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Tuesday, 4 June 2013

Surgery MCQs

Q. In a 22 year old with mid face trauma and hypotension, which one of the following is not recommended?
A. Cricothyroidotomy
B. IV fluid resuscitation
C. NG tube placement
D. Cervical neck stabilization
E. Central line placement

Answer C
1. In a patient with mid face trauma, a NG tube should never be inserted blindly
2. The NG tube can easily enter the brain via a false passage

Surgery MCQs

Q. In a 23 year old with severe face trauma and respiratory distress, the best method of obtaining airway control in the ED is?
A. Nasotracheal intubation
B. Orotracheal intubation
C. Cricothyroidotomy
D. Tracheostomy

Answer C
1. In patients with severe mid facial trauma, cricothyroidotomy is the best way to obtain airway control
2. Tracheostomy in the ER can be very risky and time consuming
3. All other types of intubation are fraught with risks and obstruction of the upper airways

Surgery MCQs

Q. A 36 year old is involved in a motor vehicle accident. Examination reveals that he has no pulses in the right leg. The leg below the knee joint appears cold. His vitals are stable. The next step in his management is?
A. Rush to Operating room
B. Angiogram
C. Doppler studies
D. Ct scan

Answer B
1. If the patient is stable, an angiogram is the best test to evaluate the extremity
2. Ultrasound Doppler is not sensitive and cannot identify the location of injury
3. CT angio is a mediocre test to assess extremity vessel injury below the knee
4. Below the groin, the angiogram is still the best test to assess the vascular anatomy.

Surgery MCQs

Q. A 45-year is suspected of having a tear in the esophagus. The best test to make a diagnosis of this injury is?
A. Endoscopy
B. Barium swallow
C. NG tube aspiration
D. Endoscopic ultrasound

Answer B
1. A barium swallow is the best test to make a diagnosis of esophageal tear
2. Ct scan of the chest is also valuable and can help determine any lung problems including an empyema
3. Endoscopy should not be performed as the scope may inadvertently make the perforation larger.

Surgery MCQs

Q. The ideal test to look for pancreatic injury after blunt trauma is?
A. Ultrasound
B. CT scan

Answer B
1. Ct scan with oral and IV contrast is the ideal test to look at the pancreas
2. If there is suspected ductal injury, then perhaps ERCP is warranted
3. However, CT scan is readily available and can be followed with ERCP
4. In most trauma cases, CT scan is helpful. 

Medicine MCQs

is the second most commonly injured vessel.

Q. A patient has developed reflex sympathetic dystrophy of his shoulder. The best treatment for him is?
A. Arthroscopic surgery
B. Physical therapy
C. Tricyclic antidepressants
D. Stellate ganglion blockade

Answer B
1. Reflex sympathetic dystrophy (RSD) is a clinical syndrome of variable course and unknown cause characterized by pain, swelling, and vasomotor dysfunction of an extremity.
2. The natural history of reflex sympathetic dystrophy (RSD) is variable and unpredictable, the pathogenesis is unknown, and few controlled treatment trials exist. Thus, evidence-based treatment guidelines do not exist, and the approach depends largely on the specialty of the treating physician.
3. Even if a disturbance in sympathetic nervous system function is important in the development of the clinical syndrome, not all patients respond to sympatholytic medications or to chemical or surgical sympathectomy.
4. Clinical experience teaches that early recognition and treatment are necessary to avoid permanent disability and that the effectiveness of treatment is limited once the patient has reached the chronic fibrotic stage.
5. Certainly, the incidence and severity of RSD can be greatly reduced by initiating prophylactic measures in situations that are known to be triggers (e.g., hemiplegic stroke, Colles fracture). These measures include immediate and aggressive mobilization of the involved extremity with passive and then active range-of-motion exercises. Similarly, in patients with established RSD, physical and occupational therapy are key components of any therapeutic regimen.

Surgery MCQs

Q. When an individual is stabbed in the front of the chest, which of the following coronary vessels is most likely to be lacerated?
A. Posterior descending
B. Circumflex
D. Left anterior descending
D. Obtuse marginal

Answer C
1. The anatomic position of the heart in relation to the anterior chest wall is critical in determining which areas of the heart are most commonly affected by penetrating cardiac trauma.
2. In a review of 1,802 cases of penetrating cardiac trauma from 20 reports published between 1967 and 1980, the right and left ventricles were injured 43% and 33% of the time, respectively. For the atria, right-sided lesions were found in 14% of cases and left-sided lesions in 5% of cases.
3. Injuries to the great vessels were found to occur with a frequency equal to that of the left atrium. This distribution of injuries is due to the disparate exposure of the cardiac chambers to the anterior surface of the chest.
4. The right ventricle covers the greatest portion of the anterior chest wall and represents 55% of the anterior cardiac surface. The frequency of involvement of the remaining cardiac chambers in penetrating injuries is proportional to the area of the anterior chest wall that they cover.
5. The coronary arteries, involved in 3.1-4.4% of penetrating cardiac injuries, are also potential sites of injury. Due to its anatomically anterior placement, the left anterior descending coronary artery is the most frequently involved, being injured in 87.5% of cases of coronary laceration. The right coronary artery is the second most commonly injured vessel.