Surgery Year 3 22 January 2013 (Omega 6)

MCQ SURGERY YEAR 3 (22ND JANUARY 2013) 1)

True regarding homeostasis

A.

Is a stable state of a normal body

B.

The The kidn kidney eys s are are esse essent ntia iall in mai maint ntai aini ning ng hom homeo eost stas asis is at at a norm normal al lev level el

C.

Elec Electi tive ve surg surger ery y sho shoul uld d caus cause e litt little le dis distu turb rban ance ce to to hom homeo eost stas asis is

D.

Emer Emerge genc ncy y sur surge gery ry sho shoul uld d cau cause se litt little le dis distu turb rban ance ce to hom homeo eost stas asis is

E. Retu Return rn to to norm normal al hom homeo eost stas asis is fol follo lowi wing ng sur surge gery ry dep depen ends ds upo upon n the the pres presen ence ce of co-morbid conditions Answers : A.

True – the milieu interior of Claude Bernard

B. True - All vital organs – the brain, heart, lung, kidney and to a lesser extent, the spleen – play important role in its maintenance C. True - in elective situation, situation, patient is always optimized prior to any any operation, thereby minimizing the homeostatic disturbance D. False - Disturbance in the homeostasis to some degree occurs in emergency surgery, depends upon extent of injury, sepsis etc E. True - if patient has co morbid conditions, post operatively the return to normal homeostasis would take longer than in those with no co-morbidity. In such cases, ICU is essential REF : Bailey & Love 25th edition page 3

2)

In stre stress ss resp respon onse se,, whi which ch of the the fol follo lowin wing g sta state teme ment nts s are are TRUE TRUE::

A.

It is graded

B.

Nitr Nitrog ogen en meta metabo bolis lism m and and excr excret etio ion n are are rela relate ted d to to deg degre ree e of of str stres ess s

C. In suc such h a situ situat atio ion n ther there e are are phys physio iolo logi gica cal, l, met metab abol olic ic and and imm immun unol olog ogic ical al changes D.

The changes cannot be modified ied

E.

The The medi mediat ator ors s for for the the inte integr grat ated ed res respo pons nse e are are init initia iate ted d by the the pitu pituita itary ry

Answers : A.

True

B.

True – in direct proportion to injury

C.

True – True – pyrexia,tachycardia pyrexia,tachycardia and tachypnoea etc

D. False – can be modified by anticipating complications and preventing them by management in ICU E.

True

Bailey&Love 25th edition page 4 & 5

3)

Whic Which h of of the the foll follow owin ing g reg regar ardi ding ng bloo blood d pre press ssur ure e in in sho shock ck are are TRU TRUE: E:

A.

Hypertensive elderly presents presents with a ‘normal’ blood pressure pressure

B.

Child Childre ren n are are able able to to main mainta tain in blo blood od pre press ssur ure e unti untill the the fina finall stag stages es of of shoc shock k

C.

Hypo Hypote tens nsio ion n is one one of the the firs firstt sign signs s of shoc shock k

D.

Beta Beta-b -blo lock cker ers s pre preve vent nt a tac tachy hyca card rdic ic resp respon onse se

E. Bloo Blood d pres pressu sure re is is incr increa ease sed d by red reduc ucti tion on in in stro stroke ke vol volum ume e and and peri periph pher eral al vasoconstriction Answers : A.

True

B.

True

C.

False – may not be seen until shock is well established.

D.

True

E. False – heart compensate to maintain CO by increasing both the rate and stroke volume. Bailey & Love 25th edition page 15

4)

Whic Which h of the the foll follow owin ing g are are TRU TRUE E reg regar ardi ding ng ino inotr trop opic ic sup suppo port rt in in shoc shock? k?

A.

This is the first line therapy in hypovolemic hypovolemic shock

B.

Pheny Phenylep lephrin hrine e and noredr noredrena enaline line are indica indicated ted in distri distribut butive ive shock shock states states

C. Dobu Dobuta tami mine ne is is the the age agent nt of of choi choice ce in in card cardio ioge geni nic c shoc shock k or sept septic ic sho shock ck complicated by low cardiac output D.

Vasopr Vasopress essin in is used used when when the vasod vasodila ilatat tation ion is resist resistant ant to catech catechola olamin mines es

E.

Use Use in in the the abse absenc nce e of of ade adequ quat ate e pre prelo load ad may may be be har harmf mful ul

Answers : A.

False – first line therapy ; IV access and administration of fluids

B.

True

C.

True

D.

True

E.

True

Bailey & Love 25th edition page 17

5)

Whic Which h of of the the foll follow owin ing g sta state teme ment nts s abo about ut bloo blood d tran transf sfus usio ion n are are TRUE TRUE::

A.

A hemoglobin level of 10g/dl 10g/dl or less is considered a typical typical indication

B. Fresh Fresh frozen frozen plasm plasma a (FFP (FFP)) is is cons conside idered red as a firs firstt line line therap therapy y in in coag coagula ulatio tion n hemorrhage C.

Cryo Cryopr prec ecip ipit itat ate e is is use usefu full in low low fib fibri rino noge genn-st stat ates es

D.

Plate latele lets ts have a shelf elf life life of 3 weeks eeks

E. Patie Patient nts s can can prepre-do dona nate te blo blood od up up to 3 week weeks s befo before re sur surge gery ry for for aut autol olog ogou ous s transfusion Answers : A.

False

B.

True

C.

True

D.

False

E.

True

Bailey & Love 25th edition page 20 & 21

6)

Facto actors rs whic which h aff affec ectt wou woun nd hea heali lin ng in inclu clude:

A.

Vascular insufficiency

B.

Diabetes mellitus

C.

Malnutrition

D.

Site of wound

E.

Smoking

Answers : ALL TRUE (Bailey&Love 25th edition page 24) 7) Pressure sores occur in the following areas A.

Sacrum

B.

Heel

C.

Occiput

D.

Greater Trochanter

E.

Ischium

Answer : A.

True. True. ( Bailey & Love 24th edition pg91)

B.

True. ( Bailey & Love 24th edition pg91)

C.

True ( Bailey & Love 24th edition pg91)

D.

True( True( Bailey & Love 24th edition pg91)

E.


8. Which are the following is a natural barrier to infection A.

Intact epithelial surface

B.

High gastric pH

C.

Antibodies

D.

Antibiotics

E.

Macrophages

Answer:

A.


B.

False ( Bailey & Love 24th edition pg119)

C.


D.

False ( Bailey & Love 24th edition pg119)

E.


9. Which are the following are risk factors for wound infection. A.

Poor perfusion

B.

Use of skin clips for wound closure

C.

Poor surgical technique

D.

Not us using pro prop phylac lactic an antibiot iotic

E.

Uremia

Answer: A.


B.

False( False( Bailey & Love 24th edition pg119)

C.


D.


E.


10. Which are the following statements are TRUE regarding abscesses A.

Staph aureus is one of the the most common causative organisms

B.

The absce bscess ss wall wall is comp omposed osed of epith ithelium lium

C. Most Most wou wound nd sit site e absc absces esse ses s occu occurr befo before re the the pati patien entt is dis disch char arge ged d from from the the hospital D.

Antib Antibio ioti tics cs are are ind indic icat ated ed if ther there e is is evi evide denc nce e of of cel cellu luli litis tis

E.

Actin ctinom omyc yces es causes uses an acute cute abs abscess

Answer

A.

True (Bailey & Love 24th edition pg122)

B. False – surrounded by an acute inflammatory response and a pyogenic membrane composed of fibrinous exudates. (Bailey & Love 24th edition pg122) C. False -75% may present after patient discharged (Bailey & Love 24th edition pg122) D.


E. False – Actinomyces causes chronic abcess (Bailey & Love 24th edition pg122)

11. Which are the following statements regarding cellulitis are TRUE A.

This is non-suppurative non-suppurative invasive infection of tissues

B.

It is poorly localized

C.

It is comm common only ly caus caused ed by Clos Clostr trid idiu ium m per perfr frin inge gens ns

D.

Systemic sign igns are not present

E.

Bloo lood cultu lture is usually positi itive

Answer: A.

True(Bailey True(Bailey & Love 24th edition pg122)

B.

True(Bailey True(Bailey & Love 24th edition pg122)

C.


D.

False(Bailey False(Bailey & Love 24th edition pg123)

E.

False(Bailey False(Bailey & Love 24th edition pg123)

12. Surgical risks in a diabetic patient patient mention include A.

Infection

B.

Myocardial in infarction

C.

Pressure sore

D.

Poor wound healing

E.

Pain control

Answer: A. True (Management of Adults with Diabetes undergoing surgery –NHS diabetes April 2011) B. True(Management True(Management of Adults with Diabetes undergoing surgery –NHS diabetes April 2011) C. True(Management True(Management of Adults with Diabetes undergoing surgery –NHS diabetes April 2011) D. True(Management True(Management of Adults with Diabetes undergoing surgery –NHS diabetes April 2011) E. False (Management of Adults with Diabetes undergoing surgery –NHS diabetes April 2011)

13.risk factor for thrombosis indicate A.

young age

B.

pregnancy

C.

smoking

D.

traumna

E.

malignancy

Answer A.

false.old false.old age (concise textbook of surgery page by s.das 7 edition:272)

B.

true. true. (concise textbook of surgery page by s.das 7 edition:272)

C.

true(concise true(concise textbook of surgery page by s.das 7 edition:272)

D.


E.


14.cause of hypoproteinaemia hypoproteinaemia

A.

burn

B.

SIDH

C.

liver disease

D.

analbuminaemia

E.

AIDS

Answer A. true.due true.due to increase capillary permeability permeability and infection(concise infection(concise textbook of surgery page by s.das 7 edition:65) B. false.not false.not asosiated with albumin but fluid overload and albumin level normal(http://en.wikipedia.org/wiki/Syndrome_of_inappropriate normal(http://en.wikipedia.org/wiki/Sy ndrome_of_inappropriate_antidiuretic_hormone _antidiuretic_hormone _secretion) C. true.production true.production of albumin by the liver(concise textbook of surgery page by s.das 7 edition:816) D. true.geneticlly true.geneticlly inherited metabolic defect characterised by defect in production of albumin(http://en.wikipedia.or albumin(http://en.wikipedia.org/wiki/Analbuminaemia) g/wiki/Analbuminaemia) E. false.not false.not associated with albumin production. ( http://en.wikipedia.org/wiki/Aids)

15.which of the following statements are true t rue regarding DEEP VEIN THROMBOSIS A.

obase patient prone to DVT DVT

B.

clin linica ical diagnosis very obvious

C.

hip hip and and knee knee repl replac acem emen entt sur surge gery ry are are pre predi disp spos osin ing g fact factor or

D.

conf confir irma mati tion on by veno venorg rgra rapy py and/ and/or or dupl duplex ex drop drople lerr ima imagi ging ng

E.

opti optimu mun n hyd hydra rati tion on is esse essens nsia iall to prev preven entt DVT DVT

Answer A. A.

true. (concise textbook of surgery page by s.das 7 edition:272)

B. true. true. swelling.tenderness,homans’sign(concise swelling.tenderness,homans’sign(concise textbook of surgery page by s.das 7 edition:274)

C. true.immobility true.immobility after surgery (concise textbook of surgery page by s.das 7 edition:274) D.

true.(concise true.(concise textbook of surgery page by s.das 7 edition:277)

E. false.not associated with DVT (concise textbook of surgery page by s.das 7 edition:279) 16.which of the following statement are true A.

rest pain is found commonly found in the calf in critically limb ischemia ischemia

B.

rest rest pain pain comm common only ly reli reliev eve e by by get getti ting ng out out of of the the bad bad

C.

hypo hypoae aest sthe hesi sia a is a feat featur ure e of preg pregan angr gren enou ous s

D.

abse absenc nce e of of foo foott pul pulse ses s ind indic icat ated ed impl implie ies s crit critic ical al isch ischem emia ia

E.

para paraly lysi sis s of of the the leg leg sug sugge gest st an acut acutel ely y isc ische hemi mic c leg leg

Answer A.


B. true.leg true.leg below the level of heart will reduce the pain.(concise textbook of surgery page by s.das 7 edition:189) C. false.not false.not hypoesthesia but hyperaesthesia. .(concise textbook of surgery page by s.das 7 edition:190) D.


E. false.it false.it suggest chonic ischemic leg.(concise textbook of surgery page by s.das 7 edition:190)

17.symptom of hyperparathyroidism hyperparathyroidism include A.

constipation

B.

anorexia

C.

polydipsia and polyuria

D.

pathologic bo bone fr fracture

E.

anxienty

Answer A. true.it true.it due to hypercalcaemia(concise hypercalcaemia(concise textbook of surgery page by s.das 7 edition:557) B. false.not false.not associated with appetide(concise textbook of surgery page by s.das 7 edition:557) C. true.hypercalcaemia cause deposition of calcium crystal on the renal tubule result in polyuria and polydipsia. (concise textbook of surgery page by s.das 7 edition:557) D. true.due true.due to increase bone resorption(concise textbook of surgery page by s.das 7 edition:557) E. false.not false.not associated with CNS. (concise textbook of surgery page by s.das 7 edition:557)

18.complication of blood transfusion are: A.

hemolytic reaction

B.

fluid overload

C.

dis dissemin eminte ted d int intra rav vascul scula ar coag coagu ulati latio on

D.

hypercalcemia

E.

infection

Answer A. true.due true.due to incompatibility.(concise textbook of surgery page by s.das 7 edition:51) B. true.in true.in massive transfusion. (concise textbook of surgery page by s.das 7 edition:52) C. true.in true.in massive transfution transfution due to failure of coagulation. coagulation. (concise (concise textbook of surgery page by s.das 7 edition:53) D. false.hypocalcemia false.hypocalcemia not hypercalcemia. (concise textbook of surgery page by s.das 7 edition:53) E. true.serum true.serum hapatits,AIDS,bacterial infection commonly occur. (concise textbook of surgery page by s.das 7 edition:52)

19. A patient of necrotising fascilitis post debridement, had skin grafting. TRUE regarding the blood supply of the graft is: A.

Skin blood supply supply comes from muscle and fascial fascial perforating vessels

B.

Direc irectt cut cuta aneou neous s ves vesse sels ls als also con contr trib ibut ute e

C.

Imbi Imbiba bati tion on is the the pro proce cess ss asso associ ciat ated ed with with full full thi thick ckne ness ss graf graftt

D.

A full thickness graft has whole dermis attached with fat trimmed off

E.

An avascular graft has its own blood supply

Answer: A. A.

False, False, (http://emedicine.medscap (http://emedicine.medscape.com/article/876379-overv e.com/article/876379-overview#aw2aab6b7) iew#aw2aab6b7)

B.

True

C. True, True, (http://cdn.intechopen.c (http://cdn.intechopen.com/pdfs/18927/InTechom/pdfs/18927/InTechFull_thickness_skin_grafts.pdf) D. True, True, whole thickness of skin excised and fat is removed to improve graft state E.

False, False, avascular graft has no blood supply

20. The structure that lie in parotid gland are: A.

Facial nerve

B.

Branches of external carotid

C.

Glossopharyngeal nerve

D.

Retromandibular vein

E.

Lymph nodes

Answer: A. A.

True, True, branches of facial nerve (Bailey & Love’s 24th edition page 727)

B. True, True, which are maxillary artery and superficial temporal artery (Bailey & Love’s 24th edition page 727) C.

False (Bailey & Love’s 24th edition page 727)

D. True, True, retromandibular vein lies in parotid gland (Bailey & Love’s 24th edition page 727) E.

True, intraparotid lymph node (Bailey & Love’s 24th edition page 727)

21. A 42 year old woman comes with midline neck swelling. Which of the following indicate increased activity of the gland? A.

Irritability

B.

Hair loss

C.

Muscle weakness

D.

Hyperkinesis

E.

Heart failure

Answer: A.

True (Bailey & Love’s 24th edition page 790)

B.


C.

True, thyrotoxic myopathy (Bailey & Love’s 24th edition page 791)

D.


E.


22. A 64 year old smoker comes with blackish discoloration of right foot. Which of the following are TRUE A. There is loss of sensation B. There is secondary infection C. The foot is foul smelling D. Mummification is part of the process E. Amputation is the treatment Answer: A. True, True, loss of sensation in peripheral arterial disease (Bailey & Love’s 24th edition page 921) B. False C. False, False, dry gangrene is not foul smelling (Bailey & Love’s 24th edition page 921) D. True (Bailey & Love’s 24th edition page 921,922) E. True (Makhan Lal Saha page 274)

23. Complications of varicose veins are: A.

Hemorrhage

B.

Skin changes

C.

Itching

D.

Gangrene

E.

Ulceration

Answer: A. A. True, when larger superficial vein is damaged (Bailey & Love’s 24th edition page 957) B.

True, True, pigmentation, thrombhophlebitis (Bailey & Love’s 24th edition page 957)

C.


D.


E.

True, True, formation of varicose ulcer (Bailey & Love’s 24th edition page 957)

24. The major risk factors for deep vein thrombosis are due to: A.

Early post operative mobilization mobilization

B.

Age

C.

Pregnancy

D.

Oral co contraceptive dr drugs

E.

Malignancy

Answer: A.

False, False, early mobilisation prevent DVT

B.


C.


D.

True, True, high dose of estrogen theraphy (Bailey & Love’s 24th edition page 970)

E.


25. Causes of lymphoedema A.

radiotherapy to axilla

B.

post operative

C.

milroy’s disease

D.

malaria

E.

fracture neck of femur

Answers A.

TRUE –radiotherapy to axilla involves the lymph nodes.

B. TRUE – Postoperative period, immobility causing DVT can lead to lymphoedema. Trauma and tissue damage by lymph node excision, radiotherapy, burns, varicose vein surgery/harvesting,etc causing lymphoedema. Postoperative pelvic radiotherapy is a risk factor. C. TRUE -Nonne-Milroy and Letessier-Meige two main forms of f amilial (hereditary) primary lymphoedema. D.

FALSE –infective causes includes filariasis, tuberculosis

E.

FALSE

Bailey & Love’s, 25th ed : 947-953 26. General features of malignancy A.

fever

B.

thrombotic ep episodes

C.

cachexia

D.

anemia

E.

absence of metastasis

Answer A.

TRUE

B.

TRUE

C.

TRUE

D.

TRUE

E.

FALSE

REF : MCQs for the MRCS Examination (Applied Basic Sciences with Explanatory Answers), Rahij Anwar, Jaypee, Jaypee, 1st ed, page 130. 27. A 40 years old woman comes with complaints complaints of slowly growing swelling in the midline of neck. Which of the following investigations will you do to confirm the diagnosis? A.

thyroid function test

B.

usg of neck

C.

ct scan of the neck

D.

echocardiogram

E,

upper limb Doppler

Answer A.

TRUE (Bailey & Love’s 25 th ed, pg 773)

B. TRUE –has value to differentiate between solid and cystic swellings, can demonstrate impalpable nodules. But its value to diagnose malignancy is limited ( A Manual on Clinical Surgery, S.Das, 8 th ed, pg 389) C. FALSE –CT, MRI, PET are reserved for the assestment of known malignancy and to assess the extent of retrosternal and occasionally recurrent goitres (Bailey & Love’s 25th ed, pg 774) D.

FALSE

E,

FALSE

28. A 50 years old man comes with complaints of black colored stools. The differential diagnosis are (note : melaena; black, tarry coloured foul smelling stool associated with upper GI bleed) A.

carcinoma colon

B.

anal fissures

C.

variceal bleed

D.

haemmorhoids

E.

duodenal ulcer

Answers A.

FALSE

B.

FALSE

C.

TRUE

D.

FALSE

E.

TRUE

REF : (Bailey & Love’s 25th ed, pg 1063-1065. A Manual on Clinical Surgery, S.Das, 8th ed, pg 458-459)

29. A 10 years old child comes with 5% superficial burns. Principles of management include: A.

Intravenous fluid for replacement replacement of fluid

B.

antibiotics

C.

topical care

D.

blood transfusion

E.

analgesia

Answer A. FALSE –consider IV fluid resuscitation for any child with burn greater than 10% (Bailey & Love’s, 25 th ed, pg 382) B.

TRUE

C.

TRUE –(Bailey & Love’s, 25th ed, pg 390)

D.

FALSE (Bailey & Love’s, 25th ed, pg 382)

E. TRUE –simple oral analgesia should be sufficient (Bailey & Love’s, 25th ed, pg 387) 30. A 38 years old man with popliteal artery stenosis is managed with: A.

anticoagulation

B.

CT angiogram

C.

angioplasty

D.

femoropopliteal by bypass gr grafting ing

E.

MR angiogram

Answer

A. 904)

FALSE –patients are given antiplatelet agents (Bailey & Love’s 25 th ed, pg

B. TRUE –CT and MR angiography recently introduced method that is gaining popularity and gradually gradually replacing Digital Subtraction Angiography Angiography (DSA) (Bailey (Bailey & Love’s 25th ed, pg 903) C. TRUE – TRUE – Percutaneous Transiluminal Transiluminal Angioplasty (PTA) (PTA) (Bailey & Love’s 25th ed, pg 904) D.

TRUE (Bailey & Love’s 25th ed, pg 905)

E.

TRUE (Bailey & Love’s 25 th ed, pg 903)

Surgery Year 3 22 January 2013 (Omega 6)

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