective GI surgery. Contaminated wounds (Class III) include open accidental wounds encountered early after injury, those with extensive introduction of bacteria into a normally sterile area of the body due to major breaks in sterile technique (eg. open cardiac massage); uncontrolled spillage of viscus contents such as from the intestine. Inflammation is apparent - examples : Penetrating abdominal trauma, large tissue injury, enterotomy during bowel obstruction Diy wounds (Class IV - include traumatic wounds in which a significant delay in treatment has occurred and in which necrotic tissue is present. Includes wounds in which pus is present. Includes those wounds created to access a perforated viscus accompanied by a high degree of contamination. Severe inflammation is seen - examples : Perforated diveiculitis, necrotizing soft tissue infection.


Question: Most common complication of pseudocyst of pancreas is

Ans. (c) InfectionRef: Sabiston 20th edition page 1530* Most common complication of Pseudo cyst is Infection* Treatment of infected Pseudocyst is external drainage


Question: Screening of prostate Ca commonly done bya) DRE (digital rectal exam)b) USGc) MRId) PSAe) CT scan

CSDT 11/e writes - "Even so, the realities of clinical practice are that the combination of digital rectal examination and serum PSA monitoring is the most effective screening protocol."
This view of CSDT is supported by Smith's Urology
But if we have to choose one investigation, it would be PSA.


Question: A surgical obturator has to be inserted


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

SCC is a malignant tumour of keratinising cells of the epidermis or its appendagesSCC is the second most common form of skin cancer (after BCC)It is strongly-related to cumulative sun exposure and damage SCC is also associated with chronic inflammation (chronic sinus tracts, pre-existing scars, osteomyelitis, burns, vaccination points) and immunosuppression. When an SCC appears in a scar it is known as a Marjolin's ulcer.Ref: Bailey and Love, 27e, page: 605


Question: Brown sign is seen in

Brown sign also called Pulsation sign is seen in glomus tumours. Glomus tumor is the most common benign neoplasm of middle ear; originating from the glomus bodies. It is extremely vascular. Thus, when ear canal pressure is raised with Siegel's speculum, the tumour pulsates vigorously and then blanches; reverse happens with the release of pressure. This is called Brown sign. Reference : page 109 Diseases of Ear, Nose and Throat & Head and Neck surgery - Dhingra 6th edition


Question: Multiple Cutaneous Sebaceous adenomas are seen in

.* Multiple sebaceous adenomas with visceral malignancy are called as Torre-Muir syndrome. * Secondaries in skin can occur like sister -Joseph nodules around the umbilicus. ref:SRB&;S manual of surgery,ed 3,pg no 244


Question: Pelvic exenteration is known as

Pelvic exenteration (or pelvic evisceration) or Brunschwig's operation is a radical surgical treatment that removes all organs from a person's pelvic cavity - rectum, anus, urinary bladder, urethra, all the lymph nodes, fat, fascia, uterus, vagina- with colostomy and urinary diversion. It is performed for many types of very advanced or recurrent cancers including genitourinary and colorectal cancers.Miles and Lloyd - Davies operations are types of abdominoperineal resection wherein sigmoid , descending colon and upper rectum are resected per abdominally and anal canal witg perianal and perirectal tissues are dissected per anally. Miles - abdomen first, perineum later; Lloyd - Davies- synchronised ( together or combined) Reference : page 958-59 SRB's manual of surgery 5th edition


Question: Tissue adhesive glue contains

Tissue adhesive glue can be used instead of sutures, advantage of quicker application but more chance of wound dehisence Cyanoacrylate is the major component.


Question: Risk of breast cancer is highest in

Atypical ductal or lobular hyperplasia are proliferative disease with atypia. Lobular carcinoma in situ carries the highest riskHISTOLOGIC DIAGNOSIS ESTIMATESRRNonproliferative disease1.0Proliferative disease without atypia1.3-1.9Proliferative disease with atypia3.7-4.2Proliferative disease with atypia and strong family history4-9LCIS >7Ref: Sabiston 20e, page: 832


Question: Early movement for surgery following ankylosis is

Indicated only when ankylosis is one sided


Question: The rectum measures

The adult rectum is approximately 12-18 cm in length and is conveniently divided into three equal pas: the upper third, which is mobile and has a peritoneal coat; the middle third where the peritoneum covers only the anterior and pa of the lateral surfaces; and the lowest third, which lies deep in the pelvis surrounded by fatty mesorectum and has impoant relations to fascial layers. Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1219


Question:
A patient is in shock with gross comminuted fracture.
Immediate treatment is to give


Question: Most common route of infection in kidney tuberculosis

Genitourinary tuberculosis (GUTB) accounts for 14% of non-pulmonary cases of TB. It is caused by dissemination of the organism through the bloodstream and is thus always secondary TB. ref : Bailey and Love 27th ed , chapter 76 , pg no 1405


Question: Reactionary hemorrhage occurs within

Reactionary haemorrhage commonly occurs in the first 24 hours after surgery, It may be caused by slippage of a ligature, displacement of blood clot, cessation of vasospasm, after coughing or increased mobility Bailey and Love 26th edition pg 19


Question: A most common cause of bowel obstruction is

ADHESIONS AND BANDS :
Adhesions and bands are the commonest causes of intestinal obstruction in Western countries. In India, hernia and then adhesions are the two common causes of intestinal obstruction.
Causes :

Infection due to peritonitis, appendicitis, post-laparotomy, and other acute infective abdominal conditions.

Type I : Fibrinous adhesions occur during the 5 - 10th postsurgical period. It usually gets resolved completely. It is avascular and flimsy.
Type II : Fibrous adhesions. Due to lack/poor blood supply, bowel gets attached to part of peritoneum or omentum or other parts of the bowel with dense vascular adhesions to maintain blood supply. It will persist and precipitate intestinal obstruction, often-subacute and recurrent type. Adhesions due to tuberculosis are severe, dense and difficult to separate.


Question: After renal transplant the commonest malignancy is


Question: Flail chest refers to

(B) Fracture of multiple ribs > A flail chest occurs when a segment of the chest wall does not have bony continuity with the rest of the thoracic cage .> Flail chest usually results from blunt trauma associated with multiple rib fractures i.e. 3 or more ribs fractured in 2 or more places.# Major chest wall trauma (Flail chest)> This occurs when several adjacent ribs are fractured in two places either on one side of the chest or either side of the sternum.> The flail segment moves paradoxically, i.e.-inwards during inspiration and outwards during expiration, thereby reducing effective gas exchange.> The net result is poor oxygenation from injury to the underlying lung parenchyma and paradoxical movement of the flail segment.> The underlying lung injury with loss of alveolar function may result in deoxygenated blood passing into the systemic circulation> This creates a right-to-left shunt and prevents full saturation of arterial blood.> In the absence of any other injuries and, if the segment is small and not embarrassing respiration, the patient may be nursed on a high-dependency unit, with regular blood gas analysis and good analgesia until the flail segment stabilizes.> In the more severe case, endotracheal intubation is required with positive-pressure ventilation for up to 3 weeks, until the fractures become less mobile.> Thoracotomy with fracture fixation is occasionally appropriate if there is an underlying lung injury to be treated at the same time.> An anterior flail segment with the sternum moving paradoxically with respiration can be stabilized by internal fixation but operative management is not usually for either.


Question: Following is a laparoscopic technique in inguinal hernia mesh repair

Two Laparoscopic techniques are commonly used in hernia repairTotally extraperitoneal (TEP) approach Transabdominal preperitoneal (TAPP) approach.In TAPP, the surgeon enters the peritoneal cavity then incises the peritoneum above the hernia defects, and reflects it away from the muscles, essentially entering the preperitoneal spaceIn TEP, the surgeon is able to create a space just deep to the abdominal muscles without entering the peritoneal cavityRef: Bailey and love 27e pg: 1033


Question: Symptoms or signs of atherosclerotic occlusive disease of the bifurcation of the abdominal aorta (Leriche syndrome) include

The slow progression of aortoiliac atherosclerotic occlusive disease is usually associated with the development of collateral flow through the lumbar branches of the aorta, anastomosing via retroperitoneal branches of the gluteal arteries with the profunda femoris arteries in the legs. This network of collateral vessels provides sufficient blood flow to nourish the extremities at rest but cannot prevent claudication of the upper and lower muscle groups of the leg during exercise. Sexual impotence, also part of the Leriche syndrome, is believed to be a result of bilateral stenosis or occlusion of the hypogastric (internal iliac) arteries. Retrograde ejaculation can occur after disruption of the sympathetic chain overlying the distal aorta and left iliac and can occur after dissection around these vessels during vascular reconstructions. Gangrene of the feet or toes is rarely seen unless distal embolization of atherosclerotic material from the aorta occludes the pedal or digital arteries. Dependent rubor is usually a sign of significant ischemia resulting from lower extremity occlusive and not aortoiliac disease. Causalgia or reflex sympathetic dystrophy is a disorder of the sympathetic nervous system that can affect the upper or lower extremities.


Question: The most common complication of transurethral resection of prostate (TURP)

Retrograde ejaculation is the most common complication of TURP - 65%. It occurs d/t disruption of bladder neck mechanism. Erectile dysfunction accounts for 5% of complications.The routine use of an Otis urethrotomy prior to TURP reduces the incidence of postoperative stricture.Incontinence is inevitable if the external sphincter mechanism is damaged. This occurs following transurethral surgery only if the resection extends beyond the verumontanum Reference : page 1046 SRB's manual of surgery 5th edition and page 1352 Bailey and Love's sho practice of surgery 25th edition


Question: Carcinoembryonic antigen is associated with


Question: Bucket handle type of fractures are seen in


Question: Lines of skin used as guidelines for putting incision


Question: Positive Kehr&;s sign is

Collection of clot under the left diaphragm irritate it and the phrenic nerve causing referred pain to the left shoulder - Kehr&;s sign and there may be associated left-sided fracture of ribs resulting in hemithorax or haemoperitoneum. SRB 5 th edition page no. 670


Question: A 45 year old female is brought to the emergency room with crush injury of thigh following a motor vehicle accident. Best method to prevent gas gangrene is

Answer: a) Thorough wound debridement (HARRISON 19TH ED, P-2077)GAS GANGRENEClostridial myonecrosis/Malignant edema/Anaerobic myositisUsually several species of Clostridia are involved along with E coli, proteus and staphylococciCl perfringens causes 60% of the cases; Most commonly by type ARemaining cases are caused by Cl septicum, Cl novyi and Cl histolyticumThe incubation period can be as short as 6 hours and is usually <4 daysMost important factor needed - low oxygen tensionPain and crepitusPatients frequently develop marked tachycardia, but in temperature may be only minimalNear absence of PMNs despite extensive tissue destruction is characteristicDiagnosisFrozen section biopsy of muscleReverse CAMP test - to identify Cl. perfringensGram staining:G+ bacilli without spores - Cl.perfringensCitron bodies and boat or leaf shaped bacilli - Cl.septicumLarge bacilli with oval or subterminal spores - Cl.novyiTreatmentSurgery debridement of the wound - mainstay of prophylaxis & treatmentClindamycin or metronidazole + penicillinHyperbaric O2Anti-gas gangrene serum - uncertain efficacy, not widely available, rarely used now


Question: The most common site of emboli lodging in lower limb is

In lower limb the most common site of emboli lodging is at the bifurcationof common femoral aery (40%); popliteal aery (15%);common iliac aery (12%); aoic bifurcation (10%).


Question: Most sentitive investigation of pancreatic carcinoma is

Ans. is 'b' i.e., ERCP ERCP is the most sensitive test for detecting pancreatic cancer but CT scan is the inv. of choice. Schwaz writes - "Currently CT is probably the single most versatile and cost effective tool for the diagnosis of pancreatic cancer." CSDT writes - "In patients with a typical clinical history and a pancreatic mass on CT, ERCP is unnecessary. In the absence of a mass, an ERCP is indicated. It is the most sensitive test (95%) for detecting pancreatic cancer though specificity in differentiation between cancer and pancreatitis is low."


Question: The operative procedure known as "microfracture" is done for the

D i.e. Osteochondral defect of femur Chondral & osteochondral fractures (osteochondritis dessicans) present clinically with meniscal symptoms of locking, catching & giving way of the knee. Ahroscopy is investigation of choice and preferred way of treatment All loose & overhanging pieces of cailage must be removed back to a stable base. The base may be drilled, abraded or microfracturedQ to bleeding bone that presumably recruit-pleuripotent stem cells to regenerate cailage. Osteochondral autograft transplant should be considered.


Question: A 45 years old man comes to a dentist with pain in the lower jaw. The dentist diagnoses it as infected last molar and decides to extract it under local anesthesia. After the anesthesia, he extracted the tooth. After this, the patient also notices numbness in the later part of lower lip, chin and the tongue. This is due to infiltration of the


Question: Karydakis procedure is used for

Surgical treatment of chronic pilonidal diseaseLaying open of all tracks with or without marsupialisation, The excision of all tracks with or without primary closure andThe excision of all tracks and then closure by some other means designed to avoid a midline wound (Limberg procedure, Z-plasty, Karydakis procedure)Bascom's procedure involves an incision lateral to the midline to gain access to the sinus cavity, which is rid of hair and granulation tissue, and excision and closure of the midline pitsRef: Bailey and love 27e pg: 1348


Question: Odynophagia occurs ina) Achalasiab) Herpes esophagitisc) Monilial esophagitisd) Barret's oesophagus

Odynophagia means painful swallowing seen in inflammatory lesions of food passage (i.e. oral cavity pharynx & esophagus)
Harrison 16/e writes -

“If odynophagia is present, candidial or herpes esophagitis or pill induced esophagitis should be suspected".

Candidial esophagitis is also known as Monilial esophagitis.


Question: Most common site for carbuncle is

Ans. c (Nape of neck). (Ref LB, 25th /1305)Carbuncle is subcutaneous tissue infection, mostly caused by staphylococci and gas producing organisms in patients with diabetes with nape of neck being classical site for it. Calf is affected mostly in Bazin's disease.


Question: Best treatment of subdural haemotoma in a deteriorating patient

Subdural haematoma is the collection of blood between the dura and arachnoid. types- acute sub, subacute and chronic subdural haematoma acute-it is due to injury to coical veins and often due to laceration of coex of brain. chronic-it is due to rupture of veins causing gradual collection of bloodin sub dural space. treatment acute SDH-antibiotics ,anticonvulsants, surgical decompression is done by craniotomy (i.e; decompressive craniectomy) chronic SDH- standard craniotomy or mini craniotomy or burrhole craniostomy and evacuation of Chronic-SDH fluid is done ,antibiotics,anticonvulsants (Ref: greenberg handbook of neurosurgery, 8th ed, p-895)


Question: Surgical indications in inflammatory bowel diseases are A/E

.if there is any occurrence of extraintestinal complications related to inflammatory bowel disease,that forms an indication for surgical management.Factors preventing spontaneous closure of faecal fistulas * High output > 500 ml/24 hr * Distal bowel obstruction * Sepsis, inflammatory bowel disease. ref:SRB&;s manual of surgery,ed 3,pg no 847


Question: Most commonly used graft for repair of aoa is

Dacron graft A Dacron graft is made out of a man-made (synthetic) polyester material. It is used to replace natural body tissues. Most Dacron grafts are in the shape of a tube to replace or repair blood vessels. A Dacron graft can be used as a stent to repair an aery, blood vessel, or other hollow structure in your body (such as the tube that carries urine) to hold it open. The graft causes very few reactions. It has no harmful chemicals and is easy for our bodies to tolerate. When it is used in blood vessels, our bodies grow a new lining to the graft over time that is like our natural blood vessel linings. Imrovements to Dacron grafts have reduced the risk of graft infection, but infections can still occur.


Question: Procedure of choice for evaluation of an aoic aneurysm

. CT scan is more reliable and precise investigation of choice -gives better information regarding extent on sides or neck,size,dimensions,size and site of the thrombus,calcification,relation of renal aeries ,inflammation and fibrosis and adjacent tissues.MRI may be better only in renal failure patients. Refer page no 198 of SRB's manual of surgery 5 th edition.


Question: The treatment of choice in fistula in ano


Question: Most common symptom of CA head of pancreas

Jaundice is the most common symptom of Ca. Head of pancreas.


Question: A child with bilious vomit and double bubble sign, and mother have polyhydramnios. Diagnosis is

Due to complete stenosis of the 2 and pa of the duodenum at the level ampulla of Vater produces bilious vomiting, 50% associated with maternal polyhydramnios, a plain x-ray reveals 2 foci of gases one in the stomach and other in the duodenum-double bubble sign. Reference SRB edition :5 page :1195,924


Question: Minimum urinary output required to excerete end products of protein metabolism is

The normal urine output is approximately 1500 mL/ day and, provided that the kidneys are healthy . A minimum urine output of 400 mL/day is required to excrete the end products of protein metabolism. Bailey and Love 26th edition Pg : 263


Question: During appendectomy if it is noticed that base of appendix is inflammed then fuher line of treatment is


Question: Most common cause of anorectal abscess is

Anorectal abscess # Usually produces a painful, throbbing swelling in the anal region. The patient often has swinging pyrexia # Subdivided according to anatomical site into perianal, ischiorectal, submucous and pelvirectal # Underlying conditions include fistula-in-ano (most common), Crohn's disesase, diabetes, immunosuppression # Treatment is drainage of pus in first instance, together with appropriate antibiotics # Always look for a potential underlying problem Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1262


Question: Complete resection of thyroid gland on one side while leaving less than 1 g of tissue adjacent to the ligament of berry on opposite side is termed

Total thyroidectomy involves excision of all visible thyroid tissue. Near-total thyroidectomy is complete resection on one side while leaving a remnant of thyroid tissue on the contralateral side, leaving less than 1 g of tissue adjacent to the RLN at the ligament of Berry. Subtotal thyroidectomy leaves a remnant of thyroid tissue bilaterally (4-5gm V shaped tissue). The typical reason to leave a remnant at the ligament of Berry is the pursuit of preservation of the RLN and blood supply to the parathyroids. Thyroid lobectomy typically includes removal of the thyroid isthmus and pyramidal lobe (if present). Thyroid isthmusectomy removes only the isthmus and is infrequently indicated.


Question: Prognosis of melanoma depends ona) Stageb) Depth of melanoma of biopsyc) Duration of growthd) Site

Prognosis of melanoma depends most importantly on staging. The most current staging system (of AJCC) takes into account following factors

depth of invasion (Breslow's thickness) - this is the single most important prognostic factor
ulceration - presence of ulceration carries worse prognosis.
lymph node status
satellite lession
distant metastasis

Other prognostic factor (not included in staging)

Site or anatomic location - people with lesion of the extermities have a better prognosis than people with melanomas of the head & neck or trunk. (feet and mucous membrane also have poor prognosis- Harrison)
Gender -females have better prognosis than males
Histologic type - Lentigo maligna has best prosnosis & acral lentiginous worst.
Old age especially > 60 have poorer prognosis.

Also know
The factor that most closely correlates with local recurrence is primary tumor ulceration (Sabiston 18/e p774)


Question: Specific marker for prostatic cancer is

PSA + DRE is the best method to screen prostate cancer.


Question: Inflammatory carcinoma is classified under

T1<= 2cm T2>2 cm but <= 5cmT3> 5cmT4aExtension to the chest wall (invasion of pectoralis only is not extension to the chest wall)T4bSkin involvement (including peau d'orange) that doesn&;t meet criteria of skin involvementT4cBoth T4a and T4b are presentT4dInflammatory carcinomaRef: AJCC 8th edition


Question: Pleomorphic adenomas arising from the minor salivary glands can be treated with


Question: Antihistamines associated with an increased risk of cardiac arrhythmias in patients receiving erythromycin or ketoconazole include

Terfenadine and astemizole are relatively new, nonsedating antihistamines that may prolong the QT interval of an electrocardiogram and cause cardiac arrhythmias. Erythromycin, ketoconazole, and itraconazole may inhibit the metabolism of terfenadine, resulting in higher blood levels and increased risk of arrhythmia. Loratadine, another nonsedating antihistamine, apparently lacks the QT prolongation effect and no drug interactions with either erythromycin or the antifungal agents listed have been established. Diphenhydramine, clemastine, and chlorpheniramine are also free of these drug interactions. However, many antihistamines have some potential to cause tachycardia and palpitations because of their antimuscarinic activity.


Question: Late deaths in burns is due to

"Following successful resucitation, most acute morbidity and virtually all mortality in severely burned patients are related to infection." - Schwartz
This is because thermal injury causes profound immunosuppression that is proportional to the TBSA of the burn.

Also know

Inspite of the burn patient at significant risk to infection, prophylactic systemic antibiotics are not part of modern burn care, as they do not reduce septic complications and only lead to increased bacterial resistance.


Question: Theirsch graft is

.theriesch graft is thick split skin graft wolfes graft is full thickness graft


Question: 60 yr old male undergoes TURP. After 3 days patient develops altered sensitiveness and drowsiness. Most probable diagnosis is

Water intoxication (also known as TURP syndrome)The absorption of water into the circulation at the time of transurethral resection can give rise to congestive cardiac failure, hyponatraemia and haemolysis. Accompanying this, there is frequently confusion and other cerebral events often mimicking a stroke. The incidence of this condition has been reduced since the introduction of isotonic glycine for performing the resections and the use of isotonic saline for postoperative irrigation.


Question: Yoyo reflux

Answer- A. Duplication of ureterReflux of the urine from one limb of the collecting system to the other limb, rather than down towards the bladder is called yo-yo reflux (saddle reflux)Cause : Duplication of ureters, paial duplication ofureters, duplicate renal pelvis


Question: Nitrogen washout curve is used in

C. i.e. (Functional residual capacity) (62- 63 Anesthesia - Janes - Duke 3rd)Functional residual capacity (RV + ERV)* Measuring FRC is the cornerstone for determining the remainder of the lung volumesThree different technique1. Helium equilibration /dilution2. Nitrogen wash out3. Body plethysmography* Plethysmography is most accurate for determining FRC in patients with COPD and applies Boyles law


Question: A patient presented with Hypovolemeia and Na is 154, The initial treatment includes


Question: Pseudoaerial aneurysm in drug abuser&;s seen in

Pseudoaneurysm is a rare condition arising from disruption in aerial wall with blood dissecting into the tissues around the damaged aery creating a perfused sac that communicates with the aerial lumen. Its incidence is on rise due to increase in endovascular procedures, hemodialysis and intravenous drug abuse. Here we repo an young male who was found by a NGO worker, lying on roadside near a Mandir with a pulsatile inguinal swelling and blood oozing out from it. He was taken immediately to emergency depament of LN Hospital. He was a rickshaw puller and known drug addict. The swelling was diagnosed as pseudo-aneurysm of common femoral aery on clinical examination and by Doppler ultrasonogrphy. He was referred to CTVS depament and admitted there for surgery. In the meanwhile, he collapsed in the hospital toilet and died due to hemorrhagic shock consequent upon rupture of pseudo- aneurysm of femoral aery. Ref: Rutherford vascular surgery 6th edition pvolume II Pgno : 248-249


Question: Patient with head and neck cancer with contralateral Lymphnode of 3 cm size. Nstaging

N0
No nodal metastasis

N1
Single
Ipsilateral
Equal to or <3 cm

N2a
Single
Ipsilateral
3 to 6 cm

N2b
Multiple
Ipsilateral
None > 6 cm

N2c
Single or Multiple
Bilateral or Contralateral
None > 6 cm

N3
Single or Multiple
Ipsilateral, Bilateral or Contralateral
Any node >6 cm


Question: Hellers operation is indicated for

Ans. is 'a' i.e., Achalasia * The most common surgical procedure for achalasia is laparoscopic Heller myotomy, usually performed in conjunction with an antireflux procedure (partial fundoplication); good to excellent results are reported in 62- 100% of cases.


Question: Most Common congenital GI Tract anamoly is

Answer- A. Meckels diveiculumMeckel's diveiculum is a true diveiculum as it has all the 3layers of the intestine.It's the most common congenital anomaly of the gastrointestinal tract


Question: Postmicturition dribbling is due to

Post micturition dribble (PMD) is the term used when an individual describes the involuntary loss of urine immediately after he/she has finished passing urine. This is a common symptom in the ageing male when the bulbar urethra fails to empty itself of urine at the completion of micturition. PMD is a symptom which is not usually remedied by a transurethral resection of the prostate. ref : Bailey and Love 27th ed , chapter 75, pg no 1375

Dribbling decreases in case of urethral stricture

Collection of Urine in U shaped curve of bulb of penis


Question: A 70 year old male , known case of chronic renal failure suffers from a pathological fracture of Rt femur, the diagnosis is

Answer- B. Secondary HyperparathyroidismIn CRF there is secondary hyperparathyroidism which causes pathological fracture.


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

Adson's Test (Scalene Test) Instruction Patient is instructed to take a deep breath and hold it Extend the neck fully Turn face towards the side Inference Maneuver tightens the anterior & middle Scalene muscles thus decreasing the interscalene space & magnifying any pre existing compression Obliteration or diminution of radial pulse suggests the diagnosis Ref: Sabiston 20th edition Pgno :1603


Question: Dermis involved in the

Third degree Full thickness burn Involve all layers of dermis Characterized by hard leathery eschar, that is painless and black, white or cherry red No capillary refilling or pin-prick sensation All dermal and epidermal components are lost Heals only by wound contractures Require excision with skin grafting to heal Ref: Sabiston 20th edition Pgno :506-507


Question: Peyronie's disease is

Ans. c (Curved deformity of erect penis due to fibrous plaque) (Ref. Bailey and Love 25th/pg. 1373)PEYRONIE'S DISEASE (Penile thickening and curvature)# Peyronie's disease is a relatively common cause of deformity of the erect penis.# On examination, hard plaques of fibrosis can usually be palpated in the tunica of one or both corpora cavernosa. The plaques may be calcified.# The presence of the unyielding plaque tissue within the normally elastic wall of the corpus cavemosum causes the erect penis to bend, often dramatically, towards the side of the plaque.# The aetiology is uncertain but it may be a result of past trauma - there is an association with Dupuytren's contracture.- Rx:# Typically self-limiting disease.# Surgery (Nesbitt's operation) may be indicated to correct deformity that interferes with sexual dysfunction# Nesbitt's operation is straightening of penis by placing non-absorbable sutures in corpus cavernosum opposite the plaque.


Question: Pulseless disease is

(C) Takayasu's disease # TAKAYASU'S ARTERITIS (Pulseless disease)> Clinical: Dizziness, syncope Absent upper extremity pulse (pulseless disease) Blood pressure discrepancy between extremities: Low in upper and higher in lower Visual disturbances> Diagnosis: Angiography# Pulses are commonly absent in the involved vessels, particularly the subclavian artery in Takayasu's.> In Giant cell arteritis patients with involvement of the temporal artery, headache is the predominant symptom and may be associated with a tender, thickened, or nodular artery, which may pulsate early in the disease but may become occluded later.


Question: Sphincter of Lutkans seen in

The mucosa of the cystic duct is arranged in spiral folds known as the valves of Heister and the wall is surrounded by a sphincteric structure called the sphincter of Lutkens.The mucous membrane contains indentations of the mucosa that sink into the muscle coat; these are the crypts of Luschka.Ref: Bailey and Love 27th edition Pg: 1188


Question: This investigation to visualize parathyroids is done using

99mTc sestamibi - Parathyroid imaging99mTc peechnetate - Thyroid, Meckel&;s diveiculum99mTc exametazime - Cerebral blood flow imaging99mTc MAG3 - Renal imaging


Question: During Splenectomy in ITP, platelet is infusion given at

Immediately after ligating splenic vein * Patients with extremely low platelet counts (<10,000/mm3) should have platelets available for surgery, but should not receive them preoperatively. * This is because the transfused platelets will get sequestered in the spleen and are lost with splenectomy. * Once the splenic pedicle is ligated, platelets are given to those who continue to bleed.


Question: Maintenance level of Mixed Venous Oxygen Saturation in shock must be

Mixed Venous Oxygen Saturation: - * This is a measure of oxygen returning to hea from body after delivery and extraction by tissues. * Normal Value- 50-70% * In cardiogenic shock and Hypovolemic shock, the tissues takes up more oxygen and hence value is low < 50% * In Septic and Distributive shock , the tissues takes up less oxygen and hence more oxygenated blood returns to hea and hence value is high > 70% Ref:- Surgery Sixer 3rd Edition; Pg num:- 8


Question: "Blueberry muffin lesion" are seen in


Question: Best treatment for gas gangrene

"High-dose penicillin G and clindamycin, along with third-generation cephalosporins, should be given intravenously until the patient's toxicity abates. The mainstay of management is early surgical excision of the necrotic tissue " Bailey and love 26th edition Pg 430


Question: Among the 3 layers of shouldice repair for the inguinal hernia, 2nd layer is by double berating of

Conjoint tendon with reflected inguinal hernia


Question: Vidian Neurectomy is indicated in

Vasomotor rhinitis: increased parasympathetic discharge Vidian neurectomy is done. Ref : SRB&;s 4thE


Question: The ideal time of repair of cleft of hard palate is


Question: Commonest spinal tumour is

Remember: Most Common Spinal tumor - Metastasis Primary spinal tumor - Nerve sheath tumor (Neurofibromas, Schwannoma Extradural tumor - Metastasis Intradural extramedullary - Nerve sheath tumor Intramedullary - Ependymoina Ref : Schwaz surgery 7/e p1891


Question: Most common malignant tumour of parotid is

Mucoepidermoid carcinoma is the most common malignant tumor of the parotid gland and can be divided into low-grade and high-grade tumorsRef: Sabiston, 20e, page no: 830


Question: Most common site for cystic Hygroma

Ans. (a) Lower third of neckRef: Bailey and Love 26th edition, Page 700* Cystic hygroma presents as swelling in posterior triangle in lower part of neck


Question: "Spider leg" deformity in excretory urogram occurs in

polycystic kidney, an autosomal dominant disease, common in females; excretory urogram shows 'spider leg' pattern - elongated and compressed renal pelvis with narrowed and stretched calyces over the cysts. ( Reference: emedicine.medscape.com/aicle/983281-workup )


Question: &;Gas&; in the tissue should be differenciates with

.*clostridial organisms can cause Extensive necrosis of muscle with production of gas (hydrogen sulphide; nitrogen; carbon dioxide) which stains the muscle brown or black. * Usually muscle is involved from origin to inseion. * Often may extend into thoracic and abdominal muscles. * When it affects the liver it causes necrosis with frothy blood--foaming liver, is characteristic..Non clostridial gas producing organisms like coliforms can also cause gas .gangrene. ref:SRB&;S manual of surgery,ed 3,pg no 45


Question: Posterior interosseous nerve is injured in

B i.e. Montegia fracture dislocation Monteggia Fracture Dislocation Fractures between the proximal third of the ulna and the base of olecranonQ combined with an anterior dislocation of the proximal radio ulnar jointQ. - Definition by Monteggia 1814 Bado extended Monteggia's original description to include- any fracture of ulna with associated dislocation of the proximal radio - ulnar (rdio - capitellar) jointQ including trans olecranon fractures in which the proximal radio - ulnar joint remains intact. (New definition) Mn: "3 M" : Monteggia - Medial bone (ulna) fracture - Mountain (upper) radio - ulnar joint dislocation. Bado's Classification Type Direction of radial head dislocation Direction of apex of ulnar shaft fracture angulation I (most common)Q AnteriorQ AnteriorQ II Posterior Posterior III Lateral Lateral IV Anterior - Fracture of both radius & ulna - Radius is fractured in proximal third below the biceptal groove Treatment - The clue to successful treatment is to restore the length of the fractured ulna; only then can the dislocated joint be fully reduced & remain stable In adults it means an operationQ - Rigid anatomical fixation by plating (DCP/LCDCP) is the method of choiceQ. * Posterior interosseous nerve has been most commonly injured nerve in forearm fractures, paicularly in association with Monteggia fracture dislocationQ.


Question: &;Homans' sign is seen in

Signs are seen in DVTHoman's sign: calf pain on dorsiflexion of the footBancroft&;s sign or Moses&; sign: pain is elicited when the calf muscle is compressed These signs are neither sensitive nor specific for the presence of thrombosis, and not done in fear of dislodgment of clotRef: Bailey and Love 27e pg: 281


Question: Dye used in diagnosis of early & late suspected esophageal perforation includes

(A) IohexolCareful endoscopic assessment at the end of any procedure combined with chest X-ray will identify many cases of perforations immediately. If not recognised immediately, early & late suspected perforations should be assessed by a water soluble contrast like Iohexol.[?]Esophageal Perforation:Diagnosis:CXR-Classic Features:Mediastinal Air with or without subcutaneous air. Left-sided pleural effusion; PneumothoraxWidened mediastinum.Radiographic evidence may not be present in early phase of disease.Gastrografin esophagogram (Gold Standard); EndoscopyManagement: Early diagnosis is key; Broad spectrum antibiotics; Surgical Repair CONTRAST MEDIA USED IN RADIOLOGICAL DIAGNOSIS* Dye used in contrast enhanced magnetic resonance angiography (MRA)Gadolinium (GDPA)* Dye used in contrast enhanced MRIGadoliniumCT Scan, DSAMetrizamide (Water soluble organic iodide media)* Myelography & VentriculographyOmnipaque (contains Iohexol)* Dye used in oral cholecystographylopanoic acid (Telepaque); Sodium lopodate (Biloptin)* Dye used in ChromocystoscopyIndigocamine* Dye used in BronchographyDionosil (Propylidone)* Dye used in SialographyNeohydiol (Lipiodol)* Dye used in UrethrographyConray 280 (contains-Meglumine iothalamate) Umbradil viscos* Dye used in FetographyEthkxhl* Dye used in Intravenous cholangiographyBiligraffin(contains Meglumine loglycamate)* Dye used in Splenoportography75% sodium metrizoate (Triozil)* Dye used in ArthrographyCon-ray 280* Dye used in GynaecographyCO2 * Dye used in Angiocardiography coronary arteriographyNiopam 370* Dye used in HysterosalpingographyCon-ray 280 (Meglumine Iothalamate); Urograffm 280* Dye used in Oesophagography (Barium swallow)Gastrografin - Barium 150%w/v.* Dye used in LymphangiographyMethylene blue or Lipiodol ultrafluid* Dye used in IVPCon ray 420 Hypaque* Dye used in for intestinal obstruction / perforationGastrograffin


Question: Investigation using dye to find out stone in salivary gland

Dye used is lipiodol or sodium diatrizoate(Hypaque).24-gauge cannula is passed into either Stenson's duct or Whaon's duct and one ml of the dye is injected into the duct and X-ray is taken. SRB,5th,406.


Question: A young girl presents with primary amenorrhoea, grade V thelarche, grade II pubarche and no axillary hair. The most probable diagnosis is

Testicular feminization syndrome - complete androgen resistance, presents as phenotypic young woman without sexual hair but with normal breast development and primary amenorrhoea Complete testicular feminization is a common form of male pseudohermaphroditism. It is the 3rd most common cause of primary amenorrhea after gonadal dysgenesis and congenital absence of the vagina. The features are characteristic. Namely, a ''woman" is asceained either because of inguinal hernia (prepubeal) or primary amenorrhea (postpubeal). The development of the breasts, the habitus, and the distribution of body fat are female in character so that most have a ''truly" feminine appearance. Axillary and pubic hairs are absent or scanty, but some vulval hairs are usually present. Scalp hairs are that of a normal woman, and facial hairs are absent. The external genitalia are unambiguously female, and the clitoris is normal. The vagina is sho and blind-ending and may be absent or rudimentary. All internal genitalia are absent except for testes that contain normal Leydig cells and seminiferous tubules without spermatogenesis. The testes may be located in the abdomen, along the course of the inguinal canal, or in the labia majora.


Question: In Volkman's ischemia, surgery should be done;


Question: Best treatment for meningioma with low recurrence rate is

The best treatment for meningioma of low recurrence rate is complete tumour resection including resection of underlying bone and associated dura. The constant principles in meningioma resection are the following: If possible, all involved or hyperostotic bone should be removed. The dura involved by the tumor as well as a dural rim that is free from tumor should be resected (duraplasty is performed). Dural tails that are apparent on MRI are best removed, even though some may not be involved with the tumor. Transaerial embolization has become a standard preoperative procedure in the preoperative management. Radiotherapy is mainly used as adjuvant therapy for incompletely resected, high-grade and/or recurrent tumors.

Tumour excision with cyst of dura mater removal

Excision surgery followed by radiotherapy


Question: Coisol level returns to normal ..... after haemorrhage


Question: A patient with spine, chest and abdominal injury in road traffic accident developed hypotension and bradycardia. Most likely reason is

Answer is neurogenic shock. It is usually due to spinal cord injury, which causes dilatation of splanchnic vessels. There will be bradycardia, hypotension, arrhythmias, and decreased cardiac output. Reference : SRB's Manual of Surgery, 6th Edition, page no = 106.


Question: Prognosis in head injury is best given by

Ans. is 'a' i.e. Glasgow coma scale Glasgow coma scale is used to determine the conscious level of the patientIt is based on EVM i.e. Eye Opening, Verbal response & Motor responseA) Eye openingB) Verbal responseC) Motor responseSpontaneous - 4 To Voice - 3 To pain - 2 None - 01Oriented - 5 Confused - 4 Inappropriate words - 3 Incomprehensible sound - 2 None -1Obeys commands - 6 Localises pain - 5 Withdraws (pain) - 4 Flexion (pain) - 3 Extension (pain) - 2 None - 1Ranges from 3 to 15.A score of 7 or less is classed as comaA score of 9 or more excludes coma


Question: Orichidopexy done at

Answer- B. 6 monthsOrichidopexy should be done at 6 months, because spontaneous descend of the testis will not occur after 4 months of age.Best time of orichidopexy is around 6 months.


Question:
A 70 year old patient with history of smoking presents with gross painless
hematuria. Likely diagnosis is

History of smoking, old age and gross hematuria it is likely to be bladder Ca.


Question: Commonest malignancy in renal transplant recipient is

Cancers seen in renal transplant recipients in decreasing order are:

Skin cancer > Lymphoma > Kaposi's Sarcoma > Ca Cervix > Renal tumors > Ca Vulva & perineum.


Question: Least likely to regress spontaneously is


Question: Arrange the incidence of various types of breast cancers in increasing incidence. a. PTEN ( Cowden disease )b. Sporadic breast cancerc. Hereditary breast cancerd. BRCA1e. BRCA2f. Familial breast cancer

Breast cancer Incidence Sporadic breast cancer 65-75 % Familial breast cancer 20-30 % Hereditary breast cancer 5-10 % BRCA1 45 % BRCA 2 35 % p53 ( Li-Fraumeni syndrome ) 1 % STK11/LKB1a (Peutz-Jegherssyndrome), PTENa (Cowdendisease), MSH2/MLH1a ( Muir-Torresyndrome), ATMa (Ataxiatelangiectasia ) Less than 1 % Unknown 20 %


Question: Most common genetic mutation in Ca pancreas

MC genetic mutation in Ca pancreas/ Cholangiocarcinoma - KRAS > p-16 MC genetic mutation in Ca- GB - P53 > K-RAS MC genetic mutation in Ca stomach - P53 > COX - II


Question: The least common organ injured by blast injury is

Ans. (d) StomachRef: Love and Bailey 26th/e p. 430 * In blast injury ear, lung, heart are injured and to a lesser extent gastrointestinal tract occurs


Question: 30 yrs female presented with unilateral breast cancer associated with axilary lymph node enlargement. Modified radical mastectomy was done, fuhur traeatment plan will be

. Chemotherapy in Carcinoma Breast (Indications) * In advanced carcinoma breast as a palliative procedure. * In postoperative period after simple mastectomy in stage III carcinoma breast with fixed axillary nodes. * In inflammatory carcinoma of breast. * In stage IV carcinoma breast with secondaries in bone, lungs, liver. * In premenopausal age group with poorly differentiated tumours. Toxic effects are: Alopecia, bone marrow suppression, cystitis, megaloblastic anaemia, GIT disturbances, nephritis. * Neoadjuvant (primary) chemotherapy is useful in large operable primary tumour to make it amenable for conservative breast surgeries. Post operative radiotherapy and chemotherapy is a must in this situation. * High dose chemotherapy with stem cell rescue is not found to be beneficial by trials in patients with heavy large nodal spread. ref:SRB&;s manual of surgery,ed 3,pg no 487

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


Question: Heimlich valve is used for drainage of

The Heimlich valve(flutter valve)is a small one-way valve used for chest drainage that empties into a flexible collection device & prevents return of gases or fluids into the pleural space.The heimlich valve is less than 13 cm long and facilitates patient ambulation. Reference:SRB's manual of surgery,5th edition,page no:1116.


Question: In upper one third femoral shaft fracture, the displacement of proximal segment is

C i.e. Flexion, abduction and internal rotation

Flexion, abduction and external rotation


Question: CSF otorrhea is caused by

CSF otorrhea is seen in middle cranial fossa fractures.


Question: Most common organism to cause OPSI

Ans (a) Streptococcal pneumoniaRef Sabiston page 1568/20th edition* 50-90% cases of OPSI is due to streptococcal pneumonia.* PPV23 vaccine is given nowadays 2 weeks prior to elective surgery


Question: Preferred incision for abdominal exploration in Blunt injury abdomen is

Adults Upper midline incision extending down across the left of the umbilicus is the preferred incision. But can be extended into the thorax or do horizontal T or extended as needed depending on internal organ injury Paediatric abdomen:- The abdomen is wider with the bladder intra abdominal. Transverse supraumbilical incisions are preferred to veical midline Scars may migrate during growth. Ref.Bailey $ Love;24th edition


Question: Best way to prevent gas gangrene is

.Prevention of gas gangrene * Proper debridement of devitalised crushed wounds * Devitalised wounds should not be sutured. * Adequate cleaning of the wounds with H2O2 and normal saline. * Penicillin as prophylactic antibiotic. ref:SRB&;s manual of surgery,ed 3,pg no 46


Question: FNAC is contraindicated in

(Bleeding disorders): (214-Baily & Love 26th edition; 467-690- H18th)FNAC - generally obtains only a suspension of cells from within a mass* This procedure is minimally invasive, and if positive or cancer it may allow inception of systemic treatment when metastatic disease is evident or it can provide a basis for planning a meticulous and extensive surgical procedureFNAC* Sample accessible sites such as- Breast, thyroid, and superficial lymphnodes* FNAC from deeper and less accessible structures eg- Liver pancreas, kidney and lung is usually assisted by ultrasound or CT guidance* Ultrasound guided trans bronchial FNA - for mediastinal masses and transmucosal FNA for submucosal gastrointestinal lesions or perivisceral lesionsAdvantages - simplicity of the procedure and the low rate of complications


Question: The most common clinical pattern of basal cell carcinoma is


Question: Positive Kehrs sign is


Question: Most common indication for Liver Transplant in paediatric Patients is

* MC indication for Liver transplant in Children- Biliary atresia * MC indication for Liver transplant in Adults - HCV induced cirrhosis * MC metabolic indication for Liver transplant- Alpha 1 AT deficiency Ref:- Surgery Sixer 3rd Editio; Pg num:- 153


Question: Hyperextensibility with normal elastic recoil is a feature of aEUR'

Ehlers Danlos syndrome Ehlers - Danlos syndrome (EDS) Ehler's danlos syndrome comprise a clinically and genetically heterogenous group of disorder that result from some defect in the synthesis or structure of fibrillar collagen. The basic abnormality in Ehler's Danlos syndrome (EDS) is some defect in the synthesis or structure of collagen Biosynthesis of collagen is a complex process It involves numerous structural collagen genes or enzymes. Which are used in post transcriptional modification of collagen. Therefore it can be disturbed by no. of genetic errors that may affect any of the numerous genes or enzymes necessary for collagen synthesis. At the molecular level, a variety of defects, varying .from mutations involving structural genes or collagens to those involving enzymes that are responsible for post transcriptional modification of mRNA have been detected. Such molecular heterogenecity result in expression of EDS as a clinically variable disorder with several patterns of inheritance. On the basis of clinical and molecular characteristics six variants of Ehler's Danlos syndrome have been identified. The common thread in all forms of EDS is some abnormality in the synthesis of collagen. Clinical features - As might be expected tissues rich in collagen such as skin, ligaments and joints are frequently involved. - Because the abnormal collagen fibre lacks adequate tensile strength, skin is hyper extensible and the joints are hypermobile. The skin is extraordinarily stretchaeble, extremely fragile and vulnerable to trauma. - Minor injuries produce gaping defects and surgical repair or intervention is accomplished with great difficulty because of the lack of normal tensile strength. - The defect in connective tissue may lead to serious internal complications which include:? - Rupture of the colon and large aeries - Occular.fragility with rupture of cornea and retinal detachment - Diaphragmatic hernia EQS type Gene defect Inheritance Clinical findings Classical Defect in type V collagen Mutation in COL5A gene Autosomal dominant Skin and joint hypermo? bility, atrophic scars, Easy bruising Hypermobility Unknow Autosomal dominant Joint hypennobility, pain, dislocations Vascular Defect in collagen type 111 Autosomal The skin, aerial or Collagen ill is abundant in Blood vessels and intestine ( *.. severe defect of these organs dominants uterine rupture, bru? ising, small joint hyperextensibility Kyphoscoliosis Reduced level of lysyl hydroxylase essential for cross linking of collagen fibres Autosomal recessive Hypotonia, joint laxity, congenital scoliosis, ocular fragility Ahrochalasia - Defect in conversion of Autosomal Severe joint hypenno? Procollagen to collagen - Results from mutation in COL IA, and COL1 A2 dominant bility, skin changes mild, scoliosis, bruising Dermatospra- xias Mutation in the procollagen N peptidase gene. Autosomal Recessive Severe skin fragility, cutis laxa, bruising Cutis laxa The inelastic hyperextensible skin fails to resume its normal shape after stretching and hence appears pendulous. Therefore affected newborn infants appear "prematurely aged". The skin abnormality is most prominent around eye, face neck. Therefore patients with cutis laxa have characteristic facial features including an aged appearance with sagging jaws (blood hound appearance) a hooked nose with eveed nostrils, a sho columella, a long upper lip and eveed lower eyelids. Hypermobility of the joint is not present. Pseudoxanthoma elasticum It is a rare group of disorders affecting the elastic tissue. It primarily affects the dermis, retina, and cardiovascular system. The skin has characteristic "plucked chicken skin" appearance. - It tends to loose its elastic recoil when stretched.


Question: Platlets can be stored at


Question: Malignant pustule is characteristic feature of


Question: Ruptured tendon is most commonly seen in

C i.e. Overuse Most frequent cause of paial or complete rupture of a muscle or tendon is eccentric overloadQ of the muscle tendon unit. One factor contributing to muscle overload is fatigue (due to over use)Q, which makes the muscle unable to absorb as much as eccentric force before overload. Strains most commonly occur in muscles that cross two joints, muscles that have higher % of type II fast twitch muscle fibers, and weaker muscle of an agonist antagonist muscle group. eg hamstring, gastrocnemius & rectus femoris. Achiles tendon rupture commonly occurs to otherwise healthy men b/w the ages of 30 & 50 years who have no previous injury or problem repoed in affected leg; typically "weekened warrious" who are active intermittently. Most TA tears occurs in left leg in the substance of TA, - 2- 6 cm - the watershed zone - above the caleaned inseion of tendon (d/t right handed more commonly push off with left foot) The most common mechanism of injury include sudden forced plantar flexion of foot unexpected dorsiflesion of foot, & violent dorsiflexion of planter flexed foot. Other mechanism indude direct trauma & less commonly, attrition of the tendon as a result of long standing peritenositis with or without tendinosis that body is unable to repair.


Question: The histopathologic feature of medullary carcinoma of thyroid is


Question: Cushing's disease is characterized by

Increased serum ACTH and serum coisol * Regardless of etiology all cases of endogenous Cushing's syndrome are due to an increased production of coisol by the adrenal gland. * In most cases, cause is bilateral adrenal hyperplasia due to hypersecretion of pituitary ACTH or ectopic production of ACTH by a nonpituitary source. * The incidence of pituitary-dependent adrenal hyperplasia is three times greater in women than in men. * The primary defect is a pituitary adenoma, as tumor is found in >90% of patients with pituitary-dependent adrenal hyperplasia. * Alternatively, the defect may occasionally reside in the hypothalamus or in higher neural centers, leading to a release of CRH inappropriate to the level of circulating coisol. * This primary defect leads to hyperstimulation of the pituitary, resulting in hyperplasia and tumor formation. * Most individuals with hypersecrete tion of pituitary ACTH are found to have a microadenoma (<10mm) in diameter and macroadenoma (>10 mm). * Traditionally, only an individual who has an ACTH producing pituitary tumor is defined as having Cushing's disease, where Cushing's syndrome refers to all causes of excess coisol: exogenous ACTH tumor, adrenal tumor, pituitary ACTH-secreting tumor, or excessive glucocoicoid treatment.

Decreased serum ACTH and increased serum coisol


Question: Sebaceous cyst does not occur in the ...................................

• Epidermoid cyst results from proliferation of epidermal cells within a circumscribed space of dermis (which had got implanted within the dermis)
• Sebaceous cyst is a misnomer as the cysts are not of sebaceous origin and the white creamy material filled within is not sebum, but is keratin (desquamated epithelial cells)
• Type of retention cyst (secretions are pent up in a gland owing to blockage of the duct)
Pathology
• Cyst wall consist of a layer of epidermis oriented with the basal layer superficial and more matured layers are deep.
• Desquamated cells (keratin) collect in the centre and form creamy substance of the cyst.
Clinical Features
• Usually asymptomatic, unless get infected or inflamed and become painful
• Firm, round, flesh colored to yellow or white subcutaneous nodules of variable size.
• Central punctum may teether the cyst to the overlying epidermis, from which the white creamy material can be expressed.
• Rarely malignancies (BCC, SCC) can develop in epidermoid cyst.
• No punctum in scrotal and scalp sebaceous cyst.
Treatment
• Excision with the wall is treatment of choice.
• Infected cyst: Incision and drainage (After resolution of the abscess, cyst wall must be excised to prevent recurrence)


Question: Most common location of extradural hematoma is

The most common site is temporal, as the pterion is not only the thinnest part of the skull but also overlies the largest meningeal artery –the middle meningeal. An EDH may also occur in other regions such as frontal as well as in the posterior fossa.


Question: Berger flap procedure is used for


Question: In the Forrest classification for bleeding peptic ulcer with a visible vessel or pigmented protuberance is classified is

Forrest Ia- spuing and bleeding, Forrest IIa - a visible vessel with ted or blue protrusion or pulsatile pseudoaneurysm, Forrest IIb - non-bleeding ulcer with clot overlying, Forrest IIc- ulcer with haematin base. SRB edition:5 page no.834


Question: Water hammer pulse seen in

Aoic regurgitation Water hammer pulse It is a large bounding pulse, associated with increased stroke volume of the left ventricle and decrease in the peripheral resistance, leading to a wide pulse pressure. The pulse strikes the palpating finger with a rapid, forcefid jerk and quickly disappears. It is best felt in the radial aery with the patients arm elevated. It is seen in Aoic regurgitation. Pathophysiology of water hammer pulse In Aoic regurgitation the stroke volume is high, so the systolic pressure is high and this is responsible for sharp rise in the pulse. The stroke volume is high because the left ventricle gets blood from two sources during the diastole i.e. blood leaking from the Aoa and the blood it receives from left atria. The collapse occurs because Diastolic leak of blood into the left ventricle from the Aoa Rapid run off to the periphery as a result of low systemic vascular resistance (the increased cardiac output stimulates the baroreceptors in the aoic arch and the result is reflex vasodilatation of the peripheral vessels into which the blood flows rapidly). Wiry are arms elevated in the examination ? When the arm is raised there is fall of blood column resulting in vasodilation and thus helps to reduce the diastolic pressure more, so the pulse pressure widens. It may be so that the aery palpated becomes more in the line of Aoa after elevation of the arm and thus allows the direct systolic ejection and diastolic backward flow.


Question: Most common site of minor salivary gland tumor


Question: Following genetic counselling in a family for Familial polyposis coli (FPC) next screening test is

Ans. is 'd' i.e. APC gene Schwartz writes - "Flexible sigmoidoscopy of first-degree relatives of FAP (Familial adenomatous polyposis) patients beginning at age 10 to 15 years has been the traditional mainstay of screening. Today following genetic counselling, APC gene testing may be used to screen family members providing an APC mutation has been identified in a family member."Familial adenomatous polyposis (FAP) is a dominantly inherited colon cancer syndrome due to germline mutations in the adenomatous polyposis coli (APC) tumor suppressor gene on chromosome 5.Patients with this syndrome develop hundreds to thousands of adenomas in the colon which if left untreated will eventually develop into colon cancer.Each of the FAP adenomas has lost the normal remaining allele of APC gene but has not yet accumulated the required additional mutations to generate fully malignant cells. In due course of time many of these adenomas acquire further genetic abnormalities and develop into fully malignant cancers. APC gene is thus considered to be a gatekeeper for colon tumorigenesis.The detection of APC gene mutation in family members of a FAP patient helps in making a definitive diagnosis before the development of polyps.So APC gene testing is used to screen family members


Question: Shape of post traumatic Epidural hematoma is

(A) Biconvex hyperdense > Epidural hematoma. Head CT after traumatic brain injury reveales a classic biconvex hyperdensity diagnostic of an epidural hematoma (arrow). There is mass effect and midline shift to the left.> Epidural Hematoma: The CT classically will show a hyperdense lesion (hematoma) that is biconvex or lens-shaped secondary to its position between the dura and the skull.


Question: The pain in the lateral thigh and pubic regions continues to be intense and unremitting. The patient is admitted to the hospital for observation and possible surgical intervention. Given this paicular pattern of renal colic and the anatomy of the renal system, it is suspected that a stone has stopped moving and is lodged.

The ureters narrow at the renal pelvis, at the pelvic brim, where they cross the iliac vessels and enter the deep pelvis, and at the urinary bladder. Thus, the probability of a nephrolith lodging in the ureter at the pelvic brim is high and is confirmed by the pattern of referred pain.

At the junction of the renal pelvis and ureter

Midureter as it passes beneath the gonadal vessels

In the intramural poion of the ureter where it penetrates the bladder


Question: In follow up of BPH, most impoant indication of surgery is

Indications for surgery in BPH are: * Prostatism *Acute retention of urine *Chronic retention of urine with residual urine > 200ml*Complications like hydroureter, hydronephrosis, stone formation, recurrent infections, bladder changes.*HematuriaReference : page 1045 SRB's manual of surgery 5th edition

Single episode of UTI requiring 3 day antibiotics


Question: Not a feature of deep burn is


Question: Knife used for harvesting split thickness skin grafts is


Question: A 60 yr old chronic smoker presents with painless gross hematuria of 1 day duration. Investigation of choice to know the cause of hematuria

Urine microscopy for malignant cytology "Painless haematuria is by far the most common symptom of bladder cancer and should be regarded as indicative of a bladder carcinoma until proven otherwise." Bailey & Love 25/e p1336 (24/e p1363) Cigarette smoking is the main etiological factor and accounts ,for about 50% of bladder cancers Among the given options 'urine microscopy' is the best choice for investigating a pt. with high suspicion for bladder ca. This is not a good screening test but a positive result is highly specific. The best investigation would be cystoscopy & biopsy. Investigations for bladder cancer 1. Urinary cytology - Exfoliated cells from both normal and neoplastic urothelium can be readily identified in voided urine. Examination of cytological specimens can detect the malignant cells either at the time of initial presentation or during follow-up. Cytological examination may be especially useful in screening high-risk population and assessing the response to treatment. 2. Cystourethroscopy and tumor resection - The diagnosis and initial staging of bladder cancer is made by cystoscopy and transurethral resection. 3.Imaging (IVP, CT, MRI) - Although various imaging techniques can detect bladder cancer, its presence is confirmed by cystoscopy & biopsy. - Therefore imaging modalities are used to image the upper urinary tract and, when infiltrating bladder tumors are detected to assess the depth of muscle wall infiltration and the presence of local & distant metastasis. - Intravenous urography remains one of the most common imaging tests for the evaluation of hematuria. However, intravenous pyelography is increasingly being replaced by computed tomography (CT) urography, which is more accurate, for evaluation of the entire abdominal cavity, renal parenchyma, and ureters in patients with hematuria. Bladder tumors may be recognized as pedunculated, radiolucent filling defects projecting into the lumen; nonpapillary, infiltrating tumors may result in fixation or flattening of the bladder wall. 4. Urinary tumor markers - - Several new tests have been developed in order to overcome the shocomings of urinary cytology such as the low sensitivity for low-grade superficial tumors and inter-observer variability. - Commercially available tests include, the BTA test, the BTA stat test, the BTA TRAK assay determination of urinary nuclear matrix protein (NMP22), Immunocyt and UroVysion . - These tests can detect cancer specific proteins in urine (BTA/NMP22) or augment cytology by identifying cell surface or cytogenetic markers in the nucleus. Other tests under investigation include identification of the Lewis X antigen on exfoliated urothelial cells, and the determination of telomerase activity in exfoliated cells. - These tests have been demonstrated to enhance detection of bladder cancer when used either individually or in combination with cytology. They have been used to detect both new index tumors as well as recurrent tumors.

Urine microscopy for malignant cytology cells


Question: Most common cause of death in electric AC current burns is

Cardiac arrythmias are usually cause of death. ECG required in all electric burns pts.


Question: Treatment of squamous cell carcinoma of anal canal is

Cancers of the anal canal can be divided into those affecting the anal margin (distal to the dentate line) and those affecting the anal canal (proximal to the dentate line)
Treatment of Anal Epidermoid or squamous cell Ca

Ca of anal margin is treated in similar way to the squamous cell ca of the skin in other locations because adequate surgical margins can usually be achieved without resecting the anal sphincter → wide local excision is adequate.
Epidermoid cancer occurring in the anal canal cannot be excised locally without destroying the sphincter so the first line therapy is → chemoradiotherapy (Nigro protocol)
More than 80% are cured by chemoradiation. If any residual tumor is left behind after chemo radiation or recurrence occurs →an abdominoperineal excision is performed.
Chemotherapy used is combination of 5FU (5-fluorouracil) and mitomycin C

Cisplastin based chemotherapy followed by radical radiotherapy

Radical radiotherapy followed by mitomycin-c based chemotherapy.


Question: Commonest site of oesophagus carcinoma is

OESOPHAGEAL CARCINOMA,6 th most common carcinoma in the world, can be predisposed to dietary deficiencies, human papillomavirus infections, achalasia cardia, oesophageal webs etc.it is most commonly seen in middle third of oesophagus (50%)and also at lower third(33%) and upper third(17%).in the lower part adenocarcinoma is common .in India 90%are squamous carcinomas.dysphagia, regurgitation, anorexia, loss of weight, ascites, palpable left supraclavicular lymph nodes are the clinical features.


Question: Most common complication of amoebic liver abscess is

Rupture into peritoneal cavity is the most common complication.


Question: In the management of symptomatic Benign Prostatic Hyperplasia with finasteride the period of trial required for determining a satisfactory response is

Finasteride is 5-alpha reductase inhibitor which inhibits conversion of testosterone to dihydrotestosterone. It is effective in palpably enlarged prostate(>50g). 5mg is used daily for at least 6 months for satisfactory response. It has fewer side effects. It is contraindicated in obstructive uropathy or carcinoma prostate.Reference : page 1047 SRB&;s manual of surgery 5th edition and page 1350 Bailey and Love&;s sho practice of surgery 25th edition


Question: Paradoxical aciduria (the excretion of acid urine in the presence of metabolic alkalosis) may occur in the presence of

The body has elaborate mechanisms to compensate for metabolic acidosis. Not only do most body functions work better in an acidotic state, the patient is able to move toward correction of the pH by excreting acid urine and by hyperventilating to "blow off" carbonic acid. On the other hand, we are poorly equipped to deal with metabolic alkalosis. We cannot hold our breath to save acid since the respiratory center overrides our efforts as the PaCO2 rises and the PaO2 falls. The kidney cannot make urine under any circumstance that is very far above normal pH. In the subtraction alkalosis that accompanies gastric outlet obstruction with loss of gastric acid by vomiting or suction, the potassium depletion and volume deficits provoke exchange of sodium for hydrogen ion in the distal tubule with resultant exacerbation of the metabolic alkalosis. All the other conditions listed would be expected to produce acidosis; consequently, acid urine would not be paradoxical.

Release of inappropriate antidiuretic hormone


Question:
A complication in the first 48 hours of total parenteral
nutrition is


Question: Most common Morphological difference between Ulcerative Colitis and Crohn's disease

Ref:- Bailey and Love 27th Edition; Pg num:- 1268


Question: Ca prostate most common metastasis to

Answer- C. Lumbar spineMost common metastatic sites of prostate carcinoma are lymph nodes & bones.Lymphatic metastasis occurs most commonly to - obturator lymph nodes.Most common site of bony metastasis is lumbar spine.


Question: Guaiac test is used for

• Based on the property of an organic compound, guaiac, to turn blue after oxidation by oxidants, peroxidases, or the pseudoperoxidase of hemoglobin in the presence of an oxygen donor such as hydrogen peroxide.
• Guaiac tests are more sensitive for detecting bleeding from the lower than from the upper GI tract because hemoglobin (and its pseudoperoxidase activity) is degraded as it moves down the GI tract.
• Fecal hemoglobin levels must exceed 10 mg/g (blood loss of 10 ml daily) for 50% of Hemoccult II tests to be positive.


Question: Commonest cause of ureteric injury during surgical operation is

Surgical trauma during pelvic surgery is the most common cause of ureteric trauma This occurs most often during vaginal or abdominal hysterectomy when the ureter is mistakenly divided, ligated, crushed or excised. Pre-emptive ureteric catheterisation makes it easier to identify the ureters. ( ref : Bailey 27th ed , chap 76 , pg no 1415 )


Question: After removal of the parotid gland, patient is having sweating on the cheeks while eating. The nerve involved in this phenomenon

Frey's syndrome (gustatory sweating) results from damage to the autonomic innervation of the salivary gland with inappropriate regeneration of the postganglionic parasympathetic nerve fibres of the auriculotemporal nerve that aberrantly stimulate the sweat glands of the overlying skin. The clinical features include sweating and erythema (flushing) over the region of surgical excision of the parotid gland as a consequence of autonomic stimulation of salivation by the smell or taste of food.Demonstrated by a starch-iodine test.Ref: Bailey and love, page no: 795


Question: In the blood bank, platelets are stored at


Question: Most common paraneoplastic syndrome in HCC

Ans. (a) HypoglycemiaRef: Sabiston 20th edition page 1459Paraneoplastic Syndrome:* Less than 1% cases present with paraneoplastic syndrome most commonly Hypercalcemia, Hypoglycemia, Erythrocytosis.* Hyper Cholesterolemia is the MC Paraneoplastic Syndrome > Hypoglycemia.


Question: Most impoant prognostic factor for colorectal carcinoma is

.Secondaries are said to be precocious, wherein liver secondary is first identified, later the primary site is detected (carcinoid tumour/colorectal carcinoma). When primary and liver secondaries are identified at the same time it is called as synchronous secondaries (carcinoma stomach). ref:SRB&;S manual of surgery,ed 3,pg no 545


Question: A patient at 17 weeks gestation is diagnosed as having an intrauterine fetal demise. She returns to your clinic 5 weeks later and has not had amiscarriage, although she has had some occasional spotting. This patient is at increased risk for

(Gleicher, 3/e, p 1153.) In modern clinical medicine, once the diagnosis of fetal demise has been made, the products of concep tion are removed. If, however, the gestational age is over 14 weeks and the fetal death occurred 5 weeks ago, coagulation abnormalities may be seen. Septic aboions were more frequently seen during the era of illegal aboions, although occasionally sepsis can occur if there is incomplete evacuation of the products of conception in either a therapeutic or spontaneous aboion.

Consumptive coagulopathy with hypofibrinogenemia


Question: Absolute contraindication of conservative breast cancer therapy is

Ans. is 'b' i.e. History of previous radiation Conservative breast cancer management: Absolute Contraindications Pregnancy is an absolute contraindication to the use of breast irradiation. However, in many cases, it may be possible to perform breast-conserving surgery in the third trimester and treat the patient with irradiation after delivery. Women with two or more primary tumors in separate quadrants of the breast or with diffuse malignant-appearing microcalcifications are not considered candidate for breast conservation treatment. A history of prior therapeutic irradiation to the breast region that would require retreatment to an excessively high total-radiation dose to a significant volume is another absolute contraindication. Persistent positive margins after reasonable surgical attempts. Relative Contraindications A history of collagen vascular disease is a relative contraindication to breast conservation treatment because published repos indicate that such patients tolerate irradiation poorly. Most radiation oncologists will not treat patients with scleroderma or active lupus erythematosus, considering it an absolute contraindication. In contrast, rheumatoid ahritisis not a relative or an absolute contraindication. The presence of multiple gross tumors in the same quadrant and indeterminate calcifications must be carefully assessed for suitability because studies in this area are not definitive. Tumor size is not an absolute contraindication to breast conservation treatment, although there is little published experience in treating patients with tumor sizes greater than four to five cm. However, a relative contraindication is the presence of a large tumor in a small breast in which an adequate resection would result in significant cosmetic alteration. In this circumstance, preoperative chemotherapy should be considered. Breast size can be a relative contraindication. Large pendulous breast is a relative contraindication, as it presents difficulty in delivering a uniform radiation dose. Centrally located tumor for which removal of the nipple areola complex is required to obtain a tumor free margin is a relative contraindication. It depends on patient acceptability. The nipple and areola can now be reconstructed.


Question: Breast Ca most important prognostic factor

"Metastasis to ipsilateral axillary nodes predicts outcome are surgery more powerfully than tumor size does”.
“The single most important predictor of 10 and 20-year survival rates in breast cancer is the number of axillary lymph nodes involved with metastatic disease”.


Question: The following is a marker of Paget's disease of the mammary gland

Ans is 'c' ie CEA Paget's ds is a chronic eczematous disease on the skin of the nipple and the areola , with an associated intraductal carcinoma of the underlying mammary gland. Pathophysiology: The pathogenesis of mammary PD and the origin of Paget cells were once controversial. It is now widely accepted as an underlying intraductal carcinoma of the breast with retrograde extension into the overlying epidermis through mammary duct epithelium. Malignant epithelial (Paget) cells infiltrate and proliferate in the epidermis, causing thickening of the nipple and the areolar skin. Paget cells often express cell markers that mimic those of the underlying breast carcinoma, including glandular epithelial cell markers (ie, low-molecular-weight cytokeratins, or CAM 5.2). They also express tumor markers, including carcinoembryonic antigen (CEA); Ca 15-3 (milk fat globule protein); some oncogenes (TP53, c-erb B-2); and other cell markers, such as epithelial membrane antigen (EMA) and gross cystic disease fluid protein (GCDFP-15) that are found in tumor cells of ductal carcinoma of the breast.


Question: 'Hippocrates facies' are seen in

Ans. A. Peritonitis. (Ref. Bailey and Love 26th/pg. 973; Fig. 61.6)Diffuse (generalised) peritonitis# Diffuse (generalised) peritonitis may present in differing ways dependent on the duration of infection.# Early- Abdominal pain is severe and made worse by moving or breathing.- It is first experienced at the site of the original lesion and spreads outwards from this point. Vomiting may occur. The patient usually lies still. Tenderness and rigidity on palpation are found typically when the peritonitis affects the anterior abdominal wall. Abdominal tenderness and rigidity are diminished or absent if the anterior wall is unaffected, as in pelvic peritonitis or, rarely, peritonitis in the lesser sac. Patients with pelvic peritonitis may complain of urinary symptoms; they are tender on rectal or vaginal examination. Infrequent bowel sounds may still be heard for a few hours but they cease with the onset of paralytic ileus.- The pulse rises progressively but, if the peritoneum is deluged with irritant fluid, there is a sudden rise. The temperature changes are variable and can be subnormal.# Late- If resolution or localisation of generalised peritonitis does not occur, the abdomen remains silent and increasingly distends.- Circulatory failure ensues, with cold, clammy extremities, sunken eyes, dry tongue, thready (irregular) pulse and drawn and anxious face (Hippocratic facies). The patient finally lapses into unconsciousness. With early diagnosis and adequate treatment, this condition is rarely seen in modem surgical practice.Additional Educational points:Clinical features of an abdominal/pelvic abscess# Malaise, Sweats with or without rigors, Abdominal/pelvic (with or without shoulder tip) pain, Anorexia and weight loss, Symptoms from local irritation, e.g. hiccoughs (subphrenic), diarrhoea and mucus (pelvic), Swinging pyrexia, and Localised abdominal tenderness/mass.


Question: Commonest type of mesentric cyst is


Question: Histological variety of breast carcinoma with the best prognosis is

Special-type breast cancer and accounts for 2% of all invasive breast cancers. Distant metastases are rare in tubular carcinoma with long-term survival approaches 100%.


Question: Best tome for surgery of hypospadias is

Best time for suegery of hypospadias is 6 - 18 months > 6 - 10 months of age.


Question: Least common quadrant of cancer breast

Ans. (d) Lower Inner Quadrant* MC site - Upper outer (60%)* Central/areolar (12%)* Upper Inner (12%)* Lower Outer (10%)* Least Common site - Lower Inner (6%)


Question: In patient of head injuries with rapidly increasing intracranial tension without hematoma, the drug of choice for initial management would be

Mannitol Mannitol is widely used to reduce ICP Commonly used preparation : 20% solution, 0.25-1 gm/kg is given IV as bolus Serum osmolality should not be allowed to go >320 mOsm/L, to avoid systemic acidosis and renal failure. Uses of mannitol To reduce increased ICT or intra ocular tension To maintain GFR and urine flow in impending renal failure Forced diuresis in hypnotic or other poisoning To counteract low osmolality of plasma/ECF due to rapid hemolysis or peritoneal dialysis Contraindications of Mannitol Acute Tubular Necrosis Anuria Pulmonary edema Acute left ventricular failure CHF Cerebral hemorrhage Ref :Harrison's 19th edition Pgno :1779-1780


Question: Cocket and Dodd’s operations for


Question: Post TURP altered sensorium cause

Water intoxication Absorption of water into the circulation at the time of trans urethral resection can give rise to congestive cardiac failure, hyponatraemia and haemolysis. Accompanying this, there is frequently confusion and other cerebral events often mimicking a stroke. The incidence of this condition has been reduced since the introduction of isotonic glycine for irrigating during resection, and fuher still with the development of bipolar TURP where saline is used as an irrigant. The treatment con-sists of fluid restriction. Ref: Bailey and love 27th edition Pgno : 1467


Question: A case of acute cholecystitis now presents with acute pain sharp going to the back diagnosis

Ans. (a) Acute pancreatitisRef: Sabiston 20th edition Page 1496 Gall stone pancreatitis:* As GB stone passes the common channel it irritates the Pancreatic system and causes pancreatitis.* Patient's will have continued back pain even after stone passes.* Most cases of gall stone pancreatitis settles by conservative management.* If symptoms do not resolve we do ERCP and Sphincterotomy.* Dilated CBD and CBD stone gives suspicion of Gallstone pancreatitis.* Patient should be operated in same admission before discharge- Laparoscopic cholecystectomy* During surgery Intra op Cholangiogram is done to rule out CBD stones.


Question: Follicular carcinoma of thyroid is mostly due to mutation of

Mutations in HRAS, KRAS, or more commonly NRAS occur in 25% of FTCs, 15% of PTCs (almost always the follicular variant of PTC), and 5% of follicular adenomas. Follicular thyroid is also associated with PAX8-PPARg. PAX8-PPARg appears to be confined to atypical follicular adenomas and FTC, and has not been detected in PTC or either poorly differentiated or undifferentiated (anaplastic) thyroid carcinomas RET and NTRK1 or more common in papillary thyroid cancer. Source : Devita principles of oncology 10th edition Pg: 1172


Question: Cortisol level returns to normal after haemorrhage


Question: Stapler used for MIPH

.. Stapled haemorrhoidopexy (Antonio Longo) is circumferential excision of the mucosa and submucosa 4 cm above the dentate line using circular haemorrhoidal stapler passed per anally (MIPH - Minimally Invasive Procedure for Haemorrhoids). Advantages are--It is less painful; less blood loss; faster recovery; sho hospital stay and equally efficacious. It is done only for prolapsed piles. Improper purse string can cause incomplete doughnut leading to severe haemorrhage. ref:SRB&;s manual of surgery,ed 3,pg no 910


Question: Treatment of garre's osteomyelitis is


Question: A 55 year old male presented with painless terminal hematuria. Cystoscopic examination revealed a solitary papillary tumor. Histopathological examination of completely resected tumor is suggestive of grade transitional cell carcinoma with no muscle invasion. fuher management of this patient is best done by

Ans. is 'c' i.e., Intravesical BCG Management of bladder cancer Cystoscopy and transurethral resection or biopsy - initially, any pt. with hematuria is examined by cystoscopy and any tumor seen is removed by transurethral resection (if possible) or biopsied. Fuher treatment decisions are made after tumor staging on histology. Such decisions are based on tumor stage (TNM), grade, size, multiplicity, and recurrence pattern. First see the staging (TNM) The primary bladder cancer is staged according to the depth of invasion into the bladder wall or beyond The urothelial basement membrane separates superficial bladder cancers into Ta (noninvasive) and T1 (invasive) tumors. The muscularis propria separates superficial disease from deeply (muscularis propria) invasive disease. Stage T2 and higher T stage tumors invade the muscularis propria, the true muscle of the bladder wall. If the tumor extends through the muscle to involve the full thickness of the bladder and into the serosa, it is classified as T3. If the tumor involves contiguous structures such as the prostate, the vagina, the uterus, or the pelvic sidewall, the tumor is classified as stage T4.


Question: Young's operation of Penile cancer is

Total amputation of penis with Bilateral ilio - inguinal Block dissection

Total amputation of penis with Unilateral ilio - inguinal Block dissection

Partial amputation of penis with Bilateral ilio - inguinal Block dissection

Partial amputation of penis with Unilateral ilio - inguinal Block dissection


Question: Not associated with fat necrosis

.Radiotherapy is used in bone metastasis, brain secondaries, to prevent paraplegia in spine involvement, and advanced axillary nodes. It is also used in painful bone secondaries,in case of carcinoma of breast. ref:SRB&;S manual of surgery,ed 3,pg no 455


Question: Cartridges should not be permitted to soak in alcohol because it

Diffuses though rubber cap causing contamination


Question: Ophthalmic findings in vitamin B12 deficiency are

* Vitamin B12 deficiency causes optic neuropathy and impaired acuity and central scotoma * Annular or ring shaped scotoma is a typical features of Retinitis pigmentosa


Question: Damage control surgery is

Minimal intervention dose to stabilize the patient and do the definitive surgery later

Maximum possible surgical intervention is done immediately


Question: Reverse 8 sign of frost berg seen in

Reverse 3 sign of frost berg seen in ampullary carcinoma of pancreas.


Question: Revascularization of skin graft occurs after


Question: Conn's syndrome is

Primary hyperaldosteronism (Conn's syndrome ) is defined by hypeension, as a result of hypersecretion of aldosterone. In PHA, plasma renin activity is suppressed.The most frequent cause of Primary hyperaldosteronism is a unilateral adrenocoical adenoma. Apa from hypeension, patients complain of non-specific symptoms: headache, muscle weakness, cramps, neurological events, polyuria, polydypsia, and nocturia.Ref: Bailey and Love 27e pg: 841


Question: Ulcer with undermined edges is seen in

Tubercular ulcers typically have undermined edges. Reference: Bailey & Love&;s Sho Practices of Surgery 27th Edition, Page no. 78


Question: The most common symptom seen in a paraoesophageal hernia is

Most common symptoms attributed to para oesophagal hernia are gastroesophageal obstructive symptoms, including dysphagia, odynophagia, and early satiety Reference: Sabiston 20th edition page: 1083


Question: Secondary osteosarcoma are associated with

Answer- A. Paget's diseaseCauses of secondary osteosarcomaPagets DiseaseFibrous dysplasiaEnchondromatosisHereditary multiple exostosisRadiationChronicosteomyelitisBone infarction


Question: Wound healing is


Question: The fold of Treves is

.peritoneum is a serous membrane lining the abdominal cavity. It is composed of outer fibrous tissue layer (which gives strength) and inner mesothelial cell layer (secretes fluid giving lubricating function to the peritoneum). Pas of Peritoneum includes Parietal peritoneum: It lines the inner surface of the abdominal wall, under surface of diaphragm and pelvic wall. It is loosely attached to the overlying walls and can be easily stripped off. It is innervated by the somatic nerves, so pain sensitive. Anterior peritoneum is most sensitive when compared to pelvic peritoneum. 2. Visceral peritoneum: It lines the outer surface of the abdominal viscera, firmly adherent, cannot be stripped off. It is innervated by autonomic nervous system; hence not pain sensitive. Surface area of peritoneum is 2 m2 - equal to surface area of skin. It has propey of bidirectional transfer of substances. It can absorb from or transfer to peritoneal cavity, fluid and electrolytes. ref:SRB&;s manual of surgery,ed 3,pg no 498

The fold of mucous membrane projecting into the lumen of the rectum

The ilio-appendicular fold of peritoneum

The fold of mucous membrane around the papilla of Vater

The fold of peritoneum over the inferior mesenteric vein


Question: The complication of using airotor at 30,000 rpm for impacted molar is


Question: Ligament of Testut is another name of

Radio scapholunate ligament. (Pg-904, Gray's anatomy,39th edition) Radioscapholunate: (ligament of Testut and Kuenz); - orignates from palmar aspect of ridge between scaphoid & lunate fossae & inses into scapholunate interosseous ligament; - it acts as neurovascular supply to scapholunate interosseous membrane and is not a true extrinsic ligament of wrist.

Ulnotriquetral (ulner collateral) ligament


Question: Commonest manifestation of Grawitz's tumor in male

Ans. c (Hematuria) (Ref. Bailey and Love 26th/ pg. 1307)Adenocarcinoma of the kidney# Haematuria is the most common clinical symptom.# May be associated with PUO, polycythaemia, hypercalcaemia, anaemia and other paraneoplastic symptoms# Metastasises via the bloodstream to bone, liver and lung (cannonball secondaries)# Renal vein extension may embolise to the pulmonary circulation during nephrectomyHYPERNEPHROMA (Syn. GRAWITZ'S TUMOR)# This is an adenocarcinoma.# It is the most common neoplasm (75 per cent) of the kidney.# It arises from renal tubular cells.# most commonly the upper pole.# Spread : The tumor is prone to grow into the renal vein.# Highly vascular metastases may pulsate.# If the tumour extends beyond the renal capsule it is liable to metastasise via the lymph nodes in the hilum of the kidney to the para-aortic nodes and beyond.# CF: M:F = 2:1.# Hematuria is the most common symptom.# In men, a rapidly developing varicocele is a rare but impressive sign, occurring most often on the left side because the left gonadal vein is obstructed where it joins the left renal vein.# Atypical C/f: Hyperpyrexia, Extreme anemia, or Polycythemia (occurs in 4%of cases), Hypercalcemia, Nephrotic synd.# Investigation: US is generally initial or screening too of choice, while CECT demonstrate the extent of the lesion more clearly and will show whether there is hilar lymphadenopathy or renal vein involvement. MRV remains the best choice for detecting renal vein invasion.# Treatment- If the tumor is confined to the kidney, treatment is nephrectomy with removal of the perinephric fat.- Nephrectomy can be performed through a loin or a transverse or oblique upper abdominal incision. The transab- dominal approach has the advantage that the renal pedicle and the IVC can be widely exposed.- The vascular pedicle should be ligated before the kidney is mobilised because handling the tumor may cause malignant cells to be released into the circulation.- Adenocarcinoma of the kidney does not respond well to radiotherapy or conventional chemotherapy. There have been early promising results from clinical trials of the cytokine interleukin-2 in this condition.- Conventional surgical treatment is by nephroureterectomy.- Percutaneous resection of these cancers is controversial.Also know:WILMS' TUMOR (Syn. NEPHROBLASTOMA)# This is a mixed tumor containing epithelial and connective tissue elements arising from embryonic nephrogenic tissue.# The tumors are usually discovered during the first 4 years of life.# Abdominal tumor. An abdominal tumor appears which grows rapidly while the general well being of the child deteriorates.# Pyrexia, which is a feature in half of these patients, disappears when the tumor is removed.# Initial Imaging is by ultrasonography,however CECT is best for evaluation.# Metastasis occurs early, mainly to the lungs. Liver and bone metastases are rare; and brain metastases even more so.# Lymphatic spread is uncommon.# The presence of bone secondaries favours a diagnosis of nephroblastoma, another renal tumor of childhood.# Rx: Nephrectomy should be performed as soon as possible and followed by radiotherapy with or without chemo- therapy.- Partial nephrectomy may be possible in patients with bilateral disease.# Prognosis- Under 1 year of age 80 per cent survive for 5 years, but the prognosis is less good in older children.- Recurrences usually occur within a year, so a child surviving for 18 months or more is probably cured.- NATIONAL WILMS' TUMOR STUDY GROUP (NWTS) STAGING SYSTEM (post-chemotheraphy based staging system in Wilms tumor). It employs Roman numerals I through V (one through five).


Question: Rectal polyp most commonly presents as

.LOWER GI BLEED- * Bleeding in the GIT below the level of the ligament of Treitz. * Normal faecal blood loss is 1.2 ml/day. A loss more than 10 ml/day is significant.* Angiodysplasia. * Diveicular disease - commonest cause in Western countries. * Tumours of colon or small bowel. * Anorectal diseases--Haemorrhoids, fissure in ano. * Ulcerative colitis * Crohn's disease. * Colorectal polyps; rectal carcinomas. * Intussusception ref:SRB&;s manual of surgery,ed 3,pg no 925.


Question: The most impoant use of transrectal ultarsonography (TRUS) is for

A transrectal ultrasound (TRUS) may also be called endorectal ultrasound. It is used to look at the prostate and tissues around it. A TRUS is often used to help diagnose prostate cancer if the prostate-specific antigen (PSA) level is high, or an abnormal area during a digital rectal exam (DRE) . TRUS is done to: look at the size and shape of the prostate look for abnormal areas in the prostate guide a needle during a biopsy to collect samples from the prostate " TRUS technology has become a mainstay of many image guided prostate interventions, including prostate biopsy, brachytherapy, cryotherapy, and high-intensity focused US " Campbell and walsh 11th edition

Systematic prostate biopsy in suspected prostate cancer

Guiding transurethral resection of prostate cancer


Question: Attitude in posterior dislocation of hip

Ref: Textbook of ohopaedics, Maheshwari and Mhaskar, 6th edition Pgno:130

Flexion, abduction and internal rotation

Flexion, adduction and internal rotation

Flexion, abduction and external rotation

Flexion, adduction and external rotation


Question: Carcinoma breast is least seen in

.Most common site is upper outer quadrant (60%) because breast tissue is more in this quadrant.* Mutation of tumour suppressor genes BRCA1/ BRCA2 is thought to be involved with high risk of breast carcinoma. BRCA1 mutation is having more risk (35-45%) than BRCA2 mutation. It is located in long arm of chromosome 17, whereas BRCA2 is located in long arm of chromosome 13. * Occasionally mutation of BRCA3 and p53 suppressor gene is also involved. * Li-Fraumen's syndrome (LFS) is autosomal dominant condition with breast cancer inheritance (90%) along with sarcoma, leukemia, brain tumours, adrenocoical tumours. * Diet low with phytoestrogens and high alcohol intake have high risk of breast cancer. * It is more common in nulliparous woman. * Attaining early menarche and late menopause have high risk of breast malignancy. ref:SRB&;s manual of surgery,ed 3,pg no 467


Question: Esophageal carcinoma is not  predisposed by

common predispositions in developing carcinoma oesophagus includes,
*human papillomavirus infection
*achalasia cardia (30%)
*oesophageal webs (25%)
*Barrett's oesophagus and also Plummer Vinson syndrome, tylosis, corrosive strictures, and nitrosamines.


Question: Pheochromocytoma is associated with

(A) Von Hippel Lindau syndrome # Pheochromocytoma is a rare catecholamine-secreting tumor derived from chromaffin cells. Tumors that arise outside the adrenal gland are termed extra-adrenal pheochromocytomas or paragangliomas. Because of excessive catecholamine secretion, pheochromocytomas may precipitate life-threatening hypertension or cardiac arrhythmias. If the diagnosis of a pheochromocytoma is overlooked, the consequences could be disastrous, even fatal; however, if a pheochromocytoma is found, it is potentially curable.> Pheochromocytomas are rare, reportedly occurring in 0.05-0.2% of hypertensive individuals. Patients may be completely asymptomatic. A retrospective study from the Mayo Clinic revealed that in 50% of cases, the diagnosis was made at autopsy. Approximately 10% of pheochromocytomas are discovered incidentally. Pheochromocytomas may occur in certain familial syndromes, including multiple endocrine neoplasia (MEN) 2A and 2B, neurofibromatosis, and von Hippel-Lindau (VHL) disease.> VHL syndrome is associated with pheochromocytomas, cerebellar hemangioblastomas, and renal cell carcinoma


Question: Pelvic abscess presents as

Pelvic abscess is the most common intraperitoneal abscess(50-60%). It is the collection of pus in rectovesical or rectouterine pouch(pouch of Douglas). Causes include: appendicitis, pelvic infections, sequelae of diffuse peritonitis, post operative and other causes(Bacteria : Bacteroides fragilis, E.coli, anaerobic streptococci ). It presents as diarrhoea and passage of mucus in stools, high temperature with chills and rigors, lower abdominal pain and distension, frequency and burning micturition. Reference : page 574 SRB's manual of surgery 5th edition


Question: Carcinoid tumor is diagnosed by.

Ans. (a) Urinary 5HIAARef: Bailey 27th edition, Page 1251* Most common used investigation to diagnose carcinoid tumor is 24 hours urinary 5HIAA* IOC to localize the tumor is DOTATATE scan