00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Mins)
  • Question 1 - A 29-year-old female presents with a history of increasingly severe ano-rectal pain for...

    Incorrect

    • A 29-year-old female presents with a history of increasingly severe ano-rectal pain for the past 24 hours. On examination, she has a low-grade fever, and the skin surrounding the anus appears normal. She has not, however, tolerated an attempted digital rectal examination (DRE).

      What is the most likely diagnosis?

      Your Answer: Solitary rectal ulcer

      Correct Answer: Intersphincteric abscess

      Explanation:

      Presence of fever and severe pain point towards the diagnosis of an abscess rather than a fissure. Although fissures may be painful, they do not, in themselves, cause fever. Moreover, a case of fissure-in-ano typically presents with bright red PR bleed.

      The management option for intersphincteric abscess includes examination of the ano-rectum under general anaesthesia and drainage of the sepsis.

    • This question is part of the following fields:

      • Colorectal Surgery
      • Generic Surgical Topics
      3
      Seconds
  • Question 2 - A 50-year-old female has a metallic heart valve and requires a paraumbilical hernia...

    Incorrect

    • A 50-year-old female has a metallic heart valve and requires a paraumbilical hernia repair. Perioperatively, she is receiving intravenous unfractionated heparin. To perform the surgery safely a normal coagulation state is required. Which of the following strategies is a routine standard practice?

      Your Answer:

      Correct Answer: Stopping the heparin infusion 6 hours pre operatively

      Explanation:

      In performing noncardiac surgery on patients on anticoagulation, the major concern is when it is safe to perform surgery without increasing the risk of haemorrhage or increasing the risk of thromboembolism (e.g., venous, arterial) after discontinuing treatment.
      Any patient who is on long-term anticoagulation and is to undergo a major surgery needs proactive management.
      Heparin is discontinued 6-12 hours before surgery and restarted at 200-400 U/h at 4-6 hours after surgery. Coumadin is restarted as soon as tolerated by the patient. Stop oral anticoagulants at least 5 days preoperatively, and do not perform the procedure until the PT is in the reference range.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      0
      Seconds
  • Question 3 - A 4-year-old boy develops a persistent fever following an open appendicectomy for gangrenous...

    Incorrect

    • A 4-year-old boy develops a persistent fever following an open appendicectomy for gangrenous appendicitis. On examination, he has erythema of the wound and some abdominal distension. What is the most appropriate course of action?

      Your Answer:

      Correct Answer: Arrange an abdominal ultrasound scan

      Explanation:

      Post-operative fever is very common.
      It is known to occur after all types of surgical procedures, irrespective of the type of anaesthesia.
      Postoperative fever can occur after minor surgical procedures but is rare and depends on the type of procedure. Overall, both abdominal and chest procedures result in the highest incidence of postoperative fever.

      In this case:
      Acute Fever
      Fever occurs in the first week (1 to 7 POD)
      POD 7 (5 to 10): Wound infection: Risk increases if the patient is immunocompromised (e.g., diabetic), abdominal wound, duration of surgery greater than 2 hours or contamination during surgery. Signs include erythema, warmth, tenderness, discharge.
      Rule out abscess or collections by physical exam plus ultrasound if needed. If an abscess is present, drainage and antibiotics are needed. Prevention is by careful surgical technique and prophylactic antibiotics (e.g., intravenous cefazolin at the time of induction of anaesthesia as well as postoperatively if needed)

      Other causes of Postoperative fever:
      An Immediate Fever
      Fever occurs immediately after surgery or within hours on postoperative days (POD) 0 or 1.
      – Malignant hyperthermia: high-grade fever (greater than 40 C), occurs shortly after inhalational anaesthetics or muscle relaxant (e.g., halothane or succinylcholine), may have a family history of death after anaesthesia. Laboratory studies will reveal with metabolic acidosis and hypercalcemia. If not readily recognized, it can cause cardiac arrest. The treatment is intravenous dantrolene, 100% oxygen, correction of acidosis, cooling blankets, and watching for myoglobinuria.
      – Bacteraemia: High-grade fever (greater than 40 C) occurring 30 to 40 minutes after the beginning of the procedure (e.g., Urinary tract instrumentation in the presence of infected urine). Management includes blood cultures three times and starting empiric antibiotics.
      – Gas gangrene of the wound: High-grade fever (greater than 40 C) occurring after gastrointestinal (GI) surgery due to contamination with Clostridium perfringens; severe wound pain; treat with surgical debridement and antibiotics.
      – Febrile non-haemolytic transfusion reaction: Fevers, chills, and malaise 1 to 6 hours after surgery (without haemolysis). Management: Stop transfusion (rule out haemolytic transfusion reaction) and give antipyretics (avoid aspirin in the thrombocytopenic patient).

      B. Acute Fever
      – Fever occurs in the first week (1 to 7 POD).
      POD 1 to 3: atelectasis: After prolonged intubation, the presence of upper abdominal incision, inadequate postoperative pain control, lying supine. Should be prevented by incentive spirometry, semi-recumbent position, adequate pain control, early ambulation. Clinically may be asymptomatic or with increased work of breathing, respiratory alkalosis, chest x-ray with volume loss. Treatment includes spirometry, chest physiotherapy, semi-recumbent position (improves expansion of alveoli by preventing pressure from intra-abdominal organs on the diaphragm and hence improving functional residual capacity)
      – POD 3: Unresolved atelectasis resulting in pneumonia (respiratory symptoms, Chest x-ray with infiltrate or consolidation, sputum culture, empiric antibiotics and modify according to culture result and sensitivity), or development of urinary tract infection (urine analysis and culture, treat with empiric antibiotics and modify according to culture result and sensitivity)
      – POD 5: Thrombophlebitis (may be asymptomatic or symptomatic, diagnose with Doppler ultrasound of deep leg and pelvic veins and treat with heparin)
      – POD 7: Pulmonary embolism (tachycardia, tachypnoea, pleuritic chest pain, ECG with right heart strain pattern (a low central venous pressure goes against diagnosis), arterial blood gas with hypoxemia and hypocapnia, confirm diagnosis with CT angiogram, and treat with heparin, if recurrent pulmonary embolism while anticoagulated with therapeutic INR, Inferior vena cava filter placement is the next step

      C. Subacute Fever
      Fever occurs between postoperative weeks 1 and 4.
      – POD 10: Deep infection (pelvic or abdominal abscess and if abdominal abscess could be sub-hepatic or sub-phrenic). A digital rectal exam to rule out the pelvic abscess and CT scan to localize intra-abdominal abscess. Treatment includes re-exploration vs. radiological guided percutaneous drainage
      Drugs: Diagnosis of exclusion includes rash and peripheral eosinophilia

      D. Delayed Fever
      Fever after more than 4 weeks.
      Skin and soft tissue infections (SSTI)
      Viral infections

    • This question is part of the following fields:

      • Principles Of Surgery-in-General
      • Surgical Technique And Technology
      0
      Seconds
  • Question 4 - A 40-year-old chef presents to the hospital with profuse bloody diarrhoea. He also...

    Incorrect

    • A 40-year-old chef presents to the hospital with profuse bloody diarrhoea. He also complains of frequent urge to defecate and pain before and during defecation. A sigmoidoscopy is arranged which reveals necrosis and ulceration of the descending colon mucosa.

      What is the most likely underlying cause?

      Your Answer:

      Correct Answer: Infection with enteroinvasive E. coli

      Explanation:

      Necrosis and ulcers of the colon are a feature of infection with enteroinvasive E. coli (EIEC). It presents with a dysentery-type illness similar to shigellosis.

      E. coli have different strains that cause a wide range of conditions. The four main types are:

      1. Enteropathogenic E. coli—cause watery diarrhoea, vomiting, and low-grade fever

      2. Enteroinvasive E. coli—cause dysentery, large bowel necrosis, and ulcers

      3. Enterotoxigenic E. coli—cause traveller’s diarrhoea

      4. Enterohaemorrhagic E. coli 0157:H7—cause haemorrhagic colitis, haemolytic uremic syndrome, and thrombotic thrombocytopenic purpura

    • This question is part of the following fields:

      • Clinical Microbiology
      • Principles Of Surgery-in-General
      0
      Seconds
  • Question 5 - A 23-year-old female with a history of bilateral vitreous haemorrhage is referred with...

    Incorrect

    • A 23-year-old female with a history of bilateral vitreous haemorrhage is referred with bilateral lesions in the cerebellar region. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Von Hippel-Lindau syndrome

      Explanation:

      von Hippel-Lindau (VHL) disease, or von Hippel-Lindau syndrome, is a rare genetic disorder characterized by visceral cysts and benign tumours in multiple organ systems that have a subsequent potential for malignant change.
      Clinical hallmarks of VHL disease include the development of retinal and central nervous system (CNS) hemangioblastomas (blood vessel tumours), pheochromocytomas, multiple cysts in the pancreas and kidneys, and an increased risk for malignant transformation of renal cysts into renal cell carcinoma. The wide age range and the pleiotropic manner in which VHL disease presents complicates diagnosis and treatment in affected individuals, as well as their at-risk relatives.

      Because VHL disease is a multiple-organ disease that widely varies in clinical presentation, various manifestations may lead to the diagnosis. Criteria are the following:
      More than one hemangioblastoma in the CNS (brain, spinal cord) or eye
      A single hemangioblastoma in the CNS or retina, plus a visceral manifestation (multiple renal, pancreatic, or hepatic cysts; pheochromocytoma; renal cancer)
      Positive family history plus any one of the above clinical manifestations
      Elucidation of a deleterious mutation in the VHL gene

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Surgical Disorders Of The Brain
      0
      Seconds
  • Question 6 - A 40-year-old man is brought to the A&E department following a motorcycle accident....

    Incorrect

    • A 40-year-old man is brought to the A&E department following a motorcycle accident. He sustained a closed, unstable spiral tibial fracture and has been managed with an intramedullary nail. However, after being transferred to the ward, he is noted to have increasing pain in the affected limb. On examination, the limb is swollen and tender with pain felt on passive stretching of the toes.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Compartment syndrome

      Explanation:

      Severe pain in the limb following fixation with intramedullary devices should raise suspicion of compartment syndrome, especially in tibial fractures.

      Compartment syndrome is a particular complication that may occur following fractures, especially supracondylar fractures and tibial shaft injuries. It is characterised by raised pressure within a closed anatomical space which may, eventually, compromise tissue perfusion, resulting in necrosis.

      The clinical features of compartment syndrome include:
      1. Pain, especially on movement
      2. Paraesthesia
      3. Pallor
      4. Paralysis of the muscle group may also occur

      Diagnosis is made by measurement of intracompartmental pressure. Pressures >20mmHg are abnormal and >40mmHg are diagnostic.

      Compartment syndrome requires prompt and extensive fasciotomy. Myoglobinuria may occur following fasciotomy, resulting in renal failure. Therefore, aggressive IV fluids are required. If muscle groups are frankly necrotic at fasciotomy, they should be debrided, and amputation may have to be considered.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
      0
      Seconds
  • Question 7 - A 30-year-old woman presents with a history of severe epigastric pain that worsens...

    Incorrect

    • A 30-year-old woman presents with a history of severe epigastric pain that worsens post prandially. On examination, the abdomen is soft and non tender with no palpable mass felt. However, a bruit is heard in the epigastrium, on auscultation. Imaging with USS shows no gallstones and OGD is normal as well.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Median arcuate ligament syndrome

      Explanation:

      The most likely diagnosis is median arcuate ligament syndrome (MALS).

      MALS, also known as coeliac artery compression syndrome, is a condition characterized by abdominal pain attributed to compression of the coeliac artery and the coeliac ganglia by the median arcuate ligament. The pain may be related to meals, may be accompanied by weight loss, and may be associated with an abdominal bruit.

      The diagnosis of MALS is one of exclusion, as many healthy patients demonstrate some degree of coeliac artery compression in the absence of symptoms. Consequently, a diagnosis of MALS is typically only entertained after more common conditions have been ruled out. Once suspected, screening for MALS can be done with USS and confirmed with CT or MRI scan.

      Treatment is generally surgical, the mainstay being open or laparoscopic division or separation of the median arcuate ligament combined with removal of the celiac ganglia. The majority of patients benefit from surgical intervention. Poorer responses to treatment tend to occur in patients of older age, those with a psychiatric condition or who use alcohol, have abdominal pain unrelated to meals, or who have not experienced weight loss.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Vascular
      0
      Seconds
  • Question 8 - A 30-year-old male falls on the back of his hand. On x-ray, he...

    Incorrect

    • A 30-year-old male falls on the back of his hand. On x-ray, he has a fractured distal radius demonstrating volar displacement of the fracture. What eponymous term is used to describe this?

      Your Answer:

      Correct Answer: Smith's

      Explanation:

      The Frykman classification of distal radial fractures is based on the AP appearance and encompasses the eponymous entities of Colles fracture, Smith fracture, Barton fracture, chauffeur fracture.

      Colles fractures are very common extra-articular fractures of the distal radius that occur as the result of a fall onto an outstretched hand. They consist of a fracture of the distal radial metaphyseal region with dorsal angulation and impaction, but without the involvement of the articular surface.
      Colles fractures are the most common type of distal radial fracture and are seen in all adult age groups and demographics. They are particularly common in patients with osteoporosis, and as such, they are most frequently seen in elderly women.

      Smith fractures, also known as Goyrand fractures in the French literature 3, are fractures of the distal radius with associated volar angulation of the distal fracture fragment(s). Classically, these fractures are extra-articular transverse fractures and can be thought of like a reverse Colles fracture.
      The term is sometimes used to describe intra-articular fractures with volar displacement (reverse Barton fracture) or juxta-articular fractures

      Barton fractures are fractures of the distal radius. It is also sometimes termed the dorsal type Barton fracture to distinguish it from the volar type or reverse Barton fracture.
      Barton fractures extend through the dorsal aspect to the articular surface but not to the volar aspect. Therefore, it is similar to a Colles fracture. There is usually associated with dorsal subluxation/dislocation of the radiocarpal joint.

      Chauffeur fractures (also known as Hutchinson fractures or backfire fractures) are intra-articular fractures of the radial styloid process. The radial styloid is within the fracture fragment, although the fragment can vary markedly in size.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
      0
      Seconds
  • Question 9 - A 33 year old man presents with an injured forearm after falling from...

    Incorrect

    • A 33 year old man presents with an injured forearm after falling from a scaffolding. Examination reveals a radial fracture and dislocated distal radio-ulnar joint. Which of the following options is synonymous with this presentation?

      Your Answer:

      Correct Answer: Galeazzi

      Explanation:

      The Galeazzi fracture is a fracture of the middle to distal one-third of the radius associated with dislocation or subluxation of the distal radioulnar joint. It presents with pain, swelling and deformity. Physical examination reveals point tenderness over the fracture site. Isolated fracture of radius is rare and there usually is an associated injury.

      Other fractures:
      – Colles’ fracture (dinner fork deformity): fall onto extended outstretched hand. Classical Colles’ fractures have 3 features:
      1. Transverse fracture of the radius
      2. 1 inch proximal to the radio-carpal joint
      3. Dorsal displacement and angulation

      – Smith’s fracture (reverse Colles’ fracture): volar angulation of distal radius fragment (Garden spade deformity). Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed

      – Bennett’s fracture: Intra-articular fracture of the first carpometacarpal joint. Impact on flexed metacarpal, caused by fist fights

      – Monteggia’s fracture: dislocation of the proximal radioulnar joint in association with an ulna fracture. Caused by a fall on outstretched hand with forced pronation.

      – Pott’s fracture: Bimalleolar ankle fracture from forced foot eversion

      – Barton’s fracture: Distal radius fracture (Colles’/Smith’s) with associated radiocarpal dislocation from a fall onto extended and pronated wrist

      – Holstein Lewis Fracture: fracture of the distal third of the humerus resulting in entrapment of the radial nerve.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
      0
      Seconds
  • Question 10 - A 64 year old man with a history of recurrent anal cancer undergoes...

    Incorrect

    • A 64 year old man with a history of recurrent anal cancer undergoes a salvage abdominoperineal excision of the anus and rectum. He was treated with radical chemotherapy prior to the procedure. At the conclusion of the surgery, there is a 10cm by 10cm perineal skin defect. Which of the following closure options would be most appropriate in this case?

      Your Answer:

      Correct Answer: Pedicled myocutaneous flap

      Explanation:

      As a reconstructive option after extensive surgery, pedicled musculocutaneous flaps offer several advantages in the setting of previous radiotherapy. Rotational skin flaps will comprise of irradiated tissue and thus won’t heal well.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
      0
      Seconds
  • Question 11 - A 46 year old woman is taken to the A&E department with a...

    Incorrect

    • A 46 year old woman is taken to the A&E department with a full thickness burn on her chest which is well circumscribed. Her saturation was reduced to 92% on 15L of Oxygen, blood pressure of 104/63 mmHg and HR 106 bpm. What is the best management step?

      Your Answer:

      Correct Answer: Escharotomy

      Explanation:

      Answer: Escharotomy

      Escharotomy is the surgical division of the nonviable eschar, which allows the cutaneous envelope to become more compliant. Hence, the underlying tissues have an increased available volume to expand into, preventing further tissue injury or functional compromise.

      Full-thickness circumferential and near-circumferential skin burns result in the formation of a tough, inelastic mass of burnt tissue (eschar). The eschar, by virtue of this inelasticity, results in the burn-induced compartment syndrome. This is caused by the accumulation of extracellular and extravascular fluid within confined anatomic spaces of the extremities or digits. The excessive fluid causes the intracompartmental pressures to increase, resulting in collapse of the contained vascular and lymphatic structures and, hence, loss of tissue viability. The capillary closure pressure of 30 mm Hg, also measured as the compartment pressure, is accepted as that which requires intervention to prevent tissue death.

      The circumferential eschar over the torso can lead to significant compromise of chest wall excursions and can hinder ventilation. Abdominal compartment syndrome with visceral hypoperfusion is associated with severe burns of the abdomen and torso. (A literature review by Strang et al found the prevalence of abdominal compartment syndrome in severely burned patients to be 4.1-16.6%, with the mean mortality rate for this condition in these patients to be 74.8%). Similarly, airway patency and venous return may be compromised by circumferential burns involving the neck.

      Performing an escharotomy will therefore improve ventilation.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
      0
      Seconds
  • Question 12 - A 6 year old boy previously diagnosed with a rare genetic disorder requires...

    Incorrect

    • A 6 year old boy previously diagnosed with a rare genetic disorder requires long term drug therapy for his condition. The drug needs to be administered intravenously. Lately, the child has been pulling at the current system of Hickman line and the parents are requesting an alternate. Which of the following would be the best alternative method?

      Your Answer:

      Correct Answer: Portacath device

      Explanation:

      Portacaths are usually inserted when there is a need for long term access to a vein. This might be to provide medication, special intravenous feeding, fluids, blood and blood product transfusion and blood tests. Broviacs would pose the same core problems as a Hickman.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      0
      Seconds
  • Question 13 - A 65 year old man is scheduled to undergo an elective femoral-popliteal bypass....

    Incorrect

    • A 65 year old man is scheduled to undergo an elective femoral-popliteal bypass. He presents to the physician with sudden onset of central crushing chest pain that radiates to his left arm. ECG is significant for some ischemic changes. The nursing staff initiates high flow oxygen and gives a spray of glyceryl trinitrate. However, this has resulted in no relief of his symptoms. Which of the following drugs should be administered next to this patient?

      Your Answer:

      Correct Answer: Aspirin 300mg

      Explanation:

      Unstable angina is a common cardiovascular condition associated with major adverse clinical events. Over the last 15 years, therapeutic advances have dramatically reduced the complication and mortality rates of this serious condition. The standard of therapy in patients with unstable angina now incorporates the combined use of a potent antithrombotic (aspirin, clopidogrel, heparin and glycoprotein IIb/IIIa receptor antagonists) and anti-anginal (β-blockade and intravenous nitrates) regimens complemented by the selective and judicious application of coronary revascularisation strategies.
      Increasingly, these invasive and non-invasive therapeutic interventions are being guided not only by the clinical risk profile but also by the determination of serum cardiac and inflammatory markers.
      Moreover, rapid and intensive management of associated risk factors, such as hypercholesterolaemia, would appear to have potentially substantial benefits even within the acute in-hospital phase of unstable angina. Aspirin 300mg should be given as soon as possible. If the patient has a moderate to high risk of myocardial infarction, then Clopidogrel should be given with a low molecular weight heparin. Thrombolysis or urgent percutaneous intervention should be given if there are significant ECG changes.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
      0
      Seconds
  • Question 14 - A 42-year-old man is brought to the emergency department following a road traffic...

    Incorrect

    • A 42-year-old man is brought to the emergency department following a road traffic accident. He has sustained a flail chest injury and is hypotensive on arrival at the hospital. Examination shows an elevated jugular venous pressure and auscultation of the heart reveals muffled heart sounds.

      Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Cardiac tamponade

      Explanation:

      This patient has presented with a classical picture of cardiac tamponade, suggested by Beck’s triad: hypotension, raised jugular venous pressure (JVP), and muffled heart sounds.

      Cardiac tamponade is a clinical syndrome caused by the accumulation of fluid in the pericardial space, resulting in reduced ventricular filling and subsequent haemodynamic compromise. This condition is a medical emergency, the complications of which include pulmonary oedema, shock, and death.

      Patients with cardiac tamponade have a collection of three medical signs known as Beck’s triad. These are low arterial blood pressure, distended neck veins, and distant, muffled heart sounds. The diagnosis may be further supported by specific ECG changes, chest X-ray, or an ultrasound of the heart. If fluid increases slowly, the pericardial sac can expand to contain more than 2 L; however, if the increase is rapid, as little as 200 mL can result in tamponade.

      Management options may include pericardiocentesis, surgery to create a pericardial window, or a pericardiectomy.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
      0
      Seconds
  • Question 15 - A 39 year old female presents with a 4 day history of a...

    Incorrect

    • A 39 year old female presents with a 4 day history of a painful purple lesion on her ring finger. A tender red/purple lesion is seen on her ring finger on examination and medical history states that she has systemic lupus erythematosus (SLE). Which of the following would be her diagnosis?

      Your Answer:

      Correct Answer: Oslers nodes

      Explanation:

      Osler nodes are small, usually raised, purplish red lesions, which are always tender, appear suddenly, and last 4 to 5 days. Painful fingers may be the earliest complaint or the chief complaint as with this patient. The nodes can appear on the dorsa of the feet and elsewhere. Osler nodes sometimes also accompany bacteraemia without endocarditis as well as septic endarteritis, typhoid fever, gonococcemia, systemic lupus erythematosus, and nonbacterial thrombotic endocarditis.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
      0
      Seconds
  • Question 16 - A 49 year old man is admitted with small bowel obstruction after having...

    Incorrect

    • A 49 year old man is admitted with small bowel obstruction after having repeated episodes of abdominal pain. A laparotomy is performed and during surgery, a gallstone ileus is identified. Which of the following is the best course of action?

      Your Answer:

      Correct Answer: Remove the gallstone via a proximally sited terminal ileal enterotomy and decompress the small bowel. Leave the gallbladder in situ.

      Explanation:

      Gallstone ileus accounts for 1-4% of all small bowel obstructions, predominantly affecting elderly females. This entity is associated with a mortality approaching 20% due to the associated comorbidities that are often present.
      Principles of treatment include stone removal via enterotomy through a site proximal to that of the obstruction.
      Decompression using a sucking apparatus with many large openings, inserted through an enterotomy, is a fast and suitable method. The danger of wound infection can be considerably reduced by careful technique and by antibiotics. Nevertheless, open suction should be used only when the peritoneal cavity is already infected, or when closed decompression by retrograde stripping into the stomach is not possible.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Hepatobiliary And Pancreatic Surgery
      0
      Seconds
  • Question 17 - An 11 year old girl who is small for her age presents to...

    Incorrect

    • An 11 year old girl who is small for her age presents to the clinic with hypermobile fingers and poor muscular development. Multiple fractures of the long bones and irregular patches of ossification are seen on the x-rays. What is her diagnosis?

      Your Answer:

      Correct Answer: Osteogenesis imperfecta

      Explanation:

      Answer: Osteogenesis imperfecta

      Osteogenesis imperfecta (OI) is a disorder of bone fragility chiefly caused by mutations in the COL1A1 and COL1A2 genes that encode type I procollagen.

      Type II – Perinatal lethal
      Some providers who treat large numbers of patients with osteogenesis imperfecta suggest that the diagnosis of Type II OI be made in retrospect for patients who do not survive the perinatal period, and that even patients with very severe forms of OI who nonetheless are long term survivors be classified as Type III. Blue sclera may be present. Patients may have a small nose, micrognathia, or both. All patients have in utero fractures, which may involve the skull, long bones, and/or vertebrae. The ribs are beaded, and the long bones are severely deformed.
      Causes of death include extreme fragility of the ribs, pulmonary hypoplasia, and malformations or haemorrhages of the CNS.

      Type III – Severe, progressively deforming

      Patients may have joint hyperlaxity, muscle weakness, chronic unremitting bone pain, and skull deformities (e.g., posterior flattening) due to bone fragility during infancy.

      Deformities of upper limbs may compromise function and mobility. The presence of dentinogenesis imperfecta is independent of the severity of the osteogenesis imperfecta. The sclera have variable hues. In utero fractures are common. Limb shortening and progressive deformities can occur. Patients have a triangular face with frontal and temporal bossing. Malocclusion is common. Basilar invagination is an uncommon but potentially fatal occurrence in osteogenesis imperfecta.
      Vertigo is common in patients with severe osteogenesis imperfecta. Hypercalciuria may be present in about 36% of patients with osteogenesis imperfecta, and adults may be at higher risk of renal calculi. Respiratory complications secondary to kyphoscoliosis are common in individuals with severe osteogenesis imperfecta.
      Constipation and hernias are also common in people with osteogenesis imperfecta.

      Obtain a radiographic skeletal survey after birth.

      In mild (type I) osteogenesis imperfecta, images may reveal thinning of the long bones with thin cortices. Several wormian bones may be present. No deformity of long bones is observed.

      In extremely severe (type II) osteogenesis imperfecta, the survey may reveal beaded ribs, broad bones, and numerous fractures with deformities of the long bones. Platyspondylia may also be revealed.

      In moderate and severe (types III and IV) osteogenesis imperfecta, imaging may reveal cystic metaphysis, or a popcorn appearance of the growth cartilage. Normal or broad bones are revealed early, with thin bones revealed later. Fractures may cause deformities of the long bones. Old rib fractures may be present. Vertebral fractures are common.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
      0
      Seconds
  • Question 18 - A three week old baby is referred to surgery by his paediatrician because...

    Incorrect

    • A three week old baby is referred to surgery by his paediatrician because she has a painful area of macerated tissue at the site of the umbilicus. When he cries, a clear-yellowish fluid is seen to be draining from the umbilicus. Which of the following would be the correct diagnosis?

      Your Answer:

      Correct Answer: Patent urachus

      Explanation:

      A patent urachus is one of the spectrum of congenital urachal anomalies. It has occasionally been termed urachal fistula. In an open (or patent) urachus, there is an opening between the bladder and the belly button (navel). The urachus is a tube between the bladder and the belly button that is present before birth. In most cases, it closes along its full length before the baby is born. An open urachus occurs mostly in infants. A patent urachus is often diagnosed in neonates when urine is noted leaking from the umbilicus. The umbilicus may also have an abnormal appearance on physical exam.

      A patent urachus predisposes to infection. If the urachal disorder presents with an infection, the infection is treated first. This requires antibiotics, possible admission for intravenous antibiotics, and occasional surgical drainage of any infected cyst or poorly draining cavity. Once the infection is under control, excision of the urachus is usually performed. This can usually be done laparoscopically or with a small incision on the lower abdomen. Patients usually stay in the hospital 1-2 days after the surgery. The urachus can be excised because in normal development it usually obliterates anyway. The umbilicus is not removed.

      Omphalitis is an infection of the umbilicus and/or surrounding tissues, occurring primarily in the neonatal period. Omphalitis is primarily a disease of the neonate and is characterized by tenderness, erythema, and induration of the umbilicus and surrounding tissues. Early on, patients may only have superficial cellulitis but, if untreated, this can progress to involve the entire abdominal wall. Patients may also have purulent drainage or be bleeding from the umbilical cord stump. Foul-smelling drainage should raise the suspicion of anaerobic infection.

      Patent vitellointestinal or persistent omphalomesenteric duct is a very unusual congenital anomaly which occurs in 2% of population related with the embryonic yolk stalk. A persistent vitellointestinal duct can induce abdominal pain, bowel obstruction, intestinal haemorrhage and umbilical sinus, fistula or hernia which commonly occurs in children.

      An umbilical granuloma is a moist, red lump of tissue that can form on a baby’s navel (belly button). It can be seen in the first few weeks of life, after the umbilical cord has dried and fallen off. It’s usually a minor problem that looks worse than it is. An umbilical granuloma does not cause pain. It may ooze a small amount of fluid that can make the skin around it red and irritated.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Paediatric Surgery
      0
      Seconds
  • Question 19 - A 34 year old mechanic suffers from a Gustilo and Anderson type IIIA...

    Incorrect

    • A 34 year old mechanic suffers from a Gustilo and Anderson type IIIA fracture of the femoral shaft after being hit by a fork lift truck. What would be the most suitable step in the management of this patient?

      Your Answer:

      Correct Answer: Debridement and external fixation

      Explanation:

      Perhaps the most important aspect in the treatment of open fractures is the initial surgical intervention with irrigation and meticulous debridement of the injury zone. Irrigation, along with debridement, is absolutely crucial in the management of open fractures.
      Early stabilization of open fractures provides many benefits to the injured patient. It protects the soft tissues around the zone of injury by preventing further damage from mobile fracture fragments. It also restores length, alignment, and rotation—all vital principles of fracture fixation. Skeletal traction and external fixation are the quickest fixation constructs to employ. The use of skeletal traction should be reserved only for selected open fracture types (i.e., pelvis fractures and very proximal femur fractures) and if used, it should only be for a short selected time. External fixation is a valuable tool in the surgeon’s arsenal for acute open fracture management. Indications for external fixation are grossly contaminated open fractures with extensive soft-tissue compromise, the Type IIIA-C injuries, and when immediate fixation is needed for physiologically unstable patients.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
      0
      Seconds
  • Question 20 - A 25-year-old man is involved in vigorous intercourse and suddenly feels a snap....

    Incorrect

    • A 25-year-old man is involved in vigorous intercourse and suddenly feels a snap. His penis becomes swollen and painful immediately after. The admitting surgeon suspects a penile fracture.

      Which of the following is the most appropriate initial management?

      Your Answer:

      Correct Answer: Immediate surgical exploration

      Explanation:

      Suspected penile fractures should be surgically explored and the injury repaired.

      Penile fractures are a rare type of urological trauma. The injury is usually in the proximal part of the penile shaft and may involve the urethra. A classical history of a snapping sensation followed by immediate pain is usually given by the patient (usually during vigorous intercourse). On examination, a tense haematoma is most commonly noted, and if the urethra is injured, blood may be seen at the meatus.

      The correct management involves surgical exploration and repair of the injury. A circumferential incision is made immediately inferior to the glans and the penile shaft is inspected. Injuries are usually sutured and the urethra is repaired over a catheter.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Urology
      0
      Seconds
  • Question 21 - A 29-year-old man presents with a five-month history of intermittent retrosternal chest pain...

    Incorrect

    • A 29-year-old man presents with a five-month history of intermittent retrosternal chest pain along with episodes of dysphagia to liquids. An upper GI endoscopy is performed and no mucosal abnormality is seen.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Motility disorder

      Explanation:

      Dysphagia that is episodic and nonprogressive and varies between solids and liquids is more likely to represent a motility disorder. It may also associated with retrosternal chest pain.

      Motility disorder is a condition where the nerves and muscles in the gastrointestinal tract are not working together correctly, which cause difficulty in the digestive process. These conditions include chronic intractable constipation, gastroesophageal reflux disease (GERD), chronic intestinal pseudo-obstruction, gastroparesis, Hirschsprung’s disease, and oesophageal achalasia, among other disorders.

      In addition to imaging studies, these conditions are usually evaluated with manometry studies which measure the pressure in different areas of the gastrointestinal tract.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Upper Gastrointestinal Surgery
      0
      Seconds
  • Question 22 - A 40-year-old male pedestrian is brought to the A&E department after being hit...

    Incorrect

    • A 40-year-old male pedestrian is brought to the A&E department after being hit by a car. On examination, he is found to be dyspnoeic and hypoxic despite administration of high flow oxygen therapy. Moreover, his pulse is 115bpm and blood pressure is 110/70 mmHg. The right side of his chest is hyper-resonant on percussion and has decreased breath sounds. His trachea is deviated to the left.

      What is the most likely underlying diagnosis?

      Your Answer:

      Correct Answer: Tension pneumothorax

      Explanation:

      This patient has developed a tension pneumothorax following a blunt trauma.

      Tension pneumothorax is a life-threatening condition that develops when air is trapped in the pleural cavity under positive pressure, displacing mediastinal structures and compromising cardiopulmonary function. Blunt or penetrating chest trauma that creates a flap-type defect on the surface of the lung can result in this life-threatening condition.

      Signs and symptoms of tension pneumothorax include:
      1. Chest pain that usually has a sudden onset, is sharp, and may lead to feeling of tightness in the chest
      2. Dyspnoea and progressive hypoxia
      3. Tachycardia
      4. Hyperventilation
      5. Cough
      6. Fatigue

      On examination, hyper-resonant percussion note and tracheal deviation are typically found. Treatment is immediate without waiting for the CXR result and includes needle decompression and chest tube insertion.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
      0
      Seconds
  • Question 23 - A 1 day old baby girl is born with severe respiratory compromise. She...

    Incorrect

    • A 1 day old baby girl is born with severe respiratory compromise. She is seen to have a scaphoid abdomen and an absent apex beat. Which anomaly does this baby have?

      Your Answer:

      Correct Answer: Bochdalek hernia

      Explanation:

      Answer: Bochdalek hernia

      A Bochdalek hernia is one of two forms of a congenital diaphragmatic hernia, the other form being Morgagni hernia. A Bochdalek hernia is a congenital abnormality in which an opening exists in the infant’s diaphragm, allowing normally intra-abdominal organs (particularly the stomach and intestines) to protrude into the thoracic cavity. In the majority of patients, the affected lung will be deformed, and the resulting lung compression can be life-threatening. Bochdalek hernias occur more commonly on the posterior left side (85%, versus right side 15%).

      In normal Bochdalek hernia cases, the symptoms are often observable simultaneously with the baby’s birth. A few of the symptoms of a Bochdalek Hernia include difficulty breathing, fast respiration and increased heart rate. Also, if the baby appears to have cyanosis (blue-tinted skin) this can also be a sign. Another way to differentiate a healthy baby from a baby with Bochdalek Hernia, is to look at the chest immediately after birth. If the baby has a Bochdalek Hernia it may appear that one side of the chest cavity is larger than the other and or the abdomen seems to be scaphoid (caved in).

      Situs inversus (also called situs transversus or oppositus) is a congenital condition in which the major visceral organs are reversed or mirrored from their normal positions. The normal arrangement of internal organs is known as situs solitus while situs inversus is generally the mirror image of situs solitus. Although cardiac problems are more common than in the general population, most people with situs inversus have no medical symptoms or complications resulting from the condition, and until the advent of modern medicine it was usually undiagnosed. In the absence of congenital heart defects, individuals with situs inversus are homeostatically normal, and can live standard healthy lives, without any complications related to their medical condition. There is a 5–10% prevalence of congenital heart disease in individuals with situs inversus totalis, most commonly transposition of the great vessels. The incidence of congenital heart disease is 95% in situs inversus with levocardia.

      Cystic fibrosis is a progressive, genetic disease that causes persistent lung infections and limits the ability to breathe over time. In people with CF, mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene cause the CFTR protein to become dysfunctional. When the protein is not working correctly, it’s unable to help move chloride — a component of salt — to the cell surface. Without the chloride to attract water to the cell surface, the mucus in various organs becomes thick and sticky. In the lungs, the mucus clogs the airways and traps germs, like bacteria, leading to infections, inflammation, respiratory failure, and other complications.

      Necrotizing enterocolitis (NEC) is a medical condition where a portion of the bowel dies. It typically occurs in new-borns that are either premature or otherwise unwell. Symptoms may include poor feeding, bloating, decreased activity, blood in the stool, or vomiting of bile.
      The exact cause is unclear. Risk factors include congenital heart disease, birth asphyxia, exchange transfusion, and premature rupture of membranes. The underlying mechanism is believed to involve a combination of poor blood flow and infection of the intestines. Diagnosis is based on symptoms and confirmed with medical imaging.

      Morgagni hernias are one of the congenital diaphragmatic hernias (CDH), and is characterized by herniation through the foramen of Morgagni. When compared to Bochdalek hernias, Morgagni hernias are:
      -anterior
      -more often right-sided (,90%)
      -small
      -rare (,2% of CDH)
      -at low risk of prolapse

      Only ,30% of patients are symptomatic. New-borns may present with respiratory distress at birth similar to a Bochdalek hernia. Additionally, recurrent chest infections and gastrointestinal symptoms have been reported in those with previously undiagnosed Morgagni hernia.
      The image of the transverse colon is herniated into the thoracic cavity, through a mid line defect and this indicates that it is a Morgagni hernia since the foramen of a Morgagni hernia occurs in the anterior midline through the sternocostal hiatus of the diaphragm, with 90% of cases occurring on the right side.

      Clinical manifestations of congenital diaphragmatic hernia (CDH) include the following:

      Early diagnosis – Right-side heart; decreased breath sounds on the affected side; scaphoid abdomen; bowel sounds in the thorax, respiratory distress, and/or cyanosis on auscultation; CDH can often be diagnosed in utero with ultrasonography (US), magnetic resonance imaging (MRI), or both
      Late diagnosis – Chest mass on chest radiography, gastric volvulus, splenic volvulus, or large-bowel obstruction
      Congenital hernias (neonatal onset) – Respiratory distress and/or cyanosis occurs within the first 24 hours of life; CDH may not be diagnosed for several years if the defect is small enough that it does not cause significant pulmonary dysfunction
      Congenital hernias (childhood or adult onset) – Obstructive symptoms from protrusion of the colon, chest pain, tightness or fullness the in chest, sepsis following strangulation or perforation, and many respiratory symptoms occur.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • The Abdomen
      0
      Seconds
  • Question 24 - A 55-year-old male presents with an ulcerated mass at the anal verge. A...

    Incorrect

    • A 55-year-old male presents with an ulcerated mass at the anal verge. A biopsy is taken and the histology demonstrates as squamous cell carcinoma. Which of the following viral infection is most likely to have contributed to the development of the condition?

      Your Answer:

      Correct Answer: Human papillomavirus 16

      Explanation:

      Anal squamous cell cancer is believed to be directly linked to the presence of a complex inflammatory process most commonly caused by HPV infection (particularly with serotypes 16 and 18) in the histologically unique area of the anal squamocolumnar epithelium. In one Scandinavian study, serotype 16 HPV DNA was detected in 73% of anal cancer specimens, and serotype 16, 18, or both were detected in 84% of specimens. In contrast, no rectal cancer specimens contained HPV DNA.

    • This question is part of the following fields:

      • Clinical Microbiology
      • Principles Of Surgery-in-General
      0
      Seconds
  • Question 25 - A 50-year-old female is being prepared for a Whipple's procedure. A right-sided subclavian...

    Incorrect

    • A 50-year-old female is being prepared for a Whipple's procedure. A right-sided subclavian line is inserted and anaesthesia is induced. Following intubation, the patient becomes progressively hypoxic and haemodynamically unstable. What is the most likely underlying explanation?

      Your Answer:

      Correct Answer: Tension pneumothorax

      Explanation:

      The complications of central vein catheterization (CVC) include infection, thrombosis, occlusion, and, in particular, mechanical complications which usually occur during insertion and are closely related to the anatomic location of the central veins. Infectious complications are reported to occur in 5% to 26% of patients, mechanical complications in 5% to 19%, and thrombotic complications in 2% to 26%. Mechanical complications associated with the insertion of central lines include arterial puncture, hematoma, haemothorax, pneumothorax, arterial-venous fistula, venous air embolism, nerve injury, thoracic duct injury (left side only), intraluminal dissection, and puncture of the aorta
      Pneumothorax is one of the most common CVC insertion complications, reportedly representing up to 30% of all mechanical adverse events of CVC insertion.
      Clinician-performed bedside US allows the diagnosis of pneumothorax to be made immediately, with a high degree of sensitivity and with better accuracy than supine chest films and equal to that of CT scan.
      Tension pneumothorax is classically characterized by hypotension and hypoxia. On examination, breath sounds are absent on the affected haemothorax and the trachea deviates away from the affected side. The thorax may also be hyper resonant; jugular venous distention and tachycardia may be present.
      If a pneumothorax is diagnosed the treatment strategy should be determined by the following factors: (I) size; (II) symptoms; (III) spontaneous breathing or use of mechanical ventilation; (IV) clinical diagnosis of a tension pneumothorax.

      Treatment consisted of: (I) observation; (II) outpatient insertion of a Heimlich valve; (III) inpatient tube thoracostomy.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      0
      Seconds
  • Question 26 - A 46 year old female who was diagnosed with hypertension complains of numbness...

    Incorrect

    • A 46 year old female who was diagnosed with hypertension complains of numbness in her right arm and leg. She has no other neurological signs. What is the most likely cause?

      Your Answer:

      Correct Answer: Lacunar infarct

      Explanation:

      Lacunar stroke or lacunar infarct (LACI) is the most common type of ischaemic stroke, and results from the occlusion of small penetrating arteries that provide blood to the brain’s deep structures.

      Types:
      Pure motor stroke/hemiparesis – It is marked by hemiparesis or hemiplegia that typically affects the face, arm, or leg of the side of the body opposite the location of the infarct. Dysarthria, dysphagia, and transient sensory symptoms may also be present.

      Ataxic hemiparesis – It displays a combination of cerebellar and motor symptoms, including weakness and clumsiness, on the ipsilateral side of the body. It usually affects the leg more than it does the arm; hence, it is known also as homolateral ataxia and crural paresis. The onset of symptoms is often over hours or days.

      Dysarthria/clumsy hand – The main symptoms are dysarthria and clumsiness (i.e., weakness) of the hand, which often are most prominent when the patient is writing.

      Pure sensory stroke – Marked by numbness (loss of sensation) on one side of the body; can later develop tingling, pain, burning, or another unpleasant sensation on one side of the body.

      Mixed sensorimotor stroke – This lacunar syndrome involves hemiparesis or hemiplegia (weakness) with sensory impairment in the contralateral side.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Surgical Disorders Of The Brain
      0
      Seconds
  • Question 27 - A 28 year old teacher is readmitted following a difficult appendicectomy. On examination,...

    Incorrect

    • A 28 year old teacher is readmitted following a difficult appendicectomy. On examination, her wound is erythematous and, on incision, foul smelling pus is drained. Which of the following organisms is responsible?

      Your Answer:

      Correct Answer: Bacteroides fragilis

      Explanation:

      Bacteroides species are anaerobic bacteria that are predominant components of the bacterial florae of mucous membranes and are therefore a common cause of endogenous infections. Bacteroides infections can develop in all body sites, including the CNS, the head, the neck, the chest, the abdomen, the pelvis, the skin, and the soft tissues. Inadequate therapy against these anaerobic bacteria may lead to clinical failure.

      These bacteria are resistant to penicillins, mostly through the production of beta-lactamase. Anaerobic bacteria can infect deep wounds, deep tissues, and internal organs where there is little oxygen. These infections are characterized by abscess formation, foul-smelling pus, and tissue destruction. Anaerobes outnumber aerobes by 1000:1 in the large intestine; thus, they play an important role in almost all intra-abdominal infections.

      Secondary peritonitis and abdominal abscesses generally occur after entry of enteric organisms into the peritoneal cavity through perforation of the intestine or other viscus as a result of obstruction, infarction, or trauma.

      Most visceral abscesses (e.g., hepatic), chronic cholecystitis, perforated and gangrenous appendicitis, postoperative wound infections and abscesses, diverticulitis, and any infection associated with faecal contamination of the abdominal cavity involve both aerobes and anaerobes.

    • This question is part of the following fields:

      • Clinical Microbiology
      • Principles Of Surgery-in-General
      0
      Seconds
  • Question 28 - A 17 year old girl is taken to the hospital with a 10...

    Incorrect

    • A 17 year old girl is taken to the hospital with a 10 hour history of pelvic pain. Her last normal menstrual cycle was 14 days ago and she is otherwise well. Her abdomen was soft with mild suprapubic pain on examination. What is the underlying cause?

      Your Answer:

      Correct Answer: Mittelschmerz

      Explanation:

      Answer: Mittelschmerz

      Mittelschmerz is midcycle abdominal pain due to leakage of prostaglandin-containing follicular fluid at the time of ovulation. It is self-limited, and a theoretical concern is treatment of pain with prostaglandin synthetase inhibitors, which could prevent ovulation. The pain of mittelschmerz usually occurs in the lower abdomen and pelvis, either in the middle or to one side. The pain can range from a mild twinge to severe discomfort and usually lasts from minutes to hours. In some cases, a small amount of vaginal bleeding or discharge might occur. Some women have nausea, especially if the pain is very strong.
      Diagnosis of pelvic pain in women can be challenging because many symptoms and signs are insensitive and nonspecific. As the first priority, urgent life-threatening conditions (e.g., ectopic pregnancy, appendicitis, ruptured ovarian cyst) and fertility-threatening conditions (e.g., pelvic inflammatory disease, ovarian torsion) must be considered.
      Many women never have pain at ovulation. Some women, however, have mid-cycle pain every month, and can tell by the pain that they are ovulating.
      As an egg develops in the ovary, it is surrounded by follicular fluid. During ovulation, the egg and the fluid, as well as some blood, are released from the ovary. While the exact cause of mittelschmerz is not known, it is believed to be caused by the normal enlargement of the egg in the ovary just before ovulation. Also, the pain could be caused by the normal bleeding that comes with ovulation.
      Pelvic inflammatory disease can be ruled out if the patient is not sexually active.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • The Abdomen
      0
      Seconds
  • Question 29 - A 3 year old boy is taken to the doctor by his mother...

    Incorrect

    • A 3 year old boy is taken to the doctor by his mother who has noticed that he has been having rectal bleeding for a few months and a cherry red lesion appeared at the anal verge after defecation. Which of the following is most likely the diagnosis?

      Your Answer:

      Correct Answer: Juvenile polyp

      Explanation:

      Juvenile polyps are benign hamartomas with neoplastic potential that are the most frequent gastrointestinal polyp of childhood, with the peak incidence between 3 and 5 years of age.. The presence of multiple juvenile polyps may indicate a premalignant condition commonly named juvenile polyposis coli or juvenile polyposis syndrome (JPS). In contrast, single or solitary juvenile polyps generally are considered benign sporadic lesions that confer little to no future risk of malignancy. Most frequent presentation is painless rectal bleeding. Other features include a prolapsing rectal mass and abdominal pain.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Paediatric Surgery
      0
      Seconds
  • Question 30 - A 58 year old lady who has had a mastectomy undergoes a breast...

    Incorrect

    • A 58 year old lady who has had a mastectomy undergoes a breast reconstruction surgery. The breast implant is placed just anterior to her pectoralis major muscle. Which of the following methods of wound closure would be the most appropriate in this case?

      Your Answer:

      Correct Answer: Use of a pedicled myocutaneous flap

      Explanation:

      The latissimus dorsi myocutaneous flap (LDMF) is one of the most reliable and versatile flaps used in reconstructive surgery. It is known for its use in chest wall and postmastectomy reconstruction and has also been used effectively for coverage of large soft tissue defects in the head and neck, either as a pedicled flap or as a microvascular free flap.

      The latissimus dorsi may be transferred as a myofascial flap, a myocutaneous flap, or as a composite osteomyocutaneous flap when harvested with underlying serratus anterior muscle and rib. For even greater reconstructive flexibility, the latissimus can be harvested for free tissue transfer in combination with any or all of the other flaps based on the subscapular vessels (the so-called subscapular compound flap or “mega-flap”), including serratus anterior, scapular, and parascapular flaps

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Passmed