Surgical Tutor Mcq

Questions 1-10

e. Pupillary dilatation usually occurs on the same side as the intracerebral haematoma

1. The following are absorbable sutures a. Catgut

5. During surgery on the submandibular gland

 b. Silk

a. An incision on the lower border of the mandible is safe

c. Polyamide (Nylon) d. Polyglyconate (Maxon) e. Polyglactin (Vicryl)

 b. The submandibular gland is seen to wrap around the posterior border of mylohyoid c. The facial artery and vein are divided as they course through the deep part of the gland

2. Peutz Jeghers Syndrome a. Is an autosomal recessive condition  b. Often presents with anaemia in childhood

d. The hypoglossal nerve is seen to loop under the submandibular duct e. Damage to the lingual nerve will cause loss of sensation to the posterior third of the tongue

c. Is characterised by circumoral mucocutaneous pigmented lesions d. Is associated with adenomatous polyps of the small intestine

6. Regarding pancreatic carcinoma

e. Malignant change occurs in 2-3% of polyps

 b. Less than 20% occur in the head of the gland

a. 90% are ductal adenocarcinomas c. The usual presentation is with pain, weight loss and obstructive jaundice

3. Regarding peptic ulceration a. H. pylori is pylori is a gram-positive bacillus

d. Ultrasound has a sensitivity of 80-90% in the detection of the tumour

 b. Duodenal is more common than gastric ulceration

e. Less than 20% of patients are suitable for curative surgery

c. Zollinger-Ellison syndrome is associated with gastrin hyposecretion d. H2-blockers will heal 85-95% of duodenal ulcers in 8 weeks

7. Regarding the management of major trauma

e. Triple therapy can eradicate H. eradicate H. pylori in pylori in 80% of patients in one week

 b. X-rays after the primary survey should be of AP Cervical spine, chest and pelvis

a. Deaths follow a trimodal distribution

c. Cardiac tamponade is characterised by raised BP, low JVP and muffled heart sounds 4. Head Injuries a. More than 1 million people are seen in UK hospitals each year with head injuries  b. Skull X-rays can exclude an intracerebral haematoma

d. Assessment of uncomplicated limb fractures should occur during the primary survey e. Deterioration of the casualty during the  primary survey should lead to the secondary survey

c. Raised intracranial pressure is associated with an increase in cerebral perfusion d. Cushing's response consists of a rise in blood  pressure and fall in heart rate

8. Regarding appendicitis a. The risk of developing the illness is greatest

in childhood  b. Mortality increases with age and is greatest in the elderly c. 20% of appendices are extraperitoneal in a retrocaecal position d. Faecoliths are present in 75-80% of resected specimens e. Appendicitis is a possible diagnosis in the absence of abdominal tenderness

9. Regarding stones in the gallbladder  a. Cholesterol stones are the most common  b. Pigment stones are due increased excretion of  polymerised conjugated bilirubin c. Are not a risk factor for the development of gallbladder carcinoma d. 90% of gallstones are radio-opaque e. A mucocele of the gallbladder is caused by a stone impacted in Hartmann's pouch

10. Stones in the common bile duct a. Are found in 30% of patients undergoing cholecystectomy (Without pre-op ERCP)  b. Can present with Charcot's Triad c. Are suggested by an bile duct diameter >8mm on ultrasound d. ERCP, sphincterotomy and balloon clearance is now the treatment of choice e. If removed by exploration of the common  bile duct the T-tube can be removed after 3 days

KEY 1.

True= A, D, E

2.

True= B, C, E

3.

True= B, D, E

4.

True= A, D, E

5.

True= B

6.

True= A,C,D,E

7.

True= A

8.

True= All true

9.

True= A, E

10. True= A, B, C, D