Dicm 227: Surgery Ii Question Paper
Dicm 227: Surgery Ii
Course:Clinical Medicine & Surgery
Institution: Kenya Methodist University question papers
Exam Year:2011
KENYA METHODIST UNIVERSITY
END OF 3''RD ''TRIMESTER 2011 EXAMINATIONS
SCHOOL : MEDICINE & HEALTH SCIENCES
DEPARTMENT : CLINICAL MEDICINE & SURGERY
UNIT CODE : DICM 227
UNIT TITLE : SURGERY II
TIME : 3 HOURS
Instructions:
MCQs
Correct Response: 1 mark
Wrong Response: 1 Marks
No Response: 0 Marks
Question One
Signs and symptoms of early pregnancy include:
Missed, light, or late menstrual period.
Breast swelling and tenderness at 4 weeks
Fatigue, nausea and urinary frequency at 5 to 6 weeks
Cervical hardening
Chadwick’s sign at 6 to 8 weeks
Question Two
Physiologic changes in pregnancy include:
Increased cardiac output and increased heart rate
Increased blood pressure
Decreased respiratory rate and decreased tidal volume
Decreased functional residual volume and decreased Pco2
Increased blood volume and decreased hematocrit
Question Three
In distinguishing true versus false labor:
False labor is defined as uterine contractions which do not lead to cervical changes.
False labor is characterized by Braxton-Hicks contractions, which are irregular in both intensity and duration.
False labor may need admission for hydration and rest.
True labor is characterized by painful, regular contractions of steadily increasing intensity and duration leading to progressive cervical dilatation.
True labor leads to progressive descent of the fetus into the pelvis.
Question Four
Active management of third stage of labor involves:
Fundal massage
Gentle cord traction with counter-traction of the fundus
Administration of oxytocin 10iu 1.M after delivery of baby
Per rectal administration of misoprostol 400 to 800 mcg in persistent uterine atony.
Oxytocics are preferably to be administered before the delivery of the placenta.
Question Five
Spontaneous perineal tears are classified thus:
Fourth degree: Involves anal sphincter only
Third degree: Involves rectal mucosa only
Fifth degree: Involves the symphysis pubis
Second degree: Involves vaginal mucosa only
First degree: involves vaginal mucosa and perineal muscles only
Question six
In hyperemesis gravidarum, the following are typically demonstrated:
Weight gain
Abdominal Pain
Abnormal vaginal bleeding
Dysmenorrhea
Intermenstrual bleeding
Question Seven
Symptoms described in the classic triad of ectopic pregnancy are:
Amenorrhoea
Abdominal pain
Abnormal vaginal bleeding
Dysmenorrhea
Intermenstrual bleeding
Question Eight
Risk factors for ectopic pregnancy include
Pelvic inflammatory disease
Previous ectopic
Tubal surgery
Endometriosis
Super-ovulatory agents
Question Nine
Pregnancy test
Pelvic ultrasound
Serial quantitative beta HCG levels
Culdocentesis
Question Ten
Features of a missed abortion may include:
Passage of chorionic membranes with retention of fetus in uterus
In utero death of embryo or fetus with retained products of conception
Open cervical os
Conversion of pregnancy test from positive to negative
Blighted ovum/Anembryonic gestational sac on ultrasound
Question Eleven
The management of suspected placenta pravia involves:
Wide bore IV access
Complete Blood Count, typing and crossmatching
Urgent obstetric ultrasound
Digital exam
Immediate delivery by c-section in placenta praevia type 1
Question Twelve
Cord prolapsed is associated with:
Multiple gestation
Malpresentation
Polyhydramnios
Rupture of membranes without head engagement
Prematurity
Question Thirteen
Complications of hypertension in pregnancy include:
Abruption placenta
Reduced liver enzymes in blood
Thrombocytosis
Increased hematocrit
Preterm birth
Question Fourteen
The following medications could be used in the treatment of eclampsia.
Magnesium sulfate
Phenytoin
Nifedipine
Hudralazing
Labetalol
Question Fifteen
Causes of post-partum haemorrhage include:
Tetanic uterus
Uterine inversion
Polycystic ovaries
Retained products of conception
Lower uterine segment placental attachment
Question Sixteen
Risk factors for endometritis include:
Caesarean section
Pre-labor rupture of membranes
Excessive pelvic examination
Prolonged labor
Poor nutritional status
Question Seventeen
In deep venous thrombosis, virchow’s triad refers to:
Venous stasis
Vessel wall injury
Hypercoagulable state
Low platelets
Elevated liver enzymes
Question Eighteen
Medical treatment of preterm prelabor rupture of membranes involves the use of:
Antibiotics
Corticosteroids
Tocolytics
Catecholamines
Anti-coagulants
Question Nineteen
The management of post-term pregnancy may involve;
Labor induction
Cervical ripening
Biophysical profile assessment
Amniotic fluid volume measurement
Caesarean section
Question Twenty
In the evolution of ovarian masses the following may be carried out:
Serum CA-125 Assay
Laparoscopy
Laparotomy
Doppler ultrasound
Magnetic resonance imaging
LONG EASSAY QUESTIONS (each 25 Marks)
ANSWER BOTH
Question One
Describe the pathophysiology of anemia in pregnancy and discuss the management of a G%P4 +0 mother who presents in emergency room complaining of dizziness and easy fatigability at 38/40 gestation.
Question Two
Describe the causes of intra-uterine growth restriction and discuss the management of a P1+0 mother who presents with loss of fetal movements for the last two days at 36/40 gestation.
STRUCTURED SHORT ANSWER QUESTIONS
At least five responses expected for each question each 5 Marks):
Question One
List surgical methods of managing post-abortion complications.
Question Two
Mention contrasting features of abruption placenta and placenta praevia
Question Three
List five steps of management of postpartum haemorrhage.
Question Four
What are the signs of intra-amniotic infection?
Question Five
Mention instances where use of tocolytics is contradicted in preterm labor.
Question Six
What are the benefits of using antenatal glucocorticoid therapy in preterm premature rupture of membranes?
Question Seven
List situations where multiparous women are at increased risk of preeclampsia.
Question Eight
Mention physical findings that one may encounter in a patient with post-partum DVT of lower limbs.
Question Nine
List complications of post-term pregnancy.
Question Ten
Mention detrimental effects of uncontrolled diabetes mellitus in pregnancy.
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