General Surgery June 2011

PAPER I

1.    What are diagnostic tumor marker? Enumerate their role in the management of specific
cancers. 5+5  

2.    a)    What is septic shock? 6  

       b)    Describe various scoring systems for sepsis. 2
       c)    Describe various components of "Systemic Inflammatory Response Syndrome."
2                                                                                                                           

3.    a)    Describe the "levels of evidence" in surgery. 5  

       b)    What is a Phase-II trial? 3  
       c)    Describe the significance of "NSABP" trials. 2  

4.    a)    Describe the various modes of supplementing nutrition in a surgical patient. 4 

       b)    What are the "pitfalls" in the use of total parenteral nutrition? 3
       c)    Describe the "Refeeding Syndrome". 3

5.    a)    Describe the various "dynamics" of wound healing. 4   

       b)    Management of a non-healing wound. 3
       c)    Describe an "ideal dressing". 3

6.    a)    Describe the "Spring Coil" effect in relevance to the closure of abdomen. 4  
       b)    Describe "mass closure" technique for abdomen. 3
       c)    What is a "Laparostomy"? 3

7.    a)    What are the risk factors in the development of "Deep Vein Thrombosis"(DVT)? 4  
       b)    Discuss briefly the various diagnostic tests to establish the diagnosis of DVT in a 65 year
old lady. 3
       c)    Describe the management of this patient. 3

8.    a)    Describe the "Cell Cycle" in relevance to cancer. 3  

       b)    Describe the scientific basis to "Hormone therapy in cancers". 4
       c)    Describe the limitations of hormone therapy and its side effects. 3

9     a)    Enumerate the local complications of acute pancreatitis.2 

       b)    Describe in brief diagnosis and management of these complications. 8

10    a)    Describe the "aetiopathogenesis of thoracic outlet syndrome". 4 

        b)    Describe the various levels of lymph nodes in the neck. 3
        c)    Enumerate the "types of neck dissections".
3                                                                                                                                                         
                   
      
PAPER II

1.    a)    What is a "High Risk" surgical patient? 2   

       b)    How do you prepare a 45 year old with obstructive jaundice due to peri-ampullary
cancer for surgery? 6
       c)    What is "Hepato-Renal syndrome"? 2

2.    a)    Enumerate the types of gall stones. 2  

       b)    Discuss the pathogenesis of gall stones. 4
       c)    List the complications of gall stones. 4

3.    a)    Discuss the approach to management of a 10 year old boy with polytrauma. 6  
       b)    What is "Triage" in the event of disaster? 2
       c)    Enumerate various imaging invasive diagnostic modalities in blunt abdominal
trauma. 2

4.    a)    What is "Cardiac Tamponade"? 3  

       b)    Discuss its management in a 40 year old lady. 4
       c)    Enumerate the indications for "Emergency Room Thoracotomy". 3

5.    a)    Describe various "Energy Sources" in Surgery. 3  

       b)    What are the characteristic of an "ideal suture". 4
       c)    Describe chemo-embolization in surgery. 3

6.    a)    Discuss the management of a 12 year old boy with 15degree thermal burns involving
head, neck and thoracic regions. 4  
       b)    What are ideal fluid replacements in a patient with thermal burns?  3
       c)    Describe the selection of the type and calculation of the amount of fluid to be
supplemented in thermal burns. 3

7.    a)    Describe the clinical presentation and diagnosis of Hydatid disease of liver. 5  
       b)    Discuss in brief the surgical procedures performed for this condition. 5

8.    a)    Describe the significance of "Total Mesorectal Excision" in the management of rectal

cancer. 4  
       b)    What is a "Metachronous" lesion? 2
       c)    Discuss the management of a 32 year old gentleman with carcinoma rectum 14cm
from the anal verge along with a solitary hepatic metastases in segment V. 4

9.    a)    What is a "Metastasis of unknown origin"? 5  

       b)    Describe the approach to management of a 50 year old man with a level-V cervical
lymph node metastasis of an unknown origin (The algorithmic approach). 5

10.   a)    Enumerate the causes of lower gastrointestinal bleeding. 3  

        b)    Describe the management of "Obscure GI hemorrhage" in a 60 year old man.
4                                                                                                                        
        c)    Describe briefly "Capsule Endoscopy". 3
 PAPER III

1.    a)    Define autologus transfusion. 2

       b)    What are the risks of blood transfusion? 4 
       c)    How will you manage transfusion reactions? 4

2.    a)    Enumerate complications of laparoscopic surgery. 3  

       b)    How to prevent injury to bowel and solid organs during laparoscopy? 3
       c)    How will you manage bleeding and bowel injury? 4

3.    a)    Write briefly lymphatic drainage of esophagus. 3  

       b)    What are the clinical features of carcinoma esophagus? 3 
       c)    How will you investigate a patient of Carcinoma esophagus? 4  

4.    a)    Discuss the etiopathogenesis of Hirschsprung disease. 3  

       b)    Write the clinical features. 3
       c)    Discuss briefly its management. 4

5.    a)    Enumerate causes of kidney lump. 2  

       b)    Write the clinical features. 
       c)    Write the clinical features of renal cell carcinoma.  

6.    a)    Define upper G.I. bleeding. 2   

       b)    Enumerate its causes. 3
       c)    Discuss management of bleeding esophagealvarices. 5  

7.    a)    Enumerate causes of foot ulcers. 3  

       b)    How will you investigate? 3
       c)    Discuss management of varicose ulcer. 4  

8.    a)    Enumerate causes of acute pancreatitis. 3  

       b)    How will you investigate? 3
       c)    Discuss assessment of severity of pancreatitis. 4

9.    a)    Classify germ cell tumors of testis. 5  

       b)    Management of non-seminomatous germ cell tumours. 5

10.   a)    Describe Glasgow Coma Scale. 4   

        b)    Discuss management of SubDural Haematoma. 6
  
PAPER IV

1.    a)    What are the indications for diagnostic peritoneal lavage? 3  
       b)    Describe the procedure.3
       c)    Discuss the grades of splenic injury. 4

2.    a)    Discuss various topical haemostatic agents. 4  

       b)    Describe briefly the thermal methods of haemostasis. 6  

3.    a)    What are the various subphrenic spaces? 5 

       b)    How do you manage subphrenic abscess and its complications? 5

4.    a)    Discuss the surgical anatomy of thyroid. 4  

       b)    What are the complications of thyroid surgery?
3                                                                                                                                                         
       c)    Management of surgical complications. 3

5.    a)    What are the indications of renal transplantation? 3  

       b)    Discuss graft rejection. 3
       c)    Immunotherapy postoperatively after renal transplantation. 4

6.    a)    Enumerate causes for generalized lymphadenopathy. 3

       b)    Describe classification and staging of Non-Hodgkin's Lymphoma (NHL). 5  
       c)    Treatment of NHL. 2

7.    a)    Discuss the causes and clinical features of entero-cutaneous fistula. 5 

       b)    Discuss the management. 5

8.    a)    Discuss the etiopathology of tension pneumothorax. 4   

       b)    Describe the clinical features of tension pneumothorax. 4
       c)    Describe briefly the management of tension pneumothorax. 2

9.    a)    Discuss the segments of liver. 4  

       b)    Describe the various types of anatomical liver resections. 6

10.  a)    Discribe "Fast track surgery". 4  

       b)    Discuss its advantages and disadvantages. 6