Thursday, January 24, 2008

23 - surgery mcqs - 191 to 200

191. Coeliac disease

a. Results from dietary glucose intolerance

b. Is associated with increased serum anti-endomysial and anti-gliadin antibodies

c. Small bowel histology shows villous hypertrophy

d. Can be effectively treated with a gluten-free diet

e. Increases the risk of small bowel lymphoma


b , d ,e are right . coeliac disease results from dietary gluten intolerance . small bowel histology shows villous atrophy


192. Papillary carcinoma of the thyroid

a. Can be reliably diagnosed using fine needle aspiration cytology

b. Is almost always unifocal

c. Histologically displays Psammoma bodies

d. Typically spread to the cervical lymph nodes

e. Requires a total thyroidectomy for large tumours


a , c , d , e are the right answers . all papillary lesions are potentially malignant and can be diagnosed by FNAC . more than 50% are multifocal and hence the need for total thyroidectomy . blood borne spread is typical of follicular lesions .


193. Regarding bladder tumours

a. 90% are squamous carcinomas

b. Painless haematuria is the commonest presentation

c. Cigarette smoking is an important aetiological factor

d. 80% of tumours are superficial (i.e. no muscle invasion)

e. Superficial tumours are often well controlled by transurethral resection


b , c , d , e are all true . 90 % are transitional carcinomas only 5% are squamous type .


194. The following are carcinogens important in bladder cancer

a. Magenta

b. Auramine

c. Benzidine

d. Beta-naphthylamine

e. Chlorinated hydrocarbons


all are true .


195. Regarding ureteric calculi

a. Are most often composed of calcium oxalate or phosphate

b. Less than 5% of those less than 5 mm in diameter pass spontaneously

c. Extracorporeal lithotripsy is useful for stones in the upper third of the ureter

d. About 30% of patients require open surgery to remove the stone

e. An obstructed ureter in the presence of infection is a surgical emergency


a , c , e are true . most stones less than 5 mm in diameter pass spontaneously . less than 1 % of patients require a uretero lithotomy


196. Cryptorchidism

a. Occurs in 5% of newborn boys

b. Increases risk of malignancy by a factor of ten

c. Is associated with normal fertility

d. Laparoscopy is the best means of identifying an impalpable testis

e. Should be treated by orchidopexy at puberty


a , b , d are true . associated with reduced fertility . 30 % - oligospermia , 10 % - azospermia . orchidopexy should be considered in the second year of life .


197. Regarding small bowel obstruction

a. In the United Kingdom is most often due to an obstructed hernia

b. Causes colicky abdominal pain and vomiting

c. Abdominal distension is seen in all patients

d. All cases can be managed conservatively for the first 24 hours

e. Rarely requires aggressive fluid resuscitation


only b is true . adhesions are the commonest cause of small bowel obstruction in UK. little distension is seen in patients with high jejunal obstruction . urgent operation is required if there are features of peritonism .
most patients are severly dehydrated and require resuscitation .


198. Regarding bone scintigraphy

a. It is less sensitive than radiographs in detecting metastatic bone disease

b. It is performed using technetium labeled biphosphonates

c. The radiation dose received is equivalent to a CT scan

d. Renal excretion of the isotope can cause false positive images

e. Has a high risk of anaphylaxis


only b and d are true . scintigraphy is the most sensitive imaging modality for bone metastasis . the radiation dose ( ~5 mSv ) is equal to two chest x rays . allergic reactions to isotopes are rare .


199. Regarding nephroblastomas

a. They are otherwise known as a Wilm's tumour

b. Account for 10% of childhood tumours

c. The commonest presentation is with an abdominal mass

d. Most commonly present in adolescence

e. They are composed purely of epithelial elements


a , b , c are true . most commonly present in the first three years of life . they are embryonic tumors composed of both epithelial and sarcomatous elements .


200. Regarding bladder calculi

a. The incidence has fallen markedly in this country ( UK ) since the late 19th century

b. They may be totally asymptomatic

c. They are more prevalent in patients with chronic urinary sepsis

d. They are associated with squamous metaplasia of the bladder mucosa

e. They increase the risk of transitional cell carcinoma


a , b , c , d are true . they increase the risk of squamous cell cancers.


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