Deep vein thrombosis Also known as phlebothrombosis. It is a semisolid clot in the vein which has got high tendency to develop pulmonary embolism and sudden death. Common site of beginning is soleal veins . Investigation:- 1. Venous doppler- investigation of choice 2. Duplex scanning- it shows non compressible vein which is wider than normal. 3. Venogram- 4. Radioactive iodine fibrinogen study 5. Haemogram with platelet count 6. Ventilation Treatment:- 1. Rest, elevation of limb and bandaging the entire limb with crepe bandage. 2. Anticoagulants- heparin, low molecular weight heparin, warfarin. 3. Low molecular weight heparin is preferred to heparin. 4. Initially high doses of heparin of 25,000 units/ day for 7 days is given. 5. Warfarin should be staed as early as possible on the same day as heparin. 6. Oral anticoagulants being teratogenic cannot be used during pregnancy. {Reference: SRB&;s manual of surgery, 5th edition , page no. 225}", "cop": 3, "opa": "Heparin", "opb": "Acetrom", "opc": "LMWH", "opd": "Aspirin", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "04c0c6ac-3bdb-4079-9d6b-711af98a8285", "choice_type": "single"} {"question": "The most frequent symptom of gastric diverticulum is", "exp": null, "cop": 1, "opa": "Epigastric pain", "opb": "Haematemesis", "opc": "Vomiting", "opd": "Pain relieved by food", "subject_name": "Surgery", "topic_name": null, "id": "127715a6-86d6-49b2-ba40-40d52adb8dae", "choice_type": "single"} {"question": "Ovarian arteries enters ovary through", "exp": "Ans c Ref: Sheila Balakrishnan page 16The ovarian artery arises from abdominal aorta just below renal arteries. It crosses the ureter at the pelvic brim and entering the infundibulopelvic ligament divides to supply ovaries and fallopian tubes.", "cop": 3, "opa": "uterosacral ligament", "opb": "round ligament", "opc": "Infundibulopelvic ligament", "opd": "Broad ligament", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "42a46a2e-d317-4975-8f2e-f7015a67a0b0", "choice_type": "single"} {"question": "Ipsilateral supraclavicular lymphnodes are positive in a patient of Ca Breast. Stage is", "exp": "According to TNM staging of carcinoma breast ,metastasis to ipsilateral supraclavicular lymphnode with or without axillary or internal mammary involvement is N3c. Stage IIIC is any TN3M0 SRB's Manual of Surgery.Edition -5. Pg no:540", "cop": 3, "opa": "II", "opb": "III B", "opc": "III C", "opd": "IV", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "4d154b2a-3885-4e95-b538-8c4cd082fc8b", "choice_type": "single"} {"question": "A new born girl not passed meconium for 48 hrs, has abdominal distention and vomiting, Initial investigation of choice would be", "exp": "bowel obstruction with an absent caecal gas shadow in ileocolic cases. A soft tissue opacity is often visible in children. A barium enema may be used to diagnose the presence of an ileocolic intussusception (the claw sign) Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1196", "cop": 3, "opa": "Manometry", "opb": "Genotyping for cystic fibrosis", "opc": "Lower GI contrast study", "opd": "Serum trypsin immunoblot", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "37a1b25b-93aa-4fc3-99f4-aa7a828d48ad", "choice_type": "single"} {"question": "Below knee, amputation is done at the level of", "exp": "In below knee amputation, approximately 10 cm below the tibial tuberosity, an anterior incision of two-thirds of the circumference is created.Posterior flap is taken longerRef: Bailey and love pg: 958", "cop": 2, "opa": "5 cm below tibial tuberosity", "opb": "10 cm below tibial tuberosity", "opc": "15 cm below tibial tuberosity", "opd": "20 cm below tibial tuberosity", "subject_name": "Surgery", "topic_name": "General surgery", "id": "ec739981-5593-46e3-83cb-feeb3efaf707", "choice_type": "single"} {"question": "Quinsy is", "exp": null, "cop": 1, "opa": "Pertonsillar abscess", "opb": "Infratemparal space infection", "opc": "Para Pharyngeal space infection", "opd": "Lateral pharyngeal space infection", "subject_name": "Surgery", "topic_name": null, "id": "47881e96-f957-479b-8672-0ae1a025e320", "choice_type": "single"} {"question": "Pregangrene is", "exp": "Pregangrene is changes in tissue which indicates that blood supply is inadequate to keep tissues alive and presents with rest pain, colour changes, oedema, hyperaesthesia.", "cop": 2, "opa": "Ulceration", "opb": "Hyperaesthesia", "opc": "Putrefaction", "opd": "Mummification", "subject_name": "Surgery", "topic_name": null, "id": "be159f6f-c814-4daa-9f96-a7bc46c0b063", "choice_type": "single"} {"question": "Surgery for elective hemicolectomy for carcinoma colon is described as", "exp": "Surgery for elective hemicolectomy for carcinoma colon is described as Clean contaminated.", "cop": 2, "opa": "Clean", "opb": "Clean contaminated", "opc": "Diy", "opd": "Contaminated", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "d4e223ea-494d-42e7-91c8-ee2fdd29da97", "choice_type": "single"} {"question": "Carotid body tumours", "exp": "Carotid body tumors may metastasize in rare cases.", "cop": 4, "opa": "Arises from the endothelial cells", "opb": "Originates from the Schwann cells", "opc": "R/T is the Rx of choice", "opd": "May metastasize", "subject_name": "Surgery", "topic_name": null, "id": "f3899805-4dac-4b54-8388-497bec9636db", "choice_type": "single"} {"question": "A girl presented with severe hyperkalemia and peaked T waves on ECG. Fastest way of shifting potassium intracellularly is aEUR'", "exp": "Insulin + glucose Tall T waves on ECG indicate cardiac manifestation of hyperkalemia. - Intravenous calcium gluconate is the first drug to be administered in a patient with hyperkalemia having E.C.G. abnormalities. - It stabilizes the myocardium immediately. - It acts within minutes and is characterized by improvement in E.C.G. appearance. But an impoant point to note - It does not affect transcellular movement of potassium. Thus it won't help in reducing the hyperkalemia. Among the agents which cause transcellular (intracellular) movement of potassium. - \"Intravenous insulin is the fastest way to lower serum potassium levels\". The goals of the therapy for the tit of acute hyperkalemia in chronological order are as follows:? i) Antagonize the affect of IC on excitable cell membranes ii) Redistribution of extracellular potassium into cells iii) Enhance elimination of potassium from the body i) Antagonize the effect of potassium on excitable cell membrane Calcium directly antagonizes the myocardial effect of hyperkalemia. It does so by reducing the threshold potential of cardiac myocytes. Calcium. for injection is available as chloride or gluconate salt. The preferred agent is the gluconate salt since it is less likely than calcium chloride to cause tissue necrosis. The onset of action is < 3 minutes. The duration of action is 30-60 minutes during which time fuher measures may be undeaken to lower p1{. ii) Redistribution of potassium into cells :? Insulin Insulin shifts potassium into cells. Potassium shift inside the cells is mediated by Na+ IC ATPase. I.V. insulin is the fastest way to lower serum potassium levelr2. The onset of action is < 15 minutes and the effect is maximal b/w 30-60 minutes. Dextrose is given along with insulin to prevent hypoglycemia. It was believed that administration of dextrose alone, can cause shift of potassium inside the cells by promoting insulin release. * The administration of hypeonic dextrose alone for hyperkalemia is not recommended for two reasons:- Endogenous insulin levels are unlikely to rise to the level necessary for a therapeutic effect. - There is a risk of exacerbating hyperkalemia by inducing hypeonicity. 5' adrenoceptor agonists These drugs can also cause movement of potassium inside the cell. High dose albuterol shows their effect in 30 minutes and persists for at least 2 hours. The effect of insulin is additive with that of albuterol. Patients taking nonselective 18 adrenoceptor blockers will be unlikely to manifest the hypokalemic effects of albuterol. - Even among patients not taking ft blockers as many as 40% seem to be resistant to the hypokalemic effect of albuterol. - The mechanism .for this resistance is unknown and currently, there is no basis for predicting which patients will respond. - For this reason albuterol should never be used as a single agent for the treatment of urgent hyperkalemia. Bicarbonate Bicarbonate (as a bolus injection) was used in the emergency t/t of hyperkalemia. Ironically this dogma was based on studies using a prolonged (4-6 hrs) infusion of bicarbonate. It has now been demonstrated that sho term bicarbonate infusion does not reduce pK in patients with dialysis dependent kidney failure, implying that it does not cause IC+ shift into cells. Sodium bicarbonate seems to have no effect to shift IC into cells even after several hours. It is likely to be effective especially in combination with a diuretic drug in enhancing urinary IC' elimination in patients with some kidney. function, although it use for this purpose has not been evaluated. iii) Elimination of potassium from the body Hyperkalemia occurs most often in patients with renal insufficiency. - However renal potassium excretion may be enhanced even in patients with significant renal impairment by increasing the delivery of solute to the distal nephron. Sodium bicarbonate A sodium bicarbonate infusion administered during 4-6 hrs at a rate designed to alkalinize the urine may enhance urinary K+ excretion and would be desirable especially in patients with metabolic acidosis. The risk of volume expansion with the bicarbonate infusion can be mitigated by use of loop acting diuretics which would, be likely to enhance the kaliuresis. Exchange resin Sodium polysterene sulfonate is a cation exchange resin. In the lumen of intestine it exchanges sodium for secreted potassium. Most of this exchange takes place in the colon, the site of most potassium secretion in the gut. There are two concerns with the use of resin in the t/t of urgent hyperkalemia The first is its slow effect - When given orally, the onset of action is at least 2 hrs and the maximum effect may not be seen for more than 6 hrs. The second is its adverse effect - It can cause intestinal necrosis Dialysis -\"Hemodialysis is the method of choice for removing potassium from the body\". - The rate of potassium removed with peritoneal dialysis is much slower than with hemodialysis.", "cop": 3, "opa": "Calcium gluconate IV", "opb": "Oral resins", "opc": "Insulin + glucose", "opd": "Sodium bicarbonate", "subject_name": "Surgery", "topic_name": null, "id": "087db105-0868-47e6-b4ef-2050e4c82c48", "choice_type": "single"} {"question": "Suppurative osteomyelitis is caused by", "exp": null, "cop": 3, "opa": "Staphylococci", "opb": "Streptococci", "opc": "Streptococci first, later replaced by staphylococci", "opd": "Staphylococci first, later replaced by streptococci", "subject_name": "Surgery", "topic_name": null, "id": "8804accc-9cb8-46ea-8b04-d92df21c5ce5", "choice_type": "single"} {"question": "Cushing disease cause is", "exp": "Ans. (a) ACTH producing pituitary tumorRef: Endocrine Surgery by Schwartz Page 27* Pituitary adenoma arising from corticotroph cells causing secretion of ACTH resulting in Cushing's disease* Corticotroph cell adenomas may be clinically silent or may cause hypercortisolism, manifested clinically as Cushing syndrome, because of the stimulatory effect of ACTH on the adrenal cortex.* When the hypercortisolism is caused by Excessive production of ACTH by the pituitary, the process is designated Cushing disease, because it is the pattern of hypercortisolism originally described by Dr. Harvey Cushing.", "cop": 1, "opa": "ACTH producing pituitary tumor", "opb": "Adrenal Tumor", "opc": "Ectopic production of ACTH", "opd": "Adrenal Hyperplasia", "subject_name": "Surgery", "topic_name": "Pancreas", "id": "c5ad5942-2cbe-4d75-be65-0c53e1fa2cd6", "choice_type": "single"} {"question": "Treatment of Acute Myositis Ossificans is", "exp": "D i.e. Immobilization", "cop": 4, "opa": "Active mobilization", "opb": "Passive mobilization", "opc": "Infra Red Therapy", "opd": "Immobilization", "subject_name": "Surgery", "topic_name": null, "id": "c2e636c6-f500-4a05-8ea1-7ae5c0743136", "choice_type": "single"} {"question": "Game Keeper's thumb is", "exp": "A i.e. Ulnar collateral ligament injury of MCP Joint", "cop": 1, "opa": "Ulnar collateral ligament injury of MCP Joint", "opb": "Radial collateral ligament injury of MCP joint", "opc": "Radial collateral ligament injury of CMC joint", "opd": "Ulnar collateral ligament injury of CMC joint", "subject_name": "Surgery", "topic_name": null, "id": "538e59ad-e782-482e-8f33-6a8dbec73f2a", "choice_type": "single"} {"question": "Investigation of choice in spontaneous Sub arachnoid bleed", "exp": "(A) CT scan", "cop": 1, "opa": "CT scan", "opb": "Ventriculography", "opc": "Ultrasound", "opd": "Cerebral angiography", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "d19aff40-4874-45b0-a90f-333a1b3bf698", "choice_type": "single"} {"question": "Most common neoplasm of appendix is", "exp": "Carcinoid tumours arise in argentaffin tissue (Kulchitsky cells of the crypts of Lieberkuhn) and are most common in the vermiform appendix.The tumour can occur in any pa of the appendix, but it is frequently found in the distal third.Ref: Bailey & Love&;s Sho Practice of Surgery", "cop": 3, "opa": "Pseudomyxoma peritonei", "opb": "Adenocarcinoma", "opc": "Carcinoid", "opd": "Lymphoma", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "d402662c-d8a6-4754-83e7-f21d3cb92a5d", "choice_type": "single"} {"question": "Most common site for carcinoma pancreas is", "exp": "More than 85 percent of pancreatic cancers are ductal adenocarcinomas.They arise most commonly in the head of the gland Bailey & Love ,26th,1137.", "cop": 1, "opa": "Head", "opb": "Body", "opc": "Tail", "opd": "Neck", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "bc233081-e516-4a0c-9222-5f289091f1bf", "choice_type": "single"} {"question": "Drawer sign seen in", "exp": "A i.e. Cruciate ligament injury", "cop": 1, "opa": "Cruciate ligament injury", "opb": "Scurvy", "opc": "Pehes's disease", "opd": "Hyperparathyroidism", "subject_name": "Surgery", "topic_name": null, "id": "a923ebcc-d67e-46e6-9989-bb1f00167dbc", "choice_type": "single"} {"question": "The closed mouth technique for mandibular nerve block is", "exp": null, "cop": 2, "opa": "Clark and Holmes technique", "opb": "Akinosi-Vazarani technique", "opc": "Gow gates technique", "opd": "Angelio sergenti technique", "subject_name": "Surgery", "topic_name": null, "id": "e2dfc50e-3115-4bcf-85ad-770d7cbebf7c", "choice_type": "single"} {"question": "Oschner sherren regime is used in management of", "exp": "Ans is 'c' i.e. Appendicular mass If an appendix mass is present and the condition of the patient is satisfactory, the standard treatment is the conservative Ochsner-Sherren regimen. This strategy is used as the inflammatory process is already localised and that inadveent surgery is difficult and may be dangerous. It may be impossible to find the appendix and, occasionally, a faecal fistula may form. For these reasons, it is wise to observe a non-operative programme but to be prepared to operate should clinical deterioration occur. Criteria for stopping conservative treatment of an appendix mass A rising pulse rate Increasing or spreading abdominal pain Increasing size of the mass Ochsner-Sherren regimen comprises hospitalization, intravenous fluids, antibiotics, analgesics and a strict watch on the vitals and general state of the patient. In 90-80% of the patients, the mass resolves without complications. The remaining 10-20% need emergency operation due to spreading infection.", "cop": 3, "opa": "Appendicular abscess", "opb": "Chronic appendicitis", "opc": "Appendicular mass", "opd": "Acute appendcitis", "subject_name": "Surgery", "topic_name": null, "id": "5b304ce1-06f1-48b1-879a-6afc2cb450d6", "choice_type": "single"} {"question": "Structure arising from the apex of infected non vital tooth is", "exp": "Answer- C. Radicular CystIs the most common type of jaw cyst.Radicular cyst develops at the apex of an infected, nonvital tooth.If the tooth is removed and the cyst persists, it is called a residual cystThere is a bimodal incidence within the third and sixth decades of life and they are rarely seen in the primary dentition.Usually presents as a radiolucent lesion around the apex ofa tooth root.", "cop": 3, "opa": "Dentigerous Cyst", "opb": "Odontogenic Keratocysts", "opc": "Radicular Cyst", "opd": "Gorlin Cysts", "subject_name": "Surgery", "topic_name": null, "id": "0f6f0de1-5481-41bc-b2b1-9b7ded779150", "choice_type": "single"} {"question": "Posterior perforated ulcer on pyloric antrum cause abscess formation in", "exp": "Commonly gastric ulcer perforates in the lesser curve near the antrum perforates.amount of gas escaped is more than the perforated DU, malignancy should always be suspected and so biopsy from the edge is a must.commonly they are prepyloric in position.distal gastrectomy, including ulcer area, is better if the patient,s condition is ourable. Ref: SRB&;s manual of surgery,5 th ed, pg no 833", "cop": 2, "opa": "Greater sac", "opb": "Lesser sac", "opc": "Pouch of morrison", "opd": "Omental bursa", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "4bf4d81f-9558-4776-bf7d-108a2db9fa8a", "choice_type": "single"} {"question": "TSH receptor antibodies are often present in", "exp": "TSH receptor antibodies (TSH-Rab or TRAB) are often present in Graves' disease. They are largely produced within the thyroid itself.Ref: Bailey and love 27e, page no: 803", "cop": 1, "opa": "Graves disease", "opb": "Hashimoto thyroiditis", "opc": "Reidels thyroiditis", "opd": "Papillary carcinoma thyroid", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "32a5ff68-3171-4a4a-8db6-dc5f040a9a7b", "choice_type": "single"} {"question": "Double contrast phase contrast arthroscopy is used\nto study", "exp": null, "cop": 3, "opa": "Clicking of TMJ", "opb": "Deviation of TMJ", "opc": "Joint space", "opd": "Disc", "subject_name": "Surgery", "topic_name": null, "id": "e234254b-f532-49ec-96dd-b7a22939521a", "choice_type": "single"} {"question": "Differentiating features between sepsis and trauma are", "exp": "Patients compensate for volume loss in the early stages of hypovolaemia, so an apparently resuscitated patient may still have a significant volume deficit. The aim for immediate resuscitation should he normal measures of pulse, blood pressure and CVP, urine output > 0.5 mI/kg/hour with normal urinary osmolality and sodium concentration. Any metabolic acidosis should be seen to be correcting. There-after, one must try to maintain normovolaemia. This is a continuous process. Critically ill patients may have capillary leak and will therefore have a continuing colloid requirement. Gelatins, being small molecules, are poorly retained and can be replaced by hydroxyethyl starch, plasma or blood at this stage. In sepsis this requirement may be very large . The impoance of blood in immediate resuscitation, the threshold at which one should transfuse urgently (i.e. con-sider using group compatible, uncross-matched blood or even Group 0 blood) and even the target haemoglobin level are controversial. Resuscitation should not be delayed whilst waiting for blood to be grouped; if acute anaemia is secondary to the bleeding resuscitation should be with Group 0 blood or group-compatible blood as it becomes available. Ref:Surgery of baily and love,26th edition.", "cop": 1, "opa": "Energy requirement", "opb": "Catabolism", "opc": "Insulin resistance", "opd": "Fluid loss", "subject_name": "Surgery", "topic_name": "General surgery", "id": "34aa4560-244a-46d2-8f5a-53caef8a0272", "choice_type": "single"} {"question": "Alvarado score is used for", "exp": "Answer- B. Acute appendicitisScoring system for Acute Appendicitis: Alvarado Score:The diagnosis of appendicitis is based primarily on clinical history and physical examination assisted by blood counts. A number of clinical and laboratory based scoring systems have been devised to assist diagnosis.The most widely used scoring system is Alvarado score.", "cop": 2, "opa": "Acute cholecystitis", "opb": "Acute appendicitis", "opc": "Acute apncreatitis", "opd": "Acute epidydimitis", "subject_name": "Surgery", "topic_name": null, "id": "3b14bc57-d2d9-4f89-8c7f-1af346656b66", "choice_type": "single"} {"question": "Ring sequestrum is seen in", "exp": "C i.e. Amputation Stump Excessive periosteal stripping is contraindicated as it may result in formation of ring sequestrum in amputation stumpQType of Sequestrum Found InRing sequestrum - Amputation stumpsQ - Around pin tracks (external fixator)Tubular sequestrum - Hematogenous osteomyelitis - Segmental fractures (middle segment)Rice grain sequestrum - Tuberculosis", "cop": 3, "opa": "Typhoid osteomyelitis", "opb": "Chronic osteomyelitis", "opc": "Amputation stump", "opd": "Tuberculosis osteomyelitis", "subject_name": "Surgery", "topic_name": null, "id": "39657b48-4f49-4857-92a4-64532431fde4", "choice_type": "single"} {"question": "Miniplate fixation is effective at", "exp": null, "cop": 1, "opa": "Zone of tension", "opb": "Near the roots of teeth", "opc": "Zone of compression", "opd": "Near to the mental foramen", "subject_name": "Surgery", "topic_name": null, "id": "5ab4be05-ca93-4b03-9f26-a25c5fe182ee", "choice_type": "single"} {"question": "Concentration of sodium in RL is", "exp": "Sodium concentrations in various crystalloids and colloid Hamann's (RL) 130mmol/L Normal saline (0.9% NaCl) 154mmol/L Dextrose saline (4% dextrose in 0.18 saline) 30mmol/L Gelofusine 150mmol/L Hemacel 145 mmol/L Hetastarch - Lactated potassium saline injection (Darrow's solution) 121mmol/L Ref: Bailey and love 27th edition Pgno :281", "cop": 3, "opa": "154", "opb": "120", "opc": "130", "opd": "144", "subject_name": "Surgery", "topic_name": "General surgery", "id": "22f45302-4183-4557-ad02-7d3086c0f56b", "choice_type": "single"} {"question": "ORF stands for", "exp": null, "cop": 1, "opa": "Open reading frame", "opb": "Oncocytic removing fraction", "opc": "Oncogenic removing frequency", "opd": "Oil fraction in blood", "subject_name": "Surgery", "topic_name": null, "id": "0607a86c-f0dd-4fdf-a5c4-290b2c42d193", "choice_type": "single"} {"question": "Cellulitis is a.", "exp": "Cellulitis Non-suppurative, invasive infection of tissues, which is usually related to the point of injury. Poor localisation in addition to the cardinal signs of spreading inflammation. Organisms such as Beta-haemolytic streptococci, staphylococci and C. perfringens. Followed by Tissue destruction, gangrene and ulceration caused by proteases Systemic signs- chills, fever and rigors.", "cop": 3, "opa": "Nonsuppurative and non-invasive", "opb": "Suppurative and non-invasive", "opc": "Nonsuppurative and invasive", "opd": "Suppurative and invasive", "subject_name": "Surgery", "topic_name": "FMGE 2019", "id": "e1d213e2-6ac6-4d8b-8461-08fd8e88dd31", "choice_type": "single"} {"question": "A i.e. Siffness of finger", "exp": "D i.e. Siffness of finger", "cop": 4, "opa": "Malunion", "opb": "Non-union", "opc": "Sudeck's osteodystrophy", "opd": "Stiffness of fingers", "subject_name": "Surgery", "topic_name": null, "id": "ae5990f4-88db-4e91-9c74-ed33a0fe988b", "choice_type": "single"} {"question": "There was a sudden increases in the size of Thyroid swelling along with pain. Most likely cause is", "exp": ". A painful nodule, sudden appearance, or rapid enlargement of a nodule raises suspicion of carcinoma but is usually due to haemorrhage into a simple nodule. Comment : more common among the given options is haemorrhage. other points to consider: Pain is not a common feature of thyroid swellings. Thyroiditis can present with a painful gland. Anaplastic carcinoma can cause local pain and pain referred to the ear if it infiltrates surrounding structures Source : Bailey and love 26 th edition Pg : 748", "cop": 1, "opa": "Hemorrhage within the cyst", "opb": "Malignant change", "opc": "Nodular goiter", "opd": "Colloid goiter", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "0c595318-67d3-415b-8f67-9378fb246b29", "choice_type": "single"} {"question": "The most impoant prognostic factor in carcinoma breast is", "exp": "The Nottingham prognostic index (NPI) is used to determine prognosis following surgery for breast cancer. Its value is calculated using three pathological criteria: the size of the lesion; the number of involved lymph nodes; and the grade of a tumour.Size of lesion is least impoant.The extent of axillary lymph node involvement by breast cancer--is the most established and reliable prognostic factor for subsequent metastatic disease and survivalDevita principles of oncology 10th edition, Bailey and love 26th edition.", "cop": 4, "opa": "Size of tumour", "opb": "Skin involvement", "opc": "Involvement of muscles", "opd": "Axillary gland involvement", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "1f75d376-9260-4d52-8384-cc83486ccb09", "choice_type": "single"} {"question": "Spontaneously regressing tumours are", "exp": "Tumors with spontaneous regression Neuroblastoma Choriocarcinoma Renal cell carcinoma Malignant melanoma Retinoblastoma Ref : Robbins 9th edition Pgno : 477, 1041, 955, 1339, 1149", "cop": 1, "opa": "Malignant melanoma", "opb": "Neuroblastoma", "opc": "Ewing's sarcoma", "opd": "Wilm's tumour", "subject_name": "Surgery", "topic_name": "Urology", "id": "53be82cc-0cb2-4dcd-9694-7f1b0d999e9c", "choice_type": "single"} {"question": "The ideal treatment of alveolar osteitis after dental extraction is", "exp": null, "cop": 3, "opa": "Topical antibiotics", "opb": "Systemic antibiotics", "opc": "Debridement of socket and sedative dressing", "opd": "Curettage to induce fresh bleeding", "subject_name": "Surgery", "topic_name": null, "id": "068aa780-9c3f-477b-9d66-e123420d0b1e", "choice_type": "single"} {"question": "Cobra head deformity is seen in", "exp": "Ureterocoele due to distal ureter dilation looks like cobra head.", "cop": 1, "opa": "Ureterocele", "opb": "Ureteric fistula", "opc": "Retrocaval ureter", "opd": "Urethral stricture", "subject_name": "Surgery", "topic_name": null, "id": "f5315ce6-b3ca-44a1-b644-f9bef1b828c2", "choice_type": "single"} {"question": "Most common presentation of chronic pancreatitis", "exp": "Ans. (c) PainRef: Bailey and Love 27th ed; pg. 1230* MC symptom of Chronic pancreatitis - Pain* Site of pain depends on the foci of disease:# Head: Epigastric and Right Subcostal Pain# Left Side pancreas: Back pain# Diffuse pain is also seen sometimes.# Radiation to shoulder also can be seen", "cop": 3, "opa": "Nausea", "opb": "Steatorrhea", "opc": "Pain", "opd": "Brittle Type 3 diabetes", "subject_name": "Surgery", "topic_name": "Pancreas", "id": "2cc1b386-7da7-49eb-852d-a0dc1fa3c153", "choice_type": "single"} {"question": "A Wahin's tumour is", "exp": "Wahin's tumor Is the second most common benign tumor of the parotid gland (1st is pleomorphic adenoma). It consists of both epithelial and lymphoid elements thus known as adenolymphoma (probably arises from remnants of parotid tissue trapped in lymphnodes within the parotid gland). Also known as papillary cystadenoma lymphomatosum. The tumor arises only in the parotid gland. Almost always arises in the lower poion of the parotid gland overlying the angle of mandible. Common in males. (Occurs most often in older white men) Age : 5th to 7th decade. Association is seen with smoking. Bilaterality is seen in 10% cases. Its well encapsulated, extremely slow growing tumor, never turns malignant. A peculiar feature of Wahins tumor is that it shows 'hot' spot in 99' Tc-peechnate scan. Other tumors of the parotid show 'cold' spot (Oncocytomas another benign parotid tumor also shows hot spot). (Because of the high mitochondrial content within oncocytes, the oncocyte-rich Wahin tumor and Oncocytomas incorporate technetium Tc 99m and appear as hot spots on radionuclide scans.) Also remember Godwin's tumor - Benign lymphoepithelial tumor of the parotid gland. Most salivary gland tumors are benign. However remember that the smaller the salivary gland, the higher is the chance of the tumor being malignant. Parotid gland - 80% benign Submandibular, Sublingual - 50% benign, 50% malignant Minor salivary glands - 25% benign, 75% malignant", "cop": 1, "opa": "An adenolymphoma of parotid gland", "opb": "A pleomorphic adenoma of parotid", "opc": "A carcinoma of the parotid", "opd": "A carcinoma of submandibular salivary gland", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "d9f99fbc-bebb-4db3-abff-ba9db4b085a6", "choice_type": "single"} {"question": "Mondor’s disease is", "exp": "Mondor's disease is thrombophlebitis of the superficial veins of the breast and anterior chest wall although it has also been encountered in the arm.\nMONDOR’S DISEASE In the absence of injury or infection, the cause of thrombophlebitis - like that of spontaneous thrombophlebitis in other sites - is obscure.\nThe pathognomonic feature is a thrombosed subcutaneous cord, usually attached to the skin.\nWhen the skin over the breast is stretched by raising the arm, a narrow, shallow subcutaneous groove alongside the cord becomes apparent.\nThe differential diagnosis is lymphatic permeation from an occult carcinoma of the breast. The only Rx required is restricted arm movements, and it subsides within a few months without recurrence, complications or deformity", "cop": 1, "opa": "Superficial thrombophlebitis of breast", "opb": "Fat necrosis in breast", "opc": "Postradiation breast and arm edema", "opd": "Skin infection over the breast", "subject_name": "Surgery", "topic_name": null, "id": "49f52b79-e932-4dd5-8ab8-164efa74119f", "choice_type": "single"} {"question": "Lower esophageal sphincter tone is due to", "exp": "Ans. (c) AcetylcholineRef: Bailey & Love 26th ed. / 988There are two types of control of LES via the Myenteric plexus:* Excitatory (cholinergic) ganglionic neurons* Inhibitory (nitric oxide) ganglionic neuronsFunctionally, inhibitory neurons mediate Deglutitive lower esophageal sphincter (LES) relaxation and the sequential propagation of peristalsis.", "cop": 3, "opa": "Vasoactive intestinal peptide", "opb": "Nitrous oxide", "opc": "Acetylcholine", "opd": "Pancreatic polypeptide", "subject_name": "Surgery", "topic_name": "Anatomy & Physiology (Oesophagus)", "id": "581bd1d1-930d-4847-bd1d-fcb6bace668f", "choice_type": "single"} {"question": "Pseudo kidney is", "exp": null, "cop": 1, "opa": "Thickened bowel loop on USG", "opb": "Hydronephrosis", "opc": "Unascended kidney", "opd": "Undescended testes", "subject_name": "Surgery", "topic_name": null, "id": "aca6b37b-4627-4f7e-a1dd-5fe994562689", "choice_type": "single"} {"question": "Milroys disease is", "exp": "PRIMARY LYMPHOEDEMA Aetiology It has been proposed that all cases of primary lymphoedema are due to an inherited abnormality of the lymphatic system, sometimes termed 'congenital lymphatic dysplasia'. Genetic susceptibility Primary lymphoedema can be familial or sporadic. In familial cases the genetic mutations can be inherited in an autosomal dominant, recessive or x-linked pattern. In the last few years the application of Next Generation Sequencing, which allows identification of genetic mutations, even in sporadic cases and smaller families, has increased our understanding of the genetic basis of lymphoedema. So far, mutations in more than 20 genes have been linked to the development of primary lymphoedema. In individuals with familial mutations the penetrance of lymphoedema can often be incomplete leading to a large variability in clinical presentation. Involvement of other systems (cardiovascular, respiratory, nervous, digestive) is common and can indicate a specific mutation. Presence of isolated lower limb lymphedema at bih, classically described as Milroy's disease, suggests mutation in FMS-like tyrosine kinase 4 (FLT4)/ vascular endothelial growth factor receptor-3 (VEGFR-3) or VEGF-C. In these patients, reduced initial uptake and presence of touous lymphatic tracts with evidence of rerouting in lymphangiography suggests mutation in the VEGF-C gene. lymphoedema can also be present as a minor sign in some well-recognised syndromes. Primary lymphoedema is present in less than 10% of cases of tuberous sclerosis (TSC1 and 2 gene mutations). Lymphoedema has been repoed in patients with Noonan syndrome in the presence of PTPN11, SOS1 or KRAS mutations, and in patients with Turner syndrome (monosomy X) and capillary malformation-aeriovenous malformation syndrome (RAS p21 protein activator 1 (RASA1) mutation). Ref : Bailey and love 27th edition Pgno : 1001", "cop": 3, "opa": "Edema due to filariasis", "opb": "Post cellulitic lymphedema", "opc": "Congenital lymphedema", "opd": "Lymphedema following trauma", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "7df85fcb-712c-41fe-8465-250f899a9b3a", "choice_type": "single"} {"question": "Amputation marked at level of 'C' is", "exp": "A is Symes (Ankle)B is Chopas (mid tarsal)C is Lisfranc (Tarsometatarsal joint)D is transmetatarsal (metatarsal head)", "cop": 1, "opa": "Lisfranc", "opb": "Chopas", "opc": "Symes", "opd": "Boyd", "subject_name": "Surgery", "topic_name": "All India exam", "id": "64f30650-9cf2-41a6-85e0-5e2b8d3c5892", "choice_type": "single"} {"question": "In Crohn's disease NOT seen is", "exp": "(C) Endomycelial antibodies # Pathological features of Crohn's disease: Starts in terminal ileum as ulcerations of intestines in 60% cases inflammatory edema with mucosal ulcers& fibrotic thickening results in hose pipe rigidity Mesenteric nodes are enlarged & calcified Intense infiltration of mononuclear Skip areas Caseation is absent Stricture causing obstruction", "cop": 3, "opa": "ASCA+", "opb": "Skip lesions", "opc": "Endomycelial antibodies", "opd": "Cobblestone appearance", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "c66e58fc-a250-485e-a482-ed446b3b61ea", "choice_type": "single"} {"question": "With over dosage of L.A agent, one would observe", "exp": null, "cop": 2, "opa": "Hypertension", "opb": "Hypotension", "opc": "No change in BP", "opd": "Cardiac arrhythmias", "subject_name": "Surgery", "topic_name": null, "id": "752d883f-6fbb-4906-9e0d-49a9585c01b1", "choice_type": "single"} {"question": "Action of toxic doses of Local anesthesia on CNS\ncan be described as", "exp": null, "cop": 1, "opa": "first stimulating the CNS followed by depression", "opb": "first depressing it followed by CNS stimulation", "opc": "only depression of the CNS", "opd": "only stimulation of the CNS", "subject_name": "Surgery", "topic_name": null, "id": "ed5cb07d-2e8e-4988-8cf4-a131dc181a39", "choice_type": "single"} {"question": "Chronic subdural haenatoma refers to collection present for a period of", "exp": "REF; GREENBERG HANDBOOK OF NEUROSURGERY 8th edi, p-895", "cop": 4, "opa": "7 days", "opb": "6 months", "opc": "1 year", "opd": "21 days", "subject_name": "Surgery", "topic_name": "Trauma", "id": "200aaa59-6fce-4f46-8e8f-7a9a82faf59d", "choice_type": "single"} {"question": "Best material for below inguinal aerial graft is", "exp": "Best graft for below inguinal aerial graft is autologous long saphenous vein, if it's not available sho saphenous can be used. If no vein is available PTFE(poly tetra fluoro ethylene) can be used. Reference Bailey and love, 27th edition, page no. 949", "cop": 1, "opa": "Saphenous vein graft (upside -down)", "opb": "PTFE", "opc": "Dacron", "opd": "Teflon", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "65b34e39-0437-4343-8d81-27ce1f62a769", "choice_type": "single"} {"question": "Complication (s) of obesity is /are", "exp": ".Complications of obesity General: Difficulty in work, fatigue, depression, back pain, ahritis and gout Cardiovascular: Hypeension, stroke, thrombophlebitis, pulmonary embolism Pulmonary: Hypoventilation, poor respiratory effo GIT: Hiatus hernia with reflux, changes in liver, pancreatitis, gallstones Endocrine: Diabetes mellitus. ref:SRB&;s manual of surgery,ed 3,pg no 90", "cop": 1, "opa": "Venous ulcer", "opb": "Pulmonary embolism", "opc": "Moality", "opd": "Prostate cancer", "subject_name": "Surgery", "topic_name": "Urology", "id": "63c7d14b-0d0b-42ab-be84-4630ae1c63aa", "choice_type": "single"} {"question": "Vitamin B12 and bile salts are decreases in the resection of", "exp": "i.e. (Ileum): (1157-Love & Baily 25th) (625-26-CSDT-l31) JEJUNUMILEUMNormalGeneralized transport of water, electrolytes, sugars proteins, fats, vitamins Most absorption occurs proximallyLocalized transport of bilesalts, cholesterol, vitamin BResection* Generalized transport work load assumed by ileum* Localized transport unaffected* No malabsorption* Generalized transport continues* Localized transport lost* Malabsorption of vitamin B 12, cholesterol bile salts andfats***Steatorrhea, diarrhea, megaloblastic anemia and malnutrion are the hall marks of Blind loop syndrome", "cop": 4, "opa": "Stomach", "opb": "Duodenum", "opc": "Jejunum", "opd": "Ileum", "subject_name": "Surgery", "topic_name": "Small & Large Intestine", "id": "e94c0b5a-9006-4d65-88d4-684700252f4c", "choice_type": "single"} {"question": "First priority in management of burn injury is", "exp": null, "cop": 4, "opa": "Exposure", "opb": "Fluid resuscitation", "opc": "Circulation", "opd": "Airway control", "subject_name": "Surgery", "topic_name": null, "id": "67a36117-6392-4b90-a4eb-833d682b2ff1", "choice_type": "single"} {"question": "Denver shunt used in", "exp": "Ans. (a) AscitesRef: Bailey & Love 26th ed. / 980* A peritoneo-venous shunt (also called Denver shunt) is a shunt which drains peritoneal fluid from the peritoneum into veins, usually the internal jugular vein or the superiorvena cava.* It is sometimes used in patients with refractory ascites.* It is a long tube with a non-return valve running subcutaneously from the peritoneum to the internal jugular vein in the neck, which flows ascitic fluid to pass directly into the systemic circulation.", "cop": 1, "opa": "Ascites", "opb": "Dialysis", "opc": "Raised ICP", "opd": "Headache", "subject_name": "Surgery", "topic_name": "Evaluation and Management of Portal Hypertension", "id": "0fc4d8de-5a9a-41f4-9637-f21553678947", "choice_type": "single"} {"question": "Replacement dose of thyroxine is", "exp": "• Daily replacement dose of thyroxine: 1.6 μg/Kg body weight (0.1-0.15 gm) .\n• For TSH suppression (in PTC and FTC), dose of thyroxine: 2.7 μg/Kg body weight.", "cop": 1, "opa": "0.1 - 0.2 mg", "opb": "0.3 - 0.4 mg", "opc": "1 - 2 mg", "opd": "3 - 4 mg", "subject_name": "Surgery", "topic_name": null, "id": "ee8524cf-c0e7-46c9-b810-73f2a0a07f92", "choice_type": "single"} {"question": "Arrange the following long acting LA in descending order of their duration of action.", "exp": "Dibucaine is longest acting and most toxic.\nEtidocaine: 200minutes.\nTetracaine~Bupivacaine:175 minutes.", "cop": 1, "opa": "Dibucaine>Etidocaine>Tetracaine> Bupivacaine.", "opb": "Dibucaine>Tetracaine>Bupivacaine> Etidocaine.", "opc": "Tetracaine>Dibucaine>Bupivacaine>Etidocaine.", "opd": "Tetracaine>Bupivacaine>Dibucaine> Etidocaine.", "subject_name": "Surgery", "topic_name": null, "id": "9643d143-adde-491a-8104-cedb9b0f86a2", "choice_type": "single"} {"question": "Commonest cause of acute intestinal obstruction is", "exp": "Adhesions and bands are the most common causes of intestinal obstruction in Western countries. In india, hernia and then adhesions are the two common causes of intestinal obstruction. There are two types of adhesions. Type1-fibrinous adhesions occur during 5-10th post-surgical peroid. Type2- fibrous adhesions, due to poor blood supply, bowel gets attached to pa of peritoneum or omentum or other pas of the bowel. Adhesions due to tuberculosis are severe, dense and difficult to seperate. Reference: SRB's Manual of Surgery, 6th Edition, page no = 924,925.", "cop": 4, "opa": "Intussusception", "opb": "Volvulus", "opc": "Inguinal hernia", "opd": "Adhesions", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "3152dbee-5787-4105-8858-066fbbf5736d", "choice_type": "single"} {"question": "Would closure for clean wounds within 6 hours of injury without risk of contamination", "exp": "Primary Closure\nAlso known as healing by primary intention Have a small, clean defect that minimizes the risk of infection Requires new blood vessels and keratinocytes to migrate only a small distance Surgical incisions, paper cuts and small cutaneous wounds usually heal by primary closure.\nFastest type of closure by simple suturing, skin grafting or flap closure Secondary Closure Also known as healing by secondary intention Healing of a wound in which the wound edges cannot be approximated Requires a granulation tissue matrix to be built to fill the wound defect Requires more time and energy than primary wound closure Creates more scar tissue The majority of wounds close by secondary wound closure.\nDelayed Primary Closure Also known as healing by tertiary intention. Combination of healing by primary and secondary intention\nThe wound is first cleaned and observed for a few days to ensure no infection is apparent, before it is surgically closed.\nE.g. traumatic injuries such as dog bites or lacerations involving foreign bodies.", "cop": 1, "opa": "Primary closure", "opb": "Delayed primary closure", "opc": "Secondary closure", "opd": "Tertiary closure", "subject_name": "Surgery", "topic_name": null, "id": "e0348afc-9c6e-49f5-a5ce-6e345077f432", "choice_type": "single"} {"question": "Borchardt&;s triad of acute epigastric pain, violent retching and inability to pass a nsogastric tube is seen in patients with", "exp": "A volvulus is a twisting or axial rotation of a poion of bowel about its mesentery. When complete it forms a closed loop of obstruction with resultant ischaemia secondary to vascular occlusion. Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1193", "cop": 2, "opa": "Achalasia cardia", "opb": "Acute gastric volvulus", "opc": "Jejunogastric intussusception", "opd": "Hitus hernia", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "55ce2d92-1b93-4744-8d3a-2d5d55618c7b", "choice_type": "single"} {"question": "Felon is", "exp": "(C) Terminal pulp space Infection # Infection of the terminal pulp space (syn. Felon) Pulp-space infection is the second most frequent infection of the hand (about 25 per cent of all cases ).> Index finger and the thumb are affected most often.> Origin of the infection is usually a prick.> Many hand infections will settle if conservative treatment is initiated (elevation of hand, splinting and antibiotics) within 24-48 hours.> But if pus appears I & D should be done (at point of maximum tenderness)> Antibiotics changed> Splinting is done in Edinburgh position.", "cop": 3, "opa": "Ulnar bursa infection", "opb": "Mid palmar space infection", "opc": "Terminal pulp space infection", "opd": "Infection of ulnar bursa", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "44d2e43a-67cb-464c-90d5-94a657867d74", "choice_type": "single"} {"question": "Stereotactic radiosurgery is done for", "exp": "Stereotactic Radiosurgery SRS is a non-surgical radiation therapy used to treat functional abnormalities & small tumors of brain Deliver precisely - targeted concentrated dose of radiation in fewer high-dose treatments to a defined volume in the brain When SRS is used to treat body tumors, its called stereotactic body radiotherapy (SRBT) Primary risks of stereotactic radiosurgery are radiation necrosis & radiation injury to surrounding structures Common uses of Stereotactic Radiosurgery (SRS) Brain tumor (Benign, malignant, primary & metastatic Tumors, single & multiple) Beingn lesions of the cranial nerves Aeriovenous malformation Trigeminal neuralgia SRBT is currently used and /or being investigated for use in treating malignant or benign small-to-medium size tumors of lung, liver, abdomen, spine, prostate, head and neck Ref: Sabiston 20th edition Pgno : 1923", "cop": 4, "opa": "Glioblastoma multiforme", "opb": "Medulloblastoma spinal cord", "opc": "Ependymoma", "opd": "AV malformation of brain", "subject_name": "Surgery", "topic_name": "Urology", "id": "eabd875a-931d-417e-ab04-374935129985", "choice_type": "single"} {"question": "Most common malignant melanoma is", "exp": "Most common type of malignant melanoma is Superficial spreading (70%). Other are Nodular melanoma(12-25%), Lentigo maligna melanoma (7-15%), Acral lentiginous melanoma(5%), amelanotic melanoma and desmoplastic melanoma. Reference : page 295-96 SRB's manual of surgery 5th edition", "cop": 1, "opa": "Superficial spreading", "opb": "Lentigo maligma melanoma", "opc": "Nodular", "opd": "Acral lentiginous", "subject_name": "Surgery", "topic_name": "Urology", "id": "6cc769da-d650-4da8-98f3-162db365c8e5", "choice_type": "single"} {"question": "Surgeon excises a poion of the liver to the left of the attachment of the falciform ligament. The segments that have been resected are", "exp": "Segments II and IIIare to the left of the left hepatic vein and falciform ligament with II superior and III inferior to the poal plane. segment I is the caudate lobe situated posteriorly around the IVC, segment IV includes the quadrate lobe. segment IV lies between the left and middle hepatic veins; it is subdivided into IVa(superior) and IVb (inferior) sub-segments easy tip: IVa is above and IVb is below the poal plane.", "cop": 3, "opa": "Segment 1a and 4", "opb": "Segment 1 and 4b", "opc": "Segment 2 and 3", "opd": "Segment 1 and 3", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "f75549e0-cd09-4f9e-acad-6edbb4c694d0", "choice_type": "single"} {"question": "Genioplasty procedure is used", "exp": null, "cop": 3, "opa": "To change the attachment of genioglossus muscle in pre-prosthetic procedure", "opb": "To change the position of genial tubercles", "opc": "To modify the position of the chin", "opd": "To modify the attachment of anterior belly of digastric", "subject_name": "Surgery", "topic_name": null, "id": "58a96261-7538-447c-af99-447b6754b2ca", "choice_type": "single"} {"question": "Cricothyrotomy is converted to tracheostomy", "exp": "Ans. (B) To avoid subglottic stenosisRef: Bailey and Love Page 695* To avoid subglottic stenosis if we give ventilation via the cricothyrotomy tube we must change it to Tracheostomy at the earliest.", "cop": 2, "opa": "To avoid hypoxia", "opb": "To avoid subglottic stenosis", "opc": "To facilitate oxygenation", "opd": "Easy consumption of food", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "93a124da-cc3a-4804-80cb-507171e13a45", "choice_type": "single"} {"question": "Local anesthetic with highest local tissue irritancy is", "exp": null, "cop": 4, "opa": "Procaine", "opb": "Chloroprocaine", "opc": "Lignocaine", "opd": "Bupivacaine agents", "subject_name": "Surgery", "topic_name": null, "id": "447742a7-f3b4-4a8e-a7f1-31da80292e51", "choice_type": "single"} {"question": "A full thickness wound that is not sutured heals by", "exp": "Here wound is full thickness wound. It is left open to heal by granulation, contraction and epithelialisation. This is know as secondary healing.", "cop": 2, "opa": "Primary healing", "opb": "Secondary healing", "opc": "Delayed primary healing", "opd": "Reepithelization", "subject_name": "Surgery", "topic_name": null, "id": "295cf974-4296-4781-a3dc-1fb879469911", "choice_type": "single"} {"question": "Commonest endocrine tumor of pancreas", "exp": "Insulinomas- arising from B cells of pancreas- are the commonest endocrine pancreatic tumour(60%). Gastrinomas - arising from non-beta cells (G cells) of the pancreas- are the 2nd most common endocrine pancreatic tumour. Then comes Glucagonomas (arising from A cells) and VIPomas (arising from D2 cells of pancreas). Reference : page 709-10 SRB's manual of surgery 5th edition", "cop": 2, "opa": "A cells", "opb": "B cells", "opc": "Delta cells", "opd": "VIPoma", "subject_name": "Surgery", "topic_name": "Urology", "id": "b204efda-8e49-4336-b389-2cb754a0a562", "choice_type": "single"} {"question": "Sub acute sponteneous peritonitis in cirrhosis patients the polymorphonuclear cells are", "exp": "Primary peritonitis is common in cirrhotic patients with ascites,as spontaneous bacterial peritonitis(SBP).Ascitic fluid WBC count if more than 250 cells mm3 with more than 50% cells are polymorphonuclear cells(PMN) suggestive of SBP. Reference:SRB' s manual of surgery,5th edition, page no:566.", "cop": 1, "opa": "More than 200 cells\\/cumm", "opb": "More than 300 cells \\/ cumm", "opc": "More than 400 cells \\/ cumm", "opd": "More than 500 cells \\/ cumm", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "83e48678-61ce-4d14-8585-6e74c004ebdd", "choice_type": "single"} {"question": "The head tilt procedure while dealing with an unconscious patient in dental chair is done to ensure", "exp": null, "cop": 1, "opa": "Patent airway", "opb": "Blood circulation to the brain", "opc": "To clear the foreign body obstacle", "opd": "To relieve spasm of respiratory muscles", "subject_name": "Surgery", "topic_name": null, "id": "f109e6df-894a-40f8-8e57-e0cc9de9a22e", "choice_type": "single"} {"question": "Tensile strength of wound become normal after", "exp": "Tensile strength of wound increase as days goes on. Maximum tensile strength is 60 - 80% of normal, but never becomes normal.", "cop": 4, "opa": "6 weeks", "opb": "4 weeks", "opc": "6 weeks", "opd": "Never", "subject_name": "Surgery", "topic_name": null, "id": "27b04b21-d938-4093-b7ac-457abfd68e86", "choice_type": "single"} {"question": "Purely for diagnostic purpose preferred mode of visualizing biliary tree will be", "exp": "MAGNETIC RESONANCE CHOLANGIO PANCREATOGRAPHY (MRCP) It is a non-invasive diagnostic method using magnetic field and energy as resonance. *T1 weighted images are used for pancreas. *T2 weighted images are used for biliary tree. (Both images are used to see invasion and adjacent structures.) Advantages * It is non-invasive. * It gives equal or better imaging than ERCP. *Pancreatic divisum or annular pancreas are identified easily by MRCP. * Ductal dilatation in chronic pancreatitis and visualization of duct beyond stricture is possible. * Islet tumours are better visualized and diagnosed by MRCP. Disadvantages * Availability. * It is only diagnostic. Not therapeutic (ERCP is both diagnostic as well as therapeutic). * Costly.Magnetic Resonance Cholangiopancreatography(MRCP) is a non-contrast non-invasive imaging method,better than ERCP as diagnostic tool in biliary and pancreatic diseases. Reference:SRB&;s manual of surgery,5th edition,page no:613", "cop": 3, "opa": "Endoscopic Retrograde Cholangiopancreatogram (ERCP)", "opb": "Percutaneous Transhepatic Cholangiogram (PTC)", "opc": "Magnetic Resonance Cholangiopancreaticogram (MRCP)", "opd": "CT angiogram", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "35b8e4b7-db73-4d61-a601-a3df1f230245", "choice_type": "single"} {"question": "Rectal incontinence is due to involvement of", "exp": "Advanced tumours may cause faecal incontinence by invasion of the sphincters and, in women, anterior extension may result in anovaginal fistulation.Incontinence, especially if there has been inadveent damage to the underlying internal sphincter. Although uncommon, this is obviously a very serious problem that is difficult to treat Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1258,1269", "cop": 1, "opa": "External anal sphincter", "opb": "Internal anal sphincter", "opc": "Ischiococcygeus", "opd": "Pubococcygeus", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "4cde3875-ba80-4f50-ae6a-ebcc5201d406", "choice_type": "single"} {"question": "16F circumference of a catheter means", "exp": "Ans. a (4.8 mm). (Ref. B & L, Surgery, 23rd ed., 1262)3.12 SF = 1mm, hence a 16F Circumference of catheter means (r)", "cop": 1, "opa": "4.8 mm", "opb": "2.8 mm", "opc": "8.4 mm", "opd": "8.2 mm", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "dd999560-395f-4f46-8666-5787ceb73ed6", "choice_type": "single"} {"question": "Anastomotic leaks are most commonly seen in", "exp": "Since there is end to end gastroduodenal anastomosis in billroth 1 there are more chances of anastomotic leak", "cop": 1, "opa": "Billroth 1", "opb": "Roux en y gastrojejunostomy", "opc": "Polya gastrectomy", "opd": "Antral gastrectomy", "subject_name": "Surgery", "topic_name": null, "id": "c3ca2ec8-36c4-47d0-b1b5-c89172443acc", "choice_type": "single"} {"question": "Rarest type of thyroid carcinoma is", "exp": "Undifferentiated (anaplastic) carcinoma\nThis is one of the most aggressive malignancies in humans. \nThankfully it is rare. It may develop de novo, or present as dedifferentiation of a papillary or poorly differentiated carcinoma. The disease is characterised by rapid growth, visceral invasion and distant metastases. The surgeon’s role in this disease is crucial. Thyroid lymphoma can be incorrectly diagnosed as anaplastic cancer and so biopsy is critical. This can be done using a core or open technique.\nReference: Bailey & Love’s short practice of surgery , 27th ed page no 816", "cop": 4, "opa": "Papillary", "opb": "Follicular", "opc": "Medullary", "opd": "Anaplastic", "subject_name": "Surgery", "topic_name": null, "id": "44d22307-4748-4368-a482-fb86b20b596f", "choice_type": "single"} {"question": "Maximum tourniquet time for upper limb is", "exp": "Excessive tourniquet time causes both local pressure and distal ischaemic effects, with nerve damage and even compament syndrome Torniquets should usually be let down after 1 hour unless close to the end of a procedure They can be reinflated after 5-10 min for a fuher hour Torniquets time for upperlimb : 1 hour Maximum tourniquet time for upper limb: 2 hours Ref: Bailey and love 25th edition Pgno : 206-207", "cop": 4, "opa": "1/2 hour", "opb": "1 hour", "opc": "1.5 hours", "opd": "2 hours", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "78b44968-a446-4293-b8c5-ab9d212f91de", "choice_type": "single"} {"question": "Boerhaave&;s syndrome is due to", "exp": "BOERHAAVE&;S syndrome is a tear in the lower third of oesophagus which occurs when a person vomits against a closed glottis, causing leaks into the mediastinum, pleural cavity, and peritoneum.site of perforation is about 2-10 cm of posterolateral pa of the lower oesophagus.investigations include chest Xray, MRI/CT, and total count.treatment includes feeding by jejunostomy, surgery with resection. Ref: SRB&;s manual of surgery,5th ed, pg no 802", "cop": 3, "opa": "Drug induced esophagus perforation", "opb": "Corrosive injury", "opc": "Spontaneous perforation", "opd": "Gastro-esophageal reflux disease", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "840dbf43-e03c-4050-bd33-ec56621f0aef", "choice_type": "single"} {"question": "Least common quadrant for breast carcinoma is", "exp": "Most common quadrant for breast carcinoma upper outer quadrant.", "cop": 4, "opa": "Upper outer", "opb": "Upper inner", "opc": "Lower outer", "opd": "Lower inner", "subject_name": "Surgery", "topic_name": null, "id": "d119ce91-883a-4ae9-ba51-44de27d95efd", "choice_type": "single"} {"question": "Normal capacity of the renal pelvis is", "exp": "• The average capacity of the renal pelvis is 4–8 ml.", "cop": 1, "opa": "7 ml", "opb": "10 ml", "opc": "15 ml", "opd": "20 ml", "subject_name": "Surgery", "topic_name": null, "id": "5d6a33ef-b45b-4134-941c-125242ed0d97", "choice_type": "single"} {"question": "Renal carcinoma with solitary lung secondary is best treated by", "exp": "Surgery is the best option because 1) cytoreductive surgery will help in increase the action of immunotherapy 2) metstatectomy ( surgery to remove metstatectomy ) with curative intent has good prognosis in pulmonary Mets Ref : Campbell and Walsh urology 11th edition . chapter 63. pg no 1502", "cop": 2, "opa": "Radiotherapy", "opb": "Surgery", "opc": "Chemotherapy", "opd": "Immunotherapy", "subject_name": "Surgery", "topic_name": "Urology", "id": "7fa34726-b876-4ac8-ac0c-647317346796", "choice_type": "single"} {"question": "Treatment of choice for medullary carcinoma of thyroid to", "exp": "Treatment is by total thyroidectomy and either prophylactic or therapeutic resection of the central and bilateral cervical lymph nodes. Bailey & Love's sho practise of surgery,25th edition,page no:798;SRB's manual of surgery,5th edition,page no:487.", "cop": 1, "opa": "Total thyroidectomy", "opb": "Paial thyroidectomy", "opc": "I131 ablation", "opd": "Hemithyroidectomy", "subject_name": "Surgery", "topic_name": "Cardio thoracic surgery ", "id": "ab9becd1-12e2-4ac2-8751-a9d3f3aab698", "choice_type": "single"} {"question": "The gas used in LA cartridge", "exp": null, "cop": 3, "opa": "O2", "opb": "Helium", "opc": "N2", "opd": "CO2", "subject_name": "Surgery", "topic_name": null, "id": "c81a8d40-3fd4-490d-9611-0d2cdf6d7708", "choice_type": "single"} {"question": "Tardy ulnar nerve palsy is seen in", "exp": "Ans. is 'b' i.e., Lateral condyle humerus Causes of tardy ulnar nerve palsy are : - Malunited lateral condyle humerus fracture (cubitus valgus) Displaced medial epicondyle humerus fracture Cubitus varus deformity (due to supracondylar fracture humerus) Elbow dislocation Contusions of ulnar nerve Shallow ulnar groove Hypoplasia of humeral trochlea Joint deformity after prolonged ahritis of elbow", "cop": 2, "opa": "Medial condyle humerus", "opb": "Lateral condyle humerus", "opc": "Humerus shaft fracture", "opd": "Fracture shaft radius", "subject_name": "Surgery", "topic_name": null, "id": "ccfbc2c1-177b-4a22-ba5a-32a1050222a7", "choice_type": "single"} {"question": "Cause of hydrocele in infants", "exp": null, "cop": 1, "opa": "Patent processus vaginalis", "opb": "Patent gubernaculum", "opc": "Impaired drainage", "opd": "Epididymal cyst", "subject_name": "Surgery", "topic_name": null, "id": "edf3e710-2fe4-4890-8ea6-4273b1b0dd5b", "choice_type": "single"} {"question": "Surgical wound of gastrojejunostomy is an example for", "exp": "GIT is breached (hence no clean), no gross spillage, so not contaminated. GI breached with no gross spillage is clean contaminated wound. These have less than 10% chance of post op infections", "cop": 2, "opa": "Clean wound", "opb": "Clean contaminated wound", "opc": "Contaminated wound", "opd": "Diy wound", "subject_name": "Surgery", "topic_name": "General surgery", "id": "d447353f-482a-4c0d-9a6f-19702bbbff1c", "choice_type": "single"} {"question": "Spastic ileus is seen in", "exp": "Answer is 'a' i.e. Porphyria Spastic, or dynamic ileus is rare and results from extreme and prolonged contraction of the intestine. It is seen in - heavy metal poisoning - porphyria - uremia - extensive intestinal ulceration.", "cop": 1, "opa": "Porphyria", "opb": "Retroperitoneal abscess", "opc": "Hypokalemia", "opd": "MI", "subject_name": "Surgery", "topic_name": null, "id": "1eabde72-9ad3-4ee9-99c2-c9005ee89276", "choice_type": "single"} {"question": "Most common clinical form of actinomycosis is", "exp": null, "cop": 1, "opa": "Cervico facial", "opb": "Thoracolumbar", "opc": "Abdominal", "opd": "Ileocecal", "subject_name": "Surgery", "topic_name": null, "id": "ee79604c-27d0-4469-b8b3-a1fbbf91587d", "choice_type": "single"} {"question": "Consider the following prognostic parameters of acute pancreatitis", "exp": "All except D is Ran son's prognostic criteria in non gallstone pancreatitis within 48hrs. SRB,5th,688.", "cop": 4, "opa": "Rise in blood urea nitrogen over 5 mg\\/dl", "opb": "Hematocrit decrease over 10%", "opc": "Base deficit more than 4 mmol\\/lit", "opd": "Blood glucose over 10 mmol\\/lit", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "9437725b-033e-4bc4-88c9-5c41015b4940", "choice_type": "single"} {"question": "The most important reason for placing an alveolar graft in cleft palate patient is", "exp": null, "cop": 3, "opa": "Improve pronunciation", "opb": "Improve breathing efficiency", "opc": "Make eruptive pathway for permanent canine", "opd": "Improve feeding efficiency", "subject_name": "Surgery", "topic_name": null, "id": "43b36491-ee9c-4717-ab9f-16529a9ddd0b", "choice_type": "single"} {"question": "Most impoant predictor of coronary aery disease aEUR'", "exp": "HDL Risk factors for atherosclerosis and cardiovascular complications (Braunwald) Abnormalities in plasma lipoproteins and derangement in lipid metabolism rank as the most firmly established risk factors for atherosclerosis. Adusted relative risk for future cardiovascular events for selected lipid fractions and lipid ratios in decreasing order are given in the following table. Adjusted relative risk of future cardiovascular events for selected lipoproteins.", "cop": 4, "opa": "VLDL", "opb": "LDL", "opc": "Chylomicron", "opd": "HDL", "subject_name": "Surgery", "topic_name": null, "id": "c232268f-c5a6-4d06-a820-578551f641ba", "choice_type": "single"} {"question": "Diabetic gangrene is due to A/E", "exp": null, "cop": 1, "opa": "Vasospasm", "opb": "Atherosclerosis", "opc": "Peripheral neuritis", "opd": "Increased sugar in blood", "subject_name": "Surgery", "topic_name": null, "id": "bcb34193-cb0c-4a2b-a954-0b74dd1eae55", "choice_type": "single"} {"question": "The most common cause of anterior compament syndrome is", "exp": "A i.e. Fracture", "cop": 1, "opa": "Fractures", "opb": "Post ischaemic swelling", "opc": "Superficial injury to muscles", "opd": "Operative trauma", "subject_name": "Surgery", "topic_name": null, "id": "aeab6054-c7c1-457c-b439-6a478b1c7d8f", "choice_type": "single"} {"question": "The most common site of mandible fracture is", "exp": null, "cop": 2, "opa": "Condylar head", "opb": "Condylar neck", "opc": "Coronoid head", "opd": "Coronoid neck", "subject_name": "Surgery", "topic_name": null, "id": "7d0f7b3b-c728-4768-9c3e-e4d595a84f81", "choice_type": "single"} {"question": "The most common tooth to get impacted (excluding the third molars) is", "exp": null, "cop": 1, "opa": "Maxillary canine", "opb": "Mandibular canine", "opc": "Maxillary II premolar", "opd": "Mandibular II premolar", "subject_name": "Surgery", "topic_name": null, "id": "0c91e537-c011-4398-9194-2120dac98d97", "choice_type": "single"} {"question": "Fever in burnt patient is caused by", "exp": "Repeated question", "cop": 1, "opa": "Septicemia", "opb": "Due to hypermetabolism", "opc": "Decreased sweating", "opd": "Release of pyrogens from dead product", "subject_name": "Surgery", "topic_name": "General surgery", "id": "2dd7e774-1827-4702-af9d-204a2c238d02", "choice_type": "single"} {"question": "A man was presented to emergency depament with head injury after an accident with vehicle. Investigation of choice should be;", "exp": "NCCT- IOC for Head Injury In NCCT - shows Biconvex or Lenticular or lens shaped hyperdense lesion In NCCT - shows Concavo- convex hyperdense lesion", "cop": 3, "opa": "CECT", "opb": "MRI", "opc": "NCCT", "opd": "MRI", "subject_name": "Surgery", "topic_name": "FMGE 2019", "id": "db529147-2784-414a-a74d-ee5c4b030bf3", "choice_type": "single"} {"question": "Treatment of choice for acute lymphadenitis", "exp": "ACUTE INFLAMMATION OF THE LYMPHATICS Acute lymphangitis is an infection, often caused by Streptococcus pyogenes or Staphylococcus aureus, which spreads to the draining lymphatics and lymph nodes (lymphadenitis) where an abscess may form. Eventually this may progress to bacteraemia or septicaemia. The normal signs of infection (rubor, calor, dolor) are present and a red streak is seen in the skin along the line of the inflamed lymphatic . The pa should be rested to reduce lymphatic drainage and elevated to reduce swelling, and the patient should be treated with intravenous antibiotics based upon actual or suspected sensitivities. Failure to improve within 48 hours suggestsinappropriate antibiotic therapy, the presence of undrained pus or the presence of an underlying systemic disorder (malignancy, immunodeficiency). The lymphatic damage caused by acute lymphangitis may lead to recurrent attacks of infection and lymphoedema; patients with lymphoedema are prone to so-called acute inflammatory episodes Ref : Bailey and love 27th edition Pgno : 996", "cop": 1, "opa": "Anitbiotics and rest", "opb": "Lymphangiography", "opc": "Excision", "opd": "No treatment needed", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "30a8a036-93d0-48c3-9023-ca1b14cb7c84", "choice_type": "single"} {"question": "Risk of malignancy in cold nodule of thyroid is", "exp": "Risk of malignancy in hot nodule is 4%.\nRisk of malignancy in cold nodule is 20%.", "cop": 3, "opa": "0.10%", "opb": "2%", "opc": "20%", "opd": "30%", "subject_name": "Surgery", "topic_name": null, "id": "3ef30e8e-3b06-4ab0-b1a7-50a6af74c33f", "choice_type": "single"} {"question": "Moth eaten alopecia is seen with", "exp": null, "cop": 2, "opa": "Leprosy", "opb": "Syphilis", "opc": "Fungal infection", "opd": "Cylindroma", "subject_name": "Surgery", "topic_name": null, "id": "d1dd5dd4-e6f3-4e3c-a130-9fabb65d940f", "choice_type": "single"} {"question": "Trauma and injury severity score (TRISSI) includes", "exp": "Predict outcome of trauma cases S - Revised Trauma Score ISS - Injury Severity Score", "cop": 2, "opa": "GCS+BP+RR", "opb": "S+ISS+ person's age", "opc": "S+ISS+GCS", "opd": "S+GCS+BP", "subject_name": "Surgery", "topic_name": "Trauma", "id": "1c2727de-7e4c-4cd7-86c2-61cc7479e02d", "choice_type": "single"} {"question": "A periapical abscess of a mandibular second molar space spreads most commonly to the", "exp": null, "cop": 1, "opa": "Submandibular space", "opb": "Temporal space", "opc": "Sublingual space", "opd": "Infra temporal space", "subject_name": "Surgery", "topic_name": null, "id": "f24c02ea-6fdc-44f8-ab8c-375f94a2941b", "choice_type": "single"} {"question": "Esophageal carcinoma is not predisposed by", "exp": ".common predispositions in developing carcinoma oesophagus includes, *human papillomavirus infection *achalasia cardia (30%) *oesophageal webs (25%) *Barrett&;s oesophagus and also Plummer Vinson syndrome, tylosis, corrosive strictures, and nitrosamines. ref : SRB&;s manual of surgery,5th ed ,pg no 804", "cop": 2, "opa": "Achalasia", "opb": "Scleroderma", "opc": "Corrosive intake", "opd": "barrett's oesophagus", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "f9230b9c-37f1-45ae-8099-78235b9f8028", "choice_type": "single"} {"question": "Colonic diverticulosis is best diagnosed by", "exp": "\"Diverticula are best seen on barium enema. Colonoscopy is a less sensitive means of detecting diverticula.\" - CMDT 2007\n\nDiverticulosis refers to the presence of multiple diverticula\nDiverticulitis refers to inflammation and infection associated with a diverticulum.\n\nBest investigation for\nDiverticulosis - Barium enema\nDiverticulitis - CT scan\n\nOn barium, enema diverticulosis shows characteristic 'sawtooth' appearance", "cop": 3, "opa": "Colonoscopy", "opb": "Nuclear scan", "opc": "Barium enema", "opd": "CT scan", "subject_name": "Surgery", "topic_name": null, "id": "cf1290a1-f7a3-41c4-a12b-858094c92c65", "choice_type": "single"} {"question": "Desmoid tumor, treatment is", "exp": "Desmo means Band/Tendon in Greek. It is a tumour arising from the musculoaponeurotic layer of abdomen, below the level of the umbilicus. It is unencapsulated, hard, fibroma, presently classified under aggressive fibromatosis.80% of cases occur in women, commonly after deliveries, over the abdominal scars, OCP use.It is often associated with Gardner's syndrome. Wide excision of the tumour with a margin of 2.5 cm along with placement of a mesh to the abdominal defect is the treatment of choice . It is moderately radiosensitive. Drugs like sulindac and tamoxifen are also used. Chemotherapeutic agents like doxorubicin, actinomycin D, dacarbazine, carboplatin are used but with significant toxicity. Recurrence rate is high--20-40%.Reference : page 742-43 SRB's manual of surgery 5th edition", "cop": 2, "opa": "Local excision", "opb": "Wide excision", "opc": "Wide excision with radiotherapy", "opd": "Radiotherapy", "subject_name": "Surgery", "topic_name": "Urology", "id": "115683d4-0124-4208-a2be-16b6b532eb67", "choice_type": "single"} {"question": "Most common origin of melanoma is from", "exp": "Sabiston (16/e) writes -\n\"Melanoma is a neoplastic disorder produced by malignant transformation of the normal melanocytes. Melanocytes are the cells responsible for the production of the pigment melanin.\nDuring the first trimester of fetal life precursor melanocytes arise in the neural crest. As the fetus develops, these cells migrate to areas such as the skin, meninges, mucous membranes, upper esophagus and eyes.\nIn each of the these locations, melanocytes have demonstrated a potential for malignant transformation, but the site most commonly associated with melanocytic transformation is the skin, where melanocytes reside at the dermal/epidermal junction\".", "cop": 1, "opa": "Junctional melanocytes", "opb": "Epidermal cells", "opc": "Basal cells", "opd": "Follicular cells", "subject_name": "Surgery", "topic_name": null, "id": "d6cdec8f-75da-460f-a651-4b3d05e7fc33", "choice_type": "single"} {"question": "30 yrs female presented with unilateral breast cancer associated with axilary lymph node enlargement. Modified radical mastectomy was done, fuher treatment plan will be", "exp": "Adriamycin based chemotherapy followed by tamoxifen depending on.... Stage I & II breast cancers (Early invasive breast cancers) are managed by 1) Primary therapy for local management & 2) Adjuvant therapy Primary therapy consists of : - Mastectomy with assessment of axillary lymph node status (or modified radical mastectomy) Or - Breast conservation (lumpectomy, wide local excision or quadrantectorny) with assessment of axillary lymph node status + radiotherapy. Various trials have found both these methods to be equally effective. Breast conservation is the preferred form of treatment because of cosmetic advantages However there are ceain contraindications for conservative surgery (described in subsequent question) Management of axillary lymph nodes Earlier dissection of axillary lymph nodes (level l and II) was performed to assess the lymph node status (i.e. presence or absence of occult metastasis) Now Sentinel lymph node biopsy is considered the standard for evaluation of the axillary lymph nodes for metastasis in women who have clinically negative lymph nodes. (the sentinel lymph node is the first regional lymph node to receive tumor cells that metastasize along the lymphatic pathway from the primary breast cancer) Axiltary Lymph node dissection is performed for clinically palpable axillary lymphnodes or metastatic disease detected in sentinel lymph node biopsy. Adjuvant chemotherapy is given to all node-positive cancers node negative cancers if > I cm in size node negative cancer > .5 cm in size with adverse prognostic factors such as blood vessel or lymph vessel invasion high nuclear grade high histological grade HER 2/neu overexpression negative hormone receptor status Adjuvant hormone therapy (tamoxifen) is added to all those with estrogen receptor positive tumors. HER-2/neu expression is determined for all patients with newly diagnosed breast cancer and may be used to provide prognostic information in patients with node-negative breast cancer and predict the relative efficacy of various chemotherapy regimens. Trastuzumab is the HER-2/neu-targeted agent that is added to the adjuvant therapy is the tumor shows overexpression of HER-2/neu receptors. Advanced Local-Regional Breast Cancer (Stage III) (Neoadjuvant chemotherapy + MRM + adjuvant radiation therapy + chemotherapy + antiestrogen therapy) Here the disease is advanced on the chest wall or in regional lymph nodes (or both), with no evidence of metastasis to distant sites. Such patients are recognized to be at significant risk for the development of subsequent metastases, and treatment addresses the risk for both local and systemic relapse. In an effo to provide optimal local-regional disease-free survival as well as distant disease-free survival for these women, surgery is integrated with radiation therapy and chemotherapy. Neoadjuvant chemotherapy (administration of therapeutic agents prior to the main treatment) should be considered in the initial management of all patients with locally advanced stage III breast cancer. Surgical therapy for women with stage HI disease is usually a modified radical mastectomy, followed by adjuvant radiation therapy and chemotherapy. Antiestrogen therapy (tamoxifen) is added for hormone receptor positive tumors. Chemotherapy is used to maximize distant disease-free survival, whereas radiation therapy is used to maximize local-regional disease-free survival. In selected patients with stage LIIA cancer, neoadjuvant (preoperative) chemotherapy can reduce the size of the primary cancer and permit breast-conserving surgery. Distant Metastases (Stage IV) (mainly palliative treatment) Treatment for stage IV breast cancer is not curative but may prolong survival and enhance a woman's quality of life. Hormonal therapies that are associated with minimal toxicity are preferred to cytotoxic chemotherapy. Appropriate candidates for initial hormonal therapy include women with hormone receptor-positive cancers: women with bone or soft tissue metastases only; and women with limited and asymptomatic visceral metastases. Systemic chemotherapy is indicated for women with hormone receptor-negative cancers, symptomatic visceral metastases, and hormone-refractory metastases. Bisphosphonates, which may be given in addition to chemotherapy or hormone therapy, should be considered in women with bone metastases. About Adjuvant Therapy Adjuvant therapy is the use of systemic therapy (chemotherapy or/and hormone therapy) in patients who have received local therapy but are at risk of relapse. The objective is to eliminate the occult metastasis responsible for late recurrences while they are microscopic and theoretically most vulnerable to anticancer agents. Adjuvant chemotherapy is given to all node-positive cancers node negative cancers if > 1 cm in size node negative cancer > .5 cm in size with adverse prognostic factors such as blood vessel or lymph vessel invasion - high nuclear grade - high histological grade HER 2/neu overexpression negative hormone receptor status Adjuvant hormone therapy (tamoxifen) is added to all those with estrogen receptor positive. The use of chemotherapy in post-menopausal women is controversial. In post menopausal women, chemotherapy is frequently used upto age 70 yrs, if she can tolerate it. In older women, chemotherapy is performed less frequently. - In estrogen positive tumors, in postmenopausal women, antiestrogen (tamoxifen/ aromatase inhibitors) therapy is the preferred form of adjuvant systemic treatment. Neoadjuvant chemotherapy - it involves the administration of adjuvant therapy before primary therapy (surgery & radiation therapy) - it has shown to down-stage the tumor. Previously CMF (cyclophosphamide, methotrexate & 5-fluorouracil) was the chemotherapeutic regimen of choice. \"CMF is no longer considered adequate adjuvant chemotherapy and modern regimens include an anthracycline ( doxorubicin or epirubicin) and the newer agents such as the taxanes (paclitaxel and docetaxel)\"- Bailey and Lore 25/e p844 Anti-HER-2/neu antibody therapy (Traztuzumab) HER-2/neu expression for all newly diagnosed patients with breast cancer is now recommended. Trastuzumab is added to the chemotherapy for tumors overexpressing HER-2/nett receptors. (Traztuzumab is added along with taxanes)", "cop": 2, "opa": "Observation and followup", "opb": "Adriamycin based chemotherapy followed by tamoxifen depending on estrogen/progesterone receptor status", "opc": "Adriamycin based chemotherapy only", "opd": "Tamoxifen only", "subject_name": "Surgery", "topic_name": null, "id": "fa730c8a-c606-430c-ac4b-16b81463fd77", "choice_type": "single"} {"question": "Cyst coming from an unerupted tooth is", "exp": "Ans. (a) Dentigerous cystRef: Radiopedia.org. Prof Gaillard et al.DENTAL CYST (Radicular or periodontal cyst or Periapical cyst)DENTIGEROUS CYST (Follicular odontoma or Follicular cysts)Most common Odontogenic cyst2nd MC odontogenic CystDevelops at the apex of chronically infected tooth with necrotic pulp'(root of normally erupted tooth)Associated with unerupted permanent toothLined by stratified squamous epitheliumLined by non-keratinizing squamous epitheliumMost common in middle ageMost common in 2nd or 3rd decadeMost common in upper jawMost common in Lower third Molar tooth (Mandible 3rd molar)2nd MC - Maxillary 3rd molar (upper)", "cop": 1, "opa": "Dentigerous cyst", "opb": "Odontogenic keratocysts", "opc": "Radicular cyst", "opd": "Gorlin cysts", "subject_name": "Surgery", "topic_name": "Oral Cavity", "id": "aca85e38-47b6-4b69-a334-1aa1c5245b15", "choice_type": "single"} {"question": "Urine cytology is used for screening of", "exp": "Carcinoma of Urinary Bladder Cytoscopy Diagnosis and initial staging is made by cytoscopy and transurethral resection (TUR) Urinary cytology Cytological examination of exfoliated cells are useful in detecting cancer in symptomatic patients and assessing response to treatment Most useful for early diagnosis of recurrence in TCC Exfoliated markers for detection of bladder cancer New Urinary tumor marker like BTA test,urinary nuclear matrix protein (NMP22) can detect cancer specific proteins in urine (BTA/NMP22) Hyaluronidase, Lewis-X-Antigen on exfoliated urothelial cells Determination of telomerase activity in exfoliated cells Have been used to detect new index tumors and recurrent tumors Expected to play impoant role in near future Ref: Smith's 18th edition Pgno : 313", "cop": 3, "opa": "Wilms tumour", "opb": "Renal cell carcinoma", "opc": "Urothelial carcinoma", "opd": "Carcinoma prostate", "subject_name": "Surgery", "topic_name": "Urology", "id": "63f10a38-88c3-459d-8a12-9f863bd45eae", "choice_type": "single"} {"question": "The most common tumor of the minor salivary gland is", "exp": "The 90% of minor salivary gland tumours are malignant-commonly adenoid cystic carcinomas 10% are benign commonly pleomorphic adenomas SRB,5th,420.", "cop": 3, "opa": "Mucoepidermoid carcinoma", "opb": "Acinic cell carcinoma", "opc": "Adenoid cystic carcinoma", "opd": "Pleomorphic adeno carcinoma", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "0f992e5d-2c4d-470e-86d2-abe3be0a2908", "choice_type": "single"} {"question": "Commonest shoulder dislocation", "exp": "Ans. is 'a' i.e., Preglenoid Anterior dislocation of the shoulder is the most common type of shoulder dislocation. Head of the humerus comes out of the glenoid cavity and lies anteriorly. Anterior dislocation of shoulder could be : - Preglenoid It is the most common type of anterior dislocation and head lies in front of glenoid. Subcoracoid :- The head lies below the coracoid process. Subclavicular (infraclavicular) :- The head lies below the clavicle. Intrathoracic :- It is very rare.", "cop": 1, "opa": "Preglenoid", "opb": "Subcoracoid", "opc": "Posterior", "opd": "Subclavicular", "subject_name": "Surgery", "topic_name": null, "id": "1a3d3abf-b7fe-42f5-9e55-1f006bdac52f", "choice_type": "single"} {"question": "Tumor appears at the earliest after birth.", "exp": "Ans. (a) Cystic hygromaRef: Bailey and Love 26th edition, Page700* Earliest swelling one can note in human beings in Cystic Hygroma.* It can present as obstructed labor", "cop": 1, "opa": "Cystic hygroma", "opb": "Branchial cyst", "opc": "Lymphoma", "opd": "Sternomastoid tumor", "subject_name": "Surgery", "topic_name": "Neck", "id": "0fc3769e-0210-4076-86ad-a595dbcef431", "choice_type": "single"} {"question": "Line joining ant. sup iliac spine to ischial tuberosity and passes a greater trochanter", "exp": "A i.e. Nelton's line Measurment of Supratrochanteric Shoening Shoening of limb length produced above the level of trochanter (due to femoral head, neck and hip joint lesions) is known as supratrochanteric shoening. And it is measured by follwing tests.", "cop": 1, "opa": "Nelaton's line", "opb": "Showmakers line", "opc": "Cniene's line", "opd": "Perkins line", "subject_name": "Surgery", "topic_name": null, "id": "7f34fdd7-ce9d-4f87-92d1-ed69bb8d6f01", "choice_type": "single"} {"question": "Gunstock deformity is due to", "exp": "C i.e. Supracondylar fracture humerus", "cop": 3, "opa": "Fracture of 1st metacarpal bone", "opb": "Fracture of lower end of radius", "opc": "Supracondylar fracture of humerus", "opd": "Lateral condylar fracture of humerus", "subject_name": "Surgery", "topic_name": null, "id": "691e0f16-4a51-4dc9-aa1a-aeb959ee17b4", "choice_type": "single"} {"question": "Most reliable sign of injury to intrathoracic aoa is", "exp": "Answer- C. Obliteration of aoic knob contourThe most reliable of these signs for the blunt aoic iniury is loss ofthe aoic knob contour.", "cop": 3, "opa": "Presence of apical cap of pleural fluid", "opb": "Depression of left main stem bronchous", "opc": "Obliteration of aoic knob contour", "opd": "Funny looking mediastenum", "subject_name": "Surgery", "topic_name": null, "id": "4f1751eb-1a0f-4e97-8a7e-0965fea87936", "choice_type": "single"} {"question": "Most frequent site of branchial cyst is at", "exp": "BRANCHIAL CYST\n\nIt arises from the remnants of second branchial cleft. Normally, 2nd, 3rd, 4th clefts disappear to form a smooth neck. Persistent 2nd cleft is called as cervical sinus (of His) which eventually gets sequestered to form branchial cyst. \nSwelling in the neck beneath the anterior border of upper third of the sternomastoid muscle. It is smooth, soft, fluctuant, often transilluminant with a sensation of ‘Half-filled double hot water bottle’.\nIt is equal in both sexes. Even though congenital, it is seen in late adolescents and early 3rd decade.\nIt contains cholesterol crystals which is from the lining of mucous membrane which contains sebaceous gland. Cheesy toothpaste like material is typical.", "cop": 3, "opa": "Upper third of posterior border of sternocleidomastoid", "opb": "Lower third of anterior border of sternocleidomastoid", "opc": "Upper third of anteromedial border of sternocleidomastoid", "opd": "Supraclavicular fossa", "subject_name": "Surgery", "topic_name": null, "id": "732a6cba-c6ba-47c5-aea2-39f1d40fde0a", "choice_type": "single"} {"question": "Abdominal Aoic Aneurysm most commonly ruptures in", "exp": "Abdominal aoic aneurysm - anterior(20%) Posterior (80%) Most common site- retroperitonium with formation if retroperitonial hematoma. Reference- SRB, 5th edition, page:200", "cop": 1, "opa": "Retroperitoneum", "opb": "Pelvic cavity", "opc": "Peritoneal cavity", "opd": "Sub hepatic space", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "41fd6b5b-0767-4274-abb1-ed0b778c2d38", "choice_type": "single"} {"question": "Features of Blunt trauma abdomen maximum injury is to", "exp": ".ABDOMINAL TRAUMA It can be * Blunt trauma * Stab injury * Abdominal wall injury General Clinical Features * Features of shock--pallor, tachycardia, hypotension, .cold periphery, sweating, oliguria. * Abdominal distension. * Pain, tenderness, rebound tenderness, guarding andmrigidity, dullness in the flank on percussion. * Respiratory distress, cyanosis depending on the amount of blood loss. * Bruising over the skin of the abdominal wall. * Features specific of individual organ injuries. ref:SRB&;s manual of surgery,ed 3,pg no 124", "cop": 2, "opa": "Proximal ileum", "opb": "Proximal jejunum", "opc": "Midilium", "opd": "Ileocaecal junction", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "ea3d481f-bada-429d-bfe2-2e0c4228a52e", "choice_type": "single"} {"question": "The most common primary tumor of mediastinum", "exp": null, "cop": 3, "opa": "Lymphoma", "opb": "Teratoma", "opc": "Neurogenic tumor", "opd": "Thymoma", "subject_name": "Surgery", "topic_name": null, "id": "4164b422-f675-4d06-bece-6eac25d24200", "choice_type": "single"} {"question": "Murmur increasing with Valsalva manouvre aEUR'", "exp": "HOCM EFFECT OF VARIOUS INTERVENTIONS ON SYSTOLIC MURMURS Valsalva maneuver Most murmurs decrease in length and intensity with valsalva mane- uver. Two exceptions are:? - HOCM --> becomes louder - Mitral valve prolapse - becomes longer and louder Mitral Regurgitation The systolic murmur of M.R. is reduced during the strain phase of valsalva maneuver.", "cop": 2, "opa": "VSD", "opb": "HOCM", "opc": "MS", "opd": "AS", "subject_name": "Surgery", "topic_name": null, "id": "f271a284-e580-4f55-a17b-4f9b5395b72a", "choice_type": "single"} {"question": "The joint cavity can be examined in detail with out much surgical exposure by", "exp": null, "cop": 2, "opa": "Sialography", "opb": "Arthroscopy", "opc": "Biopsy", "opd": "Endoscopy", "subject_name": "Surgery", "topic_name": null, "id": "2867988e-be27-41e6-832f-032d5916209b", "choice_type": "single"} {"question": "Perforators are not present at", "exp": "Blood flows from the superficial to the deep veins through perforating (communicating veins) Perforators are located below the medial malleolus (inframalleolar perforator) in the medial calf (Cockett perforators) just above (Dodd perforator) & below the knee (Boyd perforator) at the level of the adductor canal (Hunterian perforator)", "cop": 4, "opa": "Ankle", "opb": "Medial calf", "opc": "Distal to calf", "opd": "Below inguinal ligament", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "2827762b-394e-4532-82ff-8833e387b3d7", "choice_type": "single"} {"question": "In patients with cirrhosis of the liver the site of venous thrombosis is", "exp": "In poal hypeension, Hepatic venous pressure gradient (HVPG) - It is done using a balloon catheter. Difference between free hepatic vein pressure and wedged hepatic vein pressure is HVPG. Normal HVPG is 8 mm Hg. It is more than 10 mm Hg in cirrhosis. Ref: SRB&;s manual of surgery,3 rd ed, pg no 547", "cop": 3, "opa": "Infra-hepatic inferior vena cava", "opb": "Infra-renal inferior vena cava", "opc": "Hepatic veins", "opd": "Poal vein", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "da7f00a1-da6a-49f5-93d8-43d87d97197a", "choice_type": "single"} {"question": "Removal of pa of the gut is must for the following mesenteric cyst removal surgery", "exp": ".Enterogenous type of cyst arises as a diveiculum or duplication from the adjacent bowel. hence it is a thick walled cyst (contains all layers of the bowel) and receives its blood supply from the adjacent bowel (not independent). So resection of the adjacent bowel along with the cyst is essential.Enucleation is contraindicatedIn enterogenous type, removal of the cyst with resection of adjacent bowel is done, because blood supply is from adjacent bowel. ref:SRB&;s manual of surgery ,ed 3,pg no 511", "cop": 1, "opa": "Enterogenous cyst", "opb": "Chylolymphatic cyst", "opc": "Dermoid cyst", "opd": "Hydatid cyst", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "fae35641-52e6-4217-88f0-73f9f2bc25c2", "choice_type": "single"} {"question": "Treatment of choice in peptic ulcer grade III is", "exp": "Treatment for peptic ulcer includes, * Correction of dehydration and electrolytes by IV fluids--normal saline or double strength saline, calcium, potassium, magnesium. * Blood transfusion is given if there is anaemia. * TPN suppo. * Stomach wash to clean the stomach contents (using normal saline) is given using stomach tube like Oswald&;s. It also reduces the oedema of stomach wall and improves gastric emptying time by increasing the gastric muscle tone. * Surgery - Truncal vagotomy along with gastrojejunostomy of Mayo (posterior, veical, sho loop, retrocolic, is peristalsis) is done - Ideal. - Vagotomy, antrectomy (acid-secreting area) with Billroth I anastomosis along with feeding jejunostomy for nutrition is the other option. Ref: SRB&;s manual of surgery,3 rd ed, pg no 761", "cop": 2, "opa": "Vagotomy only", "opb": "Vagotomy and antrectomy", "opc": "Vagotomy and pyloroplasty", "opd": "Highly selective vagotomy", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "a82d47bc-c131-43ba-8d32-c21af23c4d23", "choice_type": "single"} {"question": "Lower Lip carcinoma <1 cm treatment is", "exp": "Ans. (c) Surgical excisionRef: Bailey and Love 27th edition Page 768Lip cancer management.Smaller Tumors <2cm)* Excision by V or W shaped under Local or General Anaesthesia.* Defect of less than 1 /3rd defect is closed by primary closure in 3 layers - Mucosa, Muscle, Skin.Intermediate Tumors:* 1 /3rd to 2/3rd defect happens- Local flaps must be used like Johansen Step ladder flapTotal Lip Reconstruction:* T 4 lesions needs complete Excision of Lip.* Radial forearm free flap or Perforator flaps such as Antero lateral Thigh or Medial Sural Artery Perforator (MSAP) free flap.", "cop": 3, "opa": "RT", "opb": "Chemotherapy", "opc": "Surgical excision", "opd": "RT + CT", "subject_name": "Surgery", "topic_name": "Oral Cavity", "id": "ecf4ba29-0130-4b87-934c-fe37cb31cfa0", "choice_type": "single"} {"question": "A patient started having sudden headache and vomiting and got unconscious, diagnosis is", "exp": null, "cop": 1, "opa": "Subarachnoid haemorrhage", "opb": "Intracerebral haemorrhage", "opc": "Subdural haemorrhage", "opd": "Extradural Haemorrhage", "subject_name": "Surgery", "topic_name": null, "id": "443e98ed-2398-487f-bd5c-2c5a5ad5b11d", "choice_type": "single"} {"question": "Hypotension in case of gas gangrene is best treated by", "exp": null, "cop": 1, "opa": "Ringer Lactate", "opb": "Normal Saline", "opc": "Plasma", "opd": "Whole blood", "subject_name": "Surgery", "topic_name": null, "id": "54188d60-8c8b-4f7d-8bf4-44ae2f8e5aaa", "choice_type": "single"} {"question": "Supra omohyoid dissection is one variety of", "exp": "Ans. (a) Selective neck dissectionRef: Bailey- 26th edition Page 720* Supraomohyoid neck dissection involves removal of neck nodes at level 1,2,3.* It is done for No neck node palpable cases and for some cases of N1.* Extended Omohyoid Neck dissection removes - Level 1,2,3 and 4 nodes.", "cop": 1, "opa": "Selective neck dissection", "opb": "Modified radical neck dissection", "opc": "Radical neck dissection", "opd": "Posterolateral dissection", "subject_name": "Surgery", "topic_name": "Oral Cavity", "id": "ebe1e237-c4d2-48b5-ba7d-1d8bff95bfec", "choice_type": "single"} {"question": "Tinel's sign is positive in", "exp": "(A) Peripheral nerve regeneration # Tinel s sign: Tinel's sign is elicited as follows:> Tap the injured nerve along its course starting peripherally.> The point at which the patient feels tingling sensation along the course of the nerve indicates that recovery has started and has reached that point.> Also seen in comparision of nerve either by neuromas or entrapment.", "cop": 1, "opa": "Peripheral nerve regeneration", "opb": "Tendon injury", "opc": "Tenosynovitis", "opd": "Rheumatoid arthritis", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "09fe0583-7148-45bb-8ad8-db75effdc125", "choice_type": "single"} {"question": "In the fracture of middle cranial fossa, loss of taste sensations from palate would be due to lesion in", "exp": "Greater petrosal nerve Middle cranial fossa fracture damages the petrous bone and thence, GP nerve lying on it. GP nerve carries the palatal taste fibres (SVA) to the geniculate ganglion", "cop": 3, "opa": "Trigeminal ganglion", "opb": "Deep petrosal nerve", "opc": "Greater petrosal nerve", "opd": "Cervical ganglion", "subject_name": "Surgery", "topic_name": null, "id": "c2deb4a8-89cd-478c-87b9-bf1372ba5903", "choice_type": "single"} {"question": "Traumatic glenohumeral instability on one direction with Bankas lesion are treated by", "exp": "B i.e. Surgery", "cop": 2, "opa": "Consv ervative methods", "opb": "Surgery", "opc": "Rehabilitation", "opd": "Observation f/b inferior capsule shift", "subject_name": "Surgery", "topic_name": null, "id": "942162be-657d-4454-b326-2bc865b21e43", "choice_type": "single"} {"question": "Most common site of ectopic testis is", "exp": "(Superficial inguinal ring) (1405-LB) (1379-B &L 25th)Ectopic testis descending order (i) Superficial inguinal ring (ii) perineum (iii) Root of the penis (iv) femoral triangle* Continued descent of the testis may progress after birth, but descent comes to a halt before 2 years of age. The degenerative changes begin to occur at 2 years of age.* Operation is indicated after 12-18 months since degenerative changes begin to take place* The incidence of testicular cancer in a cryptoorchid testis (30 times higher than the normal population)* The prognosis for fertility following orchidopexy in unilateral maldescent is 80%, whereas fertility after bilateral orchidopexy is about 50%", "cop": 1, "opa": "Superficial inguinal ring", "opb": "In the perineuim", "opc": "Root of the penis", "opd": "Femoral triangle", "subject_name": "Surgery", "topic_name": "Testis & Scrotum", "id": "2791bf05-f978-4d55-b002-24a83de97c54", "choice_type": "single"} {"question": "A male with azoospermia found to have normal FSH & testosteron levels & normal size testes. Probable cause is", "exp": null, "cop": 1, "opa": "Vas obstruction", "opb": "Kaltman syndrome", "opc": "Undescended testis", "opd": "Klinefeltor's syndrome", "subject_name": "Surgery", "topic_name": null, "id": "3e656ca4-0bb0-4f83-acbd-b0100b29854d", "choice_type": "single"} {"question": "Pathognomonic sign of traumatic fracture is", "exp": "C i.e. Crepitus Fracture is a break in structural continuity of bone. It may be no more than a crack, a crumpling or a splintering of the coex; most often the break is complete & the bone fragments are displaced.", "cop": 3, "opa": "Redness", "opb": "Swelling", "opc": "Crepitus", "opd": "Tenderness", "subject_name": "Surgery", "topic_name": null, "id": "9c5cb2d9-164c-4e69-bca1-fbeffd8ef2a1", "choice_type": "single"} {"question": "Normal level of PSA is", "exp": "In BPH , prostatitis and cancer is PSA is raised.", "cop": 1, "opa": "< 4 ng/ml", "opb": "4-7 ng/ml", "opc": "4 - 11ng/ml", "opd": "> 11 ng/ml", "subject_name": "Surgery", "topic_name": null, "id": "2f14c0f5-7f29-43f7-9a0b-bc2883ab4304", "choice_type": "single"} {"question": "A patient with critical lower limb ischemia presents with", "exp": "Critical lower limb Ischemia is characterized by rest pain. Ulcers and gangrene may occur in patients with critical limb ischemia Critical limb ischemia CLI results from severe aerial occlusive disease in whom resting blood flow cannoy provide fro basal nutrition needs of tissues Ischemic symptoms are present even during rest (rest pain) Pain is worse when legs are horizontal and may improve when legs are kept in a dependent position Ischemic ulcers, lesions on the foot and gangrene may be seen ABI <0.5 Ref: Sabiston 20th edition Pgno :1784", "cop": 3, "opa": "Intermittent claudication", "opb": "Intermittent claudication and gangrene", "opc": "Rest pain and ischemic ulcers", "opd": "Intermittent claudication and ischemic ulcers", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "22ac366c-0e44-4005-a413-f41d364f25fe", "choice_type": "single"} {"question": "Most common metabolic complication of gastrectomy is", "exp": "Nutritional disorders are common after gastrectomy. Weight loss is common after gastrectomyAnaemia may be due toeither iron or vitamin B12 deficiency.Iron-deficiency anaemia occurs after both gastrectomy and vagotomy and drainage. Reduced iron absorption is probably the most impoant factor, although the loss of blood from the gastric mucosa may also be impoant. Vitamin B12 deficiency is prone to occur after total gastrectomy. However, because of the very large vitamin B12 stores that most patients have, this maybe very late in occurring.Bone disease is seen principally after gastrectomy and mainly in women. The condition is essentially indistinguishable from the osteoporosis commonly seen in post-menopausal women.Bailey and love pg: 1127", "cop": 1, "opa": "Iron deficiency anemia", "opb": "Megaloblastic anemia", "opc": "Hypocalcemia", "opd": "Osteoporosis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "f9f12a16-56e3-48a9-9fd8-1e8d1c730fa4", "choice_type": "single"} {"question": "Commonest complication of varicose vein stripping is", "exp": "Ans. is 'c' i.e., Ecchymosis \"Complications associated with GSV stripping include ecchymosis, lymphocele formation, DVT, infection, and saphenous nerve injury.\"- Schwaz 9/e p792", "cop": 3, "opa": "Thrombo embolism", "opb": "Hemorrhage", "opc": "Ecchymosis", "opd": "Infection", "subject_name": "Surgery", "topic_name": null, "id": "c790553b-a804-4d08-a3a8-425f0ef96b2f", "choice_type": "single"} {"question": "Most common sets of Metastases of carcinoma bronchi", "exp": "Distant metastases blood stream are widespread and early.The sites affected,in descending order of involvement,are:the liver,adrenals,bones,pancreas,brain,opposite lung,kidneys & thyroid. Textbook of pathology-6th edition,Harsh Mohan,6th edition,page no:502", "cop": 1, "opa": "Liver + Bones", "opb": "Prostate", "opc": "Kidney", "opd": "Breast", "subject_name": "Surgery", "topic_name": "Cardio thoracic surgery ", "id": "41fc199d-a232-40e0-95e3-815ba10117a4", "choice_type": "single"} {"question": "Cellulitis is", "exp": "Ans. (b) A nonsuppurative invasive infection of tissues(Ref: Bailey and Love 27th Edition Page 48)* Cellulitis is a non suppurative invasive infection of Tissues, related to point of injury.* Poor localisation and spreading infection seen.* Caused by Beta Hemolytic Streptococci, Staphylococci and Clostridium perfringens.* Toxemia- Fever, Chills are common.* Blood Culture is negative.", "cop": 2, "opa": "A suppurative invasive infection of skin and subcutaneous tissues", "opb": "A nonsuppurative invasive infection of tissues", "opc": "Infection caused by Gram negative bacilli", "opd": "Infection caused by anaerobic Streptococci", "subject_name": "Surgery", "topic_name": "Infection", "id": "a3dafca7-c549-48f8-a68f-eaa6ab5ccf3a", "choice_type": "single"} {"question": "A 40 year old man presented with a flat 1 cm x 1 cm scaly, itchy clack mole on the front of thigh. Examination did reveal any inguinal lymphadenopathy. The best course of management would be", "exp": "Lymphangiomas are dilated dermal lymphatics that 'blister' onto the skin surface. The fluid is usually clear but may be blood-stained. In the long term, lymphangiomas thrombose and fibrose, forming hard nodules that may raise concerns about malignancy. If lymphangiomas are <5cm across, they are termed lymphangioma circumscriptum, and if they are more widespread, they are termed lymphangioma diffusum. If they form a reticulate pattern of ridges then it has been termed lymphoedema ab igne. Lymphangiomas frequently weep (lymphorrhoea, chylorrhoea), causing skin maceration, and they act as a poal for infection. Protein-losing diarrhoea, chylous ascites, chylothorax, chyluria and discharge from lymphangiomas suggest lymphangectasia (megalymphatics) and chylous reflux. Ulceration, non-healing bruises and raised purple-red nodules should lead to suspicion of malignancy. Lymphangiosarcoma was originally described in postmastectomy oedema (Stewa-Treves' syndrome) and affects around 0.5% of patients at a mean onset of 10 years. However, lymphangiosarcoma can develop in any long-standing lymphoedema, but usually takes longer to manifest (20 years). It presents as single or multiple bluish/red skin and subcutaneous nodules that spread to form satellite lesions, which may then become confluent. Thediagnosis is usually made late and confirmed by excision biopsy. Amputation offers the best chance of survival but, even then, most patients live for less than 3 years. It has been suggested that lymphoedema leads to an impairment of immune surveillance and so predisposes to other malignancies, although the causal association is not as definite as it is for lymphangiosarcoma. Ref : Bailey and love 27th edition Pgno : 998", "cop": 3, "opa": "FNAC of the lesion", "opb": "Incision biopsy", "opc": "Exicisional biopsy", "opd": "Wide excision with inguinal lymphadenectomy", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "421cdad6-1b11-416f-bede-39f50092cd9f", "choice_type": "single"} {"question": "In Duke's classification of colorectal carcinoma stageA means", "exp": "(A) Involvement up to muscularis propria # Duke's prognostic classification> A-growth in colon/rectum only> B-growth extending to extrarectal tissues but no metastasis to regional lymph nodes> C-secondary deposits in regional lymph nodes", "cop": 1, "opa": "Involvement upto muscularis propria", "opb": "Involvement beyond muscularis propria", "opc": "Positive lymph node involvement", "opd": "Distant metastasis", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "2a066186-3c62-4b26-995a-dee19bd8b36c", "choice_type": "single"} {"question": "Optical urethroplasty is done in", "exp": "Congenital Urethral Stricture-this rare condition may be associated with duplication of the urethra. Usually, symptoms are delayed until adolescence, when it may be indistinguishable from a stricture due to unrecognised urethral injury in childhood. A single treatment by optical urethrotomy(Direct visual internal urethrotomy) or dilatation is usually effective.Reference : page1362 Bailey and Love's sho practice of surgery 25th edition", "cop": 1, "opa": "Congenital stricture of urethra", "opb": "Hypospadies", "opc": "Epispadies", "opd": "Testicular tumour's", "subject_name": "Surgery", "topic_name": "Urology", "id": "0a070c80-5500-4466-b6f4-0f32fbb14772", "choice_type": "single"} {"question": "35 years male presents with a swelling in scrotum that is non tender and seperate from testes and on transillumination, chinese lantern pattern is seen diagnosis", "exp": "Answer- C. Epididymal cystCysts of the epididymis (multiloculated epididymal cyst, spermatocele) are not swrounded by fluid and for this reason are felt as swellings above, behind the testis, which is also easily palpable in this situation.Because of the septation, multiloculated epididlmal cysts have a characteristic 'Chinese lantern' aPPearance on transillumination.", "cop": 3, "opa": "Vaginal hydrocele", "opb": "Inguinal harnia", "opc": "Epididymal cyst", "opd": "Varicocele", "subject_name": "Surgery", "topic_name": null, "id": "820378fb-7dda-4afb-8d7b-691b6f3104ea", "choice_type": "single"} {"question": "Abdominal surgery under LA, patient suddenly felt pain due to", "exp": ".pas of peritoneum mainly includes 1. Parietal peritoneum: It lines the inner surface of the abdominal wall, under surface of diaphragm and pelvic wall. It is loosely attached to the overlying walls and can be easily stripped off. It is innervated by the somatic nerves, so pain sensitive. Anterior peritoneum is most sensitive when compared to pelvic peritoneum. 2. Visceral peritoneum: It lines the outer surface of the abdominal viscera, firmly adherent, cannot be stripped off. It is innervated by autonomic nervous system; hence not pain sensitive. ref:SRB&;s manual of surgery,ed 3,pg no 498", "cop": 3, "opa": "Liver", "opb": "Gut", "opc": "Parietal peritoneum", "opd": "Visceralperitoneum", "subject_name": "Surgery", "topic_name": "Urology", "id": "6172e0c7-8c5b-41ba-b27b-afb320656bb1", "choice_type": "single"} {"question": "Sample collection for renal tuberculosis is", "exp": "BACTERIOLOGICAL:- The diagnosis of genitourinary TB is confirmed on a tuberculin test or atleast three consecutive early morning samples of urine are collected and sent for microscopy (Ziehl-Neelsen staining), culture on Lowenstein-Jensen medium. RADIOGRAPHY:- A plain abdominal radiograph may show calcified lesions of CEMENT KIDNEY. INTRAVENOUS UROGRAPHY:-EARLY:-Normally clear cut outline of renal papillae may be rendered indistinct by presence of ulceration. TUBERCULOUS ABSCESS:-Appears as SOL , which causes adjacent calyces to splay out. LATE:- Dilatation of contralateral ureter from obstruction where the ureters passes through thickened and oedmatous bladder wall. CYSTOSCOPY:- GOLF-HOLE ureteric orifice. CXR:-Active Lung lesion. Reference : Bailey27th edition . chapter 76 , pg no: 1405", "cop": 4, "opa": "Single early morning urine sample", "opb": "24 hours urine collection", "opc": "3 random urine collection", "opd": "3 morning sample of urine", "subject_name": "Surgery", "topic_name": "Urology", "id": "04af1a86-513d-4069-9a98-2f0364e7919b", "choice_type": "single"} {"question": "Pure Radiolucent stone", "exp": "Ans. (c) Xanthine StonesRadiolucent Kidney Stones:* Pure Uric Acid Stones* Xanthine* Indinavir Drug induced StoneUric Acid Stone:* 5-10% of all stones* Seen in excessive acid urine (pH<5.5)* Uric acid is an end product of purine metabolism* Dietary protein and protein excess results in increased urinary URIC acid and stone.* Myeloproliferative diseases, chemotherapy drugs induce this stone.* Uric acid stone is also formed in normal uric acid level.* Low urine volume like in IBD, Ileostomies may also stimulate uric acid stone.* Stones are hard, multifaceted, multiple.* Pure uric acid Stones are radiolucent.", "cop": 3, "opa": "Struvite", "opb": "Cystine", "opc": "Xanthine", "opd": "Calcium oxalate", "subject_name": "Surgery", "topic_name": "Kidney & Ureturs", "id": "a837d815-d78b-4c87-9590-c68cf81affd4", "choice_type": "single"} {"question": "Most common site of ischemia of large bowel is at", "exp": "(A) Splenic flexure [B&L26-11831# Colon receives blood from both the superior and inferior mesenteric arteries.> Blood supply from these two major arteries overlap, with abundant collateral circulation via the marginal artery of the colon.> However, there are weak points, or \"watershed\" areas, at the borders of the territory supplied by each of these arteries, such as the splenic flexure and the transverse portion of the colon.> These watershed areas are most vulnerable to ischemia when blood flow decreases, as they have the fewest vascular collate ra\\s.> Rectum receives blood from both the inferior mesenteric artery and the internal iliac artery; the rectum is rarely involved by colonic ischemia due to this dual blood supply.", "cop": 1, "opa": "Splenic flexure", "opb": "Hepatic flexure", "opc": "Ascending colon", "opd": "Descending colon", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "8c76cfb1-79ad-4a19-97e4-bbc17f22714c", "choice_type": "single"} {"question": "middle aged man with a swelling over the scalp since childhood Neck swelling has a bag of worm appearance Bruit heard over the swelling Dx is", "exp": "ref : bailey and love 27th ed", "cop": 4, "opa": "Plexiform neurofibroma", "opb": "Toxic nodular goitre", "opc": "Varicocele", "opd": "cirsoid aneurysm", "subject_name": "Surgery", "topic_name": "All India exam", "id": "767818a2-43c6-4475-8e6d-b37a8f1a2562", "choice_type": "single"} {"question": "MC comp. of talus is", "exp": "A i.e Avascular necrosis", "cop": 1, "opa": "Avascular necrosis", "opb": "Non union", "opc": "Osteoahritis of ankle joint.", "opd": "Osteoahritis of subtalar joint.", "subject_name": "Surgery", "topic_name": null, "id": "870bbf70-358c-4581-b23c-725da331db0b", "choice_type": "single"} {"question": "Most common gas used for pneumoperitoneum", "exp": "Ans. (b) CO2 (Ref: Campbell Urology 11th 211)* CO2 is the most commonly used gas for laparoscopy because it is colourless, non combustible, very soluble in blood and inexpensive.", "cop": 2, "opa": "Nitrogen", "opb": "CO2", "opc": "O2", "opd": "Air", "subject_name": "Surgery", "topic_name": "Anatomy & Physiology (Peritonium)", "id": "c0d657d9-c031-4945-8451-974aec611f05", "choice_type": "single"} {"question": "Newman and Seabroocks operation is done for", "exp": "Newman and Seabroocks operation is reconstruction of duct done for parotid fistula.", "cop": 1, "opa": "Parotid fistula", "opb": "Sialothiasis", "opc": "Sjogren syndrome", "opd": "Thyroglossal cyst", "subject_name": "Surgery", "topic_name": null, "id": "34aa5173-b67a-4d24-bd9e-942d382ab56b", "choice_type": "single"} {"question": "The usual site of stress fracture includes", "exp": "D. i.e. Second metatarsal bone", "cop": 4, "opa": "Tibia", "opb": "First metacarpal bone", "opc": "Second metacarpal bone", "opd": "Second metatarsal bone", "subject_name": "Surgery", "topic_name": null, "id": "c918426d-b8ae-4ab8-be4b-048ebafe48f5", "choice_type": "single"} {"question": "In polytrauma with blunt abdominal injury, the first investigation to evaluate his abdomen is", "exp": "Ans. (a)USG is the first investigation to evaluate abdomen in bunt trauma.Ref. Schwartz 10th/e p. 179 and 9th/e p. 151; Washington Manual of Surgery 5th/e p. 373 * CT scan is the best investigation.", "cop": 1, "opa": "USG", "opb": "CT Scan", "opc": "Complete Hemogram", "opd": "Abdominal X-ray", "subject_name": "Surgery", "topic_name": "Trauma", "id": "2e811305-2c4a-4147-9718-c1a2536a58b0", "choice_type": "single"} {"question": "Return of Bulbocavernous reflex in spinal shock", "exp": "A i.e. Sign of recovery from spinal shock Spinal Shock Some times physical energy of the injury mechanism causes immediate depolarization of axonal membranes in the neural tissue. This results in functional neurological defecit that exceeds the actual tissue disruption. This condition is refered to as spinal shock. The presence of spinal shock causes the absence of all reflexesQ. And it typically lasts upto 24- 48 hours after the injuryQ. The bulbocavernosus reflex is the reflex that returns first, thus marking the end of spinal shockQ. This point has prognostic impoance because recovery from a complete neurological deficit that is still present at the end of spinal shock is extremely unlikely. In other words, a total absence of sensation & voluntary motor functions caudal to the level of spinal cord injury in the absence of spinal shock (i.e. bulbocavernosus reflex has recovered) is indicative of complete spinal cord injury and there is viually no likelihood of functional spinal cord recovery.", "cop": 1, "opa": "Sign of recovery from spinal shock", "opb": "Paial lesion of spinal cord", "opc": "Complete transection of spinal cord", "opd": "Incomplete transection of spinal cord", "subject_name": "Surgery", "topic_name": null, "id": "5d6c113e-925f-4581-a241-e6e01979ed64", "choice_type": "single"} {"question": "GCS of an intubated patient with Abnormal flexion attitude, and eye opening only to pain is", "exp": "Ans. (c) E2 VNTM3 Ref: Bailey and Love, 27th ed; pg. 331* Verbal response could not be tested in intubated patients and are scored as NT (not tested)* So, in intubated patients scores range from E1 M1 NT to E4 M6 NT", "cop": 3, "opa": "E2VTM4", "opb": "E2V1M4", "opc": "E2VNTM3", "opd": "E2V1M3", "subject_name": "Surgery", "topic_name": "Trauma", "id": "0c17ec99-143b-42f5-82bc-5bab696d99d4", "choice_type": "single"} {"question": "Chronic Burrowing ulcer is caused by", "exp": "Microaerophilic streptococci (Burrowing ulcer / Maleny's ulcer is caused by synergistic infection of microaerophilic non hemolytic streptococci and aerobic hemolytic streptococci)", "cop": 1, "opa": "Microaerophilic streptococci", "opb": "Peptostreptococcus", "opc": "Streptococcus viridans", "opd": "Streptococcus pyogenes", "subject_name": "Surgery", "topic_name": "General surgery", "id": "46cafeff-ae0d-4a3b-8987-902e2d8d6c0c", "choice_type": "single"} {"question": "Crohn&;s disease is associated with", "exp": ".10% of first degree relatives; 50% of monozygotic twins develop Crohn's disease. Genes NOD2 / CARD15 in chromosome 16q12 has got strong association with Crohn's disease. CARD15 is expressed in Paneth cells of the ileum. * Smoking is related to Crohn's disease as aetiology, as for relapse and for exacerbations. There is increased mucus membrane permeability - antigen induced cell mediated inflammatory response - release of cytokines like TNF, interleukin 2 -m defect in suppressor T cell - granuloma and other pathology. ref:SRB&;s manual of surgery ,ed 3,pg no 801", "cop": 1, "opa": "NOD2\\/CARD15 gene", "opb": "P53 supressor gene", "opc": "Philadelpha chromosomes", "opd": "BRACI gene", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "6437e449-2df3-418b-8604-7805a9b70435", "choice_type": "single"} {"question": "Most common site of Curling&;s ulcer", "exp": "Curling ulcer is acute ulcer peptic ulcer of duodenum developing as a resulting from burn injury which reduces plasma volume resulting in sloughing of the gastric mucosa. Reference SRB 5th edition page no. 822 & internet", "cop": 3, "opa": "Ileum", "opb": "Stomach", "opc": "Duodenum", "opd": "Esophagus", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "b39506e5-1b46-4a66-bab1-b89b08755793", "choice_type": "single"} {"question": "In head injury, first to be repaired is", "exp": null, "cop": 1, "opa": "Bone", "opb": "Tendon", "opc": "Muscle", "opd": "Nerve", "subject_name": "Surgery", "topic_name": null, "id": "4a5b415a-2cc2-454f-8fda-b939f46b2a74", "choice_type": "single"} {"question": ". Peutz Jeghers polyps present most commonly in", "exp": "Jejunum [Ref: Oxford textbook of medicine: Sections 18-33, Volume 3 By David A. Warrell 2005/e p6431 Oxford textbook of medicine writes- \"The syndrome stigmata are obvious with multiple pigmented spots on the lips and buccal mucosa, and multiple benign hamaomatous polyps throughout the gastrointestinal tract, most frequently affecting the jejunum.\" Peutz-Jeghers syndrome is an autosomal dominant syndrome characterized by the combination of hamaomatous polyps of the intestinal tract and hyperpigmentation of the buccal mucosa, lips, and digits. The syndrome is associated with an increased (2%-10%) risk for cancer of the intestinal tract, with cancers repoed throughout the intestinal tract, from the stomach to the rectum. There is also an increased risk for extraintestinal malignancies, including cancer of the breast, ovary, cervix, fallopian tubes, thyroid, lung, gallbladder, bile ducts, pancreas, and testicles.", "cop": 4, "opa": "Rectum", "opb": "Colon", "opc": "Esophagus", "opd": "Jejunum", "subject_name": "Surgery", "topic_name": null, "id": "b1c76634-d18f-4664-b008-c40c4e8badc2", "choice_type": "single"} {"question": "The following is a maker of Paget&;s disease of the mammary gland", "exp": ".It is superficial manifestation of an intraductal carcinoma. The malignancy spreads within the duct up to the skin of the nipple and down into the substance of the breast. It mimics eczema of nipple and areola.-- In Paget's disease, there is a hard nodule just underneath the areola, which later ulcerates and causes destruction of nipple. Histologically, it contains large, ovoid, clear Paget's cells with malignant features.Modalities of Treatment for it includes * QUA therapy. * Patey's operation or simple mastectomy with axillary clearance * Postoperative radiotherapy in high risk patients. * Hormone therapy, i.e. tamoxifen 10 mg BID. * Sentinel node biopsy when required. * Regular follow-up often with radioisotope bone scan and CEA tumour marker. ref:SRB&;s manual of surgery,ed 3,pg no 470", "cop": 3, "opa": "S-100", "opb": "HMB 45", "opc": "CEA", "opd": "Neuron specific enolase", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "1eca452d-f71c-4c3f-bd7f-1c9bacc413cf", "choice_type": "single"} {"question": "Treatment of choice for cystic hygroma", "exp": "Ans. d (Surgical excision) (Ref. Bailey and Love Surgery 25th/pg. 729).Definitive treatment of Cystic hygroma is complete excision of the cyst at an early stage. Injection of a sclerosant , may reduce the size of the cyst; however, they are commonly multicystic and if the injection is extracystic subsequent surgery may be more difficult.CYSTIC HYGROMA# In this developmental abnormality of the lymphatic system, lymphatic fluid collects in a cystic space which is often multilocular and situated in the base of the neck (post triangle).# Association with Turner's syndrome is known.# Cystic hygroma usually presents in the neonate or in early infancy, and occasionally may present at birth and be so large as to obstruct labour. The cysts are filled with clear lymph and lined by a single layer of epithelium with a mosaic appearance. Swelling usually occurs in the neck and may involve the parotid, submandibular, tongue and floor of mouth areas. The swelling may be bilateral and is soft and partially compressible, visibly increasing in size when the child coughs or cries. The characteristic that distinguishes it from all other neck swellings is that it is brilliantly translucent.# The cheek, axilla, groin and mediastinum are other less frequent sites for a cystic hygroma.# The behaviour of cystic hygromas during infancy is unpredictable. Sometimes the cyst expands rapidly and occasionally respiratory difficulty ensues, requiring immediate aspiration and even occasionally a tracheostomy. The cyst may become infected.# USG can be diagostic.", "cop": 4, "opa": "Percutaneous aspiration", "opb": "Intralesional sclerosant injection", "opc": "En bloc resection", "opd": "Surgical excision", "subject_name": "Surgery", "topic_name": "Neck", "id": "2f06fbb9-2904-439b-90df-aa19f5294895", "choice_type": "single"} {"question": "Long duration anesthesia is achieved by", "exp": null, "cop": 4, "opa": "2% Lidocaine HCL + Epinephrine 1:2,00,000", "opb": "3% Mepivacaine HCL", "opc": "4% Prilocaine HCL + Epinephrine 1:2,00,000", "opd": "0.5% Bupivacaine+ Epinephrine 1:2,00,000", "subject_name": "Surgery", "topic_name": null, "id": "de9ac748-a2fa-4683-bdae-718fbd327a22", "choice_type": "single"} {"question": "Gail Model is for risk assessment of", "exp": "Ans. (c) CA. Breast(Ref. Schwartz 10th edition Page 512)Common models used in risk assessment of cancer breast:* Gail model* Claus Model* BRCAPRO model* Tyrer-Cuzick model* Neither the Gail model nor the Claus model accounts for the risk associated with mutations in the breast cancer susceptibility genes BRCA1 and BRCA2.* Other models utilize the family history and BRCA1 and 2 mutations.", "cop": 3, "opa": "Ovarian", "opb": "Prostate", "opc": "Breast", "opd": "Lung", "subject_name": "Surgery", "topic_name": "Breast", "id": "45acaef3-aa2f-43df-890c-e6762b0fd3a4", "choice_type": "single"} {"question": "Apical cyst having a direct connection with apical foramen have been termed as", "exp": null, "cop": 2, "opa": "Residual", "opb": "Bay", "opc": "Paradental", "opd": "Collateral", "subject_name": "Surgery", "topic_name": null, "id": "7ef6f205-8856-46d9-8857-4308ec8d4332", "choice_type": "single"} {"question": "Best prognosis of thyroid cancer Is", "exp": "Best prognosis — papillary\nWorst prognosis – anaplastic", "cop": 1, "opa": "Papillary", "opb": "Medullary", "opc": "Follicular", "opd": "Anaplastic", "subject_name": "Surgery", "topic_name": null, "id": "e6e3894d-9e1c-4e52-9d19-aec5ad87350f", "choice_type": "single"} {"question": "The Ames test is a method for detecting", "exp": "Mutagenesis in bacteria The Ames test is carried out in Salmonella and detects mutations in the bacterial DNA. Because mutagenic potential is associated with carcinogenic risk for many chemicals, the Ames test is often used to claim that a paicular agent may be a carcinogen. However, the test itself only detects mutations.", "cop": 4, "opa": "Carcinogenesis in rodents", "opb": "Carcinogenesis in primates", "opc": "Teratogenesis in any mammalian species", "opd": "Mutagenesis in bacteria", "subject_name": "Surgery", "topic_name": null, "id": "c8d76274-6e3b-4098-97fe-ca96618e9133", "choice_type": "single"} {"question": "The difference between primary and secondary healing is", "exp": "In secondary healing :\n\nMore granulation tissue and fibrosis occurs.\nScar is loss cosmetic.\nSecondary healing occurs slower.\nSurgical wounds are clean cut, hence they heal by secondary healing.", "cop": 1, "opa": "More granulation tissue and fibrosis is seen in secondary healing", "opb": "Scar is more cosmetic in secondary healing", "opc": "Secondary healing occurs faster", "opd": "Surgical wound heal commonly by secondary healing", "subject_name": "Surgery", "topic_name": null, "id": "331c01c8-186b-4662-8f8f-f2227ccf5f4a", "choice_type": "single"} {"question": "Urinary catheterisation indicated in case of acute retention of urine in following conditions", "exp": "The most frequent causes of acute retention Male * Bladder outlet obstruction (the most common cause) * Urethral stricture * Acute urethritis or prostatitis * Phimosis Female * Retroveed gravid uterus * Bladder neck obstruction (rare) Both (Male and female) * Blood clot * Urethral calculus * Rupture of the urethra * Neurogenic (injury or disease of the spinal cord) * Smooth muscle cell dysfunction associated with ageing * Faecal impaction * Anal pain (haemorrhoidectomy) * Intensive postoperative analgesic treatment * Some drugs * Spinal anaesthesia Ref: Bailey and love 27th edition Pgno : 1426", "cop": 3, "opa": "Stricture", "opb": "Rupture", "opc": "Postoperative", "opd": "Carcinoma prostate", "subject_name": "Surgery", "topic_name": "Urology", "id": "d89a9cfa-d2c5-457d-ad53-e71230dd19c0", "choice_type": "single"} {"question": "Most common site of origin of RCC", "exp": null, "cop": 1, "opa": "PCT", "opb": "DCT", "opc": "Collecting ducts", "opd": "Loop of Henle", "subject_name": "Surgery", "topic_name": null, "id": "adb4b446-2c7c-464d-9528-cec5c4aa73b9", "choice_type": "single"} {"question": "Best fluid for resuscitation of burns patient", "exp": "Answer- A. Hamann solutionFluid resuscitation begins with an isotonic crystalloid solution - Ringer's lactate solution (RL)(Haman's solution) k theprefered solution (Normal saline shouldbe avoided as the volumes required for resuscitation may lead to hyperchloremic metabolic acidosis).", "cop": 1, "opa": "Hamann solution", "opb": "Colloid", "opc": "Normal saline", "opd": "5% Dextrose", "subject_name": "Surgery", "topic_name": null, "id": "d6a58881-723c-4adc-a6b1-6a5f4ca04fde", "choice_type": "single"} {"question": "One of the following does not cause increase in the size of spleen in later stages", "exp": null, "cop": 1, "opa": "Sickle cell anaemia", "opb": "Cirrhosis", "opc": "Infectious mononucleosis", "opd": "Hairy cell leukaemia", "subject_name": "Surgery", "topic_name": null, "id": "e6b15b49-474f-45ae-a333-0fb418447a1b", "choice_type": "single"} {"question": "ABO antigens are not seen in aEUR'", "exp": "C.S.F. ABO antigens are found in Sal PancreasQ Kidney Liver Semen Sweat Gastric juice Amniotic fluid Lung", "cop": 1, "opa": "C.S.F.", "opb": "Saliva", "opc": "Semen", "opd": "Sweat", "subject_name": "Surgery", "topic_name": null, "id": "daad5192-0147-4fc5-8116-13c6b1aeb11d", "choice_type": "single"} {"question": "Tamoxifen given in breast carcinoma for", "exp": "Women with hormone receptor-positive tumours will obtain a wohwhile benefit from at least 5 years of endocrine therapy, either 20 mg daily of tamoxifen if premenopausal or the Aromatase Inhibitors (anastrozole, letrozole, and exemestane) if postmenopausal. Recent trials have shown that longer durations of endocrine therapy provide a small extra benefit but with increased toxicity.It is no longer appropriate to give hormone therapy to women who do not have oestrogen or progesterone receptor-positive disease. Ref: Bailey and Love, 27e, page: 878", "cop": 3, "opa": "2 years", "opb": "3 years", "opc": "5 years", "opd": "Lifelong", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "3c0e8d69-b75d-4a94-ac33-3e50da345ce6", "choice_type": "single"} {"question": "The most common complication of clavicle fracture is", "exp": "B i.e. Malunion", "cop": 2, "opa": "Injury to brachial plexus", "opb": "Malunuion", "opc": "Stiffness of shoulder", "opd": "Non union", "subject_name": "Surgery", "topic_name": null, "id": "b0965478-7190-48b1-a8bc-c0e592294ca9", "choice_type": "single"} {"question": "The current permissible maximum storage time and temperature for platelets include", "exp": "Platelets are supplied as pooled platelet concentrate. They are stored on a special agitator at 20-24degC. Shelf life--5 days. Indication: Thrombocytopenia, platelet dysfunction. Ref: Bailey and love 27th edition Pg no:21", "cop": 2, "opa": "5 days at 1-6o C", "opb": "5 days at 20-24o C", "opc": "7 days at 22-24o C", "opd": "5 days at 25-27o C", "subject_name": "Surgery", "topic_name": "General surgery", "id": "659ba277-6282-4eee-84ea-aa99880d031e", "choice_type": "single"} {"question": "Not used as graft material in peripheral vascular disease", "exp": null, "cop": 4, "opa": "Dacron graft", "opb": "Vein", "opc": "PTFE", "opd": "PVC", "subject_name": "Surgery", "topic_name": null, "id": "9408df1d-8a3c-4793-8937-03e373b8cf0e", "choice_type": "single"} {"question": "Most common uropathic obstruction in children is", "exp": "C. i.e. (Posterior urethral valve) (1362 -B & L 25th) (1289 - S. Das 5th)POSTERIOR URETHRAL VALVES are the most common obstructive urethral lesion in newborn and infants males and most common cause of end stage renal disease in boys (1008 - CSDT 12th)* They are usually just distal to the verumontanum*** Most reliable method to confirm the diagnosis is voiding cystourethrography*** Definitive treatment by transurethral resection of the valveMarion's Disease - congenital obstruction of the neck of the bladder", "cop": 3, "opa": "Stricture", "opb": "Stones", "opc": "Posterior urethral valve", "opd": "Anterior urethral valve", "subject_name": "Surgery", "topic_name": "Urinary Tract", "id": "0d44b537-b851-41cb-b5bd-fc35c403598b", "choice_type": "single"} {"question": "In fracture of the body of mandible the miniplate is given", "exp": null, "cop": 3, "opa": "Upper border", "opb": "Lower border", "opc": "between upper and lower border", "opd": "One at the upper and lower border", "subject_name": "Surgery", "topic_name": null, "id": "83c5b37b-6317-4e5e-bf87-1204078c1f7d", "choice_type": "single"} {"question": "Lord's and Jaboulay's operation is indicated for", "exp": "(Hydrocele) (1408-LB 24th) (1382-B & L 25th)Treatment of Hydrocele - Lord's operation is suitable when the sac is reasonably thin walled. There is minimal dissection and the risk of haematoma is reduced.Eversion of the sac with placement of the testis in a pouch prepared by blunt dissection in the facial planes of the serotum is an alternative (Jabouley's procedure)Varicocele - Embolisation of the testicular vein under radiographic control is probably the treatment of choice (1407-LB)* Simplest surgical procedure is ligation of the testicular vein above the inguinal ligaments where the pempiniform plexus has coalesced into one or two vessels", "cop": 1, "opa": "Hydrocele", "opb": "Varicocele", "opc": "Seminoma", "opd": "Teratoma", "subject_name": "Surgery", "topic_name": "Testis & Scrotum", "id": "5e4a1d79-3b04-4e3b-b776-136153299779", "choice_type": "single"} {"question": "The most common malignancy found in Marjolin's ulcer is", "exp": "Repeated question", "cop": 2, "opa": "Basal cell carcinoma", "opb": "Squamous sell carcinoma", "opc": "Malignant fibrous histiocytoma", "opd": "Neurotrophic malignant melanoma", "subject_name": "Surgery", "topic_name": "General surgery", "id": "80bcab03-02aa-4e0d-8600-6c5f7e3503f5", "choice_type": "single"} {"question": "Laryngeal Papillomatosis is caused by", "exp": "Laryngeal papillomata These are rare benign tumours occurring mainly in children, but can also present in adults. They are most commonly found on the vocal folds, but may spread throughout the larynx and tracheobronchial airway (although this is less likely in adults). They are caused by papillomaviruses andneed repeated removal by carbon dioxide laser or microsurgery to maintain a reasonable voice and airway. These patients are best managed in specialist centres, with the appropriate expeise. Antiviral treatment is of doubtful value. Papilloma vaccination is, to date, of unproven benefit. Ref: Bailey and love 27th edition Pgno : 750", "cop": 1, "opa": "HPV", "opb": "EBV", "opc": "CMV", "opd": "HSV", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "420b4e91-20a6-4335-a3a9-6484081d3fce", "choice_type": "single"} {"question": "Cullens sign is seen in", "exp": "Ans. is 'a > b' i.e., Hemorrhagic pancreatitis > Ectopic pregnancy * Bleeding into the fascial planes can produce bluish discolouration of the flanks (Grey Turner's sign) or umbilicus (Cullen's sign).* These are seen in acute pancreatitis but are not pathognomic for the same.* Cullens sign was first described in association with rupture of an ectopic pregnancy.Specific signs in abdomina examinationSignDescriptionPathologyCourvoisierPalpable gall bladder and jaundiceCarcinoma of the head of the pancreasCullenPeri-umbilical bruisingHaemorrhagic pancreatitis or ectopic pregnancyGrey turnerBruising of flankHaemorrhagic pancreatitisRovsingPain on extension of the hip joint (due to psoas irritation)Retrocaecal appendicitisMurphyRight upper quadrant tenderness exacerbated by inspirationAcute cholecystitisVirchowPalpable left supraclavicular fossa lymph nodeOesophagogastric carcinoma", "cop": 1, "opa": "Hemorrhagic pancreatitis", "opb": "Ectopic pregnancy", "opc": "Liver cirrhosis", "opd": "Biliary cirrhosis", "subject_name": "Surgery", "topic_name": "Pancreas", "id": "2b4c4807-9d8b-4d46-a321-f2171452d38e", "choice_type": "single"} {"question": "The sac contains only a portion of the circumference of the intestine", "exp": null, "cop": 1, "opa": "Richter's hernia", "opb": "Littre's hernia", "opc": "Spigelian hernia", "opd": "Lumber hernia", "subject_name": "Surgery", "topic_name": null, "id": "85e84112-e8ad-4b52-9a49-bcee3726fef5", "choice_type": "single"} {"question": "Most common lobe involved in BPH is", "exp": "BENIGN PROSTATIC HYPERPLASIA Aetiology Hormones Serum testosterone levels slowly but significantly decrease with advancing age; however, levels of oestrogenic steroids are not decreased equally. According to this theory, the prostate enlarges because of increased oestrogenic effects. It is likely that the secretion of intermediate peptide growth factors plays a pa in the development of BPH Pathology BPH affects both glandular epithelium and connective tissue stroma to variable degrees. These changes are similar to those occurring in breast dysplasia , in which adenosis, epitheliosis and stromal proliferation are seen in differing propoions. BPH typically affects the submucous group of glands in the transitional zone, forming a nodular enlargement. Eventually, this overgrowth compresses the PZ glands into a false capsule and causes the appearance of the typical 'lateral' lobes. When BPH affects the subcervical CZ glands, a 'middle' lobe develops that projects up into the bladder within the internal sphincter. Sometimes, both lateral lobes also project into the bladder, so that when viewed from within, the sides and back of the internal urinary meatus are surrounded by an intravesical prostatic collar. Ref : Bailey and love 27th edition Pgno : 1458", "cop": 2, "opa": "Lateral", "opb": "Median", "opc": "Anterior", "opd": "Posterior", "subject_name": "Surgery", "topic_name": "Urology", "id": "ec589a77-0cd3-4fe8-b199-e52eac9e4a36", "choice_type": "single"} {"question": "Metabolic abnormality seen in large colorectal villous adenoma", "exp": ".Features of Adenoma * Can be asymptomatic. * Bleeding per anum is usually chronic but rarely can be acute. * Anaemia. * Prolapse--common in tubular type. * Diarrhoea common in villous type; mucus discharge. * Tenesmus, colicky abdominal pain. * Spurious diarrhoea. * Poor general health. * Electrolyte imbalance - hypokalaemia. * Per-rectal examination should be done to feel the adenoma/polyp. * Carcinomatous changes. ref:SRB&;s manual of surgery,ed 3,pg no 832", "cop": 2, "opa": "Hypokalemic metabolic acidosis", "opb": "Hypokalemic metabolic acidosis", "opc": "Chlorine sensitive metabolic acidosis", "opd": "Chlorine resistant metabolic alkalosis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "5ab4770f-f118-4c3d-8313-82ac0dd65438", "choice_type": "single"} {"question": "Toxic adenoma on scanning appear as", "exp": null, "cop": 1, "opa": "Hot nodule", "opb": "Cold nodule", "opc": "Warm nodule", "opd": "Neutral", "subject_name": "Surgery", "topic_name": null, "id": "7001a33a-5f45-425d-954d-87dd88e6b282", "choice_type": "single"} {"question": "Pseudochylous pleural effusion is most often seen in", "exp": "Most common cause of pseudochylous pleural effusion is tuberculous pleurisy.\n• Chyliform pleural effusion, often called pseudochylous or cholesterol effusion, is a high-lipid effusion that is not chylous.\n• The most common cause of this pleural reaction is tuberculous pleurisy, but it has also been described in association with rheumatoid arthritis.\n• The presence of a fat-fluid level within the pleural space is unique to pseudochylous effusion.", "cop": 3, "opa": "T.B.", "opb": "Lymphoma", "opc": "Ca.lung", "opd": "Filariasis", "subject_name": "Surgery", "topic_name": null, "id": "e4ff812c-d5a5-4313-ba31-cddb6d936c7d", "choice_type": "single"} {"question": "There is a high risk of renal dysplasia in", "exp": "Ans. is 'a' Posterior urethral valve The term renal dysplasia is technically a histological diagnosis. It occur due to abnormality in metanephric differentiation and is characterized histologically by the persistence in the kidney of abnormal structures - cartilage, undifferentiated mesenchyme and immature collecting ductules and by abnormal lobar organization.C/F of Renal dysplasiaIt can be unilateral or bilateral and is almost always cysticKidney is enlarged, extremely irregular and multicystic. (presents as a flank mass)In unilateral dysplastic kidney the prognosis is good, where as in B/L dysplastic kidney renal failure may ultimately result.Dysplastic kidney is associated with -posterior urethral valve (as part of VURD syndrome)V - posterior urethral valves U - unilateral refluxR & D- renal dysplasiaUretero pelvic obstructionUreteral agenesis or atresiaOther anomalies of lower urinary tract.", "cop": 1, "opa": "Posterior urethral valve.", "opb": "Bladder exstrophy", "opc": "Anorectal malformation", "opd": "Neonatal sepsis", "subject_name": "Surgery", "topic_name": "Miscellaneous (Urethra & Penis)", "id": "3d66a7c2-bb1a-43cf-86fc-0cfc0d74ad7c", "choice_type": "single"} {"question": "Most common infection causing OPSI after splenectomy", "exp": null, "cop": 1, "opa": "Streptococcus pneumonie", "opb": "N. Meningitidis", "opc": "E. Coli", "opd": "Salmonella typhi", "subject_name": "Surgery", "topic_name": null, "id": "e4151734-6f55-4579-a366-56158aaeda22", "choice_type": "single"} {"question": "Submandibular salivary duct calcification treatment includes", "exp": null, "cop": 2, "opa": "Longitudinal incision and suturing the duct", "opb": "Longitudinal\tincision\tand\tsuturing\tthe\twound leaving the duct open", "opc": "Transverse incision and suturing the duct", "opd": "Transverse incision and suturing the wound leaving the duct open", "subject_name": "Surgery", "topic_name": null, "id": "9ee46b99-3860-4294-b6b5-4f47ae8b49eb", "choice_type": "single"} {"question": "A pt is brought to the emergency as a case of head injury, following a head on collision road traffic accident. His BP is 90/60 mmHg. Tachycardia is present. Most likely diagnosis is", "exp": "CDST says \"Patients with blunt trauma and hypovolemia should be examined first for Intra abdominal bleeding even if there is no ove existence of abdominal trauma Ref: CDST 13th edition Pgno :196", "cop": 3, "opa": "EDH", "opb": "SDH", "opc": "Intra abdominal bleeding", "opd": "Intra cranial hemorrhage", "subject_name": "Surgery", "topic_name": "Trauma", "id": "ca861d99-20e7-47a7-81de-256c5fa09822", "choice_type": "single"} {"question": "In a patient of trauma with no head injury, the target blood pressure for resuscitation is", "exp": "The initial aim of resuscitation is to maintain the blood supply to the vital organs: the brain, hea and kidneys. For a sho time, this can be achieved with a target systolic blood pressure of 70-90 mmHgThe concept of \"permissive hypotension\" refers to managing trauma patients by restricting the amount of fluid resuscitation administered while maintaining blood pressure in the lower than normal range if there is still active bleeding during the acute period of injury. Although this treatment approach may avoid the adverse effects of early and high-dose fluid resuscitation, it carries the potential risk of tissue hypoperfusion.Bailey and love 27e 324", "cop": 2, "opa": "SBP 50-70 mm of Hg", "opb": "SBP 70-90 mm of Hg", "opc": "SBP 90-110 mm of Hg", "opd": "SBP > 110 mm of Hg", "subject_name": "Surgery", "topic_name": "Trauma", "id": "911c4952-433f-4c6e-a149-d6988e29274c", "choice_type": "single"} {"question": "Five day self limting pain is due to", "exp": "External hemorrhoids which are painful the pain reduces after 5 days.", "cop": 2, "opa": "Internal hemorrhoids", "opb": "External hemorrhoids", "opc": "Fistula in ano", "opd": "Fissure in ano", "subject_name": "Surgery", "topic_name": null, "id": "8522ed64-f615-455f-83e4-a1f311d9dc83", "choice_type": "single"} {"question": "A six yr. old female presents with constipation and urinary retention. On examination a presecral mass is noted. Most probable dignosis is", "exp": ".meningocele It is the herniation of meninges through a weak point of spine where bony fusion has not taken place effectively. Swelling is covered with pia mater and arachnoid mater without dural covering and contains CSF. Clinical Features - * Present since bih. * Soft, cystic, fluctuant with transillumination. * Signs of compressibility. * Expansile impulse when asked to cough or when child cries. Location * Lumbosacral - commonest. * Occipito cervical - 2nd most common. ref:SRB&;s manual of surgery,ed 3,pg no 1053", "cop": 4, "opa": "Pelvic neuroblastoma", "opb": "Rectal duplication cyst", "opc": "Sacrococcygeal teratoma", "opd": "Anterior Sacral meningocele", "subject_name": "Surgery", "topic_name": "Urology", "id": "1c04bfd0-3636-4aee-bd79-a2df3857728f", "choice_type": "single"} {"question": "Drug of choice for infection by Gardnerella vaginatis is", "exp": "Ans is 'b' ie Metronidazole (Ref. Harrisons, 16/e, p 767 (15/e, p 843))Gardnerella vaginalis causes Bacterial vaginosis*.Bacterial vaginosis can be differentiated from other vaginitis and diagnosed by Amsel criteria :White homogenous vaginal discharge*Vaginal discharges pH > 4.5*Liberation of distinct fishy odour* on mixing vaginal discharge with 10% solution of KOH.Microscopic demonstration of clue cells* (Vaginal epithelial cells coated with coccobacillary organisms)", "cop": 2, "opa": "Ampicillin", "opb": "Metronidazole", "opc": "Vancomycin", "opd": "Cephalosporin", "subject_name": "Surgery", "topic_name": "Established Infection", "id": "2f4d1752-b31d-410f-81f9-1df0476f248f", "choice_type": "single"} {"question": "Investigation of choice for parotid gland calculi", "exp": "For submandibular gland calucli IOC is XRay as they are radio-opaque.\nFor parotid gland calucli IOC is sialography as they are radioluscent.", "cop": 3, "opa": "Xray", "opb": "USG", "opc": "Sialography", "opd": "CT", "subject_name": "Surgery", "topic_name": null, "id": "900edda3-2092-462e-98df-07b0a6531c26", "choice_type": "single"} {"question": "Ossification centre of scaphoid appears at", "exp": "Answer- D. 4 to 6 years", "cop": 4, "opa": "1-6 months", "opb": "1 to 2 years", "opc": "2 to 4 years", "opd": "4 to 6 years", "subject_name": "Surgery", "topic_name": null, "id": "29bd845e-0178-4198-a187-15cb628f0b23", "choice_type": "single"} {"question": "Best treatment for fracture neck femur in a 65 year old lady is", "exp": "D i.e. Hemireplacement", "cop": 4, "opa": "POP cast", "opb": "Gleotomy", "opc": "Bone grafting and compression", "opd": "Hemireplacement ahroplasty", "subject_name": "Surgery", "topic_name": null, "id": "c5ab31a2-55c2-4829-98af-4ca8fa1c1a63", "choice_type": "single"} {"question": "Reflux filling the pelvicalyceal system with moderate dilatation of ureter is", "exp": "Reflux into ureter without dilation - I\nReflux filling the pelvicalyceal system without dilatation of ureter - II\nReflux filling the pelvicalyceal system with moderate dilatation of ureter- III\nBlunting of fornix into pelvicalyceal system - IV\nReflux filling the pelvicalyceal system with dilated and tortorous ureter - V.", "cop": 3, "opa": "Grade I", "opb": "Grade II", "opc": "Grade IV", "opd": "Grade IV", "subject_name": "Surgery", "topic_name": null, "id": "66493504-50c7-4161-8082-8bf7fa8aeb25", "choice_type": "single"} {"question": "Investigation of choice for fistula in ano is", "exp": "Initial investigation is fistulogram.\nIOC is MR fistulogram.", "cop": 3, "opa": "MRI", "opb": "Fistulogram", "opc": "MR fistulogram", "opd": "CT scan", "subject_name": "Surgery", "topic_name": null, "id": "0d1b2153-184a-4666-bf1f-189e7d06a4c0", "choice_type": "single"} {"question": "If a patient with a suspected fracture of the pelvis has some bleeding from the urethra and is unable to pass urine", "exp": "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.", "cop": 4, "opa": "He should be encouraged to pass urine after being given antibiotics and analgesics", "opb": "He should be immediately catheterized in the ward", "opc": "A hot water bottle should be given followed by injection of carbachol", "opd": "He should be prepared for surgery and catheterization attempted in the O.T.", "subject_name": "Surgery", "topic_name": null, "id": "e765a9ef-a9bf-4c74-83fa-d336dc1e00b1", "choice_type": "single"} {"question": "In extension type of supracondylar fracture, the usual displacement", "exp": "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.", "cop": 4, "opa": "Anterolateral", "opb": "Anterolateral", "opc": "Posteromedial", "opd": "Posterolateral", "subject_name": "Surgery", "topic_name": null, "id": "f73fecf1-9557-424a-a2fd-daaa68ea4e8d", "choice_type": "single"} {"question": "Fracture of lateral condyle of humerus seen in age group of", "exp": "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.", "cop": 3, "opa": "2 - 3 years", "opb": "3 - 5 years", "opc": "5 -15 years", "opd": "15 - 25 years", "subject_name": "Surgery", "topic_name": null, "id": "fca7d9c8-a177-454e-8c74-c387c7e8ceac", "choice_type": "single"} {"question": "Pa I of the 'death ceificate' deals with", "exp": "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.", "cop": 1, "opa": "Immediate cause, and the direct underlying cause which staed the whole trend of events leading to death", "opb": "Any significant associated diseases that contributed to the death but did not directly lead to it.", "opc": "Approximate interval between onset and cause of death.", "opd": "The mode of death", "subject_name": "Surgery", "topic_name": null, "id": "c67be03f-f7e0-4b7c-aaf6-900a2f92cc5b", "choice_type": "single"} {"question": "The most common site of lymphangiosarcoma is", "exp": "Lymphangiosarcoma is a rare tumor that develops as a complication of long-standing (usually more than 10 years lymphedema.", "cop": 3, "opa": "Liver", "opb": "Spleen", "opc": "Post mastectomy edema of arm", "opd": "Retroperitoenum", "subject_name": "Surgery", "topic_name": null, "id": "d72d010c-c6b1-4139-b56c-5b2bddbc74cf", "choice_type": "single"} {"question": "Most common Tumor of spleen is", "exp": "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.", "cop": 1, "opa": "Lymphoma", "opb": "Sarcoma", "opc": "Hemangioma", "opd": "Metastasis", "subject_name": "Surgery", "topic_name": null, "id": "8f155f5c-d60b-4510-8501-eb1c4e2fe785", "choice_type": "single"} {"question": "Meningitis caused by Cryptococcus neoformans is most often acquired by", "exp": "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.", "cop": 3, "opa": "Head trauma", "opb": "Primary gastrointestinal infection", "opc": "Hematogenous spread of fungus from the lung", "opd": "Ohopedic surgery", "subject_name": "Surgery", "topic_name": null, "id": "081195cb-1ed0-4971-b8be-03c966594bfe", "choice_type": "single"} {"question": "Preferred shunt procedure in patient with poal hypeension having acceptable operative risk and adequate liver function is", "exp": "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.", "cop": 4, "opa": "End to side poocaval shunt", "opb": "End to end poocaval shunt", "opc": "Mesocaval shunt", "opd": "Distal splenorenal shunt", "subject_name": "Surgery", "topic_name": null, "id": "a13757e9-2180-4203-83e1-0e64f2c1bdb4", "choice_type": "single"} {"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", "exp": "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)", "cop": 2, "opa": "Observation and follow-up", "opb": "Adriamycin based chemotherapy followed by tamoxifen depending on estrogen/progesterone receptor status", "opc": "Adriamycin based chemotherapy only", "opd": "Tamoxifen only", "subject_name": "Surgery", "topic_name": "Breast Cancer - Treatments", "id": "b34269d9-22cc-4f3f-9e54-e4e6ae353df1", "choice_type": "single"} {"question": "Renal calculi associated with proteus infection", "exp": "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", "cop": 2, "opa": "Uric acid", "opb": "Triple phosphate", "opc": "Calcium oxalate", "opd": "Xanthine", "subject_name": "Surgery", "topic_name": "Urology", "id": "7701e94d-7e9b-4afb-aa03-af4b319eed96", "choice_type": "single"} {"question": "Lockwood repair is done in", "exp": null, "cop": 2, "opa": "Appendicitis", "opb": "Femoral hernia", "opc": "Deep vein thrombosis", "opd": "Sigmoid volvulus", "subject_name": "Surgery", "topic_name": null, "id": "270bdd6a-699e-457d-9a3a-07ea37ed34b5", "choice_type": "single"} {"question": "A Pre pharyngeal abscess diagnosed as tuberculosis is seen in 44 year old lady with difficulties in deglutition management would be", "exp": "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", "cop": 1, "opa": "Urgent Drainage", "opb": "Staing of AKT", "opc": "Wait and Eatch", "opd": "Get an MR1 of the cervical Spine", "subject_name": "Surgery", "topic_name": null, "id": "99c41c64-a8a4-485f-947c-42239508c5bc", "choice_type": "single"} {"question": "Acinic cell carcinomas of the salivary gland arise most often in the", "exp": "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.", "cop": 1, "opa": "Parotid salivary gland", "opb": "Minor salivary glands", "opc": "Submandibular salivary gland", "opd": "Sublingual salivary gland", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "180fd5e1-e240-4ede-b9a0-495875b24081", "choice_type": "single"} {"question": "Burns involving skin superficial part of dermis is categorized as", "exp": "First degree burns involve only epidermis\nSuperficial second degree involve upper layer of dermis\nDeep second degree involves reticular layers of dermis\nThird degree involves all layers of skin\nFourth degree burns involve not only skin but also subcutaneous fat and deeper structures", "cop": 2, "opa": "First degree burns", "opb": "Superficial 2nd degree burn", "opc": "Deep 2nd degree burn", "opd": "Third degree burns", "subject_name": "Surgery", "topic_name": null, "id": "6900f977-3b02-4346-8080-a182f5c77802", "choice_type": "single"} {"question": "Cystosarcoma phyllodes are treated by", "exp": "Phyllodes tumor is usually benign and treated by simple mastectomy.", "cop": 1, "opa": "Simple mastectomy", "opb": "Radical mastectomy", "opc": "Modified radical mastectomy", "opd": "Hadfields operation", "subject_name": "Surgery", "topic_name": null, "id": "5185f73b-678e-4b8c-8dbc-47f8c95bda78", "choice_type": "single"} {"question": "Normal portal vein pressure is", "exp": "• Normal portal vein pressure: 5-10 mm Hg \n• Variceal formation occurs when portal pressure is >10 mm Hg.\n• Variceal bleeding occurs when portal pressure is >12 mm Hg.\n • Normal portal vein pressure: 10-15 cm saline\n• Definition: Portal pressure >10 mm Hg\n• MC cause of portal hypertension in United States: Cirrhosis.\n• Consequence of both increased portal vascular resistance and increased portal flow.\n• Portal hypertension results in splenomegaly with enlarged, tortuous, and even aneurysmal splenic vessels.\n• Cruveilhier-Baumgarten murmur: Audible venous hum in caput medusa\n• Hyperdynamic portal venous circulation seems to be related to the severity of the liver failure.\n• Upper G.I. bleeding is caused by the portal hypertension in about 90% of instances.\n• Most bleeding episodes occur during the first 1 to 2 years after identification of varices.\n• Colour Doppler is the investigation of choice for evaluation of PHT.\n• About one third of deaths in patients with known esophageal varices are due to upper GI bleed\n• A larger proportion dies as a result of liver failure.\n• MC causes of death in cirrhosis patients: Hepatic failure\n• 2nd MC causes of death in cirrhosis patients: variceal hemorrhage", "cop": 3, "opa": "< 3 mm Hg", "opb": "3-5 mm Hg", "opc": "5-10 mm Hg", "opd": "10 to 1 2mm of Hg", "subject_name": "Surgery", "topic_name": null, "id": "685133b7-9614-464e-8dbd-ca47e5c86e00", "choice_type": "single"} {"question": "Osteotomes differ from chisels in that they are", "exp": null, "cop": 4, "opa": "Sharp", "opb": "Slightly curved", "opc": "Non beveled", "opd": "Bi-bevelled", "subject_name": "Surgery", "topic_name": null, "id": "31f41461-0200-4a8f-81a1-b51f3fb381d1", "choice_type": "single"} {"question": "Treatment of choice for annular pancrease is", "exp": "Pancreatic ring surrounds the second or third pa of duodenum. The usual treatment is duodenoduodenostomy. Bailey & Love ,26th,1125", "cop": 2, "opa": "Division of pancreas", "opb": "Duodenoduodenostomy", "opc": "Duodenojejunostomy", "opd": "Roux-en-Y loop", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "235b711f-50d6-4ebe-bc77-15f5ebf19b58", "choice_type": "single"} {"question": "Green coloured i.v. cannula, the size is", "exp": "Answer- A. 18Green- 18Pink- 20Blue- 22Yellow/lime- 24", "cop": 1, "opa": "18", "opb": "20", "opc": "22", "opd": "24", "subject_name": "Surgery", "topic_name": null, "id": "e67413d5-8e4b-4de5-8ceb-b1dc48c5de38", "choice_type": "single"} {"question": "Medical castration is effected bya) Diethylstilbesterolb) LH RH analoguesc) Gossypold) Hanovan", "exp": null, "cop": 2, "opa": "ac", "opb": "ab", "opc": "ad", "opd": "bc", "subject_name": "Surgery", "topic_name": null, "id": "d0b45468-e8f3-4d2b-a890-d877ec87da3d", "choice_type": "single"} {"question": "Gold standard investigation for Triple assessment screening breast carcinoma in patient with Silicone breast implant", "exp": "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", "cop": 1, "opa": "MRI", "opb": "USG", "opc": "Mammography", "opd": "CT scan", "subject_name": "Surgery", "topic_name": "Breast", "id": "d34fa5ec-f29c-4221-a53e-41e2c5f7d3af", "choice_type": "single"} {"question": "Early fundoscopic sign in Papilloedema", "exp": "(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", "cop": 1, "opa": "Blurring of disc margin", "opb": "Hyperemia of disc", "opc": "Splinter hemorrhage", "opd": "Blurring of peripapillary nerve fiber layer", "subject_name": "Surgery", "topic_name": "Nervous System", "id": "7222c8c0-f58f-4a5f-89d7-a66f3c7ba5d9", "choice_type": "single"} {"question": "Splenic rupture immediate treatment is", "exp": "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", "cop": 1, "opa": "Laparotomy", "opb": "Wait and watch", "opc": "Resusciation", "opd": "Diagnostic laparoscopy", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "80b6192a-b448-434b-a8a1-d35d8cf178cc", "choice_type": "single"} {"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", "exp": "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.", "cop": 4, "opa": "Carcinoid tumor", "opb": "Melanoma", "opc": "Villous adenoma", "opd": "Peutz-Jegher syndrome", "subject_name": "Surgery", "topic_name": "Colon and Rectum - Polyps and Carcinoma", "id": "ab251a85-37c1-491b-88bf-28ec30dc5080", "choice_type": "single"} {"question": "Unna boot is used for treatment of", "exp": "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.", "cop": 2, "opa": "Diabetic foot ulcer", "opb": "Varicose ulcers", "opc": "Ankle instability", "opd": "Calcaneum fracture", "subject_name": "Surgery", "topic_name": null, "id": "cc95288d-54de-4886-8bfa-101e9c45ae8b", "choice_type": "single"} {"question": "A colles fracture is", "exp": "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.", "cop": 3, "opa": "Common in adolescence", "opb": "A fracture about the ankle joint", "opc": "Common in elderly women", "opd": "A fracture of head of the radius", "subject_name": "Surgery", "topic_name": null, "id": "509d259f-d12d-48c8-a32a-a639df2cf626", "choice_type": "single"} {"question": "Fat embolism may ensue following", "exp": "D i.e. Fracture long bones only", "cop": 4, "opa": "Fracture of spine and ribs", "opb": "Fractured fibula", "opc": "Fracture of skull bone", "opd": "Fracture of long bones only", "subject_name": "Surgery", "topic_name": null, "id": "46acb9db-7eeb-495f-a1a1-2ceb33e45100", "choice_type": "single"} {"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", "exp": "Repetitive vomiting leads to hypochloremic,hypokalemic metabolic alkalosis. the urine is initially alkaline but later becomes acidic ( paradoxical aciduria)", "cop": 4, "opa": "Hypokalemic hyperchloremic metabolic acidosis", "opb": "Hypokalemic hypochloremic metabolic acidosis", "opc": "Hypokalemic hyperchloremic metabolic alkalosis", "opd": "Hypokalemic hypochloremic metabolic alkalosis", "subject_name": "Surgery", "topic_name": "General surgery", "id": "2fb8fa54-704e-4759-9301-309c60008a17", "choice_type": "single"} {"question": "Perforated peptic ulcer is treated by", "exp": "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", "cop": 3, "opa": "Vagotomy + Pyloroplasty", "opb": "Vagotomy + Antrectomy", "opc": "Vagotomy + repair of perforation", "opd": "Graham's repair", "subject_name": "Surgery", "topic_name": "General surgery", "id": "62ceb84e-1c82-42c9-8c2b-18ba0d756918", "choice_type": "single"} {"question": "Most common complication after intestinal transplantation is", "exp": "Sepsis is the MC complication of intestinal transplant.", "cop": 2, "opa": "Graft vs host disease", "opb": "Sepsis", "opc": "Intestinal necrosis", "opd": "Intestinal obstruction", "subject_name": "Surgery", "topic_name": null, "id": "7027d3de-671b-4cb0-8e87-ee36997275a8", "choice_type": "single"} {"question": "Percentage of cold nodules that becomes malignant are", "exp": "20% of 'cold' swellings and some 5% functioning or 'warm' swellings will be malignant.Ref: Bailey and Love, page no: 804", "cop": 3, "opa": "5%", "opb": "15%", "opc": "20%", "opd": "40%", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "0629f32f-d4b6-4a26-9913-aa98475b882d", "choice_type": "single"} {"question": "Renal TB mode of infection", "exp": "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", "cop": 3, "opa": "Direct from bowel", "opb": "Ascending", "opc": "Hematogenous", "opd": "Lymphatic", "subject_name": "Surgery", "topic_name": null, "id": "daa322e4-626e-41c5-9cd6-efded024984a", "choice_type": "single"} {"question": "H.pylori infection is associated with increased risk of", "exp": "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", "cop": 2, "opa": "Proximal gastric cancer", "opb": "Carcinoma of body and pylorus of stamach", "opc": "Carcinoma of duodenum first pa", "opd": "Carcinoma involving gastroesophageal junction", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "03cf38bc-d1b8-4e93-84ab-ca701cd1db49", "choice_type": "single"} {"question": "A patient died on dental chair due to overdose of LA, cause for this can be", "exp": null, "cop": 1, "opa": "Apnea", "opb": "Hypercapnea", "opc": "Cardiac arrest", "opd": "Dyspnea", "subject_name": "Surgery", "topic_name": null, "id": "5c49519a-ffa7-4d06-88e5-4233b28aebdb", "choice_type": "single"} {"question": "Clinical stage II of carcinoma breast means", "exp": ".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", "cop": 3, "opa": "Tumor is limited to breast", "opb": "Tumor with evidence of distant metastasis", "opc": "Tumor is presents in the breast and axillary lymph nods are involved", "opd": "Tumor has involved breast, pectoral muscles and wide area of skin", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "a0d94465-8525-4381-808c-3a0f66e89556", "choice_type": "single"} {"question": "Most appropriate treatment for acute paranychia", "exp": ".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 .", "cop": 1, "opa": "Paial nail removal", "opb": "Nail removal", "opc": "Lifting of eponychium", "opd": "Incision and drainage", "subject_name": "Surgery", "topic_name": "Urology", "id": "3aa8424d-28de-4787-b363-ce845a59ccc1", "choice_type": "single"} {"question": "Calculation of IV fluids in a burns patient for 24 hours is", "exp": "First half is given in first 8 hours.\nNext half is given in next 16 hours.", "cop": 1, "opa": "Total % body surface area × weight × 4 = volume in ml", "opb": "Total % body surface area × weight × 3 = volume in ml", "opc": "Total % body surface area × weight × 2 = volume in ml", "opd": "Total % body surface area × weight × 6 = volume in ml", "subject_name": "Surgery", "topic_name": null, "id": "0892f40b-649b-4317-8534-31cad1a071e7", "choice_type": "single"} {"question": "Treatment of medullary carcinoma thyroid is", "exp": "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", "cop": 3, "opa": "Surgery and radiotherapy", "opb": "Surgery and TSH supression", "opc": "Surgery only", "opd": "Surgery and Radioiodine ablation", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "de384160-cc92-470c-861b-c4f75534e3c5", "choice_type": "single"} {"question": "Surgery for fissure in ano is", "exp": "Lateral spincterectomy is done for pts of fissure in ano whom medical treatment fails.", "cop": 2, "opa": "Seton’s procedure", "opb": "Lateral spincterectomy", "opc": "Well’s procedure", "opd": "Winter’s procedure", "subject_name": "Surgery", "topic_name": null, "id": "8dfd55ad-57c7-4979-9da8-969339735f76", "choice_type": "single"} {"question": "Investigation of choice in discrete thyroid swellings", "exp": "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", "cop": 2, "opa": "USG", "opb": "FNAC", "opc": "Biopsy", "opd": "RAI", "subject_name": "Surgery", "topic_name": "Thyroid Gland", "id": "7d367470-0ba6-4454-8f77-6eb16649a4a9", "choice_type": "single"} {"question": "Most common cause of umblicus does not separate at age of 2 years.", "exp": "(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", "cop": 2, "opa": "Raspbery tumour", "opb": "Leukocyte adhesion deficiency", "opc": "Patent urachus", "opd": "Umbilici granuloma", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "188bd506-5040-4d26-a199-e785a6c69e5b", "choice_type": "single"} {"question": "Deficiency of the abdominal muscle is associated with", "exp": "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.", "cop": 1, "opa": "Eagle-Barrette syndrome", "opb": "Christopher syndrome", "opc": "Megacystitis", "opd": "Megaureter", "subject_name": "Surgery", "topic_name": null, "id": "aea752c1-1c5b-41cc-9bf7-a3c392c20995", "choice_type": "single"} {"question": "Best time for surgery of undescended testis is", "exp": "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", "cop": 3, "opa": "Just after bih", "opb": "6 months of age", "opc": "12 months of age", "opd": "24 months of age", "subject_name": "Surgery", "topic_name": "Urology", "id": "563d0384-e841-4763-afaa-86d8205ff522", "choice_type": "single"} {"question": "Appropriate approach for thyroidectomy to remove thyroid carcinoma with retrosternal extension is", "exp": "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.", "cop": 3, "opa": "Cervical", "opb": "Thorasic", "opc": "Combined cervical and thoracic", "opd": "Thoracoscopic", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "0d744042-0192-4b92-9ab2-41009a218ccd", "choice_type": "single"} {"question": "Drugs not used for treatment of acute hyperkalemia aEUR'", "exp": "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", "cop": 2, "opa": "Insulin + glucose", "opb": "Potassium exchange resins", "opc": "Calcium carbonate", "opd": "Sodium bicarbonate", "subject_name": "Surgery", "topic_name": null, "id": "82fb5ddd-6be8-4659-91ed-e91617921f25", "choice_type": "single"} {"question": "Open biopsy is done for salivary gland tumors unless they are arising from", "exp": "Answer- D. ParotidOpen biopsy of the parotid or submandibular gland is not advised as it risks minor seeding and may complicate the indicated surgery.", "cop": 4, "opa": "Palate", "opb": "Buccal", "opc": "Sublingual", "opd": "Parotid", "subject_name": "Surgery", "topic_name": null, "id": "dc1a4a48-9908-45bc-9d59-2c53a2d1114e", "choice_type": "single"} {"question": "Most common nerve to get entrapped in laparoscopic hernial repair", "exp": "Entrappment of lateral cutaneous nerve of thigh leads to meralgio porestheica.\nm/c nerve entrapped in open hernial surgery is iliohypogastric", "cop": 3, "opa": "Ilioinguinal", "opb": "Iliohypogastric", "opc": "Lateral cutaneous nerve of thigh", "opd": "Femoral nerve", "subject_name": "Surgery", "topic_name": null, "id": "a6972775-d8fa-4afd-9764-2845b4a166c9", "choice_type": "single"} {"question": "The preferred Shunt procedure for the patient with portal\nhypertension having acceptable operative risk and adequate\nliver function is", "exp": null, "cop": 4, "opa": "End to Side Porto caval Shunt", "opb": "Side to Side Porto Caval Shunt", "opc": "Mesocaval Shunt", "opd": "Distal Spleno renal Shunt", "subject_name": "Surgery", "topic_name": null, "id": "f1696d02-de56-4754-b180-0bc66e6f3a63", "choice_type": "single"} {"question": "Displacement of a root into the maxillary sinus\nduring extraction is most likely to happen during the extraction of the maxillary", "exp": null, "cop": 3, "opa": "Canine", "opb": "Deciduous first molar", "opc": "First molar", "opd": "Second molar", "subject_name": "Surgery", "topic_name": null, "id": "49359663-d14d-4cd5-abfa-f4dcfd707331", "choice_type": "single"} {"question": "Best treatment for menigioma with low recurrence rate is", "exp": "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.", "cop": 1, "opa": "Tumour excision with cyst of dura mater removal", "opb": "Excision surgery followed by radiotherapy", "opc": "Chemotherapy", "opd": "Preop embolization + Excision surgery", "subject_name": "Surgery", "topic_name": "Urology", "id": "c00486ae-da53-4564-9830-006cd86b9ee9", "choice_type": "single"} {"question": "A female undergone surgery for left breast cancer 3 yrs back now developed blue nodule on same side", "exp": "Answer- A. LymphangiosarcomaAngiosarcoma is a vascular tumor which may arise de novo in the breast or as a complication of the radiation therapy.", "cop": 1, "opa": "Lymphangiosarcoma", "opb": "Recurrence", "opc": "Hemangioma", "opd": "Cellulitis", "subject_name": "Surgery", "topic_name": null, "id": "445ec67f-406e-489e-bd05-783378ba94e4", "choice_type": "single"} {"question": "Most common malignant parotid tumour is", "exp": "Among primary parotid malignant tumors, mucoepidermoid carcinoma is the most common, followed by adenocystic carcinoma. Reference : Bailey & love, 27th Edition, page no = 789.", "cop": 4, "opa": "Oncocytoma", "opb": "Wahins tumour", "opc": "Adenoid cystic carcinoma", "opd": "Mucoepidermoid carcinoma", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "ada5b22a-8b44-4e0f-b1be-4f76fdfc62f6", "choice_type": "single"} {"question": "In a patient of total parenteral nutrition daily monitoring is done with", "exp": "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", "cop": 1, "opa": "Body weight", "opb": "Plasma protein", "opc": "CBC", "opd": "Plasma osmolality", "subject_name": "Surgery", "topic_name": "General surgery", "id": "1f85343e-2ecb-4fc5-8a90-4e8f1ea1d5ad", "choice_type": "single"} {"question": "Bones, stones, abdominal groans and psychiatric oveones' are features of", "exp": "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", "cop": 3, "opa": "Hypehyroidism", "opb": "Hypothyroidism", "opc": "Hyperparathyroidism", "opd": "Hypoparathyroidism", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "81b9e6f1-4163-4be5-a410-a779f4780097", "choice_type": "single"} {"question": "A new born presents with discharge of urine from the umbilicus for 3 days. Diagnosis is", "exp": "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", "cop": 3, "opa": "Meckel's diveiculum", "opb": "Mesenteric cysts", "opc": "Urachal fistula", "opd": "Omphalocele", "subject_name": "Surgery", "topic_name": "Urology", "id": "0bf88a14-0a41-4841-8036-7d8920644f59", "choice_type": "single"} {"question": "On the 4th postoperative day of laparotomy a patient presents with bleeding & oozing from the wound management is", "exp": "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", "cop": 2, "opa": "Dressing of wound & observe for dehiscence", "opb": "IV fluids", "opc": "Send for USG abdomen", "opd": "Sta treatments for peritonitis", "subject_name": "Surgery", "topic_name": "Urology", "id": "fec9db23-886b-4694-aaff-0784a26d1bce", "choice_type": "single"} {"question": "Earliest symptom of Wilms tumour is", "exp": "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", "cop": 3, "opa": "Hematuria", "opb": "Pyrexia", "opc": "Abdominal mass", "opd": "Metastases", "subject_name": "Surgery", "topic_name": "Urology", "id": "d69b718c-22b3-42aa-8e3f-113b4059ae79", "choice_type": "single"} {"question": "Rigler's triad doesn't includes", "exp": "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", "cop": 3, "opa": "Pheumobilia", "opb": "Ectopic stone", "opc": "Cholangitis", "opd": "Intestinal obstruction", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "241788b5-084c-4da9-af12-6f6983c65174", "choice_type": "single"} {"question": "Focal lesion in liver is best detected by", "exp": "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", "cop": 1, "opa": "MRI", "opb": "CT", "opc": "USG", "opd": "PET", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "ab67dd74-7d14-41f7-9591-9b8e7a4c4151", "choice_type": "single"} {"question": "The best method of controlling bleeding is to", "exp": null, "cop": 2, "opa": "Apply a torniquet", "opb": "Apply direct pressure to the injury", "opc": "Compress pressure points between the injury and the heart", "opd": "Bandage the area", "subject_name": "Surgery", "topic_name": null, "id": "a9d670aa-9f5c-4115-b528-692a3fa9b7f8", "choice_type": "single"} {"question": "Ectopic tissue in stomach is of the origin of", "exp": "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", "cop": 2, "opa": "Spleen", "opb": "Pancreas", "opc": "Liver", "opd": "Kidney", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "fa57122c-520b-4f0b-b527-aba74c9f3cc8", "choice_type": "single"} {"question": "Oxygen therapy is most useful in", "exp": "(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", "cop": 1, "opa": "Arterial hypoxia", "opb": "Stagnent hypoxia", "opc": "Anemic hypoxia", "opd": "Cyanide hypoxia", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "d623b540-150b-493e-9603-08e488015662", "choice_type": "single"} {"question": "Opsomyoclonus is encountered as C/F of", "exp": "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", "cop": 2, "opa": "Meningioma", "opb": "Cerebral atrophy", "opc": "Excision", "opd": "Neurofibramatosis", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "1c7fd214-ff8c-43b4-8fb4-364fb6b9e788", "choice_type": "single"} {"question": "A 50 yr old male Raju present with occasional dysphagia for solids, regurgitation of food and foul smelling breath. Probable diagnosis is", "exp": "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.", "cop": 2, "opa": "Achalasia cardia", "opb": "Zenkers diverticulum", "opc": "CA esophagus", "opd": "Diabetic gastroparesis", "subject_name": "Surgery", "topic_name": "Esophageal Motility Disorders", "id": "f4ee606e-0e80-48e6-bb5f-ab2b69898926", "choice_type": "single"} {"question": "Burns with destruction of the epidermis and papillary dermis is", "exp": "2nd degree superficial - epidermis and papillary dermis.\n2nd degree deep - epidermis and entire dermis.", "cop": 2, "opa": "1st degree", "opb": "2nd degree", "opc": "3rd degree", "opd": "4th degree", "subject_name": "Surgery", "topic_name": null, "id": "b03e511e-b5cf-4b16-9e40-507ec8e72a96", "choice_type": "single"} {"question": "Compared to follicular Ca, papillary Ca of thyroid associared with", "exp": "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.", "cop": 2, "opa": "More male preponderance", "opb": "Radiation exposure", "opc": "Iodine deficiency", "opd": "Increased moality", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "3dcaa301-f691-4944-ad83-9c6ce4ddece6", "choice_type": "single"} {"question": "Bulbocavernosus reflex is elicited by A/E", "exp": "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", "cop": 4, "opa": "Glans pens", "opb": "Clitoris", "opc": "Tug of foley catheter", "opd": "Peri anal", "subject_name": "Surgery", "topic_name": null, "id": "5315588f-538f-4c85-afb8-0dc8a0764198", "choice_type": "single"} {"question": "In traumatic brain injury, Glasgow outcome score of 4 stands for", "exp": "Glasgow Outcome Score (GOS)Good recovery 5Moderate disability 4Severe disability 3Persistent vegetative state 2Dead 1Bailey and Love 26e pg:320", "cop": 2, "opa": "Good recovery", "opb": "Moderate disability", "opc": "Severe disability", "opd": "Persistent vegetative state", "subject_name": "Surgery", "topic_name": "Trauma", "id": "fcf32c18-a61e-4426-9abc-1d9f396edba6", "choice_type": "single"} {"question": "Aaron's sign is seen in", "exp": "Ans. is 'd' i.e., Acute appendicitis", "cop": 4, "opa": "Achlasia cardia", "opb": "Hiatus hernia", "opc": "Mediastinum emphysema", "opd": "Acute appendicitis", "subject_name": "Surgery", "topic_name": null, "id": "9e9cbbb4-8478-4e5b-b206-0e0da5e8f6e6", "choice_type": "single"} {"question": "Most common Extra intestinal Manifest of Amoebiasis", "exp": "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", "cop": 1, "opa": "Liver abscess", "opb": "Pleural Effusion", "opc": "Lung atelectasis", "opd": "Cardiac Tamponade", "subject_name": "Surgery", "topic_name": "Liver", "id": "c8219239-7f4b-41c1-ab94-cc228acb5ae7", "choice_type": "single"} {"question": "Glomus tumor arises from", "exp": "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.", "cop": 1, "opa": "Modified smooth muscle cells", "opb": "Modified skeletal muscle cells", "opc": "Merkel discs", "opd": "Melanocytes", "subject_name": "Surgery", "topic_name": "E.N.T.", "id": "d093187f-8503-4d51-a06b-a7ee024983c3", "choice_type": "single"} {"question": "Testing of receipient cells against donor serum is", "exp": "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", "cop": 2, "opa": "Major Cross Matching", "opb": "Minor Crossmatching", "opc": "Direct Coomb's Test", "opd": "Rh Group Matching", "subject_name": "Surgery", "topic_name": null, "id": "b804a3f5-946e-4ebd-8acc-4fcbae2ad45c", "choice_type": "single"} {"question": "Marjolin's ulcer is a", "exp": "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.", "cop": 1, "opa": "Malignant ulcer found on the scar of burn", "opb": "Malignant ulcer found on infected foot", "opc": "Trophic ulcer", "opd": "Meleney's gangrene", "subject_name": "Surgery", "topic_name": "General surgery", "id": "355461e7-9f95-47ae-b9cc-7394fe7fc877", "choice_type": "single"} {"question": "In the reconstruction following excision of previously irradiated cheek cancer the flap will be", "exp": null, "cop": 4, "opa": "Local tongue", "opb": "Cervical", "opc": "Forehead", "opd": "Pectoralis major myocutaneous", "subject_name": "Surgery", "topic_name": null, "id": "7baa3e80-2efb-4581-9763-179f6599bbd2", "choice_type": "single"} {"question": "Atropine is given as preanesthetic to", "exp": "(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", "cop": 2, "opa": "Reduce salivation gag reflex", "opb": "Reduce bronchial secretion", "opc": "Bronchoconstriction", "opd": "Prevent tachycardia", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "8d5cfef3-bf47-4f6b-b0fa-9c356ce353c4", "choice_type": "single"} {"question": "The optimum length of screw, for fixation of plate in mandible is", "exp": null, "cop": 3, "opa": "2mm", "opb": "3mm", "opc": "4mm", "opd": "6mm", "subject_name": "Surgery", "topic_name": null, "id": "14ecce01-b281-4fb9-b619-78c886db62d9", "choice_type": "single"} {"question": "Muir and Barclay formula is used for", "exp": "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", "cop": 3, "opa": "Total parentral nutrition", "opb": "Acute pancreatitis", "opc": "Colloid resuscitation in burns", "opd": "Enhanced recovery in colo-rectal surgery", "subject_name": "Surgery", "topic_name": "General surgery", "id": "6f485acf-a819-4455-8a17-5e965d1db12f", "choice_type": "single"} {"question": "Hyperacute rejection of transplant is due to", "exp": "Preformed antibodies will cause hyperacute rejection.\nT cells will cause acute rejection.", "cop": 3, "opa": "T cell mediated", "opb": "B cell mediated", "opc": "Preformed antibodies", "opd": "Macrophage mediated injury", "subject_name": "Surgery", "topic_name": null, "id": "47b9f3d0-ffa3-482e-a2b3-0faa40035ccf", "choice_type": "single"} {"question": "Merkel cell carcinoma is due to", "exp": "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.", "cop": 3, "opa": "Cytokeratin: 7", "opb": "Cytokeratin: 19", "opc": "Cytokeratin: 20", "opd": "Cytokeratin: 18", "subject_name": "Surgery", "topic_name": null, "id": "573ab90a-f2e5-4003-90e6-114ec63c56ba", "choice_type": "single"} {"question": "Turcot’s syndrome is not associated with", "exp": "Odontone is associated with garderner syndrome.", "cop": 4, "opa": "polyps", "opb": "CHRPE", "opc": "Brain tumors", "opd": "Odontome", "subject_name": "Surgery", "topic_name": null, "id": "8791b5ac-f9f9-41da-9401-139469813e74", "choice_type": "single"} {"question": "Ideal age for orchiopexy for cryptorchidism is", "exp": "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", "cop": 4, "opa": "At 6-10 yrs", "opb": "At 1-2 yrs", "opc": "At puberty", "opd": "< 1 yr of age", "subject_name": "Surgery", "topic_name": "Miscellaneous (Testis & Scrotum)", "id": "a53fe7e5-ca19-49df-bdbb-095a58e29d14", "choice_type": "single"} {"question": "In Lingual split technique, the instrument used to cut the tooth is", "exp": null, "cop": 1, "opa": "Chisel", "opb": "Osteotome", "opc": "Straight elevator", "opd": "Surgical bur", "subject_name": "Surgery", "topic_name": null, "id": "f59cc5f5-cf26-4f84-b869-a2bf68f72578", "choice_type": "single"} {"question": "Alpha adrenergic agonists are used in combination\nwith Local anesthetics to", "exp": null, "cop": 2, "opa": "increase the rate of liver metabolism of local anesthetic", "opb": "increase the concentration of L.A at receptor site", "opc": "stimulate myocardial contraction", "opd": "increases vascular absorption of L.A", "subject_name": "Surgery", "topic_name": null, "id": "9d12f126-48e7-4ab0-897b-6f73dfdc2f3b", "choice_type": "single"} {"question": "Premalignant lesion for carcinoma rectum is", "exp": "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", "cop": 1, "opa": "Familial polyposis", "opb": "FAP", "opc": "Juvenile polyp", "opd": "Adenomatous polyp", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "0b5bf19f-d1fd-4fe9-bad3-c53288aeb349", "choice_type": "single"} {"question": "The Hunterian Ligature operation is performed for", "exp": ". 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.", "cop": 1, "opa": "Aneurysm", "opb": "Varicose veins", "opc": "A V fistulas", "opd": "Acute aerial ischemia", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "11f00718-ad3e-430a-bc81-a4bf40f98615", "choice_type": "single"} {"question": "Treatment of calculus within the submandibular salivary gland is", "exp": null, "cop": 2, "opa": "Removal of sinus", "opb": "Removal of the gland", "opc": "Dichotomy", "opd": "Milking of the stone", "subject_name": "Surgery", "topic_name": null, "id": "361c5264-b84e-453a-ba33-93f662eb30c0", "choice_type": "single"} {"question": "Most common presentation of Hirschsprung's disease", "exp": "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)", "cop": 1, "opa": "Abdominal distention", "opb": "Vomiting", "opc": "Failure to pass meconium", "opd": "Failure to thrive", "subject_name": "Surgery", "topic_name": "Large intestine", "id": "20d917f1-ba9d-4203-85ad-c2e261a69651", "choice_type": "single"} {"question": "Slidding constituent of a large direct hernia is", "exp": "Ans. is 'a' i.e., Bladder Sigmoid colon and Caecum slide into indirect sac not in direct sac", "cop": 1, "opa": "Bladder", "opb": "Sigmoid colon", "opc": "Caecum", "opd": "Appendix", "subject_name": "Surgery", "topic_name": null, "id": "570db950-cc0e-482d-9fec-9bfa3a2b0953", "choice_type": "single"} {"question": "Following aortic reconstruction, the viability of the sigmoid colon can most reliably be evaluated by", "exp": "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.", "cop": 4, "opa": "Intraoperative measurement of inferior mesenteric artery stump pressure", "opb": "Intraoperative Doppler arterial signal in the sigmoid mesentery", "opc": "Intraoperative observation of bowel peristalsis", "opd": "Postoperative sigmoidoscopy", "subject_name": "Surgery", "topic_name": "Arterial Disorders", "id": "e3151bd5-04a1-4f3e-86ef-08723965fbb4", "choice_type": "single"} {"question": "Banka's lesion is seen at", "exp": "B i.e. Anterior surface of glenoid labrum", "cop": 2, "opa": "Post surface of glenoid labrum", "opb": "Ant surface of glenoid labrum", "opc": "Ant pa of head of humerus", "opd": "Post pa of head of humerus", "subject_name": "Surgery", "topic_name": null, "id": "f7161251-b48a-4c5d-9e58-acdfd3b7d6b6", "choice_type": "single"} {"question": "Acute vascular ischemia mainfests as", "exp": "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", "cop": 1, "opa": "Pulselessness", "opb": "Syncope", "opc": "Flushing", "opd": "Oedema", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "b2f5d42c-9022-4ffb-8809-ce0dc60c83ed", "choice_type": "single"} {"question": "Commonest metastasis in Renal Cell Carcinoma is to", "exp": null, "cop": 1, "opa": "Lung", "opb": "Bone", "opc": "Adrenal", "opd": "Liver", "subject_name": "Surgery", "topic_name": null, "id": "c366dd86-72da-4273-bbc7-f3cef1ec8596", "choice_type": "single"} {"question": "Fibrocystic disease of the breast has been associated with elevated blood levels of", "exp": "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.", "cop": 3, "opa": "Testosterone", "opb": "Progesterone", "opc": "Estrogen", "opd": "Luteinizing hormone", "subject_name": "Surgery", "topic_name": "Breast", "id": "5384dff9-e736-4a83-8ef9-cf018e116e30", "choice_type": "single"} {"question": "Least malignant melanoma is", "exp": null, "cop": 1, "opa": "Lentigo maligna", "opb": "Superifcial spreading", "opc": "Nodular", "opd": "Amelanotic", "subject_name": "Surgery", "topic_name": null, "id": "be1f29c1-d87b-4024-83d6-1d17c3beda37", "choice_type": "single"} {"question": "Treatment of choice for Warthin's tumor is", "exp": null, "cop": 2, "opa": "Enucleation", "opb": "Superficial parotidectomy", "opc": "Radiotherapy", "opd": "Observation", "subject_name": "Surgery", "topic_name": null, "id": "3523d432-21a0-4f1a-b1c7-a4732917cf3f", "choice_type": "single"} {"question": "In case of blunt injury abdomen, the incision for emergency laparotomy should be", "exp": "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.", "cop": 2, "opa": "Paramedian incision", "opb": "Midline incision", "opc": "Transverse upper abdominalincision", "opd": "Subcostal incision", "subject_name": "Surgery", "topic_name": "Trauma", "id": "07c5b9f6-2cfd-4778-987d-790a9aad143d", "choice_type": "single"} {"question": "Hangman's fracture is fracture of C2", "exp": "C i.e. Pars interaicularis", "cop": 3, "opa": "Dens fracture", "opb": "Lamina", "opc": "Pars interaicularis", "opd": "Spinous process", "subject_name": "Surgery", "topic_name": null, "id": "c96800ce-082c-42ec-9712-8dc45ff52f4a", "choice_type": "single"} {"question": "Most common cause of painful defecation is associated with", "exp": "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", "cop": 1, "opa": "Fissure in ano", "opb": "Fistula in ano", "opc": "External haemorrhoid", "opd": "Internal haemorrhoid", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "a535dc81-0ef7-4086-b3d7-2ccf2e5ba9fe", "choice_type": "single"} {"question": "Treatment of choice for Warthin's Tumor", "exp": "The treatment of all benign tumors of the parotid gland is superficial parotidectomy.", "cop": 1, "opa": "Superficial parotidectomy", "opb": "Enucleation", "opc": "Radiotherapy", "opd": "Injection of a sclerosant agent", "subject_name": "Surgery", "topic_name": null, "id": "9763744f-d824-4720-a04f-ca4e23c31388", "choice_type": "single"} {"question": "Frost bite is treated by", "exp": "• Frostbite injuries affect the peripheries in cold climates.\n• The initial treatment is with slow rewarming in a bath at 42 °C.\n• The cold injury produces delayed microvascular damage.\n• Level of damage is difficult to assess.\n• Surgery usually does not play a role in its management, until there is absolute demarcation of the level of injury.", "cop": 2, "opa": "Rapid rewarming", "opb": "Slow rewarming", "opc": "IV pentoxyphiline", "opd": "Amputation", "subject_name": "Surgery", "topic_name": null, "id": "a8476319-c4c4-4d3d-a5c9-2c8da4d31e4e", "choice_type": "single"} {"question": "Splenectomy is least useful in", "exp": null, "cop": 2, "opa": "Congenital elliptocytosis", "opb": "Thalasemia major", "opc": "Congenital spherocytic anaemia", "opd": "Hereditary nonspherocytic haemolytic anaemia", "subject_name": "Surgery", "topic_name": null, "id": "49101fe0-58d8-4b06-9270-605a3faf9c85", "choice_type": "single"} {"question": "In an elective lap cholecystectomy with no gross spillage, antibiotics required are", "exp": "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", "cop": 3, "opa": "Single dose of Preoperative IV antibiotic followed by a 5 day course of oral antibiotics", "opb": "Post operative IV antibiotics for 1 day followed by a 5 day course of oral antibiotics", "opc": "Single dose of Preoperative IV antibiotic only", "opd": "5 day course of oral antibiotics only", "subject_name": "Surgery", "topic_name": "General surgery", "id": "e57551b1-32bf-4f6c-b97a-d61c6d6e34f7", "choice_type": "single"} {"question": "The least significant finding in the palpation of neck nodes is", "exp": null, "cop": 3, "opa": "The size", "opb": "The degree of firmness", "opc": "Tenderness", "opd": "Fixation to the underlying tissues", "subject_name": "Surgery", "topic_name": null, "id": "5c60c051-3f8f-4166-b1ee-56af958f9848", "choice_type": "single"} {"question": "Calciphylaxis is more commonly seen in", "exp": "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", "cop": 2, "opa": "Primary hyperparathyroidism", "opb": "Secondary hyperparathyroidism", "opc": "Teritiary hyperparathyroidism", "opd": "Pseudo hyperparathyroidism", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "7297f271-d52a-4bce-b5b2-5e0f4d3b9a5b", "choice_type": "single"} {"question": "Collar stud abscess occurs in", "exp": null, "cop": 1, "opa": "Cervical T.B. Lymphadenitis", "opb": "Peri Tonsillar abscess", "opc": "Pyogenic Lymphadenitis", "opd": "Retro Pharyngeal abscess", "subject_name": "Surgery", "topic_name": null, "id": "08672c8f-3661-4bb1-9775-b3956faae721", "choice_type": "single"} {"question": "A patient of burns should be given", "exp": null, "cop": 4, "opa": "5% dextrose", "opb": "Hypertonic saline 0.9%", "opc": "Dextrose saline", "opd": "Human albumin 4.5%", "subject_name": "Surgery", "topic_name": null, "id": "98dad82d-ee88-4ace-a703-01bd4c17c340", "choice_type": "single"} {"question": "\"Moon face\" appearance is seen in", "exp": null, "cop": 2, "opa": "Isolated LeFort I fracture", "opb": "LeFort II and Le Fort III fractures", "opc": "Mandibular fractures", "opd": "UnilateraL zygomatic complex fractures", "subject_name": "Surgery", "topic_name": null, "id": "b4d9d659-98e5-47be-b660-08fbb37ebb10", "choice_type": "single"} {"question": "The latent period in distraction osteogenesis is", "exp": null, "cop": 2, "opa": "4-6 weeks", "opb": "5-7 days", "opc": "6-8 months", "opd": "4 months", "subject_name": "Surgery", "topic_name": null, "id": "a85ad6a8-de38-4629-9a37-f765969980a4", "choice_type": "single"} {"question": "Name the incision", "exp": "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", "cop": 2, "opa": "Kochers incision", "opb": "Chevron incision", "opc": "Lanz incision", "opd": "Maylard incision", "subject_name": "Surgery", "topic_name": "All India exam", "id": "1899062c-4a5e-4ee8-beab-4f79d4d80065", "choice_type": "single"} {"question": "Most common cause of Bacteremia includes", "exp": "(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.", "cop": 2, "opa": "Dental extraction", "opb": "Post Sigmoidoscopy", "opc": "Superficial skin infections", "opd": "Elective surgery", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "db279adc-74a6-40b5-ad11-0e570756d0b6", "choice_type": "single"} {"question": "Banka's lesion is seen in", "exp": "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.", "cop": 3, "opa": "Anterior border of head of humerus", "opb": "Posterior border of head of humerus", "opc": "Anterior glonoid cavity", "opd": "Posterior glenoid cavity", "subject_name": "Surgery", "topic_name": null, "id": "0a5c77a3-db6b-4329-add9-ef257446374c", "choice_type": "single"} {"question": "Papillary ca thyroida) Most common thyroid cancerb) Psammoma bodies seenc) Encapsulatedd) Blood borne metastasis is common", "exp": "\"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\nMore about Papillary Ca thyriod\n\nPTC is the most common type of thyroid carcinoma\nMore common in females with female : male ratio of 2 : 1.\nMean age at presentation is 30 to 40 years\nMost 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.\nMultiple 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).\nDiagnosis is confirmed by FNA biopsy of the thyroid mass or lymph node.", "cop": 4, "opa": "ab", "opb": "bc", "opc": "acd", "opd": "abc", "subject_name": "Surgery", "topic_name": null, "id": "c741c708-9320-4626-be09-64ccb8e52391", "choice_type": "single"} {"question": "Serum calcitonin may be elevated in", "exp": "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", "cop": 4, "opa": "Islet cell tumour of pancreas", "opb": "Choriocarcinoma of ovary", "opc": "Carcinoid tumour of appendix", "opd": "Medullary carcinoma of thyroid", "subject_name": "Surgery", "topic_name": "Urology", "id": "ef862717-c27d-4ad2-b7fd-c16fe989ae6b", "choice_type": "single"} {"question": "Hematoma formation is more frequent with", "exp": null, "cop": 2, "opa": "Inferior alveolar nerve block", "opb": "Posterior superior alveolar nerve block", "opc": "Greater palatine nerve block", "opd": "Infraorbital nerve block", "subject_name": "Surgery", "topic_name": null, "id": "1ef8ffdf-428b-440a-ba7f-3a3d803d10ca", "choice_type": "single"} {"question": "Subcapsular plexus of lymphatics from the thyroid drains into", "exp": null, "cop": 4, "opa": "Level I", "opb": "Level III", "opc": "Level VII", "opd": "Level VI", "subject_name": "Surgery", "topic_name": null, "id": "48b81c5a-2a38-4b3c-ac4a-f065fd390fa6", "choice_type": "single"} {"question": "Golden period for treatment of open wounds is …………………….. hours", "exp": null, "cop": 1, "opa": "4", "opb": "6", "opc": "12", "opd": "24", "subject_name": "Surgery", "topic_name": null, "id": "439ba7a3-f0f4-4a63-9411-2100425d9903", "choice_type": "single"} {"question": "Most common muscle involved in volkmann's ischemic contracture is", "exp": "B i.e. Flexor-digitorum profunds", "cop": 2, "opa": "Flexor- pollicis longus", "opb": "Flexor-digitorum profunds", "opc": "Flexor-indicis", "opd": "Abductor pollicis", "subject_name": "Surgery", "topic_name": null, "id": "f3168785-60b7-44be-9948-1d2a32077e09", "choice_type": "single"} {"question": "Basal cell carcinoma treatment of choice is", "exp": "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", "cop": 1, "opa": "Wide excision", "opb": "Chemotherapy", "opc": "Irradiation", "opd": "Commondo operation", "subject_name": "Surgery", "topic_name": "Urology", "id": "0cb887e2-4c19-4194-85a6-149752be9853", "choice_type": "single"} {"question": "Intraoperative sentinel lymph node detection in axilla is done by using", "exp": ". 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", "cop": 2, "opa": "Mammography", "opb": "Isosulfan blue dye", "opc": "MRI", "opd": "CT", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "fb68c16f-8dd1-48a5-afbc-c64d7bd5a81e", "choice_type": "single"} {"question": "Rupture of the male urethra immediately inferior to the urogenital diaphragm leads to extravasations of urine into the", "exp": "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.", "cop": 1, "opa": "superficial perineal space", "opb": "Deep perineal space", "opc": "Ischiorectal fossa", "opd": "extraperitoneal space", "subject_name": "Surgery", "topic_name": null, "id": "37a9ee0a-b374-4018-b574-1a938d6276a9", "choice_type": "single"} {"question": "Mycotic abscesses are due to", "exp": "As the name suggests, mycotic abscesses are caused by fungal infections.\nHowever 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)", "cop": 2, "opa": "Bacterial infection", "opb": "Fungal infection", "opc": "Viral infection", "opd": "Mixed infection", "subject_name": "Surgery", "topic_name": null, "id": "cc70881e-9098-4bcf-abaf-ab2dd06afe02", "choice_type": "single"} {"question": "Post operative abscess treatment of choice", "exp": "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", "cop": 3, "opa": "Hydration", "opb": "IV antibiotics", "opc": "Image guided aspiration", "opd": "Reexploration", "subject_name": "Surgery", "topic_name": "Urology", "id": "ab9d25c6-0c5b-4305-bcda-0f80cc12ab06", "choice_type": "single"} {"question": "Annual risk of having breast cancer by mammography is", "exp": "(A) 1%", "cop": 1, "opa": "1%", "opb": "0.01%", "opc": "2%", "opd": "2.50%", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "c9fcb7ec-f905-4af4-be0f-239aa2e7a394", "choice_type": "single"} {"question": "Temporal bone metastasis is seen with", "exp": "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", "cop": 2, "opa": "Ca breast", "opb": "Ca bronchus", "opc": "Ca kidney", "opd": "Ca prostate", "subject_name": "Surgery", "topic_name": "Cardio thoracic surgery ", "id": "9a57a6a3-c21c-4530-a589-06382f9a24d6", "choice_type": "single"} {"question": "Ca breast in females is least related to", "exp": "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.", "cop": 4, "opa": "BRCA-1", "opb": "BRCA-2", "opc": "Li Fraumeni syndrome", "opd": "Ataxia telangiectasia", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "162c4c94-0e9a-4ba1-af4f-162b2a159c52", "choice_type": "single"} {"question": "Investigation of choice for diagnosis of CA colon", "exp": "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", "cop": 1, "opa": "Colonoscopy", "opb": "Double contrast barium enema", "opc": "Triple phase CT", "opd": "Viual colonoscopy", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "c768293b-593b-4eb1-88c8-96994275bd59", "choice_type": "single"} {"question": "Splenectomy is not indicated for", "exp": "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", "cop": 1, "opa": "Sarcoidosis", "opb": "ITP", "opc": "Trauma", "opd": "Hereditary Spherocytosis", "subject_name": "Surgery", "topic_name": "Spleen", "id": "f1069d12-6440-4583-be89-74b13351d0c7", "choice_type": "single"} {"question": "Most common area of pressure sore is", "exp": "Pressure sore frequency in descending order Ischium Greater trochanter Sacrum Heel Malleolus (lateral than medial) Occiput Bailey and Love 27e pg: 29", "cop": 1, "opa": "Ischium", "opb": "Greater trochanter", "opc": "Sacrum", "opd": "Heel", "subject_name": "Surgery", "topic_name": "General surgery", "id": "f5da2cf3-8b2f-4722-8e15-bf0896fc6db7", "choice_type": "single"} {"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.", "exp": "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", "cop": 2, "opa": "6", "opb": "11", "opc": "12", "opd": "7", "subject_name": "Surgery", "topic_name": "Trauma", "id": "490fc00e-0dda-41b4-81fb-1d4bb7426ae4", "choice_type": "single"} {"question": "Gasless abdomen in X ray seen in", "exp": "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", "cop": 1, "opa": "Acute Pancreatitis", "opb": "Intusussception", "opc": "Ulcerative Colitis", "opd": "Necrotising Enterocolitis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "f1d5d703-8eac-47a0-a67f-7fd3bffe1861", "choice_type": "single"} {"question": "Curling ulcers are commonly seen in", "exp": ".DUODENAL ULCER FOLLOWING SUPERFICIAL BURNS ARE CALLED CURLING&;S ULCER", "cop": 2, "opa": "Stomach", "opb": "Duodenum", "opc": "Ileum", "opd": "Cecum", "subject_name": "Surgery", "topic_name": "General surgery", "id": "b00eb05d-d9b0-4c5a-9ab0-ca48c6d337bf", "choice_type": "single"} {"question": "The colloidal plasma expander used in treatment of hypovolemic shock is", "exp": null, "cop": 4, "opa": "5% dextrose saline", "opb": "Normal saline", "opc": "Ringer Lactate", "opd": "6% dextran", "subject_name": "Surgery", "topic_name": null, "id": "efb97ad1-9306-4c93-8efc-18c5856ab1b3", "choice_type": "single"} {"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'", "exp": "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", "cop": 2, "opa": "CAH due to 21 alpha hydroxylase deficiency", "opb": "Familial glucocoicoid deficiency", "opc": "Cushing syndrome", "opd": "Insulinoma", "subject_name": "Surgery", "topic_name": null, "id": "9690fac8-d893-42d5-963e-dc28396c6995", "choice_type": "single"} {"question": "Use of tamoxifen in carcinoma of breast patients does not lead to the following side effects.", "exp": "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)", "cop": 4, "opa": "Thromboembolic events", "opb": "Endometrial Carcinoma", "opc": "Cataract", "opd": "Cancer in opposite breast", "subject_name": "Surgery", "topic_name": "Breast Cancer - Treatments", "id": "c54928ed-8c98-4610-9022-c3abc108955e", "choice_type": "single"} {"question": "Best screening marker of prostate cancer is", "exp": "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**", "cop": 2, "opa": "a - feto protein", "opb": "Prostate specific antigen", "opc": "CA-19-20", "opd": "CA-125-26", "subject_name": "Surgery", "topic_name": "Prostate & Seminal Vesicles", "id": "963e9474-b956-4fcd-a63a-1bfc4583e422", "choice_type": "single"} {"question": "Flail chest is defined as", "exp": "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", "cop": 2, "opa": "Fracture of 3 or more ribs at 2 or more places", "opb": "Fracture of 2 or more ribs at 2 or more places", "opc": "Fracture of 2 or more ribs at one place", "opd": "Fracture of multiple ribs at one place", "subject_name": "Surgery", "topic_name": "Trauma", "id": "edbb5c93-1cdd-4e09-b48d-4eaf79d35300", "choice_type": "single"} {"question": "The incidence of breast cancer", "exp": "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.", "cop": 1, "opa": "Increases with increasing age", "opb": "Has declined since the 1940s", "opc": "Is related to dietary fat intake", "opd": "Is related to coffee intake", "subject_name": "Surgery", "topic_name": "Breast", "id": "f23a4483-99a3-413d-888c-b757d4e6495e", "choice_type": "single"} {"question": "Antoni A & Antoni B Pattern's are seen in", "exp": "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.", "cop": 1, "opa": "Schwannoma", "opb": "Neurofibroma", "opc": "Meningioma", "opd": "Teratoma", "subject_name": "Surgery", "topic_name": null, "id": "8898babd-1c9e-4fbf-8cc6-2ac2d9364eeb", "choice_type": "single"} {"question": "Interval cholecystectomy surgery is", "exp": "When there is no information but entry to genitourinary or gastrointestinal systems it is clean contaminated.", "cop": 2, "opa": "Clean", "opb": "Clean contaminated", "opc": "Contaminated", "opd": "Dirty", "subject_name": "Surgery", "topic_name": null, "id": "ff3bd99f-81af-42a7-8be0-e5fc91307c98", "choice_type": "single"} {"question": "Investigation of choice in an unstable patient with suspected intraabdominal injury is", "exp": "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.", "cop": 2, "opa": "DPL", "opb": "USG", "opc": "CT scan", "opd": "X-ray abdomen", "subject_name": "Surgery", "topic_name": "Trauma", "id": "85747b45-37cb-42cf-8dde-d14df8cd05bc", "choice_type": "single"} {"question": "Blood stained nipple discharge is seen in", "exp": "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", "cop": 3, "opa": "Breast abscess", "opb": "Fibroadenoma", "opc": "Ductal papilloma", "opd": "fat necrosis", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "74650dd7-fe31-4f97-b372-b5a9e2b304d4", "choice_type": "single"} {"question": "Treatment of choice in Medullary Ca thyroid", "exp": "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.", "cop": 4, "opa": "Total thyroidectomy", "opb": "Total thyroidectomy + Radical neck dissection", "opc": "Total thyroidectomy + Radiotherapy", "opd": "Total thyroidectomy + Prophylactic CCND", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "a180cbd1-a0d0-498e-9444-7eb663c0280c", "choice_type": "single"} {"question": "Management in case of rupture of disc at L5, S1 is", "exp": "C i.e. Immobilization for 2 weeks with spinal brace", "cop": 3, "opa": "Emergency removal of disc", "opb": "Joint fusion", "opc": "Immobilization for 2 weeks with spinal brace", "opd": "Traction", "subject_name": "Surgery", "topic_name": null, "id": "1e58c9fe-af39-46e2-870d-5f67fecebdc2", "choice_type": "single"} {"question": "Saggital split osteotomy was first advocated by", "exp": null, "cop": 1, "opa": "Obwegesser", "opb": "Dalpont", "opc": "Wundrer", "opd": "Moose", "subject_name": "Surgery", "topic_name": null, "id": "5a3956bf-e4c1-42f4-8872-2dff4ec365e5", "choice_type": "single"} {"question": "Not an indication for PAIR treatment in hydatid cyst", "exp": "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", "cop": 4, "opa": "Size > 5 cm", "opb": "Multiloculated", "opc": "Cyst in lung", "opd": "Recurrence after surgery", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "12f2ea49-2f1a-4b39-a280-09421f7dcd2a", "choice_type": "single"} {"question": "Hilton's method of incision and drainage of abscess has the advantage of", "exp": "Hilton's method of incision and drainage of abscess is used in neck, axilla and axilla. It avoids injury to underlying vessels and nerves.", "cop": 2, "opa": "Complete drainage of pus", "opb": "Avoids injury to underlying vessels and nerves", "opc": "Heals without scar", "opd": "Provides irrigation", "subject_name": "Surgery", "topic_name": null, "id": "27452a05-71e4-4ad0-8cf6-21ef49375724", "choice_type": "single"} {"question": "The use of 5% dextrose as an intravenous resuscitation fluid can", "exp": "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.", "cop": 4, "opa": "Improve cerebral perfusion", "opb": "Provide glucose substrate for cerebral metabolism", "opc": "Reduce intracranial pressure and cause lacity of brain", "opd": "Reduce serum osmalality and cause brain edema", "subject_name": "Surgery", "topic_name": "General surgery", "id": "29bea79f-f698-443a-9820-dbe5204ed971", "choice_type": "single"} {"question": "Massive bleeding per rectum in a elderly patient is due to", "exp": "MCC of massive bledding per rectum is diverticulosis.", "cop": 3, "opa": "Colitis", "opb": "Ca.colon", "opc": "Diverticulosis", "opd": "Peptic ulcer disease", "subject_name": "Surgery", "topic_name": null, "id": "bb1ecf0f-2e99-4853-b51d-4641dee78b90", "choice_type": "single"} {"question": "In supra condylar fracture of humerus, the nerve most commonly injured is", "exp": "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", "cop": 3, "opa": "Radial nerve", "opb": "Ulnar nerve", "opc": "Median nerve", "opd": "Auxiliary nerve", "subject_name": "Surgery", "topic_name": null, "id": "aa8f11cd-1318-4d2b-8d11-f5c7b97b8566", "choice_type": "single"} {"question": "Crohn's disease is associated with polymorphisms in", "exp": "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.", "cop": 1, "opa": "NOD2/CARD 15 gene", "opb": "P53 gene", "opc": "Philadelphia chromosome", "opd": "APC/Beta catenin", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "adcde1d3-e022-4b41-9151-9ed35c9564b5", "choice_type": "single"} {"question": "Imatinib mesylate used in the treatment of GIST is a inhibitor of", "exp": "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", "cop": 3, "opa": "IL-12", "opb": "TNF-x", "opc": "Tyrosine kinase", "opd": "VEGE", "subject_name": "Surgery", "topic_name": "Urology", "id": "b677bcc3-888d-4d44-b7fb-7f9f402b0b51", "choice_type": "single"} {"question": "Popliteal aery pulsations are difficult to feel because", "exp": "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.", "cop": 3, "opa": "It is not superficial", "opb": "It does not cross prominent bone", "opc": "It is not superficial and does not cross prominent bone", "opd": "Its pulsation are weak", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "6f7841ff-5df7-4bae-905b-5bbab9550381", "choice_type": "single"} {"question": "Splenomegaly is least likely associated with aEUR'", "exp": "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\".", "cop": 4, "opa": "CML", "opb": "Polycythemia ruba vera", "opc": "Idiopathic myelofibrosis", "opd": "Primary thrombocytosis", "subject_name": "Surgery", "topic_name": null, "id": "670ae2a5-b39e-4a61-9b85-1adfdbbebd78", "choice_type": "single"} {"question": "Squamous cell carcinoma", "exp": null, "cop": 1, "opa": "Spreads through lymphatics", "opb": "Radioresistant", "opc": "Metastasize through blood stream", "opd": "Surgical excision contraindicated", "subject_name": "Surgery", "topic_name": null, "id": "5749b5ec-58e7-423d-9515-308783402915", "choice_type": "single"} {"question": "Most common site of intraperitoneal abscess is", "exp": "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)", "cop": 3, "opa": "Right superior intraperitoneal space", "opb": "Left superior intraperitoneal space", "opc": "Right inferior intraperitoneal space", "opd": "Left inferior intraperitoneal space", "subject_name": "Surgery", "topic_name": "Peritoneal Disorders - Peritonitis", "id": "e8d8fc95-410c-4e45-970b-25487ed45b1c", "choice_type": "single"} {"question": "Corynebacterium minutissimum is causative in", "exp": "Erythrasma is caused by corynebacterium minutissimum.", "cop": 2, "opa": "Erysipelas", "opb": "Erythrasma", "opc": "Erysipeloid disease", "opd": "Scrum pox", "subject_name": "Surgery", "topic_name": null, "id": "27c4a355-d2bd-4437-aa85-41c8d552de24", "choice_type": "single"} {"question": "BRCA 1 gene is located on", "exp": "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", "cop": 3, "opa": "11q", "opb": "13q", "opc": "17q", "opd": "19q", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "f0b16a8d-e336-4670-b1c1-c7da846dac01", "choice_type": "single"} {"question": "Best Material for below inguinal arterial graft is", "exp": "Critical limb ischemia (CLI) is defined by the presence of ischemic rest pain in the distal foot, ischemic nonhealing ulcerations, or gangrene.\nCLI is the progressive evolution and clinical manifestation of peripheral arterial disease (PAD).\nIt is seen in patients with severe arterial occlusive disease in whom resting blood flow cannot accommodate basal nutritional needs of the tissues.\nPatients will complain of rest pain or a feeling of cold or numbness in the foot and toes.\nFrequently, 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.", "cop": 1, "opa": "Saphenous vein graft (upside-down)", "opb": "PTFE,", "opc": "Dacron", "opd": "Teflon", "subject_name": "Surgery", "topic_name": null, "id": "52c04c20-abf0-4bb1-942f-6268fb4ec1ad", "choice_type": "single"} {"question": "Bismuth classification for cholangiocarcinoma, type IV is", "exp": "Answer- C. Bifurcation and B/L secondary intrahepatic ducts", "cop": 3, "opa": "Common hepatic duct", "opb": "Bifurcation only", "opc": "Bifurcation and B/L secondary intrahepatic ducts", "opd": "Bifurcation and B/L right secondary intrahepatic ducts", "subject_name": "Surgery", "topic_name": null, "id": "e860bd4e-4b98-4f6a-a445-2cd915c310b7", "choice_type": "single"} {"question": "Not a cause of acute anal pain", "exp": "Ans. c. Fistula in ano", "cop": 3, "opa": "Thrombosed hemorrhoids", "opb": "Acute anal fissure", "opc": "Fistula in ano", "opd": "Perianal abscess", "subject_name": "Surgery", "topic_name": null, "id": "36341d3f-c349-41dd-bf03-9d5812d1ec44", "choice_type": "single"} {"question": "Wolf's graft is", "exp": null, "cop": 3, "opa": "Partial thickness graft", "opb": "Micro vascular free graft", "opc": "Full thickness graft", "opd": "Mucocutaneous flap", "subject_name": "Surgery", "topic_name": null, "id": "b45c677b-2685-4a1a-994e-c0c09b6e1f47", "choice_type": "single"} {"question": "In flexion injuries causing supracondylar fractures, the distal fragment is often displaced to", "exp": "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", "cop": 1, "opa": "Anterior", "opb": "Posterior", "opc": "Medial", "opd": "Lateral", "subject_name": "Surgery", "topic_name": null, "id": "8830eca5-7205-4bf2-b15b-1be5c29eb167", "choice_type": "single"} {"question": "GIST is most common in", "exp": "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", "cop": 1, "opa": "Stomach", "opb": "Duodenum", "opc": "Ileum", "opd": "Rectum", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "88d3b537-1096-4d50-b84f-84e95d295ca4", "choice_type": "single"} {"question": "Postero lateral anconeus triangle is formed by", "exp": "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.", "cop": 2, "opa": "Head of radius, lateral epicondyle, medial epicondyle", "opb": "Head of radius, lateral epicondyle, olecranon", "opc": "Olecranon, medial epicondyle, neck of radius", "opd": "Neck of radius, head of radius, lateral epicondyle", "subject_name": "Surgery", "topic_name": null, "id": "04b6849a-136d-447f-a4c7-f8f070585d18", "choice_type": "single"} {"question": "Pre tracheal and para tracheal LN are", "exp": null, "cop": 4, "opa": "Level I", "opb": "Level II", "opc": "Level IV", "opd": "Level VI", "subject_name": "Surgery", "topic_name": null, "id": "a9498139-288c-4327-960b-fefc96a1f962", "choice_type": "single"} {"question": "In staging of Hodgkin's lymphoma, bilateral involvement\nof lymph nodes on either side of diaphragm is", "exp": null, "cop": 3, "opa": "Stage-I", "opb": "State-II", "opc": "Stage-III", "opd": "Stage-IV", "subject_name": "Surgery", "topic_name": null, "id": "8cdae579-9022-4e01-802b-5a512bec4f63", "choice_type": "single"} {"question": "Investigation for injury of knee cailage", "exp": "D i.e. Ahroscopy", "cop": 4, "opa": "Aspiration", "opb": "Ahrography", "opc": "X-ray", "opd": "Ahroscopy", "subject_name": "Surgery", "topic_name": null, "id": "6195c603-b80b-4dfd-afd9-f47ca4b507ea", "choice_type": "single"} {"question": "Inversion of nipple occurs due to the involvement of", "exp": "Breast carcinoma arising from lactiferous ducts is called as ductal carcinoma.\n\nBreast carcinoma arising from lobules is called as lobular carcinoma. It is 10% common.\n\nCutaneous Manifestations of Carcinoma Breast\n\nPeau 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.\nDimpling of skin due to infiltration of ligament of Cooper.\nRetraction of nipple due to infiltration of lactiferous duct.\nUlceration, discharge from the nipple and areola.\nSkin ulceration and function.\nCancer-en-cuirasse: Skin over the chest wall and breast is studded with cancer nodules appearing like an armour coat.", "cop": 4, "opa": "Breast lobules", "opb": "Montogomory tubercles", "opc": "Cooper ligament", "opd": "Lactiferous ducts", "subject_name": "Surgery", "topic_name": null, "id": "07266217-abc8-4533-9cf7-4c855242f945", "choice_type": "single"} {"question": "MC intracranial Brain tumor in adults", "exp": "Ans. (b) MetsRef: Bailey 27th edition Page 663* MC brain tumor is Cerebral mets* MC primary to produce brain mets Lungs (40%) > Breast (15%)", "cop": 2, "opa": "Astrocytoma", "opb": "Mets", "opc": "Meningioma", "opd": "Oligodendroglioma", "subject_name": "Surgery", "topic_name": "Nervous System", "id": "301b728b-e3c8-4ac7-800e-38a1a88511f9", "choice_type": "single"} {"question": "The addition of hyaluronidase to a local anesthetic solution might", "exp": null, "cop": 4, "opa": "Increase the duration of anesthesia", "opb": "Limit the area of anesthesia", "opc": "Reduce bleeding", "opd": "Enhance diffusion of local anesthetic", "subject_name": "Surgery", "topic_name": null, "id": "cd75aaf3-5325-4053-ae04-81c36574fa21", "choice_type": "single"} {"question": "The least common site of volvulus in children is", "exp": ".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", "cop": 3, "opa": "Ilio iliac volvulus", "opb": "Ilio cecal volvulus", "opc": "Large bowel volvulus", "opd": "Sigmoid colon", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "1cf0a859-9f35-4b63-98c7-81d90886ac2c", "choice_type": "single"} {"question": "The diagnosis of congenital megacolon is confirmed by", "exp": "-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", "cop": 3, "opa": "Clinical features", "opb": "Barium enema", "opc": "Rectal biopsy", "opd": "Recto-sigmoidoscopy", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "7ed190ce-c9da-472b-8729-ac1b5ad2cd62", "choice_type": "single"} {"question": "Commonest site of Maltoma is", "exp": "Stomach is commonest site of Maltoma.", "cop": 3, "opa": "Neck", "opb": "Mediastinum", "opc": "Stomach", "opd": "Vertebra", "subject_name": "Surgery", "topic_name": null, "id": "98f517cf-0e5a-4075-9a50-badf741ad397", "choice_type": "single"} {"question": "Trauma and Injury Severity score (TRISS) includes", "exp": "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.", "cop": 2, "opa": "GCS + BP+RR", "opb": "S+ISS+Age", "opc": "S+ISS+GCS", "opd": "S+GCS+BP", "subject_name": "Surgery", "topic_name": "Trauma", "id": "bc4a324a-f875-4d29-b355-36c6665f73f7", "choice_type": "single"} {"question": "Most common cause of thoracic aortic aneurysm is", "exp": "(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", "cop": 1, "opa": "Atherosclerosis", "opb": "Tuberculosis", "opc": "Cystic degeneration", "opd": "Syphilitic", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "e652df19-2ece-4c77-99da-f87d173b0ab8", "choice_type": "single"} {"question": "Pat's fracture is fracture of", "exp": "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.", "cop": 2, "opa": "Lower end of tibia", "opb": "Lower end of tibia + fibula", "opc": "Lower end of tibia + Calcaneum", "opd": "Calcaneum + Talus", "subject_name": "Surgery", "topic_name": null, "id": "42942aa3-5e6a-40eb-86c3-05cd2a4a1255", "choice_type": "single"} {"question": "In hepatocellular carcinoma, risk factor most important is", "exp": "Cirrhosis is the most important risk factor for HCC.\n\"75-85% of HCC occur in patients with macronodular cirrhosis\" - Harrison", "cop": 3, "opa": "Alcoholic hepatitis", "opb": "Schistosomiasis", "opc": "Cirrhosis", "opd": "Fasciolepsis buski infestation", "subject_name": "Surgery", "topic_name": null, "id": "792a1f51-86cf-4374-9b27-2166839dd5d2", "choice_type": "single"} {"question": "In patients with facial disproportion producing malocclusion", "exp": null, "cop": 2, "opa": "an osteotomy alone in the mandibular ramus can be used to close an anterior open bite.", "opb": "a sagittal split osteotomy commonly produces inferior dental nerve paraesthesia", "opc": "an intra oral vertical sub sigmoid osteotomy is appropriate for treating mandibular retrognathia.", "opd": "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", "subject_name": "Surgery", "topic_name": null, "id": "2634ee9c-048c-4b31-b8a6-678170a881d6", "choice_type": "single"} {"question": "The most significant adverse consequences of accidental intravenous administration of a local anesthetic is", "exp": null, "cop": 4, "opa": "Bronchoconstriction", "opb": "Hepatic damage", "opc": "Nerve damage", "opd": "Seizures", "subject_name": "Surgery", "topic_name": null, "id": "e3bf8cbd-238b-4494-8d26-e038298d24c3", "choice_type": "single"} {"question": "Dermoid cyst is a form of", "exp": null, "cop": 2, "opa": "Cystic hamartoma", "opb": "Cystic teratoma", "opc": "Choriostoma", "opd": "Hamartoma", "subject_name": "Surgery", "topic_name": null, "id": "ccf6d305-c765-44e4-ab73-556d3c45dcd7", "choice_type": "single"} {"question": "Test of primary hemostasis", "exp": null, "cop": 2, "opa": "Coagulation time", "opb": "Bleeding time", "opc": "Prothrombin time", "opd": "Platelet count", "subject_name": "Surgery", "topic_name": null, "id": "160977bc-b6fc-4059-8637-9b2565473ee4", "choice_type": "single"} {"question": "In the abdomen, aneurysms of the .... commonly occur next only to the aoa ....", "exp": "Ans. is 'c' i.e., Splenic aery", "cop": 3, "opa": "Internal iliac aery", "opb": "External iliac aery", "opc": "Splenic aery", "opd": "Inferior mesentric aery", "subject_name": "Surgery", "topic_name": null, "id": "22e2baae-ddb0-4387-a117-4c7ff4915519", "choice_type": "single"} {"question": "A patient presents with acute renal failure with normal ultrasound abdomen repo. Next most useful investigation is", "exp": ".", "cop": 1, "opa": "DTPA scan", "opb": "X-ray abdomen and CT scan", "opc": "Retrograde pyelography", "opd": "Intravenous pyelography", "subject_name": "Surgery", "topic_name": "All India exam", "id": "a470b64c-c5d0-4c6a-a2b7-9db5c6403e6b", "choice_type": "single"} {"question": "Pringle&;s maneuver is mainly used to control bleeding from", "exp": "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", "cop": 3, "opa": "IVC", "opb": "Cystic aery", "opc": "Poal vein", "opd": "Hepatic vein", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "f503b863-124e-4a49-8ec0-9337c4c506ca", "choice_type": "single"} {"question": "Medical management of insulinoma is", "exp": "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", "cop": 3, "opa": "Octreotide", "opb": "Streptozotocin", "opc": "Diazoxide", "opd": "Somatomedin", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "d09e1827-71d2-4130-b24a-c14a5b5ad358", "choice_type": "single"} {"question": "Most impoant prognostic indicator for renal cell carcinoma", "exp": "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", "cop": 4, "opa": "Nuclear grade", "opb": "Histological type", "opc": "Size", "opd": "Pathological staging", "subject_name": "Surgery", "topic_name": "Urology", "id": "931f674c-1801-4e9a-889a-c16a22108245", "choice_type": "single"} {"question": "Most common origin of cerebral metastases is", "exp": "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", "cop": 4, "opa": "Colon", "opb": "Kidney", "opc": "Malanoma", "opd": "Lung", "subject_name": "Surgery", "topic_name": "Trauma", "id": "7c0fc3f7-a70e-4d59-a063-157bee23a8c7", "choice_type": "single"} {"question": "Most common site of adenocarcinoma among the following", "exp": "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", "cop": 1, "opa": "Duodenum", "opb": "Jejunum", "opc": "Ileum", "opd": "Appendix", "subject_name": "Surgery", "topic_name": "Small & Large Intestine", "id": "59c4add5-f1c7-4fb9-9e6e-a4c8c8a58d89", "choice_type": "single"} {"question": "Urinary stone formed in patients with regional bowel enteritis is", "exp": "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", "cop": 1, "opa": "Calcium oxalate", "opb": "Urate", "opc": "Phosphate", "opd": "Cysteine", "subject_name": "Surgery", "topic_name": "Urology", "id": "5d68cce2-70ed-4d0d-a5d6-01eb833cfffa", "choice_type": "single"} {"question": "The most frequent trace mineral deficiency developing in a patient receiving parenteral alimentation is a deficiency of", "exp": "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.", "cop": 4, "opa": "Ca", "opb": "Chromium", "opc": "Cobalt", "opd": "Zinc", "subject_name": "Surgery", "topic_name": null, "id": "b8a75430-2680-488f-a131-1caee88739a8", "choice_type": "single"} {"question": "BISAP score is used for to assess severity of", "exp": null, "cop": 1, "opa": "Pancreatitis", "opb": "Pancreatic absess", "opc": "Pseudocyst of pancreas", "opd": "Pseudocyst of pancreas", "subject_name": "Surgery", "topic_name": null, "id": "7ed96f96-dac3-4ca1-859d-a876eaffc917", "choice_type": "single"} {"question": "Genitourinary TB in a male patient presents with", "exp": "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", "cop": 2, "opa": "Painful and tender epididymis", "opb": "Bacteriuria without Pyuria", "opc": "Renal cysts (unilateral)", "opd": "Microscopic Hematuria", "subject_name": "Surgery", "topic_name": "Urology", "id": "88842b9c-bdf9-4863-b34a-0a84f4a03767", "choice_type": "single"} {"question": "Ideal graft for leg injury with 10 x 10 cm. exposed bone", "exp": "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.\nSo an exposed bone surface is covered by a graft which has its own blood supply. Such grafts are k/a flaps or pedicle grafts.\nSabiston writes - \"Pedicle graft or flap is a partially or completely isolated segment of tissue with its own blood supply.\"\n\n\"Absolute indications for flaps -\nexposed bone, radiated vessels, brain, an open joint or nonbiological implants materials. Pressure sores where a bony prominence is exposed.\"", "cop": 2, "opa": "Amniotic member graft", "opb": "Pedicle graft", "opc": "Full thickness graft", "opd": "Split thickness skin graft", "subject_name": "Surgery", "topic_name": null, "id": "b635d187-f40d-4b4e-a4a4-c50fb2a0937f", "choice_type": "single"} {"question": "Sistrunk operation is done for", "exp": "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.", "cop": 1, "opa": "Throglossal fistula", "opb": "Branchial cyst", "opc": "Parotid tumor", "opd": "Lateral abarrent thyroid", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "5b459acb-0bd8-48b8-ab1f-8b9fa9188b8c", "choice_type": "single"} {"question": "A 80 years old male presented with lung abscess in left upper zone. Best treatment modality is", "exp": "Ans. is 'a' i.e. Antibiotics according to organism", "cop": 1, "opa": "Antibiotics according to organisms", "opb": "Surgical drainage", "opc": "Tube thoracostomy", "opd": "Wait and watch", "subject_name": "Surgery", "topic_name": null, "id": "e01d4335-c977-4ee9-a8ab-920bc17e0fb0", "choice_type": "single"} {"question": "Cryptoorchidism is associated with malignant changes to", "exp": "(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**", "cop": 2, "opa": "Squamous cell carcinoma", "opb": "Seminoma", "opc": "Embryonal cell carcinoma", "opd": "Choriocarcinoma", "subject_name": "Surgery", "topic_name": "Testis & Scrotum", "id": "a0c97745-5a65-4e7d-a8c6-bd53a7662b87", "choice_type": "single"} {"question": "Commonest complication of Pseudocyst of the pancreas is", "exp": ".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", "cop": 4, "opa": "Commonest into peritoneum", "opb": "Rupture into colon", "opc": "Hemorrhage", "opd": "Infection", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "d9a64f03-506c-4db6-8009-a0df4fda2e35", "choice_type": "single"} {"question": "The most frequent symptom of gastric diveiculum is", "exp": "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.", "cop": 1, "opa": "Epigastric pain", "opb": "Haematemesis", "opc": "Vomiting", "opd": "Pain relieved by food", "subject_name": "Surgery", "topic_name": null, "id": "98f9dd78-59e8-486d-bfe6-e7bbbffe52df", "choice_type": "single"} {"question": "Left medial sector contains segment", "exp": "Left medial sector contains segment III and IV Left lateral sector contains only one segment II Ref: Sabiston 20th edition Pgno : 1421-1422", "cop": 1, "opa": "III, IV", "opb": "II, III", "opc": "I, II", "opd": "I, IV", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "c92e770d-f617-4ace-81f2-d9f714a644cd", "choice_type": "single"} {"question": "During endoscopic surgery the position of patient is", "exp": "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.", "cop": 3, "opa": "Trendelenberg", "opb": "Lateral", "opc": "Reverse trendelenberg", "opd": "Lithotomy", "subject_name": "Surgery", "topic_name": "Urology", "id": "2189275b-0582-47f4-8499-8e8616165c90", "choice_type": "single"} {"question": "40 years old patient with femur fracture with pulmonary infiltration and respiratory distress", "exp": "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", "cop": 1, "opa": "Fat embolism", "opb": "Pulmonary embolism", "opc": "Air embolism", "opd": "Obstruction", "subject_name": "Surgery", "topic_name": "FMGE 2019", "id": "7dc2116a-12f7-4043-aeeb-d73887849938", "choice_type": "single"} {"question": "Lateral internal sphincterotomy is the treatment of choice for", "exp": "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", "cop": 3, "opa": "Haemorrhoids", "opb": "Fistula in ano", "opc": "Fissure in ano", "opd": "Anal cancer", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "1df639b7-2d2c-4200-be19-8fa6cba6013b", "choice_type": "single"} {"question": "Hpylori", "exp": null, "cop": 2, "opa": "Gram -ve non flagellate spiral organism", "opb": "obligate parasite on gastric mucosa", "opc": "Doesnot infect duodenal mucosa", "opd": "Antibiotics not effective", "subject_name": "Surgery", "topic_name": null, "id": "1691a360-1396-4df5-8d16-bf30b7c57949", "choice_type": "single"} {"question": "Most common brain tumour is", "exp": "Answer- C. MetastasisMC brain tumors - MetastasesMC primary brain tumor - GliomaMC Glioma - AstrocytomasMC Astrocytomas - Glioblastoma multiforme", "cop": 3, "opa": "Astrocytoma", "opb": "Meningioma", "opc": "Metastasis", "opd": "Oligodendroma", "subject_name": "Surgery", "topic_name": null, "id": "68f6e354-673a-49a4-b3a4-dd5214c712ff", "choice_type": "single"} {"question": "Incidence Of H. pylori in Gastric ulcer is", "exp": "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", "cop": 3, "opa": "5%", "opb": "20%", "opc": "60%", "opd": "80%", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "9ef5c1eb-b0d3-461c-b056-0bdd25a4acf2", "choice_type": "single"} {"question": "A 20 year old male presents with scrotal mass. The first investigation to be done is", "exp": "Differential diagnosis are hydrocele, hematocele, epididymal cyst, spermatocele, varicocele, inguinal hernia, testicular tumours . Thus clinical examination should be done first to differentiate between them.", "cop": 1, "opa": "Clinical evaluation (Palpation and transillumination)", "opb": "USG", "opc": "Biopsy", "opd": "AFP", "subject_name": "Surgery", "topic_name": "Urology", "id": "3f9465f7-d688-4509-8348-d7f92ee569aa", "choice_type": "single"} {"question": "Tumor commonly seen in the area marked below", "exp": "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", "cop": 2, "opa": "Insulinoma", "opb": "Gastrinoma", "opc": "Non-functional tumours", "opd": "VIPoma", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "e28d4f9f-5e8e-4c43-aaf3-db545cb1dd00", "choice_type": "single"} {"question": "Rhytidectomy is", "exp": null, "cop": 1, "opa": "Removal of skin wrinkles", "opb": "A1 - of nasal septum position", "opc": "Salivary gland excision", "opd": "Cehek augmentation", "subject_name": "Surgery", "topic_name": null, "id": "4d3bca7a-166a-45d3-b433-c1ad1f95f7f9", "choice_type": "single"} {"question": "In Moore's classification of omphalocole (examphalos), type I umbilical defect is less than .... cm.", "exp": "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.", "cop": 2, "opa": "0.5", "opb": "2.5", "opc": "3.5", "opd": "4.5", "subject_name": "Surgery", "topic_name": null, "id": "34fa5a24-32a4-4168-80c4-cb87f9eb40e8", "choice_type": "single"} {"question": "Priapism in a young male could occur because of", "exp": "Priapism is persistent ( more than 4 hours) painful erection of penis. Usually seen as a compilcation of blood disorders like leukemia, sickle cell disease. Other causes include following therapeutic injection of papaverine, abnormally prolonged bout of otherwise normal sexual activity, idiopathic thrombosis of corpora cavernosa or prostatic venous plexus, malignant disease in the corpora cavernosa or the pelvis, rarely as a consequence of spinal cord disease. Reference : page 1063 SRB's manual of surgery 5th edition and page 1374 Bailey and Love's sho practice of surgery 25th edition", "cop": 3, "opa": "Testicular cancer", "opb": "Carcinoid tumour of appendix", "opc": "Leukaemia", "opd": "Penile cancer", "subject_name": "Surgery", "topic_name": "Urology", "id": "e82f1abf-971c-424c-ac57-1195fa71956a", "choice_type": "single"} {"question": "Following an oral surgical procedure, the surgical site is covered with a gauze wetted with saline because", "exp": null, "cop": 2, "opa": "Saline promotes local haemostasis at the site", "opb": "Saline decreases the tendency of the clot to get embedded in gauze mesh", "opc": "Saline has localized anti-inflammatory action", "opd": "Saline accelerates the healing of the wound", "subject_name": "Surgery", "topic_name": null, "id": "91ed5652-25ca-441c-87da-f345193cc357", "choice_type": "single"} {"question": "Dimpling in cancer breast happens due to", "exp": "Ans. (b) Infiltration of Cooper's Ligament(Ref. Bailey 26th edition Page 798)* Infiltration of Suspensory ligament of breast (Cooper's) results in Dimpling of breast in cancer", "cop": 2, "opa": "Edema", "opb": "Infiltration of cooper's ligaments", "opc": "Subdermal lymphangitis", "opd": "Scaring", "subject_name": "Surgery", "topic_name": "Breast", "id": "ba26aa1b-0239-4b12-82a4-f529e3a02d3b", "choice_type": "single"} {"question": "Elevators should not be used to remove the palatal root of an", "exp": null, "cop": 4, "opa": "Upper incisor", "opb": "Upper canine", "opc": "Upper premolar", "opd": "Upper molar", "subject_name": "Surgery", "topic_name": null, "id": "b6a6529a-3100-4853-91f7-748926f94584", "choice_type": "single"} {"question": "Dysphagia mainly for liquids is seen with", "exp": "Ans. (a) Achalasia Cardia* Achalasia is a rare disease caused by loss of inhibitory ganglion cells within the esophageal myenteric plexus* It leads to a hypertensive lower oesophageal sphincter (LOS) which fails to relax on swallowing, and by aperistalsis of the body of the oesophagus.* Long-standing achalasia is characterized by progressive dilatation and sigmoid deformity of the esophagus with hypertrophy of the LES.Clinical Presentation* Progressive dysphagia is the most common presenting symptom. It generally concerns initially liquids and later both liquids and solids from the outset.# Dysphagia: Liquids > Solid* The second most common symptom is the regurgitation of undigested food during or shortly after a meal.Investigation* Screening: Barium study- Bird beak appearance* IOC: ManometryTreatment* Medical management:# Calcium channel blockers# Nitrates# Botulinum toxin (injected into the LES under endoscopic guidance)* Surgical management:# Harrison states: \"The only durable therapies for achalasia are pneumatic dilatation and Heller myotomy\"# Surgery of choice: Heller's myotomy", "cop": 1, "opa": "Achalasia cardia", "opb": "Zenker diverticulum", "opc": "Barret esophagus", "opd": "Diffuse esophageal spasm", "subject_name": "Surgery", "topic_name": "Esophageal Motility Disorders", "id": "5f69fc3d-6697-41fa-9004-3365de4b72fd", "choice_type": "single"} {"question": "Hilton method is best used in", "exp": "Answer- B. Axillary abscessHilton's method of abscess drainage is chosen when there are plenty of impoant structures like nerves and yessels around the abscess caity, like axilla. In this method incision is made only through the skin and subcutaneous tissue. The deep fascia is not incised.", "cop": 2, "opa": "Breast abscess", "opb": "Axillary abscess", "opc": "Paronychia", "opd": "Pulp abscess", "subject_name": "Surgery", "topic_name": null, "id": "50ac8807-5905-46c3-aadb-3035a925d59c", "choice_type": "single"} {"question": "The surgery for hyperophic pyloric stenosis of infancy is", "exp": "After laparotomy hyperophied muscle is cut along the whole length adequately until mucosa bulges out, then pyloromyotomy is done. in Heller&;s operation muscle of the cardiac are cut to allow passage of food ,and is done in achalasia cardia Truncal vagotomyis done by denervating the main branch which is supply in pylorus as in cases like peptic ulcerarltion Delorme&;s operation is done for repairing a external rectal prolapse Reference: SRB 5th edition page no. 821 & internet", "cop": 1, "opa": "Ramstedt's operation", "opb": "Truncal vagotomy", "opc": "Heller's operation", "opd": "Delorme's operataion", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "0ca68dd1-02ec-4201-bf11-a02b25742c7b", "choice_type": "single"} {"question": "In testicular tumours", "exp": "(Maldescent of testis leads to malignancy) (1411-LB) (1385-B & L 25th)Tumours of the Testes* About 99% of testicular neoplasm are malignant and although they make up only about 1 -2% of malignant tumours (MC tumours in young males)* **Maldescent undoubtedly predisposes to malignancy.* Tumours of testis = Seminoma (40%) Teratoma (32%) combined (14%) interstitial tumours (1.5%) lymphoma (71%).* Malignant teratoma intermediate teratocarcinoma is the most common histologic variants of teratoma.* Clinical features(i) First noticing that he has a testicular lump. A sensation of heaviness.(ii) Only 30% of patients experience pain (Normally painless)(iii) There is a history of trauma to the affected side in over 10%(iv) 10% of patients have lax secondary hydroceleEssentials of Diagnosis (1070-CSDT 11th)* Painless firm mass within the testicle in a man aged 18-40* Elevated serum levels of the beta subunit of(i) Human chorionic gonadotropin (P-hCG) (ii) Alpha fetoprotein (AFP) (iii) Lactic dehydrogenase (LDH) or all three* Enlarged retroperitoneal nodes on abdominal CT scan* Palpable abdominal mass in advanced cases.", "cop": 2, "opa": "Only 10% are malignant", "opb": "Maldescent of testes leads to malignancy", "opc": "Extremely painful", "opd": "Excoriation of the superficial skin", "subject_name": "Surgery", "topic_name": "Testis & Scrotum", "id": "050bf53f-7568-4a4f-a381-e8c7c1d36222", "choice_type": "single"} {"question": "Confirmation of appendicitis", "exp": "The classical features of acute appendicitis begin with poorly localised colicky abdominal pain.Central abdominal pain is associated with anorexia, nausea and usually one or two episodes of vomiting that follow the onset of pain (Murphy). Anorexia is a useful and constant clinical feature, paicularly in children. The patient often gives a history of similar discomfo that settled spontaneously. Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1207,1208", "cop": 1, "opa": "Clinical examination", "opb": "USG abdomen", "opc": "X-ray abdomen", "opd": "Raised TLC\\/DLC", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "d6cb4741-0918-4056-9783-976d80ae9124", "choice_type": "single"} {"question": "Clostridium difficile infection risk increases on use of", "exp": "Ciprofloxacin increases risk of C.difficile enterocolitis.Metronidazole, vancomycin, teicoplanin are effective agaist C. difficile in cases of pseudomembranous colitis.Ref: Bailey and Love 27e pg: 56", "cop": 1, "opa": "Ciprofloxacin", "opb": "Metronidazole", "opc": "Vancomycin", "opd": "Teicoplanin", "subject_name": "Surgery", "topic_name": "General surgery", "id": "6f689c7c-b534-4124-8f42-936651956945", "choice_type": "single"} {"question": "Posterior communicating aery arises from", "exp": "Internal carotid Internal carotid aery has five main branches to the brain: anterior cerebral, middle cerebral, ophthalmic, anterior choroidal and posterior communicating aery.", "cop": 1, "opa": "Internal carotid", "opb": "Middle cerebral", "opc": "Basilar", "opd": "Posterior cerebral", "subject_name": "Surgery", "topic_name": null, "id": "7dc1097d-c6a6-425a-aedf-eb8027333bf3", "choice_type": "single"} {"question": "Lumbar sympathectomy is of value in the management of", "exp": ". Ans: b (Distal ischemia affecting the skin of toes) (Ref. Textbook of surgery by S. Das-3rd ) - Indications for sympathectomy: 1. Circulatory insufficiency of the limbs (Limb warms, pain reduces and ulcers may show signs of regression) o Atherosclerosis (with rest pain, impending gangrene of toes) o Raynaud's Syndrome (temporary relief) o Buerger's disease 2. Hyperhidrosis 3. Causalgia", "cop": 2, "opa": "Intermittent claudication", "opb": "Distal ischaemia affecting the skin of the toes", "opc": "Aeriovenous Fistula", "opd": "Back pain", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "aaaa9c5e-f605-4fd0-a334-0490793889fd", "choice_type": "single"} {"question": "Open fracture is treated by", "exp": "C i.e. Debridement", "cop": 3, "opa": "Tourniquet", "opb": "Internal fixation", "opc": "Debridement", "opd": "External fixation", "subject_name": "Surgery", "topic_name": null, "id": "d6e7e1a0-3b5f-4fa5-9c0b-d808251774b1", "choice_type": "single"} {"question": "Mark the Nerve (Arrow) to be identified during surgeryr of overlying organ", "exp": "Recurrent laryngeal (Identified during Thyroid surgery)", "cop": 4, "opa": "Superior laryngeal", "opb": "External laryngeal", "opc": "Internal laryngeal", "opd": "Recurrent laryngeal", "subject_name": "Surgery", "topic_name": "Surgical Approaches to the Thyroid", "id": "30a0c2a4-4f4b-41c6-9f9f-2876b064d6ad", "choice_type": "single"} {"question": "management of an open wound seen 12 hours after the injury", "exp": null, "cop": 2, "opa": "suturing", "opb": "debridement and suturing", "opc": "secondary suturing", "opd": "heal by granulation", "subject_name": "Surgery", "topic_name": null, "id": "78e3fc58-de0a-4e58-8697-09a9b4f5fab4", "choice_type": "single"} {"question": ". Hirschprung's disease is treated by", "exp": null, "cop": 2, "opa": "Colostomy", "opb": "Excision of aganglionic segment", "opc": "Colectomy", "opd": "Sodium chloride wash", "subject_name": "Surgery", "topic_name": null, "id": "b9fe9d49-2684-4791-a6f0-ccf00814c0ff", "choice_type": "single"} {"question": "\"Cobblestone\" appearance seen on colonoscope is cheracteristic of the following disease", "exp": ".in crohn&;s disease,Fibrosis, stricture formation, deep ulcers, oedema of mucosa between ulcer areas which looks like 'cobble stone', skipped normal areas in between, serosal opacity, mesen-teric fat stranding, enlarged mesenteric lymph nodes, abscesses in the mesentery, fistula are the pathology. Small mucosal aphthous ulcers are earliest gross feature. ref:SRB&;s manual of surgery,ed 3,pg no 800", "cop": 1, "opa": "Crohn's disease", "opb": "Ulcerative colitis", "opc": "TB colitis", "opd": "Irritable bowel syndrome", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "a1788ea7-2f01-438e-bfea-58ce508c9e9d", "choice_type": "single"} {"question": "Most common location of anorectal fistula", "exp": "Park classification of anorectal fistula is\nType 1. Intersphincteric - most common\nType 2. Transsphincteric\nType 3. Suprasphincteric\nType 4. Extrasphincteric", "cop": 1, "opa": "Intersphincteric", "opb": "Transsphincteric", "opc": "Suprasphincteric", "opd": "Extrasphincteric", "subject_name": "Surgery", "topic_name": null, "id": "258fdce4-757e-40f1-b423-49f8b6580ef0", "choice_type": "single"} {"question": "Ureteric colic due to stone is caused by", "exp": "(Increased peristalsis of the ureter to overcome obstruction) (31-Smith Urology 17th,1274-Baily & Love 25th)The severity and colicky nature of ureteric colic pain are caused by the hyper peristalsis and spasm of smooth muscles of the ureter as it attempts to rid itself of a foreign body or to overcome obstruction (smith urology 17th)Pain from acute obstruction of ureter(Stone or Blood clot)|| |Back Pain Severe colicky painThis results from capsular distensionThis results from renal, pelvic and ureteral muscle spasm. The severity and colicky pain are caused by the hyperperistalsis and spasm of this smooth muscle organ (Ureter) as it attempts to rid itself of a foreign body or to overcome obstruction* Pain classically radiates from costovertebral angle down towards the lower anterior abdominal quadrant* In Men - It may also be felt in the bladder, scrotum or testicle* In women - it may also be felt in the vulvaLocation of Ureteric Pain Stone in upper ureter - Pain radiates to testicles (T11T12) Nerve supply of testicles is similar to that of kidney & upper ureter Stone in the midportion of ureter(i) Right side - Pain referred to Me Burney's point and stimulates appendicitis (T12L1)(ii) Left side - Pain referred to left lower quadrant and stimulates diverticulitis or other disease of the descending or sigmoid colon (T12-L1) Stone in the lower portion(i) Proximal to orifice - Pain is referred to inner side of thigh or groin (L1 L2)(ii) At the level of orifice or orifice involved due to edema symptoms of vesical irritability such as frequency and urgency may occur* Ureteric peristalsis is due to intact supply of - Intrinsic smooth muscle pacemaker activity of renal calyces**** The narrowest part of ureter is at the - uretero-vesical junction*** Highest incidence of ureteric injury in- Wertheim's hysterectomyUreteric Constriction - Sitesi. Ureteropelvic junctionii. Crossing of the iliac arteryiii. Juxta position of the vas deferens or broad ligamentiv. Uretero vesical junctionv. Ureteric orifice* Phosphate stones (Staghorn calculi)Excess alkali consumption, Alkali urine*Infection with urease splitting organism eg Proteus, kleibsella, Pseudomonas* Cystine stoneForm in acidic urine*, Extremely hard stone,Relatively resistant to fragmentation with ESWL**The most sensitive imaging modality for diagnosis ureteric stone in a patient with acute colic is - Non contrastCT scan of the abdomenArterial supply of ureter are as follows(a) upper end(b) Middle portion(c) PelvisRenal arteryTesticular or ovarian arterySuperior vesical artery", "cop": 2, "opa": "Stretching of renal capsule due to back pressure", "opb": "Increased peristalsis of ureter to overcome the obstruction", "opc": "Irritation of intramural ureter", "opd": "Extravasation of urine", "subject_name": "Surgery", "topic_name": "Kidney & Ureturs", "id": "aa7b8308-458d-46c2-9a84-a29e1e3674bf", "choice_type": "single"} {"question": "Dry socket", "exp": null, "cop": 1, "opa": "Results from loss of blood clot in the socket", "opb": "Is treated with reinducing bleeding into the socket", "opc": "Is a form of osteomyelitis", "opd": "Is common in extraction of anterior teeth", "subject_name": "Surgery", "topic_name": null, "id": "d4d5e104-8e0e-4c7b-ba6f-448f298dee33", "choice_type": "single"} {"question": "Adson test used for determining vascular sufficiency is useful in", "exp": "SRB Manual of Surgery 4th edition, Pg 458 Adson's test :\nThe hand is raised above after feeling the radial pulse.\nThe patient is asked to take a deep breath and turn the same side. Any change in pulse, i.e. either becoming feeble or absent is noted. Adson's test is done in case of the Cervical rib. \nIt is not useful in varicose veins, PVD or AV fistula.", "cop": 2, "opa": "Peripheral vascular disease", "opb": "Cervical rib", "opc": "Varicose veins", "opd": "AV fistula", "subject_name": "Surgery", "topic_name": null, "id": "79a221c2-354c-412b-8eaa-b390a15b062c", "choice_type": "single"} {"question": "Ainhum is seen in", "exp": "Ainhum : is a condition usually affecting Negro males (but some females) who have run barefoot in child hood.\nClinical Features : A fissure appears at interphalangeal joint of toe -usually the fifth. This fissure becomes a fibrous band, encircles the digit and causes necrosis.", "cop": 3, "opa": "Base of great toe", "opb": "Base of fingers tips", "opc": "Base of toe", "opd": "Ankle", "subject_name": "Surgery", "topic_name": null, "id": "7a2d1f2d-b63e-4a96-95ba-40f16a35718e", "choice_type": "single"} {"question": "Most common cause of hypovolemic hyponatremia in hospitalized patient is", "exp": "(B) Diuretics induced > Hypervolemic hyponatremia cirrhosis congestive heart failure nephrotic syndrome massive edema of any cause> Euvolemic hyponatremia states of severe pain or nausea in the setting of trauma or other damage to the brain SIADH (and its many causes)Hypovolemic hyponatremia any cause of hypovolemia such as prolonged vomiting, decreased oral intake, severe diarrhea diuretic use (due to the diuretic causing a volume depleted state and thence ADH release, and not a direct result of diuretic-induced urine sodium loss)", "cop": 2, "opa": "IV fluids", "opb": "Diuretics induced", "opc": "Severe pain", "opd": "Congestive heart failure", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "583363fc-d3fc-4ba6-a632-ff3c5aa47ce7", "choice_type": "single"} {"question": "For a 8 year old child with TMJ ankylosis, the treatment of choice is", "exp": null, "cop": 3, "opa": "Gap arthroplasty", "opb": "Condylectomy", "opc": "Gap arthroplasty with costochondral grafting", "opd": "Treatment not required", "subject_name": "Surgery", "topic_name": null, "id": "3b5a9738-271e-46f3-bf9c-c8578fd9db4e", "choice_type": "single"} {"question": "Linguine sign is Seen in", "exp": "It is a sign seen in intracapsular rupture of breast implant on MRI.", "cop": 4, "opa": "Duct ectasia", "opb": "Duct papilloma", "opc": "Breast carcinoma", "opd": "Rupture of breast implant", "subject_name": "Surgery", "topic_name": null, "id": "27182e42-9c4c-4e18-94ff-12106aa8ddd6", "choice_type": "single"} {"question": "Complication of fracture scaphoid is", "exp": "D i.e. Avoscular", "cop": 4, "opa": "Avascular necrosis of distal pa", "opb": "Injury to radial aery", "opc": "Injury to radial nerve", "opd": "Avascular necrosis of proximal pa", "subject_name": "Surgery", "topic_name": null, "id": "f9956412-b4a1-47fc-b742-b85177405d62", "choice_type": "single"} {"question": "Content of staghorn calculus is", "exp": "Ans. is 'a' i.e., Phosphate Types of renal calculusOxalate calculus (calcium oxalate)* Oxalate stones are irregular in shape and covered with sharp projections, which tend to cause bleeding.* The surface of the calculus is discoloured by altered blood. A calcium oxalate monohydrate stone is hard and radiodense.Phosphate calculus* A phosphate calculus is smooth and dirty white.* It tends to grow in alkaline urine, especially when urea-splitting Proteus organisms are present. As a result, the calculus may enlarge to fill most of the collecting system, forming a staghorn calculus.* Even a very large staghorn calculus may be clinically silent for years until it signals its presence by haematuria, urinary infection or renal failure.* Because they are large, phosphate calculi are usually easy to see on radiographic films.Uric acid and urate calculi* These are hard, smooth and often multiple.* They vary from yellow to reddish brown and sometimes have an attractive, multi- faceted appearance.* Pure uric acid stones are radiolucent and appear on an excretion urogram as a filling defect, which can be mistaken for a transitional tumour of the upper urinary tract.* The presence of uric acid stones is confirmed by CT. Most uric acid stones contain some calcium, so they cast a faint radiological shadow.* In children, mixed stones of ammonium and sodium urate are sometimes found. They are yellow, soft and friable. They are radiolucent unless they are contaminated with calcium salts.Cystine calculus* These uncommon stones appear in the urinary tract of patients with a congenital error of metabolism that leads to cystinuria.* Hexagonal, translucent, white crystals of cystine appear only in acid urine. They are often multiple and may grow to form a cast of the collecting system.* Pink or yellow when first removed, they change to a greenish colour when exposed to air.* Cystine stones are radioopaque because they contain sulphur, and they are very hard.Xanthine calculus* These are extremely rare. They are smooth and round, brick-red in colour, and show lamellation on cross-section. These stones are radiolucent.", "cop": 1, "opa": "Phosphate", "opb": "Urate", "opc": "Cystine", "opd": "Xanthine", "subject_name": "Surgery", "topic_name": "Kidney & Ureturs", "id": "a8658e3f-ab97-4651-8ad2-7489b2bec887", "choice_type": "single"} {"question": "Graft Survival in first 48 hours depends on", "exp": "Ans. is 'a' ie. Plasma imbibition (Ref. Sabiston, 18/e p2135 (17/e p2185); Schwartz 9/e p165))\" Skin grafts to survive in the recipient bed, have to become revascularized. This takes place in three distinct phases\":Imbibition: refers to absorption of nutrients into the graft, which serves to feed the graft for the first 24 to 48 hrs.Inosculation: is the process whereby donor and recipient capillaries become aligned. During the first two phases, the graft becomes adhered to the recipient bed by fibrous deposition at the interface.Revascularization : is completed by differentiation of the connecting vessels into arterioles and venules.", "cop": 1, "opa": "Plasma imbibition", "opb": "Ingrowth of capillaries in donor tissue", "opc": "Amount of Saline in graft", "opd": "Connection between donor and recipient capillaries.", "subject_name": "Surgery", "topic_name": "Reconstructive Techniques", "id": "e510937d-9aad-42d9-a103-bab2467acbc9", "choice_type": "single"} {"question": "Metastasis in thyroid gland come most commonly from carcinoma of", "exp": "The above-mentioned book is solely dedicated to surgery and diseases of thyroid & parathyroid gland.\n\nIt writes -\n\"Metastatic disease to the thyroid may occur as a consequence of direct extension from upper aerodigestive malignancies, i.e., squamous cell Ca, or by hematogenous spread. Evidence at autopsy has demonstrated upto 20% of patients exhibiting distant metastasis to the thyroid gland from breast, lung, kidney, & melanoma skin most commonly.\"", "cop": 3, "opa": "Testis", "opb": "Prostate", "opc": "Breast", "opd": "Lungs", "subject_name": "Surgery", "topic_name": null, "id": "fbc41a24-740b-4266-8a82-3be0d54e66ff", "choice_type": "single"} {"question": "After the first postoperative year of cardiac transplantation, the most common cause of death is", "exp": "Chronic graft rejection is manifested in cardiac allografts as chronic vascular rejection of main and intramuscular coronary arteries. Myointimal proliferation and medial scarring result in diffuse and eccentric arterial narrowing referred to as accelerated graft atherosclerosis. Infection remains the primary cause of death within the first year of cardiac transplant, but accelerated graft arteriosclerosis is the most common cause of mortality thereafter. Percutaneous transluminal coronary angioplasty, coronary artery bypass grafting, and re-transplantation are the current options for combating this problem.", "cop": 3, "opa": "Infection", "opb": "Arrhythmia", "opc": "Accelerated graft arteriosclerosis", "opd": "Acute rejection episode", "subject_name": "Surgery", "topic_name": "Transplantation", "id": "241d2385-b917-4893-a7d9-7dad39f89f9b", "choice_type": "single"} {"question": "Harder stone with less satisfactory result in ESWL is", "exp": "Ans. (d) Cystine StonesRef Bailey and Love 27th Edition, Page 1408Extra Corporeal Shock Wave Lithotripsy:* Shock waves generated and focused on the stones.* Methods of Shock Wave Generation:# Spark Gap# Electromagnetic# Piezo Electric# Micro Expulsive* Cardiac arrhythmias can happen in cases of Spark Gap generated waves* ESWL is indicated for stones upto 1.5cm in kidney* Prophylactic antibiotics are advised.* Relatively resistant stone is CYSTINE due to its hardness.* Contraindications: Pregnancy and Oral Anticoagulant drug consuming patients* Steinstrasse - Stone street is collection of stone fragments in distal ureter after breaking by ESWL.", "cop": 4, "opa": "Oxalate", "opb": "Phosphate", "opc": "Urate", "opd": "Cystine stones", "subject_name": "Surgery", "topic_name": "Kidney & Ureturs", "id": "6f980bf7-81fd-4e4d-98f8-c7123e6f0e37", "choice_type": "single"} {"question": "Characteristic of H. Pylori is", "exp": "Normal duodenum cannot harbour H pylori, duodenum with gastric metaplasia can very well get infected by H pylori which explains why it is involved in duodenal ulcer. It is a gram-negative spiral like flagellated organism, it is most common cause of duodenal ulcer (95%), triple regime including clarithromycin - metronidazole - omeprazole is used for its treatment Reference SRB edition :5 page : 819, 820", "cop": 1, "opa": "Doesn't affect normal duodenal mucosa", "opb": "Impoant cause for gastric ulcer", "opc": "Protozoa", "opd": "Antibiotics not useful", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "4903c496-9b19-4a1d-9f21-39a3bf10730d", "choice_type": "single"} {"question": "Margin of normal tissue margin taken in excision of melanoma", "exp": "For in situ melanoma a wide excision of 5 mm is sufficient; for melanoma <1 mm deep, a 1 cm margin is sufficient; and for deeper lesions, a 2 cm only margin is recommended, as there is no evidence that wider margins make a difference.Ref: Bailey and Love, 27e, page: 611", "cop": 1, "opa": "2cm", "opb": "3cm", "opc": "4cm", "opd": "5cm", "subject_name": "Surgery", "topic_name": "General surgery", "id": "e320c533-2843-490e-9412-b9736d86b1e1", "choice_type": "single"} {"question": "The blood product of choice for treatment of hemophilics is", "exp": null, "cop": 2, "opa": "Fresh blood", "opb": "Cryoprecipitate", "opc": "Fresh frozen plasma", "opd": "Plasma", "subject_name": "Surgery", "topic_name": null, "id": "4288a22a-3e6f-4938-933d-13f3147019a3", "choice_type": "single"} {"question": "Most common testicular tumor in Pre pubertal age", "exp": "Yolk sac tumors are most commonly found in pre pubertal age group.", "cop": 4, "opa": "Seminomas", "opb": "Sertoli cell tumors", "opc": "Leydig cell tumors", "opd": "Yolk sac tumors", "subject_name": "Surgery", "topic_name": null, "id": "61a02c20-93d7-4c73-b9db-784e4ecd1097", "choice_type": "single"} {"question": "Poor prognostic indicator of Pott's paraplegia", "exp": "Ans. is 'c' i.e., Healed disease Prognosis of Pott's paraplegia Good Poor Degree Paial (only sensory or motor) Complete paraplegia (grade IV) Duration Shoer Longer (> 12 months) Type Early (acute) onset Late (chronic) onset Speed of onset Slow (insidious) Rapid (sudden) Age Younger Old General condition Good Poor Veebral disease Active Healed Kyphotic deformity < 600 > 60deg Cord on MRI Normal Myelomalacia or syringomyelia Preoperative Wet lesion Dry lesion", "cop": 3, "opa": "Early onset", "opb": "Active disease", "opc": "Healed disease", "opd": "Wet lesion", "subject_name": "Surgery", "topic_name": null, "id": "1544dd2d-cc15-4352-9bb3-002524216a59", "choice_type": "single"} {"question": "Bariatric surgical procedures include", "exp": "Treatment for Obesity includes * Dieting. * Exercise.and also the various modalities of surgery indicated is the following, * Veical banded gastroplasty. * Gastric bypass. * Laparoscopic gastroplasty or gastric bypass. * Jaw wiring. * Biliopancreatic diversion. * Jejuno-ileal bypass ref: SRB&;s manual of surgery, ed 3, pg no 90", "cop": 4, "opa": "Gastric Banding", "opb": "Gastric Bypass", "opc": "Biliopancreatic diversion", "opd": "Ileal Transposition", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "ae9e7059-d561-4b9f-a9f3-dfc9255ee7f0", "choice_type": "single"} {"question": "Tibial Fracture with > 1 cm wound, slight comminution and moderate crushing is", "exp": "B i.e. Grade II", "cop": 2, "opa": "Grade I", "opb": "Grade II", "opc": "Grade III A", "opd": "Grade III B", "subject_name": "Surgery", "topic_name": null, "id": "13957168-98d7-4309-9d4f-bc01e07f696c", "choice_type": "single"} {"question": "In newborn the most common cause of intestinal obstruction is", "exp": null, "cop": 3, "opa": "Annular pancreas", "opb": "Esophageal atresia", "opc": "Duodenal atresia", "opd": "Jejunal atresia", "subject_name": "Surgery", "topic_name": null, "id": "1417033f-fe69-46b1-9cce-c386d49b4eaa", "choice_type": "single"} {"question": "The gold standard for diagnosing acid reflux is", "exp": "The gold standard for diagnosing and quantifying acid reflux is the 24-hour pH test.Sabiston 20th edition Pg: 1070", "cop": 2, "opa": "Endoscopy", "opb": "24-hour pH monitoring", "opc": "Manometry", "opd": "Esophagogram", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "3c090ee2-4550-4033-8dfd-d1a1b0dd5d35", "choice_type": "single"} {"question": "Abdominal pain, fever and jaundice. This triad is known as;", "exp": "- Charcot's triad - abdominal pain + jaundice + fever. - Seen in Cholangitis. - For cholangitis to occur, the 2 essential factors are obstruction & infection. Predisposing factors for cholangitis: CBD stones (M.C) Stricture Cholangiocarcinoma Choledochal cyst Worms M.C organism responsible for CBD is E. coli > Klebsiella. M.C symptom - fever + chills. Inadequate treatment causes Reynold's pentad - Charcot's triad + shock + mental status changes.", "cop": 1, "opa": "Charcot's triad", "opb": "Saint's triad", "opc": "Virchow triad", "opd": "Renault's triad", "subject_name": "Surgery", "topic_name": "FMGE 2019", "id": "2f9aa54c-6a95-4a7e-9e52-e4b6b6f0e3ca", "choice_type": "single"} {"question": "Masaoka staging is used in", "exp": "The staging system for thymoma was developed by Masaoka and colleagues. It is an anatomic system in which the stage is increased on the basis of the degree of invasiveness. Diagnostic criteriaIMasaoka Staging System for ThymomasStageMacroscopiccriteriamicroscopically completely encapsulated; noinvasion through capsuleIIIIAMicroscopic invasion outside the capsuleIIBMacroscopic invasion into surrounding fat or grossly adherent to pleura or pericardiumIIIIIIAMacroscopic invasion into neighboring organs, pericardium, or pleura but not great vesselsIIIBMacroscopic invasion into neighboring organs that includesgreat vesselsIVIVAPleural or pericardial disseminationIVBLymphatic or hematogenous metastasesRef: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 123e Thymoma; Page no: 123e-1", "cop": 3, "opa": "RCC", "opb": "HCC", "opc": "Thymoma", "opd": "Lymphoma", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "4aa0b052-4c26-4695-8126-f948e663c60e", "choice_type": "single"} {"question": "Most common site for salivary gland tumors is", "exp": "The parotid gland is the most common site for salivary tumors. Most commonly seen in the superficial lobe of parotid gland.", "cop": 2, "opa": "Submandibular gland", "opb": "Parotid", "opc": "Minor salivary gland", "opd": "Sublingual gland", "subject_name": "Surgery", "topic_name": null, "id": "b33a173d-a0e1-488b-9f4c-608619b3222a", "choice_type": "single"} {"question": "Most common abdominal tumor in children is", "exp": "MCC of abdominal tumor in children is neuroblastoma. It crosses midline\n2nd MCC of abdominal tumor in children is wilms tumor it doesnt cross midline", "cop": 2, "opa": "Neuroblastoma", "opb": "Wilms tumor", "opc": "RCC", "opd": "Teratoma", "subject_name": "Surgery", "topic_name": null, "id": "2a5f3578-5666-4aeb-a95d-7a812da66778", "choice_type": "single"} {"question": "Trastuzumab is directed against", "exp": "Trastuzumab is a humanized monoclonal antibody directed against the extracellular domain of the (human epidermal growth factor receptor -2) HER-2 surface receptor and is effective treatment for HER-2-positive breast cancer Ref: Sabiston 20e, page: 840", "cop": 1, "opa": "Human epidermal growth factor receptor 2", "opb": "Vascular endothelial growth factor A", "opc": "Platelet derived growth factor", "opd": "Fibroblast growth factor 23", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "7766a8df-6025-46a3-b03e-5dac0f606135", "choice_type": "single"} {"question": "Pseudopolyps are common with", "exp": "Ans. (a) Ulcerative colitisRef: Sabiston 20th edition, Page 1260* Pseudo polyps are uninvolved areas in colon in ulcerative colitis.* If cancer arises in ulcerative colitis it arises from intervening areas of pseudo polyps.", "cop": 1, "opa": "Ulcerative colitis", "opb": "Crohn's disease", "opc": "CA colon", "opd": "Diverticulosis", "subject_name": "Surgery", "topic_name": "Small & Large Intestine", "id": "940f1ab2-8eb4-41cf-a4b6-f2d642baef26", "choice_type": "single"} {"question": "Oblique view is required to diagnose fracture of", "exp": "B i.e. Scaphoid", "cop": 2, "opa": "Capitate", "opb": "Scaphoid", "opc": "Navicular", "opd": "Hamate", "subject_name": "Surgery", "topic_name": null, "id": "30418d29-b25b-4b44-977b-ed8b301ac2d0", "choice_type": "single"} {"question": "Most common site of development of carcinoma of prostate is", "exp": "For BPH - transitional zone is most commonly involved\nFor carcinomma - peripheral zone is most commonly involved.", "cop": 3, "opa": "Central zone", "opb": "Transitional zone", "opc": "Peripheral zone", "opd": "B + C", "subject_name": "Surgery", "topic_name": null, "id": "29007f1e-7ba4-40b6-8491-bec42cda36e5", "choice_type": "single"} {"question": "Gases for Pneumoperitoneum", "exp": "CO2 is commonly used to create pneumoperitoneum as it is readily available, is cheaper, suppresses the combustion, is easily absorbed by tissues, has a high diffusion coefficient \u0002and is quickly released respiration. Other gases used are: Air, nitrous oxide, helium, argon. Reference : page 1183 SRB's manual of surgery 5th edition", "cop": 1, "opa": "CO2", "opb": "N2", "opc": "O2", "opd": "Room air", "subject_name": "Surgery", "topic_name": "Urology", "id": "d48d3d46-2847-44e3-a682-e906167ccf26", "choice_type": "single"} {"question": "Amputated digits are preserved in", "exp": "The amputated digits are cleansed under saline solution, wrapped in saline moistened gauze, and placed in a plastic bag The plastic bag containing the pa is then placed on (not packed in) a bed of ice in a suitable container The amputated pa should never be immersed in Non-physiological solution such as antiseptics or alcohol Ref: Sabiston 20th edition Pgno :1996", "cop": 3, "opa": "Cold saline", "opb": "Cold ringer lactate", "opc": "Plastic bag in ice", "opd": "Deep freezer", "subject_name": "Surgery", "topic_name": "General surgery", "id": "8eae80be-5b6d-4dd9-9061-f64d188bc1a7", "choice_type": "single"} {"question": "Ethyl alcohol is effective (against spores)", "exp": null, "cop": 1, "opa": "70%", "opb": "60%", "opc": "50%", "opd": "100%", "subject_name": "Surgery", "topic_name": null, "id": "ef80c0fe-0e65-4788-88dc-d7c24e1cbd55", "choice_type": "single"} {"question": "Screening of prostate CA is best done by", "exp": "DRE + PSA is the best way to screen prostate Ca.", "cop": 4, "opa": "PET CT", "opb": "PSA", "opc": "DRE", "opd": "DRE + PSA", "subject_name": "Surgery", "topic_name": null, "id": "a10693df-0fee-42d5-865f-edae530fd097", "choice_type": "single"} {"question": "Commonly seen Pancreatic endocrinal tumour", "exp": "Insulinoma Definition This is an insulin-producing tumour of the pancreas causing the clinical scenario know as Whipple's triad, i.e. symptoms of hypoglycaemia after fasting or exercise, plasma glucose levels <2.8 mmol/L and relief of symptoms on intravenous adminis- tration of glucose. Incidence Insulinomas are the most frequent of all the functioning PETs with a repoed incidence of 2-4 cases per million population per year. Insulinomas have been diagnosed in all age groups, with the highest incidence found in the fouh to the sixth decades. Women seem to be slightly more frequently affected. Pathology The aetiology and pathogenesis of insulinomas are unknown. No risk factors have been associated with these tumours. Viually all insulinomas are located in the pancreas and tumours are equally distributed within the gland. Approximately 90% are solitary and about 10% are multiple and associated with MEN 1 syndrome. Prognosis and predictive factors No markers are available that reliably predict the biological behaviour of an insulinoma. Approximately 10% are malignant. Insulinomas of <2 cm in diameter without signs of vascular invasion or metastases are considered benign. Clinical features Insulinomas are characterised by fasting hypoglycaemia and neuroglycopenic symptoms. The episodic nature of the hypoglycaemic attacks is caused by intermittent insulin secretion by the tumour. This leads to central nervous system symptoms such as diplopia, blurred vision, confusion, abnormal behaviour and amnesia. Some patients develop loss of consciousness and coma. The release of catecholamines produces symptoms such as sweating, weakness, hunger, tremor, nausea, anxiety and palpitations. Biochemical diagnosis A fasting test that may last for up to 72 hours is regarded as the most sensitive test. Usually, insulin, proinsulin, C- peptide and blood glucose are measured in 1- to 2-hour intervals to demonstrate inappropriately high secretion of insulin in relation to blood glucose. About 80% of insulinomas are diagnosed by this test, most of them in the first 24 hours. Elevated C-peptide levels demonstrate the endogenous secretion of insulin and exclude factitious hypoglycaemia caused by insulin injection. Ref: Bailey and love 27th edition Pgno : 849", "cop": 1, "opa": "Insulinoma", "opb": "Somatostatinoma", "opc": "Gastrinoma", "opd": "Glucagonoma", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "9e273e13-68d8-4db6-9179-44e2b17c5248", "choice_type": "single"} {"question": "Contrast media used in ultrasound is", "exp": "D. i.e. (Echovist) (39- 42 - Textbook of colour Doppler Imaging S.K. Bhargava)* Iohexol used in Myelography*** Contrast agent (ECHOVIST) have been used to evaluate tubal potency in infertility and ureteric reflux in children with renal tract infectionsContrast agents in Ultrasound* Contrast agents increases shift frequency and echo strength determines the visualization hence act as echoenhancers* Echo- enhancers are microbubbles - levovist, optisan, sonovue* Range of ultrasound frequencies that are used for clinical diagnosis microbubbles at(1 - 7 m diameter) do not diffuse across the endothelium", "cop": 4, "opa": "Ultraffin", "opb": "Hexanol", "opc": "Urograffin", "opd": "Echovist", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "314a10c5-adb5-4cdd-9d5f-211ab7513231", "choice_type": "single"} {"question": "The most common location of hypeensive intracranial haemorrhage is", "exp": "Most common locations of hypeensive intraparenchymal hemorrhage are basal ganglia (especially the putamen) thalamus cerebellum pos It usually results from spontaneous rupture of small penetrating aery deep in the brain. Ref : Harrison, 17/e p2531", "cop": 3, "opa": "Subarachnoid space", "opb": "Cerebellum", "opc": "Basal ganglia", "opd": "Brain stem", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "453f5d95-7f05-4f29-9385-39e26ea9bf4a", "choice_type": "single"} {"question": "Recurrent dislocation of shoulder occurs, because of", "exp": "C i.e. Crushed glenoid labrum,", "cop": 3, "opa": "Incomplete labrum", "opb": "Superadded secondary infection", "opc": "Crushed glenoidal labrum", "opd": "Weak posterior capsule", "subject_name": "Surgery", "topic_name": null, "id": "7ab03614-81fe-4e81-94cf-d35ba802130b", "choice_type": "single"} {"question": "Empyma is a term given for", "exp": null, "cop": 1, "opa": "Collection of pus in the tissue spaces", "opb": "Collection of blood in the tissue spaces", "opc": "Collection of air in the tissue spaces", "opd": "Collection of serous fluid in the tissue spaces", "subject_name": "Surgery", "topic_name": null, "id": "c3305278-edf6-4f53-8f63-b4bdb217dd1c", "choice_type": "single"} {"question": "Pattern theory of pain control was given by", "exp": null, "cop": 3, "opa": "Von frey", "opb": "Melzack", "opc": "Goldschneider", "opd": "Descartes", "subject_name": "Surgery", "topic_name": null, "id": "f7cffb4d-bfd3-4eb6-89bf-8f7c691005c0", "choice_type": "single"} {"question": "Cerebral perfusion pressure is measured as", "exp": "(A) MAP (mean arterial pressure) - ICP (intracranial pressure)# CEREBRAL PERFUSION PRESSURE, or CPP, is the net pressure gradient causing cerebral blood flow to the brain (brain perfusion).> It must be maintained within narrow limits because too little pressure could cause brain tissue to become ischemic (having inad-Equate blood flow), and too much could raise intracranial pressure (ICP).> Every increase of ICP can cause a change in tissue perfusion and an increase in stroke events.> From resistance: CPP can be defined as the pressure gradient causing cerebral blood flow (CBF) such that CBF = CPP / CVR CBF = CPP/CVRwhere: CVR is cerebrovascular resistanceBy intracranial pressure> An alternative definition of CPP is: CPP = MAP-ICP CPP=MAP-ICPwhere: MAP is mean arterial pressure ICP is intracranial pressure JVP is jugular venous pressure> More specifically, cerebral perfusion pressure can be defined as: CPP = MAP-ICP CPP = MAP - ICP (if ICP is higher than JVP)or CPP = MAP-JVP CPP = MAP - JVP (If JVP is higher than ICP).> Physiologically, increased ICP causes decreased blood perfusion of brain cells by mainly two mechanisms: Increased ICP constitutes an increased interstitial hydrostatic pressure that, in turn, causes a decreased driving force for capillary filtration from intracerebral blood vessels. Increased ICP compresses cerebral arteries, causing increased cerebrovascular resistance (CVR). FLOW Ranging from 20ml 100g-1 min-1 in white matter to 70ml 100g-1 min-1 in grey matter.> Autoregulation: Under normal circumstances a MAP between 60 to 160 mmHg and ICP about 10 mmHg (CPP of 50-150 mmHg) sufficient blood flow can be maintained with autoregulation. Although the classic 'autoregulation curve' suggests that CBF is fully stable between these blood pressure values (known also as the limits of autoregulation), CBF may vary as much as 10% below and above its average within this range. Outside of the limits of autoregulation, raising MAP raises CPP and raising ICP lowers it (this is one reason that increasing ICP in traumatic brain injury is potentially deadly). In trauma some recommend CPP not go below 70 mmHg. Recommendations in children is at least 60 mmHg. Within the autoregulatory range, as CPP falls there is, within seconds, vasodilatation of the cerebral resistance vessels, a fall in cerebrovascular resistance and a rise in cerebral-blood volume (CBV), and therefore CBF will return to baseline value within seconds. These adaptations to rapid changes in blood pressure (in contrast with changes that occur over periods of hours or days) are known as dynamic cerebral autoregulation.", "cop": 1, "opa": "MAP (mean arterial pressure) - ICP (intracranial pressure)", "opb": "ICP (intracranial pressure) - MAP (mean arterial pressure)", "opc": "CPP (cerebral perfusion pressure)/CVR (cerebrovasular resistance)", "opd": "MAP (mean arterial pressure) + JVP (jugular ve nous pressure)", "subject_name": "Surgery", "topic_name": "Nervous System", "id": "eec0d170-d7af-419a-9e93-54c76e2b1671", "choice_type": "single"} {"question": "Most common vessel affected in acute Limb ischaemia is", "exp": "Superficial femoral artery is most commonly affected artery in acute Limb ischaemia.", "cop": 1, "opa": "Superficial femoral artery", "opb": "Iliac artery", "opc": "Popliteal artery", "opd": "Tibial artery", "subject_name": "Surgery", "topic_name": null, "id": "6708c9f1-8812-458d-98a1-531b2639e7f1", "choice_type": "single"} {"question": "Tenesmus occurs in lesions of", "exp": null, "cop": 4, "opa": "Ileum", "opb": "Right side of colon", "opc": "Descending colon", "opd": "Sigmoid colon", "subject_name": "Surgery", "topic_name": null, "id": "a4b1e629-7166-446f-99c5-22997c17bde0", "choice_type": "single"} {"question": "Calculate GCS of 25 old head injury patient with following parameters confused,opening eyes in response to pain ,localising pain response to pain", "exp": "Glasgow coma scale: Eye opening Best verbal response Best motor response Response Score Response Score Response Score Spontaneously 4 Oriented and Converses 5 Obeys commands 6 To verbal stimuli 3 Disoriented and converses 4 Localises pain 5 To pain 2 Inappropriate words 3 Flexion- withdrawal to pain 4 Never 1 Incomprehensible words 2 Abnormal flexion (decoicate rigidity) 3 No response I Abnormal extensive obsturing 2 No response 1 Maximum score is : 15 Minimum score is :03 RE: BAILEY AND LOVE 27TH ED", "cop": 2, "opa": "6", "opb": "11", "opc": "12", "opd": "7", "subject_name": "Surgery", "topic_name": "All India exam", "id": "b390caa1-84cc-46dd-8aeb-8a4e3cfbbb4c", "choice_type": "single"} {"question": "Most common Complication of TIPSS procedure", "exp": "Since systemic blood is shunted toxins ( NH3) travel to brain\ncausing encephalopathy. Hence TIPSS is contra indicated in\nencephalopathy patients.", "cop": 2, "opa": "Heart failure", "opb": "Hepatic Encephalopathy", "opc": "Thrombosis", "opd": "Recurrent Variceal bleed", "subject_name": "Surgery", "topic_name": null, "id": "ccb0fa34-a5f0-4130-a90e-5ad3b9e86baa", "choice_type": "single"} {"question": "Normal cerebral blood flow is", "exp": "Normal cerebral bloodflow (CBF) is about 55 mL per minute for every 100 gramsof brain tissue. Ischaemia results when this rate drops below20 mL per minute, and even lower levels will result in infarctionunless promptly corrected.Flow depends on cerebral perfusion pressure (CPP), the difference between mean aerial pressure (MAP) and intracranial pressure (ICP).CPP (75-105 mmHg) = MAP (90-110 mmHg) - ICP(5-15 mmHg)Bailey and love 27e 328", "cop": 2, "opa": "45 ml/min for every 100gm of brain tissue", "opb": "55 ml/min for every 100gm of brain tissue", "opc": "65 ml/min for every 100gm of brain tissue", "opd": "75 ml/min for every 100gm of brain tissue", "subject_name": "Surgery", "topic_name": "Trauma", "id": "7680d8b8-9f14-4bd0-9883-c1036624f01d", "choice_type": "single"} {"question": "Yellow nodules over palm diagnosis", "exp": "Answer- C. CornA corn is a localized keratosis of the skin. Histologically a corn is composed of keratin masse with intact basal layer.It usually occurs at the sites of frictional pressure on the sole, foot and toes. This often occurs due to ill fitting or tight shoes.Corn is thicker than callosity and causes more cofloent to the patient.", "cop": 3, "opa": "implantation dermoid", "opb": "sebaceous cysts", "opc": "Corn", "opd": "Melanoma", "subject_name": "Surgery", "topic_name": null, "id": "9afb9ac2-c600-4a2f-a3eb-9207491de4d6", "choice_type": "single"} {"question": "Treatment of choice for transverse cell carcinoma in renal pelvis is", "exp": "Upper tract transitional cell carcinoma Accounts for 5-10% of urothelial carcinomas . Often presents late with advanced disease In the absence of metastatic disease, standard treatment is nephroureterectomy ref : Bailey and Love 27th ed , chapter 76 , pg no 1421", "cop": 4, "opa": "Paial nephrectomy", "opb": "Total nephrectomy", "opc": "Radical nephrectomy", "opd": "Radical nephroureterectomy", "subject_name": "Surgery", "topic_name": "Urology", "id": "33e24c6f-7b4f-47b3-81bf-c4eb2c1effa7", "choice_type": "single"} {"question": "High or low fistula in ano is termed according to its internal opening present with reference to", "exp": "Ans. is 'c' i.e. Anorectal ring", "cop": 3, "opa": "Anal canal", "opb": "Dentate line", "opc": "Anorectal ring", "opd": "Sacral promontory", "subject_name": "Surgery", "topic_name": null, "id": "6b1450af-f3a0-40ad-81a1-30317005d3e6", "choice_type": "single"} {"question": "Thoracic outlet syndrome is primarily diagnosed by", "exp": "The initial presentation of thoracic outlet syndrome(eg.,in cervical rib)is dependent on whether the compression is primarily vascular,neurogenic or a combination of both.Vascular thoracic outlet syndrome can involve subclan aery or vein presenting with colour changes of affected upper extremity,claudication,or diffuse pain.Neurogenic syndrome involves brachial plexus presenting as sensory loss,pain or paraesthesia. Reference:Bailey & Love's sho practise of surgery,25th edition,pageno:895.", "cop": 1, "opa": "Clinical Evaluation", "opb": "CT scan", "opc": "MRI", "opd": "Angiography", "subject_name": "Surgery", "topic_name": "Cardio thoracic surgery ", "id": "96d224b2-796f-42ec-8bae-781f7a308f00", "choice_type": "single"} {"question": "Best marker for prediction of coronary aery disease aEUR'", "exp": "LDL/HDL Risk factors for atherosclerosis and cardiovascular complications (Braunwald) Abnormalities in plasma lipoproteins and derangement in lipid metabolism rank as the most firmly established risk factors for atherosclerosis. Adjusted relative risk for future cardiovascular events for selected lipid fractions and lipid rations in decreasing order are given in the following table Relative risk for future Lipid Fractions and lipid Cardiovascular events Ratios cardio * Total chotesterol : HDL Cholestrol Ratio (TC : HDLC) * Apopratein B100: HDL Cholesterol Ratio (APo B100: HDLC) * LDL Cholesterol : HDL Cholesterol Ratio (LDLC: HDLC) * Apoprotein 8100: Apoprotein A -1 (APO B100: APO Al) * Non HDL Cholesterol fraction * Apolipoprotein B -1 Fraction * * HDL cholesterol Fraction * Total cholesterol Fraction Decreasing Predictivity * Apolipoprotein Al Fraction of Risk * LDL cholesterol Fraction", "cop": 1, "opa": "LDIJHDL", "opb": "Serum cholesterol", "opc": "Cholesterol/TG", "opd": "Blood cholesterol", "subject_name": "Surgery", "topic_name": null, "id": "808abce8-ebf6-4ee1-89e2-df257951c0bb", "choice_type": "single"} {"question": "Amyand's hernia is", "exp": null, "cop": 3, "opa": "Content is bowel", "opb": "Content is appendix", "opc": "Content is meckel's diverticulum", "opd": "Content is omentum", "subject_name": "Surgery", "topic_name": null, "id": "f9f240dc-564c-42b9-b3c9-7b66be646ec1", "choice_type": "single"} {"question": "Secondary deposits form prostatic carcinoma is commonest in", "exp": "Secondary deposits form prostatic carcinoma is commonest in boneThe prostate is the most common site of origin for skeletal metastases, followed in turn by the breast, the kidney, the bronchus and the thyroid gland. The bones involved most frequently are the pelvic bones and the lower lumbar veebrae. The femoral head, rib cage and skull are other common sites", "cop": 1, "opa": "Bone", "opb": "Lung", "opc": "Liver", "opd": "Brain", "subject_name": "Surgery", "topic_name": "Urology", "id": "bbbfda64-0a77-4587-b7d3-688e4bfacd8c", "choice_type": "single"} {"question": "During splenectomy in ITP, platelet infusion is given", "exp": "Indications for splenectomy: 1. Relapsed severe cases after treatment with steroids - for 6 weeks 2. Girls attaining menarche 3. ITP persisting even after 6-9 months refractory to treatment 4. In 2nd trimester pregnancy, with platelet count <10000/mm3 and severe bleeding problems 5. Recurrence after stopping/tapering steroids 6. Profound GI bleed and intracranial bleed Surgery * During surgery and in emergency, fresh blood transfusions or platelet transfusions are required. Sometimes the anti-platelet immune response is temporarily blocked by IgG transfusion so to allow the platelet count to rise at the time of surgery or in cases of severe bleeding or in pregnancy. * Accessory spleen should be identified and removed. * In 7 days platelet count raises to more than 100000/ cu mm. * Laparoscopic approach is ideal in elective splenectomy for ITP. Ref: SRB&;s manual of surgery,3 rd ed, pg no 607", "cop": 1, "opa": "Immediately after ligating dplenic vein", "opb": "Immediately after removal of spleen", "opc": "After incision", "opd": "Next day of surgery", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "f24ac128-a66e-4cb1-b5f5-aae24e2e96af", "choice_type": "single"} {"question": "Contraindication of local anaesthesia is", "exp": "(Clotting disorders): Ref: 50. LB (199-B &L 25th)* Contraindication of LA are local infection and clotting disorders, Not only does local infiltration spread the infection, but local anaesthetic drugs are ineffective in condition of acidity as produced by infection. Local infiltration in the presence of a clotting disorder may result in haemorrhage or may produce haematoma, which is potentially fatal in the airway, as may occure in dental surgery.", "cop": 2, "opa": "Diabetes mellitus", "opb": "Clotting disorder", "opc": "Hypertension", "opd": "Renal disease", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "93dd0830-f213-43fa-8807-d4061f813f2f", "choice_type": "single"} {"question": "Shagreen patch is seen in", "exp": "(A) Tuberous sclerosis # TUBEROUS SCLEROSIS is a genetic disorder affecting cellular differentiation and proliferation, which results in hamartoma formation in many organs (eg, skin, brain, eye, kidney, and heart).> Skin lesions (found in 70-80% of cases)> Characteristic lesions are angiofibromas, previously known by a misnomer, adenoma sebaceum.> These are pink or skin-colored telangiectatic papules commonly observed in the nasolabial folds and on the cheeks and chin. They usually appear in children younger than 10 years and increase in size and number until adolescence, remaining unchanged thereafter. Other areas in which they may be observed include in and around nails (ungual fibromas), scalp, and forehead, in the latter location reaching sizes up to several centimeters. In the oral mucosa, they may be observed in the lips, dorsa of tongue, and palate. Dental pitting occurs in about 90% of patients. A hand lens examination aids detection of these pits, which are less obvious in deciduous teeth.> Periungual fibromas (Koenen tumors) are smooth, firm, flesh-colored papules emerging from the nail folds. They can be the only manifestation in some individuals. These are noted around puberty and may increase in frequency as the patient ages.> Shagreen patches Are flesh-colored soft plaques that are frequently found in the lumbosacral area but may occur anywhere on the trunk. Surface may be pebbly (resembling pigskin or untanned leather) with prominent follicular openings. Are usually noticed during the first decade.> White macules Are ovoid, hypopigmented, ash leaf-shaped macules that can be found on the trunks or limbs. White macules offer an excellent opportunity for early diagnosis because they may be found at birth or early infancy. The use of Wood lamp accentuates these macules. Color, even though described as white, lacks the depigmented white appearance of vitiligo. Careful examination is necessary before making any firm diagnosis because hypopigmented macules may be a normal finding in newborn babies. 3 or more white macules at birth should alert the clinician regarding the possibility of tuberous sclerosis. Other skin signs include guttate leukoderma, cafe-au-lait macules, and poliosis.", "cop": 1, "opa": "Tuberous sclerosis", "opb": "Neurofibromatosis", "opc": "Sturge Weber syndrome", "opd": "Neurofibromatosis I", "subject_name": "Surgery", "topic_name": "Nervous System", "id": "ec1350b6-a9d3-4bea-b36e-09bab7190a74", "choice_type": "single"} {"question": "Surgical treatment (ligation or stripping) is preferred for GSV diameter equal to or greater than", "exp": "SAPHENOFEMORAL LIGATION AND GREAT SAPHENOUS STRIPPING An oblique groin incision is made at the level of, and lateral to, the pubic tubercle, ideally above the groin crease. The GSV is identified and dissected to the SFJ, which should be clearly established before the vein is divided to avoid disastrous inadveent transection of the superficial femoral vein. The anatomy is often variable but six GSV tributaries may be encountered close to the SFJ: Laterally: * superficial inferior epigastric vein; * superficial circumflex iliac vein; Medially: * superficial external pudendal vein; * deep external pudendal vein; Distally: * anterior accessory saphenous vein; * posteriomedial thigh vein. Classically, these are ligated distal to their divisions. A flush SFJ ligation is then performed and the GSV retrogradely stripped to around the knee. Phlebectomy is performed as discussed above. Closure of the cribriform fascia, with sutures or synthetic patches over the ligated SFJ, does not reduce groin recurrence. Stripping to the lowest point of reflux may improve results, but at a cost of increased saphenous nerve complications and is not widely performed. More recently, some surgeons argue that surgical trauma and subsequent inflammation in the groin is associated with neovascularisation, which in turn may lead to recurrence. Fuhermore, others hypothesise that it is the loss of the normal groin tributaries that may be responsible for driving the process of neovascularisation. These concepts have led some to believe that ligation of the refluxing vein should be distal to the tributaries and that the junction itself should be left untouched. There is no clear clinical evidence to suppo these hypotheses. Ref: Bailey and love 27th edition Pgno : 981", "cop": 1, "opa": "2 cm", "opb": "3 cm", "opc": "4 cm", "opd": "5 cm", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "1f6153d9-ef00-4003-85dc-29dbe2e9051e", "choice_type": "single"} {"question": "Apa from Escherichia coli, the other most common organism implicated in acute suppurative bacterial peritonitis is", "exp": "Bacteroides are commonly found in peritonitis. These Gram-negative, non-sporing organisms, although predominant in the lower intestine, often escape detection because they are strictly anaerobic and slow to grow on culture media unless there is an adequate carbon dioxide tension in the anaerobic apparatus (Gillespie). In many laboratories, the culture is discarded if there is no growth in 48 hours. These organisms are resistant to penicillin and streptomycin but sensitive to metronidazole, clindamycin, lincomycin and cephalosporin compounds. Since the widespread use of metronidazole (Flagyl), Bacteroides infections have greatly diminished. When bacteria contaminate the peritoneum as a result of spillage from an intra-abdominal viscus.* Infection in secondary bacterial peritonitis is polymicrobial* E. coli and Bacteroides are MC organisms.* The species of organism isolated vary with the source of the initial process and the normal flora present at the site. * Peritonitis is one of the MC complications of CAPDQ, occurring with an incidence of approximately one episode every 1 to 3 years.* Refractory or recurrent peritonitis is MC cause of technical failure of CAPD.* MC organism: Staphylococcus epidermidis (30-50%). Clinical Features* Patients present with abdominal pain, fever, and cloudy peritoneal dialysate containing >100 WBC/mm3, with >50% of the cells being neutrophils.* Gram staining detects organisms only in 10-40% of cases. Treatment* CAPD associated peritonitis is treated by the intraperitoneal administration of antibiotics, usually a first-generation cephalosporin.* Overall, 75% of infections are cured by culture-directed antibiotic therapy.* Recurrent or persistent peritonitis requires removal of the dialysis catheter and resumption of hemodialysis Reference:Bailey & Love's sho practise of surgery,25th edition,page no:992", "cop": 1, "opa": "Becteroides", "opb": "Klebsiella", "opc": "Peptostreptococcus", "opd": "Pseudomonas", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "a455bf66-19ff-461c-97c9-589b1f664832", "choice_type": "single"} {"question": "Duret haemorrhage is/are seen in", "exp": "Duret Hemorrhage In case of increased ICP downward herniation of brainstem occur, which cause stretching of perforators of basilar aery and may result in bleed (Duret hemorrhage) Duret hemorrhage is a small area of bleeding in ventral and paramedian pa of upper brainstem (midbrain and pons). It usually indicates a fatal outcome, however survival has been repoed Diagnosis is made on CT or MRI Ref: Robbins 9th edition Pgno :1255", "cop": 4, "opa": "Conjunctiva", "opb": "Middle ear", "opc": "Encardium of hea", "opd": "Brain", "subject_name": "Surgery", "topic_name": "Trauma", "id": "9ef59458-669d-4ade-92ad-a9b56f18946f", "choice_type": "single"} {"question": "A young patient presents with a massive injury to proximal duodenum, head of pancreas and distal common bile duct. The procedure of choice in this patient should be", "exp": ".whipple&;s operation is done by removing (tumor with) head and neck of pancreas , c loop of duodenum, 40% distal stomach, 10cm proximal jejenum, lower end of common bile duct,gall bladder, peripancreatic,pericholedochal, paraduodenal and perihepatic nodes. continuity is maintained by choledochojejunostomy, pancreaticojejunostomy, and gastrojejunostomy. few advocate pancreaticogastrostomy into posterior wall of stomach. moality in whipple&;s operation is 2-8% (Ref: SRB&;s Manual of Surgery, 5th edition, pg no. 706)", "cop": 2, "opa": "Roux-en-Y anastonmosis", "opb": "Pancreaticoduodenectomy (Whipple's operation)", "opc": "Lateral tube jejunostomy", "opd": "Retrograde jejunostomy", "subject_name": "Surgery", "topic_name": "Trauma", "id": "54314135-ea0d-4f8d-9703-dea8105ab05d", "choice_type": "single"} {"question": "Most common cause of hydronephrosis in children", "exp": "Congenital PUJ obstruction is MCC for hydronephrosis in children.", "cop": 4, "opa": "Ureterocoele", "opb": "Ureteric stricture", "opc": "Watermelon prostate", "opd": "Congenital PUJ obstruction", "subject_name": "Surgery", "topic_name": null, "id": "0c03263c-f2c1-44fb-b4ff-f575c46d4009", "choice_type": "single"} {"question": "Site of IM injection without injuring any vessels or nerves", "exp": "(B) Upper outer quadrant of buttock", "cop": 2, "opa": "Lower part of insertion of deltoid", "opb": "Upper outer quadrant of buttock", "opc": "Lower inner quadrant of buttock", "opd": "Upper inner quadrant of buttock", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "465f2677-85e0-42a3-9151-66705304b932", "choice_type": "single"} {"question": "Seat belt injury is", "exp": "C i.e. Chance fracture", "cop": 3, "opa": "Tear drop fracture", "opb": "Wedge fracture", "opc": "Chance fracture", "opd": "Whiplash injury", "subject_name": "Surgery", "topic_name": null, "id": "65afb03e-7e9d-4b1f-b66d-3942ecdacdd0", "choice_type": "single"} {"question": "MC type of carcinoma anal canal", "exp": "MC type anal carcinoma is SCC > BCC.", "cop": 2, "opa": "Adenocarcinoma", "opb": "SCC", "opc": "Basal cell carcinoma", "opd": "Hamartoma", "subject_name": "Surgery", "topic_name": null, "id": "f709ff64-dfe6-499c-b31c-c70c010b700d", "choice_type": "single"} {"question": "Child pug score is used to assess severity of", "exp": null, "cop": 2, "opa": "CKD", "opb": "Chronic liver disease", "opc": "Encephalopathy", "opd": "Biliary atresia", "subject_name": "Surgery", "topic_name": null, "id": "9e42bed8-5e01-4f32-ac87-81158c729e87", "choice_type": "single"} {"question": "A pt. with Ca tongue is found to have lymph nodes in the lower neck. The t/t of choice for the lymph nodes is", "exp": "Surgical management can be of 3 types: Radical neck dissection (RND), Modified radical neck dissection (MRND) & Selective neck dissection (SND) Radical neck dissection - is the traditional gold standard for control of cervical metastasis. - RND involves removal of levels I to V of the cervical lymph nodes + Sternocleidomastoid, IJV and the spinal accessory nerve (CN XI). Modified radical neck dissection is modification of RND that preserves nonlymphatic structures i.e. CN XI, SCM and IJV. MRND has been found to be equally effective in controlling neck disease as RND with superior functional outcome. Selective neck dissection Preservation of any of the levels I through V during neck dissection is known as Selective neck dissection. The principle behind preservation of ceain nodal groups is that specific primary sites preferentially drain their lymphatics in a predictable pattern. Types of SND include the supraomohyoid neck dissection, the lateral neck dissection, and the posterolateral neck dissection.", "cop": 4, "opa": "Lower cervical neck dissection", "opb": "Suprahyoid neck dissection", "opc": "Radiotherapy", "opd": "Radical neck dissection", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "3a3c0f17-cdc2-4f02-aa5a-ad08e988d156", "choice_type": "single"} {"question": "Lymph node first involved in Ca breast is/are", "exp": ".Levels of the axillary nodes *Level I : Below and lateral to the pectoralis minor muscle--anterior, lateral, posterior *Level II : Behind the pectoralis minor muscle--central *Level III : Above and medial to pectoralis minor muscle-- apical Note in carcinoma breast * Spread restricted to level I nodes carries better prognosis * Spread to level II has poor prognosis * Spread to level III indicates worst prognosis. ref:SRB&;s manual of surgery,ed 3,pg no 455", "cop": 1, "opa": "Axillary", "opb": "Internal mammary", "opc": "Supraclavicular", "opd": "Contralateral axillary", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "5cd3c2c2-9cfb-4a3c-b67a-3304a5e0b124", "choice_type": "single"} {"question": "Absolute contraindication of conservative breast cancer therapy isa) Large pendulous breastb) History of previous radiationc) Axillary node involvementd) Subareolar lump presente) 1\nst\n trimester pregnancy", "exp": null, "cop": 1, "opa": "be", "opb": "ad", "opc": "bc", "opd": "ce", "subject_name": "Surgery", "topic_name": null, "id": "ad671dc0-42b4-4065-90b5-29ed6377d015", "choice_type": "single"} {"question": "A 45 year old patient is suffering from diffuse toxic goiter, Therapy of choice will be", "exp": null, "cop": 3, "opa": "Surgery", "opb": "Antithyroid drugs", "opc": "Radioiodine", "opd": "Antithyroid drugs first\tfollowed by surgery", "subject_name": "Surgery", "topic_name": null, "id": "3d3ee583-5750-4325-804c-f535c862c357", "choice_type": "single"} {"question": "Delayed prolonged bleeding after a minor surgery is caused by defect in", "exp": null, "cop": 2, "opa": "Primary hemostasis.", "opb": "Secondary hemostasis.", "opc": "Defect in capillary bed to support the clot.", "opd": "Defect in connective tissue to support capillaries", "subject_name": "Surgery", "topic_name": null, "id": "5263e83e-f135-4ff1-a61e-2b3853d97363", "choice_type": "single"} {"question": "The most common type of intussuception is", "exp": ".It is telescoping or invagination of one poion (segment) of bowel into the adjacent segment. Types 1. Antegrade--Most common. 2. Retrograde--Rare (jejunogastric in gastrojejunostomy stoma). In elderly intussusception: * Colocolic is most common type * Apex is formed usually by growth * No role of hydrostatic reduction * It can be single or multiple (rare). * It can be ileo-colic (most common type, 75%), colocolic, ileoileocolic, colocolic. *It is common in weaning period of a child (common in male), between the period of 6-9 months. ref:SRB&;S manual of surgery,ed 3,pg no 863", "cop": 4, "opa": "Multiple", "opb": "Colocolic", "opc": "Ileoileal", "opd": "Ileoilecolic", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "6cd8eea4-e9d2-4c6c-96b1-e0f8b5d83450", "choice_type": "single"} {"question": "Crohn&;s disease", "exp": ".Medical therapy for crohn&;s disease includes * To induce remission - steroids * For maintenance - immunomodulating drugs like azathioprine * Antibiotics, metronidazole (as immunomodulator) * Monoclonal antibody - infliximab * Nutritional suppo Note: Patients with Crohn's disease should avoid NSAIDs ref:SRB&;s manual of surgery ,ed 3,pg no 802", "cop": 2, "opa": "Has no increased risk for colonic cancer", "opb": "Medical management includes antibiotics, immunosuppressive agents and biologic agents", "opc": "Has no effect on feility", "opd": "Associated enteroenteric fistula is an indication for urgent surgery", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "e7ccd59a-5cd2-4047-92b9-3c7731223fe1", "choice_type": "single"} {"question": "A 72 year old male presented with complete rectal prolapse with\nhistory of constipation from the last 10 years. Management for this\npatient Is", "exp": "For young pts - Abdominal rectopexy is preferred.\nFor old pts - perineal rectopexy is preferred (delormes, altamaier).\nUnderlying cause must be treated.", "cop": 1, "opa": "Delorme procedure", "opb": "Well’s resection", "opc": "Abdominal Rectopexy", "opd": "Resection Rectopexy", "subject_name": "Surgery", "topic_name": null, "id": "2238e46f-0d77-412e-9063-9ba12f0727ce", "choice_type": "single"} {"question": "Dysphagia in Plummer Vinson syndrome is due to", "exp": "Ans. is 'a' i.e. Post cricoid region commonly involved in web formation", "cop": 1, "opa": "Post cricoid region commonly involved in web formation", "opb": "Web is common in lower region", "opc": "It is due to abnormal vessels", "opd": "Web is common in middle zone", "subject_name": "Surgery", "topic_name": null, "id": "5546fecb-799b-48a0-9df1-76bb60465204", "choice_type": "single"} {"question": "Treatment for superficial bladder carcinoma with single papillary lesion is", "exp": "For low grade tumor of pTa stage only TUR (Transurethral resection of\nbladder) is done.", "cop": 1, "opa": "Transurethral resection", "opb": "Intravesical immunotherapy", "opc": "Radical cystectomy", "opd": "Intravesical Chemotherapy", "subject_name": "Surgery", "topic_name": null, "id": "4005d21d-ae4d-4337-94c2-0006989da5f4", "choice_type": "single"} {"question": "Most common site for colorectal cancer is", "exp": "Ans is 'a' i.e., Rectum * Following image demonstrates the distribution of colorectal adenocarcinoma:* Thus the most common site is Rectum. (rectum> sigmoid colon> caecum).", "cop": 1, "opa": "Rectum", "opb": "Anal canal", "opc": "Spleenic flexure", "opd": "Appendix", "subject_name": "Surgery", "topic_name": "Small & Large Intestine", "id": "3e9c365a-db13-4444-82f1-a4f28f570ef0", "choice_type": "single"} {"question": "Dupuytren's contracture is seen in", "exp": "Dupuytren's contracture refers to localised thickening of palmar aponeurosis and later formation of nodules with severe permanent changes in metacarpophalangeal and proximal interphalangeal joints. It is often associated with the following conditions : * Plantar fasciitis 5%-Ledderhose's disease * Mediastinal and retroperitoneal fibrosis * Peyronie's disease of penis 3% * Nodules in the face and ear * Pellegrini-Stieda's disease. Reference : page 163 SRB's manual of surgery 5th edition", "cop": 1, "opa": "Peyronie's disease", "opb": "Hypospadias", "opc": "Epispadias", "opd": "Exostrophy", "subject_name": "Surgery", "topic_name": "Urology", "id": "22b83e29-5406-4fb5-ad9c-175334db9419", "choice_type": "single"} {"question": "Most common cause of urinary retention in children includes", "exp": "(A) Posterior urethral valves # Posterior urethral valves: These constitute an important cause of distal urinary tract obstruction in boys.> Dribbling, abnormal urinary stream, palpable bladder and recurrent UTI are the usual presenting features.> The presence of severe obstruction in the urinary tract in utero may lead to renal dysplasia.> Mild to moderate impairment of renal function may be present at birth.> The diagnosis is made on MCU, which shows dilated posterior urethra and valves at its junction with anterior urethra.", "cop": 1, "opa": "Posterior urethral valves", "opb": "Urethral stenosis", "opc": "Urethral aplasia", "opd": "Ectopic ureteric opening", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "96eea8f3-3fd7-4e2e-b965-0b0a38a7f042", "choice_type": "single"} {"question": "Tumor marker for seminoma testis is", "exp": "Ans. (d) Lactate DehydrogenaseRef Surgery Sixer 3rd Edition Page 795Tumor markers in testicular cancers:* Beta HCG - Concentration is increased in Both Seminoma and Non Seminoma.* AFP - Concentration is increased in only non seminoma.* LDH - It is increased in both seminoma and non seminoma, but not specific.", "cop": 4, "opa": "Alfa - fetoprotein", "opb": "Carcinoembryonic antigens", "opc": "Alpha HCG", "opd": "Lactate dehydrogenase", "subject_name": "Surgery", "topic_name": "Urethra & Penis", "id": "89417783-e4f0-4262-9e4f-a06d4778c291", "choice_type": "single"} {"question": "The expression of the following oncogene is associated with a high incidence of medullary carcinoma of the thyroid", "exp": "MTC occurs most commonly in a sporadic form (80%); it occurs less commonly as an autosomal dominant inherited disorder such as MEN2A, MEN2B, and familial medullary thyroid carcinoma (FMTC).The MEN2 and FMTC syndromes involve different germline activating mutations in the RET proto-oncogene. Additionally, 40% to 50% of sporadic MTC specimens have acquired RET mutations.Ref: Sabiston 20e, page no: 932", "cop": 3, "opa": "p53", "opb": "Her-2-neu", "opc": "Ret proto-oncogene", "opd": "Rb gene", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "bb0665c7-01f1-4898-a7f4-a8e10d5372b4", "choice_type": "single"} {"question": "Gastric irritation is not caused by", "exp": "Ans. c (Paracetamol). (Ref. KD Tripathi, 5th/pg. 181)PARACETAMOL AS COMPARED TO ASPIRIN:# Does not stimulate respiration or affect acid-base balance# Causes insignificant gastric irritation# Has no cardiovascular effect# Does not affect platelet function# Is not uricosuricRemaining all above drugs can cause significant gastritis", "cop": 3, "opa": "Ibuprofen", "opb": "Aspirin", "opc": "Paracetamol", "opd": "Diclofenac", "subject_name": "Surgery", "topic_name": "Stomach & Duodenum", "id": "c360fa8e-93d1-4580-a0ec-a9085d741d46", "choice_type": "single"} {"question": "Pseudoclaudication is caused by", "exp": "Pseudoclaudication is the term used for neurogenic claudication caused due to lumbar canal stenosis. Its symptoms mimic intermittent claudication of PVD. Neurogenic claudication, consists of back and buttock or leg pain induced by walking or standing and relieved by sitting or changing posture. Symptoms in the legs are usually bilateral. Unlike vascular claudication, symptoms are often provoked by standing without walking. Spinal stenosis can be acquired, congenital, or due to a combination of these factors. Congenital causes include achondroplasia, idiopathic. Acquired causes are degenerative diseases (spondylosis, spondylolisthesis, scoliosis), trauma, spine surgery, metabolic or endocrine disorders (epidural lipomatosis, osteoporosis, acromegaly, renal osteodystrophy, hypoparathyroidism), and Paget&;s disease. Ref : Bailey and love surgery text book 27th Ed.", "cop": 3, "opa": "Femoral Aery stenosis", "opb": "Popliteal Aery stenosis", "opc": "Lumbar canal stenosis", "opd": "Radial Aery stenosis", "subject_name": "Surgery", "topic_name": "All India exam", "id": "302ef268-f42c-48d1-9e41-bb38b2658dc9", "choice_type": "single"} {"question": "The most frequently used procedure for diagnosing palpable breast masses is", "exp": "Fine needle aspiration cytology FNAC, is very useful in breast carcinoma advantages; least painful, can be done in OP basis, reliable and cheaper malignant deposit will not occur along the track of FNAC ref ;(page no;542) 5th edition of SRB&;S Manual of SURGERY", "cop": 2, "opa": "Core-cutting needle biopsly", "opb": "Fine needle aspiration", "opc": "Excisional biopsy", "opd": "Incisional biopsy", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "e31968e9-86f1-4503-960b-a27f4e3c86ef", "choice_type": "single"} {"question": "Name the wiring technique", "exp": null, "cop": 2, "opa": "Ivy’s wiring", "opb": "Risdon wiring", "opc": "Gilmers wiring", "opd": "Eyelet wiring", "subject_name": "Surgery", "topic_name": null, "id": "404ad863-40ea-4a68-8b29-fa3ddc746fe4", "choice_type": "single"} {"question": "Scissors gait is seen in", "exp": "Scissor gait is a form of gait abnormality primarily associated with spastic cerebral palsy rigidity and excessive adduction of the leg in swing plantar flexion of the ankle flexion at the knee adduction and internal rotation at the hip progressive contractures of all spastic muscles complicated assisting movements of the upper limbs when walking", "cop": 2, "opa": "Poliomyelitis", "opb": "Cerebral palsy", "opc": "Hyperbilirubinemia", "opd": "Hyponatremia", "subject_name": "Surgery", "topic_name": "Trauma", "id": "1825fbdb-260f-4277-894c-884957f106d3", "choice_type": "single"} {"question": "The parotid duct is known as", "exp": "ParotidStenson's ductOpens at upper 2nd molar toothSubmandibular glandWhaon's ductOpens into the papilla just lateral to the frenulumSublingual glandDucts of RiviniusNumerous excretory ducts(Ducts of Rivinus), directly into the oral cavityDuct of Wirsung is major pancreatic ductDuct of Santorini is accessory pancreatic ductRef: Bailey and love, page no: 779", "cop": 2, "opa": "Whaon's duct", "opb": "Stenson's duct", "opc": "Duct of Santorini", "opd": "Duct of Wirsung", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "d9600222-5c5c-423e-8f73-1de9102fb20c", "choice_type": "single"} {"question": "Most common electrolyte imbalance that causes paralytic ileus is", "exp": "In paralytic ileus uraemia and hypokalemia are the most common contributory factors. Paralytic ileus is defined as a state in which there is failure of transmission of peristaltic waves secondary to neuromuscular failure. Reference : Bailey & Love, 27th Edition, page no = 1297.", "cop": 3, "opa": "Hyponatremia", "opb": "Hypernatremia", "opc": "Hypokalemia", "opd": "Hyperkalemia", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "77cd0549-8be5-4298-b21c-90902f76831e", "choice_type": "single"} {"question": "Colonic diveiculosis is best diagnosed by", "exp": "Investigations * Barium enema (best method to diagnose) shows 'sawteeth' appearance. Champagne glass sign--Paial filling of diveicula by barium with stercolith inside-- seen in sigmoid diveicula. * Sigmoidoscopy is useful but should not be done in acute stage. Once acute stage subsides, barium enema, sigmoidoscopy, colonoscopy can be done (To rule out associated malignancy). * CT scan in acute phase to see pericolic abscess. CT scan shows thickening of muscle layer, abscess, perforation, fistula, involvement of organs like urinary bladder and associated pathology. CT is the ideal investigation. ref:SRB &;s manual of surgery,ed 3,pg no-822", "cop": 3, "opa": "Colonoscopy", "opb": "Nuclear scan", "opc": "Barium enema", "opd": "CT scan", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "f1672bb7-dd1b-46b3-81c2-546852f00ba2", "choice_type": "single"} {"question": "Headache, apathy and deteriorating level of consciousness occurring weeks after head injury suggests;", "exp": "Chronic subdral haematoma", "cop": 1, "opa": "Chronic subdral haematoma.", "opb": "Pontine hemorrhage", "opc": "Continuing cerebral.", "opd": "Depressed skull fracture.", "subject_name": "Surgery", "topic_name": null, "id": "b37eb019-4f8c-4131-8ff9-c2413a5b227e", "choice_type": "single"} {"question": "Middle segment pancrectomy avoided in", "exp": ".95% subtotal pancreatectomy. * Distal pancreatectomy--Spleen, body and tail of the pancreas are removed--Child's operation. * Puestow's operation--As the duct is dilated more than 8 mm, duct can easily be opened longitudinally. After removing all stones from the duct, it is anastomosed to the jejunum as Roux-en-Y anastomosis. In Puestow's operation spleen is removed. * Paington - Rochelle operation: Here longitudinal pancreaticojejunostomy is done using almost entire laid open pancreatic duct. Spleen is retained in this procedure. This is now commonly done procedure. * Total pancreatectomy is indicated when entire gland is diseased. It relieves the pain and also prevents the diseased pancreas from turning into malignancy. Patient has to take insulin and oral pancreatic enzymes permanently (brittle diabetes). * The cause is treated like cholecystectomy for gall stones. ref:SRB&;S manual of surgery,ed 3,pg no 629", "cop": 2, "opa": "Cystadenoma", "opb": "Tumors of head of pancreas", "opc": "Tumors of tail of pancreas", "opd": "Tumor of neck of pancreas", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "c3b74712-4036-488c-a845-483d83754dd8", "choice_type": "single"} {"question": "Ponsetti technique failure in children should be managed with", "exp": "Answer- A. Posteromedial soft tissue releaseIf treatment by manipulation and retention fails, operation should usually be undeaken before 9 months of age, mostly at 4- 6 months.The idea behind early operation is to set the tarsal bones in normal relationship to one another and to remove deforming forces, thus allowing the bones to develop in their normal shape from an early age. The procedure used is soft tissue release, i.e. postero-medial release (PMR).", "cop": 1, "opa": "Posteromedial soft tissue release", "opb": "Anterolateral soft tissue release", "opc": "Triple ahrodesis", "opd": "Lateral closing wedge osteotomy of calcaneum", "subject_name": "Surgery", "topic_name": null, "id": "9c5da77d-3acc-4e50-bd79-5042c7908bd7", "choice_type": "single"} {"question": "T/t of CBD stone includes", "exp": "ERCP-therapeutic,i.e.,Endoscopic papillotomy (sphincterotomy) and stone extraction through Dormia basket or balloon catheter is the treatment of choice for CBD stones.It has a success rate of around 95%.Other methods include mechanical/extracorporeal shock (ESW)lithotripsy and extraction;or removal through baby endoscope.CBD stent is placed insitu.Once stones are removed,laparoscopic cholecystectomy can be done. Reference:SRB's manual of surgery,5th edition,page no:651.", "cop": 1, "opa": "Endoscopic papillotomy", "opb": "ERCP", "opc": "Ursodeoxy xholic acid", "opd": "Hepatojejunostomy", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "19cd3a54-455f-4e5a-82b3-38f7d9582b92", "choice_type": "single"} {"question": "The most important prognostic factor in breast carcinoma is", "exp": null, "cop": 2, "opa": "Histological grade of the tumour", "opb": "Stage of the tumour at the time of diagnosis", "opc": "Status of estrogen and progesterone receptors", "opd": "Over expression of p53 tumor suppressor gene.", "subject_name": "Surgery", "topic_name": null, "id": "859c4db6-1149-42ed-b935-79a1e382acb5", "choice_type": "single"} {"question": "In congenital hyperophic pyloric stenosis, the defect is in", "exp": "Infantile Hyperophic Pyloric stenosis In HPS, hyperophy of circular muscle of pylorus results in constriction & obstruction of gastric outlet Accquired condition Incidence of 1 in 3000 to 4000 live bihs This condition is most common between the ages of 3-6 weeks Associated anomalies in 6-20% cases : Esophageal atresia, Hirschprung's disease, ARM and malrotation Ref: Sabiston 20th edition Pgno : 1869", "cop": 2, "opa": "Nerve fibres", "opb": "Circular muscle fibres", "opc": "Longitudinal muscle fibres", "opd": "Mucosa", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "0c365c0d-492e-41db-acbf-e1ac8a2954a0", "choice_type": "single"} {"question": "Lucid interval is a characteristic pathognomonic feature of\\", "exp": "(A) Extradural haemorrhage # Extradural haemorrhage.> It is a period in which person is liable for acts> Lucid interval is a period occurring in insanity, during which all the symptoms of insanity disappear completely. The individual is able to judge his acts soundly and he becomes liable for his acts.> If he commits an offense, he can be held completely responsible.> Because it is very difficult to whether he was suffering from mental aberration at the time of commit the offence.", "cop": 1, "opa": "Extradural haemorrhage", "opb": "Intracerebral haemorrhage", "opc": "Tumour in the frontal lobe", "opd": "Intracerebral abscess", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "c57ec386-bcdb-4f25-9900-8d69848075b1", "choice_type": "single"} {"question": "Best approach for thoracic trauma is", "exp": "Here best option is anterolateral thoracotomy. Different approaches to the contents of the chest cavity are.. Left anterolateral thoracotomy : left lung and lung hilum, Thoracic aoa, left side of hea, origin of left subclan aery and lower oesophagus. Right anterolateral thoracotomy : Right lung and lung hilum, Azygos vein, Superior vena cava, Infracardiac inferior vena cava, Upper oesophagus, Thoracic trachea. Median sternotomy : Anterior aspect of the hea, Anterior Mediastinum, Ascending aoa and arch of aoa, pulmonary aeries and Carina of trachea. Indications for thoracotomy: 1.1000ml drained at inseion of chest drain. 2.Continued brisk bleeding >100ml per 15 min. 3.Continued bleeding >200ml per hr. for 3 or 4 more hrs . 4.Rupture of bronchus, aoa, oesophagus, diaphragm. 5.Cardiac tamponade. Reference : Bailey & love, 27th Edition, page no = 371.", "cop": 3, "opa": "Midline sternotomy", "opb": "Parasternal thoracotomy", "opc": "Anterolateral thoracotomy", "opd": "Posterolateral thoracotomy", "subject_name": "Surgery", "topic_name": "Trauma", "id": "c5394999-c28d-488d-8071-5c03db892ede", "choice_type": "single"} {"question": "Most common impacted foreign body in esophagus in children is", "exp": "Ans. is 'a' i.e., Coin Foreign body impaction* Most impacted foreign bodies do not get impacted in the oropharynx. The most common exceptions are fish and chick bones.* These objects most often lodge in the soft tissues at the base of tongue, but they can also lodge in the tonsil or the pyriform fossa.* Coins are the most commonly impacted foreign bodies in children in esophagus and oropharynx followed by the food products.", "cop": 1, "opa": "Coin", "opb": "Food product", "opc": "Krayon", "opd": "Marble", "subject_name": "Surgery", "topic_name": "Oesophagus", "id": "428b5cd9-f64c-43f5-ba84-bd915dfb7e84", "choice_type": "single"} {"question": "A young male presented with dyspnea, bleeding and petechial hemorrhage in the chest after 2 days following fracture shaft of the femur right side. Most likely cause is", "exp": "(Fat -embolism) (855-56-CSDT 12th) (178-Anaesthesia- A. yadav 3rd)FAT-EMBOLISM - Fracture through a large marrow filled cavity almost inevitably results in small showers of fat emboli being swept to the lungs. This can usually be accommodated without serious consequences, but in some cases (and especially in those with multiple injuries and severe shock or in patients with associated chest injuries) it results in progressive respiratory distress and multi - organ failure (ARDS)* Blood gases should be measured soon after admission, and may suspicious signs such as shortness of breath, restless ness or a rise in temperature or pulse rate should prompt a search for petechal hemorrhages over the upper body axillae and conjunctivae* TRIAD of fat embolism - Dyspnea, confusion and petechial haemorrhage.* Capnography show fall in endtidal CO2 (ETCO2 may become zero if embolus is large enough to block the main pulmonary artery* Coagulation abnormalities like increased clotting time and decreased platelets* Serum lipase is increased* Air embolism - occure during the placement or removal of central venous catheters* Amniotic fluid-embolism - occur during active labour* Fat embolism - occur from long bones fractures- Characterised by respiratory insufficiency, Coagulopathy, encephalopathy and an upper body petechial rash* Pulmonary embolism - results from septic emboli, tumour emboli from atrial myxoma or IVC extension of renal cell carcinoma and parasitic emboli**DVT remains the most common source of pulmonary thromboembolism", "cop": 2, "opa": "Air embolism", "opb": "Fat embolism", "opc": "Pulmonary thrombo embolism", "opd": "Amniotic fluid embolism", "subject_name": "Surgery", "topic_name": "Orthopedics", "id": "cf35b125-b5c9-481c-9231-8f4c04f01fad", "choice_type": "single"} {"question": "Inhaled general anaesthetic with low blood gas\npartial coefficient are characterized by", "exp": null, "cop": 1, "opa": "Rapid induction and quick recovery from anaesthesia", "opb": "Rapid induction and slow recovery from anaesthesia", "opc": "Slow induction and slow recovery from anaesthesia", "opd": "Slow induction and quick recovery from anaesthesia", "subject_name": "Surgery", "topic_name": null, "id": "4123a684-416b-48b6-9122-fb35abbe3097", "choice_type": "single"} {"question": "Most common presenting symptom of benign breast disease", "exp": "Ans) a (Pain) Ref: Ref: Bailer & Love's short practice of surgery 25th editionBenign breast disease(BBD) is the most common cause of breast prob-lems. 30% of the women suffer fromBBD. Most common symptoms include pain & lumpiness. The symptoms of ANDI (Abnormalities of normal development & involution) often include lumpiness (seldom a discrete lump) and/or breast pain.", "cop": 1, "opa": "Pain", "opb": "Increase in size", "opc": "Lump", "opd": "Discharge", "subject_name": "Surgery", "topic_name": "Clinical Presentation and Physiology", "id": "884b8dda-0b8a-4d50-8f74-d84a8132dbd1", "choice_type": "single"} {"question": "Minimum amount of GI bleed to cause melena is", "exp": null, "cop": 3, "opa": "10 ml", "opb": "40 ml", "opc": "60 ml", "opd": "115 ml", "subject_name": "Surgery", "topic_name": null, "id": "c56febc2-8e00-447a-9077-bdda7626b5f6", "choice_type": "single"} {"question": "H. pylori infection is associated with increased risk of", "exp": "Ans. b (Carcinoma of body and pylorus of stomach) (Ref. LB 25th/1067)Helicobacter seems to he principally associated with carcinoma of the body and distal stomach rather than theproximal stomach. As Helicobacter is associated with gastritis, gastric atrophy and intestinal metaplasia, theassociation with malignancy is perhaps not surprising.Risk factors for the development of stomach/gastric carcinoma are:1. Male > Female2. Age > 40 years3. Chronic H. pylori infection4. Chronic atrophic gastritis with intestinal metaplasia5. History of partial gastric resection6. Pernicious anemia7. Blood group A8. Race: Asians especially Japanese9. Gastric ulcer and polyps10. Menetrier's disease: extreme hypertrophy of gastric rugal folds11. Cigarette smoking12. Dust ingestion13. Ingestion of spirits14. Genetic factors15. Long-term ingestion of high concentration of nitrates in dried smoke and salted foods. (Charred or burnt foods).", "cop": 2, "opa": "Proximal gastric cancer", "opb": "Carcinoma of body and pylorus of stomach", "opc": "Carcinoma of duodenum first part", "opd": "Carcinoma involving gastroesophageal junction", "subject_name": "Surgery", "topic_name": "Stomach & Duodenum", "id": "8a74618d-5a37-4ec4-a303-5f489d919aec", "choice_type": "single"} {"question": "Hinchey classification is used for perforations of colon secondary to", "exp": "Answer-C. DiveiculitisHinchey Classification is used to describe perforations of the colon due to diveiculitis.Hinchey I - localised abscess (para-colonic)Hinchey II - pelvic abscessHinchey III - purulent peritonitis (the presence of pus in the abdominal cavity)Hinchey IV - feculent peritonitis. (Intestinal perforation allowing feces into abdominal cavity)", "cop": 3, "opa": "Trauma", "opb": "Carcinoma", "opc": "Diveiculitis", "opd": "Inflammatory enteropathy", "subject_name": "Surgery", "topic_name": null, "id": "1120d2f4-d5a3-49ff-9976-7cdfe51b60f3", "choice_type": "single"} {"question": "Treatment of choice for phylloides tumor", "exp": "Treatment of choice for phylloides tumor is excision or subcutaneous mastectomy is done if malignant, total mastectomy is done phylloides tumor also known as cystosarcoma phylloides/ serocystic disease of broide they are simply giant fibroadenoma ref ;(page no;521) 5th edition of SRB&;S Manual of SURGERY", "cop": 1, "opa": "Excision", "opb": "Radical mastectomy", "opc": "Radiotherapy", "opd": "Chemotherapy", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "279cc7b9-6436-4bb7-9224-7a09c0d1fbc7", "choice_type": "single"} {"question": "Symbolic stripped 'Y' classification for cleft Lip and palate was given by", "exp": null, "cop": 2, "opa": "Veou", "opb": "Kernahan", "opc": "Jackson", "opd": "Edward H. Angle", "subject_name": "Surgery", "topic_name": null, "id": "eae9e7f3-4a30-4c5e-9146-097acda09461", "choice_type": "single"} {"question": "Intra abdominal pressure maintained during laparoscopy is", "exp": "Ans. (b) 12-15 mm Hg(Ref: Textbook of Laparoscopic surgery by R K Mishra, 3rd ed p-74-78)* Intra abdominal operation is maintained between 12-15mm of hg for avoiding any hemodynamic derangements during laparoscopy.", "cop": 2, "opa": "5-10 mm Hg", "opb": "12-15 mm Hg", "opc": "15-20 mm Hg", "opd": "20-25 mm Hg", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "a7d7f735-5ca8-4659-bd75-01f324fecd3a", "choice_type": "single"} {"question": "On thyroid function test, TSH value is raised and\nt4 value is decreased. Referred diagnosis is", "exp": "IF TSH raised ans T4 is decreased then its primary.\nIF both are decreased then its secondary.", "cop": 2, "opa": "Hyperthyroidism", "opb": "Primary hypothyroidism", "opc": "Secondary hypothyroidism", "opd": "Subclinical hypothyroidism", "subject_name": "Surgery", "topic_name": null, "id": "2d2639c9-34f5-40bf-8447-6574dfcb8919", "choice_type": "single"} {"question": "Most common site for extra mammary Paget&;s disease is", "exp": ".It is superficial manifestation of an intraductal carcinoma. The malignancy spreads within the duct up to the skin of the nipple and down into the substance of the breast. It mimics eczema of nipple and areola.most commonly extra mammary manifestations of paget&;s disease is seen in the vulva. * Paget's disease of penis (Erythroplasia of Querat is persistent rawness of glans penis). ref:SRB&;s manual of surgery,ed 3,pg no 1009,473", "cop": 1, "opa": "Vulva", "opb": "Vagina", "opc": "Penis", "opd": "Anus", "subject_name": "Surgery", "topic_name": "Urology", "id": "04519631-61e3-4ef4-b2d6-c352cf349ded", "choice_type": "single"} {"question": "Commonest injury in blunt abdominal trauma", "exp": "Splenic injury can be a subcapsular hematoma, laceration or hilar injury. It can be associated with other organ injuries It can cause torrential hemorrhage and shock. It is the most common organ injured in blunt injury abdomen (Ref; SRB,s Manual of Surgery,5th edition, pg no. 149)", "cop": 4, "opa": "Kidney", "opb": "Liver", "opc": "Bladder", "opd": "Spleen", "subject_name": "Surgery", "topic_name": "Trauma", "id": "b56f7521-5d90-4be7-b368-6e5a1a2be279", "choice_type": "single"} {"question": "In erect posture commonest site of foreign body in bronchus", "exp": "(A) (Right posterior basal) (Pretest physical diagnosis)* The most common anatomic location for a foreign body in the right main stem bronchus or the right lower lobe.* The right main stem bronchus is wider, shorter and vertically placed, and therefore the posterior segment of the right upper lobe (If the patient aspirated while supine) are anatomically susceptible to aspiration pneumonia. The superior segment of the right lower lobe and left lower lobe (If the patient supine) are also susceptible to aspiration pneumonia. These three segments are often referred to on the aspiration segments of the long the basilar segments of both lungs are susceptible to aspiration if the patients aspirates while erect or sitting up.Aspiration in supine position* Right upper lobe - posterior segment* Right lower lobe - superior segment* Left lower lobe - superior segmentAspiration in sitting position* Right basilar segments of lower lobes **", "cop": 1, "opa": "Right posterior basal", "opb": "Right anterior basal", "opc": "Lateral basal", "opd": "Medial basal", "subject_name": "Surgery", "topic_name": "Lung", "id": "139da2fa-ef0a-4ed9-a377-f3bdaf796797", "choice_type": "single"} {"question": "Neurogenic shock in acute spinal injury is due to", "exp": "Neurogenic shock presents with hypotension, anormal hea rate or bradycardia and warm peripheries.This is due to unopposed vagal tone resulting from cervical spinal cord injury at or above the level of sympathetic outflow (T1/T5). It should be treated with inotropic suppo,and care should be taken to avoid fluid overloadBailey and love 27e pg: 352", "cop": 1, "opa": "Loss of sympathetic tone", "opb": "Loss of parasympathetic tone", "opc": "Increased hea rate", "opd": "Vasovagal attack", "subject_name": "Surgery", "topic_name": "Trauma", "id": "bc3844e6-60a5-4cd7-94df-fa42a7f1adb0", "choice_type": "single"} {"question": "'N3' in Head & Neck cancer TNM staging refers to", "exp": "Answer- D. Contralateral lymph node > 6 cmN3- Metastasis in a lymph node > 6 cm in greatest dimension", "cop": 4, "opa": "Ipsilateral lymph node 3-6 cm", "opb": "Contralateral lymph node 3-6 cm", "opc": "Bilateral lymph nodes 3-6 cm", "opd": "Contralateral lymph node > 6 cm", "subject_name": "Surgery", "topic_name": null, "id": "bf8f0a62-76e9-4311-bdc8-78e49bc9e010", "choice_type": "single"} {"question": "In surgical patient malnutrition is best assessed by", "exp": ".* Weight loss more than 10% of individual's weight in 6 months is called as significant weight loss. * Body Mass Index (BMI) is body weight in kilograms divided by height in meters squared. BMI less than 18.5 signifies nutritional impairment and below 15 signifies severe malnutrition.in surgical patients malnutrition is best assessed by mid arm circumference. ref:SRB&;s manual of surgery,ed 3,pg no 86", "cop": 3, "opa": "Serum albumin", "opb": "Hb level", "opc": "Mid arm circumference", "opd": "Tricpes skin fold thickness", "subject_name": "Surgery", "topic_name": "Urology", "id": "9598d8db-c0da-4c65-84eb-641a79fc90ca", "choice_type": "single"} {"question": "Glasgow coma scale motor score 4 is", "exp": "Glasgow coma scale Motor response score: 6= obeys command 5= localised to pain 4= Withdraws from pain 3= Flexion in response to pain 2= Extension to pain 1= No motor response Reference : Bailey & Love, 27th Edition, page no = 325.", "cop": 2, "opa": "Decotricate position", "opb": "Withdrawl from pain", "opc": "Decerebrate position", "opd": "Localize pain", "subject_name": "Surgery", "topic_name": "Trauma", "id": "ef4aace2-42f8-4a77-9d9a-42d74ef15018", "choice_type": "single"} {"question": "An 18 year old patient presents with acute abdominal pain, vomiting and on clinical examination loin tenderness is present. History of pyrexia is absent. The diagnosis is", "exp": "(A) Acute testicular torsion# TESTICULAR TORSION Usually presents with sudden, severe, testicular pain (in groin and lower abdomen) and tenderness. There is often associated nausea and vomiting. Testis may be higher than its normal position. Mild pyrexia and redness of overlying area may be found. Presentation of acute appendicitis includes abdominal pain, nausea, vomiting, and fever. Appendix becomes more swollen and inflamed, it begins to irritate the adjoining abdominal wall. Leads to the localization of the pain to the right lower quadrant. Classic migration of pain may not be seen in children under three years. Pain can be elicited through signs and can be severe. Signs include localized findings in the right iliac fossa. Abdominal wall becomes very sensitive to gentle pressure (palpation). There is severe pain on sudden release of deep pressure in the lower abdomen (rebound tenderness). If appendix is retrocecal (localized behind the cecum), even deep pressure in the right lower quadrant may fail to elicit tenderness (silent appendix). This is because the cecum, distended with gas, protects the inflamed appendix from pressure. Similarly, if the appendix lies entirely within the pelvis, there is usually complete absence of abdominal rigidity. Digital rectal examination elicits tenderness in the rectovesical pouch. Coughing causes point tenderness in this area (McBurney's point).> Acute pyelonephritis develop rapidly over a few hours or a day & it can cause high fever, pain on passing urine, and abdominal pain that radiates along the flank towards the back. There is often associated vomiting.> Chronic pyelonephritis causes persistent flank or abdominal pain, signs of infection (fever, unintentional weight loss, malaise, decreased appetite), lower urinary tract symptoms and blood in the urine.> Diverticulitis symptoms may include: Tenderness, cramps, or pain in the abdomen (usually in the lower left side but may occur on the right) that is sometimes worse with movement. Fever and chills. Bloated feeling, abdominal swelling, or gas. Diarrhea or constipation. Nausea and sometimes vomiting. Loss of appetite.", "cop": 1, "opa": "Acute testicular torsion", "opb": "Acute appendicitis", "opc": "Acute pyelonephritis", "opd": "Acute diverticulitis", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "90812bcc-fb32-4ba2-ad57-f163e3e8a8d4", "choice_type": "single"} {"question": "Most common site of urethral carcinoma is men is", "exp": "There is a high prevalence of primary urethral cancer in the bulbomembranous urethra, which is also the most common location of urethral strictures. Squamous carcinoma can develop in an area of squamous metaplasia sometimes seen with a urethral stricture. Reference : page 1370 Bailey and Love's sho practice of surgery 25th edition", "cop": 1, "opa": "Bulbomembranous urethra", "opb": "Penile urethra", "opc": "Prostatic urethra", "opd": "Fossa navicularis", "subject_name": "Surgery", "topic_name": "Urology", "id": "2a5e8f33-7267-4f23-9564-7b22a5fbcdd8", "choice_type": "single"} {"question": "Hutch diveiculum is seen in", "exp": "Hutch diveiculum is a congenital type of bladder diveiculum characterised by herniation of bladder mucosa through a weak point in the wall near the ureterovesical junction, often caused by chronically high intravesical pressure.", "cop": 1, "opa": "Bladder", "opb": "Ureter", "opc": "Duodenum", "opd": "Caecum", "subject_name": "Surgery", "topic_name": "Urology", "id": "7ccd0822-46e7-4739-b4f4-6d05acf558e1", "choice_type": "single"} {"question": "Killians incision is used for", "exp": "Ans. is 'a' i.e., Submucous resection of nasal septum Killians incision* It is used for submucous resection (SMR) of the nasal septum.* It is used to address the septal deviations posterior to the nasal septum.* It is made usually along the convex side of the deviation from superiorly along the mucocutaneous junction of the nasal septum to the nasal floor and can be modified to extend laterally along the floor of the nose, so that tunneling under the submucoperichondrial flap can proceed without tearing the mucosa.* One should be mindful that the tearing of the submucoperichondrial flaps on the apposing sides can result in septal perforations which are especially symptomatic at the anterior inferior aspect of nasal septum.", "cop": 1, "opa": "Submucous resection of nasal septum", "opb": "Mastoid antral lavage", "opc": "Mandibulectomy", "opd": "Parotidectomy", "subject_name": "Surgery", "topic_name": "E.N.T.", "id": "29584477-913c-46a6-9380-8d3f1f85dc29", "choice_type": "single"} {"question": "Commonest organ injured in blast injury is", "exp": "Ans. is 'a' i.e. Lung The structures injured by the primary blast wave, in order of prevalence, are the middle ear, the lungs and the bowel\" - Love & BaileyThe hollow organs containing gas or air are most readily damaged by blast waves. The homogenous tissues like liver and muscle are least likely injured.In underwater blast, injuries occur mostly in gastrointestinal tract and less commonly in lungs.The lung injury can introduce air into the circulatory system. Death may occur from systemic air embolism.Tympanic membrane rupture is a sensitive marker for primary blast injury.", "cop": 1, "opa": "Lung", "opb": "Liver", "opc": "Spleen", "opd": "Pancreas", "subject_name": "Surgery", "topic_name": "Injury to Specific Organs", "id": "89a2b4ec-4922-4f9b-9a47-d84821639e70", "choice_type": "single"} {"question": "The score in Glasgow coma scale of conscious person is", "exp": null, "cop": 3, "opa": "8", "opb": "13", "opc": "15", "opd": "10", "subject_name": "Surgery", "topic_name": null, "id": "a69d54ad-6319-41a3-94ba-0c05b3bd7df3", "choice_type": "single"} {"question": "A.M.L. with worst prognosis", "exp": "Monsomy 7 [Ref Harrison 17th/e p 680 & leh/e p 6341 There are number of factors which determine the prognosis in A.M.L. In a number of studies in last 2 decades it has been observed that cytogenetic markers are major determinants in assessment of prognosis. Prognosis of Acute Myeloid leukemia . t (8 ; 21),Q * Good prognosis * inv (16) ordeg . t (15 ; 17)Q * Moderately ourable outome . No cytogenetic abnormalitydeg . inv (3),deg * Monosomy 7 presence deg of PTD of MLL or 1TD of FLT 3 * Poor prognosis . Uq 23,deg . 3q21,deg . 3q26deg Prognostic factors in Acute Myeloid leukenia Factors Favorable Unorable . Age <45 years < 2 year, > 60 years . Leucocytosis 25 x RP/LQ > 100 x lOYL . CNS involvement AbsentQ Present . Response to therapy Rape& Delayed/incomplete . Auer rods Present Absent . FAR type M2, B3 M4E0 M5, M6, M7 . Cell markers CD2or CD19 CD13, CD14, CD33 . Cytogenetics t (15:17)Q in M3 -7; del (7q), -50 t (8:21) in M2 del (sq)Q, 11q23 inv( 16) del(16q) abnormalities 3q21 and 3q26 abnormalities complex karyotypic abnormalities", "cop": 4, "opa": "8/21 translocation", "opb": "Inversion 16", "opc": "Normal cytogenetics", "opd": "Monosomy 7", "subject_name": "Surgery", "topic_name": null, "id": "d5801be0-198a-4393-954e-9668473a6645", "choice_type": "single"} {"question": "During an operation for presumed appendicitis, the patient appendix is found to be markedly thickened and feels rubbery to firm. The serosa is edematous and inflamed and the mesentery is thickened with fat growing about the bowel circumference. Most likely diagnosis", "exp": "Crohn's disease can present acutely, and when it involves the terminal ileum may clinically resemble appendicitis. The bowel in this patient has the characteristic gross findings and inflammatory changes of Crohn's disease including the \"creeping fat\" within the mesentery. Meckel's diveiculitis can mimic appendicitis but it presents as an inflammatory phlegmon located approximately 50 cm (2 feet) from the ileocecal varve and does not have the bowel changes seen in this patient. Ulcerative colitis is usually confined to the large bowel and, although it may occasionally be associated with inflammatory changes of the ileal mucosa (backwash ieitis), it is generally not associated with full- thickness changes described above. Ileal carcinoid would present as a mass in the ileum and would not be associated the inflammatory changes seen in this patient.", "cop": 1, "opa": "Ileal Crohn's disesase", "opb": "Meckel's diveiculitis", "opc": "Ulcerative colitis", "opd": "Ileocecal tuberculosis", "subject_name": "Surgery", "topic_name": null, "id": "3dc0e7eb-b2a4-44d2-a538-4827ce67d002", "choice_type": "single"} {"question": "Commonest site of ischemic colitis", "exp": null, "cop": 2, "opa": "Hepatic flexure", "opb": "Splenic flexure", "opc": "Transverse colon", "opd": "Sigmoid colon", "subject_name": "Surgery", "topic_name": null, "id": "3785d1f0-2e87-46d7-bd71-fdd7cee4a5cd", "choice_type": "single"} {"question": "Buerger's Disease is", "exp": "Buerger's Disease is non atherosclerotic inflammatory disorder involving medium sized and distal vessels. It is segmental, progressive , occlusive, inflammatory disease.", "cop": 2, "opa": "Non - progressive", "opb": "Segmental", "opc": "Non - inflammatory", "opd": "Atherosclerotic", "subject_name": "Surgery", "topic_name": null, "id": "bab08deb-206d-41e4-b4a6-00dd1a34e9d6", "choice_type": "single"} {"question": "Most common form of actinomycosis", "exp": "Actinomycosis is caused by Actinomyces israelii. Facio-cervical is the most common type. Infection spreads either from tonsil or from adjacent tooth. Actinomyces israelii is an anaerobic gram - positive fungal like bacterium. It is called as Ray fungus. Reference : SRB's Manual of Surgery, 6th Edition, page no = 54.", "cop": 1, "opa": "Facio cervical", "opb": "Thorasic", "opc": "Right illiac fossa", "opd": "Liver", "subject_name": "Surgery", "topic_name": "General surgery", "id": "f09887da-2e0e-458c-8804-c9ad796e03c2", "choice_type": "single"} {"question": "Gastric malignancy is predisposed with", "exp": null, "cop": 2, "opa": "Blood group O", "opb": "Intestinal metaplasia", "opc": "Gastric hyperplasia", "opd": "Duodenal ulcer", "subject_name": "Surgery", "topic_name": null, "id": "0d6b4468-147c-489b-815f-d6ac71202b22", "choice_type": "single"} {"question": "Radiological Contrast to be preferred for demonstrating TO fistula", "exp": ".", "cop": 2, "opa": "High osmolar iodine contrast", "opb": "Low osmolar iodine contrast", "opc": "Gadolinium-DTPA", "opd": "Thick barium sulphate suspension", "subject_name": "Surgery", "topic_name": "All India exam", "id": "3705ae8b-87cb-4973-bd97-4d674e0c50a2", "choice_type": "single"} {"question": "Most common clinical presentation of idiopathic retroperitoneal fibrosis is", "exp": "Idiopathic retroperitoneal fibrosis also called Ormond's disease is nonspecific inflammation of fibrofatty tissue in the retroperitoneum. It results in extensive collagen deposition surrounding the ureters, mostly at the level of the pelvic brim or below- Most patients present with ureteric obstruction, often with renal failure Reference : page 1007 Bailey and Love's sho practice of surgery 25th edition", "cop": 1, "opa": "Ureteral obstruction", "opb": "Leg edema", "opc": "Calf claudication", "opd": "Jaundice", "subject_name": "Surgery", "topic_name": "Urology", "id": "b587d464-20b4-4b6e-9066-d3b98b9f91f7", "choice_type": "single"} {"question": "Keloid scar is", "exp": "An atrophic scar is a pale, flat and stretched in appearance, often appearing on the back and in areas of tension. A hyperophic scar is defined as excessive scar tissue that does not extend beyond the boundary of the original incision or wound. A keloid scar is defined as excessive scar tissue that extends beyond the boundaries of the original incision or wound Bailey and Love 27e pg: 30", "cop": 2, "opa": "Excessive scar tissue that does not extend beyond the boundary of the original incision or wound.", "opb": "Excessive scar tissue that extends beyond the boundaries of the original incision or wound", "opc": "Pale, flat and stretched in appearance, often appearing on the back and in areas of tension.", "opd": "Pale, flat and stretched in appearance, often appearing on the chest and sternum and in areas of no tension.", "subject_name": "Surgery", "topic_name": "General surgery", "id": "9d3acbf8-4158-4c0c-a21a-88cddeb8b745", "choice_type": "single"} {"question": "Nexus criteria in trauma is used for", "exp": "Ref: ALTS, 10th edition Pgno: 140", "cop": 1, "opa": "Intubation", "opb": "Burns resuscitation", "opc": "Blood transfusion", "opd": "Taking X-Ray cervical spine", "subject_name": "Surgery", "topic_name": "Trauma", "id": "a9e47fdc-a237-467f-9afb-e21d1bc0268c", "choice_type": "single"} {"question": "Bent inner tube sign is seen in", "exp": "Ans. (a) VolvulusRef: Manipal Manual of surgery, 4th ed./739* In sigmoid volvulus, the X ray abdomen erect shows hugely dilated sigmoid loop called bent inner tube sign.* Acute sigmoid volvulus presents as intestinal obstruction and starts after straining at stool. It occurs in anti-clockwise direction and after one and a half turns, the entire loop becomes gangrenous.* The percussion note on the abdomen shall be tympanitic note.", "cop": 1, "opa": "Volvulus", "opb": "Intussusception", "opc": "Intestinal obstruction", "opd": "Gastric antral vascular ectasia", "subject_name": "Surgery", "topic_name": "Oesophagus", "id": "a3ecc768-36d9-4e9e-88ae-dbf03f300555", "choice_type": "single"} {"question": "Sequence of colour changes observed in Raynaud's disease.", "exp": "Triphasic Color Response Include Three Stages Blanching (stage of local syncope) With exposure to cold, digital aerioles goes into spasm Decreased flow is evidenced by pallor or blanching Digits may appear white Cyanosis (stage of local asphyxia) Capillaries and venules dilate Red Engorgement (stage of recovery) With rewarming or passing of attack, the digital vasospasm resolves Blood flow into dilated aeries and capillaries increases dramatically Reactive hyperemia impas bright red color to the digits", "cop": 2, "opa": "Red, blue, white", "opb": "White, blue, red", "opc": "Blue, red, white", "opd": "White, red, blue", "subject_name": "Surgery", "topic_name": "Aerial disorders", "id": "edbd92c3-686d-47c3-8631-21122787e37a", "choice_type": "single"} {"question": "Life span of microfilaria in human blood is", "exp": "Life span of micro filaria in human blood is 3 Months.", "cop": 2, "opa": "2 Months", "opb": "3 Months", "opc": "4 Months", "opd": "6 Months", "subject_name": "Surgery", "topic_name": null, "id": "6f97da22-b86f-4785-8411-d93b06be37eb", "choice_type": "single"} {"question": "Major complication of cysto gastrostomy for pseudo pancreatic cyst is", "exp": ".Cysto-gastrostomy: At laparotomy, anterior wall andvposterior wall of the stomach is opened. Brownish fluidvis aspirated. The thick capsule of pseudocyst isbopened. All fluid with necrotic material are sucked.bFluid should be sent for cytology, culture and sensitivity and amylase estimation. Cyst wall always should be biopsied. Cyst cavity should be washed with normal saline after breaking septae. Pseudocapsule is anastomosed to posterior wall of the stomach--Jurasz operation. 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", "cop": 4, "opa": "Infection", "opb": "Obstruction", "opc": "Fistula", "opd": "Haemorrhage", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "4b437e97-d10f-4c41-9e10-97782a238c86", "choice_type": "single"} {"question": "Circumcision is contraindicated in", "exp": "Circumcision is not done in patients with hypospadias as the prepuce can later be used in surgical repair. Circumcision is mostly done for cultural reasons. The medical indications for circumcision are: Phimosis & Paraphimosis Recurrent balanoposthitis. (i.e. inflammation of the foreskin) Recurrent urinary tract infection. (Circumcision is occasionally justified in boys with an abnormal upper urinary tract and recurrent urinary infection. It may also help boys with spina bifida who need to perform clean intermittent urethral catheterization.) An emerging and still controversial indication for circumcision is in the prevention of sexually acquired human immunodeficiency virus (REV) infection in communities where this disease is common; large clinical trials have recently shown that circumcision reduces the risk of HIV transmission. Circumcision for medical reasons is best performed under general anesthesia. Reference : page 1056 SRB's manual of surgery 5th edition and page1371 Bailey and Love's sho practice of surgery 25th edition", "cop": 2, "opa": "Balanitis", "opb": "Hypospadias", "opc": "Paraphimosis", "opd": "Meatal stenosis", "subject_name": "Surgery", "topic_name": "Urology", "id": "978548ac-5024-495b-a0df-4967c4d07e3e", "choice_type": "single"} {"question": "Paget's disease of the nipple is treated by", "exp": "Ans. is 'c' i.e., Biopsy and Simple mastectomy Paget's disease of nipple is a chronic eczematous eruption of nipple which may progress to an ulcerated weeping lesion. It is almost always associated with an underlying ductal carcinoma (may be in situ Ca or invasive). The underlying lesion may be palpable or not. A complete mammographic workup and biopsy of the nipple and underlying mass if present is done. Pathognomonic histological feature is presence of Paget's cells in the epithelium. A skin specimen containing cells confirms the diagnosis and can be obtained by nipple scrape cytology or biopsy. Paget's disease may be confused with superficial spreading melanoma. Differentiation from pagetoid intraepithelial melanoma is based on the presence of S-100 antigen immunostaining in melanoma and carcinoembryonic antigen immunostaining in Paget's disease. Treatment of Paget's disease includes : - mastectomy + axillary staging (axillary dissection or sentinel node biopsy) wide excision of the nipple and areola to achieve clear margins + radiation + axillary staging, or lumpectomy + radiation therapy + axillary lymph node procedure", "cop": 3, "opa": "Radiotherapy", "opb": "Radical mastectomy", "opc": "Biopsy and simple mastectomy", "opd": "Chemotherapy", "subject_name": "Surgery", "topic_name": null, "id": "b9d2baab-4f7d-4411-8650-fab5f10eba1d", "choice_type": "single"} {"question": "Hematemesis is not the most common symptom of", "exp": "Clinical features of Carcinoma esophagus Early stage cancers: Asymptomatic or mimic symptoms of GERD MC symptom : Dysphagia >Weight loss Most patients with esophageal cancer present with dysphagia and weight loss, symptoms that usually indicate advanced disease Choking, coughing and aspiration from a tracheoesophageal fistula (In advanced cases) Hoarseness and vocal cord paralysis from direct invasion into the recurrent laryngeal nerve (In advanced cases) MC site of metastasis : Liver>lung>bone Paraneoplastic manifestation associated with adenocarcinoma : Motor neuropathy Ref: Sabiston 20th edition Pgno : 1038", "cop": 3, "opa": "Esophageal varices", "opb": "Gastric ulcer", "opc": "Carcinoma esophagus", "opd": "Zollinger Ellison syndrome", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "97324a9e-dd8a-421a-84bf-8854f505d421", "choice_type": "single"} {"question": "Most common site of metastasis for Breast Carcinoma is", "exp": "1) Bone(most common) (70%) - in order -lumbar veebrae, femur, ends of long bone, thoracic veebrae, ribs, skull 2)Liver 3)Lung- causes malignant pleural effusion and cannon ball secondaries. 4)Brain- causes increased ICP 5)Adrenals and ovaries Reference: SRB's Manual of Surgery, 6th Edition, page no = 530.", "cop": 4, "opa": "Thoracic veebra", "opb": "Pelvis", "opc": "Femur", "opd": "Lumbar veebra", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "1f878ad7-2362-466d-9d06-a8e0e6e6bc15", "choice_type": "single"} {"question": "Shoulder pain post laparoscopy is due to", "exp": "Laparoscopy Needle used for pneumoperitoneum : Veress needle Most commonly used gas: CO2 Flow of gas : 1L/min Intra abdominal pressure : 12-15mmHg Trocar is inseed at or just below the umbilicus penetrating skin, superficial & deep fascia, fascia transversalis & parietal peritoneum Post-laparoscopy shoulder pain is due a to CO2 retention causing irritation of diaphragm & referred pain to the shoulder through phrenic nerve Ref: Sabiston 20th edition Pgno : 394-396", "cop": 2, "opa": "Subphrenic abscess", "opb": "CO2 retention", "opc": "Positioning of the patient", "opd": "Compression of the lung", "subject_name": "Surgery", "topic_name": "Urology", "id": "88ca5ced-be9a-4e13-89e9-5e392e51c219", "choice_type": "single"} {"question": "Laser used in the treatment of ureteric calculi is", "exp": "The Ho:YAG laser is a 2140-nm pulsed laser that is used for soft-tissue and lithotripsy applications in urology. The 2140-nm wavelength is strongly absorbed in water, traveling only about 0.5 mm in the fluid medium, making it ideal for the urologicenvironment. In the prostate, the absorption depth is about 0.4 mm resulting in a high-energy density that leads to the rapid vaporization of tissue. In the 1980s, lasers first became of interest to researchers and clinicians in urology, and at the present time a wide range of lasers are employed to treat various soft-tissue and stone conditions. Although the holmium:yttrium-aluminum-garnet (Ho:YAG) laser has become the accepted gold standard for the treatment of urinary calculi at this time, various wavelengths of lasers are employed to treat soft-tissue conditions such as stricture disease, benign prostatic hyperplasia (BPH), urothelial cell cancer, and genital skin lesions ref : Campbell - Walsh urology 11th edition , chapter 11 , pg no :- 228", "cop": 1, "opa": "Holmium", "opb": "Nd-Yag", "opc": "Argon", "opd": "CO2", "subject_name": "Surgery", "topic_name": "Urology", "id": "afe0d4c8-3ce6-4758-a617-890194320e6a", "choice_type": "single"} {"question": "In LAHSHAL terminology for cleft lip & cleft palate, LAHSHAL denotes", "exp": "Ref: Bailey and love 27th edition Pgno :637 LAHSAL system of Classification LAHSAL system is a diagrammatic classification of cleft lip & cleft palate In this classification system, mouth is divided into 6 pas. I.e., LAHSAL Right Lip; right Alveolus ; Hard palate ; Soft palate ; Left Alveolus ; Left lip First character is for patients right lip & last character for patients left lip Complete cleft is indicated with a capital letter & an incomplete cleft with small letter No cleft is represented with a dot Examples of LAHSAL system of Classification Bilateral complete cleft lip & palate LAHSAL Left complete cleft lip ..... L Right Incomplete cleft lip & Alveolus la.... Incomplete hard palate, complete soft palate defect .. hS..", "cop": 3, "opa": "Bilateral cleft palate only", "opb": "Bilateral cleft lip only", "opc": "Bilateral cleft lip & palate", "opd": "No cleft", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "23cfe240-65b5-461f-9c60-098865d37810", "choice_type": "single"} {"question": "A patient presented with episodes of flushing and hypotension. His urinary 5HIAA levels were found to be increased. The diagnosis is", "exp": "(B) Carcinoid syndrome # Carcinoid syndrome-Clinical findings include:> Flushing of the skin> Diarrhea and abdominal cramps> Right sided heart disease> Bronchoconstriction> Abdominal pain due to desmoplastic reaction of the mesentery in most patients, increased urinary excretion of 5-HIAA (5-hydroxy-indoleacetic acid), a degradation product of serotonin> Serotonin causes fibrosis of the tricuspid valve and pulmonary valve> \"TIPS\" - Tricuspid Insufficiency, Pulmonic Stenosis (fibrosis of tricuspid and pulmonary valves)", "cop": 2, "opa": "Pheochromocytoma", "opb": "Carcinoid syndrome", "opc": "Addison's disease", "opd": "SIADH", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "6e2bd1fd-ad6f-4c42-8551-7294c3240dae", "choice_type": "single"} {"question": "Petersen hernia is", "exp": "Peterson Hernia Petersen hernias are internal hernias which occur in the potential space posterior to a gastrojejunostomy. This hernia is caused by the herniation of intestinal loops through the defect between the small bowel limbs, the transverse mesocolon and the retroperitoneum, after any type of gastrojejunostomy. The laparoscopic approach facilitates the occurrence of this type of hernia, due to the lack of post-operative adhesions which prevent bowel motility and hence, herniation. These hernias occur in patients with a Roux-en-Y gastric bypass Clinical presentation usually presents with diffuse abdominal pain (could be caused by bowel obstruction with spontaneous reduction) may present as intestinal obstruction late postoperative obstruction may be due to adhesions, fibrotic stenosis, intussusception or more often, internal hernias Ref: internet sources", "cop": 1, "opa": "Internal hernia behind roux en Y limb", "opb": "Internal hernia transverse mesocolon", "opc": "Cervical hernia", "opd": "Hernia epiploic foramen", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "c41a5bca-83a2-4b58-8f40-e7073d36ddb5", "choice_type": "single"} {"question": "Indication of Sentinel node Biopsy in cancer breast", "exp": "Ans. (c) Breast Mass without palpable axillary node(Ref. Bailey and love 27th edition Page 877)* Sentinel node biopsy is indicated only for Node non palpable cases.* Palpable node always Cytology (FNAC) Done", "cop": 3, "opa": "Metastasis", "opb": "Breast mass with Palpable Axillary Node", "opc": "Breast mass without Palpable Axillary node", "opd": "Stage III cases", "subject_name": "Surgery", "topic_name": "Breast", "id": "763c7dac-a534-4473-90ca-d594cae828a6", "choice_type": "single"} {"question": "A 60 yr old smoker came with a history of painless gross hematuria for one day. Most logical investigation would be", "exp": "In this case, we should suspect bladder carcinoma ( transitional cell carcinoma ) . Smokers are at a higher risk of developing TCC.Other risk factors being chemical .industry workers in western countries and schistosomiasis in endemic regions . It is more common in males -3:1. They usually presents with painless gross hematuria. Thus the best option here is urine microsopy for RBC's and malignant cells.urine cytology even though not a good screening test because of lack of sensitivity is highly specific . Mainstay of diagnosis is cystourethroscopy. investigations include imaging ( CT , MRI ,USG ,IVU ) and blood investigations for HB , electrolytes and urea . Bailey and Love 27th edition.chapter 77.pg no 1449.", "cop": 4, "opa": "Urine routine", "opb": "Plain X ray KUB", "opc": "USG KUB", "opd": "Urine microscopy for malignant cytology", "subject_name": "Surgery", "topic_name": "Urology", "id": "7ef8dfdf-60ce-4701-8fd5-f7a6553d8fb9", "choice_type": "single"} {"question": "The most common cause of non union is", "exp": "B i.e. Inadequate immobilization", "cop": 2, "opa": "Infection", "opb": "Inadequate immobilization", "opc": "Ischaemia", "opd": "Soft tissue interposition", "subject_name": "Surgery", "topic_name": null, "id": "52413a3c-0062-4591-af3c-f2ccb6c3884c", "choice_type": "single"} {"question": "Foaming liver seen with infection by", "exp": "Foaming Liver is characteristic of gas gangrene.", "cop": 3, "opa": "Corynebacterium diphtheriae", "opb": "Clostridium tetani", "opc": "Clostridium tetani", "opd": "Mycobacterium tuberculosis", "subject_name": "Surgery", "topic_name": null, "id": "8a5d5cee-5d5b-4a3d-8f00-4cc0b4393e6d", "choice_type": "single"} {"question": "Most common extra intestinal manifestation of amoebiasisis", "exp": "Ans. is 'a' i.e., Amoebic liver abscess * Amoebic Ever abscess is the most common extraintestinal manifestation of amebiasis. Disease begins when E. histolytica trophozoites penetrate through the colonic mucosa, travel through the portal circulation, and reach the liver.* Most individuals with amebic liver abscess do not have concurrent signs or symptoms of colitis, and most do not have E. histolytica trophozoites in their stools.* The classic presentations of amebic liver abscess are right-upper-quadrant pain, fever, and hepatic tenderness.* The most common laboratory findings are leukocytosis (without eosinophilia), an elevated alkaline phosphatase level, mild anemia, and an elevated erythrocyte sedimentation rate.", "cop": 1, "opa": "Amoebic liver abscess", "opb": "Pleural effusion", "opc": "Atelactasis", "opd": "Cardiac tamponade", "subject_name": "Surgery", "topic_name": "Liver", "id": "2a277f98-5539-450f-9db9-5ed1dd9165a1", "choice_type": "single"} {"question": "The most common organism that causes the following condition is", "exp": "The above image is that of cellulitis of the leg.Cellulitis is a non-suppurative, invasive infection of tissues, which is usually related to the point of injury.Typically caused by B haemolytic streptococci, staphylococci and Clostridium perfringens. Streptococci being the commonest.Necrotising fasciitis is mostly polymicrobialGas gangrene is caused by Clostridium perfringens.Ref: Bailey and love 27th edition PG: 48", "cop": 2, "opa": "Poly-microbial", "opb": "beta haemolytic streptococci", "opc": "Clostridium perfringes", "opd": "Clostridium tetani", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "c224f3c3-6f1c-4a84-be54-753455c55b4c", "choice_type": "single"} {"question": "Membranous urethral rupture causes collection of blood in", "exp": null, "cop": 2, "opa": "Ischiorectal fossa", "opb": "Deep perineal pouch", "opc": "Superficial inguinal region", "opd": "Pelvic diaphragm", "subject_name": "Surgery", "topic_name": null, "id": "f5d55410-be14-4dcd-92c6-1dc5dda3bb98", "choice_type": "single"} {"question": "'Tennis elbow' is characterized by", "exp": "Tennis Elbow (Lateral Epicondylitis) This is the most common cause of elbow pain excluding traumatic conditions Usually occur in patients of 30-40 years, etiology is unknown in most cases Strenous or over activity may precede spymptoms Anterodistal lateral epicondyle tenderness Diagnosis Resisted wrist extension is a reliable diagnostic test Local anaesthetic injection is diagnostically helpful Treatment Vast majority improve with supervised Conservative management Open or ahroscopic release yields good results in recalcitrant cases Ahroscopic release also identifies associated pathology Ref: Bailey and love 27th edition Pgno : 448", "cop": 2, "opa": "Tenderness over the medial epicondyle", "opb": "Tenderness of common extensor origin", "opc": "Tendinitis of common flexor origin", "opd": "Painful flexion and extension", "subject_name": "Surgery", "topic_name": "Trauma", "id": "3961cabf-a37b-4581-86e4-ddd980cb039a", "choice_type": "single"} {"question": "MANTREL score is done for", "exp": "Ans. (a) Acute appendicitisCharacteristicScoreM = Migration of pain to the RLQ1A = Anorexia1N = Nausea and vomiting1T = Tenderness in RLQ2R = Rebound pain1E = Elevated temperature1L = Leukocytosis2S = Shift of WBCs to the left1Total10RLQ = right lower quadrant; WBCs = white blood cells", "cop": 1, "opa": "Acute appendicitis", "opb": "Acute pancreatitis", "opc": "Acute cholecystitis", "opd": "Acute salpingitis", "subject_name": "Surgery", "topic_name": "Acute Appendicitis", "id": "692a214e-bc29-4d61-9b9f-c39c418fb29b", "choice_type": "single"} {"question": "Incision used for modified Radical neck dissection", "exp": "Mac fee incision & Modified schobinger incision are the incisions used for MRND.", "cop": 3, "opa": "Kocher incision", "opb": "Grid iron incision", "opc": "Macfee incision", "opd": "Sistrunk incision", "subject_name": "Surgery", "topic_name": null, "id": "d8679a52-fc78-40f3-b479-c079fe2c6575", "choice_type": "single"} {"question": "The intense pain associated with a felon occurs because of", "exp": "A closed space infection : A felon is an infection of the distal pulp space of a digit, usually secondary to a puncture wound. This is a closed space at the level of the distal interphalangeal joint. Since the infection cannot spread proximal to this point, pain is throbbing and intense. Late osteomyelitis may develop in the distal phalanx if the felon is not opened appropriately.", "cop": 2, "opa": "Bone involvement", "opb": "A closed space infection", "opc": "Digital aery thrombosis", "opd": "Nail bed involvement", "subject_name": "Surgery", "topic_name": null, "id": "43476820-3ad3-4045-a2c8-25a15a908f75", "choice_type": "single"} {"question": "The most common location of hypertensive intracranial haemorrhage is", "exp": "Most common locations of hypertensive intraparenchymal hemorrhage are\n\n\nbasal ganglia (especially the putamen)\n\n\nthalamus\ncerebellum\nports\n\n\nIt usually results from spontaneous rupture of small penetrating artery deep in the brain.", "cop": 2, "opa": "Subarachnoid space", "opb": "Basal ganglia", "opc": "Cerebellum", "opd": "Brain stem", "subject_name": "Surgery", "topic_name": null, "id": "bb8666d1-54a3-43c1-8b3d-d92e6bf3b9fe", "choice_type": "single"} {"question": "Thierch graft consists of", "exp": "Thiersch graft is a split thickness skin graft and therefore consists of epidermis and variable portion of dermis.", "cop": 3, "opa": "Only epidermis", "opb": "Epidermis and entire dermis", "opc": "Epidermis and variable portion of dermis", "opd": "Dermis and subcutaneous tissue", "subject_name": "Surgery", "topic_name": null, "id": "2b4b6a70-7f52-4385-a65d-16b87b28beda", "choice_type": "single"} {"question": "French in Foley's Catheter refers to", "exp": "Ans. (c) Diameter of catheterRef Internet Sources, Wikipedia* The French scale or French gauge system (most correctly abbreviated as Fr, but also often abbreviated as FR or F) is commonly used to measure the size (diameter) of a catheter.* 1Fr=0.33mm, and therefore, the diameter of the catheter in millimeters can be determined by dividing the French size by 3:# D(mm)=Fr/3 or# Fr = D (mm) x3For example, if the French size is 9, the diameter is 3mm.Note that the French scale is a measurement of the diameter, not the circumference (diameter xp).* An increasing French size corresponds to a larger diameter catheter. This is contrary to needle-gauge size, where the diameter is 1/gauge, and where the larger the gauge the narrower the bore of the needle.", "cop": 3, "opa": "Outer circumference measurement", "opb": "Inner circumference measurement", "opc": "Diameter of catheter", "opd": "Lumen size", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "064485e5-6202-467d-8891-c24af581ece1", "choice_type": "single"} {"question": "A 16 years old female patient has abdominal lump that is movable and painless, upon exploratory laparotomy a cystic lump is found arising from mesentery, diagnosis is", "exp": "Answer- B. Mesenteric cystMesentric cyst present asA painless abdominal swellingThe swelling moves freely in a plane at right angles to the attachment of the mesentry.Recurrent attacks of abdominal pain with or without vomiting due to obstructive symptoms.", "cop": 2, "opa": "Enterocele", "opb": "Mesenteric cyst", "opc": "Choledochal cyst", "opd": "Pancreatic pseudocyst", "subject_name": "Surgery", "topic_name": null, "id": "c2cd3de2-f593-4218-83f5-4a23517a60a2", "choice_type": "single"} {"question": "Day care surgery can be done in", "exp": ".* Lateral anal sphincterotomy - Here internal sphincter is divided paially away from the fissure either in right or left lateral positions (also gives a good result). - Here closed or open methods (Notaras) are used. Sphincterotomy is done below the dentate line. In closed method no 11 blade is inseed into the intersphincteric groove to pass upwards. Blade is moved medially to cut lower 1/3 or 1/2 of the internal sphincter. In open method skin is incised laterally, external to anal verge. Hyperophied band of lower pa of internal sphincter is dissected and divided. Wound is left open. - Haematoma, perianal abscess, bruising, fistula, incontinence are the complications of lateral sphincterotomy. ref:SRB&;s manual of surgery,ed 3,pg no 913", "cop": 1, "opa": "Lateral sphincterotomy", "opb": "Rhinoplasty", "opc": "Orchidectomy", "opd": "Total thyroidectomy", "subject_name": "Surgery", "topic_name": "Urology", "id": "46303f5f-9688-4f6c-bb48-41e823b66315", "choice_type": "single"} {"question": "Eburnation is seen in", "exp": null, "cop": 2, "opa": "Malunion", "opb": "Non union", "opc": "Osteomyelitis", "opd": "Osteoradionecrosis", "subject_name": "Surgery", "topic_name": null, "id": "cee2afab-3e62-483f-bc0a-5f211d329334", "choice_type": "single"} {"question": "In BPH most common lobe involved is", "exp": "Ans is 'c' ie Median Anatomical division of ProstateProstate has 5 lobes :Anterior lobeis a small isthmus connecting the two lateral lobes in front of the urethra.Posterior lobeit connect the two lateral lobes behind the urethra. It lies behind the median lobe and the ejaculatory ducts. Carcinomas are most common in this lobe*.Median lobelies behind the upper part of the urethra, in front of the ejaculatory ducts just below the neck of the bladder.BHP arises in this lobe*.Lateral lobeslie one on each side of the urethra.Zonal or surgical division of ProstateProstate has 3 distinct zonesThe peripheral zone (PZ) - accounts for 70% of volume of young adult prostateThe Central zone (CZ) - accounts for 25%The transition zone (TZ) - accounts for 5%Carcinoma of prostate arises most commonly in -the peripheral zoneBenign prostatic hyperplasia originates in - the transition zone", "cop": 3, "opa": "Lateral", "opb": "Posterior", "opc": "Median", "opd": "Anterior", "subject_name": "Surgery", "topic_name": "Benign Prostatic Hyperplasia", "id": "9a4e8c38-a493-44c2-91e5-7863e962c5cf", "choice_type": "single"} {"question": "For Ca breast best chemotherapeutic regimen", "exp": "Chemotherapy using first generation regime such as 6-monthly cycle of cyclophosphamide, methotrexate and 5- fluorouracil(CMF) will achieve a 25% reduction in the risk of relapse over a 10-15 year peroid. Reference: Bailey and Love, 27th Edition, page no : 878.", "cop": 1, "opa": "Cyclophosphamide, methotrexate, 5-fluorouracil", "opb": "Methotrexate, cisplatin", "opc": "Cisplatin, adriamycin, steroid", "opd": "Methotrexate, adriamycin, steroid", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "54eb8bf8-4496-4667-8ca3-a441fc57a14f", "choice_type": "single"} {"question": "Initial emergency reduction of intracranial pressure is most rapidly accomplished by", "exp": "Closed head injuries may result in cerebral concussion from depression of the reticular formation of the brainstem. This type of injury is usually reversible. Local bleeding and swelling (intracranial or extracranial) produce an increase in the intracranial pressure. A characteristic symptom pattern occurs initiated by progressive depression of mental status. Increasing intracranial pressure tends to displace brain tissue away from the source of the pressure; if the pressure is sufficient, herniation of the uncal process through the tentorium cerebri occurs. Pupillary dilation is caused by compression of the ipsilateral oculomotor nerve and its parasympathetic fibers. If the pressure is not relieved, the contralateral oculomotor nerve will become involved and, ultimately, the brainstem will herniate through the foramen magnum and cause death. Hypeension and bradycardia are preterminal events. Emergency measures to reduce intracranial pressure while preparing for localization of the clot or for a craniotomy or both include hyperventilation, dexamethasone (Decadron), and mannitol infusion. Of these, hyperventilation produces the most rapid decrease in brain swelling.", "cop": 3, "opa": "Saline-furosemide (Lasix) infusion", "opb": "Urea infusion", "opc": "Hyperventilation", "opd": "Intravenous dexamethasone (Decadron)", "subject_name": "Surgery", "topic_name": null, "id": "1fc7d928-8d84-4e9a-80a3-f346be6dc327", "choice_type": "single"} {"question": "Best prognostic factor for head injury is", "exp": "The severity of head injury is classified according to glassglow coma scale(GCS) as it is the best predictor of neurological outcome. Mode of injury and age of the patient help in initial evaluation and management, CT helps in confirmation of the diagnosis. Their prognostic value is less when compared to GCS. Reference: Bailey and Love's Sho Practice of Surgery, 26th edition, Pg no:313", "cop": 1, "opa": "A.Glasgow coma scale", "opb": "B.Age", "opc": "C.Mode of injury", "opd": "D.CT", "subject_name": "Surgery", "topic_name": "Trauma", "id": "94d51fc0-0a30-409e-8406-9e14d67bbdb0", "choice_type": "single"} {"question": "Radiolucent renal stone", "exp": "Ans. (a) Uric acidRadiolucent kidney stones are-L.U.XRadio Lucent stones are Uric acid and Xanthine stones", "cop": 1, "opa": "Uric acid", "opb": "Calcium oxalate", "opc": "Triple phosphate", "opd": "Calciumphosphate", "subject_name": "Surgery", "topic_name": "Urolithiasis", "id": "023ab14d-0361-49bb-8c46-56307d805886", "choice_type": "single"} {"question": "Advantage of Minimal access surgery", "exp": "The core principles of minimal access surgery (independent of procedure or device) can be summarized by the acronym I-VITROS: * Insufflate/create space - to allow surgery to take place in the minimal access setting * Visualise - the tissues, anatomical landmarks and the environment for the surgery to take place * Identify - the specific structures for surgery * Triangulate - surgical tools (such as po placement) to optimise the efficiency of their action, and ergonomics by minimising overlap and clashing of instruments * Retract - and manipulate local tissues to improve access and gain entry into the correct tissue planes * Operate - incise, suture, anastomose, fuse * Seal/haemostasis. Ref: Bailey and love 27th edition Pgno : 105", "cop": 3, "opa": "Heat loss", "opb": "Better Hemostasis control", "opc": "Improved vision", "opd": "In wound pain", "subject_name": "Surgery", "topic_name": "Urology", "id": "ba11861d-197d-4932-b4c7-aa3de8adf917", "choice_type": "single"} {"question": "Aims of abbreviated laparotomy", "exp": null, "cop": 4, "opa": "Decreased chance of infection", "opb": "Early ambulation", "opc": "Early wound healing", "opd": "Hemostasis", "subject_name": "Surgery", "topic_name": null, "id": "5c2c1c66-366f-44ee-896e-8e2c89e0f316", "choice_type": "single"} {"question": "Most common differential diagnosis for appendicitis in children is", "exp": "Differential diagnosis of acute appendicitis in children Gastroenteritis Mesenteric adenitis Meckel's diveiculitis Intussusception Henoch-Schonlein purpura Lobar pneumonia Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1209", "cop": 2, "opa": "Gastroenteritis", "opb": "Mesentric lymphadenopathy", "opc": "Intussusception", "opd": "Meckel's diveiculitis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "3d399096-68bc-4d38-a439-0a3010791378", "choice_type": "single"} {"question": "Triple ahrodesis does not involve September 2010", "exp": "Ans. D: Tibiotalar Joint A triple ahrodesis consists of the surgical fusion of the talocalcaneal (TC), talonavicular (TN), and calcaneocuboid (CC) joints in the foot.", "cop": 4, "opa": "Calcaneocuboid Joint", "opb": "Talanovicular Joint", "opc": "Talocalcaneal Joint", "opd": "Tibiotalar Joint", "subject_name": "Surgery", "topic_name": null, "id": "54581d36-4c9c-4634-b15c-fb90353e6c7f", "choice_type": "single"} {"question": "An absent kidney is found in", "exp": "About 1 in 1400 people have a single kidney. Sometimes a ureter and renal pelvis are present with no kidney. The contralateral kidney is typically hyperophied. Reference: page 1282 Bailey and Love's sho practice of surgery 26th edition ( note : according to 27th edition Complete absence of one kidney occurs in 1 in 500-1000 bihs )", "cop": 3, "opa": "1:200 individuals", "opb": "1:700 individuals", "opc": "1:1400 individuals", "opd": "1:5000 individuals", "subject_name": "Surgery", "topic_name": "Urology", "id": "ce5dba32-2e1e-47a0-b9ce-e961ad0b5cbc", "choice_type": "single"} {"question": "From the surgery done below name the scoring used to diagnose this", "exp": "Ans. (a) ALVARDORef: Surgery Sixer 3rd Edition Page 442ALVARDO score is done to diagnose Acute appendicitis by clinical and Lab values.The mnemonic for this score is - MANTRELS* M- Migratory Pain (1 Score)* A- Anorexia* N- Nausea (1 Score)* T- Tenderness (2 Score)* E- Elevated Temperature (1 Score)* L- Leucocytosis (2 Score)* S- Shift of Neutrophils to left (1 Score)A value of > 7 is strongly suggestive of Appendicitis", "cop": 1, "opa": "ALVARDO", "opb": "RANSON", "opc": "MANTRELS", "opd": "BISAP", "subject_name": "Surgery", "topic_name": "Small & Large Intestine", "id": "388f90fd-c137-47fd-9cc5-15ad31629493", "choice_type": "single"} {"question": "Milroy's disease is", "exp": "Congenital lymphedema or Milroy disease (10%), that is present at bih and associated with an autosomal dominant familial history", "cop": 2, "opa": "Edema due to filariasis", "opb": "Congenital lymphedema", "opc": "Lymphedema following surgery", "opd": "Post cellulitic lymphedema", "subject_name": "Surgery", "topic_name": "Lymphatic System", "id": "cac3cf67-06ce-4aad-8118-2d7dc914e4cd", "choice_type": "single"} {"question": "Most common site for squamous cell ca. esophagus is", "exp": "Ans. is 'b' i.e., Middle third Distribution of Squamous cell Ca Upper 1/3 10% Middle 1/3 60% Lower 1/3 30% (Values according to Sabiston 17/e, may be different in other texts but are approx. the same)", "cop": 2, "opa": "Upper third", "opb": "Middle third", "opc": "Lower third", "opd": "Gastro-esophageal junction", "subject_name": "Surgery", "topic_name": null, "id": "20320f98-8862-4768-ae15-866262c3894c", "choice_type": "single"} {"question": "Entrance into the sinus in a Caldwell procedure is made through the", "exp": null, "cop": 2, "opa": "Malar eminence", "opb": "Canine fossa", "opc": "Tuberosity", "opd": "Zygomatic ridge", "subject_name": "Surgery", "topic_name": null, "id": "83f39d40-a41f-4d0b-a742-d42b28f158d8", "choice_type": "single"} {"question": "In a patient of acute cholecystitis, referred pain to the shoulder is k/a", "exp": "Boa's sign is the area of hyperaesthesia between 9th and 11th ribs posteriorly on the right side,i.e.,below the right scapula,sign of acute cholecystitis. Murphy's sign is right upper quadrant tenderness that is exacerbated during inspiration by the examiner's right subcostal palpation.It's also a sign of acute cholecystitis. Grey turner sign is the skin discolouration in the left flank in cases of acute hemorrhagic pancreatitis. Cullen's sign is the discolouration of umbilicus and surrounding skin(umbilical black eye).It's due to hemoperitoneum & seen in conditions like ruptured ectopic pregnancy,acute hemorrhagic pancreatitis. Reference:SRB's manual of surgery,5th edition,page no:644;Bailey & Love's manual of surgery,25th edition,page no:1121.", "cop": 3, "opa": "Murphy's sign", "opb": "Gray Turner sign", "opc": "Boa's sign", "opd": "Cullen's sign", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "b1977a59-7f72-46b8-bf70-4e9397d9fec2", "choice_type": "single"} {"question": "Lipodermatosclerosis is most commonly seen at", "exp": "Lipodermatosclerosis Lipodermatosclerosis is the name given to skin changes seen in chronic venous insufficiency Components of lipodermatosclerosis Pigmented skin Inflammed Subcutaneous tissue Elevated venous pressure facilitates the Extravasation of the RBC'S and fluid leaking to inflammation The pigmentation is due to fixation of hemosiderin in the tissue It is most commonly seen in gaiter area (above medial malleous) Ref: Sabiston 20th edition Pgno : 1832", "cop": 2, "opa": "Anterior aspect of leg", "opb": "Medial aspect of leg", "opc": "Anterior aspect if thigh", "opd": "Posterior aspect of thigh", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "0b1b4fbb-f391-41aa-9db4-9334278f846b", "choice_type": "single"} {"question": "Idea of adrenal biopsy should be made after ruling out", "exp": "Ans. (c) PheochromocytomaRef: Bailey and love, 26th ed; pg. 779Adrenal gland biopsy* Never biopsy an adrenal mass until pheochromocytoma has been biochemically excluded* The indication for adrenal gland biopsy is to confirm adrenal gland metastasis", "cop": 3, "opa": "Adrenocortical carcinoma", "opb": "Metastases", "opc": "Pheochromocytoma", "opd": "Cushing's syndrome", "subject_name": "Surgery", "topic_name": "Pancreas", "id": "b5857254-bc6d-43c0-95dc-69e5723126d8", "choice_type": "single"} {"question": "Treatment of SNT with Lymph node involvement", "exp": "Ans. (d) Total thyroidectomy + MRNDRef: Page 1537/ Schwartz 10th edition* A solitary nodule with Lymph node involvement is suggestive of Papillary cancer. So Total thyroidectomy + MRND on that side is must.", "cop": 4, "opa": "Radiation", "opb": "Chemotherapy", "opc": "Excision of nodule", "opd": "Total thyroidectomy + MRND", "subject_name": "Surgery", "topic_name": "Thyroid Gland", "id": "c4ca04ee-a1ff-478a-9784-b872dc90e86e", "choice_type": "single"} {"question": "Investigation of choice for submandibular sialolithiasis is", "exp": "X ray is IOC for submandibular sialolithiasis as most of the stones are radio-opaque.", "cop": 4, "opa": "Sialography", "opb": "CT scan", "opc": "USG", "opd": "X-ray", "subject_name": "Surgery", "topic_name": null, "id": "43c85224-1441-4cd9-b3a5-7eb8435831c3", "choice_type": "single"} {"question": "A 25 year old female complains of discharge of blood from a single duct in her breast. The appropriate treatment is", "exp": ".DUCT PAPILLOMA - * Commonest cause of bloody discharge from nipple * It is usually single, from a single lactiferous duct * It blocks the duct causing ductal dilatation * Papilliferous swelling (projection), usually seen near the nipple orifice. * Blood stained discharge from the nipple is common. * But serous or serosanguinous discharge can also occur. * Single papilloma is not premalignant. * But multiple papillomas in many ducts can be premalignant. Treatment -Microdochectomy: Probed lactiferous duct is opened, and the papilloma is excised using tennis racquet incision ref:SRB&;s manual of surgery,ed 3,pg no 467.", "cop": 2, "opa": "Radical excision", "opb": "Microdochectomy", "opc": "Radical mastectomy", "opd": "Biopsy to rule out carcinoma", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "b2503079-8eb1-4f7c-965a-e4bb4696d3e3", "choice_type": "single"} {"question": "Compament syndrome is treated by", "exp": "A i.e. Fasciotomy", "cop": 1, "opa": "Fasciotomy", "opb": "Bicarbonate", "opc": "Chloride rich fluid", "opd": "Early aggressive fluid", "subject_name": "Surgery", "topic_name": null, "id": "48a0ef45-6b97-4146-9d0a-11fb37700788", "choice_type": "single"} {"question": "The mechel&;s diveiculum is situated within about .............. cm from the ileocecal valve", "exp": ".It is a congenital diveiculum arising from the terminal ileum and is pa of the unobliterated proximal poion of the vitello intestinal duct. It is- * 2% common. * 2 feet from the ileo-caecal valve. * 2 inch in length. * It is congenital, results from incomplete closure of vitello-intestinal duct. * It is the most common congenital anomaly of small intestine. * Arises from the antimesenteric border of the ileum, containing all three layers of the bowel with independent blood supply. ref:SRB&;s manual of surgery,ed 3,pg no 798", "cop": 2, "opa": "25", "opb": "60", "opc": "75", "opd": "100", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "9a7f31ca-b77b-47c2-ba7d-fe6126240f5a", "choice_type": "single"} {"question": "Most common site of chronic fissure in ano", "exp": "Chronic fissure in ano will present as skin tags in posterior anal canal.", "cop": 3, "opa": "Anterior", "opb": "Anterolateral", "opc": "Posterior", "opd": "Lateral", "subject_name": "Surgery", "topic_name": null, "id": "0459bc71-1575-4180-884e-d89eb7a329f8", "choice_type": "single"} {"question": "Consider the following", "exp": ".", "cop": 1, "opa": "Cholesterosis", "opb": "Adenomyomatosis", "opc": "Polyposis", "opd": "Cholelithiasis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "2bed401d-132f-4010-a78d-29bc8cf7b2dc", "choice_type": "single"} {"question": "Boyd's classification is with regard to", "exp": "Boyd's classification is with regard to claudication.", "cop": 2, "opa": "Limb ischaemia", "opb": "Arterial stenosis", "opc": "Claudication", "opd": "AV fistula", "subject_name": "Surgery", "topic_name": null, "id": "66158f2a-d7fb-4cef-831e-48c7c5efd21d", "choice_type": "single"} {"question": "Treatment of Congenital Hydrocephalus is", "exp": "Ans. (d) VP shuntRef: Bailey and Love 27th edition Page 655Treatment of Congenital Hydrocephalus:* Temporary CSF diversion by External Ventricular Drain* Ventriculo peritoneal shunt is long term mainstay management* Endoscopic Third Ventriculostomy* Lumbar Puncture is also a temporary measure until VP shunt is made.", "cop": 4, "opa": "Stereotactic Surgery", "opb": "Diuretics", "opc": "Radiotherapy", "opd": "VP shunt", "subject_name": "Surgery", "topic_name": "Nervous System", "id": "44c9289d-3dc9-4fd7-8d88-dab3d2673308", "choice_type": "single"} {"question": "'Liver shrinkage diet' is advised before", "exp": "In bariatric surgery, 'liver shrinkage diet' for at least 2 weeks before surgery is advised, especially when there is central obesity, as this is associated with large livers that can make surgery impossible.Ref: Bailey and love 27e pg: 1146", "cop": 3, "opa": "Liver resections", "opb": "Whipple's procedure", "opc": "Bariatric surgery", "opd": "Biliary surgery", "subject_name": "Surgery", "topic_name": "General surgery", "id": "8ebea7a2-28d5-4021-a06f-491369bb706b", "choice_type": "single"} {"question": "Entonox is combination of", "exp": "B. i.e. (50% oxygen : 50% N2O) (132 - Lee s synopsis of anaesthesia 13th )ENTONOX - is the trade name for a 50 - 50 mixture of gaseous N2O and O2* The cylinder shoulder is painted white and blue in quarters and body is blueUses include - obstetric analgesia, and analgesia for dressed wounds, coronary infarction and dental surgery**PIN number for oxygen - 2, 5 for Entonox- 7. Nitrous oxide 3, 5, air 1, 5", "cop": 2, "opa": "25% oxygen 25%N2O", "opb": "50% oxygen 50%N2O", "opc": "75% oxygen 25% N2O", "opd": "100% oxygen 0%N2O", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "508f8cdf-8fe1-44df-8148-e30f825f4588", "choice_type": "single"} {"question": "Gate control theory of pain is due to", "exp": null, "cop": 1, "opa": "Substantial gelatinosa", "opb": "A delta fibres", "opc": "C-fibres", "opd": "Free nerve endings", "subject_name": "Surgery", "topic_name": null, "id": "c84f967d-020d-4ca2-8517-785bb5d5ca1e", "choice_type": "single"} {"question": "Aerial enhancement and venous phase washout in a liver mass larger than 2 cm is diagnostic for", "exp": ".", "cop": 4, "opa": "Hemangioma", "opb": "Focal nodular hyperplasia", "opc": "Adenoma", "opd": "Hepatocellular carcinoma", "subject_name": "Surgery", "topic_name": "All India exam", "id": "b5882156-9c5b-480d-a63b-adbf127ec110", "choice_type": "single"} {"question": "Mild head injury is having glassgow coma scale of", "exp": "There are a number of schemes to stratify the severity of head injury. Any such categorization isarbitrary and will be imperfect. A simple system based only on GCS score is as follows:* GCS 14-15 =mild* GCS 9-13 =moderate* GCS<=8 =severe ref; handbook of neurosurgery, Mark S.Greenberg P-825 glasgow coma scale EYE OPENING spontaneous -4 to speech -3 to pain -2 no response -1. VERBAL RESPONSE oriented -5 confused conversation -4 inappropriate words -3 incomprehensible sounds -2 no verbal response at all -1 MOTOR RESPONSE obeys commands -6 localises pain -5 withdrawal response -4 abnormal flexion -3 extension -2 no response -1", "cop": 4, "opa": "A.10-15", "opb": "B.13-14", "opc": "C.12-14", "opd": "D.14-15", "subject_name": "Surgery", "topic_name": "Trauma", "id": "909c97b8-90ba-491b-a65a-ad5e2d71dd48", "choice_type": "single"} {"question": "BRCA 2 gene is associated with carcinoma of", "exp": "The genes associated with breast cancers are p53, BRCA1 and BRCA2. BRCA2 is located on chromosome 13q and there is an association with male breast cancer. While BRCA1 gene has been associated with an increased incidence of breast and ovarian cancer and is located on the long arm of chromosome 17(17q). Reference : Bailey & Love, 27th Edition, page no =880.", "cop": 1, "opa": "Breast", "opb": "Lung", "opc": "Liver", "opd": "Gastric carcinoma", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "b33f4e19-22e9-412a-96e2-8a63e52df573", "choice_type": "single"} {"question": "The commonest site of lodgement of a pulmonary embolus is in the territory of", "exp": null, "cop": 4, "opa": "Rt. lower lobe", "opb": "Rt. upper lobe", "opc": "Lt. lower lobe", "opd": "Lt. upper lobe", "subject_name": "Surgery", "topic_name": null, "id": "02489143-f698-4478-aadc-923b5d93a844", "choice_type": "single"} {"question": "Preferred time for cleft lip repair surgery is", "exp": "U/L cleft lip : 5 - 6 months.\nBilateral cleft lip : 4 - 5 months.", "cop": 1, "opa": "5 - 6 months", "opb": "6 - 12 months", "opc": "12 - 18 months", "opd": "12 - 24 months", "subject_name": "Surgery", "topic_name": null, "id": "c6f5605d-fe19-4df8-86ee-db87572010c1", "choice_type": "single"} {"question": "Most common site of instrumentation perforation in oesophagus is", "exp": "Ans) a (Cervical) Ref sabiston 18th ed pi 110Endoscopic procedures are the most common cause of iatrogenic esophageal perforation, with the cricopharyngeal area most commonly injured.", "cop": 1, "opa": "Cervical", "opb": "Esophago gastric junction", "opc": "Intra-abdominal", "opd": "Lower l/3rd", "subject_name": "Surgery", "topic_name": "Oesophagus", "id": "9bf08dc3-00d8-460f-926b-3a00ef39bf51", "choice_type": "single"} {"question": "\"Figure of Eight\" bandage used commonly in the fracture of", "exp": "C i.e. Clavicle", "cop": 3, "opa": "Scapula", "opb": "Humerus", "opc": "Clavicle", "opd": "Metacarpals", "subject_name": "Surgery", "topic_name": null, "id": "2c8c1a08-5f49-4b7a-b3d6-c2f1ac4ac4fb", "choice_type": "single"} {"question": "Tumor seen in Barret's Esophagus", "exp": "Ans. (a) AdenocarcinomaRef: Surgery Sixer 3rd Edition Page 330Predisposing factors of Esophageal Adenocarcinoma:* GERD* Barret's Esophagus* Obesity* Scleroderma* High Protein Diet and Fat Diet* SmokingNote: H. pylori producing cag -A toxin is protective against Adenocarcinoma of Esophagus", "cop": 1, "opa": "Adenocarcinoma", "opb": "Squamous cell cancer", "opc": "Melanoma", "opd": "Basal Cell Carcinoma", "subject_name": "Surgery", "topic_name": "Oesophagus", "id": "a8b67fa4-297e-49f8-880d-9433e7d26e7f", "choice_type": "single"} {"question": "Full thickness graft is indicated in", "exp": "(C) Fascial regions for cosmetic effect # Whole Thickness (Wolfe's) Skin Graft# Full-thickness skin graft is a free graft including the entire epidermis and dermis.> Disadvantages of these grafts include> Better blood supply for their survival> Limited area that can be covered> The need to surgically close the donor site> The poor resistance to infection, which generally precludes use of these grafts on contaminated wounds.> Full thickness skin is best taken from locations where the skin is thin such as postauricular area, supraclavicular are and eyelids or where skin is loose and redundant such as flexor creases of the elbow, buttock and groin.> A pressure dressing of the 'tie over' variety is advisable.> The dressing should not be removed before 7 to 10 days", "cop": 3, "opa": "Deep burns", "opb": "Burns over large areas", "opc": "Fascial regions for cosmetic effect", "opd": "Over the back", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "33822044-3788-4314-ad1c-6c4e5c6cf35e", "choice_type": "single"} {"question": "Alvarado score is used in the diagnosis of", "exp": "The most widely used is the Alvarado score A score of 7 or more is strongly predictive of acute appendicitis. The Alvarado (MANTRELS) score Symptoms Score Migratory RIF pain 1 Anorexia 1 Nausea and vomiting 1 Signs Tenderness (RIF) 2 Rebound tenderness 1 Elevated temperature 1 Laboratory Leucocytosis 2 Shift to left 1 Total 10 Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1211", "cop": 4, "opa": "Diveiculitis", "opb": "Liver failure", "opc": "Chronic hepatitis", "opd": "Acute appendicitis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "f210939f-e1c4-4b8d-b290-5d64fa0055d1", "choice_type": "single"} {"question": "A Bennett's fracture is difficult to maintain in a reduced position mainly because of the pull of the", "exp": "D i.e. Abductor pollicis longus", "cop": 4, "opa": "Flexor pollicis longus", "opb": "Flexor pollicis brevis", "opc": "Extensor pollicis brevis", "opd": "Abductor pollicis longus", "subject_name": "Surgery", "topic_name": null, "id": "dfeda88d-6a81-439e-a806-010c0e1079b1", "choice_type": "single"} {"question": "The most common bone fractured during bih", "exp": "A i.e. Clavicle", "cop": 1, "opa": "Clavicle", "opb": "Scapula", "opc": "Radius", "opd": "Humerus", "subject_name": "Surgery", "topic_name": null, "id": "34727c39-c021-453b-9980-652c19b03cbb", "choice_type": "single"} {"question": "Ohobaric oxygen is used in", "exp": ".HYPERBARIC OXYGEN It is administration of oxygen 1 or 2 atmospheres above the atmospheric pressure in a compression chamber. It increases the aerial oxygen saturation so that oxygen perfusion of tissues will be increased.Indications 1. Carbon monoxide poisoning. 2. Tetanus, gas gangrene infections. 3. Bedsores, frostbites, necrotising fasciitis. 4. Drenching in paralytic ileus to reduce the nitrogen gas in distended bowel. 5. As a radiosensitizer in the treatment of cancer. ref:SRB&;s manual of surgery,ed 3,pg no 98", "cop": 1, "opa": "Carbon monoxide poisoning", "opb": "Ventilation failure", "opc": "Anaerobic infection", "opd": "Gangrene", "subject_name": "Surgery", "topic_name": "Urology", "id": "cb7ae32c-5d79-4d98-932f-885cb393d2a9", "choice_type": "single"} {"question": "Pringle's Manuever is used to stop the bleeding from", "exp": "Ans. (c) LiverRef: Bailey and Love 27th Edition Page 1162* Occlusion of Inflow vessels at epiploic Foramen by Soft Clamp is known as Pringle Manuever.* This is done during Elective Surgery and in cases of Trauma.", "cop": 3, "opa": "Pancreas", "opb": "Spleen", "opc": "Liver", "opd": "Kidneys", "subject_name": "Surgery", "topic_name": "Liver", "id": "0557e549-bc23-4b36-8e67-10707dc2265f", "choice_type": "single"} {"question": "Most common type of mesenteric cyst", "exp": "Cysts may occur in the mesentery of either the small intestine (60%) or the colon (40%). Types include ChylolymphaticEnterogenousUrogenital remnant (actually retroperitoneal but project into peritoneum)DermoidAlthough all mesenteric cysts are rare, chylolymphatic is the most common variety, arises in a congenitally misplaced lymphatic tissue.Ref: Bailey and love 27e pg: 1063", "cop": 1, "opa": "Chylolymphatic", "opb": "Enterogenous", "opc": "Urogenital remnant", "opd": "Dermoid", "subject_name": "Surgery", "topic_name": "General surgery", "id": "63ab8fae-cfaa-4ea8-8f1b-0520a13ac735", "choice_type": "single"} {"question": "The earliest manifestation of increase intracranial pressure following head injury is", "exp": "Early signs of elevated ICP includes drowsiness and a diminished level of consciousness Coma and unilateral papillary changes are late signs and require immediate intervention Ref : Harrison's 19th edition Pgno :1779", "cop": 2, "opa": "Hemiparesis", "opb": "Altered mental status", "opc": "Ipsilateral pupillary dilatation", "opd": "Contralateral pupillary dilatation", "subject_name": "Surgery", "topic_name": "Trauma", "id": "4c7a825a-dca2-40fd-a64b-0cb4940a153b", "choice_type": "single"} {"question": "The following metabolic anomaly is seen in cases of hemorrhagic shock.", "exp": "Ans. (a) Metabolic acidosisRef: \"Anion Gap: Acid Base Tutorial\". University of Connecticut Health Centre* Lactic acidosis is seen in hemorrhagic shock.* Lactic acidosis causes increase anion gap metabolic acidosis.", "cop": 1, "opa": "Metabolic acidosis", "opb": "Respiratory acidosis", "opc": "Respiratory alkalosis", "opd": "Metabolic alkalosis", "subject_name": "Surgery", "topic_name": "Fluid & Electrolyte", "id": "56741f78-2763-4271-8ab9-ccc5526b2e6e", "choice_type": "single"} {"question": "Most common bone secondaries from", "exp": "(B) (Carcinoma breast) (1085-CSDT 13th)METASTATIC BONE TUMORS:* 80% of these metastatic lesions are from primary carcinoma-particularly of the Breast, Prostate, lung, kidney, thyroid, pancreas or stomach in that order of frequency (1202-CSDT 12th).* Most common primary source of solitary skeletal metastasis at the time of first diagnosis is carcinoma of the kidney (1202 CSDT 12,h).* Most common site of bony metastasis in carcinoma breast goes to - Lumber vertebra**.* Most common quadrant site in carcinoma breast is - upper outer quadrant***.A) MOST COMMON CAUSE OF OSTEOBLASTIC SECONDARY* In males - Prostate cancer* In females - Breast cancerB) MOST COMMON CAUSE OF OSTEOLYTIC METASTASIS* In males - Lung cancers* In females - Breast cancersC) LYTIC EXPANSILE METASTASIS* Thyroid* Renal carcinoma", "cop": 2, "opa": "Carcinoma kidney", "opb": "Carcinoma breast", "opc": "Carcinoma prostrate", "opd": "Carcinoma thyroid", "subject_name": "Surgery", "topic_name": "Breast", "id": "f9e245ae-ecf4-4ae0-867b-c1c46db04eae", "choice_type": "single"} {"question": "Long term complication of live kidney donors are", "exp": "Answer- A. HypeensionHypeentionCardiovascular risksPreoteinuriaEnd stage renal disease", "cop": 1, "opa": "Hypeension", "opb": "HPV Infection", "opc": "Renal Carcinoma", "opd": "Pyelonephritis", "subject_name": "Surgery", "topic_name": null, "id": "84723197-0f71-42b4-854c-0bd2ed2dc77f", "choice_type": "single"} {"question": "Treatment of carcinoma left colon with acute obstruction", "exp": ".Obstruction due to rectosigmoid growth with patient being severely ill--Hamann's operation can be done to save the life of the patient wherein distal stump after removal of the growth is closed, proximal colon is brought out as end colostomy. ref:SRB&;s manual of surgery,ed 3,pg no 857", "cop": 1, "opa": "Harman's procedure", "opb": "Left colectomy with anastomosis", "opc": "Proximal colostomy", "opd": "Extended . colectomy with ileoanal anastomosis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "5f3d43b1-e12f-4ff7-9f1c-4ec6c3458ea2", "choice_type": "single"} {"question": "FNAC needle size", "exp": "Fine needle aspiration cytology (FNAC) is cytological study of tumour cells to find out the disease and also to confirm whether it is malignant or not. It is done using 23 or 24 gauge needle(22-26 G) fixed to specialised syringes which creates negative pressure for aspiration and contents are smeared on the slides. It is done in parotid, thyroid, lymph node, breast and all other surface lesions. Reference : page 278 SRB's manual of surgery 5th edition", "cop": 2, "opa": "18-22", "opb": "22-26", "opc": "27-29", "opd": "16-18", "subject_name": "Surgery", "topic_name": "Urology", "id": "141a99ac-3ce3-4d40-b913-5e7910b0f820", "choice_type": "single"} {"question": "A pregnant female presents with pain in abdomen on examination, tenderness is found in right lumbar region. TLC is 12000/cmm. and urine examination is normal. For diagnosis fuher test done is", "exp": "Ans is 'b' ultrasound abdomen Ultrasound is a useful diagnostic method in a pregnant female presenting with right iliac fossa pain to exclude tubal or ovarian disease. CT and X-ray should not be done for fear of radiation to the fetus.", "cop": 2, "opa": "Chest Xray with abdominal shield", "opb": "Ultrasound abdomen", "opc": "Non contrast CT abdomen", "opd": "Laproscopy", "subject_name": "Surgery", "topic_name": null, "id": "d60e37ee-b9c5-46d3-8494-9a27a4b10aac", "choice_type": "single"} {"question": "Syndrome of internal iliac aery occlusion manifested by", "exp": "Aerial pulses It is standard practice to examine the femoral, popliteal, posterior tibial and dorsalis pedis aeries together with the abdomen for an aoic aneurysm or renal aery bruit, which may coexist with lower limb occlusive disease. Diminution of a femoral and/or popliteal pulse can often be appreciated by comparing it with its opposite number; however, pedal pulses are either clinically palpable or absent. Popliteal pulses are often difficult to feel; a popliteal aery aneurysm should be suspected if the popliteal pulse is prominent with concomitant loss of the natural concavity of the popliteal fossa. Pulsation distal to an aerial occlusion is usually absent although the presence of a highly developed collateral circulation may allow distal pulses to be palpable - this is most likely to occur with an iliac stenosis. In this case, exercise (walking until claudication develops) usually causes the pulse to disappear as vasodilation occurs below the obstruction, causing the pulse pressure to reduce. An aerial bruit, heard on auscultation over the pulse, indicates turbulent flow and suggests a stenosis. It is an unreliable clinical sign as tight stenoses often do not have bruits. A continuous 'machinery' murmur over an aery usually indicates an aeriovenous fistula. Iliac obstruction Unilateral claudication in the thigh and calf and sometimes the buttock Bruit over the iliac region Unilateral absence of femoral and distal pulses Ref: Bailey and love 27th edition Pgno : 944", "cop": 2, "opa": "Pain in calf", "opb": "Absent pulse at the dorsalis pedis aery", "opc": "Intermittent claudication", "opd": "Gangrene", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "dce2c27f-0146-4630-b621-e873fae2aba1", "choice_type": "single"} {"question": "The earliest manifestation of increased intracranial pressure following head injury is", "exp": "• Early signs of elevated ICP includes drowsiness and a diminished level of consciousness.\n• Coma and unilateral papillary changes are late signs and require immediate intervention.", "cop": 3, "opa": "Ipsilateral pupillary dilatation", "opb": "Contralateral pupillary dilation", "opc": "Altered mental status", "opd": "Hemiparesis", "subject_name": "Surgery", "topic_name": null, "id": "cbce5334-28c5-48e1-b2f3-2a3b5e79e913", "choice_type": "single"} {"question": "Numbness of cheek following fracture of zygomatic complex is due to", "exp": "Tears of the antral mucosa may lead to epistaxis on the affected side, and damage to the infraorbital nerve may cause paraesthesia in its sensory distribution.", "cop": 2, "opa": "Damage of long buccal nerve", "opb": "Damage to infraorbital nerve", "opc": "Damage to middle meningeal nerve", "opd": "Damage to inferior alveolar nerve", "subject_name": "Surgery", "topic_name": null, "id": "b064b9d5-e576-4ed7-9d2b-490870266e2c", "choice_type": "single"} {"question": "Commonest complication of Zenker&;s diveiculum is", "exp": "Commonest complications are lung abcess and pneumonia. It occurs because of Regurgitation during night while turning neck. Othercomplications are abscess in the neck due to infection in the pouch, Carcinoma, Weight loss and cachexia. Reference: SRB's Manual of Surgery, 6th Edition, page no=422", "cop": 3, "opa": "Dysphonia", "opb": "Gastroesophageal reflux", "opc": "Lung abscess", "opd": "Perforation", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "b8a32a38-4d3d-492e-8c95-dab9cb707ebd", "choice_type": "single"} {"question": "The diagnostic method of submandibular sialolithiasis is", "exp": "Ans. (c) Plain X-rayRef: Bailey and Love 27th Edition Page 780* MC cause of Submandibular duct obstruction is Stones in Gland and Duct.* 80% stones are radio opaque and hence X ray is diagnostic.* 80% of salivary stones are seen in Submandibular duct.* Stones distal to Lingual nerve (Beyond 2nd Molar) - Duct lay opening and stone removal is enough", "cop": 3, "opa": "USG", "opb": "Sialography", "opc": "Plain X-ray", "opd": "CT scan", "subject_name": "Surgery", "topic_name": "Salivary Gland", "id": "f71b7dbd-6a45-410e-b589-f980d8634eff", "choice_type": "single"} {"question": "Dumbell tumour is seen in", "exp": null, "cop": 2, "opa": "Meningioma", "opb": "Neurofibroma", "opc": "Ependymoma", "opd": "Thymoma", "subject_name": "Surgery", "topic_name": null, "id": "f1224fcf-5ceb-498d-a9ea-569490e76125", "choice_type": "single"} {"question": "Most common neuroendocrine tumour of pancreas is", "exp": "TumourIncidence%Insulinoma70-80Gastrinoma20-25Non-functional tumours30-50VIPoma4Glucagonoma4Somatostatinoma<5Carcinoid<1ACTHoma<1GRFoma<1Ref: Bailey and Love 27e pg: 846", "cop": 1, "opa": "Insulinoma", "opb": "Gastrinoma", "opc": "Non-functional tumours", "opd": "VIPoma", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "e41f266f-9cc1-490b-af2e-ad439b93c9ca", "choice_type": "single"} {"question": "Reactionary hemorrhage occurs after extraction\nbecause of", "exp": null, "cop": 2, "opa": "Broken roots", "opb": "High blood pressure", "opc": "Sharp interdental septum", "opd": "Gingival laceration", "subject_name": "Surgery", "topic_name": null, "id": "0b8bc751-ab6c-48b3-931a-3be249432513", "choice_type": "single"} {"question": "Working end of cryer elevator is placed at", "exp": null, "cop": 2, "opa": "Junction of interseptal bone and mesiobuccal portion of root", "opb": "Over the interradicular bone", "opc": "Distobuccal root", "opd": "Between the teeth and gingiva", "subject_name": "Surgery", "topic_name": null, "id": "2ae66507-d70e-42e5-ac7e-d5035a124157", "choice_type": "single"} {"question": "Most common site of chronic gastric ulcer", "exp": "Ans. b. Lesser curve near incisuraRef: Essential Surgery E-Book: Problemsy Diagnosis and Management: With Student by Clive R. G. Quick; Page No- 296PEPTIC ULCER DISEASEResults from damage to the gastric or duodenal mucosa caused by impaired mucosal defense and/or | acidic gastric contents.Risk factors: H. pylori (>90% of duodenal ulcers and 70% of gastric ulcers), NSAIDs, alcohol, and tobacco use; concomitant use of corticosteroids and NSAIDs; gender (males>females).HISTORY/PEPresentation: Chronic or periodic dull, burning epigastric pain that is often related to meals and can radiate to the back; nausea; hematemesis (\"coffee-ground\" emesis); or hematochezia (blood in the stool).Examination: Usually normal but may reveal epigastric tenderness and stool guaiac.Risks: Acute perforation (rigid abdomen, rebound tenderness, and/or guarding).Most common sites:The most common sire for chronic peptic ulcers are in the first part of the duodenum or the gastric antrum, particularly along the lesser curvature.A chronic stomal ulcer may also appear at the margin of a surgical created communication between stomach and intestine (Gastroenterostomy).", "cop": 2, "opa": "Pylorus of stomach", "opb": "Lesser curve near incisura", "opc": "Lesser curve near proximal stomach", "opd": "Greater curvature", "subject_name": "Surgery", "topic_name": "Stomach & Duodenum", "id": "cee3a11b-68c8-4507-9efe-366352f3f5e0", "choice_type": "single"} {"question": "Most common cyst of the spleen are", "exp": "Pseudocyst or secondary cyst is the common cause for the development of cyst in the spleen ( constitutes 80% ). true cyst and parasitic cyst constitute 20% Reference: SRB 5th edition page no. 679", "cop": 3, "opa": "Hydatid syst", "opb": "Dermatoid cyst", "opc": "Pseudocyst", "opd": "Lymphangioma", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "d172df45-4aad-4445-8f60-2ad77374e101", "choice_type": "single"} {"question": "The best prognosis in carcinoma stomach is with", "exp": "Ca stomach may be divided into 5 morphological subtypes, that correlates loosely with the natural history and outcome.\n\nUlcerating Ca\nPolypoidal Ca\nSuperficial spreading Ca\n\n\nalso known as early gastric cancer, superficial ca is confined to mucosa and submucosa.\nthese cancers have excellent prognosis (-90% 5 year survival rate) after resection\n\nLinitis plastica or Scirrhous Ca\n\nthese tumors infiltrate the entire thickness of the stomach and cover a very large surface area, commonly involve the entire stomach. Marked desmoplastic reaction is noted, the stomach loses its pliability.\nit has the worst prognosis of all types as spread is early.\n\nAdvanced carcinoma\n\nthis largest category contains the big tumors that are found partly within and partly outside the stomach. They may originally have qualified for inclusion in one of the preceding groups but have outgrown that early stage.", "cop": 1, "opa": "Superficial spreading type", "opb": "Ulcerative type", "opc": "Linitis plastica type", "opd": "Polypoidal type", "subject_name": "Surgery", "topic_name": null, "id": "17e9db32-cb1e-4ec5-8948-cfc447eddabb", "choice_type": "single"} {"question": "Omphalocele is caused by", "exp": "There are two abdominal wall defects due to failure of development of abdominal musculature:- Ref:- Sabiston 20th edition; Pg num:- 1071", "cop": 4, "opa": "Duplication of Intestinal loops", "opb": "Reversed rotation of intestinal loop", "opc": "Abnormal rotation of the intestinal loop", "opd": "Failure of GUT to return to the body cavity from its physiological herniation", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "6f3749b2-60b9-4892-bbac-b8d1808bb77f", "choice_type": "single"} {"question": "Sister Mary Joseph nodule is most commonly seen with", "exp": "Carcinoma of stomach may spread the abdominal cavity to the umbilicus ( Sister Joseph's nodule) Bailey & Love,26th,1050.", "cop": 2, "opa": "Ovarian cancer", "opb": "Stomach cancer", "opc": "Colon cancer", "opd": "Pancreatic cancer", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "28754061-cbca-4885-b578-b6d4a937f792", "choice_type": "single"} {"question": "Classic symptom of ectopic ureter in females", "exp": "ECTOPIC URETERAL ORIFICE * Around 80% is associated with a duplication collecting system. * More common in females. Location * Males: Prostatic or posterior urethra (MC), lateral in bladder. * Females: Anterior urethra (MC), vestibule, vagina. Clinical Features * Females: continuous incontinence with an otherwise normal voiding . * Males: MC presentation Is UTI, no urinary incontinence . Diagnosis * IVP: Drooping Lily sign Treatment * Mainly expectant, Ureteric reimplantation or pole nephrectomy depending on moiety function.", "cop": 3, "opa": "Painful defecation", "opb": "Urinary frequency", "opc": "Ureteral incontinence with otherwise normal voiding", "opd": "Labial swelling", "subject_name": "Surgery", "topic_name": "Kidney and ureter", "id": "c3648da9-857c-4616-9952-05140141a7ba", "choice_type": "single"} {"question": "Mondor's disease is", "exp": "Ans. a (Superficial thrombophlebitis of breast) (Ref. Bailey and Love 25th/833)Mondor's disease is thrombophlebitis of the superficial veins of the breast and anterior chest wall although it has also been encountered in the arm.MONDOR'S DISEASEIn the absence of injury or infection, the cause of thrombophlebitis - like that of spontaneous thrombophlebitis in other sites - is obscure. The pathognomonic feature is a thrombosed subcutaneous cord, usually attached to skin. When the skin over the breast is stretched by raising the arm, a narrow, shallow subcutaneous groove alongside the cord becomes apparent. The differential diagnosis is lymphatic permeation from an occult carcinoma of the breast. The only Rx required is restricted arm movements, and it subsides within a few months without recurrence, complications or deformity.", "cop": 1, "opa": "Superficial thrombophlebitis of breast", "opb": "Fat necrosis in breast", "opc": "Postradiation breast and arm edema", "opd": "Skin infection over the breast", "subject_name": "Surgery", "topic_name": "Miscellaneous (Breast)", "id": "4b50da67-6ee5-4cfa-9a72-c3046c5f3bff", "choice_type": "single"} {"question": "Ankle sprain due to forced inversion of a plantar flexed foot is due to injury to", "exp": "Ans. a. Anterior talofibular ligament", "cop": 1, "opa": "Anterior talofibular ligament", "opb": "Posterior talofibular ligament", "opc": "Calcaneofibular ligament", "opd": "Posterior fibres of deltoid", "subject_name": "Surgery", "topic_name": null, "id": "bdf2bef7-944e-49c3-bf80-8e2b4c7f1fa7", "choice_type": "single"} {"question": "The Most common complication following splenectomy is", "exp": "(A) Left lower lobe atelectasis # Postoperative Complications after Splenectomy:> Immediate complications specific to splenectomy include haemorrhage resulting from a slipped ligature from the splenic artery.> Haematemesis from gastric mucosal damage and gastric dilatation are uncommon.> Left basal atelectasis is common and a pleural effusion may be present.> Adjacent structures at risk during the procedure include the stomach and pancreas.> A fistula may result from damage to the greater curvature of the stomach during ligation of the short gastric vessels.> Damage to the tail of the pancreas may result in pancreatitis, a localized abscess or a pancreatic fistula.> The blood platelet count may rise, and if this exceeds one million per milli litre prophylactic aspirin is recommended to prevent axillary or other venous thrombosis.> Post-splenectomy septicaemia may result from Streptococcus pneumonia, Neisseria meningitides, Haemophilus influenzae and Escherichia coli.> Opportunist Post-Splenectomy Infection (OPSI) is a major concern.> The benefit of prophylactic antibiotics in this setting is controversial.", "cop": 1, "opa": "Left lower lobe atelectasis", "opb": "Wound dehiscence", "opc": "Pneumococcal septicemia", "opd": "Deep vein thrombosis", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "35fc508b-655f-4b28-83b1-c19e1777cd62", "choice_type": "single"} {"question": "Saint Antony's Fire is a description given for", "exp": null, "cop": 1, "opa": "Erysipela's", "opb": "Impetigo", "opc": "Scarlet fever", "opd": "Streptococcal tonsillitis", "subject_name": "Surgery", "topic_name": null, "id": "fa024c03-f164-49fa-a4de-68798f0ff87f", "choice_type": "single"} {"question": "Complication of TPN is", "exp": "Complications : Related to nutrient deficiency- Hypoglycaemia/hypocalcaemia/hypophosphataemia/hypomagnesaemia(refeeding syndrome) Related to overfeeding: Excess glucose-hyperglycaemia, hyperosmolar dehydration. Hepatic steatosis, hypercapnia, increased sympathetic activity, fluid retention, electrolyte abnormalities. Excess fat-hypercholesterolaemia and formation of lipoprotein X, hyperiglyceridaemia, hypersensitivity reactions. Excess aminoacids: hyperchloraemic metabolic acidosis, hypercalcaemia, aminoacidaemia, uraemia. Related to sepsis: Catheter related sepsis Possible increased predisposition to systemic sepsis Related to line : On inseion : pneumothorax, damage to adjacent aery, air embolism, thoracic duct damage, cardiac perforation or tamponade, pleural effusion, hydromediastinum. Long term use: occlusion, venous thrombosis. Ref: Bailey and love 27th edition Pg no : 288", "cop": 2, "opa": "CHF", "opb": "Hypochloremia", "opc": "Metabolic acidosis", "opd": "Leucopenia", "subject_name": "Surgery", "topic_name": "General surgery", "id": "526f7c6a-8183-42f8-a6e9-9d0962119c05", "choice_type": "single"} {"question": "Best investigation to diagnose hemorrhoids is", "exp": "Proctoscopy is IOC for hemorrhoids.", "cop": 1, "opa": "Proctoscopy", "opb": "DRE", "opc": "Barium enema", "opd": "USG", "subject_name": "Surgery", "topic_name": null, "id": "bd682bc6-a43b-4e27-a258-b53709b5ed9c", "choice_type": "single"} {"question": "Investigation to diagnose the Laryngo pharyngeal reflux", "exp": "Ans. (b) Dual Probe Impedance pH MonitoringRef: Shackelford Page 222/8th Edition* pH monitoring at the level of Pharynx is not helpful because the acid refluxed is neutralized by the Pharyngeal secretions.* Hence a Dual (Bifurcated) catheter measuring both pH and Impedance is used across Upper esophageal sphincter, thereby permitting detection of Pharyngeal reflux", "cop": 2, "opa": "Esophageal pH monitoring", "opb": "Dual Probe Impedance pH monitoring", "opc": "Barium Esophagogram", "opd": "Scintigraphy", "subject_name": "Surgery", "topic_name": "Oesophagus", "id": "7070ef9f-9945-4470-a491-60e5b932f697", "choice_type": "single"} {"question": "In hypovolemic shock % of fluid depletion should be", "exp": "(B) 15-45% # Treatment should be aggressive and directed more by response to therapy than by initial classification.> Class I hemorrhage (loss of 0-15%):* In the absence of complications, only minimal tachycardia is seen.* Usually, no changes in BP, pulse pressure, or respiratory rate occur.* A delay in capillary refill of longer than 3 seconds corresponds to a volume loss of approximately 10%.> Class II hemorrhage (loss of 15-30%):* Clinical symptoms include tachycardia (rate >100 beats per minute), tachypnea, decrease in pulse pressure, cool clammy skin, delayed capillary refill, and slight anxiety.* The decrease in pulse pressure is a result of increased catecholamine levels, which causes an increase in peripheral vascular resistance and a subsequent increase in the diastolic BP.> Class III hemorrhage (loss of 30-40%):* By this point, patients usually have marked tachypnea and tachycardia, decreased systolic BP, oliguria, and significant changes in mental status, such as confusion or agitation.* In patients without other injuries or fluid losses, 30-40% is the smallest amount of blood loss that consistently causes a decrease in systolic BP.* Most of these patients require blood transfusions, but the decision to administer blood should be based on the initial response to fluids.> Class IV hemorrhage (loss of >40%):* Symptoms include the following: Marked tachycardia, decreased systolic BP, narrowed pulse pressure (or immeasurable diastolic pressure), markedly decreased (or no) urinary output, depressed mental status (or loss of consciousness), and cold and pale skin.", "cop": 2, "opa": "10-15%", "opb": "15-45%", "opc": "43-63%", "opd": "70%", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "ea7e19a8-0ba2-4271-9a66-806dedae1490", "choice_type": "single"} {"question": "Lower leg perforator is between", "exp": "Lower leg perforator is between posterior tibial vein and posterior arch vein (a tributary of GSV).", "cop": 3, "opa": "Femoral vein and great saphenous vein", "opb": "Posterior tibial vein and saphenous veiin", "opc": "Posterior tibial vein and posterior arch vein", "opd": "Peroneal vein and short saphenous vein", "subject_name": "Surgery", "topic_name": null, "id": "a395c800-075b-4eb8-8391-80da400aabfd", "choice_type": "single"} {"question": "One of the following is considered as best imaging\nmodality for detecting sequestra in osteomyelitis", "exp": null, "cop": 4, "opa": "Radionuclide imaging", "opb": "Tomography", "opc": "MRI", "opd": "Computed tomography", "subject_name": "Surgery", "topic_name": null, "id": "170eb4f1-2d00-4ff6-b4a2-8f990224d749", "choice_type": "single"} {"question": "Most common cause of acquired AV fistula is", "exp": ". Ans : (d) Penetrating Trauma Penetrating injuries are the most common cause , but fistulas are sometimes seen after blunt trauma . Fungal and bacterial infections are not much common as penetrating trauma in acquired AV fistula.", "cop": 4, "opa": "Bacterial infection", "opb": "Fungal infection", "opc": "Blunt trauma", "opd": "Penetrating trauma", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "ca664684-91e3-4baa-bc0b-10fbc956c4ff", "choice_type": "single"} {"question": "The treatment of choice in Cushing's disease is", "exp": "The treatment of choice in Cushing's disease is transsphenoidal excision of the pituitary adenoma, which is successful in 80% of patients. Pituitary irradiation has been used for patients with persistent or recurrent disease after surgery. However, it is associated with a high rate of panhypopituitarism, and some patients develop visual deficits. This has led to increased use of stereotactic radiosurgery, which uses CT guidance to deliver high doses of radiotherapy to the tumour (photon or gamma knife) and also bilateral laparoscopic adrenalectomy. Patients who fail to respond to either treatment are candidates for pharmacologic therapy with adrenal inhibitors (medical adrenalectomy) such as ketoconazole, metyrapone, or aminoglutethimide", "cop": 4, "opa": "Open adrenalectomy", "opb": "Bilateral adrenalectomy", "opc": "Medical management", "opd": "Transsphenoidal excision of the pituitary adenoma", "subject_name": "Surgery", "topic_name": "All India exam", "id": "1aa30759-24a7-450e-98db-58304322d30b", "choice_type": "single"} {"question": "Dietle's crises, are seen in", "exp": "Ans. b (Pelviureteric junction obstruction). (Ref. Bailey & Love, Surgery, 25th ed., 1293).Intermittent hydronephrosis (Dietl's crisis): A swelling in the loin is associated with acute renal pain. Some hours later the pain is relieved and the swelling disappears when a large volume of urine is passed.TERMMeaningDietl's crisesAfter an attack of acute renal pain a swelling in loin is found.Some hours later, following the passage of a large volume of urine, the pain is relieved and swelling disappears, known as Dietl's crises.It is seen in intermittent hydronephrosis, for e.g. due to PUJ obstruction.MengenblaseAcute abdominal pain due to gaseous distention of splenic flexureMittelschmerzMidcycle rupture of a follicular cyst with bleeding produces lower abdominal and pelvic pain, typically midcycle. Systemic upset rare, pregnancy test negative, symptoms subside within hours.Occasionally, diagnostic laparoscopy required.Retrograde menstruation cause similar symptoms.MeteorismThe gas filled, slightly dilated loops of bowel produce pain anywhere in body, or when respiration is laboured as in asthma or pneumonia, the amount of air swallowed is increased, thus containing relatively little fluid and term meteorism is applied to this appearance.StranguryBladder pain is felt as a suprapubic discomfort made worse by bladder filling. In men, a sharp pain misleadingly referred to the tip of the penis may be the result of irritation of the trigone of the bladder. Severe inflammation of the bladder can cause an extreme wrenching discomfort at the end of micturition.", "cop": 2, "opa": "Pyelonephritis", "opb": "Pelviureteric junction obstruction", "opc": "Renal trauma", "opd": "Chronic renal failure", "subject_name": "Surgery", "topic_name": "Kidney & Ureturs", "id": "82196791-deec-451e-8c2e-afa436961f6a", "choice_type": "single"} {"question": "Crohn's disease is best diagnosed by", "exp": "Diagnosis CT Enteroclysis: IOC for diagnosis of Crohn's disease Earliest radiographic findings in enteroclysis are aphthous ulceration, a coarse villous pattern of the mucosa, and thickened folds Ulcerations on the mesenteric aspect with sacculation on the antimesenteric surface. Serology : Anti-Saccharomyces cerevisiae (ASCA) autoantibodies have specificity of 92% for Crohn's disease.", "cop": 2, "opa": "Upper GI series", "opb": "CT enteroclysis", "opc": "Capsule endoscopy", "opd": "CECT", "subject_name": "Surgery", "topic_name": "Inflammatory bowel disease", "id": "87c0041e-fd26-45d7-8518-ba09ce967c3b", "choice_type": "single"} {"question": "Gail model of risk assessment is used for", "exp": "Gail risk assessment model is used for CA breast. It includes (modified): \u0002 *Age, age at menarche, age at 1st live child bih, race. \u0002 *Number of 1st degree female relatives having breast cancer. \u0002 *Number of previous breast biopsies. *\u0002 Proliferative lesion with atypia. These risk factors are translated into risk scores by specified calculations. But model does not include genetic factor. Reference : page 530 SRB's manual of surgery 5th edition", "cop": 3, "opa": "CA stomach", "opb": "CA esophagus", "opc": "CA breast", "opd": "CA prostate", "subject_name": "Surgery", "topic_name": "Urology", "id": "9720ebea-7cc8-4620-869b-7f34a8771ef2", "choice_type": "single"} {"question": "A 30 year old male, labourer, chronic smoker, alcoholic, presents with acute chest pain, severe back pain, radiation to interscapular area. The diagnosis is", "exp": "(B) Ruptured aortic aneurysm> Dilatations of localised segments of the arterial system are called aneurysms.> They can either be true aneurysms, containing the three layers of the arterial wall in the aneurysm sac, or false aneurysms, having a single layer of fibrous tissue as the wall of the sac, e.g. aneurysm following trauma and as a mycotic aneurysm. ('Mycotic' is a misnomer, as the cause is not due to a fungus but to bacterial infection).", "cop": 2, "opa": "Myocardial infarction", "opb": "Ruptured aortic aneurysm", "opc": "Pericarditis", "opd": "Tension pneumothorax", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "16c51d6b-b0b3-4c31-be16-d0b98df23fa3", "choice_type": "single"} {"question": "OPSI is related to", "exp": "Overwhelming post splenectomized infection (OPSI) is seen in patient&;s who have undergone splenectomy. post splenectomized patients are more prone to infections with pneumococcal septicaemia, Neisseria meningitides, H influenza, Babesia microfti And can occur any time after splenectomy SRB 5 the edition page no.677", "cop": 4, "opa": "Kidney", "opb": "Brain", "opc": "Lung", "opd": "Spleen", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "f8580a0a-c881-48ad-a8d1-8a27d15a432e", "choice_type": "single"} {"question": "Milian's ear sign is seen is", "exp": "Erysipelas being a cutaneous condition can spread to ear lobule = Milian's ear sign.", "cop": 2, "opa": "Cellulitis", "opb": "Erysipelas", "opc": "Lymphangitis", "opd": "Abscess", "subject_name": "Surgery", "topic_name": null, "id": "2d685068-953e-40d4-9d66-dd8f0243fc53", "choice_type": "single"} {"question": "Most common cause of abdominal aoic aneurysm is", "exp": ". Aoic wall contain smooth muscle cell matrix,elastin(in tunica media),collagen (in adventitia) as safe net in the wall to provide tensile strength prevent aneurysms formation.Elastin in tunica media is degraded and reduced significantly in infrarenal aoa in relation to collagen,abscence or less vasa vasorum in infrarenal aoa and atherosclerotic ubstability of the medial wall of aoa cause infrarenal aoa and more prone to develop aneurysms.Increased proteolytic matrix metalloproteinase(MMP) which is derived from aoic smooth muscle cells and macropgages cause elastin and collagen degradation and increase in the diameter of aneurysms. Refer; SRB's manual of Surgery page no:198.", "cop": 1, "opa": "Atherosclerosis", "opb": "Trauma", "opc": "Syphilis", "opd": "Vasculities", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "d6001ac9-48f9-4710-bfd6-ce381f4d685d", "choice_type": "single"} {"question": "A 32 year old male patient complains of swelling in left maxillary region with heaviness in the maxillary sinus following tooth extraction of maxillary first molar. Patient gives a history of tooth extraction one week before with transalveolar type of extraction.\n\nThe average mucociliary air flow transport in the maxillary sinus is", "exp": null, "cop": 1, "opa": "5 to 20mm per min", "opb": "5 to 20 cm per min", "opc": "5 to 20 km per min", "opd": "5 to 20 dm per min", "subject_name": "Surgery", "topic_name": null, "id": "5c2118f8-453c-4118-9ebb-82055a5f1758", "choice_type": "single"} {"question": "In a case of hyperophic pyloric stenosis, the metabolic disturbance is", "exp": "Hyperophic metabolic acidosis Clinical features Infant is normal at bih, symptomatic between ages of 3-6 weeks Infants with HPS typically present with projectile nonbilious vomiting Visible gastric peristalsis may be seen as a wave of contraction from the upper left quadrant to the epigastrium The infants usually feed vigorously between episodes of vomiting Typical electrolyte abnormalities Hypochloremia Hypokalemia Metabolic acidosis with paradoxical aciduria Ref: Sabiston 20th edition Pgno : 1869", "cop": 3, "opa": "Respiratory alkalosis", "opb": "Metabolic acidosis", "opc": "Metabolic alkalosis with paradoxical aciduria", "opd": "Metabolic alkalosis with alkaline urine", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "9dfb47c1-97f7-44fe-aaf7-07cc763e6af7", "choice_type": "single"} {"question": "Best surgical approach in accessing retrosternal\ngoitre is", "exp": "For retrosternal goitre cervical route is preferred.", "cop": 3, "opa": "Sternal", "opb": "Sternal", "opc": "Cervical", "opd": "VATS", "subject_name": "Surgery", "topic_name": null, "id": "7fbc522c-2219-4c53-b18e-578ad3cc4821", "choice_type": "single"} {"question": "Fournier's gangrene occurs in the", "exp": "See Idiopathic scrotal gangrene.", "cop": 2, "opa": "Toes", "opb": "Scrotum", "opc": "Fingers", "opd": "Muscles", "subject_name": "Surgery", "topic_name": null, "id": "457685e2-ac8e-438e-8386-5bcb2e5a37d5", "choice_type": "single"} {"question": "Most common histological type of the thyroid carcinoma is", "exp": "Papillary thyroid cancer is the most common cancer. Occurs in 70-80% of patients diagnosed with thyroid cancer. Common in females and younger age group. According to Woolner's Classification there are 3 types. 1)Occult primary(less than 1.5cm) 2) Intrathyroidal 3) Extrathyroidal Reference: SRB's Manual of Surgery, 6th Edition, page no = 468.", "cop": 3, "opa": "Medullary type", "opb": "Follicular type", "opc": "Papillary type", "opd": "Anaplastic type", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "9ad9a2cc-f595-4ac7-aec5-b829b3543057", "choice_type": "single"} {"question": "CBD microliths are diagnosed by", "exp": "CBD stones IOC is MRCP\nMicro stones are detected by EUS.", "cop": 2, "opa": "ERCP", "opb": "EUS", "opc": "HIDA", "opd": "CT", "subject_name": "Surgery", "topic_name": null, "id": "3ab86958-db32-473e-bfb1-5a554823682e", "choice_type": "single"} {"question": "Most common nerve to get entrapped during open inguinal hernia surgery", "exp": null, "cop": 2, "opa": "Ilioinguinal", "opb": "Itiohypogastric", "opc": "Genital branch of genitotemoral nerve", "opd": "Femoral nerve", "subject_name": "Surgery", "topic_name": null, "id": "28ef0a8e-43b0-4432-a814-65b537e38e72", "choice_type": "single"} {"question": "The Sagittal split mandibular operation", "exp": null, "cop": 4, "opa": "is a good operation for closing an anterior open bite.", "opb": "Has a very low incidence of inferior dental nerve anaesthesia or paraesthesia with a skilled operator.", "opc": "Has a lower morbidity when used for pushing back a mandible than an intra oral vertical subsigmoid osteotomy.", "opd": "Rarely leads to a non union of the osteotomy site", "subject_name": "Surgery", "topic_name": null, "id": "669ca66b-21f7-4d42-a0c1-c237e3902e48", "choice_type": "single"} {"question": "Cause of hydrocoele in infants is", "exp": null, "cop": 2, "opa": "Patent gubernaculum", "opb": "Patent processus vaginalis", "opc": "Cyst of morgagni", "opd": "Harmonal factors", "subject_name": "Surgery", "topic_name": null, "id": "c1f1e0c4-4ec4-4572-a577-85aa713fe96a", "choice_type": "single"} {"question": "Gompezian curve is used to describe", "exp": "Gompezian curve: In its early stages, growth is exponential but, as the tumour grows, the growth rate slows. This decrease in growth rate probably arises because of difficulties with nutrition and oxygenation. The tumour cells are in competition: not only with the tissues of the host but also with each other.Ref: Bailey and Love 27e pg: 143", "cop": 1, "opa": "Cancer growth", "opb": "Wound healing rate", "opc": "Haemorrhagic shock", "opd": "Nutritional requirements in surgical patients", "subject_name": "Surgery", "topic_name": "General surgery", "id": "7439dfa5-9605-4fe9-9120-766fd2a57d02", "choice_type": "single"} {"question": "Treatment of choice for TURP syndrome", "exp": "Furosamide is used to treat the dilutional hyponatremia. If not controlled 3% NaCl is used.", "cop": 3, "opa": "Normal saline", "opb": "1.5% NaCl", "opc": "Furosamide", "opd": "Thiazides", "subject_name": "Surgery", "topic_name": null, "id": "6acfd126-c31c-4179-bc1f-e686724bc18f", "choice_type": "single"} {"question": "The distinguishing feature of masticatory space\ninfection is", "exp": null, "cop": 3, "opa": "Pain", "opb": "Dysphagia", "opc": "Trismus", "opd": "Swelling", "subject_name": "Surgery", "topic_name": null, "id": "4fd316f6-74be-49d9-86cf-b1b65b32d450", "choice_type": "single"} {"question": "Ivor Lewis operation is done for", "exp": "In carcinoma surgery alone is best suited to patients with disease confined to the oesophagus (T1b, T2)The most widely practiced oesophagotomy approach is the two-phase Ivor Lewis operation, especially distal tumors.Three-phase oesophagectomy (McKeown) may be more appropriate for more proximal tumours in order to achieve better longitudinal clearance,Ref: Bailey and Love 27e pg: 1092", "cop": 1, "opa": "Carcinoma oesophagus", "opb": "Achalasia cardia", "opc": "Hiatus hernia", "opd": "GERD", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "37a6418f-e0d8-4380-8a5b-257afa503569", "choice_type": "single"} {"question": "A Toddler has few drops of blood coming out of rectum. Probable diagnosis is", "exp": "Ans is 'a' i.e. Juvenile Rectal Polyp \"The aetiology and management of rectal bleeding depends on the age of the child, the type and quantity of bleeding and the associated symptoms. Unlike adults, malignancy is exceptionally rare. In infants, an anal fissure, necrotizing enterocolitis, intussusception and allergic enterocolitis are possible causes. In older children, more common causes include an anal fissure, a juvenile polyp and certain gastroenteritides (e.g. Campylobacter infection); Meckel's diverticulum, duplication cyst and inflammatory bowel disease are less common. Bailey and LoveJuvenile polyps are the most common type of childhood polyp, occurring in up to 1% of preschool children. They are usually solitary polyps found in the rectum which most commonly present with rectal bleeding.These are hamartomatous polyps, which are usually pedunculated but can be sessile. \"The typical child with a juvenile polyp is 4 to 6 years of age, presents with intermittent painless rectal bleeding with bowel movements. Rudolph's PediatricsJuvenile polyps are usually are not premalignant.Because the gross appearance of these polyps is identical to adenomatous polyps, these lesions should also be treated by polypectomy.Juvenile polyposis is a term used when more than 5 to 10 juvenile polyps develop.Juvenile polyposis coli applies if the polyps are limited to the colon, whereas generalized juvenile polyposis describes the presence of polyps throughout the GI tract. Both have a significant malignant potential.Other mentioned options are rare in children.Familial Adenomatous Polyposis (FAP) patients present in Td to 3rd decade.Rectal ulcer (solitary rectal ulcer) is commonly seen in 20 to 40 yrs age group.Piles are rare in children. (Ref: Rudolph's Pediatrics, 21/e Chapter 17.22)", "cop": 1, "opa": "Juvenile Rectal Polyp", "opb": "Adenoid Polyposis Coli", "opc": "Rectal Ulcer", "opd": "Piles", "subject_name": "Surgery", "topic_name": "Colon and Rectum - Polyps and Carcinoma", "id": "f4726673-fe70-41d6-a541-ffa3185521df", "choice_type": "single"} {"question": "Takayasu's arteritis most commonly affects", "exp": "Subclavian artery is most commonly involved in Takayasu's arteritis.", "cop": 4, "opa": "Radial artery", "opb": "Femoral artery", "opc": "Iliac artery", "opd": "Subclavian artery", "subject_name": "Surgery", "topic_name": null, "id": "d4e6dfdc-d2ca-4315-a473-f12a53b4cace", "choice_type": "single"} {"question": "Management of a case of iliac aery embolism requires", "exp": "Ans. is 'a' i.e., Embolectomy", "cop": 1, "opa": "Embolectomy", "opb": "Injection of vasodilators", "opc": "Hypotensive therapy", "opd": "Sympathectomy", "subject_name": "Surgery", "topic_name": null, "id": "30864473-0601-4743-b583-77340d90636b", "choice_type": "single"} {"question": "Suture least adherent to tissue and have a property of\nplasticity", "exp": null, "cop": 2, "opa": "Nylon", "opb": "Prolene", "opc": "PDS", "opd": "Silk", "subject_name": "Surgery", "topic_name": null, "id": "3a08f330-b7ac-4d93-beae-4b2c50d3fa94", "choice_type": "single"} {"question": "A new bom presents with discharge of urine from the umbilicus for 3 days. Diagnosis is", "exp": "(Urachal fistula) (211,1289- B & L 24th) (776- Nelson 18th) (986-Baily 25th)A persistent urachus (Urachal cyst, sinus, patient urachus or diverticulum) is due to failure of closure of the allantoic duct and is associated with bladder outlet obstruction* Patency should be suspected if a clear, light, yellow urine- like fluid is being discharged from the umbilicus* Symptoms include drainage, a mass or cyst, abdominal pain, local erythema or infectionCongenital Omphalocele - is a herniation or protrusion of the abdominal contents into the base of the umbilical cord, the sac is covered with peritoneum without overlying skin.Bleeding from umbilical stump suggests - factor XIII deficiency** (AIIMS - May - 2007)", "cop": 3, "opa": "Meckel's diverticulum", "opb": "Mesenteric cysts", "opc": "Urachal fistula", "opd": "Omphalocele", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "e810923d-2b4d-45d6-a573-a068623a1bbe", "choice_type": "single"} {"question": "Daily requirement of sodium in an adult is", "exp": "The following are the approximate daily requirements of some electrolytes in adults:sodium: 50-90 mM/daypotassium: 50 mM/daycalcium: 5 mM/daymagnesium: 1 mM/dayRef: Bailey and Love 27e pg: 281", "cop": 2, "opa": "30-40 mM", "opb": "50-90 mM", "opc": "80-120 mM", "opd": "120 -150 mM", "subject_name": "Surgery", "topic_name": "General surgery", "id": "1a60edf4-4054-4c77-bde4-be3e63f1ba6a", "choice_type": "single"} {"question": "Brilliantly translucent swelling in the neck region in a 2 year old child, diagnosis is", "exp": "CYSTIC HYGROMA:\n• Cystic hygromas are multiloculated cystic spaces lined by endothelial cells.\n• It results due to sequestration of a portion of the jugular lymph sac from the lymphatic system.\n• Cysts are filled with clear lymph and are lined by endothelium.\n• Turner's syndrome is associated with cystic hygroma.\n• Most cystic hygromas involve the lymphatic jugular sacs.\n• MC site: Posterior neck region.\n• Other common sites: Axilla, mediastinum, inguinal and retroperitoneal regions.\n• Approximately 50% of them are present at birth.\n• It may show spontaneous regression.\nClinical Features\n• Usually present as soft cystic masses. that distort the surrounding anatomy, can result in acute airway obstruction.\n• Usually manifests in the neonates or in early infancy (50% present at birth).\n• Prone to infection and hemorrhage within the mass.\n• Swelling is soft and partially compressible and invariably increases in size, when the child coughs or cries.\n• Characteristic features: Brilliantly translucent.\nDiagnosis \n• MRI play a crucial role in preoperative planning.\nTreatment \n• Complete surgical excision is the preferred treatment.\n• Injection of sclerosing agents, such as bleomycin or OK-432 (Picibanil), derived from Streptococcus pyogenes may eradicate the cystic hygroma.", "cop": 3, "opa": "Lipoma", "opb": "Teratoma", "opc": "Cystic Hygroma", "opd": "Thyroglossal cyst", "subject_name": "Surgery", "topic_name": null, "id": "8d937e8d-c773-4ef2-875b-2a14314745bf", "choice_type": "single"} {"question": "Abbe estlandec flap is used for", "exp": ".abbe flap is used for lip reconstruction surgeries", "cop": 1, "opa": "Lip", "opb": "Nose", "opc": "Ears", "opd": "Eyelid", "subject_name": "Surgery", "topic_name": "General surgery", "id": "b0b4cf5d-c308-4b99-b849-b27dd0c26465", "choice_type": "single"} {"question": "During exploration, a patient is found to have a tumor in the thymus that is invading the pericardium and surrounding the left and right phrenic nerves. The pathologist says that appears on frozen section to be a benign thymoma. The surgeon now should", "exp": "Ans. b. Attempt as complete a resection as possibleThymomas usually appear histologically benign even though they may be grossly invasive.Thymectomies are necessary when a thymoma is present to prevent the spread of malignant thymic disease.", "cop": 2, "opa": "Repeat frozen section", "opb": "Attempt as complete a resection as possible", "opc": "Close the chest and plan irradiation therapy", "opd": "Close the chest and await permanent sections", "subject_name": "Surgery", "topic_name": "Thorax", "id": "1a1c88e7-c8a4-4730-9803-bcb33e57c0d9", "choice_type": "single"} {"question": "Inferior alveolar nerve block is given in", "exp": null, "cop": 2, "opa": "Retromolar area", "opb": "Pterygomandibular space", "opc": "Submandibular space", "opd": "Suhmental space", "subject_name": "Surgery", "topic_name": null, "id": "0379de4a-91c0-4ea8-bbf9-555f4398e87c", "choice_type": "single"} {"question": "Drug of Choice for Severe Mastitis", "exp": "* MC organism causing Mastitis- Staphylococcus aureus * Drug of Choice is- Cloxacillin Ref:- Surgery Sixer 3rd Edition; Pg num:- 268", "cop": 4, "opa": "Cefphalosporins", "opb": "Erythromycin", "opc": "Augmentin", "opd": "Cloxacillin", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "5a749376-107d-4c31-9931-8194532c0162", "choice_type": "single"} {"question": "Sentinel lymph node biopsy in carcinoma breast is done if", "exp": "Sentinel lymph node is the first axillary lymph node draining the breast. SLNB is done in all cases of early breast cancers ,T1 and T2 without clinically palpable nodes. It is not done in clinically palpable axillary nodes as tgere is already distoion of lymphatic flow due to tumour. SRB's Manual of Surgery.Edition -5. Pg no:543", "cop": 2, "opa": "LN palpable", "opb": "Breast mass but no lymph node palpable", "opc": "Breast lump with palpable axillary node", "opd": "Metastic CA breast", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "3cd35c3d-3631-4dc2-9776-ff380b80f5a9", "choice_type": "single"} {"question": "Persistent foetal lobulation of adult kidney is due to", "exp": "In humans, embryologically, the kidneys originate as distinct lobules that fuse as they develop and grow. The lobulation of the fetal kidney is usually lost as the lobules become bonded together by the growth of new coex and the renal capsule. Persistent fetal lobulation is a normal variant seen occasionally in adult kidneys . It occurs when there is incomplete fusion of the developing renal lobules.It is often seen on ultrasound, CT or MRI as smooth indentations of the renal outline in between renal pyramids. They should be distinguished from renal coical scarring , which generally overlie the pyramids. Reference : radiopaedia.org/aicles/persistent-fetal-lobulation-of-the-kidneys", "cop": 4, "opa": "Congenital renal defect", "opb": "Obstructive uropathy", "opc": "Intrauterine infections and scar", "opd": "Is a normal variant", "subject_name": "Surgery", "topic_name": "Urology", "id": "c1ed59db-4fb8-4dd6-8f27-56a765ef7ca8", "choice_type": "single"} {"question": "Odontogenic infections are mostly caused by", "exp": null, "cop": 1, "opa": "MIXED bacteria", "opb": "Anaerobic bacteria", "opc": "Aerobic bacteria", "opd": "Streptococci", "subject_name": "Surgery", "topic_name": null, "id": "a29afe5e-7ba2-4343-b6fd-ab4151cea801", "choice_type": "single"} {"question": "Glod standard test for insulinoma", "exp": "A fasting test that may last for up to 72 hrs is regarded as the most sensitive test.Usually , insulin, pro insulin, C-peptide and blood glucose are measured in 1- to 2-hr intervals to demonstrate inappropriately high secretion of insulin on relation to blood glucose. About 80% of insulinomas are diagnosed by this test,most of them in first 24 hrs . Bailey & Love ,26th,788", "cop": 1, "opa": "72 hr fasting test", "opb": "Plasma insulin levels", "opc": "C-peptide levels", "opd": "Low glucose levels < 30 mg\\/dl", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "062ba886-b753-4b24-b83b-360c4dc9bb1a", "choice_type": "single"} {"question": "Predisposing factors of Ca esophagus", "exp": "PREDISPOSING FACTORS OF SCC- 1.SEX -4 TIMES MORE IN MALE 2.ETHINICITY-AFRICAN AMERICANS, CENTRAL ASIA, MIDDLE EAST 3.ALCOHOLISM AND TOBACCO CHEWING 4.INTRINSIC DEFECTS-PLUMMER VINSON SYNDROME, ACHALASIA 5.HEREDITARY CANCER SYNDROME - TYLOSIS, FANCONI ANEMIA 6.HPV 7.H/O CAUSTIC INGESTION ADENO CARCINOMA 1.SEX -MALE 2.ETHINICITY- WHITE 3.BARRETT&;S OESOPHAGUS 4.SMOKING 5.OBESITY (SABISTON TEXTBOOK OF SURGERY 20TH EDITION)", "cop": 1, "opa": "Tylosis", "opb": "Achalasia", "opc": "Barret's esophagus", "opd": "Hiatus hernia", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "a147e4d5-4cca-4757-81f0-5eb287781f52", "choice_type": "single"} {"question": "Revised trauma score is", "exp": "Glasgow coma scale : Total score = 13-15 Mild head injury = 9-12 Mild = 3-8 Ref : SRB&;s 4thE pg:1175", "cop": 1, "opa": "Glasgow coma scale", "opb": "Pulse", "opc": "RR", "opd": "BP", "subject_name": "Surgery", "topic_name": "Trauma", "id": "106f59ed-d99f-4ce9-bc5a-9249e7570a96", "choice_type": "single"} {"question": "Day care surgery uses", "exp": "i.e. (Propofol): (81-A-Yadav 4th)Propofol is the IV agent of choice for day care surgeryBecause-(i) Early induction(ii) Early and smooth recovery(iii) Inactive metabolites(iv) Antiemetic antipruritic* Along with opioids (alfntanil or renifentanil) propofol is the agent of choice for total intravenous anaesthesia (TIVA)* Propofol infusion is used to produce sedation in ICU* Agent of choice for induction in susceptible individuals for malignant hyperthermia* *** Propofol is safe in porphyria (373- Wylie Anaesthesia)PROPOFOL (2mg/kg)It is oil based preparation containing soya bean oil egg lecithin and glycerol, so injection is painful and should be preceded by lignocaine injection. The colour of solution is milky white and used within 6 hour after opening the vial because there have been death reports following the use of contaminated solution ofpropofol (as egg lecithin is good media for bacterial growth) and to prevent this problem recently available propofol formulations have disodium edate or sodium metabisulfite as anti microbial agents* Mechanism of action is mainly GABA mediated* Most common side effect during induction of anesthesia is hypotension. Which is augmented by concomitant administration of opioids", "cop": 2, "opa": "Sodium thiopentone", "opb": "Propofol", "opc": "Methoxitone", "opd": "Ether", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "6a3cde62-32a9-424f-9762-f721081852f7", "choice_type": "single"} {"question": "Most common type of hernia in females", "exp": "Ans. (b) IndirectRef: Bailey and Love 27th edition Page 1035* MC hernia in females - Indirect Inguinal* Femoral hernia: Most common in Females than Males.* Direct hernias are very rare in Females.* Incisional Hernia is more common in Females.", "cop": 2, "opa": "Direct", "opb": "Indirect", "opc": "Femoral", "opd": "Umbilical", "subject_name": "Surgery", "topic_name": "Hernia", "id": "1a86b180-de12-4a00-b139-be9984d85d80", "choice_type": "single"} {"question": "Most common site of aoic aneurysm rupture is", "exp": "Answer- D. Infrarenal aoaRuptured aneurysm is the most common cause of aoic rupture and they are most common in the abdomen.", "cop": 4, "opa": "Descending thoracic aoa", "opb": "Arch of aoa", "opc": "Aoic Root", "opd": "Infrarenal aoa", "subject_name": "Surgery", "topic_name": null, "id": "8ca6a639-0c70-48be-8c71-4b88f6a0872a", "choice_type": "single"} {"question": "Paucity of pus is seen in", "exp": null, "cop": 2, "opa": "Quinsy", "opb": "Ludwig's angina", "opc": "Carbuncle", "opd": "Milroy disease", "subject_name": "Surgery", "topic_name": null, "id": "540481f4-8e47-4954-95cb-59f03ca54f7d", "choice_type": "single"} {"question": "Type of anaemia caused by pulmonary TB", "exp": "Microcytie hypochromic anaemia Tuberculosis is a chronic inflammatory disorder. It is associated with anemia of chronic disease Anemia that is often observed in patients with infectious inflammatory or neoplastic disease that persists for more than 1 or 2 months is called anemia of chronic disease. - The characteristic feature of this group is occurrence of anemia in the presence of ample storage iron. The erythrocytes in anemia of chronic disease are usually normocytic and nonnochronic, however hypochromia and microcytosis may also be observed. The morphological features are determined by the primary disease. - \"For instance many patients with cancer have anemia that is typically normocytic and normochromic. In contrast patients with long standing active rheumatoid ahritis or chronic infections such as tuberculosis will have a microc tic hypochromic anemia\". The key pathological feature in anemia of chronic disease is failure to mobilize stored irony (ferritin). Ferritin is present in the macrophages of bone marrow and reticuloendothelial system. Under normal circumstances, iron can be mobilized back from the ferritin into the circulation. When developing erythrocytes require iron, the iron stored as ferritin is presented to the plasma from where it is carried to the developing erythrocytes. Why there is failure of iron mobilization in anemia of chronic disease? Anemia of chronic disease occurs in ceain inflammatory conditions or chronic disease. In these conditions macrophages are activated and they release ceain cytokines e.g. IF, IL-1, TNF. These cytokines stimulate synthesis of hepcidin in the liver. Increased hepcidin synthesis inhibits release of iron from the storage pool. Thus in anemia of chronic diseases, the macrophages, despite being rich in stored iron cannot provide iron to developing erythrocyte. The other impoant effect of cytokines released by rnacrophages in chronic inflammatory disorders is inhibition of CFUE (colony forming units erythroid). The inhibition leads to decreased synthesis of erythropoletin which in turn decreases erythropoiesis and produces anemia. The Hematological Parameters in Anemia of Chronic disease Serum iron --> Normal to decreased Serum ferritin --> Normal to increased TIBC --> Decreased % saturation Normal to increase Bone marrow iron stores --> Normal to increase MCV (MCH) --> Decreased", "cop": 4, "opa": "Iron-deficiency", "opb": "Megaloblastic", "opc": "Sideroblastic", "opd": "Microcytic Hypochromic anaemia", "subject_name": "Surgery", "topic_name": null, "id": "af153ac2-c470-49be-a3c8-94cbebeebb8a", "choice_type": "single"} {"question": "Orphan Annie eyed nuclei is the characteristic histologic appearance is seen in", "exp": null, "cop": 1, "opa": "Papillary carcinoma thyroid", "opb": "Follicular carcinoma thyroid", "opc": "Medullary carcinoma thyroid", "opd": "Hashimoto's thyroiditis", "subject_name": "Surgery", "topic_name": null, "id": "6d463d69-b9e0-485e-bdf0-5a9ba70d1314", "choice_type": "single"} {"question": "Dohlman's procedure is used in", "exp": "Zenker's diveiculum is a protrusion of mucosa through killian's dehiscence, a weak area of the posterior pharyngeal wall between thyropharyngeus (oblique fibres) and cricopharyngeus (transverse fibres ) of the inferior constrictor muscle of the pharynx. It is a pulsion diveiculum. Dohlman's approach is minially invasive endoscopic technique wherein pouch is excised using double lipped endoscopy. Cautery or laser is used. It is a quicker procedure with shoer duration of anaesthesia and faster recovery. Reference : page 433-34 SRB's manual of surgery 5th edition", "cop": 4, "opa": "Rectal prolapsed", "opb": "Esophageal achalasia", "opc": "CA oesophagus", "opd": "Zenker's diveiculum", "subject_name": "Surgery", "topic_name": "Urology", "id": "266bed38-35b3-4ebb-9378-98dd0f5d807f", "choice_type": "single"} {"question": "70 years old lady underwent Right Radical mastectomy 10 years back, now presents with multiple subcutaneous nodules in right upper limb. Most probable diagnosis is", "exp": "Ans. (a) Lymphangiosarcoma(Ref Bailey and Love 27h edition page 879)Lymphangiosarcoma (Stewart Treves Syndrome)* It is a complication of Lymphedema which develops after mastectomy.* It takes the form of multiple nodules in upperlimb.* Differentiate from recurrent breast cancer.* Poor prognosis* Inter scapulothoracic (Forequarter Amputation) is rarely indicated", "cop": 1, "opa": "Lymphangiosarcome", "opb": "Multiple Lipomas", "opc": "Varicose veins", "opd": "Mets", "subject_name": "Surgery", "topic_name": "Breast", "id": "f391b63b-f5b0-4e5e-912c-fb8aea8d7e49", "choice_type": "single"} {"question": "Complication of total paranternal nutrition is", "exp": ".Complications OF TPN includes Technical - 1. Air embolism. 2. Pneumothorax. 3. Bleeding. 4. Catheter displacement, sepsis, blockage. 5. Infection, thrombosis. Biochemical- 1. Electrolyte imbalance: Hyponatraemia, hypokalaemia, hypophosphataemia. 2. Hyperosmolarity. 3. Hyperglycaemia. - common. 4. Dehydration. 5. Altered immunological and reticuloendothelial function. 6. Azotaemia. Others- 1. Dermatitis. 2. Anaemia and increased capillary permeability. 3. Cholestatic jaundice: It is common. 4. Severe hepatic steatosis. 5. Metabolic acidosis. 6. Candida infection (candidiasis), staphylococcal infection. (10-15%). ref:SRB&;s manual of surgery,ed 3,pg no 89", "cop": 3, "opa": "CHF", "opb": "Hypochloremia", "opc": "Metabolic acidosis", "opd": "Leukopenia", "subject_name": "Surgery", "topic_name": "Urology", "id": "571b398c-ab9a-4f0a-8928-1c0f458bd855", "choice_type": "single"} {"question": "Serum amylase is NOT raised in", "exp": "(D) Ruptured ovarian cyst > Appendicitis alone does not cause increased amylase. Perforated appendix, may be associated with increased amylase.> Abdominal disorders associated with increased amylase levels include> Biliary tract disease: Cholecystitis Choledocholithiasis> Intra-abdominal disease: Perforating or penetrating peptic ulcer Intestinal obstruction or infarction Ruptured ectopic pregnancy Peritonitis Aortic aneurysm Chronic liver disease Postoperative", "cop": 4, "opa": "Cholecystitis", "opb": "Peptic ulcer perforation", "opc": "Intestinal ischemia", "opd": "Ruptured ovarian cyst", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "0585b517-079a-4bb2-93f2-d9cb441bf5af", "choice_type": "single"} {"question": "In a highly selective vagotomy, the vagal supply is severed to", "exp": "Done in cases of uncomplicated duodenal ulcer wherein the fibres entering the stomach is divided both anteriorly as well as posteriorly, Nerve of Latarjet is retained to supply the tantrum. Reference: SRB 5th edition page no. 861", "cop": 2, "opa": "Proximal two-thirds of stomach", "opb": "Antrum", "opc": "Pylorus", "opd": "Whole of stomach", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "52fc5a8e-4f07-4e05-89dd-fee56cfeb715", "choice_type": "single"} {"question": "Metabolic abnormality seen in congenital hypertrophic pyloric stenosis is", "exp": "Ans. is 'a' i.e. Hypochloremic hypokalemic metabolic alkalosis * Repeated vomiting leads to hypochloremic, hypokalemic metabolic alkalosis. The urine is alkaline initially but eventually it becomes acidic {paradoxical aciduria)Cause of paradoxical aciduria - Initially the kidney compensate for metabolic alkalosis by reabsorbing hydrogen and chloride ions in exchange for sodium, potassium and bicarbonate. But gradually as the body stores of sodium and especially potassium become depleted, kidney starts retaining these ions in exchange of hydrogen ions, thus the urine becomes acidic and metabolic alkaline state is further aggravated", "cop": 1, "opa": "Hypochloremic hypokalemic metabolic alkalosis", "opb": "Hyperchlonemic hypokalemic metabolic alkalosis", "opc": "Hypochloremic hypokalemic metabolic acidosis", "opd": "Hyperchloremic hypokalemic metabolic acidosis", "subject_name": "Surgery", "topic_name": "Benign Gastric Disease", "id": "2b8ae7e0-66c8-4f8d-b9fe-688f0fee07b8", "choice_type": "single"} {"question": "Retropharyngeal space infection is mainly due to\nspread of", "exp": null, "cop": 4, "opa": "Cervical tuberculosis", "opb": "Meningo encephalitis", "opc": "Mumps", "opd": "Odontogenic infections", "subject_name": "Surgery", "topic_name": null, "id": "5f54524d-4718-4b16-9bd4-924ca9a8b5c9", "choice_type": "single"} {"question": "The operation that precipitates portosystemic encephalopathy is", "exp": "Portosystemic encephalopathy is a neuropsychiatric syndrome, It most often results from high gut protein or acute metabolic stress\n(eg, GI bleeding, infection, electrolyte abnormality) in a patient with portosystemic shunting.\nIn portosystemic shunting, absorbed products that would otherwise be detoxified by the liver enter the systemic circulation and reach the brain, causing toxicity, particularly to the cerebral cortex.", "cop": 4, "opa": "Splenorenul shunt", "opb": "Siguira operation", "opc": "Talma - Marison Operation", "opd": "Portacaval anastomosis", "subject_name": "Surgery", "topic_name": null, "id": "c75d05af-8d8d-487c-a3c8-838c4bbd0b73", "choice_type": "single"} {"question": "Most common early complication of end ileostomy is", "exp": "Early commplication - necrosis.\nLate commplication - prolapse.", "cop": 2, "opa": "dermatitis", "opb": "Necrosis", "opc": "Prolapse", "opd": "Hernia", "subject_name": "Surgery", "topic_name": null, "id": "61a0f34e-f687-4136-83f1-4a0a2d482d40", "choice_type": "single"} {"question": "Pus in burns forms in", "exp": null, "cop": 2, "opa": "2-3 days", "opb": "3-5 days", "opc": "2-3 weeks", "opd": "4 weeks", "subject_name": "Surgery", "topic_name": null, "id": "c6629a96-2ad3-40cd-ac8a-c7f455fbc162", "choice_type": "single"} {"question": "Duct ectasia, treatment of choice is", "exp": "Duct ectasia is the dilatation of breast ducts with periductal inflammation.Dilatation of one or more large lactiferous duct with stagnant brown or green secretion.Fibrosis devolop with slit like nipple retraction. Treatment:Stop smoking -antibiotics like flucloxacillin -microdochectomy- surgical excision of lactiferous ducts (Hadfield's operation.) Bailey and Love'sSho practice of surgery.Edition 23.Pg no:757", "cop": 3, "opa": "Lobectomy", "opb": "Mastectomy", "opc": "Microdochetectomy", "opd": "Lumpectomy", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "925dd32c-dc82-4789-8c50-bbb0ea10b89b", "choice_type": "single"} {"question": "Investigation of choice for choledochal cyst is", "exp": "The investigation of choice for Choledochal cyst is MRCP-to see the status of pancreatic & biliary system and pancreaticobiliary maljunction. Reference:SRB's manual of surgery,5th edition,page no:638.", "cop": 2, "opa": "Graham chole's test", "opb": "MRCP", "opc": "ERCP", "opd": "USG", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "55a866cf-cfab-4ce0-a4d1-8a92b9da0a99", "choice_type": "single"} {"question": "A person was presented with swelling of the salivary gland. Mild pain was felt by him.Investigation of choice.", "exp": "Here the most accurate answer is FNAC. The first investigation which is done is FNAC. It can be guided by ultrasound as it demonstrates if the lump is intrinsic to parotid or not. Open surgical biopsy is contraindicated unless evidence of gross malignancy is present. Reference : Bailey & love, 27th Edition, page no = 789.", "cop": 1, "opa": "FNAC", "opb": "Incisional biopsy", "opc": "X ray", "opd": "Excisional biopsy", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "b05c2cb2-cc1d-4e40-90fa-26d9699e705a", "choice_type": "single"} {"question": "Squamous cell carcinomas of the esophagus most commonly occur", "exp": "- MC type of CA Esophagus World Wide - Squamous cell carcinoma- MC type of CA in western countries - Adenocarcinoma- MC site of Squamous cell carcinoma - Middle 1/3rd- MC site of Adenocarcinoma - Lower 1/3rd- MC site of CA Esophagus overall - Middle 1/3rd- SCC - more common in low socio-economic status- Adenocarcinoma - more common in high socio-economic status", "cop": 2, "opa": "At the GEJ", "opb": "Middle 1/3rd", "opc": "In the lower thoracic esophagus", "opd": "Evenly distributed throughout the esophagus", "subject_name": "Surgery", "topic_name": "Esophagus", "id": "f7db841b-3049-4021-b022-29ebd3f6593d", "choice_type": "single"} {"question": "Best management for a contaminated wound with necrotic material", "exp": "Necrotic tissue acts as foci of infection and slows down healing. So Debridement is neccesary after initial assessment. Debridement : A wound should be explored and debrided to the limit of blood staining. Devitalized tissue must be excised until bleeding occurs with obvious exceptions of nerves, vessels and tendons.", "cop": 1, "opa": "Debridement", "opb": "Tetanus toxoid", "opc": "Gas gangrene serum", "opd": "Broad spectrum antibiotics", "subject_name": "Surgery", "topic_name": "General surgery", "id": "385b295e-47f1-4934-8d92-650eac763eca", "choice_type": "single"} {"question": "Anatomical structure injured in excision of ranula", "exp": null, "cop": 3, "opa": "Lingual vein", "opb": "Lingual artery", "opc": "Submandibular duct", "opd": "Parotid duct", "subject_name": "Surgery", "topic_name": null, "id": "4f1bf8c2-77c6-4042-a4b2-70811d27ea21", "choice_type": "single"} {"question": "To differentiate between stress incontinence and detrusor instability investigation done is", "exp": "Ans is 'b' ie Urodynamic study Genuine stress incontinence is defined as urinary leakage occuring during increased bladder pressure when this is solely due to increased abdominal pressure and not due to increased true detrusor pressure. - It is caused by sphincter weakness. Detrusor instability - this is phasic increase in detrusor pressure (due to phasic contraction of detrusor muscle) giving rise to sensation of urgency of micturition and urge incontinence. It is found in pts with several types of neurogenic bladder dysfunction such as multiple sclerosis (MS) Parkinson disease or following a stroke or ceain types of spinal injury when it is known as detrusor hyperreflexia. Usefulness of Urodynamic testing: 1) Distinguishing genuine stress incontinence from detrusor instability in women. 2) Classification of neurogenic bladder dysfunction 3) Distinguishing bladder outflow obstruction from idiopathic detrusor instability in men. 4) Investigation of incontinence.", "cop": 2, "opa": "Cystosurethroscopy", "opb": "Urodynamic study", "opc": "MCU", "opd": "Retograde urethroscopy", "subject_name": "Surgery", "topic_name": null, "id": "3d852959-c3f9-4503-957f-bc573f658997", "choice_type": "single"} {"question": "Renal calculus seen in proteus infection is", "exp": "Urease producing organisms eg :- proteus ,psuedomonas , and staphylococcus , break down urea to produce ammonia and co2.The urine becomes alkaline which promotes formation of struvite calculi ( magnesium ammonium phosphate ) which grow to become staghorn calculi.E coli never forms struvite stones ref :- Bailey and Love 27th edition .chapter 72 . pg no 1406", "cop": 3, "opa": "Uric acid", "opb": "Xanthine", "opc": "Triple phosphate", "opd": "Calcium", "subject_name": "Surgery", "topic_name": "Urology", "id": "e22f7485-634c-4200-8f90-49f54887b865", "choice_type": "single"} {"question": "Ecchymosis and hematoma are treated with", "exp": null, "cop": 1, "opa": "Intermittent ice pack", "opb": "Continuous ice pack", "opc": "Intermittent hot pack", "opd": "Pressure and pack", "subject_name": "Surgery", "topic_name": null, "id": "8d0f247b-41f3-4998-83e1-f04d81204528", "choice_type": "single"} {"question": "Galeazzi fracture is", "exp": "B i.e. Fracture of the distal radius with inferior radio ulnar joint dislocation Fractures of Forearm (Single Bone Fracture) Monteggia Fracture Dislocation Fracture of proximal third of ulna with dislocation of proximal radioulnar jointQ. Essex - Lopresti Fracture Dislocation - Fracture of radial head or neck, disruption of distal radial ulnar joint & tearing of interosseous membrane for a considerable distance proximally - Tethering effect of interosseous membrane is lost; if the radial head is resected, rapid proximal migration of the radius can occur, resulting in wrist pain from ulnar carpal impingment & elbow pain from radiocapitellar impingment. Galeazzi Fracture Dislocation Fracture of the distal third of radius and dislocation of the distal radio - ulnar jointQ. Galeazzi fracture is called the \"fracture of necessity\". Like monteggia fracture dislocation, it often go unrecognized. And a treatment regimen of closed reduction & cast immobilization has a high rate of unsatisfactory results. Rigid anatomical fixation by plating (DCP/ LC - DCP) is the treatment of choice in adultsQ.", "cop": 2, "opa": "Supracondylar fracture of the humerus", "opb": "Fracture of the distal radius with inferior radio ulnar joint dislocation", "opc": "Fracture of radius in the proximal site and dislocation of the elbow", "opd": "Fracture of the radial head", "subject_name": "Surgery", "topic_name": null, "id": "18b4892c-20b0-4238-b466-1cab0acc87eb", "choice_type": "single"} {"question": "Prostatic cancer mostly seen in", "exp": "- MC site of CA Prostate - Posterior lobe - MC site of BPH - Median lobe - On DRE - Posterior lobe is felt and medial lobe is felt when enlarged. - MC site of BPH - Transition zone - MC site of CA Prostate - Peripheral zone", "cop": 1, "opa": "Posterior", "opb": "Lateral", "opc": "Medial", "opd": "Anterior", "subject_name": "Surgery", "topic_name": "FMGE 2019", "id": "7d8f107f-1762-4f2d-9577-8ce1b46c2c6c", "choice_type": "single"} {"question": "Testicular tumour most sensitive to radiation is", "exp": "Seminomas are most radiosensitive. So after orchidectomy radiotherapy is given to increase the cure rate and also to reduce relapse(excellent results in stage 1 and 2 seminomas). Radiotherapy is not beneficial in teratomas as they are less radiosensitive. Other radiosensitive tumours are squamoua cell carcinoma, basal cell carcinoma, hodgkin's lymphoma.Reference : page 1087 and1143 SRB's manual of surgery 5th edition", "cop": 4, "opa": "Teratoma", "opb": "Lymphoma", "opc": "Mixed germ cell tumour", "opd": "Seminoma", "subject_name": "Surgery", "topic_name": "Urology", "id": "75f3b0a7-00ac-4e93-8299-838b250db4c5", "choice_type": "single"} {"question": "Disadvantage of Somatic stem cells is", "exp": "Somatic stem cells are easily available, have good expansion in vitro, low risk of malignancyNo ethical concerns (not taken from foetus, embryo and mostly used for autologus tissues)Main disadvantage is limited pluripotencyRef: Bailey and Love 27e pg: 34", "cop": 3, "opa": "Limited availability", "opb": "Poor expansion in vitro", "opc": "Limited pluripotency", "opd": "Ethical concerns", "subject_name": "Surgery", "topic_name": "General surgery", "id": "d75c6da8-7e06-4f1c-9b8c-517159375cfb", "choice_type": "single"} {"question": "Signature fracture of skull is seen in", "exp": "DEPRESSED SKULL FRACTURE It is a common neurosurgical problem among the head injuries. It means fracture depression is more than the depth of inner table of the skull. Investigations: CT scan. Problems in depressed fracture Tear in the dura beneath Haematoma in the deeper plane Injury to the cerebrum Injury to the venous sinuses--may cause life-threatening haemorrhage. Fracture should not be elevated in such occasion, as it itself can precipitate bleeding Convulsions Meningitis Treatment Antibiotics, anticonvulsants. Elevation of the depressed fracture: Burr holes are made in the adjacent normal skull. Fracture is elevated. Bony fragments and necrotic materials are removed. Dural tear is closed with interrupted sutures. Ref: SRB's Manual of Surgery 5th edition Pgno : 1099", "cop": 2, "opa": "Gutter fracture", "opb": "Depressed fracture", "opc": "Ring fracture", "opd": "Sutural seperation", "subject_name": "Surgery", "topic_name": "Trauma", "id": "6f299673-f4a7-45b6-acfa-b15c564e923b", "choice_type": "single"} {"question": "In performing a tracheostomy, authorities agree that", "exp": "Although tracheostomy is occasionally an emergency procedure, it can be more effectively performed in an operating room where hemostasis and antisepsis are readily achieved. Most authorities recommend a horizontal incision; however, limited direct midline incisions have the advantage of not opening any unnecessary tissue planes and perhaps reducing the incidence of bleeding complications. Both approaches have advocates. In either case, the skin incision is made just below the cricoid cartilage, the strap muscles are spared and retracted, the thyroid isthmus is divided if necessary, and the trachea is entered at the second tracheal ring. The second and third tracheal rings are incised vertically, allowing placement of the tracheostomy tube. The first tracheal ring and the cricoid cartilage must be left intact.", "cop": 3, "opa": "The strap muscles should be divided", "opb": "The thyroid isthmus should be preserved", "opc": "The trachea should be entered at the second or third cartilaginous ring", "opd": "Only horizontal incisions should be used", "subject_name": "Surgery", "topic_name": "Neck", "id": "b0b6da61-362e-46ef-ae04-6336b07d4c1d", "choice_type": "single"} {"question": "Diverticulosis is most common in", "exp": "Ans) a (Sigmoid colon) Ref: Sabiston's 18th editionA diverticulum is an abnormal sac or pouch protruding from the wall of a hollow organ, which is, for the purposes of this discussion, the colon. A due diverticulum is composed of all layers of the intestinal wall, whereas a false diverticulum, or pseudodiverticulum, lacks a portion of the normal bowel wall. The diverticula that commonly occur in the human colon are pseudodiverticula.Diverticula most commonly affect the sigmoid colon and are confined to the sigmoid in about half of patients with diverticulosis. The next most common area involved is the descending colon (?40% of affected individuals), and the entire colon has diverticula in 5% to 10% of patients with diverticulosis.", "cop": 1, "opa": "Sigmoid colon", "opb": "Ascending colon", "opc": "Descending colon", "opd": "Transverse colon", "subject_name": "Surgery", "topic_name": "Small & Large Intestine", "id": "b9a1d537-b14a-4406-924e-e2d54001e238", "choice_type": "single"} {"question": "A patient presents with sudden headache and vomiting and unconsciousness. The diagnosis is", "exp": "• MC cause: Trauma >Spontaneous rupture of Berry aneurysm\nClinical Features\n• Sudden transient loss of consciousness (occurs in nearly half of the patients)\n• Excruciating severe headache: presenting complaint in 45% of cases (worst headache of patients life) more common upon regaining consciousness when loss of consciousness is associated\n• Neck stiffness and vomiting: are common associations\n• Focal neurological deficit: uncommon.\n• Sudden headache in the absence of focal neurological deficit is the hallmark of aneurysmal rupture.\n• Associated prodromal symptoms (suggest location of progressively enlarging unruptured aneurysm):\n−− Third cranial nerve palsy: Aneurysm at junction of PCA and ICA\n−− Sixth nerve palsy: Aneurysm in cavernous sinus\n−− Occipital and posterior cervical pain: Inferior cerebellar artery aneurysm\n−− Pain in or behind the eye: MCA aneurysm\nDiagnosis\n• Non contrast CT scan: Investigation of choice (Lumbar puncture is not indicated prior to an imaging procedure)\n• CSF picture: Hallmark of aneurysmal rupture is blood in CSF (Xanthochromic spinal fluid)", "cop": 1, "opa": "Subarachnoid hemorrhage -", "opb": "Intracerebral hemorrhage", "opc": "Subdural hemorrhage", "opd": "Extradural hemorrhage", "subject_name": "Surgery", "topic_name": null, "id": "c2535f15-8d7b-48a4-8892-b3d21c8e01df", "choice_type": "single"} {"question": "A 3 cm size stone in CBD near the ampulla of Vater is removed by", "exp": "Ans. (a) Transduodenal ApproachRef: Sabiston 20th edition Page 1501Impacted stones at the ampulla that cannot be removed through choledochotomy or several stones in a nondilated tree can be addressed by a transduodenal sphincteroplastySteps:* Kocher maneuver,* Longitudinal duodenotomy is made on the lateral wall* Palpation of the ampulla to plan placement of the duodenotomy* After identifying ampulla- an incision made at 11' O clock* Avoid 5'O clock as pancreatic duct enters there.* The duodenal mucosa is sewn to the bile duct mucosa with absorbable 4-0 sutures.* A 1.5cm sphincterotomy is usually sufficient to allow stone removal and subsequent drainage.* Closure of the longitudinal duodenotomy in transverse fashion to avoid future duodenal stricture.", "cop": 1, "opa": "Trans duodenal approach", "opb": "Supraduodenal approach", "opc": "Chemical dissolution", "opd": "ESWL", "subject_name": "Surgery", "topic_name": "Gall Bladder & Bile Ducts", "id": "ab2d518d-8665-4af3-bb43-67209511e55c", "choice_type": "single"} {"question": "Duhamel procedure is done for", "exp": "Answer- A. Hirschsprung's diseaseSurgery in Hirschsprung's discase aims to remove the aganglionic segment and'pull-through'ganglionic bowel to the anus (e.9. Swenson, Duhamel, Soave and transanal procedures) and can be done in a single stage or in several stages after first establishing a proximal stoma in normally innervated bowel.", "cop": 1, "opa": "Hirschsprung's disease", "opb": "HPSS", "opc": "Meckels diveiculum", "opd": "Volvulus", "subject_name": "Surgery", "topic_name": null, "id": "b39935ec-d16d-4706-a237-c481831885e4", "choice_type": "single"} {"question": "Investigation of choice for spinal tuberculosis", "exp": "Ans. is 'd' i.e., MRI Investigations in musculoskeletal system Investigation of choice for AVN Hip MR1 Best initial test for osteomyelitis -9 Plain x-ray Best second line test for osteomyelitis (if there is high clinical suspician and x-ray is negative) --> MRI Most accurate diagnostic test for osteomyelitis Bone biopsy and culture. Best view for scaphoid fracture --> Oblique (scaphoid) view of wrist. Best view for C1-C2 veebrae & junction -* Open mouth odontoid (Pegs) view. Investigation of choice for ACL & PCL injury MRI Investigation of choice to detect calcification --> CT scan Investigation of choice for prolapsed interveebral disc --> MRI Investigation of choice for spinal tuberculosis -4 MRI Investigation of choice for traumatic paraplagia --> MRI Gold standard and investigation of choice for osteoporosis --> Dual energy x-ray absorptiometry (DEXA).", "cop": 4, "opa": "X-ray", "opb": "CT-Scan", "opc": "Open biopsy", "opd": "MRI", "subject_name": "Surgery", "topic_name": null, "id": "c208d885-27d9-4431-8678-981048e454b8", "choice_type": "single"} {"question": "The ganglion to be avoided while doing cervical sympathectomy to avoid Horner syndrome", "exp": "Cervical sympathectomy Open cervical sympathectomy was previously performed for vasospastic conditions affecting the hands and to treat palmar (sometimes axillary) hyperhidrosis. The operation is now obsolete, having been replaced by endoscopic transthoracic sympathectomy. Fuhermore, it has been increasingly recognised that the vasospastic conditions do not respond to this form of treatment, rendering the endoscopic intervention a therapy that is suitable solely for hyperhidrosis. Ref: Bailey and love 27th edition Pgno : 968", "cop": 1, "opa": "T1", "opb": "T2", "opc": "T3", "opd": "T4", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "19002313-631b-4eb9-8d19-32af13690c76", "choice_type": "single"} {"question": "\"Double bubble sign\" seen in", "exp": "(Annular pancreas) (1120, 1198-LB) (1137-B & L 25th)Annular pancreas - in which a ring of pancreatic tissue from the head of the pancreas surrounds the descending duodenum X-ray shows a dilated stomach and proximal duodenum (double bubble sign) and little or no air in the rest of the small bowel.Congenital duodenal obstruction - causes of duodenal obstruction are atresia, mucosal web, annular pancreas, preduodenal portal vein and peritoneal bands {Ladd's bands) from malrotations - shows - \"double bubble sign\" (1316-CSDT 11th)", "cop": 1, "opa": "Annular pancreas", "opb": "Ureterocele", "opc": "Hypertrophic pyloric stenosis", "opd": "Wilm's tumour", "subject_name": "Surgery", "topic_name": "Pancreas", "id": "01008fec-3ae8-4f2a-afcf-e496d8bcd61b", "choice_type": "single"} {"question": "Biological oxygen demand (BOD) measures the total organic content of water based on the consumption of oxygen in a sample at 20deg C Celsius over five days. A consumption of 10 to 20 mg of O2 per liter most likely represents a sample from", "exp": "Biological oxygen demand is a measure of organic content in water. The greater the demand, the greater the load of organic content that can be broken down, reflecting a high bac-terial load. Untreated freshwater has a BOD of 25 mg/l, treated sewage, 10-20, domestic sewage, 200-500, and industrial sewage, >2000.", "cop": 3, "opa": "Treated freshwater", "opb": "Untreated freshwater", "opc": "Treated sewage", "opd": "Industrial wastewater", "subject_name": "Surgery", "topic_name": null, "id": "7060390d-2394-466a-9f1c-62359207f7b6", "choice_type": "single"} {"question": "Most useful investigation in sliding hernia in female", "exp": "(Barium meal) (1281 -B&L 24th) (771-CSDT 12th) (977-Baily & Love 25th)* Finding a segment of colon in the scrotum on barium enema strongly suggests a sliding hernia (771-CSDT 12th)SLIDING -HERNIA (hernia - en-glissade) is a type of indirect inguinal hernia* Almost exclusively in men* It should be suspected in a very large globular inguinal hernia descending well into the scrotum* Right side the caecum is most commonly involved* Left side the sigmoid colon is most commonly involved* The surgical complication most often encountered following sliding hernia repair is bowel injury**", "cop": 2, "opa": "Fluroscopy", "opb": "Barium- meal", "opc": "Palpation method", "opd": "Ultrasound", "subject_name": "Surgery", "topic_name": "Hernia", "id": "6f36f1b2-53e1-4739-8d7a-f1257d74388c", "choice_type": "single"} {"question": "Helicobacter pylori is implicated as causative agent in", "exp": "Helicobacter pylori infection is causative agent in MALT Lymphoma.", "cop": 3, "opa": "Hodgkin's Lymphoma", "opb": "Non-Hodgkin's Lymphoma", "opc": "MALT Lymphoma", "opd": "Mantle cell Lymphoma", "subject_name": "Surgery", "topic_name": null, "id": "30ffa071-559a-43d8-910f-126a73aded8d", "choice_type": "single"} {"question": "Traetment of Medullary Carcinoma thyroid", "exp": "In medullary carcinoma thyroid , total thyroidectomy is treatment of choice. Radiotherapy can be considered in unresectable cases or after complete surgical resection in few cases. Note : Since medullary thyroid cancer doesnot arise from follicular cells, TSH suppression and RAI (radio active iodine) therapy have no role. Source : Sabiston 20th edition pg 910", "cop": 3, "opa": "Surgery and Radioiodine", "opb": "Radiotherapy and chemotherapy", "opc": "Surgery only", "opd": "Radioiodine ablation", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "deafee97-31c0-4c99-bbd7-01067fb8c8c4", "choice_type": "single"} {"question": "The procedure of choice for elective removal of CBD stones for most patient is", "exp": "The procedure of choice for elective removal of CBD stones is Endoscopic choledocholithotomy.i.e.,endoscopic papillotomy(sphincterotomy)and stone extraction through Dormia basket or balloon catheter.CBD stent is placed in situ.Once the CBD stones are extracted,laparoscopic cholecystectomy is done. Reference:SRB's manual of surgery,5th edition,page no:651.", "cop": 2, "opa": "Open choledocholithotomy", "opb": "Endoscopic choledocholithotomy", "opc": "Laparoscopic choledocholithotomy", "opd": "Percutaaneous choledocholithotomy", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "859f8c5e-3832-4a9c-9037-55e1dd0d6035", "choice_type": "single"} {"question": "Crohn&;s disease can be seen in", "exp": ".crohn&;s disease is a granulomatous, noncaseating inflammatory condition of the ileum commonly and of the colon often. * It is independent of age, sex, socioeconomic status and geographic areas. Main features of Crohn's disease * Ileum--most common site of occurrence--60% * Rectal sparing is usual and common * Skip lesion * Hose-pipe pattern * Linear ulcers and cobble stone appearance of mucosa * Transmural ref:SRB&;s manual of surgery,ed 3,pg no 801", "cop": 4, "opa": "Jejunum only", "opb": "Colon only", "opc": "Terminal ileum and right side", "opd": "Mouth of anus", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "84b24c41-1839-4fc1-8992-39d13f13c407", "choice_type": "single"} {"question": "Triangle of doom is associated with", "exp": "Ans. (b) Laparoscopic hernia surgeryRef Palanivel Laparosopic Surgery* The following triangles are related to Laparoscopic hernia repair:# Triangle of Doom# Triangle of Pain", "cop": 2, "opa": "Laparoscopic Nissen's Fundoplication", "opb": "Laparoscopic hernia surgery", "opc": "Endoscopic thyroidectomy", "opd": "Thoracoscopic thymectomy", "subject_name": "Surgery", "topic_name": "Hernia", "id": "1f6b08ff-5272-4d56-8086-41dd83a78708", "choice_type": "single"} {"question": "Auto nephrectomy is seen in", "exp": null, "cop": 2, "opa": "Sickle cell anemia", "opb": "Renal T.B.", "opc": "Sarcoidosis", "opd": "Lymphoma", "subject_name": "Surgery", "topic_name": null, "id": "f0c9f843-a965-48e4-bc02-4bcc5f7c3f99", "choice_type": "single"} {"question": "Position that is least likely possible by means of bilateral saggital split osteotomy is", "exp": null, "cop": 4, "opa": "Advancement", "opb": "Set back", "opc": "Rotation", "opd": "Transverse", "subject_name": "Surgery", "topic_name": null, "id": "984a8b25-b8c4-4aae-bfb6-625be5d28ca7", "choice_type": "single"} {"question": "Most common cause of acute mesenteric ischemia is", "exp": ".Superior mesenteric aery is commonly involved than inferior mesenteric aery. Often superior mesenteric vein can also get involved. Causes * Embolism (50%)--Sources - From left auricle, as seen in atrial fibrillation. - A mural infarct. - Atheroma from aoa or aneurysm. - Endocarditis vegetations. - Left atrial myxoma. * Thrombosis--may block the origin of the superior mesenteric aery and can cause ischaemia of full length of small bowel. It is life threatening. ref:SRB&;s manual of surgery,ed 3,pg no 806", "cop": 3, "opa": "Aerial thrombosis", "opb": "Venous thrombosis", "opc": "Embolism", "opd": "Non occlusive disease", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "54eaf36d-0d08-4da0-b26c-495012edc399", "choice_type": "single"} {"question": "Hypoparathyroidism following thyroid surgery occurs within", "exp": "Parathyroid insufficiency is due to the removal of the parathyroid glands or infarction through damage to the parathyroid end aeries; often both factors occur together. Vascular injury is probably far more impoant than inadveent removal. The incidence of permanent hypoparathyroidism should be less than 1% and most cases present dramatically 2-5 days after an operation but, very rarely, the onset is delayed for 2-3 weeks or a patient with marked hypocalcemia may be asymptomatic.Ref: Bailey and Love, page no: 815", "cop": 2, "opa": "24 hours", "opb": "2-5 days", "opc": "7-14 days", "opd": "2-3 weeks", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "77f02a96-79c6-4978-935c-2515a5066c71", "choice_type": "single"} {"question": "Carcinoma of pancreas associated with", "exp": ".Ampullary tumours mainly present with jaundice and weight loss.b. Carcinoma of head and neck region present with weight loss and jaundice. c. Cystadenocarcinoma of pancreas present with pain, weight loss . * Silvery stool (due to mixing of undigested fat with metabolised blood derived from the ooze of periampullary growth). * Loss of appetite and weight. * Scratch marks on the back. * Migratory superficial thrombophlebitis--Trousseau's sign (10%) is due to release of platelet aggregating factors from the tumour or its necrotic material. (Trousseau himself died of carcinoma pancreas who had migrating thrombophlebitis.) * Ascites. * Left supraclavicular palpable lymph node. * Secondaries in rectovesical pouch (Blumer's shelf). * Gall bladder may be palpable which is nontender, soft, globular, smooth, moving with respiration, mobile horizontally, dull on percussion. (30% in carcinoma head of pancreas; 50% in periampullary carcinoma). Courvoisier law ours gall bladder enlargement. * Liver is enlarged, smooth, firm, nontender, due to dilated bile filled biliary radicles--Hydrohepatosis. Liver can show multiple hard nodules due to secondaries. * Cystadenocarcinoma of pancreas can present with mass in epigastric region, which is nonmobile, not moving with respiration, smooth, soft, nontender. * Splenic vein thrombosis with splenomegaly (10%) can occur. ref:SRB&;S manual of surgery,ed 3,pg no 632", "cop": 1, "opa": "Hypoglycemia", "opb": "Syndrome of inappropriate secretion of ADH", "opc": "Erythropoisis is due to erythropoitin", "opd": "Hypercalcemia", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "c238b583-1031-4d6c-95e4-ed960a64b4f5", "choice_type": "single"} {"question": "Most common cause of bacterial peritonitis is", "exp": "Peritonitis secondary to any bowel or other visceral pathology eg. perforation, appendicitis is termed as secondary peritonitis, E-Coli is the commonest organism causing this. Primary peritonitis - there is no documented infection, it&;s monomicrobial, extraperitoneal postoperative leak after surgery for gallbladder, CBD, ERCP, duodenum, pyloroplasty Reference: SRB 5th edition page no.566,573", "cop": 2, "opa": "Primary or spontaneous", "opb": "Perforated viscus", "opc": "Foreign body", "opd": "Biliary peritonitis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "4f980985-bf68-4f19-b6b5-c3704a4238b3", "choice_type": "single"} {"question": "In nonunion of scaphoid vescularized muscle pedicle graft is taken from.", "exp": "C i.e. Pronator quadrates Blood supply of scaphoid enters distally mainly through the dorsal ridge (spiral groove, narrow non aicular region in the waist) and proximal segment is supplied by retrograde intraosseous blood flow from distal to proximal. This unusual pattern of vascularity is responsible for higher probability of nonunion & avascular necrosis of proximal fragment in fractures of scaphoid. Therefore 0-1% of distal third, 20% of middle third, 40% of proximal third and 100% of proximal pole fractures result in AVN and nonunion. Scaphoid Fracture Functional Anatomy & Epidemiology Scaphoid is the most commonly fractured bone in the - carpusQ, in adult as well as children. However unlike in adults and adolescents, the fracture is rare in young children. (d/t cailagenous nature of carpal bones in children) Scaphoid fracture is seen most commonly in males between the ages of 15 and 30. (adolscents & adults)Q - Scaphoid may be divided into proximal, middle and distal thirds. The middle third is termed the waist. The scaphoid tubercle forms the distal volar prominence. Middle third (Waist) fractures are most commonQ accounting for - 70% of scaphoid fractures > proximal pole fracture (20%) > distal pole fracture (10%), in adults & adolescents. Investigation Distal pole avulsion type fracture is most common fracture type in children Q. Anteroposterior, lateral and oblique views are all essential; often a recent fracture shown only in the oblique viewQ. So a routine scaphoid x- ray series must include:- Radial and ulnar deton PA views with the wrist in about 30deg of extension (by asking to make a fist gently) True lateral view Radial oblique (supinated PA) view and ulnar oblique (pronated PA) view. Comparison view of opposite wrist. However it is common for the fracture not to be visible on the initial films. If doubt exists, the scaphoid should be immobilized in plaster and repeat radiograph obtained in 1421 days as the late films are usually positiveQ. Bone scan, trispiral tomography are other investigations ; occult scaphoid fractures can be reliably diagnosed by MRI & nucleotide scan. Vascularity, Nonunion & AVN Blood supply of scaphoid is precarious. It receives most of its blood supply from two major vascular pedicles (dorsal & volar branches) from the radial aery, both entering distallyQ. Volar (palmar) scaphoid branch of radial aery enters the scaphoid tubercle and supplies its distal 20-30%. Dorsal scaphoid branch of radial aery enters through numerous small foramina along the spiral groove & dorsal ridge and account for 80% of its blood supply. There is usually no or rarely a single perforater proximal to the waist of scaphoid. Hence vascularity of proximal fragment is maintained by retrograde intraosseous blood flow from distal to proximal; 7080% of which is provided by dorsal branch. The distal scaphoid has a dense vascular network whereas intraosseous vascular density declines proximally, leaving the proximal pole with sparse blood supply. Because of this unusual retrograde vascular supply to proximal segment, the scaphoid has a high risk of nonunion and AVN after fracture through waist and proximal pole. Because the scaphoid aiculates with four carpal bones & radius, most of its surface is composed of aicular cailage. Therefore, the vascular supply comes through -a narrow non aicular region in the waist. Most of the blood supply to the scaphoid enters distally, so blood supply of scaphoid diminishes proximallyQ. This accounts for the fact that 1% of distal third, 20% of middle third, 40% of proximal third and 100% of proximal pole fractures result in avascular necrosis or non union of the proximal fragment2. -Because it aiculates with distal radius, and with 4 of remaining 7 carpal bones, the scaphoid moves with nearly all carpal motions, especially volar flexion. Any alteration of its aicular surface through fracture, dislocation, or subluxation or any change of its stability by ligamentous rupture can cause severe secondary changes throughout the entire carpus. Management Stable and undisplaced fractures are treated by scaphoid cast immobilization (glass holding dorsal and radial flexion positionQ impacts the scaphoid fragments and minimises the shearing effects), for 4 - 8 weeks in distal third, 6 - 12 weeks in middle third and 12- 20 weeks in proximal third fractures. Scaphoid cast is applied from the upper forearm to just sho of meta carpophalyngeal joints of fingers, but incorporating proximal phalynx of thumb. The wrist is held dorsiflexed and the thumb forwards in \"glass holding position\" - A displaced fracture, by definition, is one with > 1 mm of step-off or >60degof scapholunate or >15deg of lunato- capitate angulation. The subtle signs of displacement or instability are - opening & obliquity of fracture line, angulation of distal fragment, and fore shoening of scaphoid image. Displaced- unstable fractures are treated by percutaneous screw fixation or OR & IF by k - wires, compression screw or Herbe screw. - Undisplaced ununited (nonunion) fractures may be treated by excavation of the scaphoid & placement of volar inlay coicocancellous bone graft (Matti Russe procedure). In most cases of stable nonunion cancellous bone graft from either the distal radius (for small defects) or the iliac crest (preferable because of its superior osteogenic and mechanical propeies) is packed into the defect. Dorsal cailage is not disturbed. This provides a hinge and facilitates assessment of scaphoid length. If fracture site is angulated or collapsed coico cancellous volar graft is employed to correct the deformity. If the proximal pole is avascular and no significant radiocarpal ahritis is present, revascularization of the scaphoid with a vascularized bone graft from dorsal radius or preferably pronator quadratus graftQ should be performed. Paial radial stylodectomy should be performed in all patients with radiological signs of stage I radioscaphoid ahritis limited to scaphoid and radial styloid. - Once degenerative ahritis is evident at the radio -carpal joint, salvage procedures includes proximal row carpectomy, scaphoid excision and mid carpal ahodesis or total wrist ahrodesis. Clinical Presentation - The patient is usually and adolescent boy or young adult who gives a h/o falling on outstretched hand usually during active spos. Commonly the injury is misinterpreted as \"just a sprain\". Like colle's it is a supination - dorsiflexion injury. - Fullness & tenderness in anatomical snuff boxQ. Radial side wrist pain; passive dorsiflexion to the radial side is painful, grip is weak and release of grip gives transitory pain, resisted pinch between the thumb and index finger is uncomfoable. Proximal pressure along the axis of the thumb may be painfulQ.", "cop": 3, "opa": "Pronator teris", "opb": "Brachioradialis", "opc": "Pronator quadratus", "opd": "Extensor pollicis longus", "subject_name": "Surgery", "topic_name": null, "id": "356e988f-0eeb-4289-ad82-14fad7c32ef1", "choice_type": "single"} {"question": "Most common tumour occurring in appendix includes", "exp": "Carcinoid tumours arise in argentaffin tissue (Kulchitsky cells of the crypts of Lieberkuhn) and are most common in the vermiform appendix.The tumour can occur in any pa of the appendix, but it is frequently found in the distal third Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1217", "cop": 1, "opa": "Carcinoid tumour", "opb": "Melanoma", "opc": "Adeno carcinoma", "opd": "Mucinous", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "24c407e2-d709-4843-8be8-76a28d89076c", "choice_type": "single"} {"question": "Drug used for Buerger's disease is", "exp": "Thromboangiitis obliterans (Buerger's disease) This is characterised by occlusive disease of small- and medium-sized aeries (plantar, tibial, radial, etc.), thrombophlebitis of the superficial or deep veins and Raynaud's syndrome; it occurs in male smokers, usually under the age of 30 years. Often, only one or two of the three manifestations are present. Histologically, there are inflammatory changes in the walls of aeries and veins, leading to thrombosis. Treatment is total abstinence from smoking, which arrests, but does not reverse, the disease. Established aerial occlusions are treated as for atheromatous disease, but amputations may eventually be required. Ref : Bailey and love 27th edition Pgno : 967 Xanthinol Nicotinate Xanthinol Nicotinate (or xanthinol niacinate or complamina) is a vasodilator It is combination of xanthinol and niacin (nicotinic acid) This vasodilator is used in the treatment of Raynaud's phenomenon or Buerger's disease Ref: Wikipedia", "cop": 1, "opa": "Xanthinol nicotinate", "opb": "Propranolol", "opc": "Nicotine", "opd": "Nifedepine", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "40be8a53-bb0f-4a17-be86-1e8476dfdc13", "choice_type": "single"} {"question": "M. C. anterior mediastinum tumor is", "exp": "Ans is 'a' ie Thymoma RememberMost common mediastinal mass-Neurogenic tumorsMost common Ant. mediastinal mass-ThymomaMost common Middle mediastinal mass-Bronchogenic & pleuropericardial cystsMost common Posterior mediastinal mass-Neurogenic tumorMost common malignant mass of mediastinum-LymphomasMost common mediastinal mass in children-Neurogenic tumor", "cop": 1, "opa": "Thymoma", "opb": "Neurogenic Fibroma", "opc": "Lymphoma", "opd": "Meningocele", "subject_name": "Surgery", "topic_name": "Mediastinum, Cysts, and Neoplasms", "id": "7e7e6eba-3aaf-47ee-b4a8-56a28d829123", "choice_type": "single"} {"question": "Compound fracture is", "exp": "D i.e. Fracture with skin involvement", "cop": 4, "opa": "Fracture with aery involvement", "opb": "Fracture with nerve involvement", "opc": "Fracture with muscle involvement", "opd": "Fracture with skin involvement", "subject_name": "Surgery", "topic_name": null, "id": "39205f2a-8889-4b65-ac47-a294242e23e9", "choice_type": "single"} {"question": "Gold standard investigation for recurrent gastrointestinal stromal tumor is", "exp": ".Investigation: - Mainly CT scan - Tumour / molecular marker to differentiate it from sarcomas (immunohistochemistry). - Endosonography guided biopsy/guided FNAC are impoant to get histological confirmation. - 18 FDG PET scan is very useful adjunct to CT but reserved for difficult/equivocal cases. ref:SRB&;S manual of surgery,ed 3,pg no 792", "cop": 4, "opa": "MRI", "opb": "MIBG", "opc": "USG", "opd": "PET CT", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "2b9a32a7-718d-4f47-9bb0-2a7afb17e722", "choice_type": "single"} {"question": "The most likely cause of intermittent jaundice in elderly\nman is", "exp": "Periampullary carcinoma causes intermittent jaundice (waxing and waning of jaundice).", "cop": 2, "opa": "Liver cirrhosis", "opb": "Perlampullary carcinoma", "opc": "CA head of pancreas", "opd": "Hemolysis", "subject_name": "Surgery", "topic_name": null, "id": "01d36f5c-72d8-406a-abfc-cb86a265dba5", "choice_type": "single"} {"question": "Hernia with hydrocele is .... hernia", "exp": null, "cop": 1, "opa": "Gibbon's", "opb": "Fruber ' s", "opc": "Dobson ' s", "opd": "Leobel ' s", "subject_name": "Surgery", "topic_name": null, "id": "2882f1de-0565-47a1-aab3-113cbf8774fd", "choice_type": "single"} {"question": "Paralytic ileus caused by", "exp": "Hypokalemia leads to decreased smooth muscle contraction leading to decreased peristalsis and thus paralytic ileus. Pg NO.1296 BAILEY 27TH EDITION", "cop": 1, "opa": "Hypokalemia", "opb": "Hypoglycemia", "opc": "Hyperkalemia", "opd": "Hypercalcemia", "subject_name": "Surgery", "topic_name": "General surgery", "id": "22e44254-d037-419b-b000-75b3e7556234", "choice_type": "single"} {"question": "Excision of head of radius in a child should not be done because", "exp": "C i.e. It causes subluxation of inferior radioulnar joint", "cop": 3, "opa": "It produces instability of elbow joint", "opb": "It leads to secondary Osteo ahritis of elbow", "opc": "It causes subluxation of inferior radio-ulnar joint", "opd": "It causes myositis ossificans.", "subject_name": "Surgery", "topic_name": null, "id": "d0428abd-2a49-47dd-b7a1-73f8c0231f5f", "choice_type": "single"} {"question": "28 year old male met with an accident and sustained severe crush injury. He is most likely develop aEUR'", "exp": "Acute renal failure Crush Syndrome Severe systemic manifestation of trauma and ischaemia involving soft tissues, principally skeletal muscle, due to prolonged severe crushing. - It leads to increased permeability of the cell membrane and to the release of potassium, enzymes, and myoglobin from within cells. Ischaemic renal dysfunction secondary to hypotension and diminished renal perfusion results in acute tubular necrosis and uraemia.\" Pathophysiology Crush injury can follow prolonged continuous pressure on muscle tissue. Crush injury can lead to crush syndrome. Ischaemia reperfusion (when the pressure is released. from the crushed limb) is the main mechanism of muscle injury in crush syndrome. There is traumatic rhabdomyolysis. Rhabdomyolysis is the breakdown of muscle fibres with the leakage of potentially toxic cellular contents into the systemic circulation. Muscle injury causes large quantities of potassium, phosphate, myoglobin, creatine kinase and urate to leak into the circulation. Myoglobin levels in the plasma are normally very low. If a significant amount of skeletal muscle is damaged (>100 g) excess myoglobin is .filtered by the kidneys and can cause renal tubular obstruction and renal damage: the excess myoglobin is nephrotoxic. intravascular volume depletion and renal hypoperfusion, combined with myoglobinuria, result in renal dysfunction.2 Crush syndrome is characterised by Hypovolaemic shock (due to sequestration of water in the injured muscle cells). Hyperkalaemia (release of cellular potassium by the injured muscle cells). This can also lead to: - Metabolic acidosis (release of cellular phosphate and sulphate by the injured muscle cells) - Acute renal failure - Disseminated intravascular coagulation (DIC) The key clinical_ features of crush syndrome are : Crushing injury to a large mass of skeletal muscle. Sensory and motor disturbances in the compressed limbs, which subsequently become tense and swollen Myoglobinuria and/or haemoglobinuria Raised creatine kinase There may be oliguria Elevated levels of urea, creatinine, uric acid, potassium, phosphate Thpocalcaemia", "cop": 1, "opa": "Acute renal failure", "opb": "Hypophosphtemia", "opc": "Hypercalcemia", "opd": "Acute myocardial infarction", "subject_name": "Surgery", "topic_name": null, "id": "0297ca08-fc45-4d34-8bbe-6afa2b7aea90", "choice_type": "single"} {"question": "Screening will be significantly improve life span in", "exp": "Schwaz says \"Because the majority of Colorectal cancers are thought to arise from Adenomatous polyps, preventive measures focus upon identification and removal of these premalignant lesions. In addition, many cancers are asymptomatic and screening may detect these tumors at an early and curable stage American cancer society Recommendations for early detection of cancer in Average - Risk, Asymptomatic individuals Cancer site - Colorectal Population to be screened - Men and women aged >= 50 years Test or procedure - Fecal occult blood test(FOBT( or fecal immunochemical test (FIT( Flexible sigmoidoscopy FOBT and Flexible sigmoidoscopy Double - Contrast barium enema (DCBE( Colonoscopy Frequency Annual, staing at age 50 Every 5 years, staing at age 50 Annual FOBT, (or FIT) and flexible sigmoidoscopy every 5 years, staing at age 50 DCBE every 5 years, staing at age 50 Colonoscopy every 10 years, staing at age 50 Ref: Harrison's 19th edition Pgno : 481 Schwaz 10th edition Pgno : 298", "cop": 1, "opa": "Carcinoma colon", "opb": "Carcinoma prostate", "opc": "Carcinoma lung", "opd": "Carcinoma ovary", "subject_name": "Surgery", "topic_name": "Urology", "id": "a30ed25c-07dc-4b15-93e9-6abc81dcf8d2", "choice_type": "single"} {"question": "Radiolucent stone is", "exp": "(Uric acid calculus) (1317-LB) (1296-B &L 25th)* About 90% of calculi are radiopaque (calcium, phosphate oxalates, cystine)* Uric acid stones are radiolucent and appear on an excretion urogram as a filling defect* Spiral CT has become the study of choice in emergent situations, as the entire urinary tract can be scanned rapidly and without contrast injection. (1042-CSDT 11th)", "cop": 3, "opa": "Oxalate calculus", "opb": "Phosphate calculus", "opc": "Uric acid calculus", "opd": "Cysteine calculi", "subject_name": "Surgery", "topic_name": "Kidney & Ureturs", "id": "4eca55f6-f00f-4995-85c0-81691bdac41b", "choice_type": "single"} {"question": "Patient is placed in trendelenburg position in air embolism in order to", "exp": "Trendelenberg position keeps left ventricular air bubble away from coronary ostia, so that air bubbles do not enter and occlude coronary arteries.", "cop": 2, "opa": "Trap air in Right ventricle", "opb": "Keep left ventricular air bubble away from coronary artery ostia", "opc": "Prevent air from passing through foramen ovale", "opd": "Prevent air from entering left ventricle", "subject_name": "Surgery", "topic_name": null, "id": "611bf1fa-39e9-4cb9-ab5e-858af61547a5", "choice_type": "single"} {"question": "Mammography is performed in", "exp": "Mammography is preferred in first of the menstrual cycle.\nUsually two views are taken craniocaudal and mediolateral oblique.", "cop": 1, "opa": "First half of the menstrual cycle", "opb": "Second half of the menstrual cycle", "opc": "3rd day", "opd": "5th day", "subject_name": "Surgery", "topic_name": null, "id": "0671dd3a-a71e-40e4-841d-7d1d383c3936", "choice_type": "single"} {"question": "Thunderclap headache is a feature of", "exp": "Ans. (d) SAHRef: Sabiston 20th Page 1904* Subarachnoid hemorrhage usually results in a sudden severe thunderclap headache. A patients describes the worst headache of my life.", "cop": 4, "opa": "TIA", "opb": "Completed stroke", "opc": "ICH", "opd": "SAH", "subject_name": "Surgery", "topic_name": "Nervous System", "id": "4bbed1ed-8906-4ed1-8044-52f33d7a0987", "choice_type": "single"} {"question": "Hadfield operation is done for", "exp": "Ans. (a) Duct Ectasia(Ref. Bailey and Love 27th Edition Page 868)* Hadfield operation of resection of all ducts conically with apex at the nipple and base at pectoralis fascia level. Done for periductal mastitis (Duct Ectasia) and Duct papilloma of unknown duct origin.", "cop": 1, "opa": "Duct Ectasia", "opb": "Fibroadenoma", "opc": "Mondor", "opd": "Cancer breast", "subject_name": "Surgery", "topic_name": "Breast", "id": "079bf44e-5ab0-4807-a186-57c4a4ccb2b6", "choice_type": "single"} {"question": "Acinic cell carcinoma is found in", "exp": "Acinic cell tumour is a rare,slow growing tumour that occurs almost always in parotid and is composed of cells like serous acini.It is more common in women.It occurs in adults and elderly.It can involve facial nerve or neck lymph nodes.Clinically,it is of variable consistency with soft and cystic areas.Microscopically, it can be micro cystic,papillary,follicular, medullary,etc SRB,5th,417.", "cop": 2, "opa": "Thyroid", "opb": "Salivary glands", "opc": "Breast", "opd": "Stomach", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "22c335ac-db69-49ce-affd-44861153de98", "choice_type": "single"} {"question": "Tube (Cylinder) cast is applied for the fracture of", "exp": "D i.e. Knee Cylinder (tube) cast is used in undisplaced transverse fracture of patellaQ.", "cop": 4, "opa": "Shoulder", "opb": "Hip", "opc": "Pelvis", "opd": "Knee", "subject_name": "Surgery", "topic_name": null, "id": "44498799-616f-4cfb-b375-5baf2c1c107d", "choice_type": "single"} {"question": "Tarsometatarsal amputation is also known as", "exp": "B i.e. Lisfranc amputation Tarsometatarsal joint is known as Lisfranc joint and amputation through this joint is k/a Lisfranc amputationQ.", "cop": 2, "opa": "Chopa's amputation", "opb": "Lisfranc amputation", "opc": "Pirogoff amputation", "opd": "Symes amputation", "subject_name": "Surgery", "topic_name": null, "id": "f7e06ef1-4c44-48f6-83dd-7e11d675283a", "choice_type": "single"} {"question": "Following are features of Barrett&;s oesophagus", "exp": "Histologic changes of the distal oesophagal mucosa from its normal squamous epithelium to a columnar configuration (intestinal metaplasia). Barrett oesophagus in endoscopy appears as velvety-red \"tongues\" of mucosa that extend cephalad from the GEJ. These patients carry a higher risk to Adenocarcinoma oesophagus compared to normal population. Reference: Sabiston 20th edition page: 1074", "cop": 1, "opa": "Intestinal Metaplasia", "opb": "Always gastric type of epithelium", "opc": "Squamous carcinoma more common", "opd": "Present as patchy or ring involvement", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "aa880e21-cbad-442f-b85a-1b99fc1120d5", "choice_type": "single"} {"question": "Saw tooth appearance in abdominal barium enema X ray is seen in", "exp": "Diveicula These are abnormal outpouchings or sacs of colon wall that occur due to interactions of high intraluminal pressures, disordered motility and low diet in fiber Formed on mesenteric side of antimesenteric taenia coli Results in protrusion of mucosa and submucosa through layers of muscle It is Pseudodiveiculum or False diveiculum Radiological evidence in prediveicular disease Saw tooth appearance of colon Shoening of bowel Crowding of haustra Picket fencing of folds Ischemic colitis- Ba. Enema - Thumb print sign Ulcerative colitis", "cop": 3, "opa": "Multiple polyposis", "opb": "Ischemic colitis", "opc": "Diveiculosis", "opd": "Ulcerative colitis", "subject_name": "Surgery", "topic_name": "GIT", "id": "759faf15-dbbf-40ab-ad95-63b62e01e51b", "choice_type": "single"} {"question": "Management of stage 2 pressure sore, clean ulcer without cellulitis is", "exp": "Answer- B. Moist dressing", "cop": 2, "opa": "Protective dressing", "opb": "Moist dressing", "opc": "Absorbent dressing", "opd": "Topical antibiotics", "subject_name": "Surgery", "topic_name": null, "id": "007f86d1-96a8-4762-8dd3-4470cd71d669", "choice_type": "single"} {"question": "\"Seat belt syndrome\" is", "exp": "(Sudden deceleration can result in a torn mesentery) (1147-48-LB) (1003-4-B &L 25th)SEAT-BELT SYNDROME - If a car accident occurs when a seat belt is worn, sudden deceleration can result in a tom mesentery. This possibility should be borne in mind, particularly as multiple injuries may distract attention from this injury. If there is any bruishing of the abdominal wall or even marks of clothing impressed into the skin, laparotomy may be indicated.* Diagnostic peritoneal lavage may be helpful in this situation.", "cop": 2, "opa": "Fracture ilium with rupture of urethra", "opb": "Sudden deceleration can result in a tom mesentery", "opc": "Fracture shaft of the femur with testicular swelling", "opd": "Non-specific; mesenteric adenitis", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "61e013ba-f438-4541-b21c-f8411a4957fd", "choice_type": "single"} {"question": "Treatment of choice for simple cyst of liver", "exp": "Deroofing is the treatment of choice for simple cyst of liver.", "cop": 2, "opa": "Percutaneous drainage", "opb": "Deroofing", "opc": "Observation", "opd": "Aspiration", "subject_name": "Surgery", "topic_name": null, "id": "3d58300b-dedd-4fe0-a922-a9280658992e", "choice_type": "single"} {"question": "Best test to differentiative between medical and surgical jaundice is", "exp": "Investigations for Obstructive Jaundice 1. Serum bilirubin. A normal value is less than 1.0 mg%. Both direct and indirect bilirubin are assessed. Direct is increased in obstructive jaundice, i.e. conjugated hyperbilirubinaemia. van den Bergh's test is done. 2. Serum albumin, globulin and A: G ratio. Normal S. albumin is more than 3.5 gm%. 3. Prothrombin time. A normal value is 12-16 seconds. It is significant if it is more than 4 from the control or more than one and half times the control. It is corrected by injection vitamin K, 10 mg IM OD for 5 days or by FFP--5-10 units. 4. Serum alkaline phosphatase, SGPT, SGOT, 5' nucleotidase. 5. U/S abdomen. 6. ERCP to visualise the site of obstruction, brush biopsy, bile sample for analysis. 7. MRCP--Non-invasive diagnostic tool. Ref: SRB&;s manual of surgery,3 rd ed, pg no 588", "cop": 4, "opa": "Akaline phosphatase", "opb": "Bilirubin and serum enzymes", "opc": "Enzymes", "opd": "Ultrasound", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "a591ffd4-87f7-4a83-8021-144ee1bd0026", "choice_type": "single"} {"question": "Screening of prostate Ca is done by", "exp": "Screening for malignancy according to America cancer society Recommendations for early detection of cancer in Average - Risk, Asymptomatic individuals Cancer site : Prostate Population : Men aged >= 50 years Test or procedure : Digital rectal examination (DRE) and prostate specific antigen (PSA) test. Frequency : Offer PSA test and DRE annually, staing at age 50,for men who have life expectancy of atleast 10 years Ref: Harrison's 19th edition Pgno : 481", "cop": 2, "opa": "Transrectal USG", "opb": "Digital rectal exam", "opc": "PSA", "opd": "CT scan", "subject_name": "Surgery", "topic_name": "Urology", "id": "8a4b6ef7-b4e9-4ee2-888c-1661fa724117", "choice_type": "single"} {"question": "Injection sclerotherapy for varicose veins is by usinga) Phenolb) Absolute alcoholc) 70% alcohold) Ethanolamine oleate", "exp": "Sclerosing agents mentioned in the latest editions of Schwartz, CSDT and Bailey are:\n- hypertonic saline,\n- sodium tetradecyl sulfate, and\n- polidocanol\n2 other sclerosants are mentioned in KDT 6/e p597\n\nEthanolamine oleate\nPhenol in almond oil or Peanut oil", "cop": 1, "opa": "ad", "opb": "c", "opc": "ac", "opd": "ab", "subject_name": "Surgery", "topic_name": null, "id": "9e4afecd-a1f1-4fe6-8328-e55311b8b8e3", "choice_type": "single"} {"question": "In treatment of papillary carcinomas thyroid, radioiodine destroys the neoplastic cells predominantly by", "exp": "I131 is treated by the body just like the ordinary nonradioactive isotope, so that when swallowed it is concentrated in the thyroid gland.\nIt emits mainly β radiation (90%) which penetrates only 0.5 mm of the tissue and thus allows therapeutic effects on the thyroid without any damage to the surrounding structures, particularly the parathyroids.\nIt also emits gamma rays, which are more penetrating.\n\n\nUses\n\nI131is the preferred initial t/t for hyperthyroidism caused by Grave's disease.\nIt is used in combination with surgery in some cases of thyroid carcinoma, especially those in which metastases are sufficiently differentiated to take up iodides selectively.\n\nAlso know,\n\nIt is contraindicated in children and pregnant or breastfeeding women, and can induce or worsen ophthalmopathy.", "cop": 2, "opa": "X rays", "opb": "β rays", "opc": "γ rays", "opd": "α particles", "subject_name": "Surgery", "topic_name": null, "id": "7422396e-c847-42cc-af10-6ad261ebfe0a", "choice_type": "single"} {"question": "A cell cycle specific anticancer drug that acts mainly in the M phase of the cell cycle is", "exp": "Paclitaxel The taxanes, paclitaxel and docetaxel, interfere with the separation of chromosomes during mitosis because of their effects on micro tubules.", "cop": 4, "opa": "Bleomycin", "opb": "Cisplatin", "opc": "Etoposide", "opd": "Paclitaxel", "subject_name": "Surgery", "topic_name": null, "id": "74989b00-ff4f-4d9a-b66b-0b50593188b7", "choice_type": "single"} {"question": "Most common site of metastasis of carcinoma bronchi", "exp": null, "cop": 1, "opa": "Liver+Bones", "opb": "Prostate", "opc": "Kidney", "opd": "Breast", "subject_name": "Surgery", "topic_name": null, "id": "acab3932-bd9a-488f-a06a-7639cb374169", "choice_type": "single"} {"question": "In the extraoral technique for mandibular nerve\nblock the needle after contacting the pterygoid plate is directed", "exp": null, "cop": 2, "opa": "Anteriorly", "opb": "Posteriorly", "opc": "Superiorly", "opd": "Inferiorly", "subject_name": "Surgery", "topic_name": null, "id": "dc09ab91-83ff-48aa-ac03-5c8d0a1f05a6", "choice_type": "single"} {"question": "Decision regarding surgery in a case of hemothorax due to blunt trauma chest should be based on", "exp": "Decision regarding surgery for haemothorax due to blunt trauma chest is based on the hemodynamic status of the patient & whether features of shock present or not.Treatment usually consists of ICT placement in the mid -axillary line in the 6th intercoastal space.Thoracotomy is done when ICT shows persistent drainage /hourly collection of 200-300 ml or initial chest tube output of 1500 ml of blood .", "cop": 2, "opa": "Chest symptoms", "opb": "Hemodynamic status", "opc": "Nature of chest tube output", "opd": "X-ray finding", "subject_name": "Surgery", "topic_name": "Cardio thoracic surgery ", "id": "b580ab15-a022-45e2-9270-5b1a6e3b447f", "choice_type": "single"} {"question": "Subcapsular orchiectomy is done for", "exp": "Orchidectomy Orchidectomy is performed in advanced disease. In 1941, prostate cancer was shown to be responsive to such treatment by Charles Huggins, the only urologist to win a Nobel Prize. Bilateral orchidectomy, whether total or subcapsular, will eliminate the major source of testosterone production. Ref: Bailey and love 27th edition Pgno : 1474", "cop": 2, "opa": "Ca testis", "opb": "Ca prostate", "opc": "Ca penis", "opd": "Ca urethra", "subject_name": "Surgery", "topic_name": "Urology", "id": "85522213-04c6-4ae7-9336-446cde546851", "choice_type": "single"} {"question": "Pseudocyst of pancreas is", "exp": "Ans. b (Post-inflammation cyst). (Ref. Bailey & Love, 25th/1138.)PSEUDOCYST OF PANCREAS# A pseudocyst of pancreas is a collection of pancreatic juice enclosed in a wall of fibrous or granulomatous tissue that is usually located in lesser sac region and follows an attack of acute pancreatitis/trauma.# It is not lined by epithelium in contrast to true pancreatic cyst.# A pseudocyst with wall thickness more than 5 mm or size more than 6 cm is a mature pseudocyst and surgical treatment (cystogastrostomy) is indicated.", "cop": 2, "opa": "Post traumatic cyst", "opb": "Post inflammatory cyst", "opc": "Congenital cyst", "opd": "Neoplastic cyst", "subject_name": "Surgery", "topic_name": "Pancreas", "id": "f26b225f-4f22-4683-8645-14cc862ab259", "choice_type": "single"} {"question": "Seminoma correspond to", "exp": "Seminoma corresponds to dysgerminoma in ovaries.", "cop": 2, "opa": "Choriocarcinoma", "opb": "Dysgermonoma", "opc": "Granulosa tumor", "opd": "Luteal cyst", "subject_name": "Surgery", "topic_name": null, "id": "d4f16bf1-8fc6-4dfd-a0db-02fb35b352d6", "choice_type": "single"} {"question": "Pronator quadratus has the same innervation as the following muscl", "exp": "Flexor pollicis longus The most appropriate answer to this question is flexor pollicis longus. Anterior interosseous nerve (AIN) is the deep branch of median nerve and takes care of three muscles...namely flexor pollicis longus, pronator quadratus and the radial half of flexor digitorum profundus (for the index and middle finger) in the anterior forearm. Flexor digitorum profundus is a hybrid muscle...being supplied by two nerves....ulnar nerve supplying its medial half (ring and little finger). The middle finger can have overlap of nerve supply...and could be getting supply from ulnar nerve in paial or total entirely. Hence FPL is first option and FDP is second in preferential order..", "cop": 1, "opa": "Flexor pollicis longus", "opb": "Flexor digitorum superficialis", "opc": "Palmaris longus", "opd": "Flexor digitorum profundus of middle finger", "subject_name": "Surgery", "topic_name": null, "id": "bf1c1138-cd25-425e-bf4f-c839148be732", "choice_type": "single"} {"question": "Most common site of lymphangiosarcoma is", "exp": "Most common site of lymphangiosarcoma is arm following mastectomy, Occurs commonly after radical lymph nodes dissection- stewa treves syndrome Reference- SRB - 5th edition, sarcoma, page 311.", "cop": 4, "opa": "Liver", "opb": "Spleen", "opc": "Retroperitoneum", "opd": "Post mastectomy arm", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "e2f1527d-989d-49a6-99c3-be1855662f79", "choice_type": "single"} {"question": "The commonest thyroid malignancy is", "exp": null, "cop": 3, "opa": "Anaplastic", "opb": "Follicular", "opc": "Papillary", "opd": "Medullary", "subject_name": "Surgery", "topic_name": null, "id": "1ebb7936-0fbd-4383-a28c-1396d9bbd86e", "choice_type": "single"} {"question": "Indication for surgery in a case of adrenal incidentaloma is", "exp": "Any non-functioning adrenal tumour greater than 4 cm in diameter and smaller tumours that increase in size over time should undergo surgical resection. Non-functioning tumours smaller than 4 cm should be followed-up after 6, 12 and 24 months by imaging (MRI) and hormonal evaluationRef: Bailey and Love 27e pg: 840", "cop": 3, "opa": ">2cm", "opb": ">3cm", "opc": ">4cm", "opd": ">5cm", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "04368290-d1cb-4e78-a706-a63b05e11ec4", "choice_type": "single"} {"question": "HIPEC is used for", "exp": "Hypehermic intraperitoneal chemotherapy (HIPEC) is used for peritoneal metastases.Other treatment modalities are cytoreductive surgery, intraperitoneal chemotherapy.Ref: Bailey and love 27e pg: 1059", "cop": 3, "opa": "Identifying bone metastases", "opb": "Screening protocol for breast cancer", "opc": "Treating peritoneal metastasis", "opd": "Diagnosing tuberculosis", "subject_name": "Surgery", "topic_name": "General surgery", "id": "6cb949ae-1ecb-4685-8e52-05282952b748", "choice_type": "single"} {"question": "A 18 year old male presents with a draining sinus on his left leg with pus discharge and discharge of bony pieces since in 3 months. The diagnosis", "exp": "Answer- A. Chronic osteomyelitisA history of bone piece discharge from the chronic sinusis considered diagnostic of chronic osteomyelitis.", "cop": 1, "opa": "Chronic osteomyelitis", "opb": "Ewing's Sarcoma", "opc": "Osteoid Osteoma", "opd": "Cellulitis", "subject_name": "Surgery", "topic_name": null, "id": "78cf0a26-8c78-486d-a02f-b568cab48b31", "choice_type": "single"} {"question": "Decision analyses often include a patient's utilities in the determination of the best decision. These utilities measure", "exp": "The relative value a patient places on a paicular outcome In decision analysis, utilities refer to the relative values placed on various outcomes.", "cop": 2, "opa": "Whether a patient ors one decision over another", "opb": "Whether a physician ors one decision over another", "opc": "The difference between a patient's decision and the physician's decision", "opd": "The relative value a patient places on a paicular outcome", "subject_name": "Surgery", "topic_name": null, "id": "57bf1bf9-961c-403c-82a4-76fa73158b5c", "choice_type": "single"} {"question": "Thyroid storm after operation is due to", "exp": "Thyroid strom is acute exacerbation of hypehyroidism. It occurs if a thyrotoxic patient has been inadequately prepared for thyroidectomy. It is characterized by a high fever, fast and often irregular hea beat, vomiting, diarrhea, and agitation. Treatment include administration of intravenous fluids for dehydration, cooling the patient with ice packs for hyperpyrexia, administration of oxygen, diuretics for cardiac failure, digoxin for uncontrolled atrial fibrillation, sedation and intravenous hydrocoisone . Specific treatment is by carbimazole 10-20 mg 6-hourly, Lugol's iodine 10 drops 8-hourly by mouth or sodium iodide 1 g i.v. Propranolol intravenously (1-2 mg) or orally (40 mg 6-hourly) will block beta-adrenergic effects. Source : Bailey and Love 26th edition Pg : 762", "cop": 1, "opa": "Inadequate control of hypehyrodism", "opb": "Massive bleeding", "opc": "Recurrent laryngeal nerve injury", "opd": "Postoperative infection", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "bc6fd4d8-2fa5-4c78-9693-ea6ecf506b8d", "choice_type": "single"} {"question": "Most common renal stone is", "exp": "Calcium oxalate stones - 60% Phosphate stones( hydroxyapatite and brushite) - 22% Uric acid stones -7 % ,struvite 7%.Cystine stones - 2% Reference : Campbell and Walsh urology 11th edition , chapter 51 , pg no 1181", "cop": 2, "opa": "Triple phosphate", "opb": "Calcium oxalate", "opc": "Uric acid", "opd": "Salicylate", "subject_name": "Surgery", "topic_name": "Urology", "id": "1bd5d0ae-ac90-4a00-8d52-a88b18faaf9f", "choice_type": "single"} {"question": "Initial treatment of the patients with growth hormone secreting pituitary adenoma", "exp": "Ans. (a) Transphenoidal Surgical resection* Treatment of Choice for Pituitary tumors is initially and always is by Transsphenoidal Resection.* Preferred for both micro and macro adenomas", "cop": 1, "opa": "Transsphenoidal Surgical Resection", "opb": "Somatostatin Analogues", "opc": "Dopamine agonists drugs", "opd": "GH Receptor Antagonists", "subject_name": "Surgery", "topic_name": "Nervous System", "id": "75b7f221-1080-42ce-a294-a4aa62f677d3", "choice_type": "single"} {"question": "Oschner Sherren regimen is for", "exp": "Ans. b (Appendicular mass). (Ref. Bailey & Love, 25th ed., 1215)APPENDICULAR MASS# Following an attack of acute appendicitis infection is sealed off by greater omentum, caecum, terminal ileum, etc resulting in a tender, soft to firm appendicular mass.# Presence of appendicular mass is a contraindication for appendicectomy due to risk of faecal fistulae.# It is treated by Oschner & Sherren's regime, which includes:1. Aspiration with Ryle's tube to give rest to GIT.2. Bowel care (avoid purgatives).3. Charts--temperature, pulse, respiration, diameter of mass.4. Drugs--to cover all organisms.5. Exploratory laparotomy contraindicated.6. Fluid-IV (patient kept nil orally for few days).7. Swinging temperature & increased in size of mass indicate abscess.Criteria for stopping conservative treatment of an appendix mass include A rising pulse rate , Increasing or spreading abdominal pain and Increasing size of the mass", "cop": 2, "opa": "Appendicular abscess", "opb": "Appendicular mass", "opc": "Acute appendicitis", "opd": "Appendicular mucocele", "subject_name": "Surgery", "topic_name": "Vermiform Appendix", "id": "b1c4bff6-5bc6-4606-8bc2-3775c1929959", "choice_type": "single"} {"question": "Mondors disease is", "exp": "Mondor's disease is thrombophlebitis of superficial veins of the breast and anterior chest wall. The pathogonomic feature is the thrombosed subcutaneous cord,usually attached to skin.Thevtreatment is restricted arm movements ,and in any case the condition subsides withina few months without recurrence,complications or deformity. Bailey and Love'sSho practice of surgery.Edition 23.Pg no:756", "cop": 2, "opa": "Lymphadema", "opb": "Thrombophlebitis of breast", "opc": "Retraction of nipple", "opd": "Congenital disease", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "f975ff25-12a4-4025-ba5f-4124c150cc9c", "choice_type": "single"} {"question": "Degloving injury is characterised by", "exp": "Degloving Injury is defined as an Avulsion injury including the following layers:- * Skin * Subcutaneous Tissue with intact fascia Ref:- Bailey and Love 27th Edition; Pg num:- 27", "cop": 3, "opa": "Loss of Skin only", "opb": "Loss of Skin and Subcutaneous tissue along with Fascia", "opc": "Loss of Skin and Subcutaneous tissue with intact fascia", "opd": "Loss of Skin, Subcutaneous Tissue and Muscle", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "6eeac3e1-3190-4f23-bc1c-8f581aa4b1fe", "choice_type": "single"} {"question": "Thrombophlebitis extending from thigh to involve iliofemoral vein causes", "exp": "Answer- D. White legWhite leg (Phlegmasia alba dolens)- seen in ileofemoral thrombophlebitis.Phlegmasia alba dolens (white leg): This is characterised by aerial spasm resulting in pale, cold leg with diminished pulses, with blanching of the limb, more often seen in iliofemoral thrombophlebitis and is called milk leg of pregnancy.", "cop": 4, "opa": "Red leg", "opb": "Blue leg", "opc": "Purple leg", "opd": "White leg", "subject_name": "Surgery", "topic_name": null, "id": "0952901d-19bc-4078-b4d7-c600208c86f9", "choice_type": "single"} {"question": "The best dressing for open wounds is", "exp": null, "cop": 1, "opa": "Skin", "opb": "Amnion", "opc": "Opsite", "opd": "Tulle grass", "subject_name": "Surgery", "topic_name": null, "id": "82f5d8f4-dcd8-4baa-a8a6-a440312d0d50", "choice_type": "single"} {"question": "Grey Turner's sign (flank discoloration) is seen in", "exp": "Sign seen due to enzyme seep across etroperitoneum causing hemorrhagic spots and ecchymosis in the flanks SRB,5th,683.", "cop": 3, "opa": "Acute pylonephritis", "opb": "Acute cholecystisis", "opc": "Acute pancreatitis", "opd": "Acute peritonitis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "2567f524-991d-4f39-9a1f-8df2e7cfd27f", "choice_type": "single"} {"question": "Dumping syndrome can occur after", "exp": "Billroth ii is an operation wherein the greater curvature of the stomach is attached to 1st pa of jejunum in end to side anastomosis It occurs due to rapid delivery of osmotically active solid and liquid into jejunum due to alteration in the storage function of the stomach resulting in increased intestinal activity leading to diarrhoea and fall in blood volume. Reference SRB 5th edition page no.839", "cop": 1, "opa": "Billroth-II operation", "opb": "Heller's operation", "opc": "Whipple's operation", "opd": "Nissen fundoplication", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "2ebb0879-035d-448a-b29f-4765f15b1884", "choice_type": "single"} {"question": "Most common cause of esophagitis is", "exp": "Ans is 'd' i.e. Esophageal reflux \"Reflux esophagitis is the most common type of esophagitis. It occurs in patients with gastroesophageal reflux disease (GERD) secondary to dysfunction of the lower esophageal sphincter. \" \"Candidal esophagitis is the most common form of infectious esophagitis.\"-The Washington manual of surgical pathology pi 65", "cop": 4, "opa": "Alcohol", "opb": "Smoking", "opc": "Spicy and hot food", "opd": "Esophageal reflux", "subject_name": "Surgery", "topic_name": "Esophageal Diseases - Gastroesophageal Reflux Disease, Carcinoma", "id": "898e871e-81b7-497e-8e59-3217826bc0c7", "choice_type": "single"} {"question": "Most common complication of acute and chronic pancreatitis is", "exp": ".Complications of acute pancreatitis * Shock-hypovolaemic and septic * Respiratory failure and ARDS--Common in 7 days * Septicaemia--Common after 7 days * Hypocalcaemia * Disseminated intravascular coagulation (DIC) * Acute renal failure * Pancreatic pleural--effusion (left sided 20%) * Pancreatic pseudo aneurysm * Pancreatic ascites * Colonic stricture * Pseudocyst of pancreas * Chronic pancreatitis * Splenic vein thrombosis * Pancreatic abscess. ref:SRB&;S manual of surgery,ed 5,pg no 618", "cop": 3, "opa": "Poal vein thrombosis", "opb": "Pancreatic abscess", "opc": "Pseudocyst", "opd": "Pancreatic head mass", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "7d66dc2a-4770-46a9-8290-413145934896", "choice_type": "single"} {"question": "Hemangioma of the rectuma) Common tumourb) Fatal haemorrhage seenc) Ulcerative colitis like symptoms seend) Acute anal fissure", "exp": "Hemangioma of the rectum is an uncommon cause of serious hemorrhage.\nWhen localized in the lower part of the rectum or anal canal, a hemangioma can be excised.\nWhen the lesion is diffuse, or lying in the upper part of the rectum, the symptoms simulate ulcerative colitis.\nDiagnosis is often missed for a long period, or it is mistakenly thought to be a carcinoma.\nSelective angiography and embolization may be helpful, but excision of the rectum is sometimes required.", "cop": 1, "opa": "bc", "opb": "c", "opc": "ac", "opd": "ad", "subject_name": "Surgery", "topic_name": null, "id": "484af6d2-bf96-4730-8235-c343ab806236", "choice_type": "single"} {"question": "Growth disturbance, nonunion, elbow instability & late ulnar nerve palsy is commonly seen in", "exp": "C i.e. Fracture lateral condyle Milch Classification of Fracture Lateral Condyle Humerus Mitch type I (Salter Harris type IV) - Less common type - Fracture running through the secondary ossification centre of capitullum and entering the joint lateral to capitulotrochlear groove Cause growth defectQ Mitch type II (Salter Harris type II (?) IV (?)) - Commonest - Fracture staing in metaphysis and running along the physis of lateral condyle into trochlear i.e. fracture extends medial to capitulotrochlear groove. - Make ulnar - humeral (elbow) joint unstableQ. * If the lateral condyle is left capsized nonunion is inevitableQ : with growth elbow becomes increasingly valgus and tardy ulnar nerve palsyQ is then likely to develop.", "cop": 3, "opa": "Fracture supracondylar humerus", "opb": "Fracture medial condyle", "opc": "Fracture lateral condyle", "opd": "Fracture head radius", "subject_name": "Surgery", "topic_name": null, "id": "2effa94b-5d89-42c5-978d-8e54b299b51d", "choice_type": "single"} {"question": "Familial polysosis coli is associated with", "exp": ".HNCC (hereditary nonpolyposis colonic cancer) * No polyps. Autosomal dominant* Three members of the family have colonic cancers * Lynch syndrome I is site specific - commonly right sided, occurs in early age group, 40% are metachronous * Lynch syndrome II has other malignancy in, stomach, breast, ovary, endometrium and urinary bladder. It is cancer family syndrome * Microsatellite instability (MSI) at DNA level occurs in HNCC * Accounts for 3-5% of colonic cancers * Amsterdam criteria I (1990); Amsterdam criteria II (1999) and revised Bethesda guidelines (2002) are used to diagnose HNCC ref:SRB&;S manual of surgery,ed 3,pg no 835", "cop": 3, "opa": "Intussusception", "opb": "Toxic magacolon", "opc": "Cancer", "opd": "Ulcerative colitis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "830a833f-fbd7-41f9-8ccb-caab9f38c3ee", "choice_type": "single"} {"question": "A man presented with fractures of 4th to 10 th ribs and paradoxical respiration after RTA. He is diagnosed to have flail chest and a PaO2 of <70%. Management is", "exp": "Flail chest in fracture of 3 or more continuous ribs.\nParadoxical respiration is when during inspiration chest moves inwards and vice versa.", "cop": 2, "opa": "Tracheostomy", "opb": "IPPV with intubation", "opc": "Fixation of ribs", "opd": "Strapping of chest", "subject_name": "Surgery", "topic_name": null, "id": "ef95959a-ae6b-4753-82fb-9f26225a883e", "choice_type": "single"} {"question": "Nerve compressed by aneurysm of posterior communicating aery is", "exp": "Occulomotor nerve Most unruptured intracranial aneurysms are completely asymptomatic. Symptoms are usually due to rupture and resultant subarachnoid hemorrhage. Occasionally neurological symptoms may arise due to mass effect of the aneurysm. Progressively enlarging unruptured aneurysm most commonly involves the occulomotor nerve. This usually occurs .from an expanding aneurysm at junction of post communicating aery and internal carotid aery. Other neuropathies due to intracranial aneurysms are Cavernous sinus aneurysm can produce sixth nerve palsy. Supraclinoid carotid or anterior cerebral aery aneurysm can produce visual field defects. Posterior inferior cerebellar aery or anterior inferior cerebellar aery aneurysm may present as occipital & posterior cervical pain. An expanding middle cerebral aery aneurysm can produce pain in or behind the eye & in the low temple. Ophthalmic aery aneurysm can cause visual loss by compressing optic nerve.", "cop": 1, "opa": "Occulomotor nerve", "opb": "Optic nerve", "opc": "Hypophysis cerebri", "opd": "Trochlear nerve", "subject_name": "Surgery", "topic_name": null, "id": "4131c7e0-24ba-4984-a6d8-9dbdb0a6e21c", "choice_type": "single"} {"question": "Safest contrast in esophageal perforation", "exp": "Ans. (a) IohexolRef: Shackelford, 7th Edition, Page 86Contrasts to detect leak and perforation:Two contrasts are commonly used to detect perforation* Barium* Water soluble contrasts:# Low osmolar: Iohexol, Metrizamide# High Osmolar: Diatrazoate (Gastrograffin)* High osmolar Gastrograffin (Diatrozoate meglumine): has more chances of pulmonary edema than low osmolar contrasts like Iohexol (Omnipaque) and metrizamide (Amnipaque).In conclusion:* Best to diagnose perforations - High density Barium* Safest in usage: Low osmolar Water soluble contrasts like Iohexol and Metrizamide", "cop": 1, "opa": "Iohexol", "opb": "Barium sulphate", "opc": "Gadolinium", "opd": "Methylene blue", "subject_name": "Surgery", "topic_name": "Oesophagus", "id": "a0d180e6-c924-49e5-aeb8-924cd6bccd24", "choice_type": "single"} {"question": "The transition between the stomach and duodenum is marked by", "exp": "Prepyloric vein of mayo distinguishes pyloric canal from the first pa of the duodenum. The angular incisure or angular notch also called the incisura angularis, is a small anatomical notch on the stomach located on the lesser curvature of the stomach near the pyloric end. Its location varies somewhat in position with the state of distension of the internal organs The gastroduodenal aery is a blood vessel that arises from the common hepatic aery The hepatoduodenal ligament is the poion of the lesser omentum extending between the poa hepatis of the liver and the superior pa of the duodenum Reference: SRB 5 th edition page no.815", "cop": 1, "opa": "Vein of Mayo", "opb": "Hepatoduodenal ligament", "opc": "Gastroduodenal aery", "opd": "Incisura", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "638d7da3-d5fc-474c-a377-46ca41666ea6", "choice_type": "single"} {"question": "Preferred initial treatment for Ca anal canal is", "exp": "Anal cancer Uncommon tumour, which is usually a squamous cell carcinoma Associated with HPV More prevalent in patients with HIV infection May affect the anal verge or anal canal Lymphatic spread is to the inguinal lymph nodes Treatment is by chemoradiotherapy in the first instance Major ablative surgery is required if the above fails Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1269", "cop": 2, "opa": "Surgery", "opb": "Chemoradiation", "opc": "Immunotherapy", "opd": "Observation", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "c23b2aff-aaa2-41e9-a3e7-5bc217c2662a", "choice_type": "single"} {"question": "Most common cause of death in burns is", "exp": "Following successful resuscitation, most acute Morbidity and viually all Moality in severely burned patients are related to infection This is because thermal injury causes profound immunosuppression that is propoional to the TBSA of the burn. Inspite of burn patients at significant risk to infection, prophylactic systemic antibiotics are not pa of modern care, as they do not reduce septic complications and only lead to increased bacterial resistance MC cause of death at the site of burn: Asphyxia MC cause of death in burns : Septicemia MC cause of early death in burns :Hypovolemic shock MC cause of late death in burns : Septicemia Ref: Sabiston 20th edition Pgno :516", "cop": 4, "opa": "Neurogenic shock", "opb": "Hypovolemic shock", "opc": "Haemorrhagic shock", "opd": "Septicemic shock", "subject_name": "Surgery", "topic_name": "General surgery", "id": "93250027-688f-48f0-8fe8-9e4a9ce26ca4", "choice_type": "single"} {"question": "Ulcerative colitis involves", "exp": "Answer 'c' i.e. Mucosa Ulcerative colitis involves mucosa and superficial submucosa with deeper layers unaffected except in fulminant disease.", "cop": 3, "opa": "Serosa", "opb": "Lamina propria", "opc": "Mucosa", "opd": "Circularis muscle", "subject_name": "Surgery", "topic_name": null, "id": "3cf5378f-2087-4e5d-b735-882246ac97cc", "choice_type": "single"} {"question": "Following are the methods used for cleft lip repair", "exp": "Following techniques have been used for cleft lip repair Thompson Le Muserier Tennison-Randall but 'Rotation advancement technique' by Millard is the most widely used method", "cop": 4, "opa": "Le mesurier's method", "opb": "Tennison's method", "opc": "Millard's method", "opd": "Wardill's method", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "c92cb8cd-1dcd-43db-9133-72fdbeca1e4e", "choice_type": "single"} {"question": "Radioiodine ablation is preferred in", "exp": "Surgery is followed by RIA if thyroid tissue is left.\nI131 is used which has a half life of 8 days.", "cop": 4, "opa": "Pregnancy", "opb": "Graves disease", "opc": "Young patients", "opd": "Post surgery papillary carcinoma", "subject_name": "Surgery", "topic_name": null, "id": "9b629278-98ef-4cd6-baf9-4096a6fa9081", "choice_type": "single"} {"question": "Earliest symptom of Volkmann's Ischaemic is", "exp": "C i.e. Pain of passive extension", "cop": 3, "opa": "Pain in flexor muscles", "opb": "Absence of pulse", "opc": "Pain on passive extension", "opd": "Cyanosis of limb", "subject_name": "Surgery", "topic_name": null, "id": "0fd62c1b-17f9-435a-b0a5-8c04f99f1f60", "choice_type": "single"} {"question": "T/t of choice for grade IV vesicoureteric reflux with recurrent UTI", "exp": "Ans. is 'a' ie. Cotrimoxazole (Ref. Nelson, 18/e p2233 (16/e, p 1628))Don't get misled by this statement given in O.P. Ghai - \"Operative correction of VUR is indicated inpts. with - persistent severe (grade IV or V) refluxThis statement does not mean that any pt. with grade IV & V reflux will be given surgical management and rest medical management. Treatment is not so clear-cut.The choice b/w medical or surgical modality is based on certain principles (go through the following text to understand it).The below given explanation is a bit lengthy. Bear with me for giving such a long text, as it is one of the most important but less read topic (UG books do not give sufficient information on its treatment).This explanation will help you to tackle any future question on t/t of VUR with different patient profile (as t/t changes with grades as well as age of the patient)Vesicoureteral reflux (VUR)is the retrograde flow of urine from the bladder to the ureter and the renal pelvisGrading of VUR : is based on the appearance of the urinary tract on Micturating Cystourethrogram (MCU).Grade 1reflux into a non-dilated ureterGrade IIreflux into the upper collecting system without dilatation.Grade IIIreflux into dilated ureter and /or blunting of calyceal fornicesGrade IVreflux into a grossly dilated ureterGrade VGross dilatation of the ureter, renal pelvis & calyces : calyces show loss of papillary impression. Complications of VURReflux predisposes to renal infection (pyelonephritis) by facilitating the transport of bacteria from the bladder to the upper urinary tract.The inflammatory reaction caused by a pyelonephritic infection may result in renal injury or scarring.Extensive renal scarring impair renal function and may result in renin mediated hypertension, reflux nephropathy, renal insufficiency, end stage renal disease, reduced somatic growth and morbidity during pregnancy.* TreatmentThe goals of t/t are to prevent pyelonephritis, renal injury, and other complication of reflux.Treatment modality is either medical or surgical.Medical therapyis based on the principle that reflux often resolves over time and the antibiotics maintain urine sterility and prevent infection and complication while awaiting spontaneous resolution.Surgical therapy :the basis for surgical therapy is that in selected children, ongoing reflux has caused or has significant potential for causing renal injury.The decision to do medical or surgical t/t is based on certain principles and parental, patient preferences.Below is given a chart listing the treatment recommendation for VUR.Before going through the chart lets see the basic principles on which this chart is based -With bladder growth and maturation, there is tendency for reflux to resolve or improve over time.Lower grades of reflux are much more likely to resolve than are higher grades.For grades I & II reflux, the likelihood of resolution is similar irrespective of age at diagnosis and whether if it unilateral or bilateral.For grade III & IV a younger age at diagnosis and unilateral reflux generally are associated with a higher rate of spontaneous resolution.Grade V reflux rarely resolves.The mean age for reflux resolution is 6 - 7 yrs.Reflux is unlikely to cause any renal injury in the absence of infection.Treatment Recommendation for VUR diagnosed following a UTI.GradeAge (yrs)ScarringInitial t/tFollow-upI-iiAny-Antibiotic prophylaxis-III - IV0-5-Antibiotic prophylaxisSurgeryIII - IV6- 10-U/L: Antibiotic prophylaxisSurgeryIII - IV6 - 10-B/L: Surgery V<1-Antibiotic prophylaxisSurgeryV1 - 5NoU/L: Antibiotic prophylaxisSurgeryV1 - 5NoB/L: Surgery V1 - 5YesSurgery V6- 10-Surgery * ThusMedical Management is the initial t/t in almost all children except for -Grade III & IV (Bilateral)Grade V (Mostly)Medical management (antibiotic prophylaxis) is continued till the reflux resolves.Pt. is shifted from medical to surgical management, in children withbreakthrough UTI (Recurrent UTI despite prophylaxis)Development of new renal scarsFailure of reflux to resolve.Thus in this question we will begin with medical management ie cotrimoxazole. This pt is having recurrent UTI. This will not alter our t/t. If the pt. had recurrent UTI despite prophylaxis, we would have done a surgical management.If you have a close look at the statement of O.P. Ghai, you will note that he is not stating that grades IV & V will be t/t surgically. It is persistent grades IV & V that are t/t surgically (persistent means VUR that are not resolving over time).", "cop": 1, "opa": "Cotrimox azole", "opb": "Bilateral reimplantation of ureter", "opc": "Injection of Collegen in the ureter", "opd": "Endoscopic resection of ureter", "subject_name": "Surgery", "topic_name": "Urinary Tract", "id": "ba9d382c-f704-4922-9582-a7bf26d4ed81", "choice_type": "single"} {"question": "22 Gauge IV cannula color", "exp": "Ans. (c) BlueRef: Surgery Sixer 2nd Edition Page 14In our Hospitals commonly available cannulas for resuscitation are:* Grey: 16 G* Green: 18 G* Pink: 20 G* Blue: 22 G* Yellow: 24 G", "cop": 3, "opa": "Green", "opb": "Gray", "opc": "Blue", "opd": "Pink", "subject_name": "Surgery", "topic_name": "Burns", "id": "da93f9a1-d002-4086-853a-5ee73e73ca85", "choice_type": "single"} {"question": "Flank discoloration seen in this patient admitted with Pancreatitis is", "exp": "Ans. (a) Grey turner sign* Skin discoloration seen in the loin in cases of hemorrhagic pancreatitis is grey turner sign* Cullen sign is pigmentation around Umbilicus.", "cop": 1, "opa": "Grey turner sign", "opb": "Cullen sign", "opc": "Kehr sign", "opd": "Klein sign", "subject_name": "Surgery", "topic_name": "Pancreas", "id": "5d0bf705-7b56-41b6-9814-fd02f17097eb", "choice_type": "single"} {"question": "Facial nerve palsy is seen in the following fracture", "exp": null, "cop": 2, "opa": "Anterior cranial fossa", "opb": "Middle cranial fossa", "opc": "Cranial vault", "opd": "Posterior cranial Fossa", "subject_name": "Surgery", "topic_name": null, "id": "a2c82225-4b8e-4ceb-8770-adeff7cefafc", "choice_type": "single"} {"question": "The treatment of choice in pathological fractures is", "exp": "A i.e. Internal fixation", "cop": 1, "opa": "Internal fixation", "opb": "Plaster of Paris casts", "opc": "Skin traction", "opd": "External skeletal fixation", "subject_name": "Surgery", "topic_name": null, "id": "39fd4435-0bc9-4f0b-9c67-c1dd0f4efa70", "choice_type": "single"} {"question": "Paradoxical respiration seen in", "exp": "Answer- C. Flail chest", "cop": 3, "opa": "Diaphragm rupture", "opb": "Hemoperitoneum", "opc": "Flail chest", "opd": "Pneumothorax", "subject_name": "Surgery", "topic_name": null, "id": "022d0329-f124-4526-b6e6-191672e9782a", "choice_type": "single"} {"question": "Oxalate stones are found in", "exp": "The severity of ethylene glycol toxicity is related to the metabolic acidosis resulting from the biotransformation of ethylene glycol into toxic metabolites. Ethylene glycol is metabolized by the enzyme alcohol dehydrogenase to glycoaldehyde. Through interaction with aldehyde dehydrogenase, ethylene glycol is then metabolized to glycolic acid (GA).Glycolic acid causes severe acidosis. This glycolate is then transformed into glyoxylic acid which may be transformed into the highly toxic oxalate or the safer glutamate or a-ketoadipic acid metabolites. Thus, calcium oxalate crystals may form and accumulate in blood and deposit in kidneys and other tissues.", "cop": 1, "opa": "Ethylene glycol", "opb": "Ethanol", "opc": "Diethyl glycol", "opd": "Methyl alcohol", "subject_name": "Surgery", "topic_name": "Urology", "id": "3892eb89-7b2b-47f3-a1ea-6f903d7a7555", "choice_type": "single"} {"question": "The most common intraperitoneal abscess following peritonitis is", "exp": null, "cop": 2, "opa": "Subphrenic", "opb": "Pelvic", "opc": "Paracolic", "opd": "Interloop", "subject_name": "Surgery", "topic_name": null, "id": "735b4061-f92e-446b-a086-ca90f119be67", "choice_type": "single"} {"question": "Metabolic abnormality seen in gastric outlet obstruction is", "exp": "Ans. is 'b' i.e. Hypochloremic, hypokalemic alkalosis Repetitive vomiting leads to hypochloremic, hypokalemic metabolic alkalosis. The urine is alkaline initially but eventually it becomes acidic (paradoxical aciduria)Cause of paradoxical aciduriaInitially the kidney compensate for metabolic alkalosis by reabsorbing hydrogen and chloride ions in exchange for sodium, potassium and bicarbonate. But gradually as the body stores of sodium and especially potassium become depleted, kidney starts retaining these ions in exchange of hydrogen ions. Thus the urine becomes acidic and the metabolic alkaline state is further aggravated.", "cop": 2, "opa": "Hypochloremic, hypokalemic acidosis", "opb": "Hypochloremic, hypokalemic alkalosis", "opc": "Hyperchloremic, hypokalemic acidosis", "opd": "Hypochloremic, hyperkalemic alkalosis", "subject_name": "Surgery", "topic_name": "Benign Gastric Disease", "id": "b03d098c-84b7-4d6e-9486-e281d76a21f0", "choice_type": "single"} {"question": "Most common site of deep vein thrombosis is", "exp": "Pelvic veins are most commonly affected site in DVT.", "cop": 3, "opa": "Femoral veins", "opb": "Popliteal veins", "opc": "Pelvic veins", "opd": "Tibial vein", "subject_name": "Surgery", "topic_name": null, "id": "cc40d8fe-e580-4998-b31f-10bb55e3d710", "choice_type": "single"} {"question": "Pus in burns form in", "exp": "Burn wound will almost inevitably be colonised by micro oraganism within 24-48 hrs.", "cop": 1, "opa": "2-3 Days", "opb": "3-5 days", "opc": "2-3 weeks", "opd": "4 weeks", "subject_name": "Surgery", "topic_name": null, "id": "ff60bff5-6a97-4e21-943c-dae179bf3b52", "choice_type": "single"} {"question": "AKT 1 amplification seen in", "exp": "Answer- D. Gastric cancer AKT 1 amplification- Glioblastoma, gliosarcoma, gastric cancer, lung cancer.", "cop": 4, "opa": "CA bladder", "opb": "CA colon", "opc": "Breast cancer", "opd": "Gastric cancer", "subject_name": "Surgery", "topic_name": null, "id": "6663d8ce-aaf0-4689-acc5-80008c8af709", "choice_type": "single"} {"question": "Adenocarcinoma in oesophagus occurs in", "exp": "BARRETT's ulcer is an ulcer in columnar epithelium lined Barrett's oesophagus. It is more prone for Bleeding, Perforation, and Adenocarcinoma of oesophagus( very high, more than 40 times). Treatment for Barrett's ulcer is endoscopic biopsy and resection. Reference: SRB's Manual of Surgery, 6th Edition, page no= 788.", "cop": 3, "opa": "Midline oesophagus", "opb": "Upper oesophagus", "opc": "Barrett's esophagus", "opd": "Zenkers diveiculum", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "53a255e9-fc26-4592-8c10-ff330002cd56", "choice_type": "single"} {"question": "Anal cancer is associated with", "exp": "Ans. (a) Human papilloma virusRef: Bailey & Love 26th ed. /1266* The development of anal cancer is associated with infection by human papilloma virus.* The infection may lead to:# Anal warts (condyloma acuminata)# Anal intraepithelial neoplasia# Squamous cell carcinoma.* The risk for anal cancer is increased among homosexual males.* Anal cancer risk is increased in both men and women with AIDS, because of their immunosuppressed state", "cop": 1, "opa": "Human papilloma virus", "opb": "EBV", "opc": "HTLV-1", "opd": "Polyoma virus", "subject_name": "Surgery", "topic_name": "Neoplastic Disorders", "id": "45231193-09b7-44c4-bda2-028a55fd68eb", "choice_type": "single"} {"question": "Gastrotomy is", "exp": "an incision made in the stomach is called gastrotomy The opening created surgically in the abdominal wall for the purpose of providing access to the stomach to feed an individual who is incapable of normal food intake by inseing a tube is called gastrostomy. the opening created surgically in the abdominal wall for the purpose of providing access to the stomach to feed an individual who is incapable of normal food intake. Resecting proximal pa of stomach is called gastrectomy In subtotal gastrectomy, distal pa of a tumour is resected Reference: Bailey and love&;s edition 24 page no. 1056, SRB edition 5 page no. 858, internet", "cop": 2, "opa": "Open the stomach closed after tube inseion", "opb": "Opening the stomach", "opc": "Resecting the terminal pa of stomach", "opd": "Resecting the proximal pa of stomach", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "4049ebb0-4e1b-4e2f-af86-f74470158698", "choice_type": "single"} {"question": "A 60 year old smoker came with the history of single episode of painless gross hematuria . Most logical investigation would be.", "exp": "REPEAT QUESTION. In this case, we should suspect bladder carcinoma ( transitional cell carcinoma ) . RISK FACTORS:- 1.Smoker :- component of tobacco - 4 aminobiphenyl. 2. Cyclophosphamide.(Phenacitin also) 3.Schistosomiasis in endemic regions . 4.Chemical (Aromatic hydrocarbon -Aniline). 5.Stones. 6.Radiation. 7.F.B. It is more common in males -3:1. They usually presents with painless gross hematuria. IOC :-Thus the best option here is urine microsopy for RBC's and malignant cells.urine cytology even though not a good screening test because of lack of sensitivity is highly specific . Mainstay of diagnosis is cystourethroscopy. investigations include imaging ( CT , MRI ,USG ,IVU ) and blood investigations for HB , electrolytes and urea . Gold std:- CYSTOSCOPY Bailey and Love 27th edition.chapter 77.pg no 1449.", "cop": 4, "opa": "USG", "opb": "X-ray KUB", "opc": "Urine routine", "opd": "Urine microscopy for malignant cytology cells", "subject_name": "Surgery", "topic_name": "Urology", "id": "753e75f9-2007-452b-a25d-e5eea08a5398", "choice_type": "single"} {"question": "Most common type of renal cancer is", "exp": "Clear cell Ca is most common. It usually involves PCT", "cop": 4, "opa": "Medullary", "opb": "papillary", "opc": "chromophobe", "opd": "Clear cell cancer", "subject_name": "Surgery", "topic_name": null, "id": "15b93a96-a454-49a4-80c1-d56453bdf198", "choice_type": "single"} {"question": "Deformity of posterior dislocation of hip", "exp": "A i.e. Flexion, adduction, intenal rotation", "cop": 1, "opa": "Flexion, adduction, Internal rotation", "opb": "Flexion, abduction, external rotation", "opc": "Extension abduction, Internal rotation", "opd": "Extension adduction, external rotation", "subject_name": "Surgery", "topic_name": null, "id": "6652dae5-6363-4731-9b1d-8202a1208fd9", "choice_type": "single"} {"question": "Sentinel lymph node biopsy is used for", "exp": "Sentinel Lymph Node Mapping and Biopsy\n\nFor breast cancer, sentinel lymph node is the largest lymph node in the axilla and is the first to receive the lymph and potential metastases drained from the breast.\n\nIntraoperative lymphatic mapping and biopsy of the sentinel lymph node initially introduced for the staging of melanoma has been similarly used for the detection of axillary metastases in breast cancer, where it has also become the accepted standard of care.\n\nIn both the cases the method provides for minimally invasive surgery, and its success is now stimulating attempts to introduce it in the staging of the thyroid, gastric, colonic, lung and endometrial cancers.\nIn breast cancer surgery this technique avoids significant morbidity of axillary dissection and inexperienced hands has proven to provide acceptable rates of metastatic identification", "cop": 1, "opa": "Breast carcinoma", "opb": "Penile cacinoma", "opc": "Retroperitoneal sarcoma", "opd": "Hepatic carcinoma", "subject_name": "Surgery", "topic_name": null, "id": "511f34c3-66df-4ee4-a669-a30639db2ca8", "choice_type": "single"} {"question": "An infected pancreatic necrosis is treated with", "exp": "Answer- B. Laprotomy and surgical debridementTreatmentAn infected pancreatic necrosis is managed by laparotomy and surgical ilebridement of the necrotic tissue.Whereas pancreatic abscess are t/t by external drainage.Sterile necrotic pancreatitis is managed conservatively", "cop": 2, "opa": "iv Antibiotics", "opb": "Laprotomy and surgical debridement", "opc": "Ultrasound guided drainage", "opd": "TPN", "subject_name": "Surgery", "topic_name": null, "id": "ebe9bff0-d88e-4d59-876a-2ada2138fc44", "choice_type": "single"} {"question": "First line drug for prophylaxis of pneumocystosis is", "exp": "First line drug for prophylaxis of pneumocystosis is TMP-SMX (trimethoprim-sulfamethoxazole).Dapsone, Pyrimethamine, Atovaquone, Leucovorin, Pentamidine are second line drugs", "cop": 1, "opa": "TMP-SMX", "opb": "Dapsone", "opc": "Pyrimethamine", "opd": "Atovaquone", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "08816ed2-efa7-42d1-a169-d8d4c25dd9f1", "choice_type": "single"} {"question": "Green discharge is M. Commonly seen with", "exp": "Ans is 'b' ie Duct ectasia \"A black or green discharge is usually due to duct ectasia and its complications.\" - Bailey & Love.Duct ectasia is dilatation of lactiferous ducts associated with periductal inflammation, the pathogenesis of which is unknown.", "cop": 2, "opa": "Duct papilloma", "opb": "Duct ectasia", "opc": "Retention cyst", "opd": "Fibroadenosis", "subject_name": "Surgery", "topic_name": "Nipple Discharge", "id": "12fa7d7d-6bb2-4f39-80fe-ebb8898a0428", "choice_type": "single"} {"question": "Transverse fracture of the patella with separation of fragments is best treated by", "exp": "D i.e. Open reduction with Kirschner wire fixation of the fragment an tension band wiring", "cop": 4, "opa": "Closed reduction with cylinder cast", "opb": "Open reduction with screw fixation of the fragments", "opc": "Blind fixation of the two fragments with Kirschner wire", "opd": "Open reduction with Kirschner wire fixation of the fragment an tension band wiring", "subject_name": "Surgery", "topic_name": null, "id": "644259ba-61d1-4ae8-a059-eeb2952401fb", "choice_type": "single"} {"question": "Most commonly liver transplant in infants is done for", "exp": "10-15% of liver transplantation in children is done for biliary atresia. Acute liver failure from hemochromatosis is the primary indication for liver transplantation in the neonatal population. Cirrhosis is the most common indication for liver transplantation in adults Reference Bailey and love&;s edition 24 page 202", "cop": 1, "opa": "Biliary atresia", "opb": "Hemochromatosis", "opc": "Biliary cirrhosis", "opd": "Uremia", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "b31434d7-a892-475f-bff2-efc6635c37a6", "choice_type": "single"} {"question": "Investigation of choice to know depth of cancer invasion is", "exp": "The accuracy of T and N stages as determined by CT is less accurate than EUS.EUS (endoscopic ultrasound) is performed using a flexible endoscope with a 7.5-MHz to 12-MHz ultrasound transducer. The stomach is filled with water to distend it and provide an acoustic window, and the stomach wall is visualized as five alternating hypoechoic and hyperechoic layers. The mucosa and submucosa represent the first three layers. The fouh layer is the muscularis propria, the serosa is the fifth layerSabiston 20e pg: 1245", "cop": 4, "opa": "CECT", "opb": "MRI", "opc": "Barium", "opd": "EUS", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "60d31ad6-b80b-41b6-9fd3-b875f7fd588b", "choice_type": "single"} {"question": "Battle's sign is seen in", "exp": "(B) Basilar fracture# BATTLE'S SIGN is ecchymosis of the mastoid process of the temporal bone seen in basilar skull fracture (or basal skull fracture) which is a fracture of the base of the skull, typically involving the temporal bone, occipital bone, sphenoid bone, and/or ethmoid bone.> Other sign and symptoms include: Raccoon eyes - is periorbital ecchymosis i.e. \"black eyes\" Cerebrospinal fluid rhinorrhea Cranial nerve palsy Bleeding from the nose and ears Hemotympanum Conductive or perceptive deafness, nystagmus, vomitus.", "cop": 2, "opa": "Linear fracture", "opb": "Basilar fracture", "opc": "Depressed fracture", "opd": "Diastatic fracture", "subject_name": "Surgery", "topic_name": "Nervous System", "id": "ce93d509-16fe-4a7c-9102-abb5e886a3b9", "choice_type": "single"} {"question": "Frey's procedure is done for", "exp": "Treatment of chronic pancreatitis Most of the patients can be managed medically. There is no single therapeutic agent that can relieve symptoms Endoscopic, radiological or surgical interventions are indicated mainly to relieve obstruction of the pancreatic duct, bile duct or the duodenum, or in dealing with complications (e.g. pseudocyst, abscess, fistula, ascites or variceal haemorrhage). Decompressing an obstructed pancreatic duct can provide pain relief in some patients (the assumption is that ductal hypeension causes the pain). Endoscopic pancreatic sphincterotomy might be beneficial in patients with papillary stenosis and a high sphincter pressure and pancreatic ductal pressure. Patients with a dominant pancreatic duct stricture and upstream dilatation may benefit by placement of a stent across the stricture. The stent should be left in for no more than 4-6 weeks as it will block. The complication rate is high, and less than two-thirds of patients experience pain relief, but those who do get relief may benefit from a surgical bypass. Pancreatic duct stones maybe extracted at ERCP, and this may sometimes be combined with extracorporeal shock wave lithotripsy. Pseudocysts may be drained internally under EUS guidance. Percutaneous or transgastric drainage of pseudocysts under ultrasound or CT guidance may be performed. The role of surgery is to overcome obstruction and remove mass lesions. Some patients have a mass in the head of the pancreas, for which either a pancreatoduodenectomy or a Beger procedure (duodenum-preserving resection of the pancreatic head) is appropriate. If the duct is markedly dilated, then a longitudinal pancreatojejunostomy or Frey procedure can be of value. The natural evolution of the disease may not be altered significantly, but around half the patients get long-term pain relief. The rare patient with disease limited to the tail will be cured by a distal pancreatectomy. Patients with intractable pain and diffuse disease may plead for a total pancreatectomy in the expectation that removing the offending organ will relieve their pain. How- ever, one should keep in mind that pancreatic function and quality of life are significantly impaired after this procedure, and the operative moality rate is not tril. Moreover, there is no guarantee of pain relief (approximately a third of patients get resolution, a third show some benefit, and a third see no benefit at all). Total pancreatectomy and islet auto- transplantation has been repoed in selected patients, but it is difficult to demonstrate any overall benefit. Ref: Bailey and love 27th edition Pgno : 1231", "cop": 4, "opa": "Meckel's diveicual", "opb": "Auriculotemporal neuropathy", "opc": "Ulcerative colitis", "opd": "Chronic pancreatitis", "subject_name": "Surgery", "topic_name": "Urology", "id": "f4965c86-dc6c-4de6-b6b6-3969430c8afb", "choice_type": "single"} {"question": "Polytrauma in paediatric age group most common feature is", "exp": "Answer- B. Hypovolemic shockDue to the greater physiological capacity and ability ofchildren to compensate for fluid loss, hypotension is a very late and ominous sign of hypovolaemic shock.", "cop": 2, "opa": "Hypothermia", "opb": "Hypovolemic shock", "opc": "Hypotension", "opd": "Hypoxemia", "subject_name": "Surgery", "topic_name": null, "id": "c88f887f-62a6-4484-ada5-d26ca3648c63", "choice_type": "single"} {"question": "Optimal management of bilateral undescended testicles in an infant is", "exp": "By the second year, a testicle not in the cooler environment of the scrotal sac will begin to undergo histologic changes characterized by reduced spermatogonia. Testicles left longer in the undescended state not only have a higher incidence of malignant degeneration but are inaccessible for examination. If a malignancy should occur, diagnosis will be delayed. There is also a substantial psychological burden when children reach school age or are otherwise subjected to exposure of their deformed genitalia. Gel-filled prostheses are generally inserted when a testicle cannot be placed in the scrotum. Close follow-up by a physician until the late teens is indicated in all patients who have had an undescended testicle. Since these patients may be at increased risk for malignancy throughout life, careful training should be given in self-examination.", "cop": 2, "opa": "Immediate surgical placement into the scrotum", "opb": "Chorionic gonadotropin therapy for 1 month; operative placement into the scrotum before age 1 if descent has not occurred", "opc": "Observation until the child is 2 years old because delayed descent is common", "opd": "Observation until age 5; if no descent by then, plastic surgical scrotal prostheses before the child enters school", "subject_name": "Surgery", "topic_name": "Urinary Tract", "id": "50a0458e-21a0-4fb2-a6db-b5a04be22dda", "choice_type": "single"} {"question": "Cobble stone appearance is seen in", "exp": ".in crohn&;s disease,Fibrosis, stricture formation, deep ulcers, oedema of mucosa between ulcer areas which looks like 'cobble stone', skipped normal areas in between, serosal opacity, mesen-teric fat stranding, enlarged mesenteric lymph nodes, abscesses in the mesentery, fistula are the pathology. Small mucosal aphthous ulcers are earliest gross feature. ref:SRB&;s manual of surgery,ed 3,pg no 800", "cop": 2, "opa": "Ulcerative colitis", "opb": "Crohn's disease", "opc": "Appendicitis", "opd": "Carcinoma rectum", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "e93af707-4214-40e8-9aac-ecff5986f620", "choice_type": "single"} {"question": "'Doughnut' sign and 'Coiled spring' appearance are seen in", "exp": "(A) Intusussception # Ultrasound Axial images of intussusception showed a doughnut pattern.> Hypoechoic external ring was formed by the everted returning limb of intussusceptum and, to a lesser degree, by the intussuscipiens.> Doughnut's center varied according to the scan level.> Scans obtained at the middle or at the base of the intussusception showed a characteristic hyperechoic crescent in all cases.> This crescent was formed by the mesentery enclosing the entering limb of the intussusceptum, which the authors have termed the Crescent-in-doughnut sign'.> On scans obtained at the apex of the intussusception, the center was hypoechoic owing to the entering limb of the intussusceptum and the absence of the mesentery.> Crescent-in-doughnut sign appears to be a characteristic feature of intussusception.> Contrast enema remains the gold standard, demonstrating the intussusception as an occluding mass prolapsing into the lurren, giving the \"coiled spring\" appearance (barium in the lumen of the intussusceptum and in the intraluminal space).> Main contraindication for an enema is a perforation.", "cop": 1, "opa": "Intussusception", "opb": "Meckel's diverticulum", "opc": "Intestinal malrotation", "opd": "Volvulus", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "c68fc590-b588-4406-ab87-e017156f5472", "choice_type": "single"} {"question": "Proteus infection leads to", "exp": "(A) Struvite stones # Struvite stones are infectious stones composed of magnesium ammonium phosphate.> Struvite stones are common stones seen in SCI population, and they are caused by ureage producing bacteria.> Most common are Proteins, Psuedomonas, klebsiella, peosidentia, E.coli, Staphylococcus epidermidis, and ureaplasma urease catalyses break down of urea and water to ammonium and bicarbonate. The bicarbonate produces alkaline urine having a pH level greater than 7.2.> Alkaline urine facilitates the precipitation and crystailzation of magnesium ammonium phosphate , calcium carbonate, calcium phosphate.", "cop": 1, "opa": "Struvite stones", "opb": "Uric acid stones", "opc": "Pigment stones", "opd": "Calcium/Cholestrol stones", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "5180301f-e5b9-4671-b148-d8db7061d2b9", "choice_type": "single"} {"question": "During an operation for presumed appendicitis , the patient's appendix is found to be markedly thickened and feels rubbery to firm. The serosa is edematous and inflamed and the mesentery is thickend with fat growing about the bowel circumference. Most likely diagnosis", "exp": "Crohn's disease can present acutely, and when it involves the terminal ileum may clinically resemble appendicitis. The bowel in this patient has the characteristic gross findings and inflammatory changes of Crohn's disease including the \"creeping fat\" within the mesentery. Meckel's diveiculitis can mimic appendicitis but it presents as an inflammatory phlegmon located approximately 50 cm (2 feet) from the ileocecal varve and does not have the bowel changes seen in this patient. Ulcerative colitis is usually confined to the large bowel and, although it may occasionally be associated with inflammatory changes of the ileal mucosa (backwash ieitis), it is generally not associated with full- thickness changes described above. Ileal carcinoid would present as a mass in the ileum and would not be associated the inflammatory changes seen in this patient.", "cop": 1, "opa": "Ileal Crohn's disesase", "opb": "Meckel's diveiculitis", "opc": "Ulcerative colitis", "opd": "Ileocecal tuberculosis", "subject_name": "Surgery", "topic_name": null, "id": "18881355-aacf-4a2a-bb5f-fb9ad1fd1791", "choice_type": "single"} {"question": "Gastrinoma a/w", "exp": "Diarrhoea is due to hypergastrinaemia.It is associated with severe ulcers,not superficial SRB's manual of surgery,5th edition,710.", "cop": 1, "opa": "Diarrhoea", "opb": "Constipation", "opc": "Achlorhydria", "opd": "Multiple superficial gastric ulcers", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "3a963c53-2aa9-4e2c-96e4-4570516f18fb", "choice_type": "single"} {"question": "Blood loss in class II hemorrhagic shock is", "exp": "Ans. (b) 15-30%Ref: Sabiston 20th Page 50* Class 1 <15% blood loss* Class 2: 15- 30 % blood loss* Class 3: 30 -40% blood loss* Class 4: > 40% blood loss", "cop": 2, "opa": "< 15%", "opb": "15-30%", "opc": "30-40%", "opd": "> 40%", "subject_name": "Surgery", "topic_name": "Fluids & Electrolyte Disorders - Volume", "id": "47680a29-49f3-4037-a90d-b758fa47738c", "choice_type": "single"} {"question": "Adenoid cystic carcinoma is also known as", "exp": null, "cop": 1, "opa": "Cylindroma", "opb": "Pindborg tumor", "opc": "Warthins tumor", "opd": "Pleomorphic adenoma", "subject_name": "Surgery", "topic_name": null, "id": "67bf3828-5b19-4ff9-a1c0-4ce90351d2be", "choice_type": "single"} {"question": "Blood group associated with Gastric cancer is", "exp": "(B) A # Blood group A is associated with an increased risk for stomach cancer and poorer survival and O group people are associated with increased risk of gastric ulcer.> This observation may be related to differences in the mucous secretion, leading to altered mucosal protection from carcinogens.> A germ line mutation in the E-cadherin gene (CDH1), inherited in an autosomal dominant pattern and coding for a cell adhesion protein, has been linked to a high incidence of occult diffuse type gastric cancers in young asymptomatic carriers.> Duodenal ulcers are not associated with gastric cancer.", "cop": 2, "opa": "O", "opb": "A", "opc": "B", "opd": "AB", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "ad7efdd8-57a9-4bc5-bc59-df6d7bb84d3b", "choice_type": "single"} {"question": "Best diagnostic aid for Bronchiectasis is", "exp": "(D) CT scan # Bronchography, the previous gold standard for diagnosing bronchiectasis, has been largely replaced by CT. Though, CT is not as sensitive as bronchography, it is considerably safer and can be done sequentially to follow the patient's course.> Thin-section high resolution CT (HRCT) may be needed. A CT scan after inhalation of xenon may prove even more sensitive.", "cop": 4, "opa": "Bronchoscopy", "opb": "X-ray", "opc": "Bronchography", "opd": "CT scan", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "b39d6755-359c-4c6d-bc48-4a388be16174", "choice_type": "single"} {"question": "New born baby with Regurgitation of feeds and continuous drooling of saliva is", "exp": "Ans. (a) Esophageal AtresiaRef: Surgery Sixer 3rd Edition Page 327* Tracheo Esophageal Fistula is associated with Esophageal Atresia.* Babies born with Esophageal Atresia will have Continuous Drooling of Saliva and Regurgitates all its feeds.* Down Syndrome is associated with TEF", "cop": 1, "opa": "Esophageal atresia", "opb": "GERD", "opc": "Diffuse Esophageal Spasm", "opd": "Zenker's Diverticulum", "subject_name": "Surgery", "topic_name": "Oesophagus", "id": "cf92222c-e004-4f44-ad90-b48120f3a5f7", "choice_type": "single"} {"question": "Split skin graft take up is good if", "exp": "Light dressing over graft helps in good take up of split skin graft.", "cop": 2, "opa": "Wound is avascular", "opb": "Light compression wraps applied as dressing", "opc": "Increased purulent discharge from wound", "opd": "Insensitive area of wound", "subject_name": "Surgery", "topic_name": null, "id": "ee6a4bc0-dd5b-4111-8a16-9a9435e13fcc", "choice_type": "single"} {"question": "Injury to the male urethra below the perineal membrane causes urine to accumulate in", "exp": "Question talks about injury to bulbar urethra as in falling astride. Extravastion of urine is common in these cases. Extravasated urine collects in the superficial perineal space, passing into the penis as well as the scrotum and lower anterior abdominal wall. Source: Bailey and love 26th edition Pg 1361", "cop": 1, "opa": "Superficial perineal pouch", "opb": "Deep perineal pouch", "opc": "Space of retzius", "opd": "Pouch of douglas", "subject_name": "Surgery", "topic_name": "Urology", "id": "29f0ba86-3786-4be3-b204-1ed49bb328ee", "choice_type": "single"} {"question": "Child Turcotte Pugh score is used in", "exp": "Ans. (a) Chronic Liver DiseaseRef: Bailey and Love 27th Edition Page 1156Quantifying the severity of Chronic Liver disease:To assess the severity and perioperative risk of patients with CLD- two scoring systems are used:1. Child Turcotte - Pugh (CTP) score2. Model for End Stage Liver Disease (MELD) Score* The original Child classification was developed to predict mortality following Shunt operations in Cirrhotic cases.* Modified CTP score predicts mortality after any surgery* MELD was actually developed to see prognosis after TIPS but later adopted to make waiting list for liver transplant.", "cop": 1, "opa": "Chronic liver disease", "opb": "Chronic kidney disease", "opc": "Hepatic encephalopathy", "opd": "Uremic encephalopathy", "subject_name": "Surgery", "topic_name": "Liver", "id": "ce1b8bee-bca6-4da9-9bbe-29eeee261a8e", "choice_type": "single"} {"question": "Embolectomy should be done within", "exp": "Embolectomy should be done within 6 hours as after 6 hours, irreverside changes occur.", "cop": 2, "opa": "4 hours", "opb": "6 hours", "opc": "8 hours", "opd": "10 hours", "subject_name": "Surgery", "topic_name": null, "id": "c7fecf9f-a7be-4f63-9649-c230d8cd426f", "choice_type": "single"} {"question": "Hunt Hess scale is used for", "exp": "Ans. (a) SAH* Hunt and Hess Scale is used for Sub arachnoid hemorrhage* It helps to predict the outcome based on Clinical features.", "cop": 1, "opa": "SAH", "opb": "SDH", "opc": "Menigiomas", "opd": "Tuberculosis", "subject_name": "Surgery", "topic_name": "Nervous System", "id": "5506684f-044a-4c7b-a6ee-380953bd12e9", "choice_type": "single"} {"question": "Prognosis of carcinoma breast depends on", "exp": "”Metastasis to ipsilateral axillary nodes predicts outcome are surgery more powerfully than tumor size does.\nThe single most important predictor of 10 and 20-year survival rates in breast cancer is the number of axillary lymph nodes involved with metastatic disease.", "cop": 1, "opa": "Lymph node status", "opb": "Size of tumor", "opc": "Skin involvement", "opd": "Peude orange", "subject_name": "Surgery", "topic_name": null, "id": "0ce7e53c-f3f3-4ec3-a9d8-d41889553486", "choice_type": "single"} {"question": "A most common organism isolated in breast abscess", "exp": "Most common organism responsible is staphylococcus aureus.\nIn lactating mothers causative organisms spread from nasopharynx of the infant.", "cop": 2, "opa": "Streptococcus", "opb": "Staphylococcus aureus", "opc": "Klebsiella", "opd": "E coli", "subject_name": "Surgery", "topic_name": null, "id": "a0709216-3661-4063-b31b-42af9b8538e4", "choice_type": "single"} {"question": "This is a reason for tissue analysis in surgery after histopathology", "exp": null, "cop": 2, "opa": "FNAC repeated", "opb": "To confirm a suspected or established clinical diagnosis for prognosis of treatment", "opc": "To confirm radiological study", "opd": "Data recording", "subject_name": "Surgery", "topic_name": null, "id": "c7f6f050-59e7-410c-b3fc-ddb6a41a48bc", "choice_type": "single"} {"question": "The femur is fractured at bih at", "exp": "A i.e. Upper third of shaft", "cop": 1, "opa": "Upper third of shaft", "opb": "Middle third of shaft", "opc": "Lower third of shaft", "opd": "Neck region", "subject_name": "Surgery", "topic_name": null, "id": "e59f1669-de37-4dde-9bff-3f6c199f2b54", "choice_type": "single"} {"question": "A22 year old male patient presents with compete rectal prolapse.\nThe surgery of choice is", "exp": "For young pts - Abdominal rectopexy is preferred.\nFor old pts - perineal rectopexy is preferred (delormes, altamaier).\nUnderlying cause must be treated.", "cop": 2, "opa": "Delormes procedure", "opb": "Abdominal rectopexy", "opc": "Altamaier rectopexy", "opd": "Altamaier rectopexy", "subject_name": "Surgery", "topic_name": null, "id": "84d70c3b-16ba-4767-9494-5a6790963dc6", "choice_type": "single"} {"question": "A male is taking 60mg. of hydrocortisone daily. On the day before extraction, this dose should be", "exp": null, "cop": 1, "opa": "Remain unchanged", "opb": "Reduced to half", "opc": "Doubled", "opd": "Reduced to one fourth", "subject_name": "Surgery", "topic_name": null, "id": "8179cc4a-a9fb-475b-ac41-c85dbca5976a", "choice_type": "single"} {"question": "A cystic, transilluminant, painless scrotal swelling presented with testes separately palpable. The procedure to be done is", "exp": "(A) Lords' procedure # Hydrocele is a collection of serous fluid that results from a defect or irritation in the tunica vaginalis of the scrotum. Hydroceles also may arise in the spermatic cord or the canal of Nuck.> Structurally, hydroceles are classified into 3 principal types.> In a communicating (congenital) hydrocele, a patent processus vaginalis permits flow of peritoneal fluid into the scrotum. Indirect inguinal hernias are associated with this type of hydrocele.> In a noncommunicating hydrocele, a patent processus vaginalis is present, but no communication with the peritoneal cavity occurs.> In a hydrocele of the cord, the closure of the tunica vaginalis is defective. The distal end of the processus vaginalis closes correctly, but the mid portion of the processus remains patent. The proximal end may be open or closed in this type of hydrocele.> Hydroceles are located superior and anterior to the testis, in contrast to spermatoceles, which lie superior and posterior to the testis.> Hydrocele is bilateral in 7-10% of cases.> Hydrocele often is associated with hernia, especially on the right side of the body.> The size and the palpable consistency of hydroceles can vary with position. Hydrocele usually becomes smaller and softer after lying down it usually becomes larger and tenser after prolonged standing.> Systemic signs of toxicity are absent. The patient is usually afebrile with normal vital signs.> Abdominal or testicular tenderness are absent; no abdominal distension is present.> Bowel sounds cannot be auscultated in the scrotum unless an associated hernia is present.> Unless an infection causes an acute hydrocele, no erythema or scrotal discoloration is observed.> Transillumination A light source shines brightly through a hydrocele. Transillumination is common, but it is not diagnostic for hydrocele. Transillumination may be observed with other etiologies of scrotal swelling (eg, hernia).> The hallmark of treatment is eversion of the tunica through a surgical procedure called 'Lord's procedure' or an alternative 'Jsboulay's procedure'", "cop": 1, "opa": "Lords' procedure", "opb": "Hunters' procedure", "opc": "Gibbons' procedure", "opd": "Ombredanne's procedure", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "5c0d9ea8-b9b0-4533-9251-c29e73f4abc4", "choice_type": "single"} {"question": "The most common site for Prolapse of interveebral disc is", "exp": "D i.e. Lumbar", "cop": 4, "opa": "Cervical region", "opb": "Lower thoracic region", "opc": "Upper thoracic region", "opd": "Lumber region", "subject_name": "Surgery", "topic_name": null, "id": "b1f3faeb-2886-4536-b298-e8805eeb5558", "choice_type": "single"} {"question": "Surgery for ductal ectasia", "exp": "Answer- B. Radical duct excisionDuct ectasia of the breast or m:rmmary duct ectasia or plasma cell mastitis is a condition in which the lactiferousduct becomes blocked or clogged.This is the most common cause of greenish discharge.Clinical featuresNipple discharge of any colour, abscess, mammary duct fistula, subareolar mass and nipple retraction.TreatmentAntibiotic therapy may be tried but surgery is mostly required to cure this notoriously difficult condition. Surgery consists of excision of all the maior ducts (Hadfield's operation)", "cop": 2, "opa": "Microdochectomy", "opb": "Radical duct excision", "opc": "Radiation", "opd": "Chemotherapy", "subject_name": "Surgery", "topic_name": null, "id": "445b6361-9b9c-404e-9a5e-3a63835c4135", "choice_type": "single"} {"question": "T3 in the TNM staging of the oral malignant lesions represents", "exp": null, "cop": 4, "opa": "Carcinoma in situ", "opb": "Tumour 2 cm or less in greatest diameter", "opc": "Tumour > 2 cm but < 4 cm in greater diameter", "opd": "Tumour > 4 cm in greatest diameter", "subject_name": "Surgery", "topic_name": null, "id": "dc456cb4-8813-478c-b35a-8e08ccd1640c", "choice_type": "single"} {"question": "Osteoblastic secondaries in spine seen with", "exp": "i.e. (Carcinoma prostate): (613-H17th) (CSDT 13th) Most common cause of osteoblastic secondariesIn males - Prostate cancersIn females - Breast cancer Most common cause of osteolytic metastasisIn males - Lung cancersIn females - Breast cancers Lytic expansile metastasis - Thyroid, Renal Carcinoma(i) Peripheral zone is site for Adenocarcinoma (PAC)(ii) Transition (periurethral) is site for BPHAlthough some tumours may produce mainly osteolytic lesions (eg Kidney cancers) and other mainly osteoblastic lesions (eg prostate cancers) most lesions produces both types of lesion and may go through stages where one or the other predominates (613-H17th)", "cop": 1, "opa": "Carcinoma prostate", "opb": "Carcinoma thyroid", "opc": "Endometrial carcinoma", "opd": "Carcinoma rectum", "subject_name": "Surgery", "topic_name": "Orthopedics", "id": "f3ee6fa1-dbdc-440e-82c4-b43d2968c9e2", "choice_type": "single"} {"question": "High crural index is seen in", "exp": "Answer- A. Jumping athletesCrural index the ratio of lower leg length to thigh length. A high crural index allows application of force against the ground for a greater period of time than a lower crural index. fumping athletes (such as in basketball) and sprint swimmers tend to have above-average crural indices.", "cop": 1, "opa": "Jumping athletes", "opb": "Gymnasts", "opc": "Weight lifters", "opd": "Long - distance runners", "subject_name": "Surgery", "topic_name": null, "id": "8624bd8d-eba7-4281-8e37-a1cda89b7b11", "choice_type": "single"} {"question": "Tmreatment of hormone dependent fungating carcinoma of breasyt with secondaries in lung is", "exp": "Hormonal therapy in Carcinoma in breast Ovarian suppression or ablation Bilateral oophorectomy. Medically by LHRH agonist (Goserelin, leuprolide) SERM: Tamoxifen and Raloxifen Aromatase Inhibitors Non-steroidal : Letrozole & Anastrazole Steroidal : Exmestane Anti-Estrogens Fulvestrant Progestins Megesterol & Medroxyprogesterone acetate Ref: schwaz's principle of surgery 10th edition Pgno : 552-553", "cop": 1, "opa": "Simple mastectomy and oophoroctomy", "opb": "Radical mastectomy and oophoroctomy", "opc": "Adrenalectomy", "opd": "Lumpectomy followed by castration", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "ba8df1e2-5446-429f-b1ed-7b96790f8018", "choice_type": "single"} {"question": "Choice of intubation in Bilateral TMJ ankylosis for oral surgeries", "exp": "Intubation is generally done with the help of endotracheal tube (ETT). The internal diameter of ETT used ranges between 3 and 8 mm depending on the age, sex, and size of nares of the patient. Potex north and south polar performed Rae tubes (RAE- right angled ETT) and flexo- metallic tubes are commonly used. Out of them, North Pole Rae tube is preferred in case of ankylosis patient due to the direction of the curve of ETT which favors its placement in restricted mouth opening as in case of ankylosis.", "cop": 1, "opa": "North pole Rae tube", "opb": "South Pole Rae tube", "opc": "Tracheostomy", "opd": "Cricothyrotomy", "subject_name": "Surgery", "topic_name": null, "id": "6244829d-bb69-4a7e-88ce-4312ce13ec9d", "choice_type": "single"} {"question": "Kasai's procedure is performed in", "exp": "It is performed in in type 4b witches only extrahepatic biliary tree dilation.", "cop": 1, "opa": "Type 4B choledochal cyst", "opb": "Type 3B choledochal cyst", "opc": "Type 5 choledochal cyst", "opd": "Type 2 choledochal cyst", "subject_name": "Surgery", "topic_name": null, "id": "7f0c7860-4cbd-4704-9803-536c43a9924c", "choice_type": "single"} {"question": "Malignant melanoma most often develops from", "exp": "Dysplastic naevus is an irregular proliferation of atypical melanocytes at the basal layer of epidermis Dysplastic naevus has a familial inheritance and carries a 5-10 per cent risk of forming a superficial spreading melanoma. Bailey and Love 26th edition Pg : 591", "cop": 1, "opa": "Dysplastic naevus", "opb": "Junctional naevus", "opc": "Intradermal naevus", "opd": "Blue naevus", "subject_name": "Surgery", "topic_name": "General surgery", "id": "df9ec6b8-193f-4412-8b9e-d6776ccda534", "choice_type": "single"} {"question": "Milk production is inhibited by", "exp": "Ans (a) Ref: Sheila Balakrishnan pg 522Lactation suppression Phamnacologieal-Dopamine agonists-BromocriptineCabergolinePyridoxineNon pharmacological-Tight binding of breasts Jasmine flowers", "cop": 1, "opa": "Bromocriptine", "opb": "Ergotamine", "opc": "Metoclopromide", "opd": "Estrogen", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "ef2af782-e935-49d1-a468-7009d262fcae", "choice_type": "single"} {"question": "Fixity of the breast tissue in carcinoma of breast indicates infiltration of", "exp": "Answer- C. Pectoralis muscle and fasciaFixity of the breast tissue is tested by asking the patient to press the hand against the hip forcibly to contract Pectoralis major muscle & moves the breast over the pectoralis fascia in the direction of muscle frbres of the pectorals major muscle.Loss of normal mobility or fixity of the breast tissue indicates spread of cancer cells to underlying pectoralis muscle and fascia.", "cop": 3, "opa": "Suspensory ligaments", "opb": "Lymphatics", "opc": "Pectoralis muscle and fascia", "opd": "Internal mammary aery", "subject_name": "Surgery", "topic_name": null, "id": "5637e00c-af70-4861-9e3a-302b2dd3ea57", "choice_type": "single"} {"question": "Fetal blood is returned to the umbilical aeries and the placenta through the", "exp": "(Reece, 2/e, pp 54, 119-121.) Fetal blood is returned directly to the placenta through the two hypogastric aeries. The distal poions of the hypogastric aeries atrophy and obliterate within 3 to 4 days after bih; remnants are called umbilical ligaments. Fetal oxygenation is aided by the presence of three vascular shunts: the ductus venosus, foramen ovale, and ductus aeriosus. The ductus venosus shunts oxygenated blood from the umbilical vein into the inferior vena cava. The foramen ovale deflects the more oxygenated blood from the right atrium into the left atrium, thereby bypassing pulmonary circulation. Approximately two- thirds of the blood ejected from the right ventricle is shunted pulmonary circulation through the ductus aeriosus.", "cop": 1, "opa": "Hypogastric aeries", "opb": "Ductus venosus", "opc": "Poal vein", "opd": "Inferior vena cava", "subject_name": "Surgery", "topic_name": null, "id": "2ef22523-9ce6-4379-8422-00472e1a0649", "choice_type": "single"} {"question": "Wahin's tumor is found in", "exp": "It is a benign tumour that occurs only in parotid ,usually in the lower pole. SRB,25th,415", "cop": 1, "opa": "Salivary gland", "opb": "Thyroid gland", "opc": "Brunner's gland", "opd": "Adrenal gland", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "ca2a068e-9bf4-4d7e-82a4-24bda71cbd4b", "choice_type": "single"} {"question": "Most common site of colon malignancy is", "exp": "A. i.e. (Sigmoid colon) (1179-B& L 25th) (696 - CSDT 12th) (1060- S. Das 5th)Sigmoid colon is the most common site*** Distribution of colorectal cancerRectum (38%) > Sigmoid colon (21%) > caecum (12%) Transverse colon (5.5%) > Ascending colon (5%)> Descending colon (4%) > Hepatic flexure (2%) and anus (2%) > Appendix (0.5%)* Sigmoid colon segment of colon undergoes maximum postprandial contraction**Right colonLeft colonRectum**Unexplained weakness or Iron deficiency anemia (Most common)* Occult blood in feces* Dyspeptic symptoms* Persistent right abdominal discomfort* Change in bowel habits* Gross blood in stool* Obstructive symptom* Tenesmus* Characteristic x-ray finding* Rectal bleeding alternation in bowel habits* Sensation of incomplete evacuation* Intrarectal palpable tumor* Sigmoidoscopic finding* Metastatic disease - Jaundice, ascitis, hepatomegaly* Carcinoma of the colon - particularly the right colon is more common in women*** Carcinoma of the rectum is more common in men*** Regional lymph node involvement is the most common form of metastasis in colo rectal carcinoma**.* Marker for Gastro intestinal stromal tumour (GIST) is CD-I 17*** High fibre diet is most protective against development of colorectal cancer**Risk factor for Development of colorectal cancer (574 - H17th)* Diet - Animal fat* Streptocccus bovies bacteremia* Hereditary syndrome (AD- Inheritance)* Ureterosigmoidostomy* Polyposis coli* Tobacco-use* Nonpolyposis syndrome (Lynch syndrome) * Inflammatory bowel syndrome", "cop": 1, "opa": "Sigmoid colon", "opb": "Asending colon", "opc": "Descending colon", "opd": "Transverse colon", "subject_name": "Surgery", "topic_name": "Small & Large Intestine", "id": "a395d186-6276-4b83-8e97-092a4da6e312", "choice_type": "single"} {"question": "Occult thyroid malignancy with nodal metastases is seen in", "exp": null, "cop": 3, "opa": "Medullary carcinoma", "opb": "Follicular carcinoma", "opc": "Papillary carcinoma", "opd": "Anaplastic carcinoma", "subject_name": "Surgery", "topic_name": null, "id": "a2f07e8b-c7c8-4a5e-961d-4780741ef319", "choice_type": "single"} {"question": "Commonest presentation of wilm's tumouris", "exp": "Ans. is 'b' ie Abdominal lump \"MC presentation is painless abdominal mass usually discovered by the mother while routinely bathing the baby.\"", "cop": 2, "opa": "Hematuria", "opb": "Abdomial lump", "opc": "Hydronephrosis", "opd": "Pain in abdomen.", "subject_name": "Surgery", "topic_name": "Renal Tumors", "id": "cf9aecd9-cb46-44fc-87f3-ff77b87b97ff", "choice_type": "single"} {"question": "During extraction of the upper first molar, the mesio buccal root is missing and is suspected to have been pushed into the maxillary sinus.\nThe best position for the patient immediately after the incident is", "exp": null, "cop": 1, "opa": "To position the patient upright", "opb": "To position the patients in a semi inclined posture to visualize the perforation", "opc": "Trendelenberg position", "opd": "Reverse trendelenberg position", "subject_name": "Surgery", "topic_name": null, "id": "fc374693-12de-4ca4-8854-34bd1a9c686b", "choice_type": "single"} {"question": "Skip lesions with tuberculoid granulomas is", "exp": "Ans. is 'c' i.e., Crohn's disease", "cop": 3, "opa": "Hodgkins lymphoma", "opb": "Sarcoidosis", "opc": "Crohns disease", "opd": "Ulcerative colitis", "subject_name": "Surgery", "topic_name": null, "id": "96d06847-e50e-45cf-aeac-25890462f0e4", "choice_type": "single"} {"question": "Patients comes with fracture femur in an acute accident, the first things to do is", "exp": "A i.e. Secure airway", "cop": 1, "opa": "Secure airway and treat the shock", "opb": "Splinting", "opc": "Physical examination", "opd": "X-rays", "subject_name": "Surgery", "topic_name": null, "id": "c8ce9686-4f7d-4aaf-8c34-b30de0179175", "choice_type": "single"} {"question": "In Thyrotoxicosis there is", "exp": "(B) Hypokalemic Periodic Paralysis> Acute generalized weakness due to thyrotoxic periodic paralysis# Thyrotoxic periodic paralysis (TPP) is a disorder characterized by thyrotoxicosis, hypokalemia and predominantly proximal lower limb paralysis. Despite the female predominance of hyperthyroidism, TPP occurs most frequently in males in a ratio of 20:1, and 90% of patients are of Asian descent> Prodromal symptoms may consist of muscle stiffness or cramping. Sensation, as well as bulbar and respiratory muscle strength, remains intact.> Reflexes may be decreased or absent.> Attacks may be precipitated by a high carbohydrate meal (secondary to insulin secretion) or physical exertion.> In one series, 84% of attacks occurred between 1 and 6 am. Episodes are acute in onset and last 1-96 hours. As in this patient, symptoms and signs of hyperthyroidism may be subtle at initial presentation.> Electrocardiographic findings such as ST-segment depression with T-wave flattening and the presence of U waves are typical of hypokalemia. Findings supportive of a diagnosis of TPP are sinus tachycardia, elevated QRS voltage and first-degree AV block.> Pump sensitivity to adrenergic stimulation may be higher in patients with TPP than in those with hyperthyroidism alone, resulting in intracellular potassium shift and subsequent hypokalemia.", "cop": 2, "opa": "Hyperkalemic Periodic Paralysis", "opb": "Hypokalemic Periodic Paralysis", "opc": "Normokalemic Periodic Paralysis", "opd": "No Periodic Paralysis", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "5431b5af-5557-4341-b669-288179a6d356", "choice_type": "single"} {"question": "Parenteral nutrition is not used in", "exp": "In burns when GI tract is intact, why go for parentral nutrition. All other options GI tract may not be adequately functioning. Indications for total parenteral nutrition Inadequate absorption resulting from sho bowel syndrome Gastrointestinal fistula Bowel obstruction Prolonged bowel rest Severe malnutrition, significant weight loss and/or hypoproteinaemia when enteral therapy is not possible Other disease states or conditions in which oral or enteral feeding are not an option", "cop": 2, "opa": "Enterocutaneous", "opb": "Burns", "opc": "Crohn's disease", "opd": "Ileus", "subject_name": "Surgery", "topic_name": "General surgery", "id": "9dab2c71-cd5c-4700-8d45-14898220dfad", "choice_type": "single"} {"question": "Gleason scoring is done for", "exp": "Prostate cancer is diagnosed histologically by the Gleason grading system, which evaluates the level of abnormality in the patterns of the glandular architecture of the prostate in comparison to normal. Prostate cancers exhibit heterogeneity within the tissue, and so two histological areas of the prostate are each scored between 1 and 5, with 1 being the most differentiated and 5 being the least differentiated.The scores are added to give an overall Gleason score of between 2 and 10", "cop": 1, "opa": "Prostatic cancer", "opb": "Benign prostatic hyperophy", "opc": "Bladder cancer", "opd": "Colon cancer", "subject_name": "Surgery", "topic_name": "Urology", "id": "de7ddada-faec-4ee8-8be5-68d82a61e02b", "choice_type": "single"} {"question": "Commonest cause of skeletal metastasis is", "exp": "C. i.e. (Breast) (1202 - CSDT 12th) (450 - S. Das 5th)METASTATIC BONE TUMORS80% of these metastatic lesions are from primary carcinomas - particularly of the Breast, Prostate, lung kidney, thyroid' pancreas or stomach in that order of frequency* Breast or prostate metastasis either partly or solely osteoblastic** OSSOPHILE TUMOURS shows predilection for metastasis in the bone eg Breast, Prostate, Kidney, Bronchus, and Thyroid OSSOPHOBE TUMOURS Do not show predilection for metastasis in the bone eg GIT, urinary bladder, genitalia etc* Most common primary source of solitary skeletal metastasis at the time of first diagnosis is carcinoma of the kidney (1202 - CSDT 12th)", "cop": 3, "opa": "Kidney", "opb": "Prostate", "opc": "Breast", "opd": "Thyroid", "subject_name": "Surgery", "topic_name": "Orthopedics", "id": "4fd54342-9bf2-408a-9708-da829cf92724", "choice_type": "single"} {"question": "Organ least affected in blast injuries", "exp": "Tympanic membrane (TM) rupture is the most common primary blast injury. Other common organs are lung and intestine.The solid organs are more resistant to primary blast.Ref: Bailey and love 27e pg: 431", "cop": 2, "opa": "Lung", "opb": "Liver", "opc": "Tympanic membrane", "opd": "Intestines", "subject_name": "Surgery", "topic_name": "General surgery", "id": "db6c6244-eef6-4adb-acc9-7d2136715b6f", "choice_type": "single"} {"question": "The most common ligament injured around ankle joint is", "exp": "A i.e. Anterior Talofibular The most common site of ligament injury is ankle jointQ. The most common mode of ankle injury is inversion of planter flexed foot(2. Over 90deg% of the ankle ligament injury involves lateral collateral ligament usually the anterior tibiofibular ligamentQ.", "cop": 1, "opa": "Anterior talofibular", "opb": "Deltoid ligament", "opc": "Posterior talofibular", "opd": "Spring ligament", "subject_name": "Surgery", "topic_name": null, "id": "fa357813-8bd0-4bd9-83c2-fbe5716ec3f2", "choice_type": "single"} {"question": "Volkmann's ischemic contracture is associated with", "exp": "Compromise of blood supply to the muscles of the forearm can lead to a compartment syndrome and permanent serious functional deformity of the arm. Any patient with a compressive dressing or cast of the upper extremity can experience this potential catastrophe. Whenever a patient has increasing pain in the presence of a circular dressing around the arm or forearm, the dressing should be removed immediately. If there is tenderness in the forearm on either the ulnar or dorsal aspect, a fasciotomy should be considered.", "cop": 2, "opa": "Intertrochanteric femoral fracture", "opb": "Supracondylar fracture of the humerus", "opc": "Posterior dislocation of the knee", "opd": "Traumatic shoulder separation", "subject_name": "Surgery", "topic_name": "Orthopedics", "id": "0d28e314-fe69-4b6f-9922-f82d914b9f3a", "choice_type": "single"} {"question": "Graft survival in the initial 48 hours depends on", "exp": "The grafts will survive transfer based on a defined sequence of events that culminates in vascular independence. These events are (1) Serum imbibition--direct absorption of nutrients from recipient capillary beds that generally takes place in the first 24 hours(2) Inosculation--the connecting of donor and recipient vessels that typically begins in the 24 to 72hour period(3) Angiogenesis--vascular ingrowth of vessels from the recipient bed into the graft that stas after 72 hours. Factors that interrupt this process--such as fluid collection under the graft or mechanical shear forces--will compromise the graft take", "cop": 1, "opa": "Plasma imbibition", "opb": "Ingrowth of capillaries", "opc": "Development of lymphatics", "opd": "Saline dressing", "subject_name": "Surgery", "topic_name": "General surgery", "id": "ca13f008-fcd9-454b-8031-b17c8cf8c65d", "choice_type": "single"} {"question": "Most common site of subphrenic abscess is", "exp": "Right posterior intra-peritoneal space(Right subhepatic space/Rutherford Morison's kidney pouch) is bounded in front by the liver & gallbladder,above by the liver,behind by the right kidney & diaphragm,below by the transverse colon & hepatic flexure,to the left by foramen of Winslow & duodenum.It is the largest and deepest space of all.It is the most common site of subphrenic abscess.Causes include appendicitis,cholecystitis,post operative,perforated duodenal ulcer,intestinal obstruction. Reference:SRB' s manual of surgery,5th edition,page no:575.", "cop": 2, "opa": "Right anterior intraperitoneal space", "opb": "Right posterior intraperitoneal space", "opc": "Left anterior intraperitoneal space", "opd": "Left posterior intraperitoneal space", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "5c10b659-d49a-49cb-b05a-95e4324b8df4", "choice_type": "single"} {"question": "Most common site for carcinoid tumor", "exp": "Carcinoid tumour arise from the enterochromaffin cells (Kulchitsky cells) found in the crypts of Lieberkuhn. These cells are capable of APUD (Amine precursor uptake and Decarboxylation) and can secrete vasoactive amines like 5- HT, 5-HIAA, 5-HTP; tachykinins, peptides (chromogranins)and PGs. It commonly occurs in appendix (45%), ileum (25%) and rectum (15%). Other (15%) sites are--other pas of GIT (including pancreas and biliary tract), bronchus and testis.Reference: page 877 SRB's manual of surgery 5th edition", "cop": 1, "opa": "Appendix", "opb": "Liver", "opc": "Stomach", "opd": "Rectum", "subject_name": "Surgery", "topic_name": "Urology", "id": "c42467ff-f010-40c0-9c5e-ee27bc1b298f", "choice_type": "single"} {"question": "Linitus plastic", "exp": "Borrmann 1-single polypoidal carcinoma, Borrmann 2- ulcerated carcinoma with clear-cut margin, Borrmann 3-ulcerated carcinoma without clear-cut margin, Borrmann 4- diffuse carcinoma - linitis plastica. Reference ,SRB edition : 5 page:847", "cop": 4, "opa": "Borrmann class I", "opb": "Borrmann class II", "opc": "Borrmann class III", "opd": "Borrmann class IV", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "8c6cf281-7ed9-425d-a6f5-d252b8eeba3c", "choice_type": "single"} {"question": "Enzyme most commonly deficient in congenital adrenal hyperplasia is", "exp": "Ans. (a) 21 beta hydroxylaseRef: Bailey and love, 27th ed & Campbell 11th Ed consolidationCongenital adrenal hyperplasia or Adrenogenital syndrome: Features* Salt wasters + virilizers (due to aldosterone deficiency)* Simple virilizers (Aldosterone normal)* Non classified (no virlization, no salt wasting)# Virilization and adrenal insufficiency in children are pathognomonic of congenital adrenal hyperplasia (CAH).# Autosomal recessive disorder# The most frequent defect (95 per cent) is the 21 bhydroxylase deficiency, which has an incidence of 1 in 5000 live births.# Excessive ACTH secretion is caused by the loss of cortisol and this leads to an increase in androgenic cortisol precursors and to CAH.# CAH may present in girls at birth with ambiguous genitalia or as late-onset disease at puberty.# Little Hercules: Hypertension and short stature, caused by the premature epiphyseal plate closure, are common signs.# In female causes Female hermaphrodite# Diagnosed antenatally by 9-11 weeks by chorionic villus sampling# Antenatally mother should be treated with IV Dexamethasone# Affected patients are treated by replacement of Hydrocortisone +- fludrocortisone.# Large hypoplastic adrenals may need to be removed if symptomatic.", "cop": 1, "opa": "21 beta hydroxylase", "opb": "5 alpha reductase", "opc": "11 beta hydroxylase", "opd": "17 alpha hydroxylase", "subject_name": "Surgery", "topic_name": "Pancreas", "id": "373ac2cf-a80f-42b6-8483-3b0f6f843bf7", "choice_type": "single"} {"question": "A child presented with severe pain with twisted cord. The treatment is", "exp": "i.e. (Surgical treatment): (1379-80-Love & Bailey 25th)Prompt exploration, untwisting and fixation is the only way to save the torted testisThe patient should be counselled and consented for orchidectomy before explorationThe anatomical abnormality is bilateral and the contralateral testis should also be fixedEpididymitis - sudden pain in the scrotum, rapid unilateral scrotal enlargement, and marked tenderness that extends to the spermatic cord in the groin and may be relieved by scrotal elevation (Prehn's sign) (927- CSDT13th) some patients pain is relieved by scrotal hypothermiaTorsion of the testicular appendices (Vestigial mullerian duct structure) - gradual onset, point tenderness rathan than diffuse tenderness, visible necrotic lesion on scrotal transillumination (blue dot sign)Treatment - Self limiting since necrosis and auto amputation usually occurs, warm baths, limited activity and anti inflammatory agents", "cop": 4, "opa": "Elevation of the testes relieve the pain", "opb": "Rest and antibiotics", "opc": "Scrotal hypothermia", "opd": "Surgical treatment", "subject_name": "Surgery", "topic_name": "Testis & Scrotum", "id": "a245ff26-5221-4550-b6aa-7a9c5562fc72", "choice_type": "single"} {"question": "Intra oral vertical ramus osteotomy is done for", "exp": null, "cop": 3, "opa": "Anterior open bite", "opb": "Mandibular advancement", "opc": "Mandibular set back", "opd": "Maxillary deformity", "subject_name": "Surgery", "topic_name": null, "id": "2568ce12-41a5-4c91-9b76-8f128fc5ebbf", "choice_type": "single"} {"question": "Variant of papillary carcinoma thyroid", "exp": "Papillary carcinoma common in female and younger age group . Its called hormone dependend tumour. Types: tall cell type - very aggresive type show capsular and vascular invasion. Columnar type- seen in males . Treatment :total oe near total thyroidectomy Suppresive dose of L thyroxine. SRB's Manual of Surgery.Edition -5. Pg no:480", "cop": 3, "opa": "Medullary", "opb": "Wahin", "opc": "Columnar cell", "opd": "Insular", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "0d59e9e1-506e-49ee-bc1e-f5017d29e3dc", "choice_type": "single"} {"question": "Dysphagia lusoria means dysphagia", "exp": ".Dysphagia lusoria: It is a congenital vascular anomaly of the aoic root. Aoic arch anomalies are - double arch (40%), right arch and left ligamentum aeriosum (25%), anomalous innominate or common carotid aery or aberrant right subclan aery (10%). It is due to the disappearance of proximal right 4th aoic arch instead of the distal poion. All patients having this anomaly (dysphagia lusoria) have got an aberrant right subclan aery in a transposed position arising from descending aoa that courses posterior to the oesophagus. Often there will be a complete vascular ring around trachea and oesophagus. It is categorised based on their specific subclan anomaly - depends on the presence of an aneurysm, occlusive disease and compression. Commonly they are asymptomatic. Presentations may be dysphagia, chest pain, stridor, wheeze, recurrent respiratory infection (usually presents after the age of 40). Ref: SRB&;s manual of surgery,3 rd ed, pg no 720", "cop": 2, "opa": "For very cold items", "opb": "Due to abnormal origin and course of right subclan aery", "opc": "Atresia of esophagus", "opd": "Bengin stricture of esophagus", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "04396ac9-3771-456f-ac9e-91f80837eab4", "choice_type": "single"} {"question": "Barrets esophagus is commonly associated with one of the following", "exp": "Barrett's oesophagus is a metaplastic change in the lining mucosa of the oesophagus in response to chronic gastro-oesophageal reflux . Squamous epithelium of lower end of the oesophagus is replaced by diseased columnar epithelium. When intestinal metaplasia occurs, there is an increased risk of adenocarcinoma of the oesophagus, which is about 25 times that of the general population.Reference : page 1022-23 Bailey and Love's sho practice of surgery 25th edition", "cop": 1, "opa": "Adenocarcinoma", "opb": "Squamous cell carcinoma", "opc": "Sarcoma", "opd": "Gastrointestinal stromal tumor", "subject_name": "Surgery", "topic_name": "Urology", "id": "f4c8fe1f-e8fe-4026-8188-620b9721fb33", "choice_type": "single"} {"question": "Non union is a common feature of fracture of", "exp": "C i.e. Lower tibia Fracture through the lower third of tibia. is more liable to go onto delayed union because the lower fragment becomes relatively avascular dlt poor vascularityQ.", "cop": 3, "opa": "Supracondylar humerus", "opb": "Clavicle", "opc": "Lower tibia", "opd": "Coracoid process", "subject_name": "Surgery", "topic_name": null, "id": "24029815-69e9-45c6-b405-b96bf8f5051f", "choice_type": "single"} {"question": "Autonomous zone of sensory supply by radial nerve is", "exp": "Answer- A. P dorsal web spaceAutonomous Zone of peripheral nerves:Radial nerve:lst dorsal web space of hand (Anatomical snuff box)Median nerve:Distal phalanx (tip) of index finger (2nd finger)Unar nerve: Distal phalanx (tip) of little finger (5th finger).", "cop": 1, "opa": "P dorsal web space", "opb": "Tip of index finger", "opc": "Tip of thumb", "opd": "Tip of little finger", "subject_name": "Surgery", "topic_name": null, "id": "e12b4d6d-ef28-4be1-a66c-cd08b1471f8e", "choice_type": "single"} {"question": "Most impoant prognostic factor in melanoma", "exp": "The presence of lymph node metastases is the single most impoant prognostic index in melanoma, outweighing both tumour and host factors. The number of affected nodes and the presence of extranodal extension are also significant outcome predictors. Once regional nodes are clinically involved, 70-85% of patients will have occult distant metastases.The Breslow thickness of the primary tumour offers the best correlation with survival in stage I disease. The higher the mitotic index, the poorer is the prognosis of the primary tumour. This has greater significance than the presence or absence of ulceration.Ref: Bailey and Love, 27e, page: 612", "cop": 4, "opa": "Breslow thickness", "opb": "Mitotic index", "opc": "Ulceration", "opd": "Lymph node", "subject_name": "Surgery", "topic_name": "General surgery", "id": "1b4cf83a-4d90-4561-84a7-45a8c58abe64", "choice_type": "single"} {"question": "The treatment of choice for fibrous dysplasis of mandible in a 7 year old girl is", "exp": "Fibrous dysphasia stas in early childhood. Lesion is usually small and asymptomatic and often diagnosed accidentally during radiological examination. Lesions are small and-asymptomatic and progress slowly. Majority of fractures heal by conservative management Sarcomatous changes occur by irradiation.", "cop": 1, "opa": "Wait and watch", "opb": "Symmetrical resection of mandible", "opc": "Hemi mandibulectomy", "opd": "Local irradiation", "subject_name": "Surgery", "topic_name": null, "id": "965efd57-7e62-4a80-9112-daa22bc3318c", "choice_type": "single"} {"question": "Peritoneal mice is", "exp": "• Peritoneal loose bodies almost never cause symptoms.\n• One or more may be found in a hernial sac or in the pouch of Douglas.\n• The loose body may come from an appendix epiploica that has undergone axial rotation followed by necrosis of its pedicle and detachment but they are also found in those who suffer from subacute attacks of pancreatitis.\n• These hyaline bodies attain the size of a pea or bean and contain saponified fat surrounded by fibrin.", "cop": 2, "opa": "Pseudomyxoma peritonei", "opb": "Appendices epiploicae", "opc": "Peritoneal seedings of tumour", "opd": "Endometriosis", "subject_name": "Surgery", "topic_name": null, "id": "5e6a73d9-76f5-4a47-9bda-16f8e5e9693b", "choice_type": "single"} {"question": "Toxic megacolon is seen in", "exp": ".Toxic megacolon * 1.5% incidence * Common in transverse colon * Colon is more than 6 cm in diameter * Colon is like wet blotting paper * Commonly seen in ulcerative colitis * Can occur in bacterial colitis, pseudomembranous colitis, fulminant amoebic colitis * May be precipitated by antidiarrhoeal drugs * Emergency surgery, colectomy, colostomy/ileostomy may be required * IV fluids, blood transfusion, antibiotics, steroids are also needed * Can be life threatening* Plain X-ray is very useful. ref:SRB's manual of surgery,ed 5,pg no 895", "cop": 1, "opa": "Chronic non specific ulcerative colities", "opb": "Crohn's disease", "opc": "Colonic diveiculosis", "opd": "Hamaomatous polyp", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "91fd9163-094f-4201-9a70-517753c29ddc", "choice_type": "single"} {"question": "Asymptomatic bacteriuria is seen in", "exp": "Asymptomatic bacteriuria is used when a bacterial count of the same species over 10^5/ml in midstream clean catch specimen of urine on two occasions in women or on a single occasion in men is detected without symptoms of urinary infections. E.coli is the offending organism in over 90% cases. Other pathogens are Klebsiella pneumoniae and Proteus. Asymptomatic bacteriuria occurs in a small number of healthy people. It affects women more often than men.The following increases the risk: Diabetes Infected kidney stones Kidney transplant Older age Pregnancy -- up to 40% of pregnant women with untreated asymptomatic bacteriuria will develop a kidney infectioncatheterised patients Vesicoureteral reflux (backward movement of urine from the bladder into ureters or kidneys) in young children.", "cop": 4, "opa": "Anemia", "opb": "Hypeension", "opc": "Gestational diabetes", "opd": "PID", "subject_name": "Surgery", "topic_name": "Urology", "id": "05485138-4cfc-472d-bfb8-ec761e723ce6", "choice_type": "single"} {"question": "Investigation of choice of depth of penetration and nodal stage in rectal carcinoma is", "exp": "A colonoscopy is required if possible in all patients to exclude a synchronous tumour, be it an adenoma or a carcinoma. If a proximal adenoma is found, it can be conveniently snared and removed the colonoscope. If a synchronous carcinoma is present, the operative strategy will need changing. If a full colonoscopy is not possible, a CT colonography or barium enema can be performed Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1232", "cop": 3, "opa": "CT", "opb": "MRI", "opc": "Transrectal USG", "opd": "Barium meal", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "1bdc1b05-88d1-4aba-9882-71285fbc0621", "choice_type": "single"} {"question": "Treatment for CA Anal canal is", "exp": "Ca. Anal canal is treated by nigro’s regimen which is combine chemo + radiotherapy.", "cop": 3, "opa": "Surgery", "opb": "Surgery + Radiotherapy", "opc": "Chemoradiation", "opd": "Chemotherapy", "subject_name": "Surgery", "topic_name": null, "id": "fad3f44a-04b9-43d3-85ad-11a964388e3d", "choice_type": "single"} {"question": "Treatment of burns includes", "exp": ".SRB&;s manual of surgery,4th edition Initial Management of burns: Clothing should be removed Cooling of the pa by running water for 20minutes Cleaning the pa to remove dust,mud,etc Chemoprophylaxis-tt,antiseptics,etc Covering with dressings Comfoing with sedation amd pain killer", "cop": 1, "opa": "No bandage to head & neck", "opb": "Immediate application of ice cold water", "opc": "Superficial burns without blister-no need of dressing", "opd": "Escharotomy done for peripheral circumscribed lesions", "subject_name": "Surgery", "topic_name": "General surgery", "id": "8aa085df-36ed-4e67-8cd9-c35bc9dc5274", "choice_type": "single"} {"question": "Not a common complication of hemithyroidectomy", "exp": "As parathyroids on the opposite side are preserved and not dealt with during surgery hypoparathyroidism is not seen after hemithyroidectomy.", "cop": 1, "opa": "Hypoparathyroidism", "opb": "Reactionary hemorrhage", "opc": "Recurrent laryngeal nerve palsy", "opd": "External laryngeal nerve palsy", "subject_name": "Surgery", "topic_name": "All India exam", "id": "9d40c400-1f32-4a65-9ea9-e3e4c3c3c84a", "choice_type": "single"} {"question": "Most common site for Ca. Large bowel is", "exp": "Rectum is most common location. (if option is not given then retco - sigmoid region).", "cop": 2, "opa": "Sigmoid", "opb": "Rectum", "opc": "Ascending colon", "opd": "Descending colon", "subject_name": "Surgery", "topic_name": null, "id": "3b1486cb-c161-4716-b7aa-1de90addc350", "choice_type": "single"} {"question": "Xylocaine strength used in dentistry is", "exp": null, "cop": 1, "opa": "2%", "opb": "5%", "opc": "8%", "opd": "10% c", "subject_name": "Surgery", "topic_name": null, "id": "7b5d313d-1640-4995-a146-b9e9d5b200ef", "choice_type": "single"} {"question": "Tumor marker for Ca colon for follow up", "exp": "Up to a half of all patients with colorectal cancer will develop liver metastases at some point and regular imaging of the liver (by ultrasound and CT scan) and measurement of carcinoembryonic antigen (CEA) is designed to diagnose this early, in order to allow curative metastectomy. Trials of the optimum follow-up pathway have suggested that CEA measurement alone can be as effective as regular imaging.Ref: Bailey and Love, 27e, page: 1266", "cop": 1, "opa": "CEA", "opb": "CA 125", "opc": "CA 19-9", "opd": "AFP", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "94817898-83ed-4765-b6ed-89a2e61edac2", "choice_type": "single"} {"question": "A Bennet's fracture is difficult to maintain in reduced position because of the pull of", "exp": "C i.e. Abductor pollicis longus", "cop": 3, "opa": "Extensor pollicis longus", "opb": "Extensor pollicis brevis", "opc": "Abductor pollicis longus", "opd": "Abductor pollicis brevis", "subject_name": "Surgery", "topic_name": null, "id": "5a45bd00-b639-4c90-955d-e1e9e8496489", "choice_type": "single"} {"question": "Treatment of ameloblastoma", "exp": null, "cop": 2, "opa": "Excision of tumour", "opb": "Resection of the mandible along with the tumour", "opc": "Incisional biopsy and marsupialisation", "opd": "No active treatment is necessary", "subject_name": "Surgery", "topic_name": null, "id": "8f42bfa1-6df1-47b5-9982-9aa572b9ae90", "choice_type": "single"} {"question": "The surgical procedure of choice for skeletal class 2 malocclusion due to retrognathic Mandible is", "exp": null, "cop": 4, "opa": "Le fort I osteotomy", "opb": "Advancement genioplasty", "opc": "BSSO set back of mandible", "opd": "BSSO advancement of mandible", "subject_name": "Surgery", "topic_name": null, "id": "db2a271c-a619-4a47-b1c8-035489c7ac84", "choice_type": "single"} {"question": "The treatment of choice for an 8 mm retained common bile duct (CBD) stone is", "exp": "For CBD stones, endoscopic papillotomy is the preferred first technique with a sphincterotomy, removal of stones using Dormia basket or balloon catheter.ERCP can be used to remove retained CBD stones in 3 weeks of surgery. Reference: SRB&;s manual of surgery,5th edition, page no:652.", "cop": 3, "opa": "Laparoscopic CBD exploration", "opb": "Percutaneous stone extraction", "opc": "Endoscopic stone extraction", "opd": "Extracorporeal shock wave lithotripsy", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "949ae36a-15fa-4ff5-8b0f-adec10464f85", "choice_type": "single"} {"question": "Recommended adult prophylaxis for meningococcal infection is;", "exp": "Rifampicin 600 mg twice daily for 2 days * Recommended adult prophylaxis for meningococcal meningitis is rifampicin 600 mg twice daily for 2 days. Chemoprophylaxis is recommended for close contacts of persons with meningococcal disease.", "cop": 1, "opa": "Rifampicin 600 mg twice daily for 2 days", "opb": "Ampicillin Ig daily for 5 days", "opc": "Tetracycline 2 g daily for 1 day", "opd": "Chloramphenicol 2 g daily for 2 days", "subject_name": "Surgery", "topic_name": null, "id": "05eb5647-89e0-46a6-810f-0826e0029eea", "choice_type": "single"} {"question": "Commonest complication of Zenker's diveiculum is", "exp": "Ans is 'c' ie Lung abscess \"Pulmonary infection is the most frequent serious complication, and many patients are first seen after experiencing repeated episodes of pneumonia. \"-CSDT Aspiration pneumonia & Lung abscess are the most frequent complications of Zenker's diveiculum. Other rare complications are: Perforation Bleeding Carcinoma", "cop": 3, "opa": "Dysphonia", "opb": "Gastroesophageal reflux", "opc": "Lung abscess", "opd": "Perforation", "subject_name": "Surgery", "topic_name": null, "id": "0eae0691-942a-4678-aac1-67da0283207c", "choice_type": "single"} {"question": "Malakoplakia of the bladder is associated with", "exp": "It is an inflamatory condition caused by defect in phagocytosis.", "cop": 3, "opa": "Smoking", "opb": "Aniline dye", "opc": "Defect in phagocytosis", "opd": "Contrast dye", "subject_name": "Surgery", "topic_name": null, "id": "9ebd2da9-af01-40c0-ab53-e917ee84691d", "choice_type": "single"} {"question": "The commonest cause of significant lower gastrointestinal bleed in a middle aged person with unknown reason is", "exp": ".Diveiculosis is the initial primary stage of the disease, wherein there is hyperophy, muscular incoordination leading to increased segmentation and increased intraluminal pressure. At this stage they are asymptomatic, but often get severe spasmodic pain due to colonic segmentation called as painful diveicular disease. Sigmoid diveicula causing pericolic abscess as a known complication. Resection and primary anastomosis can be done in sigmoid diveicula after proper bowel preparation electively. ref:SRB&;s manual of surgery,ed 3,pg no 822.", "cop": 1, "opa": "Sigmoid diveicula", "opb": "Angiodysplasia", "opc": "Ischemic colitis", "opd": "Ulcerative colitis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "f9345b6d-014d-47a5-bb70-d887692a5824", "choice_type": "single"} {"question": "The greatest barrier to infection is", "exp": null, "cop": 4, "opa": "Connective tissue", "opb": "Epithelium", "opc": "Muscle", "opd": "Fascia", "subject_name": "Surgery", "topic_name": null, "id": "96e65c2f-d012-43d0-b96e-18ec7051569b", "choice_type": "single"} {"question": "Commonest complication after removal of mandibular 3rd molar", "exp": null, "cop": 2, "opa": "Lingual nerve damage", "opb": "Dry socket", "opc": "# mandible", "opd": "Bleeding", "subject_name": "Surgery", "topic_name": null, "id": "9646396e-1518-4668-8e72-14bb78762512", "choice_type": "single"} {"question": "There is a pressure sore extending into the subcutaneous tissue but underlying structures are not involved. Stage of the pressure sore is", "exp": "Stage 1Non-blanchable erythema without a breach in theepidermisStage 2Paial-thickness skin loss involving the epidermis and dermisStage 3Full-thickness skin loss extending into the subcutaneous tissue but not through underlying fasciaStage 4Full-thickness skin loss through fascia with extensive tissue destruction, maybe involving muscle, bone, tendon or joint Bailey and Love 27e pg: 29", "cop": 3, "opa": "Stage 1", "opb": "Stage 2", "opc": "Stage 3", "opd": "Stage 4", "subject_name": "Surgery", "topic_name": "General surgery", "id": "9e038a3c-f6b8-47bb-ac4d-8455955ab6d0", "choice_type": "single"} {"question": "Psammoma bodies seen in A/E", "exp": "Psammoma bodies are small, concentric , spherules of calcification, also called calcospherites, seen in Papillary carcinoma thyroid, Meningioma and Papillary serous cystadenocarcinoma of the ovary. Reference : page 52 Textbook of pathology Harshmohan 6th edition", "cop": 1, "opa": "Follicular CA of thyroid", "opb": "Papillary CA of thyroid", "opc": "Serous cystadenocarcinoma of ovary", "opd": "Meningioma", "subject_name": "Surgery", "topic_name": "Urology", "id": "9081fac3-9cc8-40b4-98b4-39eb48e197bf", "choice_type": "single"} {"question": "Barrett's esophagus is diagnosed by", "exp": "Ans. (b) Intestinal metaplasiaRef: Sabiston 19th edy page 1033* Barretts esophagus is characterized by metaplasia of esophageal squamous epithelium into columnar in distal esophagus.* For diagnosis of Barretts esophagus it requires both endoscopically visible segment of columnar lining of distal esophagus and intestinal metaplasia showing goblet cells on biopsy.* Barretts esophagus is the single most important risk factor for adenocarcinoma of esophagus.* Adenocarcinoma develops at the squamo-columnar junction or within 2 cm from the junction.", "cop": 2, "opa": "Squamous metaplasia", "opb": "Intestinal metaplasia", "opc": "Squamous dysplasia", "opd": "Intestinal dysplasia", "subject_name": "Surgery", "topic_name": "Oesophagus", "id": "df996fad-69ae-46ed-a13d-44f6076427b6", "choice_type": "single"} {"question": "Sudden headache with LOC in patient with renal cysts, intracranial bleed SAH (berry aneurysm). Diagnosis is", "exp": "(A) ADPKD# POLYCYSTIC KIDNEY DISEASE (PKD OR PCKD, also known as polycystic kidney syndrome) is a cystic genetic disorcer of the kidneys. There are two types of PKD: autosomal dominant polycystic kidney disease (ADPKD) and the less-common autosomal recessive polycystic kidney disease (ARPKD).> Major extrarenal complications of ADPKD are: Cerebral aneurysms; Hepatic and pancreatic cysts; Cardiac valve disease; Colonic diverticula; Abdominal wall and inguinal hernia. Malformations of selected vasculature, including intracranial aneurysms and aortic root dilatation (normal diamete' <35 mm), may be due to altered expression and/or function of the PKD gene in arterial smooth muscle cells. Cervicocephalic artery dissections, dolichoectasias, and central retinal vascular occlusions have also been associated with ADPKD.> CEREBRAL ANEURYSM: A ruptured cerebral aneurysm, resulting in a subarachnoid or intracerebral hemorrhage, is the most serious complication of polycystic kidney disease. The prevalence of aneurysms in ADPKD is approximately 5 percent in young adults and increases with age to as high as 20 percent in patients 60 years and older.", "cop": 1, "opa": "ADPKD", "opb": "Haemangioma of liver", "opc": "Meningioma", "opd": "Head injury", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "0454e5b3-3809-49b9-a938-01a2c54491d9", "choice_type": "single"} {"question": "Blue rubber bleb nevus syndrome is a", "exp": "(D) Venous malformation# BLUE RUBBER BLEB NEVUS SYNDROME (OR \"BRBNS\"or \"Bean syndrome\") is a rare disorder that consists mainly of abnormal blood vessels affecting the gastrointestinal tract.> BRBNS is a venous malformation, formerly, though incorrectly, thought to be related to the hemangioma. It carries significant potential for serious bleeding. Lesions are most commonly found on the skin and in the small intestine and distal large bowel. It usually presents soon after birth.> BRBNS used to be thought of as having no genetic inheritance however, in 1995 doctors discovered that information to be false, it has been suggested that it may represent a manifestation of familial venous malformation, and may be associated with TEK tyrosine kinase.", "cop": 4, "opa": "Mycotic infection", "opb": "Malignant melanoma", "opc": "Arterial malformation", "opd": "Venous malformation", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "02c40b23-c353-4afc-b7f4-020e1537fc40", "choice_type": "single"} {"question": "Most common location of thyroglossal cyst is", "exp": "Thyroglassal cyst is the reminant of thyroglossal tract and stihyoid thyroglossal cyst is the most common subtype.", "cop": 2, "opa": "At Foramen cqecum", "opb": "Subhyoid", "opc": "Supra hyoid", "opd": "Between hyoid & thyroid", "subject_name": "Surgery", "topic_name": null, "id": "2284f1f7-f029-4edd-9d7b-545dd677d8cc", "choice_type": "single"} {"question": "Operation of choice in GERD is", "exp": "Operations for GORD are based on the creation of an intra-abdominal segment of oesophagus, crural repair and some form of wrap of the upper stomach (fundoplication) around the intra-abdominal oesophagus.Nissen fundoplication is one of the commoner procedures done.Ref: Bailey and Love 27e pg: 1078", "cop": 2, "opa": "Highly selective vagotomy", "opb": "Fundoplication", "opc": "Hellers myotomy", "opd": "Gastrectomy", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "3f4b03b8-c4fb-4192-9861-ec70b6ade393", "choice_type": "single"} {"question": "Seton’s procedure is treatment for", "exp": "It is used for high lying fistula in ano.", "cop": 3, "opa": "Hemorrhoids", "opb": "Fissure in ano", "opc": "Fistula in ano", "opd": "Pilonidal sinus", "subject_name": "Surgery", "topic_name": null, "id": "24b54646-290a-4f18-92f5-9dd8cb22abd7", "choice_type": "single"} {"question": "Volkmann's Ischaemic Contracture is due to", "exp": "D i.e. Ischemic vascular injury to muscles", "cop": 4, "opa": "Injury to ulnar and median nerve", "opb": "Injury to median nerve alone", "opc": "Contracture of the palmar fascia", "opd": "Ischaemic vascular injury to the muscle", "subject_name": "Surgery", "topic_name": null, "id": "c1c56098-a09e-4103-8b41-aff8851751ed", "choice_type": "single"} {"question": "Maximum score of APACHE", "exp": "Answer- D. 71APACHE II ('Acute Physiology and Chronic Health Evaluation II\") is a severity-of-disease classification system.The APACHE II system is the most commonly used SOI scoring system in Noh America.APACHE IV uses a modified statistical model of logistic regression; it is the most recently released version of this scoring system.It is applied within 24 hours of admission of a patient to an intensive care unit (ICU): an integer score from 0 (minimum) to 7l (maximum) is computed based on several measurements; higher scores correspond to more severe disease and a igher risk of death.", "cop": 4, "opa": "41", "opb": "51", "opc": "61", "opd": "71", "subject_name": "Surgery", "topic_name": null, "id": "e094c607-9d45-476a-a617-19e62ed499ed", "choice_type": "single"} {"question": "Dashboard injury results in", "exp": "B i.e. Posterior dislocation of hip", "cop": 2, "opa": "Anterior dislocation of hip", "opb": "Posterior dislocation of hip", "opc": "Central dislocation of hip", "opd": "Fracture neck femur", "subject_name": "Surgery", "topic_name": null, "id": "22d4db90-2d4c-47dc-af0f-9728e84b37b4", "choice_type": "single"} {"question": "Most common oncogene involved in pancreatic adenoma", "exp": "85% of Carcinoma pancreas shows mutant K ras gene on codon 12. 60% show mutation of p53 gene in chromosome 17, over expression of EGFR. Reference : SRB's Manual of Surgery, 6th Edition, page no = 695.", "cop": 2, "opa": "P53", "opb": "K-RAS", "opc": "APC", "opd": "DCC", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "5c721a0e-8484-4f72-8973-e78bb7aaa2fc", "choice_type": "single"} {"question": "Tardy ulnar nerve palsy seen in", "exp": "B i.e. Lateral condyle humerus.", "cop": 2, "opa": "Medial condyle humerus", "opb": "Lateral condyle", "opc": "Supracondylar condyle humerus", "opd": "Fracture shaft humerus", "subject_name": "Surgery", "topic_name": null, "id": "09c76552-c297-4821-b6e7-af1127298c1b", "choice_type": "single"} {"question": "Cushing Ulcer seen in", "exp": "* Cushing ulcer: Ulcer in stomach in stress and head injury (Most common site is body and fundus) * Curling ulcer: Ulcer in duodenum > Stomach in burns * Cameron ulcer: Ulcer in proximal stomach in hiatus hernia (veical ulcers also known as riding ulcers) Ref:- Surgery Sixer 3rd Edition; Pg num:- 364", "cop": 1, "opa": "Stress ulcer in Head injury", "opb": "Stress ulcer in Burns", "opc": "Ulcer in Crohn's disease", "opd": "Ulcer in Hiatus hernia", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "42237757-3a1d-4b6f-85b6-e47276d8160d", "choice_type": "single"} {"question": "Recurrent periductal mastitis is", "exp": "Zuska's disease/ Zuska-Atkins disease, also called recurrent periductal mastitis, is a condition of recurrent retroareolar infections and abscesses. Smoking has been implicated as a risk factor for this condition. This syndrome is managed symptomatically by antibiotics coupled with incision and drainage as necessary.", "cop": 2, "opa": "Mondors disease", "opb": "Zuska's disease", "opc": "Cooper's disease", "opd": "Schimmelbusch's disease", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "9cfb9608-1663-46d7-981c-c594de607516", "choice_type": "single"} {"question": "Negative pressure therapy is used in", "exp": "Vaccum assisted closure Known as negative pressure wound closure Applying intermittent negative pressure of approximately - 125mmHg appears to hasten Debridement and the formation of granulation tissue in chronic wounds and ulcers A foam dressing is cut to size to fit the wound A perforated wound drain is placed over the foam and the wound is sealed with a transparent adhesive film. A vaccum is then applied to the drain. Negative pressure may act by decreasing oedema, by removing interstitial fluid and by increasing blood flow As a result bacterial counts decrease and cell proliferation increases thereby creating a suitable bed for graft or flap cover. Ref: Bailey and love 27th edition Pg no :30", "cop": 1, "opa": "Bed sore in sacrum after debridment", "opb": "After amputation", "opc": "Chronic osteomyelitis wound", "opd": "After split skin graft", "subject_name": "Surgery", "topic_name": "Trauma", "id": "7cea0588-21b6-4cf0-a8de-aea2161e53f5", "choice_type": "single"} {"question": "Rapid infusion of blood causes", "exp": null, "cop": 3, "opa": "Acute Left heart failure", "opb": "Ankle edema", "opc": "Pulmonary edema", "opd": "Respiratory Distress", "subject_name": "Surgery", "topic_name": null, "id": "09f7c6c3-99a6-4238-b44e-e12afa9881f4", "choice_type": "single"} {"question": "Breast cancer mainly spreads to the veebrae", "exp": "Answer- C. Batsons venous plexusMetastasis of breast cancer to bone, and especially to thoracic veebrae, is common due to the direct connection between the intercostal veins draining the breast and the internal veebral plexus ako known as Batson's plexus.", "cop": 3, "opa": "Aerial route", "opb": "Direct Invasion", "opc": "Batsons venous plexus", "opd": "Via Axillary lymph nodes", "subject_name": "Surgery", "topic_name": null, "id": "7464f82c-9bbd-45c9-ae72-b6d504ce7d8b", "choice_type": "single"} {"question": "Most common complication of pseudocyst of pancreas", "exp": "PSEUDOCYST A pseudocyst is a collection of amylase-rich fluid enclosed in a well-defined wall of fibrous or granulation tissue. Pseudocysts typically arise following an attack of mild acute pancreatitis, lie outside the pancreas, and represent an APFC that has not resolved and matured. Formation of a pseudocyst requires 4 weeks or more from the onset of acute pancreatitis. The Term 'pseudocyst' is often used more loosely, to include sterile WON that has failed to resolve, or a collection that has developed in the context of chronic pancreatitis or after pancreatic trauma. If carefully investigated, more than half of these will be found to have a communication with the main pancreatic duct. Pseudocysts are often single but, occasionally, patients will develop multiple pseudocysts. A pseudocyst is usually identified on ultrasound or a CT scan. It is impoant to differentiate a pseudocyst from an APFC; the clinical scenario and the radiological appearances should allow that distinction to be made. Occasionally, a cystic neoplasm may be confused with a chronic pseudocyst. EUS and aspiration of the cyst fluid is very useful in such a situation. The fluid should be sent for measurement of carcinoembryonic antigen (CEA) levels, amylase levels and cytology. Fluid from a pseudocyst typically has a low CEA level, and levels above 400 ng/mL are suggestive of a mucinous neoplasm. Pseudocyst fluid usually has a high amylase level, but that is not diagnostic, as a tumour that communicates with the duct system may yield similar findings. Cytology typically reveals inflammatory cells in pseudocyst fluid. If there is no access to EUS, then percutaneous FNA is acceptable (just aspiration, not percutaneous inseion of a drain). ERCP and MRCP may demonstrate communication of the cyst with the pancreatic duct system, demonstrate ductal anomalies, or diagnose chronic pancreatitis and thus help in planning treatment. Pseudocysts will resolve spontaneously in most instances, but complications can develop. Pseudocysts that are thick-walled or large (over 6 cm in diameter), have lasted for a long time (over 12 weeks), or have arisen in the context of chronic pancreatitis are less likely to resolve spontaneously,but these factors are not specific indications for intervention. Therapeutic interventions are advised only if the pseudocyst causes symptoms, if complications develop, or if a distinction has to be made between a pseudocyst and a tumour. There are three possible approaches to draining a pseudocyst: percutaneous, endoscopic and surgical. Percutaneous drainage to the exterior under radiological guidance should be avoided. It carries a very high likelihood of recurrence. More over, it is not advisable unless one is absolutely ceain that the cyst is not neoplastic and that it has no communication with the pancreatic duct (or else a pancreaticocutaneous fistula will develop). A percutaneous transgastric cystgastrostomy can be done under imaging guidance, and a double-pigtail drain placed with one end in the cyst cavity and the other end in the gastric lumen. This requires specialist expeise but, in experienced hands, the recurrence rates are no more than 15%. Endoscopic drainage usually involves puncture of the cyst through the stomach or duodenal wall under EUS guidance, and placement of a tube drain with one end in the cyst cavity and the other end in the gastric lumen. The success rates depend on operator expeise. Occasionally, ERCP and placement of a pancreatic stent across the ampulla may help to drain a pseudocyst that is in communication with the duct. Surgical drainage involves internally draining the cyst into the gastric or jejunal lumen. Recurrence rates should be no more than 5%, and this still remains the standard against which the evolving radiological and endoscopic approaches are measured. The approach is conventionally through an open incision, but laparoscopic cystgastrostomy is also feasible. Pseudocysts that have developed complications are best managed surgically. There is a small group of patients who, having suffered an attack of necrotising pancreatitis with duct disruption, go on to suffer repeated complications in the form of recurrent fluid collections, pseudocysts, pleural effusions or pancreatic ascites. Very often disruption of the main pancreatic duct in the neck, body or tail is compounded by a stricture or a stone in the head that cannot be treated endoscopically. In such patients, some form of surgical resection and/or a drainage procedure even though it may be technically challenging may be the only way to achieve lasting resolution. Ref: Bailey and love 27th edition Pgno : 1229", "cop": 3, "opa": "Rupture into peritoneum", "opb": "Haemorrhage", "opc": "Infection", "opd": "Rupture into colon", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "53465f12-1b30-484e-adfc-43881ba36771", "choice_type": "single"} {"question": "Acanthosis nigricans is seen with\n(A)Colonic carcinoma\n(B)Freckle\n(C)Squamous cell carcinoma of skin\n(D)Carcinoma breast", "exp": "Acanthosis nigricans can also be a reflection of an internal malignancy,\nmost commonly of the adenocarcinoma of the gastrointestinal tract, lung, uterus and breast It appears as velvety hyperpigmentation, primarily in flexural areas.\nHowever, in the majority of patients, acanthosis nigricans is associated with obesity and insulin resistance, but it may be a reflection of an endocrinopathy such as acromegaly,\nCushing’s syndrome, polycystic ovary syndrome, or insulin-resistant diabetes mellitus (type A, type B, and lipoatrophic forms).", "cop": 4, "opa": "BC", "opb": "CA", "opc": "BC", "opd": "AD", "subject_name": "Surgery", "topic_name": null, "id": "f61b0fa1-d626-4537-9fa0-be87046019f7", "choice_type": "single"} {"question": "Alvarado score consist of", "exp": "A number of clinical and laboratory-based scoring systems have been devised to assist diagnosis. The most widely used is the Alvarado score, A score of 7 or more is strongly predictive of acute appendicitis. Symptoms are : score Migratory RIF pain 1 Anorexia 1 Nausea and vomiting 1 Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1211", "cop": 2, "opa": "Leucopenia", "opb": "Anorexia", "opc": "Diarrhea", "opd": "Periumbilical pain", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "17d7d1b7-5265-4698-83fe-bb5905e0fa11", "choice_type": "single"} {"question": "The following wound is not untidy", "exp": null, "cop": 1, "opa": "Incised untidy wound", "opb": "Crushed wound", "opc": "Avulsed wound", "opd": "Lacerated wound", "subject_name": "Surgery", "topic_name": null, "id": "787a778d-d636-4ad6-9056-cc60e8443317", "choice_type": "single"} {"question": "Bleeding from peptic ulcer most commonly involve", "exp": "Bleeding peptic ulcer MC indication for operation and principal cause of death in PUD patients The most significant hemorrhage occurs when duodenal or gastric ulcers penetrate into branches of the gastroduodenal aery or left gastric aery, respectively Incidence of peptic ulcer bleeding decreased over past decade, but Moality was stable for both gastric and duodenal ulcer bleeding, higher in patients of advanced age Cause of death: Multiple system organ failure (not the exanguinating hemorrhage) Treatment Irrigation with room temperature saline to lyse red cells in an effo to return clear fluid and to allow for the performance of endoscopy Figure of eight suture to Ligate the gastroduodenal aery. A 'U' stich is placed in the base to occlude pancreatic branches of the gastroduodenal aery Truncal vagotomy and pyroplasty is the most frequently used operation for bleeding duodenal ulcer Ref: Sabiston 20th edition Pgno : 1202-1203", "cop": 1, "opa": "Gastroduodenal aery", "opb": "Left gastric aery", "opc": "Splenic aery", "opd": "Sho gastric aery", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "b10e65c8-8ab8-4df7-9836-2b565266775b", "choice_type": "single"} {"question": "Lateral aberrant thyroid is node from", "exp": "Ans. (a) Papillary cancerRef: Page 765. Bailey and love 26th edition* Lateral aberrant thyroid is a metastatic node from papillary cancer which is not palpable", "cop": 1, "opa": "Papillary cancer", "opb": "Follicular cancer", "opc": "Thyroid lymphoma", "opd": "Medullary cancer", "subject_name": "Surgery", "topic_name": "Thyroid Gland", "id": "f40e6647-478c-47e4-a766-b300e3f97823", "choice_type": "single"} {"question": "Smegma is secreted by", "exp": "Smegma was originally thought to be produced by sebaceous glands near the frenulum called Tyson's glands. Preputial glands were first noted by Edward Tyson and in 1694 fully described by William Cowper who named them Tyson's glands after Tyson. They are described as modified sebaceous glands located around the corona and inner surface of the prepuce of the human penis . They are believed to be most frequently found in the balanopreputial sulcus .Bulbourethral gland, also called Cowper's Gland , either of two pea-shaped glands in the male, located beneath the prostate gland at the beginning of the internal poion of the penis; they add fluids to semen during the process of ejaculation. The Baholin's glands (also called Baholin glands or greater vestibular glands ) are two pea sized compound racemose glands located slightly posterior and to the left and right of the opening of the vagina. They secrete mucus to lubricate the vagina and are homologous to bulbourethral glands in males.Brunner's glands (or duodenal glands ) are compound tubular submucosal glands found in that poion of the duodenum which is above the hepatopancreatic sphincter (aka sphincter of Oddi).", "cop": 1, "opa": "Tyson gland", "opb": "Brenner gland", "opc": "Cowper's gland", "opd": "Baholin's gland", "subject_name": "Surgery", "topic_name": "Urology", "id": "789fe1fe-321d-47bf-95c0-681ee7242e12", "choice_type": "single"} {"question": "In pigmented basal cell carcinoma, treatment of choice is", "exp": null, "cop": 4, "opa": "Chemotherapy", "opb": "Radiotherapy", "opc": "Cryosurgery", "opd": "Excision", "subject_name": "Surgery", "topic_name": null, "id": "b5d548af-e8c8-4119-bfd3-4df9b84c22fb", "choice_type": "single"} {"question": "Most important prognostic indicator for wilms tumor", "exp": "Histology is Most important prognostic indicator for wilms tumor\nStage of tumor is Most important prognostic indicator for RCC.", "cop": 2, "opa": "Nuclear grade", "opb": "Histological type", "opc": "Size", "opd": "Pathological staging", "subject_name": "Surgery", "topic_name": null, "id": "3bcaa526-870a-43a7-a714-f4e8a2e259ae", "choice_type": "single"} {"question": "Boorheave syndrome involves perforation of esophagus after", "exp": "Ans. is 'd' i.e., Vomiting [Ref: CSDT 13th/ep.444 & 11th/e p. 490; Schwartz 9th/ep.874 & 8th/e, p. 906; Bailey & Love 25th/e p.1014 & 24th/ep.996}* Boerhaave's syndrome is spontaneous perforation of the esophagus, occuring usually due tosevere barotrauma when a person vomits against a closed glottis. The pressure in the esophagus rapidly increases and the esophagus bursts at its weakest point, sending a stream of material into the mediastinum and often the pleural cavity as well.* Most common location of perforation is in the left posterolateral aspect 3-5 cm above the gastroesophageal junction. Second most common site of perforation is at the midthoracic esophagus on the right side.* Most cases follow a bout of heavy eating and drinking.* The principal early manifestation is pain felt in the chest and upper abdomen.", "cop": 4, "opa": "Burns", "opb": "Acid ingestion", "opc": "Stress", "opd": "Vomiting", "subject_name": "Surgery", "topic_name": "Oesophagus", "id": "f7662a77-5cde-4d1a-b20a-7ab41ddbc252", "choice_type": "single"} {"question": "Nerve most commonly injured in Mc Burney incision", "exp": "if direct right-sided inguinal hernia if present, during appendicectomy injury there will be ilioinguinal nerve injury. Reference SRB edition:5 page:994", "cop": 4, "opa": "Subcostal", "opb": "Iliohypogastric N", "opc": "11th thoracic", "opd": "Ilionguinal", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "f80c9a77-2503-4680-bad3-fcfae34b6d7d", "choice_type": "single"} {"question": "Indications of percutaneous nephrostomya) Stone removalb) Ureteral obstructionc) Renal tumor resectiond) Ischemic renal failuree) Antegrade renography", "exp": "• For HDN, DJ stenting and percutaneous nephrostomy, both are having same results but DJ stenting is less invasive.\n• For pyonephrosis, percutaneous nephrostomy is better than DJ stenting.\n• Percutaneous nephrostomy is occasionally essential, if not life saving, in the treatment of acute or chronic upper urinary tract obstruction.\n• It is the first step in obtaining antegrade access to the kidney for various procedures.", "cop": 2, "opa": "bcde", "opb": "abce", "opc": "acde", "opd": "abde", "subject_name": "Surgery", "topic_name": null, "id": "1863610e-e764-4a99-96fe-8520483807bd", "choice_type": "single"} {"question": "Chylothorax is common on right side because", "exp": "Chylothorax is common on right side because of long course of thoracic duct towards right side.", "cop": 1, "opa": "Long course of thoracic duct towards right side", "opb": "Presence of Liver on right side", "opc": "Right lung has 3 lobes in contrast to left having 2 lobes", "opd": "Due to megalymphatic congenital anomaly on right side", "subject_name": "Surgery", "topic_name": null, "id": "3f519fcc-6996-48f6-9cdb-9e33b6c44a79", "choice_type": "single"} {"question": "Diplopia after fracture results from entrapment of", "exp": null, "cop": 1, "opa": "Inferior rectus", "opb": "Inferior oblique", "opc": "Lateral rectus", "opd": "Superior oblique", "subject_name": "Surgery", "topic_name": null, "id": "cb189fa5-7107-4621-ac11-85d7a90aea51", "choice_type": "single"} {"question": "Side effect of Total Parental Nutrition includes", "exp": "(B) Fluid overloadCOMPLICATIONS OF TOTAL PARENTERAL NUTRITION (TPN)First 48 hoursFirst 2 Weeks3 Months OnwardMECHANICAL * Complications from catheter insertion:* Cephalad displacement* Pneumothorax* Hemothorax* Detachment of line at catheter hub with blood loss or air embolism* Catheter coming out of vein, more common if Silastic* Detachment of line at catheter hub with blood loss or air embolism* Thrombosis* Detachment of line at catheter hub with blood loss or air embolism* Fractures or tears in catheter* Catheter embedded in vein wallMETABOLIC * Fluid overload* Hyperglycemia* Hypophosphatemia* Hypokalemia* Cardiopulmonary failure* Re feeding edema* Hyperosmolar nonketotic* hyperglycemic coma* Acid-base imbalance* Electrolyte imbalance* Essentially fatty acid deficiency* Iron deficiency, Vitamin deficiencies* TPN metabolic bone disease* TPN liver disease* Zinc, copper, chromium, selenium, molybdenum, deficiencyINFECTIOUS* Catheter-induced sepsis* Exit site infection* Catheter-induced sepsis* Tunnel infections* Exit site infection", "cop": 2, "opa": "Hyperglyceridemia", "opb": "Fluid overload", "opc": "Fat embolism", "opd": "Fractures of bones", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "fedcf718-741a-4661-a235-76c32e5e86e1", "choice_type": "single"} {"question": "Full thickness skin graft is also known as", "exp": "Ans. is 'a' i.e., Wolfes graft Skin grafts* Full thickness (Wolfes graft) - it includes all epidermis and dermis.* Partial thickness (Thiersch graft) - it includes all epidermis and part of dermis.Partial thickness graftVsFull thickness graft* Partial thickness grafts are thin therefore uptake of graft is easy (easy survival)* Uptake is difficult because of thickness, (less chances of survival)* Large grafts could be taken as the donor site has been left with a part of dermis which will cause easy regeneration of epidermis* Small grafts could be taken as the donor site does not have epidermal or dermal remnants to allow epithelialization as in a paritial thickness graft.* Split thickness graft will contract upto 40% thus not useful for cosmetic surgeries* There is very minimal contraction making it suitable for cosmetic surgeries on face.* The donor site will heal well without any contraction, and is reusable* The donor site will have to be closed primarily or left open to granulate and contract.", "cop": 1, "opa": "Wolfes graft", "opb": "Thiersch graft", "opc": "Thieme graft", "opd": "Fernandez graft", "subject_name": "Surgery", "topic_name": "Plastic & Reconstructive Surgery", "id": "e78a590d-144a-4b0d-a09c-9547ae1fbba0", "choice_type": "single"} {"question": "A 80 years old male presented with lung abscess in left upper zone. Best treatment of modalities is", "exp": "Appropriate high dose antibiotics are staed depending on sputum culture like penicillins,3rd generation cephalosporins like cefoperazone,ceftriaxone for 3-6 weeks.Postural drainage for 2-3 hours,3 times daily.80-90% of acute abscesses resolve by medical therapy.Surgical drainage is not commonly done. Reference:SRB's manual of surgery,5th edition,page no:1120,1121", "cop": 1, "opa": "Antibiotics according to organisms", "opb": "Surgical drainage", "opc": "Tube thoracostomy", "opd": "Wait and watch", "subject_name": "Surgery", "topic_name": "Cardio thoracic surgery ", "id": "206dd8c2-5ab4-4c24-8e9c-01929321f476", "choice_type": "single"} {"question": "The type of ultraviolet radiation (UV) that is known to induce skin cancer is", "exp": null, "cop": 2, "opa": "UV - A", "opb": "UV - B", "opc": "UV - C", "opd": "UV - D", "subject_name": "Surgery", "topic_name": null, "id": "68e0c6a6-2f0c-490e-b5b3-455d97576f38", "choice_type": "single"} {"question": "Retroperitoneal fibrosis most commonly presents with", "exp": "The most impoant clinical aspect of retroperitoneal fibrosis is that the fibrotic process frequently entraps and constricts the ureters thereby causing obstructive uropathy. Retroperitoneal fibrosis - It is a nonspecific, nonsuppurative inflammation of fibro-adipose tissue of unknown cause that produces symptoms by the gradual compression of tubular structures in retroperitoneal space. Aetiology of retroperitoneal fibrosis - About 2/3rd cases are primary idiopathic, are also known as Ormond's disease Secondary Retroperitoneal fibrosis a variety of inflammatory conditions - chronic pancreatitis, histoplasmosis, tuberculosis, or actinomycosis. drugs methysergide (most imp.) b blockers hydralazine a methyldopa Etacapone (used in the t/t of Parkinson's ds.) - malignancies (prostate, non-Hodgkin's lymphoma, sarcoma, characinoid & gastric cancer). antoimmune disorders (ankylosing spondylitis, SLE PAN etc.) Symptoms of retroperitoneal fibrosis - It is more common in men between 40-60 yrs of age Early symptoms are nonspecific and vague. These are Pain - Dull noncolicky and insidious in onset. Anorexia, nausea General malaise, diarrhea Later on, symptoms result from compression of tubular retroperitoneal structures. The major structure involved are- Ureter - Most commonly involved Aoa Inferior venacava Symptoms due to the involvement of ureter (usually b/1 involvement) Dysuria Frequency of urination Chills and fever occur with secondary infection of a hydronephrotic kidney. Hematuria can occur. Diagnosis The diagnosis of retroperitoneal fibrosis usually can be made accurately by intravenous pyelography if uremia is not present. The characteristic finding on pyelogram are Hydronephrosis with a dilated touous upper ureter. Medial detion of the ureter Extrinsic ureteral compression Note: In a retroperitoneal tumor, ureter is laterally deted while in retroperitoneal fibrosis ureter medially detes. Currently, the imaging procedure of choice is the CT scan. But if renal function is compromised contrast agents are not given and then MRI is the procedure of choice. T/T of Retroperitoneal fibrosis Coicosteroids, with or without surgery, are the mainstay of medical therapy. Surgical treatment is required in patients who present with moderate or massive hydronephrosis. It consists primarily of ureterolysis (freeing the ureter from adhesions and surrounding tissue) or ureteral stenting.. Also, know Paial or complete ureteral obstruction occurs in 75 to 85% of patients. Most common site of urethral obstruction is lower third of the ureter. Ref : Love & Bailey 25/e p1007", "cop": 4, "opa": "Pedal edema", "opb": "Ascites", "opc": "Ureteric obstruction", "opd": "Back pain", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "184183a4-3a09-424e-b1f0-98bf80b935b6", "choice_type": "single"} {"question": "\"Crumbled egg appearance\" in liver seen in", "exp": "HYDATID CYST OF LIVER -Word meaning is 'dew drop' (Latin). In Greek, it means watery vesicle'. Camellotte sign: Following intra biliary rupture, gas enters into cyst causing paial collapse of the cyst wall. CT scan abdomen is more accurate in identifying cyst characteristics - cawheel like - multivesicular rosette-like. Ref: SRB&;s manual of surgery,3 rd ed, pg no 534", "cop": 3, "opa": "Hepatic adenoma", "opb": "Chronic amoebic liver abscess", "opc": "Hydatid liver disease", "opd": "Haemangioma", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "dbe072ff-90ec-491d-8db6-4357822b825b", "choice_type": "single"} {"question": "Treatment for maltoma is", "exp": "For both gastric lymphoma and maltoma treatment is R-CHOP regimen", "cop": 2, "opa": "Chlormabucil", "opb": "RCHOP regimen", "opc": "BEP regimen", "opd": "Imatinib", "subject_name": "Surgery", "topic_name": null, "id": "e21e6379-e79e-43ca-bb3f-3719122b0809", "choice_type": "single"} {"question": "Heller's myotomy is done for", "exp": "(B) Achalasia cardia[?]Achalasia, a disorder of esophagus characterized by progressive inability to swallow solids & liquids.Causes include weakened esophageal muscles & issues with lower esophageal sphincter relaxationHeller Myotomy, surgical procedure offers long term symptomatic relief to these patients.It involves weakening of muscles at gastroesophageal junction, allowing the valve between oesophagus & stomach to remain open.[?]Achalasia Treatment: 2 main methodsHeller's Myotomy:Surgical therapy now involves usually performing only an anterior myotomy, via either abdominal or thoracic approach. In addition to laparosocopic myotomy, thoracoscopic myotomy has also been described.Thoracic approach does have certain drawbacks.Heller's Cardiomyotomy - surgical 7-10 cm long incision made through lower oesophageal end & carried over to stomach, muscles are cut till mucosa bulges out. Myotomy should be extended up to aortic arch & distally up to stomach to 1-2 cm below the junction.Forceful dilatation - using Pneumatic Balloon under fluoroscopic control within LOS (300 mmHg pressure applied for 15 sec).Injection Treatment - Injection Botulinum toxin is injected in LES endoscopically, blocks ACh release.Drugs - Sublingual nifedipine gives short term relief.Endoscopic MyotomyLaparoscopic Heller's Myotomy (LHM):Myotomy from 1.5-3 cm distal to the ECJ dividing the longitudinal & oblique muscle to 6-8cm proximal to the ECJ dividing longitudinal & circular muscle of esophagus.Partial fundoplication is routinely performed as incidence of reflux after Heller's myotomy is >50%.It is due to loss of the ganglion cells in the myenteric (Auerbach's) plexus & cause is unknown.Chaga's disease (due to Trypanosoma cruzi) has marked similarities to achalasia.Other Options[?]Hiatus Hernia:True paraoesophageal hernias with cardia remains in its anatomical position are rare.Vast majority of rolling hernias are mixed hernias in which the cardia is displaced into the chest & greater curve of the stomach rolls into the mediastinum.Elective surgery includes reduction of the hernia, excision of the sac, reducing the crural defect & retention of the stomach in the abdomen.[?]Gastro Oesophageal Reflux Disease:Classical triad of symptoms is retrosternal burning pain (heartburn), epigastric pain (sometimes radiating through to the back) and regurgitation.GORD treated by medical management by proton pump inhibitor therapy +H2 receptor antagonists.Surgery includes;1. Allison repair of hiatus hernia; 2. Nissen fundoplication; 3. Hill procedure; 4. Belsey mark IV operation.[?]Duodenal stenosis:Duodenal atresia is the congenital septum of duodenal obstruction at the commencement of the third part of the duodenum.Repaired by duodenoduodenostomy.", "cop": 2, "opa": "Hiatus hernia", "opb": "Achalasia cardia", "opc": "Gastro Oesophageal Reflux Disease", "opd": "Duodenal stenosis", "subject_name": "Surgery", "topic_name": "Oesophagus", "id": "a3c79463-8c0e-462e-bd65-7b0489bdee49", "choice_type": "single"} {"question": "A child with parasymphysis fracture with no mobility and does not involve teeth is managed by", "exp": null, "cop": 3, "opa": "Circum-manidbular wiring with cap splint", "opb": "IMF", "opc": "Diet restriction and observation for 2-3 weeks", "opd": "Open reduction", "subject_name": "Surgery", "topic_name": null, "id": "10078e16-7bf6-4a0c-86b4-a733484214cd", "choice_type": "single"} {"question": "In a case of hypertrophic pyloric stenosis, the metabolic disturbance is", "exp": "Repetitive vomiting leads to hypochloremic, hypokalemic metabolic alkalosis. The urine is alkaline initially but eventually it becomes acidic (paradoxical aciduria)\n\nCause of paradoxical aciduria\n\nInitially the kidney compensate for metabolic alkalosis by reabsorbing hydrogen and chloride ions in exchange for sodium, potassium and bicarbonate. But gradually as the body stores of sodium and especially potassium become depleted, kidney starts retaining these ions in exchange of hydrogen ions. thus the urine becomes acidic and metabolic alkaline state is further aggravated.", "cop": 3, "opa": "Respiratory alkalosis", "opb": "Metabolic acidosis", "opc": "Metabolic alkalosis with paradoxical aciduria", "opd": "Metabolic alkalosis with alkaline urine", "subject_name": "Surgery", "topic_name": null, "id": "6ca668fc-5abd-4956-b22f-f88d15aced1b", "choice_type": "single"} {"question": "Best view for mandible is", "exp": "A panoramic oral radiograph, or ohopantomogram, is the radiograph of choice for the mandible as it shows the whole bone from condyle to condyle. If the patient cannot be positioned in the machines to achieve these views, radiographs should wait until the patient is f it enough. Poor radiographs can be misleading, and treatment can only be based on adequate radiographs or scans. Bailey & Love,25th,392", "cop": 4, "opa": "Antero-posterior", "opb": "Lateral", "opc": "Oblique", "opd": "Ohopentomogram", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "3d46ca90-e4e4-4141-82cb-086f6957201c", "choice_type": "single"} {"question": "Indication for sentinel node biopsy is", "exp": "The first axillary node draining the breast (by direct drainage) is designated as the sentinel node (SLN). SLN Biopsy is done in all cases of early breast cancers, T1 and T2 without clinically palpable node. It is not done in clinically palpable axillary node as there is already distoion of lymphatic flow due to tumour.I t is also not done in multifocal and multicentric tumours, as there is involvement of many lymphatic trunks from different places of breast, and chances of false-negative is high.. Ref; (page no; 543) 5th edition of SRB&;S manual of Surgery", "cop": 1, "opa": "Non palpable axillary lymph node", "opb": "Palpable axillary lymph node", "opc": "Mass > 5 cm", "opd": "Metastasis", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "65983957-33dc-45e6-856e-de658f2d50e7", "choice_type": "single"} {"question": "A 5 year old male child has multiple hyper pigmented macules over the trunk, on rubbing the lesion with the rounded end of a pen. He developed uicarial wheal, confined to the border of the lesion. The most likely diagnosis is", "exp": "Uicaria pigmentosa Uicaria is characterized by large, irregularly shaped pruritic, erythematous wheels Special forms of uicaria have special features (Dermographism, cholinergic uicaria, solar uicaria, or cold uritcaria) Most incidents are acute and self-limited over a period of 1-2 weeks Chronic uicaria (episodes lasting> 6 weeks) may have an autoimmune basis The most common immunologic mechanism is hypersensitivity mediated by IgE, seen for most patients with acute uicaria The morphology of the lesions may vary over a period of minutes to hours, resulting in geographic or bizarre, pattern, true uicaria last less than 24 hours and often only 2-4 hours. The most common cause of acute uicaria are foods, viral infections and medications Diagnosis - In vivo allergy skin testing and in vitro RAST testing Determination of serum tryptase (Increased in anaphylaxis, systemic mastocytosis, non IgE mediated disease (\"anaphylactoid reaction\") ACE inhibitors and Angiotensin II receptors antagonist therapy is contraindicated. Uicaria pigmentosa (mastocytosis) - consists of multiple irregularly shaped hyperpigmented muscle which may present on the trunk and extremities. Stroking the skin through the lesion with a blunt instrument elicits the classical \"triple response of Lewis\" called", "cop": 3, "opa": "Fixed drug eruption", "opb": "Licken planus", "opc": "Uicaria pigmentosa", "opd": "Uicarial vasculitis", "subject_name": "Surgery", "topic_name": null, "id": "a8cebb7b-f159-41a5-9867-5cf9c93617a9", "choice_type": "single"} {"question": "The Most Common Type of Carcinoma of urinary bladder", "exp": "(B) Transitional cell Carcinoma # Bladder cancer refers to any of several types of malignant growths of the urinary bladder. It is a disease in which abnormal cells multiply without control in the bladder. The bladder is a hollow, muscular organ that stores urine; it is located in the pelvis. The most common type of bladder cancer begins in cells lining the inside of the bladder and is called urothelial cell or transitional cell carcinoma (UCC or TCC).> Signs and symptoms Bladder cancer characteristically causes blood in the urine, this may be visible to the naked eye (frank haematuria) or detectable only be microscope (microscopic haematuria). Other possible symptoms include pain during urination, frequent urination or feeling the need to urinate without results These signs and symptoms are not specific to bladder cancer, and are also caused by non-cancerous conditions, including prostate infections and cystitis.> Risk factors: Carcinogens such as benzidine Drugs such as cyclophosphamide and phenacetin are known to predispose to bladder TCC.> Genetics: Genes which may be altered in bladder cancer include FGFR3, HRAS, RB1 and TP53", "cop": 2, "opa": "Squamous cell Carcinoma", "opb": "Transitional cell Carcinoma", "opc": "Adenocarcinoma", "opd": "Mixed cell carcinoma", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "f20b6bd3-68d0-42b3-b82d-84a0ce594f32", "choice_type": "single"} {"question": "An isograft is one that is transferred", "exp": "Graft: It is transfer of tissue from one area to other without its blood supply or nerve supply. Autograft: It is tissue transferred from one location to another on the same patient. Isograft: It is tissue transfer between two genetically identical individuals, i.e. between two identical twins. Allograft: It is tissue transfer between two genetically different members, e.g. kidney transplantation (Human to human) (Homograft). Xenograft: It is tissue transfer from a donor of one species to a recipient of another species (Heterograft).Reference : page 321 SRB's manual of surgery 5th edition", "cop": 2, "opa": "In the same individual", "opb": "Between monozygotic twins", "opc": "From I belonging to blood group A and other to blood group B", "opd": "From animal to human when the organ involved is identical", "subject_name": "Surgery", "topic_name": "Urology", "id": "14c98fd3-bd51-441a-abe7-a171bd874e6a", "choice_type": "single"} {"question": "Prevention of surgical wound infection done by", "exp": "Giving antibiotics prior to surgery (prophylactic antibiotics) one hour before surgery has been identified as an intervention for prevention of surgical site infections.\nShaving is now avoided and clipping of hair is preferred.\nPreop bath, Blood glucose control, and maintaining normothermia (esp in colorectal surgery) are other useful measures.", "cop": 3, "opa": "Pre-op shaving", "opb": "Monofilament sutures", "opc": "Pre-op antibiotic therapy", "opd": "Wound apposition", "subject_name": "Surgery", "topic_name": null, "id": "7e4472ee-c3f7-4977-996e-7eb84e485a59", "choice_type": "single"} {"question": "A 26 year woman presents with a palpable thyroid nodule, and needle biopsy demonstrates amyloid in the stroma of the lesion. A cervical lymph node is palpable on the same side as the lesion, the preferred treatment should be", "exp": "Ans. is 'c' i.e., Total Thyroidectomy and Modified neck dissection on the side of enlarged lymph node Presence of thyroid nodule along with palpable cervical lymph nodes and amyloid histologically is clearly indicative of Medullary Carcinoma Thyroid. Total Thyroidectomy is the treatment of choice for patients with MTC because of high incidence of multicentricity, the more aggressive course and RAI therapy usually being not effective. In patients with palpable cervical nodes, ipsilateral or bilateral modified radical neck dissection is done.", "cop": 3, "opa": "Removal of the involved node, the isthmus, and the enlarged lymph node.", "opb": "Removal of the involved lobe, the isthmus, a poion of the opposite lobe, and the enlarged lymph node.", "opc": "Total thyroidectomy and modified neck dissection on the side of the enlarged lymph node.", "opd": "Total thyroidectomy and irradiation of the cervical lymph nodes", "subject_name": "Surgery", "topic_name": null, "id": "c33d1333-be79-4018-8e5f-ccc61cf69bb5", "choice_type": "single"} {"question": "Marjolin ulcer", "exp": ".marjolin&;s ulcer is the name given to a malignancy ( usually a squamous cell carcinoma ) which arise in any long standing wound or a scar mostly scar of an old burn it grows slowly as it is avascular it is painless", "cop": 1, "opa": "Ca in marjolin's is squamous cell ca", "opb": "Chronic venous insufficiency", "opc": "Basal cell carcinoma", "opd": "arise from base of the ulcer", "subject_name": "Surgery", "topic_name": "General surgery", "id": "bd33b12f-ac10-40a4-8f1a-13cf4d118e1a", "choice_type": "single"} {"question": "The most common position adopted for surgical procedures is", "exp": ".Lithotomy position used for all perineal surgeries like for fissure, piles, fistula, and APR. ref:SRB&;s manual of surgery,ed 3,pg no 913", "cop": 3, "opa": "Trendelenburg position", "opb": "Lithotomy position", "opc": "Supine position", "opd": "Prone position", "subject_name": "Surgery", "topic_name": "Urology", "id": "43ef2f8d-f6c0-473c-9d73-cac0c1ba2e00", "choice_type": "single"} {"question": "Best for staging anal Ca. Is", "exp": "Overall best for staging is PET CT.\nFor T stage transrectal usg is used.", "cop": 2, "opa": "MRI", "opb": "PET CT", "opc": "CECT", "opd": "Transrectal usg + DRE", "subject_name": "Surgery", "topic_name": null, "id": "94e85176-1bb9-4bb2-b492-5e306e19f072", "choice_type": "single"} {"question": "Pulled up cecum is seen in", "exp": "Pulled up conical caecum is the finding seen in ileocaecal TB in Barium study X ray (enteroclysis followed by barium enema or barium meal follow through X ray) Reference : page 584 SRB's manual of surgery 5th edition", "cop": 3, "opa": "CA colon", "opb": "Carcinoid", "opc": "Ileocaecal tuberculosis", "opd": "Crohn's disease", "subject_name": "Surgery", "topic_name": "Urology", "id": "52585a42-70e8-4f18-8d9a-bcbc85b23a62", "choice_type": "single"} {"question": "In an injury with multiple fractures, most impoant is", "exp": "A i.e. Airway maintenance", "cop": 1, "opa": "Airway maintenance", "opb": "Blood transfusion", "opc": "Intravenous fluids", "opd": "Open reduction of fractures", "subject_name": "Surgery", "topic_name": null, "id": "b63b33bc-0fce-4071-8c61-ecdb80987b0a", "choice_type": "single"} {"question": "A patient presented with thunder clap headache. Followed by unconsciousness with progressive 3\"I cranial nerve palsy", "exp": "Aneurysmal subarachnoid hemorrhage Thunderclap headache is an acute and severe headache that is maximum in intensity at onset and has been likened to a clap of thunder. The term TCH was initially used by Day and Raskin in reference to the pain associated with an unrupured intracranial aneurysm. However, multiple causes of Thunderclap headache have since been described. \"Subarachnoid hemorrohage is the most common cause of thunderclap headaches\". Primary Thunder Clap headache Primary TCH is diagnosed when all other potential underlying causes have been eliminated by diagnostic testing. Primary TCH's can recur intermittently and are generally associated with benign outcome. The. International Headache Society's distagnoic criteria for Primary TCH (A) Severe headpain fUlfilling criteria B and C (B) Both of the. following characteristics. - Sudden onset, - Reaching maximum intensity in < lmin lasting .from 1 hour to 10 days. (C) Does not recur regularly over subsequent weeks or months. (D) Not attributed to another disorder (normal cerebrospinal fluid and normal brain imaging are needed) Secondary causes of Thunderclap headache Subarachnoid hemorrhagedeg Sentinel headache Cerebral venous sinus thrornbosisQ Cervical aery dissection Spontaneous intracranial hypotension Pituitary apoplexyQ Retroclival hematoma lschaemic stroke Acute hypeensive crisis Reversible cerebral vasoconstriction syndrome Third ventricle colloid cyst Intracranial infection Primary thunderclap headache Primary cough, sexual and exeional headache", "cop": 2, "opa": "Extradual hemorrhage", "opb": "Aneurysmal subarachnoid hemorrhage", "opc": "Basilar migraine", "opd": "Cluster Headache", "subject_name": "Surgery", "topic_name": null, "id": "e9d4c26e-4990-4330-bafa-0f72c2411b09", "choice_type": "single"} {"question": "A child with cramping pain and current jelly stools. Diagnosis is", "exp": ".Intussusception Clinical Features * Common in males (3:2). * Common in 6-9 months. But can also occur at later age grouped children. * Common in spring and winter, coinciding with the gastroenteritis and respiratory infections in respective periods. * Commonest cause of intestinal obstruction in infancy. * Initial colicky abdominal pain (75%) which eventually becomes severe and persistent. * Sudden onset of pain in a male child, with progressive distension of the abdomen, vomiting, with passage of \"red-currant-jelly'stool. ref:SRB&;S manual of surgery,ed 3,pg no 863", "cop": 2, "opa": "Volvulus", "opb": "Intussupection", "opc": "Dysentery", "opd": "Umbilical hernia", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "5bc52428-6f2d-41a5-bb25-bf48a6fda2f6", "choice_type": "single"} {"question": "A patient is on periodic renal dialysis. Minor oral surgery should be performed", "exp": null, "cop": 3, "opa": "One day before dialysis", "opb": "On the of dialysis", "opc": "One day after dialysis", "opd": "One week after dialysis", "subject_name": "Surgery", "topic_name": null, "id": "8daba5d6-8d70-4a91-a993-638113442497", "choice_type": "single"} {"question": "Thyroid carcinoma secreting ACTH", "exp": "Ans. (b) Medullary caMedullary Cancer Thyroid:* 5% of thyroid cancers* Arises from Parafollicular C cells which are derived from Ultimobranchial Bodies.* Mc Site is supero lateral* C cells secrete CALCITONIN* Secretes ACTH, Serotonin, Calcitonin, CEA, Histaminidases, PG E2 and PGF2 Alpha.* FNAC showing amyloid is diagnostic", "cop": 2, "opa": "Follicular ca", "opb": "Medullary ca", "opc": "Papillary ca", "opd": "Anaplastic ca", "subject_name": "Surgery", "topic_name": "Thyroid Gland", "id": "c01fedaa-088f-4295-99a8-f5f542355bba", "choice_type": "single"} {"question": "Charcot's triad include", "exp": "Charcot's triad is a feature of ascending cholangitis secondary to CBD stones.Intermittent symotoms are produced as the stone moves proximally & floats with relieving of obstruction and subsiding of symotoms.The triad includes fever,jaundice and pain(maybe colicky). SRB's manual of surgery,5th edition,page no:651.", "cop": 1, "opa": "Fever, pain, jaundice", "opb": "Fever, vomiting, jaundice", "opc": "Fever, Jaundice, Abd, distension", "opd": "Fever, chills, jaundice", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "f188b9a2-7bcc-4407-a8b7-d47116a2f6b7", "choice_type": "single"} {"question": "The most common type of tracheoesophageal fistula is", "exp": "The most common type of TRACHEO-OESOPHAGEAL FISTULA(TOF) is Atresia with distal TOF constituting 85% of all. It is also known as type C according to Gross classification of TOF. Reference : SRB's Manual of Surgery, 6th Edition, page no = 794.", "cop": 3, "opa": "Esophageal atresia with out tracheosophageal fistula", "opb": "Esophageal atresia with proximal tracheosophageal fistula", "opc": "Esophageal atresia with distal tracheoesophageal fistula", "opd": "Esophageal atresia with proximal and distal tracheosophageal fistula", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "42b13d2d-7003-44e9-bf57-055e5d35ced2", "choice_type": "single"} {"question": "Graft survives for the first 48 hours because of", "exp": "Graft survives upto first 48 hours because of plasma imbibition.", "cop": 1, "opa": "Absorption of nutrients into the graft", "opb": "Alignment of donor and recipient capillaries", "opc": "Vascularization of the graft", "opd": "Growth of lymphatics into the graft", "subject_name": "Surgery", "topic_name": null, "id": "92b260a5-1e4b-4d02-9ee8-a3fbe39f7579", "choice_type": "single"} {"question": "In rectal cancer, the distal clearance margin should be at least", "exp": "Tumor margin for curative resection IN GI malignancies (Stomach, small intestine, colon and proximal rectum), tumor margin for curative excision is 5 cm except Esophagus : 10 cm Distal rectum : 2 cm Ref: Sabiston 20th edition Pgno : 1378", "cop": 1, "opa": "2 cm", "opb": "3cm", "opc": "4 cm", "opd": "5 cm", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "9227e78b-7020-42ad-829f-2ddcc51b95a5", "choice_type": "single"} {"question": "Thickened gastric folds are not seen in", "exp": null, "cop": 4, "opa": "Carcinoma stomach", "opb": "Menetrier disease", "opc": "Eosinophilic gastritis", "opd": "Peptic ulcer disease", "subject_name": "Surgery", "topic_name": null, "id": "001d9156-4298-4193-9cc6-e9762e9e5f86", "choice_type": "single"} {"question": "The attitude of limb in traumatic dislocation of hip joint is", "exp": "B i.e. Flexion, adduction, internal rotation", "cop": 2, "opa": "Flexion, adduction, external rotation", "opb": "Flexion, adduction, internal rotation", "opc": "Flexion and adduction only", "opd": "Flexion, adduction, and external rotation", "subject_name": "Surgery", "topic_name": null, "id": "302d982b-df22-486c-a02a-806de5d06c11", "choice_type": "single"} {"question": "Her2 neu receptor is used in breast carcinoma for", "exp": "HER2 positive breast cancer is diagnosed by the IHC or FISH test. A result of HER 2 positive is impoant, as it indicates that the cancer can be treated with Herceptin, in combination with other chemotherapy drugs.", "cop": 4, "opa": "Diagnosis of cancer", "opb": "Screening of the breast carcinoma", "opc": "Detect recurrence", "opd": "Predicting response to treatment", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "afd4605f-0065-42a7-b1d8-de959f8463a6", "choice_type": "single"} {"question": "Proline is a", "exp": null, "cop": 4, "opa": "Natural absorbable suture material", "opb": "Synthetic absorbable suture material", "opc": "Natural non absorbable suture material", "opd": "Synthetic non absorbable suture material", "subject_name": "Surgery", "topic_name": null, "id": "3c3d0b8c-0f49-4a14-a117-8c9481ff0cb5", "choice_type": "single"} {"question": "Alagile syndrome is characterized by", "exp": "Ans. (a) Bile duct paucityRef: Internet sources* Alagille syndrome is an autosomal dominant genetic disorder affecting liver and heart commonly.* Bile duct paucity is the common manifestation which results in Cirrhosis and Liver failure", "cop": 1, "opa": "Bile duct paucity", "opb": "IHBR dilation", "opc": "PBC", "opd": "PSC", "subject_name": "Surgery", "topic_name": "Gall Bladder & Bile Ducts", "id": "50151dc7-e3ad-4edb-92bc-c8087df09c3b", "choice_type": "single"} {"question": "The tensile strength of the wound starts and increases after", "exp": "Wounds do not begin to gain tensile strength from collagen until 5 - 7 days.\nWound achieves around 20 % by 3 weeks, and around 60 % by four months.\nScar tissue continues to remodel for at least 6 - 12 months after an injury.", "cop": 2, "opa": "Immediately after suturing", "opb": "3 to 4 days", "opc": "7-10 days", "opd": "6 months", "subject_name": "Surgery", "topic_name": null, "id": "b4632258-239a-41cc-94f2-822a7e96b467", "choice_type": "single"} {"question": "A 45 year old postmenopausal lady presents with an 8 cm breast lump that is adherent to the skin, with one firm apical lymph node in the axilla and one more node in the ipsilateral supraclavicular area with no clinical evidence of distant metastasis. The staging is", "exp": ".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", "cop": 2, "opa": "T3 N2 M1", "opb": "T4 N3c M0", "opc": "T4 N2c M1", "opd": "T3 N3 M0", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "0f720d39-14de-4200-b2a2-1c7b08260d53", "choice_type": "single"} {"question": "Tom Smith septic ahritis affects", "exp": "Septic ahritis of hip seen in infants. At this age, the head of the femur is cailaginous and is rapidly and completely destroyed by the pyogenic process. Onset is acute with rapid abscess formation, which may burst out or be incised and heals rapidly. Usually it is mistaken as a superficial infection and the child presents some time later with complaint of a limp without any pain. On examination- it is found that the child walks with an unstable gait. The affected leg is shoer and hip movements are increased in all directions. Telescopy test is positive On X Ray, one finds complete absence of the head and neck of femur", "cop": 1, "opa": "Hip of infants", "opb": "Joint of children", "opc": "Shoulder in children", "opd": "Neck of infants", "subject_name": "Surgery", "topic_name": "Trauma", "id": "ae7cc188-d8c3-476f-99d1-33e64a5aa1e0", "choice_type": "single"} {"question": "The Histological subtype of renal cell carcinoma having worst prognosis is", "exp": "Answer- C. Collecting duct RCCCollecting duct & Medullary- poor prognosis", "cop": 3, "opa": "Clear cell carcinoma", "opb": "Chromophobe type RCC", "opc": "Collecting duct RCC", "opd": "Papillary Rcc", "subject_name": "Surgery", "topic_name": null, "id": "bd12cf8d-dc6b-4f40-8c50-b85ca72244dc", "choice_type": "single"} {"question": "The largest aery to the stomach is", "exp": ".", "cop": 1, "opa": "Left Gastric", "opb": "Right Gastric", "opc": "Left Gastroepiploic", "opd": "Right Gastroepiploic", "subject_name": "Surgery", "topic_name": "All India exam", "id": "1743f9da-aae0-4e09-b23a-c529ba66a9a6", "choice_type": "single"} {"question": "The most common site for ligamentous injuries are those of the", "exp": "D i.e. Ankle", "cop": 4, "opa": "Shoulder joint", "opb": "Elbow", "opc": "Knee joint", "opd": "Ankle joint", "subject_name": "Surgery", "topic_name": null, "id": "fb5dd5e8-4d9c-4194-b7a6-0e65df02e3fb", "choice_type": "single"} {"question": "Most common malignancy in marjolin's ulcer", "exp": "(B) Squamous cell carcinoma) (29, 548- Bailey & Love)A squamous cell carcinoma known as Marjolin's ulcer being the most common (Leg ulcers)Most frequently associated with * Chronic venous ulcer* Long standing burn scar* Squamous cell carcinoma developing in long standing scar/ulcers* Adenocarcinomas are the most common histological subtype of stomach cancer * *** Gastric carcinomas are often associated with hypochlorhydria /achlorhydria* Gastric carcinomas are relatively radioresistant* Maleny's ulcer (Burro wing ulcer) is caused by synergistic infection by Microerophilic Nonhaemolytic streptococci and Aerobic, Hemolytic staphylococci", "cop": 2, "opa": "Adenocarcinoma", "opb": "Squamous cell carcinoma", "opc": "Basal cell carcinoma", "opd": "Malignant fibrous histiocytoma", "subject_name": "Surgery", "topic_name": "Neoplasia", "id": "2245149a-d241-4c21-b396-7b66f3229d37", "choice_type": "single"} {"question": "In children persistent priapism may result due to", "exp": null, "cop": 2, "opa": "Thrombosis of venous plexus", "opb": "Leukaemia", "opc": "Wilm's tumour", "opd": "Trauma", "subject_name": "Surgery", "topic_name": null, "id": "a3ffc17a-9980-4bc9-8f83-9047e785d3b9", "choice_type": "single"} {"question": "Investigation for acute abdomen includes", "exp": ".Gram -ve septicaemia is common in acute abdomen like peritonitis, abscess, urinary infections, biliary infections, postoperative sepsis. It is commonly seen in malnutrition, old age, diabetics, immunosuppressed people. Diabetic acute abdomen -Patient with diabetes mellitus may present as acute abdomen. Free fluid in the flank may not be present. Patient may be ketotic also.the investigation of choice in a case of acute abdomen is ultrasound. ref:SRB&;s manual of surgery,ed 3,pg no 502", "cop": 1, "opa": "USG", "opb": "Multidetector CT", "opc": "Contrast enhanced CT", "opd": "X-ray", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "01c3b05f-c266-4149-a68e-13f996676e4a", "choice_type": "single"} {"question": "Hypertrophic pyloric stenosis is characterized by", "exp": "Ans. b (Metabolic alkalosis). (Ref. LB, 25th/79)Hypertrophic pyloric stenosis of infancy (CHPS)Aetiology# The incidence of this condition is approximately three cases per 1000 births.# In some cases there seems to be a familial association.# The mucosa is compressed such that only a probe can be inserted.Clinical features# Characteristically it is a first-born male child that is most commonly affected.# The condition is most commonly seen at 4 weeks after birth ranging from the third week to, on rare occasions, the seventh. Most commonly affects boys aged 2-8 weeks.# Characterised by projectile vomiting after feeds and Gastric peristalsis can be seen and a lump felt# Weight loss is a striking feature and rapidly the infant becomes emaciated and dehydrated.Imaging# Ultrasonography is the investigation of choice. Contrast radiology is not now necessary.Treatment# Following diagnosis the first concern is to correct the metabolic abnormalities. Essentially this is the same situation that pertains in adults with the patient being dehydrated, with low sodium, chloride and potassium, and a metabolic alkalosis. The child should be rehydrated with dextrose--saline and potassium (2.5 per cent dextrose plus 0.45 percent sodium chloride plus 1 g of potassium chloride per 500 ml of fluid). This will restore the infant's clinical condition and electrolytes to normal. Following this operation is required.# Ramstedt's operation is surgery of choice.", "cop": 2, "opa": "Metabolic acidosis", "opb": "Metabolic alkalosis", "opc": "Alkaline urine", "opd": "Paradoxical alkaluria", "subject_name": "Surgery", "topic_name": "Stomach & Duodenum", "id": "f16bfbdf-6789-4c3b-a92d-c14cb176d8f1", "choice_type": "single"} {"question": "Surgical ciliated cyst is often associated with surgeries of the", "exp": null, "cop": 3, "opa": "Maxillary impaction", "opb": "Mandibular set back", "opc": "Caldwell Luc procedure", "opd": "mucocele", "subject_name": "Surgery", "topic_name": null, "id": "e2cb5ab2-7ce9-4284-9e03-aa5271277b61", "choice_type": "single"} {"question": "The Most common cause of bleeding from nipple is", "exp": "(C) Duct papilloma", "cop": 3, "opa": "Scirrhous carcinoma", "opb": "Fibrocystic disease", "opc": "Duct papilloma", "opd": "Paget's disease", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "c1036c08-bb2f-468d-9ba6-12589b7b3819", "choice_type": "single"} {"question": "Erythroplasia of Quegrat occurs in", "exp": "Erythroplasia of Queyrat is Premalignant condition of Penile cancer.", "cop": 2, "opa": "Scrotum", "opb": "Penis", "opc": "Testis", "opd": "Bladder", "subject_name": "Surgery", "topic_name": null, "id": "c8c50f44-8b92-4903-9f3f-74ab84a3d0c0", "choice_type": "single"} {"question": "Secondary deposits from prostatic carcinoma is commonest in", "exp": null, "cop": 1, "opa": "Bone", "opb": "Kidney", "opc": "Liver", "opd": "Brain", "subject_name": "Surgery", "topic_name": null, "id": "087d65e0-de98-41d0-95f0-0bffb437a5c4", "choice_type": "single"} {"question": "Hippocratic facies is seen in", "exp": "Hippocratic facies--bright, hollow eyes; pale, pinched face; cold perspiration in eye brows; dry, fissured tongue; blue lips. Patient will be in severe shock. It signifies terminal status with high moality rate. It is a typical facial sign of severe end stage peritonitis.Reference : page 572 SRB's manual of surgery 5th edition", "cop": 1, "opa": "Peritonitis", "opb": "Pancreatitis", "opc": "Facial nerve injury", "opd": "Marginal mandibular nerve injury", "subject_name": "Surgery", "topic_name": "Urology", "id": "134f61d2-25a8-4f40-a5bf-e9f028ca9b2c", "choice_type": "single"} {"question": "Gardener&;s syndrome is a rare hereditary disorder involving the colon. It is characterized by", "exp": ".GARDNER'S SYNDROME * It is commonly associated with FAP - 10%. * Presents with bone, skin, soft tissue and dental abnormalities. Jaw osteomas are very common. Other features are epidermoid cysts (50%), exostoses, fibromas, lipomas. * Associated with desmoid tumours seen in the scar, abdomen, intraabdominal region and mesenteric fibromatosis. * Congenital hyperophy of pigment layer of retina (seen as pigment spots)--commonly seen. * Often associated with MEN IIb syndrome. ref:SRB&;s manual of surgery,ed 3,pg no 834", "cop": 3, "opa": "Polyposis colon, Cancer thyroid, skin tumours", "opb": "Polyposis is jejunum, pituaitary adenoma and skin tumours", "opc": "Polyposis colon, osteomas, epidermal inclusion cysts and fibrous tumours in the skin", "opd": "Polyposis of gastrointestinal tract, cholangiocarcinoma and skin tumours", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "7655f703-3028-4ffb-8da9-c37bf1aeed4d", "choice_type": "single"} {"question": "Best diagnosis of the ectopic gastric mucosa of Meckel's diveiculum is by", "exp": "Plain abdominal radiography, CT, and ultrasonography are rarely helpful.In children, the single most accurate diagnostic test for Meckel's diveicula is scintigraphy with sodium 99mTc-peechnetate. The 99mTc-peechnetate is preferentially taken up by the mucus-secreting cells of gastric mucosa and ectopic gastric tissue in the diveiculum. The diagnostic sensitivity of this scan has been repoed as high as 85%, with a specificity of 95% and an accuracy of 90% in the pediatric age group.In adults, however, the sensitivity of 99mTc-peechnetate scan falls to 63% because of the presence of less gastric mucosa in the diveiculum compared with that noted in the pediatric age group.Sabiston 20e pg:1310", "cop": 4, "opa": "Fluoroscopy", "opb": "Occult blood test in stool", "opc": "Ultrasound abdomen", "opd": "Radionuclide scan", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "85103562-ae2b-477c-b4e6-307c63b69f15", "choice_type": "single"} {"question": "The preferred bypass procedure in case of non resectable carcinoma of head of pancreas is", "exp": "It is preferable to use bile duct rather than the gall bladder.Cholecystojejunostomy is easier to perform,but the bile must then drain through the cystic duct,which is narrow and ,if the cystic duct is inseed low into the bile duct,it is vulnerable to occlusion by tumour growth. Bailey & Love 26th edition ,page no.1140 .", "cop": 4, "opa": "Cholecystojejunostomy", "opb": "Cholecystogatrostomy", "opc": "Choledochoduodenostomy", "opd": "Choledochojejunostomy", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "43f862d2-424f-4377-9361-e0b3d8cb93a1", "choice_type": "single"} {"question": "Murmur increasing with valsalva maneouvre aEUR'", "exp": "HOCM EFFECT OF VARIOUS INTERVENTIONS ON SYSTOLIC MURMURS", "cop": 2, "opa": "Mitral stenosis", "opb": "HOCM", "opc": "VSD", "opd": "Aoic stenosis", "subject_name": "Surgery", "topic_name": null, "id": "e036cece-b323-4779-8a92-50e4d94331c7", "choice_type": "single"} {"question": "Most common presentation of peutz jegher syndrome is", "exp": "Most common presentation of peutz jegher syndrome is intussusception. Mutation is STK 11 mutation.", "cop": 3, "opa": "Pancreatic Ca", "opb": "Melanoma", "opc": "Intussusception", "opd": "Malabsorption", "subject_name": "Surgery", "topic_name": null, "id": "89047107-4a73-469c-ba10-7ee9f62ddd93", "choice_type": "single"} {"question": "Catgut is preserved in", "exp": "The catgut suture is supplied sterile in \"pre-cut\" lengths or non-needled or attached to various needle in packing fluid containing: o 90% Isopropyl Alcohol, o 0.5% Sodium Benzoate, o 0.5% Diethylethanolamine and o water q.s. ad 100%.", "cop": 2, "opa": "Glutraldehyde", "opb": "Isopropyle alcohol", "opc": "Iodine", "opd": "Cetrimide", "subject_name": "Surgery", "topic_name": "Urology", "id": "e0de3fc8-7660-411a-9789-a281b089a400", "choice_type": "single"} {"question": "Proteus organisms cause", "exp": "(A) Struvite stones # STRUVITE STONE: A phosphate calculus is smooth and dirty white. It tends to grow in alkaline urine, especially when urea splitting Proteus organisms are present. As a result, the calculus may enlarge to fill most of the collecting system, forming a staghorn calculus.# TYPES OF RENAL CALCULUS:> Calcium oxalate calculus: Most common; they have hard, small and jagged surface> Uric acid and urate calculus: these are radiolucent> Cystine stones: uncommon, seen in cystinuria; appear only in acid urine; they are pink to yellow when first removed but they change colour to a greenish hue when exposed to air.> Xanthine calculi: are radiolucent; Most common symptom of renal calculi is Pain.", "cop": 1, "opa": "Struvite stones", "opb": "Calcium oxalate stones", "opc": "Cystine stones", "opd": "Xanthine stones", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "f4048160-a688-488f-bbd7-bb2b77af85f9", "choice_type": "single"} {"question": "Malignant cell in Hodgkin's lymphoma is", "exp": "Reed-Sternberg cells (also known as lacunar histiocytes for ceain types) are distinctive, giant cells found with light microscopy in biopsies from individuals with Hodgkin's lymphoma (a.k.a. Hodgkin's disease, a type of lymphoma). They are usually derived from ,B lymphocytes classically considered crippled germinal center B cells, meaning they have not undergone hypermutation to express their antibody. Seen against a sea of B cells, they give the tissue a moth-eaten appearance. Reed-Sternberg cells are large (30-50 microns) and are either multinucleated or have a bilobed nucleus with prominent eosinophilic inclusion-like nucleoli (thus resembling an \"owl's eye\" appearance)", "cop": 1, "opa": "Reed stenberg cell", "opb": "Lymphocytes", "opc": "Histocytes", "opd": "Reticulum cells", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "db94e6e6-1973-4f84-82ef-e9ec29ac1697", "choice_type": "single"} {"question": "The most malignant brain tumour is", "exp": "(D) Glioblastoma multiforme # Glioblastoma multiforme (GBM), WHO classification name \"glioblastoma\", also known as Grade IV Astrocytoma, is the most common and most aggressive malignant primary brain tumor in humans, involving glial cells and accounting for 52% of all functional tissue brain tumor cases and 20% of all intracranial tumors.", "cop": 4, "opa": "Ependymoma", "opb": "Medulloblastoma", "opc": "Oligodendroglioma", "opd": "Glioblastoma multiforme", "subject_name": "Surgery", "topic_name": "Nervous System", "id": "a34a3e24-3106-4899-8bdf-735e248324d2", "choice_type": "single"} {"question": "Most common presentation of trichobezoar is", "exp": "Ans) a (Obstruction) Ref: Sabiston's textbook of surgery 18th editionTrichobezoars are concretions of hair, generally found in long-haired girls or women who often deny eating their own hair (trichophagy). Symptoms include pain from gastric ulceration and fullness from gastric outlet obstruction & occasional gastric perforation", "cop": 1, "opa": "Obstruction", "opb": "Peritonitis", "opc": "Hemorrage", "opd": "Asymptomatic", "subject_name": "Surgery", "topic_name": "Intestinal Obstruction", "id": "5d0cf241-1341-4684-9b0e-d549ccc63fd3", "choice_type": "single"} {"question": "Fogay catheter is used for", "exp": "Fogay catheter is used to remove thrombus in acute limb ischaemiaThe aery (usually the femoral), bulging with clot, is exposed and held in silastic vessel loops. Through a transverse incision, the clot begins to extrude and is removed, together with the embolus, with the help of a Fogay balloon catheter. The catheter, with its balloon tip, is introduced both proximally and distally until it is deemed to have passed the limit of the clot.The balloon is inflated and the catheter withdrawn slowly, together with any obstructing material. The procedure is repeated until bleeding occurs.Ref: Bailey and love pg: 955", "cop": 2, "opa": "Suprapubic drainage", "opb": "Acute limb ischaemia", "opc": "Cardiac angioplasty", "opd": "Intraventricular drainage", "subject_name": "Surgery", "topic_name": "General surgery", "id": "c55a3ed8-34ff-462f-b23c-93c940f3f925", "choice_type": "single"} {"question": "Reparative granuloma of jaw is treated by", "exp": "Reparative granuloma of jaw is treated by curettage Giant Cell Reparative Granuloma Giant cell reparative granuloma is an apparently Reactive intraosseous lesion of the mandible and maxilla following trauma induced intraosseous hemorrhage and containing prominent giant cells Also known as central giant cell granuloma MC site : Anterior pa of mandible (2/3rd of cases) between the 2nd premolar and 2nd molar with extension across the midline 2nd MC site : Small bones of hands and feet Clinical features It is a disease of the young presenting as a painless swelling in the anterior jaw and Radiographically appearing as a lytic expansile lesion with a characteristic Tendency of reabsorbing the root of tips of adjacent unerupted teeth Treatment Curettage or local excision Recurrence rate : 22-50% Lesion Eradication typically does not require >2 excision Chemical cautery, electrocautery, cryotherapy, calcitonin, Interferon alpha and intralesional steroids are used for more aggressive and recurrent lesions Ref: medind.nic.in/ibn/t06/i4/ibnt06i4p677", "cop": 4, "opa": "Antibiotics", "opb": "Wedge resection", "opc": "Resection and bone grafting", "opd": "Curettage", "subject_name": "Surgery", "topic_name": "Urology", "id": "5bd08427-2df8-472d-a994-99dc14d02afc", "choice_type": "single"} {"question": "Little old lady's hernia is also know as", "exp": null, "cop": 3, "opa": "Femoral hernia", "opb": "Incisional hernia", "opc": "Obturator hernia", "opd": "Inguinal hernia", "subject_name": "Surgery", "topic_name": null, "id": "dff91aaf-7513-4f21-8fe6-832926234eb9", "choice_type": "single"} {"question": "Commonest site of a rodent ulcer is", "exp": "Rodent ulcer is synonymous with basal cell carcinoma.\n90% of basal cell carcinomas are seen in the face, above a line from the corner of mouth to the lobule of ear. The commonest site is around the inner canthus of the eye (also k/a Tear cancer).", "cop": 2, "opa": "Limbs", "opb": "Face", "opc": "Abdomen", "opd": "Trunk", "subject_name": "Surgery", "topic_name": null, "id": "87432c2b-4bad-4d79-bdad-23f60349da4f", "choice_type": "single"} {"question": "The most common complication seen in hiatus hernia is", "exp": "Ans. is 'a' i.e. Esophagitis There are 4 types of hiatal herniaType I : Sliding hernia (most common type -- 70 - 80%)Type II : Paraesophageal or rolling herniaType III : MixedType IV : these hernias are distinguished by the presence of other abdominal viscera wihin the defect i.e. omentum, transverse colon.Type I or Sliding hiatal hernia- this is characterized by upward dislocation of the cardioesophageal junction into the posterior mediastinum.Type II or Rolling Paraesophageal hernia- the cardioesophageal junction is undisplaced the whole or pa of stomach herniates into the thorax immediately adjacent and to the left of the undisplaced cardioesophageal junction.- since the normally located gastroesophageal junction functions normally in most of these hernias, reflux is uncommon", "cop": 1, "opa": "Esophagitis", "opb": "Aspiration pneumonitis", "opc": "Volvulus", "opd": "Esophageal stricture", "subject_name": "Surgery", "topic_name": null, "id": "cc91f9e8-19c4-4031-b282-e61f28bb768f", "choice_type": "single"} {"question": "Pancreatitis caused bya) Ascending cholangitisb) ↑ed PTHc) CBD stoned) Alcohole) Starvation", "exp": "Increased parathormone leads to hypercalcemia which can cause pancreatitis.", "cop": 4, "opa": "abc", "opb": "acd", "opc": "ac", "opd": "bcd", "subject_name": "Surgery", "topic_name": null, "id": "26697260-a244-4883-8cea-767ff5e3e05d", "choice_type": "single"} {"question": "Persistent urachus is a risk factor for", "exp": "Sepsis, tuberculosis, adenocarcinoma of bladder can occur in patients with patent urachus. Patent urachus with urine leak signifies obstruction distal to bladder. Reference : page 1029 SRB's manual of surgery 5th edition", "cop": 2, "opa": "Transitional cell ca of bladder", "opb": "Adenocarcinoma of bladder", "opc": "Squamous cell ca of bladder", "opd": "Undifferentiated ca of bladder", "subject_name": "Surgery", "topic_name": "Urology", "id": "42151898-10c1-4cf3-a96b-46e1e785b69c", "choice_type": "single"} {"question": "Pseudoeschar formation is seen with", "exp": "Pseudoeschar is thickened burnt skin due to repeated silver sulphadiazine application.", "cop": 2, "opa": "Silver Nitrate", "opb": "Silver sulfadiazine", "opc": "Sulfamylon", "opd": "Mafenide acetate", "subject_name": "Surgery", "topic_name": null, "id": "dad18e2c-8cc0-45bf-a27c-8ab93116c3d9", "choice_type": "single"} {"question": "Superolateral boundary of axillary dissection is", "exp": "Lateral group of axillary nodes are present along axillary vein. Axillary dissection is the removal of fat, fascia, nodes in the axilla. Usually level 1 and level 2 nodes are removed. Nodes below the axillary vein are usually removed. so the superolateral boundary of axillary dissection is axillary vein. Dissection is done through an individual crease transverse inciaion in the axilla. Reference :SRB's Manual of Surgery, 6th Edition, page no = 543, 529.", "cop": 4, "opa": "Clavipectoral fascia", "opb": "Branchial plexus", "opc": "Axillary aery", "opd": "Axillary vein", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "7b714a17-3e3d-469d-b533-2bad1ad7f548", "choice_type": "single"} {"question": "Alagille syndrome is", "exp": "Alagille syndrome is an autosomal dominant genetic disorder affecting liver,hea,kidney,etc.Liver biopsy in Alagille syndrome shows too few bile ducts(bile duct paucity) or in some cases,the complete absence of bile ducts(biliary atresia).Bile duct paucity results in reduced absorption of fat & vitamins(A,D,E,K) which may lead to rickets/a failure to thrive in children.", "cop": 1, "opa": "Bile duct paucity", "opb": "IHBR dilation", "opc": "PBC", "opd": "PSC", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "c7a05329-8bbd-4a18-92ad-e1bd5d7493f0", "choice_type": "single"} {"question": "The posture associated with the greatest lumbar intradiscal pressure is", "exp": "Nachemson's studies showed the lowest intradiskal pressure occurred with the patient supine, followed by the lateral decubitus position. Sitting produced higher intradiskal pressures than standing, and pressures were increased in both positions by flexion of the trunk. The highest pressures encountered were with the patient sitting with the trunk flexed.", "cop": 1, "opa": "Sitting, trunk flexed", "opb": "Sitting, trunk erect", "opc": "Standing, trunk flexed", "opd": "Standing, trunk erect", "subject_name": "Surgery", "topic_name": null, "id": "faeac89d-d603-4e15-838b-f0ea298df59a", "choice_type": "single"} {"question": "Watson criteria is used for", "exp": null, "cop": 1, "opa": "Treatment for tracheoesophageal fistula", "opb": "Diagnosis of tracheoesophageal fistula", "opc": "Diagnosis of peptic ulcer", "opd": "Prognosis of esophageal cancer", "subject_name": "Surgery", "topic_name": null, "id": "34e611a1-5306-467f-b0b9-1371193e03bf", "choice_type": "single"} {"question": "Percentage of malignancy in duct ectasia is", "exp": "Ans. (a) No risk(Ref. Schwartz 10th edition Page 511, Bailey 26th edition page 806)* The periductal mastitis mimics like cancer and hence mammography must be done.* Otherwise there is no risk of cancer in Duct ectasia", "cop": 1, "opa": "No risk", "opb": "5:01", "opc": "1.2 :1", "opd": "10:01", "subject_name": "Surgery", "topic_name": "Breast", "id": "16145223-bb7b-4bbc-888b-435c1b76b6b9", "choice_type": "single"} {"question": "The earliest manifestation seen after Gastrectomy", "exp": null, "cop": 2, "opa": "↑Incidence of infection", "opb": "Loss of storage capacity", "opc": "Loss of HCl", "opd": "Loss of intrinsic factor", "subject_name": "Surgery", "topic_name": null, "id": "27e96766-e7e8-4174-b181-bc0c14a8f65f", "choice_type": "single"} {"question": "Tensile strength of wound after laparoscopic cholecytectomy in a 30 years old Woman depends upon", "exp": "\"Covalent cross linking of the lysine residues provides tensile strength. The extent and type of cross linking vary from tissue to tissue. In tissues such as tendons, in which tensile strength is crucial, collagen cross linking is extremely high.\" Sabiston 26th edition Pg: 139", "cop": 2, "opa": "Replacement of type 3 collagen", "opb": "Extensive crosslinking of procollagen", "opc": "Macrophage activity\\/invasion", "opd": "Granulation tissue", "subject_name": "Surgery", "topic_name": "General surgery", "id": "b71a69ab-52ac-4f15-8e60-d71abc548070", "choice_type": "single"} {"question": "A chronic wound may be defined as one that fails to heal by", "exp": "A chronic wound may be defined as one that fails to heal in the expected time for a wound of that type, which is usually less than 3 weeks. Delays in healing can occur at any phase but most often occur in the inflammatory phase.Bailey and love 27e pg: 29", "cop": 3, "opa": "1 week", "opb": "2 weeks", "opc": "3 weeks", "opd": "4 weeks", "subject_name": "Surgery", "topic_name": "General surgery", "id": "e048320c-9a3c-4558-8c73-e9d8f2a9c6da", "choice_type": "single"} {"question": "The most common complication of intracapsular fracture neck of femur is", "exp": "C i.e. Nonunion", "cop": 3, "opa": "Mal union", "opb": "Osteoahritis", "opc": "Non-Union", "opd": "Shoening", "subject_name": "Surgery", "topic_name": null, "id": "c7b54631-f3a9-4ad1-a548-6ad5e960e410", "choice_type": "single"} {"question": "Most common site for carcinoid tumor is", "exp": "Carcinoid tumour arise from the enterochromaffin cells (Kulchitsky cells) found in the crypts of Lieberkuhn. These cells are capable of APUD (Amine precursor uptake and Decarboxylation) and can secrete vasoactive amines like 5- HT, 5-HIAA, 5-HTP; tachykinins, peptides (chromogranins)and PGs. It commonly occurs in appendix (45%), ileum (25%) and rectum (15%). Other (15%) sites are--other pas of GIT (including pancreas and biliary tract), bronchus and testis. Reference: page 877 SRB's manual of surgery 5th edition.", "cop": 3, "opa": "Esophagus", "opb": "Lung", "opc": "Appendix", "opd": "Ileum", "subject_name": "Surgery", "topic_name": "Urology", "id": "8cea42dc-1a99-42bc-84bd-ce7afd9bc2e0", "choice_type": "single"} {"question": "In carcinoma of anus distal margin of clearance of anal canal of at least", "exp": "Ans. is 'a' i.e., 2 cm", "cop": 1, "opa": "2 cm", "opb": "5 cm", "opc": "4 cm", "opd": "7 cm", "subject_name": "Surgery", "topic_name": null, "id": "6e592f10-fd9b-48cb-a3a7-1c638b34e90a", "choice_type": "single"} {"question": "Saccular diveiculum of extrahepatic bile duct in choledochal cyst is classified as", "exp": "Type 1b -saccular dilatation of extrahepatic biliary tree, Type 2-diveiculum of extrahepatic biliary tree Type 3-cystic dilatation of intraduodenal pa of CBD Type 4- dilatation of multiple pas of an extrahepatic biliary tree, dilatation of intrahepatic and extrahepatic biliary tree. Reference SRB edition 5. page637", "cop": 1, "opa": "Type I", "opb": "Type II", "opc": "Type III", "opd": "Type IV", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "b87f4b7f-1a20-42c0-a445-a44dff3ddaf8", "choice_type": "single"} {"question": "Ileocecal tuberculosis is associated with", "exp": ".* Abdominal pain is the most common symptom (90%). It is dull in mesenteric type; colicky in intestinal type. * Common in 25-50 years age group. Equal in both sexes. * Anaemia,megaloblastic type , loss of weight and appetite (80%). * Diarrhoea--10-20%. * Fever--50-70%. ref:SRB&;s manual of surgery,ed 3,pg no 514", "cop": 1, "opa": "Megaloblastic anemia", "opb": "Iron deficiency anemia", "opc": "Sideroblastic anemia", "opd": "Normocytic normochromic anemia", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "dba548d1-9a5d-46ff-b3ae-f4d3903775a8", "choice_type": "single"} {"question": "The commonest cause of acute pancreatitis is", "exp": "Major cause of acute pancreatitis is biliary calculi(50-70% of patients) A careful search of aetiology is must before labelling idiopathic and no more than 20% cases should fall into this category. Bailey & Love 26th edition,1127,1128.", "cop": 1, "opa": "Biliary calculi", "opb": "Alcohol abuse", "opc": "Infective", "opd": "Idiopathic", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "c5d6f899-20dc-47a0-bc3d-18b6852f210b", "choice_type": "single"} {"question": "Treatment for benign tumor of superficial lobe is", "exp": "All tumors of the superficial lobe of the parotid gland are treated by superficial parotidectomy.", "cop": 1, "opa": "Superficial parotidectomy", "opb": "Enucleation", "opc": "Complete parotidectomy", "opd": "Observation", "subject_name": "Surgery", "topic_name": null, "id": "9043ba6f-f362-414e-98f7-be10237a42b6", "choice_type": "single"} {"question": "Treatment of anaplastic carcinoma of thyroid", "exp": "Ans. (d) Total thyroidectomyRef: Bailey and Love page 770/ 26th editionManagement of Anaplastic Carcinoma Thyroid:* This tumor is one of the most aggressive thyroid malignancies, with few patients surviving 6 months beyond diagnosis.* All forms of treatment have been disappointing. If anaplastic carcinoma presents as a resectable mass, thyroidectomy may lead to a small improvement in survival, especially in younger individuals.* Combined radiation and chemotherapy in an adjuvant setting in patients with resectable disease has been associated with prolonged survival, although these agents are also being used in a neoadjuvant fashion.* Isthmectomy and Tracheostomy may be needed to alleviate airway obstruction.", "cop": 4, "opa": "Hemithyroidectomy", "opb": "Subtotal thyroidectomy", "opc": "Near total thyroidectomy", "opd": "Total thyroidectomy", "subject_name": "Surgery", "topic_name": "Thyroid Gland", "id": "70bd2793-18c2-48b2-9c92-26fd9c3affae", "choice_type": "single"} {"question": "Most pathognomic in pelvic abscess is", "exp": "Pelvic abscess is the most common intraperitoneal abscess(50-60%).It is the collection of pus in rectovesical / rectouterine poch (pouch of Douglas).The most characteristic features are diarrhoea & passage of mucopurulent discharge per rectum.Per rectal examination shows a soft,tender,boggy swelling in the anterior rectal wall which may burst into the rectum. Reference:Bailey & Love 's sho practise of surgery,25th edition,page no:996;SRB's manual of surgery,5th edition,page no:574", "cop": 2, "opa": "Constipation", "opb": "Mucopurulent discharge", "opc": "Loose stool", "opd": "Bleeding", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "664388ee-2d1d-409a-ab12-9da4576d90f6", "choice_type": "single"} {"question": "Best diagnostic procedure for ant. Cruciate ligament injury is", "exp": "A i.e. Lachman's test", "cop": 1, "opa": "Lachman's test", "opb": "Pivot shift test", "opc": "Anterior drawer test", "opd": "Mc Murray's test", "subject_name": "Surgery", "topic_name": null, "id": "d44daef4-8e92-4e76-af29-af11ab95f87b", "choice_type": "single"} {"question": "Normal value of ankle branchial index is", "exp": "Ankle Brachial Index ABI= Systolic BP at the ankle/systolic BP in the arms Compared to the arm, lower blood pressure in the leg is an indication of blocked aeries (peripheral vascular disease) ABI is calculated by dividing the systolic blood pressure at the ankle by the systolic blood pressures in the arm ABI is calculated by dividing the systolic blood pressure at the ankle by the systolic blood pressures in the arm ABI Interpretation >1.2 Non-compressible, severely calcified vessel (in DM & ESRD) 1.0-1.2 Normal vessels 0.5-0.9 Intermittent claudication 0.1-0.4 Critical limb ischaemia( Ischaemic ulceration, gangrene) Ref: Sabiston 20th edition Pgno :1758", "cop": 2, "opa": "0.8", "opb": "1", "opc": "1.2", "opd": "1.4", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "590e95ab-808c-4bac-a2b9-b4049c8193cb", "choice_type": "single"} {"question": "Difficulty score for a mesioangular class II position C mandibular third molar is", "exp": null, "cop": 1, "opa": "6", "opb": "7", "opc": "8", "opd": "9", "subject_name": "Surgery", "topic_name": null, "id": "0f3b15a5-8687-4512-be9f-9f0b663c85e8", "choice_type": "single"} {"question": "A patient with anterior dislocation of shoulder will most likely give a history of", "exp": "C i.e. Abduction & external rotation", "cop": 3, "opa": "Abduction and internal rotation", "opb": "Adduction and internal rotation", "opc": "Abduction and external rotation", "opd": "Adduction and external rotation", "subject_name": "Surgery", "topic_name": null, "id": "acf65e78-27a5-4301-849e-a0ec0f640b0c", "choice_type": "single"} {"question": "The substrate depleted earliest in the postoperative period is", "exp": "The metabolic response to surgery (and other trauma) is a result of neuroendocrine stimulation that sharply accelerates protein breakdown, stimulates gluconeogenesis, and produces glucose intolerance. The glycogen stores are rapidly depleted because of a fall in insulin and a rise in glucagon levels in the plasma. The peripheral effects of the neuroendocrine secretion result in an increase in plasma levels of amino acids, free fatty acids, lactate, glucose, and glycerol. In the liver, the coisol and glucagon stimulate glycogenolysis, gluconeogenesis, and increased substrate uptake.", "cop": 4, "opa": "Branched-chain amino acids", "opb": "Non-branched-chain amino acids", "opc": "Glycogen", "opd": "Glucose", "subject_name": "Surgery", "topic_name": "General surgery", "id": "831a0335-0941-4645-b290-cb05c4a8ae46", "choice_type": "single"} {"question": "Wolfe Graft is", "exp": "Split-thickness skin graftsCalled Thiersch grafts. They are used to cover all sizes of wound, are of limited durability and will contract.Full-thickness skin grafts Called Wolfe graftsUsed for smaller areas of skin replacement where good elastic skin that will not contract is required (such as fingers, eyelids, facial pas).Ref: Bailey and love 27e pg: 636", "cop": 2, "opa": "Thin split thickness graft", "opb": "Full thickness skin graft", "opc": "Local flap", "opd": "Free flap", "subject_name": "Surgery", "topic_name": "General surgery", "id": "87e676fc-d3c8-4972-a66c-1441fc2089ca", "choice_type": "single"} {"question": "A patient with a non obstructing carcinoma of the sigmoid colon is being prepared for elective resection. To minimize the risk of postoperative infectious complications, your planning should include", "exp": "Many clinical and experimental studies have looked at the optimum bowel preparation and preoperative regimen for elective colonic surgery to reduce the postoperative infectious complications of wound infection, intra-abdominal abscess, and anastomotic leakage. Currently a postoperative rate of wound infection of only 5% can be attained by combining mechanical cleansing, oral antibiotics, and perioperative parenteral antibiotics. Oral antibiotics may be administered one hour prior to surgery and should cover all anaerobes (e.g., neomycin-erythromycin), antibiotics effective against aerobes (e.g., cefoxitin) should be administered in the operating room as a single dose and not postoperatively. Both antibiotic regimens are for prophylaxis without fostering resistant against microbes.", "cop": 3, "opa": "A single preoperative parenteral dose of antibiotic effective against aerobes and anaerobes.", "opb": "Avoidance of oral antibiotics to prevent emergence of clostridium difficile", "opc": "Postoperative administration for 2 to 4 days of parenteral antibiotics effective against aerobes and anaerobes", "opd": "Postoperative administration for 5 to 7 days of parenteral antibiotics effective against aerobes and anaerobes", "subject_name": "Surgery", "topic_name": null, "id": "534a79d6-ec90-4c88-943f-e094068bacf7", "choice_type": "single"} {"question": "During insipiration the main current of airflow in a normal nasal cavity is through", "exp": "* During quite respiration inspiratory air current pass through middle pa of the nose between the turbinatcs and nasal septum. * Very little air passes through inferior meatus or olfactory region of the nose. * Therefore weak odorous substances have to be sniffed before they reach olfactory area. * During expiration air current follows the same course as during inspiration but the entire air current is not expelled directly through the nares. * Friction offered at lumen nasi conves it into eddies under cover of inferior and middle turbinates and this ventilates the sinuses through the Ostia", "cop": 1, "opa": "Middle pa of the cavity in middle meatus in a parabolic curve", "opb": "Lower pa of the cavity in the inferior meatus in a parabolic curve", "opc": "Superior pa of the cavity in the superior meatus", "opd": "Through olfactory area", "subject_name": "Surgery", "topic_name": null, "id": "ba206b17-c0f9-4b72-92dc-9b439fb5dede", "choice_type": "single"} {"question": "Gene responsible for FAP is located at", "exp": "Familial adenomatous polyp(FAP) is inherited as an autosomal dominant neoplastic condition (chromosome 5q21). It has a high potential for malignant transformation. It presents in younger age group- 15-20 yrs; equal in both sexes. It commonly involves the large intestine but can also occur in stomach, duodenum and small intestine. Reference : page 899 SRB's manual of surgery 5th edition", "cop": 1, "opa": "Chromosome 5", "opb": "Chromosome 8", "opc": "Chromosome 15", "opd": "Chromosome X", "subject_name": "Surgery", "topic_name": "Urology", "id": "86110f1c-75ea-4834-9c63-41941a70079a", "choice_type": "single"} {"question": "For extra oral maxillary nerve block the target area is", "exp": null, "cop": 1, "opa": "Anterior to lateral pterygoid plate", "opb": "Posterior to Lateral pterygoid plate", "opc": "Pterygomandibular fossa", "opd": "Pterygomandibular fissure", "subject_name": "Surgery", "topic_name": null, "id": "7ac31987-1365-4bf9-9028-717bd252e8a1", "choice_type": "single"} {"question": "Indications for fine needle aspiration in liver abscess are", "exp": "Indications of fine needle aspiration in liver abscess are - in case of large abscess (>10cm), infected abscess, failure of drug therapy, large left lobe abscess, seronegative, abscess in pregnancy where drug therapy cannot be used. Reference :SRB edition 5 ,page no.599", "cop": 4, "opa": "Recurrent", "opb": "Left lobe", "opc": "Refractory to treatment after 48-72 hrs", "opd": "> 10 cms size", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "c61e6b5c-a20d-4e9a-8530-2f94919a8919", "choice_type": "single"} {"question": "In cryptorchism histological changes appear in testis", "exp": "Answer- B. 6 months", "cop": 2, "opa": "4 months", "opb": "6 months", "opc": "8 months", "opd": "1 year", "subject_name": "Surgery", "topic_name": null, "id": "75b0481a-eb4e-462e-b5b8-fd37b16a3d2b", "choice_type": "single"} {"question": "Splenosis means", "exp": "• Splenosis or regeneration of miniscule splenic remnants in the peritoneal cavity\n• May be encountered in cases of traumatic rupture where splenic tissue disseminates throughout the peritoneal cavity.", "cop": 3, "opa": "Infection of spleen", "opb": "Presence of accessory spleen", "opc": "Rupture of spleen and distribution of its tissue on peritoneum", "opd": "Non-functioning spleen", "subject_name": "Surgery", "topic_name": null, "id": "90747c5e-70a5-4bb0-a29a-fd07eba9186c", "choice_type": "single"} {"question": "A female is presented with a breast lump of size 20 cm with no lymphadenopathy no metastasis. Her TNM staging would be", "exp": "T0 - No evidence of primary T1 - Tumor less than 2cm T2 - Tumor of size 2-5cm T3 - Tumor greater than 5cm in greater dimention. T4 - Any tumor with direct extension to chest wall or skin or both. T4a is tumor extending to chest wall while T4b is tumor infiltrating the skin and T4c is tumor showing both chest wall and skin extensions. T4d is inflammatory carcinoma. N0 means no regional lymph nodes. M0 means no metastasis So here the staging is T3N0M0. Reference : SRB's Manual of Surgery, 6th Edition, page no = 532.", "cop": 2, "opa": "T2 N0 M0", "opb": "T3 N0 M0", "opc": "T4a N0 M0", "opd": "T4b N0 M0", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "a640f9f7-1797-418d-b3da-422bc9c02056", "choice_type": "single"} {"question": "Peaud' orange develops due to", "exp": "(Lymphatic obstruction) (837-LB) (839-B & L 25th)Phenomena resulting from lymphatic obstruction In advanced breast cancer(i) Peaud's orange (ii) Cancer-en-cuirasse (iii) LymphangiosarcomaPeaud' orange - is due to cutaneous lymphatic oedema, where the infiltrate skin is fethered by the sweat ducts, it cannot swell leading to an appearance like orange skin. Occasionally the same phenomenon is seen over a chronic abscess", "cop": 2, "opa": "Vascular obstruction", "opb": "Lymphatic obstruction", "opc": "Local spread", "opd": "Endocrinal abnormality", "subject_name": "Surgery", "topic_name": "Breast", "id": "7eaa3cc5-c5d5-45c5-b02f-2236aeb06251", "choice_type": "single"} {"question": "Dye used in chromoendoscopy for detection of cancer", "exp": "Chromoendoscopy is an endoscopic technique that uses stains during endoscopy to highlight differences in mucosa, as well as dysplastic and malignant changes that are not apparent in white light. Chromoendoscopy has been used in the evaluation of Barrett esophagus, esophageal adenocarcinoma, gastric metaplasia and adenocarcinoma, colon polyps , colon cancer, and surveillance in inflammatory bowel disease. Common staining agents used are Lugol solution, methylene blue (gastric metaplasia & carcinoma ), toluidine blue, crystal violet, indigo carmine, congo red, and phenol red.", "cop": 4, "opa": "Gentian violet", "opb": "Toluidine blue", "opc": "Hemotoxiline and eosine", "opd": "Methylene blue", "subject_name": "Surgery", "topic_name": "Urology", "id": "646ed7a8-2116-4c07-a218-004238420ca4", "choice_type": "single"} {"question": "A tumor arising in a burns scar is likely to be", "exp": "Tumor rising from burns scar is marjolins ulcer Marjolin&;s ulcer refers to an aggressive ulcerating squamous cell carcinoma presenting in an areas of previously traumatized,chronically inflamed, or scarred skin.", "cop": 2, "opa": "Basal cell carcinoma", "opb": "Squamous cell carcinoma", "opc": "Malignant melanoma", "opd": "Fibrosarcoma", "subject_name": "Surgery", "topic_name": "General surgery", "id": "28189d48-8e85-42d4-8536-9f692c6e7610", "choice_type": "single"} {"question": "Tensile strength of wound becomes normal after", "exp": "Scar will continue to mature for one to two years. The maturation of collagen(TYPE III to TYPE I) leads to increase in tensile strength in the wound which is maximal at 12th week post injury and represents approximately 80% of uninjured skin strength. Bailey and Love 27th edition Pg: 25", "cop": 2, "opa": "6 weeks", "opb": "Never", "opc": "4 months", "opd": "6 months", "subject_name": "Surgery", "topic_name": "General surgery", "id": "ad89c4c1-c04e-44bc-a663-e61a378e0744", "choice_type": "single"} {"question": "Leriche syndrome is caused in", "exp": "Leriche&;s syndrome involves the blockage of the abdominal aoa as it transitions into the common iliac aeries.Aooiliac obstruction is characterized byClaudication in buttocks, thighs and calvesFemoral and distal pulses absent in both limbsBruit over aooiliac regionImpotence (Leriche)Ref: Bailey and love pg: 944", "cop": 1, "opa": "Aooiliac obstruction", "opb": "Iliac obstruction", "opc": "Femoropopliteal obstruction", "opd": "Distal obstruction", "subject_name": "Surgery", "topic_name": "General surgery", "id": "8a519a55-78e8-4734-9750-3db6696db9f6", "choice_type": "single"} {"question": "A patient is presented with a gunshot wound on 4th intercostal space producing pneumothorax. The suction pressure needed for drainage is", "exp": "Traumatic Pneumothorax Traumatic pneumothoraces can result from penetrating injuries and non penetrating chest trauma. Traumatic pneumothoraces should be treated with tube thoracotomy unless they are very small Iatrogenic pneumothorax is a type of traumatic pneumothorax that is becoming more common Leading cause are transthoracic needle aspiration,thoracocentesis and the inseion of central intravenous catheters Most can be managed with supplemental oxygen or aspiration (presure should be about 20 cmH2O), but if these measures are unsuccessful, a tube thoracostomy should be performed. Ref: Bailey and love 27th edition Pgno : 366", "cop": 3, "opa": "Less than 5cm H2O", "opb": "10 cm H2O", "opc": "20 cm H2O", "opd": "50 cm H2O", "subject_name": "Surgery", "topic_name": "Trauma", "id": "74c399ab-c0e9-42f8-9bda-6357466d2655", "choice_type": "single"} {"question": "Lady with recent delivery engorged shiny mass on breast under nipple fever", "exp": "Answer- A. Breast abscessFeaturesouringbreastabscess :Lactating womanTender swellingPyreiaTense shiny overlying skin", "cop": 1, "opa": "Breast abscess", "opb": "Fibroadenosis", "opc": "Sebaceous cyst", "opd": "Fibroadenoma", "subject_name": "Surgery", "topic_name": null, "id": "0723e551-1148-44aa-8ad9-9fc46ac267bb", "choice_type": "single"} {"question": "Rigler's triad doesn't include", "exp": "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 \n(a) Small bowel obstruction,\n(b) a gallstone outside the gallbladder\n(c) air in the bile ducts(pneumobilia).", "cop": 3, "opa": "Pheumobilia", "opb": "Ectopic stone", "opc": "Cholangitis", "opd": "Intestinal obstruction", "subject_name": "Surgery", "topic_name": null, "id": "371b66c3-9830-4dfe-88a8-61edf6436f20", "choice_type": "single"} {"question": "Infection in burns is most commonly due to", "exp": "Infection in burns is most commonly due to Beta - hemolytic streptococci.", "cop": 2, "opa": "Pseudomonas", "opb": "Streptococci", "opc": "Staphylococci", "opd": "Candida", "subject_name": "Surgery", "topic_name": null, "id": "c757c470-014c-4bf4-b29b-0e5ff5a0bd9b", "choice_type": "single"} {"question": "Carcinoma that doesnot arise from thyroid follicles", "exp": "Medullary carcinoma thyroid arise from parafollicular &;C&; cells. 20-30% of these occur in familial basis as pa of MEN 2A and MEN 2B syndromes Papillary, follicular and anaplastic carcinomas arise from follicular cells Huhle cell crcinoma is a subtype of follicular carcinoma and has more aggresive biological behaviour, compared to other follicular carcinomas of thyroid.", "cop": 1, "opa": "Medullary carcinoma-thyroid", "opb": "Papillary carcinoma-thyroid", "opc": "Anaplastic carcinoma-thyroid", "opd": "Huhle cell carcinoma-thyroid", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "83583d17-5de4-4a68-a642-71f9c40132e1", "choice_type": "single"} {"question": "Inflammatory bowel disease found in children", "exp": ".ULCERATIVE COLITIS * It is an inflammatory condition of rectum and colon of unknown aetiology perhaps related to stress, westernized diet, autoimmune factor, familial tendency, allergic factor. * Disease commonly stas in the rectum, spreads proximally to the colon and often into the ileum as back wash ileitis (5%). * More common in females (2:1), begins in 3rd decade. Watery diarrhoea, mucus or blood stained discharge per rectum. * Colicky pain, spasms. * Decreased appetite and loss of weight. * Relapses and remissions at regular intervals. ref:SRB&;s manual of surgery,ed 3,pg no 824", "cop": 1, "opa": "Ulcerative colitis", "opb": "Tropical sprue", "opc": "Crohn's disease", "opd": "Celiac disease", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "a2ea8c12-9737-4b24-b9bc-313f682459ff", "choice_type": "single"} {"question": "Etiology of bloody discharge from nipple", "exp": "blood stained nipple discharge is obtained in case of duct ectasia,duct papilloma,or carcinomaother nipple discharges of pathological impoance are clear serous discharge and black,greenish discharge. Bailey and Love'sSho practice of surgery.Edition 23.Pg no:753", "cop": 1, "opa": "Duct papiloma", "opb": "Breast abcess", "opc": "Fibroadenoma", "opd": "Cyst", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "1e593e71-7071-4c35-b427-4632ec291eb4", "choice_type": "single"} {"question": "Variant of papillary carcinoma thyroida) Medullaryb) Warthinc) Columnar celld) Insulare) Diffuse sclerosing", "exp": null, "cop": 1, "opa": "cde", "opb": "bae", "opc": "acd", "opd": "cab", "subject_name": "Surgery", "topic_name": null, "id": "0844150f-99e2-4a4b-af89-ded7d08bfc97", "choice_type": "single"} {"question": "Adult polycystic kidney is inherited as", "exp": null, "cop": 2, "opa": "X linked dominant", "opb": "Autosomal dominant", "opc": "Autosomal recessive", "opd": "X-linked recessive", "subject_name": "Surgery", "topic_name": null, "id": "ff813052-7cd0-4d61-ae12-3f64588691ae", "choice_type": "single"} {"question": "The water shed area in the marginal aery of Drummond is at", "exp": "Answer- C. Splenic flexureThe blood supply of colon is derived from the marginal aery of Drummond.It is a paracolic anastomotic aery formed by anastomosis between colic branches of superior mesentric aery ileocolic, right colic, middle colic) and colic branches of inferior muentetic aety (left colic and sigmoidal aeries),", "cop": 3, "opa": "Junction of proximal 2/3rd and distal 1/3' of transverse colon", "opb": "Junction of Ascending and transverse colon", "opc": "Splenic flexure", "opd": "At rectosigmoid junction", "subject_name": "Surgery", "topic_name": null, "id": "0f2dae13-998f-4e19-bb8c-feb015a203c2", "choice_type": "single"} {"question": "The Reynoldis pentad of fever, jaundice, right upper quadrant pain, septic shock and mental status change in typical of", "exp": "Reynold's pentad of acute obstructive cholangitis (suppurative cholangitis-5%)include persistent pain,persistent fever,persistent jaundice,shock(toxicity) & altered mental status.Here,biliary tree contains pus.It usually develop secondary to choledocholithiasis. Reference :SRB's manual of surgery,5th edition,page no:651.", "cop": 1, "opa": "Cholangitis", "opb": "Hepatitis", "opc": "Cholecystitis", "opd": "Pancreatitis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "2fdffa76-a0df-4ae0-8e07-12ab5586eaac", "choice_type": "single"} {"question": "As the thickness of split skin graft increases", "exp": "The thicker the dermis that is taken -Fewer but brisker bleeding points on the donor site The more durable will be the graft once healed (although it might take longer and require more care), Also more difficult will be donor site healingThicker grafts heal with less contracture Bailey and love 26e pg: 403", "cop": 2, "opa": "Donor sites heal better", "opb": "Fewer but brisker bleeding points on the donor site", "opc": "More the wound contracture at recipient site", "opd": "Faster the healing at recipient site", "subject_name": "Surgery", "topic_name": "General surgery", "id": "887110fe-7de0-4bef-9db3-a90ab5acd9f2", "choice_type": "single"} {"question": "Most common cause of bleeding for massive hemothorax in blunt trauma to chest is from", "exp": "Answer- A. Intercostal vesselsThe most common cause of massive haemothorax in blunt injury to chest is continuing bleeding from torn intercostal vexels or occasionallyfrom the internal mammary aety.", "cop": 1, "opa": "Intercostal vessels", "opb": "Bronchial vessels", "opc": "Pulmonary vessels", "opd": "Internal mammary aery", "subject_name": "Surgery", "topic_name": null, "id": "5a787da9-6f9a-429c-bbc0-cb0833505608", "choice_type": "single"} {"question": "Most common biochemical abnormality in congenital pyloric stenosis.", "exp": "Ans. is 'd' i.e. Hypokalemic metabolic alkalosis Repeated vomiting leads to hypochloremic, hypokalemic metabolic alkalosis. The urine is alkaline initially but eventually it becomes acidic (paradoxical aciduria)", "cop": 4, "opa": "Hyperkalemic metabolic acidosis", "opb": "Hypokalemic metabolic acidosis", "opc": "Hyperkalemic metabolic alkalosis", "opd": "Hypokalemic metabolic alkalosis", "subject_name": "Surgery", "topic_name": "Benign Gastric Disease", "id": "ab3e3f04-30f0-4900-91a8-7be8c3859622", "choice_type": "single"} {"question": "Most specific antibody seen in RA", "exp": "Answer- A. Anti CCPThe presence of serum anti-CCP antibodies has about the same sensitivity as serum RF for the diagnosis of RA.However, its diagnostic specificity approaches 95% (most specific for RA), so a positive test for anti-CCP antibodies in the setting of an early inflammatory ahritis is usefrrlfor distinguishing RA from other forms of ahritis.", "cop": 1, "opa": "Anti CCP", "opb": "Rheumatoid factor", "opc": "ANA", "opd": "Anti dsDNA", "subject_name": "Surgery", "topic_name": null, "id": "169bc620-4b33-483f-a61a-dc83101eef37", "choice_type": "single"} {"question": "Fracture of femur at the level of isthmus is best treated by", "exp": "A i.e. Intramedullary nail fixation", "cop": 1, "opa": "Intramedullary nail fixation", "opb": "Plate and screws", "opc": "Closed method", "opd": "External fixation", "subject_name": "Surgery", "topic_name": null, "id": "7546050b-1718-4e96-8bd5-b7af128335fe", "choice_type": "single"} {"question": "Follicular carcinoma of thyroid is best treated by", "exp": null, "cop": 2, "opa": "Hemi thyroidectomy", "opb": "Near total thyroidectomy", "opc": "Sub total thyroidectomy", "opd": "Radiotherapy alone", "subject_name": "Surgery", "topic_name": null, "id": "4d00e674-f630-4882-b72e-a2dfdf3291b5", "choice_type": "single"} {"question": "A new born child presents with inveed foot and the dorsum of the foot cannot touch the anterior tibia. The most probable diagnosis is", "exp": "Examination of CTEV(Clubfoot) Normally the foot of a newborn child can be Dorsi flexed until the dorsum touches the anterior aspect of the shin of the tibia. This is a good screening test for detecting milder variety of club foot. Classic findings Bilateral foot deformity in 60% cases Size of the foot smaller Foot is in equinis, varus and adduction. This can be judged by the Inability to bring the foot in the opposite direction. In late cases in addition cavus of the foot may also be present Heel is small in size, the calcaneum may be felt with great difficulty Deep skin creases on the back of the heel and on the medial side of the sole Bony prominences felt on the lateral side of the foot, the head of the talus and lateral malleolus Outer side of the foot is gently convex. There are dimples on the outer aspect of the ankle. Ref: Textbook of ohopaedics, Maheshwari and Mhaskar 6th edition pgno:212", "cop": 3, "opa": "Congenital veical talus", "opb": "Ahrogryposis multiplex", "opc": "Congenital talipes equino varus", "opd": "Flat foot", "subject_name": "Surgery", "topic_name": "Trauma", "id": "dcf21884-8142-4cae-8c81-522b9c60d56b", "choice_type": "single"} {"question": "Sialosis refers to", "exp": "Sialosis refers to enlargement of salivary gland due to fatty infiltration, as a result of various metabolic causes like diabetes, acromegaly,obesity,liver disease,alcoholism,bulimia,idiopathic,drug induced(sympathomimetics,carbimazole,thiouracil) SRB,5th,409", "cop": 3, "opa": "Bilateral parotitis", "opb": "Sjogren's syndrome", "opc": "Non inflammatory parotid enlargement", "opd": "Bilateral salivary duct ectasia", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "5db1b58f-7c42-44d9-abe8-b49e738ca728", "choice_type": "single"} {"question": "In fracture of femur popliteal aery is commonly damaged by", "exp": "B i.e. Distal fragment lit fracture supracondylar femur, the distal fragmentQ is markedly displaced by gastrocnemius, thus risking to the popliteal aery.", "cop": 2, "opa": "Proximal fragment", "opb": "Distal fragment", "opc": "Muscle haematoma", "opd": "Tissue swelling", "subject_name": "Surgery", "topic_name": null, "id": "a135fc13-5896-462d-bb20-5321a443469d", "choice_type": "single"} {"question": "Two most important clinical features of primary biliary cirrhosisa) Generalized pruritusb) Jaundicec) Fatigued) Clubbinge) Hematemesis", "exp": "• MC indication for LT: Cirrhosis from Hepatitis C (HCV)\n• 2nd MC indication for LT: Alcoholic liver disease\n• MC indication for LT in children: Biliary atresia\n• MC metabolic disorder requiring LT: Alpha-1 antitrypsin deficiency\n• MC indication for LT following acute liver failure: Acetaminophen toxicity\n• Sepsis and sepsis-induced multiple organ failure are the MC causes of death in liver transplantation.", "cop": 3, "opa": "a", "opb": "bc", "opc": "ac", "opd": "b", "subject_name": "Surgery", "topic_name": null, "id": "16d25fdb-45fe-4c6b-9081-91b55d07ecec", "choice_type": "single"} {"question": "Site of transplantation in Islet cell transplant for diabetes mellitus", "exp": "• The islets are then purified from the dispersed tissue by density-gradient centrifugation and can be delivered into the recipient liver (the preferred site for transplantation) by injection into the portal vein.", "cop": 4, "opa": "Forearm muscles", "opb": "Pelvis", "opc": "Thigh", "opd": "Injected into the portal vein", "subject_name": "Surgery", "topic_name": null, "id": "329f7d41-8601-434f-be72-fcca65d69ef6", "choice_type": "single"} {"question": "Drug approved for advanced prostate cancer", "exp": "Drugs used in advanced prostate cancer are : *LHRH agonists ( medical castration ) - leuprolide, goserelin *Phosphorylated diethylstilbestrol *Androgen receptor blocking agents like flutamide, bicalutamide *Cyproterone acetate (also has progestogenic effect ) Ganirelix, cetrorelix and abarelix are GnRH antagonists Reference : page 1050 SRB's manual of surgery 5th edition", "cop": 3, "opa": "Abarelix", "opb": "Cetrorelix", "opc": "Goserelin", "opd": "Ganirelix", "subject_name": "Surgery", "topic_name": "Urology", "id": "2f3cd871-56a6-4765-b0b0-150f93906ba5", "choice_type": "single"} {"question": "Psuedoaneurysm in I.V.drug abusers is commonly found in", "exp": "Pseudoaneurys Most common cause : Trauma (penetrating trauma or iotrogenic by catheterization) MC aery involved : Radial aery Treatment Ligation is the optimal treatment for infected pseudoaneurysm because it is easy, safe and cost effective (in IV drug abuser there is high chance of infection) RReconstruction is not recommended because of extension of infection at location of pseudoaneurysm and at aificial graft site Ref: Rutherford vascular surgery 6th edition pvolume II Pgno : 248-249", "cop": 3, "opa": "Radial aery", "opb": "Brachial aery", "opc": "Femoral aery", "opd": "External iliac aery", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "eafdce73-5471-4379-a74e-1270d021c135", "choice_type": "single"} {"question": "An itching wound suggests a", "exp": null, "cop": 1, "opa": "Hypersensitivity reaction", "opb": "Infection", "opc": "Contraction", "opd": "Separation", "subject_name": "Surgery", "topic_name": null, "id": "5b97d6c9-f4a7-4375-81cd-c6d22fd41dcb", "choice_type": "single"} {"question": "Posterior right subhepatic intraperitoneal space is", "exp": "Posterior right subhepatic intraperitoneal space is called morrison&;s pouch. Morison&;s pouch is the space that separates the liver from the right kidney. As a potential space, the recess is not filled with fluid under normal conditions. However, fluid can collect in this space in circumstances where the abdomen fills with fluid, such as hemoperitoneum Its one of the four regions seen in FAST scan", "cop": 4, "opa": "Lesser sac", "opb": "Hepatorenal pouch", "opc": "Superior pa of supracolic compament", "opd": "Morrison's pouch", "subject_name": "Surgery", "topic_name": "General surgery", "id": "c66eb51c-3896-4a53-92cb-993d5b816877", "choice_type": "single"} {"question": "This has increased risk of", "exp": "This is a cutaneous horn. Actinic (solar) keratoses (AK), i.e. cutaneous horns and keratoacanthomas, were considered to be premalignant lesions leading to SCC. Ref: Bailey and Love, 27e, page: 606", "cop": 1, "opa": "Squamous cell carcinoma", "opb": "Basal cell carcinoma", "opc": "Melanoma", "opd": "Liposarcoma", "subject_name": "Surgery", "topic_name": "General surgery", "id": "0f556558-7094-423d-b38d-3171b0d6955c", "choice_type": "single"} {"question": "Best treatment of 3 weeks old, fracture shaft femur with nonunion is", "exp": "A i.e. Bone grafting with internal fixation", "cop": 1, "opa": "Bone graft with internal fixation", "opb": "External fixation", "opc": "Internal fixation only", "opd": "Prosthesis", "subject_name": "Surgery", "topic_name": null, "id": "30c23d25-1f5b-4173-9398-ab3387034473", "choice_type": "single"} {"question": "Mechanical bowel obstruction is differentiated from paralytic ileus in X rays by", "exp": "Answer: a) Absence of rectal gas shadow (BAILEY 26th ED, P-1189)INTESTINAL OBSTRUCTIONProximal small bowelDistal small bowelLarge bowel* Vomiting early and profuse* Minimal distension* Colicky pain* Peristalsis not seen* Little evidence of air fluid levels in X-ray* Pain - intermittent, colicky* Central distension* Vomiting delayed (bilious)* Step ladder peristalsis* Multiple air fluid levels* Pronounced early distension* Pain is mild* Vomiting (faeculent) and dehydration are late* Right to left peristalsis may be seen* Proximal colon and caecum are distended on X-rayJejunum - Concertina or ladder effect due to valvulae conniventes (Herring bone pattern)Fluid levels appear later than gas shadowThree inconstant fluid levels in adults (considered normal)Fundus of stomachDuodenal capTerminal ileumFew fluid levels in the small intestine may be physiological in infants less than 1 yearFluid levels in non obstructive conditions (Inflammatory bowel disease, Acute pancreatitis, Intraabdominal sepsis)PARALYTIC ILEUSFailure of transmission of peristaltic waves secondary to neuromuscular failureIntestinal obstruction/slowing/absence of passage of luminal contents without a demonstrable mechanical obstructionEtiologyPost operativeA degree of ileus usually occurs after any abdominal procedureSelf-limiting (24-72 hours)May be prolonged in Hypoproteinemia or metabolic abnormalityIntra-abdominal inflammation(peritonitis, abscess, retroperitoneal hemorrhage)Reflex ileus: following fractures of spine/ribs, retroperitoneal hemorrhage or application of a plaster jacketMetabolic & electrolyte derangements (uremia, hypokalemia, hyponatremia, hypo and hypomagnesemia, diabetic coma, hypoparathyroidism, hypothyroidism)Drugs (opiates, psychotropic agents, anticholinergic agents, calcium channel blockers)Intestinal ischemia; Myocardial infarction; Ureteric colicClinical featuresAbdominal distension usually without colicky abdominal painNausea, vomiting, absent bowel sounds and absolute constipationNo passage of flatusIn the absence of gastric aspiration, effortless vomiting may occur X-Ray: gas filled small and large bowel loops with multiple air fluid levelsTreatmentNasogastric decompression, IV fluids, electrolyte managementTreat the underlying causeCatchpole regime: adrenergic blocking agent + cholinergic stimulant (neostigmine) used in resistant casesParalytic ileusMechanical Obstruction* Generalized, uniform, gaseous distension of the large and small bowel* Diffuse air fluid levels* Involvement of large bowel and lack of a transition point* Quiet abdomen* Dilated loops of small bowel proximal to the obstruction; no air in colon* Step ladder air/fluid levels* Transition point seen* Valvulae conniventes are visible in jejunum (concertina or ladder effect)* Featureless ileum* Initially active peristalsis; later quite", "cop": 1, "opa": "Absence of rectal gas shadow", "opb": "Elevated hemidiaphragm", "opc": "Dilated bowel loops", "opd": "Multiple air fluid levels", "subject_name": "Surgery", "topic_name": "Intestinal Obstruction", "id": "384592e6-2e12-44f8-ad43-2978ff07f736", "choice_type": "single"} {"question": "Luxatio erecta", "exp": "B i.e. Inferior dislocation of shoulder Inferior (downward/ sub- glenoid) dislocation of shoulder is known as luxatio erectaQ.Inferior Dislocation of Shoulder* It is caused by severe hyper abduction force. With the humerus as the lever and acromian as fulcrum, the humeral head is lifted across the inferior rim of glenoid socket and pokes into axilla (subglenoid position).* It is rare and also called luxatio erecta because the humeral head is subluxated (dislocated inferiorly and humerus shaft points upwards (erected).* The staling picture of a patient with his / her arm locked in almost full abduction/ elevation(2, should make diagnosis quite easy. The patient comes with his arm fixed almost by the side of his head.* Potentially serious consequences eg neurovascular damage is quite common.* Reduced by pulling upwards in the line of abducted arm with counteraction downwards.", "cop": 2, "opa": "Tear of the glenoidal labium", "opb": "Inferior dislocation of shoulder", "opc": "Anterior dislocation of shoulder", "opd": "Defect in the humeral head", "subject_name": "Surgery", "topic_name": null, "id": "130a91cd-ff42-403c-a0e4-c2f9a9bbd614", "choice_type": "single"} {"question": "A cold nodule in thyroid scintiscan mean", "exp": null, "cop": 3, "opa": "Nodule which is cold", "opb": "Hyperactive nodule", "opc": "Nodule which is nonfunctioning & malignant", "opd": "Nodule which has no signs of inflammation", "subject_name": "Surgery", "topic_name": null, "id": "543b141c-025d-4360-9e46-4f4f87894d9b", "choice_type": "single"} {"question": "The common presentation of duct papilloma of the breast is", "exp": "True polyps of epithelium lined breast ducts Benign and not precancerous Solitary and located under areola Less than 1 cm in size and can grow up to 4-5 cms Most common presentation is bloody nipple discharge\nTreatment - excision of duct along with tumor known as duct excision", "cop": 1, "opa": "Bloody nipple discharge", "opb": "Mass in breast", "opc": "Breast eczema", "opd": "Pagets disease", "subject_name": "Surgery", "topic_name": null, "id": "a59dbf5b-3293-493c-974a-26efd02de6b4", "choice_type": "single"} {"question": "Commonest symptom of pheochromocytoma is", "exp": "Ans. is 'b' i.e., Headache Hypeension is the most common symptom of pheochromocytoma followed by headache > Sweating > Palpitation.", "cop": 2, "opa": "Palpitation", "opb": "Headache", "opc": "Sweating", "opd": "Dyspnoea", "subject_name": "Surgery", "topic_name": null, "id": "c348fc34-35b6-4a83-bf83-2dc3e5f2f730", "choice_type": "single"} {"question": "The most common type of supracondylar fracture is", "exp": "C i.e. Extension", "cop": 3, "opa": "Neutral", "opb": "Flexion", "opc": "Extension", "opd": "Lateral", "subject_name": "Surgery", "topic_name": null, "id": "5fe72644-44d6-49d2-abfa-fe0e449401d8", "choice_type": "single"} {"question": "Characteristic feature of malignant gastric ulcer seen on Barium meal", "exp": "Radiological features of Benign gastric ulcer Collection of barium on dependent wall Round, oval, linear in shape with a ring shadow May project beyond the gastric lumen Hampton's line- a thin lucent line crossing the ulcer base Ulcer collar- thicker smooth rim of lucency at the ulcer base Ulcer mound- with increasing edema, symmetrically gently sloping mass can be seen. Features suspicious for malignancy Location within fundus or proximal half of greater curvature Incomplete healing Loss of mucosal pattern Carmen meniscus sign- characterized by lentiform shaped appearance of inner margin.", "cop": 2, "opa": "Hampton line", "opb": "Carman meniscus sign", "opc": "Ulcer cap", "opd": "Ulcer crater", "subject_name": "Surgery", "topic_name": "GIT", "id": "1c18d74c-f95d-4798-b5d1-ae23adb41e47", "choice_type": "single"} {"question": "Ileal obstruction due to round worm obstruction treatment is", "exp": "If the bowel wall is healthy, enterotomy and removal of the worms may be performed Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-53", "cop": 3, "opa": "Resection with end to end anstomosis", "opb": "Resection with side to side anastomosis", "opc": "Enterotomy, removal of worms and primary closure", "opd": "Diversion", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "d0153b0a-5aa4-40c9-96f8-48645f7a10b6", "choice_type": "single"} {"question": "Treatment of Anal canal stage 2 is", "exp": "AJCC staging for anal canal cancers is based on the size of the tumor and local invasion of adjacent organs or structures.A tumor that is 2 cm or smaller is designated T1, larger than 2 cm but not more than 5 cm is T2, and larger than 5 cm is T3. Any size tumor that invades a local structure is designated T4. Staging of disease includes CT of the chest, abdomen, and pelvis and pelvic MRI. Positron emission tomography scanning should be considered for larger (T2 or greater) tumors or any node-positive disease. HIV testing and checking a CD4 count should also be considered if indicated. Historically, treatment consisted of surgery alone or radiation therapy alone. Epithelial or subepithelial tumors were locally excised, and more advanced lesions underwent APR. The introduction of multimodality therapy combining chemotherapy andradiation therapy promised to preserve continence, to avoid colostomy, and to offer similar or improved survival. Nigro was the first to promote radiation therapy with chemotherapy as definitive treatment for squamous cell cancers of the anal canal. The current protocol includes infusional 5-FU with mitomycin C and external beam radiation to the pelvis with a minimum dose of 45Gy. The inguinal nodes, pelvis, anus, and perineum should be included in the radiation fields. Patients with T2 lesions and residual disease after 45 Gy, T3 or T4 tumors, or node-positive disease are usually treated with an additional 9 to 14 Gy for a total dose of 54 to 59 Gy. In patients treated with APR for persistent or locally recurrent disease, 5-year actuarial survival is repoed at 57%.46 Despite high success rates with definitive chemoradiotherapy, 15% to 30% of patients will have recurrence or fail to respondcompletely.47 Patients with persistent disease up to 6 months after treatment generally require APR. Those who have local recurrence are also recommended for APR. In the setting of isolated inguinal node recurrence, groin dissection is generally required with consideration for radiation therapy to the inguinal node basins if no prior radiotherapy was given. Up to 50% of patients treated with salvage APR can expect a 5-year cure. This is compared with approximately 27% of patients treated with salvage radiation and concurrent cisplatin-based chemotherapy who can expect cure. In those patients presenting with anal squamous cell carcinoma in the setting of HIV infection, disease severity (CD4 count and use of antiretroviral therapy) has a significant impact on success of standard chemoradiation. The current consensus is that standard protocols for chemoradiotherapy should be attempted, regardless of HIV status, and that medical management of the patient's HIV infection be optimized. The 2-year survival rates for HIV-positive patients have been repoed to be the same as for HIV-negative patients, 77% and 75%, respectively Ref: Sabiston 20th edition Pg no : 1415", "cop": 1, "opa": "Chemoradiation", "opb": "Abdominoperineal resection", "opc": "Chemotherapy and surgery", "opd": "Radiotherapy only", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "e4ae2761-4adb-4703-9870-be41cebbc49d", "choice_type": "single"} {"question": "Degree of burns in a patient with blister formation is", "exp": "Blisters are formed when only papillary dermis is destroyed.", "cop": 1, "opa": "2nd degree superficial", "opb": "2nd degree deep", "opc": "1st degree burns", "opd": "Full thickness burns", "subject_name": "Surgery", "topic_name": null, "id": "eec2ff51-7dcf-4297-8d1f-bcee7387d4a1", "choice_type": "single"} {"question": "Burkitt's Lymphoma commonly affects", "exp": "Burkitt's Lymphoma is common in Jaw.", "cop": 1, "opa": "Jaw", "opb": "Stomach", "opc": "Spleen", "opd": "kidneys", "subject_name": "Surgery", "topic_name": null, "id": "0fa4dabc-f1c2-4458-b669-cc89f71afc44", "choice_type": "single"} {"question": "Best surgery for grade IV hemorroids", "exp": "Stapled hemorroidopexy is surgery of choice for grade IV hemorrhoids.", "cop": 4, "opa": "Open hemorroidectomy", "opb": "Sclerotherapy", "opc": "Ligation of artery", "opd": "Stapled hemorroidopexy", "subject_name": "Surgery", "topic_name": null, "id": "505e3390-918a-47fb-a47d-18ca91d19be0", "choice_type": "single"} {"question": "The Least common quadrant in cancer breast is", "exp": "Ans. (d) Lower inner(Ref: Bailey and Love Principles and Practice of Surgery, 26th ed p-811)* MC site - Upper outer* Least Common - Lower Inner", "cop": 4, "opa": "Superior outer", "opb": "Inferior outer", "opc": "Sub areolar", "opd": "Lower inner quadrant", "subject_name": "Surgery", "topic_name": "Breast", "id": "40adecf7-a165-4369-a483-0752a0391893", "choice_type": "single"} {"question": "Most common cause of hemobilia is", "exp": "Hemobilia is bleeding commonly from the liver or occasionally from the gallbladder into the biliary tract.Accidental trauma,iatrogenic trauma (50%) is the most common cause.In accidents,Hemobilia is more commonly caused by blunt trauma than penetrating one.Other causes include Vascular diseases of hepatic aery,malignant and benign liver diseases,poal hypeension,parasitic liver diseases,etc. Reference:SRB's manual of surgery,5th edition,page no:662", "cop": 2, "opa": "Carcinoma", "opb": "Iatrogenic trauma", "opc": "Blunt trauma", "opd": "Cirrhosis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "1dee1a14-07c6-4466-8b8c-93fc1702c4d8", "choice_type": "single"} {"question": "The most common malignancy found in Marjolin&;s ulcer is", "exp": "Marjolin's Ulcer Low grade SCC, which develops on a chronic benign ulcer or a long standing scar tissue Arises from the edge of the ulcer. Marjolin's ulcer may develop in Post burn scar Long standing venous ulcer Chronic ulcer due to trauma. Chronically discharging osteomyelitis sinus Post - radiation ulcer Ref: schwaz's principle of surgery 10th edition Pgno :259", "cop": 2, "opa": "Basal cell carcinoma", "opb": "Squamous cell carcinoma", "opc": "Malignant fibrous histiocytoma", "opd": "Neutrophic malignant melanoma", "subject_name": "Surgery", "topic_name": "General surgery", "id": "a2619b2e-b465-4dac-8d80-e137521cde06", "choice_type": "single"} {"question": "The most common dislocation of TM] is", "exp": null, "cop": 1, "opa": "Anterior", "opb": "Posterior", "opc": "Medial", "opd": "Lateral", "subject_name": "Surgery", "topic_name": null, "id": "35853964-3c63-4743-9477-cf3b5e3d61f6", "choice_type": "single"} {"question": "Treatment with herceptin in breast cancer is indicated for", "exp": "Treatment with herceptin in breast cancer is indicated for Tumours with over-expressed C-erb B-2 protein it is a inhibitor of C-erb B-2 protein, which is a growth factor receptor also known as Transtuzumab it is currently approved by FDA for use only in metastatic disease ref ;(page no;551) 5th edition of SRB&;S Manual of SURGERY", "cop": 4, "opa": "ER receptor +ve tumours", "opb": "PR receptor +ve tumours", "opc": "K : 67 stain +ve tumours", "opd": "Tumours with over-expressed C-erb B-2 protein", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "afbd06a3-a8fd-4b58-ab92-353f4de67abf", "choice_type": "single"} {"question": "Mainstay treatment of primary hyperparathyroidism is", "exp": "The mainstay of treatment for PHPT is surgery. All symptomatic patients and asymptomatic patients with bone resorption or hypercalcemia are offered surgical intervention.Where a single adenoma ie one gland) has been confidently identified by radiological means, a minimally invasive parathyroidectomy may be offered. Else a three and a half-gland parathyroidectomy or a four gland parathyroidectomy and autotransplantation should be performed.All other options are pa of medical management.Medical management is warranted in patients who are deemed unfit or who have contraindications to surgical intervention, in patients with failed surgical intervention or in the long-term management of parathyroid carcinoma.Ref: Bailey and Love 27e pg: 829", "cop": 4, "opa": "Bisphosphonates", "opb": "Hormone relacement therapy", "opc": "Calcimimmetics", "opd": "Surgery", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "50ffd49e-d692-4459-9590-153fd8e4776f", "choice_type": "single"} {"question": "Reactionary hemorrhage is hemorrhage after surgery that occurs", "exp": null, "cop": 1, "opa": "Within 24 hours", "opb": "After 24 hour", "opc": "After 72 hours", "opd": "After 7 days", "subject_name": "Surgery", "topic_name": null, "id": "95408b63-1769-49b4-bfb9-9956addb3d4d", "choice_type": "single"} {"question": "Gold standand for diagnosis of carotid body tumour is", "exp": null, "cop": 2, "opa": "Duplex scanning", "opb": "MRI", "opc": "Computed Tomography", "opd": "Cerebral angiography", "subject_name": "Surgery", "topic_name": null, "id": "a8a22778-3992-4e50-8b28-1ec5e121eb9e", "choice_type": "single"} {"question": "Blunt injuries to the abdomen", "exp": "Ans. is 'b' i.e., Rarely need urgent laparotomy Non operative treatment is the rule rather than exception Schwaz writes- \"Over the past 20 years there has been a remarkable change in management practices and operative approach for the injured patient. With the advent of CT scanning, nonoperative management of solid organ injuries has replaced routine operative exploration. Those patients who do require operation may be treated with less radical resection techniques such as splenorrhaphy or paial nephrectomy. Colonic injuries, previously mandating colostomy, are now repaired primarily in viually all cases. Additionally, the type of anastomosis has shifted from a double-layer closure to a continuous running single-layer closure; this method is technically equivalent to and faster than the interrupted multilayer techniques. Adoption of damage control surgical techniques in physiologically deranged patients has resulted in limited initial operative time, with definitive injury repair delayed until after resuscitation in the surgical intensive care unit (SICU) with physiologic restoration. Abdominal drains, once considered mandatory for parenchymal injuries and some anastomoses, have disappeared; fluid collections are managed by percutaneous techniques.\"", "cop": 2, "opa": "May cause peritonitis", "opb": "Rarely need urgent laparotomy", "opc": "May cause intestinal obstruction", "opd": "May cause gastroduodenal ulceration", "subject_name": "Surgery", "topic_name": null, "id": "6d1cd210-9c10-45a3-bae1-3f7f18ad551c", "choice_type": "single"} {"question": "Treatment of choice of flail chest chest is", "exp": null, "cop": 3, "opa": "External fixation of flail segment and mechanical ventilation", "opb": "Strapping", "opc": "O2 administration", "opd": "Intrapleural local analgesia", "subject_name": "Surgery", "topic_name": null, "id": "57cc7e3d-7526-4b88-b8d8-04272842860b", "choice_type": "single"} {"question": "Transitional cell carcinoma is seen in", "exp": "Ans. (d) Urinary bladderRef: Bailey & Love 26th ed. /1330-35* Transitional cell epithelium lines -> the urinary tract from the renal pelvis to the ureter, urinary bladder, and the proximal two-thirds of the urethra.* Transitional cell carcinoma-Cancers can occur at any point mentioned above:# 90% of malignancies develop in the bladder# 8% in the renal pelvis# 2% in the ureter or urethra.Salient features about urothelial tumors* Bladder cancer is the fourth (4th) most common cancer in men and the thirteenth (1 +3=4) in women.* Among urothelial tumors-95% are transitional cell in origin.* Others are- Pure squamous cancers with keratinisation constitute 3%, adenocarcinomas 2%, and small cell tumors (often with paraneoplastic syndromes) <1%. Adenocarcinomas* Polychronotropism -urothelial tumors exhibit polychronotropism, which is the tendency to recur over time in new locations in the urothelial tract.* Most imp risk factor- Cigarette smoking* Other- aniline dyes, drugs phenacetin and chlornaphazine, external beam radiation. Chronic cyclophosphamide ,Schistosoma haematobium(a parasite-cause both see and tcc)* Vitamin A - protective.* 3 clinical subtypes-# Superficial (75%)# Invade muscle (20% )# Metastatic (5%)* Clinical presentation# Hematuria (painless)- Most common presentation (80-90% of cases)# Irritative bladder symptoms such as dysuria, urgency, or frequency of urination occur in 20-30% of patients with bladder cancer.* The bladder is the most common source of gross hematuria (40%),* Among bladder causes benign cystitis (22%) > bladder cancer (15%) as a cause of hematuria* Microscopic hematuria- is more commonly of prostate origin (25%)* MC site of lymphatic metastasis: -pelvic lymph nodes (obturator MC)* MC site of hematogenous spread- LIVER > LUNG* Diagnosis- diagnosis and initial staging is made by cystoscopy and TUR.# Newer; voided urine assays (i.e., bladder tumor antigen , NMP-22, fibrin/fibrinogen degradation products ) are being used for the detection and surveillance of urothelial carcinoma.* Management-cystoscopy and TUR or biopsy* Further management depends on stage, grade, size, multiplicity, recurrecnce pattern* Drugs for intravesical chemo- Mitomycin,Thiotepa, Epirubicin,BCG (most effective)", "cop": 4, "opa": "Prepuce", "opb": "Testis", "opc": "Prostate", "opd": "Urinary bladder", "subject_name": "Surgery", "topic_name": "Bladder Cancer", "id": "f8a7e7dc-426f-4774-9d6a-a59413a8ca5b", "choice_type": "single"} {"question": "Gold standard test for for insulinoma", "exp": "72 hr fasting test [Ref: Harrison 17/e p23541 \"The most reliable test to diagnose insulinonza is a fast up to 72 h with serum glucose, C-peptide, and insulin measurements every 4-8 h.\" -Harrison An insulinoma is an endocrine tumor of the pancreas derived from beta cells that ectopically secretes insulin, which results in hypoglycemia. The clinical symptoms are because of the effects of hypoglycaemia (sweating, tremor, palpitations, confusion, headache, disorientation, visual difficulties, irrational behavior, or even coma) The diagnosis of insulinoma requires the demonstration of an elevated plasma insulin level at the time of hypoglycemia. This is because insulinomas do not reduce the secretion of insulin in the presence of hypoglycaemia. Whereas in a normal person, insulin levels would decrease with decrease in blood glucose levels. The most reliable test to diagnose insulinoma is a fast up to 72 h with serum glucose, and insulin measurements every 4-8 h. The test is terminated if the the patient becomes symptomatic or glucose levels are <40 mg/dL (2.2 mmol/L). Diagnosis of insulinoma is made if: - A serum insulin level of 6 microunit/mL or more in the presence of blood glucose values below 40 mg/dL - ratio of plasma insulin to glucose is > 0.3 In addition to the above criteria, some other measurements are also required before making the diagnosis of insulinoma - C-peptide level - serum proinsulin level, - serum sulfonylurea levels These additional tests are used because any hidden use of insulin or oral hypoglycemics taken by the patient would resemble insulinoma causing high levels of insulin in presence of hypoglycaemia. The combination of elevated proinsulin levels (normal in exogenous insulin/hypoglycemic agent users), elevated C-peptide levels (low in exogenous insulin users), antibodies to insulin (positive in exogenous insulin users), and measurement of sulfonylurea levels in serum or plasma will allow the correct diagnosis to be made.", "cop": 1, "opa": ">72 hr fasting test", "opb": "Plasma insulin levels", "opc": "C-paptide levels", "opd": "Low glucose levels < 30 mg/di", "subject_name": "Surgery", "topic_name": null, "id": "88e15b64-8611-4ca0-aa8e-c57708e6ee91", "choice_type": "single"} {"question": "Investigation of choice for vesicoureteric reflex", "exp": "MCU is IOC for vesicoureteric reflex.", "cop": 2, "opa": "USG KUB", "opb": "Micturating cystourethrography", "opc": "CT", "opd": "MRI", "subject_name": "Surgery", "topic_name": null, "id": "abe18c83-edea-4c45-b412-ca1cee875e10", "choice_type": "single"} {"question": "During appendectomy if it is noticed that base of appendix is inflamed then further line of treatment is", "exp": "The following steps are usually followed in appendectomy\n\nThe base of the appendix is crushed with an artery forceps (No longer recommended).\nThe base is then ligated with an absorbable suture.\nDistal to the ligature the appendix is divided.\nA purse string suture is applied in the cecal wall around the base of the appendix. The purse string suture is tightened and the appendix stump is invaginated into the cecum. (This step has also lost its popularity and there are surgeons who are in favour of simple ligation and amputation only).\n\nMethods adopted in special circumstances\n\nWhen the cecal wall is edematous & inflamed\n\n→ purse string suture is not applied and the stump is not invaginated.\n\nWhen the base of the appendix is inflamed\n\n→ the base is not crushed for the fear of the spread of infection by way of lymphatics and bloodstream. It is ligated close to the cecum, after which the appendix is amputated and the stump invaginated.\n\nIf the base is gangrenous\n\n→it is neither crushed nor ligated. Two stitches are placed through the cecal wall close to the base of the appendix, which is amputated flush with the cecal wall after which these stitches are tied. Further closure is effected by means of the second layer of interrupted sutures.", "cop": 2, "opa": "No appendicectomy", "opb": "No burrying of stump", "opc": "Hemicolectomy", "opd": "Cecal resection", "subject_name": "Surgery", "topic_name": null, "id": "72597fcd-f3e9-4627-81f5-db26cdae1e3e", "choice_type": "single"} {"question": "Borchardt's triad of acute epigastric pain, violent retching and inability to pass a nsogastric tube is seen in patients with", "exp": "A volvulus is a twisting or axial rotation of a portion of bowel about its mesentery.\nWhen complete it forms a closed loop of obstruction with resultant ischaemia secondary to vascular occlusion.", "cop": 1, "opa": "Acute gastric volvulus", "opb": "Achalasia cardia", "opc": "Jejunogastric intussusception", "opd": "Hitus hernia", "subject_name": "Surgery", "topic_name": null, "id": "7afd0a9f-a136-4321-8093-bd40f8ba0c22", "choice_type": "single"} {"question": "Serum calcitonin is a marker for", "exp": null, "cop": 3, "opa": "Anaplastic carcinoma", "opb": "Papillary carcinoma", "opc": "Medullary carcinoma", "opd": "Follicular carcinoma", "subject_name": "Surgery", "topic_name": null, "id": "00579846-3366-4f9c-800c-6b7463709d19", "choice_type": "single"} {"question": "The commonest cancer of oral cavity is", "exp": "Ans. (d) Squamous cell carcinomaRef: Devita 9th edition, page 729* Most common site oral Cancer: Carcinoma Tongue > Carcinoma Lip* Most common histological type: Squamous Cell Cancer* Most common site of oral Cancer in India: Cancer of Buccal Mucosa* Max Risk of L.N. Metastasis: Carcinoma Tongue* Min Risk of L.N Metastasis: Carcinoma lip > hard palate* Most common age: 50-60 years", "cop": 4, "opa": "Adenocarcinoma", "opb": "Melanoma", "opc": "Sarcoma", "opd": "Squaous cell carcinoma", "subject_name": "Surgery", "topic_name": "Oral Cavity", "id": "01c76cc9-44a5-47c4-934f-31b672b30f79", "choice_type": "single"} {"question": "Cocket & Dodd's operation is for", "exp": null, "cop": 2, "opa": "Saphenofemoral flush ligation", "opb": "Subfascial ligation", "opc": "Deep vein thrombosis", "opd": "Diabetic foot", "subject_name": "Surgery", "topic_name": null, "id": "ae226df4-32c7-4788-87fd-c9921f93a95b", "choice_type": "single"} {"question": "A patient presented with local gigantism of the leg and increased pulsations of the lower limb veins. Most probable diagnosis is", "exp": "The patient is having congenital AV fistula which has caused overgrowth of the leg. Aeriovenous fistula (AVF) AVF may be congenital or acquired (by the trauma of a penetrating wound, or surgically created for renal dialysis) Structural effect on veins - Veins are aerialised*, they become dilated touous and thick walled. Physiological effects of fistula - Increased pulse pressure (Increased systolic & decreased diastolic) Enhanced venous return result in Increased HR* and Increased CO*. Left ventricular enlargement and later cardiac failure may occur A congenital fistula in the young may cause overgrowth of limb*. In the leg, indolent ulcers may result* from relative ischemia below the sho circuit. Clinical signs A pulsatile swelling* A thrill on palpation* Continuous bruit on auscultation* Nicoladonis sign' or Branham sign* - Pressure on the aery proximal to fistula causes the swelling to diminish in size, a thrill or bruit to cease, the pulse rate to fall and the pulse pressure return to normal. Ref : Bailey & Love 25/e p923", "cop": 2, "opa": "Varicose veins", "opb": "AV fistula", "opc": "Buerger disease", "opd": "Tumour", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "eb6dbaa7-ae78-445d-bf98-13f833983e0c", "choice_type": "single"} {"question": "During blood transfusion, clotting of transfused blood is associated with", "exp": "Most transfusion reactions are hemolytic and are due to clerical errors that result in administration of blood with major (ABO) and minor antigen incompatibility. Interestingly, Rh incompatibility is not associated with intravascular hemolysis. Administration of blood through hypotonic solutions such as 5% dextrose and water results in swelling of the erythrocytes and hemolysis. Calcium-containing solutions such as Ringer's lactate cause clotting within the intravenous line rather than hemolysis and may lead to pulmonary embolism. Delayed transfusion reactions, caused by a presumed anamnestic immune response that occurs 3-21 days after blood is infused, result in a hemolytic anemia.", "cop": 4, "opa": "ABO incompatibility", "opb": "Minor blood group incompatibility", "opc": "Rh incompatibility", "opd": "Transfusion through Ringer's lactate", "subject_name": "Surgery", "topic_name": "Blood Transfusion", "id": "96a6ceaa-60e1-4dbe-8bbe-216e1e101a25", "choice_type": "single"} {"question": "Low and fixed specific gravity of urine is seen in", "exp": "Normal specific gravity of urine is 1.015 - 1.025. Theoretical extremes are 1.003 to 1.032. The specific gravity will be decreased(hyposthenuria) in excessive water intake, in chronic nephritis, in acute glomerulonephritis, in pyelonephritis and in diabetes insipidus. It is increased(hypersthenuria) in diabetes mellitus, in nephrosis and in excessive perspiration. In chronic renal failure, the specific gravity of urine is low and fixed at 1.010 (isosthenuria). The earliest manifestation of renal damage may be the inability to produce concentrated urine. Reference : page 317-18 Textbook of Biochemistry D M Vasudevan 6th edition", "cop": 3, "opa": "Diabetes mellitus", "opb": "Diabates insipidus", "opc": "Chronic renal failure", "opd": "Acute glomerulonephritis", "subject_name": "Surgery", "topic_name": "Urology", "id": "5623dc06-f9e4-4b3e-957f-4e6c163f6b1f", "choice_type": "single"} {"question": "Main cause of congestive splenomegaly.", "exp": "Ans. (d) Banti syndromeRef: Internet sourcesBanti syndrome:* Congestive splenomegaly caused by obstruction of Portal veins, Splenic Veins, Hepatic veins resulting in Portal hypertension, Ascites, Thrombocytopenia, Leukopenia and Upper GI haemorrhage.", "cop": 4, "opa": "CCF", "opb": "Malaria", "opc": "DIC", "opd": "Banti syndrome", "subject_name": "Surgery", "topic_name": "Liver", "id": "341ab70f-bfa2-4b74-a87f-38590a7e040d", "choice_type": "single"} {"question": "Pelvi ureteric junction obstruction in hydronephrosis. Best diagnosis with", "exp": "[Cl i.e. (Nuclear imaging): (1294-Bailey & Love 25th)Isotope renography (Diuretic nuclear renal scan) is the best test to establish that dilatation of the renal collecting system is caused by obstruction 99m Tc labelled DTPA or MAG-3 passage through the kidneys can be tracked using a gamma camera 99mTc DTPA is quickly clearedfrom a normal kidney but is trapped in the renal pelvis on the obstructed side and will not be washed out even if the flow of urine is increased by administering furosemide* USG - regularly used to diagnose PUJ obstruction in utero* Excretion urography is only helpful if there is significant function in the obstructed kidney* Retrograde pyelography is rarely indicated but will confirm the site of obstruction immediately before corrective surgeryCongenital PUJ obstruction* Cong PUJ obstruction is the most common cause of significant dilatation of the collecting system in the fetal kidney* More common in boys (2:1)* Usually unilateral but bilateral in 10-40%*** More common in left side** Associated anomaliesa. Renal dysplasiab. Multicystic dysplastic kidneyc. Renal agenesis**d. Vesico-ureteric refluxe. PUJ obstruction was noted in 21% of children with the VATER group of anomalies* Most common presentation of cong PUJ obstruction is asymptomatic* Whitaker test (pressure flow studies) can be used to find out obstruction to flow of urineIn whitaker test catheters are placed in renal pelvis and bladder. Fluid is infused in to the kidney and the pressures are measures. A differential pressure between kidney and bladder could then be indicative of obstruction to the flow* Anderson Hynes Dismembered Pyeloplasty is the most Commonly employed technique", "cop": 3, "opa": "Ultrasound", "opb": "Excretion urogram", "opc": "Nuclear imaging", "opd": "Retrograde pyelography", "subject_name": "Surgery", "topic_name": "Kidney & Ureturs", "id": "6427a7c8-762e-456e-956c-62b9e6b23009", "choice_type": "single"} {"question": "Traumatic dislocation of hip is characterized by", "exp": "A i.e. Adduction internal rotation deformity", "cop": 1, "opa": "Adduction internal rotation deformity", "opb": "Abduction external rotation deformity", "opc": "Adduction external rotation deformity", "opd": "Abduction internal rotation deformity", "subject_name": "Surgery", "topic_name": null, "id": "0d1d66c2-1df8-420e-95dc-f8f69fa3924d", "choice_type": "single"} {"question": "Pseudoarterial aneurysm in drug abuser's seen in", "exp": "Pseudoaneurysm is a rare condition arising from disruption in the arterial wall with blood dissecting into the tissues around the damaged artery creating a perfused sac that communicates with the arterial lumen. Its incidence is on rising due to the increase in endovascular procedures, hemodialysis and intravenous drug abuse. \nHere we report a young male who was found by an NGO worker, lying on the roadside near a Mandir with a pulsatile inguinal swelling and blood oozing out from it. He was taken immediately to the emergency department of LN Hospital. He was a rickshaw puller and known drug addict. \nThe swelling was diagnosed as pseudo-aneurysm of common femoral artery on clinical examination and by Doppler ultrasonography. He was referred to CTVS department and admitted there for surgery. \nIn the meanwhile, he collapsed in the hospital toilet and died due to hemorrhagic shock consequent upon rupture of pseudoaneurysm of the femoral artery.", "cop": 3, "opa": "Radial", "opb": "Brachial", "opc": "Femoral", "opd": "Carotid", "subject_name": "Surgery", "topic_name": null, "id": "159dc1cf-0c20-4321-9f00-5e9dad28c5dd", "choice_type": "single"} {"question": "Y.V plasty procedure is used for", "exp": null, "cop": 3, "opa": "Vestibuloplasty", "opb": "Ridge augmentation", "opc": "Frenectomy", "opd": "Mucogingival surgery", "subject_name": "Surgery", "topic_name": null, "id": "4a23a7b2-c800-4837-a558-c9d8898a3c06", "choice_type": "single"} {"question": "Patey's mastectomy is a type of", "exp": "Ans. (c) Modified radical mastectomy(Ref. Bailey and Love 26th edition Page 813)* In Patey's type of MRM- Pectoralis Minor muscle removed.", "cop": 3, "opa": "Simple mastectomy", "opb": "Extended mastectomy", "opc": "Modified radical mastectomy", "opd": "Halsted's radical mastectomy", "subject_name": "Surgery", "topic_name": "Breast", "id": "dbc2cd16-e43b-49af-8840-72756f3915b9", "choice_type": "single"} {"question": "The most common nerve involved in Volkamann's ischaemic contracture of forearm includes", "exp": "C i.e. Median nerve Volkman's ischemic contracture most commonly involve flexor digitorum profundus muscleQ & median nerveQ.", "cop": 3, "opa": "Radial", "opb": "Ulnar", "opc": "Median", "opd": "Posterior interosseous", "subject_name": "Surgery", "topic_name": null, "id": "9597e906-5a5c-4a85-ac32-aad8049bcf8b", "choice_type": "single"} {"question": "Diameter of varicose veins is", "exp": "Varicose veins are dilated tortuous subcutaneous veins ≥ 3mm in diameter.", "cop": 4, "opa": "≥ 1mm", "opb": "≥ 2mm", "opc": "≥ 4mm", "opd": "≥ 3mm", "subject_name": "Surgery", "topic_name": null, "id": "5e6da621-461c-424b-85bf-cb7520327e46", "choice_type": "single"} {"question": "Highest percentage of MUFA are seen in;", "exp": "fats Saturated FA MUFA PUFA coconut oil 92 0 2 balm oil 4.6 44 10 Ground nut oil 19 50 31 safflower oil 10 15 75 sunflower oil 8 27 65 Com oil 8 27 65 Soya bean oil 14 24 62 Butter 60 37 3 margarine 25 25 50", "cop": 1, "opa": "Ground nut oil", "opb": "Soya bean oil", "opc": "Margarine oil", "opd": "Palm oil", "subject_name": "Surgery", "topic_name": null, "id": "c2ea5cdb-2497-4dc3-9bfb-83c13f9cb368", "choice_type": "single"} {"question": "Emergency management of Ulcerative colitis is by", "exp": "(D) Total Proctocolectomy with end ileostomy# OPERATIVE MANAGEMENT OF ULCERATIVE COLITIS:> Emergent Operation:- In a patient with fulminant colitis or toxic megacolon, total abdominal colectomy with end ileostomy, rather than total proctocolectomy, is recommended.> Although the rectum is invariably diseased, most patients improve dramatically after an abdominal colectomy, and this operation avoids a difficult and time-consuming pelvic dis- section in a critically ill patient. Rarely, a loop ileostomy and decompressing colostomy may be necessary if the patient is too unstable to withstand colectomy.> Definitive surgery may then be undertaken at a later date once the patient has recovered.> Complex techniques such as an ileal pouch anal reconstruction generally are contraindicated in the emergent setting.> However, massive hemorrhage that includes bleeding from the rectum may necessitate proctectomy and either a permanent ileostomy or ileal pouch anal anastomosis.> Elective Operation:- In the past, abdominal colectomy with ileorectal anastomosis often was recommended for patients with relatively quiescent rectal disease.> Risk of ongoing inflammation, the risk of malignancy, and the availability of restorative proctocolectomy have led most surgeons to now recommend elective operations that include resection of the rectum.> Abdominal colectomy with ileorectal anastomosis is still an appropriate operation for a patient with indeterminate colitis and rectal sparing.> Total proctocolectomy with end ileostomy has been the \"gold standard\" for patients with chronic ulcerative colitis.> This operation removes the entire affected intestine and avoids the functional disturbances associated with ileal pouch-anal reconstruction.> Most patients function well physically and psychologically after this operation.> Total proctocolectomy with continent ileostomy (Kock's pouch) was developed to improve function and quality of life after total proctocolectomy, but morbidity is significant and restorative proctocolectomy generally is preferred today.> Since its re introduction in 1980, restorative proctocolectomy with ileal pouch-anal anastomosis has become the procedund of choice for most patients who require total proctocolectomy but wish to avoid a permanent ileostomy.", "cop": 4, "opa": "Proctocolectomy", "opb": "Right hemicolectomy", "opc": "Left hemicolectomy", "opd": "Total proctocolectomy with end ileostomy", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "15010fcb-950e-46e2-8bcb-246768944481", "choice_type": "single"} {"question": "Normal pressure in superficial venous system of leg while walking is", "exp": "Pressure in superficial venous system decreases to 30 mmHg while walking as blood flows from superficial to deep veins.", "cop": 4, "opa": "80 mmHg", "opb": "60 mmHg", "opc": "50 mmHg", "opd": "30 mmHg", "subject_name": "Surgery", "topic_name": null, "id": "6773ca12-2ba7-4409-bd60-6e64b43908b3", "choice_type": "single"} {"question": "Cystic hygroma is", "exp": "CYSTIC HYGROMA (Cavernous Lymphangioma)\n\nIt is a cystic swelling due to sequestration of a portion of jugular lymph sac from the lymphatic system, during the developmental period in utero.\nPresent at birth and so may cause obstructed labour. Occasionally present in early infancy.\nLymphatics fail to communicate to venous system; abnormal budding of lymphatics is seen. \nOften it is associated with Turner’s, Down’s, Klinefelter syndromes and trisomy 18 and 13.\nIt is also called as hydrocoele of the neck.\nLymphatic malformation (LM) type can be microcystic (lymphangioma) or macrocystic (cystic hygroma). It can cause lymphoedema, soft tissue and bony hypertrophy, asymmetry (face), macrochelia, macroglossia, macrotia, cellulitis.\n\nKey Concept:\n It is a type of congenital lymphangioma and the common victims are infants and children. \nReference: SRB's Manual of Surgery, 5th ed, page no 86, 216, 435", "cop": 4, "opa": "A form of hydrocele", "opb": "A branchial cleft cyst", "opc": "Salivary gland enlargement", "opd": "Lymphangioma", "subject_name": "Surgery", "topic_name": null, "id": "dc824aa2-258e-46da-8cf9-27d717d13ce8", "choice_type": "single"} {"question": "Increased risk of gastric carcinomas associated with", "exp": "Chronic dysplasia - chronic gastritis leads to gastric atrophy leads to intestinal metaplasia leads to dysplasia which fuher leads to carcinoma in-situ and carcinoma- this cycle is most commonly seen in body and distal stomach and is often called as Correa cycle. Reference SRB edition 5 page no.845", "cop": 1, "opa": "Intestinal metaplasia", "opb": "Polyp-hyperplastic or adenoma", "opc": "Atrophic gastritis", "opd": "Corossive antral stricture", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "d8c4fb69-1c80-4721-8536-24bb648bf4c4", "choice_type": "single"} {"question": "The best scars are seen in", "exp": null, "cop": 4, "opa": "Infants", "opb": "Children", "opc": "Adults", "opd": "Very old people", "subject_name": "Surgery", "topic_name": null, "id": "8b639161-7908-4b6b-8c3d-5b2493fea024", "choice_type": "single"} {"question": "A major indication for orthognathic surgery before puberty is", "exp": null, "cop": 2, "opa": "Transverse deficiency of maxilla", "opb": "Ankylosis of mandible", "opc": "Prognathic mandible", "opd": "Hyperdivergent facial pattern with anterior open bite", "subject_name": "Surgery", "topic_name": null, "id": "32074c14-a2be-4adb-a8d3-452e7bccb7f0", "choice_type": "single"} {"question": "While performing a submandibular sialography the cannula is inserted in the following direction to prevent damage to Wharton's duct.", "exp": null, "cop": 2, "opa": "Upward and medial", "opb": "Medial to lateral", "opc": "Lateral to medial", "opd": "Lateral and downward", "subject_name": "Surgery", "topic_name": null, "id": "3cebda9c-5b99-4805-abd6-bfd911575fa5", "choice_type": "single"} {"question": "Disseminated seminoma is treated by", "exp": null, "cop": 1, "opa": "CT or RT and orchidectomy", "opb": "Only RT", "opc": "Only CT", "opd": "Retroperitoneal lymphnode dissection", "subject_name": "Surgery", "topic_name": null, "id": "139bdc6f-283c-4d4d-9369-92b12c869f41", "choice_type": "single"} {"question": "MC germ cell tumor is", "exp": "Seminoma Testicular seminoma originates in the germinal epithelium of the seminiferous tubules. About half of germ cell tumors of the testicles are seminomas.Treatment usually requires removal of one testicle. However, feility usually isn't affected. All other sexual functions will remain intact. Signs and symptoms The average age of diagnosis is between 15 and 35 years. This is about 5 to 10 years older than men with other germ cell tumors of the testes. In most cases, they produce masses that are readily felt on testicular self-examination; however, in up to 11 percent of cases, there may be no mass able to be felt, or there may be testicular atrophy. Testicular pain is repoed in up to one fifth of cases. Low back pain may occur after metastasis to the retroperitoneum. Some cases of seminoma can present as a primary tumour outside the testis, most commonly in the mediastinum. In the ovary, the tumor is called a dysgerminoma, and in non-gonadal sites, paicularly the central nervous system, it is called a germinoma. Ref: https://en.m.wikipedia.org/wiki/Seminoma", "cop": 4, "opa": "Embryonal teratoma", "opb": "Dermoid", "opc": "Rhabdomyosarcoma", "opd": "Seminoma", "subject_name": "Surgery", "topic_name": "Urology", "id": "67d55d22-01d7-4dcf-957d-004e071e19ce", "choice_type": "single"} {"question": "Dacron vascular graft is", "exp": ".Aneurysm is excised and the aerial graft either PTFE (Polytetrafluoroethylene), knitted dacron graft, or woven dacron graft is placed. The graft is sutured to the vessel above and below using monofilament, nonabsorbable suture material, polypropylene 5-zero. ref:SRB;s manual of surgery,ed 3,pg no 170", "cop": 2, "opa": "Nontextile synthetic", "opb": "Textile synthetic", "opc": "Nontextile biologic", "opd": "Textile biologic", "subject_name": "Surgery", "topic_name": "General surgery", "id": "ff7ac0e3-88d0-4d5d-a0cf-1f6a3b23b08d", "choice_type": "single"} {"question": ". Treatment of choice in cold nodule of thyroid", "exp": null, "cop": 4, "opa": "Subtotal thyroidectomy", "opb": "Wait and watch", "opc": "I-131", "opd": "Hemithyriodectomy", "subject_name": "Surgery", "topic_name": null, "id": "278dfca5-6193-4e47-9e2e-d58941f7e272", "choice_type": "single"} {"question": "Thyroglossal cyst can increase the risk for", "exp": "Thyroglossal cyst can increase the risk for papillary carcinoma of thyroid.", "cop": 2, "opa": "Follicular carcinoma", "opb": "Papillary", "opc": "Hurthic cell tumour", "opd": "Anaplastic carcinoma", "subject_name": "Surgery", "topic_name": null, "id": "cd7a4a11-4e2c-4b30-b0f5-eaf038e0005b", "choice_type": "single"} {"question": "Most common route of infection of Kidneys in T.B. is", "exp": null, "cop": 2, "opa": "Direct invasion", "opb": "Hematogenous", "opc": "Lymphatic", "opd": "Ascending", "subject_name": "Surgery", "topic_name": null, "id": "2c20f389-9172-4870-b89a-38fcae1a30d6", "choice_type": "single"} {"question": "Most common complication of surgery in lithotomy position", "exp": "Ans) a (Damage to low...) Ref: Complications of Urologic Surgery, style=\"font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif; margin: 0 0 0 8px; text-indent: 0\">Standard lithotomy position requires the patients' legs to be separated from the midline into 30 to 45 degrees of abduction, with the hips flexed until the thighs are angled between 80 and 100 degrees. The patient's legs are placed into stirrups, with the knees bent such that the lower legs are parallel to the plane of the torso. The lithotomy position is used for a variety of open and endoscopic urologic procedures. Therefore, an under- standing of potential postoperative complications related to this position is essential to the care of these patients. In addition to neurologic complications, which are discussed here, other complications that have been reported after procedures in the lithotomy position include lower extremity compartment syndrome, venous thrombosis, and rhabdomyolysis.", "cop": 1, "opa": "Damage to lower limb nerves", "opb": "Damage to upper limb nerves", "opc": "Hypotension", "opd": "Distal gangrene", "subject_name": "Surgery", "topic_name": "Miscellaneous (Anal Canal)", "id": "dc058f1d-d5f0-48cc-bb91-4d133d5b13c0", "choice_type": "single"} {"question": "Not a treatment for phyllodes tumour", "exp": "Treatment for Phyllodes tumour is enucleation in young women or wide local excision. Massive tumors, recurrent tumors will require mastectomy. Reference: Bailey & Love, 27th Edition, page no = 870.", "cop": 1, "opa": "Quadrantectomy", "opb": "Enucleation", "opc": "Wide local excision", "opd": "Simple mastectomy", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "c64eaf96-aab4-4efa-964f-05baac68b92c", "choice_type": "single"} {"question": "Most common complication of acute pancreatitis is", "exp": "Most common complication of acute pancreatitis is hypoxemia.", "cop": 3, "opa": "Chronic pancreatitis", "opb": "Absess", "opc": "Hypoxemia", "opd": "Pseudocyst of pancreas", "subject_name": "Surgery", "topic_name": null, "id": "e4edc9b8-21a0-46c4-b6be-de2cea74554d", "choice_type": "single"} {"question": "Tillaux's sign is seen in", "exp": "Tillaux's sign: In mesenteric cyst, the swelling moves freely in a plane at right angles to the attachment of the mesenteryRef: Bailey and love 27e pg: 1063", "cop": 3, "opa": "Abdominal tuberculosis", "opb": "Peritonitis", "opc": "Mesenteric cyst", "opd": "Misty mesentery", "subject_name": "Surgery", "topic_name": "General surgery", "id": "134c5bb9-7268-4588-a165-04ed8c3964a4", "choice_type": "single"} {"question": "A patient having Glasgow score of 12 is suffering from", "exp": "Severity of head injury is classified according to the Glasgow Coma Score (GCS), as the GCS – and in particular the motor score – is the best predictor of neurological outcome:\n- Minor head injury: GCS 15 with no loss of consciousness (LOC);\n- Mild head injury: GCS 14 or 15 with LOC;\n- Moderate head injury: GCS 9–13;\n- Severe head injury: GCS 3–8.", "cop": 3, "opa": "Minor head injury", "opb": "Mild head injury", "opc": "Moderate head injury", "opd": "Severe head injury", "subject_name": "Surgery", "topic_name": null, "id": "7d2ec283-1377-4a9e-baca-b61b5115b054", "choice_type": "single"} {"question": "The most impoant indication for surgical repair of a double uterus, such as a septate or bicornuate uterus, is", "exp": "Habitual aboion is the most impoant indication for surgical treatment of women who have a double uterus. The aboion rate in women who have a double uterus is to three times greater than that of the general population. Therefore, women who present with habitual aboion should be evaluated to detect a possible double uterus. Hysterosalpingography, hysteroscopy, ultrasound, CT, and magnetic resonance imaging (MRI) are all potentially useful imaging modalities in this investigation. Dysmenorrhea, premature delivery, dyspareunia, and menometrorrhagia are other, less impoant indicators for surgical intervention.", "cop": 1, "opa": "Habitual aboion", "opb": "Dysmenorrhea", "opc": "Menometrorrhagia", "opd": "Dyspareunia", "subject_name": "Surgery", "topic_name": null, "id": "b572428e-bd14-4973-a5ef-7cd0aacb471f", "choice_type": "single"} {"question": "Recording of data of bihs and deaths in a community continuously after 6 months survey is known as", "exp": "Sample registration system Sample Registration system (SRS) - staed in 1960 * SRS provide reliable estimated of bih rate at national and state levels. * It is dual record system Enumerator : Continuous enumeration of bih and death rate. - Independent survey : Survey every 6 month by investigator supervisor. * It cover entire country major source of death information. Census : It taken usually at intervals of 10 year Civil Registration system : It is deficient in India. * Estimation to missing event by enumerator and supervisor using well defined technique know as \"CHANDRASEKHARAN DEMMY FORMULA\"", "cop": 1, "opa": "Sample registration system", "opb": "Data linkage", "opc": "Hospital records", "opd": "Notification system", "subject_name": "Surgery", "topic_name": null, "id": "73e5b1d7-7b18-457d-8508-d6a97ac33af4", "choice_type": "single"} {"question": "Absolute contraindication for endovenous abalation in varicose veins", "exp": "An acute occlusive DVT is an absolute contraindication to endovenous thermal ablation, whereas a chronically recanalized deep venous system in the extremity to be treated is a relative contraindication. Care must be taken to ensure that superficial venous ablation will not compromise the venous outflow of the post-thrombotic limb.Ref: Sabiston 20e pg: 1866", "cop": 1, "opa": "Acute DVT", "opb": "Varicose ulcer", "opc": "Pregnancy", "opd": "Chronic DVT", "subject_name": "Surgery", "topic_name": "General surgery", "id": "d1210c1d-8be3-41d7-992e-26b4e5cdfec6", "choice_type": "single"} {"question": "Gastrointestinal stromal tumours arise form", "exp": "Gastrointestinal stromal tumours (GISTs) may arise in anypa of the gastrointestinal tract but 50% will be found inthe stomach.They are now known to be a distinct tumor derived from the interstitial cells of Cajal,The tumours are universally associated with a mutation in thetyrosine kinase c-kit oncogene (CD 117). These tumours are sensitive to the tyrosine kinase antagonist imatinibBailey and Love 27e pg: 1139", "cop": 4, "opa": "Paneth cells", "opb": "Stave cells", "opc": "Enterocytes", "opd": "Interstitial cells of Cajal", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "b81eca00-33ac-4418-8320-6dbd7e616223", "choice_type": "single"} {"question": "The common organism isolated in Emphysematous pyeloneohritis is", "exp": "Emphysematous pyelonephritis (EPN) is a severe, necrotizing infection of the renal parenchyma causing gas formation within the collecting system, renal parenchyma, and/or perirenal tissues. Also called renal emphysema and pneumonephritis. Gas in the renal pelvis alone, without parenchymal gas, is often referred to as emphysematous pyelitis.EPN most often occurs in persons with diabetes mellitus, especially women.Among the bacteria associated with emphysematous pyelonephritis (EPN), Escherichia coli is isolated in 66% of patients, and Klebsiella species are repoed in 26% of patients. Proteus,Pseudomonas, and Streptococcus species are other organisms found in patients with EPN, and Entamoeba histolytica and Aspergillus fumigatus also have been repoed to cause the disease. Mixed organisms are observed in 10% of patients. Rare organisms such as Clostridium and Candida species have also been isolated in patients with EPN.", "cop": 1, "opa": "E. Coli", "opb": "Proteus", "opc": "Pseudomonas", "opd": "Klebsiella", "subject_name": "Surgery", "topic_name": "Urology", "id": "a25051b0-38e2-489b-973f-68488093d961", "choice_type": "single"} {"question": "A patient came with lower chest trauma with pain in abdomen. His BP is 60/40 pulse 120 next best investigation", "exp": "Answer- B. USG FASTUSG is the investigation of choice in both stable as well as unstable patients.\"Blunt abdominal trauma initially is evaluated by FAST examination in most major trauma centers\"", "cop": 2, "opa": "CT abdomen", "opb": "USG FAST", "opc": "MR Angiography", "opd": "X-ray abdomen", "subject_name": "Surgery", "topic_name": null, "id": "0e3200da-551b-4629-8e45-4be0f47e52e2", "choice_type": "single"} {"question": "Investigation of choice for posterior urethral value is", "exp": "Micturating cystourethrogram is investigation of choice for posterior urethral value.", "cop": 3, "opa": "Cystourethroscopy", "opb": "Retrograde urethroscopy", "opc": "Micturating cystourethrogram", "opd": "Cystoscopy", "subject_name": "Surgery", "topic_name": null, "id": "884db2c3-84a2-4fd0-8827-5efd58a9a7a3", "choice_type": "single"} {"question": "Next Investigation to be done for painful breast lump in a lactating woman", "exp": "Ans. (b) USGRef: Bailey & Love 26th ed. / 527* Breast abscess is highly probable in this lactating patient. Ultrasonography is used to distinguish solid from cystic structures and to direct needle aspiration for abscess drainage.* Ultrasound is the imaging method of choice for the majority of women aged < 40 years and during pregnancy and lactation.* Breast MRI does not form part of the initial imaging assessment of patients in the symptomatic breast clinic. It may, however, be useful in the further investigation of some breast lesions and in the evaluation of patients with confirmed breast cancer.", "cop": 2, "opa": "Mammography", "opb": "USG", "opc": "MRI", "opd": "FNAC", "subject_name": "Surgery", "topic_name": "Breast", "id": "0ce9868b-c868-448c-abde-de4b45ce57a8", "choice_type": "single"} {"question": "A patient is diagnosed with gas gangrene of the foot. Best management would be", "exp": "All the above are pa of gasgangrene management, the main stay is debridment and antibiotics Treatment for gas gangrene includes, Inj. Benzyl penicillin 20 lacs 4th hourly. + Inj. metronidazole 500 mg 8th hourly + Inj. aminoglycosides (if blood urea is normal) or third generation cephalosporins. Polyvalent antiserum 25,000 units given intravenously after a test dose and repeated after 6 hours. Liberal incisions are given. All dead tissues are excised and debridement is done until healthy tissue bleeds. * Hyperbaric oxygen is very useful. Rehydration and maintaining optimum urine output (30 ml/hour) (0.5 ml/kg/hour). Electrolyte management. In severe cases amputation has to be done as a lifesaving procedure - stump should never be closed. Often ventilator suppo is required. ref:SRB;s manual of surgery,ed 3,pg no 46", "cop": 4, "opa": "Hyperbaric oxygen", "opb": "Polyvalent gas gangrene antitoxin", "opc": "Amputation of the involved limb", "opd": "Antibiotics with surgical debridement", "subject_name": "Surgery", "topic_name": "General surgery", "id": "0e848166-f18d-49d4-b695-545e994400e2", "choice_type": "single"} {"question": "Mc. Murray's sign is seen in injury to", "exp": "A i.e. Medial meniscus", "cop": 1, "opa": "Medial meniscus", "opb": "Medial collateral ligament", "opc": "Anterior cruciate ligament", "opd": "Posterior cruciate ligament", "subject_name": "Surgery", "topic_name": null, "id": "89fa98cf-2722-477b-88d2-06a86a209ebe", "choice_type": "single"} {"question": "Most common type of oral carcinoma is", "exp": null, "cop": 3, "opa": "Lip", "opb": "Cheek", "opc": "Tongue", "opd": "palate", "subject_name": "Surgery", "topic_name": null, "id": "fc436f89-f9f5-4dca-9d37-f4ee5b6cbada", "choice_type": "single"} {"question": "Keloid is differentiating with hypertrophic scar", "exp": "i.e. (Increased growth beyond size): (30-Bailey & Love 25th) (52, 1103-5-CSDT 13th) (152. S-Das 6th)KELOID SCAR is defined as excessive scar tissue that extends beyond the boundaries of the original incision or wound (As a true tumour arising from the connective tissue elements of the dermis)Keloids by definition extend beyond the border of the wounds and are most common in pigmented skin xiphisternum and each shoulder tipupregulation offibroplastic growth factors like TGF-b is implicated during hypertrophic or keloid scar formation (52 CSDT 13th)In the case of keloids, the over reactive proliferation of fibroblasts continues for weeks or months. By the time it ceases. Maturation with spontaneous improvement does not usually occursThe histology of both hypertrophic and keloid scars shows excess collagen with hypervascularityRadiographic Features:Spider leg aooearancePolycystic kidneySandy patchesSchistosmiasis of bladderCobra head appearanceUreteroceleDrooping flower appearanceEctopic ureterFlower vase appearanceHorse shoe kidneySoap bubble appearanceHydronephrosisRim or crescent signHydronephrosis* Familial condition, more common in women, Tuberculosis plays a role in aetiology* Claw like processess, pink and raised patch, unsighty often tender to touch and always itch, Recurs even when it is excisedHYPERTROPHIC SCAR is defined an excessive scar tissue that does not extend beyond inflammatory phase of wound healing and from unfavourable scar siting i.e. across the line of skin tension In the face, these are known as the lines of facial expression* Generally self limited** (Regresses after 6 months)* The last areas of a bum to heal are the most often hypertrophic* Usually no claw-like processes, no itching.* There is no sign of increased vascularity and the hypertrophic scar is never reddish in colour* It does not recur after excision. If the causative factors are eliminatedTreatment of choice for keloids and intractable hypertrophic scar is still injection of triamcinolone acetonide (1105-CSDT 13th)Comparison of Hypertrophic and Keloid scar (206-207 Sabiston 18th)FeaturesHypertrophic ScarKeloid ScarGeneticNot familialMay be familialRaceNot race relatedBlack > WhiteSexFemale = maleFemale > maleAgeChildren10-30 yearsBorderRemains within woundOutgrows wound areaNatural historySubsides with timeRarely subsidesSiteFlexor surfaceSternum, shoulder, faceAetiologyRelated to tensionUnknown", "cop": 3, "opa": "Decreased fibroblast", "opb": "Increased fibroblast", "opc": "Increased growth beyond size", "opd": "Increased fibrous tissue", "subject_name": "Surgery", "topic_name": "Wounds, Tissue Repair & Scars", "id": "6a4dc8b7-d4b6-4fd4-b56b-34a6fe4650f3", "choice_type": "single"} {"question": "Best test to diagnose gastroesophageal reflux disease and quantity acid output is", "exp": ".for GERD, THE INVESTIGATIONS can be, *24 hours oesophageal pH monitoring is regarded as the gold standard.PPI should be stopped for 3 weeks prior to pH monitoring. *barium study in head down position. *endoscopy to exclude other diseases. *oesophagal manometry to assess the state of lower oesophagal sphincter. Ref: SRB&;s manual of surgery,5th ed, pg no 792", "cop": 4, "opa": "Esohagogram", "opb": "Endoscopy", "opc": "Manometry", "opd": "24 Hr pH monitoring", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "5d7b3e94-bf48-4345-bcef-ea41b254007f", "choice_type": "single"} {"question": "Initial treatment of keloid", "exp": "Answer- B. Intralesional steroidIntralesional injection of steroid (Triamcinolone acetate) is now recommended as the first line of t/t for keloid.", "cop": 2, "opa": "Topical steroid", "opb": "Intralesional steroid", "opc": "Excision", "opd": "Radiotherapy", "subject_name": "Surgery", "topic_name": null, "id": "63689d44-95bd-45db-bbbf-b6aa59bfb122", "choice_type": "single"} {"question": "Traetment for periductal mastitis", "exp": "Duct cectasia is the dilatation of lactiferous ducts due to muscular relaxation of duvt wall with periductal mastitis. C/f: greenish dicharge from nipple. Slit like retraction of nipple due to fibdosis can occur May form abcess and fistula Treatment : To stop smoking Antibiotics Cone excision of major ducts-Hadfield operation. SRB's Manual of Surgery.Edition -5. Pg no:525", "cop": 1, "opa": "Hadfield's operation", "opb": "Patey's mastectomy", "opc": "Modified radical mastectomy", "opd": "Radical mastectomy", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "82a6835e-e8c7-4003-9310-caec28af96a7", "choice_type": "single"} {"question": "Lehriche syndrome is characterized by presence of aerial insufficiency in", "exp": "Answer- A. Aoo- iliac aeryBrought on by walkingNot present on taking the first step (unlike osteoahritis)Relieved by standing stillThe pain of claudication is usually felt in the calf because the superficial femoral aery is the most commonly affected.Aooiliac disease (30 per cent of cases) may cause thigh or buttock claudication.Buttock claudication in association with sexual impotence resulting from aerial insufficiency is eponymously called Leriche's syndrome. It is very rare.", "cop": 1, "opa": "Aoo- iliac aery", "opb": "Superficial femoral aery", "opc": "Temporal aery", "opd": "Brachial aery", "subject_name": "Surgery", "topic_name": null, "id": "c55861f0-fa03-4904-86e6-78ae74a11b3a", "choice_type": "single"} {"question": "The difficulty score for an mesioangutar impacted mandibular 3rd molar, Class II and level II is", "exp": null, "cop": 1, "opa": "5", "opb": "7", "opc": "10", "opd": "6", "subject_name": "Surgery", "topic_name": null, "id": "a251bc58-921f-4432-8ef6-0232cc689243", "choice_type": "single"} {"question": "The earliest manifestation of increased intrcranial pressure following head injury is", "exp": "In general, symptoms and signs that suggest a rise in ICP include altered level of consciousness, headache, vomitingwithout nausea, ocular palcies, back pain and papilledema. If papilledema is protracted, it may lead to visual disturbances, optic atrophy, and eventually blindness. The headache is classically a morning headache which may wake them from sleep. The brain is relatively poorly supplied by oxygen as a result of mild hypoventilation during the sleeping hours and also cerebral edema may worsen during the night due to the lying position. ref-Graham, D. I.; Gennarelli, T. A. (2000). \"Pathology of Brain Damage After Head Injury\". In Cooper, Paul Richard; Golfinos, John (eds.). Head Injury (4th ed.). McGraw-Hill. pp. 133-54", "cop": 3, "opa": "Ipsilateral pupillary dilatation", "opb": "Contralateral pupillary dilatation", "opc": "Altered mental status", "opd": "Hemiparesis", "subject_name": "Surgery", "topic_name": "Trauma", "id": "dce8f390-9da2-4f5a-a4ac-c872f5a4b2b0", "choice_type": "single"} {"question": "Testicular tumor with best prognosis is", "exp": "Seminomas are radiosensitive tumors so prognosis is good.", "cop": 2, "opa": "Teratoma", "opb": "Seminoma", "opc": "Yolk sac tumor", "opd": "Sertoli cell tumor", "subject_name": "Surgery", "topic_name": null, "id": "cd18524a-fd31-471b-87ea-a7931647b398", "choice_type": "single"} {"question": "Pehes affects age group", "exp": "Ans. B. 4 - 8 yrsPehe's disease is also known as osteochondritis deformans juvenilis or Coxa plana or Pseudocoxalgia.Pehe's disease is an osteochondritis of the epiphysis of the femoral head (capital femoral epiphysis).The disease occurs commonly in males in the age group of 5-10 years.", "cop": 2, "opa": "< 4 yrs", "opb": "4 - 8 yrs", "opc": "10 - 25 yrs", "opd": "> 25 yrs", "subject_name": "Surgery", "topic_name": null, "id": "403fa223-fa48-4d01-acb9-d0b8642be3e5", "choice_type": "single"} {"question": "Epulis arises from", "exp": "Epulis literally means 'upon the gum'. Thus it is a swelling situated on the gum.\nIt can originate from the mucous membrane, the periosteum or the bone giving rise to different varieties of Epulis.", "cop": 3, "opa": "Enamel", "opb": "Root of teeth", "opc": "Gingiva", "opd": "Pulp", "subject_name": "Surgery", "topic_name": null, "id": "0e9b84f1-575b-4e26-af17-4aa38b43d701", "choice_type": "single"} {"question": "Mammography radiation used is", "exp": "Ans. (b) Bremsstrahlung Xray(Ref Internet Source)* Mammography is a Low voltage and High Amperage X ray* Mammography is a type of X ray known as Bremsstrahlung/Braking X-ray generation (It is not a classical X ray)", "cop": 2, "opa": "Conventional X ray", "opb": "Brems strahlung X ray", "opc": "Low amperage X ray", "opd": "Stereo Ray", "subject_name": "Surgery", "topic_name": "Breast", "id": "f3054b04-a05f-46af-93fa-433fa7c69217", "choice_type": "single"} {"question": "Enucleation of palatal tumor results in", "exp": null, "cop": 2, "opa": "Excessive bleeding from nasopalatine vessels", "opb": "Tearing of nasal mucosa", "opc": "Damage to nasopalatine nerve", "opd": "Alteration of speech", "subject_name": "Surgery", "topic_name": null, "id": "4344c026-8a8c-420c-903e-8788b0c5c0f1", "choice_type": "single"} {"question": "Down fracture of zygomatic arch is done in the treatment of", "exp": null, "cop": 2, "opa": "TMJ ankylosis", "opb": "Chronic Subluxation", "opc": "Condylar fracture", "opd": "Zygomatic fracture", "subject_name": "Surgery", "topic_name": null, "id": "16e565cc-b61e-4029-8c68-064d33ecf107", "choice_type": "single"} {"question": "Treatment of leukoplakia", "exp": "• In most cases, lesions regress spontaneously after stopping alcohol or tobacco consumption or correction of underlying cause.", "cop": 2, "opa": "Local excision", "opb": "Repositioning of ill fitting dentures", "opc": "Topical chemotherapy", "opd": "Excision and radiotherapy", "subject_name": "Surgery", "topic_name": null, "id": "70776aa3-1067-4d0d-bc98-63985a06c4dc", "choice_type": "single"} {"question": "Avascular necrosis of bone is most common in", "exp": "B i.e. Scaphoid", "cop": 2, "opa": "Scapula", "opb": "Scaphoid", "opc": "Calcaneus", "opd": "Cervical spine", "subject_name": "Surgery", "topic_name": null, "id": "1b08e185-0d44-4c3a-bbe6-58f7309b7d1d", "choice_type": "single"} {"question": "Best time for surgery in case of combined unilateral cleft lip\nand hard palate is", "exp": "If cleft is in hard palate surgery is done between 15-18 months.", "cop": 1, "opa": "15-18 months", "opb": "3 - 6 months", "opc": "6 - 9 months", "opd": "9- 15 months", "subject_name": "Surgery", "topic_name": null, "id": "106b63a5-3139-4ca8-bb74-12fbce1de52f", "choice_type": "single"} {"question": "A lady with a long stading thyroid nodule is planned for a subtotoal thyroidectomy. Before the surgery the surgeon must check/ do", "exp": "Answer- C. Indirect LarngoscopyNerve Damage to recurrent / superior laryngeal nerve is a known complication of thyroidectomy.Hence it is impoant to document the state ofthe vocal cords before surgery to prevent litigation liability.", "cop": 3, "opa": "Serum Calcium levels", "opb": "Serum PTH assay", "opc": "Indirect Larngoscopy", "opd": "Iodine 131 scan", "subject_name": "Surgery", "topic_name": null, "id": "6b386633-d823-4093-a5b9-8b658c0086f7", "choice_type": "single"} {"question": "Features(s) of jejunal diveicula is/are", "exp": ".Jejunal diveicula are rare. Often can cause obstruction, haemorrhage. It needs surgical resection.in case of jejunal diveicula,the absorption of nutients such as vitamin B12 ar seriuosly affected. ref:SRB&;s manual of surgery,ed 3,pg no 800", "cop": 3, "opa": "Folate absorption", "opb": "Ferritin absorption", "opc": "B 12 absorption", "opd": "Urea breath test", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "e8be7e9e-85b5-4d37-a3d7-209a467bc003", "choice_type": "single"} {"question": "25 year old male with head injury comes walking, conscious oriented and then becomes unconsious. Diagnosis", "exp": ".extradural haematoma is the collection of blood in the extradural space between the dura and skull. most common site is the temporoparietal region. usually, it is associated with fracture of temporoparietal region. immediately after injury , there is transient loss of consciousness and the patient soon becomes normal. later after 6-12hours , he again falls ill and the condition deteriorates. this is the time taken to increase the intracranial pressure,coning and its effects. this crucial time gap is called lucid interval (Ref : SRB&;s Manual of Surgery, 5th editin , pg no. 1095)", "cop": 1, "opa": "EDH", "opb": "SAH", "opc": "ICH", "opd": "Rupture of aneurysm", "subject_name": "Surgery", "topic_name": "Trauma", "id": "c1e016cc-0059-481a-83c0-433f0e5f8439", "choice_type": "single"} {"question": "Most common site of BCC (Basal cell carcinoma) is", "exp": "Ans. a (Face) (Ref. Bailey and Love, 25th /609)Basal cell carcinoma# Basal cell carcinoma is the most common eyelid tumor.# These are locally malignant lesions (rodent ulcer) with rare chances of distant metastasis and are most common malignant tumors of eyelid, more common in lower eye lid.# Most common site of BCC is face.# In fact the rodent ulcer may be seen more commonly in places of face over which tear rolls down so it's aptly called tear cancer.# Though no site is exempted, yet 90% of basal cell carcinomas are seen on face above the line drawn from the angle of the mouth to the louble of the ear.# It may also occur in the scalp, neck, arm & hands.# The common sites on face are- Around inner and outer canthus of the eye.- Nose and On & around nasolobial fold- On the forehead - more common in female# Treatment: Excision with care not to deform lid (.Mohys surgical excision).", "cop": 1, "opa": "Face", "opb": "Trunk", "opc": "Neck", "opd": "Extremities", "subject_name": "Surgery", "topic_name": "Neoplasia", "id": "b58aaccc-affd-4b0b-bde8-025d30699645", "choice_type": "single"} {"question": "Most common catheter induced blood infection is due to", "exp": "Coagulase negative staphylococci fRef. Harrison 17th /e p 839 & 16th/e. p 777. 778] Intravascular catheter related infections Indwelling vascular catheters are a leading source of bloodstream infections. Amongst indwelling vascular catheters, central venous catheters are the most common culprits. Pathogenesis There are four potential sources for catheter related infections ? 1) The skin inseion site 2) The catheter hub 3) Hematogenous seeding from a distant infection 4) Contaminated infilsate The skin inseion site and the catheter hub are by for the two most impoant sources. Approximately 65% of catheter related infections originate from the skin flora, 30% from the contaminated hub and 5% from other pathways. For sho term catheters, skin contamination is the most likely mechani.sm of pathogenesis. On the other hand, for long term catheters, hub contamination is more frequent because such catheters often have to be intercepted and manipulated. Skin organisms migrate from the skin inseion site along the external surface of catheter, colonizing the distal intravascular tip of the catheter, and ultimately causing blood-stream infection. On the other hand, in hub related infections, organisms are usually introduced into the hub from the hands of medical personnel and the organisms migrate along the internal surface of the catheter, where they can cause a bloodstream infection. Microbiology Most of the micro-organisms implicated in CRIs arise from the skin flora. Staphylococci are the most frequently isolated pathogens, paricularly coagulase-negative staphylococci. Etiology of catheter related infection Microorganism Percentage * Coagulase negative staphylococci 30 - 40 * Staph aureus 5-10 * Enterococci 4 - 6 * Candida spp. 3 - 6 * Pseudonzonas aeruginosa 2 - 5 * Enterobacter spp 1 - 4 * Acinetobacter spp. 1 - 2 * Serratia spp. <1 * Others < 1 - 5", "cop": 2, "opa": ">Staphylococcus aureus", "opb": ">Coagulase negative staphylococci", "opc": ">Gram negative bacilli", "opd": ">Candida", "subject_name": "Surgery", "topic_name": null, "id": "ee42375c-6097-4c40-8caa-fe9fbe54ea27", "choice_type": "single"} {"question": "20 yr old female diagnosed previously with adenocarcinoma stomach and on examination following is seen;", "exp": "Sister Mary joseph nodule - Cutaneous metastatic deposit around umbilicus (Not Lymph node) Lymph Node involvement in Ca stomach - Involvement of left supraclavicular LN - Virchow's Node (Aka Troisier's Sign) - Involvement of Axillary LN - Irish nodes - Palpable intraperitoneal metastasis on digital rectal examination - Blummer's shelf", "cop": 1, "opa": "Sister Mary joseph nodule", "opb": "Umbilical granuloma", "opc": "Infected umbilical hernia", "opd": "Irish node", "subject_name": "Surgery", "topic_name": "FMGE 2019", "id": "732916f9-0891-490f-9e2b-3b32a876981f", "choice_type": "single"} {"question": "Recently delivered female with a shiny mass in the breast with fever", "exp": "Ans. (a) Breast Abscess(Ref Bailey and Love 866)* MC organism causing breast abscess - Staphylococcus aureus* It is due to ascending infection of a sucking Baby* Treatment is by Antibiotics and I/D if not resolved in 48 hours", "cop": 1, "opa": "Breast abscess", "opb": "Fibro adenosis", "opc": "Sebaceous cyst", "opd": "Fibroadenoma", "subject_name": "Surgery", "topic_name": "Breast", "id": "e3adcea4-bba4-496e-b05f-4d80eb852e42", "choice_type": "single"} {"question": "The best guide to adequate tissue perfusion in the fluid management of a patient with burns, is to ensure a minimum hourly urine output of", "exp": "0.5 - 1 ml / kg / hour is the urine output maintained in burns.", "cop": 3, "opa": "10 -15 ml", "opb": "15 - 30 ml", "opc": "30 - 50 ml", "opd": "50 - 80 ml", "subject_name": "Surgery", "topic_name": null, "id": "be238dfe-1e5e-4e18-9ffc-c1fb20a2e7fc", "choice_type": "single"} {"question": "Obstruction of the hepatic vein by thrombosis or a web is", "exp": "Budd Chiari syndrome is a syndrome or group of disorders caused by occlusion of major hepatic veins or IVC or both at or near the level of the hepatic vein, usually three main major hepatic veins are involved by thrombosis or block. Reference: SRB 5th edition page no 626", "cop": 3, "opa": "Schatzki's ring", "opb": "Plummer Vinson Syndrome", "opc": "Budd-Chiari syndrome", "opd": "Caroli's disease", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "a5c5c55a-ba11-4af7-aec7-d408e9a40943", "choice_type": "single"} {"question": "Nicoldoni sign is also known as", "exp": "Branham sign (or Nicoladoni sign): This sign is elicited when aeriovenous fistula is suspected. A pressure on the aery proximal to the fistula will cause: a. Reduction in size of the swelling. b. Disappearance of bruit. c. Fall in pulse rate. d. Pulse pressure returns to normal. Reference : page 1193 SRB's manual of surgery 5th edition", "cop": 4, "opa": "Murray sign", "opb": "Frei sign", "opc": "Darrier sign", "opd": "Branham sign", "subject_name": "Surgery", "topic_name": "Urology", "id": "fa0d64cc-ba3d-45ab-8eac-576b5481a724", "choice_type": "single"} {"question": "Verrucaous carcinoma of penis is causes by", "exp": "Verrucous carcinoma of penis, also called Buschke-Lowenstein tumour, is caused by HPV 6 and 11. It is a curable malignancy but is locally destructive and locally invasive. It neither spreads through lymphatics nor blood. Surgical excision or paial amputation is the treatment of choice.Reference : page 1067 SRB's manual of surgery 5th edition", "cop": 1, "opa": "HPV11", "opb": "HPV16", "opc": "HPV18", "opd": "HPV32", "subject_name": "Surgery", "topic_name": "Urology", "id": "6077a203-743c-419b-b0fa-319f8b351d5b", "choice_type": "single"} {"question": "Adamantinoma arises from", "exp": "Adamantinoma arises from odontogenic tissue which can be probably from enamel or dental lamina.So the most correct option,since it is classified under odontogenic tumours, is that it arises from odontogenic tissue SRB,5th,359.", "cop": 3, "opa": "Dental lamina", "opb": "Endothelium", "opc": "Odontogenic tissue", "opd": "Basal oral mucosa", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "5819a2d8-9eca-48be-981a-893fd22733ef", "choice_type": "single"} {"question": "Foreign body the common passage is", "exp": "A. i.e. (Right main bronchus) (297 -Dhingra 4th)Foreign bodies* Children - seeds, beans, tiny toys* Adult - meat is the most common cause of obstruction* Most common route by which a foreign body enters the nose is the anterior nares (179 - Maqbool 11th)* Commonest site of foreign bodies of food passage is at or just below the cricopharyngeal sphincter. (311 - Dhingra 4th)Most foreign bodies enter the right bronchus because it is wider and more in line with tracheal lumen causes - atelectasis or check valve obstruction* Double density sign of chest x-ray is a feature of left atrial dilatation*** Fish bone, chicken bone, needle or a denture may lodge in the pyriform fossa", "cop": 1, "opa": "Right main bronchus", "opb": "Left main bronchus", "opc": "Bronchioles", "opd": "Alveoli", "subject_name": "Surgery", "topic_name": "Lung", "id": "d95c2371-0342-4720-8840-81d54fa655c1", "choice_type": "single"} {"question": "Most common complication of chronic gastric ulcer is", "exp": "Gastric ulcers like duodenal ulcers cause pain, bleeding, and obstruction and can perforate.The most frequent complication of gastric ulceration is a perforation. Most perforations occur along the anterior aspect of the lesser curvatureHaemorrhage occurs in approximately 35% to 40% of patients.The incidence of malignancy ranges from 6% to 30% and increases with the size of the ulcer.Sabiston 20e pg: 1233", "cop": 3, "opa": "Tea pot stomach", "opb": "Adenocarcinoma", "opc": "Perforation", "opd": "Haemorrhage", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "39964155-a6f0-43c8-bd39-47c87f08cdc7", "choice_type": "single"} {"question": "A patient is brought to the emergency as a case of head injury, following a head on collision road traffic accident. His BP is 90/60 mmHg. Tachycardia is present. Most likely diagnosis is", "exp": "Due to cushings reflex HR is decreased in brain injury.", "cop": 4, "opa": "EDH", "opb": "SDH", "opc": "Intracranial hemorrhage", "opd": "Intra-abdominal bleed", "subject_name": "Surgery", "topic_name": null, "id": "4e86188c-78e6-439c-8cbf-7518aba31cf6", "choice_type": "single"} {"question": "Raynauds phenomenon is commonly seen in", "exp": ". It is an episodic vasospasam,especially aeriolar spasam usually bilateral more often seen in upperlimb of females as a result of abnormal sensitivity to cold.Patient develops blanching,cyanosis qnd later flushing .usually medial four digits and palm are involved.Thumb is spared.If vasospasam becomes longer,gangrene or ischemic ulceration supervenes along the tips of fingers. Refer page no 183 of SRB's manual of surgery5th edition.", "cop": 1, "opa": "Upper limb of female", "opb": "Lower limb of female", "opc": "Lower limb of male", "opd": "Upper limb of male", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "4468cda5-1b94-478f-b859-53eb738fc03c", "choice_type": "single"} {"question": "Whitehead's varnish in gauze is used to arrest bleeding from", "exp": null, "cop": 3, "opa": "Gingival crest", "opb": "Bleeding from pulp", "opc": "Bleeding from bone", "opd": "Bleeding from capillaries", "subject_name": "Surgery", "topic_name": null, "id": "b4e6c328-e927-4041-a98b-32b36c8a5328", "choice_type": "single"} {"question": "The intercostal drainage tube is inseed in the", "exp": "Answer- A. 5th intercostal space in the midaxillary lineSafe triangle of icd inseionAnterior border of latissimus dorsi.Lateral border ofpectoralis major.Horizontal line superior to the nipple.Horizontal line inferior to axilla.More specifcally, the tube is inseed into the 46 or 5th intercostal space slightly anterior to the mid axillary line", "cop": 1, "opa": "5th intercostal space in the midaxillary line", "opb": "3rd intercostal space in the midaxillary line", "opc": "4th intercostal space in the anterior axillary line", "opd": "9th intercostal space in the midclavicular line", "subject_name": "Surgery", "topic_name": null, "id": "de9e1199-e05c-4172-a51d-2669e71a03d4", "choice_type": "single"} {"question": "Poal triad is not formed by", "exp": "Poal triad relation CBD laterally Poal vein posteriorly Hepatic aery medially Mickey mouse view: Ultrasound image of hepatic aery, bile duct and poal vein is in a configuration, referred as Mickey Mouse View Ref: Sabiston 20th edition Pgno : 1421-1422", "cop": 4, "opa": "Hepatic aery", "opb": "Poal vein", "opc": "Bile duct", "opd": "Hepatic vein", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "d85681df-1dfe-4532-9ac7-3eec0682b0de", "choice_type": "single"} {"question": "Condition not associated with Pancreatic Panniculitis is", "exp": "Panniculitis is a group of disease whose hallmark is inflammation of subcutaneous adipose tissue. Symptoms- Tender skin nodules, Fatigue, Weight loss. Acute or chronic pancreatitis and pancreatic carcinoma (usually of acinar cells) are the most common pancreatic diseases associated with pancreatic panniculitis. However, pancreatic pseudocyst, post-traumatic pancreatitis, pancreas divisum and pancreatic vascular fistulas have also been repoed.", "cop": 4, "opa": "Pancreas cancer", "opb": "Chronic Pancreatitis", "opc": "Acute Pancreatitis", "opd": "Pancreatic mucinous cyst", "subject_name": "Surgery", "topic_name": "General surgery", "id": "0bc8a2b2-1037-4794-80d3-475251539aa8", "choice_type": "single"} {"question": "Treatment of choice for medullary carcinoma of thyroid is", "exp": "Most patients with MTC should undergo at least total thyroidectomy The presence of clinically detectable or ultrasound-detectable disease in the lateral neck warrants total thyroidectomy and level VI and lateral compament nodal dissection. Because MTC is not of follicular cell origin, TSH suppression and RAI scanning and therapy have no role in MTC. Source : Sabiston 20th edition Pg : 910", "cop": 1, "opa": "Total thyroidectomy", "opb": "Paial thyroidectomy", "opc": "I131 ablation", "opd": "Hemithyroidectomy", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "d1318011-35a5-4858-a48c-49fc53980b0e", "choice_type": "single"} {"question": "The one most consistent sign of fresh fracture is", "exp": "A i.e. Crepitus", "cop": 1, "opa": "Crepitus", "opb": "Bony tenderness", "opc": "Deformity", "opd": "Abnormal mobility", "subject_name": "Surgery", "topic_name": null, "id": "f05883be-e59b-45a5-b70e-774b481ec022", "choice_type": "single"} {"question": "Endoscopic stapling procedure would be ideal in", "exp": "Stappling of diveicula is done as a treatment procedure for pharyngeal pouch(Zenker's diveiculum). Other method is Dohlman's procedure. In this Pouch is excised using double lipped endoscopy. Cautery or laser is used. It is quicker procedure with sho duration of anaesthesia, with fast recovery. Other treatment option is Diveiculectomy with cricopharyngeal myotomy. Reference: SRB's Manual of Surgery, 6th Edition, page no= 422.", "cop": 1, "opa": "Pharyngeal pouch", "opb": "Gastric ulcer", "opc": "Esophageal varices", "opd": "Perforation", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "f7c617e5-70e0-4ade-9c4c-9e9ad2045ea0", "choice_type": "single"} {"question": "Plunging ranula is a type of", "exp": null, "cop": 1, "opa": "Retention cyst", "opb": "Extravasation cyst", "opc": "Implantation cyst", "opd": "Malignant tumor", "subject_name": "Surgery", "topic_name": null, "id": "53c20574-4120-4ac9-9a4f-3e4bc2b7f1e5", "choice_type": "single"} {"question": "Beevor sign is seen in aEUR'", "exp": "Abdominal muscle Beevor's Sign Movement of the umbilicus towards the head on flexing the neck. It is caused by weakness of the lower abdominal muscles. Physiology Beevor's sign is characteristic of spinal cord injury b/w T6-T10levels. This occurs because the upper abdominal muscles such as rectus abdominus are intact at the top of the abdomen but weak at the lower poion. Thus when the patient is asked to do a sit up only the upper muscles contract pulling the umbilicus towards the head in patients who are abnormal. It has also been described in amyotrophic lateral sclerosis and fascioscapulohunzeral muscular dystrophy.", "cop": 1, "opa": "Abdominal muscle", "opb": "Respiratory muscle", "opc": "Facial muscle", "opd": "Hand muscle", "subject_name": "Surgery", "topic_name": null, "id": "16c97344-f80a-4ec7-885b-6448422b57ca", "choice_type": "single"} {"question": "Fibroblast in healing wound is derived from", "exp": "Fibroblasts are specialized cells that differentiate from resting mesenchymal cells in connective tissue The primary function of fibroblasts is to synthesize collagen. Sabiston 20th edition Pg 137", "cop": 1, "opa": "Local mesenchyme", "opb": "Epithelium", "opc": "Endothelium", "opd": "Blood borne", "subject_name": "Surgery", "topic_name": "General surgery", "id": "612755d1-1399-46b3-a332-a4f423162828", "choice_type": "single"} {"question": "Post spinal headache is due to", "exp": "A. i.e. (CSF leaks in the dura) (517- Lee's synopsis of anaesthesia 13th)* It is low pressure headache due to seepage of CSF from dural rent (hole) created by spinal needle. The loss may be around 10 ml /hrPost spinal headache - is due to seepage of CSF. Can be minimized by using smaller bore needle (360-KDT 6th)* More common in young pregnant patients and with accidental dural puncture rate during epidural anaesthesia using Touhy needle (60 - 80%). Reduced by the introduction of size 25 G and 27G whitacre pencil point needles. Which replaced cutting needles* Typical location is bifrontal and /or occipital* CSF leakage results in changes in hydrodynamics of brain causing traction on pain sensitive structures like dura, vessels and tentorium producing painTreatment - Caffeine, sumatriptan and adreocorticotropic hormoe, \"epidural blood patch\"* Related to a reduction in CSF volume due to leakage through the dura (300 - Current. Diagnosis and treatment - pain)", "cop": 1, "opa": "CSF leaks in the dura", "opb": "Fine needle", "opc": "Toxic effects of the drug", "opd": "Traumatic damage to nerve roots", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "fd2f6f3e-5198-4e86-87d5-022acdc2cf22", "choice_type": "single"} {"question": "Pseudomembranous colitis is caused by", "exp": null, "cop": 2, "opa": "Cl. perfringens", "opb": "Cl. difficile", "opc": "Cl. oedematicus", "opd": "Si. septicum", "subject_name": "Surgery", "topic_name": null, "id": "67a563ae-3b2e-426a-89f6-110e5d51f8bf", "choice_type": "single"} {"question": "Acinic cell tumor is most commonly seen in", "exp": "Ans. (a) Parotid glandRef: Stell and Maran's Head and Neck Surgery, p-719* Acinic cell tumor is low grade tumor* Most common site of Acinic cell tumor is Parotid gland", "cop": 1, "opa": "Parotid gland", "opb": "Parathyroid", "opc": "Sublingual gland", "opd": "Thyroid", "subject_name": "Surgery", "topic_name": "Salivary Gland", "id": "6fd9d9a2-b748-497c-9040-f07f78e1971e", "choice_type": "single"} {"question": "Investigation of choice for CHPS", "exp": "Ans. (a) USGRef: Bailey and Love page 113-114/26th edition* IOC for Congenital Hypertrophic Pyloric stenosis - USG* Palpated as a Olive tumor in right Upper quadrant.* If the history and clinical mass is there - no need of USG - directly we can do Ramstedt's pylromyotomy", "cop": 1, "opa": "USG", "opb": "x-ray", "opc": "CT", "opd": "MRI", "subject_name": "Surgery", "topic_name": "Stomach & Duodenum", "id": "9d2e6fd0-4e93-480c-90bb-d9129e2d6f35", "choice_type": "single"} {"question": "Severe disease involves", "exp": "Ans. is 'c' i.e., Calcaneum", "cop": 3, "opa": "Lunate", "opb": "Tibial tubercle", "opc": "Calcaneum", "opd": "Navicular", "subject_name": "Surgery", "topic_name": null, "id": "565db13c-cf4f-437f-b733-c377446aa80c", "choice_type": "single"} {"question": "A pt presented with pulsating varicose veins of the lower limb. Most probable diagnosis is", "exp": "Ans. is 'a' ie Klippel-Trenaunay Syndrome Klippel- Trenaunay Syndrome :is characterized byCongenital AV fistulasCutaneous hemangiomasVaricose veinsHyperophy of involved extremityAbsence of deep venous system (so pathological superficial veins should not be removed without evidence of an intact deep system)*Another syndrome closely associated with A-V malformations is:Kasabach-Merritt syndrome characterised by:- thrombocytopenia* and- hemorrhagic manifestation *- d/t trapping & destruction of platelets* within the AV malformations*.", "cop": 1, "opa": "Klippel Trenaunay syndrome", "opb": "Tricuspid regurgitation", "opc": "DVT", "opd": "Right ventricular failure", "subject_name": "Surgery", "topic_name": null, "id": "63e76672-4825-493d-9a64-e3d3986eafb0", "choice_type": "single"} {"question": "The most important prognostic factor in carcinoma breast is", "exp": "The Nottingham prognostic index (NPI) is used to determine prognosis following surgery for breast cancer. \nIts value is calculated using three pathological criteria: the size of the lesion; the number of involved lymph nodes; and the grade of a tumour.\nSize of the lesion is least important.\nThe extent of axillary lymph node involvement by breast cancer—is the most established and reliable prognostic factor for subsequent metastatic disease and survival", "cop": 3, "opa": "Size of tumour", "opb": "Skin involvement", "opc": "Axillary gland involvement", "opd": "Involvement of muscles", "subject_name": "Surgery", "topic_name": null, "id": "97892350-e055-4072-aa19-399ab667d0bf", "choice_type": "single"} {"question": "Most common site of bleeding diveicula", "exp": "Diveicula most commonly affect the sigmoid colon and are confined to sigmoid colon in approximately 50% of patients with diveiculosis. Segment of sigoid colon is having smallest luminal diameter, and so colonic pressure as high as 90mm Hg can be generated. Reference : Sabiston, Textbook of Suregery, 19th Edition, page no = 1310.", "cop": 1, "opa": "Sigmoid colon", "opb": "Descending colon", "opc": "Rectum", "opd": "Ascending colon", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "0a02dd78-376a-4f9b-b938-7ce182e2c6f4", "choice_type": "single"} {"question": "Thyroid carcinoma with pulsating vascular, skeletal metastasis is", "exp": null, "cop": 1, "opa": "Follicular", "opb": "Anaplastic", "opc": "Medullary", "opd": "Papillary", "subject_name": "Surgery", "topic_name": null, "id": "25d210a2-6a0c-430a-942a-248bc7919f82", "choice_type": "single"} {"question": "Name the pathology seen in scalp", "exp": "Ans. (b) Sebaceous cyst* MC site of Sebaceous cyst is scalp.* Never seen in palms, soles, mucosa.* Ulcerated Sebaceous cyst of scalp is Cock's peculiar tumor.", "cop": 2, "opa": "Dermoid", "opb": "Sebaceous cyst", "opc": "Hemangioma", "opd": "Metastasis", "subject_name": "Surgery", "topic_name": "Plastic & Reconstructive Surgery", "id": "4ec147cc-fd88-46cb-85e7-49c4a6a2229d", "choice_type": "single"} {"question": "Malignant cells in urine cytology are most commonly seen in", "exp": "Ans. c (Urothelial carcinoma). (Ref. Harrison's Medicine 17th ed. 555)# Urothelial malignancy classically shows polychronotropism & multicentricity.# In urothelial or transitional carcinoma of renal pelvis or ureter, the examination of urine for malignant cells is positive and even may indicate whether tumor is well or poorly differentiated.# There is evidence that those with poorly differentited tumors do better if they have a short course of radiotherapy before surgery.# It is hence useful to obtain cells from tumor/urine by sampling a brush or catheter passes up the ureter under radiological control.", "cop": 3, "opa": "Renal cell carcinoma", "opb": "Prostate carcinoma", "opc": "Urothelial carcinoma", "opd": "Bladder carcinoma", "subject_name": "Surgery", "topic_name": "Urinary Tract", "id": "fab52be2-1236-4ac4-b40f-95a9b9fd37dd", "choice_type": "single"} {"question": "The best cosmetic results for large capillary (po wine) hemangiomas are achieved by", "exp": ".Po wine stain (Naevus flammeus): It presents at bih and persists throughout life without any change. Spontaneous regression will not occur. It presents as smooth, flat, reddish blue/intensely purple area; common in head, neck and face; often with maxillary and mandibular dermatomes of 5th cranial nerve. Eventually surface becomes nodular and keratotic. * It persists throughout life. * It is actually a capillary malformation even though considered under haemangioma. It results from defect in maturation of sympathetic innervation of skin causing localised vasodilatation of intradermal capillaries. * It is often associated with Sturge-Weber syndrome, Klippel - Trenaunay-Weber syndrome and Proteusnsyndrome. * It needs treatment - laser (pulsed dye/diode); excision and grafting; cosmetic coverage. Expected result by treatment is not possible many times. ref:SRB&;s manual of surgery,ed 3,pg no 180", "cop": 2, "opa": "Excision and split-thickness skin", "opb": "Laser ablation", "opc": "Cryosurgery", "opd": "Tattooing", "subject_name": "Surgery", "topic_name": "Urology", "id": "3bdd570b-4be0-4193-9832-76b6d2bc6bbe", "choice_type": "single"} {"question": "The most common intraperitoneal abscess following peritonitis", "exp": "question repeated", "cop": 2, "opa": "Subphrenic", "opb": "Pelvic", "opc": "Paracolic", "opd": "Interloop", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "23ea456a-fb54-414e-b84d-84124c2174f5", "choice_type": "single"} {"question": "Relation of hernial sac to spermatic cord in direct inguinal hernia is", "exp": "Ans. b (Sac is posterior to cord). (Ref. B & L, Surgery, 25th/pg. 70, 971)INGUINAL HERNIAS# Indirect inguinal hernia:- It is the remains of the processus vaginalis and therefore is congenital in origin.-It is more common than a direct inguinal hernia.- It is much more common in males than in females.- It is more common on the right side.- It is most common in children and young adults.- The hernial sac enters the inguinal canal through the deep inguinal ring and lateral to the inferior epigastric vessels.- An indirect inguinal hernial sac travels down the canal on anterolateral aspect of spermatic cord.- The neck of the sac is narrow.- The hernial sac may extend through the superficial inguinal- ring above and medial to the pubic tubercle. (Femoral hernia is located below and lateral to the pubic tubercle).- The hernial sac may extend down into the scrotum or labium majus.# Indirect inguinal hernia:- While a direct inguinal hernial sac comes out directly forwards through posterior wall of inguinal canal, Neck of indirect hernial sac is lateral to inferior epigastric vessels, while direct emerges medial to it.- An inguinal hernia can be differentiated from femoral by sac neck relation to medial end of inguinal ligament and pubic tubercle i.e. in inguinal hernia neck is above and medial while in femoral it is below and lateral to medial end of inguinal ligament and pubic tubercle.- So, direct hernia = sac is posterior, Indirect hernia = sac anterolateral.- Direct hernias do not often attain a large size or descend into scrotum.- In contrast to an indirect inguinal hernia, a direct inguinal hernia lies behind the spermatic cord.- As neck of the sac is wide, direct hernia s do not often strangulate.- A direct inguinal hernia is always acquired (Smoking, occupation that involve straining & heavy lifting & damage to ILIOINGUINAL NERVE)- Women practically never develop a direct inguinal hernia (It is common in old men with weak abdominal muscles and is rare in women).", "cop": 2, "opa": "Sac is anterior to cord", "opb": "Sac is posterior to cord", "opc": "Sac is medial to cord", "opd": "Sac is lateral to cord", "subject_name": "Surgery", "topic_name": "Hernia", "id": "e69d81cb-5c26-40ce-b536-1d237e2a2146", "choice_type": "single"} {"question": "Laproscopic procedure patient develops shoulder pain due to", "exp": "Ans. (c) Sub diaphragmatic migration of gas(Ref: Bailey 26th 100-101)* Shoulder pain after laparoscopy is due to pain referred from diaphragm and due to subdiaphragmatic migration of gas", "cop": 3, "opa": "Sub phrenic abscess", "opb": "positional pain during surgery", "opc": "Sub diaphragmatic migration of gas", "opd": "Injury to liver", "subject_name": "Surgery", "topic_name": "Peritoneum", "id": "338575e4-eff7-4dc2-9bf5-544488b80320", "choice_type": "single"} {"question": "In a child with a cavovarus foot deformity, the standing lateral block test assesses the flexibility of the", "exp": "The standing lateral block test is used to evaluate hind foot flexibility. It is performed by placingthe heel and lateral border of the patient's foot on a wooden block 2 to 4 cm thick, while the medial border of the foot is allowed to hang freely. This test negates any effect the forefoot may have on the hindfoot in stance. If the heel varus corrects with the patient standing on the block, the hindfoot is considered flexible.", "cop": 2, "opa": "Ankle", "opb": "Hindfoot", "opc": "Forefoot", "opd": "Ankle and hindfoot", "subject_name": "Surgery", "topic_name": null, "id": "6c3cc730-afef-4301-9b77-dc95fbb7a9b8", "choice_type": "single"} {"question": "Pneumatosis intestinalis is diagnostic of", "exp": ".Necrotising enterocolitis is an acquired inflammatory disease commonly seen in infants and newborn but occasionally can occur in children and adults. It ismore commonly seen in premature babies. It is more common in formula fed babies than breast bed babies. Reduced gut flora make virulent pathogens to act and cause sepsis. * Common site is terminal ileum, caecum and ascending colon. Often it can involve entire small bowel. * Gas in the bowel wall and often in poal vein is typical. ref:SRB&;s manual of surgery ,ed 3,pg no 810", "cop": 2, "opa": "Ileal perforation", "opb": "Necrotizing enterocolitis", "opc": "Meconium ileus", "opd": "Colonic aganglionosis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "2d38b3e9-574d-4614-90ee-06933b231ae9", "choice_type": "single"} {"question": "Earliest Sign/Symptom of Compartment Syndrome of Leg is", "exp": "Ans. (B) Pain on Passive flexion of FingersRef: Surgery Sixer 3rd Edition Page 103Repeated question so many times,Compartment syndrome of Lower leg is associated with* Early Sign- Pain on Passive stretching* Late Sign- Absent Pulses* Fasciotomy done Longitudinally at 2 sides of Tibia, at pressure >30mmHg.* Delayed Fasciotomy may result in Myoglobinuria and Renal Failure.", "cop": 2, "opa": "Tingling Numbness", "opb": "Pain on passive flexion of fingers", "opc": "Skin Changes", "opd": "Absent Pulses", "subject_name": "Surgery", "topic_name": "Trauma", "id": "e9e996c3-56e6-4f6d-b0cc-3fa769555afd", "choice_type": "single"} {"question": "In doing phrenic nerve block, it is best to infiltrate", "exp": "Phrenic nerve is blocked 3 cm above the clavicle at the posterior border of sternomastoid.", "cop": 3, "opa": "Scalenus anterior", "opb": "Scalenus posterior", "opc": "Posterior border of sternomastoid", "opd": "Anterior border of sternomastoid", "subject_name": "Surgery", "topic_name": "All India exam", "id": "c35c7075-d153-41d5-a1ca-ed237e8864ff", "choice_type": "single"} {"question": "Best test for oesophageal varices is", "exp": "B. i.e. (Gastro - oesophagoscopy) (1089 - B &L) (897 - S. Das 5th)Endoscopy - upper GI endoscopy represents the most reliable single technique as it shows the oesophageal varix and bleeding point* Dilated longitudinal veins running a Zig- Zag course*** Diffuse esophageal spasm is best diagnosed by Manometry**Management of bleeding oesophageal varices* Blood transfusion* Correct coagulopathy* Oesopageal balloon tamponade (Sengstaken - Blakemore tube)*** Drug therapy (Vasopressin /Octreotide)* Endoscopic sclerotherapy or banding* Assess portal vein potency (Doppler USG or CT)* Transjugular intrahepatic portosystemic stent shunts (TIPSS) (Contraindicated in portal vein occlusion)* Surgery- Portosystemic shunts- Oesophageal transaction- Splenectomy and gastric devascularisation* Commonest cause of acute upper GI haemorrhage - Peptic ulcer**", "cop": 2, "opa": "CT- scan", "opb": "Gastro- oesophagoscopy", "opc": "Tomography", "opd": "Ultrasound", "subject_name": "Surgery", "topic_name": "Oesophagus", "id": "d5ad8ad7-069c-4fe0-85ca-d3b4bfa4c85f", "choice_type": "single"} {"question": "Tennis Racquet cells", "exp": "Rhabdomyosarcoma An adjectival description for a relatively elongated cell, lesion, structure or radiological density that is globose at one end and elongated at the other, alike to the device used in game of tennis. Tennis racquet cell: A tennis-racquet-shaped variant of rhabdomyoblast seen in sarcoma botryoides, a form of rhabdomyosarcoma affecting children. The key cell to recognize by routine microscopy is the rhabdomyoblast, a cell with an eccentric round nucleus and variable amounts of brightly eosinophilic cytoplasm. 'Tennis racquet' appearance: A descriptive term for the ping-pong paddle-like thickening of the mesangium in glomeruli affected by Kimmelstiel Wilson disease. Tennis racquet granule: Birbeck granule; Langerhans' granule. A subcellular paicle with a pentilaminar 'handle' and bulbous terminal dilation of unceain significance that is seen by electron microscopy in the antigen-presenting Langerhans cell and in histiocytes. 'Tennis racquet sign (radiology): The description for a finding in a 'blighted ovum' in which the ultrasonically empty gestational sac is compressed (the racquet's 'handle') and adjacent to a surrounding decidual reaction (the 'paddle'); aka Tadpole sign. 'Tennis racquet' spore (microbiology): A descriptive term for the morphology of the subterminal spores in the gram positive Clostridium tetani, as well as in C. diphtheriae.", "cop": 2, "opa": "Rhabdomyoma", "opb": "Rhabdomyosarcoma", "opc": "Histiocytoma", "opd": "Eosinophilic granuloma", "subject_name": "Surgery", "topic_name": null, "id": "a486fa29-9373-4089-b386-29fc81ae001a", "choice_type": "single"} {"question": "According to Borrman's classification, Linnitis plastica is", "exp": "Classification of advanced gastric cancer according to Borrmann: Type Ipolypoid fungating Type IIulcerative with elevated distinct borders,Type IIIulcerative with indistinct bordersType IVdiffuse, indistinct borders (linitis plastica)Sabiston 20e pg: 1241", "cop": 4, "opa": "Type I", "opb": "Type II", "opc": "Type III", "opd": "Type IV", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "051eeedd-d771-4536-b8cc-fb025d642eb9", "choice_type": "single"} {"question": "The renal cell carcinoma having worst prognosis is", "exp": "Collecting duct/ bellini has the worst prognosis.", "cop": 2, "opa": "Clear cell carcinoma", "opb": "Chromophobe type RCC", "opc": "Collecting duct RCC", "opd": "Papillary RCC", "subject_name": "Surgery", "topic_name": null, "id": "bf66cfb5-f5f5-40c3-8fef-afcedf80337f", "choice_type": "single"} {"question": "\"Apple core\" sign seen in", "exp": "i.e. (Carcinoma descending colon): (1181-Love & Bailly 25th)* Barium enema showing a carcinoma of the sigmoid colon. It may have a 'apple core' appearance i.e. a short irregular stenosis with sharp shoulders at each end.* Carcinoma of the left colon appears as a fixed filling defect with an annular \"apple core\" configuration lesion of the right colon may appears as - constriction or an intraluminal mass (663 - CSDT13th)CEA levels are high in 70% of patients with cancer of large intestine but less than half of patients with localize disease are CEA positive. CEA does not therefore serve as a useful screening procedure, nor is it an accurate diagnostic test for colorectal cancer in a curable stage. CEA is helpfid in detecting recurrence after curative surgical resection; if high CEA levels return to normal after operation and then rise progressively during the follow up period, recurrence of cancer is likely (663-CSDT 13th)* Apple jelly nodules are seen in Lupus vulgaris*** Claw appearance on barium enema - Intussusception* Napkin - Ring sign - carcinoma colonRisk Factors for the Development of Colorectal cancer* Diet: Animal fat, High caloric diet, High saturated fat consumption* Hereditary syndromes (Autosomal dominant inheritance* Polyposis coli* Nonpolyposis syndrome (Lynch syndrome)* Inflammatory bowel syndrome (UC & CD)* Streptococcus bovis bacteremia* Uretero sigmoidostomy* DM and obesity* Tobacco use* Sedentary life style* High red meat consumption* High content of refined carbohydrate* There is narrowing of terminal ileum due to irritability This along with shortened rigid caecum is called as \"Sterilin sign\" seen in Crohn's disease and Ileocaecal TuberculosisCROHN'S DISEASE or REGIONAL ENTERITISULCERATIVE COLITIS* Terminal ileum is the Most common site*** Granularity & asymmetrical involvement with skip lesion* Ulcer - Apthous ulcer and fissure ulcer* Cobblestone pattern** (Serpiginous transverse ulcer seperated by areas of edema)* Rigidity of mesenteric border and pseudosacculation of anti mesenteric border (Omega sign)* Wide gapping of bowel loops due to thickening of bowel wall* Stricture : long segment (String sign of cantor)*** Collar button ulcer* Double Tracking (longitudinal submucosal ulceration over several centimeter)* Symmetrical involvement of colon* Rectum involvement in 95% of cases*** Thumbprinting** due to mucosal oedema* Blunting of haustral fold (Pipestem appearance)*** Inflammatory polyp*** Back wash ileitis. In UG when whole colon involved, the inflammation extends 1-2 cm into terminal ileum in 10-20% cases called Backwash ilitis* Gaseless abdomen in X-ray***", "cop": 1, "opa": "Carcinoma descending colon", "opb": "Ulcerative colitis", "opc": "Tuberculosis", "opd": "Diverticulitis", "subject_name": "Surgery", "topic_name": "Small & Large Intestine", "id": "577953ad-e496-463f-ba20-32754d3a005d", "choice_type": "single"} {"question": "Parotid gland contains", "exp": "Parotid glands - Contain serous acini\nSub lingual glands - Contain mucious acini\nMinor salivary glands - Contain mucious acini\nSubmandibular glands - Contain both serous and mucinous acini", "cop": 1, "opa": "Serous acini", "opb": "Mucinous acini", "opc": "Serous and mucinous acini with equal proportion", "opd": "75 % serous acini and 25 % mucinous acini", "subject_name": "Surgery", "topic_name": null, "id": "8cd8a502-ab2c-4270-b90e-045ef562fde9", "choice_type": "single"} {"question": "Most common cause of upper GI bleed is", "exp": "Most common cause of upper GI bleed is duodenal ulcer-33%. Other causes are gastric ulcer-21%, erosions-26%, mallery weis tears-4%, oesophageal varices-4%, tumours-0.5%, vascular lesions eg. Dieulafoy's disease-0.5% and others-5%. Reference : page 1063 Bailey and Love's sho practice of surgery 25th edition", "cop": 1, "opa": "Duodenal ulcer", "opb": "CA stomach", "opc": "Oesophageal varices", "opd": "Erosive gastritis", "subject_name": "Surgery", "topic_name": "Urology", "id": "fd886476-bdb8-41cd-9407-c2201dfb7101", "choice_type": "single"} {"question": "A surgeon excises a poion of the liver to the left to the attachment of the falciform ligament. The segments that have been resected are", "exp": "Segments II and III are to the left of the left hepatic vein and falciform ligament with II superior and III inferior to the poal plane.", "cop": 3, "opa": "Segment 1a and 4", "opb": "Segment 1 and 4b", "opc": "Segment 2 and 3", "opd": "Segment 1 and 3", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "caac670b-8312-4022-be4e-c5739a594f9c", "choice_type": "single"} {"question": "Lachman test is positive in", "exp": "A i.e. Anterior cruciate", "cop": 1, "opa": "Anterior cruciate ligament injury", "opb": "Posterior Cruciate ligament injury", "opc": "Medial meniscus injury", "opd": "Lateral meniscus injury", "subject_name": "Surgery", "topic_name": null, "id": "baf1907d-fe67-499d-94db-6ff29dae8c09", "choice_type": "single"} {"question": "Recovery is complete in the following injury", "exp": "Seddon's Classification Neuropraxia: It is temporary physiological paralysis of nerve conduction. Here recovery is complete. There is no reaction of degeneration. Axonotmesis: It is division of nerve fibres or axons with intact nerve sheath. There is reaction of degeneration distally with near complete recovery. Patient can present with sensory loss, paralysis of muscles or causalgia. Neurotmesis: Here complete division of nerve fibres with sheath occurs . Degeneration occurs proximally up to the first node of Ranvier as well as distal to the injury. Recovery is incomplete even after nerve suturing. There is complete loss of motor and sensory functions with loss of reflexes. If the nerve is mixed type other than pure motor or sensory recovery is still poorer. Injuries may be incised or lacerated or crushed one. Cut end of the nerve forms proximally neuroma and distally glioma. Ref: SRB's Manual of Surgery 5th edition Pgno : 264", "cop": 3, "opa": "Neurotmesis", "opb": "Axonotmesis", "opc": "Neuroparaxia", "opd": "Nerve avulsion", "subject_name": "Surgery", "topic_name": "Urology", "id": "49883e5b-7bc0-409d-b504-48baac91cf38", "choice_type": "single"} {"question": "Platelets can be stored at", "exp": ". Shelf-life 5 days Storage temperature range 20-24 oC Comments Platelets components must be agitated gently and continuously in a single layer on a platelet agitator.", "cop": 1, "opa": "20-24oC for 5 days", "opb": "20-24oC for 8 days", "opc": "4-8oC for 5 days", "opd": "4-8oC for 8 days", "subject_name": "Surgery", "topic_name": "General surgery", "id": "3a0def0f-3600-4f02-aaa8-12337d2c78fa", "choice_type": "single"} {"question": "Treatment for stage T3N1 of carcinoma maxilla is", "exp": "Maxillary carcinoma is of two types Squamous cell carcinoma -- (MC. type of carcinoma) Adenocarcinoma T/T of maxillary carcinoma Squamous cell carcinoma - Combination of Surgery and radiotherapy gives better res is than either alone. Radiotherapy can be given before or after surgery (The t/t is same in every stage of maxillary carcinoma) Adenocarcinoma - Radiotherapy is ineffective, so only surgery is done.", "cop": 2, "opa": "Surgery only", "opb": "Surgery and radiation", "opc": "Radiation therapy only", "opd": "Chemotherapy and radiation", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "bd223fae-4426-48e1-a014-ef00ff9e4661", "choice_type": "single"} {"question": "Metabolic abnormality is seen in large colorectal villous adenoma", "exp": "Villous adenomas causing profuse watery diarrhoea and hypokalemia is known as the McKittrick Wheelock syndrome after it was first described in 1954.\nMetabolic abnormalities seen are hyponatraemia, hypokalaemic, and hypochloraemic metabolic acidosis.\nSevere volume loss may cause acute renal failure and cardiovascular collapse.\nThe mechanism of fluid and electrolyte loss is unclear. Locally released prostaglandin E2 has been suggested as the secretagogue responsible for salt wasting, as has a cyclic AMP.\n\nTreatment:\n\nReversal of the biochemical derangement is the cornerstone of successful management. Once resuscitated, immediate surgical resection of the tumor, is the treatment of choice.", "cop": 2, "opa": "Hypokalemic metabolic alkalosis", "opb": "Hypokalemic metabolic acidosis", "opc": "Chlorine sensitive metabolic acidosis", "opd": "Chlorine resistant metabolic alkalosis", "subject_name": "Surgery", "topic_name": null, "id": "1e256010-8396-4455-87ff-4b27bf92073a", "choice_type": "single"} {"question": "Commonest site of meningocele is", "exp": "• Herniation of meninges through a defect in the posterior vertebral arches.\n• Spinal cord is usually normal and assumes a normal position in the spinal canal\n• There may be tethering, syringomyelia, or diastematomyelia.\nClinical Features\n• A fluctuant midline mass, that may transilluminate occurs along the vertebral column, in the lower back.\n• Most meningoceles are well covered with skin and pose no threat to the patient.\n• Anterior meningocele: Projects into pelvis through a defect in the sacrum.\n• Symptoms of constipation and bladder dysfunction develop due to the increasing size of the lesion.\nDiagnosis\n• Plain roentgenograms demonstrate a defect.\nTreatment\n• Asymptomatic children with normal neurologic findings and full-thickness skin covering the meningocele may have surgery delayed.\n• Patients with leaking CSF or a thin skin covering should undergo immediate surgical treatment to prevent meningitis.", "cop": 1, "opa": "Lumbosacral", "opb": "Occipital", "opc": "Frontal", "opd": "Thoracic", "subject_name": "Surgery", "topic_name": null, "id": "7f4e055e-a49f-45bc-81b4-adc0a9e45953", "choice_type": "single"} {"question": "In a sutured surgical wound, the process of epithelialization is completed within", "exp": "Epithelialization is defined as a process of covering the denuded epithelial surface. In a sutured surgical wounds are epithelialized within 24-48 hours. Hence Post op dressing is done only after 48 hrs.", "cop": 2, "opa": "24 hours", "opb": "48 hours", "opc": "72 hours", "opd": "96 hours", "subject_name": "Surgery", "topic_name": "General surgery", "id": "8c03b35c-3c37-48f7-8f4a-cb9685840d19", "choice_type": "single"} {"question": "Negative pressure dressing is used for", "exp": "Answer- B. Chronic non-healing diabetic ulcerNegative-pressure wound therapy (NPWT) is a therapeutic technique using a vacuum dressing to promote healing in acute or chronic wounds and enhance healing ofsecond and third degree burns.Use in the treatment of diabetes-associated chronic leg wounds.", "cop": 2, "opa": "Removal of eschar", "opb": "Chronic non-healing diabetic ulcer", "opc": "Unexplored fistulas", "opd": "Untreated osteomyelitis", "subject_name": "Surgery", "topic_name": null, "id": "37c18252-f911-4e14-bbb3-6b51ac935176", "choice_type": "single"} {"question": "Treatment of choice of cystic hygroma", "exp": "Surgical excision is most definitive treatment of cystic hygroma. Other treatments include Sclerotherapy and cautery etc.", "cop": 4, "opa": "Percutaneous aspiration", "opb": "Intralesional sclerosant injection", "opc": "En Block resection", "opd": "Surgical excision", "subject_name": "Surgery", "topic_name": null, "id": "6e5802c5-802e-43a6-a5f7-65f83cb20beb", "choice_type": "single"} {"question": "Ectopic uretor opening is not located in", "exp": "Ectopic ureters are almost always associated with ureteric duplication and 10% are bilateral. There is a female:male ratio of 7:1. The ectopic ureter drains the upper pole of the kidney and inses into the bladder more distally than normal and towards the bladder neck. In females, the ectopic ureter opens either into the urethra below the sphincter or into the vagina. A female who voids normally but who has dribbled urine for as long as she can remember is typical of the patient with an ectopic ureter. In the male, the opening of the ureter is above the external urethral sphincter so the patient is continent. An ectopic ureteric orifice in a male at the apex of the trigone, in the posterior urethra, in a seminal vesicle or in an ejaculatory duct is likely to be functionally abnormal and infection is common. A severely diseased or atrophic moiety is effectively treated by paial nephrectomy. A refluxing ureter may need re-implanting. An ectopic ureter in a female often drains hydronephrotic and chronically infected renal tissue and is best excised. Rarely, the incontinence can be cured and renal function preserved by re-implanting the ureter into the bladder. ( ref : Bailey 27 th ed , chapter 76 , pg 1401 )", "cop": 1, "opa": "Bulbar urethra", "opb": "Prostatic urethra", "opc": "Seminal vesicle", "opd": "Bladder neck", "subject_name": "Surgery", "topic_name": "Urology", "id": "87d52230-da8f-43e5-b2c0-23cc20610a70", "choice_type": "single"} {"question": "Salivary calculus is more common in", "exp": null, "cop": 1, "opa": "Submandibular gland", "opb": "Sublingual gland", "opc": "Parotid gland", "opd": "Minor salivary gland", "subject_name": "Surgery", "topic_name": null, "id": "6552e7bb-5acd-4408-9eb1-d44d4bc0e99e", "choice_type": "single"} {"question": "A young male presents with leg swelling and recurrent aphthous ulcers of his lips and tongue. He has also recently noted painful genital ulcers. There is no urethritis or conjunctivitis. On exam, he has evidence of deep vein thrombophlebitis. (SELECT 1 DIAGNOSIS)", "exp": "Behcet syndrome is a multisystem disorder that usually presents with recurrent oral and genital ulcers. Onefouh of patients develop superficial or deep vein thrombophlebitis. Iritis, uveitis, and nondeforming ahritis may also occur. The 50-year-old drug abuser also has a multisystem disease, including systemic complaints, hypeension, skin lesions, neuropathy, and an abnormal urine sediment. This complex suggests a vasculitis, paicularly polyaeritis nodosa. The disease is a necrotizing vasculitis of small and medium muscular aeries. The pathology of the kidney includes an aeritis and, in some cases, a glomerulitis. Nodular skin lesions show vasculitis on biopsy. The 19-year-old with low back pain, morning stiffness, and eye pain has complaints that suggest ankylosing spondylitis. This is an inflammatory disorder that affects the axial skeleton. It is an autoimmune disorder that has a close association with HLA-B27 histocompatibility antigen. Anterior uveitis is the most common extraaicular complaint. Aoic regurgitation occurs in a few percent of patients. The elderly male presents with nonspecific joint complaints typical of polymyalgia rheumatica. The high erythrocyte sedimentation rate is characteristic. The transient loss of vision suggests concomitant temporal aeritis, an impoant association seen paicularly.", "cop": 1, "opa": "Behcet syndrome", "opb": "Ankylosing spondylitis", "opc": "Polymyalgia rheumatic", "opd": "Polyaeritis nodosa", "subject_name": "Surgery", "topic_name": null, "id": "4ad5527c-ec51-4c57-bd54-51fdc02b8b18", "choice_type": "single"} {"question": "Drug of choice for Her 2 Neu positive Breast cancer", "exp": "Ans. (a) Trastuzumab(Ref. Bailey and Love 27th Edition Page 878)* Drug of choice for Tumors containing Growth Factor receptor positive for C- erb B2 is Trastuzumab (Herceptin)* Other agents currently available are:# Lapitinib- Oral Combined Tyrosine Kinase Inhibitor# Pertuzumab- Tyrosine Kinase inhibitor# T-DM1- A drug which has emestane is bound to Anti Her 2 agent to allow targeted delivery of Chemotherapy for HER-2 Positive cases.", "cop": 1, "opa": "Trastuzumabb.", "opb": "Tamoxifen", "opc": "Exemestane", "opd": "Fluvestart", "subject_name": "Surgery", "topic_name": "Breast", "id": "bd60f656-e7bc-4f17-b369-a7cafd5c1245", "choice_type": "single"} {"question": "EDH least common possibility is in", "exp": "(D) Saccular aneurysm # Extradural hemorrhage is most commonly due to middle meningeal artery.> Saccular aneurysm rupture is associated with subarachnoid hemorrhage.", "cop": 4, "opa": "Middle cerebral artery", "opb": "Middle meningeal artery", "opc": "Venous sinuses", "opd": "Saccular aneurysm", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "1ec556b3-6902-4457-a196-95d34e8116fc", "choice_type": "single"} {"question": "Most common site of salivary gland stone", "exp": "Stones are common in submandibular gland due to thick secretions.", "cop": 1, "opa": "Submandibular gland", "opb": "Parotid gland", "opc": "Sublingual gland", "opd": "Minor salivary glands", "subject_name": "Surgery", "topic_name": null, "id": "2ad9ad16-1730-46ad-b2b2-e9f97e89c162", "choice_type": "single"} {"question": "Jack stone calculi are made up of", "exp": "Jack stone calculi are seen in bladder formed by calcium oxalate.", "cop": 4, "opa": "Ammonium urate", "opb": "Uric acid", "opc": "Struvite", "opd": "Calcium oxalate", "subject_name": "Surgery", "topic_name": null, "id": "3558a954-221d-47eb-94ed-9f24b3fdc4bd", "choice_type": "single"} {"question": "Noble laurate among the following", "exp": "(Theodor kocher) (Internet)Theodor kocher was the first Nobel prize winner in the surgical speciality in 1909 for this work in surgery of the thyroid glandWillian Stewart Halsted* In 1882 Halsted was researching breast cancer a disorder that was becoming better understood by the time. He decided that the best way to prevent the spread of the cancerous cells was to simply remove them surgically known as radical mastectomy*** Between 1883 and 1886 Halsted published many papers on* Usuage of blood transfusion during surgery* Injection of a saline solution in to the blood to dilute it can treat shock* In 1884 a physician named Karl Koller demonstrated the use of cocaine for LA* Rubber gloves for medical purposes & its importance** in preventing infection and the spread of pathogene* Method for repair of inguinal hernia that had a lower mortality rate than other previous methods* The noble prize in physiology or medicine for 2007 was jointly awarded to Mario R. capecchi, Martin J. Evans J and Oliver Smithies for their discoveries of - Principles for introducing specific gene modification in mice by the use of embryonic stem cells**", "cop": 4, "opa": "Banker's", "opb": "Willium halsted", "opc": "Turek", "opd": "Theodor kocher", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "294a9568-35ae-4ab1-a8b9-bb4785ce6d7f", "choice_type": "single"} {"question": "A person has been brought in casualty with history of road accident. He had lost consciousness transiently and then gained consciousness but again became unconsious. Most likely, he is having brain hemorrhage of", "exp": ".extradural haematoma is the collection of blood in the extradural space between the dura and skull. most common site is the temporoparietal region.usually it is associated with fracture of temporoparietal region. immediately after injury , there is transient loss of consciousness and the patient soon become normal. later after 6-12 hours , he again falls ill and the condition deteriorates. this is the time taken to develop raised intracranial pressure,coning and its effects. this crucial time gap is called lucid interval. (Ref : SRB&;s Manual of Surgery, 5th editin , pg no.1095)", "cop": 4, "opa": "Intracerebal", "opb": "Sub arachnoid", "opc": "Sub dural", "opd": "Extra dural", "subject_name": "Surgery", "topic_name": "Trauma", "id": "b5069c73-64fb-4976-8abd-d2e215298b08", "choice_type": "single"} {"question": "Gold standard test for insulinoma is", "exp": "Insulinoma Definition This is an insulin-producing tumour of the pancreas causing the clinical scenario know as Whipple's triad, i.e. symptoms of hypoglycaemia after fasting or exercise, plasma glucose levels <2.8 mmol/L and relief of symptoms on intravenous adminis- tration of glucose. Incidence Insulinomas are the most frequent of all the functioning PETs with a repoed incidence of 2-4 cases per million population per year. Insulinomas have been diagnosed in all age groups, with the highest incidence found in the fouh to the sixth decades. Women seem to be slightly more frequently affected. Pathology The aetiology and pathogenesis of insulinomas are unknown. No risk factors have been associated with these tumours. Viually all insulinomas are located in the pancreas and tumours are equally distributed within the gland. Approximately 90% are solitary and about 10% are multiple and associated with MEN 1 syndrome. Prognosis and predictive factors No markers are available that reliably predict the biological behaviour of an insulinoma. Approximately 10% are malignant. Insulinomas of <2 cm in diameter without signs of vascular invasion or metastases are considered benign. Clinical features Insulinomas are characterised by fasting hypoglycaemia and neuroglycopenic symptoms. The episodic nature of the hypoglycaemic attacks is caused by intermittent insulin secretion by the tumour. This leads to central nervous system symptoms such as diplopia, blurred vision, confusion, abnormal behaviour and amnesia. Some patients develop loss of consciousness and coma. The release of catecholamines produces symptoms such as sweating, weakness, hunger, tremor, nausea, anxiety and palpitations. Biochemical diagnosis A fasting test that may last for up to 72 hours is regarded as the most sensitive test. Usually, insulin, proinsulin, C- peptide and blood glucose are measured in 1- to 2-hour intervals to demonstrate inappropriately high secretion of insulin in relation to blood glucose. About 80% of insulinomas are diagnosed by this test, most of them in the first 24 hours. Elevated C-peptide levels demonstrate the endogenous secretion of insulin and exclude factitious hypoglycaemia caused by insulin injection. Ref: Bailey and love 27th edition Pgno : 849", "cop": 1, "opa": "72 hour fasting test", "opb": "Plasma insulin levels", "opc": "C peptide levels", "opd": "Low glucose levels <30 mg/dl", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "2cd88df1-a42c-4025-b276-cecb4baf00df", "choice_type": "single"} {"question": "Treatment of choice for Wahin's Tumor", "exp": "Ans is 'a' i.e. Superficial parotidectomy The treatment of all benign tumors of the parotid gland is superficial parotidectomy", "cop": 1, "opa": "Superficial parotidectomy", "opb": "Enucleation", "opc": "Radiotherapy", "opd": "Injection of a sclerosant agent", "subject_name": "Surgery", "topic_name": null, "id": "0655785c-96b5-4a20-a7cc-1774868ae126", "choice_type": "single"} {"question": "Branchial cyst is found in", "exp": "A branchial cyst probably develops from the vestigial remnants of the second branchial cleft, is usually lined by squamous epithelium, and contains thick, turbid fluid full of cholesterol crystals. The cyst usually presents in the upper neck in early or middle adulthood and is found at the junction of the upper third and middle third of the sternomastoid muscle at its anterior border. It is a fluctuant swelling that may transilluminate and is often soft in its early stages so that it may be difficult to palpate. If the cyst becomes infected it becomes erythematous and tender and, on occasions, it may be difficult to differentiate from a tuberculous abscess. Ultrasound and fine-needle aspiration both aid diagnosis and treatment is by complete excision, which is best undeaken when the lesion is quiescent. Although the anterior aspect of the cyst is easy to dissect, it may pass backwards and upwards through the bifurcation of the common carotid Bailey & Love ,25th,727.", "cop": 2, "opa": "Midine of neck", "opb": "Upper and middle third of the sternomastoid muscle at its anterior border", "opc": "Nape of neck", "opd": "Upper one-third along anterior tender of trapezius", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "39857aba-79ed-4f2f-b8ec-209e4cabd406", "choice_type": "single"} {"question": "Investigation of choice for parotid fistula", "exp": "Starch iodine Test is used for Frey's Syndrome.", "cop": 4, "opa": "CT Scan", "opb": "X-ray", "opc": "Starch iodine Test", "opd": "Sialogram", "subject_name": "Surgery", "topic_name": null, "id": "c053ba31-8ef9-47a3-aa88-388049604e6e", "choice_type": "single"} {"question": "Management of 5 cm size renal struvite calculus", "exp": "For stones which are\n\n>2cm size\nHydronephrosis\nObstructed\n\nPCNL is performed", "cop": 2, "opa": "ESWL", "opb": "PCNL", "opc": "Retrograde intrarenal surgery", "opd": "Open Pyelolithotomy", "subject_name": "Surgery", "topic_name": null, "id": "1051466a-42f8-4d01-a7db-14725680b5b0", "choice_type": "single"} {"question": "Painless gross hematuria occurs in", "exp": null, "cop": 1, "opa": "Renal cell carcinoma", "opb": "Polycystic kidney", "opc": "Stricture of urethra", "opd": "Wilm's tumor", "subject_name": "Surgery", "topic_name": null, "id": "43b5690f-d59d-4c18-9a74-02821768bef4", "choice_type": "single"} {"question": "Cause of Failure to thrive include (s)", "exp": ".* Mesenteric tuberculous adenitis is more common in children. Present with anaemia, fever, loss of appetite and reduced weight, failure to thrive, palpable mass in right iliac fossa which is firm and nodular.failure to thrive as also in choledochal cysts. ref:SRB&;s manual of surgery,ed 3,pg no 522", "cop": 1, "opa": "Malabsorption", "opb": "Child abuse", "opc": "GERD", "opd": "Chomosomal disorders", "subject_name": "Surgery", "topic_name": "Urology", "id": "e01e1cf2-6869-4ea4-ac97-3861b5936043", "choice_type": "single"} {"question": "Most common cause of acute epididymitis in young males", "exp": "Young males most common organism is chlamydia\nAge > 40 most common organism is E Coli", "cop": 1, "opa": "Chlamydia", "opb": "E Coli", "opc": "N. Gonorrhoea", "opd": "Proteus", "subject_name": "Surgery", "topic_name": null, "id": "7d801b26-a860-443c-9ceb-25462732c409", "choice_type": "single"} {"question": "Water soluble contrast made up of", "exp": "There are two types of Water soluble contrast:- Ref:- Surgery Sixer 3rd Edition; Pg num:- 327", "cop": 1, "opa": "Iodine", "opb": "Barium", "opc": "Calcium", "opd": "Bromine", "subject_name": "Surgery", "topic_name": "General surgery", "id": "f21d231b-663b-427d-869a-8bd5f37fc749", "choice_type": "single"} {"question": "Dimpling in carcinoma breast is due to", "exp": "Answer- C. Subdermal lymphangitisPeaud's orange is produced due to obstruction of superficial lymph vessels by cancer cell.This causes edema of the skin giving rise to an appearance like that ofthe skin of an orange (Peau'd orange appearance).", "cop": 3, "opa": "Edema", "opb": "Contraction of cooper's ligaments", "opc": "Subdermal lymphangitis", "opd": "Scaring", "subject_name": "Surgery", "topic_name": null, "id": "313b9d00-7409-4d85-8bf1-63f85b5c9686", "choice_type": "single"} {"question": "In majority of patient with esophageal leaks in thoracic cavity of less than 12 hours duration, the treatment of choice is", "exp": null, "cop": 1, "opa": "Primary closure, drainage and antibiotics", "opb": "Early esophagogastrostomy", "opc": "Exclusion and diversion of continuity", "opd": "Total esophagectomy and gastric pull up", "subject_name": "Surgery", "topic_name": null, "id": "041f5b60-67e6-4a45-a2d4-8e4bba6a594a", "choice_type": "single"} {"question": "After extraction of upper central incisor, patient develops ophthalmoplegia, meningitis and lateral rectus paralysis. The diagnosis is", "exp": null, "cop": 1, "opa": "Cavernous sinus thrombosis", "opb": "Not related", "opc": "Cellulitis", "opd": "Ludwig's angina", "subject_name": "Surgery", "topic_name": null, "id": "7f810252-13df-404b-9fca-1ef8fccb8b5b", "choice_type": "single"} {"question": "Testis tumor is associated with secondary hydrocele in", "exp": "• Approximately 5-10% of testicular tumors may be associated with hydroceles.", "cop": 2, "opa": "1% of cases", "opb": "10% of cases", "opc": "20% of cases", "opd": "30% of cases", "subject_name": "Surgery", "topic_name": null, "id": "1695ff53-84da-48c5-82ec-721fa47c4596", "choice_type": "single"} {"question": "Sphincterotomy of sphincter of Oddi is performed at", "exp": "This cut is made superiorly (at the 11 o'clock position) for 4 to 5 mm The sphincter is incised at the 11-O'clock position to avoid injury to the pancreatic duct", "cop": 4, "opa": "3 O'clock position", "opb": "6 O'clock position", "opc": "9 O'clock position", "opd": "11 O'clock position", "subject_name": "Surgery", "topic_name": "All India exam", "id": "61c1f4c1-ea34-46d9-8208-94684557132b", "choice_type": "single"} {"question": "Curling's ulcer is seen if burns area is more than", "exp": "Curling's ulcer is seen if burns > 35%.", "cop": 1, "opa": "35%", "opb": "45%", "opc": "55%", "opd": "65%", "subject_name": "Surgery", "topic_name": null, "id": "3210e99b-7fac-46c3-8724-d2239c151f8d", "choice_type": "single"} {"question": "Patient is on autocoids for 1 year complains of severe pain epigasrium relieved iv antacids now complains of pain in right iliac fossa and epigastrium with fever and loss of liver dullness diagnosis", "exp": "Answer- A. Duodenal perforationLong term therapy with autocoids led to an ulcer that eventually perforated and now the patient has presented early signs of peritonitis.Clinical features of perfontion of duodenal ulcerPerforated duodenal ulcer is characterized by sever constant onset epogastric painPatient looks ill and lies unusually stillTachycardiaShallow respirationTender with intense guarding and rigidityIf the air has escaped into peritoneal cavity then liver dullness may be absentPeptic ulcer perforation leads to chemical peritonitis initially.", "cop": 1, "opa": "Duodenal perforation", "opb": "Diveiculitis", "opc": "Gastroenteritis", "opd": "Enteric perforation", "subject_name": "Surgery", "topic_name": null, "id": "5de33d00-7267-4c32-ba12-4c9d6598d9af", "choice_type": "single"} {"question": "In cholecystectomy, fresh frozen plasma should be given", "exp": "Ans. is 'a' i.e., Just before operation", "cop": 1, "opa": "Just before operation", "opb": "At the time of operation", "opc": "6 hours before operation", "opd": "12 hours after operation", "subject_name": "Surgery", "topic_name": null, "id": "66fd6548-5db5-4749-9619-05c51c3014f4", "choice_type": "single"} {"question": "Banka's lesion involves the of the glenoid labrum.", "exp": "D i.e. Antero-inferior lip", "cop": 4, "opa": "Anterior lip", "opb": "Superior lip", "opc": "Antero-superior lip", "opd": "Antero-inferior lip", "subject_name": "Surgery", "topic_name": null, "id": "bed740b9-6a3b-4816-b231-6fe1ce2a8569", "choice_type": "single"} {"question": "Treatment of squamous cell carcinoma of anal canal not involving the deeper structures include", "exp": "Anal cancer # Uncommon tumour, which is usually a squamous cell carcinoma # Associated with HPV # More prevalent in patients with HIV infection # May affect the anal verge or anal canal # Lymphatic spread is to the inguinal lymph nodes # Treatment is by chemoradiotherapy in the first instance # Major ablative surgery is required if the above fails Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1269", "cop": 4, "opa": "Abdomino pereneal resection", "opb": "Wide local excision + Radiotherapy", "opc": "Wide local excision + Chemoradiation", "opd": "Chemoradiation", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "68837f3f-2f59-4b38-a2ab-86431f8b854f", "choice_type": "single"} {"question": "The most common cause of epididymitis is", "exp": "Epididymitis is most common in young men ages 19 to 35. Chlamydia is the most common cause in sexually active men younger than 35 years (accounting for up to 50% of cases). Infections with urinary coliforms (eg, E coli, Pseudomonas species, Proteus species, Klebsiella species) are the most common cause in children and in men older than 35 years. Reference : page 1383 Bailey and Love's sho practice of surgery 25th edition", "cop": 2, "opa": "Gonococcal infection", "opb": "Chlamydia infection", "opc": "Proteus infection", "opd": "Tubercular infection", "subject_name": "Surgery", "topic_name": "Urology", "id": "62cfed4e-0974-4e8e-b2c8-5169c88bc88a", "choice_type": "single"} {"question": "Palpable plaque with curved penis pointing to the side of plaque is a feature of", "exp": "Ans. is 'a' i.e., Peyronies disease * Unyielding palpable plaque in penis with erect penis bent, often dramatically, towards the side of the plaque is a feature of peyronies disease.Peyronie's disease* Peyronie's disease is a common cause of deformity of the erect penis.* Hard plaques of fibrosis can usually be palpated in the tunica of one or both corpora cavernosa. The plaques may be calcified.* The presence of the unyielding plaque tissue within the normally elastic wall of the corpus cavernosum causes the erect penis to bend, often dramatically, towards the side of the plaque.* The aetiology is uncertain but it may be a result of past trauma - there is an association with Dupuytren's contracture.* Disease may continue to progress or remit after 3-5 years.* When the deformity of the penis is causing distress, it may be possible to straighten it by placing non- absorbable sutures in the corpus cavernosum opposite the plaque. This reduces the elasticity in this region to balance that caused by the plaque (Nesbitt's operation).", "cop": 1, "opa": "Peyronies disease", "opb": "Condyloma acuminate", "opc": "Penile carcinoma", "opd": "Hypospadias", "subject_name": "Surgery", "topic_name": "Urethra & Penis", "id": "f7a1bec4-04ab-4d2d-bacc-a7f7853d0136", "choice_type": "single"} {"question": "Vasodilation in spider naevi is due to aEUR'", "exp": "Estrogen", "cop": 2, "opa": "Hepatotoxin", "opb": "Estrogen", "opc": "Testosterone", "opd": "DHEA", "subject_name": "Surgery", "topic_name": null, "id": "f9836736-34ca-4073-944b-771b856e7b35", "choice_type": "single"} {"question": "A 21 years old woman has 3 cm node in the lower deep cervical chain on the left. The biopsy is interpreted as revealing normal thyroid tissue in a lymph node. The most likely diagnosis is", "exp": ". Thyroid tissue present in cervical lymph nodes in the face of a clinically normal thyroid gland is a metastasis from an occult primary thyroid carcinoma Occasionally, a metastatic papillary thyroid cancer manifests as a painless lateral neck mass that is clinically detected before detecting the primary thyroid lesion. Sabiston 20th edition pg 926", "cop": 2, "opa": "Subacute thyroiditis", "opb": "Papillary carcinoma thyroid", "opc": "Hashimoto's disease", "opd": "Lateral aberrant thyroid", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "120338f9-1d30-45b3-9ef0-d4e3963d5cd0", "choice_type": "single"} {"question": "Pringle maneuvar to arrest hehemorrhage is", "exp": "Pringle manoeuvre is used to control hemorrhage by clamping the hepatoduodenal ligament and compressing the poal triad,thereby reducing aerial and venous inflow into the liver.But it doesn't control the backflow from inferior vena cava and hepatic veins. Reference: Bailey & Love's sho practise of surgery,25 th edition,page no348.", "cop": 4, "opa": "Clamping of poal vein", "opb": "Clamping of hepatic aery", "opc": "Clamping of hepatic vein", "opd": "Clamping of hepatoduodenal ligament", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "196f9fc0-44f1-4a07-98c7-ee8078601961", "choice_type": "single"} {"question": "Radiographic appearance of the inferior dental canal and roots of the mandibular third molar", "exp": null, "cop": 2, "opa": "Tram lines visible", "opb": "Radiolucent band evident in relation to root of third molar which is grooved tunneled", "opc": "Winter's lines", "opd": "Tram lines enhanced", "subject_name": "Surgery", "topic_name": null, "id": "eb031df9-b365-40db-99b4-e4f0bf6a8786", "choice_type": "single"} {"question": "'Rubber band' extraction is a method of extraction in patients having", "exp": null, "cop": 1, "opa": "Bleeding disorders", "opb": "Myocardial infarction and angina pectoris", "opc": "Supernumerary teeth", "opd": "Impacted teeth", "subject_name": "Surgery", "topic_name": null, "id": "1490ef54-19c6-4a4e-b9f8-a329a5554bda", "choice_type": "single"} {"question": "The role of Tamoxifen in the reduction of breast cancer is", "exp": "(A) Competes with estrogen receptor in breast # Tamoxifen is a hormone treatment developed over twenty years ago. It lowers the risk of breast cancer coming back (recurring) or developing in the other breast.> Tamoxifen prevents oestrogen from going into breast cancer cells> Oestrogen can stimulate breast cancer cells to divide and grow.> The oestrogen receptor is a part of the cell that oestrogen can lock into and encourage the cell to multiply to make more breast cancer cells.> Tamoxifen locks into the oestrogen receptor and stops the oestrogen from getting to the cell. Progesterone receptors are similar 'locks' on the cell surface for progesterone, the other female sex hormone.> Breast cancers are divided into oestrogen receptor and progesterone receptor positive and Tamoxifen is given to oestrogen receptor positive patients", "cop": 1, "opa": "Competes with estrogen receptor in breast", "opb": "Decreases blood supply to tumour", "opc": "Directly acting anticancer drug", "opd": "Augments radiation therapy", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "2ade9c27-bff5-4935-940b-bb8c5a7b5ede", "choice_type": "single"} {"question": "30 yrs female presented with unilateral breast cancer associated with axillary lymph node enlargement. Modified\nradical\nmastectomy was done, a further treatment plan will be", "exp": "Stage I & II breast cancers (Early invasive breast cancers ) are managed by\n1. Primary therapy for local management \n2. Adjuvant therapy Primary therapy consists of:\nMastectomy with an assessment of axillary lymph node status (or modified radical mastectomy) or Breast conservation (lumpectomy, wide local excision or quadrantectomy) with an assessment of axillary lymph node status + radiotherapy.\nVarious 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 nodes Earlier 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 thirst 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 cancers node-negative cancers if > 1 cm in size.\n\nNode-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/neuoverexpression negative hormone receptor status Adjuvant hormone therapy (tamoxifen) is added to all those with estrogen receptor positive tumors. HER-2/neu expression is determined for all patients with newly diagnosed breast cancer and may be used to provide prognostic information in patients with node-negative breast cancer and predict the relative efficacy of various chemotherapy regimens. Trastuzumab is the HER-2/neu-targeted agent that is added to the adjuvant therapy is the tumor shows overexpression of HER-2/neu receptors. Advanced Local-Regional Breast Cancer (Stage III ) (Neoadjuvant chemotherapy + MRM + adjuvant radiation therapy + chemotherapy + antiestrogen therapy)\n\nHere the disease is advanced on the chest wall or in regional lymph nodes (or both), with no evidence of metastasis to distant sites.\nSuch 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.\nNeoadjuvant 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.\nChemotherapy is used to maximize distant disease-free survival, whereas radiation therapy is used to maximize local-regional disease-free survival.\nIn selected patients with stage IIIA cancer, neoadjuvant (preoperative) chemotherapy can reduce the size of primary cancer and permit breast-conserving surgery.\nDistant 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.\nHormonal therapies that are associated with minimal toxicity are preferred to cytotoxic chemotherapy.\nAppropriate 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.\nSystemic chemotherapy is indicated for women with hormone receptor-negative cancers, symptomatic visceral metastases, and hormone-refractory metastases. Bisphosphonates, which may be given in addition to chemotherapy or hormone therapy, should be considered in women with bone metastases. About Adjuvant Therapy, Adjuvant therapy is the use of systemic therapy (chemotherapy or/and hormone therapy) in patients who have received local therapy but are at risk of relapse.\nThe objective is to eliminate the occult metastasis responsible for late recurrences while they are microscopic and theoretically most vulnerable to anticancer agents. Adjuvant chemotherapy is given to all node-positive cancers node-negative cancers if > 1 cm in size node-negative cancer > .5 cm in size with adverse prognostic factors such as blood vessel or lymph vessel invasion high nuclear grade high histological grade HER 2/neuover expression negative hormone receptor status Adjuvant hormone therapy (tamoxifen) is added to all those with estrogen receptor positive.\n\nThe use of chemotherapy in postmenopausal women is controversial. In postmenopausal women, chemotherapy is frequently used upto age 70 yrs, if she can tolerate it. In older women, chemotherapy is performed less frequently.\n\n In estrogen-positive tumors, in postmenopausal women, antiestrogen (tamoxifen / aromatase inhibitors)\nTherapy 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 p844 Anti-HER-2/neu antibody therapy.\n(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).", "cop": 3, "opa": "Observation and follow-up", "opb": "Adriamycin based chemotherapy only", "opc": "Adriamycin based chemotherapy followed by tamoxifen depending on estrogen/progesterone receptor status", "opd": "Tamoxifen only", "subject_name": "Surgery", "topic_name": null, "id": "3568d301-59d9-4519-af0f-b2a95b29a6f0", "choice_type": "single"} {"question": ". Internal fistulas with colonic diverticulitis are most often", "exp": null, "cop": 1, "opa": "Colovesical", "opb": "Coloenteric", "opc": "Colocolonic", "opd": "Colovaginal", "subject_name": "Surgery", "topic_name": null, "id": "970d1c88-abc0-480b-ba57-ca0547e4534c", "choice_type": "single"} {"question": "Elephant foot deformity is indicative of", "exp": null, "cop": 2, "opa": "Diplopia", "opb": "Non-union of fractured edentulous mandible", "opc": "Skeletal Class II malocclusion", "opd": "Unilateral Le Fort I fracture of maxilla", "subject_name": "Surgery", "topic_name": null, "id": "6bbe0b73-0b3e-422a-932f-032872a3614f", "choice_type": "single"} {"question": "The Best investigation to visualize posterior urethra is", "exp": "Ans. (d) Ascending urethrogramRef: Campbell Urology 11th Edition, Page 3257* Best Investigation to visualize posterior urethra is micturiting cystourethrogram or ascending urethrogram", "cop": 4, "opa": "CT Scan", "opb": "IV pyelogram", "opc": "Cystoscopy", "opd": "Ascending urethrogram", "subject_name": "Surgery", "topic_name": "Urethra & Penis", "id": "952dc292-c15c-4fcc-ad03-8ebaf545c762", "choice_type": "single"} {"question": "Pseudomyxoma peritonei arises from", "exp": "Pseudomyxoma peritonei occurs more commonly in women.It is associated with mucinous cystic tumours of ovary and appendix. Reference:Bailey & Love's sho practise of surgery,25 th edition,page no:1003.", "cop": 1, "opa": "Carcinoma ovary", "opb": "Ovarion Cyst", "opc": "Ovarian dermoid", "opd": "Adenocarcinoma colon", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "a2795174-1534-4fa2-8b47-96bbab87261f", "choice_type": "single"} {"question": "Primary anatomic structure of concern in posterior mandible periradicular surgery", "exp": null, "cop": 4, "opa": "Neurovascular bundle coursing through infraorbital canal.", "opb": "Neurovascular bundle near incisive foramen", "opc": "NeurovascuLar bundle near palatine foramen", "opd": "Neurovascular bundle coursing through mandibular canal.", "subject_name": "Surgery", "topic_name": null, "id": "7629783f-6ce7-4053-900a-7b9f871e886a", "choice_type": "single"} {"question": "A 20 yr old girl presents with 9 month history of neck swelling with thyrotoxicosis symptoms. On investigation increased T4 and decreased TSH with palpable 2 cm nodule was found. Next investigation will be", "exp": "In clinical cases of thyroid nodule, Thyroid profile (T3 T4 TSH) is done. If TSH is low, thyroid scan is done to see if nodule is hot or cold. If TSH is low or normal, ultrasound followed by FNAC is done Source :Sabiston 20 th edition Pg 890", "cop": 2, "opa": "USG", "opb": "Thyroid scan", "opc": "Radioactive iodine uptake", "opd": "CT scan", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "eee6144a-9a77-4dd7-94c6-64f461421689", "choice_type": "single"} {"question": "The initial investigation of choice for a postcholecystectomy biliary stricture is", "exp": "The first step in the management of a postcholecystectomy biliary stricture is to undeake an immediate ultrasound scan of the abdomen.This will demonstrate whether there is intrahepatic /extrahepatic dilatation secondary to strictures. After that, the anatomy needs to be defined by either an ERCP or MRCP. Reference: Bailey & Love&;s sho practise of surgery,25th edition, page no:1125.", "cop": 1, "opa": "Ultrasound scan of theabdomen", "opb": "Endoscopic cholangiography", "opc": "Computed tomography", "opd": "Magnetic resonance cholangiography", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "97fde6d2-d18a-4b2c-85c9-a0723bf48d4c", "choice_type": "single"} {"question": "Brilliantly translucent swelling in the neck region in a 2 years child. Diagnosis is", "exp": "C. i.e. (Cystic hygroma) (729 B & L 25th) (625-S. Das 5th)CYSTIC HYGROMA - swelling consists of aggregation of cysts which contain clear lymph** (multilocular).Each locule is lined by a single layer of endothelium that is why this swelling is a Brilliantly Translucent swelling* ' Sequestration of a portion of the jugular lymph sac** from the lymphatic system accounts for the appearance of these swelling* Benign multilobular, multinodular cystic masses lined by a endothelial cells (mosaic appearance)* Posterior triangle of the neck is commonest site * * ** Soft, fluctuation test is positive, impulse on coughing presents regional lyrnphnode are not enlarged* Excision is the treatment of choice** and sclerotherapy with picibanil (OK- 432)", "cop": 3, "opa": "Lipoma", "opb": "Teratoma", "opc": "Cystic hygroma", "opd": "Thyroglossal cyst", "subject_name": "Surgery", "topic_name": "Neck", "id": "ad6150f6-38d4-4d4d-9972-e09436768279", "choice_type": "single"} {"question": "Physiological locking involves", "exp": "A i.e. Internal rotation of femur over stabilized tibia Physiological locking occurs in last 30 degree of extension, when femur rotates medially (internally) over stabilized tibiaQ. This very stable position is caused by quadriceps femoris muscle. Unlocking needed to initiate flexion is carried out by popliteus muscle, which moves femur laterally on stabilized tibia.", "cop": 1, "opa": "Internal rotation of femur over stabilized tibia", "opb": "Internal rotation of tibia over stabilized femur", "opc": "External rotation of tibia over stabilized femur", "opd": "External rotation of femur over stabilized tibia", "subject_name": "Surgery", "topic_name": null, "id": "0c44fab8-128a-4bb8-a19c-edf2bd47d0aa", "choice_type": "single"} {"question": "Involucrum is", "exp": null, "cop": 2, "opa": "Dead bone", "opb": "New live bone surrounding dead bone", "opc": "Previous live bone", "opd": "Sclerotic bone", "subject_name": "Surgery", "topic_name": null, "id": "eedab687-f933-4ad2-b54e-0a81069a561b", "choice_type": "single"} {"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", "exp": null, "cop": 4, "opa": "Carcinoid tumor", "opb": "Melanoma", "opc": "Villous adenoma", "opd": "Peutz-Jegher syndrome", "subject_name": "Surgery", "topic_name": null, "id": "76aa3482-4d40-4961-8073-428fffa59af8", "choice_type": "single"} {"question": "A part of adjacent intestine will be removed in", "exp": "Treatment of Enterogenous cyst is bowel resection fillowed by intestinal anastomosis.", "cop": 1, "opa": "Enterogenous cyst", "opb": "Chylolyphatic cyst", "opc": "Dermoid cyst", "opd": "Mesothelial cyst", "subject_name": "Surgery", "topic_name": null, "id": "f7f83e53-2729-4949-b860-6bebdf872b63", "choice_type": "single"} {"question": "A patient died after a blunt trauma to chest, most common cause of death in blunt trauma to chest is", "exp": "Answer is pneumothorax. The common life threatening conditions due to blunt trauma are Tension pneumothorax, Massive haemothorax, Flail chest etc, out of which Tension pneumothorax is most common cause. Pericardial tamponade needs to be differentiated from a tension pneumothorax. It is most commonly the result of penetrating trauma. Reference: Bailey & love, 27th Edition, page no = 367", "cop": 4, "opa": "Oesophageal rupture", "opb": "Tracheo bronchial rupture", "opc": "Pulmonary laceration", "opd": "Pneumothorax", "subject_name": "Surgery", "topic_name": "Trauma", "id": "8e683f23-8d17-49fc-a411-d0cb576e2427", "choice_type": "single"} {"question": "Atkin's diet is", "exp": "Carbohydrate restricted low calorie diet Traditionally, fat restricted, low calorie diet has been used for weight loss. Atkin's proposed a new theorey for weight loss based on carbohydrate restricted low calorie diet", "cop": 2, "opa": "Protein restricted low calorie diet", "opb": "Carbohydrate restricted low calorie diet", "opc": "Fat restricted low calorie diet", "opd": "Mineral restricted low calorie diet.", "subject_name": "Surgery", "topic_name": null, "id": "c19fe12c-9e73-43b7-a0dd-d187890aecc4", "choice_type": "single"} {"question": "Double Bubble sign is seen with", "exp": "It&;s a radiological sign described in cases of duodenal obstructive. A plain abdominal X-ray reveals 2 foci of gas, one in the stomach and other in the duodenum = a sign of duodenal atresia Reference bailey and love&;s edition 5 th page no.1195", "cop": 2, "opa": "Pyloric stenosis", "opb": "Duodenal atresia", "opc": "Ileal atresia", "opd": "Esophageal atesia", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "6ec69c78-2034-4d2a-960e-3cae3518e3c4", "choice_type": "single"} {"question": "Features of fracture neck of femur includes", "exp": "C i.e. Shoening & Lateral rotation Fracture neck femur and inter trochanteric femur present with - lateral rotation and shoingQ. The only difference is in the amount i.e. * Less lateral rotation deformity in fracture neck femur is due to attachment of capsule to the distal fracture fragment which prevents excessive rotation in acute cases. But gradually the deformity increases d/t stretching of hip joint capsule by the weight of limb.", "cop": 3, "opa": "Flexion at hip and lateral rotation", "opb": "Flexion at hip abduction", "opc": "Shoening and lateral rotation", "opd": "Shoening and flexion", "subject_name": "Surgery", "topic_name": null, "id": "544b4a3f-9029-46f4-b100-62aac584718c", "choice_type": "single"} {"question": "A man presented with fractures of 4th to 10th ribs and respiratory distress after a Road Traffic Accident (A). He is diagnosed to have flail chest and a PaO2, of", "exp": "Flail chest occurs when three or more contiguous ribs are fractured in at least two locations. Paradoxical movement of this free-floating segment of chest wall may be evident in patients with spontaneous ventilation, due to the negative intrapleural pressure of inspiration. The decreased compliance and increased shunt fraction caused by the associated pulmonary contusion that is typically the source of postinjury pulmonary dysfunction. Pulmonary contusion often progresses during the first 12 hours. Resultant hypoventilation and hypoxemia may require presumptive intubation and mechanical ventilation. Ref: Cothren C., Biffl W.L., Moore E.E. (2010). Chapter 7. Trauma. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e.", "cop": 2, "opa": "Tracheostomy", "opb": "IPPV with oral intubation", "opc": "Fixation of ribs", "opd": "Strapping of chest", "subject_name": "Surgery", "topic_name": null, "id": "2f70d5e2-76c3-4c9e-9995-ebec3b3e7726", "choice_type": "single"} {"question": "Peripheral aneurysm most commonly located at", "exp": ". Ans : (b) Popliteal aery - Popliteal aery aneurysm accounts for 70% of all peripheral aneurysms ; two- thirds are bilateral. - Almost all patients (97%) with Popliteal aery aneurysms are male.", "cop": 2, "opa": "Femoral aery", "opb": "Popliteal aery", "opc": "Brachial aery", "opd": "Axillary aery", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "f186ab40-c1cc-4221-81a9-bf657b233953", "choice_type": "single"} {"question": "Absorbable suture material is", "exp": "(A) Polyglactin) (38- Bailey & Love 26th)Absorbable suture material Absorption rateNon absorpable suture material* Catgut (plain)}Natural 7-10 days* Silk}Natural* Catgut (chromic)within 90 days* Linen* Polyglactin (Vicryl) 60-90 days* Polyglyconate (Maxon) 180 day* Polyglycolic acid 60-90 days* Polydiaxanone (PDS) 180 days* Polyglycaprone (Monocryl) 90-120 days* Surgical steel* Nylon (Ethilon/Nurolon)* Polyester (Mersilene/Ethibond)* Poly butester* Polypropylene (Proline)", "cop": 1, "opa": "Polyglactine", "opb": "Polypropylene", "opc": "Polyethylene", "opd": "Polybutester", "subject_name": "Surgery", "topic_name": "Wounds, Tissue Repair & Scars", "id": "4bb73b8b-c288-4a49-a57e-7f3d117a0822", "choice_type": "single"} {"question": "Sho 4th metacarpal is a feature of", "exp": "Ans. is `c' i.e., Pseudohypoparathyroidism Sho 41kmetacarpal/metatassal (metacarpal sign) Post - traumatic Post infection (from sickle cell anemia) Turner's syndrome Pseudohypoparathyroidism Pseudopseudohypoparathyroidism Hereditary multiple exostosis Chondroectodermal dysplasia (Ellis-vanCreveld syndrome)", "cop": 3, "opa": "Hyperparathyroidism", "opb": "Hyperparathyroidism", "opc": "Pseudohypoparathyroidism", "opd": "Scleroderma", "subject_name": "Surgery", "topic_name": null, "id": "45eb6fcf-b657-4382-b129-c69f41a95391", "choice_type": "single"} {"question": "Name of the procedure", "exp": "This is V-to-Y advancement. Commonly used for fingeips and extremities.Ref: Bailey and love, 27e, page: 641", "cop": 3, "opa": "Z plasty", "opb": "Rhomboid flap", "opc": "V-Y advancement flap", "opd": "Rotation flap", "subject_name": "Surgery", "topic_name": "All India exam", "id": "55737765-73f5-4057-a726-0584f11dede2", "choice_type": "single"} {"question": "Thomas test is used for testing", "exp": "Hip flexion", "cop": 3, "opa": "Knee flexion", "opb": "Knee extension", "opc": "Hip flexion", "opd": "Hip extension", "subject_name": "Surgery", "topic_name": null, "id": "c47a6145-31da-40dd-995d-1622f1f8f472", "choice_type": "single"} {"question": "Non progressive contraction of esophagus are", "exp": "Three types of contractions in the oesophagus, they are *primary -progressive, triggered by swallowing *secondary-progressive,generated by distension,or irritation *teiary -non-progressive Ref: SRB&;s manual of surgery,5th ed, pg no 788", "cop": 3, "opa": "Primary", "opb": "Secondary", "opc": "Teiary", "opd": "Quaternary", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "8d0b8803-afbb-4f8f-9276-4bae42c40922", "choice_type": "single"} {"question": "Inversion of nipple occures due to involvement of", "exp": ".* 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 the 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 fungation. * Cancer-en-cuirasse: Skin over the chest wall and breast is studded with cancer nodules appearing like an armour coat. ref:SRB&;s manual of surgery,ed 3,pg no 472", "cop": 4, "opa": "Breast lobules", "opb": "Montogomory tubercles", "opc": "Cooper ligament", "opd": "Lactiferous ducts", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "200f2067-ee70-474c-9061-38e99da90785", "choice_type": "single"} {"question": "A 60 years old male alcoholic presents with acute upper GI bleeding following bouts of vigrous vomiting. Most probable diagnosis is", "exp": "Answer- C. Mucosal and submucosal tear at cardiac orifice of stomachMallory - Weiss syndromeIs characterized by mucosal tear at the gastroesophageal junction following a bout of forceful retching (or vomiting, coughing or straining.The clinical picture consists of acute upper gastrointestinal bleeding following bouts of retching or vomitting.Other frequent associations with Mallory-Weiss tears areHiatal herniaNSAIDs abuseDisease related bleeding diathesis.", "cop": 3, "opa": "Acute gastritis", "opb": "Boerhaave's syndrome", "opc": "Mucosal and submucosal tear at cardiac orifice of stomach", "opd": "Esophageal carcinoma", "subject_name": "Surgery", "topic_name": null, "id": "84da7bc5-06fa-46d0-9961-40427ac14b71", "choice_type": "single"} {"question": "Pseudocyst of pancreas develops after attack of acute\npancreatitis", "exp": "It usually devolops at 6 weeks after acute pancreatitis.", "cop": 4, "opa": "Few days", "opb": "2 weeks", "opc": "3 weeks", "opd": "More than 4 weeks", "subject_name": "Surgery", "topic_name": null, "id": "ea51894d-38d7-41a0-8de9-6a81f2959c35", "choice_type": "single"} {"question": "Most common complication following haemorrhoidectomy is", "exp": "MC Most Common complication following haemorrhoidectomy is Pain.\n2nd Common complication following haemorrhoidectomy is urinary retension.", "cop": 4, "opa": "Internal spincter damage", "opb": "Infection", "opc": "Bleeding", "opd": "Urinary retention", "subject_name": "Surgery", "topic_name": null, "id": "9b205130-984a-40e4-a5d3-f9417924a985", "choice_type": "single"} {"question": "The most common facial abnormality seen in Gardener&;s syndrome is", "exp": ".desmoid tumor is often associated with the familial polyposis colon (FAP), osteomas, odontomes epidermal cysts-- Gardner's syndrome. Gardner's syndrome 1. Familial polyposis colon 2. Osteomas 3. Odontomes 4. Epidermal cyst - 20% ref:SRB &;s manual of surgery,ed 3,pg no-672", "cop": 3, "opa": "Ectodermal dyplasia", "opb": "Odontomes", "opc": "Multile osteomas", "opd": "Dental cysts", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "498915ea-6b70-4088-9d87-3b40a2b301fe", "choice_type": "single"} {"question": "Cricothyroidotomy is contraindicated in", "exp": null, "cop": 1, "opa": "Age below 5 years", "opb": "Age between 15-20 yrs", "opc": "Age between 20-30 yrs", "opd": "Age between 30-40 yrs", "subject_name": "Surgery", "topic_name": null, "id": "9f00aed6-cd67-4879-9b57-2bc905774137", "choice_type": "single"} {"question": "Wahins tumour is", "exp": "Wahin's tumor, or papillary cystadenoma lymphomatosum, is the second most common benign parotid tumor and occurs most often in older white men. Because of the high mitochondrial content within oncocytes, the oncocyte-rich Wahin tumor and oncocytomas will incorporate technetium Tc 99m and appear as hot spots on radionuclide scans. If fine-needle aspiration suggests a slow-growing Wahin tumor with confirmatory technetium scanning in a patient with contraindications to surgery, the tumor may be closely monitored because it has no malignant potential.", "cop": 3, "opa": "Malignant neoplasm", "opb": "Rapidly growing", "opc": "Gives hot peechnate scan", "opd": "Cold peechnate scan", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "914ca1d8-e198-4af9-b317-f94b2016341c", "choice_type": "single"} {"question": "Lesser curvature anterior seromyotomy is indicated in", "exp": ".Surgery for Uncomplicated DU * Highly Selective Vagotomy (HSV). * Selective vagotomy with pyloroplasty (SV + P). * Truncal vagotomy with gastrojejunostomy (TV + GJ). In HSV, only fibres supplying the parietal cells are ligated. The nerve of Latarjet which supplies the antrum pump is retained and so no drainage procedure is required in HSV. HSV is also called as parietal cell vagotomy or super selective vagotomy. Here nerve fibres in 6 cm of the stomach, just proximal to pylorus are preserved.(Crow's foot). Vagotomy reduces acid secretion, hence ulcer heals. No acid, No ulcer. * Posterior truncal vagotomy with anterior seromyotomy-- Taylor's operation. It can be done through laparoscopy. Note: Presently, there is no role of gastrectomy or gastrojejunostomy (Just GJ) for uncomplicated DU. Ref: SRB&;s manual of surgery,3 rd ed, pg no 760", "cop": 4, "opa": "Gastric ulcer", "opb": "Gastric CA", "opc": "Duodenal blowout", "opd": "duodenal ulcer", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "be6f5702-d132-4b8c-ac00-bfe35ad6092e", "choice_type": "single"} {"question": "Splenunculi are commonly seen in", "exp": "A. (Hilum of spleen) (1103-B & L 25th)ACCESSORY SPLEEN (Splenunculi) - probably results from a failure of infusion of splenic embryonic tissues* They are located near the hilum of the spleen in 50% of cases and related to the splenic vessels or behind the tail of pancreas in 30%. The remainder are located in the mesocolon or the splenic ligaments* These are functionally similar to the spleen and while performing splenectomy for blood dyscrasias removal of these accessory spleens are obligatory, otherwise there always remains a chance of recurrence* Axis of spleen enlargement projects into- Greater sac**", "cop": 1, "opa": "Hilum of spleen", "opb": "Tail of spleen", "opc": "Mesocolon", "opd": "Splenic ligaments", "subject_name": "Surgery", "topic_name": "Spleen", "id": "43e26e31-67d1-41b7-9def-5abfe2104297", "choice_type": "single"} {"question": "Aromatase inhibitors in Ca breast", "exp": "letrozole is nonsteroidal competitive inhibitor of enzyme aromatase this enzyme conves adrenal androgen to oestrogens it is used an adjuvant endocrine therapy in post menopausal women with hormone sensitive breast carcinoma ref ;(page no;551) 5th edition of SRB&;S Manual of SURGERY", "cop": 1, "opa": "Letrozole", "opb": "Anastrozole", "opc": "Exemestane", "opd": "Tamoxifen", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "dc27c6de-c944-4891-a5e2-608ae1c1d459", "choice_type": "single"} {"question": "TIPSS involves percutaneous creation of a shunt between", "exp": "It&;s a nonsurgical interventional radiological method wherein stent is placed in the liver between hepatic venule and poal venule through a guidewire, used in reducing poal pressure before doing an ohotopic liver transplantation in cirrhotic patients. Reference SRB edition 5 page:622", "cop": 2, "opa": "Poal vein and vena cava", "opb": "Poal vein and hepatic vein", "opc": "Hepatic vein and vena cava", "opd": "Poal vein and hepatic aery", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "620a4672-70ad-4af5-b94a-b4bb3ed703d0", "choice_type": "single"} {"question": "Most common site for carcinoid tumor in the abdomen", "exp": ".CARCINOID TUMOUR It commonly occurs in appendix (65%), ileum (25%), other pas of GIT and rarely bronchus, testis, ovary. In the small intestine, carcinoids are most often seen within the terminal 2 feet of the ileum. * They arise from the enterochromaffin cells (Kulchitsky cells) found in the crypts of Lieberkuhn. * These cells are capable of APUD (Amine precursor uptake and Decarboxylation) and can secrete vasoactive peptides. * Carcinoid syndrome is seen in 40% of patients. * Carcinoid in appendix is usually single. But commonly it causes luminal obstruction and so presents with features of appendicitis. Common site is at tip/distal 2/3. ref:SRB&;s manual of surgery ,ed 3,pg no 812", "cop": 1, "opa": "Appendix", "opb": "Liver", "opc": "Intestines", "opd": "Pancreas", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "aef65d29-b71c-44cf-beca-5d3c0979343c", "choice_type": "single"} {"question": "The degective migration of neural crest cells results in", "exp": "Hirschsprung's disease (congenital mega colon) Hirschsprung's disease is characterised by the congenital absence of intramural ganglion cells (aganglionosis) and the presence of hyperophic nerves in the distal large bowel. The absence of ganglion cells is due to a failure of migration of vagal neural crest cells into the developing gut. The affected gut is in spasm, causing a functional bowel obstruction. The aganglionosis is restricted to the rectum and sigmoid colon in 75% of patients (sho segment), involves the proximal colon in 15% (long segment) and affects the entire colon and a poion of terminal ileum in 10% (total colonic aganglionosis) . A transition zone exists between the dilated, proximal, normally innervated bowel and the narrow, distal aganglionic segment.Hirschsprung's disease may be familial or associated with Down syndrome or other genetic disorders. Gene mutations have been identified on chromosome 10 (involving the RET proto-oncogene) and on chromosome 13 in some patients. Hirschsprung's disease typically presents in the neonatal period with delayed passage of meconium, abdominal distension and bilious vomiting but it may not be diagnosed until later in childhood or even adult life, when it manifests as severe chronic constipation. Enterocolitis is a potentially fatal complication. The diagnosis requires an adequate rectal biopsy and an experienced pathologist. A contrast enema may show the narrow aganglionic segment, a cone and the dilated proximal bowel. Surgery aims to remove the aganglionic segment and 'pull-through' ganglionic bowel to the anus (e.g. Swenson, Duhamel, Soave and transanal procedures), and can be done in a single stage or in stages after first establishing a proximal stoma in normally innervated bowel. Most patients achieve good bowel control but a significant minority experience residual constipation and/or faecal incontinence or fuher enterocolitis. Ref: Bailey and love 27th edition Pgno : 136", "cop": 1, "opa": "Congenital megacolon", "opb": "Albinism", "opc": "Adrenogenital hypoplasia", "opd": "Dentinogenesis imperfecta", "subject_name": "Surgery", "topic_name": "Urology", "id": "f8130c55-651f-4b46-883e-21f18592bada", "choice_type": "single"} {"question": "Treatment of submandibular salivary gland ductcalculi is", "exp": null, "cop": 3, "opa": "Excision of submandicular gland", "opb": "Opening the duct at the frenulum", "opc": "Opening the duct and removal of calculus", "opd": "Excision of gland and duct", "subject_name": "Surgery", "topic_name": null, "id": "4ef34556-ed9f-4070-a14f-d5a377952a4d", "choice_type": "single"} {"question": "Most common benign mesenchymal tumour of the stomach", "exp": "Abdominal leiomyosarcoma Leiomyosarcoma describes a type of soft tissue cancer that occurs within smooth muscle cells Gastrointestinal stromal tumors (GISTs) are the MC mesenchymal tumors of the GIT Formerly GISTs were commonly classified as Leiomyosarcomas ;however they are noe known to arise from the interstitial cells of cajal This kind of cancer can be difficult to detect as it often causes no organ dysfunction until the tumor had gotten to be large in size Most common locations : Uterus & stomach Clinical features Asymptomatic in initial stage Earliest symptom : Noticeable lump or swelling within the abdomen The sign most often cited is bleeding. These tumors sometimes ne rose and bleed into the bowel Leiomyosarcomas that occur in the digestive tract can also cause GI Blockage or bleeding, which can manifest as blood in the stool Uterine Leiomyosarcomas can cause vagibal bleeding Ref: www.ncbi.nlm.gov", "cop": 2, "opa": "Polypoid adenoma", "opb": "Leiomyoma", "opc": "Glomus tumour", "opd": "Lipoma", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "25e44957-a9f0-485d-9dd5-e7efdf4c5976", "choice_type": "single"} {"question": "Success rate for intraligamentary anaesthesia", "exp": null, "cop": 2, "opa": "Injection under strong forward pressure", "opb": "Injection under strong back pressure", "opc": "Injection over supragingival tissue", "opd": "Injection over buccal Labial fold", "subject_name": "Surgery", "topic_name": null, "id": "d8fcfcbd-b47b-4bec-9786-92c6f5ccbf11", "choice_type": "single"} {"question": "Most serious injury is at", "exp": "Answer- A. open pneumothoraxThis is a large open defect in the chest (> 3 cm), leading to equilibration between intrathoracic and atmospheric pressure.Air accumulates in the hemithorax (rather than in the lung) with each inspiration, leading to profound hypoventilation on the affected side and hypoxia.", "cop": 1, "opa": "open pneumothorax", "opb": "diaphragmatic injury", "opc": "Flail chest", "opd": "Single rib fracture", "subject_name": "Surgery", "topic_name": null, "id": "f67122aa-e97c-4392-aa29-62d78780db79", "choice_type": "single"} {"question": "Most common carcinoma after burns is", "exp": null, "cop": 1, "opa": "Squamous cell carcinoma", "opb": "Adenocarcinoma", "opc": "Melanoma", "opd": "Mucoid carcinoma", "subject_name": "Surgery", "topic_name": null, "id": "09c83e23-4411-42a7-9239-e691bcd36957", "choice_type": "single"} {"question": "Subcapsular nephrectomy is indicated is", "exp": null, "cop": 3, "opa": "Perinephric abscess", "opb": "Hydronephrosis", "opc": "Pyonephrosis", "opd": "PCKD", "subject_name": "Surgery", "topic_name": null, "id": "f5062ea4-119d-4b33-a655-e8c06d319a94", "choice_type": "single"} {"question": "Aseptic peritonitis is seen in", "exp": "Aseptic peritonitis -peritonitis in which inflammation of the peritoneum is caused by chemicals, radiation, or injury, rather than by an infectious agent. secondary peritonitis secondary to disruption of the abdominal cavity or a hollow viscus, paicularly leakage from the gastrointestinal tract. teiary peritonitis- peritonitis which occurs after any abdominal surgeries Reference SRB edition 5 page 566,567", "cop": 3, "opa": "Latrogenic or postoperative", "opb": "Gastric perforation", "opc": "Irritation due to abnormal physiological fluid in peritoneum", "opd": "Anastomosis leak", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "0cd35487-233a-4bcc-abd1-4efde494c103", "choice_type": "single"} {"question": "Increased gastric acid secretion occurs in", "exp": "Gastric ulcersTYPELOCATIONACID LEVELI60%Lesser curve at incisuraLow to normalII15%Gastric body with duodenal ulcerIncreasedIII20%Prepyloric IncreasedIVLess than 10%High on lesser curveNormalVAnywhereNormal, NSAID-inducedSome ulcers may appear on the greater curvature of the stomach,but the incidence is less than 5%Sabiston 20e pg: 1233", "cop": 2, "opa": "Type I gastric ulcer", "opb": "Type III gastric ulcer", "opc": "Type IV gastric ulcer", "opd": "Type V gastric ulcer", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "ef3b03e4-a3ca-435b-ba9b-4ab5ab3c9c85", "choice_type": "single"} {"question": "Most common cause of acute RVF aEUR'", "exp": "Massive pulmonary embolism Acute right ventricular failure is usually caused by acute cor pulmonales. Most common cause of acute cor pulmonale is pulmonary embolism. M.C. cause of chronic cor pulmonale is pulmonary embolism Causes of acute right hea failure Pulmonary embolism (M.C.) Acute respiratory failure (especially in broncho pulmonary disease with hypoxic / hypercapnic pulmonary vasoconstrictions. ARDS Sepsis Acutely exacerbated chronic (left / biventricular) hea failure Acute inferior myocardial infarction involving the R.V.", "cop": 1, "opa": "Massive pulmonary embolism", "opb": "Tricuspid stenosis", "opc": "Pulmonary stenosis", "opd": "Tricuspid regurgitation", "subject_name": "Surgery", "topic_name": null, "id": "db51e1c5-cc9b-4ff9-95d0-ae7f409f6e1a", "choice_type": "single"} {"question": "Skip lesions with tuberculoid granulomas is characteristic of", "exp": null, "cop": 3, "opa": "Hodgkins lymphoma", "opb": "Sarcoidosis", "opc": "Crohns disease", "opd": "Ulcerative colitis", "subject_name": "Surgery", "topic_name": null, "id": "ba268af1-b5dc-48d9-83d4-98e8ed2c03ba", "choice_type": "single"} {"question": "Commonest site for ischemic colitis is", "exp": "Ans is 'b' ie. Splenic flexure \"Although splenic flexure is the most common site of ischemic colitis, any segment of colon may be affected. The rectum is relatively spared because of its rich collateral circulation.\" - Schwartz 9/eOther Commonly asked Commonest Sites*Crohn's ds* -Terminal ileum*Amoebic colitis* -Sigmoid colon*Typhoid ulcer* -Terminal ileum*Tuberculous ulcer* -Terminal ileum*Ulcerative colitis* -Rectum*Colonic diverticula* -Descending & Sigmoid colon*Gall stone ileus -Terminal ileum*Volvulus* -Sigmoid colon*Polyps in Peutz-Jeghers synd* -Jejunum*Peptic ulcer* -1st part of duodenum*Gastric ulcer* -Lesser curvature (Just beyond the junction of body & antrum)*Hirschsprung ds* -Rectum*Obstruction in meconium ileus* -Distal ileum*Bleeding in angiodysplasia* -Right colon*Colon Ca -Rectosigmoid (more specifically rectum)", "cop": 2, "opa": "Hepatic flexure", "opb": "Splenic flexure", "opc": "Descending colon", "opd": "Ascending colon", "subject_name": "Surgery", "topic_name": "Miscellaneous (Small & Large Intestine)", "id": "20ca286f-9e2c-49ba-a322-326aa186e821", "choice_type": "single"} {"question": "The most impoant single special investigation in lumbar disc prolapse is", "exp": "C i.e. MRI", "cop": 3, "opa": "Epidurography", "opb": "Myelography", "opc": "MRI", "opd": "Discography", "subject_name": "Surgery", "topic_name": null, "id": "a60e6522-3326-4d27-88fc-d064a7885734", "choice_type": "single"} {"question": "Best approach in thoracic trauma is", "exp": ".Indications for thoracotomy * Haemothorax more than 1500 ml found when ICT is placed or hourly collection in ICT is 200- 300 ml * ICT placed shows persistent drainage of blood * Diaphragmatic injury * When associated with liver and spleen injuries * Bronchus and major vessel injuries * Haemopericardium * Oesophageal and thoracic duct injuries. ref:SRB&;s manual of surgery,ed 3,pg no 1061", "cop": 3, "opa": "Midline sternotomy", "opb": "Parasternal thoracotomy", "opc": "Anterolateral thoracotomy", "opd": "Posterolateral thoracotomy", "subject_name": "Surgery", "topic_name": "Cardio thoracic surgery ", "id": "84df4ca7-b775-4095-bbe5-784ae1f300ed", "choice_type": "single"} {"question": "Gastrojejernostomy surgery belongs to", "exp": "Clean contaminated surgery :\n\nWound is exposed to not only skin but also GI tract / Respiratory tract / Urinary tract organism in controlled enviroment.\nHence Gastrojejunostomy surjery belongs to this category.", "cop": 3, "opa": "Clean surgery", "opb": "Contaminated surgery", "opc": "Clean contaminated surgery", "opd": "Dirty surgery", "subject_name": "Surgery", "topic_name": null, "id": "653e1924-a0e6-4c37-8671-d25d8832c02e", "choice_type": "single"} {"question": "Nerve involvement in Frey&;s syndrome is", "exp": "Auriculotemporal nerve. Frey's syndrome(gustatory sweating) results from damage to the autonomic innervation of the salivary gland with inappropriate regeneration of the postganglionic parasympathetic nerve fibres of the auriculotemporal nerve that aberrantly stimulate the sweat glands of the overlying skin. Reference : Bailey & love, 27th Edition, page no = 794", "cop": 3, "opa": "Trigeminal", "opb": "Mandibular", "opc": "Aurico temporal", "opd": "Lingual", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "be05ff0c-3f50-4238-9c5f-a1076d6f36a8", "choice_type": "single"} {"question": "Gleasons score is used for", "exp": "Ans. is 'a' i.e., Prostate carcinoma Gleason score and grading system* Gleason score is the most commonly used histological grading system for prostate cancer.* The two most predominant histological patterns of the prostate cancer are assigned a Gleason grade ranging from 1-5.* Primary grade is assigned to the pattern of cancer that is most commonly observed in the histological slides of the specimen.* Secondary grade is assigned to the second most commonly observed pattern in the specimen.* Gleason score is the sum of the two grades. Thus it is also known as Gleason sum.* If the entire specimen has only one pattern present, then both the primary and sencondary grades are reported as the same grade.* As Gleason grades range from 1 to 5, Gleason score thus range from 2 to 10* The Gleason score is used to help evaluate the prognosis of men with prostate cancer. Together with other parameters, the Gleason score is incorporated into a strategy of prostate cancer staging which predicts prognosis and helps guide therapy.* A point of importance is that the primary Gleason grade is most important with respect to placing patients in prognostic groups. For example in patients with a Gleason score 7, a Gleason 4+3 is a more aggressive cancer than a Gleason 3+4.", "cop": 1, "opa": "Prostate carcinoma", "opb": "Testicular carcinoma", "opc": "Renal cell carcinoma", "opd": "Malignan melanoma", "subject_name": "Surgery", "topic_name": "Prostate & Seminal Vesicles", "id": "9a3747fe-69d4-4c42-bf2b-72fba2458424", "choice_type": "single"} {"question": "Actinomycosis most commonly affects", "exp": "Facio - cervical Actinomycosis is most common type.", "cop": 2, "opa": "Thorax", "opb": "Facio - cervical region", "opc": "Liver", "opd": "Pelvis", "subject_name": "Surgery", "topic_name": null, "id": "2a56ef02-7089-4765-b730-22447bc92f28", "choice_type": "single"} {"question": "Cock's peculiar tumour is", "exp": "(Secondary to infected sebaceous cyst) (594-BaiIy & Love 25th)Cock's peculiar tumour - (Infected ulcerated sebaceous cyst)An infected cyst may discharge its contents. If an ulcerated surface remains, it can resemble an epithelioma, and to which the term 'Cock's peculiar tumour may be appliedALSO - REMEMBERS* MoIIuscum fibrosum - are polypoid or filiform soft flashy skin tags which occur on the neck trunk andface* Cylindroma (syn 'turban' tumour) - extensive turban like swelling over the scalp, relatively benign* Glomus tumour is seen in fingers (Subungual) role - thermal regulation* RANULA is a retension cyst of minor salivary glands transluscent bluish swelling in the floor of the mouth** Treatment - complete excision or marsupialization for large cystGLOMANGIOMA or Glomovenous malformation* Typical glomus tumour are sub categorized as solid glomus tumour, glomangioma & glomangiomyoma* Solid glomus tumour is the most common variety of glomus tumour* Glomangioma, comprises approximately 20% of glomus tumour are characterized by dilated veins surrounded by small clusters of glomus cells* Glomangioma occure more often during childhood are rarely subungual & are less likely to be painful or symptomatic* Most predominate on the hand and forearm*** Histologically they are usually poorly circumscribed, occasionally plaque like lesion that resemble cavernous hemangioma* Secondary thrombosis & phlebolith formation may occur in these lesions just as they would in an ordinary hemangioma* Hidradentitis suppurativa - is a chronic suppurative condition of apocrine gland (Modified sweat gland**) bearing skin which is found in the axillae, sub mammary regions, nape of the neck, groin, mons pubis, inner thigh & sides of the scrotum as well as the perineum & buttocks* Fordyce's spot's - are ectopic sebaceous glands*, which has no erythcmous halos & are found in the mouth of healthy individuals**. It is not a sign of internal malignancy* Miliaria - is a disorder that occurs as a result of either obliteration or disruption of the Eccrine sweat gland*** Milium - is a small sub epidermal keratin cyst that occurs in under developed sebaceous glandDercum's disease (Adiposis Dolarosa) - It is characterized by the presence of multiple circumscribed or diffuse painful sub cutaneous fat depositions on the trunk and limbs**, particularly near the kneeAcute Febrile Neutrophilic Dermatosis (SWEET'S SYNDROME)Characterized by, fever, neutrophilia, erythematous, tender papulo- nodulo- plaques and targetoid lesions with pseudo vesiculation. Common women following RTIAssociated with malignancy, AML, lymphoma, myeloma, myelodysplastic syndromes and solid tumours (primarily of the genitor-urinary tract) as well as drugs (cg-all- transretinoic acid)", "cop": 1, "opa": "Secondary to infected sebaceous cyst", "opb": "Secondary to osteomyelitis of skull bones", "opc": "Secondaries in skull bones from carcinoma thyroid", "opd": "Epithelioma of scalp", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "52b3e825-5dc6-4b35-b039-b8a2dd375ce0", "choice_type": "single"} {"question": "A patient with distal gastric carcinoma, following procedure, is done. Name the procedure", "exp": "In the above image, after distal gastrectomy Roux-en-Y reconstruction is done.In this anastomosis, the Roux limb is the efferent or antegrade limb that serves as the primary recipient of food after the surgery (Gastro-jejunostomy), while the hepatobiliary or afferent limb that anastomoses with the biliary system serves as the recipient for biliary secretions, which then travel through the excluded small bowel to the distal anastomosis at the mid-jejunum (Jejuno-jejunostomy)In Billroth I technique gastroduodenal anastomosis after distal gastrectomyIn Billroth II technique gastrojejunal anastomosis is donebailey and love 27e pg: 1136", "cop": 4, "opa": "Billroth I", "opb": "Billroth II", "opc": "Polya's operation", "opd": "Roux-en-Y gastrectomy", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "7ed3b45b-fba6-480e-a616-45c9c1d1da1a", "choice_type": "single"} {"question": "According to the Bismuth/Strasberg classification &; Cystic blow out&; is classified as", "exp": "Strasberg classification \u0002 Class A: Bile leak from the cystic duct or an accessory duct showing continuity with the common bile duct \u0002 Class B: Section/injury of an accessory duct/sectorial ducts aberrant right hepatic duct with no continuity with the common bile duct with occlusion \u0002 Class C: Leak/open drainage from a sectorial duct/aberrant right hepatic duct with no continuity with the common bile duct \u0002 Class D: Paial section/lateral injury of an extrahepatric duct bile duct with no complete loss of continuity with the rest of the bile duct system \u0002 Class E: Complete section/circumferential injury of the bile duct with subtypes according to the length of the stump at various levels - E1- Stricture/injury at more than 2 cm distal to bifurcation. - E2 - Stricture/injury less than 2 cm distal to bifurcation. - E3 - Stricture/injury at bifurcation - E4 - Stricture/injury involving right and left hepatic ducts - E5 - Complete obstruction of entire bile duct Note: Only right and left paial injuries are not included in this classification SRB's Manual of Surgery, 4th Edition, pg. no. 708", "cop": 1, "opa": "TYPE A", "opb": "TYPE B", "opc": "TYPE C", "opd": "TYPE D", "subject_name": "Surgery", "topic_name": "Trauma", "id": "718d02e9-8bc0-4b45-92fb-1dfbd1ab41cb", "choice_type": "single"} {"question": "Abbey estender flap is based on", "exp": ".abbey flap is used for lip reconstruction so it is based on labial aery", "cop": 3, "opa": "Lingual aery", "opb": "Facial aery", "opc": "Labial aery", "opd": "Internal maxillary aery", "subject_name": "Surgery", "topic_name": "General surgery", "id": "1b39d3ab-4b52-4ccf-8e31-b74ef0feca8d", "choice_type": "single"} {"question": "Non absorbable suture material is", "exp": null, "cop": 4, "opa": "Catgut", "opb": "Fascialata", "opc": "Polyglycolic", "opd": "Nylon", "subject_name": "Surgery", "topic_name": null, "id": "934b1155-87d3-4205-8679-4e0b26862511", "choice_type": "single"} {"question": "Meniere's disease is characterized by", "exp": "(Veigo, tinnitus and hearing loss) Ref: Dhingra, 5th edition,Page 51,111 Meniere's disease (Endolymphatic hydrops) Characterized by tetrad of symptoms Episodic veigo 2.Flactuating sensorineural hearing loss (more severe in lower frequencies) A sensation of aural fullness Tinnitus (low- pitched and roaring) Hennebe's sign and Tulio's phenomenon is present Diagnosis Normal intact tympanic membrance with negative fistula test Recruitment is frequently present Impedence auidiometry is normal and there is no tone decay Sensory neural hearing loss , Rinne test is positive ,ABC is reduced in affected ear and Weber's is Lateralized to the better ear Radiography of the mastoid will be normal as views of the internal audiotry meati BERA - reduced latency of wave V Most sensitive and diagnostic is Electrochochleography Treatment Medicaltreatment Surgicaltreatment . Reassurance,bedrest,salt restriction,a lowcaffinediet avoidanceof nicotine. . Diuretics,labyrinthinesedative . Vasodilators . Streptomycintherapyisgivenin bilateralcasesto inducethe labyrinthinedamage Indicationsevereincapacitatingveigooinnitusoo preventfuher deteriorationofhearing (i)Decompressionofendolymphaticsacandinseionofa shuntbetween themembranouslabyrinthandsubarachnoidspace (ii)Vestibularneurectomy (iii)Totaltransmastoidlabyrinthectomy-whichrelievesveigoinover90% ofpatients (iv)Sacculotomy(Fick'soperation) Medicaltreatment Surgicaltreatment . Reassurance,bedrest,salt restriction,a lowcaffinediet avoidanceof nicotine. . Diuretics,labyrinthinesedative . Vasodilators . Streptomycintherapyisgivenin bilateralcasesto inducethe labyrinthinedamage Indicationsevereincapacitatingveigooinnitusoo preventfuher", "cop": 4, "opa": "Conductive hearing loss and tinnitus", "opb": "Veigo ear discharge, tinnitus and headache", "opc": "Veigo tinnitus hearing loss headache", "opd": "Veigo tinnitus and hearing loss", "subject_name": "Surgery", "topic_name": null, "id": "8ca565ed-c820-404d-904a-fd877f09aabd", "choice_type": "single"} {"question": "Most common complication of central venous line is catheterisation is", "exp": "Central Venous Catheterisation:\nMost common complication - Catheter related sepsis \nMost dangerous complication - Pneumothorax", "cop": 3, "opa": "Air embolism", "opb": "Pneumothorax", "opc": "Catheter related sepsis", "opd": "Injury to artery veins", "subject_name": "Surgery", "topic_name": null, "id": "4e081925-19b0-4d08-b732-f11a83647a47", "choice_type": "single"} {"question": "A most common site for squamous cell ca. esophagus is", "exp": "Distribution of Squamous cell Ca\n\nUpper 1/3 - 10%\nMiddle 1/3 - 60% \nLower 1/3 - 30%", "cop": 2, "opa": "Upper third", "opb": "Middle third", "opc": "Lower third", "opd": "Gastro-esophageal junction.", "subject_name": "Surgery", "topic_name": null, "id": "5c0b6706-5220-4d19-98a3-d1116b21d32b", "choice_type": "single"} {"question": "Adder head appearance on I.V.P is seen in", "exp": "Ans. (b) UreteroceleRef.: Bailey & Love 26th ed. /1285A ureterocele is a congenital saccular dilatation of terminal portion of the ureter. The most common presentation is that of urinary tract infection or uro-sepsis in children. Stasis of urine can lead to calculus formation. Some children may present with palpable mass due to hydro nephritic kidney .Cyst may prolapse into internal urethral opening causing obstruction to bladder outflow. This condition may remain unrecognized until adult life. Ureterocele is usually discovered on radiological examination or during endoscopy.", "cop": 2, "opa": "Ureteral duplication", "opb": "Ureterocele", "opc": "Ureteric hypoplasia", "opd": "Polycystic kidneys", "subject_name": "Surgery", "topic_name": "Miscellaneous (Kidney & Uterus)", "id": "a67076db-9c4d-479e-9d8c-1212a490c2b0", "choice_type": "single"} {"question": "Treatment of mucocele on lower lip", "exp": null, "cop": 3, "opa": "Incision", "opb": "Excision", "opc": "Excision with adjacent glands", "opd": "Biopsy", "subject_name": "Surgery", "topic_name": null, "id": "ef319208-620c-43ee-825d-d2f192c40543", "choice_type": "single"} {"question": "Bilateral vestibular Schwannomas are associated with", "exp": "(D) Neurofibromatosis Type 2# Central neurofibromatosis, or Neurofibromatosis type 2 (NF2), is a multisystem genetic disorder associated with bilateral vestibular schwannomas, spinal cord schwannomas, meningiomas, gliomas, and juvenile cataracts, with a paucity of cutaneous features (which are seen more consistently in neurofibromatosis type 1 ).> Although quite variable in its age of onset and severity of symptoms in affected individuals, NF2 is associated with significant morbidity and decreased life span. Furthermore, diagnosis in childhood is often difficult because of the absence of central nervous system (CNS) involvement at a young age.> Complications of NF2 may include the following: Unilateral or, frequently, bilateral vestibular schwannomas leading to tinnitus, hearing loss, and/or problems with balance Meningiomas, gliomas, ependymomas, and other cerebral, cerebellar, or spinal cord lesions that may result in neurologic deficits, seizures, and/or hydrocephalus Peripheral nerve schwannomas, mixed tumors, and, occasionally, neurofibromas Peripheral neuropathies Visually significant juvenile cataracts", "cop": 4, "opa": "Multiple endocrine neoplasia Type-1", "opb": "Multiple endocrine neoplasia Type-2", "opc": "Neurofibromatosis Type 1", "opd": "Neurofibromatosis Type 2", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "4a1628b4-4429-4117-beef-5119923e5c5d", "choice_type": "single"} {"question": "Earliest symptom of carcinoma rectum is", "exp": "Early symptoms of rectal cancer # Bleeding per rectum # Tenesmus # Early morning diarrhoea Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1231", "cop": 3, "opa": "Pain", "opb": "Alteration of bowel habits", "opc": "Bleeding PR", "opd": "Tenesmus", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "89ca56ea-b031-4d06-9fb9-4b8723cc1e1f", "choice_type": "single"} {"question": "Rodent ulcer is", "exp": "Basal cell cancer Aka Rodent ulcer Locally invasive Destruction of surrounding tissues - Aka Tear Cancer Seen in face above the line joining ear lobule to angle or corner of mouth - Arises from Basal layer of epidermis - Most common site - Nose > Inner canthus Types of BCC (based on pathology) - Nodular MC type Classical sign- Central depression with umbilication - Pigmented - Cystic - Superficial Diagnosis - IOC for Dx - Wedge Biopsy Management - Wide Local Excision- If tumor is non-aggressive involving trunk or extremities - MOH'S micrographic surgery- If tumor is aggressive involving vital areas, cosmetic areas and recurrent", "cop": 1, "opa": "Basal cell cancer", "opb": "Squamous cell ca", "opc": "Rhinophyma", "opd": "Adenocarcinoma", "subject_name": "Surgery", "topic_name": "FMGE 2019", "id": "7c49925d-cb65-46a4-93a4-aa5e7273cc6f", "choice_type": "single"} {"question": "The Most common type of imperforate anus is", "exp": "(C) Anorectal agenesis # Imperforate anus> (The term is used as a well-recognised description. Strictly it should be 'agenesis' and 'atresia' of the rectum and anus.)> One infant in 4500 is born with an imperforate anus, or with imperfect fusion of the post-allantoic gut with the proctodaeum.> The condition is divided into two main groups: the high and the low, depending on whether the termination of the bowel is above or below the pelvic floor.> Low varieties are easy to diagnose and relatively simple to treat, and the outlook is good.> High varieties often have a fistula into the urinary tract together with a deficient pelvic floor, and are difficult to treat.# Low abnormalities:> Covered anus. The underlying anal canal is covered by a bar of skin with atrack running forwards to the perineal raphe. The track should be opened with scissors, followed by routine dilatation of the anus.> Ectopic anus. The anus is situated anteriorly and may open in the perineum in boys, or more commonly in the vulva in girls, or rarely into thevagina. A plastic 'cut back' operation isrequired (Pena).> Stenosed anus. The anus is microscopic, but careful examination usually reveals a minute opening which responds to regular dilatation.> Membranous stenosis. Here the anus is normally sited, but is covered with a thin membrane which bulges with retained meconium. It is rare, and an incision will cure the condition.# High abnormalities:> These are often associated with a fistulous connection between the blind rectal stump and the bladder, or other abnormalities of the pelvic structures.> Anorectai agnesis. A blind rectal pouch lies just above the pelvic floor -- its anterior aspect in the male is attached to the bladder and often there is a rectovesical fistula manifested by the passage of gas or meconium in the urine. In the female, the fistula is usually into the posterior fornix.> Rectal atresia. The anal canal is normal but ends blindly at the level of the pelvic floor. The bowel also ends blindly above the pelvic floor without a fistulous opening. This anomaly is rare but must be treated by mobilisation of the rectum and excision of the stricture. After that, end-to-end anastomosis of the anus and rectum must be attempted.> More conservative measures are followed by an intractable stricture.> Cloaca. This occurs only in females and here the bowel, urinary and genital tracts all open into a common wide cavity. Commonly severe malformations of the area are associated with other developmental abnormalities, e.g. tracheobronchial fistula.", "cop": 3, "opa": "Anal stenosis", "opb": "Anal agenesis", "opc": "Anorectal agenesis", "opd": "Membranous atresia", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "e8f5c6f8-a23a-494c-ac0e-b1623a9a23f1", "choice_type": "single"} {"question": "Sistrunk operation is preferred treatment for", "exp": "Thyroglossal Cyst Congenital Age of presentation - 15-30 years Location Most common location- Subhyoid C/F Midline swelling in anterior pa of neck Thyroglossal cyst moves with deglutination Moves up on protrusion of tongue. Complications of Thyroglossal cyst- Infection - Abscess - if Incision and Drainage|Thyroglossal fistula (acquired condition due to I & D of abscess of thyroglossal cyst)- Increased risk of papillary carcinoma of thyroid Rx TOC - Sistrunk operation. The cyst passes body of hyoid bone - so excision is made Enbloc removal of central pa or body of hyoid bone + cyst.", "cop": 3, "opa": "Retrosternal goiter", "opb": "Endemic goiter", "opc": "Thyroglossal cyst", "opd": "Adrenal Incidentaloma", "subject_name": "Surgery", "topic_name": "Thyroid", "id": "83ff4e94-dd7f-4d9e-995b-cbea0a072e0a", "choice_type": "single"} {"question": "Structures pierced during pleural tapping are a/e", "exp": null, "cop": 2, "opa": "endothoracic fascia", "opb": "pulmonary pleura", "opc": "skin", "opd": "intercoastal muscle", "subject_name": "Surgery", "topic_name": null, "id": "9412f7f1-0fb7-4fe9-8ee5-ec439e474008", "choice_type": "single"} {"question": "Early postoperative complication of ileostomy", "exp": "Ans. is 'd' i.e. Necrosis \"Stoma necrosis may occur in the early postoperative period and usually is caused by skeletonizing the distal small bowel and/or creating an overly tight fascial defect. Schwartz 9/e pl031Stomal ComplicationsCategoryComplication EarlyLateStomaPoor locationProlapse RetractionStenosis Ischemic necrosisParastomal hernia DetachmentFistula formation Abscess formationGas Opening wrong endOffensive OdourPeristomal skinExcoriationParastomal varices DermatitisDermatoses Cancer Skin manifestations of inflammatory bowel diseaseSystemicHigh outputBowel obstruction NonclosureMay also develop as a late complication.Other complications are:DiarrheaUrinary tract calculiGallstonesImportant points about OstomiesAn intestinal stoma is an opening of the bowel onto the surface of the abdomen.Depending upon the clinical situation, a stoma may be temporary or permanent. It may be end-on or a loop.A temporary ileostomy often is used to \"protect\" an anastomosis that is at risk for leakage (low in the rectum, in an irradiated field, in an immunocompromised or malnourished patient, and in some emergency operations). In this setting, the stoma often is constructed as a loop ileostomy.A permanent ileostomy sometimes is required after total proctocolectomy or in patients with obstruction. An end ileostomy is the preferred configuration for a permanent ileostomy.Most colostomies are created as end colostomies rather than loop colostomies. The bulkiness of the colon makes a loop colostomy awkward for an appliance, and prolapse is more likely with this configuration.However, regardless of the indication for a stoma, placement and construction are crucial for function.A stoma should be located within the rectus muscle to minimize the risk of a postoperative parastomal hernia.It also should be placed where the patient can see it and easily manipulate the appliance.The surrounding abdominal soft tissue should be as flat as possible to ensure a tight seal and prevent leakage.The optimal position for an ileostomy is in the right lower quadrant.The most desirable position for a sigmoid or descending colostomy is usually in the left lower quadrant of the abdomen. However, if the patient is obese, it may be preferable to site the colostomy in the left upper quadrant so that it is visible to the patient and not trapped on the undersurface of a panniculus. If a distal transverse colostomy is planned, the left upper quadrant is usually the preferable site.The left colon should be used for a colostomy if possible; the distal transverse colon is also a reasonable choice. Proximal colostomies should be avoided, as they will combine the worst features of both a colostomy and an ileostomy: liquid, high-volume, foul-smelling effluent.Parastomal hernia is the most common late complication of a colostomy.Parastomal hernia is less common after an ileostomy than after a colostomy.Most common indication:According to Maingot's Abdominal Operations, the most common indication for an ostomy is Ulcerative colitis, followed by Colorectal cancer.Most common indication for ileostomy is Inflammatory bowel disease (Ulcerative colitis).The most common indication for a colostomy is colorectal cancer.", "cop": 4, "opa": "Obstruction", "opb": "Prolapse", "opc": "Diarrhoea", "opd": "Necrosis", "subject_name": "Surgery", "topic_name": "Miscellaneous (Small & Large Intestine)", "id": "f4d1696f-3c3a-4c08-905d-fb4ba28b52de", "choice_type": "single"} {"question": "Indication of liver transplantation", "exp": ".In cirrhotic patients with HCC, total hepatectomy with ohotopic liver transplantation is required. Now it is found that even resection candidates will do better by transplantation than resection. But waiting period for transplantation is long. To bridge this waiting period for transplantation radiofrequency ablation, transaerial embolization, ethanol/acetic acid injections are used. Liver transplantation is the good surgical option for hepatocellular carcinoma. Liver transplantation may be beneficial for ascites in liver diseases. Ref: SRB&;s manual of surgery,3 rd ed, pg no 557", "cop": 3, "opa": "Biliary atresia", "opb": "Sclerosing cholangitis", "opc": "Hepatitis A", "opd": "Cirrhosis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "c2094ee2-305e-44bd-8104-5e709442ec0b", "choice_type": "single"} {"question": "Sistrunk operation used for", "exp": "Ans. (a) Thyroglossal CystRef Sabiston 20th edition Page 1861* Sistrunk operation involves complete excision of the cyst in continuity with its tract, the central portion of the hyoid bone, and the tract interior to the hyoid bone extending to the base of the tongue", "cop": 1, "opa": "Thyroglossal Cyst", "opb": "Branchial Cyst", "opc": "Cystic Hygroma", "opd": "Laryngocele", "subject_name": "Surgery", "topic_name": "Thyroid Gland", "id": "8e042147-4cdc-4a24-a31c-1efc14ea32e9", "choice_type": "single"} {"question": "Treatment of choice for pleomorphic adenoma", "exp": "Treatment of Pleomorphic adenoma (or any benign lession of Salivary gland)\n\nin Parotid → Superficial protidectomy\nin other salivary glands → Excision of the affected gland.", "cop": 1, "opa": "Superficial parotidectomy", "opb": "Radical parotidectomy", "opc": "Enucleation", "opd": "Radiotherapy", "subject_name": "Surgery", "topic_name": null, "id": "ce12de8f-6736-4f99-940a-0f8906ee50e8", "choice_type": "single"} {"question": "Recurrent prolapse of the rectum in children is treated by", "exp": null, "cop": 4, "opa": "Thiersh wiring", "opb": "Digital reposition", "opc": "Excision", "opd": "Ripstein's operation", "subject_name": "Surgery", "topic_name": null, "id": "121170a1-c447-454a-b3b0-3040ead988cc", "choice_type": "single"} {"question": "CSF otorrhoea is caused by", "exp": "Ans is 'c' ie Fracture of petrous temporal boneC.S.F. otorrhea is seen in fracture (longitudinale) of temporal bone C.S.F. is seen in external and middle ears T/T -It usually ceases spontaneously surgical intervention is rarely needed. Antibiotics (Co-trimoxazole) is given as it us sensitive to bacter ious causing URTI and it can cross blood brain barrier.", "cop": 3, "opa": "Fracture of cribriform plate", "opb": "Fractureof parietal bone", "opc": "Fractureof petrous temporal bone", "opd": "Fracture of tympanic membrane", "subject_name": "Surgery", "topic_name": "E.N.T.", "id": "0c7504d0-209a-437c-aa41-fa3e5f5cd950", "choice_type": "single"} {"question": "The most common cyst of the oral region is", "exp": "repeated question.", "cop": 4, "opa": "Dentigerous cyst", "opb": "Keratosis cyst", "opc": "Dermoid cyst", "opd": "Periapical cyst", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "b74bd8b4-c7d8-4481-a3e8-5e4b2a89c300", "choice_type": "single"} {"question": "Veins involve in stomach varices are", "exp": "The left gastric vein(or coronary vein) carries blood low in oxygen, tributaries derived from both surfaces of the stomach; it runs from right to left along the lesser curvature of the stomach, between the two layers of the lesser omentum, to the esophageal opening of the stomach, where it receives some esophageal veins ..so the coronary veins are involved in gastric varices.", "cop": 1, "opa": "Coronary vein", "opb": "Sho gastric vein", "opc": "Right Gastroepiploic vein", "opd": "Left Gastroepiploic vein", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "2fe76c53-c201-4cff-b22f-3e4db1d90738", "choice_type": "single"} {"question": "Best indication for testicular biopsy in a male is", "exp": "\"The testis biopsy is a useful adjunct in the infertility evaluation because it provides direct information regarding the state of spermatogenesis.............. This procedure is most useful in the azoospermic patient, in which it is often difficult to distinguish between a failure of sperm production and obstruction within the reproductive tract ducts. A testis biopsy allows definitive delineation between these 2 conditions and can guide further treatment options in azoospermic men \" - Smith's Urology", "cop": 4, "opa": "Polyspermia", "opb": "Oligospermia", "opc": "Necrospermia", "opd": "Azoospermia", "subject_name": "Surgery", "topic_name": null, "id": "cc80a3bd-7f4e-45ac-86ac-cb8867072215", "choice_type": "single"} {"question": "A 25 year old man presents with 3 days history of pain in the right lower abdomen and vomitings. patient's general condition is satisfactory and clinical examination reveals a tender lump in right iliac fossa. The most appropriate management in this case would be", "exp": "Ans. is 'c' i.e., Oschner Sherren regimen", "cop": 3, "opa": "Immediate appendicectomy", "opb": "Exploratory laprotomy", "opc": "Oschner Sherren regimen", "opd": "External drainage", "subject_name": "Surgery", "topic_name": null, "id": "4f119cb6-5290-471b-9ead-1a79ff46d2bf", "choice_type": "single"} {"question": "In case of sub condylar fracture, the condyle move\nin", "exp": null, "cop": 4, "opa": "Anterior — lateral direction", "opb": "Posterior — medial direction", "opc": "Posterior — Lateral direction", "opd": "Anterior — medial direction", "subject_name": "Surgery", "topic_name": null, "id": "5c3a354d-7b9c-4145-986c-5706e3abbcd2", "choice_type": "single"} {"question": "Runt's disease is associated with", "exp": "GVHD Robbins, 7 edition, Page 222 * Runt's disease: is a pathological condition in which cells from the transplanted tissue of a donor initiate an immunologic attack on the cells and tissue of the recipient Complications of small bowel transplantation: * Most of the moality after bowel transplantation is due to sepsis and multiorgan failure. * The risk of infection after small bowel transplantation is heightened by the additional requirements for immunosuppression in order to control graft rejection. * This accounts for the relatively high incidence of Lymphoproliferative disease (around 10%) observed in patients who have undergone small bowel transplantation. * Because of the large amount of donor lymphoid tissue transplanted Graft- Versus-Host Disease (GVHD) may occasionally be an added complication", "cop": 3, "opa": "Acute rejection", "opb": "Hyperacute rejection", "opc": "GVHD", "opd": "Chronic rejection", "subject_name": "Surgery", "topic_name": null, "id": "6f9d620d-4afb-4eff-9ad7-893c8214f50e", "choice_type": "single"} {"question": "Most common cause of clicking", "exp": null, "cop": 1, "opa": "Disc displacement with reduction", "opb": "Disc displacement without reduction", "opc": "Hypermobility", "opd": "Loose articular bodies", "subject_name": "Surgery", "topic_name": null, "id": "7d106348-aab7-4858-a213-a9acd57eb43b", "choice_type": "single"} {"question": "Most reliable investigation in bladder rupture is", "exp": null, "cop": 3, "opa": "IVP", "opb": "Cystoscopy", "opc": "Retrograde cystogram", "opd": "Catheterisation", "subject_name": "Surgery", "topic_name": null, "id": "c68f16ca-dfea-4290-9323-e5010fe32ca1", "choice_type": "single"} {"question": "Reduction of size and vascularity prior to thyroidectomy is done by", "exp": "Ans. (a) Lugol iodineRef: Bailey and Love 26th edition Page 760* Lugol's Iodine: 10% Potassium Iodine+ 5% Iodide is used on last 10 days before surgery to make the gland firm and stronger and decreases the vascularity of gland", "cop": 1, "opa": "Lugol Iodine", "opb": "Propylthiouracil", "opc": "Radioiodine", "opd": "Propranolol", "subject_name": "Surgery", "topic_name": "Thyroid Gland", "id": "ce59994c-d089-4d2a-9ced-1c1de3b1f807", "choice_type": "single"} {"question": "In an emergency room an alcoholic patient enters with hematemesis. On examination he has ascites with splenomegaly and gynecomastia. Etiology is", "exp": "Ans. (b) Portal hypertension due to alcholic cirrhosisRef: Sabiston 20th edition Page 1437* Clinical features and findings suggest that the patient is a known case of Alcoholic cirrhosis with portal hypertension.* So most common cause in him is Varices bleeding", "cop": 2, "opa": "Portal hypertension secondary to viral hepatitis", "opb": "Portal hypertension due to Alcoholic cirrhosis", "opc": "Budd chiari syndrome", "opd": "Primary sclerosing cholangitis", "subject_name": "Surgery", "topic_name": "Liver", "id": "d4d511fc-c4e3-4893-8caf-545b4184b384", "choice_type": "single"} {"question": "Major mineral of the bone is", "exp": "Hydroxyapatite Hydroxyapatite crystals are the major mineral of bone Hydroxyapatite (also k/a bone mineral) is the salt of calcium and phosphorus with the formula Calc(PO4)6(01)2. Structural composition of bone : Also know Bone has to be 50% mineralised to be visible on radiographs.", "cop": 2, "opa": "Calcite", "opb": "Hydroxyapatite", "opc": "Calcium oxide", "opd": "Calcium carbonate", "subject_name": "Surgery", "topic_name": null, "id": "b88f2d01-ba55-4c2b-9749-33134f164239", "choice_type": "single"} {"question": "Commonest cause of moality in Ivor Lewis operation", "exp": "Ivor Lewis operation is done for esophageal carcinoma. It is a 2 stage operation, in which abdomen is opened first, closed and then thoracotomy is performed. As it involves esophago- gastric anastomosis, Major complication causing moality is anastomotic leak. Aggressive investigation for leak is mandatory in case of unexplained fever or clinical event. Reference: Bailey and love, 27th edition, page 1092,1093", "cop": 2, "opa": "Pulmonary atelectasis", "opb": "Anastmotic leak", "opc": "Thorasic duct fistula", "opd": "Sub diphragmatic collection", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "087c8a41-0a7e-426e-86c8-4b8081dc9901", "choice_type": "single"} {"question": "Colonoscopy as a part of screening is not needed in.", "exp": "Ans. (a) MEN 2 syndromeRef Bailey and Love 27th edition, Page 1259* MEN2B syndrome is not associated with colorectal cancers.; FAR HNPCC, Cronkhite, Banayan, all these syndromes; have associated colorectal cancers.", "cop": 1, "opa": "MEN 2 syndrome", "opb": "Lynch", "opc": "FAP", "opd": "Cronkhite Canada", "subject_name": "Surgery", "topic_name": "Small & Large Intestine", "id": "78d9fcff-cebd-4206-a152-bd3e8a871fda", "choice_type": "single"} {"question": "Feline Esophagus is", "exp": "(A) Eosinophilic Esophagitis[?]Feline Oesophagus:Feline oesophagus also known as Oesophageal shiver, refers to the transient transverse bands seen in the mid and lower oesophagus on a double contrast barium swallow.The appearance is almost always associated with active gastro oesophageal reflux and is thought to be due to contraction of the muscularis mucosae with resultant shortening of the oesophagus and 'bunching up' of the mucosa in the lumen. In given image, there are numerous 1-2 mm radiolucent folds across the oesophagus. The folds are angled with respect to the center of the oesophagus in a \"herringbone\" pattern.The folds occur transiently:Feline oesophagus also known as oesophageal shiver, refers to the transient transverse bands seen in the mid and lower oesophagus on a double contrast barium swallow.The appearance is almost always associated with active gastro-oesophageal reflux and is thought to be due to contraction of the muscularis mucosae with resultant shortening of the oesophagus and 'bunching up' of the mucosa in the lumen.Radiographic features:The folds are 1-2 mm thick and run horizontally around the entire circumference of the oseophageal lumen. The findings are transient, seen following reflux and not during swallowing. The appearance is confined to the distal two-thirds of the thoracic oesophagus.Other Options[?]Diffuse Esophageal Spasm:Unknown etiologyNon-progressive dysphagia with solids & liquids & non-exertional chest pain that responds to nitroglycerin.Corkscrew on barium.Diagnosis by Manometry:Periodic occurrence of simultaneous high-amplitude contractions with intervening periods of normal peristalsis.Therapy transplant treatment: Rule out CAD, then medical management of reassurance, nitrates & CCBs.Botulinum toxin injection, surgery does not have an established role.[?]Radiation-Induced Esophagitis:Seen in up to 80% of patients receiving XRT to the chest.Use of cytotoxic chemo has an additive effect.Typically chest pain, dysphagia & odynophagia occur shortly after the initiation of therapy.Late stricture formation is a common complication.Usually self-limited, treatment is symptomatic.[?]Diagnostic Criteria for Eosinophilic Esophagitis:Esophageal dysfunction (clinical symptoms)>15 eosinophils in 1 high power field of 1 or more esophageal specimens.No response to proton pump inhibitor therapy up to 2 mg/kg/day or normal pH monitoring seen in the distal esophagus.", "cop": 1, "opa": "Eosinophilic Esophagitis", "opb": "GERD", "opc": "Radiation esophagitis", "opd": "Diffuse esophageal spasm", "subject_name": "Surgery", "topic_name": "Oesophagus", "id": "ee928c66-bafb-4389-8e3c-1b1ce959f5cc", "choice_type": "single"} {"question": "Post operatively wound dehiscence occurs between", "exp": "Wound dehiscence is disruption of any or all of the layers in a wound. Wound dehiscence most commonly occurs from the fifth to the eighth postoperative day when the strength of the wound is at its weakest.Risk factors in wound dehiscenceGeneralLocal MalnourishmentDiabetesObesityRenal failureJaundiceSepsisCancerTreatment with steroidsInadequate or poor closure of woundPoor local wound healing, e.g. because of infection, haematoma or seromaIncreased intra-abdominal pressure, e.g. in postoperative patients suffering from chronic obstructive airway disease, during excessive coughingRef: Bailey and love 27e pg: 297", "cop": 3, "opa": "1-2 days", "opb": "3-5 days", "opc": "5-8 days", "opd": "8-12 days", "subject_name": "Surgery", "topic_name": "General surgery", "id": "a1aa051a-db24-4dcb-9bb7-d790ccb860b3", "choice_type": "single"} {"question": "Bochdalek hernia occurs through", "exp": "A hernia through foramen Bochdalek (through the pleuroperitoneal canal) (95% left-sided, only 5% right sided) * It is a commonest congenital diaphragmatic hernia. * This is a developmental defective condition, due to a failure of fusion of pleuroperitoneal canal leaving a direct communication between pleura and peritoneum on left side. This allows herniation of contents of the abdomen into the left side thorax. * Common content is a colon. Occasionally small bowel, stomach is the contents. * 80% cases do not have a hernial sac. Only 20% cases have got sac. Ref: SRB&;s manual of surgery,3 rd ed, pg no 1078", "cop": 1, "opa": "Diaphragm", "opb": "Lumbar triangle", "opc": "Femoral region", "opd": "obturator canal", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "a3d1f5d2-0cfb-4e3d-9082-2f51a0bbee3b", "choice_type": "single"} {"question": "Most radiosensitive testicular tumor is", "exp": "Ans. a (Seminoma). (Ref. LB, 25th/1384)Radiosensitive tumors are seminoma, Ewing's sarcoma, Hodgkin's lymphoma, few gynaecological malignancies and medulloblastoma.Radiotherapy -is the treatment of choice for# Oral cavity, lip, tongue, cheek# Nasopharynx, Oropharynx and hypopharynx# Nasal cavity# Larynx# Skin cancers (except melanoma)# Cervix# Bladder (except Tl)# Testis - Seminoma# Hodgkin's disease - early disease# NHL - early disease# Medulloblastoma (following surgery)# Retinoblastoma# Astrocytomas (grade 3 and 4)Radiosensitivity of different tumorsHighly radiosensitiveModerately radiosensitiveRelatively resistantHighly resistantLymphomaSeminomaMyelomaEwing's sarcomaWilm's tumorsSmall cell lung cancerBreast cancerBasal cell carcinomaMedulloblastomaTeratomaOvarian cancerSquamous cell lung cancerRCCRectal carcinomaBladder carcinomaSoft tissue sarcomaCervical cancerMelanomaOsteosarcomaPancreatic Ca", "cop": 1, "opa": "Seminoma", "opb": "Teratoma", "opc": "Lymphoma", "opd": "Sertoli cell tumor", "subject_name": "Surgery", "topic_name": "Testis & Scrotum", "id": "9b03ac41-c74c-4cf2-8a10-fa907d67c567", "choice_type": "single"} {"question": "Most common nerve injured in face lift surgery is", "exp": "Ans. is 'd' i.e., Frontal branch of facial nerve Nerve injury during facelift surgery Some sensory reduction after facelift surgery is considered a consequence and not a complication of facelift surgery. Care must be taken to avoid injury to the greater auricular nerve. The most commonly injured nerve is the frontal branch of the facial nerve.", "cop": 4, "opa": "Zygomatic branch of the facial nerve", "opb": "Greater auricular nerve", "opc": "Mandibular branch of facial nerve", "opd": "Frontal branch of facial nerve", "subject_name": "Surgery", "topic_name": null, "id": "f01e26da-ba87-4b77-99bf-2486624262f3", "choice_type": "single"} {"question": "Induration of seminal vesicle is seen most oftenly in", "exp": "TUBERCULOSIS OF THE PROSTATE AND SEMINAL VESICLES Tuberculosis of the prostate and seminal vesicles is rare and associated with renal tuberculosis. In 30% of cases, there is a history of pulmonary tuberculosis within 5 years of the onset of genital tuberculosis. Tuberculosis of one or both seminal vesicles may be found when examining a patient with chronic tuberculous epididymitis, no symptoms being referable to the internal genitalia. On rectal examination, the affected vesicle is found to be nodular. When the prostate is involved, rectal examination reveals nodules in one or both lateral lobes. Patients with tuberculous prostatitis usually present with the following: * urethral discharge; * painful, sometimes blood-stained, ejaculation; * mild ache in the perineum; * infeility; * dysuria; * abscess formation. Special forms of investigation Radiography sometimes displays areas of calcification in the prostate and/or the seminal vesicles. Bacteriological examina tion of the seminal fluid yields positive cultures for tubercle bacilli. Treatment The general treatment is that for tuberculosis. If a prostatic abscess forms, it should be drained transurethrally. Ref: 1475", "cop": 1, "opa": "Tuberculosis", "opb": "Lymphogranuloma venereum", "opc": "Gonorrhea", "opd": "Syphilis", "subject_name": "Surgery", "topic_name": "Urology", "id": "02873583-51c5-42e0-b6a4-b84337c06e75", "choice_type": "single"} {"question": "Traetment of breast cancer with pregnant lady in first trimester", "exp": "1st trimester MRM (modified radical mastectomy) If axillary node is +ve then pregnancy is terminated; (MTP), chemotherapy is given Second trimester; MRM,Chemotherapy carefully Third trimester; MRM, After delivery, chemotherapy with suppression of lactation Ref; (page no; 561) 5th edition of SRB&;S manual of Surgery.", "cop": 3, "opa": "Neoadjuvent chemotherapy + Surgery", "opb": "Breast conservation", "opc": "MTP followed by treatment according to protocol", "opd": "Radiotherapy", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "5479144e-d9f7-455b-964a-edba876cd0a7", "choice_type": "single"} {"question": "Commonly done treatment of single perforation of typhoid in ileum.", "exp": "Ans. (a) Direct closureRef: Sabiston 20th edition, Page 1267Typhoid intestinal perforation:* Intestinal perforation occurs in 2% cases.* Typically, it is usually a single perforation in Peyer's patch areas* Simple closure is the treatment of choice* Multiple perforation occurs in 25% cases* In such cases of multiple perforations resection is done followed by anastomosis or exteriorization depending upon the case", "cop": 1, "opa": "Direct closure", "opb": "Graham patch", "opc": "Resection of ileum", "opd": "Ileostomy", "subject_name": "Surgery", "topic_name": "Small & Large Intestine", "id": "3b7ef24e-6003-4c84-9971-f0c710a28d50", "choice_type": "single"} {"question": "Surgical treatment of parotid tumor involving the deep lobe is", "exp": "Answer- A. Total parotidectomy with facial nerve preservationThe primary treatment of salivary malignancies is surgical excision.For parotid tumors that arise in the lateral lobe, superficial parotidectomy with preservation of CN VII is indicated", "cop": 1, "opa": "Total parotidectomy with facial nerve preservation", "opb": "Total parotidectomy with facial nerve sacrifise", "opc": "Sub total parotidectomy", "opd": "Subtotal parotidectomy with facial nerve sacrifice", "subject_name": "Surgery", "topic_name": null, "id": "c3888ff2-e2d7-4ac3-a354-2f0e5dc17cc9", "choice_type": "single"} {"question": "The most common mechanism of perforation in appendix is", "exp": "Appendicular Perforation Immediate appendectomy has long been the recommended treatment for acute appendicitis because of the presumed risk of progression to rupture The overall rate of perforated appendicitis is 25.8% Children <5 years of age and patients >65 years of age have the highest rates of perforation (45 & 51% respectively) Risk factors for Appendicular Perforation Fecolith Diabetes mellitus Immunosuppression Extremes of age Pelvic appendix Previous abdominal surgery It has been suggested that delays in presentation are responsible for the majority of perforated Appendices Appendiceal rupture occurs most frequently distal to the point of luminal obstruction along the anti mesenteric border of the appendix Rupture should be suspected in the presence of fever with a temperature of < 39% (102degF) and a WBC count of >18000 cells/mm3 MC bacteria isolated in perforated appendicitis : Bacteroides fragilis (80%) > E.coli (77%) Ref: Sabiston 20th edition Pgno : 1297", "cop": 1, "opa": "Impacted fecolith", "opb": "Tension gangrene", "opc": "Necrosis of lymphoid patch", "opd": "Retrocecal infection", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "c2c14d3b-3293-480e-a53d-0bcfcefc1e38", "choice_type": "single"} {"question": "Head & neck burn in children is", "exp": "Berkow formula to estimate Burn size Body pa 0-1 year 1-4 years 5-9 years Head 19 17 13 Neck 2 2 2 Anterior trunk 13 13 13 Posterior trunk 13 13 13 Ref: Sabiston 20th edition Pgno :508", "cop": 2, "opa": "15%", "opb": "18%", "opc": "12%", "opd": "32%", "subject_name": "Surgery", "topic_name": "General surgery", "id": "7a28aeeb-e982-468f-89d4-6cd907595ec8", "choice_type": "single"} {"question": "In treatment of papillary carcinoma thyroid, radioiodine destroys the neoplastic cells predominantly by", "exp": "RADIOACTIVE IODINE (I131) THERAPY:\n\nI131 is an effective agent for delivering high radiation doses to the thyroid tissue\nIt emits mainly beta radiation (90%), which penetrates only 0.5 mm of the tissue and thus allow therapeutic effects on the thyroid without any damage to the surrounding structures, particularly the parathyroids.\n\nMechanism of Action:\n\nI131 emits beta particles and X-rays.\nBeta rays are utilized for their destructive effects on thyroid cells.\nX-rays are useful for tracer studies.", "cop": 2, "opa": "X-rays", "opb": "Beta rays", "opc": "Gamma rays", "opd": "Alpha particles", "subject_name": "Surgery", "topic_name": null, "id": "7b7aa1fd-11d8-4ecb-ad7c-c7f2dfad7161", "choice_type": "single"} {"question": "Gold standard investigation for chronic pancreatitis", "exp": "ERCP(Endoscopic retrograde cholangiopancreatography) is the most accurate way of elucidating the anatomy of duct and, in conjunction with the whole organ morphology, can help to determine the type of operation required. Reference : Bailey & Love, 27th Edition, page no = 1231", "cop": 2, "opa": "MRI", "opb": "ERCP", "opc": "Pancreatic function tests", "opd": "Faecal fat estimation", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "bbcad208-bb1b-47ab-8314-ab595dd0c1b1", "choice_type": "single"} {"question": "A 40 year old female presents with fever, faigue, diffuse painful swelling in the midline of the neck, FNAC of the same reveals epithelioid cells and giant cells, the likely diagnosis is", "exp": "Painful midline diffuse swelling in neck with fever and fatigue points to thyroiditis. In sub acute granulomatous thyroiditis (De Quervain&;s thyroiditis) there is the presence of multinucleated giant cells composed of epitheloid cells. De Quervain&;s thyroiditis : May follow a viral infection. In a typical subacute presentation, there is pain in the neck, fever, malaise and a firm, irregular enlargement of one or both thyroid lobes. Note : Gaint cells and epithelioid cells are seen in any granulomas, not just tuberculosis. Caseation is hall mark of TB granulomas. Source : Bailey and Love 26th edition Pg : 771", "cop": 2, "opa": "Acute thyroiditis", "opb": "Subactue thyroiditis", "opc": "Tubercular lymphadenitis", "opd": "Hashimotos thyroiditis", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "7c70ab5d-3c67-4c46-9eb6-0bd6473cecca", "choice_type": "single"} {"question": "Cavernous sinus thrombosis following infection of anterior maxillary teeth most often from spread of infection along", "exp": null, "cop": 3, "opa": "Facial artery", "opb": "Angular artery", "opc": "Ophthalmic vein", "opd": "Pterygoid plexus", "subject_name": "Surgery", "topic_name": null, "id": "5d2a8a7a-1f66-4409-833c-4cb69e0b410d", "choice_type": "single"} {"question": "Most common organ involved in blunt abdominal trauma is", "exp": ".repeated", "cop": 2, "opa": "Liver", "opb": "Spleen", "opc": "Pancreas", "opd": "Stomach", "subject_name": "Surgery", "topic_name": "Trauma", "id": "5c57f2cd-727b-436d-8fc1-0ac90fea8090", "choice_type": "single"} {"question": "Moneteggia fracture is fracture of", "exp": "D i.e. Upper 1/3rd of ulna", "cop": 4, "opa": "Lower 1/3rd of Radius", "opb": "Upper 1/3rd of radius", "opc": "Lower 1/3rd of ulna", "opd": "Upper 1/3rd of Ulna", "subject_name": "Surgery", "topic_name": null, "id": "c7bd0a45-ed62-4826-8c2e-abe04a92723f", "choice_type": "single"} {"question": "According to Johnson's classification prepyloric Plus duodenal ulcers is", "exp": "TYPE\nLOCATION\n\n\nI\nLesser curve at incisura\n\n\nII\nGastric body with duodenal ulcer\n\n\nIII\nPrepyloric\n\n\nIV\nHigh on lesser curve\n\n\nV\nAnywhere", "cop": 2, "opa": "Type 1", "opb": "Type 2", "opc": "Type 3", "opd": "Type 4", "subject_name": "Surgery", "topic_name": null, "id": "ddadf18f-52de-481e-a014-a5617fec014d", "choice_type": "single"} {"question": "Fibroadenoma of the breast are", "exp": "Ans. is 'd' i.e. Solitary mobile mass", "cop": 4, "opa": "Fixed mass", "opb": "Diffuse mass", "opc": "Multiple duffuse mass", "opd": "Solitary mobile mass", "subject_name": "Surgery", "topic_name": null, "id": "81b8fcc8-b634-4ce1-b4df-05be05c9e20a", "choice_type": "single"} {"question": "Most common cause of Foley catheter induced UTI", "exp": "Ans. (a) E. coliRef Bailey and Love 26th Edition, Page 276* Urinary infection is the most commonly associated infection in postoperative period* Most common organism isolated in catheter related Infections: E. coli", "cop": 1, "opa": "E. coli", "opb": "Klebsiella", "opc": "Pseudomonas", "opd": "Staphylococci", "subject_name": "Surgery", "topic_name": "Urethra & Penis", "id": "d1ea3ca3-fc30-4991-80fa-91cbfe3c4c7a", "choice_type": "single"} {"question": "Typhoid ulcer ruptures at", "exp": "C. i.e. (3rd week) (69- 5 B & L 25th) (995- S. Das 5th)* After the second week, signs of peritonitis usually denotes perforation, which is confirmed by the presence of free.gas seen on x-ray (69-.B & L 25th)* Perforation usually occurs during the third week it occurs through ulcerated peyer's patches in the terminal ileum (commonest site)** (995 - S-Das 5th)* Typhoid ulcer are longitudinal (Tuberculous ulcers are transverse)**** Treatment - laparotomy - close the peritoneum and leave the wound open for secondary closure* In typhoid, chronic carriers are those - Urinary carriers with anomaly*** Chronic burrowing ulcer is caused by - Microaerophilic streptococci**", "cop": 3, "opa": "1st week", "opb": "2nd week", "opc": "3rd week", "opd": "4th week", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "39ed66e7-d7cb-4e8d-b166-6c0d531b2fbf", "choice_type": "single"} {"question": "A patient with abdominal injury presents to the emergency depament with signs of signs of peritonitis and shock. Airway and breathing were secured and IV fluids were staed with 2 large bore cannulas. The next line of management should be", "exp": ".Treatment for abdominal injury includes, Emergency laparotomy. Indications includes * Frank haemoperitoneum * Significant diagnostic peritoneal lavage * Haemodynamically unstable patient * U/S or CT scan shows significant intra-abdominal injuries ref:SRB&;s manual of surgery,ed 3,pg no 124", "cop": 2, "opa": "FAST", "opb": "Exploratory Laparotomy under general anesthesia", "opc": "Inseion of abdominal drain followed by laparotomy", "opd": "Laproscopy", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "c22ed2bf-fc6e-479e-9930-b0f5f85ed971", "choice_type": "single"} {"question": "Cleft lip surgery is earliest done at", "exp": "Ref: Sabiston 20th edition Pgno : 1947 \"Rule of 10s\" by surgeon Wilhelmmensen and Musgrave Surgery is done in cleft lip in a child when Age >= 10 weeks Weight >= 10 pounds Hemoglobin >= 10 gm Management of cleft lip and cleft palate Surgical techniques are aimed at restoring normal anatomy Cleft lip Repaired between 3 and 6 months of age Cleft palate Repaired between 6 and 18 months", "cop": 1, "opa": "3 months", "opb": "6 months", "opc": "9 months", "opd": "12 months", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "91969eb9-e167-4fed-9bba-2bb4c8becbdd", "choice_type": "single"} {"question": "A 35 year female comes with Size 5 cm tumour of the oral cavity + single lymph node of 2 cm diameter on the same side in the neck is staged as", "exp": "TNM staging of oral cancer :\nTx : Cannot be assessed e.g. already excised.\nT0 : No evidence of primary tumor (occult primary).\nTis : Carcinoma in - situ.\nT1 : Equal to or less than 2 cm in greatest dimension.\nT2 : More than 2 cm. bul less than or equal to 4 cm.\nT3 : More than 4 cm.\nT4a : Moderately advanced local disease :\nLip and check - involvement of cortical bone, skin, inferior alveolar nerve.\nTongue - extrinsic muscles, skin.\nT4b : Very advanced local disease :\nCheck - involvement of masticatory space, base of skull, internal carotid artery.\nInternal carotid artery.\nTNM staging of cavity tumors. Status of lymph nodes 'N' :", "cop": 2, "opa": "T2NI MO", "opb": "T3 NI MO", "opc": "T2 N2 MO", "opd": "TI NI MO", "subject_name": "Surgery", "topic_name": null, "id": "51a40381-1c82-41fd-8be7-899ce5f59248", "choice_type": "single"} {"question": "Metabolic abnormality seen in congenital hyperophic pyloric stenosis is", "exp": "To control alkalosis, kidney secretes excess bicarbonate. Due to hyponatremia, body conserves sodium and so bicarbonate is secreted along with the hydrogen in. Urine becomes acidic and called as paradoxical aciduria Reference: SRB edition: 5th page no:830", "cop": 1, "opa": "Hypochloremic hypokalemic metabolic alkalosis", "opb": "Hyperchlonemic hypokalemic metabolic alkalosis", "opc": "Hypochloremic hypokalemic metabolic acidosis", "opd": "Hyperchoremic hypokalemic metabolic acidosis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "3bcf953e-670c-4c34-98c0-b5fff374823b", "choice_type": "single"} {"question": "Carcinoma thyroid localized and well differentiated, treatment consists of", "exp": "The primary treatment of DTC (differentiated thyroid cancer) , is surgical ablation. The other mainstays of therapy are RAI ablation and TSH suppression. A patient diagnosed with PTC will undergo either total or near-total thyroidectomy as the preferred initial treatment. Therapeutic neck dissection is performed with initial thyroidectomy for patients with PTC with neck node metastasis. Adjuvant therapy includes postoperative TSH suppression with thyroxine therapy. If the patient is considered low risk, TSH levels are acceptable into the low range of normal. High-risk patients are often maintained at <=0.1 mIU/L. Postoperative radioactive abalation is reserved for patients with high-risk PTC or patients with a diagnosis of follicular or HCC (huhle cell cancer). External beam radiation therapy is used in patients with reccurrence or metastasis that is not amenable to surgery. Also is tried in patients with anaplastic carcinoma. Source : Devita Principles of Oncology 10th edition : Pg 1182", "cop": 1, "opa": "Near total thyroidectomy, radioisotope", "opb": "Subtotal thyroidectomy with external beam irradiation", "opc": "Near total thyroidectomy, iodine, external beam irradiation", "opd": "Total thyroidectomy, external beam radiation, life long eltroxin", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "933f153f-5eed-463f-885c-bde4625ac4fd", "choice_type": "single"} {"question": "McNeal's peripheral Zone in prostate gland is the seat of", "exp": "Carcinoma prostate arises from the peripheral zone in prostatic gland proper, commonly in posterior lobe. BPH arises from the submucosal glands of periurethral transitional zone. Reference : page 1044 and1048 SRB's manual of surgery 5th edition", "cop": 2, "opa": "Benign Hyperophy", "opb": "Cancer", "opc": "Prostatitis", "opd": "Calculi", "subject_name": "Surgery", "topic_name": "Urology", "id": "ef7f2c9d-c40e-44fd-87a4-bc90df0502b6", "choice_type": "single"} {"question": "Best indicator to determine fluid required in hypovolemic patient is", "exp": "Best Indicator to determine fluid required is PCWP", "cop": 1, "opa": "PCWP", "opb": "CVP", "opc": "Intra arterial BP", "opd": "2D echo", "subject_name": "Surgery", "topic_name": null, "id": "2456a08f-e3dc-4c57-969b-cacb5f2d17fa", "choice_type": "single"} {"question": "Normal poal vein pressure is", "exp": "Poal veins carries approximately 75% of blood supply to the liver, formed by the junction of the superior mesenteric and splenic veins behind neck of pancreas&;s Normal poal vein pressure is 5-10mmHg if there is sustained elevation in the poal venous pressure more than 10mmHg. Reference SRB edition :5 page:614", "cop": 3, "opa": "< 3 mm Hg", "opb": "3-5 mm Hg", "opc": "5-10 mm Hg", "opd": "10 to 12 mm of Hg", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "7eed47ed-348d-43fa-947b-04989292e3a1", "choice_type": "single"} {"question": "Diversion of urinary bladder is best done at", "exp": "Permanent urinary tract diversion is most commonly performed by conduit diversion. The ureters are implanted into a sho, isolated segment of ileum or, less commonly, colon. The conduit dives the urine onwards to a cutaneous stoma for collection in an ileostomy bag. Ileal segment is the best for urinary diversion after cystectomy. Still better method is \"Continent cutaneous diversion\" method. But the best method is \"Ohotopic neobladders\". \"Incontinent cutaneous urinary diversion\" by ileal conduit: a segment of ileum is exteriorized in the form of a stoma through the abdominal wall, around which an appliance is secured and into which urine continuously drains. \"Continent cutaneous diversions\" -- All continent cutaneous reservoirs rely upon a low-pressure pouch constructed of various detubularized bowel segments and a functional mechanism that connects the reservoir to the skin, designed to prevent involuntary urine flow. The most obvious advantages of this type of diversion are the ability to avoid continuous urine drainage and the need for an external appliance. These continent cutaneous diversions require intermittent clean self-catheterization through the stoma both to empty the reservoir and to irrigate mucous. No stomal appliance is usually required. Although continent cutaneous diversions have been largely supplanted by the ohotopic neobladder, this procedure is used when the urethra or bladder neck is non-functional or involved by tumor, and avoidance of an external appliance is desired. \"Ohotropic neobladders\"-- Ohotropic neobladders are internal reservoirs that are connected to the native urethra and rely upon the external striated sphincter for continence. These reservoirs are constructed from a segment of detubularized intestine (usually ileum) anastomosed to the native urinary outflow tract. Because this approach facilitates the restoration of normal self-image by approximating normal voiding, construction of an ohotropic neobladder has become the procedure of choice for most patients following cystectomy for bladder cancer in both men and women. It is contraindicated if the urethra is nonfunctional or involved with tumor. Bailey and Love Pg : 1336", "cop": 2, "opa": "Jejunum", "opb": "Ileum", "opc": "Cecum", "opd": "Colon", "subject_name": "Surgery", "topic_name": "Urology", "id": "f722b698-ae43-4d24-b9c7-feea27efeeb1", "choice_type": "single"} {"question": "Carcinoma tongue is most common at", "exp": "Carcinoma Tongue Most common site is middle of lateral border or ventral aspect of the tongue Most common histological type is squamous cell carcinoma Most common associated risk factors are tobacco and alcohol Most common variety is ulcerative 30% patients presents with cervical node metastasis Ref: Bailey and love 27th edition Pgno : 616", "cop": 1, "opa": "Lateral border", "opb": "Dorsum", "opc": "Posterior 1/3rd", "opd": "Tip of tongue", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "c14eacf4-db35-4f90-8331-2ea1820d0df9", "choice_type": "single"} {"question": "Sudden loud sound is more likely to damage the cochlea than prolonged sounds because", "exp": null, "cop": 4, "opa": "Basilar fibers are sensitive to sudden sounds but adapt to prolonged sounds", "opb": "A sudden sound carries more energy", "opc": "Tympanic membrane becomes flaccid during prolonged loud sounds", "opd": "There is a latent period before the attenuation reflex can occur", "subject_name": "Surgery", "topic_name": null, "id": "f024ef5f-f995-40d8-b104-6561dd6b41e9", "choice_type": "single"} {"question": "Lithotripsy is the equipment used to crush the stones", "exp": ".Cystoscopic litholapaxy Under GA, cystoscope is passed and the stone is visualized. It is fragmented by pneumatic, laser, electromagnetic waves or mechano-hydraulic lithotripsy. The bladder is flushed using an irrigator (Freyer's evacuator or irrigator or Ellik's evacuator).in extracopreal shock wave lithotripsy (ESWL)Piezo-Ceramic or Electromagnetic shock waves are passed to the stone through water bath or water cushion which acts as a media. Shocks are produced at 2/sec. 1000-4000 shocks are required for each stone. * Dornier Lithotripter is used for fragmenting stones. * Stone is located and observed through fluoroscope (C-ARM) or ultrasound. Shock waves are triggered to create compressive waves over the stone, to fragment it. These fragments are flushed out later. ref:SRB&;s manual of surgery,ed 3,pg no 957", "cop": 1, "opa": "High frequency (CW) US used", "opb": "High frequency pulsed wave", "opc": "Low frequency continuous wave", "opd": "Medium range (2.5 MHz) pulsed wave are used", "subject_name": "Surgery", "topic_name": "Urology", "id": "c2fde556-3d51-45ef-b019-7ca3744b8c51", "choice_type": "single"} {"question": "The organism most frequently related to mediastina fibrosis is", "exp": "Fibrosing mediastinitis or mediastinal fibrosis is the least common,but the most severe ,late complication of histoplasmosis.It is due to an abnormal immunological response to antigens released by the soil based fungus Histoplasma capsulatum.It is characterised by invasive calcified fibrosis centered at locations of lymph nodes,which occludes major vessels & airways.", "cop": 2, "opa": "Actinomycosis", "opb": "Histoplasma", "opc": "Hansen's bacillus", "opd": "Staphylococcus", "subject_name": "Surgery", "topic_name": "Cardio thoracic surgery ", "id": "e89be3cc-60a2-4aa0-85cc-31ce586bc17b", "choice_type": "single"} {"question": "Most common site of basal cell carcinoma is", "exp": "Basal cell carcinoma is usually a slow-growing, locally-invasive, malignant tumour of pluripotential epithelial cells arising from basal epidermis and hair follicles; hence, it affects the pilosebaceous skinThe strongest predisposing factor to BCC is UVR.Ref: Bailey and Love, 27e, page: 605", "cop": 1, "opa": "Face", "opb": "Chest", "opc": "Abdomen", "opd": "Extremities", "subject_name": "Surgery", "topic_name": "General surgery", "id": "385d302f-c770-474e-9780-a400e729ac6c", "choice_type": "single"} {"question": "Cock’s peculiar tumour is", "exp": null, "cop": 1, "opa": "infected sebaceous cyst", "opb": "osteomyelitis of skull", "opc": "cyst in the skull", "opd": "tumour of the skull", "subject_name": "Surgery", "topic_name": null, "id": "e06cc560-f320-4e89-aa0e-74bdf28f09aa", "choice_type": "single"} {"question": "Distance from Olecranon in amputation should be", "exp": "C i.e. 15 - 20 cm Type of Amputation Traditional Length of StumpAbove knee 12 cmBelow knee 14 cmBelow Elbow 18 cmQAbove Elbow 20 cm", "cop": 3, "opa": "5-10 cm", "opb": "10-25 cm", "opc": "15-20 cm", "opd": "20-30 cm", "subject_name": "Surgery", "topic_name": null, "id": "391c172b-3a4f-4764-981e-2dddb0fcea97", "choice_type": "single"} {"question": "MC duct stones involved is in", "exp": null, "cop": 1, "opa": "Submandibular gland", "opb": "Sublingual salivary gland", "opc": "Parotid gland", "opd": "Minor salivary gland", "subject_name": "Surgery", "topic_name": null, "id": "55376bcb-e44f-4ec2-9940-2c8891f488d6", "choice_type": "single"} {"question": "Nerves of latarjet are spared in", "exp": "Types of vagotomy\n\nHighly selective vagotomy (HSV)\nVagotomy and drainage (V+D)\nVagotomy and antrectomy (V+A)\n\nVagotomy is a component of each of these procedures. It decreases the acid secretion by stopping cholinergic input into the stomach.\nBut since vagus nerve is also the motor supply of stomach and the antropyloroduodenal segment a truncal vagotomy leads to gastric stasis.\nGastric stasis is prevented by adding a drainage procedure to the truncal vagotomy (Vagotomy & drainage - V+ D).\nDrainage procedure used are :\n\nGastrojejunostomy\nPyloroplasty\n\n\nIn Highly selective vagotomy (also known as parietal cell vagotomy or proximal gastric vagotomy) the vagal innervation to the antrum and pylorus (nerves of Latarjet) are preserved, only the vagal supply to the proximal two- thirds of the stomach (where essentially all the parietal cells are located) is cut.\n\nThis preserves gastric motility\nAdvantages\n\nTechnical simplicity & preservation of entire gastric reservoir capacity.\nLowest mortality and side effects\nMinimal chances of dumping syndrome\n\nDisadvantage\n\nRecurrence rates are higher than V + D or V + A.\n\nVagotomy plus antrectomy\n\nIn this operation, a distal gastrectomy (about 50% of the stomach) is done. This removes almost all the gastrin-producing mucosa, thus acid reduction is maximum in this operation.\n\nAdvantages - lowest recurrence rate\nDisadvantage - high mortality & morbidity", "cop": 1, "opa": "Highly selective vagotomy", "opb": "Vagotomy and antrectomy", "opc": "Vagotomy and Drainage", "opd": "truncal Vagotomy", "subject_name": "Surgery", "topic_name": null, "id": "dc711009-5dd8-4af0-9799-efa3d95ee787", "choice_type": "single"} {"question": "Features of right side carcinoma colon are\nI. Obstruction\nII. Altered bowel habit\nIII. Anemia\nIV. Melena", "exp": "Right sided Ca. Bleeds ( melena) causing anemia.", "cop": 3, "opa": "1 only", "opb": "1 and 2", "opc": "3 and 4", "opd": "2, 3 and 4", "subject_name": "Surgery", "topic_name": null, "id": "09a608b1-5588-4640-80f1-b5042d243ac9", "choice_type": "single"} {"question": "Risdon wiring is indicated for", "exp": null, "cop": 3, "opa": "Body fracture", "opb": "Angle fracture", "opc": "Symphysis fracture", "opd": "Subcondylar fracture", "subject_name": "Surgery", "topic_name": null, "id": "bf2b67fd-bf3c-462f-8bc9-61534bbb3805", "choice_type": "single"} {"question": "Diffuse peritonitis in acute appendicitis is caused due to", "exp": "Diffuse peritonitis can develop rapidly because of the underdeveloped greater omentum, which is unable to give much assistance in localising the infection. Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1209", "cop": 1, "opa": "Early rupture of appendix", "opb": "Late rupture of appendix", "opc": "Fecolith", "opd": "Old age", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "5ef1c722-e55f-4be9-9cf6-42a77c69db6f", "choice_type": "single"} {"question": "Chvostek's and Trousseau's signs are related to", "exp": "Chvostek's and Trousseau's signs are related to hypocalcemia.Chvostek's sign refers to contraction of the ipsilateral facial muscles on percussion of the facial nerve below the zygoma. Trousseau's sign refers to the development of carpopedal spasm secondary to occlusion of the arm (usually with a blood pressure cuff).Ref: Bailey and Love 27e pg: 831", "cop": 1, "opa": "Hypocalemia", "opb": "Hypercalcemia", "opc": "Hypokalemia", "opd": "Hyperkalemia", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "174ae4e5-481f-4eac-ba13-fba2e87fb252", "choice_type": "single"} {"question": "A 36 year old male patient has reported to you with swelling in the submandibular region. His tongue is elevated and he complains of dysphagia. He has high fever. Intra oral examination reveals grossly destructed lower first molar.\n\nCST (culture sensitivity test) is carried out to evaluate", "exp": null, "cop": 3, "opa": "Severity of infection", "opb": "Whether the antibiotic dosage is adequate", "opc": "Antibiotic is most sensitive or least resistant", "opd": "To decide when to stop the Antibiotics", "subject_name": "Surgery", "topic_name": null, "id": "a61bf770-5aed-4aad-aac3-fc09208ff552", "choice_type": "single"} {"question": "In hand injury first structure to be repaired should be", "exp": "For musculoskeletal injuries, early total care allows definitive fixation of all unstable long bone, spinal and pelvic fractures within 36 hours of injury. This facilitates nursing care, allows early mobilisation of the patient and reduces pulmonary complications and length of stay on intensive care. If a sequence of fracture fixations is required, at the conclusion of each procedure the surgeon and anaesthetist should determine whether the patient's physiological status has been maintained sufficiently to allow the next procedure, or whether the patient should return to critical care for a fuher period of resuscitation. Ref: Bailey and love 27th edition Pgno : 326 Sequence of repair in Hand injuries Bone shoening and stabilization/Fixation Extensor tendon repair Flexor tendon repair Aerial anastomosis Nerve repair Venous anastomosis Skin/Wound closure Pneumonic: BE FAN of VeinS Ref: Master techniques in ohopaedic surgery series by Morgan and cooney (2008) Pgno : 487", "cop": 2, "opa": "Muscle", "opb": "Bone", "opc": "Skin", "opd": "Nerve", "subject_name": "Surgery", "topic_name": "Trauma", "id": "8e39df31-f028-48bd-9fd2-797563cfd081", "choice_type": "single"} {"question": "Most commonest bladder stone is", "exp": "MC primary bladder stone - ammonium urate\nMC secondary bladder stone - uric acid (MC overall).", "cop": 2, "opa": "Ammonium urate", "opb": "Uric acid", "opc": "Struvite", "opd": "Calcium oxalate", "subject_name": "Surgery", "topic_name": null, "id": "e4740103-58a8-4f40-9717-985d6175d4bc", "choice_type": "single"} {"question": "Cause of nephrocalcinosis in granulomatous ds aEUR'", "exp": "Increased calcium absorption [Ref: Robbin's 7/e p. 2387; Harrison 17/e p. 23871 Hypercalcemia associated with sarcoidosis The predominant mechanism for the development of hypercalcemia and hypercalciuria is the increased intestinal absorption of calcium induced by elevated calcitriol (1,25 hydroxyvitamin D). Sarcoidosis is associated with ectopic and unregulated synthesis of calcitriol by steroid tissue in response to sunlight or ingestion of vitamin D. The macrophage monocyte line of immune cells express the enzyme la hydroxylase which is identical to the I a hydroxylase present in kidney. - 1 a hydroxylase conves 25 hydroxyvitamin D to 1,25 hydroxy vitamin D. (calcitriol) la hydroxylase 25 hydroxy vitamin D > 1,25 dihydroxy vitamin D (Calcitriol) - (Normally this conversion takes place in kidney) 1,25 hydoxyvitamin D in turn causes increased absorption of calcium in intestine. Activity of I a hydroxylase enzyme is under negative feedback control in normal tissues. - However, in granulomatous disorder normal feed hack inhibition is abolished, probably by the effects of interferon gamma. - Interferon gamma induces the activity of la hydroxylase this leads to increased production of calcitriol (1,25 hydroxyvitamin D). - Increased production of calcitriol causes augumented intestinal absorption of calcium. Hypersensitivity to vitamin D remains despite b/I nephrectomy indicating that increase in serum calcitriol is not mediated by renal I a hydroxylase.", "cop": 1, "opa": "Increased absorption", "opb": "Increased conversion to 1,25 OH", "opc": "Dystrophic calcification", "opd": "Mutation in calcium sensing receptor", "subject_name": "Surgery", "topic_name": null, "id": "90122096-215d-4b49-8b7e-bf8ce0e8bb7e", "choice_type": "single"} {"question": "Pain in endometrium is closely associated with", "exp": "Ans B Ref: Williams gynaec page 230Underlying cause of pain is unclear: proinflammatory cytokines (PGF2alpha) released by the endometriotic implants into peritoneal fluidEvidence to suggest that pain from endometrium correlate to depth of invasion and site of pain- many indicate lesion location.Recent data suggest pain result from neuronal invasionRef: Sheila Balakrishnan, gynaec page 143Severe endometriosis can produce pain by peritoneal inflammation, deep infiltration and scarring, invasion of nerve endings, adhesions, collection of menstrual blood.", "cop": 2, "opa": "site of endometrium", "opb": "depth of invasion", "opc": "stage of disease", "opd": "size of lesion", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "45496e49-b0e8-4746-b538-75676a0e29e1", "choice_type": "single"} {"question": "In triage green colour indicates", "exp": "Triage consists of rapidly classifying the injured on the basis of the severity of their injuries and the likelihood of their survival with prompt medical intervention. The most common classification uses the internationally accepted 4 colour code system. RED indicates high priority treatment or transfer, YELLOW signals medium priority, GREEN indicates ambulatory patients and BLACK for dead or moribund patients. Reference : page 796 Park's textbook of Preventive and Social Medicine 23rd edition", "cop": 1, "opa": "Ambulatory patients", "opb": "Dead or moribund patients", "opc": "High priority treatment or transfer", "opd": "Medium priority or transfer", "subject_name": "Surgery", "topic_name": "Urology", "id": "848afdce-70cb-4151-a957-0fec08c6b5ee", "choice_type": "single"} {"question": "Least malignant thyroid cancer is", "exp": "Ans is (a) i.e. Papillary Cancer", "cop": 1, "opa": "Papillary carcinoma", "opb": "Follicular carcinoma", "opc": "Medullary carcinoma", "opd": "Anaplastic carcinoma", "subject_name": "Surgery", "topic_name": null, "id": "97f6f7d9-022d-4fcf-a14e-d3f2a61f5563", "choice_type": "single"} {"question": "A patient presents with sudden headache and vomiting and unconciousness. The diagnosis is", "exp": "Sub Arachnoid Hemorrhage Most common cause : Trauma >Spontaneous rupture of Berry aneurysm Clinical features Sudden transient loss of consciousness (occurs in nearly half of the patients) Excruciating severe headache: presenting complaint in 45% of cases (worst headache of patients life) more common upon regaining consciousness when loss of consciousness is associated. Neck stiffness and vomiting are common associations Focal neurologicalal deficit : uncommon Sudden headache in the absence of Focal neurological deficit is the Hallmark of aneurysmal rupture Associated prodromal symptoms (suggest location of progressively enlarging unruptured aneurysm) Third nerve cranial nerve palsy :Aneurysm at junction of PCS and ICA Sixth nerve palsy :Aneurysm in cavernous sinus Occipital and posterior cervical pain: Inferior cerebellar aery aneurysm Pain in or behind the eye :MICA aneurysm Ref: Sabiston 20th edition Pgno :1918", "cop": 1, "opa": "Subarachnoid hemorrhage", "opb": "Intracerebral hemorrhage", "opc": "Sudural hemorrhage", "opd": "Exbtradural hemorrhage", "subject_name": "Surgery", "topic_name": "Trauma", "id": "23a5d5e8-2681-4bdd-bf0d-df9f9e043391", "choice_type": "single"} {"question": "Highest incidence of acute appendicitis occurs in", "exp": "(B) 2nd decade # Peak incidence of acute appendicitis is in the 2nd & 3rd decades of life.> It is relatively rare at the extreams of age.> Apendicular perforation is more common in infancy & in the elderly, during which periods mortality rates are highest.", "cop": 2, "opa": "1st decade", "opb": "2nd decade", "opc": "5th decade", "opd": "6th decade", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "7e34774f-d26c-46a2-8db5-926a90ced7f0", "choice_type": "single"} {"question": "Commando's operation is for", "exp": "It is en-bloc removal ,which includes wide excision of primary tumour with hemimandibulectomy and neck block dissection,examples : it is done usually in carcinoma of tongue or floor of the mouth ;it is a composite resection of primary tumour ,mandible and radical neck dissection(RND) SRB,5th,451.", "cop": 4, "opa": "Mandible", "opb": "Radical mastectomy", "opc": "Leg amputation", "opd": "Oral cancer", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "46315b77-4eef-4508-9d9e-260c89ade01b", "choice_type": "single"} {"question": "Painless Breast lump in a young female", "exp": "Ans. (a) Fibroadenoma(Ref. Bailey and Love 27th edition Page 870)* Fibroadenoma (Breast mouse) is mc in young females, painless and freely mobile with Firm Indian rubbery consistency", "cop": 1, "opa": "Fibroadenoma", "opb": "Fibroadenosis", "opc": "Cancer", "opd": "Mastalgia", "subject_name": "Surgery", "topic_name": "Breast", "id": "f9a7a931-09d6-4393-8d55-42949b233f5f", "choice_type": "single"} {"question": "Commonest cause of blood discharge from the nipple is", "exp": "Duct papilloma is the Commonest cause of blood discharge from the nipple Duct papilloma are epithelium lined true polyps of breast lactiferous ducts it is usually single,from a single lactiferous duct it blocks the duct causing ductal dialatation ref ;(page no;528) 5th edition of SRB&;S Manual of SURGERY", "cop": 2, "opa": "Duct carcinoma", "opb": "Duct papilloma", "opc": "Chronic cystic mastitis", "opd": "Cystosarcoma phyllodes", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "e6648db7-e867-48e9-ae46-f2f2a0a86ce9", "choice_type": "single"} {"question": "The commonest site for extra gonadal germ cell tumour", "exp": "Anterior Mediastinal Masses Thymoma (MC in anterior mediastinum) Lymphoma Germ cell tumors. Thyroid and parathyroid masses Bronchogenic cyst Aneurysm Germ cell tumors constitute 11% of Total tumors in anterior mediastinum Ref: Sabiston 20th edition Pgno : 1608", "cop": 4, "opa": "Retroperitoneum", "opb": "Sacrococcygeal region", "opc": "Pineal gland", "opd": "Mediastinum", "subject_name": "Surgery", "topic_name": "Urology", "id": "8b4a463c-0559-4398-b8ca-2489a5b68b9a", "choice_type": "single"} {"question": "The most useful investigation for profuse lower gastrointestinal bleeding is", "exp": ".Indications for colonoscopy includes * Bleeding per rectum, resistant anaemia. * To take biopsies from different pas of the bowel. * To identify synchronous growths, ulcerative colitis. * To remove polyps. * When barium enema shows irregularity. * For therapy--colonoscopic polypectomy, dilatation of stricture colon, fulgaration. Contraindicated in Acute ulcerative colitis. ref:SRB&;s manual of surgery,ed 3,pg no 891", "cop": 2, "opa": "Proctosigmoidoscopy", "opb": "Colonoscopy", "opc": "Double contrast barium enema", "opd": "Selective aeriolgraphy", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "c22a7efd-5736-4cea-aa5a-f1999c65ac62", "choice_type": "single"} {"question": "Ideal age for PMSTR is", "exp": "Answer- B. 1 - 3 yearsPMSTR: Posteromedial Soft tissue release:It is the soft tissue surgical treatment for congenitaltalipesEquinovarus.The results of early operation for treatment of congentialtalipesequino varus, in paicular neonatal surgery have not been shown to be better than those of late surgeryDelaying surgery until the child is near walking age has the advantage of operating of larger foot (making surgery easier)Posteromedial soft tissue release (PMSTR), (Turcos) is best done at young age (l-3 years)", "cop": 2, "opa": "< 1 year", "opb": "1 - 3 years", "opc": "3 - 6 years", "opd": "6 - 9 years", "subject_name": "Surgery", "topic_name": null, "id": "9c3267c3-209b-4dff-b6c2-74ba3c51873e", "choice_type": "single"} {"question": "A 20 year old male come to causality with head injury. Examination reveals normal consciousness and blood in the tympanic membrane. Most likely cause is", "exp": "Ans. is 'd' i.e. basilar fracture", "cop": 4, "opa": "Extradural hemorrhage", "opb": "Subdural hemorrhage", "opc": "Intraventricular hemorrhage", "opd": "Basilar fracture", "subject_name": "Surgery", "topic_name": null, "id": "60a2b1a6-9fa8-4d5b-a377-33021cdc83c1", "choice_type": "single"} {"question": "&;SEPS&; is a procedure used for", "exp": "
SEPS:- Subfascial endoscopic perforator ligation surgery A special telescope is introduced deep to deep fascia through a single small veical incision at proximal leg selecting healthy skin. Potential space between muscle and deep fascia with loose areolar tissue us easy to dissect using endoscope. Endoscope is advanced down along the medial border of tibia. Perforators travelling in subfascial plane are identified and fulgurated using bipolar cautery or clips can be applied into the perforators. It is recommended in Chronic venous insufficiency. {Reference: SRB&;s manual of surgery, 5th edition , page no. 237}", "cop": 1, "opa": "Veins", "opb": "Aeries", "opc": "Lymphatics", "opd": "AV fistula", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "d0ca279b-8ec3-4d34-b5e7-1622b0c504a4", "choice_type": "single"} {"question": "Staghorn calculus is made of", "exp": null, "cop": 2, "opa": "Oxalate", "opb": "Phosphate", "opc": "Uric acid", "opd": "Cystine", "subject_name": "Surgery", "topic_name": null, "id": "ecf06461-6f3f-4fa3-acf0-8b3c79b82b1c", "choice_type": "single"} {"question": "Treatment of Medullary carcinoma of thyroid is", "exp": "Management Total thyroidectomy + Routine central lymph node dissection + ipsilateral modified radical node dissection (Tumor > 1cm) +- Bilateral modified Radical neck dissection (if any lymph node is positive) MCT - Poor prognosis (because it does not respond to radioactive iodine ablation) Vandetanib - Only FDA approved drug in advanced progressive medullary thyroid cancer.", "cop": 3, "opa": "Surgery and Radiotherapy", "opb": "Radiotherapy and Chemotherapy", "opc": "Surgery only", "opd": "Radioactive ablation", "subject_name": "Surgery", "topic_name": "Thyroid", "id": "1bed1be5-3e08-4967-9a9c-5e55b005120b", "choice_type": "single"} {"question": "The drug of choice to prevent graft rejection in recipient is", "exp": null, "cop": 1, "opa": "Steroids", "opb": "Vincristine", "opc": "Cyclophosphamide", "opd": "Methotrexate", "subject_name": "Surgery", "topic_name": null, "id": "0c0ba95a-1d1f-4728-afb4-c034c79589a2", "choice_type": "single"} {"question": "During renal rupture the nephrectomy is NOT attempted until", "exp": "(Contra-lateral renal function is scertain)Nephrectomy is a possibility so it is important to establish that the contralateral kidney is functioning (1291- Bally & Love 25th)Injury to the Kideny * Haematuria is a cardinal sign of a damaged kidney *** Meterorism - abdominal distension comes on about 24-48 hours after the accident (retroperitoneal haematoma implicating splanchnic nerves)* An Intravenous urogram (IVP) should be obtained urgently to show that the other kidney is normal. A leak of urine on the damaged side is often demonstrated* Before proceeding to surgical procedure for bleeding a renal arteriogram should be performed if possible. If the bleeding vessel is visualized it may be embolised with small starch microspheres to stop bleeding* Should the necessity for a urgent operation arise and facilities for urography not be available, the presence of a functioning kidney on the contralateral side can often be confirmed by chromo- cystoscopyTREATMENT1. Nephrectomy - Kidney is found to rupture in several places or kidney pedicle is damaged2. Small tear can be sutured over oxycel or a piece of detached muscle3. Nephrostomy - Larger single rents in the middle of the kidney4. Partial Nephrectomy - laceration is confined to one pole of the kidney", "cop": 3, "opa": "Fluid replacement", "opb": "Antibiotics covers", "opc": "Contralateral renal function is ascertain", "opd": "Renal angiogram", "subject_name": "Surgery", "topic_name": "Kidney & Ureturs", "id": "9ca8a95b-0a41-4f27-acdc-1f31e57e0425", "choice_type": "single"} {"question": "The most popular incision for open general thoracic surgical procedure is", "exp": "For open general thoracic surgery,the most popular incision is median sternotomy.Here,an incision is made from the jugular or suprasternal notch to the lower end of the xiphisternum.The sternum is divided & retracted to expose the thymus superiorly & the pericardium inferiorly. Reference:Bailey & Love's sho practise of surgery,25 th edition,page no:851", "cop": 2, "opa": "Anterior thoracotomy", "opb": "Median sternotomy", "opc": "Lateral thoracotomy", "opd": "Transverse thoracosternotomy", "subject_name": "Surgery", "topic_name": "Cardio thoracic surgery ", "id": "08000db5-3a0f-480e-accf-e2b876d4e3f3", "choice_type": "single"} {"question": "A 32 year old male patient complains of swelling in left maxillary region with heaviness in the maxillary sinus following tooth extraction of maxillary first molar. Patient gives a history of tooth extraction one week before with transalveolar type of extraction.\n\nThe most common microbial population found in a infected maxillary sinus are", "exp": null, "cop": 1, "opa": "Poly Microbial with Anaerobic Organism", "opb": "Aerobic Organisms", "opc": "Fungal", "opd": "Viral", "subject_name": "Surgery", "topic_name": null, "id": "d0736494-1d6b-489d-9ec2-01f600cfb693", "choice_type": "single"} {"question": "Most common location of posterior urethral value is", "exp": null, "cop": 3, "opa": "Proximal to Verumoutanum", "opb": "At the level of Vermoutanum", "opc": "Distal to Vermoutanum", "opd": "At the bladder neck", "subject_name": "Surgery", "topic_name": null, "id": "782d8fe0-fa82-46a0-94a3-37f357f98dd1", "choice_type": "single"} {"question": "The preferred initial treatment for carcinoma of the anal canal is", "exp": "#Treatment is by chemoradiotherapy in the first instance # Associated with HPV # More prevalent in patients with HIV infection # May affect the anal verge or anal canal # Lymphatic spread is to the inguinal lymph nodes # Uncommon tumour, which is usually a squamous cell carcinoma # Major ablative surgery is required if the above fails Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1269", "cop": 4, "opa": "Abdominoperineal resection", "opb": "Abdominoperineal resection followed by radiotherapy", "opc": "Radiotherapy alone", "opd": "Chemoradiation", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "4faa15b3-62e3-4655-8fe9-05ccef144511", "choice_type": "single"} {"question": "Posterior mandible resorbs at a rate approximately\ntimes faster than the anterior mandible", "exp": null, "cop": 2, "opa": "2 times", "opb": "4 times", "opc": "6 times", "opd": "8 times", "subject_name": "Surgery", "topic_name": null, "id": "eb31a686-4824-4ba5-903f-5fe771a25cfd", "choice_type": "single"} {"question": "Secondary deposits from carcinoma breast are commonest in", "exp": "Bone metastasis is commonest. In order of frequency the lumbar veebrae, femur, thoracic veebrae, rib and skull are affected and these deposits are generally osteolytic.Metastases may also commonly occur in the liver, lungs and brain and, occasionally, the adrenal glands and ovaries.Ref: Bailey and Love, 27e, page: 873", "cop": 4, "opa": "Lung", "opb": "Liver", "opc": "Brain", "opd": "Bone", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "0925b0c7-0195-424b-8098-b0d3e421f742", "choice_type": "single"} {"question": "A fracture mandible should be immobilized for an\naverage of", "exp": null, "cop": 2, "opa": "3 weeks", "opb": "6 weeks", "opc": "9 weeks", "opd": "12 weeks", "subject_name": "Surgery", "topic_name": null, "id": "cbcc1548-5118-467e-b733-88247fb98942", "choice_type": "single"} {"question": "Seton used in fistula in anosurgery is draining seton and", "exp": "Setons (Latin: seta = bristle) have been used in a variety of ways in fistula surgery and it is impoant for surgeons to be clear about what they are trying to achieve in a paicular situation. Loose setons are tied such that there is no tension upon the encircled tissue; there is no intent to cut the tissue. A variety of materials have been used but the seton should be non-absorbable, nondegenerative and comfoable. Tight or cutting setons are placed with the intention of cutting through the enclosed muscle. Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1264,1265", "cop": 1, "opa": "Cutting seton", "opb": "Dissolving seton", "opc": "Dissecting seton", "opd": "Fibrosing seton", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "1d7ad622-8929-42e6-82e2-c94e08c77a81", "choice_type": "single"} {"question": "Screening of prostate Ca commonly done by", "exp": "Screening for carcinoma prostate is done by measurement of PSA (prostate specific antigen ). It is a organ specific protease produced from the prostatic epithelium, secreted in the semen to cleave and liquefy the seminal coagulum formed after ejaculation. It is sensitive for carcinoma prostate but not specific. Normal value is 4 ng/ml of plasma. Value >10 ng/ml is significant. Cancer detection rate is 2-4%. About 30% of men with elevated PSA will have prostate cancer confirmed by biopsy. But about 20% of those with clinically significant prostate cancer have PSA level within normal range. Reference : page 1043, 1044 SRB's manual of surgery 5th edition and page 1354 Bailey and Love's sho practice of surgery 25th edition", "cop": 4, "opa": "DRE ( Digital rectal exam)", "opb": "USG", "opc": "MRI", "opd": "PSA", "subject_name": "Surgery", "topic_name": "Urology", "id": "2d6f0989-e396-410f-a609-28b74e8482f8", "choice_type": "single"} {"question": "Cottons fracture is fracture of", "exp": "Ankle", "cop": 3, "opa": "Foot", "opb": "Knee", "opc": "Ankle", "opd": "Hip", "subject_name": "Surgery", "topic_name": null, "id": "ac643be9-a857-4d0c-9080-bc9700f5ddf8", "choice_type": "single"} {"question": "The best cosmetics results for large capillary (po wine) hemangiomas are achieved by", "exp": "Po wine stain treatment is with intense pulsed light and pulse dye laser . PWS may be associated with various syndroms Sturge-Weber syndrome Klippel-Trenaunay syndrome Proteus syndrome: Bailey and love 26th edition pg 599", "cop": 2, "opa": "Exision and split-thickness skin", "opb": "Laser ablation", "opc": "Cryosurgery", "opd": "Tattooing", "subject_name": "Surgery", "topic_name": "General surgery", "id": "140070b5-e218-46d8-99df-65819d82453c", "choice_type": "single"} {"question": "Meckel&;s diveiculum is remnant of", "exp": "It is a congenital diveiculum arising from the terminal ileum and is pa of the unobliterated proximal poion of the vitello intestinal duct..Intestinal endof the vitelline duct may remain patent forming Meckel's diveiculum, which may be attached to umbilicus with a fibrous band. Meckel's diveiculum itself can cause diveiculitis, obstruction. ref:SRB&;S manual of surgery,ed 3,pg no 798", "cop": 4, "opa": "Thyroglossal tract", "opb": "Midgut", "opc": "Urachus", "opd": "Vitelline duct", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "9344ac73-84d2-495b-ac56-30886508ed86", "choice_type": "single"} {"question": "Most common type of shock in emergency room is", "exp": "Hypovolaemic shock is the most common form of shock", "cop": 2, "opa": "Cardiogenic", "opb": "Hypovolaemic shock", "opc": "Obstructive", "opd": "Neurogenic", "subject_name": "Surgery", "topic_name": "General surgery", "id": "e70b9e6a-856a-4d84-8dab-0219f8cd070b", "choice_type": "single"} {"question": "Tardy ulnar nerve palsy occur as a delayed sequele of", "exp": "C i.e. Fracture lateral condyle humerus", "cop": 3, "opa": "Supracondylar fracture of humerus", "opb": "Posterior dislocation of elbow", "opc": "Fracture of lateral condyle of humerus in children", "opd": "Fracture of Olecranon", "subject_name": "Surgery", "topic_name": null, "id": "33955184-e6fd-469e-b3ab-026e1a13689a", "choice_type": "single"} {"question": "Avascular necrosis of bone is most commonly seen in", "exp": "C i.e. Scaphoid", "cop": 3, "opa": "Calcaneus", "opb": "Cervical spine", "opc": "Scaphoid", "opd": "Scapula", "subject_name": "Surgery", "topic_name": null, "id": "54507e51-4d55-4325-b53f-1e3cc8b61822", "choice_type": "single"} {"question": "Parastomal hernia is most frequently seen with", "exp": "end colostomy is always permanent colostomy,which is done 6 cm above and medial to the anterior superior iliac spine in the left iliac fossa.it is also done as bringing out of proximal colon as in Haman's procedure. Ref:SRB's manual of surgery,ed,3,pg no 839", "cop": 1, "opa": "End colostomy", "opb": "Loop colostomy", "opc": "End iliostomy", "opd": "Loop iliostomy", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "7e780261-ac33-420a-ac86-d1c3ec1f658d", "choice_type": "single"} {"question": "Most common tumour of the pancreas is", "exp": "Exocrine tumors are mostly Solid tumors (75%) among which main is Ductal adenocarcinoma(85%).", "cop": 4, "opa": "Adeno-carcinoma", "opb": "Squamous cell carcinoma", "opc": "Adeno-squamous cell carcinoma", "opd": "Duct cell adeno carcinoma", "subject_name": "Surgery", "topic_name": null, "id": "cef8710f-4e19-46c2-9e13-0795506623fb", "choice_type": "single"} {"question": "&;Cystosarcoma phyllodes&; is best treated by", "exp": "Cystosarcoma phylloides are not simply giant fibroadenoma. They show a wide spectrum of activity, varying from almost a benign condition (85%) to a locally aggressive and sometimes metastatic tumour (15%). Depending on mitotic index and degree of pleomorphism they are graded as low grade to high grade tumours. Treatment; Excision or subcutaneous or simple mastectomy is done. If malignant (sarcoma), total mastectomy is indicated Ref; (page no; 520) 5th edition of SRB&;S manual of Surgery", "cop": 1, "opa": "Simpel mastectomy", "opb": "Lumpectomy", "opc": "Radiotherapy", "opd": "Radical mastectomy", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "32670c24-d24c-45e7-a6e1-389248067536", "choice_type": "single"} {"question": "Potter syndrome is not assoiated with", "exp": "Since there is b/l kidney agenesis or cystic disease there is no urine production\nleading to oligohydromnios", "cop": 1, "opa": "Bilateral renal agenesis", "opb": "Bilateral multicystic kidney disease", "opc": "oligohydromnios", "opd": "Polyhydromnios", "subject_name": "Surgery", "topic_name": null, "id": "91cfdd64-e451-462f-b6a2-c5b338415892", "choice_type": "single"} {"question": "Carcinoma tongue less than 2 cm is treated by", "exp": "Ans. is 'a' i.e., Excision", "cop": 1, "opa": "Excision", "opb": "Radiotherapy", "opc": "Chemotherapy", "opd": "Excision and Radiotherapy", "subject_name": "Surgery", "topic_name": null, "id": "4883c556-3517-4d48-b65b-4d4baa4eb29f", "choice_type": "single"} {"question": "The expression of the following oncogene is associated with a high incidence of Medullary carcinomas of thyroid", "exp": null, "cop": 3, "opa": "p53", "opb": "Her 2 neu", "opc": "Ret proto-oncogene", "opd": "Rb gene", "subject_name": "Surgery", "topic_name": null, "id": "daecb0f5-010c-4cb7-b23b-0685efef04c1", "choice_type": "single"} {"question": "A person present in Emergency. On examination he is found to open eyes only on painful stimuli, he says inappropriate words and moves his limbs on commands. His GCS is", "exp": "Ans. (a) 11Ref Surgery Sixer 2nd edition Page 109Based on GCS table* Eye opening on painful stimuli - 2 points* Inappropriate words - 3 points* Obeys commands to motor response - 6 points", "cop": 1, "opa": "11", "opb": "10", "opc": "9", "opd": "13", "subject_name": "Surgery", "topic_name": "Trauma", "id": "20f5715c-74d2-4dac-9962-0da693534600", "choice_type": "single"} {"question": "Treatment of choice for medullary carcinoma thyroid", "exp": "Ans) a (Total thyroidectomy) Ref Bailey 25th ed 797Medullary carcinomaTumors of parafollicular cells derived from the neural crest. Amyloid stroma is characteristic.High levels of CEA & calcitonin (useful for follow up)Diarrhoea 30% (due to 5 - hydroxy tryptamine or PG)10 - 20% case familialMEN 2A - Med carcinoma thyroid hyperparathyroidism phaeochromocytoma (adrenal)MEN 2B - MEN 2A +mucosal neuromas +marfanoid habitusLymphnode involvement in 50 - 60% casesBlood bom mets commonTumor is not TSH dependent and do not take radioactive iodine.TreatmentTotal thyroidectomy & either prophylactic or therapeutic resection of the central & bilateral cervical nodes.Familial casesGenetically screened for RET proto oncogene along with S.calcitonin levels.Prophylactic surgery is now recommended for infants with genetic traits.Surgical cases should exclude phaeochromocytoma with urinary catecholamine levelsMost common thyroid cancer - Papillary CaBest prognosis is for Papillary CaClassification of thyroid neoplasmBenignFollicular adenomaMalignantPrimaryFollicular epithelial differentiated - follicular & papillaryFollicular epithelial undifferentiated - AnaplasticParafollicular cells - MedullaryLymphoid cells - LymphomaSecondaryMetastaticLocal infiltration", "cop": 1, "opa": "Total thyroidectomy", "opb": "Partial thyroidectomy", "opc": "Subtotal thyroidectomy", "opd": "Radioactive ablation", "subject_name": "Surgery", "topic_name": "Thyroid Gland", "id": "b59dad12-b5e2-4759-84cd-3abffc878da3", "choice_type": "single"} {"question": "Best investigation for carcinoma colon", "exp": null, "cop": 4, "opa": "Barium enema", "opb": "Colonic biopsy", "opc": "Clinical examination", "opd": "Colonscopy", "subject_name": "Surgery", "topic_name": null, "id": "6b7f21d5-934e-42c5-9a2c-b0fa7f1cfa7d", "choice_type": "single"} {"question": "In Forrest classification visible clot at ulcer base is", "exp": "FORREST - Classification of upper gastrointestinal hemorrhage\nAcute hemorrhage\nForrest IA - Active spurting hemorrhage\nForrest IB - Oozing hemorrhage\nSigns of recent hemorrhage\nForrest IIA - Non-bleeding visible vessel\nForrest IIB - Adherent clot\nForrest IIC - Hematin on ulcer base\nLesions without active bleeding\nForrest III - Clean-base ulcers.", "cop": 3, "opa": "1A", "opb": "2A", "opc": "2B", "opd": "3", "subject_name": "Surgery", "topic_name": null, "id": "45ca6ec5-b38e-45a0-9836-f987c9a9cb26", "choice_type": "single"} {"question": "75% Lymph from breast goes to", "exp": "Answer- A. Axillary L.N.Lymphatic drainage of Breast is as follows : -Axillary nodes (75%)Internal mammary or Paresternal nodes (20%)Posterior intercostal lymph nodes (5%)", "cop": 1, "opa": "Axillary L.N.", "opb": "Subclavicular L.N.", "opc": "Internal mammary L.N.", "opd": "Cephalic L.N.", "subject_name": "Surgery", "topic_name": null, "id": "873ce785-fbfb-414b-b3e8-e226cbd5f8be", "choice_type": "single"} {"question": "Amide type of local anesthetic agents undergo bio transformation primarily in the", "exp": null, "cop": 2, "opa": "Kidney", "opb": "Liver", "opc": "Plasma", "opd": "Excreted in unaltered form", "subject_name": "Surgery", "topic_name": null, "id": "9a2e1c84-4485-49c2-ae33-66904c95f7d8", "choice_type": "single"} {"question": "Recurrent fibroma refers to Desmoid tumor arising in", "exp": null, "cop": 2, "opa": "Uterus", "opb": "Scar tissue", "opc": "Ovary", "opd": "Muscle", "subject_name": "Surgery", "topic_name": null, "id": "79462375-4260-4f5f-9aff-03ce1d5e0a12", "choice_type": "single"} {"question": "Modified amstredam criteria is used for diagnosis of", "exp": "HNPCC / lynch is diagnosed bt modified emstredam eciteria.", "cop": 2, "opa": "Peutz jegher", "opb": "HNPCC", "opc": "Turcot", "opd": "FAP", "subject_name": "Surgery", "topic_name": null, "id": "9ebb40f1-5858-42da-8ce8-c3a55d2f8478", "choice_type": "single"} {"question": "A full thickness wound having length greater than the depth caused by a sharp object is described as", "exp": null, "cop": 2, "opa": "Stab wound", "opb": "Slash wound", "opc": "Lacerated wound", "opd": "Incision wound", "subject_name": "Surgery", "topic_name": null, "id": "4fbade98-bbe5-4965-8e04-a82a7a8f16a5", "choice_type": "single"} {"question": "Ormond's disease is", "exp": "In 70% cases of Ormond's disease Idiopathic retro peritoneal fibrosis is seen.", "cop": 3, "opa": "Retractile testis", "opb": "Idiopathic retro peritoneal lymphadenopathy", "opc": "Idiopathic retro peritoneal fibrosis", "opd": "Idiopathic mediastinotis", "subject_name": "Surgery", "topic_name": null, "id": "91f8fb0b-de67-43d5-92f7-bb4d5498982e", "choice_type": "single"} {"question": "Battle's sign is", "exp": "(B) Ecchymosis around mastoid area # Battle's sign, or mastoid ecchymosis, is an indication of fracture of posterior cranial fossa of the skull, and may suggest underlying brain trauma.> Battle's sign (named after William Henry Battle) consists of bruising over the mastoid process, as a result of extravasation of blood along the path of the posterior auricular artery.> Note well that this sign will take at least one day to appear after the initial traumatic basilar skull fracture, similar to Raccoon eyes.> It is usually seen after head injuries resulting in injury to mastoid process leading to bruising.> Battle's sign may be confused with a spreading hematoma from a fracture of the mandibular condyle (less serious injury).", "cop": 2, "opa": "Periorbital ecchymosis", "opb": "Ecchymosis around mastoid area", "opc": "Facial congestion and cyanosis", "opd": "Pulsatile ear discharge", "subject_name": "Surgery", "topic_name": "Nervous System", "id": "78b85333-cfa7-488a-8408-0be3ad0cf27c", "choice_type": "single"} {"question": "Most common nerve injured during thyroidectomy", "exp": "MC injured nerve - External branch of superior laryngeal nerve (aka External laryngeal nerve)", "cop": 1, "opa": "External laryngeal nerve", "opb": "Recurrent laryngeal nerve", "opc": "Vagus nerve", "opd": "Facial nerve", "subject_name": "Surgery", "topic_name": "Thyroid", "id": "d27b71e0-8917-4bab-8cfb-b3d76fea6e2b", "choice_type": "single"} {"question": "The commonest anterior mediastinal tumour is", "exp": "Thymomas are the most common anterosuperior mediastinal tumors accounting for 25% of the total.They are commonly associated with myasthenia gravis.Diagnosis and treatment is best achieved by complete thymectomy. Reference:SRB's manual of surgery,5th edition,page no:1127.", "cop": 3, "opa": "Aneurysm of descending aoa", "opb": "Neurogenic tumour", "opc": "Thymoma", "opd": "Bronchogenic cyst", "subject_name": "Surgery", "topic_name": "Cardio thoracic surgery ", "id": "e298a08c-d54b-4d1b-9589-2478f5a426a3", "choice_type": "single"} {"question": "Normal CVP is", "exp": ".CENTRAL VENOUS PRESSURE (CVP) It is a method to measure the right atrial pressure by placing a venous catheter (20 cm) into the SVC. Commonly for CVP monitoring, a venous catheter is passed through internal jugular vein or infraclavicular subclan vein to the SVC (used for TPN purpose).Normal value is 2-10 cm of saline. If less than 2 cm, more fluid is infused. If more than 10 cm, fluid infusion should be restricted. ref:SRB&;s manual of surgery,ed 3,pg no 96", "cop": 2, "opa": "0-3 cm", "opb": "5-8 cm", "opc": "12-15 cm", "opd": ">20 cm", "subject_name": "Surgery", "topic_name": "Urology", "id": "fd42d432-0ffa-424d-840c-30b71ce6c16b", "choice_type": "single"} {"question": "Carcinoma of the prostate arise from", "exp": "(Peripheral zone) (1045-CSDT 12th) (1354-B &L 25th)CARCINOMA OF PROSTATE - 90% of tumours are adenocarcinoma the tumour arises primarily in the peripheral zone (70%) an area that differs in embryoic derivation from the periurethral (transition) zone which is the site of formation of benign prostatic hyperplasiaScreening - by transrectal ultrasound (TRUS/and prostate specific antigen (PSA)* PSA = (under age 55 years) normal > 2.5 ng/ml= over age 65 years/ normal > 6.5 ng/ml.* PSA density (PSA divided by prostate volume) >0.15 suggest cancer* Percent free PSA (Total PSA minus complexed PSA) where when < 10% the risk of prostate cancer is 60% (only useful with total PSA 2-10 mg/ml)* Newer methods for measuring unbound (free) PSA have substantial promise for differentiating benign from malignant disease", "cop": 2, "opa": "Central zone", "opb": "Peripheral zone", "opc": "Transitional zone", "opd": "Periurethral zone", "subject_name": "Surgery", "topic_name": "Prostate & Seminal Vesicles", "id": "df6e04ab-272e-48d2-a1c5-07c1f17a6c00", "choice_type": "single"} {"question": "Le dance sign is seen in", "exp": "Le dance sign is empty right iliac fossa, seen in Intussusception.", "cop": 2, "opa": "Appendicitis", "opb": "Intussusception", "opc": "Meconium ileus", "opd": "Large bowel obstruction", "subject_name": "Surgery", "topic_name": null, "id": "fbc64063-ce70-4d19-8cab-2e9c0432738a", "choice_type": "single"} {"question": "Lower lip paresthesia occurs in", "exp": null, "cop": 1, "opa": "Body fracture", "opb": "Symphysis fracture", "opc": "Coronoid fracture", "opd": "Condyle fracutre", "subject_name": "Surgery", "topic_name": null, "id": "fd7062f2-c584-49d2-98ec-604e47ff30de", "choice_type": "single"} {"question": "Sentinal lymph node for carcinoma penis is know as", "exp": "Cabana Node ⇒ Superficial injuinal node is the sentinal lymph node for carcinoma penis.", "cop": 3, "opa": "Delphian node", "opb": "Darwins node", "opc": "Cabana node", "opd": "Virchan node", "subject_name": "Surgery", "topic_name": null, "id": "c77deea5-97c4-46a6-918d-45c2fbba6f30", "choice_type": "single"} {"question": "Reperfusion is useful for aEUR'", "exp": "Hibernating Myocardium \"Hibernating myocardium\" is a state of persistently impaired myocar- dial and left ventricular function at rest due to reduced coronary blood flow that can be paially or completely restored to normal if the myocardial oxygen supply demand relationship is ourably allered either by improving blood flow and/ or by reducing demand - Hibernation is a response to chronic reduction in resting coronary blood flow, leading to a new equilibrium where myocardial metabolism was altered with a subsequent reduction in energy production and myocardial contractility The initial triggering event i.e., reduction the blood flow was followed by a downregulation in cardiac function to a point at which the limited Oxygen supply enabled the maintenance of biochemical functions that sustained cell integrity - If the myocardial oxygen supply/demand was subsequently altered either temporarily or permanently then symptoms or signs of ischemia and/or necrosis might- occur - The hibernating response of the hea, namely a reduction of cardiac .function to cope with a reduced myocardial blood flow was considered an act of self preservation (Little blood, Little work) This chronic adaption occurs in the absence of angina (the lack of resting pain is a unique sign of chronic hibernation) or electrocardiographic evidence of ischemia and was thought to be a protective mechanism reducing the oxygen demand of hypoperfused myocardium and preserving long term bility On imaging, the hea is presented as area of left ventricular wall that could have been hypokinetic, akinetic dyskinetic Myocardial stunning This describes a clinical state where after a period of \"transient ischemia\" the hea goes into period of \"Persistent dysfunction\" even after the flow is reversed The impoant point to note in myocardial stunning is that the left ventricular dysfunction persisted after reperfusion despite the absence of irreversible damage and despite the restoration of normal or near normal coronary blood flow. It is believed or proposed that due to ischemia the hea is stunned .for a period of time. So even after the blood flow is restored the hea will not regain its function immediately. It will remain in its dysfunctional state for a ceain period of time and then resumes its normal activity. Its should be noted that myocardial stunning is a fully reversible abnormally, provided of course that sufficient time is allowed for myocardiunt to recover. Hibernating and stunned myocardium are clinically very impoant conditions of contractile asynergy, since they are potentially reversible Hibernating myocardium is similar to stunned myocardium in that both are characterized by ble myocardial cell with depressed function. When ischemia is relieved the hibernating myocardium exhibits nearly \"immediate return\" of function where as stunned myocardium exhibit \"gradual recovery\"", "cop": 1, "opa": "Stunt myocardium", "opb": "Hibernating myocardium", "opc": "Non ischaemic ble myocardium", "opd": "Mixed ischaemic myocardium", "subject_name": "Surgery", "topic_name": null, "id": "380d1724-9c3b-4d6c-93a7-7b0eee692248", "choice_type": "single"} {"question": "Treatment of choice for annular pancreas is", "exp": "Ans. is 'a' i.e., Duodenoduodenostomy \"The usual treatment is bypass (duodenoduodenostomy)\" -- Bailey and Love\"Retrocolicduodenojejunostomy is the procedure of choice.\" -- Harrison\"Treatment usually involves bypass, through duodenojejunostomy, rather than resection.\" -- Sabiston\"The surgical treatment of choice for duodenal obstruction due to duodenal stenosis or atresia or annularpancreas is a duodenoduodenostomy.\" -- Schwartz 9/e", "cop": 1, "opa": "Duodenoduodenostomy", "opb": "Gastrojejunostomy", "opc": "Vagotomy", "opd": "Billroth type II gastrectomy", "subject_name": "Surgery", "topic_name": "Pancreas", "id": "de2c04f9-610b-459a-b59b-126bc05c1a94", "choice_type": "single"} {"question": "Compament syndrome is commonly seen in", "exp": "Answer-A. Fracture of proximal tibiaHigh-risk injuries for development of compament syndrome are fractures of the elbow, forearm bones, proximal third of the tibia, and also multiple fractures of the hand or foot, crush iniuries and circumferentialburns.", "cop": 1, "opa": "Fracture of proximal tibia", "opb": "Fracture shaft humerus", "opc": "Fracture of femur shaft", "opd": "Fracture distal end radius", "subject_name": "Surgery", "topic_name": null, "id": "123c4bd4-a7aa-4aae-8761-09be0801c38c", "choice_type": "single"} {"question": "Consider the following with reference to the management of poal hypeension surgery", "exp": "Surgeries for poal hypeension * Devascularisation surgeries * Decompression surgeries * Ohotopic liver transplant (OLT) Surgeries for oesophageal varices and poal hypeension Nonselective shunts * End to side poa caval shunt (ECK fistula) * Side to side poa caval shunt * Mesenteric-caval shunt * Mesenteric-caval shunt with graft * Proximal splenorenal shunt--Linton's shunt * TIPSS Selective shunts * Distal splenorenal shunt--Warren's shunt * Inokuchi shunt between left gastric vein and IVC through a graft. Poa azygos disconnection * Oesophageal stapler transection of Johnston * Boerema--Crile operation--thoracic approach * Milnes--Walker thoracic oesophageal transection * Tanner's abdominal oesophagogastric transection * Hassab operation. Devascularisation and splenectomy. * Sugiura--Futagawa operation--vagotomy, pyloroplasty, devascularisation, splenectomy. * Splenectomy *Liver transplant Ref: SRB&;s manual of surgery,3 rd ed, pg no 555", "cop": 2, "opa": "Influsion of vasopression", "opb": "General resuscitation", "opc": "Devascularisation procedure", "opd": "Endoscopic sclerotherapy", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "08e7d251-c426-4ed7-a434-c46e0a44c59f", "choice_type": "single"} {"question": "Fever in burnt patient is cause by", "exp": "Fever in burn patients Many of the physiological criteria that has been claimed to reflect sepsis are non-infectious manifestations of post injury hypermetabolism Hypehermia (39degC or greater) is occasionally a febrile a response to infection, paicularly in children, but episodic elevation in temperature are common in uninfected burn patients The hypermetabolism phase mediated by greatly increased levels of catecholamines, prostaglandins, glucagon and coisol occurs after the acute phase and also produces pathophysiological changes Burn patients exhibit increased blood flow to organs and tissues, an increased internal core temperature, hypoproteinaemia and edema formation Ref: Sabiston 20th edition Pgno :516", "cop": 1, "opa": "Septicemia", "opb": "Due to hypermetabolism", "opc": "Toxin released by dead tissue", "opd": "Dead product", "subject_name": "Surgery", "topic_name": "General surgery", "id": "a2e661f6-1ac6-4d27-b325-d36fd26e6352", "choice_type": "single"} {"question": "Healing below knee joint is slow because of", "exp": "D i.e. Poor vascularily", "cop": 4, "opa": "Decreased subcutaneous fat", "opb": "Increased movement", "opc": "Weight bearing", "opd": "Poor vascularity", "subject_name": "Surgery", "topic_name": null, "id": "17297d71-089a-4050-ae96-173bda780eed", "choice_type": "single"} {"question": "Crush syndrome is managed by", "exp": "C i.e. Maintaining high Crush Syndrome It is seen when a limb is compressed for many hours in a vehicle, rubble or pneumatic antishock garment, resulting in massive crushing of musclesQ and release of large amounts of myohaemoglobinQ", "cop": 3, "opa": "20% Dextrose", "opb": "Hydrocoisone", "opc": "Maintaining high urine output", "opd": "Acidification of urine", "subject_name": "Surgery", "topic_name": null, "id": "bbb2daab-9018-497b-aeb1-b248c85ed761", "choice_type": "single"} {"question": "Most common type of sarcoma of breast", "exp": "Ans. (a) Angioarcoma(Ref. Sabiston page 842,20th edition)* Angiosarcoma most commonly follows RT to the axilla.* Characterized by Bluish purple nodule clinically", "cop": 1, "opa": "Angiosarcoma", "opb": "Rhabdomyosarcoma", "opc": "Kaposi sarcoma", "opd": "Synovial", "subject_name": "Surgery", "topic_name": "Breast", "id": "e13c4cbb-c4ad-45e5-955d-e638b30a3572", "choice_type": "single"} {"question": "The symptom that doesn&;t improve with TURP is", "exp": "Post-micturition dribble will not improve with TURP. It can be related to weak sphincter or other causes which may not improve with TURPBailey and Love 27e pg: 1459", "cop": 2, "opa": "Nocturia", "opb": "Post micturition dribble", "opc": "Incomplete emptying", "opd": "Urge incontinence", "subject_name": "Surgery", "topic_name": "Urology", "id": "9b5248f7-bda0-487e-ab33-8d4bc85162e7", "choice_type": "single"} {"question": "Investigation of choice in the early phase of renal transplant", "exp": "• Vascular complications after renal transplantation are low, presents during the first week after transplantation with sudden pain and swelling at the site of the graft.\n• Diagnosis is confirmed by Doppler ultrasonography.\n• Urgent surgical exploration is indicated and, in most cases, transplant nephrectomy is required.", "cop": 3, "opa": "IVP", "opb": "Retrograde cystourethrogram", "opc": "Ultrasonogram", "opd": "CT scan", "subject_name": "Surgery", "topic_name": null, "id": "f45fead1-36e2-4aac-833d-ff1ca0408595", "choice_type": "single"} {"question": "Hose pipe appearance of intestine is a feature of", "exp": ".Pathology of crohn&;s disease, Transmural inflammation >>Granuloma formation with linear snake like ulcers>>Cicatrisation>> Thickening of the bowel wall (Hose pipe pattern)>>Adhesions>> Fistula formation.Barium enema--shows loss of haustrations, narrow contracted colon (hose pipe colon), mucosal changes, pseudo polyps. It is avoided in fulminant cases. ref:SRB&;s manual of surgery ,ed 3,pg no 825", "cop": 1, "opa": "Crohns disease", "opb": "Malabsorption syndrome", "opc": "Ulcerative colitis", "opd": "Hirsprung disease", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "a5cf9572-05b9-4c21-90f7-d1e0dbae9825", "choice_type": "single"} {"question": "The causal mechanism in carcinoid syndrome is due to", "exp": "Carcinoid syndrome develops (in 10% of carcinoid tumours) due to release of 5-HT (serotonin), kinins, prostaglandins, histamine and indoles causing flushing, diarrhoea, cyanosis, asthmatic attacks, hepatomegaly, cardiac lesion on right side.. Reference : page 878 SRB's manual of surgery 5th edition", "cop": 2, "opa": "Erythropoietin and immunoglobulin", "opb": "Serotonin and bradykinin", "opc": "Insulin and insulin like substances", "opd": "ACTH and ACTH like substances", "subject_name": "Surgery", "topic_name": "Urology", "id": "5595b6f5-5c98-4372-93d7-a41ad795d837", "choice_type": "single"} {"question": "The commonest site of an intraperitoneal abscess", "exp": "Pelvis is the most common intraperitoneal abscess.(50-60%).It is the collection of pus in rectovesical or rectouterine pouch(pouch of Douglas). The pelvis is the commonest site of an intraperitoneal abscess because the vermiform appendix is often pelvic in position and the fallopian tubes are frequent sites of infection. Reference:Bailey & Love's sho practise of surgery,25th edition,page no:996;SRB's manual of surgery,5th edition,page no:576.", "cop": 1, "opa": "Pelvis", "opb": "Subphrenic space", "opc": "Periappendicular", "opd": "Paracolic gutter", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "b1f79ff4-0f34-4e75-a22b-07f8873c52ce", "choice_type": "single"} {"question": "Prevention of human brucellosis depends primarily on", "exp": "Prevention of human brucellosis depends on pasteurization of dairy products from cows, goats, and sheep; education of farmers and workers in the livestock industry as to the dangers of infected animals; and care in handling products from aboed animals. There is no insect vector. No vaccine for human use is available. Since person-to-person transmission does not occur, treatment of individual cases will not control spread of brucellosis. Destruction of infected animals will prevent transmission to other animals and is a method to control an outbreak in animals. Vaccine is available for livestock, for prevention but not control of outbreak. Immunity from the vaccine lasts only two years.", "cop": 1, "opa": "Pasteurization of dairy products derived from goats, sheep, or cows", "opb": "Treatment of human cases", "opc": "Control of the insect vector", "opd": "Immunization of farmers and slaughterhouse workers.", "subject_name": "Surgery", "topic_name": null, "id": "57258479-9a89-4a90-88fd-f7e0aa4e7466", "choice_type": "single"} {"question": "The term Bennett's fracture is used to describe", "exp": "D i.e. Fracture dislocation of trapezometacarpal joint", "cop": 4, "opa": "Fracture-dislocation of metacarpophalangeal joint of thumb", "opb": "Interphalangeal fracture dislocation of thumb", "opc": "Anterior marginal fracture of distal end of radius", "opd": "Fracture dislocation of trapezometacarpal joint", "subject_name": "Surgery", "topic_name": null, "id": "dc219af4-c4c4-45ca-94b5-f945c690ae25", "choice_type": "single"} {"question": "Cavity formation in bronchogenic carcinoma occurs in", "exp": null, "cop": 2, "opa": "Oat cell carcinoma", "opb": "Squamous cell carcinoma", "opc": "Adenocarcinoma", "opd": "Bronchoalveolar", "subject_name": "Surgery", "topic_name": null, "id": "043981ae-7d06-444a-a7a6-503d4f97df2b", "choice_type": "single"} {"question": "A 10 month old infant presents with intussesception, likely cause is", "exp": "Most common cause of intussusception in children is hypertrophy of Peyer's patches due to Rotavirus infection.", "cop": 3, "opa": "Meckel's diverticulum", "opb": "Mucosal polyp", "opc": "Peyer's patch hypertrophy", "opd": "Duplication cyst", "subject_name": "Surgery", "topic_name": null, "id": "60014abf-614b-4233-b170-204640b55305", "choice_type": "single"} {"question": "Fluid levels are not visible in", "exp": "In meconium ileus meconium is so thick that it is unable to form air-fluid level despite complete small intestinal obstruction (Note the multiple air-fluid level is a feature of mechanical small bowel obstruction & paralytic ileus).", "cop": 1, "opa": "Meconeum ileus", "opb": "Intussusception", "opc": "Colon pouch", "opd": "Duodenal obstruction", "subject_name": "Surgery", "topic_name": null, "id": "9a87a276-c322-4400-9265-404b53c5a8d0", "choice_type": "single"} {"question": "Duga's test is helpful in", "exp": "Di.e. Anterior Dislocation of shoulder Anterior Dislocation of ShoulderShoulder is the commonest joint to undergo recurrent & /or nonrecurrent (traumatic) dislocationQ.Anterior dislocation is the commonest type of shoulder dislocationQ accounting for - 97% of cases.", "cop": 4, "opa": "Dislocation of hip", "opb": "Scaphoid fracture", "opc": "Fracture neck of femur", "opd": "Anterior dislocation of shoulder", "subject_name": "Surgery", "topic_name": null, "id": "0122ee1a-4736-4d39-8e1d-1fe271bc2b69", "choice_type": "single"} {"question": "The most common neoplasm of kidney is", "exp": null, "cop": 2, "opa": "Wilm' s tumour", "opb": "Renal cell carcinoma", "opc": "Renal adenoma", "opd": "Haemagioma", "subject_name": "Surgery", "topic_name": null, "id": "e445a4c1-763b-469d-898f-86aa6a2d8828", "choice_type": "single"} {"question": "Treatment of choice of flail chest is", "exp": ".It is fracture of two or more consecutive ribs, with each rib having two or more fracture sites. Such segment is called as flail segment. Treatment \u0002 Intercostal tube drainage. \u0002 Applying clips to fracture ribs and fi xing above and below to normal ribs. \u0002 Antibiotics like penicillins, cefotaxime. \u0002 Blood transfusion, IV fluids. \u0002 Bronchodilators, steroids. \u0002 Ventilator suppo with IPPV--IPPV is treatment of choice. Assisted ventilation is required for several days until the chest wall stabilises. If ventilator suppo is required for more than 10 days, then tracheo stomy is done to prevent laryngeal stenosis which can occur due to prolonged endotracheal intubation. \u0002 Thoracotomy--when required only. Ref: SRB's Manual of Surgery, 4th Edition, pg. no. 1196", "cop": 1, "opa": "Ext. fixation of flail segment & mech ventilation", "opb": "Strapping", "opc": "O2 administration", "opd": "Intrapleural local analgesia", "subject_name": "Surgery", "topic_name": "Trauma", "id": "320d9a3d-97f8-44cb-9c90-2aa6f7dc6040", "choice_type": "single"} {"question": "Nipple retraction in Ca breast due to infiltration of", "exp": "Answer- B. Lactiferous ductsIt is seen in breast carcinoma due to infltration of the lactiferous ducts by carcinoma.It is due to extention of the growth along the lactiferous ducts and subsequent fibrosis.Nipple retraction is circumferential in carcinoma and slit like in periductal mastitis.", "cop": 2, "opa": "Suspensory ligaments", "opb": "Lactiferous ducts", "opc": "Lymphatics", "opd": "Pectoralis fascia", "subject_name": "Surgery", "topic_name": null, "id": "1549adc4-6fcc-48e2-b107-3fd67065e5f5", "choice_type": "single"} {"question": "Liver donor healthy person", "exp": "(D) Mortality for donor is 0.5 %# DEATH AFTER LIVING DONOR LIVER TRANSPLANTATION (LDLT) has been reported at 0% (Japan), 0.3% (USA) and <1% (Europe), with risks likely to decrease further as surgeons gain more experience in this procedure.> Risk of dying from living liver donor surgery may be as high as 0.5% when donating the right lobe. If ail complications are included, 1 of every 3 donors will experience a complication; most are considered minor or have no permanent sequelae. Thus, centers must carefully weigh the risks against the benefits.> Likewise, potential living liver donors should balance the decision to donate with the advice of family, friends, an independent conor advocate, and the medical/surgical team.> As stated by Marsh and colleagues, \"no matter how carefully right lobar living donor transplantation is applied, the historical verdict on the ethics of this procedure may be harsh.\"", "cop": 4, "opa": "Mortality for donor is 1%", "opb": "Mortality for donor is 0.2 to 0.4 %", "opc": "Mortality for donor is 0.6 to 0.8 %", "opd": "Mortality for donor is 0.5 %", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "b21a4d6e-cf13-467f-a393-d04311fdffe3", "choice_type": "single"} {"question": "A Sentinel pile indicates", "exp": "Ans. c (Fissure in ano) (Ref. Bailey and Love Surgery 26th/1250; Ref. Q. 216 of MH-2007).SENTINEL PILE- This misnomer is given to a skin tag marking--and often containing within it--the distal end of an anal fissure, found usually in the posterior midline.", "cop": 3, "opa": "Internal hemorrhoids", "opb": "Pilonidal sinus", "opc": "Fissure in ano", "opd": "Fistula in ano", "subject_name": "Surgery", "topic_name": "Anal Fissures", "id": "2fe65856-520a-4e00-8420-9cc2f9fa1f53", "choice_type": "single"} {"question": "Earliest method of diagnosing pituitary tumour", "exp": "Ans. is 'a' i.e., CT Scan", "cop": 1, "opa": "CT scan", "opb": "Visual field chaing", "opc": "Visual evoked potential", "opd": "X-ray skull", "subject_name": "Surgery", "topic_name": null, "id": "d6dc62bb-1a9b-47dc-a657-864be5930829", "choice_type": "single"} {"question": "Fogarty,s catheter used for", "exp": null, "cop": 2, "opa": "Urethral catheterization", "opb": "Removal of blood clots from the arteries", "opc": "Bladder drainage", "opd": "TPN", "subject_name": "Surgery", "topic_name": null, "id": "058cdba9-ac7a-44a6-b29f-2f1ad9be67b0", "choice_type": "single"} {"question": "80 kg male with bilateral upper limb, right lower limb with perineum burns 3rd degree, amount of fluid required in first 8 hours is", "exp": "Answer- D. 6560 mlThe amount of fluid required fot the above patient = 4ml x 80 x 41 = 13120 ml.Half of the calculated fluid is gtum in first 8 hrs and half in next 76 hrs.So the amount of fluid to be given in the first hrs = total fluid required/ 2 = 1312O/ 2 = 6560ml", "cop": 4, "opa": "3920 ml", "opb": "4920 ml", "opc": "5920 ml", "opd": "6560 ml", "subject_name": "Surgery", "topic_name": null, "id": "06b7b438-c67c-4808-bcd7-f2367cd155c7", "choice_type": "single"} {"question": "Most common type of carcinoma of thyroid", "exp": "Papillary carcinoma\nPapillary carcinoma is the most common thyroid malignancy. \nNonetheless, when papillary cancer is diagnosed most patients will be offered treatment. The disease is known for its propensity for lymph node metastases. These are more common in younger patients, in whom they do not affect the otherwise excellent survival.\nReference: Bailey & Love’s short practice of surgery , 27th ed page no 818", "cop": 1, "opa": "Papillary", "opb": "Follicular", "opc": "Medullary", "opd": "Anaplastic", "subject_name": "Surgery", "topic_name": null, "id": "c9703a9a-bfb0-4028-93dd-cbe98cec135a", "choice_type": "single"} {"question": "Triple assessment for CA Breast includes", "exp": "Triple assessment: In any patient who presents with a breast lump or other symptoms suspicious of carcinoma, the diagnosis should be made by a combination of clinical assessment, radiological imaging and a tissue sample taken for either cytological or histological analysis the so-called triple assessment. Ref : Bailey and love 26thE pg 818", "cop": 4, "opa": "History, Clinical examination and mammogram", "opb": "History, Clinical examination and FNAC", "opc": "USG, Mammogram and FNAC", "opd": "Clinical examination, Mammogram and FNAC", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "4f0a4d5f-4c7c-45ab-8aa6-fa37b79f5274", "choice_type": "single"} {"question": "Paresthesia over nasal and upper lip following fractured zygoma is because of involvement of", "exp": null, "cop": 3, "opa": "Facial nerve", "opb": "Posterior superior alveolar nerve", "opc": "Infraorbital nerve", "opd": "Mental nerve", "subject_name": "Surgery", "topic_name": null, "id": "f060d24d-b53d-4962-b5e9-cf67f0c82190", "choice_type": "single"} {"question": "Hypoparathyroidism after thyroidectomy commonly manifests in", "exp": "Parathyroid insufficiency after thyroidectomyThis is due to removal of the parathyroid glands or infarction through damage to the parathyroid end aery; often, both factors occur together. Vascular injury is probably far more impoant than inadveent removal. The incidence of permanent hypoparathyroidism should be less than 1 per cent and most cases present dramatically 2-5 days after operation but, veryrarely, the onset is delayed for 2-3 weeks or if a patient with marked hypocalcaemia is asymptomatic.", "cop": 2, "opa": "1 day", "opb": "2-5 days", "opc": "After a week", "opd": "After a month", "subject_name": "Surgery", "topic_name": "All India exam", "id": "3fb0c2c9-7562-471d-91a5-3ca366ad2433", "choice_type": "single"} {"question": "Bag of worms in scrotum is seen in", "exp": "Ans. is 'a' i.e.,Varicocele Varicocele* A varicocele is a varicose dilatation of the veins draining the testis.* Most varicoceles present in adolescence or early adulthood, usually on the left.* In many cases the dilated vessels are cremasteric veins and not part of the pampiniform plexus.* Obstruction of the left testicular vein by a renal tumour or after nephrectomy is a cause of varicocele in later life; characteristically, the varicocele does not decompress in the supine position.* Varicocele is usually symptomless but there may be an annoying dragging discomfort that is worse if the testis is unsupported.* The scrotum on the affected side hangs lower than normal, and on palpation, with the patient standing, the varicose plexus feels like a bag of worms.* There may be a cough impulse.* If the patient lies down the veins empty by gravity and this provides an opportunity to ensure that the underlying testis is normal to palpation.* In longstanding cases the affected testis is smaller and softer than its fellow owing to a minor degree of atrophy.* It is widely believed that varicocele causes infertility but the evidence is inconclusive.", "cop": 1, "opa": "varicocele", "opb": "Spermatocele", "opc": "Inguinal hernia", "opd": "Hydrocele", "subject_name": "Surgery", "topic_name": "Testis & Scrotum", "id": "9e7bc87f-48a1-4c77-ad54-71bafd7bfcff", "choice_type": "single"} {"question": "A person has been brought in casualty with history of road accident. He had lost consciousness transiently and gained consciousness but again became unconscious. Most likely, he is having brain hemorrhage of", "exp": "Lucid interval' is a classical feature of extradural hemorrhage. Ref : Sabiston, 17/e p755", "cop": 4, "opa": "Intracerebral", "opb": "Subarachnoid", "opc": "Subdural", "opd": "Extradural", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "0ec5e259-bb51-4d2c-b6be-b0cf1c43c62e", "choice_type": "single"} {"question": "A morbid patient unlikely to survive 24 hours with or\nwithout surgery is classified as", "exp": null, "cop": 3, "opa": "ASA I", "opb": "ASA III", "opc": "ASA V", "opd": "ASA VI", "subject_name": "Surgery", "topic_name": null, "id": "e1436f0e-0a3e-46dc-9086-0d6688867d3d", "choice_type": "single"} {"question": "Xanthogranulomatous pyelonephritis is often associated with infection by", "exp": null, "cop": 1, "opa": "Proteus", "opb": "E. coli", "opc": "S. aureus", "opd": "Klebsiella", "subject_name": "Surgery", "topic_name": null, "id": "ea00bc1d-7ca2-4eaf-8387-b7c95390a945", "choice_type": "single"} {"question": "Most common cause of death in Crohn&;s disease is due to", "exp": ".Complications of Crohn's * Intestinal obstruction * Stricture * Bleeding * Fistula formation * Carcinoma * Perianal abscess * Peritonitis * Pericolic abscess. ref:SRB&;s manual of surgery,ed 3,pg no 802", "cop": 4, "opa": "Sepsis", "opb": "Thromboembolic complication", "opc": "Electrolyte disturbance", "opd": "Malignancy", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "a2982fe1-1467-4a92-ac32-ebed335af4ba", "choice_type": "single"} {"question": "Long term complication of a liver kidney donor is", "exp": "In donor - hypertension.", "cop": 2, "opa": "Amyloid nephropathy", "opb": "Hypertension", "opc": "Pylonephritis", "opd": "Renal cell carcinoma", "subject_name": "Surgery", "topic_name": null, "id": "f2c08efb-61f9-4c4f-ad4b-73db524d151f", "choice_type": "single"} {"question": "T/t used for lower ureteric stone is", "exp": "Ans is 'a' ie Endoscopic removal Best modality of t/t for ureteric stone is - Ureteroscopic removal.There are other methods alsoEndoscopic Dormia basket - can only be used for small stones that are within 5-6 cm of the orifice.This has been replaced by ureteroscopic technique.Endoscopic Meatotomy - this is for removal of stones lodged in the intramural part of the ureter.Push bang method - If the stone is lying in the upper or middle part of the ureter; it can be pushed into the kidney pelvis using a ureteral catheter. The pt. can then be referred for ESWL (Extracorporeal shock wave lithotripsy)Lithotripsy in situ", "cop": 1, "opa": "Endoscopic removal", "opb": "Diuretics", "opc": "Drug dissolution", "opd": "Laser", "subject_name": "Surgery", "topic_name": "Urolithiasis", "id": "b409d99c-a0ac-427b-b91e-4182e2e06798", "choice_type": "single"} {"question": "The most common cause of shock of children is", "exp": "Hypovolemic shock is the most common cause of shock in children and adults.", "cop": 1, "opa": "Hypovolemic shock", "opb": "Cardiogenic shock", "opc": "Septic shock", "opd": "Neurogenic shock", "subject_name": "Surgery", "topic_name": null, "id": "e01350ae-98a1-4984-83b9-2ba97da269d6", "choice_type": "single"} {"question": "Trendelenberg test is positive in palsy of", "exp": "Ans. is 'b' i.e., Gluteus medius Trendelenberg test : It tests the stability of the hip and paicularly of the abductor mechanism of the limb on which the patient is standing. Principle of the test : Normally when one leg is raised from the ground the pelvis tilts upwaras on that side, through the action of the hip abductors of the standing limb. If the abductors are inefficient they are unable to sustain the pelvis against the body weight and it tilts downwards instead of rising up on the side of the lifted leg. Note that the test is performed with the patients standing on the affected leg. Abductor mechanism : It can be compared with the lever, with the body weight being trying to tilt the pelvis down; the hip joint being the fulcrum and the abductor muscles being the power acting throught the lever arm (from the head of the femur to attachment of the abductor muscles on the greater trochanter - the neck of the femur). Causes of positive trendelenberg test : Any failure of abductor mechanism causes dipping of the pelvic (ASIS) on the normal side. There are three fundamental causes : 1) Paralysis of the abductor muscles (Supplies gluteus medius & minimus) eg. Polio. Paralysis of superior gluteral nerve 2) Marked approximation of the inseion of the abductor muscles to their origin by upward displacement of the greater trochanter ; so that the muscles are slack. eg. Severe coxa vara, dislocation of hip 3) Absence of stable fulcrum & lever arm about which the abductor muscles can act Neck femur fracture Dislocation of hip, Destructruction of head as in Pehe's diseases.", "cop": 2, "opa": "Gluteus maximus", "opb": "Gluteus medius", "opc": "Rectus femoris", "opd": "Vastus medialis", "subject_name": "Surgery", "topic_name": null, "id": "8adfdd1e-cf44-40d1-9d43-4892f6ff43ff", "choice_type": "single"} {"question": "Increased risk factor for carcinoma breast is", "exp": "Risk factors of breast carcinoma Mutation of tumour suppressor genes BRCA1/BRCA2 is thought to be involved with high-risk of breast carcinoma Diet low with phytoestrogens and high alcohol intake have high-risk of breast cancer. Vitamin C reduces the risk. It is more common in nulliparous woman. Attaining early menarche and late menopause have high-risk of breast malignancy. Early child-bearing and breastfeeding reduces the chances of malignancy. Early 1st child bih reduces the risk; late first child bih after 35 years increases the risk. It is more common in obese individuals Ref; (page no;530 ) 5th edition of SRB&;S manual of Surgery.", "cop": 1, "opa": "BRCA1 mutation", "opb": "Breast feeding", "opc": "Multiparity", "opd": "Smoking", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "efbeca31-3cd5-44e0-960d-ba1a78a3f4b6", "choice_type": "single"} {"question": "Most common oral cancer;", "exp": "MC histological type- Squamous cell ca MC type of cancer in India - CA oral cavity MC site of CA Oral cavity - Tongue > lip IOC for Dx - Edge Biopsy", "cop": 1, "opa": "Squamous cell ca", "opb": "Adenocarcinoma", "opc": "Transition cell ca", "opd": "Mucoepidermoid", "subject_name": "Surgery", "topic_name": "FMGE 2019", "id": "c8acce46-b608-4d74-a4a3-6f905dacf82b", "choice_type": "single"} {"question": "Aims of abbreted laparotomy", "exp": "DAMAGE CONTROL SURGERY (Abbreted laparotomy) Following major injury, protracted surgery in the physiologically unstable patient can in itself prove fatal. Patients with the 'deadly triad' (hypothermia, acidosis and coagulopathy) are those at highest risk. 'Damage control' or 'damage limitation surgery' is a concept that originated from naval ship- building strategy, whereby ships were designed so that the damage was kept 'local' and which allowed only the minimal repairs needed to prevent it from sinking, while definitive repairs waited until it had reached po. The technique has been adopted following major trauma, and includes initial care and resuscitation (damage control resuscitation) and the surgical correction of the injury (damage control surgery). The minimum amount of surgery needed to stabilise the patient's condition may be the safest course until the physiological derangement can be corrected. Damage control surgery is restricted to only two goals: * stopping any active surgical bleeding; * controlling any contamination. Once these goals have been achieved then the operation is suspended and the abdomen temporarily closed. The patient's resuscitation then continues in the intensive care unit, where other therapeutic interventions can take place.Once the physiology has been corrected, the patient warmed and the coagulopathy corrected, the patient is returned to the operating theatre for any definitive surgery. Indications for Damage control surgery Anatomical Inability to achieve haemostasis Complex abdominal injury, e.g. liver and pancreas Combined vascular, solid and hollow organ injury, e.g. aoic or caval injury Inaccessible major venous injury, e.g. retrohepatic vena cava Demand for non-operative control of other injuries, e.g. fractured pelvis Anticipated need for a time-consuming procedure Physiological (decline of physiological reserve) Temperature <34oC pH <7.2 Serum lactate >5 mmol/L (normal: <2.5 mmol/L) Prothrombin time (PT) >16 s Paial thromboplastin time (PTT) >60 s >10 units blood transfused Systolic blood pressure <90 mmHg for >60 min Environmental Operating time >60 min (core temperature loss in usually 2degC/h) Inability to approximate the abdominal incision Desire to reassess the intra-abdominal contents (directed relook) Ref: Bailey and love 27th edition Pgno : 379", "cop": 4, "opa": "Decreased chance of infection", "opb": "Early ambulation", "opc": "Early wound healing", "opd": "Haemostasis", "subject_name": "Surgery", "topic_name": "Urology", "id": "2ca876fe-3af0-47d5-9b53-7075579b98d8", "choice_type": "single"} {"question": "Most common cause of a Krukenberg tumour is", "exp": "A Krukenberg tumor refers to a malignancy in the ovary that metastasized from a primary site, classically the gastrointestinal tract, although it can arise in other tissues such as the breast. Gastric adenocarcinoma, especially at the pylorus, is the most common source.Krukenberg tumors are often (over 80%) found in both ovaries, consistent with its metastatic nature. Krukenberg tumors can be seen in all age groups, with an average age of 45 years. In most countries, cancer that has metastasized to the ovary accounts for only about 1 to 2% of ovarian cancer; in the remainder, the ovary itself is the primary cancer site. However, in Japan they represent a much higher percentage of malignancies in the ovary (almost 20%) due to the increased prevalence of gastric cancer. Ref: Internet sources (Wiki)", "cop": 3, "opa": "Ovarian cancer", "opb": "HCC", "opc": "Stomach cancer", "opd": "RCC", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "64c72fbf-a2e7-4652-b33b-4a6088f1adbd", "choice_type": "single"} {"question": "Incision used in thyroidectomy", "exp": null, "cop": 2, "opa": "Barking incision", "opb": "Collar incision", "opc": "Kocher incision", "opd": "Koebner incision", "subject_name": "Surgery", "topic_name": null, "id": "39d9d781-e0ef-4c65-a29a-bb136223b21a", "choice_type": "single"} {"question": "Best prognosis among RCC is", "exp": "Chromophobe has best prognosis\nCollecting duct has the worst prognosis.", "cop": 3, "opa": "Clear cell", "opb": "Papillary", "opc": "Chromophobe", "opd": "Collecting duct", "subject_name": "Surgery", "topic_name": null, "id": "2eaa6457-b849-44b7-89fd-79c1928c625c", "choice_type": "single"} {"question": "Fracture shaft of femur in adult unites by", "exp": "C i.e. 3-4 months It is said that a fractured shaft femur should unite in 100 days, plus minus 20 (3 - 4 rnonths)Q. But nonunion is probably best defined by a lack of progression of healing combined with clinical symptoms of discomfo at a minimum of 6 months from the time of treatment. Fuher, a nonunion implies that healing is considered unlikely without fuher intervention.", "cop": 3, "opa": "3 to 4 weeks", "opb": "3 to 4 weeks", "opc": "3 to 4 months", "opd": "4 to 6 months", "subject_name": "Surgery", "topic_name": null, "id": "cb61e246-1153-4961-9980-cb194a11c21f", "choice_type": "single"} {"question": "Preferred time for prophylactic antibiotic administration for surgery", "exp": "Prophylactic Antibiotics Antibiotics should be used when local wound defences are not established (the decisive period) Ideally, maximal blood and tissue levels should be present at the time at which the first incision is made and before contamination occurs. IV administration at induction of anaesthesia is optimal If induction is not mentioned in the option go for 30 minutes to 1 hour before surgery. In long operations, those involving the inseion of a prosthesis, when there is excessive blood loss or when unexpected contamination occurs, Antibiotics may be repeated 8 to 16 hours later. The use of the newer, broad spectrum antibiotics for prophylaxis should be avoided. Benzylpenicillin should be used if clostridium gas gangrene infection is a possibility Patients with hea valve disease or a prosthesis should be protected from bacteraemia caused by dental work, urethral instrumentation or visceral surgery Ref: Sabiston 20th edition Pgno :224", "cop": 2, "opa": "1 day before surgery", "opb": "At the time of induction of anaesthesia", "opc": "I. V. during surgery", "opd": "I. M. before 6 hr", "subject_name": "Surgery", "topic_name": "General surgery", "id": "3fd167a0-9c9f-43a9-9d27-a56618c56ef4", "choice_type": "single"} {"question": "Massive edema in body in a patients of burns is due to", "exp": "Massive edema in burns is due to altered pressure gradient because of injury to basement membrane.", "cop": 2, "opa": "Cardiac dysfunction due to release of cardiac depressants", "opb": "Basement membrane injury causing altered pressure gradient", "opc": "Acute Renal failure", "opd": "Fluid overload", "subject_name": "Surgery", "topic_name": null, "id": "f4da212d-ed50-4b1f-aa43-97cdc1167c60", "choice_type": "single"} {"question": "A 50 Yr. old male presents with obstructive symptoms. Biopsy of stomach reveals Gastrointestinal stromal tumor (GIST). Most appropriate marker for GIST is", "exp": ".* GIST arises from interstitial cell of Cajal (pacemaker cell which intercalates between smooth muscle cells and intramural neurons). Mutation of tyrosine kinase and platelet derived growth factor alpha (PDGFa) are the newer pathogenetic theories. * GIST is classified as very low risk (2 cm); low risk (2-5 cm); intermediate risk (5-10 cm) and high risk (> 10 cm) based on tumour size and mitotic activity of cells. * 95% of GISTS express c-kit - CD117 mutations - a specific molecular marker. ref:SRB&;s manual of surgery ,ed 3,pg no 791", "cop": 2, "opa": "CD 34", "opb": "CD 117", "opc": "CD 30", "opd": "CD 10", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "c1338d85-9a00-425f-a576-3219e658476a", "choice_type": "single"} {"question": "The Gold standard investigation for GERD is", "exp": "(A) 24 hr pH monitoring > Useful investigations may include barium swallow X-rays, esophageal manometry, 24 hour esophageal pH monitoring and Esophagogastroduodenoscopy (EGD). In general, an EGD is done when the patient does not respond well to treatment, or has alarm symptoms including: dysphagia, anemia, blood in the stool (detected chemically), wheezing, weight loss, or voice changes. Some physicians advocate once-in-a-lifetime endoscopy for patients with longstanding GERD, to evaluate the possible presence of Barrett's esophagus, a precursor lesion for esophageal adenocarcinoma.> Esophagogastroduodenoscopy (EGD) (a form of endoscopy) involves insertion of a thin scope through the mouth and throat into the esophagus and stomach (often while the patient is sedated) in order to assess the internal surfaces of the esophagus, stomach, and duodenum.> Esophageal manometry is a test that measures the function of the lower esophageal sphincter and the motor function of the esophagus. A tube is passed down your throat until it reaches the esophagus. It is often performed along with 24-hour pH probe study.> In a 24-hour pH probe study, a thin tube is placed down into your esophagus for 24 hours.", "cop": 1, "opa": "24 hr pH monitoring", "opb": "Endoscopy", "opc": "CT scan", "opd": "MRI", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "5d3f7560-0631-4701-a06f-170299b12789", "choice_type": "single"} {"question": "The prognosis of rhabdomyosarcoma is likely to be poor if the site of the tumour is", "exp": "Rhandomyosarcoma Rhabdomyosarcoma Arises from Mesenchymal tissues MC sites of origin : Head and neck (Parameningeal) > Extremities > Genitourinary tract > Trunk MC pediatric soft tissue sarcoma : Rhabdomyosarcoma Associated with : NF, Beckwith- Weidman syndrome, Li-Fraumeni and fetal alcohol syndrome Prognosis of Rhabdomyosarcoma Favourable primary sites Unourable primary sites Orbit Nonparameningeal head and neck Paratestis Vagina Extremity Parameningeal Ref: Devita 9th edition Pgno : 1780-1784", "cop": 3, "opa": "Orbit", "opb": "Para testicular", "opc": "Extremity", "opd": "Urinary bladder", "subject_name": "Surgery", "topic_name": "Urology", "id": "ff55298e-34c8-45c2-8bbd-e9720d4b1269", "choice_type": "single"} {"question": "Best investigation to diagnose colonic diveiculosis", "exp": "Investigation of choice for colonic diveiculosis: Barium enema Investigation of choice for diveiculitis: CT scan", "cop": 1, "opa": "Barium enema", "opb": "CT Scan", "opc": "Ultrasound", "opd": "MRI", "subject_name": "Surgery", "topic_name": "Large intestine", "id": "4cef860d-f394-4c1f-92ca-4337b0b7e526", "choice_type": "single"} {"question": "Water content in infant", "exp": "Ans. is 'b' i.e., 75-80% Schwaz writes - \"the highest percentage of Total Body Water is found in newborns, with approximately 80% of their total body weight comrpised of water. This decreases to about 65% by 1 year of age and therafter remains fairly constant through childhood\".", "cop": 2, "opa": "60-70 %", "opb": "75-80 %", "opc": "80-90 %", "opd": "> 90%", "subject_name": "Surgery", "topic_name": null, "id": "9417dd9e-d8d3-440b-9920-ddd8cdb900ca", "choice_type": "single"} {"question": "26 year old man died while playing. His autopsy of the hea revealed myocyte hyperophy. Diagnosis is aEUR'", "exp": "HOCM Sudden death associated with spos or vigorous exeion along with the presence of hyperophied septum suggests the diagnosis of HOCM. Remember HOCM does not give specific symptoms. This disorder has variable presentation. Most patients are asymptomatic, and unfounately the .first clinical manifestation of the disease in such individuals may be death. M.C. manifestation of H.O.C.M. in symptomatic patients Dyspnea The essential feature of HOCM is massive myocardial hyperophyQ without ventricular dilatation. - The impoant feature of hyperophy is that it is asymmetricalQ, the ventricular septum is characteristically involved but ventricular wall is spared.", "cop": 1, "opa": "HOCM", "opb": "DCM", "opc": "Arrhythmogenic cardiac problem", "opd": "Restrictive cardiomyopathy", "subject_name": "Surgery", "topic_name": null, "id": "0e868cc5-066e-4094-907d-a5a4e67ec3b7", "choice_type": "single"} {"question": "Pierre Robin Sequence includes", "exp": "Pierre robin syndrome includes cleft palate retrognathia posteriorly displaced tongue(glossoptosis) early respiratory and feeding difficulties SRB ,5th,347.", "cop": 1, "opa": "Glossoptosis", "opb": "Airway obstructions", "opc": "Cleft lip", "opd": "Micrognathia", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "cff5f5df-84da-4011-9e7c-bb9d7433fcc7", "choice_type": "single"} {"question": "Injury around the ankle joint occur at", "exp": "A i.e. Inversion of foot", "cop": 1, "opa": "Inversion of foot", "opb": "Eversion of foot", "opc": "Internal rotation of foot", "opd": "External rotation of foot", "subject_name": "Surgery", "topic_name": null, "id": "280e968a-3c01-4746-af9c-647f824608c2", "choice_type": "single"} {"question": "Osteomyelitis of the jaw can be cured by", "exp": null, "cop": 3, "opa": "Resection", "opb": "Physiotherapy", "opc": "Sequestrectomy with antibiotic treatment", "opd": "Drainage", "subject_name": "Surgery", "topic_name": null, "id": "1aad3f87-b6ba-475e-b30a-903c1c4705c9", "choice_type": "single"} {"question": "In Budd Chiari syndrome, the occlusion is at the", "exp": "Budd chiari syndrome occurs when venous drainage of the liver is occluded by hepatic venous thrombosis or obstruction from a venous web Reference Bailey and love&;s 24 the edition page no.1074", "cop": 3, "opa": "IVC", "opb": "Renal Vein", "opc": "Hepatic vein", "opd": "Splenic vein", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "9224b722-39a0-4617-bfd6-224112523de1", "choice_type": "single"} {"question": "Carcinoma sigmoid colon with obstruction Management includes", "exp": "- Obstruction due to rectosigmoid growth with patient being severely ill--Hamann's operation can be done to save the life of the patient wherein distal stump after removal of the growth is closed, proximal colon is brought out as end colostomy.Resection of the gangrenous sigmoid done; proximal cut is brought out as end colostomy: distal end closed - Hamann's operation. Later in 6-12 weeks colorectal anastomosis is maintained. ref:SRB&;s manual of surgery,ed 3,pg no 856", "cop": 1, "opa": "Hamann's procedure", "opb": "Resection and end to end anastomosis with proximal colostomy", "opc": "Proximal colostomy with distal ligation", "opd": "Sub-total colectomy", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "f8dd984b-ee51-47f5-b8d3-bc36a9e97862", "choice_type": "single"} {"question": "Mets form prostatic carcinoma are common in", "exp": "Through batson plexus cancer spreads through bone.", "cop": 3, "opa": "Liver", "opb": "Kidney", "opc": "Bone", "opd": "Brain", "subject_name": "Surgery", "topic_name": null, "id": "3cc7cc3f-5b14-474c-8f32-13e9b9dc17f1", "choice_type": "single"} {"question": "Verres needle is used for", "exp": "Verres needle is used for creation of a pneumoperitoneum in closed method.Although this method is fast and relatively safe, there is a small but significant potential for intestinal or vascular injury on introduction of the needleRef: Bailey and Love 27e pg: 108", "cop": 1, "opa": "Creating pneumoperitoneum", "opb": "Liver biopsy", "opc": "Bone marrow biopsy", "opd": "Spinal anaesthesisa", "subject_name": "Surgery", "topic_name": "General surgery", "id": "bb956290-4668-488c-a488-b817a1e1db5d", "choice_type": "single"} {"question": "Catgut suture is packed in", "exp": null, "cop": 1, "opa": "Isopropyl alcohol", "opb": "Ethanol", "opc": "Formalin", "opd": "Gluteraldehyde", "subject_name": "Surgery", "topic_name": null, "id": "971dbf49-a03a-427a-a0cd-73fccba80ce7", "choice_type": "single"} {"question": "The most posterior teeth are removed", "exp": null, "cop": 4, "opa": "Least", "opb": "Maximal", "opc": "Last", "opd": "First", "subject_name": "Surgery", "topic_name": null, "id": "dd10cc26-32c0-4c9c-a7be-e46f4594f600", "choice_type": "single"} {"question": "In order to activate helper/inducer T (CD41) lymphocytes, macrophages release", "exp": "Interleukin 1 (IL-1) is a thymocyte mitogen produced by activated macrophages as well as many other types of cells (e.g., monocytes, dendritic cells, Langerhans cells, neutrophils, microglial cells). It induces interleukin 2 production by the helper T cell, which initiates a cascade of immunoregulatory and inflammatory functions.", "cop": 1, "opa": "Interleukin 1", "opb": "Interleukin 2", "opc": "Interleukin 3", "opd": "Interleukin 4", "subject_name": "Surgery", "topic_name": "Transplantation", "id": "55bad8d7-c10b-4355-913a-c8e1df1aeb81", "choice_type": "single"} {"question": "The etiologic factor implicated in the development of pulmonary insufficiency following major nonthoracic trauma is", "exp": "Posttraumatic pulmonary insufficiency in the absence of significant thoracic trauma has been attributed to a wide variety of etiologic agents, including aspiration, simple atelectasis, lung contusion, fat embolism, pneumonia, pneumothorax, pulmonary edema, and pulmonary thromboembolism. In a landmark monograph entitled Respiratory Distress Syndrome of Shock and Trauma, Blaisdell and Lewis identified fat embolism syndrome as the etiologic factor. The mechanism of this condition appears to be pulmonary alveolar injury due to the mobilization of free fatty acids in the blood as an adrenergic response to trauma, rather than pulmonary injury from embolization of fat globules from fractured bones, as was originally thought.", "cop": 3, "opa": "Aspiration", "opb": "Atelectasis", "opc": "Fat embolism syndrome", "opd": "Fluid overload", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "ed331766-25a3-46bb-a544-044d1fd17703", "choice_type": "single"} {"question": "The first to appear in a cause of acute intestinal obstruction is", "exp": "Symptoms of intestinal obstruction Symptoms of intestinal obstruction : Pain, vomiting, distension and constipation Pain is the first symptom encountered ; it occurs suddenly and is usually severe Pain in intestinal obstruction It is colicky in nature and is usually centered on the umbilicus(small bowel) or lower abdomen (large bowel) The pain coincides with increased peristaltic activity With increasing distension, the colicky pain is replaced by a mild constant diffuse pain The development of severe pain is indicative of the presence of strangulation Pain may not be a significant feature in post operative simple mechanical obstruction and does not usually occur in paralytic ileus Ref: Bailey and love 27th edition Pgno : 1285", "cop": 1, "opa": "Colicky pain", "opb": "Constipation", "opc": "Vomiting", "opd": "Distension", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "1deeeee4-b89d-4d1e-894b-20d42080e7d5", "choice_type": "single"} {"question": "26 yr old female came for the first time in OPD with lump in breast first investigation", "exp": "Answer- B. MammogramRadiological investigations for the initial assessment for breast lump are either USG or Mammography.Since the patient given in the question is a young female. Ultrasonography is a preferred first investigation for evaluation of breast lump.ultrasound is paicularly useful in young women with dense breasts in whom mammograms are difficult to interpret, and in distinguishing cysts from solid lesions.", "cop": 2, "opa": "USG", "opb": "Mammogram", "opc": "MRI", "opd": "PET scan", "subject_name": "Surgery", "topic_name": null, "id": "c2df32c7-ee32-45dd-a7c8-c8931b328673", "choice_type": "single"} {"question": "Nelson syndrome is seen following", "exp": "Nelson's syndrome also referred to as post adrenalectomy syndrome occurs following bilateral adrenalectomy in patients with pituitary dependant Cushing's syndrome. The common symptoms include: hyper-pigmentation of the skin, visual disturbances, headaches, abnormal high levels of beta-MSH and ACTH, abnormal enlargements of the pituitary gland(invasive pituitary macroadenoma), interruption of menstrual cycles in women.Reference : page 776 Davidson's principles and practice of Medicine 22nd edition", "cop": 4, "opa": "Cholecystectomy", "opb": "Spleenectomy", "opc": "Duodenectomy", "opd": "Adrenalectomy", "subject_name": "Surgery", "topic_name": "Urology", "id": "ff986622-4486-4fe0-b332-556a7ae8490d", "choice_type": "single"} {"question": "Treatment of Papillary Ca of Thyroid with bony metastasis", "exp": "Ans. is 'd' i.e. Near total thyroidectomy with radioiodine & radiotherapy As already mentioned in previous question, Total or Near total thyroidectomy is t/t of choice in PTC and also FTC (except minimally invasive cancer). Radioactive iodine '3'1is used post-operatively to detect and destroy any metastatic disease. It is also advised by some expes to do a routine 1311scan and therapy for all patients of differentiated thyroid cancer, postoperatively (except those with occult or minimally invasive disease). Screening with RAI is more sensitive than chest x-ray or CT scanning for detecting metastases; however, it is less sensitive than Tg measurements for detecting metastatic disease in most differentiated thyroid cancers except Huhle cell tumors. External beam radiotherapy is used to treat bone metastasis (to prevent fracture or to control pain). It is also occasionally used to control unresectable, locally invasive or recurrent thyroid carcinoma. There is no role for routine chemotherapy in differentiated thyroid cancers. Other Postop management in differentiated thyroid cancers Thyroid Hormone T4 is given as replacement therapy in patients after total or near-total thyroidectomy, and has the additional effect of suppressing TSH and reducing the growth stimulus for any possible residual thyroid cancer cells. TSH suppression reduces tumor recurrence rates. Thyroglobulin measurement Thyroglobulin (Tg) is produced only by thyroid follicular cells. Following total thyroidectomy, it should be undetectable in serum and any detectable level then indicates the persistence or recurrence of neoplastic disease. This is the basis for the use of Tg as a post-operative tumor marker in the follow-up of thyroid cancer patients Tg levels in patients who have undergone total thyroidectomy should be <2 ng/mL when the patient is taking T4 , and <5 ng/mL when the patient is hypothyroid.", "cop": 4, "opa": "Radiotherapy", "opb": "Radioiodine", "opc": "Near total thyroidectomy with radiotherapy", "opd": "Near total thyroidectomy with radioiodine & radiotherapy", "subject_name": "Surgery", "topic_name": null, "id": "887ff857-d31e-43e9-bf3f-d0ab0ef5542a", "choice_type": "single"} {"question": "Treatment for achalasia associated with high rate of recurrence", "exp": "Treatment of choice in case of high chance of recurrence is Endoscopic injection of botulinum toxin to sphincter. Botulinum toxin is neurotoxic protein derived from Clostridium botulinum is highly toxic poisonous substance. Very small amount is used for therapeutic purpose. 7 types of toxins are found. It blocks cholinergic nerve ends reducing the cholinergic acetylcholine release causing flaccid paralysis of muscles. Reference: SRB's Manual of Surgery, 6th Edition, page no= 791.", "cop": 4, "opa": "Pneumatic dilatation", "opb": "Laparoscopic myotomy", "opc": "Open surgical myotomy", "opd": "Botulinum toxin injection", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "16cf71dc-849a-4022-abcd-cc539ec2c744", "choice_type": "single"} {"question": "Standard views for mammography are", "exp": "Mammography views : Craniocaudal from above downward. Mediolateral from side to side. Ref : SRB&;s 4thE pg:547", "cop": 3, "opa": "AP and Lateral", "opb": "AP and Medio-lateral oblique", "opc": "Cranio- caudal and Medio-lateral view", "opd": "Cranio-caudal and lateral oblique", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "711a5c0c-fe32-4b21-b355-757df11b4dac", "choice_type": "single"} {"question": "Wilm' s tumor associated with A/E", "exp": "The genitourinary anomalies most commonly associated with Wilms tumor are\n\nhypoplasia,\nfusion and ectopia of the kidney,\nduplications of the collecting systems,\nhypospadias, and\ncryptorchidism\n(Bilateral polycystic kidney disease is not associated with the Wilm's tumor)\n\nSyndromes Associated with Wilms Tumor\n\nSeveral syndromes and congenital abnormalities commonly are reported in patients with Wilms tumor.\nWAGR syndrome (contiguous gene deletion of WT1 & PAX6 on 11P13)\nIt consists of\nWilms tumor,\nAniridia,\nGenitourinary abnormalities (cryptorchidism, streak ovaries, bicornuate uterus, ambiguous genitalia), and\nMental retardation.\nPatients with this syndrome have a constitutional deletion of chromosome 11p13 where the Wilms tumor gene,\nWT1, and the aniridia gene, PAX6, are located.\nDenys- Drash syndrome(missense mutation in WT1 gene) \nIt is characterized by\nMale pseudohermaphrodism,\nEarly-onset renal failure characterized by mesangial sclerosis and\nIncreased risk of Wilms tumor.\nPatients with this syndrome typically carry a missense mutation in the WT1 gene.\nBeckwith-Wiedemann syndrome (WT2 gene abnormality on chromosome 11P15.5)\nIt is characterized by\nHemihypertrophy,\nMacroglossia,\nVisceromegaly,\nOmphalocele\nRisk of developing Wilms tumor (3-5%)\nA variety of 11p15.5 abnormalities have been reported in patients with this syndrome, and it is postulated that a second Wilms tumor gene, WT2, is located in this region. Loss of imprinting of the insulin-like growth factor 2 gene, an epigenetic process, also is associated with Wilms tumor.\n\n\nOther syndromes or conditions with an increased risk of Wilms tumor include:\n\nHemihypertrophy,\nSporadic aniridia,\nGenitourinary anomalies,\nPearlman syndrome,\nSotos syndrome,\nNeurofibromatosis (von Recklinghausen disease), and Von Willebrand disease.\n\nAbout option 'c' Hypertension.\n\"Hypertension also has been described and probably is due to renal ischemia.\"- Nelson\nMore about Wilm's tumor (also k/a nephroblastoma):\n\nWilm's tumor is the most common renal neoplasm & 2nd most common malignant abdominal tumor, in children (Most common abdominal malignant tumor is neuroblastoma)\nPeak incidence is between 2 and 5 yrs of age.\n5-10% are bilateral; either both kidneys are involved simultaneously (synchronous) or one after the other (metachronous)\n\nClinical features of W.T.\n\nAbdominal lump (most common presenting feature)\nAbdominal pain\nVomiting\nHematuria\nHypertension\n\nTreatment:\n\nHigh cure rates of 80-90% can be achieved with multimodality treatment using surgery, chemotherapy & radiotherapy\nSurgical resection is done in all stages followed by chemotherapy (stage I&II) or chemotherapy + radiotherapy (stage III, IV, V)\nPre op chemotherapy is given in inoperable & bilateral cases\n\nChemotherapeutic agents used are Vincristine, Dactinomycin, Doxorubicin & Cyclophosphamide.", "cop": 4, "opa": "Hemihypertrophy", "opb": "Aniridia", "opc": "Hypertension", "opd": "Bilateral polycystic kidney disease", "subject_name": "Surgery", "topic_name": null, "id": "ba0e5700-7d01-4259-98e8-e1053b1eb8a9", "choice_type": "single"} {"question": "Most common sarcoma in a child is", "exp": "Ans. is 'b' i.e., Rhabdomyosarcoma", "cop": 2, "opa": "Fibrosarcoma", "opb": "Rhabdomyosarcoma", "opc": "Leiom yo sarcoma", "opd": "Liposarcoma", "subject_name": "Surgery", "topic_name": null, "id": "529387b7-0038-4720-8d6d-a02acd4e09b8", "choice_type": "single"} {"question": "Hippocrates facies is seen in", "exp": "Most cases of peritonitis are caused by an invasion of the peritoneal cavity by bacteria, so that when the term 'peritonitis' is used without qualification, bacterial peritonitis is implied.When the peritoneum becomes inflamed, the temperature, and especially the pulse rate, rise. Abdominal pain increases and usually there is associated vomiting. The most impoant sign is guarding and rigidity of the abdominal wall over the area of the abdomen that is involved, with a positive 'release' sign (rebound tenderness). Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-992,993", "cop": 1, "opa": "Peritonitis", "opb": "Pancreatitis", "opc": "Facial nerve injury", "opd": "Marginal mandibular nerve injury", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "6ca15464-fd9f-4b52-8991-c369a93a85c6", "choice_type": "single"} {"question": "Most common location of Subdural hematoma is", "exp": "Overall 85% of subdural haematomas are unilateral in adults. However, 75-85% are bilateral in infants. Common sites for subdural hematomas are frontoparietal convexities and the middle cranial fossa Reference: Textbook of Adult Emergency Medicine by Peter Cameron, 4th edition, page no: 78 :.", "cop": 3, "opa": "Temporoparietal", "opb": "Frontotemporal", "opc": "Frontoparietel", "opd": "Parieto-occipital", "subject_name": "Surgery", "topic_name": "Trauma", "id": "61a53e35-ee3d-470e-b130-caa8f6d34a1d", "choice_type": "single"} {"question": "In thyroid, the bruit is heard in", "exp": "Ans. (b) Upper pole.Ref: Rajamahendran Long Cases In Surgery- Page 32 2nd Edition* Systolic bruit may be heard in superior pole outwards due to increased vascularity.", "cop": 2, "opa": "Lower pole", "opb": "Upper pole", "opc": "Medial side", "opd": "Lateral side", "subject_name": "Surgery", "topic_name": "Thyroid Gland", "id": "a0aca6ec-05a7-452d-88bb-cbb6157b84a4", "choice_type": "single"} {"question": "Physiologic jaundice in term newborns is best characterized by", "exp": "A rise in serum bilirubin concentration of less... Physiologic jaundice in term newborns is characterized by the appearance of clinical jaundice after 24 hours, an increase in bilirubin concentration of less than 5 mg/dl/day, total serum bilirubin concentrations of less than 13 mg/dl, direct serum bilinibin levels of less than 1.5-2 mg/dl, and the resolution of jaundice by the age of 1 week. Jaundice related to breast-feeding is termed breastfeeding jaundice, which typically responds to temporary discontinuation of breast-feeding.", "cop": 4, "opa": "The onset of clinical jaundice by 12 hours of age.", "opb": "Persistence of clinical jaundice for at least 1 week.", "opc": "Equal elevation of direct and indirect serum bilirubin values", "opd": "A rise in serum bilirubin concentration of less than 5 mg/dllday", "subject_name": "Surgery", "topic_name": null, "id": "ea4c3ce2-7c22-4a3e-ab32-23f534501072", "choice_type": "single"} {"question": "Gene therapy is given in aEUR'", "exp": "Severe combined immunodeficiency [Ref KDT 6m/e p. 843, 8441 Gene therapy Gene therapy refers to introduction of functional genetic material usually D.N.A. into target cells to replace or supplement defective genetic material. In contrast to all other therapies or drugs, gene therapy impas, new functions to a cell. Gene defects result in.fallure to synthesize a functional protein or in the synthesis of a dysfunctional protein. Equipping the cell with a normal copy of the defective gene would overcome the deficieny at the site where it is needed on a long term. Approaches in gene therapy :? Gene therapy tries to either modify or transfer the genes. Gene modification This involves correction of the defective poion of a genomic sequence or removal of the whole defective gene and its replacement by a normal copy. Gene transfer This involves introduction of genes without removing or altering the existing ones. Gene transfer is carried out in the following ways? i) Injection of naked D.N.A. ii) Transfer of generic material using virus as a carrier with D.N.A. incorporated into its genome. iii) Transfer of D.N.A. encapsulated within a liposome Applications of Gene therapy (where genetherapy is being considered) :? Cystic fibrosis (inseion of CFTR gene into respiratory epithelial cells) Severe combined immunodeficiency disease (introducing genes for adenosine deaminase) Growth hormone deficiency Familial hypercholesterelimia Lysch Nyhan syndrome Parkinsonism Alzhiemer's disease, Huntington's chorea. Familial amyotrophic lateral sclerosis, Gaucher's disease Stroke, head injury, multiple sclerosis Duchenne muscular dystrophy Prevention of restenosis of grafted coronary vessel Anemia Sickle cell anemia Haemophilia HIV infection Cancers Current status of Gene therapy (www.Fda.gov/Biologic.s bloodvaccines/cellular gene therapy) The food and drug administration has not yet approved any human gene therapy product for sale. - Current gene therapy is experimental and has not proven very successful in clinical trials. - Clear cut success in gene therapy has been achieved in Severe combined immunodeficiency (adenosine deaminase deficiency). - But there were repos that children treated with gene therapy in severe combined immunodeficiency developed leukemia. - Based on current data, the efficacy of gene transfer, .for severe combined immunodeficiency is convincing there have been no complications in the six children treated on this protocol, but longer term follow up will be required to determine whether this approach is sufficiency safe to he used in place of pegylated form of the enzyme adenosine deaminase.", "cop": 4, "opa": "Cystic fibrosis", "opb": "Thalassemia", "opc": "Sickle cell anemia", "opd": "Severe combined", "subject_name": "Surgery", "topic_name": null, "id": "79d8b14a-f0ff-4333-a1da-a32b7b3d1073", "choice_type": "single"} {"question": "The most common cause of Superficial Thrombophlebitis is", "exp": "Ans is A i.e. Intravenous catheters/infusion", "cop": 1, "opa": "Intravenous catheters/infusion", "opb": "DVT", "opc": "Varicose veins", "opd": "Trauma", "subject_name": "Surgery", "topic_name": null, "id": "32459f94-1ff5-4c8d-8110-af7f478b2a2a", "choice_type": "single"} {"question": "Old male came with jaundice, palpable mass in the right hypochondrium not associated with pain.", "exp": "Ans. (a) Carcinoma Ampulla of VaterRef: Long cases surgery RRM* As per Courvoisier law\"GB palpable is due to cancer-Distal CBD or Periampullary cancer\"", "cop": 1, "opa": "Carcinoma Ampulla of Vaster", "opb": "Acute cholecystitis", "opc": "Chronic cholecystitis", "opd": "Chronic pancreatitis", "subject_name": "Surgery", "topic_name": "Gall Bladder & Bile Ducts", "id": "0b90f15f-d1b8-41cd-9543-348b18a31c6d", "choice_type": "single"} {"question": "Most common complication of Giant cell aeritis", "exp": "GIANT CELL AERITIS (TEMPORAL AERITIS) Superficial temporal, veebral & major aoic arch branches may be involved. Ischemic symptoms are common, including claudication of facial or extremity muscles & retinal ischemia Blindness, usually irreversible, is a dreaded complicated.", "cop": 3, "opa": "Stroke", "opb": "MI", "opc": "Blindness", "opd": "Renal failure", "subject_name": "Surgery", "topic_name": "Aerial disorders", "id": "70525068-a19a-445c-9d17-26367c65ea7d", "choice_type": "single"} {"question": "Intermittent claudication", "exp": "(A) Most common in calf region# INTERMITTENT CLAUDICATION:> Cramp like pain felt in the muscles that is brought on by walking, not present on taking the first step (OA) relieved by standing still (IVD)> The distance walked is called the claudication distance.> Most commonly felt in the CALF, but can affect the thigh or the buttock.> Less common in the upper limb (writhing or manual labor).CLINICAL SPECTRUM OF CLAUDICATIONIntermittent(Atherosclerosis)Neurogenic(Lumbar Spinal Stenosis)Venous(Deep Vein Thrombosis)* Pain is in the muscle of the calf, thigh or buttock* Pain is in whole leg can be associated with tingling and numbness* Involvement of whole leg* Unilateral in femoropopliteal disease* Bilateral (Can also be less commonly unilateral)* Patient may describe feeling their \"leg is going to burst\"* Bilateral in aorto-iliac disease* Comes on suddenly on standing up or walking* Most commonly unilateral* Gradual onset after walking \"claudication distance\"* Relieved by sitting down, bending over and stop walking* Gradual onset after beginning to walk* Pain is relieved by rest* Unable to straighten legs* Relief on elevating the leg* Absent/reduced pulses * Cyanosed* Varicose veins* edematousNB, The claudication distance is a constant distance the patient was able to walk before the onset of symptoms", "cop": 1, "opa": "Most common in calf region", "opb": "Occurs at rest", "opc": "Claudication distance is not consistent for an individual", "opd": "Pain is positional", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "b7857751-3e5e-404c-8ace-254aa3799b00", "choice_type": "single"} {"question": "Post gonococcal stricture urethra is most commonly situated in the", "exp": null, "cop": 1, "opa": "Bulbar Urethra", "opb": "Penoscrotal Jn.", "opc": "Distal part of spongy urethra", "opd": "Just distal to external meatus", "subject_name": "Surgery", "topic_name": null, "id": "6a36eaa5-52b2-4035-9ea1-5a34cad86f15", "choice_type": "single"} {"question": "Alpha feto protein is increased in", "exp": "Alpha fetoprotein AFP is a normal component of plasma protein of the fetus secreted by yolk sac and embryonal hepatocytes(fetal liver) which usually reduces after bih and persists as a low value level. Normal value is upto 10 ng/ml. It is an impoant tumour marker for hepatocellular carcinoma (100-1000 ng/ml). It also increases in non seminomatous testicular tumours, hepatoblastoma and some ovarian tumours(yolk sac tumours). It also increases in benign conditions (<100 ng/ml). It is useful in diagnosing omphalocele, ataxia telengiectasia, neural tube defects. Reference : page 594 SRB's manual of surgery 5th edition", "cop": 1, "opa": "Hepatoblastoma", "opb": "Neuroblastoma", "opc": "Seminoma", "opd": "Renal cell carcinoma", "subject_name": "Surgery", "topic_name": "Urology", "id": "3b22b4e2-5001-4f66-8770-02796f08747f", "choice_type": "single"} {"question": "The most common cause of pathological fracture is", "exp": "D i.e. Secondary deposits", "cop": 4, "opa": "Delayed union", "opb": "Mal union", "opc": "Non union", "opd": "Secondary deposits", "subject_name": "Surgery", "topic_name": null, "id": "1ff79ae3-0fba-41fe-8ac2-fcb4767c5a31", "choice_type": "single"} {"question": "A chronic alcoholic presents with abdominal pain radiating to the back that responds to analgesics. At evaluation the pancreatic duct was found to be dilated and stones were noted in the tail of pancreas. The most appropriate management is", "exp": "conservative (70-90%) is first to be done in acute pancreatitis due to any cause SRB,5th,686.", "cop": 4, "opa": "Pancreatic tail resection", "opb": "Pancreatico jejunostomy", "opc": "Percutaneous removal of stone", "opd": "Medical management", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "19d68d3d-5171-4a6f-b1f9-f1986480ea18", "choice_type": "single"} {"question": "IOC for acute appendicitis in children", "exp": ".", "cop": 1, "opa": "USG", "opb": "MRI", "opc": "CECT", "opd": "X ray", "subject_name": "Surgery", "topic_name": "All India exam", "id": "5bf37242-00f4-46a0-9acd-19f4bd8fb4a8", "choice_type": "single"} {"question": "Congenital hyperophic pyloric stenosis associated with", "exp": "Due to electrolyte changes because of vomiting, hypochloremic, hyponatremic, hypokalemic, hypocalcemic, hypomagnesemic alkalosis occurs with paradoxical aciduria. Reference: SRB 5th edition page no. 829", "cop": 2, "opa": "Hypokalemic acidosis", "opb": "Hypokalemic alkalosis", "opc": "Hyperkalemic acidosis", "opd": "Hyperkalemic alkalosis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "ae6111fc-be22-4ab4-b4be-9d14d7d7c8d7", "choice_type": "single"} {"question": "Investigation of choice to diagnose hyperophic pyloric Stenosis in infants is", "exp": "Ultrasonography is recommended because its sensitivity and specificity are close to 100% for this disease. Ultrasound is reliable and easily performed and has replaced barium studies as the main investigation.There is a normal variation of pylorus muscle measurements with age and gestation but ultrasound has a very high sensitivity and specificity.", "cop": 3, "opa": "Contrast radiology", "opb": "Gastroscopy", "opc": "Ultrasound abdomen", "opd": "CT scan abdomen", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "35c0afe3-4dd7-4455-8db7-37f5950bcb23", "choice_type": "single"} {"question": "In triage green color indicates", "exp": null, "cop": 1, "opa": "Ambulatory patients", "opb": "Dead or moribund", "opc": "High priority treatment or transfer", "opd": "Medium priority or transfer", "subject_name": "Surgery", "topic_name": null, "id": "a5814bc5-8d0c-4911-84ac-cb2ccbcb88d9", "choice_type": "single"} {"question": "Mikulicz's disease is", "exp": null, "cop": 3, "opa": "An inflammatory disease", "opb": "Neoplastic disease", "opc": "An autoimmune disease", "opd": "Viral infection", "subject_name": "Surgery", "topic_name": null, "id": "2c23f1e0-628e-46cd-8281-1235d5a39d33", "choice_type": "single"} {"question": "Treatment of Choice for Annular Pancreas", "exp": "Ans. (a) Duodeno duodenostomyRef: Bailey And Love 27th edition Page 1219* Annular Pancreas is the result of failure of complete rotation of ventral pancreatic bud during development, so that the ring of pancreatic tissue is surrounding the 2nd or 3rd part of pancreas.* Most common in down syndrome cases.* Presents with Vomiting in neonatal age.* Treatment is Duodeno Duodenostomy* In late cases presenting with pancreatitis - resection of head of pancreas is preferable to a lesser procedure than resection.", "cop": 1, "opa": "Duodeno duodenostomy", "opb": "Gastro jejunostomy", "opc": "Vagotomy and GJ", "opd": "Billroth 2 reconstruction", "subject_name": "Surgery", "topic_name": "Pancreas", "id": "e9686f93-2cad-4ecc-af80-8860c36b5703", "choice_type": "single"} {"question": "Treatment of choice for cystic hygroma is", "exp": "Definitive treatment for Cystic hygroma is complete excision of the cyst at an early stage if possible. Injection of a sclerosing agent is an alternative strategy and may reduce the size of the cyst, however they are usually multicystic and therefore complete resolution is a challenge. Reference : Bailey & Love, 27th Edition, page no = 754.", "cop": 4, "opa": "Percutaneous aspiration", "opb": "Intralesional sclerosant injection", "opc": "En-bloc resection", "opd": "Surgical excision", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "d38053d6-7013-4c40-9063-4c92cbf6b34f", "choice_type": "single"} {"question": "IV formula for Bum is", "exp": "A. i.e. (Total % body surface area x weight (kg) x 4 = volume (ml)) (384 -B &L 25th)* Simplest and most widely used formula is the Parkland formulaTotal % body surface area x weight (kg) x 4 = Volume (ml)* Half this volume is given in the first 8 hours and second half is given in the subsequent 16 hours* In children with bum over 10% TBS A and adults with bums over 15% TBSA, consider the need for intravenous fluid resuscitation* The key is to monitor urine output* The commonest colloid - based formula is the Muir and Barclay formula0.5 x % body surface area burnt x weight = one portion* * Ringer lactate is the most commonly used crystalloid", "cop": 1, "opa": "Total % body surface area x weight (kg) x 4 = volume (ml)", "opb": "Total % body surface area x weight (kg) x 5 = volumc/ml)", "opc": "Total % body surface area x weight (kg) x 6 = volume /ml)", "opd": "Total % body surface area x weight (kg) x 7 = volume (ml)", "subject_name": "Surgery", "topic_name": "Burns", "id": "d2ef7f96-c2d5-44e0-8c4e-f943a9e626f5", "choice_type": "single"} {"question": "Volkmann's ischaemic contracture mostly involves", "exp": "C i.e. Flexor digitorum profundus", "cop": 3, "opa": "Felxor digitorum superficialis", "opb": "Pronator teres", "opc": "Flexor digitorum profundus", "opd": "Flexor c arpi radialis longus", "subject_name": "Surgery", "topic_name": null, "id": "56974aaa-b442-4a1d-935b-588a090f6f29", "choice_type": "single"} {"question": "Treatment of choice for squamous anal carcinoma is", "exp": "Radiotherapy with concurrent chemotherapy (Chemoradiotherapy) is the standard of care for patients with nonmetastatic squamous cell anal cancer. Most patients treated with chemoradiotherapy have an excellent prognosis. Nigro Regime :Initial radiotherapy for 3 weeks 3000 rads (30 Gy total) to perineum and pelvis. Then chemotherapy--5 FU, for 4-5 days; is a radiosensitizer, staed on 1st day of as 1000 mg/m2 continuous infusion. Mitomycin C is 15 mg/m2 as single dose on 1st day of . Reference : page 987 SRB's manual of surgery 5th edition", "cop": 3, "opa": "Abdominoperineal resection", "opb": "Laser", "opc": "Chemoradiotherapy", "opd": "Platinum based chemotherapy", "subject_name": "Surgery", "topic_name": "Urology", "id": "7f35fd53-064c-4be5-b740-115087bbcc0f", "choice_type": "single"} {"question": "Most common Site of tongue Cancer", "exp": "Ans. (c) Lateral margin of tongueRef.: SRB Manual of Surgery 4th ed. /1310Squamous cell cancer of the tongue is the commonest cancer. The location is at the following sites* Lateral margin -50%* Posterior 1/3 rd tongue-20%* Dorsum-6.5%* Ventral surface- 6%* Tip-10%", "cop": 3, "opa": "Base of tongue", "opb": "Tip of tongue", "opc": "Lateral margin of tongue", "opd": "Posterior attachment of tongue", "subject_name": "Surgery", "topic_name": "Oral Cavity", "id": "db9c2f9e-49fa-4c05-b3c8-9675e3cc7811", "choice_type": "single"} {"question": "Burns with vesiculation, destruction of the epidermis and upper dermis is", "exp": null, "cop": 2, "opa": "1st degree", "opb": "2nd degree", "opc": "3rd degree", "opd": "4th degree", "subject_name": "Surgery", "topic_name": null, "id": "c6ad5632-ef25-449b-ae39-025f0cc55511", "choice_type": "single"} {"question": "According to Rule of Nine , burns involving perineum are", "exp": "BURNS in % BSA\n\nDetermination of burn size estimates the extent of injury.\nBurn size is assessed by Wallace rule of nines (By Alfred Russel Wallace)\n\nWallace Rule of Nines \n\nIn adults:\n\n- Each upper extremity: 9%\n- Head and neck: 9%\n- Lower extremities: 18%\n- Anterior and posterior aspects of the trunk: 18%\n- Perineum and genitalia: 1%\n\nChildren have a relatively larger proportion of body surface area in their head and neck, which is compensated by a relatively smaller surface area in the lower extremities.\n\n- In infants: Head and neck- 21%; Each leg-13%\n\nBerkow formula is used to accurately determine burn size in children.\nFor estimating smaller burns: Area of open hand (including palm and extended fingers) of the patient is approximately 1% of TBSA.\nThis method is helpful in evaluating splash burns and burns of mixed distribution.", "cop": 1, "opa": "1%", "opb": "9%", "opc": "18%", "opd": "27%", "subject_name": "Surgery", "topic_name": null, "id": "2f6509db-41e7-4977-b804-97847cc9da00", "choice_type": "single"} {"question": "Sensitive most investigation to detect minimal intraperitoneal free air", "exp": "Although as little as 1 ml of free gas can be demonstrated radiographically, either in chest PA or a left lateral decubitus abdominal film, CT is superior to plain radiographs in detecting minute quantities of pneumoperitoneum. Chest PA view is more sensitive than even a left lateral decubitus abdominal film.", "cop": 3, "opa": "Standing x-ray abdomen", "opb": "Right lateral decubitus x-ray", "opc": "Chest x-ray", "opd": "Left lateral decubitus x-ray", "subject_name": "Surgery", "topic_name": "All India exam", "id": "dd7a3e4b-7eaa-4391-809f-aacce49dd288", "choice_type": "single"} {"question": "A Poly A base sequence would be most likely found at the", "exp": "The addition of a poly A tail to the 3' end is one of the post-transcriptional modifications that occurs in the processing of eukaryotic messenger RNA (mRNA). A cap consisting of a guanosine derivative is attached to the 5' end. Intervening sequences (introns) are removed by splicing. All of these processing events occur in the nucleus of eukaryotes. Prokaryotic mRNA undergoes none of these modifications.", "cop": 4, "opa": "5' end of a prokaryotic messenger RNA (mRNA)", "opb": "3' end of a prokaryotic mRNA", "opc": "5' end of a eukaryotic mRNA", "opd": "3' end of a eukaryotic mRNA", "subject_name": "Surgery", "topic_name": null, "id": "757489e2-1d81-48b0-b83c-9015ebb54943", "choice_type": "single"} {"question": "Radioiodine is preferred for the treatment of", "exp": "Ans. (d) Diffuse toxic goiter in > 45 years old.Ref: Schwartz 10th edition, Page 1533Contraindications for RAI ablation in Graves' disease* Pregnancy* Lactation* Young (Children and adolescents)* Nodules in thyroid gland* Ophthalmopathy (Progression of Graves ophthalmopathy happens)", "cop": 4, "opa": "Young patient", "opb": "Pregnancy", "opc": "Recent onset of toxic goiter", "opd": "Diffuse Toxic goiter in > 45 years old", "subject_name": "Surgery", "topic_name": "Thyroid Gland", "id": "e6cfbf20-72d6-4eba-863a-92109a8b7667", "choice_type": "single"} {"question": "Hyperkalemia with no ECG finding. The drug that should not be used isaEUR'", "exp": "Calcium gluconate (Also see AIIMS May 2010) . Calcium gluconate is the fastest acting agent used in t/t of hyperkalemia. . In acts within nzinutes but an impoant point to note is that it does not cause transcellular movement of potassium, instead it acts on cell membrane. - It stabilizes the cardiac cell membrane and reduces chances of cardiac arryhthmia. - Thus it has no use when there are no E.C.G. features. NaHCO3 NaHCO3 has been routinely used in the treatment of hyperkalemia. It was believed that NaHCO3 caused movement of potassium inside the cells by causing alkalosis. But studies do not suppo this - They claim that NaHCO3 do not cause movement of potassium inside the cells in acute cases of hyperkalemia. - It only decreases potassium when there is coexisting acidosis. - NaHCO3 can decrease potassium level in chronic hyperkalemia. It increases potassium delivery to the kidney. But the use of NaHCO3 still continues in most hospitals and institutes across the world. - It is now hypothesized that NaHCO3 does not cause IC* entry inside the cell by mechanism earlier believed to be, but by another mechanism. The question does not say anything about acidosis. Don't think that acidosis occurs only in severe hyperkalemia. Most patients with C.R. F. present with acidosis and mild moderate hyperkalemia. In hyperkalemia with no E.C.G. feature, calcium prophylaxis is not indicated - Calcium gluconate is administered to stabilize the cardiac membrane - Instability of the cardiac membrane is indicated by E.C.G. changes - Absence of E.C.G. changes suggest that the cardiac membrane is stable. In these cases there is no use of calcium administration. Prophylactic calcium gluconate is of no use.", "cop": 2, "opa": "Sodium bicarbonate", "opb": "Calcium gluconate", "opc": "Glucose with insulin", "opd": "Resins", "subject_name": "Surgery", "topic_name": null, "id": "2672f81f-6579-42ba-8f30-e02dfb5fc990", "choice_type": "single"} {"question": "Commonest cause of non traumatic subarachnoid hemorrhage", "exp": "Ans. (b) Berry aneurysm ruptureRef: Bailey 26th 320 Schwartz 10th 1730* Most common cause of SAH - TRAUMA* Most common cause of non traumatic subarachnoid hemorrhage - BERRY ANEURYSM RUPTURE", "cop": 2, "opa": "Idiopathic", "opb": "Berry aneurysm rupture", "opc": "Hypertension", "opd": "AV malformation", "subject_name": "Surgery", "topic_name": "Nervous System", "id": "a808bf6b-8d1e-4555-9fe3-666ec1150eba", "choice_type": "single"} {"question": "The Father of Modern Surgery is", "exp": "Though it may seem ridiculous to remember the names of innumerable scientists and personalities it assumes great impoance in view of the current trend of AIPGME and AIIMS exams which contain at least 1 persona based question each time. Here is a comprehensive list of all the FATHERS of all our SUBJECTS : Father of Anatomy Herophilus of Chalcedon Father of Physiology Claude Bernard Father of Microbiology Louis Pasteur Father of Bacteriology Sir Robe Koch Father of Chemotherapy Paul Ehrlich Father of Pharmacology Oswald Schmiedberg Father of Modern Pathology Rudolf Virchow Father of Forensic Medicine Bernard Spillsbury Father of Modern Epidemiology John Snow Father of Occupational Health Ramazzini Father of Modern Medicine Hippocrates Father of Indian Medicine Charaka Father of American Medicine William Osler Father of Modern Surgery Ambroise Pare Father of Indian Surgery Sushruta Father of Antiseptic Surgery Joseph Lister Father of Modern Inguinal Hernia Surgery Edoardo Bassini Father of Thyroid Surgery Emil Kocher Father of Genetics Gregor Mendel Father of Modern Human Genetics Dr Victor A. McKusick Father of Psychoanalysis Sigmund Fruend Father of Porphyrin chemistry Hans Fischer Father of PTCA Andreas Gruntzig Father of Modern Psychiatry Johann Weyer Father of American Psychiatry Benjamin Rush Father of Biology Aristotle Father of Diagnostic Imaging Roentgen", "cop": 3, "opa": "Sushruta", "opb": "Claude Bernard", "opc": "Ambroise Pare", "opd": "Andrews Gruntzig", "subject_name": "Surgery", "topic_name": "General surgery", "id": "c504aaeb-8649-4d50-8830-1c7063c319b6", "choice_type": "single"} {"question": "Treatment of malignant hyperthermia is", "exp": null, "cop": 3, "opa": "Propranolol", "opb": "Halothane", "opc": "Dantrolene", "opd": "Nitrous oxide", "subject_name": "Surgery", "topic_name": null, "id": "8322f496-2130-4b53-b1ab-e7389cd8cf88", "choice_type": "single"} {"question": "The most common complication of ERCP", "exp": "ERCP carries additional risks. Pancreatitis occurs in about 5% of patients undergoing ERCP and is seen in up to 25% of patients with sphincter of Oddi dysfunction. Young anicteric patients with normal ducts are at increased risk. Post-ERCP pancreatitis is usually mild and self-limited but may infrequently result in prolonged hospitalization, surgery, diabetes, or death. Bleeding occurs after 1 % of endoscopic phincterotomies. Ascending cholangitis, pseudocyst infection, and retroperitoneal perforation and abscess may all occur as a result of ERCP. Common cause of pancreatitis 1. Gallstones (including microlithiasis) 2. Alcohol (acute and chronic alcoholism) 3. Hyperiglyceridemia 4. Endoscopic retrograde Cholangiopancreatography (ERCP), especially after biliary manometry 5. Trauma (especially blunt abdominal trauma) 6. Postoperative (abdominal and non abdominal operations) 7. Drugs (azathioprine, 6-mercaptopurine, sulfonarnides, estrogens, tetracycline, valproic acid, anti-HIV medications) 8. Sphincter of Oddi dysfunction.", "cop": 1, "opa": "Acute pancreatitis", "opb": "Acute Cholangitis", "opc": "Duodenal perforation", "opd": "Acute cholecystitis", "subject_name": "Surgery", "topic_name": null, "id": "a1292050-3005-4d0c-9e06-785a083d129f", "choice_type": "single"} {"question": "In Recurrent Anterior dislocation of shoulder, the movements that causes dislocation is", "exp": "B i.e. Abduction & external rotation", "cop": 2, "opa": "Flexion and internal rotation", "opb": "Abduction and external rotation", "opc": "Abduction and internal rotation", "opd": "Extension", "subject_name": "Surgery", "topic_name": null, "id": "dad135cb-46b0-4099-b60c-a96a27396649", "choice_type": "single"} {"question": "Looser's zone is present in September 2010 March 2013 (a, f)", "exp": "Ans. B: Osteomalacia Pseudo-fracture (Looser zone): A lucent band of decreased coical density Perpendicular to bone surface Often multiple, +/- symmetrical +/- callus formation \"Pathognomonic\" of osteomalacia and seen on compressive (concave) side (eg, prox femur) Also seen in Paget dz on tensile (convex) side", "cop": 2, "opa": "Multiple myeloma", "opb": "Osteomalacia", "opc": "Pseudoparathyroidism", "opd": "Osteoporosis", "subject_name": "Surgery", "topic_name": null, "id": "efbe695e-d04a-481e-adcc-4b7f4f99b472", "choice_type": "single"} {"question": "Maastricht classification of category 3 stands for DCD donor\nstands for", "exp": null, "cop": 4, "opa": "Brought dead", "opb": "Cardiac arrest during brain dead", "opc": "Cardiac arrest and unsuccessful resuscitation in hospital", "opd": "Awaiting cardiac arrest after withdrawl of life support", "subject_name": "Surgery", "topic_name": null, "id": "d5bd8255-47d5-412f-aaea-d644049aa681", "choice_type": "single"} {"question": "An ulcer that may develop in burn tissue is", "exp": "Marjolin's ulcer is the name given to a malignancy (usually sq cell ca) which arises in a:\n\nany long-standing wound or\na scar: eg scar of an old burn\n\n\nIt presents the following characteristics\nIt grows slowly as the scar is relatively avascular\nIt is painless as scar tissue contains no nerves.", "cop": 1, "opa": "Marjolins", "opb": "Rodent", "opc": "Melanoma", "opd": "Curlings", "subject_name": "Surgery", "topic_name": null, "id": "b4927e86-b0a7-4d63-9eed-103943eb8644", "choice_type": "single"} {"question": "Charcot's/neuropathic joint are most commonly seen in", "exp": ".", "cop": 1, "opa": "Diabetes Mellitus", "opb": "Spyringomyelia", "opc": "Leprosy", "opd": "Rheumatic Ahritis", "subject_name": "Surgery", "topic_name": "Trauma", "id": "6fe0d6a1-cc5c-4975-98ba-77700d6f31fa", "choice_type": "single"} {"question": "A patient was operated 2 months back and at that time a midline incision was used. Now he requires a second operation and this the ideal incision to be used now is", "exp": "(B) The scar of the previous incision is excised and the same incision is used # Scar of the previous incision is excised and the same incision is used .> We should not create more scars on patient body unnecessarily.> If it is possible we have use the same scar.", "cop": 2, "opa": "A fresh transverse incision", "opb": "The scar of the previous incision is excised and the same incision is used", "opc": "The same incision used without excision of old scar", "opd": "A paramedian incision is to be used", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "1bf2e4e5-0925-47a8-a481-b5a84d8412f2", "choice_type": "single"} {"question": "Adson test is used for determining vascular suffiency. It is useful in", "exp": null, "cop": 3, "opa": "Peripheral vascular disease", "opb": "Varicose veins", "opc": "Cervical rib", "opd": "AV fistula", "subject_name": "Surgery", "topic_name": null, "id": "1680ce83-7d23-4014-ad4b-afc17f5c66d8", "choice_type": "single"} {"question": "Human papillomavirus is most commonly associated with", "exp": "Papillomavirus infects the skin or mucosa and causes benign tumors. The lesion is termed condyloma acuminatum. These tumors may undergo malignant conversion and become squamous cell carcinomas. Classification of the human papillomavirus is done by DNA hybridization, and to date 46 types have been recognized. Some types, such as 16 and 18 are more frequently associated with carcinoma, while others, such as 6 and 11, are associated with benign tumors or was.", "cop": 3, "opa": "Rectal polyps", "opb": "Prostate cancer", "opc": "Condyloma acuminatum", "opd": "Hepatic carcinoma", "subject_name": "Surgery", "topic_name": null, "id": "57964548-a9d9-46c5-8d55-275a9d0be79f", "choice_type": "single"} {"question": "Spigelian hernia occurs through", "exp": "Ans) b (Aponeurotic ....) Ref Sabiston 18th ed pg 1214Spigelian herniaOccurs through the spigelian fascia which is composed of the aponeurotic layer between the rectus muscle medially and the semilunar line laterally. Small -1 -2cm in diameter.Develop during the fourth to seventh decades of life.Localised pain in the area without a bulge (beneath the intact external oblique aponeurosis.)USG or CT abdomen confirms diagnosis.Risk for incarceration due to its relatively narrow neck.Obturator herniaWeakening of obturator membrane covering obturator canal. Obturator canal is formed by union of the pubic bone and ischium.Causes intestinal incarceration & strangulation.Howship-Romberg sign - compression of the obturator nerve which causes pain in the medial aspect of thigh.One half of patients present with complete or partial bowel obstruction.CT abdomen confirms diagnosis.Lumbar herniaEither congenital or acquired & occur in the lumbar region of the posterior abdominal wall. Hernias through superior lumbar triangle are more common.Superior lumbar triangle (Grynfeltt's triangle)- bounded by the 12,h rib, paraspinal, and internal oblique muscle.Inferior lumbar triangle (Petit's triangle)- bounded by the iliac crest, latissimus dorsi muscle, & external oblique muscle.Lumbar hernias are not prone to incarceration.Some named hernias1) Richter's hernia -Hernia in which the sac contains only a portion of the circumference of the intestine (usually small intestine). It usually complicate femoral & rarely Obturator hernia.2) Laugier's femoral hernia -This is a hernia through a gap in the lacunar (Gimbernat's) ligament. The hernia commonly strangulates.3) Narath's femoral hernia -Occurs only in patients with congenital dislocation of the hip & is due to lateral displacement of psoas muscle. Hernia is hidden behind the femoral vessels4) Cloquet's hernia -Sac lies under the fascia covering the pectineus muscle. Sac may co exist with the usual type femoral hernia sac5) Spigelian hernia -Hernia occurs through the linea semilunaris at the level of arcuate line i.e, a few centimeters above the inguinal ligament. Victims are above 50 years of age.6) Lumbar hernia -Occurs through Petit's triangle bounded below by crest of the ilium, laterally by the external oblique & medially by latissimus dorsi7) Hernia-en-glissade or Sliding hernia -A piece of extraperitoneal bowel, usually the caecum on the right side or the pelvic colon on the left side or the urinary bladder on either sides slides down out side the hernial sac forming a part of its wall being covered by the peritoneum on the hernial aspect only. Since left side is much more common than right side Sigmoid is the most common content of sliding hernia8) Littre'shernia -Hernia which contains Meckel's diverticulum9) Maydl's hernia or Hernia-en-w or Retrograde strangulation -Two loops of bowels remains in the sac & the connecting loop remains within the abdomen and be- comes strangulated.10) Gibbon's hernia - it is hernia with hydrocele11) Berger's hernia - Hernia in pouch of Douglas", "cop": 2, "opa": "Superior lumbar triangle", "opb": "Aponeurotic layer between rectus muscle and semilunar line", "opc": "Membrane covering canal between pubic bone & ischium", "opd": "Inferior lumbar triangle.", "subject_name": "Surgery", "topic_name": "Hernia", "id": "54e809b4-bb9a-49f0-b07d-0dea734d5ce6", "choice_type": "single"} {"question": "Most common cause of urethral stricture is", "exp": "Urethral stricture CAUSES The common causes of urethral stricture are: * Inflammatory * Secondary to urethritis * Secondary to balanitis xerotica obliterans (BXO) * Traumatic (MC) * Bulbar urethral injury * Pelvic fracture urethral disruption injury * Iatrogenic * Secondary to urethral instrumentation including cath- eterisation and transurethral prostatectomy * Secondary to radical prostatectomy * Secondary to radiotherapy for prostate cancer * Idiopathic CLINICAL FEATURES Symptoms are usually hesitancy of micturition, straining to void and a poor urinary stream. The relative youthfulness of the patient often rules out prostatic enlargement, which characteristically occurs after the age of 50. As the stream becomes narrower, micturition is prolonged and is followed by postmicturition dribbling as a result of urine trickling from the dilated urethra proximal to the stricture. Urinary frequency by day and night is common and is due to incomplete bladder emptying, coexisting detrusor overactivity or urinary infection. If the stricture is tight enough, the patient will go into acute retention, although this is rare. If this happens, there is a danger that clumsy attempts to pass a urethral catheter will result in a false passage. If a patient has gone into retention because of a urethral stricture, its lumen will be too narrow to pass even a tiny catheter and suprapubic catheterisation is required. Investigation involves uroflowmetry, urethroscopy, urethrography and ultrasound scanning to assess bladder emptying and to detect any upper tract dilatation. The urinary flow rate is typically prolonged and plateau shaped while urethroscopy allows the stricture to be viewedas a circumferential scar. Openings of false passages commemorate previous misguided attempts to pass a urethral catheter. Urethrography using a water-soluble contrast medium will show the extent and severity of the stricture Ref: Bailey and love 27th edition Pgno : 1482", "cop": 1, "opa": "Trauma", "opb": "Infection", "opc": "Congenital", "opd": "Post endoscopy", "subject_name": "Surgery", "topic_name": "Urology", "id": "85c2c1ef-e36a-4240-bd6c-fb614655b4c9", "choice_type": "single"} {"question": "The best treatment for the following skin lesion is", "exp": "This is a case of basal cell carcinoma of skin. The most frequently occurring form of skin cancer BCCs are abnormal, uncontrolled growths or lesions that arise in the skin's basal cells, which line the deepest layer of the epidermis (the outermost layer of the skin). BCCs often look like open sores, red patches, pink growths, shiny bumps, or scars. Usually caused by a combination of cumulative UV exposure and intense, occasional UV exposure, BCC can be highly disfiguring if allowed to grow, but almost never spreads (metastasizes) beyond the original tumor site.", "cop": 3, "opa": "Radio therapy", "opb": "Chemotherapy", "opc": "Surgery", "opd": "Immunotherapy", "subject_name": "Surgery", "topic_name": "All India exam", "id": "c293325d-5ed4-43e9-ab6f-fb66bbd67bba", "choice_type": "single"} {"question": "Long standing goitre leads to", "exp": "Long standing goitre leads to cancer, usually follicular. Dominant or rapidly growing nodules in longstanding goitres should always be subjected to aspiration cytology. Reference: Bailey & Love's Sho Practice of Surgery, 27th Edition, page no= 807.", "cop": 1, "opa": "Follicular carcinoma", "opb": "Colloid carcinoma", "opc": "Medullary carcinoma", "opd": "Papillary carcinoma", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "a92998a6-102c-44c7-a31f-ff2efa2a82a8", "choice_type": "single"} {"question": "Tumor with perineural invasion", "exp": ".SRB&;S Manual of Surgery 4th edition pg Adenoid cystic carcinoma has got high affinity for perineural spread both axially and circumferentially, antegrade and retrograde fashion along mandibular and maxillary divisions of trigeminal nerve and facial nerve. It infiltrates nerve more proximally for long distance. Tumor may reach Gasserion ganglion, pterygopalatine ganglion and cavernous sinus.", "cop": 2, "opa": "Adenocarcinoma", "opb": "Adenoid cystic Ca", "opc": "Basaal cell Ca", "opd": "Squamous cell ca", "subject_name": "Surgery", "topic_name": "General surgery", "id": "4a9d72f7-b797-4672-a910-c099569251a3", "choice_type": "single"} {"question": "Seabrocks operation is done for", "exp": "Ans. (a) Parotid FistulaRef: SRB Manual of surgery, 4th ed p-438-39* Parotid fistula usually results following surgery or Trauma or infection* Fistulas from Parotid gland usually heals* Fistulas from duct wont heal and will need Newman and Seabrook operation - reconstruction of duct by double cannulation.", "cop": 1, "opa": "Parotid fistula", "opb": "Thyroglossal fistula", "opc": "Thyroglossal cyst", "opd": "Branchial fistula", "subject_name": "Surgery", "topic_name": "Salivary Gland", "id": "8c3d7206-af07-4400-af29-2fdea94ace99", "choice_type": "single"} {"question": "Most common renal tumour is", "exp": "(Renal cell carcinoma) (1329-30-LB) (1309-B &L 25th)Renal neoplasmBenignMalignant neoplasms* Adenoma* Wilm's tumour (Nephroblastoma in children)* Angioma* Grawitz tumour (Adenocarcinoma, hypernephroma)* Angiomyolipoma* Transitional cell carcinoma of the renal pelvis and collecting system* Squamous carcinoma of the renal pelvis* Renal cell carcinoma (Hypernephroma, Grawitz tumour). This is adenocarcinoma and is the most common neoplasm (75%) of the kidney.", "cop": 1, "opa": "Renal cell carcinoma", "opb": "Wilm's tumour", "opc": "Squamous cell carcinoma of the renal pelvis", "opd": "Transitional cell carcinoma of the renal pelvis", "subject_name": "Surgery", "topic_name": "Kidney & Ureturs", "id": "0bec9d05-74f4-4bcf-be50-093bf0d4e3b7", "choice_type": "single"} {"question": "Moon's molars seen with", "exp": "Moon's- or Mulberry Molar is a condition where the first lower molar tooth has become dome-shaped due to malformation by congenital syphilis.", "cop": 1, "opa": "Syphilis", "opb": "Leprosy", "opc": "Amyloidosis", "opd": "Actinomycosis", "subject_name": "Surgery", "topic_name": null, "id": "7de78ad9-cae6-4252-ab66-36a8d8578eb7", "choice_type": "single"} {"question": "Earliest tumor to appear after birth is", "exp": null, "cop": 1, "opa": "Cystic hygroma", "opb": "Lymphoma", "opc": "Branchial cyst", "opd": "Sternomastoid tumor", "subject_name": "Surgery", "topic_name": null, "id": "16715d45-987d-444e-a4ce-83a40f9f27da", "choice_type": "single"} {"question": "Commonest treatment of Branchial cyst", "exp": "A branchial cyst probably develops from the vestigial remnants of the second branchial cleft, is usually lined by squamous epithelium, and contains thick, turbid fluid full of cholesterol crystals. The cyst usually presents in the upper neck in early or middle adulthood and is found at the junction of the upper third and middle third of the sternomastoid muscle at its anterior border. It is a fluctuant swelling that may transilluminate and is often soft in its early stages so that it may be difficult to palpate. If the cyst becomes infected it becomes erythematous and tender and, on occasions, it may be difficult to differentiate from a tuberculous abscess. Ultrasound and fine-needle aspiration both aid diagnosis and treatment is by complete excision, which is best undeaken when the lesion is quiescent. Although the anterior aspect of the cyst is easy to dissect, it may pass backwards and upwards through the bifurcation of the common carotid. Bailey & Love,5th,727", "cop": 3, "opa": "Cystectomy", "opb": "Aspiration", "opc": "Excision", "opd": "Nothing done", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "5d10159b-1c13-4072-97de-b058a048178f", "choice_type": "single"} {"question": "A 20 years male patients following road traffic accident presented with pulse 100/minute, BP 100/70 mmHg and Respiratory rate 21/minute. The chest move in inspiration and move out in expiration. Diagnosis is", "exp": "i.e. (Flail chest): (689-Schwartz 7th) (161, 179-190- CSDT 13th)FLAIL CHEST - Massive trauma to the chest with multiple fracture of multiple ribs or bilateral disruption of the costo chondral junctions can result in free floating segment of chest wall may produce a paradoxical motion that impairs lung expansion.Flail chest is characterized by paradoxical motion of the chest wall (inward with inspiration and outward with expiration) The chances of having an intra thoracic injury in this situation increases several folds PaCO2 increases. In addition hypoventilation leads to progressive atelectasis and hypoxemia (and most important consequence of flail chest is respiratory failure).* PaO2: FiO2 ratio yields an estimate of the extent of intrapulmonary shunt and may be used as a parameter to determine the need for mechanical ventilationTreatment* Analgesia intercostal nerve block, epidural anaesthesia* Endotracheal intubation and mechanical ventilation with peak end expiratory pressure are usually indicated provided that pain control is adequate* Intubation is delayed until clear evidence of a need of ventilator suport develops; a respiratory rate of 40/min, a falling PaCO2 (evidence of excessive work of breathing) or a PaO2 below 60 torr or inspired O2 fraction of over 0.5 (689-Schwartz 7th)* Suggested parameters for instituting ventilator support are respiratory rate >30 breaths per minute PaO2 <60 mmHg or PaCO2 >45 mmHg (894-W.Shields 7th)* Open reduction plus internal fixation of sternal or rib fractures is rarely neededTENSION PNEUMOTHORAX - develops when a flap valve leak allows air to enter the pleural space but prevents its escape, intrapleural pressure rises, causing total collapse of the lung and a shift of the mediastinal viscera to the opposite side interfering with venous return to the heart It must be relieved immediately to avoid impairment of cardiac functionsCP- hypotension in the presence of distended neck veins, decreased or absent breath sounds of the affected side hyper resonance to percussion and tracheal shift away from the affected side, cyanosis (late manifestation)Treatment - Insertion of a large bore needle or plastic IV cannula (angiocath) through the chest wall into the pleural space in the second intercostal space in the second intercostal space along the mid clavicular line to relieve pressure. Tension pneumothorax should be treated definitively by tube thoracostomy.Suckling chest wound - which allow air to pass in and out of the pleural cavity should be promptly treated by a three sided occlusive dressing and tube thoracostomy", "cop": 1, "opa": "Flail chest", "opb": "Tension pneumothrax", "opc": "Suckling chest wound", "opd": "Haemothorax", "subject_name": "Surgery", "topic_name": "Trauma", "id": "1d125b3c-c6fd-4f8f-8624-be2b9e704274", "choice_type": "single"} {"question": "Terminal heamaturia occurs in", "exp": "(Prostatic urethra) (411, 434. S. Das-clinical surgery 7th)* Most common cause of haematuria is cystitis**Bladder stone - Heamaturia is characterised by the passage of a few drops of bright-red blood at the end of micturition and is due to the stone abrading the vascular trigone-a fact that also accounts for the pain (1348-LB)* Blood appears at the beginning of the act (urethral) towards the end of the act (vesical) or is intimately mixed throught the process (prerenal, renal or vesical). S. Das* Painless, profuse and paroxysmal heamaturia is the main and only symptom of Papilloma* Common cause of isolated heamaturia includes - stones, neoplasms, TB, trauma, and prostatitis* * Urogenital neoplasms in patients with isolated painless heamaturia (non dysmorphic RJBCs) increases with age (251-H)* Best answers is urinary bladder (vesical) (1286 -B &L 25th)", "cop": 2, "opa": "Urethra", "opb": "Prostatic urethra", "opc": "Kidney", "opd": "Prolate", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "6a37ea21-3ed8-4a72-9885-ef343594f09c", "choice_type": "single"} {"question": "IV fluid replacement in a trauma patient is determined by", "exp": "Adequacy of fluid replacement should be checked with hemodynamic stability and urine output. When very large fluid shifts are expected and the patient has compromised renal insufficiency it is necessary to monitor fluid status using central venous pressure(CVP). Manipal manual of surgery-Shenoy,4th edition,pg", "cop": 1, "opa": "Urine output", "opb": "Chest condition", "opc": "CVP", "opd": "BP", "subject_name": "Surgery", "topic_name": "General surgery", "id": "2698da84-1c2b-4454-8852-c06a146a4c28", "choice_type": "single"} {"question": "Commonest presentation of Hodgkin's lymphoma is", "exp": "Most patients present with palpable lymphadenopathy that is nontender; in most patients, these lymph nodes are in the neck, supraclavicular area, and axilla. More than half the patients will have mediastinal adenopathy at diagnosis, and this is sometimes the initial manifestation. Subdiaphragmatic presentation of Hodgkin's disease is unusual and more common in older males.", "cop": 3, "opa": "Pruritis", "opb": "Fever", "opc": "Painless enlargement of lymph node", "opd": "Leucocytosis", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "870c6b9d-9954-41e7-90f6-66c79a771da2", "choice_type": "single"} {"question": "Reconstruction surgery in breast carcinoma, Best myocutaneous flap is", "exp": "D. i.e. (Transverse rectus abdominis) (1241 - CSDT 12th) (845 -B&L 25th) (737 - S. Das 5th)* Majority surgeons now prefer to use transverse rectus abdominis (TRAM-flap) - TRAM- flap reconstruction results in a soft natural and ptotic breast and avoids the need for additional prosthetic volume replacement. Excellent cosmetic results are achieved at the expanse of 5 -7 days hospital stay, a 4 to 6 weeks convalescent period and an overall complication rate of 16% to 28%BREAST - RECONSTRUCTION is new regarded as an integral part of breast cancer management and is requested with increasing frequency by informed women at the time of mastectomy* The easiest type of reconstruction is using a silicone gel implant under the pectoralis major muscle* The latissimus dorsi myocutaneous flap is used most often for reconstruction of breast with an implant* Abbey - Estlander flap used for lip* ** that may be used to correct a tight upper lip due to severe tissue deficiency (1238 - CSDT 12th)* Abbey estlendes flap is based on Labial artery*** Lingual nerve block is given in neck of mandible**", "cop": 4, "opa": "Pectoralis minor", "opb": "Pectoralis major", "opc": "Latissimus dorsi", "opd": "Transverse rectus abdominis", "subject_name": "Surgery", "topic_name": "Breast", "id": "94a09852-2028-427d-9b65-5e14710f00ed", "choice_type": "single"} {"question": "Seabrooks operation is done for", "exp": "Parotid Fistula Internal fistula opens inside the mouth and doesn't give rise to symptoms External fistula : Gland fistula or duct fistula Causes Rupture of parotid abscess Inadveent incision during drainage of parotid abscess Penetrating injury After superficial parotidectomy Clinical presentation When the external fistula is connected to the gland, external opening is pinpoint, though discharge is present for several months, usually closes spontaneously When external fistula is connected with major duct, there is outpouring of parotid secretions onto cheek during meals with excoriation of surrounding skin Diagnosis Sialography or sialogram Treatment Newman and Seabrock's operation (in case of fistula connected with main duct, this operation reconstructs the duct) Ref: Bailey and love 27th edition Pgno : 778", "cop": 1, "opa": "Parotid gland", "opb": "Thyroglossal fistula", "opc": "Thyroglossal cyst", "opd": "Branchial fistula", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "a048b226-6dad-4485-a190-6286a687f3be", "choice_type": "single"} {"question": "The treatment of annular pancreas is", "exp": "Duodenal obstruction typically causes vomiting in neonate.The usual treatment is bypass(duodenoduodenostomy) Bailey & Love ,26th,1125.", "cop": 2, "opa": "Gastro-jejunostomy", "opb": "Duodeno-duodenostomy", "opc": "Duodeno-jejunostomy", "opd": "Gastro-duodenostomy", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "b26695c3-f63d-47f8-ba52-ba23cca04508", "choice_type": "single"} {"question": "Age for regular mammography is", "exp": "Screening mammography: For screening purpose it is done after 40 years. Early screening is indicated when there is family history of carcinoma breast or histological risk factor. Mammography before 35 years of age is usually not done unless there is a suspicious lump or a strong family history. Screening is done in asymptomatic female where even cancer is suspected. Ref; (page no; 515) 5th edition of SRB&;S manual of Surgery.", "cop": 3, "opa": "20", "opb": "30", "opc": "40", "opd": "50", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "a9fed167-929e-4a5a-a15d-863cb70919d8", "choice_type": "single"} {"question": "The following can lead to increased Intra cranial pressure accept", "exp": "Ans. (d) MigraineRef: Sabiston 20th Page 1934* Hemorrhage within the cranium cause a rise in ICP* Meningitis causes fever malaria altered mental status and increase in ICP.", "cop": 4, "opa": "Meningitis", "opb": "Subarachnoid Hemorrhage", "opc": "Subdural hemorrhage", "opd": "Migraine", "subject_name": "Surgery", "topic_name": "Nervous System", "id": "0c02ec1c-b75b-47cc-9e7e-31cc7de93d29", "choice_type": "single"} {"question": "Thyroid carcinoma with pulsating vascular skeletal metastasis is", "exp": "In Follicular carcinoma the Blood-borne metastases are more common and the eventual moality rate is twice that of pappillary cancer. bone secondaries are typically vascular ,warm pulsatile, localised,commonly in skull,longbones, ribst. ref ;(page no;794)25th edition of Bailey and love&;s sho practice of surgery", "cop": 1, "opa": "Follicular", "opb": "Anaplastic", "opc": "Medullary", "opd": "Papillary", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "3f5c636e-ee84-43d5-a2bb-7c32e9c8210b", "choice_type": "single"} {"question": "Most common site of lentigo maligna melanoma is", "exp": null, "cop": 1, "opa": "face", "opb": "legs", "opc": "trunks", "opd": "soles", "subject_name": "Surgery", "topic_name": null, "id": "f00ceaeb-cc90-4a58-8423-b17e5ff57a46", "choice_type": "single"} {"question": "The compression fracture is commonest in", "exp": "C i.e. Lower thoracic spine - Aproximately 90% of all spinal fractures occur in the thoracic and lumbar spines. Infact, the majority of thoracic and lumbar injuries occur with in the region between T11 & L1, commonly referred as thoraco- lumbar junction. - Compression/ wedge fractures involves bucking , or fracture of anterior and middle aspect of veebral body (unlike burst , there is no involvement of posterior veebral body). Axial loading with a flexion movement is the mechanism of injury. - Osteoporosis is the most common cause of multiple compression fractures - Compression fractures are most common in thoracolumbar spineQ (lower dorsal > upper lumbar)Q.", "cop": 3, "opa": "Cervical spine", "opb": "Upper thoracic spine", "opc": "Lower thoracic spine", "opd": "Lumbosacral region", "subject_name": "Surgery", "topic_name": null, "id": "4c5348c3-4700-4fef-bba4-a16a9adef305", "choice_type": "single"} {"question": "The normal ankle brachial pressure index (ABPI) is 1.0.A value of 0.8 suggests", "exp": ". The normal value of Ankle Brachial Pressure index (ABPI) will be less than 0.3.one should check blood pressure in all the 4 limbs.ABPI is checked in supine position;systolic blood pressure in upper and lower limbs is checked and higher value of each extremities is taken;ABPI is calculated.Results->0.9 is normal ;.70-0.89 is mild disease; 0.50-0.69 is moderate;< 0.50 is severe. Refer page no 171 of SRB's manual of surgery 5 th edition.", "cop": 2, "opa": "Good flow", "opb": "Some degree of alterial obstruction", "opc": "Impending gangrene", "opd": "Presence of collaterals", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "5db0a202-d4f1-4345-bf2e-d14b26225105", "choice_type": "single"} {"question": "Investigation of choice in appendicitis in adults", "exp": "Answer- A. CT Scan", "cop": 1, "opa": "CT Scan", "opb": "USG", "opc": "Serum ESR", "opd": "MRI Abdomen", "subject_name": "Surgery", "topic_name": null, "id": "f973a066-51eb-4914-8306-e7e125a332af", "choice_type": "single"} {"question": "Pheochromocytomas if extra adrenal are most commonly located in", "exp": "Ans. (a) Posterior mediastinumRef: Bailey and love, 26th ed; pg. 869* Neurogenic tumors derived from the sympathetic nervous system or the peripheral nerves, more common in posterior mediastinum.* Mostly incidental findings in Chest radiograph* May be painful also* Includes neuroblastoma in childhood* Schwannomas and neurofibromas in adults, which are usually benign.* Pheochromocytoma arises from the sympathetic chain and produces the characteristic endocrine syndrome.* Excision of neurogenic tumors by thoracotomy, for smaller tumors a VATS approach done.", "cop": 1, "opa": "Posterior mediastinum", "opb": "Superior mediastinum", "opc": "Anterior mediastinum", "opd": "Middle mediastinum", "subject_name": "Surgery", "topic_name": "Pancreas", "id": "ea7061e6-4b2b-4401-bd63-cc8549ee25fd", "choice_type": "single"} {"question": "Controlled hyperventilation (induced hypocapnia) is frequently recommended following head trauma. The therapeutic consequences of this therapy include", "exp": "Controlled hyperventilation to a PaCO2 of 25 kPa raises tissue pH, increases cerebrovascular resistance, decreases cerebral blood flow, and consequently reduces intracerebral pressure (ICP). In the effort to avoid brain swelling by lowering cerebral blood flow and ICP, the clinician must be wary of causing ischemic brain damage through hypoperfusion. The metabolic compensation to induced hypocapnia leads to normalization of the pH by loss of bicarbonate (metabolic acidosis), and over 8-24 h the beneficial effects of the hypocapnia will have been lost. The partial pressures of carbon dioxide should be allowed to slowly return to normal and should be held in reserve in case unanticipated increases in ICP require another pulse of short-term reduction. It is important to monitor the patient while the PaCO2 is rising because untoward or rapid increases in ICP may occur in response to the rising cerebral blood flow.", "cop": 3, "opa": "Reduction of endogenous catecholamines", "opb": "Reduction of intracellular potassium levels", "opc": "Increase in cerebrovascular resistance", "opd": "Induction of compensatory metabolic alkalosis", "subject_name": "Surgery", "topic_name": "Nervous System", "id": "0d643107-3230-4b80-b775-a8e723f3fb5a", "choice_type": "single"} {"question": "Death in Ludwig's angina occurs due to", "exp": null, "cop": 2, "opa": "Sepsis", "opb": "Respiratory obstruction", "opc": "Cavernous sinus thrombosis", "opd": "Carotid blow-out", "subject_name": "Surgery", "topic_name": null, "id": "c5ec9297-17ae-49f7-8723-78b26527aca5", "choice_type": "single"} {"question": "Imaging IOC for acute pancreatitis", "exp": "Ans. (a) CT ScanRef: Sabiston Page 1530/ 20th edition* The imaging investigation of choice for acute pancreatitis is CECT scan.* CECT scan is done after 72 hours of onset- ideally on the 7th day.", "cop": 1, "opa": "CT scan", "opb": "USG", "opc": "X ray", "opd": "MRI", "subject_name": "Surgery", "topic_name": "Pancreas", "id": "7f322553-fc0b-40ce-b5ae-6da7231e4200", "choice_type": "single"} {"question": "Glomus tumor is seen in", "exp": "GLOMUS TUMOUR, also called as glomangioma, arises from the cutaneous glomus composed of a touous aeriole which communicates directly into the venule (Sucquet-Hoyer canal) and these vessels being surrounded by network of small nerves making this lesion very painful. It consists of a mixture of blood spaces, nonmedullated nerve tissue, muscle fibres derived from the wall of the aeriole, with large cuboidal glomus cells--angiomyoneuroma. They are often seen in limbs and common in nail-beds near the finger tips, as purple red swelling. Excision cures the condition. Reference : page 81 SRB'S manual of surgery 5th edition", "cop": 4, "opa": "Liver", "opb": "Adrenals", "opc": "Pitutary", "opd": "Finger", "subject_name": "Surgery", "topic_name": "Urology", "id": "1d1be44f-2679-4514-9a8e-a53afe90f5f9", "choice_type": "single"} {"question": "Excision of the hyoid bone is done in", "exp": null, "cop": 3, "opa": "Branchial cyst", "opb": "Branchial fistula", "opc": "Thyroglossal cyst", "opd": "Sublingual dermoids", "subject_name": "Surgery", "topic_name": null, "id": "ca6c88ed-5a97-4b5d-942f-e836ecd3a235", "choice_type": "single"} {"question": "A person might become quadriplegic if injury to spine is at level of", "exp": "Expected outcomes in spinal injuriesIf an injury at the level of C3-C4: Power wheelchair with mouth or chin control. Verbalise care, communicate through adaptive equipment. Maybe ventilatordependent.If an injury at the level of C5: Power wheelchair, dress upper body, self-feed with aids, wash face with assistanceIf an injury at the level of C6: Propel power wheelchair, possibly push a manual wheelchair, transfer with assistance, dress upper body (lower body with assistance), self-groom with aids, bladder/bowel care with assistance, self-feed with splints, able to driveIf an injury at the level of C7: Manual wheelchair, independent transfer, dressing (with aids), feeding, bathing, self-care. Bladder and bowel care withassistanceIf an injury at the level of C8-T4: Independent with most activities of daily living, and bowel and bladder careBailey and Love 26e PG: 340", "cop": 1, "opa": "C3", "opb": "C5", "opc": "C7", "opd": "T1", "subject_name": "Surgery", "topic_name": "Trauma", "id": "696407b1-1f13-4ddc-b693-0fb1fd8e6656", "choice_type": "single"} {"question": "The long acting analgesic used in post operative pain is", "exp": ".Bupivacaine (Marcaine): It has got prolonged action. It is a vasodilator also. Dose: 3 mg/kg. Epidural block: 0.5% Spinal 0.5% 3 ml.* An epidural catheter is placed in the space and fixed. 2% xylocaine with adrenaline or 0.5% bupivacaine is injected into the space to achieve anaesthesia up to the desired level. ref:SRB&;s manual of surgery,ed 3,pg no 1105", "cop": 1, "opa": "Bupivacane", "opb": "Dubivacine", "opc": "Morphine", "opd": "Tramadol", "subject_name": "Surgery", "topic_name": "Urology", "id": "7ededa24-06ec-406d-9448-fa194e32b139", "choice_type": "single"} {"question": "The ideal replacement for the oesophagus after oesophagus after esophagectomy is", "exp": ".Only 20% of oesophageal cancers present early and becomes curable. In such early growths confirmed with an absence of nodal spread, curative surgery is the main approach - radical oesophagectomy. Proximal extent of resection should be 10 cm above a macroscopic tumour and distal extent of resection is 5 cm from the macroscopic distal end of a tumour. Proximal stomach has to be removed commonly especially in lower 1/3 a tumour. Sufficient removal of contiguous structures may be needed in the curative resection. Orringer approach, i.e. Trans hiatal blind total oesophagectomy with anastomosis in the left side of the neck. Through laparotomy, stomach and lower pa of the oesophagus are mobilised. Through left-sided neck approach, the upper pa of the oesophagus is mobilised using a finger. Ref: SRB&;s manual of surgery,3 rd ed, pg no 740", "cop": 1, "opa": "Stomach", "opb": "Jejunum", "opc": "Colon", "opd": "Synthetic stent", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "bb0e4fdd-cc3e-4a34-8aa7-28f0eed417af", "choice_type": "single"} {"question": "Medial meniscus of knee joint is injured more often than the lateral meniscus because the medial meniscus is relatively", "exp": "B i.e. Less mobile Medial meniscus is more frequently torn than the lateral because the medial meniscus is securely attached around the entire peripheryQ of the joint capsule, which makes it less mobileQ. - where as the lateral meniscus is more mobile and has no weak point between a movable and relatively fixed point. popliteus muscle sends few fibers into the posterior margin of lateral meniscus. Thus muscle contraction withdraws & protects the lateral meniscus by drawing it posterolaterally during flexion of the knee and medial rotation of the tibia.", "cop": 2, "opa": "More mobile", "opb": "Less mobile", "opc": "Thinner", "opd": "Attached lightly to femur", "subject_name": "Surgery", "topic_name": null, "id": "e2cea5e6-f4db-4ab1-922a-6bb3b16e8afe", "choice_type": "single"} {"question": "Percentage of cold nodules that become malignant are", "exp": "About 80% of discrete swellings are cold. The risk of malignancy is higher in \"cold\" lesions (20%) compared to \"hot\" or \"warm\" lesions (<5%) Ref: Bailey and love 27th edition Pgno :804", "cop": 3, "opa": "10%", "opb": "15%", "opc": "20%", "opd": "40%", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "6d0e8411-3a28-49d2-b686-ce18c77429bb", "choice_type": "single"} {"question": "Peritoneal metastasis in colon cancer is staged as", "exp": "T1 Invades submucosaT2Invades muscularis propriaT3Invades through the muscularis propria into perirectal tissuesT4aInvades through the visceral peritoneumT4bDirectly invades to adjacent organs or structuresN1aOne node positiveN1b2-3 nodes positiveN1cNo regional lymph nodes positive, but there are tumour deposits in the subserosa, Mesentery or non-peritonealized pericolic/ perirectal/ mesorectal tissues N2a4-6 lymph nodes positiveN2b7 or more lymph nodes positiveM1aMetastasis to one site or organ, without peritoneal metastasisM1bMetastasis to 2 or more sites or organs without peritoneal metastasisM1c Metastasis tothe peritoneal surface (alone or along with other site/organ)Ref: AJCC 8e", "cop": 3, "opa": "M1a", "opb": "M1b", "opc": "M1c", "opd": "M1d", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "110b6743-9ca1-4a24-a641-d09cc313b19f", "choice_type": "single"} {"question": "Treatment of choice for pleomorphic adenoma is", "exp": "Superficial parotidectomy is the most common procedure for parotid gland pathology and procedure of choice for pleomorphic adenoma.A superficial parotidectomy is when the pa of the gland superficial to the facial nerve has removed The aim of superficial parotidectomy is to remove the tumour with a cuff of normal surrounding tissue.A deep lobe parotidectomy is when the pa of the gland beneath the nerve is removed and total parotidectomy is when both are dissected and removed.Radical parotidectomy involves removal of all parotid gland tissue and elective division of the facial nerve, usually through the main trunk. Radical parotidectomy is performed for patients in whom there is clear histological evidence of a high-grade malignant tumourRef: Bailey and love, page no: 791", "cop": 1, "opa": "Superficial parotidectomy", "opb": "Radical parotidectomy", "opc": "Enucleation", "opd": "Total parotidectomy", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "40dd4adc-1f00-4738-b1e8-18c46681df1d", "choice_type": "single"} {"question": "Jeep&;s disease is", "exp": "The term pilonidal sinus describes a condition found in the natal cleft overlying the coccyx, consisting of one or more, usually non-infected, midline openings, which communicate with a fibrous tract lined by granulation tissue and containing hair lying loosely within the lumen. A common affliction amongst the military, it has been referred to as Jeep disease. Reference : Bailey & Love, 27th Edition, page no = 1347.", "cop": 3, "opa": "Anal incontinence", "opb": "Haemorrhoids", "opc": "Pilonidal sinus", "opd": "Anal fissure", "subject_name": "Surgery", "topic_name": "General surgery", "id": "664f1a29-223a-4740-b84a-3fae2e0c410f", "choice_type": "single"} {"question": "Most common complication of condylar injuries in\nchildren", "exp": null, "cop": 2, "opa": "Pain", "opb": "Ankylosis", "opc": "Osteoarthritis", "opd": "Fracture of glenoid fossa", "subject_name": "Surgery", "topic_name": null, "id": "0a65dacc-a7ac-4525-9d45-0e0ba0487ce3", "choice_type": "single"} {"question": "Nipple inversion occurs due to involvement of", "exp": "Mastitis in many cases the lactiferous ducts will first become blocked by epithelial debris leading to stasis; this theory is suppoed by the relatively high incidence of mastitis in women with a retracted nipple.Periductal fibrosis is a sequela of periductal mastitis and may result in nipple retraction.Schwaz surgery 15th edition pg: 509", "cop": 2, "opa": "Cooper ligament", "opb": "Subareolar duct", "opc": "Parenchyma of breast", "opd": "Subdermal lymphatics", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "7c924194-9b28-48a8-8408-cd9d6c7d9b91", "choice_type": "single"} {"question": "Features of pyloric stenosis", "exp": "Because of vomiting-hypochloremia hyponatremia, hypocalcemia, hypomagnesemia alkalosis occurs. Reference: SRB edition:5th page no: 829", "cop": 1, "opa": "Hypokalemic alkalosis", "opb": "Peristalsis right to left", "opc": "Commonly caused by carcinoma stomach", "opd": "Retention vomiting present", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "bdcb2ed5-f741-45bb-afc8-bd6ae94a654f", "choice_type": "single"} {"question": "Wolf Chaikoff effect is due to excess", "exp": "Ans. (a) IodidesRef: Schwartz 9th Edition Page2599/E book* Excessively large doses of iodide may lead to initial increased organification, followed by suppression, a phenomenon called the Wolff-Chaikoff effect", "cop": 1, "opa": "Iodide", "opb": "Radio iodine", "opc": "Propylthiouraci", "opd": "Thyroxine", "subject_name": "Surgery", "topic_name": "Thyroid Gland", "id": "d0b06ff5-be6a-4221-9aa2-bc6049ad8960", "choice_type": "single"} {"question": "In triage &;red&; denotes", "exp": "First priority: Red - Critical, but likely to survive if treatment given earlySecond priority: Yellow - Critical, likely to survive if treatment given within hoursThird priority: Green - Stable, likely to survive even if treatment is delayed for hours to daysLast priority: Black - Not breathing, pulseless, so severely injured that no medical care is likely to helpBailey and love 26e pg: 422", "cop": 1, "opa": "Critical, but likely to survive if treatment given early", "opb": "Critical, likely to survive if treatment given within hours", "opc": "Stable, likely to survive even if treatment is delayed for hours to days", "opd": "Not breathing, pulseless, so severely injured that no medical care is likely to help", "subject_name": "Surgery", "topic_name": "Trauma", "id": "d9ce49d6-00c2-4dbd-b1db-881da2894fc8", "choice_type": "single"} {"question": "In primary pulmonary hypeension basic abnormality in gene lies in", "exp": "Bone morphogenetic protein receptor II Mutation in the bone morphogenetic protein receptor-2 (BMPR-II) cause pulmonary aerial hypeension. The BMPR-II gene plays a role in regulating the number of cells in ceain tissues. Researchers suggest that a mutation in this gene promotes cell division or prevents cell death, resulting in an overgrowth of cells in small aeries throughout the lungs. As a result, these aeries narrow in diameter which increases the resistance to blood flow. The blood pressure in the pulmonary aery and the right ventricle of the hea increases to overcome the increased resistance to blood flow resulting in pulmonary hypeension.", "cop": 1, "opa": ">Bone morphogenetic protein receptor II", "opb": ">Endothelin", "opc": ">Homeobox gene", "opd": ">PAX-11", "subject_name": "Surgery", "topic_name": null, "id": "7117d200-3ace-4897-95c2-73bc7d333f87", "choice_type": "single"} {"question": "Most common complication of TURP", "exp": "Retrograde ejaculation is MC complication of TURP due to injuiry to openings of ejaculatory ducts.", "cop": 2, "opa": "Hyponatremia", "opb": "Retrograde ejaculation", "opc": "Stricture", "opd": "Infection", "subject_name": "Surgery", "topic_name": null, "id": "166026d7-8256-4949-bfd3-04132c545280", "choice_type": "single"} {"question": "Male patient with euthyroid state presents with the following condition", "exp": "Ans. (b) Multiple nodular goiterRef.: Bailey & Love 26th ed. / 749* Notice the multiple enlarged lobes of this multiple nodular goiter which represents a spectrum of disease ranging from a single hyper-functioning nodule (toxic adenoma) within a multi-nodular thyroid to a gland with multiple areas of hyper function.* Thyroglossal cyst is ruled out as it is present in midline.* The answer should not be given as toxic nodular goiter because we cannot comment on thyrotoxicosis status of patient as eye signs etc. are not visible or given and the question also mentions a EUTHYROID status of the patient.* Autonomous hyperactivity is conferred by somatic mutations of the thyrotropin, or thyroid-stimulating hormone (TSH), receptor in 20-80% of toxic adenomas and some nodules of multinodular goiters. Autonomously functioning nodules may become toxic in 10% of patients.* Hyperthyroidism predominantly occurs when single nodules are larger than 2.5 cm in diameter. Signs and symptoms of TNG are similar to those of other types of hyperthyroidism.", "cop": 2, "opa": "Thyroglossal cyst", "opb": "Multiple nodular goiter", "opc": "Solitary thyroid nodule", "opd": "Toxic nodular goiter", "subject_name": "Surgery", "topic_name": "Disorders of Thyroid Metabolism", "id": "7c086a4c-3924-4683-9639-51ceb6fee4e8", "choice_type": "single"} {"question": "The maximum dose of lignocaine without adrenaline that can be admitted to a patient is", "exp": null, "cop": 1, "opa": "4 Mg/Kg body wt", "opb": "5 Mg/Kg body wt", "opc": "7 Mg/Kg body wt", "opd": "9 Mg/Kg body wt", "subject_name": "Surgery", "topic_name": null, "id": "ef8638c2-0c90-4e2c-8bed-19ec3fb43440", "choice_type": "single"} {"question": "Mainly elevators in exodontia works on the principle of", "exp": null, "cop": 1, "opa": "Lever I.", "opb": "Lever I & II.", "opc": "Lever III", "opd": "Wedge", "subject_name": "Surgery", "topic_name": null, "id": "0043f314-a3a4-47b9-bb0c-8a89490b4f85", "choice_type": "single"} {"question": "Treatment for brown tumor is", "exp": null, "cop": 4, "opa": "Curettage", "opb": "Surgical enucleation", "opc": "Intralesional steroids", "opd": "Parathyroidectomy", "subject_name": "Surgery", "topic_name": null, "id": "f1fb4bf9-ee5c-4adb-a66d-a1dd2881be56", "choice_type": "single"} {"question": "Features of left side Ca colon are", "exp": ". Patient can have de novo multiple primary carcinomas in different pas of the colon at the same time, i.e. synchronous (5-10%), or can present with growth in different pas of the colon in different periods, i.e. metachronous (10-20%). Gross types: Annular, tubular, ulcerative, cauliflower like. Annular (stenosing) type: * It is more common on left side. * Here the growth spreads round the internal wall and so it often presents with intestinal obstruction. * Left sided growth presents with colicky pain, altered bowel habits (alternating constipation and diarrhoea), palpable lump, distension of abdomen due subacute/ chronic obstruction. Later may present like complete colonic obstruction. Tenesmus, with passage of blood and mucus, with alternate constipation and diarrhoea, is common. Bladder symptoms may warn colovesical fistula. ref:SRB&;s manual of surgery,ed 3,pg no 838", "cop": 2, "opa": "Anemia", "opb": "Obstruction", "opc": "Altered bowel habit", "opd": "Melena", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "d2791573-0a66-4eb6-bd4f-5d9f110700a0", "choice_type": "single"} {"question": "Hunt Hess scale is used to grade manifestations of", "exp": "Answer-A. Subarachnoid hemorrhageThe initial clinical manifestations of SAH are graded using the Hunt-Hess or World Federation of Neurosurgical Societies classification schemes.A grading system has therefore been developed to document the severity of patient's disease in order to guide therapy and prognostication.", "cop": 1, "opa": "Subarachnoid hemorrhage", "opb": "Meningioma", "opc": "Hydrocephalus", "opd": "Tuberculous meningitis", "subject_name": "Surgery", "topic_name": null, "id": "9d1d907c-0fe9-4755-ac8e-67b0fdb45241", "choice_type": "single"} {"question": "Best treatment protocol of a Enterogenic cyst", "exp": "Ans. (b) Resection with intestine partRef: Bailey & Love 2&h ed. / 903* Enterogenous cyst arises from either a diverticulum of the mesentric border of the intestine that has become sequestrated from the intestinal canal during embryonic life or from a duplication of the intestine.* An enterogenous cyst has a thicker wall than a chylolymphatic cyst and is lined by mucous membrane, sometimes ciliated.* The content is mucinous and is either colourless or yellowish brown as a result of past haemorrhage. The muscle in the wall of an entric duplication cyst and the bowl with which it is in contact have a common blood supply, consequently removal of the cyst always entails resection of the related portion of intestine.", "cop": 2, "opa": "Enucleation", "opb": "Resection with intestine part", "opc": "Aspiration with marsupialization", "opd": "Observe", "subject_name": "Surgery", "topic_name": "Peritoneum", "id": "bf092133-7eb3-4111-9076-2c8a627f6a6d", "choice_type": "single"} {"question": "Most common malignancy found in Marjolins ulcer is", "exp": "Marjolin&;s ulcer is a well-differentiated squamous cell carcinoma which occurs in chronic scars like burn scar, scar of venous ulcer. It is relatively avascular and hence grows slowly. As scar tissue does not contain lymphatics and nerves, it will not spread to lymph nodes and it is painless respectively. Once it reaches the normal skin it behave like any other SCC, it will spread to lymph nodes. Wide excision is treatment of choice. Radiotherapy should not be given as it may turn into poorly differentiated squamous cell carcinoma. Reference : page 290 SRB&;s manual of surgery 5th edition", "cop": 2, "opa": "BCC", "opb": "SCC", "opc": "Malignant fibrous histiocytoma", "opd": "Malignant melanoma", "subject_name": "Surgery", "topic_name": "Urology", "id": "d61bc726-9d99-40d4-9258-60abd6d02b33", "choice_type": "single"} {"question": "Commonest salivary gland to get stones", "exp": "Eighty per cent of all salivary stones occur in the submandibular glands because their secretions are relatively viscous. Eighty per cent of submandibular stones are radio-opaque and can be identified on plain radiography. Stones are mainly composed of phosphate and oxalate salts.Ref: Bailey and love, 27e, page no: 780", "cop": 2, "opa": "Parotid", "opb": "Submandibular", "opc": "Minor salivary gland", "opd": "Sublingual", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "4792f061-9b7f-4aa5-8d57-34e661e2b888", "choice_type": "single"} {"question": "50 year tobacco chewer comes with chief complaints of a mass in the oral cavity of 1.5 cm with a single lymph node size <3 cm on ipsilateral neck. TNM stage is.......", "exp": "Ans. (d) T1 N1Ref: Bailey and Love Page 709Staging of Oral cavity Cancer:* T1 - <2cm* T2- 2-4cm* T3 - 4-6cm* T4 - adjacent structure involvement* N1-Ipsilateral single node <3cm* N2 a- Ipsilateral single node 3-6cm* N2 b- Ipsilateral multiple nodes all <6cm* N2 c- Contralateral nodes<6cm* N3- any node >6cm size* M1-metastasis", "cop": 4, "opa": "T1 N3", "opb": "T3 N1", "opc": "T2 N2", "opd": "T1 N1", "subject_name": "Surgery", "topic_name": "Oral Cavity", "id": "ced942ac-2242-45e6-9b4a-8f989ff979ab", "choice_type": "single"} {"question": "A GCS of an intubated person with abdominal flexion attitude and eye opening only to pain is", "exp": "Glasgow Coma Scale score for head injury. Eyes open Spontaneously 4 To verbal command 3 To painful stimulus 2 Do not open 1 Verbal Normal oriented conversation 5 Confused 4 Inappropriate/words only 3 Sounds only 2 No sounds 1 Intubated patient T Motor Obeys commands 6 Localises to pain 5 Withdrawal/flexion 4 Abnormal flexion 3 Extension 2 No motor response 1 Ref: Bailey and love 27th edition Pgno: 331", "cop": 3, "opa": "E2 V1 M4", "opb": "E2 V1 M4", "opc": "E2 Vnt M3", "opd": "E2 V1 M3", "subject_name": "Surgery", "topic_name": "Trauma", "id": "3ab7ab65-a5f6-4fd7-b2b2-77c85701cbc3", "choice_type": "single"} {"question": "Most common cause of hyperparathyroidism is", "exp": "Most common cause of hypoparathyroidism is iatrogenic cause that is accidental removal of parathyroid glands during thyroidectomy.", "cop": 2, "opa": "Di George syndrome", "opb": "Following thyroid surgery", "opc": "Mccune albright syndrome", "opd": "Parathyroid hypoplasia", "subject_name": "Surgery", "topic_name": null, "id": "98c1d2f0-6c2c-40cc-b270-24614ccfb4c5", "choice_type": "single"} {"question": "Metabolic disorder leading to acute pancreatitis", "exp": "(B) Hyperparathyroidism# Causes of Acute Pancreatitis> Common Causes Gallstones (including microlithiasis) Alcohol (acute and chronic alcoholism); Hypertriglyceridemia Endoscopic retrograde cholangiopancreatography (ERCP), especially after biliary manometry Trauma (especially blunt abdominal trauma) Postoperative (abdominal and non-abdominal operations) Drugs (azathioprine, 6-mercaptopurine, sulfonamides, estrogens, tetracycline, valproic acid, anti-HIV medications) Sphincter of Oddi dysfunction> Uncommon causes Vascular causes and vasculitis (ischemic-hypoperfusion states after cardiac surgery) Connective tissue disorders and thrombotic thrombocytopenic purpura (TTP) Cancer of the pancreas Hypercalcemia Periampullary diverticulum Pancreas divisum Hereditary pancreatitis Cystic fibrosis Renal failure> Rare causes Infections (mumps, coxsackievirus, cytomegalovirus, echovirus, parasites) Autoimmune (e.g., Sjogren's syndrome)> Causes to consider in patients with recurrent bouts of acute pancreatitis without an obvious etiology Occult disease of the biliary tree or pancreatic ducts, especially microlithiasis, sludge Drugs Hypertriglyceridemia Pancreas divisum Pancreatic cancer Sphincter of Oddi dysfunction Cystic fibrosis Idiopathic", "cop": 2, "opa": "Hypoparathyroidism", "opb": "Hyperparathyroidism", "opc": "Hypothyroidism", "opd": "Hyperthyroidism", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "48477a1a-07f4-4e41-868c-8586303acc71", "choice_type": "single"} {"question": "The pivot test is for", "exp": "A i.e. Anterior cruciate", "cop": 1, "opa": "Anterior cruciate ligament", "opb": "Posterior cruciate ligament", "opc": "Medial meniscus", "opd": "Lateral meniscus", "subject_name": "Surgery", "topic_name": null, "id": "5d22c455-f4a2-489d-9a85-86c24c67a856", "choice_type": "single"} {"question": "Surgery is not useful in", "exp": null, "cop": 1, "opa": "Cerebral oedema", "opb": "Depressed fracture", "opc": "Extral dural haemorrhage", "opd": "Subdural haemorrhage", "subject_name": "Surgery", "topic_name": null, "id": "74c0292e-a07f-41ed-8cde-966664aae7ca", "choice_type": "single"} {"question": "Protein content of <4mg/ml is seen in", "exp": null, "cop": 3, "opa": "Dentigerous", "opb": "Periapical", "opc": "Keratocyst", "opd": "Periodontal cyst", "subject_name": "Surgery", "topic_name": null, "id": "b5167e8a-61b5-4efa-bbc2-ae6b8d2e3a44", "choice_type": "single"} {"question": "The commonly inured carpal bone next to scaphoid is", "exp": "A i.e. Trapezium", "cop": 1, "opa": "Trapezium", "opb": "Trapezoid", "opc": "Lunate", "opd": "Capitate", "subject_name": "Surgery", "topic_name": null, "id": "3e05fb07-5d44-4a97-9e03-4d54baca91d3", "choice_type": "single"} {"question": "\"adder head\" appearance on excretory urography is seen in", "exp": "(Ureterocele) (1310-LB) (1290-B & L 25th)Ureterocele is a cystic enlargement of the intramural portion of the ureter thought to result from congenital atresia of the ureteric orifice.* The \"adder-head' on excretory urography is typical* Usually the cyst wall is composed of urothelium only and the diagnosis is confirmed by the cystoscopic appearance of a translucent cyst enlarging and collapsing as urine flows in from the upper ureter.", "cop": 3, "opa": "Hydronephrosis", "opb": "Infantile polycystic kidney", "opc": "Ureterocele", "opd": "Horseshoe kidney", "subject_name": "Surgery", "topic_name": "Kidney & Ureturs", "id": "5dc6b516-2384-4b24-8b9e-09ccaaf45084", "choice_type": "single"} {"question": "Clinical scenario with bag of worms", "exp": "Answer- A. VaricoceleA varicocele is a varicose (touous) dilatation of the vein draining the testis.C/FOn palpation, testicules may feels like a bag of wormsvaricocele is painless and the only complaint of the patient is swelling.", "cop": 1, "opa": "Varicocele", "opb": "Hydrocele", "opc": "Torsion of testis", "opd": "Congenital hernia", "subject_name": "Surgery", "topic_name": null, "id": "c011736e-287d-437e-ba75-97fbed053ece", "choice_type": "single"} {"question": "Pringle manoeuvre may be required for treatment of", "exp": "In case of liver lacerations, the inflow from the poal triad is controlled by a Pringle's manoeuvre, with direct compression of poal triad, either digitally or using a clamp. This has the effect of reducing aerial and poal venous inflow into the liver, although it doesn't control the back flow from inferior vena cava and hepatic veins. Reference : Bailey & Love, 27th Edition, page no = 374.", "cop": 4, "opa": "Injury to tail of pancreas", "opb": "Mesentric ischemia", "opc": "Bleeding esophageal varices", "opd": "Liver laceration", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "29d27d2a-5871-40ee-a09d-8bc1bcdd8c41", "choice_type": "single"} {"question": "BASDAI criteria is indicated in", "exp": "BASDAI(Bath Ankylosing Spondylitis disease activity index) Used to know effectiveness of drug therapy On a scale of 1-10 it is measured by various factors like discomfo, pain, morning stiffness etc If the value is >4 there is suboptimal control of disease", "cop": 1, "opa": "Ankylosing spondylitis", "opb": "Rheumatic Ahritis", "opc": "Kawasaki Disease", "opd": "Any autoimmune disease", "subject_name": "Surgery", "topic_name": "Trauma", "id": "ecdacc04-6369-4fb1-a791-73f9a796fb2a", "choice_type": "single"} {"question": "Most common carcinoma caused by Cirrhosis.", "exp": "Ans. (a) HCCRef: Sabiston 20th edition Page 1458* Cirrhosis leads to HCC.* High rate of HCC formation is seen in - HBV infection, Hemochromatosis* Low rate of HCC formation is seen in - Alcohol, Primary Biliary Cirrhosis* Cirrhosis with high DNA replication rates have increased risk of cancer liver", "cop": 1, "opa": "HCC", "opb": "Fibrolamellar carcinoma", "opc": "Hepato blastoma", "opd": "Pancreatic cancer", "subject_name": "Surgery", "topic_name": "Liver", "id": "652c9700-7cd5-4e4e-b1e9-0a0e4b2538c0", "choice_type": "single"} {"question": "This thyroiditis is also known as \"Painless Thyroiditis.", "exp": ". Subacute lymphocytic thyroiditis is a form of thyroiditis that is also known as silent thyroiditis or painless thyroiditis. Subacute lymphocytic thyroiditis may occur at any age and is more common in females. A variant of subacute lymphocytic thyroiditis occurs postpaum, postpaum thyroiditis. Both of these entities can be considered subtypes of Hashimoto&;s thyroiditis and have an autoimmune basis. Anti-thyroid antibodies are common in all three and the underlying histology is similar. This disorder should not be confused with de Quervain&;s thyroiditis which is another form of subacute thyroiditis.", "cop": 1, "opa": "Subacute lymphocytic", "opb": "Dequervain's", "opc": "Hashimoto", "opd": "Riedel", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "44ebdcf3-6211-41f3-b2b9-71fe2a405060", "choice_type": "single"} {"question": "High or low fistula is ano is termed according to its internal opening present with reference to", "exp": "The anorectal ring marks the junction between the rectum and the anal canal. It is formed by the joining of the puborectalis muscle. the deep external sphincter, conjoined longitudinal muscle and the highest pa of the internal sphincter. The anorectal ring can be clearly felt digitally, especially on its posterior and lateral aspects. Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1240", "cop": 3, "opa": "Anal canal", "opb": "Dentate line", "opc": "Anorectal ring", "opd": "Sacral promontary", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "22d07568-d0cc-4d7d-976a-03421c1eb49d", "choice_type": "single"} {"question": "Intestinal polyps that have highest potential to grow into cancer", "exp": "Classification of intestinal polypsInflammatory Inflammatory polyps (pseudopolyps in UC)Metaplastic Metaplastic or hyperplastic polypsHamaomatous Peutz-Jeghers polypJuvenile polypNeoplastic AdenomaTubularTubulovillousVillousAdenocarcinomaCarcinoid tumourRef: Bailey and Love, 27e, page: 1259", "cop": 2, "opa": "Inflammatory polyp", "opb": "Adenomatous polyp", "opc": "Hyperplastic polyp", "opd": "Hamaomatous polyp", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "db2a20ce-0d79-46e3-bc34-2dd30640d80e", "choice_type": "single"} {"question": "For vascular anastomosis sutures of choice", "exp": "Answer- A. PolypropyleneVascular anastomoses require an extremely accurate closure as they must be immediately wateight at the end of the operation when the vascular clamps are removed.In many cases, some form of prosthetic material or graft may be used which will never be integrated into the body tissues and so the integrity of the suture line needs to be permanent.For this reason, polypropylene is one of the best sutures as it is not biodegradable. It is used in its monofilament form,mounted on an atraumatic, curved, round bodied needle.", "cop": 1, "opa": "Polypropylene", "opb": "Chromic catgut", "opc": "Silk", "opd": "Nylon", "subject_name": "Surgery", "topic_name": null, "id": "f6bbeeb3-bb30-49ef-82bb-da3ddb49120b", "choice_type": "single"} {"question": "Structures not removed in radical neck dissection", "exp": "The classic operation involves resection of the cervical lymphatics and lymph nodes and those structures closely associated: the internal jugular vein, the accessory nerve, the submandibular gland and the sternocleidomastoid muscle. These structures are all removed en blocand in continuity with the primary disease if possible. The main disability that follows the operation is weakness and drooping of the shoulder due to paralysis of the trapezius muscle as a consequence of excision of the accessory nerve Bailey & Love ,25th,733.", "cop": 1, "opa": "X nerve", "opb": "XI nerve", "opc": "Tail of parotid", "opd": "Parotid and post-auricular nerve", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "dee53ebd-81ed-4950-8bd9-b7593ec5c1a1", "choice_type": "single"} {"question": "Most common posterior mediastinal tumour is", "exp": "The most common tumour of posterior mediastinum is neurofibromas,which constitutes around 75% of the total.Other tumors include ganglioneuromas,aneurysm of descending aoa,lymph node mass. Reference:SRB's manual of surgery,5th edition,page no:1126.", "cop": 2, "opa": "Dermoid", "opb": "Neurofibroma", "opc": "Lipoma", "opd": "Lymphoma", "subject_name": "Surgery", "topic_name": "Cardio thoracic surgery ", "id": "b8d011ad-1aeb-46f0-bd57-e32e6ac7a0c8", "choice_type": "single"} {"question": "The flap not used to reconstruct Breast is", "exp": "Ans. (c) Pectoralis major myocutaneous flap(Ref: Bailey 26th /e p. 816, Sabiston 20th edition 867)Flaps used to reconstruct Breast:* Transverse rectum abdominis flap (Pedicled or Free flaps)* Latissimus Dorsi flap* Gluteal flap* Ruben's flap* Thoraco epigastric flap* Lateral thigh flap", "cop": 3, "opa": "Transverse rectus abdominis myocutaneous flap", "opb": "Latissimus dorsi myocutaneous flap", "opc": "Pectoralis major myocutoneous flap", "opd": "Transversus rectus abdominis free flap", "subject_name": "Surgery", "topic_name": "Breast", "id": "cd63be70-7813-4dbd-9bec-4fb4f8552448", "choice_type": "single"} {"question": "Treatment of stage I bladder cancer is", "exp": "Answer- B. Endoscopic removal with intravesical chemotherapy", "cop": 2, "opa": "Radical cystectomy", "opb": "Endoscopic removal with intravesical chemotherapy", "opc": "Chemotherapy", "opd": "Radiotherapy", "subject_name": "Surgery", "topic_name": null, "id": "c6ee94d7-8677-4e8f-87e9-14927cf93914", "choice_type": "single"} {"question": "Flask shaped undermined ulcers in rectosigmoid area are seen in", "exp": "Most amoebic ulcers occur in the rectosigmoid. On sigmoidoscopy shallow skip lesions and 'flaskshaped' or 'collar-stud' undermined ulcers may be seen and can be biopsied or scrapings can be taken along with mucus for immediate microscopic examination. The presence of trophozoites distinguishes the condition from ulcerative colitis.Ref: Bailey and Love 27e pg: 58", "cop": 1, "opa": "Amoebiasis", "opb": "Typhoid", "opc": "Tuberculosis", "opd": "Hydatid disease", "subject_name": "Surgery", "topic_name": "General surgery", "id": "9a80c649-3f64-40dd-ba66-55f2bc37ee19", "choice_type": "single"} {"question": "Subperiosteal abscess, penetrating deep is seen after extraction of", "exp": null, "cop": 2, "opa": "Maxillary 3rd molar", "opb": "Mandibular 3rd molar", "opc": "Maxillary 1st molar", "opd": "Mandibular 1st molar", "subject_name": "Surgery", "topic_name": null, "id": "252ef32f-29e3-488b-a5dc-cce7f7500691", "choice_type": "single"} {"question": "Familial polyposis coli is due to", "exp": ".desmoid tumour is often associated with the familial polyposis colon (FAP), osteomas, odontomes epidermal cysts-- Gardner's syndrome.it is usually due to genetic abnormality involving chromosome 5. ref:SRB&;s manual of surgery ,ed 3,pg no 776", "cop": 1, "opa": "Abnormality of chromosomes five", "opb": "Abnormality of chromosomes", "opc": "Intestinal tuberculosis", "opd": "Intussusception", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "f63adfd6-b5fe-41d1-a0c0-0bef096df4d8", "choice_type": "single"} {"question": "Absolute indication for surgery in hyperparathyroidism is", "exp": null, "cop": 3, "opa": "Serum calcium < 2.85mmol/lit", "opb": "Increased bone density", "opc": "Urinary tract calculi", "opd": "Patient more than 50 years of age", "subject_name": "Surgery", "topic_name": null, "id": "e1fe77d8-4afe-4b79-83e1-1ca92067c1d8", "choice_type": "single"} {"question": "Uterine artery is a branch of", "exp": "Ans C Ref: Williams Obstetrics page 26Vascular supply of uterus is derived principally from uterine artery which is amain branch of internal iliac artery. Sheila Balakrishnan (Ob-stetric) page 16Internal iliac artery is the feeding vessel of pelvis Anterior division:Parietal branches- ObturatorPosterior division-has only parietal branchesDiolumbar Inferior glutealInternal pudendalVisceral branches- Superior vesical Lateral Sacral Obliterated umbilicalInferior vesicalMiddle rectalUterine & vaginal Superior gluteal", "cop": 3, "opa": "External iliac artery", "opb": "Superior vesical", "opc": "Internal iliac artery", "opd": "Aorta", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "e23c936c-590f-4739-8584-22c6fa716e4d", "choice_type": "single"} {"question": "Man comes with head injury investigation of choice", "exp": "Answer- D. Plain CTInvestigation of choice for head trauma patient is CT scan.", "cop": 4, "opa": "CECT", "opb": "X - ray", "opc": "MRI", "opd": "Plain CT", "subject_name": "Surgery", "topic_name": null, "id": "26ce5c11-46fe-4206-8157-98849d5a52e4", "choice_type": "single"} {"question": "Most common Cause of pseudaneurysm of aoa is", "exp": "Answer- B. TraumaAoic pseudoaneurysms are contained ruptures of the aoa in which the majority of the aoic wall has been breached, and luminal blood is held in only by a thin rim of the remaining wall or adventitia.They typically occur from focal aoic transection-penetrating traumaBlunt trauma", "cop": 2, "opa": "Smoking", "opb": "Trauma", "opc": "Marfans Syndrome", "opd": "Age related degeneration", "subject_name": "Surgery", "topic_name": null, "id": "d131e08b-df33-42bc-8dc8-db3339b8494c", "choice_type": "single"} {"question": "Latency period in distraction osteosynthesis is defined as", "exp": null, "cop": 1, "opa": "Time period between surgical osteotomy and starting of distraction", "opb": "Time period between starting of distraction to the completion of distraction", "opc": "Time period for completion of distraction process", "opd": "Time period between distraction and functional Loading of the area", "subject_name": "Surgery", "topic_name": null, "id": "29400939-f320-42a0-a587-708e0014cdd7", "choice_type": "single"} {"question": "Inosculation refers to", "exp": "Inosculation is alignment of donor and recipient capillaries for graft uptake.", "cop": 2, "opa": "Growth of lymphatics into the graft", "opb": "Alignment of donor and recipient capillaries", "opc": "Growth of arteries into the graft", "opd": "Diffusion of nutrients into the graft", "subject_name": "Surgery", "topic_name": null, "id": "efffb857-3e4b-464d-b493-e23085f4f514", "choice_type": "single"} {"question": "Alpha feto protein is a marker of", "exp": "(Yolk sac carcinoma): (999-CSTD 13th edition; 424-Shaw's 15th)MARKERS1. Endodermal sinus (Yolk sac) tumour* Alpha-fetoprotein and alpha-1 antitrypsin2. Choriocarcinoma - hCG3. Embryonal cell carcinoma - AFP & hCG4. Dysgerminoma and pure germinomas do not secrete these markers but secretes lactose dehydrogenase", "cop": 1, "opa": "Yolk sac carcinoma", "opb": "Embryonic cell", "opc": "Dysgerminoma", "opd": "Choriocarcinoma", "subject_name": "Surgery", "topic_name": "Testis & Scrotum", "id": "b4962abb-472a-4d8e-b596-3a2b665a4198", "choice_type": "single"} {"question": "Pheochromocytoma with malignant potential exclusively secretes", "exp": null, "cop": 1, "opa": "Dopamine", "opb": "Epinephrine", "opc": "Metanephrine", "opd": "Norepinephrine", "subject_name": "Surgery", "topic_name": null, "id": "790987c0-aba4-41b4-b021-e22743b2b94d", "choice_type": "single"} {"question": "Hand joining sign is characteristic of", "exp": "Both kidneys meet in midline seen has hand joining sign.", "cop": 4, "opa": "Pelviceal duplication", "opb": "Uerterocoele", "opc": "Ureteric duplication", "opd": "Horseshoe kidney", "subject_name": "Surgery", "topic_name": null, "id": "f126ad0e-19b6-4738-8ce2-d787280c0bf2", "choice_type": "single"} {"question": "Cleft palate should be repaired", "exp": "Cleft palate is usually repaired in 12–18 months. Early repair causes retarded maxillary growth (probably due to trauma to growth center and periosteum of the maxilla during surgery if done early). Late repair causes speech defect. \nAbnormal insertion of tensor palati is released. \nWardill- Kilner push back operation—by raising mucoperiosteum flaps based on greater palatine vessels. \nThe exact timing of repair of a palate cleft is controversial. In general, the velum must be closed before the development of speech sounds that require an intact palate.\n\nReference: SRB's Manual of Surgery, 5th ed, page no 350, Fonseca 4th ed page no 503", "cop": 2, "opa": "After 5 years of age", "opb": "Before 1 year", "opc": "1½ to 2 years", "opd": "Any time", "subject_name": "Surgery", "topic_name": null, "id": "8097c76f-66c3-4510-9233-d25e25290088", "choice_type": "single"} {"question": "Treatment for fibrous dysplasia in a young 25 yrs old patient involving maxilla is best treated by", "exp": null, "cop": 2, "opa": "Enbloc resection", "opb": "Cosmetic contouring", "opc": "Maxillary resection", "opd": "Radiation therapy", "subject_name": "Surgery", "topic_name": null, "id": "fd7d154c-dc3a-437b-a859-d475590559a0", "choice_type": "single"} {"question": "List the following pediatric parotid neoplasms in order from most frequent to least frequent", "exp": "Parotid tumours incidence: Common parotid tumors Histopadiology Incidence Pleomorphic adenoma 59% Mucoepidermoid carcinoma 7.9% Wahin's tumor 7.3% Carcinoma Ex-Pleomorphic adenoma 4.4% Acinic cell carcinoma 3.5% Adenoid cystic carcinoma 3.1% Squamous cell carcinoma 2.0%", "cop": 2, "opa": "Pleomorphic adenoma > acinic cell > mucoepidermoid > adenoid cystic", "opb": "Pleomorphic adenoma > mucoepidermoid > acinic cell > adenoid cystic", "opc": "Pleomorphic adenoma > adenoid cystic > mucoepidermoid > acinic cell", "opd": "Mucoepidermoid > pleomorphic adenoma > acinic cell > adenoid cystic", "subject_name": "Surgery", "topic_name": "Salivary Glands", "id": "58a822cb-204f-43de-8127-eeb4aa863e76", "choice_type": "single"} {"question": "Tom smith's ahritis is due to", "exp": "Answer- A. Pyogenic infection in infancyTom smith ahritis is the sepfic ahritis of hip joint, occurs in infancy. At this stage head of the femur is cailaginous and is rapidly and completely destroyed by the pyogenic process.", "cop": 1, "opa": "Pyogenic infection in infancy", "opb": "TB", "opc": "RA", "opd": "OA", "subject_name": "Surgery", "topic_name": null, "id": "dbad4a1d-da9f-41de-a672-227f5e2959b1", "choice_type": "single"} {"question": "Osteotomies", "exp": null, "cop": 3, "opa": "of the Le Fort III type, like the Le Fort III fracture, are not associated with great blood loss and therefore the patient rarely needs more than 2 pints of blood transfused.", "opb": "of the Le Fort III type, if done with the use of a bicoronal flap are not followed by nerve paraesthesias postoperatively", "opc": "of the Le Fort III type are most commonly indicated in syndromes associated with the early closure of cranial sutures", "opd": "of the Le Fort II type produce maxillary necrosis in the cleft palate patient", "subject_name": "Surgery", "topic_name": null, "id": "0ececf64-2027-414f-9b96-6265b146277d", "choice_type": "single"} {"question": "The disadvantage of elemental include diets in childrena) Hypertonic dehydrationb) Lower caloric inputc) Dumping syndromed) High nitrogen input", "exp": null, "cop": 3, "opa": "ad", "opb": "bc", "opc": "ac", "opd": "bd", "subject_name": "Surgery", "topic_name": null, "id": "91206e84-d814-45db-a178-16276555f1de", "choice_type": "single"} {"question": "A known patient with renal stone disease developed pathological fracture along with abdominal pain and certain psychiatric symptoms.\nHe should be investigated for", "exp": null, "cop": 3, "opa": "Polycystic kidney", "opb": "Renal tubular acidosis", "opc": "Hyperparathyroidism", "opd": "Paget's disease of bone", "subject_name": "Surgery", "topic_name": null, "id": "42dc531a-846a-4e83-ab50-1a4c5b4d4982", "choice_type": "single"} {"question": "A new born boy is having lumbosacral meningomyelocele and awaiting the surgical repair. The sac is best protected with sterile gauze piece soaked with", "exp": "Ans. (d) Normal salineRef: Bailey & Love 26th ed. / 482-83The first step in the management of a newborn with myelomeningocele is a careful clinical assessment followed by open defects which should be covered with a saline-moistened non-adherent dressing to prevent injury to and dessication of the neural placode.", "cop": 4, "opa": "Mercurochrome", "opb": "Tincture benzoin", "opc": "Methylene blue", "opd": "Normal saline", "subject_name": "Surgery", "topic_name": "Pediatric Neurosurgery", "id": "34ef3abc-d37a-4d0e-8689-409ecdf9ebd4", "choice_type": "single"} {"question": "Golf hole ureter is seen in", "exp": "Tb will cause golf hole ureter causing reflex. TB will also give rise to cement kidney , thimble bladder , watermelon prostate.", "cop": 2, "opa": "Ureteric stricture", "opb": "Tuberculosis of ureter", "opc": "ureteocoele", "opd": "Ormond’s disease", "subject_name": "Surgery", "topic_name": null, "id": "f9c8a914-b5dc-42fb-9e94-b4fdce1bf9d4", "choice_type": "single"} {"question": "Symptoms of hyperthyroidism include", "exp": null, "cop": 4, "opa": "Intolerance to cold", "opb": "Decreased appetite", "opc": "Weight gain", "opd": "Palpitations", "subject_name": "Surgery", "topic_name": null, "id": "8c2489f3-660f-43bb-b5b0-aac7b884dc8a", "choice_type": "single"} {"question": "Massive colonic bleeding in a patient of diverticulosis is from", "exp": "Although diverticulosis involves mainly the left side of colon, bleeding occurs mostly from right side of colon. Right side is supplied by superior mesentric artery.\n\"Hemorrhage from a colonic diverticula is the most common cause of hematochezia in patients over the age of 60.\" - Harrison 16/e, p 1796", "cop": 2, "opa": "Inferior mesentric artery", "opb": "superior mysentric artery", "opc": "coeliac artery", "opd": "Gastro duodenal artery", "subject_name": "Surgery", "topic_name": null, "id": "df26e308-3dc9-435a-a7a5-264f0b3249cf", "choice_type": "single"} {"question": "Commonly encountered complication during extraction of maxillary third molar is", "exp": null, "cop": 4, "opa": "Oro-antral communication", "opb": "Root displacement into sinus", "opc": "Excessive hemorrhage", "opd": "Fracture of the maxillary tuberosity", "subject_name": "Surgery", "topic_name": null, "id": "896bb484-71a6-477c-a283-8aacac444c54", "choice_type": "single"} {"question": "Most frequent tooth to be impacted is", "exp": "Impacted tooth Is the tooth that has failed to erupt completely or paially to its correct position in the dental arch and its eruption potential has been lost. Order of frequency Mandibular 3rd molar (i.e. Lower 3rd molar) Maxillary 3rd molar (Upper 3rd molar) Maxillary canine", "cop": 2, "opa": "Upper third molar", "opb": "Lower third molar", "opc": "Upper premolar", "opd": "Lower premolar", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "aa920f42-c195-43e9-9878-20de967df6c7", "choice_type": "single"} {"question": "Not a complication of Colles' fracture", "exp": "D i.e. Wrist drop", "cop": 4, "opa": "Stiffness of wrist", "opb": "Stiffness of shoulder", "opc": "Carpal tunnel syndrome", "opd": "Wrist drop", "subject_name": "Surgery", "topic_name": null, "id": "64249c93-cb66-4907-9d4a-bd03ae9d4fd7", "choice_type": "single"} {"question": "Tumor arsing from Olfactory nasal mucosa", "exp": "Esthesioneuroblastoma (Olfactory Neuroblastoma) Esthesioneuroblastoma is a rare unique tumor of neural crest origin Arises from the basal neural cells of the olfactory mucosa of the cribriform plate, upper nasal wall and superior turbinate. Seen in either sex and most common in 3rd and 4th decade Clinical Features: Presents as unilateral polypoidal mass in the upper third of the nasal cavity with symptoms of nasal obstruction, epistaxis and anosmia. It is a vascular tummor that bleeds profusely on biopsy. LN and systemic metastases can occur. Treatment: Favored treatment is surgical excision followed by radiation Ref: Dhingra 5th edition Pgno: 217", "cop": 4, "opa": "Nasal glioma", "opb": "Adenoid cystic carcinoma", "opc": "Nasopharyngeal carcinoma", "opd": "Esthesioneuroblastoma", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "2cf631a3-9576-4d2e-9150-9b79536c2660", "choice_type": "single"} {"question": "Contra indication for nasotracheal intubation", "exp": "In anterior cranial fossa # and maxillo facial injuries it is avoided.", "cop": 1, "opa": "Anterior cranial fossa #", "opb": "Middle cranial fossa #", "opc": "Post cranial fossa #", "opd": "GCS < 8", "subject_name": "Surgery", "topic_name": null, "id": "c645c549-7568-47a2-8d2b-2e12afbea5ed", "choice_type": "single"} {"question": "Tensile strength in the wound scar is", "exp": "This maturation of collagen leads to increased tensile strength in the wound which is maximal at the 12th-week post-injury and represents approximately 80% of the uninjured skin strength. Bailey and love 27e pg: 25", "cop": 3, "opa": "Similar to normal skin", "opb": "More than normal skin", "opc": "80% of normal skin", "opd": "50% of normal skin", "subject_name": "Surgery", "topic_name": "General surgery", "id": "e8d0ba5e-f21a-4ca9-b715-1ffe3457c462", "choice_type": "single"} {"question": "Tip of nose reconstruction is done by", "exp": "Local flaps A local flap is raised next to a tissue defect in order to reconstruct it Basic patterns of local flaps Transposition flap Most basic design, leaving a graftable donor site Z-plasty For lengthening scars or tissues Rhomboid flap For cheek, temple, back and flat surface defects Rotation flap For convex surfaces Advancement flap For flexor surfaces, may need triangles excised at the base to make it work (commonly called Burrow's triangles) V-to-Y advancement Commonly used for fingeips and extremities Bilobed flap For convex surfaces, especially the nose Bipedicle flap For eyelids, rarely elsewhere Ref: Sabiston 20th edition Pgno :836", "cop": 2, "opa": "Bipedicled flap", "opb": "Bilobed flap", "opc": "Full thickness skin graft", "opd": "Split skin graft", "subject_name": "Surgery", "topic_name": "General surgery", "id": "adedd3ae-7bc3-4463-b53c-eb8d79804631", "choice_type": "single"} {"question": "Most common tumor of anterior mediastimum is", "exp": "Thymomas are the most common tumours of anterosuperior mediastinum in the adult,accounting for 25% of the total.They are most common in the 5th and 6th decades of life.Both sexes are equally affected.They vary in behaviour from benign to aggressively invasive.Diagnosis and treatment are best achieved by complete thymectomy.", "cop": 1, "opa": "Thymoma", "opb": "Lymphoma", "opc": "Germ cell cumor", "opd": "Thyroid tumors", "subject_name": "Surgery", "topic_name": "Cardio thoracic surgery ", "id": "89c32a78-ae92-4dbe-b065-f9c15d8c90fa", "choice_type": "single"} {"question": "Wilm's tumor associated with A/E", "exp": "Wilm's tumour ( nephroblastoma ) is a mixed tumour containing blastemal, stromal and epithelial elements arising from embryonic nephrogenic tissue. It is the most common primary tumour of kidney in children . Most commonly between 2 and 5 years of age . It is associated with three congenital malformation syndromes 1) WAGR SYNDROME . wilms tumour , ANIRIDIA , mental retardation 2 ) DENYS - DRASH SYNDROME . gonadal dysgenesis and renal abnormalities. These two syndromes are associated with WT1 mutations. 3) BECKWITH-WIDEMANN SYNDROME is associated with Macroglossia,Visceromegaly, enlargement of entire segment (HEMI HYPEROPHY) , enlargement of adrenal coical cells ( adrenal cytomegaly ) is charecteristic microscopic feature.Midline abdominal wall defect .BWS is an example of disorder of genomic imprinting. CLINICL FEATURES :- 1.Flank mass M/C clinical presentation 2.Hematuria(Extension into renal pelvis) 3.HTN 4.Weight loss. 5.Pain (least common) IOC:CT scan (CECT) CXR (lung metastasis M/C) ref : - Robbins basic pathology . 9th edition .chapter 6 .pg no :- 262 Bailey and Love 27th edition . chapter 76 .pg no 1421.0", "cop": 4, "opa": "Hemihyperophy", "opb": "Aniridia", "opc": "Hypeension", "opd": "Bilateral polycystic kidney disease", "subject_name": "Surgery", "topic_name": "Urology", "id": "8b85cd2b-8ddd-4e3b-ab9c-34ed556399f9", "choice_type": "single"} {"question": "Early stage of trauma is characterized by", "exp": "Injury Phase (Phase of catabolism):-- Begins at the time of injury and lasts for 2-5 days-- Phase of hypermetabolism-- Stress hormones (coisol, catecholamines and glucagon) and volume control hormones (renin-angiotensin, aldosterone and ADH) are increased. This leads to proteolysis, lipolysis, hyperglycemia and wound healing despite of negative nitrogen balance.* Turning Point:-- Transient period marked physiologically by turning off of the neuroendocrine response and clinically by the appearance of getting well. * Early Anabolic Phase:-- Marked by gain in muscular strength or positive nitrogen balance.* Late Anabolic Phase:-- Marked by gain in weight and body fat or positive caloric balance", "cop": 1, "opa": "Catabolism", "opb": "Anabolism", "opc": "Glycogenesis", "opd": "Lipolysis", "subject_name": "Surgery", "topic_name": "Trauma", "id": "4ee59051-7c07-46df-ab93-49ca6d608e76", "choice_type": "single"} {"question": "The propensity of recurrence after surgical intervention is the least in", "exp": null, "cop": 3, "opa": "Ameloblastoma", "opb": "Odontogenicmyxoma", "opc": "Odontoma", "opd": "Fibrocarcoma", "subject_name": "Surgery", "topic_name": null, "id": "a7612cbf-2036-4179-8fd1-1ff77bed41d4", "choice_type": "single"} {"question": "Most important prognostic factor for colorectal carcinoma is", "exp": "\"The number of positive nodes appeared to be the single most important prognostic factor.\"-DeVita", "cop": 4, "opa": "Site of lesion", "opb": "Tumour size & characteristics", "opc": "Age of patient", "opd": "Lymph node status", "subject_name": "Surgery", "topic_name": null, "id": "552c4ff2-f0b8-44a5-a482-62e97f407ece", "choice_type": "single"} {"question": "A driver wearing seat belt applied brake suddenly to avoid accident. Most common organ injured in seat belt injury", "exp": "Most common seat belt injury is mesentery", "cop": 3, "opa": "Liver", "opb": "Spleen", "opc": "Mesentery", "opd": "Abdominal aorta", "subject_name": "Surgery", "topic_name": null, "id": "9b8224e6-3199-4229-86b3-0614243cb058", "choice_type": "single"} {"question": "Minimum nitrogen required for an adult with dynamic tissue turnover to maintain a positive nitrogen balance is", "exp": ".minimum nitrogen required for an adult with dynamic tissue turnover to maintain a positive nitrogen balance is about 5.5 to 6.5 g.* Glucose requirement is 200 g per day; fat requirement is 200 g per week; nitrogen (protein) requirement is 0.15 g/kg per day. Nitrogen need increases to 0.25 g/kg/day in hyper catabolic status. ref:SRB&;s manual of surgery,ed 3,pg no 86", "cop": 2, "opa": "3.5-4.5 g", "opb": "5.5-6.5 g", "opc": "7.5-8.5 g", "opd": "9.5-10.5 g", "subject_name": "Surgery", "topic_name": "Urology", "id": "b928d87c-49fb-4af9-b298-73d69f0e3bfa", "choice_type": "single"} {"question": "Total parenteral nutrition should have", "exp": ".Components used in TPN * Carbohydrates. * Fat and amino acids. * Vitamins and trace elements. Monitoring the patient by body weight, fluid balance, blood glucose, electrolytes, blood urea, LFT serum calcium, magnesium, phosphate should be done at regular intervals. A weight gain more than one kg/day signifies fluid overload. ref:SRB&;s manual of surgery,ed 3,pg no 89", "cop": 2, "opa": "Proteins not carbohydrates", "opb": "Lipid administration < 0.11 g\\/kg\\/hr", "opc": "2 in 1 solution contains lipid", "opd": "10% of total calories is provided as lipids", "subject_name": "Surgery", "topic_name": "Urology", "id": "9e7819e1-9455-4e8f-9cc0-c425e224f56d", "choice_type": "single"} {"question": "Symmetrical areflexic bladder bowel & lower limb occur in", "exp": "B i.e. Conus medullaris syndrome", "cop": 2, "opa": "Cauda equina syndrome", "opb": "Conus medullaris syndrome", "opc": "Nerve root damage", "opd": "Brown sequerd syndrome", "subject_name": "Surgery", "topic_name": null, "id": "ba9b82fb-cefe-42d1-9c3a-9501d98e8d85", "choice_type": "single"} {"question": "Mucocele of the appendix isa) Benign tumourb) Low grade malignancyc) Retention cystd) Infective process", "exp": "Mucocele of appendix:\nA mucocele of the appendix is an obstructive dilatation by intraluminal accumulation of mucoid material.\nMucoceles may be caused by one of four processes: retention cysts, mucosal hyperplasia, cystadenomas, and cystadenocarcinomas.\nThe clinical presentation of a mucocele is nonspecific, and often it is an incidental finding at operation for acute appendicitis.\nAn intact mucocele presents no future risk for the patient; however, rupture may lead to pseudomyxoma peritonei or mucinous carcinomatosis of appendiceal origin\nEvery effort is made to keep the mucocele intact during extraction, including placing the specimen in a bag and converting a laparoscopic procedure to open.\nManagement of Mucocele:\nIncludes resection of the appendix, plus wide resection of the mesoappendix to include all the appendiceal lymph nodes, collection and cytologic examination of all intraperitoneal mucus, and careful inspection of the base of the appendix.\nRight hemicolectomy is done for patients with a positive margin at the base of the appendix or positive periappendiceal lymph nodes.", "cop": 1, "opa": "abc", "opb": "bc", "opc": "acd", "opd": "bcd", "subject_name": "Surgery", "topic_name": null, "id": "ff7ca074-339d-4e2b-808a-739d3f4bf207", "choice_type": "single"} {"question": "The most common cause of acquired aeriovenous fistula is", "exp": ". Trauma is the most common cause of accquired atreiovenous fistula(AV fistula).most common sites involved are femoral region,brachial region,popliteal region,wrist,aoa-vena canal,abdomen.It may be following road traffic accidents,penetrating wounds,cock fight injury(common in south india).Other causes includes after surgical intervention of major vessels,cimino fistula(AVF created for renal dialysis). Refer page no 219 of SRB's manual of surgery 5th edition.", "cop": 4, "opa": "Bacterial infection", "opb": "Fungal infection", "opc": "Blunt trauma", "opd": "Penetrating trauma", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "387fcb24-1da0-405c-a1e2-3ba2fd9cb891", "choice_type": "single"} {"question": "Not a component of Glasgow coma scale", "exp": "GLASGOW COMA SCALE EYE OPENING VERBAL RESPONSE MOTOR RESPONSE spontaneous -4 oriented -5 obeys commands -6 to speech -3 confused -4 localises pain -5 to pain -2 inappropriate words -3 flexion to pain -4 none -1 incomprehensible words -2 abnormal flexion -3 none -1 extension to pain -2 none -1 .TOTAL SCORE :15 MILD HEAD INJURY:13-15 MODERATE HEAD INJURY: 9-12 SEVERE HEAD INJURY: less than 8(3-8)", "cop": 3, "opa": "Eye opening", "opb": "Motor response", "opc": "Pupil size", "opd": "Verbal response", "subject_name": "Surgery", "topic_name": "Trauma", "id": "66000391-c6f1-46ab-aeef-1d48317734df", "choice_type": "single"} {"question": "Commonest cause of acute folliculitis (hair follicle infection) is", "exp": "Acute folliculitis are of two types: superficial and deep. The most common causative organism is Staphylococcus aureus. Superficial folliculitis is also caused by Pseudomonas aeruginosa.Reference : page 41 IADVL's Concise Textbook of Dermatology", "cop": 1, "opa": "Staphylococcus aureus", "opb": "Beta hemolytic streptococcus", "opc": "Propionibacterium acnes", "opd": "Streptococcus viridans", "subject_name": "Surgery", "topic_name": "Urology", "id": "791a766e-23e8-454a-9bb7-6edc1c2dd0b5", "choice_type": "single"} {"question": "In Couinaud classification, segment IV of liver is", "exp": "Segment 1 - caudate lobe, segment 4 - quadrate lobe ,.segments( 1,2,3,4) left lobe, segments (5,6,7,8)- right lobe Reference SRB edition :5 page:593 and internet", "cop": 2, "opa": "Caudate lobe", "opb": "Quadrate lobe", "opc": "Right lobe", "opd": "Left lobe", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "17f984ba-e24c-43c3-a537-2eb8e45e2290", "choice_type": "single"} {"question": "Garden's classification is applicable to", "exp": "B i.e. Fracture neck of femur", "cop": 2, "opa": "Interochanteric fracture", "opb": "Fracture neck of femur", "opc": "Epiphyseal separation", "opd": "Posterior dislocation of hip", "subject_name": "Surgery", "topic_name": null, "id": "cebbf93f-84e5-4753-bbe9-a5838ca32f6f", "choice_type": "single"} {"question": "Most common cause of lower gastro intestinal bleeding is;", "exp": "(Colo.rectal carcioma) (1310-CSDT 12th) (1160-B &L 25th)* Although diverticulitis, cancer and / angiodysplasia are the most common cause of lower GI bleeding in adults (1310-CSDT 12th)* Diverticular diseases (Very common in western countries, though it is quite rare in this country (1104. S.Das 5th)Diverticulitis (1161-B&L)Symptoms and signs of colorectal cancer (1178-B & L)Complications1. Recurrent periodic abscess2. Perforation leading to general peritonitis3. Intestinal obstruction4. Haemorrhage - profuse colonic haemorrhage5. Fistula formation Diverticulitis is not a precancerous conditions but cancer may coexist* Right sided tumour - Iron deficiency anemia, abdominal mass* Left sided tumours - rectal bleeding alteration in bowel habit, tenesmus obstruction* Metastatic disease - Jaundice, ascitis, hepatomegaly, other symptoms and sign from rarer sites of metastasis.* In Infants - anal fissures continue to be the most common cause of rectal bleeding.* Juvenile polyps - are the single most common cause of lower GI bleeding in children (20-30%)", "cop": 2, "opa": "Diverticulitis", "opb": "Colorectal carcinoma", "opc": "Angiodysplasia", "opd": "Anal fissure", "subject_name": "Surgery", "topic_name": "Small & Large Intestine", "id": "418cb3a7-a0f8-41b4-923c-b63a7f223aeb", "choice_type": "single"} {"question": "Inguinal hernia with hydrococle is know as", "exp": null, "cop": 1, "opa": "Gibbon's hernia", "opb": "Pantalan's hernia", "opc": "Sliding hernia", "opd": "Norath's hernia", "subject_name": "Surgery", "topic_name": null, "id": "d0e65527-c0da-4418-8839-7805ae67fb93", "choice_type": "single"} {"question": "For lacerated wound, delayed primary suturing is done within", "exp": "For clean wound, primary suturing done within 6 hr.\nFor locerated wound, delayed primary suturing is done within 48 hrs.\nFor infected wound, secandary suturing done within 10 - 14 days.", "cop": 2, "opa": "24 hr", "opb": "48 hr", "opc": "36 hr", "opd": "50 hr", "subject_name": "Surgery", "topic_name": null, "id": "6d5d7789-415a-410a-9ea2-058773ed4c64", "choice_type": "single"} {"question": "Most common cause of AVN of the hip is", "exp": "Answer- A. IdiopathicCauses ofAVN hipldiopathic (most common)Infection- septic ahritis, osteomyelitisHematological malignancies- leukemia, lymphomaAlcohol,coicosteroidsSLEPregnancyCassions diseaseHyperlipidemiaPehes diseasIonising radiation", "cop": 1, "opa": "Idiopathic", "opb": "Alcoholism", "opc": "Caissons Disease", "opd": "Fracture neck of femur", "subject_name": "Surgery", "topic_name": null, "id": "e98ad559-be53-4e3f-8552-cf4cde9e2190", "choice_type": "single"} {"question": "The effect of local anesthesia can be increased by the addition of", "exp": null, "cop": 1, "opa": "Adrenaline", "opb": "Isoprenaline", "opc": "Dopamine", "opd": "Felypressin (synthetic vasopressin)", "subject_name": "Surgery", "topic_name": null, "id": "3dd86b4a-6ac3-418c-b4b8-d4087355effa", "choice_type": "single"} {"question": "Testicular cancer is common in", "exp": null, "cop": 2, "opa": "Ectopic testis", "opb": "Undescended abdominal testis", "opc": "Atrophic testis", "opd": "Anteverted testis", "subject_name": "Surgery", "topic_name": null, "id": "293fba13-b5d6-429a-ac20-d81c04c4da5e", "choice_type": "single"} {"question": "Omental bursa (lesser sac)A posteriorly perforating ulcer in the pyloric antrum of the stomach is most likely to produce initial localized peritonitis or abscess formation in the following", "exp": "Ans. is 'a' i.e., Omental bursa BDC writes - \"The posterior surface of the stomach is related to structures forming the stomach bed, all of which are separated from the stomach by the cavity of the lesser sac.\" Thus an ulcer on the posterior wall of stomach would perforate into the lesser sac. Also remember Most perforated ulcers are located on the anterior wall. The moality rate for perforated gastric ulcer is higher than that for duodenal ulcer. This is generally due to the gastric ulcer patients' more advanced age, increased medical comorbidities, delay in seeking medical attention, and the larger size of gastric ulcers.", "cop": 1, "opa": "Omental bursa (lesser sac)", "opb": "Greater sac", "opc": "Right subphrenic space", "opd": "Hepato renal space (pouch of Morison)", "subject_name": "Surgery", "topic_name": null, "id": "398a9955-3983-48cb-84bf-098f6a2bf585", "choice_type": "single"} {"question": "A patient with abdominal injury presents to the emergency department with signs of signs of peritonitis and shock. Airway and breathing were secured and IV fluids were started with 2 large bore cannulas. The next line of management should be", "exp": "Treatment for abdominal injury includes Emergency laparotomy.\nIndications include \n\nFrank haemoperitoneum\nSignificant diagnostic peritoneal lavage\nHaemodynamically unstable patient \nU/S or CT scan shows significant intra-abdominal injuries", "cop": 2, "opa": "FAST", "opb": "Exploratory Laparotomy under general anesthesia", "opc": "Insertion of abdominal drain followed by laparotomy", "opd": "Laproscopy", "subject_name": "Surgery", "topic_name": null, "id": "eaf7b45b-5e8b-45f4-a261-dfc3b4f3ca83", "choice_type": "single"} {"question": "Tension pneumothorax due to fracture rib is treated by", "exp": null, "cop": 2, "opa": "Strapping", "opb": "Tube drainage", "opc": "IPPV", "opd": "Internal fixation with open reduction", "subject_name": "Surgery", "topic_name": null, "id": "291afa26-a462-49e2-b99d-ba6ff5ee3b6f", "choice_type": "single"} {"question": "Least glycemic index is seen in", "exp": "* Glycemic index is a measure of a foods' ability to elevate blood sugar level. * The indexing is done by comparing a food stuffs digestion rate to that of glucose, with a glycemic index of 100. * The higher the glycemic index, the faster will it enter the blood and increase the blood sugar level. * Glycemic index is used to label the food as good and evil. Food with a high glycemic index of 60 and above is considered unhealthy as they break down quickly and spike blood sugar level. Low glycemic foods enter the blood stream slowly and provide sustain long term energy (maintain stable blood sugar levels). High glycemic index Glucose 100 Baked potato 85 Corn flakes 84 Honey 73 Watermelon 72 White bread 70 -72 Table sugar 65 Ice-cream 61 Moderately glycemic food Orange papaya 58 White rice 58 Brown rice 55 Pop corn 55 Sweet potato 54 Mango 55 Banana 50 Carrots 49 Orange 44 Low glycemic food Apple 37 Yoghu 33 Skimmed milk 32 Kidney beans 27 Peanuts 14", "cop": 2, "opa": "Baked potato", "opb": "Brown rice", "opc": "Ice cream", "opd": "Whole white bread", "subject_name": "Surgery", "topic_name": null, "id": "afadfdfa-195d-44ce-8344-38420d20d238", "choice_type": "single"} {"question": "Commando’s operation is for", "exp": null, "cop": 2, "opa": "Radical mastectomy", "opb": "Oral cancer", "opc": "Mandible", "opd": "Leg amputation", "subject_name": "Surgery", "topic_name": null, "id": "d31da558-dd00-4e5f-b2ac-3350681018e7", "choice_type": "single"} {"question": "The most commonly practiced operative procedure for a perforated duodenal ulcer is", "exp": "Here perforation is identified and an omental patch is placed & closed with interrupted, horizontal sutures. Because of its adhesion propey, it seals perforation, maintain good vascularity, and promote lymphatic drainage Reference: SRB 5th edition, page no: 832", "cop": 4, "opa": "Vagotomy and pyloroplasty", "opb": "vagotomy and antrectomy", "opc": "Vagotomy and perforation closure", "opd": "Graham's omentum patch repair", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "a89f2006-078a-47da-9bd0-fd396a01002c", "choice_type": "single"} {"question": "Tamsulosin belongs to", "exp": "The mainstay of treatment for LUTS due to BPH is a1-adrenergic receptor blockers.a-adrenergic receptors are the most common adrenergic receptors in the bladder, and a1 is the most common subtype in the lower urinary system, prostate, and urethra. The action of a1 blockers is to relax the smooth muscle in the bladder neck and prostate and to reduce outflow resistance. (Prazosin)This class of drugs has become progressively more selective to the a1 subtypes, and many now target the a1asubtype receptor specifically. (Tamsulosin, Alfuzosin)The most common side effects of these drugs are dizziness related to ohostasis, retrograde ejaculation, and rhinitis.The second category of pharmacologic therapy is the 5a-reductase inhibitors that target the glandular component of the prostate. These drugs block the conversion of testosterone to dihydrotestosterone in the prostate and subsequently reduce the prostate volume, thereby reducing outflow resistance. (Finasteride, Dutasteride)Sabiston 20e pg: 2108", "cop": 2, "opa": "5a-reductase inhibitors", "opb": "a1a receptor blockers", "opc": "a1a receptor agonist", "opd": "5a-transferase inhibitors", "subject_name": "Surgery", "topic_name": "Urology", "id": "2684a5b9-ae21-4e5c-b8f4-57af48761299", "choice_type": "single"} {"question": "Indications of percutaneous nephrostomy", "exp": "Nephrostomy is the term used to describe a passageway maintained by tube , stent or catheter that perforates the skin , passes to abdominal wall and renal paranchyma and terminates in renal pelvis or calyx . Access to kidney inferior calyx. Exception -Horseshoe kidney superior pole. Indications :- 1) when upper urinary tract drainage is desired and retrograde ureteral stent placement is not feasible 2) instillation of chemotherapeutic agents for malignancy ( mitomycin c and BCG ) and dissolution of stones COMPLICATIONS:- Heamtoma, Hematuria,Colonic perforation. ref :- Campbell - walsh urology 11th ed , chapter no 6 , pg no 133. , Medscape \" NEPHROSTOMY\" aicle", "cop": 2, "opa": "Stone removal", "opb": "Ureteral obstruction", "opc": "Anterograde renography", "opd": "Renal tumor resection", "subject_name": "Surgery", "topic_name": "Urology", "id": "2d974f14-6aee-4365-8750-2d254ce7e061", "choice_type": "single"} {"question": "Treatment of Hormone dependent fungating carcinoma of breast with secondaries in the lung in a female patient aged 30 years is", "exp": "Hormonal therapy in Carcinoma Breast Ovarian suppression or ablation Bilateral oophorectomy. Medically by LHRH agonist (Goserelin, leuprolide) SERM: Tamoxifen and Raloxifen Aromatase Inhibitors Non-steroidal : Letrozole & Anastrazole Steroidal : Exmestane Anti-Estrogens Fulvestrant Progestins Megesterol & Medroxyprogesterone acetate Ref: schwaz's principle of surgery 10th edition Pgno : 552-553", "cop": 1, "opa": "Simple mastectomy followed by oophorectomy", "opb": "Radical mastectomy followed by oophorectomy", "opc": "Adrenalectomy", "opd": "Lumpectomy followed by castration", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "866a127c-7481-4541-9a8d-dd490fcb8d1c", "choice_type": "single"} {"question": "Circumcision cannot be used in management of", "exp": "Answer- D. Penile CancerPhimosisBalanitis PosthitisParaphimosisSevere UTIs", "cop": 4, "opa": "Phimosis", "opb": "Severe balanitis xerotica", "opc": "Paraphimosis", "opd": "Penile Cancer", "subject_name": "Surgery", "topic_name": null, "id": "585d0658-9473-49cd-bd50-aac207535963", "choice_type": "single"} {"question": "Hot flush is not associated with", "exp": "Hot flashes Hot flashes (also called hot flushes, vasomotor symptoms) have been recognized as a side effect of androgen ablation (medical or surgical) Described as a subjective feeling of warmth in the upper torso and head followed by objective perspiration Are among the most common side effects of androgen ablation, affecting between 50% and 80% of patients Treatment of hot flushes should be reserved for those who find them bothersome Drugs used for treatment : DES, oral progestogen, cyproterone acetate, clonidine, seraline, venlafaxine Ref: Bailey and love 27th edition Pgno : 1473", "cop": 4, "opa": "Medical castration", "opb": "Surgical castration", "opc": "Ketoconazole therapy", "opd": "Radical prostectomy", "subject_name": "Surgery", "topic_name": "Urology", "id": "891a58d8-d9f6-4d25-b7ea-13b780a04fbb", "choice_type": "single"} {"question": "Central dot sign is seen in", "exp": "\"central dot\" sign: enhancing dots within the dilated intrahepatic bile ducts, representing poal radicles (seen in CT).", "cop": 3, "opa": "Primary sclerosing cholangitis", "opb": "Liver Hamaoma", "opc": "Caroli's disease", "opd": "Polycystic liver disease", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "fcde14ea-557e-4cb0-b76b-612c6bd8a847", "choice_type": "single"} {"question": "Bilateral pulseless disease in upper limbs is caused by", "exp": "Aooaeritis or Takayasu's ds. is an inflammatory & stenotic disease of the medium and large-sized aeries with a strong predilection for the aoic arch and its branches (therefore also k/a aoic arch syndrome). Narrowing of the lumen of the involved vessels occur with or without thrombosis, leading to symptoms of vascular compromise. Subclan aery is the most commonly involved vessel, leading to loss or weakening of pulses (thus also k/a pulseless ds.) It is mostly seen in adolescent girls and young women. It is more common in Asia.", "cop": 1, "opa": "Aooaeritis", "opb": "Coarctation of aoa", "opc": "Buerger's disease", "opd": "Aooiliac dissection", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "aafb8f2c-20c4-42ad-ba0c-8de61f638d16", "choice_type": "single"} {"question": "Most common bladder tumor is", "exp": "TCC is most common cancer of bladder.", "cop": 1, "opa": "TCC", "opb": "SCC", "opc": "Adenocarcinoma", "opd": "STS", "subject_name": "Surgery", "topic_name": null, "id": "35a3d3a8-126b-4ab7-8e07-ce2074718e67", "choice_type": "single"} {"question": "Most common cause of death after anaesthesia", "exp": "(C) (Cardiac arrest) (131- Ajay Yadav 5th)More than 80% of cardiac arrest occurs at the time of inductionHypotension -may occurs in intraoperative and post ooperatve period due to effect of anaesthatic drugs, inadequate fluid infusion, excessive loss, cardiac arrhythmiasHypothermia - is the most common thermal pertubation seen in anaesthesia.* Heat loss during general anaesthosia may be as high as 30 kcal /hr* Shivering occurs as a protective mechanism to hypothermia, 02 consumption may increase to 4 times (400%)* Shivering can be abolished by inhibition of hypothalamus* Most common shivering is seen after halothane* Pethidine is drug of choice. Tramodol is 2nd drug of choiceAtelectasis is the MC pulmonary complications of GA in post operative period and the MC cause of at electasis is bronchial obstruction by secretions leading to lobar or segmental collapse (V/Q mismatch).Post operative respiratory depression has been cited as the most common cause of anaesthesia related death in perioperative period.", "cop": 3, "opa": "Hypothermia", "opb": "Hypotension", "opc": "Cardiac arrest", "opd": "Atelectasis", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "7e4ca7b7-ba8e-455c-8e9c-08ae31a86bbd", "choice_type": "single"} {"question": "During an attempted extraction of upper posterior teeth, to determine the position of the roots displaced into antrum, ideal radiograph would be", "exp": null, "cop": 3, "opa": "Bitewing radiography of maxillary posteriors", "opb": "IOPA of mandibular posterior teeth", "opc": "Upper oblique occlusal radiograph", "opd": "Lateral oblique view of mandibular posteriors", "subject_name": "Surgery", "topic_name": null, "id": "976333bc-a2e5-4251-9963-b642d5a104ee", "choice_type": "single"} {"question": "IOC for polyscystic kidney disease", "exp": null, "cop": 1, "opa": "USG", "opb": "MRI", "opc": "IVU", "opd": "CECT", "subject_name": "Surgery", "topic_name": null, "id": "3e713fd9-7a35-4a0c-b675-068a1f96e05e", "choice_type": "single"} {"question": "Investigation of choice for DVT is", "exp": ". Duplex scanning shows noncompressible vein which is wider than normal.On compression over calf muscles,it does not show any augmentation of flow.Normal venous sound atg the area of femoral vein which disappears during inspiration is conspicuously absent in DVT. Refer page no 224 of SRB's manual of surgery 5 th edition.", "cop": 1, "opa": "Duplex USG", "opb": "VQ scan", "opc": "Plethysmography", "opd": "D-dimer assay", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "90a650fe-5e95-4014-bf3f-6e58a51e221c", "choice_type": "single"} {"question": "Not a complication of total parenteral nutrition", "exp": ".Biochemical COMPLICATIONS OF TOTAL PARENTERAL NUTRITON INCLUDES 1. Electrolyte imbalance: Hyponatraemia, hypokalaemia, hypophosphataemia. 2. Hyperosmolarity. 3. Hyperglycaemia. - common. 4. Dehydration. 5. Altered immunological and reticuloendothelial function. 6. Azotaemia. ref:SRB&;s manual of surgery,ed 3,pg no 89", "cop": 3, "opa": "Hyperammonemia", "opb": "Hypercholesterolemia", "opc": "Neutrophil dysfunction", "opd": "Hyperphosphatemia", "subject_name": "Surgery", "topic_name": "Urology", "id": "fb6c087f-16ac-430e-b805-affe63e8e370", "choice_type": "single"} {"question": "Action of intramedullary 'K' nail is", "exp": "B i.e. Three - point fixation", "cop": 2, "opa": "Two-point fixation", "opb": "Three-point fixation", "opc": "Compression", "opd": "Weight concentration", "subject_name": "Surgery", "topic_name": null, "id": "3acff2e2-e05c-42e2-b0d3-59c49b6bf74d", "choice_type": "single"} {"question": "Normal capacity of renal pelvis is", "exp": "The renal pelvis is roughly pyramidal, with the base facing the parenchyma and the apex funneling down into the ureter. It usually has a capacity of 3 to 10 mL of urine. ref : campbell - walsh urology 11th ed , chapter 42 , pg no : 973", "cop": 1, "opa": "7 ml", "opb": "12 ml", "opc": "15 ml", "opd": "20 ml", "subject_name": "Surgery", "topic_name": "Urology", "id": "7b976d2f-3eed-4b4f-9875-dd8332f8d9de", "choice_type": "single"} {"question": "Cock's peculiar tumor is", "exp": "Ans is 'c' i.e. Ulcerated sebaceous cyst Repeat from May 04Cocks peculiar tumor is actually a complication of sebaceous cyst.- When the sebaceous cyst of the scalp ulcerates excessive granulation tissue forms resembling fungating epithelioma. This is called cock's peculiar tumor.Also know these termsCylindroma-A malignant epithelial tumour also k/a Turban tumorKnown as cylindroma because of histological appearancePilomatrixoma (Calcifying epithelioma of Malherbe) -It is a benign hair follicle derived tumour.Pott's puffy tumour -It is osteomyelitis of the skull associated with subperiosteal swelling and edema.", "cop": 3, "opa": "Basal cell CA", "opb": "Squamous cell CA", "opc": "Ulcerated sebaceous cyst", "opd": "Cylindroma", "subject_name": "Surgery", "topic_name": "Plastic & Reconstructive Surgery", "id": "36111486-b310-4b1b-bae6-c04e64ada99e", "choice_type": "single"} {"question": "Earliest symptom of Wilm's tumour", "exp": null, "cop": 3, "opa": "Hematuria", "opb": "Pyrexia", "opc": "Abdominal mass", "opd": "Metastases", "subject_name": "Surgery", "topic_name": null, "id": "3158508d-bfb4-4387-8142-ab4a62144bd5", "choice_type": "single"} {"question": "Most common cause of bowel obstruction is", "exp": ".ADHESIONS AND BANDS - Adhesions and bands are the commonest causes of intestinal obstruction in Western countries. In India, hernia and then adhesions are the two common causes of intestinal obstruction. Causes- * Infection due to peritonitis, appendicitis, postlaparotomy, and other acute infective abdominal conditions. Type I--Fibrinous adhesions occur during 5-10th postsurgical period. It usually gets resolved completely. It is avascular and flimsy. Type II--Fibrous adhesions. Due to lack/poor blood supply, bowel gets attached to pa of peritoneum or omentum or other pas of the bowel with dense vascular adhesions to maintain blood supply. It will persist and precipitate intestinal obstruction, often-subacute and recurrent type. Adhesions due to tuberculosis are severe, dense and difficult to separate. ref:SRB&;s manual of surgery ,ed 3,pg no 870", "cop": 3, "opa": "Malignancy", "opb": "Vovulus", "opc": "Peritoneal adhesions", "opd": "External hernia", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "35ea057a-f530-48d9-b686-7437d30ba7be", "choice_type": "single"} {"question": "Commonest type of cleft lip is", "exp": "Distribution of Cleft types Cleft lip alone - 15% Cleft lip & palate - 45% Isolated cleft palate - 40% Ref : Bailey & Love 25/e p657", "cop": 4, "opa": "Cleft lip alone", "opb": "Bilateral", "opc": "Midline", "opd": "Combined with cleft palate", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "6be70c42-4983-42dd-b39a-fc92cae285a1", "choice_type": "single"} {"question": "Parkland formula is amount of RL given in 24 hrs is calculated as", "exp": "Parklands regime: 4 * %burn * weight (kg) for 24hoursMaximum percentage of burns considered is 15%Half of the volume is given in first 8hours , Rest given in 16hours", "cop": 3, "opa": "Percentage of burns * weight (kg) * 2", "opb": "Percentage of burns * weight (kg) * 3", "opc": "Percentage of burns * Weight (kg)* 4", "opd": "Percentage of burns * weight (kg) * 5", "subject_name": "Surgery", "topic_name": "General surgery", "id": "04fe69e2-91d3-44bd-b92d-bcd4ddcdaf82", "choice_type": "single"} {"question": "It is difficult to obtain local infiltration anesthesia in the presence of inflammation because of", "exp": null, "cop": 1, "opa": "a decreased PH", "opb": "increased vascularity", "opc": "oedema", "opd": "pain", "subject_name": "Surgery", "topic_name": null, "id": "2e2af0dd-0fe3-40d6-93ba-f1de6e319b42", "choice_type": "single"} {"question": "Dysphagia caused by in Plummer Vinson Syndrome is due to", "exp": "(Web) (1024-25-LB) (737, 1043-B &L 25th)Plummer-Vinson Syndrome (Brown-Kelly Paterson syndrome or sideropenic dysphagia)* Young women with iron deficiency anaemia and dysphagia referred high in the neck.* The dysphagia was said to be caused by spasm or a web in the post-cricoid area. The patients were said to have an increased tendency to post-cricoid cancer.* Web certainly occurs in the upper oesophagus. More recently it has been noted that there is often a patch of heterotopic gastric mucosa in the upper oesophagus (probably congenital)* Complications - ulceration, stricture and adenocarcinoma", "cop": 2, "opa": "Stenosis", "opb": "Web", "opc": "Stricture", "opd": "Ulceration", "subject_name": "Surgery", "topic_name": "Oesophagus", "id": "93bee656-c09b-4907-89d5-b6adc81a2aa0", "choice_type": "single"} {"question": "22 Gauge iv cannula colour is", "exp": "Orange : 14G\nGray : 16G\nGreen : 18G\nPink : 20G\nBlue : 22G\nYellow : 24G", "cop": 3, "opa": "Green", "opb": "Grey", "opc": "Blue", "opd": "Pink", "subject_name": "Surgery", "topic_name": null, "id": "a70fa772-ba7e-48b3-a4eb-20a741d8c0ce", "choice_type": "single"} {"question": "Management of rectosigmoid obstructive carcinoma in elderly frail", "exp": "Colostomy MC indication for fashioning a colostomy : CA rectum. Colostomies are also constructed as treatment for Obstructing lesions of the distal large intestine and for actual or potential perforation. Type by Anatomic Location End-sigmoid colostomy (MC) End-descending colostomy Transverse colostomy Cecostomy Decompressing Colostomy Diveing colostomy Indications Distal obstructive lesions causing massive dilation of the proximal colon without ischaemic necrosis Severe sigmoid diveiculitis with phlegmon Selected patients with toxic mega colon Types of Decompressing stomas Blow-hole Cecostomy Blow-hole transverse colostomy Tube type of Cecostomy Loop-tramsverse colostomy Indications When distal segment of bowel has been completely resected (as during APR) Known or suspected perforation or obstruction of the distal bowel (e.g., Obstructing carcinoma, diveiculitis, leaking anastomosis or trauma) Destruction or infection of the distal colon, rectum, or a us (eg: Crohn's disease or failed anal sphincter reconstruction) Type of Diveing Stomas Loop-tramsverse colostomy Loop sigmoid colostomy Ref: Sabiston 20th edition Pgno : 1326-1330", "cop": 1, "opa": "Colostomy", "opb": "Abdomino-perineal resection (APR)", "opc": "Resection & primary anastomosis", "opd": "Hamann procedure", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "dae55b31-c4cc-43e8-bc4d-3de7398d74fd", "choice_type": "single"} {"question": "Metastasis of ca buccal mucosa goes to", "exp": "Tumors in this area have a propensity to spread locally and to metastasize to regional lymphatics . Lymphatic metastasis of Buccal ca go to submandibular and later upper jugular nodes. MC type of Buccal ca - Squamous cell ca Commonest site of origin - angle of mouth or the line of occlusion of upper and lower teeth", "cop": 3, "opa": "Hea", "opb": "Brain", "opc": "Regional lymph node", "opd": "Lungs", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "6f1bb127-8195-4e73-aab7-577da852e8a6", "choice_type": "single"} {"question": "Abscess that arise from the tuberculous origin is", "exp": null, "cop": 3, "opa": "Cystic hygroma.", "opb": "Collar stud abscess.", "opc": "Cold abscess.", "opd": "Laryngocele.", "subject_name": "Surgery", "topic_name": null, "id": "f1d0b6d7-730a-46e8-9dd1-f903bbe3e13e", "choice_type": "single"} {"question": "Cisterna chyli lies in front of vertebrae", "exp": "Cisterna chyli is a lymph sac lying in front of L1 and L2 vertebrae between aorta and crus of diaphragm.", "cop": 3, "opa": "T11 and T12", "opb": "T12 and L1", "opc": "L1 and L2", "opd": "L2 and L3", "subject_name": "Surgery", "topic_name": null, "id": "631a0fe6-0a96-4d4c-b5be-2efdc4121b75", "choice_type": "single"} {"question": "&;Tennis elbow&; is characterized by", "exp": ".tennis elbow(lateral epicondylitis) characterised by pain and tenderness at the lateral epicondyle of the humerus due to non-specific inflammation of the origin of extensor muscle of the forearm. clinical features-tenderness ,precisely localized to the lateral epicondyle of the humerus.pain is aggravated by putting the extensor tendons to a stretch (Ref: Essential ohopaedics, Maheshwari and Mhaskar,5th edition,pg no. 302)", "cop": 2, "opa": "Tenderness over the medial epicondyle", "opb": "Tendinitis of common extensor origin", "opc": "Tendonitis of common flexer origin", "opd": "Painful flexion and extension", "subject_name": "Surgery", "topic_name": "Trauma", "id": "b779c28a-d77f-47c9-bc69-5eded70688cb", "choice_type": "single"} {"question": "The most common complication of supracondylar fracture is", "exp": "D i.e. Malunion with gunstock deformity", "cop": 4, "opa": "Osteosarcoma", "opb": "Genu valgum", "opc": "Blood vessel injury", "opd": "Malunion with gun stock deformity", "subject_name": "Surgery", "topic_name": null, "id": "d0065131-badc-40b1-ac9c-09c101c81228", "choice_type": "single"} {"question": "Osteoblastic secondaries occurs with", "exp": "(Carcinoma prostate) (1086-CSDT 13th)* Although some tumours may produce mainly osteolytic lesions (eg Kidney cancers) and others mainly osteoblastic lesions (eg prostate cancers), most metastatic lesion produce both types of lesion and may go through stages where one or the other predominates - 613- Harrison 17th* Osteolytic lesions are associated with hypercalcemia* and hydroxyproline - containing peptides* Osteoblastic lesions are associated with increased levels of serum alkaline phosphatase** Most common cause of osteolytic metastasis- In males - lung cancer- In female - Breast cancer Most common cause of Osteoblastic metastasis- In male - Prostate cancer- In female - Breast cancer* Lytic expansile metastasis seen in Thyroid, Renal carcinomaCarcinoma of prostate - 90% tumours are adeno carcinoma the tumour arises primarily in the peripheral zone (70%)**Periurethral (Tansition) zone - site for benign prostatic hyperplasia**Screening by transrectal Ultrasound TRUS / and PSATRUS - most useful for Taking guided biopsy*** Most common cause of sclerotic skeletal metastasis in a female patients is - Carcinoma breast", "cop": 1, "opa": "Carcinoma prostate", "opb": "Carcinoma rectum", "opc": "Carcinoma endometrium", "opd": "Wilm's tumour", "subject_name": "Surgery", "topic_name": "Orthopedics", "id": "03299af5-d88a-432b-8d25-54fedcbf64ea", "choice_type": "single"} {"question": "Banka's lesion involves", "exp": "B i.e. Anterior aspect of glenoid labrum", "cop": 2, "opa": "Anterior aspect of the head of humerus", "opb": "Anterior aspect of glenoid labrum", "opc": "Posterior aspect of glenoid labrum", "opd": "Posterior aspect of head of humerus", "subject_name": "Surgery", "topic_name": null, "id": "2e207f1d-c705-4b63-84c5-2aa4faa577ee", "choice_type": "single"} {"question": "Punched out Ulcer in Esophagus on Endoscopy in a Immunocompromised patient is seen in", "exp": "Herpes Simplex Esophagitis: - * Common in Immunocompromised patients. * Characterised by small raised herpetic vesicles few days before on the lips. * Endoscopy reveals- Vesicles and small ulcers with raised margins (Punched out) usually in upper half of esophagus. Ref:- Bailey and Love 27th Edition; Pg num:- 1104", "cop": 1, "opa": "Herpes simplex", "opb": "Herpes Zoster virus", "opc": "CMV", "opd": "Candidiasis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "4b2480ff-dd79-4ec9-9ffb-bc45e16b81a2", "choice_type": "single"} {"question": "Selective toxicity of zindovudine for HIV is based on inhibition of", "exp": "HIV binds to a surface molecule on CD4 lymphocytes and enters the cell, where viral RNA serves as a template for both positive and negative strands of complementary DNA. Reverse transcriptase (RNA-dependent DNA polymerase) transcribes the viral RNA. The double- stranded complementary DNA is then spliced into the host cell genome by a virus-encoded integrase. The mtegrated complementary DNA is then transcribed and translated into viral proteins. The dideoxy nucleosides including zidovudine, selectively inhibit revers transcriptase. Host cell DNA polymerase is more than 100 times less sensitive than the HIV polymerase to zidovudine.", "cop": 2, "opa": "Viral genomic RNA replication", "opb": "Complementary DNA synthesis", "opc": "Incorporation of complementary DNA into the host genome", "opd": "Transcription of viral DNA by host RNA polymerase", "subject_name": "Surgery", "topic_name": null, "id": "0abc4abd-67b4-42aa-aa95-2104a608509b", "choice_type": "single"} {"question": "Hinge fracture is seen in", "exp": "Skull base fractures Anteruor cranial fossa Subconjunctival hematoma CSF Rhinorrhea Carotico-cavernous fistula Periorbital hematoma or \"Raccoon eyes\" Middle cranial fossa fracture CSF otorrhea Hemotympanum Ossicular disruption Battle sign : Bruising behind the ear 7th and 8th cranial nerve palsies Ref: Bailey and love 27th edition Pgno : 333", "cop": 3, "opa": "Vault", "opb": "Ant cranial fossa", "opc": "Middle cranial fossa", "opd": "Posterior cranial fossa", "subject_name": "Surgery", "topic_name": "Trauma", "id": "4404dd1e-7b37-484e-b439-7e00d09bd832", "choice_type": "single"} {"question": "CSF rhinorrhoea is diagnosed by", "exp": "(B) Beta 2 transferrin # investigations:> CSF as compare to nasal secretion has a central area of blood with outer ring or halo (Halo sign)> Glucose testing: CSF glucose is low compared to serum glucose.> Beta 2 transferring assay: This marker is very specific to CSF. However, the test is expensive & results may take several days to a few weeks to receive. Most leaks will have closed before the results are available, making this a poor test> Protein used in iron transport> Beta 1 - Serum, nasal secretions, tears, saliva> Beta 2 - CSF, perilymph and aqueous humor.> Diagnosis: History - surgeries, accident, unilateral, watery, intermittent, assocaited features like headache, positional variation, associated with anosmia or hyposmia etc.,> Laboratory Tests: Glucose oxidase test: Glucose oxidase strips show color change on detection of glucose (high false negative so abondoned) b2 transferring in the nasal secretions. In CSF Beta 2 transferring is present, and it is absent in normal nasal secretions. (100%sensitivity and 95% specificity. b Trace protection: 100% sensitive and specific Intrathecal radionucleotide test: Most specific Test that help to localise the CSF leak MR cysternography, CT Cysternography (Contraindicated in active meningitis or High ICP) Intrathecal administration of non-ionic contrast with high resolution CT scan. Intrathecal administration of low quantities of Fluorescein can also be used. If the leak is present it can be seen in the nasal cavity with a 490 nm light generated by a special optical filter. Dye injection is done using Barbolage technique in which 1-2 drops of 5% Fluorescein is diluted with the patients own CSF, and then injected partially, then CSF is withdrawn further diluting the dye and then reinjecting the dye.# CSF contains glucose which can be demonstrated by oxidase peroxidase paper strip or biochemical tests. Beta 2 transferrin is specific for CSF.> Analysis of the collected nasal fluid can be both problematic and useful. Analysis of nasal fluid is problematic because simple testing such as observing how the drainage dries on paper (Ring sign) or measuring the sugar content (reflecting the elevated glucose content of CSF) may not be valid.> Presence of the enzyme Beta2-transferrinase is only found in CSF, but requires the collection of several milliliters of fluid to be sent for highly specialized laboratory testing.> To confirm or further identify the route of CSF rhinorrhea, three forms of imaging are available.> Isotope cisternogram is the most sensitive, but least specific form of imaging. Nuclear medicine study consists of placing a low yield radioactive isotope in the subarachnoid space via a lumber puncture or spinal tap. Presence of isotope containing CSF in the nose is confirmed by measuring radioactivity within the nasal cavity or on cotton pledgets placed at probable sites of cerebral spinal fluid drainage from the cranial cavity. Contrast CT cisternography is a more specific, but a less sensitive form of imaging for CSF rhinorrhea. Requires an active leakage of CSF to the nose and involves the placement of an agent opaque to CT imaging within the subarachnoid space. Coronal CT scan is then performed to image the defect within the floor of the anterior or middle cranial fossa, and the route of drainage into the nose.> Magnetic resonance imaging is a non-radiographic procedure utilizing the detection of electromagnetic energy released from the hydrogen atom as the electron circling the nucleus descends to a lower energy level. Soft tissue contains various amounts of water and the physics of detecting changes in energy rather than density (as in the case of CT) significantly favor the former. MR imaging is the examination of choice tor visualizing potential brain anomalies, such as encephaloceles (herniation of brain into the nose or ear). MR also permits the identification of CSF draining into the nose without the use of contract, but does not visualize well bony detect in the skull base or currently lacks the detail provided by CT cisternography.", "cop": 2, "opa": "Beta 2 microglobulin", "opb": "Beta 2 transferrin", "opc": "Thyroglobulin", "opd": "Transthyretin", "subject_name": "Surgery", "topic_name": "Nervous System", "id": "c2b0b84f-e503-4ff0-951b-9a02ef61293a", "choice_type": "single"} {"question": "The recent treatment of sho bridle passable stricture of urethra in the penile and bulbous urethra is", "exp": "Endoscopic (internal) urethrotomy Internal urethrotomy is performed using the optical urethrotome. The stricture is cut under visual control using a knife passed through the sheath of a rigid urethroscope. The stricture is usually cut at the 12 o'clock position, taking care not to cut too deeply into the vascular spaces of the corpus spongiosum that surrounds the urethra. It is possible to get lost when trying to cut a way through a very tight stricture, and this is especially true when there are false passages because of previous dilatation attempts. Accordingly, a guidewire should be passed through to the bladder prior to incision of the stricture in order to establish the true lumen of the urethra. Following urethrotomy a catheter should be left in situ for 1-3 days afterwards. A single urethrotomy seems to give a permanent cure of an uncomplicated stricture in about 50% of patients. Success rates are highest when the stricture is sho and when it is present within the bulbar urethra. In contrast, failure rates are highest in long strictures, strictures within the penile urethra and in recurrent strictures. The main complications are infection and bleeding. Ref: Bailey and love 27th edition Pgno : 1484", "cop": 2, "opa": "Internal urethrotomy with Thompson-Walker's urethrotome", "opb": "Optical internal urethrotomy", "opc": "Syme's operation", "opd": "Wheelhouse operation", "subject_name": "Surgery", "topic_name": "Urology", "id": "29b70167-7b41-4cf9-b6f4-73e646d88352", "choice_type": "single"} {"question": "Earliest manifestation of increased intracranial pressure following head injury is", "exp": "Ans. (c) Altered mental statusRef: Bailey 26th 310Altered mental status is the earliest manifestation of increased intracranial pressure.Cushing's triad of increased ICP* Intracranial hypertension* Brady cardia* Irregualr respiration", "cop": 3, "opa": "Ipsilateral papillary dilatation", "opb": "Contralateral papillary dilation", "opc": "Altered mental status", "opd": "Hemiparesis", "subject_name": "Surgery", "topic_name": "Nervous System", "id": "71913216-c2a5-4a68-ab00-9b1e1b246621", "choice_type": "single"} {"question": "Ascites with SAAG < 1 is seen in", "exp": "SAAG is calculated by subtracting ascitic fluid from serum albumin level, if swag is less than 1.1 then it is called low gradient SAAG which suggests an absence of poal hypeension and is seen in a condition like nephritic syndrome. SAAG more than 1.1 suggest presence of poal hypeension, it is called high gradient SAAG is seen in cirrhosis, Budd Chiari syndrome, cardiac ascites Reference : SRB edition : 5 page: 625", "cop": 4, "opa": "Cirrhosis", "opb": "Budd chiari syndrome", "opc": "Cardiac ascitis", "opd": "Nephrotic syndrome", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "639d150c-c698-41a2-a44d-e64117d73d73", "choice_type": "single"} {"question": "Acute urinary retention in a male child may be due to", "exp": "Acute urinary retention in a male child may be due to local inflammatory causes like meatal ulcer with scabbing.", "cop": 4, "opa": "Prostatic radiotherapy", "opb": "Urethral stricute", "opc": "Hysteria", "opd": "Meatal ulcer with scabbing", "subject_name": "Surgery", "topic_name": null, "id": "85adb493-e3a8-49c3-a382-59592b5ae208", "choice_type": "single"} {"question": "Retractile mesenteis may be seen in", "exp": "Ans. is 'a' i.e., Ormond's disease", "cop": 1, "opa": "Ormonds's disease", "opb": "Gardner' syndrome", "opc": "Turner's syndrome", "opd": "Down's syndrome", "subject_name": "Surgery", "topic_name": null, "id": "81fe5ae5-deb6-4fb3-bd7f-41175d2d69e6", "choice_type": "single"} {"question": "Investigation of choice for spinal TB", "exp": "Answer- C. MRIBest view for Cl-C2 veebrae & junction - open mouth odontoid (pegs) view.Investigation of choice for spinal tuberculosis - MRIInvestigation of choice for traumatic paraplagia - MRI", "cop": 3, "opa": "X-ray", "opb": "CT Scan", "opc": "MRI", "opd": "PET Scan", "subject_name": "Surgery", "topic_name": null, "id": "1d88f1a9-f7eb-42a6-a893-8443e0ba0a13", "choice_type": "single"} {"question": "A patient presents with bilateral proptosis, heat intolerance and palpitations. Most unlikely diagnosis here would be", "exp": null, "cop": 4, "opa": "Hashismoto's thyropidittis", "opb": "Thyroid adenoma", "opc": "Diffuse thyroid goitre", "opd": "Reidel,s thyroiditis", "subject_name": "Surgery", "topic_name": null, "id": "0c05e387-5c3a-4b0a-a003-bee1db15d1d8", "choice_type": "single"} {"question": "Most common paraneoplastic syndrome in HCC is", "exp": "Paraneoplastic syndromes on HCC Hypercholesterolemia Hypoglycemia Erythrocytosis Hypercalcemia Hypercholesterolemia > Hypoglycemia > Erythrocytosis > Hypercalcemia Ref: Sabiston 20th edition Pgno : 1459", "cop": 1, "opa": "Hypoglycaemia", "opb": "Hypeension", "opc": "Hypercalcemia", "opd": "Erythrocytosis", "subject_name": "Surgery", "topic_name": "Urology", "id": "38747410-14ef-40ba-aa4a-bc689fdfb95c", "choice_type": "single"} {"question": "MTC associated with MEN 3 syndrome has", "exp": "MITC associated with MEN 3 syndrome is very aggressive.\nChromosome 10 ( RET) mutation is present.", "cop": 2, "opa": "Good prognosis", "opb": "Bad prognosis", "opc": "Late presentation", "opd": "Chromose 11 mutation", "subject_name": "Surgery", "topic_name": null, "id": "2751b2d1-a099-4759-8b57-c0a3b03d765c", "choice_type": "single"} {"question": "A new born presented with bloated abdomen sholy after bih with passing of less meconium. A full thickness biopsy rectal biopsy finding is most likely to be present.", "exp": ".hirschsprung disease is a congenital, familial condition, occurring in newborn due to the absence of ganglion cells-- Auerbach's and Meissner's plexus in anorectum, which may extend proximally either a pa or full length of the colon. * It always involves the anus, internal sphincter and rectum (paly or entirely). * There is narrow, spasmodic, non relaxing pathological segment. * Transitional zone proximal to it contains only few ganglion cells with formation of cone. ref:SRB&;s manual of surgery,ed 3,pg no 818", "cop": 4, "opa": "Fibrosis of submucosa", "opb": "Hyalinisation of the muscular coat", "opc": "Thickened Muscularis propria", "opd": "Lack of ganglion cells", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "6e2842a0-408d-4cfa-be7a-c93181a830c8", "choice_type": "single"} {"question": "This surgical blade is used for", "exp": "This is Number 12 surgical blade. It is used for suture removal.", "cop": 2, "opa": "Minor surgical procedures", "opb": "Suture removal", "opc": "Abscess drainage", "opd": "Abdominal incision", "subject_name": "Surgery", "topic_name": null, "id": "031e44a5-b16c-4eb8-b82a-b6beff3efb5f", "choice_type": "single"} {"question": "Best treatment modality for SCC of bladder", "exp": "SCC of bladder is treated by radical cystectomy.", "cop": 3, "opa": "Chemotherapy", "opb": "Radiotherapy", "opc": "Radical cystectomy", "opd": "TURBT", "subject_name": "Surgery", "topic_name": null, "id": "610896d6-5210-4e2c-a62e-a7e8c67708ba", "choice_type": "single"} {"question": "It can be stated that the superior haemorrhoidal veins —a) Drain into the inferior mesentric veinb) Have no valvec) Leave the anal canal at the pactinate lined) Cause external haemorrhoids", "exp": null, "cop": 3, "opa": "ac", "opb": "a", "opc": "ab", "opd": "bc", "subject_name": "Surgery", "topic_name": null, "id": "f41ab83a-3f7f-45c8-a1c4-cb8b3f544136", "choice_type": "single"} {"question": "The earliest symptom in primary biliary cirrhosis is", "exp": "Pruritis occurs because of deposition of bile salts in the skin, this clinical symptom occurs before the development of jaundice.", "cop": 2, "opa": "Jaundice", "opb": "Pruritus", "opc": "Melanosis", "opd": "Vomiting", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "48dfa859-bc7a-45ec-a8a9-ff5e5fdc49be", "choice_type": "single"} {"question": "Most common type of malignant melanoma is", "exp": "A. i.e. (Superficial spreading melanoma) (613 -B & L 25th) (111- 13 S. Das 5th)MALIGNANT MELANOMA* Commonest type is superficial spreading melanoma (70%) and Least is acral lentiginous melanoma (2 - 8%)* Nodular melanoma is the most malignant form*** The presence of lymph node metastasis is the single most important prognostic index in melanoma* Skin is the most common site of malignant melanoma (palms, soles and external genitalia are the common site)* Cardinal symptoms of malignant change in a mole or naevus1. Increase in size2. Change in colour3. Bleeding4. Evidence of local spread5. Enlarged regional lymph nodes", "cop": 1, "opa": "Superficial spreading", "opb": "Nodular melanoma", "opc": "Lentigo maligna melanoma", "opd": "Acral lentiginous melanoma", "subject_name": "Surgery", "topic_name": "Neoplasia", "id": "d552cd6e-f186-4cb9-ae6b-f0442a93dac4", "choice_type": "single"} {"question": "Most common nutritional deficiency seen after gastrectomy", "exp": "Most common complication is violin deficiency.", "cop": 1, "opa": "Iron deficiency", "opb": "B12 deficiency", "opc": "Vitamin d deficiency", "opd": "Vitamin k deficiency", "subject_name": "Surgery", "topic_name": null, "id": "fe4d1339-8e4a-4a5d-af4a-4fdc74e570cb", "choice_type": "single"} {"question": "Least common quadrant in cancer breast is", "exp": "Most malignant type of CA breast : Inflammatory breast cancer Best prognosis is seen in : Tubular MC site of CA breast : Upper outer quadrant (left breast >right) Least common site of CA breast lower inner quadrant MC site of metastasis is Bone (osteolytic deposits in lumbar veebrae >Femur >Thoracic veebrae >Rib > Skull Ref: Sabiston 20th edition Pgno :837", "cop": 4, "opa": "Upper outer", "opb": "Lower outer", "opc": "Sub areolar", "opd": "Lower inner", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "0ca38a02-b48c-4c91-9263-e9d8813a0ad2", "choice_type": "single"} {"question": "Sequence of colour changes observed in Raynaud’s disease", "exp": null, "cop": 2, "opa": "Red, blue, white", "opb": "White, blue, red", "opc": "Blue, red, white", "opd": "White, red, blue", "subject_name": "Surgery", "topic_name": null, "id": "f0c9ec88-9f0a-490e-aee4-24d9d6e1078d", "choice_type": "single"} {"question": "Pain and ahritis of distal interphalangeal joint is seen in", "exp": "Answer- A. Osteoahritis", "cop": 1, "opa": "Osteoahritis", "opb": "Rheumatoid Ahritis", "opc": "Ankylosing spondylitis", "opd": "Dequervain's disease", "subject_name": "Surgery", "topic_name": null, "id": "887a2761-be12-4ee7-ab17-399110f8b7d4", "choice_type": "single"} {"question": "In reduction genioplasty", "exp": null, "cop": 1, "opa": "Symphysis part of mandible is reduced", "opb": "Symphysis part of mandible is advanced", "opc": "Parasymphysis part of the mandible is reduced", "opd": "Parasymphysis part of the mandible is advanced", "subject_name": "Surgery", "topic_name": null, "id": "70c5040a-7981-4911-8177-2949730186c5", "choice_type": "single"} {"question": "Cullen Sign is a feature of", "exp": "Ans. (a) hemorrhagic pancreatitisRef: Bailey and Love 27th edition Page 1222* Cullen sign: Hemorrhagic Pancreatitis causing Pigmentation in Umbilicus* Grey turner sign: Hemorrhagic Pancreatitis causing Pigmentation at Loin* Fox sign: Hemorrhagic pancreatitis causing pigmentation in Inguinal region.", "cop": 1, "opa": "Hemorrhagic pancreatitis", "opb": "Liver trauma", "opc": "Ectopic pregnancy", "opd": "Cirrhosis liver", "subject_name": "Surgery", "topic_name": "Pancreas", "id": "74ba4996-0ef8-4fea-9558-0a9ef5d1fa7d", "choice_type": "single"} {"question": "30 year old patient with pain in right hypochondrium for 5 days with soft and tender liver and intercostal tenderness. He complains of catch in breath on inspiration and has a non productive cough. On examination the lung fields are clear, patient looks pale and emaciated. Probable diagnosis is", "exp": "Ans. (a) Ameobic liver abscessRef:Manipal Manual of surgery, 4th ed./521Refer to the above explanationHydatid cystUsually clinically silentEnlarged liver with smooth surface and is non tender.Pyogenic liver abscessMultiple abscess leading to spiky fever and enlarged liver.Hepatic adenomaPresents in young women on OCP and is solitary. Liver enlargement may or may not be seen.", "cop": 1, "opa": "Amoebic liver abscess", "opb": "Pyogenic live abscess", "opc": "Hydatid cyst", "opd": "Hepatic adenoma", "subject_name": "Surgery", "topic_name": "Hepatic Tumors, Cysts, and Abscesses", "id": "a29bb139-1b53-463c-b01d-8c6404f7f06d", "choice_type": "single"} {"question": "Standard treatment of appendicular mass is", "exp": "[Cl (Ochsner: sherren regimen) (1216-LB) (1215-B &L 25th)Management of a appendix mass* If an appendix mass is present and the condition of the patients is satisfactory, the standard treatment is the conservative Ochsner-Sherren regimen* It is advisable to remove the appendix after an interval of 6-8 weeksAppendicitis During Pregnancy - Appendicitis is the most common non-obstetric surgical disease of the abdomen during pregnancy.* Laparoscopic appendectomy (specifically the pneumoperitoneum) is well tolerated by the mother and fetus (669-CSDT IT)", "cop": 3, "opa": "Immediate laproscopic excision", "opb": "Needle aspiration", "opc": "Ochsner - Sheren regimen", "opd": "Appendectomy", "subject_name": "Surgery", "topic_name": "Vermiform Appendix", "id": "8eaa0d2f-bfa3-4c30-bfa1-e037202a538d", "choice_type": "single"} {"question": "A child is passing blood with act of defecation. The probable diagnosis is", "exp": "Ans. (a) Juvenile rectal polypRef : Bailey & Love 26th ed. /1224The most common cause of bleeding per rectum in children is juvenile rectal polyp up to adolescence age. Though in infants and young children (up to 1 yrs) the cause is anal fissure.", "cop": 1, "opa": "Juvenile rectal polyp", "opb": "Adenomatous Polyposis", "opc": "Rectal ulcer", "opd": "Post Surgery", "subject_name": "Surgery", "topic_name": "Rectum", "id": "b19f6ea0-4e07-427c-a11c-5a8df7c84f1e", "choice_type": "single"} {"question": "Most common site of metastasis in Ca colon is", "exp": "One-third of patients will have liver metastases at the time of diagnosis and 50% will develop them at some point, accounting for the majority of deaths. The lung is the next most common site; metastasis to ovary, brain, kidney, and bone is less common.Ref: Bailey and love, page: 1262", "cop": 1, "opa": "Liver", "opb": "Lung", "opc": "Bone", "opd": "Brain", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "cf5ff80f-138e-433b-ac94-53a05531eaa8", "choice_type": "single"} {"question": "As per CEAP classification healed venous ulcer is", "exp": "CEAP (Clinical-aEtiology-Anatomy-Pathophysiology) classification for chronic venous disorders Clinical classificationC0: no signs of venous disease;C1: telangectasia or reticular veins;C2: varicose veins;C3: oedema;C4a: pigmentation or eczema (some include malleolar flare in this category);C4b: lipodermatosclerosis or atrophie blanche;C5: healed venous ulcer;C6: active venous ulcer.Etiological classificationEc: congenitalEp: primaryEs: secondary (post-thrombotic)En: no venous cause identified.Anatomical classificationAs: superficial veinsAp: perforator veinsAd: deep veinsAn: no venous location identified.Pathophysiological classificationPr: refluxPo: obstructionPr,o: reflux and obstructionPn: no venous pathophysiology identifiable.Ref: Bailey and love pg: 974", "cop": 4, "opa": "C2", "opb": "C3", "opc": "C4", "opd": "C5", "subject_name": "Surgery", "topic_name": "General surgery", "id": "bae15fcf-8266-4465-bc44-22f11f5d3505", "choice_type": "single"} {"question": "In prostate Ca. metastasis, lymph nodes most commonly affected are", "exp": "Obturator LN are first nodes involved in prostate Ca.", "cop": 2, "opa": "Sacral LN", "opb": "Obturator LN", "opc": "Paraaortic LN", "opd": "Iliac LN", "subject_name": "Surgery", "topic_name": null, "id": "7dede929-58f6-41ad-9d3d-03206fbd103e", "choice_type": "single"} {"question": "In general commonest hemorrhage following head injury is", "exp": "SUBDURAL HAEMATOMA Types Acute Chronic Acute Subdural Haematoma It is a collection of blood between the brain and dura. It is due to injury to the coical veins and often due to laceration of coex of brain which bleeds and blood gets collected in the subdural space forming a haematoma. Here haematoma is extensive and diffuse. There is no lucid interval. There is severe primary brain damage. Haematoma may be of coup and contre-coup type. Loss of consciousness occurs immediately after trauma and Is progressive. Convulsion is common. Features of raised intracranial pressure is obviously seen high BP, bradycardia, vomiting. Focal neurological deficits or hemiparesis can occur. CT scan shows concavo-convex lesion. Treatment Antibiotics, anticonvulsants. Surgical decompression is done by craniotomy. Chronic Subdural Haematoma It is due to the rupture of veins between dura and brain (cerebral hemispheres), causing gradual collection of blood in subdural space. It is commonly seen in elderly people following any minor trauma like fall, slipping (which might have gone unnoticed). In elderly people, brain atrophies and even minor injuries can cause shearing and bleeding from these veins. Blood collects gradually over 2-6 weeks. Plasma and cellular components get separated. Eventually cellular pa gets absorbed leaving only fluid component. It is called as chronic subdural hygroma. Usual haematoma collection is 60-120 ml. Often in 50% of cases, it is bilateral. Clinical Features Common in old age, with history of minor trauma. Patient presents with confusion, disorientation, gradually with altered level of consciousness and drowsiness. Later convulsions, features of intracranial hypeension, features of coning develops. Extensor plantar response and pupillary changes develop eventually. Investigations CT scan (shows concavo-convex lesion). Serum electrolytes. Blood grouping and cross matching. Differential Diagnosis Electrolyte imbalance. Intracranial space occupying lesion. Treatment Craniotomy and evacuation of clot is done when required on both sides. Antibiotics. Anticonvulsants for 3 years. Complications Epilepsy Meningitis Coning Neurological deficits Ref: SRB's Manual of Surgery 5th edition Pgno : 1096", "cop": 3, "opa": "Subcoical", "opb": "Extradural", "opc": "Subdural", "opd": "Intraventricular", "subject_name": "Surgery", "topic_name": "Trauma", "id": "2b77e17c-f4d5-4a10-8c9f-e4f2d8d2f741", "choice_type": "single"} {"question": "Buerger's angle that indicates severe ischaemia is", "exp": "If Buerger's angle is < 30°, it indicates severe ischaemia.", "cop": 4, "opa": "120°", "opb": "80°", "opc": "60°", "opd": "30°", "subject_name": "Surgery", "topic_name": null, "id": "19b007b0-3f48-422c-b240-28e2db44f7f4", "choice_type": "single"} {"question": "Most common site of carcinoma of stomach in developed countries is", "exp": "The proximal stomach is now the most common site for gastriccancer in resource-rich western countriesIt can be seen that just under 60% of all of the malignancies occurring in the oesophagus and stomach occur in proximity to the oesophago-gastric junction.This high prevalence of proximal gastric cancer is not seen in Japan, where distal cancer still predominates, as it does in most of the rest of the world.Bailey and Love 27e pg: 1132", "cop": 1, "opa": "Proximal stomach", "opb": "Gastric antrum", "opc": "Lesser curvature", "opd": "Greater curvature", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "52ac7564-e4c4-4273-b5c2-c634c2831303", "choice_type": "single"} {"question": "Thoracic duct can be identified by", "exp": "Thoracic duct is identified within Poirier's triangle which is formed by arch of aorta, left subclavian artery & vertebral column.", "cop": 2, "opa": "Bear's triangle", "opb": "Poirier's triangle", "opc": "Petit's triangle", "opd": "Koch's triangle", "subject_name": "Surgery", "topic_name": null, "id": "af6d6bf5-bf37-4dbd-8b95-e6ae149a5cb9", "choice_type": "single"} {"question": "The commonest earliest complication of TV and GJ is", "exp": null, "cop": 4, "opa": "Stomal obstruction", "opb": "Paralytic ileus", "opc": "Gastric leak", "opd": "Anastomotic Hemorrhage", "subject_name": "Surgery", "topic_name": null, "id": "54ffece1-5920-4af1-aae3-4944a7e552f0", "choice_type": "single"} {"question": "Pseudo obstruction of intestine is also known as", "exp": "Ans. (c) Ogilvie's syndromeRef.: Bailey & Love 26th ed. /1198* Pseudo-obstruction of the colon is called as ogilvie's syndrome which is characterized by distention of the colon, with signs and symptoms of colonic obstruction, in the absence of an actual physical cause of the obstruction. The cause of the dilation was attributed to the malignant infiltration of the sympathetic ganglia.* Mirizzi syndrome is a gallstone becoming impacted in cystic duct or neck of gall bladder causing compression of CBD and resultant obstructive Jaundice.", "cop": 3, "opa": "Hartmanns syndrome", "opb": "Ozilis syndrome", "opc": "Ogilvies syndrome", "opd": "Mirizzi syndrome", "subject_name": "Surgery", "topic_name": "Intestinal Obstruction", "id": "9478ec4e-4b82-41b1-b826-82911ca60272", "choice_type": "single"} {"question": "The following is the commonest site for venous ulcer", "exp": "Venous ulcers usually lie just proximal to the medial or lateral malleolus. Venous ulcers are accompanied by lipodermatosclerosis and hemosiderosis (if these are not present then the ulcer is probably not of venous origin). Ref : Bailey & Love 25/e p937", "cop": 3, "opa": "Sole of foot", "opb": "Lower 2/3 of leg", "opc": "Lower 1/3 of leg and ankle", "opd": "Middle 1/3 of leg", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "b7b5c466-6a4d-469c-be95-494da0d850e2", "choice_type": "single"} {"question": "An elderly male presents with pain in his shoulders and hands. ESR is 105 mm/L. History includes transient blindness and unilateral headache. (SELECT 1 DIAGNOSIS)", "exp": "Behcet syndrome is a multisystem disorder that usually presents with recurrent oral and genital ulcers. Onefouh of patients develop superficial or deep vein thrombophlebitis. Iritis, uveitis, and nondeforming ahritis may also occur. The 50-year-old drug abuser also has a multisystem disease, including systemic complaints, hypeension, skin lesions, neuropathy, and an abnormal urine sediment. This complex suggests a vasculitis, paicularly polyaeritis nodosa. The disease is a necrotizing vasculitis of small and medium muscular aeries. The pathology of the kidney includes an aeritis and, in some cases, a glomerulitis. Nodular skin lesions show vasculitis on biopsy. The 19-year-old with low back pain, morning stiffness, and eye pain has complaints that suggest ankylosing spondylitis. This is an inflammatory disorder that affects the axial skeleton. It is an autoimmune disorder that has a close association with HLA-B27 histocompatibility antigen. Anterior uveitis is the most common extraaicular complaint. Aoic regurgitation occurs in a few percent of patients. The elderly male presents with nonspecific joint complaints typical of polymyalgia rheumatica. The high erythrocyte sedimentation rate is characteristic. The transient loss of vision suggests concomitant temporal aeritis, an impoant association seen paicularly.", "cop": 3, "opa": "Behcet syndrome", "opb": "Ankylosing spondylitis", "opc": "Polymyalgia rheumatic", "opd": "Polyaeritis nodosa", "subject_name": "Surgery", "topic_name": null, "id": "ae48f253-a85c-42f6-ab5b-bfc5b97140a7", "choice_type": "single"} {"question": "Aim of damage control laparatomy are", "exp": "DAMAGE CONTROL SURGERY (Abbreted laparotomy) Following major injury, protracted surgery in the physiologically unstable patient can in itself prove fatal. Patients with the 'deadly triad' (hypothermia, acidosis and coagulopathy) are those at highest risk. 'Damage control' or 'damage limitation surgery' is a concept that originated from naval ship- building strategy, whereby ships were designed so that the damage was kept 'local' and which allowed only the minimal repairs needed to prevent it from sinking, while definitive repairs waited until it had reached po. The technique has been adopted following major trauma, and includes initial care and resuscitation (damage control resuscitation) and the surgical correction of the injury (damage control surgery). The minimum amount of surgery needed to stabilise the patient's condition may be the safest course until the physiological derangement can be corrected. Damage control surgery is restricted to only two goals: * stopping any active surgical bleeding; * controlling any contamination. Once these goals have been achieved then the operation is suspended and the abdomen temporarily closed. The patient's resuscitation then continues in the intensive care unit, where other therapeutic interventions can take place.Once the physiology has been corrected, the patient warmed and the coagulopathy corrected, the patient is returned to the operating theatre for any definitive surgery. Indications for Damage control surgery Anatomical Inability to achieve haemostasis Complex abdominal injury, e.g. liver and pancreas Combined vascular, solid and hollow organ injury, e.g. aoic or caval injury Inaccessible major venous injury, e.g. retrohepatic vena cava Demand for non-operative control of other injuries, e.g. fractured pelvis Anticipated need for a time-consuming procedure Physiological (decline of physiological reserve) Temperature <34oC pH <7.2 Serum lactate >5 mmol/L (normal: <2.5 mmol/L) Prothrombin time (PT) >16 s Paial thromboplastin time (PTT) >60 s >10 units blood transfused Systolic blood pressure <90 mmHg for >60 min Environmental Operating time >60 min (core temperature loss in usually 2degC/h) Inability to approximate the abdominal incision Desire to reassess the intra-abdominal contents (directed relook) Ref: Bailey and love 27th edition Pgno : 379", "cop": 2, "opa": "Provide fascial closure", "opb": "Arrest haemorrhage", "opc": "Control contamination", "opd": "Prevent infection", "subject_name": "Surgery", "topic_name": "Urology", "id": "3e375780-219f-4dfb-9d7f-b67c20a7c10c", "choice_type": "single"} {"question": "The initial pharmacologic therapy of choice in this stable patient (refer to Q 87) is", "exp": "Vagotonic maneuvers such as carotid massage or the Valsalva maneuver could ceainly be tried first. If these are unsuccessful, adenosine, with its excellent safety profile and extremely sho half-life, is the drug of choice for supraventricular tachycardia at an initial dose of 6 mg. Dosage can be repeated if necessary a few minutes later at 12 mg. Verapamil is the next alternative; if the initial dose of 2.5 to 5 mg does not yield conversion, one or two additional boluses 10 min apa can be used. Diltiazem and digoxin may be useful in rate control and conversion, but have a much slower onset of action.", "cop": 1, "opa": "Adenosine 6 mg rapid IV bolus", "opb": "Verapamil 2.5 to 5 mg IV over 1 to 2 min", "opc": "Diltiazem 0.25 mg /kg IV over 2 min", "opd": "Digoxin 0.5 mg IV slowly", "subject_name": "Surgery", "topic_name": null, "id": "9dbd4d81-99ae-4131-8921-14c2942c26ab", "choice_type": "single"} {"question": "Most common variant of carcinoma breast among the following is", "exp": "Invasive Epithelial Cancers (Percentage of Total)Invasive lobular carcinoma (10%)Invasive ductal carcinomaInvasive ductal carcinoma, not otherwise specified (50%-70%)Tubular carcinoma (2%-3%)Mucinous or colloid carcinoma (2%-3%)Medullary carcinoma (5%)Invasive cribriform carcinoma (1%-3%)Invasive papillary carcinoma (1%-2%)Adenoid cystic carcinoma (1%)Metaplastic carcinoma (1%)Ref: Sabiston 20e, page: 837", "cop": 2, "opa": "Invasive lobular carcinoma", "opb": "Invasive ductal carcinoma", "opc": "Tubular carcimoma", "opd": "Medullary carcinoma", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "9404639f-23c7-44de-9cb9-c1f034e72659", "choice_type": "single"} {"question": "Purely radilucent renal stones are", "exp": "Ans. is 'c' i.e., Xanthine Renal stone disease* Routine use of noncontast CT Scan has completely revolutionized te imaging evaluation of renal stone disease, nearly completely replacing plain radigrpahs and X urography for diagnosis of acute ureteral obstruction by renal stones.* Nephrolithiasis refers to the presence of calculi in the renal collecting system.* Nearly 10 % of the population will form a renal stone in their lifetime.* Sufficient calcium oxalate and phosphate is present in 80 % of the renal calculi for them to be radio-opaque on the plain radiographs.* Struvite (magnesium ammonium phosphate stones formed in the presence of alkaline urine and infection make up 15% of the renal calculi and also radio opaque on radiographs.* Cysteine stones make up 1 - 2% of the renal stones, and are mildly radio opaque. They are found in patients with congenital cystinuria.* The remaining 3 - 4% of the renal stones are composed of urate or xanthiene and are radiolucent on radiographs.", "cop": 3, "opa": "Sturvite", "opb": "Cystiene", "opc": "Xanthine", "opd": "Calium oxalate", "subject_name": "Surgery", "topic_name": "Kidney & Ureturs", "id": "e46c2339-023c-4e2a-8d62-132cf7f415dc", "choice_type": "single"} {"question": "Protein metabolism after trauma is characterized by", "exp": "Injury and sepsis result in accelerated protein breakdown with increased urinary nitrogen loss and increased peripheral release of amino acids. The negative nitrogen balance represents the net result of breakdown and synthesis (with breakdown increased and synthesis increased or diminished). Amino acids such as alanine are released by muscle and transported to the liver for incorporation into acute-phase proteins including fibrinogen, complement, haptoglobin, and ferritin. The amino acids also undergo gluconeogenesis to glucose, which is utilized primarily by the brain and other glycolytic tissues such as peripheral nerves, erythrocytes, and bone marrow. Other tissues receive energy from fat in the form of fatty acids or ketone bodies during starvation following major trauma; this helps to conserve body protein. Glutamine is the most abundant amino acid in the blood, and its levels in muscle and blood decrease following injury and sepsis as it is consumed rapidly by replicating fibroblasts, lymphocytes, and intestinal endothelial cells. The use of glutamine may decrease protein catabolism in the intestine and may help prevent atrophy of the gastrointestinal tract in starved and parenterally nourished patients. Along with the counterregulatory hormones (glucagon, epinephrine, cortisol), interleukin 1 appears to mediate muscle breakdown. Recent studies have indicated that TNF (also called cachectin because of the role it plays in muscle wasting in septic or oncologic patients) also may be a principal catabolic cytokine in the traumatized patient. This protein is secreted by macrophages and further affects metabolism by inducing secretion of interleukin 1 and inhibiting synthesis and activity of lipogenic enzymes.", "cop": 4, "opa": "Decreased liver gluconeogenesis", "opb": "Inhibition of skeletal muscle breakdown by interleukin 1 and tumor necrosis factor (TNF, cachectin)", "opc": "Decreased urinary nitrogen loss", "opd": "Hepatic synthesis of acute-phase reactants", "subject_name": "Surgery", "topic_name": "Trauma", "id": "14cd73f3-bfe7-4f8e-a3fe-6272fdf81d6b", "choice_type": "single"} {"question": "Initial investigation of choice in obstructive jaundice is", "exp": "Transabdominal ultrasound scan is universally established as the most useful first line imaging study in the jaundiced adult.It provides an excellent evaluation of liver parenchyma & assessment of the presence/absence of bile duct dilatation. Reference:SRB's manual of surgery,5th edition,page no:656.", "cop": 1, "opa": "USG", "opb": "ERCP", "opc": "CT scan", "opd": "PTC", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "c523e2c8-4ee7-41f0-be82-f44b12205129", "choice_type": "single"} {"question": "Ectopic ureter in females of ectopic pelvis opens into", "exp": "According to weger meyert rule ectopic urethra opens into urethra in males and\nvagina in females.", "cop": 2, "opa": "Urethra", "opb": "Vagina", "opc": "Cervix", "opd": "Distal bladder", "subject_name": "Surgery", "topic_name": null, "id": "8ca3497f-a3e6-49f5-a22e-6662f35f2fdf", "choice_type": "single"} {"question": "Very commonly used suture material in oral surgical procedures", "exp": null, "cop": 4, "opa": "Chromic gut", "opb": "Polygalactin", "opc": "Cotton", "opd": "Black silk", "subject_name": "Surgery", "topic_name": null, "id": "68e63a43-122d-4f4d-9988-221ca575bf38", "choice_type": "single"} {"question": "Infectionrate without antibiotic prophylaxis for clean contaminated surgery is", "exp": "Type of surgery\nInfection rate with prophylaxis\nInfection rate without prophyloxis\n\n\nClean surgery\n1 - 2 %\n1 - 2 %\n\n\nClean contaminated surgery\n3%\n6 - 9 %\n\n\nContaminated surgery\n6 %\n13 - 20%\n\n\nDirty surgery\n7%\n40%", "cop": 3, "opa": "1 - 2 %", "opb": "2 - 5 %", "opc": "6 - 9 %", "opd": "10 - 15 %", "subject_name": "Surgery", "topic_name": null, "id": "a8e977a7-f2b7-4b0f-9271-691abfc49304", "choice_type": "single"} {"question": "This is a specimen of", "exp": "This is a specimen of familial adenomatous polyposis with multiple polyps.Polyps are usually visible on sigmoidoscopy by the age of 15 years and will almost always be visible by the age of 30 years.Carcinoma of the large bowel develops 10-20 years after the onset of the polyposis.If over 100 adenomas are present at colonoscopy, the diagnosis can be made confidently.Ref: Bailey and love, 27e, page: 1260", "cop": 1, "opa": "FAP", "opb": "Ulcerative colitis", "opc": "Crohns disease", "opd": "Peutz jeghers syndrome", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "b91598ce-bd0d-4937-ab06-e6c9698336ee", "choice_type": "single"} {"question": "Meckel's derived from;", "exp": "Ans. (a) Proximal part of VIDRef: Sabiston 20th edition, Page 1284* Meckel's diverticulum results from incomplete closure of proximal VID* Raspberry tumor (Umbilical adenoma) is persistence of distal VID", "cop": 1, "opa": "Proximal part of VID", "opb": "Distal part of VID", "opc": "Entire VID", "opd": "Urachus", "subject_name": "Surgery", "topic_name": "Small & Large Intestine", "id": "a2914d7d-f520-476f-a51e-1e5ac51f12c7", "choice_type": "single"} {"question": "In obstruction of the large gut rupture occurs at the", "exp": null, "cop": 1, "opa": "Cecum", "opb": "Ascending colon", "opc": "Transverse colon", "opd": "Descending colon -", "subject_name": "Surgery", "topic_name": null, "id": "d72cac74-bfaf-4785-9194-7e04d66e1cce", "choice_type": "single"} {"question": "Diverticular disease is not common in", "exp": "• Most common sites of diverticula: CMD PES JAI (Colon >Meckel’s >Duodenum >Pharynx >Esophagus >Stomach >Jejunum >Appendix >Ileum)", "cop": 4, "opa": "Colon", "opb": "Jejunum", "opc": "Duodenum", "opd": "Stomach", "subject_name": "Surgery", "topic_name": null, "id": "ee7d48ba-c7ea-435d-b3db-3d601e0eced6", "choice_type": "single"} {"question": "Hyperacute rejection is due to", "exp": "Hyperacute rejection occurs when preformed anti-donor antibodies are present in the circulation of the recipient. Such antibodies may be present in a recipient who has previously rejected kidney transplant, Multiparous women, Prior blood transfusionsHyperacute Rejection occurs within minutes or hours after transplantation.Robbins pathology 9e Pg: 233", "cop": 1, "opa": "Preformed antibodies", "opb": "Cytotoxic T lymphocyte mediated injury", "opc": "Endothelitis caused by donor antibodies", "opd": "Circulating macrophage mediated injury", "subject_name": "Surgery", "topic_name": "General surgery", "id": "8c22bc36-1a71-4fda-a3cf-347e85c752f5", "choice_type": "single"} {"question": "Carcinoma testis, the lymphatic metastasis goes to the first site seen in", "exp": "(Para-aortic lymph node) (1386-Baily & Love 25th)Metastasis first develop in the retroperitoneal nodes; right sided tumours metastasize primarily to the inner aortocaval region just below the renal vessels and left sided tumours primarily to the left para-aortic area at the same level (953-CSDT 13th)Lymphatics of the Testis - runs upwards in the spermatic cord and passing through the internal inguinal rings.They branch fountain- wise (behind and adherent to the posterior peritoneum) towards the para-aortic lymphnodes in the region of the origin of spermatic vessels. Above this level the lymph drains into thoracic duct which extends through the mediastinum to the left supraclavicular fossa where it drains into the left innominate vein. Lymphatics from the medial side of the testis may run with the artery to the vas and drain into lymph node at the bifurcation of the common iliac arteryInguinal lymphnodes are only affected if the scrotum in involved.ALSO - REMEMBER* Most common tumour above 50 years of age - Lymphoma* Most common testicular tumour in prepubertal adults (Infant and children) is Yolk sac tumour* Seminoma are most common testicular tumours, better prognosis, most radiosensitive tumours* Non seminoma are more malignant than seminoma* Seminomas as well as nonseminomas typically metastasize through- lymphatics*** a- feto protein is elevated in 70% of patients with non seminomatous testicular cancer but is not elevated in seminoma* Markers {LDH, fihCG, a-fetoprotieri) are used mainly to follow tumour regression or predict recrudescence as even minute amounts of tumour may cause serum elevations however tumour may be present without elevation of serum markers* Most common germ cell tumour is - Seminoma", "cop": 1, "opa": "Para-aortic lymph nodes", "opb": "Superficial inguinal nodes", "opc": "Deep inguinal nodes", "opd": "Internal iliac nodes", "subject_name": "Surgery", "topic_name": "Testis & Scrotum", "id": "947d3fec-56dc-415b-be8c-724635a77018", "choice_type": "single"} {"question": "Initial periumbilical pain shifting to right iliac fossa is symptoms suggestive of", "exp": "In acute appendicitis, visceral pain stas around the umbilicus d/t distension of appendix, later after few hours somatic pain occurs in the right iliac fossa d/t irritation of parietal peritoneum by inflamed appendix.In mesenteric ischemia, abdominal pain is out of propoion in relation to tenderness; pain is around umbilicus to begin with which later becomes diffuse. Right ureteric colic pain is colicky in type and radiates from right loin to groin often to the tip of genitalia, testis in males, labia majora in females.The abdomen is moderately-to-severely tender in a diffuse or localized pattern, usually on the right side in case of abdominal worms. Reference : page 940, 871, 1019SRB's manual of surgery 5th edition", "cop": 3, "opa": "Abdominal worms", "opb": "Mesenteric ischemia", "opc": "Acute appendicitis", "opd": "Right ureteric colic", "subject_name": "Surgery", "topic_name": "Urology", "id": "0046b489-addf-4fd8-aeeb-d01ebc880b8a", "choice_type": "single"} {"question": "Commonest complication of Zenker's diverticulum is", "exp": "\"Pulmonary infection is the most frequent serious complication, and many patients are first seen after experiencing repeated episodes of pneumonia.\"-CSDT\n\nAspiration pneumonia & Lung abscess are the most frequent complications of Zenker's diverticulum.\nOther rare complications are:\nPerforation\nBleeding\nCarcinoma", "cop": 3, "opa": "Dysphonia", "opb": "Gastroesophageal reflux", "opc": "Lung abscess", "opd": "Perforation", "subject_name": "Surgery", "topic_name": null, "id": "2b270300-5f22-446d-a0cf-2ae715b5bde6", "choice_type": "single"} {"question": "Most common complication seen with prostatitis is", "exp": "PROSTATITIS In both acute and chronic prostatitis, the seminal vesicles and posterior urethra are usually also involved. Acute prostatitis Aetiology Acute prostatitis is common, but underdiagnosed. The usual organism responsible is Escherichia coli, but Staphylococcus aureus, Staphylococcus albus, Streptococcus faecalis, Neisseria gonorrhoeae or Chlamydia may be responsible. The infection may be haematogenous from a distant focus or it may be secondary to acute urinary infectionClinical features General manifestations overshadow the local: the patient feels ill, shivers, may have a rigor, has 'aches' all over, especially in the back, and may easily be diagnosed as having influenza. The temperature may be up to 39degC. Pain on micturition is usual, but not invariable. The urine contains threads in the initial voided sample, which should be cultured. Perineal heaviness, rectal irritation and pain on defaecation can occur; a urethral discharge is rare. Frequency occurs when the infection involves the bladder. Rectal examination reveals a tender prostate; one lobe may be swollen more than the other, and the seminal vesicles may be involved. A frankly fluctuant hygiene abscess is uncommon. Treatment Treatment must be rigorous and prolonged or the infection will not be eradicated and recurrent attacks may ensue. Spread of infection to the epididymides and testes may occur. Prolonged treatment with an antibiotic that penetrates the prostate well is indicated (trimethoprim or ciprofloxacin) Chronic prostatitis Many urologists find the diagnosis of chronic prostatitis and 'prostatodynia' very difficult, for many men present with perigenital pain, testicular pain, prostatic pain exacerbated by sexual intercourse or pain that apparently renders sexual intercourse out of the question. Psychosexual dysfunction in such patients may be the underlying problem. The diagnosis of chronic prostatitis has to be based on: * persistent threads in voided urine; * prostatic massage showing pus cells with or without bacteria in the absence of urinary infection. Aetiology This is thought to be the sequela of inadequately treated acute prostatitis. While pus is present in the prostatic secretion, the responsible organism is often difficult to find. Other organisms such as Chlamydia species may be responsible for chronic abacterial prostatitis. Clinical features The clinical features are extremely varied. Only men with symptoms of posterior urethritis, prostatic pain and perigenital pain accompanied by intermittent fever and pus cells or bacteria in the post-prostatic massage specimen should be diagnosed as having chronic prostatitis. Diagnosis The three-glass urine test is valuable. If the first glass with the initial voided sample shows urine containing prostatic threads, prostatitis is present. Rectal examination of the prostate may be normal or may show a soft, boggy and tender prostate. Examination of the prostatic fluid obtained by prostatic massage should show pus cells and bacteria. Urethroscopy may reveal inflammation of the prostatic urethra, and pus may be seen exuding from the prostatic ducts. The verumontanum is likely to be enlarged and oedematous. In many men with the symptoms described above, all investigations are normal. Treatment Antibiotic therapy should be administered only in accordance with bacteriological sensitivity tests. Trimethoprim or ciprofloxacin penetrate well into the prostate. If Trichomonas or anaerobes are the responsible agent, a rapid response is obtained from administration of metronidazole (200mg t.d.s. for 7 days to both paners). If Chlamydia is suspected, doxycycline is the antibiotic treatment of choice. There is little evidence that prostatic massage helps in eradicating the infection. Ref: Bailey and love 27th edition Pgno : 1475", "cop": 1, "opa": "Epididymitis", "opb": "Orchitis", "opc": "Sterility", "opd": "Seminal vesciculitis", "subject_name": "Surgery", "topic_name": "Urology", "id": "d1306a58-1cad-454f-965b-30c615d7944c", "choice_type": "single"} {"question": "Calot's triangle is an impoant landmark for", "exp": "Calot's triangle: area bound superiorly by the inferior surface of the liver, laterally by the cystic duct and the medial border of the gallbladder and medially by the common hepatic duct. It is an impoant surgical landmark as the cystic aery, usually can be found within its boundaries.Ref: Bailey and love 27e pg: 1188", "cop": 2, "opa": "Cystic duct", "opb": "Cystic aery", "opc": "Common bile duct", "opd": "Hepatic vein", "subject_name": "Surgery", "topic_name": "General surgery", "id": "461738a8-e574-401b-a030-f6804033ebe0", "choice_type": "single"} {"question": "The ideal treatment for fracture of the angle of\nmandible is", "exp": null, "cop": 4, "opa": "Transosseous wiring", "opb": "Intermaxillary fixation", "opc": "Plating on the Lateral side of the body of the mandible", "opd": "Plating at the inferior border of the mandible", "subject_name": "Surgery", "topic_name": null, "id": "8b64aecd-0d6a-41b0-91ae-0c008bb1d22b", "choice_type": "single"} {"question": "The most common complication seen in a hiatus hernia is", "exp": null, "cop": 1, "opa": "Esophagitis", "opb": "Aspiration pneumonitis", "opc": "Volvulus", "opd": "Esophageal stricture", "subject_name": "Surgery", "topic_name": null, "id": "34e47f91-5c15-452a-baa6-94e17cc383b4", "choice_type": "single"} {"question": "Cerebral perfusion pressure is", "exp": "Cerebral perfusion pressure (CPP), is the difference between mean aerial pressure (MAP) and intracranial pressure (ICP): CPP (75-105 mmHg) = MAP (90-110 mmHg) - ICP (5-15 mmHg).Normal cerebral blood flow (CBF) is about 55 mL/minute for every 100 g of brain tissue. Ischaemia results when this rate drops below 20 mL/min,Bailey and love 26e pg: 310", "cop": 4, "opa": "mean aerial pressure + intracranial pressure", "opb": "cerebral blood flow * brain surface area in m^2", "opc": "cerebral blood flow / brain surface area in m^2", "opd": "mean aerial pressure - intracranial pressure", "subject_name": "Surgery", "topic_name": "Trauma", "id": "171513dc-b81a-4250-a5d2-dfbaa0b720cb", "choice_type": "single"} {"question": "\"TIPS\" is contraindicated in", "exp": "Main contraindication for TIPSS is poal vein occlusion,which can be due to poal vein thrombosis.Post- shunt encephalopathy is the confusional state caused by the poal blood bypassing the detoxication of the liver.TIPSS is indicated in poal hypeension associated with cirrhosis,control of variceal bleeding,etc. Reference:Bailey & Love's sho practise of surgery,25the edition,page no:1089", "cop": 3, "opa": "Post-shunt encephalopathy", "opb": "Cirrhosis", "opc": "Poal vein thrombosis", "opd": "Variceal bleeding", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "4a0eb2ed-8142-433a-9d32-36332a6b828b", "choice_type": "single"} {"question": "Male with history of bilateral undescended testis", "exp": "Male with bilateral undescended testis (especially intra-abdominal testes) are usually sterile. To optimise spermatogenesis the testis needs to be in the scrotum below body temperature at a young age. Incompletely descended testes are often macroscopically normal in early childhood but by pubey the testis is poorly developed, gradually atrophies. The epithelial elements are immature histologically and by late pubey irreversible destructive changes halt spermatogenesis and limit the production of androgens leading to sterility.Malignant transformation in undescended testis is 20 times more common than normally descended testis. Pathophysiology include gubernacular dysfunction, lack of gonadotrophin, lack of 'calcitonin gene related peptide'(CGRP) , familial , altered hypothalamo-pituitary-gonadal axis, deficiency of mullerian inhibiting substance, Prune-Belly syndrome. These patients also require psychological intervention. Reference : page77 and 1377 Bailey and Love's sho practice of surgery 25th edition and page1079 SRB's manual of surgery 5th edition", "cop": 1, "opa": "Is likely going to be sterile", "opb": "Risk of testicular neoplasm is same as other males", "opc": "Pathophysiology is merely mechanical problem in descent of testis", "opd": "Intervention for psychological purpose is not a requirement", "subject_name": "Surgery", "topic_name": "Urology", "id": "09091c50-0a44-486d-b02e-9437a2e1afbe", "choice_type": "single"} {"question": "Most common sign/symptom of phaeochromocytoma", "exp": "Clinical signs of phaeochromocytomaSymptomsPrevalence (%)Hypeension Paroxysmal Continuous 80-9050-6030Headache 60-90Sweating 50-70Palpitation 50-70Pallor 40-45Weight loss 20-40Hyperglycaemia 40Nausea 20-40Psychological effects 20-40Ref: Bailey and Love 27e pg: 845", "cop": 1, "opa": "Hypeension", "opb": "Headache", "opc": "Sweating", "opd": "Palpitation", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "2f9d1532-4ba4-4bb3-957f-9fe0e33f9c96", "choice_type": "single"} {"question": "Carcinoma Ex pleomorphic adenoma is", "exp": "Carcinoma Ex pleomorphic Adenoma / Malignant mixed tumour\n\nMalignant change of pleomorphic adenoma\nHas rapid growth and painful\nLeads to paraesthsia and facial weakness.", "cop": 1, "opa": "Malignant change of pleomorphic adenoma", "opb": "Regrowth of pleomorphic adenoma after superficial parotidectomy due to inadquate removal", "opc": "Painless condition", "opd": "Slow and progressive growth of pleomorphic adenoma", "subject_name": "Surgery", "topic_name": null, "id": "0360935a-8a74-47e5-927a-d621be8855db", "choice_type": "single"} {"question": "Most common cause of Pseudocyst of pancreas is", "exp": "PSEUDOCYST A pseudocyst is a collection of amylase-rich fluid enclosed in a well-defined wall of fibrous or granulation tissue. Pseudocysts typically arise following an attack of mild acute pancreatitis, lie outside the pancreas, and represent an APFC that has not resolved and matured. Formation of a pseudocyst requires 4 weeks or more from the onset of acute pancreatitis. The Term 'pseudocyst' is often used more loosely, to include sterile WON that has failed to resolve, or a collection that has developed in the context of chronic pancreatitis or after pancreatic trauma. If carefully investigated, more than half of these will be found to have a communication with the main pancreatic duct. Pseudocysts are often single but, occasionally, patients will develop multiple pseudocysts. A pseudocyst is usually identified on ultrasound or a CT scan. It is impoant to differentiate a pseudocyst from an APFC; the clinical scenario and the radiological appearances should allow that distinction to be made. Occasionally, a cystic neoplasm may be confused with a chronic pseudocyst. EUS and aspiration of the cyst fluid is very useful in such a situation. The fluid should be sent for measurement of carcinoembryonic antigen (CEA) levels, amylase levels and cytology. Fluid from a pseudocyst typically has a low CEA level, and levels above 400 ng/mL are suggestive of a mucinous neoplasm. Pseudocyst fluid usually has a high amylase level, but that is not diagnostic, as a tumour that communicates with the duct system may yield similar findings. Cytology typically reveals inflammatory cells in pseudocyst fluid. If there is no access to EUS, then percutaneous FNA is acceptable (just aspiration, not percutaneous inseion of a drain). ERCP and MRCP may demonstrate communication of the cyst with the pancreatic duct system, demonstrate ductal anomalies, or diagnose chronic pancreatitis and thus help in planning treatment. Pseudocysts will resolve spontaneously in most instances, but complications can develop. Pseudocysts that are thick-walled or large (over 6 cm in diameter), have lasted for a long time (over 12 weeks), or have arisen in the context of chronic pancreatitis are less likely to resolve spontaneously,but these factors are not specific indications for intervention. Therapeutic interventions are advised only if the pseudocyst causes symptoms, if complications develop, or if a distinction has to be made between a pseudocyst and a tumour. There are three possible approaches to draining a pseudocyst: percutaneous, endoscopic and surgical. Percutaneous drainage to the exterior under radiological guidance should be avoided. It carries a very high likelihood of recurrence. More over, it is not advisable unless one is absolutely ceain that the cyst is not neoplastic and that it has no communication with the pancreatic duct (or else a pancreaticocutaneous fistula will develop). A percutaneous transgastric cystgastrostomy can be done under imaging guidance, and a double-pigtail drain placed with one end in the cyst cavity and the other end in the gastric lumen. This requires specialist expeise but, in experienced hands, the recurrence rates are no more than 15%. Endoscopic drainage usually involves puncture of the cyst through the stomach or duodenal wall under EUS guidance, and placement of a tube drain with one end in the cyst cavity and the other end in the gastric lumen. The success rates depend on operator expeise. Occasionally, ERCP and placement of a pancreatic stent across the ampulla may help to drain a pseudocyst that is in communication with the duct. Surgical drainage involves internally draining the cyst into the gastric or jejunal lumen. Recurrence rates should be no more than 5%, and this still remains the standard against which the evolving radiological and endoscopic approaches are measured. The approach is conventionally through an open incision, but laparoscopic cystgastrostomy is also feasible. Pseudocysts that have developed complications are best managed surgically. There is a small group of patients who, having suffered an attack of necrotising pancreatitis with duct disruption, go on to suffer repeated complications in the form of recurrent fluid collections, pseudocysts, pleural effusions or pancreatic ascites. Very often disruption of the main pancreatic duct in the neck, body or tail is compounded by a stricture or a stone in the head that cannot be treated endoscopically. In such patients, some form of surgical resection and/or a drainage procedure even though it may be technically challenging may be the only way to achieve lasting resolution. Ref: Bailey and love 27th edition Pgno : 1229", "cop": 1, "opa": "Pancreatitis", "opb": "Post-pancreatic surgery", "opc": "Trauma", "opd": "Tumours", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "60b69674-b84f-4fc9-854b-cc6bc51b1ea9", "choice_type": "single"} {"question": "Treatment of choice of Desmoid tumour is", "exp": "Ans. is 'a' i.e., Surgery", "cop": 1, "opa": "Surgery", "opb": "Chemotherapy", "opc": "Radiotherapy", "opd": "Surgery + Radiotherapy", "subject_name": "Surgery", "topic_name": null, "id": "ba231956-ac36-4ddf-96d8-927e00af716f", "choice_type": "single"} {"question": "Management of 4 cm size renal staghorn calculus.", "exp": "ANS. B* Management of renal calculi* Stones <6 mm--conservative treatment* Stones from 6 mm to 2 cm: ESWL* Stones >2 cm: PCNL* For stones at lower renal calyx: Do PCNL* For staghorn calculi: ESWL+PCNL (Sandwich technique)Shapes of urinary stonesLeucine stones--spherical-shapedTyrosine stones--needle-shaped", "cop": 2, "opa": "Extracorporeal shock wave lithotripsy (ESWL)", "opb": "Percutaneous nephrolithotomy (PCNL)", "opc": "Pyeloplasty", "opd": "Open pyelolithotomy", "subject_name": "Surgery", "topic_name": "Kidney & Ureturs", "id": "950eef13-6567-4a1d-8327-8224576d9c5c", "choice_type": "single"} {"question": "A young man had a stab injury in left 5th ICS at the mid clavicular line. On examination there is no deviation of trachea, heart sounds diminished, systolic BP is 80 mmHg, and RR is 20/min. The diagnosis is", "exp": "(A) Cardiac tamponade# Cardiac tamponade is a clinical syndrome caused by the accumulation of fluid in the pericardial space, resulting in reduced ven-tricular filling and subsequent hemodynamic compromise.> 3 phases of hemodynamic changes in tamponade.> Phase I: The accumulation of pericardial fluid causes increased stiffness of the ventricle, requiring a higher filling pressure. During this phase, the left and right ventricular filling pressures are higher than the intrapericardial pressure.> Phase II: With further fluid accumulation, the pericardial pressure increases above the ventricular filling pressure, resulting in reduced cardiac output.> Phase III: A further decrease in cardiac output occurs, which is due to equilibration of pericardial and left ventricular (LV) filling pressures.> Beck triad or acute compression triad This complex of physical findings refers to increased jugular venous pressure, hypotension & diminished heart sounds These findings result from a rapid accumulation of pericardial fluid. However, this classic triad is usually observed in patients with acute cardiac tamponade.> Pulsus paradoxus or paradoxical pulse: This is an exaggeration (>12 mm Hg or 9%) of the normal inspiratory decrease in systemic blood pressure", "cop": 1, "opa": "Cardiac tamponade", "opb": "Massive left hemothorax", "opc": "Tension pneumothorax", "opd": "Flail chest", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "3d21ff00-104b-472c-b6de-043552bc0f53", "choice_type": "single"} {"question": "Commonest cancer in burn scar is", "exp": "The commonest cancer associated with burns is squamous cell carcinoma. This is also known as marjolin's ulcer and this malignancy sta from the scar tissue of burns. Treatment is wide local excision, in case of large ulcer, amputation is required. Reference : SRB's Manual of Surgery, 6th Edition, page no = 283.", "cop": 1, "opa": "Squamous cell carcinoma", "opb": "Fibrosarcoma", "opc": "Adenocarcinoma", "opd": "Adenosquamous carcinoma", "subject_name": "Surgery", "topic_name": "General surgery", "id": "5967895f-321c-4d73-958a-b59f83d14fe2", "choice_type": "single"} {"question": "If head of the radius is removed, it will result in", "exp": "B i.e. Valgus deformity Classically the head of radius should not be excised in children because ? - It will interfere with the synchronous growth of radius and ulnar producing wrist & elbow deformity. - It leads to proximal radial migration & subluxation of inferior radio ulnar joINTEGER(2. - It causes weakness of extremity & discomfo in distal radio - ulnar joint with heavy activities - May produce cubitus valgus deformityQ and instability.", "cop": 2, "opa": "Lengthening of limb", "opb": "Valgus deformity", "opc": "Varus deformity", "opd": "No deformity", "subject_name": "Surgery", "topic_name": null, "id": "67d1c3cb-7212-4f18-bce1-99fd12740d0f", "choice_type": "single"} {"question": "The most useful incision in the operating room for patients with penetrating pericardium injury is", "exp": "The subxiphoid incision is useful for determining if there is blood in the pericardium and if there is an intracardiac injury; however, exposure is extremely limited, and definitive repair can rarely be performed through the incision. Left (or right) anterior thoracotomy is easily performed, especially in the emergency room, and gives adequate exposure to ceain areas of the hea. However, each has significant limitations in exposure. Either may be extended across the thoracotomy into the other side of the chest, thus producing a bilateral anterior thoracotomy. Exposure is excellent through this incision, and most injuries can be satisfactorily repaired through this approach. Most cardiac operations today are performed through median sternotomy incisions. If the patient is in the operating room, this incision is easily performed and always provides excellent exposure for all areas of the hea.", "cop": 4, "opa": "Left anterior thoracotomy", "opb": "Right anterior thoracotomy", "opc": "Subxyphoid", "opd": "Median sternotomy", "subject_name": "Surgery", "topic_name": "Cardio thoracic surgery ", "id": "f9dfa1fb-b5ae-4cdf-92ae-fe36e623bf19", "choice_type": "single"} {"question": "Cowden syndrome is commonly associated with", "exp": "(D) Hamartoma # Cowden syndrome (also known as \"Cowden's disease,\" and \"Multiple hamartoma syndrome\") is a rare autosomal dominant inherited disorder characterized by multiple tumor-like growths called hamartomas and an increased risk of certain forms of cancer.> Stauffer syndrome - paraneoplastic, non-metastatic liver disease is a sign of Renal cell carcinoma.> Thymic carcinomas are, for the most part, of epithelial origin, although a few other unusual cell types can be found. All these lesions are very uncommon, and several are rare. They include some with low malignant potential (eg, well-differentiated squamous cell carcinoma, basaloid carcinoma, mucoepidermoid carcinoma) and those with features of a more aggressive malignancy (E.g., Sarcomatoid carcinoma, clear cell carcinoma, neuroendocrine carcinoma, lymphoepitheliomalike tumors, anaplastic undifferentiated tumors).", "cop": 4, "opa": "Renal cell carcinoma", "opb": "Thymic Carcinoid", "opc": "Cerebellar haemangioblastoma", "opd": "Hamartoma", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "878a3ebf-1048-48df-aa63-2590fee7ba5d", "choice_type": "single"} {"question": "Most common site for anal fissure is", "exp": "An anal fissure (synonym: fissure-in-ano) is a longitudinal split in the anoderm of the distal anal canal (Fig. 69.24), which extends from the anal verge proximally towards, but not beyond, the dentate line.most common site for anal fissure is 6 O&; clock Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1251", "cop": 2, "opa": "3 O' clock", "opb": "6 O' clock", "opc": "2 O' clock", "opd": "10 O' clock", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "a9bd3ead-5a08-4560-b828-1c6d9ce42f22", "choice_type": "single"} {"question": "Tumor invades muscularis propria and 2 lymph nodes involved. TNM staging is", "exp": "T1 Invades submucosaT2Invades muscularis propriaT3Invades through the muscularis propria into pericolrectal tissuesT4aInvades through the visceral peritoneumT4bDirectly invades to adjacent organs or structuresN1aOne node positiveN1b2-3 nodes positiveN1cNo regional lymph nodes positive, but there are tumour deposits in the subserosa, Mesentry or non peritonealized pericolic/ perirectal/ mesorectal tissues N2a4-6 lymph nodes positiveN2b7 or more lymph nodes positiveM1aMetastasis to one site or organ, without peritoneal metastasisM1bMetastasis to 2 or more sites or organs without peritoneal metastasisM1c Metastasis to the peritoneal surface (alone or along with other site/organ)Ref: AJCC 8e", "cop": 1, "opa": "T2 N1", "opb": "T2 N2", "opc": "T3 N1", "opd": "T3 N2", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "fab38051-a2a1-4346-88e1-545b53bde6f6", "choice_type": "single"} {"question": "Deformity in anterior dislocation of hip is", "exp": "Ans. is 'a' i.e., Ext. rotation, abduction, flexion Anterior dislocation of hip Anterior dislocation of the hip is much less common than posterior dislocation. Indeed, it is a very uncommon injury. It is caused by forced abduction and lateral (external) rotation of hip, usually in a violent injury such as a motor accident on aircraft crash. Clinically, the limb is in marked external (lateral) rotation, flexion and abduction There may be apparent lengthening due to abduction deformity. Closed reduction under anaesthesia is the treatment of choice. Complications are avascular necrosis, and secondary osteoahritis.", "cop": 1, "opa": "Ext. rotation, abduction, flexion", "opb": "Ext. rotation, adduction, flexion", "opc": "Int. rotation, abduction, flexion", "opd": "Int. rotation, adduction , flexion", "subject_name": "Surgery", "topic_name": null, "id": "4819d222-e5cc-467a-b28d-18ee9aa8d135", "choice_type": "single"} {"question": "Commonest cause of periumbilical pain after 30 min. of TURP done under spinal anesthesia with Bupivacaine", "exp": "Ans is 'b' ie Perforation of the bladder Perforation of bladder is one of the complications of TURP. It can present with periumblical pain. This pt. experiences pain 30 minutes after TURP. This is because he is under spinal anesthesia. In this pt. the effect of spinal anesthesia terminates 30 min. after the operation. Now he is able to perceive the pain of bladder perforation. Meteorism - is distention of the abdomen or intestines by gas. This is seen in Renal injury but not in TURP.", "cop": 2, "opa": "Meteorism", "opb": "Perforation of bladder", "opc": "Recovery from bupivacaine anaesthesia", "opd": "Mesentery aery i schemia", "subject_name": "Surgery", "topic_name": null, "id": "0a7faf6a-15f0-4a9b-a7f8-0340741af464", "choice_type": "single"} {"question": "Cidex is", "exp": null, "cop": 1, "opa": "Gluteraldehyde", "opb": "Alcohol", "opc": "A phenolic compound", "opd": "A caustic agent", "subject_name": "Surgery", "topic_name": null, "id": "8054db28-aa2d-437f-80ff-2d215980d73f", "choice_type": "single"} {"question": "Tt for CTEV should start from", "exp": "Ans. is 'a' ie immediately after birth", "cop": 1, "opa": "Immediately after birth", "opb": "After 3 month", "opc": "After 6 month", "opd": "After 24 hrs", "subject_name": "Surgery", "topic_name": "Orthopedics", "id": "fde68b9e-938e-4ed5-9f24-d69302e428ab", "choice_type": "single"} {"question": "30 year male with chronic diarrhoea, anemia, raised liver enzymes. Most likely associated with", "exp": "Anti-endomysial antibody The clinical features are suggestive of celiac sprue0. The typical symptoms of celiac sprue are weight loss, chronic diarrhoea, abdominal distension, growth retardation anemia. Raised liver enzymes is not mentioned in many text books including Harrison. But according to C.M.D.T. 'Mild elevation of aminotransferases are seen in upto 40% of patientsdeg \" Impoant points about the diagnosis of celiac sprue Small intestinal biopsy in celiac sprue demonstrates characteristic features but it is not specific for the diagnosis of celiac sprue. It can be seen in tropical sprue also. Serological tests helpful in the diagnosis of celiac sprue are - Anti endomysial antibody (Anti EMA) - Anti tissue (t) transglutaminase antibody Anti (t) TGA A negative test excludes the diagnosis of celiac sprueQ The diagnosis of celiac sprue still rests upon - Clinical demonstration of malabsotptioni2 - Demonstration of intestinal lesion by small bowel biopsyo - Unequivocal improvement in both symptoms and mensal histology on gluten with drawl from the diets'. Antimitochondrial antibody Antimitochondrial antibody testing is done for primary biliary cirrhosis. The points against the diagnosis of primary biliary cirrhosis. - It typically presents in middle aged females. - initial clinical manifestations of the disease are - Pruritus -Fatigue - Characteristic elevation of alkaline phosphatase Antismooth muscle antibody Antismooth muscle antibody testing is done for autoiminune hepatitis Antoimmune hepatitis is common in young women. The usual presentation is an acute attack of hepatitis.", "cop": 2, "opa": "Antimitochondrial antibody", "opb": "Anti-endomysial antibody", "opc": "Anti-smooth muscle antibody", "opd": "Antinuclear antibody", "subject_name": "Surgery", "topic_name": null, "id": "a822906a-35c1-4869-a209-fe731d11aa32", "choice_type": "single"} {"question": "Commonest site of metastasis of Wilm’s tumour is", "exp": "Lungs is MC site for mets in wilms tumor.", "cop": 2, "opa": "Bones", "opb": "Lungs", "opc": "Liver", "opd": "Brain", "subject_name": "Surgery", "topic_name": null, "id": "7a47bc6e-3ed4-4f6f-ab49-7a686456a744", "choice_type": "single"} {"question": "Post operative abscess treatment of choice nowadays", "exp": "Ans. (c) Image guided aspiration(Ref: Bailey 26th 978)* Modern management of an abscess is by radiological diagnosis using ultrasound or CT guidance followed by drainage.", "cop": 3, "opa": "Hydration", "opb": "IV antibiotics", "opc": "Image guided aspiration", "opd": "Reexploration", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "2b85a57b-3844-4d0e-ab60-a10261c2d9c8", "choice_type": "single"} {"question": "The commonest clinical pattern of basal cell carcinoma is", "exp": ".basal carcinomas are composed of islands of basaloid cells ( like cells of basal layer of epidermis) with palisading of cells at the periphery and a haphazard arrangement of those in the centres of the islands . the tumour cells have a hypochromatic nucleus with relatively poorly defined cytoplasm they spread by local invasion . lymphatic spread is not seen so regional lympnodes are not enlarged they are diagnosed using wedge biopsy most common site is inner canthus of eye also called tear cancer they show a nodular pattern", "cop": 1, "opa": "Nodular", "opb": "Morpheaform", "opc": "Superficial", "opd": "Keratotic", "subject_name": "Surgery", "topic_name": "General surgery", "id": "e92ff7b1-6370-4e0b-ab5c-f50f3812e6f5", "choice_type": "single"} {"question": "For split skin graft the best source is", "exp": "(A) Autograft # Autograft is skin graft taken from an uninjured part of body (e.g. thigh skin) and is used for skin grafting in same person.> It is the best skin graft for open wounds because of very high rate of successful grafting.", "cop": 1, "opa": "Autograft", "opb": "Homograft", "opc": "Isograft", "opd": "Xenograft", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "a06e8b92-642c-4ef7-b104-c7a9e28f0822", "choice_type": "single"} {"question": "First autologous renal transplantation was done by", "exp": ".The first successful autologous renal transplantation ( autotransplantation )was performed by Dr.Hardy in 1963 in a patient with severe ureteral injury . This has been described for complex paial nephrectomies , extensive vascular injuries , recurrent stone formers ( renal pelvis is directly anastamosed to the bladder ) ref :- campbell - walsh urology 11th edition . chapter 47 .pg no 1087", "cop": 1, "opa": "Hardy", "opb": "Kavosis", "opc": "Higgins", "opd": "Studor", "subject_name": "Surgery", "topic_name": "Urology", "id": "36e1b838-3b73-465e-ad85-3059d03d0be9", "choice_type": "single"} {"question": "Bad prognosis in AML is indicated by aEUR'", "exp": "Monosomy Prognostic factors in AML Favourable prognostic factors Unourable prognostic factors Miscellaneous prognostic factors * Age < 40 yrs * del (7q) * In recent years, with availability * AML without antecedent MDS/ MPD * dui (5q) of markers on bone marrow * Blast cells with Auer rods * 11q23 - MLL +ve trephine sections, it has been * TLC < (25 x 109/L) * 3q21 possible to study antiogenesis, * t (15;17) in AML - M3- PMURARA +ve ' Expression of MDR-1 gene (Multidrug proliferative index, apoptosis and * t (8;21) in AML-M, * Inv (16) in AML- M4Eo resistance gene) * 3q26 other parameters * FAB subtype - AML- M2, M3, M4 *Complex karyotypes * High WBC count > 100 x 109/L * AML with preceeding MDS/ PMD * Extremes of age <2 years and > 55 years FLT-3 mutation * -7/7q * Extramedullary disease in AML- M5 * Presence of CNS involvement * FAB subtype AML -MO, M6, M7 -- * t (8 ; 21)Q in AML - M2 Good prognosis * Inv (16) in AML- M4 E,, * t (15 ; 17)Q in AML - M3 - PML /RAFA +ve Moderately ourable outome * No cytogenetic abnormality Q * del (7q) * Monosomy 5 or 7 * del (5q) * inv (3) (q 21. q 26) * 11(123 - MLL +ve * t (3;3) Poor prognosis * 3q21 * t (6:11) * Expression of MDR-1 gene * t (10:11) * 3q26 * t (9;22) Genetic abnormalities in normal cytogenetic AML Name Prognosis Prevalence Expression NPM-1 (nuclephosmin) Favourable 50-60% Mutation FLT3-ITD The Ems - like tyrosine kinase 3 Gene Unourable 3040% Mutation FLT3 -Asp835 Unclear 5 - 10% Mutation BAALC (Brain and acute leukemia cytoplasmic) Unourable 65.7% Over expression MNI (Meningioma I) Unourable 50% Over expression MLI -PTD (Mixed lineage leukemia) Unourable 7.7% Mutation / over expression CEBPa (CCAT/Enhancer binding protein alpha gene) Favour able 15 - 20% Mutation ERG-I (The E1S-related gene Unoruable 25% Over expression AF-lq expression Unourable 75% Over expression Nuleophosmin (NPM1) mutations The most common molecular abnormality present in -50% of AML's with normal karyotype. nK- AML constitutes -45% of AML's and conveys an \"intermediate\" (but heterogenous) prognosis. Exon 12 NEM] mutations (always 4bp inseions) disrupt a key regulatory region. \"AML with mutated NPM (nusleophosmin) has a ourable prognosis\". Loss of X.Y chromosome There is a correlation between t (8;21) and involvement of sex chromosomes (X, Y chromosomes) - Involvement of sex chromosome occur in cases with t (8;21) that may be either in the .form of loss of X chromosome or duplication of Y chromosome. - Loss of the Y chromosome or loss of the X chromosome is associated with t (8;21) in 80% to 90% cases. - But the significance of these abnormalities on prognosis is not clear. Most probably they have ourable prognosis just as t(8;21).", "cop": 1, "opa": "Monosomy", "opb": "Deletion of X or Y chromosome", "opc": "T (8 : 21)", "opd": "Nucleophosmin mutation", "subject_name": "Surgery", "topic_name": null, "id": "ad98e47b-48cc-4532-9a84-67f93e507ae0", "choice_type": "single"} {"question": "In exocrine pancreatic, cancer, the commonest tumor marker to be elevated in", "exp": ".Investigations for exocrine pancreatic tumors includes * Liver function tests: Serum bilirubin, direct component (conjugated) is increased (van den Bergh's test). Serum albumin is decreased with altered A : G ratio. Prothrombin time is widened. Serum alkaline phosphatase is increased * U/S abdomen to see gall bladder, liver, growth, CBD size (normal diameter is < 10 mm), lymph node status, poal vein, ascites. * Barium meal shows widened duodenal \"C\" loop-- pad sign. Reverse 3 sign is seen in carcinoma--periampullary region. * Spiral CT scan (ideal) shows poal vein infiltration, retroperitoneal lymph nodes, size of the tumour. * ERCP with pancreatic juice cytology or brush biopsy is useful. MRCP to see biliary tree. * CA 19-9 (carbohydrate antigen) is a useful tumour marker. * Coeliac and superior mesenteric angiogram can be done to reveal tumour circulation and invasion. * Gastroduodenoscopy reveals ampullary tumour and biopsy can also be taken. * Endosonography is useful to see the invasion and size, to stage and to do EUS guided FNAC. * Urine for bile salts (Hay's test), bile pigments (Fouchet's test), urobilinogen. ref:SRB&;S manual of surgery,ed 5,pg no 634", "cop": 4, "opa": "CA 125", "opb": "CEA", "opc": "CA 15-3", "opd": "CA 19-9", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "e325dab2-1ab5-4b17-adb6-c8db2c66d1fd", "choice_type": "single"} {"question": "BIRADS stage of 5 is", "exp": "Ans. (d) Highly suggestive of malignancy(Ref. Sabiton 20th edition Page 831)* BIRADS - Breast Imaging Reporting and Data System)* This system is used to categorize the degree of suspicion o malignancy based on Mammography findings.* BIRADS-5 is highly suggestive of malignancyCategoryDefinitionFurther Plan0Incomplete assessmentNeed additional imagingslNegativeAdvised annual screening2Benign FindingRecommend annual screening3Probably BenignShort interval follow up4Suspicious of malignancyBiopsy must5Highly suggestive of malignancyTake appropriate action6Known biopsy proved malignancy", "cop": 4, "opa": "Negative", "opb": "Probably benign", "opc": "Suspicious abnormality", "opd": "Highly suggestive of malignancy", "subject_name": "Surgery", "topic_name": "Breast", "id": "cc0accd8-d952-4295-a2a4-560380a32ed0", "choice_type": "single"} {"question": "Transplantation of liver is contraindicated in", "exp": "Contraindications to Liver Transplantation Absolute Relative Uncontrolled extrahepatobiliary infection Active, untreated sepsis Incorrect able, life-limiting congenital anomalies Active substance or alcohol abuse Advanced cardiopulmonary disease Extrahepatobiliary malignany (not including nonmelanoma skin cancer) Metastatic malignancy to the liver Cholangiocarcinoma AIDS Life-threatening systemic diseases Age >70 years Prior extensive hepatobiliary surgery Poal vein thrombosis Renal failure not attributable to liver disease Previous extrahepatic malignancy( not including nonmelanoma akin cancer) Severe Obesity Severe malnutrition/wasting Medical noncompliance HIV seropositivity with failure to control HIV viraemis or CD4 <100/uL Intrahepatic sepsis Severe hypoxemia secondary to right - to-left intrapulmonary shunts (Po2<50mmHg) Severe pulmonary hypeension(mean pulmonary aery pressure >35 mmHg) Uncontrolled psychiatric disorder Ref: Sabiston 20th edition Pgno : 637-638", "cop": 4, "opa": "Metastasis of liver", "opb": "Acute fulminant liver disease", "opc": "Viral hepatitis", "opd": "Renal failure", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "a48f9277-8a49-4abf-b5fb-de363a8ce694", "choice_type": "single"} {"question": "Normal lower oesophageal sphincter pressure is", "exp": "The normal lower oesophageal sphincter is 3-4 cm in length and has a pressure of 10-25 mmHgThe LOS is a zone of relatively high pressure that prevents gastric contents from refluxing into the lower oesophagusRef: Bailey and Love 27e pg: 1068", "cop": 2, "opa": "5-8 mm of Hg", "opb": "10-25 mm of Hg", "opc": "25 - 40 mm of Hg", "opd": "> 40 mm of Hg", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "bc5a423e-768e-4742-b95e-06af29906257", "choice_type": "single"} {"question": "Optimum rate of movement during distraction osteogenesis is", "exp": null, "cop": 1, "opa": "1 mm per day", "opb": "5 mm per day", "opc": "1 cm per week", "opd": "5 cm per week", "subject_name": "Surgery", "topic_name": null, "id": "5885fd7d-2c0b-4e17-a80a-07e23bbda489", "choice_type": "single"} {"question": "Mondor&;s disease is", "exp": "Mondor&;s disease is spontaneous thrombophlebitis of the superficial veins of the breast and anterior chest wall cause is unknown it is often self limited it often mimics the lymhatic permeation of the carcinoma of breast ref ;(page no;525) 5th edition of SRB&;S Manual of SURGERY", "cop": 1, "opa": "Superficial thrombophlebitis of breast", "opb": "Fat necrosis in breast", "opc": "Postradiation breast and arm edema", "opd": "Skin infection over the breast", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "91db51ac-63a0-465c-a8d9-817db2f08b86", "choice_type": "single"} {"question": "Triangular relation of Elbow is maintained in", "exp": "D i.e. Supracondylar fracture", "cop": 4, "opa": "Fracture ulna", "opb": "Anterior dislocation of Elbow", "opc": "Posterior dislocation of Elbow", "opd": "Supracondylar fracture", "subject_name": "Surgery", "topic_name": null, "id": "4b000b25-970e-4448-8207-2fccf25dd4e1", "choice_type": "single"} {"question": "Least common complication of peptic ulcer", "exp": "(A) Gastric Outlet Obstruction # GASTRIC OUTLET OBSTRUCTION:> The two common causes of gastric outlet obstruction are gastric cancer (see below) and pyloric stenosis secondary to peptic ulceration.> Previously the latter was more common. Now, with the decrease in the incidence of peptic ulceration and the advent of potent medical treatments, gastric outlet obstruction should be considered malignant until proven otherwise, at least in the West. The term pyloric stenosis is normally a misnomer.> The stenosis is seldom at the pylorus. Commonly, when the condition is due to underlying peptic ulcer disease, the stenosis is found in the first part of the duodenum, the most common site for a peptic ulcer.> True pyloric stenosis can occur due to fibrosis around a pyloric channel ulcer. However, in recent years the most common cause of gastric outlet obstruction has been gastric cancer. In this circumstance the metabolic consequences may be somewhat different from those of benign pyloric stenosis because of the relative hypochlorhydria found in patients with gastric cancer.", "cop": 1, "opa": "Gastric Outlet Obstruction", "opb": "Bleeding", "opc": "Perforation", "opd": "Epigastric Pain", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "65ae4d11-4c1c-47d2-b7be-e19f3320bb35", "choice_type": "single"} {"question": "In pelvis fracture, the amount of blood loss is around", "exp": "D i.e. 4 - 8 units In pelvis fracture intrapelvic haemorrhage is by far, the most serious complication. Haemorrhage frequently results from fracture surfaces and small vessels in the retro peritoneum. Amount of blood loss is around 4 - 8 unitsQ. It must be emphasised, however, that these cases may need transfusion of very large quantities of blood. It is not uncommon for the amount of blood transfused to be in excess of the patients's total blood volume. In cases of hemodynamic instability, an external fixator should be applied immediately to decrease motion at fracture sites as well as to decrease pelvic volume and generate temponade of the pelvic venous plexus.", "cop": 4, "opa": "1-4 units", "opb": "2-4 units", "opc": "2-6 units", "opd": "4-8 units", "subject_name": "Surgery", "topic_name": null, "id": "57547446-1ac0-4e3e-8f2a-534f863361ce", "choice_type": "single"} {"question": "GCS of 10 is classified as", "exp": "Head injury classification using the GlasgowComa Scale (GCS) score.Minor head injury GCS 15 with no loss of consciousness(LOC)Mild head injury GCS 14 or 15 with LOCModerate head injury GCS 9-13Severe head injury GCS 3-8Bailey and love 27e 329", "cop": 2, "opa": "Mild head injury", "opb": "Moderate head injury", "opc": "Severe head injury", "opd": "Moribund head injury", "subject_name": "Surgery", "topic_name": "Trauma", "id": "8926c9a5-d10f-46b0-9bb2-0d65a80996a3", "choice_type": "single"} {"question": "Brain abscess in cyanotic heart disease is commonly located in", "exp": "Brain abscesses in congenital cyanotic heart diseases occur due to hematogenous seeding of bloodborne bacteria. These blood borne bacteria bypass the pulmonary capillary bed d/t right to left shunt. They commonly infect parietal & frontal lobes (territory of middle cerebral artery).", "cop": 4, "opa": "Cerebellar hemisphere", "opb": "Thalamus", "opc": "Temporal lobe", "opd": "Parietal lobe", "subject_name": "Surgery", "topic_name": null, "id": "cbc5f62f-3587-4936-9967-fef25b85fb10", "choice_type": "single"} {"question": "Investigation of choice for posterior chethral stricture is", "exp": "Investigation of choice :\na) Anterior Urethral stricture ⇒ Retrograde Urethrogram.\nb) Posterior Urethral stricture ⇒ Anterograde urethrogram.", "cop": 2, "opa": "Retrograde Urethrogram", "opb": "Anterograde Urethrogram", "opc": "IV Pydogram", "opd": "Ascending Urethrogram", "subject_name": "Surgery", "topic_name": null, "id": "9c2acb88-d7fe-4016-8343-9096ac160aa7", "choice_type": "single"} {"question": "In Random flaps, the length to breadth ratio should be no more than", "exp": "Random flaps. Three sides of a rectangle, bearing no specific relationship to where the blood supply enters the length to breadth ratio is no more than 1.5:1Axial flaps. Much longer flaps, based on known blood vessels supplying the skin.", "cop": 2, "opa": "1:01", "opb": "1.5:1", "opc": "2:01", "opd": "2.5:1", "subject_name": "Surgery", "topic_name": "General surgery", "id": "e6bc33e0-49ca-42fa-a9ae-a9b10b6388fc", "choice_type": "single"} {"question": "A 70 year old male known case of a ceain malignancy presents with elevated erythropoietin levels and PCV of 52%. Most likely tumour is", "exp": "Answer- A. Renal Cell CarcinomaErythrocytosis (d/t secretion of erythropoietin by RCC) (but anemia is a more common finding)HypeensionAbnormal liver function (Stauffers syndrome ie non metastatic hepatic dysfunction)HypercalcemiaNeuromyopathyAmyloidosisIncreased ESR (MC paraneoplastic syndrome)DysfibrogenemiaGalactorrhoeaFeminization and masculanization", "cop": 1, "opa": "Renal Cell Carcinoma", "opb": "Medullary thyroid carcinoma", "opc": "Gastric Carcinoma", "opd": "Colorectal CA", "subject_name": "Surgery", "topic_name": null, "id": "277d9002-fb4f-4a2e-badd-ebf6f02c2a3b", "choice_type": "single"} {"question": "Patient can present with pyoderma gangrenosum in", "exp": "In Non-Hodgkin's Lymphoma, Pyoderma gangrenosum may be the presentation.", "cop": 2, "opa": "Hodgkin's Lymphoma", "opb": "Non-Hodgkin's Lymphoma", "opc": "Mantle cell Lymphoma", "opd": "MALToma", "subject_name": "Surgery", "topic_name": null, "id": "c1b0f19f-272c-4837-aade-71798afb2fa9", "choice_type": "single"} {"question": "Bohler's angle is decreased in fracture of", "exp": "Calcaneum 1Ref. Apley's 8/e, p 750-75]; Ebnezar Ohopedics 3/e, p 263-264; Maheshwari 3/e, p 1401 Bohler's angle (also k/a Tuber joint angle) measures the angular relationship between talus and calcanecum. Flattening of this angle is a classic x-ray sign of depressed fracture of calcaneum. Other angle which is of impoance in calcaneal fracture is Crucial angle of \"Gissane\" More about calcaneal Calcaneum is the most commonly fractured tarsal bone In 5-10% of cases is bilateral * Most common mechanism of injury is fall front height, often from a ladder, onto one or both heels. The calcaneum is driven up against the talus and is split or crushed. About one fifth of these patients suffer associated injuries of the spine, pelvis or hip. * Also k/a loveri fracture' * Plain x-rays done for calcaneal fracture include lateral, oblique and axial views, Axial view of calcaneum is also k/a Hans view. * CT is the inv. of choice * With severe injuries and especially with bilateral fractures - it is essential to x-ray the knees, the spine and the pelvis as well Other angles of impoance Cobb's angle - Scoliosis (Apley's 8/e, p 377; Maheshwari 3/e, p 235) Kite's angle - CTEV (Apley's 8/e, p 489; Maheshwari 3/e, p 196) Meary's angle _> Pes cavus (plantaris (Apley's 8/e, p 497) deformity) Hilgenreiner's epiphyseal angle Congenital coxa vera (Apley's 8/e, p 420) Baurnann's angle Supra condylar (Apley's 8/e, p 597) C alcaneum 1Ref. Apley's 8/e, p 750-75]; Ebnezar Ohopedics 3/e, p 263-264; Maheshwari 3/e, p 1401 * Bohler's angle (also k/a Tuber joint angle) measures the angular relationship between talus and calcanecum.", "cop": 1, "opa": "Calcaneum", "opb": "Talus", "opc": "Navicular", "opd": "Cuboid", "subject_name": "Surgery", "topic_name": null, "id": "77966c06-c70f-47c2-9f2a-3fb6a0803e4e", "choice_type": "single"} {"question": "Chemical cauterization in odontogenic keratocyst\nis done by", "exp": null, "cop": 2, "opa": "Hydrogen peroxide", "opb": "Carnoy's solution", "opc": "Superoxide solution", "opd": "Betadine", "subject_name": "Surgery", "topic_name": null, "id": "56b0de07-072d-4c5c-9cfa-22230feb9f58", "choice_type": "single"} {"question": "Child with midline swelling in the neck most probable diagnosis", "exp": "Ans. (a) Thyroglossal CystRef: Schwartz 10th edition, Page 1602* Midline masses include thyroglossal duct remnants, thyroid masses, thymic cysts, or dermoid cysts* Thyroglossal cysts account for about 75% of congenital midline swellings in childhood, and they are the most common abnormality of the midline neck seen in children", "cop": 1, "opa": "Thyroglossal cyst", "opb": "Thyroid", "opc": "Cystic hygroma", "opd": "Dermoid cyst", "subject_name": "Surgery", "topic_name": "Neck", "id": "dc85e00e-9dc5-4907-869d-46571049ef85", "choice_type": "single"} {"question": "Cullen's sign", "exp": "Cullen's sign seen in acute pancreatitis due to enzymes seeping through falciform ligament and causing discolouration around umbilicus SRB,5th,683.", "cop": 2, "opa": "Bluish disclolouration of the flanks", "opb": "Bluish discolouration in the umbilicus", "opc": "Migratory thrombophelebitis", "opd": "Subcutaneous fat necrosis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "ec6da1f6-32b7-4c72-9178-f1247cfbddad", "choice_type": "single"} {"question": "The type of mammary ductal carcinoma is situ (DCIS) most likely to result in a palpable abnormality in the breast is", "exp": "Ans. is 'd' Comedo DCIS Ductal carcinoma in situ (DCIS) can be divided into two types : Comedo carcinomas and Non-comedocarcinomas DCIS are usually detected as calcifications on mammography but comedo carcinomas can present as palpable nodules.", "cop": 4, "opa": "Apocrine DCIS", "opb": "Neuroendocrine DCIS", "opc": "Well differentiated DCIS", "opd": "Comedo DCIS", "subject_name": "Surgery", "topic_name": null, "id": "2c52e735-bcb1-432b-8b92-cd6f56186764", "choice_type": "single"} {"question": "Impacted canines", "exp": null, "cop": 2, "opa": "Most likely to be ankylosed", "opb": "They may damage roots of other teeth", "opc": "Good function is impossible without them", "opd": "They will not erupt until root formation is complete", "subject_name": "Surgery", "topic_name": null, "id": "9bc02db9-679b-4a95-9e7f-17fb38da2f61", "choice_type": "single"} {"question": "Burns involving skin superficial pa of dermis is categorized as", "exp": "First degree burns involve only epidermis Superficial second degree involve upper layer of dermis Deep second degree involves reticular layers of dermis Third degree involves all layers of skin Fouh degree burns involve not only skin but also subcutaneous fat and deeper structures", "cop": 2, "opa": "First degree burns", "opb": "Superficial 2nd degree burn", "opc": "Deep 2nd degree burn", "opd": "Third degree burns", "subject_name": "Surgery", "topic_name": "General surgery", "id": "9e36c6a8-de51-4d08-9a02-3043a8ad6a35", "choice_type": "single"} {"question": "Most common type of Thyroid carcinoma is", "exp": "Papillary Histology type Incidence Papillary 80%, Follicular 10%, Medullary 5%, Anaplastic 1% * Papillary carcinoma thyroid (Frequently asked facts) a. Commonest carcinoma of thyroid gland (80%) b. Commonest carcinoma in iodine sufficient area. c. More common in patients with previous exposure to radiation (past childhood) d. Commonest age 30-40 year. e. Multifocal (more common) f. Lymph node metastases more common (i.e., lymphatic spread) g. Distant metastasis uncommon commonest site - lung followed by bone, liver, brain. h. Prognosis excellent - 10 years survival (95%)", "cop": 1, "opa": "Papillary", "opb": "Follicular", "opc": "Medullary", "opd": "Anaplastic", "subject_name": "Surgery", "topic_name": null, "id": "6c7a0816-6caa-4c83-a41f-ef692f414e11", "choice_type": "single"} {"question": "Once phaeochromocytoma is diagnosed, preoperatively following is given", "exp": "Once a phaeochromocytoma has been diagnosed, an a- adrenoreceptor blocker (phenoxybenzamine) is used to block the effects of catecholamine excess and its consequences during surgery. A dose of 20 mg of phenoxybenzamine initially should be increased daily by 10 mg until a daily dose of 100-160 mg is achieved and the patient repos symptomatic postural hypotension. Additional b-blockade is required if tachycardia or arrhythmias develop; this should not be introduced until the patient is a-blocked. The infusion of large volumes of fluid or administration of noradrenaline can be necessary to correct postoperative hypotension in the presence of unopposed a-blockade.Ref: Bailey and Love 27e pg: 846", "cop": 2, "opa": "Alpha adrenergic agonist", "opb": "Alpha adrenergic blocker", "opc": "Beta adrenergic blocker", "opd": "Beta adrenergic blocker", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "acb1c6c0-29dc-49d3-aaca-75ed696ab4d4", "choice_type": "single"} {"question": "The most reliable urine specimen is obtained by", "exp": "the most reliabe urine sample is obtained through suprapubic aspiration .it is superior to clean catch or catheter specimen with sensitivity for bacteriuria being 100% and rarely contaminated.But this is not routinely indicated . A midstream sample is obtained for urine analysis in both males and females after cleaning of genitalia to prevent contamination but in females if uti is suspected midstream sample is unreliable and a catheterised sample is obtained.Indications for suprapubic aspiration 1) chilren below 2 years if urine culture is to be done 2) urinary retention ( bph , malignancy , phimosis , urethral stricture ) 3) chronic infection of urethral or periurethral glands 4) urethral trauma. contraindications . 1) empty or unidentifiable bladder 2) bladder tumour 3) lower abdominal wounds or cellulitis ( campbell walsh urology 11th edition . chapter 1.,aicle 82964 .suprapubic aspiration ,medscape by alexander d tapper et al )", "cop": 4, "opa": "Urethral catheterization", "opb": "Catheter aspiration", "opc": "Midstream voiding", "opd": "Suprapubic aspiration", "subject_name": "Surgery", "topic_name": "Urology", "id": "9745c17b-251b-4e2c-9846-e7ab5ea4d86c", "choice_type": "single"} {"question": "The most common presentation of endemic goitre", "exp": "Endemic Goiter Worldwide, diffuse goiter is most commonly caused by iodine deficiency and is termed endemic goiter when it affects >5% of the population Endemic goiter occurs in geographical areas where soil, water and food supply contains low levels of iodine The lack of iodine leads to decreased Synthesis of thyroid hormones and a compensatory increase in TSH which in turn leads to follicular cell hyperophy and hyperplasia and goitrous Enlargement leading to diffuse hyperplastic goiter Mostly, patients are euthyroid Ref : Harrison's 19th edition Pgno :2301", "cop": 1, "opa": "Diffuse goitre", "opb": "Solitary nodule", "opc": "Hypothyroid", "opd": "Hypehyroid", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "b39fdea1-3a3e-4331-b8f4-de9d68662b5c", "choice_type": "single"} {"question": "18 yr female with itchy erythema, swelling of toes every winter season seen due to", "exp": "Answer- C. ChilblainsAlso known as pernio, It is an inflammatory skin condition presenting after exposure to cold as pruritic and/or painful erythematous to viloaceous acral lesions.It may be idiopathic or secondary to an underlying disease.", "cop": 3, "opa": "Raynauds disease", "opb": "Raynauds phenomenon", "opc": "Chilblains", "opd": "Frost bite", "subject_name": "Surgery", "topic_name": null, "id": "e991d5cf-ab81-4f00-b887-0bb497ef7f10", "choice_type": "single"} {"question": "Truma and injury severity score (TRISS) includes", "exp": "(B) (Revised Trauma score /injury severity score + Age) (The Trauma Manual by Moore 2 Mattox)Trauma and injury severity score (TRISS) Combines the Reviseds Trauma score (RTS)and injury severity score (ISS) with the 'Age' of patient together with the method of injury (Blunt or penetrating).Trauma and Injury Severity score (TRISS)* The TRISS is a combined scoring system used to predict the outcome following major trauma* It combines the anatomic derangements (ISS) and physiological derangements (RTS)together with patientsAge and Mechanism of Injury (Blunt or penetrating) to predict survival after trauma.TRISS (Trauma and injury Severity Score)* Injury severity Score (ISS)* Revised Trauma Score (RTS)* Age* Mechanism of injury (Blunt/penetrating)* The TRISS scoring system provides a rough predictor medicating whether mortality in a given patient is expected to be greater or less than 50 percent.TRIAGE- the screening and classification of sick, wounded or injured persons during war or other disaster to determine priorty needs for efficient uses of medical and nurshing manpower, equipment and facilities. It is also done in imergency rooms and in acute care clinics to determine priorty of treatment use of triage is essential if the maximum number of lives are to be saved during an emergency situation that produces many more sick and wounded than the available medical care facilities and personnel can possibly handle.", "cop": 2, "opa": "GCS+BP+RR", "opb": "Revised trauma score ^injury severity score +age", "opc": "Revised trauma score +injury severity score +GCS", "opd": "Revised trauma score + GCS +BP", "subject_name": "Surgery", "topic_name": "Trauma", "id": "7c7be28d-9c3b-48b4-a162-fb3680967b6c", "choice_type": "single"} {"question": "Pain in left hypochondrium vomiting, diarrhea, malena, weight loss diagnosis", "exp": "Answer- C. Zollinger Ellison syndromePeptic ulceration is the most common manifestation of Zollinger Ellison syndrome leading to left hypochondriac pain, vomlting and weight loss and ulcers refractory to medical therapy.A bleeding ulcer gives rise to malena.", "cop": 3, "opa": "Cholangitis", "opb": "Enterocolitis", "opc": "Zollinger Ellison syndrome", "opd": "Amebiasis", "subject_name": "Surgery", "topic_name": null, "id": "e0d7c92d-7e34-406c-9f0d-cf61f9cf5d89", "choice_type": "single"} {"question": "As per 'rule of nine' each lower limb is", "exp": "Each upper limb is 9% TBSA, Each lower limb 18%, (front 9%, Back 9%)Chest 18% (front 9%, Back 9%)Abdomen 18% (front 9%, Back 9%)The head and neck 9%Perineum 1%Ref: Bailey and love 27e pg: 621", "cop": 2, "opa": "9%", "opb": "18%", "opc": "27%", "opd": "36%", "subject_name": "Surgery", "topic_name": "General surgery", "id": "9143e30a-93a6-460c-9189-5bf9c2f3b043", "choice_type": "single"} {"question": "Clostridium difficile is responsible for", "exp": null, "cop": 3, "opa": "Tetanus", "opb": "Gas gangrene", "opc": "Superinfection", "opd": "Food poisoning", "subject_name": "Surgery", "topic_name": null, "id": "2034f991-1cf8-4752-89aa-086bab0e9787", "choice_type": "single"} {"question": "S. aureus causes a wide variety of infections, ranging from wound infection to pneumonia. Treatment of S. aureus infection with penicillin is often complicated by the", "exp": "Staphylococci are Gram-positive, non-sporeforming cocci. Clinically, their antibiotic resistance poses major problems. Many strains produce 13-lactamase (penicillinase), an enzyme that destroys penicillin by opening the lactam ring. Drug resistance, mediated by plasmids, may be transferred by transduction.", "cop": 2, "opa": "Inability of penicillin to penetrate the membrane of S. aureus", "opb": "Production of penicillinase by S. aureus", "opc": "Production of penicillin acetylase by S. aureus", "opd": "Lack of penicillin binding sites on S. aureus", "subject_name": "Surgery", "topic_name": null, "id": "ab3c35f4-4462-45e9-869c-7285ae3f3823", "choice_type": "single"} {"question": "Infection of Eyelash follicle is", "exp": null, "cop": 1, "opa": "Stye", "opb": "Impetigo", "opc": "Boil", "opd": "Carbuncle", "subject_name": "Surgery", "topic_name": null, "id": "2815c648-c97d-44d5-b00b-0bd80c517e5a", "choice_type": "single"} {"question": "Most common tumor in the posterior mediastinum is", "exp": "Most common tumour of posterior mediastinum is neurofibromas constituting 75% of the total.Others include ganglioneuromas,aneurysm of descending aoa,lymph node mass. Reference: SRB's manual of surgery,5th edition,page no:1126.", "cop": 1, "opa": "Neurofibroma", "opb": "Teratoma", "opc": "Lymphoma", "opd": "Bronchogenic cyst", "subject_name": "Surgery", "topic_name": "Cardio thoracic surgery ", "id": "8904bfc2-5358-4e6e-9eae-e17fa5c05f85", "choice_type": "single"} {"question": "Not a predisposing factor for Ca esophagus", "exp": "OESOPHAGEAL CARCINOMA,6 th most common carcinoma in the world, can be predisposed to dietary deficiencies, human papillomavirus infections, achalasia cardia, oesophageal webs etc.it is most commonly seen in middle third of oesophagus (50%)and also at lower third(33%) and upper third(17%).in the lower pa adenocarcinoma is common .in India 90%are squamous carcinomas.dysphagia, regurgitation, anorexia, loss of weight, ascites, palpable left supraclavicular lymph nodes are the clinical features. Ref: SRB&;s manual of surgery,5th ed, pg no805", "cop": 3, "opa": "Diveicula", "opb": "Human papilloma virus", "opc": "Mediastinal fibrosis", "opd": "Caustic ingestion", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "35e4f628-06e6-4f0f-aac9-75d336ff39fb", "choice_type": "single"} {"question": "Sterile pyuria is seen in", "exp": "Many diseases in the urinary tract produce significant pyuria in the absence of bacteriuria . whereas TB is a well recognised example of sterile pyuria , stag horn calculi and stones of smaller size can produce intense pyuria with clumps of wbc in the absence of UTI . any injury to urinary tract ,from Chlamidial urethritis to glomerulonephritis and interstitial cystitis can elicit sterile pyuria ref : Campbell- Walsh urology pa3 , chapter 12 ,pg no 251", "cop": 1, "opa": "Renal TB", "opb": "Wilms tumor", "opc": "PID", "opd": "Diabetes", "subject_name": "Surgery", "topic_name": "Urology", "id": "01713b0a-ff39-4320-9abd-0ca7f74218cc", "choice_type": "single"} {"question": "Gold standard diagnostic test in varicose veins is", "exp": null, "cop": 2, "opa": "Photoplethysmography", "opb": "Duplex imaging", "opc": "Ultrasonography", "opd": "Radio - labeled fibrinogen study", "subject_name": "Surgery", "topic_name": null, "id": "db651c38-3a5e-4ff4-9dca-9a4268142a42", "choice_type": "single"} {"question": "Compensatory mechanisms during acute hemorrhage include", "exp": "Acute hemorrhage triggers the potent vasopressor activity of both angiotensin and vasopressin to increase blood flow to the heart and brain via selective vasoconstriction of the skin, kidneys, and splanchnic organs. Adrenergic discharge also results in selective vasoconstriction of skin, renal, and splanchnic vessels. Myocardial contractility and heart rate are increased, with a resultant increased cardiac output. Hyperventilation is the typical response to the metabolic (lactic) acidosis associated with hemorrhagic shock and hypoperfusion. Aldosterone release, with subsequent increased renal sodium resorption, is mediated by angiotensin II and ACTH, which prevents further intravascular depletion.", "cop": 4, "opa": "Decreased cerebral and coronary blood flow", "opb": "Decreased myocardial contractility", "opc": "Renal and splanchnic vasodilation", "opd": "Increased respiratory rate", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "9c6a4de4-9d07-4d6e-a1e6-c6d7675c547d", "choice_type": "single"} {"question": "A patient operated for thyroid surgery for a thyroid swelling, later in the evening developed difficulty in breathing. There was swelling in the neck. The immediate management would be", "exp": "Haemorrhage is the most frequent life-threatening complication of thyroidectomy. Around 1 in 50 patients will develop a haematoma, and in almost all cases this will develop in the first 24 hours. If an aerial bleed occurs, the tension in the central compament pressure can rise until it exceeds venous pressure. Venous oedema of the larynx can then develop and cause airway obstruction leading to death. If a haematoma develops, clinical staff should know to remove skin sutures in order to release some pressure and seek senior advice immediately. Endotracheal intubation should be used to secure the airway while the haematoma is evacuated and the bleeding point controlled.Ref: Bailey and Love, page no: 815", "cop": 4, "opa": "Epinephrine injection", "opb": "Tracheostomy", "opc": "IV calcium gluconate", "opd": "Open the wound sutures in the ward", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "8a2b9435-fb12-4769-b1af-71d73b30860e", "choice_type": "single"} {"question": "Most common site of traumatic aoic rupture is", "exp": "Answer- A. Descending thoracic aoaThe proximal descending aoa, where the relatively mobile aoic arch can move against the fixed descending aoa (ligamentum aeriousm), is at greatest risk from the shearing forces of sudden deceleration. Thus the aoa is a greatest risk in frontalor side impacts, and falls from heights.", "cop": 1, "opa": "Descending thoracic aoa", "opb": "Descending thoracic aoa", "opc": "Arch of aoa", "opd": "Aoic Root", "subject_name": "Surgery", "topic_name": null, "id": "b15309f5-faa8-4de3-91a6-e0808802cc1f", "choice_type": "single"} {"question": "Chronic Gastric Ulcers are much more common on the location of", "exp": "(C) Incisura angularisGASTRIC ULCERS tend to be larger in comparison to Duodenal Ulcers.Fibrosis results rarely & shown as hourglass contraction of the stomach.Large chronic ulcers may erode posteriorly into the pancreas & erode major vessels such as the splenic artery.Less commonly erode into other organs such as the transverse colon.Chronic gastric ulcers are much more common on the lesser curve (especially at the incisura angularis)Chronic gastric ulcers are less common on the greater curve and, even when high on the lesser curve, they tend to be at the boundary between the acid-secreting and the non-acid-secreting epithelia.With atrophy of parietal cell mass, non-acid-secreting epithelium migrates up the lesser curvature.Major causative factor (60% of gastric & up to 50-75% of duodenal ulcers) is chronic inflammation due to Helicobacter pylori that colonizes the antral mucosa.Majority of Gastric ulcers can be attributed to either H. pylori infection or NSAID induced mucosal damage.Types of Gastric ulcer:Type I - located near the angularis incisura on the lesser curvature, close to the border between the antrum & the body of the stomach.These patients usually have normal or decreased acid secretion.Type II ulcer: Occurs in conjunction with active or healed duodenal ulcer disease.Type III: Prepyloric ulcerType IV ulcer: Gastro esophageal junction at the lesser curve.Type V ulcer: Anywhere in the stomach associated with chronic NSAID use or aspirin use.MOST COMMON SITE OF GASTROINTESTINAL TRACT LESIONS*. Most common site of Perforation of oesophagusOesopahgeal introitus*. Most common site of Oesopahgeal webProximal portion of oesophagus*. Most common site of Carcinoma oesophagusMiddle 1/3rd*. Dilatation of gut in Chaga's diseaseOesopahgus& Colon*. Congenital hour-glass stomachIncisura angularis*. Most common site of Gastric ulcers (95%)Incisura angularis of Lesser curvature*. Most common site of Duodenal ulcers (95%)Within 2 cm of pylorus (duodenal bulb)*. Most common site of Pulsion diverticulum of stomachGreater curvature & posterior fundus*. Carcinoma stomachPrepyloric region*. Carcinoma stomach associated with pernicious anaemiaFundal & polypoid*. Lymphoma (Non Hodgkins)Stomach (least common-Rectum)*. Haemangioma in internal organLiver*. ZES gastrinomaPancreas*. Intestinal rupture in blast injuryPelvic colon*. Crohn's diseaseTerminal Ileum*. Ulcerative colitisSigmoid colon*. Untreated amoebic liver abscess bursts intoRight lung*. Intestinal tuberculosisIleo-caecal region*. Typhoid ulcerSmall intestine (Longitudinal) *. Most common site of Perforation in TyphoidSmall intestine Ileocaecal junction*. Most common site of Meckel's diverticulumFrom the Ileum (60-90 cm from the Ileocaecal valve)*. Pneumatosis cystoidesSmall intestine*. Most common site of Diverticuiosis90% in Sigmoid (Rectum is never involved)*. Polypi in Puetz-Jeghers syndromeAlways jejunum is involved*. Adenomatous polypiSigmoid, Rectum*. Familial polyposis and Gardner's syndromeColon*. LipomaCaecum*. Carcinoma small intestineJejunum*. Most common site of Carcinoma colonsigmoid colon & Rectosigmoid junction*. Carcinoid tumoursAppendix (90%)*. Loop colostomyTransverse colon*. Acute intestinal obstructionIleum*. Intussusception with gangreneIleocaecal*. Intussusception in infantLast 50 cms of Ileum*. Most common site of Intussusception in adolescentThick of inverted Meckel's diverticulum*. Volvulus small intestineIleum*. Perforation in simple obstruction of colon (in absence of strangulation)Caecum*. Intraperitoneal abscessPelvis*. Most common site of Hirschsprung's diseaseUsually upper limit is Rectosigmoid junction", "cop": 3, "opa": "Prepyloric", "opb": "Fundus", "opc": "Incisura angularis", "opd": "Cardia", "subject_name": "Surgery", "topic_name": "Stomach & Duodenum", "id": "902f119b-db3e-455e-937c-3e4248230005", "choice_type": "single"} {"question": "In CA stomach, T4 lesion means", "exp": "T1a Tumour involves lamina propria T1b Tumour involvessubmucosaT2 Tumour invades muscularis propriaT3 Tumour involves subserosa T4a Tumour perforates serosaT4b Tumour invades adjacent organsBailey and love 27e pg: 1135", "cop": 1, "opa": "Involved till serosa", "opb": "Involved till lamnia propria", "opc": "Involved till submucosa", "opd": "Involved till muscularis propria", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "bfad0536-1c5d-4dde-ad97-d85ddfccc861", "choice_type": "single"} {"question": "A 50 year old male presents with painupper abdomen, pruzitus, jaundice and weight loos, elevated ANA, the likely diagnosis is", "exp": ".Primary sclerosing cholangitis is one wherein no cause is found and is associated with ulcerative colitis, Sjogren's syndrome, Crohn's disease, Grave's disease. It eventually leads to biliary cirrhosis. Primary sclerosing cholangitis (PSC) is an idiopathic, progressive, chronic, cholestatic pathology with diffuse inflammation, sclerosis, and obliteration of intra and extra hepatic biliary systems. There will be multiple areas of strictures and dilatations. It has high risk for cholangiocarcinoma. It could be an autoimmune disease. ref:SRB&;S manual of surgery,ed 5,pg no 590", "cop": 1, "opa": "Primary sclerosing cholangitis", "opb": "Klatskin tumor", "opc": "Secondary sclerosing cholangitis", "opd": "Choledocholinthiasis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "a85d12ac-e8ae-45e6-af47-234800443ffb", "choice_type": "single"} {"question": "In transoral sialolithotomy of the submandibular duct, the incision for removal of an anterior sialolith should be placed", "exp": null, "cop": 1, "opa": "Medial to the plica", "opb": "Lateral to the plica", "opc": "Directly over the duct", "opd": "Lateral to the duct", "subject_name": "Surgery", "topic_name": null, "id": "a86d50cf-eaf6-4bd3-be3a-dac860c04733", "choice_type": "single"} {"question": "Mammography is used for screening from", "exp": "Ans. (c) 40 years(Ref Schwartz page 513/ 10th edition)* American Cancer Society (ACS) recommends screening from 40 years* Other many recommend - from 50 years. (But Sabiston 20th edition also recommends 40 years - so let us go with 40 years)", "cop": 3, "opa": "20 years", "opb": "30 years", "opc": "40 years", "opd": "50 years", "subject_name": "Surgery", "topic_name": "Breast", "id": "682a419f-203b-4637-ba9d-99dc786dd89d", "choice_type": "single"} {"question": "Best vein for total parenteral nutrition is", "exp": "Ans. a (Subclavian vein). (Ref. Baily and Love surgery 25th/pg. 231)TOTAL PARENTERAL NUTRITIONDefined as the intravenous provision of all nutritional requirements, without the use of GIT.Indications:# Proximal intestinal fistula# Inflammatory bowel disease# Massive intestinal resection (especially if <100 cm of small bowel remains)# Ileus# Pancreatitis (severe)Preferred vein:# Peripheral line (for short period < 2 weeks)# Central line (for long period)Central venous route is chosen more commonly, and the catheter should be inserted via either subclavian, internal/ external jugular vein should be avoided as it is associated with high incidence of infection and thrombosis. The catheter tip should be in distal SVC to minimize risk of central venous or cardiac thrombosis.Complications of TPN:Catheter relatedFeeding Regimen related# Arterial, venous injuries and cardiac perforation and thrombosis# Hyperglycemia# Hypoglycemia# Brachial plexus and stellate ganglion injury# Hypertriglyceridemia# Pneumothorax# Hyperchloremic acidosis# Thoracic duct injury# Electrolyte imbalance# Air embolism# Trace element and vitamin deficiency# Catheter related infections # Catheter migration/embolus # Thrombotic catheter occlusion # SABE", "cop": 1, "opa": "Subclavian vein", "opb": "Femoral vein", "opc": "Brachial vein", "opd": "Saphenous vein", "subject_name": "Surgery", "topic_name": "Fluid & Electrolyte", "id": "ddd3876b-64d6-4c9e-a5c3-79348561e3e7", "choice_type": "single"} {"question": "Hangman's fracture is", "exp": "B Fracture dislocation of C2 Hangman's fracture is traumatic spondylolisthesis of axis (C2) veebrae on C3Q due to fracture line passing through the neural arch (pedicle/ pars interaicularis)Q", "cop": 2, "opa": "Subluxation of C5 over C6", "opb": "Fracture dislocation of C2", "opc": "Fracture dislocation of ankle joint", "opd": "Fracture of odontoid", "subject_name": "Surgery", "topic_name": null, "id": "500258bf-1887-44c4-92eb-60449d0bd074", "choice_type": "single"} {"question": "A bicyclist suddenly applies brake and lands on his perineum on the cross bar of the bicycle on an attempt to urinate he develops marked swelling of scrotum. The structure most probably injured is", "exp": "A bicyclist directly lands on his perineum leading to spongy urethrs / Bulbar urethral injury.", "cop": 3, "opa": "Bladder", "opb": "prostatic urethra", "opc": "Spongy urethra", "opd": "Membranous urethra", "subject_name": "Surgery", "topic_name": null, "id": "a8f39f2f-805e-463c-85bf-a7473430486a", "choice_type": "single"} {"question": "The 'decisive period' in preventing wound infections is", "exp": "There is up to a 4-hour interval before bacterial growth becomes established enough to cause an infection after a breach in the tissues, whether caused by trauma or surgery. This interval is called the 'decisive period' and strategies aimed at preventing infection from taking a hold become ineffective after this time period.It is therefore logical that prophylactic antibiotics should be given to cover this periodRef: Bailey and Love 27e pg: 46", "cop": 1, "opa": "4 hr post incision", "opb": "12 hr prior to incision", "opc": "12 hr post incision", "opd": "48 hr post incision", "subject_name": "Surgery", "topic_name": "General surgery", "id": "31ab0f4e-85ba-4311-860d-3199ff123f8f", "choice_type": "single"} {"question": "Concentration of sodium in Ringer lactate in (meq/L) is", "exp": "Concentration of sodium in Ringer lactate is 130meq/L\nConcentration of sodium in Normal saline is 154meq/L", "cop": 3, "opa": "154", "opb": "120", "opc": "130", "opd": "144", "subject_name": "Surgery", "topic_name": null, "id": "439c0291-5690-4ebf-99b9-422d56b10e67", "choice_type": "single"} {"question": "Urinary retention in child is most commonly caused by", "exp": "(A) Metal scab with ulceration # Acute urinary retention in a male child may be due to local inflammatory causes like meatal ulcer with scabbing.> Etiology of Urinary Retention in Children: Neurological processes Severe voiding dysfunction UTI Constipation Adverse drug effect Local inflammatory causes Locally invading neoplasms Benign obstructing lesions Idiopathic Combined UTI and Constipation Incarcerated Inguinal Hernia.", "cop": 1, "opa": "Metal scab with ulceration", "opb": "Posturethral valve", "opc": "Urethral stricture", "opd": "Epispadius", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "ca61830b-c89f-49ae-8227-1f66acd20e6e", "choice_type": "single"} {"question": "WRONG pair among the following", "exp": "(C) H. pylori-Hypergastrenemia # H. pylori infection is associated with increased levels of HCL not Gastrin.> Carcinoid tumours, Proton pump inhibitors, gastrinoma increase gastrin levels.", "cop": 3, "opa": "Zollinger-Ellison syndrome - Increased HC1", "opb": "Polyp-Obstruction", "opc": "H. pylori-Hypergastrenemia", "opd": "Menetrier disease-Hypoalbunemia", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "dc004ce5-8905-48da-9f1f-25cc15200da9", "choice_type": "single"} {"question": "The most common benign tumor of the lung is", "exp": "The most common benign lung tumor is a hamaoma,a developmental abnormality containing mesothelial & endothelial elements.Diagnosis is achieved by excision of the lesion. Reference:Bailey & Love's sho practise of surgery,25th edition,page no:891", "cop": 1, "opa": "Hamaoma", "opb": "Alveolar adenoma", "opc": "Teratoma", "opd": "Fibroma", "subject_name": "Surgery", "topic_name": "Cardio thoracic surgery ", "id": "f7636d66-0877-44f8-aa99-72c1fb13ea5f", "choice_type": "single"} {"question": "Commonest site of carcinoma tongue", "exp": "Most common site is middle of the lateral border or the ventral aspect of the tongue.", "cop": 2, "opa": "Apical", "opb": "Lateral borders", "opc": "Dorsum", "opd": "Posterior 1/3", "subject_name": "Surgery", "topic_name": null, "id": "77eb596b-db78-469a-af11-aaef7545f4c0", "choice_type": "single"} {"question": "\"Lucid Interval\" is associated with", "exp": "(A) Extradural hematoma # In about 50% of the cases of head injury, there is an initial recovery from the symptoms of concussion & this is followed, after a variable period as mentioned above, by unconsciousness, the sequence being as follows: unconsciousness due to concussion # consciousness due to recovery # unconsciousness due to raised intracranial tension.> The state of consciousness between the two states of unconsciousness in known as the lucid interval.> In these cases, the apparent recovery & the interval between the infliction of injury and the onset of symptoms frequently leads to the defence that the blow was not the cause of death.> Alternatively, this period may cover some further volitional activity which may mislead lay persons as to the actual cause of haemorrhage.> In emergency medicine, a lucid interval is a temporary improvement in a patient's condition after a traumatic brain injury, after which the condition deteriorates.> A lucid interval is especially indicative of an epidural hematoma.> An estimated 20 to 50% of patients with epidural hematoma experience such a lucid interval.", "cop": 1, "opa": "Extradural hematoma", "opb": "Acute subdural hematoma", "opc": "Chronic subdural hematoma", "opd": "Subarachnoid hemorrhage", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "e28699eb-fb0b-495b-87ca-5dc3669dc8f5", "choice_type": "single"} {"question": "The most common site of fracture neck of femur that causes avascular necrosis is", "exp": "A i.e. Subcapital Malunion is rarest complication of fracture neck femur (almost not seen) because intracapsular fracture neck femur almost never unite unless thay are anatomically reduced and stabliy fixed. Most common complications of intracapsular fracture neck femur are nonunioin & fixation failure (more common in most series of displaced fractures) and avascular necrosis (more common in most series of undisplaced fractures). Shoening is seen in almost all cases of nonunion & AVN. Chances of avascular necrosis (AVN) and nonunion increases as the fracture site becomes more proximal Q. The more proximal the fracture located the worse the prognosis. Chances of AVN & nonunion (or worseness of prognosis) in decreasing order is Subcapital Q > transcervical > basal > interochanteric Transphyseal > transcervical > cervicotrochanteric > interochanteric (in children) Complications of Hip Fractures Intracapsular Fracture Neck Femur Extracapsular Fracture Interochanteric Femur Most - Non union (in MalunionQ common displaced fracture) - Avascular (Osteo) necrosis (in undisplaced fracture) Least common MalunionQ NonunionQ Nonunion is second most common complication (after avascular necrosis) of undisplaced fracture neck femurQ. The probable causes of nonunion in fracture neck femur are - - Cambium layer of periosteum which produce callus is missing. There fore femoral neck must heal direct endosteal healing only. There is no contact with soft tissues which could promote callus formation. Precarious blood supply: by tearing the ascending cervical branches or retinacular vessels the injury deprives head of its main blood supplyQ. Synol fluid interfere with fracture healing as it prevents clotting of fracture hematoma and release angiogenic inhibiting factors. - Inadequate reduction and improper immobilization. * It is impoant to note that avascular necrosis and nonunion are independent events, because AVN is based on vascular supply of femoral head, whereas nonunion is based on the healing process. So AVN can occur even in united fractures. * Femoral neck fractures should unite by 6 months. If there is no evidence of healing or patient continued to have pain at 3 - 6 months after surgery then a delayed (3 months) or non union ( 6 months) should be contemplated. * AVN is a late complication and ischemic collapse usually occur with in 2 -years of fracture. According to anatomical location of fracture neck femur the chances of AVN & nonunion in decreasing order are: subcapital (transepiphyseal in children) > TranscervicalQ > Basicervical. - Temponade effect of intracapsular hematoma causing floating of both fracture ends and making reduction difficult.", "cop": 1, "opa": "Sub-capital", "opb": "Interochanteric", "opc": "Trans-cervical", "opd": "Basal", "subject_name": "Surgery", "topic_name": null, "id": "ffae3726-79c6-4338-96f7-caf2d017b808", "choice_type": "single"} {"question": "The most impoant prognostic factor in breast carcinoma is", "exp": "Stage I and II has got better prognosis. Spread to axillary nodes is the most impoant prognostic indicator. Age: Younger the age worser the prognosis. Sex: Carcinoma male breast has got worser prognosis compared to female breast. Because of early spread in carcinoma male breast. Atrophic scirrhous has got best prognosis. Medullary carcinoma has got better prognosis than scirrhous carcinoma because of lymphocytic infi ltration. Invasive carcinoma has got worser prognosis. Inflammatory carcinoma breast has worst prognosis. Ref; (page no;559 ) 5th edition of SRB&;S manual of Surgery", "cop": 2, "opa": "Histological grade of the tumor", "opb": "Stage of the tumor at the time of diagnosis", "opc": "Status of estrogen and progesterone receptors", "opd": "Over expression of p-53 tumour suppressor gene", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "9954aebd-4d12-4239-b332-29e6ca333eef", "choice_type": "single"} {"question": "In a ulcer over skin if there is undermined edges it suggests", "exp": "Flat sloping venous or septic, often with a transparent healing edge along pa of its circumference. Punched-out syphilitic, trophic, diabetic, ischaemic, leprosy. Undermined tuberculosis, pressure necrosis paicularly over the buttocks, carbuncles. Raised rodent ulcer , often with a slightlyrolled appearance. Raised and eveed carcinoma Hamilton bailey 19th edition Pg 64", "cop": 2, "opa": "Syphilis", "opb": "Tuberculosis", "opc": "Cancerous ulcer", "opd": "Venous ulcer", "subject_name": "Surgery", "topic_name": "General surgery", "id": "cf05f3d3-db3b-4c32-b1d7-14bff10fb97a", "choice_type": "single"} {"question": "Treatment of papillary carcinoma thyroid with level VI lymph\nnode metastasis is", "exp": "IF level VI is affected then CND is done. If any other LN is involved then modified radical neck dissection is preferred.", "cop": 2, "opa": "Total thyroidectomy", "opb": "Total thyroidectomy + central neck dissection", "opc": "Total thyroidectomy + radioiodine ablation", "opd": "Total thyroidectomy + radical neck dissection", "subject_name": "Surgery", "topic_name": null, "id": "b44a245c-1999-4d0b-9d5a-d7666b5386ef", "choice_type": "single"} {"question": "Cystic compressible, translucent swelling in the posterior triangle of neck", "exp": null, "cop": 1, "opa": "Cystic hygroma", "opb": "Branchial cyst", "opc": "Thyroglossal cyst", "opd": "Dermoid cyst", "subject_name": "Surgery", "topic_name": null, "id": "d37d279b-e436-48bd-9a1c-ce5b4759bc0a", "choice_type": "single"} {"question": "A 88 years male patients presented with end stage renal disease with coronary aery block and metastasis in the lungs. Now presents with acute cholecystitis, patients relatives needs treatments to do something", "exp": ".In open cholecystectomy - After the removal of gall bladder, on table cholangiogram is done through cystic duct using water soluble iodine dye to see any stones in CBD. Using stay sutures choledochotomy is done (opened longitudinally) to remove stones in CBD. After choledochotomy, stones are removed using Des jardin's choledocholithotomy forceps. Bake's CBD dilator is used to confirm the CBD patency. - T-tube (Kehr's) is then placed in the CBD and kept for 14 days. - After 14 days a post-operative T-tube cholangiogram is done to see for free flow of dye into the duodenum, so that T-tube can be removed. ref : SRB&;s manual of surgery,3 rd ed,pg no 584", "cop": 2, "opa": "Open cholecystectomy", "opb": "Tube cholecystectomy", "opc": "Laproscopic cholecystectomy", "opd": "Antibiotics then elective cholecystectomy", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "1c6dfd7c-e314-4b32-88ff-c34d9d0b7684", "choice_type": "single"} {"question": "Commonly undergoing malignant transformation is/are", "exp": ".FAMILIAL ADENOMATOUS POLYP (FAP) is inherited as an autosomal dominant neoplastic condition (chromosome no. 5). * It presents in younger age group--15-20 years. * Incidence is equal in both sex, involving commonly the large intestine but can also occur in stomach, duodenum and small intestine. * It is familial with a high potential for malignant transformation. If there is no adenoma at the age of 30 years, then it is not FAP of colon. * It can be associated with duodenal or ampullary carcinomas , Gardner's syndrome (Desmoid tumour in the abdomen, osteomas (75%) and epidermoid cysts) and also Turcot\"s syndrome (FAP + brain tumour (medulloblastoma or gliomas)) or sarcoma of bone. * Usually multiple (over 100). * Presents with lower abdominal pain, loose stools with blood and mucus, weight loss. ref:SRB&;s manual of surgery,ed 3,pg no 838", "cop": 1, "opa": "FAP", "opb": "Crohn's disease", "opc": "Ulcerative colitis", "opd": "Enteric colitis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "bac465c7-ed77-4291-a50a-4a3863f5b9e3", "choice_type": "single"} {"question": "Diagnosis of traumatic rupture of diaphragma) Laparoscopyb) Chest X rayc) Diagnostic peritoneal lavaged) IPPV", "exp": "• Diaphragmatic injuries are often caused by penetrating injuries.\n• Patients sustaining penetrating injuries below the nipples and above the costal margins should be investigated to rule out diaphragmatic injury.\nEtiology\n• Penetrating trauma (knife, bullet, repair of hiatus hernia)\n• Blunt trauma (motor vehicle accident, fall from height, bout of hyperemesis):\n−− Caused by compressive force applied to the pelvis and abdomen.\n−− Rupture is usually large, with herniation of abdominal content into chest\nClinical Features\n• Most diaphragmatic injuries are silent and the presenting features are those of injury to the surrounding organs.\n• Late complication: Herniation of abdominal contents in to the chest.\n• Herniation of organ: Stomach >Colon >Small intestine >Omentum >Spleen >Kidney and pancreas.\nDiagnosis\n• There is no single standard investigation to diagnose diaphragmatic injuries.\n• Chest X-ray after placement of a nasogastric tube may be helpful (as this may show the stomach herniated into the chest)\n• Contrast study of upper or lower GIT, CT scan and diagnostic peritoneal lavage all lack positive or negative predictive value.\n• Most accurate evaluation is by video assisted thracoscopy (VATS) or laparoscopy, offering the advantage of allowing the surgeon to proceed to repair and additional evaluation of the abdominal organs.\nTreatment\n• Operative repair is recommended in all cases.\n• All penetrating diaphragmatic injury must be repaired via the abdomen and not the chest, to rule out penetrating hollow viscus injury.\nBergvist Triad: Rib fracture + Fracture of spine /pelvis + Traumatic rupture of diaphragm", "cop": 1, "opa": "ab", "opb": "a", "opc": "ad", "opd": "bc", "subject_name": "Surgery", "topic_name": null, "id": "aaa72154-8c39-456d-af2d-1b657a0b82b7", "choice_type": "single"} {"question": "Head shaking test is done to diagnose", "exp": null, "cop": 3, "opa": "Maxillary sinusitis", "opb": "Vertigo", "opc": "Position of root in relation to maxillary antrum", "opd": "Maxillary fracture", "subject_name": "Surgery", "topic_name": null, "id": "637b87d4-b853-4f86-b4d9-2804f57ab5ee", "choice_type": "single"} {"question": "May thurner or cockett syndrome involves", "exp": "May-Thurner syndrome -- also called iliocaval compression syndrome and Cockett syndrome or iliac vein compression syndrome -- occurs secondary to compression of the left iliac vein by the overriding right iliac aery.The sustained compression and trauma caused by the pulsatile force of the aery on the vein damage the intima and lead to the formation of membranes or bands in the vascular lumen that hinder or obstruct the flow of blood in the vein, oring thrombus formation. The current treatment strategy of choice is endovascular vein patch angioplasty and stenting with the aim of improving the caliber of the lumen and enabling normal venous drainage", "cop": 4, "opa": "Common iliac aery obstruction", "opb": "Internal iliac aery obstruction", "opc": "Internal iliac vein obstruction", "opd": "Left iliac vein compression", "subject_name": "Surgery", "topic_name": "Urology", "id": "03a26135-2089-42c8-8377-38a1e3defaad", "choice_type": "single"} {"question": "Needle aspiration of a central bone lesion is useful", "exp": null, "cop": 1, "opa": "To rule out a vascular lesion", "opb": "To determine thickness of buccal plate", "opc": "To diagnose traumatic bone cyst", "opd": "To feel root surfaces", "subject_name": "Surgery", "topic_name": null, "id": "61c61cf3-95ac-435e-aa5d-ce41f9f89ffe", "choice_type": "single"} {"question": "A blood stained discharge from the nipple indicates one of the following", "exp": "Discharge can occur from one or more lactiferous ducts.Discharge can be: * clear, serous - fibrocystic disease,duct ectasia,carcinoma. * blood stained - carcinoma,duct papilloma,duct ectasia. * black or green -duct ectasia. Blood stained discharge is seen in duct papilloma. Bailey and Love'sSho practice of surgery.Edition 23.Pg no:753", "cop": 3, "opa": "Breast abscess", "opb": "Fibroadenoma", "opc": "Duct papilloma", "opd": "Fat Necrosis of Breast", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "407d0cc5-030f-4e83-8a55-138a89f79cc4", "choice_type": "single"} {"question": "Most common organism causing peritonitis is", "exp": "Most common cause of Peritonitis is E.coli 2nd most common cause is Klebsiella.", "cop": 2, "opa": "Klebsiella", "opb": "E.coli", "opc": "Staphylococcus aureus", "opd": "Streptococcus", "subject_name": "Surgery", "topic_name": null, "id": "746dc4ec-0e05-45ee-bdc3-260a0ee7f43f", "choice_type": "single"} {"question": "A deviation of mandible to right side may suggest", "exp": null, "cop": 4, "opa": "Fracture of left condyle", "opb": "Hyperplasia of right condyle", "opc": "HypopLasia of left condyle", "opd": "Fracture of right condyle", "subject_name": "Surgery", "topic_name": null, "id": "7f4e9f95-1012-4ab6-8791-f59bdbb16464", "choice_type": "single"} {"question": "A patient Came with Necrotising cellulitis after a hug bite on leg. The ideal initial management is", "exp": "(D) Surgical exploration # Necrotizing fasciitis is a rapidly progressing bacterial infection of the soft tissue that destroys the subcutaneous fat and fascia. In most cases, the deep fascia and the muscle are spared from destruction by the infection, but myonecrosis can occur due to a compartment syndrome.> Many different bacteria can cause destruction of the soft tissue in a \"flesh-eating\" manner.> Proper diagnosis is critical in the treatment of necrotizing fasciitis, and in many cases, it is the major factor between life & death> One major clue that a soft-tissue infection is in fact necrotizing fasciitis is the failure of the infection to respond to antibiotic therapy within 24 to 48 hours.> Plain radiographs showing evidence of gas in the soft tissue is another key indicator, along with elevated muscle compartment pressure.> 5 A positive frozen-section biopsy specimen will also aid in proper diagnosis.> Once the diagnosis of necrotizing fasciitis is made, immediate debridement of necrotic tissue is called for. It is very common for a patient to undergo more than one debridement to make sure all of the necrotic tissue has been removed.> At the same time, aggressive antibiotic therapy with clindamycin should be started.> Wound should be examined daily, and the decision of whether or not to perform further debridement should be made> Amputation of an entire limb is sometimes performed, but this is only done as a life-saving measure.> Surgical debridement of the necrotic tissue is an essential part of the treatment of a necrotizing soft-tissue infection", "cop": 4, "opa": "MRI of leg", "opb": "CT of leg", "opc": "C-reactive protein estimation", "opd": "Surgical exploration", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "c4e6e2c7-80f6-4820-b959-f989fa14ad87", "choice_type": "single"} {"question": "Van Nuys grading is used for", "exp": "Van Nuy's prognostic index score(VNPI) is used for Ductal Carcinoma In Situ. For calculating VNPI score we consider Size in mm, Clearance margin in mm, Grade and necrosis, Age in years and each has score according to a definite criteria. All the scores are added together. 1)If points are 4-6 = % of local recurrence is 1%, 5 year survival is 97-99%, Risk is low 2) if points are 7-9, then % of local recurrence is 20%, 5 year survival is 73-84%, Risk is intermediate 3) if the points are 10-12, then % of local recurrence is 50%, 5 year survival is 34-51%, and Risk is High. Reference : SRB's Manual of Surgery, 6th Edition, page no = 524.", "cop": 2, "opa": "LCIS", "opb": "DCIS", "opc": "Medullary carcinoma breast", "opd": "Inflammatory breast cancer", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "097d80fe-0ee8-4b11-8791-67be51722c4a", "choice_type": "single"} {"question": "The most common nerve involvement is dislocation of Lunate is", "exp": "A i.e. Median nerve", "cop": 1, "opa": "Median nerve", "opb": "Anterior interosseus", "opc": "Posterior interosseus", "opd": "Median nerve", "subject_name": "Surgery", "topic_name": null, "id": "f8fff268-5703-4aed-bf33-0f8441698faa", "choice_type": "single"} {"question": "Nicoladini's Branham sign is seen in", "exp": "Nicoladini's Branham sign is seen in arteriovenous fistula, wherein compression proximal to AV - fistula results in bradycardia.", "cop": 4, "opa": "Aortic dissection", "opb": "Buerger's disease", "opc": "Aneurysm", "opd": "AV - Fistula", "subject_name": "Surgery", "topic_name": null, "id": "afd204cd-959e-43c7-94fd-d2c26f9b74a1", "choice_type": "single"} {"question": "In a patient of syncope the pupils are", "exp": null, "cop": 4, "opa": "Constricted", "opb": "Constricted and non- reacting to light", "opc": "Dilated-fixed and non-reacting to light", "opd": "Dilated and fixed", "subject_name": "Surgery", "topic_name": null, "id": "6ed7f105-71b2-44c1-a298-485afb6b5845", "choice_type": "single"} {"question": "Stage I seminoma testis, t/t of choice is", "exp": "Ans. is 'b' i.e. high inguinal orchidectomy & radiotherapy Testicular Cancer - is mainly of two types - Germ cell tumors (GCT) 95% - Non germinal neoplasms -- 5% (includes leydig cells, seoli cells, gonadoblastoma) Germ cell tumors are of 2 types Seminomas (More common, better prognosis) Nonseminomas i.e. - Embryonal Ca Teratoma Choriocarcinoma Yalk sac (Endodermal sinus) Carcinoma Germ Cell Tumor Staging and Treatment Treatment Stage Extent of Disease Seminoma Nonseminoma IA Testis only, no vascular/ lymphatic invasion (TI) Radiation therapy RPLND or observation IB Testis only, with vascular/ lymphatic invasion (T2), or extension through tunica albuginea (T2), or involvement of spermatic cord (T3) or scrotum (T4) Radiation therapy RPLND HA Nodes <2 cm Radiation therapy RPLND or chemotherapy often followed by RPLND BE Nodes 2-5 cm Radiation therapy RPLND +/- adjuvant chemotherapy or chemotherapy followed by RPLND IIC Nodes >5 cm Chemotherapy Chemotherapy, often followed by RPLND III Distant metastases Chemotherapy Chemotherapy, often followed by surgery (biopsy or resection) RPLND : retroperitoneal lymph node dissection Extra gonadal Germ cell tumors --> Infrequently GCTs arise from an extra gonadal site. They have poor prognosis. They are treated by chemotherapy.", "cop": 2, "opa": "high inguinal orchidectomy", "opb": "high inguinal orchidectomy & radiotherapy", "opc": "radiotherapy and chemotherapy", "opd": "trans-scrotal orchidectomy", "subject_name": "Surgery", "topic_name": null, "id": "73c7c1b4-1696-4636-9a52-9e29221c2289", "choice_type": "single"} {"question": "Trismus during block anesthesia is as a result of", "exp": null, "cop": 2, "opa": "Massive edema", "opb": "Damage to medial pterygoid", "opc": "Damage to lateral pterygoid", "opd": "Damage to inferior alveolar nerve", "subject_name": "Surgery", "topic_name": null, "id": "41fbf0b7-ba70-4de3-bc7a-e5adf857cff3", "choice_type": "single"} {"question": "The narrowest part of the ureter is at the", "exp": null, "cop": 4, "opa": "Uretero-pelvic junction", "opb": "Iliac vessel crossing", "opc": "Pelvic ureter", "opd": "Uretero-vesical junction", "subject_name": "Surgery", "topic_name": null, "id": "a63d1af4-3bad-4ddf-a8d1-fc263f636915", "choice_type": "single"} {"question": "Malignant ulcer is differentiated from benign by", "exp": null, "cop": 1, "opa": "Heaping up of margins", "opb": "Fibrous scars radiating from crater", "opc": "Induration of base", "opd": "clean base", "subject_name": "Surgery", "topic_name": null, "id": "df6a9cab-7da4-4487-87be-e8a95f3997ce", "choice_type": "single"} {"question": "Most common site of peripheral aneurysm", "exp": ". Among peripheral aneurysm popliteal type is the most common one.peripheral aneurysms occurs in descending order of frrequency in popliteal,femoral,subclan,axillary,and carotid aeries. Refer page no 201 of SRB's manual of surgery 5th edition.", "cop": 3, "opa": "Femoral aery", "opb": "Radial aery", "opc": "popliteal aery", "opd": "Brachial aery", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "9f0805db-bca6-4e27-a45a-5666cb93d207", "choice_type": "single"} {"question": "Flap that is most commonly used in breast reconstruction", "exp": "Ans. (b) TRAM(Ref: Bailey and Love 26th edition Page 817)* TRAM flap based on Superior Epigastric vessels is the MC used flap for breast reconstruction", "cop": 2, "opa": "Serratus anterior", "opb": "TRAM", "opc": "Flap from arm", "opd": "Delto-pectoral flap", "subject_name": "Surgery", "topic_name": "Breast", "id": "3ac0df0e-d21d-4798-b164-7797618aa984", "choice_type": "single"} {"question": "Used in head injury", "exp": "(C) Hypertonic saline # Initial management of HEAD INJURY:> Unconscious patients should be intubated and ventilated to maintain Po2 over 13.5 kPa and PCO2at 4.5-5.0 kPa.> Systemic blood pressure must be maintained normal or above normal to allow for good neurological outcome, initially by fluid resuscitation.> Glucose-containing solutions should be avoided.> Blood loss from other injuries should be replaced by blood products as usually.> Hypertonic saline solution (7.5%) may improve outcome in patients with multiple trauma because of its effect on ICP.> Extracranial injuries that threaten life should be treated before definitive neurosurgical treatment, but otherwise simply stabilized beforehand.", "cop": 3, "opa": "0.9% Normal saline", "opb": "0.45% normal saline", "opc": "Hypertonic saline", "opd": "5% dextrose saline", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "48b15c78-8122-40bd-8f5c-c45c197ea3a8", "choice_type": "single"} {"question": "The microscopic feature that differentiates a follicular carcinoma from a follicular adenoma is", "exp": "Follicular carcinoma can normally only be differentiated from follicular adenoma by the architecture of histology.Histologic diagnosis of FTC depends on the demonstration of follicular cells occupying abnormal positions, including capsular or vascular invasion. The cells may not demonstrate nuclear atypia; however, when present, marked nuclear atypia is associated with a worse prognosis.Ref: Sabiston 20e, page no: 927", "cop": 3, "opa": "Nuclear pleomorphism", "opb": "Huhle cell change", "opc": "Capsular invasion", "opd": "Absence of colloid", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "1418572d-95e9-4793-aeed-3393b5ba23ac", "choice_type": "single"} {"question": "Inverted \"3\" sign seen in", "exp": null, "cop": 3, "opa": "Ampullary Ca", "opb": "Insulinoma", "opc": "Ca. head pancreas", "opd": "Ca. stomach", "subject_name": "Surgery", "topic_name": null, "id": "9ea4ae20-f791-4adc-bcd6-5cf5fad86189", "choice_type": "single"} {"question": "Ablett classification is used for grading", "exp": "Ablett classification grades severity of tetanus.", "cop": 2, "opa": "Hidradenitis suppurativa", "opb": "Tetanus", "opc": "Pyogenic abscess", "opd": "Pyogenic granuloma", "subject_name": "Surgery", "topic_name": null, "id": "6a843619-0dba-4381-8e97-c5dd59ed8b2e", "choice_type": "single"} {"question": "Sialolithiasis is most commonly seen in", "exp": null, "cop": 1, "opa": "Submandibular", "opb": "Parotid", "opc": "Sublingual", "opd": "Minor salivary gland", "subject_name": "Surgery", "topic_name": null, "id": "09307d16-9e4d-4604-9e2d-e8db9bd1331c", "choice_type": "single"} {"question": "Acinic cell tumor is tumor of", "exp": "Ans. a (Parotid tumor). (Ref. LB, 25th/pg. 756)Salivary gland tumor TypeSubgroup1AdenomaPleomorphic (80-90%), Warthin's tumor, Adenolymphoma2CarcinomaAcinic cell carcinoma (LG-low grade), Adenoid cystic carcinoma (LG),Mucoepidermoid (LG and HG), Adenocarcinoma (HG), Squamous cell carcinoma (HG)3Non epithelial tumorsHemangioma, Lymphangioma4LymphomaPrimary, Secondary5SecondariesLocal, Distant (skin and bronchus)6Tumor like lesionsAdenomatoid hyperplasia, Benign lymphoepithelial lesion, Salivary gland cysts", "cop": 1, "opa": "Parotid gland", "opb": "Breast", "opc": "Parathyroid", "opd": "Thyroid", "subject_name": "Surgery", "topic_name": "Salivary Gland", "id": "936ba537-1358-4cff-ba5a-0a3acff43ddc", "choice_type": "single"} {"question": "REPEAT QUESTION. Renal Calculi associated with proteus infection", "exp": "Triple phosphate or struvite ( Calcium phosphate with ammonium magnesium phosphate ) is smooth and diy white. It grows in alkaline urine. Proteus being urea splitting organism splits urea to give ammonia and co2 whixh makes urine alkaline and promotes stag horn calculus ref : - Bailey and Love 27th edition ,chapter 76 , pg no 1406", "cop": 1, "opa": "Triple phosphate", "opb": "Uric Acid", "opc": "Calcium Oxalate", "opd": "Cysteine Stones.", "subject_name": "Surgery", "topic_name": "Urology", "id": "b5139f9d-4c7e-42b5-be1d-e8a42894238b", "choice_type": "single"} {"question": "Following is an upper GI contrast study. Probable diagnosis is", "exp": "Single contrast study from the same patient showing the apple core appearance of the stomach due to the invasive gastric adenocarcinoma.Upper gastrointestinal radiology is not used as much as in previous years, as endoscopy is a more sensitive investigation for most gastric problems.Endoscopy is regarded as the most sensitive and specific diagnostic method in patients suspected of harbouring gastric cancer. Endoscopy allows direct visualisation of tumour location, the extent of mucosal involvement, and biopsy (or cytologic brushings) for tissue diagnosisBailey and love 27e 1111", "cop": 2, "opa": "Gastric ulcer", "opb": "Gastric carcinoma", "opc": "Duodenal ulcer", "opd": "Duodenal perforation", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "ee741712-ae5d-4470-adb0-19085f2c0d46", "choice_type": "single"} {"question": "Bilateral spider leg appearance of kidney in IVP is seen in", "exp": null, "cop": 2, "opa": "Hydronephrosis", "opb": "Polycystic kidney", "opc": "Medullary sponge kidney", "opd": "Renal cell carcinoma", "subject_name": "Surgery", "topic_name": null, "id": "545fb418-09a2-49ef-ad4f-50b951964471", "choice_type": "single"} {"question": "Degloving injury is overlsion injury involving", "exp": "Degloving injury is avulsion injury involving skin and subcutaneous tissuewith intact fascia.", "cop": 3, "opa": "Skin only", "opb": "Skin and subcutaneous tissue, with intact fascia", "opc": "Skin and subcutaneous tissue along with fascia", "opd": "Skin, subcutaneous tissue and muscle", "subject_name": "Surgery", "topic_name": null, "id": "af470992-4105-4c8a-bc3c-0e4713f005f8", "choice_type": "single"} {"question": "Commonest site of peptic ulcer is", "exp": "Common sites for peptic ulcers are the first pa of the duodenum and the lesser curve of the stomach, but they also occur on the stoma following gastric surgery, the oesophagus and even in a Meckel's diveiculum, which contains ectopic gastric epithelium.Bailey and love pg: 1116", "cop": 1, "opa": "1st pa of duodenum", "opb": "2nd pa of duodenum", "opc": "Distal 1/3rd of stomach", "opd": "Pylorus of the stomach", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "943a58a0-78cc-4eeb-8f12-25978875382b", "choice_type": "single"} {"question": "Cleft lip repair minimum age to repair", "exp": "Ans. (a) 6 monthsRef: Bailey and Love 26th edition. Page 638Timing of surgery of each type of Cleft is given by Delaire sequence:* Unilateral cleft lip alone - One operation at 5-6 months* Bilateral cleft lip - One operation at 4-5 months* Soft palate only - One operation at 6 months* Soft and Hard Palate Only - as Two operations (Soft palate at 6 months and Hard palate at 15-18 months)* Combined Cleft lip and Palate (Unilateral or Bilateral): Two operations (Cleft lip and Soft palate at 5-6 months. Hard Palate at 15-18 months)", "cop": 1, "opa": "6 months", "opb": "12 months", "opc": "2 years", "opd": "5 years", "subject_name": "Surgery", "topic_name": "Cleft Lip & Palate", "id": "890e6715-85ff-4ec9-8293-6bac11b71397", "choice_type": "single"} {"question": "Duputryens contracture is associated with", "exp": "Duputryens contracture - Plamar fibromatosis is seen in Peyronie's disease.", "cop": 1, "opa": "Peyranies diaease", "opb": "Hypospadias", "opc": "Epispadias", "opd": "Exotropy", "subject_name": "Surgery", "topic_name": null, "id": "3aa41c60-a015-4b6d-ab98-eda2843c1e91", "choice_type": "single"} {"question": "For Thyroglossal Cyst Most Common site is", "exp": "Although Thyroglossal Duct cysts may occur anywhere from the Base of the tongue to the thyroid gland , most are found at or just below the hyoid bone. Source : Sabiston 20th edition Pg : 1862", "cop": 2, "opa": "Suprahyoid", "opb": "Subhyoid", "opc": "Foreman caecum", "opd": "At Thyroid Isthmus", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "6373e0aa-3a6b-4027-a3af-e499472a4080", "choice_type": "single"} {"question": "Type of renal stone formed in a patient with regional enteritis", "exp": "Ans. (a) Calcium oxalate* Calcium oxalate kidney stones are most common in CD.* Cholesterol type gallstones are also most common in CD.", "cop": 1, "opa": "Calcium oxalate", "opb": "Cysteine", "opc": "Struvite", "opd": "Urate", "subject_name": "Surgery", "topic_name": "Small & Large Intestine", "id": "1b8e6e22-e7a9-43cd-96fe-42a4a01b96d1", "choice_type": "single"} {"question": "Prepyloric or channel ulcer in the stomach is termed as", "exp": "Type 1- in the antrum, near the lesser curvature, type 2: combined gastric ulcer (in the body ) with duodenal ulcer, type 3. Prepyloric, type 4 gastric ulcer in the proximal stomach of the cardia type 5- ulcer anywhere associated with NSAIDs. SRB edition 5 page no. 824", "cop": 3, "opa": "type 1", "opb": "type 2", "opc": "type 3", "opd": "type 4", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "d1032713-6430-41f5-a4eb-763fc7bc756f", "choice_type": "single"} {"question": "Most common site of carcinoma of stomach is", "exp": "60 %of all malignancies occurring in the oesophagus and stomach occur in proximity to the oesophagogastric junction. Because the lower oesophagus is a very common site for adenocarcinoma it is aificial to separate stomach from oesophagus. Bailey and love 26 th ed pg 1046", "cop": 1, "opa": "Proximal stomach", "opb": "Distal stomach", "opc": "Lesser curvature", "opd": "Greater curvature", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "62b8a2e8-7f77-4bce-98d3-5fe0b8894637", "choice_type": "single"} {"question": "Management of grade 3 splenic trauma in a stale child", "exp": "Splenic organ injury scale Grade I- Nonexpanding subcapsular haematoma <10% surface area. Non-bleeding capsular laceration with <1 cm depth Grade II- Nonexpanding subcapsular haematoma 10-50% surface area. Nonexpanding intraparenchymal haematoma <2 cm Grade III- Expanding subcapsular or intraparenchymal haematoma. Bleeding subcapsular haematoma or subcapsular haematoma > 50% area or intraparenchymal haematoma >2 cm or parenchymal laceration >3 cm depth Grade IV- Ruptured intraparenchymal haematoma with active bleed; laceration involving segmental or hilar vessels with > 25% devascularisation Grade V- Shattered or avulsed spleen; hilar disconnection with entire spleen devascularisation. Clinically close observation, serial haematocrit evaluation, serial CT abdomen/U/S abdomen at regular intervals to assess the progress or regress of the bleeding spleen has to be done. * Absolute bed rest, sedation, antibiotic coverage and proper monitoring are needed. * It is often suppoed by angiographic embolisation to improve the splenic salvage rate. But it may cause pain, splenic abscess or infarction. * Indications for non-operative treatment - Only splenic injury - no other associated injuries.grade 1,2, and 3. Ref: SRB&;s manual of surgery,3 rd ed, pg no;603", "cop": 1, "opa": "Embolization", "opb": "Paial splenoctomy", "opc": "Total splenoctomy", "opd": "Conservative", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "80b7b022-0598-42fe-b81c-00a360f9687e", "choice_type": "single"} {"question": "Delorme's operation is for", "exp": "Ans. B. Rectal prolapse. (Ref. LB 25th pg. 1225)RECTALPROPLASE# It may be mucosal or full thickness (whole wall included).# Commences as rectal intussusception.# In children, the prolapse is usually mucosal an should be Rxed conservatively.# In the adults, the prolapse is often full thickness and is frequently asociated with incontinence.# Surgery is necessary for full-thickness reactla prolpase.# The operation is performed either via perineum (Thiersch operation, Delorme's operation, &/or Altemeier operation) or via the abdomen (Well's operation, Ripstein's operation, or laparosocpic approach).Rx of RECTAL PROPLASE:# An abdominal rectopexy has a lower rate of recurrence but, when the patient is elderly and very frail, a perineal operation is indicated. As an abdominal procedure risks damage to the pelvic autonomic nerves, resulting in possible sexual dysfunction, a perineal approach is also usually preferred in young men.A. Perineal approach -These procedures have been used most commonly.# Thiersch operation- This procedure, which aimed to place a steel wire or, more commonly, a silastic or nylon suture around the anal canal, has become obsolete as the suture would often break or cause chronic perineal sepsis, or both, or the anal stenosis so created would produce severe functional problems. Delorme's operation is now the preferred perineal operation.# Delorme's operation- In this procedure, the rectal mucosa is removed circumferentially from the prolapsed rectum over its length. The underlying muscle is then plicated with a series of sutures, such that, when these are tied, the rectal muscle is concertinaed towards the anal canal. The anal canal mucosa is then sutured circumferentially to the rectal mucosa remaining at the tip of the prolapse. The prolapse is reduced, and a ring of muscle is created above the anal canal, which prevents recurrence.# Altemeier's procedure- This consists of excision of the prolapsed rectum and associated sigmoid colon from below, and construction of a coloanal anastomosis.B. Abdominal approach# The principle of all abdominal operations for rectal prolapse is to replace and hold the rectum in its proper position. They are recommended in patients with complete prolapse who are otherwise in good health.# Many variations have been described: in Wells' operation, the rectum is fixed firmly to the sacrum by inserting a sheet of polypropylene mesh between them; Ripstein's operation involves hitching up the rectosigmoid junction by a Teflon sling to the front of the sacrum; many surgeons simply suture the mobilised rectum to the sacrum using four to six interrupted non-absorbable sutures - so called sutured rectopexy. Recently, the technique has been performed laparoscopically.", "cop": 2, "opa": "Solitary rectal ulcer", "opb": "Rectal prolapse", "opc": "Rectal stricture", "opd": "Rectal carcinoma", "subject_name": "Surgery", "topic_name": "Rectum", "id": "e2994055-53ec-4b2e-b14b-ed9faa704209", "choice_type": "single"} {"question": "Indication of surgery in benign hyperplasia of prostate is", "exp": "Indications for surgery in BPH are: * Prostatism *Acute retentionof urine *Chronic retention of urine with residual urine > 200ml*Complications like hydroureter, hydronephrosis, stone formation, recurrent infections, bladder changes.*HematuriaReference : page 1045 SRB's manual of surgery 5th edition", "cop": 1, "opa": "Post void urine volume is 200 ml", "opb": "Weakened urinary stream", "opc": "Dysuria", "opd": "Residual urine < 100 ml", "subject_name": "Surgery", "topic_name": "Urology", "id": "8c8d5c61-51e1-4779-83b1-24f1ef90cace", "choice_type": "single"} {"question": "Following nutritional consequences are possible following peptic ulcer surgeries other than vagotomy", "exp": ".COMPLICATIONS OF GASTRIC SURGERY * Haemorrhage. * Stomal obstruction. * Biliary fistula. * Injury to CBD. * Duodenal blow out--on 4th postoperative day. * Pancreatitis.* Recurrent ulcer stomal ulcer. * Gastrojejunocolic fistula. * Dumping syndrome (Postcibal syndrome). * Nutritional disturbances, diarrhoea. * Pulmonary tuberculosis. * Carcinoma in gastric remnant (after 10-15 years). * Gallstone formation. * Alkaline gastritis. * Afferent and efferent loop syndrome. * Afferent loop obstruction--common. * Efferent loop obstruction. Nutritional deficiencies following gastrectomy Iron deficiency anaemia 40% * Megaloblastic anaemia (after 5 years) 25% (100mg B12 is given IM weekly, later monthly) *Vit. B deficiency 10% *Calcium deficiency 40% *Calcium deficiency with bone changes (after 5 years) 5% ref:SRB&;s manual of surgery,ed 3,pg no 770", "cop": 4, "opa": "Iron deficiency", "opb": "Weight loss", "opc": "Vitamin B12 deficiency", "opd": "Folic acid deficiency", "subject_name": "Surgery", "topic_name": "Urology", "id": "ca9c6246-8b3e-4ee4-94cc-38672c9ab5c1", "choice_type": "single"} {"question": "Benign prostatic hyperplasia first develops in the", "exp": "Benign prostatic hyperplasia arises from submucosal glands of periurethral transitional zone with stromal proliferation and adenosis forming a nodular enlargement. It eventually compresses the peripheral zone glands into a false capsule and causes the appearance of typical 'lateral' lobes. Reference : page1345 Bailey and Love's sho practice of surgery 25th edition", "cop": 1, "opa": "Periurethral transition zone", "opb": "Peripheral zone", "opc": "Central zone", "opd": "Anterior fibromuscular stroma", "subject_name": "Surgery", "topic_name": "Urology", "id": "ea2d0a08-5f7f-479b-9138-ea6f2db14a7c", "choice_type": "single"} {"question": "If during blood transfusion reaction develops in the form of incompatibility, the first thing to be done is", "exp": null, "cop": 1, "opa": "Stop the transfusion", "opb": "Inj Hydrocortisone to be given", "opc": "Inj Chlorpheneramine maleate to be given", "opd": "Inj Frusemide to be given", "subject_name": "Surgery", "topic_name": null, "id": "2376676b-4585-44fe-b5e3-31b38eedd1f9", "choice_type": "single"} {"question": "Peutz Jeghers polyps present most commonly in", "exp": ".PEUTZ-JEGHER'S POLYP is common in small intestine (jejunum) but can also occur in large intestine. * Features are multiple, familial, hamaomatous intestinal polyps. * Asssociated with melaenosis of the oral mucosa, lips (lower lip) and occasionally digits (not in tongue). * Microscopically it contains tree like branching filaments of mucosa with smooth muscle wall. * It can occasionally turn into malignancy ref:SRB&;s manual of surgery,ed 3,pg no 831", "cop": 4, "opa": "Rectum", "opb": "Colon", "opc": "Esophagus", "opd": "Jejunum", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "804920d6-fe8f-4877-b2ad-3c742ac2f536", "choice_type": "single"} {"question": "Giacomini vein is", "exp": "Giacomini vein is posterior thigh extension of short saphenous vein.", "cop": 3, "opa": "Posterior thigh extension of GSV", "opb": "Anterior thigh extension of SSV", "opc": "Posterior thigh extension of SSV", "opd": "Anterior thigh extension of GSV", "subject_name": "Surgery", "topic_name": null, "id": "5b7cc937-65c2-4323-b8a3-88eefe359198", "choice_type": "single"} {"question": "Mirrizi syndrome", "exp": "Answer- B. Stone in cystic duct compressing CBDIt comprises obstructive jaundice due to stone impacted in the neck of gall bladder, which compresses the common hepatic duct and eventually ulcerates into common hepatic duct causing cholecysto-choledochal fistula", "cop": 2, "opa": "Cyst present in CBD", "opb": "Stone in cystic duct compressing CBD", "opc": "Obstruction of pancreatic duct", "opd": "Stone in Rt hepatic duct", "subject_name": "Surgery", "topic_name": null, "id": "bbfa09c1-f282-4745-b20e-cefa095dca4a", "choice_type": "single"} {"question": "Treatment of congenital hydrocele is", "exp": "Congenital hydrocele is due to patent processus vaginalis. \nHerniotomy is the option. Infantile hydrocele is treated by excision of sac followed by eversion.", "cop": 1, "opa": "Herniotomy", "opb": "Excision of sac", "opc": "Eversion of sac", "opd": "Jaboilays procedure", "subject_name": "Surgery", "topic_name": null, "id": "0d934b36-56ef-4a14-904d-8c11d727735d", "choice_type": "single"} {"question": "Expansile lytic osseous metastases are characteristic of primary malignancy of", "exp": "Ans. is 'a' i.e. Kidney", "cop": 1, "opa": "Kidney", "opb": "Bronchus", "opc": "Breast", "opd": "Prostate", "subject_name": "Surgery", "topic_name": null, "id": "bef9f83c-6c1d-4ebb-92e1-e42738c22c5f", "choice_type": "single"} {"question": "Best prognosis in carcinoma of pancreas in the region of", "exp": "Periampullary carcinoma AAdenocarcinoma of head of the pancreas (40-60%) Adenocarcinoma of ampulla of vater (10-20%) Distal Bile duct adenocarcinoma (10%) Duodenal adenocarcinoma (5-10%) Patients with pancreas adenocarcinoma involving the body or tail of the gland are more likely to have weight loss and abdominal pain as their initial complaints These lesions can grow to a larger size before producing symptoms and are often diagnosed at a later stage with a poorer prognosis Most body and tail cancers have already metastasized to distant sites or extended locally to involve nodes, nerves, or major vessels by the time of diagnosis. Best prognosis : Duodenal adenocarcinoma > Ampullary carcinoma > Distal Bile duct adenocarcinoma > Head of pancreas > Body and tail of pancreas Ref: Shackelford 7th edition Pgno : 1187-1206", "cop": 4, "opa": "Head", "opb": "Tail", "opc": "Body", "opd": "Periampullary", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "dda76b05-6e91-4849-b277-07a1d9970c4a", "choice_type": "single"} {"question": "A young man gets into a fight after taking bear and is kicked in the lower abdomen. There was pelvic fracture, blood at meatus. Most likely cause is", "exp": "Ans. is 'a' i.e., Rupture of membranous urethra", "cop": 1, "opa": "Rupture of membranous urethra", "opb": "Bulbar urethral injury", "opc": "Bladder rupture", "opd": "Kidney laceration", "subject_name": "Surgery", "topic_name": null, "id": "c32360d8-d2d5-4c55-bd0a-5c2a1e349325", "choice_type": "single"} {"question": "Clostridial organism are", "exp": "The genus Clostridium consists of Gram-positive, anaerobic and spore forming bacilli.Eg: C.tetani, C.perfringens, C.difficile,C.botulinum etc. These are responsible for tetanus, gas gangrene and food poisoning. Reference : page 251 Ananthanarayan and Panicker's Textbook of Microbiology 9th edition.", "cop": 2, "opa": "Gram-positive aerobes", "opb": "Gram-positive anaerobes", "opc": "Gram-positive aerobes", "opd": "Gram-negative anaerobes", "subject_name": "Surgery", "topic_name": "Urology", "id": "1475347e-2b5d-4428-ab38-4ddfaccb867e", "choice_type": "single"} {"question": "Most of the incidentalomas are", "exp": "An incidentaloma is an adrenal mass, detected incidentally by imaging studies conducted for other reasons, not known previously to have been present or causing symptomsMore than 75% are non-functioning adenomas but Cushing's adenomas, phaeochromocytomas, metastases, adrenocoical carcinomas and Conn's tumours can all be found this wayRef: Bailey and Love 27e pg: 839", "cop": 1, "opa": "Non-functioning adenoma", "opb": "Adrenocoical carcinoma", "opc": "Adrenal metastasis", "opd": "Pheochromocytoma", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "f0ce84f0-861b-4149-85e6-7e517a5cafd6", "choice_type": "single"} {"question": "Incidence of absent of kidney is", "exp": "(1500) (1305-LB) (1286-B & L 25th)* An absent or grossly atrophic kidney is found in about 1:1400 individuals (1305-LB)* Renal ectopia - In approximately 1:1000 people, the kidney does not ascend, ectopic kidneys are usually found near the pelvic brim (1306-LB)", "cop": 2, "opa": "300", "opb": "1500", "opc": "3000", "opd": "5000", "subject_name": "Surgery", "topic_name": "Kidney & Ureturs", "id": "327dff34-716a-478e-afa3-6af8e8f134d2", "choice_type": "single"} {"question": "In a shock patient, good clinical indicator of perfusion status among the following is", "exp": "Urine output is a good measure of organ perfusion and the best monitor of the adequacy of shock therapy. However, this is an hourly measure and does not give a minute-to-minute view of the shocked state. The level of consciousness is an impoant marker of cerebral perfusion, but brain perfusion is maintained until the very late stages of shock, and hence is a poor marker of adequacy of resuscitation.Currently, the only clinical indicators of perfusion of the gastrointestinal tract and muscular beds are the global measures of lactic acidosis (lactate and base deficit) and the mixed venous oxygen saturation. There is no 'normal' central venous pressure (CVP) for a shocked patient, and reliance cannot be placed on an individual pressure measurement to assess volume status. Some patients may require a CVP of 5 cmH2O, whereas some may require a CVP of 15 cmH2O or higher.Bailey and love 27e pg: 16", "cop": 3, "opa": "Urine output", "opb": "Level of consciousness", "opc": "Mixed venous oxygen saturation", "opd": "Central venous pressure", "subject_name": "Surgery", "topic_name": "General surgery", "id": "f4031713-db14-4e56-9987-4ba69593bd6b", "choice_type": "single"} {"question": "Dacron Graft", "exp": "Vascular graft Bioprosthetic Autograft Homograft (Allograft) Heterograft (Xenograft) Tissue engineered Synthetic Textile - Dacron Non-textile - ePTFE, polyurethane Dacron graft Woven Threads are interlaced in a simple over and under pattern both in lengthwise & circumferential directions Less porous, used where bleeding is a risk (thoracic Aoic aneurysmal surgery) Stiff & diffucult to handle, display more fraying of cut edges Knitted Yarns are looped around each other Yarn is oriented Predominantly in longitudinal or circumferential direction More stable, can be easily incised & resutured More porous than woven grafts, require preclotting prior to use Ref: Sabiston 20th edition Pgno :234", "cop": 2, "opa": "Nontextile synthetic", "opb": "Textile synthetic", "opc": "Nontextile biologic", "opd": "Textile biologic", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "0dd66f90-67d0-4cfd-ba2d-2f86753a4d9b", "choice_type": "single"} {"question": "The thickness of split thickness skin graft used in maxitlofacial surgery ranges from", "exp": null, "cop": 3, "opa": "2 to 3 mm", "opb": "1 to 2 mm", "opc": "0.3 to 0.5 mm", "opd": "1.3 to 1.5 mm", "subject_name": "Surgery", "topic_name": null, "id": "f1ace64d-d9e4-417b-b352-de9497fbdfa4", "choice_type": "single"} {"question": "Investigation of choice in DVT is", "exp": "
Deep vein thrombosis Also known as phlebothrombosis. It is a semisolid clot in the vein which has got high tendency to develop pulmonary embolism and sudden death. Common site of beginning is soleal veins . Investigation:- 1. Venous doppler- investigation of choice 2. Duplex scanning- it shows non compressible vein which is wider than normal. 3. Venogram- 4. Radioactive iodine fibrinogen study 5. Haemogram with platelet count 6. Ventilation Treatment:- 1. Rest, elevation of limb and bandaging the entire limb with crepe bandage. 2. Anticoagulants- heparin, low molecular weight heparin, warfarin. 3. Low molecular weight heparin is preferred to heparin. 4. Initially high doses of heparin of 25,000 units/ day for 7 days is given. 5. Warfarin should be staed as early as possible on the same day as heparin. 6. Oral anticoagulants being teratogenic cannot be used during pregnancy. {Reference: SRB&;s manual of surgery, 5th edition , page no. 225}", "cop": 2, "opa": "Venogram", "opb": "Color doppler", "opc": "Plethysmography", "opd": "X-ray", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "594e194b-22af-4dd0-978a-14cc073fe118", "choice_type": "single"} {"question": "\"Chocolate sauce' colour fluid seen in", "exp": "A. i.e. (Amoebic liver abscess) (885 - S. Das 5th) (49 -B & L 25th)\"Chocolate sauce or anchovy sauce\" colour of pus- seen in Amoebic liver disease* Amoebic abscess are most common high in the diaphragmatic surface of the right lobe, solitary* It may burst into (a) right pleural cavity (b) right lung (c) peritoneal cavity* First symptoms are usually malaise and fatigue* USG or CT scans are the most useful diagnostic tests* Treatment mainly drug therapy* Surgical treatment Multiple loculated collection or when abscess cavity contains a large amount of necrotic debries* Amoeboma - most commonly seen in caecum*** CT scan is the best imaging modality in Hydatid disease - the diagnostic feature is a space - occupying lesion with a smooth out line with septa* Auxiliary orthotopic liver transplant is indicated for Acute fulminant liver failure for any cause*** Pingle maneuver is a means to stop bleeding from - Liver and cystic artery", "cop": 1, "opa": "Amoebic liver abscess", "opb": "Hydatid liver disease", "opc": "Hepatoma", "opd": "Infective hepatitis", "subject_name": "Surgery", "topic_name": "Liver", "id": "9aa675ec-a8b2-49fe-9773-081505e9c36c", "choice_type": "single"} {"question": "Golden hour is", "exp": "The concept of the ‘golden hour’ describes the urgent need for treatment of trauma victims within the first hour after injury.", "cop": 2, "opa": "Within first half hour after trauma", "opb": "Within one hour after trauma", "opc": "Within one and half hours after trauma", "opd": "Within two hours after trauma", "subject_name": "Surgery", "topic_name": null, "id": "16f4dd0d-4288-49bc-a8d7-00821c60ccbc", "choice_type": "single"} {"question": "Treatment of choice for stone in Submandibular duct compressing distal to Lingual nerve is", "exp": "Distal Stones are removed by intraoral method.\nProximal stones are removed by submandibular excision.", "cop": 3, "opa": "Submandibular excision", "opb": "Antibiotics", "opc": "Intraoral removal", "opd": "Observe", "subject_name": "Surgery", "topic_name": null, "id": "a38655f1-26e2-4542-89ee-54788db6872d", "choice_type": "single"} {"question": "First line of treatment for keloid is", "exp": "First line of management for keloid is intra keloidal injection of Triam cinolone acetate.", "cop": 1, "opa": "Intralesional injection of steroid", "opb": "Local steroid", "opc": "Wide excision", "opd": "Radiotherapy", "subject_name": "Surgery", "topic_name": null, "id": "9cce27c5-6e60-46c9-9feb-6fa9b837e09a", "choice_type": "single"} {"question": "Constricting type of colonic carcinoma is seen in", "exp": "Ans. a (Left colon). (Ref. Bailey and Love, 25,h/pg. 1179)Carcinoma ColonSiteClinical presentationCarcinoma of the left side of the colon- Most tumours occur in this location. They are usually of the stenosing variety. Left-sided tumours: rectal bleeding, alteration in bowel habit, tenesmus, obstruction.- The main symptoms are those of increasing intestinal obstruction.- Alteration of bowel habit. An adult previously having a predictably regula bowel habit suddenly develops irregularity.- The episodes of constipation may be followed by attacks of diarrhoea.- Distension. Lower abdominal distension is not uncommon and, as with the pain, is relieved by passing flatus.Carcinoma of the sigmoid- This follows the general pattern of the above, with these differences:- Pain is usually colicky from the outset.- Tenesmus. Low tumours may give rise to a feeling of the need for evacuation, which may result in tenesmus accompanied by the passage of mucus and blood, especially in the early morning.- Bladder symptoms are not unusual and in some instances may herald a colovesical fistula.Right-sided tumours- iron deficiency anaemia, abdominal mass are presenting features.Carcinoma of the transverse colon- This may be mistaken for a carcinoma of the stomach because of the position of the tumour together with anaemia and lassitude.Carcinoma of the caecum and ascending colon* Anaemia, severe and unyielding to treatment; there may be a palpable tumour present.* The presence of a mass in the right iliac fossa. Colonoscopy may be needed to confirm the diagnosis.* Caecal carcinoma is sometimes discovered unexpectedly at operation for acute appendicitis or for an appendix abscess failing to resolve. On rare occasions the appendix is inflamed, or even gangrenous, from the obstruction to its lumen by the tumour.* A carcinoma of the caecum can be the apex of an intussusception presenting with the symptoms of intermittent obstruction.", "cop": 1, "opa": "Left colon", "opb": "Right colon", "opc": "Transverse colon", "opd": "Caecum", "subject_name": "Surgery", "topic_name": "Small & Large Intestine", "id": "135fae1e-01e8-44f9-8ef1-351c38bd7d94", "choice_type": "single"} {"question": "A traumatic wound was cleaned and dressed. A few days later suturing was done to approximate the edges. This type of wound healing is", "exp": "Primary intention healing happens when wound edges are approximated by sutures, staples..etc The delayed primary intention is when this approximation is delayed, as it might be necessary for contaminated or untidy wounds. Also called teiary intention.Secondary intention occurs in wounds that are left open and allowed to heal by granulation, contraction and epithelialisationBailey and love 27e pg:26", "cop": 4, "opa": "Primary intention", "opb": "Secondary intention", "opc": "Delayed secondary intention", "opd": "Teiary intention", "subject_name": "Surgery", "topic_name": "General surgery", "id": "d0a6ab63-f520-41d4-937b-848bcfbc34c5", "choice_type": "single"} {"question": "Treatment of choice in cold nodule of thyroid", "exp": null, "cop": 3, "opa": "Sub-total thyroidectomy", "opb": "I-131", "opc": "Hemithyroidectomy", "opd": "Excision of nodule", "subject_name": "Surgery", "topic_name": null, "id": "23aa5a2c-9f94-4a64-be65-07b8c6628baf", "choice_type": "single"} {"question": "Bone apposition is best in", "exp": "D i.e. Osteoblastic activiting in hocoship's lacunae * Since bone itself is a hard and unyielding structure, it can only increase in size by the relatively slow process of appositional growth.* The concept that bone remodelling takes place in small coherent packets of resorption (Howships lacuna in trabecular bone or cutting cone in coical bone) followed by formation is very impoant* In adult skeleton after cessation of skeleton growth, no new lamellar bone formation occurs with out a preceding episod of bone resorption. This constraint applies with in the coex, where the physical lack of space for new bone necessitates preceding resorption, and it also seems to apply to periosteal and endosteal sutfaces(2 * There is, however, debate as to whether periosteal accretion can occur in adults without preceding bone resorption. There are two definte, pathological exceptions to this rule. One is- during the production of callus in a healing fractured where woven bone will form de novo.- after cancllous autograft, where new bone will form directly on to the cancellous graft.* However, the contribution of these circumstances to overall bone homeostasis is likely to be very small.* The total body rate of resorption (is the product of) = number of new cavities eroded in a defined time period Xaverage volume of each cavity. Since the amount of bone eroded in each resorption cavity is constant (roughly), the rate of activation (i.e. rate at which new osteoclastic erosion cavities are begun) determines the total body bone resorption, as well as the rate of total body bone resorption, as well as the rate of total body bone formation.", "cop": 4, "opa": "Osteoblastic activity at the area of stress", "opb": "Endochondral ossification", "opc": "Subperiosteal cambian layer", "opd": "Osteoblastic activity in howship's lacunae", "subject_name": "Surgery", "topic_name": null, "id": "7ff9b6cd-b5a4-42fb-8f05-335fbf5117e0", "choice_type": "single"} {"question": "The most common site of enlargement of the lymph nodes in Hodgkin's lymphoma is", "exp": "In about 50% of patients who have both Hodgkin's and non-Hodgkin's lymphoma, the mediastinum may be the primary site.\" Ref : Schwaz 9/e p575", "cop": 3, "opa": "Cervical", "opb": "Axillary", "opc": "Mediastinal", "opd": "Abdominal", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "e3c8ba80-237f-4457-8d59-b720501d070c", "choice_type": "single"} {"question": "Cock&;s peculiar tumor is", "exp": ".cocks peculiar tumour is actually a complication of sebaceous cyst when sebaceous cyst ulcerates excessive granulation tissue forms resembling fungating epithelioma and this iscalled cock&;s peculiar tumour", "cop": 3, "opa": "Basal cell CA", "opb": "Squamous cell CA", "opc": "Ulcerated sebaceous cyst", "opd": "Cylindroma", "subject_name": "Surgery", "topic_name": "General surgery", "id": "a640781c-2556-438f-a905-a9bf8d376c38", "choice_type": "single"} {"question": "Halstaed's mastectomy is", "exp": "Ans. (c) Radical Mastectomy(Ref Internet Sources)Halstaed Radical mastectomy is historical.* It involves removal of Entire breast, Nipple and areola with tumor* Also removes all level 1,2,3 nodes* Muscles like Pectoralis major, Serratus Anterior are also removed.* It's a very high morbid procedure and hence not done now a days after the wide usage of chemotherapy and radiotherapy.* Now we commonly do MRM- in which Pectoralis major muscle is preserved.", "cop": 3, "opa": "Simple mastectomy", "opb": "Wide local excision", "opc": "Radical mastectomy", "opd": "Modified radical Mastectomy", "subject_name": "Surgery", "topic_name": "Breast", "id": "40bf295a-ba02-4696-9261-cc906206cc06", "choice_type": "single"} {"question": "Orchidopexy for cryptorchidism is done at the age of", "exp": "Orchidopexy is usually performed after the age of 1 year to avoid the risks of operating on a tiny patient. Testes should be brought down into the scrotum before the boy stas school. Reference : page1378 Bailey and Love's sho practice of surgery 25th edition", "cop": 1, "opa": "1 to 2 years", "opb": "5 to 6 years", "opc": "Pubey", "opd": "Neonatal period", "subject_name": "Surgery", "topic_name": "Urology", "id": "b1ecb107-967d-4adb-9f8c-5dc4e70a4b8d", "choice_type": "single"} {"question": "Retrosternal Goitre Approach is", "exp": "* Retrosternal goitre is 99% extension from Goitre in neck due to enlargement. And such extended retrosternal goitres are mostly removed by neck incision itself by putting the fingers and hooking out the gland. * Such manoeuvre of removal neck incision is known as Toboggan Technique. * Very rarely Sternotomy is done if the goitre is primary mediastinal goitre. Ref:- Surgery Sixer 3rd Edition; Pg num:- 227", "cop": 1, "opa": "Transcervical approach", "opb": "Transthoracic 2nd ICS", "opc": "Transthoracic 4th ICS", "opd": "Transsternal Anterior mediastinum", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "578cad99-fdf2-4853-9eb6-0f6e24556ce1", "choice_type": "single"} {"question": "Prepyloric channel ulcer is of grade", "exp": "Type 1- In the antrum near the lesser curve, Type 2- combined gastric ulcer ( in the body) with duodenal ulcer, Type 3 - prepyloric ulcer, Type 4 - gastric ulcer in the proximal ulcer or cardia. Reference : SRB edition : 5 page: 824", "cop": 3, "opa": "1", "opb": "2", "opc": "3", "opd": "4", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "1477ebf5-b5cd-4759-bda9-41e33d43b92b", "choice_type": "single"} {"question": "Stemmer's sign and buffalo hump'are features of", "exp": "Lymphoedema characteristically involves the foot.The contour of the ankle is lost through infilling of the submalleolar depressions, A 'buffalo hump' forms on the dorsum of the foot,The toes appear 'square' because of confinement of footwear and The skin on the dorsum of the toes cannot be pinched because of subcutaneous fibrosis (Stemmer's sign).Ref: Bailey and love 27e pg: 998", "cop": 1, "opa": "Lymphoedema", "opb": "Cushings disease", "opc": "Hypothyroidism", "opd": "Carcinoid tumour", "subject_name": "Surgery", "topic_name": "General surgery", "id": "018e3569-6e92-49bf-9915-72ead515b154", "choice_type": "single"} {"question": "Treatment of hypeensive crisis in pheochromocytoma", "exp": "Ref:KD Tripathi 7thE pg: 565 Phentolamine is used for pheochromocytoma. Note Non selective alfa-blockers cause fall in t.p.r, which is compensated by increased HR and C.O. So, they are not used routinely for htn. They block both alfa-1 and alfa-2 receptors- NA release is accentuated. Reserved for special situations like pheochromocytoma, clonidine withdrawal, cheese reaction, where circulating CA&;s are responsible for the rise in BP.", "cop": 1, "opa": "Phentolamine", "opb": "Hydralazine", "opc": "Guanethidine", "opd": "Salameterol", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "0011209a-f0fa-4c74-b7de-506bf6b19828", "choice_type": "single"} {"question": "The commonest bladder stone is", "exp": "IInd MC vesical calculi → Sturvite stones", "cop": 3, "opa": "Triple phosphate", "opb": "Xanthine", "opc": "Uric acid", "opd": "Cysteine", "subject_name": "Surgery", "topic_name": null, "id": "6de6e47c-80c0-4c2a-a15a-b9ed5c10199f", "choice_type": "single"} {"question": "Immediate treatment of compound fracture of tibia is", "exp": "B i.e. Thorough debridement", "cop": 2, "opa": "Intravenous antibiotics", "opb": "Thorough debridement", "opc": "Internal fixation of fracture", "opd": "Amputation of limb", "subject_name": "Surgery", "topic_name": null, "id": "412cba86-23b5-4b78-b815-9250bcbe15cf", "choice_type": "single"} {"question": "Most common site of intra peritoneal abscess is", "exp": "Most common site of abscess in lying and dependent positive - Right inferior intra peritoneal space.", "cop": 3, "opa": "Right superior intra peritoneal space", "opb": "Left superior intra peritoneal space", "opc": "Right inferior intra peritoneal space", "opd": "Left inferior intra peritoneal space", "subject_name": "Surgery", "topic_name": null, "id": "d24276e4-a4cb-4acd-a8cf-c4c29941b7f3", "choice_type": "single"} {"question": "The beneficial effect of oxygen therapy in histotoxic\nhypoxia is about", "exp": null, "cop": 1, "opa": "0%", "opb": "50%", "opc": "100%", "opd": "30%", "subject_name": "Surgery", "topic_name": null, "id": "44347cbf-bbd2-4459-9d2c-4d9f8820118d", "choice_type": "single"} {"question": "In an asymptomatic abdominal aoa aneurysm, elective repair is indicated if the aneurysmal diameter is greater than", "exp": "An asymptomatic abdominal aoic aneurysm in an otherwise fit patient should be considered for repair if >55 mm in diameter (measured by ultrasonography). The annual incidence of rupture rises from 1% or less in aneurysms that are <55 mm in diameter to a significant level, perhaps as high as 25%, in those that are 70 mm in diameter.Ref: Bailey and love pg: 961", "cop": 1, "opa": "5.5 cm", "opb": "6.5 cm", "opc": "7.5 cm", "opd": "8.5 cm", "subject_name": "Surgery", "topic_name": "General surgery", "id": "becddd8a-446f-4e1e-87fe-c1e749bdb81c", "choice_type": "single"} {"question": "Characteristic feature of basal cell carcinoma is", "exp": "The characteristic finding is of ovoid cells in nests with a single 'palisading' layer. It is only the outer layer of cells that actively divide, explaining why tumour growth rates are slower than their cell cycle speed would suggest.Ref: Bailey and Love, 27e, page: 605", "cop": 3, "opa": "Keratin pearls", "opb": "Foam cells", "opc": "Nuclear palisading", "opd": "Psammoma bodies", "subject_name": "Surgery", "topic_name": "General surgery", "id": "368caae4-4944-4d3f-94e6-1824501fc608", "choice_type": "single"} {"question": "The best treatment for uncomplicated fractures of the ribs is", "exp": "The ideal treatment for uncomplicated fracture of ribs is on an outpatient basis with administration of analgesics like NSAIDs or narcotics if not sufficient.Immediate surgery in the absence of complications is not needed.", "cop": 1, "opa": "Leave it alone", "opb": "Immediate surgery and wiring of the fragments", "opc": "Strapping of the chest", "opd": "Injection of local anesthetic around the involved intercostal nerve", "subject_name": "Surgery", "topic_name": "Cardio thoracic surgery ", "id": "d28cfe3f-7ad0-4d0a-967e-8815de1fca26", "choice_type": "single"} {"question": "Treatment for malignant melanoma is", "exp": "Treatment of Malignant melanoma Surgical excision with sentinel LN biopsy (Margin : 1 cm for <1 mm thickness, 2cm for 1-4 mm thickness, 2-3 cm for >4 mm thickness LN dissection if LN is palpable or positive on sentinel LN biopsy MM is radioresistant tumor ; Chemotherapy : IFN-alpha 2b Clark's levels (on the basis of depth of invasion) : EPIRS I Melanoma restricting to epidermis and appendages II Invading papillary dermis without filling it III Reach interface of papillary and reticular dermis IV Invading reticular dermis V Invading subcutaneous tissue MM is subclassified into 5 Clark levels, to indicate their depth of invasion and prognosis Breslow's depth of invasion : Actual measurement of deepest invasion from granular layer Breslow's Thickness Stage I <0.75 mm Stage II 0.75-1.5 mm Stage III 1.6-4.0 mm Stage IV >4.0 mm Ref: Sabiston 20th edition Pgno : 729", "cop": 1, "opa": "Wide excision", "opb": "Radiotherapy", "opc": "Excision", "opd": "Chemotherapy", "subject_name": "Surgery", "topic_name": "Urology", "id": "5d9e66a3-e169-4b0f-a513-c6842fdc99e7", "choice_type": "single"} {"question": "Arsenic is used in treatment of", "exp": "Acute promyelocytic leukemia /Ref Harrison 16th/e p 636] Arsenic trioxide is used in the treatment of Acute promyelocytic leukemia Treatment of Acute promyelocytic leukemia Usually all the cases of AML other than acute promyelocytic leukemia are treated with cytarabine + Anthracycline. But in case of Acute promyelocytic leukemia, these drugs are not used, instead Tretinoin is used for induction. It is a well known fact that acute promyelocytic leukemia may lead to D.I.C. When acute promyelocytic leukemia is treated with anthracycline and cytarabine, DIC is induced by the release of granule components of dying tumour cells. Tretinoin does not produce D.I.C., instead it may produces another complication known as retinoic acid syndrome, which occurs in the first 3 weeks of treatment and is characterized by fever, dyspnoea, chest pain, pulmonary infiltrates, pleural and pericardial effusions. If the patient is refractory to tretinoin therapy, Arsenic trioxide is used : \"Arsenic trioxide produces, meaningful response in upto 85% of patients refractory to tretinoin\"", "cop": 1, "opa": ">Acute promyelocytic leukemia", "opb": ">A.L.L.", "opc": ">CML", "opd": ">Transient myeloproliferative disorder", "subject_name": "Surgery", "topic_name": null, "id": "624c6892-f963-4232-ad8c-03fafae0052a", "choice_type": "single"} {"question": "Plasma expanders are used in", "exp": "During endotoxic shock,the amount of blood that can be delivered to the tissues get reduced due to loss of RBC's and decrease in blood volume which causes a decrease in blood pressure. Therefore,plasma expanders are used for the maintanence of blood volume in the body.They act by increasing osmotic pressure. Ref : SRB's manual of surgery 6th edition", "cop": 1, "opa": "Endotoxic shock", "opb": "Neurogenic shock", "opc": "Vasovagal shock", "opd": "Anaphylactic shock", "subject_name": "Surgery", "topic_name": "General surgery", "id": "b3fad0e8-8374-440f-82db-081558d17553", "choice_type": "single"} {"question": "\"String sign of Kantor\" is seen in", "exp": "(Crohn's disease) (1170-LB) (1171-B & L 25th)* Crohn's disease - The principal findings include thickened bowel wall with stricture (\"String sign of kantor\")* Rovsing's sign - A sharp pressure over the left iliac fossa produces pain in the right iliac fossa in Acute Appendicitis* Murphy's sign - The patient experiences pain and \"Catches the breath\" just before the zenith of respiration when the gall bladder area is gently pressed in acute cholecystitis* Boas sign - There may be an area of hyperaesthesia between the ninth and eleventh ribs posteriorly on the right side in Acute cholecystitis.", "cop": 2, "opa": "Ulcerative colitis", "opb": "Crohn's disease", "opc": "Cholecystitis", "opd": "Appendicitis", "subject_name": "Surgery", "topic_name": "Small & Large Intestine", "id": "48e7a634-d7b8-4824-b708-320ed7b57030", "choice_type": "single"} {"question": "Treatment of choice for ureterocele", "exp": "Ureteric reimplantation or endoscopic incision is the treatment of option for\nureterocoele.", "cop": 1, "opa": "Ureteric reimplantation", "opb": "LASER ablation", "opc": "Antibiotics + observation", "opd": "Urinary diversion", "subject_name": "Surgery", "topic_name": null, "id": "89c93f95-7121-4b57-a6fa-bf86efbd40ed", "choice_type": "single"} {"question": "A robust male baby with vigorous feeding and immediate vomiting at 2 months of age. Most probable diagnosis is", "exp": "Congenital hyperophic pyloric stenosis is seen between 3 rd and 6 the week of age of an infant because the time taken by the hyperophied muscle to cause complete obstruction is between 3rd and 6 the week, as well as the congenital hyperophic pyloric stenosis is most commonly seen in firstborn males. Reference: SRB 5 the edition page no. 821", "cop": 4, "opa": "Paralytic ileus", "opb": "Hirschsprung's disease", "opc": "Brain tumor", "opd": "Congenital hyperophic pyloric stenosis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "e4fd56ae-abf5-4950-964f-2470e538a5b7", "choice_type": "single"} {"question": "Congenital hypertrophic pyloric stenosis associated with", "exp": "Ans is 'b' i.e. Hypokalemic alkalosis Repeat from Nov 09Repetitive vomiting leads to hypochloremic, hypokalemic metabolic alkalosis. The urine is alkaline initially but eventually it becomes acidic (paradoxical aciduria)Cause of paradoxical aciduriaInitially the kidney compensate for metabolic alkalosis by reabsorbing hydrogen and chloride ions in exchange for sodium, potassium and bicarbonate. But gradually as the body stores of sodium and especially potassium become depleted, kidney starts retaining these ions in exchange of hydrogen ions, thus the urine becomes acidic and metabolic alkaline state is further aggravated.Hypertrophic Pyloric Stenosis (HPS)The musculature of the pylorus and adjacent antrum is grossly hypertrophied, the hypertrophy being maximum in the pylorus itself.It occurs in approximately 3 in 1000 live birth and is the most common surgical cause of vomitting in infancy.M > F (4 : 1)*Characteristically the first born male child is affected.The condition is most commonly seen at 4 wks. after birth ranging from the 3rd wk. to on rare occasion, the 7th. However, 20% of infants are symptomatic from birth, and most are symptomatic within the first 2 months after birth.Non-bilious vomiting, becoming increasingly projectile, occurs over several days to weeks. Eventually the infant will develop a nearly complete obstruction by the second to fourth week of life and will not be able to hold down even clear liquids. This invariably proceeds to severe dehydration if not t/t.These infants develop a metabolic alkalosis with severe depletion of potassium and chloride ions.\"The diagnosis of pyloric stenosis usually can be made on physical examination by palpation of the typical 'olive' in the right upper quadrant and the presence of visible gastric waves on the abdomen.When the olive cannot be palpated, ultrasound in experienced hands will diagnose the condition accurately in 95 percent of pts. \" - Schwartz.TreatmentPyloric stenosis is never a surgical emergency although dehydration and electrolyte abnormalities may present a medical emergencyFluid resuscitation and correction of electrolyte abnormalities and metabolic alkalosis is essential before surgery.Surgery: Fredet-Ramstedt pyloromyotomy. (In it the pyloric mass is split without cutting the mucosa)Also knowAdministration of erythromycin in early infancy has been linked to the subsequent development of HPS.Jaundice may be seen in HPS, although cause is not clear.", "cop": 2, "opa": "Hypokalemic acidosis", "opb": "Hypokalemic alkalosis", "opc": "Hyperkalemic acidosis", "opd": "Hyperkalemic alkalosis", "subject_name": "Surgery", "topic_name": "Benign Gastric Disease", "id": "10b0981d-f6fa-4f30-aacf-de321ab75f23", "choice_type": "single"} {"question": "Remodelling phase (maturing phase) is characterized by", "exp": "Normal wound healing have 3 or 4 phases, most commonly agreed to be 1 the inflammatory phase (2-3 days) 2 the proliferative phase (3 days - 3 weeks) 3 the remodelling phase (maturing phase) (stas on day 6-7and may extend up to a year) In the remodelling phase is characterised by the maturation of collagen (type I replacing type III until a ratio of 4:1 is achieved). There is a realignment of collagen fibres along the lines of tension, decreased wound vascularity, and wound contraction due to fibroblast and myofibroblast activity. Bailey and Love 27e pg: 25", "cop": 2, "opa": "Type I replacing type IV collagen", "opb": "Type I replacing type III collagen", "opc": "Type IV replacing type I collagen", "opd": "Type III replacing type I collagen", "subject_name": "Surgery", "topic_name": "General surgery", "id": "8703ba80-1339-4f57-898e-a8a620fdd14c", "choice_type": "single"} {"question": "Moures sign is seen in", "exp": "Moure's sign: in normal persons, there is a click felt when the larynx is moved from side to side over the veebral column. This sign is absent in patients with post-cricoid carcinoma (Moure's sig n positive).", "cop": 1, "opa": "Carcinoma", "opb": "Appendicitis", "opc": "Varicose vein", "opd": "Pancreatitis", "subject_name": "Surgery", "topic_name": "Urology", "id": "e4ad9873-9a7e-4070-9479-3716147bb398", "choice_type": "single"} {"question": "Milan Criteria is used for", "exp": "Ans. (a) Liver transplantRef: Bailey and Love 27th edition, Page 1555Milan criteria is for liver transplant in HCC patients:* Single nodule <5cm or less than 3 nodules, the largest of which is <3cm* Those who meet these criteria - recurrence rate less than 20%* Those who fall outside, recurrence rate 60%", "cop": 1, "opa": "Liver transplant", "opb": "Kidney transplant", "opc": "Lung Transplant", "opd": "Heart transplant", "subject_name": "Surgery", "topic_name": "Transplantation", "id": "af1fc5ce-696f-44a1-a069-e27dd5c8aa33", "choice_type": "single"} {"question": "Buschke Lowentein tumour is", "exp": "Buschke Lowentein tumour :\n\nit is locally invasive cancer.\nHistological pattern is similar to verrucous cancer.", "cop": 4, "opa": "Condyloma lata", "opb": "Molluscan contagious", "opc": "Benign lesion of penis", "opd": "Verrucous carcinoma of penis", "subject_name": "Surgery", "topic_name": null, "id": "3268359f-792e-43fa-b799-fc0118d8eac9", "choice_type": "single"} {"question": "Most common type of mesentric cyst is", "exp": "Chelolymphalic cyst :\n\nIt is commonest type of mesentric cyst.\nIt has congenital misplaced lymphatic tissue.", "cop": 2, "opa": "Entergenous cyst", "opb": "Chelolymphalic cyst", "opc": "O mental cyst", "opd": "Urogenital cyst", "subject_name": "Surgery", "topic_name": null, "id": "dd2a0d9a-28f5-4679-9d0b-9d9c8f4d0e29", "choice_type": "single"} {"question": "Lord's and Jaboulay's operation is done for", "exp": "These operations are done for hydrocele .Lord's operation or plication is suitable when the sac is small, thin walled and contains clear fluid. Here tunica is bunched into a 'ruff' at its attachment to the testis by using a series of multiple interrupted chromic catgut sutures to plicate the redundant tunica vaginalis, so as to make the sac to form fibrous tissue. Jaboulay's procedure - Eversion of the sac following paial excision with placement of the testis in a pouch prepared by dissection in the fascial planes of the scrotum.Reference : page 1072 SRB's manual of surgery 5th edition and page 1382 Bailey and Love's sho practice of surgery 25th edition", "cop": 4, "opa": "Rectal prolapse", "opb": "Fistula in ano", "opc": "Inguinal hernia", "opd": "Hydrocele", "subject_name": "Surgery", "topic_name": "Urology", "id": "c62f8468-7743-4111-b540-468f41ff4f2f", "choice_type": "single"} {"question": "Breast cancer is conservatively treated by following methods", "exp": "Breast conservation surgery The amount of breast tissue excised with the lesion may vary with the clinical situation, but is typically 5mm to 10mm in all directions BCS may consist of removal of tumor with 1 cm margin of normal tissue (wide local excision) or a more extensive excision of a whole quadrant of breast (Quandrantectomy) Ref: Mastery of Surgery 5th edition Pgno : 525", "cop": 1, "opa": "It is based on relative size of breast tumor", "opb": "Radiotherapy is given", "opc": "Chemotherapy is given", "opd": "Surgery is best modality of treatment", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "4ecc0d27-24c2-4b0c-829a-bb96857ce60e", "choice_type": "single"} {"question": "50 year old male with positive family history of prostate cancer has come to you for a screening test. The screening test done to pickup prostate cancer is", "exp": "Prostate-specific antigen (PSA) and Digital rectal examination (DRE) Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years. Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65). Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).", "cop": 3, "opa": "DRE", "opb": "PSA", "opc": "DRE + PSA", "opd": "Endorectal coil MRI with T1 and T2 W images", "subject_name": "Surgery", "topic_name": "Urology", "id": "e7748524-13f1-45f7-8fa8-c2ad528570ba", "choice_type": "single"} {"question": "Most common malignant lesion of the eyelid is", "exp": "Basal cell carcinoma This is usually a slow-growing, locally-invasive, malignant tumour of pluripotential epithelial cells arising from basal epidermis and hair follicles; hence, it affects the pilo-sebaceous skin. EPIDEMIOLOGY The strongest predisposing factor to BCC is UVR. It occurs in the elderly or the middle-aged after excessive sun exposure, with 95% occurring between the ages of 40 and 80 years. The incidence of BCC rises with proximity to the equator, although 33% arise in pas of the body not usually sunexposed. Other predisposing factors include exposure to arsenical compounds, coal tar, aromatic hydrocarbons, ionising radiation and genetic skin cancer syndromes. White- skinned people are almost exclusively affected. BCC is more common in men than women. PATHOGENESIS BCCs have no apparent precursor lesions and their development is propoional to the initial dose of the carcinogen, but not duration of exposure. The most likely model of pathogenesis for BCCs involves mesodermal factors as intrinsic promoters coupled with an initiation step. BCCs metastasise extremely rarely. MACROSCOPIC BCC can be divided into localised (nodular; nodulocystic; cystic; pigmented and naevoid) and generalised (superficial: multifocal and superficial spreading; or infiltrative: morphoeic, ice pick and cicatrizing). Nodular and nodulocystic variants account for 90% of BCC. MICROSCOPIC Twenty-six histological subtypes have been described. The characteristic finding is of ovoid cells in nests with a single 'palisading' layer. It is only the outer layer of cells that actively divide, explaining why tumour growth rates are slower thantheir cell cycle speed would suggest, and why incompletely excised lesions are more aggressive. Morphoeic BCCs synthesize type 4 collagenase and so spread rapidly Ref: Bailey and love 27th edition Pgno : 604", "cop": 2, "opa": "Squamous cell carcinoma", "opb": "Basal cell carcinoma", "opc": "Malignant melanoma", "opd": "Adenocarcinoma", "subject_name": "Surgery", "topic_name": "Urology", "id": "2ee35b19-619b-4ea1-a997-5593a2cda11e", "choice_type": "single"} {"question": "Typhoid perforation occurs during", "exp": "• Enteric fever is a potentially life - threatening systemic disease characterized by fever and abdominal pain.\n• It is caused by Salmonella typhi or paratyphi.\n• Typhoid is the MC cause of ileal perforation in tropical countries (India).\nPathology :\n• Ulceration and necrosis of ileocecal Peyer’s patches.\n• The ulcer is parallel to the long axis of the gut and is usually situated in the lower ileum (longitudinal ulcers).\n• Perforation of a typhoid ulcer usually occurs during the third week and is occasionally the first sign of the disease.\nClinical Features :\n• Fever and abdominal pain are hallmark symptoms.\n• Non-specific symptoms : Headache, cough, sweating, myalgia, arthralgia, fatigue.\n• Paralytic ileus is the MC complication of typhoid.\n• Intestinal hemorrhage (2nd MC) may be the leading symptom.", "cop": 3, "opa": "Ist week", "opb": "2nd week", "opc": "3rd week", "opd": "4th week", "subject_name": "Surgery", "topic_name": null, "id": "9f04cb11-845b-4c65-8f7d-cb53a16794e4", "choice_type": "single"} {"question": "A patient with long standing multinodular goitre develops hoarseness of voice; also, the swelling undergoes sudden increase in size. Likely diagnosis is", "exp": "Ans. is 'a' i.e., Follicular Ca History of sudden growth in a long standing goiter and hoarseness are suggestive of malignant change. Most common carcinoma to develop in developing in long standing multinodular goiter is Follicular carcinoma.", "cop": 1, "opa": "Follicular ca", "opb": "Papillary ca", "opc": "Medullary ca", "opd": "Anaplastic ca", "subject_name": "Surgery", "topic_name": null, "id": "ae684419-1915-4241-9ab9-17afae58970d", "choice_type": "single"} {"question": "The Most common complication in varicose vein surgery is", "exp": "(A) Ecchymosis # Complications of varicose vein surgery: Bruising and discomfort are common following removal of varices, especially where the veins were of very large diameter. However, the pain usually requires only mild analgesics.", "cop": 1, "opa": "Ecchymosis", "opb": "Deep vein thrombosis", "opc": "Recurrence of varicosity", "opd": "Venous ulcer", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "072290c4-b911-42df-852d-bc92f95f1c68", "choice_type": "single"} {"question": "The sequence of symptoms in pulmonary embolism is", "exp": null, "cop": 3, "opa": "Fever, pain, dyspnoea", "opb": "Fever, dyspnoea", "opc": "Dysponea, pain, haemoptysis", "opd": "Dysponea, cough, purulent sputum", "subject_name": "Surgery", "topic_name": null, "id": "9d342123-cb4d-4037-b1eb-8f7c7e36a256", "choice_type": "single"} {"question": "The best predictor of prognosis in congenital diaphragmatic hernia", "exp": "Pulmonary hypoplasia and immaturity of the lungs remain the leaden cause of death, from pulmonary hypeension (right-to-left shunting) with resultant hypoxemia. The best predictor of prognosis in congenital diaphragmatic hernia Pulmonary hypeension.", "cop": 1, "opa": "Pulmonary hypeension", "opb": "Gestational age at which baby is born", "opc": "Time of surgery", "opd": "Size of the herniated sac", "subject_name": "Surgery", "topic_name": "All India exam", "id": "05f2eac8-be65-4c15-ac86-bdb3ce4351c0", "choice_type": "single"} {"question": "Most common cause of unilateral diaphragmatic paralysis is", "exp": "(A) Surgical trauma # UNILATERAL DIAPHRAGMATIC PARALYSIS may be idiopathicl or secondary to multiple causes, among which the most common is a tumour with phrenic nerve involvement or surgical trauma,> Causes of unilateral paralysis are diseases of the cervical spinal cord affecting the anterior horn cells of the fourth segment, such as poliomyelitis, tumour, progressive muscular atrophy, myelitis, haemorrhage, and injuries and caries of the cervical vertebrae.> Peripheral lesions of the phrenic nerve or its roots include neck wounds, polyneuritis (usually diphtheritic), destruction by neoplastic masses (usually near the hilum of the lung), and avulsion from birth injury as an extension of Erb's palsy.> Unilateral diaphragmatic paralysis is often discovered incidentally in patients undergoing chest radiography for some other reason Patients usually are asymptomatic at rest but experience dyspnea upon exertion and have a decrease in exercise performance.> If the patient has an underlying lung disease, dyspnea may occur at rest.> Some patients may develop orthopnea, which is less intense than bilateral diaphragmatic paralysis.", "cop": 1, "opa": "Surgical trauma", "opb": "Poliomyelitis", "opc": "Polyneuritis", "opd": "Tumour", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "3918a688-1a90-484f-beae-28dbeb344584", "choice_type": "single"} {"question": "Most common type of cyst in jaw", "exp": "Radicular Radicular Cyst 1. Also known as dental cyst or periodontal cyst or periapical granulomaQ 2 Most common cyst of jaw 3 It usually develops due to continuous irritation of infected tooth which stimulate the nests of cell to proliferate. 4 Occur more frequently in upper jaw. Presentation * Cyst present at the apexQ of the affected tooth * Expansion of jaw * Painless (unless infected) * Bone in thinned out with eggshell crackling. X- ray- well circumscribed radiolucency at the apex of the affected tooth. The margin of the cyst may be sclerosed. Treatment- Extraction of the carious tooth with curettage (intra oral approach)", "cop": 1, "opa": "Radicular", "opb": "Dentigerous cyst", "opc": "Solitary bone cyst", "opd": "Nasolabial cyst", "subject_name": "Surgery", "topic_name": null, "id": "34e4f221-a6ab-45c6-add2-ab99269d41dd", "choice_type": "single"} {"question": "A 60 year old male was diagnosed as carcinoma right lung. On CECT chest there was tumour of 5 x 5 cm in upper lobe and another 2 x 2 cm size tumour nodule in middle lobe. The primary modality of treatment is", "exp": "Refer above table Treatment of operable NSCCL Stage IA, IB, IIA, IIB : Surgical resection Adjuvant chemotherapy is given in stage II Stage IIIA with minimal N2 involvement : Neoadjuvant chemotherapy followed by surgical resection with complete Mediastinal LN dissection Postoperative radiotherapy for patients found to have N2 disease Ref : Sabiston 20th edition Pgno : 1591", "cop": 3, "opa": "Radiotherapy", "opb": "Chemotherapy", "opc": "Surgery", "opd": "Suppoive treatment", "subject_name": "Surgery", "topic_name": "Urology", "id": "46cf1710-951b-460d-a4d8-4d83cc50abd1", "choice_type": "single"} {"question": "'Gold standard' in diagnosis of GERD is", "exp": "24-hour pH recording is the 'gold standard' for diagnosis of GORDNormally endoscopy with biopsy is done. If the typical appearance of reflux oesophagitis, peptic stricture or Barrett's oesophagus is seen, the diagnosis is clinched,In patients with atypical or persistent symptoms despite therapy, oesophageal manometry and 24-hour oesophageal pH recording (ideally with impedance measurement) is done.Manometry and pH recording are essential in patients being considered for antireflux surgery.A CT scan gives the best appreciation of gastro-oesophageal anatomy. This may be impoant in the context of surgery for rolling or mixed hiatus hernias,Ref: Bailey and Love 27e pg: 1078", "cop": 1, "opa": "24 Hr oesophageal pH", "opb": "Oesophageal manometry", "opc": "Upper GI endoscopy", "opd": "CT chest", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "b896839c-a737-48ae-8df5-de4719112535", "choice_type": "single"} {"question": "Among the given populations risk of hernia is least in", "exp": "Inguinal hernia is less common in obese patients, with hernia risk being negatively related to body mass index (BMI). Hernia is more common in smokers.Hernia development is more common in pregnancy due to hormonally induced laxity of pelvic ligaments. It is also more common in elderly people due to degenerative weakness of muscles and fibrous tissue. Ref: Bailey and love 27e pg: 1024", "cop": 4, "opa": "Smokers", "opb": "Pregnant", "opc": "Elderly", "opd": "Obese", "subject_name": "Surgery", "topic_name": "General surgery", "id": "87e69307-236f-40ee-a6c0-cf9d85aa42f5", "choice_type": "single"} {"question": "High incidence of oral malignancies is attributed to", "exp": "In the Indian subcontinent, the use of 'pan' (a combination of betel nut, areca nut, lime and tobacco), as well as reverse smoking (smoking a cheroot with the burning end inside the mouth), are responsible for the high incidence of oral cancer. Betel quid appears to be the major carcinogen, although there is also a relationship between slaked lime and the areca nut and cancer.Ref: Bailey and love pg: 760", "cop": 1, "opa": "Use of pan", "opb": "Poor hygiene", "opc": "High incidence of HPV", "opd": "Poor nutrition", "subject_name": "Surgery", "topic_name": "General surgery", "id": "39dc21c5-41f3-4c9e-9754-4a80ae1fa14e", "choice_type": "single"} {"question": "In an adult, % of total body surface required to be involved in a burn injury to cause shock", "exp": "As the size approaches 10-15% of total body surface area (TBSA), the loss of intravascular fluid can cause a level of circulatory shock. Fuhermore, once the area increases to 25% of TBSA, the inflammatory reaction causes fluid loss in vessels remote from the burn injury.Ref: Bailey and love 27e pg: 619", "cop": 1, "opa": "15", "opb": "20", "opc": "25", "opd": "30", "subject_name": "Surgery", "topic_name": "General surgery", "id": "3e8acf07-508d-468b-aede-e48c3725f3de", "choice_type": "single"} {"question": "Ductopenia seen in", "exp": "Ans. (b) Alagille syndromeRef: Internet Sources* Alagille syndrome is an autosomal dominant genetic disorder affecting liver and heart commonly.* Bile duct paucity is the common manifestation which results in Cirrhosis and Liver failure", "cop": 2, "opa": "Primary biliary cholangitis", "opb": "Alagille syndrome", "opc": "Caroli's disease", "opd": "EHPVO", "subject_name": "Surgery", "topic_name": "Gall Bladder & Bile Ducts", "id": "64d15b30-c6d4-4a43-bd62-da14fc920dbf", "choice_type": "single"} {"question": "Per rectum examination is not a useful test for diagnosis of", "exp": "PILONIDAL SINUS/DISEASE (Jeep Bottom; Driver's Bottom) Pilus--hair; Nidus--nest It is epithelium lined tract, situated sho distance behind the anus, containing hairs and unhealthy diseased granula- tion tissue. It is due to penetration of hairs through the skin into subcutaneous tissue. It forms granuloma/unhealthy granulation tissue in the deeper plane. It is of infective origin and occurs in sacral region between the buttocks, umbilicus, axilla. Other indications of per rectal examination are:Carcinoma rectum, Stricture rectum, Polyps, BPH and carcinoma prostate, Secondaries in the rectovesical pouch (Blumer shelf), Sphincter tone, Pelvic abscess (is felt as boggy swelling), to feel the internal opening of anal fistulas, in bimanual palpation of the bladder or pelvic tumours, in acute abdominal conditions--it reveals dilated empty rectum with tenderness.Reference : page 967 and 952 SRB's manual of surgery 5th edition", "cop": 3, "opa": "Anal fissure", "opb": "Hemorrhoid", "opc": "Pilonidal sinus", "opd": "Rectal ulcer", "subject_name": "Surgery", "topic_name": "Urology", "id": "f3bf8583-231b-4b7a-828c-179b0f9ccdd9", "choice_type": "single"} {"question": "The technique of laparoscopic cholecystectomy was first described by.", "exp": "Ans. (b) Erich MuheRef Blumgart 5/e p 512* 1st Lap Cholecystectomy was done by ERIC MUHE in 1982.* 1st Lap Appendectomy was done by KURT SEMM in 1980", "cop": 2, "opa": "Sleisinger", "opb": "Eric Muhe", "opc": "Kurt semm", "opd": "Starzl", "subject_name": "Surgery", "topic_name": "Gall Bladder & Bile Ducts", "id": "80ed191d-1b6b-4f79-9062-cadad0c4079c", "choice_type": "single"} {"question": "Most frequent site of mandibular fracture is", "exp": "Most common site of fracture is in the neck of condyles( 35%) as it is the weakest point, condyle is displaced in front and medially often with dislocation. Reference SRB edition:5 page :355", "cop": 1, "opa": "Condylar neck", "opb": "Canine fossa", "opc": "Mandibular body", "opd": "Symphysis menti", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "d685fccb-c3a8-4520-88d0-327a8de166e2", "choice_type": "single"} {"question": "Renal trauma is best treated by", "exp": null, "cop": 1, "opa": "Observation and supportive measures", "opb": "Early drainage of perirenal haematoma", "opc": "Heminephrectomy", "opd": "Nephrostomy", "subject_name": "Surgery", "topic_name": null, "id": "531ad4cb-6f64-454e-bd90-f1be4feea72e", "choice_type": "single"} {"question": "Ultrasound is investigation of choice for", "exp": "Focused abdominal sonogram for trauma (FAST) Focused assessment with sonography for trauma (FAST) examination is a bedside screening tool to identify free intra peritoneal, pleural and pericardial fluid. It is limited ultrasound examination with 6 views. The average time to perform a complete FAST examination is 2-4 minutes.", "cop": 3, "opa": "Somatostatinoma", "opb": "Urethral stricture", "opc": "Blunt abdominal trauma", "opd": "Intraductal Pancreatic calculi", "subject_name": "Surgery", "topic_name": "All India exam", "id": "6c4ad04d-a563-4b38-9262-46ea74a401bf", "choice_type": "single"} {"question": "A newborn child presents with inveed foot and the dorsum of the foot cannot touch the anterior tibia. The most probable diagnosis is", "exp": "CTEV [Ref: Maheshwari Ohopaedics 3/e p195; Ebnezar 3/e p454J In a new born child it is possible to dorsiflex and eve the foot till the dorsum of foot touches anterior surface of tibia.This is not possible in CTEV. This is known as 'clorsillexion test' and can be used as a screening test. Ahrogryposis Multiplex Congenita is a rare congenital disorder that is characterized by multiple joint contractures and muscle atrophy and fibrosis. It is a non-progressive disease. CTEV can be seen as one of the components of AMC. So AMC can also be the answer but since it's much rarer than CTEV and in the question other joints involvement is not mentioned, answer would be `CTEV'. Congenital veical talus is a'rare disease usually affecting both feet, characterized by rigid flatfoot deformity, with the plantar aspect of the foot having a convex contour. The heel is in valgus, and the forefoot is abducted and dorsiflexed. In the newborn having this condition, the dorsal aspect of the foot may be in close approximation to the distal aspect of tibia. Flat foot or Pes planus is a condition characterized by varying degrees of loss of the longitudinal arch of the foot. This condition can be normal which usually disappears as the child grows, or can be pathological as seen in Congenital veical talus, tarsal coalition, inflammatory joint disorder or a neurological disorder. Congenital Talipes Equinovarus (Idiopathic club-food -Talipes is a term for any foot deformity that centres around the talus. - Equinus implies that the foot is flexed in the plantar direction. - Varus implies that the foot is inveed and adducted so that the sole faces inwards. CTEV is a complex deformity of the foot where the foot is both turned and twisted inwards so that the sole faces posteromedially. Deformities noted are: - plantar flexion (equines) - in version - adduction - supination - sometimes cavus (high medial arch) The involved foot is generally smaller than the opposite side with varying amounts of calf atrophy. More common in boys (2:1) Bilateral in 1/3 cases.(Ret Apley's Ohopaedics 11/e 591) Clinical tests in CTEV: 1)Dorsiflexion test: described above. 2)Plumbline test: This test helps to detect the tibial torsion. The child is made to sit on a table with both the lower limbs hanging from the edge. A line drawn from the centre of the patella to the tibial tubercle when extended down, should cut the foot at the first or second intermetatarsal space normally. This is called the pulmline. In CTEV, with medial rotation of the tibia. the plumbline cuts the zith or 5th intermetatarsal space. 3)Scratch test: This test is performed to detect muscle imbalance in an infant who cannot obey commands. - Medial scratch test- In a normal child when the medial sole is scratched, the foot eves. The tests the peroneals. - Lateral scratch test- When the lateral sole is scratched, the child inves the foot. This tests the inveors. X-ray: Radiographs AP and Lateral are obtained in maximally corrected position. The talo-calcaneal angle (Kite's angle) obtained in both AP and lateral views is reduced in CTEV.", "cop": 3, "opa": "Congenital veical talus", "opb": "Ahrogryposis Multiplex", "opc": "CTEV", "opd": "Flat foot", "subject_name": "Surgery", "topic_name": null, "id": "0a155755-ccd8-46e7-9b89-1276ae27a4a2", "choice_type": "single"} {"question": "Not classified as untidy wound is", "exp": "Answer- B. Incised woundUsually involves crushing and tearing and contain devitalized tissues.Needs conversion to tidy wound before closure is considered.These wounds result from crushing, avulsion or burns. Fractures are common and may be multifragmentary.Treatment - Once the untidy wound is convereted to a didy one by wound excision, it can be saiely closed or allowed to heal by second intention.", "cop": 2, "opa": "Burn wound", "opb": "Incised wound", "opc": "Crush wound", "opd": "Lacerated wound", "subject_name": "Surgery", "topic_name": null, "id": "1160a4df-ad48-406e-9a02-e09c59eb1dbe", "choice_type": "single"} {"question": "Most common cause of brain metastases", "exp": "Origin PercentageLung 40Breast 15Melanoma 10Renal/genitourinary 10Other/unknown 25Ref: Bailey and love 27e pg: 664", "cop": 1, "opa": "Lung", "opb": "Liver", "opc": "Breast", "opd": "Melanoma", "subject_name": "Surgery", "topic_name": "General surgery", "id": "e6cbedbe-8bcb-4823-a540-f5602c5254ac", "choice_type": "single"} {"question": "Posterior triangle lymph nodes are", "exp": "ISub mandibulaeIIUpper deep cervicalIIIMid-cervicalIVLower cervicalVPosterior triangleVIPre laryngeal/pre trachealVIIMediastinalRef: Bailey and love pg: 764", "cop": 2, "opa": "Level 4", "opb": "Level 5", "opc": "Level 6", "opd": "Level 7", "subject_name": "Surgery", "topic_name": "General surgery", "id": "3f7b13f4-ddfe-4ded-aeb2-869dbc854c17", "choice_type": "single"} {"question": "Bile strictures are seen in", "exp": "Biliary strictures are most commonly present post operatively(80%),especially following laparoscopic cholecystectomy.It can also occur following open cholecystectomy,biliary surgery,gastrectomy,liver surgery,duodenal and pancreatic surgery. Choledocholithiasis(CBD stones) can lead to recurrent attacks of cholangitis and thereby biliary structures.But cholelithiasis cannot usually lead to CBD strictures. Biliary strictures can also occur following malignancy(cholangiocarcinoma) & worm infestations like Ascaris lumbricoides,Clonorchis sinensis. Reference:SRB's manual of surgery,5th edition,page no:657.", "cop": 1, "opa": "Cholelithiasis", "opb": "Malignancy", "opc": "Post operative", "opd": "Worm infestation", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "9099574d-ab2d-44c8-9d52-8a598dfe0a72", "choice_type": "single"} {"question": "A women noticed mass in her left breast with bloody discharge. Histopathology revealed duct ectasia. Traetment is", "exp": "Duct ectasia is the dilatation of lactiferous duct due to muscukar relaxation of duct wall with periductal mstitis. C/f:greenish discharge from nippleindurated mass under areolaslit like retravtion of nipple,may present as mastalgia. Treatment is cessation of smokingantibioticscone excisionof invilved duct-Hadfields operation. SRB's Manual of Surgery.Edition -5. Pg no:525", "cop": 4, "opa": "Simple mastectomy", "opb": "Microdochotomy", "opc": "Lobectomy", "opd": "Hadfield operation", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "7c356a50-9657-45e1-9b27-4b32d6b9d957", "choice_type": "single"} {"question": "After bilateral adrenalectomy, patient developed gradual loss of vision, with hyperpigmentation of skin, and headache. Likely cause is", "exp": "In 10% of patients with Cushing's disease who undergo a bilateral adrenalectomy after failed pituitary surgery, the pituitary adenoma causes Nelson's syndrome due to continued ACTH secretion at high levels, causing hyperpigmentation as a result of chemical synergies between ACTH and melanocyte-stimulating hormoneRef: Bailey and Love 27e pg: 842", "cop": 2, "opa": "Addison's disease", "opb": "Nelson's syndrome", "opc": "Cushing's disease", "opd": "Harrisons syndrome", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "2c6af89a-5789-491f-97ca-e8e9a00e65ac", "choice_type": "single"} {"question": "Orchidopexy is done in cases of undescended testes at the age of", "exp": "Ans. is 'a' i.e. Infancy 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\".", "cop": 1, "opa": "Infancy", "opb": "1-2 yrs", "opc": "5 yrs", "opd": "Puberty", "subject_name": "Surgery", "topic_name": "Miscellaneous (Testis & Scrotum)", "id": "5ebc3bc6-5483-4f16-bdb5-6d95fcd15958", "choice_type": "single"} {"question": "After Cleft lip operation sutures are removed on", "exp": "Guidelines go rday of suture removal by Area Body region Removal Eyelid 3-4 days Eyebrow 3-5 days Nose 3-5 days Lip 3-4 days Face(other) 3-4 days Scalp 6-8 days Chest, abdomen 8-10 days Ear 10-14 days Back 12-14 days Extremities 12-14 days Hand 10-14 days Foot, sole 12-14 days Ref: Sabiston 18th edition Pgno :2134", "cop": 2, "opa": "2nd day", "opb": "4th day", "opc": "7th day", "opd": "10th day", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "4e661256-bbb0-42b5-988b-bb51373456c4", "choice_type": "single"} {"question": "The \"Van Nuys grading\" is used for", "exp": "Ans. (b) DCIS(Ref: Sabistons Textbook of Surgery, 20th ed p-853)* DCIS prognosis is based on Van Nuy's Grading* Van Nuys Grading is used to decide whether RT can be avoided in selective cases after Lumpectomy* Van Nuys favorable cases for whom RT can be avoided are - Low and Intermediate grade, DCIS <2.5cm size and Margin minimum 1cm after excision", "cop": 2, "opa": "LCIS", "opb": "DCIS", "opc": "Medullary carcinoma breast", "opd": "IDC", "subject_name": "Surgery", "topic_name": "Breast", "id": "11c53486-ce41-4a8a-8b64-a9c4d5d68f5b", "choice_type": "single"} {"question": "Dacron vascular, graft is", "exp": "Textile synthetic graft → Dacron\nNontextile synthetic graft → PTFE (polytetra fluoro ethylene)", "cop": 2, "opa": "Nontextile synthetic", "opb": "Textile synthetic", "opc": "Nontextile biologic", "opd": "Textile biologic", "subject_name": "Surgery", "topic_name": null, "id": "0d724a00-bc8f-435f-8c44-7f40148c7010", "choice_type": "single"} {"question": "The most common cause of acute sciatica is due to", "exp": "C i.e. Acute prolapsed disc", "cop": 3, "opa": "Trauma", "opb": "Secondaries of spine", "opc": "Acute prolapsed Interveebral disc", "opd": "Tuberculosis of spine", "subject_name": "Surgery", "topic_name": null, "id": "6c6bf8f2-9beb-449a-96cc-be653dfeb038", "choice_type": "single"} {"question": "In CPR the sternum should be depressed at a rate of", "exp": null, "cop": 2, "opa": "1 inch per 1 second", "opb": "2 inch per 1 second", "opc": "1 inch per 5 second", "opd": "2 inch per 5 second", "subject_name": "Surgery", "topic_name": null, "id": "e8eb7d62-0d47-4fff-aac6-b3134db2b5ad", "choice_type": "single"} {"question": "Keloid formulation is not seen over", "exp": null, "cop": 4, "opa": "Ear", "opb": "Face", "opc": "Neck", "opd": "Eyelids", "subject_name": "Surgery", "topic_name": null, "id": "5f1ebefe-fb2e-400c-a836-9220f31343ed", "choice_type": "single"} {"question": "The most common type of mode of meniscal injury is", "exp": "C i.e. Flexion & rotation movement The twisting force (rotation) in a weight bearing flexed knee is the commonest mode of meniscal (semilunar cailage) injuryQ. Menisci follow the tibial condyles during flexion & extension, but during rotation, they follow the femur and move on the tibia; consequently the medial meniscus becomes distoed. Its anterior and posterior attachments follow the tibia, but its intervening pa follows the femur, thus it is likely to be injured during rotation. However, the lateral meniscus b/o firm attachment to popliteus muscle, ligament of Wrisberg or Humphry, follows the lateral femoral condyle during rotation and therefore is less likely to be injured. In addition popliteus muscle, by way of arcuate ligament, draws the posterior segment of lateral meniscus backward there by preventing it from being caught between the condyles of femur & plateau of tibia when tibia is rotated internally and knee is flexed(2.", "cop": 3, "opa": "Extension of knee", "opb": "Flexion of knee", "opc": "Flexion and rotation movement", "opd": "Extension and rotation of movement", "subject_name": "Surgery", "topic_name": null, "id": "bd4ae356-9d59-426f-b428-c65cfc7b6d1f", "choice_type": "single"} {"question": "Insensible daily water loss is", "exp": null, "cop": 2, "opa": "500-600 ml", "opb": "800-1000 ml", "opc": "1000-1500 ml", "opd": "2000 ml", "subject_name": "Surgery", "topic_name": null, "id": "eb950eec-ed28-4de4-b785-7e33bb74d7f6", "choice_type": "single"} {"question": "Most common complication after ERCP is", "exp": "Complication perforation(1.3%)/hemorrhage (1.4%),pancreatitis (4.3%) and sepsis (3-30%). Bailey & Love 26th, 208", "cop": 1, "opa": "Acute Pancreatitis", "opb": "Acute cholangitis", "opc": "Acute cholecystitis", "opd": "Duodenal perforation", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "15285e5f-a482-4072-a123-0ebf1995c01b", "choice_type": "single"} {"question": "The following is ideal for the treatment with injection of sclerosing agents", "exp": "It is ideal for first-degree internal hemorrhoids which bleed and for early second-degree internal hemorrhoids, injecting sclerosant will produce fibrosis in the submucosal region (sclerosis leading to mucosal fixation on to deeper planes and occlusion of lakes) thereby fixes the cushion which does not prolapse, causes strengthening of the vessel wall and obliteration of the vessel lumen it is done on op basis and gives 95% cure rate in the first-degree prolapse , it&;s a painless procedure and results are quick for prolapsed piles stapled haemorrhoidectomy is preferred, for external piles excision is done, for strangulated haemorrhoidectomy conservative management by sitz bath after 5days haemorrhoidectomy is done Reference SRB edition 5 page no. 972,974,976", "cop": 2, "opa": "External hemorrhoids", "opb": "Internal hemorrhoids", "opc": "Prolapsed hemorrhoids", "opd": "Strangulated hemorrhoids", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "39438c8f-bbcb-4c99-819a-e0a0ba5cb695", "choice_type": "single"} {"question": "Murphy's sign is seen in", "exp": "In the acute cholecystitis, the patient may have right upper quadrant tenderness that is exacerbated during inspiration by the examiner's right subcostal palpation (Murphy's sign). A positive Murphy's sign suggests acute inflammation and may be associated with a leukocytosis and moderately elevated liver function tests.Ref: Bailey and love 27e pg: 1199", "cop": 1, "opa": "Acute cholecystitis", "opb": "Cholangiocarcinoma", "opc": "Cholangitis", "opd": "Periampullary cancer", "subject_name": "Surgery", "topic_name": "General surgery", "id": "8b43d94d-691d-4cb3-ad9f-5914664723d9", "choice_type": "single"} {"question": "Serum marker used after surgery for differentiated thyroid cancer is", "exp": "Measurement of peripheral Thyroglobulin has predictive value for the recurrence of differentiated thyroid cancer (ie papillary and follicular thyroid cancers),locally or in metastatic deposits after initial total thyroidectomy . Basal or stimulated calcitonin levels are sensitive markers for primary or recurrent medullary thyroid cancer. Source : Sabiston 20th edition Pg : 886", "cop": 2, "opa": "T4", "opb": "Thyroglobulin", "opc": "Calcitonin", "opd": "PTH", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "9eafdf96-3321-43b3-8e66-56bf4a7d068b", "choice_type": "single"} {"question": "Most common infections after splenectomy are", "exp": "Oppounist post-splenectomy infection is caused by capsulated bacteria.Post-splenectomy septicaemia may result from Streptococcus pneumoniae, Neisseria meningitides, Haemophilus influenzae and Escherichia coli.Bailey and love 26th edition pg: 1096", "cop": 1, "opa": "Capsulated bacteria", "opb": "Uncapsulated bacteria", "opc": "Gram positive sepsis", "opd": "Gram negative bacteria", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "e2a08164-9683-4e7e-b860-771e1e6cda66", "choice_type": "single"} {"question": "Most common site of oesophageal rupture in rigid bronchoscopy", "exp": "Rigid bronchoscopy--It is used for removal of the foreign body and bronchial wash. It reaches up to third generation bronchioles. It is used to take the biopsy from carcinoma of proximal divisions but not from carcinoma of the peripheral lung. The rigid scope has got multiple holes to allow ventilation during the procedure (Oesophagoscope does not have side holes). It is done under general anaesthesia. Ref: SRB&;s manual of surgery,3 rd ed, pg no 1079", "cop": 1, "opa": "Cervical region", "opb": "Cardiac region", "opc": "Mid esophagus", "opd": "GE junction", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "da61fae7-097f-4d33-82c6-734ad6fa9110", "choice_type": "single"} {"question": "Dentigerous cyst arises from", "exp": "Dentigerous cyst is a unilocular cystic swelling arising in relation to the dental epithelium from an unerupted tooth SRB,5th edition,360.", "cop": 3, "opa": "The root of a caries tooth", "opb": "The periosteum of the fractured mandible", "opc": "An unerupted permanent tooth", "opd": "The sequenstrum of osteomyelitis of mandible", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "3a93fcb5-91b7-413d-bd1a-4a02fe29d80b", "choice_type": "single"} {"question": "A vibration perceptile on palpation is", "exp": null, "cop": 2, "opa": "Detritus", "opb": "Fremitus", "opc": "Auscultatus", "opd": "Somnatus", "subject_name": "Surgery", "topic_name": null, "id": "ad3cac8f-4647-48e0-a548-2a653cf0343a", "choice_type": "single"} {"question": "Amyl nitrate inhalation test is used to detect", "exp": "Amyl nitrate inhalation (useful adjunct to the radiographic examination)seems to distinguish patients with pseudoachalasia from those with idiopathic achalasia. *In pseudoachalasia patients with tumour infiltration of the distal oesophagus, the narrow lower oesophagal sphincter segment was unaffected by the smooth-muscle relaxant effect of amyl nitrite. *amyl nitrate caused a measurable increase of 2 mm or more in sphincter diameter in patients with idiopathic achalasia ( smooth-muscle relaxant effect of amyl nitrite).", "cop": 2, "opa": "Carcinoma esophagus", "opb": "Achalasia cardia", "opc": "Oesophageal diveiculum", "opd": "Transeoesophageal fistula", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "626b74d1-89b7-4345-9d42-1d79ba5ea4b5", "choice_type": "single"} {"question": "Use of an acrylated arch bars for closed reduction of mandible was described by", "exp": null, "cop": 1, "opa": "Schuchardt(1956)", "opb": "Risdon (1929)", "opc": "Stanstout (1943)", "opd": "Leonard (1977)", "subject_name": "Surgery", "topic_name": null, "id": "bdb503d3-5b05-4336-bd68-862b68a2ca06", "choice_type": "single"} {"question": "Cause for nipple retraction in breast carcinoma is", "exp": "Infiltration of the Cooper’s ligament will give rise to dimpling of skin.\nBlocking of subcutaneous lymph nodes will give rise to peau d'orange appearance.", "cop": 3, "opa": "Blocking of lymphatics", "opb": "Involvement of the Cooper's ligament", "opc": "Infiltration of ducts", "opd": "Skin infiltration", "subject_name": "Surgery", "topic_name": null, "id": "1970ad79-6a9a-4295-ac12-88c600cbbb40", "choice_type": "single"} {"question": "Most common type of appendix is", "exp": "Ans. a (Retrocecal). (Ref. Bailey and Love, 25th/pg.l205)Vermiform appendix is a muscular tubular structure arising from caecum.Its various positions include:Retrocaecal74%Pelvic21%Paraceacal2%Sub-caecal1.5%Preileal1%Postileal0.5%The appendicular artery is branch of lower division of iliocolic artery.", "cop": 1, "opa": "Retrocecal", "opb": "Pelvic", "opc": "Retrocolic", "opd": "Subhepatic", "subject_name": "Surgery", "topic_name": "Vermiform Appendix", "id": "bac89b0c-9c48-43d2-94f9-1f33e1a40426", "choice_type": "single"} {"question": "A 50 year old male known case of ulcerative colitis presents with distention of the abdomen of acute onset with vomiting. The next investigation would be", "exp": "Answer- A. Abdominal X rayToxic megacolon is defined as a transverse colon with a diameter of more than 5.0 to 6.0 cm with loss ofhaustration.Although usually associated with ulcerative colitis, toxic megacolon can also be seen in Crohn's disease.Plain abdominal railiographs are essmtial for the iliagnosk and management of toxic megacolon (toxic colitis)", "cop": 1, "opa": "Abdominal X ray", "opb": "USG", "opc": "CT scan", "opd": "MRI abdomen", "subject_name": "Surgery", "topic_name": null, "id": "6f5f3aba-e734-4b33-9e55-07ce08eaae3e", "choice_type": "single"} {"question": "While treating benign prostatic hyperplasia with finasteride the period of trial required for maximum response", "exp": "Minimum time to act - 1 month\nMaximum response around 6 months.", "cop": 3, "opa": "1 month", "opb": "3 months", "opc": "6 months", "opd": "18 months", "subject_name": "Surgery", "topic_name": null, "id": "2072a77c-1992-482b-9708-f6ea03d910fb", "choice_type": "single"} {"question": "Most common cancer in men is", "exp": "Answer- C. Prostate cancerCancers in males in India: Lip / oralcavity > Prostate > Colorectum > Pharynx (other than nssopharynx) > Larytx", "cop": 3, "opa": "Bladder cancer", "opb": "Colorectal cancer", "opc": "Prostate cancer", "opd": "Oral cancer", "subject_name": "Surgery", "topic_name": null, "id": "ea4c19f4-4e56-4c2c-bac0-c159769581d0", "choice_type": "single"} {"question": "A fracture of the mandible in the canine region in a 6 year old child should be managed by", "exp": null, "cop": 1, "opa": "Cap splint fixation", "opb": "Intermaxillary fixation", "opc": "Risdon wiring", "opd": "Transosseous wiring", "subject_name": "Surgery", "topic_name": null, "id": "651867a3-749f-428e-8460-490a6bde7d5e", "choice_type": "single"} {"question": "Increased incidence of reaction to L.A will occur by", "exp": null, "cop": 1, "opa": "Rapid rate of injection", "opb": "Using an aspirating technique", "opc": "Addition of vaso constrictor to the solution", "opd": "Premedication with barbiturate", "subject_name": "Surgery", "topic_name": null, "id": "f59c5b87-f89b-4a6a-b5d2-52f51e246792", "choice_type": "single"} {"question": "Hyperthyroidism is diagnosed by", "exp": "Ans. (b) T3, T4 and TSHRef: Bailey and Love page 751/26th editionNormal Values:* TSH: 0.5 to 5 Micro Units/ml* Total T3: 1.5-3.5nmol/l* Total T4: 55-150nmol/l* Free T3: 3-9pmol/l* Free T4: 12-28pmol/l* Radioactive Iodine Uptake Study is useful to diagnose the activity in nodules but not to diagnose Hyperthyroidism as such.", "cop": 2, "opa": "T3, T4", "opb": "T3, T4, TSH", "opc": "T3, T4, RAI", "opd": "T3, T4, RAI and TSH", "subject_name": "Surgery", "topic_name": "Thyroid Gland", "id": "1c1b0a87-f1ba-4477-a7a8-83628440ba28", "choice_type": "single"} {"question": "Minimum amount of GI bleed to cause malena is", "exp": "Melaena refers to the passage of typical black, tarry coloured foul smelling stool. It signifies upper GI bleed. At least 50-60 ml bleeding should be there to cause melaena. Reference : page 834 SRB's manual of surgery 5th edition", "cop": 3, "opa": "10 ml", "opb": "40 ml", "opc": "60 ml", "opd": "115 ml", "subject_name": "Surgery", "topic_name": "Urology", "id": "d5050f74-0d57-41a2-8b48-42b4337dc4ac", "choice_type": "single"} {"question": "Cabitus varus is most commonly seen in", "exp": "D i.e. Malunited sypracondylar", "cop": 4, "opa": "Rickets", "opb": "Post inflammatory epiphyseal damage", "opc": "Fracture lateral condyle humerus", "opd": "Malunited supracondylar fracture", "subject_name": "Surgery", "topic_name": null, "id": "366a0989-7974-4af7-9179-1da4eb93ed81", "choice_type": "single"} {"question": "Most common syndrome associated with cleft palate", "exp": "Although most clefts of the lip and palate occur as an isolated deformity, Pierre Robin sequence is an impoant association. This sequence comprises isolated cleft palate, retrognathia and a posteriorly displaced tongue (glossoptosis), which is associated with early respiratory and feeding difficulties. Stickler (ophthalmic and musculoskeletal abnormalities), Shprintzen (cardiac anomalies), Down, Ape and Treacher Collins syndromes are other common syndromes where cleft lip and palate are frequently encountered.Ref: Bailey and love pg: 689", "cop": 1, "opa": "Pierre Robin sequence", "opb": "Stickler syndrome", "opc": "Treacher Collins syndrome", "opd": "Downs syndrome", "subject_name": "Surgery", "topic_name": "General surgery", "id": "d3da7ea1-0931-454e-9aba-1138aca77774", "choice_type": "single"} {"question": "Extradural haemorrhage is caused by", "exp": "(A) Rupture of Middle meningeal artery # Extradural haematoma (EDH), also known as an Epidural haematoma, is a collection of blood that forms between the inner surface of the skull and outer layer of the dura, which is called the periosteal layer.> They are commonly associated with a history of trauma and associated skull fracture.> The source of bleeding is usually a torn meningeal artery (most commonly, the middle meningeal artery).> EDHs are typically biconvex in shape and can cause a mass effect with herniation.> They are usually limited by cranial sutures, but not by venous sinuses.> Both CT and MRI are suitable to evaluate EDHs.> When the blood clot is evacuated promptly (or treated conservatively when small), the prognosis of EDHs is generally good.", "cop": 1, "opa": "Rupture of Middle meningeal artery", "opb": "Rupture of Middle meningeal vein", "opc": "Rupture of Bridging veins", "opd": "Rupture of Internal carotid artery", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "8b9c892e-a431-41bf-a750-f8bc53e76a88", "choice_type": "single"} {"question": "Pain at left shoulder tip in a patient with splenic trauma is known as", "exp": "Referred pain is due to irritation of the diaphragm and phrenic nerves by the blood in the peritoneal cavity (hemoperitoneum). Reference SRB edition 5 page no.1196", "cop": 2, "opa": "Trosseu sign", "opb": "Kehr's sign", "opc": "Cullen sign", "opd": "Rovsing's sign", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "bd556d5e-00da-4be9-86cf-d899227a0441", "choice_type": "single"} {"question": "A 20 yr old girl presents with 9 month history of neck swelling with thyrotoxic symptoms. On investigation increased T4 and decreased TSH with palpable 2 cm nodule was found. Next investigation will be", "exp": null, "cop": 2, "opa": "USG", "opb": "Thyroid scan", "opc": "Radioactive iodine uptake", "opd": "CT scan", "subject_name": "Surgery", "topic_name": null, "id": "b378675c-5f48-4954-ab00-e239f820d525", "choice_type": "single"} {"question": "Secondary vesical calculus refers to stones formed due to", "exp": "Secondary vesical calculus - occurs in the presence of infection. E.coli is the common organism. Usually phosphate stone. Occurs in bladder only. Primary vesical calculus - occurs in sterile urine. Usually oxalate stone(Jack stone). Usually comes down from kidney through ureter into the bladder and enlarges here. Most vesical calculi are formed de novo within the bladder, but some initially may have formed within the kidneys as a dissociated Randall plaque or on a sloughed papilla and subsequently may have passed into the bladder, where additional deposition of crystals cause the stone to grow. * Most renal stones that are small enough to pass through the ureters are also small enough to pass through a normally functioning bladder and an unobstructed urethra. * In older men with bladder stones composed of uric acid, the stone most likely formed in the bladder.* Stones composed of calcium oxalate are usually initially formed in the kidney.* In adults, MC type of vesical stone (seen in >50% of cases) is composed of uric acid. * Less frequently, bladder calculi are composed of calcium oxalate, calcium phosphate, ammonium urate, cystine, or magnesium ammonium phosphate (when associated with infection). Endemic Bladder Calculi * In children, stones are composed mainly of ammonium acid urate, calcium oxalate, or an impure mixture of ammonium acid urate and calcium oxalate with calcium phosphate.* The common link among endemic areas relates to feeding infants human breast milk and polished rice.* These foods are low in phosphorus, ultimately leading to high ammonia excretion.* These children also usually have a high intake of oxalate-rich vegetables (increased oxalate crystalluria) and animal protein (low dietary citrate). * Vesical calculi may be single or multiple, especially in the presence of bladder diveicula, and can be small or large enough to occupy the entire bladder. They range from soft to extremely hard, with surfaces ranging from smooth and faceted to jagged and spiculated (\"jack\" stones). * Most bladder stones are secondary, more common in older males (>50 years), usually because of bladder outlet obstruction.* MC type: Uric acid (sterile urine) > Struvite stones (Infected urine)* Bladder stones are usually solitary, multiple in 25% patients.Etiology* Bladder outlet obstruction (MC cause)* Neurogenic bladder* Foreign body (Foley's catheter, forgotten DJ stents)* Bladder diveiculaClinical Features* Typical symptoms are intermittent, painful voiding and terminal hematuria with severe pain at the end of micturition.* Pain may be referred to the tip of the penis or to the labia majora.Diagnosis* A large percentage of bladder stones are radiolucent (uric acid).* USG bladder: Identifies the stone with its characteristic shadowing and stone moves with changing body position.Treatment* Small stones: Removed or crushed transurethrally (Cystolitholapexy)* Larger stones: Disintegrated by transurethral electrohydraulic lithotripsy or Cystolithotomy Stones of Genitourinary Tract * MC renal stone: Calcium oxalate* MC primary bladder stone: Ammonium urate* MC bladder stone: Uric acid >Struvite* MC prostate stone: Calcium phosphate Ref : Bailey and Love 25/e p1323", "cop": 3, "opa": "Hypercalciuria", "opb": "Injury", "opc": "Infection", "opd": "Migrating from kidney", "subject_name": "Surgery", "topic_name": "Urology", "id": "d2d7badb-ea7a-4641-8d08-73fa7e7b66dc", "choice_type": "single"} {"question": "Most common cause of upper GI bleed", "exp": "Answer- C. Duodenal ulcersCauses ofupper GI bleeding (in descending order)Peptic ulcer - Duodenal ulcer - gastric ulcerOesophageal varicesGastritis erosionsMallory-Weiss tearsUncommon causes - Gastric carcinoma, esophagitis, pancreatits.", "cop": 3, "opa": "Gastric cancer", "opb": "Oesophageal varices", "opc": "Duodenal ulcers", "opd": "Gastric ulcers", "subject_name": "Surgery", "topic_name": null, "id": "c3e04f77-6ba3-4ee6-8193-774a3360585e", "choice_type": "single"} {"question": "Absent parathyroid, thymic aplasia with immunodeficiency and heart defects are features of", "exp": "Ans. c (Di george syndrome) (Ref. Harrison's medicine 17th ed., Ch. 310)22q11 deletion syndromes:# DiGeorge syndrome --thymic, parathyroid, and cardiac defects. Occurs Due to aberrant development of 3rd and 4th branchial pouches. Cleft palate, Abnormal facies, Thymic aplasia T-cell deficiency, Cardiac defects, Hypocalcemia 2deg to parathyroid aplasia, due to microdeletion at chromosome 22q11.# Velocardiofacial syndrome-palate, facial, and cardiac defects.THE DIGEORGE SYNDROME# classic example of isolated T cell deficiency# results from maldevelopment of thymic epithelial elements derived from the 3rd and 4th pharyngeal pouches.# The gene defect is on chromosomal position 22q11 in most patients with the DiGeorge syndrome.# Defective development of organs dependent on cells of embryonic neural crest origin includes:- Congenital cardiac defects, particularly those involving the great vessels;- Hypocalcemic tetany, due to failure of parathyroid development; and- Absence of a normal thymus.# Facial abnormalities may include abnormal ears, shortened philtrum, micrognathia, and hypertelorism.# Serum immunoglobulin concentrations are frequently normal, but antibody responses, particularly of IgG and IgA isotypes, are usually impaired. T cell levels are |, whereas B cell levels are normal.Pendred syndromeAn autosomal-recessive syndrome consisting of a bilateral congenital sensorineural hearing loss and goiter years later in mid-childhood. T4 levels are usually low to absent, and a perchlorate test is diagnostic. The hearing loss is nonreversible.Also Know:Features of Polyglandular Autoimmune (PGA) syndromesPGA IPGA IIAutosomal recessivePolygenic inheritanceMutations in APECED geneHLA-DR3 and HLA-DR4 associatedChildhood onsetAdult onsetEqual male:female ratioFemale predominanceDisease Associations Mucocutaneous candidiasisAdrenal insufficiencyHypoparathyroidismHypogonadismAdrenal insufficiencyGraves' diseaseHypogonadismType 1 diabetesAlopeciaHypothyroidismDental enamel hypoplasiaMyasthenia gravisMalabsorptionVitiligoChronic active hepatitisAlopeciaVitiligoPernicious anemiaPernicious anemiaCeliac disease", "cop": 3, "opa": "Autoimmune polyglandular syndrome", "opb": "Pendred syndrome", "opc": "Digeorge syndrome", "opd": "Lesch-Nyhan syndrome", "subject_name": "Surgery", "topic_name": "Parathyroid & Adrenal Glands", "id": "ee753d26-dc41-4181-9b45-8b007f3d3002", "choice_type": "single"} {"question": "Dukes classification is used for", "exp": "Dukes' classification was originally described for rectal tumours but has been adopted for histopathological repoing of colon cancer as well. Dukes' classification for colon cancer is as follows: A: confined to the bowel wall; B: through the bowel wall but not involving the free peritoneal serosal surface; C: lymph nodes involved.Dukes himself never described a D stage, but this is often used to describe either advanced local disease or metastases to the liver.Dukes classified carcinoma of the rectum into three stages: A: The growth is limited to the rectal wall (15%); prognosis excellent. B: The growth is extended to the extrarectal tissues, but no metastasis to the regional lymph nodes (35%): prognosis reasonable. C: Secondary deposits in the regional lymph nodes (50%); prognosis is poor. These are subdivided into C1, in which the local pararectal lymph nodes alone are involved, and C2, in which the nodes accompanying the supplying blood vessels are implicated up to the point of division.A stage D is often included, which was not described by Dukes which signifies the presence of widespread metastases, usually hepatic.Reference : page 1180 and 1230 Bailey and Love's sho practice of surgery 25th edition", "cop": 4, "opa": "Pancreas carcinoma", "opb": "Gastric carcinoma", "opc": "Urinary bladder carcinoma", "opd": "Colo-rectal carcinoma", "subject_name": "Surgery", "topic_name": "Urology", "id": "d18f9c3b-015e-45f7-949f-96f6043e32cd", "choice_type": "single"} {"question": "Test used for presence of residual helicobacter pylori infection", "exp": "Urease breath test is used for both diagnosis and eradication.", "cop": 1, "opa": "Urease breath test", "opb": "Rapid urease test", "opc": "Gastric biopsy", "opd": "Serological markers", "subject_name": "Surgery", "topic_name": null, "id": "6fc51fab-62f1-4e75-9487-28e0ed4fc9ff", "choice_type": "single"} {"question": "Most common tumour of pancreas is", "exp": "Pathology of carcinoma pancreas More than 85% of pancreatic cancers are ductal adenocarcinomas. The remaining tumours constitute a variety of pathologies with individual characteristics. Endocrine tumours of the pancreas are rare. Ductal adenocarcinomas arise most commonly in the head of the gland. They are solid, scirrhous tumours, characterised by neoplastic tubular glands within a markedly desmoplastic fibrous stroma. Fibrosis is also a characteristic of chronic pancreatitis, and histological differentiation between tumour and pancreatitis can cause diagnostic difficulties. Ductal adenocarcinomas infiltrate locally, typically along nerve sheaths, along lymphatics and into blood vessels. Liver and peritoneal metastases are common. Proliferative lesions in the pancreatic ducts can precede invasive ductal adenocarcinoma. These are termed pancreatic intraepithelial neoplasia or PanIN, and can demonstrate a range of structural complexity and cellular atypia. Cystic tumours of the pancreas may be serous or mucinous. Serous cystadenomas are typically found in older women, and are large aggregations of multiple small cysts, almost like bubblewrap. They are benign. Mucinous tumours, on the other hand, have the potential for malignant transformation. They include mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms (IPMNs). MCNs are seen in perimenopausal women, show up as multilocular thick-walled cysts in the pancreatic body or tail, and, histologically, contain an ovarian-type stroma. IPMNs are more common in the pancreatic head and in older men, but an IPMN arising from a branch duct can be difficult to distinguish from an MCN. IPMNs arising within the main duct are often multifocal and have a greater tendency to prove malignant. Thick mucus seen extruding from the ampulla at ERCP is diagnostic of a main duct IPMN. Mucinous tumours can be confused with pseudocysts. Occasionally, lympho epithelial cysts, lymphangiomas, dermoid cysts and intestinal duplication cysts can show up in the pancreas. Solid pseudopapillary tumour is a rare, slowly progressive but malignant tumour, seen in women of childbearing age, and manifests as a large, pa-solid, pa-cystic tumour. Tumours arising from the ampulla or from the distal common bile duct can present as a mass in the head of the pancreas, and constitute around a third of all tumours in that area. Adenomas of the ampulla of Vater are diagnosed at endoscopy as polypoid submucosal masses covered by a smooth epithelium. They can harbour foci of invasive carcinoma; the larger the adenoma, the greater the risk. Biopsies taken at endoscopy may not always include the malignant focus. Endoscopic surveillance, endoscopic resection or even surgical transduodenal ampullary excision should be considered . Patients with familial adenomatous polyposis (FAP) can present with multiple duodenal polyps. Malignant transformation in a duodenal polyp is a significant cause of moality in these patients, mandating endoscopic follow-up and pancreatoduodenectomy in selected patients with high- grade dysplasia within the polyp. Ampullary adenocarcinomas often present early with biliary obstruction. Their natural history is distinctly more ourable compared with pancreatic ductal adenocarcinoma. Ampullary carcinomas are relatively small when diagnosed, which may account for their better prognosis. Occasionally, other malignant neoplasms can arise at the ampulla, such as carcinoid tumours and high-grade neuroendocrine carcinomas. Ref: Bailey and love 27th edition Pgno : 1234", "cop": 4, "opa": "Adeno-carcinoma", "opb": "Squamous cell carcinoma", "opc": "Adeno-squamous cell carcinoma", "opd": "Duct cell adeno carcinoma", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "ece02523-1d28-4469-8795-38caddc51a9f", "choice_type": "single"} {"question": "Paralytic ileus is caused by", "exp": null, "cop": 1, "opa": "Peritonitis", "opb": "Hyperkalemia", "opc": "Acute intestinal obstruction", "opd": "Head injury", "subject_name": "Surgery", "topic_name": null, "id": "ba39d520-accd-4b84-992a-3f200f10c891", "choice_type": "single"} {"question": "Slit shaped nipple seen in", "exp": "Answer- A. Duct ectasiaDuct ectasia is dilatation of lactiferous ducts associated with periductal inflammation.Chronic inflammation and scarring will lead to indrawing and slit-shaped inversion of the nipple.If secondary infection supervenes, a mammary duct fistula can also develop.", "cop": 1, "opa": "Duct ectasia", "opb": "Duct pappiloma", "opc": "Paget's disease", "opd": "CA breast", "subject_name": "Surgery", "topic_name": null, "id": "1707f3c0-400e-427e-b96d-4ec03a1f0f55", "choice_type": "single"} {"question": "Intussusceptions frequently associated with", "exp": null, "cop": 2, "opa": "Subserosal lipoma", "opb": "Submucosal lipoma", "opc": "Intramural lipoma", "opd": "Subfascial lipoma", "subject_name": "Surgery", "topic_name": null, "id": "60e2e94a-cca6-4ee6-bcae-a6f9b29ef9f1", "choice_type": "single"} {"question": "If a patient with Raynaud’s disease immersed his hand in cold water, the hand will", "exp": null, "cop": 3, "opa": "Become red", "opb": "Remain unchanged", "opc": "Turn white", "opd": "Become blue", "subject_name": "Surgery", "topic_name": null, "id": "865beafc-5709-40ef-9303-25829373cb35", "choice_type": "single"} {"question": "Number of liver segment marked 'F\" as per Couinaud", "exp": "F is segment IV In diagram G, H are II and III, E is I (caudate lobe) D, C, A, B are V, VI, VII, VIIIThe Couinaud classification of liver anatomy divides the liver into eight functionally indepedent segments.Each segment has its own vascular inflow, outflow and biliary drainage.In the centre of each segment there is a branch of the poal vein, hepatic aery and bile duct.In the periphery of each segment there is vascular outflow through the hepatic veins.Right hepatic vein divides the right lobe into anterior and posterior segments.Middle hepatic vein divides the liver into right and left lobes (or right and left hemiliver). This plane runs from the inferior vena cava to the gallbladder fossa.The Falciform ligament divides the left lobe into a medial- segment IV and a lateral pa - segment II and III.The poal vein divides the liver into upper and lower segments.The left and right poal veins branch superiorly and inferiorly to project into the center of each segment.", "cop": 3, "opa": "II", "opb": "III", "opc": "IV", "opd": "V", "subject_name": "Surgery", "topic_name": "All India exam", "id": "7c431ac7-c1da-433f-bf4a-1538bf0b5334", "choice_type": "single"} {"question": "Upper dose limit of lignocaine in a 70 kg adult is", "exp": "Few common local anaesthetic drugs Name Maximum dose Comments Lignocaine 3 mg/kg (7 mg/kg with adrenaline) Early onset, sho acting, good sensory block Bupivacaine 2 mg/kg Long lasting, more cardio toxic, must never be used intravenously Prilocaine 6mg/kg (9 mg/kg with adrenaline) Least systemic toxicity, causes methemoglobinemia) Ropivacaine 3-4 mg/kg Less cardio toxic, greater sensory-motor seperation Levobupivacaine 2mg/kg Isomer of Bupivacaine with fewer cardio toxic propeies Ref: Bailey and love 27th edition Pgno : 273", "cop": 3, "opa": "100 mg", "opb": "150 mg", "opc": "200 mg", "opd": "250 mg", "subject_name": "Surgery", "topic_name": "Urology", "id": "c5e85ee1-dae6-40f2-af5d-b6782bd3128e", "choice_type": "single"} {"question": "Sensitivity to local anaesthetics is greater in", "exp": null, "cop": 2, "opa": "Type B fibres", "opb": "Type C fibres", "opc": "Type A delta fibres", "opd": "Fibres supplying the muscle spindles", "subject_name": "Surgery", "topic_name": null, "id": "509ea3f4-c562-40d3-84f0-fe792af6efea", "choice_type": "single"} {"question": "Treatment of Medullary Carcinoma thyroid", "exp": ". A total thyroidectomy with bilateral neck dissection is the gold standard for treating medullary thyroid cancer, and is the most definitive means of achieving a cure in patients without distant metastases or extensive nodal involvement. Due to the extreme level of difficulty in successfully performing the neck dissection without extensive morbidity, it is very impoant for patients to seek care under an experienced surgeon at a Center of Excellence who operates on MTC patients at least several times a year. Risks of surgery include loss of vocal control, irreparable nerve damage, death or the need for second operation to clean out residual diseased lymph nodes left behind if the sentinel node biopsy was positive for cancerous spread. Extensive surgery can be effective when the condition is detected early, but a risk for recurrence remains, paicularly in patients with multiple positive lymph nodes or extracapsular invasion. About half of patients have metastasis to regional lymph nodes at the time of diagnosis.", "cop": 3, "opa": "Surgery and radiotherapy", "opb": "Radiotherapy and chemotherapy", "opc": "Surgery only", "opd": "Radioiodine ablation", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "1c0453c9-7283-41bf-a90f-8b5411a8b0b6", "choice_type": "single"} {"question": "A 6 year old child has an accident and had elbow, after 4 years presented with tingling and numbness in the ulnar side of finger, fracture is", "exp": "B i.e. Lateral condyle", "cop": 2, "opa": "supra condylar humerus", "opb": "lateral condylar humerus", "opc": "olecranon", "opd": "dislocation of elbow", "subject_name": "Surgery", "topic_name": null, "id": "27b8cf81-a85a-491e-997f-94fb58af3730", "choice_type": "single"} {"question": "Anomaly associated with duodenal atresia is", "exp": "Duodenal atresia (DA) is thought to occur as a result of the failure of vacuolization of the duodenum from its solid cord stage.\nThe range of anatomic variants includes duodenal stenosis causing constipation, mucosal web with the intact muscular wall (so-called windsock deformity); two ends separated by a fibrous cord, or complete separation with a gap within the duodenum.\nAssociated Anomalies: DA is associated with several conditions, including prematurity, Down syndrome, maternal polyhydramnios, malrotation, annular pancreas, and biliary atresia.\nOther anomalies, such as cardiac, renal, esophageal, and anorectal anomalies, are also common.\nIn most cases, the duodenal obstruction is distal to the ampulla of Vater, and infants present with bilious emesis in the neonatal period.\nIn patients with a mucosal web, the symptoms of postprandial emesis may occur later in life. Diagnosis:\nThe classic plain abdominal radiograph of DA is termed the double-bubble sign (air-filled stomach and duodenal bulb, In cases in which there is no distal air, the diagnosis is secured, and no further studies are necessary. On the other hand, if the distal air is present, an upper gastrointestinal contrast study is performed fairly rapidly.\nThis study is important not only to confirm the diagnosis of duodenal stenosis or atresia but also to exclude midgut volvulus, which would constitute a surgical emergency.\nTreatment: The management of DA is by surgical bypass of the duodenal obstruction as either a side-to-side or proximal transverse-to-distal longitudinal (diamond-shaped) duodenoduodenostomy.", "cop": 1, "opa": "Down syndrome", "opb": "Duodenal adenomas", "opc": "Limb defects", "opd": "Autoimmune disorders", "subject_name": "Surgery", "topic_name": null, "id": "84e3f046-2f2e-4ee5-93ce-bd84763f5a9d", "choice_type": "single"} {"question": "Most common testicular tumor in prepubeal adults is", "exp": ".Seminoma Testis * Stas in the mediastinum of testis. * Grossly it is lobulated, fleshy, homogenous, creamy or pinkish in colour and it compresses adjacent testicular tissue. * Histologically, malignant cells resemble spermatocytes which are cells containing clear cytoplasm with large nucleus, and are arranged in sheets with fibrous stroma in between which is in turn infiltrated by lymphocytes. * It spreads through testicular lymphatics into the paraaoic lymph nodes and then to left supra-clavicular lymph node. Through blood, it spreads to lungs, bone, brain, liver. Histological Classification * Germ cell tumour. - Seminomatous - classic; spermatocytic; anaplastic. - Nonseminomatous type - embryonal carcinoma; teratomas; choriocarcinoma; yolk sac tumour (endodermal sinus tumour contains Schiller Duval bodies). * Sex cord stromal tumours - Leydig cell tumour; Seoli cell tumour; granulosa cell tumour. * Combined germ cell and gonadal stromal tumour - Gonadoblastoma. * Adnexal and paratesticular tumours - mesothelioma; sarcomas. * Others - carcinoids; lymphomas. * Secondaries. ref:SRB&;s manual of surgery,ed 3,pg no 1032", "cop": 1, "opa": "Yolk sac tumor", "opb": "Embryonal cell Ca", "opc": "Seminoma", "opd": "Teratoma", "subject_name": "Surgery", "topic_name": "Urology", "id": "b78f97fb-98a9-44ba-965b-9fed1f6bb064", "choice_type": "single"} {"question": "Commonest benign tumour of the esophagus", "exp": "Benign tumours of the oesophagus are unusual and constitute less than 1% of all oesophagal neoplasms. Approximately 60% of benign oesophagal lesions are leiomyomas, 20% are cysts, 5% are polyps, and the remaining 5% are other neoplasms.Ref: Sabiston 2oth edition pg:1047", "cop": 1, "opa": "Leiomyoma", "opb": "Papilloma", "opc": "Adenoma", "opd": "Hemangioma", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "c8ea3d08-b0b1-40ed-a375-c4316cb36c57", "choice_type": "single"} {"question": "A useful though temporary improvement in a patient's ischaemic foot can be attained by giving intravenously", "exp": null, "cop": 3, "opa": "10% Mannitol", "opb": "10% Dextrose", "opc": "Dextran 40", "opd": "Dextran 100", "subject_name": "Surgery", "topic_name": null, "id": "52739c3e-b48e-44ce-9949-9761f6efe2f9", "choice_type": "single"} {"question": "BIRAD's Score is designed to", "exp": "Answer- A. Maintain uniformity in the repoing of imaging findings of various breast diseasesBIRADS stands for Breast Imaging-Repoing and Data System. It's a quality assurance tool developed by American college of Radiology.The system is designed to standardize both the repoing of imaging findings and the recommendations for fuher management.", "cop": 1, "opa": "Maintain uniformity in the repoing of imaging findings of various breast diseases", "opb": "Prognosticate CA Breast", "opc": "Evaluate the effect of brachial aery thrombosis", "opd": "Clinicoradiological association of breast malignancy", "subject_name": "Surgery", "topic_name": null, "id": "41fb11b4-dc3c-45b5-8ae2-67fae105ac1a", "choice_type": "single"} {"question": "Lymph nodes involved in anal Ca. Is", "exp": "Inguinal lymph nodes are involved in anal ca.", "cop": 1, "opa": "Inguinal lymph nodes", "opb": "Iliac lymph nodes", "opc": "Para aortic", "opd": "Subclavicular", "subject_name": "Surgery", "topic_name": null, "id": "fc762b8d-4382-43b7-a4c9-769bb90ebbc9", "choice_type": "single"} {"question": "This develops along lines of embryological fusion in the floor of the mouth. SELECT ONE.", "exp": "Dermoid cysts arise along line of fusion of embryonic parts. In the floor of the mouth, the swelling forces the tongue upward. Alternatively, the swelling may occur below the mylohyoid muscle, where it gives the impression of a double chin. It is not a premalignant lesion. It has an epithelial lining and may contain secretions, sloughed-off cells, and hair.", "cop": 2, "opa": "Cholesteatoma", "opb": "Dermoid cyst", "opc": "Glomus tumor", "opd": "Neurofibroma", "subject_name": "Surgery", "topic_name": "Neck", "id": "35a52572-6f2d-4b81-9cfd-13e272afb36f", "choice_type": "single"} {"question": "Commonest cause of lung abscess is", "exp": "Lung abscess Lung abscess refers to a microbial infection of the lung that results in necrosis of the pulmonary parenchyma MC cause of primary lung abscess : Anaerobic bacteria Etiology of anaerobic lung abscess : Aspiration Routes of infection Aspiration of organisms that colonize oropharynx (MC) Inhalation of infection or aerosols Hematogenous dissemination from extrapulmonary site Direct inoculation (as in tracheal intubation or stab wounds) Contiguous spread from an adjacent site of infection Ref: schwaz's principle of surgery 10th edition Pgno : 650", "cop": 3, "opa": "Aspiration", "opb": "Hematogenous spread from distant date", "opc": "Direct contact", "opd": "Lymphatic spread", "subject_name": "Surgery", "topic_name": "Cardio thoracic surgery ", "id": "d337d21f-f500-4a61-b045-4ee005e4b5e2", "choice_type": "single"} {"question": "Most common cause of lower gastro intestinal bleeding is", "exp": ".Diveiculitis is the second stage due to inflammation of one or more diveicula with pericolitis.It presents with persistent pain in left iliac fossa, fever, loose stool, recurrent constipation, tenderness in right iliac fossa, palpable and thickened sigmoid colon. P/R may reveal a tender mass. Features of diveiculitis - Pain in left iliac fossa which is constant radiates to back and groin, tenderness, bloody stool, often massive haemorrhage, fever, rigidity and mass in left iliac fossa. Mass is usually tender, firm, resonant, nonmobile. ref:SRB&;s manual of surgery,ed 3,pg no 821", "cop": 1, "opa": "Diveiculitis", "opb": "Colorectal carcinoma", "opc": "Angiodysplasia", "opd": "Anal fissure", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "5ffc43dd-98cf-4136-aebe-3a57c4451853", "choice_type": "single"} {"question": "Burst abdomen most commonly occurs on the", "exp": "Ans. is 'c' i.e., 7\"' day", "cop": 3, "opa": "2nd day", "opb": "3rd day", "opc": "7th day", "opd": "9th day", "subject_name": "Surgery", "topic_name": null, "id": "4958b62d-09fc-4404-9a6b-d96997dcc326", "choice_type": "single"} {"question": "Gastrointestinal secretion with highest amount of carbohydrate", "exp": "NaKClHCO3Saliva10251030Stomach5015110-Duodenum1405100-Ileum 140510030Pancreas140575115Bile140510035Ref: Bailey and Love 27e pg: 281", "cop": 4, "opa": "Saliva", "opb": "Duodenal secretions", "opc": "Bile", "opd": "Pancreatic juice", "subject_name": "Surgery", "topic_name": "General surgery", "id": "386a0c81-96db-4a15-8f4d-b85ecc8d9c94", "choice_type": "single"} {"question": "Snow storm ascites is seen in", "exp": ".meconium is neonatal manifestation of fibrocystic disease of the pancreas, wherein thick meconium which is viscid and paste like, gets collected in the terminal ileum. Because of inspissation it forms a firm bolus leading to obstruction of the ileum Meconium ileus- * Commonly associated with cystic disease of pancreas but not necessarily always * Respiratory dysfunction * Exocrine pancreatic insufficiency * High salt in the sweat > 90 mmol/L * Ileal obstruction * Soap bubble appearance in X-ray * Gelatin in X-ray film will not get digested by patient's vomitus * Bishop-Koop operation, ileostomy, dissolving ileal meconium pellets are required. ref:SRB&;s manual of surgery,ed 3,pg no 862", "cop": 1, "opa": "Meconium ileus", "opb": "Hirschsprung disease", "opc": "Ileocaecal tuberculosis", "opd": "Pseudomyxoma peritonei", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "1dc70b77-534c-456c-8215-70dfe6f7f20f", "choice_type": "single"} {"question": "In fracture neck of fibula, the following nerve is involved", "exp": "A i.e. Common peroneal nerve Smallar terminal branch of sciatic nerve, the common peroneal (lateral popliteal) nerve arises in the lower third of thigh. It runs down ward through the popliteal fossa (lateral side) closely following the medial border of biceps femoris muscle. It leaves the fossa by crossing superficially the lateral head of the gastrocnemius muscle. It then passes behind the head of the fibula, winds laterally around the neckQ of the bone, pierces the peroneus longus muscle, and divides into two terminal branches superficial and deep peroneal nerve. The common peroneal nerve is extremely vulnerable to injury as it winds around the neck of fibulaQ by direct trauma and fractures. Injury to common peroneal nerve causes foot dropQ. Beware : an isolated fracture of proximal fibula is rare : it may be merely the most visible pa of a more extensive rotational injury of leg involving a serious fracture or ligament injury of the ankle (the Misonneuve fracture). So alsways X - ray the ankle !", "cop": 1, "opa": "Common peroneal nerve", "opb": "Anterior tibial nerve", "opc": "Posterior tibial nerve", "opd": "Medial popliteal nerve", "subject_name": "Surgery", "topic_name": null, "id": "e9d19b6c-b244-46cc-84ca-4dc18f8ed0ee", "choice_type": "single"} {"question": "GCS minimum value", "exp": "Answer- A. 3Glasgow coma scale is used to determine the conscious level of the patient.Ranges from 3 to 15.", "cop": 1, "opa": "3", "opb": "6", "opc": "0", "opd": "4", "subject_name": "Surgery", "topic_name": null, "id": "adf180eb-7fc0-494d-880e-1a522c4ee6d2", "choice_type": "single"} {"question": "Marsupialization is the procedure done in", "exp": null, "cop": 1, "opa": "Large cyst", "opb": "P.D. cyst", "opc": "Aneurismal bone cyst", "opd": "Stafne cyst", "subject_name": "Surgery", "topic_name": null, "id": "f327999d-c2d5-45b7-b64f-ec4bd9e99604", "choice_type": "single"} {"question": "A 40 years old male with CA descending colon presents with acute intestinal obstruction. Emergency treatment of choice is", "exp": null, "cop": 1, "opa": "Hartman’s procedure", "opb": "Ileostomy", "opc": "Left hemicolectomy", "opd": "Total colectomy", "subject_name": "Surgery", "topic_name": null, "id": "ed031816-aa41-4e79-a0a5-4772702917ea", "choice_type": "single"} {"question": "Vocal cord palsy in thyroid surgery is due to injury to", "exp": "Reccurent laryngeal nerve injury is classically described as a paralyzed vocal cord with loss of movement from the midline (supplies all the intrinsic muscles of the larynx, except cricothyroid muscles). Injury to the external branch of the superior laryngeal nerve leads to loss of tension in the vocal cord (supplies cricothyroid) with diminished power and range in the voice Source : Bailey and Love 26th edition Pg: 762", "cop": 2, "opa": "Superficial laryngeal nerve", "opb": "Recurrent laryngeal nerve", "opc": "Ansa cervicalis", "opd": "Vagus nerve", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "5c995de7-39e3-4ceb-8453-00476bf8ad27", "choice_type": "single"} {"question": "This appearance of mammary skin is due to", "exp": "Ans. (c) Lymphatic penetration.Observe the dotted dimpling on the skin which resembles orange peel, hence the name peau-d-orange.Peau-d-orange is due to cutaneous lymphatic blockage, leading to an appearance like orange skin, this condition is due to lymphatic penetration by tumor cells.Image source- style=\"font-family: Times New Roman, Times, serif\">", "cop": 3, "opa": "Intra-epithelial cancer", "opb": "Sub-epidermal cancer", "opc": "Lymphatic penetration", "opd": "Vascular embolization", "subject_name": "Surgery", "topic_name": "Breast Cancer - Types and Staging", "id": "b8611cc2-ccc3-4ac7-9e5e-ca7fa40211d5", "choice_type": "single"} {"question": "Spermatocoeles are most commonly found at", "exp": "Answer- A. The Head of epidydimisSpermatoceles typically arise from the caput (head) of the epididymis, which is located on the superior aspect of the testicle.", "cop": 1, "opa": "The Head of epidydimis", "opb": "Testis", "opc": "Prostate", "opd": "Seminal Vescicles", "subject_name": "Surgery", "topic_name": null, "id": "3fefe690-072e-407e-b5db-eca2eb79299d", "choice_type": "single"} {"question": "Chylothorax means pleural cavity containing", "exp": "(A) Lymph # CHYLOTHORAX OR CHYLE LEAK is a type of pleural effusion &results from lymph formed in the digestive system called chyle accumulating in the pleural cavity due to either disruption or obstruction of the thoracic duct.> Causes: It is rare but serious, and It results from leakage of lymph fluid from the thoracic duct (or one of its tributaries). This can result from direct laceration (e.g., from surgery) or from nontraumatic causes. The most common nontraumatic cause is malignancy, especially lymphoma. Less common is left-heart failure, infections, and developmental abnormalities such as Down syndrome and Noonan syndrome.> Treatment of Chylothorax: Drainage of the fluid out of the pleural space is essential to obviate damage to organs, especially the inhibition of lung function by the counter pressure of the chyle. Pleuroperitoneal shunting (creating a communication channel between pleural space and peritoneal cavity). Loss of essential triglycerides that escape the thoracic duct can be prevented. Omitting fat (in particular FFA) from the diet is essential. Surgical or chemical pleurodesis: leaking of lymphatic fluids is stopped by irritating the lungs and chest wall, resulting in a sterile inflammation. Llung and the chest wall to be fused together which prevents the leaking of lymphatic fluids into the pleural space. Octreotide has been shown to be beneficial and in some cases will stop the chylothorax after a few weeks.", "cop": 1, "opa": "Lymph", "opb": "Blood", "opc": "Air", "opd": "Pus", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "378311af-67c1-4755-bebe-320de06879cb", "choice_type": "single"} {"question": "Charcots/neuropathic joints are most commonly seen in September 2007", "exp": "Ans. A: DM Any condition that causes sensory or autonomic neuropathy can lead to a Charcot joint. Charcot ahropathy occurs as a complication of diabetes, syphilis, chronic alcoholism, leprosy, meningomyelocele, spinal cord injury, syringomyelia, renal dialysis, and congenital insensitivity to pain. Diabetes is considered to be the most common cause of Charcot ahropathy Acute Charcot ahropathy almost always presents with signs of inflammation. Profound unilateral swelling, an increase in local skin temperature (generally, an increase of 3-7 degrees above the nonaffected foot's skin temperature), erythema, joint effusion, and bone resorption in an insensate foot are present. These characteristics, in the presence of intact skin and a loss of protective sensation, are often pathognomonic of acute Charcot ahropathy. Pain can occur in more than 75% of patients; however, the pain's severity is significantly less than would be expected based on the severity of the clinical and/or radiographic findings. Instability and loss of joint function also may be present. Passive movement of the joint may reveal a \"loose bag of bones.\" Approximately 40% of patients with acute Charcot ahropathy have concomitant ulceration, which complicates the diagnosis and raises concerns that osteomyelitis is present.", "cop": 1, "opa": "DM", "opb": "Syringolmyelia", "opc": "Leprosy", "opd": "Rheumatoid ahritis", "subject_name": "Surgery", "topic_name": null, "id": "cc0322be-c834-4c99-8f44-a5f8db3e91b1", "choice_type": "single"} {"question": "Blisters are seen in", "exp": "Superficial second degree burns Involve upper layer of dermis (papillary dermis) Erythematous Blisters are seen Blanch to touch Painful Heals without scarring in 7-14 days Ref: Sabiston 20th edition Pgno :506-507", "cop": 2, "opa": "1st degree burn", "opb": "Superficial 2nd degree burn", "opc": "Deep 2nd degree burn", "opd": "3rd degree burn", "subject_name": "Surgery", "topic_name": "General surgery", "id": "fdfdc54c-df08-4f84-b066-7a2f244abe8a", "choice_type": "single"} {"question": "Not used for intravascular volume maintainence is", "exp": "Answer- C. ErythropoetinErytheropoetin InjectionsErythropoietins available for use as therapeutic agents are produced by recombinant DNA technology in cell culture, They are used in treating anemia resulting from chronic kidney disease, chemotherapy induced anemia in patients with cancer, inflammatory bowel disease (Crohn's disease and ulcerative colitis).", "cop": 3, "opa": "Hydroxy ethyl starch", "opb": "Dextran", "opc": "Erythropoetin", "opd": "Gelatin", "subject_name": "Surgery", "topic_name": null, "id": "a5b90d0b-3047-401a-8a8a-c8f1beca4822", "choice_type": "single"} {"question": "Ulcerative colitis starts in", "exp": "(A) Rectum # Pathology of ulcerative colitis: In 95%t of cases the disease starts in the rectum and spreads proximally.> When the ileocaecal valve is incompetent, retrograde (backwash) ileitis involving the last 30 cm of the ileum is likely to occur.> It is a nonspecific inflammatory disease, primarily affecting the mucosa and superficial submucosa, and only in severe disease are the deeper layers of the intestinal wall affected> There are multiple minute ulcers, and microscopic evidence proves that the ulceration is almost always more severe and extensive than the gross appearance indicates.> When the disease is chronic, inflammatory polyps (pseudopolyps) occur in up to 20 per cent of cases and may be numerous.> They result from previous episodes of ulceration heaving islands of spared mucosa which will remain prominent when the adjacent mucosa heals.> In severe fulminant colitis a section cf the colon, usually the transverse colon, may become acutely dilated and the intestinal wall then becomes extremely thin and may perforate ('toxic megacolon').> On microscopic investigation there is an increase of inflammatory cells in the lamina propia, the walls of crypts are infiltrated by inflammatory cells and there are crypt abscesses.> There is depletion of goblet cell mucin. The crypts are reduced in number and appear to be atrophic and irregularly spaced. With time these changes become severe and precancerous changes can develop (severe dysplasia or carcinoma in situ).", "cop": 1, "opa": "Rectum", "opb": "Transverse colon", "opc": "Caecum", "opd": "Descending colon", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "d919bc11-ec89-4256-b70c-dea00ffb6fd0", "choice_type": "single"} {"question": "Bassini's repair for hernia is done for", "exp": null, "cop": 1, "opa": "Inguinal hernia", "opb": "Femoral hernia", "opc": "Spigelion hernia", "opd": "Epigostric hernia", "subject_name": "Surgery", "topic_name": null, "id": "7e747b7b-8c40-47d9-b722-81def1080837", "choice_type": "single"} {"question": "The use of medical history in extraction patients is", "exp": null, "cop": 3, "opa": "In medico legal cases", "opb": "To assess the growth stage of a patient", "opc": "To determine bleeding disorder", "opd": "To determine communicable disease", "subject_name": "Surgery", "topic_name": null, "id": "7770ebf4-6aa9-41a2-a9fc-e415e79db740", "choice_type": "single"} {"question": "Amount of thyroid tissue left after subtotal thyroidectomy is", "exp": "Total thyroidectomy involves excision of all visible thyroid tissue. Near-total thyroidectomy is complete resection on one side while leaving a remnant of thyroid tissue on the contralateral side, leaving less than 1 g of tissue adjacent to the RLN at the ligament of Berry. Subtotal thyroidectomy leaves a remnant of thyroid tissue bilaterally. Subtotal resection of each lobe is carried out, leaving a remnant of 4-5 g on each side. Thyroid lobectomy typically includes removal of the thyroid isthmus and pyramidal lobe (if present). Source : Sabiston 20th edition Pg : 912 Bailey and Love 26th edition Pg : 761", "cop": 2, "opa": "4gm on one side", "opb": "4gm on each side", "opc": "6gm on one side", "opd": "6gm on each side", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "cca0069d-bfec-46ab-8cb2-1e18cfd3a432", "choice_type": "single"} {"question": "Partial thickness graft is", "exp": "Ans. b (Thierch graft) (Ref. Bailey and Love 26th/pg.402)SKIN GRAFTSSplit Thickness (Therisch)Full Thickness (Wolfe)Donor site factor# Large area available# Smaller area# Donor site heals spontaneously# Donor site must be closed# Reusable donor site# Donor site scarsRecipient site factors# Poor color match# Good color match# Easily abraded# Abrasion resistant# inferior cosmetic results# Good cosmetic results# More reliable take# Less reliable take# Shiny texture, inelastic# Normal texture, elastic(Note: Wolfe's graft is a Whole (Full) thick-ness graft)", "cop": 2, "opa": "Wolfian graft", "opb": "Thierch graft", "opc": "Pedicle graft", "opd": "Patch graft", "subject_name": "Surgery", "topic_name": "Plastic & Reconstructive Surgery", "id": "233665a6-0cc5-4fe9-89f3-084cf0d58443", "choice_type": "single"} {"question": "A metastatic carcinoma in the brain of an adult, most often comes from primary in the", "exp": "Ans. is 'd' i.e. Lung", "cop": 4, "opa": "Stomach", "opb": "Ovary", "opc": "Oral cavity", "opd": "Lung", "subject_name": "Surgery", "topic_name": null, "id": "24427d15-111d-4289-8aac-1424c302af21", "choice_type": "single"} {"question": "In the immediate post operative period, body potassium is", "exp": "There is increased Adreno cortical activity which causes Na+ retention & K+ excretion.", "cop": 4, "opa": "Exchanged with calcium", "opb": "Exchanged with magnesium", "opc": "Retained in body", "opd": "Excreted excessively", "subject_name": "Surgery", "topic_name": null, "id": "f8ccdfcf-695d-45ae-8317-caf6fe2f36b0", "choice_type": "single"} {"question": "Most appropriate management of advanced stage rectal carcinoma", "exp": "(B) Abdominoperineal resection # 'RECTAL CARCINOMA' located at 5 cm from the anal verge lies in the lower rectum.> Considering the conventional methods of treatments Anterior resection is possible for tumors of upper 2/3rd of rectum Abdominoperineal resection is indicated for tumors of lower 1/3rd of rectum> General site specific plan> Upper Rectum (> 11 cm) Anterior Resection , Mid Rectum (6-11 cm) Low Anterior resection , Lower Rectum (< 6 cm) Abdominal- perineal resection> Note: Length of rectum is about 12 to 15 cm and the anal canal is about 4 cm, any tumor 5 cm from anal verge would thus lie at lower rectum.> General considerations for tumors in lower Rectum: Abdominoperineal Resection (APR) is the gold standard for the treatment of distal rectal cancer. 'APR' involves complete excision of rectum and anus, by concomitant dissection through abdomen and perineum, with permanent closure of perineal rafe and creation of an end colostomy. The most significant disadvantage of this procedure is that it sacrifices the sphincter mechanism and hence now focus is shifting towards a number of sphincter sparing procedures.> It is important however to note here that the information provided is too limited to comment upon the possibility of performing sphincter saving procedures such as local resection or a posterior proctotomy.> Sphincter sparing procedures may be carried out for Young patients who have a favourable body habitus Patients with good preoperative sphincter function Lack of sphincter involvement by tumor Limited extension of tumor into rectal wall (T1 or T2 lesions) Low grade tumors> Sphincter sparing procedures include: Colonal anastomosis Local excision Transanal excision Trans sphincteric excision Posterior proctotomy (Kraske procedure)", "cop": 2, "opa": "Anterior resection", "opb": "Abdominoperineal resection", "opc": "Proximal colostomy", "opd": "Ileostomy", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "f5ade5e7-7d25-4f98-9153-36ff2752ce6e", "choice_type": "single"} {"question": "HLA B27 is seen associated with aEUR'", "exp": "Ankylosing spondylitis HLA B27 is associated with: Ankylosing spondylitisQ Reiter's syndromeQ Reactive ahritis (yersinia, salmonella, shigella, Chlamydia) Psoriatic spondylitisQ", "cop": 2, "opa": "Rhematoid ahritis", "opb": "Ankylosing spondylitis", "opc": "Sjogren syndrome", "opd": "Scieroderma", "subject_name": "Surgery", "topic_name": null, "id": "afc2f78a-3647-49ad-a87f-e91ea330d749", "choice_type": "single"} {"question": "Gas most commonly used to create pneumoperitonium is", "exp": "Ans) a (CO2) Ref:hnp:/Avww.researchgate.net/pubHcation/6252R23_Pathophysiologic effects of CO2-pneiimopentoneum in lupanmnpic surgeryLaparoscopic surgery is one of the most important diagnostic and therapeutic tools in general surgery. This minimally invasive procedure requires pneumoperitoneum for adequate visualization and operative ma-nipulation.Carbon dioxide is the most commonly used gas for creating pneumoperitoneum, because of its high diffusibility and rapid rate of absorption and excretion.Certain specific surgeries that in the past required long hospitalization and were associated with severe post- operative pain and frequent compli-cations are today performed laparoscopically. This minimally invasive technique potentially offers reduced operative time and morbidity, decreased hospital stay and earlier return to normal activities, less pain and less post-operative ileus compared with the traditional open surgical procedures.Because the postoperative benefits are superior to open surgical pro-cedures, laparoscopy is today also used in many high risk patients in ad-vanced age and pre-existent cardiopulmonary and respiratory diseases.However, insufflations of carbon dioxide into the peritoneum may lead to alteration in the acid-base balance, cardiovascular and pulmonary physiology. Although these changes may be well tolerated in healthy pa-tients, in high risk patients they may increase the rate of perioperative complications.", "cop": 1, "opa": "CO2", "opb": "N2", "opc": "NO2", "opd": "Helium", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "0ee35b3e-a64d-4b67-83a9-49bb93c92f9d", "choice_type": "single"} {"question": "A 12 year old girl presents with a 0.4 cm slightly raised strawberry coloured nodule in the skin of the abdomen below the umbilicus. It is present for many years and not changed in color or size. Diagnosis", "exp": "Answer: c) Hemangioma (ROBBINS 9th ED, P-516)HEMANGIOMAHemangiomas are very common tumors characterized by increased numbers of normal or abnormal vessels filled with bloodMost are present from birth and initially increase in size, but many eventually regress spontaneouslyWhile hemangiomas typically are localized lesions confined to the head and neck, they can occasionally be more extensive (angiomatosis) and can occur internally.Nearly one third of these internal lesions are found in the liverMalignant transformation is rare.Capillary hemangiomasMost common typeOccur in the skin, subcutaneous tissues, and mucous membranes of the oral cavities and lips, as well as in the liver, spleen, and kidneysJuvenile hemangiomas (strawberry type hemangiomas)Juvenile hemangiomas of the newborn are extremely common and can be multiple.These arise in the skin and grow rapidly for a few months, but then fade by 1 to 3 years of age and completely regress by age 7 in the vast majority of cases.Cavernous hemangiomasComposed of large, dilated vascular channelsAs compared to capillary hemangiomas, cavernous hemangiomas are more infiltrative, frequently involve deep structures, and do not spontaneously regress.Intravascular thrombosis and associated dystrophic calcification are common.They can be locally destructive, and as a result some may require surgery.Cavernous hemangiomas are one component of von Hippel-Lindau diseasePyogenic granulomasCapillary hemangiomas that present as rapidly growing red pedunculated lesions on the skin, gingival, or oral mucosa.They bleed easily and are often ulceratedRoughly a quarter of lesions develop after trauma, reaching a size of 1 to 2 cm within a few weeks.Curettage and cautery is usually curative.Pregnancy tumor (granuloma gravidarum) is a pyogenic granuloma that occurs infrequently (1% of patients) in the gingiva of pregnant women.These lesions may spontaneously regress (especially after pregnancy), or undergo fibrosis, but occasionally require surgical excision", "cop": 3, "opa": "Carcinoma", "opb": "Melanoma", "opc": "Hemangioma", "opd": "Lymphoma", "subject_name": "Surgery", "topic_name": "Neoplasia", "id": "d1558bab-94ad-4fac-95c5-aa2bf7cf5325", "choice_type": "single"} {"question": "The most common facial abnormality in Gardener's syndrome", "exp": "Ans. is 'c' i.e. Multiple osteomas Osteomas is mandible and skull are the most common facial lesions in Gardner syndrome. Gardner syndrome is a variant of FAP characterized by: - Colorectal polyposis - Epidermoid cysts - Desmoid tumors - Osteomas - Thyroid neoplasms, and - Congenital hyperophy of the retinal pigment epithelium", "cop": 3, "opa": "Ectodermal dysplasia", "opb": "Odontome", "opc": "Multiple osteomas", "opd": "Dental cysts", "subject_name": "Surgery", "topic_name": null, "id": "6d1d98c5-077f-41ec-8495-dc53fd1a8c18", "choice_type": "single"} {"question": "Commonest cause of cellulitis is", "exp": "Ans. (b) Streptococcus(Ref: Bailey 26th 55)* Most common cause of cellulitis is Streptococci. Other causes include Staphylococci, and C.Perfringens", "cop": 2, "opa": "Staphylococcus", "opb": "Streptococcus", "opc": "E. coli", "opd": "Hemophilus", "subject_name": "Surgery", "topic_name": "Pathogenesis", "id": "b1592ee0-88f7-4c40-b064-f6f7f8275514", "choice_type": "single"} {"question": "The advantage of bladder drainage over enteric drainage after pancreatic transplantation is better monitoring of", "exp": "The specific complications of enteric drainage include intra-abdominal sepsis and adhesive small intestinal obstruction.Bladder drainage of the exocrine pancreas may result in the following complications:* bladder/duodenal anastomotic leaks;* cystitis (owing to effect of pancreatic enzymes);* urethritis/urethral stricture;* reflux pancreatitis;* urinary tract infection;* haematuria;* metabolic acidosis (due to loss of bicarbonate in the urine).Urinary drainage of the pancreas has the advantage that urinary amylase levels can be used to monitor for graft rejection. However, after bladder drainage, urinary complications are commonBailey and Love 26th edition pg: 1427", "cop": 2, "opa": "HBA IC levels", "opb": "Amylase levels", "opc": "Glucose levels", "opd": "Electrolyte levels", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "f0e21a4e-a880-4349-8591-6ef93109cd68", "choice_type": "single"} {"question": "\"Doughnut\" sign is seen in", "exp": ".CONGENITAL HYPEROPHIC PYLORIC STENOSIS is hyperophy of musculature of pyloric antrum, especially the circular muscle fibres, causing primary failure of pylorus to relax. Duodenum is normal. Clinical features of congenital pyloric stenosis 1. Vomiting 2. VGP 3. Palpable mass 4. Constipation and dehydration Diagnosis is established by -- Clinical examination. -- U/S abdomen (very useful)--Doughnut sign. * Pyloric muscle 4 mm or more in thickness. * Length of pyloric canal > 1.8 cm. -- Barium meal shows obstruction. ref:SRB&;S manual of surgery,ed 3,pg no 752", "cop": 3, "opa": "Intussusception", "opb": "Carcinoma colon", "opc": "CHPS", "opd": "Volvulus", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "0c5fa0ac-8bd7-43e3-a78c-219dfa4afb39", "choice_type": "single"} {"question": "CT severity index is a measure of", "exp": "Ans. (b) PancreatitisRef: Sabiston 20th ed; pg. 1528* Balthazar scoring is a CT scoring system* CTSI is one of the best system used to classify the severity of pancreatitis.", "cop": 2, "opa": "Hepatitis", "opb": "Pancreatitis", "opc": "Cerebral trauma", "opd": "Meningitis", "subject_name": "Surgery", "topic_name": "Pancreas", "id": "95af4f95-0c29-4f85-bdc7-cb1fe44e7cbc", "choice_type": "single"} {"question": "Lumbar sympathectomy is the treatment for", "exp": "(B) Distal ischaemia affecting the skin of the toes with rest pain", "cop": 2, "opa": "Trophic ulcer", "opb": "Distal ischaemia affecting the skin of the toes with rest pain", "opc": "Arteriovenous fistula", "opd": "Diabetic neuropathy", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "5a8defb0-e030-40ac-a378-87d539ffe26d", "choice_type": "single"} {"question": "The facial space that is divided by styloid process into an anterior and posterior compartment is", "exp": null, "cop": 2, "opa": "Pterygomandibular", "opb": "Lateral pharyngeal", "opc": "Retropharyngeal", "opd": "Infratemporal", "subject_name": "Surgery", "topic_name": null, "id": "4bc695dc-42ae-4f33-9bd9-8619e496a171", "choice_type": "single"} {"question": "Earliest sign of deep vein thrombosis is", "exp": null, "cop": 1, "opa": "Calf tenderness", "opb": "Rise in temperature", "opc": "Swelling of calf muscle", "opd": "Homan's sign", "subject_name": "Surgery", "topic_name": null, "id": "573cbc44-2226-4ade-9755-c38d3230c772", "choice_type": "single"} {"question": "Treatment of choice for Tension pneumothroax is", "exp": "tension pneumothorax must be treated as a medical emergency. If the tension in the pleural space is not relieved, the patient is likely to die from the inadequate cardiac output or marked hypoxemia. A large-bore needle should be inseed into the pleural space through the second anterior intercostal space. If large amounts of gas escape from the needle after inseion, the diagnosis is confirmed. The needle should be left in place until a thoracostomy tube can be inseed. Ref : Harrison 17/e p1660; Bailey & Love 25/e p879", "cop": 1, "opa": "Immediate IC tube drainage", "opb": "Continuous aspiration by needle", "opc": "Intermittent aspiration by needle", "opd": "Thoractomy with repair of leakage", "subject_name": "Surgery", "topic_name": "Cardio thoracic surgery ", "id": "d565be66-1c8b-426e-97d1-7a7aef4fb7cb", "choice_type": "single"} {"question": "Skip lesions are seen in", "exp": "in ileocaecal tuberculosis,.Ulcerative--commonest 60%. Circumferential transverse often multiple 'girdle' ulcers - with skip lesions. It i common in old, malnourished people. skip lesions are typical in the case of crohn&;s diseaseskip lesions are also observed in wet gangrene and necrotizing enterocolitis . ref:SRB&;s manual of surgery,ed 3,pg no 513", "cop": 2, "opa": "Ulcerative colitis", "opb": "Crohn's disease", "opc": "Typhoid", "opd": "Tuberculosis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "c578e074-2063-40bd-bcb2-e46852c541f6", "choice_type": "single"} {"question": "The colour of a nitrous oxide cylinder is", "exp": null, "cop": 2, "opa": "Red", "opb": "Blue", "opc": "White", "opd": "Black", "subject_name": "Surgery", "topic_name": null, "id": "40f7ca2b-a0f6-4e57-9346-a8098065c1b8", "choice_type": "single"} {"question": "The occurrence of hyperthyroidism following administration of supplemental iodine to subject with endemic iodine deficiency goitre is known as", "exp": null, "cop": 1, "opa": "jod – basedow effect", "opb": "wolff- chalkoff effect", "opc": "thyrotoxicosis facticia", "opd": "dequervain’s thyroiditis", "subject_name": "Surgery", "topic_name": null, "id": "09e510b2-76ed-4ed3-b3b2-85df34bcad1e", "choice_type": "single"} {"question": "Most common ovarian malignancy in post menopausal period is", "exp": "Ans a Ref: Sheila balakrishnan page 256Epithelial tumor: Majority are seen in post menopausal woman, peak incidence between 50-60.30-40:peak incidence of borderline tumorsLess common under 40 yrsMost common epithelial tumor is serous cystadenoma followed by mucinous.Sex cord stromal tumors: can occur at all ages Germ cell tumors: common among children, young adults", "cop": 1, "opa": "Serous cystadenoma", "opb": "Fibroma/thecoma", "opc": "Teratoma", "opd": "Mucinous tumor", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "60dc0006-d1a0-46e9-ba6f-0410f242830a", "choice_type": "single"} {"question": "Most common cause of lymphedema of upper limb is", "exp": null, "cop": 4, "opa": "Filariasis", "opb": "Bacterial infection", "opc": "Congenital", "opd": "Post mastectomy", "subject_name": "Surgery", "topic_name": null, "id": "99900a12-a4ff-46f6-8e9b-277341174db8", "choice_type": "single"} {"question": "Nodular regenerating hyperplasia is associated with aEUR'", "exp": "Drug [Ref: www.ijpmonline.org; Depament of Pathology AFMC Pune D.shelly, MS Tevetial Nodular regenerative hvperplasia Nodular regenerative hyperplasia of the liver is an uncommon condition characterized by diffuse benign transformation of the hepatic parenchyma into small regenerative nodules with minimal or no fibrous septa i.e., \"unlike cirrhosis there is absence of fibrosis\". It is also known as :? - Nodular transformation - Noncirrhotic nodules - Paial nodular transformation Nodular regenerative hyperplasia belongs to a group of liver diseases that causes an intrahepatic noncirrhotic poal hypeension (NCPHP. In addition to nodular regenerative hyperplasia this group includes incomplete septal cirrhosis and hepatopoal sclerosis. Nodular regenerative hyperplasia is the most common cause of noncirrhotic poal hypeension in the western world and is responsible for 14-27% of cases of NCPH. Conditions associated with nodular regenerative hyperplasia Nodular regenerative hyperplasia has been described in association with a variety of conditions. Most of them are systemic autoimmune diseases or hematological disorders and less frequently solid neoplasms, drugs. Connective tissue disease associated with nodular regenerative hyperplasia Antiphospholipid syndromeQ Felty's syndrome Lupus erythematosis Sjogren's syndrome Systemic sclerosis Hematological disorders associated with Nodular regenerative hyperplasia Usually myeloproliferative disorders Drugs associated with nodular regenerative hyperplasia AzathioprineQ Pathogenesis of nodular regenerative hyperplasia:- Pathogenesis is unceain but seems to be related to abnormalities of hepatic blood flow. The vascular lesions in nodular regenerative hyperplasia could be due to recurrent entbolization of the poal vein radicals by platelet aggregates and thrombi originating in the poal venous system.", "cop": 3, "opa": "Budd-chiari syndrome", "opb": "Alcohol", "opc": "Drug", "opd": "Hepatitis B", "subject_name": "Surgery", "topic_name": null, "id": "ed62788f-77e5-4bf6-8a4d-4c4a2cc62ab2", "choice_type": "single"} {"question": "A man takes peanut and develop stridor, neck swelling, tongue swelling and hoarseness of voice. Most probable diagnosis is", "exp": "Angioneuritic edema (Ref. Harrison 17th/e p 2066 & 16riVe p 52, 1952] Angioedema is essentially an anaphylaxis limited to the skin and subcutaneous tissues and can be due to drug allergy, insect stings or bites, desensitization injections or ingestion of ceain foods (paicularly eggs, shellfish or nuts) Sometimes reactions occur explosively after ingestion of minute amounts. Others (e.g. reactions to strawberries), may occur only after overindulgence and possibly result from direct (toxic) mediator liberation. It is characterized by a diffuse and painful swelling of loose subcutaneous tissue, e.g. dorsum of hands or feet, eyelids, lips, genitalia and mucous membrane. Edema of the upper airways may produce respiratory distress and the stridor may be mistaken for asthma. Treatment Epinephrine should be the first treatment for acute pharyngeal or laryngeal angioedema. This may be supplemented, by a nebulized agonist (e.g. albuterol) and an I.V. antihistamine (diphenhydramine). This is usually sufficient to prevent airway obstruction hut intubating or performing a tracheostomy and administering 0, might be necessary. Also know Uicaria This is also an anaphylaxis reaction, but in uicarias the disease is limited to the superficial tissues. Uicaria is characterized by local wheals and erythema in the superficial dermis whereas angioedema is a deeper swelling due to edematous areas in the deep dermis and subcutaneous tissue. Generally, pruritus is the first symptom, which is followed sholy by the appearance of wheals that may remain small (1-5 mm) or enlarge. The larger ones tend to be clear in the centre and may be noticed, first as large rings (> 20 cm across) of erythema and edema. Also know If acute angioedema is recurrent progressive, painful rather than pruritic and not associated with uicaria a hereditary enzyme deficiency should be considerd. Hereditary angioneurotic edema occurs due to loss of C1 inhibitor (regulatory protein) CIF of hereditary angioneuroedema - Episodes of laryngeal edema - Prominence of recurrent gastrointestinal attacks - lack of pruritus and of uicarial lesions Laboratory diagnosis of hereditary angioneuroedema - It depends upon demonstrating the deficiency of C1 inhibitor", "cop": 4, "opa": ">Foreign body bronchus", "opb": ">Parapharyngeal abscess", "opc": "Foreign body larynx", "opd": "Angioneurotic edema", "subject_name": "Surgery", "topic_name": null, "id": "cf73726d-1829-4846-a2e8-5f0a72c53dfd", "choice_type": "single"} {"question": "Most common thyroid malignancy is", "exp": "Malignancy Relative incidencePapillary carcinoma 80%Follicular carcinoma 10%Poorly differentiated/anaplastic carcinoma 5%Medullary carcinoma 2.5%Lymphoma 2.5%Ref: Bailey and love, page no: 816", "cop": 4, "opa": "Anaplastic carcinoma", "opb": "Follicular carcinoma", "opc": "Medullary carcinoma", "opd": "Papillary carcinoma", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "8af9569a-a573-458d-87a0-44e1f789c150", "choice_type": "single"} {"question": "Bleeding from externaJ auditory meatus in a case of head injury is suggestive of", "exp": "(B) Middle cranial fossa fracture > 'Panda' sign': Bilateral periorbital haematoma in a patient with a fracture of the anterior cranial fossa.# Base of skull fractures :-> Anterior cranial fossa fracture (involves frontal or ethmoid sinuses) Sub conjunctival hematomas (extending to posterior limits of sclera) Anosmia, epistaxis, Nasal tip paraesthesia, CSF rhinorhoea, caroticocavernous fistula, causes rupture of anterior inferior cerebral artery> Middle cranial fossa fracture (involves petrous temporal bone) - CSF otorrhoea or rhinorrhoea through Eustachian tube, hemotympanum, ossicular disruption, Battle sign, VII and VIII cranial nerve palsies. Battle sign- Bruising behind ear after 36 hours of head injury involving petrous temporal bone", "cop": 2, "opa": "Anterior cranial fossa fracture", "opb": "Middle cranial fossa fracture", "opc": "Fracture of occipital bone", "opd": "Posterior cranial fossa fracture", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "7f4fa215-07ed-414d-8e25-984664430df4", "choice_type": "single"} {"question": "Forceps used for maxillary fracture disimpaction", "exp": null, "cop": 1, "opa": "Rowe's", "opb": "Bristows", "opc": "Ashs", "opd": "Walshams", "subject_name": "Surgery", "topic_name": null, "id": "412a173a-22e2-487d-ae6e-5be7fb36ae32", "choice_type": "single"} {"question": "Most common presenting symptom of fibroadenosis is", "exp": ".Tamoxifen used in- * Carcinoma breast * Benign diseases of the breast like fibroadenosis * Infeility in males * Desmoid tumour. Differential diagnosis for carcinoma breast * Fibroadenosis * Traumatic fat necrosis * Tuberculosis of breast * Blood good cyst * Filariasis breast * Mastitis etc. usually ibroadenosis presents with pain. ref:SRB&;s manual of surgery,ed 3,pg no 456", "cop": 1, "opa": "Pain", "opb": "Discharge from nipple", "opc": "Non-tender lump in the breast", "opd": "Mass", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "75f994f0-8dbe-42c5-8c65-6a81e9b9b1b3", "choice_type": "single"} {"question": "Most commonly used local anesthesia", "exp": null, "cop": 4, "opa": "1:20,000 xylocaine Hcl", "opb": "1:50,000 xylocaine Hcl", "opc": "1:10,000 xylocaine Hcl", "opd": "1:80,000 xylocaine Hcl", "subject_name": "Surgery", "topic_name": null, "id": "42560df5-b1de-4eab-81af-26904ec56ffa", "choice_type": "single"} {"question": "Pulled elbow is", "exp": "B i.e. Dislocation of head", "cop": 2, "opa": "A sprain of extensor tendons", "opb": "Dislocation of head of radius", "opc": "Fracture of lateral condyle of humerus", "opd": "Dislocation of elbow", "subject_name": "Surgery", "topic_name": null, "id": "328073b3-a949-4f51-9afd-d58d84361ba0", "choice_type": "single"} {"question": "Latest method \"Gail model'' of risk assessment is for", "exp": "Ans. (c) Breast cancer.(Ref Schwartz principles of surgery, 10th ed p-512)Because of the increased risk of breast cancer in US - Gail developed a most commonly used model to predict the cumulative risk of breast cancer. It includes the following factors# Age# Age at menarche# Age at 1st child birth# Number of breast biopsy specimens# History of atypical hyperplasia# Number of 1st degree relatives with breast cancer* A scoring is calculated by a software based on these and predicts the 5 year risk and life time risk of breast cancerFor Extra Edge - Know the other similar models used for cancer breast:# Clauss model# BRCAPRO model# Tyrer-Cuzick model", "cop": 3, "opa": "Ovarian ca", "opb": "Prostate ca", "opc": "Breast ca", "opd": "Lung ca", "subject_name": "Surgery", "topic_name": "Breast", "id": "915cd459-56c3-4fc5-8adf-b042eb703ffd", "choice_type": "single"} {"question": "Commonest cause of Ludwig's Angina is", "exp": "Commonest cause of Ludwig's angina is dental infection of 2nd and 3rd molar teeth.", "cop": 2, "opa": "Dental infection of canine tooth", "opb": "Dental infection of 2nd molar teeth", "opc": "Dental infection of 2nd premolar teeth", "opd": "Dental infection of Incisor teeth", "subject_name": "Surgery", "topic_name": null, "id": "a7705f79-82e4-4d95-9ee0-5e45579b5adc", "choice_type": "single"} {"question": "Improper direction of the needle insertion during inferior alveolar nerve block results in", "exp": null, "cop": 1, "opa": "Facial nerve paralysis", "opb": "Paraesthesia", "opc": "Hematoma", "opd": "Trismus", "subject_name": "Surgery", "topic_name": null, "id": "22d5ad5a-12e2-4712-89c0-13727e1fecc9", "choice_type": "single"} {"question": "A ranula is a", "exp": null, "cop": 4, "opa": "Type of epulis", "opb": "Sublingual thyroid", "opc": "Thyroglossal cyst", "opd": "Cystic swelling in the floor of the mouth", "subject_name": "Surgery", "topic_name": null, "id": "2a98f534-098d-4eea-9bea-6aa926f28bf4", "choice_type": "single"} {"question": "Nerve supply of the skeletal muscles element of diaphragm is", "exp": "Phrenic nerve Phrenic nerve is the sole motor nerve supply to diaphragm. Under the influence of phrenic nerve input, the diaphragm contributes more than any other muscle to inspiration. With deeper respiration, there is more extensive descent of the domes which brings them inferior to the central tendon.", "cop": 3, "opa": "Thoracodorsal nerve", "opb": "Intercostal nerves", "opc": "Phrenic nerve", "opd": "Long thoracic nerve", "subject_name": "Surgery", "topic_name": null, "id": "dd7b6d06-dcc1-4446-9fae-8156c774b870", "choice_type": "single"} {"question": "Not preserved in modified radical mastectomy is", "exp": "Ans. (d) Branches of Inter costobrachial Nerve(Ref. Bailey and Love 6th Edition Page 813)Structures preserved in MRM:* Axillary Vessels* Bells nerve* Cephalic vein* Nerve to Latissmus dorsi* Pectoralis Major", "cop": 4, "opa": "Cephalic vein", "opb": "Pectoralis minor", "opc": "Pectoralis major", "opd": "Branches of Inter costobrachial Nerve", "subject_name": "Surgery", "topic_name": "Breast", "id": "85b77ecf-fb8d-4443-8fee-feb7e516f3b8", "choice_type": "single"} {"question": "Perirectal abscess drainage belongs to", "exp": "Contaminated surgery :\n\nWound is exposed to any organism in uncontrolled environment.\nPerisectal abscess drainage belongs to this category.", "cop": 2, "opa": "Clean surgery", "opb": "Contaminated surgery", "opc": "Clean contaminated surgery", "opd": "Dirty surgery", "subject_name": "Surgery", "topic_name": null, "id": "fbc79319-f1f1-4b6c-8a8b-dc18825c9be6", "choice_type": "single"} {"question": "Optimal timing of administration of prophylactic antibiotic for surgical patients is", "exp": null, "cop": 1, "opa": "at the induction of anesthesia", "opb": "any time during surgical procedure", "opc": "one hour after induction", "opd": "one hour prior to induction of anesthesia", "subject_name": "Surgery", "topic_name": null, "id": "2dbfc8a4-cd01-43c3-a8a8-5fec07fe9f59", "choice_type": "single"} {"question": "Fundoplication is used in treatment of", "exp": "Ans. a (Hiatus hernia). (Ref. LB 25th ed., 1024)PARAOESOPHAGEAL ('ROLLING') HIATUS HERNIA# Rolling hiatus hernias are dangerous# Unlike sliding hiatus hernia a rolling hiatus hernia is a true hernia that is prone to complications. True paraoesophageal hernias in which the cardia remains in its normal anatomical position are very rare and confined to museum exhibits and personal collections of interesting cases. The hernia is commonest in the elderly, but may occur in young fit people.# The symptoms of rolling hernia are mostly due to twisting and distortion of the oesophagus and stomach. Dysphagia is common. Chest pain may occur due to distension of an obstructed stomach. Classically the pain is relieved by a loud belch. Symptoms of GORD are variable.# The hernia may be visible on a plain X-ray of the chest as a gas bubble, often with a fluid level behind the heart. Fluid levels are not seen in sliding hernias. A barium meal is the best method of diagnosis. Endoscopic look may be confusing, especially in large hernias endoscopist feels as if have lost sense of direction.# Rolling hernias always require surgical repair as they are potentially dangerous. However, major surgery may not be an attractive prospect in frail elderly patients or in someone who has few symptoms. The essential part of the operation is reduction of the hernia and some form of gastropexy. Some surgeons perform a fundoplication arguing that this is a very effective means of maintaining reduction and that it deals with the associated GORD.# Laparosopic repair has recently become popular. Full anatomical repair of a large rolling hernia can be tedious and difficult by the laparoscopic approach and it is more common simply to reduce the hernia and perform a gastropexy. Some surgeons lay a sheet of prosthetic mesh across the hiatal opening to stop the bowel entering it.# Total or partial fundoplication? The disadvantage of the Nissen fundoplication is that it can produce an overcompetent cardia resulting in dysphagia or the gas bloat syndrome in which belching is prevented. As a result the stomach fills with air and the patient feels very full after meals and passes excessive flatus. The problem of the overcompetent cardia has been largely overcome by the floppy Nissen in which the fundoplication is made very loose around oesophagus and also by making a short fundoplication of 1 cm or so.", "cop": 1, "opa": "Hiatus hernia", "opb": "Achalasia cardia", "opc": "CHPS", "opd": "Ca oesophagus", "subject_name": "Surgery", "topic_name": "Oesophagus", "id": "9f0f3c6a-785a-46cd-8886-f0b4708c22c6", "choice_type": "single"} {"question": "Sign of lymphatic spread in carcinoma stomach is", "exp": "Troisier's sign : tumour appearing in the supraclavicular nodes, it is by lyphatic spreadBlumer's shelf (pouch of Douglas), Krukenberg's (ovaries) and Sister Josephs's (umbilicus) are by transperitoneal spreadTrousseau sign of malignancy is migratory thrombophlebitis a Non-metastatic effect of malignancyTrousseau sign of latent tetany: In hypocalcemia, a blood pressure cuff is placed around the arm and inflated to a pressure greater than the systolic blood pressure and held in place for 3 minutes. This will induce spasm of the muscles of the hand and forearm.Bailey and love 27e pg: 1133", "cop": 1, "opa": "Troisier's sign", "opb": "Krukenberg's tumour", "opc": "Sister Mary Joseph's nodules", "opd": "Trousseau's sign", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "b1dcdf89-df2c-41ff-b7c1-dd88e76f61c4", "choice_type": "single"} {"question": "A female post open cholecystectomy through general Anesthesia after 12 hours she is dyspneic. Right lower lobe crepitations present. Probable cause is", "exp": "Ans. (b) AtelectasisRef: Bailey and Love 26th edition Page 273Post op complications - Respiratory:* MC post operative complications are - Hypoxemia, Hypercarbia and Aspiration in recovery room* Hypoxia reasons:# Upper airway obstruction due to secretion# Laryngeal edema# Recurrent laryngeal nerve injury after thyroid surgery# Hypoventilation related to anesthesia# Atelectasis# Pneumonia# Pulmonary edema of cardiac origin# Pulmonary embolism", "cop": 2, "opa": "Drug collapse", "opb": "Atelectasis", "opc": "Pulmonary edema", "opd": "Myocardial infarction", "subject_name": "Surgery", "topic_name": "Gall Bladder & Bile Ducts", "id": "163a20d0-1c59-4cfb-b642-bf73aca3fe2d", "choice_type": "single"} {"question": "Principles of treatment of Pyogenic infection of skeletal system are", "exp": ". Treatment is antibiotics,radical wound excision with removal of pus and all necrosed muscle and compament release haemodialysis is needed until recovery if there is renal failure later secondary suturing or skin grafting is needed. (Ref: SRB's Manual of surgery,5th edition,pg no.65)", "cop": 2, "opa": "Analgesics", "opb": "Antibiotics", "opc": "Steroids", "opd": "Non-operative", "subject_name": "Surgery", "topic_name": "Trauma", "id": "9e2e06b7-461a-432d-a753-b7fa247a4afd", "choice_type": "single"} {"question": "Most common cause of death in burns patients is", "exp": "Septic shock is most common cause of death.\nAsphyxia is MCC death in immediate phase of burns.", "cop": 1, "opa": "Septic shock", "opb": "Cardiac arrest", "opc": "Hypovolemic shock", "opd": "Asphyxia", "subject_name": "Surgery", "topic_name": null, "id": "4cb00dcc-cde2-460c-a623-1fcff051184b", "choice_type": "single"} {"question": "Causes of oesophagal carcinoma", "exp": ".common causes of developing oesophageal carcinoma include cardiac achalasia, Plummer Vinson syndrome, oesophageal websBarrett&;ss oesophagus, corrosive strictures and also TYLOSIS.Tylosis is an inherited disorder in which there is thickening of the skin of palm and sole, also known by the name Hovels Evans syndrome. Ref: SRB&;s manual of surgery,5th ed, pg no 804", "cop": 1, "opa": "Tylosis", "opb": "Reflux esophagities", "opc": "Lye ingestion", "opd": "perforation", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "2b51077f-0f72-477c-8045-2f9f27147e40", "choice_type": "single"} {"question": "The fracture of the tooth bearing segment of the\nmandible is", "exp": null, "cop": 3, "opa": "Simple", "opb": "Complex", "opc": "Compound", "opd": "Comminuted", "subject_name": "Surgery", "topic_name": null, "id": "7ab56968-520e-4e5f-b64c-5992623283d7", "choice_type": "single"} {"question": "Emergency operation done in cases of", "exp": "Surgery is required to prevent or relieve ischaemia.When a removable lesion is found in the caecum, ascending colon, hepatic flexure or proximal transverse colon, an emergency right hemicolectomy should be performed. Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1191,1200", "cop": 1, "opa": "Volvulus", "opb": "Obstructed hernia", "opc": "Appendicular perforation with paralytic ileus", "opd": "Toxic megacolon", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "50335c46-2333-46e2-9762-4e163eb27a57", "choice_type": "single"} {"question": "SEPS is used for", "exp": ". SEPS-Subfascial Endoscopic Perforator Ligation Surgery,it us recommended in chronic venous insufficiency. procedure: A special telescope is introduced deep to deep fascia through a single small veical incision at proximal leg selecting healthy skin.potential space between muscle and deep fascia with loose areolar tissue is easy to detect using endscope.Technique is done under torniquet 300 mm hg pressure.Endoscope is advanced down along the medial border of tibia.Perforators travelling in subfascial plane are identified and fulgurated using bipolar cauery or clips can be applied into the perforators.It is recommended in chronic venous insufficiency.But its limitation is difficuilty in getting \"lift off\" skin in cases with severe lipodermatosclerosis to identify the perforators. Refer page no 237 of SRB's manual of surgery 5 th edition.", "cop": 2, "opa": "Aery", "opb": "Veins", "opc": "Lymphatics", "opd": "Lymphnodes", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "f733951f-60fc-49e9-837f-71d64f195124", "choice_type": "single"} {"question": "Most common tumor of eyelid is", "exp": "Ans. a (Basal cell carcinoma). (Ref. Baily & Love, 25th/pg. 609)BASAL CELL CARCINOMA (BCC, rodent ulcer)# Basal cell carcinoma is the commonest form of skin cancer and typically affects individuals between the ages of 40 and 79 years; 50 percent are male.85 percent occur in the head and neck region.# Are thought to originate from pluripoten epithelial cells of the epidermis and hair follicles.# BCCs grow slowly, but locally invasive and penetrate deeper tissues -- hence the term rodent ulcer,# Metastasis is rare.# Typically these tumours have a nodular appearance with a pearly rolled edge (which is apparent on stretching the skin) and telangiectatic vessels.# Clinically types in order of frequency:- Nodular: 50-54%; (90% nodular/nodular cystic). Superficial : 9-11%;- Cystic: 4-8%; Pigmented: 6%; Morpheic : 2%.# Treatment:- Surgical excision -- the treatment of choice with cure rates between 85 and 95%.- Electrodessication and curettage -- commonly used for small superficial lesions (2--5 mm in diameter) gives cure rates between 85 and 100%.- Radiotherapy -- BCC is very radiosensitive and has an overall response of 92 % in selected patients. This is reserved for elderly patients who are not suitable for surgery or for specialised anatomical sites.- Moh's micrographic surgery (chemosurgery) --involving serial horizontal excision and mapping of the tumour. Usually reserved for recurrent lesions, tumours in difficult areas or those with indistinct borders (morphea-form).- Following complete excision it is unnecessary routinely to follow-up these patients unless they have a familial disposition for BCC formation (Gorlin's syndrome).", "cop": 1, "opa": "Basal cell carcinoma", "opb": "Keratoacanthoma", "opc": "Melanoma", "opd": "Squamous cell carcinoma", "subject_name": "Surgery", "topic_name": "Neoplasia", "id": "5d96ace8-2f21-466d-9368-8ee16b9716cf", "choice_type": "single"} {"question": "Cyst around crown of uninterrupted tooth is", "exp": "Dentigerous cyst is a unilocular cystic swelling arising in relation to the dental epithelium from an unerupted tooth SRB,5th edition,360 .", "cop": 3, "opa": "Periapical cyst", "opb": "Radicular cyst", "opc": "Dentigerous cyst", "opd": "Odontogenous cyst", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "ea5f04af-3e74-4b2a-87f2-e0754f512fb0", "choice_type": "single"} {"question": "Hirschsprung&;s disease is due to", "exp": ".* It is a congenital, familial condition, occurring in newborn due to the absence of ganglion cells-- Auerbach's and Meissner's plexus in anorectum, which may extend proximally either a pa or full length of the colon. ref:SRB&;s manual of surgery,ed 3,pg no 818", "cop": 3, "opa": "Loss of ganglion cells in the sympathetic chain", "opb": "Atrophy of longitudinal muscles", "opc": "Failure of migration of neural crest cells from cranial to caudal direction", "opd": "Malformed teania coli", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "fd06bc47-62b8-4a18-b134-191562f2c180", "choice_type": "single"} {"question": "Screening of prostate CA is commonly done by", "exp": "Screening of prostate cancerPSAIn general, one would advise men aged50-69 years to undergo prostate biopsy if the PSA was more than ~3 ng/mL. The threshold would be lower in younger men with a strong family history.DREIrregular induration, characteristically stony hard in pa or in the whole of the gland (with obliteration of the median sulcus), suggests carcinomaBailey and love 27 e pg: 1458", "cop": 1, "opa": "DRE (digital rectal exam) & PSA", "opb": "MRI pelvis", "opc": "TURP", "opd": "TRUS", "subject_name": "Surgery", "topic_name": "Urology", "id": "72534ba2-5680-4397-8924-30f20e7ca041", "choice_type": "single"} {"question": "A lady with 50% TBSA burn with involvement of dermis & subcutaneous tissue came to emergency depament. Burns will be classified as;", "exp": "Third degree burns - Aka full thickness burn - Involvement of Epidermis + dermis + Subcutaneous fat - Burn Surface has Black coloured leathery eschar - Escharotomy is done to prevent compament syndrome - Characteristic features No pain, No blister, No pin prick sensation Healing occurs with contracture - To prevent contracture - Excision of burned skin with skin grafting", "cop": 4, "opa": "1st degree", "opb": "2nd degree superficial", "opc": "2nd degree deep", "opd": "3rd degree burn", "subject_name": "Surgery", "topic_name": "FMGE 2019", "id": "e440e0ca-0a0c-4d2a-911b-fa3c2e1b0e87", "choice_type": "single"} {"question": "Surgical blade number useful for aeriotomy is", "exp": "Surgical blade for aeriotomy is 11 Minor surgical procedures- 15 Abdominal incisions- 22 Reference: Bailey and love, 27th edition, page:85", "cop": 2, "opa": "10", "opb": "11", "opc": "15", "opd": "22", "subject_name": "Surgery", "topic_name": "Vascular surgery", "id": "a2f12788-7d85-4fd8-9c8d-264abefad10e", "choice_type": "single"} {"question": "The origin of thyroglossal duct is", "exp": null, "cop": 1, "opa": "Foramen caecum", "opb": "Tuberculum impar", "opc": "Rathke's pouch", "opd": "Rosenmuller's fossa", "subject_name": "Surgery", "topic_name": null, "id": "2fd077e4-e432-41cd-9bd4-142757a4293c", "choice_type": "single"} {"question": "Most common cause of umbilicus does not separate at age of 2 years", "exp": "Ans. is 'b' i.e., Leukocyte adhesion deficiency", "cop": 2, "opa": "Raspbery tumour", "opb": "Leukocyte adhesion deficiency", "opc": "Patent urachus", "opd": "Umblical granuloma", "subject_name": "Surgery", "topic_name": null, "id": "e947a1fe-dc52-4f2e-bcc9-cdd095f7b6a4", "choice_type": "single"} {"question": "Male patient with EHL weakness", "exp": "(A) L4-L5 slip disc CLINICAL FEATURES OF LUMBAR DISC PROLAPSENerve Root CompressedL1L2L3L4L5S1Level of Disc ProlapseT12-L1L1-L2L2-L3L3-L4L4-L5L5-S1PainThoraco lumbar junction groin, proximal part of thighThoracolumbar junction, groin, proximal part of thighUpper lumbar spine, atnerior aspect of proximal thighLower back, hip, posterolateral thigh, anterior legSacroiliac joint, hip, lateral thigh & lateral legSacroiliac joint, hip, posteriolateral leg to heelParesthesiaOblique band proximal 3rd of thigh anteriorly just below inguinal ligamentOblique band mid 3rd of thigh anteriorlyOblique band lower part of thigh anteriorly just above the kneeMedial to shin of tibia, medial aspect of the footLateral leg, dorsum of foot, 1st web spacePosterior aspec: of thigh, back of calf lateral side & sole of footMuscle Affected MainlyIliopsoas (Hip flexion)Iliopsoas (Hip flexion), Quadriceps (Knee extension), adductor brevis, longus magnus (Hip adduction)Iliopsoas (HIP flexion), Quadriceps (knee extension), adductor brevis, longus, magnus (Hip adduction)Tibialis anterior (foot inversion), Quadriceps (knee extension), adductor brevis, longus magnus (Hip)Extensor Hallucis Longus (Dorsiflexion of great toe), Extensors brevis (Dorsiflexion of foot), GluteusPeroneus Longus & Brevis (Foot eversion), Flexor hallucis longus (Plantar flexion of great toe), Flexor digitorum longus & brevis> Extensor hallucis longus is a thin muscle, situated between Tibialis anterior and Extensor digitorum longus, functions to extend big toe and dorsiflex foot, & assists with foot eversion and inversion.> Innervation: Deep peroneal (fibular) nerve, branch of common peroneal (fibular) nerve (L4, L5, S1).", "cop": 1, "opa": "L4-L5 slip disc", "opb": "L5-S1 slip disc", "opc": "S2-S3 slip disc", "opd": "L2-L3 slip disc", "subject_name": "Surgery", "topic_name": "Nervous System", "id": "8ad90433-cdff-4a4b-85bf-dd3890187449", "choice_type": "single"} {"question": "Common bule duct injuries are most commonly seen in", "exp": "Bile duct injuries are most common in laparoscopic cholecystectomy(0.8 %),i.e.,around 3 times more than that of an open cholecystectomy.BDI can lead to bile leak,fistula formation,biliary strictures and lately biliary cirrhosis and poal hypeension. Reference:SRB's manual of surgery,5th edition,page no:666", "cop": 4, "opa": "Radical gastrectomy", "opb": "Penetrating injuries of abdomen", "opc": "ERCP & sphincterotomy", "opd": "Laparoscopic cholecystectomy operation", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "92246a4e-bcfb-47db-a23a-379a11f08f15", "choice_type": "single"} {"question": "A blood stained discharge from the nipple indicates", "exp": "(Duct papilloma) (831 - Baity & Love 25th, 281- CSDT 13th)Blood discharge from nipple caused by benign papilloma in the ductCauses of blood stained discharge from nippleBlood stained discharge from a single ductMore than one duct,* Intraductal carcinoma* Intraductal papilloma*** Duct ectasia* Carcinoma* Ectasia* Fibrocystic diseaseCauses of other tvpe of discharge from nippleSerous (any colour)Grumous/GramPurulentMilk* Fibrocystic disease* Duct ectasia* Carcinoma* Duct ectasiaInfections* Lactation* OCP users* Estrogen replacement therapyGreenish discharge is seen in fibroadenosis and mammary duct ectasia* Treatment of ductal papilloma (<40 years) - Michrodochectomy*** Lobular carcinoma are associated with bilaterality, A biopsy of the contralateral breast is therefore requiredCEA is a marker of Paget's disease of the mammary gland (Infiltratina ductal carcinoma)Post radical neck dissection syndrome - arising from denervation and atrophy of the trapezius muscle due to sacrifice of the spinal accessory nerve (SAN)- Inability to abduct the shoulder beyond 90deg cephalad- Long standing pain in the shoulder- Deformity of the shoulder girdle- Drooping of the shoulder, shoulder abduction and external rotationCauses of Fat necrosis1. After surgery / surgical trauma -* Wide local excision* Reduction mammoplsty*** Breat reconstruction* Breast biopsy2. Following radiotherapy* including iridium implant3. following trauma4. Autologous fat injection using the liposuction* technique to fill in irregular contours & small soft tissue defects in the breast may lead to fat necrosis secondary to poor blood supply in the injected fat5. Conservative treatment of breast cancer with lumpectomy & radiation therapy may also result in fat necrosis* Phenomena resulting from lymphatic obstruction in advanced breast cancer(i) Peaud's orange (due to cutaneous lymphatic oedema)(ii) Cancer-en-cuirasse(iii) Lymphangiosarcoma* Aromatase Inhibitors are used in Breast carcinoma are - Letrozole, Anastrozole, Exemestane, Aminoglutethimide", "cop": 3, "opa": "Breast abscess", "opb": "Fibroadenoma", "opc": "Duct papilloma", "opd": "Fat necrosis of breast", "subject_name": "Surgery", "topic_name": "Breast", "id": "0fe16ab1-5ed2-4a5e-b1fe-13398ba8a0c4", "choice_type": "single"} {"question": "Blumberg's sign is", "exp": "Positive Blumberg's sign or rebound tenderness or Release sign is indicative of peritonitis which can occur in diseases like appendicitis, perforated peptic ulcer and may occur in ulcerative colitis with rebound tenderness in the right lower quadrant etc. Rebound tenderness on abdominal palpation is d/t the fact that the parietal peritoneum which has already been inflamed due to the presence of underlying inflamed organ also springs back along with the abdominal muscles. < p> Reference : page 458 A manual on clinical surgery Das 10th edition", "cop": 1, "opa": "Rebound tenderness during abdominal palpation", "opb": "Board-like rigidity of abdomen", "opc": "Pressure over left iliac fossa causing pain in right iliac fossa", "opd": "Pressure over right iliac fossa causing pain in left iliac fossa", "subject_name": "Surgery", "topic_name": "Urology", "id": "67920c05-612b-4bd6-8ff6-96d4f541630a", "choice_type": "single"} {"question": "The commonest gastric polyp is", "exp": ".Metaplastic/hyperplastic Polyp -* Metaplastic- indicates a difference in appearance from normal mucosa. * Very minute in size- 1-2 mm. Multiple. * Common in rectum. Also occurs in other pas of colon. * Contains columnar epithelium, cystic dilatation, goblet cells, and lymphocytes. * Not a pre-malignant entity. ref:SRB&;s manual of surgery,ed 3,pg no 831", "cop": 1, "opa": "Hyperplastic polyp", "opb": "Inflammatory polyp", "opc": "Adenomatous polyp", "opd": "Pa of familial polyposis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "cc4213d2-a766-4423-b538-6b962f3680e1", "choice_type": "single"} {"question": "In a healthy adult scheduled for an elective operation, solid food shoulder be withheld for at least .......... hours before surgery", "exp": "Nil by mouth and regular medications Patients are advised not to take solids within 6 hours and clear fluids (isotonic drinks and water) within 2 hours before anaesthesia to avoid the risk of acid aspiration syndrome. These restrictions are fuher reduced in infants, as keeping hydrated reduces discomfo and is known to improve post- operative outcomes. If the surgery is delayed, oral intake of clear fluids should be allowed until 2 hours before surgery or intravenous fluids should be staed, especially in vulnerable groups of patients, e.g. children, the elderly and diabetics. Patients can continue to take their specified routine medications with sips of water in the NBM period. Ref: Bailey and love 27th edition Pgno : 259", "cop": 3, "opa": "2", "opb": "4", "opc": "6", "opd": "8", "subject_name": "Surgery", "topic_name": "Urology", "id": "dcabb8fa-9636-4e9c-bc67-6764d8fc49ca", "choice_type": "single"} {"question": "A patient undergone emergency laparotomy and Ileostomy closure done after 3 months then he developed swelling in the ileostomy region with Cough impulse. This is known as", "exp": "Ans. (b) Incisional herniaRef: Practical Question* Question is very clear - Ileostomy is reversed in 3 months - so this cannot be a parastomal hernia.* Parastomal hernia is one which develops via a defect in the opening made for Ileostomy or Colostomy, and the hernia is present in the presence of stoma.* Now here it is clear the stoma is reversed and hence this is a Incisional hernia via the incision made for creating stoma", "cop": 2, "opa": "Lumbar hernia", "opb": "Incisional hernia", "opc": "Spigelian hernia", "opd": "Parastomal hernia", "subject_name": "Surgery", "topic_name": "Hernia", "id": "3d921d3a-85e3-41fd-ac34-ba7f1aefb5eb", "choice_type": "single"} {"question": "High T3, high T4, low TSH and low radioiodine uptake is seen in", "exp": "Ans) c ( Subacute thyroiditis) Ref Bailey 25th ed pg 800Subacute thyroiditisAlso called Granulomatous or Dequervines thyroiditisCaused by viral infections. Presents with pain in the neck, fever, malaise, firm irregular enlargement of one or both thyroid lobes.ESR raised, absent thyroid auto antibodies, serum T4 high.Iodine 133 uptake low. It is self limiting.There may be a period of hypothyroidism before recovery.Specific treatment - Prednisolone 10- 20mg for 7 days.Grave's disease & toxic noduleHyperthyroidism with increased radioiodine uptakeHashimoto's thyroiditisMild hyperthyroidism initially but hypothyroidism inevitable. Decreased T3 & T4.", "cop": 3, "opa": "Hashimoto's thyroiditis", "opb": "Grave's disease", "opc": "Subacute thyroiditis", "opd": "Toxic nodule", "subject_name": "Surgery", "topic_name": "Thyroid Gland", "id": "b3734353-6b8b-4df1-9c13-94e84da86b3d", "choice_type": "single"} {"question": "Best diagnostic modality for parotid swelling is", "exp": "Best diagnostic modality - FNAC Best imaging investigation - MRI (MRI is the most sensitive study to determine soft-tissue extension and involvement of adjacent structures but it lacks the specificity for differentiating benign from malignant neoplasms.)", "cop": 2, "opa": "Enucleation", "opb": "FNAC", "opc": "Superficial parotidectomy", "opd": "Excisional biopsy", "subject_name": "Surgery", "topic_name": "Head and neck", "id": "3fb75de4-deea-4b59-b618-65161e855ca2", "choice_type": "single"} {"question": "Fuctional GI disorders can be differentiated from organic GI disorders by", "exp": "Common causes of Bleeding per rectum hemorrhoids anal fissures (tears in the rectal tissue), diveicula (diveiculitis, including Meckel's diveiculum), infections (bacterial and other pathogens) inflammatory bowel diseases (Crohn's disease and ulcerative colitis), angiodysplasia (fragile blood vessels), tumors,polyps, and bowel trauma. Less common causes include upper GI tract problems like ulcers and Mallory-Weiss tears in the esophagus or a dilated vein or varix. Ref:", "cop": 4, "opa": "Abdominal pain", "opb": "Diarrhea", "opc": "Tenesmus", "opd": "Bleeding PR", "subject_name": "Surgery", "topic_name": "Urology", "id": "7a734da4-2613-43df-986c-16a6d1cfbc9a", "choice_type": "single"} {"question": "Early stage of carcinoma esophagus is diagnosed by", "exp": ".investigations for carcinoma oesophagus includes 1)barium swallow -shouldering sign and irregular filling defect.RAT TAIL defect in fluoroscopy is typical. 2)oesophagoscopy -to know lesion, extent and types. 3)biopsy -histological evaluation 4)X-ray /CT/MRI/ bronchoscopy/chromoendoscopy/oesophageal endosonography ref: SRB&;s manual of surgery,5th ed, pg no 806", "cop": 1, "opa": "Barium meal", "opb": "Trans oesophageal USG", "opc": "MRI", "opd": "Fluoroscopy", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "71791d0e-b564-4757-9995-304653ef6948", "choice_type": "single"} {"question": "Cause of congestive splenomegaly is", "exp": "Answer- B. Budd Chiari SyndromeCauses of congestive splenomegalyBudd Chiari SyndromeHepatic vein obstructionPoal vein obstruction", "cop": 2, "opa": "Visceral Leishmaniasis", "opb": "Budd Chiari Syndrome", "opc": "Gaucher's Disease", "opd": "Hodgkin's Lymphoma", "subject_name": "Surgery", "topic_name": null, "id": "86973508-286f-4726-8542-9fc25626b3d0", "choice_type": "single"} {"question": "Abbey estlander flap is used for", "exp": null, "cop": 3, "opa": "Lingual artery", "opb": "Facial artery", "opc": "Labial artery", "opd": "Internal maxillary artery", "subject_name": "Surgery", "topic_name": null, "id": "9afbc5c7-4fe1-4bb9-85b4-91f308b55b68", "choice_type": "single"} {"question": "The tensile strength of wound after laparoscopic cholecystectomy in a 30 years old Woman depends upon", "exp": "\"Covalent cross-linking of the lysine residues provides tensile strength. The extent and type of crosslinking vary from tissue to tissue. In tissues such as tendons, in which tensile strength is crucial, collagen cross-linking is extremely high.\"Sabiston 20th edition Pg: 139", "cop": 2, "opa": "Replacement of type 3 collagen", "opb": "Extensive cross linking of procollagen", "opc": "Macrophage activity/invasion", "opd": "Granulation tissue", "subject_name": "Surgery", "topic_name": "General surgery", "id": "6c0698f7-2352-4203-9d6f-24f049fcecdf", "choice_type": "single"} {"question": "Plexiform neurofibromatosis commonly affects...", "exp": null, "cop": 2, "opa": "Facial nerve", "opb": "Trigeminal nerve", "opc": "Peripheral nerve", "opd": "Glossopharyngeal nerve", "subject_name": "Surgery", "topic_name": null, "id": "289720ad-f5bc-4601-abe6-8aff067d1278", "choice_type": "single"} {"question": "In Pediatric age group, the most common feature of polytrauma is", "exp": "As the surface area to body volume ratio of children is high, thermal energy loss is higher and hypothermia is a higher risk. Due to the greater physiological capacity and ability of children to compensate for the fluid loss, hypotension is a very late and ominous sign of hypovolaemic shock.", "cop": 1, "opa": "Hypothermia", "opb": "Hypotension", "opc": "Hypovelomic shock", "opd": "Hypoxemia", "subject_name": "Surgery", "topic_name": "Trauma", "id": "5c4b51d7-f873-467f-8c25-c35df59cf1aa", "choice_type": "single"} {"question": "Capillary refill is present in", "exp": null, "cop": 3, "opa": "Third degree burns", "opb": "First degree burns", "opc": "Second degree burns", "opd": "Fourth degree burns", "subject_name": "Surgery", "topic_name": null, "id": "7d78f12e-fbd8-42f5-997b-e60190fc55af", "choice_type": "single"} {"question": "Initial treatment in the management of trauma is", "exp": ".primary management Airway management(blocked by food,vomiting,clot,fallen tongue) Breathing Circulation Disability and level of consciousness assessment by Glasgow coma scale Exposure of patient from head to toe for final assessment Fingers and tubes: Finger evaluation, Foley&;s catheterisation (Ref: SRB&;s Manual of Surgery, 5th edition, pg no.140)", "cop": 1, "opa": "Airway maintenance", "opb": "IV Fluids", "opc": "Fracture stabilization", "opd": "Do not shift", "subject_name": "Surgery", "topic_name": "Trauma", "id": "488abec8-d07c-4d03-990f-c40c6c585384", "choice_type": "single"} {"question": "Most Commonly done screening test for diagnosing Acute Pancreatitis", "exp": "Ans. (a) Serum AmylaseRef: Bailey and Love 27th ed. pg. 1214* Most common used to diagnose Acute pancreatitis - Serum amylase (will be elevated for first 3 days and declines in 4-8 days)* Serum Lipase though more sensitive is not widely available.", "cop": 1, "opa": "Serum amylase", "opb": "Serum lipase", "opc": "Serum trypsin", "opd": "NBT PABA", "subject_name": "Surgery", "topic_name": "Pancreas", "id": "1b1ebf50-8c6e-4b81-a90c-057c9c295f8e", "choice_type": "single"} {"question": "The operation that precipitates poosystemic encephalopathy is", "exp": "Poosystemic encephalopathy is a neuropsychiatric syndrome, It most often results from high gut protein or acute metabolic stress (eg, GI bleeding, infection, electrolyte abnormality) in a patient with poosystemic shunting. In poosystemic shunting, absorbed products that would otherwise be detoxified by the liver enter the systemic circulation and reach the brain, causing toxicity, paicularly to the cerebral coex.", "cop": 4, "opa": "Splenorenul shunt", "opb": "Siguira operation", "opc": "Talma - Marison Operation", "opd": "Poacaval anastomosis", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "8020f615-76f6-4347-8b37-21582f0b0280", "choice_type": "single"} {"question": "The treatment of choice for the management of carcinoma of the anal canal is", "exp": "Nowadays, primary treatment is by chemoradiotherapy , the chemotherapy sually including a combination of 5-fluorouracil (5-FU) with mitomycin C or cisplatin. The surgeon, however, has an impoant role in management: initial diagnosis is surgical; small marginal tumours are still best treated by local excision; radical surgery is indicated in those with persistent or recurrent disease following CMT; and a defunctioning stoma may be indicated for those in whom treatment and disease regression is associated with radionecrosis, incontinence or fistula. Other anal malignancies Adenocarcinomata within the anal canal are usually extensions of distal rectal cancers. Rarely, adenocarcinoma may arise from anal glandular epithelium or develop within a longstanding (usually complex) anal fistula; treatment is as for low rectal cancers but prognosis is less good. Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1269", "cop": 3, "opa": "Abdominoperineal resection", "opb": "Primary radiotherapy", "opc": "Combined radio-and chemotherapy", "opd": "Neoadjuvant chemotherapy and local excision", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "87a66290-293e-406a-8951-cc2b9e30f73b", "choice_type": "single"} {"question": "Epispadias is associated with", "exp": "Epispadias Epispadias is very rare. In penile epispadias, the urethral opening is on the dorsum of the penis and is associated with an upward curvature of the erect penis . Epispadias often coexists with bladder exstrophy and other severe developmental defects. Associated anomalies Extrophy of bladder (ectopiae vesicae) with pubic diastasis and waddling gait Dorsal chordee VUR in 40 % cases Ref: Smith's 18th edition Pgno : 639 Bailey and love 27th edition Pgno : 1478", "cop": 1, "opa": "Chordee", "opb": "Bifid pubic symphysis", "opc": "Intestinal obstruction", "opd": "Anal atresia", "subject_name": "Surgery", "topic_name": "Urology", "id": "0b2f65c8-0fdc-4953-b18b-2c4d17331947", "choice_type": "single"} {"question": "Psudomyxoma peonei is", "exp": ".PSEUDOMYXOMA PERITONEI * Jelly like mucoid yellowish-brown substance accumulates in peritoneal cavity * Due to ruptured adenocarcinoma appendix/ mucocele or mucinous carcinoma of ovary * Common in females * Painless progressive distension of abdomen with intestinal obstruction occurs eventually * Shifting dullness is absent * Surgical debulking, oophorectomy, appendicectomy, omentectomy are often done * Chemotherapy is useful--Cisplatin * Carries poor prognosis ref:SRB&;s manual of surgery ,ed 3,pg no 884", "cop": 3, "opa": "Carcinoma colon", "opb": "Pancreatic Adenocarcinoma", "opc": "Mucinous cystadeno carciona of ovary", "opd": "Adenoma of stomach", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "c54be6a3-7873-4784-a9ad-29a5e2141046", "choice_type": "single"} {"question": "Most common cause of secondary tumors affecting spinal cord is from", "exp": "(C) Secondaries from lungs # Secondary spinal cord tumors, which are more common, are metastases of cancer originating in another part of the body and thus are always cancerous. Metastases most commonly spread to the vertebrae from cancers that originate in the lungs, breasts, prostate gland, kidneys, or thyroid gland. Metastases compress the spinal cord or nerve roots from the outside. Lymphomas may also spread to the spine and compress the spinal cord.> Advanced prostate cancer can spread to other parts of the body, possibly causing additional symptoms. The most common symptom is bone pain, often in the vertebrae (bones of the spine), pelvis, or ribs. Spread of cancer into other bones such as the femur is usually to the proximal part of the bone. Prostate cancer in the spine can also compress the spinal cord, causing leg weakness and urinary and fecal incontinence. Spread to the lymph nodes can cause a swelling or lump, either under your arm or in another part of the body. If the lymph nodes in your armpit are affected, your hand and arm may swell. Secondary breast cancer in the bone can cause aching or pain in the affected bone. If the breast cancer has spread to your liver you may feel ill and tired. Women with secondary breast cancer in their lungs usually first notice a cough, or find that they get short of breath easily. If a secondary breast cancer develops in the brain, you may have headaches and feel sick. Secondary spinal cord tumors, which are more common, are metastases of cancer originating in another part of the body and thus are always cancerous. Metastases most commonly spread to the vertebrae from cancers that originate in the lungs, breasts, prostate gland, kidneys, or thyroid gland. Metastases compress the spinal cord or nerve roots from the outside. Lymphomas may also spread to the spine and compress the spinal cord. The liver is a common site for other gastrointestinal cancers to spread to, particularly colorectal cancer, resulting in so-called secondary deposits or metastatic cancer", "cop": 3, "opa": "Secondaries from prostate gland", "opb": "Secondaries from breasts", "opc": "Secondaries from lungs", "opd": "Secondaries from gastrointestinal tract", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "220a1bea-e882-4fbb-adb2-2276211dc65d", "choice_type": "single"} {"question": "Primary closure of incised wounds must be done within", "exp": "• Primary suture:\n−− Clean wounds\n−− Selected contaminated wounds after thorough wound toileting and debridement\n• Delayed primary suture:\n−− Heavily contaminated wounds\n−− Wounds in which wound toileting has been delayed for 6–8 hours\n• Left open to heal by secondary closure", "cop": 3, "opa": "2 hrs", "opb": "4 hrs", "opc": "6 hrs", "opd": "12 hrs", "subject_name": "Surgery", "topic_name": null, "id": "1ef4bec0-4ec4-47a8-b2f7-bd1d6473d92c", "choice_type": "single"} {"question": "BRCA 1positive woman hav ..........% increased risk of breast carcinoma", "exp": "Mutation of tumour suppressor genes BRCA1/BRCA2 is thought to be involved with high-risk of breast carcinoma. BRCA1 mutation is having more risk (35-45%) than BRCA2 mutation It is located in long arm of chromosome 17, whereas BRCA2 is located in long arm of chromosome 13. BRCA1 more commonly shows ER negative status, high grade, aneuploid with raised S fraction than BRCA2 which shows ER positive status. BRCA1 is associated with increased risk in males. Lifelong risk of breast cancer in BRCA1 and BRCA2 mutations is 50-70%. Both are associated with high-risk for ovarian cancer. Ref; (page no;530 ) 5th edition of SRB&;S manual of Surgery", "cop": 3, "opa": "10", "opb": "20", "opc": "40", "opd": "60", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "7efe7e77-12e9-45d9-a5e6-d9e8a49ab3c5", "choice_type": "single"} {"question": "Fogarty's catheter is used for", "exp": "Fogarty's catheter is used for removal of embolus from the blood vessels.", "cop": 1, "opa": "Removal of embolus from blood vessels", "opb": "Parenteral hyperalimentation", "opc": "Drainage of urinary bladder", "opd": "Ureteric catheterisation", "subject_name": "Surgery", "topic_name": null, "id": "946f6de5-34df-43b7-a401-3f26b54e4218", "choice_type": "single"} {"question": "A displaced mandibular fracture in a child should\nbe managed by", "exp": null, "cop": 2, "opa": "Circum mandibular wiring", "opb": "Early mobilization", "opc": "Intermaxillary fixation", "opd": "Transosseous wiring", "subject_name": "Surgery", "topic_name": null, "id": "aefc98e4-d733-447d-b6ab-9c49aabebc09", "choice_type": "single"} {"question": "The screening test for neonatal hypothyroidism", "exp": "Ans. (c) TSH and T4 assaysRef Harrison 17th edition Chapter 335* Neonatal hypothyroidism is due to thyroid gland dysgenesis in 80-85%, to inborn errors of thyroid hormone synthesis in 10-15%, and is TSH-R antibody-mediated in 5% of affected newborns.* Because of the severe neurologic consequences of untreated congenital hypothyroidism, neonatal screening programs have been established.* These are generally based on measurement of TSH or T4 levels in heel-prick blood specimens* When the diagnosis is confirmed, T4 is instituted at a dose of 10-15g/Kgper day, and the dose is adjusted by close monitoring of TSH levels.* T4 requirements are relatively great during the first year of life, and a high circulating T4 level is usually needed to normalize TSH.* Early treatment with T4 results in normal IQ levels, but subtle neurodevelopmental abnormalities may occur in those with the most severe hypothyroidism at diagnosis or when treatment is suboptimal", "cop": 3, "opa": "Blood iodine levels", "opb": "Radioiodine uptake", "opc": "TSH and T4 assays on heel prick blood sample", "opd": "USG", "subject_name": "Surgery", "topic_name": "Thyroid Gland", "id": "58e100c7-0b15-4a57-9dc2-37c72194bcac", "choice_type": "single"} {"question": "Tardy Ulnar nerve palsy is caused by", "exp": "A i.e. Fracture lateral epicondyle of humerus Tardy Ulnar Nerve Palsy Tardy ulnar nerve palsy as a late complication of fractures of the lateral condyle physisQ is well known, especially after the development of cubitus valgusQ from malunion or nonunion of fractures. The symptoms are usually gradual in onset and may appear years after injuryQ (upto 22 years also). Motor loss occur first, with sensory changes developing somewhat later. Anterior transposition of ulnar nerve is most commonly used procedure. With development of cubitus valgus there is outward detion of forearm 1/ t stretching of medial structures (including ulnar nerve) and causing tardy ulnar nerve palsy.", "cop": 1, "opa": "Fracture lateral epicondyle of humerus", "opb": "Fracture medial epicondyle of humerus", "opc": "Elbow dislocation", "opd": "Supra condylar fracture of humerus", "subject_name": "Surgery", "topic_name": null, "id": "12ee6149-8642-4b78-8188-86ffabea3206", "choice_type": "single"} {"question": "Period of onset in tetanus refers to the time between", "exp": "The interval between first symptom(dysphagia and stiffiness of jaw) to a reflex spasm is called period of onset. If this is less than 48hours,the prognosis is poor and if more than 48hours,prognosis is better. Ref:Manipal manual of surgery,4th edition,pg", "cop": 2, "opa": "First injury to spasm", "opb": "First symptom to spasm", "opc": "First spasm to death", "opd": "Trismus to laryngeal spasm", "subject_name": "Surgery", "topic_name": "General surgery", "id": "634824ca-bc84-4854-b847-dafa85161d42", "choice_type": "single"} {"question": "Jeeps disease is known as", "exp": "Pilonidal sinus is seen in drivers mainly hairy jeep drivers in military.", "cop": 4, "opa": "Hemorvhoids", "opb": "Fissure in ano", "opc": "Fistula in ano", "opd": "Pilonidal sinus", "subject_name": "Surgery", "topic_name": null, "id": "8b4a922b-bf1b-44b4-83c0-f0e57cd6cda1", "choice_type": "single"} {"question": "Most common site for squamous cell carcinoma of esophagus is", "exp": "Ans. is 'b' i.e., Middle 1/3* Esophageal Carcinoma is of two common histological typesi) Squamous cell Ca - the MC type in world (-95% according to Sabiston)ii) Adenocarcinoma - where incidence is increasing at a rapid rate and is now the MC type in USA (Ref: Harrison, Schwartz)* Distribution of Squamous Cell Ca.# Upper 1/3 - 10%# Middle 1/3 - 60%# Lower 1/3 - 30% * Adenocarcinoma is mainly located in lower 1/3.", "cop": 2, "opa": "Upper 1/3", "opb": "Middle 1/3", "opc": "Lower 1/3", "opd": "Upper 1/2", "subject_name": "Surgery", "topic_name": "Oesophagus", "id": "c4fe5b63-3fa3-4689-a444-b88224f3c4f3", "choice_type": "single"} {"question": "Pringle's Maneuver is used to stop the bleeding from", "exp": "Pringle maneuver is soft clamping hepatic artery and portal\nvein at the point of entry. It is done for liver trauma patients.", "cop": 1, "opa": "Liver", "opb": "Spleen", "opc": "Kidneys", "opd": "Flail chest", "subject_name": "Surgery", "topic_name": null, "id": "10eb7b46-7593-4873-8b02-197ad01a240b", "choice_type": "single"} {"question": "Acute onset of anuria in elderly men", "exp": null, "cop": 2, "opa": "Bilateral infarction of kidneys", "opb": "Obstructive urinary disease", "opc": "Acute tubular necrosis", "opd": "Acute cortical necrosis", "subject_name": "Surgery", "topic_name": null, "id": "ac28b1e8-0d31-44d9-832d-4563c514121d", "choice_type": "single"} {"question": "&;FAST&; can detect free blood if it is a minimum of", "exp": "Focused abdominal sonar for trauma (FAST) is a technique whereby ultrasound (sonar) imaging is used to assess the torso for the presence of free blood, either in the abdominal cavity or in the pericardium. The technique, therefore, focuses on six areas: the pericardium, the areas around the liver and the spleen, the left and right pericolic gutters, and the peritoneal space in the pelvis. FAST is accurate at detecting >100 mL of free blood;Bailey and Love 26e pg: 359", "cop": 2, "opa": "10 ml", "opb": "100ml", "opc": "200ml", "opd": "400ml", "subject_name": "Surgery", "topic_name": "Trauma", "id": "79dfa65d-eff7-4689-a486-5e49fb7543d8", "choice_type": "single"} {"question": "Causes for primary hyperparathyroidism", "exp": null, "cop": 1, "opa": "Parathyroid carcinoma", "opb": "Renal failure", "opc": "Rickets", "opd": "Malabsorption", "subject_name": "Surgery", "topic_name": null, "id": "46265301-1658-424f-945f-5c4014a3aac3", "choice_type": "single"} {"question": "History of lucid interval is present in", "exp": ".extradural haematoma is the collection of blood in the extradural space between the dura and skull. most common site is temporoparietal region . usually , it is associated with fracture of temporoparietal region. immediately after injury, there is transient loss of consciousness and the patient soon becomes normal. later after 6-12 hours, he again falls ill and condition deteriorates. this is the time taken to develop raising intracranial pressure , coning and its effects. this crucial time gap is caleed lucid interval. (Ref : SRB&;s Manual of Surgery, 5th editin , pg no. 1095)", "cop": 1, "opa": "EDH", "opb": "SAH", "opc": "ICH", "opd": "Rupture of aneurysm", "subject_name": "Surgery", "topic_name": "Trauma", "id": "975f454f-8783-45e4-af26-80c0e205f524", "choice_type": "single"} {"question": "Congenital hydrocele is best treated by", "exp": "Congenital hydrocele is best treated with herniotomy if they do not resolve spontaneously. Established acquired hydrocele often have thick walls. They are treated by subtotal excision of the sac. If the sac is small, thin walled and contains clear fluid, Lord's operation is done. Jaboulay's operation where the sac is eveed with placement of testis in a pouch created by dissection in the fascial planes of the scrotum, is an alternative. Reference : page 1328 Bailey and Love's sho practice of surgery 25th edition and page 1072 SRB's manual of surgery 5th edition", "cop": 4, "opa": "Eversion of sac", "opb": "Excision of sac", "opc": "Lord's procedure", "opd": "Herniotomy", "subject_name": "Surgery", "topic_name": "Urology", "id": "fa2a40f5-7d07-473b-9175-f891e8923e19", "choice_type": "single"} {"question": "The treatment of choice for squamous cell anal cancer is", "exp": "Anal cancer # Uncommon tumour, which is usually a squamous cell carcinoma # Treatment is by chemoradiotherapy in the first instance # More prevalent in patients with HIV infection # May affect the anal verge or anal canal # Lymphatic spread is to the inguinal lymph nodes #Associated with HPV # Major ablative surgery is required if the above fails Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1269", "cop": 3, "opa": "Abdominoperennial resection", "opb": "Laser fulgaration", "opc": "chemoradiotherapy", "opd": "Platinum-based chemotherapy", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "12a8fe18-03ea-4556-bd9f-322c6a578f3a", "choice_type": "single"} {"question": "Fine needle aspiration cytology is not suitable for diagnosing", "exp": "Aneurysmal bone cyst, abbreted ABC, is an osteolytic bone neoplasm characterized by several sponge-like blood or serum filled, generally non-endothelialized spaces of various diameters. On a radiograph, well-defined, expansile, lytic lesion is observed. Expansion of coex gives the lesion a balloon-like appearance. Larger lesions may appear septated The afflicted may have relatively small amounts of pain that will quickly increase in severity over a time period of 6-12 weeks. The skin temperature around the bone may increase, a bony swelling may be evident, and movement may be restricted in adjacent joints. Spinal lesions may cause quadriplegia and patients with skull lesions may have headaches. Commonly affected sites are metaphyses of veebra, flat bones, femur and tibia. Approximate percentages by sites are as shown: Skull and mandible (4%) Spine (16%) Clavicle and ribs (5%) Upper extremity (21%) Pelvis and sacrum (12%) Femur (13%) Lower leg (24%) Foot (3%) Ref: Internet sources (Wiki)", "cop": 4, "opa": "Tubercular lymphadenitis", "opb": "Papillary carcinoma thyroid", "opc": "Plasmacytoma", "opd": "Aneurymal bone cyst", "subject_name": "Surgery", "topic_name": "Urology", "id": "1a29fd4c-9f47-4ded-b727-b188ea71e35a", "choice_type": "single"} {"question": "The concept of One Stage Full Mouth Disinfection has been put forth to prevent", "exp": null, "cop": 3, "opa": "Adhesion of microorganisms", "opb": "Proliferation of microorganisms", "opc": "Translocation of microorganisms", "opd": "Bacterial invasion", "subject_name": "Surgery", "topic_name": null, "id": "0f16441f-8220-4923-891c-3c4a2dcd931f", "choice_type": "single"} {"question": "Wolfe grafts is", "exp": ".wolfe graft is a ful thickness graft consisiting of epidermis and full layer of dermis thiersch graft is a paial thickness graft consisiting of epidermis and variable layers of dermis", "cop": 1, "opa": "Full thickness skin grafts", "opb": "Paial thickness skin grafts", "opc": "Split-skin grafts", "opd": "Pedicled flap", "subject_name": "Surgery", "topic_name": "General surgery", "id": "fdf194db-8fce-4f10-ae19-488a8f1e81af", "choice_type": "single"} {"question": "\"Peritoneal mice\" is", "exp": "Ans. is 'b' i.e., Appendices epiploicae", "cop": 2, "opa": "Pseudomyxoma peritonei", "opb": "Appendices epiploicae", "opc": "Peritoneal seedings of tumour", "opd": "Endometriosis", "subject_name": "Surgery", "topic_name": null, "id": "f9aea536-518d-4cd7-a90a-eb707dd323e1", "choice_type": "single"} {"question": "Melanoma of anal canal", "exp": "Malignant melanoma of the anus is very rare and usually presents as a bluish-black soft mass that may mimic a thrombosed external pile, although it may be amelanotic.The prognosis, irrespective of treatment, is extremely poor. Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1269", "cop": 3, "opa": "Presents with bleeding", "opb": "AP resection gives better result then local excision", "opc": "Local recurrence at same site", "opd": "Radiosensitive", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "5771a383-3e9e-492c-9388-ef1588a47824", "choice_type": "single"} {"question": "A young man gets into a fight after taking beer and is kicked by the lower abdomen. There was pelvic fracture. Blood at meatus. Most likely cause is", "exp": "Rupture of membranous urethra is usually associated with pelvic fractures. It is characterised by blood in external meatus, failure or difficulty in passing urine, extravasation of urine to scrotum, perineum and abdominal wall, shock .\nBulbar urethral injury is usually d/t a fall astride a projecting object leading to blood at meatus, perineal hematoma, retention of urine.\nIn case of kidney laceration- features of shock, hematuria, clot colic, bruising,swelling and tenderness in the loin.", "cop": 1, "opa": "Bulbar urethral injury", "opb": "Kidney laceration", "opc": "hematuria", "opd": "Rupture of membranous urethra", "subject_name": "Surgery", "topic_name": null, "id": "695f6d15-4eff-43e9-885d-fb6c6b927af0", "choice_type": "single"} {"question": "Most common type of melanoma", "exp": "Superficial spreading melanoma (SSM) This is the most common presentation (70%), usually arising in a pre-existent naevus after several years of slow change, followed by rapid growth in the preceding months before presentation.Ref: Bailey and Love, 27e, page: 609", "cop": 2, "opa": "Nodular melanoma", "opb": "Superficial spreading melanoma", "opc": "Lentigo maligna melanoma", "opd": "Acral lentigious melanoma", "subject_name": "Surgery", "topic_name": "General surgery", "id": "c362f6d1-8d74-43c2-882e-f0a3e51611d2", "choice_type": "single"} {"question": "Burns with vesiculation of the epidermis and upper dermis is", "exp": "Second degree burns Paial thickness burn Involve epidermis and some pa of dermis Divided into : Superficial and deep second degree Superficial second degree Involve upper layer of dermis (papillary dermis) Erythematous Blisters are seen Blanch to touch Painful Heals without scarring in 7-14 days Deep second degree burns Also known as deep paial thickness burn Injury extends to reticular layer of dermis Dont blanch Mottled pink and white colour of wound surface Capillary refilling is absent or occurs slowly Pain is absent Pin-prick sensation is absent or occurs slowly Heals in 3-9 weeks with scar formation Ref: Sabiston 20th edition Pgno : 506-507", "cop": 2, "opa": "1st degree", "opb": "2nd degree", "opc": "3rd degree", "opd": "4th degree", "subject_name": "Surgery", "topic_name": "General surgery", "id": "721ae0be-e489-42b0-b84b-c39abb6ba797", "choice_type": "single"} {"question": "The least common type of intussuception is", "exp": "Ans. is 'a' i.e., Multiple", "cop": 1, "opa": "Multiple", "opb": "Colocolic", "opc": "Ileoileal", "opd": "Ileoilecolic", "subject_name": "Surgery", "topic_name": null, "id": "19415321-4228-48bc-b1c5-cc770c769851", "choice_type": "single"} {"question": "Ormand's disease is", "exp": "Ans. b (Idiopathic retroperitoneal fibrosis) (Ref. Bailey and Love surgery 25th/pg. 1007)RETROPERITONEAL FIBROSIS (RPF) / ORMAND'S DISEASE# This is one of a group of fibromatoses (others being Dupuytren's contracture and Peyronie's disease).# This process was first identified in 1905 by Albarran who encountered a patient with an extensive fibrotic retroperitoneal process at surgery.# Causes of retroperitoneal fibrosis: Idiopathic (Ormond's disease), Chronic inflammation, Extravasation of urine, Retroperitoneal irritation by leakage of blood or intestinal Content, Aortic aneurysm ('inflammatory type'), Trauma, Drugs: Chemotherapeutic agents Methysergide Beta-Adrenoceptor antagonists, Lymphoma, Carcinoid tumours, Secondary deposits (especially from carcinoma of stomach, colon, breast and prostate)# Most cases are idiopathic.# It is most commonly observed in middle-aged to elderly men between the ages of 40 and 70.# Familial cases are known, involving mediastinal fibrosis, sclerosing cholangitis, Riedel's thyroiditis and orbital pseudotumour. Extensive collagen deposition surrounds the ureters, mostly at the level of the pelvic brim or below. Most patients present with ureteric obstruction, often with renal failure.# The hallmark IVU feature of RPF is deviation of both ureters medial to the lumbar vertebral pedicles.0# Multislice CT remains the standard imaging employed to evaluate patients in whom RPF is suspected.# Ureteric stenting and steroid therapy are often effective.", "cop": 2, "opa": "Retractile testis", "opb": "Idiopathic retroperitoneal fibrosis", "opc": "Idiopathic retroperitoneal lymphadenopathy", "opd": "Idiopathic mediastinitis", "subject_name": "Surgery", "topic_name": "Peritoneum", "id": "296b8c52-096e-4f38-a14b-0eb741b9550a", "choice_type": "single"} {"question": "Hamman's sign is most characteristic of", "exp": "(D) Pneumomediastinum # Subcutaneous emphysema is a frequently found in pneumothorax (air outside of the lung in the chest cavity) and may also result from air in the mediastinum, pneumo- pericardium (air in the pericardial cavity around the heart). Pneumothorax (plural pneumothoraces) is a collection of air or gas in the pleural cavity of the chest between the lung and the chest wall. It may occur spontaneously in people without chronic lung conditions (\"primary\") as well as in those with lung disease (\"secondary\"), and many pneumothoraces occur after physical trauma to the chest, blast injury, or as a complication of medical treatment. Pneumopericardium is a medical condition where air enters the pericardial cavity.lt can be congenital, or introducec by a wound Hamman's crunch is caused by pneumomediastinum , and is associated with tracheobronchial injury due to trauma, medical procedures (e.g., bronchoscopy) or proximal pulmonary bleb rupture", "cop": 4, "opa": "Subcutaneous emphysema", "opb": "Pneumothorax", "opc": "Pneumopericardium", "opd": "Pneumomediastinum", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "2df0edb8-5feb-422e-a0ec-f719ef5fab16", "choice_type": "single"} {"question": "Curling&;s ulcer is seen in", "exp": ".Acute ulcers after cerebral trauma or neurosurgeries are called as Cushing's ulcers. Acute ulcers after major burns are called as Curling ulcers. Diagnosis is by gastroscopy presenting as pain in the epigastric region, vomiting or haematemesis. Treatment is conservative- IV ranitidine. IV pantoprazole 80 mg in 100 ml DNS--slow, later 40 mg IV maintenance. Note: Curling's ulcer occurs when burn injury is more 35%. It is observed in the body and fundus, not in antrum and duodenum. Ref: SRB&;s manual of surgery,3 rd ed, pg no 770", "cop": 2, "opa": "Drowning", "opb": "Burns", "opc": "Electric shock", "opd": "Intracranial tumor", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "46007dce-44b6-4c80-ada1-6a3fc0d65e69", "choice_type": "single"} {"question": "Heller's cardiomyotomy done for", "exp": "Ans. (b) AchalasiaRef: Bailey and Love 27th Edition, Page 1098Treatment for Achalasia:There are various modes of treatment for achalasia cardia:Medical Treatment:* Calcium channel blockers like sublingual Nifedipine* Sildenafil citrate* NitratesEndoscopic Treatment:* Pneumatic balloon dilatation: 30mm - 40mm plastic balloon are used. Most common complication is perforation around 0.5%. Results are good for age above 40 years* Botulinum toxin: injected in the LOS which destroys the excitatory effect of cholinergic neurons. Effect is temporary and we have to repeat after few months. Hence used only for Unfit elderly patients.* Endoscopic myotomy known as peroral endoscopic myotomy (POEM)Heller's Myotomy:* Gold standard of all procedures. Myotomy done from 1-2 cm on stomach side extending up to 6-8 cm on esophagus side anteriorly* Most common complication is GERD* Hence nowadays Dor anterior fundoplication is done along with myotomy.* Successful in 90% cases.", "cop": 2, "opa": "CHPS", "opb": "Achalasia", "opc": "GERD", "opd": "Duodenal stenosis", "subject_name": "Surgery", "topic_name": "Oesophagus", "id": "2db41c1e-3f94-487d-9610-8a3a0a4d3625", "choice_type": "single"} {"question": "Wolffian duct give rise to", "exp": "(Vas deference) (1403-LB) (1377-B &L 25,h)* The testis develops from the genital fold medial to the mesonephros (Wolffian body)* The Wolffian duct becomes the epididymis and vas deferensDevelopment of genitourinary System:Embryonic structureStructure developing in MALEStructure developing in FEMALEGenital tuberclePenis (C. cavernosa)ClitorisUrethral foldsPenile urethra (C. spongiosa)Labia minoraGenital swellingScrotumLabia majoraGubemaculumGubemaculums testisLigament of ovaryRound ligament of uterus Genital glandsTestisOvary (genital ridge)Germinal cordsSeminiferous tubulesPfluger's tubeMesonephric duct (Wolffian duct)Epididymis, Vas deferens and seminal vesicles Ejaculatory ductsAppendix epididymidisDuct of epoophoron Gartner's duct vesicular appendageUreter, renal pelvis etc Trigonal structure**Ureter, renal pelvis, et^ Trigonal structuresMullerian duct (Paramesonephric duct)Appendix testisProstatic utricleUterine tubes, Uterus, Vagina (upper four- fifths)Muller's tubercleVeromontanumSite of hymenSinovaginal bulb from urogenital sinusPart of prostatic utricleLower one-fifth of vaginaJunction of sinovaginal bulb and urogenital sinusDisappears normally (remnants probably from posterior urethral valves)HymenUrogenital sinusVentral and pelvic partUrinary bladder (except the trigone)Supramontanel part of prostatic urethraUrinary bladder (except the trigone) whole urethraPhallic or urethral portionInframontanal part of prostatic urethra Membranous urethraVaginal vestibules", "cop": 1, "opa": "Vas deference", "opb": "Appendix testis", "opc": "Testis", "opd": "Prostate", "subject_name": "Surgery", "topic_name": "Testis & Scrotum", "id": "2d6df48d-cd66-40d7-9ad9-7b6d7081cb40", "choice_type": "single"} {"question": "In classic Barret's, the length of columnar epithelium in distal oesophagus is", "exp": "Classic Barrett's (>= 3cm columnar epithelium);Sho-segment Barrett's (<3 cm of columnar epithelium);Cardia metaplasia (intestinal metaplasia at the oesophagogastric junction without any macroscopic change at endoscopy).The relative risk of cancer rises with increasing length of abnormal mucosa.", "cop": 3, "opa": ">1cm", "opb": ">2cm", "opc": ">3cm", "opd": ">4cm", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "48e3bfd0-de65-4387-8426-ae2a954c87c3", "choice_type": "single"} {"question": "Maximum dose of xylocaine with out adrenaline that can be given in 60kg adults is", "exp": null, "cop": 2, "opa": "500mg", "opb": "300mg", "opc": "400mg", "opd": "600mg", "subject_name": "Surgery", "topic_name": null, "id": "7933dc44-80a0-48ab-890c-353b09fdc4db", "choice_type": "single"} {"question": "Paget's disease of breast is a manifestation of", "exp": "Ans. (a) Ductal carcinoma(Ref Bailey and Love 27th edition Page 873)* Paget's disease of nipple is the manifestation of underlying Ductal carcinoma, Nipple gets eroded completely and disappears.* Large ovoid cells with abundant Pale staining cytoplasm in malphigian layer of skin is Paget's cells", "cop": 1, "opa": "Ductal carcinoma", "opb": "Lobular carcinoma", "opc": "DCIS", "opd": "LCIS", "subject_name": "Surgery", "topic_name": "Breast", "id": "5a4359bb-e4bc-4582-ba49-c3138cf587e6", "choice_type": "single"} {"question": "Conscious sedation in dentoalveolar surgery is best done by", "exp": null, "cop": 3, "opa": "Sevoflurane", "opb": "Isoflurane", "opc": "Midazolam", "opd": "Morphine", "subject_name": "Surgery", "topic_name": null, "id": "e0b5cc5b-cc7b-493c-84c7-0a67a6ce7f3f", "choice_type": "single"} {"question": "Infection draining the ring finger goes to", "exp": "Mid palmar space Infection from thumb and index finger --- thenar space Middle and ring finger--mid palmar space Little finger-- fore arm space of Parona", "cop": 2, "opa": "Thenar space", "opb": ". Mid palmar space", "opc": "Ulnar bursa", "opd": "Radial bursa", "subject_name": "Surgery", "topic_name": null, "id": "1689f5df-9261-4203-b588-863c3c78bbfe", "choice_type": "single"} {"question": "Trismus associated with infection of Lateral pharyngeal space is related to irritation of the", "exp": null, "cop": 4, "opa": "Buccinator", "opb": "Masseter", "opc": "Lateral pterygoid", "opd": "Medial pterygoid", "subject_name": "Surgery", "topic_name": null, "id": "414756c5-ed76-42d4-bbaf-7985f0d29bbc", "choice_type": "single"} {"question": "The treatment of choice for perforation of the cervical esophagus is", "exp": "Surgical exploration of the neck conr with drainage of the retro visceral space is the preferred treatment of persons who have a cervical esopre perforation. Drainage can be performed under G. anesthesia and improvement is prompt. Suture may be required for major lacerations. All persons having an esophageal injury should receive parenteral administered antibiotics and appropriate fluid electrolyte solutions; however, relying on these measures alone-without surgery-is dangerous and may be fatal.", "cop": 3, "opa": "Bed rest and use of antibiotics", "opb": "Nasogastric intubation and use of antibiotics", "opc": "Cervical exploration and drainage of superior mediastinum and use of antibiotics", "opd": "Resection and colonic interposition", "subject_name": "Surgery", "topic_name": null, "id": "c10d2ca3-a6d9-46dc-b13c-4aba92b72747", "choice_type": "single"} {"question": "Tinnels sign indicates", "exp": null, "cop": 4, "opa": "Atrophy of nerves", "opb": "Neuroma", "opc": "Injury to nerve", "opd": "Regeneration of nerves", "subject_name": "Surgery", "topic_name": null, "id": "f0854828-10e4-43f3-affc-20d58cc2ca0f", "choice_type": "single"} {"question": "Tietz syndrome is", "exp": "It causes breast pain which is non cyclical.", "cop": 1, "opa": "Costochondritis of second rib", "opb": "Costochondritis of 4th rib", "opc": "Superficial thrombophlebitis of breast", "opd": "Fibroadenoma of breast", "subject_name": "Surgery", "topic_name": null, "id": "0c621508-1081-4b8e-ae73-9c4ddfe2502f", "choice_type": "single"} {"question": "Investigation of choice in discrete thyroid swelling is", "exp": "Fine-needle aspiration cytology is the investigation of choice in discrete thyroid swellings. FNAC has excellent patient compliance, is simple and quick to perform in the outpatient depament and is readily repeated Comment : This question is based on above lines from bailey and love. In workup of solitary nodule of thyroid , thyroid profile is done after history and physical eamination. In normal or elevated TSH patients , USG neck is done. following which FNAC is done Previously thyroid scan used to be very impoant investigation in solitary nodule workup. Now its limited to toxic nodules. May be question is framed to highlight this point. Source : Sabiston 20th edition Pg : 890 Bailey and Love 26th edition Pg : 750", "cop": 4, "opa": "Isotope scans", "opb": "Ultrasonography", "opc": "Autoantibody titres", "opd": "FNAC", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "eac09bc0-db00-4ff4-bb03-d839fa8c89a3", "choice_type": "single"} {"question": "Contraindication of major thoracic surgery is", "exp": "(A) Myocardial infarction in recent 3 months# CARDIOVASCULAR FITNESS:1. All patients for lung resection should have a preoperative ECG.2. All patients with an audible cardiac murmur should have an echocardiogram.3. Patients who have had a myocardial infarction should normally not be operated on for lung resection within 6 weeks.4. Any patient who has had a myocardial infarction within 6 months and is being assessed for thoracic surgery should have a cardiology opinion.5. Patients who have had coronary artery bypass surgery should not be precluded from having lung resection. They should be assessed as for other patients with possible cardiac risk factors.6. The guidelines from the American College of Cardiology and the American Heart Association should be used as a basis for assessing the perioperative cardiovascular risk of patients undergoing lung resection.# Major risk:(a) These patients should have a formal cardiological assessment and their management discussed at a multidisciplinary meeting.(b) Patients found to have significant lesions on coronary angiography should be considered for coronary artery bypass surgery before lung resection.# Intermediate Risk:(a) Patients in this group with reasonable functional capacity (able comfortably to walk up one flight of stairs) should not normally be regarded as at greater than average risk for postoperative complications. They do not need further cardiac testing.(b) Patients with poor functional capacity and those in whom there is doubt about the degree of severity of their angina pectoris or who report breathlessness which may be due to cardiac disease should have an ECG monitored exercise test and echocardiogram and the results should be discussed with a cardiologist.# Minor Risk:> Patients in this group with one risk factor should not normally be considered to be at greater than average risk for postoperative complications.", "cop": 1, "opa": "Myocardial infarction is recent 3 months", "opb": "Myocardial infarction in recent 9 months", "opc": "Myocardial infarction in recent 12 months", "opd": "Myocardial infarction in 18 months", "subject_name": "Surgery", "topic_name": "Miscellaneous", "id": "7c57d79b-244f-4100-b2c6-6b328ff52a33", "choice_type": "single"} {"question": "Split skin grafts in young children should be harvested from", "exp": ".* Once the area granulates well, in 3 weeks usually, split skin grafting is done (SSG, Thiersch graft). * For wider area MESH split skin graft is used. * If there is eschar, escharotomy is required to prevent compression of vessels. * In ceain areas like face and ear, full thickness graft (Wolfe graft) or flap is required. ref:SRB;s manual of surgery,ed 3,pg no 112", "cop": 2, "opa": "Buttocks", "opb": "Thigh", "opc": "Trunk", "opd": "Upper limp", "subject_name": "Surgery", "topic_name": "General surgery", "id": "a2f6fcac-e254-4ef2-9023-7ac3908f2d75", "choice_type": "single"} {"question": "Elective cholecystectomy is", "exp": "Clean no viscus opened EX: thyroid, breast surgeries Clean-contaminated viscus opened, minimal spillage) Cholecystectomy, Gastric surgery Contaminated open viscus with spillage or inflammatory disease Inflamed appendix, rectal surgeries Diy pus or perforation, or incision through an abscess I&d wound debridement", "cop": 1, "opa": "Clean contaminated", "opb": "Clean", "opc": "Diy", "opd": "Contaminated", "subject_name": "Surgery", "topic_name": "General surgery", "id": "7a14f171-7aaa-417f-a8ac-384306205e16", "choice_type": "single"} {"question": "Hyperbaric oxygen is indicated for", "exp": null, "cop": 2, "opa": "Obstructive lung diseases", "opb": "Osteoradionecrosis", "opc": "Cardiac failure", "opd": "Renal diseases", "subject_name": "Surgery", "topic_name": null, "id": "5f138ce5-f0c0-4b51-a384-f1e0ae86d45c", "choice_type": "single"} {"question": "The most common underlying aetiology of primary hyperparathyroidism is", "exp": "The underlying aetiology of PHPT is usually a solitary parathyroid adenoma, however, in a small number of patient (2-4%), there are double adenomas. It may occur in a sporadic fashion or it can be familial (MEN type 1 or type 2A, hyperparathyroidism-jaw tumour syndrome (HPT-JT)Ref: Bailey and Love 27e pg: 826", "cop": 1, "opa": "Parathyroid adenoma", "opb": "MEN-1", "opc": "MEN-2A", "opd": "Parathyroid adenocarcinoma", "subject_name": "Surgery", "topic_name": "Endocrinology and breast", "id": "59baaa7c-f10b-465c-961a-c550de5bea1a", "choice_type": "single"} {"question": "Treatment of contaminated wound in Gas Gangrene isa) Debridement of woundb) Systemic penicillinc) Metronidazole Administrationd) Peroxide dressings", "exp": null, "cop": 2, "opa": "ac", "opb": "ab", "opc": "ad", "opd": "bc", "subject_name": "Surgery", "topic_name": null, "id": "2bf4af66-b302-4995-9c6b-93cfcca777cc", "choice_type": "single"} {"question": "Bakers cyst is a type of", "exp": "Answer- A. Pulsion diveiculum of knee jointIt is the pulsion diveiculum of the knee joint, caused by chronic disease in the joint.Bulging of the posterior capsule and synol herniation may produce a swelling in the popliteal fossa.", "cop": 1, "opa": "Pulsion diveiculum of knee joint", "opb": "Retention cyst", "opc": "Bursistis", "opd": "Benign tumor", "subject_name": "Surgery", "topic_name": null, "id": "16dd351c-fdad-445f-86fe-746824e2daae", "choice_type": "single"} {"question": "Pulp space infection is known as", "exp": "A felon is an abscess between the specialised fibrous septae in the fingeip pulp. It causes intense pain and may lead to terminal phalangeal osteomyelitis. Reference : Bailey & Love, 27th Edition, page no = 503.", "cop": 1, "opa": "Felon", "opb": "Paronychia", "opc": "Perionychia", "opd": "Onychonychia", "subject_name": "Surgery", "topic_name": "General surgery", "id": "94f45edd-86b1-48ef-a67e-0b8140e661b3", "choice_type": "single"} {"question": "In cholecystectomy, fresh plasma should be given", "exp": ".Indications for cholecystectomy, * Gallstones--symptomatic. * Cholecystitis--acute, chronic. * Acalculous cholecystitis. * Empyema gallbladder. * Mucocele gallbladder. Approaches employed are * Open - Right subcostal incision (Kocher's). - Right paramedian. - Horizontal incision. - Mayo-Robson incision. * Laparoscopic approach. Technique After opening the abdomen, colon is pushed downwards and stomach medially. Duct--first method: Here Calot's triangle is dissected. Cystic aery is identified and ligated. Cystic duct is ligated close to the gallbladder. Gallbladder is separated from gallbladder fossa and removed. Haemostasis is maintained. Fundus--first method: It is done in difficult gallbladder due to dense adhesions. Fundus is separated from themliver bed. Dissection is carried proximally until cystic duct and cystic aery are identified, which are then ligated. Drain is placed, which is removed after 72 hours. On table cholangiogram is a must after cholecystectomy. ref : SRB&;s manual of surgery,3 rd ed,pg no 595", "cop": 1, "opa": "Just before operation", "opb": "6 hours before operation", "opc": "6 hours before operation", "opd": "12 hour after operation", "subject_name": "Surgery", "topic_name": "G.I.T", "id": "874cffe5-764b-45ae-801d-3089262b54ff", "choice_type": "single"} {"question": "Most common complication of end colostomy is", "exp": null, "cop": 3, "opa": "Obstruction", "opb": "Prolapse", "opc": "Parastomal hernia", "opd": "Dermatitis", "subject_name": "Surgery", "topic_name": null, "id": "cad8e903-9b93-4f27-8ee0-833812607b9d", "choice_type": "single"} {"question": "Risk factors of pulmonary embolisma) 30 yrs female on OCP' sb) Pregnancyc) Leg paralysisd) 50 yrs person with uncomplicated cholecystectomye) Bechet's disease", "exp": null, "cop": 4, "opa": "bcde", "opb": "abcd", "opc": "acde", "opd": "abce", "subject_name": "Surgery", "topic_name": null, "id": "89aa504a-f4c8-4d0a-b5fb-241e31895f5c", "choice_type": "single"} {"question": "Hormonal therapy is useful if Cancer breast expresses ...", "exp": "Ans. (a) Estrogen receptor(Ref. Sabiston 20th edition Page 853)* ER positive cases are provided Hormone therapy* HER-2/neu Positive cases are provided Trastuzumab HERCEPTIN (VEGF inhibitor)", "cop": 1, "opa": "Estrogen receptor", "opb": "Progesterone receptor", "opc": "Selling Her 2 neu", "opd": "VEGF", "subject_name": "Surgery", "topic_name": "Breast", "id": "48938307-aff2-479d-ab46-2cf143bddcb1", "choice_type": "single"} {"question": "Lymphnode metastasis commonest in .... Carcinoma thyriod", "exp": null, "cop": 2, "opa": "Follicular", "opb": "Papillary", "opc": "Anaplastic", "opd": "Medullary", "subject_name": "Surgery", "topic_name": null, "id": "aceac0e4-36e1-418b-bcbe-84ad22614553", "choice_type": "single"} {"question": "The typical appearance of \"spider leg\" on excretory urography is seen in", "exp": "REPEAT QUESTION polycystic kidney, an autosomal dominant disease, common in females; excretory urogram shows 'spider leg' pattern - elongated and compressed renal pelvis with narrowed and stretched calyces over the cysts. ( Reference: emedicine.medscape.com/aicle/983281-workup )", "cop": 2, "opa": "Hydronephrosis", "opb": "Polysystic kidney", "opc": "Medullary sponge kidney", "opd": "Renal cell carcinoma", "subject_name": "Surgery", "topic_name": "Urology", "id": "3d64137d-6c1d-40c4-b55b-d0225590d45e", "choice_type": "single"} {"question": "Testicular tumor in man aged 70 years is most likely to be", "exp": "Lymphoma is common in old age patients.", "cop": 2, "opa": "Sertoli cell tumor", "opb": "Lymphoma", "opc": "Yolk sac tumors", "opd": "Teratoma", "subject_name": "Surgery", "topic_name": null, "id": "815baaf1-3aec-4906-b03f-d256a4794d6b", "choice_type": "single"} {"question": "Treatment for pagets disease of breast is", "exp": "Simple mastectomy along with lymph node assessment is usually treatment of choice.", "cop": 1, "opa": "Simple mastectomy", "opb": "Radical mastectomy", "opc": "Microdochectomy", "opd": "Hadfeilds operation", "subject_name": "Surgery", "topic_name": null, "id": "5bbf7709-3173-4038-9e82-1a3fb77eab4f", "choice_type": "single"}