Free Questions

Free MCQs in Surgery

Thyroid storm

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Q) 40 year old lady was on anti thyroid medications which she stopped for 2 weeks. She presented in emergency with high grade fever and hypotension. ( Thyroid Storm)   What is not a part of further management?

a) Oxygen

b) Beta blockers

c) Radio active Iodine

d) Lugol's idodine

Thyroid MCqs

Ans  c

This is Thyroid storm

Predisposing factors for thyroid storm are 

  1. Cessation of antithyroid medications
  2. Infection
  3. Thyroid or non thyroid surgery in untreated thyrotoxicosis
  4. Trauma in patients with untreated thyrotoxicosis.
  5. Amiodarone
  6. Iodinated contrast agents
  7. RAI therapy

Management is 

  1. Beta blockers
  2. Oxygen and hemodynamic support
  3. IV Lugol iodine
  4. PTU
  5. Corticosteroids

The symptoms of thyroid storm are more intense and severe than typical hyperthyroidism symptoms. They can include severe fever, rapid and irregular heartbeat (tachycardia), elevated blood pressure, restlessness, confusion, agitation, tremors, excessive sweating, nausea, vomiting, diarrhea, dehydration, and in severe cases, even delirium, seizures, and coma.

Schwartz page 1638

Grades of Splenic Injury – Image based Question

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Q) 45 year old male with road side accident and fracture of 3 ribs on left side. CT scan of the abdomen is shown below. Out of the five grades of splenic injury What is the grade  in him ?

Splenic Injury grades

 

 

 

 

 

 

 

a) Grade II

b) Grade III

c) Grade IV

d) Grade V 

Take the practice MCQ tests  ( Some are free). Others are for Premium Members

Take the free image based mock test 

Ans b Grade III

Grade 1
Subcapsular haematoma <10% of surface area
Parenchymal laceration <1 cm depth Capsular tear
Grade 2
Subcapsular haematoma 10–50% of surface area; Intraparenchymal haematoma <5 cm
Parenchymal laceration 1–3 cm
Grade 3
Subcapsular haematoma >50% surface area; ruptured subcapsular or intraparenchymal haematoma ≥5 cm Parenchymal laceration >3 cm depth
Grade 4
Any injury in the presence of a splenic vascular
injury or active bleeding confned within the splenic
capsule
Parenchymal laceration involving segmental or hilar
vessels producing >25% devascularisation
Grade 5
Any injury in the presence of splenic vascular injurya
with active bleeding extending beyond the spleen
into the peritoneum – shattered spleen
Vascular injury is defined as a pseudoaneurysm or arteriovenous fistula and appears as a focal collection of vascular contrast that decreases in attenuation with delayed imaging.
Active bleeding from a vascular injury presents as vascular contrast, focal or diffuse, that
increases in size or attenuation in the delayed phase
Bailey 1224 

THE vs TTE

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Q) THE vs TTE which is not true? ( Question asked in all AIIMS and INI exams since 2017) 

a) Leak rates are more with TTE 

b) Pulmonary complication is more with TTE

c) Side to side stapler anastomosis has less leaks than open two layer suturing

d) THE can be done through minimally invasive surgery

Esophagus Mock test  1

Esophagus Mock test 2 

Ans c

Pulmonary complications 57% with TTE 27% with  THE  ( SKF 409)

Anastomotic leak 16% TTE and 14% THE ( not significant) subclinical leak slightly more in THE

Option D is correct

Cardiac complications, Vocal cord paralysis , wound infection, chyle leak are all more with TTE

Blackmon et al. published a propensity-matched analysis comparing outcomes between side-to-side stapled anastomosis, end-to-end circular stapled anastomosis, and handsewn,
with no significant difference in leak rate noted.  ( SKF page 475)

SKF page 409

Medullary thyroid cancer – Management

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Q) Male patient with 1 cm nodule in Right side of Thyroid. Biopsy shows medullary carcinoma. No neck nodes are seen on USG. What is the management

a) Total thyroidectomy

b) Total thyroidectomy with central node dissection

c) Total thyroidectomy with lateral and central neck dissection

d) Right hemithyroidectomy

Thyroid MCQs 

Thyroid Mock test 1 

Thyroid Mock test 2 

Thyroid 3 

Ans b 

For patients with disease confned to the thyroid, total thyroidectomy is recommended to remove all C cells with elective dissection of the central neck nodes. If there is evidence of nodal metastases, gross
disease should be remove

Bailey 28th page 831

 

Carcinoma Breast and Pregnancy

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Q) 30 year old female in 2nd trimester of pregnancy has a 2 cm Ca breast with no axillary lymph node What should be the management?

a) Terminate Pregnancy and MRM

b) Wait till completion of pregnancy and MRM

c) Lumpectomy plus chemo

d) Lumpectomy + axillary dissection + chemo

Breast

Neet SS 22 paper

Ans d

Lumpectomy plus axillary dissection + chemo

Axillary dissection is ideally done  after SLNB

Radiotherapy can be given after termination of pregnancy

Hormonal therapy is also given after pregnancy if required

No need to terminate pregnancy

Bailey 28th page 942

Anal malformation

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Q) Newborn with abdominal distension on day 2, not passed meconium. There is absent anal orifice. WHat is the next step? # NEET SS 22 

a) Cross table X ray

b) Invertogram

c) Anoplasty

d) Sigmoid colostomy

Ans a) Cross table X ray

1st step in such cases Rule out congenital abnormalities of spine, sacrum , kidney heart etc

2nd step Cross table x ray  If it shows Perineal fistula do ANoplasty, If x ray shows rectal gas below coccyx do PSA RP with or without colostomy, If it shows gas above coccyx with associated defects do colostomy

Table 67.14 Sabiston 

 

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