Sunday, January 13, 2008

5 - surgery mcqs - 11 to 20

11. Regarding crystalloid solutions

a. Normal saline contains 154 mmol sodium and 154 mmol of chloride

b. 3 litres of dextrose saline in a day will provide 90 mmol of sodium

c. 2 grams of potassium chloride is equal to 27 mmol of the salt

d. Hartmann's solution contains calcium and bicarbonate

e. The daily maintenance potassium requirement of a 40 Kg woman is about 40 mmol


all the above statements are true


12. Regarding colloid solutions

a. Human albumin has a molecular weight of 69 kDa

b. Albumin has a half life in the circulation of about 15 hours

c. Gelatins (e.g. Haemaccel®) are polysaccharides with a MW of about 35 kDa

d. Dextrans reduce platelet aggregation and can induce anaphylaxis

e. 6% Hydroxylethyl Starch (HES) is synthetic polysaccharide derived from amylopectin


the options a , d , e are right ---------- albumin has a half life of about 15 days and gelatins are polypeptides not polysaccarides .


13. Central parenteral nutrition

a. Is a hypo-osmolar solution

b. Typically contains 14-16g nitrogen as D-amino acids

c. Typically contains about 250g glucose

d. Is associated with metabolic disturbances in about 5% patients

e. Can induce derangement of liver function tests


the options c , d , e are true ------- TPN is a hyperosmolar solution . central administration reduces thromobophlebitis . typically contains 14 - 16 g amino acids but they are L - isomers .


14. Solitary thyroid nodules

a. Are more prevalent in women

b. In the adult population less than 10% are malignant

c. More than 50% of scintigraphically cold nodules are malignant

d. The risk of a hot module being malignant is negligible

e. Should be surgically removed in all patients


the options a , b , d are true . 80 % of solitary thyroid nodules are found in women . less than 20 % cold nodules are malignant . clinically benign nodules with supporting FNAC can be observed .


15. Regarding abdominal wall hernias

a. Almost 100,000 hernia operations are performed annually in the United Kingdom

b. 20% of inguinal hernias are indirect

c. In women inguinal hernias are as common as femoral hernias

d. The mortality assocaited with strangulation is over 10%

e. The mortality has reduced dramatically over the past 30 years


the options a , c , d are true . over 60 % of the hernias in the adult population are indirect . the mortality associated with strangulation is the same . hence the need for early operation .


16. The femoral canal

a. Lies lateral to the femoral vein

b. Has the inguinal ligament as its anterior border

c. Has the lacunar ligament as its lateral border

d. Has the pectineal ligament as its posterior border

e. Contains the lymph node of Cloquet


the options b , d , e are true . the femoral vein is the lateral boundary of the femoral canal .


17. Intermittent claudication

a. Affects less than 1% of men over the age of 50 years

b. At 5 years 10% of claudicants will have progressed to an amputation

c. At 5 years 20% of claudicants will have died from ischaemic heart disease

d. Is usually associated with an ankle / brachial pressure index (ABPI) > 0.7

e. Is associated with a fall in the ABPI on exercise with delayed recovery


the options b , c , e are true . about 5 % males above 50 years have claudication . the ABPI of a claudicant is usually in the range 0.3 - 0.7 .


18. The pathology of ulcerative colitis

a. Shows full thickness inflammation

b. The rectum is almost always involved

c. 10% patients have terminal ileal disease

d. Enterocutaneous or intestinal fistulae are common

e. The serosa is usually normal


the options b , c , e are true . in ulcerative colitis the inflammation is confined to the mucosa . fistulae are seen in about 10 % of patients with crohn's disease.


19. Regarding surgery for ulcerative colitis

a. 30% patients with total colitis will require surgery within 5 years

b. Panproctocolectomy and pouch formation is appropriate as an emergency operation

c. Pouches can be fashioned as 'S' 'J' or 'W' loops

d. Over 90% patients with a pouch have perfect continence

e. With a pouch the mean stool frequency is about 6 times per day


a , c , e are true . total colectomy and ileostomy is the appropriate emergency operation . 90 % will be continent during day and only 60 % will be continent during night .


20. Regarding benign breast disease

a. Cyclical mastalgia is the commonest reason for referral to the breast clinic

b. Fibroadenomas are derived from the breast lobule

c. Lactational breast abscesses are usually due to Staph aureus

d. Duct ectasia is more common in smokers

e. Atypical lobular hyperplasia is associated with an increased risk of breast cancer


all are true .


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