00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Mins)
Retry this test Dashboard

  • Question 1 - A 65 year old man develops persistent pyrexia on his 2nd postoperative day....

    Incorrect

    • A 65 year old man develops persistent pyrexia on his 2nd postoperative day. He has undergone an open extended right hemicolectomy for carcinoma of the colonic-splenic flexure. What is the least likely cause?

      Your Answer: Atelectasis

      Correct Answer: Ileus

      Explanation:

      Pyrexia is a very common post operative finding and can most likely result from an infection. However, it is highly unlikely to occur as a result of ileus. Anastomotic leaks are uncommon after right sided colonic surgery. In this scenario atelectasis would be the most likely underlying cause, as open extended right hemicolectomies will necessitate a long midline incision.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      55.9
      Seconds

  • Question 2 - A 56 year old man is scheduled for flexible sigmoidoscopy to investigate bright...

    Correct

    • A 56 year old man is scheduled for flexible sigmoidoscopy to investigate bright red rectal bleeding. Which of the following would be the most appropriate preparation for this procedure?

      Your Answer: Single phosphate enema 30 minutes pre procedure

      Explanation:

      Bowel preparation is a significant aspect of the flexible sigmoidoscopy procedure. Clear visibility of the bowel mucosa is critical for a thorough examination. The combination of a light breakfast in the morning and the application of 1 or 2 phosphate enemas a few hours before the examination is a safe and commonly used method of preparing a patient for a flexible sigmoidoscopy procedure.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      38.8
      Seconds

  • Question 3 - A 39-year-old woman who is a known case of acute myeloid leukaemia requires...

    Correct

    • A 39-year-old woman who is a known case of acute myeloid leukaemia requires venous access for chemotherapy. Which of the following is the best option?

      Your Answer: Groshong line

      Explanation:

      Chemotherapy for acute myeloid leukaemia (AML) requires long-term therapy and multiple blood tests. Therefore, an indwelling device, such as Groshong line, is preferable.

      Tunnelled lines such as Groshong and Hickman lines are popular devices for patients with long-term therapeutic requirements. These devices are usually inserted, using ultrasound guidance, into the internal jugular vein and then tunnelled under the skin. A cuff of woven material is sited near the end and helps to anchor the device into the tissues. These cuffs require formal dissection to allow the device to be removed.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      102.4
      Seconds

  • Question 4 - A 6-year-old boy undergoes a closure of a loop colostomy. Which of the...

    Incorrect

    • A 6-year-old boy undergoes a closure of a loop colostomy. Which of the following should be used as a thromboprophylaxis?

      Your Answer: Daily low dose low molecular weight heparin until discharged

      Correct Answer: None

      Explanation:

      Clinical characteristics associated with increased venous thromboembolism (VTE) risk in children (listed alphabetically, owing to the current lack of expert consensus or robust data regarding relative risk contributions)
      -Anticipated hospitalization > 72 h
      -Cancer (active, not in remission)
      -Central venous catheter presence
      -Oestrogen therapy started within the last 1 month
      -Inflammatory disease (newly diagnosed, poorly controlled, or flaring)
      -Intensive care unit admission
      -Mechanical ventilation
      -Mobility decreased from baseline (Braden Q‐score < 2)
      -Obesity (BMI > 99th percentile for age)
      -Post pubertal age
      -Severe dehydration, requiring intervention
      -Surgery > 90 min within last 14 days
      -Systemic or severe local infection (positive sputum/blood culture or viral test result, or empirical antibiotics)
      -Trauma as admitting diagnosis

      Pharmacological prophylaxis may be instituted in the following risk groups:
      Children in an ICU with a CVC and one other risk factor fit a high‐risk profile and may benefit from pharmacological thromboprophylaxis in the absence of strong contraindications.
      For children with either a CVC or admission to an ICU (but not both), two risk factors are recommended before the initiation of pharmacological thromboprophylaxis.
      For children with neither a CVC nor ICU admission, at least three risk factors should be present before the initiation of pharmacological thromboprophylaxis.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      27.3
      Seconds

  • Question 5 - A 50-year-old female has a metallic heart valve and requires a paraumbilical hernia...

    Correct

    • 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: 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
      183.6
      Seconds

  • Question 6 - A 32 year old man has had a total pancreatectomy done. He has...

    Incorrect

    • A 32 year old man has had a total pancreatectomy done. He has severe necrotizing pancreatitis that is unresponsive to conservative therapy. Which statement regarding the physiological effects of a total pancreatectomy on this patient is false?

      Your Answer: The patient is at a higher risk of developing iron deficient anaemia

      Correct Answer: Loss of fat emulsification will result in the malabsorption of vitamins A, C, D, and K

      Explanation:

      Answer: Loss of fat emulsification will result in the malabsorption of vitamins A, C, D, and K

      Vitamins are classified as either fat soluble (vitamins A, D, E and K) or water soluble (vitamins B and C). This difference between the two groups is very important. It determines how each vitamin acts within the body. The fat soluble vitamins are soluble in lipids (fats). These vitamins are usually absorbed in fat globules (called chylomicrons) that travel through the lymphatic system of the small intestines and into the general blood circulation within the body. These fat soluble vitamins, especially vitamins A and E, are then stored in body tissues.
      Vitamin C is a water soluble vitamin which makes the statement false.
      Primary pancreatic maldigestion of carbohydrate, protein, and fat is caused by decreased activity of amylase, trypsin, and lipase. Pancreatic lipase is an enzyme secreted from the pancreas. As the primary lipase enzyme that hydrolyses dietary fat molecules in the human digestive system, it is one of the main digestive enzymes, converting triglyceride substrates found in ingested oils to monoglycerides and free fatty acids.
      The duodenum plays a key role in absorption of vitamins and minerals, and is removed in PD resections. This, in combination with malabsorption and increased metabolic demand, results in increased risk of micronutrient deficiencies. Routine supplementation of fat soluble vitamin and trace elements are recommended following resection.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      44.5
      Seconds

  • Question 7 - A 57 year old woman, known case of idiopathic thrombocytopenic purpura is scheduled...

    Incorrect

    • A 57 year old woman, known case of idiopathic thrombocytopenic purpura is scheduled to undergo a splenectomy. Her platelet count has dropped to 50. Which of the following is the optimal timing for a platelet transfusion in this case?

      Your Answer: 24 hours pre-operatively

      Correct Answer: After ligation of the splenic artery

      Explanation:

      The timing of platelet transfusion in a patient of ITP undergoing splenectomy should be carefully monitored, it should neither be done too soon or too late. If done too soon it will be rendered ineffective, if too late it will result in unnecessary bleeding. The ideal time for a platelet transfusion would be when the splenic artery has been ligated.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      103.1
      Seconds

  • Question 8 - A 65 year old man with a history of carcinoma of the distal...

    Correct

    • A 65 year old man with a history of carcinoma of the distal oesophagus undergoes an Ivor-Lewis oesophagogastrectomy. The next day a pale opalescent liquid is noticed in the right chest drain. Which of the following is the most likely explanation of this finding?

      Your Answer: Chyle leak

      Explanation:

      Chyle leakage is one of the most challenging complications following an esophagectomy and can lead to hypovolemia, metabolic and nutritional depletion, infection, and even death. The leakage occurs in 1.1 to 3.7% of esophagectomy patients; mortality occurs in excess of 50% of patients. Surgeons administer a lipid rich material prior to surgery to facilitate its identification if it occurs.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      38.3
      Seconds

  • Question 9 - A 54 year old man undergoes Milligan Morgan haemorrhoidectomy. He had no associated...

    Incorrect

    • A 54 year old man undergoes Milligan Morgan haemorrhoidectomy. He had no associated co-morbidities. Which of the following would be the best option for immediate post operative analgesia?

      Your Answer: IV fentanyl

      Correct Answer: Caudal block

      Explanation:

      Open haemorrhoidectomy is traditionally viewed as a painful procedure. Most operations are performed under general or regional anaesthesia. Following excisional haemorrhoidectomy, severe pain is not unusual, a well placed caudal anaesthetic will counter this. A pudendal nerve block is an alternative but is less effective than a caudal.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      56.9
      Seconds

  • Question 10 - A 55-year-old alcoholic male presents with acute pancreatitis. He is clinically dehydrated. His...

    Correct

    • A 55-year-old alcoholic male presents with acute pancreatitis. He is clinically dehydrated. His blood results show normal renal function and electrolytes. Which of the intravenous fluids below should be prescribed?

      Your Answer: Hartmann's solution

      Explanation:

      Management of Acute Pancreatitis revolves around supportive care, adequate nutrition, and intravenous hydration. The rationale for hydration is based on the need to resolve the hypovolemia that occurs secondary to vomiting, reduced oral intake, third space extravasation, respiratory losses and diaphoresis. Besides, early hydration provides macrocirculatory and microcirculatory support to prevent the cascade of events leading to pancreatic necrosis.
      There is a lack of high level evidence to guide the choice of fluid in AP. Crystalloids are recommended by the American Gastroenterological Association, and colloids (packed red blood cells) are considered in cases of low haematocrit (< 25%) and low serum albumin (< 2 g/dL). Among the crystalloids, Ringer's lactate solution is preferred over Normal saline. However, there is an urgent need of studies on this issue.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      27.8
      Seconds

  • Question 11 - A 27-year-old woman presents with abdominal pain. On investigation, her serum calcium is...

    Incorrect

    • A 27-year-old woman presents with abdominal pain. On investigation, her serum calcium is found to be 3.5 mmol/L. What should be the most appropriate initial management?

      Your Answer: Intravenous calcitonin

      Correct Answer: Intravenous 0.9% sodium chloride

      Explanation:

      The immediate treatment of hypercalcaemia involves intravenous fluid resuscitation. This may be complemented with the use of bisphosphonates and sometimes, diuretics. However, fluids are administered first. Normal saline is usually preferred for this over other solutions.

      Urgent management in hypercalcaemia is indicated if:
      1. Serum calcium level >3.5 mmol/L
      2. Reduced consciousness
      3. Severe abdominal pain
      4. Pre-renal failure

      Management options include:
      1. Intravenous fluid resuscitation with 3–6 litres of 0.9% normal saline in 24 hours
      2. Concurrent administration of calcitonin to help lower calcium levels
      3. Medical therapy (usually if corrected calcium >3.0mmol/L)

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      130.9
      Seconds

  • Question 12 - A 65 year old man is brought to the emergency department after he...

    Correct

    • A 65 year old man is brought to the emergency department after he collapsed at the bus station. Clinical examination is significant for a ruptured abdominal aortic aneurysm. On arrival he is hypotensive and moribund. Which of the following is most likely to be his ASA?

      Your Answer: 5

      Explanation:

      ASA-V: A moribund patient who is not expected to survive without the operation. Examples include (but not limited to): ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction

      ASA Grading
      1 – No organic physiological, biochemical or psychiatric disturbance. The surgical pathology is localised and has not invoked systemic disturbance
      2 – Mild or moderate systemic disruption caused either by the surgical disease process or though underlying pre-existing disease
      3 – Severe systemic disruption caused either by the surgical pathology or pre-existing disease
      4 – Patient has severe systemic disease that is a constant threat to life
      5 – A patient who is moribund and will not survive without surgery

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      66.6
      Seconds

  • Question 13 - A 60 year old woman with Crohn's disease presents with a high output...

    Incorrect

    • A 60 year old woman with Crohn's disease presents with a high output enterocutaneous fistula. She is started on total parenteral nutrition (TPN) to reduce the output of the fistula and improve her nutritional status. Which of the following statements regarding TPN is incorrect?

      Your Answer: It increases the risk of acalculous cholecystitis

      Correct Answer: It may result in metabolic complications such a refeeding syndrome, resulting in hyperkalaemia, hypermagnesemia, and hyperphosphatemia

      Explanation:

      Answer: It may result in metabolic complications such a refeeding syndrome, resulting in hyperkalaemia, hypermagnesemia, and hyperphosphatemia.

      Refeeding syndrome can be defined as the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally. These shifts result from hormonal and metabolic changes and may cause serious clinical complications. The hallmark biochemical feature of refeeding syndrome is hypophosphatemia. However, the syndrome is complex and may also feature abnormal sodium and fluid balance; changes in glucose, protein, and fat metabolism; thiamine deficiency; hypokalaemia; and hypomagnesaemia.
      During refeeding, glycaemia leads to increased insulin and decreased secretion of glucagon. Insulin stimulates glycogen, fat, and protein synthesis. This process requires minerals such as phosphate and magnesium and cofactors such as thiamine. Insulin stimulates the absorption of potassium into the cells through the sodium-potassium ATPase symporter, which also transports glucose into the cells. Magnesium and phosphate are also taken up into the cells. Water follows by osmosis. These processes result in a decrease in the serum levels of phosphate, potassium, and magnesium, all of which are already depleted. The clinical features of the refeeding syndrome occur as a result of the functional deficits of these electrolytes and the rapid change in basal metabolic rate.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      90.2
      Seconds

  • Question 14 - 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: Simple pneumothorax

      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
      49.5
      Seconds

  • Question 15 - A 69 year old woman presents with chest pain. She has undergone esophagogastrectomy...

    Correct

    • A 69 year old woman presents with chest pain. She has undergone esophagogastrectomy for carcinoma of the distal oesophagus. The next day, a brisk bubbling is noticed in the chest drain when the suction is applied. Which of the following would be the most likely cause of this finding?

      Your Answer: Air leak from lung

      Explanation:

      The possible causes of post-operative pneumothorax after thoracotomy and esophagectomy include lung parenchymal leak/injury, bronchopleural fistula, ruptured bullae and malpositioned chest drains. When suction is applied to the chest drainage system, active and persistent bubbling may be seen. Although an anastomotic leak may produce a small pneumothorax, a large volume air leak is more indicative of lung injury.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      43.2
      Seconds

  • Question 16 - A 34 year old man is suffering from septic shock and receives an...

    Incorrect

    • A 34 year old man is suffering from septic shock and receives an infusion of Dextran 70. Which of the following complications may potentially ensue?

      Your Answer: Vomiting

      Correct Answer: Anaphylaxis

      Explanation:

      Dextran 40 and 70 have a higher rate of causing anaphylaxis than either gelatins or starches.

      Dextrans are branched polysaccharide molecules, with dextran 40 and 70 available. The high-molecular-weight dextran 70 may persist for up to eight hours. They inhibit platelet aggregation and leucocyte plugging in the microcirculation, thereby, improving flow through the microcirculation. They are primarily used in sepsis.
      Unlike many other intravenous fluids, dextrans are a recognised cause of anaphylaxis.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      119.1
      Seconds

  • Question 17 - A 30-year-old woman undergoes a laparotomy for a perforated duodenal ulcer and broad-spectrum...

    Correct

    • A 30-year-old woman undergoes a laparotomy for a perforated duodenal ulcer and broad-spectrum antibiotics are administered. However, she develops hearing impairment postoperatively.Which of the following agents is responsible for this adverse effect?

      Your Answer: Gentamicin

      Explanation:

      Ototoxicity is a recognised adverse reaction with the aminoglycoside antibiotics.

      Gentamicin belongs to a class of drugs known as aminoglycoside antibiotics. It is a broad-spectrum antibiotic that is most affective against aerobic gram-negative rods. Gentamicin acts by inhibiting bacterial protein synthesis. This creates a pool of inactive bacterial ribosomes that can no longer re-initiate and translate new proteins.

      The hearing loss produced by gentamicin is known as gentamycin-induced ototoxicity. The antibiotic itself is not dangerous. It becomes toxic when it binds to iron in the blood and produces destructive chemical agents known as free radicals.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      128.8
      Seconds

  • Question 18 - A 64 year old woman received midazolam before a colonoscopy. During the procedure...

    Correct

    • A 64 year old woman received midazolam before a colonoscopy. During the procedure her respiratory rate slows down and she becomes hypoxic. The anaesthetist decides to reverse her sedation. Which of the following drugs should be administered?

      Your Answer: Flumazenil

      Explanation:

      Reversal of the central effects of midazolam by intravenous flumazenil after general anaesthesia. Since many benzodiazepines have longer half lives than flumazenil patients still require close monitoring after receiving the drug. Other drugs provided in the options would not characteristically be used for the reversal of midazolam.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      34.9
      Seconds

  • Question 19 - A 58 year old man has recently undergone a successful coronary artery bypass...

    Incorrect

    • A 58 year old man has recently undergone a successful coronary artery bypass procedure and is coming off the cardiac bypass circuit. Which of the following drugs should be administered to him to normalize his clotting prior to decannulation and chest closure?

      Your Answer: Intravenous vitamin K

      Correct Answer: Protamine sulphate

      Explanation:

      Protamine is used in patients undergoing off-pump coronary artery bypass (OPCAB) surgery to reverse the anticoagulant effects of heparin and restore coagulation. FFP may be effective but would carry a significant risk of fluid overload.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      79.8
      Seconds

  • Question 20 - A 43-year-old male with no significant medical history is currently being kept nil-by-mouth...

    Incorrect

    • A 43-year-old male with no significant medical history is currently being kept nil-by-mouth for an elective bilateral inguinal hernia repair. Which of the following describes the best fluid regimen for this patient over the following 24 hours?

      Your Answer: 2 L Hartmann’s solution and 1 L 5% dextrose with 20 mmol potassium

      Correct Answer: 1 L normal saline with 20 mmol potassium and 2 L 5% dextrose with 20 mmol potassium in each bag

      Explanation:

      If patients need IV fluids for routine maintenance alone, restrict the initial prescription to:
      25–30 ml/kg/day of water and
      approximately 1 mmol/kg/day of potassium, sodium and chloride and
      approximately 50–100 g/day of glucose to limit starvation ketosis.
      Weight-based potassium prescriptions should be rounded to the nearest common fluids available (for example, a 67 kg person should have fluids containing 20 mmol and 40 mmol of potassium in 24 hours). Potassium should not be added to intravenous fluid bags as this is dangerous.

      Sodium chloride 0.9%, with or without additional potassium, is one of the most commonly used IV fluids in UK practice.

      Glucose 5% solution provides a useful means of giving free water for, once the glucose is metabolised, the fluid is distributed throughout total body water. It is, therefore, a potentially useful means of correcting or preventing simple dehydration and the glucose content will also help to prevent starvation ketosis, although it is important to recognize that it will not make much of a contribution to covering patients overall nutritional needs. The use of 5% glucose, will increase risks of significant hyponatraemia, particularly in children, the elderly, patients on diuretics and those with excess ADH due to osmotic and non-osmotic stimuli (a problem is seen quite frequently in hospitalized patients). Nevertheless, hyponatremia is likely to be avoided by not exceeding recommended volumes of maintenance IV fluids and by careful monitoring of patients’ clinical volume status and electrolyte measurements.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      42.3
      Seconds

  • Question 21 - A 62 year old woman who has undergone a right hip hemiarthroplasty for...

    Incorrect

    • A 62 year old woman who has undergone a right hip hemiarthroplasty for a fractured femoral neck, is found to have low serum sodium of 124mmol/L a few days postoperatively. Which of the following is the least likely cause of her deranged labs?

      Your Answer: Syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH)

      Correct Answer: Vomiting

      Explanation:

      Vomiting usually results in hypokalaemia, and hyponatremia would least likely occur as a result of it. Hyponatremia is a common postoperative finding among patients and hence serum sodium must be carefully monitored. Addison disease, SIADH, diuretic therapy can all cause hyponatremia.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      30.2
      Seconds

  • Question 22 - A 55-year-old male with a history of Type I diabetes mellitus and hypertension...

    Correct

    • A 55-year-old male with a history of Type I diabetes mellitus and hypertension undergoes an uncomplicated anterior resection for rectal malignancy. Three days after his operation, he describes faintness while walking to the toilet in the morning. His vital signs include a blood pressure of 78/55 mmHg, heart rate of 130/min and respiratory rate of 27/min. His oxygen saturation is normal. A finger-prick glucose check shows a value of 18 mmol/L. Which of the following is the most appropriate immediate investigation for this patient?

      Your Answer: ECG

      Explanation:

      Postoperative hypertension, arrhythmias, and heart failure commonly occur in the first 2 days after surgery, but the risk of myocardial infarction persists for at least 5 or 6 days after surgery.
      ECG should be done to exclude it.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      29.8
      Seconds

  • Question 23 - A 6 year old boy previously diagnosed with a rare genetic disorder requires...

    Correct

    • 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: 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
      71.8
      Seconds

  • Question 24 - A 26 year old man is admitted for severe anorexia nervosa and he...

    Incorrect

    • A 26 year old man is admitted for severe anorexia nervosa and he is given nasogastric feeding which is initially tolerated well. Four days later, he becomes acutely agitated and confused. On examination, his heart rate is 121/min with regular rhythm and a blood pressure of 97/86 mmHg. despite all this, he appears adequately hydrated and has no fever. Which investigation would be the best one for this patient?

      Your Answer: Serum urea and electrolytes

      Correct Answer: Serum phosphate

      Explanation:

      Answer: Serum phosphate

      Refeeding syndrome can be defined as the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally. These shifts result from hormonal and metabolic changes and may cause serious clinical complications. The hallmark biochemical feature of refeeding syndrome is hypophosphatemia. However, the syndrome is complex and may also feature abnormal sodium and fluid balance; changes in glucose, protein, and fat metabolism; thiamine deficiency; hypokalaemia; and hypomagnesaemia.
      During refeeding, glycaemia leads to increased insulin and decreased secretion of glucagon. Insulin stimulates glycogen, fat, and protein synthesis. This process requires minerals such as phosphate and magnesium and cofactors such as thiamine. Insulin stimulates the absorption of potassium into the cells through the sodium-potassium ATPase symporter, which also transports glucose into the cells. Magnesium and phosphate are also taken up into the cells. Water follows by osmosis. These processes result in a decrease in the serum levels of phosphate, potassium, and magnesium, all of which are already depleted. The clinical features of the refeeding syndrome occur as a result of the functional deficits of these electrolytes and the rapid change in basal metabolic rate.

      Symptoms of hypophosphatemia include:

      confusion or hesitation
      seizures
      muscle breakdown
      neuromuscular problems
      acute heart failure

      Deficiency in thiamine can lead to Korsakoff’s syndrome (retrograde and anterograde amnesia, confabulation) and Wernicke’s encephalopathy (ocular abnormalities, ataxia, confusional state, hypothermia, coma). These symptoms are not present in the patient so Thiamine deficiency can be ruled out and there is no need to do tests for Serum vitamin B.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      40.7
      Seconds

  • Question 25 - A 42-year-old female has undergone a total thyroidectomy for multinodular goitre. You are...

    Correct

    • A 42-year-old female has undergone a total thyroidectomy for multinodular goitre. You are called to see her because of respiratory distress. On examination, she has marked stridor, her wound seems healthy but there is a swelling within the operative site. What is the most likely explanation for this problem?

      Your Answer: Contained haematoma

      Explanation:

      Airway obstruction: In the first 24 hours it is most likely from a compressive hematoma. After 24 hours consider laryngeal dysfunction secondary to hypocalcaemia.
      In this patient, the most likely cause is a haematoma.
      Definitive therapy is opening the surgical incision to evacuate the hematoma. Re-intubation may be lifesaving for persistent airway obstruction. Consider awake fibreoptic intubation.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      11
      Seconds

  • Question 26 - A 3-year-old boy is brought to the A&E department following a trauma. He...

    Incorrect

    • A 3-year-old boy is brought to the A&E department following a trauma. He is haemodynamically unstable. Initial attempts at intravenous access are proving unsuccessful.What should be the best course of action?

      Your Answer: Insert a Broviac line

      Correct Answer: Insert an intraosseous infusion system

      Explanation:

      Gaining venous access in small children is challenging most of the times especially in cases of trauma. Therefore, intraosseous infusions should be preferred in this setting. Broviac lines are long-term IV access systems with narrow lumens and, hence, would be unsuitable.

      Intraosseous access is typically undertaken at the anteromedial aspect of the proximal tibia and provides access to the marrow cavity and circulatory system. Although traditionally preferred in paediatric practice, it may be used in adults as well, and a wide range of fluids can be infused using this approach.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      37.9
      Seconds

  • Question 27 - A 56 year old man presenting with acute appendicitis undergoes an appendicectomy through...

    Incorrect

    • A 56 year old man presenting with acute appendicitis undergoes an appendicectomy through a lower midline laparotomy incision. Which of the following would be the best option for providing post operative analgesia?

      Your Answer: Epidural

      Correct Answer: Patient controlled analgesic infusion

      Explanation:

      Patient-controlled analgesia (PCA) is a delivery system with which patients self-administer predetermined doses of analgesic medication to relieve their pain. The use of PCA in hospitals has been increasing because of its proven advantages over conventional intramuscular injections. These include improved pain relief, greater patient satisfaction, less sedation and fewer postoperative complications.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      22.4
      Seconds

  • Question 28 - A 33-year-old man with a 4cm lipoma on his flank is due for...

    Correct

    • A 33-year-old man with a 4cm lipoma on his flank is due for its surgical removal, as a day case. He is, otherwise, completely asymptomatic.According to the above description, what is his physical status according to the ASA classification?

      Your Answer: 1

      Explanation:

      Absence of comorbidities and a small procedure with no likelihood of systemic compromise will equate to an ASA score of 1.

      The ASA physical status classification system is a system for assessing the fitness of patients before surgery. It has six grades, as described below:

      ASA 1: No physiological, biochemical, or psychiatric disturbance. The surgical pathology is localised and has not invoked systemic disturbance.

      ASA 2: Mild or moderate systemic disruption caused either by the surgical disease process or through an underlying pre-existing disease.

      ASA 3: Severe systemic disruption, not life-threatening, caused either by the surgical pathology or a pre-existing disease.

      ASA 4: Patient has severe systemic disease that is a constant threat to life.

      ASA 5: Patient is moribund and will not survive without surgery.

      ASA 6: A brain-dead patient whose organs are being removed with the intention of transplanting them into another patient.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      30
      Seconds

  • Question 29 - A 63 year old lawyer presents with marked agitation after undergoing a transurethral...

    Correct

    • A 63 year old lawyer presents with marked agitation after undergoing a transurethral resection of the prostate which took one hour to perform. He has a heart rate of 105 beats per minute and his blood pressure is 170/100mmHg. He is suspected to be in a fluid overloaded state. Lab results reveal a sodium level of 120mmol/L. Which of the following is the most likely cause of this presentation?

      Your Answer: TURP syndrome

      Explanation:

      Complications of Transurethral Resection: TURP
      T URP syndrome
      U rethral stricture/UTI
      R etrograde ejaculation
      P erforation of the prostate

      TURP syndrome can cause a wide variety of symptoms that include asymptomatic hyponatremia, ECG changes, fatigue, vomiting, confusion, visual loss, coma and death. In a conscious and alert patient, changes in the mental state of may be the first sign of TURP syndrome and bladder perforation.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      87.2
      Seconds

  • Question 30 - A woman with type II diabetes is undergoing a bilateral hernia repair as...

    Incorrect

    • A woman with type II diabetes is undergoing a bilateral hernia repair as a day-case procedure under general anaesthetic. Which of the following is most appropriate?

      Your Answer: They should be kept nil by mouth at least 6 hours before the procedure

      Correct Answer: They should be placed first on the operating list whenever possible

      Explanation:

      Answer: They should be placed first on the operating list whenever possible

      Patients with diet controlled diabetes are all
      suitable for day case surgery if the procedure itself
      is suitable for day surgery and all other criteria are
      fulfilled.
      People with diabetes controlled by oral or injected
      medication are suitable for day case surgery if:
      • They fulfil all day case criteria
      • They can be first / early on a morning or afternoon
      list.
      Prioritise patients with diabetes on the list. This reduces the starvation time and hence the likelihood of the patient requiring a VRIII.

      Insulin should never be stopped in people with Type 1 diabetes because this will lead to ketoacidosis. If the starvation period is expected to require omission of more than one meal, a variable rate intravenous insulin infusion (VRIII) with concomitant glucose and electrolyte infusion will be required. Insulin requirements are increased by:
      • Obesity
      • Prolonged or major surgery
      • Infection
      • Glucocorticoid treatment.
      When a VRIII is used, insulin and substrate should be infused continuously. If the infusion is stopped, there will be no insulin present in the circulation after 3-5 minutes leading to immediate catabolism.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      61
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Peri-operative Care (14/30) 47%
Principles Of Surgery-in-General (14/30) 47%
Passmed
Retry this test Dashboard