National Board Exam SS questions 101-110

Questions from National Board Exam


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Q101) All are precancerous for oral cancers except?

a. Erythroplakia.
b. Speckled erythroplakia.
c. Discoid lupusi
d. Chronic hyperplastic  candidiasis


Q102) After vagotomy, minimum how long time does it take for carcinoma to develop ?

a) 5 years

b) 10 years

c) 15 years

d) 20 yearsy


Q103) SA Node is supplied by which artery

a) Right coronary

b) Left coronary

c) Left circumflex

d) Anterior interventricular


Q 104 Things to do to decrease stress in surgery all except
a. Minimal invasive Surgery
b. Afferent block.
c. 8 hours fasting
d. Early mobilization


Q105 ) Lymphatic drainage of Right adrenal gland is to 
a. Para aortic group
b. Inter Aortocaval
c. Pre aortic.
d. Para Caval


Q106) Fullers zone 1 injury, surgery includes mobilisation of
a. Right medial rotation.
b. Left Medial rotation.
c. Duodenal dissection.
d. Lesser sac approach


Q107) All are true about tropical pancreatitis except?

a. Associated with Tapioca.
b. Patients have  large stones with fibrosis.
c. Cancerous

d) Onset of disease at 50 years 


Q108) Which of the following is a clinical marker of myocardial ischemia

a) Troponin I 

b) LDH

c) Alkaline phosphatase

d) CPK MB 


Answer 101

c

Squamous cell carcinoma is the most common tumor of the oral cavity. Majority of the oral cancers are due to tobacco and alcohol and not associated with premalignant conditions.

Conditions associated with oral cancers include

Conditions associated with malignant
transformation
High-risk lesions
Erythroplakia (Irregular bright red plaque in oral cavity)
Speckled erythroplakia (Highest rate, It is leukoplakia arising on erythematous base)
Chronic hyperplastic candidiasis (leukoplakia around the commisuures of mouth)
Medium-risk lesions
Oral submucous fibrosis
Syphilitic glossitis
Sideropenic dysphagia (Paterson–Kelly syndrome)
Low-risk/equivocal-risk lesions
Oral lichen planus
Discoid lupus erythematosus
Discoid keratosis congenita

(DLE) Discoid lupus erythematosus  is a chronic skin condition of sores with inflammation and scarring favoring the face, ears, and scalp and at times on other body areas.

Ref: Bailey 26th page 708


102) b

10 years

Vagotomy and drainage procedures have been shown to be independent risk factors for carcinoma stomach. Increased risk is 4 times than the general population.

Most notable cause is bile reflux leading to intestinal metaplasia

Lag phase is 10 years

Highly selective vagotomy is not asssociated with malignancy risk.

Bailey page 1040


103) a

Coronary arteries originate from ascending aorta, above the aortic valves from the aortic sinuses. Right coronary artery passes between the right atrial appendage and pulmonary trunk in the atrio ventricular septum and continues as posterior descending artery or interventricular artery.

It gives off  the SA  as well as AV nodal arteries and  also gives off marginal branches.

The left coronary artery is inaccessible and gives of left anterior descending and left circumflex artery. LAD continues as posterior descending arteries (PDA) 

The LAD is the most frequently diseased coronary artery and most often bypassed during CABG surgery

Ref: BAiley 26th page 826


104) c

8 hrs fasting

Minimally invasive surgery are done to decrease stress and postoperative pain and morbidity.

Afferent block done to reduce postoperative pain and increase early mobilisation.

8 hours fasting not required..4 hours fasting enough

Early mobilisation and early feeding increases recovery


105 

a) Para aortic

Small lymphatic channels from both cortex and medulla drain into  the hilum, from where larger calibre lymphatic emerge to drain directly into the lateral group of  para-aortic lymph nodes

  • arterial supply is via three adrenal arteries 
    • superior adrenal artery (from inferior phrenic artery)
    • middle adrenal artery (from abdominal aorta)
    • inferior adrenal artery (from renal artery)
  • venous drainage 
    • adrenal veins emerge from the hilum and drain to different veins depending on the side:
      • left adrenal vein drains to the left renal vein 
      • right adrenal gland drains to the IVC

106 ) b

Left medial visceral rotation.

The operative approach for SMA injuries is based on the level  of injury. Fullen zone I SMA injury located posterior to pancreas , are best exposed by a left
medial visceral rotation.

Fullen II injuries are approached via lesser sac.

Fullen III and IV are  approached directly within the mesentery.( Schwartz 10th page 190)


107 ) d

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

Etiology 

Malnutrition 

Cassava

Hydrocarbons exposure

These patients have increased risk of cancer

It is associated with SPINK 1 mutation

Ref https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1742869/pdf/v079p00606.pdf


108) a

Troponin I  - Most sensitive and specific, peaks with in 9 hours.  Troponin I is extremely specific for the cardiac muscle and has not been isolated from the skeletal muscle.  The only disadvantage of cTn is the late clearance that makes it difficult to identify a recurrent myocardial infarction.

 CPK MB is next more specific. It  rises in the serum at 4–9 h after the onset of chest pain, peaks at 24 h and returns to baseline values at 48–72 h. It is useful to detect 2nd attack of MI
LDH is not specific
Alkaline phosphatase in biliary obstruction, bone growth, liver regeneration
Ref Bailey 275