MCQ SURGERY YEAR 3 (22ND JANUARY 2013)

1)

True regarding homeostasis Is a stable state of a normal body The kidneys are essential in maintaining homeostasis at a normal level Elective surgery should cause little disturbance to homeostasis Emergency surgery should cause little disturbance to homeostasis

A. B. C. D.

E. Return to normal homeostasis following surgery depends upon the presence of co-morbid conditions Answers : A. True the milieu interior of Claude Bernard

B. True - All vital organs the brain, heart, lung, kidney and to a lesser extent, the spleen play important role in its maintenance C. True - in elective situation, patient is always optimized prior to any operation, thereby minimizing the homeostatic disturbance D. False - Disturbance in the homeostasis to some degree occurs in emergency surgery, depends upon extent of injury, sepsis etc E. True - if patient has co morbid conditions, post operatively the return to normal homeostasis would take longer than in those with no co-morbidity. In such cases, ICU is essential REF : Bailey & Love 25th edition page 3

2) A. B.

In stress response, which of the following statements are TRUE: It is graded Nitrogen metabolism and excretion are related to degree of stress

C. In such a situation there are physiological, metabolic and immunological changes D. E. The changes cannot be modified The mediators for the integrated response are initiated by the pituitary

Answers : A. True

B. C.

True in direct proportion to injury True pyrexia,tachycardia and tachypnoea etc

D. False can be modified by anticipating complications and preventing them by management in ICU E. True

Bailey&Love 25th edition page 4 & 5

3) A. B. C. D.

Which of the following regarding blood pressure in shock are TRUE: Hypertensive elderly presents with a normal blood pressure Children are able to maintain blood pressure until the final stages of shock Hypotension is one of the first signs of shock Beta-blockers prevent a tachycardic response

E. Blood pressure is increased by reduction in stroke volume and peripheral vasoconstriction Answers : A. B. C. D. True True False may not be seen until shock is well established. True

E. False heart compensate to maintain CO by increasing both the rate and stroke volume. Bailey & Love 25th edition page 15

4) A. B.

Which of the following are TRUE regarding inotropic support in shock? This is the first line therapy in hypovolemic shock Phenylephrine and noredrenaline are indicated in distributive shock states

C. Dobutamine is the agent of choice in cardiogenic shock or septic shock complicated by low cardiac output D. Vasopressin is used when the vasodilatation is resistant to catecholamines

E.

Use in the absence of adequate preload may be harmful

Answers : A. B. C. D. E. False first line therapy ; IV access and administration of fluids True True True True

Bailey & Love 25th edition page 17

5) A.

Which of the following statements about blood transfusion are TRUE: A hemoglobin level of 10g/dl or less is considered a typical indication

B. Fresh frozen plasma (FFP) is considered as a first line therapy in coagulation hemorrhage C. D. Cryoprecipitate is useful in low fibrinogen-states Platelets have a shelf life of 3 weeks

E. Patients can pre-donate blood up to 3 weeks before surgery for autologous transfusion Answers : A. B. C. D. E. False True True False True

Bailey & Love 25th edition page 20 & 21

6)

Factors which affect wound healing include:

A. B. C. D. E.

Vascular insufficiency Diabetes mellitus Malnutrition Site of wound Smoking

Answers : ALL TRUE (Bailey&Love 25th edition page 24) 7) Pressure sores occur in the following areas A. B. C. D. E. Sacrum Heel Occiput Greater Trochanter Ischium

Answer : A. B. C. D. E. True. ( Bailey & Love 24th edition pg91) True. ( Bailey & Love 24th edition pg91) True ( Bailey & Love 24th edition pg91) True( Bailey & Love 24th edition pg91) True( Bailey & Love 24th edition pg91)

8. Which are the following is a natural barrier to infection A. B. C. D. E. Intact epithelial surface High gastric pH Antibodies Antibiotics Macrophages

Answer:

A. B. C. D. E.

True ( Bailey & Love 24th edition pg119) False ( Bailey & Love 24th edition pg119) True ( Bailey & Love 24th edition pg119) False ( Bailey & Love 24th edition pg119) True ( Bailey & Love 24th edition pg119)

9. Which are the following are risk factors for wound infection. A. B. C. D. E. Poor perfusion Use of skin clips for wound closure Poor surgical technique Not using prophylactic antibiotic Uremia

Answer: A. B. C. D. E. True ( Bailey & Love 24th edition pg119) False( Bailey & Love 24th edition pg119) True( Bailey & Love 24th edition pg119) True( Bailey & Love 24th edition pg119) True( Bailey & Love 24th edition pg119)

10. Which are the following statements are TRUE regarding abscesses A. B. Staph aureus is one of the most common causative organisms The abscess wall is composed of epithelium

C. Most wound site abscesses occur before the patient is discharged from the hospital D. E. Antibiotics are indicated if there is evidence of cellulitis Actinomyces causes an acute abscess

Answer

A.

True (Bailey & Love 24th edition pg122)

B. False surrounded by an acute inflammatory response and a pyogenic membrane composed of fibrinous exudates. (Bailey & Love 24th edition pg122) C. False -75% may present after patient discharged (Bailey & Love 24th edition pg122) D. True (Bailey & Love 24th edition pg122)

E. False Actinomyces causes chronic abcess (Bailey & Love 24th edition pg122)

11. Which are the following statements regarding cellulitis are TRUE A. B. C. D. E. This is non-suppurative invasive infection of tissues It is poorly localized It is commonly caused by Clostridium perfringens Systemic signs are not present Blood culture is usually positive

Answer: A. B. C. D. E. True(Bailey & Love 24th edition pg122) True(Bailey & Love 24th edition pg122) True (Bailey & Love 24th edition pg123) False(Bailey & Love 24th edition pg123) False(Bailey & Love 24th edition pg123)

12. Surgical risks in a diabetic patient mention include A. B. C. D. E. Infection Myocardial infarction Pressure sore Poor wound healing Pain control

Answer: A. True (Management of Adults with Diabetes undergoing surgery NHS diabetes April 2011) B. True(Management of Adults with Diabetes undergoing surgery NHS diabetes April 2011) C. True(Management of Adults with Diabetes undergoing surgery NHS diabetes April 2011) D. True(Management of Adults with Diabetes undergoing surgery NHS diabetes April 2011) E. False (Management of Adults with Diabetes undergoing surgery NHS diabetes April 2011)

13.risk factor for thrombosis indicate A. B. C. D. E. young age pregnancy smoking traumna malignancy

Answer A. B. C. D. E. false.old age (concise textbook of surgery page by s.das 7 edition:272) true. (concise textbook of surgery page by s.das 7 edition:272) true(concise textbook of surgery page by s.das 7 edition:272) true(concise textbook of surgery page by s.das 7 edition:272) true(concise textbook of surgery page by s.das 7 edition:272)

14.cause of hypoproteinaemia

A. B. C. D. E.

burn SIDH liver disease analbuminaemia AIDS

Answer A. true.due to increase capillary permeability and infection(concise textbook of surgery page by s.das 7 edition:65) B. false.not asosiated with albumin but fluid overload and albumin level normal(http://en.wikipedia.org/wiki/Syndrome_of_inappropriate_antidiuretic_hormone _secretion) C. true.production of albumin by the liver(concise textbook of surgery page by s.das 7 edition:816) D. true.geneticlly inherited metabolic defect characterised by defect in production of albumin(http://en.wikipedia.org/wiki/Analbuminaemia) E. false.not associated with albumin production. ( http://en.wikipedia.org/wiki/Aids)

15.which of the following statements are true regarding DEEP VEIN THROMBOSIS A. B. C. D. E. obase patient prone to DVT clinical diagnosis very obvious hip and knee replacement surgery are predisposing factor confirmation by venorgrapy and/or duplex dropler imaging optimun hydration is essensial to prevent DVT

Answer A. true. (concise textbook of surgery page by s.das 7 edition:272)

B. true. swelling.tenderness,homanssign(concise textbook of surgery page by s.das 7 edition:274)

C. true.immobility after surgery (concise textbook of surgery page by s.das 7 edition:274) D. true.(concise textbook of surgery page by s.das 7 edition:277)

E. false.not associated with DVT (concise textbook of surgery page by s.das 7 edition:279) 16.which of the following statement are true A. B. C. D. E. rest pain is found commonly found in the calf in critically limb ischemia rest pain commonly relieve by getting out of the bad hypoaesthesia is a feature of pregangrenous absence of foot pulses indicated implies critical ischemia paralysis of the leg suggest an acutely ischemic leg

Answer A. true.(concise textbook of surgery page by s.das 7 edition:189)

B. true.leg below the level of heart will reduce the pain.(concise textbook of surgery page by s.das 7 edition:189) C. false.not hypoesthesia but hyperaesthesia. .(concise textbook of surgery page by s.das 7 edition:190) D. true.(concise textbook of surgery page by s.das 7 edition:190)

E. false.it suggest chonic ischemic leg.(concise textbook of surgery page by s.das 7 edition:190)

17.symptom of hyperparathyroidism include A. B. C. D. E. constipation anorexia polydipsia and polyuria pathologic bone fracture anxienty

Answer A. true.it due to hypercalcaemia(concise textbook of surgery page by s.das 7 edition:557) B. false.not associated with appetide(concise textbook of surgery page by s.das 7 edition:557) C. true.hypercalcaemia cause deposition of calcium crystal on the renal tubule result in polyuria and polydipsia. (concise textbook of surgery page by s.das 7 edition:557) D. true.due to increase bone resorption(concise textbook of surgery page by s.das 7 edition:557) E. false.not associated with CNS. (concise textbook of surgery page by s.das 7 edition:557)

18.complication of blood transfusion are: A. B. C. D. E. hemolytic reaction fluid overload disseminted intravascular coagulation hypercalcemia infection

Answer A. true.due to incompatibility.(concise textbook of surgery page by s.das 7 edition:51) B. true.in massive transfusion. (concise textbook of surgery page by s.das 7 edition:52) C. true.in massive transfution due to failure of coagulation. (concise textbook of surgery page by s.das 7 edition:53) D. false.hypocalcemia not hypercalcemia. (concise textbook of surgery page by s.das 7 edition:53) E. true.serum hapatits,AIDS,bacterial infection commonly occur. (concise textbook of surgery page by s.das 7 edition:52)

19. A patient of necrotising fascilitis post debridement, had skin grafting. TRUE regarding the blood supply of the graft is: A. B. C. D. E. Skin blood supply comes from muscle and fascial perforating vessels Direct cutaneous vessels also contribute Imbibation is the process associated with full thickness graft A full thickness graft has whole dermis attached with fat trimmed off An avascular graft has its own blood supply

Answer: A. B. False, (http://emedicine.medscape.com/article/876379-overview#aw2aab6b7) True

C. True, (http://cdn.intechopen.com/pdfs/18927/InTechFull_thickness_skin_grafts.pdf) D. True, whole thickness of skin excised and fat is removed to improve graft state E. False, avascular graft has no blood supply

20. The structure that lie in parotid gland are: A. B. C. D. E. Facial nerve Branches of external carotid Glossopharyngeal nerve Retromandibular vein Lymph nodes

Answer: A. True, branches of facial nerve (Bailey & Loves 24th edition page 727)

B. True, which are maxillary artery and superficial temporal artery (Bailey & Loves 24th edition page 727) C. False (Bailey & Loves 24th edition page 727)

D. True, retromandibular vein lies in parotid gland (Bailey & Loves 24th edition page 727) E. True, intraparotid lymph node (Bailey & Loves 24th edition page 727)

21. A 42 year old woman comes with midline neck swelling. Which of the following indicate increased activity of the gland? A. B. C. D. E. Irritability Hair loss Muscle weakness Hyperkinesis Heart failure

Answer: A. B. C. D. E. True (Bailey & Loves 24th edition page 790) False (Bailey & Loves 24th edition page 790) True, thyrotoxic myopathy (Bailey & Loves 24th edition page 791) True (Bailey & Loves 24th edition page 790) True (Bailey & Loves 24th edition page 791)

22. A 64 year old smoker comes with blackish discoloration of right foot. Which of the following are TRUE A. There is loss of sensation B. There is secondary infection C. The foot is foul smelling D. Mummification is part of the process E. Amputation is the treatment Answer: A. True, loss of sensation in peripheral arterial disease (Bailey & Loves 24th edition page 921) B. False C. False, dry gangrene is not foul smelling (Bailey & Loves 24th edition page 921) D. True (Bailey & Loves 24th edition page 921,922) E. True (Makhan Lal Saha page 274)

23. Complications of varicose veins are: A. B. C. D. E. Hemorrhage Skin changes Itching Gangrene Ulceration

Answer: A. True, when larger superficial vein is damaged (Bailey & Loves 24th edition page 957) B. C. D. E. True, pigmentation, thrombhophlebitis (Bailey & Loves 24th edition page 957) True (Bailey & Loves 24th edition page 957) False (Bailey & Loves 24th edition page 957) True, formation of varicose ulcer (Bailey & Loves 24th edition page 957)

24. The major risk factors for deep vein thrombosis are due to: A. B. C. D. E. Early post operative mobilization Age Pregnancy Oral contraceptive drugs Malignancy

Answer: A. B. C. D. E. False, early mobilisation prevent DVT True (Bailey & Loves 24th edition page 970) True (Bailey & Loves 24th edition page 970) True, high dose of estrogen theraphy (Bailey & Loves 24th edition page 970) True (Bailey & Loves 24th edition page 970)

25. Causes of lymphoedema A. B. C. D. E. radiotherapy to axilla post operative milroys disease malaria fracture neck of femur

Answers A. TRUE radiotherapy to axilla involves the lymph nodes.

B. TRUE Postoperative period, immobility causing DVT can lead to lymphoedema. Trauma and tissue damage by lymph node excision, radiotherapy, burns, varicose vein surgery/harvesting,etc causing lymphoedema. Postoperative pelvic radiotherapy is a risk factor. C. TRUE -Nonne-Milroy and Letessier-Meige two main forms of familial (hereditary) primary lymphoedema. D. E. FALSE infective causes includes filariasis, tuberculosis FALSE

Bailey & Loves, 25th ed : 947-953 26. General features of malignancy A. B. C. D. E. fever thrombotic episodes cachexia anemia absence of metastasis

Answer A. B. C. D. E. TRUE TRUE TRUE TRUE FALSE

REF : MCQs for the MRCS Examination (Applied Basic Sciences with Explanatory Answers), Rahij Anwar, Jaypee, 1st ed, page 130. 27. A 40 years old woman comes with complaints of slowly growing swelling in the midline of neck. Which of the following investigations will you do to confirm the diagnosis? A. B. C. D. E, thyroid function test usg of neck ct scan of the neck echocardiogram upper limb Doppler

Answer A. TRUE (Bailey & Loves 25th ed, pg 773)

B. TRUE has value to differentiate between solid and cystic swellings, can demonstrate impalpable nodules. But its value to diagnose malignancy is limited (A Manual on Clinical Surgery, S.Das, 8th ed, pg 389) C. FALSE CT, MRI, PET are reserved for the assestment of known malignancy and to assess the extent of retrosternal and occasionally recurrent goitres (Bailey & Loves 25th ed, pg 774) D. E, FALSE FALSE

28. A 50 years old man comes with complaints of black colored stools. The differential diagnosis are (note : melaena; black, tarry coloured foul smelling stool associated with upper GI bleed) A. B. C. D. E. carcinoma colon anal fissures variceal bleed haemmorhoids duodenal ulcer

Answers A. FALSE

B. C. D. E.

FALSE TRUE FALSE TRUE

REF : (Bailey & Loves 25th ed, pg 1063-1065. A Manual on Clinical Surgery, S.Das, 8th ed, pg 458-459)

29. A 10 years old child comes with 5% superficial burns. Principles of management include: A. B. C. D. E. Intravenous fluid for replacement of fluid antibiotics topical care blood transfusion analgesia

Answer A. FALSE consider IV fluid resuscitation for any child with burn greater than 10% (Bailey & Loves, 25th ed, pg 382) B. C. D. TRUE TRUE (Bailey & Loves, 25th ed, pg 390) FALSE (Bailey & Loves, 25th ed, pg 382)

E. TRUE simple oral analgesia should be sufficient (Bailey & Loves, 25th ed, pg 387) 30. A 38 years old man with popliteal artery stenosis is managed with: A. B. C. D. E. anticoagulation CT angiogram angioplasty femoropopliteal bypass grafting MR angiogram

Answer

A. FALSE patients are given antiplatelet agents (Bailey & Loves 25 th ed, pg 904) B. TRUE CT and MR angiography recently introduced method that is gaining popularity and gradually replacing Digital Subtraction Angiography (DSA) (Bailey & Loves 25th ed, pg 903) C. TRUE Percutaneous Transiluminal Angioplasty (PTA) (Bailey & Loves 25 th ed, pg 904) D. E. TRUE (Bailey & Loves 25th ed, pg 905) TRUE (Bailey & Loves 25th ed, pg 903)