Surgery QUIZ

Amoebic liver abscesses

• Typically occur in the right lobe of the liver

• Are always accompanied by jaundice

• Yield yellowish pus on aspiration

• Can be complicated by rupture into the pleuropulmonary cavity

• Are excluded by a negative history of amoebic dysentery in the past

Answer explanation

Amoebic liver abscesses typically occur in the right lobe of the liver and can lead to complications such as rupture into the pleuropulmonary cavity. They are not always associated with jaundice or yellowish pus.

In the patient with gastric outlet obstruction:

• The vomiting of gastric contents results in hypochloraemic alkalosis

• Vomitus usually contains bile

• The patient is hyponatraemic and dehydrated

• Urine may become paradoxically acid

• Physical examination may reveal succussion splash

Answer explanation

In gastric outlet obstruction, vomiting gastric contents leads to loss of hydrochloric acid, causing hypochloraemic alkalosis. Patients are often hyponatraemic and dehydrated. Urine can become paradoxically acid due to volume contraction. Succussion splash may be noted on exam.

The following are proven to reduce the risk of surgical infection

• Admission on the day of surgery

• Shaving the operation site prior to admission

• Early physiotherapy

• Prophylactic antibiotics

• Inserting an indwelling catheter

Answer explanation

Prophylactic antibiotics are proven to reduce surgical infection risk by preventing bacterial growth. Early physiotherapy helps maintain circulation and lung function, further reducing infection risk post-surgery.

Regarding antibiotic prophylaxis:

• It should be given to a patient with a history of rheumatic fever

• Cefuroxime covers against anaerobic organisms

• It is best administered before the patient is transferred to the operating theatre

• Topical antibiotic application is practiced

• It is more effective if prescribed for 5 days

Answer explanation

Antibiotic prophylaxis is crucial for patients with a history of rheumatic fever to prevent infective endocarditis. This choice is correct as it directly addresses the patient's risk factors.

In colorectal cancers:

• Carcinoma of the left colon classically presents with anaemia

• Obstruction is more common in the left than right-sided tumours

• Tumours with HNPCC gene are usually left-sided

• FAP patients usually present before age 40

• ~30% have occult liver metastases at diagnosis

Answer explanation

Obstruction is more common in left-sided colorectal cancers due to the narrower lumen. FAP typically presents before age 40, and about 30% of patients have occult liver metastases at diagnosis.

Perforated gastric ulcer

• Caused by chronic NSAID abuse

• Is a surgical emergency

• Diagnosed by air under the diaphragm

• Is a diagnosis of exclusion

• May cause gastric lymphoma after 2 years

Answer explanation

Perforated gastric ulcers are often caused by chronic NSAID abuse, represent a surgical emergency due to potential complications, and can be diagnosed via imaging showing air under the diaphragm.

Causes of cardiogenic shock include:

• Compound pelvic fracture

• Pulmonary embolism

• Bee sting

• Myocardial infarction

• Fluid overload

Answer explanation

Cardiogenic shock is primarily caused by conditions that impair the heart's ability to pump effectively. Myocardial infarction (heart attack) directly damages heart muscle, while pulmonary embolism can obstruct blood flow, both leading to shock.

In resuscitation of hypovolemic shock:

• Inotropic agents help increase diastolic filling and perfusion

• Hypovolemia must be addressed first

• Long, wide-bore catheters allow rapid fluids

• No need to monitor urine output

• Hypotonic fluids should be used

Answer explanation

In hypovolemic shock, restoring blood volume is crucial. Addressing hypovolemia first ensures adequate perfusion and oxygen delivery, making it the priority over other interventions.

Para-umbilical hernia

• Usually occurs around the umbilicus

• Is congenital in origin

• Does not resolve spontaneously

• Does not increase in size over time

• Requires surgical repair

Answer explanation

Para-umbilical hernias typically occur around the umbilicus, do not resolve on their own, and usually require surgical repair to prevent complications. They can increase in size over time.

Prognostic features of breast carcinoma include

• Size of primary tumour

• Pathological state of axillary nodes

• Oestrogen receptor status

• CA 19-9

• Presence of sentinel lymph node

Answer explanation

Prognostic features of breast carcinoma include the size of the primary tumor, the pathological state of axillary nodes, and oestrogen receptor status, as they provide critical information about disease progression and treatment response.