Professional Documents
Culture Documents
Amc Surgery 2005 To 2009
Amc Surgery 2005 To 2009
2005
Snake bite:
A middle-aged man is brought to your surgery with a history of being bitten by a black
snake. On examination there are scratch marks on the lower leg and no other symptoms.
What is your management?
Ans: e.
Apply bandage immediately on the bite site firmly but not very firmly, extend 15 cm above
(JM p.1345).
Trauma:
Photograph 3: X-ray showing an open fracture of the fibula & tibia. A young man, after an
accident on his motorcycle, presented with 3 cm of bone protruding through the skin of
his leg. What is your next line of management?
Ans: D.
Endocrinology:
Photograph 5: Shows the head & neck of a female. There is a large swelling at the center
of the neck and no exophthalmos of the eyes. What is the most likely diagnosis? ***
a) Multinodular goiter
b) Ca thyroid
c) Sub acute thyroiditis
d) Thyroid cyst
e) Graves disease
1. Graves disease
2. Hashimotos thyroiditis (Déjà p.133).
Graves ds and Sud acute thyroiditis (transient phase) can present with hyperthyroidism.
Skin:
Ans: E.
Ortho:
b) The plaster cast is not suitable to correct the fracture in the elderly
c) Immediate internal fixation
d) Plaster cast from below elbow to MCP joint, for at least 10 weeks
Ans: E.
JM p.1399.
Rh:
Ans: B
Skin:
Photograph 9: A young child with a patch of hair loss on the scalp. Some small flakes of
skin are present. What is your diagnosis?
a) Tinea
b) Psoriasis
c) Alopecia areata
d) Trichotillomania
e) SLE
Skin:
Photograph 10: A man came with his wife. A slow growing soft large lump on his back in
between the scapulae remains in that position for last 10 years. WOF is your MX -
Ans: A.
4|Page ps
Ortho:
A man is suffering from back pain, so he is sleeping on a hard wooden bed for last three
weeks. Now he complains of pain in his right elbow. WOF is the cause of the pain in
elbow-
a) Olecranon bursitis
b) Injury to the insertion of flexor muscles
c) Injury to the insertion of extensor muscles
Ethics:
During an operation spleen was accidentally injured and splenectomy was done to
minimize the complications. Next morning the patient asked you about the success &
progress of that operation. As an intern you will tell him----
Ans: D.
Trauma:
A young man injured in a road traffic accident (RTA) has fractures of three ribs anteriorly
on the left and a minimal left pneumothorax. Peritoneal lavage is positive for blood, and
laparotomy is planned for intraperitoeal hemorrhage. The most important step prior to
laparotomy is -
CVS:
a) Fresh blood
b) Desmopressin
c) Fresh frozen plasma
d) Cryosipitate
e) Factor VIII
CVS:
A man came to you complaining of pain in the leg. O/E you could not find pulse in his leg.
You clinically become sure that there is atherosclerasis or atheroma in the peripheral
artery. This is due to -
Ans: b.
CVS:
A 42-years old man complaint of pain in his right hand. He tells you that the previous day
he used a chainsaw for long hours to cut trees. O/E you found his right arm is slightly
swollen than other arm, and there is pain too. WOF is most appropriate investigation--***
a) Venogram
b) Lymphanogram (Dx: Raynaud’s phenomenon; due to use of vibratory tools)
c) CT Scan
d) MRI
e) Arteriogram
AA p.445
GUT:
a) Malignancy
b) Varicocele
c) Ingiunal hernia(Indirect)
d) Hydrocele
e) Torsion of the testis
f) Direct Ingunal hernia
Ans:
GIT:
A 64-years old man presents with profuse bright red bleeding per rectum. What is the
most likely cause? ***
a) Ca colon
b) Polyp
c) Diverticulosis
d) Duodenal ulcer
e) Haemorrhoids
Ans: C.
JM p.362
A 50-year old man presents with sudden onset of severe abdominal pain. Which of the
following is least likely to be the cause?
7|Page ps
a) Acute appendicitis
b) Perforated peptic ulcer
c) Acute pancreatitis
d) Ruptured abdominal aortic aneurysm
e) Renal colic
Ans: A.
JM p.321
Malignancy:
Which of the following disseminated malignancies has the worst prognosis? ***
Ans: E. No reference
Breast:
Which of the following is the most common cause of bloody discharge from the nipple?
a) Intraductal carcinoma
b) Intraductal papilloma
c) Paget’s disease of the braest
d) Fibroadenoma
e) Duct ectasia
Ans: A.
d) Irregular border
e) Irregular colour (from black to brown)
Ans: B.
JM p.1220.
Ulcer:
A diabetic patient with an ulcer at the head of the 2nd metatarsal on the sole of the foot,
which of the following would be the most likely cause?
a) Macrovasclar disease
b) Diabetic neuropathy
c) Infection
d) Varicose venis
e) Hyperglycaemia
Ans: B.
Harrison p.2168
GIT:
A 60-year old man presents with 3 days vomiting and loss of weight (3 kg.). Six years ago
he was treated with Cimetidine. Over the last 3 months he has had epigastric pain
intermittently, for which he takes aspirin. Vomitus is clear in colour with identifiable food
particles. The likely diagnosis is?
Ans: E.
GIT:
The most common cause of diarrhoea in bedridden elderly patients is?
9|Page ps
a) Ca colon
b) Crohn’s disease
c) Ulserative colitis
d) Diverticulosis
e) Faecal impaction
Ans: E.
Breast:
A female had mastalgia for the last 1 year. Conservative treatment has not worked. How
would you manage this patient?
a) Bromocriptine
b) Danazole
c) Clomiphene
d) OCP
e) NSAID’s
Ans: Danazol
JM p.969
CVS:
Ans: D.
Maheshwari p.34
GIT:
A 65-year old woman develops acute abdominal pain with distension. There is a history of
12 hours of vomiting and cramping pain. On examination, irregular pulse 120/min, BP-
10 | P a g e ps
100/60 mmHg, abdomen is tender with guarding and bowel sounds are absent. Rectal
examination reveals a dark bloodstone on the finger. Which of the following is most
likely?
Ans: B.
Atrial fibrillation.
Trauma:
A 21-year old man presents with increasing dysponea, tachypnoea a hyperinflated left
hemithorax with evidence of a mediastinal shift. Your immediate management would be?
Ans: D.
ENT:
Ans: A.
ENT:
Ans: D.
a) Claudication
b) Pallor
c) Pain on walking
d) Shooting pain down the posterior aspect of the thigh
Ans: D.
Malignancy:
a) Prostate cancer
b) Melanoma
c) Small cell carcinoma of the lung
d) Breast cancer
e) Renal carcinoma
Ans: prostate.
GIT:
Which of the following is not a feature of uncomplicated haemorrhoids?
Ans: Pain
Ortho:
GIT:
A female complaints of bloating & belching. She is found to have gallstones, which is
subsequently treated by cholecystectomy. Cholangiogram was done during the operation
and was clear (nothing was found). She was symptom free for 1 week, but then the same
symptoms returned. What is the most likely? ***
a) Pancreatities
b) Cystic duct stump syndrome
c) Stone left in the common bile duct
d) Symptoms are not related to the gallstones
e) Post cholecystectomy syndrome
Ans:
a) Usually asymptomatic
b) Stone in the bile duct presents with clinical sepsis
c) Ususally radiolucent
d)
Ans: http://emedicine.medscape.com/article/175667-overview
Bailey p.1109.
Breast:
13 | P a g e ps
Ans:
GIT:
All of the following would be expected after splenectomy for spherocytosis, except? ***
a) Transient leucocytis
b) Persistence of anaemia
c) Same osmotic fragility
d) Persistence of spherocytosis
e) Normal life span of the erythrocytes
Ans: E.
Ortho:
Ans: Debridement.
GIT:
A 35-years-old woman having severe sudden abdominal pain throughout the night wakes
up and passes dark urine in the bathroom. She immediately goes to see the doctor.
Investigations showed:
- bilirubin – 5 times normal
- Alkaline phosphatase – 3 times normal
- AST & ALT – 4 times normal
- S.amylase – 2 times normal
What is the most likely diagnosis?
14 | P a g e ps
a) Acute cholelithiasis
b) Acute cholecystitis
c) Ca gallbladder
d) Acute choledocholithiasis
e)
Ans: D.
GIT:
What is true about fistulas?
Ans: a.
Pain:
Ans: C. Potential accumulation of norpethidine limits its utility for repeated dosing (KDT
p.459).
Trauma:
You are performing external cardiac massage on a patient who has just suffered a cardiac.
Which of the following provides best indication that resuscitation is effective?
a) ECG
15 | P a g e ps
JMp.1352
Breast:
All of the following are risk factors for breast cancer, except?
f) age - peak incidence 45-75 years but any age postmenarche >> 4x
g) country of residence - high in West > 4x e.g. UK, low in East e.g. Japan
h) previous breast cancer > 4x
i) irradiation of chest - shows a linear dose-response relationship 2-4x
j) social class (I vs. V) 2-4x
k) race - more common in Caucasians < 2x
l) previous ovarian or endometrial cancer < 2x
m) early menarche or late menopause < 2x
n) nulliparity or older than 30 years before first child < 2x
o) hormonal supplementation < 2x
p) obesity - oestrogen synthesis in adipose tissue
q) alcohol consumption
In the male, Klinefelter's syndrome is a risk factor for breast cancer.
Ans: a.
CNS:
A 32-years old man felt pain in the maxillary area at night, which radiates to the side of his
head. There was water inside his nostrils during the attack. WOF is your diagnosis-
a) Migraine
16 | P a g e ps
Ans: b.
Ortho:
A 35-years old female came with complaints of wake up during the night with pain in her
right hand & a shooting pain up the arm. She has difficulty using her right hand when
carrying a shopping bag. Examination shows slight thenar wasting. What is your
diagnosis?
a) Brachial neuritis
b) Thoracic outlet obstruction
c) Cervical spondylosis
d) Carpal tunnel syndrome
e) Cervical rib
GIT:
a) Hydrocele
b) Saphena varix
c) Femoral hernia
d) Varicocele
e) Direct inguinal hernia
Ans: B.
A saphena varix is a dilatation at the top of the long saphenous vein due to valvular
incompetence. It may reach the size of a golf ball or larger.
GUT:
A 25 years old man is awakened during night very severe pain in his right loin. He notices
bright blood in his urine. Next morning he comes to you- you found him a febrile and plain
X ray shows calcium oxalate stone in his bladder. WOF you will advice --
Burns:
a) Irreversible shock
b) Septicaemia
c) Respiratory failure due to respiratory tract burns
d) Unable to maintain positive nitrogen balance
Ans: b.
GIT:
All of the following cause acute pancreatitis, except--
Ans: e.
Preop:
18 | P a g e ps
Ans: b.
GIT:
A female pt. Complaints of fullness fat indigestion after fatly meals. In an ultrasound
stones seen in gallbladder, but there is no sepsis. After surgery no stone left in the gall
bladder and free of symptoms for few weeks, then symptoms recur. What is the
explanation-***
Ans: D.
GIT:
A middle aged female complaints of morning diarrhoea and cramps. On examination
there are no remarkable findings. Which is the most likely diagnosis?
Ans: A.
45.A patient came with weakness in extension of hand and pronation. On examination there
is no wasting of hand muscles. Flexion normal, Biceps & Triceps reflexes also normal. No
Brachioradialis jerk. Where is the lesion?
19 | P a g e ps
a) Median nerve
b) Radial nerve
c) Ulner nerve
d) Nerve to Posterior interoseus
e) Nerve to Anterior interoseus
a) 1 in 2
b) 1 in 4- mode of inheritance
c) 1 in 25
d) 1 in 100
e) 1 in 2500- number of incidence
Ans: e.
20 | P a g e ps
2006
Picture: Dark discolouration on the side of the nose. After excision report shows it as a
Nodular malignant malanoma.WOF is next Mx- (Antho-397 picture on the Sole)
a.Observe
b.Do nothing
c. Wider local excision
d. Radiotherapy
e. Excision
Picture: A child with rash on the buttocks and legs .Both ankles swollen and tender, also
abdominal pain, but no fever. No neck stiffness.WOF is most common major complication-
(Dx:HS purpura ;AMC-286)
a.Nephritis
4.Photo:Lipoma on the neck of a man.H/O soft swelling present for last 3 yrs, never had any
trouble for that swelling.But now he came to you for your opinion.WOF you will do-
a.Reassure, nothing need to do ( Anthology-399)
b.Refer for specialist opinion
c.FNAC
Picture: X-ray chest of a 8 months old infant with opacity in Rt lower zone and
pneumatoceles(Staph. Pneumonia). Rx- (AMC: Fig-119)
I/V Flucloxacillin
Picture: Eye and dilated pupil.Man came to you with h/o pain in the eye, also has
headache and vomiting. Mx-
a.Tropical Acetazolamide
b.Patch the eye to look for FB
cAtropine eye drops
d. Topical Pilocarpine
Picture: A man came with a soft swelling in groin for last 2 years.It is soft, slowly growing
over inguinal ligament & lateral to pubic tubercle.WOF is your Dx-
a. Lipoma
b. Inguinal Hernia (May-2005)
c. Femoral Hernia
Picture: X-ray chest of a 9 months old infant as shown in AMC book(page-119). What is the
Dx? Staph. Pneumonia( But most common in this age group is Streptococcus pneumonia)
11.Photo: CT Scan. A lady complains that she feels her left side of body she feels heavy. She
also has paralysis & weakness of left side. WOF is your Dx-
a. Cerebral Tumour
b. Cerebral Haemorrhage
c. Cerebral Infarction
d. SAH
A pt. present with ptosis of left eye, left side sensory loss of face. Left side gag reflex was
absent, Rt. Sided hemiparesis and incoordination of Rt. Upper and lower limb.Where is
the lesion?
a.Middle Cerebral Artery
b.Internal Carotid Artery
c. Vertebral Artery
d. Multiple Sclerosis
e.Post. Cerebral Artery
In pt. with pancreatitis for purpose of statistical studies ,AOF are useful EXCEPT-
a.Case control
b.Cohort
c.Case report/case study—(one study)
22 | P a g e ps
A pt. complains of severe pain on pressing on nail of thumb.WOF is most likely the cause-
a.Fibrosarcoma
b.Osteosarcoma
c.Glomus tumour
GIT:
On 10th day after appendectomy apatient presents with diarrhoea with fever and
difficulty in passing urine, what is the most likely cause?
Pelvic abscess
GIT:
After screening with faecal blood test WOF is the correct percentage of detection of Duke
A1 colonic carcinoma: Scott-323
a.<3%
b.15% ( Duke A-tumour confined to bowel wall-survival 90%)
c.25%
d.50%
e.75%
23 | P a g e ps
GIT:
After screening with faecal blood test WOF is the correct percentage of detection of Duke
A1 colonic carcinoma: Scott-323
a.<3%
b.15% ( Duke A-tumour confined to bowel wall-survival 90%)
c.25%
d.50%
e.75%
A 62 yr old man presents with tiredness ,weight loss,anemia and fatigability. What is the
Ix you will do first?
a.Barium meal Oct.’92
b.Sigmoidoscopy
c.Colonoscopy
d.Fecal occult blood test
A patient has hammered his nail and came to you with Subungual haematoma under his
nail.WOF is your Mx-
a.Oral Trebinafine
b.Oral Griseoflvin OHCS-738
c.Remove the nail
d.Expressing the blood through a hole trephined in the nail
A 43 yr old man came to your surgery as he is worried about his chances of getting of
colon cancer.He told you that his father and elder brother had died of colon cancer. What
you will advice him?
a.Sigmoidoscopy
b.Colonoscopy
24 | P a g e ps
GIT:
A 33 yr old man came in ER with H/O 3 days vomiting followed by mid abdominal pain.O/E
abdomen is rigid, distended absent bowel sound on auscultation.Plain X-ray shows
multiple air fluid level.WOF is the appropriate fluid therapy for the patient:
a.2000ml of dextrose in 4.5% NaCl preoperatively
b.2000 ml of Hartmann’s solution preoperatively
c.2000ml of Hartmann’s solution during the operation
A 22 yr old football player during a game fell down in awkward position, and developed
pain and rapidly increasing swelling of the knee. Anterior, posterior and lateral X-rays are
normal.WOF injuries you expect to find-
a.Tear of Medial Meniscus
b.Rupture of Anterior Cruciate Ligament
A patient with INR 2.1: An old man is on Warfarin and now he is discovered with a
resectable colon cancer.Management:
Stop Warfarin and start low dose Heparin; operate when INR is normal
A man presents with sudden onset of Horner’s syndrome, 9 & 10 nerves palsy and loss of
touch and temperarure sensation on the opposite side of the body.Where is the site of
lesion?
a.Vertebrobasilar artery
b.Basilar artery
c.middle cerebral artery
26 | P a g e ps
d.Vertebral artery
e.Carotid artery
GIT:
A lady undergone surgery for gallstones.She developed fever and tachycardia after 6
hrs.Oral Cholangiogram was done; findindings were normal.Dx-
a.Atelectesis
b.Wound infection
c.Allergy to dye
A 63 yr old man presents with 3 days vomiting and has lost 3 kilos.Five years ago he was
treated with cimetidine.Over the last two months he has epigastric pain and has been
treated with aspirin.Vomitus is clear in colour with identifiable food paticles.The Dx is:
a.Drug induced gastritis
b.Chronic duodenal ulcer
c.Cancer of duodenum
d.Pyloric stenosis
e.Cancer of cardia
A 45 yr old lady complains of irregular menstrual bleeding.She has been treated for CIN-II
previously and a Pap smear done 6 months ago was fond normal.WOF is the most
appropriate investigation for her?
a.Colposcopy Repeat: March’06
b.USG to detect endometrial thickness
c.Cone biopsy (see the difference: Q-40/oct’04)
d.Endometrial curettage
e.Repeat Papsmear
A labourer who is a heavy smoker find difficult to perform his duties and worried about
his physical conditions.On examination there is ankle oedema, raised JVP, huge hepato-
splenomegaly and ascitisWOF is likely- (May’05)
a.Cirrhosis
b.Costrictive pericarditis due to previous tuberculosis
c.SVC obstruction
d.Budd Chiari Syndrome
A foot ball player while playing got injury in his Rt.Knee.The knee is locked.Dx: [Outline of
fractures-224:Locking is common & important
Tear of Medial Meniscus feature of torn medial meniscus.Knee suddenly gives way]
27 | P a g e ps
A 57 yr old lady develops sudden onset of left sided weakness and right eye blindness.This
is most likely due to-
a.Vertebro-basilar insufficy
b.Pituitary tumour
c.Carotid artery stenosis
d.Cerebellar lesion
e.Retinal detachment
A patient presents with impaired sensation on medial aspect of the hand, 4th and 5th
fingers of the hand are flexed.Where is the lesion?
Ulner nerve at elbow
GIT:
GIT:
Pain in epigastrium which does not releifs by eating or any effort.Has no relation with
food.Dx-
Hiatus hernia
A boxer comes to the ED after a fight in which he was knocked out.His left pupil is dilated,
but otherwise he is normal and he feels ok.WOF would you do-
a.Give Manitol
b.CT Scan of head
A man presents with pain over the L4 region.His X-ray shows multiple metastatic lesions in
the spine.WOF investigations is most appropriate:
a. Prostate specific antigen
b. CT Scan
c. MRI
A 12 yr old boy presented with painless lump in the scrotum for the last 6 months.He is
otherwise healthy grown up.What is the most likely Dx?
a.Hernia
b.Seminoma
c.Encysted hydrocelc of the cord
d.Saphena varix
e.Haematocele
A mother of a 4 yr old child noticed that there is a solid mass in the Rt. Loin area of her
child which she noticed for the first time with occasional blood in urine.WOF is your initial
Dx: OHCS-220
a.Neuroblastoma Wilm’s tumour:Commonest intraabdominal tumour of
b.Wilms tumour childhood.Haematuria not common,but fever,flank pain c c.Hydronephrosis
abdominal mass found. US-pelvicdisortion,hydronephrosis
d.Plycystic kidney disease .
Two months old child’s mother noticed a firm lump in her baby in the left side of upper
abdomen while bathing.Child has bilateral periorbital ecchymosis.what is the most likely
cause?
a.Neuroblastoma May-2000
b.Wilm’s tumour
Mother of a 3 year old child noticed a mass in the abdomen on the left side.AOF could be
the cause,except-
a.Hydronephrosis October’96
b.Neuroblastoma
c.Nephroblastoma(Wilm’s tumour)
d.Poly cystic kidneys—(Die before 1 year of age )
29 | P a g e ps
e.Chr. constipation
A 23 yr old man limped into ED and stated that he was kicked in the post. Aspect of the leg
during a game of foot ball.He experienced immediate sharp pain which subsided.O/E
there is decreased planter flexion.What is the Dx-
Rupture of achillis tendon
2007
Ortho:
Hereditary predisposition
Cirrhosis
GIT:
Ortho:
A boy came with fever and pain in the right leg. He hardly moves the leg and does not
allow you to move it either. He refuses to carry weight on that leg. What could be the dx?
Ans: A
A. Pain
B. Change of colour
C. Swelling
D. Stiffness
Ans: Pain
Ortho:
A. ulnar n.
B. Median n.
C. Digital n.
D. sciatic n
E. Common peroneal n.
Ans: Ulner.
GIT:
A patient came with 12 hr H/O severe vomiting. Pain in upper abdomen which is now
constant in the epigastrium. There is rigity and guarding in the abdomen. Dx?
A. ac. pancreatitis
B. Perforated DU
C. perforated GU
GIT:
32 | P a g e ps
A pt came with an ill defined mass in the RIF and loose watery stools. He has fever and has
lost 6 kgs of weight recently. Dx?
A. Crohn disease
B. Meckel diverticulitis
C. UC
D. Ca large gut
Ans: A.
Déjà p.41
Git:
GIT:
A patient came with a pus discharging bead at 5 o'clock position at the anal verge. on
probing there was a track discovered which extended in the rectum for 15 cm. (these were
the exact words). DX?
A. Crohn dis
B. Ankylostomiasis
C. Ca rectum
D. Haemorrhoids
Ans: a.
GCS:
A patient opens his eyes to pain, withdraws to painful stimulus ans is unable to answer
any questions. What is his GCS?
A. 7-9
B. 10-12
C. 3-5
C. 13-15
Ortho:
33 | P a g e ps
(I think the one who was the least serious about the exam, could even manage to get this
one pinned.)
GIT:
What is the lymphatic drainage of anal canal below dentate line?
Ans: A.
A. strep pneumoniae
Burns:
Another old authentic typical ques.: A burn patient with soot in the throat and singening
of nasal hair etc etc. Mn?
Ans: intubate
CNS:
A man came with ipsilateral horner's syn., cerebellar S/S, dissociated sensory loss. (I could
diagnose the case as having lateral medullary syndrome). which artery is involved?
Ans: PICA
CNS:
ans: A.
CHEST:
Another repeated ques. (and confusing as well!!): Which org does not cause lung abscess"
A. Staph aureus
B. P. carinii
C. M. pneuminiae
D. M. TB
Ans: C
Ortho:
A man fell from height and was complaining low back pain. No other abnormality. What is
the inv you do?
A. X ray spine
B. MRI spine
C. CT spine
D. Nothing needed
Ans: A.
GIT:
Most commomn cause of intestinal obstruction in Australian community? (I think this was
the only ques I found from the AMCQ book that everybody reads so intently!!)
Ans: Adhesion
GIT:
A child came with pain and redness and swelling of one eye. He had fever and was
(probably) vomiting. i could diagnosis it as orbital cellulitis. Mn?
A. Ceftriaxon IV
35 | P a g e ps
B. Ampi + Genta IV
C. Cefurixime + metro
Ans: A.
RHP p.264
Endo:
An incidentaloma was found on one of the adrenals which measured 5 mm. What do you
do?
A. ignore
B. ask to come 6 wk later
c. ask to come 6 months later
CNS:
A picture of a man protruding his tongue. It showed wasting on the right side. What will
be correct for this.
GIT:
An x-ray of large gut showing obstruction. Cause?
Trauma:
Ans:
GIT:
An infant was brought who was vomiting from birth. He was pale, dehydrated and not
gainig weight. What is most likely to find?
A. Lump
B. Distension
C. Anuria
37 | P a g e ps
Ans: b.
Duodenal atresia is a disease of newborn infants. Cases of duodenal stenosis or perforated duodenal
web (diaphragm) rarely remain undiagnosed until childhood or adulthood; these cases represent the
exception rather than the rule. Duodenal atresia appears to be equally distributed between infants of
both sexes, with no reported predilection for one race.
The use of modern ultrasonography has allowed many infants with duodenal obstruction to be
identified prenatally. In a large cohort study of 18 different congenital malformation registries from 11
European countries, 52% of infants with duodenal obstruction were identified in utero.5 Duodenal
obstruction is characterized by a double-bubble sign on prenatal ultrasonography. The first bubble
corresponds to the stomach and the second to the postpyloric and prestenotic dilated duodenal loop.
Prenatal diagnosis allows the mother the opportunity to receive prenatal counseling and to consider
delivery at or near a tertiary care facility that is able to care for infants with GI anomalies. 5,6
Presenting symptoms and signs are the result of high intestinal obstruction. Duodenal atresia is
typically characterized by onset of vomiting within hours of birth. While vomitus is most often bilious, it
may be nonbilious because 15% of defects occur proximal to the ampulla of Vater. Occasionally,
infants with duodenal stenosis escape detection of an abnormality and proceed into childhood or,
rarely, into adulthood before a partial obstruction is noted. Nevertheless, one should assume any child
with bilious vomiting has a proximal GI obstruction until proven otherwise, and further workup should
be begun expeditiously.
Once delivered, an infant with duodenal atresia typically has a scaphoid abdomen. One may
occasionally note epigastric fullness from dilation of the stomach and proximal duodenum. Passing
meconium within the first 24 hours of life is not usually altered. Dehydration, weight loss, and
electrolyte imbalance soon follow unless fluid and electrolyte losses are adequately replaced. If
intravenous (IV) hydration is not begun, a hypokalemic/hypochloremic metabolic alkalosis with
paradoxical aciduria develops, as with other high GI obstruction. An orogastric (OG) tube in an infant
with suspected duodenal obstruction typically yields a significant amount of bile-stained fluid.
Ans: b.
CNS:
A picture of a man with the tongue deviated to right. The question was which side is the
lesion and to which side is the tongue deviated.
Ans: Rt side.
38 | P a g e ps
CNS:
A man with difficulty in extending the wrist and fingers. All other movement and
sensations are normal. Reflexes normal. What is the lesion?
1. radial n
2. ulnar n
3. median n
Ans: 4.
GIT:
Condition which typically produce profuse watery discharge per rectum to the level to
produce electrolyte imbalance.
a.colonic polyp b. pelvic abscess c.carcinoma.
CNS:
Coma scale
Ortho:
A lady with history of pain and stiffness of joints for a few weeks. While playing golf she
had sudden onset of pain and swelling in calf. What is the diagnosis
a.ruptured popliteal bursa
b.spontaneous haematoma
c.achilles tendonitis
Ans:
Maheshwari p.275
RH:
39 | P a g e ps
b.headache
c.iritis
Ans: Iritis
CVS:
Ans: Embolism
CNS:
b.carotid stenosis
c.infarct
Ophthal:
GUT:
Ans: D.
40 | P a g e ps
GUT:
[10:28:28 PM] dr_gauravsuneja: An ectopic testis has deviated from the normal path of
descent after it has emerged through the external inguinal ring.
* in the superficial inguinal pouch which lies anterior to the external oblique aponeurosis
* in the perineum
The ectopic testis cannot be pushed down into the scrotum. Unlike an incompletely
descended testis, the ectopic one is usually well developed and histologically normal.
Treatment is by orchidopexy.
[10:28:45 PM] dr_gauravsuneja: The undescended testis lies along the correct path of
descent but outside the scrotum. It may be abdominal, inguinal or retractile.
41 | P a g e ps
* 1% at l year
There is little evidence that testes descend spontaneously after the first year.
The right testis is affected alone in 50% of cases and the left alone in 30%. The condition is
bilateral in 20%.
The scrotum is often underdeveloped and flattened. At operation, the testis often appears
grossly abnormal. It is small and soft, and has a dissociated epididymis. It is accompanied by
a hernial sac.
Absence of testicular tissue suggests intrauterine torsion or true testicular agenesis. If the
latter is suspected, than an abdominal ultrasound should be performed to check for renal
agenesis.
* increased risk of malignancy, particularly seminomas in the late second or third decade
Infection:
Bed rest
Elevate limb
Infection:
A man was treated for cellulites of leg with antibiotics. After few days he presented with
hypotention and tachycardia. his leg was dusky in colour and crepitus was present.what is
the immediate management.
a.continue antibiotics
b.wound debridement
c.hyperbarric oxygen
d.antitoxin
Ans: b.
Immunization:
A 4 year old child with lacerated wound after falling on garden bed. He has taken dtpa at 2
and 4 months. After that no vaccination was given. What will you do
a.give antibiotics b.give immunoglobulins cgive dtpa and Ig
d.dtpa and booster after 2 months e.give dtpa
Ans: JM p.1385
43 | P a g e ps
Ortho:
RH:
A woman with pain and stiffnes of metacarpophalangeal and pip joints. She has malar
rash. What is the initial management
a.NSAID
b.steroids
c.methotrexate
RH:
A patient with pain and swelling around the knee. Aspirated fluid (microscopy) contains
neutrophils. No organisms or crystal found. Diagnosis?
a. septic arthritis b. gout c.rheumatoid arthritis d? e?
Ans: C.
Septic arthritis: gram stain and culture positive (Tor p.Rh31, Tor p.Rh8).
Skin:
Two darkish brown spots was found on the leg of a lady on examination. She did not
notice any change in appearance of those spots for the past years. What is the diagnosis
a.benign junctional naevi
b.melanoma
c.???spots
d?
Ans:
A smoker with and indurated ulcer on the tongue. The ulcer margins are white. He has
caries tooth.
a.sq carcinoma of the tongue
b syphilitic ulcer
Ans: A.
Rh:
Ans:
Drug:
GIT:
A patient with anal fistula. Internal opening in rectum and external opening at 5 o’clock
position.what is the most common underlying lesion
a.crohn’s disease b.anal gland infection
GIT:
A patient given radiotherapy for ca cervix. Now presents with bloody diarrhea.
a.proctitis b.rectovaginal fistula c.metastatic carcinoma
Ans: Proctatits
GIT:
Lower part of the anal canal drains into which lymph nodes
a.superficial inguinal b.deep inguinal c.paraaortic
Ans: Superficial
45 | P a g e ps
GIT:
b.cholecystitis
GIT:
Ultrasonography is best used for the diagnosis of which condition in a jaundiced patient.
a.gall stones b dilated bileduct c.cholecystitis d.ca liver
Breast:
b. progesterone
c.ocp
Ans: B. Jmp.969
Womens health:
Ans: B. JM p.1015
Chest:
GIT:
GIT:
The most common presenting feature of a patient with duodenal stricture secondary to
duodenal ulcer.
a.vomting one hour after each meal
b.vomioting of large amounts 2-3 times a day
c.? d?
Ans: A
Nausea and vomiting are the cardinal symptoms of GOO. Vomiting usually is described as
nonbilious, and it characteristically contains undigested food particles. In the early stages of
obstruction, vomiting may be intermittent and usually occurs within 1 hour of a meal.
CNS:
Neck stiffness often makes the investigator think of meningitis. However, it may also be
caused by:
* subarachnoid haemorrhage
* tetanus
* retropharyngeal abscess
* rheumatoid arthritis
Infection:
PICTURE of an adult man. Center of the umbilicus is red. Erythema of the surrounding skin.
A.omphalitis B.obstructed paraumbilical hernia c.necrotising faciitis
d.herpes zoster e.?
47 | P a g e ps
Ans: A.
Epidemiology:
A drug was introduced which decreased the fatality of the disease but doesnot bring
about complete cure of the disease. This means
a. incidence of the disease decrease. B.prevalence decrease
incidence increase prevalence increase. Both increase.