Question: Investigation of choice for parotid gland calculi

For submandibular gland calucli IOC is XRay as they are radio-opaque.
For parotid gland calucli IOC is sialography as they are radioluscent.


Question: Ossification centre of scaphoid appears at


Question: Best treatment for fracture neck femur in a 65 year old lady is


Question: Reflux filling the pelvicalyceal system with moderate dilatation of ureter is

Reflux into ureter without dilation - I
Reflux filling the pelvicalyceal system without dilatation of ureter - II
Reflux filling the pelvicalyceal system with moderate dilatation of ureter- III
Blunting of fornix into pelvicalyceal system - IV
Reflux filling the pelvicalyceal system with dilated and tortorous ureter - V.


Question: Investigation of choice for fistula in ano is

Initial investigation is fistulogram.
IOC is MR fistulogram.


Question: If a patient with a suspected fracture of the pelvis has some bleeding from the urethra and is unable to pass urine

D i.e. He should be prepared for surgery and catheterization attempted in the O.T. Urogenital injuries are common in pelvic fractures (5-10%), especially in men. These injuries should be suspected in conscious patients Who is unable to voidQ or who has gross hematurie - Bloody urethral dischargeQ Swelling or ecchymosis of the penis or perineum - High riding or floating prostate on rectal examination. No attempt should be made to pass a catheter, as this could conve a paial to a complete tear of urethraQ. A retrograde urethrogram should be obtained before attempting to introduce a foley catheter.

He should be encouraged to pass urine after being given antibiotics and analgesics

He should be immediately catheterized in the ward

A hot water bottle should be given followed by injection of carbachol


Question: In extension type of supracondylar fracture, the usual displacement

Ans. is 'd' i.e., Posterolateral Types of supracondylar fracture Supracondylar fracture is broadly classified into extension type and flexion type. 1. Extension type It is the most common type (97 - 99%). Distal fragment is extended (tilted backward/posteriorly) in relation to proximal fragment. Occurs due to hyperextension injury after fall on outstretched hands. Generally, displacement of distal fragment may be : ? Posteromedial (70-80%) Posterolateral (20-30%) 2. Flexion type It is less common type (1-3 %) Distal fragment is flexed (tilted forward/anteriorly) in relation to proximal fragments. The mechanism of injury generally is believed to be a fall directly onto the elbow rather than a fall on outstretched hand. As the extension type fracture is more common (97 - 99%), the most common elbow injury in children is extension type of supracondylar fracture.


Question: Fracture of lateral condyle of humerus seen in age group of

C i.e. 5 - 15 years The lateral condylar (or capitellar) epiphysis beings to ossify during the first year of life & fuses with shaft at 12-16 yearsQ. Between these ages it may be sheared off or avulsed by forceful traction. The maximum chances of injury is between 5 -15 yearsQ.


Question: Pa I of the 'death ceificate' deals with

According to death ceificate recommended by WHO for international use, Pa I deals with the immediate cause, and the direct underlying cause (the essence of international death ceificate) which staed the whole trend of events leading to death. But it does not include the mode of dying. In pa II is recorded any significant associated disease that contributed to the death but did not directly lead to it.

Immediate cause, and the direct underlying cause which staed the whole trend of events leading to death

Any significant associated diseases that contributed to the death but did not directly lead to it.

Approximate interval between onset and cause of death.


Question: The most common site of lymphangiosarcoma is

Lymphangiosarcoma is a rare tumor that develops as a complication of long-standing (usually more than 10 years lymphedema.


Question: Most common Tumor of spleen is

Ans. is 'a' i.e., Lymphoma "Non-Hodgkin's lymphoma is the most common malignant neoplasm of the spleen."- Maingot's 11/e Primary neoplasms of spleen are a rare entity. Most common primary neoplasm of spleen is hemangioma and the most common primary malignant neoplasm is angiosarcoma.


Question: Meningitis caused by Cryptococcus neoformans is most often acquired by

C. neoformans causes cryptococcus, especially cryptococcal meningitis. C. neoformans is an oval, budding yeast surrounded by a large polysaccharide capsule. It occurs widely in nature and grows abundantly in soil containing bird droppings. The organism is most often inhaled and spread hematogenously from the lungs. Lung infections range from asymptomatic to pneumonia. Cryptococcosis is the most common encapsulated infection in the immunocompromised host. The organism disseminates hematogenously to the central nervous system (meningitis) andother organs. It can be cultured from cerebral spinal fluid (CSF) or diagnosed by serologic tests for either antibody or antigen. Amphotericin B and flucytosine are used to treat cryptococcal meningitis.

Hematogenous spread of fungus from the lung


Question: Preferred shunt procedure in patient with poal hypeension having acceptable operative risk and adequate liver function is

Answer- D. Distal splenorenal shuntPoosystemic shunt procedures such as splenorenal shunt and mesocaval shunt, may be indicated in patients with complication of poal hypeension.Given the early occlusion rate and the need for constant surveillance, it is generally advised that TIPS should be reserved for Child C classification of cirrhosis, whereas a distal splenorenal shunt is safe, durable, preferred and effective treatment in patients with acceptable operative risk and still good liver function.


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

Ans. is 'b' i.e. Adriamycin based chemotherapy followed by tamoxifen depending on.... Stage I & II breast cancers (Early invasive breast cancers) are managed byPrimary therapy for local management &Adjuvant therapyPrimary therapy consists of:Mastectomy with assessment of axillary lymph node status (or modified radical mastectomy) orBreast conservation (lumpectomy, wide local excision or quadrantectomy) with assessment of axillary lymph node status + radiotherapy.Various trials have found both these methods to be equally effective. Breast conservation is the preferred form of treatment because of cosmetic advantages However there are certain contraindications for conservative surgery (described in subsequent question)Management of axillary lymph nodesEarlier dissection of axillary lymph nodes (level I and II) was performed to assess the lymph node status (i.e. presence or absence of occult metastasis)Now Sentinel lymph node biopsy is considered the standard for evaluation of the axillary lymph nodes for metastasis in women who have clinically negative lymph nodes, (the sentinel lymph node is the first regional lymph node to receive tumor cells that metastasize along the lymphatic pathway from the primary breast cancer)Axillary Lymph node dissection is performed for clinically palpable axillary lymph nodes or metastatic disease detected in sentinel lymph node biopsy.Adjuvant chemotherapy is given to all node-positive cancersnode negative cancers if > 1 cm in size * node negative cancer > .5 cm in size with adverse prognostic factors such as blood vessel or lymph vessel invasion high nuclear grade high histological grade HER 2/neu overexpression negative hormone receptor statusAdjuvant hormone therapy (tamoxifen) is added to all those with estrogen receptor positive tumors.HER-2/neu expression is determined for all patients with newly diagnosed breast cancer and may be used to provide prognostic information in patients with node-negative breast cancer and predict the relative efficacy of various chemotherapy regimens. Trastuzumab is the HER-2/neu-targeted agent that is added to the adjuvant therapy is the tumor shows overexpression of HER-2/neu receptors.Advanced Local-Regional Breast Cancer (Stage III)(Neoadjuvant chemotherapy + MRM + adjuvant radiation therapy + chemotherapy + antiestrogen therapy)Here the disease is advanced on the chest wall or in regional lymph nodes (or both), with no evidence of metastasis to distant sites. Such patients are recognized to be at significant risk for the development of subsequent metastases, and treatment addresses the risk for both local and systemic relapse.In an effort to provide optimal local-regional disease-free survival as well as distant disease-free survival for these women, surgery is integrated with radiation therapy and chemotherapy.Neoadjuvant chemotherapy (administration of therapeutic agents prior to the main treatment) should be considered in the initial management of all patients with locally advanced stage III breast cancer.Surgical therapy for women with stage III disease is usually a modified radical mastectomy, followed by adjuvant radiation therapy and chemotherapy. Antiestrogen therapy (tamoxifen) is added for hormone receptor positive tumors.Chemotherapy is used to maximize distant disease-free survival, whereas radiation therapy is used to maximize local-regional disease-free survival.In selected patients with stage IIIA cancer, neoadjuvant (preoperative) chemotherapy can reduce the size of the primary cancer and permit breast-conserving surgery.Distant Metastases (Stage IV)(mainly palliative treatment)Treatment for stage IV breast cancer is not curative but may prolong survival and enhance a woman's quality of life.Hormonal therapies that are associated with minimal toxicity are preferred to cytotoxic chemotherapy. Appropriate candidates for initial hormonal therapy include women with hormone receptor-positive cancers; women with bone or soft tissue metastases only; and women with limited and asymptomatic visceral metastases.Systemic chemotherapy is indicated for women with hormone receptor-negative cancers, symptomatic visceral metastases, and hormone-refractory metastases.Bisphosphonates, which may be given in addition to chemotherapy or hormone therapy, should be considered in women with bone metastases.About Adjuvant TherapyAdjuvant therapy is the use of systemic therapy (chemotherapy or/and hormone therapy) in patients who have received local therapy but are at risk of relapse.The objective is to eliminate the occult metastasis responsible for late recurrences while they are microscopic and theoretically most vulnerable to anticancer agents.Adjuvant chemotherapy is given to all node-positive cancersnode negative cancers if > 1 cm in size node negative cancer > .5 cm in size with adverse prognostic factors such as blood vessel or lymph vessel invasion high nuclear grade high histological grade HER 2/neu overexpression negative hormone receptor statusAdjuvant hormone therapy (tamoxifen) is added to all those with estrogen receptor positive.* The use of chemotherapy in post-menopausal women is controversial.In post menopausal women, chemotherapy is frequently used upto age 70 yrs, if she can tolerate it.In older women, chemotherapy is performed less frequently.In estrogen positive tumors, in postmenopausal women, antiestrogen (tamoxifen/ aromatase inhibitors) therapy is the preferred form of adjuvant systemic treatment.Neoadjuvant chemotherapy it involves the administration of adjuvant therapy before primary therapy (surgery & radiation therapy) it has shown to down-stage the tumor.Previously CMF (cyclophosphamide, methotrexate & 5-fluorouracil) was the chemotherapeutic regimen of choice. "CMF is no longer considered adequate adjuvant chemotherapy and modem regimens include an anthracycline (doxorubicin or epirubicin) and the newer agents such as the taxanes (paclitaxel and docetaxel)"- Bailey and Love 25/e p844Anti-HER-2/neu antibody therapy (Trastuzumab)HER-2/neu expression for all newly diagnosed patients with breast cancer is now recommended.Trastuzumab is added to the chemotherapy for tumors overexpressing HER-2/neu receptors. (Trastuzumab is added along with taxanes)

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


Question: Renal calculi associated with proteus infection

Triple phosphate or struvite( Calcium phosphate with ammonium magnesium phosphate ) is smooth and diy white, grows in alkaline medium. Proteus being urea splitting organism splits urea to give ammonium which provides the required alkaline medium. Reference : page 1292 Bailey and Love's sho practice of surgery 26th edition


Question: Lockwood repair is done in


Question: A Pre pharyngeal abscess diagnosed as tuberculosis is seen in 44 year old lady with difficulties in deglutition management would be

Answer- A. Urgent DrainageDevelopment of new neurodeficit or its worsening on AKTReappearance ofprevious neurodeficit on AKTNo improvement in neurodeficit for 4-6 weeksDifficulty in deglutition due to a prepharyngeal abscess


Question: Acinic cell carcinomas of the salivary gland arise most often in the

Acinic cell tumors or carcinomas arise most commonly in parotid gland followed by submandibular gland. Acinic cell carcinomas are rare tumors composed of cells resembling the normal serous acinar cells of salivary glands. Minor glands are rarely involved as they have only few serous cells. Acinic cell tumors, like Wahin tumors can be bilateral and multicentric.


Question: Burns involving skin superficial part 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
Fourth degree burns involve not only skin but also subcutaneous fat and deeper structures


Question: Cystosarcoma phyllodes are treated by

Phyllodes tumor is usually benign and treated by simple mastectomy.


Question: Normal portal vein pressure is

• Normal portal vein pressure: 5-10 mm Hg
• Variceal formation occurs when portal pressure is >10 mm Hg.
• Variceal bleeding occurs when portal pressure is >12 mm Hg.
 • Normal portal vein pressure: 10-15 cm saline
• Definition: Portal pressure >10 mm Hg
• MC cause of portal hypertension in United States: Cirrhosis.
• Consequence of both increased portal vascular resistance and increased portal flow.
• Portal hypertension results in splenomegaly with enlarged, tortuous, and even aneurysmal splenic vessels.
• Cruveilhier-Baumgarten murmur: Audible venous hum in caput medusa
• Hyperdynamic portal venous circulation seems to be related to the severity of the liver failure.
• Upper G.I. bleeding is caused by the portal hypertension in about 90% of instances.
• Most bleeding episodes occur during the first 1 to 2 years after identification of varices.
• Colour Doppler is the investigation of choice for evaluation of PHT.
• About one third of deaths in patients with known esophageal varices are due to upper GI bleed
• A larger proportion dies as a result of liver failure.
• MC causes of death in cirrhosis patients: Hepatic failure
• 2nd MC causes of death in cirrhosis patients: variceal hemorrhage


Question: Osteotomes differ from chisels in that they are


Question: Treatment of choice for annular pancrease is

Pancreatic ring surrounds the second or third pa of duodenum. The usual treatment is duodenoduodenostomy. Bailey & Love ,26th,1125


Question: Green coloured i.v. cannula, the size is

Answer- A. 18Green- 18Pink- 20Blue- 22Yellow/lime- 24


Question: Medical castration is effected bya) Diethylstilbesterolb) LH RH analoguesc) Gossypold) Hanovan


Question: Gold standard investigation for Triple assessment screening breast carcinoma in patient with Silicone breast implant

Ans. (a) MRI(Ref. Bailey and Love 26th edition Page 800)Indications for MRI in Breast:* Distinguish scar and recurrence* For diagnosing multicentricity in LCIS and Extent in DCIS* Breast implants* Best screening tool for high risk women


Question: Early fundoscopic sign in Papilloedema

(A) Blurring of disc margin # EARLY PAPILLEDEMA:> Disc elevation> Venous distention and tortuosity> Obscuration of the normal disc margin and overlying retinal vessels.> Absence of spontaneous venous pulsations.# Papilloedema symptoms are generally absent or vague and vision may be unimpaired for a long time.> This applies particularly to the central vision which may be unaffected sometimes even in the presence of a macular fan> Episodes of transient attacks of blurred vision, or transient obscurations of vision, usually described as bilateral or monocular 'black-outs' lasting for a few seconds often precipitated by changes in posture, are not uncommon in the initial stages.> As the condition progresses, however, two additional signs may be found--an enlargement of the blind spot owing to separation of the retina around the disc by the oedema and a progressive contraction of the visual field due to atrophy of the nerve.> At this stage, relative scotoma, first to green and red, may be present

Blurring of peripapillary nerve fiber layer


Question: Splenic rupture immediate treatment is

Immediate laparotomy is indicated for splenic rupture if there is obvious evidence of continuing blood loss despite adequate resuscitation. The incidence of major associated intra and abdominal injuries are also exceeded 50% and so laparotomy should be considered if there is strong suspicion of trauma to other organs Thoracoabdominal extension of left subcostal /midline incision is made to be rapid control of bleeding for injury to large tropical spleen with the severe bleeding. SRB 5th edition page no. 671 Bailey and love&;s 24 the edition page no. 1087


Question: Lalita, a female pt. presents with pigmentation of the lips and oral mucosa and intestinal polyps. Her sister also gives the same history. Most probable diagnosis is

Ans. is 'd' ie. Peutz-Jeghers syndrome Peutz-.I ethers syndrome consists of;hamartomatous polyps throughout the intestine with maximum density in the jejunum *melanosis of the oral mucous membrane and the lips. The melanosis takes the form of melanin spots sometimes presents on the digits and the perianal skin, but the pigmentation of the lips is the sine quanon.


Question: Unna boot is used for treatment of

Answer- B. Varicose ulcersIt is named for the dermatologist Paul Gerson Unna.This boot can be used to treat uninfected nonnecrotic leg and foot ulcers that result from such conditions as venous insuftciency (varicose ulcers) and stasis dermatitis.


Question: A colles fracture is

C i.e. Common in elderly women Coll's fracture is fracture of lower end of radius at its coico cancellous junctionQ (- 2.5 cm / 1.5 inch above the distal aicular surface) mostly occuring in post menopausal osteoporotic elderly womenQ ; as a result of fall on outstretched hand. (with wrist in extension). It is most common of all fractures in older people.


Question: Fat embolism may ensue following


Question: A 70 kg man presents with pyloric strenosis resulting from peptic ulcer disease is admitted for resuscitation after one week of prolonged vomiting. The metabolic disturbance is associated with

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

Hypokalemic hyperchloremic metabolic acidosis

Hypokalemic hypochloremic metabolic acidosis

Hypokalemic hyperchloremic metabolic alkalosis

Hypokalemic hypochloremic metabolic alkalosis


Question: Perforated peptic ulcer is treated by

Vagotomy is a procedure that transects the vagal trunks (truncal vagotomy) or distal nerve fibers (highly selective vagotomy). Truncal vagotomy aims to reduce the gastric acid secretion, thus reducing the risks of recurrent PUD. Ref Srb surgery 978p


Question: Most common complication after intestinal transplantation is

Sepsis is the MC complication of intestinal transplant.


Question: Percentage of cold nodules that becomes malignant are

20% of 'cold' swellings and some 5% functioning or 'warm' swellings will be malignant.Ref: Bailey and Love, page no: 804


Question: Renal TB mode of infection

Answer- C. HematogenousGenitourinary tuberculosis is always secondary to pulmonary infection, though in many cases, the primary focus has healed or is quiescent.Infection occurs the hematogenous route


Question: H.pylori infection is associated with increased risk of

Helicobacter seems to be principally associated with carcinoma of the body and distal stomach rather than proximal. The aetiology of proximal cancer remains an enigma. It is not associated with h.pylori but is associated with obesity and socioeconomic status. Bailey and Love 26 th ed: pg 1046

Carcinoma of body and pylorus of stamach

Carcinoma involving gastroesophageal junction


Question: A patient died on dental chair due to overdose of LA, cause for this can be


Question: Clinical stage II of carcinoma breast means

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

Tumor with evidence of distant metastasis

Tumor is presents in the breast and axillary lymph nods are involved

Tumor has involved breast, pectoral muscles and wide area of skin


Question: Most appropriate treatment for acute paranychia

.ACUTE PARONYCHIA * It is the most common hand infection. * It occurs in subcuticular area under the eponychium. * Minor injury to finger is the common cause. * Suppuration occurs very rapidly. * It tracks around the skin margin and spreads under the nail causing hang nail or floating nail. * Organisms are Staphylococcus aureus and Streptococcus pyogenes Treatment --* Pus is sent for culture and sensitivity. * Antibiotics like cloxacillin, amoxycillin. * Analgesics. * The pus is drained by making an incision over the eponychium. * If there is a floating nail, then the nail is dead and it has to be removed. Recovery is fast. ref:SRB&;s manual of surgery,ed 3,pg no 132 .


Question: Calculation of IV fluids in a burns patient for 24 hours is

First half is given in first 8 hours.
Next half is given in next 16 hours.

Total % body surface area × weight × 4 = volume in ml

Total % body surface area × weight × 3 = volume in ml

Total % body surface area × weight × 2 = volume in ml

Total % body surface area × weight × 6 = volume in ml


Question: Treatment of medullary carcinoma thyroid is

MTC can be cured only by complete resection of a primary tumour and local and regional metastases. Total thyroidectomy with prophylactic level VI nodal dissection is done.Because MTC is not of follicular cell origin, TSH suppression and RAI scanning and therapy have no role in MTC.Ref: Sabiston 20e, page no: 910


Question: Surgery for fissure in ano is

Lateral spincterectomy is done for pts of fissure in ano whom medical treatment fails.


Question: Investigation of choice in discrete thyroid swellings

Ans. (b) FNACRef: Bailey and Love page 751/26th edition* Fine-needle aspiration cytology is the investigation of choice in discrete thyroid swellings* A discrete swelling in an otherwise impalpable gland is termed isolated or solitary, whereas the preferred term is dominant for a similar swelling in a gland with clinical evidence of generalised abnormality in the form of a palpable contralateral lobe or generalised mild nodularity.* About 70 per cent of discrete thyroid swellings are clinically isolated and about 30 per cent are dominant


Question: Most common cause of umblicus does not separate at age of 2 years.

(Leukocyte adhesion deficiency) (1289- B & L 24th) (61-62-Basis pathology 7th) (985-Baily & Love 25th)* Leukocyte adhesion deficiency (LAD-1)- Defects in b chain of CD 11 /CD 18 integrins- Characterised by recurrent bacterial infections and impaired wound healing* Leukocyte adhesion deficiency (LAD-2)- Defect in fucosyl transferase required for synthesis of sialylated oligosaccharide- Characterised by recurrent bacterial infections* Raspberry tumour - (Umbilical adenoma) - due to a partially (occasionally completely) unobliterated vitellointestinal duct. Mucosa prolapsing through the umbilicus gives rise to a raspberry like tumour, which is moist and tends to bleed - Treatment umbilectomy


Question: Deficiency of the abdominal muscle is associated with

Answer is 'a' i.e. Eagle Barrete syndrome Eagle Barrett or Prune-Belly syndrome Consists of a triad of abnormalites i.e. 1) deficient abdominal wall musculature 2) bilateral cryptorchidism 3) dilatation of urogenital tract Deficient abdominal wall musculature leads to extremely lax lower abdominal wall. The term Prune belly is derived from the wrinkled appearance of the anterior abdominal wall. Genitourinary abnormalities are hydroureters (without any obstruction) hydronephrosis distended bladder - cryptorchidism vescico-ureteric reflux leading to UTI Pulmonary hypoplasia is also seen in some cases. The condition is seen almost exclusively in males.


Question: Best time for surgery of undescended testis is

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.Orchidopexy during the second year of life is currently recommended by paediatric surgeons. Orchidopexy before 2 years of age improves feility, may reduce the risk of malignancy and has psychological benefits. Reference : page1378 and 77 Bailey and Love's sho practice of surgery 25th edition


Question: Appropriate approach for thyroidectomy to remove thyroid carcinoma with retrosternal extension is

Surgical removal of retrosternal thyroid is done. Commonly, it can be removed through an incision in neck(as blood supply of retrosternal goitre is from neck), but in case of large retrosternal extension or in malignant type median sternotomy is required. Reference: SRB's Manual of Surgery, 6th Edition, page no= 458.


Question: Drugs not used for treatment of acute hyperkalemia aEUR'

Potassium exchange resins Repeat from May 10 Q no. 101. EMERGENCY Modality Mechanism of action Onset Duration Calcium gluconate Antagonizes cardiac conduction abnormalities 0-5 minutes 1 hour Sodium Bicarbonate Distributes K+ into cells (only indicated with acidosis ) 15-30 minutes 1-2 hours Insulin Distributes K+ into cells 15-60 minutes 4-6 hours Albuterol Distributes K+ into cells 15-30 minutes 2-4 hours NONEMERGENCY Modality Mechanism of action Duration of treatment Loop diuretic I Renal K+ excretion 0.5-2 hours Sodium polystyrene sulfonate (kayexalate) Ion-exchange resin binds K+ 1-3 hours Hemodialysis Extracorporeal K+ removal 48 hours Peritoneal dialysis Peritoneal K+ removal 48 hours


Question: Open biopsy is done for salivary gland tumors unless they are arising from

Answer- D. ParotidOpen biopsy of the parotid or submandibular gland is not advised as it risks minor seeding and may complicate the indicated surgery.


Question: Most common nerve to get entrapped in laparoscopic hernial repair

Entrappment of lateral cutaneous nerve of thigh leads to meralgio porestheica.
m/c nerve entrapped in open hernial surgery is iliohypogastric


Question:
The preferred Shunt procedure for the patient with portal
hypertension having acceptable operative risk and adequate
liver function is


Question:
Displacement of a root into the maxillary sinus
during extraction is most likely to happen during the extraction of the maxillary


Question: Best treatment for menigioma with low recurrence rate is

Surgical treatment should be, wherever possible, total excision. If this includes the site of dural attachment, the recurrence rate is less than 10 per cent. Incomplete excision of the dural attachment will result in a recurrence rate of between 20 and 30 per cent. Subtotal excision will result in 40 pet cent showing progressive growth. The role of radiotherapy is controversial and is usually reserved foumours with aggressive histological features or recurrenttumours, or where a subtotal resection has been performed. Ref:Surgery of Bailey and Love,26th edition.

Tumour excision with cyst of dura mater removal

Excision surgery followed by radiotherapy


Question: A female undergone surgery for left breast cancer 3 yrs back now developed blue nodule on same side

Answer- A. LymphangiosarcomaAngiosarcoma is a vascular tumor which may arise de novo in the breast or as a complication of the radiation therapy.


Question: Most common malignant parotid tumour is

Among primary parotid malignant tumors, mucoepidermoid carcinoma is the most common, followed by adenocystic carcinoma. Reference : Bailey & love, 27th Edition, page no = 789.


Question: In a patient of total parenteral nutrition daily monitoring is done with

Fluid overload can be avoided by daily weighing of the patient. A weight change of >1 kg/day normally indicates fluid retention. PG NO.282 27th edition BAILEY


Question: Bones, stones, abdominal groans and psychiatric oveones' are features of

The early descriptions of patients with primary hyperparathyroidism were dominated by those with osteitis fibrosa cystica. Brown tumours of the long bones and associated subperiosteal bone reabsorption, distal tapering of the clavicles and the classical 'salt and pepper' erosions of the skull were typical findings. Over 80% of patients had associated renal stones, significant neuromuscular dysfunction and muscle weakness.This led to the traditional mnemonic that patients with PHPT presented with 'bones, stones, abdominal groans and psychiatric oveones'.Currently, most of the patients might be asymptomatic.Ref: Bailey and Love 27e pg: 825


Question: A new born presents with discharge of urine from the umbilicus for 3 days. Diagnosis is

Urachal fistula or patent urachus is between dome of the urinary bladder and umbilicus. Presents with persistent discharge often stained with urine from the umbilicus at bih or commencing soon after. Investigation : fistulogram, US abdomen. Treatment : Surgical excision of tract and closure of distal obstruction after exclusion of distal obstruction . In adults urachal cyst my get infected and present as urachal fistula and may harbour adenocarcinoma... Ref: Bailey and Love.27th edition.chapter 77 pg no.1438 Reference : page 739-40 SRB's manual of surgery 5th edition


Question: On the 4th postoperative day of laparotomy a patient presents with bleeding & oozing from the wound management is

GENERAL POSTOPERATIVE COMPLICATIONS Bleeding Postoperative haemorrhage is most common in the immediate postoperative period. It may be caused by an aerial or venous leak, but also by a generalised ooze or a coagulopathy. Slow bleeds may go undetected for hours and then the patient suddenly decompensates. All patients must have their vital signs (pulse rate, blood pressure, oximetry, central venous pressure, if available, and urine output) monitored regularly. Dressings and drains should be inspected regularly in the first 24 hours after surgery. If haemorrhage is suspected, blood samples should be taken for a full blood count, coagulation profile and cross match. A large bore intravenous cannula should be sitedand fluid resuscitation commenced. If the source of bleeding is in doubt and the patient is stable, an ultrasound or computed tomography (CT) scan may be required to determine the nature of the bleed (most commonly if a haematoma is suspected in the days following surgery). If the patient's cardiovascular system is unstable or compromised in any way (for example neck haematoma or bleeding tonsil) they should be taken back to the operating theatre immediately. The treatment of haemorrhage is both to stop the bleeding and suppoive. Suppoive treatment includes oxygen and fluid resuscitation. It may require correction of coagulopathy. All patients will require close observation. Blood transfusion carries risks (acute haemolytic transfusion reaction, sensitisation, fluid overload, hyperkalaemia, transfusion-related lung injury and transmission of blood-borne infection). There is much published about what is the right transfusion trigger and how to balance the need for adequate tissue perfusion and the risks of transfusion. The decision about when to transfuse should be based on the individual patient; in general, however, the accepted transfusion trigger is 75 g/L except in the presence of known or suspected coronary aery disease when a higher trigger is acceptable. All hospitals should have a 'major haemorrhage protocol' in place. The consultant surgeon, anaesthetist and haematologist should all be involved early on in the care of unstable patients. Ref : Bailey and love 27th edition Pgno : 296

Dressing of wound & observe for dehiscence


Question: Earliest symptom of Wilms tumour is

Nephroblastoma Usually presents in the first five years of life ,Typically presents with an abdominal mass , May cause haematuria, abdominal pain or fever Metastasises to the lung . tretment is usually chemotherapy followed by nephrectomy . Eighty per cent survive long term with modern chemotherapy and surgery. The prognosis is worse in those with metastases and in older children ref : Bailey and Love 27th ed , chapter 76 , pg no :- 1421


Question: Rigler's triad doesn't includes

Rigler's triad is a combination of findings on an abdominal radiograph of people with gallstone ileus,a condition where a large gallstone causes bowel obstruction.it consists of (a)Small bowel obstruction,(b)a gallstone outside the gallbladder(c)air in the bile ducts(pneumobilia). Reference:SRB's manual of surgery,5th edition,page no:649


Question: Focal lesion in liver is best detected by

MRI in Liver lesions MRI had emerged as the best imaging test for liver lesion detection and characterization MRI provides high lesion-to-liver contrast and does not use radiation Liver-specific contrast media, such as mangofodipir trisodium (taken up by hepatocytes) and ferrumoxides (taken up by kupffer cells) demonstrate selective uptake in the liver and primarily used for lesion detection These two contrast agents are also useful in characterising specific liver tumors, such as FNH, hepatic adenoma and HCC Ref: Shackelford 7th edition Pgno : 1560


Question: The best method of controlling bleeding is to

Compress pressure points between the injury and the heart


Question: Ectopic tissue in stomach is of the origin of

Pancreatic tissue outside boundaries of the pancreas without anatomic or vascular connections to the pancreas, Also called ectopic pancreas. Ectopic pancreas can be found in submucosa of stomach, duodenum or small intestine, gallbladder, spleen Reference Bailey and love&;s edition 24 page no .1120


Question: Oxygen therapy is most useful in

(Arterial hypoxia) (75-77-A yadav 4th)Hypoxic hypoxia responds best to oxygen therapy while there is no benefit to oxygen therapy in histotoxic cyanoidpoisoning) hypoxiaClinical presentation of hypoxia is cyanosis, which is produced if reduced Hb level is more than 5g/dl (which roughly corresponds to O2 saturation) < 85 to 90% or pO2 < 50 mmHg) methaemoglobin > 1.5g/dL and sulphaemoglobin >0.5 g/dLCharacteristic features of diffeent types of HvpoxiaFeaturesHypoxic hypoxiaAnemic hypoxiaStagnant hypoxiaHistotoxic hypoxia1. CO2 in arterial bloodReducedNormalNormalNormal2. O2 carrying capacity of bloodNormalReducedNormalNormal3. Rate of blood flowNormalNormalReducedNormal4. Utilization of O2 by tissue100%75%50%Not usefulOXYGEN TOXICITY - toxic radicals of oxygen damage the capillary membrane increasing capillary permeability and ARDS like picture, Abnormality in ciliary transport, absorption atelectasis** and tracheobronchitis, decreased pulmonary compliance**In neonates pulmonary toxicity manifests as bronchopulmonary dysplasia**, Retrolental fibroplasia** (premature neonates (<36 weeks) are greatest risk.* Acute oxygen toxicity may manifest as convulsions this is called as paulbert effectHYPER BARIC OXYGEN : USESA.Poisonings- CO, cyanoid poisoningB.Gas bubble disease- Decompression sickness, Air embolismC.Ischaemia- Crush injury, Ischemic ulcer, Radiation necrosisD.Infections- Clostridial, Mucormycosis, Refractory osteomyelitisE.Others- Oxygen support during lung lavage, Bums cerebral edemaHeliox (80% helium + 20% oxygen) is used for upper air way obstruction like tracheal stenosis


Question: Opsomyoclonus is encountered as C/F of

At least 50% of children with opsoclonus-myoclonus have an underlying neuroblastoma." - Harrison Opsoclonus-Myoclonus Syndrome Opsoclonus is a disorder of eye movement characterized by involuntary, chaotic saccades that occur in all directions of gaze; it is frequently associated with myoclonus and ataxia. Causes of Opsoclonus-myoclonus Idiopathic Cancer-related (paraneoplastic) Cancers associated with opsoclonus-myoclonus are usually lung and breast cancers in adults and neuroblastoma in children. Ref : Harrison 17/e p626


Question: A 50 yr old male Raju present with occasional dysphagia for solids, regurgitation of food and foul smelling breath. Probable diagnosis is

Ans. is 'b' Zenker's diverticulum Symptoms of Zenker's diverticulumPresenting symptoms include dysphagia associated with the spontaneous regurgitation of undigested, bland material, after interrupting eating or drinking.The dysphagia is occasional when the diverticula gets filled with food. Dysphagia is relieved when the diver- ticulum empties.Other symptoms areHalitosis (foul mouth odour) gurgling noise after eating swelling in the neck aspiration of contents leading to recurrent pneumonia, lung abscessDiagnosis is confirmed by barium swallowIn Achalasia & Ca esophagus, the dysphagia is progressive and not occasional, though regurgitation may be seen in achalasia.Diabetic gastroparesis is a rare disorder leading to motor abnormality of the esophagus.


Question: Burns with destruction of the epidermis and papillary dermis is

2nd degree superficial - epidermis and papillary dermis.
2nd degree deep - epidermis and entire dermis.


Question: Compared to follicular Ca, papillary Ca of thyroid associared with

Papillary carcinoma thyroid is more seen in radiation exposure, and also has high lymph node involvement. Follicular thyroid carcinoma is associated with iodine deficiency. It has hematogenous spread and comparitively a less otable outcome Both are common in females.


Question: Bulbocavernosus reflex is elicited by A/E

D i.e. Perianal area Reflex Location of lesion (Root value) Norma response Abnormal response Significance Cremasteric T12 - Ll Stroking the medial thigh No motion of proximal to distal produce upward motion of scrotumQ scrotum Return of normal response of Anal wink Sz - S4 Stroking perianal skin cause anal No anal sphincter bulbocaverno sphincter contractionQ contraction us, anal & Bulbocavernosus S3 - S4 Squeezing the glans penis in males, applying pressure to clitoris in females, or tugging (pulling) the bladder catheter in eitherQ cause anal sphincter contractionQ. No anal sphincter contraction. cremesteric reflex indicate that the spinal shock is over


Question: In traumatic brain injury, Glasgow outcome score of 4 stands for

Glasgow Outcome Score (GOS)Good recovery 5Moderate disability 4Severe disability 3Persistent vegetative state 2Dead 1Bailey and Love 26e pg:320


Question: Aaron's sign is seen in


Question: Most common Extra intestinal Manifest of Amoebiasis

Ans. (a) Liver AbscessRef: Bailey and Love 27th edition Page 1169* MC Extraintestinal Manifest of Amoebiasis - Amoebic Liver abscess* 1/3rd of cases of liver abscess have History of Amoebic; Diarrhea and the rest of the cases have subclinical Amoebic infection.* MC complication of amoebic liver abscess- peritoneal Rupture


Question: Glomus tumor arises from

Ans. is 'a' i.e., Modified smooth muscle cells Glomus tumors (Glomangioma)* Glomus tumors are benign but exquisitely painful tumors arising from modified smooth muscle cells of the glomus bodies, arteriovenous structures involved in thermoregulation.* Although they may superficially resemble hemangiomas, glomangiomas arise from smooth muscle cells rather than endothelial cells.* They are most commonly found in the distal portion of the digits, especially under the fingernails.* Excision is curative.


Question: Testing of receipient cells against donor serum is

Answer- B. Minor CrossmatchingMinor cross-match: Recipient red cells are tested against donor serum to detect donor antibodies directed against a patient's antigens.This is no longer required. It is assumed that the small amount of donor serum and antibodies left in a unit of packed cells will be diluted in a recipient


Question: Marjolin's ulcer is a

Marjolin's ulcer is well-differentiated squamous cell carcinoma which occurs in chronic scars like burn scar, scar of venous ulcer. It is slow growing, locally malignant disease. Reference : SRB's Manual of Surgery, 6th Edition, page no = 283.

Malignant ulcer found on the scar of burn


Question: In the reconstruction following excision of previously irradiated cheek cancer the flap will be


Question: Atropine is given as preanesthetic to

(B) (Reduce bronchial secretions) (268, 56 Arun Yadav 5th)ATROPINE- Use to teeat bradyarrhythmiasOther uses:1. As pre medication to decrease respiratory secretions2. In reversal along with neostigmine to prevent muscarinic effects3. Organosphosphorus PoisoningGOALS OF PREMEDICATIONS* To relieve anxiety* To produce haemodynamic stability* To induce sedation (good sleep) and reduce metabolic rate* To provide analgesia and amnesia* To decrease the chances of aspiration* To contral oral and respiratory secretions* To prevent postoperative nausea and vomiting* To control infections* Atropine is a bronchodilator and reduce air way resistance specially COPD and Asthma patients* Atropine prevent bradycardia, hypotension


Question: The optimum length of screw, for fixation of plate in mandible is


Question: Muir and Barclay formula is used for

The Muir and Barclay Formula estimates the amount of fluid that needs to be infused during the first 36 hours after a major burn. The Muir and Barclay Formula was described for albumin as the resuscitation fluid.0.5 x percentage body surface area burnt x weight = one poion;Periods of 4/4/4, 6/6 and 12 hours, respectively;One poion to be given in each period.Ref: Bailey and love 27e pg: 624

Enhanced recovery in colo-rectal surgery


Question: Hyperacute rejection of transplant is due to

Preformed antibodies will cause hyperacute rejection.
T cells will cause acute rejection.


Question: Merkel cell carcinoma is due to

Cytokeratin 20: *Merkel cell carcinoma (MCC) is a rare, aggressive, primary skin cancer exhibiting neuroendocrine differentiation. oThe histogenesis of MCC is controversial. Possible cells of origin include the epidermal MC, a dermal MC equivalent, a neural-crest- derived cell of the amine precursor uptake and decarboxylation (APUD) system, and a residual epidermal stem cell. oCytogenetic abnormalities are present in 30-47% of MCCs. The most frequent change is loss of heterozygosity due to translocations or deletions of chromosome 1; specifically, 2 distinct regions in the most distal band 1 p36 on the sho arm of chromosome 1are implicated in MCC. Similar abnormalities near this site occur in several neuro cystic tumors, including melanoma, neuroblastoma, and pheochromocytoma. Other abnormalities described in MCC include losses at chromosomes 3, 13, and 22 and paial trisomy 01 chromosomes 1, 11, 18, and X. Unlike neuroendocrine (small cell) carcinoma of the lung, gene amplifications are rare in cutaneous MCC. oCytokeratin 20 is expressed in a dot like paranuclear or crescentic pattern; other low molecular weight (MW) cytokeratin antibodies (E.g., CAM5.2, MNF116), white less specific, react in a similar localization pattern. oElectron microscopic findings are char9- cteristic, revealing a lobulated nucleus that may contain rodlets. The cytoplasm is electron- lucent and contains a prominent Golgi apparatus and numerous ribosomes. Intermediate filaments are numerous and often assume a parallel or whorled arrangement near the nucleus, accounting for the dot like pattern of cytokeratin distribution visualized by immunohistochemistry. Desmosomes may be present. Most diagnostic is the dense core granule (80-120 mn in diameter), the source and the locus of the neuroendocrine peptides.


Question: Turcot’s syndrome is not associated with

Odontone is associated with garderner syndrome.


Question: Ideal age for orchiopexy for cryptorchidism is

Ans. is 'd' i.e. < 1 yr of age Campbell's Urology writes - "Definitive treatment of an undescended testis should take place between 6 and 12 months of age. Because spontaneous descent occurs in most boys by 3 months of age and uncommonly thereafter, earlier interventions should be considered in order to theoretically prevent the complication of cryptorchidism that may be manifested before 1 yr of age


Question: In Lingual split technique, the instrument used to cut the tooth is


Question:
Alpha adrenergic agonists are used in combination
with Local anesthetics to

increase the rate of liver metabolism of local anesthetic

increase the concentration of L.A at receptor site


Question: Premalignant lesion for carcinoma rectum is

This autosomal dominantly inherited condition is characterised by the development of multiple rectal and colonic polyps around pubey. A colonoscopy and biopsy will confirm the diagnosis.as this condition is pre-malignant, a total colectomy must be performed; often, the rectum can be preserved, but regular flexible endoscopy and removal of polyps before they develop carcinoma are required. Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1228,1229


Question: The Hunterian Ligature operation is performed for

. Ans : (a) Aneurysm Hunterian ligature is a method of treatment of aneurysms, the parent aery is ligated on the proximal side of aneurysm above the first collateral.


Question: Treatment of calculus within the submandibular salivary gland is


Question: Most common presentation of Hirschsprung's disease

Clinical Presentation Neonates First few weeks of life Otherwise healthy children and adults Suspected in all neonates presenting with: Delayed passage of meconium beyond the first 24 hours of lifeQ Abdominal distension following feedsQ Suspected in any child presenting in first few weeks of life with: Gross abdominal distensionQ Chronic constipationQ Failure to thriveQ Sho segment Hirschprung disease should be suspected in otherwise healthy children and adultsQ presenting with: Severe constipation without fecal soilingQ Faecal soiling is usually not a feature of this condition. Investigation of choice - Rectal Biopsy (Suction Biopsy > full Thickness Biopsy)


Question: Slidding constituent of a large direct hernia is

Ans. is 'a' i.e., Bladder Sigmoid colon and Caecum slide into indirect sac not in direct sac


Question: Following aortic reconstruction, the viability of the sigmoid colon can most reliably be evaluated by

Viability of the colon can be evaluated intraoperatively by Doppler auscultation of the bowel mesentery and serosa, observation of bowel peristalsis, and measurement of the IMA stump pressure. A strong, pulsatile Doppler signal in the mesentery; active sigmoid peristalsis; a chronically occluded IMA; or a patent IMA with stump pressure greater than 40 mm Hg presage viability of the sigmoid colon postoperatively. However, none of these observations excludes the possibility of late sigmoid ischemia. Serial postoperative sigmoidoscopic examination is the best predictor of ischemic colitis and in experienced hands allows assessment of the depth of ischemic injury before frank perforation has occurred. Barium enema is not as accurate as sigmoidoscopy in determining depth of injury and carries grave risks of contamination by barium and feces if perforation occurs.

Intraoperative measurement of inferior mesenteric artery stump pressure

Intraoperative Doppler arterial signal in the sigmoid mesentery

Intraoperative observation of bowel peristalsis


Question: Banka's lesion is seen at

B i.e. Anterior surface of glenoid labrum


Question: Acute vascular ischemia mainfests as

Peripheral aery occlusion Clinical features of peripheral aerial occlusion are classically remembered by 5 P's : pain, pallor, pulselessness, paralysis and paraesthesia Some add 6th P: Poililothermia or perishing cold Most common presenting symptom of acute aerial occlusion : Pain Ref: Sabiston 20th edition Pgno :1756


Question: Commonest metastasis in Renal Cell Carcinoma is to


Question: Fibrocystic disease of the breast has been associated with elevated blood levels of

Fibrocystic disease (chronic cystic mastitis) is a common disorder of the adult female breast. It is rare after cessation of ovarian function, either natural or induced. Its association with estrogens is inferential. In postmenopausal women it only occurs when replacement estrogen therapy is in use. Its main clinical significance relates to the need to differentiate irregular breast tissue from cancer. Patients afflicted with this disorder are often frustrated by the repeated biopsies that may be recommended.


Question: Least malignant melanoma is


Question: Treatment of choice for Warthin's tumor is


Question: In case of blunt injury abdomen, the incision for emergency laparotomy should be

Upper midline incision extending down across the left of the umbilicus is the preferred incision. But surgeon should not be hesitant to extend the incision into the thorax or do horizontal T or extend as needed depending on the internal organ injury. Reference : SRB's Manual of Surgery, 6th Edition, page no = 142.


Question: Hangman's fracture is fracture of C2


Question: Most common cause of painful defecation is associated with

ANAL FISSURE Definition An anal fissure (synonym: fissure-in-ano) is a longitudinal split in the anoderm of the distal anal canal, which extends from the anal verge proximally towards, but not beyond, the dentate line. Clinical features Although simple epithelial splits, acute anal fissures are, because of their location involving the exquisitely sensitive anoderm, characterised by severe anal pain associated with defaecation, which usually resolves spontaneously after a variable time only to recur at the next evacuation, as well as the passage of fresh blood, normally noticed on the tissue after wiping. Chronic fissures are characterised by a hyperophied anal papilla internally and a sentinel tag externally (both consequent upon attempts at healing and breakdown), between which lies the slightly indurated anal ulcer overlying the fibres of the internal sphincter. When chronic, patients may also complain of itching secondary to irritation from the sentinel tag, discharge from the ulcer or discharge from an associated intersphincteric fistula, which has arisen through infection penetrating the fissure base. Although most sufferers are young adults, the condition can affect any age, from infants to the elderly. Men and women are affected equally. Anterior fissures account for about 10% of those encountered in women (and many of these may occur postpaum) but only 1% in men. A fissure sited elsewhere around the anal circumference or with atypical features should raise the suspicion of a specific aetiology, and the inability to be able to conduct an adequate examination in the clinic should prompt early examination under anaesthesia, with biopsy and culture to exclude Crohn's disease, tuberculosis, sexually transmitted or human immunodeficiency virus (HIV)-related ulcers (syphilis, Chlamydia, chancroid, lymphogranuloma venereum, HSV, cytomegalovirus, Kaposi's sarcoma, B-cell lymphoma) and squamous cell carcinoma. Ref: Bailey and love 27th edition Pgno : 1352


Question: Treatment of choice for Warthin's Tumor

The treatment of all benign tumors of the parotid gland is superficial parotidectomy.


Question: Frost bite is treated by

• Frostbite injuries affect the peripheries in cold climates.
• The initial treatment is with slow rewarming in a bath at 42 °C.
• The cold injury produces delayed microvascular damage.
• Level of damage is difficult to assess.
• Surgery usually does not play a role in its management, until there is absolute demarcation of the level of injury.


Question: Splenectomy is least useful in

Hereditary nonspherocytic haemolytic anaemia


Question: In an elective lap cholecystectomy with no gross spillage, antibiotics required are

Elective lap cholecystectomy is a clean-contaminated surgery, single preoperative IV antibiotic during decisive period is sufficientThere is no evidence that fuher doses of antibiotics after surgery are of any value in prophylaxis against infectionWhen wounds are heavily contaminated or when an incision is made into an abscess, a 5-day course of therapeutic antibiotics may be justifiedRef: Bailey and Love 27e pg: 53

Single dose of Preoperative IV antibiotic followed by a 5 day course of oral antibiotics

Post operative IV antibiotics for 1 day followed by a 5 day course of oral antibiotics

Single dose of Preoperative IV antibiotic only


Question: The least significant finding in the palpation of neck nodes is


Question: Calciphylaxis is more commonly seen in

Calciphylaxis (calcific uraemic aeriolopathy) is a syndrome of disseminated calcification resulting in both vascular calcification and skin necrosis. It accounts for approximately 4% of patients undergoing surgical intervention for secondary hyperparathyroidism. It presents with expanding painful cutaneous purpuric lesions, predominantly on the extremities, although it can also be seen on the lower abdomen.Ref: Bailey and Love 27e pg: 831


Question: Collar stud abscess occurs in


Question: A patient of burns should be given


Question: "Moon face" appearance is seen in


Question: The latent period in distraction osteogenesis is


Question: Name the incision

This is Chevron incision or roof-top incision or bilateral subcostal incision. Used in PancreaticoduodenectomyKochers is right subcostal incision, for open cholecystectomyLanz incision used in appendicitisMaylard for pelvic surgeries, rectus muscle is cut in this


Question: Most common cause of Bacteremia includes

(B) Post Sigmoidoscopy # BACTERAEMIA is unusual following superficial SSIs.> Common after anstomotic break down (deep SSIs).> Bacteraemia is dangerous if the patient has a prosthesis.> Sepsis accompanied by MODS may follow anastomotic leak.> Bacteraemia is common after indwelling catheterization.# Bacteraemia is common after endoscopy especially colonoscopy or sigmoidoscopy.


Question: Banka's lesion is seen in

C i.e. Anterior glenoid cavity Two major lesions in patients with Recurrent Anterior Dislocation Banka lesion - An anterior capsule injury associated with the tear of the glenoid labrum off the anterior (more specifically anteriorinferior) glenoid rimQ.Banka described the essential lesion as stripping off fibrocailagenous labrum from anterior glenoid which did not heal.As capsular ruptures & anterior glenoid ri m fractures usually heal rapidly these did not play significant role in recurrent dislocation. Hill- Sachs Lesion It is compression fracture of the postero lateral aicular surface of humeral headQ (more specifically on superior aspect)- With the trauma of repeated dislocation, the humeral head is forced upon glenoid rim and the relatively soft bone of humeral head is curshed. The end result is an impression of the glenoid rim that is made on the humeral head. As such these "defects are often referred to as "impression fractures".- In anterior dislocation these defects are created on the posterolateral aspect of humeral head & referred to as Hill Sachs lesion. And in posterior shoulder dislocation these defects are created on anteramedial aspect of humeral head and referred to as reverse Hill Sachs lesion.


Question: Papillary ca thyroida) Most common thyroid cancerb) Psammoma bodies seenc) Encapsulatedd) Blood borne metastasis is common

"Most patients are euthyroid and present with a slow-growing painless mass in the neck Dysphagia, dyspnea, & dysphonia are usually associated with locally advanced invasive disease. Lymph node metastases are common, especially in children and young adults, and may be the presenting complaint. The so called 'lateral aberrant thyroid', almost always denotes a cervical lymph node that has been invaded by metastatic cancer. Diagnosis is established by FNAB of the thyroid mass or lymph node" - Schwartz Surgery
More about Papillary Ca thyriod

PTC is the most common type of thyroid carcinoma
More common in females with female : male ratio of 2 : 1.
Mean age at presentation is 30 to 40 years
Most common presentation is a painless nodule in neck or a cervical lymph node (lateral aberrant thyroid) Spread to the lymph nodes is common but blood borne metastasis is unusual.
Multiple foci may occur in the same lobe as the primary tumor or, less commonly in both lobes (this may be due to lymphatic spread in the rich intrathyroidal lymph plexus, or due to multicentric growth).
Diagnosis is confirmed by FNA biopsy of the thyroid mass or lymph node.


Question: Serum calcitonin may be elevated in

Calcitonin is a polypeptide of 32 amino acids derived from ultimobranchial body. It is secreted from C cells of thyroid (parafollicular cells). It lowers the plasma calcium and phosphorus levels. It blocks the PTH induced bone resorption. Calcium from the circulation is shunted into the bone. It increases the excretion of calcium, phosphorus, sodium and potassium. Normally it is less than 0.08 ng/L (undetectable). It is increased in medullary carcinoma of thyroid. It is very good tumour marker for MCT. It confirms the relapse/ metastases/residual disease. Increased levels in family members confirm the genetic relation and such relatives should undergo prophylactic total thyroidectomy. Reference : page 488 SRB's manual of surgery 5th edition


Question: Hematoma formation is more frequent with


Question: Subcapsular plexus of lymphatics from the thyroid drains into


Question: Golden period for treatment of open wounds is …………………….. hours


Question: Most common muscle involved in volkmann's ischemic contracture is


Question: Basal cell carcinoma treatment of choice is

Basal cell carcinoma Locally invasive carcinoma, Arises from the basal layer of epidermis. MC type of skin cancer 90% of BCC are seen in the face, above a line from the corner of mouth to lobule of ear MC site : Nose >Inner canthus of the eye, also known as tear cancer Treatment Non-aggressive tumor on trunk or extremities: Excision or electrodissection and curettage Large, aggressive, located at vital areas or recurrent : Moh's micrographic surgery Ref: Sabiston 20th edition Pgno : 748


Question: Intraoperative sentinel lymph node detection in axilla is done by using

. The first axillary node draining the breast (by direct drainage) is designated as the sentinel node (SLN). Sentinel node is localised by preoperative (within 12 hours prior) or peroperative injection of patent blue (Isosulfan vital blue dye 2.5-7.5 ml) or 99m TC radioisotope labelled albumin (one mCi on previous day)/sulphur colloid (6 hours before) near the tumour (peri tumour area) or into subdermal plexus around the nipple SLN Biopsy is done in all cases of early breast cancers, T1 and T2 without clinically palpable node. It is not done in clinically palpable axillary node as there is already distoion of lymphatic flow due to tumour.I t is also not done in multifocal and multicentric tumours, as there is involvement of many lymphatic trunks from different places of breast, and chances of false-negative is high.. Ref; (page no; 543) 5th edition of SRB&;S manual of Surgery


Question: Rupture of the male urethra immediately inferior to the urogenital diaphragm leads to extravasations of urine into the

Tmmediately inferior to the urogenital diaphragm in the male, the urethra enters the bulb of the penis within the superficial perineal space. Also within this space are the crura of the penis, the ischiocavernosus muscles, the bulbospongiosus iriuscie, and the superficial transverse perineal muscle. The superficial perineal space is bound inferiorly by Colic's fascia. Colic's fascia is attached to the ischiopubic rami laterally and the posterior border of the urogenital diaphragm. When urine extravasates into the superficial perineal space, it can pass into the anterior abdominal wall, the penis, and the scrotum.


Question: Mycotic abscesses are due to

As the name suggests, mycotic abscesses are caused by fungal infections.
However remember that mycotic aneurysm is a misnomer and is caused due to bacterial infection of arterial wall. The infection weakens the wall to cause aneurysm formation (Organisms are usually Staphylococcal, streptococcal, or salmonella)


Question: Post operative abscess treatment of choice

Localised infection An abscess may present with persistent abdominal pain, focal tenderness and a spiking fever. The patient may have a prolonged ileus. If the abscess is deep-seated these symptoms may be absent. The patient will have a neutrophilic leucocytosis and may have positive blood cultures. An ultrasound or CT scan of the abdomen should identify any suspicious collectionand will identify a subphrenic abscess, which can otherwise be difficult to find and aspiration is done under ultrasound Ref: Bailey and love 27th edition Pgno : 297


Question: Annual risk of having breast cancer by mammography is


Question: Temporal bone metastasis is seen with

Temporal Bone metastasis Metastatic tumors to the temporal bone are uncommon Usually seeded by the Hematogenous route. MC metastatic lesion in the temporal bone : CA breast Lung, prostate and renal carcinomas are well documented for their metastatic potential to the temporal bone Ref: www.ncbi.nlm.gov.63(suppl 1) Jul 2011


Question: Ca breast in females is least related to

Mutation of tumour suppressor genes BRCA1 % BRCA2 is thought to be involved with high risk of breast carcinoma. BRCA1 mutation is having more risk (35-45%) than BRCA2 mutation. BRCA1 is located in the long arm of chromosome 17, whereas BRCA2 is located on the long arm of chromosome13. Li-Fraumen's syndrome(LFS) is autosomal dominant condition with breast cancer inheritance(90%). Breast cancer is also associated with ataxia telangiectasia. But comparing others it is least related to. Reference: SRB's Manual of Surgery, 6th Edition, page no = 522.


Question: Investigation of choice for diagnosis of CA colon

Colonoscopy is the "gold standard" for establishing the diagnosis of colon cancer. It permits biopsy of a tumour to verify the diagnosis while allowing inspection of the entire colon to exclude metachronous polyps or cancers; the incidence of a synchronous cancer is approximately 3%. Colonoscopy is generally performed even after a cancer is detected by barium enema to obtain a biopsy specimen and to detect (and remove) small polyps that may be missed by the contrast studyRef: Sabiston, 20e, page: 1398


Question: Splenectomy is not indicated for

Ans. (a) SarcoidosisRef Bailey And Love 27th edition Page 1185 Indications for SplenectomyTraumaHematologicalOncologicalPortal hypertension* Accidental* Operative trauma* HereditarySpherocytosis* ITP* Hypersplenism* Part of En bloc Resection in Gastrectomy or pancreatectomy* Diagnostic for Lymphoma* Therapeutic for spleen tumors* Part of Shunt operations and Variceal surgery* PSRS shunt* Sugiura operation


Question: Most common area of pressure sore is

Pressure sore frequency in descending order Ischium Greater trochanter Sacrum Heel Malleolus (lateral than medial) Occiput Bailey and Love 27e pg: 29


Question: Glasgow coma scale of a patient with head injury. He is confused, able to localize on right side and does flexion on left side and opens eye for painful stimuli on sternum.

Ans. b. 11Ref: Bailey and Loves Short Practice of Surgery 27th Ed; Page No-331GLASGOW COMA SCALEEyes openVerbalMotorResponseScoreResponseScoreResponseScoreSpontaneously4Normal oriented conversation5Obeys commands6To verbal command3Confused4Localizes to pain5To painful stimulus2Inappropriate/words only3Withdrawal/flexion4Do not open1Sounds only2Abnormal flexion3 No sounds1Extension2 No motor response1 1Confused sate=4Able to localize the pain=5Eye opens for painful stimuli=2Total value of coma scale=4+5+2=11


Question: Gasless abdomen in X ray seen in

Causes of Gasless Abdomen: * Mesentric Ischemia * Midgut volvulus * Acute Pancreatitis Signs in X ray in Acute Pancreatitis:- * Colon cut off sign * Sentinel Loop * Ground glass appearance * Renal halo sign * Gasless abdomen Ref:- Surgery Sixer; Pg num:- 692


Question: Curling ulcers are commonly seen in

.DUODENAL ULCER FOLLOWING SUPERFICIAL BURNS ARE CALLED CURLING&;S ULCER


Question: The colloidal plasma expander used in treatment of hypovolemic shock is


Question: A previously healthy 6 week old female infant is found unresponsive in her crib. In the emergency depament, she is noted to be well developed and well nourished with normal blood pressure and appearance of the genitalia but with increased pigmentation of her skin. Blood glucose level is 30 mg/dL. The most likely diagnosis is aEUR'

Familial glucocoicoid deficiency Familial glucocoicoid deficiency is a rare autosomal recessive condition. It is characterized by adrenal insufficiency. The pathological examination of the adrenal gland reveals that:- This causes low coisol concentration because the zona fasciculata is primarily responsible for glucocoicoid production. Because the zona glomerulosa is well preserved mineralocoicoid action is usually unaffected. Low circulating serum coisol results in lack of feedback inhibition to the hypothalamus which results in increased ACTH secretion from pituitary. Clinical features Zona glomerulosa --> well preserved Zona fasciculata atrophied Zona reticularis --> atrophied Patients with familial glucocoicoid deficiency generally presents with signs and symptoms of "adrenal insufficiency" with the impoant distinction that mineralocoicoid production is always normal. The most common initial presenting sign is "deep hyperpigmentation" of the skin, mucous membrane or both as a result of the action of adrenocoicotrophic hormone (ACTH) on cutaneous melanocyte stimulating hormone (MSH) receptors. The symptoms are compatible with glucocoicoid deficiency. Many patients presents with recurrent hypoglycemia or severe infections. - In the neonatal period, frequent presenting signs include - feeding problems, failure to thrive, regurgitation and hypoglycemia manifesting as seizures

CAH due to 21 alpha hydroxylase deficiency


Question: Use of tamoxifen in carcinoma of breast patients does not lead to the following side effects.

Ans. is 'd' i.e. Cancer in opposite breast Adverse effects of Tamoxifen: - Hot flushes, nausea vomiting (most common side effects)*Menstrual irregularities, vaginal bleeding, discharge, pruritus vulvae & dermatitisEndometrial cancerThromboembolismCataractsRetinal deposits & decreased visual acuityUses of Tamoxifen: -Estrogen receptor positive breast cancer: used in both pre and postmenopausal women.May slow the development of osteoporosis in postmenopausal women (due to its estrogenic effect)


Question: Best screening marker of prostate cancer is

B. i.e. (Prostate - specific antigen) (1045 - CSDT 12th)* Combination of digital rectal examination and serum PSA monitoring is the most effective screening protocol* AFP is elevated in 70% of patients with non seminomatous testicular cancer but is not elevated in patients with seminoma *** AFP| in - Hepatocellular CA, Gonadal germ cell tumour, cirrhosis. Hepatitis* Finding of a PSA > 10 nmol/ml is suggestive of cancer and > 35 ngml is almost diagnostic of advanced prostate cancer. A decrease in PSA to the normal range following hormonal ablation is a good prognostic sign* Trans rectal ultrasonogram in evaluation of carcinoma prostate most useful for - Taking guided biopsy*** CA of prostate arise from peripheral zone** and BPH from Transition zones**


Question: Flail chest is defined as

Flail chest : Fracture of two or more consecutive ribs, with each rib having two or more fracture sites. Such segment is called flail segment. Ref : SRB&;s 4thE pg:1196

Fracture of 3 or more ribs at 2 or more places

Fracture of 2 or more ribs at 2 or more places


Question: The incidence of breast cancer

Breast cancer is rarely seen before the age of 20, but thereafter its incidence increases inexorably. While the prevalence of breast cancer (the raw number of patients alive with disease) is greatest among perimenopausal women, the incidence of breast cancer (the number of new cases per 100,000 population) rises so sharply that it is twice as common among women between 80 and 85 years of age as among those 60 to 65. In addition, the age-adjusted incidence has increased steadily since the mid-1940s. No data is presently available consistently linking the incidence of breast cancer to dietary factors. A possible linkage between breast cancer and alcohol consumption at an early age is being studied.


Question: Antoni A & Antoni B Pattern's are seen in

Schwannoma *Distinctive histologic patterns seen within the peripheral nerve sheath tumor Schwan noma include the Antoni A and Antoni B regions oThese are the classic microscopic appearances of a schwannoma, which is benign. oNote the more cellular "Antoni A" pattern on the left with palisading nuclei surrounding pink areas (Verocay bodies). On the right is the "Antoni B" pattern with a looser stroma, fewer cells, and myxoid change. oNotice the whirly swirly pattern and how the cell nuclei are closely bunched together ... almost as if they're forming a fence (Verocay bodies). oSchwannomas are benign spindle cell tumors that occur along the edges of peripheral nerves.They can usually be removed without damaging the nerve itself.


Question: Interval cholecystectomy surgery is

When there is no information but entry to genitourinary or gastrointestinal systems it is clean contaminated.


Question: Investigation of choice in an unstable patient with suspected intraabdominal injury is

The investigation of choice in an unstable patient with suspected intraabdominal injury is ultrasound. Focused abdominal sonar for trauma(FAST) is a technique whereby ultrasound(sonar) imaging is used to assess the torso for the presence of free fluid, either in the abdominal cavity, and is extended into the thoracic cavities and pericardium(eFAST). eFAST is accurate at detecting <100ml of free blood. CT is the gold standard for the intr-abdominal diagnosis of injury in the stable patient. Reference: Bailey & love, 27th Edition, page no = 372.


Question: Blood stained nipple discharge is seen in

Discharge can occur from single or multiple ducts. The discharge acn be clear serous discharge ,blood stained,black or greenish discharge. Blood stained discahrge is seen in duct ectasia,duct papilloma,mammary dysplasia. Bailey and Love'sSho practice of surgery.Edition 23.Pg no:753


Question: Treatment of choice in Medullary Ca thyroid

Surgery is the main therapeutic modality. Total thyroidectomy with bilateral central node dissection and ipsilateral lateral neck dissection if primary tumor is greater than 1cm or central nodes are positive. Reference: SRB's Manual of Surgery, 6th Edition, page no= 477. Reference: Bailey & love, 26th Edition, page no =769.

Total thyroidectomy + Radical neck dissection


Question: Management in case of rupture of disc at L5, S1 is

C i.e. Immobilization for 2 weeks with spinal brace


Question: Saggital split osteotomy was first advocated by


Question: Not an indication for PAIR treatment in hydatid cyst

INDICATIONS for PAIR (Puncture-Aspiration-Injection -and Reaspiration) .Inoperable patients * Patients who refuse surgery * CL, CE 1, CE 2 and CE 3 types * Anaphylaxis - 0.1 - 0.2% * Relapse cysts * Infected cysts * In pregnant women; * Cysts more than 5 cm in trolled by antibiotics different liver segments * Local recurrences - 4% - repeat PAIR can be done. ref: SRB&;S manual of surgery, ed 3, pg no 536


Question: Hilton's method of incision and drainage of abscess has the advantage of

Hilton's method of incision and drainage of abscess is used in neck, axilla and axilla. It avoids injury to underlying vessels and nerves.

Avoids injury to underlying vessels and nerves


Question: The use of 5% dextrose as an intravenous resuscitation fluid can

5% dextrose is a free water solution. Dextrose gets metabolised and plasma osmolality is decreased. This increases the brain oedema in head injury and hence should be avoided.

Provide glucose substrate for cerebral metabolism

Reduce intracranial pressure and cause lacity of brain

Reduce serum osmalality and cause brain edema


Question: Massive bleeding per rectum in a elderly patient is due to

MCC of massive bledding per rectum is diverticulosis.


Question: In supra condylar fracture of humerus, the nerve most commonly injured is

C i.e. Median nerve Anterior interosseous nerve is the most commonly injured nerve with loss of motor- power to flexor pollicis longus & deep flexor to the index finger in extension type supracondylar fractureQ Over all involvement of peripheral nerve in fracture supracondylar humerus is AIN > median nerve > radial nerve > ulnar nerveQ


Question: Crohn's disease is associated with polymorphisms in

Individuals with allelic variants of CARD15/NOD2 have a 40 fold relative risk for Crohn's disease compared with general population. Reference : Sabiston Textbook of Surgery, 19th Edition, page no = 1245.


Question: Imatinib mesylate used in the treatment of GIST is a inhibitor of

Imatinib mesylate used in the treatment of GIST ( GastroIntestinal Stromal Tumours) is a c-kit(transmembrane receptor tyrosine kinase) tyrosine kinase inhibitor. GIST is rare but most common nonepithelial small bowel tumours. More than 95% show c-kit mutation. Reference : page 877 SRB's manual of surgery 5th edition


Question: Popliteal aery pulsations are difficult to feel because

Popliteal aery is difficult to feel.It is palpated better in prone position with knee flexed about 40-50 degree,to relax the popliteal fascia.It is felt in the lower pa of the fossa over the flat posterior surface of upper end of tibia.In upper end of the fossa,aery is not felt as there is no bony area in intercondylar region. Refer page no173 of SRB's manual of surgery 5 th edition.

It is not superficial and does not cross prominent bone


Question: Splenomegaly is least likely associated with aEUR'

Primary thrombocytosis The question is about the differential diagnosis of myeloprohferative syndrome. - Myeloproliferative disorders are characterized by splenomegaly except for essential thrombocytosis. In Essential thrombocytosis - "Physical examination is generally unremarkable except occasionally for mild splenomegaly. Massive splenomegaly is more indicative of another myeloproliferative disorder in paicular polvcythetnia vera, idiopathic mvelofibrosis and chronic myeloid leukemia".


Question: Squamous cell carcinoma


Question: Most common site of intraperitoneal abscess is

Ans. (c) Right inferior Intraperitoneal spaceRef: Bailey 26th edition Page 978* MC site of Intra abdominal abscess- Pelvic abscess in Sitting posture* MC site of abscess in lying and dependent posture- Right Inferior intra peritoneal space (Right subhepatic- Morrison pouch)


Question: Corynebacterium minutissimum is causative in

Erythrasma is caused by corynebacterium minutissimum.


Question: BRCA 1 gene is located on

BRCA1 (on chromosome 17q21) and BRCA2 (on chromosome 13q12.3) are both large genes, and hundreds of different mutations distributed throughout their coding regions have been associated with familial breast cancers.Ref: Robbins; 9th edition; Chapter 23; The Breast; Page no: 1054


Question: Best Material for below inguinal arterial graft is

Critical limb ischemia (CLI) is defined by the presence of ischemic rest pain in the distal foot, ischemic nonhealing ulcerations, or gangrene.
CLI is the progressive evolution and clinical manifestation of peripheral arterial disease (PAD).
It is seen in patients with severe arterial occlusive disease in whom resting blood flow cannot accommodate basal nutritional needs of the tissues.
Patients will complain of rest pain or a feeling of cold or numbness in the foot and toes.
Frequently, these symptoms occur at night when the legs are horizontal and improve when the legs are in a dependent position. With severe ischemia, rest pain may be persistent.


Question: Bismuth classification for cholangiocarcinoma, type IV is

Answer- C. Bifurcation and B/L secondary intrahepatic ducts

Bifurcation and B/L right secondary intrahepatic ducts


Question: Not a cause of acute anal pain


Question: Wolf's graft is


Question: In flexion injuries causing supracondylar fractures, the distal fragment is often displaced to

A i.e. Anterior Most common type of elbow injury in children Fracture supracondlar humerusQ (-- 50- 70% of & adolescents all elbow injuries) Most common type of supracondylar fracture Extension typeQ (-98% of all supracondylar ) Most common type of distal fragment Posterior (dorsal/ backward) shift and tiltQ displacement in fracture supracondylar humerus or extension type fracture supracondylar humerus (because it occurs in extension type) Most common type of displacement in flexion type fracture supracondylar humerus Anterior displacement & angulation tiltQ Most common cause of supracondylar fracture Hyperextenson injuryQ


Question: GIST is most common in

Most common nonepithelial tumour of the gastrointestinal tract in which most common site is the stomach about 50%, small intestine constitute about 25%, rectum 15% & colon 10 %. Reference SRB 5 th edition page no. 857


Question: Postero lateral anconeus triangle is formed by

B i.e. Head of radius, lateral epicondyle, olecranon Radial head, lateral epicondyle and tip of olecranonQ form a triangle over the posterolateral aspect of elbow joint. This space is occupied by anconeus inuscle(2 and so known as anconeus triangle.

Head of radius, lateral epicondyle, medial epicondyle

Olecranon, medial epicondyle, neck of radius

Neck of radius, head of radius, lateral epicondyle


Question: Pre tracheal and para tracheal LN are


Question:
In staging of Hodgkin's lymphoma, bilateral involvement
of lymph nodes on either side of diaphragm is


Question: Investigation for injury of knee cailage


Question: Inversion of nipple occurs due to the involvement of

Breast carcinoma arising from lactiferous ducts is called as ductal carcinoma.

Breast carcinoma arising from lobules is called as lobular carcinoma. It is 10% common.

Cutaneous Manifestations of Carcinoma Breast

Peau d’orange: Due to obstruction of dermal lymphatics, openings of the sebaceous glands and hair follicles get buried in oedema giving rise to orange peel appearance.
Dimpling of skin due to infiltration of ligament of Cooper.
Retraction of nipple due to infiltration of lactiferous duct.
Ulceration, discharge from the nipple and areola.
Skin ulceration and function.
Cancer-en-cuirasse: Skin over the chest wall and breast is studded with cancer nodules appearing like an armour coat.


Question: MC intracranial Brain tumor in adults

Ans. (b) MetsRef: Bailey 27th edition Page 663* MC brain tumor is Cerebral mets* MC primary to produce brain mets Lungs (40%) > Breast (15%)


Question: The addition of hyaluronidase to a local anesthetic solution might


Question: The least common site of volvulus in children is

.It is the twist (rotation) in the axis of the loop of the bowel either clockwise or anticlockwise. * 15% of large bowel obstruction is due to volvulus. * Sigmoid colon is the commonest site (anticlockwise)-- 65%. * Caecum is the second common site (clockwise) (C for C)--30%. It is common in females, present as intestinal obstruction. Resection and anastomosis is the treatment. *Caecal volvulus is the commonest cause of large bowel obstruction in pregnancy. X-ray shows round gas shadow in right iliac region. CT scan is very useful. Barium enema is also helpful. * Volvulus of small intestine (midgut), volvulus neonatorum, gastric volvulus are other volvulus which can occur. ref:SRB&;s manual of surgery ,ed 3,pg no 868


Question: The diagnosis of congenital megacolon is confirmed by

-Biopsy from all three zones to study the ganglions and hyperophic nerve terminals in spasmodic segment. Staing from 2 cm above the dentate line, a full thickness rectal biopsy is ideal. * Barium enema is done to look for the extent of disease and three zones. Foley's catheter should not be used while doing barium enema in case of Hirschsprung's disease * Anorectal manometry--shows the absence of rectoanal reflex in Hirschsprung's disease, which is diagnostic. * Acetylcholine esterase staining shows hyperophied nerve bundles. ref:SRB &;s manual of surgery,ed 3,pg no-819


Question: Commonest site of Maltoma is


Question: Trauma and Injury Severity score (TRISS) includes

TRISS methadology is impoant because it attempts to combine the Revised trauma score (S),physiologic component of injuryand the Injury severity score (ISS), anatomic component of injury. It also incorporates patient&;s age. Reference: Greenfield&;s Surgery - Scientific Principles & Practices, 5th edition, Page no :390-391.


Question: Most common cause of thoracic aortic aneurysm is

(A) AtherosclerosisDISEASES OF THE AORTA: ETIOLOGY & ASSOCIATED FACTORSAortic aneurysmAortic occlusion* Atherosclerosis* Atherosclerosis* Cystic medial necrosis* Thromboembolism* Tuberculosis* Aortitis* Syphilitic infection* Syphilitic aortitis* Mycotic infection* Rheumatic aortitis* Rheumatic aortitis* Takayasu's arteritis* Trauma* Giant cell arteritis* Aortic dissection * Cystic medial necrosis * Systemic hypertension * Atherosclerosis * Takayasu's arteritis * Giant cell arteritis


Question: Pat's fracture is fracture of

B i.e. Lower end of tibia + fibula Pott's fracture is bimalleolarQ and cotton's fracture is trimalleolar fractureQ. Name of Fracture Site of Fracture Jefferson's Fracture Atlas veebrae (C1) Hangman's Fracture Axis veebra (C2) Clayshovellers Fracture Spinous process of C7 veebraeQ Monteggia Fracture Dislocation Fracture of proximal third of ulnaQ with disolation of proximal radioulnar jointQ Galleazzi fracture Dislocation Fracture of distal third of radiusQ with dislocation of distal radioulnar jointQ Colle's Fracture Distal metaphyseal fracture of radius with dorsal displacement & angulationQ Smith's fracture (Reverse Colle's) Hand and wrist displaced volarly with respect to forearm in distal metaphyseal fracture of radius. Baon's Fracture Fracture through the aicular surface of distal radius with subluxation of wrist. Chauffer's Fracture Radial styloid fracture Night Stick Fracture Isolated fracture of shaft ulna Bennet's Fracture Dislocation Paial fracture of 1st metacarpal base with trapezium - metacarpal joint dislocationQ Rolando's Fracture Dislocation Comminuted intraaicular (T or V) fractures of base of 1st metacarpal Boxer's fracture Fracture neck of 5th metacarpal Maisonneuve's fracture Ankle fracture a/w spiral fracture of neck of fibula Ator's fracture Fracture neck of talus Pott's Fracture Bimalleolar (medial & lateral malleolar) fractureQ. Cotton's Fracture TrimalleolarQ (medial, lateral & posterior malleolar) fracture. Pilon (explosion) Fracture When a large force drives the talus upwards against the tibial plafondQ, like a pestle (pilon) being struck into a moar, causing damage to the aecular cailage & subchondral bone (into several pieces) Lisfranc's fracture dislocation Fracture dislocation through tarsometatarsal joint Chopa fracture dislocation Through intearsal joints March Fracture Stress fracture of 2nd metatarsal neck Jone's Fracture Fracture of base of 5th metatarsal.


Question: In hepatocellular carcinoma, risk factor most important is

Cirrhosis is the most important risk factor for HCC.
"75-85% of HCC occur in patients with macronodular cirrhosis" - Harrison


Question: In patients with facial disproportion producing malocclusion

an osteotomy alone in the mandibular ramus can be used to close an anterior open bite.

a sagittal split osteotomy commonly produces inferior dental nerve paraesthesia

an intra oral vertical sub sigmoid osteotomy is appropriate for treating mandibular retrognathia.

following a down fracture of the maxilla at Le Fort I level the blood supply to the alveolus relies only on the integrity of the greater palatine artery


Question: The most significant adverse consequences of accidental intravenous administration of a local anesthetic is


Question: Dermoid cyst is a form of


Question: Test of primary hemostasis


Question: In the abdomen, aneurysms of the .... commonly occur next only to the aoa ....


Question: A patient presents with acute renal failure with normal ultrasound abdomen repo. Next most useful investigation is


Question: Pringle&;s maneuver is mainly used to control bleeding from

Pringle&;s manoeuvre is done by compressing the poa near foramen Winslow to control bleeding from poal vein as well as from hepatic aery ( not more than 30 min)Reference SRB edition 5 page no. 149


Question: Medical management of insulinoma is

Medical management is reserved only for patients who are unable or unwilling to undergo surgical treatment or for unresectable metastatic disease. Diazoxide suppresses insulin secretion by direct action on the beta cells and offers reasonably good control of hypoglycaemia in approximately 50%.Ref: Bailey and Love 27e pg: 849


Question: Most impoant prognostic indicator for renal cell carcinoma

Impoant prognostic factors for cancer-specific survival in patients with nonmetastatic RCC include specific clinical signs or symptoms, tumor-related factors, and various laboratory findings . Overall, tumor-related factors such as pathologic stage,tumor size, nuclear grade, and histologic subtype have the greatest utility on an independent basis. However, an integrative approach, combining a variety of factors that have proved to have independent value on multivariate analysis, appears to be most powerful Pathologic stage has proved to be the single most impoant prognostic factor for RCC ref : Campbell-Walsh 11th ed , chapter 57 , pg no :- 1339


Question: Most common origin of cerebral metastases is

Metastatic Brain Tumors Metastatic brain tumors are the most common tumors of the brain They out number primary brain tumors by 10 to 1 Location: Cerebral hemispheres (80%) mainly the frontal lobes, cerebellum (15%) and brain stem (5%) Most common primary sites : CA Lung (50%) >breast cancer(15-20%) Metastasis to brain are multiple in >70% of cases Ref: Harrison's 19th edition Pgno :1604


Question: Most common site of adenocarcinoma among the following

Ans. (a) DuodenumRef: Sabiston 19th edition, Page 1263* Most common type of cancer in small intestine is adenocarcinoma* Most common site is duodenum > proximal jejunum


Question: Urinary stone formed in patients with regional bowel enteritis is

Calcium oxalate stones are more common in Crohn's patients (regional bowel enteritis)than in the general population because of fat malabsorption. Fat binds to calcium, leaving oxalate free to be absorbed leading to hyperoxaluria and deposition in the kidney, where it can form into stones ref : Bailey 27th edition , chapter 76 , 69 , pg no :- 1406 , 1244


Question: The most frequent trace mineral deficiency developing in a patient receiving parenteral alimentation is a deficiency of

Zinc deficiency is marked by an eczematoid rash either diffusely or in interiginous areas. A microcytic anemia can develop from a lack of copper and glucose intolerance and may be associated with a lack of chromium. Daily administration of trace metal supplements obtes these problems.


Question: BISAP score is used for to assess severity of


Question: Genitourinary TB in a male patient presents with

symptoms of GU TB are often non specific.Typical TB constitutional symptoms of fever , weight loss , night sweats and malaise are seen in less than 20%.upto 50% have only dyspnoea on presentation.50% have storage symptoms . 33% have hematuria and flank pain.Typical laboratory finding include sterile pyuria and/or hematuria and is found in more than 90% of patients in developing countries. ref: Campbell-Walsh urology 11th edition . pa1 .chapter 17 .pg no 422


Question: Ideal graft for leg injury with 10 x 10 cm. exposed bone

For a skin graft (Full thickness or split thickness or amniotic membrane) to survive, it must be revascularized by recipient bed. Radiation damaged tissues and relatively avascular structures such as bone, tendon, cartilages are therefore poor recipient sites.
So an exposed bone surface is covered by a graft which has its own blood supply. Such grafts are k/a flaps or pedicle grafts.
Sabiston writes - "Pedicle graft or flap is a partially or completely isolated segment of tissue with its own blood supply."

"Absolute indications for flaps -
exposed bone, radiated vessels, brain, an open joint or nonbiological implants materials. Pressure sores where a bony prominence is exposed."


Question: Sistrunk operation is done for

Treatment must include excision of the whole thyroglossal tract, which involves removal of the body of the hyoid bone and the suprahyoid tract through the tongue base to the vallecula at the site of the primitive foramen caecum, together with a core of tissue on either side. This operation is known as Sistrunk's operation and prevents recurrence, most notably from small side branches of the thyroglossal tract Bailey & Love ,5th,730.


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

Ans. is 'a' i.e. Antibiotics according to organism


Question: Cryptoorchidism is associated with malignant changes to

(Seminoma): (1307-1308-S. Das 7th edition; 1378-Bctily & Love 26th)CRYPTORCHIDISM - predisposes to testicular cancer, with the incidence increasing inversely with the level of testicular descent (i.e testicles remaining in the abdomen have a much incidence of cancer) Seminoma is more common in this situationHazards of incomplete descent are* Sterility in bilateral cases (especially intra- abdominal cases)* Indirect inguinal hernia* Pain, Torsion* Epididymo-orchitis can mimic appendicitis* Atrophy of an inguinal testis before puberty* An incompletely descended testis is smaller than the normally descended testis is smaller than the normally descended testis and it may undergo more atrophy particularly when it is situated in the inguinal canal due to recurrent trauma* An completely descended testis tends to atrophy as the boy approaches puberty, atrophy of an inguinal testes can occur even before puberty, possibly due to recurrent minor trauma**** Orchidopexy (synonym-orchiopexy) consists firstly of mobilization of the testis and spermatic cord and secondly retaining the testis in the scrotum* Most pediatric surgeons perform orchidopexy at around the first year of life*** Preoperative localization of the intra- abdominal undescended testis using CT, MRI or ultrasound may be helpful, laparoscopy is currently the procedure of choice**


Question: Commonest complication of Pseudocyst of the pancreas is

.Complications of pseudocyst--* Rupture--3% - into bowel or peritoneum * Infection, commonest--20% * Bleeding from the splenic vessels--7% * Cholangitis * Duodenal obstruction * Poal/splenic vein thrombosis and segmental poal hypeension * Cholestasis due to CBD block ref:SRB&;S manual of surgery,ed 3,pg no 623


Question: The most frequent symptom of gastric diveiculum is

Ans. is 'a' i.e. Epigastric pain' Most gastric diveicula occur around the posterior asepct of the cardia or fundus. Mostly they are asymptomatic and are discovered incidently. Symptoms occur due to complications - diveiculitis - cuasing pain or bleeding Well I am not very sure of the answer but must be pain because of diveiculitis. However the most common presentation is asymptomatic.


Question: Left medial sector contains segment

Left medial sector contains segment III and IV Left lateral sector contains only one segment II Ref: Sabiston 20th edition Pgno : 1421-1422


Question: During endoscopic surgery the position of patient is

The reverse Trendelenburg position is one in which a person is lying supine with the head elevated higher than the rest of the body and the feet suppoed with a foot board. It is the opposite of the Trendelenburg position, in which a person is placed in a supine position with the foot of the bed raised about 30 to 45 degrees. Reverse trendelenburg position improves endoscopic field of view and reduces intraoperative blood loss compared to other positions. It also helps to achieve an effective level of epidural or spinal anesthesia, prevent pulmonary aspiration due to vomiting. In lithotomy position, the patient lies on his back, the legs are flexed in the hip (90 degrees) and abducted (30 degrees) in the hip. The knees are bent 70 to 90 degrees, the lower legs are suppoed on padded leg shells.This position of the patient is needed for examinations or operations in urology, gynecology or proctology. The lithotomy position is also used as a common position for childbih.


Question: 40 years old patient with femur fracture with pulmonary infiltration and respiratory distress

Fat embolism Patient presenting long bone fractures + respiratory distress +petechiae / hemorrhage in brain suggests: fat embolism syndrome Generally associated with displaced long bone fractures of lower extremities Fat embolism will reach in the brain through a right to left cardiac shunt or through an intact pulmonary circulation in the patient without the shunt Major clinical characteristics: respiratory insufficiency, neurologic symptoms, and petechial skin rash


Question: Lateral internal sphincterotomy is the treatment of choice for

ANAL FISSURE Definition An anal fissure (synonym: fissure-in-ano) is a longitudinal split in the anoderm of the distal anal canal, which extends from the anal verge proximally towards, but not beyond, the dentate line. Operative measures Historically, under regional or general anaesthesia, forceful manual (four- or eight-digit) sphincter dilatation was used to reduce sphincter tone; however, this was achieved in an uncontrolled fashion with potential disruption at multiple sites of the internal (and even external) sphincter. The risk of incontinence following this procedure has now made it unpopular, although more conservative controlled stretching is still practised in young men with very high sphincter tone. Fissure healing can also be achieved by a posterior division of the exposed fibres of the internal sphincter in the fissure base, but this is associated with prolonged healing, as well as passive anal leakage thought mainly to be due to the resulting keyhole gutter deformity; however, it may be indicated if there is an associated intersphincteric fistula. Lateral anal sphincterotomy In this operation, the internal sphincter is divided away from the fissure itself - usually either in the right or the left lateral positions (Notaras). The procedure can be carried out using an open or a closed method, under local, regional or general anaesthesia, and with the patient in the lithotomy or prone jack-knife position. The distal internal sphincter is palpated with a bivalved speculum at the intersphincteric groove. In the closed method, a small longitudinal incision is made over this, and the submucosal and intersphincteric planes are carefully developed to allow precise division of the internal sphincter with a knife or scissors to the level of the apex of the fissure; the wound is then closed with absorbable sutures. Alternatively, either plane can be entered using a scalpel , with the blade advanced parallel to the sphincter and then rotated such that the sharp edge faces the internal sphincter, which can then be divided along its distal third. Pressure should be applied to the wound for a few minutes to prevent haematoma formation. In the open technique, the anoderm overlying the distal internal sphincter is divided longitudinally to expose the sphincter, which is divided, and the wound is closed with absorbable sutures. Although the fissure needs no specific attention, problematic papillae and external tags can be excised concomitantly. Early complications of sphincterotomy include haemorrhage, haematoma, bruising, perianal abscess and fistula. Despite low recurrence rates, the most impoant complication is incontinence of a variable nature and severity, which may affect up to 30% of patients, paicularly women, who have weaker, shoer sphincter complexes and in whom there may already have been cove sphincter compromise incurred by childbih. Ref: Bailey and love 27th edition Pgno : 1352


Question: Hpylori


Question: Most common brain tumour is

Answer- C. MetastasisMC brain tumors - MetastasesMC primary brain tumor - GliomaMC Glioma - AstrocytomasMC Astrocytomas - Glioblastoma multiforme


Question: Incidence Of H. pylori in Gastric ulcer is

H pylori produce cag A strain which results in gastric ulcer which finally results in gastric carcinoma, it causes 6 fold increase in incidence. Reference SRB 5th edition page no.845


Question: A 20 year old male presents with scrotal mass. The first investigation to be done is

Differential diagnosis are hydrocele, hematocele, epididymal cyst, spermatocele, varicocele, inguinal hernia, testicular tumours . Thus clinical examination should be done first to differentiate between them.

Clinical evaluation (Palpation and transillumination)


Question: Tumor commonly seen in the area marked below

Most sporadic gastrinomas are located in the first and second pa of the duodenum. The anatomical area comprising the head of the pancreas, the superior and descending poion of the duodenum and the relevant lymph nodes has been called the 'gastrinoma triangle' because it harbours the vast majority of these tumoursRef: Bailey and Love 27e pg: 851


Question: Rhytidectomy is


Question: In Moore's classification of omphalocole (examphalos), type I umbilical defect is less than .... cm.

Ans. is b i.e. 2.5 Moore suggested a classification of omphalocele into types 1, 2 and 3 with the diameters of < 2.5cm, 2.5 to 5 cm and > 5 cm respectively.