Quiz

Question :1 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 :2 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 :3 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 :4 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 :5 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 :6 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 :7 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 :8 Which of following is poor prognostic factor for colorectal malignancy with liver metastasis except

Metachronous metastasis
Lymph node involvement
>5cm lesion
Synchronous metastasis

Question :9 Which of the following is a complication of Caroli’s disease

Renal disorders
Recurrent cholecystitis
Nephrospongiosis
Cholangiocarcinoma

Question :10 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 :11 Origin of the parasympathetic innervation of the left colon is

T6-T12
L1-L3
Vagus nerve
S2-S4

Question :12 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 :13 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 :14 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 :15 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 :16 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 :17 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 :18 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 :19 Not a component of Chinese university prognostic index scoring system for HCC:

Serum bilirubin
TNM stage
Serum albumin
Serum ALP

Question :20 A 45 year old male presented with progressive jaundice over the past 3 mths 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 :21 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 :22 Not a component of the Truelove and Witt’s classification:

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

Question :23 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 :24 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 :25 False regarding Hartman’s Pouch is

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

Question :26 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 :27 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 :28 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 :29 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 :30 Primitive streak remnant gives rise to

Neuroblastoma
Wilm's tumor
Sacrococcygeal teratoma
Hepatoblastoma

Question :31 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 :32 All of the following are risk for Pancreatic adenocarcinoma except

Tobacco
Alcohol
Type 2 DM
Obesity

Question :33 Most common organism causing biliary infections is

Staphylococci
E.coli
Pseudomonas
Bacteroides

Question :34 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 :35 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 :36 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 :37 Complete surgical excision is possible in _____ percentage of Bile duct cancer patients

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

Question :38 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 :39 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 :40 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 :41 Investigation of choice for swallowing dysfunction is

Barium swallow
Endoscopy
Videofluoroscopy
X ray lateral view neck

Question :42 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 :43 Hemifacial atrophy of the skin soft tissue and bone is seen in

Parry Romberg disease
Klippel trenaunay syndrome
Parkes Weber syndrome
Proteus syndrome

Question :44 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 :45 Which of the following sutures is the first to close

Sagittal
Metopic
Coronal
Lambdoid

Question :46 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 :47 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 :48 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 :49 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 :50 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 :51 Which is not placed in high risk category for surgery

Urgent body cavity
Major vascular surgery
Open aortic surgery
Breast surgery

Question :52 Persistent erection lasting than _ hours considered as Priapism

2
4
6
8

Question :53 Acute phase of peyronies disease lasts

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

Question :54 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 :55 Fertility rate of intracytoplasmic sperm injection is

20%
30%
40%
50%

Question :56 No of negative semen analysis need to conclude after vasectomy as effective method

2
3
4
5

Question :57 Supermicrosugery involves ananstomosis of vessel what size except

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

Question :58 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 :59 Bipedicle flap used for reconstruction of

Nose
Upper eyelid
Lower eyelid
Forehead

Question :60 For Local Random flap , flap raised at what level

Sub dermal
Sub cutaneous
Sub fascial
Prefascial

Question :61 Struvite stones caused by all except

Staphylococcus
Proteus
Pseudomonas
E.coli

Question :62 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 :63 SONDE endoscopy used for

Esophagus
Stomach
Small bowel
Large bowel

Question :64 What is the investigation used to differentiate between contussion & actual presence of blood in torso trauma patient

Chest X ray
USG
CT
MRI

Question :65 Radiation dose of CT KUB

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

Question :66 Leibovich prognostic score is associated with

Renal cancer
Bladder cancer
Penile cancer
Prostate cancer

Question :67 Percentage of DVT with bilateral involvement is

10%
20%
30%
40%

Question :68 Ability of cancer cells to establish an autonomous lineage is mediated by:

Epithelial Mesenchymal transition
Epigenetic modification
Oncogenes
Tumor suppressor genes

Question :69 Chance of testicular pain in short term after vasectomy is

0%
5%
10%
20%

Question :70 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 :71 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 of 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 :72 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 :73 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 :74 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 :75 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 :76 All are warning signs of soft tissue tumors except

>5 cm
Painful
Superficial to fascia
Recurrence after previous excision

Question :77 What percentage of fibroids transform into malignancy

<1%
1%
5%
10%

Question :78 Most consistent feature of cancer is

Self renewal
Lack of consistency
Antiapoptotic
Angiogeneic

Question :79 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 :80 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 :81 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 :82 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 :83 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 :84 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 :85 Risk factors for development of soft tissue sarcoma include all of the following except:

Retinoblastoma
Li-Fraumeni syndrome
von Hippel-Lindau syndrome
Lymphedema

Question :86 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 :87 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 :88 Coarctation of aorta commonly occurs in

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

Question :89 Alcohol risk factor for all except

Head and neck cancer
Gastric cancer
Oesophageal cancer
Hepatoma

Question :90 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 :91 Investigation of choice for ureteropelvic junction obstruction is

DTPA
MAG 3
IVU
MRI

Question :92 Which of following is not responsible for pyrexia (NEET SS PATTERN 2018)

IL1
TNF alpha
IL4
IL8

Question :93 Optimal timing for CT in acute pancreatitis is

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

Question :94 How much CSF should be drained for relieving Communicating Hydrocephalus

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

Question :95 Triad of Normal pressure Hydrocephalus include all except

Headache
Gait disturbance
Incontinence
Cognitive decline

Question :96 Strength of association between smoking and cancer is measured using

Population attributable fraction
Population attributable risk
Attributable risk
Cumulative incidence rate

Question :97 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 :98 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 :99 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 :100 Early onset breast cancer, sarcomas, leukemia & brain, adrenocortical tumors would be consistent with

Cowden disease
Li fraumeni syndrome
Peutz jeghers syndrome
Ataxia telengiectasia