Robotic surgery principles US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Robotic surgery principles. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Robotic surgery principles US Medical PG Question 1: The surgical equipment used during a craniectomy is sterilized using pressurized steam at 121°C for 15 minutes. Reuse of these instruments can cause transmission of which of the following pathogens?
- A. Non-enveloped viruses
- B. Sporulating bacteria
- C. Prions (Correct Answer)
- D. Enveloped viruses
- E. Yeasts
Robotic surgery principles Explanation: ***Prions***
- Prions are **abnormally folded proteins** that are highly resistant to standard sterilization methods like steam autoclaving at 121°C, making them a risk for transmission through reused surgical instruments.
- They cause transmissible spongiform encephalopathies (TSEs) like **Creutzfeldt-Jakob disease**, where even trace amounts can be highly infectious.
*Non-enveloped viruses*
- Non-enveloped viruses are generally **more resistant to heat and disinfectants** than enveloped viruses but are typically inactivated by recommended steam sterilization protocols.
- Standard autoclaving conditions are effective in destroying most non-enveloped viruses.
*Sporulating bacteria*
- **Bacterial spores**, such as those from *Clostridium* or *Bacillus*, are known for their high resistance to heat and chemicals, but are usually **inactivated by steam sterilization at 121°C** for 15 minutes.
- This method is specifically designed to kill bacterial spores effectively.
*Enveloped viruses*
- Enveloped viruses are the **least resistant to heat and chemical disinfectants** due to their lipid envelope.
- They are readily **inactivated by standard steam sterilization** at 121°C.
*Yeasts*
- **Yeasts** are eukaryotic microorganisms that are typically **susceptible to heat sterilization**.
- They are effectively killed by typical steam autoclaving conditions used for surgical instruments.
Robotic surgery principles US Medical PG Question 2: A 26-year-old woman presents to her primary care physician for 5 days of increasing pelvic pain. She says that the pain has been present for the last 2 months; however, it has become increasingly severe recently. She also says that the pain has been accompanied by unusually heavy menstrual periods in the last few months. Physical exam reveals a mass in the right adnexa, and ultrasonography reveals a 9 cm right ovarian mass. If this mass is surgically removed, which of the following structures must be diligently protected?
- A. External iliac artery
- B. Ureter (Correct Answer)
- C. Ovarian ligament
- D. Cardinal ligament of the uterus
- E. Internal iliac artery
Robotic surgery principles Explanation: ***Ureter***
- During **oophorectomy** (removal of an ovarian mass), the **ureter** is particularly vulnerable to injury due to its close proximity to the **ovary** and its blood supply.
- The right ureter courses directly posterior to the **right ovarian vessels** within the infundibulopelvic ligament, making it susceptible to **ligation** or **transection** during surgical maneuvers.
*External iliac artery*
- The external iliac artery is located more laterally within the **pelvis** and supplies the lower extremity; it is generally not in the immediate surgical field for ovarian mass removal.
- While injury to major pelvic vessels is always a concern, the **anatomical relationship** of the external iliac artery makes it less directly vulnerable compared to the ureter during this specific procedure.
*Ovarian ligament*
- The **ovarian ligament** connects the ovary to the **uterus** and is typically dissected or ligated during oophorectomy.
- Although it is cut during the procedure, it is not a structure that requires meticulous protection in the same way as the **ureter**, as its injury primarily impacts **ovarian removal** rather than causing significant morbidity.
*Cardinal ligament of the uterus*
- The **cardinal ligament** provides support to the **cervix** and **upper vagina** but is generally not directly involved in the removal of an **isolated ovarian mass**.
- Injury to this ligament is more typically associated with **hysterectomy** or procedures involving the **uterus**.
*Internal iliac artery*
- The **internal iliac artery** supplies blood to the **pelvic organs** and is situated deeper within the pelvis, making it less prone to direct injury during an oophorectomy compared to the **ureter**.
- While it gives off branches to the uterus and vagina, its main trunk is not as immediately adjacent to the **ovary** as the ureter.
Robotic surgery principles US Medical PG Question 3: During a surgical procedure to repair an abdominal aortic aneurysm, the surgeon must be careful to avoid injury to which of the following arterial structures that originates near the level of the renal vessels?
- A. Left renal artery (Correct Answer)
- B. Celiac trunk
- C. Right renal artery
- D. Superior mesenteric artery
Robotic surgery principles Explanation: ***Left renal artery***
- The **left renal artery** arises from the aorta usually just below the superior mesenteric artery, making it susceptible to injury during an **abdominal aortic aneurysm (AAA) repair** if the aneurysm extends proximally.
- Its proximity to the typical location of AAA, often near or involving the **infrarenal aorta**, necessitates careful identification and protection during clamping or graft placement.
*Celiac trunk*
- The **celiac trunk** originates higher up from the aorta, typically at the level of **T12-L1 vertebrae**, well above the common infrarenal AAA repair site.
- While important, it is generally less directly threatened during a typical infrarenal AAA repair compared to arteries immediately adjacent to or within the aneurysm sac.
*Right renal artery*
- The **right renal artery** also originates from the aorta near the level of the renal veins, but it is typically located more posteriorly and usually passes behind the inferior vena cava.
- Although it can be at risk, the left renal artery's course is often more anterior and directly in the field of dissection for the **aortic neck** during AAA repair.
*Superior mesenteric artery*
- The **superior mesenteric artery (SMA)** originates from the aorta proximal to the renal arteries, typically around the L1 vertebral level.
- While crucial, its origin is usually cephalad to the infrarenal aneurysm neck, making it generally less prone to direct injury during infrarenal AAA repair, though flow must be monitored.
Robotic surgery principles US Medical PG Question 4: A 97-year-old man visits the urology clinic 5 days after experiencing urinary retention at an emergency department visit. The patient has a history of hypertension, type II diabetes mellitus, stroke, dyslipidemia, a past myocardial infarction, and severe osteoarthritis in his right hip. He is not compliant with his medications and his multiple comorbidities are poorly managed. In the hospital, the patient’s urinary retention was treated with Foley catheterization. At clinic, the patient’s serum-specific prostate-specific antigen (PSA) is 6.0 ng/mL (normal is < 4 ng/mL). Digital rectal examination (DRE) demonstrates a nontender prostate with several rock hard nodules. The patient's Foley is removed and he is able to urinate on his own. Which is the most appropriate next step in management?
- A. Repeat PSA test
- B. CT abdomen and pelvis
- C. Cystourethroscopy
- D. Reassurance
- E. Transrectal prostate biopsy (Correct Answer)
Robotic surgery principles Explanation: ***Transrectal prostate biopsy***
- The combination of an elevated **PSA** (6.0 ng/mL) and **palpable, rock-hard nodules** on digital rectal examination is highly suspicious for **prostate cancer**.
- A definitive diagnosis requires a **tissue biopsy** to determine the presence of malignancy and its Gleason score.
*Repeat PSA test*
- While a repeat PSA can sometimes be useful to confirm a trend or rule out transient elevation, the presence of **palpable prostatic nodules** on DRE makes a repeat PSA insufficient given the high suspicion of malignancy.
- Delaying definitive workup, such as a biopsy, could be detrimental if cancer is present.
*CT abdomen and pelvis*
- A CT scan would be more appropriate for **staging** if prostate cancer were confirmed, to assess for metastasis, rather than for initial diagnosis.
- It would not provide the definitive **tissue diagnosis** needed to confirm prostate cancer.
*Cystourethroscopy*
- **Cystourethroscopy** is used to visualize the urethra and bladder, often for issues like hematuria, strictures, or bladder masses.
- It is not the primary diagnostic tool for **prostate cancer** originating in the peripheral zone given the DRE findings.
*Reassurance*
- Given the patient's elevated **PSA** and **palpable rock-hard nodules** on DRE, providing reassurance is inappropriate and could lead to delayed diagnosis and treatment of potentially aggressive prostate cancer.
- These findings are highly indicative of prostate pathology requiring further investigation.
Robotic surgery principles US Medical PG Question 5: An 8-year-old boy is brought to the physician by his father because of abnormal movements of his limbs. For the past four days, he has had uncontrolled jerking movements of his arms and legs and has been dropping cups and toys. His symptoms are worse when he is excited and improve while he is asleep. During the same time period, he has become increasingly irritable and tearful. He had a sore throat 6 weeks ago that resolved without treatment. His temperature is 37.3°C (99.2°F). Examination shows occasional grimacing with involuntary jerking movements of his limbs. Muscle strength and tone are decreased in all extremities. When he grips the physician's index and middle fingers with his hands, his grip increases and decreases continuously. This patient is at increased risk for which of the following complications?
- A. Extraneural metastasis
- B. Early-onset dementia
- C. Diabetes mellitus
- D. Attention deficit hyperactivity disorder
- E. Mitral regurgitation (Correct Answer)
Robotic surgery principles Explanation: ***Mitral regurgitation***
- This patient has **Sydenham chorea**, a major manifestation of **acute rheumatic fever (ARF)** following group A streptococcal pharyngitis 6 weeks ago
- Classic features present: choreiform movements, emotional lability, milkmaid's grip (motor impersistence), hypotonia, and symptoms that worsen with stress and improve with sleep
- **Rheumatic heart disease** develops in 50-60% of ARF patients, with the **mitral valve** being the most commonly affected (70-80% of cases)
- Chronic valvular damage occurs due to molecular mimicry between streptococcal M protein and cardiac myosin, leading to autoimmune-mediated inflammation
- **Mitral regurgitation** is the most common valvular lesion in acute ARF, and patients require long-term antibiotic prophylaxis to prevent recurrent episodes and progressive cardiac damage
*Extraneural metastasis*
- This refers to cancer spreading outside the nervous system and is completely unrelated to the clinical presentation
- The patient has a post-infectious autoimmune condition (ARF), not a malignancy
- Chorea in children with cancer would suggest paraneoplastic syndrome or CNS involvement, not metastasis
*Early-onset dementia*
- Sydenham chorea causes transient behavioral and cognitive changes but does not lead to progressive cognitive decline or dementia
- Cognitive symptoms typically resolve within months, though some emotional/behavioral issues may persist
- Dementia in children would suggest neurodegenerative disorders (e.g., leukodystrophies, storage diseases), not post-streptococcal sequelae
*Diabetes mellitus*
- There is no pathophysiologic link between acute rheumatic fever and diabetes mellitus
- This metabolic disorder involves insulin deficiency or resistance and is unrelated to post-streptococcal autoimmune phenomena
- Completely inappropriate complication for this clinical scenario
*Attention deficit hyperactivity disorder*
- While Sydenham chorea can cause transient hyperactivity, emotional lability, and attention difficulties, these are manifestations of the acute illness
- True ADHD is a chronic neurodevelopmental disorder with different pathophysiology and diagnostic criteria
- Behavioral symptoms in Sydenham chorea typically improve as the chorea resolves (usually within 3-6 months), unlike the persistent pattern required for ADHD diagnosis
Robotic surgery principles US Medical PG Question 6: A 24-year-old man presents to the emergency department after a motor vehicle collision. He was in the front seat and unrestrained driver in a head on collision. His temperature is 99.2°F (37.3°C), blood pressure is 90/65 mmHg, pulse is 152/min, respirations are 16/min, and oxygen saturation is 100% on room air. Physical exam is notable for a young man who opens his eyes spontaneously and is looking around. He answers questions with inappropriate responses but discernible words. He withdraws from pain but does not have purposeful movement. Which of the following is this patient's Glasgow coma scale?
- A. 9
- B. 15
- C. 7
- D. 11 (Correct Answer)
- E. 13
Robotic surgery principles Explanation: ***11***
- **Eye-opening (E)**: The patient opens his eyes spontaneously, scoring **E4**.
- **Verbal response (V)**: He gives inappropriate responses but discernible words, scoring **V3**.
- **Motor response (M)**: He withdraws from pain but does not have purposeful movement, scoring **M4**.
- Therefore, the total Glasgow Coma Scale (GCS) score is **E4 + V3 + M4 = 11**.
*9*
- This score would imply a lower verbal or motor response, such as **incomprehensible sounds (V2)** or **abnormal flexion (M3)**, which is not consistent with the patient's presentation.
- For example, E4 + V2 + M3 would equal 9.
*15*
- A GCS of 15 indicates **normal neurological function**, meaning the patient would be fully oriented, obey commands, and open eyes spontaneously, which is not the case here.
- This score is for a patient who is fully conscious and responsive.
*7*
- A GCS of 7 suggests a **severe brain injury**, which would typically present with a much poorer response, such as **no verbal response (V1)** or **abnormal extension (M2)**.
- For example, E4 + V1 + M2 would equal 7.
*13*
- This score would mean a higher level of consciousness, such as **confused conversation (V4)** or **localizing pain (M5)**, which is better than the patient's described responses.
- For example, E4 + V4 + M5 would equal 13.
Robotic surgery principles US Medical PG Question 7: A 32-year-old man visits his primary care physician for a routine health maintenance examination. During the examination, he expresses concerns about not wanting to become a father. He has been sexually active and monogamous with his wife for the past 5 years, and they inconsistently use condoms for contraception. He tells the physician that he would like to undergo vasectomy. His wife is also a patient under the care of the physician and during her last appointment, she expressed concerns over being prescribed any drugs that could affect her fertility because she would like to conceive soon. Which of the following is the most appropriate action by the physician regarding this patient's wish to undergo vasectomy?
- A. Explain the procedure's benefits, alternatives, and potential complications (Correct Answer)
- B. Refer the patient to a psychotherapist to discuss his reluctance to have children
- C. Discourage the patient from undergoing the procedure because his wife wants children
- D. Insist that the patient returns with his wife to discuss the risks and benefits of the procedure together
- E. Call the patient's wife to obtain her consent for the procedure
Robotic surgery principles Explanation: ***Explain the procedure's benefits, alternatives, and potential complications***
- The physician's primary ethical obligation is to the individual patient, ensuring informed consent for any medical procedure. Providing comprehensive information about **vasectomy benefits, alternatives, and risks** allows the patient to make an autonomous decision.
- While patient-physician confidentiality generally prohibits disclosing specific details of one spouse's medical history to the other, the general knowledge that his wife desires children creates an important backdrop for the discussion. It is the patient's responsibility to consider this and convey this information to his wife.
*Refer the patient to a psychotherapist to discuss his reluctance to have children*
- It is **not appropriate** to assume the patient has a psychological issue solely based on his desire for a vasectomy, even with his wife's conflicting wishes. This action could be seen as judgmental and dismissive of the patient's autonomy.
- A patient's preference for sterilization, even if contrary to a partner's desires, does not inherently indicate a need for psychiatric evaluation unless there are other concerning psychological symptoms.
*Discourage the patient from undergoing the procedure because his wife wants children*
- **Discouraging** the patient based on his wife's wishes infringes upon the patient's **autonomy and reproductive rights**. The physician's role is to provide information and support the patient's informed decisions, not to act as a relationship counselor or impose personal values.
- Medical decisions, especially concerning fertility, are deeply personal, and a physician should not pressure a patient into a decision they do not want based on a partner's separate, yet relevant, wishes.
*Insist that the patient returns with his wife to discuss the risks and benefits of the procedure together*
- While open communication between spouses about reproductive decisions is beneficial, **insisting** on the wife's presence for the consultation undermines the patient's **confidentiality and individual autonomy**. The patient has the right to make medical decisions independently.
- The physician should encourage the patient to discuss this with his wife, but it is ultimately the patient's decision whether to involve her in the consultation for his procedure.
*Call the patient's wife to obtain her consent for the procedure*
- This action would be a **breach of patient confidentiality**. The physician cannot disclose information about the patient's decision or medical discussions with a third party, even a spouse, without the patient's explicit consent.
- A spouse's consent is **not legally or ethically required** for an individual to undergo a vasectomy in most jurisdictions, as it is a decision pertaining to the individual's body and reproductive rights.
Robotic surgery principles US Medical PG Question 8: A 58-year-old obese male has noticed the gradual development of a soft bulge on his right groin that has been present over the past year and occasionally becomes very tender. He notices that it comes out when he coughs and strains during bowel movements. He is able to push the bulge back in without issue. After examination, you realize that he has an inguinal hernia and recommend open repair with mesh placement. After surgery, the patient returns to clinic and complains of numbness and tingling in the upper part of the scrotum and base of the penis. What nerve was most likely injured during the procedure?
- A. Ilioinguinal nerve (Correct Answer)
- B. Iliohypogastric nerve
- C. Lateral femoral cutaneous nerve
- D. Obturator nerve
- E. Genitofemoral nerve
Robotic surgery principles Explanation: **Ilioinguinal nerve**
- The **ilioinguinal nerve** supplies sensory innervation to the skin of the **scrotum** (or labia majora in females), the medial thigh, and the base of the penis.
- Injury to this nerve during an open inguinal hernia repair can cause **numbness and tingling** in these specific areas, consistent with the patient's symptoms.
*Iliohypogastric nerve*
- The **iliohypogastric nerve** primarily provides sensation to the skin over the **suprapubic region** and a small part of the buttock.
- Damage to this nerve would not typically result in numbness of the scrotum or base of the penis.
*Lateral femoral cutaneous nerve*
- This nerve is responsible for sensory innervation of the **lateral aspect of the thigh**.
- Its injury would lead to symptoms of numbness or pain on the lateral thigh (**meralgia paresthetica**), not the scrotum or penis.
*Obturator nerve*
- The **obturator nerve** is a motor nerve that innervates the **adductor muscles of the thigh** and provides sensory innervation to a small area of the medial thigh.
- Damage to this nerve would result in **adductor weakness** and sensory loss in the medial thigh, which does not match the patient's complaints.
*Genitofemoral nerve*
- The **genitofemoral nerve** has two branches: the genital branch (supplies the cremaster muscle and scrotal skin) and the femoral branch (supplies skin of the anterior thigh).
- While the genital branch does innervate the scrotum, injury to this nerve more commonly causes **cremasteric reflex loss** or pain radiating to the anterior thigh, and the described symptoms (base of penis) are more characteristic of ilioinguinal nerve involvement.
Robotic surgery principles US Medical PG Question 9: A 63-year-old man comes to the emergency department because of pain in his left groin for the past hour. The pain began soon after he returned from a walk. He describes it as 8 out of 10 in intensity and vomited once on the way to the hospital. He has had a swelling of the left groin for the past 2 months. He has chronic obstructive pulmonary disease and hypertension. Current medications include amlodipine, albuterol inhaler, and a salmeterol-fluticasone inhaler. He appears uncomfortable. His temperature is 37.4°C (99.3°F), pulse is 101/min, and blood pressure is 126/84 mm Hg. Examination shows a tender bulge on the left side above the inguinal ligament that extends into the left scrotum; lying down or applying external force does not reduce the swelling. Coughing does not make the swelling bulge further. There is no erythema. The abdomen is distended. Bowel sounds are hyperactive. Scattered rhonchi are heard throughout both lung fields. Which of the following is the most appropriate next step in management?
- A. Laparoscopic surgical repair
- B. Surgical drainage
- C. Antibiotic therapy
- D. Open surgical repair (Correct Answer)
- E. Surgical exploration of the testicle
Robotic surgery principles Explanation: ***Open surgical repair***
- The patient presents with a **painful, non-reducible inguinal hernia** that has likely **incarcerated** or **strangulated**, given the acute onset of severe pain, vomiting, and abdominal distension with hyperactive bowel sounds.
- In cases of suspected incarceration or strangulation, **urgent open surgical repair** is indicated to prevent **bowel ischemia** and its serious complications (e.g., perforation, sepsis).
*Laparoscopic surgical repair*
- While laparoscopic repair is an option for elective hernia repair, it is generally **contraindicated** in cases of **incarcerated or strangulated hernias** due to the higher risk of bowel injury, inadequate assessment of bowel viability, and longer operative times in an emergency setting.
- Also, the patient's **COPD** might make him a less ideal candidate for laparoscopy due to the risks associated with pneumoperitoneum.
*Surgical drainage*
- Surgical drainage is typically performed for abscesses or fluid collections, which are **not the primary issue** in this presentation.
- A hernia involves displacement of organs, not an accumulation of fluid or pus requiring drainage.
*Antibiotic therapy*
- Although antibiotics might be considered as an adjunctive therapy if infection is suspected or confirmed (e.g., with bowel necrosis), they are **not the definitive primary treatment** for an incarcerated or strangulated hernia.
- The mechanical obstruction and potential ischemia require surgical intervention for resolution.
*Surgical exploration of the testicle*
- While the bulge extends into the scrotum, the primary concern is the **incarcerated hernia** itself.
- Surgical exploration of the testicle would be indicated for conditions like testicular torsion, epididymitis, or testicular masses, which are not suggested by the presented symptoms.
Robotic surgery principles US Medical PG Question 10: A 32-year-old woman undergoes laparoscopic excision of ovarian endometrioma. During surgery with the patient in Trendelenburg position and pneumoperitoneum at 15 mmHg, the anesthesiologist notes peak airway pressures rising from 25 to 40 cmH2O, oxygen saturation dropping to 88%, and blood pressure decreasing. Apply the appropriate immediate intervention.
- A. Increase tidal volume and respiratory rate
- B. Increase FiO2 and administer fluid bolus only
- C. Release pneumoperitoneum and decrease Trendelenburg (Correct Answer)
- D. Administer bronchodilators for bronchospasm
- E. Check for endobronchial intubation and reposition tube
Robotic surgery principles Explanation: ***Release pneumoperitoneum and decrease Trendelenburg***
- High **peak airway pressures** (40 cmH2O), **hypoxemia**, and **hypotension** indicate severe physiological compromise from **pneumoperitoneum** and positioning.
- Releasing the gas and leveling the patient immediately facilitates **diaphragmatic descent**, increases **lung compliance**, and restores **venous return** to improve cardiac output.
*Increase tidal volume and respiratory rate*
- Increasing **tidal volume** in the presence of already high airway pressures significantly increases the risk of **barotrauma** and further cardiovascular collapse.
- This intervention does not address the mechanical cause of **diaphragmatic splinting** caused by the CO2 insufflation.
*Increase FiO2 and administer fluid bolus only*
- While oxygenation may temporarily improve, this fails to correct the **reduced functional residual capacity** caused by the **positive pressure** in the abdomen.
- Fluids may not compensate for the **inferior vena cava compression** if the source of high **intra-abdominal pressure** remains unchanged.
*Administer bronchodilators for bronchospasm*
- High airway pressures in laparoscopy are usually due to **decreased thoracic compliance**, not necessarily **bronchospasm**.
- The sudden drop in blood pressure suggests a hemodynamic/mechanical cause rather than an isolated **obstructive lung** pathology.
*Check for endobronchial intubation and reposition tube*
- While cephalad movement of the diaphragm can cause **endobronchial intubation**, it does not typically explain the systemic **hypotension** seen here.
- This step should follow the **immediate release** of abdominal pressure, which is the most life-threatening contributor to the current vitals.
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