Koncpt GB Pant

8/16/2019 Koncpt GB Pant

1/96

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ReportQuestion 1:

Recombinant human activated protein C(drotecogrin alpha) is

indicated in all of the following except:

a) APACHE II score 18.

b) Evidence of multiorgan failure.

c) APACHE II score 28.

d) Adult patient with sepsis induced organ dysfunction.

Total Questions: 200

KONCPT-GB PANT MODEL

Score : 0/800( 0.00 )


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Explanation

Correct Answer is

Option 1 a) APACHE II score 18.

ref: pg 85, box 5-2, sabiston volume 1, 19th edn.

ReportQuestion 2:

All of the following statements are true except:

a) An intestinal fistula with a tract length of >2 cm is a favorable factor for

healing.

b) Treatment with PPIs does not actively aid in closure of bowel fistula.

c) Duodenal stump fistulas have poorer healing compared to lateral

duodenal fistula.

d) Skin changes in relation to bowel fistulas are more with duodenal

fistulas compared to gastric fistulas.

Explanation

Correct Answer is

Option 3 c) Duodenal stump fistulas have poorer healing compared to

lateral duodenal fistula.

ref: sabiston 19th edn pg 319.

ReportQuestion 3:

Most common vasculitis affecting the hepatic arterial network is:

a) Kawasakis disease

b) Cogan’s disease.

c) Non specific medium vessel vasculitis.

d) Polyarteritis nodosa.

Explanation


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Correct Answer is

Option 4 d) Polyarteritis nodosa.

ref: blumgart 5th edn, pg 351.

ReportQuestion 4:

Not an indication of retrievable IVC filter?:

a) In cases where anticoagulation therapy is contraindicated.

b) Extensive proximal thrombosis affecting the lower extremity.

c) Prophylaxis in craniovertebral injuries

d) As a protective measure in venous thrombolytic therapy.

Explanation

Correct Answer is

Option 3 c) Prophylaxis in craniovertebral injuries

ref: box 65-4, page 1817, sabiston 19th edn.

ReportQuestion 5:

Lyres sign on DSA scan is a feature seen in:

a) Branchial cyst.

b) Potato tumor of neck.

c) Thyroglossal cyst.

d) Vertebral artery aneurysm.

Explanation

Correct Answer is

Option 2 b) Potato tumor of neck.

potato tumor= chemodectoma; ref: bailey, dhingra ENT.


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ReportQuestion 6:

The first successful coronary artery bypass grafting is credited to:

a) Cooley.b) De bakey.

c) Gibbon.

d) Vineberg.

Explanation

Correct Answer is

Option 2 b) De bakey.

) ref: page 1652, table 60-2, sabiston 19th edn.

ReportQuestion 7:

Which of the following vessels shows maximum variation in size?

a) Superior mesenteric artery

b) Celiac artery.c) Middle rectal artery.

d) Inferior rectal artery.

Explanation

Correct Answer is

Option 3 c) Middle rectal artery.

middle rectal artery; ref: shackelford 7th edn.

ReportQuestion 8:

Catchpole regimen is used in the management of which of the

following conditions?


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a) Appendiceal carcinoid.

b) Mesenteric abscess.

c) Appendicular mass.

d) Ogilvies syndrome.

Explanation

Correct Answer is

Option 4 d) Ogilvies syndrome.

Ogilvies syndrome; ref: Bailey and love.

ReportQuestion 9:

Which of the following anti microbial agent has the propensity to

alter the acid base balance?

a) 0.5% silver nitrate.

b) Polymyxin B

c) Mafenide acetate 5%.

d) Dakin’s solution.

Explanation

Correct Answer is

Option 3 c) Mafenide acetate 5%.

mafenide acetate; ref: pg 533, table 21-5, sabiston 19th edn.

ReportQuestion 10:

All of the following statements about burn injuries are true except?

a) Hydrofluoric acid burns may present with alteration of QT interval on

ECG.

b) Formic acid burns may be associated with hemoglobinuria.

c) A 25 year old man with burns exclusively involving the hands mandates

referral to a burn unit.


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d) Hydrochloric acid is the strongest inorganic acid known.

Explanation

Correct Answer is

Option 4 d) Hydrochloric acid is the strongest inorganic acid known.

ref: sabiston 19th edn., pages 543-545.

ReportQuestion 11:

Which of the following variants of melanoma exhibits neurotropism?

a) Lentigo maligna melanoma.b) Desmoplastic melanoma.

c) Acral lentiginous melanoma.

d) Nodular melanoma.

Explanation

Correct Answer is

Option 2 b) Desmoplastic melanoma.

Desmoplastic melanoma.; ref: sabiston 19th edn., page 747.

ReportQuestion 12:

Pseudolymphoma or Lymphoma like benign picture is seen in all

except:

a) Monoclonal gammopathy.b) Phenobarbitone therapy.

c) Sjogrens syndrome.

d) Dysgammaglobulinemia.

Explanation

Correct Answer is

Option 1 a) Monoclonal gammopathy.


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ReportQuestion 13:

The most well vascularised zone of a TRAM pedicled flap is?

a) Zone I

b) Zone II

c) Zone III

d) All are equally well perfused

Explanation

Correct Answer is

Option 1 a) Zone I

Zone I; ref: sabiston page 875.

Report

Question 14:Not a component of the Bishop and Cairo criteria?

a) Cardiac arrhythmia.

b) Seizure.

c) Serum potassium > 6meq/l.

d) Serum calcium > 8mg/dl.

Explanation

Correct Answer is

Option 4 d) Serum calcium > 8mg/dl.

Ref: Bishop and cairo criteria for tumor lysis syndrome: devita textbook of

oncology.


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ReportQuestion 15:

A 50 year patient with CKD right side has been put on

immunosuppressive therapy. He is being planned up for renal

transplant. On 3rd day of starting the therapy, the patient develops

sudden onset high grade fever, with SBP falling to 70 mm Hg and

breathlessness. The TLC was recorded to be 25000. The 24 hour urine

output was 400 ml. What could be culprit agent?

a) Azathioprine.

b) OKT3.

c) Mycophenolate mofetil.

d) Basiliximab.

Explanation

Correct Answer is

Option 2 b) OKT3.

ref: sabiston 19th edn, page 642-645.

ReportQuestion 16:

Not a pro inflammatory cytokine?

a) IL-7.

b) IL-10.

c) IL-5.

d) TNF alpha.

Explanation

Correct Answer is

Option 2 b) IL-10.

IL-10; ref: sabiston page 623.


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ReportQuestion 17:

As per the hospital safety codes issued by the NABH, which of the

following is not a correct match?

a) Code Blue: cardiorespiratory critical care.

b) Code Red: Fire.

c) Code pink: stable.

d) Code grey: Internal disaster.

Explanation

Correct Answer is

Option 3 c) Code pink: stable.

code pink: missing child.

ReportQuestion 18:

Which part of the gut is maximal affected in blast injuries?

a) Duodenum.b) Proximal jejunum.

c) Terminal ileum.

d) Ascending colon.

Explanation

Correct Answer is

Option 3 c) Terminal ileum.

terminal ileum; ref: sabiston page 613.

Report


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Question 19:

A 45 year man presented to surgery OPD with vague aching pain in

Right flank for the past 3 months. He has no other systemic

complaints. On USG, a mass was noted in right renal area with mixed

echogenecity. A CECT was done which revealed a mass involving the

lower pole of right kidney; about 8 cm in greatest dimension,

involving the right wall of IVC with evidence of involvement of the

right adrenal gland. There is involvement of the right paracaval

nodal group as well. No evidence of any systemic involvement. The

TNM staging would be?

a) T3N1M0

b) T4N1M0

c) T3cN2M0

d) T4N2M0

Explanation

Correct Answer is

Option 2 b) T4N1M0

ref: medscape staging of RCC. AJCC 10th edn.

ReportQuestion 20:

Not a component of the TRISS scoring for trauma?

a) Mechanism of injury (blunt/penetrating)

b) Systolic BP.

c) Heart rate.

d) Age.

Explanation

Correct Answer is

Option 3 c) Heart rate.

heart rate; ref: sabiston page 433.


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ReportQuestion 21:

All of the following statements are true except?

a)�� The original description of damage control surgery was given byFabian and co-workers and had 5 phases.

b) Abdominal compartment syndrome is always associated with evidence

of a new organ dysfunction

c) Secondary abdominal compartment syndromes refer to the

conditions that originate from the abdominopelvic region.

d) Normal intra-abdominal pressure is 5-7 mmHg in a critically ill patient.

Explanation

Correct Answer is

Option 3 c) Secondary abdominal compartment syndromes refer to the

conditions that originate from the abdominopelvic region.

Ref: Sabiston page 471-472.

ReportQuestion 22:

All of the following statements about meconium ileus are true

except?

a) Affects 1 in 1000-2000 live births.

b) Associated with AFI


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ReportQuestion 23:

The most common site affected by lumbar disk herniation is?

a) L4-L5b) L5-S1.

a)�� L2-L3.

d) L3-L4

Explanation

Correct Answer is

Option 2 b) L5-S1.

Ref: sabiston page 1896, table 68-5.

ReportQuestion 24:

Which of the following is not a correct match?

a) Type I flap: gastrocnemius.

b) Type II flap: trapezius.c) Type III flap: serratus anterior.

d) Type V flap: tibialis anterior.

Explanation

Correct Answer is

Option 4 d) Type V flap: tibialis anterior.

tibialis anterior is type IV; ref: sabiston page 1918.

ReportQuestion 25:

Clinodactyly refers to?


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a) Curvature of digit in radial/ulnar deviation.

b) Total duplication of proximal/distal phalanges.

c) Splitting of a single digit.

d) Triphalangia with duplication.

Explanation

Correct Answer is

Option 1 a) Curvature of digit in radial/ulnar deviation.

Ref: sabiston page 1992.

ReportQuestion 26:

Not true about hand infections?

a) The most common causative organism in paronychia is Staphylococcus

sp.

b) Infection of the parona’s space occurs deep to the pronator

quadratus muscle.

c) Herpetic whitlow follows a self limited course.

d) Kanavels cardinal signs have been given for flexor tenosynovitis.

Explanation

Correct Answer is

Option 2 b) Infection of the parona’s space occurs deep to the pronator

quadratus muscle.

it occurs superficial to P. quadrates. Ref; sabiston page 1977-1979.

ReportQuestion 27:

Which of the following does not merit replantation of the amputated

digit?

a) Multiple injured digits.

b) Single digit amputation in children.


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c) Thumb amputation.

d) Single digit amputation in an 18 year old proximal to FDS insertion.

Explanation

Correct Answer is

Option 4 d) Single digit amputation in an 18 year old proximal to FDSinsertion.

ref: sabiston page 1972.

ReportQuestion 28:

Allens classification is used in which of the following?

a)Fingertip injuries based on level of amputation.

b) Assessment of distribution of radial/ulnar arterial supply to the hand.

c) Neural injuries of hand.

d) None of the above.

Explanation

Correct Answer is

Option 1 a)Fingertip injuries based on level of amputation.

ref: Medscape. This question was asked in DNB SS 2014.

ReportQuestion 29:

Most common variant of mesenteric cyst?

a) Chylolymphatic.

b) Enterogenous.

c) Urachal.

d) Dermoid.

Explanation

Correct Answer is


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Option 1 a) Chylolymphatic.

ref: bailey and love.

ReportQuestion 30:

Thyroglossal cyst is a type of?

a) Implantation dermoid.

b) Mucous retention cyst.

c) Cartilaginous remnant.

d) Tubulodermoid.

Explanation

Correct Answer is

Option 4 d) Tubulodermoid.


ReportQuestion 31:

All of the following are correct match except?

a) Adamantinoma- metaphysic.

b) Ewing’s sarcoma- diaphysis.

c) Osteosarcoma- metaphysis.

d) Chondroblastoma- epiphysis.

Explanation

Correct Answer is

Option 1 a) Adamantinoma- metaphysic.

it arises from diaphysis. Ref: bailey and love.


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ReportQuestion 32:

The Total surface area of the peritoneum is approx:

a) 3 m2.b) 4 m2.

c) 2 m2

d) 5 m2.

Explanation

Correct Answer is

Option 3 c) 2 m2

ref: sabiston page 1097

ReportQuestion 33:

A middle aged perimenopausal woman presents to surgical OPD with

complaints of a dragging sensation in lower abdomen. It apparently

increases on exertion. It developed suddenly about 2 mths back

following a bout of heavy sprinting exercise. On examination, an ill

defined fullness was noted in right lumbar region. On carnets test, it

showed no change in its size. Which of the following statements

about this condition is incorrect?

a) Most of the cases respond with analgesics and rest.

b) The condition is more common in athletic males than females.

c) There may be associated signs like grey turner/ cullens.

d) It is important to take history of OCP or warfarin intake in these cases.

Explanation

Correct Answer is

Option 2 b) The condition is more common in athletic males than

females.

more common in females. Ref: Sabiston page 1094; Rectus sheath

hematoma.


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ReportQuestion 34:

Consider the following statements about congenital umbilical hernia.Which of the following statements is not correct?

a) Gastroschisis mostly occurs to the right of the umbilicus.

b) Chances of concomitant congenital anomalies are more with

omphalocele than gastroschisis.

c) Periop fluid requirements are more with omphalocele than

gastroschisis.

d) Omphalocele forms a component of the cantrells pentalogy.

Explanation

Correct Answer is

Option 3 c) Periop fluid requirements are more with omphalocele than

gastroschisis.


ReportQuestion 35:

Which of the following statements is true?

a) Levator scapulae is the most common flap used to cover the

exposed carotid artery post RND.

b) MRND type II saves the sternomastoid muscle.

c) The pectoralis major myocutaneous flap is also called the Bakamjian

flap.

d) The deltopectoral flap is considered the working horse for head andneck reconstructions.

Explanation

Correct Answer is

Option 1 a) Levator scapulae is the most common flap used to cover the

exposed carotid artery post RND.


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ref; sabiston page 818.

ReportQuestion 36:

Which of the following histological variants of RCC has the leafy

pattern on histology?

a) Clear cell.

b) Papillary.

c) Chromophobe.

d) Bellini duct.

Explanation

Correct Answer is

Option 3 c) Chromophobe.

Chromophobe; ref: campbells urology.

ReportQuestion 37:

Which of the following mandates surgical intervention in a patient

with hyperparathyroidism?

a) BMD at lumbar spine, hip or distal radius showing a T score of >-2.5.

b) Patient aged 25 years with primary hyperparathyroidism.

c) Patient aged 65 years with secondary hyperparathyroidism.

d) Serum calcium level of 10.5 mg/dl.

Explanation

Correct Answer is

Option 2 b) Patient aged 25 years with primary hyperparathyroidism.

ref: sabiston page 928; box 39-2.


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ReportQuestion 38:

A patient aged 24 years presents with a malignant appearing thyroid

mass about 5 cms in greatest dimension, with involvement of

contralateral level 4,5,6 cervical nodes and multiple cutaneous

nodules on anterior part of left leg with histological evidence of

malignant cells. AJCC 7th edn stage?

a) Stage I

b) Stage II

c) Stage III

d) Stage IV.

Explanation

Correct Answer is

Option 2 b) Stage II

in age < 45 years, M1= stage II.

ReportQuestion 39:

The most common electrolyte imbalance seen in patients with

advanced stage Ca penis is?

a) Hyperphosphatemia.

b) Hyperkalemia.

c) Hypocalcemia.

d)Hypercalcemia.

Explanation

Correct Answer is

Option 4 d)Hypercalcemia.

Ref: campbells urology


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ReportQuestion 40:

Middle adrenal artery is a branch of?

a)�� Abdominal aorta.b) Renal artery.

c) Gonadal artery.

d) Inferior phrenic artery.

Explanation

Correct Answer is

Option 1 a)�� Abdominal aorta.


ReportQuestion 41:

Not true about MEN syndrome?

a)MEN I patients may present with collagenomas.

b) MEN 2b patients merit prophylactic thyroidectomy by 5 years ofage.

c) MEN 2a patients may present with amyloid deposition in papillary

dermis.

d) Hirschsprungs disease has been seen in association with MNE 2a.

Explanation

Correct Answer is

Option 2 b) MEN 2b patients merit prophylactic thyroidectomy by 5 years

of age.

surgery at infancy needed ( 6mths); ref: sabiston pages 1000-1004.


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ReportQuestion 42:

DTIC (Dacarbazine) has been used in the management of which of the

following pancreatic NET?

a) GRFoma.

b) Neurotensinoma.

c) Glucagonoma.

d) Somatostatinoma.

Explanation

Correct Answer is

Option 3 c) Glucagonoma.

Glucagonoma. (ref: blumgart/shackelford).

ReportQuestion 43:

Which of the following conditions of hypergastrinemia is not

associated with increased acid output?

a) Pernicious anemia

b) Retained gastric antrum

c) ZES.

d) GOO.

Explanation

Correct Answer is

Option 1 a) Pernicious anemia


Report


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Question 44:

Which of the following statements about thyroid anatomy is not

true?

a) Non recurrent laryngeal nerve may occur in 0.5% cases and is

more common on the left side.

b) Jolls triangle has inferior thyroid artery as one of its branches.c) The parafollicular cells are concentrated along the upper part of the

thyroid gland.

d) The organ of Zuckerkandl is an important landmark in near total

thyroidectomy

Explanation

Correct Answer is

Option 1 a) Non recurrent laryngeal nerve may occur in 0.5% cases and is

more common on the left side.

more common on right side; ref: stell and maran’s head and neck.

ReportQuestion 45:

Leaderhose disease is?

a) Plantar fibromatosis.

b) Dermatofibrosarcoma protuberans

c) Fibrosarcoma of thigh.

d) Massive DVT of upper extremity.

Explanation

Correct Answer is

Option 1 a) Plantar fibromatosis.

ref: deVita oncology.

Report


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a) Serum TAG level > 150 mg/dL.

b) Random glucose level > 100mg/dL.

c) SBP > 130 mmHg.

d) HDL level < 40 mg/dL.

Explanation

Correct Answer is

Option 2 b) Random glucose level > 100mg/dL.

fasting glucose not random; ref: sabiston page 148.

ReportQuestion 49:

Not true about enteral nutrition?

a) Nasojejunal feeding is the preferred mode of nutrition in patients with

severe acute pancreatitis.

b) Refeeding syndrome is more common with parenteral nutrition

than enteral nutrition.

c) Janeways method is used for gastrostomy.

d) Modular formulas used for enteral nutrition contain a singular nutrient

as the source of calories.

Explanation

Correct Answer is

Option 2 b) Refeeding syndrome is more common with parenteral

nutrition than enteral nutrition.

more with enteral; ref: sabiston pages 132-135.; shackelford 7th edn.

ReportQuestion 50:

Calculate the serum osmolality in a patient with serum sodium 130

meq/L, Serum BUN of 40 mg/l and serum glucose of 300 mg/dl.

a) 380 mosm/l.


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b) 290 mosm/l

c) 260 mosm/l.

d) 330 mosm/l.

Explanation

Correct Answer is

Option 2 b) 290 mosm/l

2* serum sodium + BUN/2.8 + glucose/18.

ReportQuestion 51:

Which of the following serum parameters is the best indicator of

oxygen debt?

a) Serum lactate.

b) pH.

c) sPO2.

d) Serum bicarbonate.

Explanation

Correct Answer is

Option 1 a) Serum lactate.

serum lactate; ref: sabiston page 75.

ReportQuestion 52:

Which of the following anesthetic agents causes redistribution

hypothermia?

a) Ketamine.

b) Propofol.

c) Meperidine.

d) Thiopentone.


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Explanation

Correct Answer is

Option 2 b) Propofol.

propofol; ref: sabiston page 288.

ReportQuestion 53:

Which of the following statements about surgical wounds is correct?

a) Liechtensteins hernioplasty is an example of clean contaminated

wound.

b) Laparoscopic cholecystectomy with bile spillage intraop is an example

of infected wound.

c) The class I wounds have infection rate of around 1-3%.

d) A patient with Hinchey stage IV diverticulitis undergoing surgery is an

example of class III wound.

Explanation

Correct Answer is

Option 3 c) The class I wounds have infection rate of around 1-3%.


ReportQuestion 54:

False about wound healing is:

a) Doxorubicin therapy adversely affects wound healing.

b) In patients with obstructive jaundice wound healing is poor due to

inhibition of an oxidase enzyme by bile pigments.

c) Chevrons incision has one of the best wound healing rates.

d) Zinc is an important cofactor for wound healing.

Explanation


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Correct Answer is

Option 2 b) In patients with obstructive jaundice wound healing is poor

due to inhibition of an oxidase enzyme by bile pigments.

hydroxylase enzyme not oxidase, inhibited by bile salts not pigments. (ref:

sabiston/ blumgart).

ReportQuestion 55:

QUORUM guidelines ensure the quality of:

a) Randomized controlled trials.

b) Cohort studies.c) Clinical database.

d) Meta-analyses.

Explanation

Correct Answer is

Option 4 d) Meta-analyses.

Quality of Reporting of Meta-analyses. (QUORUM); ref: sabiston page 193.

ReportQuestion 56:

Which of the following statements is false?

a) The ANOVA test is used when comparing more than 2 groups with

continuous outcome variable.

b) Kaplan meier analyses is a measurement of time to event such assurvival analyses in cancer patients.

c) The power of a statistical study is determined by the number of false

negative or the beta error.

d) A wide confidence interval in a statistical study is indicative of

minimal uncertainity or high precision.

Explanation


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Correct Answer is

Option 4 d) A wide confidence interval in a statistical study is indicative of

minimal uncertainity or high precision.

it indicates low precision; ref: sabiston pages 195-196.

ReportQuestion 57:

Monocryl suture is a polymer of?

a) Glycolide and lactide.

b) Glycolide and caprolactone.

c) Polyethylene terephthalate.d) Polyester.

Explanation

Correct Answer is

Option 2 b) Glycolide and caprolactone.


ReportQuestion 58:

Most common fungal infection in recipients of renal transplant is?

a) Candida.

b) Cryptococcus.

c) Histoplasma.

d) Blastomyces.

Explanation

Correct Answer is

Option 1 a) Candida.

candida; ref: sabiston page 265.


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ReportQuestion 59:

Bisgaards regimen is used in the management of which of the

following conditions?

a) Chronic venous ulcer.

b) Lymphedema.

c) Varicose veins.

d) Arterial ulcer.

Explanation

Correct Answer is

Option 1 a) Chronic venous ulcer.

Chronic venous ulcer; ref: bailey and love.

ReportQuestion 60:

Consider the following statements about arteriovenous fistulas:

I. In long standing cases, there occurs dilation of the proximal veins.

II. Cirsoid aneurysm is an AV fistula of internal carotid artery.

III. Caroticocavernous fistulas (CCF) are associated with radiological

dilation of superior ophthalmic vein.

IV. Nicoladonis sign is associated with fall in SBP.

a) a) I and II are true.

b) b) II,III,IV are true.c) c) I,III, IV are true.

d) All are true.

Explanation

Correct Answer is

ref: sabiston.


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ReportQuestion 61:

Which of the following statements about splenic anatomy is nottrue?

a) The splenic milleu is usually acidotic

b) The distributed vascular pattern is the most common pattern in spleen.

c) Spleen develops from the ventral mesogastrium at around 5 weeks

of life.

d) The lienorenal ligament contains the tail of pancreas.

Explanation

Correct Answer is

Option 3 c) Spleen develops from the ventral mesogastrium at around 5

weeks of life.


ReportQuestion 62:

Barley water fluid on aspirate is a feature of which of the following

pathologies of scrotum?

a) Spermatocele.

b) Lymphocele.

c) Pyocele.

d) Chylocele.

Explanation

Correct Answer is

Option 1 a) Spermatocele.

spermatocele.


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ReportQuestion 63:

Which of the following is a mismatch about intravenous fluids?

a) Ringer lactate: fluid of choice in burns.b) Isolyte G: rich in chloride ions.

c) 0.9% normal saline: contains 154 meq/l of sodium in one vac.

d) Hypertonic saline : used in wound management.

Explanation

Correct Answer is

Option 3 c) 0.9% normal saline: contains 154 meq/l of sodium in one vac.

contains 154 meq in 1 liter not 1 vac.

ReportQuestion 64:

Trigeminal neuralgia is most commonly associated with abnormality

in which vessel?

a) Anterior cerebral artery.b) Superior cerebellar artery.

c) Inferior cerebellar artery.

d) Lenticulostriate artery.

Explanation

Correct Answer is

Option 2 b) Superior cerebellar artery.

ref: sabiston page 1904-5.

ReportQuestion 65:

Supraduodenal artery of Wilkie is most commonly a branch of?


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a) Common hepatic artery.

b) Superior mesenteric artery.

c) Gastroduodenal artery.

d) Right hepatic artery.

Explanation

Correct Answer is

Option 1 a) Common hepatic artery.


ReportQuestion 66:

Which of the following agents has been implicated in causing a

picture similar to gallstones (pseudolithiasis)?

a) Ciprofloxacin.

b) Ceftriaxone.

c) Penicillin.

d) Aspirin.

Explanation

Correct Answer is

Option 2 b) Ceftriaxone.

ceftriaxone; ref: blumgart.

ReportQuestion 67:

Peritoneal mice are?

a) Calcific deposits of saponified fat in acute pancreatitis

b) Talc induced calcified peritoneal granuloma.

c) Necrosed appendices epiploicae.

d) Calcified tubercular mesenteric nodes.


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Explanation

Correct Answer is

Option 3 c) Necrosed appendices epiploicae.


ReportQuestion 68:

Not true about internal hernias?

a) Most common is paraduodenal hernia on the left side.

b) Approximately 75% of the mesocolic hernias occur on the left side.

c) The most common acquired internal hernia is Peterson hernia,

through the roux en y loop.

d) The mesocolic hernia sac should not be opened at the neck to avoid

injury to the superior mesenteric vessels

Explanation

Correct Answer is

Option 3 c) The most common acquired internal hernia is Peterson

hernia, through the roux en y loop.

most common is transverse mesocolic defect (stammers hernia); ref:

shackelford/ Sabiston page 1106.

ReportQuestion 69:

False statement about laparoscopic inguinal hernia repair

a) The myopectineal orifice is bounded by the coopers ligament medially

and rectus sheath laterally.

b) The aberrant obturator artery uis a branch of the inferior mesenteric

artery.

c) The indirect inguinal hernias develop in the lateral fossa.

d) Both a and b.


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ReportQuestion 72:

False about mediastinal masses:

a) Neurogenic tumors are most commonly present in the posterior

mediastinum.

b) Thymoma with involvement of adjacent organs with no mets is

masaoka stage III.

c) During the surgical removal of dumbbell neural tumor, the intraspinal

part should be removed first.

d) The primary mediastinal goiter derives its main blood supply from

the superior thyroid artery.

Explanation

Correct Answer is

Option 4 d) The primary mediastinal goiter derives its main blood supply

from the superior thyroid artery.

it derives supply from thoracic aorta; ref; sabiston pages 1603-1606.

ReportQuestion 73:

The thoracic incision providing maximum exposure of operative field

is?

a) Posterolaterlal thoracotomy.

b) Anterolateral thoracotomy.

c) Median sternotomy.

d) Clamshell thoracotomy.

Explanation

Correct Answer is

Option 4 d) Clamshell thoracotomy.

clamshell


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ReportQuestion 74:

False statement about neuroblastoma:a) Shows spontaneous regression.

b) Hyperdiploidy is associated with favorable prognosis.

c) N myc amplification is associated with a favorable outcome.

d) Stage 4S has a better prognosis than stage 3.

Explanation

Correct Answer is

Option 3 c) N myc amplification is associated with a favorable outcome.

has worse outcome; ref: sabiston pages 1859-1860.

ReportQuestion 75:

Which of the following perforators does not fall in the Short

saphenous vein territory?a) Bassi’s perforator.

b) Leonardo’s vein.

c) Soleal point perforator.

d) Gastrocnemius point perforator.

Explanation

Correct Answer is

Option 2 b) Leonardo’s vein.

Leonardo’s vein; ref: sabiston page 1801.

ReportQuestion 76:


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False about extrahepatic biliary atresia?

a) Most common associated anomaly is preduodenal portal vein.

b) Cytomegalovirus has been implicated in the immunological theory of

pathogenesis.

c) Type 3 atresia is the most common type.

d) GGT levels are one of the earliest liver markers to rise alarmingly inEHBA.

Explanation

Correct Answer is

Option 1 a) Most common associated anomaly is preduodenal portal vein.

polysplenia is most common anomaly. Ref; sabiston/blumgart.

ReportQuestion 77:

Pain in acute appendicitis caused by gentle traction on the right

testicle is called?

a) Ronsohoff sign.

b) Tenhorn sign.

c) Danforth sign.d) Aaron sign.

Explanation

Correct Answer is

Option 2 b) Tenhorn sign.

ref: sabiston page 1147, table 47-1.

ReportQuestion 78:

Not a component of the Blatchford scoring:

a) Melena.


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b) Raised blood urea.

c) Fall in SBP.

d) Elevated PT.

Explanation

Correct Answer is

Option 4 d) Elevated PT.

ref: Schwartz pretest.

ReportQuestion 79:

Not true about GI hormone:

a) GRP: stimulates release of secretin.

b) Peptide YY: mediates the ileal brake reflex.

c) GIP: released by the K cells.

d) CCK: relaxation of sphincter of Oddi.

Explanation

Correct Answer is

Option 1 a) GRP: stimulates release of secretin.

GRP stimulates release of all hormones except secretin; ref: sabiston page

1235, table 50-3.

ReportQuestion 80:

True about short chain fatty acids:

a) The primary SCFAs are acetate, propionate and butyrate in 5:1:1 ratio.

b) Acetate mediates cholesterol synthesis.

c) Butyrate is the least important SCFA.

d) About 90% SCFAs are lost in the feces.

Explanation


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Correct Answer is

Option 2 b) Acetate mediates cholesterol synthesis.

) ref: sabiston page 1306.

ReportQuestion 81:

The following statements about LGI bleed are true except:

a) Bleeding from colonic diverticula usually occur at the neck.

b) The most common location for angiodysplasia is the rectosigmoid

junction as it is a watershed zone.

c) Heyde syndrome occurs in association with aortic stenosis.d) Massive colonic hemorrhage complicates UC more commonly

compared to CD.

Explanation

Correct Answer is

Option 2 b) The most common location for angiodysplasia is the

rectosigmoid junction as it is a watershed zone.

most common site is right/ascending colon/caecum. Ref: sabiston page

1175-76.

ReportQuestion 82:

Criminal nerve of grassi is a branch of:

a) Posterior vagus nerve.b) Anterior vagus nerve.

c) Common vagal trunk.

d) Celiac branch of vagus.

Explanation

Correct Answer is


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Option 1 a) Posterior vagus nerve.

posterior vagus; ref: sabiston page 1183.

ReportQuestion 83:

False statement about GI hormonal mediator:

a) The predominant form of somatostatin is somatostatin-14.

b) In patients undergoing Roux en y gastric bypass, the ghrelin levels fall

by about 77%.

c) The major stimulant of neurotensin release in the gut is fat.

d) Elastase cleaves the peptide bonds involving the aromatic amino

acids.

Explanation

Correct Answer is

Option 4 d) Elastase cleaves the peptide bonds involving the aromatic

amino acids.

cleaves the neutral aliphatic AAs. (ref: sabiston page 1232).

ReportQuestion 84:

The most common neoplasm arising in a meckels diverticulum is:

a) Adenocarcinoma.

b) Carcinoid.

c) Lymphoma.

d) Sarcoma

Explanation

Correct Answer is

Option 2 b) Carcinoid.

carcinoid. (ref: sabiston page 1268-9, shackelford.)


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ReportQuestion 87:

Not true about duodenal diverticula:

a) More common in malesb) Mostly affects the second part of duodenum.

c) Usually located along the mesenteric border of the bowel.

d) Hemorrhage is usually as a result of erosion through superior

mesenteric artery.

Explanation

Correct Answer is

Option 1 a) More common in males

more common in females. (ref: sabiston page 1265-66.)

ReportQuestion 88:

Which of the following statements about pneumatosis intestinalis is

true?a) Most commonly affects the subserosa of ileocolic junction.

b) Males and females have an equal incidence.

c) Usually spares the rectum.

d) Rupture leads to a sterile pneumoperitoneum.

Explanation

Correct Answer is

Option 3 c) Usually spares the rectum.


Report


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ReportQuestion 91:

All are true about the physiology of colonic absorption except:

a) The total absorptive surface area of colon is approximately 900cm2.b) The stool contains less sodium than the ileal effluent.

c) The most widely expressed water channel for absorption in the colonic

epithelium is the Aquaporin 8.

d) The sodium/proton exchanger is activated in the distal colon and

is unaffected by the effect of aldosterone.

Explanation

Correct Answer is

Option 4 d) The sodium/proton exchanger is activated in the distal colonand is unaffected by the effect of aldosterone.

it is activated in proximal colon and is under aldosterone control. (ref;

shackelford page 1729.

ReportQuestion 92:

All are true about large gut volvulus except:

a) Ileosigmoid knotting phenomenon is predisposed by a hypermobile

small bowel with a short redundant sigmoid.

b) The increased incidence of volvulus has been seen in places with high

intake of fibre in the diet.

c) Usually after successful detorsion of the sigmoid volvulus,

recurrences are only seen in about 10% cases.

d) Caecal volvulus has a somewhat higher incidence in females than

males.

Explanation

Correct Answer is

Option 3 c) Usually after successful detorsion of the sigmoid volvulus,

recurrences are only seen in about 10% cases.

recurrences are high, 70% requiring surgery. (ref: sabiston page 1315-6;


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shackelford.)

ReportQuestion 93:

All are true about esophageal anastomosis except

a) The stapled technique has been associated with a lower rate of

strictures and leaks than hand sewn technique in cervical anastomosis.

b) Anastomotic leaks that occur before 48hrs are usually attributed to

graft ischemia due to arterial cause

c) There is no difference in leak rate between hand sewn v/s stapled

technique in intrathoracic anastomosis.

d) The chances of anastomotic site necrosis is less with cervicalanastomosis vis a vis thoracic anastomosis.

Explanation

Correct Answer is

Option 4 d) The chances of anastomotic site necrosis is less with cervical

anastomosis vis a vis thoracic anastomosis.


ReportQuestion 94:

False statement about the esophageal anatomy:

a) The allisons membrane usually splits into 3 layers scaffolding

around the lower part of esophagus.

b) The laimers triangle is formed by the triangular area deprived ofmusculature on the esophageal wall.

c) The gender differences in esophageal length are usually attributed to

variations in individual’s height.

d) The retrosternal route of esophageal conduit is longer than the

posterior medistinal route.

Explanation


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Correct Answer is

Option 1 a) The allisons membrane usually splits into 3 layers scaffolding

around the lower part of esophagus.

ref: shackelford pages 9-18.

ReportQuestion 95:

False statement about the embryology of foregut:

a) The fetus takes its first swallow by the 14th week of gestation.

b) The development of esophagus begins in the 3rd week of gestation.

c) The endodermal and mesodermal development of the gut tube areunder the control of homeobox genes.

d) The primitive esophagus at around 5th week of gestation is lined

by ciliated columnar epithelium.

Explanation

Correct Answer is

Option 4 d) The primitive esophagus at around 5th week of gestation is

lined by ciliated columnar epithelium.

ref: sabiston pages 1013-4.

ReportQuestion 96:

False statement about the rectal pain syndromes

a) Levator syndrome usually affects left side more commonly.b) Proctalgia fugax is characteristically devoid of any relevant physical

signs.

c) Spasm of perianal musculature has been implicated in the

pathogenesis of proctalgia fugax.

d) True coccygodynia is not a functional pain syndrome going by the

definition.


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d) Martin anoplasty

Explanation

Correct Answer is

Option 3 a)�� S-plasty.

S plasty; ref: shackelford page 1929-30.

ReportQuestion 99:

False statement about Endo anal ultrasound:

a) The perineal body thickness is assessed at the level of mid anal canal.b) The internal anal sphincter is most prominently seen in the distal

anal canal.

c) The external anal sphincter usually appears hyperechoic.

d) In patients with SRUS, the submucosa appears hyperechoic because of

fibrosis

Explanation

Correct Answer is

Option 2 b) The internal anal sphincter is most prominently seen in thedistal anal canal.

shackelford pages 1765-9.

ReportQuestion 100:

The pickrell procedure of anal encirclage uses which of the following?

a) Silver wire.

b) Bulbocavernosus.

c) Gracilis.

d) Silicone elastomer.

Explanation


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Correct Answer is

Option 3 c) Gracilis.

gracilis (ref: shackelford page 1778).

ReportQuestion 101:

Hyperpigmented macules on glans penis are a feature of:

a) Cronkhite Canada syndrome.

b) Mc kittrick Wheelock syndrome.

c) Cowden syndrome.

d) Banayan Riley Ruvalcaba syndrome.

Explanation

Correct Answer is

Option 4 d) Banayan Riley Ruvalcaba syndrome.

ref: shackelford page 2047.

ReportQuestion 102:

Rebeccamycin is a novel therapeutic agent used in the management

of:

a) Cholangiocarcinoma.

b) Carcinoma pancreas.

c) HCC.

d) Anal canal carcinoma.

Explanation

Correct Answer is

Option 1 a) Cholangiocarcinoma.

ref: wikipedia.


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ReportQuestion 103:

Which pharmacological agent has been implicated in the prevention

of sinusoidal obstruction syndrome caused by oxaliplatin?

a) Aspirin.

b) Clopidogrel.

c) Dipyridamole.

d) Inchinkoto herb

Explanation

Correct Answer is

Option 1 a) Aspirin.

aspirin (ref: blumgart).

ReportQuestion 104:

Tunnel of love is an important landmark in which surgical procedure?a) Miles procedure.

b) LAR

c) Kausch whipples procedure.

d) Freys procedure

Explanation

Correct Answer is

Option 3 c) Kausch whipples procedure.

………..

ReportQuestion 105:


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False about Crohn’s disease of perianal region:

a) Most of the manifestations are painful in nature.

b) Fissures are typical multiple and off-midline

c) Use of infliximab in perianal CD has been associated with higher

incidence of pouchitis post IPAA.

d) Sphincterotomy is the management of choice in crohn’s relatedanal fissure.

Explanation

Correct Answer is

Option 4 d) Sphincterotomy is the management of choice in crohn’s

related anal fissure.

ref: sabiston pages 1399-1400.

ReportQuestion 106:

The upper limit of pressure while creating pneumoperitoneum for

lap cholecystectomy is:

a) 10-12 mmHg

b) 12-15 mmHg.c) 8-10 mmHg.

d) 18-20 mmHg.

Explanation

Correct Answer is

Option 2 b) 12-15 mmHg.

ref: blumgart page 517; 5th edn.

ReportQuestion 107:

All of the following statements about intrahepatic calculi are false

except:


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a) Intrahepatic biliary tract tumors arising in the setting of calculi express

CDX2 but stain negative for MUC2 in most of the cases.

b) There is a higher incidence of intrahepatic calculi in patients with

clonorchis infection as compared to ophisthorcis infection.

c) The intrahepatic calculi mostly arise in the setting of infection and hence

are poor in cholesterol concentration.

d) None of the above.

Explanation

Correct Answer is

Option 4 d) None of the above.

None of the above.

ReportQuestion 108:

Consider the following statements about IgG4 associated

cholangitis:I. More common in the 25-45 years age group. II. Females

are affected twice as commonly as males. III. Seldom affects any

other organ. IV. Obliterative phlebitis is a characteristic picture in

most of the cases. Which of the above statements is/are true?

a) I and IV.

b) I, II and IV.

c) Only IV.

d) None of the above is true

Explanation

Correct Answer is

Option 3 c) Only IV.

ref: blumgart page 678; 5th edn. Table 43.3.

ReportQuestion 109:


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Arrow head appearance of bile ducts is a cholangiographic finding in:

a) Primary sclerosing cholangitis.

b) Recurrent pyogenic cholangitis

c) Biliary ascariasis.

d)Chronic graft rejection.

Explanation

Correct Answer is

Option 2 b) Recurrent pyogenic cholangitis

ref: blumgart page 681.

ReportQuestion 110:

Creeping resection strategy is employed in surgical resection of:

a) IPMN.

b) MCN

c) Intrahepatic cholangiocarcinoma.

d) Klatskin tumor

Explanation

Correct Answer is

Option 1 a) IPMN.

ref: shackelford page 1230; 7th edn.

ReportQuestion 111:

Choose the incorrect statement about pancreatic embryology:

a) The first detectable endocrine cells during pancreatic development are

the glucagon containing cells.

b) Ngn 3 marker is required for endocrine lineage development of the

gland.


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c) The suppression of sonic hedgehog promotes dorsal pancreatic

development

d) The B celss form 70% of the core of the pancreatic endocrine cells

are are distributed peripherally in the gland.

Explanation

Correct Answer is

Option 4 d) The B celss form 70% of the core of the pancreatic endocrine

cells are are distributed peripherally in the gland.

ref: shackelford pages 1111-1119, sabiston page 944.

ReportQuestion 112:

On ERCP in a patient with a 3 weeks old pseudocyst presenting with

severe pain abdomen and features of obstructive jaundice the

following picture was reported: A 6*5 cms pseudocyst in the tail of

pancreas with a single stricture in the pancreatic duct

communicating with the apex of the cyst; rest of the duct and the

gland normal. Based on the above report which Nealon’s category

does it fall under?

a) Nealon type II.

b) Nealon type IV.

c) Nealon type III.

d) Nealon type VI.

Explanation

Correct Answer is

Option 2 b) Nealon type IV.

Ref: shackelford page 1150.

ReportQuestion 113:


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The normal daily output of bicarbonate rich pancreatic juice is:

a) 1.5 L/day.

b) 2.0 L/day.

c) 2.5 L/day.

d) 0.5 L/day.

Explanation

Correct Answer is

Option 3 c) 2.5 L/day.


ReportQuestion 114:

� All of the following statements about colorectal NETs are true

except:

a) Colonic NETS are usually more proximal in location and are often large

at the time of diagnosis.

b) Most rectal NETS arise in the mid rectum.

c) Rectal NETs are mostly subserosal in location.

d) Segmental resection forms the mainstay of management in cases ofcolonic NETs.

Explanation

Correct Answer is

Option 3 c) Rectal NETs are mostly subserosal in location.

mostly submucosal; ref: shackelford pages 2191-2.

ReportQuestion 115:

� All of the following statements about pancreatic lymphoma are

true except:


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a) Primary pancreatic lymphomas are rare malignancies accounting for


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Question 117:

Which of the following toxins does not cause centrilobular hepatic

necrosis?

a) Yellow phosphorus.

b) Amanita mushroom.

c) Carbon tetrachloride.d) Valproate.

Explanation

Correct Answer is

Option 1 a) Yellow phosphorus.

ref: shacelford pages 1553-4.

ReportQuestion 118:

The most common sole agent used in transarterial

chemoembolisation is:

a) FUDR.

b) Doxorubicin.

c) Methotrexate.d) 5-FU.

Explanation

Correct Answer is

Option 2 b) Doxorubicin.


ReportQuestion 119:

The PRETEXT staging is used in which of the following malignancies?

a) HCC.


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b) HCC in children.

c) Hepatoblastoma.

d) Hepatic lymphoma.

Explanation

Correct Answer is

Option 3 c) Hepatoblastoma.


ReportQuestion 120:

Which of the following statements most correctly describes Von

Myenburg complexes?

a) The incidence is about 30% in autopsied specimen.

b) They are commonly precursors of cholangiocarcinoma and hence need

special attention.

c) They represent hamartomas and are not connected with the

biliary tree

d) They represent aberrant remodeling of the hepatocytes and sinusoids.

Explanation

Correct Answer is

Option 3 c) They represent hamartomas and are not connected with the

biliary tree

ref: blumgart pages 1243-4.

ReportQuestion 121:

The least common genetic variant of hepatocellular adenoma is:

a)Beta catenin mutated.

b) HNF 1 alpha mutated.

c) MODY 3 associated


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d) Telangiectatic variant.

Explanation

Correct Answer is

Option 1 a)Beta catenin mutated.

ref: blumgart 1236.

ReportQuestion 122:

Choose the correct statement about HCC:

a) The clear cell variant of HCC is usually associated withhypercholesterolemia

b) The fibrolamellar variant are well defined and well encapsulated and

hence have the best prognosis.

c) The sclerosing variant of HCC usually affects the younger age group.

d) The nodular pattern of HCC is tyicalseen in patients with no cirrhosis.

Explanation

Correct Answer is

Option 1 a) The clear cell variant of HCC is usually associated withhypercholesterolemia


ReportQuestion 123:

The ablation modality for HCC least susceptible to heat and curret

sinking effects is:

a) Laser interstitial thermotherapy.

b) Irreversible electroporation.

c) HIFU.

d) Microwave ablation.


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Explanation

Correct Answer is

Option 2 b) Irreversible electroporation.

ref: blumgart page 1415-6.

ReportQuestion 124:

The following statements about desmoid tumor are true except:

a) There has been a positive association found between desmoids tumor

and OCP intake.

b) The tumor appears homogenous and isointense compared with muscle

on T1 weighted imaging and on T2 weighted scans it appears slightly less

intense than fat.

c) The tumor stains positive for vimentin and negative for beta

catenin.

d) On histology, the centre of the tumor is acellular compared to the

periphery which contains most of the fibroblasts.

Explanation

Correct Answer is

Option 3 c) The tumor stains positive for vimentin and negative for beta

catenin.

positive for both vimentin and beta catenin; ref: sabiston page 1095.

ReportQuestion 125:

Tillaux’s triad is mentioned in reference to:

a) Omental cyst.

b) Slerosing mesenteritis.

c) Rectus sheath hematoma.

d) Mesenteric cyst.


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ref: mastery of surgery.

ReportQuestion 130:

Gambee suture is:

a) Interrupted single layer inverted full thickness.

b) Continuous single layer full thickness.

c) Interrupted single layer seromuscular

d) Interrupted single layer mucosa only.

Explanation

Correct Answer is

Option 1 a) Interrupted single layer inverted full thickness.

ref: shackelford page 922-3.

Report

Question 131:Valtrac sutureless anastomosis ring has been devised as a

biofragmentable device for sutureless intestinal anastomosis. The

device has 2 rings composed of:

a) Dexon and barium sulphate.

b) Prolene and dexon.

c) Fibrinogen and prolene.

d) Dexon and polyglactin.

Explanation

Correct Answer is

Option 1 a) Dexon and barium sulphate.



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ReportQuestion 132:

A 30 year olf man presented to the casualty with a history of blunt

trauma abdomen by impact against the seatbelt on a RTA. On

exploratory laparotomy, the bowel showed evidence of gangrene

affecting the whole of jejunum and ileum with patches of gangrene

extending upto the proximal 2-3 cm of ascending colon. The rest of

the large bowel and duodenum was normal. There were pulsations

palpable in the root of mesentery. True statement is:

a) SMA trauma Fullen zone I.

b) SMA trauma Fullen zone III.

c) SMA trauma fullen zone II.

d) SMA trauma fullen zone IV.

Explanation

Correct Answer is

Option 2 b) SMA trauma Fullen zone III.


ReportQuestion 133:

Taylor repair for peptic ulcer disease is:

a) Posterior TV alone.

b) Posterior TV with anterior HSV.

c) Posterior TV with anterior lesser curve seromyotomy.

d) Supradiaphragmatic TV.

Explanation

Correct Answer is

Option 3 c) Posterior TV with anterior lesser curve seromyotomy.

ref: shackelford page 704


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ReportQuestion 134:

Aprepitant is a novel antiemetic drug used mainly in chemotherapy

induced vomiting. It acts by:

a) Substance P agonist.

b) Kallikrein receptor inhibition

c) Neurokinin-1 receptor antagonist.

d) 5-HT4 agonist.

Explanation

Correct Answer is

Option 3 c) Neurokinin-1 receptor antagonist.


ReportQuestion 135:

All of the following statements about enteric duplications are true

except:

a) Mostly are found along the antimesenteric side of ileum.

b) May be saccular or tubular in morphology.

c) Most of the patients are diagnosed in the first year of life.

d) They may be located in subserosal or intermuscular layers of the

Explanation

Correct Answer is

Option 1 a) Mostly are found along the antimesenteric side of ileum.


ReportQuestion 136:


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False statement about gastric volvulus is:

a) Most of the cases are organoaxial, usually secondary to diaphragmatic

hernia

b) Primary gastric volvulus may be associated with splenic abnormalities

c) The classification of gastric volvulus into 2 types was stated by

Borchardt.d) Acute gastric volvulus presents with the Borchardt triad in 70% cases.

Explanation

Correct Answer is

Option 3 c) The classification of gastric volvulus into 2 types was stated by

Borchardt.


ReportQuestion 137:

True statements about hepatic artery aneurysm are all except:

a) More common in young females.

b) Most of the cases are pseudoaneurysm in the present era.

c) Frank rupture may occur in 10-30% casesd) Extrahepatic aneurysms are more likely to be degenerative secondary

to atherosclerotic changes.

Explanation

Correct Answer is

Option 1 a) More common in young females.


ReportQuestion 138:

�Investigation of choice for diagnosis of Mesenteric venous

thrombosis is:


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c) Mantle cell lymphoma

d) Marginal zone lymphoma.

Explanation

Correct Answer is

Option 3 c) Mantle cell lymphoma


ReportQuestion 141:

The following esophageal pathology presents with severe chest pain

and dysphagia with multiple peaks on esophageal motility study and

a distal contractile integral to the tune of 8000-9000 mm Hg-s-cm:

a) Nutcracker esophagus.

b) Jackhammer esophagus

c) Type III achalasia.

d) Diffuse esophageal spasm.

Explanation

Correct Answer is

Option 2 b) Jackhammer esophagus


ReportQuestion 142:

The type of achalasia cardia showing best response to therapy is:

a) Type I.

b) Type II.

a)�� Type III.

d) All show equal response

Explanation


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ReportQuestion 145:

False statement about esophageal carcinogenesis is:

a) BMP-4 is involved in metaplasia of squammous to cardiac mucosa.

b) The intestinal metaplasia when present, is always located at the top of

the neosquammocolumnar junction

c) Exposure to a pH of 3-5 promotes oxyntocardiac mucosa

development and is relatively protective against carcinogenesis.

d) Cdx-2 gene mediates intestinal metaplasia and poses a high risk for

carcinoma development

Explanation

Correct Answer is

Option 3 c) Exposure to a pH of 3-5 promotes oxyntocardiac mucosa

development and is relatively protective against carcinogenesis.


ReportQuestion 146:

All of the following are eligible candidates for EMR for esophageal

cancer, except:

a) Lesion 1 cm in size.

b) No lymph nodal involvement

c) Polypoid lesion with evidence of ulceration on the apex.

d) Well differentiated histology.

Explanation

Correct Answer is

Option 3 c) Polypoid lesion with evidence of ulceration on the apex.



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ReportQuestion 147:

The local ablative therapy used for barrets esophagus that carries

the maximum risk of metaplastic changes hidden beneath the

normal appearing epithelium is:

a) Ps-PDT.

b) ALA-PDT

c) SRER.

d) EMR.

Explanation

Correct Answer is

Option 1 a) Ps-PDT.


ReportQuestion 148:

Following statements are true about myogenic dysphagia except:

a) Mostly seen in oculopharyngeal form of muscular dystrophy.

b) There is overactivity of pharyngeal muscles, which showed

irregular peaks.

c) Nocturnal bronchorrhea often wakes up the patient at night.

d) Shows a good response to cricopharyngeal myotomy.

Explanation

Correct Answer is

Option 2 b) There is overactivity of pharyngeal muscles, which showedirregular peaks.

ref; shackelford pages 329-33


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ReportQuestion 149:

The most common genomic event in esophageal carcinogenesis is:

a) Chromosome 8q amplificationb) KRAS mutation.

c) P16INK4A inactivation.

d) PTEN activation.

Explanation

Correct Answer is

Option 1 a) Chromosome 8q amplification


ReportQuestion 150:

False statement about esophageal diverticula:

a) Killian-Jameisson diverticula are located below the cricopharyngeus and

are lateral in location.b) Most traction diverticula arise within 4-5 cm proximal or distal to the

carina.

c) Epiphrenic diverticula are false diverticula and have a predilection

to involve the region around 5 cm distal to the carina.

d) The techinique of dividing the zenker’s diverticulum septum using laser

technology was introduced by Van overbeek.

Explanation

Correct Answer is

Option 3 c) Epiphrenic diverticula are false diverticula and have a

predilection to involve the region around 5 cm distal to the carina.

involves the distal 10 cm of esophagus. Ref: shackelford pages 363-72.


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ReportQuestion 151:

Consider the following risk factorsI. High carbohydrate diet. II.

NSAIDs. III. Obesity. IV. Scleroderma. V. H. pylori.

a) I and V are protective against adenocarcinoma of esophagus

b) I and III are protective against SCC esophagus.

c) III, IV and V are high risk factors for adenocarcinoma esophagus.

d) All are high risk factors for SCC esophagus.

Explanation

Correct Answer is

Option 2 b) I and III are protective against SCC esophagus.


ReportQuestion 152:

� Endoscopic study results are normal in case of:

a) Vigorous achalasia.b) DES.

c) Achalasia type I.

d)Nutcracker esophagus.

Explanation

Correct Answer is

Option 1 a) Vigorous achalasia.

ref: sabiston page 1026, table 43-2.

ReportQuestion 153:

The most common location of congenital esophageal cysts is:


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Question 155:

The ability of hepatic artery to respond acutely to changes in portal

flow is called the hepatic arterial buffer response. What is the

proposed mediator of this response?

a) Accumulation of substance P.

b) Accumulation of adenosine.c)Decrease in pH.

d) Calcium accumulation in sinusoids.

Explanation

Correct Answer is

Option 2 b) Accumulation of adenosine.


ReportQuestion 156:

All of the following are scoring systems for liver fibrosis except:

a) Ishak-Knodell.

b) APRI.

c) SHASTA.d) Littles scoring

Explanation

Correct Answer is

Option 4 d) Littles scoring

it is for cholangitis; ref: blumgart page 108.

ReportQuestion 157:

What is the preferred site of placement of HAI pump in a patient with

HCC in the Right lobe with an aberrant right hepatic artery?


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a) Gastroduodenal artery.

b) Common hepatic artery.

c) Left hepatic artery.

d) Superior mesenteric artery.

Explanation

Correct Answer is

Option 1 a) Gastroduodenal artery.


ReportQuestion 158:

All of the following are correct about the Belghiti’s maneuver except:

a) The most pivotal step in this maneuver is defining the anterior plane of

the IVC.

b) The upper surface of the liver is exposed up to the anterior surface of

suprahepatic IVC.

c) The maneuver has been proposed for left and extended left

hepatectomies.

d) The veins draining the caudate process are also ligated while

mobilization.

Explanation

Correct Answer is

Option 3 c) The maneuver has been proposed for left and extended left

hepatectomies.


ReportQuestion 159:

Laparoscopic hepatic resection can be undertaken in the following

cases except:


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Correct Answer is

Option 4 d) HAT very rarely presents with biliary complications


ReportQuestion 164:

Which of the following is not a component of the PELD score?

a) Serum creatinine

b) Serum bilirubin.

c) INR.

d) Serum albumin.

Explanation

Correct Answer is

Option 1 a) Serum creatinine

ref: Blumgart page 1756.

ReportQuestion 165:

The most predictive finding on endoscopic ultrasound done for

chronic pancreatitis is:

a) Honeycombing lobularity.

b) Irregular main pancreatic duct contour

c) Main pancreatic duct calculi.

d) Pancreatic duct dilation> 3.5 mm in the body.

Explanation

Correct Answer is

Option 3 c) Main pancreatic duct calculi.

ref: sabiston page 1529; box 56-4.


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ReportQuestion 166:

The correct sequence of molecular pathway of pancreatic

carcinogenesis is:

a) K ras->DPC4-->CDKN2A.

b) Kras->CDKN2A-->p53.

c) P53-->Kras-->CDKN2A.

d) Kras->MYC-->PTEN.

Explanation

Correct Answer is

Option 2 b) Kras->CDKN2A-->p53.

ref: sabiston page 1537, fig. 56-21.

ReportQuestion 167:

The first laparoscopic pancreatoduodenectomy is credited to:a) Lortat-Jacob.

b) Kendrick- Cusati.

c) Gagney-Pomp.

d) Palanivelu.

Explanation

Correct Answer is

Option 3 c) Gagney-Pomp.


Report


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Question 168:

Following are the metabolic risk factors for development of acute

pancreatitis except:

a) Hypercalcemia.

b) Hyperparathyroidism.

c) Type III hyperlipidemia.d) Type II hyperlipidemia.

Explanation

Correct Answer is

Option 3 c) Type III hyperlipidemia.


ReportQuestion 169:

Accessory Gall bladder appearance on cholangiography is a feature

of:

a) Type III choledochal cyst.

b) Forme fruste type choledochal cyst.

c)Type VI choledochal cyst.d) Type II choledochal cyst.

Explanation

Correct Answer is

Option 4 d) Type II choledochal cyst.

………….

ReportQuestion 170:

The middle hepatic artery in adults is usually a branch of:

a) Celiac trunk.


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Correct Answer is

Option 1 a) Cardiovascular disease.


ReportQuestion 173:

Which of the following biochemical markers has been studied on

experimental basis as a potential marker of intestinal function in

short gut syndrome?

a) Serum ornithine.

b) Serum arginine.c) Serum calprotectin.

d) Serum conitine

Explanation

Correct Answer is

Option 3 c) Serum calprotectin.

serum calprotectin; ref: sabiston page 686.

ReportQuestion 174:

The most common indication for undergoing small bowel transplant

in pediatric age group based on the epidemiological data is:

a) Gastroschisis.

b) Necrotizing eneterocolitis.c) Midgut volvulus.

d) Jejunoileal atresia.

Explanation

Correct Answer is

Option 1 a) Gastroschisis.


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ReportQuestion 175:

All of the following statements are true about Transplant of human

organs act except:

a)�� Given in 1994 and underwent amendment in 2008.

b) It has been amended to include organs and tissues but not blood.

c) The term near relatives has been expanded to include the

grandparents, uncles and aunts in the amended act.

d) The treating medical staff and ICU care staff are not entitled to

request the relatives of the dead for the provision of organ donation.

Explanation

Correct Answer is

Option 4 d) The treating medical staff and ICU care staff are not entitled

to request the relatives of the dead for the provision of organ donation.

ref: transplant of human organs act (amended) online.

ReportQuestion 176:

Not true about HNPCC is:

a) Autosomal dominant condition, accounting for about 2% of all

colorectal cancers.

b) The earliest description given by Aldred Warthin in 1913.

c) Subset of patients who have positive gene mutation but do notmeet the Amsterdam criteria are labeled as familial cancer type X.

d) The first two MMR genes identified in HNPCC were MSH2 and MLH1.

Explanation

Correct Answer is

Option 3 c) Subset of patients who have positive gene mutation but do


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not meet the Amsterdam criteria are labeled as familial cancer type X.

shackelford pages 2041-2.

ReportQuestion 177:

All of the following statements about juvenile polyposis syndrome

are correct except:

a) The polyps in JPS appear at an earlier age than in cases with

solitary juvenile polyp alone.

b) Juvenile polyposis of infancy is characterized by protein losing

eneteropathy.

c) In patients with SMAD4 mutation there may be association with

Hereditary hemorrhagic telangiectasia.

d)Screening colonoscopy should begin by the age of 15-18 years.

Explanation

Correct Answer is

Option 1 a) The polyps in JPS appear at an earlier age than in cases with

solitary juvenile polyp alone.


ReportQuestion 178:

All of the following statements about cowden syndrome are true

except:

a) Mutation of PTEN gene, chromosome 10q.

b) As per the NCCN criteria, neurological involvement in the form of

Lhermite Duclos syndrome comes under minor criteria of diagnosis.

c) Males with cowden syndrome have an increased risk of developing

Carcinoma breast.

d) Colorectal cancer falls under the minor diagnostic criteria of cowden

syndrome.


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Explanation

Correct Answer is

Option 2 b) As per the NCCN criteria, neurological involvement in the

form of Lhermite Duclos syndrome comes under minor criteria of

diagnosis.

it is major criteria; ref: Schwartz pretest; shackelford pages 2046-7.

ReportQuestion 179:

The most common extraintestinal manifestation of FAP is:

a)�� Desmoid tumor.

b) Thyroid cancer.

c) CHRPE.

d) CNS tumor.

Explanation

Correct Answer is

Option 3 c) CHRPE.

shackelford page 2035.

ReportQuestion 180:

Reverse 3 sign on Barium enema is a feature seen in:

a) Acute appendicitis.

b) Ileocaecal TB.

c) Caecal diverticula.

d) Carcinoma head of the pancreas.

Explanation

Correct Answer is

Option 1 a) Acute appendicitis.


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ReportQuestion 181:

A patient who presented with history of pain abdomen and altered

stools for last 3 mths was found to have multiple strictures all >5 cm

length spanning over a length of 150-200 cm distal to DJ flexure on

exploratory laparotomy done in view of acute intestinal obstruction.

The surgeon took the decision of preserving the bowel since the

contamination was minimal and hence thought of stricturoplasty.

Which of the following would be the best method in this case?

a) Judd stricturoplasty.b) Moskel- Neumayer stricturoplasty.

c) Michelassi stricturoplasty.

d) Jaboulay’s stricturoplasty.

Explanation

Correct Answer is

Option 3 c) Michelassi stricturoplasty.


ReportQuestion 182:

All of the following statements about IPAA are true except:

a) To achieve an adequate length of the pouch without undue

tension on the mesentery, the middle colic artery may be dividedclose to the origin from SMA.

b) The anastomosis is fashioned between the apex of the ileal pouch and

the anal dentate line.

c) The S pouch was the earliest pouch described.

d) In cases of inability to mobilize the ileal pouch adequately, saphenous

vein may be used as an interposition graft to the SMA.


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Explanation

Correct Answer is

Option 1 a) To achieve an adequate length of the pouch without undue

tension on the mesentery, the middle colic artery may be divided close to

the origin from SMA.

ref: sabiston page 1327-8.

ReportQuestion 183:

All are true about Post IPAA pouchitis except:

a)�� The Pouchitis disease activity index incorporates recatl bleeding

and stool urgerncy as two of its important criteria.

b) The incidence of Pouchitis varies between 11-34%.

c) Extraintestinal manifestations similar to those seen in IBD may be

present.

d) The mainstay of management is medical therapy in the form of

steroids and immunosuppressants.

Explanation

Correct Answer is

Option 4 d) The mainstay of management is medical therapy in the form

of steroids and immunosuppressants.


ReportQuestion 184:

Which of the following scenarios would not be a contraindication to

resection of locally recurrent rectal cancer?

a) Patient giving a history of sciatica.

b) Presenting with bilateral hydronephrosis

c) ASA grade III.


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d) Bony involvement of S3-4.

Explanation

Correct Answer is

Option 4 d) Bony involvement of S3-4.

ref: shackelford page 2140, box 170-3

ReportQuestion 185:

All are true about colorectal lymphoma except:

a) Caecum is one of the most common sites.b) T-cell histology predominates in countries like Taiwan and china.

c) Affects females of elderly age group twice as commonly as males.

d) Prognosis worse than that of gastric and small gut lymphoma.

Explanation

Correct Answer is

Option 3 c) Affects females of elderly age group twice as commonly as

males.

shackelford page 2192-3.

ReportQuestion 186:

As per the RTOG garding of radiation enteritis, small bowel

perforation secondary to radiation necrosis falls under which grade?

a) Grade 4

b) Grade 5

c) Grade 2

d) Grade 3.

Explanation

Correct Answer is


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Option 1 a) Grade 4

ref: shackelford page 988, table 78-1.

ReportQuestion 187:

All of the following have been clinically accepted as agents for

radioprotection except:

a) Glutamine.

b) Pentoxifylline.

c) Sucralfate.

d) WR-2771.

Explanation

Correct Answer is

Option 1 a) Glutamine.

ref: shackelford page 995; table 78-2.

ReportQuestion 188:

All of the following statements about GIST are true except:

a) The GISTs in Carney’s triad are usually C-Kit negative.

b) Most of the pediatric GISTs are CD117 positive but very few actually

harbor C-kit mutation.

c) Type III tumors are located in the antropyloric region and are best

approached by laparoscopic distal gastrectomy.

d) The most common site of genetic mutation of KIT involves the exon 11

in juxtamembrane domain.

Explanation

Correct Answer is

Option 3 c) Type III tumors are located in the antropyloric region and are

best approached by laparoscopic distal gastrectomy.


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ReportQuestion 189:

Following points are true about the anatomy of small gut except:

a) Jejunum has thicker and heavier walls than ileum.

b) Ileal mesentery has more fat reservoir than the jejuna mesentery.

c) The ileal mesentery has shorter vas recta with many short loops than

the jejunal mesentery.

d) There are approximately 4-6 jejunal and 12-14 ileal branches

originating from the right side of the SMA to supply the jejunum and

the ileum respectively.

Explanation

Correct Answer is

Option 4 d) There are approximately 4-6 jejunal and 12-14 ileal branches

originating from the right side of the SMA to supply the jejunum and the

ileum respectively.

left side not right side…ref: shackelford pages 1067-71; figure 84-8.

ReportQuestion 190:

All are true about chronic mesenteric ischemia except:

a) Females are affected more than males by a ratio of 3:1.

b) On a long run, the patients develop sitophobia and may present with

loss of weight.c) The Darmouth criteria on duplex velocity scan assesses the end

diastolic velocity, with a value of >55 cm/sec in Coeliac artery and >45

cm/sec in SMA corresponding to >50% stenosis.

d) The evolution of symptoms in CMI is typically rapid and explosive

(over a few days).

Explanation


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ReportQuestion 195:

Which of the following prognostic modalities has a value if done

within 24 hours of admission in a case of acute pancreatitis?

a) BISAP.

b) CRP.

c)Imrie.

d) Ranson.

Explanation

Correct Answer is

Option 1 a) BISAP.


ReportQuestion 196:

Not a component of the Sugiura procedure for portal hypertension:

a) Splenectomy.

b) Pyloroplasty.

c) Vagotomy.

d) Proximal gastrectomy.

Explanation

Correct Answer is

Option 4 d) Proximal gastrectomy.

ref: Blumgart pages 1141-2.


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ReportQuestion 197:

In all of the following conditions the normal relationship of portal

triad to the central hepatic venule is disrupted except:

a) Primary biliary cirrhosis.

b) Alcoholic cirrhosis.

c)Wilson’s disease.

d) Hereditary hemochromatosis.

Explanation

Correct Answer is

Option 1 a) Primary biliary cirrhosis.

ref; Blumgart page 1081

ReportQuestion 198:

Plasminogen activator inhibitor levels have found usefulness as a

diagnostic marker in cases of:

a) Budd-Chiari syndrome.

b) Veno-occlusive disease.

c) Membranous obstruction of IVC.

d) Myeloproliferative disease.

Explanation

Correct Answer is

Option 2 b) Veno-occlusive disease.

ref: Blumgart page 1199.

ReportQuestion 199:


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