Sunday, January 13, 2008

6 - surgery mcqs - 21 to 30

21. Regarding anal fissures

a. 10% occur in the posterior midline

b. Multiple fissures suggest a diagnosis of tuberculosis or Crohn's Disease

c. 50% of acute fissures heal with the use of a bulking agent

d. Sphincterotomy has a success rate of over 90%

e. Sphincterotomy is associated with minor faecal incontinence in over 15% of patients


b , c , d , e are true . 90 % of anal fissures occur in the posterior midline .


22. Tamoxifen in the treatment of breast cancer

a. 20 mg per day is as effective as higher doses

b. Treatment for longer than 5 years has been proven to be beneficial

c. Is only of benefit in patients with oestrogen receptor positive tumours

d. Reduces the risk of contralateral breast cancer by 40%

e. Is effective in both pre and post menopausal women


a , d , e are true . it is also beneficial in patients with oestrogen receptor negative cases . treatment upto 2 years and upto 5 years may be beneficial .


23. Fibroadenomas

a. Are benign monoclonal neoplasms

b. Most commonly present in late adolescence or the early 20s

c. Should be diagnosed by triple assessment

d. At least 30% reduce in size over a 2 year period

e. Can be safely managed conservatively


b , c , d , e are the right answers . about the option a ... they are polyconal aberrations of normal breast development not monoclonal . over 2 years --- 50 % remain static , 30 % decrease in size , 20 % increase in size .

24. Familial adenomatous polyposis

a. Is inherited as an autosomal recessive condition

b. Is characterised by polyp formation in late adulthood

c. Is associated with osteomas and epidermoid cysts in Gardener's Syndrome

d. Is due to a mutation on the short arm of chromosome 12

e. Can be screened for by rigid or flexible sigmoidoscopy


only c and e are true . inherited as autosomal dominant condition . polyps formed in late adolesence or early adulthood . mutations are on chromosome no 5 .


25. Warfarin

a. Reduces the concentration of vitamin A dependent clotting factors

b. Has a half life of about 36 hours

c. Crosses the placenta and should be avoided in pregnancy

d. Doses should be reduced in liver disease

e. An INR of between 2.0 and 3.0 is appropriate in the treatment of DVT


b , c , d , e are true . it is mainly excreted by the liver , so doses shud be reduced in liver disease . it reduces the concentration of vit k dependent factors because it is a vitamin k antagonist.


26. Heparin

a. Is a heterogeneous mixture of sulphated polypeptides

b. Potentiates the actions of antithrombin III

c. Has a half life of 12 hours

d. Can be reversed by protamine sulphate

e. Can induce an idiosyncratic thrombocytopenia


b , d , e are true . heparin is made up of sulphated polysaccarides . half life of 90 minutes .


27. Regarding rectal cancer

a. It often arises in metaplastic polyps

b. The rectum is the commonest site of colorectal tumours

c. A cancer in the upper 1/3 of the rectum is appropriately managed by AP resection

d. Local recurrence of rectal cancer can be reduced a Total Mesorectal Excision

e. Chemotherapy is of proven benefit in Duke's A tumours


only b and d are true . colorectal cancers arise in adenomatous polyps . for an upper rectal tumor an anterior resection is indicated . chemotherapy is of use in duke's C tumors and possibly in duke's B tumors .


28. The following cause hypercalcaemia

a. Sarcoidosis

b. Primary hyperparathyroidism

c. Acute pancreatitis

d. Metastatic bronchial carcinoma

e. Milk-Alkali syndrome


a . b , d , e causes hypercalcemia . acute pancreatitis causes hypocalcemia .


29. Regarding malignant melanoma

a. The incidence is halving every 10 years

b. Superficial spreading melanoma is the commonest clinico-pathological type

c. Tumour thickness is the most important prognostic indicator

d. Regional lymphadenectomy provides survival benefit in patients with 'thick' tumours

e. Acral lentiginous tumours are usually found on the trunk and proximal limbs


only b and c are true . incidence of melanoma is doubling every 10 years . regional lymphadenectomy does not improve survival in thick or thin tumors .it may be of benefit in intermediate thickness lesions .
acral lentiginous lesions occur on the sole of the foot .

30. Regarding oesophageal cancer

a. Squamous carcinomas predominate in the upper 2/3 of the oesophagus

b. Overall 5 year survival is greater than 50%

c. Tylosis genetically predisposes to the disease

d. 15% of adenocarcinomas are associated with Barrett's oesophagus

e. For palliation an Atkinson tube can be inserted endoscopically


a , c , d , e are true . overall 5 year survival rate is less than 20 % .


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