Question: Most common complication seen with prostatitis is

PROSTATITIS In both acute and chronic prostatitis, the seminal vesicles and posterior urethra are usually also involved. Acute prostatitis Aetiology Acute prostatitis is common, but underdiagnosed. The usual organism responsible is Escherichia coli, but Staphylococcus aureus, Staphylococcus albus, Streptococcus faecalis, Neisseria gonorrhoeae or Chlamydia may be responsible. The infection may be haematogenous from a distant focus or it may be secondary to acute urinary infectionClinical features General manifestations overshadow the local: the patient feels ill, shivers, may have a rigor, has 'aches' all over, especially in the back, and may easily be diagnosed as having influenza. The temperature may be up to 39degC. Pain on micturition is usual, but not invariable. The urine contains threads in the initial voided sample, which should be cultured. Perineal heaviness, rectal irritation and pain on defaecation can occur; a urethral discharge is rare. Frequency occurs when the infection involves the bladder. Rectal examination reveals a tender prostate; one lobe may be swollen more than the other, and the seminal vesicles may be involved. A frankly fluctuant hygiene abscess is uncommon. Treatment Treatment must be rigorous and prolonged or the infection will not be eradicated and recurrent attacks may ensue. Spread of infection to the epididymides and testes may occur. Prolonged treatment with an antibiotic that penetrates the prostate well is indicated (trimethoprim or ciprofloxacin) Chronic prostatitis Many urologists find the diagnosis of chronic prostatitis and 'prostatodynia' very difficult, for many men present with perigenital pain, testicular pain, prostatic pain exacerbated by sexual intercourse or pain that apparently renders sexual intercourse out of the question. Psychosexual dysfunction in such patients may be the underlying problem. The diagnosis of chronic prostatitis has to be based on: * persistent threads in voided urine; * prostatic massage showing pus cells with or without bacteria in the absence of urinary infection. Aetiology This is thought to be the sequela of inadequately treated acute prostatitis. While pus is present in the prostatic secretion, the responsible organism is often difficult to find. Other organisms such as Chlamydia species may be responsible for chronic abacterial prostatitis. Clinical features The clinical features are extremely varied. Only men with symptoms of posterior urethritis, prostatic pain and perigenital pain accompanied by intermittent fever and pus cells or bacteria in the post-prostatic massage specimen should be diagnosed as having chronic prostatitis. Diagnosis The three-glass urine test is valuable. If the first glass with the initial voided sample shows urine containing prostatic threads, prostatitis is present. Rectal examination of the prostate may be normal or may show a soft, boggy and tender prostate. Examination of the prostatic fluid obtained by prostatic massage should show pus cells and bacteria. Urethroscopy may reveal inflammation of the prostatic urethra, and pus may be seen exuding from the prostatic ducts. The verumontanum is likely to be enlarged and oedematous. In many men with the symptoms described above, all investigations are normal. Treatment Antibiotic therapy should be administered only in accordance with bacteriological sensitivity tests. Trimethoprim or ciprofloxacin penetrate well into the prostate. If Trichomonas or anaerobes are the responsible agent, a rapid response is obtained from administration of metronidazole (200mg t.d.s. for 7 days to both paners). If Chlamydia is suspected, doxycycline is the antibiotic treatment of choice. There is little evidence that prostatic massage helps in eradicating the infection. Ref: Bailey and love 27th edition Pgno : 1475


Question: Calot's triangle is an impoant landmark for

Calot's triangle: area bound superiorly by the inferior surface of the liver, laterally by the cystic duct and the medial border of the gallbladder and medially by the common hepatic duct. It is an impoant surgical landmark as the cystic aery, usually can be found within its boundaries.Ref: Bailey and love 27e pg: 1188


Question:
The ideal treatment for fracture of the angle of
mandible is

Plating on the Lateral side of the body of the mandible

Plating at the inferior border of the mandible


Question: The most common complication seen in a hiatus hernia is


Question: Cerebral perfusion pressure is

Cerebral perfusion pressure (CPP), is the difference between mean aerial pressure (MAP) and intracranial pressure (ICP): CPP (75-105 mmHg) = MAP (90-110 mmHg) - ICP (5-15 mmHg).Normal cerebral blood flow (CBF) is about 55 mL/minute for every 100 g of brain tissue. Ischaemia results when this rate drops below 20 mL/min,Bailey and love 26e pg: 310

mean aerial pressure + intracranial pressure

cerebral blood flow * brain surface area in m^2

cerebral blood flow / brain surface area in m^2

mean aerial pressure - intracranial pressure


Question: "TIPS" is contraindicated in

Main contraindication for TIPSS is poal vein occlusion,which can be due to poal vein thrombosis.Post- shunt encephalopathy is the confusional state caused by the poal blood bypassing the detoxication of the liver.TIPSS is indicated in poal hypeension associated with cirrhosis,control of variceal bleeding,etc. Reference:Bailey & Love's sho practise of surgery,25the edition,page no:1089


Question: Male with history of bilateral undescended testis

Male with bilateral undescended testis (especially intra-abdominal testes) are usually sterile. To optimise spermatogenesis the testis needs to be in the scrotum below body temperature at a young age. Incompletely descended testes are often macroscopically normal in early childhood but by pubey the testis is poorly developed, gradually atrophies. The epithelial elements are immature histologically and by late pubey irreversible destructive changes halt spermatogenesis and limit the production of androgens leading to sterility.Malignant transformation in undescended testis is 20 times more common than normally descended testis. Pathophysiology include gubernacular dysfunction, lack of gonadotrophin, lack of 'calcitonin gene related peptide'(CGRP) , familial , altered hypothalamo-pituitary-gonadal axis, deficiency of mullerian inhibiting substance, Prune-Belly syndrome. These patients also require psychological intervention. Reference : page77 and 1377 Bailey and Love's sho practice of surgery 25th edition and page1079 SRB's manual of surgery 5th edition

Risk of testicular neoplasm is same as other males

Pathophysiology is merely mechanical problem in descent of testis

Intervention for psychological purpose is not a requirement


Question: Most common sign/symptom of phaeochromocytoma

Clinical signs of phaeochromocytomaSymptomsPrevalence (%)Hypeension Paroxysmal Continuous 80-9050-6030Headache 60-90Sweating 50-70Palpitation 50-70Pallor 40-45Weight loss 20-40Hyperglycaemia 40Nausea 20-40Psychological effects 20-40Ref: Bailey and Love 27e pg: 845


Question: Carcinoma Ex pleomorphic adenoma is

Carcinoma Ex pleomorphic Adenoma / Malignant mixed tumour

Malignant change of pleomorphic adenoma
Has rapid growth and painful
Leads to paraesthsia and facial weakness.

Regrowth of pleomorphic adenoma after superficial parotidectomy due to inadquate removal

Slow and progressive growth of pleomorphic adenoma


Question: Most common cause of Pseudocyst of pancreas is

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: Treatment of choice of Desmoid tumour is


Question: Management of 4 cm size renal staghorn calculus.

ANS. B* Management of renal calculi* Stones <6 mm--conservative treatment* Stones from 6 mm to 2 cm: ESWL* Stones >2 cm: PCNL* For stones at lower renal calyx: Do PCNL* For staghorn calculi: ESWL+PCNL (Sandwich technique)Shapes of urinary stonesLeucine stones--spherical-shapedTyrosine stones--needle-shaped

Extracorporeal shock wave lithotripsy (ESWL)


Question: A young man had a stab injury in left 5th ICS at the mid clavicular line. On examination there is no deviation of trachea, heart sounds diminished, systolic BP is 80 mmHg, and RR is 20/min. The diagnosis is

(A) Cardiac tamponade# Cardiac tamponade is a clinical syndrome caused by the accumulation of fluid in the pericardial space, resulting in reduced ven-tricular filling and subsequent hemodynamic compromise.> 3 phases of hemodynamic changes in tamponade.> Phase I: The accumulation of pericardial fluid causes increased stiffness of the ventricle, requiring a higher filling pressure. During this phase, the left and right ventricular filling pressures are higher than the intrapericardial pressure.> Phase II: With further fluid accumulation, the pericardial pressure increases above the ventricular filling pressure, resulting in reduced cardiac output.> Phase III: A further decrease in cardiac output occurs, which is due to equilibration of pericardial and left ventricular (LV) filling pressures.> Beck triad or acute compression triad This complex of physical findings refers to increased jugular venous pressure, hypotension & diminished heart sounds These findings result from a rapid accumulation of pericardial fluid. However, this classic triad is usually observed in patients with acute cardiac tamponade.> Pulsus paradoxus or paradoxical pulse: This is an exaggeration (>12 mm Hg or 9%) of the normal inspiratory decrease in systemic blood pressure


Question: Commonest cancer in burn scar is

The commonest cancer associated with burns is squamous cell carcinoma. This is also known as marjolin's ulcer and this malignancy sta from the scar tissue of burns. Treatment is wide local excision, in case of large ulcer, amputation is required. Reference : SRB's Manual of Surgery, 6th Edition, page no = 283.


Question: If head of the radius is removed, it will result in

B i.e. Valgus deformity Classically the head of radius should not be excised in children because ? - It will interfere with the synchronous growth of radius and ulnar producing wrist & elbow deformity. - It leads to proximal radial migration & subluxation of inferior radio ulnar joINTEGER(2. - It causes weakness of extremity & discomfo in distal radio - ulnar joint with heavy activities - May produce cubitus valgus deformityQ and instability.


Question: The most useful incision in the operating room for patients with penetrating pericardium injury is

The subxiphoid incision is useful for determining if there is blood in the pericardium and if there is an intracardiac injury; however, exposure is extremely limited, and definitive repair can rarely be performed through the incision. Left (or right) anterior thoracotomy is easily performed, especially in the emergency room, and gives adequate exposure to ceain areas of the hea. However, each has significant limitations in exposure. Either may be extended across the thoracotomy into the other side of the chest, thus producing a bilateral anterior thoracotomy. Exposure is excellent through this incision, and most injuries can be satisfactorily repaired through this approach. Most cardiac operations today are performed through median sternotomy incisions. If the patient is in the operating room, this incision is easily performed and always provides excellent exposure for all areas of the hea.


Question: Cowden syndrome is commonly associated with

(D) Hamartoma # Cowden syndrome (also known as "Cowden's disease," and "Multiple hamartoma syndrome") is a rare autosomal dominant inherited disorder characterized by multiple tumor-like growths called hamartomas and an increased risk of certain forms of cancer.> Stauffer syndrome - paraneoplastic, non-metastatic liver disease is a sign of Renal cell carcinoma.> Thymic carcinomas are, for the most part, of epithelial origin, although a few other unusual cell types can be found. All these lesions are very uncommon, and several are rare. They include some with low malignant potential (eg, well-differentiated squamous cell carcinoma, basaloid carcinoma, mucoepidermoid carcinoma) and those with features of a more aggressive malignancy (E.g., Sarcomatoid carcinoma, clear cell carcinoma, neuroendocrine carcinoma, lymphoepitheliomalike tumors, anaplastic undifferentiated tumors).


Question: Most common site for anal fissure is

An anal fissure (synonym: fissure-in-ano) is a longitudinal split in the anoderm of the distal anal canal (Fig. 69.24), which extends from the anal verge proximally towards, but not beyond, the dentate line.most common site for anal fissure is 6 O&; clock Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1251


Question: Tumor invades muscularis propria and 2 lymph nodes involved. TNM staging is

T1 Invades submucosaT2Invades muscularis propriaT3Invades through the muscularis propria into pericolrectal tissuesT4aInvades through the visceral peritoneumT4bDirectly invades to adjacent organs or structuresN1aOne node positiveN1b2-3 nodes positiveN1cNo regional lymph nodes positive, but there are tumour deposits in the subserosa, Mesentry or non peritonealized pericolic/ perirectal/ mesorectal tissues N2a4-6 lymph nodes positiveN2b7 or more lymph nodes positiveM1aMetastasis to one site or organ, without peritoneal metastasisM1bMetastasis to 2 or more sites or organs without peritoneal metastasisM1c Metastasis to the peritoneal surface (alone or along with other site/organ)Ref: AJCC 8e


Question: Deformity in anterior dislocation of hip is

Ans. is 'a' i.e., Ext. rotation, abduction, flexion Anterior dislocation of hip Anterior dislocation of the hip is much less common than posterior dislocation. Indeed, it is a very uncommon injury. It is caused by forced abduction and lateral (external) rotation of hip, usually in a violent injury such as a motor accident on aircraft crash. Clinically, the limb is in marked external (lateral) rotation, flexion and abduction There may be apparent lengthening due to abduction deformity. Closed reduction under anaesthesia is the treatment of choice. Complications are avascular necrosis, and secondary osteoahritis.


Question: Commonest cause of periumbilical pain after 30 min. of TURP done under spinal anesthesia with Bupivacaine

Ans is 'b' ie Perforation of the bladder Perforation of bladder is one of the complications of TURP. It can present with periumblical pain. This pt. experiences pain 30 minutes after TURP. This is because he is under spinal anesthesia. In this pt. the effect of spinal anesthesia terminates 30 min. after the operation. Now he is able to perceive the pain of bladder perforation. Meteorism - is distention of the abdomen or intestines by gas. This is seen in Renal injury but not in TURP.


Question: Cidex is


Question: Tt for CTEV should start from


Question: 30 year male with chronic diarrhoea, anemia, raised liver enzymes. Most likely associated with

Anti-endomysial antibody The clinical features are suggestive of celiac sprue0. The typical symptoms of celiac sprue are weight loss, chronic diarrhoea, abdominal distension, growth retardation anemia. Raised liver enzymes is not mentioned in many text books including Harrison. But according to C.M.D.T. 'Mild elevation of aminotransferases are seen in upto 40% of patientsdeg " Impoant points about the diagnosis of celiac sprue Small intestinal biopsy in celiac sprue demonstrates characteristic features but it is not specific for the diagnosis of celiac sprue. It can be seen in tropical sprue also. Serological tests helpful in the diagnosis of celiac sprue are - Anti endomysial antibody (Anti EMA) - Anti tissue (t) transglutaminase antibody Anti (t) TGA A negative test excludes the diagnosis of celiac sprueQ The diagnosis of celiac sprue still rests upon - Clinical demonstration of malabsotptioni2 - Demonstration of intestinal lesion by small bowel biopsyo - Unequivocal improvement in both symptoms and mensal histology on gluten with drawl from the diets'. Antimitochondrial antibody Antimitochondrial antibody testing is done for primary biliary cirrhosis. The points against the diagnosis of primary biliary cirrhosis. - It typically presents in middle aged females. - initial clinical manifestations of the disease are - Pruritus -Fatigue - Characteristic elevation of alkaline phosphatase Antismooth muscle antibody Antismooth muscle antibody testing is done for autoiminune hepatitis Antoimmune hepatitis is common in young women. The usual presentation is an acute attack of hepatitis.


Question: Commonest site of metastasis of Wilm’s tumour is

Lungs is MC site for mets in wilms tumor.


Question: Post operative abscess treatment of choice nowadays

Ans. (c) Image guided aspiration(Ref: Bailey 26th 978)* Modern management of an abscess is by radiological diagnosis using ultrasound or CT guidance followed by drainage.


Question: The commonest clinical pattern of basal cell carcinoma is

.basal carcinomas are composed of islands of basaloid cells ( like cells of basal layer of epidermis) with palisading of cells at the periphery and a haphazard arrangement of those in the centres of the islands . the tumour cells have a hypochromatic nucleus with relatively poorly defined cytoplasm they spread by local invasion . lymphatic spread is not seen so regional lympnodes are not enlarged they are diagnosed using wedge biopsy most common site is inner canthus of eye also called tear cancer they show a nodular pattern


Question: For split skin graft the best source is

(A) Autograft # Autograft is skin graft taken from an uninjured part of body (e.g. thigh skin) and is used for skin grafting in same person.> It is the best skin graft for open wounds because of very high rate of successful grafting.


Question: First autologous renal transplantation was done by

.The first successful autologous renal transplantation ( autotransplantation )was performed by Dr.Hardy in 1963 in a patient with severe ureteral injury . This has been described for complex paial nephrectomies , extensive vascular injuries , recurrent stone formers ( renal pelvis is directly anastamosed to the bladder ) ref :- campbell - walsh urology 11th edition . chapter 47 .pg no 1087


Question: Bad prognosis in AML is indicated by aEUR'

Monosomy Prognostic factors in AML Favourable prognostic factors Unourable prognostic factors Miscellaneous prognostic factors * Age < 40 yrs * del (7q) * In recent years, with availability * AML without antecedent MDS/ MPD * dui (5q) of markers on bone marrow * Blast cells with Auer rods * 11q23 - MLL +ve trephine sections, it has been * TLC < (25 x 109/L) * 3q21 possible to study antiogenesis, * t (15;17) in AML - M3- PMURARA +ve ' Expression of MDR-1 gene (Multidrug proliferative index, apoptosis and * t (8;21) in AML-M, * Inv (16) in AML- M4Eo resistance gene) * 3q26 other parameters * FAB subtype - AML- M2, M3, M4 *Complex karyotypes * High WBC count > 100 x 109/L * AML with preceeding MDS/ PMD * Extremes of age <2 years and > 55 years FLT-3 mutation * -7/7q * Extramedullary disease in AML- M5 * Presence of CNS involvement * FAB subtype AML -MO, M6, M7 -- * t (8 ; 21)Q in AML - M2 Good prognosis * Inv (16) in AML- M4 E,, * t (15 ; 17)Q in AML - M3 - PML /RAFA +ve Moderately ourable outome * No cytogenetic abnormality Q * del (7q) * Monosomy 5 or 7 * del (5q) * inv (3) (q 21. q 26) * 11(123 - MLL +ve * t (3;3) Poor prognosis * 3q21 * t (6:11) * Expression of MDR-1 gene * t (10:11) * 3q26 * t (9;22) Genetic abnormalities in normal cytogenetic AML Name Prognosis Prevalence Expression NPM-1 (nuclephosmin) Favourable 50-60% Mutation FLT3-ITD The Ems - like tyrosine kinase 3 Gene Unourable 3040% Mutation FLT3 -Asp835 Unclear 5 - 10% Mutation BAALC (Brain and acute leukemia cytoplasmic) Unourable 65.7% Over expression MNI (Meningioma I) Unourable 50% Over expression MLI -PTD (Mixed lineage leukemia) Unourable 7.7% Mutation / over expression CEBPa (CCAT/Enhancer binding protein alpha gene) Favour able 15 - 20% Mutation ERG-I (The E1S-related gene Unoruable 25% Over expression AF-lq expression Unourable 75% Over expression Nuleophosmin (NPM1) mutations The most common molecular abnormality present in -50% of AML's with normal karyotype. nK- AML constitutes -45% of AML's and conveys an "intermediate" (but heterogenous) prognosis. Exon 12 NEM] mutations (always 4bp inseions) disrupt a key regulatory region. "AML with mutated NPM (nusleophosmin) has a ourable prognosis". Loss of X.Y chromosome There is a correlation between t (8;21) and involvement of sex chromosomes (X, Y chromosomes) - Involvement of sex chromosome occur in cases with t (8;21) that may be either in the .form of loss of X chromosome or duplication of Y chromosome. - Loss of the Y chromosome or loss of the X chromosome is associated with t (8;21) in 80% to 90% cases. - But the significance of these abnormalities on prognosis is not clear. Most probably they have ourable prognosis just as t(8;21).


Question: In exocrine pancreatic, cancer, the commonest tumor marker to be elevated in

.Investigations for exocrine pancreatic tumors includes * Liver function tests: Serum bilirubin, direct component (conjugated) is increased (van den Bergh's test). Serum albumin is decreased with altered A : G ratio. Prothrombin time is widened. Serum alkaline phosphatase is increased * U/S abdomen to see gall bladder, liver, growth, CBD size (normal diameter is < 10 mm), lymph node status, poal vein, ascites. * Barium meal shows widened duodenal "C" loop-- pad sign. Reverse 3 sign is seen in carcinoma--periampullary region. * Spiral CT scan (ideal) shows poal vein infiltration, retroperitoneal lymph nodes, size of the tumour. * ERCP with pancreatic juice cytology or brush biopsy is useful. MRCP to see biliary tree. * CA 19-9 (carbohydrate antigen) is a useful tumour marker. * Coeliac and superior mesenteric angiogram can be done to reveal tumour circulation and invasion. * Gastroduodenoscopy reveals ampullary tumour and biopsy can also be taken. * Endosonography is useful to see the invasion and size, to stage and to do EUS guided FNAC. * Urine for bile salts (Hay's test), bile pigments (Fouchet's test), urobilinogen. ref:SRB&;S manual of surgery,ed 5,pg no 634


Question: BIRADS stage of 5 is

Ans. (d) Highly suggestive of malignancy(Ref. Sabiton 20th edition Page 831)* BIRADS - Breast Imaging Reporting and Data System)* This system is used to categorize the degree of suspicion o malignancy based on Mammography findings.* BIRADS-5 is highly suggestive of malignancyCategoryDefinitionFurther Plan0Incomplete assessmentNeed additional imagingslNegativeAdvised annual screening2Benign FindingRecommend annual screening3Probably BenignShort interval follow up4Suspicious of malignancyBiopsy must5Highly suggestive of malignancyTake appropriate action6Known biopsy proved malignancy


Question: Transplantation of liver is contraindicated in

Contraindications to Liver Transplantation Absolute Relative Uncontrolled extrahepatobiliary infection Active, untreated sepsis Incorrect able, life-limiting congenital anomalies Active substance or alcohol abuse Advanced cardiopulmonary disease Extrahepatobiliary malignany (not including nonmelanoma skin cancer) Metastatic malignancy to the liver Cholangiocarcinoma AIDS Life-threatening systemic diseases Age >70 years Prior extensive hepatobiliary surgery Poal vein thrombosis Renal failure not attributable to liver disease Previous extrahepatic malignancy( not including nonmelanoma akin cancer) Severe Obesity Severe malnutrition/wasting Medical noncompliance HIV seropositivity with failure to control HIV viraemis or CD4 <100/uL Intrahepatic sepsis Severe hypoxemia secondary to right - to-left intrapulmonary shunts (Po2<50mmHg) Severe pulmonary hypeension(mean pulmonary aery pressure >35 mmHg) Uncontrolled psychiatric disorder Ref: Sabiston 20th edition Pgno : 637-638


Question: Normal lower oesophageal sphincter pressure is

The normal lower oesophageal sphincter is 3-4 cm in length and has a pressure of 10-25 mmHgThe LOS is a zone of relatively high pressure that prevents gastric contents from refluxing into the lower oesophagusRef: Bailey and Love 27e pg: 1068


Question: Optimum rate of movement during distraction osteogenesis is


Question: Mondor&;s disease is

Mondor&;s disease is spontaneous thrombophlebitis of the superficial veins of the breast and anterior chest wall cause is unknown it is often self limited it often mimics the lymhatic permeation of the carcinoma of breast ref ;(page no;525) 5th edition of SRB&;S Manual of SURGERY


Question: Triangular relation of Elbow is maintained in


Question: Least common complication of peptic ulcer

(A) Gastric Outlet Obstruction # GASTRIC OUTLET OBSTRUCTION:> The two common causes of gastric outlet obstruction are gastric cancer (see below) and pyloric stenosis secondary to peptic ulceration.> Previously the latter was more common. Now, with the decrease in the incidence of peptic ulceration and the advent of potent medical treatments, gastric outlet obstruction should be considered malignant until proven otherwise, at least in the West. The term pyloric stenosis is normally a misnomer.> The stenosis is seldom at the pylorus. Commonly, when the condition is due to underlying peptic ulcer disease, the stenosis is found in the first part of the duodenum, the most common site for a peptic ulcer.> True pyloric stenosis can occur due to fibrosis around a pyloric channel ulcer. However, in recent years the most common cause of gastric outlet obstruction has been gastric cancer. In this circumstance the metabolic consequences may be somewhat different from those of benign pyloric stenosis because of the relative hypochlorhydria found in patients with gastric cancer.


Question: In pelvis fracture, the amount of blood loss is around

D i.e. 4 - 8 units In pelvis fracture intrapelvic haemorrhage is by far, the most serious complication. Haemorrhage frequently results from fracture surfaces and small vessels in the retro peritoneum. Amount of blood loss is around 4 - 8 unitsQ. It must be emphasised, however, that these cases may need transfusion of very large quantities of blood. It is not uncommon for the amount of blood transfused to be in excess of the patients's total blood volume. In cases of hemodynamic instability, an external fixator should be applied immediately to decrease motion at fracture sites as well as to decrease pelvic volume and generate temponade of the pelvic venous plexus.


Question: GCS of 10 is classified as

Head injury classification using the GlasgowComa Scale (GCS) score.Minor head injury GCS 15 with no loss of consciousness(LOC)Mild head injury GCS 14 or 15 with LOCModerate head injury GCS 9-13Severe head injury GCS 3-8Bailey and love 27e 329


Question: Brain abscess in cyanotic heart disease is commonly located in

Brain abscesses in congenital cyanotic heart diseases occur due to hematogenous seeding of bloodborne bacteria. These blood borne bacteria bypass the pulmonary capillary bed d/t right to left shunt. They commonly infect parietal & frontal lobes (territory of middle cerebral artery).


Question: Investigation of choice for posterior chethral stricture is

Investigation of choice :
a) Anterior Urethral stricture ⇒ Retrograde Urethrogram.
b) Posterior Urethral stricture ⇒ Anterograde urethrogram.


Question: In Random flaps, the length to breadth ratio should be no more than

Random flaps. Three sides of a rectangle, bearing no specific relationship to where the blood supply enters the length to breadth ratio is no more than 1.5:1Axial flaps. Much longer flaps, based on known blood vessels supplying the skin.


Question: A 70 year old male known case of a ceain malignancy presents with elevated erythropoietin levels and PCV of 52%. Most likely tumour is

Answer- A. Renal Cell CarcinomaErythrocytosis (d/t secretion of erythropoietin by RCC) (but anemia is a more common finding)HypeensionAbnormal liver function (Stauffers syndrome ie non metastatic hepatic dysfunction)HypercalcemiaNeuromyopathyAmyloidosisIncreased ESR (MC paraneoplastic syndrome)DysfibrogenemiaGalactorrhoeaFeminization and masculanization


Question: Patient can present with pyoderma gangrenosum in

In Non-Hodgkin's Lymphoma, Pyoderma gangrenosum may be the presentation.


Question: Bohler's angle is decreased in fracture of

Calcaneum 1Ref. Apley's 8/e, p 750-75]; Ebnezar Ohopedics 3/e, p 263-264; Maheshwari 3/e, p 1401 Bohler's angle (also k/a Tuber joint angle) measures the angular relationship between talus and calcanecum. Flattening of this angle is a classic x-ray sign of depressed fracture of calcaneum. Other angle which is of impoance in calcaneal fracture is Crucial angle of "Gissane" More about calcaneal Calcaneum is the most commonly fractured tarsal bone In 5-10% of cases is bilateral * Most common mechanism of injury is fall front height, often from a ladder, onto one or both heels. The calcaneum is driven up against the talus and is split or crushed. About one fifth of these patients suffer associated injuries of the spine, pelvis or hip. * Also k/a loveri fracture' * Plain x-rays done for calcaneal fracture include lateral, oblique and axial views, Axial view of calcaneum is also k/a Hans view. * CT is the inv. of choice * With severe injuries and especially with bilateral fractures - it is essential to x-ray the knees, the spine and the pelvis as well Other angles of impoance Cobb's angle - Scoliosis (Apley's 8/e, p 377; Maheshwari 3/e, p 235) Kite's angle - CTEV (Apley's 8/e, p 489; Maheshwari 3/e, p 196) Meary's angle _> Pes cavus (plantaris (Apley's 8/e, p 497) deformity) Hilgenreiner's epiphyseal angle Congenital coxa vera (Apley's 8/e, p 420) Baurnann's angle Supra condylar (Apley's 8/e, p 597) C alcaneum 1Ref. Apley's 8/e, p 750-75]; Ebnezar Ohopedics 3/e, p 263-264; Maheshwari 3/e, p 1401 * Bohler's angle (also k/a Tuber joint angle) measures the angular relationship between talus and calcanecum.


Question:
Chemical cauterization in odontogenic keratocyst
is done by


Question: Child with midline swelling in the neck most probable diagnosis

Ans. (a) Thyroglossal CystRef: Schwartz 10th edition, Page 1602* Midline masses include thyroglossal duct remnants, thyroid masses, thymic cysts, or dermoid cysts* Thyroglossal cysts account for about 75% of congenital midline swellings in childhood, and they are the most common abnormality of the midline neck seen in children


Question: Cullen's sign

Cullen's sign seen in acute pancreatitis due to enzymes seeping through falciform ligament and causing discolouration around umbilicus SRB,5th,683.


Question: The type of mammary ductal carcinoma is situ (DCIS) most likely to result in a palpable abnormality in the breast is

Ans. is 'd' Comedo DCIS Ductal carcinoma in situ (DCIS) can be divided into two types : Comedo carcinomas and Non-comedocarcinomas DCIS are usually detected as calcifications on mammography but comedo carcinomas can present as palpable nodules.


Question: Impacted canines

Good function is impossible without them

They will not erupt until root formation is complete


Question: Burns involving skin superficial pa of dermis is categorized as

First degree burns involve only epidermis Superficial second degree involve upper layer of dermis Deep second degree involves reticular layers of dermis Third degree involves all layers of skin Fouh degree burns involve not only skin but also subcutaneous fat and deeper structures


Question: Most common type of Thyroid carcinoma is

Papillary Histology type Incidence Papillary 80%, Follicular 10%, Medullary 5%, Anaplastic 1% * Papillary carcinoma thyroid (Frequently asked facts) a. Commonest carcinoma of thyroid gland (80%) b. Commonest carcinoma in iodine sufficient area. c. More common in patients with previous exposure to radiation (past childhood) d. Commonest age 30-40 year. e. Multifocal (more common) f. Lymph node metastases more common (i.e., lymphatic spread) g. Distant metastasis uncommon commonest site - lung followed by bone, liver, brain. h. Prognosis excellent - 10 years survival (95%)


Question: Once phaeochromocytoma is diagnosed, preoperatively following is given

Once a phaeochromocytoma has been diagnosed, an a- adrenoreceptor blocker (phenoxybenzamine) is used to block the effects of catecholamine excess and its consequences during surgery. A dose of 20 mg of phenoxybenzamine initially should be increased daily by 10 mg until a daily dose of 100-160 mg is achieved and the patient repos symptomatic postural hypotension. Additional b-blockade is required if tachycardia or arrhythmias develop; this should not be introduced until the patient is a-blocked. The infusion of large volumes of fluid or administration of noradrenaline can be necessary to correct postoperative hypotension in the presence of unopposed a-blockade.Ref: Bailey and Love 27e pg: 846


Question: The most reliable urine specimen is obtained by

the most reliabe urine sample is obtained through suprapubic aspiration .it is superior to clean catch or catheter specimen with sensitivity for bacteriuria being 100% and rarely contaminated.But this is not routinely indicated . A midstream sample is obtained for urine analysis in both males and females after cleaning of genitalia to prevent contamination but in females if uti is suspected midstream sample is unreliable and a catheterised sample is obtained.Indications for suprapubic aspiration 1) chilren below 2 years if urine culture is to be done 2) urinary retention ( bph , malignancy , phimosis , urethral stricture ) 3) chronic infection of urethral or periurethral glands 4) urethral trauma. contraindications . 1) empty or unidentifiable bladder 2) bladder tumour 3) lower abdominal wounds or cellulitis ( campbell walsh urology 11th edition . chapter 1.,aicle 82964 .suprapubic aspiration ,medscape by alexander d tapper et al )


Question: The most common presentation of endemic goitre

Endemic Goiter Worldwide, diffuse goiter is most commonly caused by iodine deficiency and is termed endemic goiter when it affects >5% of the population Endemic goiter occurs in geographical areas where soil, water and food supply contains low levels of iodine The lack of iodine leads to decreased Synthesis of thyroid hormones and a compensatory increase in TSH which in turn leads to follicular cell hyperophy and hyperplasia and goitrous Enlargement leading to diffuse hyperplastic goiter Mostly, patients are euthyroid Ref : Harrison's 19th edition Pgno :2301


Question: 18 yr female with itchy erythema, swelling of toes every winter season seen due to

Answer- C. ChilblainsAlso known as pernio, It is an inflammatory skin condition presenting after exposure to cold as pruritic and/or painful erythematous to viloaceous acral lesions.It may be idiopathic or secondary to an underlying disease.


Question: Truma and injury severity score (TRISS) includes

(B) (Revised Trauma score /injury severity score + Age) (The Trauma Manual by Moore 2 Mattox)Trauma and injury severity score (TRISS) Combines the Reviseds Trauma score (RTS)and injury severity score (ISS) with the 'Age' of patient together with the method of injury (Blunt or penetrating).Trauma and Injury Severity score (TRISS)* The TRISS is a combined scoring system used to predict the outcome following major trauma* It combines the anatomic derangements (ISS) and physiological derangements (RTS)together with patientsAge and Mechanism of Injury (Blunt or penetrating) to predict survival after trauma.TRISS (Trauma and injury Severity Score)* Injury severity Score (ISS)* Revised Trauma Score (RTS)* Age* Mechanism of injury (Blunt/penetrating)* The TRISS scoring system provides a rough predictor medicating whether mortality in a given patient is expected to be greater or less than 50 percent.TRIAGE- the screening and classification of sick, wounded or injured persons during war or other disaster to determine priorty needs for efficient uses of medical and nurshing manpower, equipment and facilities. It is also done in imergency rooms and in acute care clinics to determine priorty of treatment use of triage is essential if the maximum number of lives are to be saved during an emergency situation that produces many more sick and wounded than the available medical care facilities and personnel can possibly handle.

Revised trauma score ^injury severity score +age

Revised trauma score +injury severity score +GCS


Question: Pain in left hypochondrium vomiting, diarrhea, malena, weight loss diagnosis

Answer- C. Zollinger Ellison syndromePeptic ulceration is the most common manifestation of Zollinger Ellison syndrome leading to left hypochondriac pain, vomlting and weight loss and ulcers refractory to medical therapy.A bleeding ulcer gives rise to malena.


Question: As per 'rule of nine' each lower limb is

Each upper limb is 9% TBSA, Each lower limb 18%, (front 9%, Back 9%)Chest 18% (front 9%, Back 9%)Abdomen 18% (front 9%, Back 9%)The head and neck 9%Perineum 1%Ref: Bailey and love 27e pg: 621


Question: Clostridium difficile is responsible for


Question: S. aureus causes a wide variety of infections, ranging from wound infection to pneumonia. Treatment of S. aureus infection with penicillin is often complicated by the

Staphylococci are Gram-positive, non-sporeforming cocci. Clinically, their antibiotic resistance poses major problems. Many strains produce 13-lactamase (penicillinase), an enzyme that destroys penicillin by opening the lactam ring. Drug resistance, mediated by plasmids, may be transferred by transduction.

Inability of penicillin to penetrate the membrane of S. aureus

Production of penicillinase by S. aureus

Production of penicillin acetylase by S. aureus

Lack of penicillin binding sites on S. aureus


Question: Infection of Eyelash follicle is


Question: Most common tumor in the posterior mediastinum is

Most common tumour of posterior mediastinum is neurofibromas constituting 75% of the total.Others include ganglioneuromas,aneurysm of descending aoa,lymph node mass. Reference: SRB's manual of surgery,5th edition,page no:1126.


Question: Not a predisposing factor for Ca esophagus

OESOPHAGEAL CARCINOMA,6 th most common carcinoma in the world, can be predisposed to dietary deficiencies, human papillomavirus infections, achalasia cardia, oesophageal webs etc.it is most commonly seen in middle third of oesophagus (50%)and also at lower third(33%) and upper third(17%).in the lower pa adenocarcinoma is common .in India 90%are squamous carcinomas.dysphagia, regurgitation, anorexia, loss of weight, ascites, palpable left supraclavicular lymph nodes are the clinical features. Ref: SRB&;s manual of surgery,5th ed, pg no805


Question: Sterile pyuria is seen in

Many diseases in the urinary tract produce significant pyuria in the absence of bacteriuria . whereas TB is a well recognised example of sterile pyuria , stag horn calculi and stones of smaller size can produce intense pyuria with clumps of wbc in the absence of UTI . any injury to urinary tract ,from Chlamidial urethritis to glomerulonephritis and interstitial cystitis can elicit sterile pyuria ref : Campbell- Walsh urology pa3 , chapter 12 ,pg no 251


Question: Gold standard diagnostic test in varicose veins is


Question: Compensatory mechanisms during acute hemorrhage include

Acute hemorrhage triggers the potent vasopressor activity of both angiotensin and vasopressin to increase blood flow to the heart and brain via selective vasoconstriction of the skin, kidneys, and splanchnic organs. Adrenergic discharge also results in selective vasoconstriction of skin, renal, and splanchnic vessels. Myocardial contractility and heart rate are increased, with a resultant increased cardiac output. Hyperventilation is the typical response to the metabolic (lactic) acidosis associated with hemorrhagic shock and hypoperfusion. Aldosterone release, with subsequent increased renal sodium resorption, is mediated by angiotensin II and ACTH, which prevents further intravascular depletion.

Decreased cerebral and coronary blood flow


Question: A patient operated for thyroid surgery for a thyroid swelling, later in the evening developed difficulty in breathing. There was swelling in the neck. The immediate management would be

Haemorrhage is the most frequent life-threatening complication of thyroidectomy. Around 1 in 50 patients will develop a haematoma, and in almost all cases this will develop in the first 24 hours. If an aerial bleed occurs, the tension in the central compament pressure can rise until it exceeds venous pressure. Venous oedema of the larynx can then develop and cause airway obstruction leading to death. If a haematoma develops, clinical staff should know to remove skin sutures in order to release some pressure and seek senior advice immediately. Endotracheal intubation should be used to secure the airway while the haematoma is evacuated and the bleeding point controlled.Ref: Bailey and Love, page no: 815


Question: Most common site of traumatic aoic rupture is

Answer- A. Descending thoracic aoaThe proximal descending aoa, where the relatively mobile aoic arch can move against the fixed descending aoa (ligamentum aeriousm), is at greatest risk from the shearing forces of sudden deceleration. Thus the aoa is a greatest risk in frontalor side impacts, and falls from heights.


Question: Chronic Gastric Ulcers are much more common on the location of

(C) Incisura angularisGASTRIC ULCERS tend to be larger in comparison to Duodenal Ulcers.Fibrosis results rarely & shown as hourglass contraction of the stomach.Large chronic ulcers may erode posteriorly into the pancreas & erode major vessels such as the splenic artery.Less commonly erode into other organs such as the transverse colon.Chronic gastric ulcers are much more common on the lesser curve (especially at the incisura angularis)Chronic gastric ulcers are less common on the greater curve and, even when high on the lesser curve, they tend to be at the boundary between the acid-secreting and the non-acid-secreting epithelia.With atrophy of parietal cell mass, non-acid-secreting epithelium migrates up the lesser curvature.Major causative factor (60% of gastric & up to 50-75% of duodenal ulcers) is chronic inflammation due to Helicobacter pylori that colonizes the antral mucosa.Majority of Gastric ulcers can be attributed to either H. pylori infection or NSAID induced mucosal damage.Types of Gastric ulcer:Type I - located near the angularis incisura on the lesser curvature, close to the border between the antrum & the body of the stomach.These patients usually have normal or decreased acid secretion.Type II ulcer: Occurs in conjunction with active or healed duodenal ulcer disease.Type III: Prepyloric ulcerType IV ulcer: Gastro esophageal junction at the lesser curve.Type V ulcer: Anywhere in the stomach associated with chronic NSAID use or aspirin use.MOST COMMON SITE OF GASTROINTESTINAL TRACT LESIONS*. Most common site of Perforation of oesophagusOesopahgeal introitus*. Most common site of Oesopahgeal webProximal portion of oesophagus*. Most common site of Carcinoma oesophagusMiddle 1/3rd*. Dilatation of gut in Chaga's diseaseOesopahgus& Colon*. Congenital hour-glass stomachIncisura angularis*. Most common site of Gastric ulcers (95%)Incisura angularis of Lesser curvature*. Most common site of Duodenal ulcers (95%)Within 2 cm of pylorus (duodenal bulb)*. Most common site of Pulsion diverticulum of stomachGreater curvature & posterior fundus*. Carcinoma stomachPrepyloric region*. Carcinoma stomach associated with pernicious anaemiaFundal & polypoid*. Lymphoma (Non Hodgkins)Stomach (least common-Rectum)*. Haemangioma in internal organLiver*. ZES gastrinomaPancreas*. Intestinal rupture in blast injuryPelvic colon*. Crohn's diseaseTerminal Ileum*. Ulcerative colitisSigmoid colon*. Untreated amoebic liver abscess bursts intoRight lung*. Intestinal tuberculosisIleo-caecal region*. Typhoid ulcerSmall intestine (Longitudinal) *. Most common site of Perforation in TyphoidSmall intestine Ileocaecal junction*. Most common site of Meckel's diverticulumFrom the Ileum (60-90 cm from the Ileocaecal valve)*. Pneumatosis cystoidesSmall intestine*. Most common site of Diverticuiosis90% in Sigmoid (Rectum is never involved)*. Polypi in Puetz-Jeghers syndromeAlways jejunum is involved*. Adenomatous polypiSigmoid, Rectum*. Familial polyposis and Gardner's syndromeColon*. LipomaCaecum*. Carcinoma small intestineJejunum*. Most common site of Carcinoma colonsigmoid colon & Rectosigmoid junction*. Carcinoid tumoursAppendix (90%)*. Loop colostomyTransverse colon*. Acute intestinal obstructionIleum*. Intussusception with gangreneIleocaecal*. Intussusception in infantLast 50 cms of Ileum*. Most common site of Intussusception in adolescentThick of inverted Meckel's diverticulum*. Volvulus small intestineIleum*. Perforation in simple obstruction of colon (in absence of strangulation)Caecum*. Intraperitoneal abscessPelvis*. Most common site of Hirschsprung's diseaseUsually upper limit is Rectosigmoid junction


Question: In CA stomach, T4 lesion means

T1a Tumour involves lamina propria T1b Tumour involvessubmucosaT2 Tumour invades muscularis propriaT3 Tumour involves subserosa T4a Tumour perforates serosaT4b Tumour invades adjacent organsBailey and love 27e pg: 1135


Question: A 50 year old male presents with painupper abdomen, pruzitus, jaundice and weight loos, elevated ANA, the likely diagnosis is

.Primary sclerosing cholangitis is one wherein no cause is found and is associated with ulcerative colitis, Sjogren's syndrome, Crohn's disease, Grave's disease. It eventually leads to biliary cirrhosis. Primary sclerosing cholangitis (PSC) is an idiopathic, progressive, chronic, cholestatic pathology with diffuse inflammation, sclerosis, and obliteration of intra and extra hepatic biliary systems. There will be multiple areas of strictures and dilatations. It has high risk for cholangiocarcinoma. It could be an autoimmune disease. ref:SRB&;S manual of surgery,ed 5,pg no 590


Question: In transoral sialolithotomy of the submandibular duct, the incision for removal of an anterior sialolith should be placed


Question: Mammography is used for screening from

Ans. (c) 40 years(Ref Schwartz page 513/ 10th edition)* American Cancer Society (ACS) recommends screening from 40 years* Other many recommend - from 50 years. (But Sabiston 20th edition also recommends 40 years - so let us go with 40 years)


Question: Best vein for total parenteral nutrition is

Ans. a (Subclavian vein). (Ref. Baily and Love surgery 25th/pg. 231)TOTAL PARENTERAL NUTRITIONDefined as the intravenous provision of all nutritional requirements, without the use of GIT.Indications:# Proximal intestinal fistula# Inflammatory bowel disease# Massive intestinal resection (especially if <100 cm of small bowel remains)# Ileus# Pancreatitis (severe)Preferred vein:# Peripheral line (for short period < 2 weeks)# Central line (for long period)Central venous route is chosen more commonly, and the catheter should be inserted via either subclavian, internal/ external jugular vein should be avoided as it is associated with high incidence of infection and thrombosis. The catheter tip should be in distal SVC to minimize risk of central venous or cardiac thrombosis.Complications of TPN:Catheter relatedFeeding Regimen related# Arterial, venous injuries and cardiac perforation and thrombosis# Hyperglycemia# Hypoglycemia# Brachial plexus and stellate ganglion injury# Hypertriglyceridemia# Pneumothorax# Hyperchloremic acidosis# Thoracic duct injury# Electrolyte imbalance# Air embolism# Trace element and vitamin deficiency# Catheter related infections # Catheter migration/embolus # Thrombotic catheter occlusion # SABE


Question: Hangman's fracture is

B Fracture dislocation of C2 Hangman's fracture is traumatic spondylolisthesis of axis (C2) veebrae on C3Q due to fracture line passing through the neural arch (pedicle/ pars interaicularis)Q


Question: A bicyclist suddenly applies brake and lands on his perineum on the cross bar of the bicycle on an attempt to urinate he develops marked swelling of scrotum. The structure most probably injured is

A bicyclist directly lands on his perineum leading to spongy urethrs / Bulbar urethral injury.


Question: The 'decisive period' in preventing wound infections is

There is up to a 4-hour interval before bacterial growth becomes established enough to cause an infection after a breach in the tissues, whether caused by trauma or surgery. This interval is called the 'decisive period' and strategies aimed at preventing infection from taking a hold become ineffective after this time period.It is therefore logical that prophylactic antibiotics should be given to cover this periodRef: Bailey and Love 27e pg: 46


Question: Concentration of sodium in Ringer lactate in (meq/L) is

Concentration of sodium in Ringer lactate is 130meq/L
Concentration of sodium in Normal saline is 154meq/L


Question: Urinary retention in child is most commonly caused by

(A) Metal scab with ulceration # Acute urinary retention in a male child may be due to local inflammatory causes like meatal ulcer with scabbing.> Etiology of Urinary Retention in Children: Neurological processes Severe voiding dysfunction UTI Constipation Adverse drug effect Local inflammatory causes Locally invading neoplasms Benign obstructing lesions Idiopathic Combined UTI and Constipation Incarcerated Inguinal Hernia.


Question: WRONG pair among the following

(C) H. pylori-Hypergastrenemia # H. pylori infection is associated with increased levels of HCL not Gastrin.> Carcinoid tumours, Proton pump inhibitors, gastrinoma increase gastrin levels.

Zollinger-Ellison syndrome - Increased HC1


Question: The most common benign tumor of the lung is

The most common benign lung tumor is a hamaoma,a developmental abnormality containing mesothelial & endothelial elements.Diagnosis is achieved by excision of the lesion. Reference:Bailey & Love's sho practise of surgery,25th edition,page no:891


Question: Commonest site of carcinoma tongue

Most common site is middle of the lateral border or the ventral aspect of the tongue.


Question: "Lucid Interval" is associated with

(A) Extradural hematoma # In about 50% of the cases of head injury, there is an initial recovery from the symptoms of concussion & this is followed, after a variable period as mentioned above, by unconsciousness, the sequence being as follows: unconsciousness due to concussion # consciousness due to recovery # unconsciousness due to raised intracranial tension.> The state of consciousness between the two states of unconsciousness in known as the lucid interval.> In these cases, the apparent recovery & the interval between the infliction of injury and the onset of symptoms frequently leads to the defence that the blow was not the cause of death.> Alternatively, this period may cover some further volitional activity which may mislead lay persons as to the actual cause of haemorrhage.> In emergency medicine, a lucid interval is a temporary improvement in a patient's condition after a traumatic brain injury, after which the condition deteriorates.> A lucid interval is especially indicative of an epidural hematoma.> An estimated 20 to 50% of patients with epidural hematoma experience such a lucid interval.


Question: The most common site of fracture neck of femur that causes avascular necrosis is

A i.e. Subcapital Malunion is rarest complication of fracture neck femur (almost not seen) because intracapsular fracture neck femur almost never unite unless thay are anatomically reduced and stabliy fixed. Most common complications of intracapsular fracture neck femur are nonunioin & fixation failure (more common in most series of displaced fractures) and avascular necrosis (more common in most series of undisplaced fractures). Shoening is seen in almost all cases of nonunion & AVN. Chances of avascular necrosis (AVN) and nonunion increases as the fracture site becomes more proximal Q. The more proximal the fracture located the worse the prognosis. Chances of AVN & nonunion (or worseness of prognosis) in decreasing order is Subcapital Q > transcervical > basal > interochanteric Transphyseal > transcervical > cervicotrochanteric > interochanteric (in children) Complications of Hip Fractures Intracapsular Fracture Neck Femur Extracapsular Fracture Interochanteric Femur Most - Non union (in MalunionQ common displaced fracture) - Avascular (Osteo) necrosis (in undisplaced fracture) Least common MalunionQ NonunionQ Nonunion is second most common complication (after avascular necrosis) of undisplaced fracture neck femurQ. The probable causes of nonunion in fracture neck femur are - - Cambium layer of periosteum which produce callus is missing. There fore femoral neck must heal direct endosteal healing only. There is no contact with soft tissues which could promote callus formation. Precarious blood supply: by tearing the ascending cervical branches or retinacular vessels the injury deprives head of its main blood supplyQ. Synol fluid interfere with fracture healing as it prevents clotting of fracture hematoma and release angiogenic inhibiting factors. - Inadequate reduction and improper immobilization. * It is impoant to note that avascular necrosis and nonunion are independent events, because AVN is based on vascular supply of femoral head, whereas nonunion is based on the healing process. So AVN can occur even in united fractures. * Femoral neck fractures should unite by 6 months. If there is no evidence of healing or patient continued to have pain at 3 - 6 months after surgery then a delayed (3 months) or non union ( 6 months) should be contemplated. * AVN is a late complication and ischemic collapse usually occur with in 2 -years of fracture. According to anatomical location of fracture neck femur the chances of AVN & nonunion in decreasing order are: subcapital (transepiphyseal in children) > TranscervicalQ > Basicervical. - Temponade effect of intracapsular hematoma causing floating of both fracture ends and making reduction difficult.


Question: The most impoant prognostic factor in breast carcinoma is

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

Stage of the tumor at the time of diagnosis

Status of estrogen and progesterone receptors

Over expression of p-53 tumour suppressor gene


Question: In a ulcer over skin if there is undermined edges it suggests

Flat sloping venous or septic, often with a transparent healing edge along pa of its circumference. Punched-out syphilitic, trophic, diabetic, ischaemic, leprosy. Undermined tuberculosis, pressure necrosis paicularly over the buttocks, carbuncles. Raised rodent ulcer , often with a slightlyrolled appearance. Raised and eveed carcinoma Hamilton bailey 19th edition Pg 64


Question:
Treatment of papillary carcinoma thyroid with level VI lymph
node metastasis is

IF level VI is affected then CND is done. If any other LN is involved then modified radical neck dissection is preferred.

Total thyroidectomy + central neck dissection

Total thyroidectomy + radioiodine ablation

Total thyroidectomy + radical neck dissection


Question: Cystic compressible, translucent swelling in the posterior triangle of neck


Question: A 88 years male patients presented with end stage renal disease with coronary aery block and metastasis in the lungs. Now presents with acute cholecystitis, patients relatives needs treatments to do something

.In open cholecystectomy - After the removal of gall bladder, on table cholangiogram is done through cystic duct using water soluble iodine dye to see any stones in CBD. Using stay sutures choledochotomy is done (opened longitudinally) to remove stones in CBD. After choledochotomy, stones are removed using Des jardin's choledocholithotomy forceps. Bake's CBD dilator is used to confirm the CBD patency. - T-tube (Kehr's) is then placed in the CBD and kept for 14 days. - After 14 days a post-operative T-tube cholangiogram is done to see for free flow of dye into the duodenum, so that T-tube can be removed. ref : SRB&;s manual of surgery,3 rd ed,pg no 584

Antibiotics then elective cholecystectomy


Question: Commonly undergoing malignant transformation is/are

.FAMILIAL ADENOMATOUS POLYP (FAP) is inherited as an autosomal dominant neoplastic condition (chromosome no. 5). * It presents in younger age group--15-20 years. * Incidence is equal in both sex, involving commonly the large intestine but can also occur in stomach, duodenum and small intestine. * It is familial with a high potential for malignant transformation. If there is no adenoma at the age of 30 years, then it is not FAP of colon. * It can be associated with duodenal or ampullary carcinomas , Gardner's syndrome (Desmoid tumour in the abdomen, osteomas (75%) and epidermoid cysts) and also Turcot"s syndrome (FAP + brain tumour (medulloblastoma or gliomas)) or sarcoma of bone. * Usually multiple (over 100). * Presents with lower abdominal pain, loose stools with blood and mucus, weight loss. ref:SRB&;s manual of surgery,ed 3,pg no 838


Question: Diagnosis of traumatic rupture of diaphragma) Laparoscopyb) Chest X rayc) Diagnostic peritoneal lavaged) IPPV

• Diaphragmatic injuries are often caused by penetrating injuries.
• Patients sustaining penetrating injuries below the nipples and above the costal margins should be investigated to rule out diaphragmatic injury.
Etiology
• Penetrating trauma (knife, bullet, repair of hiatus hernia)
• Blunt trauma (motor vehicle accident, fall from height, bout of hyperemesis):
−− Caused by compressive force applied to the pelvis and abdomen.
−− Rupture is usually large, with herniation of abdominal content into chest
Clinical Features
• Most diaphragmatic injuries are silent and the presenting features are those of injury to the surrounding organs.
• Late complication: Herniation of abdominal contents in to the chest.
• Herniation of organ: Stomach >Colon >Small intestine >Omentum >Spleen >Kidney and pancreas.
Diagnosis
• There is no single standard investigation to diagnose diaphragmatic injuries.
• Chest X-ray after placement of a nasogastric tube may be helpful (as this may show the stomach herniated into the chest)
• Contrast study of upper or lower GIT, CT scan and diagnostic peritoneal lavage all lack positive or negative predictive value.
• Most accurate evaluation is by video assisted thracoscopy (VATS) or laparoscopy, offering the advantage of allowing the surgeon to proceed to repair and additional evaluation of the abdominal organs.
Treatment
• Operative repair is recommended in all cases.
• All penetrating diaphragmatic injury must be repaired via the abdomen and not the chest, to rule out penetrating hollow viscus injury.
Bergvist Triad: Rib fracture + Fracture of spine /pelvis + Traumatic rupture of diaphragm


Question: Head shaking test is done to diagnose

Position of root in relation to maxillary antrum


Question: May thurner or cockett syndrome involves

May-Thurner syndrome -- also called iliocaval compression syndrome and Cockett syndrome or iliac vein compression syndrome -- occurs secondary to compression of the left iliac vein by the overriding right iliac aery.The sustained compression and trauma caused by the pulsatile force of the aery on the vein damage the intima and lead to the formation of membranes or bands in the vascular lumen that hinder or obstruct the flow of blood in the vein, oring thrombus formation. The current treatment strategy of choice is endovascular vein patch angioplasty and stenting with the aim of improving the caliber of the lumen and enabling normal venous drainage


Question: Needle aspiration of a central bone lesion is useful


Question: A blood stained discharge from the nipple indicates one of the following

Discharge can occur from one or more lactiferous ducts.Discharge can be: * clear, serous - fibrocystic disease,duct ectasia,carcinoma. * blood stained - carcinoma,duct papilloma,duct ectasia. * black or green -duct ectasia. Blood stained discharge is seen in duct papilloma. Bailey and Love'sSho practice of surgery.Edition 23.Pg no:753


Question: Most common organism causing peritonitis is

Most common cause of Peritonitis is E.coli 2nd most common cause is Klebsiella.


Question: A deviation of mandible to right side may suggest


Question: A patient Came with Necrotising cellulitis after a hug bite on leg. The ideal initial management is

(D) Surgical exploration # Necrotizing fasciitis is a rapidly progressing bacterial infection of the soft tissue that destroys the subcutaneous fat and fascia. In most cases, the deep fascia and the muscle are spared from destruction by the infection, but myonecrosis can occur due to a compartment syndrome.> Many different bacteria can cause destruction of the soft tissue in a "flesh-eating" manner.> Proper diagnosis is critical in the treatment of necrotizing fasciitis, and in many cases, it is the major factor between life & death> One major clue that a soft-tissue infection is in fact necrotizing fasciitis is the failure of the infection to respond to antibiotic therapy within 24 to 48 hours.> Plain radiographs showing evidence of gas in the soft tissue is another key indicator, along with elevated muscle compartment pressure.> 5 A positive frozen-section biopsy specimen will also aid in proper diagnosis.> Once the diagnosis of necrotizing fasciitis is made, immediate debridement of necrotic tissue is called for. It is very common for a patient to undergo more than one debridement to make sure all of the necrotic tissue has been removed.> At the same time, aggressive antibiotic therapy with clindamycin should be started.> Wound should be examined daily, and the decision of whether or not to perform further debridement should be made> Amputation of an entire limb is sometimes performed, but this is only done as a life-saving measure.> Surgical debridement of the necrotic tissue is an essential part of the treatment of a necrotizing soft-tissue infection


Question: Van Nuys grading is used for

Van Nuy's prognostic index score(VNPI) is used for Ductal Carcinoma In Situ. For calculating VNPI score we consider Size in mm, Clearance margin in mm, Grade and necrosis, Age in years and each has score according to a definite criteria. All the scores are added together. 1)If points are 4-6 = % of local recurrence is 1%, 5 year survival is 97-99%, Risk is low 2) if points are 7-9, then % of local recurrence is 20%, 5 year survival is 73-84%, Risk is intermediate 3) if the points are 10-12, then % of local recurrence is 50%, 5 year survival is 34-51%, and Risk is High. Reference : SRB's Manual of Surgery, 6th Edition, page no = 524.


Question: The most common nerve involvement is dislocation of Lunate is


Question: Nicoladini's Branham sign is seen in

Nicoladini's Branham sign is seen in arteriovenous fistula, wherein compression proximal to AV - fistula results in bradycardia.


Question: In a patient of syncope the pupils are


Question: Stage I seminoma testis, t/t of choice is

Ans. is 'b' i.e. high inguinal orchidectomy & radiotherapy Testicular Cancer - is mainly of two types - Germ cell tumors (GCT) 95% - Non germinal neoplasms -- 5% (includes leydig cells, seoli cells, gonadoblastoma) Germ cell tumors are of 2 types Seminomas (More common, better prognosis) Nonseminomas i.e. - Embryonal Ca Teratoma Choriocarcinoma Yalk sac (Endodermal sinus) Carcinoma Germ Cell Tumor Staging and Treatment Treatment Stage Extent of Disease Seminoma Nonseminoma IA Testis only, no vascular/ lymphatic invasion (TI) Radiation therapy RPLND or observation IB Testis only, with vascular/ lymphatic invasion (T2), or extension through tunica albuginea (T2), or involvement of spermatic cord (T3) or scrotum (T4) Radiation therapy RPLND HA Nodes <2 cm Radiation therapy RPLND or chemotherapy often followed by RPLND BE Nodes 2-5 cm Radiation therapy RPLND +/- adjuvant chemotherapy or chemotherapy followed by RPLND IIC Nodes >5 cm Chemotherapy Chemotherapy, often followed by RPLND III Distant metastases Chemotherapy Chemotherapy, often followed by surgery (biopsy or resection) RPLND : retroperitoneal lymph node dissection Extra gonadal Germ cell tumors --> Infrequently GCTs arise from an extra gonadal site. They have poor prognosis. They are treated by chemotherapy.


Question: Trismus during block anesthesia is as a result of


Question: The narrowest part of the ureter is at the


Question: Malignant ulcer is differentiated from benign by


Question: Most common site of peripheral aneurysm

. Among peripheral aneurysm popliteal type is the most common one.peripheral aneurysms occurs in descending order of frrequency in popliteal,femoral,subclan,axillary,and carotid aeries. Refer page no 201 of SRB's manual of surgery 5th edition.


Question: Flap that is most commonly used in breast reconstruction

Ans. (b) TRAM(Ref: Bailey and Love 26th edition Page 817)* TRAM flap based on Superior Epigastric vessels is the MC used flap for breast reconstruction


Question: Used in head injury

(C) Hypertonic saline # Initial management of HEAD INJURY:> Unconscious patients should be intubated and ventilated to maintain Po2 over 13.5 kPa and PCO2at 4.5-5.0 kPa.> Systemic blood pressure must be maintained normal or above normal to allow for good neurological outcome, initially by fluid resuscitation.> Glucose-containing solutions should be avoided.> Blood loss from other injuries should be replaced by blood products as usually.> Hypertonic saline solution (7.5%) may improve outcome in patients with multiple trauma because of its effect on ICP.> Extracranial injuries that threaten life should be treated before definitive neurosurgical treatment, but otherwise simply stabilized beforehand.


Question: The microscopic feature that differentiates a follicular carcinoma from a follicular adenoma is

Follicular carcinoma can normally only be differentiated from follicular adenoma by the architecture of histology.Histologic diagnosis of FTC depends on the demonstration of follicular cells occupying abnormal positions, including capsular or vascular invasion. The cells may not demonstrate nuclear atypia; however, when present, marked nuclear atypia is associated with a worse prognosis.Ref: Sabiston 20e, page no: 927


Question: Inverted "3" sign seen in


Question: Ablett classification is used for grading

Ablett classification grades severity of tetanus.


Question: Sialolithiasis is most commonly seen in


Question: Acinic cell tumor is tumor of

Ans. a (Parotid tumor). (Ref. LB, 25th/pg. 756)Salivary gland tumor TypeSubgroup1AdenomaPleomorphic (80-90%), Warthin's tumor, Adenolymphoma2CarcinomaAcinic cell carcinoma (LG-low grade), Adenoid cystic carcinoma (LG),Mucoepidermoid (LG and HG), Adenocarcinoma (HG), Squamous cell carcinoma (HG)3Non epithelial tumorsHemangioma, Lymphangioma4LymphomaPrimary, Secondary5SecondariesLocal, Distant (skin and bronchus)6Tumor like lesionsAdenomatoid hyperplasia, Benign lymphoepithelial lesion, Salivary gland cysts


Question: REPEAT QUESTION. Renal Calculi associated with proteus infection

Triple phosphate or struvite ( Calcium phosphate with ammonium magnesium phosphate ) is smooth and diy white. It grows in alkaline urine. Proteus being urea splitting organism splits urea to give ammonia and co2 whixh makes urine alkaline and promotes stag horn calculus ref : - Bailey and Love 27th edition ,chapter 76 , pg no 1406


Question: Following is an upper GI contrast study. Probable diagnosis is

Single contrast study from the same patient showing the apple core appearance of the stomach due to the invasive gastric adenocarcinoma.Upper gastrointestinal radiology is not used as much as in previous years, as endoscopy is a more sensitive investigation for most gastric problems.Endoscopy is regarded as the most sensitive and specific diagnostic method in patients suspected of harbouring gastric cancer. Endoscopy allows direct visualisation of tumour location, the extent of mucosal involvement, and biopsy (or cytologic brushings) for tissue diagnosisBailey and love 27e 1111


Question: Bilateral spider leg appearance of kidney in IVP is seen in


Question: Degloving injury is overlsion injury involving

Degloving injury is avulsion injury involving skin and subcutaneous tissuewith intact fascia.

Skin and subcutaneous tissue, with intact fascia

Skin and subcutaneous tissue along with  fascia


Question: Commonest site of peptic ulcer is

Common sites for peptic ulcers are the first pa of the duodenum and the lesser curve of the stomach, but they also occur on the stoma following gastric surgery, the oesophagus and even in a Meckel's diveiculum, which contains ectopic gastric epithelium.Bailey and love pg: 1116


Question: Cleft lip repair minimum age to repair

Ans. (a) 6 monthsRef: Bailey and Love 26th edition. Page 638Timing of surgery of each type of Cleft is given by Delaire sequence:* Unilateral cleft lip alone - One operation at 5-6 months* Bilateral cleft lip - One operation at 4-5 months* Soft palate only - One operation at 6 months* Soft and Hard Palate Only - as Two operations (Soft palate at 6 months and Hard palate at 15-18 months)* Combined Cleft lip and Palate (Unilateral or Bilateral): Two operations (Cleft lip and Soft palate at 5-6 months. Hard Palate at 15-18 months)


Question: Duputryens contracture is associated with

Duputryens contracture - Plamar fibromatosis is seen in Peyronie's disease.


Question: For Thyroglossal Cyst Most Common site is

Although Thyroglossal Duct cysts may occur anywhere from the Base of the tongue to the thyroid gland , most are found at or just below the hyoid bone. Source : Sabiston 20th edition Pg : 1862


Question: Type of renal stone formed in a patient with regional enteritis

Ans. (a) Calcium oxalate* Calcium oxalate kidney stones are most common in CD.* Cholesterol type gallstones are also most common in CD.


Question: Prepyloric or channel ulcer in the stomach is termed as

Type 1- in the antrum, near the lesser curvature, type 2: combined gastric ulcer (in the body ) with duodenal ulcer, type 3. Prepyloric, type 4 gastric ulcer in the proximal stomach of the cardia type 5- ulcer anywhere associated with NSAIDs. SRB edition 5 page no. 824


Question: Most common site of carcinoma of stomach is

60 %of all malignancies occurring in the oesophagus and stomach occur in proximity to the oesophagogastric junction. Because the lower oesophagus is a very common site for adenocarcinoma it is aificial to separate stomach from oesophagus. Bailey and love 26 th ed pg 1046


Question: Management of grade 3 splenic trauma in a stale child

Splenic organ injury scale Grade I- Nonexpanding subcapsular haematoma <10% surface area. Non-bleeding capsular laceration with <1 cm depth Grade II- Nonexpanding subcapsular haematoma 10-50% surface area. Nonexpanding intraparenchymal haematoma <2 cm Grade III- Expanding subcapsular or intraparenchymal haematoma. Bleeding subcapsular haematoma or subcapsular haematoma > 50% area or intraparenchymal haematoma >2 cm or parenchymal laceration >3 cm depth Grade IV- Ruptured intraparenchymal haematoma with active bleed; laceration involving segmental or hilar vessels with > 25% devascularisation Grade V- Shattered or avulsed spleen; hilar disconnection with entire spleen devascularisation. Clinically close observation, serial haematocrit evaluation, serial CT abdomen/U/S abdomen at regular intervals to assess the progress or regress of the bleeding spleen has to be done. * Absolute bed rest, sedation, antibiotic coverage and proper monitoring are needed. * It is often suppoed by angiographic embolisation to improve the splenic salvage rate. But it may cause pain, splenic abscess or infarction. * Indications for non-operative treatment - Only splenic injury - no other associated injuries.grade 1,2, and 3. Ref: SRB&;s manual of surgery,3 rd ed, pg no;603


Question: Delorme's operation is for

Ans. B. Rectal prolapse. (Ref. LB 25th pg. 1225)RECTALPROPLASE# It may be mucosal or full thickness (whole wall included).# Commences as rectal intussusception.# In children, the prolapse is usually mucosal an should be Rxed conservatively.# In the adults, the prolapse is often full thickness and is frequently asociated with incontinence.# Surgery is necessary for full-thickness reactla prolpase.# The operation is performed either via perineum (Thiersch operation, Delorme's operation, &/or Altemeier operation) or via the abdomen (Well's operation, Ripstein's operation, or laparosocpic approach).Rx of RECTAL PROPLASE:# An abdominal rectopexy has a lower rate of recurrence but, when the patient is elderly and very frail, a perineal operation is indicated. As an abdominal procedure risks damage to the pelvic autonomic nerves, resulting in possible sexual dysfunction, a perineal approach is also usually preferred in young men.A. Perineal approach -These procedures have been used most commonly.# Thiersch operation- This procedure, which aimed to place a steel wire or, more commonly, a silastic or nylon suture around the anal canal, has become obsolete as the suture would often break or cause chronic perineal sepsis, or both, or the anal stenosis so created would produce severe functional problems. Delorme's operation is now the preferred perineal operation.# Delorme's operation- In this procedure, the rectal mucosa is removed circumferentially from the prolapsed rectum over its length. The underlying muscle is then plicated with a series of sutures, such that, when these are tied, the rectal muscle is concertinaed towards the anal canal. The anal canal mucosa is then sutured circumferentially to the rectal mucosa remaining at the tip of the prolapse. The prolapse is reduced, and a ring of muscle is created above the anal canal, which prevents recurrence.# Altemeier's procedure- This consists of excision of the prolapsed rectum and associated sigmoid colon from below, and construction of a coloanal anastomosis.B. Abdominal approach# The principle of all abdominal operations for rectal prolapse is to replace and hold the rectum in its proper position. They are recommended in patients with complete prolapse who are otherwise in good health.# Many variations have been described: in Wells' operation, the rectum is fixed firmly to the sacrum by inserting a sheet of polypropylene mesh between them; Ripstein's operation involves hitching up the rectosigmoid junction by a Teflon sling to the front of the sacrum; many surgeons simply suture the mobilised rectum to the sacrum using four to six interrupted non-absorbable sutures - so called sutured rectopexy. Recently, the technique has been performed laparoscopically.


Question: Indication of surgery in benign hyperplasia of prostate is

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


Question: Following nutritional consequences are possible following peptic ulcer surgeries other than vagotomy

.COMPLICATIONS OF GASTRIC SURGERY * Haemorrhage. * Stomal obstruction. * Biliary fistula. * Injury to CBD. * Duodenal blow out--on 4th postoperative day. * Pancreatitis.* Recurrent ulcer stomal ulcer. * Gastrojejunocolic fistula. * Dumping syndrome (Postcibal syndrome). * Nutritional disturbances, diarrhoea. * Pulmonary tuberculosis. * Carcinoma in gastric remnant (after 10-15 years). * Gallstone formation. * Alkaline gastritis. * Afferent and efferent loop syndrome. * Afferent loop obstruction--common. * Efferent loop obstruction. Nutritional deficiencies following gastrectomy Iron deficiency anaemia 40% * Megaloblastic anaemia (after 5 years) 25% (100mg B12 is given IM weekly, later monthly) *Vit. B deficiency 10% *Calcium deficiency 40% *Calcium deficiency with bone changes (after 5 years) 5% ref:SRB&;s manual of surgery,ed 3,pg no 770


Question: Benign prostatic hyperplasia first develops in the

Benign prostatic hyperplasia arises from submucosal glands of periurethral transitional zone with stromal proliferation and adenosis forming a nodular enlargement. It eventually compresses the peripheral zone glands into a false capsule and causes the appearance of typical 'lateral' lobes. Reference : page1345 Bailey and Love's sho practice of surgery 25th edition


Question: If during blood transfusion reaction develops in the form of incompatibility, the first thing to be done is

Inj Chlorpheneramine maleate to be given


Question: Peutz Jeghers polyps present most commonly in

.PEUTZ-JEGHER'S POLYP is common in small intestine (jejunum) but can also occur in large intestine. * Features are multiple, familial, hamaomatous intestinal polyps. * Asssociated with melaenosis of the oral mucosa, lips (lower lip) and occasionally digits (not in tongue). * Microscopically it contains tree like branching filaments of mucosa with smooth muscle wall. * It can occasionally turn into malignancy ref:SRB&;s manual of surgery,ed 3,pg no 831


Question: Giacomini vein is

Giacomini vein is posterior thigh extension of short saphenous vein.


Question: Mirrizi syndrome

Answer- B. Stone in cystic duct compressing CBDIt comprises obstructive jaundice due to stone impacted in the neck of gall bladder, which compresses the common hepatic duct and eventually ulcerates into common hepatic duct causing cholecysto-choledochal fistula


Question: Treatment of congenital hydrocele is

Congenital hydrocele is due to patent processus vaginalis.
Herniotomy is the option. Infantile hydrocele is treated by excision of sac followed by eversion.


Question: Expansile lytic osseous metastases are characteristic of primary malignancy of


Question: Best prognosis in carcinoma of pancreas in the region of

Periampullary carcinoma AAdenocarcinoma of head of the pancreas (40-60%) Adenocarcinoma of ampulla of vater (10-20%) Distal Bile duct adenocarcinoma (10%) Duodenal adenocarcinoma (5-10%) Patients with pancreas adenocarcinoma involving the body or tail of the gland are more likely to have weight loss and abdominal pain as their initial complaints These lesions can grow to a larger size before producing symptoms and are often diagnosed at a later stage with a poorer prognosis Most body and tail cancers have already metastasized to distant sites or extended locally to involve nodes, nerves, or major vessels by the time of diagnosis. Best prognosis : Duodenal adenocarcinoma > Ampullary carcinoma > Distal Bile duct adenocarcinoma > Head of pancreas > Body and tail of pancreas Ref: Shackelford 7th edition Pgno : 1187-1206


Question: A young man gets into a fight after taking bear and is kicked in the lower abdomen. There was pelvic fracture, blood at meatus. Most likely cause is

Ans. is 'a' i.e., Rupture of membranous urethra


Question: Clostridial organism are

The genus Clostridium consists of Gram-positive, anaerobic and spore forming bacilli.Eg: C.tetani, C.perfringens, C.difficile,C.botulinum etc. These are responsible for tetanus, gas gangrene and food poisoning. Reference : page 251 Ananthanarayan and Panicker's Textbook of Microbiology 9th edition.


Question: Most of the incidentalomas are

An incidentaloma is an adrenal mass, detected incidentally by imaging studies conducted for other reasons, not known previously to have been present or causing symptomsMore than 75% are non-functioning adenomas but Cushing's adenomas, phaeochromocytomas, metastases, adrenocoical carcinomas and Conn's tumours can all be found this wayRef: Bailey and Love 27e pg: 839


Question: Incidence of absent of kidney is

(1500) (1305-LB) (1286-B & L 25th)* An absent or grossly atrophic kidney is found in about 1:1400 individuals (1305-LB)* Renal ectopia - In approximately 1:1000 people, the kidney does not ascend, ectopic kidneys are usually found near the pelvic brim (1306-LB)


Question: In a shock patient, good clinical indicator of perfusion status among the following is

Urine output is a good measure of organ perfusion and the best monitor of the adequacy of shock therapy. However, this is an hourly measure and does not give a minute-to-minute view of the shocked state. The level of consciousness is an impoant marker of cerebral perfusion, but brain perfusion is maintained until the very late stages of shock, and hence is a poor marker of adequacy of resuscitation.Currently, the only clinical indicators of perfusion of the gastrointestinal tract and muscular beds are the global measures of lactic acidosis (lactate and base deficit) and the mixed venous oxygen saturation. There is no 'normal' central venous pressure (CVP) for a shocked patient, and reliance cannot be placed on an individual pressure measurement to assess volume status. Some patients may require a CVP of 5 cmH2O, whereas some may require a CVP of 15 cmH2O or higher.Bailey and love 27e pg: 16


Question: Dacron Graft

Vascular graft Bioprosthetic Autograft Homograft (Allograft) Heterograft (Xenograft) Tissue engineered Synthetic Textile - Dacron Non-textile - ePTFE, polyurethane Dacron graft Woven Threads are interlaced in a simple over and under pattern both in lengthwise & circumferential directions Less porous, used where bleeding is a risk (thoracic Aoic aneurysmal surgery) Stiff & diffucult to handle, display more fraying of cut edges Knitted Yarns are looped around each other Yarn is oriented Predominantly in longitudinal or circumferential direction More stable, can be easily incised & resutured More porous than woven grafts, require preclotting prior to use Ref: Sabiston 20th edition Pgno :234


Question: The thickness of split thickness skin graft used in maxitlofacial surgery ranges from


Question: Investigation of choice in DVT is

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


Question: "Chocolate sauce' colour fluid seen in

A. i.e. (Amoebic liver abscess) (885 - S. Das 5th) (49 -B & L 25th)"Chocolate sauce or anchovy sauce" colour of pus- seen in Amoebic liver disease* Amoebic abscess are most common high in the diaphragmatic surface of the right lobe, solitary* It may burst into (a) right pleural cavity (b) right lung (c) peritoneal cavity* First symptoms are usually malaise and fatigue* USG or CT scans are the most useful diagnostic tests* Treatment mainly drug therapy* Surgical treatment Multiple loculated collection or when abscess cavity contains a large amount of necrotic debries* Amoeboma - most commonly seen in caecum*** CT scan is the best imaging modality in Hydatid disease - the diagnostic feature is a space - occupying lesion with a smooth out line with septa* Auxiliary orthotopic liver transplant is indicated for Acute fulminant liver failure for any cause*** Pingle maneuver is a means to stop bleeding from - Liver and cystic artery


Question: Golden hour is

The concept of the ‘golden hour’ describes the urgent need for treatment of trauma victims within the first hour after injury.


Question: Treatment of choice for stone in Submandibular duct compressing distal to Lingual nerve is

Distal Stones are removed by intraoral method.
Proximal stones are removed by submandibular excision.


Question: First line of treatment for keloid is

First line of management for keloid is intra keloidal injection of Triam cinolone acetate.


Question: Constricting type of colonic carcinoma is seen in

Ans. a (Left colon). (Ref. Bailey and Love, 25,h/pg. 1179)Carcinoma ColonSiteClinical presentationCarcinoma of the left side of the colon- Most tumours occur in this location. They are usually of the stenosing variety. Left-sided tumours: rectal bleeding, alteration in bowel habit, tenesmus, obstruction.- The main symptoms are those of increasing intestinal obstruction.- Alteration of bowel habit. An adult previously having a predictably regula bowel habit suddenly develops irregularity.- The episodes of constipation may be followed by attacks of diarrhoea.- Distension. Lower abdominal distension is not uncommon and, as with the pain, is relieved by passing flatus.Carcinoma of the sigmoid- This follows the general pattern of the above, with these differences:- Pain is usually colicky from the outset.- Tenesmus. Low tumours may give rise to a feeling of the need for evacuation, which may result in tenesmus accompanied by the passage of mucus and blood, especially in the early morning.- Bladder symptoms are not unusual and in some instances may herald a colovesical fistula.Right-sided tumours- iron deficiency anaemia, abdominal mass are presenting features.Carcinoma of the transverse colon- This may be mistaken for a carcinoma of the stomach because of the position of the tumour together with anaemia and lassitude.Carcinoma of the caecum and ascending colon* Anaemia, severe and unyielding to treatment; there may be a palpable tumour present.* The presence of a mass in the right iliac fossa. Colonoscopy may be needed to confirm the diagnosis.* Caecal carcinoma is sometimes discovered unexpectedly at operation for acute appendicitis or for an appendix abscess failing to resolve. On rare occasions the appendix is inflamed, or even gangrenous, from the obstruction to its lumen by the tumour.* A carcinoma of the caecum can be the apex of an intussusception presenting with the symptoms of intermittent obstruction.


Question: A traumatic wound was cleaned and dressed. A few days later suturing was done to approximate the edges. This type of wound healing is

Primary intention healing happens when wound edges are approximated by sutures, staples..etc The delayed primary intention is when this approximation is delayed, as it might be necessary for contaminated or untidy wounds. Also called teiary intention.Secondary intention occurs in wounds that are left open and allowed to heal by granulation, contraction and epithelialisationBailey and love 27e pg:26


Question: Treatment of choice in cold nodule of thyroid


Question: Bone apposition is best in

D i.e. Osteoblastic activiting in hocoship's lacunae * Since bone itself is a hard and unyielding structure, it can only increase in size by the relatively slow process of appositional growth.* The concept that bone remodelling takes place in small coherent packets of resorption (Howships lacuna in trabecular bone or cutting cone in coical bone) followed by formation is very impoant* In adult skeleton after cessation of skeleton growth, no new lamellar bone formation occurs with out a preceding episod of bone resorption. This constraint applies with in the coex, where the physical lack of space for new bone necessitates preceding resorption, and it also seems to apply to periosteal and endosteal sutfaces(2 * There is, however, debate as to whether periosteal accretion can occur in adults without preceding bone resorption. There are two definte, pathological exceptions to this rule. One is- during the production of callus in a healing fractured where woven bone will form de novo.- after cancllous autograft, where new bone will form directly on to the cancellous graft.* However, the contribution of these circumstances to overall bone homeostasis is likely to be very small.* The total body rate of resorption (is the product of) = number of new cavities eroded in a defined time period Xaverage volume of each cavity. Since the amount of bone eroded in each resorption cavity is constant (roughly), the rate of activation (i.e. rate at which new osteoclastic erosion cavities are begun) determines the total body bone resorption, as well as the rate of total body bone resorption, as well as the rate of total body bone formation.

Osteoblastic activity at the area of stress

Osteoblastic activity in howship's lacunae


Question: The most common site of enlargement of the lymph nodes in Hodgkin's lymphoma is

In about 50% of patients who have both Hodgkin's and non-Hodgkin's lymphoma, the mediastinum may be the primary site." Ref : Schwaz 9/e p575


Question: Cock&;s peculiar tumor is

.cocks peculiar tumour is actually a complication of sebaceous cyst when sebaceous cyst ulcerates excessive granulation tissue forms resembling fungating epithelioma and this iscalled cock&;s peculiar tumour


Question: Halstaed's mastectomy is

Ans. (c) Radical Mastectomy(Ref Internet Sources)Halstaed Radical mastectomy is historical.* It involves removal of Entire breast, Nipple and areola with tumor* Also removes all level 1,2,3 nodes* Muscles like Pectoralis major, Serratus Anterior are also removed.* It's a very high morbid procedure and hence not done now a days after the wide usage of chemotherapy and radiotherapy.* Now we commonly do MRM- in which Pectoralis major muscle is preserved.


Question: Orchidopexy for cryptorchidism is done at the age of

Orchidopexy is usually performed after the age of 1 year to avoid the risks of operating on a tiny patient. Testes should be brought down into the scrotum before the boy stas school. Reference : page1378 Bailey and Love's sho practice of surgery 25th edition


Question: Retrosternal Goitre Approach is

* Retrosternal goitre is 99% extension from Goitre in neck due to enlargement. And such extended retrosternal goitres are mostly removed by neck incision itself by putting the fingers and hooking out the gland. * Such manoeuvre of removal neck incision is known as Toboggan Technique. * Very rarely Sternotomy is done if the goitre is primary mediastinal goitre. Ref:- Surgery Sixer 3rd Edition; Pg num:- 227


Question: Prepyloric channel ulcer is of grade

Type 1- In the antrum near the lesser curve, Type 2- combined gastric ulcer ( in the body) with duodenal ulcer, Type 3 - prepyloric ulcer, Type 4 - gastric ulcer in the proximal ulcer or cardia. Reference : SRB edition : 5 page: 824


Question: Stemmer's sign and buffalo hump'are features of

Lymphoedema characteristically involves the foot.The contour of the ankle is lost through infilling of the submalleolar depressions, A 'buffalo hump' forms on the dorsum of the foot,The toes appear 'square' because of confinement of footwear and The skin on the dorsum of the toes cannot be pinched because of subcutaneous fibrosis (Stemmer's sign).Ref: Bailey and love 27e pg: 998


Question: Treatment of hypeensive crisis in pheochromocytoma

Ref:KD Tripathi 7thE pg: 565 Phentolamine is used for pheochromocytoma. Note Non selective alfa-blockers cause fall in t.p.r, which is compensated by increased HR and C.O. So, they are not used routinely for htn. They block both alfa-1 and alfa-2 receptors- NA release is accentuated. Reserved for special situations like pheochromocytoma, clonidine withdrawal, cheese reaction, where circulating CA&;s are responsible for the rise in BP.


Question: The commonest bladder stone is

IInd MC vesical calculi → Sturvite stones


Question: Immediate treatment of compound fracture of tibia is


Question: Most common site of intra peritoneal abscess is

Most common site of abscess in lying and dependent positive - Right inferior intra peritoneal space.


Question:
The beneficial effect of oxygen therapy in histotoxic
hypoxia is about


Question: In an asymptomatic abdominal aoa aneurysm, elective repair is indicated if the aneurysmal diameter is greater than

An asymptomatic abdominal aoic aneurysm in an otherwise fit patient should be considered for repair if >55 mm in diameter (measured by ultrasonography). The annual incidence of rupture rises from 1% or less in aneurysms that are <55 mm in diameter to a significant level, perhaps as high as 25%, in those that are 70 mm in diameter.Ref: Bailey and love pg: 961


Question: Characteristic feature of basal cell carcinoma is

The characteristic finding is of ovoid cells in nests with a single 'palisading' layer. It is only the outer layer of cells that actively divide, explaining why tumour growth rates are slower than their cell cycle speed would suggest.Ref: Bailey and Love, 27e, page: 605


Question: The best treatment for uncomplicated fractures of the ribs is

The ideal treatment for uncomplicated fracture of ribs is on an outpatient basis with administration of analgesics like NSAIDs or narcotics if not sufficient.Immediate surgery in the absence of complications is not needed.

Immediate surgery and wiring of the fragments

Injection of local anesthetic around the involved intercostal nerve


Question: Treatment for malignant melanoma is

Treatment of Malignant melanoma Surgical excision with sentinel LN biopsy (Margin : 1 cm for <1 mm thickness, 2cm for 1-4 mm thickness, 2-3 cm for >4 mm thickness LN dissection if LN is palpable or positive on sentinel LN biopsy MM is radioresistant tumor ; Chemotherapy : IFN-alpha 2b Clark's levels (on the basis of depth of invasion) : EPIRS I Melanoma restricting to epidermis and appendages II Invading papillary dermis without filling it III Reach interface of papillary and reticular dermis IV Invading reticular dermis V Invading subcutaneous tissue MM is subclassified into 5 Clark levels, to indicate their depth of invasion and prognosis Breslow's depth of invasion : Actual measurement of deepest invasion from granular layer Breslow's Thickness Stage I <0.75 mm Stage II 0.75-1.5 mm Stage III 1.6-4.0 mm Stage IV >4.0 mm Ref: Sabiston 20th edition Pgno : 729