Thursday, January 24, 2008

25 - surgery mcqs - 211 to 220

211. Ectopic pregnancy

a. Occurs in about 10% of pregnancies

b. The risk is increased in those with a history or pelvic inflammatory disease

c. Usually presents between 2 and 4 months of gestation

d. Patients usually have a negative pregnancy test

e. if shocked early laparotomy is essential


only b and e are true . occurs in about 1 % of pregnancies .usually presents between 6 weeks and 8 weeks of gestation . a sensitive beta HCG is usually positive .


212. Pelvic inflammatory disease

a. Usually arises from haematogenous spread from another site

b. Is most commonly a chlamydial infection

c. Untreated can progress to a pyosalpinx

d. Reduces the risk of ectopic pregnancy

e. 20% of patients develop chronic pain


b , c , e are the right answers . acute salpingitis is usually an ascending sexually transmitted disease . it increases the risk of ectopic pregnancy .


213. The following colonic polyps are pre-malignant

a. Juvenile polyps

b. Hamartomatous polyps associated with Peutz-Jeghers syndrome

c. Villous adenomas

d. Tubular adenomas

e. Metaplastic polyps


b , c , d are the right answers . villous adenomas ( 40 % )have higher malignant potential than tubular adenomas .metaplastic polyps are epithelial lesions but are benign .


214. Tetanus

a. Is due to an infection with a gram-negative spore forming rod

b. The organism produces a powerful endotoxin

c. The toxin prevents the release of inhibitory neurotransmitter

d. Clostridium tetani is sensitive to penicillin

e. Risus sardonicus is the typical facial spasm


c , d , e are right . neurotoxin is a powerful exotoxin . gram positive anaerobic rod - clostridium tetani .


215. Multiple myeloma

a. Results from a polyclonal proliferation of lymph node plasma cells

b. Often presents with back pain or pathological fractures

c. Hypercalcaemia develops in 50% of patients

d. X-rays are normal in most patients

e. Most patients have a serum paraproteinaemia


b , c , e are true . multiple myeloma results from monoclonal proliferation of the bone marrow plasma cells. over 70 % patients have lytic lesions on skeletal x rays . over 98 % patients have a serum paraproteinemia .


216. Regarding pathological terms

a. Hypertrophy is an increase in tissue size due to increased cell number

b. Hyperplasia is an increase in tissue size due to an increase in cell size

c. Atrophy is an increase in tissue size to disuse

d. Metaplasia is a change form one abnormal tissue type to another

e. A hamartoma is a developmental abnormality


only e is true . hypertrophy - increase in cell size . hyperplasia - increase in cell number . atrophy - decrease in tissue size to disuse . metaplasia is a change in normal cell type .


217. Osteoporosis is associated with

a. Vitamin D deficiency

b. Vitamin A deficiency

c. Chronic renal failure

d. Prolonged bed rest

e. Hyperparathyroidism


only d is true . osteomalacia is due to vitamin D deficiency .


218. The haemoglobin-oxygen dissociation curve is shifted to the left by

a. Increased body temperature

b. Metabolic acidosis

c. Chronic hypoxia

d. Anaemia

e. Erythropoietin


all are false . pyrexia and acidosis shift the curve to the right .

219. Metastatic calcification is seen in

a. Hyperparathyroidism

b. Sarcoidosis

c. Fat necrosis

d. Atheroma

e. Tuberculosis


a and b . metastatic calcification is due to hypercalcemia . dystrophic calcification is due to abnormal tissues . ( eg: scars )


220. Intrinsic factor

a. Is a polysaccharide

b. Is produced by the parietal cells in the stomach

c. Acts in the terminal ileum

d. Is important in the absorption of folic acid

e. Deficiency can be treated with oral B12


only b and c are true . IF is a polypeptide . it is important in B12 absorption . deficiency required B 12 injections once every 2 or 3 months .


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