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L3 (1ST BMEX) > SURG 2 > Flashcards

SURG 2 Flashcards

1
Q

Which of the following is a possible complication of endoscopy?

A. Perforation
B. Weight loss
C. Increased red blood cells
D. Muscle spasm

A

A. Perforation

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2
Q

Which of the following is NOT a complication associated with pneumoperitoneum?

A. Hyperthermia
B. Acidosis
C. Cardiac arrhythmia
D. Gas embolism

A

A. Hyperthermia

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3
Q

Which of the following statements regarding pneumoperitoneum are TRUE?

A. A Tuohy needle can be used to achieve access to the peritoneal cavity
B. The usual intraperitoneal pressure maintained during surgery is 25 mmHg
C. The temperature of the gas used is maintained at normal body temperature
Should be maintained at 200C to achieve pneumoperitoneum
D. The gases used for the pneumoperitoneum have high water content

A

A. A Tuohy needle can be used to achieve access to the peritoneal cavity

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4
Q

Which of the following statements are true in relation to the risks of electrosurgery in laparoscopic surgery?

A. The majority occur following the use of monopolar diathermy
B. This is determined late
C. The electrical injuries are usually recognized at the time of occurrence
D. The injuries are usually minor

A

B. This is determined late

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5
Q

A 64-year-old male who had underwent laparoscopic resection of his colonic cancer presents with a lump on his abdominal wall over one of the port scars. The lump is hard and painless. There is no cough impulse, and it was not reducible. What could be the cause of this lump?

A. Port site bleeding
B. Port site hernia
C. Port site recurrence
D. Deep vein thrombosis

A

C. Port site recurrence

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6
Q

A 36-year-old female who underwent laparoscopic cholecystectomy 2 days ago was brought to the ER complaining of increasing abdominal pain and distention. On examination, she is very unwell, and abdomen shows signs of peritonitis. What is the possible problem?

A. Port site recurrence
B. Deep vein thrombosis
C. Major vessel injury
D. Bowel perforation

A

D. Bowel perforation

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7
Q

A 37-year-old female had an uneventful diagnostic laparoscopy 4 hours previously. The nurses observe that the dressings are getting soaked with blood despite repeated changing. She is tachycardic but is otherwise okay. Her abdomen is soft and nontender. What is the possible complication?

A. Port site bleeding
B. Port site recurrence
C. Port site herniation
D. Deep vein thrombosis

A

A. Port site bleeding

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8
Q

A 37-year-old female had an uneventful diagnostic laparoscopy 4 hours previously. The nurses observe that the dressings are getting soaked with blood despite repeated changing. She is tachycardic but is otherwise okay. Her abdomen is soft and nontender. What is the possible complication?

A. Port site bleeding
B. Port site recurrence
C. Port site herniation
D. Deep vein thrombosis

A

A. Port site bleeding

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9
Q

A 40-year-old female who underwent a laparoscopic cholecystectomy the previous day complains of pain over her right shoulder. She is otherwise stable, and her abdomen is soft and nontender.

A. Deep vein thrombosis
B. Referred pain
C. Major vessel injury
D. Bowel perforation

A

B. Referred pain

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10
Q

A 55-year-old male underwent laparoscopic cholecystectomy that presents with slowly increasing lump over the substernal scar. This gets prominent with sitting and coughing. It is causing him local discomfort. Clinical examination reveals 2-cm lump over the area. It is reducible and has a cough impulse. What is the problem?

A. Port site bleeding
B. Port site hernia
C. Port site recurrence
D. Deep vein thrombosis

A

B. Port site hernia

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11
Q

A 70-year-old obese female who had a laparoscopic cholecystectomy a week ago is readmitted with chest pain and shortness of breath. A CT pulmonary angiogram confirms the diagnosis.

A. Port site bleeding
B. Port site hernia
C. Port site recurrence
D. Deep vein thrombosis

A

D. Deep vein thrombosis

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12
Q

A 30-year-old slim female was scheduled to have a diagnostic laparoscopy for unexpected pelvic pain. The vital signs collapsed after introduction of the trocar and the laparoscopist could not visualize any structures in the peritoneal cavity as the view had a “red-out”. The abdomen became distended.

A. Deep vein thrombosis
B. Referred pain
C. Major vessel injury
D. Bowel perforation

A

C. Major vessel injury

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13
Q

What is the contraindication for laparoscopic cholecystectomy for cholecystolithiasis?

A. Patient cannot tolerate treatment
B. More than one stone
C. Liver is inflamed
D. Gallbladder is inflamed

A

C. Liver is inflamed

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14
Q

With minimally invasive surgery, which of the following statements is FALSE?

A. Light cable is the fiberoptic cable that transmits light from the source to the endoscopic treatment. Sometimes called a light guide.
B. In video-assisted endoscopy, the cable that transmits digital data from the camera head to the camera control unit and digital data from the image system, camera control unit, and from the monitor to the output recorder is the video cable.
C. A channel that extends the full length of a flexible endoscope and receives instruments during flexible endoscopy is called an Elevator channel.
D. A term meaning “inside the body” in minimally invasive surgery refers to a suturing technique in which sutures are knotted and secured inside the body. This called intracorporeal.

A

C. A channel that extends the full length of a flexible endoscope and receives instruments during flexible endoscopy is called an Elevator channel.

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15
Q

An abdomen is insufflated or distended with carbon dioxide gas during this laparoscopy

A. Thoracoscopy Endoscopy of the thorax
B. Arthroscopy Endoscopy of the joint
C. Stereoscopic viewer
D. Pneumoperitoneum

A

D. Pneumoperitoneum

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16
Q

What device regulates the flow and amount of carbon dioxide gas during insufflation?

A. Insufflation unit
B. Capacitor
C. Balloon dissector
D. Resectoscope

A

A. Insufflation unit

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17
Q

Which of the following statements is true?

A. During a video-assisted surgery, the digital output recorder transmits digital data from the camera head to the camera control unit or CCU.
B. A procedure for adjusting the light color of the video camera to other components of the system is referred to as white balance.
C. Surgery performed through a small incision using telescope instruments is referred to as auxiliary water channel.
D. An abdomen insufflated or distended with carbon dioxide gas during laparoscopy is referred to as surgeon’s console.

A

B. A procedure for adjusting the light color of the video camera to other components of the system is referred to as white balance.

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18
Q

The following are absolute contraindications to laparoscopic surgery, except?

A. Bleeding disorders
B. Inability to tolerate general anesthesia
C. Lack of proper equipment
D. Young surgeon

A

D. Young surgeon

19
Q

Which of the following is a complication associated with creating a pneumoperitoneum?

A. Hematoma
B. Abdominal wall hernia
C. Gas dissection into the thoracic cavity
D. Omental tears

A

A. Hematoma

20
Q

The following are basic instruments in laparoscopic surgery except

A. Optical instrument such as video camera unit
B. Access device such as gas insufflators
C. Operating device such as graspers
D. Electronic source such as electrocautery machine

A

B. Access device such as gas insufflators

21
Q

What is the endoscopic treatment for achalasia injected at the lower esophageal sphincter?

A. Calcium channel blockers
B. Nitrates
C. Botulinum toxin
D. Muscle relaxants

A

C. Botulinum toxin

22
Q

What is the endoscopic management for high-risk dysphagia in Barrett’s esophagus?

A. Surveillance endoscopic biopsy every 12 months until the cancer is detected
B. Endoscopic ablation
C. Endoscopic esophagectomy
D. Open surgical operation

A

B. Endoscopic ablation

23
Q

What is an endoclot?

A. It is a polysaccharide hemostatic system
B. RBCs and coagulation proteins attract the clot
C. The rapid formation of the hemostatic later is due to the action of the endoclot on the platelets
D. It absorbs and coagulates concentrating plate

A

A. It is a polysaccharide hemostatic system

24
Q

What is “bear claw”?

A. Endoscopic device that acts like a variceal banding device
B. Dissecting device that frees the varix from the esophageal wall
C. It has sharp claws that closes over and coagulate the varix
D. It is an endoscopic device that deploy chemical coagulants

A

A. Endoscopic device that acts like a variceal banding device

25
Q

What is true about Danis stent?

A. It is a metal mesh inserted endoscopically into the lower esophagus for the treatment of esophageal varices
B. Radiologic guidance is needed for insertion
C. Can remain in situ for up to 6 months
D. The Sengstaken Blakemore tube continues to be more superior over Danis stent in terms of control of bleeding

A

A. It is a metal mesh inserted endoscopically into the lower esophagus for the treatment of esophageal varices

26
Q

When should a repeat colonoscopy be performed based on prior biopsy?

A. Age 40+ or 10 years before family member’s colon cancer diagnosis
B. Hyperplastic polyp: in 10 years
C. 1-2 small (<1cm) tubular adenoma without high- grade dysplasia: in 10 years

A

B. Hyperplastic polyp: in 10 years

27
Q

Which of the following is a physiologic systemic effect of CO2 pneumoperitoneum?
A. Pain
B. Elevated diaphragm
C. Myocardial stress
D. Vagal response

A

C. Myocardial stress

28
Q

During laparoscopy, excessive pressure on inferior vena cava cause decreased venous return and cardiac output. Which of the following is the most common arrhythmia in laparoscopy?

A. Sinus bradycardia
B. Sinus tachycardia
C. Atrial fibrillation
D. Premature ventricular contraction

A

A. Sinus bradycardia

29
Q

Local physiologic effects of CO2 pneumoperitoneum

A. Hypercarbia
B. Acidosis
C. Altered venous return
D. Increased catecholamines

A

C. Altered venous return

30
Q

What is the appropriate treatment in a patient with decreased urine output 1 hour after laparoscopic procedure?

A. Give IV loop diuretic
B. Correct serum electrolytes
C. Fast drip IV fluid
D. None of the above

A

D. None of the above

31
Q

In performing laparoscopy, the following should be done or given to prevent deep vein thrombosis, except:

A. compression stockings
B. systemic clopidogrel
C. subcutaneous heparin
D. low molecular weight heparin

A

B. systemic clopidogrel

32
Q

Which of the following is/are considered as an adverse physiologic effect/s of CO2 pneumoperitoneum?

A. Lesser diaphragmatic excursion
B. Irreversible acute oliguria
C. Lesser immunosuppression
D. Direct implantation of neoplastic cells

A

A. Lesser diaphragmatic excursion

33
Q

Which of the following is true about pneumoperitoneum during laparoscopy?

A. Retained pneumoperitoneum rarely causes shoulder pain post-operatively
B. Has a tamponade effect thus stop bleeding at port site
C. Pressure should be maintained at the highest possible level to have an adequate working space
D. Retained smoke admixed with pneumoperitoneum is known to cause cardiac arrhythmia

A

D. Retained smoke admixed with pneumoperitoneum is known to cause cardiac arrhythmia

34
Q

Which of the following is ergonomically acceptable when doing laparoscopic surgery?

A. Surgeon’s arm should be abducted while the shoulders be internally rotated
B. Finger-to-ring grasp
C. Monitor 25 degrees above the patient
D. Foot dorsiflex

A

A. Surgeon’s arm should be abducted while the shoulders be internally rotated

35
Q

After the initial working port is inserted in a patient with a previous midline laparotomy scar, subsequent ports can be guided by which of the following

A. Anatomy
B. Concurrent surgery
C. Surgeon’s preference
D. All of the above

A

D. All of the above

36
Q

Which of the following patients is diagnostic laparoscopy appropriate?

A. A 30-year-old female with colonic adenocarcinoma with poorly differentiated histopathology and liver metastasis.
B. A 50-year-old known male with a solitary stab wound on the RUQ who came in with stable vital signs. He has undergone CABG 2 months ago.
C. A 26-year-old sexually active female with RLQ tenderness.
D. An 18-year-old pregnant patient who came in due to acute abdominal pain. Patient has hypotension, tachycardia, markedly pale.

A

C. A 26-year-old sexually active female with RLQ tenderness.

37
Q

Which of the following principles is TRUE?

A. Solid-organ injury is better assessed with diagnostic laparoscopy than CT imaging
B. Abdominal exploration should always start underneath the initial trocar site
C. In bowel exploration, always start at the ligament of Treitz going distally
D. A and C only

A

A. Solid-organ injury is better assessed with diagnostic laparoscopy than CT imaging

38
Q

Which of the following is TRUE regarding laparoscopy in pregnant women

A. Gravid patients are put in a left lateral decubitus position
B. Symptomatic gallstones should be immediately treated laparoscopically
C. Prophylactic administration of tocolytics in all pregnant women prior to laparoscopy
D. A and C only

A

A. Gravid patients are put in a left lateral decubitus position

39
Q

I In cases of difficult dissection in achieving the critical view of safety during laparoscopic cholecystectomy, what should be done?

A. Re-explore Calot’s triangle closer to the infundibulum
B. Dome-down technique
C. Consider subtotal cholecystectomy
D. Convert to open

A

D. Convert to open

40
Q

A 40-year-old male was brought in the ER due to a solitary stab wound in the LUQ. His initial examination’s vital signs are:
 BP: 110/70
 RR:20
 HR:95
 Clear and equal breath sounds
 Equivocal abdomen
Patient was subjected for diagnostic laparoscopy. Intraoperatively, patient suddenly developed desaturation and hypotension. What is your primary impression?

A. Malignant hyperthermia
B. Massive hemothorax
C. Cardiac tamponade
D. Tension pneumothorax

A

D. Tension pneumothorax

41
Q

Which of the following are true regarding the safety of pregnant women in a laparoscopic procedure?

A. It must be done during the second trimester if possible
B. Woman must be positioned in the left lateral decubitus position
C. Open (Hasson) approach should be used
D. All of the above

A

D. All of the above

42
Q

Which of the following are true regarding pediatric laparoscopy, except?

A. Laparoscopy in infant and young children requires specialized instrument
B. A pneumoperitoneum pressure of 20 mmHg provides adequate exposure
C. 5-mm telescope provides sufficient illumination in most operations
D. Most of the instruments are smaller and most are 3 mm in diameter

A

B. A pneumoperitoneum pressure of 20 mmHg provides adequate exposure

43
Q

Which of the following is an advantage of computer-enhanced surgery than a traditional laparoscopic surgery?

A. There will be tremor elimination
B. Ergonomic workstation with 3D imaging
C. Natural wrist movement and improved manual dexterity
D. All of the above

A

D. All of the above

44
Q

The following are true in performing laparoscopic surgery in elderly and infirm, except?

A. Operations on these patients require close monitoring
B. Late mobility should be allowed for a laparoscopic surgery to be safe
C. Advantage of the minimally invasive surgery is the result after the operation
D. Most of the morbidity of the elderly is impaired mobility

A

B. Late mobility should be allowed for a laparoscopic surgery to be safe

L3 (1ST BMEX) (18 decks)

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