91. Which jaw cyst is pre-malignant?

a) Radicular Cyst
b) Dental Cyst
c) Odontogenic keratocyst
d) Dentigerous Cyst
Answer: Odontogenic keratocyst
Explanation:
Odontogenic keratocyst is developmental odontogenic cyst of epithelial origin.
The odontogenic keratocyst is known for its high recurrence rate, aggressive
behavior, and its occasional association with the nevoid basal cell carcinoma
syndrome.
92. A toddler has few drops of blood coming out of rectum. Probable diagnosis is
a) Juvenile rectal polyp
b) Adenoid polyposis coli
c) Rectal cancer
d) Piles
Answer: Juvenile rectal polyp
Explanation:
Juvenile polyps are most common type of childhood polyps occurring in up to 1 % of
preschool children.
They are solitary polyps found in the rectum which most commonly present with
rectal bleeding.
93. Barretts esophagus is diagnosed by
a) Squamous metaplasia
b) Intestinal metaplasia
c) Squamous dysplasia
d) Intestinal dysplasia
Answer: Intestinal metaplasia
Explanation:
Barretts esophagus is a serious complication of GERD (Gastro-esophageal reflux
disease). In Barretts esophagus, normal tissue lining the esophagus changes to
tissue that resembles the lining of the intestine.
Barrett esophagus is marked by the presence of columnar epithelia in the lower
esophagus, replacing the normal squamous cell epitheliuman example of
metaplasia. This metaplasia confers an increased risk of adeno-carcinoma.
The presence of goblet cells, called intestinal metaplasia, is necessary to make a
diagnosis of Barrett esophagus.
94. Most common mechanism of GERD

a) Transient LES relaxation

b) Hypotension at lower esophageal sphincter
c) Hiatus Hernia
d) Gastritis
Answer: Transient LES relaxation
Explanation:
Gastro-esophageal reflux disease (GERD) is associated with a set of typical
(esophageal) symptoms, including heartburn, regurgitation, and dysphagia.
In addition to these typical symptoms, abnormal reflux can cause atypical (extraesophageal) symptoms, such as coughing, chest pain, and wheezing.
Transient LES relaxation (TLESR) is the single most common mechanism underlying
GER in both normal subjects and patients with GERD.
Patients with GERD may also experience significant complications associated with
the disease, such as esophagitis, stricture, and Barrett esophagus.
95. Patient presents with pain and tenderness in left iliac fossa. There is 3 cm stone
in renal pelvis without any hydro-nephrosis. Most appropriate management isa) PCNL
b) E.S.W.L.
c) Diuretics
d) Medical dissolution therapy with Potassium Citrate
Answer: A
Explanation:
Management of nephrolithiasis through percutaneous techniques is most often
reserved for stones greater than 1.5 cm to 2.0 cm, in a staghorn configuration,
behind a stenosed Infundibulum, in a calyceal diverticulum, in a kidney with
uretero-pelvic junction obstruction, or in anomalous kidneys.
The two most common indications for PCNL are renal stones >2cm in size and
staghorn calculi.
Absolute contraindications to PCNL include uncorrected coagulopathy and an active,
untreated urinary tract infection.
The American Urological Association Stone Guidelines Panel has classified ESWL as
a potential first-line treatment for ureteral and renal stones smaller than 2 cm.
Absolute contraindications to extracorporeal shockwave lithotripsy (ESWL) include
the following:
Acute urinary tract infection or urosepsis
Uncorrected bleeding disorders or coagulopathies
Pregnancy
Uncorrected obstruction distal to the stone
96. A 40 year male presents with hematemesis. On examination his BP was 90/60
mmHg and Heart Rate was 120/min. Spleenomegaly was also present. The most

probable cause of his bleeding is

a) Portal Hypertension
b) Gastric ulcer
c) Duodenal ulcer
d) Drug-induced GI injury
Answer: Portal Hypertension
Explanation:
Complications of portal hypertension:
Esophageal and gastric varices and associated life threatening bleeding
Ascites
Splenomegaly or enlargement of the spleen
Decreased white blood cell counts and mild pan-cytopenia
Hepato-renal syndrome
Spontaneous bacterial peritonitis
Hepatic encephalopathy
97. After removal of the Parotid gland, patient is having sweating on cheeks while
eating. Auriculo-temporal nerve which contains parasympathetic secreto-motor
fibers to parotid gland is fused with
a) Greater petrosal nerve
b) Facial nerve
c) Greater auricular nerve
d) Buccal nerve
Answer: Greater auricular nerve
Explanation:
Freys syndrome often results as a side effect of surgeries of or near the parotid
gland or due to injury to the Auriculo-temporal nerve, which passes through the
parotid gland in the early part of its course.
The Auriculo-temporal branch of the Trigeminal nerve carries parasympathetic fibers
to the sweat glands of the scalp and the parotid gland.
As a result of severance and inappropriate regeneration, the parasympathetic nerve
fibers may switch course and is fused with somatic sensory greater auricular nerve,
resulting in gustatory Sweating or sweating in the anticipation of eating, instead
of the normal salivatory response.
98. A patient of Crohns disease underwent resection anastomosis. Now presents on
7th post-op day with anastomotic site leak from a fistula. Everyday leakage volume
adds up to 150-200ml. There is no intra-abdominal collection and the patient is
stable without any complains. What will be the next line of management?
a) Do conservative treatment and leave him and hope for the spontaneous
resolution
b) Perform laparotomy and check for leakage site and healthy margins

c) Perform laparotomy and completely exteriorize the fistula

d) Perform Laparotomy and place lateral drains and leave
Answer: Do conservative treatment and leave him and hope for the spontaneous
resolution
Explanation:
Conservative management to promote spontaneous resolution is the treatment of
choice for intestinal fistula.
Surgery is done if the fistula fails to resolve and consist of resection of the fistula
tract together the segment of intestine from which it originates.
99. A lady has dysphagia, intermittent epigastric pain. On endoscopy esophagus
was dilated above and narrow at the bottom. Treatment is
a) Hellers Cardiomyotomy
b) Esophagectomy
c) Dilatation
d) PPIs
Answer: Hellers Cardiomyotomy
Explanation:
Achalasia is a rare disease of the muscle of the lower esophageal body and the
lower esophageal sphincter.
Common symptoms of achalasia include difficulty in swallowing, chest pain, and
regurgitation of food and liquids.
In achalasia, the video-esophagram shows that the esophagus is dilated (enlarged
or widened), with a characteristic tapered narrowing of the lower end, sometimes
likened to a birds beak. In addition, the barium stays in the esophagus longer
than normal before passing into the stomach.
Esophageal manometry, can demonstrate specifically the abnormalities of muscle
function that are characteristic of achalasia, that is, the failure of the muscle of the
esophageal body to contract with swallowing and the failure of the lower
esophageal sphincter to relax.
Endoscopy also is helpful in the diagnosis of achalasia although it can be normal
early in achalasia.
Treatments for achalasia include oral medications, stretching of the lower
esophageal sphincter (dilation), surgery, and the injection of botulinum toxin (Botox)
into the sphincter.
A laparoscopic Hellers myotomy and partial fundoplication is the procedure of
choice for esophageal Achalasia.
100. After doing a graft repair of a Thoraco-abdominal aneurysm, a person
developed weakness in both legs. It is due to
a) Lumbo-sacral nerve injury
b) Thoracic splanchnic nerve injury

c) Decreased blood supply to lower limbs

d) Discontinuation of Arteria Radicularis Magna
Answer: Discontinuation of Arteria Radicularis Magna
Explanation:
Three spinal arteries, one anterior and a pair of posterior spinal arteries from the
vertebral arteries, supply the cord.
The anterior spinal artery is the principal artery of the three, supplying the anterior
two-thirds of the cord, including the critical motor area.
Segmental arteries from subclavian, inter-costal, upper lumbar and branches from
the internal iliac and middle sacral arteries regularly feed the anterior spinal artery.
The great radicular artery of Adamkiewicz or Arteria Radicularis Magna originates as
a branch from a left inter-costal artery between T9 and T12 in 75% of patients.
Operative interference with this artery is implicated as one of the causes of
paraplegia in thoraco-abdominal aneurysmal repair.
101. True about epigastric Hernia is
a) Located below the umbilicus and always in the midline
b) Located above the umbilicus and always in the midline
c) Located above the midline and on either side
d) Can be seen anywhere on abdomen
Answer: Located above the umbilicus and always in the midline
Explanation:
An epigastric hernia is an opening or weakness in the fibrous tissue of the abdomen
between the breast bone and the belly button.
It is caused by incomplete closure of the fibrous tissue of the abdomen during
development.
In adults, too much abdominal pressure can cause an epigastric hernia.
102. External Hemorrhoids, below the dentate line isa) Painful
b) Skin Tag is not seen in these cases
c) May turn malignant
d) ligation is done as management
Answer: Painful
Explanation:
Hemorrhoids present above the dentate line are classified as internal hemorrhoids.
Hemorrhoids occurring below the dentate line are classified as external
hemorrhoids.
External hemorrhoids are in sensitive anal canal skin and are painful, while internal
hemorrhoids are in insensitive anal canal mucosa and are painless.
Prolapse of internal hemorrhoids is highly characteristic of more advanced and

chronic hemorrhoidal disease.

103. Early complication of ileostomy in the post-operative period
a) Diarrhoea
b) Obstruction
c) Necrosis
d) Prolapse
Answer: Necrosis (?)
Explanation:
Many studies focusing on ostomy-related complications measured their incidence
over the first 1 to 2 postoperative years.
Duchesne and co-investigators reported results of a retrospective review of 204
ostomy patients during a 3-year period.
Early postoperative complications included prolapse (22%), necrosis (22%), stenosis
(17%), irritation (17%), infection (15%), bleeding (5%), and retraction (5%).
Stomal necrosis is defined as the death of stomal tissue resulting from impaired
blood flow.
Ischemia typically occurs within 24 hours of the ostomy surgery, resulting in a dark,
necrotic stoma that appears maroon to black and is typically soft and flabby to
palpation.
Causes of stomal necrosis include constricting sutures, mesenteric tension,
disproportionate clipping of the mesentery, emboli, pressure associated with barrier
wafer constriction, and abdominal edema or distension.
104. Ca Breast Stage T4b involves all EXCEPT
a) Nipple retraction
b) Skin ulcer over the swelling
c) Dermal Edema
d) Satellite Nodule
Answer: Nipple retraction
Explanation:
T0: No clinical evidence of primary tumor
Tis: Carcinoma in situ
T1: Tumor 2 cm or less in greatest dimension
T2: Tumor more than 2 cm but not more than 5 cm
T3: Tumor more than 5 cm in greatest dimension
T4: Tumor of any size with direct extension to chest wall or skin or both
T4a: Extension to chest wall excluding the pectoralis
T4b: Edema including Peauds Orange or ulceration of the skin of the breast, or
satellite skin nodules confined to same breast.
T4c: Both T4a and T4b
T4d: Inflammatory carcinoma

105. Which of the following anti-estrogen drug is used in estrogen receptor positive
breast cancer?
a) Tamoxifen
b) Clomiphene Citrate
c) Estrogen
d) Adriamycin
Answer: Tamoxifen
Explanation:
Tamoxifen is only effective in treating estrogen receptor positive breast cancers.
Tamoxifen belongs to class of drugs known as selective estrogen receptor
modulators.
Tamoxifen is used to treat patients with early stage breast cancer as well as those
with metastatic breast cancer.
106. Acalculus cholecystitis are caused by
a) DM
b) TPN
c) Leptospirosis
d) Estrogen therapy
Answer: a, b and c
Explanation:
Acalculous cholecystitis is a severe illness that is a complication of various other
medical or surgical conditions.
Causes of Acalculous cholecystitis
Severe trauma
Burn
Postpartum period
Total parental hyper-alimentation
Biliary sludge
DM
Leptospira, Salmonella or V. coli
107. Right sided colon Ca is associated with
a) Anemia
b) Bleeding P/R
c) Mass P/A
d) Alternate constipation and diarrhoea
e) Internal obstruction
Answer: a and c
Explanation:

Right sided colon Ca:

Hypo-chromic microcytic anemia
Fatigue
Palpitation
Transverse and ascending colon Ca:
Abdominal cramp
Occasional obstruction and apple core or napkin ring in radiographs
Recto-sigmoid Ca:
Hematochezia
Tenesmus
Narrowing of caliber of stool
108. Emergency operation done in cases of
a) Volvulus
b) Obstructed hernia
c) Appendicular perforation with paralytic ileus
d) Pt. on A.T.T & has associated cecal obstruction
Answer: a, b and c
Explanation:
Indications of immediate surgery in intestinal obstruction:
Volvulus
Obstructed or strangulated hernia
Acute obstruction e.g. perforation
Operative decompression needed
109. Intra-tubular germ cell tumor found adjacent to
a) Spermatocytic seminoma
b) Dysgerminoma
c) Yolk sac tumor
d) Embryonal carcinoma
e) Chorio-carcinoma
Answer: d and e
Explanation:
Most tumors in germ cell group originate from intra-tubular germ cell neoplasia and
found adjacent to
Embryonal carcinoma
Chorio-carcinoma
110. True about neuroblastoma
a) Seen in adrenal glands
b) VMA/HVA
c) Lymphatic metastasis more common than blood metastasis

d) Presents with abdominal mass

e) Old age presentation implies good prognosis
Answer: a, b and d
Explanation:
In childhood, about 40 % of neuroblastoma arises in adrenal medulla and presents
with abdominal mass, fever and weight loss.
Second most solid malignancy of childhood
Metastasize widely through hematogenous
Disseminated neuroblastoma may present as Blue Berry Muffin Baby
Raised VMA/HVA
Children older than 5 years usually have extremely poor outcome irrespective of
stage
111. Surgical indication in the Rx of hemoptysis
a) Profuse uncontrolled bleeding
b) Bronchiectasis
c) Bronchial adenoma
d) Bronchial fistula
Answer: a, c and d
Explanation:
Absolute indications of pulmonary resection in management of hemoptysis:
Massive hemoptysis
Broncho-pleural fistula
Suspicious of carcinoma
Destroyed lung and positive sputum
112. Contra-indication for radical mastectomy in Ca breast
a) Distant metastasis
b) Fixity to chest wall
c) Axillary L.N involvement
d) Supra-clavicular L.N involvement
Answer: a and d
Explanation:
Contra-indication for radical mastectomy in Ca breast:
Small tumor
Non palpable lesion
Distance metastasis
Patients who wants reconstructive surgery
Co-existence of severe systemic disease
113. Splenectomy is indicated in

a) Hypersplenism
b) Hereditary spherocytosis
c) I.T.P
d) G. 6PD deficiency
e) Portal hypertension
Answer: All
Explanation:
114. True about Barretts esophagus
a) Metaplasia
b) Peptic stricture
c) Paraesophageal hernia
d) Squamous carcinoma
Answer: a, b and c
Explanation:
Complication of Barretts esophagus:
Peptic ulcer in lower end of esophagus
Stricture
Dysplasia (Adenocarcinoma)
Perforation
Important points:
Intestinal metaplasia with goblet cells in the esophagus is diagnostic of Barrette
esophagus.
115. In Crohns disease all are seen except
a) Hyper-plastic polyps
b) Diverticulosis
c) Fissuring ulcer
d) Epitheloid granuloma
e) Crypt abscess
Answer: a and b
Explanation:
Pathological features of Crohns disease:
Aphthous ulcer
Crypt abscess
Non caseating type of Epitheloid granuloma
116. B/L breast Ca
a) Lobular Ca
b) Ductal Ca
c) Comedo Ca

d) Cysto-sarcoma phyllodes
e) Scirrhous carcinoma
Answer: Lobular Ca
Explanation:
Invasive lobular Ca is frequently multifocal, multi-centric and bilateral.
117. Contraindication of enteral nutrition
a) Intestinal obstruction
b) Acute pancreatitis
c) Severe diarrhoea
d) IBD
e) Intestinal fistula
Answer: a, b, c and e
Explanation:
Contraindication of enteral nutrition:
Small bowel obstruction or ileus
Severe diarrhoea
Proximal small intestinal fistula
Severe pancreatitis
118. True about MEN II-b (Sipple syndrome)
a) Pheochromocytoma
b) Hyperparathyroidism
c) Muco-cutaneous neuromas
d) Medullary Ca of thyroid
Answer: a, c and d
Explanation:
MEN II-b (Sipple syndrome):
Medullary Ca of thyroid
Muco-cutaneous neuromas
Pheochromocytoma
Marfanoid features
119. Indications of surgery in pulmonary TB
a) Suspicion of malignancy
b) Cavitary lesion with Aspergilloma
c) Massive hemoptysis
d) All
Answer: All
Explanation:

Absolute indications of pulmonary resection in management of hemoptysis:

Massive hemoptysis
Broncho-pleural fistula
Suspicious of carcinoma
Destroyed lung and positive sputum
120. Low risk in Ca thyroid
a) Men<40 year
b) Women <50 year
c) Papillary Ca <4 cm
d) Metastasis
e) Follicular Ca > 5cm
Answer: a, b and c
Explanation:
Low risk in Ca thyroid:
Age <40 year
Metastasis None
Size < 2 cm
Grade- Well differentiated
Extent- No capsular invasion

121. True about ulcerative colitis

a) Involves colon only
b) Trans-mural involvement
c) Recurrent with watery diarrhea
d) Crypt abscess
e) Serosa involvement seen
Answer: Crypt abscess
Explanation:
Ulcerative colitis:
Continuous without skip areas
Commonly rectum, sigmoid colon and extending upward
Usually superficial and confined to mucosal layer
Pseudo-polyps commonly present
Crypt abscess
Bloody diarrhoea
122. Pre- malignant condition is /are
a) Ulcerative colitis
b) Amoebic colitis

c) Familial polyposis coli

d) Juvenile polyposis
e) Peutz- jeghers polyps
Answer: a and c
Explanation:
Juvenile polyposis and Peutz- jeghers polyps- Do not have malignant potential
Pre- malignant condition:
Ulcerative colitis
Peutz- jeghers syndrome
Juvenile polyposis syndrome
Hereditary non-polyposis colon cancer
Familial adenomatous polyposis
123. True about Mondors disease
a) Superficial thrombophlebitis of chest wall veins over the breast
b) Lymphoma
c) Cord like veins
d) Occurs all over the body
Answer: Superficial thrombophlebitis of chest wall veins over the breast
Explanation:
Mondors disease is most often observed as a cordlike indurated plaque on the
upper antero-lateral aspect of the chest wall characterized by a sclerosing
thrombophlebitis of the subcutaneous veins.
Mondors disease may involve the thoraco-epigastric vein, the lateral thoracic vein,
and the superior epigastric vein.
124. Migratory thrombophlebitis seen in
a) Pancreatic Ca
b) Bladder Ca
c) Stomach Ca
d) Breast Ca
e) Liver Ca
Answer: Pancreatic Ca
Explanation:
Also known as Trousseaus sign of malignancy, migratory thrombophlebitis is
described as thrombophlebitis that travels, often from one leg to the other.
It has a strong association with adeno-carcinoma of the pancreas and lung.
Gliomas as well as adeno-carcinomas of the pancreas and lung are associated with
hyper-coagulability.
125. Trendelenburg operation is/are done in

a) Flush ligation
b) Stripping of great saphenous vein
c) Incompetent perforator ligation
d) Short saphenous ligation
Answer: a, c and d
Explanation:
Trendelenburg operation:
Flush ligation
Incompetent perforator ligation
Short saphenous ligation
Important point:
Trendelenburg operation is done for varicose vein which involve ligation of
saphenous vein.
126. Accidental finding of incidentaloma (Adrenal mass) is detected on USG.
Following is/are to be ruled out
a) Cushings disease
b) Metastasis
c) Adrenal adenoma
d) Carcinoma
e) Adrenal hyperplasia
Answer: All
Explanation:
Adrenal incidentaloma:
Aldosterone producing adenoma- 1 %
Metastatic carcinoma- 2 %
Adreno-cortical carcinoma- 5 %
Pheochromocytoma- 5 %
Pre-clinical Cushings- 5 %
Presumed non-functional adenoma- 82 %
127. A patient was presented with strangulated hernia, next line of management
a) Operate immediately
b) I.V. fluids
c) CT Scan
d) USG
e) X- ray abdomen
Answer: a and b
Explanation:
The diagnosis of strangulated hernia is made on clinical ground.
Vigorous resuscitation with intra-venous fluids, nasogastric aspiration and antibiotic

administration
Emergency or immediate operation
128. A/E used to detect Ca prostate
a) PSA
b) MRI
c) CT scan
d) DSA
e) TRUS
Answer: b, c and d
Explanation:
Investigation of Ca prostrate:
Digital rectal examination
TRUS (Trans-rectal USG)
Prostatic biopsy by TRUS or TURP
PSA
Important points:
CT scan is rarely accurate for staging and not routinely recommended.
Like CT, MRI is incapable of accurately differentiating intra-prostatic lesions.
DSA (Digital subtraction angiography)
129. Childs criteria includes
a) Encephalopathy
b) SGOT/SGPT
c) Ascites
d) Creatinine
e) Albumin
Answer: a, c and e
Explanation:
Revised Childs classification of clinical severity of cirrhosis: Criteria
Nutritional status
Ascites
Serum albumin
Serum bilirubin
Prothrombin time
Hepatic encephalopathy
130. Catheterization of bladder done in
a) Ca prostate
b) Post operative retention
c) Pre operative before taking the patient for appendicitis
d) Stricture

e) Rupture
Answer: a and b
Explanation:
Catheterization of bladder is done in Ca prostate, post operative retention and
major and lengthy operation.
Antihistaminics, antihypertensive, anti-cholinergic and antidepressant can induce
retention of urine.
131. True about thyroid Ca
a) Follicular Ca have worse prognosis than papillary Ca
b) Papillary Ca spreads by hematogenous route more frequently than follicular Ca
c) Papillary Ca has increased mortality than follicular Ca
d) Follicular Ca is more bilateral than papillary Ca
e) Follicular Ca has more male incidence than papillary Ca
Answer: a and e
Explanation:
Follicular Ca:
Male incidence- 35 %
Lymph node metastasis- 13 %
Blood vessel invasion- 60 %
Recurrence rate- 29 %
Overall mortality rate- 24 %
Papillary Ca:
Male incidence- 22 %
Lymph node metastasis- 35 %
Blood vessel invasion- 40 %
Recurrence rate- 19 %
Overall mortality rate- 11 %
Important points:
Thyroid tumor associated with MEN II: Medullary ca
Thyroid tumor with best prognosis: Papillary Ca
Thyroid tumor with worst prognosis: Anaplastic Ca
Thyroid tumor occurring in long standing goiter: Follicular Ca
Thyroid tumor occurring in Thyroglossal cyst: Papillary Ca
Thyroid tumor occurring in Cowden syndrome: Papillary Ca
132. True about solitary thyroid nodule
a) THR- antibody
b) Lined by columnar epithelium
c) Diffuse hyperplasia of thyroid
d) Common in female
e) Thyroidectomy done

Answer: d and e
Explanation:
Solitary thyroid nodule is about four times more common in women than men.
Solitary thyroid nodule is removed surgically to exclude malignancy.
133. Good prognostic markers in breast Ca
a) ER (receptors) +ve
b) Progesterone (receptors) +ve
c) HER -2 /neu (receptors) +ve
d) CD44 receptor +ve
e) P53 gene +ve
Answer: a and b
Explanation:
Good prognostic markers in breast Ca:
ER (receptors) +ve
Progesterone (receptors) +ve
Worst prognostic markers in breast Ca:
HER -2 /neu (receptors) +ve
Mutated P53 gene
Presence of more micro-vessels
Non-diploid tumors
Tumor with poor nuclear grade
Cell cycle antigen PCNA/ki67
134. In the Rx of hydatid cyst, PAIR is contraindicated in
a) Lung/bone cyst
b) Size> 5cm
c) Not amenable to Rx with Albendazole
d) Multiple
e) Inaccessible location
Answer: a d, and e
Explanation:
Indications of PAIR (Puncture, aspiration, injection, re-aspiration):
Non-echoic lesion 5 cm
Cyst with daughter cysts
Multiple cysts if accessible to puncture
Infected cyst
Contra-indications of PAIR (Puncture, aspiration, injection, re-aspiration):
Inaccessible location
Multiple cysts not accessible to puncture
Cyst in spine, brain, bone, lung, heart

Inactive and calcified lesions

Cyst communicating or open to other organs or cavity
135. The caudate lobe of liver corresponds to with segment of Couinaud
classification
a) Segment I
b) Segment II
c) Segment III
d) Segment IV
e) Segment V
Answer: a
Explanation:
Couinaud classification:
Segment I: Caudate lobe
Segment II and III: Lateral segment of left lobe
Segment IV: Medial segment of left lobe
Segment V to VIII: Right lobe
136. Papillary ca thyroid
a) Most common thyroid cancer
b) Psammoma bodies seen
c) Encapsulated
d) Blood borne metastasis is common
Answer: a and b
Explanation:
Papillary ca thyroid:
It is most common primary malignant tumor of the thyroid gland.
It has a propensity to spread via the lymphatic system but can metastasize
hematogenous route as well.
Histological findings: Orphan Annie Eyed Nuclei
Regional metastasis is common.
137. Aromatase inhibitors used in Ca breast are
a) Letrozole
b) Anastrozole
c) Exemestane
d) Tamoxifen
Answer: a, b and c
Explanation:
Aromatase inhibitors used in Ca breast:
Letrozole

Anastrozole
Exemestane
Aminoglutethimide
Important points:
Tamoxifen is an antagonist of the estrogen receptor in breast tissue.
138. Screening increases life span in which of the following carcinoma
a) Breast
b) Colon
c) Prostate
d) Lung
Answer: a, b and c
Explanation:
Screening increases life span in the following carcinoma and screening techniques:
Breast- Self breast examination and mammography
Colon- Fecal occult blood, sigmoidoscopy and colonoscopy
Prostate- Digital rectal examination and PSA
Cervical cancer- Pap smear
139. Hemangioma of the rectum
a) Common tumour
b) Fatal hemorrhage seen
c) Ulcerative colitis like symptoms seen
d) All
Answer: b and c
Explanation:
Hemangioma of the rectum:
An uncommon tumor
Large tumor and sometime bleed profusely
Ulcerative colitis like symptoms in diffuse neoplasm or tumor location in upper part
of rectum and treated with selective angiography and embolization
Hemangioma of lower part of rectum is treated with local excision.
140. Gases used for Pneumo-peritoneum are
a) CO2
b) N2
c) O2
d) Room air
e) N2O
Answer: a, c, d and e
Explanation:

Gases used for Pneumo-peritoneum:

The abdomen is inflated with about 1 to 4 L carbon dioxide.
But diagnostic purpose, nitrous oxide, room air or oxygen can be used.
141. Charcots triad includes
a) Pain
b) Fever
c) Jaundice
d) Anemia
Answer: a, b and c
Explanation:
Charcots triad is an eponym referring to two sets of clinical features: one for acute
cholangitis or, less commonly, a second set for multiple sclerosis.
Charcots triad:
Pain
Fever
Jaundice
Charcots neurologic triad:
Nystagmus
Intention tremor
Scanning or staccato speech
Charcots neurologic triad is associated with multiple sclerosis however, it is not
considered pathognomonic for it.
142. Pyogenic granuloma, true statements is/are
a) Vascular pathology
b) Bleeds rarely
c) Increased in pregnancy
d) Local excision
e) Recurrent & malignant
Answer: a, c and d
Explanation:
Pyogenic granuloma (lobular capillary hemangioma) is a relatively common benign
vascular lesion of the skin and mucosa.
Pyogenic granulomas are misnamed; they are neither infectious nor granulomatous.
The lesion usually occurs in children and young adults as a solitary, glistening red
papule or nodule that is prone to bleeding and ulceration.
Pyogenic granulomas typically evolve rapidly over a period of a few weeks, most
often on the head, neck, extremities, and upper trunk.
Pyogenic granuloma often arises in pregnancy (or rarely with oral contraceptive
usage and then is termed the pregnancy tumor.
Recurrence occurs infrequently.

Treatment:
Curettage and Cauterization
Laser surgery
Cryotherapy
143. True about struma ovarii
a) Ectopic thyroid
b) Ectopic ovary
c) Malignancy
d) Benign lesion
e) Included in Teratoma
Answer: d and e
Explanation:
Struma ovarii is a rare ovarian tumor defined by the presence of thyroid tissue
comprising more than 50% of the overall mass.
It most commonly occurs as part of a Teratoma, but may occasionally be
encountered with serous or mucinous cystadenomas.
The vast majority of struma ovarii are benign; however, malignant disease is found
in a small percentage of cases.
144. T/t of malignant tracheo- oesophageal fistula includes
a) Expandable metal stent
b) Surgery with graft
c) Gastrostomy tube
d) Radiotherapy
e) Chemotherapy
Answer: a, b and c
Explanation:
Malignant tracheo- oesophageal fistula:
Expanding metal stent- Probably best treatment
Semi-rigid prosthetic tubing or Gastrostomy tube
Surgical bypass and esophageal exclusion
Important point:
It is sign of incurable esophageal carcinoma.
145. A pt on TPN develops deficiency of
a) Folic acid
b) Iron
c) Vitamin B-12
d) Copper
e) Fatty acids

Answer: All
Explanation:
Complication of TPN (Late 3 months onward):
Essential fatty acid deficiency
Vitamin deficiency
Zn, Iron, Copper, chromium and selenium deficiency
146. True about branchial cyst
a) Seen deep to lower 1/3 of sterno-cleidomastoid
b) Wall consists of lymphoid tissue
c) Filled with straw colored fluid with cholesterol crystals
d) None
Answer: b and c
Explanation:
Brachial cyst:
Brachial cysts are characteristically found anterior and deep to upper third of
sterno-cleidomastoid.
Second brachial remnants are the most common
Usually lined by squamous epithelium and shows layer of lymphoid tissue
Contain thick turbid full of cholesterol crystals
Treatment- Surgical excision
147. Structures not removed in radical neck dissection
a) X nerve
b) XI nerve
c) Tail of parotid
d) Parotid and post- auricular nerve
Answer: a and d (?)
Explanation:
Structures not removed in radical neck dissection:
Carotid artery
Brachial plexus
Phrenic nerve
Vagus nerve
Marginal mandibular branch of facial, lingual and glosso-pharyngeal nerves
Cervical sympathetic chain
Structures removed in classical radical neck dissection:
Cervical lymphatics and lymph nodes
Internal jugular vein
Accessory nerve
Sterno-cleidomastoid
Omohyoid

Tail of parotid
Submandibular gland
148. Variant of papillary carcinoma thyroid
a) Medullary
b) Warthins
c) Columnar
d) Insular
e) Diffuse sclerosing
Answer: c, d and e
Explanation:
Variants of papillary carcinoma thyroid:
Pure papillary
Follicular variant
Diffuse sclerosing
Tall cell variant
Columnar cells variant
Insular
Variants of follicular carcinoma thyroid:
Minimally invasive
Widely invasive
Hrthle cell carcinoma
Insular
149. Diagnosis of traumatic rupture of diaphragm is made by
a) Laparoscopy
b) Chest X ray
c) Diagnostic peritoneal lavage
d) None
Answer: a and b
Explanation:
Diagnosis of traumatic rupture of diaphragm:
Chest X-ray after placement of nasogastric tube
The most accurate evaluation is by VATS (Video assisted thoracoscopy) and
laparoscopy.
Contrast study of GI, CT scan and diagnostic peritoneal lavage all lacks positive or
negative predictable value.
150. True about breast carcinoma in men
a) Estrogen receptor positive
b) Associated with gynecomastia
c) Radiotherapy contraindicated due to close proximity to chest wall

d) None
Answer: a and b
Explanation:
Breast carcinoma in men:
Approximately 90 % of male breast cancers contain estrogen receptors.
Associated with gynecomastia and risk of cancer is much greater in men with
gynecomastia
Irradiation is the first step in treating localized metastasis.