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Question and Answers of TNPSC Exam for Assistant Surgeons, held on October
16th, 2005
Controversial Questions (Question Numbers as per Series A)
A question becomes controversial because of a lot of reasons
-
2 choices
are given in books. In such case, you have to assume that you have got this
question wrong while calculating your marks. In addition you can
represent to TNPSC in writing /
Telegram with the necessary proof
-
The concept
is vaguely given in books
and can be interpreted in more than one way. You can represent.
-
The concept
is given clearly, but we have not
seen the correct book for reference. This is Our Fault. Hance we
cannot do any thing, expect repeating the mistake in future exams
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32 Conjugated hyperbilirubinemia is found in the following conditions, except
a Dubin-johnson syndrome
b
Criggler-Najjar syndrome
c Rotor syndrome
d Gilbert
syndrome
Reference Page 479, Textbook of Bio-chemistry, chatterjee, 6th edition.
Please
avoid controversies and confusion.
Assume that you have got this question wrong
while calculating your marks
Controversy due to : 2 answers in Books
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41 The main
type of lipids found in tissues in starving individual in the end of first week
of fasting is
a Phospholipids
b
Triacylglycerol
c Cholesterol
d
Cholesteroal esters
Reference : Chaterjee 6th Edition Pages 373,466
Controversy due to : Concept not
clear in many books
Opinion
:
No need for confusion.
This question is different from the question that reads "Energy during 2nd week
of fasting is given by"
Please note
the question which asks about the the main type of lipids
found in tissue. This
question is different from the next question which deals about the lipids found
in circulation (blood or plasma). Phospholipids are integral components of
tissue (notably the bilayer of cell membranes). Let us see what Harper says in
24th Edition, Page 286. "As glucose utilisation diminishes in adipose tissue and
the inhibitory effect of insulin on lipolysis becomes less, fat is mobilised as
free fatty acid and glycerol." This means that TAG (Tri acyl glycerol) is split
into Glycerol and Free Fatty Acid (FFA). So TAG will be dimishing in Starvation.
"The free fatty acids are transported to the tissues, where they are either
oxidised or esterified". Thus it is clear that we have a cycle where TAG is
transformed into FFA, of which a part of FFA is oxidised and other part is again
esterified. Thus gradually TAG reserves diminish
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42 Which of the following lipoproteins would contribute to a measurement of
plasma cholesterol in a normal individual following a 12 hour fast ?
a Chylomicrons
b VLDL
c both VLDL & LDL
d LDL
Reference : Chaterjee 6th Edition Page 384
Controversy due to : Concept not
clear in many books
Opinion
:
No need for confusion.
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76 Work output of left ventricle is
a 5 times more than that of right
b same as that of right
c less than that of right
d 20 times more than that of right
Reference : Chaudhuri 2nd Edition Page 217.
Work =
Force x Distance
Work by
heart = Resistance x Cardiac Output (Stroke Volume)
Since,
Output of Both ventricles are equal and since the work is directly proportional
to the Resistance, the ration of work outputs will be the ration of the
resistances (blood pressure) of aorta and pulmonary artery, which is equal to 5
The
actual formula is W=Q.R + ((mv2)/2g)
Controversy due to : Not searching
the answer properly
Opinion
:
No need for confusion.
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111 In a surgical patient which of the following preoperative preparation
effectively reduces injection rate ?
a Antiseptic bathing of the patient's body
b Shorter
period of preoperative hospital stay
c Preoperative shaving five minutes before surgery
d
Antiseptic scrubbing of the surgeon's hands
Reference : Bailey and Love 24th Edition Page 126
Please note
that there is "no hard evidence" for the usefulness of Antiseptic bathing
and preoperative shaving "should be avoided except for aesthetic reasons."
That leaves us to choose between choice (b) and (d). Now As per bailey, "Short
preoperative stay lowers the risk of acquiring MRSA and multiply resistant
coagulase-negative staphylococci (MRCNS). So we choose (b) inspite of the fact
that (d) is also a correct option
Controversy due to : Not clear in
Bailey. Varied books give varied
answers. Spelling mistake in Question
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115 Most malignant type of Ca stomach is
a Proliferative growth
b
Ulcerative type
c Linitis Plastica
d
Superficial Spreading type
Reference : Robbins 7th Edition Page 825
Different
books give varied opinions
Controversy due to : 2 answers in Books
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122 Lignocaine toxicity includes
a Convulsions
b Asystole
c Methaemoglobinaemia
d All of
these
Answer : d All of these
Reference : Harrison
16th Edition Page 2590 Table 377-4 (Methemoglobinaemia) and K.D.Tripathi 5th
Edition Page and Katzung 9th Edition
Page 426
Methemoglobinemia results from exposure to chemicals that oxidize the ferrous
(Fe2+) iron in hemoglobin to the ferric (Fe3+) state. Concomitant oxidation of
hemoglobin protein may cause its precipitation in erythrocytes and consequent
hemolytic anemia, manifest as Heinz bodies and "bite cells," respectively, on
peripheral blood smear. Oxidizing agents include aniline and its derivatives,
aminophenols, aminophenones, chlorates, dapsone,
local anesthetics (particularly benzocaine), nitrites, nitrates, naphthalene, nitrobenzene and related
chemicals, oxides of nitrogen, phenazopyridine, primaquine and related
antimalarials, and sulfonamides.
Controversy due to : Limiting the
reference to one book. It is clearly given in Harrison that local anaesthetics
cause methemoglobinemia. The side effects of Local anaesthetics are described
under 4 headings in Katsung namely 1.CNS, 2. Neuro toxicity, 3.CVS and 4.
Hematological - Methemoglobinemia and 5. Allergic reactions.
Opinion
:
No need for confusion.
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126 The following are true about Ideopathic hypertrophic Aortic stenosis, except
a Autosomal dominant with complete penetrance
b Sudden
death
c Associated Mitral Regurgitation
d Verapamil
ameliorate symptoms
Reference Harrison, 15th edition Chapter 61
The
inehritance is Autosomal Dominance wih Incomplete penetrance
Controversy due to : Not looking for the
answer in standard textbooks. It is clearly given in Harrison about INCOMPLETE
penetrance
Opinion
:
No need for confusion.
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137 In the following, mention the drug which is not used in Erythematous Nodosum
Leprosum
a Steroids
b Chlorpromazine
c Thalidomide
d Adriamycin
Reference :
http://www.dgho.de/aktuell/17130_thalidomid-konsensus-050213.pdf
* VAD, Vincristin, Adriamycin (Doxorubicin), Dexamethasone
*
Thalidomide combined with vincristine, adriamycin and dexamethasone (T-VAD) is
effective treatment
Controversy due to : 2 answers in Books
Opinion
:
No need for confusion.Adriamycin
(Doxorubicin) is used in latest Trails
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139 In renal transplantation, the dreaded cause for graft loss is
a Acute rejection
b Vascular thrombosis of artery
c Vascular thrombosis of vein
d Anastomotic dehiscence.
Reference : Searching
Controversy due to :
2 answers in Books
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157 Oral rehydrating salt contains
a 15 gm/Litre of glucose
b 20 gm/Litre of glucose
c 25 gm/Litre of glucose
d 30 gm/Litre of glucose
Reference Park, 18th edition Page 179
Controversy due to :
the fact that WHO ORS gives 12 gm/litre
Opinion
:
No need for confusion. 12 gms is NOT given in any of the choices
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159 Cholera is characterised by all, except
a Effortless vomitting
b Painful watery ( Rice water ) stools
c Hypotension
d Acute Renal Failure
Reference : Page 18th edition Page 178, Nelson 15th Edition Chap 185 and
Ananthanarayanan 7th Edition Page 308
Controversy due to : the fact the of
missing "painful" while reading the choices
* Copious
effortless vomiting
* painless
watery diarrhoea
Opinion
:
No need for confusion.
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171 Regularly irregular pulse occurs in
a Sinus arrhythmias
b II degree heart block
c Multifocal extrasystoles
d None of these
Reference : Mathew 1st edition Page 272
Note that
2nd choice cannot be ruled out
Assume that you have got this question wrong
while calculating your marks
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172 Pleural effusion protein analysis less than 2 gms occurs in
a Meig's syndrome
b Pulmonary infarction
c Malignancy
d Pneumonia
Reference : No need to discuss this question. Consider this as wrong for you.
Assume that you have got this question wrong
while calculating your marks
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173 Beta-Blockers are contraindicated in hypertension management when associatd
with
a Congestive cardiac failure
b Renal failure
c Liver failure
d All of these
Reference : tripathi 5th Edition Page 127, 508, 516 and Katsung 9th edition,
Page 150
No "hard"
evidence for other choices.
Adverse
effects and Contraindications of Propanolol.
-
Accentuates
myocardial insufficiency
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Bradycardia
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COPD -
worsened
-
Prinzmetal's angina exacerabated
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Carbohydrate tolerance impaired in Prediabetics
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Altered
plasma lipid profile
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Upon Abrupt
withdrawal - rebound hypertension
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Partial and
Complete heart block
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Tiredness
and reduced capacity
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Cold hands
and feet
Contraindications of beta blockers.
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LVF
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Bradycardia,
Conduction defects
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Asthma, PVD
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Diabetic or
Borderline Glucose intolerance
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Abnormal
lipid profile
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Requirement
of optimum physical and mental activity
As per
katzung, The elimination of drugs like propanolol may be prolonged in liver
failure. Whether that is a contraindication or not is for you to decide
Assume that you have got this question wrong
while calculating your marks
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182 Hysterosalpingogram is useful in the diagnosis of all the following
conditions, except
a Cervical incompetence
b Tuberculous endometritis
c Asherman's syndrome
d Scar integrity in previous LSLC
Answer : b Tuberculous endometritis
Reference Page 518, Dutta (Gynaec), 2nd edition, Pg : 350, Dutta (OBS), 5th
edition and Shaw 11th Edition Page 548
Indications of HSG (Hysterosalphingography)
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To test the
patency of tubes in infertility
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To test the
patency of tubes following tuboplasty and to evalutate the result of tuboplasty
post operatively
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To confirm
diagnosis of secondary abdominal pregnancy
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To diagnose
cervical incompetence
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To detect
uterine malformation in recurrent midtrimester abortion
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To identify
translocated IUCD - whether intrauterine or extrauterine
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To detect
uterine abnormality such as fibroid polyps in menorrhagia septate and bicornuate
uterus in habitual abortion, and in
Asherman's Syndrome
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To study
the internal os in habitual abortion
Contraindications of HSG (Hysterosalphingography)
-
Presence of
Pelvic Infection
-
Suspected
Genital Tract Tuberculosis
-
Suspected
Pregnancy
-
Post-ovulatory
phase of menstruation
-
Iodine
sensitivity
Note :
We have changed the answer from (d) to (b)
However we
are still not sure how HSG will be useful in Condition (d)
Though HSG "should not be done for a suspected case" of Genital TB, but HSG "is
useful in the diagnosis"... This statement is similar to " Crepitus should not
be elicited in cases of fracture, but crepitus is useful in the diagnosis of
fracture"
Assume that you have got this question wrong
while calculating your marks
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