Surgery p6(251-300)
Surgical Insights Quiz
Test your surgical knowledge with our comprehensive quiz containing 54 detailed questions designed for medical professionals. Each question is focused on critical concepts in surgery, including post-operative care, trauma management, and conditions requiring surgical intervention.
Engage with a variety of topics such as:
- Intracranial pressure effects
- Pancreatic conditions
- Otorhinolaryngology
- Orthopedic trauma
- Surgical indications and contraindications
Which physical exam finding below is usually not associated with increasing intracranial pressure?
A. Deteriorating level of consciousness
B. Increasing heart rate and increasing blood pressure
C. yawning, hiccuping, vomiting
D. seizures
E. Unilateral sixth cranial nerve palsy
Which of the following is false regarding post-operative wound infections?
A. S. Aureus is the most common cause
B. Usually present with fever post of day 3-4
C. Increased likelihood in diabetics
D. Mainly treated with antibiotics
E. Risk increases with length of surgery
Which of the following signs and symptoms warrant surgical intervention for patients with small bowel obstruction?
A. Abdominal tenderness
B. air-fluid levels on abdominal x-ray
C. Worsening abdominal pain
D. Feculent vomitus
E. Air in the colon and rectum on abdominal x-ray
A59 year-old woman presents to her family physician with a 3 cm palpable, well circumscribed, non-tender breast mass. She first noticed it several months ago and believes it has increased in size since then. Her mother and maternal aunt were diagnosed with breast cancer in their early 50’s. She has no other health complaints. A subsequent mammogram shows no abnormalities. Which of the following is the next most appropriate step in management?
A. Prophylactic mastectomy
B. Repeat mammogram in 6 months
C. Repeat mammogram ion 1 year
D. Excisional biopsy
E. ultrasound
Which of the following is false regarding pancreatic pseudocysts?
A. It is caused by duct leakage
B. Clinically suspected if persisting pain > 2 weeks following diagnosis of acute pancreatitis
C. Majority are treated surgically
D. Surgical intervention is typically delayed to allow pseudocyst to mature
E. Lacks true epithelium
An overweight, 45 year-old man presents with left lower quadrant tenderness and a one week history of abdominal pain, loose non-bloody stools and worsening fever. Laboratory investigation yields leukocytosis with neutrophilia and left shift. What is the diagnostic modality of choice?
A. CT scan
B. Barium enema
C. ultrasound
D. Plain abdominal film
E. angiography
A19 year-old woman is brought to the emergency room following involvement in a motor vehicle accident. On examination, she has a GCS of 10 and swelling over the occipital protuberance. The most appropriate imaging study is:
A. MRI of skull and contents
B. Skull films
C. head CT with contrast
D. head CT without contrast
E. CT myelogram
Which of the following radiographic features is most consistent with osteoarthritis of the knee?
A. Marginal erosions
B. juxta-articular osteopenia (demineralization)
C. Loss of articular cartilage with narrowing of the radiologic joint space
D. osteonecrosis (avascular necrosis) of the medial femoral condyle
E. Syndesmophyte formation
Which of the following statements is incorrect with respect to wound healing?
A. Epithelialization can occur within 24 hours following primary closure of a wound
B. Maximum wound strength is often achieved after 2 years
C. Wounds continue to gain strength after collagen synthesis has reached an equilibrium
D. Wound contracture is mediated by myofibroblasts
E. The incidence of wound infection increases with healing by secondary intention
Which of the following is not a cause of sensor-neural hearing loss:
A. Ossicular discontinuity
B. ototoxicity
C. Méniére disease
D. noise
E. presbycusis
Which of the following is not true of Meniere’s disease?
A. Characterized by quadrad of vertigo, hearing loss, tinnitus and aural fullness
B. Vertigo burns out with time
C. Can be treated with diuretics
D. It is the result of an abnormal buildup of potassium
E. The vertigo lasts for seconds
A neurosurgeon complains of a 3 week history of awakening at night with right-hand discomfort that resolves after several minutes. On examination, he has mild weakness of thumb abduction and diminished pain sensibility on the palmar aspect of the thumb and index finger. The most likely diagnosis is:
A. Carpal tunnel syndrome
B. Cervical radiculopathy
C. Reflex sympathetic dystrophy
D. tendonitis
E. Left middle cerebral artery ischemic attacks
A73 year-old woman presents with a 6 month history of deteriorating gait and low back discomfort, exacerbated by walking. Examination is unremarkable except for hypoactive muscle stretch reflexes in the legs. X-rays of the lumbosacral area shows the expected degenerative changes associated with a woman of her age. The most likely diagnosis is:
A. Acute lumbar disc hernation
B. Lumbar stenosis
C. myopathy
D. Normal pressure hydrocephalus
E. Cervical stenosis
Which of the following findings is inconsistent with cardiac tamponade?
A. hypotension
B. Pulsus paradoxus
C. Kussmaul sign
D. Jugular venous distension
E. Muffled heart sounds
Tension pneumothorax is best diagnosed with:
A. stat CT scan
B. Chest x-ray
C. Watch and wait
D. Clinical exam
E. None of the above
Which of the following is NOT a cause of major lower gastrointestinal hemorrhage?
A. diverticulitis
B. angiodysplasia
C. Aortoenteric fistula
D. None of the above
All of the following have been associated with posterior shoulder dislocation EXCEPT:
A. ethanol
B. electricity
C. exercise
D. epilepsy
E. encephalitis
Management of an open fracture should always include each of the following EXCEPT:
A. Assessment of neurovascular status
B. Reduction and fixation of fracture
C. Irrigation and debridement of wound
D. Application of sterile dressing
E. Application of topical antibiotic
What is the most common type of thyroid cancer?
A. medullary
B. papillary
C. follicular
D. lymphoma
E. anaplastic
Which of the following is an absolute indication for a tonsillectomy?
A. Airway obstruction
B. recurrent (>5) episodes of tonsillitis
C. Peritonsillar abscess
D. Tonsillar hypertrophy
E. halitosis
Which of the following statements regarding the Glasgow coma scale is true?
A. It serves as a scale to assess the long-term sequelae of head trauma
B. A high score correlates with a high mortality
C. It includes measurement of intracranial pressure
D. It includes measurement of pupillary reflexes
E. It includes measurement of verbal response
Controlled hyperventilation (induced hypocapnia) is frequently recommended following head trauma. The therapeutic consequences of this therapy include
A. Reduction of endogenous catecholamines
B. Reduction of intracellular potassium levels
C. Increase in cerebrovascular resistance
D. Induction of compensatory metabolic alkalosis
E. Requirement of monitoring the intracranial pressure
Which of the following statements regarding skull fractures is true?
A. Depressed fractures are those in which the patient’s level of consciousness is diminished or absent
B. Compound fractures are those in which the skull is fractured and the underlying brain is lacerated
C. Any bone fragment displaced more than 1 cm inwardly should be elevated surgically
D. Drainage of cerebrospinal fluid via the ear or nose requires prompt surgical treatment
E. Most skull fractures require surgical treatment
An 18-year-old man is admitted to the emergency room following a motorcycle accident. He is alert and fully oriented, but witnesses to the accident report an interval of unresponsiveness following the injury. Skull films disclose a fracture of the left temporal bone. Following x-ray, the patient suddenly loses consciousness and dilation of the left pupil is noted. This patient should be considered to have
A. Ruptured berry aneurysm
B. Acute subdural hematoma
C. Epidural hematoma
D. Intraabdominal hemorrhage
E. Ruptured arteriovenous malformation
An acute increase in intracranial pressure is characterized by which of the following clinical findings?
A. Respiratory irregularities
B. Decreased blood pressure
C. Tachycardia
D. Papilledema
E. Compression of the fifth cranial nerve
Which of the following statements regarding cerebral contusions is true?
A. They occur most frequently in the occipital lobes
B. They may occur opposite the point of skull impact
C. They are rarely accompanied by parenchymal bleeding
D. They may occur spontaneously in patients receiving anticoagulants
E. Anticonvulsants have no role in the early management of this disorder
While watching a golf tournament, a 37-year-old man is struck on the side of the head by a golf ball. He is conscious and talkative after the injury, but several days later he is noted to be increasingly lethargic, somewhat con- fused, and unable to move his right side. For description above, select the type of vascular event with which it is most likely to be associated.
A. Subdural hematoma
B. Epidural hematoma
C. Carotid dissection
D. Brain contusion
E. Ruptured intracranial aneurysm
Total joint replacement is a frequently performed operation. Which of the following is correct with regard to a joint replacement?
A. It is indicated in cases of septic arthritis
B. It loosens quickly if "held in place" by methyl methacrylate cement
C. It is contraindicated in patients with poor dentition
D. It is contraindicated below the age of 60 years
E. It produces "wear particles" which may result in granulomatous disease
A 62 year old woman has multiple small bowel fistulae following a complicated course of peritonitis. What is the most likely abnormality that will be found on her arterial blood gas (ABG) and biochemistry analysis?
A. Respiratory alkalosis
B. Metabolic acidosis with increased anion gap
C. Respiratory acidosis with bicarbonate retention
D. Metabolic acidosis with normal anion gap
E. Metabolic alkalosis with decreased anion gap
A 19 year old man, presents to the Emergency Department with a supra-condylar fracture of the distal humerus. Later that evening, after surgical fixation he is noted to have a wrist drop with a patch of numbness on the dorso-radial aspect of the wrist. What is this most likely to be due to?
A. A median nerve injury
B. An ulnar nerve injury
C. A musculo-cutaneous nerve injury
D. An anxilliary nerve injury
E. A radial nerve injury
A 72 year old man suddenly develops pain, and weakness of his right shoulder. On examination, he has trouble initiating abduction at the shoulder but with the arm at 90 degrees abduction strength is near normal. Rupture of which of the following tendon is most likely to produce this deficit?
A. Biceps
B. Deltoid
C. Supraspinatus
D. Infraspinatus
E. Triceps
A 25 year old man who sustains a clean, fairly superficial, 3cm long laceration to his left forearm on a piece of broken glass. Which one of the following statements about management is true?
A. Prophylactic antibiotics are required
B. Thorough cleansing with saline is the decontamination method of choice
C. Immediate tetanus prophylaxis is required as this is a tetanus-prone wound
D. X-ray is required even if the whole length and depth of the wound can be visualised
E. The wound should be closed in layers
A 72 year old retired office worker, has a chest X-ray prior to elective surgery. This shows a solitary 5cm nodule. Which of the following does NOT suggest a diagnosis of lung cancer as the cause of pulmonary nodule?
A. Smoking history
B. Increasing age
C. Nodule size >2cm
D. Nodule calcification
E. Haemoptysis
A 72 year old man has a fracture of the neck of his left femur after a fall. Six days later after internal fixation, his left leg and thigh are swollen. His temperature is 37.5ºC and is otherwise asymptomatic. What is the next step in management?
A. Continue observation
B. Arrange a plain X-ray of his left lower limb
C. Arrange a venous duplex ultrasound of his left lower limb
D. Perform a blood culture and start empirical antibiotics
E. Perform hip surgery immediately
A 17 year old student who fell off his skateboard 2 days ago. He presents to the Emergency Department with pain over the base of his thumb and tenderness over the region of the anatomical snuffbox. There is also a small amount of swelling over the same region with no other deformity. What is the most likely diagnosis?
A. Tenosynovitis
B. Scaphoid fracture
C. Base of thumb arthritis
D. Dislocation of the radiocarpal joint
E. Distal radio-ulnar dislocation
A 28 year old man is involved in a head-on vehicle collision. He had allegedly been drinking at a pub with friends and left after a dispute. He was initially trapped in the car with the major impact on his right thigh. He is brought into the Emergency Department conscious, but pale with a pulse of 135bpm and blood pressure of 90/60mmHg. He has deformity of his mid thigh with visible bone protruding from a wound. Which of the following is the correct terminology to describe his fracture?
A. Greenstick fracture
B. Pathological fracture
C. Stress fracture
D. Impacted fracture
E. Compound fracture
A 28 year old man, is involved in a head-on vehicle collision. He had allegedly been drinking at a pub with friends and left after a dispute. He was initially trapped in the car with the major impact on his right thigh. He is brought into the Emergency Department conscious, but pale with a pulse of 135bpm and blood pressure of 90/60mmHg. He has deformity of his mid thigh with visible bone protruding from ananterior wound. Which of the following is the most likely early complication?
A. Femoral artery injury
B. S1 nerve root injury
C. Ruptured bladder
D. Pulmonary embolus
E. L5 nerve root injury
Soft tissue healing is an ordered process. Which of the following is NOT a stage in this type of wound healing?
A. Acute inflammatory reaction
B. Formation of fibrous tissue
C. Granuloma formation
D. Formation of the coagulum
E. Angiogenesis
Which of the following is true regarding surgical therapy for colorectal cancer?
A. Adjuvant therapy is indicated for all patients with colorectal cancer
B. The goal of adjuvant therapy is to improve the chances of cure
C. Adjuvant radiotherapy is indicated for patients with colon cancer
D. Adjuvant chemotherapy for colon cancer should continue for at least 12 months
E. Adjuvant chemotherapy is unsuitable for patients over 65 years of age
A 7 year old child who weighs 25 kilograms is fasting for a series of investigations and a possible operative procedure. Assuming normal hydration initially, what would be an appropriate intra-venous maintenance fluid volume?
A. 110 ml/hr
B. 1.5 l/day
C. 25 ml/hr
D. 2 ml/kg/hr
E. 2.5 l/day
What is the most useful guide to the likely post-operative opioid requirements of a patient undergoing a laparotomy?
A. The weight of the patient
B. The estimated lean body mass of the patient
C. The gender of the patient
D. The age of the patient
E. The magnitude of the surgery
A 55 year old woman, presents to the Emergency Department with a 24 hour history of right upper quadrant pain, passing dark coloured urine and a fever of 38.7ºC. Abdominal ultrasound shows multiple gallstones in the gallbladder and a dilated common bile duct of 1.5 cm. What is the most likely diagnosis?
A. Acute appendicitis
B. Acute pancreatitis
C. Acute cholecystitis
D. Acute cholangitis
E. Acute hepatitis
Which of the following is true regarding the management of burns?
A. All patients require prophylactic antibiotics
B. Superficial (or first degree) burns have minor blisters only and should not require pain relief
C. Full thickness (or third degree) burns are very painful and require pain relief
D. Adults should receive 3 litres of normal saline within the first 12 hours to replace fluid lost via burnt skin
E. First aid involves placing the burnt area under cold running tap water for 20 minutes
You are called to see a 65 year old man on the surgical ward. He underwent a hemicolectomy for carcinoma of the colon 5 days ago, and has had increasing abdominal pain over the past 24 hours. He is able to talk to you but looks unwell. His heart rate is 130/minute, his blood pressure is 90/60 mmHg, his temperature is 38.5ºC, and his respiratory rate is 32/minute. His peripheral oxygen saturation is 96 percent while receiving oxygen via a simple face mask. What should your initial response be?
A. Change the mask to a reservoir mask (non-rebreather) to increase the oxygen supply
B. Request a chest X-ray
C. Give one litre of normal saline as quickly as possible intravenously
D. Take some blood for a cross-match
E. Insert a urinary catheter to monitor urine output
Which of the following is the organism most likely to cause endocarditis early after prosthetic valve surgery?
A. Fungus
B. Streptococcus
C. Enterococcus
D. Staphylococcus
E. Haemophilus
A 71 year old former gardener, presents with acute back pain which has steadily worsened over the past 6 weeks. On examination, you note thoracic kyphosis with no scoliosis. His mid-thoracic spine is tender to palpation and his spinal mobility is limited. You suspect an osteoporotic fracture. Which of the following is the next most appropriate diagnostic test to confirm your suspicion?
A. Thoracolumbar X-ray
B. Whole body Tc MDP nuclear medicine bone scan
C. MRI thorax
D. PET scan
E. Bone mineral density scan (osteodensitometry)
A 79 year old man with chronic atrial fibrillation who presents complaining of severe persistent periumbilical pain over the last 12 hours. On examination he looks unwell but is afebrile and has a pulse rate of 96. On abdominal examination he is diffusely tender but has no rebound, no localising signs and bowel sounds are occasionally heard.Which of the following is the most likely diagnosis?
A. Perforated peptic ulcer
B. Acute cholecystitis
C. Acute pancreatitis
D. Acute diverticulitis
E. Acute mesenteric ischaemia
A 64 year old female presents with a two-year history of perianal itching and irritation more noticeable in the past month. Inspection of the perineum shows an area of hyperkeratosis, leucoplakia and an associated large irregular ulcer on the anal verge in the mid-line posteriorly. What should be the next step in her management?
A. Perform a wide local excision
B. Prescribe a steroid cream
C. Patient to apply rectogesic ointment 5 percent (nitroglycerin-base)
D. Perform an internal anal sphincterotomy
E. Perform an incisional biopsy
A 45 year old man is involved in a motor vehicle accident. He presents 2 weeks later with pain involving the right shoulder, scapula and upper limb. What sensory findings would be suggestive of a C6 radiculopathy?
A. Numbness in a patch over the deltoid
B. Parasthesia over the upper trapezius
C. Numbness in the axilla
D. Paraesthesia of the index finger and thumb
E. Numbness of the little and ring fingers
Which of the following is NOT an indication for tracheotomy?
A. Acute airway obstruction
B. Prolonged ventilation
C. Recurrent bronchial toilet
D. Moderate sleep apnoea
E. Major head and neck cancer resections
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