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SRI VENKATESWARA INSTITUTE OF MEDICAL SCIENCES

Alipiri Road, Tirupati, Chittoor District

All the candidates are requested to send objections on the question paper and
key in the format given in the following page. Kindly download the form, fill it up and to
send to the following e.mail address only. Send proof in favour of your objection as an
attachment. Please use separate form for each objection.
svimstirupatiexamsection@gmail.com
The objections without on the stipulated format and with no valid reasons and
relevant proof will not be entertained. The candidates have to send their objections
before 5.00 P.M of 26th June, 2013. Any objections received after 5.00 P.M of 26th
June, 2013 will not be entertained.

Controller of Examinations

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DM/MCh ENTRANCE EXAMINATION 2013
FORMAT ON OBJECTIONS TO QUESTION AND KEY
Note: To fill separate form for each question.

Name of the candidate

Roll Number

Speciality applied for

1) Question number (to which the objection pertains):

2) Nature of objection (Tick below what is applicable):

a) The question is not properly framed or is ambiguous
b) There are more than one correct answers
c) All provided choices are wrong
d) Correct answer is different from the one indicated in the released key
e) Any other
3) Give details

4) Attach scanned copy of proof in favour of objection:

a) Statement in a standard text book (indicate name of book, author, edition no.,
Page no.)
b) Statement in a peer reviewed journal article (indicate journal name, index no.,
year and Page no.)
c) Any other

Note: Objection without valid reason and relevant proof will not be entertained.

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1) Positron Emission Tomography depends on the
A. Density of the tissue
B. Uptake of glucose by the cells
C. Uptake of amino acids by the cells
D. Reflexion at tissue interface
2) The liver segments to the right of Cantiles line are
A. 4,5,6 and 7
B. 5,6,7, and 8
C. 6,7 and 8
D. 3,4,5 and 6
3) Rutherford Morisons pouch is
A. Right sub-hepatic space
B. Right sub-phrenic space
C. Left sub-hepatic space
D. Left sub-phrenic space
4) Pelvic abscess is best drained
A. Through suprapubic route
B. By laparotomy
C. Through the perineum
D. Through the rectum
5) Which of the following does not form the boundary for the femoral ring
A. Inguinal ligament
B. Astley Cooper ligament
C. Femoral vein
D. Transversalis fascia
6) Richters hernia is hernia with
A. Meckels diverticulum
B. A portion of the circumference of the intestine
C. A W-shaped loop of the intestine
D. Omentum
7) The incision first described by McArthur for appendicectomy is
A. Transverse skin crease incision
B. Paramedian incision
C. Gridiron incision
D. Midline incision
8) Amyand hernia is inguinal hernia that contains
A. Appendix
B. Ovary
C. Meckels diverticulum
D. Sigmoid colon
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9) In liver resection, left lateral segmentectomy involves removal of
A. Segments 1,2 and 3
B. Segments 2 and 3
C. Segments 2, 3 and 4
D. Segments 3 and 4
10) Which of the following is not true about Fibro-lamellar hepato-cellular carcinoma
A. Is commonly seen in younger age
B. Usually well demarcated and encapsulated
C. Produces high levels of AFP
D. Is associated with long term survival after complete resection
11) The Model for End stage Liver Disease scale (MELD) does not include
A. Bilirubin
B. Creatinine
C. INR
D. Albumin
12) Isolated metastasis in the liver that can be resected with, well documented, long term
survival is from
A. Colon
B. Stomach
C. Pancreas
D. Oesophagus
13) Which of the following is not true about Hepatoblastoma
A. Most common primary hepatic tumour of childhood
B. May be associated with familial polyposis syndrome
C. Usually occurs after the age of five
D. Majority of cases show elevated AFP
14) Child-Pughs criteria for assessment of hepatic functional reserve include the following
except
A. Ascites
B. Albumin
C. Prothrombin time
D. Creatinine
15) The most sensitive test for detection of gastric varices is
A. Upper GI endoscopy
B. Endoscopic ultrasound
C. Transabdominal ultrasound
D. CT scan
16) According to Laplace law, the esophageal variceal wall tension is related to the following
except
A. Transmural pressure
B. Varix radius
C. Variceal wall thickness
D. Variceal strength
contd

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17) Houstans valves are seen in
A. Rectum
B. Cystic duct
C. Great saphenous vein
D. Ascending colon
18) Superior Rectal artery
A. Is continuation of inferior mesenteric artery
B. Arises from internal pudendal artery
C. Arises from internal iliac artery
D. Arises directly from aorta
19) Which of the following is not true about Familial Adenomatous Polyposis?
A. Is autosomal dominant
B. Gene responsible lies on chromosome 15
C. Is a premalignant condition
D. Presents with multiple colon and rectal polyps at puberty
20) Genetic disorder associated with increased risk for peri-ampullary carcinoma is
A. Osler Weber Rendu disease
B. Turners syndrome
C. Cowdens disease
D. Familial adenomatous polyposis syndrome
21) Which is not part of the micelles complex formation that helps to maintain cholesterol in
solution?
A. Cholesterol
B. Mucin
C. Lecithin
D. Bile salt
22) Absolute contraindication for Trans-jugular Intrahepatic Portosystemic Shunt (TIPS) is
A. Active variceal bleed after failed sclerotherpy
B. Right heart failure
C. Child C cirrhosis
D. Intractable ascites
23) In Sengstaken-Blakemore tube, used for tamponade in oesophageal varceal bleed, which of
the following is not present
A. Gastric balloon inflation tube
B. Oesophageal balloon inflation tube
C. Gastric aspiration tube
D. Oesophageal aspiration tube
24) Bile secretion is increased by all except
A. Secretin
B. Cholecystokinin
C. Gastrin
D. Splanchnic nerve stimulation
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25) Rectum is separated from vagina by
A. Denonvilliers fascia
B. Waldeyers fascia
C. Scarpas fascia
D. Campers fascia
26) Which of the following is not true about Primary Sclerosing Cholangitis
A. Strictures occur only in intra hepatic bile ducts
B. Has strong association with ulcerative colitis
C. Associated with increased risk of cholangio-carcinoma
D. Is a progressive disease resulting in biliary cirrhosis
27) Which does not form the boundary of Calots triangle?
A. Cystic duct
B. Cystic artery
C. Inferior border of liver
D. Common hepatic duct
28) Type III Choledochal cyst as per Todanis classification is
A. Fusiform dilatation of extra hepatic biliary tree
B. Dilatation confined to intra hepatic bile ducts
C. Diverticular dilatation of extra hepatic biliary tree
D. Cystic dilatation of the intra-duodenal portion of CBD
29) Islet tissue is frequently present in ectopic pancreas when it is located in
A. Colon
B. Appendix
C. Meckels diverticulum
D. Stomach
30) Serum Ascites Albumin Gradient (SAAG) greater than 1.1 gm/dl is seen in
A. Tuberculosis peritonitis
B. Cirrhosis
C. Biliary ascites
D. Peritoneal carcinomatosis
31) Carcinoid tumor arises in
A. Kulchitsky cells of crypts of Lieberkuhn
B. Intestitial cells of Cajal
C. Paneth cells
D. Goblet cell
32) Which of the following acts as a high resistance water shed between porto-azygos system.
A. Gastric zone
B. Truncal zone.
C. Palisade zone
D. Perforating zone.
Contd

33) In abdomino perineal excision of rectum

A. Denonvilliers fascia is removed
B. Anal sphincter is preserved
C. Flush ligation of superior mesenteric artery is done
D. Mesorectum is partly removed
34) In Hartmanns operation for rectal cancer
A. Resection and coloanal anastomosis is done
B. Resection and colorectal anastomosis is done
C. Rectum is excised, distal stump closed and colostomy performed
D. Transverse colostomy is done
35) Cholecystokinin release is not stimulated by
A. Intra-luminal fat
B. Intra-luminal amino acids
C. Gastric acid
D. Bile
36) Inokuchi shunt is
A. Distal spleeno-renal shunt
B. Coronary vein inferior vena caval shunt
C. Small diameter interposition porta caval shunt
D. Superior mesenteric vein inferior vena caval interposition shunt
37) Familial adenomatous polyposis is not associated with
A. Epidermoid cyst
B. Osteomas
C. Desmoid tumours
D. Pigmented lesions of skin
38) Which is not true about Portal Hypertensive Gastropathy (PHG)
A. More common after eradication of varices
B. Mainly involves the antrum
C. Granular mucosa and cherry red spots seen in endoscopy.
D. Is associated with increased mucosal perfusion than congestion.
39) The best tool for localization of bleeding in acute upper GI hemorrhage is
A. Angiography
B. Esophago Gastro Duodenoscopy
C. Isotope Tagged RBC scan
D. Barium contrast study
40) Charcots triad of symptoms signify
A. Acute cholecystitis
B. Acute cholangitis
C. Severe obstructive jaundice
D. Acute pancreatitis
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41) In Delormes operation for rectal prolapse
A. The mobilized rectum is fixed to presacral fascia with a mesh
B. Perineal rectosigmoidectomy is done
C. Rectal mucosa is removed circumferentially and the muscle plicated
D. Sigmoid resection and mesh fixation is done
42) Duodenal diverticularization is done for
A. Grade III pancreatic injuries
B. Grade IV and V pancreatic injuries
C. Grade II pancreatic injuries
D. Extensive gastric antral injury
43) Non-epthelial cancers of the pancreas include the following except
A. Leiomyosarcoma
B. Plasmacytoma
C. Acinar cell carcinoma
D. Lymphoma
44) Hereditary spherocytosis is diagnosed by the following except
A. Spherocytes in peripheral smear
B. Increased reticulocyte count
C. Decreased osmotic fragility
D. Negative Coombs test
45) Internal sphincter of anal canal is
A. Distal continuation of the longitudinal muscle of rectum
B. Involuntary non-striated muscle
C. In a tonic state of contraction
D. Innervated by autonomic nervous system
46) Duct of Luschka is
A. Cholecysto hepatic duct
B. Right hepatic duct
C. Left hepatic duct
D. Cystic duct
47) Venus drainage from the caudate lobe of the liver is
A. Directly into the inferior vena cava
B. By right hepatic vein
C. By middle hepatic vein
D. By left hepatic vein
48) Scarpas fascia of the abdominal wall
A. Lies between the skin and Campers fascia
B. Is made up of subcutaneous fat
C. Is contiguous with the fascia lata
D. Lies deep to the external oblique muscle

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49) The clinical hallmarks of Short Bowel Syndrome include the following except
A. Diarrhoea
B. Fluid and electrolyte deficiency
C. Malnutrition
D. Decreased incidence of gall stones
50) The genetic alterations identified in gastric cancer include the following except
A. Mutation of APC gene
B. Reduction in the cell adhesion molecule E-Cadherin
C. Activation of P53 gene
D. Overexpression of c-erbB2 oncogene
51) Which of the following is not true about Retained Antrum Syndrome?
A. Can occur after Billroth II anastomosis
B. Associated with hypogastrinemia
C. Technetium scan may help in diagnosis
D. Conversion to Billroth I reconstruction is indicated
52) Which of the following is not true about Angiodysplasia of the colon
A. More common in splenic flexure
B. May be associated with aortic stenosis
C. Colonoscopy identifies the lesions
D. Angiography shows early venous filling or slow emptying of veins
53) Hypergastrinemia does not occur in
A. Retained excluded antrum
B. Gastric outlet obstruction
C. Short Gut Syndrome
D. Megaloblastic anaemia
54) The most common gastric lymphoma is
A. Extranodal marginal cell lymphoma
B. Burkitts lymphoma
C. Follicular lymphoma
D. Diffuse large B cell lymphoma
55) Borchardts triad in gastric volvulus does not include
A. Haemetemesis
B. Acute severe upper abdominal pain
C. Recurrent retching with little vomitus
D. Inability to pass a nasogastric tube
56) Boerhaave Syndrome is perforation of oesophagus due to
A. Tear during removal of foreign body
B. Vomiting against closed glottis
C. Rupture during balloon dilatation
D. Oesophageal tumour dilatation

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57) Epidermoid carcinoma of anal canal of <2cms size and node negative is best treated by
A. Chemoradiation
B. Radiation therapy alone
C. Chemo therapy alone
D. Abdomino perineal excision of rectum
58) In Pancreas Divisum
A. Dorsal pancreas drains through Vaters papilla
B. Ventral pancreas drains through Vaters papilla
C. Ventral pancreas drains through duct of Santorini
D. Ventral pancreas drains at minor papilla
59) Which is not true about Helicobactor pilori?
A. Is spiral gram negative rod
B. Often Colonizes the oesophagus.
C. Splits urea into ammonia and bicarbonate
D. Is associated with increased gastrin levels
60) The invasive tests for the diagnosis of H.pilori are the following except
A. Carbon labeled urea breath test
B. Rapid urease test
C. Histology
D. Culture
61) Which is not true about Zollinger Ellison Syndrome
A. Gastric acid hyper secretion
B. Beta cell tumors of the pancreas
C. Severe peptic ulcers
D. Hypergastrinemia
62) The right vagus nerve supplying the stomach
A. Lies anteriorly at the GE junction
B. Gives off the hepatic branch
C. Continues as the anterior nerve of Latarjet
D. Gives off the nerve of Grassi
63) Which of the following is not a symptom of Early Dumping Syndrome?
A. Hypoglycemia
B. Nausea & vomiting
C. Cramping abdominal pain
D. Explosive diarrhoea
64) In TMN classification of carcinoma of stomach, stage III B is
A. T3 N1M0
B. T3N2M0
C. T4N0M0
D. T4N1-3M0
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65) Mallory Weiss Tear
A. Is disruption of gastric mucosa on the greater curvature
B. Is associated with massive bleeding
C. May occur during coughing or straining
D. Surgery is often indicated to control bleeding.
66) Which is not true about Arc of Riolan
A. Anastomotic vessel between proximal SMA with proximal IMA
B. Also known as meandering mesenteric artery
C. Highly variable in size
D. Connects the foregut vessel with midgut vessel
67) Courvoisiers sign is
A. Right upper quadrant tenderness exacerbated during inspiration
B. A palpable non-tender gall bladder
C. Periumbilical bruising
D. Shoulder pain on inspiration
68) Charcots triad does not include
A. Pain abdomen
B. Hypotension
C. Jaundice
D. Fever with rigor
69) Fluid from a Pancreatic Pseudocyst does not have
A. High amylase level
B. Low CEA level
C. Dysplastic cells
D. Inflammatory cells
70) Carcinoid syndrome of appendicular carcinoid include the following except
A. Asthmatic attack
B. Cutaneous flushing
C. Constipation
D. Hepatomegaly
71) Which of the following is found in Littres hernia?
A. Jejunal diverticulum
B. Ovary
C. Meckels diverticulum
D. Sigmoid colon
72) Signs to elicit in appendicitis are the following except
A. Murphys sign
B. Pointings sign
C. Rovsings sign
D. Psoas sign
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73) The drug that is most effective in advanced gastro intestinal stromal tumour is
A. Cyclophosphamide
B. Doxorubicin
C. Imatinib
D. Infliximab
74) The diagnostic features of Systemic Inflammatory Response Syndrome include the
following except
A. Temparature >38 C
B. Respiratory rate < 20 / min
C. Heart rate > 90/ min
D. White cell count <4000 c.mm
75) In enterocutaneous fistula spontaneous closure often occurs
A. In High output fistula
B. When bowel discontinuity is present
C. In lateral fistula
D. In Fistula with distal obstruction
76) Best investigation for staging of neuroendocrine tumours is
A. Ultrasound
B. MRI
C. Octriotide scan
D. CT scan
77) Pringles Manoeuvre is
A. Mobilization of the duodenum
B. Compression of the portal triad
C. Mobilization of the splenopancreatic pedicle
D. Mobilization of the right colon
78) Double bubble sign on plain X-Ray is seen in
A. Oesophageal atrecia
B. Duodenal atrecia
C. Ileal atrecia
D. Imperforate anus
79) The patent intestinal end of the Vitellointestinal duct persists as
A. Omphalomesenteric cyst
B. Urachal cyst
C. Umbilical adenoma
D. Meckels diverticulum
80) Dysphagia lusoria is due to
A. Enlarged right atrium
B. Oesophageal diverticulum
C. Aberrant right subclavian artery
D. Oesophagial web

Contd

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81) Which is not true about annular pancreas?

A. Is due to failure of complete rotation of the ventral pancreatic bud
B. Surrounds the second or third part of duodenum
C. Child presents with vomiting
D. Is treated by gastro jejunostomy
82) Extraintestinal manifestations of Crohns disease that does not improve after resection of the
diseased bowel is
A. Arthritis
B. Erythema Nodosum
C. Primary sclerosing cholangitis
D. Pyoderma gangrenosum
83) Which is not true about cystic fibrosis
A. Results from mutation within the cystic fibrosis transmembrane regulator gene
B. Is autosomal dominant
C. Associated with abnormal chloride transport
D. May involve the salivary glands
84) Grade IIa of Forrest classification of endoscopic findings in peptic ulcer is
A. Acute non-pulsatile bleeding
B. Ulcer with clean base
C. Adherent clot
D. Visible vessel with no bleed
85) Gastric acid secretion is increased by the following except
A. Histamine
B. Gastrin
C. Somatostatin
D. Vagal stimulation

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86. In Swenson procedure for Hirschsprung's disease,

A. Aganglionic bowel is removed and coloanal anastomosis done
B. Aganglionic segment is left behind and normal bowel anastomosed to posterior
wall of rectum close to anal canal
C. Endorectal mucosal dissection done and coloanal pull through of normal colon
through the muscle cuff done
D. Laparotomy and diverting colostomy is done
87. During normal development of the human embryo the herniated midgut returns to the
abdominal cavity by
A. 11th week of gestation
B. 20th week of gestation
C. 6th week of gestation
D. 24th week of gestation
88. Bochdalek's hernia (congenital Diaphragmatic hernia) in situated in
A. Postero lateral aspect of diaphragm
B. Antero medial aspect of diaphragm
C. Thro the central portion of diaphragm
D. Antero lateral aspect of diaphragm
89. Grey Turner's sign in acute pancreatitis is
A. Peri umbilical ecchymosis
B. Tender Sub cutaneous induration due to fat necrosis
C. Flank ecchymosis
D. Erythema of epigastric skin
90. Ovarian-like stroma is seen in
A. Mucinous tumour of pancreas
B. Serous cyst adenoma of pancreas
C. Intraductal papillary mucinous tumour of pancreas
D. Solid and pseudo papillary tumour of pancreas
91. Paneth cells of small intestine produce
A. Mucus
B. Lysozyme
C. Neurotensin
D. Enteroglucagon
92. The following are true about Superior mesenteric artery syndrome, except
A. The III part of the duodenum is compressed by the artery
B. Patients present with vomiting & weight loss
C. Surgical management of choice is Posterior Gastro jejunostomy
D. May be associated with placement of body cast

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93. Erosion of splenic artery into a communicating pseudocyst of pancreas may cause the
following except
A. Typically cause haemosuccus pancreaticus
B. Presents with abdominal pain
C. Angiography is often diagnostic
D. Pancreatico-duodenectomy often results in cure page
94. Transjugular intrahepatic portosystemic shunt is between
A. Portal vein and IVC
B. Portal vein and hepatic vein
C. Superior mesenteric vein and IVC
D. Left coronary vein and IVC
95. The first line treatment of low grade malt lymphoma confined to gastric wall is S
A. Radiotherapy only
B. Chemotherapy with radiation
C. H pylori eradication and follow up
D. Surgery followed by chemotherapy
96. When the right hepatic artery arises from the superior mesenteric artery it courses
A. Posterior and to the right of the portal vein
B. Anterior to portal vein
C. Anterior to common bile duct
D. To the left of the portal vein
97. Common late complications of colostomy include all except
A. Parastomal hernia
B. Prolapse
C. Necrosis of stoma
D. Stenosis
98. The cell of origin of gastro intestinal stromal tumour is
A. Epithelial cell
B. Enterochromaffin cell
C. Lymphocyte
D. Interstial cell of Cajal
99. Vitamin B12 insufficiency occurs after the following surgical procedures except
A. Gastric resection
B. Gastric bypass
C. Ileal resection
D. Colonic resection
100. Common bariatric surgery where the mechanism of action is " restrictve" include all except
A. Laparoscopic gastric banding
B. Jejunoileal bypass
C. Sleeve gastrectomy
D. Vertical banded gastroplasty
***

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SRI VENKATESWARA INSTITUTE OF MEDICAL SCIENCES, TIRUPATI
M.Ch SURGICAL GASTROENTEROLOGY
ENTRANCE EXAMINATION, 2013 - KEY
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