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General Surgery June 2011 PAPER I 1. What are diagnostic tumor marker? Enumerate their role in the management of specific cancers. 5+5 2. a) b) c) What is septic shock? 6 Describe various scoring systems for sepsis. 2 Describe various components of "Systemic Inflammatory Response Syndrome." 3. a) b) c) Describe the "levels of evidence" in surgery. 5 What is a Phase-II trial? 3 Describe the significance of "NSABP" trials. 2 4. a) b) c) Describe the various modes of supplementing nutrition in a surgical patient. 4 What are the "pitfalls" in the use of total parenteral nutrition? 3 Describe the "Refeeding Syndrome". 3 5. a) b) c) Describe the various "dynamics" of wound healing. 4 Management of a non-healing wound. 3 Describe an "ideal dressing". 3 6. a) b) c) Describe the "Spring Coil" effect in relevance to the closure of abdomen. 4 Describe "mass closure" technique for abdomen. 3 What is a "Laparostomy"? 3 2 7. a) What are the risk factors in the development of "Deep Vein Thrombosis"(DVT)? 4 b) Discuss briefly the various diagnostic tests to establish the diagnosis of DVT in a 65 year old lady. 3 c) Describe the management of this patient. 3 8. a) b) c) Describe the "Cell Cycle" in relevance to cancer. 3 Describe the scientific basis to "Hormone therapy in cancers". 4 Describe the limitations of hormone therapy and its side effects. 3 9 a) b) Enumerate the local complications of acute pancreatitis.2 Describe in brief diagnosis and management of these complications. 8 10 a) b) c) Describe the "aetiopathogenesis of thoracic outlet syndrome". 4 Describe the various levels of lymph nodes in the neck. 3 Enumerate the "types of neck dissections". 3 PAPER II 1. a) What is a "High Risk" surgical patient? 2 b) How do you prepare a 45 year old with obstructive jaundice due to peri-ampullary cancer for surgery? 6 c) What is "Hepato-Renal syndrome"? 2 2. a) b) c) Enumerate the types of gall stones. 2 Discuss the pathogenesis of gall stones. 4 List the complications of gall stones. 4 3. a) Discuss the approach to management of a 10 year old boy with polytrauma. 6 b) What is "Triage" in the event of disaster? 2 c) Enumerate various imaging invasive diagnostic modalities in blunt abdominal trauma. 2 4. a) b) c) What is "Cardiac Tamponade"? 3 Discuss its management in a 40 year old lady. 4 Enumerate the indications for "Emergency Room Thoracotomy". 3 5. a) b) c) Describe various "Energy Sources" in Surgery. 3 What are the characteristic of an "ideal suture". 4 Describe chemo-embolization in surgery. 3 6. a) Discuss the management of a 12 year old boy with 15degree thermal burns involving head, neck and thoracic regions. 4 b) What are ideal fluid replacements in a patient with thermal burns? 3 c) Describe the selection of the type and calculation of the amount of fluid to be supplemented in thermal burns. 3 7. a) b) Describe the clinical presentation and diagnosis of Hydatid disease of liver. 5 Discuss in brief the surgical procedures performed for this condition. 5 8. a) Describe the significance of "Total Mesorectal Excision" in the management of rectal cancer. 4 b) What is a "Metachronous" lesion? 2 c) Discuss the management of a 32 year old gentleman with carcinoma rectum 14cm from the anal verge along with a solitary hepatic metastases in segment V. 4 9. a) What is a "Metastasis of unknown origin"? 5 b) Describe the approach to management of a 50 year old man with a level-V cervical lymph node metastasis of an unknown origin (The algorithmic approach). 5 10. a) b) 4 c) Enumerate the causes of lower gastrointestinal bleeding. 3 Describe the management of "Obscure GI hemorrhage" in a 60 year old man. Describe briefly "Capsule Endoscopy". 3 PAPER III 1. a) b) c) Define autologus transfusion. 2 What are the risks of blood transfusion? 4 How will you manage transfusion reactions? 4 2. a) b) c) Enumerate complications of laparoscopic surgery. 3 How to prevent injury to bowel and solid organs during laparoscopy? 3 How will you manage bleeding and bowel injury? 4 3. a) b) c) Write briefly lymphatic drainage of esophagus. 3 What are the clinical features of carcinoma esophagus? 3 How will you investigate a patient of Carcinoma esophagus? 4 4. a) b) c) Discuss the etiopathogenesis of Hirschsprung disease. 3 Write the clinical features. 3 Discuss briefly its management. 4 5. a) b) c) Enumerate causes of kidney lump. 2 Write the clinical features. Write the clinical features of renal cell carcinoma. 6. a) b) c) Define upper G.I. bleeding. 2 Enumerate its causes. 3 Discuss management of bleeding esophagealvarices. 5 7. a) b) c) Enumerate causes of foot ulcers. 3 How will you investigate? 3 Discuss management of varicose ulcer. 4 8. a) b) c) Enumerate causes of acute pancreatitis. 3 How will you investigate? 3 Discuss assessment of severity of pancreatitis. 4 9. a) b) Classify germ cell tumors of testis. 5 Management of non-seminomatous germ cell tumours. 5 10. a) b) Describe Glasgow Coma Scale. 4 Discuss management of SubDural Haematoma. 6 PAPER IV 1. a) b) c) What are the indications for diagnostic peritoneal lavage? 3 Describe the procedure.3 Discuss the grades of splenic injury. 4 2. a) b) Discuss various topical haemostatic agents. 4 Describe briefly the thermal methods of haemostasis. 6 3. a) b) What are the various subphrenic spaces? 5 How do you manage subphrenic abscess and its complications? 5 4. a) b) Discuss the surgical anatomy of thyroid. 4 What are the complications of thyroid surgery? c) Management of surgical complications. 3 5. a) b) c) What are the indications of renal transplantation? 3 Discuss graft rejection. 3 Immunotherapy postoperatively after renal transplantation. 4 6. a) b) c) Enumerate causes for generalized lymphadenopathy. 3 Describe classification and staging of Non-Hodgkin's Lymphoma (NHL). 5 Treatment of NHL. 2 7. a) b) Discuss the causes and clinical features of entero-cutaneous fistula. 5 Discuss the management. 5 8. a) b) c) Discuss the etiopathology of tension pneumothorax. 4 Describe the clinical features of tension pneumothorax. 4 Describe briefly the management of tension pneumothorax. 2 9. a) b) Discuss the segments of liver. 4 Describe the various types of anatomical liver resections. 6 3 10. a) b) Discribe "Fast track surgery". 4 Discuss its advantages and disadvantages. 6