PRINCIPLES OF SURGERY

ESSENTIAL TOPICS FOR THE PART I EXAMINATION OF THE

MS (General Surgery / Orthopedics / Otorrhinolaryngology)
UKM
PREOPERATIVE MANAGEMENT
1. Investigations in Surgical Practice
a. General Investigations
b. Preoperative Investigations (including imaging techniques)
2. Preoperative assessment
3. Endoscopy in Surgical Practice
4. Consent for Surgery
5. Medical Problems in the Surgical Patients
6. Surgical Nutrition
7. Surgery in Special Patients
a. The Elderly
b. The Pregnant Woman
c. The Immunocompromised
8. Preoperative Skin Preparation
9. Preoperative Bowel Preparation
10. Principles of Wound Healing
11. Antibiotic Usage in Surgery

ANAESTHESIA
1. Principles of Premedication
2. Principles of Anesthesia
a) General anesthesia
b) Regional Anesthesia
c) Local Anesthesia "'
SURGICAL OPERATIONS AND RELATED TOPICS
1. Setting up the Operating Theatre
2. Principles of Sterilization and Disinfection
3. Day Care or Ambulatory Surgery
4. Hazards in the Operating Theatres
5. Principles and Anatomy of Surgical Access
6. Basic surgical techniques (including sutures and suture materials, dressings,
plaster casts etc.)
7. Homeostasis in Surgery
8. The Use of Diathermy in Surgery
9. Basic Principles of Usage of Implants and Prosthesis in Surgery
10. Basic Principles of Minimal Access Surgery
11. Surgical Drains

POSTOPERATIVE MANAGEMENT
1. Management of Postoperative Pain
2. Pyrexia in the Postoperative Period
3. Postoperative Respiratory Complications
4. Postoperative Abdominal Complications
5. Postoperative Wound Infection and Dehiscence
6. Deep Vein Thrombosis
7. Acute Pulmonary Embolism

CRITICAL CARE SURGERY

1. Metabolic Response to Trauma, Starvation and Sepsis
2. Systemic Inflammatory Response Syndrome (SIRS)
3. Septicemia
4. Monitoring the Critically III Patient
5. Fluid and Electrolyte Therapy
6. Acid Base Balance
7. Surgical Hematology and Transfusion Practice
a) Blood transfusion
b) Blood Component products
8. Acute Renal Failure
9. Acute Respiratory Failure.
a. Acute respiratory distress syndrome
b. Pulmonary Embolism
c. Fat Embolism
10. Acute Hepatic Failure
11. Disseminated intravascular coagulation (DIVC)
SURGICAL EMERGENCIES
1. Basic Principles in the Management of Shock and Multiple Trauma (including
chest tube insertion, diagnostic peritoneal lavage, tracheostomy, central venous
catheter insertion etc.)
2. Basic Principles in the Management of Fractures
3. Basic Principles in the Management of Bums
4. Acute Gastrointestinal Bleeding
5. Acute abdomen

SURGICAL ONCOLOGY
1. Tumourogenesis and Oncogenes
2. Tumor Markers
3. Principles of Ontological Management
4. Principles of Adjuvant and Neoadjuvant therapy
5. Principles of Radiation Therapy
 6. Principles of Chemotherapy & Hormonal Therapy

OTHER GENERAL TOPICS IN SURGERY

1. Management of Skin Ulcers e.g. diabetic ulcers, pressure sores etc.
2. Surgical infections including Tuberculosis, Viral (Hepatitis, AIDS), Bacterial
(tetanus, gas gangrene)
3. Nosocomial Infection and Outbreak of Wound Infection
4. Surgical Audit

SURGERY MCQs
1. The following are true of the management of hemorrhage
A. In a healthy adult, loss of 500 cc blood is associated with tachycardia at rest = F
B. In a patient on concomitant intermittent positive pressure ventilation,
measurement of central venous pressure remains low despite adequate
replacement of blood loss - F
C. A urine output of 0.25 cc/kg/hour indicates adequate replacement of blood loss -
F
D. Hypokalemia is a complication of stored blood transfusion - F
E. The oxygen carrying capacity of stored blood is lower in the first 24 hours post
transfusion - T

2. When inserting a central venous line

A. The catheter tip should be positioned in the innominate vein - F
B. The internal jugular route is the best for long term management - F
C. The normal central venous pressure should read 5-12 cmH20 - T
D. Via the subclavian route, failing on one side should prompt an attempt on the
other side - F
E. A wide bore catheter is preferred mainly for blood transfusion - F

3. Regarding Advanced Trauma Life Support (ATLS):

A. The first priority is gaining venous access - F
 B. Central lines are preferable to peripheral lines for resuscitation - F
C. Supplemental oxygen should only be given when hypoxia has been
demonstrated - F
D. Cervical collars can be removed when normal cervical spine x-rays have been
obtained - F
E. Failure to visualize C7/T1 on standard lateral views indicates the need for CT
scan - F

4. The following are true of nutritional support in the surgical patient

A. There is no definite association between malnutrition and increased morbidity
and mortality - F
B. Where possible administration of specific enteral diets through a feeding tube is
preferable to a total parenteral nutrition via a central line - T
C. Short term total parenteral nutrition improves the clinical course of severe acute
pancreatitis - F
D. Hypoalbuminemia is a specific parameter of a poor nutritional status - F
E. Short term treatment with isotonic glucose solutions does not affect the outcome
negatively after major elective operations - T

5. The following are true of systemic inflammatory response syndrome (SIRS)

A. It occurs in association with infection or non-infectious insult such as trauma or
burns - T
B. Gram negative bacteria are responsible in 90% of cases - T
C. The typical features of presentation includes pyrexia, tachycardia and
tachypnoea - T
D. SIRS is a sequel of multiple organ dysfunction - F
E. Specifically directed therapies are successful in influencing outcome of SIRS - F

6. In osteoarthritis
A. Pathological changes occur primarily in articular cartilage - T
B. There is no effect on surrounding soft tissues of the joint - F
C. The earliest abnormality is increase of water content of articular cartilage - T
D. The pathological changes are qualitatively similar to ageing - T
E. There is progressive cartilage destruction - T

7. The following are true of pulmonary thromboembolism (PTE)

A. Majority of patients have clinical signs and symptoms of deep venous thrombosis
-F
B. The incidence increases with increasing age - T
 C. The clinically significant PTE commonly arises from the calf veins - F
D. Friction rub if present is commonly heard over the lung bases - T
E. Ventilation perfusion scanning using 133 Xenon is the definitive method of
establishing diagnosis - F

8. In traumatic complete severance of the ulnar nerve at the wrist

A. Only the palmar interossei are paralysed - F
B. Froment's sign tests the adductor pollicis - T
C. Wallerian degeneration occurs proximal to the level of severance - F
D. Autonomic function over the ulnar aspect of the hand remains intact - F
E. Electrical stimulation of the nerve prevents neuroma formation - F

9. In obstructive jaundice
A. Liver function test accurately diffentiates between the different types of jaundice -
F
B. Endoscopic retrograde choledocho-pancreatogram should be the first line
radiological investigation - F
C. Due to oriental cholangitis, treatment by a sphicterotomy is effective - F
D. Due to a retained stone following a common bile duct exploration, the T-tube
should be left in-situ for six weeks to facilitate further management - T
E. Vitamin K should be administered for all patients with obstructive jaundice - T

10. The following is/are true regarding tracheostomy

A. It reduces the respiratory dead space - T
B. It is the best way to relieve airway obstruction in laryngeal trauma - T
C. It is performed between the 3rd and 4th tracheal rings - T
D. Injury to the recurrent laryngeal nerve is a common complication - F
E. A cuff tracheostomy tube is best for long term use - F

11. Following the rapid loss of 1.5 liters of blood

A. There is increased impulse activity in the carotid sinus nerves - F
B. There will be an immediate reduction in hematocrit - F
C. Load pressure will be approximately 100 - 80/60 - T
D. Angiotensin II causes the release of aldosterone from the zona fasciculata of the
adrenal cortex - F
E. Sympathetic stimulation causes strong contraction of the afferent arterioles of the
juxta medullary nephrons - F

12. A patient is in shock following fractures to both legs. An arterial blood sample
taken on admission to hospital shows pH 7.02, pC02 7.3 kPa (55 mmHg) and
p02 4kPa (30mmHg)
A. The acidosis is partly due to anaerobic metabolism - T
B. The acidosis is partly due to carbon dioxide retention - T
C. Renal plasma flow will be approximately 700 ml per minute - F
D. Blood insulin levels will be high - F
E. He is likely to have had pre existing respiratory disease - T

13. In a 70 kg man, the following suggest inadequate perfusion of vital organs

A. An arterial hydrogen ion concentration of 33 nM - F
 B. A brachial artery BP of 100/60 mmHg - F
C. A cardiac index of 1.5 1/min/sq m - T
D. A urine output of 400 ml/24 hours - T
E. A mixed venous P02 of 3.3 kPa (25 mmHg) - T

14. A healthy man loses 500 ml blood in five minutes while remaining horizontal
A. His systolic blood pressure will fall significantly - F
B. His heart rate will be 80 - 100/minute - T
C. There will be a substantial fall in C.V.P - F
D. He will be pale and sweating - F
E. There will be an increase in ADH in the plasma due to stimulation of the left atrial
receptors - F

15. Cardiac Tamponade is characterized by

A. Bradycardia - F
B. A raised JVP with altered wave form - T
C. A fall in systolic blood pressure of less than 5 mmHg on inspiration - F
D. A widening of the pulse pressure - F
E. Rapidly increasing dyspnoea - T

16. In a patient with a massive pulmonary embolus

A. The sitting position is preferred - F
B. J receptors are stimulated - T
C. The only cause for cyanosis is central - F
D. Atrial fibrillation may occur - T
E. A right to left shunt may occur across an atrial septal defect in 25% of normal
people - T

17. Following a severe hemorrhage, a patient has a cardiac output of 2 litres /

minute
A. An arterial blood sample would show pH 7.18, and PC02 3.7 kPa (28 mmHg) - T
B. Their urine output will be approximately 40 ml/hour - F
C. Blood free fatty acids will be elevated - T
D. Thirst is due to stimulation of receptors in the ventro medial nucleus of the
hypothalamus - F
E. Their dead space/tidal volume ratio will be greater than 30% - T

18. In a patient with left ventricular failure

A. The ratio of blood volume in the pulmonary circulation to that in the systemic
circulation is decreased - F
B. The Pa02 decreases and the PaC02 invariably increases - F
C. Lung compliance is decreased - T
D. Pulmonary capillary wedge pressure is 6 mmHg - F
E. The left ventricular end diastolic pressure may be 10 to 25 mmHg - T

19. Anaphylactic Shock

A. May follow the administration of diagnostic contrast media for radiology - T
B. Occurs chiefly by histamine acting on H2 receptors - F
C. Is accompanied by prolonged smooth muscle contraction produced by the
 leukotrienes C4 D4 and E4 - T
D. Its production always involves IgE - F
E. May be accompanied by a supraventricular arrhythmia - T

20. In a burned patient

A. The increased capillary permeability lasts 8 hours from the time of injury - F
B. The total water loss is approximately 2 to 3 ml/kg/% burn/day - T
C. There is a loss of 1% of the RBC mass for every 2% surface area burned - T
D. An adult with burns covering 50% body surface requires approximately 5000
kcals and 35G nitrogen/day - T
E. If infection supervenes, metabolic rate rises by 5%/oC rise in temperature - F

21. An arterial blood sample from a 25-year-old diabetic patient showed PH7.06,
PC02 3.5 kPa (26 mmHg), P02 12 kPa (90 mmHg), plasma Na+ 125mM, and
K+3.0mM
A. There is a metabolic acidosis - T
B. The patient has primary dehydration - F
C. The plasma HC03 in the sample is approximately 12 mM - F
D. Cardiac contractility will be increased - F
E. Urine to plasma osmolarity will be less than 2:1 - F

22. Endotoxic Shock

A. May be caused by Proteus infections -T
B. During phase 1 arterio venous oxygen difference is markedly increased - F
C. Is accompanied by D.I.C - T
D. In phase 1 blood pressure is elevated - F
E. ARDS is a complication - T

23. The pharmacological effects of histamine given parenterally in man include

A. A rise in systemic blood pressure - F
B. Increased pepsin output from the stomach - T
C. Bronchoconstriction - T
D. Pupillary dilatation - F
E. Relaxation of intestinal smooth muscle - F

24. With respect to plasma expanders

A. Dextran 70 is usually given as a 6% solution in 0.9% sodium chloride - T
B. Dextran 70 may interfere with blood typing - T
C. Hemaccel is urea linked gelatin - T
D. Dextran is a 1 : 4 linked polymer of glucose - F
E. Dextran 70 exerts a colloid osmotic pressure of 25 mmHg - F

25. Right ventricular failure

A. May occur in patients with a large AV fistula - T
B. Is associated with a right ventricular pressure of 8-20 mmHg - T
C. Is associated with the development of acute ankle edema - F
D. The patient may complain of pain in the right upper quadrant of the abdomen - T
E. Ascites is an early manifestation - F
26. A patient with cor pulmonale has the following features
A. Cyanosis - T
B. Sacral edema when lying down - T
C. A normal PaC02 - F
D. A JVP of 1 cm above the sternal angle when examined in the 45o position - F
E. Signs of a congested liver - T

27. In septicaemic shock

A. A white cell count of less than 10 x 109/1 makes a staphylococcal infection
unlikely - F
B. Staphylococcal septicemia may be associated with raised serum lipids - F
C. Skin hemorrhages may be a feature - T
D. Tumor necrosis factor is a mediator in endotoxic shock - T
E. The active portion of the endotoxin is lipid A antigen - T

28. Cardiogenic shock due to coronary artery occlusion

A. May follow the occlusion of the anterior descending branch of the left coronary
artery - T
B. May be associated with bradycardia - T
C. Pulmonary capillary wedge pressure is 6-10 mmHg - F
D. Lung compliance is normal - F
E. Mitral regurgitation may occur - T

29. In a patient who has suffered blood loss

A. Due to a fractured femur, up to .5 1 of blood may have been lost - T
B. The immediate measurement of the haematocrit is a good indicator of the volume
lost - F
C. Hyperventilation is in part due to ischemia of the carotid sinus - F
D. Of one liter, if the patient is not transfused, red cell mass will be restored to
normal in 4-8 weeks - T
E. A systolic BP < lOOmmHg indicates a deficit > 30% in circulating blood volume -
T

30. In a 70kg patient with 30% burns

A. If the wounds become infected it is usually with pseudomonas pyocyanae - T
B. IIeus usually lasts for 12-24 hours post burn - F
C. Total water loss per day will be approximately 2.5L - F
D. Blood viscosity will be reduced - F
E. Cimetidine may be used in treatment - T

31. In a patient with severe mitral stenosis

A. Pulmonary capillary wedge pressure is 6 to 12 rnmHg - F
B. There are radiological appearances of pulmonary haemosiderosis - T
C. They suffer from orthopnoea - T
D. They are predisposed to re entrant arrhythmias - T
E. They have a very large right atrium - F
32. Indicators for the immediate assessment of severity of blood loss include
A. Haematrocrit - F
B. Heart rate - T
C. Blood pressure - T
D. Plasma urea concentration - F
E. CVP - T

33. After a hemorrhage of 1 liter in 15 minutes in an adult

A. The type B atrial receptors are stimulated - F
B. There is an increased rate of discharge of neurones in the supra optic nucleus - T
C. Blood pressure is approximately 80 of normal - F
D. Circulating plasma volume is restored after 6 days - F
E. Red cell mass is restored to normal after 12 weeks - F

34. In a patient who has suffered a hematemesis from bleeding esophageal

varices
A. A small warning bleed often occurs prior to the major bleed - T
B. Clotting factor deficiency is best replaced with intra muscular Vitamin K - F
C. Octreotide may be used in treatment - T
D. Following the bleed there is often worsening of any hepatic encephalopathy
which may be present - T
E. Renal failure is a complication - T

35. Vaso vagal syncope

A. May follow a strong emotional experience - T
B. Is associated with arteriolar vasoconstriction in the striated muscle beds - F
C. The arterioles of blood vessels supplying the skin are widely dilated - F
D. Bradycardia is present - T
E. Is often associated with an 'abdominal sinking' feeling - T

36. Leukoplakia
A. Can be removed by scrapping - F
B. Is always a smooth white patch - F
C. Is more common in males - T
D. In the lips account for 10% of all cases - T
E. Dysplastic epithelium is more commonly seen in the nodular type - T

37. Factors which increase the risk of malignancy in leukoplakia

A. Male sex - F
B. Megaloblastic anemia - F
C. Excessive alcohol intake - T
D. Excessive tobacco consumption - T
E. Larger Erythroplakic component - T

38. In Slipped Upper Femoral Ephiphyses (SUFE)

A. 70% of time it is acute in onset - F
B. Is more common in boys - T
 C. The peak age of onset is 8yrs in girls and 10yrs in boys - F
D. The posterior periosteum is commonly torn - F
E. Pinning in situ is done for cases with more then 50% slip - F

39. In Perthe’s disease the below mentioned radiological changes points towards
a worse prognosis
A. Lytic area in the lateral part of the epiphysis and the adjacent metaphysis - T
B. Calcification lateral to the epiphysis - T
C. Extensive metaphyseal changes - T
D. Horizontal growth plates - T
E. Increase in the joint space - F

40. The below mentioned are the changes seen in CDH

A. A lax psoas tendon - F
B. Atrophied ligamentum teres - F
C. Retroverted femoral neck - F
D. Hour glass constriction of the capsule - T
E. Shallow acetabulum - T

41. In CDH
A. The fibrocartilaginous labrum is everted - F
B. The femoral neck is retroverted - F
C. The bony nucleus of the capital epiphysis appears earlier - F
D. Is bilateral in 2% of cases - F
E. The acetabulum faces posterolaterally - F

42. In Perthe’s disease

A. Girls are affected more commonly - F
B. Typical age of onset is 10 to 13 yrs old - F
C. Is bilateral in 2% of cases - F
D. Radiographs show a decrease in joint space - F
E. The process of creeping substitution is denoted by an increase in the density on
the radiographs - T

43. Regarding Diabetic Vasculopathy

A. Is more common in females - F
B. The gangrene that ensues is of the dry type - T
C. Can be prevented by strict control of blood sugar - F
D. Can cause amputation of toes - T
E. Is usually associated with absent pulses - T

44. Drugs used with caution in patients with liver disease include
A. Cimetidine - T
B. Spironolactone - F
C. Chlorpropamide - T
D. Benzylpenicillin - F
E. Oral contraceptives - T
45. Side effects of morphine include
A. Venoconstriction - F
B. Pupillary dilatation - F
C. Nausea and vomiting - T
D. Relaxation of the Sphincter of Oddi - F
E. Itching - T

46. Drugs used in the treatment of cardiac arrhythmias include

A. Lignocaine - T
B. Temazepam - F
C. Verapamil - T
D. Amitriptyline - F
E. Metoprolol - T

47. Dopamine
A. Exerts a positive inotropic effect - T
B. Causes vasoconstriction of renal arterioles at all doses - F
C. Causes bronchodilatation - F
D. Is the drug of choice in anaphylactic shock - F
E. Is usually given in a dose of 2-5 mg/kg/min initially - T

48. Warfarin
A. Prevents the formation of clotting factors 2, 7, 9 and 10 - T
B. Effects are monitored by measurement of the APTT - F
C. Crosses the placenta- T
D. Is effective as an anticoagulant within 12-18 hours of the first dose being given -
F
E. Can be displaced from plasma protein binding sites by aspirin - T

49. Chloramphenicol
A. Does not penetrate the blood brain barrier - F
B. Must be administered parenterally - F
C. Can be safely used in premature infants - F
D. Can cause depression of the bone marrow functions -T
E. Can cause discoloration of developing teeth when given to children - F

50. Nitrous Oxide

A. Can be used with oxygen as a carrier gas for Halothane - T
B. Has poor analgesic properties - F
C. Forms an explosive vapor - F
D. Sensitises the heart to the action of catecholamines - F
E. is effective in inducing anesthesia - T

51. Constipation may be caused by

A. Propantheline - T
B. Trimetaphan - T
 C. Morphine - T
D. Hypokalaemia- T
E. Methyl Cellulose - F

52. Salbutamol
A. Has no action on heart rate - F
B. Can cause hypokalaemia in high doses - T
C. Causes bronchodilatation - T
D. Can cause a fine tremor of the hands - T
E. Is effective when swallowed - F

53. Thiopentone
A. Is a highly lipid soluble barbiturate - T
B. Is predominantly excreted in the urine - F
C. Has its anesthetic action terminated by metabolism to an inactive compound - F
D. Has good analgesic properties - F
E. In aqueous solution is alkaline and irritant if the injection is misplaced outside the
vein - T

54. Gentamycin
A. Is effective against aerobic Gram Negative bacilli - T
B. Prevents normal association of mRNA with ribosomes - F
C. Is nephrotoxic - T
D. May impair neuromuscular transmission - T
E. Is very effective for pneumococcal infections - F

55. Codeine
A. Is present in opium - T
B. Frequently causes diarrhea - F
C. May enhance the effects of alcohol - T
D. Is equipotent to pethidine as an analgesic - F
E. Depresses the cough reflex - T

56. Cimetidine
A. Is a histamine H¹ receptor antagonist - F
B. Causes both a reduction in volume and [H+] in gastric juice - T
C. Delays gastric emptying - F
D. Is an inhibitor of drug oxidizing enzymes - T
E. May cause gynaecomastia - T

57. Bronchodilator drugs include

A. Terbutaline - T
B. Sodium Chromoglycate - F
C. Ipratropium - T
D. Theophylline - T
E. Carbamazepine - F
58. With respect to antihypertensive drugs
A. Clonidine is an alpha 2 adrenoceptor agonist suppressing sympathetic outflow - T
B. Reserpine blocks the amine pump for noradrenaline reuptake into nerve endings
-F
C. Bendrofluazide is used in a dose of 2.5 - 5 mg taken in the morning - T
D. Hydralazine is a very potent venodilator - F
E. ACE inhibitors may cause a dramatic drop in blood pressure in patients on
diuretic therapy - T

59. Tetracyclines
A. In therapeutic doses are bacteriocidal - F
B. Are mainly excreted in the urine - T
C. May cause liver damage in pregnancy - T
D. Are concentrated in the bile - T
E. Depress protein anabolism - F

60. Halothane
A. May cause hypotension - T
B. Is inflammable - F
C. Commonly induces coughing and breath holding - F
D. Can be hepatotoxic on repeated exposure - T
E. Is eliminated 70% in the kidneys - F

61. Pethidine
A. Is as potent an analgesic agent as morphine - F
B. Can be given orally - T
C. Does not cross the placenta - F
D. Produces atropine like effects - T
E. Effects are not antagonised by naloxone - F

62. Frusemide
A. Acts on the thick portion of the ascending limb Loop of HenIe - T
B. Causes urinary loss of Ca++ and Mg++ - T
C. May cause deafness if used in large doses T
D. May cause hyperkalemia - F
E. Produces a diuresis which is complete within 2 hours following oral administration -
F

63. With respect to Beta adrenoceptor blocking agents

A. Oxprenolol administration may lead to bronchoconstriction - T
B. Acebutalol is relatively cordioselective - T
C. They cause vasodilatation in skeletal muscle - F
D. Hyperglycaemia may occur with non specific agents - F
E. These include phenoxybenzamine - F
64. With respect to chemotherapeutic agents
A. Plicamycin (Mithramycin) is used to treat hypercalcaemia of malignant disease - T
B. Doxorubicin can cause a cardiomyopathy in high dose - T
C. A side effect of cyclophosphamide therapy is haemorrhagic cystitis - T
D. Bleomycin causes very marked suppression of bone marrow function - F
E. They are effective in the treatment of esophageal carcinoma - F

65. Anti-emetic agents include

A. Hyoscine - T
B. Clofibrate - F
C. Prochlorperazine - T
D. Metoclopramide - T
E. Domperidone- T

66. With respect to the Cephalosporins

A. Their excretion is mainly into the bile - F
B. Ceftazidime is active against Pseudomonal Infections - T
C. Cefuroxime is a third generation cephalosporin - F
D. They can be used in the treatment of biliary tract infection - T
E. Cephamandole is rapidly inactivated by penicillinases - F

67. Omeprazole
A. Is a H+, K' - ATPase inhibiter - T
B. Inhibits stimulated but not basal acid secretion - F
C. To be effective needs to be administered at 6 hourly intervals - F
D. Can prolong the elimination of diazepam and phenytoin - T
E. Inhibits glucose reabsorption in the proximal tubule of the kidney - F

68. In the post-operative period

A. A fatal pulmonary' embolus is usually preceded by evidence of a deep thrombosis
in the legs - F
B. Dehiscence of an abdominal wound is more likely to occur in patients who develop
pulmonary collapse - T
C. Thrombus usually begins to form in leg veins in the 2nd week - F
D. Staphytococcal enterocolitis should be treated with a broad spectrum antibiotic - F
E. Less than 1% of wounds become infected - F

69. Carcinoma of the colon

A. Occurs most frequently in the transverse colon - F
B. Spread by the blood stream occurs late - T
C. Invariably develops in patients with familial polyposis of the colon unless they are
treated surgically - T
D. Occurs in more than 50°o of cases ofulcerative colitis, of 20 years duration - F
E. Is more likely to cause intestinal obstruction if the tumour is in the ascending colon
-F

70. In acute cholecystitis

A. Severe nausea and vomiting are features in the early stages - T
B. Cholecystectomy is best performed about one week after the onset of the illness -
F
 C. Leucocytosis occurs - T
D. Bacteroides is commonly cultured from bile or the gall bladder wall - F
E. A tender mass can often be felt in the upper abdomen -T

71. In a patient with a solid lump in the breast

A. Tethering of the lump to the skin is pathognomonic of carcinoma - F
B. Diagnosis of fat necrosis should not be made unless there is a history of trauma- T
C. Excision biopsy is mandatory - T
D. Associated blood stained discharge from the nipple is strongly suggestive of
carcinoma - F
E. Pre menstrual pain in the lump is suggestive of localised chronic mastitis - T

72. In the treatment of thyrotoxicosis

A. By surgery, carbimazole 30-40mg a day is the drug of choice for preparation - T
B. By radio iodine, the incidence of thyroid insufficiency may reach 10% after ten
years - F
C. By anti thyroid drugs, some goitres enlarge and become very vascular - T
D. By surgery, subtotal resection of each lobe is performed, leaving 4-5G by thyroid
tissue on each side - T
E. By radio iodine, a substantial improvement is seen in approximately two weeks - F

73. The differential diagnosis of acute appendicitis includes

A. Pneumonia- T
B. Herpes zoster - T
C. Ectopic gestation - T
D. Pericarditis - F
E. Right ureteric colic - T

74. Spontaneous bleeding in septic shock suggests

A. Hypovolemia - F
B. Liver failure - T
C. Excessive plasmin activity - T
D. DIC - T
E. Increased activity of anti thrombin III - F

75. Skin grafting of burns

A. Should usually be with a full thickness skin graft - F
B. Is more likely to be successful if performed in the 1st week post bum - T
C. The site should contain less than 105 bacteria/g of tissue and no streptococci - T
D. Minimises scar contracture - T
E. A priority area for grafting is the eyelids - T

76. Basal cell carcinomas

A. Usually spread via the lymphatics - F
B. Are less common than squamous cell carcinoma - F
C. The rolled border is due to external invasion of the tumour under the intact dermis
 -T
D. Are particularly common on the nose, eyelids and cheeks - T
E. Exposure to sunlight is a predisposing factor - T

77. In pleural effusions

A. The usual presentation is progressive dyspnoea - T
B. 250 mls of fluid are needed for clinical detection - F
C. Rapid aspiration of fluid is advisable in the case of a large effusion - F
D. Continuous aspiration of old dark red blood is characteristic of malignancy on X-
ray - T
E. Blunting of the costophrenic angle may be the only finding - T

78. In an unconscious patient evidence of serious intra abdominal injury may be

gained by
A. Peritoneal lavage - T
B. The presence of "pattern bruising" on the skin of the abdominal wall - T
C. Falling haemoglobin values - T
D. The presence of diarrhoea - F
E. Radiography - T

79. Biliary colic

A. Is often precipitated by fatty foods - T
B. Lasts 5 to 20 minutes - F
C. Is frequently associated with radiation of the pain to between the shoulder blades -
T
D. Jaundice and dark urine may follow an attack - T
E. Is accompanied by nausea and vomiting - T

80. A Meckels' diverticulum of the small intestine

A. Is commonly situated on the antimesenteric border of the small intestine, 60 cm
from the ileocaecal valve - T
B. Possesses all three coats of the intestinal wall - T
C. In 20% of cases the mucosa contains heterotopic epithelium - T
D. Most commonly presents as diverticulitis - F
E. Is present in approximately 20% of human beings - F

81. Carcinoma of the rectum

A. Is usually of squamous cell origin - F
B. Spread via the venous system usually occurs early - F
C. Frequently presents with fecal impaction - F
D. In approximately 90% of cases the neoplasm can be felt digitally on rectal
examination - T
E. Pain is an early symptom - F

82. Carcinoma of the prostate

A. Is commonly of squamous cell origin - F
B. Usually produces an increase in serum acid phosphatase - T
 C. LHRH analogues can be used in treatment - T
D. Bony metastases appear in bone scans before they do in radiographs - T
E. Most can be recognized on rectal examination - T

83. A fracture of the scaphoid

A. Occurs following a fall onto the outstretched hand - T
B. Presents with much swelling and bruising - F
C. Is usually seen in young men - T
D. Is prone to avascular necrosis - T
E. Is usually seen on an early scaphoid X-ray - F

84. Osteogenic osteosarcoma

A. Is most frequent in the 2nd and 3rd decades of life - T
B. Readily metastasises via the blood stream to produce pulmonary secondary
deposits - T
C. Paget's disease is a predisposing cause -T
D. Five year survival rate with treatment is approximately 50% - F
E. Sunray spicules can be seen on X-ray - T

85. With respect to bronchial carcinoma

A. It is most commonly an adenocarcinoma - F
B. Patients often present with cough, haemoptysis and dyspnoea - T
C. On physical examination finger clubbing may be seen - T
D. In patients with no evidence of spread, resection of the tumour is followed by a 5
year survival rate of 85 to 90% - F
E. the tumor is very sensitive to chemotherapy - F

86. Crohn's Disease

A. May present as intestinal obstruction - T
B. Anal fissure is a complication - T
C. Long term steroid therapy is indicated - F
D. Diarrhea is in part due to the action of unabsorbed bile salts in the colon - T
E. The recurrence rate after resection of ileal lesions is approximately 10% - F

87. A femoral hernia

A. Occurs more commonly in males than females - F
B. Is more common on the left than the right side - F
C. Must be distinguished from a saphenous varix - T
D. Is not prone to strangulation - F
E. Is readily controlled by a truss - F

88. Association of haemoptysis and finger clubbing is suggestive of

A. Bronchial carcinoma- T
B. Bronchiectasis- T
C. Empyema- F
D. Bronchial adenoma- F
E. Pulmonary metastases - F
89. In the treatment of acute pancreatitis
A. Pain should be relieved by morphine - F
B. Blood transfusion may be required - T
C. Antibiotics are unnecessary - F
D. Calcium gluconate 10 ml of a 10% solution daily may be required - T
E. Surgery should not be performed unless the diagnosis is certain - F

90. Pain due to a renal calculus

A. Is not necessarily severe - T
B. Is usually relieved if the patient lies still - F
C. Is often accompanied by vomiting - T
D. Is rarely associated with hematuria- F
E. Is typically intermittent - F

91. Features of prolapsed intervertebral disc between L4 and 5 vertebrae include

A. Sciatic pain aggravated by coughing - T
B. Sensory loss on the lateral side of the foot - F
C. Weakness of dorsi flexion of the great toe - T
D. Diminished knee jerk - F
E. Flattening of the normal lumbar lordosis - T

92. A deep venous thrombosis of the lower limb

A. Is often symptomless - T
B. Commences where there are eddy currents around a valve - T
C. Usually starts to be formed towards the end of the first post operative week - F
D. May occur following venography - T
E. Oral anticoagulants should be given for one week after the patient has become
ambulant - F

93. In the use of chenodeoxycholic acid to dissolve gallstones

A. Best results are obtained if the gallstones are radiolucent - T
B. The gall bladder need not be functioning - F
C. Diarrhea occurs in about 50% of patients treated - T
D. Is preferred to ursodeoxycholic acid as it is non hepatotoxic - F
E. Recurrence occurs in about 30% of patients on cessation of therapy- T

94. Carcinoma of the bladder

A. Usually presents with supra pubic pain radiating to the perineum - F
B. Is usually accompanied by haematuria- T
C. Most often occurs in the vault of the bladder - F
D. Is best diagnosed by cystoscopy - T
E. Transitional cell carcinoma accounts for over 95% of all bladder tumours - T

95. Burn Wound Sepsis

A. Is less common in partial than full thickness bums- T
B. Is more common in burns greater than 20% body surface area - F
C. Is commonly caused by pseudomonal infections - T
D. Is avoided by the immediate application of a sterile occlusive dressing - F
E. Can precipitate congestive heart failure - T
96. Fibroadenosis of the breast
A. Is an aberration of normal cyclical changes that occur in the breast during
menstrual cycles - T
B. Is normally unilateral - F
C. Is most common between 45 and 55 years of age - T
D. Bromocryptine; can be used for pain relief - T
E. The nodules enlarge after the menopause - F

97. Inguinal hernia

A. Before the age of 10, are more common on the right side in the male - T
B. Of the indirect type are congenital in origin - T
C. Of the indirect type strangulate rarely - F
D. Of the direct type is always acquired - T
E. Of the direct type commonly descend into the scrotum - F

98. Patients with acute colonic diverticulitis

A. Have pain which is usually in the left lower quadrant - T
B. Often present with pyrexia- T
C. Symoidoscopy may show mucosal oedema and erythema - T
D. Very commonly suffer from vomiting - F
E. Should be treated with morphine - F

99. Carcinoma of the oesophagus

A. Is in most cases an adenocarcinoma - F
B. Is more common in males than females - T
C. Occurs most frequently in the upper third - F
D. Is commonly spread by lymphatics - T
E. Is very sensitive to chemotherapy - F

100. In ulcerative colitis

A. In 95° o of the cases the disease starts in the rectum and spreads proximally - T
B. The disease is more common in women than men - T
C. Abdominal pain is usually present from the onset - F
D. Extensive inflammatory changes also occur in the ileum - F
E. The earliest sign on barium enema is loss of haustrations - T

101. Internal haemorrhoids

A. Usually cause pruritis - T
B. Are often associated with intense pain - F
C. Often become infected - F
D. Sclerotherapy is indicated for all 1st degree and small 2nd degree hemorrhoids - T
E. Profuse hemorrhage most often occurs in the early stages of 2nd degree
hemorrhoids - T
102. Abdominal aortic aneurysms
A. Are due to atherosclerosis in 50% of cases - F
B. Characteristically produce epigastric pain - F
C. Are associated with duodenal ulceration - T
D. Asymptomatic aneurysms found incidentally on examination need repair if they
are over 7cm in diameter - T
E. An aortogram is indicated in most instances - F

103. In fractures of the upper third of the shaft of the femur

A. The proximal fragment is usually flexed by iliopsoas - T
B. The proximal fragment is usually abducted by gluteal muscles - T
C. The distal fragment is usually adducted and drawn proximally by the hamstrings
and quadriceps - T
D. The common femoral vessels are usually damaged - F
E. There is no more than 300 mis of blood in the thigh in adults - F

104. In head injuries the causes of a rising intra cranial pressure include
A. Intracerebral hemorrhage - T
B. Cerebral oedema - T
C. Rhinorrhoea - F
D. Meningitis - T
E. A rise in PaC02 - T

105. Duodenal ulcer

A. Pain usually occurs 1-2 hours after food - T
B. Is commonly associated with vomiting - F
C. Is associated with marked loss of weight - F
D. A 6-8 week course of cimetidine, 400 mg bd will lead to ulcer healing in 80-90%
patients - T
E. In almost all patients, fasting plasma gastrin levels are considerably elevated - F

106. Varicose veins

A. Incidence male : female is 1 : 5 - T
B. Of the primary variety develop when the deep venous system is thrombosed - F
C. Saphenofemoral incompetence can be confirmed by the Trendelenburg test - T
D. Occurring before the age of 20 may be due to a congenital AV fistula - T
E. Sclerotherapy is a suitable treatment for saphenofemoral incompetence - F

107. Malignant melanoma

A. Approximately 50% are believed to arise in pre existing naevi - T
B. Nodular melanoma is the commonest type - F
C. Spread readily by blood and lymphatics - T
 D. Frozen section examination of an excision biopsy is important - T
E. DTIC is a useful single agent in the treatment of pulmonary secondaries and
lymph node involvement - T

108. In a patient who has had an arterial embolus in a limb

A. A source for the embolus cannot usually be found - F
B. It is important to keep the affected limb warm - F
C. The early administration of heparin is required - T
D. Surgery is almost certainly required if the muscles of the limb are paralysed - T
E. Whenever possible, surgery should be deferred for at least 24 hours - F

109. A 65 year old man is unconscious following an accident in which he suffered a

head injury
A. The finding of a hemiparesis is an indication for urgent surgery - F
B. Restlessness should be controlled by morphine - F
C. It is important to exclude cerebral oedema by observing the effect of intravenous
mannitol before proceeding to surgery - F
D. Nasogastric feeding should be started if the patient is unable to swallow after 12
hours - T
E. It is essential to X-ray the skull - T

110. In Peritonitis
A. Paralytic ileus occurs - T
B. If due to perforation of the G.I.T, Clostridium welchii is the commonest invader
-F
C. Collapse of the lung may result may result from sub diaphragmatic infection -
T
D. Diagnosis is greatly helped by a plain X-ray of the abdomen - F
E. Leucocytosis usually occurs - T

111. Treatment of bums

A. Shock is best treated by infusion of plasma - T
B. Mortality rate of burns of both legs and front of trunk is about 50% - T
C. Skin grafting is required if granulisation is still present after two weeks - T
D. Exposure of a deep burn to the air is contraindicated - F
E. Anemia may be severe enough to require blood transfusion - T

112. Carcinoma of the breast

A. Most often commences in the upper inner quadrant - F
B. Is most common in women between 45 and 55 years of age - T
C. Skeletal metastases occur most frequently in the thoracic vertebrae - F
D. 70° o are hormone responsive - F
E. In stage II there are affected mobile lymph nodes in the axilla of the same side as
the tumor - T
113. Acute Pancreatitis
A. Has a mortality rate of approximately 40% - F
B. Is more common in females than males - F
C. The maximum incidence is between 50 and 60 years - T
D. The leucocytosis of30x lO^/l may occur - T
E. A level of serum amylase of 500 i.u/1 is the minimum necessary to support
a diagnosis of acute pancreatitis - F

114. Carcinoma of the stomach

A. Is the 4th commonest tumour in the UK - T
B. Is three times as common in females than males - F
C. Is commoner in patients with blood group 0 - F
D. Is more common in the fundus of the stomach - F
E. The five year survival is approximately 5% - T

115. Tetanus
A. May have a incubation period of over 20 days - T
B. Can be prevented by the immediate administration of tetanus toxoid - F
C. Is more common after scalp lacerations than wounds of the limbs - F
D. The first symptom is often difficulty in swallowing - T
E. The prognosis is related to the time interval between the 1st symptom and the
frrst reflex spasm - T

116. Thyroglossal cyst

A. usually presents in early adult life - F
B. is a remanant of 5th pharyngeal arch mesoderm - F
C. should be excised with the thyroid cartilage - F
D. the swelling moves upwards on protrusion of the tongue - T
E. a common site is beneath the hyoid bone - T

117. In a patient with a perforated duodenal ulcer

A. The perforation usually lies on the anterior surface of duodenum - T
B. Usually presents with acute onset of severe back pain - F
C. A plain abdominal X-ray taken in the erect position shows a transulucent area
beneath the right cupula of the diaphragm in 70% of cases - T
D. Significant vomiting is common - F
E. Is usually treated by closure of the perforation with interrupted sutures reinforced
with an omental patch - T

118. Large intestinal obstruction

A. Is most commonly caused by colonic diverticular disease - F
B. Has its maximum incidence between 40 and 50 years - F
C. Frequently presents with vomiting - F
D. Usually begins with constant suprapubic pain - F
E. If unrelieved may lead to perforation of the anterior wall of the caecum - T

119. The incidence of Crohn's Disease

A. Is independent of geographical location - F
 B. Occurs with the same frequency in males and females - T
C. Peaks in the 3rd decade - T
D. Has a familial tendency - T
E. Is reduced in people who consume low fibre diets - F

120. Villous papillomas of the colon

A. Are usually sessile- T
B. Are more common on the right side -F
C. Are associated with spurious diarrhoea - T
D. Comprise 85% of colonic polyps - F
E. Rarely become malignant - F

121. Ureteric calculi

A. Nearly always have their birth in the kidney - T
B. Frequently cause haematuria- T
C. Are not usually radio-opaque - F
D. Often result from a urinary tract infection - T
E. Morphine should not be used to relieve the colic as it causes spasm of the ureteric
muscle - F

122. With respect to venous ulcers of the lower limb

A. Local venous hypertension is the main factor in development - T
B. Commonly follow D.V.T - T
C. Most commonly occur below the medial malleolus - F
D. Will usually heal when a firm bandage is applied - T
E. Local application of strong cleansing agents is necessary - F

123. Dupuytren's contracture of the palm

A. Is known to be familial- T
B. Is predominantly seen in women - F
C. Has an association with glomerulo nephritis - F
D. Of long standing is often associated with secondary fibrosis of the interphalyngea!
Joints - T
E. Is seen in epileptics who take phenytoin sodium - T

124. Lesions affecting the lateral popliteal nerve

A. Sensory loss is limited to the dorsal aspect of the 1st interdigital cleft - F
B. There is weakness of dorsiflexion of the foot - T
C. There is weakness of eversion of the foot - T
D. The toes become clawed - F
E. Can be produced by fracture of the upper end of the fibula - T

125. A Colles' fracture

A. Is a fracture of the distal radius produced by a fall onto the outstretched hand - T
B. Is commonest between the ages of 20 and 30 years - F
 C. There is always injury to the inferior radio ulnar joint - T
D. Before reduction radial and ulnar styloid processes are at the same level - T
E. A full encircling Colles' plaster is applied immediately after manipulation - F

126. Benign prostatic hyperplasia

A. Begins in the inner zone glands - T
B. Results in bladder trabeculation - T
C. Gives rise to frequency as the earliest symptom - T
D. Hematuria is very unusual - F
E. Retro pubic prostatectomy is the method of choice in treatment of prostates less
than 90g in weight - F

127. Pleomorphic adenoma of the parotid

A. Comprises 90% of benign parotid tumours - T
B. Grow very slowly - T
C. Is usually bilateral - F
D. Tend to recur if incompletely excised - T
E. Are very radio sensitive - F

128. The following statements are true regarding the arteries of head and neck
A. Common carotid artery derived at level C6 - T
B. Internal carotid artery give no branch in the neck - T
C. Inferior thyroid artery closely related to external laryngeal nerve - F
D. Facial artery gives branch to supply palatine tonsil T
E. Opthalmic artery enters the orbit through the superior orbital fissure - F

129. The following are true regarding the nerve supply

A. All muscles arising from the 2nd pharyngeal pouch are supplied by the facial nerve
-T
B. Structures developing from occipital myotomes are supplied by the hypoglossal
nerve - T
C. Corda tympani carries parasympathetic fibers - T
D. Stylopharyngeal muscle is supplied by the glossopharyngeal nerve - T
E. Omohyoid muscle is supplied by the ansa cervicalis nerve - T

130. The statements are true regarding nerve injuries in the upper limb
A. Injury to the lower trunk of brachial plexus causes loss of sensation along lateral
border of the arm - F
B. Injury of the upper trunk causes paralysis of the serratus anterior - F
C. Ulnar nerve injury at wrist produces ulna claw hand - T
D. Flexion of wrist is not possible if median nerve is injured at the elbow - F
E. Supination is still possible if radial nerve is injured in the spiral groove - T

131. The statements are true regarding venous drainage of the lower limbs
 A. Venous blood flow from superficial to deep systems in the foot - F
B. Great saphenous vein lies anterior to the medial malleolus - T
C. Venous valves directed towards deep vein in the perforated vein - T
D. Superior epigastric vein open into the great saphaneous vein - T
E. No valve in the femoral vein proximal to profundus femoral vein - F

132. The following structures can be injured in submandibulectomy

A. Cervical branch of facial nerve - F
B. Otic ganglion - F
C. Hypoglossal nerve - T
D. Lingual nerve - T
E. Retromandibular vein - F

133. The following statements are true regarding perianal suppuration

A. It arises from the anal glands - T
B. It travels to the ischiorectal fossa via the external sphincter - T
C. It passes intersphintericly through anal skin - T
D. Surgical drainage leads to perianal fistula - T

134. The following statements are true regarding stomach

A. Muscle layers are derived from somatosplanchhnic mesoderm - F
B. Epithelial lining mucosa contains goblets cells - F
C. Mucosa is composed of two layers - F
D. Serosa derived from ectoderm
E. Parietal cells are seen in pyloric portion - T

A B C D E
1. F F F F T
2. F F T F F
3. F F F F F
4. F T F F T
5. T T T F F
6. T F T T T
7. F T F T F
8. F T F F F
9. F F F T T
10. T T T F F
11. F F T F F
12. T T F F T
13. F F T T T
14. F T F F F
15. F T F F T
16. F T F T T
17. T F T F T
18. F F T F T
19. T F T F T
20. F T T T F
21. T F F F F
22. T F T F T
23. F T T F F
24. T T T F F
25. T T F T F
26. T T F F T
27. F F T T T
28. T T F F T
29. T F F T T
30. T F F F T
31. F T T T F
32. F T T F T
33. F T F F F
34. T F T T T
35. T F F T T
36. F F T T T
37. F F T T T
38. F T F F F
39. T T T T F
40. F F F T T
41. F F F F F
42. F F F F T
43. F T F T T
44. T F T F T
45. F F T F T
46. T F T F T
47. T F F F T
48. T F T F T
49. F F F T F
50. T F F F T
51. T T T T F
52. F T T T T
53. T F F F T
54. T F T T F
55. T F T F T
56. F T F T T
57. T F T T F
58. T F T F T
59. F T T T F
60. T F F T F
61. F T F T F
62. T T T F F
63. T T F F F
64. T T T F F
65. T F T T T
66. F T F T F
67. T F F T F
68. F T F F F
69. F T T F F
70. T F T F T
71. F T T F T
72. T F T T F
73. T T T F T
74. F T T T F
75. F T T T T
76. F F T T T
77. T F F T T
78. T T T F T
79. T F T T T
80. T T T F F
81. F F F T F
82. F T T T T
83. T F T T F
84. T T T F T
85. F T T F F
86. T T F T F
87. F F T F F
88. T T F F F
89. F T F T F
90. T F T F F
91. T F T F T
92. T T F T F
93. T F T F T
94. F T F T T
95. T F T F T
96. T F T T F
97. T T F T F
98. T T T F F
99. F T F T F
100. T T F F T
101. T F F T T
102. F F T T F
103. T T T F F
104. T T F T T
105. T F F T F
106. T F T T F
107. T F T T T
108. F F T T F
109. F F F T T
110. T F T F T
111. T T T F T
112. F T F F T
113. F F T T F
114. T F F F T
115. T F F T T
116. F F F T T
117. T F T F T
118. F F F F T
119. F T T T F
120. T F T F F
121. T T F T F
122. T T F T F
123. T F F T T
124. F T T F T
125. T F T T F
126. T T T F F
127. T T F T F
128. T T F T F
129. T T T T T
130. F F T F T
131. F T T T F
132. F F T T F
133. T T T T
134. F F F ? T

PRINCIPLES OF SURGERY VAIVA QUESTIONS

Prof Freda Meah
1. Define shock, types and physiological response towards shock
2. Regarding spleen – embryological development, anatomical relationshipand
complications following splenectomy
3. Regarding pancreas, embryological development, functions and anatomical
relationship
4. Lesser sac boundries
5. Preoperative assessment (scenario) – 60year old man with h/o altered bowel
habits for 3 months with a mass in the left iliac fossa
6. Post-operative hypoxia
7. Post-operative analgesia
8. Causes of post-operative fever
9. Wound healing - the phases and the factors effecting healing
10. Anatomy of the esophagus – course, blood supply and lymphatic drainage
11. A post gastrectomy patient on post-op day 1 was noted to be tachycardic with
hypotension. Outline your management with regards to complication of
gastrectomy.
12. Blood products and complication of blood transfusion including problems
associated with massive blood transfusion.
13. Autologous blood transfusion and alternatives to human blood
14. Surgical diathermy
15. Tell me about surgical drainage: types, indications, principles of choice,
 complications
16. Operation theatre hazards with regards to staff, environment and equipment
17. How to set up an operation theatre
18. Calcium metabolism – causes, clinical features and management of both hypo
and hypercalcemia
19. How do you divide the neck into different areas
20. Describe the submandibular triangle and discuss the surgical approach and
important structures encountered during a submandibular gland excision
21. Tell me about gall stones
22. Describe the stomach bed structures
23. Management of a polytrauma patient
24. Surgical nutrition(scenario) – a patient with supraglottic / hypopharyngeal /
esophageal malignancy – how do you asses the nutritional status (based on
history, examination, anthropological measurements and investigations).
Discuss also the choice of method of improving the nutritional status of the
patient – oral, tube feeding, parenteral nutrition (give advantages and
problems encountered)
Questions of Prof Ben / Mr. Amin
25. Tell me about the special characteristics of cerebral circulation
26. Shock: types, stages, changes in specific vital organs during shock
27. changes in cerebral circulation during period of hypotension
28. tell me about minimal surgical access
29. How would you manage a polytrauma patient
30. What are the clinical features of upper airway obstruction and how would you
mange such a case
31. Blood storage and transfusion in surgical practise