MCH – General Surgery questions

Q1. Covering of indirect inguinal hernia all except?

a) Int spermatic fascia
b) External spermatic fascia
c) Transversalis fascia
d) Fatty tissue

Ans c) Transversalis fascia


Q2. Nylon suture is 

a) Polyamide

Ans Polyamide- 

Degrades at 15-20% per year


Q3. polyglycaprone loses tensile strength in
Ans 3 to 4 weeks
ref


Q4. Cutting current in diathermy is 

a) Continuous wave low voltage high frequency

b) Continuous wave high voltage high frequency

Ans a 

Cutting current is low  voltage

fulguration is high voltage


Q4) Chovstek sign with normal calcium seen in
a) Hypomagnesemia
b) Hypermagnesemia
c) Hyperphosphatemia

d) Hypokalemia

Ans a) 

Hypomagnesemia is very common in surgical settings, and is often missed. It can occur with normal calcium or magnesium and can also cause hypokalemia and hypocalcemia

Causes of hypomagnesemia are 

Poor Intake - Starvation, Alcohol, TPN without magnesium replacement, 

Increased loss-   Renal - Alcohol, Diuretic use, Amphotericin, Primary Aldosternoism

                              GI - Diarrhea, Malabsorbtion, pancreatitis

Clinical features - Neuromuscular and CNS

Hyperreflexia, tetany, tremors, Positive Chovstek and Trousseau signs, 

Prolonged QT interval, Prolonged PT interval, St segment depression, Flat or inverted P wave, 

Ref Schwartz 


Q5. ASA stage severe disease with limitation, not life threatening

Ans ASA stage III

In 1941, The American Society of Anaesthesiologists (ASA) asked a committee of three physicians to devise a system for the collection and tabulation of statistical data in anaesthesia to allow anaesthesiologists to record the overall health status of a patient prior to surgery and, thereby, allow patients outcome to be stratified by a general assessment of illness severity

The ASA score is a subjective assessment of a patient’s overall health that is based on five classes (I to V).

  1. Patient is a completely healthy fit patient.

  2. Patient has mild systemic disease.

  3. Patient has severe systemic disease that is not incapacitating.

  4. Patient has incapacitating disease that is a constant threat to life.

  5. A moribund patient who is not expected to live 24 hour with or without surgery.

E. Emergency surgery, E is placed after the Roman numeral.


Q6)Tumor lysis  syndrome which is not seen

a. hyperkalemia

b hypocalcemia

c. hypophosphatemia

d. hyperuricemia

Ans is c

Tumor lysis syndrome releases, various intracellular  metabolites such as uric acid, potassium and phosphorous which overwhelm the excretory capacities of the kidney.

The metabolic anomalies are

Hyperuricemia

Hyperkalemia

Hyperphosphatemeia

Hypocalcemia

It mostly occurs in poorly differentiated leukemias and lymphomas


Q7) 70 yr old female with weight loss, halitosis and regurgitation . X ray with barium swallow given

A) Killian

b) Zenker's

C) Carcinoma upper esophagus

d) Upper esophageal stricture spasm

ANs a

Killian diverticulum  is a  pulsion diverticulum that protrudes below the cricopharyngeus muscle. It is less frequent than the more common Zenker diverticulum. On barium imaging, Killian is lateral and Zenker is  posterior.

Clinical Features

Age 70 years

sticking in the throat.

A nagging cough, excessive salivation, and intermittent dysphagia often are signs of progressive disease. As the sac increases in size, regurgitation of foul-smelling, undigested material is common. Halitosis, voice changes, retrosternal pain, and respiratory infections are especially common in older adults. The most serious complication from an untreated Zenker diverticulum is aspiration pneumonia or lung abscess. In an older patient, this can be morbid and sometimes fatal

Ref Sabiston page 1019