9781841101866ws

645 views

Published on

Published in: Education, Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
645
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
25
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

9781841101866ws

  1. 1. SURGERY MCQS AND EMQS by R. W. Parks MD, FRCSI, FRCS (Ed) Senior Lecturer/Honorary Consultant Surgeon Department of Clinical and Surgical Sciences (Surgery) University of Edinburgh T. Diamond BSc, MD, FRCS, FRCSI Consultant Surgeon Mater Hospital Belfast London o San Francisco Sme_FM.qxd 25/06/03 1:11 PM Page iii
  2. 2. www.greenwich-medical.co.uk © 2003 Greenwich Medical Media Limited 137 Euston Road, London NW1 2AA 870 Market Street, Ste 720 San Francisco, CA 94102 ISBN 1841101869 First Published 2003 While the advice and information in this book is believed to be true and accurate, neither the authors nor the publisher can accept any legal responsibility or liability for any loss or damage arising from actions or decisions based in this book. The ultimate responsibility for the treatment of patients and the interpretation lies with the medical practitioner. The opinions expressed are those of the authors and the inclusion in this book of information relating to a particular product, method or technique does not amount to an endorsement of its value or quality, or of the claims made by its manufacturer. Every effort has been made to check drug dosages; however, it is still possible that errors have occurred. Furthermore, dosage schedules are constantly being revised and new side-effects recognised. For these reasons, the medical practitioner is strongly urged to consult the drug companies' printed instructions before administering any of the drugs mentioned in this book. Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the UK Copyright Designs and Patents Act 1988, this publication may not be reproduced, stored, or transmitted, in any form or by any means, without the prior permission in writing of the publishers, or in the case of reprographic reproduction only in accordance with the terms of the licences issued by the appropriate Reproduction Rights Organisations outside the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publishers at the London address printed above. The rights of R. W. Parks and T. Diamond to be identified as authors of this Work have been asserted by them in accordance with the Copyright Designs and Patents Act 1988. The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made. A catalogue record for this book is available from the British Library. Typeset by Mizpah Publishing Services, Chennai, India Printed by Bell & Bain Ltd, Glasgow Distributed by Plymbridge Distributors Ltd and in the USA by JAMCO Distribution Sme_FM.qxd 25/06/03 1:11 PM Page iv
  3. 3. vv Contents Preface ........................................................................................................viii List of Abbreviations ....................................................................................ix Section 1 – Multiple Choice Questions (MCQs) Preoperative Management – Questions ......................................................3 Principles of Anaesthesia – Questions ..........................................................6 Postoperative Management – Questions......................................................8 Nutritional Support – Questions ................................................................10 Surgical Sepsis: Prevention & Therapy – Questions....................................12 Surgical Techniques & Technology – Questions..........................................14 Trauma: General Principles of Management – Questions ........................16 Intensive Care – Questions ..........................................................................19 Principles of Cancer Management – Questions..........................................21 Ethics, Legal Aspects & Assessment of Effectiveness – Questions ............24 Haemopoietic & Lymphoreticular Systems – Questions ............................25 Alimentary System – Questions ..................................................................26 Vascular Surgery – Questions ......................................................................33 Endocrine Surgery – Questions....................................................................35 Breast – Questions........................................................................................39 Thoracic Surgery – Questions ......................................................................42 Genitourinary System – Questions ..............................................................44 Head & Neck – Questions ............................................................................46 Central Nervous System – Questions ..........................................................48 Musculoskeletal System – Questions ..........................................................50 Paediatric Surgery – Questions....................................................................52 Preoperative Management – Answers........................................................55 Principles of Anaesthesia – Answers ..........................................................58 Postoperative Management – Answers ......................................................60 Nutritional Support – Answers....................................................................64 Surgical Sepsis: Prevention & Therapy – Answers ......................................66 Sme_FM.qxd 25/06/03 1:11 PM Page v
  4. 4. Surgical Techniques & Technology – Answers ............................................70 Trauma: General Principles of Management – Answers ............................74 Intensive Care – Answers ............................................................................79 Principles of Cancer Management – Answers ............................................82 Ethics, Legal Aspects & Assessment of Effectiveness – Answers................86 Haemopoietic & Lymphoreticular Systems – Answers................................87 Alimentary System – Answers......................................................................89 Vascular Surgery – Answers ........................................................................99 Endocrine Surgery – Answers ....................................................................101 Breast – Answers ........................................................................................108 Thoracic Surgery – Answers ......................................................................112 Genitourinary System – Answers ..............................................................114 Head & Neck – Answers ............................................................................118 Central Nervous System – Answers ..........................................................121 Musculoskeletal System – Answers ..........................................................123 Paediatric Surgery – Answers ....................................................................125 Section 2 – Extended Matching Questions (EMQs) Classification of Fitness for Surgery ..........................................................131 Preoperative Prophylactic Measures ........................................................132 Discontinuation of Drug Treatment Prior to Surgery ..............................133 Appropriate Anaesthetic Techniques........................................................134 Blood Transfusion ......................................................................................135 Anaesthesia/Analgesia ..............................................................................136 Classification of Surgical Wounds ............................................................138 Wound Closure ..........................................................................................139 Head Injury ................................................................................................140 Sepsis ..........................................................................................................141 Clinical Research ........................................................................................142 Auto-immune Disease................................................................................143 Intestinal Obstruction ................................................................................144 Investigations ............................................................................................146 Perianal Conditions....................................................................................147 Causes of Chronic Arterial Disease............................................................148 Acute Arterial Disease................................................................................149 Management of Vascular Disease ............................................................150 Breast Disease ............................................................................................151 Management of Chest Trauma..................................................................152 Chest X-ray Findings ..................................................................................153 Scrotal Swellings ........................................................................................154 Treatment of Scrotal Swellings..................................................................155 vi Sme_FM.qxd 25/06/03 1:11 PM Page vi
  5. 5. Presentation of Urological Pathology ......................................................156 Head & Neck Swellings ..............................................................................157 Depressed Level of Consciousness ............................................................158 Fracture Complications ..............................................................................160 Neonatal & Childhood Intestinal Obstruction..........................................161 Paediatric Emergencies..............................................................................162 vii Sme_FM.qxd 25/06/03 1:11 PM Page vii
  6. 6. Section 1 Multiple Choice Questions (MCQs) Preoperative Management – Questions ......................................................3 Principles of Anaesthesia – Questions ..........................................................6 Postoperative Management – Questions......................................................8 Nutritional Support – Questions ................................................................10 Surgical Sepsis: Prevention & Therapy – Questions....................................12 Surgical Techniques & Technology – Questions..........................................14 Trauma: General Principles of Management – Questions ........................16 Intensive Care – Questions ..........................................................................19 Principles of Cancer Management – Questions..........................................21 Ethics, Legal Aspects & Assessment of Effectiveness – Questions ............24 Haemopoietic & Lymphoreticular Systems – Questions ............................25 Alimentary System – Questions ..................................................................26 Vascular Surgery – Questions ......................................................................33 Endocrine Surgery – Questions....................................................................35 Breast – Questions........................................................................................39 Thoracic Surgery – Questions ......................................................................42 Genitourinary System – Questions ..............................................................44 Head & Neck – Questions ............................................................................46 Central Nervous System – Questions ..........................................................48 Musculoskeletal System – Questions ..........................................................50 Paediatric Surgery – Questions....................................................................52 Sme(MCQs)_Question.qxd 25/06/03 2:32 PM Page 1
  7. 7. Preoperative Management – Answers........................................................55 Principles of Anaesthesia – Answers ..........................................................58 Postoperative Management – Answers ......................................................60 Nutritional Support – Answers....................................................................64 Surgical Sepsis: Prevention & Therapy – Answers ......................................66 Surgical Techniques & Technology – Answers ............................................70 Trauma: General Principles of Management – Answers ............................74 Intensive Care – Answers ............................................................................79 Principles of Cancer Management – Answers ............................................82 Ethics, Legal Aspects & Assessment of Effectiveness – Answers................86 Haemopoietic & Lymphoreticular Systems – Answers................................87 Alimentary System – Answers......................................................................89 Vascular Surgery – Answers ........................................................................99 Endocrine Surgery – Answers ....................................................................101 Breast – Answers ........................................................................................108 Thoracic Surgery – Answers ......................................................................112 Genitourinary System – Answers ..............................................................114 Head & Neck – Answers ............................................................................118 Central Nervous System – Answers ..........................................................121 Musculoskeletal System – Answers ..........................................................123 Paediatric Surgery – Answers ....................................................................125 Sme(MCQs)_Question.qxd 25/06/03 2:32 PM Page 2
  8. 8. Surgery MCQs and EMQs 3MCQs 1. The American Society of Anesthesiologists (ASA) classification of fitness of patients for surgery includes the following A. ASA 1 where there is no organic, physiological, biochemical or psychiatric disturbance B. ASA 3 where there is mild to moderate systemic disturbance which does not limit normal activity C. ASA 4 where there are severe life-threatening systemic disorders D. ASA 5 where the patient is moribund with little chance of recovery E. ASA E where the letter E after a particular classification denotes an emergency operation 2. Concerning the risk of myocardial infarction during or following surgery A. Infarction Ͻ3 months prior to surgery increases the risk by 30% B. Infarction Ͼ6 months prior to surgery increases the risk by 6% C. The risk is 5–10% when there is no previous history of infarction D. Elective surgery should not be performed within 6 months of a myocardial infarction E. Gastrointestinal endoscopy should not be performed within 6 months of a myocardial infarction 3. Hypertension A. Is defined by the World Health Organisation as a systolic blood pressure Ͼ160mmHg and/or a diastolic blood pressure Ͼ105mmHg B. Is present in approximately 25% of adult patients C. Is a contraindication to elective surgery if the diastolic pressure exceeds 115mmHg Q Q Q Preoperative Management Questions Sme(MCQs)_Question.qxd 25/06/03 2:32 PM Page 3
  9. 9. Surgery MCQs and EMQs4 MCQs PreoperativeManagementQuestions D. Should be treated with intravenous beta-blockers or glyceryl trinitrate if emergency surgery is necessary E. Treatment should be discontinued 2 weeks before elective surgery 4. The following drugs should be discontinued prior to surgery A. Prednisolone B. Progesterone-only oral contraceptive pill C. Aspirin D. Propranolol E. Warfarin 5. The following investigations are appropriate prior to surgery A. An ECG in all patients Ͼ30 years B. A chest X-ray on all patients Ͼ40 years C. A biochemical screen (block) on all patients Ͼ30 years undergoing major surgery D. A haematocrit on all female patients E. A coagulation screen in all patients with obstructive jaundice 6. In a diabetic patient undergoing surgery A. The dose of depot insulin should be halved on the day prior to surgery and supplemented with soluble insulin later in the day B. Half the morning dose of insulin should be given on the day of surgery C. An intravenous infusion of 5% dextrose is erected on the morning of surgery D. Insulin requirements may increase after major surgery E. The majority of diabetic patients undergoing surgery have insulin-dependent (Type I) diabetes 7. The following statements concerning prophylaxis of thrombo-embolic disease are true A. An appropriate regimen involves enoxaparin 20mg bd, given subcutaneously Q Q Q Q Sme(MCQs)_Question.qxd 25/06/03 2:32 PM Page 4
  10. 10. B. Clinically significant thromboembolism occurs in approximately 1% of patients undergoing major surgery C. Mechanical measures contribute significantly to reduce the incidence of thromboembolism D. Dextran 70 is widely used to reduce the incidence of postoperative deep vein thrombosis E. Age Ͼ35 years, obesity and malignancy are all significant risk factors for the development of deep vein thrombosis Surgery MCQs and EMQs 5MCQs PreoperativeManagementQuestions Sme(MCQs)_Question.qxd 25/06/03 2:32 PM Page 5
  11. 11. Surgery MCQs and EMQs6 MCQs 1. The following are intravenous induction anaesthetic agents A. Propofol B. Etomidate C. Sevoflurane D. Thiopentone E. Halothane 2. The following are depolarising neuromuscular blocking drugs A. Suxamethonium B. Atracurium C. Vecuronium D. Pancuronium E. Atracurium 3. The following statements concerning opioid analgesics are true A. Morphine is a synthetic alkaloid B. Morphine may be administered orally, intravenously, intramuscularly, subcutaneously and via the epidural (neuraxial) route C. Papavertum contains a mixture of morphine, pethidine and papaverine D. Fentanyl is a synthetic derivative of morphine E. Fentanyl causes significant cardiovascular instability 4. The following are correct contents of common crystalloid solutions A. NaCl 0.9% contains 154mmol of sodium per litre B. NaCl 0.9% contains 72mmol of chloride per litre Q Q Q Q Principles of Anaesthesia Questions Sme(MCQs)_Question.qxd 25/06/03 2:32 PM Page 6
  12. 12. C. Glucose 5% contains 20mmol of potassium per litre D. Hartmann’s contains 40mmol of potassium per litre E. Hartmann’s contains 150kCal per litre 5. The following are significant advantages of regional anaesthesia A. Avoidance of unconsciousness B. Absence of respiratory depression C. Sympathetic blockade D. Blockade of motor function E. Avoidance of Hypotension 6. Local anaesthesia A. Only affects sensory nerve fibres B. Is very effective for incision and drainage of cutaneous abscesses C. Must be injected into the tissues to become effective D. In high doses can cause convulsions and bradycardia E. May not be used in the region of an end-artery 7. In general anaesthesia A. Pulse oximetry is used routinely to record the heart rate and oxygen saturation B. Patients require mechanical ventilation for the operative period C. Preoperative starvation ensures that the stomach is empty D. Bradycardia is treated with neostigmine E. Opioids do not cause direct myocardial depression Q Q Q Surgery MCQs and EMQs 7MCQs PrinciplesofAnaesthesiaQuestions Sme(MCQs)_Question.qxd 25/06/03 2:32 PM Page 7
  13. 13. Surgery MCQs and EMQs8 MCQs 1. Complications of blood transfusion are A. Urticaria B. Hypokalaemia C. Hepatitis C D. ARDS E. Jaundice 2. Atelectasis A. May impair gas exchange B. May predispose to chest infection C. Can be prevented by prophylactic treatment with antibiotics D. Is a common cause of an early postoperative fever E. May necessitate fibreoptic bronchoscopy to extract mucus plugs 3. Postoperative fluid management of the surgical patient should A. Include administration of 40–60mmol of potassium in the first 24h B. Account for insensible losses of up to 1500ml if the patient is septic C. Include packed red blood cells if the haematocrit falls below 40% D. Aim to provide at least 1000 calories for the first three postoperative days E. Be increased if the central venous pressure falls below 8cm H2O 4. With regard to postoperative complications A. The most common site of intra-abdominal abscess formation is in the pelvis Q Q Q Q Postoperative Management Questions Sme(MCQs)_Question.qxd 25/06/03 2:32 PM Page 8
  14. 14. B. Secondary haemorrhage is often associated with diffuse bleeding from an infected operative site C. Hypotension is the earliest sign of hypovolaemia D. The risk of deep venous thrombosis and pulmonary embolism is increased with malignancy E. Acute tubular necrosis due to inadequate renal perfusion is irreversible 5. Following major abdominal surgery A. Epidural anaesthesia often masks the clinical signs of post- operative secondary haemorrhage B. Insertion of a nasogastric tube prevents intestinal ileus C. Swinging pyrexia and diarrhoea are characteristic clinical features of a pelvic abscess D. Open drainage reduces the risk of septic complications E. Subcutaneous heparin administration reduces the incidence of deep venous thrombosis 6. Postoperative pyrexia may occur secondary to A. Subphrenic abscess B. Deep venous thrombosis C. Urinary tract infection D. Atelectasis E. Blood transfusion 7. The following are well-recognised specific postoperative complications A. Renal failure in jaundiced patients B. Deep venous thrombosis after varicose vein surgery C. Hyperglycaemia, high lactate levels and a prolonged prothrombin time following liver resection for colorectal metastases D. Positive Chvostek’s sign after thyroid lobectomy E. Urinary incontinence following inguinal hernia repair Q Q Q Surgery MCQs and EMQs 9MCQs PostoperativeManagementQuestions Sme(MCQs)_Question.qxd 25/06/03 2:32 PM Page 9
  15. 15. Surgery MCQs and EMQs10 MCQs 1. Parameters used to assess nutritional status include: A. Serum albumin B. Triceps skin-fold thickness C. White cell count D. Handgrip strength E. Prothrombin time 2. Severe malnutrition is indicated by A. Ͼ10% recent weight loss B. Serum albumin Ͻ30g/l C. Peripheral oedema D. Koilonychia E. Gynaecomastia 3. Enteral nutrition A. Increases the incidence of bacterial translocation B. Maintains the gut mucosal barrier function C. May be safely administered immediately after abdominal surgery D. Should be considered the first choice of feeding for severe head injury patients E. Is associated with increased risk of infective complications compared to TPN-fed patients 4. Daily nutritional requirements for a 70kg man are: A. 35–40kCal/kg/day B. 1–2g nitrogen/day C. 15g protein/day D. 70mmol Kϩ /day E. 2500ml water/day Q Q Q Q Nutritional Support Questions Sme(MCQs)_Question.qxd 25/06/03 2:32 PM Page 10
  16. 16. 5. TPN A. Most commonly is administered via large central veins B. Is indicated in approx 25% of patients in hospital requiring nutritional support C. Is indicated for all patients with paralytic ileus D. Should be administered using an infusion pump E. May induce hepatocyte dysfunction Q Surgery MCQs and EMQs 11MCQs NutritionalSupportQuestions Sme(MCQs)_Question.qxd 25/06/03 2:32 PM Page 11
  17. 17. Surgery MCQs and EMQs12 MCQs 1. Features of the systemic inflammatory response syndrome (SIRS) include A. Temp Ͼ38.4ЊC B. Temp Ͻ35.6ЊC C. WCC Ͻ4cells/ml D. Respiratory rate Ͼ20/min E. PaCO2 Ͼ32mmHg 2. Factors which prevent overgrowth of pathogenic bacteria in the gastrointestinal tract include A. Small intestinal stasis B. Secretion of IgE C. Mucus production D. Antibiotics E. Blind loops 3. Factors predisposing to nosocomial pneumonia include A. Oropharyngeal colonisation due to increased mouth breathing B. Routine use of H2 antagonists C. Use of a nasogastric tube D. Endotracheal intubation E. Impaired gag reflex 4. Systemic endotoxin may trigger the release of A. Pro-inflammatory cytokines B. Anti-inflammatory cytokines C. Complement D. Platelet activating factor (PAF) E. Endotoxin antibodies Q Q Q Q Surgical Sepsis: Prevention & Therapy Questions Sme(MCQs)_Question.qxd 25/06/03 2:32 PM Page 12
  18. 18. 5. Factors predisposing to wound infection include A. Inadequate haemostasis B. Prolonged operation C. Diabetes D. Obstructive jaundice E. Malnutrition 6. Features of Adult Respiratory Distress Syndrome (ARDS) include A. Increased lung compliance B. Hypoxaemia associated with decreasing inspired oxygen concentration C. Pulmonary infiltrates on a chest X-ray D. Encephalopathy E. Dyspnoea or tachypnoea 7. Regarding antibiotics A. Penicillins act by disrupting the peptidoglycan of the bacterial cell wall B. Ampicillin is effective against pseudomonas infections C. Cephalosporans are usually prescribed as a monotherapy D. Vancomycin is the treatment of choice for MRSA E. Aminoglycosides may cause nephrotoxicity 8. Indications to isolate patients infected with HIV, HBV or HCV include those with A. Bleeding oesophageal varices B. Profuse diarrhoea C. Urinary tract infections D. Diabetes E. Surgical drains Q Q Q Q Surgery MCQs and EMQs 13MCQs SurgicalSepsis:Prevention&TherapyQuestions Sme(MCQs)_Question.qxd 25/06/03 2:32 PM Page 13
  19. 19. Surgery MCQs and EMQs14 MCQs 1. Injection of 1% lignocaine with 1 in 200,000 adrenaline is a useful form of anaesthesia for A. Reducing a Smith’s fracture B. Performing a Zadek’s procedure C. Repair of an indirect inguinal hernia D. Central line insertion E. Insertion of a Seton suture 2. Diathermy A. Produces coagulation by oscillation of tissue ions B. In bipolar form is useful at circumcision C. In monopolar form is useful to obtain haemostasis in grade IV liver injuries D. May cause burns at sites distant from the point of contact E. In NdYAG form is used to destroy lesions in the gastrointestinal tract 3. Wound healing A. Is characterised by increased vascular permeability B. Is associated with release of growth factors and cytokines by leukocytes and macrophages C. Is characterised by wound contracture due to shortening of myofibrils D. Is retarded by vitamin A deficiency E. Is improved by nutrients 4. The following factors may adversely affect the healing of wounds A. Exposure to ultraviolet light B. Obstructive jaundice C. Advanced neoplasia Q Q Q Q Surgical Techniques & Technology Questions Sme(MCQs)_Question.qxd 25/06/03 2:32 PM Page 14
  20. 20. D. Exposure to ionising radiation E. Infection 5. Wound infection rates A. Are approximately 10% in clean wounds B. Can be reduced by shaving the operative site 24h prior to surgery C. Can be reduced by minimizing the prehospital stay D. Can be reduced by application of chlorhexidine or iodine preparations in theatre to the operative site E. Are increased in patients with zinc deficiency 6. Burn injuries A. Involving 20% of body surface area can be managed by daily dressings by a district nurse B. Involving the thorax may require escarotomy C. Of partial thickness are often painless, but needle pricks can usually be felt D. Requires fluid replacement of 2–4ml/kg per percent body surface burn within the first 24h E. To the head and neck have the lowest mortality rates 7. The general effects of burn injury are A. Increased metabolic rate B. Impaired immune function C. Hypernatraemia D. Hypoalbuminaemia E. Impairment of gut barrier function 8. Contemporary management of burn injuries includes A. Early enteral feeding B. Administration of broad-spectrum antibiotics to prevent colonisation of the burn site prior to skin grafting C. Meshing of split-skin grafts to allow up to six times the potential coverage of the graft D. Application of occlusive, nonabsorptive dressings which should be changed on a daily basis E. Early release of contractures to allow early mobilisation and to obtain the best functional and aesthetic result Q Q Q Q Surgery MCQs and EMQs 15MCQs SurgicalTechniques&TechnologyQuestions Sme(MCQs)_Question.qxd 25/06/03 2:32 PM Page 15
  21. 21. Surgery MCQs and EMQs16 MCQs 1. When a casualty has severe facial injuries A. An immediate danger to life is blood loss B. Transport to the casualty department should be in the supine position C. Airway obstruction can occur due to inhaled blood D. Surgical cricothyroidotomy may be required due to oedema E. Cervical spine injury should be considered after securing a definitive airway 2. In the early assessment and resuscitation of a trauma patient A. Application of a tourniquet to control obvious external blood loss from a limb is essential to minimise hypovolaemic shock B. Airway patency ensures adequate ventilation C. A urinary catheter should be inserted if the patient is unconscious D. A normal lateral cervical spine X-ray excludes a cervical spine injury E. Nasotracheal intubation should be undertaken in the apnoeic patient 3. In compensated hypovolaemia due to haemorrhage A. There is no significant reduction of systemic blood pressure B. The vital organs are inadequately perfused C. There will be associated bradycardia D. The patient may feel thirsty E. 1000ml of blood may have been lost from the intravascular compartment Q Q Q Trauma: General Principles of Management Questions Sme(MCQs)_Question.qxd 25/06/03 2:32 PM Page 16
  22. 22. Trauma:GeneralPrinciplesofManagementQuestions 4. Severe head injury may be associated with A. Raised systemic arterial blood pressure B. No evidence of damage on CT scan C. Secondary injury due to tissue hypoxia D. Retention of carbon dioxide E. A Glasgow Coma Score of 10 5. Indications for emergency thoracotomy include A. Patients with penetrating precordial injuries who are in EMD B. Immediate evacuation of 750ml blood on insertion of a chest drain C. Continued blood loss from a chest drain of 200ml/h for Ͼ3h D. A haemodynamically stable patient with a wide mediastinum on chest X-ray E. A patient with hypoxia and a flail chest segment 6. Definite indications for emergency laparotomy are A. Stab wounds to the back with evidence of injury to the renal parenchyma B. Gunshot wound to the abdomen C. Stab wound to periumbilical region with protrusion of bowel D. Haemodynamically stable patient with a liver laceration and free intra-abdominal fluid on CT scan E. Injured diaphragm 7. Diagnostic peritoneal lavage (DPL) A. Is less sensitive than a CT scan for intraperitoneal bleeding B. Is positive if the red cell count is Ͼ10,000 RBCs/mm3 C. Is positive if the white cell count is Ͼ1000 WBCs/mm3 D. Should be performed in a haemodynamically unstable patient with peritonism E. Is positive if the aspirate contains bowel contents Q Q Q Q Surgery MCQs and EMQs 17MCQs Sme(MCQs)_Question.qxd 25/06/03 2:32 PM Page 17
  23. 23. Trauma:GeneralPrinciplesofManagementQuestions 8. Liver injuries A. Are predominantly due to blunt trauma in the UK B. Due to deceleration forces, as in road traffic accidents, commonly cause lacerations between the anterior and posterior sectors of the right lobe of the liver C. May result in hyperpyrexia D. Frequently necessitate anatomical resection of the involved liver lobe E. Can be managed by packing gauzes into hepatic lacerations and transferring the patient to a specialist liver unit for definitive surgical treatment 9. In the management of burn injuries A. Patients should receive 35% oxygen via a face mask if inhalation injury is suspected B. 2–4ml crystalloid per kilogram body weight per percent body surface burn is required in the first 24h to maintain an adequate circulating blood volume C. One half of the estimated fluid requirement for the first 24h should be administered over the first 4h D. Prophylactic antibiotics are indicated in the early postburn period E. Acid burns are generally more serious than alkali burns 10. The metabolic response to injury includes A. Increased ADH secretion B. Elevation of serum growth hormone C. Increased ACTH secretion from the hypothalamus D. Transient hypoglycaemia in the early stage after injury E. Increased urinary resorption of potassium Q Q Q Surgery MCQs and EMQs18 MCQs Sme(MCQs)_Question.qxd 25/06/03 2:32 PM Page 18
  24. 24. Surgery MCQs and EMQs 19MCQs 1. Cardiac output A. Is a function of stroke volume and mean arterial pressure B. Is regulated by the autonomic nervous system C. Is regulated by chemoreceptors D. Can be measured by a thermodilutional technique E. Can increase to 40L/min with exercise 2. Cardiac tamponade A. Is exacerbated by restrictive pulmonary disease B. May result from penetrating cardiac wounds C. Results in a low CVP D. Is associated with pulsus paradoxus E. Requires open surgical evacuation of blood and clot 3. The Adult Respiratory Distress Syndrome (ARDS) A. May occur following massive blood transfusion B. Is characterised by the development of radiological signs prior to clinical deterioration C. Is associated with the systemic inflammatory response syndrome (SIRS) D. Is associated with increased lung compliance E. Often requires respiratory support using artificial ventilation with positive end-expiratory pressure (PEEP) 4. Artificial ventilation A. Is indicated for type III respiratory failure B. Is best achieved with relatively low tidal volumes at a relatively fast rate C. For a short duration will be easier to be weaned from than that continued for a more prolonged period D. Necessitates paralysis of the patient E. May reduce venous return if PEEP is used Q Q Q Q Intensive Care Questions Sme(MCQs)_Question.qxd 25/06/03 2:32 PM Page 19
  25. 25. 5. The Systemic Inflammatory Response Syndrome (SIRS) A. Implies a focus of sepsis which must be localised and treated B. Rarely leads to end organ failure C. Stimulates fixed tissue macrophages to secrete cytokines D. May be associated with gut barrier dysfunction E. May be associated with a compensatory anti-inflammatory response 6. Acute renal failure A. May cause a metabolic acidosis B. Is diagnosed when the urinary output falls below 800ml in 24h C. In critically ill patients should be treated by haemodialysis D. Is associated with hypokalaemia E. May be minimised by treating with a Dopamine infusion at 0.5–3mg/kg/h 7. Acute liver failure may be associated with A. Reduced systolic blood pressure B. Hyperglycaemia C. Hypernatraemia D. An increased prothrombin time E. Encephalopathy Q Q Q Surgery MCQs and EMQs20 MCQs IntensiveCareQuestions Sme(MCQs)_Question.qxd 25/06/03 2:32 PM Page 20

×