Gastrointestinal MCQ’s
Di Flood
1. Regarding patients with upper GI bleeds which is incorrect?
a. Use of NSAIDs doubles the risk for an upper GI bleed
b. Urea will increase relative to creatinine in acute bleed
c. Presence of fresh blood on aspiration of NG tube increases mortality as
opposed to a clear aspirate.
d. Active bleeding seen at endoscopy has a 10% risk of rebleeding after
treatment.
e. Most deaths occur from decompensation of other organ systems rather
than exsanguination.
2. Which of the following therapies is proven to reduce mortality and morbidity
in bleeding peptic ulcers?
a. Endoscopic procedures
b. H2 antagonists
c. Proton pump inhibitors
d. Octreotide
e. Antacids
3. Which is not true of bleeding oesophageal varices?
a. Mortality approaches 25-40%
b. Use of octreotide IV is as effective as sclerotherapy controlling
bleeding in 74-92% of cases.
c. Sclerotherapy has a high rate of complications (40%) including
perforation, aspiration, pyrexia, chest pain, ulcers and strictures.
d. Endoscopic variceal ligation is as effective as sclerotherapy with fewer
side effects.
e. Use of the sengstaken-blackmore tube is effective in controlling severe
bleeding, is easy to insert and has almost no complications.
4. Which is the most common cause of lower GI bleed under 50 years of age?
a. Anal fissures
b. Benign polyps
c. Haemorrhoids
d. Inflammatory bowel disease
e. Diverticulosis
5. Which is not a characteristic of diverticulosis?
a. Acquired defects in bowel wall
b. More common in distal colon
c. Bleeding usually intermittent
d. Significant bleeding usually arises from right side of colon
e. Occur at point of entry nutrient vessel
1=D 2=A 3=E 4=C 5=C
6. A 55 year old woman presents with intermittent bright red PR bleeding. On
examination she is stable, and PR shows small external haemorrhoid. What is
appropriate treatment for this lady?
a. Reassure, prescribe treatment for haemorrhoids
b. Refer to surgeons for elective haemorrhoidectomy
c. Prescribe treatment for haemorrhoids, and arrange outpatient
colonoscopy with surgical follow-up.
d. No further treatment necessary.
e. Admit to hospital for colonoscopy or double contrast barium enema.
7. Which is not a predisposing factor for GORD?
a. High fatty food intake
b. Cholinergic drugs
c. Caffeine
d. Nicotine
e. Gastric outlet obstruction
8. Which is the most common cause of oesophageal perforation?
a. Iatrogenic causes
b. Trauma
c. Boerhaave’s syndrome
d. Foreign body
e. Tumour
9. Which is incorrect of swallowed foreign bodies?
a. 80% occur in children
b. 97% of adults with distal meat impactions have pathological conditions
so all need Barium swallow studies.
c. The most common area for FB’s to be found in children is at the
cricopharyngeal narrowing (C6).
d. Glucagon is used to relax smooth muscle but is contraindicated in
phaeochromocytoma.
e. Carbonated drinks can be used safely in upper oesophageal
obstructions to try and dilate oesophagus to allow FB to pass.
10. Which of the following FB’s needs to be removed as an emergency?
a. 50 cent coin in the stomach
b. 50 cent coin in the oesophagus
c. lithium button battery in stomach
d. lithium button battery in oesophagus
e. 5 grams of cocaine in condom sitting in small intestine
6=C 7=B 8=A 9=E 10=D
11. Which is the most common cause of peptic ulcer disease of the following?
a. Smoking
b. NSAID’s
c. Zollinger-Ellison syndrome
d. Ethanol excess
e. Family hx of PUD
12. Which is not true of H.pylori infection?
a. 80% of patients with chronic infection will develop ulcers
b. the most common cause of peptic ulcer disease
c. it is a risk factor for adenocarcinoma of the stomach
d. IgG antibody test will remain positive for up to 2 years post eradication
limiting its usefulness
e. The CLO test is approx 90% sensitive and 100% specific for H.pylori
13. Which is not correct regarding treatment of peptic ulcer disease/
a. Antacids are as effective as H2 antagonists in healing ulcers
b. Proton pump inhibitors show more rapid healing and pain relief over 24 weeks compared to H2 antagonists.
c. Colloidal bismuth subcitrate will suppress H.pylori and chelate with
the base of the ulcer to aid healing.
d. H.pylori eradication with omeprazole, Amoxil and metronidazole
requires only one week of treatment.
e. Misoprostal is indicated for prevention of NSAID induced ulcers,
when treatment necessary with NSAID’s.
14. Which is the most common complication of Peptic ulcer disease?
a. Perforation
b. Gastric outlet obstruction
c. Penetration
d. Haemorrhage
e. All are uncommon occurring in less than 5% of patients.
15. Which is incorrect regarding acute appendicitis?
a. Between 50-75% of patients present with the classical symptoms and
signs of acute appendicitis.
b. Presence of a good appetite makes appendicitis unlikely
c. Rovsings sign may be helpful in diagnosis especially in obese patients
d. PR tenderness is seen in 90% of patients with acute appendicitis
e. Vomiting prior to onset of pain makes appendicitis unlikely
11=B 12=A 13=D 14=D 15=D
16. Which is incorrect regarding investigation of acute appendicitis?
a. The WCC is increased in 70-90% of patients.
b. CRP will usually be normal in early appendicitis
c. USS is operator dependant but has sensitivity of around 80-90%.
d. USS sensitivity is lowered to around 30% in cases of gangrenous and
perforated appendicitis.
e. CT is the investigation of choice in children due to lower sensitivity in
this group with USS.
17. Which is the least common cause of large bowel obstruction?
a. Neoplasm
b. Diverticulitis
c. Volvulus
d. Adhesions
e. Faecal impaction
18. Which of the following features suggests a complete large bowel obstruction?
a. Presence of multiple loops of bowel with plicae circularis on AXR
b. Bilious vomiting
c. Distended abdomen, with high pitched bowel sounds with normal
flatus.
d. Empty rectum on PR exam
e. Dilated loops of bowel with haustra visible
19. What is the upper limit of normal for large bowel?
a. 3cm
b. 4cm
c. 5cm
d. 6cm
e. 10cm
20. A 50 year old women presents with small bowel obstruction, and on
examination has a hard tender mass lateral and inferior to symphysis pubis.
What is this most likely to be?
a. direct inguinal hernia
b. indirect inguinal hernia
c. femoral hernia
d. obturator hernia
e. spigelian hernia
21. Which of the following hernia is most likely to incarcerate and strangulate?
a. Congenital umbilical hernia
b. Spigelian hernia
c. Direct inguinal hernia
d. Sportsman hernia
e. Indirect inguinal hernia
16=E 17=D 18=E 19=C 20=C 21=E
22. Which is incorrect regarding inflammatory bowel disease?
a. The risk of developing ulcerative colitis is higher in non-smokers than
smokers.
b. Patients with Crohn’s disease are more at risk of colorectal cancer than
UC patients.
c. Effectiveness of colonoscopic surveillance in detecting colorectal
cancer is controversial in IBD.
d. Toxic megacolon occurs in Crohn’s and ulcerative colitis.
e. Cobblestone appearance on bowel wall is more characteristic of Crohn
disease
23. Which is not an extra-abdominal manifestation of inflammatory bowel disease?
a. Erythema marginatum
b. Ankylosing spondylitis
c. Episcleritis
d. Thromboembolic disease
e. Sacroiliitis
24. Which is true of the complications of Crohn’s disease?
a. Perianal complications occur in 50% of patients.
b. GI bleeding is common and often life-threatening
c. Toxic megacolon occurs in 6% but almost never perforates.
d. There is no increased risk of neoplasm of GI tract unlike UC.
e. The majority of patients will not require surgery throughout their
illness.
25. Which is incorrect regarding management of Crohn’s Disease?
a. Mesalamine (pentasa) has fewer side effects than sulphasalazine.
b. Azathioprine has been used in severe cases.
c. Metronidazole has a role in long-term treatment of perianal disease
postoperatively to prevent relapse.
d. Corticosteroids have a proven role in maintenance therapy to prevent
relapse.
e. Loperamide can be used to control diarrhoea.
26. Which is INCORRECT regarding Ulcerative Colitis?
a. Affects men more than woman
b. Mild disease affects 60% of patients and consists of less than 4 bowel
motions per day, with the disease limited to rectum in 80%.
c. In severe disease there is usually hypoalbuminemia and mildly
deranged LFT’s.
d. Loperamide and other antidiarrhoeal agents should be avoided as they
increase the risk of toxic megacolon.
e. Toxic megacolon is usually treated conservatively unless the bowel is
wider than 6 cm or the patient severely ill.
22=B 23=A 24=C 25=D 26=E
27. Which is not true of pseudomembranous colitis?
a. Usually occurs following a course of antibiotic treatment.
b. Approx 25% will resolve with supportive treatment only.
c. Vancomycin is the treatment of choice
d. The ELISA C. difficile toxin test is 60-90% sensitive
e. It may rarely result in toxic megacolon and perforation.
28. Which is not true of diverticulitis?
a. Occurs in 10-25% of patients with diverticulae
b. Mostly occurs in the left side of the colon
c. Urinary frequency, pyuria and dysuria is not uncommon
d. Sigmoidoscopy is the best diagnostic tool at time of presentation.
e. Mild cases can be treated as outpatients with oral Amoxil plus
clavulanic acid for 7 days.
29. Which is not true of haemorrhoids?
a. Portal venous hypertension can cause enlarged external haemorrhoids
b. Third degree are permanently prolapsed to some degree
c. Thrombosed external haemorrhoids can usually be excised under local
anaesthetic.
d. Blood mixed in with the stool raises the possibility of other diagnoses
like carcinoma.
e. Internal haemorrhoids occur proximal to the dentate line.
30. Which is true regarding these anorectal disorders?
a. Anal fissures usually occur on the anterior wall medially and any
fissure outside of this area raises suspicion for other pathology.
b. Glycerol trinitrate ointment has been used with success in anal fissures.
c. Perianal abscess is usually located in the natal cleft in the midline.
d. Ischiorectal abscesses are usually very obvious on examination of the
perineum with fluctuant abscess lateral to anus.
e. Anal fistulae are most commonly secondary to Crohn’s disease.
31. Which of the following is not true regarding antiemetics?
a. There is a 1% incidence of dystonic reactions with metoclopramide.
b. Prochlorperazine is a category A drug in pregnancy.
c. Droperidol is from the butyrophenome family.
d. Warm flushing and headache are among the most common side effects
of ondansetron.
e. Promethazine is relatively contraindicated in children less than 2 yrs.
32. Which is not true regarding diarrhoea?
a. Wright’s stain detects faecal leucocytes
b. C. difficle toxin test is a rapid assay available within 2 hours.
c. Ciprofloxacin 500mg BD for 7 days has shown to shorten the duration
of infectious diarrhoea secondary to bacteria.
d. Patients with acute diarrhoea should avoid caffeine.
e. Loperamide is not harmful to use in a patient with Salmonella
gastroenteritis.
27=C 28=D 29=A 30=B 31=B 32=B
33. Which is not a cause of unconjugated hyperbilirubinemia?
a. Sepsis
b. Gilberts syndrome
c. Congestive cardiac failure
d. Prematurity neonates
e. Infectious mononucleosis
34. Which is not a risk factor for gallstones?
a. Cystic fibrosis
b. Congestive cardiac failure
c. Familial tendency
d. Diabetes
e. Pregnancy
35. Which is incorrect regarding biliary tract disease?
a. Pigment stones are more radio-opaque than cholesterol stones.
b. Bacterial infection occurs in 50-80% of patients with cholecystitis.
c. Murphies sign is 97% sensitive for cholecystitis.
d. CT is as sensitive as USS for detecting gallstones.
e. The classic Charcot’s triad is present in only 25% of patients with
cholangitis.
36. Which is not a cause of acute hepatitis?
a. Wilson’s disease
b. Mushroom poisoning – amanita phalloides
c. Halothane
d. Ecstasy poisoning
e. Cytomegalovirus
37. Which is not correct regarding viral hepatitis?
a. Anti HAV IgG indicates past infection and immunity to Hep A.
b. Chronic hepatitis occurs in about 5% of patients infected with Hep B.
c. Anti HBc indicates immunity and recovery from Hep B.
d. Hep B immunoglobulin protects 75% of people exposed to Hep B if
given within 7 days of exposure.
e. Patients with Hep B have approx 15% risk of transmission with sexual
contacts.
38. Which is NOT a complication of hepatic cirrhosis?
a. Spontaneous bacterial peritonitis.
b. Hepatocellular carcinoma.
c. Thrombocytosis.
d. Portal hypertension.
e. Portal vein thrombosis.
33=E 34=B 35=D 36=A 37=C 38=C
39. Which is incorrect regarding LFT’s?
a. Normally conjugated bilirubin makes up 70% of the total bilirubin.
b. ALT is a more specific marker of hepatocellular dysfunction than AST.
c. AST: ALT ratio of greater then 2 is common in alcoholic hepatitis.
d. Isolated elevation of ALP may be seen in primary biliary cirrhosis and
sclerosing cholangitis.
e. Elevated ammonia levels do not correlate with worsening hepatic
function in cirrhosis.
f. The half life of albumin is 3 weeks so is not a good indicator of acute
decline in liver function unlike PR which will climb in days.
40. Which statement regarding spontaneous bacterial peritonitis is incorrect?
a. The yearly risk with ascites is about 30%.
b. Diagnosis is confirmed by paracentesis with WBC > 1000/ cubic mm,
and PMN > 250/ cubic mm.
c. Bacterial are rarely grown from ascitic fluid.
d. The most common bacteria are anaerobes.
e. Antibiotic choices include cefotaxime or ceftriaxone 2g/day.
41. Which is true of hepatic encephalopathy?
a. It only occurs in chronic hepatic failure.
b. Stage 3 consists of drowsiness and asterixis.
c. Can be due to cerebral oedema as well as accumulation of toxic wastes.
d. Lactulose use is now been shown to be the treatment of choice.
e. Ammonia levels can be used as an index of encephalopathy.
42. Which is not true of acute liver failure?
a. Use of N-acetyl cysteine has been shown to reduce mortality up to 36
hrs post ingestion.
b. Hypotension is usually treated with dobutamine as it is due to cardiac
suppression.
c. Mortality is higher in acute liver failure due to Hepatitis B than Hep A.
d. Mortality from paracetamol acute liver failure is higher if the patient is
acidotic.
e. Encephalopathy can be managed by dietary protein withdrawal initially.
43. Which is not true of pancreatitis?
a. Alcohol is the most common cause.
b. Pain is usually severe and relieved by sitting forward.
c. Cullen’s sign is blue discolouration around umbilicus secondary to
hemoperitoneum.
d. Amylase is less sensitive in alcoholic pancreatitis than gallstone
pancreatitis.
e. CT will be abnormal in the vast majority including mild disease.
39=A 40-D 41=C 42=B 43=E
44. Which is not part of Ranson’s criteria at initial presentation?
a. Calcium < 1.9 mm/l
b. Age >55
c. WCC >16 000.
d. LDH > 400 IU
e. Glucose > 11 mmol/l
45. Which number of Ransons criteria fits with predicted mortality?
a. 1-2 risk factors - 5% mortality
b. 3-4 risk factors – 16% mortality
c. 5-6 risk factors – 50% mortality
d. > 6 risk factors – 90% mortality
e. All of the above are correct.
46. Which is not true of pancreatitis?
a. Pancreatic necrosis is often seen on CT and may result in pancreatic
insufficiency.
b. Most of the mortality is secondary to systemic effects.
c. Choledocholithiasis does not cause chronic pancreatitis.
d. Abdominal pain associated with chronic pancreatitis improves with
progression of the disease.
e. Serum lipase and amylase are usually normal in acute bouts of chronic
pancreatitis.
44=A 45=B 46=D
GASTOINTESTINAL
SUSAN TUCKER
Answer questions 1-5 by choosing the correct answers from the list below. Multiple
answers may be correct.
a)
b)
c)
d)
e)
f)
g)
h)
i)
HBs Ag +ve
Anti HepBs Ab +ve
HepBc Ag +ve
Anti HepBc Ab +ve… IgG
Anti HepBc Ab +ve… IgM
E Ag +ve
Anti Hep E Ab
Hep B DNA
Anti delta virus
1.In a person with up to date vaccination of Hepatits B, with no history of infection,
what would the serology show?
2.What serology would be seen in seen in a person with prior (5years ago) completely
resolved Hepatitis B infection?
3.What would the serology show in a currently infected person with acute Hep B?
4.What would the serology show in a Hep B carrier?
5.What would the serology show in chronic active hepatitis?
6.What would the serology show in co infection with delta virus?
7.Which of the above parameters cannot be measured in the serum?
8.Which statement is false regarding hepatitis A?
a) it is usually mild to moderate in severity with adults usually worse than
children
b) chronic hepatitis does not occur
c) both vaccination and immunoglobulin are available
d) it is spread by the faecal –oral route
e) it has a high mortality in pregnant women
9.Which is false about hepatitis C?
a) it is usually a mild acute disease
b) the chronicity rate is very high, about 50-80%
c) immunoglobulin is available for contacts
d) there is no vaccine available
e) treatment is symptomatic, interferon being useful for some patients
10.Which drug is not well known to cause acute hepatitis?
a) isoniazid
b) flucloxacillin
c) amioderone
d) chlorpromazine
e) cephalothin
11.Which of the below has been shown to be of benefit in the ED in upper GI
bleeding due to duodenal ulceration.
a) antacids
b) proton punp inhibitors
c) H2 antagonists
d) Octroetide
e) None of the above
12.Which is the first line pharmacological agent in the use of upper GI bleeding from
oesophageal varices?
a) H2 antagonists
b) Vasopressin
c) Octreotide
d) Proton pump inhibitors
e) Antacids
13.Which statement is false of peptic ulcer disease?
a) helicobacter pylori is found in more duodenal ulcers than gastric ulcers
b) NSAIDS cause more ulcers than helicobacter pylori
c) The rate of release with peptic ulceration if treated with H2 antagonists alone
is about 80%
d) NSAIDS cause more gastric ulcers than duodenal ulcers
e) Omeprazole heals ulcers more quickly than H2 antagonists
14.Which is false about hepatic encephalopathy?
a) it is due to ammonia produced in the gut reaching the brain unchanged
b) increased dietary protein and GIT bleeding are both risk factors
c) renal failure is a risk factor
d) neomycin works by removing urease producing gram –ves in the bowel
e) lactulose is the agent of choice, causing increased transit time as well as
decreased ammonia production
15.Which statement is false regarding amylase and lipase in pancreatitis?
a) lipase remains elevated longer than amylase
b) lipase is elevated to the same extent in both alcohol and gallstone pancreatitis
c) amylase is elevated more in gallstone pancreatitis than alcholol
d) lipase may be elevated in conditions other than pancreatitis
e) amylase may be elevated in conditions than other pancreatitis
16.Which is not part of Ransons criteria on presentation?
a) AST >150
b) Glucose >11
c) Calcium <1.9
d) Age >55
e) WCC>16 000
17.The recommended antibiotics for acute cholecystitis are?
a) ampicillin ,gentimicin and flagyl
b) ampicillin and gentamicin
c) cefotaxime
d) gentamicin and flagyl
e) ampicillin and cefotaxime
18.Which is NOT true of staph aureus and bacillus cereus gastroenteritis ?
a) They both have a short incubation period
b) They both cause an illness limited to no more than 24 hours
c) Illness is caused by ingesting food with the toxin already produced by these
bacteria
d) Illness is caused by ingesting the bacteria which then form the toxin in the gut
e) Antibiotic treatment is not indicated
19.Which statement is FALSE?
a) Enterohemorrhagic E coli gastro is associated with haemolytic ureamic
syndrome
b) Giardia Lamblia is usually treated with Norfloxacin in adults
c) Salmonella gastro in children can cause osteomyelitis and meningitis
d) Campylobactor gastro has been associated with reactive arthritis
e) Campylobactor gastro has been associated with guillain-barre syndrome
20.Which of these hernias frequently incarcerate?
a) indirect inguinal
b) direct inguinal
c) femoral
d) umbilical
e) A and C
21.How should a babe with an asymptomatic umbilical hernia be managed?
a) referred for urgent operation
b) referred for operation if still present at 6 months of age
c) referred for operation if still present at 1 year of age
d) referred for operation if still present at 4 years of age
e) referred for operation if still present at 12 years of age
22.Which is the most common hernia in women?
a) indirect
b) femoral
c) umbilical
d) incisional
e) direct
23.Which statement is true?
a) all incarcerated inguinal hernias should be reduced in ED regardless of the
duration
b) no incarcerated inguinal hernias should be reduced in ED
c) if there are signs of bowel obstruction an incarcerated inguinal hernias should
be reduced in ED
d) if a patients vital signs are unstable an incarcerated inguinal hernia should be
reduced in ED urgently
e) if there are signs of bowel obstruction and ischemia an incarcerated inguinal
hernias should NOT be reduced ED
24.What is the ost common cause of a large bowel obstruction?
a) adhesions
b) neoplasms
c) volvulus
d) diverticulitis
e) foreign body
25.In patients under 50 hears what is the most common cause of rectal bleeding?
a) haemorhoids
b) anal fissure
c) inflammatory bowel disease
d) carcinoma
e) diverticulosis
26.In patients over 50 years with rectal bleeding and obvious hemorrhoids, how much
further should the lower GIT be imaged?
a) no further
b) sigmoidocsopy or all
c) colonscopy for all
d) only investigate further if bleeding still present in 6 months
e) only investigate further if still bleeding in 12 months
27.Which statement is false about inflammatory bowel disease?
a) perianal disease is more common with Crohns disease than UC
b) steroids are used to induce and maintain remission
c) aminosalicylates are used to induce and maintain remission
d) metronidazole can be useful in treating perianal disease
e) the risk of developing UC is higher in smokers than non smokers
28.Which statement is false re IBD?
a) Crohns disease is transmural inflammation
b) UC is mucosal inflammation only
c) Neoplasia is more common with UC than Crohns
d) Total proctocolectomy is curative in both UC and Crohns
e) UC always involves the rectum, Crohns does not
ANSWERS
1)B
9)C
2)B,D,G
10)E 11)E
20)E
21)D 22)A 23)E
3)A,E,F,H
4)E
12)C 13)B 14)E
5)A,D,F,H
15)D 16)C
24)B
27)B
Surgery MCQs
1
25)A 26)C
6)A,E,F,H,I 7)C
17)B 18)D 19)B
8)E
28)D
1.
Which of the following regarding rectal bleeding is incorrect?
a)
50 - 70% of diverticular bleeding occurs in the right colon
b)
10-15% cases originate proximal to the small bowel
c)
haemorrhoids are the most common cause in patients under
50
d)
most angiodysplastic lesions are acquired rather than
congenital
e)
intermittent minor bleeds are characteristic of diverticular
bleeds
2.
Which of the following regarding rectal bleeding are true?
a)
labelled RBC scans enable precise location of bleeding
source
b)
most aortoenteric fistulae occur in an untreated AAA
c)
most bleeds can have definitive treatment electively
d)
the majority of angiodysplastic lesions will cause problems
e)
angiography is usually sensitive in detection of bleeding site
3.
With regards to anorectal abscesses
a)
waiting until fluctuance develops assists in healing post op
b)
most are due to anal gland obstruction
c)
majority can be managed with simple incision and drainage
d)
some degree of external swelling will be visible
e)
fistula formation and recurrence occur in <10 %
4.
Which of these is incorrect with regards to perianal conditions?
a)
GTN ointment can be an effective treatment for anal fissure
b)
c)
d)
e)
5.
Chlamydia can cause rectal scarring
Syphilitic chancres usually involve the rectal mucosa
Laxatives for haemorrhoids should not liquefy stool
Salbutamol is effective in treatment of proctalgia fugax
Choose the most correct w.r.t. suspected urinary tract trauma
a)
the degree of haematuria corresponds to the degree of injury
b)
perineal lacerations should be explored to determine depth
c)
adult patients with isolated microscopic haematuria do not
require imaging
d)
almost 95% of bladder injuries are associated with gross
haematuria
e)
suprapubic catheterisation is contraindicated in severely
injured patients
Surgery MCQs
2
1.
In urinary tract trauma
a)
Grade III renal injury extends through to collecting system
b)
Renal pedicle injuries are usually not associated with other
injuries
c)
CT is the most useful imaging to visualise renovascular
injury
d)
Renal injuries are the most common
e)
Renal contusion accounts for about 60% of renal injuries
2.
Which of the following is incorrect?
a)
Posterior urethral injuries result in the classic ‘butterfly’
perineal haematoma
b)
The classic triad of bladder rupture is abdo pain, haematuria
and inability to void
c)
Extraperitoneal bladder ruptures can be managed by catheter
placement alone
d)
80% of female urethral injuries present with vaginal
bleeding
e)
Renal parenchymal lacerations extending to renal collecting
system does not always need surgical repair
3.
With regards to renal vein thrombosis, which of the following is
incorrect?
a)
pregnancy is a predisposing factor
b)
it often presents with loin pain
c)
d)
e)
4.
children who develop it are commonly volume depleted
adults who develop it usually have underlying nephropathy
it can cause haematuria
With regards to haematuria, which of the following is correct?
a)
treatment of the primary streptococcal infection with
antibiotics prevents poststreptococcal glomerulonephritis
b)
there is an underlying pathology in up to 80% of patients
who develop haematuria while on oral anticoagulants
c)
the most common cause of haematuria worldwide is
bacterial infection
d)
urethral catheterisation causes microscopic haematuria in up
to 80% of patients
e)
chronic hypertension is a predisposing factor
Surgery MCQs
3
1.
With regards to dipstick urine testing for blood, which of the
following is incorrect?
a)
household bleach in the urine container can cause a false
positive result
b)
high concentration of ascorbic acid in the urine can cause a
false negative result
c)
betadine can cause a false negative result
d)
high specific gravity can cause a false negative result
e)
porphyrins can cause a false positive result
2.
Which of the following is not considered a specific risk group for
UTIs?
a)
neonates
b)
older men
c)
girls
d)
young women
e)
young men
3.
Which of the following is incorrect?
a)
bacteriuria is rare in males under the ago of 50
b)
asymptomatic bacteriuria occurs in up to 30% of pregnant
women
c)
E.coli is responsible for 50% of urinary infections
d)
in pregnancy, UTI may precipitate pre eclampsia and
e)
4.
miscarriage
anaerobes do not grow well in urine and are rarely
pathogenic
With regards to urinary infection, which of the following is correct?
a)
urethral gram stain is more sensitive than urinary
leucocytosis in detecting chlamydial infection
b)
10% of patients develop UTI after single catheterisation
c)
cloudiness in urine is usually due to WBC or bacteria
d)
in an infected and obstructed kidney, pyuria may be absent
e)
the presence of urinary nitrites is highly sensitive for UTI,
but with only moderate specificity
Surgery MCQs
4
1.
With respect to abdominal herniae which of the following
statements is incorrect?
a)
congenital failure of obliteration of the processus vaginalis is
one of the causes of indirect inguinal herniae
b)
direct inguinal herniae rarely incarcerate and strangulate
c)
a Richter hernia is incarceration of a single wall of a hollow
viscus
d)
obturator herniae frequently incarcerate
e)
epigastric hernia is of approximately equal incidence by sex
2.
Which of the following is not a likely cause of large bowel
obstruction in a 70 year old man?
a)
carcinoma of the colon
b)
volvulus
c)
adhesions
d)
pseudo-obstruction
e)
faecal impaction
3.
Which of the following statements is incorrect?
a)
a postural blood pressure change is discriminatory for
intravascular volume depletion
b)
the presence of hyperactive/obstructive bowel sounds
increases the likelihood of SBO fivefold
c)
false positive rebound tenderness occurs in on in four
patients without peritonitis
d)
positive Murphy’s sign is 97% sensitive for cholecystitis
e)
pain in diverticulitis is confined to the LLQ in < ¼ of cases
4.
Which of the following statements is incorrect?
a)
likelihood ratio of a positive test is the true positive rate over
the false positive rate (TPR/FPR)
b)
a negative likelihood ratio is the likelihood that a negative
test result would be found in a patient without the target
disorder
c)
the specificity of a test is the number of true negatives over
(true negatives + false positives)
d)
a positive likelihood ratio is clinically significant if >1
e)
a test with a high specificity has a low number of false
negatives
Surgery MCQs
1.
5
Which of the following is not true of mesenteric ischaemia?
a)
patients with mesenteric ischaemia tend to have a substantial
degree of age-related comorbidity
b)
the small bowel has a warm ischaemia time of 2-3 hours
c)
serial serum lactates that remain persistently normal reduce
the pretest likelihood of diagnosing mesenteric ischaemia by
more than tenfold
d)
patients may become transiently better after a few hours of
ischaemia
e)
initial presentation is characterised by abdominal pain and
tenderness
Regarding swallowed foreign bodies
a.
b.
c.
d.
e.
30.
The most common site of foreign body oesophageal obstruction in the
paediatric patient is at the level of the aortic arch.
Button batteries lodged in the oesophagus can be treated by watching
and waiting for them to pass.
Meat impaction in the oesophagus should be treated immediately with
papain.
15-35% of ingested open safety pins or razor blades will cause
intestinal perforation.
Coins in the oesophagus lie in the sagittal plane on xray.
Regarding acute appendicitis
a.
b.
A white count above 10000/ul is highly specific for appendicitis.
Graded compression ultrasonography for diagnosis of appendicitis is
reported to have sensitivity of 60-69%.
c.
d.
Vomiting occurs in >80% of patients presenting with acute appendicitis.
Appendicitis is the 2nd most common extrauterine surgical emergency
in pregnancy.
Mortality rates for patients over 70 with acute appendicitis approach
30%.
e.
31.
Many patients with abdominal pain present to ED daily. Complications of
gallstone disease must be treated emergently. Which of the following
statements is correct?
a.
The classic Charcot triad of fever, jaundice, and RUQ pain is noted in
about 45% of patients with cholangitis.
Emphysematous cholecystitis complicates the course of ~ 5% of
patients with cholecystitis.
Of all patients with gallstones, 15-20% will develop pancreatitis as a
result of biliary calculi.
Gall bladder empyema is usually caused by staphylococcal organisms.
The sensitivity of Murphy’s sign is only 68% in the elderly.
b.
c.
d.
e.
19The following are used as Ranson Criteria in acute pancreatitis EXCEPT:
a)
b)
c)
d)
e)
Age over 55 years
Systolic BP < 90mmHg
Hyperglycaemia
Hypocalcaemia
Metabolic acidosis
14 Regarding ischaemic colitis which is incorrect
A. angiography has no role and if performed will be negative
B. pain is often diffuse
C. Commonly have diarrhoea
27 Regarding intussusception
A ileocaecal is the commonest site
B On abdominal X ray loops in the RUQ suggest colonic intussusception
14 = a 27 = a
6. Which of the following is NOT a Ranson’s criterion for acute pancreatitis on admission:
a) age > 55 years old
b) serum calcium < 2mmol/L
c) white cell count > 16,000 cells/microlitre
d) serum LDH > 350 IU/L
e) serum glucose > 10mmol/L
(b: The Emergency Medicine Manual vol 4. page 330)
B
45. The commonest causes of large bowel obstruction in adults, in decreasing order, are:
a) diverticulitis, volvulus, neoplasm, adhesions, hernia
b) adhesions, hernia, neoplasm, diverticulitis, volvulus
c) volvulus, neoplasm, adhesions, hernia, diverticulitis
d) neoplasm, diverticulitis, volvulus, adhesions, hernia
e) volvulus, neoplasm, diverticulitis, hernia, adhesions
Cam 233
D
52. Superior mesenteric artery thrombosis is associated with:
a) Decreased haematocrit
b) Positive abdominal paracentesis
c) Abdominal XR with a paucity of bowel gas
d) Raised serum amylase
e) Decreased serum phosphate
Abdominal paracentesis should be normal
Early signs of mesenteric ischaemia and intestinal ischaemia mimic bowel obstruction, but as vascular occlusion
progresses the bowel wall becomes oedematous and necrotic with severe thickening
Serum amylase levels:
Raised in pancreatitis, small bowel perforation, pancreatic cancer, salivary gland disease, impaired renal
function, CBD obstruction AND ischaemic bowel
Decreased amylase levels associated with PET, chronic pancreatitis, cirrhosis, hepatitis
Bowel infarction is associated with SMA occlusion and is associated with HYPER-phosphataemia
Associated with atherosclerosis and low cardiac output states
D
1. A staff member is referred to the ED with the following results of a routine hepatitis B
serology assay. He is asymptomatic, and cannot recall if he has received Hep B
vaccination before.
HBs antigen: significantly positive
Anti-HBs: not detected
Anti-HBc: low titres
Select the correct statement:
a) he has received Hep B vaccination and is immune
b) he has received Hep B vaccnation, but is not immune
c) he is a highly infective chronic carrier
d) there is a 2-30% risk of seroconversion in a recipient if he was the source in
a needlestick injury
e) none of the above
Cam 333
D
53. Re-bleeding occurs most commonly with which cause of upper gastrointestinal bleeding?
a) Oesophagitis
b) Gastritis
c) Mallory-Weiss tear
d) Peptic ulcer disease
e) Varices
Ros 1904
E
56. Regarding Hepatitis A:
a) It is a reportable / notifiable disease in Australia.
b) It is caused by a DNA virus.
c) The incubation period is usually longer than that of Hep B.
d) Passive immunisation against Hep A is not available.
e) Chronic hepatitis often succeeds the acute infection.
Cam 332
A
22. Oesophageal foreign bodies can be treated with all of the following
EXCEPT:
e)
a) foley catheter
b) sodium bicarbonate
c) papain
d) glucagon
tartaric acid
C
2)
a.
b.
c.
d.
e.
With regards to abdominal hernias
Femoral hernias is more common than inguinal hernia in women
Saphena varix and femoral hernia can only be distinguished at operation
Umbilical hernias rarely strangulate
Inguinal hernias may transilluminate
2)
With regard to abdominal hernias
a.
Femoral hernias are more common than inguinal hernias in women. – Femoral
hernias are more common in women vs men but they are still less frequent than
inguinal hernias in women.
b.
Saphena varinx and femoral hernia can only be distinguished at operation. –
crap just use a colour flow Doppler
c.
Umbilical hernias rarely strangulate. Crap – they frequently complicate in
adults but rarely complicate in children less than 4 years old.
d.
** Inguinal hernias may transilluminate – unlikely but not impossible, they
need to be fluid filled to transilluminate and this is more common with hydrocoele.
5)
a.
b.
c.
d.
e.
Inflammatory bowel disease, which is correct
Ulcerative colitis needs an operation in >80%
Chrons disease involves the terminal ileum most commonly
5)
Inflammatory bowel disease, which is correct
a.
*Ulcerative colitis needs operation in >80%. Often responds to medical
management however risk of colon cancer quite high
b.
**Crohns involves terminal ileum most often.
10)
Regarding acute cholecystitis which is false
a.
2-12% are Acalculus
b.
In penicillin allergy it is appropriate to treat with cefotaxime only
c.
Is commonly associated with mild jaundice
d.
Is associated with cystic duct obstruction
e.
Commonly cultured organisms are GN and anaerobes
10)
Regarding acute cholecystitis which is false
a.
2-12% acalculus. Tintanelli syas 5-10%
b.
In penicillin allergy it is appropriate to treat with cefotaxime as a single agent.
True – antibiotic guidelines say that anaerobic infection is rare. Recommends Amoxy
+ gent or cefotaxime/ceftriaxone as single agents
c.
Is commonly associated with mild jaundice – true
d.
Is associated with cystic duct obstruction. True
e.
*Commonly cultured organisms are GN and anaerobes. False – anaerobes rare,
gram negs common
25)
Regarding a febrile oncology patient, which is true
a.
Increased risk of bacterial infection if neutrophils >500mm3
b.
Increased risk of fungal infection with broad spectrum antibiotic
administration
c.
Line sepsis is most common source
d.
e.
26)
a.
b.
c.
d.
e.
Regarding GI bleed, which is true
60% associated with PUD
Octreotide is of no additive benefit to sclerotherapy in banding
25)
Regarding febrile oncology patients which is true?
a.
Increased risk of bacterial infection if neutrophils >500/mm – no < 500
b.
*Increased risk of fungal infection with broad spectrum antiobiotics – this is
true for any one but especially immunocompromised
c.
Line sepsis is most common source – false, it can be a source but it is more
frequently due to UTI> chest
26)
Regarding GIT bleed which is true?
a.
*60% associated with PUD – true according to tintanelli
b.
Octreotide is of no added benefit to sclerotherapy in banding – I presume this
is talking about oesophageal varacies where octreotide has a proven and important
role either alone or in combination with other treatments
41)
Which of the following is most likely to result in a non therapeutic laparotomy
following stab wound to the anterior abdomen
a.
Generalised peritonitis
b.
Fresh blood in the NGT
c.
Diaphragm involvement
d.
Extravasation of contrast on CT in the upper GI region
e.
41)
Which of the following is most likely to result in a non theraputic laparotmy
following a stab wound to the anterior abdomen
a.
Generalized peritonitis. True
b.
*Fresh blood in NGT. Possible but maybe from nose bleed/trauma of putting
in NGT
c.
Diaphragm involvement. True
d.
Extravasation of contrast on CT in the upper GI region. True
51)
a.
b.
c.
d.
e.
With respect to anal fissures
They often point away from the anal verge
Originate at anal valves
Situated between internal & external shincters
52)
With respect to large bowel obstruction
a.
Often associated with diverticulitis in the elderly
b.
Associated with sigmoid volvulus in children under 2
c.
d.
e.
51)
With respect to anal fissures
a.
**They often point away from the anal verge. True
b.
Originate at anal valves. False – originate in skin and rarely extend to valves.
Usually valses spasm causing more pain
c.
Situated btn internal and external valves. Bosh
52)
With respect to large bowel obstruction
a.
b.
Often associated with diverticulitis in the elderly. More often Ca
*Associated with sigmoid volvulus in under 2
14)
a.
b.
c.
d.
e.
Regarding pancreatitis which of the following is TRUE?
Amylase is negative in 50% of cases
15)
a.
b.
c.
d.
e.
With respect to the diagnosis of appendicitis
WCC is greater than 10,000 in 70% of cases
14)
Regarding pancreatitis which of the following is true
a.
Amylase is negative in 50%. Acute pancreatitis amylase has sensitivity 80-90
and specificity 75. Lipase sensitivity is 90 and specificity is 90. Pancreatitis occurs
with no rise in amylase in 10-20% especially in chronic. Lipase is more useful in this
setting
15)
With repsct to the diagnosis of appendicitis
a.
WCC >10,000 in 70%. WCC >10,000/ul is 70-90% sensitive but specificity is
very low
26)
a.
b.
c.
d.
e.
With respect to abdominal hernias which of the following statements is TRUE?
Hydrocele is the commonest testicular abnormality in kids
Inguinal hernias are commonest in premature infants
Male and female ratio of femoral hernias
26)
With respect to abdominal hernias
a.
Hydrocoele is the commonest abnormality in kids. Hernias probably more
common than hydrocoeles and can be difficult to distinguish.
b.
**Inguinal hernias are commonest in prems
c.
Male:female ratio of fem hernias = 5:1
3. Acute Liver failure
Paracetamol most common cause hepatitis B with D according to Rosen, viral
hepatitis according to ICU manual but in the UK paracetamol poisoning is the most
common. UK and USA is paracetamol (google)
9. The following is true of abdominal xrays except
Free air 1-2ml can be detected – not true
Lateral decubitis xray has high sensitivity for free air if the patient cannot stand
Definitive diagnosis is made in 80% of small bowel obstruction
Dose of radiation 50 times that of CXR
Most children < 3yo need diagnostic barium enema
10. Regarding diverticular disease
Attacks are more severe in patients under 40yo True (Dunn)
A mass is rarely felt can be felt PR or on abdominal palpation
50% of patients have occult blood in bowel motions
Some may have only right sided tenderness 1.5%, increased in Asians
Most AXRs in diverticular disease show ileus and distension
17Which of the following is TRUE regarding meat impaction in the oesophagus?
A. Endoscopy should be performed within 6 h, even in patients who are
handling their own secretions.
B. Oesophageal pathology is present in up to 50% of patients.
C. Glucagon, nifedipine, and meat tenderiser should all be tried before
endoscopy.
D. After the patient feels the bolus has passed, a barium swallow should be
performed.
E.
Patients without airway compromise can be observed as outpatients and
scheduled for a 24-h follow up.
18Which of the following statements is MOST correct regarding abdominal
pain the elderly?
F.
Elderly patients are unlikely to have the problems of younger patients,
such as appendicitis or cholecystitis.
G. Given the same underlying diagnosis for an acute abdominal disorder, the
elderly have about the same mortality rate as younger patients.
H. The elderly exhibit less pain and tenderness than younger patients, but
they are more likely to have fever and leukocytosis than are younger
patients.
I.
Diagnostic delays and pre-existing illnesses lead to a higher mortality in
elderly patients than in younger patients.
J.
The elderly are more likely than younger patients to seek early medical
attention for abdominal pain.