arise academy 75 questions discussion - 1 file download
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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