Question: The transition between the stomach and duodenum is marked by

Prepyloric vein of mayo distinguishes pyloric canal from the first pa of the duodenum. The angular incisure or angular notch also called the incisura angularis, is a small anatomical notch on the stomach located on the lesser curvature of the stomach near the pyloric end. Its location varies somewhat in position with the state of distension of the internal organs The gastroduodenal aery is a blood vessel that arises from the common hepatic aery The hepatoduodenal ligament is the poion of the lesser omentum extending between the poa hepatis of the liver and the superior pa of the duodenum Reference: SRB 5 th edition page no.815


Question: Preferred initial treatment for Ca anal canal is

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


Question: Most common cause of death in burns is

Following successful resuscitation, most acute Morbidity and viually all Moality in severely burned patients are related to infection This is because thermal injury causes profound immunosuppression that is propoional to the TBSA of the burn. Inspite of burn patients at significant risk to infection, prophylactic systemic antibiotics are not pa of modern care, as they do not reduce septic complications and only lead to increased bacterial resistance MC cause of death at the site of burn: Asphyxia MC cause of death in burns : Septicemia MC cause of early death in burns :Hypovolemic shock MC cause of late death in burns : Septicemia Ref: Sabiston 20th edition Pgno :516


Question: Ulcerative colitis involves

Answer 'c' i.e. Mucosa Ulcerative colitis involves mucosa and superficial submucosa with deeper layers unaffected except in fulminant disease.


Question: Following are the methods used for cleft lip repair

Following techniques have been used for cleft lip repair Thompson Le Muserier Tennison-Randall but 'Rotation advancement technique' by Millard is the most widely used method


Question: Radioiodine ablation is preferred in

Surgery is followed by RIA if thyroid tissue is left.
I131 is used which has a half life of 8 days.


Question: Earliest symptom of Volkmann's Ischaemic is


Question: T/t of choice for grade IV vesicoureteric reflux with recurrent UTI

Ans. is 'a' ie. Cotrimoxazole (Ref. Nelson, 18/e p2233 (16/e, p 1628))Don't get misled by this statement given in O.P. Ghai - "Operative correction of VUR is indicated inpts. with - persistent severe (grade IV or V) refluxThis statement does not mean that any pt. with grade IV & V reflux will be given surgical management and rest medical management. Treatment is not so clear-cut.The choice b/w medical or surgical modality is based on certain principles (go through the following text to understand it).The below given explanation is a bit lengthy. Bear with me for giving such a long text, as it is one of the most important but less read topic (UG books do not give sufficient information on its treatment).This explanation will help you to tackle any future question on t/t of VUR with different patient profile (as t/t changes with grades as well as age of the patient)Vesicoureteral reflux (VUR)is the retrograde flow of urine from the bladder to the ureter and the renal pelvisGrading of VUR : is based on the appearance of the urinary tract on Micturating Cystourethrogram (MCU).Grade 1reflux into a non-dilated ureterGrade IIreflux into the upper collecting system without dilatation.Grade IIIreflux into dilated ureter and /or blunting of calyceal fornicesGrade IVreflux into a grossly dilated ureterGrade VGross dilatation of the ureter, renal pelvis & calyces : calyces show loss of papillary impression. Complications of VURReflux predisposes to renal infection (pyelonephritis) by facilitating the transport of bacteria from the bladder to the upper urinary tract.The inflammatory reaction caused by a pyelonephritic infection may result in renal injury or scarring.Extensive renal scarring impair renal function and may result in renin mediated hypertension, reflux nephropathy, renal insufficiency, end stage renal disease, reduced somatic growth and morbidity during pregnancy.* TreatmentThe goals of t/t are to prevent pyelonephritis, renal injury, and other complication of reflux.Treatment modality is either medical or surgical.Medical therapyis based on the principle that reflux often resolves over time and the antibiotics maintain urine sterility and prevent infection and complication while awaiting spontaneous resolution.Surgical therapy :the basis for surgical therapy is that in selected children, ongoing reflux has caused or has significant potential for causing renal injury.The decision to do medical or surgical t/t is based on certain principles and parental, patient preferences.Below is given a chart listing the treatment recommendation for VUR.Before going through the chart lets see the basic principles on which this chart is based -With bladder growth and maturation, there is tendency for reflux to resolve or improve over time.Lower grades of reflux are much more likely to resolve than are higher grades.For grades I & II reflux, the likelihood of resolution is similar irrespective of age at diagnosis and whether if it unilateral or bilateral.For grade III & IV a younger age at diagnosis and unilateral reflux generally are associated with a higher rate of spontaneous resolution.Grade V reflux rarely resolves.The mean age for reflux resolution is 6 - 7 yrs.Reflux is unlikely to cause any renal injury in the absence of infection.Treatment Recommendation for VUR diagnosed following a UTI.GradeAge (yrs)ScarringInitial t/tFollow-upI-iiAny-Antibiotic prophylaxis-III - IV0-5-Antibiotic prophylaxisSurgeryIII - IV6- 10-U/L: Antibiotic prophylaxisSurgeryIII - IV6 - 10-B/L: Surgery V<1-Antibiotic prophylaxisSurgeryV1 - 5NoU/L: Antibiotic prophylaxisSurgeryV1 - 5NoB/L: Surgery V1 - 5YesSurgery V6- 10-Surgery * ThusMedical Management is the initial t/t in almost all children except for -Grade III & IV (Bilateral)Grade V (Mostly)Medical management (antibiotic prophylaxis) is continued till the reflux resolves.Pt. is shifted from medical to surgical management, in children withbreakthrough UTI (Recurrent UTI despite prophylaxis)Development of new renal scarsFailure of reflux to resolve.Thus in this question we will begin with medical management ie cotrimoxazole. This pt is having recurrent UTI. This will not alter our t/t. If the pt. had recurrent UTI despite prophylaxis, we would have done a surgical management.If you have a close look at the statement of O.P. Ghai, you will note that he is not stating that grades IV & V will be t/t surgically. It is persistent grades IV & V that are t/t surgically (persistent means VUR that are not resolving over time).


Question: 22 Gauge IV cannula color

Ans. (c) BlueRef: Surgery Sixer 2nd Edition Page 14In our Hospitals commonly available cannulas for resuscitation are:* Grey: 16 G* Green: 18 G* Pink: 20 G* Blue: 22 G* Yellow: 24 G


Question: Flank discoloration seen in this patient admitted with Pancreatitis is

Ans. (a) Grey turner sign* Skin discoloration seen in the loin in cases of hemorrhagic pancreatitis is grey turner sign* Cullen sign is pigmentation around Umbilicus.


Question: Facial nerve palsy is seen in the following fracture


Question: The treatment of choice in pathological fractures is


Question: Paradoxical respiration seen in


Question: Oxalate stones are found in

The severity of ethylene glycol toxicity is related to the metabolic acidosis resulting from the biotransformation of ethylene glycol into toxic metabolites. Ethylene glycol is metabolized by the enzyme alcohol dehydrogenase to glycoaldehyde. Through interaction with aldehyde dehydrogenase, ethylene glycol is then metabolized to glycolic acid (GA).Glycolic acid causes severe acidosis. This glycolate is then transformed into glyoxylic acid which may be transformed into the highly toxic oxalate or the safer glutamate or a-ketoadipic acid metabolites. Thus, calcium oxalate crystals may form and accumulate in blood and deposit in kidneys and other tissues.


Question: The most common intraperitoneal abscess following peritonitis is


Question: Metabolic abnormality seen in gastric outlet obstruction is

Ans. is 'b' i.e. Hypochloremic, hypokalemic alkalosis Repetitive vomiting leads to hypochloremic, hypokalemic metabolic alkalosis. The urine is alkaline initially but eventually it becomes acidic (paradoxical aciduria)Cause of paradoxical aciduriaInitially the kidney compensate for metabolic alkalosis by reabsorbing hydrogen and chloride ions in exchange for sodium, potassium and bicarbonate. But gradually as the body stores of sodium and especially potassium become depleted, kidney starts retaining these ions in exchange of hydrogen ions. Thus the urine becomes acidic and the metabolic alkaline state is further aggravated.


Question: Most common site of deep vein thrombosis is

Pelvic veins are most commonly affected site in DVT.


Question: Pus in burns form in

Burn wound will almost inevitably be colonised by micro oraganism within 24-48 hrs.


Question: AKT 1 amplification seen in

Answer- D. Gastric cancer AKT 1 amplification- Glioblastoma, gliosarcoma, gastric cancer, lung cancer.


Question: Adenocarcinoma in oesophagus occurs in

BARRETT's ulcer is an ulcer in columnar epithelium lined Barrett's oesophagus. It is more prone for Bleeding, Perforation, and Adenocarcinoma of oesophagus( very high, more than 40 times). Treatment for Barrett's ulcer is endoscopic biopsy and resection. Reference: SRB's Manual of Surgery, 6th Edition, page no= 788.


Question: Anal cancer is associated with

Ans. (a) Human papilloma virusRef: Bailey & Love 26th ed. /1266* The development of anal cancer is associated with infection by human papilloma virus.* The infection may lead to:# Anal warts (condyloma acuminata)# Anal intraepithelial neoplasia# Squamous cell carcinoma.* The risk for anal cancer is increased among homosexual males.* Anal cancer risk is increased in both men and women with AIDS, because of their immunosuppressed state


Question: Gastrotomy is

an incision made in the stomach is called gastrotomy The opening created surgically in the abdominal wall for the purpose of providing access to the stomach to feed an individual who is incapable of normal food intake by inseing a tube is called gastrostomy. the opening created surgically in the abdominal wall for the purpose of providing access to the stomach to feed an individual who is incapable of normal food intake. Resecting proximal pa of stomach is called gastrectomy In subtotal gastrectomy, distal pa of a tumour is resected Reference: Bailey and love&;s edition 24 page no. 1056, SRB edition 5 page no. 858, internet

Open the stomach closed after tube inseion


Question: A 60 year old smoker came with the history of single episode of painless gross hematuria . Most logical investigation would be.

REPEAT QUESTION. In this case, we should suspect bladder carcinoma ( transitional cell carcinoma ) . RISK FACTORS:- 1.Smoker :- component of tobacco - 4 aminobiphenyl. 2. Cyclophosphamide.(Phenacitin also) 3.Schistosomiasis in endemic regions . 4.Chemical (Aromatic hydrocarbon -Aniline). 5.Stones. 6.Radiation. 7.F.B. It is more common in males -3:1. They usually presents with painless gross hematuria. IOC :-Thus the best option here is urine microsopy for RBC's and malignant cells.urine cytology even though not a good screening test because of lack of sensitivity is highly specific . Mainstay of diagnosis is cystourethroscopy. investigations include imaging ( CT , MRI ,USG ,IVU ) and blood investigations for HB , electrolytes and urea . Gold std:- CYSTOSCOPY Bailey and Love 27th edition.chapter 77.pg no 1449.

Urine microscopy for malignant cytology cells


Question: Most common type of renal cancer is

Clear cell Ca is most common. It usually involves PCT


Question: Deformity of posterior dislocation of hip

A i.e. Flexion, adduction, intenal rotation


Question: Sentinel lymph node biopsy is used for

Sentinel Lymph Node Mapping and Biopsy

For breast cancer, sentinel lymph node is the largest lymph node in the axilla and is the first to receive the lymph and potential metastases drained from the breast.

Intraoperative lymphatic mapping and biopsy of the sentinel lymph node initially introduced for the staging of melanoma has been similarly used for the detection of axillary metastases in breast cancer, where it has also become the accepted standard of care.

In both the cases the method provides for minimally invasive surgery, and its success is now stimulating attempts to introduce it in the staging of the thyroid, gastric, colonic, lung and endometrial cancers.
In breast cancer surgery this technique avoids significant morbidity of axillary dissection and inexperienced hands has proven to provide acceptable rates of metastatic identification


Question: An infected pancreatic necrosis is treated with

Answer- B. Laprotomy and surgical debridementTreatmentAn infected pancreatic necrosis is managed by laparotomy and surgical ilebridement of the necrotic tissue.Whereas pancreatic abscess are t/t by external drainage.Sterile necrotic pancreatitis is managed conservatively


Question: First line drug for prophylaxis of pneumocystosis is

First line drug for prophylaxis of pneumocystosis is TMP-SMX (trimethoprim-sulfamethoxazole).Dapsone, Pyrimethamine, Atovaquone, Leucovorin, Pentamidine are second line drugs


Question: Green discharge is M. Commonly seen with

Ans is 'b' ie Duct ectasia "A black or green discharge is usually due to duct ectasia and its complications." - Bailey & Love.Duct ectasia is dilatation of lactiferous ducts associated with periductal inflammation, the pathogenesis of which is unknown.


Question: Transverse fracture of the patella with separation of fragments is best treated by

D i.e. Open reduction with Kirschner wire fixation of the fragment an tension band wiring

Open reduction with screw fixation of the fragments

Blind fixation of the two fragments with Kirschner wire


Question: Most commonly liver transplant in infants is done for

10-15% of liver transplantation in children is done for biliary atresia. Acute liver failure from hemochromatosis is the primary indication for liver transplantation in the neonatal population. Cirrhosis is the most common indication for liver transplantation in adults Reference Bailey and love&;s edition 24 page 202


Question: Investigation of choice to know depth of cancer invasion is

The accuracy of T and N stages as determined by CT is less accurate than EUS.EUS (endoscopic ultrasound) is performed using a flexible endoscope with a 7.5-MHz to 12-MHz ultrasound transducer. The stomach is filled with water to distend it and provide an acoustic window, and the stomach wall is visualized as five alternating hypoechoic and hyperechoic layers. The mucosa and submucosa represent the first three layers. The fouh layer is the muscularis propria, the serosa is the fifth layerSabiston 20e pg: 1245


Question: Battle's sign is seen in

(B) Basilar fracture# BATTLE'S SIGN is ecchymosis of the mastoid process of the temporal bone seen in basilar skull fracture (or basal skull fracture) which is a fracture of the base of the skull, typically involving the temporal bone, occipital bone, sphenoid bone, and/or ethmoid bone.> Other sign and symptoms include: Raccoon eyes - is periorbital ecchymosis i.e. "black eyes" Cerebrospinal fluid rhinorrhea Cranial nerve palsy Bleeding from the nose and ears Hemotympanum Conductive or perceptive deafness, nystagmus, vomitus.


Question: Frey's procedure is done for

Treatment of chronic pancreatitis Most of the patients can be managed medically. There is no single therapeutic agent that can relieve symptoms Endoscopic, radiological or surgical interventions are indicated mainly to relieve obstruction of the pancreatic duct, bile duct or the duodenum, or in dealing with complications (e.g. pseudocyst, abscess, fistula, ascites or variceal haemorrhage). Decompressing an obstructed pancreatic duct can provide pain relief in some patients (the assumption is that ductal hypeension causes the pain). Endoscopic pancreatic sphincterotomy might be beneficial in patients with papillary stenosis and a high sphincter pressure and pancreatic ductal pressure. Patients with a dominant pancreatic duct stricture and upstream dilatation may benefit by placement of a stent across the stricture. The stent should be left in for no more than 4-6 weeks as it will block. The complication rate is high, and less than two-thirds of patients experience pain relief, but those who do get relief may benefit from a surgical bypass. Pancreatic duct stones maybe extracted at ERCP, and this may sometimes be combined with extracorporeal shock wave lithotripsy. Pseudocysts may be drained internally under EUS guidance. Percutaneous or transgastric drainage of pseudocysts under ultrasound or CT guidance may be performed. The role of surgery is to overcome obstruction and remove mass lesions. Some patients have a mass in the head of the pancreas, for which either a pancreatoduodenectomy or a Beger procedure (duodenum-preserving resection of the pancreatic head) is appropriate. If the duct is markedly dilated, then a longitudinal pancreatojejunostomy or Frey procedure can be of value. The natural evolution of the disease may not be altered significantly, but around half the patients get long-term pain relief. The rare patient with disease limited to the tail will be cured by a distal pancreatectomy. Patients with intractable pain and diffuse disease may plead for a total pancreatectomy in the expectation that removing the offending organ will relieve their pain. How- ever, one should keep in mind that pancreatic function and quality of life are significantly impaired after this procedure, and the operative moality rate is not tril. Moreover, there is no guarantee of pain relief (approximately a third of patients get resolution, a third show some benefit, and a third see no benefit at all). Total pancreatectomy and islet auto- transplantation has been repoed in selected patients, but it is difficult to demonstrate any overall benefit. Ref: Bailey and love 27th edition Pgno : 1231


Question: Polytrauma in paediatric age group most common feature is

Answer- B. Hypovolemic shockDue to the greater physiological capacity and ability ofchildren to compensate for fluid loss, hypotension is a very late and ominous sign of hypovolaemic shock.


Question: Optimal management of bilateral undescended testicles in an infant is

By the second year, a testicle not in the cooler environment of the scrotal sac will begin to undergo histologic changes characterized by reduced spermatogonia. Testicles left longer in the undescended state not only have a higher incidence of malignant degeneration but are inaccessible for examination. If a malignancy should occur, diagnosis will be delayed. There is also a substantial psychological burden when children reach school age or are otherwise subjected to exposure of their deformed genitalia. Gel-filled prostheses are generally inserted when a testicle cannot be placed in the scrotum. Close follow-up by a physician until the late teens is indicated in all patients who have had an undescended testicle. Since these patients may be at increased risk for malignancy throughout life, careful training should be given in self-examination.

Immediate surgical placement into the scrotum

Chorionic gonadotropin therapy for 1 month; operative placement into the scrotum before age 1 if descent has not occurred

Observation until the child is 2 years old because delayed descent is common

Observation until age 5; if no descent by then, plastic surgical scrotal prostheses before the child enters school


Question: Cobble stone appearance is seen in

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


Question: 'Doughnut' sign and 'Coiled spring' appearance are seen in

(A) Intusussception # Ultrasound Axial images of intussusception showed a doughnut pattern.> Hypoechoic external ring was formed by the everted returning limb of intussusceptum and, to a lesser degree, by the intussuscipiens.> Doughnut's center varied according to the scan level.> Scans obtained at the middle or at the base of the intussusception showed a characteristic hyperechoic crescent in all cases.> This crescent was formed by the mesentery enclosing the entering limb of the intussusceptum, which the authors have termed the Crescent-in-doughnut sign'.> On scans obtained at the apex of the intussusception, the center was hypoechoic owing to the entering limb of the intussusceptum and the absence of the mesentery.> Crescent-in-doughnut sign appears to be a characteristic feature of intussusception.> Contrast enema remains the gold standard, demonstrating the intussusception as an occluding mass prolapsing into the lurren, giving the "coiled spring" appearance (barium in the lumen of the intussusceptum and in the intraluminal space).> Main contraindication for an enema is a perforation.


Question: Proteus infection leads to

(A) Struvite stones # Struvite stones are infectious stones composed of magnesium ammonium phosphate.> Struvite stones are common stones seen in SCI population, and they are caused by ureage producing bacteria.> Most common are Proteins, Psuedomonas, klebsiella, peosidentia, E.coli, Staphylococcus epidermidis, and ureaplasma urease catalyses break down of urea and water to ammonium and bicarbonate. The bicarbonate produces alkaline urine having a pH level greater than 7.2.> Alkaline urine facilitates the precipitation and crystailzation of magnesium ammonium phosphate , calcium carbonate, calcium phosphate.


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

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


Question: Gastrinoma a/w

Diarrhoea is due to hypergastrinaemia.It is associated with severe ulcers,not superficial SRB's manual of surgery,5th edition,710.


Question: Blood loss in class II hemorrhagic shock is

Ans. (b) 15-30%Ref: Sabiston 20th Page 50* Class 1 <15% blood loss* Class 2: 15- 30 % blood loss* Class 3: 30 -40% blood loss* Class 4: > 40% blood loss


Question: Adenoid cystic carcinoma is also known as


Question: Blood group associated with Gastric cancer is

(B) A # Blood group A is associated with an increased risk for stomach cancer and poorer survival and O group people are associated with increased risk of gastric ulcer.> This observation may be related to differences in the mucous secretion, leading to altered mucosal protection from carcinogens.> A germ line mutation in the E-cadherin gene (CDH1), inherited in an autosomal dominant pattern and coding for a cell adhesion protein, has been linked to a high incidence of occult diffuse type gastric cancers in young asymptomatic carriers.> Duodenal ulcers are not associated with gastric cancer.


Question: Best diagnostic aid for Bronchiectasis is

(D) CT scan # Bronchography, the previous gold standard for diagnosing bronchiectasis, has been largely replaced by CT. Though, CT is not as sensitive as bronchography, it is considerably safer and can be done sequentially to follow the patient's course.> Thin-section high resolution CT (HRCT) may be needed. A CT scan after inhalation of xenon may prove even more sensitive.


Question: New born baby with Regurgitation of feeds and continuous drooling of saliva is

Ans. (a) Esophageal AtresiaRef: Surgery Sixer 3rd Edition Page 327* Tracheo Esophageal Fistula is associated with Esophageal Atresia.* Babies born with Esophageal Atresia will have Continuous Drooling of Saliva and Regurgitates all its feeds.* Down Syndrome is associated with TEF


Question: Split skin graft take up is good if

Light dressing over graft helps in good take up of split skin graft.

Light compression wraps applied as dressing


Question: Injury to the male urethra below the perineal membrane causes urine to accumulate in

Question talks about injury to bulbar urethra as in falling astride. Extravastion of urine is common in these cases. Extravasated urine collects in the superficial perineal space, passing into the penis as well as the scrotum and lower anterior abdominal wall. Source: Bailey and love 26th edition Pg 1361


Question: Child Turcotte Pugh score is used in

Ans. (a) Chronic Liver DiseaseRef: Bailey and Love 27th Edition Page 1156Quantifying the severity of Chronic Liver disease:To assess the severity and perioperative risk of patients with CLD- two scoring systems are used:1. Child Turcotte - Pugh (CTP) score2. Model for End Stage Liver Disease (MELD) Score* The original Child classification was developed to predict mortality following Shunt operations in Cirrhotic cases.* Modified CTP score predicts mortality after any surgery* MELD was actually developed to see prognosis after TIPS but later adopted to make waiting list for liver transplant.


Question: Embolectomy should be done within

Embolectomy should be done within 6 hours as after 6 hours, irreverside changes occur.


Question: Hunt Hess scale is used for

Ans. (a) SAH* Hunt and Hess Scale is used for Sub arachnoid hemorrhage* It helps to predict the outcome based on Clinical features.


Question: Prognosis of carcinoma breast depends on

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


Question: A most common organism isolated in breast abscess

Most common organism  responsible is staphylococcus aureus.
In lactating mothers causative organisms spread from nasopharynx of the infant.


Question: This is a reason for tissue analysis in surgery after histopathology

To confirm a suspected or established clinical diagnosis for prognosis of treatment


Question: The femur is fractured at bih at


Question:
A22 year old male patient presents with compete rectal prolapse.
The surgery of choice is

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


Question: A male is taking 60mg. of hydrocortisone daily. On the day before extraction, this dose should be


Question: A cystic, transilluminant, painless scrotal swelling presented with testes separately palpable. The procedure to be done is

(A) Lords' procedure # Hydrocele is a collection of serous fluid that results from a defect or irritation in the tunica vaginalis of the scrotum. Hydroceles also may arise in the spermatic cord or the canal of Nuck.> Structurally, hydroceles are classified into 3 principal types.> In a communicating (congenital) hydrocele, a patent processus vaginalis permits flow of peritoneal fluid into the scrotum. Indirect inguinal hernias are associated with this type of hydrocele.> In a noncommunicating hydrocele, a patent processus vaginalis is present, but no communication with the peritoneal cavity occurs.> In a hydrocele of the cord, the closure of the tunica vaginalis is defective. The distal end of the processus vaginalis closes correctly, but the mid portion of the processus remains patent. The proximal end may be open or closed in this type of hydrocele.> Hydroceles are located superior and anterior to the testis, in contrast to spermatoceles, which lie superior and posterior to the testis.> Hydrocele is bilateral in 7-10% of cases.> Hydrocele often is associated with hernia, especially on the right side of the body.> The size and the palpable consistency of hydroceles can vary with position. Hydrocele usually becomes smaller and softer after lying down it usually becomes larger and tenser after prolonged standing.> Systemic signs of toxicity are absent. The patient is usually afebrile with normal vital signs.> Abdominal or testicular tenderness are absent; no abdominal distension is present.> Bowel sounds cannot be auscultated in the scrotum unless an associated hernia is present.> Unless an infection causes an acute hydrocele, no erythema or scrotal discoloration is observed.> Transillumination A light source shines brightly through a hydrocele. Transillumination is common, but it is not diagnostic for hydrocele. Transillumination may be observed with other etiologies of scrotal swelling (eg, hernia).> The hallmark of treatment is eversion of the tunica through a surgical procedure called 'Lord's procedure' or an alternative 'Jsboulay's procedure'


Question: The most common site for Prolapse of interveebral disc is


Question: Surgery for ductal ectasia

Answer- B. Radical duct excisionDuct ectasia of the breast or m:rmmary duct ectasia or plasma cell mastitis is a condition in which the lactiferousduct becomes blocked or clogged.This is the most common cause of greenish discharge.Clinical featuresNipple discharge of any colour, abscess, mammary duct fistula, subareolar mass and nipple retraction.TreatmentAntibiotic therapy may be tried but surgery is mostly required to cure this notoriously difficult condition. Surgery consists of excision of all the maior ducts (Hadfield's operation)


Question: T3 in the TNM staging of the oral malignant lesions represents

Tumour 2 cm or less in greatest diameter

Tumour > 2 cm but < 4 cm in greater diameter


Question: Osteoblastic secondaries in spine seen with

i.e. (Carcinoma prostate): (613-H17th) (CSDT 13th) Most common cause of osteoblastic secondariesIn males - Prostate cancersIn females - Breast cancer Most common cause of osteolytic metastasisIn males - Lung cancersIn females - Breast cancers Lytic expansile metastasis - Thyroid, Renal Carcinoma(i) Peripheral zone is site for Adenocarcinoma (PAC)(ii) Transition (periurethral) is site for BPHAlthough some tumours may produce mainly osteolytic lesions (eg Kidney cancers) and other mainly osteoblastic lesions (eg prostate cancers) most lesions produces both types of lesion and may go through stages where one or the other predominates (613-H17th)


Question: High crural index is seen in

Answer- A. Jumping athletesCrural index the ratio of lower leg length to thigh length. A high crural index allows application of force against the ground for a greater period of time than a lower crural index. fumping athletes (such as in basketball) and sprint swimmers tend to have above-average crural indices.


Question: Tmreatment of hormone dependent fungating carcinoma of breasyt with secondaries in lung is

Hormonal therapy in Carcinoma in breast Ovarian suppression or ablation Bilateral oophorectomy. Medically by LHRH agonist (Goserelin, leuprolide) SERM: Tamoxifen and Raloxifen Aromatase Inhibitors Non-steroidal : Letrozole & Anastrazole Steroidal : Exmestane Anti-Estrogens Fulvestrant Progestins Megesterol & Medroxyprogesterone acetate Ref: schwaz's principle of surgery 10th edition Pgno : 552-553


Question: Choice of intubation in Bilateral TMJ ankylosis for oral surgeries

Intubation is generally done with the help of endotracheal tube (ETT). The internal diameter of ETT used ranges between 3 and 8 mm depending on the age, sex, and size of nares of the patient. Potex north and south polar performed Rae tubes (RAE- right angled ETT) and flexo- metallic tubes are commonly used. Out of them, North Pole Rae tube is preferred in case of ankylosis patient due to the direction of the curve of ETT which favors its placement in restricted mouth opening as in case of ankylosis.


Question: Kasai's procedure is performed in

It is performed in in type 4b witches only extrahepatic biliary tree dilation.


Question: Malignant melanoma most often develops from

Dysplastic naevus is an irregular proliferation of atypical melanocytes at the basal layer of epidermis Dysplastic naevus has a familial inheritance and carries a 5-10 per cent risk of forming a superficial spreading melanoma. Bailey and Love 26th edition Pg : 591


Question: Milk production is inhibited by

Ans (a) Ref: Sheila Balakrishnan pg 522Lactation suppression Phamnacologieal-Dopamine agonists-BromocriptineCabergolinePyridoxineNon pharmacological-Tight binding of breasts Jasmine flowers


Question: Fixity of the breast tissue in carcinoma of breast indicates infiltration of

Answer- C. Pectoralis muscle and fasciaFixity of the breast tissue is tested by asking the patient to press the hand against the hip forcibly to contract Pectoralis major muscle & moves the breast over the pectoralis fascia in the direction of muscle frbres of the pectorals major muscle.Loss of normal mobility or fixity of the breast tissue indicates spread of cancer cells to underlying pectoralis muscle and fascia.


Question: Fetal blood is returned to the umbilical aeries and the placenta through the

(Reece, 2/e, pp 54, 119-121.) Fetal blood is returned directly to the placenta through the two hypogastric aeries. The distal poions of the hypogastric aeries atrophy and obliterate within 3 to 4 days after bih; remnants are called umbilical ligaments. Fetal oxygenation is aided by the presence of three vascular shunts: the ductus venosus, foramen ovale, and ductus aeriosus. The ductus venosus shunts oxygenated blood from the umbilical vein into the inferior vena cava. The foramen ovale deflects the more oxygenated blood from the right atrium into the left atrium, thereby bypassing pulmonary circulation. Approximately two- thirds of the blood ejected from the right ventricle is shunted pulmonary circulation through the ductus aeriosus.


Question: Wahin's tumor is found in

It is a benign tumour that occurs only in parotid ,usually in the lower pole. SRB,25th,415


Question: Most common site of colon malignancy is

A. i.e. (Sigmoid colon) (1179-B& L 25th) (696 - CSDT 12th) (1060- S. Das 5th)Sigmoid colon is the most common site*** Distribution of colorectal cancerRectum (38%) > Sigmoid colon (21%) > caecum (12%) Transverse colon (5.5%) > Ascending colon (5%)> Descending colon (4%) > Hepatic flexure (2%) and anus (2%) > Appendix (0.5%)* Sigmoid colon segment of colon undergoes maximum postprandial contraction**Right colonLeft colonRectum**Unexplained weakness or Iron deficiency anemia (Most common)* Occult blood in feces* Dyspeptic symptoms* Persistent right abdominal discomfort* Change in bowel habits* Gross blood in stool* Obstructive symptom* Tenesmus* Characteristic x-ray finding* Rectal bleeding alternation in bowel habits* Sensation of incomplete evacuation* Intrarectal palpable tumor* Sigmoidoscopic finding* Metastatic disease - Jaundice, ascitis, hepatomegaly* Carcinoma of the colon - particularly the right colon is more common in women*** Carcinoma of the rectum is more common in men*** Regional lymph node involvement is the most common form of metastasis in colo rectal carcinoma**.* Marker for Gastro intestinal stromal tumour (GIST) is CD-I 17*** High fibre diet is most protective against development of colorectal cancer**Risk factor for Development of colorectal cancer (574 - H17th)* Diet - Animal fat* Streptocccus bovies bacteremia* Hereditary syndrome (AD- Inheritance)* Ureterosigmoidostomy* Polyposis coli* Tobacco-use* Nonpolyposis syndrome (Lynch syndrome) * Inflammatory bowel syndrome


Question: Occult thyroid malignancy with nodal metastases is seen in


Question: Commonest presentation of wilm's tumouris

Ans. is 'b' ie Abdominal lump "MC presentation is painless abdominal mass usually discovered by the mother while routinely bathing the baby."


Question:
During extraction of the upper first molar, the mesio buccal root is missing and is suspected to have been pushed into the maxillary sinus.
The best position for the patient immediately after the incident is

To position the patients in a semi inclined posture to visualize the perforation


Question: Skip lesions with tuberculoid granulomas is


Question: Patients comes with fracture femur in an acute accident, the first things to do is


Question: In Thyrotoxicosis there is

(B) Hypokalemic Periodic Paralysis> Acute generalized weakness due to thyrotoxic periodic paralysis# Thyrotoxic periodic paralysis (TPP) is a disorder characterized by thyrotoxicosis, hypokalemia and predominantly proximal lower limb paralysis. Despite the female predominance of hyperthyroidism, TPP occurs most frequently in males in a ratio of 20:1, and 90% of patients are of Asian descent> Prodromal symptoms may consist of muscle stiffness or cramping. Sensation, as well as bulbar and respiratory muscle strength, remains intact.> Reflexes may be decreased or absent.> Attacks may be precipitated by a high carbohydrate meal (secondary to insulin secretion) or physical exertion.> In one series, 84% of attacks occurred between 1 and 6 am. Episodes are acute in onset and last 1-96 hours. As in this patient, symptoms and signs of hyperthyroidism may be subtle at initial presentation.> Electrocardiographic findings such as ST-segment depression with T-wave flattening and the presence of U waves are typical of hypokalemia. Findings supportive of a diagnosis of TPP are sinus tachycardia, elevated QRS voltage and first-degree AV block.> Pump sensitivity to adrenergic stimulation may be higher in patients with TPP than in those with hyperthyroidism alone, resulting in intracellular potassium shift and subsequent hypokalemia.


Question: Parenteral nutrition is not used in

In burns when GI tract is intact, why go for parentral nutrition. All other options GI tract may not be adequately functioning. Indications for total parenteral nutrition Inadequate absorption resulting from sho bowel syndrome Gastrointestinal fistula Bowel obstruction Prolonged bowel rest Severe malnutrition, significant weight loss and/or hypoproteinaemia when enteral therapy is not possible Other disease states or conditions in which oral or enteral feeding are not an option


Question: Gleason scoring is done for

Prostate cancer is diagnosed histologically by the Gleason grading system, which evaluates the level of abnormality in the patterns of the glandular architecture of the prostate in comparison to normal. Prostate cancers exhibit heterogeneity within the tissue, and so two histological areas of the prostate are each scored between 1 and 5, with 1 being the most differentiated and 5 being the least differentiated.The scores are added to give an overall Gleason score of between 2 and 10


Question: Commonest cause of skeletal metastasis is

C. i.e. (Breast) (1202 - CSDT 12th) (450 - S. Das 5th)METASTATIC BONE TUMORS80% of these metastatic lesions are from primary carcinomas - particularly of the Breast, Prostate, lung kidney, thyroid' pancreas or stomach in that order of frequency* Breast or prostate metastasis either partly or solely osteoblastic** OSSOPHILE TUMOURS shows predilection for metastasis in the bone eg Breast, Prostate, Kidney, Bronchus, and Thyroid OSSOPHOBE TUMOURS Do not show predilection for metastasis in the bone eg GIT, urinary bladder, genitalia etc* Most common primary source of solitary skeletal metastasis at the time of first diagnosis is carcinoma of the kidney (1202 - CSDT 12th)


Question: Organ least affected in blast injuries

Tympanic membrane (TM) rupture is the most common primary blast injury. Other common organs are lung and intestine.The solid organs are more resistant to primary blast.Ref: Bailey and love 27e pg: 431


Question: The most common ligament injured around ankle joint is

A i.e. Anterior Talofibular The most common site of ligament injury is ankle jointQ. The most common mode of ankle injury is inversion of planter flexed foot(2. Over 90deg% of the ankle ligament injury involves lateral collateral ligament usually the anterior tibiofibular ligamentQ.


Question: Volkmann's ischemic contracture is associated with

Compromise of blood supply to the muscles of the forearm can lead to a compartment syndrome and permanent serious functional deformity of the arm. Any patient with a compressive dressing or cast of the upper extremity can experience this potential catastrophe. Whenever a patient has increasing pain in the presence of a circular dressing around the arm or forearm, the dressing should be removed immediately. If there is tenderness in the forearm on either the ulnar or dorsal aspect, a fasciotomy should be considered.


Question: Graft survival in the initial 48 hours depends on

The grafts will survive transfer based on a defined sequence of events that culminates in vascular independence. These events are (1) Serum imbibition--direct absorption of nutrients from recipient capillary beds that generally takes place in the first 24 hours(2) Inosculation--the connecting of donor and recipient vessels that typically begins in the 24 to 72hour period(3) Angiogenesis--vascular ingrowth of vessels from the recipient bed into the graft that stas after 72 hours. Factors that interrupt this process--such as fluid collection under the graft or mechanical shear forces--will compromise the graft take


Question: Most common site of subphrenic abscess is

Right posterior intra-peritoneal space(Right subhepatic space/Rutherford Morison's kidney pouch) is bounded in front by the liver & gallbladder,above by the liver,behind by the right kidney & diaphragm,below by the transverse colon & hepatic flexure,to the left by foramen of Winslow & duodenum.It is the largest and deepest space of all.It is the most common site of subphrenic abscess.Causes include appendicitis,cholecystitis,post operative,perforated duodenal ulcer,intestinal obstruction. Reference:SRB' s manual of surgery,5th edition,page no:575.


Question: Most common site for carcinoid tumor

Carcinoid tumour arise from the enterochromaffin cells (Kulchitsky cells) found in the crypts of Lieberkuhn. These cells are capable of APUD (Amine precursor uptake and Decarboxylation) and can secrete vasoactive amines like 5- HT, 5-HIAA, 5-HTP; tachykinins, peptides (chromogranins)and PGs. It commonly occurs in appendix (45%), ileum (25%) and rectum (15%). Other (15%) sites are--other pas of GIT (including pancreas and biliary tract), bronchus and testis.Reference: page 877 SRB's manual of surgery 5th edition


Question: Linitus plastic

Borrmann 1-single polypoidal carcinoma, Borrmann 2- ulcerated carcinoma with clear-cut margin, Borrmann 3-ulcerated carcinoma without clear-cut margin, Borrmann 4- diffuse carcinoma - linitis plastica. Reference ,SRB edition : 5 page:847


Question: Enzyme most commonly deficient in congenital adrenal hyperplasia is

Ans. (a) 21 beta hydroxylaseRef: Bailey and love, 27th ed & Campbell 11th Ed consolidationCongenital adrenal hyperplasia or Adrenogenital syndrome: Features* Salt wasters + virilizers (due to aldosterone deficiency)* Simple virilizers (Aldosterone normal)* Non classified (no virlization, no salt wasting)# Virilization and adrenal insufficiency in children are pathognomonic of congenital adrenal hyperplasia (CAH).# Autosomal recessive disorder# The most frequent defect (95 per cent) is the 21 bhydroxylase deficiency, which has an incidence of 1 in 5000 live births.# Excessive ACTH secretion is caused by the loss of cortisol and this leads to an increase in androgenic cortisol precursors and to CAH.# CAH may present in girls at birth with ambiguous genitalia or as late-onset disease at puberty.# Little Hercules: Hypertension and short stature, caused by the premature epiphyseal plate closure, are common signs.# In female causes Female hermaphrodite# Diagnosed antenatally by 9-11 weeks by chorionic villus sampling# Antenatally mother should be treated with IV Dexamethasone# Affected patients are treated by replacement of Hydrocortisone +- fludrocortisone.# Large hypoplastic adrenals may need to be removed if symptomatic.


Question: A child presented with severe pain with twisted cord. The treatment is

i.e. (Surgical treatment): (1379-80-Love & Bailey 25th)Prompt exploration, untwisting and fixation is the only way to save the torted testisThe patient should be counselled and consented for orchidectomy before explorationThe anatomical abnormality is bilateral and the contralateral testis should also be fixedEpididymitis - sudden pain in the scrotum, rapid unilateral scrotal enlargement, and marked tenderness that extends to the spermatic cord in the groin and may be relieved by scrotal elevation (Prehn's sign) (927- CSDT13th) some patients pain is relieved by scrotal hypothermiaTorsion of the testicular appendices (Vestigial mullerian duct structure) - gradual onset, point tenderness rathan than diffuse tenderness, visible necrotic lesion on scrotal transillumination (blue dot sign)Treatment - Self limiting since necrosis and auto amputation usually occurs, warm baths, limited activity and anti inflammatory agents

Elevation of the testes relieve the pain


Question: Intra oral vertical ramus osteotomy is done for


Question: Variant of papillary carcinoma thyroid

Papillary carcinoma common in female and younger age group . Its called hormone dependend tumour. Types: tall cell type - very aggresive type show capsular and vascular invasion. Columnar type- seen in males . Treatment :total oe near total thyroidectomy Suppresive dose of L thyroxine. SRB's Manual of Surgery.Edition -5. Pg no:480


Question: Dysphagia lusoria means dysphagia

.Dysphagia lusoria: It is a congenital vascular anomaly of the aoic root. Aoic arch anomalies are - double arch (40%), right arch and left ligamentum aeriosum (25%), anomalous innominate or common carotid aery or aberrant right subclan aery (10%). It is due to the disappearance of proximal right 4th aoic arch instead of the distal poion. All patients having this anomaly (dysphagia lusoria) have got an aberrant right subclan aery in a transposed position arising from descending aoa that courses posterior to the oesophagus. Often there will be a complete vascular ring around trachea and oesophagus. It is categorised based on their specific subclan anomaly - depends on the presence of an aneurysm, occlusive disease and compression. Commonly they are asymptomatic. Presentations may be dysphagia, chest pain, stridor, wheeze, recurrent respiratory infection (usually presents after the age of 40). Ref: SRB&;s manual of surgery,3 rd ed, pg no 720

Due to abnormal origin and course of right subclan aery


Question: Barrets esophagus is commonly associated with one of the following

Barrett's oesophagus is a metaplastic change in the lining mucosa of the oesophagus in response to chronic gastro-oesophageal reflux . Squamous epithelium of lower end of the oesophagus is replaced by diseased columnar epithelium. When intestinal metaplasia occurs, there is an increased risk of adenocarcinoma of the oesophagus, which is about 25 times that of the general population.Reference : page 1022-23 Bailey and Love's sho practice of surgery 25th edition


Question: Non union is a common feature of fracture of

C i.e. Lower tibia Fracture through the lower third of tibia. is more liable to go onto delayed union because the lower fragment becomes relatively avascular dlt poor vascularityQ.


Question: Autonomous zone of sensory supply by radial nerve is

Answer- A. P dorsal web spaceAutonomous Zone of peripheral nerves:Radial nerve:lst dorsal web space of hand (Anatomical snuff box)Median nerve:Distal phalanx (tip) of index finger (2nd finger)Unar nerve: Distal phalanx (tip) of little finger (5th finger).


Question: Most impoant prognostic factor in melanoma

The presence of lymph node metastases is the single most impoant prognostic index in melanoma, outweighing both tumour and host factors. The number of affected nodes and the presence of extranodal extension are also significant outcome predictors. Once regional nodes are clinically involved, 70-85% of patients will have occult distant metastases.The Breslow thickness of the primary tumour offers the best correlation with survival in stage I disease. The higher the mitotic index, the poorer is the prognosis of the primary tumour. This has greater significance than the presence or absence of ulceration.Ref: Bailey and Love, 27e, page: 612


Question: The treatment of choice for fibrous dysplasis of mandible in a 7 year old girl is

Fibrous dysphasia stas in early childhood. Lesion is usually small and asymptomatic and often diagnosed accidentally during radiological examination. Lesions are small and-asymptomatic and progress slowly. Majority of fractures heal by conservative management Sarcomatous changes occur by irradiation.


Question: Peritoneal mice is

• Peritoneal loose bodies almost never cause symptoms.
• One or more may be found in a hernial sac or in the pouch of Douglas.
• The loose body may come from an appendix epiploica that has undergone axial rotation followed by necrosis of its pedicle and detachment but they are also found in those who suffer from subacute attacks of pancreatitis.
• These hyaline bodies attain the size of a pea or bean and contain saponified fat surrounded by fibrin.


Question: Toxic megacolon is seen in

.Toxic megacolon * 1.5% incidence * Common in transverse colon * Colon is more than 6 cm in diameter * Colon is like wet blotting paper * Commonly seen in ulcerative colitis * Can occur in bacterial colitis, pseudomembranous colitis, fulminant amoebic colitis * May be precipitated by antidiarrhoeal drugs * Emergency surgery, colectomy, colostomy/ileostomy may be required * IV fluids, blood transfusion, antibiotics, steroids are also needed * Can be life threatening* Plain X-ray is very useful. ref:SRB's manual of surgery,ed 5,pg no 895

Chronic non specific ulcerative colities


Question: Asymptomatic bacteriuria is seen in

Asymptomatic bacteriuria is used when a bacterial count of the same species over 10^5/ml in midstream clean catch specimen of urine on two occasions in women or on a single occasion in men is detected without symptoms of urinary infections. E.coli is the offending organism in over 90% cases. Other pathogens are Klebsiella pneumoniae and Proteus. Asymptomatic bacteriuria occurs in a small number of healthy people. It affects women more often than men.The following increases the risk: Diabetes Infected kidney stones Kidney transplant Older age Pregnancy -- up to 40% of pregnant women with untreated asymptomatic bacteriuria will develop a kidney infectioncatheterised patients Vesicoureteral reflux (backward movement of urine from the bladder into ureters or kidneys) in young children.


Question: Investigation of choice of depth of penetration and nodal stage in rectal carcinoma is

A colonoscopy is required if possible in all patients to exclude a synchronous tumour, be it an adenoma or a carcinoma. If a proximal adenoma is found, it can be conveniently snared and removed the colonoscope. If a synchronous carcinoma is present, the operative strategy will need changing. If a full colonoscopy is not possible, a CT colonography or barium enema can be performed Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1232


Question: Treatment for CA Anal canal is

Ca. Anal canal is treated by nigro’s regimen which is combine chemo + radiotherapy.


Question: Treatment of burns includes

.SRB&;s manual of surgery,4th edition Initial Management of burns: Clothing should be removed Cooling of the pa by running water for 20minutes Cleaning the pa to remove dust,mud,etc Chemoprophylaxis-tt,antiseptics,etc Covering with dressings Comfoing with sedation amd pain killer

Superficial burns without blister-no need of dressing

Escharotomy done for peripheral circumscribed lesions


Question: Not a common complication of hemithyroidectomy

As parathyroids on the opposite side are preserved and not dealt with during surgery hypoparathyroidism is not seen after hemithyroidectomy.


Question: Most common site for Ca. Large bowel  is

Rectum is most common location. (if option is not given then retco - sigmoid region).


Question: Xylocaine strength used in dentistry is


Question: Tumor marker for Ca colon for follow up

Up to a half of all patients with colorectal cancer will develop liver metastases at some point and regular imaging of the liver (by ultrasound and CT scan) and measurement of carcinoembryonic antigen (CEA) is designed to diagnose this early, in order to allow curative metastectomy. Trials of the optimum follow-up pathway have suggested that CEA measurement alone can be as effective as regular imaging.Ref: Bailey and Love, 27e, page: 1266


Question: A Bennet's fracture is difficult to maintain in reduced position because of the pull of


Question: Treatment of ameloblastoma

Resection of the mandible along with the tumour


Question: The surgical procedure of choice for skeletal class 2 malocclusion due to retrognathic Mandible is


Question: The treatment of choice for an 8 mm retained common bile duct (CBD) stone is

For CBD stones, endoscopic papillotomy is the preferred first technique with a sphincterotomy, removal of stones using Dormia basket or balloon catheter.ERCP can be used to remove retained CBD stones in 3 weeks of surgery. Reference: SRB&;s manual of surgery,5th edition, page no:652.


Question: Recommended adult prophylaxis for meningococcal infection is;

Rifampicin 600 mg twice daily for 2 days * Recommended adult prophylaxis for meningococcal meningitis is rifampicin 600 mg twice daily for 2 days. Chemoprophylaxis is recommended for close contacts of persons with meningococcal disease.


Question: Commonest complication of Zenker's diveiculum is

Ans is 'c' ie Lung abscess "Pulmonary infection is the most frequent serious complication, and many patients are first seen after experiencing repeated episodes of pneumonia. "-CSDT Aspiration pneumonia & Lung abscess are the most frequent complications of Zenker's diveiculum. Other rare complications are: Perforation Bleeding Carcinoma


Question: Malakoplakia of the bladder is associated with

It is an inflamatory condition caused by defect in phagocytosis.


Question: The commonest cause of significant lower gastrointestinal bleed in a middle aged person with unknown reason is

.Diveiculosis is the initial primary stage of the disease, wherein there is hyperophy, muscular incoordination leading to increased segmentation and increased intraluminal pressure. At this stage they are asymptomatic, but often get severe spasmodic pain due to colonic segmentation called as painful diveicular disease. Sigmoid diveicula causing pericolic abscess as a known complication. Resection and primary anastomosis can be done in sigmoid diveicula after proper bowel preparation electively. ref:SRB&;s manual of surgery,ed 3,pg no 822.


Question: The greatest barrier to infection is


Question: Commonest complication after removal of mandibular 3rd molar


Question: There is a pressure sore extending into the subcutaneous tissue but underlying structures are not involved. Stage of the pressure sore is

Stage 1Non-blanchable erythema without a breach in theepidermisStage 2Paial-thickness skin loss involving the epidermis and dermisStage 3Full-thickness skin loss extending into the subcutaneous tissue but not through underlying fasciaStage 4Full-thickness skin loss through fascia with extensive tissue destruction, maybe involving muscle, bone, tendon or joint Bailey and Love 27e pg: 29


Question: Psammoma bodies seen in A/E

Psammoma bodies are small, concentric , spherules of calcification, also called calcospherites, seen in Papillary carcinoma thyroid, Meningioma and Papillary serous cystadenocarcinoma of the ovary. Reference : page 52 Textbook of pathology Harshmohan 6th edition


Question: Barrett's esophagus is diagnosed by

Ans. (b) Intestinal metaplasiaRef: Sabiston 19th edy page 1033* Barretts esophagus is characterized by metaplasia of esophageal squamous epithelium into columnar in distal esophagus.* For diagnosis of Barretts esophagus it requires both endoscopically visible segment of columnar lining of distal esophagus and intestinal metaplasia showing goblet cells on biopsy.* Barretts esophagus is the single most important risk factor for adenocarcinoma of esophagus.* Adenocarcinoma develops at the squamo-columnar junction or within 2 cm from the junction.


Question: Sudden headache with LOC in patient with renal cysts, intracranial bleed SAH (berry aneurysm). Diagnosis is

(A) ADPKD# POLYCYSTIC KIDNEY DISEASE (PKD OR PCKD, also known as polycystic kidney syndrome) is a cystic genetic disorcer of the kidneys. There are two types of PKD: autosomal dominant polycystic kidney disease (ADPKD) and the less-common autosomal recessive polycystic kidney disease (ARPKD).> Major extrarenal complications of ADPKD are: Cerebral aneurysms; Hepatic and pancreatic cysts; Cardiac valve disease; Colonic diverticula; Abdominal wall and inguinal hernia. Malformations of selected vasculature, including intracranial aneurysms and aortic root dilatation (normal diamete' <35 mm), may be due to altered expression and/or function of the PKD gene in arterial smooth muscle cells. Cervicocephalic artery dissections, dolichoectasias, and central retinal vascular occlusions have also been associated with ADPKD.> CEREBRAL ANEURYSM: A ruptured cerebral aneurysm, resulting in a subarachnoid or intracerebral hemorrhage, is the most serious complication of polycystic kidney disease. The prevalence of aneurysms in ADPKD is approximately 5 percent in young adults and increases with age to as high as 20 percent in patients 60 years and older.


Question: Blue rubber bleb nevus syndrome is a

(D) Venous malformation# BLUE RUBBER BLEB NEVUS SYNDROME (OR "BRBNS"or "Bean syndrome") is a rare disorder that consists mainly of abnormal blood vessels affecting the gastrointestinal tract.> BRBNS is a venous malformation, formerly, though incorrectly, thought to be related to the hemangioma. It carries significant potential for serious bleeding. Lesions are most commonly found on the skin and in the small intestine and distal large bowel. It usually presents soon after birth.> BRBNS used to be thought of as having no genetic inheritance however, in 1995 doctors discovered that information to be false, it has been suggested that it may represent a manifestation of familial venous malformation, and may be associated with TEK tyrosine kinase.


Question: Most common location of thyroglossal cyst is

Thyroglassal cyst is the reminant of thyroglossal tract and stihyoid thyroglossal cyst is the most common subtype.


Question: Operation of choice in GERD is

Operations for GORD are based on the creation of an intra-abdominal segment of oesophagus, crural repair and some form of wrap of the upper stomach (fundoplication) around the intra-abdominal oesophagus.Nissen fundoplication is one of the commoner procedures done.Ref: Bailey and Love 27e pg: 1078


Question: Seton’s procedure is treatment for

It is used for high lying fistula in ano.


Question: Volkmann's Ischaemic Contracture is due to

D i.e. Ischemic vascular injury to muscles


Question: Maximum score of APACHE

Answer- D. 71APACHE II ('Acute Physiology and Chronic Health Evaluation II") is a severity-of-disease classification system.The APACHE II system is the most commonly used SOI scoring system in Noh America.APACHE IV uses a modified statistical model of logistic regression; it is the most recently released version of this scoring system.It is applied within 24 hours of admission of a patient to an intensive care unit (ICU): an integer score from 0 (minimum) to 7l (maximum) is computed based on several measurements; higher scores correspond to more severe disease and a igher risk of death.


Question: Dashboard injury results in


Question: Most common oncogene involved in pancreatic adenoma

85% of Carcinoma pancreas shows mutant K ras gene on codon 12. 60% show mutation of p53 gene in chromosome 17, over expression of EGFR. Reference : SRB's Manual of Surgery, 6th Edition, page no = 695.


Question: Tardy ulnar nerve palsy seen in


Question: Cushing Ulcer seen in

* Cushing ulcer: Ulcer in stomach in stress and head injury (Most common site is body and fundus) * Curling ulcer: Ulcer in duodenum > Stomach in burns * Cameron ulcer: Ulcer in proximal stomach in hiatus hernia (veical ulcers also known as riding ulcers) Ref:- Surgery Sixer 3rd Edition; Pg num:- 364


Question: Recurrent periductal mastitis is

Zuska's disease/ Zuska-Atkins disease, also called recurrent periductal mastitis, is a condition of recurrent retroareolar infections and abscesses. Smoking has been implicated as a risk factor for this condition. This syndrome is managed symptomatically by antibiotics coupled with incision and drainage as necessary.


Question: Negative pressure therapy is used in

Vaccum assisted closure Known as negative pressure wound closure Applying intermittent negative pressure of approximately - 125mmHg appears to hasten Debridement and the formation of granulation tissue in chronic wounds and ulcers A foam dressing is cut to size to fit the wound A perforated wound drain is placed over the foam and the wound is sealed with a transparent adhesive film. A vaccum is then applied to the drain. Negative pressure may act by decreasing oedema, by removing interstitial fluid and by increasing blood flow As a result bacterial counts decrease and cell proliferation increases thereby creating a suitable bed for graft or flap cover. Ref: Bailey and love 27th edition Pg no :30


Question: Rapid infusion of blood causes


Question: Breast cancer mainly spreads to the veebrae

Answer- C. Batsons venous plexusMetastasis of breast cancer to bone, and especially to thoracic veebrae, is common due to the direct connection between the intercostal veins draining the breast and the internal veebral plexus ako known as Batson's plexus.


Question: Most common complication of pseudocyst of pancreas

PSEUDOCYST A pseudocyst is a collection of amylase-rich fluid enclosed in a well-defined wall of fibrous or granulation tissue. Pseudocysts typically arise following an attack of mild acute pancreatitis, lie outside the pancreas, and represent an APFC that has not resolved and matured. Formation of a pseudocyst requires 4 weeks or more from the onset of acute pancreatitis. The Term 'pseudocyst' is often used more loosely, to include sterile WON that has failed to resolve, or a collection that has developed in the context of chronic pancreatitis or after pancreatic trauma. If carefully investigated, more than half of these will be found to have a communication with the main pancreatic duct. Pseudocysts are often single but, occasionally, patients will develop multiple pseudocysts. A pseudocyst is usually identified on ultrasound or a CT scan. It is impoant to differentiate a pseudocyst from an APFC; the clinical scenario and the radiological appearances should allow that distinction to be made. Occasionally, a cystic neoplasm may be confused with a chronic pseudocyst. EUS and aspiration of the cyst fluid is very useful in such a situation. The fluid should be sent for measurement of carcinoembryonic antigen (CEA) levels, amylase levels and cytology. Fluid from a pseudocyst typically has a low CEA level, and levels above 400 ng/mL are suggestive of a mucinous neoplasm. Pseudocyst fluid usually has a high amylase level, but that is not diagnostic, as a tumour that communicates with the duct system may yield similar findings. Cytology typically reveals inflammatory cells in pseudocyst fluid. If there is no access to EUS, then percutaneous FNA is acceptable (just aspiration, not percutaneous inseion of a drain). ERCP and MRCP may demonstrate communication of the cyst with the pancreatic duct system, demonstrate ductal anomalies, or diagnose chronic pancreatitis and thus help in planning treatment. Pseudocysts will resolve spontaneously in most instances, but complications can develop. Pseudocysts that are thick-walled or large (over 6 cm in diameter), have lasted for a long time (over 12 weeks), or have arisen in the context of chronic pancreatitis are less likely to resolve spontaneously,but these factors are not specific indications for intervention. Therapeutic interventions are advised only if the pseudocyst causes symptoms, if complications develop, or if a distinction has to be made between a pseudocyst and a tumour. There are three possible approaches to draining a pseudocyst: percutaneous, endoscopic and surgical. Percutaneous drainage to the exterior under radiological guidance should be avoided. It carries a very high likelihood of recurrence. More over, it is not advisable unless one is absolutely ceain that the cyst is not neoplastic and that it has no communication with the pancreatic duct (or else a pancreaticocutaneous fistula will develop). A percutaneous transgastric cystgastrostomy can be done under imaging guidance, and a double-pigtail drain placed with one end in the cyst cavity and the other end in the gastric lumen. This requires specialist expeise but, in experienced hands, the recurrence rates are no more than 15%. Endoscopic drainage usually involves puncture of the cyst through the stomach or duodenal wall under EUS guidance, and placement of a tube drain with one end in the cyst cavity and the other end in the gastric lumen. The success rates depend on operator expeise. Occasionally, ERCP and placement of a pancreatic stent across the ampulla may help to drain a pseudocyst that is in communication with the duct. Surgical drainage involves internally draining the cyst into the gastric or jejunal lumen. Recurrence rates should be no more than 5%, and this still remains the standard against which the evolving radiological and endoscopic approaches are measured. The approach is conventionally through an open incision, but laparoscopic cystgastrostomy is also feasible. Pseudocysts that have developed complications are best managed surgically. There is a small group of patients who, having suffered an attack of necrotising pancreatitis with duct disruption, go on to suffer repeated complications in the form of recurrent fluid collections, pseudocysts, pleural effusions or pancreatic ascites. Very often disruption of the main pancreatic duct in the neck, body or tail is compounded by a stricture or a stone in the head that cannot be treated endoscopically. In such patients, some form of surgical resection and/or a drainage procedure even though it may be technically challenging may be the only way to achieve lasting resolution. Ref: Bailey and love 27th edition Pgno : 1229


Question:
Acanthosis nigricans is seen with
(A)Colonic carcinoma
(B)Freckle
(C)Squamous cell carcinoma of skin
(D)Carcinoma breast

Acanthosis nigricans can also be a reflection of an internal malignancy,
most commonly of the adenocarcinoma of the gastrointestinal tract, lung, uterus and breast It appears as velvety hyperpigmentation, primarily in flexural areas.
However, in the majority of patients, acanthosis nigricans is associated with obesity and insulin resistance, but it may be a reflection of an endocrinopathy such as acromegaly,
Cushing’s syndrome, polycystic ovary syndrome, or insulin-resistant diabetes mellitus (type A, type B, and lipoatrophic forms).


Question: Alvarado score consist of

A number of clinical and laboratory-based scoring systems have been devised to assist diagnosis. The most widely used is the Alvarado score, A score of 7 or more is strongly predictive of acute appendicitis. Symptoms are : score Migratory RIF pain 1 Anorexia 1 Nausea and vomiting 1 Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1211


Question: The following wound is not untidy


Question: Bleeding from peptic ulcer most commonly involve

Bleeding peptic ulcer MC indication for operation and principal cause of death in PUD patients The most significant hemorrhage occurs when duodenal or gastric ulcers penetrate into branches of the gastroduodenal aery or left gastric aery, respectively Incidence of peptic ulcer bleeding decreased over past decade, but Moality was stable for both gastric and duodenal ulcer bleeding, higher in patients of advanced age Cause of death: Multiple system organ failure (not the exanguinating hemorrhage) Treatment Irrigation with room temperature saline to lyse red cells in an effo to return clear fluid and to allow for the performance of endoscopy Figure of eight suture to Ligate the gastroduodenal aery. A 'U' stich is placed in the base to occlude pancreatic branches of the gastroduodenal aery Truncal vagotomy and pyroplasty is the most frequently used operation for bleeding duodenal ulcer Ref: Sabiston 20th edition Pgno : 1202-1203


Question: Lateral aberrant thyroid is node from

Ans. (a) Papillary cancerRef: Page 765. Bailey and love 26th edition* Lateral aberrant thyroid is a metastatic node from papillary cancer which is not palpable


Question: Smegma is secreted by

Smegma was originally thought to be produced by sebaceous glands near the frenulum called Tyson's glands. Preputial glands were first noted by Edward Tyson and in 1694 fully described by William Cowper who named them Tyson's glands after Tyson. They are described as modified sebaceous glands located around the corona and inner surface of the prepuce of the human penis . They are believed to be most frequently found in the balanopreputial sulcus .Bulbourethral gland, also called Cowper's Gland , either of two pea-shaped glands in the male, located beneath the prostate gland at the beginning of the internal poion of the penis; they add fluids to semen during the process of ejaculation. The Baholin's glands (also called Baholin glands or greater vestibular glands ) are two pea sized compound racemose glands located slightly posterior and to the left and right of the opening of the vagina. They secrete mucus to lubricate the vagina and are homologous to bulbourethral glands in males.Brunner's glands (or duodenal glands ) are compound tubular submucosal glands found in that poion of the duodenum which is above the hepatopancreatic sphincter (aka sphincter of Oddi).


Question: In pigmented basal cell carcinoma, treatment of choice is


Question: Most important prognostic indicator for wilms tumor

Histology is Most important prognostic indicator for wilms tumor
Stage of tumor is Most important prognostic indicator for RCC.


Question: Boorheave syndrome involves perforation of esophagus after

Ans. is 'd' i.e., Vomiting [Ref: CSDT 13th/ep.444 & 11th/e p. 490; Schwartz 9th/ep.874 & 8th/e, p. 906; Bailey & Love 25th/e p.1014 & 24th/ep.996}* Boerhaave's syndrome is spontaneous perforation of the esophagus, occuring usually due tosevere barotrauma when a person vomits against a closed glottis. The pressure in the esophagus rapidly increases and the esophagus bursts at its weakest point, sending a stream of material into the mediastinum and often the pleural cavity as well.* Most common location of perforation is in the left posterolateral aspect 3-5 cm above the gastroesophageal junction. Second most common site of perforation is at the midthoracic esophagus on the right side.* Most cases follow a bout of heavy eating and drinking.* The principal early manifestation is pain felt in the chest and upper abdomen.


Question: Nerve most commonly injured in Mc Burney incision

if direct right-sided inguinal hernia if present, during appendicectomy injury there will be ilioinguinal nerve injury. Reference SRB edition:5 page:994


Question: Indications of percutaneous nephrostomya) Stone removalb)  Ureteral obstructionc) Renal tumor resectiond) Ischemic renal failuree) Antegrade renography

• For HDN, DJ stenting and percutaneous nephrostomy, both are having same results but DJ stenting is less invasive.
• For pyonephrosis, percutaneous nephrostomy is better than DJ stenting.
• Percutaneous nephrostomy is occasionally essential, if not life saving, in the treatment of acute or chronic upper urinary tract obstruction.
• It is the first step in obtaining antegrade access to the kidney for various procedures.


Question: Chylothorax is common on right side because

Chylothorax is common on right side because of long course of thoracic duct towards right side.

Long course of thoracic duct towards right side

Right lung has 3 lobes in contrast to left having 2 lobes

Due to megalymphatic congenital anomaly on right side


Question: Diplopia after fracture results from entrapment of


Question: Side effect of Total Parental Nutrition includes

(B) Fluid overloadCOMPLICATIONS OF TOTAL PARENTERAL NUTRITION (TPN)First 48 hoursFirst 2 Weeks3 Months OnwardMECHANICAL * Complications from catheter insertion:* Cephalad displacement* Pneumothorax* Hemothorax* Detachment of line at catheter hub with blood loss or air embolism* Catheter coming out of vein, more common if Silastic* Detachment of line at catheter hub with blood loss or air embolism* Thrombosis* Detachment of line at catheter hub with blood loss or air embolism* Fractures or tears in catheter* Catheter embedded in vein wallMETABOLIC * Fluid overload* Hyperglycemia* Hypophosphatemia* Hypokalemia* Cardiopulmonary failure* Re feeding edema* Hyperosmolar nonketotic* hyperglycemic coma* Acid-base imbalance* Electrolyte imbalance* Essentially fatty acid deficiency* Iron deficiency, Vitamin deficiencies* TPN metabolic bone disease* TPN liver disease* Zinc, copper, chromium, selenium, molybdenum, deficiencyINFECTIOUS* Catheter-induced sepsis* Exit site infection* Catheter-induced sepsis* Tunnel infections* Exit site infection


Question: Full thickness skin graft is also known as

Ans. is 'a' i.e., Wolfes graft Skin grafts* Full thickness (Wolfes graft) - it includes all epidermis and dermis.* Partial thickness (Thiersch graft) - it includes all epidermis and part of dermis.Partial thickness graftVsFull thickness graft* Partial thickness grafts are thin therefore uptake of graft is easy (easy survival)* Uptake is difficult because of thickness, (less chances of survival)* Large grafts could be taken as the donor site has been left with a part of dermis which will cause easy regeneration of epidermis* Small grafts could be taken as the donor site does not have epidermal or dermal remnants to allow epithelialization as in a paritial thickness graft.* Split thickness graft will contract upto 40% thus not useful for cosmetic surgeries* There is very minimal contraction making it suitable for cosmetic surgeries on face.* The donor site will heal well without any contraction, and is reusable* The donor site will have to be closed primarily or left open to granulate and contract.


Question: A 80 years old male presented with lung abscess in left upper zone. Best treatment of modalities is

Appropriate high dose antibiotics are staed depending on sputum culture like penicillins,3rd generation cephalosporins like cefoperazone,ceftriaxone for 3-6 weeks.Postural drainage for 2-3 hours,3 times daily.80-90% of acute abscesses resolve by medical therapy.Surgical drainage is not commonly done. Reference:SRB's manual of surgery,5th edition,page no:1120,1121


Question: The type of ultraviolet radiation (UV) that is known to induce skin cancer is


Question: Retroperitoneal fibrosis most commonly presents with

The most impoant clinical aspect of retroperitoneal fibrosis is that the fibrotic process frequently entraps and constricts the ureters thereby causing obstructive uropathy. Retroperitoneal fibrosis - It is a nonspecific, nonsuppurative inflammation of fibro-adipose tissue of unknown cause that produces symptoms by the gradual compression of tubular structures in retroperitoneal space. Aetiology of retroperitoneal fibrosis - About 2/3rd cases are primary idiopathic, are also known as Ormond's disease Secondary Retroperitoneal fibrosis a variety of inflammatory conditions - chronic pancreatitis, histoplasmosis, tuberculosis, or actinomycosis. drugs methysergide (most imp.) b blockers hydralazine a methyldopa Etacapone (used in the t/t of Parkinson's ds.) - malignancies (prostate, non-Hodgkin's lymphoma, sarcoma, characinoid & gastric cancer). antoimmune disorders (ankylosing spondylitis, SLE PAN etc.) Symptoms of retroperitoneal fibrosis - It is more common in men between 40-60 yrs of age Early symptoms are nonspecific and vague. These are Pain - Dull noncolicky and insidious in onset. Anorexia, nausea General malaise, diarrhea Later on, symptoms result from compression of tubular retroperitoneal structures. The major structure involved are- Ureter - Most commonly involved Aoa Inferior venacava Symptoms due to the involvement of ureter (usually b/1 involvement) Dysuria Frequency of urination Chills and fever occur with secondary infection of a hydronephrotic kidney. Hematuria can occur. Diagnosis The diagnosis of retroperitoneal fibrosis usually can be made accurately by intravenous pyelography if uremia is not present. The characteristic finding on pyelogram are Hydronephrosis with a dilated touous upper ureter. Medial detion of the ureter Extrinsic ureteral compression Note: In a retroperitoneal tumor, ureter is laterally deted while in retroperitoneal fibrosis ureter medially detes. Currently, the imaging procedure of choice is the CT scan. But if renal function is compromised contrast agents are not given and then MRI is the procedure of choice. T/T of Retroperitoneal fibrosis Coicosteroids, with or without surgery, are the mainstay of medical therapy. Surgical treatment is required in patients who present with moderate or massive hydronephrosis. It consists primarily of ureterolysis (freeing the ureter from adhesions and surrounding tissue) or ureteral stenting.. Also, know Paial or complete ureteral obstruction occurs in 75 to 85% of patients. Most common site of urethral obstruction is lower third of the ureter. Ref : Love & Bailey 25/e p1007


Question: "Crumbled egg appearance" in liver seen in

HYDATID CYST OF LIVER -Word meaning is 'dew drop' (Latin). In Greek, it means watery vesicle'. Camellotte sign: Following intra biliary rupture, gas enters into cyst causing paial collapse of the cyst wall. CT scan abdomen is more accurate in identifying cyst characteristics - cawheel like - multivesicular rosette-like. Ref: SRB&;s manual of surgery,3 rd ed, pg no 534


Question: Treatment for maltoma is

For both gastric lymphoma and maltoma treatment is R-CHOP regimen


Question: Heller's myotomy is done for

(B) Achalasia cardia[?]Achalasia, a disorder of esophagus characterized by progressive inability to swallow solids & liquids.Causes include weakened esophageal muscles & issues with lower esophageal sphincter relaxationHeller Myotomy, surgical procedure offers long term symptomatic relief to these patients.It involves weakening of muscles at gastroesophageal junction, allowing the valve between oesophagus & stomach to remain open.[?]Achalasia Treatment: 2 main methodsHeller's Myotomy:Surgical therapy now involves usually performing only an anterior myotomy, via either abdominal or thoracic approach. In addition to laparosocopic myotomy, thoracoscopic myotomy has also been described.Thoracic approach does have certain drawbacks.Heller's Cardiomyotomy - surgical 7-10 cm long incision made through lower oesophageal end & carried over to stomach, muscles are cut till mucosa bulges out. Myotomy should be extended up to aortic arch & distally up to stomach to 1-2 cm below the junction.Forceful dilatation - using Pneumatic Balloon under fluoroscopic control within LOS (300 mmHg pressure applied for 15 sec).Injection Treatment - Injection Botulinum toxin is injected in LES endoscopically, blocks ACh release.Drugs - Sublingual nifedipine gives short term relief.Endoscopic MyotomyLaparoscopic Heller's Myotomy (LHM):Myotomy from 1.5-3 cm distal to the ECJ dividing the longitudinal & oblique muscle to 6-8cm proximal to the ECJ dividing longitudinal & circular muscle of esophagus.Partial fundoplication is routinely performed as incidence of reflux after Heller's myotomy is >50%.It is due to loss of the ganglion cells in the myenteric (Auerbach's) plexus & cause is unknown.Chaga's disease (due to Trypanosoma cruzi) has marked similarities to achalasia.Other Options[?]Hiatus Hernia:True paraoesophageal hernias with cardia remains in its anatomical position are rare.Vast majority of rolling hernias are mixed hernias in which the cardia is displaced into the chest & greater curve of the stomach rolls into the mediastinum.Elective surgery includes reduction of the hernia, excision of the sac, reducing the crural defect & retention of the stomach in the abdomen.[?]Gastro Oesophageal Reflux Disease:Classical triad of symptoms is retrosternal burning pain (heartburn), epigastric pain (sometimes radiating through to the back) and regurgitation.GORD treated by medical management by proton pump inhibitor therapy +H2 receptor antagonists.Surgery includes;1. Allison repair of hiatus hernia; 2. Nissen fundoplication; 3. Hill procedure; 4. Belsey mark IV operation.[?]Duodenal stenosis:Duodenal atresia is the congenital septum of duodenal obstruction at the commencement of the third part of the duodenum.Repaired by duodenoduodenostomy.


Question: A child with parasymphysis fracture with no mobility and does not involve teeth is managed by

Circum-manidbular wiring with cap splint

Diet restriction and observation for 2-3 weeks


Question: In a case of hypertrophic pyloric stenosis, the metabolic disturbance is

Repetitive vomiting leads to hypochloremic, hypokalemic metabolic alkalosis. The urine is alkaline initially but eventually it becomes acidic (paradoxical aciduria)

Cause of paradoxical aciduria

Initially the kidney compensate for metabolic alkalosis by reabsorbing hydrogen and chloride ions in exchange for sodium, potassium and bicarbonate. But gradually as the body stores of sodium and especially potassium become depleted, kidney starts retaining these ions in exchange of hydrogen ions. thus the urine becomes acidic and metabolic alkaline state is further aggravated.

Metabolic alkalosis with paradoxical aciduria


Question: Best view for mandible is

A panoramic oral radiograph, or ohopantomogram, is the radiograph of choice for the mandible as it shows the whole bone from condyle to condyle. If the patient cannot be positioned in the machines to achieve these views, radiographs should wait until the patient is f it enough. Poor radiographs can be misleading, and treatment can only be based on adequate radiographs or scans. Bailey & Love,25th,392


Question: Indication for sentinel node biopsy is

The first axillary node draining the breast (by direct drainage) is designated as the sentinel node (SLN). SLN Biopsy is done in all cases of early breast cancers, T1 and T2 without clinically palpable node. It is not done in clinically palpable axillary node as there is already distoion of lymphatic flow due to tumour.I t is also not done in multifocal and multicentric tumours, as there is involvement of many lymphatic trunks from different places of breast, and chances of false-negative is high.. Ref; (page no; 543) 5th edition of SRB&;S manual of Surgery


Question: A 5 year old male child has multiple hyper pigmented macules over the trunk, on rubbing the lesion with the rounded end of a pen. He developed uicarial wheal, confined to the border of the lesion. The most likely diagnosis is

Uicaria pigmentosa Uicaria is characterized by large, irregularly shaped pruritic, erythematous wheels Special forms of uicaria have special features (Dermographism, cholinergic uicaria, solar uicaria, or cold uritcaria) Most incidents are acute and self-limited over a period of 1-2 weeks Chronic uicaria (episodes lasting> 6 weeks) may have an autoimmune basis The most common immunologic mechanism is hypersensitivity mediated by IgE, seen for most patients with acute uicaria The morphology of the lesions may vary over a period of minutes to hours, resulting in geographic or bizarre, pattern, true uicaria last less than 24 hours and often only 2-4 hours. The most common cause of acute uicaria are foods, viral infections and medications Diagnosis - In vivo allergy skin testing and in vitro RAST testing Determination of serum tryptase (Increased in anaphylaxis, systemic mastocytosis, non IgE mediated disease ("anaphylactoid reaction") ACE inhibitors and Angiotensin II receptors antagonist therapy is contraindicated. Uicaria pigmentosa (mastocytosis) - consists of multiple irregularly shaped hyperpigmented muscle which may present on the trunk and extremities. Stroking the skin through the lesion with a blunt instrument elicits the classical "triple response of Lewis" called


Question: The Most Common Type of Carcinoma of urinary bladder

(B) Transitional cell Carcinoma # Bladder cancer refers to any of several types of malignant growths of the urinary bladder. It is a disease in which abnormal cells multiply without control in the bladder. The bladder is a hollow, muscular organ that stores urine; it is located in the pelvis. The most common type of bladder cancer begins in cells lining the inside of the bladder and is called urothelial cell or transitional cell carcinoma (UCC or TCC).> Signs and symptoms Bladder cancer characteristically causes blood in the urine, this may be visible to the naked eye (frank haematuria) or detectable only be microscope (microscopic haematuria). Other possible symptoms include pain during urination, frequent urination or feeling the need to urinate without results These signs and symptoms are not specific to bladder cancer, and are also caused by non-cancerous conditions, including prostate infections and cystitis.> Risk factors: Carcinogens such as benzidine Drugs such as cyclophosphamide and phenacetin are known to predispose to bladder TCC.> Genetics: Genes which may be altered in bladder cancer include FGFR3, HRAS, RB1 and TP53


Question: An isograft is one that is transferred

Graft: It is transfer of tissue from one area to other without its blood supply or nerve supply. Autograft: It is tissue transferred from one location to another on the same patient. Isograft: It is tissue transfer between two genetically identical individuals, i.e. between two identical twins. Allograft: It is tissue transfer between two genetically different members, e.g. kidney transplantation (Human to human) (Homograft). Xenograft: It is tissue transfer from a donor of one species to a recipient of another species (Heterograft).Reference : page 321 SRB's manual of surgery 5th edition

From I belonging to blood group A and other to blood group B

From animal to human when the organ involved is identical


Question: Prevention of surgical wound infection done by

Giving antibiotics prior to surgery (prophylactic antibiotics) one hour before surgery has been identified as an intervention for prevention of surgical site infections.
Shaving is now avoided and clipping of hair is preferred.
Preop bath, Blood glucose control, and maintaining normothermia (esp in colorectal surgery) are other useful measures.


Question: A 26 year woman presents with a palpable thyroid nodule, and needle biopsy demonstrates amyloid in the stroma of the lesion. A cervical lymph node is palpable on the same side as the lesion, the preferred treatment should be

Ans. is 'c' i.e., Total Thyroidectomy and Modified neck dissection on the side of enlarged lymph node Presence of thyroid nodule along with palpable cervical lymph nodes and amyloid histologically is clearly indicative of Medullary Carcinoma Thyroid. Total Thyroidectomy is the treatment of choice for patients with MTC because of high incidence of multicentricity, the more aggressive course and RAI therapy usually being not effective. In patients with palpable cervical nodes, ipsilateral or bilateral modified radical neck dissection is done.

Removal of the involved node, the isthmus, and the enlarged lymph node.

Removal of the involved lobe, the isthmus, a poion of the opposite lobe, and the enlarged lymph node.

Total thyroidectomy and modified neck dissection on the side of the enlarged lymph node.

Total thyroidectomy and irradiation of the cervical lymph nodes


Question: Marjolin ulcer

.marjolin&;s ulcer is the name given to a malignancy ( usually a squamous cell carcinoma ) which arise in any long standing wound or a scar mostly scar of an old burn it grows slowly as it is avascular it is painless


Question: The most common position adopted for surgical procedures is

.Lithotomy position used for all perineal surgeries like for fissure, piles, fistula, and APR. ref:SRB&;s manual of surgery,ed 3,pg no 913


Question: Best for staging anal Ca. Is

Overall best for staging is PET CT.
For T stage transrectal usg is used.


Question: Pulled up cecum is seen in

Pulled up conical caecum is the finding seen in ileocaecal TB in Barium study X ray (enteroclysis followed by barium enema or barium meal follow through X ray) Reference : page 584 SRB's manual of surgery 5th edition


Question: In an injury with multiple fractures, most impoant is


Question: A patient presented with thunder clap headache. Followed by unconsciousness with progressive 3"I cranial nerve palsy

Aneurysmal subarachnoid hemorrhage Thunderclap headache is an acute and severe headache that is maximum in intensity at onset and has been likened to a clap of thunder. The term TCH was initially used by Day and Raskin in reference to the pain associated with an unrupured intracranial aneurysm. However, multiple causes of Thunderclap headache have since been described. "Subarachnoid hemorrohage is the most common cause of thunderclap headaches". Primary Thunder Clap headache Primary TCH is diagnosed when all other potential underlying causes have been eliminated by diagnostic testing. Primary TCH's can recur intermittently and are generally associated with benign outcome. The. International Headache Society's distagnoic criteria for Primary TCH (A) Severe headpain fUlfilling criteria B and C (B) Both of the. following characteristics. - Sudden onset, - Reaching maximum intensity in < lmin lasting .from 1 hour to 10 days. (C) Does not recur regularly over subsequent weeks or months. (D) Not attributed to another disorder (normal cerebrospinal fluid and normal brain imaging are needed) Secondary causes of Thunderclap headache Subarachnoid hemorrhagedeg Sentinel headache Cerebral venous sinus thrornbosisQ Cervical aery dissection Spontaneous intracranial hypotension Pituitary apoplexyQ Retroclival hematoma lschaemic stroke Acute hypeensive crisis Reversible cerebral vasoconstriction syndrome Third ventricle colloid cyst Intracranial infection Primary thunderclap headache Primary cough, sexual and exeional headache


Question: A child with cramping pain and current jelly stools. Diagnosis is

.Intussusception Clinical Features * Common in males (3:2). * Common in 6-9 months. But can also occur at later age grouped children. * Common in spring and winter, coinciding with the gastroenteritis and respiratory infections in respective periods. * Commonest cause of intestinal obstruction in infancy. * Initial colicky abdominal pain (75%) which eventually becomes severe and persistent. * Sudden onset of pain in a male child, with progressive distension of the abdomen, vomiting, with passage of "red-currant-jelly'stool. ref:SRB&;S manual of surgery,ed 3,pg no 863


Question: A patient is on periodic renal dialysis. Minor oral surgery should be performed


Question: Thyroid carcinoma secreting ACTH

Ans. (b) Medullary caMedullary Cancer Thyroid:* 5% of thyroid cancers* Arises from Parafollicular C cells which are derived from Ultimobranchial Bodies.* Mc Site is supero lateral* C cells secrete CALCITONIN* Secretes ACTH, Serotonin, Calcitonin, CEA, Histaminidases, PG E2 and PGF2 Alpha.* FNAC showing amyloid is diagnostic


Question: Charcot's triad include

Charcot's triad is a feature of ascending cholangitis secondary to CBD stones.Intermittent symotoms are produced as the stone moves proximally & floats with relieving of obstruction and subsiding of symotoms.The triad includes fever,jaundice and pain(maybe colicky). SRB's manual of surgery,5th edition,page no:651.


Question: The most common type of tracheoesophageal fistula is

The most common type of TRACHEO-OESOPHAGEAL FISTULA(TOF) is Atresia with distal TOF constituting 85% of all. It is also known as type C according to Gross classification of TOF. Reference : SRB's Manual of Surgery, 6th Edition, page no = 794.

Esophageal atresia with out tracheosophageal fistula

Esophageal atresia with proximal tracheosophageal fistula

Esophageal atresia with distal tracheoesophageal fistula

Esophageal atresia with proximal and distal tracheosophageal fistula


Question: Graft survives for the first 48 hours because of

Graft survives upto first 48 hours because of plasma imbibition.

Alignment of donor and recipient capillaries


Question: In rectal cancer, the distal clearance margin should be at least

Tumor margin for curative resection IN GI malignancies (Stomach, small intestine, colon and proximal rectum), tumor margin for curative excision is 5 cm except Esophagus : 10 cm Distal rectum : 2 cm Ref: Sabiston 20th edition Pgno : 1378


Question: Thickened gastric folds are not seen in


Question: The attitude of limb in traumatic dislocation of hip joint is

B i.e. Flexion, adduction, internal rotation

Flexion, adduction, and external rotation


Question: Her2 neu receptor is used in breast carcinoma for

HER2 positive breast cancer is diagnosed by the IHC or FISH test. A result of HER 2 positive is impoant, as it indicates that the cancer can be treated with Herceptin, in combination with other chemotherapy drugs.


Question: Proline is a

Synthetic non absorbable suture material


Question: Alagile syndrome is characterized by

Ans. (a) Bile duct paucityRef: Internet sources* Alagille syndrome is an autosomal dominant genetic disorder affecting liver and heart commonly.* Bile duct paucity is the common manifestation which results in Cirrhosis and Liver failure


Question: The tensile strength of the wound starts and increases after

Wounds do not begin to gain tensile strength from collagen until 5 - 7 days.
Wound achieves around  20 % by 3 weeks,  and around 60 % by four months.
Scar tissue continues to remodel for at least 6 - 12 months after an injury.


Question: A 45 year old postmenopausal lady presents with an 8 cm breast lump that is adherent to the skin, with one firm apical lymph node in the axilla and one more node in the ipsilateral supraclavicular area with no clinical evidence of distant metastasis. The staging is

.TNM Staging Tumour: 1. T1 --Tumour size < 2 cm in greatest diameter. (T1a--0.1-0.5 cm; T1b--0.5-1 cm; T1c--1-2 cm). 2. T2--Size 2-5 cm. 3. T3--Size >5 cm. 4. T4--Tumour fixed to chest wall or skin. (T4a--Fixed to chest wall; T4b--Fixed to skin; T4c--T4a + T4b; T4d--inflammatory carcinoma of breast). Node: N0-- No nodes. N1-- Axillary nodes mobile (ipsilateral). N2-- Axillary nodes fixed to one another and other structures (or only internal mammary lymph nodes are involved but not axillary nodes). N3 -- Supraclavicular nodes. Oedema of arm and internal mammary lymph nodes (ipsilaterally) (or-internal mammary lymph nodes and also axillary lymph nodes are involved). Metastasis: M0 No metastasis. M1 Distant Metastases. ref:SRB&;s manual of surgery,ed 3,pg no 476


Question: Tom Smith septic ahritis affects

Septic ahritis of hip seen in infants. At this age, the head of the femur is cailaginous and is rapidly and completely destroyed by the pyogenic process. Onset is acute with rapid abscess formation, which may burst out or be incised and heals rapidly. Usually it is mistaken as a superficial infection and the child presents some time later with complaint of a limp without any pain. On examination- it is found that the child walks with an unstable gait. The affected leg is shoer and hip movements are increased in all directions. Telescopy test is positive On X Ray, one finds complete absence of the head and neck of femur


Question: The Histological subtype of renal cell carcinoma having worst prognosis is

Answer- C. Collecting duct RCCCollecting duct & Medullary- poor prognosis


Question: The largest aery to the stomach is


Question: The most common site for ligamentous injuries are those of the


Question: Most common malignancy in marjolin's ulcer

(B) Squamous cell carcinoma) (29, 548- Bailey & Love)A squamous cell carcinoma known as Marjolin's ulcer being the most common (Leg ulcers)Most frequently associated with * Chronic venous ulcer* Long standing burn scar* Squamous cell carcinoma developing in long standing scar/ulcers* Adenocarcinomas are the most common histological subtype of stomach cancer * *** Gastric carcinomas are often associated with hypochlorhydria /achlorhydria* Gastric carcinomas are relatively radioresistant* Maleny's ulcer (Burro wing ulcer) is caused by synergistic infection by Microerophilic Nonhaemolytic streptococci and Aerobic, Hemolytic staphylococci


Question: In children persistent priapism may result due to


Question: Investigation for acute abdomen includes

.Gram -ve septicaemia is common in acute abdomen like peritonitis, abscess, urinary infections, biliary infections, postoperative sepsis. It is commonly seen in malnutrition, old age, diabetics, immunosuppressed people. Diabetic acute abdomen -Patient with diabetes mellitus may present as acute abdomen. Free fluid in the flank may not be present. Patient may be ketotic also.the investigation of choice in a case of acute abdomen is ultrasound. ref:SRB&;s manual of surgery,ed 3,pg no 502