orthopaedics quiz

Quiz Type

Practice

Subject

Surgery

Level

Level 400

Questions

10 questions

Created By

Nathaniel Kwame Brenyah

Quick Rules

Time limit: 10 minutes
Multiple attempts are not allowed
All questions must be answered to submit

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Question 1 of 10

Question 1

Multiple choice

A 60-year-old male patient is presenting for a total hip replacement after a long history of osteoarthritis. His pre-operative lab results reveal a serum calcium level of 3.2 mmol/L. The patient is asymptomatic but admits to taking high doses of vitamin D supplements for years due to concerns about bone health. Given this scenario, what should be the immediate step taken before proceeding with surgery?

Proceed with the surgery as planned since the patient is asymptomatic.

Administer intravenous calcium to correct hypocalcaemia.

Measure parathyroid hormone (PTH) levels to assess the etiology of hypercalcaemia.

Correct

Ensure the patient stops all vitamin D supplements immediately.

Explanation

Measuring PTH levels helps determine whether the hypercalcaemia is primary (due to conditions like hyperparathyroidism) or secondary (possibly due to excessive vitamin D). Proceeding with surgery without addressing the hypercalcaemia could lead to complications, regardless of whether the patient is symptomatic.

Question 2

Multiple choice

During a laparoscopic cholecystectomy, a surgeon encounters significant bleeding due to varices in a patient with portal hypertension. The surgical team is faced with the challenge of controlling the bleeding. Which approach should be taken first?

Apply direct pressure and continue surgery to remove the gallbladder.

Administer intravenous fluids rapidly to stabilize the patient.

Identify and control the source of bleeding before proceeding.

Correct

Convert to an open procedure immediately.

Explanation

Identifying and controlling the source of bleeding is critical in managing intraoperative hemorrhage, particularly in the presence of portal hypertension, which complicates matters. Administering fluids is important for stabilization, but direct control of the bleeding source is vital to prevent further blood loss.

Question 3

Multiple choice

A patient is admitted with a suspected fracture of the distal radius. An x-ray confirms the fracture, but the patient also exhibits symptoms consistent with hypercalcaemia. What is the most appropriate immediate response to manage this situation?

Immediate surgical fixation of the fracture.

Start IV bisphosphonates to lower calcium levels.

Correct

Begin oral calcium supplements to strengthen the bone.

Request an endocrinology consult to understand the calcium levels.

Explanation

Starting IV bisphosphonates would be the immediate action to lower dangerously high calcium levels, while surgical fixation is not urgent until the patient's metabolic status is stabilized. Oral calcium supplements would exacerbate hypercalcaemia.

Question 4

Multiple choice

In a recent case, a 70-year-old female patient undergoes surgery for a proximal femur fracture and is found to have elevated phosphate levels postoperatively. Given her history of chronic kidney disease, what factor should the surgical team be most vigilant about during her recovery?

Encourage early mobilization to prevent thromboembolism.

Monitor for signs of hypocalcaemia and related complications.

Correct

Administer vitamin D to improve bone health.

Limit fluid intake to avoid overload.

Explanation

Patients with chronic kidney disease can develop hypocalcaemia due to phosphate retention and disrupted metabolism, making monitoring calcium levels critical to prevent complications like tetany or cardiac issues.

Question 5

Multiple choice

A 45-year-old male patient scheduled for a nephrectomy presents with fatigue and muscle cramps. Lab tests reveal low magnesium levels alongside elevated calcium. In what manner should the surgical team prepare for this patient's surgery, given the potential risks?

Proceed with nephrectomy without alterations, as surgery is urgent.

Correct the magnesium deficiency prior to surgery.

Correct

Administer additional calcium supplements preoperatively.

Monitor magnesium levels closely but proceed if they do not stabilize.

Explanation

Since magnesium deficiency can lead to arrhythmias and neuromuscular dysfunction, it is vital to correct this before surgery to reduce perioperative risks, rather than proceeding with surgery with unaddressed electrolyte imbalances.

Question 6

Multiple choice

A 55-year-old female patient with a history of hyperparathyroidism is undergoing a parathyroidectomy. Intraoperatively, the surgeon notes unexpectedly high levels of calcium in the blood sample. What would be the most effective immediate action in this surgical situation?

Discontinue the surgery and monitor the patient's levels.

Administer intravenous fluids and consider diuretics.

Correct

Increase the rate of anesthesia to stabilize the patient.

Proceed with the removal of the parathyroid gland.

Explanation

Administering IV fluids along with potentially using diuretics can help manage the high calcium levels, stabilize the patient, and prevent complications such as cardiac events.

Question 7

Multiple choice

After surgery for a gastric bypass, a patient experiences recurrent muscle spasms and neurological symptoms. Blood tests reveal hypocalcaemia. Considering the patient's recent surgical history, what is the most probable underlying cause for their condition?

Dietary deficiency of calcium postoperatively.

Malabsorption of calcium due to altered intestinal anatomy.

Correct

Over-supplementation of vitamin D.

Primary hyperparathyroidism developing post-surgery.

Explanation

The most likely cause in this scenario is the alteration in gastrointestinal absorption due to the gastric bypass surgery, leading to hypocalcaemia, not simply a dietary deficiency or other endocrine issues.

Question 8

Multiple choice

A patient undergoing thyroidectomy has a documented deficiency of vitamin D preoperatively. Not long after the surgery, they develop low calcium levels. What is the best strategy to manage this complication postoperatively?

Administer calcium gluconate or calcium carbonate orally.

Monitor calcium levels and provide supportive care.

Initiate intravenous calcium supplementation and monitor closely.

Correct

Increase the patient's dietary calcium intake.

Explanation

Administering IV calcium is crucial for acute management of symptomatic hypocalcaemia, particularly after thyroid surgery where potential hypoparathyroidism can occur and oral supplements may not suffice.

Question 9

Multiple choice

A surgical team is preparing for an operation on a patient with a known malignant hypercalcaemia secondary to cancer. In the pre-operative assessment, the patient's calcium levels were significantly elevated. Which factor should be prioritized during the surgical planning phase?

Consult with oncology about the cancer treatment plan.

Ensure adequate hydration to manage renal function.

Correct

Proceed with surgical resection to resolve hypercalcaemia.

Prioritize pain management post-surgery.

Explanation

Ensuring adequate hydration is key to preemptively address the potential for renal compromise associated with hypercalcaemia and may aid in minimizing complications during anesthesia and recovery.

Question 10

Multiple choice

A 60-year-old male patient with a history of osteoporosis presents to the surgical clinic for evaluation of a planned hip replacement due to osteoarthritis. During his preoperative assessment, serum tests reveal elevated calcium levels (3.2 mmol/L) and phosphate levels (1.8 mmol/L). The patient's medications include vitamin D supplements and a thiazide diuretic for hypertension. What is the most appropriate initial step to address his current condition before proceeding with surgery?

Increase the dosage of vitamin D supplements to correct the hypercalcemia.

Discontinue the thiazide diuretic and replace it with a loop diuretic.

Correct

Administer intravenous fluids to enhance calcium excretion via the kidneys.

Schedule the hip replacement surgery without further modifications, as his hypercalcemia is likely benign.

Explanation

Discontinuing the thiazide diuretic is the most appropriate initial step because thiazide diuretics can cause increased calcium reabsorption in the kidneys, contributing to hypercalcemia. Switching to a loop diuretic may help increase urinary calcium excretion. Increased dosage of vitamin D could worsen hypercalcemia. Administering intravenous fluids can help, but the root cause related to the diuretic must be addressed first.