SURGERY FINAL PDF 6TH SEM 3RD YR 2K22

1-120 - DR ALI SIR

121-253 - ANKIT AKELA & MANISH KUMAR SINGH

1. The tensile strength of a wound after in jury can reaches upto 80% till which week
a. 8th week
b. 10th week
c. 12th week
d. 14th week
e. 16th week
2. A patient arrives to OPD with a history of hit on his leg 4 hours ago. On examination there was a pain
on stretching and distal pulses are palpable. What is your diagnosis
a.DVT
b.Buerger disease
c.Necrotising fasciitis
d.Compartment syndrome
e. None

3. True about wound healing:

a. Infected wound heal by primary intention
b. No Deep dermal wound heal by scar formation
c. Wound contraction is found in healing by secondary intention
d. More intense inflammatory response in primary intention
e. Infected wound easy to treat

4. True about chronic wound:

a. Not Found in DM
b. Always require surgical treatment
c. May not be associated with vascular compromise
d. Monofilament sutures prevent infection
e. Any wound that does heal within 3 month

5. Cell not involved in healing of clean wound:

a. Macrophages
b. Platelet
c. Fibroblasts
d. Polymorphonuclear leukocytes
e. Proteins

6. Management of an open wound seen 12 hours after the injury:

a. Suturing
b. Debridement and suture
c. Secondary suturing
d. Heal by granulation
e. None

7. The vitamin which has inhibitory effect on wound healing is:

a. Vitamin A
b. Vitamin E
c. Vitamin C
d. Vitamin B-complex
e. Vitamin D
8. The tensile strength of the wound starts and increases after:
a. Immediate suture of the wound
b. 3–4 days
c. 7–10 days
d. 6 months
e. 1 year

9. In a sutured surgical wound, the process of epithelialization is completed within:

a. 24 hours
b. 48 hours
c. 72 hours
d. 96 hours
e. 1 week

10. Factors that may adversely affect the healing of wounds include all the following except:
a. Exposure to UV light
b. Exposure to radiation
c. Obstructive jaundice
d. Advanced neoplasia

11. Primary closure of incised wounds must be done within:

a. 2 hours
b. 4 hours
c. 6 hours
d. 12 hours
e. 16 hours

12. The tensile strength of wound reaches that of normal tissue by:
a. 6 weeks
b. 2 months
c. 4 months
d. 4 weeks
e. None

13. Following are required for wound healing except:

a. Zinc
b. Copper
c. Vitamin C
d. Anticoagulant
d.None

14. 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
e. Dressed

15. When is the maximum collagen content of wound tissue?

a. Between 3rd to 5th day
b. Between 6th to 17th day
c. Between 17th to 21st day
d. Between 1st and 2nd month
d. None of the above

16. A patient with grossly contaminated wound presents 12 hours after an accident, his wound should be
managed by:
a. Thorough cleaning and primary repair
b. Thorough cleaning with debridement of all dead and devitalized tissue without primary closure
c. Primary closure over a drain
d. Covering the defect with split skin graft after cleaning
e. None

17. Delayed wound healing is seen in all except:

a. Malignancy
b. Hypertension
c. Diabetes
d. Infection
e. Elderly patient

18. In the healing of clean wound the maximum immediate strength of the wound is reached by:
a. 2–3 days
b. 4–7 days
c. 10–12 days
d. 13–18 days
e. 22-27 days

19. A clean incised wound heals by:

a. Primary intention
b. Secondary intention
c. Tertiary intention
d. Excessive scaring
e. None of the above

20. Which one of the following surgical procedures is considered to a have a clean-contaminated wound?
a. Elective open cholecystectomy for cholelithiasis
b. Herniorrhaphy with mesh repair
c. Lumpectomy with axillary node dissection
d. Appendectomy with walled off abscess
e. None

21. Fibroblasts in healing wound are derived from:

a. Local mesenchyme
b. Epithelium
c. Endothelium
d. Vascular fibrosis
e. None

22. Tensile strength of wound becomes normal after:

a. 6 weeks
b. Never
c. 4 months
d. 6 months
e. 1 year

23. True statement(s) regarding hypertrophic scar:

a. Grow beyond wound margin
b. More common in female
c. Not familial
d. Rarely subsides
e. None of them

24. All are true about keloid except:

a. Grows beyond would margin
b. Excess collagen deposition
c. More common in female
d. Whites are at high risk
e. None

25. Most common site of hypertrophic keloid is:

a. Face
b. Leg
c. Presternal area
d. Arm
e. Genitals

26. First line treatment for keloid is:

a. Intralesional injection of keloid
b. Local steroid
c. Radiotherapy
d. Wide excision
e. None

27. Drug used for intralesional injection keloid is:

a. Prednisolone
b. Triamcinolone
c. Androgen
d. Hydrocortisone
e. Ampicillin

28. Keloid scar is made up:

a. Dense collagen
b. Loose fibrous tissue
c. Granulamatous tissue
d. Loose areolar tissue
e. None

29. What is true about keloids?

a. It appears immediately after surgery
b. It appears a few days after surgery
c. It is limited in its distribution
d. It is common in old people
e. None

30. Keloid is best treated:

a. Intralesional injection of trimacinolone
b. Wide excision and grafting
c. Wide excision and suturing
d. Deep X-ray therapy
e. All of them

31. The following statement about keloid is true:

a. They do not extend into normal skin
b. Local recurrence is common after excision
c. They often undergo malignant change
d. They are more common in whites than in blacks
e. All of them

32. The worst position for scars is:

a. Back
b. Shoulder
c. Sternum
d. Abdomen
e. Leg

33. Keloid formation is not seen over:

a. Ear
b. Face
c. Eyelids
d. Neck
e. All of them

34. The best scars are seen in:

a. Infants
b. Children
c. Adults
d. Very old people
e. Girls

35. If suture marks are to be avoided, skin sutures should be removed by:
a. 72 hours
b. 1 week
c. 2 weeks
d. 3 weeks
e. 1 month

36. Degloving injury is:

a. Surgeon made wound
b. Lacerated wound
c. Blunt injury
d. Avulsion injury
e. Abrasive wound

37. In treatment of hand injuries, the greatest priority is:

a. Repair of tendons
b. Restoration of skin cover
c. Repair of nerves
d. Repair of blood vessels
e. None of them

38. During the surgical procedure:

a. Tendons should be repaired before nerves
b. Nerves should be repaired before tendons
c. Tendons should not be repaired at the same time
d. None is true
e. Nerves should not be repaired at the same time

39. ‘Lims salvage’ primarily depends on:

a. Vascular injury
b. Skin cover
c. Bone injury
d. Nerve injury
e. All of them

40. Most appropriate management of recurrent keloid scar?

a.excisional surgery
b.intramarginal excision followed by radiation
c.cryosurgery
d.silicone gel sheating
e.none is true
41. Criteria for viability of muscle are all except:
a. Colour
b. Intact fascia
c. Contractibility
d. Bleeding on cutting
e. None is true

42.During proliferative phase of wound healing the fibroblast requires which vitamin to produce collagen.
a.Vit.A
b. Vit.B
c. Vit.C
d.Vit D.
e. Vit A and B
43.The maturation of collagen fibers is achieved when type 1 replace type 3 until a ratio of

a. 2.1
b. 3.1
c. 4.1
d. 6.1
e. 7.1

44.which organ has highest chances of graft rejection response

a.cornea
b. gut
c.liver
d. skin
e. lung
45. If a person falls from a height and lands on
feet, the pattern of fracture will be all except:
A. Calcaneus fracture bilaterally
B. Pilon fracture at ankle
C. Vertebral crush fracture
D. Fracture of femur
E. All of them

46. In green stick fracture:

A. Bone strength is abnormal
B. Load is abnormal
C. Both are abnormal
D. None is abnormal
E. Its common to elderly people

47. Butterfly fracture is due to:

A. Direct trauma
B. Indirect trauma
C. Twisting force
D. Repeated stress
E. Radiational trauma

48. Spiral fracture is due to:

A. Blunt trauma
B. Axial compression
C. Twist
D. Direct impact
E. Repeated stress

49. Most common type of epiphyseal fracture in

Salter Harris classification is:
A. Type 1
B. Type 2
C. Type 3
D. Type 4
E. Type 5
50. Epiphyseal injuries causing growth disturbances in children are due to:
A. Avascular necrosis of the plate
B. Crushing or infection of the plate
C. Hypermia of the plate
D. Formation of a callus bridge between bony
epiphysis and metaphysis
E. All of the above

51. Which form of growth plate injury requires

open reduction and internal fixation:
A. Separation of epiphysis from metaphysis but
without fracture
B. Severe ‘end on’ crush
C. Intra-articular fracture, the line passing
through plate and part of metaphysis
D. All of the above
E. None of above

52. Type of epiphyseal fracture most difficult to

diagnose is:
A. Type 2
B. Type 3
C. Type 5
D. Type 1
E. All of the above

53. 32 B3.2 in AO classification refers to fracture:

A. Simple proximal fracture femur
B. Simple distal fracture femur
C. Distal comminuted fracture femur
D. Distal comminuted fracture tibia
E. None of above

54. All are true of closed reduction except:

A. Relies on soft tissue attachments to reduce
the fragments
B. Rarely adequate for intra-articular fractures
C. Difficult to perform in children
D. Damage to blood vessel is likely
E. Distal comminuted fracture femur

55. In fracture open reduction is needed in

presence of:
A. Failed closed reduction
B. Intra-articular fracture in children
C. Displaced intra-articular fracture
D. Unstable fracture
E. Each of the above
56. Normal callus formation is prevented by:
A. Rigid fixation
B. Non-rigid fixation
C. Both of the above
D. None of the above
E. Thread at the tip

57. Ideally to hold two fragments by screw

fixation, the screw should have:
A. Thread at the tip
B. Thread throughout
C. Thread only proximally
D. None of the above

58. The function of plate fixation is to:

A. Neutralise
B. Butress
C. Compress
D. All of the above

59. Buttress plates are best for:

A. Oblique fracture
B. Green stick fracture
C. Transverse fracture
D. Comminuted fracture
E. All of above

60. Figure of eight wire construction is commonly done in fracture:

A. Clavicle
B. Medical femoral condyle
C. Patella
D. Talus
E. All of above

61. Fracture reduction, internal fixation achieves:

A. Accurate reduction
B. Stable fixation
C. Strong fixation
D. All of the above

62. Disadvantages of internal fixation include:

A. Demand strong aseptic technique
B. The alloy can be allergenic, toxic and
carcinogenic
C. Local osteoporosis
D. Each of the above

63. Advantage of intramedullary nails are:

A. Early mobilisation
B. Locking screws give better stability
C. Periosteal blood supply is preserved
D. All of the above

64. Removal of internal fixation is due to risk of:

A. Osteoporosis
B. Allergy by transitional metals
C. Stress raiser causing further fracture
D. All of the above

65. Advantages of external fixation include:

A. Rigid fixation
B. Adjustable
C. Allows good wound toilet
D. All of the above

66. Indications for external fixator include all

except:
A. Compound fracture tibia
B. Pelvic fracture
C. Fracture surgical neck of humerus
D. Presence of bone loss in limb fractures
E. None is true

67. The basic philosophy of fracture is:

A. Rest
B. Immobilisation
C. Stabilisation
D. None of the above
E. All of the above

68. Compartment syndrome is common in:

A. Upper arm
B. Fore arm
C. Thigh
D. Foot
E. Pelvic

69. Compartment syndrome be suspected best in

presence of:
A. Absent pulse
B. Numb fingers
C. Pain on extension of finger
D. Any of the above
E. None of the above

70. Sings and symptoms of vascular impairment

in a limb include:
A. Pain B. Paresthesia
C. Pallor D. Paralysis
E. All of the above
71. In compartment syndrome which of the
following is only a false sign of vascular
security:
A. Rest pain
B. Muscle tenderness
C. Normal distal pulse
D. Pain on passive stretching
E. All of the above

72.Trauma to spleen in a stable patient is best diagnosed

by:
a. X-ray abdomen
b. USG
c. CTscan
d. Diagnostic peritoneal lavage
e. Puncture

73. Investigation of choice for diagnosing intra-abdominal bleeding in an unstable patient:

a. CT scan
b. MRI scan
c. USG
d. diagnostic peritoneal lavage
e. puncture

74. A man sustained injury and presented with fluid coming out through nose. What could be the possible
fracture?
a. Fracture base of skull
b. Fracture of mandible
c. Fracture of maxilla
d. None of the above
e. Fracture of vertebra

75. What is not found in head injury?

a. Confusion
b. Loss of consciousness
c. Lucid interval
d. GCS score of 0
e. All of above

76. Minimum score in glasgow coma scale:

a. 0
b. 1
c. 2
d. 3
e. 4

77. True statement regarding fracture base of the

skull are all of the following, except:
a. Prophylactic antibiotics are usually not required
b. Associated with 8 cranial nerve palsy
c. Early surgery is indicated for optimal outcome
d. May present with CSF otorrhea
e. All of the above is correct

78. Emergency management for tension pneumothorax is:

a. Thoracotomy
b. Insertion of a chest tube
c. Needle decompression
d. Tracheostomy
e. CPR

79. Management of flail chest with respiratory failure is:

a. Chest tube drainage
b. Oxygen administration
c. IPPV
d. Internal operative fixation of the fractures segments
e. All of the above

80. True about flail chest are all, except:

a. Ultimately leads to respiratory failure
b. Paradoxical respiration
c. Fracture of 3–4 ribs at 2 or more places
d. Mediastinal shift
e. a and b are correct

81. Condition which builds within hemithorax

resulting in collapsed lung, flattened diaphragm,
contralateral mediastinal shift and compromised
venous return to right side of heart is known as:

a. Open pneumothorax
b. Flail chest
c. Massive pulmonary hemorrhage
d. Tension pneumothorax
e. Mediastinal shift

82. IPPV is useful in:

a. Hemopneumothorax
b. Pneumothorax
c. Flail chest
d. Hemothorax
e. Mediastinal shift

83. Glasgow coma scale in death is:

a. 0
b. 1
c. 2
d. 3
e. 4

84. In an adult patient with pleural effusion, the most appropriate site for pleurocentesis done by inserting a
needle is in:
a. 5th intercostal space in midclavicular line
b. 7th intercostal space in midaxillary line
c. 2nd intercostal space adjacent to the sternum
d. 10th intercostal space adjacent to the vertebral
column
e. 7th intercostal space in midclavicular line

85. A 24-year-old man falls on the ground when he is struck in the right temple by a baseball. While being
driven to the hospital, he lapses into coma. He is unresponsive with the dilated right pupil when he reaches
the emergency department. The most important step in initial management is:
a. Craniotomy
b. CT scan of the head
c. X-ray of the skull and cervical spine
d. Doppler ultrasound examination of the neck
e. Antibiotic therapy

86. According to the glassgow coma scale a verbal

score of 1 indicates:
a. No response
b. In appropriate words
c. Incomprehensive sounds
d. Disoriented response
e. All of them

87. The most common site of leak in CSF rhinorrhea is:

a. Spenoidal sinus
b. Frontal sinus
c. Cribriform plate
d. Tegmen tympani
e. Occipital region

88. The earliest manifestation of increased intracranial pressure in head injury is:
a. Ipsilateral pupillary dilatation
b. Contralateral pupillary dilatation
c. Altered mental status
d. Hemiparesis
e. None of above

89. The dangerous complication of flail chest:

a. Pneumothorax
b. Hemothorax
c. Respiratory failure
d. all the above

90. Lucid interval is associated with:

a. Intracerebral hematoma
b. Extradural hematoma
c. Subarachnoid hemorrhage
d. All the above
e. None of above

91. Positive pressure ventilation is useful for:

a. Pneumothorax
b. Flail chest
c. Hemothorax
d. Hemopneumothorax
e. Intra-abdominal organ injury

92. Shock in trauma is most likely due to:

a. Head injury
b. Intra-abdominal organ injury
c. Rib fracture
d. Fracture tibia
e. Extradural hematoma

93. Source of chronic subdural hematoma is:

a. Arterial
b. Tear of bridging veins
c. Capillaries
d. None of the above
e. All of above
94. Extradural hemorrhage commonly occurs from tearing of:
a. Maxillary artery
b. Middle meningeal artery
c. Bridging veins
d. All of the above
e. Carotid artery

95. What is the site for putting needle in chest in a

patient with tension pneumothorax:
a. 2nd intercostal space, midclavicular line
b. 7th intercostal space, midaxillary line
c. 5th intercostal space, midclavicular line
d. 5th intercostal space, just lateral to vertebral
column
e. 2nd intercostal space, scapula line

96. Which of the following is the cause of sudden and unexpected onset of dyspnea at rest:
a. Severe anemia
b. Spontaneous pneumothorax
c. COPD
d. Large pleural effusion
e. All of the above

97. Glasgow coma scale (GCS) in case of mild head injury:

a. 15 with no loss of consciousness
b. 14-15 with loss of consciousness
c. 9–13
d. 3–8
e. 0-3

98. First aid to control external hemorrhage is:

a. Endoscopic control
b. Apply pressure
c. Drugs
d. Operation
e. Wash the wound

99. Seat belt injury causes damage to:

a. Head injury due to wind screen
b. Thorax injury
c. Duodenum
d. All the above
e. Leg

100. The hormone that is not released in trauma

a. Thyroxine
b. Glucagon
c. ADH
d. GH
e. None

101. Regarding compartmental syndrome of lower

limb all are true, except: (Sep 2010)
a. m/c occurs in closed lower limb injuries
b. Early sign is absent distal pulse
c. Fasciotomy done in longitudinal direction of
limb
d. Two incisions are used on either side of subcutaneous
border of tibia.

102. Regarding compartment syndrome in lower limb: the fasciotomy is done when pressure is above
____mm Hg
a. 10 mm Hg
b. 20 mm Hg
c. 30 mm Hg
d. 40 mm Hg
e. 50 mm Hg

103. Calculate the Glasgow coma scale of a patient with eye opening on pain, conscious but confused
cannot tell time and exhibits flexion on painful stimuli?
a.8
 b.9
c.10
d.11
e.13

104. A patient with multiple rib fracture presents to surgery department.He is conscious and speaking
single words. On examination RR-40 and BP -90/40 mm of Hg . What is the next immediate step,
a.urgent Iv fluids
b.intubate the patient
c.chest x-ray
d.Insert needle in 2nd IC space
e.None of the above
105. According to “rule of nines”, burns involving perineum are:
a. 1%
b. 9%
c. 18%
d. 27%
e. 30%

106. A five years old child presents to the emergency department with burns. The burn area
corresponding to the size of his
palm is equal to:
a. 1% BSA
b. 5% BSA
c. 10% BSA
d. 20%
e. 30%

107. Head and neck involvement in burns in infant is:

a. 9%
b. 18%
c. 27%
d. 32%
e. 34%

108. An adult whose both lower limbs are charred along with genitalia has……..burns.
a. 18%
b. 19%
c. 36%
d. 37%
e. 45%

109. In a 6 years old child with burns involving the whole of head and trunk, estimated body surface area
of burns is:
a. 44%
b. 52%
c. 55%
d. 58%
e. 65%
110. Rule of nine of estimate surface area of a burnt patient was introduced by:
a. Mortix Kaposi
b. Alexander Wallace
c. Joseph Lister
d. Thomas Barclay
e. Hippocrates

111. Best method to assess burns in 5 years old child caused by boiling water:
a. Palm method
b. Rule of 9
c. Lund and Browder chart
d. Rule of one
e. Cross matching

112. A child has circumferential burn of both of thighs and buttocks, face and scalp with singeing of
hairs. Calculate the
percentage of burns:
a. 24
b. 27
c. 37
d. 45
e. 50

113. Head and face burn in infant is:

a. 15%
b. 18%
c. 12%
d. 32%
e. 34%

114. Percentage of burn in children is best assessed by?

a. Rule of 9
b. Rule of palm = 1%
c. Lund and Browder chart
d. Wallace rule
e. Hippocrates rule

115. A burn patient is referred when:

a. 10% superficial burn in child
b. Scald in face
c. 25% superficial burn in adult
d. 25% deep burn in adult
e. Burn in palm

116. In burns heat loss is by/due to:

a. Dilatation of veins
b. Shock
c. Exposed area by evaporation
d. None of the above
e. All of the above
117. Metabolic derangements in severe burns are all except:
a. ↑corticosteroid secretion
b. Hyperglycemia
c. ↑secretion of HCl
d. Neutrophil dysfunction

118. Pus in burns form in:

a. 2-3 days
b. 3-5 days
c. 2-3 weeks
d. 4 weeks
e. 1 month

119. Fever in burnt patient is caused by:

a. Septicemia
b. Decreased sweating
c. Release of pyrogens from dead product
d. Dehydration
e. Pain

120. Undue restlessness in a patient during the immediate post

burn period is often a manifestation of: (Karnataka 95)
a. Hypoxia
b. Hypovolemia
c. Hyperkalemia
d. Anxiety
e. Oliguria

121. All require hospitalization, except:

a. 5% burns in children
b. 10% scalds in children
c. Electrocution
d. 15% deep burns in adults
e. Chemical burns of face

122. True about burns:

a. Hyperglycemia is seen in early burns
b. Child with burns should have damp dressing
c. Chemical powder burns should be kept dry
d. 3rd degree burns are painful
e. 1st degree burns is characterized by formation of blisters

123. In a patient with the burn wound extending into the superficial epidermis without involving the
dermis would present all of the following, except:
a. Healing of the wound spontaneously without scar formation
b. Anesthesia at the site of burn
c. No Blister formation
d. Painful
e. Hyperemia
124. A third degree circumferential burn in the arm and forearm region, which of the following is most
important for monitoring?
a. Blood gases
b. Carboxy-oxygen level
c. Macroglobinuria cryoglobinuria
d. Peripheral pulse and circulation
e. None of the above

125. In 3rd degree burns, all are seen except:

a. Vesicles are absent
b. Painful
c. Leathery skin
d. Reddish due to Hb infiltration
e. Painless

126. Degree of burns in a patient with prominent vessels with

decreased needle prick sensation and dryness:
a. Superficial partial thickness burns
b. Deep partial thickness burns
c. Electric burns
d. Full thickness burns
e. None of the above

127. Burn involving epidermis and full thickness of dermis:

a. First degree burns
b. Partial-thickness second degree burns
c. Full-thickness second degree burns
d. Third degree burns
e. 4th degree

128. True about burn is:

a. Full thickness burn feels, leathery, painless
b. Electric burn are superficial
c. IV fluid formula used Curreri and Brooke
d. Skin grafting done after 48 hours
e. Electrical burn you can treat at home

129. Which of the following is not seen in 3rd degree burns?

a. Loss of skin appendages
b. No vesicles
c. Red color
d. Extremely painful
e. All of the above

130. In second degree burns, re-epithelialisation occurs around:

a. 1 week
b. 2 weeks
c. 3 weeks
d. 4 weeks
e. 5 weeks

131. Which of the following is false regarding deep 2nd degree burns?
a. Heal by scar deposition
b. Painless
c. Damage to deeper dermis
d. Less blanching
e. Formation of blisters

132. Superficial burns; true is/

a. Always requires skin grafting
b. Dry and inelastic
c. Blister formation
d. Painless
e. All of the above

133. Not a feature of deep burn is:

a. Black charred skin
b. White leathery skin
c. Loss of pain sensation
d. Blisters
e. No formation of scar

134. Burns with vesiculation, destruction of the epidermis and upper dermis is:
a. 1st degree
b. 2nd degree
c. 3rd degree
d. 4th degree
e. 5th degree

135. Blisters are seen in which type of burns?

a. Superficial first degree
b. Superficial second degree
c. Third degree
d. Deep first degree
e. 4th degree

136. All may be seen in deep burns except:

a. Hyperthermia
b. Increase vascular permeability
c. Fluid loss by evaporation
d. Vasodilation
e. Formation of scar

137. 2nd degree burns indicate involvement of:

a. Epidermis
b. Dermis
c. Subcutaneous tissue
d. Deep fascia
e. Bone
138. Parkland formula is:
a. Percentage of burns × weight (kg) × 4 = volume in ml
b. Percentage of burns × weight (kg)/2 = 1 volume in ml
c. Percentage of burns × weight (kg) × 9 = volume in ml
d. 500 ml/m2 BSA + 1500 ml/m2 = volume in ml
e. Percentage of burns × weight (kg) × 11 = volume in ml

139. IV formula for burn is:

a. Total % body surface area x weight x 4 = volume in ml
b. Total % body surface area x weight x 5 = volume in ml
c. Total % body surface area x weight x 6 = volume in ml
d. Total % body surface area x weight x 7 = volume in ml
e. Total % body surface area x weight x 8 = volume in ml

140. Which of the following formula for fluid administration in a patient with burns is not correct?
a. Parkland: 4 ml Kg/%TBSA burn of RL
b. Brooks: 1.5 ml Kg/%TBSA burn of RL + 0.5ml kg % burn+2000 ml D5W
c. Shrine: 5000 ml m2 TBSA burn + 2000 ml m2 TBSA
d. Evans: 8ml Kg/% TBSA burn of RL
e. Parkland: 10 ml Kg/%TBSA burn of RL

141. The ideal temperature of water to cool the burnt surface is:
a. 15°C
b. 10°C
c. 8°C
d. 6°C
e. 4°C

142. What should be the ideal temperature of the cool water to be applied over burns?
a. Ice cold
b. 3-4ºC
c. 8-10ºC
d. 14-15ºC
e. 17-20 ºC

143. Safest strategy of treatment for a patient of inhalational burn injury who has presented within 4-5
hours:
a. Binasal catheter O2 inhalation
b. O2 therapy with well-fitting face mask
c. Elective cricothyroidotomy
d. Elective endotracheal intubation
e. None of the above

144. In burns management, which of the following is the fluid of choice?

a. Dextrose 5%
b. Normal saline
c. Ringer lactate
d. Isolyte-M
e. Tea

145. All of the following are true regarding fluid resuscitation in burn patients except:
a. Consider intravenous resuscitation in children with burns greater than 15% TBSA
b. Oral fluids must contain salts
c. Most preferred fluid is Ringer’s lactate
d. Half of the calculated volume of fluid should be given in first 8 hours

146. What is the most important aspect of management of burn injury in the first 24 hours?
a. Fluid resuscitation
b. Dressing
c. Escharotomy
d. Antibiotics
e. Washing

147. In excessive burns, least useful is:

a. Blood
b. Dextran
c. Ringer lactate
d. Nasogastric intubation
e. NaCl 0,9%

148. True statement about burn resuscitation:

a. Colloid preferred in initial 24 hours
b. Colloid preferred if burnt area is >15% of total BSA
c. Half of the calculated fluid given in initial 8 hours
d. Diuretics should be given to all patients of electric burn
e. Half of the calculated fluid given in initial 18 hours

149. Which of the following is true about burns?

a. 3rd generation cephalosporin is drug of choice
b. S. aureus is most common infection of burn
c. Toxic shock syndrome is most common in burns patients
d. Pseudomonas is most common infection in dry wound
e. 1st degree of burns should be treated at hospital

150. Which of the following is true about burn management?

a. Intravenous access fluid is done and antibiotics is not given in children
b. Escharotomy should be done for peripheral circumscribed lesion
c. Moist dressing is done
d. Parkland formula is used with 8ml/kg body weight
e. Escharotomy should not be done

151. Exposure treatment is done for burns of the:

a. Upper limb b. Lower limbs
c. Thorax d. Abdomen
e. Head and neck

152. Deep skin burn is treated with:

a. Split thickness graft
b. Full thickness graft
c. Amniotic membrane
d. Synthetic skin derivatives
e. Antibiotics

153. The cold water treatment of burns has the disadvantage that it increase the chances of:
a. Pain
b. Exudation
c. Infection
d. None of the above
e. Shock

154. The best guide to adequate tissue perfusion in the fluid management of a patient with burns, is to
ensure a minimum hourly urine output of:
a. 10-30 ml
b. 30-50 ml
c. 50-70 ml
d. 70-100 ml
e. 100-200ml

155. Burns in which part of body are nursed without occlusive dressing?
a. Hands
b. Legs
c. Head and Neck
d. Chest
e. Abdomen

156. Which of the following is effected against Pseudomonas and is used in burns patients?
a. Silver sulphadiazine
b. Silver sulphazine
c. Sulphamethoxazole
d. Sulphadoxine
e. Hydrogen peroxide

157. In children with burns, maintenance IV fluid normally given is ?

a. Ringer lactate
b. 5% dextrose
c. Normal saline
d. Dextrose saline
e. Silver sulphadiazine

158. Late deaths in burns is due to:

a. Sepsis
b. Hypovolemia
c. Contractures
d. Neurogenic
e. Pain

159. Most common cause of death due to burns in early period is:
a. Sepsis
b. Hypovolemic shock
c. Both
d. None
e. Pain

160. Most common carcinoma after burns is:

a. Squamous cell carcinoma
b. Adenocarcinoma
c. Melanoma
d. Mucoid carcinoma
e. Polyps

161. Most common cause of death in burns is:

a. Primary shock
b. Secondary shock
c. Hemorrhagic shock
d. Septicemic shock
e. Pain

162. Burns shock is:

a. Hypovolemic
b. Neurogenic
c. Endotoxic
d. Cardiogenic
e. Anaphylactic

164. Death from burns in first 10 days is due to all except:

a. Shock
b. Infection
c. Renal failure
d. Respiratory distress
e. Sepsis

165) False regarding carbuncle is

a) infective gangrene of subcutaneous tissue
b) caused by staphylococcus
c) diabetics are more prone
d) caused by streptococcus
e) its more than 2 furuncles which are connected to each other

166) Not true about carbuncle is

a) red, swollen
b) painful cluster of boils
c) occurs usually single
d) caused byStaphylococcus aureus
e) its more than 2 furuncles which are connected to each other

167) In carbuncles bacteria can cause infection by

a) entering the skin through a hair follicle, small scrape, or puncture
b) blood vessels
c) entering through cut injury
d) after post surgery
e) having bath

168)not Risk Factors for Carbuncles

a)Older age,
b)obesity,
c)poor hygiene
d) high fat diets
e) sepsis

169) Not true about carbuncles

a) There is surrounding soft-tissue infection (cellulitis
b) A person has a weakened immune system
c) An infection has spread to other parts of the body
d) bacteria from a carbuncle can not escape into the bloodstream and will not cause serious
complications
e) its more than 2 furuncles which are connected to each other

170) Not true about furuncle is

a) red, swollen
b) painful cluster of boils
c) occurs usually single
d) caused byStaphylococcus aureus
e) inflammation of hair follicle

171) Is not sign of furuncle

a) Boils are bumpy,
b) red, pus-filled lumps around a hair follicle that are tender,
c) warm
d) not painful.
e) painful

172) In Paraproctitis symptoms do not include

a) acute pain in the rectal region,
b) tenderness during defecation,
c) decreased body temperature,
d) appearance of an infiltrate in the anal region
e) none of the above

173) Treatment of Paraproctitis includes administration of

a) antibiotics
b) anti-inflammatory
c) surgical lancing of the abscess in the suppurative stage
d) all of above
e) none of the above

174) Lymph nodes are filled with ------------ blood cells that help your body fight off infections
a) RBC b) WBC c) Platelets d) none e) plasma

175) Infections that spread to lymph nodes are usually not caused by
a) bacteria, b) viruses, c) fungi d) none e) all
176) Symptom of lymphadenitis excludes
a) Nodes that increase in size suddenly ,
b) Nodes that are filled with pus (an abscess)
c) Both a and b
d) None

177) lymphadenitis is diagnosed by following test

a) Blood tests to look for infection
b) Taking a piece of the lymph node or fluid from inside the lymph node to study under a microscope
c) Placing fluid from the lymph node into a culture to see what type of germs grow
d) All of above
e) none of above

178) Treatment for lymphadenitis may include

a) Antibiotics
b) Medication to control pain and fever , reduce swelling
c) Surgery to drain a lymph node that has filled with pus
d) all of above
e) none of above
179) Mastitis is an infection and inflammation
a) Breast b) lymph nodes
c) hair follicle d) none e)sweat glands

180) Bacteria causing mastitis enter through

a) crack in the skin of the breast b) lymph node c) hair follicles d) all e)
meal

181) Symptoms of mastitis excludes

a) redness, b) pain c) swelling d) clogged milk duct e)
none

182) In mastitis, the treatment includes

a) by taking antibiotics b) to practice prevention c) fever-reducing agents
d) all

183) If you are breastfeeding, following is true in case of mastitis

a) you will most likely be encouraged to continue breastfeeding
b) this often actually helps relieve pressure
c) the infection will not enter the breast milk
d) all of above
e) none

184) Generalized lymphadenitis is related to

a) This type of lymph node infection occurs in two or more lymph node groups
b) may be caused by an infection that spreads through the bloodstream
c) may be caused by an infection that spreads through another illness that affects the whole body
d) all of above
e) none
185) Microbe causing tetanus is
a) Clostridium tetani b) Clostridium botulinum c) Clostridium difficile d) Clostridium perfringens
e) Cl.aureus

186) C. tetani spores can be found in

a) soil b)intestines and feces of many household and farm animals and humans
c)both a and b d) water e)none

187) False about C. tetani

a)spores can be found in the soil and in the intestines and feces of many household and farm animals and humans.
b)The bacteria usually enter the human body through a puncture (in the presence of anaerobic [low oxygen]
conditions, the spores will germinate).
c)Tetanus is not spread from person to person.
d) C. tetani bacteria can very well grow in the presence of oxygen
e) its anaerobic infection

188) The incubation period varies from

a)3–21 days, with an average of 8 days b) 23–41 days, with an average of 18 days
c) 30–121 days, with an average of 60 days d) 19–21 days, with an average of 20 days
e) 25–30 days, with an average of 27 days

189) The symptoms of tetanus excludes

a)spasm of the jaw muscles, b)stiffness of the neck, c) difficulty in swallowing, d) opisthotonos e) none

190)First appearing symptoms of tetanus

a)spasm of the jaw muscles,
b)stiffness of the neck,
c)difficulty in swallowing,
d) stiffness of the abdominal muscles
e) septic shock

191) If it occurs , complete recovery of patients suffering from tetanus

a) within few minutes b)as soon as medication
c) with in few hours d)may take months
e) may take years

192) Diagnosis of tetanus is based on

a)the clinical signs and symptoms only b)blood reports
c)CT scan d)history alone
e) X-Ray

193) Tetanus bacilli live in the

a)soil, b)animal feces, c)manure d)all e) none

194) Not true about treatment for tetanus

a) There is no complete "cure" for tetanus once a person develops symptoms,
b) just supportive treatment and management of complications.
c)The best "treatment" is prevention through immunization
d)spontaneous treatment soon after medication
e) a and b is true
195) Vaccines preparations are all given as
a)injection b)tablets c)capsules d)oral drops e) gas

196) Vaccines preparations are all given as injection in

a)the anterolateral thigh muscle b)the deltoid muscle c)gluteal muscles d)a and b

197) The usual schedule of vaccine for infants is a series of

a)4 doses of DTaP b)5 doses of DtaP c) 6 doses of DTaP d)3 doses of DtaP e) 10 doses of
DTaP

198) The usual schedule for infants is a series of doses of DTaP given at
a)2, 4, 6, and 15–18 months of age b) 2, 4, 6, and 15–18 weaks of age
c) 2,4,8, and 25–28 months of age d) 2, 6, 10, and 25–28 weaks of age
e) 2,4,8, and 28–30 months of age

199) A fifth shot, or booster dose, is recommended between-------------, unless the fourth dose was given late (after
the fourth birthday)
a) age 4 and 6 years b) age 14 and 16 years c) age 24 and 26 years d)not required e) age
30 and 40 years

200)True about doses of tetanus vaccine is

a) For people who were never vaccinated or who may have started but not completed a series of shots, a 3-
dose series of Td should be given with 1 to 2 months between dose #1 and #2, and 6 to 12 months
between dose #2 and #3.
b) One of the doses, preferably the first, should also contain the pertussis component in the form of Tdap.
c) Because immunity to diphtheria and tetanus wanes with time, boosters of Td are needed every ten years.
d) All above are true

201) Pregnant women should receive Tdap

a)during each pregnancy, preferably between 27 and 36 weeks’ gestation
b)only in first pregnency
c)never
d)in first trimester as soon as pregnency is confirmed
e)none

202) Reduced opening of the jaws caused by spasm of the muscles of mastication
a) Trismus b)risus sardonicus c)ophisthotonus d) Kernig’s sign e)none

203)Rigid spine is
a) Trismus b)risus sardonicus c)ophisthotonus d) Kernig’s sign e)none

204)The rigidity of facial muscles that can lead to grimace is referred to

a) Trismus b)risus sardonicus c)ophisthotonus d) Kernig’s sign e)none

205) The symptoms of tetanus are caused by the tetanus toxin acting on the
a)central nervous system b)major arteries c)heart and circulatory system d)ligaments, tendons
e)smooth muscles

206) Tetanus has a -----------fatality rate

a)high b)low c)100% death rate d)100% survival rate e)never
207. What is not true of osteomyelitis in neonates:
A. Only clue to diagnosis is failure to move the limb
B. Prematures are more susceptible
C. Staph. aureus is always the pathogen
D. Treatment should not await blood culture
E. Pathogen can be mixed

208. Prevention of osteomyelitis in open fractures

is by:
A. Remove all dead tissue
B. Leave wound open
C. Stabilize fragments by external fixators
D. All of the above
E. Using antibiotics

209. Acute osteomyelitis is commonly caused by:

A. Staph. aureus
B. S. pyogenes
C. H. influenzae
D. Salmonella
E. Cl.tetanus

210. Regarding investigations in osteomyelitis all

are true except:
A. MRI is the investigation of choice
B. CT may show bone erosion and collection
C. Isotope scans are sensitive but less specific
D. X-ray change is present at outset
E.
211. In osteomyelitis, pus culture will only yield
organism, if antibiotic is stopped before:
A. 3 days
B. 7 days
C. 10 days
D. 15 days
E. 20 days

212. Improper treatment of osteomyelitis in

children leads to:
A. Septic arthritis
B. Growth arrest
C. Joint deformity
D. Transfer to chronic
E. Each of the above

213. In acute long bone osteomyelitis, surgery is

indicated if:
A. Sever symptoms
B. Delayed presentation
C. Poor response to antibiotic
D. B + C
E. All of the above

214. Acute osteomyelitis usually begins at:

A. Epiphysis
B. Metaphysis
C. Diaphysis
D. Any of the above
E. None of the above
215. The treatment of a child with suspected
osteomyelitis seen 48 hours after onset of
symptoms is:
A. IV cloxacillin + Ampicillin
B. Incision
C. A + B
D. None of the above

216. In Cierny and Madar classification of chronic

osteomyelitis involvement of both cortical and
cancellous bone conforms to:
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
E. Stage 5

217. What is true of surgical intervention in chronic

osteomyelitis:
A. Removal of sequestrum
B. Wound packing with gentamicin beads
C. Obliteration of dead space by muscle flap/
cancellous bone chips
D. All of the above

218. The definite way of establishing malignancy

in bone tumour is:
A. X-ray
B. Bone scan
C. Biopsy
D. CT scan
E. Endoscopy

219. The radiological features of benign bone lesion

are all except:
A. Smooth distinct sclerotic borders
B. Geographic bone destruction
C. Codman’s triangle
D. Uninterrupted periosteal reaction

220. Constant bone pain not affected by activity and

awakening patient at night is most likely to
be due to:
A. Osteomyelitis
B. Malignant bone tumour
C. Bone tuberculosis
D. Brodie’s abscess
E. None of the above

221. In osteogenesis imperfecta, collagen defect

manifests with:
A. Fragile capillaries
B. Lax ligaments
C. Dental problems
D. All of the above

222. The articular tissue first affected in rheumatoid

arthritis is:
A. Articular cartilage
B. Subchondral bone
C. Synovial membrane
D. Periarticular tissue
E. None of the above

223. The bone infarct in acute osteomyelitis is

known as:
A. Involucrum
B. Sequestrum
C. Cloaks
D. All of the above
E. Abscess

224. Heberden’s nodes of osteoarthritis are seen in:

A. Carpometacarpal joint
B. Proximal interphalangeal joint
C. Distal interphalangeal joint
D. Metacarpophalangeal joint
E. None of the above

225. The joint rarely affected by osteoarthritis is:

A. Hip
B. Knee
C. Shoulder
D. Elbow
E. Tibia

226. Primary osteoarthritis first affects:

A. Articular bone
B. Articular cartilage
C. Synovial lining
D. Joint capsule
E. None of the above

227. The first X-ray abnormality in osteoarthritis is:

A. Marginal lipping
B. Narrow joint space
C. Sclerosis of periarticular bone
D. Subchondral cysts
E. None of the above

228. Surgical options for advanced osteoarthritis

include:
A. Osteotomy
B. Arthrodesis
C. Joint replacement
D. All of the above

229. Mallet finger is treated with reduction and

splintage in full extension for:
A. 2 weeks
B. 4 weeks
C. 6 weeks
D. 8 weeks
E. 10 weeks

230. Mallet finger refers to:

A. Hyperextension of thumb
B. Hyperflexion of thumb
C. 30° flexion of terminal phalanx
D. 60° flexion of terminal phalanx
E. 90° flexion of terminal phalanx
231. Bennett’s fracture refers to:
A. Fracture of first metacarpal
B. Dislocation of base of first metacarpal
C. Dislocation of first metacarpal
D. None of the above

232. Felon, in surgical language refers to infection

of:
A. Subcuticular space
B. Proximal pulp space
C. Terminal pulp space
D. Eponychium
E. none of the above

233. What is true of chronic paronychia:

A. Usually follows acute paronychia
B. Antibiotics are helpful
C. Griseofulvin is useful in long-term treatment
D. All are true

234. In infection of webspace, the incision for

drainage should be:
A. Longitudinal
B. Transverse
C. Oblique
D. Any of the above

235. Incision for the drainage of space of Parona

should be:
A. Transverse
B. Longitudinal
C. Oblique
D. All of the above

236. Lymphatics accompany veins everywhere in

body except in:
A. Heart
B. Lungs
C. CNS
D. Kidney
E. Stomach

237. All the following are part of lymphatic system

except:
A. Spleen
B. Tonsil
C. Thymus
D. Liver
E. Lymph nodes

238. In liver lymphatics take origin from:

A. Portal triad
B. Porta hepatis
C. Space of Disse
D. Venous sinusoids
E. None of the above

239. Lymph trunks are innervated by:

A. Sympathetic
B. Parasympathetic
C. Sensory endings
D. All of the above

240. Pressure in interstitial fluid compartment of

skin and subcutaneous tissue is:
A. 5-10 mmHg
B. 1-5 mmHg
C. 5-10 cm H2O
D. – 2 to – 6 mm H2O
E. – 6 to – 10 mm H2O

241. Contractility of lymph channels is increased

by all except:
A. Serotonin
B. Thromboxane
C. Nitric oxide
D. Endothelin

242. Daily lymph drainage to circulation is:

A. 1-2 lit
B. 2-4 lit
C. 4-6 lit
D. 6-7 lit
E. 7-10 lit

243. Lymphoedema tarda presents at:

A. Birth
B. Puberty
C. Adulthood
D. None of the above

244. The most common cause of primary lymphoedema

is:
A. Congenital hyperplasia
B. Proximal obliteration
C. Distal obliteration
D. All of the above
E. None of the above

245. In chyluria, all the following occurs except:

A. Renal colic
B. Hypoproteinemia
C. Haematuria
D. Milky white urine

246.Which of the following is not scanned by FAST technique

a.pericardium
b.pleural cavity
c.spleen
d.liver
e.all of the above

247.Seat belt injury leads to

a.splenic laceration
b.splenic contusion
c.gut ischemia
d.mesenteric adenitis
e.all of the above
248.Which ulcer is likely to develop in a long standing chronic venous ulcers
a.marjolin ulcer
b.apthous ulcer
c.Bazin ulcer
d.arterial ulcer
e.none of the above

249. A 58-year-old cattle farmer normally a resident in the subcontinent, on a short visit to the
United Kingdom, was brought into the A&E department with convulsions. The episode started
with lassitude, irritability, dysphagia and spasm of facial muscles. He showed generalised
tonic and clonic spasm.
1 Abscess
2 Bacteraemia and sepsis
3 Cellulitis and lymphangitis
4 Clostridium tetani
5. Osteomyelitis

250.A 68-year-old woman underwent an amputation of her right leg following severe crush injury.
Three days postoperatively she has pyrexia and tachycardia and looks toxic. The amputation
site looks red and brawny with the limb swollen with crepitus in the intermuscular planes.
1 Abscess
2 Bacteraemia and sepsis
3 Cellulitis and lymphangitis
4. Gas gangrene
5. Clostridium tetani

251.A 75-year-old man underwent a low anterior resection. Five days postoperatively he became
toxic. A contrast CT scan showed an anastomotic leak.
1 Abscess
2 Bacteraemia and sepsis
3 Cellulitis and lymphangitis
4 Clostridium tetani
5 Gas gangrene

252. A 38-year-old woman sustained a superficial wound of her thumb from a puncture while
gardening. Twenty-four hours later, her thumb became swollen and very painful, with red
inflamed streaks all along the skin up to the axilla.
1 Abscess
2 Bacteraemia and sepsis
3 Cellulitis and lymphangitis
4 Clostridium tetani
5 Gas gangrene

253. A 25-year-old man presented with a tender lump in the right supraclavicular area of 3 days’
duration. The lump is red and fluctuant. He looks unwell with pyrexia. A week before the
onset of this episode he had his right ear pierced, which became infected.
1 Abscess
2 Bacteraemia and sepsis
3 Cellulitis and lymphangitis
4 Clostridium tetani
5 Gas gangrene