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Surgery Paper Ii (Dicm 333) Question Paper

Surgery Paper Ii (Dicm 333)

Course:Clinical Medicine

Institution: Kenya Methodist University question papers

Exam Year:2013

TIME : 3 HOURS

Instructions:
Write your University number and not name
Use a pen not pencil
Attempt all questions
Number all the questions
Multiple choice questions
Mark T for True or F for False
You score a mark for every correct response
You do not score or lose any mark for not responding
You will be penalized 1 mark (minus) for every wrong response.

SECTION A
Question One
True or false concerning sarcomas
Liposarcomas are benign tumours of smooth muscle.
Rhabdomyosarcoma are malignant tumours of skeletal muscle.
Sarcoma are not found in blood vessels
Kaposis sarcoma is found only in patients with AIDs.
Synovial sarcoma is a tumour of the synorium.

Question Two
Ludwig’s angina is:
Submandibular space infection
Submaxillary space infection
Sublingual space infection
An infection originating from the teeth rooks
Is common in neonates.

Question Three
The following conditions, present as acute abdomen.
Abdorminal Aortic Aneurysm.
Ischemic bowel
Pancreatitis
Nephrolithiasis (kidney stones)
Food poisoning

Question Four
The following are risk factors for abscess formation
Poor hygiene
Poor circulation
Chronic steroid therapy
Diabetes Insipidus
Diabetes Mellitus

Question Five
Skin ulcers can be treated by:
Cleansing
Moisturizing
Incontinent protection
Avoiding exposure to secondary smoke
Debridement.

Question Six
True or False concerning breast infections.
Prevalent in post menopausal women
Mastitis causes benign breast man.
Fibroadenoma causes mastitis
Breast abscess results from bacterial infection.
Incision and Drainage is contraindicated when breastfeeding.

Question Seven
About rectal conditions.
Rectal vaginal fistula is common in patients with Haemarrhoids.
Anal fissure is a small tear in the anus.
Rectal prolapse is also rectocele
Rectal prolapsed is associated with long term diarrhea.
Pilonidal cyst is found between the buttocks in the cleft.

Question Eight
True or False concerning Osteomyelitis
It is an infection of the bones
Occurs only in children
Recent surgery around a bone can expose one to osteomyelitis
Peripheral neuropathy is not a risk factor to osteomyelitis.
Fever and chills can be associated.

Question Nine
Ganglions
Are small cysts that often appear on the hands and wrists.
Treatment involves broad spectrum antibiotics.
Require urgent surgical intervention
Injecting hydrocortisone dissolves them.
Keloids and Ganglions are the same.

Question Ten
True or False concerning Gangrene
Wet gangrene is the most dangerous type.
Wet gangrene is an indication of infection
Dry gangrene can result due to arteriosclenosis
Dry gangrene often begins with the affected area becoming hot and painful.
Gas gangrene means gas is present in the gangrenous tissue.

Question Eleven
A patient presented to hospital and was diagnosed to have empyema
Empyema is the same as Emphysema
Chest X-ray is indicated in this condition
Thoracentesis is contraindicated
Complications include pericardial thickening
Decortications can be done.

Question Twelve
The stages wound healing include
Remodeling
Tissue degeneration
Angiogenesis
Fibroblast proliferation
Inflammation

Question Thirteen
Colorectal Cancer symptoms include
Fatigue
Weight loss
Constipation
Narrow stools
Foul smelling flatus

Question Fourteen
True or False concerning Ludwig’s angina
It is a submandibular space infection
Can cause oltagia (ear ache)
CT scan of the neck is not recommended.
Treatment may include tracheostomy
Complications include septic shock.

Question Fifteen
Testicular torsion is usually due to;
Urinary tract infections
Undescended testis
Syphilis
Orgasm
All the above

Question Sixteen
True or False concerning epistaxis
Common in elderly women
Initial treatment is cauternization
Almost always caused by trauma
Can lead to hypovalaemia
Arterior nasal packing is indicated.

Question Seventeen
The following are investigations of a ruptured liver
CT scan of the abdomen
Diagnostic peritoneal lavage
MRI of the abdomen
Ultra sound is contraindicated
All the above.

Question Eighteen
The treatment for paraphimosis includes;
Reduction
Circumcision
Intravenous Ampicillin
Acyclovir
Aspiration

Question Nineteen
Complications of POP on the forearm include
Compartment syndrome
Gangrene of the digits
Thromboplebitis
Degloving
Skin ulcers.

Question Twenty
The management for pressure sores includes;
Oxygen therapy
Debridement
Broad spectrum antibiotics
Daily dressing with sugar
Non of the above.

Question Twenty One
The following are symptoms of Acute Intestinal obstruction:
Scarphoid abdomen
Bloody diarrhea
Vomiting
Ascites
Passage of fouls smelling flatus

Question Twenty Two
Glossitis requires the following treatment
Immediate antiretroviral treatment
Administration of vitamin B complex
Surgical cleaning with spirit
Cotrimoxazole administration
Any of the above

Question Twenty Three
True or False
Cancer of stomach is common in adolescents
Symptoms of cancer stomach include bloody stools
Peptic ulcer symptoms may mimic Ca. stomach
Diet low in vegetables and fruits is associated with causes of Ca. stomach
Surgery is the main stay of Ca. Stomach management.

Question Twenty Four
True or False concerning burns;
2nd degree burn involves the dermis
Face, groin and buttocks 2nd degree burns are treated as major burns.
Tetanus toxoid is not necessary for minor burns.
Complications of burns include keloid formation.
Application of egg whites or butter is recommended in burns.

Question Twenty Five
A 40 year old man presenting with upper gastrointestinal haemorrhage may be managed by;
Securing an intravenous line
Monitoring of pulse and blood pressure
Nasogastric tube feeding
Induction of emesis to clear blood from stomach.
Blood transfusion prophylactically.

Question Twenty Six
Colostomies are commonly indications for the following
Rectal injuries
Pancreatitis
Appendiatis
Colonic carcinoma
Large bervel obstruction

Question Twenty Seven
The following are true concerning prolapsed intervertebral disc;
Common cause of low back pain
Common in the thoracic spine
Skeletal traction is the main stay of management
Sciatica is usually present
Pain is relieved by sneezing

Question Twenty Eight
Transillumination test is positive in the following scrotal disorders;
Scrotal haematocode
Seminoma
Encysted hydrocele of the cord
Testicular hydrocele
Scrotal cyst

Question Twenty Nine
Causes of burst abdomen include
Posture
Poor closure technique
Coughing or vomiting
Deep wound infection
Poor metabolic state of patient

Question Thirty
A 20 year old lay is admitted with a 2 day history of right lower limb smelling. The limb is warm and tender
She may be having cellulites
Deep venous thrombosis is likely
Elevation of the limb is not necessary
Lymphoedema is the definition diagnosis
Filariasis is the cause

Question Thirty One
A patient was brought to you with history of confusion and agitation one hour after a RTA. What could be causing this?
Sepsis
Cerebral injury
Psychosis
Hypovolaemic shock
Anxiety neurosis

PART B
Question One
The following are medical conditions that adversely affect patient with burns.
Anaemia
Thyrotoxicosis
Hypertension
Obesity
Diabetes Mellitus

Question Two
Mr. Gideon has a crash injury of a finger which require amputation for the Surgical Management.
The following are true
What nerve block can be used
The brachial plexus block should be used.
Digital block using Lignocaine with adrenaline in contraindicated.
The operation should be done under general anaesthesia
Digital block using lignocaine with adrenaline is indicated.

Question Three
Jane was operated for appendicitis (appedicectomy) was done. The following incission is commonly used for appendicectomy.
Transverse
Lower Midiline
Pfanisteil’s incision
Paramedian incision
Bird iron incision

Question Four
A 25 year person was involved in RTA and sustained chest injury with flail chest.
The following are the symptoms;
Hemateniesis
Rhonchus
Hemophysis
Chest pain
Dyspnoea

Question Five
The following are malignant tumours
Lipoma
Carcinoma
Neurofibroma
Sarcoma
Adenoma

Question Six
Dry gangrene (thromboangitis obliterans) is a medical condition associated with
Excessive intake of alcohol
Infection by bacteria of chostristin species
Smoking of cannabis sativa
Excessive tobacco smoking
Diabetes Mellitus

Question Seven
The following are true of cardiac tamponade
Defective heart valves
Its an irregular arrhythmic heart beats
Presence of blood in the pericardial sac
Presence of blood in the thoracic cavity
Presence of excess blood in the heart chambers

Question Eight
Achalasia Cardia
It is diagnosed by use of Barium swallow or Barium meal.
It’s a deformity of the stomach
Is a condition associated with diffective peristalisis of the oesophagus
It’s a condition associated with heart disease

Question Nine
Hematemesis can be associated with the following
Oesophageal varicles
Colonic tumours
Septic ulcer disease
Oesophagial carcinoma
Late complication of liver cirrhosis

Question Ten
The following are common causes of intestinal obstruction in elderly patients.
Lignoid vulvulus
Intestinal intersusception
Tapeworm
Parambilical hernia
Ascariasis

Question Eleven
Gloria was involved in fight and she sustained a blunt object injury in her abdomen. She was symptomless for the first 3 days but later presented with abdominal distention and severe Anaemia.
She had sustained an hepatic rapture
She had sustained renal injury
She had raptured the Mesenteric Vessels
She had sustained intracapsular splenic rapture
She had perforated stomach

Question Twelve
Parthe’s disease
Is associated with, Rheumatoid arthritis
Is associated with slipped tibial epiphysis
Is associated with prolapsed of interventibral disc
Is associated with slipped epiphysis of femoral head
Is secondary to an infection.

Question Thirteen
Rheumatoid arthritis is
Its always associated with positive Rheumatoid test
Is successfully managed by monthly Benzathine penicillin
Is an autoimmune disease
Is associated with injury at the joint
Is associated with bacterial infection of the joint.

Question Fourteen
A patient with facial burns second degree 4% of the total body surface area. The following are true of his management.
He can be managed in level three (3) health facility.
Skin craft should be considered
Can be treated from home
Respiratory system injuries are a possibility
Should be admitted

Question Fifteen
Colles fracture
Is a fracture of the tibial tuberosity
Is a fracture of the femor
Is a fracture of distal end of the ulna
Is a fracture of the phalage of the upper limb
Is a fracture of the distal end of radius.

Question Sixteen
Which of the following is a surgical emergency?
Constipation
Intestinal obstruction due to intestinal intussuception
Hemolytic Jaundice
Intestinal obstruction due to ascariasis in a child
Acute appendicitis

Question Seventeen
Hypospadia
Is a deformity corrected by surgical intervention only
Is a deformity created by a surgeon while operating
Is a deformity corrected using chemotherapy
Is a condition associated with ureteric deformity
Is a condition associated with urethral deformity

Question Eighteen
Jane who is eighteen years old sustained supracondylar fracture humerous. What are the possible types of fracture found in the fracture site on an X-ray;
Transverse fracture
Greenstick fracture
Spiral fracture
Fracture with dis-location
Compound fracture

Question Nineteen
Gouty Arthritis is
Is the adult presentation of Juvenile Rheumatoid Arthritis.
None of the above is true
It is an autoimmune joint disease
It is associated with diposition of uric crystals in the joints synorium.
Associated with infection of the joints.

Question Twenty
Breast tumours are best diagnosed by;
Excisional Biopsy
Fine needle Biopsy
Ultrasound examination
Mammography
Plain X-ray

Question Twenty One
The following are some of the causes of surgical jaundice
Hepatoma
Tumours of the head of pancrease
Bile stones
Pancreatitis
Cholecystitis

Question Twenty Two
Carcinoma of the Oesophagus is associated with
Presenting with hoarse voice
Is associated with dysphagia
Vomiting after ingesting foods in the early stages
Inability to swallow solids in the primary stages
Lifestyle of the patient.

Question Twenty Three
Peritonitis
Should always be managed as a surgical emergency
May complicate and close abdominal trauma
It is diagnosed by displaying of rebound tenderness
It is always associated with an infective agent.
It is an inflammation of the peritonieum

Question Twenty Four
Tension pneumothorax
Is managed by aspiration of air in the thoracic cavity using a vacuum pump.
Is managed by aspiration of the air in the thoracic cavity using a syringe
Originates from perforating injury to the lund
Is treated with test tube under water seal

Question Twenty Five
The fracture femour mid-shaft in 40 year old patient managed by open reduction internal fixation (ORIE). The following can be used;
Bone graft
Prosthetic femour
K-nail
Screw and wire
Plate and screws

Question Twenty Six
Spina bifida occulta
Can present with only a taft hair at the site of the lesion
Leakage of the spinal fluid through the lesion
Is a apotrudion of the durameter
Is a protrusion of the spinal cord
All the above is true.

Question Twenty Seven
Concerning otitis media with effusion
It is as a result of negative pressure in the inner ear.
Typanostomy tubes (grommet) reduces recurrence
Causes conductive hearing loss
Adenoid hypertrophy is a cause
Treatment is with penicillin only

Question Twenty Eight
True or False concerning bells palsy
May present with hyperacusi’s
Loss of taste sensation in the anterior 2/3 of the tongue is a feature
Bell’s palsy is a diagnosis of exclusion
Bell’s palsy is a dysfunction of cranial verve VIII
Corticosteroids such as prednisolone improve recovery of bells palsy.

Question Twenty Nine
The following are possible causes of Epistaxis
Low immunity status
Bleeding disorder
Leukemia
Deviated nasal septum
Hypertension

Question Thirty
The following are criteria for admitting a patient with closed head injury.
History of diplopia
History of hemi paresis or peripheral paresis
Vomiting after the injury
History of loss of consciousness
Headache which is increasing in intensity.

Surgery Paper Ii (Dicm 333) Question Paper

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