Types of question  DNB SS 2018 CET 

Q 11-15        Q16-20                 21-30 Neurosurgery (in progress)   31-40


Q1. ) What are natural killer cells?

a) Multinuclear monocytes

b) Special macrophages

c) Antibody presenting cells

d) Large granular lymphocytes?


Q2) What is the ideal suture is to wound length ratio for appropriate wound closure?

a) 4:1

b) 3:1

c) 2:1

d) 1:1


Q3. What should be the ratio of length : breadth in an elliptical incision

a) 1:1

b) 2:1

c) 3:1

d) 4:1


Q4 ) Blade used for arteriotomy?

a) No. 11

b) No. 22

c) No. 10

d) No. 23


Q5.  Vascular anastomosis, preferable suture material
A. Non-absorbable, elastic
B. Non-absorbable, non-elastic
C. Absorbable, elastic
D. Absorbable, non-elastic


Q6 . In a critically ill patient best way to monitor cardiac output  is by 
A. Pulmonary artery catheter
B. Pulmonary vein catheter
C. Femoral artery catheter
D. Subclavian vein catheter


Q7 CT abdomen is equal to how many CXR
A. 100
B. 500
C. 1000
D. 1500


Q8) Hot air oven sterlization is done for:

a)  glass

b) Surgical instruments

c) Culture media

d) Endoscopes


Q 9) Isotonic fluid  solution is
A. Half normal saline
B. 1/5
th normal saline
C. Ringer lactate
D. Dextrose in Normal saline


Q10  False in hemorrhagic shock
A. Low heart rate
B. Cold extremity
C. Due to fluid losses
D. Vascular resistance high


Accessory Question from AIIMS

Q) All are true about disinfectants in surgery  except
A. Povidone iodine needs to dry up prior to its action
B. Alcohol disinfectants act against all organisms except clostridium difficile
C. Single dose of first generation cephalosporin should be givens prophylaxis for vascular
procedures and bladder catheterisation
D. Chlorhexidine is bactericidal, viricidal, fungicidal, and has rapid onset of action and persistent
duration.


Answers 

  1. d

Large granular lymphocytes

Natural killer cells are a part of lymphocytes called "null cells"  These are large granular lymphocytes and the 1st line of defence against viruses and bacteria

They belong to null cells as they do not rely on specific match or memory.

They control both tumor and microbial spread in the body. 

Unlike T cells ( which mature in thymus), natural killer cells develop in bone marrow. They identify the viruses and other harmful cells by lack of major histocompatibility complexes (MHC)

Antigen presenting cells are B cells

T cells are direct cyto toxic cells

 

Ref: https://study.com/academy/lesson/natural-killer-cells-definition-functions-quiz.html

        Sabiston 20th page 601


2. a

 For abdominal wall closure, the length of the suture material should be at least four times the
length of the wound to be closed to minimise the risk of abdominal dehiscence or later incisional hernia
 .

Transverse incisions are better than vertical incisions

Ref: Bailey 26th page 34


3. c

Elliptical incisions are most commonly used for melanomas, cosmetic and pre cancerous lesions.

They should be placed parallel to the langer's lines.

For an elliptical wound to close without tension the length is to breadth ratio should be 3:1

Ref Bailey 26th page 33


4. a

No. 11

22 is used for abdominal incisions

11 for arteriotomy

15 for minor surgical procedures

Ref Bailey 26th page 33


5, b 

For Vascular anastomoses- Non elastic Non absorbable suture is preferred

Bile duct - absorbable that has no tissue reaction

Bailey 26th page 5


6. a 

Pulmonary artery catheter

Pulmonary artery catheters measure cardiac output and cardiac index as well as oxygen delivery to the tissues. 

They are however invasive and can lead to complications such as arrythmias and pulmonary artery rupture.

Bailey page 259, 26th edition


7  b 

Bailey 26th table 13.1


8) a

Glass ware

Hot air oven operate between 50 degree to 300 degree.They kill micro organisms by heat.

  • 1.5 to 2 hours at 160 °C (320 °F)
  • 6 to 12 minutes at 190 °C (374 °F)

They can only be used for things which do not get destroyed by heat such as glass, oily fluids, powders, flasks

Surgical instruments and endoscopes would loose their shape and are sterlized with cresol and glutareldehyde

Culture media- Tyndallisation


9

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


10 A

In Hypovlolemic shock, the heart rate increases and cardiac output decreases. The peripheral resistance increases and the venous pressures are low.

Extremities are cool and clammy with low mixed venous saturation and base deficit is high.

Bailey 26th page 14. Check the table


Answer to AIIMS Question

Answer d

Povidone-iodine solution is used for surgical site preparation, it must be allowed to dry for microbicidal effect. 

Chlorhexidine is  a phenol which is  used in concentrations of 0.5% to 4.0% alone or in lower concentrations in combination with an alcohol as a skin antiseptic. ....

Chlorhexidine has all actions,  bactericidal, viricidal, and fungicidal, Its onset of action is slow but persistent 

Alcohol hand cleansers are effective except against the spores of Clostridium difficile, which requires cleansing with soap and water.

Ref Sabiston page 244

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