General Surgery Question Bank

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1. Tramadol and Meperidine should not be given in patients receiving.

Tramadol and meperidine have serotonergic activity and can precipitate serotonin syndrome when given with monoamine oxidase inhibitors, so this combination must be avoided.

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2. Mechanism of action of tramadol.

Tramadol acts by multiple mechanisms: it is a weak mu-opioid receptor agonist and inhibits the reuptake of norepinephrine and serotonin. Therefore all of the above apply.

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3. Mechanism of action of NSAIDs

NSAIDs primarily inhibit cyclooxygenase (COX), reducing prostaglandin synthesis; some have additional effects, but COX inhibition is the principal mechanism. The keyed 'all of the above' overstates this. [REVIEW: keyed answer (all of the above) is imprecise — NSAIDs act mainly by inhibiting cyclooxygenase, not lipoxygenase or phospholipase].

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4. Common complication of retrobulbar block in extremely myopic eye.

In a highly myopic eye (long axial length, thin sclera), retrobulbar block carries an increased risk of inadvertent globe perforation by the needle.

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5. The landmark for doing deep peroneal nerve block.

The dorsalis pedis artery on the dorsum of the foot is the landmark for blocking the adjacent deep peroneal nerve.

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6. Most common complication of intercostals nerve block.

The most common complication of intercostal nerve block is pneumothorax, from inadvertent pleural puncture during needle placement.

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7. Local anesthetic technique which uses lidocaine spray 10%.

Application of lidocaine 10% spray to mucosal surfaces is a form of topical (surface) anesthesia.

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8. Needle puncture during spinal anesthesia can be made safely at the interspace

Spinal (subarachnoid) puncture is performed safely below the conus medullaris (which ends near L1 in adults); the L4-L5 interspace is a standard safe site.

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9. Mechanism of chronic pain which is often referred to as "nociceptive pain"

Nociceptive pain arises from activation of peripheral nociceptors by tissue damage/inflammation and is therefore a peripheral mechanism of pain.

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10. Management for central type pf pain:

Central pain (e.g., from CNS lesions) is often opioid-responsive among the listed options; opioids are used for such severe pain, although adjuvants are frequently needed. [REVIEW: central neuropathic pain often responds poorly to opioids alone and is typically managed with anticonvulsants/antidepressants; the keyed answer is debatable].