COMPILED BY TARGET 2023. 4TH YEAR MED.

SURGERY QUESTIONS AND ANSWERS 2023.

[ABU KANU]

Q1a. State four conditions that can cause obstruction of the appendiceal lumen,
subsequently leading to acute appendicitis

ANS:

i. Lymphoid Hyperplasia
ii. Inspissated Fecal matter(fecolith)
iii. Foreign bodies
iv. Parasites eg.

Q1b. Outline the pathophysiology of acute appendicitis from obstruction of appendiceal

lumen to perforation of the appendix

ANS:

The process of acute appendicitis follows the following pathogenesis

Appendiceal obstruction (mechanical, physiological or static)

Increased intraluminal pressure

Impaired lymphatic and venous drainage (there is local oedema)

Limit arterial flow

Impaired tissue integrity

Necrosis with subsequent perforation

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 COMPILED BY TARGET 2023. 4TH YEAR MED.

Q1c. Why acute appendicitis is uncommon at the extremes of ages

ANS:

The appendix usually has a narrow lumen which can only admit a match-stick and is
continuous with that of the caecum. In the infant, the lumen
is relatively wide and drains readily into the caecum while in
the aged, it is usually obliterated. Acute appendicitis is
therefore uncommon at the extremes of life.

[PASCAL]

Q2. List in the correct order the layers the spinal needle crosses when performing a
spinal puncture.

Answer:

When performing a spinal puncture, the structures that the needle will cross from outside to
inside are:

Skin

Subcutaneous Tissue

Supraspinous Ligaments

Intraspinous Ligaments

Ligamentun Flavum

Epidural Space

Dura Space

Q3a. Define a fracture

Q3b. Describe briefly the 3 phases or stages in fracture management.

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Answers:

Q3a. A fracture is a break in the continuation of bone and soft tissue injury.

Q3b. Phases/stages/principles in fracture management:

1. REDUCTION of the fracture to restore the displaced fragments to their anatomical

position. It can be done manually or mechanically using traction
2. IMMOBILIGATION/STABILIZATION of the fracture fragments long enough to
allow union using external fixation or internal splint.

3. REHABILITATION of the soft tissues and joints to restore normal functions to the
injured part. . It is aimed initially at maintaining the function of the uninjured parts
and, once the fracture is united, restoring function of the injured parts.

[ABU KANU]

Q4a. List 5 types of burns

ANS:

According to wound Depth According to aetiology, burns can

be:
1. Epidermal (first Degree) 1. Flame burn
2. Moist heat (scald)
2. Superficial partial thickness (second degree) 3. Contact burn
4. Electrical burn
3. Deep partial thickness (second degree) -High voltage (>1000 volts)
-Low voltage (<1000 volts)
4. Full thickness (third degree) 5. Chemical burns
6. Radiation burns
5. Sub dermal (fourth degree)
7. Friction burns
8. Frost bite

Q4b. List 5 immediate complications of burns

ANSWER:

• Hypovolemic shock • Septicemia

• Acute renal failure • Depression/delirium
• ARDS • Deep venous thrombosis
• Pneumonia • Wound infection
• Urinary tract Infection • Anemia
• Acute gastric dilatation • Compartment syndrome
• Paralytic ileus • Thrombophlebitis
• Curling’s ulcer

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 COMPILED BY TARGET 2023. 4TH YEAR MED.

Q4c. List 5 Criteria for Admission in burns

ANS:

i. Burn wound >10% in children & >15% in adults

ii. Patients <2 or >60 years old
iii. Burn involving hands, feet, face, perineum, axilla, joints, neck, and other flexural
surfaces
iv. Patients presenting with other associated injuries such as fractures etc
v. Patients with significant co-morbid factors such as Asthma, Heamoglobinopathy,
seizure disorders etc
vi. Patients with inhalation injury
vii. Deep circumferential burn involving the limbs

[ABDULLAH O. KOROMA]

Q5. Briefly outline the management of a 32-year-old farmer who presents to the A & E
with a 5-hour history of Abdominal pain and Vomiting.

Answer:
The managements are as follows:
i. History taking
ii. Physical Examination
iii. Resuscitation ( if there is need)
iv. Investigations
v. Possible treatments.

1. HISTORY TAKING
 Introduce yourself
 Informed consent
 Bio data
Ask for
 Duration
 Use SOCRATES method
 Incidence (before ,during and after)
 Recurrent symptoms
 GI symptoms
Vomiting

 How frequent is the vomiting

 Consistency
 Onset
 Taste, colour, smell, projectile and quantity
 Blood in the vomit

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 COMPILED BY TARGET 2023. 4TH YEAR MED.

2. PHYSICAL EXAMINATION
 Inspection
 Palpation
 Percussion
 Auscultation

To complete the examination do:

 Digital Rectal Examination

3. INVESTIGATIONS
BLOOD
 FBC
 Urea and Creatinine
 LFT
 Amylase
 Troponin
 Lipase
 Arterial Blood Gas

URINE

 Urinalysis
 Microscopy

4. POSSIBLE TREATMENT
 IV fluids
 Antiemetic drugs
 Analgesics
 Surgery ( based on examination and findings)

UNISA A. JALLOH

Q6. Outline the managements of a patient with BPH

ANS:
a. Watchful waiting
b. Medications
c. Surgical approach
Watchful waiting:
1. lifestyle modifications, timing of drugs administration
2. No impacts on the quality of life on IPSS
3. Enlarge prostate on USS reassurance
4. Treat when symptoms become bothersome.

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Medications:
Aim to:
 Reduce symptoms and to improve the quality of life
 Reduce the disease progressions
 Minimize low incidence side effects
Drugs
1. Alpha adrenergic blockers
2. 5α- reductase inhibitors
Surgical approach:
A. Minimally invasive surgery
1. TUMT (Transurethral Microwave Thermotherapy)
2. TUNA ( Transurethral Needle Ablation)
3. Prostate urethral lift
B. Open surgery
1. Retropubic
2. Suprapubic
3. Perineal
C. Electrosurgical
1. TURP (Transurethral resection of the prostate)
2. TUVP ( Transurethral Electrovaporization of the prostate)
3. TUIP (Transurethral Incision of Prostate)
Q7. 22-year old man with typhoid perforation is being prepared for laparotomy,
describe how you would manage his fluid balance both pre and post-operative.

ANSWER.
Pre-operative care.
1. NPO
2. Pass 2 iv line
3. Pass NG tube
4. Pass a urinary catheter
5. Give antibiotics
6. Give normal saline(NS)
Post-operative care.
1. Continue iv fluid
2. Monitor urine output hourly
3. Give antibiotics
4. Calculate 24hrs urine output.
5. Confirmed whether within normal range
6. If patient not making urine evaluate the kidneys.

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 COMPILED BY TARGET 2023. 4TH YEAR MED.

EMMANUEL SESAY
Q8.
a. List the three principles of applying plaster of Paris (POP) to immobilize a
fracture
b. list two advantages of using POP for fracture immobilization
c. list two disadvantages of using POP for fracture immobilization

ANSWERS.
Q8a.
1. Never put plaster directly on unprotected skin
2. Moulding should be done with the palms of the hands and not the finger tips
3. Application should be continuous to allow the cast to dry as a single, solid piece
4. The edges of the POP should be covered and not chafe or puncture the skin.
5. Apply the cast starting from fracture site and continue to the joint near the fracture.
Q8b.
Advantages of using POP for fracture immobilization:
1. It is cheap
2. Infinitely mouldable when wet
Disadvantages of using POP for fracture immobilization:
1. Heavy in weight
2. Messy
3. Significantly weakened if cast is wet
4. It is partially radio-opaque

Q9a. Defined hypertrophic scars and keloid scars

Q9b. state the differences between keloid scars and hypertrophic scars.

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Answers:
Q9a
Hypertrophic scar is a cutaneous condition characterized by depositions of excessive
amount of collagen which gives rise to a raised scar, that do not grow beyond the
boundaries of the original wound.
Keloid scar is an abnormal proliferation of scar tissue that forms at the site of cutaneous
injury. Keloid scars keeps growing and become bigger than the original wound.

Q9b.

ABUBAKARR BANGURA
Q10.
a. Calculate the maintenance fluid, potassium and sodium requirements for a 10
year old male who has just been diagnosed with a perforated appendix and is
awaiting surgery. He is Nil Per Os and weighs 30kg.
b. Write a clear order for the nursing staff on how the fluid you have calculated in
10a. above should be administered.
c. If a neonate has 75% of his body weight has water, calculate the percentage of
water in intracellular, interstitial and intravascular compartments of this
neonate.

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Answer.
10a.
Age: 10-year-old
Weight: 30kg.
Maintenance fluid.
100×10= 1000
50×10= 500
20×10= 200
1700cc/day
Sodium
30(2-3) = (60-90) mEq/day.
Sodium /1.7l/day= (35-53) mEq/l
Potassium
30(1-2) = (30-60) mEq/day.
Potassium/ 1.7l/day = (18-35) mEq/l
10b.
 Base on the calculated sodium requirements, we select the right fluid needed and
looking at things, the right fluid needed is 0.2NS.
 We add D5W maintenance fluid to maintain the osmolality.
 Add 20mEq/l of KCl to give the lost potassium base from the calculation.
 Avoid giving the child cold fluid.
 The fluid should be given in 24 hours.
10c.
Percentage of water body weight = 75%
Intracellular compartment
= × 75% = 50%
Interstitial compartment
= × extracellular compartment.
But ECF = 75% - 50% = 25%
Thus, interstitial compartment = ×25% = 16.67%
Intravascular compartment
= 25% ˗ 16.67%= 8.33%