DNB General Surgery 1-10 Q11-16 Q17-20 21-30 Neurosurgery (in progress)
Q31 Warfarin sodium acts by
A. Inhibits carboxylation of Factor VII, IX, X
B. Factor X a inhibition
C. Thrombin inhibitor and X a inhibition
D. IX, XI, XII, factor and thrombin inhibition
Q 32) During fluid resuscitation in a burns patient using Parkland’s formula, volume of fluid given
in first 8 hrs
A. 50%
B. 25
C. 75
D. 100
Q33) Spillage of blood on the OT floor is best cleaned by
a) Alcoholic solution
b) Chlorinated solution
c) Iodinated concentrate
d) Formalin
Q 34) Most common malignancy in post-transplant individuals
A. PTLD
B. Skin- Squamous cell carcinoma
C. Kaposi sarcoma
D. CNS Lymphoma
Q 35) Most nephrotoxic drug is
A. Cyclosporine
B. Sirolimus
C. Azathioprine
D. Steroids
Q36) Most common indication for Liver transplant is
A. HCV induced cirrhosis
B. HBV induced cirrhosis
C. PSC
D. HCC
Q 37 ) Most common indication for Pediatric liver transplant
A. Biliary atresia
B. Metabolic diseases
C. Alagille syndrome
D. HCV
Q 38 Antiproliferative agent used in transplant is
A. Azathioprine
B. Cyclosporine
C. Tacrolimus
D. MTOR inhibitor
Q39) Action of Cyclosporine
A. Blocks IL2 transcription
B. Depletion of lymphocytes
C. Antiproliferative
D. Anti-inflammatory
Q 40) Concordant xenografts are
A. Between closely related different species
B. Between same species of different races
C. Between same species
D. Between nonidentical twins
Answer 31
a)
Warfarin inhibits the terminal carboxylation of Vit K dependent clotting factors. The bleeding caused by warfarin can be inhibited by PCC (Prothrombin complex concentrates) which contains Vit K containing factors and Protein C and Protein S.
Tranexamic acid inhinits fibrinolysis.
REf Sabiston page 568
32) a
Fluid loss is maximum in 1st eight hours. Parkland formula is total percentage Body Surface area X 4 X weight
Half is given in 1st 8 hours and half in next 16 hours.
BAiley
33) b
Hypochlorites Aqueous preparations (Eusol, Milton, Chloramine T) Instrument and surface cleaning
Alcohol is used for skin preparation
Cetrimide for hand washing and surface cleaning
Ref BAiley 20th page 62
34) b
After transplants immune system is sufficiently suppressed by using medicines like Tacrolimus, MMF and steroids.
Skin cancers especially Squamous cell cancer are the most common malignancies after transplants.
Ref Sabiston 20th page 629
35) a
Most nephrotoxic drug is cyclosporines and tacrolimus. Drug levels have to be frequently monitored. Other side effects of cyclosporines are, hypertension, dyslipidemia, hirsutism, gingival hypertrophy.
Azathioprine- Leukopenia, Thrombocytopenia, Hepatotoxicity, GI Side effects
Sirolimus- Thrombocytopenia, Delayed wound healing, Pneumonitis
Steroids- Long list
Ref Bailey page 1414
36) a
Now hepatitis c, is the most common cause of liver transplant world wide
Hepatitis C -24%
Alcohol 13%
FHF 6%
PSC 5%
PBC 5%
HEP B 3%
Ref Sabiston 20th 638
37) a
Biliay atresia
MOst common cause or liver transplant in children. Presents as persistent jaundice after birth. Etiology is not clear
Findings include absent extrahepatic ducts and gallbladder. Biopsy is diagnostic
38) a
Azathioprine
Agent Principal mode of action
| Corticosteroids | Widespread anti-inflammatory effects |
| Azathioprine | Prevents lymphocyte proliferation |
| Mycophenolic acid | Prevents lymphocyte proliferation |
Calcineurin inhibitors
(ciclosporin/tacrolimus) Blocks IL-2 gene transcription
mTOR inhibitors Blocks IL-2 receptor signal transduction
ALG Depletion and blockade of lymphocytes
Anti-CD25 mAb Targets activated T cells
Anti-CD52 mAb Depletion of lymphocytes
Anti-CD20 Depletion of B lymphocytes
CTLA-4Ig Blocks T-cell costimulation
Commonly used regimens in liver transplant is Tacrolimus, MMF and steroids
REf Bailey 26th page 1413
39) a
Ref Bailey 26th page 1413
40) a
Transplant between closely related species
For humans these are apes and old world monkeys.
ref Sabiston 20th 631