36 - PGI december 2008 surgery mcqs - 1

1q: which of the following affect wound healing ?

a. age of the patient
b. mechanical stress
c. fatty acid deficiency
d. discharge
e. vitamin B deficiency

answer: a,b,d. i have no idea about the other two .

if u can explain with reference please post in the comments .

35 - AIIMS november 2008 surgery mcqs

135.IN A MALE AFTER LAPROSCOPIC CHOLECYSTECTOMY CARCINOMA GALL BLADDER STAGE Ia WAS DETECTED ON HISTOPATH. WHAT IS THE NEXT APPROPRIAT MANAGEMENT?
A. CONSERVATIVE AND FOLLOW UP
B. RADICAL PORTAL LYMPHADENECTOMY
C. RADIOTHERAPY
D.

136. BOUNDARY OF TRIANGLE OF DOM ARE FORMED BY ALL EXCEPT?
A. PERITONEAL FOLD REFLECTION
B. COOPERS LIGAMENT
C. TESTICULAR VESSELS
D. VAS DEFRENS

137.MOST COMMON SITE OF CURLINGS ULCER IN A BURNS PATIENT IS?
A. DUODENUM
B. ILEUM
C. COLON
D. OESOPHAGUS

138.MOST COMMON SITE OF PERIPHERAL ANEURYSM?
A. FEMORAL A.
B. POPLITEAL A
C. BRACHIAL A
D. RADIAL A

139. THE CHILDREN HOSPITAL OF EASTERN ONTARIO PAIN SCALE(CHEOPS) FOR RATING POST OPERATIVE PAIN IN CHILDREN INCLUDES A/E?
A. CRY
B. TOUCH
C. TORSO
D. OXYGEN SATURATION

140. A MAN COMES TO EMERGENCY WITH STEB INJURY TO LEFT FLANK.HE HAS STABLE VITALS WHAT WOULD BE THE NEXT STEP IN MANAGEMENT?
A. CECT
B. CELIOTOMY/SCOPY
C. DIAGNOSTIC PERITONEAL LAVAGE
D. LAPAROTOMY

141. RECURRENT GIST IS DIAGNOSED BY?
A. PET SCAN
B. MIBG
C. MRI
D. USG

142. NICOLADONI’S SIGN IS ALSO KNOWN AS?
A. BRANHAMS SIGN
B. MURRAY SIGN
C.
D. FREI SIGN

143.NOT A COMPLICATION OF TOTAL PARENTERAL NUTRITION?
A. CONGESTIVE CARDIAC FAILURE
B. METABOLIC BONE DISEASE
C. ESSENTIAL FATTY ACID DEFICIENCY
D.HYPOPHOSPHATEMIA

144. SURGERY NOT DONE IN MORBID OBESITY?
A. ILEAL TRANSPOSITION
B. PANCREATICO BILIARY DIVERSION
C. SLEEVE GASTRECTOMY
D. GASTRIC BYPASS

145.A PERSON WITH MULTIPLE INJURIES DEVELOPS FEVER TACHYCARDIA TACHYPNEA AND A PERIUMBILICAL RASH. DIAGNOSIS IS?
A. FAT EMBOLISM
B. PULMONARY EMBOLISM
C.
D.

146. GLOMUS TUMOUR IS SEEN IN?
A.PITUITARY
B. ADRENAL
C. LIVER
D. FINGER

147. HUNTERIAN LIGATURE IS USED IN?
A. VARICOSE VEIN
B. POPLITEAL ANEURYSM
C. AV MALFORMATION
D. LIMB ISCHEMIA

148.TREATMENT OF MEDULLARY CARCINOMA THYROID?
A. SURGERY ALONE
B. RADIOIODINE ABLATION
C. SURGERY AND RADIOTHERAPY
D. CHEMO AND RADIATION

149.IN A PATIENT OF CARCINOMA BREAST SUPRACLAVICULAR LYMPH NODES ARE POSITIVE FOR METASTASIS.STAGE IS?
A.II
B. IIIb
C. IIIc
D. IV

150.BEST TEST TO DIAGNOSE GERD AND QUANTIFY ACID OUTPUT IS?
A. ESOPHAGOGRAM
B. ENDOSCOPY
C. 24 hour PH MONITORING
D. MANOMETRY

151.VIRCHOWS TRIAD INCLUDES A/E?
A. INJURY TO VEIN
B. VENOUS THROMBOSIS
C. VENOUS STASIS
D. HYPERCOAGULABILITY OF BLOOD

152.A 25 YEAR MALE PRESENTED WITH PAIN ABDOMEN, ON USG MIXED ECHOGENICITY WAS FOUND AT LEFT RENAL HILUM AND A MULTIFOCAL NECROTIC MASS IS DETECTED.PROBABLE DIAGNOSIS IS?
A. METASTATIC GERM CELL TUMOUR
B. TRANSITIONAL CELL CARCINOMA
C. LYMPHOMA
D. METASTATIC MALIGNANT MELANOMA

153.MOST COMMON SITE OF CHOLANGIO CARINOMA?
A. DISTAL BILIARY TREE
B. HILUM
C. INTRAHEPATIC BILIARY DUCT
D. MULTIFOCAL

154.TRUE ABOUT GLEASONS STAGING?
A. SCORE FROM 1-10
B. HIGH SCORE IS ASSOCIATED WITH BAD PROGNOSIS
C. HELPS IN GRADING OF TUMOUR
D. HELPS DECEIDE TREATMENT MODALITY

155.MOST COMMON CAUSE OF ACUTE MESENTRIC ISCHEMIA?
A. THROMBOSIS
B. EMBOLISM
C.NON OCCLUSIVE MESENTRIC ISCHEMIA
D.

156.A WOMAN NOTICED MASS ON BREAST WITH BLOODY DISCHARGE.
HISTOPATH REVEALED DUCT ECTASIA.TREATMENT IS?
A. MICRODOCHECTOMY
B. LOBECTOMY
C. RADICAL DUCT EXCISION
D. SIMPLE MASTECTOMY

to view all the 200 mcqs of AIIMS november 2008 click here

34 - renal transplantation mcqs

case : A 32-year-old man with diabetic
nephropathy undergoes an
uneventful renal transplant from
his sister (two-haplotype match).
His immunosuppressive regimen
includes azathioprine, steroids, and
cyclosporine. For each development
in the postoperative period, select
the most appropriate next step.

a. Begin gancyclovir
b. Administer steroid boost
c. Withhold steroids
d. Decrease cyclosporine
e. Increase cyclosporine
f. Decrease azathioprine
g. Obtain renal ultrasound
h. Begin broad-spectrum antibiotics
i. Administer filgrastim (Neupogen)
j. Administer FK50

question 1:

On postoperative day 3 the
patient is doing well, but you
notice on his routine laboratory
tests that his white blood cell count
is 2.0. (SELECT 1 STEP)

question 2:

The patient’s WBC count
gradually returns to normal, but on
postoperative day 7 he develops a
fever of 39.44°C (103°F) and a
nonproductive cough. A chest xray
reveals diffuse interstitial infiltrates,
and a “buffy coat” is positive
for viral inclusions. (SELECT 1
STEP)

question 3:

The patient recovers from the
above illness and is discharged
home on postoperative day 18. At
3-mo follow-up he is doing well,
but you notice that his creatinine is
2.8 mg/dL. He has no fever, his
graft is not tender, and his renal
ultrasound is normal. (SELECT 1
STEP)

question 4:

Six months following his
transplant, the patient begins to
develop fever, malaise, and pain of
the right lower quadrant. Upon palpation,
the graft is tender. Chest xray
and urine and blood cultures
are normal. Renal ultrasound shows
an edematous graft. (SELECT 1
STEP)

The answers are question 1-f, question 2-a, question 3-d, question 4-b.

(Greenfield,2/e, pp 577–581.) Routine postoperative immunosuppression for a renal
transplant recipient includes cyclosporine, azathioprine, and steroids.
Cyclosporine is nephrotoxic and is frequently withheld in the postoperative
period until the creatinine returns to normal following transplantation.
Transplants,Immunology,and Oncology Answers 151
Azathioprine has bone marrow toxicity as its major side effect and both
WBC and platelet counts need to be monitored in the immediate posttransplant
period. The patient’s decrease in WBCs is secondary to azathioprine
toxicity, and the most appropriate step is to decrease the dose of
azathioprine.
Viral infections are a serious cause of morbidity following transplantation.
A “buffy coat” is the supernatant of a centrifuged blood sample that
contains the WBCs. Viral cultures from this supernatant as well as localization
of inclusion bodies can identify transplant patients infected with
cytomegalovirus (CMV). This patient has CMV pneumonitis and needs to
be treated with high-dose gancyclovir.
An elevation in creatinine at 3-mo follow-up can be secondary to
rejection, anastomotic problems, urologic complications, infection, or
nephrotoxicity of various medications. With a normal ultrasound, no fever,
and no graft tenderness, the most likely cause is cyclosporine-induced
nephrotoxicity and the most appropriate step is a reduction in the
cyclosporine dose.
Finally, at 6 mo with graft tenderness, fever, and an edematous kidney
on ultrasound, rejection must be suspected. Negative cultures make infection
unlikely, and a steroid boost is appropriate. Addition of monoclonal
antibodies to CD3 (OKT3) or pooled antibodies against lymphocytes
(ALG) is also appropriate in the treatment of a first

33 - surgery cases mcqs - 2

Question 2 :

A 45-year-old man skidded from the road at

high speed and hit a tree. Examples of deceleration

injuries in this patient include:

(A) Aortic valve rupture

(B) Kidney injury

(C) Posterior dislocation of shoulder

(D) Mesenteric avulsion

(E) Stomach rupture

Answer:

(E) Deceleration injuries occur when the body

is subjected to a sudden stop when traveling at

a high speed (e.g., high-speed automobile hitting

a tree, fall from a height). As the impacting

part of the body comes to a sudden halt, the

organs behind continue to travel forward, thus

causing shearing injuries at the junction of

mobile and fixed parts; such as mesenteric

avulsion. The other choices are possible but

much less common.

32 - surgical cases mcqs - 1

CASE 1 :

Twenty-four hours after colon resection, urine

output in a 70-year-old man is 10 mL/h. Blood

chemistry analysis reveals sodium, 138 mEq/L;

potassium, 6 mEq/L; chloride, 100 mEq/L; bicarbonate,

14 mEq/L. His metabolic abnormality

is characterized by which of the following?

(A) Abdominal distension

(B) Peaked T waves

(C) Narrow QRS complex

(D) Cardiac arrest in systole

(E) J wave or Osborne wave

ANSWER:

(B) Hyperkalemia can manifest by GI or

cardiovascular signs. GI symptoms include

nausea, vomiting, intestinal colic, and diarrhea.

Abdominal distension as a result of paralytic

ileus is due to hypokalemia. An ECG is useful

to monitor potassium levels. Hyperkalemia

is characterized by peaked T waves. ECG

changes also include ST-segment depression,

widened QRS complex, and heart block.

Cardiac arrest occurs in diastole with increasing

levels of potassium. Osborne (J) wave is

seen in hypothermia.

31 - thyroid mcqs 1 to 100

THE THYROID GLAND

1. what is the colour of the normal thyroid gland ?

answer : brownish-red colour .

2. the thyroid gland is highly vascular. TRUE OR FALSE ?

answer : true .

3. which of the following statements about thyroid is true ?

a- thyroid is located anteriorly in the upper neck
b- thyroid is located posteriorly in the upper neck
c- thyroid is located anteriorly in the lower neck
d- thyroid is located posteriorly in the lower neck

answer : c . the thyroid is located anteriorly in the lower neck .

4. what is the vertical extension of the thyroid in relation to the vertebrae ?

a- C4 to T1
b- C5 to T1
c- C6 to T1
d- C3 to T1

answer : b . fifth cervical vertebra to the first thoracic vertebra . C5 to T1.

5. thyroid is ensheathed by a fascia . what is it ?

answer : pretracheal layer of the deep cervical fascia .

6. what are the number of lobes in thyroid ?

answer : 2 lobes . right and left lobes connected by a narrow, median isthmus .

7. what is the weight of the thyroid ?

answer : 25 g ( usually but can vary ) .

8. among men and women, who have heavier thyroids ?

answer : women have slightly heavier thyroids when compared to males.

9. a woman came to the doctor with complaints of increase in the size of thyroid during menstruation . if u were the doctor there, what would u do ?

answer : I would tell her that it is perfectly normal for the size of a woman’s thyroid to increase during menstruation .

10. a pregnant woman came to ur clinic with complaints of enlarged thyroid . what would you suggest ?

answer : I would tell her that there is nothing to worry , because it is absolutely normal for a woman’s thyroid to enlarge during pregnancy and menstruation .

11. how will you normally estimate the size of the thyroid gland ?

answer : by doing diagnostic ultrasound .

12. As I already told u women have heavier thyroids than men, hence the volume of thyroid in women is slightly more than in men. But there is a phase of life in both males and females where no significant difference between the volumes of the male and female thyroid was observed. When is that phase ?

answer : from 8 months to 15 years . between these ages the volumes of both male and female thyroid show no significant difference .

13. what is the shape of the lobes of the thyroid gland ?

answer : approximately conical .

14. the bases of the thyroid lobes are level with which tracheal cartilage ?

answer : 4th or 5th tracheal cartilages .

15. what is the length of each thyroid lobe ?

answer : 5cms long .

16. the posteromedial aspects of the thyroid lobes are attached to which structure ?

answer : cricoid cartilage .

17. what is the name of the ligament which attaches the lobes of thyroid to the cricoid cartilage posteromedially ?

answer : lateral thyroid ligament .

18. what is the part of the thyroid that connects the lower parts of the two lobes called ?

answer : isthmus .

19. what would you suggest to a healthy patient who has no isthmus ?

answer : I would suggest that it is physiologically normal for a person to be born without an isthmus and this happens occasionally . I would assure him that there is nothing to worry .

20. what is the length of the isthmus ?

answer : 1.25 cms transversely and vertically .

21. the isthmus normally lies anterior to which tracheal cartilages ?

answer : it usually lies anterior to second and third tracheal cartilages. ( it can lie slightly higher or slightly lower sometimes because of the variations in size and site of the thyroid gland )

22. what is the tumor marker of the medullary carcinoma of the thyroid?

answer : calcitonin .

23. what is the most common position of the thyroglossal cyst ?

answer : below the hyoid bone . ( check again ).

24. what is the name of the surgery done to treat the thyroglossal cyst/fistula ?

answer : sistrunk’s operation .

25. what is the hormone secreted by the thyroid that controls the calcium metabolism ?

answer : calcitonin .

26. superior thyroid artery is a branch of which artery ?

answer : external carotid artery .
( the branches of the external carotid artery are 1. superior thyroid artery 2.lingual artery 3.posterior auricular artery 4.facial artery 5.occipital artery 6.ascending pharyngeal artery 7.maxillary artery 8.superficial temporal artery ------ SLPFOAMS ------ SISTER LUCY’S POWDERED FACE OFTEN ATTRACTS MEDICAL STUDENTS . )

27. which is the only medial branch of the external carotid artery ?

answer : ascending pharyngeal artery . ( out of context but important .)

28. the thyroid develops from ?

a- ectoderm
b- mesoderm
c- dorsal pharyngeal gut endoderm
d- ventral pharyngeal gut endoderm

answer : d . ventral pharyngeal gut endoderm .

29. the development of thyroid occurs in which week of the intrauterine life ?

answer : 4th week .

30. what are the cells in the thyroid which produce the calcitonin ?

answer : C cells ( also called as the parafollicular cells .)

31. what is the function of calcitonin ?

answer : lowers blood calcium by inhibiting the bone resorption and inhibiting the calcium recovery from renal tubule ultrafiltrate .

32. the embryonic thyroid descends from a foramen located in the posterior part of the tongue . what is it ?

answer : it is called the foramen caecum .

33. the thyroid usually reaches the front of the trachea by the end of how many months of the intrauterine life ?

answer : by the end of 2nd month of intrauterine life .

34. the thyroglossal duct is originally a hollow tube running from foramen caecum to pharynx . TRUE OR FALSE ?

answer : true . ( check again )

35. thyroglossal duct tissue normally becomes solid and remains uncanalised after transit of the thyroid . TRUE OR FALSE ?

answer : FALSE ( check again )

36. the pyramidal lobe of the thyroid represents part of the thyroglossal duct . TRUE OR FALSE?

answer : TRUE ( check again ) .

37. most common histological type of thyroid cancer ?

answer : papillary carcinoma .

38. thyroid carcinoma with best prognosis ?

answer : papillary carcinoma .

39. screening method for medullary carcinoma of thyroid ?

a- serum calcitonin
b- serum calcium
c- serum ALP
d- serum acid phosphatase

answer : a . serum calcitonin .

40. the carcinoma of thyroid associated with hypocalcemia ?

answer : medullary carcinoma of thyroid . ( remember it secretes calcitonin ).

41. medullary carcinoma of thyroid arises from ?

a- parafollicular cells
b- cells lining the acini
c- capsule of thyroid
d- stroma of the gland

answer : a . parafollicular cells .

42. papillary carcinoma of thyroid usually presents as ?

answer : single nodule + local lymph node .

43. which of the following is/are used in the management of thyroid malignancy?

a- Iodine 131
b- Iodine 125
c- Technitium 99
d- Phosphorus 32
e- strontium

answer is a . Iodine 131 .

44. which of the following factors contribute to the development of duodenal ulcer ?

a- Iodine 131
b- Iodine 125
c- Technitium 99
d- Phosphorus 32

answer : a . iodine 131 .

45. characteristic eye sign in dysthyroid status ?

a- exopthalmos
b- ptosis
c- optic neuropathy
d- myopathy

answer : a . exopthalmos .

45. hurthle cells are seen in ?

a- hashimoto’s thyroiditis
b- follicular cell carcinoma
c- hurthle cell thyroid adenoma
d- all the above

answer is d . all the above .

46. the C cells of the thyroid parenchyma belongs to the APUD system of dispersed neuron-endocrine cells . what is APUD system ?

answer : AMINE PRECURSOR UPTAKE AND DECARBOXYLATION SYSTEM .

47. how did the C cells get their name ?

answer : C stands for Clear cells , because they have pale staining cytoplasm and hence appear clear .

48. what is arteria thyroidea ima ?

answer : an artery supplying thyroid which is seen occasionally and arises from the brachiocephalic trunk or aortic arch .

49. what are the two main arteries that supply the thyroid ?

answer : superior and inferior thyroid arteries . superior thyroid artery is a branch of the external carotid artery and the inferior thyroid artery is branch of the thyrocervical trunk .

50. C cells populate which part of the lateral lobe of the thyroid ?

a- upper one-third of the lateral lobe of thyroid
b- middle one-third of the lateral lobe of thyroid
c- lower one-third of the lateral lobe of the thyroid
d- distributed equally all over the lateral lobe of the thyroid

answer : b . C cells populate the middle one-third of the lateral lobe of the thyroid .
( typically found scattered within thyroid follicles , inside the basal lamina but not reaching the follicle lumen .)

51. pick out the correct statements .

a- the external laryngeal nerve runs close to the superior thyroid artery .
b- the recurrent laryngeal nerve runs close to the inferior thyroid artery .
c- the external laryngeal nerve runs close to the inferior thyroid artery .
d- the recurrent laryngeal nerve runs close to the superior thyroid artery .

answer : both a and b are correct . ( so the surgeon has to be very careful while ligating those arteries, while performing thyroidectomy ).

52. what are the branches of the thyrocervical trunk ?

answer : 1. inferior thyroid artery 2.suprascapular artery 3.transverse cervical artery ( also called transversalis artery colli ) .

53. thyrocervical trunk arises from which artery ?

answer : subclavian artery .

54. what are the active thyroid hormones secreted by the follicular epithelial
cells of the thyroid ?

answer: tri-iodothyronine T3 and tetra-iodothyronin T4 ( thyroxine ) .

55. treatment of medullary carcinoma of the thyroid with lymphnode metastasis?

a- subtotal thyroidectomy + radioiodine
b- subtotal thyroidectomy + radiotherapy
c- neartotal thyroidectomy + radioiodine
d- neartotal thyroidectomy + radiotherapy
e- total thyroidectomy + radiotherapy

answer : e . total thyroidectomy + radiotherapy .

56. what is near total thyroidectomy ?

a- right lobectomy + isthmusectomy
b- left lobectomy + isthmusectomy
c- bilateral lobectomy with isthmusectomy
d- right lobectomy + isthmusectomy + left half lobectomy
e- right and left lobectomy

answer : d .

57. papillary carcinoma of thyroid with bone metastasis is treated by?

a- subtotal thyroidectomy + radioiodine
b- subtotal thyroidectomy + radiotherapy
c- near total thyroidectomy + radioiodine
d- near total thyroidectomy + radiotherapy
e- total thyroidectomy + chemotherapy

answer : c and d . both . near total thyroidectomy with radioiodine and radiotherapy.

58. most common cause of thyroiditis is ?

a- hashimoto’s thyroiditis
b- reidl’s thyroiditis
c- subacute thyroiditis
d- viral thyroiditis

answer : a . hashimoto’s thyroiditis .

59. recurrent laryngeal nerve is in close association with ?

a- superior thyroid artery
b- inferior thyroid artery
c- middle thyroid vein
d- superior thyroid vein

answer : b . inferior thyroid artery .

60. thyroglossal cyst may occasionally give rise to which carcinoma ?

a- papillary
b- anaplastic
c- medullary
d- follicular

answer : a . papillary carcinoma of the thyroid .

61. a post-thyroidectomy patient develops signs and symptoms of tetany. The management is ?

a- I.V calcium gluconate
b- Bicarbonate
c- Calcitonin
d- Vitamin D

Answer : a . I.V calcium gluconate .

62. hypoparathyroidism following thyroid surgery occurs with in ?

a- 24 hours
b- 2-5 days
c- 7-14 days
d- 2-3 weeks

Answer : b . 2-5 days .

63. what are the normal levels of calcium in our body ?

answer : calcium,ionized - wholeblood – 1.1 to 1.4 mmol/litre – 4.5 to 5.6 mg/dl(meq/l) .

calcium - serum - 2.2 to 2.6 mmol/litre – 9 to 10.5 mg/dl(meq/l) .


64. a patient undergoes thyroid surgery following which he develops perioral tingling . his blood calcium is 8.9 meq/l. next step in the management is ?

a- vitamin D orally
b- oral calcium and vitamin D
c- intravenous calcium gluconate and serial monitoring
d- wait for calcium to decrease to less than 7 meq/l before taking further action

answer : b . oral calcium and vitamin D .

65. a patient after undergoing thyroid surgery presents with perioral paraesthesia . serum calcium level is 7 mg/dl . what will be the best management ?

a- oral vitamin D3
b- oral vitamin D3 and calcium
c- I.V calcium gluconate
d- Oral calcium

Answer : d . oral calcium .

66. which of the following is not a complication of total thyroidectomy ?

a- bleeding
b- airway obstruction
c- hoarseness
d- hypercalcemia

answer : d . hypercalcemia .

67. in post operative room after thyroid surgery , patient developed sudden respiratory distress , dressing was removed and it was found to be slightly blood stained and wound was bulging . what will be the first thing to be done ?

a- tracheostomy
b- cricothyroidectomy
c- laryngoscopy and intubation
d- remove the stitch and take the patient to O.T

answer : d . remove the stitch and take the patient to the O.T .

67. a patient presents with swelling in the neck following a thyroidectomy. What is the most likely resulting complication ?

a- respiratory obstruction
b- recurrent laryngeal nerve palsy
c- hypovolemia
d- hypocalcemia

answer : a . respiratory obstruction .

68. a patient presents with neck swelling and respiratory distress few hours after a thyroidectomy surgery. Next management would be ?

a- open immediately
b- tracheostomy
c- wait and watch
d- oxygen by mask

answer : a . open immediately .

69. after thyroidectomy patient developed stridor within 2 hours. All are likely causes of stridor except ?

a- hypocalcemia
b- recurrent laryngeal nerve palsy
c- laryngomalacia
d- wound hematoma

answer : a . hypocalcemia due to hypoparathyroidism after thyroid surgey normall results with in 2-5 days .

70. which of the following will not lead to respiratory distress after thyroid surgery?

a- laryngomalacia
b- bilateral recurrent laryngeal nerve palsy
c- hypocalcemia
d- none

answer : d . none . all the 3 can lead to respiratory distress .

71. how does hypocalcemia result in respiratory distress ?

answer : pending .

72. papillary carcinoma of the thyroid ( PCT ) patients are ?

a- euthyroid
b- hypothyroid
c- hyperthyroid
d- T3 thyrotoxicosis

Answer : a . euthyroid .

73. medullary carcinoma of thyroid is derived from which cells ?

a- follicular
b- para follicular
c- oxyphilic
d- lymphocytes

answer : para follicular cells ( also called C cells ) .

74. HURTHLE cell carcinomas are derived from which cells ?

a- follicular cells
b- para follicular cells
c- oxyphilic cells
d- lymphocytes

answer : c . oxyphilic cells .

75. patients with MEN 2a also may have hirschsprung’s and lichen cutaneous amyloidosis ? TRUE OR FALSE ?

answer : true .

76. the malignancy which is common on long standing goiter ?

a- PCT
b- MCT
c- FCT
d- Anaplastic

Answer : c . Follicular carcinoma of the thyroid .

77. cancer common in iodine deficient areas ?

a- papillary
b- medullary
c- anaplastic
d- follicular

answer : c and d . follicular and anaplastic both are common .

78. least malignant thyroid cancer ?

e- papillary
f- medullary
g- anaplastic
h- follicular

answer : e . papillary .

79. commonest tumor of the thyroid ?

answer : papillary carcinoma of the thyroid .

80. which of the following gene defects is associated with development of the medullary carcinoma of the thyroid ?

a- RET proto oncogene
b- FAP gene
c- RB gene
d- BRCA 1 gene

Answer : a . RET proto oncogene .

81. what are the other diseases associated with the RET gene ?

answer : medullary thyroid carcinoma, hirschsprung’s disease and pheochromocytoma.

82. RET proto-oncogene encodes for ?

a- tyrosine kinase receptor on the cytoplasmic membrane
b- protein kinase
c- IP3
d- All the above

Answer : a . tyrosine kinase receptor on the cytoplasmic membrane .

83. RET gene is located on which chromosome ?

Answer : 10 th chromosome .

84. rearrangement of RET gene leads to ?

a- PTC
b- MTC
c- FCT
d- Lymphoma

Answer : a. papillary thyroid cancer .

85. gene implicated in papillary thyroid cancer is ?

a- RET
b- K ras
c- C myc
d- APC

Answer : a . RET gene .

86. point mutation of RET gene leads to ?

answer : familial medullary carcinoma ( MEN 2A AND MEN 2B ).

87. RET ligand is identified as ?

Answer: GDNF ( glial cell line-derived neurotropic factor ).

88. psammoma bodies are seen in all of the following conditions except ?

a- serous cystadenoma of ovary
b- papillary carcinoma of thyroid
c- meningioma
d- mucinous cystadenoma of ovary

answer : d .

89. all of the following are early life threatening complications of thyroid operation except ?

a- tracheomalacia and collapse of larynx
b- wound hematoma with compression of the trachea
c- hypocalcemia
d- thyroid storm

answer : c . hypocalcemia .

90. in pregnancy ?

a- thiouracil is contraindicated
b- surgery is contraindicated
c- radioiodine is contraindicated
d- none

answer: c . only radioiodine is contraindicated .

91. amyloid stroma is seen in which carcinoma of thyroid?

Answer : medullary carcinoma of thyroid .

92. lateral aberrant thyroid refers to ?

a- congenital thyroid abnormality
b- metastatic foci from primary in the thyroid
c- struma ovarii
d- lingual thyroid

answer : b . metastatic foci from primary carcinoma in the thyroid .

93. a patient with long standing multinodular goiter develops hoarseness of voice ; also the swelling undergoes sudden increase in size. Likely diagnosis is ?

answer : follicular carcinoma of thyroid .

94. a patient has pituitary tumor and pheochromocytoma and a thyroid nodule . which carcinoma is most likely to occur ?

answer : medullary carcinoma of the thyroid . the condition is MEN 2a or MEN 2b. MEN 1 comprises of parathyroid , pituitary and pancreatic tumors. MEN 2a comprises of parathyroid, medullary carcinoma of thyroid and pheochromocytoma tumors. MEN 2b comprises of medullary carcinoma of thyroid, pheochromocytoma and neuromas .

95. a patient presented with headache and flushing . he has a family history of his relative having died of a thyroid tumor. The investigation that would be required for this patient will be ?

a- chest x-ray
b- measurement of 5-HIAA
c- measurement of catecholamine
d- intravenous pyelography

answer : c . measurement of catecholamines . headache and flushing suggest symptoms of adrenal tumor and a history of thyroid tumor in the relative suggest the MEN syndrome type 2a or 2b . so the adrenal tumor is probably pheochromocytoma and so catecholamines have to be measured .

96. cancer that develops after irradiation ?

a- PCT
b- MCT
c- FCT
d- Anaplastic

Answer : papillary carcinoma of the thyroid .

97. what is an oncogene ?

answer : gene that contributes directly to tumor genesis .

98. mutated p53 gene is formed in most of ?

a- anaplastic carcinomas
b- PCT
c- MCT
d- FCT

Answer : a . anaplastic carcinomas .

99. deletion of which chromosome accompanies transformation of follicular adenoma to follicular adeno carcinoma ?

answer : 3p .

100. treatment of choice for medullary carcinoma of thyroid is ?

a- total thyroidectomy
b- partial thyroidectomy
c- iodine 131 ablation
d- hemithyroidectomy

answer : a . total thyroidectomy .

30 - thoracocentesis ( video and notes )

Definition

Thoracentesis is a procedure to remove fluid from the space between the lining of the outside of the lungs (pleura) and the wall of the chest. Normally, very little fluid is present in this space. An accumulation of excess fluid between the layers of the pleura is called a pleural effusion.

Alternative Names

Pleural fluid aspiration; Pleural tap

How the test is performed

A small area of skin on your chest or back is washed with a sterilizing solution. Some numbing medicine (local anesthetic) is injected in this area. A needle is then placed through the skin of the chest wall into the space around the lungs called the pleural space. Fluid is withdrawn and collected and may be sent to a laboratory for analysis (pleural fluid analysis).

How to prepare for the test

No special preparation is needed before the procedure. A chest x-ray is may be performed before and after the test.

Do not cough, breathe deeply, or move during the test to avoid injury to the lung.

How the test will feel

You will on a bed or sit on the edge of a chair or bed with your head and arms resting on a table. The skin around the procedure site is disinfected and the area is draped. A local anesthetic is injected into the skin. The thoracentesis needle is inserted above the rib into the pleural space.

There will be a stinging sensation when the local anesthetic is injected, and you may feel a sensation of pressure when the needle is inserted into the pleural space.

Inform your health care provider if you develop shortness of breath or chest pain.

Why the test is performed

The test is performed to determine the cause of the fluid accumulation or to relieve the symptoms associated with the fluid accumulation.

Normal Values

Normally the pleural cavity contains only a very small amount of fluid.

What abnormal results mean

The analysis of the fluid will indicate possible causes of pleural effusion such as infection, cancer, heart failure, cirrhosis, and kidney disease. If infection is suspected, a culture of the fluid is often done to determine whether microorganisms are present and if so, to identify them.

Additional conditions under which the test may be performed include the following:

• Pneumonia
• Hemothorax
• Pulmonary veno-occlusive disease
• Pancreatitis
• Pulmonary embolism
• Thyroid disease
• Collagen vascular disease
• Asbestos-related pleural effusion
• Drug reactions

What the risks are

• Pneumothorax (collapse of the lung)
• Fluid re-accumulation
• Pulmonary edema
• Bleeding
• Infection
• Respiratory distress

Special considerations

A chest x-ray is often done after the procedure to detect possible complications.

29 - white hand sign

THE WHITE HAND SIGN, A NEW SIMPLE MANEUVER USEFUL IN THE DIAGNOSIS OF
THORACIC OUTLET SYNDROME

Southern Medical Association. 96th Annual Scientific Assembly - Washington,
November 13-16, 2002

A simple objective test to assess the positional vascular obstruction at the thoracic outlet is the observation of the change of colors of the hands when the patient elevates the hands above the shoulder girdle, with the fingers pointed to the ceiling and the palms facing the observer. The appearance of the paleness, sometimes cadaveric, in one or both hands is called the White Hand Sign.

Thoracic Outlet Syndrome is a group of symptoms arising not only from the upper extremity, but also from the chest, neck, shoulders and head. The symptoms are produced by a positional intermittent compression of the brachial plexus and/or subclavian artery, vein and the vertebral artery; the diagnosis is readily suspected by the physician who is aware of the symptoms. The White Hand Sign will objectively assess the postural vascular compression at the thoracic outlet. The absence of the color changes on the elevation of the hands should not be construed that Thoracic Outlet Syndrome is not present, severe nerve compression can exist without vascular compression.

The use in the physical examination of a triad consisting of tenderness of the supraclavicular area, paleness and/or paresthesias on elevation of the hands, and weakness of the abductors and adductors of the 5th finger, will make the diagnosis of Thoracic Outlet Syndrome consistent and reproducible.

A new physical sign called the White Hand Sign is described. When used with the diagnostic triad in the routine physical examination, it will standardize the diagnosis of Thoracic Outlet Syndrome.

28 - kuntz nerve or nerve of kuntz

Over the last few years many questions about the Kuntz Nerve have been asked. "What do you know about the Kuntz Nerve? What do you do with the Kuntz Nerve?" It is somewhat difficult to explain the controversy surrounding the name Kuntz nerve which is causing a lot of confusion among laymen and physicians alike.

An understanding of the origin of the sympathetic enervation of the upper limb is important in surgical sympathectomy procedures (ETS). During the 1920's sympathectomy was done for a variety of reasons such as elevated blood pressure, circulation problems within the hands, cardiac pain, etc. Most of the above mentioned reasons were found not to be helped by the sympathectomy. When the sympathectomy was done for circulation problems in the hand there was an initial improvement with warming of the hands and better blood flow but most of those failed after 6 months to a year. This high failure rate prompt Doctor Kuntz to look for a reason for the failure. Since one could not perform post mortem examinations on patients, he performed anatomical studies on cats. While doing this anatomical dissection on cats he found some nerve fibers connecting the sympathectic nerve to other nerves within the chest cavity. Since then the name Kuntz nerve came about. These particular anatomical findings were not found in humans. The reasons for the failures when sympathectomy was done for vascular problems is known now to be unrelated to sympathectomy. The reason for the failure is due to post denervation hypersensitivity (meaning extra sensitivity to circulating chemicals within the blood causing the blood vessels to constrict). Somehow this term Kuntz nerve found its way into the modern sympathectomy literature.

Over the last few years there were two anatomical studies done on cadavers trying to solve this issue. In both studies they found a nerve segment that goes in between the first intercostal nerve and the brachial plexus. The exact function of this nerve segment is unknown. The intercostal nerves are made of bundles of sensory and motoric and sympathetic fibers that run in between the ribs. The brachial plexus is a motoric nerve bundles that inervate the upper extremities and the shoulders. The exact function of that particular nerve is not known. Moreso the space between the first rib and the intercostal nerve is generally speaking an area not touched by ETS surgeons doing the ETS procedure. The fact that this area is generally not touched by ETS sugeons makes it less significant in regards to true nature of this elusive nerve.

The mere fact that an anatomical nerve was found does not mean that it has any physiological role in the sympathetic function. Surgeons who claim to see and cut the Kuntz nerve do not even do the disection in those above mentioned areas. The eponym, nerve of Kuntz, should be restricted to descriptions of the intra thoracic branch of the first intercostal nerve. Practically those surgeons who are performing the ETS on a daily basis do not even get to that site. Bleeding problems as well as severe collateral injuries restrict the approach to those sites. In order to expose this elusive nerve one must perform a very delicate dissection with two or three instruments to enable this step. Most of the ETS surgeons who perform this operation do it with one single instrument that does not allow this type of dissection.

Recently Dr. Reisfeld went back to the anatomy laboratory and performed 6 cadaver studies. This means that 12 separate disections were done in the upper part of the chest cavity trying to even further clear the issue of the "Kuntz nerve". Those disections were done with the help of 2 experienced Anatomists (University Medical Doctors who teach anatomy in medical school). In none of those disections no significant nerve connections were found between the second ganglia to the first ganglia. Between the first ganglia and the brachial plexus some very fine fibres were found but there exact psyiological function is not known. This particular area is not being touched by any ETS surgeon because of the proximity to a variety of other important structures and because of the fact that it is not as accessible.

Doctor Reisfeld believes that the clinical and anatomical data do not support the Kuntz nerve as a significant reason in recurrence after a successful ETS. The most likely reason for late recurrence is the creation of alternate pathways within the Spinal cord. The possibility of a re-growth of the sympathetic chain is a practical possibility since the sympathetic chain has the canny ability for regrowth. The regrowth can happen if the operation is being done with the cutting method, excision, or ultrasound desication. Dr. Reisfeld found that with the clamping method the recurrence rate is even lower than with the cutting method.

The above outlined views about the Kuntz nerve was supported also in the last meeting held in finland in 2001. In the international meeting held in 2001 in Finland this view was supported by other leading ETS surgeons.

27 - Richter's hernia

These are the pictures of a type of hernia called the richter's hernia . It involves the herniation of only one side wall of the intestine which can lead to gangrene and perforation but there will be no symptoms of intestinal obstruction. 


Antimesenteric border only of the small intestine is incarcerated in the deep inguinal ring, therefore intestinal obstruction may be absent, but gangrene of the bowel wall may occur.



It is named after German surgeon August Gottlieb Richter (1742-1812).

Richter's hernia is seen most commonly in Femoral hernia . 


Amyand hernia is a type of hernia which contains appendix in it .

26 - surgery mcqs - 221 to 260

221) Strawberry haemangioma is

a. Capillary Hemangioma

b. Cavernous Hemangioma

c. Arterial Hemangioma

d. Plexiform Hemangioma

Answer : (a)

Reference: Surgical Short Cases, S.Das, 2^nd Edition Page 12

222) Most Common Neoplasm of Major Salivary Glands is

a. Pleomorphic Adenoma

Answer : (a) Pleomorphic Adenoma

Reference: Surgical Short Cases, S.Das, 2^nd Edition Page 99

Bailey and Love 24^th Edition Page 730

223) MC Parotid Tumour is

a. Pleomorphic Adenoma

Answer : (a) Pleomorphic Adenoma

Reference: Surgical Short Cases, S.Das, 2^nd Edition Page 99

Bailey and Love 24^th Edition Page 730

NOTE – The same question was asked twice in TNPG 2006

224) Parotid Gland is transversed by branches of

a. VII Nerve

b. IX Nerve

c. X Nerve

d. XI Nerve

Answer : ( a) VII Nerve

Reference: Bailey and Love 24^th Edition Page 727

225) All are characteristic features of Gout except

a. Due to problems in Pyrimidine Degradation

b. Heberden’s node

c. Bouchard’s nodes

d. Metatarsophalangeal joint of the first toe is often involved

Answer : ( a) Due to problems in Pyrimidine Degradatio

Reference: Harrison 16^th Edition Pages 2046 and 2308

226) Occult Filariasis means

a. Microfilarie Not Seen In peripheral blood, but seen in tissues

b. Microfilarie Not Seen In tissues but seen in peripheral blood

c. Both

d. None of the above

Answer : ( d)

Reference:

Bailey and Love 24^th Edition Page 164

Ä The term Occult Filariasis is commonly used to designate filarial infections in which mf are not found in the periphral blood although they may be seen in other body fluids and tissues. However, it has now been shown that in some cases with occult filariasis, mf may actually be found after more careful blood examination despite their low density. Occult filariasis is believed to result from a hypersensitivity reaction to filarial antigens derived from microfilariae.Only a very small proportion of individuals in a community where filariasis is endemic develop occult forms of the disease.

227) Asymmetrical Septal Hypertrophy with Myocardial disarray is seen in

a. VSD

b. ASD

c. HOCM

d. None of the above

Answer : ( c) HOCM

Reference: Braunwald Chapter 3 - echocardiography

Hypertrophy of the septum with abnormal organization of myocardial cells may be one of the basic abnormalities of HCM, and a key echocardiographic finding is disproportionate hypertrophy of the septum in relation to the posterior wall of the left ventricle, so that the ratio of thickness of the septum to the free wall exceeds 1.3:1.0 and the motion of the hypertrophied septum is reduced. It has also been shown that asymmetrical septal hypertrophy (ASH) is frequently transmitted as an autosomal dominant trait and that there are patients with asymmetrical septal hypertrophy who do not show SAM and therefore do not have obstruction to left ventricular outflow. These patients may be considered to have HCM without obstruction. While the concept of recognizing ASH with or without obstruction to left ventricular outflow by echocardiography is an important one, there are limitations to echocardiographic diagnosis. First, the thickness of the septum may be difficult to measure precisely echocardiographically. Second, it must be appreciated that ASH is not pathognomonic for HCM and related myopathies and can occur in a variety of other disease states, including right ventricular hypertrophy. In addition, some patients with HCM may have concentric rather than asymmetrical hypertrophy, in which the septal and posterior left ventricular walls are equal in thickness.

228) Ranula

a. ExtraVasation Cyst

b. Retention Cyst

c. Exudation Cyst

d. None of the above

Answer : ( b) Retention Cyst

Reference: Surgical Short Cases, S.Das, 2^nd Edition Page 57

229) Prostatic Cancer in T2 Weighted Image presents as

a. Decreased Signal

b. Increased Signal

c. No Change

d. None of the above

Answer : ( a ) Decreased Signal

Reference: Harrison 16^th Edition Page 546

230) Best Method Of Investigation of Gall Stone is

a. X Ray

b. USG

c. CT

d. MRI

Answer : ( b) USG

Reference:

Bailey and Love 24^th Edition Page 1097

231) Cranio Facial Dysjunction is seen in

a. Lefort I Fracture

b. Lefort II Fracture

c. Lefort III Fracture

d. None of the above

Answer : (C ) Lefort III

Reference: Bailey and Love 24^th Edition Page 667

232) All are true regarding Mobius Syndrome except

a. Bilateral Abductor Palsy

b. Bilateral Facial Palsy

c. Both

d. None

Answer : ( d)

Reference: Nelson 15^th Edition Table 266.1 and Chapter 574

Ä The distinctive features of Möbius syndrome are congenital facial paresis and abduction weakness.

o The facial palsy is commonly bilateral, frequently asymmetric, and often incomplete, tending to spare the lower face and platysma. Ectropion, epiphora, and exposure keratopathy may develop.

o The abduction defect may be unilateral or bilateral. It is usually complete, and esotropia is common.

Ä The etiology is unknown. Whether the primary defect is maldevelopment of cranial nerve nuclei, hypoplasia of the muscles, or a combination of central and peripheral factors is unclear. Gestational factors such as trauma, illness, and intake of various drugs, particularly thalidomide, have been implicated. Some familial cases have been reported. Associated developmental defects may include ptosis, palatal and lingual palsy, hearing loss, pectoral and lingual muscle defects, micrognathia, syndactyly, supernumerary digits, or the absence of hands, feet, fingers, or toes. Surgical correction of the esotropia is indicated in selected cases, and any attendant amblyopia should be treated.

Ä In newborns, the first symptom is an inability to suck. Excessive drooling and strabismus (crossed eyes) may occur. Other symptoms may include lack of facial expression; inability to smile; feeding, swallowing, and choking problems; eye sensitivity; motor delays; high or cleft palate; hearing problems; and speech difficulties. Deformities of the tongue, jaw, and limbs, such as club foot and missing or webbed fingers, may also occur.

Ä Most patients have low muscle tone, especially in the upper body. Mental retardation may also occur. As children get older, lack of facial expression and inability to smile become the dominant visible symptoms.

233) Percentage of Cold nodes that are malignant

a. About 20 %

b. About 50 %

c. About 75 %

d. 100 %

Answer : ( a) About 20 %

Reference: Bailey and Love 24^th Edition Page 785

234) Most common form of External abdominal hernia is

a. Inguinal

b. Paraumbilical

c. Incisional

d. Femoral

Answer : (a) Inguinal

Reference: Bailey and Love 24^th Edition Page 1274

235) Enterofaecal Fistula which results in leakage of feces is due to

a. Persistent Omphalo Mesenteric Duct

b. Patent Urachus

c. Both

d. None

Answer : ( a) Persistent Omphalo Mesenteric Duct

Reference: Surgical Short Cases, S.Das, 2^nd Edition Page 235

Omphalomesenteric Duct Remnants.

Ä Remnants of the omphalomesenteric (vitelline) duct may present as abnormalities related to the abdominal wall. In the fetus, the omphalomesenteric duct connects the fetal midgut to the yolk sac. This normally obliterates and disappears completely. However, any or all of the fetal duct may persist and give rise to symptoms.

Ä An umbilical polyp is a small excrescence of omphalomesenteric duct mucosa that is retained in the umbilicus. Such polyps resemble umbilical granulomas except that they do not disappear after silver nitrate cauterization. They may be associated with a persistent vitelline duct or umbilical sinus. Appropriate treatment is excision of the mucosal remnant.

Ä Umbilical sinuses result from the continued presence of the umbilical end of the omphalomesenteric duct. These resemble umbilical polyps, but close inspection reveals the presence of a sinus tract deep to the umbilicus. The morphology of the sinus tract can be readily delineated with a sinogram. Treatment is excision of the sinus.

Ä Persistence of the entire omphalomesenteric duct is heralded by the passage of enteric contents from the umbilicus. This is seen in the early neonatal period and should be treated promptly with laparotomy and excision of the duct to avoid intussusception or volvulus.

Ä Cystic remnants of the omphalomesenteric duct may persist and be asymptomatic for long periods of time. The cysts may be connected to the ileum with a fibrous band that is a remnant of the obliterated omphalomesenteric duct. Patients may present with acute volvulus and intestinal obstruction or with acute abdomen because of cyst infection. The cysts usually remain undiagnosed until operation, at which time they should be excised.

Ä Meckel's diverticulum results when the intestinal end of the omphalomesenteric duct persists. This is a true diverticulum of the intestine with all layers of the intestinal wall represented.

236) Paralytic Ileus is due to all except

a. Peritonitis

b. Hyperkalemia

c. Fracture Spine or Ribs

d. Abdominal Surgery

Answer : ( b) Hyperkalemia

Reference: Bailey and Love 24^th Edition Page 1201

237) Mycotic aneurysm is an aneurysm infected because of :

a. Fungal infection.

b. Blood borne infection (intravascular)

c. Infection introduced from outside (extravascular)

d. Both intravascular & extravascular infection.

Answer (b) Blood borne infection (intravascular)

Reference: Harrison 16th Edition Page 1481 and Oxford Textbook of Medicine Chapter 7.7.7

238) Laryngocele arises as a herniation of laryngeal mucosa through the following membrance:

a. Thyrohyoid.

b. Criciothyroid.

c. Crico-tracheal.

d. Crisosternal.

Answer a Thyrohyoid.

Reference: A Concise textbook of Surgery, 3rd Edition Page 623

239) The treatment of choice for the management of carcinoma of the anal canal is :

a. Abdomino perineal resection.

b. Primary radiotherapy.

c. Combined radio-and chemotheraphy.

d. Neoadjuvant chemotherapy and local excision.

Answer (c) Combined radio-and chemotheraphy.

Reference: Bailey and Love 24th Edition Page 1271

240) Which of the following drugs is not a part of the ‘Triple Therapy’ immunosuppression for post renal transplant patients?

a. Cyclosporine.

b. Azathioprine.

c. FK 506.

d. Prednisolone.

Answer (c) FK 506.

Reference: Tripathi 5th Edition Page 790 and Sabistons 15th Edition Chapter 20

241) A 30 year old man, smoker developed gangrene foot. The most probable diagnosis

a. TAO

b. Atherosclerosis

c. Raynaud’s syndrome

d. None of the above

Answer: a) TAO

Reference: Bailey and Love 24^th Edition Page 951

242) Latest Investigation for detecting adrenal and extra adrenal phaeochromocytoma is

a. CT Scan

b. Radio Iodine labeled MIBG

c. MRI

d. USG

Answer : b) Radio Iodine labeled MIBG

Reference: Bailey and Love 24^th Edition Page 819

243) Cobra head appearance in IVU

a. Ureterocele

b. Ca Bladder

c. Renal Artery Stenosis

d. Chronic Pyelonephritis

Answer a) Ureterocele

Reference: Bailey and Love 24^th Edition Page 1310

244) Most Common infection of Parotid gland is

a. Fungal

b. Viral

c. Bacterial

d. Parasitic

Answer : b) Viral

Reference: Harrison 15^th Edition Chapter 196

245) Cystosarcoma phylloides treatment

a. Enucleation

b. Radiation

c. Radical mastectomy

d. CHemotherapy

Answer a) Enucleation

Reference: Bailey and Love 24^th Edition Page 835

246) Treatment of Anaplastic carcinoma of Thyroid

a. Isthmusectomy

b. Hemithyroidectomy

c. Sub total thyroidectomy

d. Total Thyroidectomy

Answer a) Isthmusectomy

Reference: Bailey and Love 24^th Edition Page 801

247) Most important prognostic factor for Malignant melanoma

a. Depth of invasion

b. White / black race

c. Lymphatic spread

d. None of these

Answer a) Depth of Invasion

Reference: Sabiston 15^th Edition Chapter 21

248) True about Malignant Melanoma

a. Prognosis depends on depth of lesion

b. Spreads by local, lymphatic and blood spread

c. suspicious mole to be excised

d. All of these

Answer d) All of the above

Reference: Sabiston 15^th Edition Chapter 21

249) True about Femoral hernia

a. Common in females

b. Most Common Hernia is Females

c. Both

d. None

Answer a) Common in females

Reference: Surgical Short Cases Das 2^nd Edition Page 280

250) The carcinoma that spreads by blood

a. Ca cervix

b. Bladder Carcinoma

c. Renal cell carcinoma

d. Squamous cell carcinoma

Answer c) Renal Cell Carcinoma

Reference: Bailey and Love 24^th Edition Page 1330

251) Type of renal stone in alkaline urine is

a. Uric Acid

b. Oxalate

c. Cystin

d. Calcium Phosphate

Answer d) Calcium Phosphate

Reference: Bailey and Love 24^th Edition Page 1316

252) Painless lock jaw

a. Dental abscess

b. Submandibular abscess

c. Tetanus

d. None

Answer c) tetanus

Reference: Harrison 15^th Edition Chapter 143

253) Frey’s syndrome is associated with

a. Parotid

b. Spleen

c. Lungs

d. None of the above

Answer a) Parotid

Reference: Bailey and Love 24^th Edition Page 734

254) Which lobe of liver is related to lesser sac

a. Tuberomentale

b. Caudate lone

c. Quadrate lobe

d. Riedel’s lobe

Answer b) caudate

Reference: Gray’s Anatomy

255) Ulcer with undermined edges is

a. Tuberculosis

b. Gumma

c. Rodent Ulcer

d. Squamous cell carcinoma

Answer a) Tuberculosis

Reference: A manual of Surgery Das , page 47

256) A patient presenting with acute abdomen is being examined. On palpation of. Right hypochondrial region , there is pain on deep inspiration and the patient catches breath The diagnosis is probably

a. Acute Appendicitis

b. Acute cholecystitis

c. Rupture Spleen

d. Ca Caecum

Answer B) Acute cholecystitis

Reference: Bailey and Love 24^th Edition Page 1105

257) M.leprae can be grown as a culture in

a. 9 banded armadillo

b. Food pad of mice

c. Both

d. None

Answer B) Both

Reference: Ananthanarayanan 7^th Edition Page 371

258) MC Cause of lymphedema all over the world is

a. HL

b. NHL

c. Filariasis

d. Bacterial infection

Answer C) Filariasis

Reference: Bailey and Love 24^th Edition Page 976

259) Anderson – Hynes Operation is for

a. Hydronephrosis

b. Mitral Stenosis

c. AV Fistula of Lower Limb

d. Incisional hernia

Answer : A) hydronephrosis

Reference: Bailey and Love 24^th Edition Page 1315

260) Implanatation dermoid most commonly seen in

a. Finger

b. Skull

c. Scalp

d. Hip

Answer a) Finger

Reference: Surgical short Cases Das 2^nd Edition Page 3