176. Gas Bloat syndrome is a complication of
A. Partial Gastrectomy
B. Nissen's funduplication
C. Dor funduplication
D.Toupet funduplication
Ans B
Nissen fundoplication is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatus hernia. In GERD it is usually performed when medical therapy has failed, but with paraesophageal hiatus hernia, it is the first-line procedure.
Nissen fundoplication is generally considered to be safe and effective, with a mortality rate of less than 1%. Studies have shown that after 10 years, 89.5% of patients are still symptom-free.
Complications include "gas bloat syndrome", dysphagia (trouble swallowing), dumping syndrome, excessive scarring, vagus nerve injury, and rarely, achalasia.[5] The fundoplication can also come undone over time in about 5-10% of cases, leading to recurrence of symptoms. If the symptoms warrant a repeat surgery, the surgeon may use Marlex or another form of artificial mesh to strengthen the connection.[6] Postoperative irritable bowel syndrome, which lasts for roughly 2 weeks, is possible.
In "gas bloat syndrome", fundoplication can alter the mechanical ability of the stomach to eliminate swallowed air by belching, leading to an accumulation of gas in the stomach or small intestine. Data varies, but some degree of gas-bloat may occur in as many as 41% of Nissen patients; whereas the occurrence is less with patients undergoing partial anterior fundoplication.[7] Gas bloat syndrome is usually self-limiting within 2 to 4 weeks, but in some it may persist. The offending gas may also come from dietary sources (especially carbonated beverages), or involuntary swallowing of air (aerophagia). If postoperative gas-bloat syndrome does not resolve with time, dietary restrictions, and counselling regarding aerophagia, correction may be necessary, either by endoscopic balloon dilatation[citation needed] or repeat surgery to revise the Nissen fundoplication to a partial fundoplication.
Vomiting is often difficult or even impossible with a fundoplication. In some cases, the purpose of this operation is to correct excessive vomiting. However, when its purpose is to reduce gastric reflux, difficulty in vomiting may be an undesired outcome. Initially, vomiting is impossible; however, small amounts of vomit may be produced after the wrap settles over time, and in extreme cases such as alcohol poisoning or food poisoning, the patient may be able to vomit freely.
177. The commonest graft used for CABG is
A. internal mammary artery,
B. radial artery
C. long saphenous vein
D. short saphenous vein
Ans C
The saphenous vein in the leg is the most common vein used as a bypass graft
Long saphenous vein is the most common conduit utilized for surgical coronary revascularizatio
178. Giant cell reparative granuloma of Jaw is treated by
A. Antibiotics
B. wedge resection
C. resection and bone grafting
D. curettage
Ans D
the traditional treatment of GCRG is represented by surgical removal via an intra-oral approach and the extent of tissue removal ranges from a simple curettage to an en bloc resection. Curettage alone, or in combination with a periostal bone resection is the treatment modality most often used. Curettage has also been supplemented with cryosurgery and peripheral ostectomy. The surgical defect usually heals by secondary intention.
179. The commonest cause for esophageal perforation is
A. barotrauma
B. foreign bodies
C. latrogenic
D. penetrating injury to the chest
Ans c
Most esophageal perforations are iatrogenic
180. Which of the following is a delayed absorbable synthetic suture material ?
A. Chromic catgut
B. Vicryl
C. Silk .
D. Nylon
Ans B
The delayed absorbable monofilament sutures such as polydioxanone (PDS®) and polyglyconate (Maxon®), used for abdominal wound closure have good tensile strength and low tissue reaction, but the knots are not as strong. Polydioxanone (PDS) is also good for contaminated fields because it has a low affinity for bacteria. It is good for general use, tissue approximation, biliary work, anastomoses, fascial closures, heart surgery, and orthopaedic
Vicryl
• Tensile strength
65% @ 14 days
40% @ 21 days
10% @ 35 days
• Absorption complete by 70 days
Polydioxone
8. Tensile strength
70% @ 14 days
50% @ 28 days
14% @ 56 days
9. Absorption complete by 180 days
181. The ischiorectal fossa is at an increased risk for infection due to
A. absence of deep fascia
B. proximity to anus
C. poor blood supply
D. presence of fibro fatty tissue
Ans C
Both the Perianal and Ischiorectal spaces are common site of abscesses. Poor blood supply and coarse lobulated fat predispose it for infection. The Ischiorectal abscess may be the result of spread of infection from the nearby area - skin, lumen of bowel or perirectal tissue above the levator ani or through the blood or lymphatic. They can be excised fearlessly because of the poor vascularity of the fossa.
Abscesses in this region are - (a) Perianal abscess (b) Ischiorectal abscess (c) Supra levator abscess
182. "Thumb printing" on plain skiagram of abdomen is characteristic sign of
A. Crohn's colitis
B. Ischemic colitis
C. Amoebic colitis
D. Ulcerative colitis
Ans B
183. Which one of the following is TRUE regarding Warthin tumour ?
A. It is the second most common benign tumor of parotid gland
B. About 50% are bilateral
C. It is a malignant tumor
D. Occurs in young individuals
Ans A
Warthin's tumor primarily affects older individuals (age 60–70 years). There is a slight female predilection according to recent studies, but historically it has been associated with a strong male predilection
Warthin's tumor is the second most common benign parotid tumor.
184. All of the following patients presenting with abdominal pain and shock need immediate laparotomy, EXCEPT
A. Ruptured ectopic pregnancy
B. Haemorrhagic pancreatitis
C. Rupture abdominal aortic aneurysm
D. Ruptured liver hemangioma
Ans D
he classical indications for either surgery or minimally invasive therapy are the relief of symptoms due to the hemangioma or the treatment of the spontaneously ruptured hemangioma. The latter event is potentially life-threatening. However, emergent surgical resection of the ruptured hemangioma is associated with a high morality rate.
Top priority in the patient with a ruptured hepatic hemangioma is hemodynamic stabilization. Some authors have recommended surgical ligation of the hepatic artery as a next step. Others have recommended arterial embolization instead. Once the patient is stabilized, formal surgical resection of the hepatic hemangioma can be performed.
185. Which one of the following statements about acute diverticulitis is INCORRECT?
A. Sigmoid is the commonest site
B. Peri-colic abscess can occur
C. Fistulization is an immediate cause for emergency surgery
D. Conservative treatment may be successful in severe attack
Ans D
With the aid of CT scanning, patients can be grouped into categories at presentation based upon their imaging findings. Hinchey et al4 devised a classification system encompassing four clinical stages of perforated diverticulitis, which was later modified. Kaiser et al retrospectively evaluated the management of the patient based on the modified Hinchey classification (stage 0 mild clinical diverticulitis, Ia confined pericolic inflammation, Ib confined pericolic abscess, II pelvic or distant intraabdominal abscess, III generalized purulent peritonitis, IV fecal peritonitis) at presentation based on clinical, CT, or operative findings. Patients who were in the stage 0 and Ia groups did very well with just antibiotics. Only ~6% of these patients required a semiurgent resection because of an inadequate response to conservative therapy. All patients in stages III and IV underwent an urgent surgical resection. The patients in stages Ib and II were managed with a combination of antibiotics, percutaneous image guided drainage, and surgery. The higher the patient's stage, the less likely they were to avoid resective surgery, both in the short and long term.5 Patients with stage III and IV disease should be managed with surgery; patients with stage I or II disease are generally candidates for nonoperative management
Fistulas are another recognized complication from diverticulitis. Both colo-vaginal and colo-vesicle fistulas can occur. The primary treatment for both of these situations is surgical. In a poor-risk patient, nonoperative therapy may be appropriate. Some patients may develop a small bowel obstruction from sigmoid diverticulitis due to a loop of small bowel being involved in the inflammatory process. This may improve with time as the colonic inflammation improves.
186. Lower esophageal sphincter is relaxed by all EXCEPT
A. Theophylline
B. Caffeine
C. Prostaglandin F2
D. Dopamine
Ans C
187. Which one of the following type of cutaneous melanoma carries the best prognosis ?
A. Superficial Spreading Melanoma . (SSM)
B. Nodular Melanoma (NM)
C. Lentigo Maligna Melanoma (LMM)
D. Acral Lentigenous Melanoma (ALM)
Ans C
188.Fournier's gangrene is characterized by all EXCEPT
A. Sudden appearance of scrotal inflammation
B. Known to follow minor injuries or procedures in the perineal areas
C. Obvious cause is evident
D. Haemolytic streptococcus associated with other organisms causes a fulminating
inflammation of subcutaneous tissues
Ans D
Wound cultures from patients with Fournier gangrene reveal that it is a polymicrobial infection with an average of 4 isolates per case. Escherichia coli is the predominant aerobe, and Bacteroides is the predominant anaerobe.
Other common microflora include the following:
• Proteus
• Staphylococcus
• Enterococcus
• Streptococcus (aerobic and anaerobic)
• Pseudomonas
• Klebsiella
Clostridium
In the majority of cases Fournier gangrene is a mixed infection caused by both aerobic and anaerobic bacteria.[1] Death can result from Fournier gangrene
Impaired immunity (eg, from diabetes) is important for increasing susceptibility to Fournier gangrene. Trauma to the genitalia is a frequently recognized vector for the introduction of bacteria that initiate the infectious process.
Although originally described as idiopathic gangrene of the genitalia, Fournier gangrene has an identifiable cause in 75-95% of cases.[11] The necrotizing process commonly originates from an infection in the anorectum, the urogenital tract, or the skin of the genitalia.[12]
Anorectal causes of Fournier gangrene include perianal, perirectal, and ischiorectal abscesses; anal fissures; and colonic perforations. These may be a consequence of colorectal injury or a complication of colorectal malignancy,[13, 14] inflammatory bowel disease,[15] colonic diverticulitis, or appendicitis.
Urogenital tract causes include infection in the bulbourethral glands, urethral injury, iatrogenic injury secondary to urethral stricture manipulation, epididymitis, orchitis, or lower urinary tract infection (eg, in patients with long-term indwelling urethral catheters).
Dermatologic causes include hidradenitis suppurativa, ulceration due to scrotal pressure, and trauma. Inability to practice adequate perineal hygiene, such as in paraplegic patients, results in increased risk.
Accidental, intentional, or surgical trauma[16] and the presence of foreign bodies may also lead to the disease
189. Facial disproportionate growth is characteristic of which of the following syndromes ?
A. Treacher Collins
B. Crouzon
C. Pierre Robin
D. All of the above
190. Dieulafoy's lesion is
A. an arteriovenous malformation of stomach
B. an angiodysplasia of colon
C. a type of esophageal varices
D. an aorto enteric fistula
Ans A
Dieulafoy's lesion (exulceratio simplex Dieulafoy) is a medical condition characterized by a large tortuous arteriole in the stomach wall that erodes and bleeds. It can cause gastric hemorrhage
191. The commonest deformity seen in CTEV is
A. forefoot equinus
B. equine varus of forefoot and hindfoot
C. calcaneo valgus of hindfoot
D. subluxation of calcaneo cuboid joint
Calcaneo-Navicular most common (2/3)
- talocalcaneal middle facet is next most common (1/3)
- rest uncommon
192. Histologically tumour osteoid is found in
A. Ewing's Sarcoma
B. Chondrosarcoma
C. Osteosarcoma
D. Chordoma
Ans C
Osteosarcoma is diagnosed most easily when it appears in its classic, or conventional, form. The tumor cells vary from spindled to polyhedral; their nuclei are pleomorphic and hyperchromatic. Mitotic figures are easily demonstrable, and atypical mitotic figures also may be identified. The tumor cells are engaged in the production of extracellular matrix that may be osseous, cartilaginous, or fibrous in various proportions. The production of bone or osteoid directly by tumor cells at least somewhere in the tumor is the absolute requirement for diagnos
193. Swan Neck deformity of hand is a feature of
A. Psoriatic arthritis
B. Rheumatoid arthritis
C. Osteoarthritis
D. Gouty arthritis
Ans b
Swan neck deformity is a deformed position of the finger, in which the joint closest to the fingertip is permanently bent toward the palm while the nearest joint to the palm is bent away from it (DIP hyperflexion with PIP hyperextension). It is commonly caused by injury or inflammatory conditions like rheumatoid arthritis or sometimes familial (congenital, like Ehlers-Danlos syndrome
194. Parathyroid Hormone (P.T.H.) does NOT lead to
A. increased tubular reabsorption of calcium
B. increased tubular reabsorption of phosphates
C. bone resorption in skeleton
D. augmentation of calcium absorption in the intestine
Ans B
195. Radiograph shows Looser's zones (pseudo-fractures) in which one of the following conditions ?
A. Rickets
B. Osteomalacia
C. Scurvy
D. Unicameral Bone cyst
Ans A
Looser's zones (also known as cortical infarctions) are wide transverse lucencies traversing bone usually at right angles to the involved cortex and are associated most frequently with osteomalacia and rickets . They are pseudofractures and considered a type of insufficiency fracture. Typically, the fractures have sclerotic irregular margins, and are often symmetrical
196. Caries Sicca is
A. tuberculosis of the shoulder
B. flake formation (Rice water bodies) in synovial tuberculosis
C. tuberculosis of the sacrum
D. tuberculosis of the Sacroiliac
Ans A
Caries sicca (shoulder tuberculosis)
197. Which type of the following is NOT an External Fixator ?
A. Schanz pins
B. Llizarov
C. Knowle's pins
D. Joshi's
Ans C
Schanz pins – TEMPORARY EXT FIXATOR
oshi's external stabilisation system fixator in the management of idiopathic clubfoot
if surgery is indicated, open reduction and internal fixation using a Knowles pin is an effective method for managing mid-third clavicular fracture
198. Spondylolysis is the term used for
A. forward slip of the vertebra over the lower vertebra
B. degenerative changes in the spine
C. defect in the pars-interarticularis
D. straightening of the lumbar spine
Spondylolysis is a defect of a vertebra. More specifically it is defined as a defect in the pars interarticularis of the vertebral arch.
199. 'Thomas Splint' was initially designed by HO. Thomas
A. as a first aid for First World War Soldiers
B. for the treatment of fracture shaft femur
C. for initial ambulation and First Aid of supracondylar fracture femur
D. for immobilisation in the treatment for tuberculosis of the knee joint
Ans D
The Thomas half-ring splints consist of a padded half-circle of steel which is strapped to the hip, hinged to a U-shaped rod that extends along both sides of the leg. An ankle strap may be fashioned from cloth, and tied or twisted to apply traction force. It was deviced by H.O. Thomas, initially for immobilization for tuberculosis of the knee. It is now commonly used for the immobilisation of hip and thigh injuries
200. All the following statements are TRUE regarding Intertrochanteric fracture femur, EXCEPT
A. Is a very common fracture in old age
B. Can be managed conservatively
C. Open reduction and internal fixation with early ambulation is the ideal treatment
D. Non-union is a common complication
Ans D
intertrochanteric fractures should be considered for conservative treatment
Nonunion is much less common in Intertrochanteric fractures
Open reduction and internal fixation with early ambulation is the ideal treatment
Nonoperative management is often appropriate in the following circumstances:
• Nonambulatory or demented patients with mild pain
• Patients with old nondisplaced or impacted fractures and mild pain
• Unstable patients with major, uncorrectable comorbid disease
Patients at the end stage of a terminal illness
Nonunion
A fracture of the femoral neck is particularly likely to go on to nonunion - the situation in which the healing process has halted and the fracture will not heal without intervention. In young people with femoral neck fractures this condition would likely be treated by some form of bone grafting procedure and re-fixation in an attempt to obtain healing without sacrificing the hip joint. In the elderly, nonunion would more likely be treated by artificial hip replacement with the aim of getting the patient comfortable and back on their feet quickly.
Nonunion is much less common in Intertrochanteric fractures but the same principles appl
Intertrochanteric fracture
Intertrochanteric hip fracture in a 17-year-old male
Fracture supported by dynamic hip screw
An intertrochanteric fracture, below the neck of the femur, has a good chance of healing. Treatment involves stabilizing the fracture with a lag screw and plate device to hold the two fragments in position. A large screw is inserted into the femoral head, crossing through the fracture; the plate runs down the shaft of the femur, with smaller screws securing it in place.
The fracture typically takes 3–6 months to heal. As it is only common in elderly, removal of the dynamic hip screw is usually not recommended to avoid unnecessary risk of second operation and the increased risk of re-fracture after implant removal. The most common cause for hip fractures in the elderly is osteoporosis; if this is the case, treatment of the osteoporosis can well reduce the risk of further fracture. Only young patients tend to consider having it removed; the implant may function as a stress riser, increasing the risk of a break if another accident occurs.
A. Partial Gastrectomy
B. Nissen's funduplication
C. Dor funduplication
D.Toupet funduplication
Ans B
Nissen fundoplication is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatus hernia. In GERD it is usually performed when medical therapy has failed, but with paraesophageal hiatus hernia, it is the first-line procedure.
Nissen fundoplication is generally considered to be safe and effective, with a mortality rate of less than 1%. Studies have shown that after 10 years, 89.5% of patients are still symptom-free.
Complications include "gas bloat syndrome", dysphagia (trouble swallowing), dumping syndrome, excessive scarring, vagus nerve injury, and rarely, achalasia.[5] The fundoplication can also come undone over time in about 5-10% of cases, leading to recurrence of symptoms. If the symptoms warrant a repeat surgery, the surgeon may use Marlex or another form of artificial mesh to strengthen the connection.[6] Postoperative irritable bowel syndrome, which lasts for roughly 2 weeks, is possible.
In "gas bloat syndrome", fundoplication can alter the mechanical ability of the stomach to eliminate swallowed air by belching, leading to an accumulation of gas in the stomach or small intestine. Data varies, but some degree of gas-bloat may occur in as many as 41% of Nissen patients; whereas the occurrence is less with patients undergoing partial anterior fundoplication.[7] Gas bloat syndrome is usually self-limiting within 2 to 4 weeks, but in some it may persist. The offending gas may also come from dietary sources (especially carbonated beverages), or involuntary swallowing of air (aerophagia). If postoperative gas-bloat syndrome does not resolve with time, dietary restrictions, and counselling regarding aerophagia, correction may be necessary, either by endoscopic balloon dilatation[citation needed] or repeat surgery to revise the Nissen fundoplication to a partial fundoplication.
Vomiting is often difficult or even impossible with a fundoplication. In some cases, the purpose of this operation is to correct excessive vomiting. However, when its purpose is to reduce gastric reflux, difficulty in vomiting may be an undesired outcome. Initially, vomiting is impossible; however, small amounts of vomit may be produced after the wrap settles over time, and in extreme cases such as alcohol poisoning or food poisoning, the patient may be able to vomit freely.
177. The commonest graft used for CABG is
A. internal mammary artery,
B. radial artery
C. long saphenous vein
D. short saphenous vein
Ans C
The saphenous vein in the leg is the most common vein used as a bypass graft
Long saphenous vein is the most common conduit utilized for surgical coronary revascularizatio
178. Giant cell reparative granuloma of Jaw is treated by
A. Antibiotics
B. wedge resection
C. resection and bone grafting
D. curettage
Ans D
the traditional treatment of GCRG is represented by surgical removal via an intra-oral approach and the extent of tissue removal ranges from a simple curettage to an en bloc resection. Curettage alone, or in combination with a periostal bone resection is the treatment modality most often used. Curettage has also been supplemented with cryosurgery and peripheral ostectomy. The surgical defect usually heals by secondary intention.
179. The commonest cause for esophageal perforation is
A. barotrauma
B. foreign bodies
C. latrogenic
D. penetrating injury to the chest
Ans c
Most esophageal perforations are iatrogenic
180. Which of the following is a delayed absorbable synthetic suture material ?
A. Chromic catgut
B. Vicryl
C. Silk .
D. Nylon
Ans B
The delayed absorbable monofilament sutures such as polydioxanone (PDS®) and polyglyconate (Maxon®), used for abdominal wound closure have good tensile strength and low tissue reaction, but the knots are not as strong. Polydioxanone (PDS) is also good for contaminated fields because it has a low affinity for bacteria. It is good for general use, tissue approximation, biliary work, anastomoses, fascial closures, heart surgery, and orthopaedic
Vicryl
• Tensile strength
65% @ 14 days
40% @ 21 days
10% @ 35 days
• Absorption complete by 70 days
Polydioxone
8. Tensile strength
70% @ 14 days
50% @ 28 days
14% @ 56 days
9. Absorption complete by 180 days
181. The ischiorectal fossa is at an increased risk for infection due to
A. absence of deep fascia
B. proximity to anus
C. poor blood supply
D. presence of fibro fatty tissue
Ans C
Both the Perianal and Ischiorectal spaces are common site of abscesses. Poor blood supply and coarse lobulated fat predispose it for infection. The Ischiorectal abscess may be the result of spread of infection from the nearby area - skin, lumen of bowel or perirectal tissue above the levator ani or through the blood or lymphatic. They can be excised fearlessly because of the poor vascularity of the fossa.
Abscesses in this region are - (a) Perianal abscess (b) Ischiorectal abscess (c) Supra levator abscess
182. "Thumb printing" on plain skiagram of abdomen is characteristic sign of
A. Crohn's colitis
B. Ischemic colitis
C. Amoebic colitis
D. Ulcerative colitis
Ans B
183. Which one of the following is TRUE regarding Warthin tumour ?
A. It is the second most common benign tumor of parotid gland
B. About 50% are bilateral
C. It is a malignant tumor
D. Occurs in young individuals
Ans A
Warthin's tumor primarily affects older individuals (age 60–70 years). There is a slight female predilection according to recent studies, but historically it has been associated with a strong male predilection
Warthin's tumor is the second most common benign parotid tumor.
184. All of the following patients presenting with abdominal pain and shock need immediate laparotomy, EXCEPT
A. Ruptured ectopic pregnancy
B. Haemorrhagic pancreatitis
C. Rupture abdominal aortic aneurysm
D. Ruptured liver hemangioma
Ans D
he classical indications for either surgery or minimally invasive therapy are the relief of symptoms due to the hemangioma or the treatment of the spontaneously ruptured hemangioma. The latter event is potentially life-threatening. However, emergent surgical resection of the ruptured hemangioma is associated with a high morality rate.
Top priority in the patient with a ruptured hepatic hemangioma is hemodynamic stabilization. Some authors have recommended surgical ligation of the hepatic artery as a next step. Others have recommended arterial embolization instead. Once the patient is stabilized, formal surgical resection of the hepatic hemangioma can be performed.
185. Which one of the following statements about acute diverticulitis is INCORRECT?
A. Sigmoid is the commonest site
B. Peri-colic abscess can occur
C. Fistulization is an immediate cause for emergency surgery
D. Conservative treatment may be successful in severe attack
Ans D
With the aid of CT scanning, patients can be grouped into categories at presentation based upon their imaging findings. Hinchey et al4 devised a classification system encompassing four clinical stages of perforated diverticulitis, which was later modified. Kaiser et al retrospectively evaluated the management of the patient based on the modified Hinchey classification (stage 0 mild clinical diverticulitis, Ia confined pericolic inflammation, Ib confined pericolic abscess, II pelvic or distant intraabdominal abscess, III generalized purulent peritonitis, IV fecal peritonitis) at presentation based on clinical, CT, or operative findings. Patients who were in the stage 0 and Ia groups did very well with just antibiotics. Only ~6% of these patients required a semiurgent resection because of an inadequate response to conservative therapy. All patients in stages III and IV underwent an urgent surgical resection. The patients in stages Ib and II were managed with a combination of antibiotics, percutaneous image guided drainage, and surgery. The higher the patient's stage, the less likely they were to avoid resective surgery, both in the short and long term.5 Patients with stage III and IV disease should be managed with surgery; patients with stage I or II disease are generally candidates for nonoperative management
Fistulas are another recognized complication from diverticulitis. Both colo-vaginal and colo-vesicle fistulas can occur. The primary treatment for both of these situations is surgical. In a poor-risk patient, nonoperative therapy may be appropriate. Some patients may develop a small bowel obstruction from sigmoid diverticulitis due to a loop of small bowel being involved in the inflammatory process. This may improve with time as the colonic inflammation improves.
186. Lower esophageal sphincter is relaxed by all EXCEPT
A. Theophylline
B. Caffeine
C. Prostaglandin F2
D. Dopamine
Ans C
187. Which one of the following type of cutaneous melanoma carries the best prognosis ?
A. Superficial Spreading Melanoma . (SSM)
B. Nodular Melanoma (NM)
C. Lentigo Maligna Melanoma (LMM)
D. Acral Lentigenous Melanoma (ALM)
Ans C
188.Fournier's gangrene is characterized by all EXCEPT
A. Sudden appearance of scrotal inflammation
B. Known to follow minor injuries or procedures in the perineal areas
C. Obvious cause is evident
D. Haemolytic streptococcus associated with other organisms causes a fulminating
inflammation of subcutaneous tissues
Ans D
Wound cultures from patients with Fournier gangrene reveal that it is a polymicrobial infection with an average of 4 isolates per case. Escherichia coli is the predominant aerobe, and Bacteroides is the predominant anaerobe.
Other common microflora include the following:
• Proteus
• Staphylococcus
• Enterococcus
• Streptococcus (aerobic and anaerobic)
• Pseudomonas
• Klebsiella
Clostridium
In the majority of cases Fournier gangrene is a mixed infection caused by both aerobic and anaerobic bacteria.[1] Death can result from Fournier gangrene
Impaired immunity (eg, from diabetes) is important for increasing susceptibility to Fournier gangrene. Trauma to the genitalia is a frequently recognized vector for the introduction of bacteria that initiate the infectious process.
Although originally described as idiopathic gangrene of the genitalia, Fournier gangrene has an identifiable cause in 75-95% of cases.[11] The necrotizing process commonly originates from an infection in the anorectum, the urogenital tract, or the skin of the genitalia.[12]
Anorectal causes of Fournier gangrene include perianal, perirectal, and ischiorectal abscesses; anal fissures; and colonic perforations. These may be a consequence of colorectal injury or a complication of colorectal malignancy,[13, 14] inflammatory bowel disease,[15] colonic diverticulitis, or appendicitis.
Urogenital tract causes include infection in the bulbourethral glands, urethral injury, iatrogenic injury secondary to urethral stricture manipulation, epididymitis, orchitis, or lower urinary tract infection (eg, in patients with long-term indwelling urethral catheters).
Dermatologic causes include hidradenitis suppurativa, ulceration due to scrotal pressure, and trauma. Inability to practice adequate perineal hygiene, such as in paraplegic patients, results in increased risk.
Accidental, intentional, or surgical trauma[16] and the presence of foreign bodies may also lead to the disease
189. Facial disproportionate growth is characteristic of which of the following syndromes ?
A. Treacher Collins
B. Crouzon
C. Pierre Robin
D. All of the above
190. Dieulafoy's lesion is
A. an arteriovenous malformation of stomach
B. an angiodysplasia of colon
C. a type of esophageal varices
D. an aorto enteric fistula
Ans A
Dieulafoy's lesion (exulceratio simplex Dieulafoy) is a medical condition characterized by a large tortuous arteriole in the stomach wall that erodes and bleeds. It can cause gastric hemorrhage
191. The commonest deformity seen in CTEV is
A. forefoot equinus
B. equine varus of forefoot and hindfoot
C. calcaneo valgus of hindfoot
D. subluxation of calcaneo cuboid joint
Calcaneo-Navicular most common (2/3)
- talocalcaneal middle facet is next most common (1/3)
- rest uncommon
192. Histologically tumour osteoid is found in
A. Ewing's Sarcoma
B. Chondrosarcoma
C. Osteosarcoma
D. Chordoma
Ans C
Osteosarcoma is diagnosed most easily when it appears in its classic, or conventional, form. The tumor cells vary from spindled to polyhedral; their nuclei are pleomorphic and hyperchromatic. Mitotic figures are easily demonstrable, and atypical mitotic figures also may be identified. The tumor cells are engaged in the production of extracellular matrix that may be osseous, cartilaginous, or fibrous in various proportions. The production of bone or osteoid directly by tumor cells at least somewhere in the tumor is the absolute requirement for diagnos
193. Swan Neck deformity of hand is a feature of
A. Psoriatic arthritis
B. Rheumatoid arthritis
C. Osteoarthritis
D. Gouty arthritis
Ans b
Swan neck deformity is a deformed position of the finger, in which the joint closest to the fingertip is permanently bent toward the palm while the nearest joint to the palm is bent away from it (DIP hyperflexion with PIP hyperextension). It is commonly caused by injury or inflammatory conditions like rheumatoid arthritis or sometimes familial (congenital, like Ehlers-Danlos syndrome
194. Parathyroid Hormone (P.T.H.) does NOT lead to
A. increased tubular reabsorption of calcium
B. increased tubular reabsorption of phosphates
C. bone resorption in skeleton
D. augmentation of calcium absorption in the intestine
Ans B
195. Radiograph shows Looser's zones (pseudo-fractures) in which one of the following conditions ?
A. Rickets
B. Osteomalacia
C. Scurvy
D. Unicameral Bone cyst
Ans A
Looser's zones (also known as cortical infarctions) are wide transverse lucencies traversing bone usually at right angles to the involved cortex and are associated most frequently with osteomalacia and rickets . They are pseudofractures and considered a type of insufficiency fracture. Typically, the fractures have sclerotic irregular margins, and are often symmetrical
196. Caries Sicca is
A. tuberculosis of the shoulder
B. flake formation (Rice water bodies) in synovial tuberculosis
C. tuberculosis of the sacrum
D. tuberculosis of the Sacroiliac
Ans A
Caries sicca (shoulder tuberculosis)
197. Which type of the following is NOT an External Fixator ?
A. Schanz pins
B. Llizarov
C. Knowle's pins
D. Joshi's
Ans C
Schanz pins – TEMPORARY EXT FIXATOR
oshi's external stabilisation system fixator in the management of idiopathic clubfoot
if surgery is indicated, open reduction and internal fixation using a Knowles pin is an effective method for managing mid-third clavicular fracture
198. Spondylolysis is the term used for
A. forward slip of the vertebra over the lower vertebra
B. degenerative changes in the spine
C. defect in the pars-interarticularis
D. straightening of the lumbar spine
Spondylolysis is a defect of a vertebra. More specifically it is defined as a defect in the pars interarticularis of the vertebral arch.
199. 'Thomas Splint' was initially designed by HO. Thomas
A. as a first aid for First World War Soldiers
B. for the treatment of fracture shaft femur
C. for initial ambulation and First Aid of supracondylar fracture femur
D. for immobilisation in the treatment for tuberculosis of the knee joint
Ans D
The Thomas half-ring splints consist of a padded half-circle of steel which is strapped to the hip, hinged to a U-shaped rod that extends along both sides of the leg. An ankle strap may be fashioned from cloth, and tied or twisted to apply traction force. It was deviced by H.O. Thomas, initially for immobilization for tuberculosis of the knee. It is now commonly used for the immobilisation of hip and thigh injuries
200. All the following statements are TRUE regarding Intertrochanteric fracture femur, EXCEPT
A. Is a very common fracture in old age
B. Can be managed conservatively
C. Open reduction and internal fixation with early ambulation is the ideal treatment
D. Non-union is a common complication
Ans D
intertrochanteric fractures should be considered for conservative treatment
Nonunion is much less common in Intertrochanteric fractures
Open reduction and internal fixation with early ambulation is the ideal treatment
Nonoperative management is often appropriate in the following circumstances:
• Nonambulatory or demented patients with mild pain
• Patients with old nondisplaced or impacted fractures and mild pain
• Unstable patients with major, uncorrectable comorbid disease
Patients at the end stage of a terminal illness
Nonunion
A fracture of the femoral neck is particularly likely to go on to nonunion - the situation in which the healing process has halted and the fracture will not heal without intervention. In young people with femoral neck fractures this condition would likely be treated by some form of bone grafting procedure and re-fixation in an attempt to obtain healing without sacrificing the hip joint. In the elderly, nonunion would more likely be treated by artificial hip replacement with the aim of getting the patient comfortable and back on their feet quickly.
Nonunion is much less common in Intertrochanteric fractures but the same principles appl
Intertrochanteric fracture
Intertrochanteric hip fracture in a 17-year-old male
Fracture supported by dynamic hip screw
An intertrochanteric fracture, below the neck of the femur, has a good chance of healing. Treatment involves stabilizing the fracture with a lag screw and plate device to hold the two fragments in position. A large screw is inserted into the femoral head, crossing through the fracture; the plate runs down the shaft of the femur, with smaller screws securing it in place.
The fracture typically takes 3–6 months to heal. As it is only common in elderly, removal of the dynamic hip screw is usually not recommended to avoid unnecessary risk of second operation and the increased risk of re-fracture after implant removal. The most common cause for hip fractures in the elderly is osteoporosis; if this is the case, treatment of the osteoporosis can well reduce the risk of further fracture. Only young patients tend to consider having it removed; the implant may function as a stress riser, increasing the risk of a break if another accident occurs.
