Q1. Safe dosage limit for local anesthetic are: a. b. c. d.
Lignocaine 40ml of 2% bupivacaine 40 ml of 1% Ropivacaine 40 ml of 1% Prilocaine 40 ml of 1%.
Key: D Safe doses of local anesthetic for an adult are lognocaine 400 mg, bupivaciane 150 mg, ropivacaine 225 mg, and prilocaine 400 mg. th
Reference: chapter 14 anaesthesia and pain relieve 25 edition bailey and love short Practice of Surgery page no 194-208 . Q2. Mrs. A 40 years requires cholecystectomy. Preanesthetic is unremarkable except history of intake of diuretics for hypertension and regular use of oral contraceptives. The LEAST useful step of periopertive anesthetic management is: a. b. c. d.
TLC estimation Serum potassium estimation Use of perioperative HEPARIN Continued use of antihypertensive on the morning of SURGERY.
Key: A A TLC has very little value in this situation, although it is usually ordered as part of routine blood testing. Diuretics may alter serum sodium and potassium, affecting anesthesia. Some patients, e.g., those on oral contraceptives, those who are obese, and those undergoing hip or knee surgery, benefit from periopoerative heparinization to prevent DVT and PE. A patient on antihypertensive should continue the medication on the morning of surgery. Reference:chapter 13,preoperative preparation.25 Surgery page no 183-193.
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Q3. In hemophilia A the levels of factor VIII may be very low. Which are the lowest levels recorded in living patients? a. b. c. d.
Less than 80% of normal. Less than 30% of normal. Less than 10% of normal. Less than 1% of normal.
Key: D Hemophiliacs may survive with very low factors VIII levels. Before surgery, patients should receive factor VIII in the form of cryoprecipitate (or, better, factor VIII concentrate). Ideal factor VIII levels before surgery are 100% of normal. However, minor surgery is possible even at 30% levels. Reference: chapter 13,preoperative preparation.25 Surgery page no 183-193.
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Q4. A 60 year-old, 60 kilo male is admitted with cholangitis. His stool is normal, and urine output is 1250ml daily. If oral intake is poor, how much I/v fluid is suitable for him in one day? a. b. c. d.
1200 ml. 1000-2000 ml. 3000-3500 ml. 4500-5000 ml.
Key: C At a urine loss of 1200, and estimated insensible losses of at least 1 liter (patients with cholangitis have fever), and fecal loses of about 2500 ml, his minimum requirements is 2500 ml. In jaundiced patients it is better to overestimate the fluid need, rather than to underestimate it. th
Reference:chapter 17 nutrition and fluid 25 edition Bailey and Love short Practice of Surgery short Practice of Surgery page no 223-232. Q5. The protein value of food is often expressed as nitrogen. Approximately how much nitrogen is present in 100 G protein? a. b. c. d.
5-10 G 15-20 G 25-30 G 35-40 G
Key: B For most proteins, 6.25 G proteins contain 1 G nitrogen. th
Reference:chapter 17 nutrition and fluid 25 edition Bailey and Love short Practice of Surgery page no 223-232. Q6. In severe sepsis and injury, the hormonal changes create all of the following effects, EXCEPT: a. b. c. d.
Anabolism. Lipid mobilization. Utilization of amino acids for energy. Increased metabolic rate.
Key: A Injury and sepsis result in the release of cytokines that mediate a marked catabolic effect. The most important of these cytokines are TNF alpha and interleukin 6. The levels of insulin, the anabolic hormone, are low. th
Reference:chapter 1 the metabolic response to injury 25 edition Bailey and Love short Practice of Surgery page no 1-12.
Q7. Nutritional impairment is said to be present when the BMI is below: a. b. c. d.
75 42 30.5 18
Key: D BMI is weight (kg)/height (m)2. Ideal BMI is 22.5, the accepted range being 20-25. A BMI below 18.5 indicates malnutrition, and a BMI below 15 has particularly poor prognosis. The other methods of nutritional assessment include triceps skin-fold thickness, mid-arm circumference, hand-grip strength and serum protein levels, particularly albumin. Urinary creatinine excretion is related to muscle mass. th
Reference chapter 1 the metabolic response to injury 25 edition Bailey and Love short Practice of Surgery page no 1-12.
Q8. Most tissues heal by repair and scarring: which of the following tissues is best able to grow: a. b. c. d.
Renal parenchyma Pancreatic parenchyma. Liver parenchyma. Lung parenchyma.
Key: C. Liver and epithelium can regrow. th
Reference:chapter 3 wound,tissue repair and scar,25 edition Bailey and Love short Practice of Surgery page no 24-31. Q9. A small bowel anastomosis healing is adversely affected by all, EXCEPT: a. b. c. d.
Sutures that invert the serosa. Distal obstruction. Diabetes. Jaundice.
Key: A. Bowel anastomosis is inverted to achieve serosa-to-serosa contact, because serosa heals better than mucosa. Skin and vascular structures are best everted. th
Reference:chapter 18 basic surgical skill and anastomosis,25 edition Bailey and Love short Practice of Surgery page no 234-246. Q10. Cellulitis is most often caused by: a.
Beta-hemolytic streptococci.
b. c. d.
E-coli. Pseudomonas aeruginosa. Bacteroides.
Key. A Cellulitis is most often streptococcal. Abscess is most often staphylococcal. Reference: chapter 4 surgical infection,25
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Q11. In a wound abscess, the commonest bacterium found is: a. b. c. d.
Staph aureus. Strep pyogenes. Pseudomonas aeruginosa. Bacteroides.
Key: A. Staphylococci is by far the most common organisms found in pus. Reference chapter 4 surgical infection,25
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Q12. Infection, pancreatitis, multiple trauma or burns may result in an uncontrolled, widespread inflammatory response. This is known as: a. b. c. d.
MODS MSOF SIRS SSSI
Key: C. ‘Systemic inflammatory response syndrome’. There is an even more frightening name for this destructive condition. ‘Malignant intravascular inflammation’ th
Reference:. chapter 1 the metabolic response to injury 25 edition Bailey and Love short Practice of Surgery page no 1-12. Q13. The bankart lesion: a. b. c. d.
Shoulder dislocation Tennis elbow. Avascular necrosis at the lip. Meniscus injury of the knee.
Key: A. It is a detachment of the anteroinferior glenoid labrum and damage to the humeral head. th
Reference:chapter 34,upper limb pathology,assessment and management.25 edition Bailey and Love short Practice of Surgery page no 484-513.
Q14. All of the following are options in treating osteoarthritis of the shoulder, EXCEPT: a. b. c. d.
Debridement and osteotomy. Arthrodesis. Replacement of part of joint. Replacement of the entire joint.
Key: A. Total joint replacement or hemiarthroplasty relieve pain. Arthrodesis is an option in the younger patient. Debridement and osteotomy have very little role. th
Reference chapter 34,upper limb pathology,assessment and management.25 edition Bailey and Love short Practice of Surgery page no 484-513 Q15. A 10 year old presents with a swelling in the upper humerus. Which of the following is the most common cause: a. b. c. d.
Osteosarcoma. Metastatic tumors. Myeloma. Lymphoma.
Key: A Acute osteomyelitis, osteosarcoma and ewing’s tumors are among the commonest causes of swellings in the upper humerus in children. th
Reference: chapter 34,upper limb pathology,assessment and management.25 edition Bailey and Love short Practice of Surgery page no 484-513 Q16. The following are all component of the ELLIS-VAN CREVELD syndrome, Except: a. b. c. d.
Dwarfism Polydactyly. Congenital heart disease. UDT.
Key: D. The ellis-van creveld syndrome is an uncommon birth defect affecting the bones and other symptoms. UDT is not a component of this syndrome. th
Reference:chapter 38, paedriatc orthopaedic,25 edition Bailey and Love short Practice of Surgery page no 562-589.
Q17. The following are ALL risk factors for the increased occurrence of congenital dislocation of the hip, EXCEPTLY: a. b. c. d.
First-born child. Breech delivery. Family history. Male sex.
Key: D. The tighter pelvic muscles and pressures in a breech presentation contribute to a higher incidence of CDH. Up to 20% of breech babies will have CDH. A family history increases the risk 30 times. CDH is 5 times more common in girls than in boys. th
Reference chapter 38, paedriatc orthopaedic,25 edition Bailey and Love short Practice of Surgery page no 562-589. Q18. An orthopedic surgeon sees a newborn in whom the hip easily dislocates. The orthopedic surgeon will usually advise: a. b. c. d.
Observation for 6-9 months. Physiotherapy. Closed reduction and splint. Surgery.
Key: C. Initial treatments with splints to hold the hip in the reduced position: abduction and flexion. A complication of rigid splints is avascular necrosis of the hip. th
Reference: chapter 38, paedriatc orthopaedic,25 edition Bailey and Love short Practice of Surgery page no 562-589.
Q19. Compressive lesions of the spine are best assessed by: a. b. c. d.
CT-scan. MRI. Myelography. Angigraphy.
Key: B If MRI is unavailable, CT scan and CT myelography are good alternatives. th
References. : chapter 33,the spine;25 edition Bailey and Love short Practice of Surgery page no 467-489. Q20. Pain in back may occur from diseses other than those of the spine. Which of the following is LEAST likely to present as pain in the back: a. b. c. d.
Acute pancreatitis. Renal stone diseases. Retroperitoneal tumor. Colitis involving the entire colon.
Key: C Colonic diseases rarely presents as back pain.
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References: chapter 33,the spine;25 edition Bailey and Love short Practice of Surgery page no 467-489. . Q21. Spinal tumors may be vertebral column tumors, and intraspinal tumors. A 60 year old female presents with pain in the back. Imaging reveals a lesion that looks like tumors in the vertebral body. Which is the LEAST likely of the following cancers: a. b. c. d.
Myeloma. Breast tumor. Thyroid cancer. Lung cancer.
Key: A. Primary tumors of the vertebral column are rare. However, while investigating malignant or even benign lesions of the spine, a myeloma must be kept in mind. th
Reference: :chapter 33,the spine;25 edition Bailey and Love short Practice of Surgery page no 467-489. Q22. Following an injury, a patient is found to have absences of sensation in the sole of the foot. which dermatone has been affected: a. b. c. d.
L1 L3-L4 S1 S2-S3
Key: c Almost the entire sole is an S1 dermatone. th
Reference:chapter 33,the spine;25 edition Bailey and Love short Practice of Surgery page no 467-489. Q23. The following is true regarding the minor salivary glands: a. b. c. d.
There are about 50-100 in the oral cavity. They may be found in the lip mucosa. They are histologically distinct from mucosa secreting major salivary glands. They do not contribute to saliva.
Key: B There are almost 450 glands, similar to major salivary glands, and contribute to 10% saliva. th
Reference:chapter 47,the disorders of salivary glands;25 edition Bailey and Love short Practice of Surgery page no 751-767. Q24. Salivary glands tumors: a. b. c. d. Key: C.
Do not occur outside the oral cavity. Are more likely to be malignant if they arise from the major glands. If less than 1 cm and benign, should undergo excisional biopsy. If less than 1 cm and malignant, should be treated by radiotherapy.
Minor salivary gland tumors can occur outside the oral cavity, and are more likely to be malignant than major gland tumors. Surgery is the treatment of choice for all salivary cancers. th
Reference. chapter 47,the disorders of salivary glands;25 edition Bailey and Love short Practice of Surgery page no 751-767 Q25. Inflammation of the submandibular salivary gland: a. b. c. d.
Is usually associated with radio-opaque stones in the duct. Causes pain that decreases during meals. May cause a hard, nontender swelling. Should be treated conservatively.
Key: A Pain increases at mealtime, the swelling is painful, and treatment is surgical removal of the stone or gland. th
Reference: chapter 47,the disorders of salivary glands;25 edition Bailey and Love short Practice of Surgery page no 751-767.
