multiple choice questions
Test yourself
The MCQ and extended matching section in Surgery is designed to
test your knowledge of selected topics in this issue of the journal.
For questions 1–4, select which statements are true and which are
false. The correct answers are given below.
1 Ultrasound in Surgery
When considering the use of ultrasound scanning:
A Contrast agents are not utilised.
B It can be used to evaluate full- and partial-thickness
rotator cuff tears.
C It is unhelpful in distinguishing breast conditions in
younger patients.
D It has limitations in visualising areas of the liver
under the diaphragm and beneath the ribs.
E E
 ndoscopic ultrasound is much more accurate than
all other imaging modalities in assessment of the
T- and N-stage of oesophageal cancer.
2 Interpreting a radiograph of the chest
When examining a chest X-ray:
A A
 n anteroposterior projection gives the most
accurate representation of heart and mediastinal
size.
B A
 hydro pneumothorax results in the loss of the
meniscus sign.
C K
 erley B lines are the result of malignant
infiltration.
D L
 inear atelectasis is the result of subsegmental
collapse.
E C
 hilaiditi’s syndrome is seen as a result of
eventration of the diaphragm.
3 Interpreting a radiograph of the abdomen
When examining an abdominal X-ray:
A F
 luid levels may be used to distinguish between
small bowel obstruction and ileus.
B G
 as in the bowel wall is always a sign of
impending perforation.
C In cases of small bowel obstruction, the large
bowel calibre is often reduced.
D A
 ‘gasless’ abdomen can be seen in normal
subjects.
E T
 he level of obstruction as judged by the gas
pattern may be more proximal than the true level.
SURGERY 26:6
MCQ and extended
matching
W E G Thomas ms frcs Consultant Surgeon Royal Hallamshire
Hospital, Sheffield, UK. Past member of Court of Examiners of the
Royal College of Surgeons and Intercollegiate Panel of Examiners.
Member of Council of Royal College of Surgeons on England.
4 CT and MRI
When considering the use of CT and MRI scanning:
A U
 sing a multi-detector CT scanner, very thin slices
of the entire body can be scanned in 15–30 seconds.
B T
 he gadolinium based contrast used in MRI
scanning is entirely risk free with regard to
nephrotoxicity.
C M
 RI is unable to differentiate the spinal cord
from the surrounding cerebro-spinal fluid without
intrathecal contrast medium.
D C
 T is the preferred investigation following trauma
and suspected subarachnoid haemorrhage.
E M
 RI is more successful at identifying gallstones
than renal stones.
5 Perioperative use of radioisotopes
Theme: Radioisotope scanning
A 111In-labelled octreotide
B 99mTc-labelled macro-aggregated albumin
C 99mTc-labelled mercaptoacetyltriglycerine
D [ 18F] fluorodeoxyglucose PET/CT
E 99mTc-labelled HIDA
F 99mTc-labelled sestamibi
G 99mTc-labelled diethylenetriamine penta-acetic acid
aerosol
H Labelled white blood cells
For each of the clinical scenarios listed below, select
the single most appropriate agent from the options
listed above. Each option may be used only once,
more than once or not at all.
1 A
 54 year old female patient with hypercalcaemia
requiring a parathyroidectomy.
2 A
 68 year old male patient who had undergone a
low anterior resection 2 years previously who now
presents with weight loss and anorexia.
3 A
 35 year old male patient who is suspected of
having the carcinoid syndrome.
4 A
 45 year old male patient with hydronephrosis in
whom there is a need to exclude obstruction.
see next page
276 © 2008 Published by Elsevier Ltd.
 multiple choice questions
Questions cont.
Answers
1. B D E
2. B D
3. C D E
4. A D E
5. 1 – F, 2 – D, 3 – A, 4 – C
Answers to incorrect statements
Question 1
A Ultrasound does utilise contrast agents at times and
these consist of tiny membrane-stabilised microbubbles
containing gas, which are injected intravenously.
C Ultrasound is particularly useful in situations where
mammography is contraindicated such as pregnancy,
in younger patients and after mastectomy or
radiotherapy.
Question 2
A A posteroanterior projection gives the most accurate
representation of heart and mediastinal size. An
anteroposterior view falsely magnifies these contours.
C Kerley B lines are due to interstitial pulmonary oedema
causing septal lines representing fluid thickening of the
interstitial tissue in the septa of the lungs.
surgery 26:6
E Chilaiditi’s syndrome is when a loop of colon is
interposed between the right hemidiaphragm and the
liver and is a normal variant. It can be confused with a
pneumoperitoneum, but there is no actual free air and
there is no underlying abnormality of the diaphragm.
Question 3
A Fluid levels can be misleading and cannot be used to
differentiate between obstruction and ileus.
B Gas in the bowel wall usually indicates bowel necrosis
but there are benign situations such as pneumatosis
cystoides intestinalis where there are multiple cysts in
the bowel wall, most commonly in the left hemicolon.
Question 4
B It was initially thought that unlike the iodine based
contrast used in CT, that gadolinium-based contrast
used in MRI was entirely safe from the risks of
nephrotoxicity. However, there are increasing reports of
nephrogenic systemic fibrosis after gadolinium contrast
medium injections, and this is a rare but potentially
fatal condition.
C MRI is now the preferred investigation for imaging
spinal pathology because it can differentiate the
spinal cord from the surrounding cerebro-spinal fluid
WITHOUT the need for intrathecal contrast medium.
277 © 2008 Published by Elsevier Ltd.