Misc mixed questions (1-5)          Q6-10           11-20 (General Surgery)         21-30 (liver)

Q11) In a patient who is on warfarin for mechanical heart valve, prostatectomy is to be done. When will you stop warfarin?

a) 1 day back

b) 2 days back

c) 3 days back

d) 5 days back

Q12 ) Test done before  radial artery harvesting?

a) Allen test

b)  Pratt's test


Q13) Which of the following does not cause fever

a) IL1

b) IL2

c) TNF alpha

d) IL8

Q14) True about suturing technique in vascular anastomosis

a) Anastomosis may not be completely water tight

b) To prevent intimal injury needle should be moved from with in to out

c) 4-0 suture is preferred for aorta

d) Any bio degradable suture which is monofilament can be used

Q15) Pressure sore, grade II is

a) Partial thickness skin loss, epidermis and dermis are involved

b) Full thickness skin loss, involving subcutaneous tissue but not underlying fascia

c) Non blanchable erythema, no breach in epidermis

d) Involvement of bones and tendons

Q16) Questions on keloid

Same as previous exams 3 questions on keloid from previous DNB and NEET exams

Check here

Q22 on this page 

Q 8 here 

Q17) True about fasciotomy of the lower limb

a) Fasciotomy should be done when distal pulses are absent

b) If there are no clinical signs and compartment pressure is more than 30 mm Hg, fasciotomy should be done

c) Multiple small incisions should be given on the leg

d) Crush injuries that manifest late, fasciotomy is preferred

Answer 17

Answer 11) d

Recommendations concerning warfarin anticoagulant management
Low-risk procedures
 No adjustment to anticoagulation required
Check INR within the week before procedure

Avoid elective procedures when anticoagulation is above the
therapeutic range

High-risk procedure in a patient with a low-risk condition
 Discontinue warfarin 5 days before the procedure
 Check INR on day of procedure to ensure <1.5
Restart warfarin on evening after procedure if uncomplicated and recheck INR in 1 week

High-risk procedure in a patient with a high-risk condition
DDiscontinue warfarin 5 days before the procedure
 Start low molecular weight heparin (LMWH) 2 days after
stopping warfarin

 Check INR on day of procedure to ensure <1.5

 Omit LMWH on day of procedure

Warfarin may be resumed the night of the procedure

LMWH should be continued until INR adequate

The decision to administer intravenous heparin should be

ref BAiley 27th edition page 220-221

12 ) a Allen’s test
● The patient makes a tight fist while the surgeon compresses
both distal and ulnar arteries digitally; this squeezes blood
from the hand
● The hand is then relaxed and compression of the ulnar artery
is released; the speed of returning colour to the hand is
● If colour returns in 5–7 s, patency and collateral flow from the
ulnar artery is confirmed

13) b

Proinflammatory cytokines including interleukin­1 (IL­1), tumour necrosis factor alpha (TNFα), IL­6 and IL­8 are produced within the first 24 hours and act directly on the hypothalamus to cause pyrexia.

These also cause proteolysis and release acute phase proteins.

They cause peripheral insulin resistance

Bailey page 4

14) b

Vessels should always be sewn with the needle moving from within to without on the downstream edge of the vessel to avoid creating an intimal flap and to fix any atherosclerotic plaque.

Tip of the needle should be at right angle to the intima and curve of the needle should be followed

Distal clamp is released first

Non absorbable sutures should be used

2-0 should be used for aorta 4-0 for femoral and 6-0 for popliteal

Only non absorbable monofilament sutures are used in vascular anastomosis

Bailey 27 page 99

15) a

Pressure sores occurs when ext pressure exceeds the capillary occlusive pressure (30 mmHg) approximately 5% of all hospitalised patients

Stage                   Description

1                        Non-blanchable erythema without a breach in the epidermis

2                       Partial-thickness skin loss involving the epidermis and dermis

3                       Full-thickness skin loss extending into the subcutaneous tissue but not through underlying fascia

4                        Full-thickness skin loss through fascia with extensive tissue destruction, maybe involving muscle, bone, tendon or joint

Bailey - page 29

17) b

Compartment syndrome of leg presents with pain, tenderness on passive stretching, sensory loss or absence of distal pulses. Absent of pulses is a late sign and a surgeon should not wait for this to occur

If  compartment pressures are constantly greater than 30 mmHg or if the above clinical signs are present, then fasciotomy should be performed.

Fasciotomy involves incising the deep muscle fascia and is best carried out via longitudinal incisions of skin, fat and fascia oboth sides of tibia

In crush injuries that present several days after the event, a late fasciotomy can be dangerous because dead muscle produces myoglobin which, if suddenly released into the blood stream, causes myoglobinuria.

bailey page 28

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