AM - Surgery 2

"Early clinical features of simple mechanical obstruction of the upper ileum do not include which of the following? a.Generalized abdominal discomfort. b.Constipation. c.Vomiting. d.Diarrhea."

"Diarrhea. Diffuse, poorly-localized, colicky upper abdominal pain is an early feature of simple mechanical obstruction; generalized abdominal discomfort is a later feature if obstruction is not relieved. Abdominal distension is also not an early feature of simple mechanical obstruction.

"Which of the following statements is correct of post-operative psychiatric complications? a.They are rare in the aged. b.Anxiety is an unusual presentation. c.Effective communication between the surgeon and the patient prevents or reduces the complications. d.They are more likely in a patient who has developed a relationship of trust with the surgeon."

"Effective communication between the surgeon and the patient prevents or reduces the complications. d.They are more likely in a patient who has developed a relationship of trust with the surgeon.

"In the immediate post-operative period which of the following findings is a pointer to extracellular fluid volume depletion? a.A urinary output of 50ml/hr. b.A blood pressure of 70/50mmg. c.A temperature of 37.2°C. d.Equal, normally-reacting pupils."

A blood pressure of 70/50mmg.

"Which of the following statements about colorectal carcinomas is correct? a.A patient with early ascending colon carcinoma is likely to be cachexic. b.Left-sided colonic carcinomas are not expected to cause obstructive symptoms. c.Severe anemia is an unreliable sign, prognostically. d.A palpable right-sided abdominal mass may be due to cecal or ascending colonic carcinoma."

A palpable right-sided abdominal mass may be due to cecal or ascending colonic carcinoma.

"Symptoms and signs of early breast carcinoma include which of the following? a.Breast skin dimpling. b.Edema of the skin. c.Backache. d.A small, hard, irregular-shaped breast mass."

A small, hard, irregular-shaped breast mass.

"Which of the following on management of abdominal wall hernias is incorrect? a.The sac of a wide hernia may be returned into the peritoneal cavity. b.A narrow-necked hernial sac should be excised and the neck closed. c.Herniotomy is the operation of choice in congenital indirect inguinal hernia. d.All strangulated herias have gangrenous contents."

All strangulated herias have gangrenous contents.

"Peri-rectal suppuration: Which of the statements below is correct? a.An abscess forms between the longitudinal intersphincteric muscles and the internal anal sphincter. b.Pilonidal abscess is an unlikely cause. c.Peri-anal abscess is difficult to palpate and the patient is usually afebrile. d.Antibiotic therapy is the most important form of therapy."

An abscess forms between the longitudinal intersphincteric muscles and the internal anal sphincter.

"Proper wound care does not involve which of the following? a.Application of concentrated antiseptic solution to the surface of a wound before suturing. b.Taking a history of the wound before doing something definitive to it. c.Thorough inspection to decide whether the wound is infected or contaminated. d.Closing a deep wound in layers."

Application of concentrated antiseptic solution to the surface of a wound before suturing.

"Post-operative complications: Which of the statements below is correct? a.Atelectasis usually occurs after a minimum of 48 hours following a major surgery. b.An elderly patient with a pre-existing heart disease is prone to arrhythmias. c.Serosanguineous wound discharge 48 hours post-operatively is a good sign of wound dehiscence. d.Pain at the operation site and intermittent fever five days after surgery is a pointer to wound infection."

Atelectasis usually occurs after a minimum of 48 hours following a major surgery.

"Which of the following statements about burns is correct? a.Burns involving the head and neck may result in pharyngeal and laryngeal edema. b.Hoarseness of the voice and tachypnea contraindicate laryngoscopy or endotracheal intubation. c.Partial thickness burn is synonymous with first degree burn. d.Third-degree burns do not involve sebaceous glands and hair follicles."

Burns involving the head and neck may result in pharyngeal and laryngeal edema.

"Which of the following is a major constituent of gallstones? a. Calcium b.Iron. c.Potassium. d.Phosphate."

Calcium

"Which of the following is not an extramural bowel wall disease responsible for intestinal obstruction? Volvulus b.Intussusception. c.Carcinoma of the colon. d.Constrictive adhesive bands."

Carcinoma of the colon.

"Which of the following statements about suture materials is correct? a.Chromic catgut is tanned with chromium salts. b.Plain and chromic catgut are solubilized by tissue collagenase within two weeks of applying them to human tissue. c.Nylon and silk should be left in-situ when there is evidence of wound infection. d.Uninfected tissue is expected to react to non-absorbable materials more than absorbable ones."

Chromic catgut is tanned with chromium salts.

"Which of the following statements about wound healing is correct? a.Inflammation is detrimental to wound healing. b.Epithelialization of a secondary healing wound usually lasts less than 24 hours. c.Granulation tissue consists of poorly perfused proliferating capillaries. d.Contraction plays an important role in filling skin wound defects."

Contraction plays an important role in filling skin wound defects.

"Which of the following is expected in patients with common bile duct stones? a.Left shoulder tip pain. b.Dull right upper abdominal quadrant pain. c.Dark urine and pale stools. d.Gall bladder distension as an operative finding."

Dark urine and pale stools.

"Which of the following suture materials is absorbable? a.Silk. b.Dexon. Nylon d.Cotton."

Dexon.

"Which of the following is an acceptable mechanical method of closing a bleeding point? a.Digital pressure. b.Simple ligature for transected large arteries. c.Distant pressure by tourniquet application. d.Pressure by application of warm wet pack for diffuse bleeding."

Digital pressure.

"Diseases of the appendix do not include which of the following? a.Tuberculosis. b.Carcinoid. c.Diverticulitis d.Adenocarcinoma."

Diverticulitis

"When amebic liver abscess ruptures, its contents may not enter which of the following? a.Pleural cavity. b.Pericardial cavity. c.Peritoneal cavity. d.Endometrial cavity."

Endometrial cavity.

"In achalasia which of the following statements is correct? a.Men are four times more prone than women. b.Middle-aged individuals are less likely than elderly patients. c.Dysphagia in early cases is to solid and warm foods. d.Esophagomyotomy is effective treatment."

Esophagomyotomy is effective treatment.

"Which of the following statements about shock is correct? a.When there is paradoxical pulse myocardial infarction is the most likely cause of shock. b.Hypotension, warm, dry skin and reduced pulse rate are features of cardiogenic shock. c.Exposure to noxious stimuli may precipitate shock. d.A patient with strangulated small bowel obstruction is unlikely to have septic shock."

Exposure to noxious stimuli may precipitate shock.

"Features of acute appendicitis include which of the following? a.Abdominal pain which usually starts from the right lower quadrant. b.Severe protracted vomiting initially. c.Fecalith in the lumen of the appendix. d.Marked derangement in vital signs even in uncomplicated cases."

Fecalith in the lumen of the appendix.

" "Which of the following statements about intestinal obstruction is correct? a.The quiet intervals between burst of peristalsis are longer in upper intestinal than lower intestinal obstruction. b.Markedly reduced fluid absorption is the primary cause of distension above the level of obstruction. c.Fluid and electrolytes are not lost into bowel wall. d.Free peritoneal fluid is expected in a patient with unrelieved lower ileal obstruction."

Free peritoneal fluid is expected in a patient with unrelieved lower ileal obstruction.

"Complications of long-standing duodenal ulcer do not include which of the following? a.Massive upper gastrointestinal hemorrhage. b.Gastric outlet obstruction. c.Gastric ulcer. d.Intractable abdominal pain."

Gastric ulcer.

"In severe hypovolemic shock the diversion of blood flow is expected to be to which of the following organs? a.Kidneys. Heart c.Skin. d.Liver."

Heart

"Which of the following is not a feature of gastrointestinal disease? a.Obstipation. b.Ileus. c.Hematocolpos. d.Anorexia."

Hematocolpos.

"Which of the following statements about carcinoma of the prostate is correct? a.Lower back pain is an uncommon symptom. b.Treatment of choice for advanced cases is radical prostatoseminalvesiculectomy. c.Histologically most of them are adenocarcinomas. d.Orchiectomy should not be considered when there is metastasis."

Histologically most of them are adenocarcinomas.

"Which of the following statements about abdominal wall hernias is correct? a.An inguinal hernia is a ventral hernia. b.In a strangulated hernia the contained organ is incarcerated. c.A sliding hernia is one in which the blood supply is compromised. d.A hernia at the junction between the linea semilunaris and linea semicircularis is called Petit's triangle hernia."

In a strangulated hernia the contained organ is incarcerated.

"Which of the following statements about inguinal hernias is correct? a.A left-sided hernia which reduces with difficulty in an elderly patient is unlikely to be a sliding hernia. b.An indirect hernia protrudes through Hesselbach's triangle. c.A scrotal hernia is commonly a direct hernia. d.Incarceration is unlikely in a direct inguinal hernia."

Incarceration is unlikely in a direct inguinal hernia.

"Which of the following statements about an adult with 45% burns is correct? a.They may have first-degree burns. b.Crystalloid solutions may be used in the first 48 hours post-bur but not colloid solutions. c.Intravenous fluid therapy should aim at ensuring a urinary output of not less than 30ml/hr. d.Pain is a significant feature in the areas with third-degree burns."

Intravenous fluid therapy should aim at ensuring a urinary output of not less than 30ml/hr.

"Anal fissure: Which of the statements below is correct? a.It spares the portion of anal canal lined by skin. b.It characteristically causes anal pain during and after defecation. c.In most cases it affects the midline of the anal canal anteriorly. d.It preferentially responds to lateral partial internal sphincterotomy."

It characteristically causes anal pain during and after defecation.

"Carcinoma of the esophagus: Which of the statements below is correct? a.It is usually of squamous cells in the esophago-gastric junction. b.It affects females more than males. c.It commonly affects the upper esophagus. d.It commonly presents as progressive dysphagia."

It commonly presents as progressive dysphagia.

"Which of the following statements about long-standing gastric ulcer is correct? a.It is usually located in the greater curvature of the stomach. b.It is a differential diagnosis of gastric cancer. c.Weight loss is an expected feature, not anorexia. d.Delayed gastric emptying is less likely than gastric outlet obstruction."

It is a differential diagnosis of gastric cancer.

"Acute cholecystitis: Which of the statements below is incorrect? a.It is usually caused by impacted stones in Hartmann's pouch. b.It presents as ulceration of the gall bladder muscle. c.It may result from septicemia. d.It is dissimilar to intercostal nerve herpes zoster."

It is dissimilar to intercostal nerve herpes zoster.

"Fibroadenoma: Which of the statements below is correct? a.It is commonest in the fifth decade. b.It is firm and rubbery in consistency. c.It presents mostly as multiple lumps. d.It is usually fixed to the skin of the affected breast."

It is firm and rubbery in consistency.

"Goiter: Which of the statements below is correct? a.The term refers to thyroid enlargement whether benign or malignant. b.It is not a cause of dysphagia. c.It frequently causes recurrent laryngeal nerve paralysis with hoarseness. d.It is usually associated with a euthyroid state."

It is usually associated with a euthyroid state.

"Cystic hygroma: Which of the statements below is incorrect? a.It results from obstruction of developing lymph vessels. b.It is usually found anterior to the sterocleidomastoid. c.It is usually multiple. d.It may affect the tongue and floor of the mouth."

It is usually found anterior to the sterocleidomastoid.

"Chronic cholecystitis: Which of the statements below is correct? a.It presents with left upper abdominal quadrant pain which radiates to the scapular tip. b.It is not associated with Rokitansky-Aschoff sinuses. c.It may be complicated by gall bladder perforation. d.It presents as intolerance of carbohydrates."

It may be complicated by gall bladder perforation.

"Gastric cancer: Which of the statements below is correct? a.It is usually squamous cell carcinoma. b.It may present as a palpable upper abdominal mass. c.When associated with Virchow's node, it indicates early disease. d.It may be associated with Krukenberg tumor in adult males."

It may present as a palpable upper abdominal mass.

"Benign prostatic hyperplasia: Which of the statements below is correct? a.It rarely manifests as nocturia. b.It predisposes to development of inguinal hernias. c.It does not cause vesical calculi. d.It should be treated by prostatectomy in patients with renal impairment."

It predisposes to development of inguinal hernias.

"Torsion of the testis: Which of the statements below is incorrect? a.It is usually of sudden onset. b.It presents as an exquisitely tender testis and edematous scrotum. c.It frequently simulates epididymitis. d.It rarely leads to infarction if untreated."

It rarely leads to infarction if untreated.

"Cryptorchidism: Which of the statements below is correct? a.It is synonymous with ectopic testis. b.It is commoner in full term male infants than in the premature. c.It subjects the testes to reduced temperature. d.It should be treated by orchidopexy."

It should be treated by orchidopexy.

"Carcinoma of the breast: Which of the statements below is correct? c.It presents as an ulcer early in the course of the disease. d. It spreads to axillary lymph nodes making them hard. a.It is usual in an 18-year-old female. b.It is rarely a scirrhous adenocarcinoma."

It spreads to axillary lymph nodes making them hard.

"Amebic liver abscess: Which of the statements below is correct? a.It is usually multiple. b.It has amebas in the necrotic zone of the abscess. c.It is usually located in the left lobe of the liver. d.It usually presents as fever and chills associated with right upper quadrant or epigastric pain."

It usually presents as fever and chills associated with right upper quadrant or epigastric pain.

"Which of the following statements about Meckel's diverticulum is incorrect? a.Its location is the antimesenteric border of the ileum, about 100cm. from the ileo-cecal valve. b.It may be involved in intestinal obstruction. c.Appendicitis is a differential diagnosis. d.When symptomatic, surgical intervention is the treatment of choice."

Its location is the antimesenteric border of the ileum, about 100cm. from the ileo-cecal valve.

"Which of the following is correct of extracellular fluid loss in a pre-operative patient? Bradycardia b.Elevated blood pressure in a known normotensive. c.Loss of 7% of body weight. d.Increased urinary output."

Loss of 7% of body weight.

"Complications of gastrosophageal reflux do not include which of the following? a.Esophageal stenosis. b.Esophagitis. c.Lower esophageal constriction ring. d.Lower gastro-intestinal hemorrhage."

Lower gastro-intestinal hemorrhage.

"Dysphagia is unlikely to be a presentation of which of the following? a.Lower gastrointestinal bleeding. b.Esophageal carcinoma. c.Retropharyngeal abscess. d.Poliomyelitis."

Lower gastrointestinal bleeding.

"Which of the following conditions is not expected to cause shock? a.Cardiac tamponade. b.Malaria in the semi-immune. c.Acute gastric dilatation. d.Myocardial infarction."

Malaria in the semi-immune.

"Which of these does not represent extracellular fluid loss with redistribution? a.Ascites. b.Crush injuries. c.Mild epistaxis. d.Intestinal secretions in intestinal obstruction."

Mild epistaxis.

"Electrocautery: Which of the statements below is correct? a.It causes vasoconstriction. b.It is time-consuming. c.More tissue than is desired may be necrosed. d.The patient does not suffer burns."

More tissue than is desired may be necrosed.

"Which of the following statements about intestinal obstruction is correct? a.Essentially high levels of chloride, sodium and potassium in early cases. b.Progressive fall in hematocrit in the early phase. c.Polyuria causing dehydration in early cases. d.Multiple gas-fluid levels on plain erect abdominal radiographs."

Multiple gas-fluid levels on plain erect abdominal radiographs.

"Which of the following is an appropriate step in the management of patients with intestinal obstruction? a.Delay in surgical intervention in the presence of a markedly tender localized area of the abdomen with a mass. b.Establishing an intravenous line just to keep the vein open. c.Nasogastric intubation. d.Prompt surgical intervention to relieve intestinal obstruction which has lasted for 36 hours."

Nasogastric intubation.

"Which of the following statements about intravenous fluids is correct? a.Normal saline contains same concentration of sodium and chloride ions. b.The lactate in sodium lactate is converted into lactic acid. c.One-sixth molar sodium lactate solution may be used to correct metabolic alkalosis. d.Isotonic saline solution should not be used in cases of hypochloremia and hyponatremia."

Normal saline contains same concentration of sodium and chloride ions.

"Findings in patients with intestinal obstruction include which of the following? a.Gaseous distension principally caused by carbon dioxide. b.Occlusion of blood supply to a portion of intestine in cases of strangulation. c.Absent bowel sounds in simple mechanical obstruction lasting 24 hours. d.Loss of large volumes of hypotonic extracellular fluid in simple mechanical obstruction of small bowel."

Occlusion of blood supply to a portion of intestine in cases of strangulation.

"Which of the following is true of blood banked for transfusion? a.ACD- and CPD-solutions are inefficient blood preservatives b.Storage of whole blood is usually done at a temperature of 10°C. Banked whole blood should not be transfused if older than 28 days. c.It is still rich in platelets if older than one day. d.Oxygen transportation is reduced as blood gets older in the blood bank."

Oxygen transportation is reduced as blood gets older in the blood bank.

"Likely causes of pain in the left lower quadrant of the abdomen do not include which of the following? a.Appendicitis. b.Abdominal wall hematoma. c.Ureteric calculi. d.Pancreatitis."

Pancreatitis.

"Which of the following statements about abdominal wall hernias is correct? a.The defect in a congenital umbilical hernia rarely closes before age four years. b.Parturition is a known predisposing factor to umbilical hernia. c.Femoral hernias are found mainly in males. d.Inguinal hernias are commoner in females."

Parturition is a known predisposing factor to umbilical hernia.

"Which of the following statements about duodenal ulcer is correct? a.Females are affected more than males. b.When there is generalized abdominal pain the ulcer has penetrated into the pancreas. c.Penetration may result in massive upper gastrointestinal hemorrhage. d.Melena is an uncommon feature."

Penetration may result in massive upper gastrointestinal hemorrhage.

"Which of the following is not a complication of blood transfusion? Transmission of malaria. Disseminated intravascular coagulation Progressive c.Progressive blood pressure rise in anesthetized patients. Urticaria"

Progressive c.Progressive blood pressure rise in anesthetized patients.

"Clinical features of internal hemorrhoids include which of the following? a.Defecation with painful bright red rectal bleeding. b.Prolapse. c.Identification by palpation. d.Calcification."

Prolapse.

"Which of the following is not a cause of upper abdominal pain? Pancreatitis b.Cholecystitis. c.Pneumonia. d.Prostatitis."

Prostatitis.

"Which of the following factors negatively affects healing of a wound? a.Re-trauma. b.Globular protein aggregation. c.Collagen synthesis. d.Collagen remodeling."

Re-trauma.

"Which of the following changes takes place in blood stored for more than 24 hours? a.Factor VIII levels are unaffected. b.pH increases. c.Rise in ammonia concentration. d.A reduction in potassium concentration."

Rise in ammonia concentration.

"Which of the following statements about gastrosophageal reflux is correct? a.Patients rarely have associated sliding esophageal hiatal hernia. b.Scleroderma predisposes to gastrosophageal reflux. c.Heartburn is an uncommon symptom. d.Antacids are contraindicated."

Scleroderma predisposes to gastrosophageal reflux.

"Features of duodenal ulcer perforation include which of the following? a.Gradually developing symptoms. b.Normal skin turgor. c.Bradycardia. d.Sub-diaphragmatic air in an upright chest radiograph."

Sub-diaphragmatic air in an upright chest radiograph.

"With regards to wound care, which of the following statements is incorrect? a.Sucuticular sutures tend to make the scar wider than it would have been following suture removal. b.Dry sterile gauze is desirable for dressing wounds. c.Wet dressing may cause maceration of surrounding normal skin d.Dressing and sutures should be removed after inspection shows that the wound edges are held together properly."

Sucuticular sutures tend to make the scar wider than it would have been following suture removal.

"Burns involving which of the following parts of an adult's body represents the stated percentage of total body surface area? a.Half of the anterior surface of the trunk, 18%. b.The entire anterior surface of the head and neck, 3%. c.The front of the two upper extremities, 9%. d.The posterior surfaces of the two lower limbs, 36%."

The front of the two upper extremities, 9%.

"Which of the following statements regarding achalasia is correct? a.Peristaltic movement of the esophagus is normal. b.The lower esophageal sphincter does not relax during deglutition. c.There are constriction and tortuosity of the esophagus. d.Patients are not prone to developing esophageal carcinoma."

The lower esophageal sphincter does not relax during deglutition.

"Varicose veins: Which of the statements below is correct? a.They are deep vein branches. b.They have incompetent bicuspid valves. c.They may cause lower limb swelling relieved by standing. d.They may be managed non-operatively by walking."

They may cause lower limb swelling relieved by standing.

"Which of the following statements about vomiting is correct? a.Reverse peristalsis in the stomach explains vomiting of gastrointestinal origin. b.Vomiting is not a feature of migraine. c.Vomiting is usually preceded by anorexia and nausea in carcinoma of the stomach. d.Nausea is expected to precede vomiting in cases of raised intracranial pressure."

Vomiting is usually preceded by anorexia and nausea in carcinoma of the stomach.

"Which of the following statements about treatment of hypovolemic shock is incorrect? a.When due to external hemorrhage, replacement with crystalloids is adequate. b.Electrolyte solutions are useful in cases of peritonitis. c.Balanced salt solution infusions are a useful initial therapy in hemorrhagic shock. d.The Trendelenburg position is inappropriate for the patient."

When due to external hemorrhage, replacement with crystalloids is adequate.

"Which of the following statements about diarrhea is incorrect? a.It may result from vagotomy. b.Malabsorption is a known cause. c.When severe, diarrhea may cause acidosis. d.When protracted, hyperkalemia may result."

When protracted, hyperkalemia may result.

"Fistula-in-ano: Which of the statements below is correct? a.It arises from an abscess in the space between the glutei. b.It has a secondary internal opening in the anal canal at the dentate line. c.When superficial, it is a palpable indurated cord. d.The transsphincteric variety traverses the internal anal sphincter but not the external sphincter."

When superficial, it is a palpable indurated cord.

"Which of the following is a correct statement about ganglion? a.Unlikely locations include the dorsum and flexor surface of the wrist. b.When the distal inter-phalangeal joint is affected there is associated osteoarthritis. c.Connection with the wrist joint is unusual. d.A bloodless operative field is superfluous during ganglion excision."

When the distal inter-phalangeal joint is affected there is associated osteoarthritis.