Wessex Core Surgical Training Nov 2014 Candidate Name:______

Wessex Core Surgical Training Nov 2014 Candidate Name:______

Laparoscopy Module

Pre-Course MCQ

1. Which one of the following is not true?

a. The Hasson technique is a safe port insertion technique in patients with suspected adhesions

b. Visiport and Xcel are similar types of ports

c. Permanent renal impairment can occur with pneumoperitoneum

d. Asystole and bradycardia can occur with peritoneal insufflation

e. CO2 embolism can cause hypotension

2. Which of the following is not a differential diagnosis of upper abdominal pain?

a. Acute cholecystitis

b. Fitz-Hugh-Curtis syndrome

c. Alcoholic cirrhosis with portal hypertension

d. Basal pneumonia

e. Myocardial infarction

f. Perforated peptic ulcer

g. Acute appendicitis

3. If you encounter bleeding from the appendicular stump during a laparoscopic appendicectomy, which of the following are most helpful (circle 4)?

a. Call for help immediately f. inform the anaesthetist

b. Use a tonsillar swab g. Use a haemostatic sponge

c. Diathermise carefully h. Suture stump

d. Get suction irrigation i. Staple caecal pole

e. Convert to open J. Ask for cross-matched blood

4. Which of the following is true of Calot’s triangle?

a. one border is the cystic duct

b. one border is the common bile duct

c. the cystic artery runs through it

d. the cystic duct arises from the right hepatic duct 1/3rd of the time

e. Surgeons call it the critical view when they display it

f. Mirizzi’s syndrome obscures it

5. What is not a strategy to improve a laparoscopic view?

a. Change from a 30 degree to 0 degree scope

b. Use hot water to demist the scope

c. Release smoke from a port

d. Change patient tilt

e. Check with anaesthetist if patient is paralysed

f. Check insufflation pressure and flow

g. Look through a different or new port

6. Lap appendix - what 2 are not true?

a. An acceptable negative appendicectomy rate is 25%

b. Ultrasound can identify acute appendicitis

c. Ultrasound is useful in looking for gynaecological causes

d. Laparoscopic appendicectomy in children is questionable

e. Pelvic lavage is better with laparoscopic vs. open approach

f. Laparoscopic appendicectomy is contraindicated in the morbidly obese

7. Asymptomatic gallstones (circle all true)

a. They should be considered for removal in diabetics

b. 10% become symptomatic within a year

c. A 7mm polyp within the gallbladder can be highly malignant

d. Sludge in the gallbladder is commonly seen in fasting or ITU patients and can be ignored

e. If cholecystectomy needs to be done during pregnancy, the safest time is the second trimester

8. Gallstones risk factors (circle all that apply)

a. Obesity e. Sickle-call disease

b. Pregnancy f. Gastrectomy

c. Weight loss g. Hypercholesterolaemia

d. Terminal ileal Crohn’s i. Hereditary spherocytosis

9. Which are the optimal port positions for a laparoscopic fundoplication?

a. umbilical, left flank, LUQ, epigastrium

b. epigastrium, left and right UQ, left flank

c. umbilical, left and right UQ, right flank

d. epigastrium, left and right UQ, right flank

e. none of the above

10. Which of the following is not true of laparoscopy?

a. Insufflation pressure above 16 is dangerous

c. Loss of relaxant can raise pressures above 20

d. The flow should be kept to a minimum

e. A safe place to insert a Verres needle is the LUQ

f. Enseal and Thunderbeat are types of bipolar diathermy

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