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8. Which of the following antiseptic is inappropriate for skin preparation of the operative site?
1. Chlorhexidine
2. Povidone Iodine
3. Cetrimide
4. Hexachlorophane
9. Definition of systemic inflammatory response
syndrome (SIRS) includes all, EXCEPT:
1. Hyperthermia (> 38C) 2. Bradycardia (60/min)
3. Tachypnoea (> 20/min) 4. WBC count < 4000/min
10. Following regarding Tropical chronic
pancreatitis is false:
1. Affects alcoholic elderly from lower socioeconomic
region esp. South India
2. Associated with ingestion
of cassava
3. Imaging studies reveal nodular fibrotic pancreas
with dilated ducts filled with stones
4. Surgery reserved for intractable pain
11. Regarding typhoid all are true, EXCEPT:
1. Caused by gram Negative bacillus
2. Diagnosis is by leucopenia, stool and blood cultures
and positive Widal test
3. Perforation of ulcer in 1st week carries poor
prognosis than 2nd week
4. Surgical intervention done in case of complications
12. For in order of minimize surgical site in the
operation theatre all are true, EXCEPT:
1. First scrubs should be for 3 mins.
2. Bacterial count to be kept below 10 CFU/cmm
3. Temp should below 19-22C and humidity between
45-55%
4. Good prepping and maintaining distance of
unscrubbed staff of atleast 50 cms from sterile field
13. Thymus gland abscess is congenital syphilis
are called:
1. Politizer's abscess
2. Fouchier's abscess
3. Duboi's abscess
4. Mycotic abscess
14. Malignant pustule occurs in:
1. Melanoma
2. Anthrax
3. Carbuncle
4. Actinomycosis
15. Following are true of eryiseplas, EXCEPT:
1. Streptococcal infection
2. Margins are raised
3. Commonly seen in temperate region
4. None of the above
16. Commonest cause of acute LN-adenitis in India
is:
1. TB
2. Lymphoma
3. Staphylococcal skin infection 4. Bare foot walking
3. GH levels decreased
4. Glucose tolerance decreased
2. CI. Welchi
4. CI. Septicum
2. Dental Anomaly
4. Pregnancy tumor
2. Myocutaneous flap
4. Fasciomyocutaneous flap
1. Uraemia
3. Malignancy
2. Rejection
4. Infection
4. Causalgia
3. Mucoid
4. Colloid
3. Chronic cystitis
4. Malignancy
163. To differentiate between stress
incontinence and Detrusor instability
investigation done is :
1. Cystourethroscopy
2. Urodynamic study
3. MCU
4. Retrograde urethroscopy
164. For treatment of the ectopia vesicae,
which of the following bone is divided to
reach the site :
1. Pubic ramic
2. IIiac bone
3. Ischium bone
4. Symphysis
165. A patient Kailash presents with haematuria for
many days. On investigations he is found to have
renal calculi, calcifications in the wall of urinary
bladder and small contracted bladder. Most probable
cause is :
1. Schistosomiasis
2. Amyloidosis
3. Tuberculosis
4. Ca urinary bladder
166. About ectopic vesicae, following is true, EXCEPT:
1. Ca bladder may occur
2. Ventral curvature of penis
3. Incontinence of urine
4. Visible uretero - vesicle efflux
167. Rahul developed a neuropathic bladder after
an accident. The lesion is found above T10. He has
incomplete bladder emptying but a good capacity
bladder. He can be managed by :
1. Condom drainage
2. Clean intermittent
3. catheterisation
4. Endoscopic sphincterotomy
5. Bladder reconstruction with fitment of artificial
urinary sphincters
168. Most common complication of ileal conduit as
a method of permanent urinary diversion is:
1. Ureteroileal stricture
2. Stenosis at the percutaneous site
3. Urine infection
4. Reabsorption of urine
169. Komal complained of urine loss during
laughing & sneezing. Which of the following is
FALSE regarding her condition?
1. It is usually seen in those with H/O caesarian
section
2. History of difficult labour with use of forceps
3. Seen with epispadias
3. Erythroplasia of Queyrat
4. Bowen disease
179. Rehman 33 year male presented with carcinoma
of penis. At presentation there were no nodes
palpable in the groin. However he developed nodes
in the right. side of groin 2 months after surgery.
Further treatment should include:
1. Observation
2. Antibiotics
3. Chemotherapy & radiation
4. Unilateral ilioinguinal node dissection
180. Malignant transformation occurs in ulcer after
many years of which of the following STI in the penis?
1. Lymphogranuloma venereum
2. Granuloma inguinale
3. Condylomata acuminata
4. None of the above
181. Androgen production from a cryptorchid testis
at 16 years of age is :
1. Reduced to half of normal output
2. Not reduced at all
3. Reduced by 30%
4. Reduced by 75%
182. Typical of Buschke-Lowenstein tumor is all,
EXCEPT:
1. Treatment is surgical
2. Locally destructive;
3. Spreads to lymph nodes>
4. It is a verrucous carcinoma
183. The most common cause of priapsm in of the in
recent years is :
1. Leukemic infiltration of pains
2. Spinal cord trauma
3. Sickle cell disease
4. Intracavernous injectiontheraphy
184. Balanoposthitis is associated with all of the
following, EXCEPT:
1. Penile cancer
2. Psoriasis
3. Gonorrhoea
4. Lichen planus
185. Chemotherapeutic drug used against penile
calJper are all, EXCEPT:
1. Etoposide
2. Cisplatin
3. Methotrexate
4. Bleomycin
186. Non-filarial elephantiasis of the scrotum is due
to infection with:
1. HIV
2. Lymphogranuloma venereum
3. Chancroid 4. Syphillis
2. Cauterization of ulcers
3. Truncal vagotomy and pyloroplasty
4. Ligation of gastroduodenal artery
211. Commonest cause of duodenal fistula is :
1. As a complication of gastrectomy
2. An abscess connected with perforated duodenal ulcer
3. Traumatic rupture of duodenum
4. As a complication of Right colectomy
212. Which of the following should be avoided in
acute upper gastrointestinal bleed ?
1. Intravenous vasopressin
2. Intravenous blockers
3. Endoscopic Sclerotheraphy
4. Ballon Tamponade
213. In post gastrectomy nutritional syndrome
following occur , EXCEPT :
1. Calcium deficiency
2. Steatorrhoea
3. Constipation
4. vit. B12 defficiency
214. Most likely cause of loss of periodicity of
symptoms and sense of epigastric bloating in a case
of duodenal ulcer is :
1. Gastric outlet obstruction 2. Perforation
3. Carcinoma
4. Pancreatitis
215. In a case of hypertrophic pyloric stenosis, the
metabolic disturbance is :
1. Respiratory alkalosis
2. Metabolic acidosis
3. Metabolic alkalosis with paradoxical aciduria
4. Metabolic alkalosis with alkaline urine
216. A 25 year old office executive presents with
recurrent duodenal ulcer of 2.5 cm size. The
procedure of choice would be :
1. Truncal vagotomy
2. Truncal vagotomy with antrectomy
3. Highly selective vagotomy
4. Laparoscopic vagotomy and gastrojejunostomy
217. Treatment of choice for Duodenal atresia is :
1. Gastroduodenostomy
2. Duodenoduodenostomy
3. Duodenojejunostomy
4. Gastrojejunostomy
218. Correct statement about operation for morbid
obesity is:
1. Bacterial overgrowth in the By passed segment is a
complication of jejunoileal bypass
2. Following gastric bypass the patient may be
permitted to resume normal eating habits
3. Long term weight loss is not sustained after a
jejunoileal bypass
4. Hemorrhoids
4. Hepaticojejunostomy
264. Which of the following is not an indication for
cholecystectomy?
1. 40 year old male with symptomatic cholelithiasis
2. 15 year old male with sickle cell anemia and gall stones
3. 30 year old male with large gall bladder polyp
4. 25 year old with asymptomatic gallstones
265. Which of the following is not associated with
cholangio carcinoma:
1. Gall stones
2. Ulcerative colitis
3. Sclerosing cholangitis
4. Clonorchis sinensis
266. A patient presents with CBD stone of 2.5 cm 1
year after cholecystectomy. The treatment of choice
would be :
1. Supraduodenal choledochotomy
2. Transduodenal sphincterotomy
3. Endoscopic sphincterotomy with stone extraction
4. Transduodenal Choledochojejunostomy
267. Treatment of type I choledochal cyst in 2 year
old infant:
1. Cholecystectomy
2. Cholecystojejunostomy
3. Cystectomy
4. Excision and reconstruction with Roux loop .
268. Treatment for symptomatic retained CBD stones
in 40 year old female with cholecystectomy done 6
months ago:
1. Medical dissolution of stones
2. Conservative treatment with antibiotics
3. Immediate surgery
4. Endoscopic sphincterotomy
269. Contraindications for laparoscopic
cholecystectomy are all, EXCEPT:
1. Cirrhosis
2. Prior upper abdominal surgery
3. Suspected carcinoma gall bladder
4. Mucocle of gall bladder
270. After exploration of common bile duct, the TTube is removed on which of the following days :
1. 6 Postop day
2. 4 Postop day
3. 12 Postop day
4. 3 Postop Day
1. (3)
Following infection by the HIV-1 virus into the blood, there is a
brief seroconversjon illness that is characterized by flu-like
illness & lymphadenopathy. There then follows a latent period
when the infected subject appears well but has a progressive
fall in CD4 counts. In this phase, there is actually a fall in viable
HIV virus in the body that subsequently rises during
development of AIDS. Systemic immune deficiency occurs
during. AIDS phase of illness.
2. (1)
Risk with solid-needle is 10-fold less than with hollow-needle.
Post-exposure HIV prophylaxis should be offered when the
source patient from high-risk group & his HIV status is
unknown. As it should be started within 1 hour when possible
it is inappropriate to wait to know HIV status. 3 drug
prophylaxis (Zidovudine, Lamivudine & indinavir) is given for
1 month.
3. (2)
It is the most important aspect of treating wound abscess,
whether antibiotics are used or not. Antibiotics usage is
controversial unless cellulitis, lymphangitis or related sepsis is
suspected. (3) & (4) are associated with poor healing
of wound abscess.
4. (3)
Cellulitis is a poorly localized, non-suppurative invasive
infection of tissues. All cardinal signs of inflammation are
present. Blood cultures are often negative, but SIRS is common.
Lymphangitis presents with painful red streaks & painful
enlarged lymph nodes.
Abscess is well-localised.
SSSI is superficial surgical site infection or an infected wound.
5. (1 )
A major wound infection is defined as a wound that either
discharges significant quantities of pus spontaneously or needs
a secondary procedure to drain it (3) & (4) may also be
associated.
Minor wound infections will also discharge pus or infected
serous fluid, but is not associated with (2), (3) and (4).
6. (2)
Most abscesses take 7-9 days to form after surgery. As many as
75% of infections may present after the patient has
left hospital & thus, may be overlooked by the surgical team.
7. (3)
Control of air quality in a modern OT is important because
non-visceral bacterial contamination of the wounds is
predominantly from the air in OT. (1), (2) and (4) are all
26. (4)
90% of malignant melanomas arise from junctional naevi. They
are likely to undergo proliferation from time to time.
34. (3)
A deltopectoral flap has only skin and fascia hence it is a
fasciocutaneous flap. It is based on the 2nd/3rd perforator
branches of internal mammary artery and used for head &
neck reconstructions.
27. (4)
Malignant transformation of neurofibromatosis occurs in 5 10%. It is also called von Recklinghausen's disease
It is MC Hereditary Neurocutaneous syndrome
2 forms NF-1-Lisch nodules /cafe all lait spots
NF-2- Bilat vestibular Schwannomas.
Both Autosomal dominant
Neurofibromas differ from Schwanomas in that
They are unencapsulated benign neoplasms of Schwann cells
and fibro blasts Tumor involves nerve and hence nerve needs
to be sacrificed.
28. (4)
Neuroblastoma, Retinoblastoma/RCC & malignant melanomas
have shown spontaneous regression in few cases.
29. (4)
Congo torticollis is presents at birth causes are
Sternomastoid tumor (mc)
Pterygium coli
Klippel feil syndrome.
Hemivertebrae
Usually associated with Breech deliveries leading to injury to
Sternocleidomastoid mastoid muscle
Rx includes -passive stretching, exercises and splinting
Surgical release is used of consecutive Rx fails.
30. (1)
Epulis - Dental anomaly
Syphilis Infection T.palidum
Ephilis is a type of freckle
31. (3)
If sqcellca < 2cms = 4mm margins required
> 2 cms == 1 cm margins
If malignant melanoma < 1 mm deep =1cm margin.
Deeplesions = 2cm margin.
These little data to support use of margin under than 2 cms
If BCC, margins b/w 2-15 mm depends on macroscopic variant
32. (4)
Full thickness grafts give a good color match and texture and
hence good cosmesis. Only small areas can be grafted by full
thickness graft.
The scrotum back and scalp do not require cosmetic grafts;
hence split thickness is better. Full thickness is
commonly used for the face.
33. (4)
A free fibula flap will give the best cosrnesis and function.
Skin graft is not an option as it will not give any tissue bulk and
the contour is not even. A pectoralis major myocutaneous flap
is an option if a free fibula is not possible.
35. (3)
It derives the blood supply from the Deep inferior epigastric
artery and hence is also called the DlEA flap.
It can be used as a pedicled or free flap for breast
reconstruction.
36. (2)
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
structure such as bone, tendon, cartilages are therefore poor
recipient sites.
So an exposed bone surface is covered by a graft which has its
own blood supply. Such grafts are k/a flaps or pedicle grafts.
Sabiston writes - "Pedicle graft or flap is a partially or
completely isolated segment of tissue with its own blood
supply"
"Absolute indications for flapsExposed bone, radiated vessels, brain, an open joint or
nonbiological implant materials. Pressure sores where a bony
prominence isexposed."
37. 4
Skin
substitutes
Advantage
Disadvantage
1. Cultured
allogenic
Keratinocytes
graft
2.
Bioengineered
dermal
replacements
3. Cultured
Bilayer skin
equivalent
Prevents
contracture
Good re aration
for raft a lication
More closely
mimics normal
anatomy
Does not need 2
procedure
Easil handled,
sutured or meshed
unstable
Doesn't prevent
wound contracture
Fragile
Possible of disease
transmission
Inadequate cosmesis
Temporary
dressings
Decreased
reepithelisation
Cost
Short half life
True en raftment
questionable
38. (4)
Capillary Hemangiomas are
1) Salman patch - Present since birth
- Forehead or occiput
- Disappears by age 1 year
2) Portwinestains - diffuse telengaotenia, no swelling
- Face/lips/Buccal mucosa presense since
Birth
N 2O
Max storage
48
time (hrs)
24
24
8
6
8
Advantage
Low risk of venous gas
embolus Does not support
combustion
Insignificant acid-base
change, Decreased pain
Helium
Argon
Disadvantage
Hypercarbia and
acidosis
support combustion
in the presence of H2
or CH3 gas
Risk of venous
embolism subacute
emphysema
Cardiac depression
42. (2)
In suffilator used to monitor the intra abdominal pressure and
insufflate gas. Usually pressure set between 12-15 mm kg as
high pressures cause hypercarbia/acidosis and adverse
cardiorespiratory problems.
43. (4)
Principle causes of death in Renal transplant patients in
decreasing order is :
a) Heart disease
b) Infection
c) Stroke
Infection is usually viral origin commonly CMV.
44. (3)
Types of Graft Reiection
Types
Hyperacute
Time
Immediately
Acute
1st 6
months
Chronic
After 6
months
Cause
Preformed
antibodies
T cell De en dent
immune
response
Non immune
factors
HP
Intravascular
thrombosis
Mononuclear cell
infiltration
Myointimal
proliferation of
graft vessels
46. (3)
The transplant kidney is placed in the iliac fossa in
retroperitoneal position living the native kidney in situ. Donor
Renal vein is anastomosed to Ext iliac vein. The donor renal A
is anastomosed end to side to ext iliac artery. If donor Arter:y
lacks a Carel's patch like in living donor, it is anastomosed to
intiliac artery end to end.
47. (3)
NOTES is natural orifice transluminal endoscopic surgery. It's a
technique whereby the peritoneal cavity is entered
endoscopically with natural orifices like month, anus or vagina
and surgery done ego Cholecystectomy and
appendicectomy.
48. (3)
Triangle of doom is bound by vas deferens, testicular vessels
and reflected part of peritoneal folds. It is a danger area of no
tackers/sutures or dissection in lap Hemia Surgery. It contains
iliac vessels.
49. (4)
Variable length is 18-45 cms but regularly used instruments
are 36 ems in adults and 28 cms for Paediatrics patients. 18
cms to 25 ems for cervical cases and paediatric.
45 cms = obese /very tall points.
Vessels needle used is b/w 80- 120 mm in length.
80 mm - thin patients, 120 mm for obese patients.
50. (4)
Donor-type lymphoid cells transplanted within a graft may
recognize the host's tissue as foreign and mount an immune
response against the host. This response, termed graft versus
host disease (GVHD), is common in bone marrow
transplantation and is an important source of morbidity and
mortality. Treatment requires more aggressive immuno
suppression. Current clinical practice includes depletion of
lymphocytes from the marrow graft in order to prevent the
development of GVHD, GVHD has been documented following
liver transplantation, presumably because of the large amount
of lymphoid tissue in the donor liver. GVHD has not been
51. (2)
Congenital lymphedema is usually bilateral. It affects lower
limbs more often and commonly occurs before puberty.
Repeated lymphangitis causes obliteration of the already
deficient lymphatics and edema is worsened.
52. (3)
Topical antibiotics are ineffective in healing leg ulcers and are
particularly likely to produce skin sensitization. They should
never be used in the management of venous ulceration.
Patients who have eczematous reactions around their ulcers
may require the use of topical steroids to treat the allergic
response.
53. (4)
The use of graduated compression stockings, exercise during
the flight and the avoidance of alcohol and sleeping tablets is
probably all that is required. In particularly high risk
passengers, that is those with a previous history of venous
thromboembolism, recent surgery or strong family history of
thrombosis, low-molecular weight heparin can be
administered subcutaneously before the flight.
54. (3)
The commonest Iymphangiographic finding in lymphoedema
praecox is distal obliteration with absent or reduced
distal superficial lymphatics. It is also termed aplasia or
hypoplasia.
55. (3)
(1), (2) and (4) are true statements. DEC destroys the parasites
but does not reverse the lymphatic changes,
although there may be some regression over time.
56. (2)
Isotope Iympho-scintigraphy has now largely replaced
lymphangiography, which was previously considered the gold
standard. Radioactive Tc-labelled protein or colloid particles
are injected into an interdigital web space and specifically
taken up by lymphatics, and serial radiographs are taken with
a gamma-camera.
57. (4)
Management of primary lymphoedema required a holistic
approach. The current preferred term 'decongestive
lymphoedema therapy' (DL T) includes 2 phases.
(1) 1st intensive phase (therapist -led) consisting of (1), (2),
(3) and exercises.
(2) 2nd maintenance phase (self -care)
Diuretics are of no value in pure lymphoedema.
58. (2)
Filariasis is the commonest cause of chyluria occurring in 1-2%
of cases 10-20 years after initial infestation. It presents as
painless passage of milky white urine, particularly after a fatty
meal. It may also be caused by ascariasis,
Malaria, tumour and tuberculosis.
59. (3)
Aetioloaical classification of! Mohoedema
Primary
Congenital (onset <2 Years old); sporadic;
lymphoedema
familial (Nonne-Milroy's disease) Praecox
(onset 2-35 Years old):
Sporadic; familial (Iatessier - Meige's
disease)
Tarda (onset after 35 years old)
Secondary
lymphoedema
Parasitic infection(filariasis)
Fugal infection (tinea pedis)
Exposure to foreign body material (silica
particles)
Primary lymphatic malignancy
Metastatic spread to lymph nodes
Surgical excision of lymph nodes
Trauma (particularly degloving injuries)
Superficial thrombophlebitis
Deep venous thrombosis
Stewart Treve's syndrome is Iyrnphagiosarcoma in chronic
lymphadernatous limb.
60. (2)
Alemtuzumab Antibody agent against CD52 antigen - Rx of
lymphoma.
Rituximab - Antibody against CD20 antigen - Rx of lymphoma.
Tyrosine kinases receptors inhibitors - Imatinib - Rx of GIST.
Gefitinib/Erlotinib - Rx - Non small cell lung tumors
Farnesyl transferase inhibitors = Lonafarnibl Tipifarnib Against leukaemia
61. (2)
Severity of unilateral lymphoedema is classified as. Mild - <
20% excess volume
Mod -20-40%
Severe - > 40%
62. (2)
Bad prognosis in Hodgkin's disease seen with
- Albumin < 4 gm %
- Age> 45 yrs
- Hb < 10.5 gm%
- WBC 15,000/cm
- Male
- Stage IV disease
- lymphocyte count < 600/l or 8% of WBC.
63. (4)
Working formulation for NHL is
Low grade
- Small cell lymphocyte
- Follicular small cleaved cues.
- Follicular small and large cleaved cells.
Int grade
- Follicular large cell - Diffuse small cell
- Diffuse large cell
- Diffuse mixed cell
High grade
- Lymphoblastic
- Immunoblastic
- Small non cleaved cells.
Option a, c, d - come under Integrade. b is low grade. Of int
grade, most aggressive is diffuse large cell type.
64. (2)
83. (3)
Rx for chronic lymphoedema includes charleslThompson and
Iympho venous anastomosis surgeries.
Sx for cleft lip is include millard's Rx, Lemesurier's Sx and
Tennessean's Sx.
Sx for cleft palate include Hynes and Wardills pharyngoplasty.
Newman's' and SeaBrock's Sx is for repair and parotid fistula.
84. (3)
Lymph mets of buccal Ca goes to sub mandibular and upper
deep central nodes.
Ca lip spreads to sub mental LNS; also form tip of tongue.
Bilateral lymphatic spread is common in following tumors of
the head and neck
Lower lip Supraglottis Soft palate
85. (3)
TNM staging for oropharyngeal Ca includes
T = No evidence of 1 tumor
T5 = Ca insitu
T1 = < 2 cms size
T2 = 2 - 4 cms size
T3 = > 4 cms size
T4 = involves adjoining structures!
Muscles, Bones
Nx = lymph nodes cannot be assessed
N0 = No LN mets
N1 = Mets in single ipsilateral size <3 cms.
89. (4)
Medical treatment with antifungal drugs may be necessary for
many months to eliminate the organisms & reinfection is a
constant problem. Surgical excision is recommended for
persistent lesions.
90. (2)
Oral submucous fibrosis is not in itself premalignant but is
associated with a higher than normal incidence of oral cancer.
(1) & (3) are conditions about which there is doubt as to
whether their association with oral cancer is causal or casual.
(4) is a premalignant condition.
91. (4)
In contrast with mandibular alveolar tumours, deep infiltration
into the underlying bone is uncommon. Reverse smoking is
responsible for palatal cancers. Most of them arise from minor
salivary gland.
92. (2)
MRI is investigation of choice for oropharyngeal cancer. The
advantage over CT is that the image is not degraded by the
presence of metallic dental restorations. It is very good at
imaging soft tissue infiltration.
Plain radiography is of limited value in investigation of oral
cancer. At least 50% of the calcified component of bone must
be lost before any radiographic change is apparent.
Tongue
70%
Palate
80%
Check
65-75%
40%
40%
30-50%
and IV
So for same stage, Ca lip has highest 5 year survival rate or
have best prognosis.
100. (3)
Maxillary Ca is two types:
(a) Sq cell Ca (m.c. type)
(b) Adeno ca
Rx of Ca maxilla is
Sq cell ca -7 combination of Sx and RT gives better results than
either Rx alone. (Rx is same in every stage of maxillary Ca).
Adena ca - only Sx done as RT is in effective.
101. (4)
MEN - II syndromes are due to mutation in RET.
Protooncogene present on chromosome 10,
MEN IIA - Medullary thyroid cancer, Pheochromocytoma
hyperparathyroidism.
MEN II B - Medullary thyroid cancer. Pheochromocytoma.
Mucosal neuromas, megacolon, skeletal abnormalities.
102. (4)
Excision of both adrenal glands
Schwartz
"Patients undergoing surgical treatment of endogenous
hypercortisolism require glucocorticoid replacement steroids
are not given preoperatively because these patients are
already hypercortisolemic. Instead hydrocortisone 100 mg i.v,
is given after the removal of the~cor}qhYperplastic adrenal
gland.
C.S.D.T.
"After total adrenalectomy, life long corticosteroid
maintenance theraphy becomes necessary. The following
schedule is commonly used. No cortisol is given until the
adrenals are removed during surgery.
On the firest day 100 mg iv is given every 8 hours.
Love & Bailey
According to L&B, 23rd /e corticosteroid replacement is
necessary during both intraoperative and postoperative while
according to 24th/e corticosteroid therapy intraoperative is
only needed when the patient has been treated with
Ketoconazole or mitotane.
L&B 23rd /e
"It is essential that all patients who are to be subjected to
adrenalectomy are supported intraoperatively and
postoperatively by adrenocortical hormone replacement
therapy irrespective of the extent of adrenal resection ,
corticosteroids are started when anaesthesia is induced,"
L&B 24th
" In the new edition they have removed these lines and states
that
Only patients who have received medical therapy with
mitotane and Ketoconazole should be given
Corticosteroid at the induction of anaesthesia and also adds
that "All patients who have undergone adrenal surgery
(U/L or B/L) will require Post operative steroid replacement.
103. (4)
All the given options can cause Cushing's syndrome. However
exogenous administration of steroids for treatment is most
common cause of Cushing's syndrome. Most common
Opacity
Calcification
Breast
parenchyma
Nipple/areola
Skin
Coocer
liaaments
Ducts
Benign
Smooth margin
Low density
Homogenous
Thin halo
Macro calcification
(> 5 mmin
diameter)
Malignant
III defined margin, Irregular
stellate, speculated margin,
comet tail
High density
In homogenous Wide halo
Microcalcification (<5mm in
diameter)
Architectural distortion
Retracted
Normal
Normal
Normal
Retracted
Thickened
Thickened, increased
number
Focal dilatation
Normal
Obliterated
118. (3)
Simple Mastectomy
Since this patient is showing diffuse microcalcification on
mammography, a simple mastectomy would be the most
appropriate procedure.
Treatment of Ductal Ca in situ (DCIS)
DCIS carries a high risk for progression to an invasive cancer.
Schwartz writes - "The risk of invasive breast cancer is
increased nearly five fold in women with DCIS that was
originally detected, suggesting that DCIS is and anatomic
precursor of invasive ductal carcinoma."
The treatment of intraductal lesion is controversial. It can be
tit by either
- Simple mastectomy
- Breast conservation with wide excision (Lumpectomy) with
radiation therapy.
Choice of operation depends on both surgeon and patient
preference, however, following points must be kept in mind.
Simple mastectomy is the gold standard procedure with no
need of radiation and less recurrence rate (~2%), but there is
loss of breast, a big psychological trauma to the patient.
Breast conserving procedure is better cosmetically but
recurrence rate is more.
The patient also has to be monitored regularly both clinically
and by mammography for any recurrent disease.
Those in favour of conservative procedure, however say that
local recurrences of occur, can be successfully managed with
salvage mastectomy.
Simple mastectomy is recommended for the following DCIS
DCIS with evidence of widespread disease (involving two or
more quadrants) Mammographically identified multicentric
disease or diffuse suspicious calciflcation. Persistent positive
margins after re-excision.
Unacceptable cosmesis to obtain negative margins.
A patient not motivated to preserve her breast
Size greater than 40 mm
Comedo appearance on histology Negative estrogen receptor
status
High grade tumor
For patients with contraindications to radiation therapy
a) Prior radiation to the breast region
b) Presence of collagen vascular disease (SLE, Sclerodernia)
c) First or second trimester pregnancy
Axillary lymph node dissection is not necessary for DCIS.
Adjuvant Tamoxifen therapy is given to all DCIS patients.
Treatment of lobular carcinoma in situ (LCIS)
- LCIS is not an anatomical precursor of invasive disease like
PCIS rater it is considered as a risk factor for invasive breast
carcinoma (Which canb be either invasive or lobular type).
- The risk for invasive cancer is equal for both breast, so there
no benefit to excise LCIS.
- Treatment of LCIS is
- Observation with or without tamoxifen
- The goal of treatment is to detect the invasive cancer at an
early stage which will develop in about 25 to 35% of these
women.
- For patients who are unwilling to accept the increased risk of
breast cancer may be offered bilateral simple mastectomy.
Also remember
- The majority of invasive cancer which subsequently develops
in LCIS are of ductal nature (~65%) not lobular.
131.(2)
Chronic subdural haematomas. These haematomas are
most common in infants and in adults over 60 years of
age. They present with progressive neurological deficits
more than 3 weeks after the trauma. Often, the initial
head injury has been completely forgotten and the
pathology has been attributed to either dementia or a
brain tumour until patients are scanned. The initial
haemorrhage may be relatively small or may occur in
elderly patients with large ventricles or a dilated
subarachnoid space. Membranes derived from the dura
and arachnoid mater encapsulate the haematoma, which
remains clotted for 2-3 weeks then liquefies. The acute
clotted blood initially appears white on a CT scan. As it
liquefies, it slowly becomes black. Thus, there is a point
in time where it appears iso-dense with brain and all that
can be seen is apparent inexplicable shift on an otherwise
normal CT. These collections can then either resolve or
increase in size from osmotic effects or repeated small
136. (3)
The finding of bilateral vestibular schwannomas
involving cranial nerve VIII is considered diagnostic for
neurofibromatosis type II.
137. (2)
Mannitol an osmotic dehydrating agent, Works by
drawing water from parts of the brain with an intact
blood-brain barrier. If this is disrupted, as in a cerebral
contusion, mannitol can leak out into the brain and
potentiate the mass effect. In head injuries it should
therefore, only be administered after consultation with a
neurosurgeon. It becomes ineffective when brain
osmolality becomes iso-osmolar with that of the serum.
Steroids work by stabilizing the blood-brain barrier and
reducing oxygen radical injury. Barbiturates give rise to
vasoconstriction. Frusemide reduces ICP by
reducing cerebral oedema and CSF production.
138. (3)
Lesch nodules (pigmented hamartomas of the iris) and
optic gliomas are two of the criteria that can be used to
diagnose neurofibromatosis type I. Other characteristics
include plexiform neurofibromas and autosomal
dominant inheritance.
139. (1)
These findings are suggestive of hypercortisolism. This
may be secondary to a number of sources including
adrenal tumors, exogenous steroid use, pituitary tumors,
and malignancies at other sites (e.g. small cell carcinoma
of the lung). Among the choices, Cushing's disease
defined as hypercortisolism secondary to an
adrenocorticotropic hormone (ACTH)-producing
pituitary adenoma is the most likely diagnosis.
140. (4)
A suprasellar calcification is typical of
Craniopharyngioma
Polyuria is d/t diabetes insipidus caused d/t
compression by the tumor over pituitary.
- "Clinically, patients with suprasellar tumors typically
present with diabetes insipidus, endocrinopathy" .
141. (4)
Dandy walker malformation is a cystic expansion.of 4th
ventricle in the post fossa due to failure of roof of 4th
ventricle development.
- 90% patients have hydrocephalus.
- As anomalies include agenesis of post. cerebellar vermis
and corpus callosum.
- Most children have evidence of long tract signs/
cerebellar ataxia & delayed motor and cognitive mile
stone.
- Management is shunting the cystic cavity in case of
hydrocephalus.
142. (2)
Berry aneurysm is me type of intracranial aneurysm
- Congenital weakness of wall
- Increased risk with Ehler Dan los /NF1, marfan's /
APKD /fibromuscular dysplasia.
- Predisposing factor - HTN and smoking.
- Rupture usually occurs at apex of sac leading to SAH or
Intraparenchymal hrg or both
- 90% occurs in Ant circulation.
- The wall is made up of thickened hyaline intima.
Rx - Embolisation /clipping of the Sac.
143. (3)
Fronal lobe lesion tends to present with personality
change, gait ataxia and urinary incontinence, Pathological
joking (Witzel Schultz syndrome). Parietal lobe lesions
are associated with sensory inattention, dressing apraxia,
asterognosis [a graphia, Lt-to-Rt Disorientation and
Shelf life
35 days
42 days
5 days
24 hrs
1 yr
24 hrs
3 yrs
Cryoprecipitate
1 yr
< - 30C
- Frozen
20 - 24C
4 hrs
- Thawed
Stored blood lacks functional platelets after 24 hrs.
148. (3)
Symptoms of hemolytic transfusion in
Conscious patient
- Sensation of heat and oain in the
limbs
- Headache
Unconscious patient
- Diffuse Bleedina and
severe.
Hypotension
- Tachycardia
- Urticarial rash
- Raising airway pressure
on IPPV
149. (3)
Shock is defined as in adequate perfusion to maintain
normal organ function. Thus, the goal in the Rx of shock
is restoration is of adequate organ perfusion and tissue
Oxygenation.
Urine output is quantitative and relatively reliable
indicator of organ perfusion Adequacy of resucitation can
be determined by urine output and blood pH.
150. (2)
Platelet concentrate is required for patients with
thrombocytopenia.
FFP can be given in any of the congenital clotting factor
deficiency diseases, especially Christmas disease (factor
IX deficiency) or haemophilia B. Cryoprecipitate is a very
rich source of factor VIII.
151. (4)
The following are causes of retroperitoneal fibrosis also
known as retroperitoneal fasciitis or chronic
retroperitoneal fibroplasias.
1) Hodgkin's disease
2) Ca breast
3) Ca colon
4) Methysergide used for migraine headaches
5) Membranous glomerular disease
6) Inflammatory bowel disease
7) Leaking aortic aneurysm
152. (4)
There is a narrowing where the ureter is coursing in the
bladder wall & not before entering the bladder wall.
153. (3)
Stretching of renal capsule gives pain in the loin which
deep seated sickening ache.
Ureteric colic gives pain which radiates from loin groin,
the more distal the stone, the more the pain radiates to
the groin.
Severe inflammation of bladder causes wrenching
discomfort at end of micturation. Urethral pain is
167. (2)
The patient with incomplete bladder emptying & good
capacity may be managed by means of clean intermittent
catheterisation (CISC).
The patient with complete bladder emptying &
reasonable capacity with normal upper tracts may be
managed by means of condom drainage.
Patients with poor emptying, low capacity & upper tract
dilatation require addditional treatment.
168. (1)
The main complication is uretero ileal stricture which
can be limited by spatulation of the distal ureters & an
end-to- end anastomosis.
Stenosis at the ileocutaneous site is less frequent & a
short isoperistaltic conduit limits the formation of a
residual urine volume to reduce infection & avoid the
problems of reabsorption of urine.
169. (1)
The patient is suffering from genuine stress incontinence.
It is usually found in multiparous women with a history
of difficult labour often accompanied by the use of
forceps. It can be found in normal young women who
indulge in competitive trampooning & also in patients
with epispadias. The symptoms may change with the
menstrual cycle.
170. (2)
Cis-platinum plus gemcitabine given before
(Neoadjuvant) radical cystectomy has been shown to be
of benefit.
171. (4)
Full distension of the bladder is needed if searching for a
diverticulum. With inadequate distension of the bladder,
the mouth of the diverticulum is closed with epithelium
thrown into radiating pleats.
Ivu may give information regarding size of diverticulum.
(3) is done only during video urodynamic investigation &
will also give information about the emptying
characteristics of the bladder & diverticulum
172. (3)
The most common sites for superficial tumours are the
trigone & lateral walls of the bladder.
173. (4)
Oestrogen deficiency, which may give rise to lowered
local resistance seen in menopausal females predisposes
to UTI. Other causes are:
1. Meatal stenosis
2. Bladder diverticulum
3. Presence of calculus, foreign body or neoplasm.
4. Diabetes
5. Immunosuppression
231. (2)
It is important to confirm the absence of a mechanical
cause of the obstruction by colonoscopy or single
contrast water soluble bariums enema. Colonoscopy is
also the treatment of choice for decompression. It may
recur in 25% of cases. If colonoscopy fails, a cecostomy
may be required.
232. (1)
Synchronous malignancy means two separate sites of the
colon having a malignancy or the same tumour within 6
months. This is seen in 5% of cases. Hence, it is important
to have a coloscopy for all patients of rectal or sigmoid
cancer in order to look for a synchronous cancer in the
caecum/transverse or ascending colon.
233. (2)
It is usually a clockwise twist of the caecum - obstruction
may be partial. Caecopexy or Caecostomy is the
treatment of choice.
234. (1)
Sigmoidoscopy done is a patient with acute diverticulitis
of colon shows inflammation of the mucosa.
The X-Ray abdomen in acute diverticulitis shows saw
tooth appearance of the mucosa rigid sigmoidoscope
could be passed upto 16 cm and flexible sigmoidoscope
upto 60 cm of colon.
235. (3)
Presence of Pseudomonas, Klebsiella and proteus is urine
of a child of high imperforate anus is suggestive of
communication between the anus and bladder.
236. (4)
Lower gastrointestinal bleeding is defined as a bleeding
from a site distal to the ligament of Treitz.
"Hemorrhoids and anal fissure are the most common
cause of lower G. I. bleeding however the bleeding is
rarely massive",
Angiodysplasia and diverticulitis are the other two
common causes of bleeding and they usually present
with massive bleeding:
Here are the causes of acute lower GI bleeding :Common
- Angiodysplasia
- Diverticulosis
- Anorectal disease
Less common
- Neoplasia Carcinoma, polyps
- Colitis Radiation, ischaemic, ulcerative
- Infective Enteric fever, amoebic ulcer, T.B.
HIV related (gonorrhoea, CMV.)
Rare
- Meckel's diverticulum
- Intussusception
237. (2)
Rectal polyps are most commonly seen in juvenile
patient. The most common presentation of rectal polyp is
painless bleeding per rectum. Meckel's diverticulum is
most commonly present as diverticulitis and this causes
pain in abdomen with bleeding P/r
238. (4)
Not only a solitary but even multiple metastasis is not a
contraindication for surgery because surgery is also the
best palliative measure.
If only a solitary liver metastasis (even upto 3 static
lesions) is present it can be later resected with good
prognosis. Carcinoma of the left side of the colon usually
of stenosing variety. The main symptoms are those of
increasing intestinal obstruction, altered bowel habits;
tenesmus and bleeding.
Anemia (severe and unyielding) is seen in right sided
lesions.
Mucinous and 'signet ring' cell varities have poor
prognosis.
Colorectal carcinomas are resistant to most
chemotherapeutic agents. Recently 5 FU and levamisole
have been found to be of some use. They are used as
adjuvant chemotherapy in Dukes stage C lesions.
239. (2)
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.
251. (2)
Patients with Insulinoma do not have weight loss.
Insulinomas are usually benign and solitary and hence
can be enucleated during surgery.
252. (3)
Areas of ductal dilatation altemating with areas of ductal
stenosis are common findings in alcoholic patients who
have severe chronic pancreatitis. This type of duct
obstruction cannot be relieved by sphincteroplasty
because of multiple areas of stenosis along the duct.
Although total pancreatectomy would be a beneficial
approach, morbidity and mortality with this procedure is
extremely high. Thus the procedure of choice in such
cases is side to side pancreaticojejunostomy
253. (4)
ERCP is rarely required in acute setting as management
is essentially conservative.
Serum amylase rise is nonspecific and occurs in injuries
of any intraabdominal organ.
246. (2)
254. (2)
276. (3)
Lockwoods' repair is low approach for the repairs of a
femoral hernia.
Lotheissein's repair is an inguinal approach to repair of
femoral hernia through the incision over inguinal canal
as for inguinal hernia.
Stopa's repair is great prosthetic reinforcement of
peritoneal sac, which tackles both inguinal as well as
femoral hernia.
Moloneys darning is done only in repairing lnguinal
hernia.
277. (1)
In children the omentum is small and under developed.
Hence generalised peritonitis occurs early. Ingestion of
food, enema stimulates gut motility and hence hinders
localisation. Option (3) causes immunosuppression.
278. (4)
This is because contractions of the bladder commence at
apex and pass towards the base. Hence a patent urachus
which opens into the apex of bladder in temporarily
closed during micturition. This fistula will therefore
present only when there is obstruction to urinary
outflow.
280. (4)
Conservative treatment is successful in 93% of cases
hence it is preferable to wait for 2 years. This is a case of
congenital umbilical hernia. Coin strapping is advised
upto 2 years. If hernia persists beyond 2 years,
herniorrhaphy is indicated.
289. (4)
Progressive bacterial synergistic gangrene is due to
synergism between bacteria from the intra peritoneal
environrnent and those colonizing the skin. The
maximum intraperitoneal contamination among given
option is with option 1 and 4. But in option 1 surgery
done is colostomy which affectively drains out all the
intraperitoneal contamination. So the answer would be
option 4.
281. (3)
Desmoid is a fibroma, which usually occurs in
musculoaponeurotic tissues of abdominal wall especially
below umbilicus. It can also occur in old hernia scar and
intraperitoneally.
290. (3)
Most common presentation of tuberculous paritonitis is
pain in abdomen (present in 90%) followed by fever
(60%), loss of weight (60%), ascites (60%)night sweats
and abdominal mass.
282. (1)
Although divarication of recti is seen principally in
elderly women and multipara the form that limits the
divarication to above umbilicus is commoner in babies.
291. (3)
Exomphalos also mean omphalocle or umbilical hernia. It
is a disease of abdominal wall because it results from
failure of all or part of gut to return to the coelom during
early fetal life. Exomphalos has covering of amnion and
peritoneum where as gastroschisis have no coverings.
283. (4)
Secondary carcinoma at umbilicus 'Sister Joseph's node'
is due to primary in stomach, ovary colon and breast. The
spread is believed to be along the falciform ligament
from liver mets.
284. (3)
Age female sex and relation to menses clinch the
diagnosis of Endometrioma. Raspberry tumour usually
presents in childhood.
285. (4)
Pregnancy and female sex are predisposing factors for
femoral hernia as they contribute to laxity of ligaments.
However femoral hernia is also seen in males. It is most
likely to strangulate.
286. (4)
Raspberry tumour is exuberant granulation tissue
pouting out from the unobliterated distal portion of
vitellointestinal duct.
287. (4)
Familial Mediterranean fever also known as periodic
peritonitis is commoner in females. Colchicine is not the
causative agent it is used in prevention of recurrent
attack of the disease.
288. (1)
Prevesical hernia is a narrow necked hernia through a
gap in medial. panpfonjoint tendon just above pubic
292. (3)
Serosanguinous discharge is the forerunner of disruption
in 50% cases and signifies that intraperitoneal contents
are lying extraperitoneally. Pain and shock are absent.
Signs of intestinal obstruction may be present, but is not
usual. An emergency operation is required to replace
bowel, relieve obstruction and resuture wound. There is
biochemical evidence that healing after disruption
produces stronger wound.
293. (2)
Colonic perforation during colonoscopy is usually
detected early (within 6h - of perforation) and also the
colon is already prepared before taking up patient for
colonoscopy. Hence primary closure of defect should be
done.
294. (1)
Omphalitis is infection of umbilical cord stump.
Staphylococcus aureus is the most common organism
responsible, followed by Streptococci, E. Coli and
Clostridium tetani.
295. (2)
Hematoma of rectus sheath is due to tearing of inferior
epigastric artery, which is common in elderly females,
muscular males, in multipara and in late pregnancy.
Distinguishing between rectus sheath hematoma and
strangulated Spigelian hernia is difficult. Absence of