Saturday, January 12, 2008

3 - surgery mcqs - 1 to 10

1. The following are absorbable sutures

a. Catgut
b. Silk
c. Polyamide (Nylon)
d. Polyglyconate (Maxon)
e. Polyglactin (Vicryl)
the options a , d , e are true .... catgut is absorbed by proteolysis and the vicryl is absorbed by hydrolysis

2. Peutz Jeghers Syndrome

a. Is an autosomal recessive condition
b. Often presents with anaemia in childhood
c. Is characterised by circumoral mucocutaneous pigmented lesions
d. Is associated with adenomatous polyps of the small intestine
e. Malignant change occurs in 2-3% of polyps
the options b , c , e are true . it is an autosomal dominant disorder and the polyps are hamartomatous

3. Regarding peptic ulceration

a. H. pylori is a gram-positive bacillus
b. Duodenal is more common than gastric ulceration
c. Zollinger-Ellison syndrome is associated with gastrin hyposecretion
d. H2-blockers will heal 85-95% of duodenal ulcers in 8 weeks
e. Triple therapy can eradicate H. pylori in 80% of patients in one week
the options b , d , e are true and h.pylori is a gram negative bacillus . Z E S is associated with gastrin hypersecretion .

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
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
e. Pupillary dilatation usually occurs on the same side as the intracerebral haematoma
the options a , d , e are true . if an intracerebral bleed is suspected then a CT must be done . raised intracranial pressure is associated with decreases cerebral perfusion.

5. During surgery on the submandibular gland

a. An incision on the lower border of the mandible is safe
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
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
only the option b is true .........the incision over the mandible will damage the mandibular branch of the facial nerve. the facial vessels pass superficial to the gland. the lingual nerve supplies the taste and sensation of the anterior two thirds of the tongue .

6. Regarding pancreatic carcinoma

a. 90% are ductal adenocarcinomas
b. Less than 20% occur in the head of the gland
c. The usual presentation is with pain, weight loss and obstructive jaundice
d. Ultrasound has a sensitivity of 80-90% in the detection of the tumour
e. Less than 20% of patients are suitable for curative surgery
the options except b are true , because the 80 percent of the pancreatic carcinomas mostly affect the body of the pancreas

7. Regarding the management of major trauma

a. Deaths follow a trimodal distribution
b. X-rays after the primary survey should be of AP Cervical spine, chest and pelvis
c. Cardiac tamponade is characterised by raised BP, low JVP and muffled heart sounds
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
only a is true . lateral C spine x ray shud be taken after the primary survey . hypotension and raised jvp are the features of the cardiac tamponade.. assessment of limb fracture shud be assessed during the secondary survey ,

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
all the statements are true . pelvic appendicitis can present with few abdominal signs and symptoms . a rectal examination is the key to the diagnosis .

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
the options a and e are true . pigment stones are made from unconjugated bilirubin , gall stones are a risk factor for gallbladder carcinoma . 10 percent of gall stones are radioopaque.

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-----------------------------------------------------------
the options a , b , c , d are true . charcots triad consists of intermittent fever , rigors and jaundice . a t- tube shud be left for 10 days .

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