 Basic Surgical Techniques PL05- PL07.

1. Sutures and Suturing.

***) Twenty milliliters of 2% Lidocaine contains:
A. 20 mgs
B. 40 mgs
C. 200 mgs
D. 400 mgs
E. 800 mgs

Answer: D* 400mgs

 Wounds PL07- PL13.

1. Wounds.
???) Wound healing is enhanced by the administration of all the following, except:
A. High protein diet
B. Vitamin C
C. Cortisol
D. Oxygen
E. Zinc

Answer: C* Cortisol

???) The major cause of impaired wound healing is:

A. Anemia
B. Diabetes mellitus
C. Local tissue infection
D. Malnutrition
E. Steroid therapy

Answer: C* Local tissue infection

???) Wound healing is affected by all the following except:

Black skin
Oxygen
Blood supply
Nutrition
Vitamin C

Answer: 1* Black skin

???) The most common source of bacteria in wound infection after groin hernia repair is:
The patient's skin
The patient's nasopharynx
Operating room air
Surgical instruments
Operating room staff

Answer: 1* The patient's skin

???) Management of contaminated contused wound is best by:

Primary suturing
Dressing and antibiotics
Wound debridement, dressing daily, antibiotics and suturing later on
Primary excision and grafting
Tetanus toxoid and primary suturing

Answer: 3* Wound debridement, dressing daily, antibiotics and suturing later on

???) Regarding crushed (war) wounds all of the following should be done, except:
Good debridement
Washing the inside of the wound with normal saline
Giving good doses of broad spectrum antibiotics
Giving tetanus immunoglobulin
Primary wound closure

Answer: 5* Primary wound closure

???) The most dangerous type of wounds is the:

Incised
Lacerated
Penetrating
Crushed
Abrasion

Answer: 4* Crushed

???) The immediate treatment of a sucking wound in the chest should be:
Thoracoscopy
Tracheostomy
Under water seal drainage
Immediate closure of the wound by any maneuver irrespective of bacterial contamination
Give good dose of morphine and antibiotics

Answer: 4* Immediate closure of the wound by any maneuver irrespective of bacterial

contamination

???) Factors which contribute to wound dehiscence include all except:

Vit C deficiency
Local radiation
Hypoproteinemia
Anemia
Malignancy

Answer: 4* Anemia

???) In wound dehiscence all are considered to be causes, except:

Anemia
Hypoalbuminemia
Ascites
Chronic pulmonary disease
Chronic cough

Answer: 5* Chronic cough

 Ulcers PL14- PL16.

1. Lower Limb Ulcers.
???) A chronic leg ulcer just above the medial malleolus and surrounded by brownish skin
pigmentation is usually:
Ischemic ulcer
Venous ulcer
Tuberculous ulcer
Chronic non-specific ulcer
Malignant ulcer

Answer: 2* Venous ulcer

???) All of the following are causes of leg ulceration, except:

Venous insufficiency
Arterial insufficiency
Sickle cell disease
Erythema nodosum
Post-cellulitis

Answer: 4* Erythema nodosum

???) All of the following are causes of leg ulceration, except:

Beta-thalassemia trait
Ulcerative colitis
Syphilis
Polyarteritis nodosa
Diabetes mellitus
Answer: 2* Ulcerative colitis

???) Regarding diabetic foot all of the following are true, except:
Correction of an associated anemia or pulmonary disease improves the condition of the foot
Diabetes has to be controlled by insulin therapy
Amputation is required once bone is infected
Sympathectomy has a major role in the management
Antibiotics against aerobes and anaerobes are to be given

Answer: 3* Amputation is required once bone is infected

???) Patients with diabetic foot, all are causes for the condition, except:
Unnoticed trauma
High blood sugar
Altered immunity of the patient
Infection
Ischemia of the lower limb

Answer: 3* Altered immunity of the patient

???) As regard diabetic foot all of the following are correct, except:
Infection, neuropathy and angiopathy share in its development
Pockets of pus must be opened widely
Sympathectomy is of great benefit
Angiography may be needed
In infected type diabetes must be controlled by insulin

Answer: 3* Sympathectomy is of great benefit

???) In the management of infected diabetic foot all of the following are correct, except:
Diabetes is controlled by one of the hypoglycemic drugs
The limb has to be elevated on one or two pillows
Antibiotics against aerobes and anaerobes should be given
Any associated blood, chest or heart disease causing tissue hypoxia should be managed
If amputation is required conservative one is usually adopted

Answer: 1* Diabetes is controlled by one of the hypoglycemic drugs

???) The most important predisposing cause to diabetic foot is:

Hyperglycemia
Ischemia
Neuropathy
Infection
Unnoticed injury
Answer: 1* Hyperglycemia

???) The least important factor in developing diabetic foot ulcers is:
Atherosclerosis
Peripheral neuropathy
Microangiopathy
Obesity
Decreased immunity

Answer: 4* Obesity

???) Regarding diabetic foot ulcers all are true except:

It is the most common cause of amputation in adults
Diabetic foot with cellulites should be treated with IV antibiotics
Patients with severe infections and high serum glucose should be given oral hypoglycemic drugs
Prevention of diabetic foot ulcers is better than treatment
30% of patients with amputation will need another amputation in 5 years

Answer: 3* Patients with severe infections and high serum glucose should be given oral
hypoglycemic drugs

2. Pressure Ulcers.
???) The most important factor in the development of ulcers in a spinal cord injury patient is:
Malnutrition
Septic episodes
Anemia
Local pressure
Diminished sensation

Answer: 4*Local pressure

 Burns PL16- PL21.

1. Burns.
???) All of the following are signs of burn inhalation Injury except:
Erythema of oral mucosa
Coughing
Black sputum
Red colored burn
Burn of nasal hair

Answer: 4* Red colored burn

???) All of the following are true regarding second degree burn except:
It involves the epidermis and part of the dermis
Red to white
Wet
Painless
Blisters

Answer: 4* Painless

???) The burn that is difficult to estimate in percentage is the:

Electrical burn
Sun burn
Scald burn
Direct flame burn
Chemical bum

Answer: 1* Electrical burn

???) The best dressing for an excised burn wound is:

Silver sulfadiazine (Flamazine)
Nitrofurazone (Furacine)
Mafenide acetate (Sulfamylon).
Autograft
Allograft

Answer: 4* Autograft

???) Immediate shock in the burn patient is caused by:

Fluid loss through the burn wound
Fluid shift to the extravascular compartment
Edema of burned tissues
Edema of unburned tissues
Other injury

Answer: 5* Other injury

???) The most important step in the early management of extensive burns is:
Prevention of burn shock by giving i.v. fluids and analgesics
Giving tetanus toxoid
Antibiotics administration
Immediate split thickness grafting
Dressing of the burn area

Answer: 1* Prevention of burn shock by giving i.v. fluids and analgesics

???) 40 years old patient presented to ER with 10% thickness burns, is best treated by:
Admission to hospital + 2 liters i.v. R/L daily
Admission to hospital + i.v. fluids + antibiotics
Dressing + outpatient follow up
Immediate excision + grafting
Admission to hospital + i.v. fluid + blood transfusion

Answer: 2* Admission to hospital + i.v. fluids + antibiotics

???) All of the following features are common in the early period after severe burns, except:
Hypotension
Tachycardia
Oliguria
Low hematocrit value
Confusion

Answer: 2* Tachycardia

???) A 20 years old patient arrived at the accident and emergency department with a burn
involving the whole right lower extremity. The surface area involved will be:
10%
7%
18%
9%
36%

Answer: 3* 18%

???) If the whole skin of one of the lower extremities is burnt the, percentage of burn is:
9%
18%
27%
36%
50%

Answer: 2* 18%

 Hand PL21-PL27.
1. Hand Infections.
***) In hand infections all of the following are true, except:
A. Early antibiotic therapy is essential and may abort the inflammation
B. Early recognition of the presence of pus is necessary
C. Incision, evacuation of the pus and debridement of the wall of the abscess must be done
D. Physiotherapy and exercises form an important part of the late after-treatment
E. Lowering of the affected limb is essential to reduce pain, edema and spread of the
inflammation
Answer: E* Lowering of the affected limb is essential to reduce pain, edema and spread of the
inflammation

2. Fractures and Dislocations.

???) Bennet’s fracture occurs at:
A. Distal end of radius
B. Base of the first metacarpal bone
C. Neck of femur
D. Ankle joint
E. Surgical neck of the humerus

Answer: 2* Base of the first metacarpal bone

 Craniofacial Injuries PL28- PL32.

1. Fractures.
???) Concerning base skull fracture involving the anterior fossa all of the following are true
except:
Epistaxis
Battle sign
Blindness
Raccoon eyes
CSF Rhinorhea

Answer: 2* Battle sign

???) The absolute indication for surgical repair of depressed skull fracture Is:
Overlying the saggital sinus
Over an eloquent area with no neurological deficits
Compound dirty fractures
Sharp angle of fracture
Underlying thin noncompressing sub dural hematoma

Answer: 3* Compound dirty fractures

???) In basal skull fracture all are correct except:

Rhinorrhea : cerebrospinal fluid is leaking from the nose
Otorrhea : cerebrospinal fluid is leaking from the ears
Raccoon eyes : periorbital ecchymosis
Battle's sign : retroauricular ecchymosis
Treatment is often surgical

Answer: 5* Most basal skull fractures do not require treatment. These fractures tend to heal
themselves.
???) Which one of the following needs urgent surgical treatment:
Brain concussion
Brain stem laceration
Compound fracture of the vault of the skull
Linear fracture of the vault of the skull
Compound fracture of the skull base

Answer: 5* Compound fracture of the skull base

 Pediatric Plastic Surgery PL34- PL36.

1. Craniofacial Anomalies.
???) Surgical repair of cleft lip is usually undertaken at the age of:
One week after birth
At the age of 3 months
At the age of one year
At the age of two years
At the age of five years

Answer: 2* At the age of 3 months