Surgery 3
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Questions and Answers

The most dangerous pneumothorax is:

  • Tension pneumothorax (correct)
  • Open pneumothorax
  • Closed pneumothorax
  • Spontaneous pneumothorax

    • Depletion (low levels) of which mineral leads to bowel paralysis?

  • Na
  • Ca
  • Cl
  • K (correct)

    • Necrotizing pancreatitis - which of the following statements is NOT true?

  • Severity of the pancreatitis cannot be predicted at the time of admission
  • Nasojejunal tube is indicated for enteral nutrition once necrotizing pancreatitis is confirmed
  • Surgical treatment - necrosectomy - should be performed as soon as possible (correct)
  • Extent of necrosis can be assessed by CT scan performed 48 hours or later after onset of symptoms

    • Which of the following statements is NOT true for the patient with acute pancreatitis?

    <p>Every patient should receive nasogastric tube, urinary catheter, bowel rest, parenteral nutrition, PPI’s, painkillers, and prophylactic antibiotics</p> Signup and view all the answers

    There are several well-established indications for ERCP. Which of the following is not such indications?

    <p>Obstruction cholangitis</p> Signup and view all the answers

    Which of the following is standard and accepted mortality of ERCP?

    <p>1%</p> Signup and view all the answers

    Sengstaken (Blakemore) tube can be used in the treatment of:

    <p>Bleeding esophageal varices (as compression therapy)</p> Signup and view all the answers

    Which of the following is true for strangulated hernia?

    <p>Immediate laparoscopic repair is the method of choice</p> Signup and view all the answers

    Diagnosis of acute appendicitis can be confirmed by:

    <p>Abdominal ultrasonography</p> Signup and view all the answers

    Which is the localization where pain during palpation should be expected in acute appendicitis?

    <p>Mc Burney’s point</p> Signup and view all the answers

    Which of the following is NOT a typical finding in acute appendicitis?

    <p>Slowly progressing right iliac fossa pain</p> Signup and view all the answers

    The most common symptom of esophageal cancer is?

    <p>Dysphagia</p> Signup and view all the answers

    Esophagectomy requires reconstruction of GIT continuity. Which of the following is most widely used for this purpose?

    <p>Stomach</p> Signup and view all the answers

    Which of the following is the proper term for painful swallowing?

    <p>Odynophagia</p> Signup and view all the answers

    The most appropriate treatment of acute cholecystitis diagnosed within 48 hours from onset of symptoms is:

    <p>Cholecystectomy</p> Signup and view all the answers

    Left hemi hepatectomy is defined as removal of the following liver segments:

    <p>I, II, III, IV</p> Signup and view all the answers

    Charcot's triad - typical signs of acute cholangitis include

    <p>Jaundice, fever, right hypochondrium pain</p> Signup and view all the answers

    The most common presentation of bleeding gastroduodenal peptic ulcer is:

    <p>Hematemesis</p> Signup and view all the answers

    Which of the following findings does not belong to typical presentation of perforated peptic ulcer?

    <p>Melanic stool</p> Signup and view all the answers

    Which of the complications of peptic ulcer is usually managed endoscopically?

    <p>Bleeding</p> Signup and view all the answers

    After esophagectomy the esophagus is replaced by the most:

    <p>Stomach</p> Signup and view all the answers

    Pneumoperitoneum is caused by:

    <p>The perforation of a hollow organ in the abdominal cavity</p> Signup and view all the answers

    Esophageal varices bleeding can be stopped with:

    <p>Sengstaken – Blakemore tube</p> Signup and view all the answers

    The most common malignant neoplasm of the small bowel is:

    <p>Metastatic neoplasm</p> Signup and view all the answers

    The most common postoperative complication after appendectomy is:

    <p>Infection</p> Signup and view all the answers

    A prevention of thromboembolism include:

    <p>Low molecular weight heparin (LMWH)</p> Signup and view all the answers

    Which of the following is not a risk factor for gastric adenocarcinoma?

    <p>Diets high to protein</p> Signup and view all the answers

    The most common symptom affecting patients with acute abdomen is:

    <p>Pain</p> Signup and view all the answers

    Which of the following statement is false about acute pancreatitis?

    <p>Administration of antibiotics is always necessary</p> Signup and view all the answers

    In evaluating patients with acute abdominal pain, the most effective tools for diagnosing appendicitis are

    <p>History and physical examination</p> Signup and view all the answers

    The term bleeding from upper GI understand bleeding of:

    <p>Esophagus, stomach, until duodenojejunal flexure</p> Signup and view all the answers

    Massive hemorrhage appears:

    <p>Melena, enterorrhagies, hematemesis</p> Signup and view all the answers

    The most common cause of massive bleeding from the upper GIT is:

    <p>Gastroduodenal peptic ulcer</p> Signup and view all the answers

    Acute abdominal pain emergency (AAE) is divided into:

    <p>Atraumatic and ileus AAE</p> Signup and view all the answers

    Mechanical ileus may be caused by:

    <p>All arguments are correct</p> Signup and view all the answers

    Cardinal symptoms of AAE are (acute abdominal pain emergency):

    <p>Abdominal pain, vomiting, stop passing wind and stool</p> Signup and view all the answers

    AAE include (acute abdominal pain emergency):

    <p>Ruptured spleen, gall bladder colic, acute pancreatitis</p> Signup and view all the answers

    Crohn’s disease:

    <p>All are correct</p> Signup and view all the answers

    Familial adenomatous polyposis is:

    <p>Hereditary precancerous</p> Signup and view all the answers

    Hemoragy occult test has long been used for screening events for:

    <p>Colorectal cancer</p> Signup and view all the answers

    The most common gastrointestinal cancer is:

    <p>Colorectal cancer</p> Signup and view all the answers

    In case of colonic cancer locate in the cecum, the primary operation is:

    <p>Right hemicolectomy</p> Signup and view all the answers

    Primary investigation in case of intestinal obstruction is:

    <p>Plan abdominal X-ray</p> Signup and view all the answers

    Chronic anemia is the most common symptom of cancer located in:

    <p>Cecum</p> Signup and view all the answers

    Changing pattern of defecation and quality of stool is typical for cancer located in:

    <p>Sigmoid colon and rectum</p> Signup and view all the answers

    The main role of lymphadenectomy in onco-surgery is:

    <p>To stratify prognosis if the disease and need for adjuvant oncological treatment</p> Signup and view all the answers

    Screening programmed for cancer is deficient if:

    <p>All the above</p> Signup and view all the answers

    Definitive diagnosis of colorectal cancer is based on:

    <p>Colonoscopy</p> Signup and view all the answers

    TNM classification for cancer is used for:

    <p>Staging</p> Signup and view all the answers

    Neoadjuvant oncological treatment means:

    <p>Oncological treatment first, surgery second</p> Signup and view all the answers

    Preferred treatment option for Chron’s disease is:

    <p>Conservative treatment</p> Signup and view all the answers

    The most common symptom of bleeding from gastrointestinal peptic ulcer is:

    <p>Melanic stool</p> Signup and view all the answers

    To confirm the diagnosis of gastrointestinal perforation we are looking for:

    <p>All the above</p> Signup and view all the answers

    The most common imaging methods used to detect pneumoperitoneum is:

    <p>Plain X-ray of the abdomen</p> Signup and view all the answers

    Sengstaken–Blakemore tube is used to:

    <p>Compress esophageal varices</p> Signup and view all the answers

    In cause of upper GI bleeding the prefer diagnosis tool is:

    <p>Endoscopy</p> Signup and view all the answers

    The most common reason for enterorrhagia is:

    <p>Colorectal cancer</p> Signup and view all the answers

    Meckel diverticulum is lakeside in:

    <p>Ileum</p> Signup and view all the answers

    Acute appendicitis is confirmed by:

    <p>Histology</p> Signup and view all the answers

    The reason of multiple recurrent gastroduodenal peptic ulceration may be:

    <p>Gastronome</p> Signup and view all the answers

    Which of the following is a thromboembolism preventative agent?

    <p>Low molecular weight heparin</p> Signup and view all the answers

    Fecal occult blood test is used for:

    <p>Colorectal cancer</p> Signup and view all the answers

    How many parathyroid is necessary to prevent hypoparathyroidism?

    <p>3</p> Signup and view all the answers

    There are different etiological factors contributing to hernia formation. Which of following does NOT belong to such factors?

    <p>smoking</p> Signup and view all the answers

    Which is true for the indication of hernia truss (belt)?

    <p>indicated in children less than 2 years old who are diagnosed with umbilical hernia as a bridge to spontaneous closure of the umbilicus</p> Signup and view all the answers

    Which of the following is potentially ideal treatment for groin hernia?

    <p>endoscopic mesh repair - TAPP or TEP</p> Signup and view all the answers

    Which of procedures below is appropriate as a curative surgery for stage II. gastric cancer?

    <p>gastrectomy</p> Signup and view all the answers

    Study Notes

    Pneumothorax

    • The most dangerous pneumothorax is a tension pneumothorax.

    Minerals

    • Depletion of potassium leads to bowel paralysis.

    Pancreatitis

    • Necrotizing pancreatitis is not typically associated with a normal serum amylase level.
    • In acute pancreatitis, the patient's serum lipase level is elevated, and the patient may experience abdominal pain, nausea, and vomiting.

    ERCP

    • ERCP indications do not include diagnostic purposes for patients with acute pancreatitis.
    • The standard and accepted mortality rate for ERCP is 1-2%.

    Sengstaken Tube

    • Sengstaken (Blakemore) tube can be used in the treatment of bleeding esophageal varices.

    Hernia

    • Strangulated hernia is characterized by a triangulated hernia with compromised blood flow.
    • Hernia truss (belt) is indicated for symptomatic hernias.
    • The potentially ideal treatment for groin hernia is a Lichtenstein tension-free hernia repair.

    Appendicitis

    • Diagnosis of acute appendicitis can be confirmed by a positive McBurney's point test.
    • Pain during palpation should be expected in the right lower quadrant (RLQ) in acute appendicitis.
    • Rebound tenderness is not a typical finding in acute appendicitis.

    Esophageal Cancer

    • The most common symptom of esophageal cancer is dysphagia.
    • Esophagectomy requires reconstruction of gastrointestinal continuity using a gastric tube or colonic interposition.

    Cholecystitis

    • The most appropriate treatment of acute cholecystitis diagnosed within 48 hours from symptom onset is laparoscopic cholecystectomy.

    Hepatectomy

    • Left hemi hepatectomy is defined as removal of liver segments II, III, and IV.

    Acute Cholangitis

    • Charcot's triad includes typical signs of acute cholangitis, such as jaundice, fever, and abdominal pain.

    Peptic Ulcer

    • The most common presentation of bleeding gastroduodenal peptic ulcer is hematemesis.
    • A typical presentation of perforated peptic ulcer does not include massive bleeding.
    • Endoscopic treatment is usually used to manage bleeding peptic ulcer.

    Esophageal Reconstruction

    • After esophagectomy, the esophagus is replaced by the stomach.

    Pneumoperitoneum

    • Pneumoperitoneum is caused by a perforated viscus.
    • Pneumoperitoneum can be diagnosed using imaging methods such as CT scan or upright chest X-ray.

    Esophageal Varices

    • Esophageal varices bleeding can be stopped with a Sengstaken-Blakemore tube.

    Malignant Neoplasms

    • The most common malignant neoplasm of the small bowel is adenocarcinoma.

    Postoperative Complications

    • The most common postoperative complication after appendectomy is wound infection.

    Thromboembolism

    • A prevention of thromboembolism includes using low-molecular-weight heparin.

    Gastric Adenocarcinoma

    • A risk factor for gastric adenocarcinoma is Helicobacter pylori infection.

    Acute Abdomen

    • The most common symptom affecting patients with acute abdomen is abdominal pain.

    Acute Pancreatitis

    • A false statement about acute pancreatitis is that it is always associated with a normal serum lipase level.

    Upper GI Bleeding

    • Bleeding from upper GI refers to bleeding from the esophagus, stomach, or duodenum (proximal to the ligament of Treitz).
    • Massive hemorrhage appears as hematemesis or melena.

    Gastrointestinal Cancer

    • The most common gastrointestinal cancer is colorectal cancer.

    Colonic Cancer

    • In case of colonic cancer located in the cecum, the primary operation is a right hemicolectomy.

    Intestinal Obstruction

    • Primary investigation in case of intestinal obstruction is a plain abdominal X-ray.

    Crohn's Disease

    • Crohn's disease is a chronic inflammatory bowel disease.

    Familial Adenomatous Polyposis

    • Familial adenomatous polyposis is an autosomal dominant inherited disorder.

    Hemorrhage

    • Hemoccult test has long been used for screening for occult gastrointestinal bleeding.

    Cancer Screening

    • Screening programs for cancer are deficient if they do not include a fecal occult blood test (FOBT) for colorectal cancer.

    Lymphadenectomy

    • The main role of lymphadenectomy in onco-surgery is to remove regional lymph nodes.

    Onco-Surgery

    • Definitive diagnosis of colorectal cancer is based on histopathological examination.
    • TNM classification for cancer is used for staging.
    • Neoadjuvant oncological treatment means preoperative chemotherapy or radiotherapy.

    Inflammatory Bowel Disease

    • Preferred treatment option for Crohn's disease is a step-up approach, starting with aminosalicylates and corticosteroids.

    Peptic Ulcer Bleeding

    • The most common symptom of bleeding from gastrointestinal peptic ulcer is hematemesis.

    Gastrointestinal Perforation

    • To confirm the diagnosis of gastrointestinal perforation, we are looking for free air under the diaphragm.

    Meckel Diverticulum

    • Meckel diverticulum is located in the ileum.

    Acute Appendicitis

    • Acute appendicitis is confirmed by a positive McBurney's point test.

    Recurrent Peptic Ulceration

    • The reason for multiple recurrent gastroduodenal peptic ulceration may be Helicobacter pylori infection.

    Thromboembolism Prevention

    • A thromboembolism preventative agent is low-molecular-weight heparin.

    Fecal Occult Blood Test

    • Fecal occult blood test is used for screening for colorectal cancer.

    Parathyroid

    • At least one parathyroid gland is necessary to prevent hypoparathyroidism.

    Hernia Formation

    • A factor that does not contribute to hernia formation is a genetic predisposition.

    Curative Surgery

    • Curative surgery for stage II gastric cancer is a subtotal gastrectomy with lymph node dissection.

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