19 - surgery mcqs - 151 to 160

151) 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

152) 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.

153) 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

154) 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

155) 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.

156) 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

157) 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

158) 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

159) 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

160) 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

18 - surgery mcqs - 141 to 150

141) 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

142) 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

143) 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

144) 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

145) 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

146) 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.

147) 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.

148) 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

149) 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

150) 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

17 - surgery mcqs - 131 to 140

131. 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 .

------------------------------------

132. 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 .

---------------------------

133. 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 .

-----------------------------------------

134. 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 .

-------------------------------

135. 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 .

------------------------------------

136. 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 .

-------------------------------

137. 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 .

-----------------------------------------

138. 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 .

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139. 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 )

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140. 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 .

---------------------------------------

16 - surgery mcqs - 121 to 130

121. Regarding gas gangrene

a. It is due to Clostridium botulinum infection

b. Clostridial species are gram-negative spore forming anaerobes

c. The clinical features are due to the release of protein endotoxin

d. Gas is invariably present in the muscle compartments

e. Surgical debridement and antibiotics are an essential part of treatment

--------------------------------------------------

only d and e are right . it is due to clostridium perfringes . gram positive anaerobes - clostridia . systemic toxicity results from protein exotoxins .

--------------------------------------------

122. Hodgkin's disease

a. Most commonly occurs in patients over 60 years of age

b. Usually presents as painless lymphadenopathy

c. The Pel-Epstein fever is a characteristic feature

d. Stage III disease is confined to one side of the diaphragm

e. Reed-Sternberg cells are a diagnostic feature

---------------------------------------------

b , c , e are true . occurs mostly in early adult hood . pel- epstein fever is swinging pyrexia that occurs every few days . stage 3 disease is present on both sides of the diaphragm .

----------------------------------------

123. Regarding varicose veins

a. They affect over 20% of the population

b. Over 20% are recurrent varicosities

c. The sural nerve is in danger during stripping of the long saphenous vein

d. The saphenous nerve is closely associated with the short saphenous vein

e. 5% oily phenol is an appropriate sclerosant for venous sclerotherapy

-----------------------------

only a and b are true . the saphenous nerve lies close to the long saphenous vein below the knee . the sural nerve lies close to the short saphenous vein . 5 % oily phenol is used for sclerosing hemorrhoids .

1-3 % sodium tetradodecyl sulphate are is the appropriate venous sclerosant .

--------------------------------------

124. The following are clinical features of Horner's syndrome

a. Miosis

b. Failure of abduction of the orbit

c. Ptosis

d. Increased sweating on the contralateral side of the forehead

e. Exophthalmos

---------------------------------

only a and c . horner's syndrome results due to interruption of the sympathetic supply to the eye . it is characterised by ptosis , miosis , reduced sweating on the ipsilateral side and enopthalmos .

------------------------------

125. Side effects of suxamethonium include

a. A rash

b. A profound tachycardia

c. Muscle pain

d. Malignant hypopyrexia

e. Prolonged neuromuscular blockade

-----------------------------------

a , c , e are the answers . depolarising muscle relaxant like succinyl choline . rash is due to histamine release . a profound bradycardia rather than tachycardia often occurs . the post operative muscle pain is due to fasciculation . malignant hyperpyrexia is a life threatening complication . neuromuscular blockade occurs due to pseudo choline esterase deficiency .

------------------------------------------

126. Conn's syndrome


a. Is due to secondary hyperaldosteronism

b. Can result in hypokalaemia

c. Can result in a metabolic alkalosis

d. Is most often due to an adrenal adenoma

e. Can cause severe hypotension

------------------------

b , c , d are true . conns syndrome is due to primary hyper aldosteronism . presents as hypertension and hypokalemia . hypokalemia results from failure of potassium reabsorption .

----------------------------

127. Haemorrhage of over one litre will produce

a. A reduction in renal blood flow

b. An increase in platelet count

c. A fall in arterial pH

d. Increased fibrinolysis

e. A fall in body temperature

--------------------------------

all are true .

---------------------------

128. A prolonged prothrombin time is found in the following conditions

a. Liver failure

b. Adrenal failure

c. Pre-hepatic jaundice

d. Factor VII deficiency

e. Malabsorption with steatorrhoea

------------------------------

a , d , e are the right answers . liver failure reduces the synthesis of prothrombin . increased prothrombin time is seen in obstructive jaundice . malabsorption is associated with failure of vitamin k absorption.

-------------------------

129. The radial nerve

a. Is a branch of the posterior cord of the brachial plexus

b. Is derived from the posterior primary rami of C5 to C7

c. Supplies the extensors of the arm

d. Gives rise to the anterior interosseous nerve

e. Injury produces a classical wrist drop

------------------------------

a , c , e are the right answers . derived from the anterior primary rami of C5 to T1 . gives rise to the posterior interosseous nerve .

--------------------------

130. Amyloidosis

a. Appears as extracellular basophilic hyaline material

b. Can be stained with Congo Red dye

c. Show an apple green birefringence in polarised light

d. Is a complication of medullary carcinoma of the thyroid

e. Is a complication of Hodgkin's disease

----------------------------------

only a is wrong . amyloid appears as an eosinophilic material . it is deposited in many inflammatory and malignant conditions .

-----------------------------------

15 - surgery mcqs - 111 to 120

111. Coeliac disease

a. Results from dietary glucose intolerance

b. Is associated with increased serum anti-endomysial and anti-gliadin antibodies

c. Small bowel histology shows villous hypertrophy

d. Can be effectively treated with a gluten-free diet

e. Increases the risk of small bowel lymphoma

---------------------------------------------

b , d ,e are right . coeliac disease results from dietary gluten intolerance . small bowel histology shows villous atrophy

-------------------------------------

112. Papillary carcinoma of the thyroid

a. Can be reliably diagnosed using fine needle aspiration cytology

b. Is almost always unifocal

c. Histologically displays Psammoma bodies

d. Typically spread to the cervical lymph nodes

e. Requires a total thyroidectomy for large tumours

-------------------------------------

a , c , d , e are the right answers . all papillary lesions are potentially malignant and can be diagnosed by FNAC . more than 50% are multifocal and hence the need for total thyroidectomy . blood borne spread is typical of follicular lesions .

---------------------------------------

113. Regarding bladder tumours

a. 90% are squamous carcinomas

b. Painless haematuria is the commonest presentation

c. Cigarette smoking is an important aetiological factor

d. 80% of tumours are superficial (i.e. no muscle invasion)

e. Superficial tumours are often well controlled by transurethral resection

--------------------------------------

b , c , d , e are all true . 90 % are transitional carcinomas only 5% are squamous type .

---------------------------------------------

114. The following are carcinogens important in bladder cancer

a. Magenta

b. Auramine

c. Benzidine

d. Beta-naphthylamine

e. Chlorinated hydrocarbons

---------------------------------------

all are true .

--------------------------------

115. Regarding ureteric calculi

a. Are most often composed of calcium oxalate or phosphate

b. Less than 5% of those less than 5 mm in diameter pass spontaneously

c. Extracorporeal lithotripsy is useful for stones in the upper third of the ureter

d. About 30% of patients require open surgery to remove the stone

e. An obstructed ureter in the presence of infection is a surgical emergency

------------------------------------------

a , c , e are true . most stones less than 5 mm in diameter pass spontaneously . less than 1 % of patients require a uretero lithotomy

---------------------------------------------------

116. Cryptorchidism

a. Occurs in 5% of newborn boys

b. Increases risk of malignancy by a factor of ten

c. Is associated with normal fertility

d. Laparoscopy is the best means of identifying an impalpable testis

e. Should be treated by orchidopexy at puberty

-------------------------------------------

a , b , d are true . associated with reduced fertility . 30 % - oligospermia , 10 % - azospermia . orchidopexy should be considered in the second year of life .

------------------------------------------

117. Regarding small bowel obstruction

a. In the United Kingdom is most often due to an obstructed hernia

b. Causes colicky abdominal pain and vomiting

c. Abdominal distension is seen in all patients

d. All cases can be managed conservatively for the first 24 hours

e. Rarely requires aggressive fluid resuscitation

--------------------------------------------

only b is true . adhesions are the commonest cause of small bowel obstruction in UK. little distension is seen in patients with high jejunal obstruction . urgent operation is required if there are features of peritonism .
most patients are severly dehydrated and require resuscitation .

--------------------------------------

118. Regarding bone scintigraphy

a. It is less sensitive than radiographs in detecting metastatic bone disease

b. It is performed using technetium labeled biphosphonates

c. The radiation dose received is equivalent to a CT scan

d. Renal excretion of the isotope can cause false positive images

e. Has a high risk of anaphylaxis

---------------------------------------------------

only b and d are true . scintigraphy is the most sensitive imaging modality for bone metastasis . the radiation dose ( ~5 mSv ) is equal to two chest x rays . allergic reactions to isotopes are rare .

----------------------------------

119. Regarding nephroblastomas

a. They are otherwise known as a Wilm's tumour

b. Account for 10% of childhood tumours

c. The commonest presentation is with an abdominal mass

d. Most commonly present in adolescence

e. They are composed purely of epithelial elements

------------------------------------------------

a , b , c are true . most commonly present in the first three years of life . they are embryonic tumors composed of both epithelial and sarcomatous elements .

-------------------------------------------------

120. Regarding bladder calculi

a. The incidence has fallen markedly in this country ( UK ) since the late 19th century

b. They may be totally asymptomatic

c. They are more prevalent in patients with chronic urinary sepsis

d. They are associated with squamous metaplasia of the bladder mucosa

e. They increase the risk of transitional cell carcinoma

-------------------------------------------------

a , b , c , d are true . they increase the risk of squamous cell cancers.

----------------------------------------