LEC 1 GANGRENE

Q1. Regarding gangrene all are true except:

a. A medical term used to describe the death of an area of the body

b. It develops when the blood supply is cut off to the affected area.
c. Upper extremities are more commonly involved than lower extremities.
d. Often associated with diabetes and long term smoking

Q2. A 60 years old male who is a diabetic patient, comes to you with ischemia in the distal part
of lower limb. The affected part is shrunken, dark reddish black and has sensation of coldness.
The gangrene appeared gradually and has progressed slowly. State which type of gangrene is it:

a. Wet gangrene
b. Dry gangrene
c. Gas gangrene
d. None of above

Q3. Regarding gas gangrene all are true except:

a. The wound requires immediate debridement

b. It should be treated as a medical emergency
c. It is caused by the aerobic bacteria Clostridium perfringen
d. It spreads rapidly to surrounding tissues

Q4. A 40 years old female had an infection in her hands that occurred during a surgery. The
affected area is swollen and extremely painful. You observe that the area has become black and
produces foul-smelling odor. Her blood results show increased White blood cells. The best
treatment for this type of gangrene will be:

a. Restoring the blood supply

b. Surgical debridement of the wound
c. Intravenous antibiotics
d. Both b and c

Q5. A patient comes to you in emergency with brown-red or bloody discharge oozing from an
infected wound. The patient has also developed fever, increased heart rate and rapid
breathing. On pressing the wound a crackling sensation is produced. What is your most likely
diagnosis?

a. Wet gangrene
 b. Dry gangrene
c. Gas gangrene
d. None of above

Q6. The following conditions are the risk factors for the development of gangrene:

a. Injuries or trauma such as crush injury/frostbite

b. Diseases that affect circulation i.e. diabetes, smoking etc.
c. Infection of wounds
d. All of the above

Q7. The physical examination of a 5 years old malnourished child shows inflamed areas of
mucous membranes of the mouth and skin ulcers that cause the tissues of the lips and cheeks
to die. Such gangrenous disease is called:

a. Wet gangrene
b. Noma
c. Internal gangrene
d. None of the above

Q8. A 40 years old diabetic male comes to you with pain, tenderness and swelling in his genital
area. He has a recent history of urinary tract infection. Which type of gangrene will it be?

a. Noma
b. Wet gangrene
c. Dry gangrene
d. Fournier gangrene

Q9. A diabetic patient comes to you with an infected foot ulcer that has lead to gangrene due to
the restricted blood supply. What treatment will be necessary to prevent the spread of
infection and further damage to the healthy tissues?

a. Antibiotics only
b. Revascularization
c. Amputation of the affected limb
d. None of the above

Q10. Below knee amputation is done:

a. 8 inches below tibial tuberosity

b. 12 inches below tibial tuberosity
c. 6 inches below tibial tuberosity
 d. None of above

LEC 2 CPR
1. CPR stands for:
 Cardiopulmonary rehabilitation
 Cardiopulmonary resuscitation
 Cardiopulmonary re-modeling
 Cardiopulmonary reconstruction

2. A male electrician is wiring an electric motor of your house. During this task he receives severe
electric shock and gets unconscious, breathing and have pulse. Being a medical practitioner what will
you do?

 Bring him to hospital immediately

 Wait for the ambulance
 Sprinkle water on his face to make him conscious again
 Make a safe position for breathing facilitation & choking prevention until EMR arrival

3. Which of the following is done during CPR?

 Give adrenaline every 6-8 minutes

 Interrupted chest compressions
 Give oxygen
 All of the above

4. 35 years old anjum is rescued from the earthquake and presented to hospital with multiple trauma
and severe pain. Repeated doses of pethidine are administered causing drug overdose. He is the suitable
candidate for:

 Immediate surgery for trauma management

 Cardiopulmonary resuscitation
 Both
 Only (B)

5. CPR is not indicated in:

 Diabetes
 Stroke
 Smoke inhalation
 Hematemesis
6. A patient is brought to EMR.O/E you find no breathing and his heart has stopped pumping. You will
classify him in the category of:

 Cardiac arrest
 Respiratory arrest
 Clinical death
 All of above

7. Chest compressions in CPR are delivered at which of the following site:

 Lower half of sternum

 Upper half of sternum
 Medial half of sternum
 Lateral half of sternum

8. CPR is different in infants & adults because in infants:

 Chest compression is given at lower half of sternum

 Only two fingers are used
 CPR for infants and adults is similar
 Pump at the rate of 100 compressions per minute

9. Dr. Saba is walking by the side of road and someone gets unconscious suddenly in front of her. What
will her initial step to clear airway:

 Jaw lifting
 Mouth to mouth breathing
 CPR
 None of above

10. Injuries related to CPR include all of the above except:

 Ribs fractures
 Laceration of lungs
 Laceration of liver
 CPR does not cause any injury

Mcq’s from head injury lec 3

1. In examination, primary survey involves
a. Definitive management
b. Resuscitation
c. Checks GCS
d. Radiological examination
2. In GCS, severe disability has scale
 a. 1
b. 8
c. 3
d. 0

3 --A 65 years old patient is brought into emergency department with severe blow on skull, after lucid
interval he got into unconscious state. The doctor observed contralateral hemiparesis and hypotension.
What would be the diagnosis of this patient?
A. Extradural hematoma
B. acute subdural hematoma
C. raised intracranial pressure
D. Head Injury

4—Burrhole is indicated under what circumstances?

A. head injury
B. extradural hematoma
C. subdural hematoma
D. both A and B

5. Which of the following statements is CORRECT regarding Intracranial

Haematomas?

A. Epidural haematomas are crescent shaped on CT

B. Subarachnoid haematomas are commonly seen in the elderly and in

Alcoholics

C. Intracerebral haematomas usually involve the anterior temporal or posterior frontal lobe

D. Subdural haematomas are commonly caused by skull fracture and tearing of

The middle meningeal artery

6. Which of the following is TRUE of head injury

A. Extradural haematomas commonly occur without skull fracture
B. Papilloedema is an early sign of raised intracranial pressure
C.CSF leak occurs in 20% of base of skull fractures
D. Adults are more likely than children to develop cerebral oedema in head trauma.

7. The following is TRUE regarding head injuries:

A. Acute subdural hematoma most commonly develops due to a skull fracture
Overlying the middle meningeal artery
B. Intracerebral hematomas’ in the occipital lobes are more common than in
the other parts of the brain, because of the backwards motion of the brain
during acceleration-deceleration injury
C. In more than 80% of cases a unilateral fixed dilated pupil is the result of
Ipsilateral cerebral herniation
D. The administration of prophylactic anti-epileptic drugs does not reduce the
Incidence of seizures in the long term, but it does reduce the incidence of early post-traumatic seizures.

8. When resuscitating the major trauma victim:

A. Platelets should be given if > 10 units of blood are used.
B.Hypothermia <32 degrees is recommended for cerebroprotection
C. Clotting factors should be transfused if total blood loss > 3 litres
D. Micropore filters reduce complications of transfusion

9. Which of the following is NOT high risk according to the Canadian CT HEAD
Rules?
A. Vomiting >= 2 episodes
B. Any sign of basal skull #
C. Age >=60yrs
D. Suspected open or depressed skull #

10. Principles of Trauma Management include all of the below EXCEPT

A. Organised team approach
B. Transfer to Trauma Centre
C. Assumption of most serious injury
D. Frequent reassessment

11. According to the Canadian CT Head rules, a CT head is indicated in all of

the following situations EXCEPT
A. Retrograde amnesia of 15 minutes or less.
B. Suspected open skull fracture
C. Vomiting 2 or more times
D. CSF otorrhoea or rhinorrhoea.

12. In acute traumatic head injury in the emergency department setting which of
the following is true?
A. Paediatric subdural haemorrhage is always accidental.
B. Primary cellular death results mainly from an increase in cellular glutamate.
C. Diffuse axonal injury is most likely with delayed coma onset.
D. Hypocapnia should be avoided

MCQS SURGERY
lec 4 CHEST TRAUMA
By: 4MI

1.Abdominal injuries are common with:

a) chest trauma
b) cardiopulmonary
c) gall bladder
d) none of above

2. Pair of ribs are:

a) 8
b) 10
c) 12
d) 14

3. Low energy thoracic penetrating trauma is due to:

a) Military, hunting rifles & high powered hand guns
b) Extensive injury due to high pressure cavitation
c) injury caused by direct contact and cavitation
d) All of above

4. Serious pathological causes in chest trauma are:

a) Hypoxia
b) Hypovolemia
c) Myocardial failure
d) All of above

5. Immediately life threatening injuries are all except:

a) Tension pneumothorax
b) open pneumothorax
c) flial chest
d) cardiac contusion

6. Serious chest wall injury with underlying pulmonary injury will;

a) increases volume of respiration
b) reduces volume of respiration
c) adds to increased mortality
d) both b and c

7. Pulmonary contusion is the most common chest injury in:

a) children
b) adults over age 35
c) adults over age 45
d) none of above

8. Complication of pulmonary contusion are all except:

a) Atelectasis
b) pneumonia
c) pneumothorax
d) ARDS
 9. Diaphragmatic rupture mostly on:
a) right side
b) left side
c) both a and b
d) none of above

10. Acute thoractomy includes all except:

a) cardiac temponade
b) massive air leak
c) esophageal injury
d) chest tube output output <200cc/hour

LECT CHEST TRAUMA

All of the following are anatomy physiology of the thorax except

sternum

12 pairs of c-shaped ribs

Xiphiod process

Abdominal injuries

Diaphragm structure is

Muscular dome like structure

Separate chest to abdomen

Affixed to upper border of rib cage

None of above

12 pairs of c-shaped ribs present in

Thorax

Abdomen

Spine

Diaphragm

Chest truma serious pathological consequences are

Hypoxia
hypovoleamia

myocardial failure

all of the above

the potential life thearts of chesT trauma are

All of the following management of chest injury in patient except

Consider analgesics for pain

To improve chest excrusion

Nitrous oxide

Morphine sulphate

Open pneumothorax

High flow oxygen

Covers site with sterile

Progressive air way

Management

All of the above

Immediately life threatening injuries are

Airway obstruction

Trachea bronchial

Aortic disruption

Cardiac contusion

Treatment of flail chest is

Humidified nitrogen

Adequate resuscitation

Pain management

None of above

To stabilize the chest

Internal-ventilator

External-sand bags

Both a&b

None of above

NECK LEC MCQz

A spinal cord injury above 7th cervical vertebrae would result in

A. Quadriplegia
B. Paraplegia
C. Hemi plegia
D. Diaplegia

A spinal cord injury below 7th cervical vertebrae would result in

A. Quadriplegia
B. Paraplegia
C. Tetraplegia
D. None of above

A patient comes in OPD with symptoms of thoracic outlet syndrome, what will be the clinical
presentation of that patient :

A. Diffuse arm symptoms

B. Numbness
C. Tingling
D. All of above

Patient having TOS , symptoms worsen with :

A. Overhead activity
B. Eating
 C. Lying
D. Sitting

Following are the contents of thoracic outlet except :

A. Brachial plexus
B. Subclavian artery /vein
C. Axillary artery / vein
D. Ulnar artery

A patient comes in OPD, having fluctuant, transilluminent , contains cholesterol crystals, cyst in his neck.
This is the clinical feature of what type of cyst :

A. Brachial cyst
B. Pharyngeal pouch
C. Ranula
D. None of above

What is the urgical treatment of Ranula :

A. Removal of ranula
B. Excision of tongue
C. Removal of sublingual gland
D. None of above

Tracheotomy is :

A. Operative procedure that creates an artificial opening in trachea

B. Creation of permanent or semi permanent opening in trachea
C. None of above
D. All of above

Tracheostomy is :

A. Operative procedure that creates an artificial opening in trachea

B. Creation of permanent or semi permanent opening in trachea
C. None of above
D. All of above

Indications for tracheostomy are :

A. Upper airway obstruction

B. Pulmonary ventilation
C. Pulmonary toilet
D. All of above
Topic : cardiac surgry
1.Types of cardiac surgery are---------------

A. Bypass surgeries

B. Angioplasty

C. Heart valve replacements

D. Heart transplants

E. All of above

2.most common complications of cardiac surgery are -----------

A. Sternal instability and non healing

B. Chest infection
C. Wound infection
D. All of above

3.Surgical Approaches to heart are ------------

A. Median sternotomy
B. Lateral sternotomy
C. Left lateral thoracotomy
D. Both a and c

4.By pass surgery indications are

a. Tripple vessel disease

b. Failure of angioplasty
c. Both a and b
d. None of above

5.Cardiac tamponade---------

a. Rapid accumulation of blood in the pericardial sac

b. Compression of the cardiac chambers, decrease diastolic filling
c. decreased cardiac output
d. all of above are correct

6.Precautions after median sternotomy are---------

a. Limit Patient’s functional upper limb activity

b. To prevent sternal non union or instability
c. Limit lower limb activity
 d. Both a and b

7. Consequences of not identifying the atypical chest pain-----

a. Chronic chest pain

b. Anxiety
c. Interruption in daily activities
d. All of above

8. It is done for the exposure of the heart ,pericardium and structures in the anterior
mediastinum

a. Lateral sternotomy
b. Medial sternotomy
c. Lateral thoracotomy
d. Medial thoracotomy

9.In by pass surgry overall mortality rate is

a. 1.25%
b. 2-3%
c. 3-6%
d. 0%

10.Valve repair indications are-------

a. Aortic stenosis
b. Aortic regurgitation
c. Mitral stenosis
d. All of above