Surgery Sixer for NBE

MULTIPLE CHOICE QUESTIONS

Section 1     General Surgery

10. In surgical patient malnutrition is best assessed by

RECENT PATTERN 2017 AND 2018
QUESTIONS
1. Best guide for the management of resuscitation is:
 (AIIMS Nov 2017)
a. CVP b. Urine output
c. Blood pressure d. Saturation of oxygen
2. Modified shock index formula is: (AIIMS Nov 2017)
a. Heart rate / Systolic BP
b. Heart rate / Diastolic BP
c. Heart rate/ Mean arterial pressure
d. Pulse rate/ Systolic BP
3. 22 Gauge IV cannula color  (AIIMS Nov 2017)
a. Green b. Gray
c. Blue d. Pink
4. Which of the following is considered balanced resuscitation?
 (AIIMS Nov 2017)
 (Recent Pattern 2013)
a. Serum albumin b. Hb level
c. Mid arm circumference d. Tricpes skin fold thickness
11. During nutritional assessment of a surgical patient, the
status of muscle of muscle protein is indicated by which one
of the following parameters: (Recent Pattern 2014)
a. Serum albumin b. Triceps skinfold thickness
c. Mid-arm circumference d. Hb level
12. The length of the feeding tube to be inserted for transpyloric
feeding is measured from the tip of: (AIIMS Nov 2002)
a. Nose to the umbilicus
b. Ear lobe to the umbilicus
c. Nose to the knee joint
d. Ear lobe to the knee joint
13. Ramesh met an accident with a car and has been in ‘deep
coma’ for the last 15 days. The most suitable route for the
administration of protein and calories is by:(All India 2002)

e
a. Giving colloids and crystalloids ratio of 1:1
a. Jejunostomy tube feeding
b. Maintaining pH by ensuring acid base are balanced

3/
b. Gastrostomy tube feeling
c. Maintaining permissible hypotension to avoid bleeding
c. Nasogastric tube feeding
d. Maintaining airway breathing and circulation
d. Central venous hyper alimentation
5. Nasogastric tube length is measured by: (AIIMS Nov 2017)
a. Nose to ear to midpoint between xiphisternum and umbi-
r,
14. A patient undergoes a prolonged and complicated
pancreatic surgery for chronic pancreatitis. Most preferred
xe
licus
route for supplementary nutrition in this patient would be:
b. Nose to ear to xiphoid process
 (All India 2008)
c. Nose to umbilicus
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a. Total parenteral nutrition

d. Nose to ear to pubic symphysis
b. Feeding gastrostomy
6. A patient requiring total parenteral nutrition for more than
c. Feeding jejunostomy
a month via central venous catheter. All are done, except:
y

d. Oral feeding
 (JIPMER MAY 2017)
15. A patient undergoes a prolonged and complicated
er

a. Change central venous catheter tube every two weeks

pancreatic surgery for chronic pancreatitis. Most preferred
Ans. routinely
route for supplementary nutrition in this patient would b:
b. LFT, BUN must be done weekly once
rg

1. b  (Recent Pattern 2009)

c. Electrolytes must be checked every 2–3 days once
2. b a. Total parenteral nutrition
d. Sudden glucose intolerance is an early sign of sepsis
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3. c b. Feeding gastrostomy
4. c c. Feeding jejunostomy
5. b d. Oral feeding
6. a OLD EXAM PATTERN QUESTIONS 16. Not a contraindication of enteral nutrition: (Punjab 2009)
7. c a. Severe diarrhea b. Severe pancreatitis
8. c NUTRITION IN SURGERY c. IBD d. Intestinal fistula
9. b 7. Preferred route for giving TPN for a patient for < 14 days 17. In percutaneous endoscopic gastrostomy (PEG), which of
10. a and there is no other use of central vein: the following is not used? (MHSSMCET 2008)
11. c  (Recent Pattern 2017) a. Push technique b. Pull technique
12. b a. EJV b. IJV c. Retraction method d. Introducer technique
13. a c. Peripheral Vein d. PICC 18. Which of the following nutrients are not included in TPN?
14. c 8. Which of the following is not an indication of TPN?  (All India 2011)
15. c  (Recent Pattern 2015) a. Lipids b. Carbohydrates
16. b a. Acute pancreatitis c. Proteins d. Fibers
17. c b. Enterocolic fistula 19. Best vein for total parenteral nutrition is:
18. d c. Chronic liver disease  (MHPGMCET 2002)
19. a d. Fecal fistula a. Subclavian vein
9. Complication of TPN are all, except (Recent Pattern 2015) b. Femoral vein
a. Volume overload b. Hypochloremia c. Brachial vein
c. Metabolic acidosis d. Hypokalemia d. Saphenous vein

16
 Multiple Choice Questions

20. One is not indication of total parenteral nutrition: 30. Complication of TPN include: (AIIMS 2007)

Chapter 1     Basic Concepts in Surgery

 (AIIMS Nov 2005) a. Hyperglycemia
a. Acute pancreatitis b. Entero colic fistula b. Hyperkalemia
c. Chronic liver disease d. Fecal fistula c. Hyperosmolar dehydration
21. Best vein for total parenteral nutrition is: d. Azotemia
 (Recent Pattern 2013) e. All of the above
a. Subclavian vein b. Femoral vein 31. Albumin infusion for parenteral use is restricted because:
c. Brachial vein d. Saphenous vein  (AIIMS 2004)
22. Which of the following is not a complication of TPN: a. It is costly
 (JIPMER 2014) b. Carcinogenic
a. Hyper ammonemia c. Does not raise oncotic pressure
b. Hypercholesterolemia d. All of the above
c. Neutrophil dysfunction 32. Following TPN, one expects weight gain after:
d. Hyperphosphatemia  (AIIMS 2000)
23. Which of the following is not a complication of total a. 2 days b. 7 days
parenteral nutrition? (AIIMS Nov 2008) c. 4 weeks d. 6 weeks
a. Metabolic bone disease 33. Deficiency of following elements is seen with hyperalimen-
b. Essential fatty acid deficiency tation, except: (JIPMER 2003)
c. Congestive cardiac failure a. Calcium b. Phosphates
d. Hypophosphatemia c. Zinc d. Magnesium
24. Most common complication of parenteral nutrition includes 34. Following, TPN, weight loss is seen: (Orissa 2001)

e
all except: (MCI Sept 2009) a. Up to 7 days b. 7-10days

3/
a. Hyperglycemia c. 10-15th day d. 15th day onwards
b. Hyperkalemia 35. TPN may be complicated by: (AIIMS 2000)
c. Hyperosmolar dehydration a. Obstructive jaundice
d. Azotemia
r, b. Hyperosteosis
c. Hypercalcemia
xe
25. Which of the following is preferred for cannulation in TPN?
 (MCI Sept 2009) d. Pancreatitis
a. Subclavian vein 36. Complication of total parenteral nutrition is:
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b. Great saphenous vein  (Recent Pattern 2013)

c. Median cubital vein a. CHF b. Hypochloremia
c. Metabolic acidosis d. Leucopenia
d. External jugular vein
y

26. Which is the best method for supplementing nutrition in

SHOCK, FLUIDS, ACID-BASE BALANCE AND
er

patients who have undergone massive resection of the small

intestine is? (MCI Sept 2009) ELECTROLYTES IMBALANCE Ans.
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a. Parenteral 37. After an RTA adult patient was admitted in Hospital with 20. c
b. Enteral PR=116/minute, RR=24/minute, BP =120/80 mm Hg, Mild 21. a
c. Gastrostomy
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anxious nature, How much amount of blood is lost in this 22. d

d. All f the above patient? (Recent Pattern 2017) 23. c
27. All of the following are complications in a patient on total a. <750 mL b. 750- 1500 mL 24. d
parenteral nutrition, except: (MCI Sept 2008) c. 1500-2000 mL d. >2000 mL 25. a
a. Hypercholesterolemia 38. After haemorrhage, Blood cortisol which gets raised will be 26. a
b. Hyperglycemia elevated for how many weeks: (Recent Pattern 2017) 27. c
c. Hypotriglyceridemia a. 1 week 28. a
d. Hypophosphatemia b. 2 weeks 29. a
28. Which of the following is the most common complication of c. 3 weeks 30. e
TPN? (Recent Pattern 2013) d. 4 weeks 31. a
a. Catheter related complications 39. Type of shock seen in burns cases: (Recent Pattern 2017) 32. b
b. Acidosis a. Hypovolemic 33. None
c. Acalculous cholecystitis b. Cardiogenic 34. a
d. Hypokalmeia c. Neurogenic 35. c
29. A patient on total parenteral nutrition for 20 days presents d. None of the above 36. c
with weakness, vertigo and convulsions. Diagnosis is: 40. Which of the following is the immediate response to 37. b
 (All India 2000) decrease in blood volume? (Recent Pattern 2017) 38. a
a. Hypomagnesemia a. Increased adrenaline 39. a
b. Hyperammonemia b. Shift of fluids from IC to EC compartment 40. a
c. Hypercalcemia c. Angiotensin increase
d. Hyperkalemia d. Thyroxine release

17
 Surgery Sixer for NBE

41. In what type of hemorrhagic shock, there is 15–30% blood 53. Hypokalemia with alkalosis is found in: (Orissa 2011)
Section 1     General Surgery

loss:  (Recent Pattern 2017) a. Diarrhea

a. Class 1 b. Class 2 b. Vomiting
c. Class 3 d. Class 4 c. Ureterosigmoidostomy
42. Initial fluid of choice in treatment of hypovolemia in trauma d. Villous adenoma of rectum
patient: (CET 2017 June) 54. Condition which does not cause metabolic acidosis:
a. Colloid b. Blood  (AIIMS 2004)
c. Crystalloid d. Plasma expanders a. Renal failure
43. Which of the following is the best guide for fluid resuscita- b. Ureterosigmoidostomy
tion in shock? (AIIMS NOV 2015) c. Pancreatic or biliary fistula
a. CVP b. Urine output d. Pyloric stenosis
c. Pulse rate d. Pulse volume 55. Following fistulous conditions give rise to maximum fluid
44. In case of massive bleeding during surgery which sized and electrolyte imbalance: (AIIMS 2005)
cannula is used? (AIIMS NOV 2015) a. Distal ileal
a. 16G b. 20G b. Gastric
c. 22G d. 24G c. Duodenal
45. Small 4 years child presents with shock and circulatory d. Sigmoid
collapse. It is not possible to get intravenous access. Then 56. Highest concentration of potassium is seen in:
what must be done next: (Recent Pattern July 2016)  (AIIMS 2002)
a. Intraosseus cannulation a. Jejunum
b. Ileum

e
b. Intracardiac infusion
c. Thoracotomy c. Duodenal

3/
d. CPR d. Sigmoid colon
57. Most common cause of metabolic alkalosis is:
46. Which of the following is not used for intravascular volume
 (Karnataka 2004)
maintenance is: (July 2016)
a. Hydroxy ethyl starch b. Dextran

r, a. Cancer stomach
b. Pyloric stenosis
xe
c. Erythropoetin d. Gelatin
c. Small-bowel obstruction
47. The most common shock in children is:
d. Diuretics
 (Recent Pattern 2016)
Si

58. All of the following are seen in persisting vomiting, except:

a. Hypovolemic b. Cardiogenic
 (AIIMS Nov 2009)
c. Septic d. Neurogenic
a. Hypokalemia
48. The following metabolic anomaly is seen in cases of
y

b. Decreased K+ in urine
hemorrhagic shock (Recent Pattern 2016)
c. Elevated pH of blood
er

a. Metabolic acidosis
d. Metabolic alkalosis
Ans. b. Respiratory acidosis 59. After ureterosigmoidostomy which electrolyte abnormality
rg

41. b c. Respiratory alkalosis may occur: (AIIMS June 09)

42. c d. Metabolic alkalosis a. Hyperchloremic acidosis
49. Which of the following indicates hypoperfusion? 
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43. a b. Metabolic alkalosis

44. a  (Recent Pattern 2015) c. Metabolic acidosis
45. a a. Systolic BP<90 mm Hg d. Hypokalemic acidosis
46. c b. Lactic acidosis 60. In post-burn patient, true is: (AIIMS June 2004)
47. a c. Oliguria a. Hypokalemic alkalosis
48. a d. All of the above b. Hyperkalemic alkalosis
49. d 50. Blood loss in class II hemorrhagic shock is c. Hyperkalemic acidosis
50. b  (Recent Pattern 2013) d. Hypokalemic acidosis
51. b a. <15% b. 15-30 % 61. Which of the following is not an important cause of hypona-
52. c c. 30-40% d. >40% tremia? (All India 2004)
53. b 51. Most common type of shock in emergency room is:  a. Gastric fistula
54. d  (Recent Pattern 2013) b. Excessive sweating
55. c a. Cardiogenic c. Excessive sweating
56. d b. Hypovolemic shock d. Prolonged Ryle’s tube aspiration
57. b c. Obstructive 62. Metabolic changes associated with excessive vomiting
58. b d. Neurogenic includes the following: (All India 99)
59. a 52. Concentration of sodium in Ringer lactate in (mEq /L) is: a. Metabolic acidosis
60. c  (Recent Pattern 2013) b. Hyperchloremia
61. c a. 154 b. 120 c. Hypokalemia
62. c c. 130 d. 144 d. Decreases bicarbonates

18
 Multiple Choice Questions

63. The highest concentration of potassium is in:(AIIMS 2005) 74. A young man weighing 65 kg was admitted to the hospital

Chapter 1     Basic Concepts in Surgery

a. Plasma with severe burns in a severe catabolic sate. An individual
b. Isotonic saline in this state requires 40 kcal per kg body weight per day 1 g
c. Ringer lactate of protein/kg body weight/day. This young man was given
d. Darrow’s solution a solution containing 20% glucose and 4.25% protein. If
64. Haemacel contains: (AIIMS 2004) 3,000 mL of solution in infused per day: (AIIMS Nov 2003)
a. Albumin a. The patient would not be getting sufficient protein
b. Degraded gelatin b. The calories supplied would be inadequate
c. Calcium c. Both protein and calories would be adequate
d. Sodium d. Too much protein infused
65. In the immediate postoperative period, body potassium is: 75. After 30% loss of blood volume in road traffic accident.
 (JIPMER 2003) What is the next management (Recent Pattern 2013)
a. Exchanged with calcium a. IV fluids only
b. Exchanged with magnesium b. IV fluids with cardiac stimulant
c. Retained in body c. Dopamine
d. Excreted excessively d. Vasopressor drug
66. Low molecular weight dextran is contraindicated in: 76. Which of the following is hypertonic: (Recent Pattern 2009)
 (AIIMS 2001) a. 5% dextrose
a. Foetal distress syndrome b. 0.45% normal saline
b. Cerebrovascular accident c. 0.9% normal saline
c. Electrical burns

e
d. 3% normal saline
d. Thrombocytopenia 77. All electrolyte abnormalities are seen in immediate postop-

3/
67. Central venous pressure (CVP) and pulmonary wedge erative period, except: (AIIMS Nov 2000)
pressure give an accurate assessment of all the following,
a. Negative nitrogen balance
except: (UPSC 2005)
b. Hypokalemia


a. Tissue perfusion
b. Volume depletion

r, c. Glucose intolerance
xe
d. Hyponatremia
c. Volume overload
78. Concentration of sodium in RL is: (Recent Pattern 2013)
d. Myocardial function
a. 154 b. 120
Si

68. 10% dextrose is: (Recent Pattern 2005)

c. 130 d. 144
a. Isotonic b. Hypotonic
79. The ideal colloidal solution is: (MHSSMCET 2005)
c. Hypertonic d. None
a. Dextran b. Plasma
y

69. In a patient with multisystem trauma, the presence of

c. Albumin d. Hydroxyethyl starch
hypotension along with elevated central venous pressure is
er

80. Which of the following is the best parameter to assess fluid

suggestive of: (UPSC 2007)
a. Upper airway obstruction intake in a poly-trauma patient? (All India 2004) Ans.
rg

b. Major abdominal bleed a. Urine output b. BP 63. d

c. Cardiopulmonary problem c. Pulse d. Pulse oximetry 64. b
81. Following is the most important factor in the management
Su

d. Spinal cord injury 65. d

70. Which of the following is the best method to assess the of shock: (AIIMS 84) 66. d
adequacy of replacement? (AIIMS 2000) a. Blood pressure 67. a
a. Decrease in thirst b. Cardiac output 68. c
b. Increase in urine output c. CVP to 8 cm of water 69. c
c. Blood pressure d. Deficiency of effective circulation 70. b
d. Increased PaO2 82. Which of the following is true for shock? (MCI Sept 2006) 71. c
71. Content of Na+ in ringer lactate is mEq/L: (TN 2001) a. Hypotension 72. b
a. 154 b. 12 b. Hypoperfusion to tissues 73. d
c. 130 d. 144 c. Hypoxia 74. c
72. Sodium content of one liter of isotonic saline is: d. All of the above 75. a
 (Recent Pattern 2011) 83. Neurogenic shock is characterized by: (All India 2004) 76. d
a. 140 mEq b. 154 mEq a. Hypertension and tachycardia 77. d
c. 40 mEq d. 70 mEq b. Hypertension and bradycardia 78. c
73. Most common cause of water intoxication in surgical patient c. Hypotension and tachycardia 79. c
is due to: (COMEDK 2005) d. Hypotension and bradycardia 80. a
a. Colorectal wash with plain water 84. Immediate management of a patient with multiple fracture 81. d
b. Syndrome of inappropriate secretion of ADH and fluid loss includes the infusion: (All India 2004) 82. d
c. Irrigation during transurethral resection of prostate a. Blood b. Dextran 83. d
d. Excessive infusion of 5% glucose c. Normal saline d. Ringer lactate 84. d

19
 Surgery Sixer for NBE

85. Hemorrhage leads to: (MCI Sept 2005) 96. A patient with spine, chest and abdominal injury in road
Section 1     General Surgery

a. Septic shock traffic accident developed hypotension and bradycardia.

b. Neurogenic shock Most likely reason is: (AIIMS Nov 2013)
c. Hypovolemic shock a. Hypovolemic shock
d. Cardiogenic shock b. Hypovolemic + neurogenic shock
86. In traumatic cases, shock is most likely due to: c. Hypovolemic + septicemic shock
 (Recent Pattern 2011; MCI Sept 2007) d. Neurogenic shock
a. Injury to intra-abdominal solid organ 97. Patient in shock. IV cannulation not possible, intraosseous
b. Head injury line for IVF shock be done within: (WBPG 2014)
c. Septicemia a. 1 minute b. 1.5 minutes
d. Cardiac failure c. 2 minutes d. 2.5 minutes
87. Which of the following is ideal in moderate hemorrhagic
shock: (Karnataka 2012, MCI Set 2007) BLOOD TRANSFUSION AND BLOOD PRODUCTS
a. Dextrose
b. Ringer lactate 98. Massive blood transfusion is defined as:
c. Blood  (Recent Pattern 2013)
d. Dextran a. Whole blood volume in 24 hrs
88. Compensatory mechanism in a patient with hypovolemic b. Half blood volume in 24 hrs
shock: (JIPMER 2011) c. 40% blood volume in 24 hrs
a. Increased renal blood flow d. 60% blood volume in 24 hrs
b. Decrease in cortisol 99. In case of trauma blood transfusion is not indicated for:

e
c. Decreased in vasopressin  (Recent Pattern 2014)

3/
d. Decreased cutaneous blood flow a. 20% Rapid loss of blood
89. Features of hypovolemic shock are all, except: b. O2 carrying capacity less than 50%
 (NIMHANS 2006) c. Hb <6


a. Oliguria
c. Low BP
b. Bradycardia
d. Acidosis

r, d. Tachycardia and hypotension refractomy to volume
expansion
xe
90. One of the following is the earliest indication of concealed 100. Most common blood transfusion reaction is:
acute bleeding: (All India 2005) (All India 2008)
a. Febrile nonhemolytic transfusion reaction
Si

a. Tachycardia
b. Postural HT b. Hemolysis
c. Oliguria c. Transmission of infections
d. Electrolyte imbalance
y

d. Cold clammy fingers

91. Most common type of shock in surgical practice: 101. All of the following infections may be transmitted via blood
er

 (Recent Pattern 2014) transfusion, except: (AIIMS May 2009)

Ans. a. Cardiogenic b. Hypovolemic a. Parvo B-19 b. Hepatitis G
rg

85. c c. Neurogenic d. Septic shock c. Dengue virus d. Cytomegalovirus

86. a 92. The most important cause of the death in septic shock is: 102. Which of the following is the least likely complication after
Su

87. b  (JIPMER 2000) massive blood transfusion? (AIIMS May 2009)

88. d a. DIC b. Respiratory failure a. Hyperkalemia b. Citrate toxicity
89. b c. Renal d. Cardiac c. Hypothermia d. Metabolic acidosis
90. a 93. 35-years old Mona developed feature of septicemia. Shock 103. Fresh hold blood transfusion is done within how much time
91. b in form of hypotension and low urine output. She was being of collection? (Recent Pattern 2006)
92. d treated for colonic necrosis. What will be the management? a. Immediately b. 1 hours
93. a  (AIIMS June 2000) c. 4 hours d. 24 hours
94. a a. IV fluids+ dopamine 104. Which of the following investigations should be done
95. b b. IV fluids only immediately to best confirm a non-matched blood
96. d c. Only dopamine transfusion: (All India 2010)
97. b d. Antibiotic in high dose a. Indirect Coomb’s test
98. a 94. Plasma expanders are used in: (Recent Pattern 2013, 2012) b. Direct Coomb’s test
99. a a. Septic shock c. Antibody in patient’s serum
100. a b. Vasovagal shock d. Antibody in donor serum
101. c c. Neurogenic shock 105. A man is rushed to casualty, nearly dying after a massive
102. d d. Cardiogenic shock blood loss in an accident. There is not much time to match
103. d 95. What is normal pulmonary capillary wedge pressure? blood groups, so the physician decides to order for one of
104. b  (MHSSMECT 2005) the following blood groups. Which one of the following
105. a a. 4-8 mm Hg blood groups should the physician decide:
b. 8-12mm Hg  (AIIMS June 2004)
c. 12-16 mm Hg a. O negative b. O positive
d. 15-25 mm Hg c. AB positive d. AB negative
20
 Multiple Choice Questions

106. One unit of fresh blood arises the Hb% concentration by: 117. True about FFP (Fresh frozen plasma) is the following

Chapter 1     Basic Concepts in Surgery

 (All India 2003) except: (MHPGMCET 2009)
a. 0.1 gm% b. 1 gm% a. Good source of all coagulation factors
c. 2 gm% d. 2.2 gm% b. Prepared from single unit of blood
107. Which of the following is better indicator of need for c. Coagulation factor levels are equal to Plasma
transfusion? (AIIMS 2002) d. None of the above
a. Urine output b. Haematocrit 118. Stored plasma is deficient in: (Recent Pattern 2000)
c. Colour of skin d. Clinical examination a. Factors 7 and 8
108. How long can blood stored with CPDA? (JIPMER 2003) b. Factors 2 and 5
a. 12 days c. Factors 5 and 8
b. 21 days d. Factors 7 and 9
c. 28 days 119. With reference to fresh frozen plasma (FFP), which one of
d. 48 days the following statement is not correct? (UPSC 2008)
109. Massive blood transfusion is defined as: a. It is used as volume expander
 (Recent Pattern 2013) b. It is stored at -40°C to -50°C
a. Whole blood volume in 24 hours c. It is a source of coagulation factors
b. Half blood volume in 24 hours d. It is given in a dose of 12-15 mL/kg body weight
c. 40% blood volume in 24 hours 120. In cholecystectomy, fresh frozen plasma should be given:
d. 60% blood volume in 24 hours  (UPPG2008)
110. After blood transfusion the febrile non-hemolytic transfu- a. Just before operation
sion reaction (FNHTR) occurs due to? b. At the time of operation

e
 (Recent Pattern 2012) c. 6 hours before operation

3/
a. Alloimmunization d. 12 hours after operation
b. Antibodies against donor leukocytes and HLA Ag 121. Rosenthal’s syndrome is seen in deficiency of factor:
c. Allergic reaction  (Recent Pattern 2001)
d. Anaphylaxis
111. Blood grouping and cross-matching is must prior to infu-

r, a. II
b. V
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sion of: (AIPG 2008) c. IX
a. Gelatin b. Dextran d. XI
Si

c. Albumin d. FFP 122. Cryoprecipitate contains: (MCI March 2009)

112. Collection of blood for cross matching and grouping is a. Factor II
done before administration of which plasma expander? b. Factor V
y

 (MHSSMCET 2007) c. Factor VIII

a. Hydroxyl ethyl starch b. Dextran d. Factor IX
er

c. Mannitol d. Hemacele 123. Cryoprecipitate is a rich source of: (AIIMS 2005)

113. All of the following are major complications of massive a. Thromboplastin
Ans.
rg

transfusion, except: (All India 2006) b. Factor VIII 106. b

a. Hypokalemia b. Hypothermia c. Factor X 107. b
Su

c. Hypomagnesemia d. Hypocalcemia d. Factor VII 108. c

114. The maximum life of a transfused RBC is: (JIPMER 2002) 124. Which one of the following blood fractions is stored at 109. a
a. One hour b. One day -40°C? (Recent Pattern 2013) 110. b
c. 15 days d. 50 days a. Cryoprecipitate 111. b
e. 100 days b. Human albumin 112. b
115. Platelets can be stored at: (AIIMS Nov 2005) c. Platelet concentrate 113. a
a. 20-24° C for 5 days b. 20-24° C for 8 days d. Packed red cells 114. d
c. 4-8°C for 5 days d. 4-8°C for 8 days 125. Cryoprecipitate contains all, except: (AIIMS Nov 2007) 115. a
116. Blood platelets in stored blood do not remain functional a. Factor VIII 116. a
after: (Recent Pattern 2009) b. Factor IX 117. a
a. 24 hours b. 48 hours c. Fibrinogen 118. c
c. 72 hours d. 96 hours d. VWF 119. a
120. a
121. d
122. c
123. b
124. a
125. b

21
 Surgery Sixer for NBE

ANSWERS WITH EXPLANATIONS OF MULTIPLE CHOICE QUESTIONS

Section 1     General Surgery

1. Ans.  (b) Urine output Components of Damage Control or

Ref: Bailey and Love 27th edition Page 18)
Hemostatic Resuscitation
•• Permissive hypotension until definitive surgical control
•• Best measure of organ perfusion and Best monitor for
•• Minimize crystalloid use
adequacy of fluid resuscitation is Urine output. Only
•• Initial use of 5% hypertonic saline
problem is – this is a hourly measure and does not give
•• Early use of blood products (PRBCs, FFP, platelets,
minute to minute value.
cryoprecipitates)
•• CVP – there is no normal CVP for a shock patient and
•• Consider drugs to treat coagulopathy (rFVlla, prothrombin
cannot be placed as assessment of shock as alone. CVP is a
concentrate, TXA)
poor reflector of preload.
•• Lactic acid is one best measure of GIT perfusion 5. Ans.  (b) Nose to ear to xiphoid process.
•• Adequacy of Consciousness for Brain Perfusion.
Ref: Page 992 Surgery Sixer 2nd Edition
2. Ans.  (b) Heart Rate/ MAP •• Happy to see one direct question from Surgery Sixer .
Ref: Sabiston 20th edition Page 52) •• Nasogastric Tube (Ryles Tube) is measured by keeping the
tube from Ear lobe to tip of nose and then upto Xiphoid
•• Shock index is defined as Heart rate divided by systolic BP.
process.
•• Shock Index is known as hemodynamic stability indicator •• The standard lengths used in adults are 110 cm or 130 cm

e
in Shock cases. tubes.
•• Modified Shock Index (MSI) includes Diastolic BP also and

3/
•• Prime purpose of the tubes are- Feeding and Aspiration*
defined as heart rate divided by Mean arterial pressure.
•• MAP= Systolic Pressure+ (2 X Diastolic Pressure) divided
by 3
•• High MSI indicates- Hypodynamic state r,
xe
•• Low MSI indicates- Hyperdynamic state
•• MSI is better indicator than SI to predict the mortality in
shock
Si

3. Ans.  (c) Blue

y

Ref: Surgery Sixer 2nd Edition Page 14

er

In our Hospitals commonly available cannulas for resusci-

tation are:
rg

•• Grey: 16 G
•• Green: 18 G
•• Pink: 20 G
Su

•• Blue: 22 G
•• Yellow: 24 G

4. Ans.  
(c) Maintaining permissible hypotension to avoid
bleeding
Ref: Sabiston Page 69, Surgery Sixer page 11)
•• It has been found in trauma resuscitation with crystalloids
it stimulated the inflammation more severe than any other
fluid.. It has also been observed the lowest inflammatory
response is seen with 7.5% HTS (Hypertonic Saline) fluid .
•• Usage of aggressive crystalloids also resulted in abdominal
compartment syndrome.
•• Hence a new concept of damage control/Hemostatic/
balanced resuscitation came into act which used permissible
hypotension to avoid bleeding from trauma sites.
•• With the promotion of damage control resuscitation,
clinical studies indicated that aggressive early use of blood
products, such as PRBCs and FFP, actually reduced the total
volume of PRBCs used by 25% (PRBC- Packed red blood
cells)
22
6. Ans.  (a) Change central venous catheter tube every two
weeks routinely
Ref: Page no 56/ Schwartz 10th Edition
Patients on Long term TPN via Central venous catheter:
•• Central venous Catheter must be managed very carefully
with full sterile precautions.
•• Inspect daily the catheter site for infection
•• Early sign of Catheter related sepsis is Sudden Glucose
intolerance
•• Suspected Catheter sepsis- Remove the catheter and send
for Culture and sensitivity.
•• Catheter is changed only in suspected infections- Not
changed routinely
•• Increased risk of catheter related infections is seen in Multi
lumen catheter.
•• Risk is highest with Femoral Vein catheter> IJV > Subclavian
vein catheter
 Multiple Choice Questions

•• Monitor LFT and RFT every week once Surgeries where early feeding must not be given:

Chapter 1     Basic Concepts in Surgery

•• Monitor electrolytes level every 2-3 days •• Esophageal surgery
•• Elevation of Liver enzymes is associated with Steatosis due •• Gastric resection
to Overfeeding •• Major hepatic surgery
•• Major Pancreatic Surgery
7. Ans.  (c) Peripheral vein
15. Ans.  (c) Feeding jejunostomy
Ref: Bailey and Love 27th edition Page 287)
For delivering TPN: 16. Ans.  (b) Severe pancreatitis
•• < 2 weeks: Peripheral Veins are used in wrist veins changing
every 12 hours. Ref: Schwartz 10th edition page 57
•• PICC : Peripherally inserted central venous catheter is also •• In IBD and granulomatous disease sometimes available
used , which has patency of 7 days only. normal mucosa is less or absent and such cases parenteral
•• For duration > 2 weeks: Subclavian Vein approach of central nutrition is preferred.
vein is best
17. Ans.  (c) Retraction method
8. Ans.  (c) Chronic liver disease
Ref: Bailey 26th Edition Page 267
Ref: Sabiston’s Textbook of surgery, 20th ed p-117-19
There are three methods of putting PEG tube
•• In acute pancreatitis nutritional management begin with •• Direct Stab technique (Introducer technique)
abstinence of alcohol and relief from abdominal pain with •• Push through technique

e
low oral fat diet (enteral nutrition) •• Pull Technique
•• Chronic liver disease is not an indication for TPN.

3/
There is no retraction technique
•• In acute pancreatitis severe type TPN is given.
18. Ans.  (d) Fibers
9. Ans.  (b) Hypochloremia
Ref: Sabiston’s Textbook of surgery, 20th ed p-121-22 r, Ref: Bailey 26/e p264
xe
Total Parenteral nutrition contains:
•• In TPN hyperchloremic acidosis occurs. •• Carbohydrates
•• Lipids
Si

10. Ans.  (a)  Serum albumin

•• Amino acids
Ref: Sabiston 20th Edition Page 108 •• Electrolytes
y

•• Serum albumin is useful in detecting and quantifying •• Trace elements

•• Vitamins
er

malnutrition.
•• Water
11. Ans.  (c) Mid-arm circumference
rg

19. Ans.  (a) Subclavian vein

Anthropometric techniques of Nutritional Assessment:
•• Skin fold thickness- at Ulnar, Triceps, Subcapsular and Ref: Sabiston 19/e p137-138
Su

Suprailiac regions.
•• Mid arm circumference 20. Ans.  (c) Chronic liver disease

12. Ans.  (b) Ear lobe to the umbilicus 21. Ans.  (a) Subclavian vein
•• The length of the feeding tube to be used is measured by
measuring the length from ear lobe to epigastrium* 22. Ans.  (d) Hyperphosphatemia
•• Hypophosphatemia is the complication of TPN
13. Ans.  (a) Jejunostomy tube feeding
•• Hyperphosphatemia is not seen*
Ref: Sabiston 19/e p132-136)
23. Ans.  (c) Congestive cardiac failure
•• Patient in coma has a normal GIT. So he can be given
enteral feed.
24. Ans.  (d) Azotemia
•• Of the enteral feeds- NG feeding has risk of aspiration as
he is in Coma. So either of NJ tube of surgical jejunostomy •• Least common problem seen is azotemia*
is ideal.
25. Ans.  (a) Subclavian vein
14. Ans.  (c) Feeding jejunostomy
•• Jejunostomy will be the ideal for patients who have 26. Ans.  (a) Parenteral
undergone pancreatic surgery. Jejunostomy feeding gives
rest to pancreatic stimulation. 27. Ans.  (c) Hypotriglyceridemia
•• Hyper triglyceridemia is the complication seen in TPN
23
 Surgery Sixer for NBE
Section 1     General Surgery

28. Ans.  (a) Catheter related complications •• Pulse pressure decreases at Class 2 Hemorrhagic shock

29. Ans.  (a) Hypomagnesemia 38. Ans.  (a) 1 week

Features of Hypomagnesemia: Ref: Internet Sources
•• Weakness •• Stress hormones like cortisol are released following trauma
•• Muscle cramps and hemorrhage and will remain elevated up to 1 week after
•• Neuromuscular and CNS irritability removal of stress. The level becomes normal after restoring
•• Nystagmus blood by transfusion.
•• In burns it may get elevated up to 4 weeks*
30. Ans.  (e) All of the above
39. Ans.  (a) Hypovolemic Shock
31. Ans.  (a) It is costly
Ref: Bailey and Love 27th edition Page 13)
32. Ans.  (b) 7 days Causes of hypovolemic shock: (the most common form of Shock)
Hemorrhagic Nonhemorrhagic
33. Ans.  None
Trauma •• Dehydration
•• Vomiting
34. Ans.  (a) Up to 7 days
•• Diarrhea
•• Diabetes having urinary loss
35. Ans.  (c) Hypercalcemia

e
•• Evaporation in Burns
•• Third space loss pancreatitis, bowel

3/
36. Ans.  (c) Metabolic acidosis obstruction
•• Hyperchloremic Metabolic acidosis happens on TPN*
40. Ans.  (a) Increased Adrenaline
37. Ans.  (b) 750-1500 mL r, Ref: Bailey and Love 27th edition page 14)
xe
Ref: Bailey and Love 27th Edition Page 19) In response to Stress hormones status is depicted below
Based on the table we have discussed already. This is a
Si

Hormones Changes
hemorrhagic shock with only pulse rate and RR are increased,
BP is normal** ACTH Increased
So as per the table below it is Class 2 Shock** Growth Hormone
y

•• Class 1 Shock is 15% of 5 Litres of Blood= < 750 mL TSH/ FSH/LH Variable
er

•• Class 2 Shock is 15- 30%: 750-1500 mL Vasopressin Increased

•• Class 3 Shock is 30-40 %= 1500-2000 mL
Cortisol Increased
rg

•• Class 4 Shock is > 40%= > 2 litres

Aldosterone (1st one is Adrenaline)
Class Adrenaline
Su

PARAMETER Nor adrenaline

I II III IV
Blood loss (%) 0–15 15–30 30–40 >40 Insulin Decreased
Glucagon
Central Slightly Mildly Anxious or Confused
nervous anxious anxious confused or T3 and T4 Decreased or Variable
system lethargic
41. Ans.  (b) Class 2
Pulse <100 >100 >120 >140
(beats/min) Ref: Bailey and Love Page 19/ 27th edition)
Blood pressure Normal Normal Decreased Decreased Already explained

Pulse pressure Normal Decreased Decreased Decreased 42. Ans.  (c) Crystalloids
Respiratory 14–20/min 20–30/ 30–40/min >35/min
Ref: Bailey and Love 27th edition page 19)
rate min
The ideal fluid of choice in emergency ward is crystalloids and
Urine (mL/hr) >30 20–30 5–15 Negligible
especially the best is normal saline > Ringer lactate.
Fluid Crystalloid Crystalloid Crystalloid Crystalloid
+ blood + blood 43. Ans.  (a) CVP
Ref: Bailey and love 26/e, p17)
•• Pulse rate increases at Class 2 Hemorrhagic shock •• Accurate method to monitor IV fluids, inotropic agents and
•• Blood pressure decreases at Class 3 Hemorrhagic shock vasodilators in shock is CVP**
24
 Multiple Choice Questions

Chapter 1     Basic Concepts in Surgery

•• Adequacy of resuscitation is best monitored by urine output. •• Class 2 : 15- 30 % blood loss
•• Please note CVP is not ideal in cardiogenic shock and septic •• Class 3 : 30 -40% blood loss
Shock- In such cases pulmonary capillary wedge pressure is •• Class 4 : > 40% blood loss
most sensitive*
•• Urine Output is the BEST CLINICAL PARAMETER for all 51. Ans.  (b) Hypovolemic shock
kinds of shock**
Ref: Bailey 26th 14
44. Ans.  (a) 16G •• Hypovolemic shock is the most common type of shock.
•• Grey Venflon is used for blood transfusion during massive
52. Ans.  (c) 130
bleeding- Size of Grey Venflon= 16 G
•• Green Venflon is commonly used during surgery- Size of Ref: Sabiston 20th 69
green Venflon = 18 G •• Concentration of sodium in RL is 130 mEq /L
•• Concentration of sodium in NS is 154 mEq/L
45. Ans.  (a) Intraosseus cannulation
Ref: Leidel BA, Kirchhoff C, Bogner V, Stegmaier J, Mustchler W, 53. Ans.  (b) Vomiting
Kanz KG, et al. Is the intraosseous access route fast and efficacious
compared to conventional central venous catheterization in 54. Ans.  (d) Pyloric stenosis
adult patients under resuscitation in the emergency deparment? •• Pyloric stenosis , Chronic DU with cicatrisation and
A prospective abservational pilot study. Patient Saf Surg. 2009 other causes of GOO Causes
Oct 8. 3(1):24. ƒƒ Hypochloremia

e
•• Intraosseus cannulation is straightforward and safe in ƒƒ Hypokalemia

3/
children less than 6 years. ƒƒ Hyponatremia
ƒƒ Metabolic alkalosis
46. Ans.  (c) Erythropoetin ƒƒ Paradoxical aciduria
Ref: Crystalloids versus colloids in fluid resuscitation: a
r,
55. Ans.  (c) Duodenal
xe
systematic review. Crit Care Med.
•• Colloids increase intravascular volume Ref: Sabiston 19/e p1271)
•• Colloids are dextran, gelatin, hydroxyethyl starch. High output fistula is seen in fistulas arising from:
Si

(> 500 mL)

47. Ans.  (a) Hypovolemic •• Stomach
y

Ref: Recognition and Initial Management of Shock. Nichols DG, •• Duodenum (Maximum Fluid and electrolyte imbalance)
ed. Roger’s Textbook of Pediatric Intensive Care. Philadelphia •• Proximal jejunum
er

PA: Lippincott, Willam and Wilkins; 2008. 372-383 •• Biliary

ƒƒ Hypovolemic shock is the most common shock in Low Output fistula is seen in fistulas arising from:
rg

children (< 200 mL)

ƒƒ It is the Most common type of shock for Adults also. •• Ileum
Su

•• Colon
48. Ans.  (a) Metabolic acidosis •• Pancreatic
Ref: ‘’Anion Gap: Acid Base Tutorial’’. University of Connecticut 56. Ans.  (d) Sigmoid colon
Health Centre
Ref: Schwartz 10/e p69
•• Lactic acidosis is seen in hemorrhagic shock.
•• Lactic acidosis causes increase anion gap metabolic acidosis. •• Highest concentration of potassium seen in Colon (30
mEq/L)
49. Ans.  (d) All of the above •• Highest absorption of potassium occurs in colon
Ref: Bailey and Love Principles and Practice of Surgery, 26th ed 57. Ans.  (b) Pyloric stenosis
p-13-18
Indicators of hypoperfusion 58. Ans.  (b) Decreased K+ in urine
•• Systolic BP < 90 mm hg
•• Increased potassium excretion happens resulting in
•• Mean blood pressure by 30 mm of hg
hypokalemia*
•• Acidosis
•• pH in blood is metabolic alkalosis (Increased pH)
•• Elevated lactate level
•• Oliguria. 59. Ans.  (a) Hyperchloremic acidosis
50. Ans.  (b) 15–30 % •• Uretero sigmoidostomy results in metabolic acidosis*
•• Hyperchloremia is seen* (Just opposite to GOO)
Ref: Sabiston 20 th Page 50
•• Class 1 <15% blood loss 25
 Surgery Sixer for NBE

70. Ans.  (b) Increase in urine output

Section 1     General Surgery

60. Ans.  (c) Hyperkalemic acidosis

•• Hyperkalemic acidosis is seen in acute burns*
71. Ans.  (c) 130
61. Ans.  (c) Excessive sweating Ringer lactate is composed of
•• Sodium- 131
62. Ans.  (c) Hypokalemia •• Potassium- 5
•• Chloride- 111
63. Ans.  (d) Darrow’s solution •• Lactate- 29
Highest potassium concentration is seen in Darrow solution** •• Calcium-2

Composition 72. Ans.  (b) 154 mEq

Lac- Glu- Calo- Contents of Nacl:
Na+ K+ Cl– Ca++
tate cose ries •• Sodium- 154
IV fluid 5.4 112 1.8 27 - - •• Chloride- 154
Ringer's
73. Ans.  (d) Excessive infusion of 5% glucose
lactate 130 – 154 – – – –
(Hartmann's)
74. Ans.  (c) Both protein and calories would be adequate
Normal saline
154 – 154 – – – – Ref: Sabiston 19/e p138
(0.9% NaCl)

e
10% glucose – – – – – 100 400 Calories are calculated by catabolism of glucose (not proteins)

3/
Glucose:
0.45 NaCl/5%
77 – 77 – – 50 200 •• Amount of glucose in 20% glucose in 3000 mL of solution:
glucose
3000 × 20/100= 600 g
Darrow's
solution
121 35 103 – 53 – –
r, •• 1 g of glucose on catabolism produces: 4.2 Kcal
•• 600 g of glucose would produce 600 x 4.2 = 2520 kcal
xe
Protein
64. Ans.  (b) Degraded gelatin
•• Percentage of protein in fluid: 4.25%
•• Hemaccel is made up of degraded  gelatin polypeptides 
Si

•• Percentage of Protein in 3000 mL of fluid: 3000 × 4.2/100=

cross-linked via urea bridges.
127.5 g
65. Ans.  (d) Excreted excessively Conclusion:
y

•• Calories required for the patient: 40 × 65 =2600 Kcal

•• In immediate post op period due to increased Adreno
er

•• Proteins required for the patient: 2 × 65 = 130 g

corticoid activity there will be Na+ Retention and K+
•• We have provided both in ideal amount as calculated above*
Excretion*
rg

66. Ans.  (d) Thrombocytopenia 75. Ans.  (a) IV fluids only

Su

•• Dextran interferes with Platelet function.* Ref: Sabiston 19/e p72

67. Ans.  (a) Tissue perfusion 76. Ans.  (d) 3% normal saline
Ref: Sabiston 19/e p87
Hypotonic Isotonic Hypertonic
•• The best guide for tissue perfusion is urine output**
Hemodynamic monitoring: 0.45% NS 5% Dextrose 5% Dextrose +
•• CVP Saline 0.9% ½ NS
•• PCWP Ringer Lactate 5% Dextrose
ƒƒ Urine output is best for Tissue perfusion, response to •• These are the + NS
resuscitation common fluids we 10% Dextrose
ƒƒ PCWP is the best for measuring blood volume, left have in wards
ventricular function and to guide inotrophic agents*
77. Ans.  (d) Hyponatremia
68. Ans.  (c) Hypertonic
78. Ans.  (c) 130
69. Ans.  (c) Cardiopulmonary problem
In trauma causing hypotension due to bleeding there will be 79. Ans.  (c) Albumin
low CVP*
In cardiogenic shock: 80. Ans.  (a) Urine Output
•• Hypotension
•• Elevated CVP
26
 Multiple Choice Questions

Chapter 1     Basic Concepts in Surgery

81. Ans.  (d) Deficiency of effective circulation*
•• Shock is inadequate delivery of oxygen and nutrients due to
poor perfusion and inadequate effective circulation*
82. Ans.  (d) All the above
•• Hydrocortisone is used in septic shock if the hypotension
does not respond to IV fluids and vasopressors*
•• Patients with severe sepsis (APACHE-II score > 25 or
multiorgan failure) must be given recombinant human
activated protein C**

83. Ans.  (d) Hypotension and bradycardia 94. Ans.  (a) Septic shock
•• Colloids are used in septic shock at rate of 300—500 mL in
84. Ans.  (d) Ringer lactate 30 minutes*
•• The best fluid for blood loss- Blood*
95. Ans.  (b) 8-12 mm Hg
•• In trauma in the initial few hours of resuscitation the fluid
that is best is Ringer lactate as it is balanced salt solution and •• Normal PCWP- 6-12 mm Hg
mimic extracellular fluid. •• Measured by using Swan Ganz Catheter*
•• Resuscitation with colloids is no more effective than
96. Ans.  (d) Neurogenic shock
crystalloids but is more expensive*
•• Hypotension and tachycardia means the patient had
85. Ans.  (c) Hypovolemic Shock developed hemorrhagic shock (Chest/ Abdominal injuries)
in trauma*
86. Ans.  (a) Injury to solid intra-abdominal organs •• Hypotension and bradycardia in a trauma means the patient
had developed neurogenic shock*

e
87. Ans.  (b) Ringer lactate

3/
97. Ans.  (b) 1.5 minutes
•• Current principles crystalloids + blood is preferred for
•• In patients on shock it is difficult to get peripheral IV access.
moderate hemorrhage
So immediately get a central venous line or intraosseous line
88. Ans.  (d) Decreased cutaneous blood flow r, in 90 seconds*
xe
•• Decreased in cutaneous blood flow results in Cold 98. Ans.  (a) Whole blood volume in 24 hrs
peripheries*
Ref: Schwartz 10th 100)
Si

89. Ans.  (b) Bradycardia •• Massive transfusion is defined as whole blood volume
transfusion in 24 hrs.
y

90. Ans.  (a) Tachycardia

99. Ans.  (a) 20% Rapid loss of blood
er

•• The earliest indication of concealed hemorrhage is increased

in pulse rate (Tachycardia)- Earliest sign** Ref: Sabiston 20 th 50 Bailey 26 th 22
rg

•• Tachycardia is not seen in Class 1 Shock. It’s seen in Class 2 •• 20% blood loss comes under Class 2 shock which is managed
Shock only (at blood loss more than 15%) by crystalloid
Su

91. Ans.  (b) Hypovolemic 100. Ans.  (a) Febrile non-hemolytic transfusion reaction
•• Most common complication on Blood transfusion is fever*
92. Ans.  (d) Cardiac
101. Ans.  (c) Dengue virus
Ref: Sabiston 85/19th Edition
•• Dengue virus is not transmitted in blood.
•• Most common cause of death in septic shock- Hypotension*
•• But Malaria can be transfused via blood*
•• Hypotension is due to decreased cardiac output leading to
hypotension* 102. Ans.  (d) Metabolic acidosis
•• Electrolyte imbalance in Massive transfusion:
93. Ans.  (a) IV fluids+ Dopamine
ƒƒ Hyper kalemia
Ref: Sabiston Page 85: (Highly expected question ƒƒ Hypocalcemia
International Guidelines for Management of Severe Sepsis ƒƒ Hypomagnesemia
ƒƒ Metabolic alkalosis
and Septic Shock:
ƒƒ Very Rare- Metabolic acidosis.
•• Target CVP >8 mm Hg, crystalloids or colloids are used*
•• Maintain MAP >65 mm Hg. Vasopressors are not initially 103. Ans.  (d) 24 hours
advised- Dopamine and Noradrenaline are the initial
•• Fresh blood transfusion is the term given if you transfuse
vasopressors of choice*
within 24 hours of collecting*
•• For renal perfusion low dose Dopamine must not be used*
•• Dobutamine is used as inotrophic if cardiac function is
poor*
27
 Surgery Sixer for NBE
Section 1     General Surgery

104. Ans.  (b) Direct Coomb’s test Disadvantage:

•• Direct anti-globin test (Direct Coomb) is used to detect •• It induces rouleaux formation and interferes with blood
antibodies against transfused blood immediately after grouping and cross matching and hence a blood sample
transfusion from patient’s blood sample* must be taken before doing transfusion or else it will confuse
with cross matching test*
105. Ans.  (a) O negative •• It interferes with platelet function also (hence more than
100 mL must not be transfused)
•• Universal donor- O negative group blood
•• Universal recipient- AB negative group persons 112. Ans.  (b) Dextran
106. Ans.  (b) 1 gm%
113. Ans.  (a) Hypokalemia
•• 1 unit Packed cells increases 1 gm Hb*
114. Ans.  (d) 50 days
107. Ans.  (b) Hematocrit
•• Best indicator for blood transfusion- Hematocrit Ref: Schwartz 10/e p1914-1915
•• Shelf life of RBC in Packed cells- 5 weeks* (35 days*)
108. Ans.  (c) 28 days
115. Ans.  (a) 20-24°C for 5 days
Ref: Sabiston 19/e p588
•• If CPD(Citrate Phosphate dextrose) is used for storage 116. Ans.  (a) 24 hours
Blood can be stored for 21 days at 1-6°C.

e
•• If adenine is added to CPD we can increase storage time to 117. Ans.  (a) Good source of all coagulation factors

3/
35 days
•• FFP is a good source of only stable coagulation factors.
•• With SAG-M- 5 weeks (latest storage material)
Labile factors like 5 and 8 will be diminished*
•• On storage there is diminished count of Factor 5 and 8*
109. Ans.  (a) Whole blood volume in 24 hours
•• Massive blood transfusion is defined as transfusion r,
xe
118. Ans.  (c) Factors 5 and 8
of Patient’s total blood volume in 24 hours or as acute
transfusion of more than 10 units of blood in few hours. 119. Ans.  (a) It is used as volume expander
Si

•• This is nothing but transfusing 5000 mL in 24 hours for

•• FFP is not used as routine as plasma or volume expander*
adult.
•• It has also been defined as single huge transfusion of 2,500 120. Ans.  (a) Just before operation
y

mL
•• Transfusion must be done just before shifting to operation
er

110. Ans.  (b) Antibodies against donor leukocytes and HLA Ag room*
rg

121. Ans.  (d) XI

111. Ans.  (b) Dextran
•• Hemophilia C (Rosenthal Syndrome) is due to deficiency
Dextran:
Su

of Factor XI*
•• It is a polysaccharide polymer of varying molecular weight
producing an osmotic pressure similar to plasma. 122. Ans.  (c) Factor VIII
•• Types:
ƒƒ LMW dextran 123. Ans.  (b) Factor VIII
ƒƒ HMW dextran
ƒƒ LMW dextran- Short acting, Prevents sludging of RBC in 124. Ans.  (a) Cryoprecipitate
vessels and renal shut down in severe hypotension. Less
chances of Rouleaux formation* 125. Ans.  (b) Factor IX
•• Cryoprecipitate contains- Fibrinogen, factor 8, VWF*

28
 Multiple Choice Questions

EXTRA EDGE PGI CHANDIGARH QUESTIONS

Chapter 1     Basic Concepts in Surgery

1. Contraindications of enteral nutrition: (PGI Dec 2006)
a. Intestinal obstruction b. Severe pancreatitis
c. Severe diarrhea d. IBD
e. Intestinal fistula
2. Recognized frequent complications of enteral feeding:
 (PGI June 2005)
a. Constipation b. Diarrhea
c. Aspiration pneumonia d. Hypoglycemia
e. Hypernatremia
3. Parenteral nutrition is not used in: (PGI June 2008)
a. Enterocutaneous fistula b. Burns
c. Crohn’s disease d. Paralytic ileus
e. Pancreatitis
4. A patient on TPN develops deficiency of: (PGI Dec 2006)
a. Folic acid b. Iron
c. Vitamin B12 d. Copper
e. Fatty acids
5. Side-effect(s) of parenteral nutrition is/are: (PGI Nov 2011)
13. Blood loss during major surgery is best estimated by:
 (PGI June 2000)
a. Visual assessment
b. Suction bottles
c. Transesophageal USG Doppler
d. Cardiac output by thermodilution
14. Shock is clinically best assessed by: (PGI Dec 2007)
a. Urine output b. CVP
c. BP d. Hydration
15. Blood clot the size of a clenched fist is roughly equal to:
 (PGI 2001)
a. 250 mL b. 350 mL
c. 500 mL d. 600 mL
16. Blood components products are: (PGI Dec 2005)
a. Whole blood b. Platelets
c. Fresh frozen plasma d. Leukocyte reduced RBC
e. All of the above
17. Which of the following statements about acute hemolytic

e
a. Hypoglycemia b. Hyperglycemia blood transfusion reaction is true? (PGI June 2004)
c. Hypercalcemia d. Hypercapnia a. Complement mediated hemolysis is seen

3/
e. Hypophosphatemia b. Type III hypersensitivity is responsible for most cases
6. TPN is indicated in all, except: (PGI Dec 2005) c. Rarely life threatening


a. Short bowel syndrome
b. Burn


r, d. Renal blood flow is always maintained
e. No need for stopping transfusion
xe
c. Sepsis 18. True about blood transfusions: (PGI June 98)
d. Entero cutaneous fistula a. Antigen “D” determines Rh positivity
7. True about TPN: (PGI June 2008) b. Febrile reaction is due to HLA antigens
Si

a. Carbohydrate forms about 40% of energy source c. Anti-d is naturally occurring antibody
b. In abdominal injury early parenteral nutrition should be d. Cryoprecipitate contains all coagulation factors
started 19. Massive blood transfusion is defined as: (PGI 05)
y

c. Proteins forms 60% of energy source a. 350 mL in 5 min b. 500 mL in 5 min

er

d. Lipids form 20% of energy source c. 1 litre in 5 min d. Whole blood volume
8. In IV hyperalimentation, we give: (PGI June 2002) 20. Massive transfusion in previous healthy adult male can Ans.
rg

a. Hypertonic saline b. Fats cause hemorrhage due to: (PGI 2000) 1. a,c,e
c. Amino acids d. Dextrose a. Increased t-PA 2. a,b,c
e. LMW dextran b. Dilutional thrombocytopenia
Su

3. e
9. The minimum amount of proteins needed for positive c. Vitamin K deficiency 4. All
nitrogen balance is: (PGI 2004) d. Decreased fibrinogen 5. All
a. 20-30 g/day b. 35-40 g/day 21. Mismatched blood transfusion in anesthetic patient 6. c
c. 50 g/day d. 60 g/day presents is: (PGI June 2000) 7. d
10. Chronic vomiting leads to all except: (PGI Nov 2011) a. Hyperthermia and hypertension 8. b,c,d
a. Hyponatremia b. Hypotension and bleeding from site of wound 9. d
b. Hypochloremia c. Bradycardia and hypertension 10. d
c. Metabolic alkalosis d. Tachycardia and hypertension 11. c
d. Metabolic acidosis 22. Massive transfusions results in: (PGI 2008) 12. a
13. b
e. Hypokalemia a. DIC b. Hypothermia
14. a
11. A postoperative patient with pH 7.25, MAP (men arterial c. Hypercalcemia d. Thrombocytopenia 15. c
pressure) 60 mm of Hg treated with: (PGI 2003) 23. Indication of fresh frozen plasma is/are: 16. e
a. IV sodium bicarbonate (PGI Nov 2011) 17. a
b. Only normal saline a. Hypovolemia 18. a,b
c. Fluid therapy with CVP monitoring b. Nutritional supplement 19. d
d. Fluid restriction c. Coagulation factor deficiency 20. b
12. Which among the following is best method to assess the d. Warfarin toxicity 21. b
response to given fluids in polytrauma patient? e. Hypoalbuminemia 22. a,b,d
 (PGI June 2006) 24. Half-life of factor VIII is: (PGI 2008) 23. c,d
a. Urinary output b. CVP a. 4 hours b. 8 hours 24. b
c. Pulse d. BP c. 34 hours d. 48 hours
29
 Surgery Sixer for NBE

ANSWERS WITH EXPLANATIONS

Section 1     General Surgery

1. Ans.  (a) Intestinal obstruction, (c) Severe diarrhea,
(e) Intestinal fistula
Ref: Sabiston 19th edition Page-1523
•• Severe pancreatitis is not a contraindication for enteral
feeding as per recent updates.
•• Although TPN provides most nutritional requirements, it is
associated with mucosal atrophy, decreased intestinal blood
flow, increased risk of bacterial overgrowth in the small
bowel, antegrade colonization with colonic bacteria, and
increased bacterial translocation.
•• In addition, patients with TPN have more central line
infections and metabolic complications (e.g., hyperglycemia,
electrolyte imbalance).
•• Whenever possible, enteral nutrition should be used, rather
than TPN.
2. Ans.  (a) Constipation, (b) Diarrhea, (c) Aspiration
11. Ans.  (c) Fluid therapy with CVP monitoring
•• The best monitor for fluid therapy is PCWP, but commonly
used is CVP in managing fluids.
12. Ans.  (a) Urine output
13. Ans.  (b) Suction bottles
Ref: Sabiston Page 112/19th edition
Blood loss in major surgery is measured by – adding up the
volume of fluid in suction bottle+ (weight of soaked swab- dry
weight of the swab)
14. Ans.  (a) Urine Output
•• Most common type of Shock- Hypovolemic shock
•• Most best parameter to monitor/guide tissue perfusion*-
Urine output
•• Most best method to manage shock with fluids- PCWP* >

e
pneumonia
CVP monitor*

3/
Ref: Sabiston 19/e p135 •• There will be Metabolic acidosis associated with Shock*

3. Ans.  (e) Pancreatitis 15. Ans.  (c) 500 mL

Ref: Sabiston 19/e p137-141 r, •• Clenched Fist size clot = 500 mL blood loss
xe
•• Even for pancreatitis if patient cannot tolerate Enteral 16. Ans.  (e) All of the above
nutrition we give them TPN
Si

17. Ans.  (a) Complement mediated hemolysis is seen

4. Ans.  (a) Folic acid, (b) Iron, (c) Vitamin B12, (d) Copper
(e) Fatty acids •• Acute hemolytic transfusion reaction is Type 2
hypersensitivity reaction caused by Complement mediated
y

5. Ans.  (a) Hypoglycemia, (b) Hyperglycemia, hemolysis*

er

(c) Hypercalcemia, (d) Hypercapnia, •• These are life threatening and can lead to oliguria and Acute
(e) Hypophosphatemia renal failure due to decreased renal blood flow*
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18. Ans.  (a) Antigen “D” determines Rh positivity; (b) Febrile

6. Ans.  (c) Sepsis
reaction is due to HLA antigens
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7. Ans.  (d) Lipids form 20% of energy source
Ref: Sabiston 19/e p138
•• Fat free TPN- has no fat
•• Fat TPN has 20% of fat as energy source
•• Fat free TPN needed in Hepatic steatosis*
8. Ans.  (b) Fats, (c) amino acids, (d) Dextrose
•• Cryoprecipitate contains only factor-8
•• Anti- D is not naturally occurring antibody. It is prepared
for infusing in Rh incompatible babies. (Rh Negative
mother with Rh Positive baby)
19. Ans.  (d) Whole blood volume
•• Patient’s whole blood volume getting replaced is known as
massive blood transfusion- e.g. 5 litres in adults.

9. Ans.  (d) 60 gm/day 20. Ans.  (b) Dilutional thrombocytopenia

10. Ans.  (d) Metabolic acidosis
Ref: Sabiston 19/e p1196
•• Hypochloremic, Hypokalemic, Metabolic Alkalosis with
Paradoxical renal aciduria are the feature of Chronic
vomiting*
21. Ans.  (b) Hypotension and bleeding from site of wound
Ref: Schwartz 10/e p119
•• The dominant sign of mismatched blood transfusion
in sedated patient in theatre- Diffuse bleeding and
hypotension*

30
 Multiple Choice Questions

•• Most common symptom in conscious patient- Sensation of FFP indications:

Chapter 1     Basic Concepts in Surgery

heat and pain along the transfusion vein.
•• Most common sign of hemolytic reaction in conscious
patient- Oliguria > Hemoglobinuria*
22. Ans.  (a) DIC, (b) Hypothermia; (d) Thrombocytopenia
23. Ans.  (c) Coagulation factor deficiency; (d) Warfarin
toxicity
Ref: Sabiston 19/e p588
•• To correct coagulopathies
•• Rapid reversal of Warfarin Toxicity
•• To supply deficient Plasma proteins
•• To treat Thrombotic Thrombocytopenic purpura
FFP is an acellular component and hence will not transmit
intracellular infections like CMV*
24. Ans.  (b) 8 hours
•• Factor 8 half life= 8*(8-12 hours)

e
3/
r,
xe
Si
y
er
rg
Su

31