Surgery Questions

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Peritonitis

Q) True statement regarding peritonitis is 

a) Raised serum amylase is only seen in pancreatitis

b) Rectal examination is better diagnostic of appendicitis than per abdominal examination

c) Ultrasound has diagnostic accuracy of 90% for diagnosing acute appendictis

d) Catarrhal appendicitis mostly leads to gangrene of appendix and perforation

Answer for premium members http://www.mcqsurgery.com/appendix

 

Endovenous Laser Ablation of varicose veins

Q )  Endovenous Laser Ablation (EVLA)  of  varicose veins is best suited for those :

a) With needle phobia

b) Thrombophlebitis

c) Excess tortuousity

d) Primary varicose veins

Answer

EVLA is thermal ablation of varicose veins in which laser  fibre is inserted in the lumen and ablation is done from inside. It is a good modality for primary and recurrent varicose veins and work in both long and short segments.

This treatment is not effective in cases where there is needle phobia or the veins are having excessive tortuousity or thrombophlebitis. This procedure is done under ultrasound guidance and  wire is passed from the superficial to the deep veins.

Tumescent local anesthesia also helps

Ref Bailey: Page 909

Traction diverticula

traction diverticulum esophagus

Q) What is true about traction diverticula of the esophagus?

a) It is a common diverticulum at the lower end of esophagus

b)Most  of these diverticula are symptomatic and require surgery

c) Mediastinal fibrosis is a common etiologial factor

d) They are most common on the left side

 

Answer 

c) Mediastinal fibrosis

Most of the traction diverticula are in mid esophagus on the right side. The common etiological factors are mediastinal infections, tuberculosis, mediastinal fibrosis and histoplasmosis.

These are true traction diverticula and have all the walls of esophagus.

They are mostly discovered incidentally during the workup of other diseases. Most of these are asymptomatic but can present with dysphagia, chest pain and regurgitation.

 

High speed injury

Q14) A young 18 years old unrestrained car driver has an head on collision with a truck and becomes unconscious. He is intubated on the site of accident and resuscitated with IV fluids. He is brought to the emergency in a state of shock,( BP 90/60 and pulse 120/min) but opens eyes on commands. On examination he does not have  pallor but neck veins are distended.

There are no signs suggestive of head or spine injury. Xray chest reveals normal cardiac chambers, no free gas and mild pleural effusion on left with no evidence of fracture ribs.

What will be the next step of management

a) Resuscitation and simultaneous CT thorax

b) Resuscitation and simultaneous Echo cardiography

c) Exploratory laparotomy

d) Chest tube drainage left side

Answer for Premium - Type of injuries in high speed accidents and points to look at

Esophageal hiatus hernia

Q) Many structures routinely pass through esophageal hiatus. What is type III esophageal hernia? 

a) Paraesophageal hiatus hernia

b) Sliding hiatus hernia

c) Both sliding and paraesophageal hernia

d) Large part of stomach in the mediastinum with pylorus near the esophageal hiatus

Answer  c

Hiatal hernias are protrusion of stomach through a defect in the esophageal hiatus into the mediastinum.

They are of two types

  1. Sliding - GE junction migrates to the mediastinum and rests superior to the diaphragm.
  2. Paraesophgaeal - Part of stomach migrates through the esophageal hiatus into the mediastinum with GE junction remaining at its normal position.

paraesophgeal hiatus hernia

  1. There are IV types of hiatal hernia

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Ductal carcinoma in situ

Q) IN RTOG trial for ductal carcinoma in situ (DCIS) favourable tumor was defined as

a) <3,5 cm in size and 2mm free resection margin

b) <2.5 cm and 2mm margin

c) <3 cm size and 3 mm margin

d) <2.5 cm size and 3 mm margin

Answer - Free answers to surgery mcqs
d

Ductal carcinoma in situ is a pre invasive state in which the cancer cells have not breached the epithelial membrane. It can develop into cancer in 20%.

Simple mastectomy is the standard of care but many centers now consider it over treatment.

Van Nuys system uses

  1. Age of the patient
  2. type of DCIS
  3. presence of microcalcification
  4. Size
  5. resection margin

On mammography this is seen as clustered clustered calcification

Treatment options are 

  1. Mastectomy
  2. Breast conserving therapy (Lumpectomy +radiation and hormonal)

More recently, Eastern Cooperative Oncology Group investigators reported the frst result of a relatively large prospective single-arm study of surgery with negative margins of at least 3 mm without radiation therapy for patients with favorable subsets of DCIS.

 Patients with low-grade or intermediate-grade DCIS measuring 2.5 cm or smaller had a 5-year rate of ipsilateral breast recurrence of only 6.1%. In contrast, patients with high-grade disease had a much higher 5-year ipsilateral breast recurrence rate of 15.3%.

REF : Sabiston 853

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334775/

 

Complications of Surgery of Aortic aneurysm

Q) A 68 year old man undergoes repair of infra renal aortic aneurysm. On 2nd POD he has abdominal pain, bloody diarrhea and tachycardia. BP is 120/70. Abdomen is mildly distended and tender especially in the left lower quadrant.

How will you proceed

a) Send stool for clostridium and spores

b) CT Abdomen

c) Exploratory laparotomy

d) Higher antibiotics

Answer for premium - Discuss the complications of Surgery for aortic aneurysm