past year surgical mcq

Which of the following statements regarding flail chest is TRUE?

• It occurs when more than two adjacent ribs are fractured in one place each

• It causes paradoxical chest wall movement during respiration

• It causes a left-to-right intracardiac shunt

• Endotracheal intubation is always required in all cases

• Flail chest alone is an absolute indication for thoracotomy

Answer explanation

Flail Chest
A. False – Must be three or more ribs fractured in two places.
B. True – Paradoxical movement is the hallmark.
C. False – No link to intracardiac shunt.
D. False – Intubation is not always required; reserved for respiratory failure.
E. False – Flail chest is not an absolute indication for thoracotomy.

Which of the following is TRUE regarding acute cholecystitis?

• It only occurs in the presence of gallstones

• Charcot’s triad is a common presentation

• White blood cell count remains normal in most cases

• It may be associated with elevated serum amylase

• A positive Murphy's sign confirms gallstones as the cause

Answer explanation

Acute Cholecystitis
A. False – Acalculous cholecystitis exists.
B. False – Charcot’s triad relates to cholangitis, not cholecystitis.
C. False – WBC count is usually elevated.
D. True – Amylase may be raised due to associated pancreatitis.
E. False – Murphy’s sign supports diagnosis but not specific to gallstones.

Which of the following statements regarding sterilisation is CORRECT?

• It kills all microbial life including spores

• Autoclaving is suitable for sterilising steel instruments

• Ethylene oxide is a non-corrosive gas used for sterilisation

• Plastic instruments are sterilised using a hot air oven

• Gamma irradiation is used for sterilisation in industrial settings

Answer explanation

Sterilisation Techniques
A. True – Definition of sterilisation includes spores.
B. True – Autoclaving is suitable for metal instruments.
C. True – Ethylene oxide is non-corrosive and used for heat-sensitive items.
D. False – Hot air ovens are not suitable for plastic.
E. True – Gamma irradiation is used industrially.

Which of the following is a recognised complication of massive blood transfusion?

• Hypercalcaemia

• Leukopenia

• Coagulopathy

• Hepatic coma

• Hypokalaemia

Answer explanation

Complications of Massive Blood Transfusion
A. False – Causes hypocalcaemia due to citrate binding.
B. False – Leukopenia is not typical.
C. True – Dilutional coagulopathy is a key complication.
D. False – Hepatic coma is not directly related.
E. False – Hyperkalaemia is more likely.

Which of the following measures is proven to reduce the risk of surgical site infections?

• Shaving the surgical site the day before admission

• Prophylactic antibiotic administration

• Insertion of an indwelling catheter

• Pre-operative physiotherapy

• Prolonged hospital admission before surgery

Answer explanation

Prevention of Surgical Site Infections
A. False – Pre-op shaving increases infection risk if done too early.
B. True – Antibiotics reduce SSI when timed correctly.
C. False – Catheterisation increases infection risk.
D. False – Not directly related.
E. False – Longer pre-op stay increases risk.

Which of the following statements is TRUE regarding prophylactic antibiotic use?

• It is indicated in all patients with a history of rheumatic fever

• Cefuroxime is effective against anaerobic organisms

• Optimal timing is just before induction of anaesthesia

• They should be given for five days post-operatively

• Topical antibiotics are routinely used as prophylaxis

Answer explanation

Prophylactic Antibiotics
A. False – Only for procedures involving high risk of bacteraemia.
B. False – Cefuroxime has limited anaerobic cover.
C. True – Best given within 30–60 minutes before incision.
D. False – Extended post-op use not recommended.
E. False – Topicals are not routine.

Which of the following neck swellings typically moves with deglutition?

• Carotid body tumour

• Thyroglossal duct cyst

• Cystic hygroma

• Pre-tracheal lymph node

• Thyroid adenoma

Answer explanation

Neck Swellings Moving with Swallowing
A. False – Carotid body tumours don’t move with swallowing.
B. False – Moves with tongue protrusion, not deglutition.
C. False – Cystic hygroma does not move with swallowing.
D. False – Lymph nodes are fixed.
E. True – Thyroid swellings move with swallowing.

Which of the following is TRUE about portal hypertension?

• It is commonly caused by hepatic vein thrombosis

• Associated ascites is exudative in nature

• It may lead to hypersplenism

• It is commonly associated with hyperalbuminemia

• Esophageal varices are treated surgically in all cases

Answer explanation

Portal Hypertension
A. False – Most common cause is cirrhosis, not hepatic vein thrombosis.
B. False – Ascites is transudative.
C. True – Hypersplenism may occur due to splenic congestion.
D. False – Hypoalbuminemia is typical.
E. False – Not all varices require surgery.

Which of the following is TRUE in a patient with gastric outlet obstruction?

• Vomitus commonly contains bile

• Patients develop hyperchloraemic metabolic acidosis

• Succussion splash is a typical finding

• Patients present with hypernatremia and fluid overload

• Urine pH becomes alkaline due to vomiting

Answer explanation

Gastric Outlet Obstruction (GOO)
A. False – Vomitus is usually non-bilious.
B. False – Causes hypochloraemic metabolic alkalosis.
C. True – Succussion splash is characteristic.
D. False – Causes dehydration and hyponatremia.
E. False – Urine tends to be acidic.

Which of the following statements is CORRECT about perforated gastric ulcer?

• It is a diagnosis of exclusion

• It often results from chronic NSAID use

• It is managed conservatively unless complications arise

• Free air under diaphragm confirms the diagnosis

• It may progress to gastric lymphoma after 2 years

Answer explanation

Perforated Gastric Ulcer
A. False – Often diagnosed clinically with imaging.
B. True – NSAIDs are a common cause.
C. False – Usually needs surgical intervention.
D. True – Free air under diaphragm on X-ray is diagnostic.
E. False – No such progression to lymphoma.