END OF POSTING EXAMINATION

POSTING : SURGERY

M.B.B.S. YEAR 5 OCTOBER 2011/2012 SESSION (SEPTEMBER 2012 EXAMINATION)

DATE: 05 SEPTEMBER 2012

1.

Acute appendicitis: A. Causes pain in the umbilical area, which moves to right iliac fossa (RIF). B. Is excluded if the WCC and temperature are normal. C. Is mistaken for ovarian cyst rupture. D. Is treated by laparoscopic appendicectomy. E. F. Mimics mesenteric adenitis. Answer A. True; Pain is frequently noticed in periumbilical region, then moves to RIF (Bailey & Loves Short Practice of Surgery, 24th Edition, page 1206) B. False; During the first 6 hours, there is rarely any alteration in temperature (Bailey & Loves Short Practice of Surgery, 24th Edition, page 1207) C. True; It can mimic Torsion or heamorrhagic ovarian cyst (Bailey & Loves Short Practice of Surgery, 24th Edition, page 1209) D. True; both conventional and lap appendicectomy can be used, (Bailey & Loves Short Practice of Surgery, 24th Edition, page 1212) E. True; Commonly mistaken as mesenteric adenitis in children (Bailey & Loves Short Practice of Surgery, 24th Edition, page 1208)

2.

Ureteric colic: A. Produce pain that is colicky in nature. B. Analgesia is used to alleviate pain. C. Are predominantly triple phosphate types. D. Can be treated by lithotripsy. E. Predispose to transitional cell carcinoma of the ureter. Answer A. True; It produces ureteric colic (Bailey & Loves Short Practice of Surgery, 24th Edition, page 1321) B. True; NSAIDs like diclofenac and indomethacin (Bailey & Loves Short Practice of Surgery, 24th Edition, page 1322) C. False; majority of ureteric stones are calcium oxalate types (S. Das, A Concise Textbook of Surgery, 7th Edition, page 1219) D. True; Provided it is in the part of ureter that can be identified by the imaging system of lithotripter (Bailey & Loves Short Practice of Surgery, 24th Edition, page 1323)

E. True; calculi is an etiology for transitional cell carcinoma of the renal pelvis and ureter, http://emedicine.medscape.com/article/452449-overview#a0102

3.

Clinical features of acute pancreatitis: A. Tetany. B. Paralytic ileus. C. Vomiting. D. Jaundice. E. Pleural effusion. Answer A. False; (Bailey & Loves Short Practice of Surgery, 24th Edition, page 1123-1124) B. True; Abdominal distension occur due to ileus (Bailey & Loves Short Practice of Surgery, 24th Edition, page 1124) C. True; Vomiting is frequent and persistent (Bailey & Loves Short Practice of Surgery, 24th Edition, page 1123) D. True; Mild icterus (Bailey & Loves Short Practice of Surgery, 24th Edition, page 1124) E. True; present in 10-20% of patient (Bailey & Loves Short Practice of Surgery, 24th Edition, page 1124)

4.

A fistula: A. Arises from a blind-ending abscess cavity. B. Will never heal spontaneously. C. Connects two separate epithelial surfaces. D. Is found in the anal canal. E. Gives rise to severe fluid and electrolyte losses. Answer A. False; a blind-ending tract is a sinus (Bailey & Loves Short Practice of Surgery, 24th Edition, page 209) B. True C. True; Fistula is an abnormal communication between 2 epithelium lined surfaces (Bailey & Loves Short Practice of Surgery, 24 th Edition, page 210) D. True; Fistula-in-ano (Bailey & Loves Short Practice of Surgery, 24th Edition, page 1265)

E. True; In case of intestinal fistula, fluid and electrolyte imbalance may occur due to escapes of fluid or stool through skin http://emedicine.medscape.com/article/179444-workup#a0756

5.

Carcinoma of stomach is associated with A. Blood group O. B. Cigarette smoking. C. Pernicious anaemia. D. Iron deficiency anaemia. E. Trancoelomic spread to the ovary. Answer A. False; More common in blood group A (Manipal Manual of Surgery, 3th Edition, page 418) B. True; Carcinoma of stomach is associated with cigarette smoking and dust ingestion (Bailey & Loves Short Practice of Surgery, 24th Edition, page 1050) C. True; increase risk in patient with pernicious anaemia (Bailey & Loves Short Practice of Surgery, 24th Edition, page 1050) D. False; (Bailey & Loves Short Practice of Surgery, 24th Edition, page 1050) E. True; the ovaries may sometimes be the sole site of trancoelomic spread (Bailey & Loves Short Practice of Surgery, 24th Edition, page 1053)

6.

Carcinoma of prostate: A. Occurs frequently in men aged over 65 years. B. Responds to testosterone therapy. C. Causes renal stricture. D. Produces osteosclerotic secondary bone deposits. E. Spreads to pelvic lymph nodes. Answer A. True; Carcinoma of prostate is the most common malignant tumour in men aged over 65 years. (Bailey & Loves Short Practice of Surgery, 24th Edition, page 1380) B. False; The aim of medical therapy is to decrease the testosterone level (Bailey & Loves Short Practice of Surgery, 24th Edition, page 1385)

C. False; Rectum may become stenosed by the tumour infiltrating around it (Bailey & Loves Short Practice of Surgery, 24th Edition, page 1381) D. True; Abdominal radiography may show characteristic of sclerotic metastases in lumbar vertebrae and pelvic bone (Bailey & Loves Short Practice of Surgery, 24th Edition, page 1383) E. True; spread to pelvic lymph nodes via lymphatic spread (Bailey & Loves Short Practice of Surgery, 24th Edition, page 1382)

7.

An abdominal aortic aneurysm: A. Is seen on a plain abdominal radiograph. B. Presents with collapsing pulse. C. Is the result of syphilis. D. Needs treatment when symptomatic. E. Usually involves the renal arteries. Answer A. True; Found on physical examination, radiography or ultrasound examination (Bailey & Loves, 25th Edition, page 918) B. False; It is not one of the causes of collapsing pulse (P.J Metha, 19th Edition, page 39) C. True; Syphllis is one of the rare causes of aneurysms (Manipal Manual of Surgery, 3rd Edition, page 215) D. True; In symptomatic patient, it is said that without surgery 80% with symptomatic aneurysms will be dead in a year, with surgery, 80% will be alive. (Bailey & Loves, 25th Edition, page 918) E. False; Do not involve renal arteries (The only renal thing it involved is post operatively. Renal failure and infection of the graft are rare events occurring post op. (Bailey & Loves, 25th Edition, page 923)

8.

Deep Vein Thrombosis (DVT): A. Usually results from incompetent superficial veins. B. Prevented by heparin. C. Is treated by heparin. D. Is more common in malignancy. E. Is diagnosed by duplex scanning. Answer A. False; It is due to acute thrombosis of the deep veins (Manipal Manual of Surgery, 3rd Edition, page 114)

B. True; Low dose heparin is given 5000 units subcutaneously for prophylaxis (Manipal Manual of Surgery, 3rd Edition, page 116) C. True; Injection heparin 10,000 unit IV (Manipal Manual of Surgery, 3rd Edition, page 116) D. True; Malignancy causes sluggish blood flow which leads to thrombus formation (Manipal Manual of Surgery, 3rd Edition, page 114) E. True; Duplex scanning, along with Doppler study and contrast venography is used in DVT (Manipal Manual of Surgery, 3rd Edition, page 115)

9.

With regard to haemorrhoids: A. Thrombosis is a recognized complication. B. Is treated by band ligation. C. First degrees are best treated by haemorrhoidectomy. D. They predispose carcinoma. E. Strangulation is treated with haemorrhoidectomy. Answer A. True; Thrombosis and fibrosis is a complication (Manipal Manual of Surgery, 3rd Edition, page 644) B. True; Rubber band ligation is recommended for grade 1 to 3 (http://en.wikipedia.org/wiki/Hemorrhoid) C. False; It is indicated Grade 2 and 3 haemorrhoidectomy (Manipal Manual of Surgery, 3rd Edition, page 645) D. False; They predispose to suppuration, ulceration, thrombosis, fibrosis, gangrene and pyemia but not carcinoma (Manipal Manual of Surgery, 3rd Edition, page 644) E. True; Surgery is a good treatment for strangulated haemorrhoids as long as adequate antibiotic cover is given to prevent portal pyemia, although it is not one of the indications. (Bailey & Loves, 25th Edition page 1255-1256 & http://www.ncbi.nlm.nih.gov/pubmed/1687254)

10. The incidence of breast cancer is higher in patients who: A. Have already had breast cancer. B. Are young. C. Have breast fed their children. D. Are obese. E. Have a family history of ovarian carcinoma.

Answer A. True: Risk of developing second breast cancer is about 0.5% or 0.7% in woman with previous invasive breast cancer (Manipal Manual of Surgery, 3rd Edition, page 340) B. False: rare in young common from 35 to 75 years (Manipal Manual of Surgery, 3rd Edition, page 340) C. False: Breast feeding appear to be protective (Bailey & Loves, 25th Edition, page 837) D. True: Correlated, because it is more common in woman undeveloped world who have higher consumption of fat (Bailey & Loves, 25th Edition, page 837) E. True: Ovarian cancer, HRT all causes increased risk of breast cancer (Bailey & Loves, 25th Edition, page 837)

11. An undescended testis: A. Should be brought into scrotum after the age of 10. B. Is associated with inguinal hernia. C. Is prone to malignant change. D. Is more likely to undergo torsion of testis. E. May undergo spontaneous symptomatic remissions. Answer A. False: Orchidopexy, an operation to bring testis into scrotum, is done after 2 years in bilateral cases and 4 years in unilateral cases. (Manipal Manual of Surgery, 3rd Edition, page 807) B. True: It is seen in hernia when the scrotum is empty; it is due to undescended testis. Complication of undescended testis is also indirect hernia (Manipal Manual of Surgery, 3rd Edition, page 683) C. True: Associated with seminoma of testis or malignancy (Manipal Manual of Surgery, 3rd Edition, page 806) D. True: (Manipal Manual of Surgery, 3rd Edition, page 806) E. True: Even with treatment by surgery (orchidopexy), remissions of malignancy can still occur (Bailey & Loves, 25th Edition, page 1378)

12. Crohns disease: A. Is associated with finger clubbing. B. May cause protein malabsorption. C. Is characteristically associated with dilatation of the terminal ilium.

D. Hardly ever affect the colon. E. May undergo symptomatic remissions. Answer A. True: It is one of the GIT causes of clubbing (PJ Metha, 19th Edition, page 14) B. True: It causes malabsorption and treatment also requires high protein diet due to the malabsorption (K. George Mathew, 3rd Edition page 524) C. False: It is associated with thickened and leathery terminal ileum with the lumen narrowed, this it is stenosed, not dilated (K. George Mathew, 3rd Edition page 524) D. False: Colon is the 2nd most common affected part after the terminal ileum (K. George Mathew, 3rd Edition page 524) E. True: It is a chronic disease with exacerbations and remissions (K. George Mathew, 3rd Edition page 524)

13. Surgical emphysema is caused by: A. Spontaneous pneumothorax. B. Perforation of the oesophagus. C. Hyperventilation. D. Traumatic pneumothorax. E. Smoking. Answer A. False: (Bailey & Loves, 25th Edition, page 879) B. True: Surgical emphysema is the presence of air in the tissues. It requires a breach of an air-containing viscus in communication with soft tissues, and the generation of positive pressure to push the air along tissue planes. The most serious cause is a ruptured oesophagus. ((Bailey & Loves, 25th Edition, page 879) C. False: (Bailey & Loves, 25th Edition, page 879) D. False: (Bailey & Loves, 25th Edition, page 879) E. False: (Bailey & Loves, 25th Edition, page 879)

14. A full thickness burn of the right leg: A. Is estimated to represent 5% of the entire body surface area. B. May cause peptic ulcer. C. May result in thrombosis. D. Is treated by resuscitation with intravenous fluids. E. Should be covered with ice.

Answer A. False: Rule of Nine each lower limb represent 18% (Bailey & Loves, 25th Edition, page 382) B. True: Acute ulceration of the stomach and duodenum has been noticed as a common complication of major thermal injury (S. Das A Concise Textbook of Surgery, 7th Edition page 66) C. True: There is no capillary return and thrombosed vessels can be seen under the skin. (Bailey & Loves, 25th Edition, page 382) D. True: Intravenous resuscitation required in adults with burns over 15% TBSA. (Bailey & Loves, 25th Edition, page 382) E. False: It should be performed with cool water 1025 C (5077 F) and not ice water as the latter can cause further injury (http://en.wikipedia.org/wiki/Burn#Wound_care) Topical treatment: 1% silver sulphadiazine cream 0.5% silver nitrate solution mafenide acetate cream serum nitrate, silver sulphadiazine and cerium nitrate

15. Acute extradural haemorrhage: A. Causes a rise in pulse rate. B. Causes a rise in blood pressure. C. Results in hemiparesis. D. Is associated with a dilated pupil on the side of the injury. E. Can be distinguished from subdural haemorrhage by CT. Answer A. True: Increase pulse rate (S. Das A Concise Textbook of Surgery, 7th Edition page 403) B. False: Hypotension (S. Das A Concise Textbook of Surgery, 7th Edition page 403 & Bailey & Loves, 25th Edition, page 300) C. True: Contralateral hemiparesis. (Bailey & Loves, 25th Edition, page 303) D. True: Ipsilateral dilatation of pupil. (Bailey & Loves, 25th Edition, page 303) E. True: Lentiform or biconvex hyperdense lesion on CT / subdural concave lesion on CT Bailey & Loves, 25th Edition, page 303-304)

16. Hepatitis B: A. Is transmitted by the faeco-oral route. B. Vaccine should be given to at-risk healthcare workers. C. Predisposes to hepatocellular carcinoma. D. Causes of liver cirrhosis. E. Is an RNA virus. Answer A. False: parenteral (blood products, surgical or medical procedure), perinatal and sexual transmission (Baveja Microbiology page 493) B. True: prophylaxis immunization (Baveja Microbiology page 495) C. True: increases the risk of primary liver cancer. (Bailey & Loves, 25th Edition, page 1094) D. True: produces long-term liver damage with development of liver cirrhosis. (Bailey & Loves, 25th Edition, page 1094) E. False: DNA virus (Baveja Microbiology page 491)

17. Thyroid carcinoma: A. of the papillary type usually affects young adults. B. presents as lump in the neck that moves on swallowing. C. of the anaplastic type carries the best prognosis. D. of the medullary type is a tumour of parafollicular cells. E. typically causes thyroid dysfunction. Answer A. True: higher incidence in the third and fourth decades (S. Das, A Concise Textbook of Surgery, 7th Edition, page 545), young females commonly affected, aged 20-40. (Manipal Manual of Surgery, 3rd Edition, page 296) B. False: fixed in inflammation or malignant infiltration (S. Das, A Concise Textbook of Surgery, 7th Edition, page 287 & Manipal Manual of Surgery, 3rd Edition, page 296) C. False: worse prognosis. survival rarely exceeds 6 months. (Bailey & Loves, 25th Edition, page 797) D. True: tumours of parafollicular cells (C cells) E. False: TSH levels are often raised in carcinoma (Bailey & Loves, 25th Edition, page 793)

18. Which of the following conditions are associated with metabolic acidosis? A. On controlled diabetes mellitus. B. Marked hyperthyroidism. C. Acute renal failure. D. Prolonged vomiting due pyloric stenosis. E. End stage emphysema. Answer A. False: uncontrolled DM which leads to diabetic ketoacidosis (Davidsons Principle and Practice of Medicine, Edition, page 443) B. C. True: cause overproduction of ketone bodies (http://books.google.co.in/books?id=Ap2Gc5U0TPwC&pg=PA168& lpg=PA168&dq=can+hyperthyroidism+cause+metabolic+acidosis& source=bl&ots=Wx6PDINH7H&sig=RuDxX98KvqFuw9iCxjEpF0Kn VcU&hl=en&sa=X&ei=CKbUcODMcmqrAf8xoG4Aw&ved=0CGAQ6AEwCA#v=onepage&q=c an%20hyperthyroidism%20cause%20metabolic%20acidosis&f=fals e) D. True: causes increased anion gap (Davidsons Principle and Practice of Medicine, Edition, 443) E. True: causes overproduction of ketone bodies (http://books.google.co.in/books?id=Ap2Gc5U0TPwC&pg=PA168& lpg=PA168&dq=can+hyperthyroidism+cause+metabolic+acidosis& source=bl&ots=Wx6PDINH7H&sig=RuDxX98KvqFuw9iCxjEpF0Kn VcU&hl=en&sa=X&ei=CKbUcODMcmqrAf8xoG4Aw&ved=0CGAQ6AEwCA#v=onepage&q=c an%20hyperthyroidism%20cause%20metabolic%20acidosis&f=fals e) F. False: causes respiratory acidosis due accumulation of C02 because of reduced effective alveolar ventilation and respiratory failure (Davidsons Principle and Practice of Medicine, Edition, page 445)

19.

A femoral hernia: A. Is commoner in women than in men B. Emerges below and lateral to the pubic tubercle C. Is related on its medial side to the lacunar ligament and laterally to the femoral vein D. Has a significantly higher rate of complication than an inguinal hernia

E. Is cured by Bassinis operation Answer A. True: Femoral hernia is more common in women occurs 20% in women and 5% in men (Bailey & Loves Short Practice of Surgery, 25th Edition, page 977) B. True: The femoral hernias lies below and lateral to pubic tubercle whereas inguinal hernia emerges above and medial to it. (Bailey & Loves Short Practice of Surgery, 25th Edition, page 971, Figure 57.4) C. True: femoral ring is bounded anteriorly by the inguinal ligament, posteriorly by iliopectinal ligament, the pubic bone and fascia over pectineus muscle; medially by lacunar ligament; laterally by a thin septum separating it from the femoral vein (Bailey & Loves Short Practice of Surgery, 25th Edition, page 978) D. True: A femoral hernia strangulates frequently and gangrene rapidly develops because of its narrow, unyielding femoral ring (Bailey & Loves Short Practice of Surgery, 25th Edition, page 979) E. False: is cured by low operation (Lockwood), the high operation (McEvedy) and inguinal operation (Lotheissen). (Bailey & Loves Short Practice of Surgery, 25th Edition, page 979)

20. Which of the following(s) is/are known to cause small bowel obstruction? A. Crohns disease B. Foramen of Bochdalek - Congenital diaphragmatic hernia C. Phytobezwar D. Ladds band E. Ligament of Treitz Answer A. True: Crohn's disease causing adhesions or inflammatory strictures (http://en.wikipedia.org/wiki/Bowel_obstruction) B. True: Hernia is a cause of small bowel obstruction (http://en.wikipedia.org/wiki/Bowel_obstruction) C. True: Phytobezoars are the firm mass of undigested fruit/vegetable fibre (Bailey & Loves Short Practice of Surgery, 25th Edition, page 1190) D. True: Ladd's band is a fibrous stalk of peritoneal tissue that attaches the cecum to the abdominal wall, and creates an obstruction of the duodenum. (http://en.wikipedia.org/wiki/Ladd's_bands) E. False: Ligament of Treitz is the suspensory muscle of duodenum

21. A 45 year old male presents with pain in the right gluteal region. On examination swelling was tenderness and crepitus was felt. Which of the following is/are TRUE? A. Gas in subcutaneous tissues is also known as surgical emphysema B. Gas in the tissues usually shows up in X-ray C. Clostridium botulinum typically causes gas producing tissue infection D. Anaerobic staphylococci are the common cause of gas producing necrotizing fasciitis E. Early cases of gas gangrene need surgical treatment and are not successfully treated medically Answer A. False: When gas or air is present in the subcutaneous layer of the skin is caused by surgery it is called surgical emphysema (http://en.wikipedia.org/wiki/Subcutaneous_emphysema) B. True: Radiography can visualize the gas in the soft tissues (Bailey & Loves Short Practice of Surgery, 25th Edition, page 422) C. False: Common causative organism is Clostridium perfingens (Bailey & Loves Short Practice of Surgery, 25th Edition, page 422) D. False: Gas producing necrotizing fasciitis caused by gas forming organism Clostridium http://emedicine.medscape.com/article/2051157-overview#a0101 E. True: The mainstay of management is early surgical excision of necrotic tissue (Bailey and Loves Short Practice of Surgery page 422)

22. A physician informs that he is sending you a 45-year old woman with a palpable neck mass and obvious thyrotoxicosis. His diagnosis is toxic adenoma of the thyroid. You would expect tp receive a patient who: A. Has tachycardia B. Complains of chronic constipation C. Has single thyroid nodule with diffuse enlargement of the remaining gland D. Has elevated T3, T4, and TSH E. Has a malignancy as detected Answer A. True: Thyrotoxicosis patient comes with tachycardia (Bailey & Loves Short Practice of Surgery, 25th Edition, page 784)

B. False: Thyrotoxicosis causes diarrhoea (Bailey & Loves Short Practice of Surgery, 25th Edition, page 786) C. True: An adenoma is typically solitary (single nodule) http://en.wikipedia.org/wiki/Thyroid_adenoma D. False: TSH level will be suppressed in toxic nodule of thyroid (Bailey & Loves Short Practice of Surgery, 25th Edition, page 783) E. False: Thyroid Adenoma is a benign tumor of thyroid gland (Bailey & Loves Short Practice of Surgery, 25th Edition, page 792)

23. Which of the following cancer is/are known to be linked to a viral infection? A. Burkitts lymphoma B. Nasopharyngeal carcinoma C. Hepatoma D. Carcinoma of the cervix E. Brochogenic Ca Answer A. True: caused by Epstein Barr Virus (EBV) B. True: caused by Epstein Barr Virus (EBV) C. True: Hepatoma or hepatocellular Carcinoma by Hepatitis C virus D. True: Caused by Human Papilloma Virus (HPV) E. False: Mainly caused by smoking not infections Source: https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=7 5890

24. In which of the following causes of shock is the intravascular fluid volume likely to be normal? A. Shock following prolonged intestinal obstruction B. Shock following a large burn C. Shock following spinal anaesthesia D. Shock following a penicillin injection E. Shock in a patient with an enteric fistula Answer A. True: Hypovolaemic shock due to reduction in total blood volume B. True: Hypovolaemic shock C. False : Anaphylactic shock

D. False : Anaphylactic shock E. True: Hypovolaemic shock due to blood loss Souce : SRBs Manual of Surgery Page 91 Topic: Shock http://www.aic.cuhk.edu.hk/web8/shock.html

25. During the process of wound healing: A. The inflammatory phase begins 2-3 days after injury. B. The proliferative phase last from 3days to 3weeks following the injury. C. The remodeling phase involves fibroblast activity and production of collagen and ground substance. D. Fibroblast requires vitamin C to produce collagen. E. The white cells stick to the damaged endothelium and release Adenosine Diphosphate (ADP) and cytokines. Answer A. False; the inflammatory process begins immediately after wounding and last 2-3days (Bailey & Loves Short Practice of Surgery, 25th Edition, page 24) B. True; the proliferative phase lasts from the 3rd day to the 3rd week (Bailey & Loves Short Practice of Surgery, 25th Edition, page 24) C. False; the proliferative phase is the one, which involves fibroblast activity and production of collagen and ground substance. Meanwhile the remodelling phase is characterised by maturation of collagen. (Bailey & Loves Short Practice of Surgery, 25th Edition, page 24) D. True; Fibroblasts requires vitamin C to produce collagen (Bailey & Loves Short Practice of Surgery, 25th Edition, page 24) E. False; it is the platelets that stick to the damaged endothelium and release ADP and cytokines. (Bailey & Loves Short Practice of Surgery, 25th Edition, page 24)

26. With regard to 0.9% normal saline, intravenous fluid the following statements explain the characters: A. It has the same sodium concentration as plasma. B. It has equimolar concentration of sodium and chloride. C. It is low in potassium. D. It is dextrose free fluid. E. It is the best fluid to be used in hypovolaemia.

Answer A. False; 0.9% normal saline has 154mEq/L sodium concentration meanwhile in plasma the sodium concentration is 135 and 145 mEq/L. (Bailey & Loves Short Practice of Surgery, 25 th Edition, page 226. Also can refer here; http://en.wikipedia.org/wiki/Hyponatremia) B. True; both sodium and chloride have concentration of 154mEq/L in the 0.9% normal saline. (Bailey&Loves 25th edition page 226) C. False; it does not contain any potassium. (Bailey & Loves Short Practice of Surgery, 25th Edition, page 226) D. True; 0.9% normal saline only contains sodium and chloride ions. (Bailey & Loves Short Practice of Surgery, 25th Edition, page 226) E. True; http://en.wikipedia.org/wiki/Saline_(medicine)

27. With regards to Glasgow Coma Scale (GCS) in head trauma: A. The maximum score is 15. B. The optimum score is 0. C. A GCS score of 10 the patient is in coma. D. Eye opening to command/speech is scored 2. E. GCS 6 the patient is in coma. Answer A. True; (Alagappan: Manual of Practical Medicine, 4th Edition page 428) B. False; the optimum/best score in GCS is 15. (Alagappan: Manual of Practical Medicine, 4th Edition page 428) and the score cannot be lower than 3 (http://www.brainline.org/content/2010/10/what-isthe-glasgow-coma-scale.html) C. False; 8 or less score in GCS is for comatose patient (http://healthfitnessnme.blogspot.in/2013/03/glasgow-coma-scalefor-adults.html) D. False; eye opening to command/speech is scored 3 in GCS (Alagappan: Manual of Practical Medicine, 4th Edition page 428) E. True; score 8 or less in GCS is for comatose patient. (http://healthfitnessnme.blogspot.in/2013/03/glasgow-coma-scalefor-adults.html)

28. The following edges of an ulcer indicate malignancy: A. Sloping.

B. C. D. E.

Overhanging. Everted. Punched out. Rolled

Answer A. False; it is found in healing traumatic and venous ulcers (S. Das: A Manual on Clinical Surgery, 7th Edition page 47) B. False; found in corneal ulcers (http://en.wikipedia.org/wiki/Corneal_ulcer) C. True; found in epithelioma benign /malignant tumour of epithelium (S. Das: A Manual on Clinical Surgery, 7th Edition page 47) D. False; found commonly in gummatous ulcer or deep trophic ulcer. (S. Das: A Manual on Clinical Surgery, 7th Edition page 47) E. True; found in basal cell carcinoma (S. Das: A Manual on Clinical Surgery, 7th Edition page 47)

29. The causes of non-dynamic intestinal obstruction include: A. Paralytic ileus. B. Hernia. C. Mesenteric vascular obstruction. D. Pseudo-obstruction. E. Adhesion Answer A. True; (Bailey & Loves Short Practice of Surgery, 25th Edition, page 1188) B. False; it is classified under dynamic and extramural type of intestinal obstruction (Bailey & Loves Short Practice of Surgery, 25th Edition, page 1188) C. True; (Bailey&Loves short practice of surgery 25th edition page 1188) D. True; (Bailey & Loves Short Practice of Surgery, 25th Edition, page 1188) E. False; it is classified under dynamic and extramural type of intestinal obstruction (Bailey & Loves Short Practice of Surgery, 25th Edition, page 1188)

30. The differential diagnosis of acute appendicitis in an adult female includes: A. Rupture of ectopic pregnancy. B. Renal calculi. C. Acute salpingitis. D. Right pyelonephritis. E. Inferior myocardial infarction Answer A. True; (Bailey & Loves Short Practice of Surgery, 25th Edition, page) 1210 B. False; ureteric colic can be one of the differential diagnosis in adult acute appendicitis however it does not commonly cause diagnostic difficulty as the character and radiation of pain differs from that of appendicitis. (Bailey & Loves Short Practice of Surgery, 25th Edition, page 1210) C. True; Pelvic inflammatory disease (PID) is one of the differential diagnoses of acute appendicitis. PID comprises of spectrum of diseases include salpingitis etc. (Bailey & Loves Short Practice of Surgery, 25th Edition, page 1210) D. True; right sided acute pyelonephritis can be one of the differential diagnoses (Bailey & Loves Short Practice of Surgery, 25th Edition, page 1210) E. False; (Bailey & Loves Short Practice of Surgery, 25th Edition, page 1210)