(Study Material) ALL INDIA 2005 (AIPGE 2005 January, Answers, Explanation and Notes) (Pg-3)
PAPER : ALL INDIA 2005 (AIPGE 2005 January, Answers, Explanation and Notes)
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Q.51 Contact lens wear is proven to have deleterious effects on the corneal
physiology which of the following statements is incorrect in connection with
contact lens wear?
1 The level of glucose availability in the corneal epithelium is reduced.
2 There is a reduction in hemidesmosome density.
3 There is increased production of CO2 in the epithelium.
4 There is a reduction in glucose utilization by corneal epithelium
Answer is 4
Grayson Disease of Cornea 4th ed./25.
Effect of contact lens wear on epithelial metabolism.
A. Normal state. Most of the oxygen diffuses through the tears from the
atmosphere; glucose is supplied by the aqueous humor; carbon dioxide is released
into the atmosphere; lactate diffuses into the aqueous humor.
B, During polymethylmethacrylate lens wear, oxygen supply and carbon dioxide
release are impaired and must occur through passage of tears beneath the lens.
As a result of hypoxia, glucose demand and lactate production are increased.
C, During hydrophilic contact lens wear, oxygen supply is improved because some
oxygen can pass through the lens, but glucose demand and lactate production are
increased moderately.
D, With highly oxygen-permeable rigid contact lenses, oxygen supply, glucose
demand, and lactate production are near normal.
1)
During hypoxia.
¯
Glucose utilization by anaerobiosis(so increased utilization because of block in
kreb,s cycle.)
¯
lactate accumulate and it increasesosmotic solute load
¯
It leads to
stromal edema and reduction in hemidesmosome activity.
Q.52 Lumbar sympathectomy is of value in the management of:
1 Intermittent claudication.
2 Distal ischemia affecting the skin of the toes.
3 Arteriovenous Fistula.
4 Back pain.
Answer is 2
H. George Burkitt /Clive RG Quick, Essential surgery, problem, diagnosis
and management 3rd ed/459
• Blood flow in skin in controlled by sympathetic nervous system but not in
muscle (specially during exercise). Claudication is due to muscle ischemia
during exercise while rest pain is due to skin ischemia. So rest pain in skin
may sometime be relieved by sympathetic blockade but claudication is never
relieved. So claudication is contraindication for the Sympathectomy
• Sympathectomy is of no value in intermittent claudication, as it does not
influence muscle blood flow. It is successful in early rest pain. It may also be
helpful in healing ulcer where moderate ischemia is present in combination with
some other factor such as chronic venous insufficiency.
PEARLS POINTS
• Lumbar sympathectomy done with extraperitoneal approach.
• Chemical sympathectomy done with 6% aqueous phenol.
• Medical sympathectomy - Methyl Dopa.
1 Intermittent claudication is contraindication for sympathectomy,
2 Rest pain is an indication
3 A.V fistula treated with surgery. no role of sympathectomy is there
4 Back pain (radicular nerve block can be done), so pain relieved
5 Sympathectomy –dilatation of arteries occur- so effective in distal ischemia
affecting the skin & toes
Indication of sympathectomy
1. Rest pain
2. Causalgia
3. Hyperhydrosis
4. Definite treatment of congenital prolonged QT syndrome
Q.53 A blood stained discharge from the nipple indicates one of the following:
1 Breast abscess.
2 Fibroadenoma.
3 Duct Papilloma.
4 Fat Necrosis of Breast.
Answer is 3
LB 24TH/828 Essential surgery/3rd Ed
Nipple discharge
|
Milky |
Pregnancy or hyperprolactinaemia |
|
Clear |
Physiological |
|
Green |
Perimenopausal, duct ectasia, fibroadenotic cyst |
|
Blood-stained |
Possible carcinoma or intraduct papilloma. |
Recent inversionSuggests a fibrosing underlying lesion such as carcinoma or mammary duct ectasis.
‘ Eczema’ (rash involving nipple or areola, or both)if unilateral, this is the classic sign of Paget’s disease of the nipple, a presentation of breast cancer.
Duct papillomas benign hyperplastic lesions rather than neoplasms and are not premalignant. Duct papillomas present with nipple bleeding or a blood-stained discharge. The differential diagnosis thus includes intraduct carcinoma and infiltrating carcinoma which must be excluded. Ductography may confirm the presence of a duct Papilloma (Fig. 39.23). Duct papillomas are usually treated by surgical excision of the affected segment of breast (microdochectomy). The affected segment is identified during operation by passing a probe into the duct from where blood can be expressed.
Q.54 The earliest manifestation of increased intracranial pressure following head injury is:
a. Ipsilateral papillary dilation.
b. Contralateral papillary dilatation.
c. Altered mental status.
d. Hemiparesis.
Answer is 3
Bailey and love’s 24th ed/610
Essential surgery 3RD ED /pg 138
These finding are in serial events of manifestation of raised intracranial
tension
| Observation | Observation |
| Conscious
level (Glasgow come Falling score scale) Pupil size and light response Respiratory pattern and rate Developing neurological signs Pulse rate Blood pressure |
Dilatation, loss of
light reaction or |
Q.55 In which of the following conditions Splenectomy is not useful?
1 Hereditary spherocytosis.
2 Porphyria.
3 Thalassemia.
4 Sickle cell disease with large spleen.
Answer is 2
Harrison principle of internal medicine 15th ed/670,672,673
HEREDITARY SPHEROCYTOSIS
The major clinical features of hereditary spherocytosis are anemia,
splenomegaly, and
jaundice. Splenectomy reliably corrects the anemia, although the RBC defect and
its consequent morphology persist. The operative risk is low. RBC survival after
Splenectomy is normal or nearly
It should be noted that Cholecystectomy should not be performed without
Splenectomy in any patient of hemolytic anemia, as intrahepatic gallstones may
result.
Splenectomy in children should be postponed until age 4, if possible, to
minimize the risk of severe infections with gram-positive encapsulated
organisms. Polyvalent pneumococcal vaccine should be administered at least 2
weeks before splenectomy.
THALLESSIMIA
In-patient of thallessimia Splenectomy is required if the annual transfusion
requirement, volume of RBCs per kilogram body weight per year increases by 50%.
SICKLE CELL ANEMIA
In sickle cell anemia repeated microinfarction in tissues occur due to sickling.
Thus, the spleen is frequently infarcted within the first 18 to 36 months of
life called autosplenectomy, causing susceptibility to infection, particularly
from pneumococci. Acute venous obstruction of the spleen (splenic sequestration
crisis leads to congestive splenomegaly), a rare occurrence in early childhood,
may require emergency transfusion and/or splenectomy to prevent trapping of the
entire arterial output in the obstructed spleen.
Q.56 The following is ideal for the treatment with injection of sclerosing
agents.
1 External hemorrhoids.
2 Internal hemorrhoids.
3 Prolapsed hemorrhoids.
4 Strangulated hemorrhoids.
Answer is 2
CMDT2004/619,
Bailey and Love’s Surgery 24th ed/1257.
There is 3 degree of hemorrhoids according to position.
|
Ist degree |
Bleed only, not prolapsed (internal) |
|
2nd degree |
Prolapsed but will reduce spontaneously or can be reduced digitally and will remain reduced |
|
3rd degree |
Continuously remain prolapsed. |
|
Stage I & II |
Injection sclerotherapy or rubber banding |
|
Stage III |
Hemorrhoidectomy. |
Material commonly used of injection sclerotherapy is – Phenol, Almond oil,
Iodoquinone, Acetic acid cannot be used because it is a very weak sclerosing
agent.
|
Stage II - spontaneously reduced 2nd degree is further Stage III -IS manually reduced. divided in |
Q.57 In which of the following locations. Carcinoid tumor is most common?
1 Esophagus.
2 Stomach.
3 Small bowel.
4 Appendix.
Answer is 4
According to Harrison the ileum is the most common site of carcinoid.But all other books (Robbins 7th ed, Schwartz surgery, Dahnert radiology, Margulis gastrointestinal radiology, Sabiston surgery, Devita, s cancers, CSDT etc.) still say that Appendix is the most common site for carcinoid. So in my opinion answer will be appendix.
Q.58 Pancreatitis, pituitary tumor and phaeochromocytoma may be associated with:
1 Medullary carcinoma of thyroid.
2 Papillary carcinoma of thyroid.
3 Anaplastic carcinoma of thyroid.
4 Follicular carcinoma of thyroid.
Answer is 1
Harrison principle of internal medicine 15th ed/2185
|
MEN 1Wermer's |
Parathyroid adenoma |
|
MEN 2A |
MTC0Parathyroid
adenoma |
|
MEN 2B0Mucosal Neuroma syndrome |
Phaeochromocytoma |
MEN1 gene, located on chromosome 11q13,
Mutations of the - RET proto-oncogene have been identified in 93 to 95% of patients with MEN 2, but it is located on 10th chromosome.
Q.59 ardener’s syndrome is a rare hereditary disorder involving the colon. It is characterized by:
1 Polyposis colon, cancer thyroid, skins tumors.
2 Polyposis in jejunum, pituitary adenoma and skin tumors.
3 Polyposis colon, osteomas, epidermal inclusion cysts and fibrous tumors in the skin.
4 Polyposis of gastrointestinal tract, cholangiocarcinoma and skin tumors.
Answer is 3
Harrison principle of internal medicine 15th ed/583
|
Gardner's syndrome. |
Osteomas, Epidermal
inclusion cyst, |
|
Turcot's syndrome. |
CNS Glioma, Polyposis coli |
Q.60 The most common cancer, affecting Indian urban women in Delhi, Mumbai
and Chennai, is:
1 Cervical Cancer.
2 Ovarian Cancer.
3 Breast cancer.
4 Uterine Cancer.
Answer is 3
- K. Purk P.S.M, 17th ed/PG.287, Table 2.
• Overall M/C Cancer in India is C.A. Cervix.
• M/C Cancer of rural area - C.A. cervix.
• M/C cancer in Urban area - C.A. Breast.
• M/C Cancer of male in India - of C.A. of orodigestive tract.
• In Delhi and Mumbai - C.A. Breast is most common cancer
Q.61 All of the following are true for patients of ulcerative colitis associated
with primary sclerosing cholangitis (PSC), except:
1 They may develop biliary cirrhosis.
2 May have raised alkaline phosphatase.
3 Increased risk of hilar cholangiocarcinoma.
4 PSC reverts after a total colectomy.
Answer is 4
CMDT 2004/604 Robbins 7th Ed /915 Harrison 16th Ed /1784
Primary sclerosing cholangitis (PSC) is characterized by both intrahepatic and
extra hepatic bile duct inflammation and fibrosis, frequently leading to
secondary biliary cirrhosis and hepatic failure. About 1 to 5% of patients with
IBD have PSC, but 50 to 75% of patients with PSC have
IBD. it can be recognized after the diagnosis of IBD and PSC can be detected
earlier or even years after proctocolectomy. During acute attack patients have
raised level of alkaline phosphatase. Patients with this entity are at higher
risk of developing cholangiocarcinoma.
Important point about ulcerative colitis in contrast with crohn’s disease –
1 Risk of carcinoma is significantly higher in U.C. than C.D.
2 Toxic megacolon develops in < 2% of cases of U.C., it can also occur in
C.D.
3 Steroid is not used as a maintenance therapy in the treatment of U.C.
4 P-ANCA -ve and ASCA +ve has a 95% positive predictive value and 92%
Specificity for diagnosis of C.D.
5 P-ANCA +ve and ASCA -ve has a 88% PPV and 98% specificity for
Diagnosis of U.C.
Q.62 Which one of the following is not a feature of liver histology in
non-cirrhotic portal fibrosis (NCPF)?
1 Fibrosis in and around the portal tracts.
2 Thrombosis of the medium and small portal vein branches.
3 Non specific inflammatory cell infiltrates in the portal tracts.
4 Bridging fibrosis.
Answer is 4
Schiff’s Diseases of liver 8th ed/406
Robbins pathology / Anderson’s pathology
Dahnert Radiological review manual 5th ed/682
BANTI syndrome = NON CIRRHOTIC PORTAL FIBROSIS = Hepatorenal
Sclerosis = Idiopathic portal HTN.
It is characterized by splenomegaly, hypersplenism; portal HTN, but there is no
feature of cirrhosis and of liver failure. So there are absence of Ascites,
encephalopathy, other signs of liver failure and Bridging fibrosis, which is the
characteristic histological finding of cirrhotic liver. So the Complication of
disease well tolerated and is not associated with the dismal prognosis of
variceal bleeding in cirrhotic patient. It is characterized by gastro esophageal
variceal hemorrhage in a young patient with prominent splenomegaly.
POSTULATED ETIOLOGIES –
|
Arsenic
exposure |
Malaria |
-Main lesion described as an obliterative portal venopathy of liver’ with patchy
Segmental sub endothelial thickening of intrahepatic portal veins.
-Thrombus formation with variable obliteration or recanalization.
-Scarring and fibrosis of portal tract.
-Fibrosis prominent in extra hepatic portal vein and its intrahepatic branches.
-Liver surface may appears nodular but it is never cirrhotic
-Widening and fibrosis of space of disse
-Capillarization of sinusoids
- Non-specific inflammatory cell in portal tracts leads to fibrotic reaction.
- NCPF Common in India + Japan.
- Male predominance seen with mean age 25-35 yr
- Difference in Japanese and Indian -
• All patient has increase portal and splenic pressure. Japanese have elevated hepatovenous portal gradient (HVPG), while Indian may have normal or increase HVPG
• Japanese are likely to have 10-20 yr older and shows female predominance.
- Imaging modality of choice - splenoportography with help of Doppler (Doppler flowmetry).
- Best investigation is - liver biopsy.
Q.63 The most common complication seen in hiatus hernia is:
1 Oesophagitis.
2 Aspiration pneumonitis.
3 Volvulus.
4 Esophageal stricture.
Answer is 1
Robbins Pathologic basis of disease7ED/802
Dahnert Radiological review manual 5th ed/p 832.
Reflux Oesophagitis is frequently seen in association with sliding hernias
Association of Hiatus hernia
|
Reflux Oesophagitis (25%) |
Duodenal ulcer (20%) |
Q.64 Patients of Rectovaginal fistula should be initially treated with:
1 Colostomy.
2 Primary repair.
3 Colporrhaphy.
4 Anterior resection.
Answer is 2
Maggot’s Abdominal Surgery Ed. /p.2147-49
Prior to surgery of Rectovaginal fistula, a complete 3-day mechanical and
antibiotic bowel preparation should be performed and colon must be completely
emptied, cleansed and sterilized prior to surgery. When all signs of infection
have resolved, no evidence of fistulitis is there, and fresh granulation tissue
is present, the primary repair can be performed.
Even in recurrent fistulas or fistulas after pelvic irradiation, they recommend
a Martius graft technique for repair. So even in recurrent condition they does
not perform the colostomy initially.
Whether or not to perform a diverting colostomy? There Preference is not to
perform a colostomy in individuals undergoing their first repair with a Martius
graft.
- Colporrhaphy done in prolapsed uterus
- Anterior resection done in C.A. rectum.
Q.65 A young woman met with an accident and had mild quadriparesis. Her lateral
X-ray cervical spine revealed C5-C6 fracture dislocation. Which of the following
is the best line of management?
1 Immediate anterior decompression.
2 Cervical traction followed by instrument fixation.
3 Hard cervical collar and bed rest.
4 Cervical laminectomy.
Answer is 2
Chapman’s Orthopedic Surgery 3rd ed/3699
Apley’s Orthopedics 8th ed/654
Maheshwari Orthopedics
TREATMENT of Fracture dislocation at lower cervical spine (below C3 spine)
• The displacement must be reduced as a matter of urgency.
• Skull traction is used, it is started with 5 kg and increasing it step wise
by similar amount up to 30 kg.
• If closed treatment with traction up to 2/3 of body weight or 65 pounds
(Whichever is less) is unable to achieve adequate reduction, operative
intervention is required.
• If reduction fails - Posterior open reduction and fusion is done.
Q.66 Which of the following catheter materials is most suited for long-term use
is?
1 Latex.
2 Silicone.
3 Rubber.
4 Polyurethane.
Answer is 2
Essential surgery, problems, diagnosis and management H. George
Burkitt/Clive R.G. Quick 3rd ed/393
With either type of catheterization (urethral or suprapubic), the major problems
are catheter blockage and infection. Catheter rapidly becomes blocked by
epithelial debris or by gradual accretion of calculus. Modern silicone or
silicone - coated ‘long term’ catheters are better in this respect but must
also be changed regularly (every 3 month’s 10-12 wks).
Q.67 The main site of bicarbonate reabsorption is:
1 Proximal convoluted tubule.
2 Distal convoluted tubule.
3 Cortical collecting duct.
4 Medullary collecting duct.
Answer is 1
Harrison principle of internal medicine 16th ed/1641
Also see Q 8
Reclamation of filtered HCO3? takes place largely in the proximal tubule
(80-90%) and, under normal circumstances, is virtually complete below a critical
plasma HCO3? concentration. The threshold concentration, which is normally about
26 m mol/L, in human, is identical to the concentration of HCO3? in plasma. As a
consequence, HCO3? wastage is totally prevented normally.
Q.68 Which of the following is the most troublesome source of bleeding during a
radical retro pubic prostatectomy?
1 Dorsal venous complex.
2 Inferior vesical pedicle.
3 Superior vesical pedicle.
4 Seminal vesicular artery.
Answer is 1
Glenn’s Urologic surgery 5th ed/277
Michael J. Drdler, Surgical management of urological disease, An anatomic
approach Ist ed/PG 654.
There are two dorsal venous plexus around the prostate. Superficial dorsal vein
is divided and then sutured directly. But the deep dorsal vein complex runs
parallel to the urethra at the apex of prostate and then fans out over the
anterior of prostate. We feel that it is important to control these vessels
preemptively rather than simply to incise them and place sutures afterward.
A Mc- -Dougal clamp is useful for this purpose.
Santorini’s plexus provides the major source of venous drainage of the
prostate. This plexus lies on the anterior surface of the prostate in the
puboprostatic space. The deep dorsal vein of the penis and its tributaries are
the major contributors to the plexus. During retropubic prostatectomy this
vessel should be controlled separately (1) before capsulotomy in cases of simple
retropubic procedures and (2) before opening endopelvic fascia and dividing
puboprostatic ligaments in cases of radical prostatectomy.
Q.69 The most common cause of renal scarring in a 3 year old child is:
1 Trauma.
2 Tuberculosis.
3 Vesicoureteral reflux induced pyelonephritis.
4 Interstitial nephritis.
Answer is 3
Dahnert radiological review manual 5th ed/p 983, 946
VESICOURETERIC REFLUX - (Congenital reflux = Primary reflux)
9-10% of normal Caucasian babies
1.4% of schoolgirls
30% of children with a first episode of UTI
Reflux nephropathy also called chronic atrophic pyelonephritis. It leads to the
scarring of kidney. Scar formation occurs only up to age 4 years. Vesicoureteral
reflux induced Pyelonephritis is most common cause of renal scarring in
children.
Q.70 The most sensitive imaging modality for diagnosing ureteric stones in a
patient with acute colic is:
1 X-ray KUB region
2 Ultra sonogram
3 non-contrasts CT scan of the abdomen.
4 Contrast enhanced CT scan of the abdomen.
Answer is 3
Dahnert Radiological review manual 5th ed/P 981-982
M/c type of calculus is Calcium stone
|
M/c type of calculus is Calcium stone
Radiolucent stone -Uric acid |
Q.71 Which one of the following is not used as tumor marker in testicular
tumors?
1 AFP.
2 LDH.
3 HCG.
4 CEA.
Answer is 4
Bailey and love’s surgery 23rd ed/1280
Harrison principle of internal medicine 15th ed/chapter 90
The serum lactate dehydrogenase (LDH) level serves as an additional marker of
all GCTs of testis, but it is not as specific as either AFP or HCG. LDH levels
are increased in 50 to 60% patients with metastatic nonseminoma and in up to 80%
of patients with advanced seminoma.
While plasma carcinoembryonic antigen (CEA) level predicts eventual tumor
recurrence in colonic carcinoma.
Q.72 Which one of the following is the common cause of congenital
Hydrocephalus is?
1 Craniosynostosis.
2 Intra uterine meningitis
3 Aqueductal stenosis
4 Malformations of great vein of Galen.
Answer is 3
Dahnert radiological review manual 5th edi/291
Congenital Hydrocephalus
1- M/c cause is aqueduct stenosis (43%)
2- 2nd commonest is communicating hydrocephalus (38%).
3- On USG assessment is difficult prior to 20 wks GA, as ventricles ordinarily
Constitutes a large portion of cranial vault.
4- On USG - dangling choroid plexus sign is seen.
5- CAUSES OF INFANTILE HYDROCEPHALUS –
|
|
Q.73 In a child, non-functioning kidney is best diagnosed by:
1 Ultrasonography.
2 IVU.
3 DTPA Renogram.
4 Creatinine clearance.
Answer is 3
Grainger and Allinson, Diagnostic Radiology 3rd ed/115
Urinary Tract imaging in Pediatrics age group
A two-part evaluation of the kidney is now commonplace; renal morphology is
assessed with ultrasound and renal function by radionuclide study. Both
congenital and acquired conditions may result in reduced renal function, and
radionuclide imaging is superior to excretory urography in providing
information. In the neonatal period, this conjoint imaging technique is
excellent in evaluating cystic dysplastic conditions, obstructive uropathies,
and renovascular disturbances.
Renal scintigraphy and ultrasonography complement each other.
Renal function and the status of the collecting system can be assessed by agents
which are filtered by the glomeruli-like radiographic contrast media - 99mTc
diethylene-triaminepentaacetic acid (DTPA) - or secreted by the renal tubules -
iodine-131 (131I-) labelled ortho-iodohippurate (OIH), 99mTc
mercaptoacetyltriglycine (MAG3). An agent which binds in the cortex is used to
assess functioning renal parenchyma: 99mTc dimercaptosuccinic acid (DMSA). By
combining features
of both the above groups, 9mTc glycoheptonate (GH) is partially cleared by
filtration (85%) and
partially bound to proximal renal tubules (15%).
Q.74 The most common malignant neoplasm of infancy is:
1 Malignant Teratoma.
2 Neuroblastoma.
3 Wilms’ tumor.
4 Hepatoblastoma.
Answer is 2
Dahnert radiological review manual 5th ed/932-933
Grainger and Allinson, diagnostic radiology, 5th ed/1757
Neuroblastoma is the most common solid abdominal mass of infancy (12.3% of all
perinatal neoplasm). It constitutes 3rd M/C malignant tumor of infancy (after
leukemia > CNS tumor). But
Neuroblastoma is 2nd M/C tumor of childhood (Wilms tumor is first)
- Site of metastasis in Neuroblastoma - bone (60%) > L.N. (42%) > orbit
> liver (15%) < intracranial.
- Syndrome associated with metastasis of neuroblastoma -
1) Hutchinson syndrome
2) Pepper syndrome
3) Blueberry muffin syndrome.
Q.75 The most common presentation of a child with Wilm’s tumor is:
1 An asymptomatic abdominal mass.
2 Hematuria.
3 Hypertension.
4 Hemoptysis due to pulmonary secondary.
Answer is 1
Grainger and Allinson, diagnostic radiology, 5th ed/1760
Dahnert radiological review manual 5th ed/984-85
-Wilm’s tumor - (Nephroblastoma)
|
-
Clinical presentation |
-
Rules of 10’s |
10% tumor is - phaeochromocytoma
10% rule is also seen in Craniopharyngioma of brain.
PEARL POINTS
- D/d from Neuroblastoma is very imp. Note that in Neuroblastoma there is
Encasement/elevation of aorta while Wilms tumor have invasion properly.
- Neuroblastoma shows stippled regular calcification while curvilinear
Calcification is seen in Wilm’s tumor.
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