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50 Cards in this Set
- Front
- Back
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Which of the following substances is not used as an irrigant during transurethral resection of the prostate ?
A) Normal Saline B) 1.5% Glycine C) 5% Dextrose D) Distilled water |
A
Answer (Select an option above to get the answer):Correct Answer : Explanation: Option A Normal saline is an electrolyte. Electrocautery does not work in electrolytic solutions as current is conducted by it. It is the best answer Options B, C & D Bailey & Love,23rd,Pg-1247 - Water intoxication is famous but occurs only in prolonged surgery. (So, distilled water can be used.) Water intoxication - Symptoms and signs of water intoxication may include mild headache, confusion, anorexia, nausea, vomiting, coma, and convulsions. Now a days the incidence of Water Intoxication is reduced with the use of 1. 5 % Isotonic Glycine or Normal Saline [Here note that Glycine is used intraoperatively, whereas Normal saline is used post-operatively.] The involuntary movement occurring in Water Intoxication is Athetosis Contributors - Dr Reja, Dr. J.M.A. Bruno Mascerenhas |
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Regarding varicose veins, which one of the following statements is true ?
A) Over 20% are recurrent varicosities B) The sural nerve is in danger during stripping of the long saphenous vein C) The saphenous nerve is closely associated with short saphenous vein D) 5% oily phenol is an appropriate sclerosant for venous sclerotherapy |
D
Explanation: Recent Advances in Surgery No. 26 Recurrent varicosities are seen in 10 - 15 % cases So, Option A is incorrect Sural nerve accompanies short saphenous vein, so it is in danger during short saphenous vein surgery So, Option B is incorrect Saphenous nerve accompanies long saphenous vein, so it is in danger during long saphenous vein surgery So, Option C is incorrect KDT's Pharmacology 5 % phenol in almond or peanut oil is the commonly used sclerosant So, Option D appears to be the best answer |
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The treatment of choice for symptomatic 'retained common bile duct stones' is ?
A) immediate surgery B) conservative treatment with antibiotics C) endoscopic sphincterotomy D) medical dissolution of the stones |
C
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During bilateral adrenalectomy for Cushing's disease, intraoperative dose of hydrocortisone should be given after ?
A) On opening the abdomen B) Ligation of left adrenal vein C) Ligation of right adrenal vein D) Excision of both adrenal glands |
D
Explanation: Maingot's Abdominal Operations (10/e)- Patients with adrenal tumor causing Cushing's syndrome (i.e. Unilateral Adrenalectomy) - must receive Glucorticoids POSTOPERATIVELY. Hydrocortisone @ maintenance dose of 12 - 15 mg / m2 / day. Mineralocorticoid replacement is not necessary in this subset of patients Patients with Bilateral Adrenalectomy - Both Glucorticoids & Mineralocorticoids (fludrocortisone 100 microgms / day) is necessary. However, it also writes - Adrenal insufficiency (post-operatively) is prevented by administering stress doses of steriods PERIOPERATIVELY, in selected patients. Bailey & Love's Short Practice of Surgery (23/e)- All patients who are subjected to adrenalectomy, should be supported intraoperatively & postoperatively by adrenocortical hormone replacement therapy, irrespective of the extent of adrenal resection. Corticosteriods are started when anaesthesia is induced. C.S.D.T. - After total adrenalectomy, life long corticosteriod maintenance therapy is necessary. The following schedule is commonly used: No cortisol is given until the adrenals are removed during surgery. Schwartz's Textbook of Surgery - Patients undergoing Bilateral Adrenalectomy need glucocorticoid and mineralocorticoid replacement therapy postoperatively. Overall, we see that Post operatively - the replacement is obviously necessary (as both the glands are being removed). Intra operatively - the purpose is to prevent postoperative adrenal insufficiency (as stated in Maingot's) the insufficiency begins after both the glands are excised (not after ligation of right / left adrenal vein). so D) should be the answer [Thanks to Dr. Abhishek for pointing out the error...!!!] |
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A 40 year old patient has undergone an open cholecystectomy. The procedure was reported as uneventful by the operating surgeon. She has 100 ml of bile output from the drain kept in the gall bladder bed on the first post operative day. On examination she is afebrile and anicteric. The abdomen is soft and bowel sounds are normally heard. As an attending physician, what should be your best possible advice ?
A) Order an urgent endoscopic retrograde cholangiography and biliary stenting B) Urgent laparotomy C) Order an urgent hepatic iminodiacetic acid scintigraphy (HIDA) D) Clinical observation |
D
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A young man weighing 65 Kg was admitted to the hospital with severe burns in a severe catabolic state. An individual in this state requires 40 Kcal per Kg body weight/day. This young man was given a solution containing 20% glucose and 4.25% protein. If 3000ml of solution is infused per day ?
A) The patient would not be getting sufficient protein B) The calories supplied would be inadequate C) Both protein and calories would be adequate D) Too much protein is being infused |
C
Explanation: [Explanation - This is a simple calculation keeping in mind that 1 gm of carbohydrate gives 4.3 Kcal. - by "Dr. Ved Prakash"] A) The patient would not be getting sufficient protein [By - " Dr. Debsanjay", thanks...!!!] |
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A 50 year old male suffering from renal failure, underwent kidney transplant. He was prescribed a nucleotide derivative following the organ transplant. The nucleotide derivative of therapeutic importance in this organ transplant is ?
A) Azathioprine B) 5-Fluorouracil C) Cytarabine D) Allopurinol |
A
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A three year old male child presents with history of constipation and abdominal distension for the last two years. The plain radiograph of abdomen reveals fecal matter containing distended bowel loops. A barium enema study done subsequently shows a transition zone at the rectosigmoid junction with reversal of recto-sigmoid ratio. The most probable diagnosis is ?
A) Anal atresia B) Malrotation of gut C) Hirschprung's disease D) Congenital megacolon |
C
Explanation: [Query - Why not congenital megacolon, is in't that both same ? - Dr. Sandeep Srivastava] |
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A young patient presents with history of dysphagia more to liquids than solids. The first investigation you will do is ?
A) Barium swallow B) Esophagoscopy C) Ultrasound of the chest D) C T Scan of the chest |
A
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After a minor head injury a young patient was unable to close his left eye and had drooling of saliva from left angle of mouth. He is suffering from ?
A) VIIth nerve injury B) Vth nerve injury C) IIIrd nerve injury D) Combined VIIth adn VIIIth nerve injury |
A
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Examples of sclerosants tjat can be used during endoscopic treayment of oesophageal varices
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Sodium MorrhuateSpdium tetradecyl sulphateEthanolamine*cyanocrulateglue injection for gastric varices
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Clinical features of hydrocephalus
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Enlarged headWifened anyerior fontanelleBulging and tense fontanelleCraniofascia disproportionProminent scalp veinsUp gaze palsyParinauds syndrome
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Monteggia #
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Fracture of the upper third of the ulna with dislocation of the head of the radius
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The adrenal cortex and the hormones it secretes
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Zona glomerulosa - AldosteroneZona fasciculata - CortisolZona reticularis -testosterone rep sex hormones
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What are the surgical options for PTC?
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1.Thyroid lobectomy+/- isthmusectomy2.Near total thyroidectomy3.Total thyroidectomy
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In what places in Ghana is goitre endemic?
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Need to find out
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What is Obscure bleeding?
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Bleeding that persists or recurs after negative endoscopy
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If histochemisyry of a breast mass rebeals Her-2 neu 2+,what next?
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FISHFluorescence in situ hybridizationHer2- neu positive breast ca is sensitive to transtuzumab.It is expensive and is associated with cardiac toxicity. If transtuzumab fails,try-Lapatinib-Emtansine (TDMC)
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Chronic osteomyelitis that starts denovo and not as a sequele of acute infection is called
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Brodie's abscess
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How long does it take for ESR to go up?
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24hrs
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How does oral contraceptives cause DVT?
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Oestrogen relaxes smooth muscles.Veins and venules are composed of smooth muscles.There will be pooling in the periphery which we call stasis.
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What is the length of the large intestine?
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100cm
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What are the guidelines for endoscopic resection of early gastric cancer?
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●tumour limited to the mucosa●No lymphovascular invasion●tumour smaller than 2cm●No ulceration
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What is massive blood transfusion?
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This is defined as transfusion of a volume greater than the recipient's blood volume in less than 24 h.
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What is the full meaning of warfarin?
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Winconsin Alumni Research Foundation + coumarm
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The amino acids released when skeletal muscle is broken down
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A-AlanineG-GlutamineM-muscle
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In what conditions is oral anticoagulant contraindicated
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Cerebral thrombosisPeripheral vascular diseaseHypertensive
Antiplatelet (75-100mg aspirin daily) is an alternative |
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Why must a patient stop Alcohol intake prior to surgery?
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Regular alcohol intake leads to induction of liber enzymes resulting in tolerance to anaesthesia; anaesthetic agents have to be increased during surgery.
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Why must a patient stop Alcohol intake prior to surgery?
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Regular alcohol intake leads to induction of liber enzymes resulting in tolerance to anaesthesia; anaesthetic agents have to be increased during surgery.
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Preparine a patient with obstructibe jaundice for surgery
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F-fluid to prevent renal dysfunctionM-Mannitol notC- Coagulation profileL-LactuloseA- Antibiotic prophylaxisB- Biliary drainage not routine
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what creatinine level is an independent risk factor for cardiac complications preoperatively?
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preoperative creatinine level of 2.0 mg/dL or higher is an independent risk factor for cardiac complications.
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How will you determine the cardiopulmonary functional status for noncardiac surgery?
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An easy and inexpensive method to determine cardiopul- monary functional status for noncardiac surgery is the patient’s ability or inability to climb two fights of stairs.
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For how long should you waitwait after MI to perform elective surgery?
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General recommendations are to wait 4 to 6 weeks after MI to perform elective surgery.
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Advantages of LMWH
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2-4 times half live of standard heparinBetter bioavailabilityRapidly reabsorbed after sc injection
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What is the gold standard for the diagnosis of osteomyelitis?
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Bone biopsy with histopathologic examination and tissue culture
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Pathogenesis of osteomyelitis
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•Bacteria seeds the bone•Bacteria adheres to bone 2ru adhesin•Inflammatory response•Inc. Intraosseous pressure•Impairment of blood flow•Ischaemic necrosis•Dead bone (sequestrum)•Sequestrum acts a non living surface for biofilm attachment
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Classify osteomyelitis
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Endogenous Acute haematogenous monomicrobial,Conservative rxExogenous Contiguous focus osteomyelitis without vascular insufficiency Trauma,surgery Contiguous focus with vascular insufficiency Dm foot,polymicrobial
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Cystic HygromaOptions for treatment
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Complete surgical excisionSclerotherapye.g intralesional bleomycin
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What are the features of Dandy walker syndrome?
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◆hypoplasia of the cerebellum◆cyst in the posterior fossa◆transverse sinus is elevated
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What is the Adeloye odeku cyst?
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A solitary congenital subgaleal inclusion dermoid cyst of the anterior fontanelle
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Length of each part of the Duodenum
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12341st 1 inch 2.5cm intraperitoneal1st part 2 inch 5cm2nd part 3 inch 7.5cm3rd part 4inch 10cm4th part 1 inch 2.5cmTotal=25cm
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A50-year-old man with small-bowel fistula has been receiving TPN for the previous 3 weeks through a single-lumen central venous catheter. He is scheduled for exploratory laparotomy and closure of fistula. On the morning of the day of surgery, TPN is discontinued and intra- venous infusion with balanced salt solution (Ringer’s lactate) is started. An hour later, the patient is found to be anxious, sweating, and tachycardic. What is the most likely cause?
(A) Anxiety (B) Hypoglycemia (C) Hypovolemia (D) Unexplained hemorrhage(E) Hyperglycemia |
(B)
Patients on TPN with hypertonic glucose solutions have elevated islet-cell production of insulin. Sudden cessation of TPN can lead to rebound hypoglycemia, because pancreatic islet-cell insulin secretion is not immediately downregulated. Symptoms are attrbutable to high catecholamine release secondary to hypo- glycemia. In general, the TPN rate should be reduced to 50 mL/h during surgery. This pre- vents both hypoglycemia and the hyper- glycemia seen with higher infusion rates. Weaning from TPN should be done gradually over 24–48 hours. In instances where TPN is discontinued suddenly, a solution of D10W should be administered in the interim. |
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A67-year-old man with severe ARDS is receiv- ing pressure assisted control ventilation. He is requiring an FiO2 of 100% to maintain the fol- lowing blood gas levels: pH = 7.26, PCO2= 60, PO2=58. You decide to put the patient in prone position. Fifteen minutes later, on the same vent settings, the patient’s tidal volume is now de- creased and his blood gas values are pH = 7.09, PCO2 = 76, PO2 = 89. He is hemodynamically unchanged and his chest x-ray (CXR) is also unchanged. The most likely cause of his wors- ening respiratory acidosis in the prone posi- tion is
(A) Pneumothorax (B) Increased dead space (C) Decreased cardiac filling (D) Reduced chest wall compliance (E) Pulmonary edema |
(D)
The prone positioning reduces the dispar- ity in mechanics between the dependent and nondependent regions of the lungs. This reduces the collapsing of the alveoli in the dependent portions of the lungs and overdis- tention in the nondependent portions of the lungs. The prone position also has other effects—it allows a more normal curvature of the diaphragm and allows better function. It also stiffens the chest wall allowing a more even distribution of ventilation and reduction in overventilation of nondependent alveoli. |
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A40-year-old woman is given a routine injection of ragweed allergen immunotherapy by her family physician. She developed a shortness of breathand asensationof throatswelling. She was taken to the emergency department where she was noted to be flushed and sweating profusely and in moderate distress. She was also noted to be wheezing, tachycardic and hypotensive. Which of the following interventions is most appropriate at this time?
(A)Ranitidine 50 mg PO (B) Diphenhydramine 50 mg PO (C)Ringer’s lactate, 250 ml over 1 hour (D) Methylprednisolone 125 mg PO (E) Epinephrine 0.5 mL intramuscular (IM) |
(E)
The patient is suffering from anaphylaxis, and the treatment of choice is epinephrine. Epinephrine IM has been shown to be more effective than SC for the treatment of anaphy- laxis. |
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You are called to the emergency department to evaluate a 55-year-old woman following motor vehicle crash with associated head trauma. She withdraws to pain and is intubated for airway protection. In order to calculate the Glasgow Coma Scale score, which of the following com- ponents of the neurologic examination are necessary?
(A) Motor response, verbal response, corneal reflexes (B) Motor response, eye opening, verbal response (C) Eye opening, pupillary light reflexes, motor response (D) Pupillary light reflexes, motor response, verbal response (E) Corneal reflexes, pupillary light reflexes, motor response |
(B)
The Glasgow Coma Score scale is made up of eye opening, verbal response, and motor response. |
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A 55-year-old male presents to the emergency room (ER) with a history suggestive of myocar- dial infarction, but without a diagnostic ECG pattern of ST-segment elevation. Which of the following ECG patterns strongly suggests that thrombolytic therapy should be administered.(A) Right bundle branch block
(B) Left bundle branch block (C) Second-degree AV block (Wenckebach type)(D) Complete artrioventricular (AV) block (E) Runs of V tachycardia |
(B)
The only ECG rhythm, which can obscure ST-segment changes seen in acute myocardial infarction, is left bundle branch block. All the other rhythms would allow visualization of the ST-segment changes. |
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A 28-year-old female several minutes after receiving an intravenous dose of ampicillin for dental prophylaxis against endocarditis devel- ops diffuse pruritis, cutaneous erythema, and hypotension (BP = 60/40 mm Hg). All of the following hemodynamic parameters are typical of this type of shock initially, except
(A) Increased HR (B) Intravascular hypovolemia (C) Vasodilation (D) Increased cardiac output(E) Decreased preload |
(D)
In anaphylactic shock, which this patient is showing, the HR would reflexively increase due to the drop in BP. The intravascular hypovolemia and decreased preload are clearly present along with the vasodilation; however, the cardiac output is initially decreased not increased. |
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A 65-year-old male is resuscitated using hy- droxyethyl starch (hetastarch). Which of the fol- lowing is associated with the use of hetastarch ?(A) Thrombotic thrombocytopenia
(B) Elevated levels of factor VIII (C) Elevation of serum creatinine (D) Hyperbilirubinemia (E) Hyperamylasemia |
(E)
Hetastarch is a synthetic colloid that is metabolically inert and can be infused IV. A 6% solution of hetastarch has the same osmotic properties as 5% albumin. Relatively few com- plications are associated with hetastarch. Large volumes do cause dilution of plasma proteins as well as coagulation and platelet function disorders. Hetastarch binds to amylase and impairs renal excretion of amylase causing hyperamylasemia. |
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During the treatment of septic shock, a 28-year- old male remains hypotensive despite adequate volume replacement; PA occlusion pressure is 18 mm Hg. When dopamine is started , ventric- ular tachycardia develops and this is unre- sponsive to lidocaine. The V-tach converts back to sinus rhythm once the dopamine is stopped.Questions: 90–104 15At this point, which of the following treatments aremostappropriate for thishypotensive patient?
(A) Amrinone (B) Dobutamine (C) Epinephrine (D) Phenylephrine (E) Intra-aortic balloon pump |
(D)
Dopamine activates b1-receptors and this was probably the reason for the arrhythmia. Amrinone will inhibit phosphodiesterase and result in an increased cyclic AMPlevel, pro- ducing the same result as b-receptor stimu- lation. Dobutamine and epinephrine also stimulate the b- receptors. The only choice which stimulates only a-adrenergic receptors is phenylephrine. Intra-aortic balloon pump is invasive, therefore, less appropriate as a choice. |
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A 20-year-old man has undergone appendectomy for perforated appendicitis with generalized peri- tonitis. Seven days postoperatively, his temperature continues to spike to 103.8°F despite antibiotic ther- apy with ampicillin, gentamicin, and metronidazole. ACT scan reveals a large pelvic abscess. Soon after- ward, he has bleeding from the mouth and nose with increasing oozing from the surgical wound and all intravenous puncture sites. What is the most likely diagnosis?
(A) Anaphylactoid reaction to intravenous dye (B) Disseminated intravascular coagulation (DIC) (C) Antibiotic-induced coagulopathy (D) Liver failure(E) Congenital bleeding disorder |
(B)
Disseminated intravascular coagulation is characterized by diffuse intravascular coagu- lation, thrombosis, and fibrinolysis. It results in thrombocytopenia, hypofibrinogenemia, pro- longation of PT and PTT, and increased con- centration of fibrin degradation products in plasma. Sepsis is a major factor that can trigger DIC. |
