Correct Answer B
Spleniculi or accessory spleens are most commonly ( about 80%) seen at the hilum of the spleen. Also know: Location of accessory spleen in decreasing order are: .| Splenic hilum ◦ Gastrocolic ligament Tail ofpancreas ◦Greater omentum •Greater curvature of stomach .Splenocolic ligament .Small and large bowel mesentery . Left broad ligament of women .Left spermatic cord in men
Ref: Schwartz 9/e, Page 1246; Bailey & Love 25/e, Page 25/e, Page 1103
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Correct Answer B
The commonest type of melanoma is the superficial spreading melanoma (SSM). The melanoma progress through 3 phases: in situ, radial growth, vertical growth. NB: A primary melanoma with no recognizable adjacent in situ or radial growth phase is nodular melanoma.
Melanoma with similar prevalence in all ethnic groups- acral lentiginous.
Ref: Rook's textbook of dermatology, Edition-8, Page-54.45
Correct Answer -A The CT severity index (CTSI)-described by Balthazar Balthazar CT Severity Index CT Grade Score A. Normal- O B. Enlarged gland -1 C. Peri-pancreatic inflammation-2 • D. One fluid collection-3 • E. Two or more collections- 4 Necrosis Score
• 30%-50%- (4) .>50% -(6) Ref: ACR Appropriateness Criteria,Acute Pancreati
Correct Answer-B The bulbar urethra is crushed upwards onto pubic bone, typically with significant bruising. Cycling accidents, loose manhole cover and gymnasium accidents astride the beam account for numbr of cases. CLINICAL FEATURES The signs of a ruptured bulbar urethra are perineal bruising and haematoma, typically with a butterfly distribution' There is usually bleeding irom the urethral meatus and retenrion of urine is also typically present Rupture of the membranous urethra typically occurs in association with a fractured pelvis and may be associated with an extraperitoneal rupture of the bladder. The most common causes of pelvic fracture are road traffic accidents, severe crush injuries and falls. The clinical fearures include urinary retention, blood at the urethral meatus. There is typically marked bruising of the pubic area, scrorum and penis.
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Q.]During acclimitisation, decreased sweating is due to down regulation of?
a) Epinephrine receptors
b) Norepinephrine receptors
c) Acetylcholine receptors
d) Dopamine receptors
Correct Answer-A Squamous cell carcinoma is the most common type of anal cancer. This cancer begins in the outer lining of the anal canal. Mainly three types of malignant neoplasm are seen in anal canal • Squamous cell carcinoma (most common) • Basal cell carcinoma (2nd most common) • Melanoma Also remember: Most common type of rectal and colon cancer Adenocarcinoma
Ref: S. Das textbook of surgery 3/e, Page 1078.
Correct Answer A
Gall stone
REF: Sutton's textbook of radiology, Th edition, volume 1 page 713 Mercedes Benz sign/Seagull sign/Crow feet sign: Gall bladder stone if radiopaque has a stellate faceted appearance with gas containing fissures on the plain radiograph and is called as Mercedes Benz sign/Seagull sign or Crow feet sign
Correct Answer - A It is characterized clinically by medullary thyroid carcinoma (MTC) pheochromocytoma, and hyperparathyroidism. Approximately 70- 95% of individuals with MEN 2A develop MTC, 50% develop pheochromocytoma, and 15-30% develop hyperparathyroidism
Ref: Bailey and Love's Short Practice of Surgery, 24th Edition, Page 802; Harissons Internal Medicine, 18th Edition, Chapter 351
Correct Answer -D
Postoperative adhesions REF: Bailey & Love 25th edition page 1188, http:/lemedicine.medscape.comlarticle/774140overview "The most common cause of small-bowel obstruction (SBO) is postsurgical adhesions"
The most common causes of intestinal obstruction in adults are: Intestinal adhesions - bands of fibrous tissue in the abdominal cavity that can form after abdominal or pelvic surgery
In children, the most common cause of intestinal obstruction is telescoping of the intestine (intussusception).
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Correct Answer -C Although isolated metastasis to spleen is rare, studies found the most common primary neoplasms with splenic metastasis to be gynecologic (61%), with majority being ovarian, colorectal (15%), lung (9%), and stomach (4%). Ref: CT and MRI of the Abdomen and Pelvis: A Teaching File edited by Pablo R. Ros. Koenraad J. Mortele, 2006, Page 218
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Correct Answer- B Spleniculi or accessory spleens are most commonly ( about 80%) seen at the hilum of the spleen. Also know: Location of accessory spleen in decreasing order are: .| Splenic hilum Gastrocolic ligament • Tail of pancreas • Greater omentum • Greater curvature of stomach • Splenocolic ligament O Small and large bowel mesentery ◦ Left broad ligament of women • Left spermatic cord in men
Ref: Schwartz 9/e, Page 1246; Bailey & Love 25/e, Page 25/e, Page 1103
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[9.2] A 59-year-old man is admitted to the intensive care unit for a myocar- dial infarction. He is given a ẞ-adrenergic antagonist and instructed to avoid emotional turmoil to decrease sympathetic stimulation of the heart. From a cellular perspective, sympathetic stimulation of the heart does which of the following?
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A previously healthy, 27-year-old agricultural worker develops nausea, vomiting, abdominal cramps, cough with wheezing and dyspnoea, salivation, and lacrimation 1 hour after leaving work in a field. On examination, he is afebrile with a heart rate of 50/min and blood pressure of 90/55 mm Hg. Laboratory studies show plasma cholinesterase activity less than 50% of normal. Atropine is given intravenously, and his condition improves. He was most likely exposed to which of the following substances?
A Aflatoxin
B Cyclodiene
C Dioxin
D Ergot alkaloid
E Organophosphate
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A 30-year-old woman presents with complaints of fatigue, dizziness, and shortness of breath on exertion for the past few weeks. On physical examination, a systolic murmur is noted at the left sternal border, with no signs of heart failure or valvular abnormalities. Laboratory findings reveal a hemoglobin of 7.5 g/dL, MCV of 72 fL, and low ferritin levels. Her reticulocyte count is slightly elevated. Which of the following is the most likely cause of the murmur in this patient?
A) Iron-deficiency anemia
B) Thalassemia minor
C) Aortic regurgitation
D) Mitral valve prolapse
E) Sickle cell disease
Correct Answer Hemobilia presents with the triad of biliary colic, obstructive jaundice, and occult or gross intestinal bleeding. Causes are, . Hepatic trauma . Ductal parasitism (Ascaris lumbricoides) . Oriental cholangiohepatitis ◦ Hepatic neoplasms . Rupture of a hepatic artery aneurysm ◦ Hepatic abscess . Choledocholithiasis The diagnosis may be suspected from a technetium-99m-labeled red blood cell scan, but an arteriogram is usually required for diagnosis and planning of therapy
Ref: Doherty G.M. (2010). Chapter 25. Biliary Tract. In G.M. Doherty (Ed), CURRENT Diagnosis & Treatment: Surgery, 13e.
Correct Answer-B Squamous cell anal cancer is rare but associated with Human papilloma virus infection (HPV), Anal intra-epithelial neoplasia (AIN) and immunosuppression. The current treatment of anal canal carcinoma is chemoradiotherapy (combined modality therapy). Chemotherapy include a combination of 5-FU with mitomycin C or Cisplatin. Ref: Bailey and Love Short Practice of Surgery, 25th Edition, Page 1269; The MD Anderson Manual of Medical Oncology, 2nd Edition, Chapter 22.
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Wishing you all bright and prosperous Diwali. Let this Diwali be a time of renewal and prosperity in both our professional and personal lives.
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Correct Answer -C Ulcerated sebaceous cyst [Ref. Love & Bailey 23/e page 173, 595; Das text book of Surgery3/e p81] Repeat from May 04 . Cock's peculiar tumour is a sebaceous cyst linked growth that can resemble a squamous cell carcinoma The proliferating cyst is usually solitary, but it often arises from a simple trichilemmal cysts in the hair follicle epithelium.
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Correct Answer - A
Both acute and chronic rejection may result in hypertension. The former causes acute fluid retention and plugging of peritubular capillaries with inflammatory cells. This may progress to intimal swelling and medial necrosis and eventuate in ischemia secondary to endothelial proliferation and obliteration of small vessels. Chronic rejection, thought to be related to protracted humoral injury, results in obliteration of capillaries via the development of intimal hyperplasia. Cyclosporine has a vasoconstrictive effect which, through activation of the renin-angiotensin system, may lead to hypertension. RTAS is responsible for hypertension in 4% to 12% of renal allograft recipients. It responds well to percutaneous angioplasty. A careful trial of angiotensin-converting enzyme inhibitors may be diagnostic of RTAS. Recurrent disease such as membranoproliferative glomerulonephritis and focal glomerular sclerosis may result in significant hypertension in renal allograft rejections.
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