Analyzing and resolving a communication crisis in Dhaka textiles LTD.pptx
SBA new.pdf
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launch a RESIDENCY LONG BATCH named "RIGEL"
Course starts on APRIL 5. Those who are
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a minimum cost. Special discount available for
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2. 100 SBA question bank
PREPARED BY—
DR. MAHDI SATTAR KHAN RIZA
MBBS (SUST)
BCS (HEALTH)
FCPS PART-1 (SURGERY)
1. A 55yr male undergone a major surgery. Within 24 hours following
metabolic changes occurred except-----
a. inactivation of peripheral thyroid hormones
b. High circulatory IGF-1
c. insulin resistance
d. Hypersecretionof growth hormone
e. Decreased gonadal function.
EXPLANATION—
Changes that occur during metabolic response—
1.increased lipolysis.
2. increased hepatic gluconeogenesis.
3. skeletal muscle protein metabolism.
4. hepatic acute phase protein synthesis.
5. pyrexia.
Must to know----
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3. Hormones that decrease during metabolic response—
1.thyroid hormone.
2. IGF-1
3. testosterone.
4. insulin.
ANS-----B
2. Negative reactant in acute traumatic state—
a. fibrinogen
b. prothrombin
c.plasminogen
d.albumin
e.CRP
EXPLANATION----
Positive acute phase reactants are—
-C reactive protein.
-fibrinogen.
- procalcitonin.
- ferritin.
- hepcidin.
- serum amyloid A
NEGATIVE REACTANTS ARE—
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4. -albumin.
- transferrin.
ANS--D
3. A 55 yr old diabetic patient underwent routine laparoscopic surgery under
G/A. Chief surgeon alerts his trainee that this patient may develop
uncontrolled DM because of insulin resistance due to excessive metabolic
response. This insulin resistance may persist upto—
a. 7days
b. 14days
c. 2months
d. 6months
e. never subside
Ans—B
EXPLANATION—
Following surgery/trauma, postoperative hyperglycaemia develops as a
result of—
increase glucose production.
Decrease glucose uptake in peripheral tissues.
Following routine upper abdominal surgery, insulin resistance may persist
upto—2weeks/14 days.
RX—IV insulin infusion.
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5. 4. Unavoidable factor that compound the response to injury---
a.hypothermia
b.continoushaemorrhage
c.bleeding disorder
d.tissue underperfusion
e.immobility.
EXPLANATION—
Avoidable factors that compound the response to injury—
1.Continuous haemorrhage.
2. hypothermia.
3. tissue oedema.
4. tissue underperfusion.
5. starvation.
6. immobility.
Ans—C
5. Which one is not the feature of EBB phase?
a.energy conserving phase
b.hypermetabolism
c.reduced CO
d.lactic acidosis
e.hyperthermia.
EXPLANATION—
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6. Ebb phase begins at the time of injury& last for approximately 24-48 hours.
CHARACTERISED BY—
1.hypovolumia.
2. decreased basal metabolic rate.
3. reduced cardiac output.
4. hypothermia.
5. lactic acidosis.
This phase correspond with shock.
The predominant hormones regulating the ebb phase are-
-catecholamines.
-cortisol.
-aldosterone.
This phase is followed by activation of rennin-angiotensin
system.
*This phase is energy conserving phase.
Ans—B
6. Regarding “FLOW PHASE” of metabolic stress response,which of the
following is true?
a. body’s energy expenditure decreases
b. increase in muscle protein synthesis
c. decrease in urinary nitrogen loss
d. decrease in synthesis of positive acute phase proteins
e. decrease in synthesis of negative acute phase proteins.
EXPLANATION—
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7. *Following resuscitation, ebb phase is converted to flow phase which
correspond to SIRS.
*Characterized by—
1. Tissue oedema.
2. Increased basal metabolic rate.(hypermetabolism)
3. Raised body temperature.
4. Incresed cardiac output.
5. Leukocytosis.
6. Incresed oxygen consumption.
7. Increased gluconeogenesis.
*This flow phase is subdivided into—
- initial catabolic phase (3-10days).
- anabolic phase (for weeks).
Ans—E
7 .Which of the following factor is responsible for delayed recovery following
surgery?
A. prolong bed rest
B. minimal periods of starvation
C. minimal access techniques
D. epidural analgesia
E. spinal analgesia
Ans—A
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8. EXPLANATION—
A proactive approach to prevent unnecessary aspects of the surgical
stress response—
• Minimal access techniques.
• Blockade of afferent painful stimuli. (Epidural analgesia, Spinal
analgesia, Wound catheters.)
• Minimal periods of starvation.
• Early mobilization.
8. Following major injury/sepsis, albumin TER may be increased----
A. 2fold
B. 7 fold
C. 10 fold
D. 3fold
E. 6 fold.
EXPLANATION—
Liver & skeletal muscle together account for >50% of daily protein turnover.
• Albumin is the major export protein produced by liver & is renewed
at the rate of about 10% per day.
• The transcapillary escape rate of albumin is about 10 times the rate
of synthesis.
• Albumin TER may be increased 3fold following major injury/sepsis.
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9. Ans—D
9. Following which pro-inflammatory cytokine promote hepatic acute phase
response?
A. IL-1
B. IL-12
C. IL-6
D. IL-8
E. TNF-alfa
EXPLANATION—
IL-1 = responsible for fever.
IL-12 = increased production of IFN-gamma.
IL-6 = promote hepatic acute phase response.
TNF-ALFA= responsible for fever, anorexia, cancer cachexia********.
Acute inflammatory cytokines are—TNF, IL-1,6,17, Chemokines.
Chronic inflammatory cytokines are—IL-12,17, INF-gamma.
Ans—C
10.Following which is not the metabolic response to starvation?
A. low plasma insulin
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10. B. protein catabolism
C. lipolysis
D. loss of adaptive ketogenesis
E. hepatic gluconeogenesis
EXPLANATION—
Metabolic response to starvation—
• Low plasma insulin.
• High plasma glucagon.
• Hepatic glycogenolysis.
• Protein catabolism.
• Hepatic gluconeogenesis.
• Lipolysis.
• Adaptive ketogenesis.*********
• Decrease energy expenditure.*******
Try to remember—
• In response to starvation- there will be adaptive ketogenesis &
decreased energy expenditure.
• In response to trauma/sepsis—there will be loss of adaptive
ketogenesis & fluid retention with associated
hypoalbuminaemia.******
Ans—D
11. In acute starvation upto 5days calorie is not provided by—
A. fat
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11. B. muscle
C. glycogen
D. ketone body
E. ammonia.
EXPLANATION—
Upto 5 days—
• The main labile energy reserve in the body is fat.
• The labile protein reserve is skeletal muscle.
• Glycogen storage in liver.
After 5 days---
• Decresed systemic proteolysis.
• Use ketone body as main fuel.
Ans—E
12. Which of the following doesn’t occur in septic shock?
A. high cardiac output
B. low vascular resistance
C. low mixed venous oxygen saturation
D. fluid loss into interstitial spaces
E. dysfunction of cellular utilization of oxygen.
EXPLANATION—
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12. Clinical features of septic shock—
• Pt looks anxious/confused.
• Fever with occasional intermittent chills.******
• Hypotension & tachycardia.
• Skin warm,dry & pinkish.******
• Adequate urine output.
Metabolic characters are******—
• High cardiac output.
• Low vascular resistance.
• Low venous pressure.
• High mixed venous saturation.
• High base deficit.
• Managed by noradrenaline.
Ans—C
13.Global end point of resuscitation of shock patient is determined by—
A. blood pressure
B. serum lactate level
C. mixed arterial oxygen saturation
D. metabolic alkalosis
E. urine output.
EXPLANATION—
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13. Parameters of traditional end point of resuscitation—
1. Pulse.
2. Blood pressure.
3. Urine output.
Parameters of global end point of resuscitation—
1. Base deficit.
2. Lactate.
3. Mixed venous oxygen saturation.
Ans—B
14. A 33 yr old man is hit by a car & has multiple fractures.His pulse is
150b/min, BP is 80/45mm Hg, respiratory rate is 24b/min & urine output is
25ml/min.Justify the type of shock---
A. hypovolumic shock
B. cardiogenic shock
C. septic shock
D. anaphylactic shock
E. obstructive shock
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14. Ans—A
15.Which of the following about reactionary haemorrhage is not true?
A. this is delayed haemorrhage occuring within 24hour after operation.
B. usually caused by slippage of ligature
C. associated with infection
D. can be significant requiring re-exploration
E. it is usually arterial.
EXPLANATION—
Reactionary haemorrhage is delayed haemorrhage within 24hours of operation.
CAUSES—
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15. 1. Dislodgement of clots.
2. Slippage of ligature.
3. Normalization of blood pressure.
4. Vasodilation.
ANS—C
16. Following which is the poor indicator of degree of haemorrhage?
A. haemoglobin level
B. pulse rate
C. blood pressure
D. urine output
E. lactic acidosis
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16. Ans--A
17. Following which is one of the last signs of shock?
A. tachycardia
B. tachypnea
C. prolong capillary refill time
D. lactic acidosis
E. hypotension
EXPLANATION—
• Hypotension is one of the last signs of shock.
• Pitfalls of shock—
• 1. Capillary filling time.
• 2. Pulse
• 3. Blood pressure.
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17. ANS—E
18. Following are the complications of massive blood transfusion except—
A. coagulopathy
B. hypocalcaemia
C. hyperkalemia
D. hyponatremia
E. hypothermia
ANS—D
EXPLANATION—
Complication of massive blood transfusion—
1. coagulopathy.
2. Hypocalcaemia.
3. Hyperkalaemia.
4. Hypokalaemia.
5. Hypothermia.
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18. 19.Fresh frozen plasma is an important blood product that is used in
coagulopathic condition. How long the fresh frozen plasma can be stored at -40
to -50’c?
A. 12months
B. 6months
C. 24months
D. 36months
E. 5years
ANS—C
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20. 20. Which level of haemoglobin act as a transfusion trigger?
A. >8 gm/dl
B. 6-8 gm/dl
C. 6 gm/dl
D. >10 gm/dl
E. <10 gm/dl
EXPLANATION—
Transfusion trigger—6gm/dl.
• <6gm/dl = will probably benefit from transfusion.
• 6-8gm/dl = transfusion unlikely to be of benefit in the absence of
bleeding or impending surgery.
• >8gm/dl = no indication for transfusion in the absence of other risk
factors.
ANS—C
21. Which is not correct about compensated shock?
A. mild lactic acidosis
B. reduced urine output
C. mild tachycardia
D. normal blood pressure
E. conscious
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21. EXPLANATION—
In compensated shock—
• Mild lactic acidosis.
• Normal urine output.*******
• Conscious.
• Respiratory rate & blood pressure normal.
• Mild tachycardia.
Try to remember—
• In case of compensated shock & mild uncompensated shock, urine
output level is normal.
• Urine output is reduced in moderate uncompensated shock & in
severe form of shock pt is anuric.********
ANS—B
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22. 22. Which of the following systemic factor influences wound healing?
A. loss of tissue
B. site of wound
C. Contamination
D. previous irradiation
E. zinc deficiency
EXPLANATION—
Local factors—
• site of the wound.
(in case of face- fast healing. )
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23. ( In case of foot- slow healing).
• Structures involved.
• Mechanism of wound.
• Contamination.
• Loss of tissue.
• Vascular insuffiency.
• Haematoma.
• Immobilization.
• Previous radiation.
• Pressure.
Systemic factors—
• Malnutrition.
• Vitamin A, C,D deficiency.
• Mineral deficiency ( zn, Mn, Ca, Cu).
• Diabetes mellitus.
• Steroid.
• Smoking.
• Immunosuppresion.
ANS-E
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24. 23.Wound healing runs through a series of events .During remodeling phase,
iniatially produced type-3 collagen is replaced by-
A. type 1 collagen
B. type 2 collagen
C. type 3 collagen
D. type 5 collagen
E. type 7 collagen
EXPLANATION—
• Remodelling phase is characterized by maturation of collagen.
• Type 1 replacing type 3 until a ratio of 4:1 is achieved.
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25. ANS—A
24.Which of the following disease commonly not associated with leg ulcer?
A. varicose vein
B. rheumatoid arthritis
C. thyroid disease
D. syphilis
E. self inflicted trauma.
EXPLANATION—
Causes of leg ulcers—
• Varicose veins.
• Atherosclerosis.
• Diabetes.
• Rheumatoid arthritis.
• SLE.
• Self inflicted trauma.
• Tuberculosis.
• Syphilis.
• Squamous cell carcinoma.
• Basal cell carcinoma.
• Sarcoma.
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26. ANS—C
25.Which of the following is not common site of pressure sore?
A. ischium
B. nape of the neck
C. occiput
D. greater trochanter .
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27. E. malleolus.
EXPLANATION—
Sites of pressure sore in descending order—
• Ischium.
• Greater trochanter.
• Sacrum.
• Heel.
• Lateral malleolus.
• Medial malleolus.
• Occiput.
ANS—B
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28. 26.Following which is not correct about vacuum assisted closure?
A. used in non healing ulcer
B. reduce oedema
C. remove interstitial fluid
D. reduce cell proliferation
E. create suitable bed for graft/flap.
EXPLANATION—
Vacuum assisted closure / negative pressure wound closure----
• Negative pressure of approximately -125mm/hg is applied to hasten
debridment & form granulation tissue in chronic wound & ulcers.
• Decrease oedema.
• Remove interstial fluid.
• Increase blood flow.
• Bacterial count decrease.
• Cell proliferation increase.
• Create a suitable bed for graft or flap cover.
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29. ANS—D
27. In the healing wound,the maximal tensile strength is achieved by—
A. 3rd day
B. 3rd week
C. 6th week
D. 7th week
E. 12th week.
EXPLANATION—
In healing wound , maximal tensil strength is achieved by -12th
week.*******
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30. ANS—E
28. Which of the following treatment option is used only for keloid?
A. silicon gel sheeting
B. intralesional steroid
C. intralesional steroid
D. vitamin E
E. Laser
EXPLANATION—
Treatment of hypertrophic & keloid scars—
• Pressure- local moulds or elasticated garments.
• Silicon gel sheeting.
• Intralesional steroid injection. (Triamcinolon)
• Excision & steroid injection.
• Excision & postoperative radiation.
• Intralesional excision is used only for keloids.*****
• Laser.
• Vitamin E or palm oil massage.
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31. ANS---B
29.Which is not false about keloid?
A. soon after injury,subside with time
B. less recurrence rate
C.male & female equally affected
D. less malignant potential
E. significant familial predisposition.
EXPLANATION—
In case of keloid—
• Autosomal dominant.
• More significant familial predisposition.
• Female predominant.
• Most common in 10-30 years pt.
• Outgrowth its boundary.
• Months after injury never subsides.
• Occurs mostly in face,earlobes, chest.
• More malignant potential.******
• Often worse after injury.
• Recurrence rate is most common.
ANS—C
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32. 30Regarding wound healing which is true statement?
A. inflammatory phase last for 2-3hours
B. matured scar contains numerous fibroblast
C. smoking delays wound healing
D. avulsed wound heals faster than incised wound.
E. hypertrophic scar is the result of mismatched remodelling phase.
EXPLANATION—
Wound healing consist of 3 phases—
1. Acute inflammatory phase.
2. Proliferative phase.
3. Maturation phase.
INFLAMMATORY PHASE—
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33. Begins immediately after wound & last for 2-3 days.
• Characterized by aggregation of neutrophil.
PROLIFERATIVE PHASE—
Last for 3rd
day-3rd
week.
• Fibroblast- increased collagen, ground substance.
• Angiogenesis.
• Re-epithelialization.
REMODELLING PHASE—
Maturation of collagen. ( type 3 is replaced by type 1)
• Re-alignment of collagen fibers.
• Decrease vascularity.
• Wound contraction.
• Increase tensile strength. ( maximum @ 12th
week, 80%).
ANS—E
31. Following cells are used for tissue engineering except---
a. Somatic stem cell
b. Induced pleuripotent stem cell
c. Fetal cell
d. Somatic cells
e. Gonadal cells
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34. ANS—E
32.Following which of the tissue engineering cell is not pleuripotent?
A. somatic stem cell
B. fetal cell
C.somatic cell
D. induced pleuripotent stem cell
E. human embryonic stem cell.
EXPLANATION—
E
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35. Excellent pleuripotency—
• Human embryonic stem cell.
• Induced pleuripotent stem cell.
Limited pleuripotency—
• Somatic stem cell.
• Fetal cell.
No pleuripotency-----somatic cell.
ANS—C
32. Which is the major risk of cell based therapy?
A. transmission of infection
B. rejection
C. tumour formation
D. poor viability
E. loss of function
EXPLANATION—
RISKS OF CELL BASED THERAPY—
• Tumour formation. (major)******
• Genetic & epigenetic abnormalities.
• Transmission of infection.
• Poor viability & loss of function.
• Differentiation to undesired cell types.
• Rejection.
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36. • Side effects of immunosuppression ( allogenic).
ANS—C
34. A patient came with a injury on hand which occurred 24 hours ago& right
hand is oedematous with bluish black discolouration& sweet odour is
present.Which is most responsible?
• A. staphylococcus saprophyticus
• B. staphylococcus aureus
• C. streptococci
• D. pseudomonas
• E. clostridium perfringens .
EXPLANATION—
Above scenario indicates—GAS GANGRENE / MYONECROSIS.
It is a special type of moist gangrene caused by anaerobic spore bearing
organism like—
• Clostridium perfringens / welchii. (90%).********
• Clostridium bifermentens.
• Clostridium Septicum.
• Clostridium Histiolyticum.
• Clostridium sporogens.
• Fallax.
• Streptococcus pyogens.
• Pseudomonas.
• Acromonas.
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37. Ans-----E
35.In a hospital admitted patient of burn which organism causes infection?
• A. staphylococcus aureus
• B. pseudomonas
• C. clostridium perfringens
• D. streptococcus
• E. staphylococcus saprophyticus.
EXPLANATION—
• PSEUDOMONAS spp. Tend to colonize burns, tracheostomy
wounds, urinary tract.********
• Once pseudomonas has colonized wards & ICU, its difficult to
eradicate.
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38. • In case of dressing of burn wound, ketamine & midazolam is
used.***
Ans--B
36.In which condition antibiotic prophylaxis is needed for a clean cut surgery?
• A. elderly patient
• B. DM
• C. implantation of prosthesis
• D. malnourished patient
• E. obese patient.
EXPLANATION—
ANTIBIOTIC PROPHYLAXIS—
• Not required in clean surgery unless a prosthesis is implanted.****
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39. • Use antibiotics that are effective against expected pathogen witnin
local hospital guideline.
• Plan for single shot intravenous administration at induction.
• Repeat only during long operations or if there is excessive blood
loss.******
• Pt. with heart valve disease or a prosthesis should be protected from
bacteraemia caused by dental work, urethral instrumentation or
visceral surgery.
• Ans-----C
37.Which of the following factor doesn’t determine whether a wound will
become infected or not?
• A. host response
• B. virulence of infective agent
• C. vascularity.
• D. systemic shock.
• E. absence of antibiotic.
EXPLANATION—
FACTORS THAT DETERMINE WHETHER A WOUND WILL BECOME
INFECTED OR NOT---
• Host response.
• Virulence & inoculums of infective agent.
• Vascularity & health of tissue being invaded. (including local
ischaemia as well as systemic shock.)
• Presence of dead or foreign tissue.
• Presence of antibiotics during the decisive period.
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40. Ans----E
38. Which is not true about abscess?
• A. contain hyperosmolar fluid
• B. most abscess related to surgical wounds take 7 -10 days to form after
surgery.
• C. need drainage
• D. an open abscess cavity heals by 2ndary intention.
• E. antibiotics are indicated in all cases.
EXPLANATION—
ABSCESS—
• Pyogenic organism, predominantly STAPHYLOCOCCUS
AUREUS, cause tissue necrosis and suppuration.
• Pus is composed of dead & dying WBC predominantly neutrophils,
that have succumbed to bacterial toxins.
• Abscess contain hyperosmolar material that draws in fluid.
• Most abscesses relating to surgical wounds take 7-10days to form
after surgery.
• Antibiotics are indicated if the abscess cavity is not left open to drain
freely.*******
• An open abscess cavity heels by secondary intention.
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41. • Ans—E
39.Which of the following statement regarding cellulitis is not true?
• A. non suppurative, invasive infection of the tissue.
• B. poorly localised.
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42. • c. commonly caused by streptococci
• D. systemic signs are not present.
• E. blood cultures are usually negative.
EXPLANATION—
CELLULITIS & LYMPHANGITIS—
COMMONLY CAUSED BY—
• Beta haemolytic streptococci.
• Staphylococci.
• Clostridia.
Non-suppurative, poorly localized.
Blood cultures are often negative.
ANS-D
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43. 40.Following which antibiotic is mainly responsible for antibiotic associated
diarrhoea?
A.. METRONIDAZOLE.
B. VAANCOMYCIN.
C. CIPROFLOXACIN.
D. MEROPENEM.
E. AMINOGLYCOSIDE.
Ans---C
41.Which of the following organism is difficult to eradicate from ward & ICU
if once colonizes?
• A. streptococci
• B. staphylococci
• C. pseudomonas
• D. clostridia
• E. bacteroids.
Ans—C
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44. Pseudomonas is difficult to eradicate from ward &
ICU.
42.A 25 year old boy has come with erythematous spreading lesion.Which
organism is responsible for this type of spreading lesion?
• A. pseudomonas
• B. bacteroids.
• C. Viridens streptococci
• D. staphylococcus aureus.
• E. streptococcus pyogens.
EXPLANATION—
STREPTOCOCCUS PYOGENS—
Diseases caused by—
• Pharyngitis
• Tonsillitis
• Cellulitis
• Spreading type erythematous lesion (hyaluronidase is the spreading
factor).******
• Impetigo.
• Septic arthritis.
• Meningitis.
• Necrotizing fasciitis.
• Scarlet fever.
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45. Ans—E
43.A 30 years old lady come with micturition difficulties with suprapubic pain
& dysuria which is not associated with fever ,nausea &
vomiting.
Which organism most likely responsible ?
• A. E.coli
• B. proteus
• C. gonorrhoea
• D. campylobacter jejuni
• E. pseudomonas.
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46. EXPLANATION—
ORGANISMS RESPONSIBLE FOR UTI—
• E. Coli. (MOST COMMON)
• Staphylococcus saprophyticus. (sexually active female).
• Pseudomonas. (catheterized pt).
• Klebsiella.
• Staphylococcus aureus.
• Enterobacter.
• Proteus mirabilis.
Ans---A
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47. 44.Gas gangrene is a special specific infection which is caused by—
• A. streptococcus
• B. helicobacters
• C. clostridium perfringens.
• C. pseudomonas.
• E. clostridium tetani.
EXPLANATION-
Gas gangrene is mainly caused by CLOSTRIDIUM PERFRINGENS which
is—
• Gram positive.
• Anaerobic.
• Spore bearing rod.
• Widely found in nature mainly in soil & faeces.
Ans---C
45.A 35 years old burn patient came to the hospital.after few days you see an
extra layer in the wound area.For a burn patient which organism may be the
causative agent?
• A. streptococcus
• B. staphylococcus.
• C. clostridium perfringens.
• D. pseudomonas.
• E. E.coli.
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48. EXPLANATION—
Pseudomonas spp. tend to colonize in burn wound, tracheostomy wound &
urinary tract.
Ans--D
46.Most widely used drug for anaerobic coverage in surgical field—
• A. ampicillin
• B. gentamicin
• C. meropenem
• D. metronidazole
• e. ceftazidime.
• Ans—D
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49. 47.Which organism is mainly responsible for intra-abdominal abscess after
colorectal or gynaecological surgery?
• A. bacteroids
• B. clostridium
• C. peptostreptococcus
• D. staphylococcus
• E.pseudomonas.
EXPLANATION—
BACTERIODES FRAGILIS-
• Non spore bearing.
• Strict anaerobe.
• Colonize in large bowel, vagina & oropharynx.
• Along with aerobic gram negative bacilli, it can cause SSI.
• It can cause intra-abdominal abscess after colorectal or
gynaecological surgery.
• It is sensitive to metronidazole & cefotaxim.
Ans—A
48.Extent of decisive period is—
• A. 30 min
• B. 1hour
• C. 4 hour
• D. 2 hour
• E. 24 hour.
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50. EXPLANATION---
Decisive period is upto 4 hour interval before bacterial growth becomes
established enough to cause an infection after a breach in the tissues, whether
caused by trauma or surgery.
Ans—C
49.Following which is not correct regarding major SSI?
• A. significant quantity of pus.
• B. early return to home
• C. patients are systemically ill.
• D.tachycardia
• E. pyrexia.
EXPLANATION—
CRITERIA OF MAJOR SSI—
• Significant quantity of pus.
• Delayed return to home.
• Patients are systemically ill.
Ans—B
50.Synergistic spreading type of gangrene in the abdominal wall is called—
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51. • A. Meleney’s gangrene
• B. burst abdomen
• C. hospital acquired infection.
• D. markel’s syndrome
• E. ormond’s disease.
EXPLANATION—
SYNERGISTIC SPREADING GANGRENE / SUBDERMAL GANGRENE/
NECROTISING FASCITIS--
Caused by—
• Coliforms.
• Staphylococci.
• Bacteriod spp.
• Anaerobic streptococci.
• Peptostreptococci.
Synergistic gangrene in abdominal wall is called—MELENEY’S
SYNERGISTIC GANGRENE.
Synergistic gangrene in scrotum—FOURNIER’S GANGRENE.
ANS--A
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52. 51.Regarding SIRS—
• A. hypothermia (<36’c).
• B. tachycardia (>90/min) with beta blocker.
• C. tachypnea
• D. WBC count >12k / <4k.
• E. hyperthermia (>38’c).
EXPLANATION—
SIRS is 2 of—
• Hyperethermia (>38’c) or, Hypothermia (<36’c).
• Tachycardia (>90/min, no beta blocker) or, Tachypnea (>20/min).
• WBC count >12k or <4k.
Sepsis is SIRS with a documented infection.
• Ans—B
52.Which one is a major pathogen in postoperative chest infection?
• A. covid-19.
• B. streptococcus pyogens.
• C. clostridium botulinum
• D. streptococcus pneumoniae.
• E. mycobacterium tuberculosis.
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53. Ans—D
Streptococcus is responsible for post operative chest infection.
53.Following which antibiotic is most sensitive for soft tissue infections &
osteomyelitis?
• A. penicillin
• B. flucloxacillin
• C. ticarcillin
• D. cephalosporins
• E. metronidazole.
EXPLANATION—
• PENICILLIN—most effective against gram positive pathogens.
• FLUCLOXACILLIN— useful in treating soft tissue infection &
osteomyelitis.
• TICARCILLIN, PIPERACILLIN—used in septicaemia, hospital
acquired pneumonia, complex UTI.
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54. • CEPHALOSPORINS—effective in intra-abdominal skin & soft
tissue infection.
• METRONIDAZOLE—wide anaerobic coverage.
Ans---B
54.Following which is not the criteria of ASEPSIS SCORE?
• A. purulent discharge
• B. erythema
• C. separation of deep tissue
• D. purulent exudate
• E. isolation of bacteria from wound.
EXPLANATION—
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55. Criteria of ASEPSIS SCORE—
• Additional treatment.
• Serous discharge.
• Erythema.
• Purulent exudates.
• Separation of deep exudates.
• Isolation of bacteria.
• Stay in hospital prolonged over 14days.
Ans—A
55.Shameful exposure of the testis following excision of the gangrenous
skin—a classic presentation of ---
• A. fournier’s gangrene.
• B.acute edidymitis.
• C. meleney’s synergistic gangrene
• D. ormonds syndrome
• E. torsion of testis.
EXPLANATION—
A classic presentation of FOURNIER’S GANGRENE of the scrotum is
“shameful exposure of the testes” following exposure of the gangrenous skin.
• Ans—A
56.Amoeboma most commonly seen in—
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56. • A. appendix.
• B. right lobe of liver
• C. colon
• D. small intestine
• E. caecum.
EXPLANATION—
AMOEBOMA—
• This is a chronic granuloma arising in the large bowel, most
commonly seen in the caecum.
• This can easily be mistaken for a carcinoma.
• Iron deficiency anaemia may present in amoeboma because of
chronic malnutrition.
• Ans---E
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57. 57.Regarding treatment of amoebiasis---
• A. mainstay of treatment is surgery.
• B. for large abscess, repeated aspiration is combined with drug treatment.
• C. medical treatment is very effective.
• D. acute toxic megacolon& severe haemorrhage are the intestinal
complication.
• E. when an amoeboma is suspected in a colon mass, cancer should be
excluded.
EXPLANATION—
Treatment of amoebiasis—
• Medical treatment is very effective.
• For large abscesses, repeated aspiration is combined with drug
treatment.
• Surgical treatment is reserved for complications, like rupture into
pleural, peritoneal or pericardial cavity.
• Acute toxic megacolon & severe haemorrhage are the intestinal
complications.******
• When an amoeboma is suspected in a colonic mass, cancer should be
excluded by appropriate imaging & biopsy.
Ans---A
58.Asiatic cholangiohepatitis—
• A. increased risk of cholangiocarcinomna.
• B. may remain dormant for many years.
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58. • C. stool examination for eggs/worm is diagnostic.
• D. causative organism is fasciola hepatica.
• E. produces bile duct hyperplasia.
EXPLANATION—
• Causative parasite is- CLONORCHIS SINENSIS.
• Produces bile duct hyperplasia, intrahepatic duct dilatation & stones.
• Increases the risk of cholangiocarcinoma.
• May remain dormant for many years.
• When active, there are biliary tract symptoms in a generally unwell
patient.
• Stool examination for eggs or worms is diagnostic.
• USG & ERCP are also diagnostic.
Ans==D
59.Regarding round worm—
• A. contaminated by faeco-oral route.
• B. eggs in the biliary tract form a nidus.
• C. when worm lodged in pancreatic duct causes acute pancreatitis.
• D. larvae causes pulmonary symptoms.
• E. larvae causes intestinal symptoms.
EXPLANATION—
ASCARIASIS—
• It is the commonest intestinal nematode affecting humans.
• Typically found in humid atmosphere & poor sanitary conditions.
• Larvae cause pulmonary symptoms.
• Adult worms cause gastrointestinal, biliary & pancreatic symptoms.
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59. • Ascending cholangitis & obstructive jaundice occurs when a worm is
lodged in the common bile duct.
• Acute pancreatitis occurs when a worm is lodged in the pancreatic
duct.
Ans----E
60.Regarding filariasis—
• A. blood tests often reveal an elevated eosinophil count.
• B. microfilariae can be seen in nocturnal peripheral blood smear.
• C.medical treatment with diethylcarbamazepine is effective even when huge
elephantiasis occurs.
• D. filariasis is the 2nd most common cause of long term disability.
• E. can be easily treated with operations to reduce the size of the limb.
EXPLANATION—
FILAARIASIS—
• Caused by- WUCHERERIA BANCROFTI which is carried by
mosquito.
• Lymphatics are mainly affected.
• Eosinophilia occurs.
• Immature worms may be seen in a nocturnal peripheral blood smear.
• Filariasis is the 2nd
most common cause of long term disability after
leprosy.
• Early cases are very amenable to medical treatment.
• Intermittent pneumatic compression gives some relief.
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60. • Ans—E
61.Which of the tropical diseases complicate with characteristic disfigurement
of LEONINE FACE ?
• A. tuberculosis
• B. hydatid disease
• C. mycetoma
• D. leprosy
• E. filariasis.
EXPLANATION—
LEPROSY—
• Typical leonine facies.
• Face has an aged look with collapse of nasal bridge & ocular
changes.
• Thickened peripheral nerves.
• Patches of anesthetic skin.
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61. • Claw hand.
• Foot drop.
• Trophic ulcers.
Ans—D
62.Which one is correct statement regarding hydatid disease?
• A. dog is intermediate host
• B. medical treatment with diethylcarbamazine is very effective in the late
stage.
• C. cannot colonize every organ.
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62. • D. lung is the organ most often affected.
• E. hypertonic solution is applied in PAIR THERAPY.
EXPLANATION—
HYDATID DISEASE—
• Causative organism—ECHINOCOCCUS GRANULOSUS/ dog
tapeworm.
• A variant of the disease occurs in the colder climates caused by
ECHINOCOCCUS MULTILOCULARIS.
• Liver & lungs are most commonly affected.
• Scolicidal agents are used in PAIR therapy.
• .
Ans---E
63.Regarding tuberculous cervical lymphadenitis-
• A.a matted lymph nodal mass is the typical clinical feature.
• B. mass may be cystic.
• C. in early stages,cold abscess may form.
• D. abscess may burst forming a sinus.
• E. diagnosed by culture of pus & biopsy of the lymph node.
EXPLANATION—
TUBERCULOUS CERVICAL LYMPHADENITIS—
• This is a common condition at any age.
• A matted lymph nodal mass is the typical clinical feature.
• In later stages the mass may be cystic, denoting an abscess.
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63. • The abscess denotes underlying caseation & does not show any
features of inflammation—hence called a cold abscess.
• Ultimately the abscess may burst, forming a sinus.
• Involvement of other systems must be excluded.
• Treatment is mainly medical.
• Ans—C
64.Following which one is the 2nd most commonest organ affected in hydatid
disease?
• A. pancreas
• B.brain
• C.lung
• D. terminal ileum
• E.colon
• Ans—C
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64. 65.Regarding tuberculosis of the small intestine—
• A. mesenteric lymphadenopathy is mainly common in ulcerative variety.
• B. ulcerative type occurs when the virulence of the organism is greater than
the host defence.
• C. small bowel strictures are common in hyperplastic type.
• D. in ulcerative type bowel serosa is studded with tubercles.
• E. macroscopically hyperplastic type may be confused with crohn’s disease.
EXPLANATION—
Intestinal tuberculosis is of 2 types—
ULCERATIVE VARIETY—
• Commonly occurs in terminal ileum, causing transverse ulcers with
typical undermined edges.
• Severe form
• Virulence of the organism is greater than the host defence.
• Bowel serosa is studded with tubercles.
HYPERPLASTIC VARIETY—
• Macroscopically this type may be confused with Crohn’s disease.
• It is caused by drinking infected unpasteurized milk.
• Host resistance is greater than the virulence of the organism.
• Small bowel strictures are common.
• Ans—A
66.Commonest site of bowel perforation from typhoid is ---
• A. terminal ileum
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65. • B. caecum
• C. colon
• D. duodenum
• E. appendix.
EXPLANATION--
Commonest site of bowel perforation in typoid is-- Terminal ileum.
• Ans—A
67.Pulmonary symptoms caused by the larval stage of the round worm is
called---
• A. ascariasis
• B. hydatid disease
• C.Loeffler’s syndrome.
• D. Ormond’s disease
• E.Leriche’s syndrome
EXPLANATION—
Larval stage of ASCARIS LUMBRICOIDES in the lungs causing—
• Dry cough.
• Chest pain.
• Dyspnoea.
• Fever.
------------- is called LOEFFLER’S SYNDROME.
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66. .
Ans—C
68. Following which is not scolicidal agent??
• A. hypertonic saline.
• B. ethanol
• C. 1% povidon iodine
• D. 10% povidon iodine
• E. hypotonic saline.
EXPLANATION--
Scolicidal agents are—
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67. • Hypertonic saline (15-20%).
• Ethanol (75-95%)
• 1% povidon iodine.
Ans—E
69.Following which is not the characteristic feature of HANSEN’S DISEASE?
• A. thickened tender peripheral nerves.
• B. patches of anaesthetic skin.
• C. claw hands
• D. foot drop
• E. mongoloid facies.
EXPLANATION--
LEPROSY—
• Typical leonine facies.
• Face has an aged look with collapse of nasal bridge & ocular
changes.
• Thickened peripheral nerves.
• Patches of anesthetic skin.
• Claw hand.
• Foot drop.
• Trophic ulcers.
Ans—E
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68. 70.In case of typhoid, carrier state may be present in ---
• A. caecum
• B. appendix.
• C. colon
• D. Terminal ileum.
• E. gall bladder.
EXPLANATION—
In typhoid , carrier state of SALMONELLA may be present in gall bladder for
14days.
• Ans--E
71. Most amoebic ulcers occur in—
• A. terminal ileum
• B. rectosigmoid junction
• C. caecum
• D. appendix
• E. gall bladder.
EXPLANATION—
Most amoebic ulcers occur in –Rectosigmoid junction.
In sigmoidoscope, there is—
• Shallow skip lesions.
• Flask shaped/ collar stud undermined edges.
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69. Ans—B
72.Hydatid cyst is caused by Eccinococcus granulosus which is treated by
PAIR therapy. which is not a component of pair?
• A. puncture
• B. aspiration
• C. injection
• D. re-exploration
• E. reaspiration..
EXPLANATION—
Component of PAIR THERAPY—
• PUNCTURE.
• ASPIRATION.
• INJECTION. (scolicidal agent).
• REASPIRATION.
Ans—D
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70. 73.Systemic inflammatory response syndrome doesn’t have following criteria?
• A. hypothermia
• B. Hyperthermia
• C. tachypnea
• D. leukocytosis
• E. bradycardia.
EXPLANATION--
SIRS is 2 of—
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71. • Hyperthermia (>38’c) or, Hypothermia (<36’c).
• Tachycardia (>90/min, no beta blocker) or, Tachypnea (>20/min).
• WBC count >12k or <4k.
Sepsis is SIRS with a documented infection
Ans--E
74.In histology hallmark of granulomatous diseases confirmed by—
• A. epitheloid cell
• B. fibroblast
• C. giant cell
• D. neutrophil
• E. lymphocyte.
EXPLANATION—
• Hallmark of granulomatous disease—Epitheloid cell.
• Cell responsible for wound contraction—Myoepithelial cell.
• Acute inflammatory cell- Neutrophil.
• Chronic inflammatory cell- Lymphocyte.
Ans--A
75.In response to trauma, which acute phase reactants will be lowered?
• A. fibrinogen
• B. albumin
• C. CRP
• D. TNF
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72. • E. ferritin.
EXPLANATION—
Negative acute phase reactants are-
• Albumin.
• Transferrin.
Ans—B
76.Tissue engineering is becoming popular topics day by day. From which
tissue we can produce osteoblast, chondrocyte, adipocyte , tenacytes &
myocytes?
• A. somatic cell
• B. stem cell
• C. mesenchymal cell
• D. embryonic stem cell
• E. none of them above.
Ans--C
77.Regarding benefits of laparospic surgery?
• A. better cosmesis.
• B. earlier return of normal physiological function
• C. more postoperative pain.
• D. shorter hospital stay
• E. earlier resumption of normal activity.
EXPLANATION—
Benefits of laparoscopic surgery—
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73. • Less postoperative pain.
• Better cosmesis.
• Earlier return of normal physiological function.
• Shorter hospital stay.
• Earlier resumption of normal activities.
Ans—C
78.Following which is not characteristic of ideal suture material?
• A. serile
• B. lack of secured knotting ability
• C. non-capillary
• D. predictable tensile strength
• E. minimal tissue reaction.
EXPLANATION—
Characteristics of ideal suture material—
• Easy to handle.
• Predictable behavior in tissues.
• Predictable tensile strength.
• Sterile.
• Glides through tissues easily.
• Secure knotting ability.
• Inexpensive.
• Minimal tissue reaction.
• Non-capillary.
• Non-allergic.
• Non-carcinogenic.
• Non-electrolytic.
• Non-shrinkage.
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74. Ans—B
79. Regarding wound healing by secondary intention—
• A. healthy granulation tissue
• B. overexuberant granulation tissue
• C. black eschar.
• D. skin grafting.
• E. infected sloughy wound.
EXPLANATION—
Primary intention—
• Clean wound.
Secondary wound—
• Healthy granulation tissue.
• Overexuberant granulation tissue.
• Infected sloughy wound.
• Black eschar.
Tertiary intention—
• Delayed closure.
• Skin grafting.
Ans—D
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75. 80. Following which suture material has memory?
• A. silk
• B. catgut
• C. polypropylene
• D. vicryl
• E. polyglactin.
EXPLANATION—
Polypropylene has memory.
Ans—C
81.Following which suture material is responsible for suture abscess?
• A. catgut
• B. PDS
• C. vicryl
• D. silk
• E. polyglactin.
EXPLANATION—
SILK is responsible for suture abscess.
Ans--d
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76. 81. Following which is the standard surgical knot?
• A. aberdeen knot
• B. reef knot
• C. surgeon’s knot
• D. granny knot
• E. slip knot.
Standard surgical knot is reef knot.
Ans—B
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77. 83.Followings are the alternative to sutures except—
• A. tissue glue
• B. skin adhesive strips
• C. clips
• D. square knot
• E. staples.
EXPLANATION—
Alternatives to sutures—
• Skin adhesive strips.
• Tissue glue ( n-butyl-2-cyanoacrylate monomer).
• Clips.
• Staples.
Ans--D
84.Regarding vascular anastomosis, which statement is not correct?
• A. non absorbable suture material should be used
. • B. a smooth intimal suture line is essential.
• C. double ended sutures make the procedure easier.
• D. knots require multiple throws in order to ensure security.
• E. suture must pass from outer to inner direction.
EXPLANATION—
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78. VASCULAR ANASTOMOSIS—
• Non absorbable monofilament suture material should be used. Ex-
polypropylene.
• A smooth intimal suture line is essential.
• Knots require multiple throws in order to ensure security.
• The suture must pass from within outwards on the downflow aspect
of the anastomosis.
Ans—E
85.During surgical wound closure of abdominal wound , a surgeon must keep
in mind that to have a tension free closure, the length of suture material should
be—
• A. equal to wound length
• B. two times of wound length
• C. two & half times of wound length
• D. three times of wound length
• E. four times of wound length.
EXPLANATION—
It has been estimated that, for abdominal wall closure, the length of the suture
material should be atleast 4 times the length of the wound to be closed to
minimize the risk of abdominal dehiscence or later incisional hernia.
Ans—E
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79. 86.Which of the following dangerous complication may arise during
monopolar diathermy in circumcision?
• A. electrocution.
• B. explosion
• C. burns
• D. channeling
• E. capacitance coupling
Ans--D
87. Which of the following is atraumatic forceps?
• A. alli’s tissue forceps.
• B. tooth forceps
• C. kochers forceps
• D. DeBakey’s forceps
• E. adson forceps
Ans—D
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80. 88.Entry point in natural orifice transluminal surgery —
• A. ear canal
• B. vagina
• C. umbilicus
• D. nipple
• E. retroperitoneum
Ans--B
89.A mother came to you with a boy of 6 weeks old, with the complaints of
projectile vomiting after feeds. There is visible peristalsis & olive like palpable
tumour found in right upper quadrant. What may be the possible diagnosis?
• A. oesophageal obstruction
• B. infantile hypertrophic pyloric stenosis.
• C. duodenal atresia
• D. sigmoid volvulus
• E. congenital megacolon.
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81. EXPLANATION—
INFANTILE HYPERTROPHIC PYLORIC STENOSIS—
• Most commonly affects boys aged 2-8weeks.
• Projectile vomiting after feeds.
• Testfeed or ultrasound to confirm the diagnosis.
• Gastric peristalsis can be seen & an olive felt.
• Hypochloremic metabolic alkalosis must be corrected before surgery.
• Pyloromyotomy splits the hypertrophied muscle leaving the mucosa
intact.
Ans—B
90.30 years old female came to you with abdominal pain and vomiting . You
advise for plain radiograph and there was air fluid level lies centrally with
complete valvular conniventes. What may be the diagnosis?
• A. small bowel obstruction
• B. large bowel obstruction
• C. sigmoid volvulus
• D. diverticulitis
• E. none of the above.
EXPLANATION—
XRAY FINDING OF SMALL BOWEL OBSTRUCTION—
• Multiple air fluid level lies centrally in a step-lader pattern.
• Valvulae conniventes seen in jejunum.
• Featureless ileum.
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82. Ans—A
91.Which of the following genes protect against neoplasm?
• A. sis
• B. ras
•C. p53
• d. myc
• E. APC
• Ans--C
92.You are working with a patient of shock having high cardiac output and
low venous pressure.what type of shock it is?
• A. hypovolumic
• B. cardiogenic
• C. obstructive
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83. • D. septic
• E. endocrine.
EXPLANATION—
Metabolic characters of septic shock--
• High cardiac output.
• Low vascular resistance.
• Low venous pressure.
• High mixed venous saturation.
• High base deficit.
Managed by noradrenaline.
Ans—D
93.Regarding undescended testis—
• A. a retractile testis reaches the base of the scrotum but retracts.
• B. an undescended testis may be palpable or impalpable.
• C. orchidopexy after 1 year of age improves fertility..
• D. ectopic testis lies outside the normal line of descend.
• E. impalpable undescended testis undergo a single stage orchidopexy.
EXPLANATION—
UNDESCENDED TESTIS—
• A retractile testis reaches the base of the scrotum but retracts.
• An undescended testis may be palpable or impalpable.
• An ectopic testis lie outside the normal line of descent.
• Palpable undescended testes undergo a single stage orchidopexy..
• Impalpable undescended testes undergo a single stage orchidopexy.
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84. • Orchidopexy before 1 year of age improves fertility & may reduce
the risk of malignancy.
Ans—C
94.Following which is not correct regarding infantile hypertrophic pyloric
stenosis?
• A. most commonly affects boys aged 2-8 weeks.
• B. projectile non bilious vomiting after feeds.
• C. gastric peristalsis can be seen as an olive shaped mass.
• D. hypochloraemic metabolic alkalosis must be corrected before surgery.
• E. USG can be done to confirm the diagnosis.
EXPLANATION--
INFANTILE HYPERTROPHIC PYLORIC STENOSIS—
• Most commonly affects boys aged 2-8weeks.
• Projectile vomiting after feeds.
• Testfeed or ultrasound to confirm the diagnosis.
• Gastric peristalsis can be seen & an olive felt.
• Hypochloremic metabolic alkalosis must be corrected before surgery.
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85. Pyloromyotomy splits the hypertrophied muscle leaving the mucosa intact.
Ans—B
95.Following which is performed in case of infantile hypertrophic pyloric
stenosis?
• A. heller’s cardiomyotomy
• B. ivor lewis procedure
• C. Remstedt’spyloromyotomy
• D. Hartmann procedure
• e. whipple procedure
Ans—C
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86. 96.Wound healing occurs through several stages .In the later period at about
12th week ,wounded skin gets maximum strength. How much it is?
• A. 70%
• B. 80%
• C. 90%
• D. 100%
• E. 60%.
EXPLANATION—
At about 12th
week, wounded skin gets maximum strength which is about
80%.
Ans--B
97.Liver trauma is the 2nd most common abdominal trauma. For liver trauma
patient which of the following blood product will be most appropriate?
• A. packed cell
• B. fresh frozen plasma
• C. platelet
• D. cryoprecipitate
• E. whole blood
For liver trauma patient, fresh frozen plasma will be most appropriate.
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87. ans--B
98.Following which is not the criteria of ASEPSIS wound score?
• A. antibiotics for wound infection
• B. purulent discharge
• C. erythema
• D. purulent exudate
• E. isolation of bacteria from the wound.
EXPLANATION--
Criteria of ASEPSIS SCORE—
• Additional treatment.
• Serous discharge.
• Erythema.
• Purulent exudates.
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88. • Separation of deep exudates.
• Isolation of bacteria.
Stay in hospital prolonged over 14days
Ans—B
99.Subdermal gangrene in the scrotum is called—
• A. Meleney’s synergistic gangrene
• B. Fournier’s gangrene
• C. Ormond’s disease
• D. Loeffler’s syndrome
• E. Lerich’s syndrome
Ans—B
100.Following which antibiotic is most sensitive against PSEUDOMONAS?
• A. penicillin
• B.ampicillin
• C. metronidazole
• D. flucloxacillin
• E. ticarcillin
• Ans—E
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