Q. Best predictor in the GCS
A. Eye opening
B. Motor response
C. Verbal response
23) B, Motor response
Motor score is the best predictor of neurological outcome.
The m component of the GCS, is not only linearly related to survival, but preserves almost all the predictive power of the GCS
Q) Out of the following which will require Spinal immobilization most?
a. 22 yr Female had a high-speed motor vehicle collision who complains of backpain and no
b.16 yr male jumped from 6ft landed on both foot denies back pain and weakness
C. Gunshot injury
D. Abdominal injury
Answer is free
Spinal cord injuries are a common cause of morbidity and expenditure. Mortality is associated with cervical injuries but not lower spinal cord injuries.
Motor vehicle accidents are the most common cause and gunshot injuries the least common for spinal cord injuries.
Mechanism of injury
- Blunt trauma - Direct impingement, Ischemia, compression or bleeding
- Penetrating - Laceration of spinal cord
Chance fracture - is a type of spinal cord fracture in which there is transverse fracture of all vertebral elements
1 Complete immobilisation
2. Management of associated neurogenic shock ( due to loss of sympathetic tone) with vasopressors and fluids
Sabiston page 420
Q )Management of isolated liver injury in children commonly is
c) Intervention and embolization of bleeding vessel
d) Liver packing
Answer for members only
Q) Penetrating injury to the abdomen, with BP 84/60, Pulse 116/min, what is the next best step in management?
b) CT Abdomen with contrast
c) Ultrasound abdomen
d) Take to OT
Answer for premium
Q) Commonest cause of breathing difficulty in unconscious patient is
a) Foreign body
d) Impacted teeth
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Q) All are true about tropical pancreatitis except?
a. Associated with Tapioca.
b. Patients have large stones with fibrosis.
d) Onset of disease at 50 years
Answer d - Free. See here for other questions and this question
Onset 50 years
Tropical pancreatitis is an idiopathic disease which begins in teens. It has a high association with diabetes and Pancreatic duct calculi. It is common in South India, Asia, Africa and central America
These patients have increased risk of cancer
It is associated with SPINK 1 mutation
Q Things to do to decrease stress in surgery all except
a. Minimal invasive Surgery
b. Afferent block.
c. 8 hours fasting
d. Early mobilization
Q) Fascial compartments of leg
A. Anterior, lateral, Superficial and deep posterior
B. Anterior, posterior, medial
C. Medial, lateral posterior
D. Anterior, medial, lateral
Answer and diagram for premium members
Q) Isotonic fluid solution is
A. Half normal saline
B. 1/5th normal saline
C. Ringer lactate
D. Dextrose in Normal saline
Answer is free
Ringer lactate and Normal saline are isotonic fluid. they are useful in replacing GI losses. Ringer lactate has a bit of potassium as well.
Body actually requires bicarbonate and not lactate. Lactate is the more stable form in IV solutions and is used, it is converted by liver into bicarbonates.
Half NS is used in replacing losses when sodium concentration is high in the body, mainly as maintenance fluid
1/5th NS is hardly used clinically
Dextrose in Saline or DNS is used for maintenance and is not isotonic
Q)All are indications of Bariatric Surgery except?
a) Cosmetic outcome
b) Medical expenditure decreases
c) Increases life expectancy
d) Decreases comorbidities
Answer for premium members
Q) Which of the following is false in Capsule endoscopy
A. Sedation is not required
B. Accurate localisation possible
C. Not suitable for patients with stricture
D. Can visualise entire small bowel
Answer for Premium Members
Q CT abdomen is equal to how many CXR
Q) Simple nipple inversion is seen in?
a) Duct ectasia
c) Peri ductal fibrosis
d) Carcinoma breast
Inversion of nipple is seen in a lot of conditions, both benign and malignant. Common causes are
- Duct ectasia
- After breast Surgery
- Fat necrosis
- Mondor disease
- Chronic peri ductal mastitis
- Carcinoma breast
Rapid unilateral development of inversion of nipple is a dangerous sign and warrants further diagnosis. Further circumferential retraction is also sign of carcinoma.
Simple nipple inversion occurring at puberty or retracted nipple is of unknown cause and is bilateral in 25%. Mostly No treatment is required for this and condition resolves spontaneously during pregnancy and lactation.
Suction pumps and cosmetic surgery can also help.
Inversion of nipple associated with malignancy may be with or without the presence of lump. Associated discharge from the nipple can point to the diagnosis.
Ref - Bailey 801
Grading of benign nipple inversions for management
In grade I, the nipple is easily pulled out manually and maintains its projection quite well. It has minimal fibrosis thus, manual traction and a single, buried purse-string suture are enough for the correction.
Grade II (majority) the nipples can be pulled out but cannot maintain projection and tend to go back again. These nipples are thought to have moderate fibrosis beneath the nipple.
In grade III, to which the least number of inverted-nipple cases belong, the nipple can hardly be pulled out manually. Severe fibrosis made it impossible to reach optimal release of the fibrotic band with the preservation of the ducts.