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) A

Hypochlorites Aqueous preparations (Eusol, Milton, Chloramine T)  Instrument and surface cleaning
(debriding agent in open
wounds?)
Toxic to tissues

Ref BAiley 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 acidPrevents 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

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