Surgery - homeopathy360
MCQ'S

Surgery

Q.1. Neurogenic ulcer is (MPPSC/MO/09):
a) Varicose ulcer
b) Post-thrombotic ulcer
c)Gravitational ulcer
d) Diabetic ulcer
Answer: (d)

Note: Out of above-given variables (d) Diabetic ulcer – is suggested choice.
Stem: Neurogenic ulcer

Recall
Neuropathic ulcers are related to the loss of protective sensation (LOPS) in the feet and legs as a result of a primary neurological condition, metabolic disease process (e.g., diabetes and/or renal failure), trauma, or surgery.
Characteristics neuropathic ulcers: These are usually painless unless an arterial component or infection is present. They have even, well-defined wound margins with or without undermining.
Ref: http://www.viha.ca/NR/rdonlyres/18FC0E44-7476-4D4E-8118-263EC684AF87/0/ Chapter7NeuropathicUlcers.pdf

Review of variables
(a) Varicose ulcer: Venous ulcers (venous insufficiency ulceration, stasis ulcers, stasis dermatitis, varicose ulcers, or ulcus cruris) are wounds that are thought to occur due to improper functioning of venous valves, usually of the legs. They are the major occurrence of chronic wounds, occurring in 70% to 90% of leg ulcer cases. Venous ulcers develop mostly along the medial distal leg and can be very painful.
Ref: http://en.wikipedia.org/wiki/Venous_ulcer
(b) Post-thrombotic ulcer: Post-thrombotic syndrome (PTS) is a problem that can develop in nearly half of all patients who experience a deep vein thrombosis (blood clot) in the leg. PTS symptoms include chronic leg pain, swelling, redness, and ulcers (sores).
Ref: http://circ.ahajournals.org/content/121/8/e217.full
(c) Gravitational: Gravitational ulcer is chronic ulcer of the leg with impaired healing due to the dependent position of the extremity and incompetence of the valves in the deep venous system of the leg and thigh; venous return stagnates and creates hypoxemia.
Ref: http://medical-dictionary.thefreedictionary.com/gravitational+ulcer Also refer: Varicose ulcer – as above-.
(d) Diabetic ulcer: The development of neurotrophic foot ulcers in patients with diabetes mellitus has several components, including neuropathy, biomechanical pressure, and vascular supply. Peripheral neuropathy is clearly the dominant factor in the pathogenesis of diabetic foot ulcers.
Ref: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/ prevention-treatment-diabetic-leg-and-foot-ulcers/



Q.2. Fever in Pyogenic Liver Abscess usually is (MPPSC/MO/09):
a) Intermittent type
b) Relapsing type
c) Hectic type
d) Continuous type
Answer: (c)

Note: Out of above-given variables (c) Hectic type is the suggested choice.
Stem: Fever in Pyogenic Liver Abscess

Recall
Pyogenic liver abscess is a type of liver abscess caused by bacteria. In such conditions fever is usually Hectic type.

Review of variables
(a) Intermittent type: Fever that persists for several hours and always touches the baseline between attacks is known as intermittent fever. It is of following three types:
1. Quotidian: it is characterized by paroxysm of fever that occurs daily (Daily rise and fall). This type of fever may be found in tuberculosis, UTI, Septicemia.
2. Tertian: it is characterized by paroxysm of fever that occurs on alternate days. This may be found in benign terrain malaria (due to plasmodium vivax, rarely P. ovale)
3. Quartan: it is characterized by paroxysm of fever that occurs with two days interval between consecutive attacks. This is encountered in quartan malaria due to Plasmodium malariae (rare).
Ref: Pg-33, Long cases in Clinical Medicine by ABM Abdullah
(b) Relapsing type: Relapsing fever is characterized by episodes of acute worsening with recovery and remains stable between relapses. Usually encountered in Malaria, Borreliosis and occasionally Hodgkin’s Lymphoma.
Ref: Pg-491, 34, Long cases in Clinical Medicine by ABM Abdullah
(c) Hectic type: Hectic fever is characterized by sudden rise of very high temperature usually associated with chill and rigor, persist for few hours and then fall with profuse sweating. This may be found if pus is anywhere in the body, e.g. lung abscess, pyogenic liver abscess, empyema thoracis, sub-phrenic abscess, empyema of gall bladder, perinephric abscess, etc.
Ref: Pg-34, Long cases in Clinical Medicine by ABM Abdullah
(d) Continuous type: When the fluctuation of fever is not > 1°C (1.5°F) and the fever does not touch the baseline it is called continued fever. This is found in typhoid, typhus, military tuberculosis, meningococcal meningitis, rheumatic fever, drug fever.
Ref: Pg-33, Long cases in Clinical Medicine by ABM Abdullah



Q.3. The rare form of hernia is (MPPSC/MO/09):
a) Inguinal
b) Obturator
c) Incisional
d) Umbilical
Answer: (b)

Note: Out of above given variables (b) Obturator hernia – is suggested choice.
Stem: Rare form of Hernia

Recall
Hernia is a general term used to describe a bulge or protrusion of an organ through the structure or muscle that usually contains it.
Ref: http://medical-dictionary.thefreedictionary.com/hernia

Rare external Hernias:
1. Perineal hernia
2. Obturator hernia
3. Gluteal and sciatic hernias
Ref: Pg-967,968; Bailey & Love’s Short Practice of Surgery; 26th Edition

Review of variables
(a) Inguinal: Inguinal hernia into the inguinal canal
(b) Obturator: Obturator hernia is the one protruding through the obturator foramen. It is considered as a rare type of hernia.
Ref: Pg-967,968; Bailey & Love’s Short Practice of Surgery; 26th Edition
(c) Incisional: Incisional hernia is the one through an old abdominal incision.
(d) Umbilical: Umbilical hernia an abdominal hernia with intestine inside the umbilicus and the body wall defect and protruding intestine covered by skin and subcutaneous tissue.



Q.4. Most common cause of hemothorax is? (AP/MD/HOMOEO/ENT/13-14):
a) Trauma
b) Iatrogenic injury
c) Pleural malignancy
d) Post-operative haemorrhage
Answer: (a)

Note: Out of above-given variables (a) Trauma – is suggested choice.
Stem: Hemothorax

Recall
Hemothorax is a collection of blood in the space between the chest wall and the lung (the pleural cavity).

Causes
The most common cause of hemothorax is chest trauma. It can also occur in patients who have:
Blood clotting defect
Chest (thoracic) or heart surgery
Death of lung tissue (pulmonary infarction
Lung or pleural cancer
Tear in a blood vessel when placing a central venous catheter
Tuberculosis
Ref: http://www.nlm.nih.gov/medlineplus/ency/article/000126.htm
Ref: http://www.nytimes.com/health/guides/disease/hemothorax/overview.html

Review of variables
(a) Trauma: The most common cause of hemothorax is chest trauma. Mechanism of trauma include; blunt, penetrating, blast, crush and thermal. The most common cause of blunt trauma is a motor vehicle accident (MVA).
(b) Iatrogenic injury: Tear in a blood vessel when placing a central venous catheter
Ref: http://www.nlm.nih.gov/medlineplus/ency/article/000126.htm
Ref: http://www.nytimes.com/health/guides/disease/hemothorax/overview.html
(c) Pleural malignancy: Lung or pleural cancer
Ref: http://www.nlm.nih.gov/medlineplus/ency/article/000126.htm
Ref: http://www.nytimes.com/health/guides/disease/hemothorax/overview.html
(d) Postoperative haemorrhage: Chest (thoracic) or heart surgery
Ref: http://www.nlm.nih.gov/medlineplus/ency/article/000126.htm
Ref: http://www.nytimes.com/health/guides/disease/hemothorax/overview.html



Q.5. Adynamic ileus may be seen in? (AP/MD/HOMOEO/ENT/13-14):
a) Bezoars
b) Annular pancreas
c) Peritonitis
d) Volvulus
Answer: (c)

Note: Out of above-given variables (c) Peritonitis – is suggested choice.
Stem: Peritonitis

Recall
It is an inflammation of the peritoneum. Peritonitis may be localized or generalized, and may result from infection (often due to rupture of a hollow abdominal organ as may occur in abdominal trauma or inflamed appendix) or from a non-infectious process.
Collateral manifestations include: Development of ileus paralyticus (i.e., intestinal paralysis), which also causes nausea, vomiting and bloating.
Ref: http://en.wikipedia.org/wiki/Peritonitis

Review of variables
(a) Bezoars: A bezoar is a tightly packed partially digested or undigested material that is unable to exit the stomach. It often occurs in patients with abnormal gastric emptying, especially those that have diabetic gastroparesis, as well as after gastric surgery. Many bezoars are asymptomatic, but some cause symptoms of gastric outlet obstruction. Some can be dissolved enzymatically, others removed endoscopically, and some require surgery.
Ref: bodies/bezoars.html
(b) Annular pancreas: Annular pancreas is a rare condition in which the second part of the duodenum surrounds the head of the pancreas. This part of pancreas can constrict the duodenum and impair the passage of food. It occurs in 1 out of 12,000 to 15,000 newborns. The ambiguity arises from the fact that not all cases are symptomatic.
Ref: http://en.wikipedia.org/wiki/Annular_pancreas
(c) Peritonitis: See as above
(d) Volvulus: A volvulus is a twisting or axial rotation of a portion of bowel about its mesentery. Depending on the location of the volvulus, symptoms may vary. In case of caecal volvulus, the predominant symptoms point to small bowel obstruction (nausea, vomiting and lack of stool or flatus), in patients with a sigmoid volvulus, although abdominal pain may be present, symptoms of constipation may be more prominent.
Ref: http://en.wikipedia.org/wiki/Volvulus



Q.6. The most common cause of Pancreatic ascitis is? (AP/MD/HOMOEO/ENT/13-14):
a) Pancreatic duct disruption
b) Acute pancreatitis
c) Chronic pancreatitis
d) Mucoviscidosis
Answer: (a)

Note: Out of above-given variables (a) Pancreatic duct disruption – is suggested choice
Stem: Pancreatitis

Recall
Pancreatic duct: A duct connecting the pancreas with the intestine. It runs from left to right through the body of the gland, passes out its neck, and empties into the duodenum either through an opening shared with the common bile duct or through one close to it—called also duct of Wirsung, Wirsung’s duct.
Ref: http://www.merriam-webster.com/dictionary/pancreatic%20duct

Pancreatic duct disruption: The causes of pancreatic duct disruption include acute pancreatitis, chronic pancreatitis, surgery, and trauma. Persistent disruption can result in fluid collections, ascites, or fistulas.
Ref: http://www.ajronline.org/doi/full/10.2214/AJR.04.1775

Pancreatic ascites: It can be defined as the persistent accumulation of “massive” amounts of intra-peritoneal fluid during the course of chronic pancreatitis which is characterized by a high amylase level and a high protein content. In most cases the ascites is serous in nature, but it may be sero-sanguinous, turbid or chylous.
Ref: link.springer.com/content/pdf/10.1007%2F978-3-642-75319-0_34.pdf

Review of variables
(a) Pancreatic duct disruption: See as above
(b) Acute pancreatitis: Sudden inflammation of the pancreas. The cause of acute pancreatitis is most often alcohol abuse or gallstones. Other causes include use of prescribed drugs, trauma or surgery to the abdomen, or abnormalities of the pancreas or intestine. In rare cases, the disease may result from infections, such as mumps. In about 1 case in 6 or 7, the cause is unknown.
Ref: http://www.medicinenet.com/script/main/art.asp?articlekey=16730
(c) Chronic pancreatitis: Chronic pancreatitis is commonly defined as a continuing, chronic, inflammatory process of the pancreas, characterized by irreversible morphologic changes.
Ref: http://emedicine.medscape.com/article/181554-overview
(d) Mucoviscidosis: Cystic fibrosis (CF), also known as mucoviscidosis, it is an autosomal recessive disorder which affects mostly the lungs but also the pancreas, liver, kidneys and intestine. Long-term complaints include thick mucous secretions causing difficulty in breathing and coughing and frequent lung infections. Other features include sinus infections, poor growth, fatty stool, clubbing of the finger and toes, and infertility in males.
Ref: ;



Q.7. The commonest site of a peripheral aneurysm is? (AP/MD/HOMOEO/ENT/13-14):
a) Femoral artery
b) Popliteal artery
c) Subclavian artery
d) Carotid artery
Answer: (b)

Note: Out of above-given variables (b) Popliteal artery – is suggested choice.
Stem: Peripheral Aneurism

Recall
Definition: Aneurysm is a permanent dilatation of a blood vessel due to congenital or acquired weakening of the vessel wall.
Ref: Pathology, Harsh Mohan

Type: Aneurysms can also be grouped according to their shape:
Fusiform
Saccular
Dissecting
Ref: Arterial disorder, Love and Bailey

Age: Mean age at presentation-65
Sex: Male:female ratio is-> 20:1.

Incidence: About-70%-are Popliteal aneurysms Two-thirds of them are bilateral. (Ref; Love and Bailey) About-20% account for ilio-femoral aneurysms

Cause:
-Atherosclerotic
-Traumatic
-Collagen disease; Marfan’s syndrome
-Mycotic: The term mycotic indicates infection as a causal element in the formation of the aneurysm, they are usually due to:
-Salmonellae,
-Staphylococci,
-Treponema pallidum (syphilitic aneurysm).
Ref: Arterial disorder, Love and Bailey

Clinical presentation: Peripheral arterial aneurysms are usually asymptomatic at the time of detection.

Course:
-Rupture; infrequent
-Thromboembolism.

Review of variables
(a) Femoral artery:-NA True aneurysm of the femoral artery is uncommon (Ref: Love and Bailey)
(b) Popliteal artery:–Yes- About-70%-are Popliteal aneurysms. Two-thirds of them are bilateral. (Ref: Love and Bailey)
(c) Subclavian artery: –NA- See as above
(d) Carotid artery: –NA- See as above



Q.8. Which of the following malignancies of the breast is often bilateral? (AP/MD/HOMOEO/ENT/13- 14):
a) Infiltrating duct carcinoma
b) Lobular carcinoma
c) Inflammatory carcinoma
d) Colloid carcinoma
Answer: (b)

Note: Out of above-given variables (b) Lobular carcinoma– is suggested choice.

Recall
Lobular carcinoma in situ is not a palpable or grossly visible tumour. Patients of in-situ lobular carcinoma treated with excisional biopsy alone develop invasive cancer of the ipsilateral breast in about 25% cases in
10 years as in intra-ductal carcinoma but, in addition, have a much higher incidence of developing a contra- lateral breast cancer (30%).
Ref: Pg-788, TB of Pathology by Harsh Mohan 5th Ed
Lobular Carcinoma: it is an incidental finding in a breast biopsy. It has no symptoms, and has no characteristic pattern on mammography. It has been found to occur in multiple sites in the same breast in 40 to 90% of cases. In 50% of the cases, it may also occur in the opposite breast.
Ref: http://www.medicinenet.com/script/main/art.asp?articlekey=21902&page=2

Review of variables
(a) Infiltrating duct carcinoma:
Infiltrating ductal carcinoma begins in ducts of the breast. It is the most common form of breast cancer, comprising about 65-85% of all cases.
On physical examination, this lump usually feels much harder or firmer than other benign causes of lumps in the breast.
Ref: http://www.medicinenet.com/script/main/art.asp?articlekey=21902&page=2
(b) Lobular carcinoma: See as above
(c) Inflammatory carcinoma: Inflammatory carcinoma of the breast is named for its typical clinical presentation. The breast becomes red, swollen, and warm, and the skin becomes quite thickened. The breast appears as if it were infected. The cancer has already spread to the lymph nodes in 90% of the cases at the time of diagnosis. The prognosis for this cancer is very poor, but it is relatively uncommon.
Ref: http://www.medicinenet.com/script/main/art.asp?articlekey=21902&page=2
(d) Colloid carcinoma: Mucinous carcinoma of the breast — sometimes called colloid carcinoma — is a rare form of invasive ductal carcinoma
It tends to affect post-menopausal women, the average age at diagnosis is in the 60s or early 70s. Though mucinous carcinoma is an invasive breast cancer, it tends to be a less aggressive and responds well to treatment. Mucinous carcinoma is less likely to spread to the lymph nodes than other types of breast cancer.
Ref: http://www.breastcancer.org/symptoms/types/mucinous/symptoms_diagnosis



Q.9. The commonest cause of esophageal perforation is? (AP/MD/HOMOEO/ENT/13-14):
a) Barotrauma
b) Foreign bodies
c) Iatrogenic
d) Penetrating injury to the chest
Answer: (c)

Note: Out of above-given variables (c) Iatrogenic– is suggested choice.
Stem: Esophageal perforation

Recall
Perforation of the oesophagus is usually iatrogenic (at therapeutic endoscopy) or due to ‘barotrauma’ (spontaneous perforation). Many instrumental perforations can be managed conservatively, but spontaneous perforation is often a life-threatening condition that regularly requires surgical intervention.
Ref: Pg-991, Bailey and Love’s Short Practice of Surgery 26th Ed.

Iatrogenic-e.g. post instrumentation or post thoracic surgery is most common cause of esophageal perforation (most common-80% of cases).
Ref: http://radiopaedia.org/articles/oesophageal-perforation

Esophageal rupture 56% of esophageal perforations are iatrogenic, usually due to medical instrumentation such as an endoscopy or paraesophageal surgery.
Ref: http://en.wikipedia.org/wiki/Boerhaave_syndrome

Review of variables
(a) Barotrauma:
Spontaneous perforation, Boerhaave syndrome: This occurs classically when a person vomits against a closed glottis. The pressure in the oesophagus increases rapidly, and the oesophagus bursts at its weakest point in the lower third, sending a stream of material into the mediastinum and often the pleural cavity as well.
The condition was first reported by Boerhaave, who reported the case of a grand admiral of the Dutch fleet who was a glutton and practised auto-emesis.
Boerhaave syndrome is the most serious type of perforation because of the large volume of material that is released under pressure. This causes rapid chemical irritation in the mediastinum and pleura followed by infection if untreated. Barotrauma has also been described in relation to other pressure events when the patient strains against a closed glottis (e.g. defaecation, labour, weight lifting).
Ref: Pg-992, Bailey and Love’s Short Practice of Surgery 26th Ed
(b) Foreign bodies: The oesophagus may be perforated during removal of a foreign body but, occasionally, an object that has been left in the oesophagus for several days will erode through the wall.
Ref: Pg-993, Bailey and Love’s Short Practice of Surgery 26th Ed
Swallowing a foreign object or caustic chemicals, such as household cleaners, disk batteries, and battery acid.
Ref: http://www.nlm.nih.gov/medlineplus/ency/article/000231.htm
(c) Iatrogenic: See as above
(d) Penetrating injury to the chest: Perforation by knives and bullets is uncommon, even in war, as the oesophagus is a relatively small target surrounded by other vital organs.
Ref: Pg-993, Bailey and Love’s Short Practice of Surgery 26th Ed
Trauma-blunt (crush-type injury) and penetrating-occurs in <0.1% of blunt chest trauma.
Ref: http://radiopaedia.org/articles/oesophageal-perforation



Q.10. Which one of the following is TRUE regarding Warthin tumour? (AP/MD/HOMOEO/ENT/13- 14):
a) It is the second most common benign tumor of parotid gland
b) About 50% are bilateral
c) It is a malignant tumor
d) Occurs in young individuals
Answer: (a)

Note: Out of above-given variables (a) It is the second most common benign tumour of parotid gland – is suggested choice.
Stem: Warthin’s tumour

Recall
A Warthin tumour (or papillary cystadenoma lymphomatosum) is a benign sharply demarcated tumour of the parotid gland. It is bilateral in 10-15% of cases.
Epidemiology: it is the 2nd most common (upto 10% of all parotid tumours) benign parotid tumour (after pleomorphic adenoma / mixed tumor).
Ref: Pg-352, Essential Pathology for Dental Students by Harsh Mohan Ref: http://radiopaedia.org/articles/warthin-tumour
Sex: Male predilection.
Presentation: Painless parotid swelling.
Ref: http://radiopaedia.org/articles/warthin-tumour

Review of variables
(a) It is the second most common benign tumor of parotid gland:-True- See as above
(b) About 50% are bilateral:-False- Commonest bilateral or multifocal benign parotid tumour.
Ref: http://radiopaedia.org/articles/warthin-tumour
(c) It is a malignant tumor:-False- It is a benign tumor of parotid gland (see as above)
Ref: Pg-353, Essential Pathology for Dental Students by Harsh Mohan
Ref: http://radiopaedia.org/articles/warthin-tumour
(d) Occurs in young individuals:-False- Age: Seen more commonly in men from 4th to 7th decade of life.
Ref: Pg-353, Essential Pathology for Dental Students by Harsh Mohan
Occurs in the elderly (6th decade).
Ref: http://radiopaedia.org/articles/warthin-tumour



Q.11. Fournier’s gangrene is characterized by all EXCEPT? (AP/MD/HOMOEO/ENT/13-14):
a) Sudden appearance of scrotal inflammation
b) Known to follow minor injuries or procedures in the perineal areas
c) Obvious cause is evident
d) Hemolytic streptococcus associated with other organisms causes a fulminating inflammation of subcutaneous tissues
Answer: (c)

Note: Out of above-given variables (c) Obvious cause is evident– is suggested choice.
Stem: Fournier’s gangrene

Recall
Fournier gangrene is a type of necrotizing infection or gangrene usually affecting the perineum. It was first described by Baurienne in 1764 and is named after a French venereologist, Jean Alfred Fournier following five cases he presented in clinical lectures in 1883.
Ref: en.wikipedia.org/wiki/Fournier_gangrene

Review of variable
(a) Sudden appearance of scrotal inflammation:-True- Jean Alfred Fournier described a series in which 5 previously healthy young men suffered from a rapidly progressive gangrene of the penis and scrotum without apparent cause.
Impression: Onset is sudden and progressive.
Ref: http://emedicine.medscape.com/article/2028899-clinical#a0256
(b) Known to follow minor injuries or procedures in the perineal areas:-True- The following have been reported in the literature as precipitating factors:
Blunt thoracic trauma
Superficial soft-tissue injuries
Genital piercings
Penile self-injection with cocaine
Urethral instrumentation
Prosthetic penile implants
Intramuscular injections
Steroid enemas (used for the treatment of radiation proctitis)
Rectal foreign body
Ref: http://emedicine.medscape.com/article/2028899-clinical#a0256

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