Question: Auxiliary ohotopic liver transplant is indicated for

If the transplantation is done at the same site after doing hepatectomy, it is called as ohotopic liver transplantation.In cirrhotic patients with HCC, total hepatectomy with ohotopic liver transplantation is required.it is also required in poal hypeension as well as any cases of acute fulminant liver failure for any cause. Ref: SRB&;s manual of surgery,3 rd ed, pg no 559

As a standby procedure until finding a suitable donor

Acute fulminant liver failure for any cause


Question: Cleft lip repair is commonly performed at

Cleft lip repair is commonly performed between 3 and 6 months of ageCleft palate repair is frequently performed between 6 and 18 monthsRef: Bailey and love pg: 692


Question: rug used in estrogen dependent breast cancer

Ans. is 'a' i.e., Tamoxifen Hormonal drug therapy for breast cancer targets estrogen receptor positive breast cancer. It aims at blocking the action of estrogen on estrogen receptor positive breast cells. The hormonal therapy of choice for breast cancer in premenopausal women is Tamoxifen. Tamoxifen belongs to class of drugs known as "Selective Estrogen Receptor Modulator". Tamoxifen binds to the estrogen receptors on tumours and blocks the effect of estrogen on these cells. Tamoxifen is only effective in treating estrogen receptor positive breast cancers. - Therefore the tumour's hormone receptor status should be determined before deciding on treatment option for breast cancer. Tamoxifen is used to treat patients with early stage breast cancer as well as those with metastatic breast cancer Adjuvant therapy with Tamoxifen - Chemotherapy after primary t/t to increase the chance of cure. It helps in preventing the recurrence and also helps to prevent the development of new cancers in the other breast. When used as adjuvant chemotherapy it is usually taken for 5 years. When taken for 5 years if reduces the chance of the original breast cancer coming back in the same breast or elsewhere. It also reduces the risk of developing secondary primary cancer. Metastatic cancer therapy with Tamoxifen - As a treatment for metastatic breast cancer, the drug slows or stops the growth of cancer cells that are present in the body. Patient with metastatic breast cancer may have to take tamoxifen for varying lengths of time.


Question: Mucoepidermoid carcinoma arises form

Mucoepidermoid carcinomas are composed of variable mixtures of squamous cells, mucus-secreting cells, and intermediate cells. "The low-grade mucoepidermoid carcinoma is composed of largely mucin-secreting cells, whereas in high-grade tumors, the epidermoid cells predominate." They are the most common malignant tumors of the salivary glands. Treatment The primary t/t of all salivary malignancy is surgical excision: for parotid malignancies- Superficial parotidectomy with preservation of CN VII. Total parotidectomy with nerve preservation if deep lobe is involved. for other salivary gland - Enbloc removal of the involved gland Neck dissection for lymph nodes is done clinically palpable nodes for high grade malignancies Radiation therapy is used postoperatively for specific indications high grade histology presence of extraglandular disease perineural invasion direct invasion of regional structureregional metastasis


Question: Most common cause of bleeding per rectum is

Most common cause of bleeding per rectum is - hemorrhoids.
Most common cause of bleeding per rectum in children is - polyps.


Question: Treatment of choice for Tension pneumothorax is

Once clinically diagnosed, a wide bore needle(intercostal drain) is immediately placed in the second intercostal space in midclavicular line, and a sterile glove is kept on the hub (blunt) end of the needle to create a valve so as to prevent inward sucking of the air from outside.


Question: Phytobezoars are composed of

Answer- B. Vegetable MatterPhytobezoars are composed of vegetable matter and, are usually seen in association with gastroparesis or gastric outlet obstruction.


Question: The most impoant prognosis factor of carcinoma breast is

Spread to axillary nodes is the most impoant prognostic indicator. Age: Younger the age worser the prognosis. Stage I and II has got better prognosis. Sex: Carcinoma male breast has got worser prognosis compared to female breast. Because of early spread in carcinoma male breast. Atrophic scirrhous has got best prognosis. Medullary carcinoma has got better prognosis than scirrhous carcinoma because of lymphocytic infi ltration. Invasive carcinoma has got worser prognosis. Inflammatory carcinoma breast has worst prognosis. Ref; (page no;559 ) 5th edition of SRB&;S manual of Surgery .


Question: Sistrunk&;s operation consists of

Sistrunk operation include excision of the whole thyroglossal tract, which involves removal of the body of the hyoid bone and the suprahyoid tract through the tongue base to the vallecula at the site of the primitive foramen caecum, together with a core of tissue on either side. Bailey and Love 26th edition Pg : 702

Excision of hyoid bone and cone of tongue muscle

Excision of central pa of hyoid bone and cone of tongue muscle upto foreman caecum


Question: In bacterial meningitis, CSF has


Question: Struma ovarii is a

Struma is a river in europe,along its banks endemic goitre was noted. Strauma is loosely used for goitre in europe. A Struma ovarii benign ovarian tumor is a form of teratoma that contains mostly thyroid tissue, which may develop thyrotoxicosis. Source : Bailey and love 26th edition Pg : 748


Question: According to Boyd classification of intermittent Claudication; Rest pain is seen in


Question: Most common foreign body in Children in Esophagus

Ans. (a) CoinRef Bailey And Love 27th edition, Page 1073* Most common foreign body in esophagus in adult - Food bolus due to some underlying pathology causing narrowing* Most common foreign body in esophagus in children is coin* Most common site of foreign body impaction is cricopharynx


Question: As per EHS classification, a primary, direct inguinal hernia with 4 cm width would be

The European Hernia Society has suggested a simplified system of classificationPrimary or recurrent (P or R);Lateral, medial or femoral (L, M or F);Defect size in fingerbreadths (each finger is assumed to be 1.5 cm.)Ex1) A primary, direct inguinal hernia with 4 cm width would be PM3Ex 2) A Recurrent, indirect, inguinal hernia with a 3-cm defect size would be RL2Ref: Bailey and love 27e pg: 1031


Question: Intermittent claudication is caused by


Question: "Red current jelly" stool in an infant is characteristic of

Initially, the passage of stool may be normal, whereas, later, blood and mucus are evacuated - the 'redcurrant jelly' stool.Vomiting may or may not occur at the outset but becomes conspicuous and bile-stained with time. Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1194


Question: In craniocerebral trauma, lumbar puncture is essential in only one of the following

(D) When meningitis is suspected # BACTERIAL MENINGITIS, although potentially a life-threatening infection, seldom requires neurosurgical intervention.> Treatment involves confirming diagnosis & identifying organism by a CSF sample, usually via lumbar puncture.> Broad-spectrum intravenous (i.v.) antibiotics with good CSF penetration should then be commenced without delay.> Ceftriaxone 2g 12 hourly & metronidazole 400 mg 8 hourly & adjusted as cultures & sensitivities become available.


Question: The 'Search lines' to detect fracture line on occipitamental radiographic view of midfacial skeleton fracture was described by


Question: The most common elbow injury in children is

A i.e. Extension type of supracondylar fracture

Extension type of supracondylar fracture of humerus


Question: In erect posture commonest siteof foreign body in bronchus

Foreign bodies like pins,coins entering the trachea pass into the right bronchus,which is wider,more veical & is in line with trachea.Most of the human beings want to take the path of least resistance,so the foreign bodies in the trachea travel down into right bronchus and then into posterior basal segments of the lower lobe of the lung. Reference:B D Chaurasia's Human anatomy-Volume 1,5th edition,page no:288


Question: Bascom technique is employed in surgery of

Pilonidal sinus(Jeep bootom or Driver's bottom) is epithelium lined tract, situated sho distance behind the anus, containing hairs and unhealthy diseased granula- tion tissue. It is due to penetration of hairs through the skin into subcutaneous tissue; occurs in sacral region between the buttocks, umbilicus, axilla. Bascom technique of excision through lateral approach is a good method of treatment. Through small lateral incision or multiple small lateral incisions 2-4 mm sized sinus is approached and pus is drained; hairs are removed with only minimal excision of sinus. Cavity walls are not excised. Lateral small wounds are either sutured or left open for spontaneous healing. Reference : page 968 SRB's manual of surgery 5th edition


Question: Intracranial pressure is not raised during

Ans. is 'a' i.e., Hyperventilation * Hyperventilation is used as a treatment with raised intracranial pressure.* Hyperventilation causes decreased PaCO2 which subsequently leads to arterial vasoconstriction thus lowering cerebral blood flow (CBF), cerebral blood volume, and intracranial pressure.Causes of ICTi) Intracranial mass (tumor)ii) Intracranial bleed (e.g. subdural hematoma, intraventricular or intracerebral)iii) Subarachnoid hemorrhage (aneurysm rupture)iv) Encephalitis/meningitsv) Head injuryvi) Status epilepticusvii) Strokeviii) Hydrocephalus


Question:
The mechanical advantage obtained from the wheel
and axle principle of elevator is


Question: According to Illingworth's theory, the inclusion of ectopic parotid epithelium in the upper deep cervical lymph nodes leads to the formation of

Branchial cyst
• It develops from persistence of precervical sinus, a small depression deep to the second arch that normally disappears during development.
• According to Illingworth's theory, inclusion of ectopic parotid epithelium in the upper deep cervical lymph nodes leads to branchial cyst formation.
• Though congenital, it often manifests itself between 20-25 yrs. of age, or even later. Presents as a painless swelling in the upper and lateral part of the neck.
• It shows a tendency of recurrent infection due to presence of lymphoid tissue in its wall. In that case it becomes painful.
• Cholesterol crystals can be demonstrated in the aspirated fluid from a branchial cyst.


Question: Drug of choice for DVT

. <p> Deep vein thrombosis Also known as phlebothrombosis. It is a semisolid clot in the vein which has got high tendency to develop pulmonary embolism and sudden death. Common site of beginning is soleal veins . Investigation:- 1. Venous doppler- investigation of choice 2. Duplex scanning- it shows non compressible vein which is wider than normal. 3. Venogram- 4. Radioactive iodine fibrinogen study 5. Haemogram with platelet count 6. Ventilation Treatment:- 1. Rest, elevation of limb and bandaging the entire limb with crepe bandage. 2. Anticoagulants- heparin, low molecular weight heparin, warfarin. 3. Low molecular weight heparin is preferred to heparin. 4. Initially high doses of heparin of 25,000 units/ day for 7 days is given. 5. Warfarin should be staed as early as possible on the same day as heparin. 6. Oral anticoagulants being teratogenic cannot be used during pregnancy. {Reference: SRB&;s manual of surgery, 5th edition , page no. 225}


Question: The most frequent symptom of gastric diverticulum is


Question: Ovarian arteries enters ovary through

Ans c Ref: Sheila Balakrishnan page 16The ovarian artery arises from abdominal aorta just below renal arteries. It crosses the ureter at the pelvic brim and entering the infundibulopelvic ligament divides to supply ovaries and fallopian tubes.


Question: Ipsilateral supraclavicular lymphnodes are positive in a patient of Ca Breast. Stage is

According to TNM staging of carcinoma breast ,metastasis to ipsilateral supraclavicular lymphnode with or without axillary or internal mammary involvement is N3c. Stage IIIC is any TN3M0 SRB's Manual of Surgery.Edition -5. Pg no:540


Question: A new born girl not passed meconium for 48 hrs, has abdominal distention and vomiting, Initial investigation of choice would be

bowel obstruction with an absent caecal gas shadow in ileocolic cases. A soft tissue opacity is often visible in children. A barium enema may be used to diagnose the presence of an ileocolic intussusception (the claw sign) Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1196


Question: Below knee, amputation is done at the level of

In below knee amputation, approximately 10 cm below the tibial tuberosity, an anterior incision of two-thirds of the circumference is created.Posterior flap is taken longerRef: Bailey and love pg: 958


Question: Quinsy is


Question: Pregangrene is

Pregangrene is changes in tissue which indicates that blood supply is inadequate to keep tissues alive and presents with rest pain, colour changes, oedema, hyperaesthesia.


Question: Surgery for elective hemicolectomy for carcinoma colon is described as

Surgery for elective hemicolectomy for carcinoma colon is described as Clean contaminated.


Question: Carotid body tumours

Carotid body tumors may metastasize in rare cases.


Question: A girl presented with severe hyperkalemia and peaked T waves on ECG. Fastest way of shifting potassium intracellularly is aEUR'

Insulin + glucose Tall T waves on ECG indicate cardiac manifestation of hyperkalemia. - Intravenous calcium gluconate is the first drug to be administered in a patient with hyperkalemia having E.C.G. abnormalities. - It stabilizes the myocardium immediately. - It acts within minutes and is characterized by improvement in E.C.G. appearance. But an impoant point to note - It does not affect transcellular movement of potassium. Thus it won't help in reducing the hyperkalemia. Among the agents which cause transcellular (intracellular) movement of potassium. - "Intravenous insulin is the fastest way to lower serum potassium levels". The goals of the therapy for the tit of acute hyperkalemia in chronological order are as follows:? i) Antagonize the affect of IC on excitable cell membranes ii) Redistribution of extracellular potassium into cells iii) Enhance elimination of potassium from the body i) Antagonize the effect of potassium on excitable cell membrane Calcium directly antagonizes the myocardial effect of hyperkalemia. It does so by reducing the threshold potential of cardiac myocytes. Calcium. for injection is available as chloride or gluconate salt. The preferred agent is the gluconate salt since it is less likely than calcium chloride to cause tissue necrosis. The onset of action is < 3 minutes. The duration of action is 30-60 minutes during which time fuher measures may be undeaken to lower p1{. ii) Redistribution of potassium into cells :? Insulin Insulin shifts potassium into cells. Potassium shift inside the cells is mediated by Na+ IC ATPase. I.V. insulin is the fastest way to lower serum potassium levelr2. The onset of action is < 15 minutes and the effect is maximal b/w 30-60 minutes. Dextrose is given along with insulin to prevent hypoglycemia. It was believed that administration of dextrose alone, can cause shift of potassium inside the cells by promoting insulin release. * The administration of hypeonic dextrose alone for hyperkalemia is not recommended for two reasons:- Endogenous insulin levels are unlikely to rise to the level necessary for a therapeutic effect. - There is a risk of exacerbating hyperkalemia by inducing hypeonicity. 5' adrenoceptor agonists These drugs can also cause movement of potassium inside the cell. High dose albuterol shows their effect in 30 minutes and persists for at least 2 hours. The effect of insulin is additive with that of albuterol. Patients taking nonselective 18 adrenoceptor blockers will be unlikely to manifest the hypokalemic effects of albuterol. - Even among patients not taking ft blockers as many as 40% seem to be resistant to the hypokalemic effect of albuterol. - The mechanism .for this resistance is unknown and currently, there is no basis for predicting which patients will respond. - For this reason albuterol should never be used as a single agent for the treatment of urgent hyperkalemia. Bicarbonate Bicarbonate (as a bolus injection) was used in the emergency t/t of hyperkalemia. Ironically this dogma was based on studies using a prolonged (4-6 hrs) infusion of bicarbonate. It has now been demonstrated that sho term bicarbonate infusion does not reduce pK in patients with dialysis dependent kidney failure, implying that it does not cause IC+ shift into cells. Sodium bicarbonate seems to have no effect to shift IC into cells even after several hours. It is likely to be effective especially in combination with a diuretic drug in enhancing urinary IC' elimination in patients with some kidney. function, although it use for this purpose has not been evaluated. iii) Elimination of potassium from the body Hyperkalemia occurs most often in patients with renal insufficiency. - However renal potassium excretion may be enhanced even in patients with significant renal impairment by increasing the delivery of solute to the distal nephron. Sodium bicarbonate A sodium bicarbonate infusion administered during 4-6 hrs at a rate designed to alkalinize the urine may enhance urinary K+ excretion and would be desirable especially in patients with metabolic acidosis. The risk of volume expansion with the bicarbonate infusion can be mitigated by use of loop acting diuretics which would, be likely to enhance the kaliuresis. Exchange resin Sodium polysterene sulfonate is a cation exchange resin. In the lumen of intestine it exchanges sodium for secreted potassium. Most of this exchange takes place in the colon, the site of most potassium secretion in the gut. There are two concerns with the use of resin in the t/t of urgent hyperkalemia The first is its slow effect - When given orally, the onset of action is at least 2 hrs and the maximum effect may not be seen for more than 6 hrs. The second is its adverse effect - It can cause intestinal necrosis Dialysis -"Hemodialysis is the method of choice for removing potassium from the body". - The rate of potassium removed with peritoneal dialysis is much slower than with hemodialysis.


Question: Suppurative osteomyelitis is caused by

Streptococci first, later replaced by staphylococci

Staphylococci first, later replaced by streptococci


Question: Cushing disease cause is

Ans. (a) ACTH producing pituitary tumorRef: Endocrine Surgery by Schwartz Page 27* Pituitary adenoma arising from corticotroph cells causing secretion of ACTH resulting in Cushing's disease* Corticotroph cell adenomas may be clinically silent or may cause hypercortisolism, manifested clinically as Cushing syndrome, because of the stimulatory effect of ACTH on the adrenal cortex.* When the hypercortisolism is caused by Excessive production of ACTH by the pituitary, the process is designated Cushing disease, because it is the pattern of hypercortisolism originally described by Dr. Harvey Cushing.


Question: Treatment of Acute Myositis Ossificans is


Question: Game Keeper's thumb is

A i.e. Ulnar collateral ligament injury of MCP Joint

Radial collateral ligament injury of MCP joint

Radial collateral ligament injury of CMC joint

Ulnar collateral ligament injury of CMC joint


Question: Investigation of choice in spontaneous Sub arachnoid bleed


Question: Most common neoplasm of appendix is

Carcinoid tumours arise in argentaffin tissue (Kulchitsky cells of the crypts of Lieberkuhn) and are most common in the vermiform appendix.The tumour can occur in any pa of the appendix, but it is frequently found in the distal third.Ref: Bailey & Love&;s Sho Practice of Surgery


Question: Most common site for carcinoma pancreas is

More than 85 percent of pancreatic cancers are ductal adenocarcinomas.They arise most commonly in the head of the gland Bailey & Love ,26th,1137.


Question: Drawer sign seen in


Question: The closed mouth technique for mandibular nerve block is


Question: Oschner sherren regime is used in management of

Ans is 'c' i.e. Appendicular mass If an appendix mass is present and the condition of the patient is satisfactory, the standard treatment is the conservative Ochsner-Sherren regimen. This strategy is used as the inflammatory process is already localised and that inadveent surgery is difficult and may be dangerous. It may be impossible to find the appendix and, occasionally, a faecal fistula may form. For these reasons, it is wise to observe a non-operative programme but to be prepared to operate should clinical deterioration occur. Criteria for stopping conservative treatment of an appendix mass A rising pulse rate Increasing or spreading abdominal pain Increasing size of the mass Ochsner-Sherren regimen comprises hospitalization, intravenous fluids, antibiotics, analgesics and a strict watch on the vitals and general state of the patient. In 90-80% of the patients, the mass resolves without complications. The remaining 10-20% need emergency operation due to spreading infection.


Question: Structure arising from the apex of infected non vital tooth is

Answer- C. Radicular CystIs the most common type of jaw cyst.Radicular cyst develops at the apex of an infected, nonvital tooth.If the tooth is removed and the cyst persists, it is called a residual cystThere is a bimodal incidence within the third and sixth decades of life and they are rarely seen in the primary dentition.Usually presents as a radiolucent lesion around the apex ofa tooth root.


Question: Posterior perforated ulcer on pyloric antrum cause abscess formation in

Commonly gastric ulcer perforates in the lesser curve near the antrum perforates.amount of gas escaped is more than the perforated DU, malignancy should always be suspected and so biopsy from the edge is a must.commonly they are prepyloric in position.distal gastrectomy, including ulcer area, is better if the patient,s condition is ourable. Ref: SRB&;s manual of surgery,5 th ed, pg no 833


Question: TSH receptor antibodies are often present in

TSH receptor antibodies (TSH-Rab or TRAB) are often present in Graves' disease. They are largely produced within the thyroid itself.Ref: Bailey and love 27e, page no: 803


Question:
Double contrast phase contrast arthroscopy is used
to study


Question: Differentiating features between sepsis and trauma are

Patients compensate for volume loss in the early stages of hypovolaemia, so an apparently resuscitated patient may still have a significant volume deficit. The aim for immediate resuscitation should he normal measures of pulse, blood pressure and CVP, urine output > 0.5 mI/kg/hour with normal urinary osmolality and sodium concentration. Any metabolic acidosis should be seen to be correcting. There-after, one must try to maintain normovolaemia. This is a continuous process. Critically ill patients may have capillary leak and will therefore have a continuing colloid requirement. Gelatins, being small molecules, are poorly retained and can be replaced by hydroxyethyl starch, plasma or blood at this stage. In sepsis this requirement may be very large . The impoance of blood in immediate resuscitation, the threshold at which one should transfuse urgently (i.e. con-sider using group compatible, uncross-matched blood or even Group 0 blood) and even the target haemoglobin level are controversial. Resuscitation should not be delayed whilst waiting for blood to be grouped; if acute anaemia is secondary to the bleeding resuscitation should be with Group 0 blood or group-compatible blood as it becomes available. Ref:Surgery of baily and love,26th edition.


Question: Alvarado score is used for

Answer- B. Acute appendicitisScoring system for Acute Appendicitis: Alvarado Score:The diagnosis of appendicitis is based primarily on clinical history and physical examination assisted by blood counts. A number of clinical and laboratory based scoring systems have been devised to assist diagnosis.The most widely used scoring system is Alvarado score.


Question: Ring sequestrum is seen in

C i.e. Amputation Stump Excessive periosteal stripping is contraindicated as it may result in formation of ring sequestrum in amputation stumpQType of Sequestrum Found InRing sequestrum - Amputation stumpsQ - Around pin tracks (external fixator)Tubular sequestrum - Hematogenous osteomyelitis - Segmental fractures (middle segment)Rice grain sequestrum - Tuberculosis


Question: Miniplate fixation is effective at


Question: Concentration of sodium in RL is

Sodium concentrations in various crystalloids and colloid Hamann's (RL) 130mmol/L Normal saline (0.9% NaCl) 154mmol/L Dextrose saline (4% dextrose in 0.18 saline) 30mmol/L Gelofusine 150mmol/L Hemacel 145 mmol/L Hetastarch - Lactated potassium saline injection (Darrow's solution) 121mmol/L Ref: Bailey and love 27th edition Pgno :281


Question: ORF stands for


Question: Cellulitis is a.

Cellulitis Non-suppurative, invasive infection of tissues, which is usually related to the point of injury. Poor localisation in addition to the cardinal signs of spreading inflammation. Organisms such as Beta-haemolytic streptococci, staphylococci and C. perfringens. Followed by Tissue destruction, gangrene and ulceration caused by proteases Systemic signs- chills, fever and rigors.


Question: A i.e. Siffness of finger


Question: There was a sudden increases in the size of Thyroid swelling along with pain. Most likely cause is

. A painful nodule, sudden appearance, or rapid enlargement of a nodule raises suspicion of carcinoma but is usually due to haemorrhage into a simple nodule. Comment : more common among the given options is haemorrhage. other points to consider: Pain is not a common feature of thyroid swellings. Thyroiditis can present with a painful gland. Anaplastic carcinoma can cause local pain and pain referred to the ear if it infiltrates surrounding structures Source : Bailey and love 26 th edition Pg : 748


Question: The most impoant prognostic factor in carcinoma breast is

The Nottingham prognostic index (NPI) is used to determine prognosis following surgery for breast cancer. Its value is calculated using three pathological criteria: the size of the lesion; the number of involved lymph nodes; and the grade of a tumour.Size of lesion is least impoant.The extent of axillary lymph node involvement by breast cancer--is the most established and reliable prognostic factor for subsequent metastatic disease and survivalDevita principles of oncology 10th edition, Bailey and love 26th edition.


Question: Spontaneously regressing tumours are

Tumors with spontaneous regression Neuroblastoma Choriocarcinoma Renal cell carcinoma Malignant melanoma Retinoblastoma Ref : Robbins 9th edition Pgno : 477, 1041, 955, 1339, 1149


Question: The ideal treatment of alveolar osteitis after dental extraction is

Debridement of socket and sedative dressing


Question: Cobra head deformity is seen in

Ureterocoele due to distal ureter dilation looks like cobra head.


Question: Most common presentation of chronic pancreatitis

Ans. (c) PainRef: Bailey and Love 27th ed; pg. 1230* MC symptom of Chronic pancreatitis - Pain* Site of pain depends on the foci of disease:# Head: Epigastric and Right Subcostal Pain# Left Side pancreas: Back pain# Diffuse pain is also seen sometimes.# Radiation to shoulder also can be seen


Question: A Wahin's tumour is

Wahin's tumor Is the second most common benign tumor of the parotid gland (1st is pleomorphic adenoma). It consists of both epithelial and lymphoid elements thus known as adenolymphoma (probably arises from remnants of parotid tissue trapped in lymphnodes within the parotid gland). Also known as papillary cystadenoma lymphomatosum. The tumor arises only in the parotid gland. Almost always arises in the lower poion of the parotid gland overlying the angle of mandible. Common in males. (Occurs most often in older white men) Age : 5th to 7th decade. Association is seen with smoking. Bilaterality is seen in 10% cases. Its well encapsulated, extremely slow growing tumor, never turns malignant. A peculiar feature of Wahins tumor is that it shows 'hot' spot in 99' Tc-peechnate scan. Other tumors of the parotid show 'cold' spot (Oncocytomas another benign parotid tumor also shows hot spot). (Because of the high mitochondrial content within oncocytes, the oncocyte-rich Wahin tumor and Oncocytomas incorporate technetium Tc 99m and appear as hot spots on radionuclide scans.) Also remember Godwin's tumor - Benign lymphoepithelial tumor of the parotid gland. Most salivary gland tumors are benign. However remember that the smaller the salivary gland, the higher is the chance of the tumor being malignant. Parotid gland - 80% benign Submandibular, Sublingual - 50% benign, 50% malignant Minor salivary glands - 25% benign, 75% malignant

A carcinoma of submandibular salivary gland


Question: Mondor’s disease is

Mondor's disease is thrombophlebitis of the superficial veins of the breast and anterior chest wall although it has also been encountered in the arm.
MONDOR’S DISEASE In the absence of injury or infection, the cause of thrombophlebitis - like that of spontaneous thrombophlebitis in other sites - is obscure.
The pathognomonic feature is a thrombosed subcutaneous cord, usually attached to the skin.
When the skin over the breast is stretched by raising the arm, a narrow, shallow subcutaneous groove alongside the cord becomes apparent.
The differential diagnosis is lymphatic permeation from an occult carcinoma of the breast. The only Rx required is restricted arm movements, and it subsides within a few months without recurrence, complications or deformity


Question: Lower esophageal sphincter tone is due to

Ans. (c) AcetylcholineRef: Bailey & Love 26th ed. / 988There are two types of control of LES via the Myenteric plexus:* Excitatory (cholinergic) ganglionic neurons* Inhibitory (nitric oxide) ganglionic neuronsFunctionally, inhibitory neurons mediate Deglutitive lower esophageal sphincter (LES) relaxation and the sequential propagation of peristalsis.


Question: Pseudo kidney is


Question: Milroys disease is

PRIMARY LYMPHOEDEMA Aetiology It has been proposed that all cases of primary lymphoedema are due to an inherited abnormality of the lymphatic system, sometimes termed 'congenital lymphatic dysplasia'. Genetic susceptibility Primary lymphoedema can be familial or sporadic. In familial cases the genetic mutations can be inherited in an autosomal dominant, recessive or x-linked pattern. In the last few years the application of Next Generation Sequencing, which allows identification of genetic mutations, even in sporadic cases and smaller families, has increased our understanding of the genetic basis of lymphoedema. So far, mutations in more than 20 genes have been linked to the development of primary lymphoedema. In individuals with familial mutations the penetrance of lymphoedema can often be incomplete leading to a large variability in clinical presentation. Involvement of other systems (cardiovascular, respiratory, nervous, digestive) is common and can indicate a specific mutation. Presence of isolated lower limb lymphedema at bih, classically described as Milroy's disease, suggests mutation in FMS-like tyrosine kinase 4 (FLT4)/ vascular endothelial growth factor receptor-3 (VEGFR-3) or VEGF-C. In these patients, reduced initial uptake and presence of touous lymphatic tracts with evidence of rerouting in lymphangiography suggests mutation in the VEGF-C gene. lymphoedema can also be present as a minor sign in some well-recognised syndromes. Primary lymphoedema is present in less than 10% of cases of tuberous sclerosis (TSC1 and 2 gene mutations). Lymphoedema has been repoed in patients with Noonan syndrome in the presence of PTPN11, SOS1 or KRAS mutations, and in patients with Turner syndrome (monosomy X) and capillary malformation-aeriovenous malformation syndrome (RAS p21 protein activator 1 (RASA1) mutation). Ref : Bailey and love 27th edition Pgno : 1001


Question: Amputation marked at level of 'C' is

A is Symes (Ankle)B is Chopas (mid tarsal)C is Lisfranc (Tarsometatarsal joint)D is transmetatarsal (metatarsal head)


Question: In Crohn's disease NOT seen is

(C) Endomycelial antibodies # Pathological features of Crohn's disease: Starts in terminal ileum as ulcerations of intestines in 60% cases inflammatory edema with mucosal ulcers& fibrotic thickening results in hose pipe rigidity Mesenteric nodes are enlarged & calcified Intense infiltration of mononuclear Skip areas Caseation is absent Stricture causing obstruction


Question: With over dosage of L.A agent, one would observe


Question:
Action of toxic doses of Local anesthesia on CNS
can be described as

first stimulating the CNS followed by depression

first depressing it followed by CNS stimulation


Question: Chronic subdural haenatoma refers to collection present for a period of

REF; GREENBERG HANDBOOK OF NEUROSURGERY 8th edi, p-895


Question: Best material for below inguinal aerial graft is

Best graft for below inguinal aerial graft is autologous long saphenous vein, if it's not available sho saphenous can be used. If no vein is available PTFE(poly tetra fluoro ethylene) can be used. Reference Bailey and love, 27th edition, page no. 949


Question: Complication (s) of obesity is /are

.Complications of obesity General: Difficulty in work, fatigue, depression, back pain, ahritis and gout Cardiovascular: Hypeension, stroke, thrombophlebitis, pulmonary embolism Pulmonary: Hypoventilation, poor respiratory effo GIT: Hiatus hernia with reflux, changes in liver, pancreatitis, gallstones Endocrine: Diabetes mellitus. ref:SRB&;s manual of surgery,ed 3,pg no 90


Question: Vitamin B12 and bile salts are decreases in the resection of

i.e. (Ileum): (1157-Love & Baily 25th) (625-26-CSDT-l31) JEJUNUMILEUMNormalGeneralized transport of water, electrolytes, sugars proteins, fats, vitamins Most absorption occurs proximallyLocalized transport of bilesalts, cholesterol, vitamin BResection* Generalized transport work load assumed by ileum* Localized transport unaffected* No malabsorption* Generalized transport continues* Localized transport lost* Malabsorption of vitamin B 12, cholesterol bile salts andfats***Steatorrhea, diarrhea, megaloblastic anemia and malnutrion are the hall marks of Blind loop syndrome


Question: First priority in management of burn injury is


Question: Denver shunt used in

Ans. (a) AscitesRef: Bailey & Love 26th ed. / 980* A peritoneo-venous shunt (also called Denver shunt) is a shunt which drains peritoneal fluid from the peritoneum into veins, usually the internal jugular vein or the superiorvena cava.* It is sometimes used in patients with refractory ascites.* It is a long tube with a non-return valve running subcutaneously from the peritoneum to the internal jugular vein in the neck, which flows ascitic fluid to pass directly into the systemic circulation.

Evaluation and Management of Portal Hypertension


Question: Replacement dose of thyroxine is

• Daily replacement dose of thyroxine: 1.6 μg/Kg body weight (0.1-0.15 gm) .
• For TSH suppression (in PTC and FTC), dose of thyroxine: 2.7 μg/Kg body weight.


Question: Arrange the following long acting LA in descending order of their duration of action.

Dibucaine is longest acting and most toxic.
Etidocaine: 200minutes.
Tetracaine~Bupivacaine:175 minutes.


Question: Commonest cause of acute intestinal obstruction is

Adhesions and bands are the most common causes of intestinal obstruction in Western countries. In india, hernia and then adhesions are the two common causes of intestinal obstruction. There are two types of adhesions. Type1-fibrinous adhesions occur during 5-10th post-surgical peroid. Type2- fibrous adhesions, due to poor blood supply, bowel gets attached to pa of peritoneum or omentum or other pas of the bowel. Adhesions due to tuberculosis are severe, dense and difficult to seperate. Reference: SRB's Manual of Surgery, 6th Edition, page no = 924,925.


Question: Would closure for clean wounds within 6 hours of injury without risk of contamination

Primary Closure
Also known as healing by primary intention Have a small, clean defect that minimizes the risk of infection Requires new blood vessels and keratinocytes to migrate only a small distance Surgical incisions, paper cuts and small cutaneous wounds usually heal by primary closure.
Fastest type of closure by simple suturing, skin grafting or flap closure Secondary Closure Also known as healing by secondary intention Healing of a wound in which the wound edges cannot be approximated Requires a granulation tissue matrix to be built to fill the wound defect Requires more time and energy than primary wound closure Creates more scar tissue The majority of wounds close by secondary wound closure.
Delayed Primary Closure Also known as healing by tertiary intention. Combination of healing by primary and secondary intention
The wound is first cleaned and observed for a few days to ensure no infection is apparent, before it is surgically closed.
E.g. traumatic injuries such as dog bites or lacerations involving foreign bodies.


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

A volvulus is a twisting or axial rotation of a poion of bowel about its mesentery. When complete it forms a closed loop of obstruction with resultant ischaemia secondary to vascular occlusion. Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1193


Question: Felon is

(C) Terminal pulp space Infection # Infection of the terminal pulp space (syn. Felon) Pulp-space infection is the second most frequent infection of the hand (about 25 per cent of all cases ).> Index finger and the thumb are affected most often.> Origin of the infection is usually a prick.> Many hand infections will settle if conservative treatment is initiated (elevation of hand, splinting and antibiotics) within 24-48 hours.> But if pus appears I & D should be done (at point of maximum tenderness)> Antibiotics changed> Splinting is done in Edinburgh position.


Question: Stereotactic radiosurgery is done for

Stereotactic Radiosurgery SRS is a non-surgical radiation therapy used to treat functional abnormalities & small tumors of brain Deliver precisely - targeted concentrated dose of radiation in fewer high-dose treatments to a defined volume in the brain When SRS is used to treat body tumors, its called stereotactic body radiotherapy (SRBT) Primary risks of stereotactic radiosurgery are radiation necrosis & radiation injury to surrounding structures Common uses of Stereotactic Radiosurgery (SRS) Brain tumor (Benign, malignant, primary & metastatic Tumors, single & multiple) Beingn lesions of the cranial nerves Aeriovenous malformation Trigeminal neuralgia SRBT is currently used and /or being investigated for use in treating malignant or benign small-to-medium size tumors of lung, liver, abdomen, spine, prostate, head and neck Ref: Sabiston 20th edition Pgno : 1923


Question: Most common malignant melanoma is

Most common type of malignant melanoma is Superficial spreading (70%). Other are Nodular melanoma(12-25%), Lentigo maligna melanoma (7-15%), Acral lentiginous melanoma(5%), amelanotic melanoma and desmoplastic melanoma. Reference : page 295-96 SRB's manual of surgery 5th edition


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

Segments II and IIIare to the left of the left hepatic vein and falciform ligament with II superior and III inferior to the poal plane. segment I is the caudate lobe situated posteriorly around the IVC, segment IV includes the quadrate lobe. segment IV lies between the left and middle hepatic veins; it is subdivided into IVa(superior) and IVb (inferior) sub-segments easy tip: IVa is above and IVb is below the poal plane.


Question: Genioplasty procedure is used

To change the attachment of genioglossus muscle in pre-prosthetic procedure

To change the position of genial tubercles

To modify the attachment of anterior belly of digastric


Question: Cricothyrotomy is converted to tracheostomy

Ans. (B) To avoid subglottic stenosisRef: Bailey and Love Page 695* To avoid subglottic stenosis if we give ventilation via the cricothyrotomy tube we must change it to Tracheostomy at the earliest.


Question: Local anesthetic with highest local tissue irritancy is


Question: A full thickness wound that is not sutured heals by

Here wound is full thickness wound. It is left open to heal by granulation, contraction and epithelialisation. This is know as secondary healing.


Question: Commonest endocrine tumor of pancreas

Insulinomas- arising from B cells of pancreas- are the commonest endocrine pancreatic tumour(60%). Gastrinomas - arising from non-beta cells (G cells) of the pancreas- are the 2nd most common endocrine pancreatic tumour. Then comes Glucagonomas (arising from A cells) and VIPomas (arising from D2 cells of pancreas). Reference : page 709-10 SRB's manual of surgery 5th edition


Question: Sub acute sponteneous peritonitis in cirrhosis patients the polymorphonuclear cells are

Primary peritonitis is common in cirrhotic patients with ascites,as spontaneous bacterial peritonitis(SBP).Ascitic fluid WBC count if more than 250 cells mm3 with more than 50% cells are polymorphonuclear cells(PMN) suggestive of SBP. Reference:SRB' s manual of surgery,5th edition, page no:566.


Question: The head tilt procedure while dealing with an unconscious patient in dental chair is done to ensure


Question: Tensile strength of wound become normal after

Tensile strength of wound increase as days goes on. Maximum tensile strength is 60 - 80% of normal, but never becomes normal.


Question: Purely for diagnostic purpose preferred mode of visualizing biliary tree will be

MAGNETIC RESONANCE CHOLANGIO PANCREATOGRAPHY (MRCP) It is a non-invasive diagnostic method using magnetic field and energy as resonance. *T1 weighted images are used for pancreas. *T2 weighted images are used for biliary tree. (Both images are used to see invasion and adjacent structures.) Advantages * It is non-invasive. * It gives equal or better imaging than ERCP. *Pancreatic divisum or annular pancreas are identified easily by MRCP. * Ductal dilatation in chronic pancreatitis and visualization of duct beyond stricture is possible. * Islet tumours are better visualized and diagnosed by MRCP. Disadvantages * Availability. * It is only diagnostic. Not therapeutic (ERCP is both diagnostic as well as therapeutic). * Costly.Magnetic Resonance Cholangiopancreatography(MRCP) is a non-contrast non-invasive imaging method,better than ERCP as diagnostic tool in biliary and pancreatic diseases. Reference:SRB&;s manual of surgery,5th edition,page no:613

Endoscopic Retrograde Cholangiopancreatogram (ERCP)

Percutaneous Transhepatic Cholangiogram (PTC)

Magnetic Resonance Cholangiopancreaticogram (MRCP)


Question: Rectal incontinence is due to involvement of

Advanced tumours may cause faecal incontinence by invasion of the sphincters and, in women, anterior extension may result in anovaginal fistulation.Incontinence, especially if there has been inadveent damage to the underlying internal sphincter. Although uncommon, this is obviously a very serious problem that is difficult to treat Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1258,1269


Question: 16F circumference of a catheter means

Ans. a (4.8 mm). (Ref. B & L, Surgery, 23rd ed., 1262)3.12 SF = 1mm, hence a 16F Circumference of catheter means (r)


Question: Anastomotic leaks are most commonly seen in

Since there is end to end gastroduodenal anastomosis in billroth 1 there are more chances of anastomotic leak


Question: Rarest type of thyroid carcinoma is

Undifferentiated (anaplastic) carcinoma
This is one of the most aggressive malignancies in humans.
Thankfully it is rare. It may develop de novo, or present as dedifferentiation of a papillary or poorly differentiated carcinoma. The disease is characterised by rapid growth, visceral invasion  and  distant  metastases. The  surgeon’s  role  in  this disease is crucial. Thyroid lymphoma can be incorrectly diagnosed as anaplastic cancer and so biopsy is critical. This can be done using a core or open technique.
Reference: Bailey & Love’s short practice of surgery , 27th  ed page no 816


Question: Maximum tourniquet time for upper limb is

Excessive tourniquet time causes both local pressure and distal ischaemic effects, with nerve damage and even compament syndrome Torniquets should usually be let down after 1 hour unless close to the end of a procedure They can be reinflated after 5-10 min for a fuher hour Torniquets time for upperlimb : 1 hour Maximum tourniquet time for upper limb: 2 hours Ref: Bailey and love 25th edition Pgno : 206-207


Question: Boerhaave&;s syndrome is due to

BOERHAAVE&;S syndrome is a tear in the lower third of oesophagus which occurs when a person vomits against a closed glottis, causing leaks into the mediastinum, pleural cavity, and peritoneum.site of perforation is about 2-10 cm of posterolateral pa of the lower oesophagus.investigations include chest Xray, MRI/CT, and total count.treatment includes feeding by jejunostomy, surgery with resection. Ref: SRB&;s manual of surgery,5th ed, pg no 802


Question: Least common quadrant for breast carcinoma is

Most common quadrant for breast carcinoma upper outer quadrant.


Question: Normal capacity of the renal pelvis is

• The average capacity of the renal pelvis is 4–8 ml.


Question: Renal carcinoma with solitary lung secondary is best treated by

Surgery is the best option because 1) cytoreductive surgery will help in increase the action of immunotherapy 2) metstatectomy ( surgery to remove metstatectomy ) with curative intent has good prognosis in pulmonary Mets Ref : Campbell and Walsh urology 11th edition . chapter 63. pg no 1502


Question: Treatment of choice for medullary carcinoma of thyroid to

Treatment is by total thyroidectomy and either prophylactic or therapeutic resection of the central and bilateral cervical lymph nodes. Bailey & Love's sho practise of surgery,25th edition,page no:798;SRB's manual of surgery,5th edition,page no:487.


Question: The gas used in LA cartridge


Question: Tardy ulnar nerve palsy is seen in

Ans. is 'b' i.e., Lateral condyle humerus Causes of tardy ulnar nerve palsy are : - Malunited lateral condyle humerus fracture (cubitus valgus) Displaced medial epicondyle humerus fracture Cubitus varus deformity (due to supracondylar fracture humerus) Elbow dislocation Contusions of ulnar nerve Shallow ulnar groove Hypoplasia of humeral trochlea Joint deformity after prolonged ahritis of elbow


Question: Cause of hydrocele in infants


Question: Surgical wound of gastrojejunostomy is an example for

GIT is breached (hence no clean), no gross spillage, so not contaminated. GI breached with no gross spillage is clean contaminated wound. These have less than 10% chance of post op infections


Question: Spastic ileus is seen in

Answer is 'a' i.e. Porphyria Spastic, or dynamic ileus is rare and results from extreme and prolonged contraction of the intestine. It is seen in - heavy metal poisoning - porphyria - uremia - extensive intestinal ulceration.


Question: Most common clinical form of actinomycosis is


Question: Consider the following prognostic parameters of acute pancreatitis

All except D is Ran son's prognostic criteria in non gallstone pancreatitis within 48hrs. SRB,5th,688.

Rise in blood urea nitrogen over 5 mg\/dl


Question: The most important reason for placing an alveolar graft in cleft palate patient is

Make eruptive pathway for permanent canine


Question: Most impoant predictor of coronary aery disease aEUR'

HDL Risk factors for atherosclerosis and cardiovascular complications (Braunwald) Abnormalities in plasma lipoproteins and derangement in lipid metabolism rank as the most firmly established risk factors for atherosclerosis. Adusted relative risk for future cardiovascular events for selected lipid fractions and lipid ratios in decreasing order are given in the following table. Adjusted relative risk of future cardiovascular events for selected lipoproteins.


Question: Diabetic gangrene is due to A/E


Question: The most common cause of anterior compament syndrome is


Question: The most common site of mandible fracture is


Question: The most common tooth to get impacted (excluding the third molars) is


Question: Fever in burnt patient is caused by


Question: A man was presented to emergency depament with head injury after an accident with vehicle. Investigation of choice should be;

NCCT- IOC for Head Injury In NCCT - shows Biconvex or Lenticular or lens shaped hyperdense lesion In NCCT - shows Concavo- convex hyperdense lesion


Question: Treatment of choice for acute lymphadenitis

ACUTE INFLAMMATION OF THE LYMPHATICS Acute lymphangitis is an infection, often caused by Streptococcus pyogenes or Staphylococcus aureus, which spreads to the draining lymphatics and lymph nodes (lymphadenitis) where an abscess may form. Eventually this may progress to bacteraemia or septicaemia. The normal signs of infection (rubor, calor, dolor) are present and a red streak is seen in the skin along the line of the inflamed lymphatic . The pa should be rested to reduce lymphatic drainage and elevated to reduce swelling, and the patient should be treated with intravenous antibiotics based upon actual or suspected sensitivities. Failure to improve within 48 hours suggestsinappropriate antibiotic therapy, the presence of undrained pus or the presence of an underlying systemic disorder (malignancy, immunodeficiency). The lymphatic damage caused by acute lymphangitis may lead to recurrent attacks of infection and lymphoedema; patients with lymphoedema are prone to so-called acute inflammatory episodes Ref : Bailey and love 27th edition Pgno : 996


Question: Risk of malignancy in cold nodule of thyroid is

Risk of malignancy in hot nodule is 4%.
Risk of malignancy in cold nodule is 20%.


Question: Moth eaten alopecia is seen with


Question: Trauma and injury severity score (TRISSI) includes

Predict outcome of trauma cases S - Revised Trauma Score ISS - Injury Severity Score


Question: A periapical abscess of a mandibular second molar space spreads most commonly to the


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. ref : SRB&;s manual of surgery,5th ed ,pg no 804


Question: Colonic diverticulosis is best diagnosed by

"Diverticula are best seen on barium enema. Colonoscopy is a less sensitive means of detecting diverticula." - CMDT 2007

Diverticulosis refers to the presence of multiple diverticula
Diverticulitis refers to inflammation and infection associated with a diverticulum.

Best investigation for
Diverticulosis - Barium enema
Diverticulitis - CT scan

On barium, enema diverticulosis shows characteristic 'sawtooth' appearance


Question: Desmoid tumor, treatment is

Desmo means Band/Tendon in Greek. It is a tumour arising from the musculoaponeurotic layer of abdomen, below the level of the umbilicus. It is unencapsulated, hard, fibroma, presently classified under aggressive fibromatosis.80% of cases occur in women, commonly after deliveries, over the abdominal scars, OCP use.It is often associated with Gardner's syndrome. Wide excision of the tumour with a margin of 2.5 cm along with placement of a mesh to the abdominal defect is the treatment of choice . It is moderately radiosensitive. Drugs like sulindac and tamoxifen are also used. Chemotherapeutic agents like doxorubicin, actinomycin D, dacarbazine, carboplatin are used but with significant toxicity. Recurrence rate is high--20-40%.Reference : page 742-43 SRB's manual of surgery 5th edition


Question: Most common origin of melanoma is from

Sabiston (16/e) writes -
"Melanoma is a neoplastic disorder produced by malignant transformation of the normal melanocytes. Melanocytes are the cells responsible for the production of the pigment melanin.
During the first trimester of fetal life precursor melanocytes arise in the neural crest. As the fetus develops, these cells migrate to areas such as the skin, meninges, mucous membranes, upper esophagus and eyes.
In each of the these locations, melanocytes have demonstrated a potential for malignant transformation, but the site most commonly associated with melanocytic transformation is the skin, where melanocytes reside at the dermal/epidermal junction".


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

Adriamycin based chemotherapy followed by tamoxifen depending on.... Stage I & II breast cancers (Early invasive breast cancers) are managed by 1) Primary therapy for local management & 2) Adjuvant therapy Primary therapy consists of : - Mastectomy with assessment of axillary lymph node status (or modified radical mastectomy) Or - Breast conservation (lumpectomy, wide local excision or quadrantectorny) with assessment of axillary lymph node status + radiotherapy. Various trials have found both these methods to be equally effective. Breast conservation is the preferred form of treatment because of cosmetic advantages However there are ceain contraindications for conservative surgery (described in subsequent question) Management of axillary lymph nodes Earlier dissection of axillary lymph nodes (level l and II) was performed to assess the lymph node status (i.e. presence or absence of occult metastasis) Now Sentinel lymph node biopsy is considered the standard for evaluation of the axillary lymph nodes for metastasis in women who have clinically negative lymph nodes. (the sentinel lymph node is the first regional lymph node to receive tumor cells that metastasize along the lymphatic pathway from the primary breast cancer) Axiltary Lymph node dissection is performed for clinically palpable axillary lymphnodes or metastatic disease detected in sentinel lymph node biopsy. Adjuvant chemotherapy is given to all node-positive cancers node negative cancers if > I cm in size node negative cancer > .5 cm in size with adverse prognostic factors such as blood vessel or lymph vessel invasion high nuclear grade high histological grade HER 2/neu overexpression negative hormone receptor status Adjuvant hormone therapy (tamoxifen) is added to all those with estrogen receptor positive tumors. HER-2/neu expression is determined for all patients with newly diagnosed breast cancer and may be used to provide prognostic information in patients with node-negative breast cancer and predict the relative efficacy of various chemotherapy regimens. Trastuzumab is the HER-2/neu-targeted agent that is added to the adjuvant therapy is the tumor shows overexpression of HER-2/neu receptors. Advanced Local-Regional Breast Cancer (Stage III) (Neoadjuvant chemotherapy + MRM + adjuvant radiation therapy + chemotherapy + antiestrogen therapy) Here the disease is advanced on the chest wall or in regional lymph nodes (or both), with no evidence of metastasis to distant sites. Such patients are recognized to be at significant risk for the development of subsequent metastases, and treatment addresses the risk for both local and systemic relapse. In an effo to provide optimal local-regional disease-free survival as well as distant disease-free survival for these women, surgery is integrated with radiation therapy and chemotherapy. Neoadjuvant chemotherapy (administration of therapeutic agents prior to the main treatment) should be considered in the initial management of all patients with locally advanced stage III breast cancer. Surgical therapy for women with stage HI disease is usually a modified radical mastectomy, followed by adjuvant radiation therapy and chemotherapy. Antiestrogen therapy (tamoxifen) is added for hormone receptor positive tumors. Chemotherapy is used to maximize distant disease-free survival, whereas radiation therapy is used to maximize local-regional disease-free survival. In selected patients with stage LIIA cancer, neoadjuvant (preoperative) chemotherapy can reduce the size of the primary cancer and permit breast-conserving surgery. Distant Metastases (Stage IV) (mainly palliative treatment) Treatment for stage IV breast cancer is not curative but may prolong survival and enhance a woman's quality of life. Hormonal therapies that are associated with minimal toxicity are preferred to cytotoxic chemotherapy. Appropriate candidates for initial hormonal therapy include women with hormone receptor-positive cancers: women with bone or soft tissue metastases only; and women with limited and asymptomatic visceral metastases. Systemic chemotherapy is indicated for women with hormone receptor-negative cancers, symptomatic visceral metastases, and hormone-refractory metastases. Bisphosphonates, which may be given in addition to chemotherapy or hormone therapy, should be considered in women with bone metastases. About Adjuvant Therapy Adjuvant therapy is the use of systemic therapy (chemotherapy or/and hormone therapy) in patients who have received local therapy but are at risk of relapse. The objective is to eliminate the occult metastasis responsible for late recurrences while they are microscopic and theoretically most vulnerable to anticancer agents. Adjuvant chemotherapy is given to all node-positive cancers node negative cancers if > 1 cm in size node negative cancer > .5 cm in size with adverse prognostic factors such as blood vessel or lymph vessel invasion - high nuclear grade - high histological grade HER 2/neu overexpression negative hormone receptor status Adjuvant hormone therapy (tamoxifen) is added to all those with estrogen receptor positive. The use of chemotherapy in post-menopausal women is controversial. In post menopausal women, chemotherapy is frequently used upto age 70 yrs, if she can tolerate it. In older women, chemotherapy is performed less frequently. - In estrogen positive tumors, in postmenopausal women, antiestrogen (tamoxifen/ aromatase inhibitors) therapy is the preferred form of adjuvant systemic treatment. Neoadjuvant chemotherapy - it involves the administration of adjuvant therapy before primary therapy (surgery & radiation therapy) - it has shown to down-stage the tumor. Previously CMF (cyclophosphamide, methotrexate & 5-fluorouracil) was the chemotherapeutic regimen of choice. "CMF is no longer considered adequate adjuvant chemotherapy and modern regimens include an anthracycline ( doxorubicin or epirubicin) and the newer agents such as the taxanes (paclitaxel and docetaxel)"- Bailey and Lore 25/e p844 Anti-HER-2/neu antibody therapy (Traztuzumab) HER-2/neu expression for all newly diagnosed patients with breast cancer is now recommended. Trastuzumab is added to the chemotherapy for tumors overexpressing HER-2/nett receptors. (Traztuzumab is added along with taxanes)

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


Question: Cyst coming from an unerupted tooth is

Ans. (a) Dentigerous cystRef: Radiopedia.org. Prof Gaillard et al.DENTAL CYST (Radicular or periodontal cyst or Periapical cyst)DENTIGEROUS CYST (Follicular odontoma or Follicular cysts)Most common Odontogenic cyst2nd MC odontogenic CystDevelops at the apex of chronically infected tooth with necrotic pulp'(root of normally erupted tooth)Associated with unerupted permanent toothLined by stratified squamous epitheliumLined by non-keratinizing squamous epitheliumMost common in middle ageMost common in 2nd or 3rd decadeMost common in upper jawMost common in Lower third Molar tooth (Mandible 3rd molar)2nd MC - Maxillary 3rd molar (upper)


Question: Urine cytology is used for screening of

Carcinoma of Urinary Bladder Cytoscopy Diagnosis and initial staging is made by cytoscopy and transurethral resection (TUR) Urinary cytology Cytological examination of exfoliated cells are useful in detecting cancer in symptomatic patients and assessing response to treatment Most useful for early diagnosis of recurrence in TCC Exfoliated markers for detection of bladder cancer New Urinary tumor marker like BTA test,urinary nuclear matrix protein (NMP22) can detect cancer specific proteins in urine (BTA/NMP22) Hyaluronidase, Lewis-X-Antigen on exfoliated urothelial cells Determination of telomerase activity in exfoliated cells Have been used to detect new index tumors and recurrent tumors Expected to play impoant role in near future Ref: Smith's 18th edition Pgno : 313


Question: The most common tumor of the minor salivary gland is

The 90% of minor salivary gland tumours are malignant-commonly adenoid cystic carcinomas 10% are benign commonly pleomorphic adenomas SRB,5th,420.


Question: Commonest shoulder dislocation

Ans. is 'a' i.e., Preglenoid Anterior dislocation of the shoulder is the most common type of shoulder dislocation. Head of the humerus comes out of the glenoid cavity and lies anteriorly. Anterior dislocation of shoulder could be : - Preglenoid It is the most common type of anterior dislocation and head lies in front of glenoid. Subcoracoid :- The head lies below the coracoid process. Subclavicular (infraclavicular) :- The head lies below the clavicle. Intrathoracic :- It is very rare.


Question: Tumor appears at the earliest after birth.

Ans. (a) Cystic hygromaRef: Bailey and Love 26th edition, Page700* Earliest swelling one can note in human beings in Cystic Hygroma.* It can present as obstructed labor


Question: Line joining ant. sup iliac spine to ischial tuberosity and passes a greater trochanter

A i.e. Nelton's line Measurment of Supratrochanteric Shoening Shoening of limb length produced above the level of trochanter (due to femoral head, neck and hip joint lesions) is known as supratrochanteric shoening. And it is measured by follwing tests.


Question: Gunstock deformity is due to


Question: Most reliable sign of injury to intrathoracic aoa is

Answer- C. Obliteration of aoic knob contourThe most reliable of these signs for the blunt aoic iniury is loss ofthe aoic knob contour.


Question: Most frequent site of branchial cyst is at

BRANCHIAL CYST

It arises from the remnants of second branchial cleft. Normally, 2nd, 3rd, 4th clefts disappear to form a smooth neck. Persistent 2nd cleft is called as cervical sinus (of His) which eventually gets sequestered to form branchial cyst.
Swelling in the neck beneath the anterior border of upper third of the sternomastoid muscle. It is smooth, soft, fluctuant, often transilluminant with a sensation of ‘Half-filled double hot water bottle’.
It is equal in both sexes. Even though congenital, it is seen in late adolescents and early 3rd decade.
It contains cholesterol crystals which is from the lining of mucous membrane which contains sebaceous gland. Cheesy toothpaste like material is typical.

Upper third of posterior border of sternocleidomastoid

Lower third of anterior border of sternocleidomastoid

Upper third of anteromedial border of sternocleidomastoid


Question: Abdominal Aoic Aneurysm most commonly ruptures in

Abdominal aoic aneurysm - anterior(20%) Posterior (80%) Most common site- retroperitonium with formation if retroperitonial hematoma. Reference- SRB, 5th edition, page:200


Question: Features of Blunt trauma abdomen maximum injury is to

.ABDOMINAL TRAUMA It can be * Blunt trauma * Stab injury * Abdominal wall injury General Clinical Features * Features of shock--pallor, tachycardia, hypotension, .cold periphery, sweating, oliguria. * Abdominal distension. * Pain, tenderness, rebound tenderness, guarding andmrigidity, dullness in the flank on percussion. * Respiratory distress, cyanosis depending on the amount of blood loss. * Bruising over the skin of the abdominal wall. * Features specific of individual organ injuries. ref:SRB&;s manual of surgery,ed 3,pg no 124


Question: The most common primary tumor of mediastinum


Question: Murmur increasing with Valsalva manouvre aEUR'

HOCM EFFECT OF VARIOUS INTERVENTIONS ON SYSTOLIC MURMURS Valsalva maneuver Most murmurs decrease in length and intensity with valsalva mane- uver. Two exceptions are:? - HOCM --> becomes louder - Mitral valve prolapse - becomes longer and louder Mitral Regurgitation The systolic murmur of M.R. is reduced during the strain phase of valsalva maneuver.


Question: The joint cavity can be examined in detail with out much surgical exposure by


Question: Perforators are not present at

Blood flows from the superficial to the deep veins through perforating (communicating veins) Perforators are located below the medial malleolus (inframalleolar perforator) in the medial calf (Cockett perforators) just above (Dodd perforator) & below the knee (Boyd perforator) at the level of the adductor canal (Hunterian perforator)


Question: In patients with cirrhosis of the liver the site of venous thrombosis is

In poal hypeension, Hepatic venous pressure gradient (HVPG) - It is done using a balloon catheter. Difference between free hepatic vein pressure and wedged hepatic vein pressure is HVPG. Normal HVPG is 8 mm Hg. It is more than 10 mm Hg in cirrhosis. Ref: SRB&;s manual of surgery,3 rd ed, pg no 547


Question: Removal of pa of the gut is must for the following mesenteric cyst removal surgery

.Enterogenous type of cyst arises as a diveiculum or duplication from the adjacent bowel. hence it is a thick walled cyst (contains all layers of the bowel) and receives its blood supply from the adjacent bowel (not independent). So resection of the adjacent bowel along with the cyst is essential.Enucleation is contraindicatedIn enterogenous type, removal of the cyst with resection of adjacent bowel is done, because blood supply is from adjacent bowel. ref:SRB&;s manual of surgery ,ed 3,pg no 511


Question: Treatment of choice in peptic ulcer grade III is

Treatment for peptic ulcer includes, * Correction of dehydration and electrolytes by IV fluids--normal saline or double strength saline, calcium, potassium, magnesium. * Blood transfusion is given if there is anaemia. * TPN suppo. * Stomach wash to clean the stomach contents (using normal saline) is given using stomach tube like Oswald&;s. It also reduces the oedema of stomach wall and improves gastric emptying time by increasing the gastric muscle tone. * Surgery - Truncal vagotomy along with gastrojejunostomy of Mayo (posterior, veical, sho loop, retrocolic, is peristalsis) is done - Ideal. - Vagotomy, antrectomy (acid-secreting area) with Billroth I anastomosis along with feeding jejunostomy for nutrition is the other option. Ref: SRB&;s manual of surgery,3 rd ed, pg no 761


Question: Lower Lip carcinoma <1 cm treatment is

Ans. (c) Surgical excisionRef: Bailey and Love 27th edition Page 768Lip cancer management.Smaller Tumors <2cm)* Excision by V or W shaped under Local or General Anaesthesia.* Defect of less than 1 /3rd defect is closed by primary closure in 3 layers - Mucosa, Muscle, Skin.Intermediate Tumors:* 1 /3rd to 2/3rd defect happens- Local flaps must be used like Johansen Step ladder flapTotal Lip Reconstruction:* T 4 lesions needs complete Excision of Lip.* Radial forearm free flap or Perforator flaps such as Antero lateral Thigh or Medial Sural Artery Perforator (MSAP) free flap.


Question: A patient started having sudden headache and vomiting and got unconscious, diagnosis is


Question: Hypotension in case of gas gangrene is best treated by


Question: Supra omohyoid dissection is one variety of

Ans. (a) Selective neck dissectionRef: Bailey- 26th edition Page 720* Supraomohyoid neck dissection involves removal of neck nodes at level 1,2,3.* It is done for No neck node palpable cases and for some cases of N1.* Extended Omohyoid Neck dissection removes - Level 1,2,3 and 4 nodes.


Question: Tinel's sign is positive in

(A) Peripheral nerve regeneration # Tinel s sign: Tinel's sign is elicited as follows:> Tap the injured nerve along its course starting peripherally.> The point at which the patient feels tingling sensation along the course of the nerve indicates that recovery has started and has reached that point.> Also seen in comparision of nerve either by neuromas or entrapment.


Question: In the fracture of middle cranial fossa, loss of taste sensations from palate would be due to lesion in

Greater petrosal nerve Middle cranial fossa fracture damages the petrous bone and thence, GP nerve lying on it. GP nerve carries the palatal taste fibres (SVA) to the geniculate ganglion


Question: Traumatic glenohumeral instability on one direction with Bankas lesion are treated by


Question: Most common site of ectopic testis is

(Superficial inguinal ring) (1405-LB) (1379-B &L 25th)Ectopic testis descending order (i) Superficial inguinal ring (ii) perineum (iii) Root of the penis (iv) femoral triangle* Continued descent of the testis may progress after birth, but descent comes to a halt before 2 years of age. The degenerative changes begin to occur at 2 years of age.* Operation is indicated after 12-18 months since degenerative changes begin to take place* The incidence of testicular cancer in a cryptoorchid testis (30 times higher than the normal population)* The prognosis for fertility following orchidopexy in unilateral maldescent is 80%, whereas fertility after bilateral orchidopexy is about 50%


Question: A male with azoospermia found to have normal FSH & testosteron levels & normal size testes. Probable cause is


Question: Pathognomonic sign of traumatic fracture is

C i.e. Crepitus Fracture is a break in structural continuity of bone. It may be no more than a crack, a crumpling or a splintering of the coex; most often the break is complete & the bone fragments are displaced.


Question: Normal level of PSA is

In BPH , prostatitis and cancer is PSA is raised.


Question: A patient with critical lower limb ischemia presents with

Critical lower limb Ischemia is characterized by rest pain. Ulcers and gangrene may occur in patients with critical limb ischemia Critical limb ischemia CLI results from severe aerial occlusive disease in whom resting blood flow cannoy provide fro basal nutrition needs of tissues Ischemic symptoms are present even during rest (rest pain) Pain is worse when legs are horizontal and may improve when legs are kept in a dependent position Ischemic ulcers, lesions on the foot and gangrene may be seen ABI <0.5 Ref: Sabiston 20th edition Pgno :1784

Intermittent claudication and ischemic ulcers


Question: Most common metabolic complication of gastrectomy is

Nutritional disorders are common after gastrectomy. Weight loss is common after gastrectomyAnaemia may be due toeither iron or vitamin B12 deficiency.Iron-deficiency anaemia occurs after both gastrectomy and vagotomy and drainage. Reduced iron absorption is probably the most impoant factor, although the loss of blood from the gastric mucosa may also be impoant. Vitamin B12 deficiency is prone to occur after total gastrectomy. However, because of the very large vitamin B12 stores that most patients have, this maybe very late in occurring.Bone disease is seen principally after gastrectomy and mainly in women. The condition is essentially indistinguishable from the osteoporosis commonly seen in post-menopausal women.Bailey and love pg: 1127


Question: Commonest complication of varicose vein stripping is

Ans. is 'c' i.e., Ecchymosis "Complications associated with GSV stripping include ecchymosis, lymphocele formation, DVT, infection, and saphenous nerve injury."- Schwaz 9/e p792


Question: Most common sets of Metastases of carcinoma bronchi

Distant metastases blood stream are widespread and early.The sites affected,in descending order of involvement,are:the liver,adrenals,bones,pancreas,brain,opposite lung,kidneys & thyroid. Textbook of pathology-6th edition,Harsh Mohan,6th edition,page no:502


Question: Cellulitis is

Ans. (b) A nonsuppurative invasive infection of tissues(Ref: Bailey and Love 27th Edition Page 48)* Cellulitis is a non suppurative invasive infection of Tissues, related to point of injury.* Poor localisation and spreading infection seen.* Caused by Beta Hemolytic Streptococci, Staphylococci and Clostridium perfringens.* Toxemia- Fever, Chills are common.* Blood Culture is negative.

A suppurative invasive infection of skin and subcutaneous tissues

Infection caused by Gram negative bacilli

Infection caused by anaerobic Streptococci


Question: A 40 year old man presented with a flat 1 cm x 1 cm scaly, itchy clack mole on the front of thigh. Examination did reveal any inguinal lymphadenopathy. The best course of management would be

Lymphangiomas are dilated dermal lymphatics that 'blister' onto the skin surface. The fluid is usually clear but may be blood-stained. In the long term, lymphangiomas thrombose and fibrose, forming hard nodules that may raise concerns about malignancy. If lymphangiomas are <5cm across, they are termed lymphangioma circumscriptum, and if they are more widespread, they are termed lymphangioma diffusum. If they form a reticulate pattern of ridges then it has been termed lymphoedema ab igne. Lymphangiomas frequently weep (lymphorrhoea, chylorrhoea), causing skin maceration, and they act as a poal for infection. Protein-losing diarrhoea, chylous ascites, chylothorax, chyluria and discharge from lymphangiomas suggest lymphangectasia (megalymphatics) and chylous reflux. Ulceration, non-healing bruises and raised purple-red nodules should lead to suspicion of malignancy. Lymphangiosarcoma was originally described in postmastectomy oedema (Stewa-Treves' syndrome) and affects around 0.5% of patients at a mean onset of 10 years. However, lymphangiosarcoma can develop in any long-standing lymphoedema, but usually takes longer to manifest (20 years). It presents as single or multiple bluish/red skin and subcutaneous nodules that spread to form satellite lesions, which may then become confluent. Thediagnosis is usually made late and confirmed by excision biopsy. Amputation offers the best chance of survival but, even then, most patients live for less than 3 years. It has been suggested that lymphoedema leads to an impairment of immune surveillance and so predisposes to other malignancies, although the causal association is not as definite as it is for lymphangiosarcoma. Ref : Bailey and love 27th edition Pgno : 998

Wide excision with inguinal lymphadenectomy


Question: In Duke's classification of colorectal carcinoma stageA means

(A) Involvement up to muscularis propria # Duke's prognostic classification> A-growth in colon/rectum only> B-growth extending to extrarectal tissues but no metastasis to regional lymph nodes> C-secondary deposits in regional lymph nodes


Question: Optical urethroplasty is done in

Congenital Urethral Stricture-this rare condition may be associated with duplication of the urethra. Usually, symptoms are delayed until adolescence, when it may be indistinguishable from a stricture due to unrecognised urethral injury in childhood. A single treatment by optical urethrotomy(Direct visual internal urethrotomy) or dilatation is usually effective.Reference : page1362 Bailey and Love's sho practice of surgery 25th edition


Question: 35 years male presents with a swelling in scrotum that is non tender and seperate from testes and on transillumination, chinese lantern pattern is seen diagnosis

Answer- C. Epididymal cystCysts of the epididymis (multiloculated epididymal cyst, spermatocele) are not swrounded by fluid and for this reason are felt as swellings above, behind the testis, which is also easily palpable in this situation.Because of the septation, multiloculated epididlmal cysts have a characteristic 'Chinese lantern' aPPearance on transillumination.


Question: Abdominal surgery under LA, patient suddenly felt pain due to

.pas of peritoneum mainly includes 1. 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. ref:SRB&;s manual of surgery,ed 3,pg no 498


Question: Sample collection for renal tuberculosis is

BACTERIOLOGICAL:- The diagnosis of genitourinary TB is confirmed on a tuberculin test or atleast three consecutive early morning samples of urine are collected and sent for microscopy (Ziehl-Neelsen staining), culture on Lowenstein-Jensen medium. RADIOGRAPHY:- A plain abdominal radiograph may show calcified lesions of CEMENT KIDNEY. INTRAVENOUS UROGRAPHY:-EARLY:-Normally clear cut outline of renal papillae may be rendered indistinct by presence of ulceration. TUBERCULOUS ABSCESS:-Appears as SOL , which causes adjacent calyces to splay out. LATE:- Dilatation of contralateral ureter from obstruction where the ureters passes through thickened and oedmatous bladder wall. CYSTOSCOPY:- GOLF-HOLE ureteric orifice. CXR:-Active Lung lesion. Reference : Bailey27th edition . chapter 76 , pg no: 1405


Question: Pure Radiolucent stone

Ans. (c) Xanthine StonesRadiolucent Kidney Stones:* Pure Uric Acid Stones* Xanthine* Indinavir Drug induced StoneUric Acid Stone:* 5-10% of all stones* Seen in excessive acid urine (pH<5.5)* Uric acid is an end product of purine metabolism* Dietary protein and protein excess results in increased urinary URIC acid and stone.* Myeloproliferative diseases, chemotherapy drugs induce this stone.* Uric acid stone is also formed in normal uric acid level.* Low urine volume like in IBD, Ileostomies may also stimulate uric acid stone.* Stones are hard, multifaceted, multiple.* Pure uric acid Stones are radiolucent.


Question: Most common site of ischemia of large bowel is at

(A) Splenic flexure [B&L26-11831# Colon receives blood from both the superior and inferior mesenteric arteries.> Blood supply from these two major arteries overlap, with abundant collateral circulation via the marginal artery of the colon.> However, there are weak points, or "watershed" areas, at the borders of the territory supplied by each of these arteries, such as the splenic flexure and the transverse portion of the colon.> These watershed areas are most vulnerable to ischemia when blood flow decreases, as they have the fewest vascular collate ra\s.> Rectum receives blood from both the inferior mesenteric artery and the internal iliac artery; the rectum is rarely involved by colonic ischemia due to this dual blood supply.


Question: middle aged man with a swelling over the scalp since childhood Neck swelling has a bag of worm appearance Bruit heard over the swelling Dx is


Question: MC comp. of talus is


Question: Most common gas used for pneumoperitoneum

Ans. (b) CO2 (Ref: Campbell Urology 11th 211)* CO2 is the most commonly used gas for laparoscopy because it is colourless, non combustible, very soluble in blood and inexpensive.


Question: Newman and Seabroocks operation is done for

Newman and Seabroocks operation is reconstruction of duct done for parotid fistula.


Question: The usual site of stress fracture includes


Question: In polytrauma with blunt abdominal injury, the first investigation to evaluate his abdomen is

Ans. (a)USG is the first investigation to evaluate abdomen in bunt trauma.Ref. Schwartz 10th/e p. 179 and 9th/e p. 151; Washington Manual of Surgery 5th/e p. 373 * CT scan is the best investigation.


Question: Return of Bulbocavernous reflex in spinal shock

A i.e. Sign of recovery from spinal shock Spinal Shock Some times physical energy of the injury mechanism causes immediate depolarization of axonal membranes in the neural tissue. This results in functional neurological defecit that exceeds the actual tissue disruption. This condition is refered to as spinal shock. The presence of spinal shock causes the absence of all reflexesQ. And it typically lasts upto 24- 48 hours after the injuryQ. The bulbocavernosus reflex is the reflex that returns first, thus marking the end of spinal shockQ. This point has prognostic impoance because recovery from a complete neurological deficit that is still present at the end of spinal shock is extremely unlikely. In other words, a total absence of sensation & voluntary motor functions caudal to the level of spinal cord injury in the absence of spinal shock (i.e. bulbocavernosus reflex has recovered) is indicative of complete spinal cord injury and there is viually no likelihood of functional spinal cord recovery.


Question: GCS of an intubated patient with Abnormal flexion attitude, and eye opening only to pain is

Ans. (c) E2 VNTM3 Ref: Bailey and Love, 27th ed; pg. 331* Verbal response could not be tested in intubated patients and are scored as NT (not tested)* So, in intubated patients scores range from E1 M1 NT to E4 M6 NT


Question: Chronic Burrowing ulcer is caused by

Microaerophilic streptococci (Burrowing ulcer / Maleny's ulcer is caused by synergistic infection of microaerophilic non hemolytic streptococci and aerobic hemolytic streptococci)


Question: Crohn&;s disease is associated with

.10% of first degree relatives; 50% of monozygotic twins develop Crohn's disease. Genes NOD2 / CARD15 in chromosome 16q12 has got strong association with Crohn's disease. CARD15 is expressed in Paneth cells of the ileum. * Smoking is related to Crohn's disease as aetiology, as for relapse and for exacerbations. There is increased mucus membrane permeability - antigen induced cell mediated inflammatory response - release of cytokines like TNF, interleukin 2 -m defect in suppressor T cell - granuloma and other pathology. ref:SRB&;s manual of surgery ,ed 3,pg no 801


Question: Most common site of Curling&;s ulcer

Curling ulcer is acute ulcer peptic ulcer of duodenum developing as a resulting from burn injury which reduces plasma volume resulting in sloughing of the gastric mucosa. Reference SRB 5th edition page no. 822 & internet


Question: In head injury, first to be repaired is


Question: . Peutz Jeghers polyps present most commonly in

Jejunum [Ref: Oxford textbook of medicine: Sections 18-33, Volume 3 By David A. Warrell 2005/e p6431 Oxford textbook of medicine writes- "The syndrome stigmata are obvious with multiple pigmented spots on the lips and buccal mucosa, and multiple benign hamaomatous polyps throughout the gastrointestinal tract, most frequently affecting the jejunum." Peutz-Jeghers syndrome is an autosomal dominant syndrome characterized by the combination of hamaomatous polyps of the intestinal tract and hyperpigmentation of the buccal mucosa, lips, and digits. The syndrome is associated with an increased (2%-10%) risk for cancer of the intestinal tract, with cancers repoed throughout the intestinal tract, from the stomach to the rectum. There is also an increased risk for extraintestinal malignancies, including cancer of the breast, ovary, cervix, fallopian tubes, thyroid, lung, gallbladder, bile ducts, pancreas, and testicles.


Question: The following is a maker of Paget&;s disease of the mammary gland

.It is superficial manifestation of an intraductal carcinoma. The malignancy spreads within the duct up to the skin of the nipple and down into the substance of the breast. It mimics eczema of nipple and areola.-- In Paget's disease, there is a hard nodule just underneath the areola, which later ulcerates and causes destruction of nipple. Histologically, it contains large, ovoid, clear Paget's cells with malignant features.Modalities of Treatment for it includes * QUA therapy. * Patey's operation or simple mastectomy with axillary clearance * Postoperative radiotherapy in high risk patients. * Hormone therapy, i.e. tamoxifen 10 mg BID. * Sentinel node biopsy when required. * Regular follow-up often with radioisotope bone scan and CEA tumour marker. ref:SRB&;s manual of surgery,ed 3,pg no 470


Question: Treatment of choice for cystic hygroma

Ans. d (Surgical excision) (Ref. Bailey and Love Surgery 25th/pg. 729).Definitive treatment of Cystic hygroma is complete excision of the cyst at an early stage. Injection of a sclerosant , may reduce the size of the cyst; however, they are commonly multicystic and if the injection is extracystic subsequent surgery may be more difficult.CYSTIC HYGROMA# In this developmental abnormality of the lymphatic system, lymphatic fluid collects in a cystic space which is often multilocular and situated in the base of the neck (post triangle).# Association with Turner's syndrome is known.# Cystic hygroma usually presents in the neonate or in early infancy, and occasionally may present at birth and be so large as to obstruct labour. The cysts are filled with clear lymph and lined by a single layer of epithelium with a mosaic appearance. Swelling usually occurs in the neck and may involve the parotid, submandibular, tongue and floor of mouth areas. The swelling may be bilateral and is soft and partially compressible, visibly increasing in size when the child coughs or cries. The characteristic that distinguishes it from all other neck swellings is that it is brilliantly translucent.# The cheek, axilla, groin and mediastinum are other less frequent sites for a cystic hygroma.# The behaviour of cystic hygromas during infancy is unpredictable. Sometimes the cyst expands rapidly and occasionally respiratory difficulty ensues, requiring immediate aspiration and even occasionally a tracheostomy. The cyst may become infected.# USG can be diagostic.


Question: Long duration anesthesia is achieved by

2% Lidocaine HCL + Epinephrine 1:2,00,000

4% Prilocaine HCL + Epinephrine 1:2,00,000

0.5% Bupivacaine+ Epinephrine 1:2,00,000


Question: Gail Model is for risk assessment of

Ans. (c) CA. Breast(Ref. Schwartz 10th edition Page 512)Common models used in risk assessment of cancer breast:* Gail model* Claus Model* BRCAPRO model* Tyrer-Cuzick model* Neither the Gail model nor the Claus model accounts for the risk associated with mutations in the breast cancer susceptibility genes BRCA1 and BRCA2.* Other models utilize the family history and BRCA1 and 2 mutations.


Question: Apical cyst having a direct connection with apical foramen have been termed as


Question: Best prognosis of thyroid cancer Is

Best prognosis — papillary
Worst prognosis – anaplastic


Question: The Ames test is a method for detecting

Mutagenesis in bacteria The Ames test is carried out in Salmonella and detects mutations in the bacterial DNA. Because mutagenic potential is associated with carcinogenic risk for many chemicals, the Ames test is often used to claim that a paicular agent may be a carcinogen. However, the test itself only detects mutations.


Question: The difference between primary and secondary healing is

In secondary healing :

More granulation tissue and fibrosis occurs.
Scar is loss cosmetic.
Secondary healing occurs slower.
Surgical wounds are clean cut, hence they heal by secondary healing.

More granulation tissue and fibrosis is seen in secondary healing

Scar is more cosmetic in secondary healing

Surgical wound heal commonly by secondary healing


Question: Urinary catheterisation indicated in case of acute retention of urine in following conditions

The most frequent causes of acute retention Male * Bladder outlet obstruction (the most common cause) * Urethral stricture * Acute urethritis or prostatitis * Phimosis Female * Retroveed gravid uterus * Bladder neck obstruction (rare) Both (Male and female) * Blood clot * Urethral calculus * Rupture of the urethra * Neurogenic (injury or disease of the spinal cord) * Smooth muscle cell dysfunction associated with ageing * Faecal impaction * Anal pain (haemorrhoidectomy) * Intensive postoperative analgesic treatment * Some drugs * Spinal anaesthesia Ref: Bailey and love 27th edition Pgno : 1426


Question: Most common site of origin of RCC


Question: Best fluid for resuscitation of burns patient

Answer- A. Hamann solutionFluid resuscitation begins with an isotonic crystalloid solution - Ringer's lactate solution (RL)(Haman's solution) k theprefered solution (Normal saline shouldbe avoided as the volumes required for resuscitation may lead to hyperchloremic metabolic acidosis).


Question: One of the following does not cause increase in the size of spleen in later stages


Question: ABO antigens are not seen in aEUR'

C.S.F. ABO antigens are found in Sal PancreasQ Kidney Liver Semen Sweat Gastric juice Amniotic fluid Lung


Question: Tamoxifen given in breast carcinoma for

Women with hormone receptor-positive tumours will obtain a wohwhile benefit from at least 5 years of endocrine therapy, either 20 mg daily of tamoxifen if premenopausal or the Aromatase Inhibitors (anastrozole, letrozole, and exemestane) if postmenopausal. Recent trials have shown that longer durations of endocrine therapy provide a small extra benefit but with increased toxicity.It is no longer appropriate to give hormone therapy to women who do not have oestrogen or progesterone receptor-positive disease. Ref: Bailey and Love, 27e, page: 878


Question: The most common complication of clavicle fracture is


Question: The current permissible maximum storage time and temperature for platelets include

Platelets are supplied as pooled platelet concentrate. They are stored on a special agitator at 20-24degC. Shelf life--5 days. Indication: Thrombocytopenia, platelet dysfunction. Ref: Bailey and love 27th edition Pg no:21


Question: Not used as graft material in peripheral vascular disease


Question: Most common uropathic obstruction in children is

C. i.e. (Posterior urethral valve) (1362 -B & L 25th) (1289 - S. Das 5th)POSTERIOR URETHRAL VALVES are the most common obstructive urethral lesion in newborn and infants males and most common cause of end stage renal disease in boys (1008 - CSDT 12th)* They are usually just distal to the verumontanum*** Most reliable method to confirm the diagnosis is voiding cystourethrography*** Definitive treatment by transurethral resection of the valveMarion's Disease - congenital obstruction of the neck of the bladder


Question: In fracture of the body of mandible the miniplate is given


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

(Hydrocele) (1408-LB 24th) (1382-B & L 25th)Treatment of Hydrocele - Lord's operation is suitable when the sac is reasonably thin walled. There is minimal dissection and the risk of haematoma is reduced.Eversion of the sac with placement of the testis in a pouch prepared by blunt dissection in the facial planes of the serotum is an alternative (Jabouley's procedure)Varicocele - Embolisation of the testicular vein under radiographic control is probably the treatment of choice (1407-LB)* Simplest surgical procedure is ligation of the testicular vein above the inguinal ligaments where the pempiniform plexus has coalesced into one or two vessels


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


Question: Laryngeal Papillomatosis is caused by

Laryngeal papillomata These are rare benign tumours occurring mainly in children, but can also present in adults. They are most commonly found on the vocal folds, but may spread throughout the larynx and tracheobronchial airway (although this is less likely in adults). They are caused by papillomaviruses andneed repeated removal by carbon dioxide laser or microsurgery to maintain a reasonable voice and airway. These patients are best managed in specialist centres, with the appropriate expeise. Antiviral treatment is of doubtful value. Papilloma vaccination is, to date, of unproven benefit. Ref: Bailey and love 27th edition Pgno : 750


Question: Cullens sign is seen in

Ans. is 'a > b' i.e., Hemorrhagic pancreatitis > Ectopic pregnancy * Bleeding into the fascial planes can produce bluish discolouration of the flanks (Grey Turner's sign) or umbilicus (Cullen's sign).* These are seen in acute pancreatitis but are not pathognomic for the same.* Cullens sign was first described in association with rupture of an ectopic pregnancy.Specific signs in abdomina examinationSignDescriptionPathologyCourvoisierPalpable gall bladder and jaundiceCarcinoma of the head of the pancreasCullenPeri-umbilical bruisingHaemorrhagic pancreatitis or ectopic pregnancyGrey turnerBruising of flankHaemorrhagic pancreatitisRovsingPain on extension of the hip joint (due to psoas irritation)Retrocaecal appendicitisMurphyRight upper quadrant tenderness exacerbated by inspirationAcute cholecystitisVirchowPalpable left supraclavicular fossa lymph nodeOesophagogastric carcinoma


Question: The sac contains only a portion of the circumference of the intestine


Question: Most common lobe involved in BPH is

BENIGN PROSTATIC HYPERPLASIA Aetiology Hormones Serum testosterone levels slowly but significantly decrease with advancing age; however, levels of oestrogenic steroids are not decreased equally. According to this theory, the prostate enlarges because of increased oestrogenic effects. It is likely that the secretion of intermediate peptide growth factors plays a pa in the development of BPH Pathology BPH affects both glandular epithelium and connective tissue stroma to variable degrees. These changes are similar to those occurring in breast dysplasia , in which adenosis, epitheliosis and stromal proliferation are seen in differing propoions. BPH typically affects the submucous group of glands in the transitional zone, forming a nodular enlargement. Eventually, this overgrowth compresses the PZ glands into a false capsule and causes the appearance of the typical 'lateral' lobes. When BPH affects the subcervical CZ glands, a 'middle' lobe develops that projects up into the bladder within the internal sphincter. Sometimes, both lateral lobes also project into the bladder, so that when viewed from within, the sides and back of the internal urinary meatus are surrounded by an intravesical prostatic collar. Ref : Bailey and love 27th edition Pgno : 1458


Question: Metabolic abnormality seen in large colorectal villous adenoma

.Features of Adenoma * Can be asymptomatic. * Bleeding per anum is usually chronic but rarely can be acute. * Anaemia. * Prolapse--common in tubular type. * Diarrhoea common in villous type; mucus discharge. * Tenesmus, colicky abdominal pain. * Spurious diarrhoea. * Poor general health. * Electrolyte imbalance - hypokalaemia. * Per-rectal examination should be done to feel the adenoma/polyp. * Carcinomatous changes. ref:SRB&;s manual of surgery,ed 3,pg no 832


Question: Toxic adenoma on scanning appear as


Question: Pseudochylous pleural effusion is most often seen in

Most common cause of pseudochylous pleural effusion is tuberculous pleurisy.
• Chyliform pleural effusion, often called pseudochylous or cholesterol effusion, is a high-lipid effusion that is not chylous.
• The most common cause of this pleural reaction is tuberculous pleurisy, but it has also been described in association with rheumatoid arthritis.
• The presence of a fat-fluid level within the pleural space is unique to pseudochylous effusion.


Question: There is a high risk of renal dysplasia in

Ans. is 'a' Posterior urethral valve The term renal dysplasia is technically a histological diagnosis. It occur due to abnormality in metanephric differentiation and is characterized histologically by the persistence in the kidney of abnormal structures - cartilage, undifferentiated mesenchyme and immature collecting ductules and by abnormal lobar organization.C/F of Renal dysplasiaIt can be unilateral or bilateral and is almost always cysticKidney is enlarged, extremely irregular and multicystic. (presents as a flank mass)In unilateral dysplastic kidney the prognosis is good, where as in B/L dysplastic kidney renal failure may ultimately result.Dysplastic kidney is associated with -posterior urethral valve (as part of VURD syndrome)V - posterior urethral valves U - unilateral refluxR & D- renal dysplasiaUretero pelvic obstructionUreteral agenesis or atresiaOther anomalies of lower urinary tract.


Question: Most common infection causing OPSI after splenectomy


Question: Submandibular salivary duct calcification treatment includes

Longitudinal incision and suturing the duct

Longitudinal	incision	and	suturing	the	wound leaving the duct open

Transverse incision and suturing the duct

Transverse incision and suturing the wound leaving the duct open


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

CDST says "Patients with blunt trauma and hypovolemia should be examined first for Intra abdominal bleeding even if there is no ove existence of abdominal trauma Ref: CDST 13th edition Pgno :196


Question: In a patient of trauma with no head injury, the target blood pressure for resuscitation is

The initial aim of resuscitation is to maintain the blood supply to the vital organs: the brain, hea and kidneys. For a sho time, this can be achieved with a target systolic blood pressure of 70-90 mmHgThe concept of "permissive hypotension" refers to managing trauma patients by restricting the amount of fluid resuscitation administered while maintaining blood pressure in the lower than normal range if there is still active bleeding during the acute period of injury. Although this treatment approach may avoid the adverse effects of early and high-dose fluid resuscitation, it carries the potential risk of tissue hypoperfusion.Bailey and love 27e 324


Question: Five day self limting pain is due to

External hemorrhoids which are painful the pain reduces after 5 days.


Question: A six yr. old female presents with constipation and urinary retention. On examination a presecral mass is noted. Most probable dignosis is

.meningocele It is the herniation of meninges through a weak point of spine where bony fusion has not taken place effectively. Swelling is covered with pia mater and arachnoid mater without dural covering and contains CSF. Clinical Features - * Present since bih. * Soft, cystic, fluctuant with transillumination. * Signs of compressibility. * Expansile impulse when asked to cough or when child cries. Location * Lumbosacral - commonest. * Occipito cervical - 2nd most common. ref:SRB&;s manual of surgery,ed 3,pg no 1053


Question: Drug of choice for infection by Gardnerella vaginatis is

Ans is 'b' ie Metronidazole (Ref. Harrisons, 16/e, p 767 (15/e, p 843))Gardnerella vaginalis causes Bacterial vaginosis*.Bacterial vaginosis can be differentiated from other vaginitis and diagnosed by Amsel criteria :White homogenous vaginal discharge*Vaginal discharges pH > 4.5*Liberation of distinct fishy odour* on mixing vaginal discharge with 10% solution of KOH.Microscopic demonstration of clue cells* (Vaginal epithelial cells coated with coccobacillary organisms)