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?

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?

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

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

Obstruction cholangitis Signup and view all the answers

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

1% Signup and view all the answers

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

Bleeding esophageal varices (as compression therapy) Signup and view all the answers

Which of the following is true for strangulated hernia?

Immediate laparoscopic repair is the method of choice Signup and view all the answers

Diagnosis of acute appendicitis can be confirmed by:

Abdominal ultrasonography Signup and view all the answers

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

Mc Burney’s point Signup and view all the answers

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

Slowly progressing right iliac fossa pain Signup and view all the answers

The most common symptom of esophageal cancer is?

Dysphagia Signup and view all the answers

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

Stomach Signup and view all the answers

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

Odynophagia Signup and view all the answers

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

Cholecystectomy Signup and view all the answers

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

I, II, III, IV Signup and view all the answers

Charcot's triad - typical signs of acute cholangitis include

Jaundice, fever, right hypochondrium pain Signup and view all the answers

The most common presentation of bleeding gastroduodenal peptic ulcer is:

Hematemesis Signup and view all the answers

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

Melanic stool Signup and view all the answers

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

Bleeding Signup and view all the answers

After esophagectomy the esophagus is replaced by the most:

Stomach Signup and view all the answers

Pneumoperitoneum is caused by:

The perforation of a hollow organ in the abdominal cavity Signup and view all the answers

Esophageal varices bleeding can be stopped with:

Sengstaken – Blakemore tube Signup and view all the answers

The most common malignant neoplasm of the small bowel is:

Metastatic neoplasm Signup and view all the answers

The most common postoperative complication after appendectomy is:

Infection Signup and view all the answers

A prevention of thromboembolism include:

Low molecular weight heparin (LMWH) Signup and view all the answers

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

Diets high to protein Signup and view all the answers

The most common symptom affecting patients with acute abdomen is:

Pain Signup and view all the answers

Which of the following statement is false about acute pancreatitis?

Administration of antibiotics is always necessary Signup and view all the answers

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

History and physical examination Signup and view all the answers

The term bleeding from upper GI understand bleeding of:

Esophagus, stomach, until duodenojejunal flexure Signup and view all the answers

Massive hemorrhage appears:

Melena, enterorrhagies, hematemesis Signup and view all the answers

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

Gastroduodenal peptic ulcer Signup and view all the answers

Acute abdominal pain emergency (AAE) is divided into:

Atraumatic and ileus AAE Signup and view all the answers

Mechanical ileus may be caused by:

All arguments are correct Signup and view all the answers

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

Abdominal pain, vomiting, stop passing wind and stool Signup and view all the answers

AAE include (acute abdominal pain emergency):

Ruptured spleen, gall bladder colic, acute pancreatitis Signup and view all the answers

Crohn’s disease:

All are correct Signup and view all the answers

Familial adenomatous polyposis is:

Hereditary precancerous Signup and view all the answers

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

Colorectal cancer Signup and view all the answers

The most common gastrointestinal cancer is:

Colorectal cancer Signup and view all the answers

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

Right hemicolectomy Signup and view all the answers

Primary investigation in case of intestinal obstruction is:

Plan abdominal X-ray Signup and view all the answers

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

Cecum Signup and view all the answers

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

Sigmoid colon and rectum Signup and view all the answers

The main role of lymphadenectomy in onco-surgery is:

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

Screening programmed for cancer is deficient if:

All the above Signup and view all the answers

Definitive diagnosis of colorectal cancer is based on:

Colonoscopy Signup and view all the answers

TNM classification for cancer is used for:

Staging Signup and view all the answers

Neoadjuvant oncological treatment means:

Oncological treatment first, surgery second Signup and view all the answers

Preferred treatment option for Chron’s disease is:

Conservative treatment Signup and view all the answers

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

Melanic stool Signup and view all the answers

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

All the above Signup and view all the answers

The most common imaging methods used to detect pneumoperitoneum is:

Plain X-ray of the abdomen Signup and view all the answers

Sengstaken–Blakemore tube is used to:

Compress esophageal varices Signup and view all the answers

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

Endoscopy Signup and view all the answers

The most common reason for enterorrhagia is:

Colorectal cancer Signup and view all the answers

Meckel diverticulum is lakeside in:

Ileum Signup and view all the answers

Acute appendicitis is confirmed by:

Histology Signup and view all the answers

The reason of multiple recurrent gastroduodenal peptic ulceration may be:

Gastronome Signup and view all the answers

Which of the following is a thromboembolism preventative agent?

Low molecular weight heparin Signup and view all the answers

Fecal occult blood test is used for:

Colorectal cancer Signup and view all the answers

How many parathyroid is necessary to prevent hypoparathyroidism?

3 Signup and view all the answers

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

smoking Signup and view all the answers

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

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

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

endoscopic mesh repair - TAPP or TEP Signup and view all the answers

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

gastrectomy 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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