NEET-SS General Surgery

presents
National-level Free
MOCK EXAM on
NEET-SS:
General
Surgery
DISCLAIMER: The questions
here have been created by
experts in line with exam
patterns and the syllabus.
Questions from previous NEET-
SS exams have not been
reproduced here.
1.Which of the following is a classical feature of metabolic response seen in trauma and
sepsis which differentiates it from starvation?
A. Hepatic glycogenolysis
B. High plasma glucagon levels
C. Loss of adaptive ketogenesis
D. Lipid oxidation
C. Loss of adaptive ketogenesis
Metabolic changes in starvation are often similar to changes in trauma and sepsis. Adaptive
ketogenesis doesn’t however occur in trauma and sepsis.
Metabolic response to trauma and sepsis

● Increased counter-regulatory hormones: adrenaline, noradrenaline, cortisol,
glucagon and growth hormone
● Increased energy requirements (up to 40 kcal/kg per day)
● Increased nitrogen requirements
● Insulin resistance and glucose intolerance
● Preferential oxidation of lipids
● Increased gluconeogenesis and protein catabolism
● Loss of adaptive ketogenesis
● Fluid retention with associated hypoalbuminemia
Ref: Bailey & Love's Short Practice of Surgery, 27th Edition, Chapter 19
2. What is the amount of energy required to raise the core body temperature by 1 degree
Celsius in an average 75 kg man?.
A. 50 kcals
B. 22 kcals
C. 82 kclas
D. 62 kcals
D. 62 kcals
It takes 62.25 kcal (75 kg × 0.83) to raise body temperature by 1° C. If a patient were to
lose 62.25 kcal, body temperature would drop by 1° C.
Ref: Sabiston Textbook of Surgery, 20th edition, Chapter 4, Shock, electrolytes and
fluids.
3. A 56year lady accidentally sustained burns in her right leg and picture as shown. She
worried about the wound and visited a plastic surgeon after a couple of weeks for further
management. This lesion has healed by
A. Primary intention
B. Secondary intention
C. Delayed primary intention
D. None
B. Secondary intention
In this particular patient, eschar formation has occurred. Eschar is essentially healing by
secondary intention.
4. SIMS hospital in Chennai recently purchased a Thunderbeat coagulation device for use
by their GI team. Thunderbeat works by the mechanism of:
A. Ultrasound vibration
B. Bipolar
C. Monoplane
D. Both A & B
D. Both A & B
Thunderbeat STM (Olympus), has combined both modalities in a single device. By

simultaneously using ultrasonic vibration and bipolar diathermy, this device is able to seal
and divide arteries and veins up to 7 mm in diameter. There is also a ‘seal only’ mode
activated by a separate button, which activates bipolar diathermy only.
5. The commonest site of fistulation in the below condition is
A. Rectovesicle
B. Rectobulbar urethra
C. Rectovaginal
D. Rectoperineal
B. Rectobulbar urethra
Anorectal malformations
The anus is either imperforate or replaced by a fistula which does not pass through the
muscle complex and opens away from the specialised skin which represents the true anal
site. The sacrum and genitourinary tract are often abnormal. In boys, there may be a
rectoperineal fistula but the most common anomaly is an imperforate anus with a
rectobulbar urethral fistula . In girls, the commonest anomalies are a fistula opening in the
posterior vestibule behind the vagina or on the perineum.
6. The angiogenic competence limit of a tumor mass is
A. 1mm
B. 2mm
C. 1cm
D. 2cm
A. 1 mm
Acquired angiogenic competence

A mass of tumour cells cannot, in the absence of a blood supply, grow beyond a diameter
of about 1 mm. This places a severe restriction on the capabilities of the tumour: it cannot
grow much larger or spread widely within the body. If, however, the mass of tumour cells
is able to attract or to construct a blood supply then it is able to quit its dormant state and
behave in a far more aggressive fashion. The ability of a tumour to form blood vessels is
termed ‘angiogenic competence’ and is a key feature of malignant transformation.
7. Cardiopulmonary exercise testing(CPET) is used as a screening tool to identify high-risk

patients. The oxygen (O2) consumption and carbon dioxide (CO2) production of the
patient are measured while they undergo a 10 minute period of incrementally demanding
exercise (usually on a cycle ergometer) up to their maximally tolerated level. Which of the
following is false about CPET?
A. Anaerobic threshold(AT) greater than 11ml/kg/min puts patients at a higher risk of
morbidity and mortality
B. Peak oxygen consumption(VO2) below 15ml/kg/min puts patients at a higher risk
of morbidity and mortality
C. When delivery of CO2 becomes inadequate, anaerobic metabolism occurs
D. 6 minute walk test is an substitute for CPET
C. When delivery of CO2 becomes inadequate, anaerobic metabolism occurs.
CPET is based on the principle that when a subject’s delivery of O2 to active tissues
becomes inadequate, anaerobic metabolism begins; lactate is buffered by bicarbonate and
the resulting CO2 increases out of proportion to the escalation in physical difficulty and O2
consumption. The ‘anaerobic threshold’ (AT) is the O2 consumption in mL/kg/min above
which this occurs. Peak oxygen consumption (VO2) is also measured. They are the end
product of a subject’s combined respiratory, cardiac, vascular and musculoskeletal fitness,
and subjects with either an AT above a somewhat arbitrary cutoff of 11 and a VO2 below
15 mL/kg/min are at higher risk of morbidity and mortality after surgery. When CPET is
not available, a simple walk test, such as the 6-minute walk test (6MWT) and the
incremental shuttle walk test (ISWT), can be used to assess the functional capacity of the
patient.
8. Which of the following is a definite risk factor for post-ERCP pancreatitis?
A. Young age
B. Female sex
C. Low volume of ERCPs performed
D. Absent CBD stones
A. Young age
9. What is not true about the use of tranexamic acid in trauma?

A. Useful only when given within 24 hrs of injury
B. Given in all trauma patients with systolic BP <110 mmHg
C. Tranexamic acid reduces mortality after trauma
D. Useful in both blunt and penetrating trauma
A. Useful only when given within 24 hrs of injury
Tranexemic acid
It is useful only when given within 3 hours of injury.
Tranexamic acid is an antifibrinolytic drug that reduces the risk of mortality from bleeding
in both blunt and penetrating trauma. One gram is given intravenously over 10 minutes,
followed by a further 1 g dose over 8 hours. Tranexamic acid should be given to all trauma
patients suspected to have significant haemorrhage, including those with a systolic blood
pressure of <110 mmHg or a pulse of over 110 per minute.
10. Pulmonary aspiration of gastric contents during anaesthesia is an uncommon but

serious complication. To prevent aspiration, NPO guidelines have been developed for
patients scheduled for anesthesia and surgery. Which of the following is not true regarding
the following statements?
A. Clear liquids 2 hrs before surgery
B. Non human milk 6 hrs before surgery
C. Infant formula 4 hrs before surgery
D. Solid foods 6 hrs before procedure
C. Infant formula 4 hrs before surgery
Ref: Sabiston Textbook of Surgery, 20th edition, Chapter 10
11. Which is true about the ‘deadly dozen’ injuries?

A. Open pneumothorax and tension pneumothorax are potentially and immediately
life-threatening conditions respectively
B. All 12 conditions should be evaluated in primary survey as they represent threats
to life
C. Diaphragmatic rupture is a potentially life-threatening condition.
D. All of the above
C. Diaphragmatic rupture is a potentially life-threatening condition.
Life-threatening injuries can be remembered as the ‘deadly dozen’. Six are immediately
life-threatening and should be sought for and managed during the primary survey and six
are potentially life threatening and should be detected during the secondary survey. A high
index of suspicion must be maintained thereafter to diagnose the potential threats to life, as
their symptoms and signs can be very subtle.
Immediately life threatening:

1. Airway obstruction
2. Tension pneumothorax
3. Open pneumothorax
4. Pericardial tamponade
5. Massive haemothorax
6. Flail chest
Potentially life threatening:

1. Aortic injuries
2. Tracheobronchial injuries
3. Oesophageal injuries
4. Diaphragm rupture
5. Pulmonary contusion
6. Myocardial contusion
12. Hepatitis B viral prophylaxis for a person having a needle stick injury during ward
procedure should include all except
A. Hepatitis B immunoglobulin within 24 hrs
B. Testing for Hepatitis B antigen
C. Starting vaccination schedule
D. If already vaccinated checking for anti-Hepatitis immune status
B. Testing for Hepatitis B antigen
Postexposure Management: Baseline HBV Testing of Exposed* Person

● Test for anti-HBs if person has been vaccinated, but vaccine response is unknown
● Baseline testing not necessary if vaccine response is known
● If an exposed person has been vaccinated and is a known responder to the vaccine,
no PEP is necessary
Unvaccinated - HBIG x 1 and initiate hepatitis B vaccine series
Previously vaccinated Antibody response unknown - Test exposed person for anti-HBs
1. If adequate, no treatment
2. If inadequate, HBIG x 1 and vaccine booster
Ref : CDC Guidelines :Centre For Disease Control and Prevention, Hepatitis B
13. Rejecting a null hypothesis when it is true is called as:
A. Type 1 error
B. Type 2 error
C. Type 3 error
D. Type 4 error
A. Type 1 error
Null hypothesis - Statement opposite to hypothesis.
14. How does the skin graft survive in the first 6hrs?
A. Imbibition
B. Inosculation
C. Neoangiogenesis
D. None
A. Imbibition
Split-thickness skin grafts survive initially by imbibition of plasma from the wound bed;
after 48 hours, fine anastomotic connections are made, which lead to inosculation of blood.
Capillary ingrowth then completes the healing process with fibroblast maturation. Because
only tissues that produce granulation will support a graft, it is usually contraindicated to
use grafts to cover exposed tendons, cartilage or cortical bone.
15. What is the most common tissue of origin for brain metastasis?
A. Lung
B. Breast
C. Colon
D. Melanoma
A. Lung
16. Ms Devi Karpagam, a 49 years old female is undergoing elective laparoscopic

cholecystectomy for Symptomatic Gallstone disease. During the creation of
pneumoperitoneum the anaesthetist and surgeon were intently watching the ECG monitor.
Which is the most common complication anticipated?
A. Sinus tachycardia
B. Sinus bradycardia
C. Atrial fibrillation
D. Ventricular fibrillation
B. Sinus bradycardia
Insufflation of gas is necessary to achieve pneumo-peritoneum for enhanced access to the

abdomen. The peritoneal stretch causes a vaso-vagal response which is manifested as Sinus
bradycardia. It is managed by giving vagolytics like atropine, reducing the insufflation
pressures or and preventing hypovolemia by fluid resuscitation.
Ref: Schwartz Principles of Surgery, Absite and Board Review, 10th edition, Chapter
14
17. Band keratopathy is a pathognomonic for

A. Primary hyperthyroidism
B. Secondary hyperthyroidism
C. Primary hyperparathyroidism
D. Secondary hyperparathyroidism
C. Primary hyperparathyroidism
Band keratopathy is pathognomonic of the primary hyperparathyroidism is due to

deposition of calcium phosphate crystals in the cornea.
18. Which statement regarding mesenchymal stem cells is not true?

A. They are adherent to plastic
B. They express haematopoietic stem cell markers
C. They resemble fibroblasts
D. They can be obtained from umbilical cord
B. They express haematopoietic stem cell markers

MSCs are multipotent stromal cells that can be sourced from a variety of tissues, including
bone marrow, adipose tissue and umbilical cord. Morphologically they resemble fibro-
blasts. They are adherent to plastic, express certain cell surface markers (CD105, CD73
and CD90), and do not express the cell surface markers associated with haematopoietic
stem cells (such as CD34 and CD45). MSCs were initially shown to have the ability to be
directed to differentiate into a variety of specialised cell types of the mesodermal lineages,
including osteoblasts, chondrocytes, adipocytes, tenocytes and myocytes. Recent studies
suggest that they may also be directed into cells of the ectoderm and endoderm lineages.
19. Synovial thickening is one of the best ways to detect early arthropathy. Which
investigation modality is sensitive in detecting synovial thickening
A. Gadolinium DTPA enhanced MRI
B. CT scan
C. USG
D. High resolution X rays
A. Gadolinium DTPA enhanced MRI
Early arthropathy will be missed on radiographs and, with the advent of disease-modifying
drugs, it is important to detect early synovitis before it is even apparent on clinical
examination.
Gadolinium diethyl triamine penta-acetic (DTPA)-enhanced MRI is the most

sensitive method for detecting synovial thickening of numerous joints, but ultrasound is
also sensitive, albeit more laborious to perform. Ultrasound shows effusions and synovial
thickening clearly, and shows the increased blood flow around the affected joints without
the use of contrast agents.
20. Thyroid transcription factor – 1(TTF -1) is used as immunohistochemical marker for
which malignancy?
A. Lung
B. Parathyroid
C. Thyroid
D. Desmoid and bone
A. Lung
TTF- 1 is a factor that is involved in embryonic development and differentiation of lung

and thyroid tissue. It is highly specific for cancers of the lung.
● Prostate: prostate-specific antigen (PSA)

● Lung: thyroid transcription factor-1 (TTF-1)
● Thyroid: thyroglobulin
● Colorectum: cytokeratin 20 (CK20), CDX2
● Liver: HepPar
● Gastrointestinal stromal tumour (GIST): CD117, DOG-1
21. Which of the following is not true regarding Hyperbaric oxygen(HBO) therapy?
A. HBO therapy involves inhalation of 100% O2 at 1.9 to 2.5atm , which increases
tissue PaO2 by 10 times.
B. The higher PaO2 is sufficient to supply all metabolic requirements, even in the
absence of hemoglobin.
C. Pneumothorax is the most common complication.
D. It’s contraindicated in patients on Doxorubicin therapy
C. Pneumothorax is the most common complication.
HBO therapy involves inhalation of 100% O2 at 1.9 to 2.5atm , which increases tissue
PaO2 by 10 times. The higher PaO2 is sufficient to supply all metabolic requirements,
even in the absence of hemoglobin, this elevated level lasts for 2-4 hours after termination
of HBO therapy.
HBO therapy used for

1. Decompression sickness
2. Necrotizing fasciitis
3. Flap survival and salvage
4. Improvement of split thickness graft survival
5. Acute thermal burns
6. Hypoxia wounds
7. Chronic non healing ulcer
8. Ionising radiation, osteoradionecrosis.
Complications
1. Tympanic membrane perforation is the most common complication.
2. Pneumothorax
3. O2 toxicity- ARDS, seizure, transient myopia
Contraindications
1. Pneumothorax
2. Current or recent treatment with bleomycin or doxorubicin
3. Treatment with disulfiram( increased risk of oxygen toxicity)
22.Technological advances have revolutionised the field of surgery. What does VATS refer
to?
A. Video assisted thoracic surgery
B. Video assisted transplant surgery
C. Video assisted transverse surgery
D. Video assisted thoracoscopic surgery.
.D. Video assisted thoracoscopic surgery.
Video assisted thoracoscopic surgery is a minimal access technique to visualise the

thorax during thoracic surgery. The great advantage of VATS over sternotomy or
thoracotomy is avoidance of muscle division and bone fractures that allows for
diminished duration and intensity of pain and a shorter time to return to full
activity.
23. Leonine facies is a feature of:

A. Mycetoma
B.Filariasis
C.Leprosy
D.Poliomyelitis
C. Leprosy
Nodular lesions on the face in the acute phase of the lepromatous variety are known as
‘leonine facies’ (looking like a lion).
24. Artefactual inflation of survival time seen in screening programs is known as?
A. Length-time bias
B. Selection bias
C. Lead-time bias
D. None of the above
C. Lead-time bias
Lead time bias describes the phenomenon whereby early detection of a disease will always
prolong survival from the time of diagnosis when compared to disease picked up at a later
stage in its development whether or not the screening process has altered the progression of
the tumour.
Selection bias describes the finding that individuals who accept an invitation for screening
are, in general, healthier than those who do not and consequently will tend to live longer,
independent of the condition.
Length-time bias occurs because slow-growing tumours are likely to be picked up by
screening whereas fast-growing tumours are likely to arise and produce symptoms in
between screening rounds.
25. The proliferation phase of wound healing lasts up to

A. 3 months
B. 3 weeks
C. 3 days
D. 30 days
B. 3 weeks
Phases of Wound Healing:

● Inflammatory phase: Hours to 3 days
● Proliferative phase: 3 days to 3 weeks
● Remodelling phase: Upto months
26. A patient presents with sudden respiratory distress after 8 hours following
thyroidectomy. The suture site is bulging. Patient was shifted to OT immediately. Clots
were evacuated. This is an example of:
A.Primary hemorrhage
B.Secondary hemorrhage
C.Reactionary hemorrhage
D.Tertiary hemorrhage
C. Reactionary hemorrhage
Primary haemorrhage: Occurs immediately as a result of an injury or surgery.
Reactionary haemorrhage: It is delayed haemorrhage within 24 hours is usually caused by

dislodgement of clot by resuscitation, normalisation of blood pressure or vasodilation.
Secondary haemorrhage: Sloughing of wall of a vessel. It usually occurs 7-14 days after
injury and is precipitated by factors such as infection, pressure necrosis or malignancy.
27. Apfel score is used to assess risk of

A.Post-op wound infection
B.Post-op vomiting
C.Abdominal wound dehiscence
D.Post-op headache
B. Post-op vomiting
Apfel and Koivuranta scores are commonly used for assessing risk of
postoperative nausea and vomiting.
28. In the first 24 hours after a patient starts to starve, the major source of glucose in the
body is from
A.Gluconeogenesis
B.Glycogenolysis
C.Fatty acid oxidation
D.Ketosis
B. Glycogenolysis
Energy sources in starvation

● <12 hrs: Food from last meal
● 12-24 hrs: Glycogenolysis
● >24 hrs: Gluconeogenesis
● 48-72 hrs: Lipid oxidation
29. Which of the following drugs has dual action as an opioid and as an SNRI?
A. Pregabalin
B. Tapentadol
C. Gabapentin
D. Buprenorphine
B. Tapentadol
Tapentadol has a dual action on opioid and noradrenaline selective reuptake inhibition
pathways and may provide relief in patients with pain of both neuropathic and nociceptive
elements.
Pregabalin and gabapentin reduce spontaneous neuronal activity by their action on the
alpha-2-delta subunit of calcium channels, and are now used for managing neuropathic
chronic pain.
Severe and debilitating non-malignant chronic pain are managed with opioid analgesics
like buprenorphine.
30. Which of the following types of blast and injury and mechanism of injury is correctly
matched?
A. Primary blast - Blunt trauma

B. Tertiary blast - Effect of device additions
C. Secondary blast - Penetrating injury
D. Quaternary blast - Blast overpressure
C. Secondary blast - Penetrating

31. Which of the following statements is not true about resuscitation protocols in trauma?
A.Target BP should be 120 mmHg
B.Initial Bolus of 250 ml of crystalloid or O Negative blood is given
C.Excessive intravenous crystalloid or colloid solutions should be avoided because they
cause haemodilution and increase coagulopathy
D.Blood:FFP:Platelets ratio is 1:1:1
A. Target BP should be 120 mmHg

Target systolic blood pressure is 70–90 mmHg, although a higher pressure of >90 mm Hg
should be the target if a head injury is suspected. Small boluses of IV fluids (e.g. 250 mL
of O negative blood, or normal saline, if blood is not immediately available) should be
administered to achieve this target. Excessive intravenous crystalloid or colloid solutions
should be avoided because they cause haemodilution, increase coagulopathy and can cause
ARDS. In massive transfusion protocol, fluids should always be warmed and
Blood:FFP:Platelets ratio is 1:1:1.
32. The following are absolute contraindications to emergency day surgery pathway
except
A.System sepsis
B.Unstable diabetes
C.Age
D.Parenteral analgesia
C. Age
The only absolute contraindications for emergency day care surgery are systemic sepsis,
unstable diabetes, major comorbidities and if parenteral, rather than oral, analgesia is
required. Age is not a contraindication.
33. Blue dot sign is seen in

A. Testicular torsion
B. Testicular hydatid torsion
C. Pediatric hernia strangulation
D. Epididymo-orchitis
B. Testicular hydatid torsion
Torsion of the appendix testis/hydatid of morgagni is a benign situation. Although necrotic

appendix testis is reabsorbed without any sequelae in almost all cases, the clinical
presentation is a major challenge to clinicians. The classic presentation of torsion of the
appendix testis is "blue dot sign", where the inflamed and ischemic appendage can be
visualized from scrotal skin in the upper pole. The appendix testis (or hydatid of Morgagni)
is a vestigial remnant of the Müllerian duct, present on the upper pole of the testis and
attached to the tunica vaginalis. It is present about 90% of the time.
34. A large bedsore in the back was planned for surgery. However the surgeon in charge
wanted to attempt VAC closure before surgery.The pressure in a Vacuum assisted closure
(VAC) device is
A. -125 mm Hg
B. -100 mm Hg
C. +125 mm Hg
D. +100 mm Hg
A. -125 mm Hg
The use of negative pressure of -125 mm Hg applied to a tissue defect has positive effects
on wound closure, as well as making difficult and complex wounds more manageable
during the early stages of granulation.
Exudate is removed and the suction pressure affects angiogenesis and tissue regeneration.
The technique can be applied as part of early wound management before definitive surgical
closure has been planned, or in some cases to avoid the need for surgery altogether. The
foam sponge dressing is connected by a tube to a negative pressure pump that can be
controlled to give intermittent suction.
35. Sutherland formula is used to calculate feeding formulas for patients with burns. Ms
Krishnapriya, a 30 year old nurse is admitted in the burns ward. The plastic surgeon in the
burns ward wants to initiate early enteral feeding. What is accurate regarding the
Sutherland formula?
A. 35 Kcal/kg + 50 Kcal % TBSA

B. 60 Kcal/Kg + 35 Kcal %TBSA
C. 70 Kcal/Kg + 20 Kcal %TBSA
D. 20 Kcal/kg + 70 Kcal %TBSA
D. 20 Kcal/kg + 70 Kcal %TBSA
Any adult with a burn greater than 15% (10% in children) of TBSA has an increased
nutritional requirement. All patients with burns of 20% of TBSA or greater should receive
a nasogastric tube. (Feeding should start within 6 hours of the injury to reduce gut mucosal
damage.) A number of different formulae are available to calculate the energy
requirements
Curreri formula:
● Age 16-59 years: (25)W + (40)TBSA
● Age 60+ years: (20)W + (65)TBSA
Sutherland formula:
● Children: 60 kcal/kg + 35 kcal%TBSA
● Adults: 20 kcal/kg + 70 kcal%TBSP of patients
36. Which of the following statements regarding Bowen’s Disease is false?

A. It can affect the mucous membranes.
B. It usually presents as solitary lesions.
C. It may be associated with pruritus.
D. It can be treated with topical corticosteroid agents
D. It can be treated with topical corticosteroid agents
Bowen’s disease represents an intra-epithelial squamous cell carcinoma (carcinoma in situ).

It can involve the skin or mucous membranes in the mouth, anus, or genitalia. It usually
appears as a solitary, erythematous, scaly plaque. It is associated with pruritus, superficial
crusting and discharge. There is a 7% increase in incidence of internal malignancies of the
bladder, bronchus, breast and oesophagus. Treatment includes surgical excision or a
combination of curettage and electrodessication. Adequate excision is essential, as lesions
may become invasive squamous cell carcinomas and metastasize. Topical therapy such as
5-fluorouracil might be effective if multiple lesions are present.
37. Which is true regarding the Delaire regimen for cleft repair?
A. Unilateral cleft lip and palate repair requires only one operation at 5-6 months.
B. Bilateral cleft lip repair requires only one operation at 4-5 months.
C. Hard palate repair is done before a year of age.
D. Cleft palate always requires two operations.
B. Bilateral cleft lip repair requires only one operation at 4-5 months.
Cleft lip alone:

-Unilateral: One operation at 5–6 months
-Bilateral: One operation at 4–5 months
Cleft palate alone:

-Soft palate only: One operation at 6 months
-Soft and hard palate: Soft palate at 6 months; Hard palate at 15–18 months
Cleft lip and palate:

-Unilateral: Cleft lip and soft palate at 5–6 months; Hard palate and gum pad with or
without lip revision at 15–18 months
-Bilateral: Cleft lip and soft palate at 4–5 months; Hard palate and gum pad with or without
lip revision at 15–18 months
38. Which is not an indication for surgery in suspected tuberculosis?

A. Metastatic tuberculous abscess
B. Aspergilloma with tuberculous cavity
C. Chronic TB abscess
D. Life threatening haemoptysis
A. Metastatic tuberculous abscess

Metastatic tuberculous abscess is a rare form of skin tuberculosis. It is characterized by
nodule and abscess formation throughout the body after hematogenous spread of
mycobacterium tuberculosis from a primary focus during a period of impaired immunity.
Indications for surgery in Suspected TB is
● Suspicious lesion on chest radiograph in which neoplasia cannot be excluded.
● Chronic tuberculous abscess, resistant to chemotherapy
● Aspergilloma within a tuberculous cavity
● Life-threatening haemoptysis
39. Prognosis is better in malignancies located at:
A. Lateral border of anterior tongue

B. Base of tongue
C. Retro-molar trigone
D. Floor of the mouth
B. Base of tongue
The anatomical sites that are frequently involved in mouth cancer include the floor of the
mouth, the lateral border of the anterior tongue, buccal sulcus and the retromolar trigone. It
is essential to appreciate the anatomical boundaries of the oral cavity when defining
tumour sites, particularly with respect to prognosis; the aetiological influence of HPV and
its implication of improved outcomes is restricted to tumours of the oropharynx (in
particular tonsillar and base of tongue subsites).
40. The most common cancer of the upper lip is

A. SCC
B. Basal cell carcinoma
C. Mucosal melanoma
D. Adenoid squamous carcinoma
B. Basal cell carcinoma
Most lip cancers occur on the lower lip (90% to 95%), and cancers occur less often on the
upper lip (2% to 7%) and commissures (1%). Lip cancer develops most commonly in white
men 50 to 80 years old. Sun exposure and pipe smoking are associated with lip cancer.
Although SCC is the most common lip cancer (90%), the most common cancer of the
upper lip is basal cell carcinoma. SCC is most commonly seen on the lower lip. Other lip
cancers include variants of SCC (e.g., spindle cell and adenoid squamous carcinoma),
mucosal melanoma, and minor salivary gland cancers.
41. A 45 year old hypertensive male Sheldon O’Neal was admitted to the neurosurgery unit
after an SAH. The neurosurgeon Dr Shashikant classified his symptoms according to the
WFNS grading. His GCS was 13 and he had significant weakness in his left lower limb.
What is his WFNS grade?
A. I
B. II
C. III
D. IV
C. III
World Federation of Neurological Surgeons (WFNS) grading for SAH is done after
resuscitation of patients. Higher the score, the poorer the prognosis. GCS I3 with more
deficit comes under Grade III.
42. A woman with a history of high grade glioblastoma, right lower limb osteosarcoma as a
teenager and breast cancer at the age of 40 is likely to have which of the following?
A. Cowden syndrome
B. Li-Fraumeni syndrome
C. Peutz-Jeghers syndrome
D. Ataxia-telangiectasia
B. Li-Fraumeni syndrome
Li-Fraumeni syndrome is caused by mutations in p53 and is associated with breast cancer,
sarcomas, glioblastoma, and adrenocortical cancers.
43. What is false about Conn’s syndrome?
A. Potassium levels are a reliable feature

B. Most common cause is unilateral adrenal adenoma
C. Clinical features are non-specific
D. Plasma renin activity is suppressed
A. Potassium levels are a reliable feature
Primary hyperaldosteronism (PHA) aka Conn’s syndrome is defined by hypertension, as a

result of hypersecretion of aldosterone (ergo, plasma renin activity is suppressed). The
most frequent cause is a unilateral adrenocortical adenoma. Up to 12% of hypertensive
patients have PHA with normal potassium levels, thus potassium levels are an inconsistent
diagnostic feature.
44. The half life of parathormone (PTH) is
A. 5 min
B. 5 hours
C. 15 min
D. 5 days
A. 5 min
The half life of PTH is 3-5 minutes. The Miami criteria to predict the extent of resection is
based on the short half life of PTH. A drop in the PTH into the normal range and to less
than half the maximum preoperative PTH at 10 minutes appears to accurately predict
single-gland disease.
45. Hyperparathyroid jaw tumour syndrome (HPT-JT) is associated with mutations of

which protein coded by gene HRPT2 ?
A. Parathyronin
B. Paramufibronin
C. Parafibromin
D. Paracalcitonin
C. Parafibromin
HPT-JT is a rare cause of PHPT. It arises due to inactivating mutations in the HRPT2 gene
on chromosome 1 q21-32, encoding parafibromin. It classically presents with early-onset
PHPT (mean age of 32 years), the aetiology of which can be either single or multiple-gland
disease but is predominantly cystic in nature. It presents with severe hypercalcaemia and is
associated with an increased risk of an underlying parathyroid carcinoma.
46. Which of the following malignancies arises from thyroglossal cyst?

A. Follicular CA
B. Papillary CA
C. Medullary CA
D. No malignancies occur in thyroglossal cyst
B. Papillary CA
Incidence of thyroglossal duct cysts undergoing malignant transformation is about 1%.

Among those that are found to contain cancer it is usually papillary (85%). Medullary
carcinoma thyroid never occurs in thyroglossal cysts.
Ref: Schwartz's Principles of Surgery, 10th Edition, Chapter 38
47. The thyroid gland is derived from which embryological structure?

A. First pharyngeal arch
B. Third pharyngeal pouch
C. Third pharyngeal arch
D. Fourth pharyngeal pouch
A. First pharyngeal arch

The thyroid gland is one of the earliest endocrine glands to develop. It arises from the first
and second pharyngeal arches. The superior parathyroid gland develops from the fourth
pharyngeal pouch while the inferior parathyroid gland develops from the third pharyngeal
pouch. The third pharyngeal arch helps in the development of the stylopharyngeus muscle
while the fourth pharyngeal arch allows for the development of the cricothyroid
muscle.(Parathyroid derives from the Pouch).
48. A 50-year-old man Mr Rasappan has a 6 cm infrarenal abdominal aortic aneurysm.

How should he be treated?
A. Surgical aneurysmal repair
B. No intervention required as patient is asymptomatic.
C. Medical management
D. Continue monitoring every 3 months
A. Surgical aneurysmal repair

Any symptomatic aneurysm or with diameter > 55mm requires surgical intervention. There
is no medical management per se, although lipid profile and hypertension should be
controlled. Regular ultrasound monitoring is indicated in asymptomatic patients with
diameter < 55mm.
49. Rajaji Hospital in Salem wanted to buy a machine to treat varicose veins. They were
considering Endovenous laser ablation (EVLA) and Radiofrequency ablation (RFA).
Which of the following statements is true?
A. EVLA has continuous pullback system and is easy to master
B. RFA has a continuous pullback system and is therefore easy to learn
C. RFA does not require continuous pullback and has a smaller learning curve
D. RFA is only meant for very skilled surgeons unlike EVLA
C. RFA does not require continuous pullback and has a smaller learning curve
RFA does not require a continuous pullback unlike EVLA, thereby reducing the learning
curve. This also frees the surgeon’s focus allowing better communication with the patient
and indeed, with care, concurrent treatment, e.g. infiltrating local anaesthetic into the
tributaries and performing phlebectomy, reducing procedural times. RFA has a
standardised treatment protocol that is automated, minimising the uncertainty and learning
curve for the ablation portion of the procedure and the possibility of a novice making a
mistake with the energy delivery.
50. A 26 year old male presented to the OPD with multiple cutaneous naevi and a
markedly longer left leg. He also had varicose veins. The diagnosis given was
A. Park-Weber syndrome
B. Klippel-Trenaunay syndrome
C. Madison-Ashley syndrome
D. May-Thurber syndrome
B. Klippel-Trenaunay syndrome
Klippel-Trenaunay syndrome is a congenital but non-familial condition that is

characterised by port-wine stains, asymmetrical limb growth and venous malformations
manifesting as varicose veins. They are also prone to develop deep vein thrombosis. The
condition must be distinguished from the Parkes-Weber syndrome, in which there are
multiple arteriovenous fistula causing venous hypertension, ulceration and high-output
cardiac failure.
51. Stemmer’s sign is seen in which grade of lymphedema?

A.Latent
B.1
C.2
D.3
C. 2
Brunner’s Grade for lymphedema:

● Latent- No clinical lymphedema but excess interstitial fluid present
● Grade 1- Pitting edema, disappears on limb elevation
● Grade 2- Non-pitting edema, no response to elevation, skin on the dorsum of toes
cannot be pinched (Stemmer’s sign)
● Grade 3- Irreversible skin change (eg. Fibrosis, papillae)
52. Which of the following procedures for lymphedema is correctly matched to its
complication?
A. Homans - Pilonidal sinus

B. Thompson - Skin flap necrosis
C. Charles - Graft failure
D. Thompson - Graft failure
C. Charles – Graft Failure
Homan’s procedure: Involves raising skin flaps to allow the excision of a wedge of skin
and a large volume of subcutaneous tissue down to the deep fascia. Surgery to the medial
and lateral aspects of the leg must be separated by at least 6 months to avoid skin flap
necrosis, which is the most common complication.
Charles’ procedure: Circumferential excision of lymphedematous tissue down to and

including the deep fascia followed by SSG. Graft failure is common and it has poor
cosmetic results but is useful in reducing girth.
Thompson’s procedure: Intended to create new lymphatic connections between superficial

& deep systems. One skin flap is sutured to the deep fascia and buried under the second
flap and so, pilonidal sinus formation is common.
53. Atherosclerosis is a major cause of morbidity and mortality in India. What is the
earliest evidence of atherosclerosis?
A. Fatty dots
B. Fatty streaks
C. Fibrous plaque
D. Macrophages
B.Fatty streaks.
Fatty streaks is the earliest lesion which is seen in the atherosclerotic process. This appears
as yellow streaks along the major arteries.It consists of smooth muscle cells filled with
cholesterol and foam cells.
54. While obtaining consent, which of the following is not true?

A. Provision of translators is necessary if patient doesn’t understand the language
B. Any member of the surgical team can take consent.
C. Enough time must be given for the patient to arrive at a decision.
D. Consent should be taken in a quiet room.
B. Any member of the surgical team can take consent
Ideally, only the operating surgeon should take consent as other members may not be
informed enough to know the details. The consent is taken in a quiet venue and and
enough time is to be given to decide. Translators are a must when the patient does not
understand the language in which the consent is being taken
55. The most common benign chest wall tumor is:

A. Chondromas
B. Osteochondromas
C. Desmoid tumor
D. Osteoma
A. Chondromas
Chondromas, seen primarily in children and young adults, are one of the more common
benign tumors of the chest wall. They usually occur at the costochondral junction
anteriorly and may be confused with costochondritis, except that a painless mass is present.
56. An uncontrolled diabetic presents with redness of scrotum and perianal area with high
fever and prostration. On examination, small necrotic areas on the scrotal skin are seen.
What constitutes further management?
A. Plenty fluids, oral antibiotics, glycemic control
B. Admit for IV Antibiotics only
C. Aggressive debridement of necrotic tissue, IV Antibiotics and ICU care
D. Glycerine magnesium sulphate dressing for cellulitis
C. Aggressive debridement of necrotic tissue, IV Antibiotics and ICU care
The above patient has signs and symptoms concerning necrotizing soft tissue infection of
the perineal region, or Fournier’s gangrene.This patient requires early and aggressive
surgical debridement, not be delayed for radiographic imaging .
Intravenous antibiotics without surgical intervention is associated with a near 100%
mortality rate. Necrosis eats through the scrotal tissue leaving the testis exposed. Despite
best care, the condition is associated with 50% mortality.
57. Which of the following is not a cause of ischemic priapism?

A. Sickle cell anaemia
B. Drugs- anti hypertensives, anti psychotics
C. Traumatic damage to central penile artery
D. Intra cavernosal injections
C. Traumatic damage to central penile artery
Traumatic damage to the central penile artery occurs as a consequence of blunt perineal
trauma. A fistula develops between the artery and the sinusoidal space, which results in a
persistent erection that is painless, in contrast to the ischaemic priapism. Blood gas analysis
shows the characteristics of arterial blood and Doppler scanning and selective
arteriography will demonstrate the fistula. Treatment is not an emergency, since there is no
ischaemia, and is achieved by selective arterial embolisation.
58. Sipuleucel T vaccine was recently approved by FDA for the treatment of:
A. Renal cancer
B. Bladder cancer
C. Testicular cancer
D. Prostate cancer
D. Prostate cancer
Sipuleucel-T is an autologous dendritic cell vaccine that is produced by exposure and

activation of the patient’s peripheral blood mononuclear cells to PAP (prostate acid
phosphatase), a tumor associated antigen. The activated dendritic cells are then infused
back into the patient where they travel to lymph nodes and present processed antigen to T
cells along with costimulatory signals to develop an immune response.
59. True regarding TURP procedure is

A. Strips are cut from bladder neck to verumontanum
B. Ellik evacuator is used to remove the prostate chips
C. Collings knife is used in case of bladder neck stenosis
D. All of the above
D) All of the above
Men with indwelling catheters, those with recent urinary infection, those with chronic
retention or those with prosthetic material or heart valves benefit from prophylactic
antibiotics in addition to the standard for clean surgery at induction. Strips of tissue are cut
from the bladder neck down to the level of the verumontanum using a high-frequency
diathermy current. The ‘chips’ of prostate are then removed from the bladder using an Ellik
evacuator. In men with small prostates or bladder neck dyssynergia or stenosis, it is better
to divide the bladder neck and prostatic urethra with a Collings knife.
60. Which of the following muscarinic receptors is associated with bladder contracture?
A. M2
B. M1
C. M3
D. M4
C.M3
The bladder has mainly M1, M2 (80%) and M3 (20%) cholinergic receptor types, but only
M3 cholinergic receptors are responsible for the parasympathetic detrusor contraction. M3
receptors of the bladder are found mainly in smooth muscles and glands. Stimulation of
M3 receptors with acetylcholine causes the release of IP3 and calcium, which leads to
smooth muscle contraction
61. A 56 year old man is involved in a road traffic accident. He is found to have a pelvic
fracture. He reports that he has some lower abdominal pain. Peritonism is positive in the
lower abdomen. The surgical resident reported that he has not passed any urine and blood
is seen in the external urethral meatus. A CT scan shows evidence of free fluid.What is
likely to be the diagnosis?
A. Bulbar urethral rupture

B. Membranous urethral rupture
C. Bladder rupture
D. Bladder contusion
C. Bladder rupture
A pelvic fracture and lower abdominal peritonism and he was not able to pass urine and
CT showed free fluid in abdomen suspicions of bladder rupture(intraperitoneal). Most
bladder injuries occur due to blunt trauma. 85% are associated with pelvic fractures
62. Dr Raghavan, the senior urologist at VHS Hospital wants to ask you a few
questions.Which is the most common type of renal stones?
A. Calcium oxalate
B. Cysteine
C. Uric acid
D. Calcium phosphate
A. Calcium oxalate
Calcium oxalate(85% of all stones)
● Hypercalciuria is a major risk factor

● Hyperoxaluria may also increase risk
● Hypocitraturia increases risk because citrate forms complexes with calcium
making it more soluble
● Stones are radio-opaque (though less than calcium phosphate stones)
63. Which of the following methods is used to repair damage to the ureter if there is
significant loss of length leaving almost no ureter?
A. Nephrectomy
B. Spatulation
C. Psoas hitch
D. Boari operation
A) Nephrectomy
Repair of a damaged ureter:

● If there is no loss of length - Spatulation and end to end anastomosis without
tension
● If there is a little loss of length - mobilize kidney, psoas hitch, Boari operation
● If there is marked loss of length - Transureteroureterostomy, Interposition of
isolated bowel loop or mobilized appendix, nephrectomy
64. During HLA typing for transplants, which of the following HLA types is most
important?
A. HLA - DR
B. HLA - DP
C. HLA - A1
D. HLA - DQ
A. HLA - DR
When HLA matching for a transplant the relative importance of the HLA antigens are as
follows DR > B > A
65. Hyperacute rejection occurs most commonly following transplantation of which organ?
A. Kidney
B. Liver
C. Heart
D. Lung
A. Kidney
Kidneys are highly susceptible to hyper acute rejection after transplants.

Other organs such as liver, lung and heart are surprisingly resistant. It is believed
that organs with dual blood supply are relatively resistant to hyperacute rejection.
66. A 49 year old woman, Raveena Bhat, with end stage renal failure undergoes a
cadaveric renal transplant. However, after reviewing the patient after 4 months she
presented with oliguria and right lower leg edema. What is the probable etiology?
A. Lymphocele
B. Acute rejection
C. Renal vein thrombosis
D. CNI toxicity
A. Lymphocele
Lymphocele is a fluid collection between the renal graft and the urinary bladder. It is an
uncommon complication (0.6% to 18%) following renal transplantation. The development
of lymphocele has been ascribed to inadequate ligation of the afferent lymphatics coursing
over the recipient iliac vessels or located within the allograft hilum. Many collections
remain subclinical. In fact, up to 50% of patients may show a small collection on
ultrasound scanning after renal transplantation and most of them resolve spontaneously.
Large collections may present clinically by deterioration of renal graft function or as a

painless ipsilateral lower limb edema, at 2 weeks to 6 months after transplantation.
Ultrasound is the key to diagnosis, but other radiological procedures such as the isotope
renal scanning, computed tomography, intravenous urography and magnetic resonance
imaging might be necessary in complicated cases. Prevention by careful ligation of
lymphatics during the dissection of iliac vessels is better than intervention later for cure.
67. Which of the following is not true about Tacrolimus?

A. It is metabolized by cytochrome P450 enzyme
B. More potent than cyclosporine and graft survival is also higher than cyclosporine
C. Half life is 12 hrs
D. New onset Diabetes is proven complication.
B. More potent than cyclosporine and graft survival is also higher than cyclosporine.
Multicenter studies in the USA and in Europe indicate that both graft and patient survival
are similar for the two drugs. Tacrolimus can be administered orally or intravenously. The
half-life of the intravenous form is approximately 9–12 hours. metabolized primarily by P
450 enzymes in the liver, and there is potential for drug interactions. The dosage is
determined by the blood level at steady state. Its toxic effects are similar to those of
cyclosporine and include nephrotoxicity, neurotoxicity, hyperglycemia, hypertension,
hyperkalemia, and gastrointestinal complaints. New onset diabetes is a characteristic
complication.
68. What is the most common malignancy following solid organ transplants?
A. Squamous cell carcinoma (SCC)
B. Basal cell carcinoma (BCC)
C. Kaposi sarcoma
D. Post transplant lymphoproliferative disorder
A. Squamous cell carcinoma (SCC)
Skin cancer is the most common malignancy following solid organ transplant. (SCC>BCC).
There is a 50% risk of cutaneous malignancy within 20 years of a solid organ transplant.
69. The order of anastomoses in lung transplant is:

A. Pulmonary vein, bronchus, pulmonary artery
B. Pulmonary artery, pulmonary vein, bronchus
C. Bronchus, pulmonary artery, pulmonary vein
D. Pulmonary artery, bronchus, pulmonary vein
A. Pulmonary vein, bronchus, pulmonary artery
During lung transplantation, the donor pulmonary veins on a left atrial cuff are
anastomosed to the recipient's left atrium. Next, the bronchial anastomosis and the
pulmonary arterial anastomosis are completed.
70. What is the optimum cold storage time for heart in cardiac transplant?
A. 3 hrs
B. 4 hrs
C. 5 hrs
D. 6 hrs
A. 3 hrs
The optimum cold storage time for the heart and lung is <3 hrs.
71. What is the Milan criteria used for?

A. Liver transplant in Cirrhosis
B. Liver transplant in HCC
C. Liver transplant in metastasis
D. All of the above
B. Liver transplant in HCC
The Milan criteria for liver transplantation for HCC (single nodule <5 cm or upto three
nodules, the largest of which is <3 cm) are used to predict the risk of recurrent disease after
transplantation. There should also be no evidence of vascular invasion, regional
lymphadenopathy, or distant disease. Tumors limited to a particular liver segment do not
factor into selecting appropriate candidates. Patients who meet these criteria have a risk of
recurrence that is less than 20%, whereas patients outside the criteria have a recurrence rate
of approximately 60%.

72. A 56 year old man Sivaram Varma underwent cadaveric renal transplant. Patient died
after a couple of months. What is the most likely cause for his death?
A. Myocardial infarction
B. Sepsis
C. Graft rejection
D. Uremia
A. Myocardial infarction
Kidney transplantation is associated with 17% risk reduction for myocardial infarction (MI)
compared to patients in the waiting list. However, MI remains a leading cause of death in
patients with functioning renal transplantation. The risk of MI is highest in the early
postoperative period and mortality rates after hospitalization for MI is approximately 50%
at 5 years, which affects allograft longevity also.
73. Kala Ramanan a 38 year old woman from Trivandrum underwent a cadaveric renal
transplant. 45 days later she was diagnosed with post transplant viral nephropathy. What is
the most likely cause?
A. BK Polyomavirus
B. HSV
C. HCV
D. HHV-8
A. BK Polyomavirus
BK Polyoma virus is emerging as an important cause of graft dysfunction after renal

transplantation. Infection with BK virus is almost universal during childhood, with latent
infection in the epithelium of the urinary tract. Immunosuppression causes lytic BK virus
replication with graft involvement in 1–5% of renal transplants.
74. Which cell type is matched with the correct primary anatomic location?
A. Chief cell - gastric antrum

B. G cell - gastric cardia
C. D cell - gastric fundus
D. Endocrine cell - gastric body
D. Endocrine cell - gastric body
Endocrine cells in the body of the stomach are responsible for ghrelin production.
Ref: Sabiston Textbook of Surgery, 20th edition, Chapter 48.
75. Which of the following is not a luminal amoebicidal agent ?

A. Paromomycin
B. Iodoquinol
C. Diloxanide furoate
D. Chloroquine
D. Chloroquine
After treatment of the liver abscess, it is recommended that luminal agents such as
iodoquinol, paromomycin, and diloxanide furoate be administered to treat the carrier state.
Chloroquine is a tissue amoebicide, not a luminal amoebicide.
Systemic amoebicides - for liver abscess

● Chloroquine
● Emetine
● Dehydroemetine
Luminal amoebicides - to eliminate carrier state

● Iodoquinol
● Paromomycin
● Diloxanide furoate
Mixed amoebicides
● Metronidazole
● Tinidazole
76. During fasting, the liver provides energy substrates by all but which of the following
mechanisms?
A. Glycogenolysis
B. Glycolysis
C. Gluconeogenesis from alanine
D. Formation of ketone bodies from fatty acids
B. Glycolysis
The liver plays a pivotal role in energy metabolism. In the fed state, glucose is converted to
glycogen for storage. The liver itself obtains its energy primarily from keto acids rather
than glucose, although it can use glycolysis during periods of glucose excess (fed state).
During fasting, the liver produces glucose by the breakdown of the stored glycogen
(glycogenolysis). Glucose is a critical energy source for red blood cells, the central nervous
system, and the kidneys. Because glycogen stores are depleted after about 48 h, the liver
generates glucose from other sources.
Alanine, other amino acids, lactate, and glycerol can serve as carbon sources for
gluconeogenesis.
Lipolysis occurs during prolonged fasting, and the fatty acids released from adipose stores
are oxidized in hepatocytes to form ketone bodies. Ketone bodies are an important
alternative fuel source for the brain and muscle.
77. Dohlman procedure is performed in
A. Boerhaave's syndrome
B. Zenker's diverticulum
C. Severe GERD
D. Achalasia cardia
B. Zenker's diverticulum
An alternative to open surgical repair in Zenker's diverticulum is the endoscopic Dohlman
procedure, which has become more popular. Endoscopic division of the common wall
between the esophagus and diverticulum using a laser, electrocautery, or stapler device has
been similarly successful. Because of the configuration of the inline stapling device, this
approach has been advocated for larger diverticula.
78. All of the following agents decrease LES pressure except
A. Secretin
B. Glucagon
C. CCK
D. Bombesin
D. Bombesin
Hormonal and Pharmacologic Agent influencing Lower Esophageal Sphincter Resting

Pressure
Ref: Schwartz Principles of Surgery, 11th edition, Chapter 25.
79. Sestamibi scan is increasingly used to localise parathyroid adenomas. Which statement
regarding Sestamibi scanning for parathyroid is not true?
A. 2-methoxy-2-methylpropyl isonitrile is the actual name for the scanning isotope
B. Sestamibi accumulates in lysosomes and therefore washes out at differential rates
depending on the number of lysosomes within individual tissues
C. Parathyroid adenomas have higher oxyphil count which helps in localising
Sestamibi
D. Hurthle cell adenomas can give false positives
B. Sestamibi accumulates in lysosomes and therefore washes out at differential rates

depending on the number of lysosomes within individual tissues
Sestamibi accumulates in mitochondria and therefore washes out at differential rates

depending on the number of mitochondria within individual tissues. Parathyroid adenomas
often have a high concentration of oxyphilic cells with high mitochondrial content. Hurthle
cell adenomas can give false positives due to high oxyphil content.
2-methoxy-2-methylpropyl isonitrile is the actual name for the scanning isotope.
There are three different protocols for sestamibi scanning:
1. Single-isotope dual-phase scan
2. Dual isotope subtraction imaging
3. Single-photon emission computed tomography (SPECT).
The sensitivity and specificity of sestamibi, regardless of the protocol used, are 79% and
90%, respectively.
80. Metabolic derangement in congenital hypertrophic pyloric stenosis

A. Hyperchloremic acidosis
B. Hyperchloremic alkalosis
C. Hypochloremic alkalosis
D. Hypochloremic acidosis
C. Hypochloremic alkalosis
Congenital Hypertrophic pyloric stenosis is a disease of the newborns, with incidence of 1

in 300 to 900 live births. It is most common between the ages of 2 and 8 weeks. Boys are
affected four times more often than girls, with first-born male infants being at highest risk.
Hypertrophy of the circular muscle of the pylorus results in constriction and obstruction of
the gastric outlet, leading to non-bilious, projectile emesis, loss of hydrochloric acid with
the onset of hypokalemic hypochloremic metabolic alkalosis, and dehydration.
81. True statement regarding diabetes and bariatric surgery is/are

A. Metabolic syndrome comprises high blood pressure, dyslipidemia and polycystic
ovary syndrome.
B. Control of diabetes after bariatric surgery occurs after significant weight loss
occurs.
C. After bariatric surgery, diabetic patients had remission but there was increased
incidence of diabetes in non diabetic people.
D. All the above
A. Metabolic syndrome comprises high blood pressure, dyslipidemia and

polycystic ovary syndrome
It has been known for more than 20 years that control of type 2 diabetes improves with
weight loss. Remarkably, after several types of bariatric surgery, diabetes control appears
to improve before significant weight loss occurs. Changes in gut hormones levels such as
GLP-1 had a significant effect on glucose metabolism. GLP-1 is an incretin, which
stimulates the beta cells in the pancreas to restore the normal first phase insulin response
after eating.
Diabetes ‘remission’ is defined as patients being off all medication with normal glucose
homeostasis. In the SOS study, diabetic patients not only went into remission after surgery,
but there was a decreased incidence of patients becoming diabetic.
Ref: Bailey & Love, Short Practice of Surgery, 27th edition, Chapter 64
82. Which of the following is not true about hemangioma liver?

A. Most common benign tumor
B. More common in men
C. Usually solitary
D. Equal incidence in right and left hemilivers
B. More common in men
Hemangioma is the most common benign tumor of the liver. It occurs in women more than
in men (3 :1 ratio) and at a mean age of approximately 45 years. Small capillary
hemangiomas are of no clinical significance, whereas larger cavernous hemangiomas more
often come to the attention of the liver surgeon. They are usually solitary and less than 5
cm in diameter, and they occur with equal incidence in the right and left hemiliver.
83. The richest source of Fibrinogen is
A. Cryoprecipitate
B. Buffy coat
C. Fresh Frozen plasma
D. Whole blood
A. Cryoprecipitate
Cryoprecipitate is a supernatant precipitate of FFP and is rich in factor VIII & fibrinogen.
It is stored at-30°C with a two year shelf life. It is given in low fibrinogen states or factor
VIII deficiency.
84. A 55 year old woman Shruthi Murali has presented to your clinic with a 2.5 cm sized
lesion on the face that has been diagnosed as a malignant melanoma by biopsy. Depth of
the tumour is 2 mm. Which of the following is not correct regarding the surgical
management of this woman?
A. Surgical margins should be measured from the edge of the biopsy site.
B. Successful cure is dependent on achieving as wide excision as possible within
anatomical limits.
C. A 1 cm margin is adequate for excision.
D. Primary closure can be done only if the long axis of the incision is more than thrice
the length of the short axis.
B. Successful cure is dependent on achieving as wide excision as possible within

anatomical limits
The surgical margin is generally measured from the edge of the biopsy site or residual
intact component of the lesion. The risk of local recurrence correlates more with tumour
thickness than with margins of surgical excision. Patient with melanoma in situ, a 0.5-cm
to 1-cm margin is adequate. Patients with invasive melanoma less than 1 mm thick can be
treated with a 1-cm margin of excision. For patients with melanoma 1 to 2 mm thick, a
simple recommendation is difficult but in general, a 2-cm margin is preferred if
anatomically and functionally feasible, and in regions of anatomical constraint (e.g., the
face), a 1-cm margin is sufficient. Patients with melanoma 2 to 4 mm thick can be treated
with a 2-cm margin.
In patients with a melanoma thicker than 4 mm, a 2-cm margin is probably safe and is
generally employed. Primary closure is the method of choice for most lesions, but it should
be avoided when it will distort the appearance of a mobile facial feature or interfere with
function. Many defects can be closed using an advancement flap, undermining the skin and
subcutaneous tissues to permit primary closure. Primary closure usually requires that the
longitudinal axis of an elliptical incision be approximately three times the length of the
short axis.
85. What is the most common cause of chronic pancreatitis?
A. Alcohol
B. Gallstones
C. Autoimmune
D. Hypertriglyceridemia
A. Alcohol
High alcohol consumption is the most frequent cause of chronic pancreatitis, accounting
for 60–70% of cases, but only 5–10% of people with alcoholism develop chronic
pancreatitis. The exact mechanism of how alcohol causes chronic inflammation in these
patients is unclear; genetic and metabolic factors may be at play.
86. Identify this novel method used to treat obesity
A. Intragastric balloon
B. EndoCinch
C. TOGA
D. EndoPark
A. Intragastric balloon
Intragastric balloon is a space occupying technique used for weight loss. It consists of an
acid resistant silicon spherical balloon filled with saline. It possesses a radio-opaque self
sealing valve that can be localised by imaging. It has a capacity of 600 - 800 ml. There are
single and double balloon systems in the market. It serves as a bridge for weight loss
before bariatric surgery or as a means for short term weight loss. Vomiting is a very
troublesome complication and the balloon usually stays in place for 6 months.
Ref: Tate CM, Geliebter A. Intragastric Balloon Treatment for Obesity: Review of
Recent Studies. Advances in Therapy. 2017 Aug;34(8):1859-1875. DOI:
10.1007/s12325-017-0562-3.
87. Pappenheimer bodies refer to
A. Iron granules
B. Nuclear remnants
C. Denatured hemoglobin
D. Acanthocytes
A. Iron granules
Pappenheimer bodies are abnormal basophilic granules of iron found inside red blood cells
on routine blood stain.They are a type of inclusion body composed of ferritin aggregates,
or mitochondria or phagosomes containing aggregated ferritin. They appear as dense, blue-
purple granules within the red blood cell and there are usually only one or two, located in
the cell periphery. They stain on a Romanowsky stain because clumps of ribosomes are
co‐precipitated with the iron‐containing organelles. They may be found in blood after
splenectomy.
Other findings after splenectomy
● Howell-Jolly bodies (nuclear remnant),

● Heinz bodies (denatured hemoglobin),
● Pappenheimer bodies (iron granules),
● Acanthocytes (spur cells),
● Codocytes (target cells).
88. What is the incidence of post-ERCP pancreatitis?

A. 1%
B. 5%
C. 0.5%
D. 10%
B. 5%
Complications of ERCP
1. Duodenal perforation (1.3%)/haemorrhage (1.4%) after scope insertion or

sphincterotomy,
2. Pancreatitis (4.3%)
3. Sepsis (3–30%)
4. Mortality rate approaches 1%.
89. Which is the most common cause of retroperitoneal fibrosis?

A. Idiopathic
B. Drug induced
C. Retroperitoneal hemorrhage
D. Neoplastic
A. Idiopathic
Seventy percent of cases are idiopathic (Ormond disease), whereas 30% are associated
with various drugs (most notably, ergot alkaloids or dopaminergic agonists), infections,
trauma, retroperitoneal hemorrhage or retroperitoneal operations, radiation therapy, or
primary or metastatic neoplasms. Many idiopathic cases are associated with inflammatory
abdominal aortic aneurysms; thus, idiopathic retroperitoneal fibrosis might best be
categorized with inflammatory abdominal aortic aneurysms and perianeurysmal
retroperitoneal fibrosis as a form of chronic peri-aortitis.
90. Which of the following statements about traumatic hernias of abdomen is true?
A. Could occur following traumatic denervation causing muscle atrophy
B. Blunt injury does not lead to a traumatic hernia
C. Occurs mainly at anatomical defects of the abdomen
D. All of the above
A. Could occur following traumatic denervation causing muscle atrophy
Traumatic hernia: These hernias arise through non-anatomical defects caused by injury.
They can be classified into three types: 1. Hernias through abdominal stab wound sites.
These are effectively incisional hernias. 2. Hernias protruding through splits or tears in the
abdominal muscles after blunt trauma. 3. Abdominal bulging secondary to muscle atrophy
that occurs as a result of nerve injury or other traumatic denervation. Akin to the
lumbar pseudo-hernia seen after open nephrectomy, these can arise after a chest injury with
damage to the intercostal nerves.
Traumatic hernias present as any other hernia. The key to the aetiology is in the history
and the non-anatomical location of the hernia.
Ref: Bailey and Love Short Practice of Surgery, 27th edition, Chapter 60
91. Which of the following factors prevents indirect hernia?

A. Calcitonin gene related peptide
B. Hepatocyte growth factors
C. Both
D. None
C. Both
An inguinal hernia (indirect) also occurs through the developmental failure of the
processus vaginalis to close. As the testis descends, it pulls a tube of peritoneum along with
it. This tube should naturally fibrose and become obliterated but often it fails to fibrose and
allows a hernia to form. Recent studies have shown that calcitonin gene-related peptide and
hepatocyte growth factor influence the closure of the processus, raising the possibility of a
hormonal cause of hernia development.
92. Which of the following compounds is not a specialised pro-resolving mediator (SPM)?
A. Maresins
B. Gundesins
C. Protectins
D. Resolvins
B. Gundesins
A group of local mediators known as specialised pro-resolving mediators (SPM) that

include essential fatty acid-derived lipoxins, resolvins, protectins and maresins play a role
in return to homeostasis at local level after injury.
93. What is the most common complication following open splenectomy?
A. Left Basal atelectasis

B. Infection with H. influenza
C. Thrombocytopenia
D. Hemorrhage from a slipped ligature.
A. Left Basal atelectasis
Complications following Splenectomy
Complications of splenectomy may be classified as pulmonary, hemorrhagic, infectious,

pancreatic, and thromboembolic. Left lower lobe atelectasis is the most common
complication after open splenectomy (OS); pleural effusion and pneumonia also can occur.
Hemorrhage can occur intraoperatively or postoperatively, presenting as subphrenic
hematoma. Transfusions have become less common since the advent of LS, although the
indication for operation influences the likelihood of transfusion as well. Subphrenic
abscess and wound infection are among the perioperative infectious complications. The
placement of a drain in the left upper quadrant may be associated with postoperative
subphrenic abscess and is not routinely recommended. Pancreatitis, pseudocyst, and
pancreatic fistula are among the pancreatic complications that may result from
intraoperative trauma to the pancreas during dissection of the splenic hilum
Hematologic Outcomes The results of splenectomy may be appraised according to the

level of hematologic response (e.g., rise in platelet and hemoglobin levels) in those
disorders in which the spleen contributes to the hematologic problem. Hematologic
responses may be divided into initial and long-term responses. For thrombocytopenia, an
initial response typically is defined as a rise in platelet count within several days of
splenectomy. Reported series demonstrate the effectiveness of LS in providing a long-
term platelet response in approximately 80% of individuals with ITP . These results are
consistent with the long-term success rate associated with OS.
94. The sphincter of oddi complex contains ______ sphincters .

A. 3
B. 4
C. 5
D. 1
B. 4
The entire sphincter mechanism is actually composed of four sphincters containing both
circular and longitudinal smooth muscle fibers . The four sphincters are the superior and
inferior sphincter choledochus, the sphincter pancreaticus, and the sphincter of the ampulla.
95. The false statement about Roux-en-Y gastric bypass surgery is

A. It includes short, vertical lesser curvature based gastric pouch
B. Linear stapler with suture closure of the defect, circular stapler and entirely hand
sewn are the available techniques of pouch-jejunostomy
C. The biliary limb is kept long and the Roux limb is kept short to reduce vitamin and
mineral deficiencies
D. Patients lose weight mainly because of change in appetite rather than
malabsorption of calories.
C. The biliary limb is kept long and the Roux-en limb is kept short to reduce vitamin
and mineral deficiencies
Roux-en-Y gastric bypass includes a short vertical lesser curvature-based gastric pouch.
The available techniques of pouch-jejunostomy are linear stapler with suture closure of the
defect, circular stapler and entirely hand sewn. The biliary limb is usually kept short with
the objective to reduce vitamin and mineral deficiencies and the Roux limb length is varied
between 100 and 150 cm.
Despite the widespread belief that the mechanism of action is a combination of restriction
and malabsorption of calories, there is no evidence to suggest this. Patients lose weight, at
least in part, because they eat less, due to a change in appetite, facilitated by a change in
satiety gut hormones. Other mechanisms such as changes in energy expenditure and
change in food preferences, may also play a role.
96. The most probable cause of intussusception in a 5 year old girl is
A. Hyperplasia of Peyer's patches

B. Polyposis
C. CA Colon
D. Lymphoma
A. Hyperplasia of Peyer's patches
Intussusception is encountered most commonly in children, with a peak incidence between

five and ten months of age. About 90 per cent of cases are idiopathic, but an associated
upper respiratory tract infection or gastroenteritis may precede the condition. It is believed
that hyperplasia of Peyer’s patches in the terminal ileum may be the initiating event.
Weaning, loss of passively acquired maternal immunity and common viral pathogens have
all been implicated in the pathogenesis of intussusceptions in infancy. This occurs when
one portion of the gut invaginates into an immediately adjacent segment; almost invariably,
it is the proximal into the distal. Children with intussusceptions associated with a
pathological lead point such as Meckel’s diverticulum, polyp, duplication, Henoch-
Schonlein purpura or appendix are usually older than those with idiopathic disease.
After age of 2 years, a pathological lead point is found in at least one-third of affected
children. Adult cases are invariably associated with a lead point, which is usually a polyp
(e.g. Peutz-Jeghers syndrome), a submucosal lipoma or other tumour.
97. What is the most common site of NSAID induced ulcer in the small bowel beyond the
ligament of Treitz?
A. 3rd part of duodenum
B. 4th part of duodenum
C. Jejunum
D. Ileum
D. Ileum
NSAID-induced ulcers occur more commonly in the ileum, with single or multiple
ulcerations noted. Complications necessitating operative intervention include bleeding,
perforation, and obstruction. In addition to ulcerations, NSAIDs are known to induce an
enteropathy characterized by increased intestinal permeability leading to protein loss and
hypoalbuminemia, malabsorption, and anemia. Treatment of complications from small
bowel ulcerations is segmental resection and anastomosis.
98. The most accurate diagnostic test for Zollinger-Ellison syndrome (ZES) is
A. Fasting serum gastrin

B. Computed tomography (CT ) scan
C. Endoscopy
D. Secretin stimulation test
D. Secretin stimulation test
All patients with gastrinoma have an elevated gastrin level and hypergastrinemia in the
presence of elevated basal acid output (BAO) strongly suggests gastrinoma. Patients with
gastrinoma usually have a BAO >15 mEq/h or >5 mEq/h if they have had a previous
procedure for peptic ulcer. Acid secretory medications should be held for several days
before gastrin measurement, because acid suppression may falsely elevate gastrin levels.
Causes for hypergastrinemia can be divided into those associated with hyperacidity and
those associated with hypoacidity.
The diagnosis of Zollinger- Ellison syndrome (ZES) is confirmed by the secretin
stimulation test. An intravenous (IV) bolus of secretin (2 U/kg) is given and gastrin levels
are checked before and after injection. An increase in serum gastrin of 200 pg/mL or
greater suggests the presence of gastrinoma.
Patients with gastrinoma should have serum calcium and parathyroid hormone levels
determined to rule out multiple endocrine neoplasia type 1 MEN1) and, if present,
parathyroidectomy should be considered before resection of gastrinoma.
Ref: Schwartz Principles of Surgery, 11th edition, Chapter 26
99. Late dumping syndrome after gastrectomy is typically associated with

A. Hypomagnesemia
B. Hypoglycemia
C. Hyperkalemia
D. Hypernatremia
B. Hypoglycemia
LATE DUMPING SYNDROME:

The basic defect of late dumping is rapid gastric emptying; however, it is related to specific
carbohydrates being delivered rapidly into the proximal intestine. When carbohydrates are
delivered to the small intestine, they are quickly absorbed, resulting in hyperglycemia,
which triggers the release of large amounts of insulin to control the increasing blood sugar
level. An overcompensation results so that profound hypoglycemia occurs in response to
the insulin. This hypoglycemia activates the adrenal gland to release catecholamines,
which results in diaphoresis, tremulousness, light-headedness, tachycardia, and confusion.
The symptom complex is indistinguishable from insulin shock.
Ref: Bailey & Love's Short Practice of Surgery, 27th edition, Chapter 63
100. What is the most common non obstetric disease requiring surgery in pregnancy?
A. Acute appendicitis
B. Acute cholecystitis
C. Nephrolithiasis
D. Gastric perforation
A. Acute appendicitis
Appendicitis is the most common non obstetric disease requiring surgery, occurring in
1/1500 pregnancies. It’s symptoms typically consist of right lateral abdominal pain, nausea,
and anorexia, yet “typical” presentations account for only 50% to 60% of cases.
Fever is uncommon unless the appendix is perforated with abdominal sepsis. Symptoms
are sometimes attributed to the underlying pregnancy, and a high index of suspicion must
be maintained. Laboratory studies can also be misleading. Leukocytosis as high as 16,000
cells/μL is common in pregnancy, and labor can increase the count to 21,000 cells/μL.
Many authors have suggested that a neutrophil shift of more than 80% is suggestive of an
acute inflammatory process such as appendicitis, yet others have observed that only 75%
of patients with proven
101. Which of the following exotoxins produced by C. perfringens causes myocardial

suppression?
A. Phi-toxin
B. Alpha-toxin
C. Kappa-toxin
D. Iota-toxin
A. Phi-toxin
C. perfringens produces 17 different exotoxins but many of their exact roles are unclear.
Alpha-toxin, the most important, is a lecithinase, which destroys red and white blood cells,
platelets, fibroblasts and muscle cells. The phi-toxin produces myocardial suppression
while the kappa-toxin is responsible for the destruction of connective tissue and blood
vessels.

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presents

C. Loss of adaptive ketogenesis

Metabolic response to trauma and sepsis

Thunderbeat STM (Olympus), has combined both modalities in a single device. By

5. The commonest site of fistulation in the below condition is

Acquired angiogenic competence

7. Cardiopulmonary exercise testing(CPET) is used as a screening tool to identify high-risk

C. When delivery of CO2 becomes inadequate, anaerobic metabolism occurs.

8. Which of the following is a definite risk factor for post-ERCP pancreatitis?

9. What is not true about the use of tranexamic acid in trauma?

10. Pulmonary aspiration of gastric contents during anaesthesia is an uncommon but

C. Infant formula 4 hrs before surgery

Ref: Sabiston Textbook of Surgery, 20th edition, Chapter 10

11. Which is true about the ‘deadly dozen’ injuries?

Immediately life threatening:

Potentially life threatening:

B. Testing for Hepatitis B antigen

Postexposure Management: Baseline HBV Testing of Exposed* Person

Unvaccinated - HBIG x 1 and initiate hepatitis B vaccine series

13. Rejecting a null hypothesis when it is true is called as:

Null hypothesis - Statement opposite to hypothesis.

16. Ms Devi Karpagam, a 49 years old female is undergoing elective laparoscopic

Insufflation of gas is necessary to achieve pneumo-peritoneum for enhanced access to the

17. Band keratopathy is a pathognomonic for

Band keratopathy is pathognomonic of the primary hyperparathyroidism is due to

18. Which statement regarding mesenchymal stem cells is not true?

B. They express haematopoietic stem cell markers

A. Gadolinium DTPA enhanced MRI

Gadolinium diethyl triamine penta-acetic (DTPA)-enhanced MRI is the most

TTF- 1 is a factor that is involved in embryonic development and differentiation of lung

● Prostate: prostate-specific antigen (PSA)

C. Pneumothorax is the most common complication.

HBO therapy used for

Ref: Sabiston Textbook of Surgery, 20th edition, Chapter 6

.D. Video assisted thoracoscopic surgery.

Video assisted thoracoscopic surgery is a minimal access technique to visualise the

23. Leonine facies is a feature of:

25. The proliferation phase of wound healing lasts up to

Phases of Wound Healing:

Primary haemorrhage: Occurs immediately as a result of an injury or surgery.

Reactionary haemorrhage: It is delayed haemorrhage within 24 hours is usually caused by

27. Apfel score is used to assess risk of

Energy sources in starvation

A. Primary blast - Blunt trauma

C. Secondary blast - Penetrating

A. Target BP should be 120 mmHg

33. Blue dot sign is seen in

B. Testicular hydatid torsion

Torsion of the appendix testis/hydatid of morgagni is a benign situation. Although necrotic

A. 35 Kcal/kg + 50 Kcal % TBSA

D. 20 Kcal/kg + 70 Kcal %TBSA

● Age 16-59 years: (25)W + (40)TBSA

● Age 60+ years: (20)W + (65)TBSA

● Children: 60 kcal/kg + 35 kcal%TBSA

● Adults: 20 kcal/kg + 70 kcal%TBSP of patients

36. Which of the following statements regarding Bowen’s Disease is false?

D. It can be treated with topical corticosteroid agents

Bowen’s disease represents an intra-epithelial squamous cell carcinoma (carcinoma in situ).

Cleft lip alone:

Cleft palate alone:

Cleft lip and palate:

38. Which is not an indication for surgery in suspected tuberculosis?

A. Metastatic tuberculous abscess