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Test yourself MCQ and extendedmatching

The MCQ and extended matching section in  Surgery  is designed to testyour knowledge of selected topics in this issue of the journal.

Michael G Wyatt   MSc MD FRCS FRCSEd (ad hom)   Consultant Surgeon,Freeman Hospital, Newcastle upon Tyne, UK; Honorary Reader,

Newcastle University; Clinical Editor, SURGERY; Honorary Secretary,

The Vascular Society of Great Britain and Ireland, and Member of the

Court of Examiners for the Intercollegiate MRCS 

For questions 1e4, select the statements which are true and

which are false. The correct answers are given below.

1 Sutures, ligatures and knots

When considering sutures, ligatures and knots:

 A    Synthetic materials have taken over the market as

they have more predictable characteristics and avoidconcerns of using animal-derived materials, both

cultural and infection-related.

B   Non-absorbable sutures remain in the body life-

long.

C    Sutures impregnated with antimicrobial agents have

been shown to afford a statistically significant

reduction in surgical site infections in selected

patient populations.

D   The surgeon’s knot involves a ‘double-throw’ in the

first instance, followed by a further two throws in

the opposite direction.

E   A mattress suture involves two passes of the needlethrough each side of the wound.

2 Classification and management of acutewounds and open fractures

For patients with acute wounds and open fractures:

 A    The ASEPSIS scoring system assigns a number of 

scores to various wound characteristics evaluated

during serial assessment over a 7-day period.

B   The Gustilo and Anderson classification is the most

commonly used to describe closed fractures.

C    Antibiotic-loaded beads or vacuum foam dressings

cannot be recommended for use in dead-spacemanagement, whilst definitive soft tissue cover is

achieved.

D   Modern multiplanar and circular fixators can be

used if there is a significant contamination, or

segmental bone loss.

E   The viability of muscle is assessed by the four Cs:

colour, consistency, contractility and capacity to

bleed.

3 The principles of safe laparoscopic surgery

When considering the principles of safe laparoscopic

surgery:

 A    Laparoscopic cholecystectomy requires the patient to

be supine and in the Trendelenburg position, with

some left-sided tilt to allow good access to the gall-

bladder and Calot’s triangle.

B   Pneumoperitoneum can cause cardiovascular compro-

mise manifested as hypotension or bradycardia,

through a reduction in venous return to the heart.

C    Atraumatic graspers such as the Johannes graspers are

smooth instruments that are used for handling delicate

tissues such as bowel.

D   Suture ligation is always performed laparoscopically

with pre-tied endoloops.

E   Deep fascial layer closure should be undertaken for all

port sites that are 5 mm or greater in size in order to

prevent the development of port site hernias.

4 Tourniquet uses and precautions

For patients requiring tourniquets:

 A    Patients with peripheral vascular disease are predis-

posed to thromboembolic events after tourniquet use.

B   A commonly used tourniquet application pressure is

40 mmHg above systolic blood pressure.

C    Modern surgical tourniquets are composed of pneu-

matic bladder covered with a reinforced material to

prevent puncture.

D   Intramedullary reaming prior to nail insertion is not a

contraindication to the use of a tourniquet.

E  A tourniquet should never be applied to a site where anerve crosses a bone as this increases the likelihood of 

nerve damage.

5 The systemic response to surgery

Theme: The systemic response to surgery.

 A    The secretion of this peptide from the anterior pituitary

increases in response to surgery and trauma, and is

correlated to the severity of the injury.

MCQS

see next page

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Questions cont.

B   Is secreted from the adrenal cortex, increases rapidly

following the start of surgery and has complex

metabolic effects on carbohydrate, fat and protein.

C    The posterior pituitary produces arginine vaso-pressin, which has a major role in this capacity, and

its secretion is increased during surgery.

D   Is an opioid peptide, which is a product of the

breakdown of the precursor pro-opiomelanocortin.

E   Inhibits protein catabolism and lipolysis, and has a

largely anabolic effect.

F   Stimulates the secretion of glucocorticoids from the

adrenal cortex; surgery is one of the most potent

activators of ACTH and thus cortisol secretion.

G   Stimulate the oxygen consumption of most of the

metabolically active tissues of the body and increase

the sensitivity of the heart to the action of cate-cholamines by increasing the affinity and number of 

cardiac beta-adrenoreceptors.

H   Is secreted from the anterior pituitary and is

increased as part of the stress response to surgery;

its exact purpose in this context is unknown.

When considering the components involved inthe systemic response to surgery listed below,select the single most likely true statement fromthe list above. Each option may be used onlyonce, more than once or not at all.

1   ACTH

2   GH

3   Beta-endorphin

4   Prolactin

5   Cortisol

6   Thyroid hormones

7   Anti-diuretic hormone

8   Insulin

Answers

1   All

2   D, E

3   B, C

4   A, C, E

5   1F, 2A, 3D, 4H, 5B, 6G, 7C, 8E

Answers to incorrect statements

Question 2

 A    The ASEPSIS scoring system assigns a number of scores to

various wound characteristics evaluated during serial

assessment over a 5-day period.

B   The Gustilo and Anderson classification is the most

commonly used to describe open fractures.

C    The use of antibiotic-loaded beads or vacuum foam

dressings can be extremely useful in dead-space manage-ment, whilst definitive soft tissue cover is achieved.

Question 3

 A    Laparoscopic cholecystectomy requires the patient to be

supine and in the reverse Trendelenburg position, with

some left-sided tilt to allow good access to the gallbladder

and Calot’s triangle.

D   Suture ligation can either be performed laparoscopically

with pre-tied endoloops or with intra-corporeal knot

tying.

E   Deep fascial layer closure should be undertaken for all port

sites that are 10 mm or greater in size in order to prevent

the development of port site hernias.

Question 4

B   A commonly used tourniquet application pressure is 100

mmHg above systolic blood pressure.

D   Intramedullary reaming prior to nail insertion is a contra-

indication to the use of a tourniquet.

MCQS

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