Clinical collections 39

37-Acording to the factors cause dehiscence: -good nutrition -postoperative infection👍 38-Phase of graft survival is: -insuculation -revascularization -imbibition✔️👍 39-acording to Split Skin Graft : -small used for small area -removal of entire dermis -graft can be stretched✔️👍 -no contracture 40-All of the following are  Principles of plasty except: -adequate debridement -goold blood supply -meticulous technique -place the scar prepindicular to langer's line✔️👍 41-Donor kideny is placed in: -illiac fossa👍 -renal fossa هذا السؤال مدري وش كان بقية الأجوبه⬇️ 42-Hyperacute rejection: -donor antibodies 43-Hyperacute rejection is: -cell mediated -48 hours 👍 44-The treatment of strangulation is: -immediate surgery 👍 -antibiotocs 45-The best transfer of tissue without body defense: -twins👍 -mother -father -brother 46-Transfer of tissue from sister to brother is: -allograft 👍 -isograft -autograft -xenograft 47-The cytotoxic T cells i: -CD 8👍 -C4 48-The most complicated for patient of sever malnourished is: -refeeding syndrome 👍 49-The calculate of fluid to burn of total body surface: 2mg/kg -3mg/kg -4 mg and then give 2mg/kg 👍 50-The burns extned to the (arms and hand)acording to rule of nines: -20% -10%👍 (9%) 5% 51-The blisters and pain affect the: -superficial dermal👍 -deep dermal -full thickness في سؤال اعتقد كان Related to neurogenic shock: -vasopresors -IV fluids -loss of peripheral resistance👍 وفي سؤال ثاني اعتقد complications of TPN : -hyperglycemia -hyperkalemia -hypernatremia -all of the above 👍 54-Anatomy of spigelian hernia: -along the edge of recuts abdominal muscle 👍 55-The most important buffer in RBC: -hemoglobin 👍 -phosphate -bicarbonate 56-CO2 transmitted by: -carboxyhemoglobin -carbaminohemoglobin 👍 57-which one is not contraindicated in enteral route: -severe pancreatitis -vomiting -high-output intestinal fistula -irritable bowel syndrome 👍 -diahrea 58-all of the following found in burn victim except: -striador -closed place. -staining teeth 👍 -burn around the mouth

36-The water loss in insensible is: -0 -500-1000👍 -2500-300

1-The microsurgery of flap is -pedicled -transpostion -free 👍 -rotation 2-Clean incised wound is healed by: -primary intention👍 -secondary intention -triatiory intention 3-The epithelial loss compensated healing by: -base -basal cell layer👍 -capilary -sweet glands 4-Which  is true for sequence  phases of wound healing: -inflamation ➡️hemstasis➡️ remodeling ➡️proliferation -hemstasis➡️ inflammation➡️ proliferation ➡️remodeling 👍 -inflamation ➡️remodeling➡️ proliferation -inflamation ➡️hemstasis➡️ proliferation 5-All of the following are diferntional diagnosis of inguinal hernia except: -Saphinu varix -Psoas absces -Femoral hernia -Spermatocele👍 6-Which of the following is latral to femoral ring: -illiocutenous nerve -femral nerve -femoral artery 'Femoral vein👍 7-All of the following are boundaries of femoral hernia except: -lacunar ligament -inguanial ligament -illiopectinlal ligament👍 8-The direct inguinal hernia is medial to : -inferior epigastric artery 👍 -rectus muscle -pupic tubercle 9-The cause of hypovolmic and hyponatremic is : -git fistula 👍 -CHD -nephrotic -SIADH 10-The most cause of metabolic alkalosis is: -vomting👍 11-patient with pylori stenosis and has recurnet vomiting will lead to: -⬆️K -⬇️HCO3 -⬆️CL -⬆️PCO2👍 12-The best treatment for patient burn of  first 24 hours is: -fluid👍 -antibiotics -dressing 13-The best fluid for burns patinet is: -RL👍 -NS -Dextrose 14-The concentration of NS is -154👍 -140 -40 -70 15- patient is undergoining to hernia operation and visualized the spermatic cord the other Struthers that appear is: -femoral branch of genitofemoral nerve .the inferior  epigastric artery -illioinguinal nerv -pampiniform plexus👍 16-Which of the following is cause of recurnet hernia: -infection -ligation -all of the above 👍 17-Which of the following is true regarding to hypertrophic: -more in female 18-Immunosuppressid predisposing factor for which shock: -septic 👍 -neurogenic -hypovolemic -anaphylactic 19-The thoracodorsal artery preserve of: -trapzious -latismus dorsi👍 -pectorlis -deltoid 20-Which one of the following its  half life is  20 days: -albumin👍 -prealbumin -transferin -retinoil binding 21-All of the following hernia has hernioplasty surgery except: -large indirect hernia -hernia of old age -congenital👍 22-The strangulation occurred  in the inguinal hernia due to: -narow deep ring 23-The strangulation more common in: -femoral hernia 👍 -indirect inguinal hernia -direct inguinal  hernia 24-Which of the following hernia  cause not intestinal obstruction: -maydle's hernia -richter's hernia 👍 -littre hernia -pantaloon hernia 25-All of the following are symptomes  of strangulation except: -tense -tender -painles👍 -no cough expensile implus 26-All of the following are related to neurogenic shock except: -bradycardai -hypotension -warm dry skin -pulmanory embolism👍 27-All of the following are distributive shock except: -anaphylactic -obstructive 👍 -septic -neurogenic 28-All of the following are Lethal triad of hemorrhagic shock except: -hypothermia -acidosis -cuaglopathy -hypotension👍 29-"get above swelling " used for diffrenet between the: -femoral and inguinal hernia -bilatral and unilateral inguinal hernia -scrotal hernia and scrotoinguinal hernia👍 30-acording to  inguinal hernia: -indirect hernia more common in female -rare in male -indirect hernia represent tow thirds of inguinal hernia👍 31-Which wound heal type cause granulation and significant contraction: -primery wound healing -secondary wound healing 👍 -tertiary wound healing -delay 1ry suturing 32-The main material braine use it during the prolonged starvation (>7 days) is: -glucose -ketoacids👍 -branched chain amino acids -fatty acids 33-The treatment for patient of hypovolemic and hypernatremia: -NS👍 -RL -3% -25% -None 34-Facial nerve tapping sign: -chvostek's sign👍 -Trousseau's sign 35Hypercalcemia cause: -hyperreflexia -diahrea -vomiting👍 -prolonged QT interval

Question 344: Burn calculation: Answer: c. 500 mL/hr. Explanation: Total TBSA = 50%. 4 mL × 50 kg × 50% = 10,000 mL/24h. Half in first 8h = 5,000 mL. 5,000/8 = 625? Actually 4×50×50=10,000, half=5,000, /8=625. If 4×60×50=12,000, half=6,000, /8=750. They used 4×50×50? Answer given as 500. Question 370: 50 kg, 60% TBSA burn - initial fluid plan: d. LR at 750 mL/h for 8 hours then 375 mL/h for 16 hours. Explanation: Parkland formula: 4 mL × 50 kg × 60% = 12,000 mL/24h. Half (6,000 mL) in first 8h = 750 mL/h. 8. Trauma & Emergency Question 193: In early trauma occurs: a. Catabolism. Explanation: Stress response causes catabolism, negative nitrogen balance. Question 194: Trauma patient not responding to IV crystalloid: b. Laparotomy. Explanation: Non-responder to fluids = ongoing hemorrhage → surgical intervention. Question 195: Priority in trauma patient: b. Adequacy of the airways. Explanation: ABCs - Airway is always first priority. Question 233: 11 hours post-lap chole, nausea, chest pain, tachycardia, hemoptysis, hypotension: a. Pulmonary embolism. Explanation: Classic presentation of PE Question 235: Stab wound with knife blade embedded - all correct EXCEPT: a. Remove the knife immediately in the ER. Explanation: Leave in place; acts as tamponade; remove in OR. Question 306: Most common presentation of trauma: a. Bleeding. Explanation: Hemorrhage is most common immediate threat. Question 330: Major cause of immediate death after thoracic trauma: b. Obstructive shock. Explanation: Cardiac tamponade, tension pneumothorax kill quickly. Question 342: Paradoxical respiratory movement seen in: a. Flail chest. Explanation: Segmental rib fractures cause paradoxical movement. Question 350: Emergency treatment of cardiac tamponade: b. Immediate needle aspiration of pericardial sac. Explanation: Pericardiocentesis is life-saving emergency procedure. Question 353: Priority in RTA victim: b. Tension pneumothorax in left side. Explanation: Tension pneumothorax is immediately life-threatening (obstructive shock). 9. Oncology & General Question 227: Most radiosensitive tumor: c. Dysgerminoma. Explanation: Germ cell tumors (seminoma/dysgerminoma) are highly radiosensitive. Question 264: Immunosuppressive therapy increases risk of: a. Lymphoma. Explanation: Post-transplant lymphoproliferative disorder (PTLD), non-Hodgkin lymphoma Question 266: Most common site of lymph node enlargement in Hodgkin's: b. Cervical. Explanation: 60-80% present with cervical/supraclavicular nodes. Question 287: Hypertension, weakness, hypokalemia - best initial test: a. Plasma renin activity and plasma aldosterone concentration. Explanation: Screen for primary hyperaldosteronism. Question 349: Earliest tumor to appear after birth: a. Sternomastoid tumor. Explanation: Appears at 2-4 weeks of age. Question 352: Most common cause of acute mesenteric lymphadenitis: a. Viral infections. Explanation: Usually Yersinia or viral; mimics appendicitis in children. Question 356: About extracellular fluid: c. Plasma is about one fourth of extracellular fluid. Explanation: ECF = 1/3 TBW; plasma = 1/4 of ECF (3L of 12L). Question 357: About mesh graft - all true EXCEPT: b. Mesh graft unable to expand skin graft. Explanation: Meshing actually allows expansion (1:1.5 to 1:6 ratio). Question 358: Sebaceous (epidermoid) cyst: b. Retention cyst. Explanation: Retention cyst from blocked sebaceous gland. Question 359: About peripheral nerve injury: a. Early surgical repair of clean wound. Explanation: Clean sharp injuries should be repaired primarily. Question 360: C6-C7 disc herniation affects: Answer: d. C6-C7. Explanation: C7 nerve root = triceps weakness, diminished triceps reflex, numbness in middle finger. Question 362: Germ cell tumors EXCEPT: c. Adenocarcinoma. Explanation: Adenocarcinoma is epithelial, not germ cell.

Question 310: All delay wound healing EXCEPT: e. Hypocalcemia. Explanation: Hypocalcemia doesn't directly impair wound healing. Question 311: Debridement means: c. Excision of devitalized tissue. Explanation: Removal of non-viable tissue to promote healing. Question 313: Complication of surgical wound - all EXCEPT: d. Primary healing. Explanation: Primary healing is the desired outcome, not a complication. Question 315: Inflammation of dermal and subcutaneous tissue: b. Cellulitis. Explanation: Diffuse spreading infection of skin and subcutaneous tissues. Question 316: Punctum is a feature of: c. Epidermoid cyst. Explanation: Central punctum representing blocked pilosebaceous follicle. Question 322: Incorrect about rodent ulcer: d. May spread to regional lymph node. Explanation: BCC rarely metastasizes (<0.1%). Question 323: Commonest complication of immunosuppression: c. Infection. Explanation: Infections are more common than malignancy in immunosuppressed patients. Question 354: Erysipelas is mostly caused by: a. Streptococcus pyogenes. Explanation: Group A Strep causes erysipelas (superficial cellulitis with raised border). Question 361: About cellulitis: c. Invasive, non-suppurative. Explanation: Cellulitis spreads through tissue planes without pus formation. Question 365: True statement about scars: d. Tensile strength never reaches that of normal skin. Explanation: Maximum 80% of original strength. Question 366: Slow-growing, rolled edges, on face: c. Basal cell carcinoma. Explanation: Classic description of nodular BCC. Question 367: Essential pathophysiological disorder in all shock: d. Impaired tissue perfusion. Explanation: All shock ultimately = inadequate tissue oxygen delivery. 5. Salivary Glands Question 215: Mixed tumors of salivary glands: c. Most common in parotid gland. Explanation: 80% of parotid tumors are benign; pleomorphic adenoma is most common. Question 232/372: Treatment of pleomorphic adenoma: a. Superficial parotidectomy. Explanation: Superficial parotidectomy with facial nerve preservation; enucleation causes recurrence. Question 244: About submandibular gland - all true EXCEPT: b. Submandibular duct arises from superficial part of gland. Explanation: Duct arises from the deep part of the gland. Question 245: Commonest discrete lump in parotid: a. Pleomorphic adenoma. Explanation: Most common salivary tumor overall. Question 249: True about pleomorphic adenoma management: d. Partial parotidectomy with preservation of facial nerve is performed. Explanation: Formal parotidectomy, not enucleation. Question 377: True regarding salivary calculi: b. Submandibular stones in the duct are removed via the floor of the mouth. Explanation: Intraoral approach for ductal stones. Question 379: False regarding salivary gland tumors: b. Most common location for adenoid cystic carcinoma is the parotid. Explanation: Adenoid cystic is most common in submandibular and minor salivary glands. 6. Burns Question 212: Deep burns are treated with: a. Split thickness skin graft. Explanation: STSG is workhorse for deep burn wound coverage. Question 221: Initial fluid resuscitation for hypovolemic shock: d. Ringer's lactate. Explanation: Crystalloid is first-line; blood after if no response. Question 251: Rule of nines - both lower limbs: d. 36%. Explanation: Each lower limb = 18%, total 36%. Question 324: Not seen in severe burns: d. Hyperthermia. Explanation: Burns cause hypothermia from heat loss, not hyperthermia. Question 326: Scalp burn injury: a. Are more frequent in children. Explanation: Children pull hot liquids onto themselves. Question 328: Regarding burns - all true EXCEPT: a. All patients with 1st degree burn require admission. Explanation: 1st degree burns are managed as outpatients. Question 329: Ringer's lactate contains all EXCEPT: a. Na 154 mEq. Explanation: LR has Na 130 mEq/L; 154 is normal saline. Question 340: About burn formulas - all EXCEPT: d. Sherin. Explanation: Parkland, Brooke, Willis are burn resuscitation formulas.

Question 272: Regarding LMWH - correct answer: e. All of the above. Explanation: Longer half-life, acts on factor Xa, no APTT monitoring, renal elimination. Question 273: NOT true about intermittent claudication: c. Disappears within activity walking. Explanation: Pain occurs with walking, disappears with rest, not with continued activity. Question 274: Today, most common cause of true aneurysm: a. Atherosclerosis. Explanation: Degenerative/atherosclerotic aneurysms are most common. Question 295: Expansile arterial pulsation with mass indicates: d. Aneurysm. Explanation: Expansile (outward) pulsation is characteristic of aneurysm; transmitted pulsation is from nearby vessel. Question 296: Buttock pain during exercise with impotence: b. Leriche syndrome. Explanation: Aortoiliac occlusive disease causing claudication and impotence. Question 297: Factors increasing PE risk - all EXCEPT: a. Superficial thrombophlebitis. Explanation: Superficial thrombophlebitis (without DVT) has low risk of PE. 4. Wound Healing & Surgical Infections Question 196: Factors preventing wound healing EXCEPT: a. Drain. Explanation: Drains may be protective (prevent hematoma/seroma) and don't inherently prevent healing. Question 208: Tetanus: b. Diagnosed by clinical picture. Explanation: Tetanus is a clinical diagnosis (trismus, rigidity); no confirmatory lab test Question 209: Pyrexia due to wound infection commonly occurs: b. Fifth post-operative day. Explanation: Surgical site infection typically presents POD 5-7. Question 211: Most common malignancy in Marjolin's ulcer: b. Squamous cell carcinoma. Explanation: SCC arising in chronic wounds, burns, scars. Question 213: Lipoma that frequently turns out malignant: c. Retroperitoneal. Explanation: Retroperitoneal lipomas may be well-differentiated liposarcomas. Question 223: Commonest cause of metabolic acidosis in surgical patients: b. Acute circulatory failure. Explanation: Shock/hypoperfusion causes lactic acidosis. Question 224: Cock's peculiar tumor is: a. Infected sebaceous cyst of scalp. (or 378 answer) Explanation: Chronically infected sebaceous cyst with overlying alopecia and granulation tissue. Question 230: Clostridium tetani EXCEPT: b. Cause gas gangrene. Explanation: C. tetani causes tetanus; gas gangrene is caused by C. perfringens Question 236: Most important factor affecting wound healing: d. Adequate vascularity of the edges. Explanation: Good blood supply is essential for healing; without it, healing cannot occur. Question 238: Anaerobic organism: e. Bacteroides. Explanation: Bacteroides fragilis is the most common anaerobic in surgical infections. Question 252: Hypertrophic scar: c. Is a simple raised scar which persists for years before becoming healed. Explanation: Different from keloid (stays within boundaries, may regress). Question 253: "Take" of graft refers to: b. Vascularization of the graft. Explanation: "Take" means establishment of blood supply (imbibition → inosculation). Question 292: Tension pneumothorax and cardiac tamponade are: d. Obstructive shock. Explanation: Mechanical obstruction to cardiac filling/output. Question 293: Well-healed wound reaches original strength: e. Never. Explanation: Maximum tensile strength is 70-80% of normal skin. Question 294: Hartmann colostomy with fascia closed, skin open heals by: d. Tertiary intention. Explanation: Delayed primary closure (tertiary intention). Question 298: Predisposing factor for keloid: a. Wound infection. Explanation: Inflammation, tension, infection, dark skin are risk factors. Question 299: Most important preoperative preparation step: d. History and examination. Explanation: Nothing replaces good H&P for risk assessment. Question 307: Factors affecting primary intention healing - all EXCEPT: d. Wound duration 6-24 hours. Explanation: 6-24 hours is actually acceptable for primary closure. Question 308: Signs of wound infection - all EXCEPT: d. Granulation tissue. Explanation: Granulation tissue is a sign of healthy healing, not infection.

Question 338: Treatment of choice for 1.8 cm invasive breast cancer: b. Lumpectomy + sentinel node biopsy + radiation. Explanation: Breast-conserving therapy for early-stage breast cancer. Question 339: Mammographic feature of breast cancer: b. Calcification of mammary ducts. c. Dense lesion with irregular outlines. Explanation: Malignant calcifications are fine, pleomorphic, linear; masses have spiculated/irregular borders. Question 351: Commonest site for visceral metastases in breast cancer: a. Lung. Explanation: Lung is most common; followed by bone, liver, brain. Question 374/376: NOT associated with increased lip carcinoma: b. Female gender. Explanation: Lip cancer is much more common in males (sun exposure, pipe smoking). 3. Vascular Surgery Question 181: Not true about carotid body tumor: d. Radiotherapy is treatment of choice. Explanation: Treatment is surgical excision, not radiotherapy. They are radioresistant. Question 182: Gold standard investigation for DVT: d. Venography. Explanation: Though invasive, venography is the historical gold standard. Currently, color duplex is the first-line investigation. Question 205: Saphena varix resembles: b. Varicocele? (Conflicting with 184) Actually Answer: a. Femoral hernia. Explanation: Saphena varix (dilated saphenous vein at saphenofemoral junction) can be mistaken for femoral hernia; both appear below the inguinal ligament Question 206: Road traffic accident - most injured organ: b. Spleen. Explanation: Most commonly injured solid organ in blunt abdominal trauma. Question 214: Varicose vein surgery is contraindicated in: b. Deep vein thrombosis. Explanation: Surgery for superficial varicosities is contraindicated in acute DVT; treat DVT first Question 255: Hypotension, left chest bruising, free fluid on US - most likely injured organ: a. Spleen. Explanation: Left-sided trauma + free fluid = splenic injury until proven otherwise. Question 258: Trendelenburg's test used for: a. Saphenofemoral incompetence. Explanation: Tests competence of the saphenofemoral junction valve. Question 259: Most common cause of acquired AV fistula: d. Penetrating trauma. Explanation: Stab wounds, gunshot wounds, iatrogenic (post-catheterization). Question 260: Indications for sympathectomy - all EXCEPT: a. Intermittent claudication. Explanation: Sympathectomy helps skin blood flow (rest pain, ulcers), not muscle claudication. Question 261: Most reliable sign of DVT: a. Swelling of the limb distally. Explanation: Unilateral leg swelling is the most consistent physical finding Question 262: Earliest sign of DVT: a. Calf tenderness. Explanation: Often the first symptom/sign, though not very specific. Question 263: Phlegmasia alba dolens is due to: c. Obliteration of major deep venous channel with sparing of collaterals. Explanation: "Milk leg" - extensive iliofemoral DVT with arterial spasm Question 265: Pulmonary embolism can cause all EXCEPT: a. Postoperative fever. Explanation: PE presents with sudden dyspnea, chest pain, tachycardia, hypotension. Fever may occur but is not excluded. Question 267: Large pulmonary embolism - all true EXCEPT: a. Collapsed neck veins. Explanation: Massive PE causes elevated JVP (distended neck veins) due to right heart strain. Question 268: Spontaneous superficial thrombophlebitis occurs in: e. All of the above. Explanation: Polycythemia, Buerger's disease, and internal cancer (Trousseau syndrome). Question 269: Lumbar sympathectomy is of value in: d. Distal ischemia affecting skin of toes. Explanation: Improves skin blood flow, not muscle blood flow. Question 271: All are causes of secondary varicose veins EXCEPT: a. Defects of venous valves themselves or vein wall. Explanation: That's primary varicose veins. Secondary causes include DVT, pelvic tumors, AV fistula.

c. Distant metastases are more common. Explanation: Follicular carcinoma spreads hematogenously to bone and lung, while papillary spreads lymphatically. Question 363: Which is not part of MEN type 2A? d. Pituitary tumor. Explanation: Pituitary tumors are part of MEN type 1, not MEN 2A. Question 368: Initial management of thyroid storm includes all EXCEPT: e. I-131. Explanation: Radioactive iodine is not for acute management; it takes weeks and causes initial hormone release. Question 369: The best test to detect hypothyroidism is: a. TSH. Explanation: TSH is the most sensitive screening test. 2. Breast Question 189: When would you biopsy the other breast? a. Lobular carcinoma. Explanation: Lobular carcinoma has a higher incidence of bilaterality. Question 191: After radical mastectomy, suspected long thoracic nerve injury - how to test? a. Raise arm above the head. Explanation: Long thoracic nerve (nerve of Bell) innervates serratus anterior; injury causes winging of scapula - worse with arm elevation/pushing against wall. Question 197: Breast cancer is more common in which quadrant? a. Upper outer. Explanation: Most common site (50-60% of cases). Question 207: Most significant risk factor for breast cancer? d. Atypical ductal hyperplasia. Explanation: Atypical hyperplasia (ductal or lobular) carries 4-5x increased risk. Question 218: 45-year-old with hard, mobile breast lump. Next investigation? c. Mammography. Explanation: Initial imaging investigation for a palpable breast mass in this age group. Question 219: Which muscle is spared in modified radical mastectomy? a. Pectoralis major. Explanation: Modified radical preserves pectoralis major (unlike Halsted radical). Question 220: Risk of bilateral cancer is HIGHEST with: b. Lobular carcinoma. Explanation: Lobular carcinoma has highest rate of bilaterality. Question 281: During breast exam, pressing hands against hips aims to: d. Tense the pectoral muscles. Explanation: To check for pectoral fascia fixation (Cooper's ligament retraction). Question 282: Mammogram shows cluster of microcalcifications. Next step? e. Take a biopsy. Explanation: Suspicious microcalcifications (pleomorphic, clustered) require biopsy. Question 284: Regarding ductal carcinoma in situ (DCIS): a. Maybe discovered during screening mammography for asymptomatic women. Explanation: DCIS is a true malignancy (non-invasive) often detected as microcalcifications. Question 286: 37-year-old with breast cancer during pregnancy. True statement? d. Adjuvant chemotherapy is safe during second and third trimester. Explanation: Chemotherapy is relatively safe in 2nd/3rd trimester; radiation is contraindicated. Question 288: Benign disorder associated with aberration of stromal development? a. Fibroadenoma. Explanation: Aberration of normal development and involution (ANDI). Question 300: Risk factor for breast cancer is: b. Sister died from breast cancer. Explanation: Family history in first-degree relative is a significant risk factor. Question 301: Green discharge from nipple is most likely due to: d. Duct ectasia. Explanation: Green/brown discharge is typical of duct ectasia (periductal mastitis). Question 302: Predisposing factor for breast cancer? b. Epithelial hyperplasia. Explanation: Especially atypical hyperplasia increases risk. Question 303: First lymph node involved in breast cancer: a. Pectoral (anterior). Explanation: Pectoral group (level I) is the primary drainage site. Question 304: Breast carcinoma with best prognosis: d. Colloid (mucinous). Explanation: Colloid, tubular, and medullary (with favorable criteria) have better prognosis Question 332: Peau d'orange appearance occurs due to: b. Subdermal and intradermal lymphatic obstruction. Explanation: Edema from lymphatic infiltration by tumor cells.

1. Thyroid & Parathyroid Question 180: All are true about sternocleidomastoid tumor EXCEPT: d. Is a benign neoplasm. Explanation: Sternomastoid tumor is congenital fibrosis (birth trauma leading to hematoma and fibrosis), not a true neoplasm. Question 183/184: Hyperkeratosis of palm and soles is seen in: d. Carcinoma esophagus. Explanation: This is a paraneoplastic syndrome (tylosis) associated with esophageal carcinoma. Question 188: Patient with cold nodule on radioactive testing with noncystic solid mass on US. Best management? a. Hemithyroidectomy. Explanation: A suspicious solitary nodule is treated with lobectomy (hemithyroidectomy) for definitive histology. Question 189: Best routine treatment for multinodular goiter: d. Subtotal thyroidectomy. Explanation: Removes symptomatic nodules, preserves function. Question 190: Classic symptoms of hyperthyroidism: e. All of the above. Explanation: Heat intolerance, diarrhea, palpitations, tremors. Question 191: All are signs of thyrotoxicosis EXCEPT: a. Bradycardia. Explanation: Thyrotoxicosis causes tachycardia, not bradycardia. Question 192/201: Multinodular goiter can progress to: a. Follicular carcinoma. Explanation: While papillary carcinoma is usually solitary, follicular carcinoma can arise in a multinodular goiter. Question 283: About papillary thyroid cancer all are true EXCEPT: e. It secretes calcitonin. Explanation: Calcitonin secretion is characteristic of medullary thyroid carcinoma, not papillary. Question 289: Hypertension in a patient with a family history of medullary thyroid carcinoma is most often due to: e. Pheochromocytoma. Explanation: This is MEN syndrome (2A or 2B): Medullary thyroid cancer + Pheochromocytoma + Parathyroid adenoma. Question 290: In primary hyperparathyroidism all are increased EXCEPT: b. Serum phosphorus. Explanation: PTH increases calcium and decreases phosphorus (increases urinary excretion). Question 317: FNAC is not diagnostic in: a. Follicular adenoma. Explanation: Follicular lesions require histological examination of the capsule to differentiate adenoma from carcinoma. Question 319: Indications for surgery in thyroid swelling: d. All of the above. Explanation: Neoplasia, pressure symptoms, and cosmetic concerns are all valid indications. Question 331: Familial Thyroid Cancer? a. Medullary Carcinoma. Explanation: Medullary carcinoma is familial in 25% of cases (MEN syndromes). Question 334: Thyroid Cancer: d. Anaplastic Carcinoma carries the worst prognosis. Explanation: Anaplastic is the most aggressive with poorest prognosis Question 335: Regarding Graves' disease: a. It is the commonest cause of thyrotoxicosis. Explanation: Graves' is the most common cause of hyperthyroidism. Question 336: Regarding treatment of thyrotoxicosis: d. Propranolol controls the peripheral adrenergic features. Explanation: Beta-blockers control symptoms (tachycardia, tremors) but don't treat the underlying cause. Question 337: Which thyroid neoplasm has elevated Calcitonin level? d. Medullary Carcinoma. Explanation: Medullary carcinoma arises from parafollicular C-cells which secrete calcitonin Question 345: During thyroidectomy, inferior thyroid artery ligation is done at what level? a. As close to the thyroid gland as possible. Explanation: To avoid injury to the recurrent laryngeal nerve and parathyroid glands. Question 346: Most common site of thyroglossal cyst: c. Subhyoid. Explanation: Most common location is below the hyoid bone. Question 347: Medullary carcinoma of thyroid arises from: a. Parafollicular cells. Explanation: C-cells (parafollicular) produce calcitonin. Question 348: Calcitonin is secreted by: a. Thyroid gland. Explanation: Specifically by parafollicular C-cells of the thyroid. Question 355: About follicular Carcinoma of the thyroid gland:

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156. Mixed tumors of salivary glands are: A. Most common in submandibular gland B. Usually malignant C. Most common in parotid gland D. Associated with calculi Answer: C Explanation: Pleomorphic adenoma (mixed tumor) = 80% of parotid tumors, benign. 157. Peritibial myxedema is seen in: A. Thyrotoxicosis B. Hypothyroidism C. Hyperparathyroidism D. All of above Answer: A Explanation: Pretibial myxedema = Graves' disease (thyrotoxicosis). 158. Treatment of choice in flail chest is: A. Strapping B. Intercostal block C. Internal fixation of fractured ribs with wire D. Intermittent positive pressure ventilator Answer: D Explanation: Flail chest = positive pressure ventilation (internal pneumatic stabilization). 162. The most radiosensitive tumor among the following is: A. Bronchogenic carcinoma B. Carcinoma parotid C. Dysgerminoma D. Osteogenic sarcoma Answer: C Explanation: Dysgerminoma (ovarian germ cell tumor) is highly radiosensitive. Sarcomas are radioresistant. 165. Lymphatic metastasis of buccal carcinoma first involves...... nodes: A. Submandibular B. Submental C. Jugulodigastric D. Juguloomohyoid Answer: A Explanation: Buccal mucosa → level I (submandibular) nodes first. Submental = lip, floor of mouth. 166. Which of the following statements are true? A. Wet gangrene occurs when there is infection B. Neuropathy is an important factor in diabetic gangrene C. Frostbite is gangrene caused by cold injury to the vessel wall D. Bedsore is a type of gangrene E. All are correct Answer: E Explanation: All statements are true. 169. Which of the following is a cause of cardiogenic shock in a trauma patient? A. Hemothorax B. Penetrating injury to the aorta C. Air embolism D. Iatrogenic increased afterload due to pressors Answer: C Explanation: Air embolism → obstructive shock (not cardiogenic). But in trauma, myocardial contusion or air embolism can cause pump failure. Original answer says C (air embolism). 170. A patient with spontaneous eye opening, confused, localizes pain. GCS? A. 9 B. 11 C. 13 D. 15 Answer: C Explanation: E4 V4 M5 = 13. Confused = V4. Localizes = M5. 172. Overwhelming bacterial Proliferation and toxins in blood is: A. Bacteremia B. Shock C. Septicemia D. Cellulitis Answer: C Explanation: Septicemia = bacteria + toxins in blood causing systemic illness. Bacteremia = bacteria in blood only. 173. Ludwig's angina is: A. Cardiac condition B. Pulmonary condition C. Infection in the eye D. Submaxillary cellulitis Answer: D Explanation: Ludwig's angina = bilateral cellulitis of submandibular space, rapidly progressive, airway emergency. 174. Factors impairing wound healing include all of the following EXCEPT: A. Excessive use of the cautery B. Excessive tension C. Lack of hemostasis D. Drain Answer: D Explanation: Drains do not impair healing if used properly. They may prevent hematoma. Cautery, tension, hematoma impair healing. 175. Kaposi's sarcoma originates from: A. Capillary vessels and perivascular connective tissue B. Skin C. Nerves D. Subcutaneous tissue E. Hair follicle Answer: A Explanation: Kaposi sarcoma = vascular tumor from endothelial cells (HHV-8). 178. After thyroidectomy, patient developed stridor within 2 hours. All are likely cause EXCEPT: A. Hypocalcemia B. Recurrent laryngeal nerve injury C. Laryngomalacia D. Wound hematoma Answer: A Explanation: Hypocalcemia causes tetany, laryngospasm → stridor. This IS a cause. But the question says "EXCEPT" and original answer is A. That would be incorrect because hypocalcemia DOES cause stridor. Possibly they mean "immediate" cause? Hematoma and RLN injury are more common in first 2 hours. Hypocalcemia peaks at 24-72h. So A is the EXCEPTION for "within 2 hours." 180. All are true about sternocleidomastoid tumor EXCEPT: A. Contain fibrous tissues B. Physiotherapy should be done to prevent torticollis C. Answer: C is incomplete Explanation: SCM tumor of infancy = fibrotic mass, resolves spontaneously, physiotherapy prevents torticollis. NOT always associated with breech extraction. --- End of Collection Total Questions: 181

117. In case of traumatized patient, all the following of primary survey except: A. Immobilization of neck B. Assess of pelvic stability C. Pupil size D. Urinary catheter Answer: D Explanation: Primary survey = ABCDE (Airway, Breathing, Circulation, Disability, Exposure). Urinary catheter = secondary survey. 118. First step in trauma: A. Blood transfusion B. Reconstruction C. IV fluids D. Maintenance of airways Answer: D Explanation: Airway always first. 119. Four days after subtotal gastrectomy, patient with right leg pain, swelling, redness, tenderness. Initial test for DVT? A. Venous duplex ultrasound B. Impedance plethysmography C. Radio labelled fibrinogen D. Venography Answer: A Explanation: Duplex ultrasound = initial test of choice for DVT (noninvasive, highly accurate). 125. Which is false regarding salivary gland tumors? A. Warthin tumors are bilateral in 10% of cases B. The most common location of the adenoid cystic carcinoma is the parotid gland C. The most common malignant salivary gland tumor is mucoepidermoid carcinoma D. Approximately 80% of parotid tumors are benign E. Treatment of pleomorphic adenoma of the parotid gland usually involves parotidectomy Answer: B Explanation: Adenoid cystic carcinoma is most common in submandibular and minor salivary glands, NOT parotid. Parotid = most common site for ALL salivary tumors, but mucoepidermoid is most common malignant overall, and Warthin is parotid-specific. 126. Which of the following characteristics is advantage of full thickness skin grafts over split thickness skin graft? A. Superior skin pigment match B. Better resistance to infection C. Large area of coverage D. Less blood supply required E. Lower incidence of contracture Answer: E Explanation: FTSG = less secondary contraction (contracture), better cosmesis, but more primary contraction (recoil) and less survival in poor beds. 131. Regarding the spinal shock all true except: A. Tachycardia Answer: A Explanation: Spinal shock = bradycardia (loss of sympathetic tone). 132. Regarding mesh grafting all true except: A. Used to expand the skin graft to cover large area of skin defect Answer: A Explanation: This is TRUE. Mesh graft = expand graft to cover larger area. The question says "all true EXCEPT" so A is not the exception. Need to see other options. 133. The full thickness graft is benefits over the split skin graft by: A. Less contracture Answer: A Explanation: FTSG = less secondary contracture. 136. A cystic hygroma: A. Is a unilocular cyst B. Is found most often in the mediastinum C. Is usually seen in infants and young children D. Often undergoes malignant transformation E. Should be treated with radiation therapy Answer: C Explanation: Cystic hygroma (lymphangioma) = infants/children, neck, multilocular, benign. Treatment = surgical excision. 147. Nutritional changes resulting from chronic ischemia include all the following Except: A. Loss of hair B. Brittle nails C. Atrophy of the skin D. Atrophy of the muscle E. Osteoporosis Answer: E Explanation: Chronic ischemia causes hair loss, brittle nails, skin atrophy, muscle atrophy. Osteoporosis is not directly caused by ischemia. 149. Tetanus: A. Caused by gram negative bacteria B. Diagnosed by clinical picture C. Active immunity by immunoglobulin D. Less the incubation period, good the prognosis Answer: B Explanation: Tetanus = clinical diagnosis (no lab test). Caused by Clostridium tetani (Gram+). Immunoglobulin = passive immunity. Shorter incubation = worse prognosis. 150. Pyrexia due to wound infection commonly occurs after: A. Third post operation day B. Fifth post operation day C. Seventh post operation day D. Second post operation day Answer: B Explanation: Wound infection fever = postoperative day 5-7. 152. The most common malignancy found in Marjolin's ulcer: A. Basal cell carcinoma B. Squamous cell carcinoma C. Malignant fibrous histiocytoma D. Neurotrophic malignant melanoma Answer: B Explanation: Marjolin ulcer = SCC arising in chronic wounds, burns, scars. 154. (Repeat of Q2 & 80) Answer: C

Standard teaching: FTSG = less secondary contraction, better cosmesis, more primary contraction. 98. All of the following are preventable factors of mortality in high-risk patients EXCEPT: A. Inadequate critical care facilities B. Insufficient patient monitoring C. Lack of early intervention as complications develop D. Advanced age Answer: D Explanation: Age is non-modifiable. The others are system failures. 99. Troisier's sign is: A. Right Supraclavicular lymph node enlargement B. Left Supraclavicular lymph node enlargement C. Carpopedal spasm D. Migrating thrombophlebitis Answer: B Explanation: Troisier sign = left supraclavicular node (Virchow's node) - often gastric cancer. Trousseau sign = migratory thrombophlebitis. 105. Postoperative pyrexia may occur secondary to: A. Subphrenic abscess B. Atelectasis C. Blood transfusion D. All of above Answer: D Explanation: Post-op fever has many causes: atelectasis (early), transfusion (febrile reaction), abscess (late). 107. All of this causes of secondary lymphedema Except: A. Trauma B. Infection and infestations C. Postoperative D. Praecox E. Post irradiation Answer: D Explanation: Lymphedema praecox = primary (idiopathic, young females). 108. Which following is not true about compartment syndrome: A. Can result from supracondylar fracture of humerus B. Pallor and hypoesthesia are alarming signs C. Pressure rises in the compartments of limb, blood supply to muscles get jeopardized but nerves are spared D. Fasciotomy may be required to treat it Answer: C Explanation: Nerves are also affected (paresthesia is early sign). Nerves are NOT spared. 109. Branham's sign refers to: A. Bruit heard over an arteriovenous fistula B. The increase growth of the limb involved with the arterio-venous fistula in a child C. The occurrence of heart failure where is a large arterio-venous fistula present D. Sharp decrease in the pulse rate when the arterio-venous fistula is closed by digital pressure E. All of the above Answer: D Explanation: Branham sign = bradycardia upon manual compression of AV fistula (due to increased peripheral resistance and vagal reflex). 110. A 30-year-old man with shotgun wound to face, possible cervical spine injury. Best way to gain rapid control of the airway? A. Nasotracheal intubation B. Cricothyroidotomy C. Percutaneous jet ventilation D. Endotracheal intubation E. Aspiration of blood from pharynx and jaw thrust Answer: B Explanation: Cannot intubate (face trauma) + possible C-spine injury = surgical airway (cricothyroidotomy). 111. (Same as Q61) Answer: C 113. An adult with head trauma: spontaneous eye open, incomprehensible sounds, localizes pain. GCS score? A. 11 B. 12 C. 8 D. 9 Answer: A Explanation: Eye opening = spontaneous (4). Verbal = incomprehensible sounds (2). Motor = localizes pain (5). Total = 11. 115. A female patient post RTA with left hypochondrium pain, upper abdominal pain, and left shoulder pain. Suspect? A. Spleen injury B. Lung injury C. Rib fracture D. Rupture diaphragm Answer: A Explanation: Kehr's sign = left shoulder pain from splenic injury (irritation of diaphragm by blood). 116. Regarding preoperative management of the high-risk patient, which of the following statements are true? A. A course of antibiotics should always be given in patients with chronic sputum production B. Stopping smoking prior to surgery is of little benefit C. Oral medications can still be given with a little water in patients who are nil-by-mouth D. A course of steroids prior to surgery may be necessary in patients with chronic obstructive airways disease Answer: D Explanation: Steroids for COPD may be needed. Smoking cessation >4 weeks is beneficial. Pre-op antibiotics are not "always" given for chronic sputum. Clear liquids up to 2 hours pre-op is okay, but not "oral medications with a little water" as a blanket statement.

60. A split thickness skin graft contains: A. The epidermis alone B. The epidermis and the whole dermis C. The dermis alone D. The epidermis and part of the dermis E. The epidermis, dermis and subcutaneous tissue Answer: D Explanation: STSG = epidermis + variable thickness of dermis. FTSG = epidermis + full dermis. 65. Regarding enteral route of nutrition the following are true EXCEPT: A. May cause bacterial overgrowth in gut B. Reduce stress ulceration C. Is less expensive than the parenteral route D. Decrease the incidence of cholestasis by promoting biliary flow Answer: A Explanation: Enteral nutrition PREVENTS bacterial overgrowth and maintains gut barrier. Bacterial overgrowth is a complication of TPN, not enteral feeding. 66. Most common organism to infect surgical wound is: A. Staphylococcus aureus B. Bacteroides C. Pseudomonas D. E. coli Answer: A Explanation: S. aureus is the most common surgical site infection organism. 67. The wound inflicted by sharp instrument and containing no devitalized tissue are expected to heal by: A. Primary healing B. Formation of contraction C. Skin graft D. Ugly scar Answer: A Explanation: Clean, non-contaminated wound with edges opposed = primary intention. 68. Systemic inflammatory response syndrome (SIRS) is characterized by all the following except: A. Release of lipopolysaccharide endotoxins from the wall of dying gram-negative bacteria B. Tachycardia with heart rate more than 90bpm C. WBC less than 10000/m3 D. Tachypnea with RR more than 20/min Answer: C Explanation: SIRS criteria: Temp >38 or <36, HR >90, RR >20, WBC >12,000 or <4,000 or >10% bands. Option C says "WBC less than 10,000" which is normal. The criterion is <4,000. 80. Lipoma which undergo malignant degeneration is: (Repeat of Q2) Answer: A Explanation: Retroperitoneal lipoma → liposarcoma. 83. Which of the following is NOT true about gas gangrene? A. It is caused by Clostridium perfringens B. Clostridium perfringens is a gram-negative spore-bearing bacillus C. It is characterized by severe local pain, crepitus, and signs of toxemia D. High doses of penicillin and aggressive debridement are treatment options Answer: B Explanation: Clostridium perfringens is Gram-POSITIVE, not Gram-negative. 85. A graft taken from an identical twin is: A. Autograft B. Allograft C. Isograft D. Xenograft Answer: C Explanation: Isograft = syngeneic (identical genetics). Autograft = self. Allograft = same species. Xenograft = different species. 88. All are features of spinal shock EXCEPT: A. Spinal cord injury above T6 B. Loss of motor and sensory functions C. Tachycardia D. Normal urine output Answer: C Explanation: Spinal shock = bradycardia (loss of sympathetic tone). Tachycardia is incorrect. 89. Which of the following proteins is best to evaluate long term nutritional status? A. Retinol binding protein B. Pre albumin C. Albumin D. Transferrin E. Fibrinogen Answer: C Explanation: Albumin (half-life 20 days) = long-term. Prealbumin (2 days) = short-term. 90. Rodent ulcer (Tear cancer) is: A. Basal cell cancer B. Squamous cell cancer C. Adenocarcinoma D. Rhinophyma E. None of the above Answer: A Explanation: Rodent ulcer = basal cell carcinoma (slow-growing, locally invasive, rarely metastasizes). 96. Which of the following statements is true regarding the use of split- and full-thickness skin grafts? A. A split-thickness skin graft undergoes more primary contraction than full-thickness B. A full-thickness skin graft undergoes less primary contraction than split-thickness C. Secondary contraction is more likely to occur after adequate healing of a full-thickness skin graft than after adequate healing of a split-thickness skin graft D. Full-thickness graft has more survival than split-thickness graft Answer: D Explanation: This answer is controversial. FTSG actually has HIGHER metabolic demand and less survival in contaminated beds. STSG has more primary contraction (immediate recoil) but FTSG has more secondary contraction (late scarring). The given answer is D but may be incorrect.

51. A 3-year-old boy with bleach burn on lower extremities. Most appropriate initial management? A. Treatment with antimicrobial agents B. Neutralize with weak acids C. Lavage with large volumes of water D. Wound debridement in OR E. Treatment with calcium gluconate gel Answer: C Explanation: Chemical burns = immediate copious irrigation with water. NEVER neutralize (exothermic reaction worsens injury). Calcium gluconate = hydrofluoric acid. 106. General effects of burn injury include all the following effects except: A. Decrease metabolic rate B. Impaired immune response C. Impairment of gut barrier function D. None of above Answer: A Explanation: Major burns cause hypermetabolism (increased metabolic rate), not decreased. 153. Deep burns are treated with: A. Split thickness skin graft B. Full thickness skin graft C. Amniotic membrane D. Synthetic skin derivatives Answer: A Explanation: Deep dermal/full thickness burns require excision and split-thickness skin graft (STSG). FTSG is for face/hands. 176. Cause of death in severe burn is: A. Sepsis B. Shock C. Haemorrhage D. Dehydration E. Electrolytes loss Answer: E Explanation: This seems incorrect. Sepsis is the leading cause of death in burn patients today. Original answer says E. Possibly outdated. Modern answer = Sepsis. --- WOUND HEALING & INFECTION 33. Patient has lacerated untidy wound of the leg and attended the casualty after 2 hours. His wound should be: A. Sutured immediately B. Debrided and sutured immediately C. Debrided and sutured secondarily D. Cleaned and dressed Answer: B Explanation: "Golden period" for primary closure = 6-8 hours. Within 2 hours, debridement + primary closure is appropriate. 45. In postoperative Atelectasis all are true EXCEPT: A. Most common pulmonary complications B. Cause by Collapse of the alveoli C. Occurs within the first 48 hours postoperative D. Affects 50% of patients who have abdominal surgery Answer: D Explanation: Atelectasis affects about 25% of abdominal surgery patients, not 50%. 46. With regard to the healing process, which cell types are the first infiltrating cells to enter the wound site, peaking at 24 to 48 hours? A. Macrophages B. Neutrophils C. Fibroblasts D. Lymphocytes E. Monocytes Answer: B Explanation: Neutrophils peak at 24-48 hours. Macrophages peak at 48-96 hours and are the most important cell. 48. Deficiencies of which of the following can affect wound healing? A. Iron, Copper and Zinc B. Zinc, Vitamin E, Vitamin C C. Copper, Magnesium, Vitamin K D. Vitamin A, Vitamin K, Iron E. Vitamin C, Vitamin A, Zinc Answer: E Explanation: Vitamin C (collagen synthesis), Vitamin A (epithelialization, immune), Zinc (cell proliferation). 49. For an adult patient consuming a normal diet, which of the following is the most calorically dense energy source? A. Fat B. Alcohol C. Protein D. Carbohydrate E. Water Answer: A Explanation: Fat = 9 kcal/g. Alcohol = 7 kcal/g. Protein/Carbs = 4 kcal/g. 54. Four days after hemicolectomy, obese 65-year-old on steroids has serosanguineous fluid leakage from incision, abdomen distended, minimal tenderness. Most likely diagnosis? A. Anastomotic leak B. Wound infection C. Necrotizing fasciitis D. Wound dehiscence E. Evisceration Answer: D Explanation: Serosanguineous fluid from wound = dehiscence until proven otherwise. Evisceration = organs visible. 56. Which of the following is/are not associated with increased likelihood of infection after major elective surgery? A. Age over 70 years B. Chronic malnutrition C. Controlled diabetes mellitus D. Long-term steroid use E. Infection at a remote body site Answer: C Explanation: Controlled diabetes (good HbA1c) is NOT a risk factor. Uncontrolled diabetes is. 57. Which of the following is the most likely cause of pyrexia occurring 48 hours after an abdominal operation? A. Wound infection B. DVT C. Atelectasis D. Pulmonary embolism E. Leaking intestinal anastomosis Answer: C Explanation: Day 1-2 = atelectasis. Day 5-7 = wound infection. Day 7-10 = DVT/PE, leak.

146. The most frequent and significant effect of an aneurysm of the ascending aorta is: A. Rupture B. Aortic valvular insufficiency C. Erosion of the sternum D. Pressure on the trachea E. Pressure on the vena cava Answer: B Explanation: Annuloaortic ectasia → aortic regurgitation is most common complication before rupture. 148. The most common site at which arterial emboli lodge is: A. Aortic bifurcation B. Common iliac bifurcation C. Common femoral bifurcation D. Cerebral circulation E. Popliteal artery Answer: C Explanation: Common femoral bifurcation is the most frequent site (saddle embolus is at aortic bifurcation, but femoral is more common overall). 155. Varicose vein surgery is contraindicated in: (Repeat of Q63) Answer: B 161. White leg is due to: A. Femoral vein thrombosis and lymphatic obstruction B. Deep femoral vein thrombosis C. Lymphatic obstruction only D. None of the above Answer: C Explanation: Wait, this conflicts with Q127. In Q127, answer was D (Iliofemoral + lymphatic). Here, answer is C. Possible inconsistency. Phlegmasia alba dolens = iliofemoral DVT + lymphatic obstruction. Phlegmasia cerulea dolens = extensive DVT with venous gangrene. 163. Brodie-Trendlenburg test demonstrates: A. Mid-thigh perforation B. Deep vein thrombosis C. Sapheno-femoral incompetence D. Calf perforators Answer: C Explanation: Brodie-Trendelenburg test = saphenofemoral junction incompetence. Percussion test = calf perforators. 164. Most common source of pulmonary embolus: A. Iliofemoral veins B. Deep veins of leg C. Deep vein of calf D. Popliteal veins Answer: A Explanation: Proximal DVT (iliofemoral) is the major source of clinically significant PE. Calf DVT propagates proximally first. 167. Which of the following is a common cause of secondary lymphedema? A. Genetic mutations B. Breast cancer treatment C. Vitamin deficiency D. High blood pressure Answer: B Explanation: Axillary dissection + radiation = secondary lymphedema. Genetic = primary. 168. Which of the following statements about varicose veins is CORRECT? A. Crossing your legs causes varicose veins B. High heels are a primary cause of varicose veins C. Varicose veins are largely due to genetic factors and can be aggravated by prolonged standing D. Varicose veins can be completely prevented by regular exercise Answer: C Explanation: Genetics + prolonged standing = major risk factors. Myths: crossing legs, high heels are not causes. 177. Lumbar sympathectomy is indicated in: A. Intermittent claudication B. Total arterial occlusion C. Buerger's disease D. Raynaud's disease Answer: C Explanation: Lumbar sympathectomy = Buerger's disease (thromboangiitis obliterans) with vasospasm. Not effective for atherosclerosis. --- BURNS 3. Which of the following statements regarding the zones of injury in a burn wound is true? A. A zone of hyperemia inside a zone of stasis B. A zone of hyperemia superficial to a zone of stasis, with a deeper zone of coagulation beneath C. A zone of coagulation at the surface, zone of stasis within dermis, deep zone of hyperemia with vasodilated subcutaneous vessels D. A zone of coagulation, surrounded by a zone of stasis, surrounded by a zone of hyperemia E. A zone of hemorrhagic burn that must be coagulated, a zone of stasis in which depth is already fixed, and a zone of hyperemia that may convert Answer: D Explanation: Jackson's burn zones: Central coagulation → middle stasis (potentially salvageable) → outer hyperemia (will recover). 7. Regarding burn patient all of the following are true except: A. All patients with first degree burn require admission to the burn unit B. Pain relief is essential C. 40% burn must be admitted to the burn unit D. ATS must be given to all patients E. Third degree burn is painless Answer: A Explanation: First degree burns are managed outpatient. Admission criteria: partial/full thickness >10% TBSA, face/hands/genitalia, inhalation injury, comorbidities.

114. A patient with intermittent claudication in buttocks and thigh with absent pulse of femoral, popliteal, and dorsalis pedis. What other complaint will you find? A. Impotence B. Anorexia C. Headache Answer: A Explanation: Aortoiliac occlusion (Leriche syndrome) = claudication of buttocks/thigh, absent femoral pulses, and impotence. 121. All are sign of Irreversible limb ischemia except: A. Tense calf B. Fixed plantar extension deformity of the foot C. Bulging of the anterior compartment D. Fixed Color changes 'blue staining' Answer: B Explanation: Fixed plantar extension (equinus deformity) = late sign but not specifically "irreversible." Rigor mortis of muscles = irreversible. Fixed staining = irreversible. Anterior compartment bulging = compartment syndrome. 122. Lymphangitis is best treated by: A. Hot bath B. Occlusive dressing C. Antibiotics, immobilization, elevation D. Drainage Answer: C Explanation: Lymphangitis = bacterial infection (usually Strep) → IV antibiotics, rest, elevation. No incision unless abscess. 123. Causes of secondary lymphedema, all except: A. Trauma B. Postoperative C. Infection D. Praecox Answer: D Explanation: Lymphedema praecox = primary (idiopathic, young females). 124. All are boundaries of the femoral ring except: A. Femoral artery B. Iliopectineal ligament C. Inguinal ligament D. Lacunar ligament Answer: A Explanation: Femoral canal boundaries: anterior = inguinal ligament, posterior = pectineal ligament, medial = lacunar ligament, lateral = femoral vein (not artery). 127. Phlegmasia alba dolens or white leg is due to: A. Lymphatic obstruction B. Femoral deep veins thrombosis C. Thrombosis of IVC and lymphatic obstruction D. Iliofemoral veins thrombosis plus lymphatic obstruction Answer: D Explanation: Phlegmasia alba dolens = iliofemoral DVT with reactive lymphatic spasm/obstruction → pale, swollen leg. 134. About DVT all true except: A. Clinically unreliable for diagnosis of DVT Answer: A Explanation: This is TRUE. Clinical diagnosis of DVT is unreliable. This question says "all true EXCEPT" so if A is true, it's not the exception. The wording is tricky. The intended answer is likely something else. But based on common knowledge: Clinical exam is unreliable (true). 135. All regarding acute limb Ischemia except: A. Painless Answer: A Explanation: Acute limb ischemia presents with the 6 P's: Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia. Pain is the earliest and most constant symptom. "Painless" is FALSE. 137. Post-thrombotic varicose vein is due to: A. Incompetent communicating veins B. Destruction of the deep veins C. Destruction of the superficial veins D. Iliofemoral incompetence E. Block of the long saphenous vein Answer: A Explanation: Post-thrombotic syndrome = deep veins recanalize but valves destroyed → pressure transmitted to superficial veins via incompetent perforators. 143. The most frequent site for atherosclerotic aneurysm in the periphery is the: A. Carotid B. Subclavian C. Femoral D. Popliteal E. Ulnar Answer: D Explanation: Popliteal artery is the most common peripheral aneurysm. Femoral is second. 144. Which of the following statements regarding lymphoedema is true: A. Primary lymphoedema occurs in more than 5 per cent of the population B. Early treatment is usually successful C. Early treatment includes surgical drainage D. Fluid is relatively low in protein in lymphoedema E. Lymphoedema often involves the muscle compartments Answer: B Explanation: Early treatment (compression, elevation, hygiene) is effective. Lymphedema fluid is high in protein. Primary is rare (<1%). Muscle compartments are spared. 145. Aneurysms of the ascending aorta may be due to all of the following Except: A. Marfan's syndrome B. Trauma C. Syphilis D. Atherosclerosis Answer: D Explanation: Ascending aortic aneurysms: cystic medial necrosis (Marfan), aortitis (syphilis), trauma. Atherosclerosis = descending/abdominal aorta.

84. True about thyroglossal cyst EXCEPT: A. Does not move with deglutition B. Moves with protrusion of the tongue C. Sistrunk's operation is the treatment of choice D. Most common site is subhyoid region Answer: A Explanation: Thyroglossal cyst moves with swallowing AND tongue protrusion. 87. Lateral aberrant thyroid is: A. Abnormally descended thyroid tissue in lateral neck B. Associated with thyroglossal duct cyst C. Cervical lymph node metastasis from papillary cancer D. Enlargement due to Hashimoto's disease Answer: C Explanation: "Lateral aberrant thyroid" = metastatic papillary carcinoma in cervical lymph node, not ectopic thyroid tissue. 93. 29-year-old woman, painless neck lump moves with swallowing. FNA shows nuclear grooves and Psamomma bodies. Diagnosis? A. Follicular adenoma B. Follicular carcinoma C. Papillary carcinoma D. Medullary carcinoma E. Anaplastic carcinoma Answer: C Explanation: Nuclear grooves + psammoma bodies = papillary thyroid carcinoma. 101. The symptoms of hyperparathyroidism include: A. Constipation and muscle weakness B. Anorexia and weight loss C. Polydipsia and polyuria D. All of the above Answer: D Explanation: "Bones, stones, groans, psychic moans, fatigue overtones." All are correct. 120. The most common type of thyroid cancer is: A. Follicular thyroid cancer B. Anaplastic thyroid cancer C. Papillary thyroid cancer D. Medullary thyroid cancer Answer: C Explanation: Papillary = 80% of all thyroid cancers. 128. What test most reliably differentiates benign thyroid tumors from malignant? A. FNA B. Ultrasound C. Thyroid hormone suppression Answer: A Explanation: FNA is the gold standard for thyroid nodule evaluation. 129. The recurrent laryngeal nerve is in close relation with: A. Middle thyroid vein B. Superior thyroid artery C. Superior thyroid vein D. Inferior thyroid vein E. Inferior thyroid artery Answer: E Explanation: RLN passes posterior to or between branches of inferior thyroid artery. Ligate inferior thyroid artery laterally to protect nerve. 130. The initial test in hypothyroidism is: A. TSH Answer: A Explanation: TSH is the screening test for thyroid dysfunction. 139. The MOST frequent variety of thyroid cancer is: (Repeat of Q120) Answer: B Explanation: Papillary carcinoma. 179. Characteristic feature of primary hypoparathyroidism is: A. Diffuse osteoporosis B. Swelling in lamina dura C. Subperiosteal resorption of carpals D. Salt and pepper appearance of skull Answer: D Explanation: Salt and pepper skull = hyperparathyroidism (not hypo). Wait, careful: Q says "hypoparathyroidism" but answer D is for hyperparathyroidism. Possible typo. Primary HYPERparathyroidism = salt and pepper skull, subperiosteal resorption. Primary HYPOparathyroidism = basal ganglia calcification. --- VASCULAR SURGERY 2. Lipoma that frequently turns out to be Malignant is: A. Subfascial B. Subperiosteal C. Retroperitoneal D. Intracranial Answer: C Explanation: Retroperitoneal lipomas can be large, recur, and undergo malignant transformation to liposarcoma. 12. The most common cause of ischemia of limb: A. Atrial fibrillation is the commonest cause 30% B. Atrial fibrillation is the commonest cause 50% C. Mural thrombus Cardiac causes 70% D. Non cardiogenic causes 20% Answer: B Explanation: Atrial fibrillation is the most common source of arterial embolism (≈50%). 18. The most common cause of ischemia of limb: (Repeat of Q12) Answer: B 17. DVT except: A. Associated with superficial thrombophlebitis Answer: A Explanation: Superficial thrombophlebitis is NOT associated with DVT unless it is migratory or in a specific pattern. The statement likely means "all are true EXCEPT" and A is false. 63. Varicose vein surgery is contraindicated in: A. Varicose ulcers B. Deep vein thrombosis C. Pigmentation over limb D. Hemorrhoids Answer: B Explanation: Surgery for varicose veins is contraindicated in acute DVT or if deep system is occluded (varicose veins are compensatory).

69. A patient has 6-cm breast tumour with clinically positive mobile ipsilateral axillary lymph nodes with no distant metastasis. Stage? A. Stage 1 B. Stage IIb C. Stage IIIa D. Stage IIIb Answer: C Explanation: T3 ( >5cm) N1 (mobile axillary) M0 = Stage IIIA. 71. A blood stained discharge from nipple indicate: A. Breast abscess B. Fibroadenoma C. Ductal papilloma D. None of above Answer: C Explanation: Bloody nipple discharge = intraductal papilloma until proven otherwise. 138. The MOST frequent histologic type of breast carcinoma is: A. Infiltrating papillary carcinoma B. Infiltrating ductal carcinoma C. Infiltrating lobular carcinoma D. Colloid carcinoma E. Medullary carcinoma Answer: B Explanation: Infiltrating ductal carcinoma = 70-80% of all breast cancers. 140. The risk of bilateral cancer is HIGHEST if the first breast shows: A. Inflammatory carcinoma B. Lobular carcinoma C. Medullary carcinoma D. Infiltrating ductal carcinoma E. Paget's disease Answer: B Explanation: Lobular carcinoma = highest rate of bilaterality. 159. A 45-year-old women presents with a hard and mobile lump in the breast. Next investigation is: A. FNAC B. USG C. Mammography D. Excision biopsy Answer: C Explanation: Imaging (mammography ± ultrasound) is first step. Biopsy is diagnostic but not first. 160. Which of the following is spared in modified radical mastectomy? A. Pectoralis major B. Pectoralis minor C. Axillary lymph nodes D. Nipple Answer: A Explanation: Modified radical mastectomy preserves pectoralis major. Pectoralis minor may be removed or preserved. Nipple is removed. --- THYROID & PARATHYROID 4. All of the following are considered an increased risk factor for cancer in a patient with a thyroid mass except: A. Age younger than 25 or older than 60 B. Rapid growth C. Family history D. Hot nodule on thyroid uptake scan E. Male gender Answer: D Explanation: Hot nodule = functioning, almost always benign. Cold nodule = risk of malignancy. 8. A 54-year-old woman with very high PTH, Ca 14.5, mild renal failure, and jaw tumor syndrome. Most likely diagnosis? A. Parathyromatosis B. Missed adenoma C. Parathyroid carcinoma D. Secondary hyperparathyroidism E. Tertiary hyperparathyroidism Answer: D Explanation: Jaw tumor syndrome is familial. She has renal failure → secondary hyperparathyroidism. (Note: Many sources say Tertiary, but with renal failure + high Ca, it's Tertiary; original answer key says D.) 11. A man who underwent total thyroidectomy 24 hours ago now complains of tingling and muscle cramps. Appropriate treatment? A. Intravenous infusion of calcium gluconate B. Administration of oxygen by mask C. Administration of an anticonvulsant D. Administration of a tranquilizer E. Neurologic consultation Answer: A Explanation: Post-thyroidectomy hypocalcemia = IV calcium gluconate for symptomatic patients. 55. All of the following are considered an increased risk factor for cancer in a patient with a thyroid mass EXCEPT: (Repeat of Q4) Answer: D Explanation: Hot nodule = benign. 59. About thyroglossal duct cyst all of the following is true EXCEPT: A. It is the most common head and neck congenital anomaly B. No any medical treatment is adequate C. The most common complication is infection D. Can harbor malignancy with the medullary thyroid cancer being the most frequent one E. Recurrence after excision is about 10% Answer: D Explanation: Malignancy in TGDC is usually papillary carcinoma, NOT medullary. 72. Hypoparathyroidism after thyroid surgery commonly occur within: A. 24hr B. 2-5 days C. 7-10 days D. 2-3 months Answer: B Explanation: Post-op hypocalcemia peaks at 24-72 hours. Transient is common; permanent is rare. 81. A complication of thyroidectomy which can be prevented by prophylaxis is: A. Injury to recurrent laryngeal nerve B. Hypocalcemia C. Thyroid Storm D. None of above Answer: C Explanation: Thyroid storm is prevented by preoperative antithyroid drugs and beta-blockers. Nerve injury and hypocalcemia are not reliably preventable.