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1

Designates symptoms and signs of intra-abdominal disease, usually treated best by

a. Acute Appendicitis

c. Acute Abdomen

b. Acute Pain

d. Abdominal Pain

c. Acute Abdomen

2

The primitive gut divides into foregut, midgut and hindgut at this time of fetal development.

a. After 3rd week

c. before 3rd week

b. After 4th week

d. before 10th week

a. After 3rd week

3

The blood supply to the midget.

a. Celiac Artery

c. Inferior Mesenteric

b. Superior mesenteric

d. Portal vein

b. Superior mesenteric

4

This pain is perceived at a site distant from the source of stimulus.

a. Referred pain
c. ulceral pain
b. Somatic pain
d. parental pain

a. Referred pain

5

5. The focal issue in the evaluation of the patient suspected of having an acute abdomen.

a. Anorexia
c. Fever
b. Vomiting
d. Pain

d. Pain

6

Steps in physical examination for acute abdomen.

a. Inspection, Auscultation, Palpation

b. Palpation, Inspection, Auscultation

c. Auscultation, Palpation, Inspection

d. Inspection, Palpation, Auscultation

a. Inspection, Auscultation, Palpation

7

7. The sign is positive when pressure applied to the left lower quadrant results in right lower quadrant pain or tenderness.

a. Murphy’s sign
c. Rovsing’s sign
b. Obturator sign
d. Psoas sign

c. Rovsing’s sign

8

8. During inspiration the inflamed gallbladder touches blue examiners fingers resulting in the sudden
cessation of inspiration.

a. Murphy’s sign
c. Rovsing’s sign
b. Obturator sign
d. Psoas sign

a. Murphy’s sign

9

The most important and useful steps on the evaluation of patients with abdominal pain.

a. Ultrasound and Abdominal X-Rays

b. CT Scan and Ultrasound

c. History and Physical Examination

d. Physical Examination and CT Scan

c. History and Physical Examination

10

10. The preferred treatment for the acute appendicitis is:

a. Observation and bowel rest
b. Antibiotics and Observation
c. Pain Relievers
d. Appendectomy

d. Appendectomy

11

The normal frequency of bowel sounds

a. 5 to 10/minute
c. 10 to 20/minute
b. 5 to 34/minute
d.30 to 50/minute

b. 5 to 34/minute

12

12. Acute Appendicitis is most commonly associated with which of the following signs and symptoms.

a. White blood cell count greater than 20,000 per cm. mm.

b. Frequent loose stools

c. Temperature above 40o C

d. Anorexia, abdominal pain and right lower quadrant tenderness


d. Anorexia, abdominal pain and right lower quadrant tenderness

13

13. During the abdominal evaluation of abdominal pain, which of the following characteristics of pain is/are important to elicit?

a. Character
c. Duration
b. Severity
d. All of the above

d. All of the above

14

14. The most reliable physical findings associated with acute appendicitis?

a. Cutaneous hyperesthesia
c. Tenderness on rectal exam
b. Psoas sign
d. Localized right lower quadrant tenderness

d. Localized right lower quadrant tenderness

15

15. Which is not true regarding acute appendicitis

a. Anorexia is usually present

b. Pain often begins in the epigastric upper umbilical area

c. Pnsto[atopm pr diarrhea may occur

d. Vomitting usually precedes pain

d. Vomitting usually precedes pain

16

16. A 23 year old woman presents to the ER at midpoint of her menstrual cycle with right lower quadrant abdominal pain and tenderness, fever at 39 o C, mild draw heat two episodes of vomiting. The white blood cell count is 12,500/mm3. Which of the following is the most likely diagnosis?

a. Acute gastroenteritis
c. Pelvic inflammatory
b. Acute appendicitis
d. Ectopic pregnancy

b. Acute appendicitis

17

17. What is the appropriate course of action for the patient in the preceding question?

a. Hydration
c. Antibiotics and O
b. Appendectomy
d. Pain relievers

b. Appendectomy

18

18. During evaluation of a male patient with right lower quadrant pain the following are included in the
differential diagnosis.

a. Acute mesenteric Adenitis, Gastroenteritis and acute appendicitis

b. Acute appendicitis, ovarian cyst, acute appendicitis

c. Gastroenteritis, ovarian cyst, acute appendicitis

d. Acute mesenteric adenitis, torso of the fallopian tube, acute appendicitis

a. Acute mesenteric Adenitis, Gastroenteritis and acute appendicitis

19

19. Patients presenting with abdominal pain and free intra-abdominal gas seen on radiograph warrant ________________________ with limited exceptions.

a. Operation (lapanotory in lapanoscopy)

b. Observation and further study

c. Observation only

d. Repeat abdominal x-rays


a. Operation (lapanotory in lapanoscopy)

20

20. A point 1 1⁄2 - 2 inches from the anterior spinous process of the of the ilium on a line drawn to the umbilicus.

a. Semmis Point
c. Mc Arthurs point
b. Mc Burney’s Point
d. Fitz Point

b. Mc Burney’s Point

21

21. For a normal healthy adult individual consuming a normal diet, which of the following energy sources is the most abundant?

a. Fat
c. Water
b. Carbohydrate
d. Protein

b. Carbohydrate

22

22. Who among the following patients will greatly benefit in perioperative nutritional support?

a. Patient for breast surgery

b. Patient with 60% total body surface area burn

c. Patient for hernia surgery

d. Patient for thyroidectomy

e. none of the above

b. Patient with 60% total body surface area burn

23

23. Which of the following statement most accurately describe muscle glycogen?

a. Muscle glycogen is a significant contributor to plasma glucose level maintenance.

b. Muscle glycogen remains within the muscle because muscle tissue lacks glucose 6 phosphatase.

c. Muscle glycogen levels can exceed 120g in a 70kg adult individual.

d. Glucagon mobilizes muscle glycogen to allow for use by the liver.

e. None of the above

b. Muscle glycogen remains within the muscle because muscle tissue lacks glucose 6 phosphatase.

24

24. Which of the following statement is true regarding hormonal regulation of the blood glucose level?

a. An increased glucagons/insulin ratio allows mobilization of liver glycogen.

b. An increased circulating insulin level with glucose intake allows increase glucagon secretion.

c. Insulin allows tissues, such as liver, muscle and adipose tissue to release glucose

d. All of the above

a. An increased glucagons/insulin ratio allows mobilization of liver glycogen.

25

25. What is the dietary protein recommendation for a 60 kg man with adequate protein stores?

a. 0.8-1.0 g/kg/day

c. 4-5g/kg/day

b. 2-3g/kg/day

d. 6-7g/kg/day

a. 0.8-1.0 g/kg/day

26

To prevent gluconeogenesis, glucose administration must be carefully monitored. The protein-sparing effect of glucose administration begins to be manifested after administration of how much glucose?

a. 75 g
d. 200 g
b. 100 g
e. 300 g
c. 150 g

b. 100 g

27

27. Which of the following is true regarding vitamins is true?

a. These are produced in the body and do not require exogenous supplies.

b. These are a source of energy.

c. All are water soluble and can be eliminated easily from the body if excesses are consumed.

d. Some are necessary for the release of energy from carbohydrate, fat, and protein.

d. Some are necessary for the release of energy from carbohydrate, fat, and protein.

28

28. Blood tests to determine the status of which of the following visceral proteins yield results in 1-2 days?

a. Albumin
c. Thyroxine-binding pre-albumin
b. Retinol-binding protein
d. Transferrin

c. Thyroxine-binding pre-albumin

29

29. When evaluating a patient’s nutritional status, which of the following indicate
declining nutritional status?

a. Serum albumin level of 2.0 g/dl.

b. Indirect calorimetric studies indicate the patient requires 1600 kcal/day, and the patient has been consuming
1600-1800kcal/day.

c. Patient has not met the tube feeding rate of 1500ml/day for 1 week due to nausea and vomiting.

d. A and C
e. All of the above


d. A and C

a. Serum albumin level of 2.0 g/dl.

c. Patient has not met the tube feeding rate of 1500ml/day for 1 week due to nausea and vomiting.

30

30. A patient has gained 4 pounds after the third day from surgery. What is the most likely cause of weight increase?

a. Poor eating habits established before admission to the hospital.

b. Increase in dietary intake over the past 3 days that exceeds nutritional requirements.
c. Consumption of high –calorie beverages on a liquid diet.
d. Fluid retention
e. None of the above

b. Increase in dietary intake over the past 3 days that exceeds nutritional requirements.

31

32. Which of the following is a contraindication for enteral nutrition support?

a. Poor oral intake
c. Bowel obstruction
b. Recent surgery
d. Weight loss

c. Bowel obstruction

32

33. Which condition contraindicates using enteral feedings?

a. Head trauma
c. Recent surgery
b. Cachexia
d. High output enteric fistula

d. High output enteric fistula

33

31. Which of the following would be the likely calorie recommendation for a postsurgical patient weighing 72 kilograms neither obese nor a burn patient?

a. 1250- 1450 kcal
c. 1500- 2225 kcal
b. 1375- 2100 kcal
d. 1820- 2545 kcal

d. 1820- 2545 kcal

34

34. How many calories are provided in one 500-ml bottle of 10% intravenous fat solutions?

a. 150 kcal
c. 450 kcal
b. 200 kcal
d. 500 kcal

c. 450 kcal

35

35. Which of the following statement/s are true regarding nutrition?

a. The main goal is to prevent or reverse the catabolic effects of disease or injury

b. Patients for whom nutritional support is not essential for life but may serve to shorten the post operative
recovery phase & minimize the number of complication

c. Patient may become ill or may die secondary to starvation rather than the underlying disorder.

d. Meet substrate requirements for protein synthesis.

e. All of the above


e. All of the above

36

36. The following statements are true regarding the adrenergic-corticoid phase of injury EXCEPT?

a. ↑ glucose turnover

c. Alteration in rates of gluconeogenesis, acute phase protein production & immune cell activity

b. ↑proinflammatory mediators

d. (+) nitrogen balance – synthesis of proteins e. B and D

d. (+) nitrogen balance – synthesis of proteins e. B and D

37

37. Which among the following conditions require the highest daily nutritional requirements?

a. Trauma
b. Burns
c. Hernia
d. Pancreatitis

b. Burns

38

38. What vitamin deficiency causes Beri-beri?

a. Vit B1
b. Vit C
c. Vit D
d. Vit E
e. Vit A

a. Vit B1

39

39. The following statements are true EXCEPT?

a. Healthy patients without malnutrition undergoing uncomplicated surgery can tolerate 10 days of partial starvation

b. Parenteral feeding reduces infection complications and acute phase protein production

c. Enteral feeding is the preferred route because of reduced cost and associated risks of intravenous routes

d. Combination of enteral and parenteral feeding is the preferred route for patients with short-bowel syndrome or clinical malabsorption.

b. Parenteral feeding reduces infection complications and acute phase protein production

40

40. The following conditions may require parenteral nutrition EXCEPT?

a. Surgical patients with prolonged paralytic ileus following major operations (>7 to 10 days).

b. Enterocutaneous fistulas with >500 mL/d.

c. Patients with granulomatous colitis, ulcerative colitis, and tuberculous enteritis, in which major portions of the absorptive mucosa are diseased.

d. Patients with normal bowel length but with malabsorption secondary to sprue, hypoproteinemia, enzyme or pancreatic insufficiency, regional enteritis, or ulcerative colitis.

b. Enterocutaneous fistulas with >500 mL/d.

41

41. A 36y/0 Male who weighs 50kg needs a balance caloric intake before an elective surgery. Compute for the daily fat energy requirement?

a. 520 kcal/ day
c. 260 kcal/day
b. 780 kcal/ day
d. 900 kcal/day

a. 520 kcal/ day

42

42. Which of the following statements is/are true?

a. There is no single nutritional formulation that is appropriate for all patients.

b. Degree of insult can affect protein synthesis

c. Late anabolic phase occurs from weeks to months after severe injury

d. a and c

e. all of the above

e. all of the above

43

43. The Harris –Benedict Formula is used to compute for the basal energy expenditure of a patient. Which of the following parameters is not needed for the computation?

a. Weight (kg)
d. Activity
b. Height (cm)
e. none of the above
c. Age (years)

d. Activity

44

44. In a patient with 60% TBSA burn how much kcal/day is needed to support his daily nutritional requirements?

a. 10
b. 20
c. 30
d. 40
e. 50

d. 40

45

45. What vitamin deficiency can cause pernicious anemia?

a. Vit A
b. Vit B12
c. Vit C
d. Vit D
e. Vit K

b. Vit B12

46

46. Which of the following statements is/ are true?

a. Enteral route is the preferred route for nutrition

b. Parenteral feeding only uses central venous line

c. Enteral route reduces mucosal atrophy

d. a and c

e. all of the above

d. a and c

a. Enteral route is the preferred route for nutrition

c. Enteral route reduces mucosal atrophy

47

47. Which of the following is NOT a factor in the choice of enteral formula?

a. extent of organ dysfunction
b. nutrient needs to restore optimal function and healing
c. cost of specific products
d. none of the above
e. all of the above

d. none of the above

48

48. This enteral formula contains predigested nutrients for ease of absorption especially for patients with gut impairment

a. Elemental formula
d. Calorie dense Formula
b. Low residue isotonic formula
e. High Protein Formula
c. Renal failure formula

a. Elemental formula

49

49. This enteral formula has a caloric density of 1.5 kcal/day?

a. Elemental formula
d. Calorie dense Formula
b. Low residue isotonic formula
e. High Protein Formula
c. Renal failure formula

d. Calorie dense Formula

50

50. What is the preferred access of enteral feeding of patient who is comatose?

a. Nasogastric tube
b. Gastrostomy tube
c. Jejunostomy tube
d. a and b
e. b and c

c. Jejunostomy tube

51

61. Surgery involving the jejunum is a

a. Clean wound
b. Clean contaminated wound
c. Contaminated wound
d. Dirty wound

b. Clean contaminated wound

52

62. Appendectomy in suppurative stage is a classified as

a. Clean wound
b. Clean contaminated wound
c. Contaminated wound
d. Dirty wound

c. Contaminated wound

53

62. Appendectomy in suppurative stage is a classified as

a. Clean wound
b. Clean contaminated wound
c. Contaminated wound
d. Dirty wound

c. Contaminated wound

54

3. Surgical removal of a perforated sigmoid is a

a. Clean wound
b. Clean contaminated wound
c. Contaminated wound
d. Dirty wound

d. Dirty wound

55

64. Thyroid gland surgery is a

a. Clean wound
b. Clean contaminated wound
c. Contaminated wound
d. Dirty wound

a. Clean wound

56

65. The type of wound in a patient with multiple deep abrasions and lacerations secondary to a vehicular accident.

a. Clean wound
c. Contaminated wound
b. Clean contaminated wound d. Dirty wound

d. Dirty wound

57

66. This is frequently seen in acne and usually begins in hair follicles

a. Furuncle
c. Hidradenitis suppurativa
b. Carbuncle
d.Cellulitis

a. Furuncle

58

67. The causative agent is usually gram positive cocci in clusters, EXCEPT:

a. Furuncle
c. Hidradenitis suppurativa
b. Carbuncle
d. Cellulitis

d. Cellulitis

59

68. The infection involves apocrine glands in axilla, inguinal and perineal regions

a. Furuncle
c. Hidradenitis suppurativa
b. Carbuncle
d. Cellulitis

c. Hidradenitis suppurativa

60

69. Multiple cutaneous abscesses that spread through the dermis into the subcutaneous region and are commonly seen in diabetic patients.

a. Furuncle
c. Hidradenitis suppurativa
b. Carbuncle
d. Cellulitis

b. Carbuncle

61

70. Inflammation of the dermal and subcutaneous tissues secondary to non suppurative bacterial invasion, producing redness , edema and localized tenderness.

a. Furuncle
b. Carbuncle
c. Hidradenitis suppurativa
d. Cellulitis

d. Cellulitis

62

71. Exotoxins play in the pathogenicity of

a. Clostridium species
b Staphlococcus aureus
c. Streptococccus pyogenes d. A and B
e. All of the above

e. All of the above

63

72. Endotoxins play in the pathogenicity of

a. Escherichia coli
b. Klebsiella
c. Salmonella
d. A and B
e. All of the above

e. All of the above

64

73. This organism has thick capsule making them resistant to phagocytosis

a. Salmonella typhi
b. Streptococcos pneumoniae c. Cryptococcus neoformans d. A and B
e. All of the above

e. All of the above

65

74. Macrophages are

a. Phagocytic cells
b. Kupffer cells in liver
c. Initiates immune response that can elaborate cytokines
d All of the above

d All of the above

66

75. Important in preventing microbial penetration in tissues

a. Cellular immunity
b. Humoral immunity
c. Epithelium
d. Coagulation system

c. Epithelium

67

76. Type of peritonitis managed by surgery

a. Primary peritonitis
b. Secondary peritonitis
c. Tertiary peritonitis
d. Peritonitis like syndrome

b. Secondary peritonitis

68

77. Most common nosocomial infection in the surgical service

a. Respiratory tract infection
b. Urinary tract infection
c. Wound infection
d. Cutaneous infection

b. Urinary tract infection

69

78. Principle of antibiotic prophylaxis, EXCEPT
a. Choose an antibiotic effective against the most likely pathogen
b. Administer a full therapeutic dose preoperatively
c. Give antibiotics for at least 48 hrs
d. Choose an antibiotic with low toxicity

c. Give antibiotics for at least 48 hrs

70

79. Agent of choice for bacteroides species

a. Penicillin
b. Metronidazole
c. Ciprofloxacin
d. Chloramphenicol

b. Metronidazole

71

80. Agent of choice for staphyloccus

a. Cloxacillin
b Erythromycin
c Clindamycin
d Amikacin

a. Cloxacillin