arise academy 75 questions discussion - 1 file download

ARISE Academy 50 Repeat Questions DiscussionDR. RAJAMAHENDRAN MS, MRCS, MCH

AUTHOR SURGERY SIXER

Section A : GENERAL

Question 1Correct position of inserting a Nasogastric Tube is

a. Supine with Neck flexed

b. Supine with Neck extended

c. Sitting with Neck flexed

d. Sitting with Neck Extended

Ans. C. Sitting with Neck flexed

Nasogastric tube

NEX and NEMU rules

Method to insert Ryles tube

Identification of Tip in Stomach

Question 2Which of the following is not scanned by e-FAST?

a. Pericardium

b. Liver

c. Bowel

d. Spleen

Ans. C. Bowel

FASTFocussed Assessment with Sonography for Trauma.

To assess presence of blood in peritoneum or pericardium.

Focuses on four areas only: Epigastric (pericardial), splenic, hepatic, pelvic

e-FASTTwo more places are also examined- Left and right thoracic cavities.

Helps to detect Pneumothorax and Collection in Thoracic cavity.

Question 3Prophylactic antibiotics to minimise the SSI are given

a. 60 minutes before skin incision

b. 1-3 hours before skin incision

c. At time of surgical incision

d. Night before surgery

Ans. a. 60 minutes before skin incision

Question 4Calculate the GCS of a patient exhibiting eye opening on painful stimulus, Conscious but confused and unable to tell time and exhibits flexion on painful noxious stimuli to the arm

a. 8

b. 9

c. 10

d. 11

Ans. C 10

Glassgow coma scale(EVM-456)

Question 5Amount of Blood lost in Class III Hemorrhagic Shock

a. 15-30%

b. 30-40%

c. 40- 45%

d. 45-50%

Ans. B 30-40%

Question 650 kg patient has 40% Burns on his body surface area. Calculate the Ringer lactate fluid to be given in 1st 8 hours.

a. 1 L

b. 2 L

c. 4 L

d. 8 L

Ans. C

PARKLAND FORMULA

Question 7Which of the following needle is used to suture skin?

a. Cutting needle

b. Reverse cutting needle

c. Round Body needle

d. Straight body needle

Ans. A

Question 8Which of the following is the best parameter to monitor the response to shock management?

a. Urine output

b. Respiratory rate

c. BP

d. CVP

Ans. a. urine output

Question 9 What is the investigation of choice in hemodynamically stable blunt injury abdomen patient?

a. USG

b. CECT abdomen

c. MRI

d. Diagnostic Peritoneal Lavage

Ans. B

Question 10 Identify the procedure shown here for providing nutrition

a. Feeding Jejunostomy

b. Percutaneous endoscopic gastrostomy

c. Central vein insertion

d. Hickman lines

Ans. B Percutaenous endoscopic gastrostomy

TechniquesDirect Stab

Push Through

Section B- Head and Neck, Thyroid and Breast

Question 11What is the location of Kilian’s dehiscence?

a. Below Superior Constrictor

b. Below Inferior Constrictor

c. Below Cricopharyngeal muscle

d. Below upper third of Smooth musces in esophagus

Ans. B Below Inferior Constrictor

Question 12Which procedure is done for Ranula Management?

a. Incision and drainage

b. Aspiration

c. Excision of Sublingual gland

d. Marsupialization

Ans. C. Excision of Sublingual gland

Question 13Which cancer in thyroid arises from Parafollicular C cells?

a. Anaplastic cancer

b. Medullary cancer

c. Follicular cancer

d. Papillary cancer

Ans. B. Medullary cancer

Question 14FNAC can diagnose all the following lesions except

a. Follicular cancer

b. Papillary cancer

c. Medullary cancer

d. Hashimotos thyroiditis

Ans. A

Question 15Warthin’s Tumor is seen arising from

a. Submandibular gland

b. Parotid gland

c. Sublingual gland

d. Minor salivary glands

Ans. B Parotid Gland

Warthin Tumor

Question 16Most common nerve injured in Thyroid Surgery

a. RLN

b. ELN

c. ILN

d. Vagus nerve

Ans. B. ELN

Course of Recurrent Laryngeal Nerve❑The nerve runs posteriorly and enters at the level of cricothyroid joint where the BERRY Ligament is attached.

❑Please remember Berry Ligament is the posterior attachment of Pretracheal fascia that binds Trachea and Thyroid ( One important reason for Gland moving with deglutition.

❑This is the point where nerve is at highest risk of injury**

❑This point is known as BEAHR’S Triangle

Beahr’s triangleBoundaries :

•Tracheo Oesophageal Groove

•Common Carotid artery

•Inferior Thyroid Artery

Question 17Stage the Breast cancer – Size 3cm and 4 axillary nodes in Axilla

a. Stage I

b. Stage II

c. Stage III

d. Stage IV

Ans. B Stage II

Question 18Which is correct regarding paeu de orange in breast cancer?

a. Infiltration of Cooper’s ligament

b. Infiltration of subdermal lymphatics

c. Associated with Lobular cancer

d. Good prognosis

Ans. B. Infiltration of Subdermal lymphatics

Question 19For Sentinel Node Biopsy in Breast cancer , where is the Dye injected ideally.

a. Subareolar

b. Axilla

c. Tail of Spence

d. Peritumoral

Ans. D Peritumoral

Question 20What is the diagnosis of this mammography picture shown here :

a. Fibroadenoma

b. Fibroadenosis

c. Cancer breast

d. Paget disease

Ans. A. Fibroadenoma

Section CGIT

Question 21Which of the following is not done in Cancer esophagus evaluation?

a. Biopsy

b. pH metry

c. CT Chest

d. PET Scan

Ans. B pH Metry

Identify this investigation

SURGERY SIXER BY RRM

SURGERY SIXER BY RRM

Rat tail appearance in ca esophagus

SURGERY SIXER BY RRM

Question 22Gastric outlet obstruction leads to

a. Hypochloremic metabolic alkalosis

b. Hypochloremic metabolic acidosis

c. Hypernatremic metabolic alkalosis

d. Hyponatremic metabolic acidosis

Ans. A. Hypochloremic Metabolic Alkalosis

Question 23Congenital Hypertrophic Pyloric stenosis presents at

a. 3 days

b. 4 weeks

c. 3 months

d. 4 years

Ans. B. 4 weeks

CHPS

Ramstaed’s Pyloromyotomy

Question 24Achalasia Cardia presents with all except

a. Increased LES tone

b. Normal Peristalsis

c. Proximal Dilatation

d. Malignant risk

Ans. B Normal Peristalsis

SURGERY SIXER BY RRM

Identify this investigation?

SURGERY SIXER BY RRM

Question 25Boerhaave syndrome is

a. Spontaneous rupture of esophagus

b. Traumatic rupture of esophagus

c. Tear at GE junction

d. Foreign Body esophagus

Ans. a. Spontaneous Rupture of esophagus

SURGERY SIXER BY RRM

Question 26What is the diagnosis of this Barium enema?

a. Diverticulum

b. Intussusception

c. Volvulus

d. Fistula

Ans. B Intussusception

Question 27A 26 year old male patient presented with RIF pain and Fever. USG image is shown below:

a. Acute diverticulitis

b. Crohns disease

c. Acute appendicitis

d. Perforation

Ans. C. Acute Appendicitis

Question 28Which is false about Crohn’s Disease?

a. No occurrence after surgery

b. Apthous ulcers

c. Skip lesions

d. Fistula formation

Ans. A No occurrence after surgery

Fistula

Cobble stoning

Serpiginous ulcers

Terminal Ileitis

Strictures

Question 29Best treatment for Anal Cancer Squamous cell cancer

a. Chemoradiation

b. Radiation only

c. Surgery

d. Chemo only

Ans. A Chemoradiation

Question 30Which is true about Carcinoid Tumor?

a. Always Benign

b. Kulchisky cells origin

c. Present with Paroxysmal hypertension

d. Punch biopsy is done

Ans. B. Kulchisky cell origin

Question 31Which of the following polyp is least likely to turn malignant?

a. Inflammatory polyp

b. Hamartomatous polyp

c. Hyperplastic polyp

d. FAP polyps

Ans.C Hyperplastic polyps

Question 32Most common location of Lymphoma in GIT?

a. Ileum

b. Stomach

c. Colon

d. Rectum

Ans. B Stomach

Question 33All are true about Femoral hernia except:

a. Common in Nulliparous women

b. Lockwood infrainguinal approach is done

c. Cough impulse is seen

d. High incidence of strangulation

Ans. A. Common in Nulliparous women

Obstructed Femoral hernia

Question 34The content of Littre’s hernia is

a. Omentum

b. Bladder

c. Meckel’s diverticulum

d. Appendix

Ans. C. Meckel’s Diverticulum

Question 35In Nyhus Classification Type 3A stands for which hernia?

a. Femoral

b. Direct

c. Pantaloon

d. Indirect

Ans. B Direct hernia

Section D HBP and Spleen

Question 36 MC immediate complication of splenectomy:

a. Fistula

b. Bleeding from Gastric mucosa

c. Pancreatitis

d. Hemorrhage

Ans. D. Hemorrhage

Question 37A 6 year old girl brought with high fever with rigors for 5 days with pain in right hypochondrium. On examination patient is anicteric and tenderness is noted in right upper quadrant. What is the best investigation in this case?

a. USG

b. Serology

c. SGOT/LFT

d. Contrast CT scan

Ans. D. Contrast CT scan

CT scan- Irregular margins

CT scan- Rim enhancementsmooth edges: Amoebic liver abscess

Question 38What is the name of the investigation shown here?

a. MRCP

b. ERCP

c. PTC

d. T tube cholangiogram

Ans. B ERCP

Question 39A patient with RUQ pain – USG done shows this image:

Diagnosis is

a. GB malignancy

b. GB stones

c. GB polyps

d. Porcelain GB

Ans. B GB Stones

Question 40Pringle’s manuever is used to control bleeding from

a. IVC

b. Cystic artery

c. Hepatic artery

d. Hepatic vein

Ans. C

Question 41Severity of Acute pancreatitis is assessed by

a. Serum Amylase

b. Stool Trypsin

c. RANSON score

d. ARDS development

Ans. C RANSON Score

Ranson’s ScoreOn Admission At 48 Hours

L- LDH > 350 Units/L B- Base deficit > 4 mmol/L

A- AST>250 Units/L U-Urea Nitrogen > 5mg/dl

G- Glucose>1.1mmol/L ( >200 mg/dl) C- Calcium < 2 mmol/L

A- Age > 55 years H- Hematocrit fall > 10%

W- WBC count > 16X10^9/L O- PaO2 < 60 mmHg ( 8 Kpa)

W- Water Fluid Sequestration >6 L

Question 42In case of Annular Pancreas, what is the surgery of Choice

a. Duodeno-duodenostomy

b. Duodeno-Jejunostomy

c. Pancreatico jejunostomy

d. Porto enterostomy

Ans. A. Duodeno Duodenostomy

Section E Specialty topics

Question 43Which of these is the best for management of a 3cm stone in renal pelvis without evidence of hydronephrosis?

a. ESWL

b. PCNL

c. Antegrade pyeloplasty

d. Retrograde pyeloplasty

Ans. PCNL

Surgery Sixer UNDER THE KNIFE 94

PCNL

Surgery Sixer UNDER THE KNIFE 95

Question 44A 40 year old man after TURP for BPH develops seizures in post operative state. What is the diagnosis?

a. Water intoxication

b. Anaesthetic Over dosage

c. Mismatched Blood Transfusion

d. Malignant Hyperthermia

Ans. a. water intoxication

Surgery Sixer UNDER THE KNIFE 97

Surgery Sixer UNDER THE KNIFE 99

Surgery Sixer UNDER THE KNIFE 100

Post op irrigationRemember that normal saline is used after the operation it is used for post operative irrigation

( but not for resection)

Surgery Sixer UNDER THE KNIFE 102

Question 45Bell Clapper testis predisposes to

a. Torsion

b. Varicocele

c. Cancer

d. Hydrocele

Ans. A torsion

Torsion testisPredisposing factors:

- Undescended testis

- Testicular Inversion

- Bell Clapper deformity ( MC anomaly) in which the tunica vaginalis is highly invested

Surgery Sixer UNDER THE KNIFE 104

Bell clapper

Surgery Sixer UNDER THE KNIFE 106

▫ In the 1st hour the torsion can be treated by

manipulation (but later on surgery has to be

done to fix the testis )

▫ If not correctable by manipulation or more

than one hour has passed then surgery has

to be done.

▫ Surgery must be done within 4 hours.

Otherwise the testis will be dead

Question 46Chordee is associated with

a. Hypospadias

b. Phimosis

c. Paraphimosis

d. Posterior urethral valve

Ans. a. Hypospadias

Hypospadias

Surgery Sixer UNDER THE KNIFE 108

Clinical features❑MC anomaly of Lower Urinary System

❑1 in 250

❑No treatment needed for Glandular type ( MC type)

❑Cryptorchidism may be associated- 8%

❑Indirect hernia may be associated

❑Best time to operate 6 months- 12 months

❑Circumcision is Contraindicated.

Question 47Most common complication of stripping varicose veins below knee is

a. Hemorrhage

b. Neuralgia

c. Thromboembolism

d. Infection

Ans. B Neuralgia

GSV stripping

Question 48All are true about Buerger’s disease except

a. Ulnar and peroneal vessels involved

b. Nerve involvement can occur

c. Superficial thrombophlebitis seen

d. Small acral vessels of limb involvement causes Hypohidrosis

Ans. D

Question 49What is xenograft?

a. Transplant from one relative to other

b. Transplant between identical twins

c. Transplant of tissues self

d. Transplant from one other species to human

Ans. D

Question 50Craniopharyngioma is a brain tumor arising from

a. Posterior Pituitary

b. Median eminence

c. Neurohypophysis

d. Rathke pouch

Ans. D

Thank you