MCQ Cram Sheet : Basic surgical skill and anastomoses

Bailey Chapter 4 Based MCQs

Basic surgical skill and anastomoses

1	Which of the following is true statement regarding elliptical incisions ? Two times as long as it is wide Five times as long as it is wide Four times as long as it is wide Three times as long as it is wide	Answer: A Rule of thumb for elliptical incisions: ‘an elliptical incision must be at least three times as long as it is wide’ for the wound to heal without tension.
2	Consider following statements regarding abdominal incisions :  Transverse incisions tend to be associated with fewer respiratory complications Transverse incisions tend to be associated with better cosmetic outcome Midline incisions tend to be associated with fewer respiratory complications Midline incisions tend to be associated with better cosmetic outcome Identify true statements from the following ? Both 1 and 3 are true Both 1 and 2 are true Both 2 and 4 are true Both 3 and 4 are true	Answer: B Transverse incisions tend to be associated with fewer respiratory complications and a better cosmetic outcome. In the past, traditionally vertical midline or paramedian incisions were used for the majority of abdominal procedures, but there is a current trend to utilise transverse incisions wherever possible as this minimises postoperative complications
3	For abdominal wall closure, what should be the ration of the length of the suture material to the length of the wound to be closed? 3:1 4:1 2:1 5:1	Answer: B For abdominal wall closure, the length of the suture material should be at least four times the length of the wound to be closed to minimise the risk of abdominal dehiscence or later incisional hernia.
4	Skin grafting is a form of: Primary Intention Healing Secondary Intention Healing Tertiary Intention Healing Quaternary Intention Healing	Answer: C Delayed primary closure or tertiary intention is utilised when there is a high probability of the wound being infected. The wound is left open for a few days and then if any infective process is resolved then the wound is closed to heal by primary intention. Skin grafting is another form of tertiary intention healing
5	In Vascular anastomosis the suture material used should be all except: Non Absorbable Elastic Non Elastic Monofilament	Answer: B Vascular anastomoses require smooth, non-absorbable, non-elastic, monofilament material. It is wise to avoid braided material as platelet adherence may predispose to distal embolisation. Non-absorbable materials tend to be preferred where persistent strength is required and, as an artificial graft or prosthesis never heals fully or integrates into a host artery, persistent monofilament suture materials, such as polypropylene, are almost universally used
6	In Biliary anastomoses, the suture material should have all properties except: Absorbable Does not promote tissue reaction Should Promote good fibrotic reaction Does not promote stone formation	Answer: C Biliary anastomosis require an absorbable material that will not promote tissue reaction or stone formation
7	The diameter of 0 silk in mm is: 0.500–0.599 0.400–0.499 0.350–0.399 0.300–0.349	Answer: C Range of diameter (mm) USP (‘old’) 0.100–0.149 => 5–0 5 0.150–0.199  => 4–0 0.200–0.249  => 3–0 0.300–0.349  => 2–0 0.350–0.399  => 0 0.400–0.499  => 1 0.500–0.599  => 2
8	Which of the following statement is false about bowel anastomosis? Seromuscular technique is currently the most widely accepted technique of bowel anastomosis Extramucosal technique is currently the most widely accepted technique of bowel anastomosis Submucosa has a high collagen content Submucosa is the most stable suture layer in all sections of the gastrointestinal tract	Answer : A Halsted favoured a one layer extramucosal closure, and this was subsequently advocated by Matheson as it was felt to cause the least tissue necrosis or luminal narrowing. This technique has now become widely accepted. The extramucosal suture must include the submucosa as this has a high collagen content and is the most stable suture layer in all sections of the gastrointestinal tract.
9	Which of the following is false regarding the absorption of following suture materials: Chromic is absorbed by Phagocytosis and enzymatic degradation Polyglactin is absorbed by hydrolysis Polyglyconate is absorbed by enzymatic degradation Polydioxanone is absorbed at 180 days	Answer: C Catgut (Plain): Phagocytosis and enzymatic degradation within 7–10 days Catgut (Chromic): Phagocytosis and enzymatic degradation within 90 days. Tensile strength lost within 21 days. Polyglactin: Complete absorption 60–90 days. Approximately 60% remains at 2 weeks Approximately 30% remains at 3 weeks Polyglyconate: Hydrolysis. Complete absorption by 180 days Polydioxanone (PDS): Hydrolysis. Complete absorption at 180 days
10	Vicryl is Polyester polymer Copolymer of glycolic acid and trimethylene carbonate Polymer of polyglycolic acid Copolymer of lactide and glycolide	Answer: D Vicryl is copolymer of lactide and glycolide Copolymer of glycolic acid and trimethylene carbonate: Polyglyconate   Polymer of polyglycolic acid:Polyglycolic acid Polyester polymer: Polydioxanone (PDS)
11	Which of the following statements is false wrt to bowel anastomosis? Suture materials should be of 2/0–3/0 size Absorbable polymers are used to suture Both braided or monofilament can be used Suture bites should be approximately 6-8 mm apart	Answer: D The apposition of bowel edges should be as accurate as possible and the suture bites should be approximately 3–5 mm deep and 3–5 mm apart depending on the thickness of the bowel wall.  The suture materials should be of 2/0–3/0 size and made of an absorbable polymer, which can be braided (e.g. polyglactin), or monofilament (e.g. polydioxanone), mounted on an atraumatic round-bodied needle.
12	Which of the following technique is used in cases of minor discrepancy in the size of anastomotic bowel ends? Kocher’s Maneuver Baley’s Technique  Petersen’s Technique Cheatle Technique	Answer : D In cases of major size discrepancy, a side-to-side or end-to-side anastomosis may be safer.  In cases of minor size discrepancy, a Cheatle split (making a cut into the  antimesenteric border) may help to enlarge the lumen of distal, collapsed bowel and allow an end-to-end anastomosis to be fashioned.
13	Internal hernias which occur in the potential space posterior to a Roux en y gastrojejunostomy is known as: Laugier’s Hernia Richter’s Hernia Petersen’s Hernia Narath’s Hernia	Answer: C Internal hernias which occur in the potential space posterior to a Roux en y gastrojejunostomy are called as Petersen's hernia
14	What is the suture size used for vascular anastomoses involving Aorta? 1/0 2/0 3/0 4/0	Answer: B Suture size depends on vessel calibre: 2/0 is suitable for the aorta, 4/0 for the femoral artery and 6/0 for the popliteal to distal arteries. Microvascular anastomoses are made using a loupe and an interrupted suture down to 10/0 size
15	Which of the statements regarding vascular anastomosis is false? Outside to inside on the graft and from inside to outside on the artery Double ended sutures make the procedures easier This is done to minimise the risk of intimal flap formation Inside to outside on the graft and from outside to inside on the artery	Answer: D The suture should go from outside to inside on the graft and from inside to outside on the artery, again to minimise the risk of intimal flap formation. Double ended sutures make the procedures easier
16	Which of the following statement regarding the use of T tube is false? T-tubes should remain in for 20 days T-tube cholangiogram is done to see free flow of bile into the duodenum  T-tube cholangiogram is done to ensure there are no retained stones T Tube allows bile to drain while the sphincter of Oddi is in spasm postoperatively	Answer: A Common bile duct T-tubes should remain in for 10 days. However, once the T-tube cholangiogram has shown that there is free flow of bile into the duodenum and that there are no retained stones, some surgeons like to clamp the T-tube prior to removal. The 10-day period is required to minimise the risk of biliary peritonitis after removal.
17	Diathermy injury due to capacitance coupling is seen in which of the following cases: Metal Port with Insulated Diathermy hook and a Metal cuff Metal Port with Insulated Diathermy hook and a Plastic cuff Metal Port with Insulated Diathermy hook with no Metal or Plastic cuff Plastic Port with Insulated Diathermy hook and a Plastic cuff	Answer: B Capacitance coupling is a phenomenon in which a capacitor is created by having an insulator sandwiched between two metal electrodes. This can be created in situations where there is a metal laparoscopic port and the diathermy hook with insulation coating is passed through it. The insulation of the diathermy hook acts as the sandwiched insulator and by means of electromagnetic induction, the diathermy current flowing through the hook can induce a current in the metal port, which can potentially damage intraperitoneal structures. In most cases, this current is  dissipated from the metal port through the abdominal wall, but if a plastic cuff is used, this dissipation of current does not occur and the danger of capacitance coupling is significantly increased. Therefore, metal ports should never be used with a plastic cuff. The danger of capacitance coupling can be prevented by using entirely plastic ports.
18	Ligasure is a monopolar technology that uses the body’s own collagen and elastin to both seal and divide. It can seal vessels up to what size? 5mm 6mm 7mm 8mm	Answer: C Ligasure can seal vessels of up to 7 mm diameter, with an average seal time of 2–4 seconds, as well as pedicles, tissue bundles and lymphatics with a consistent controlled and predictable effect on tissue, including less dessication
19	The harmonic scalpel is an instrument that uses ultrasound technology to cut tissues while simultaneously sealing them. The scalpel vibrates in what ultrasonic range? Upto  20,000 Hz range 20,000–50,000 Hz range  20,000-80,000 Hz range 20,000-1,00,000 Hz range	Answer: B During use, the scalpel vibrates in the 20 000–50 000 Hz range and cuts through tissues, affecting haemostasis by sealing vessels and tissues by means of protein denaturation caused by vibration rather than heat (in a similar manner to whisking an egg white). It provides cutting precision, even through thickened scar tissue, and visibility is enhanced due to less smoke being created by this system during use compared to routine electrosurgery.

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