Quiz

Question :1 Which of the following cancers rarely metastasize to the liver?

Colon Cancer
Breast cancer
Prostate cancer
Melanoma

Question :2 Primary indication for fine-needle aspiration of renal mass is which suspected clinical diagnosis

Renal cell carcinoma
Renal oncocytoma
Renal angiomyolipoma
Renal metastasis

Question :3 Medial displacement of both pelvic ureteral segments might result from:

Pelvic lipomatosis
Postabdominoperineal Surgery
Retroperitoneal fibrosis
All of the above

Question :4 Which Of the following is true regarding Poland's syndrome

Both breasts are typically involved
Men are more commonly affected
It classically presents with a sunken chest
It is due to an absence Of the chest wall muscles

Question :5 Which of the following is true regarding femoral hernias

Watchful waiting or surgical repair are both reasonable options to consider in otherwise healthy patients diagnosed with asymptomatic femoral hernia
Mesh plug repair is the pre erred approach in emergent cases
Rate of incarceration and strangulation is reported as greater than 40%
Men are more likely than women to experience this type of hernia

Question :6 Indications for percutaneous puncture of renal collecting system is

Antegrade pyelography
Nephrostomy catheter drainage
Dilatation of ureteral strictures
All of the above

Question :7 Transfusion of a unit of pRBCs into hemodynamically stable patient with hemoglobin 7.5 g/dL does which of the following

Increases systemic oxygen delivery (D02)
Increases tissue extraction Of oxygen
Increases systemic oxygen uptake (V02)
Increases arterial 02 saturation (Sa02)

Question :8 An asymptomatic patient is found to have serum calcium level of 13.5 mg/dL. Which of the following medications should be avoided?

Bisphosphonates
Thiazide diuretics
Mithramycin
Calcitonin

Question :9 A 46-year-old male is undergoing an anterior cervical disk fusion. Which of the following is correct with regard to the RLN

Left RLN loops around the subclavian artery and ascends medially into the neck
Right RLN loops around the inferior thyroid artery, ascends laterally to medially, and enters cricothyroid membrane
Right inferior laryngeal nerve is nonrecurrent in 0.5%—1% of patients
RLNs innervate the true vocal cords and cricothyroid muscles

Question :10 Which of the following is not a suitable wound bed for a skin graft

Muscle without overlying fascia
Muscle with overlying fascia
Tendon devoid of paratenon
Bowel with a layer of granulation tissue

Question :11 Which testicular cancer cell type is extremely radiosensitive (DNB SS 2015)

AEmbryonal carcinoma
Yolk sac tumor
Seminoma
Choriocarcinoma

Question :12 Level II cervical lymph node basin is subdivided into IIA and IIB by:

Spinal accessory nerve
Sternomastoid
Internal jugular vein
Posterior belly digastrics

Question :13 Most common type of gastric lymphoma is

GIST
Diffuse large B cell lymphoma
MALToma
Burkitt’s lymphoma

Question :14 Not considered as high grade tumour in carcinoma parotid (NEET SS 2018)

Malignant pleomorphic adenoma
Squamous cell carcinoma
Acinic cell carcinoma
Adenocarcinoma

Question :15 Stewart treves syndrome is

Epitheloid angiosarcoma
Radiation induced angiosarcoma
Angiosarcoma in the context of lymphoedema
Idiopathic angiosarcoma

Question :16 All the following genetic disorders are associated with Pancreatic Neuroendocrine tumors Except

MEN I
Von Hippel Lindau syndrome
Von Recklinghaussen syndrome
Heriditary pancreatitis

Question :17 Most common location of missed adenoma in patients undergoing reoperative parathyroid surgery is in

Thymus
Normal upper position
Normal lower position
Tracheoesophageal groove

Question :18 Ultrasound features of thyroid malignancy include all except

Microcalcification
Hyperechogenic
Intranodular vascularity
More taller than wide

Question :19 Which of the following is not true about testicular cancer

Most common solid malignancy in men age 15 to 35 years
Most men are diagnosed with an symptomatic enlarging mass
A major risk for the development of testicular cancer is cryptorchidism
Most neoplasms arise from the germ cells

Question :20 All are clinical grading for SAH except

Hunt & Hess
WFNS
Botterell
Modified Fischer

Question :21 "Ebb" and "flow" phase response to injury concept was given by

Cushing
Murphy
Maldwyn
David Cuthbertson

Question :22 In Scaphocephaly there is premature fusion of

Metopic suture
Sagittal suture
Coronal suture
Lambdoid suture

Question :23 Characteristic loss of long arm of chromosome 1 & short arm of chromosome 19 seen in

Glioblastoma Multiforme
Oligodendroglioma
Ganglioglioma
Neurocytoma

Question :24 Ulcerative colitis differs from Crohn’s disease by the following features

Rectum is always involved
Granuloma formation
Structures are more common
Associated with perianal lesions

Question :25 A boy of 10 yrs came with abdominal pain.Which of the following is true

He would be having multiple hamartomatous GI polyps
It is autosomal recessive syndrome
Genetic defect is on 18q & 10q (MADH4 & BMPR1A)
Likely diagnosis is Cowden syndrome

Question :26 Which of the following is largely restrictive & mildly malabsorptive

Roux-NY Gastric bypass
Vertical band gastroplasty
Duodenal switch
Laproscopic sleeve gastrectomy

Question :27 Which of the following is true regarding anorectal anatomy?

Levator ani marks the transition point between the rectum and sigmoid colon
Presacral fascia separates the rectum from presacral venous plexus and pelvic nerves
Waldeyer fascia is anterior to Denonvilliers fascia
In men, Denonvilliers fascia separates rectum from sacrum

Question :28 Which of the following cancers most commonly metastasizes to the thyroid

Parathyroid gland
Kidney
Lung
Breast

Question :29 A flexible endoscopic examination demonstrates an endoscopically unresectable mass or cancer is located at approximately 14 cm from anal verge and a biopsy is performed. Next best step to evaluate the lesion is

CT pelvis
Rigid proctoscopy
Serum CEA level
Hepatic function tests

Question :30 Which of the following is contraindication for negative-pressure wound therapy

Newly grafted skin
Wounds with a fistula
Diabetic wounds
Ischemic wounds

Question :31 A 62-year-old male with a history of diverticulitis presents with pneumaturia, urinary frequency and dysuria for several days. He is afebrile and hemodynamically stable. Urine culture grows multiple organisms. For this patient the definitive management consists of:

Total parenteral nutrition, bowel rest, and antibiotics
Colon resection with primary closure Of bladder
Colon resection and excision Of cuff Of bladder
Partial cystectomy

Question :32 A 75 year-old man has a 1 week history of left iliac fossa pain. He is feverish and generally unwell, and has vomited on several occasions. He has a history of diverticular disease. On examination he is pyrexial and tachycardic. Abdominal examination shows a tender mass in the left iliac fossa. Remainder of abdomen is nontender. What is the single most likely complication of diverticular disease to have occurred

Colonic structure
Diverticular haemorrhage
Pericolic abscess
Sigmoid perforation with generalized peritonitis

Question :33 A 25 year-old man has noticed a lump in his right testis. It is painless and his general health is good. He had a right orchidopexy for an undescended testis at age of 5 yrs. Examination shows a 3cm firm and irregular lump arising from right testis. What is the single most likely diagnosis

Acute epididymitis
Epididymal cyst
Hydrocele
Testicular tumour

Question :34 Polyhydramnios is frequently observed in all of the following conditions except:

Esophageal atresia
Duodenal atresia
Pyloric atresia
Hirschsprung's disease

Question :35 Neonates with NEC may demonstrate all of following findings on abdominal films Except:

Pneumatosis intestinalis
Portal vein air
Pneumoperitoneum
Colovesical fistula

Question :36 Bloody stools with ileus is seen in which stage of NEC

Stage 1
Stage 2
Stage 3a
Stage 3b

Question :37 True about Acral lentigenous melanoma are all except

Common on mucosal surfaces
Etiology is likely dependent on UV Exposure
Accounts for <5% melanoma
Has prolonged RGP

Question :38 Hemobilia is commonly associated with

Hepatic hemangioma
Hepatocellular carcinoma
Blunt injury of liver
Budd-Chiari syndrome

Question :39 Febrile transfusion reaction is due to

Anaphylactic reaction
Graft -versus- host response from leukocytes of transfused blood
It is a blood group antigen antibody reaction
None of the above

Question :40 Muscle viability judged by all except

Color
Bleeding pattern
Edema
Contractility

Question :41 Critical length of jejunum with jejunocolic anastomosis will always require long term TPN

<100 cm
<50 cm
<150 cm
<200 cm

Question :42 Most common site of damage in Endotracheal intubation is

Epiglottis
Subglottis
At cricoid cartilage
Trachea

Question :43 Operative management of a newborn with chest X-ray shown in figure is done

Immediately after birth
Within 24 hours
Within 72 hours
Within 2 to 4 days

Question :44 According to frankel classification which scale have no sensation at all

A
B
E
C

Question :45 Substitution urethroplasty has a success rate of

80%
60%
70%
90%

Question :46 False about Anal fissure is

Longitudinal split in anoderm of distal anal canal
Extends from the anal verge proximally towards, but not beyond dentate line
Location is usually Anterior midline
Anterior anal fissure is more common in women following vaginal delivery

Question :47 True regarding results of surgery of rectal cancer

Resectability rate for rectal cancer is less than 5%.
Operative mortality is as high as 95%
Overall, the 5-year survival rate is about 30%
Survival rates with node +ve patients doing worse than those with node -ve lesions

Question :48 Risk factors for perforation of the appendix is

Extremes of age
Diabetes mellitus
Pelvic appendix
All of the above

Question :49 All are indications for early surgical intervention in Acute intestinal obstruction except

Obstructed external hernia
Clinical features suspicious of intestinal strangulation
Obstruction in a ‘virgin’ abdomen
Obstruction in a ‘virgin’ abdomen

Question :50 Which of the following is true about Carcinoma colon

Carcinoma of the colon is most common in the 5th decade of life
Emergency presentation occurs in 80% of cases and is associated with worse prognosis
Those with 1st degree relatives who have developed CRC <45 years may be part of one of familial syndromes
Tumours of right side of colon usually present with change in bowel habits

Question :51 Which of the following is true about Small Bowel Lymphoma

Small bowel lymphoma more commonly primary lymphoma
Incidence of small bowel lymphoma is High in Crohn’s Disease and AIDS
Hodgkin’s lymphoma doesn’t affect the small bowel at all
T-cell lymphoma develops in patients with Crohn’s disease

Question :52 Which of the following are Pro inflammatory mediators except

IL-1
IL-4
IL-6
TNF Alpha

Question :53 Which of the following is not a limitation of minimal access surgery

Reliance on remote vision and operating
Best tactile feedback
Difficulty with haemostasis
Extraction of large specimens

Question :54 Oxygen carrying capacity of crystalloids and colloids is

100 percent
90 percent
50 percent
Zero percent

Question :55 Which of the following is true about Hayflick hypothesis

Normal cells are permitted to undergo infinite number of divisions
Abnormal cells are permitted to undergo only a finite number of divisions
Normal cells are permitted to undergo only a finite number of divisions
Abnormal cells are permitted to undergo infinite number of divisions

Question :56 Gastroenterologist is evaluating a 3-month-old patient with polysplenia for surgery. Which of the following anomalies is classically associated with this syndrome?

Choanal atresia
Necrotizing enterocolitis
Common atrioventricular canal
Bilateral trilobed lungs

Question :57 Most sensitive test for the diagnosis of biliary dyskinesia

Abdominal CT scan
ERCP
Cholecystokinin-Tc-HIDA scan
Abdominal US

Question :58 Normal amount of bile produced by the liver daily

500–1000 ml
1000–2000 ml
1000–1500 ml
200–400 ml

Question :59 Which of following medications is used postoperatively to prevent gallstone formation after bariatric surgery

Cholestyramine
Ursodiol
Octreotide
Simvastatin

Question :60 Small intestinal motility is characterized by which of the following?

A “pacemaker potential” that is responsible for initiating peristaltic contractions
Both peristaltic and segmental contractions
Mean transit time through the small intestine of 24 hrs
A migrating motor complex that facilitates digestion of consumed protein

Question :61 Which of the following has been shown to increase LES pressure?

Cholecystokinin
Ethanol
Estrogen
Motilin

Question :62 All are true about microscopic anatomy of liver EXCEPT:

Divided into concepts of hepatic lobule and hepatic acinus
Histopathology of liver is discussed on basis of lobular architecture
Space of Disse represent mononuclear phagocyte system
Canals of Hering connect bile canaliculi to bile ductules in periportal region

Question :63 A 30-year-old patient with H/O antibodies to HCV for 6 months duration and his AST/ALT is normal. There is no symptom or stigmata of liver disease. Most appropriate approach:

Reassure the patient
Repeat titre every 3 years
Repeat enzymes yearly
Do liver biopsy and start antiviral drugs accordingly

Question :64 Greatest predisposition to pancreatic cancer is associated with:

Peutz-Jeghers syndrome
Hereditary pancreatitis
Familial breast and ovarian cancers
HNPCC

Question :65 Most commonly seen mutation in Hereditary pancreatitis:

PRSS1
SPINK1
CFTR
All of the above

Question :66 Which of the following assesses the health care currently being provided against standard guideline

Clinical audit
Research proposal
Service evaluation
Project

Question :67 Non parametric test used to compare three/more independent groups of sampled data

Chi square test
F test
Kruskal Wallis test
McNemar test

Question :68 Which statement is true concerning the surgical anatomy of the pancreas?

The head lies over the first lumbar vertebra
The lesser duct enters the third part of the duodenum
The superior mesenteric vessels pass behind the uncinate process
SMA lies to the left of the SMV

Question :69 Entire colon of a patient was evaluated and 4 cm sessile polyp is noted in the distal descending colon. Subsequent biopsy is done which shows moderately differentiated adenocarcinoma with extension past the lamina propria. No other lesions are seen in colon. Which of following is next best step in management

Left colectomy
Repeat colonoscopy to determine if the lesion is amenable to endoscopic resection
CT/PET scan
CT scan

Question :70 A decision is made to take the patient to the operating room for a laparoscopic appendectomy. Regarding possibilities that may occur during the operation, which of the following is correct?

If the appendix appears normal, a diagnostic laparoscopy should be performed to look for other potential causes of the patient’s right lower quadrant pain. The appendix should not be removed in such cases
If subcentimeter mass identified at appendiceal tip, one should perform an ileocecectomy
If an enterotomy occurs during trocar placement, one should perform a bowel resection and not attempt primary repair
If one encounters a perforated appendix, leaving a drain has not been shown to reduce the rate of abscess formation

Question :71 Surgical management of the ileosigmoid fistula in crohn’s disease patient is best approached with which of following techniques?

En bloc resection of all inflamed tissue with proximal diversion
Debridement and primary closure of fistula site on sigmoid colon if there are no secondary signs of inflammation
Enterectomy, debridement of fistula tract, and segmental colectomy
Small bowel resection with primary anastomosis alone

Question :72 Preoperative staging reveals a 4 cm moderately differentiated adenocarcinoma T2N1M0 located at 9 cm from the anal verge.What is preferred treatment strategy

Pre-operative chemotherapy followed by chemoradiation therapy followed by full thickness transanal excision of the primary lesion
Low anterior resection o the rectum followed by chemotherapy or chemoradiation therapy based on pathologic evaluation o the resection specimen
Low anterior resection o the rectum followed by chemotherapy or chemoradiation therapy based on pathologic evaluation o the resection specimen
Chemoradiation followed by low anterior resection of the rectum

Question :73 Which of the following is a component of the pentalogy of Cantrell?

Coloboma
Gigantism
Ectopic cordis
Genital hypoplasia

Question :74 A 63-year-old woman is admitted to the hospital with a UGI bleed that subsides spontaneously within a short time after admission. A barium study shows a gastric ulceration that is described by the radiologist as having a “doughnut sign.” What is most likely diagnosis?

Lipoma
Gastric ulcer
Ectopic pancreas
GIST

Question :75 A patient has been diagnosed with achalasia. He refused surgery initially, preferring to try nonoperative therapy. He tried life style modification, calcium channel blockers, botulinum toxin injection, and endoscopic pneumatic dilatation. None of the treatments alleviated his symptoms. What are his surgical options?

Esophagectomy
Surgical esophagomyotomy proximal to the LES
Modified Heller myotomy and partial fundoplication
Repeat pneumatic dilation using pressures of loops

Question :76 Which statement is true regarding operative management in patients undergoing pancreaticoduodenectomy?

Pancreaticogastrostomy has lowered incidence of pancreatic leak than pancreaticojejunostomy
External drainage of pancreaticojejunostomy has decreased pancreatic leak rate
Octreotide has decreased incidence o clinically significant pancreatic leak rate
Internal drainage of pancreaticojejunostomy has decreased pancreatic fistula rate

Question :77 Orally administered glucose provokes a greater insulin response than an equivalent amount of intravenously administered glucose. Incremental response to ingested glucose is due to the effects of which of following hormones

Gastric inhibitory peptide
Somatostatin
Pancreatic polypeptide
Secretin

Question :78 Investigations of a 43-year-old woman with pluriglandular syndrome were scheduled to determine if a gastrinoma (ZES) was present. The serum gastrin level was slightly elevated. Further assessment to establish the diagnosis can be made by repeating the serum gastrin level after stimulation with which of the following?

Phosphate
Potassium
Calcium
Chloride

Question :79 A patient has compressive symptoms of the esophagus. He has a barium esophagram that shows posterior extrinsic compression of esophagus. Which of following is true?

Vascular rings are acquired atherosclerotic lesions
Both the trachea and esophagus can be affected by vascular rings
2 most common types of complete vascular rings- double aortic arch & left aortic arch
There is no role for Echo and Doppler

Question :80 A patient is diagnosed with Boerhaave’s syndrome. Best Management is

Administration of intravenous antibiotics and TPN
Administration of iv antibiotics,TPN and insertion of Chest and Nasogastric tubes
Administration of iv antibiotics and TPN, and insertion of a nasogastric tube
Resuscitation and emergency surgery either by laparotomy or thoracotomy

Question :81 Most common urological complication in Crohn’s disease

Ureteral obstruction
Glomerulonephrtitis
Nephrotic syndrome
Amyloidosis

Question :82 In remodeling phase all are true except

Type 3 replacing type 1
Realignment of fibres along lines of tension
Decreased vascularity
Wound contraction

Question :83 Not true about Compartment syndrome

Pain on passive flexion of affected muscle
Distal sensory disturbance
Absence of pulse distally
Can't occur with an open injury

Question :84 Complications of massive transfusion includes all except

Hypokalemia
Hyperkalemia
Hyponatremia
Hypocalcemia

Question :85 Regarding damage control resiscitation all are true except

Anticipate and treat traumatic coagulopathy
Permissive hypotension until hemorrhage control
Excess crystalloid and colloid infusion
DCS to control hemorrhage and physiology

Question :86 Jefferson fracture is

Fracture of atlas ring
Atlantoaxial fracture
Odontoid fracture
Occipito atlantal fracture

Question :87 Critical length of jejunum with diverting jejunostomy will always require long term TPN

<100 cm
<50 cm
<150 cm
<200 cm

Question :88 Snake like ulcer pattern may be seen in

Tuberculous colitis
Crohn’s disease
Ulcerative colitis
Amebic colitis

Question :89 Most common hormone produced by small intestinal neuroendocrine tumor is

Serotonin
Secretin
Peptide Y
Somatostatin

Question :90 What is the initial diagnostic test of choice after pancreas transplantation

Colour Doppler flow imaging
Ultrasound
Blood glucose level
Serum lipase level

Question :91 All are absolute contraindications for liver transplantation except

Cholangiocarcinoma
Too short survival after transplantation
Unacceptable postoperative quality of life
Active alcoholism

Question :92 Which of the following patients would most likely benefit from robotic-assisted versus laparoscopic surgery or colorectal cancer

75 year old admitted with a lower gastrointestinal bleed, ound to have a bleeding cecal tumor on colonoscopy
60-year-old man with a low rectal cancer Abutting prostate on EUS
64-year-old man with no significant medical history with a descending colon mass
55-year-old man admitted with obstipation with obstructing sigmoid tumor

Question :93 Which of the following is not true regarding Traumatic hernia

Hernias arise through anatomical defects caused by injury
Include incisional hernia
Hernias through abdominal stab wound sites
Hernias protruding through splits or tears in the abdominal muscles after blunt trauma

Question :94 Factors that favour development of diffuse peritonitis include all except

Speed of peritoneal contamination is a prime factor
Stimulation of peristalsis by the ingestion of food or even water hinders localisation
Virulence of infecting organism is great as to render localisation of infection difficult or impossible
Perforation distal to an obstruction is associated with severe generalised peritonitis and a high mortality rate

Question :95 True regarding 24 hr pH Monitoring is

Patterns of reflux cant be made out
Not useful in patients with atypical reflux symptoms
Total time when pH is <4 in a 24'hour period does not exceed 4% in a healthy adult
Intermittent measurement of pH is accepted as most accurate method for the diagnosis of GERD

Question :96 All are true about Arterial supply of stomach and duodenum except

On lesser curve, left gastric artery forms anastomosis with right gastric artery
Gastroduodenal artery passes behind 2nd part of the duodenum
Superior pancreaticoduodenal artery supplies the duodenum and pancreatic head
Right gastroepiploic artery runs along greater curvature of the stomach

Question :97 Conditions associated with severe and complex obesity include

Non-alcoholic fatty liver disease
Obstructive sleep apnoea
Gastro-oesophageal reflux disease
All of the above

Question :98 Which of the following match of conditions with common presentation is not true

Budd chiari syndrome-Ascites
Primary sclerosing cholangitis- Jaundice
Caroli disease- Jaundice
Polycystic liver disease- Hepatomegaly

Question :99 All are true about splenic artery aneurysm except

Twice as common in women
Usually multiple
May be consequence of intra-abdominal sepsis and pancreatic necrosis
They are more likely to be associated with arteriosclerosis in elderly patients

Question :100 All are true about Bile composition Except

Bile is produced by the liver and stored in the gallbladder
Composed of Bile salts in major quantity
Liver excretes bile at a rate estimated to be approximately 40 mL/hour
About 95% of bile salts are reabsorbed in the terminal ileum

Question :101 True about pancreatic fistula is

Usually follows operative trauma to gland/complication of acute or chronic pancreatitis
Management includes correction of metabolic and electrolyte disturbances and adequate drainage of the fistula
Investigate the cause of fistula before the fistula closure is done
All of the above

Question :102 A 69-year-old man is admitted to the emergency department with an acute UGI hemorrhage following a bout of repeated vomiting. Fiberoptic gastoscopy reveals three linear mucosal tears at the GE junction. What is the diagnosis?

Reflux esophagitis with ulceration
Barrett’s esophagus
Carcinoma of the esophagus
Mallory-Weiss tear

Question :103 A patient with achalasia is expressing significant concerns over cosmesis. Which developing minimally invasive technique is considered an acceptable alternative to multi-port laparoscopic Heller myotomy?

Per-oral endoscopic myotomy (POEM)
Single-port laparoscopic Heller myotomy
Hand-assisted laparoscopic Heller myotomy
Transvaginal NOTES myotomy

Question :104 Ideal candidate for bariatric surgery is

A 50-year-old female with a BMI of 37 with no comorbidities
A 34-year-old male with history of GERD and BMI of 34
A 19-year-old female with a history of type 1 diabetes, and a BMI of 32
A 48-year-old male with a history of hypertension, type 2 diabetes, and a BMI of 42

Question :105 Contraindications to liver surgery for metastatic tumor resection include

Resection that would remove 5 hepatic segments
Bilobar liver involvement
Tumor involving common hepatic artery
4 cm liver lesion

Question :106 A 1-month-old infant is brought to the physician by her parents. She has had repeated bouts of bilious vomiting over the past month and cant be fed adequately. She is in the 10th percentile for weight and the 50th percentile for length. An upper GI series discloses marked narrowing of the midportion of the duodenum. What is the most likely cause of this infant’s GI obstruction

Annular pancreas
Duodenal polyp
Islet cell adenoma
Pancreatic pseudocyst

Question :107 Which of following is poor prognostic factor for colorectal malignancy with liver metastasis except

Metachronous metastasis
Lymph node involvement
>5cm lesion
Synchronous metastasis

Question :108 Which of the following is a complication of Caroli’s disease

Renal disorders
Recurrent cholecystitis
Nephrospongiosis
Cholangiocarcinoma

Question :109 A 40-year-old female alcoholic is suspected of having hepatic mass.Percutaneous ultrasound guided liver biopsy is contraindicated in which of following

Hepatocellular carcinoma
Metastatic carcinoma
Cirrhosis
Hepatic adenoma

Question :110 Origin of the parasympathetic innervation of the left colon is

T6-T12
L1-L3
Vagus nerve
S2-S4

Question :111 Most common early complication of a Roux-en-Y gastric bypass is

Wound dehiscence
Pulmonary embolism
Anastomotic stricture
Small bowel obstruction due to internal hernia

Question :112 A 19-year-old woman presents to clinic with complaints of intermittent episodes of acute knife-like midepigastric and left upper quadrant abdominal pain, nausea, and vomiting that have persisted over the last year. She also reports early satiety and progressive weight loss as well as the sensation of a heavy abdominal mass that is especially noticeable when she is supine. She denies any history of abdominal trauma, travel outside of North America, medication use, or any other significant medical history. Except for a palpable spleen, her physical examination is unremarkable. A CT abdomen is obtained. Following is most likely to be elevated:

CA 19-9
EBV IgM titer
p53
lipase

Question :113 All of the following statements about microscopic anatomy of stomach are true except:

The endocrine G cells are located in greatest quantity in the antral glands
In the cardia of stomach, the mucosa is arranged in branched glands and the pits are short
Gastric glands are more tubular and the pits are longer in fundus and corpus of stomach
Glands in the antrum of the stomach are less branched and have abundance of parietal cells

Question :114 All of the following statements are true about post gastrectomy syndromes except:

Basic defect of late dumping syndrome is rapid gastric emptying and it is related specifically to carbohydrates being delivered rapidly into the proximal intestine
Megaloblastic anemia from vitamin B12 deficiency only rarely develops after partial gastrectomy and is independent of the amount of stomach removed
Bilious vomiting offers an immediate relief of symptoms in case of afferent loop syndrome
More than 50% of the cases of efferent loop obstruction post gastroenterostomy occur within first postoperative month

Question :115 All of the following statements about small bowel immunology are true except:

Peyer’s patches are unencapsulated lymphoid nodules that constitute an afferent limb of the gut associated lymphoid tissue
M cells are contained within the follicle associated epithelium that aid in antigen recognition and are targeted by pathogens like Salmonella and Shigella for invasion
.B lymphocytes become surface IgG bearing lymphoblasts which serve a critical role in mucosal immunity
Most of the intraepithelial lymphocytes are found to be T cell type

Question :116 Which of the following manometric findings indicates dysfunction of internal sphincter

Resting pressure 20 mmHg
Squeeze pressure 60 mmHg
Presence of Recto anal inhibitory reflex
High pressure zone 3 cm

Question :117 Not a component of the PIRO staging system for sepsis:

Pre-existing medical conditions
Type of infecting organism
Composite score of number of failing organs
Type of antibiotic given previously in the management

Question :118 Not a component of Chinese university prognostic index scoring system for HCC:

Serum bilirubin
TNM stage
Serum albumin
Serum ALP

Question :119 A 45 year old male presented with progressive jaundice over the past 3 months with weight loss and passage of clay colored stools. CECT abdomen showed the following. Structures marked by the arrow clockwise from the right to left are:

Mass from head of the pancreas, portal vein, splenic vein
Dilated CBD, periampullary mass, dilated pancreatic duct
Mass from periampullary region, portal vein, splenic vein
Mass from periampullary region, splenic vein, pancreatic duct

Question :120 A 60 year old lady with vague abdominal complaints associated with painless enlargement of abdomen for the past 3 mths presented with the following picture on CECT scan .Which of the following statements about the condition is true

Condition develops with equal frequency in males and females
Patient will be best managed by placement of bilateral intraperitoneal drains
Positive history of analgesic abuse would be expected in the patient
Patient should undergo immediate laparotomy with faecal diversion

Question :121 Not a component of the Truelove and Witt’s classification:

Number of bloody stools per day
Hemoglobin levels
Erythrocyte sedimentation rate
Malaise

Question :122 True statement regarding the embryology of pancreas all except:

Pluripotent pancreatic epithelial stem cell give rise to only exocrine cell lines
Dorsal and ventral pancreatic buds arise from primitive duodenal endoderm
Dorsal bud appears first and develops into superior head, neck, body and tail
Ventral bud arise from hepatic diverticulum

Question :123 Assessment of severity in Acute Pancreatitis, all true except:

Ransons – 11 parameters and different for gallstone pancreatitis
APACHE II score of 8 or higher defines severe pancreatitis
Severe pancreatits – any e/o organ failure or local pancreatic complication
CRP and lipase correlates with severity

Question :124 False regarding Hartman’s Pouch is

Congenital outpouching of infundibulum
Acquired diverticulum
Indicates prolonged gallbladder outflow obstruction
May lead to inflammation and perforation

Question :125 Which of the following statements about Wilms’ tumour is false

It is a tumour of embryonic nephrogenic tissue occurring below the age of 5 years
Haematuria and fever are the commonest presentations
Lymphatic spread is rare
Imaging modalities are US, CT and MRI

Question :126 A 60-year-old man complains of haematuria associated with pain in his left loin radiating to the lower abdomen. He passes clots which are ‘worm-like’. On examination he has an enlarged left kidney, and scrotal examination reveals a varicocele which he finds uncomfortable.

Renal stone
Hypernephroma
Congenital (idiopathic) hydronephrosis
Pyonephrosis

Question :127 Which of the following is not true of bladder cancer

95% of primary bladder cancers are transitional cell carcinomas
Painful haematuria is the most significant symptom
Depth of invasion (T) in TNM classification and grade (WHO classification I, II, III) are important factors in planning treatment
In a quarter of new patients, the muscle is invaded

Question :128 A 35-year-old male complains of deformity of his penis during erection. He has increasing difficulty in sexual intercourse. In the past he had urethritis, which was treated successfully with antibiotics.

Balanoposthitis
Peyronie’s disease
Persistent priapism
Chordee

Question :129 Primitive streak remnant gives rise to

Neuroblastoma
Wilm's tumor
Sacrococcygeal teratoma
Hepatoblastoma

Question :130 Cushing's reflex is

Increase mean arterial pressure with increased intracranial pressure
Increase mean arterial pressure with decreased intracranial pressure
Decrease mean arterial pressure with increased intracranial pressure
Decrease mean arterial pressure with decreased intracranial pressure

Question :131 All of the following are risk for Pancreatic adenocarcinoma except

Tobacco
Alcohol
Type 2 DM
Obesity

Question :132 Most common organism causing biliary infections is

Staphylococci
E.coli
Pseudomonas
Bacteroides

Question :133 Which of the following is true regarding liver transplantation

Usual preferred approach is heterotopic transplantation
ABO compatibility & HLA matching are essential
The commonest indication in children is biliary atresia
All the above are true

Question :134 According to WHO classification of hydatid cyst, USG finding in CE2 is

Multivesicular cyst wall,rosette like
Detached laminated membrane, water lily sign, decreased intracystic pressure
Cyst wall, hydatid sand
Heterogenous hypoechoic/ hyperechogenic degenerative contents, no daughter cysts

Question :135 True about Lymphatic metastases include all Except

Predominantly occurs in upward direction
In field of middle rectal artery primary lateral spread to pelvic wall occurs
Metastasis at higher level than main trunk of superior rectal artery occurs late
Predominantly occurs in Downward direction

Question :136 Complete surgical excision is possible in _____ percentage of Bile duct cancer patients

1-10%
10-20%
20-30%
30-40%

Question :137 All are true about Necrotising sialometaplasia Except

Typically it occurs in the palate and mimics an aggressive cancer
Presents as a deep punched out ulcer with an indurated margin
Cant be distinguished from a neoplastic lesion by biopsy
Resolves spontaniously with symptomatic treatment

Question :138 True among following statements regarding Degenerative disorders of salivary gland is

Primary Sjogren syndrome is assocated with Connective tissue disorder
Secondary sjogren syndrome is associated with widespread exocrine dysfunction
20% of benign lymphoepithelial lesion patients develop Lymphoma
Xerostomia is more severe in Secondary sjogren’s syndrome

Question :139 All are True about metabolic poisoning in burns except

Most common cause is carbon monoxide
Carbon monoxide binds to haemoglobin with an affinity 240 times greater than that of oxygen
Concentrations above 10% are dangerous & need treatment with pure oxygen for >24 hours
Carbon monoxide causes metabolic acidosis by interfering with mitochondrial respiration

Question :140 Investigation of choice for swallowing dysfunction is

Barium swallow
Endoscopy
Videofluoroscopy
X ray lateral view neck

Question :141 True about behavior of cystic hygromas include all Except

Cyst may expands rapidly
May not require immediate aspiration
Definitive treatment involving complete excision of cyst
Most common site is neck

Question :142 Hemifacial atrophy of the skin soft tissue and bone is seen in

Parry Romberg diaease
Klippel trenaunay syndrome
Parkes Weber syndrome
Proteus syndrome

Question :143 All are true about Lithium induced hyperparathyroidism except

Mild elevation in calcium with failure to suppress PTH
Interference with Parathyroid kinase C & Wnt pathway
Resolve with discontinuation of Lithium
Minimally invasive surgery is done in majority of cases

Question :144 Which of the following sutures is the first to close

Sagittal
Metopic
Coronal
Lambdoid

Question :145 Facial nerve courses in which fascial layer within the temporal region

Superficial temporal fascia
Superficial layer of deep temporal fascia
Temporal fat pad
Deep layer of deep temporal fascia

Question :146 A 58-year-old woman underwent left superficial parotidectomy for a pleomorphic adenoma 2 years ago. She presents with complaints of occasional perspiration and redness of left cheek and ear after eating. Which nerves is most likely source

Great auricular
Frontal branch of the facial nerve
Auriculotemporal
Lingual

Question :147 A patient is admitted to the hospital after ingesting lye. The following day he complains of chest pain. His pulse is 120 bpm. On physical examination he is found to have subcutaneous crepitus on palpation. His chest x-ray shows widening of mediastinum and a pleural effusion. What has occurred?

Aortic rupture
Coagulation necrosis
Esophageal perforation
Oropharyngeal inflammation

Question :148 Which of the following is TRUE of invasive lobular carcinoma of the breast

It is harder to detect metastasis on intraoperative frozen section analysis of sentinel nodes
Lobular cancers are typically hormone receptor negative
Breast conservation therapy is contraindicated
Invasive lobular cancers typically appear on mammogram and ultrasound as a discrete mass

Question :149 Which of the following ECG findings is not associated with hyperkalemia

Peaked T waves
Prolonged PR interval
Loss of the P wave
Narrowing of QRS complex

Question :150 Which is not placed in high risk category for surgery

Urgent body cavity
Major vascular surgery
Open aortic surgery
Breast surgery

Question :151 Persistent erection lasting than _ hours considered as Priapism

2
4
6
8

Question :152 Acute phase of peyronies disease lasts

1-2 yr
2-3yr
3-4yr
6 months- 1 yr

Question :153 Mafenide Acetate cream (5%) in burns dressing -

Painful to apply
Associated with metabolic acidosis
Needs to be changed every 2 hourly
Both A and B

Question :154 Fertility rate of intracytoplasmic sperm injection is

20%
30%
40%
50%

Question :155 Length to breadth ratio in random flap is (NEET SS PATTERN 2017)

1.5:1
2:1
3:1
1:3

Question :156 No of negative semen analysis need to conclude after vasectomy as effective method

2
3
4
5

Question :157 Supermicrosugery involves ananstomosis of vessel what size except

0.2-0.4mm
0.4-0.6mm
0.6-0.8mm
>1mm

Question :158 Which of the following not correct for thick split skin graft

Heals with less contracture n more durable
Donor site healing is difficult
Require less care than thin slip skin
More brisk punctate bleeding at donor site

Question :159 Bipedicle flap used for reconstruction of

Nose
Upper eyelid
Lower eyelid
Forehead

Question :160 For Local Random flap , flap raised at what level

Sub dermal
Sub cutaneous
Sub fascial
Prefascial

Question :161 Struvite stones caused by all except

Staphylococcus
Proteus
Pseudomonas
Pseudomonas

Question :162 In Torso trauma patient with hemodynamically unstable or spine at risk - what is initial investigation of choice

USG
AP supine Chest X ray
Chest X ray Erect
MRI

Question :163 SONDE endoscopy used for

Esophagus
Stomach
Small bowel
Small bowel

Question :164 What is the investigation used to differentiate between contussion & actual presence of blood in torso trauma patient

Chest X ray
USG
CT
MRI

Question :165 Radiation dose of CT KUB

2-3MSv
3-5
5-7
7-10

Question :166 Leibovich prognostic score is associated with

Renal cancer
Bladder cancer
Penile cancer
Prostate cancer

Question :167 Percentage of DVT with bilateral involvement is

10%
20%
30%
40%

Question :168 Ability of cancer cells to establish an autonomous lineage is mediated by:

Epithelial Mesenchymal transition
Epigenetic modification
Oncogenes
Tumor suppressor genes

Question :169 Chance of testicular pain in short term after vasectomy is

0%
5%
10%
20%

Question :170 A 82-year-old female presented with history of loss of vision in right eye for about 15 minutes and it cleared up. She has a history of diabetes and hypertension. She had which showed old infarct on right side. Carotid duplex showed that patient had 99% carotid artery stenosis. Which one of the following statements is true

60% chance that extra cranial carotid artery stenosis is the cause of transient ischemic attack
It is always due to platelet emboli
25% may be intracranial bleed
0.5 to 10% may have cardiac and other causes of TIA

Question :171 A 19-year-old man is brought into the emergency department with a gunshot wound that occurred 4 hours before admission. At exploratory laparotomy, an injury is noted in transverse colon with extensive tissue destruction. There is a large amount fecal contamination. Management of this injury should include which of the following?

Debridement and closure of wound with a proximal colostomy
Resection with proximal colostomy and distal mucous fistula
Resection of the injured colon with primary anastomosis and proximal colostomy
Resection of the wound with primary anastomosis and proximal cecostomy

Question :172 Which structure would be encountered during repair of an inguinal hernia in a male

Spermatic cord, cremaster muscle, transversalis fascia, deep epigastric vessels, conjoined tendon
Round ligament, transversalis fascia, deep epigastric vessels, conjoined tendon
Obturator nerve, cremaster muscle, transversalis fascia, deep epigastric vessels
Symphysis pubis, transversalis fascia, deep epigastric vessels, conjoined tendon

Question :173 Following admission to the emergency department, a 26-year-old woman with severe menorrhagia states that both her father and sister have a bleeding disorder. Hemostatic disorder transmitted by autosomal-dominant mode is which of the following?

Factor X deficiency
Von Willebrand’s disease
Factor VIII deficiency
Factor IX deficiency

Question :174 A 45-year-old soccer player presents with a 6-month history of an ulcerative nodular lesion,1.5 cm in diameter in the region of the right oral comunissure. Biospy reveals basal cell carcinoma. Preferred treatment is:

Mohs micrographic surgery and subsequent reconstruction
Excision with a clinical margin and local flap repair
Topical 5-FU
Local radiation therapy

Question :175 A 45-year-old premenopausal woman undergoes a left breast lumpectomy for a 1.5-cm, lymph node positive, hormone sensitive invasive breast cancer. She receives chemotherapy, radiotherapy, and is on tamoxifen. Recommended follow-up after therapy should always include:

Blood tumor markers drawn every 3–6 months after treatment
Routine monitoring of liver function tests every 3–6 months after treatment
Yearly bone scans
Routine clinical examination every 3–6 months for the first 5 years after treatment as well as continued yearly mammography

Question :176 All are warning signs of soft tissue tumors except

>5 cm
Painful
Superficial to fascia
Recurrence after previous excision

Question :177 What percentage of fibroids transform into malignancy

<1%
1%
5%
10%

Question :178 Most consistent feature of cancer is

Self renewal
Lack of consistency
Antiapoptotic
Angiogeneic

Question :179 A 54-year-old manager of a bank is noted to have solitary 1.5-cm nodule on a routine chest x ray. He is asymptomatic. Most suggestive feature of malignancy would be the finding of which of the following

A lesion in the lingula lobe
Central calcification
A laminated calcium pattern
Indistinct margins

Question :180 A 58-year-old man is in cardiogenic shock in emergency department after sustaining an acute myocardial infarction (MI). An intraaortic balloon pump (IABP) is inserted. Which statement is TRUE about IABP?

The balloon increases coronary perfusion during diastole
The balloon increases coronary perfusion during systole
The balloon increases peripheral resistance
The balloon is inflated in systole and diastole

Question :181 A 52-year-old painter injured his lower back 3 weeks ago when he fell off a ladder. He presents for evaluation of abnormal findings on plain radiographs of his lumbar spine.His pain has subsided, and he is now asymptomatic. Physical examination reveals a dense tuft of hair in his lumbosacral region that has been present for as long as he can remember. There is no tenderness or palpable abnormality in his spine. Findings on his neurologic examination are unremarkable. The radiographs mentioned show absence of the spinous processes and laminae at the levels of L5 and S1, with their corresponding pedicle displaced and angled laterally. What is the diagnosis?

An L5–S1 spondylolisthesis
A burst fracture of L5 and S1
Spina bifida
Spinal stenosis

Question :182 A 1-month-old infant presents to your office with an umbilical hernia. It is reducible but prolapses again almost immediately. It is true that this defect

Is present in all children at birth
Will not close spontaneously
Should be repaired if still present at 3 months of age
Should be repaired at this time if it is >1 cm in diameter

Question :183 A 78-year-old woman develops a liver abscess following stent drainage of jaundice. What is preferred Therapy

Oral administration of antibiotics
Aspiration of abscess
CT-guided percutaneous drainage alone
Administration of antibiotics and CT-guided percutaneous drainage

Question :184 A 28-year-old woman has new onset hypertension and a bruit on abdominal examination. An arteriogram shows fibromuscular dysplasia of the right renal artery. What is best treatment

Aortorenal saphenous vein bypass
Patch angioplasty of the renal artery
Percutaneous transluminal angioplasty
Transaortic renal endarterectomy

Question :185 Risk factors for development of soft tissue sarcoma include all of the following except:

Retinoblastoma
Li-Fraumeni syndrome
von Hippel-Lindau syndrome
Lymphedema

Question :186 A 61-year-old man With T3N2cMO SCC supraglottic larynx total with left radical neck dissection/right modified radical neck dissection and primary pharyngeal closure without any intraoperative complications. Tube feeding is Started on postoperative day 2. On day 3 patient is noted to have high output Of yellow/cloudy fluid from the left neck drain recorded to be 400 ml over past 24 hours.Hemoglobin concentration and white blood cell Stable. Patient is afebrile with no signs of infection at surgical Site. What is next most appropriate step

Immediate reexploration and Closure of fistula
Thoracotomy with clamping Of the thoracic duct
Closed wound drainage, pressure dressings and feeding consisting of medium-chain triglycerides
Continuation of the current postop management

Question :187 Which of the following is false about resuscitation in trauma

All patients should receive high-flow oxygen
Hypotension is to be avoided
All hospitals managing severe trauma should have a massive transfusion protocol
Tranexamic acid should be given to all trauma patients suspected to have significant hemorrhage

Question :188 Coarctation of aorta commonly occurs in

Proximal ascending aorta
Distal ascending aorta
Proximal to ductus arteriosus
Distal to the left subclavian artery

Question :189 Alcohol risk factor for all except

Head and neck cancer
Gastric cancer
Oesophageal cancer
Hepatoma

Question :190 Patient on anticoagulant undergoing endoscopy for diagnosis and therapy should have INR less than ___________ to avoid risk of significant bleeding

1.3
2
1.5
2.5

Question :191 Investigation of choice for ureteropelvic junction obstruction is

DTPA
MAG 3
IVU
MRI

Question :192 Which of following is not responsible for pyrexia (NEET SS PATTERN 2018)

IL1
TNF alpha
IL 4
IL 8

Question :193 Optimal timing for CT in acute pancreatitis is

6hr
6-12 hrs
24-48 hrs
48 to 72 hrs

Question :194 How much CSF should be drained for relieving Communicating Hydrocephalus

2-10 ml
10-30 ml
30-40 ml
40-50 ml

Question :195 Triad of Normal pressure Hydrocephalus include all except

Headache
Gait disturbance
Incontinence
Cognitive decline

Question :196 Strength of association between smoking and cancer is measured using

Population attributable fraction
Population attributable risk
Attributable risk
Cumulative incidence rate

Question :197 Which of the following statements regarding pancreatic anatomy is true?

Majority of the pancreas is drained through major papilla by duct of Santorini
Minor papilla communicates with the small duct of Wirsung, draining the inferior head and uncinate process
Nervous innervation of the pancreas arises in the superior mesenteric ganglion
Arterial supply is from branches of the celiac axis and superior mesenteric artery

Question :198 Technical considerations of corrective surgery for Hirschprung’s disease include:

Taking multiple biopsies to determine exactly when the first few ganglion cells are seen, in order to resect as little colon as possible
Resection from the level of the dentate line to the ganglionated intestine
Routinely performing a protective colostomy or ileostomy
A tension free anastomosis

Question :199 When comparing male and female breast cancers breast cancer in men is

More likely to be DCIS than in women
Less likely to be HER2 +ve
Less likely to be estrogen receptor +ve
Less likely to require mastectomy

Question :200 Early onset breast cancer, sarcomas, leukemia & brain, adrenocortical tumors would be consistent with

Cowden disease
Li fraumeni syndrome
Peutz jeghers syndrome
Ataxia telengiectasia