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Question 1

Warburg effect

Answer 1

Cancer cells - producing energy by high rate of glycolysis (200 times higher than the normal counterpart) followed by lactate fermentation in cytosol
Normal cells - low rate of glycolysis followed by oxidation of pyruvate in mitochondria as in most normal cells

Question 2

SIRS
Sepsis
Severe sepsis
Septic shock

Answer 2

SIRS 
Two or more of the following:
 • Temperature >38° C or <35° C
 • Heart rate >90 beats/min
 • Respiratory rate >20 breaths/min or Paco2 <32 mm Hg 
• WBC count >12,000 or <4000/mm3

Sepsis
SIRS + documented infection

Severe Sepsis
Sepsis + organ dysfunction or hypoperfusion (e.g., lacticacidosis, oliguria, altered mental status)

Septic Shock
Sepsis + organ dysfunction + hypotension (SBP <90 mm Hg or SBP >90 mm Hg with vasopressors)

Question 3

Reason for steroid use in septic shock and dose

Answer 3

Septic shock patients are frequently found to have adrenal insufficiency and resistance to glucocorticoid receptors .
Dose - hydrocortisone 50 mg 6th hourly iv, for 7 days, if the patient SBP remains less than 90 in spite of appropriate fluid and vasopressors therapy.

Question 4

Cloquet node

Answer 4

Superior most deep inguinal node.

Question 5

Side effects of octreotide

Answer 5

Gallbladder problems (>60%): Decreased gallbladder contractility, gallstones, cholecystitis, cholestatic hepatitis ->60%
Dysglycemia - 25%
Hypothyroidism -25%
Bradycardia - 25%
ECG changes-10%
Arrhythmia -9%

Question 6

Granulation tissue - constitute

Answer 6

Capillary bed
Fibroblasts, fibronectin,
Collagen (loosely arranged)
RBC, WBC, macrophages
Hyaluronic acid

Question 7

Features of healthy granulation tissue

Answer 7

Pulse full
Pin head appearance 
Punctate haemorrhage (bleeds on touch)
Pink colour
Painless

Question 8

Normal abdominal pressure in an adult ?
Intra abdominal pressure in a critically ill patient ?
Intra-abdominal hypertension ?
Abdominal compartment syndrome?

Answer 8

0-5 mm hg
5- 7 mm hg
>12 mm Hg
Persistent IAHT >20 mmHg + new onset organ failure

Question 9

Grading of intra-abdominal hypertension

Answer 9

Grade 1- 12-15 mmHg
Grade 2- 16- 20
Grade 3 - 21- 25
Grade 4 - 25 and above

Question 10

Child Turcot Pugh score

Answer 10

FACTOR NO. OF POINTS
1 2 3

Bilirubin (mg/dL). <2 2-3 >3
Albumin (g/dL) >3.5 2.8-3.5 <2.8 Prothrombin time (increased seconds) 1-3 4-6 >6
Ascites None Slight Moderate Encephalopathy None Minimal Advanced

Question 11

Name of the grading system for endoscopic evaluation of caustic ingestion?

Answer 11

Zargar grading

Question 12

Name of the gastric ulcer classification

Answer 12

Modified Johnson

Question 13

Modified Johnson classification of gastric ulcer

Answer 13

I   - Lesser curve at incisura 
II  - Gastric body with duodenal ulcer 
III  - Prepyloric 
IV  - High on lesser curve 
V   - Anywhere (drug induced)

Question 14

Zargar endoscopic grading of caustic injury

Answer 14

Grade 0 - a normal mucosa
grade 1 - only slight swelling and redness of the mucosa
grade 2A - presence of superficial ulcers, bleeding, and exudates
grade 2B - local or encircling deep ulceration
grade 3A - focal necrosis
grade 3B - extensive necrosis

Question 15

Fundal varices classification

Answer 15

Sarin’s classification
GOV -1 : esophageal varices extending into the lesser curvature
GOV -2 : extending into the greater curvature
IGV -1 : varices in gastric fundus alone
IGV-2: varices in fundus and other part of stomach.

Question 16

Splenic artery anatomy type

Answer 16

Magistrate type (30%)
Distributed type (70%)

Question 17

Splenic artery branches

Answer 17

Superior polar artery
Superior terminal artery 
Middle terminal artery 
Inferior terminal artery 
Inferior polar artery

Question 18

Eastern cooperative oncology group (ECOG) performance status

Answer 18

• 0: fully active and is able to carryout normal activities without any restriction.
• 1: Symptoms restrict strenuous activity but is able to carryout light sedentary activities.
• 2: Ambulatory but unable to carryout normal activities.. Up and about >50% waking hours.
• 3: only limited self care. confined to bed for >50% of waking hours.
• 4: completely confined to bed , disabled, needs assistance.

Question 19

BMI

Answer 19

Underweight : <18. 5
normal :—18. 5–24. 9
overweight : —25–29. 9
obese :—30 or higher

Question 20

Bilirubin

Answer 20

Normal - 0.2-0.8 mg%
Latent jaundice - 1 to 1.9 mg%
Clinical jaundice - more than 2mg%

Question 21

Degree of clubbing

Answer 21

1st degree: There is only increased fluctuation of the nail bed.
2nd degree: in addition to fluctuation, there is increased anteroposterior and transverse diameter of the nail.
3rd degree: Above changes with increased pulp tissue in the terminal phalanges.
4th degree: combination of above changes with subperiosteal thickening of bones of wrist and ankle (hypertrophic osteoarthropathy)

Question 22

Pyrexia

Answer 22

Normal temperature- 99 degree Fahrenheit
Pyrexia - more than 100.4
Hyper pyrexia - more than 106
Hypothermia - less than 95