Thursday, January 24, 2008

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, 2nd 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, 2nd Edition Page 99

Bailey and Love 24th Edition Page 730

223) MC Parotid Tumour is

a. Pleomorphic Adenoma

Answer : (a) Pleomorphic Adenoma

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

Bailey and Love 24th 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 24th 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 16th 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)


Bailey and Love 24th 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


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, 2nd 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 16th Edition Page 546

230) Best Method Of Investigation of Gall Stone is

a. X Ray

b. USG

c. CT

d. MRI

Answer : ( b) USG


Bailey and Love 24th 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 24th 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 15th 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 24th 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 24th 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, 2nd 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 24th 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 24th 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 24th 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 24th Edition Page 1310

244) Most Common infection of Parotid gland is

a. Fungal

b. Viral

c. Bacterial

d. Parasitic

Answer : b) Viral

Reference: Harrison 15th Edition Chapter 196

245) Cystosarcoma phylloides treatment

a. Enucleation

b. Radiation

c. Radical mastectomy

d. CHemotherapy

Answer a) Enucleation

Reference: Bailey and Love 24th 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 24th 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 15th 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 15th 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 2nd 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 24th 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 24th Edition Page 1316

252) Painless lock jaw

a. Dental abscess

b. Submandibular abscess

c. Tetanus

d. None

Answer c) tetanus

Reference: Harrison 15th 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 24th 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 24th 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 7th 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 24th 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 24th 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 2nd Edition Page 3

25 - surgery mcqs - 211 to 220

211. Ectopic pregnancy

a. Occurs in about 10% of pregnancies

b. The risk is increased in those with a history or pelvic inflammatory disease

c. Usually presents between 2 and 4 months of gestation

d. Patients usually have a negative pregnancy test

e. if shocked early laparotomy is essential


only b and e are true . occurs in about 1 % of pregnancies .usually presents between 6 weeks and 8 weeks of gestation . a sensitive beta HCG is usually positive .


212. Pelvic inflammatory disease

a. Usually arises from haematogenous spread from another site

b. Is most commonly a chlamydial infection

c. Untreated can progress to a pyosalpinx

d. Reduces the risk of ectopic pregnancy

e. 20% of patients develop chronic pain


b , c , e are the right answers . acute salpingitis is usually an ascending sexually transmitted disease . it increases the risk of ectopic pregnancy .


213. The following colonic polyps are pre-malignant

a. Juvenile polyps

b. Hamartomatous polyps associated with Peutz-Jeghers syndrome

c. Villous adenomas

d. Tubular adenomas

e. Metaplastic polyps


b , c , d are the right answers . villous adenomas ( 40 % )have higher malignant potential than tubular adenomas .metaplastic polyps are epithelial lesions but are benign .


214. Tetanus

a. Is due to an infection with a gram-negative spore forming rod

b. The organism produces a powerful endotoxin

c. The toxin prevents the release of inhibitory neurotransmitter

d. Clostridium tetani is sensitive to penicillin

e. Risus sardonicus is the typical facial spasm


c , d , e are right . neurotoxin is a powerful exotoxin . gram positive anaerobic rod - clostridium tetani .


215. Multiple myeloma

a. Results from a polyclonal proliferation of lymph node plasma cells

b. Often presents with back pain or pathological fractures

c. Hypercalcaemia develops in 50% of patients

d. X-rays are normal in most patients

e. Most patients have a serum paraproteinaemia


b , c , e are true . multiple myeloma results from monoclonal proliferation of the bone marrow plasma cells. over 70 % patients have lytic lesions on skeletal x rays . over 98 % patients have a serum paraproteinemia .


216. Regarding pathological terms

a. Hypertrophy is an increase in tissue size due to increased cell number

b. Hyperplasia is an increase in tissue size due to an increase in cell size

c. Atrophy is an increase in tissue size to disuse

d. Metaplasia is a change form one abnormal tissue type to another

e. A hamartoma is a developmental abnormality


only e is true . hypertrophy - increase in cell size . hyperplasia - increase in cell number . atrophy - decrease in tissue size to disuse . metaplasia is a change in normal cell type .


217. Osteoporosis is associated with

a. Vitamin D deficiency

b. Vitamin A deficiency

c. Chronic renal failure

d. Prolonged bed rest

e. Hyperparathyroidism


only d is true . osteomalacia is due to vitamin D deficiency .


218. The haemoglobin-oxygen dissociation curve is shifted to the left by

a. Increased body temperature

b. Metabolic acidosis

c. Chronic hypoxia

d. Anaemia

e. Erythropoietin


all are false . pyrexia and acidosis shift the curve to the right .

219. Metastatic calcification is seen in

a. Hyperparathyroidism

b. Sarcoidosis

c. Fat necrosis

d. Atheroma

e. Tuberculosis


a and b . metastatic calcification is due to hypercalcemia . dystrophic calcification is due to abnormal tissues . ( eg: scars )


220. Intrinsic factor

a. Is a polysaccharide

b. Is produced by the parietal cells in the stomach

c. Acts in the terminal ileum

d. Is important in the absorption of folic acid

e. Deficiency can be treated with oral B12


only b and c are true . IF is a polypeptide . it is important in B12 absorption . deficiency required B 12 injections once every 2 or 3 months .


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