SURGERY MCQ AND EMQ - Cambridge University Press

1 SURGERY MCQSAND EMQSbyR. W. ParksMD, FRCSI, FRCS (Ed)Senior Lecturer/Honorary Consultant SurgeonDepartment of Clinical and Surgical Sciences ( SURGERY ) University of EdinburghT. DiamondBSc, MD, FRCS, FRCSIC onsultant SurgeonMater HospitalBelfastLondon San 25/06/03 1:11 PM Page 2003 Greenwich Medical Media Limited137 Euston Road, LondonNW1 2AA870 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, neitherthe authors nor the publisher can accept any legal responsibility or liability for any loss ordamage arising from actions or decisions based in this book. The ultimate responsibility forthe treatment of patients and the interpretation lies with the medical practitioner. Theopinions expressed are those of the authors and the inclusion in this book of informationrelating to a particular product, method or technique does not amount to an endorsementof its value or quality, or of the claims made by its manufacturer.

2 Every effort has beenmade to check drug dosages; however, it is still possible that errors have , dosage schedules are constantly being revised and new side-effects these reasons, the medical practitioner is strongly urged to consult the drug companies'printed instructions before administering any of the drugs mentioned in this from any fair dealing for the purposes of research or private study, or criticism orreview, as permitted under the UK Copyright Designs and Patents Act 1988, this publicationmay not be reproduced, stored, or transmitted, in any form or by any means, without theprior permission in writing of the publishers, or in the case of reprographic reproductiononly in accordance with the terms of the licences issued by the appropriate ReproductionRights Organisations outside the UK. Enquiries concerning reproduction outside the termsstated here should be sent to the publishers at the London address printed rights of R.

3 W. Parks and T. Diamond to be identified as authors of this Work have beenasserted by them in accordance with the Copyright Designs and Patents Act publisher makes no representation, express or implied, with regard to the accuracy ofthe information contained in this book and cannot accept any legal responsibility orliability for any errors or omissions that may be catalogue record for this book is available from the British by Mizpah Publishing Services, Chennai, IndiaPrinted by Bell & Bain Ltd, GlasgowDistributed by Plymbridge Distributors Ltd and in the USA by JAMCO 25/06/03 1:11 PM Page ivvvContentsPreface ..viiiList of Abbreviations ..ixSection 1 Multiple Choice Questions (MCQs)Preoperative Management Questions ..3 Principles of Anaesthesia Questions ..6 Postoperative Management Support Questions ..10 Surgical Sepsis: Prevention & Therapy Questions.

4 12 Surgical Techniques & Technology : 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 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 .. 25/06/03 1:11 PM Page vSurgical Techniques & Technology Answers ..70 Trauma: General Principles of Management Answers.

5 74 Intensive Care Answers ..79 Principles of Cancer Management Answers ..82 Ethics, Legal Aspects & Assessment of Effectiveness Answers ..86 Haemopoietic & Lymphoreticular Systems System 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 Transfusion ..135 Anaesthesia/Analgesia ..136 Classification of Surgical Wounds ..138 Wound Closure ..139 Head Injury ..140 Sepsis ..141 Clinical Research ..142 Auto-immune Disease.

6 143 Intestinal Obstruction ..144 Investigations ..146 Perianal Conditions ..147 Causes of Chronic Arterial Disease ..148 Acute Arterial of Vascular Disease ..150 Breast Disease ..151 Management of Chest X-ray Findings ..153 Scrotal Swellings ..154 Treatment of Scrotal 25/06/03 1:11 PM Page viPresentation of Urological Pathology ..156 Head & Neck Swellings ..157 Depressed Level of Consciousness ..158 Fracture Complications ..160 Neonatal & Childhood Intestinal Obstruction ..161 Paediatric Emergencies .. 25/06/03 1:11 PM Page viiSection 1 Multiple Choice Questions (MCQs)Preoperative Management Questions ..3 Principles of Anaesthesia Questions ..6 Postoperative Management Support Questions ..10 Surgical Sepsis: Prevention & Therapy Questions ..12 Surgical Techniques & Technology : General Principles of Management Questions ..16 Intensive Care Questions.

7 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 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) 25/06/03 2:32 PM Page 1 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.

8 82 Ethics, Legal Aspects & Assessment of Effectiveness Answers ..86 Haemopoietic & Lymphoreticular Systems System 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) 25/06/03 2:32 PM Page 2 SURGERY MCQs and American Society of Anesthesiologists (ASA)classification of fitness of patients for SURGERY includesthe 1 where there is no organic, physiological, biochemicalor psychiatric 3 where there is mild to moderate systemic disturbancewhich does not limit normal 4 where there are severe life-threatening 5 where the patient is moribund with little chance E where the letter E after a particular classificationdenotes an emergency the risk of myocardial infarction during orfollowing 3 months prior to SURGERY increases the risk by 30% 6 months prior to SURGERY increases the risk by 6% risk is 5 10% when there is no previous history SURGERY should not be performed within 6 months ofa myocardial endoscopy should not be performed within 6 months of a myocardial defined by the World Health Organisation as a systolicblood pressure 160 mmHg and/or a diastolic blood pressure 105 present in approximately 25% of adult a contraindication to elective SURGERY if the diastolicpressure exceeds 115 mmHgQQQP

9 ReoperativeManagementQuestionsSme(MCQs) 25/06/03 2:32 PM Page 3 SURGERY MCQs and EMQs4 MCQsPreoperative be treated with intravenous beta-blockers or glyceryltrinitrate if emergency SURGERY is should be discontinued 2 weeks before following drugs should be discontinued prior oral contraceptive following investigations are appropriate prior ECG in all patients 30 chest X-ray on all patients 40 biochemical screen (block) on all patients 30 yearsundergoing major haematocrit on all female coagulation screen in all patients with obstructive a diabetic patient undergoing dose of depot insulin should be halved on the day prior tosurgery and supplemented with soluble insulin later in the the morning dose of insulin should be given on the dayof intravenous infusion of 5% dextrose is erected on themorning of requirements may increase after major majority of diabetic patients undergoing SURGERY haveinsulin-dependent (Type I) following statements concerning prophylaxis ofthrombo-embolic disease are appropriate regimen involves enoxaparin 20 mg bd, givensubcutaneouslyQQQQSme(MCQs) 25/06/03 2.

10 32 PM Page significant thromboembolism occurs inapproximately 1% of patients undergoing major measures contribute significantly to reduce theincidence of 70 is widely used to reduce the incidence ofpostoperative deep vein 35 years, obesity and malignancy are all significant riskfactors for the development of deep vein thrombosisSurgery MCQs and EMQs5 MCQsPreoperative ManagementQuestionsSme(MCQs) 25/06/03 2:32 PM Page 5 SURGERY MCQs and following are intravenous induction following are depolarising neuromuscular following statements concerning opioid analgesicsare is a synthetic may be administered orally, intravenously,intramuscularly, subcutaneously and via the epidural(neuraxial) contains a mixture of morphine, pethidine is a synthetic derivative of causes significant cardiovascular following are correct contents of common contains 154 mmol of sodium per contains 72 mmol of chloride per litreQQQQP rinciples ofAnaesthesiaQuestionsSme(MCQs) 25/06/03 2.