Can you generate mcqs in PDF from bailey and love short practice of surgery 28th edition
Asking for Preferences
Random mix from both systemic and general surgery
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Reading File
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Running Command
mkdir -p /home/daytona/workspace/bailey-love-mcqs && echo "Directory ready"
Writing File
~/bailey-love-mcqs/generate_mcq_pdf.py
from reportlab.lib.pagesizes import A4
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm
from reportlab.lib import colors
from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, HRFlowable, Table, TableStyle
from reportlab.lib.enums import TA_LEFT, TA_CENTER, TA_JUSTIFY
output_path = "/home/daytona/workspace/bailey-love-mcqs/Bailey_Love_MCQs.pdf"
doc = SimpleDocTemplate(
output_path,
pagesize=A4,
rightMargin=2*cm,
leftMargin=2*cm,
topMargin=2*cm,
bottomMargin=2*cm
)
styles = getSampleStyleSheet()
title_style = ParagraphStyle(
'TitleStyle',
parent=styles['Title'],
fontSize=18,
textColor=colors.HexColor('#1a3a5c'),
spaceAfter=6,
fontName='Helvetica-Bold',
alignment=TA_CENTER,
)
subtitle_style = ParagraphStyle(
'SubtitleStyle',
parent=styles['Normal'],
fontSize=11,
textColor=colors.HexColor('#4a6a8a'),
spaceAfter=4,
alignment=TA_CENTER,
)
section_style = ParagraphStyle(
'SectionStyle',
parent=styles['Normal'],
fontSize=13,
textColor=colors.white,
fontName='Helvetica-Bold',
spaceAfter=6,
spaceBefore=10,
)
q_num_style = ParagraphStyle(
'QNum',
parent=styles['Normal'],
fontSize=11,
textColor=colors.HexColor('#1a3a5c'),
fontName='Helvetica-Bold',
spaceBefore=12,
spaceAfter=3,
)
question_style = ParagraphStyle(
'Question',
parent=styles['Normal'],
fontSize=11,
textColor=colors.HexColor('#1a1a1a'),
fontName='Helvetica-Bold',
spaceAfter=5,
leading=15,
)
option_style = ParagraphStyle(
'Option',
parent=styles['Normal'],
fontSize=10.5,
textColor=colors.HexColor('#333333'),
leftIndent=15,
spaceAfter=2,
leading=14,
)
answer_label_style = ParagraphStyle(
'AnswerLabel',
parent=styles['Normal'],
fontSize=10,
textColor=colors.HexColor('#1a6e35'),
fontName='Helvetica-Bold',
spaceBefore=5,
spaceAfter=2,
)
answer_style = ParagraphStyle(
'Answer',
parent=styles['Normal'],
fontSize=10,
textColor=colors.HexColor('#1a6e35'),
leftIndent=15,
spaceAfter=2,
)
explanation_label_style = ParagraphStyle(
'ExplLabel',
parent=styles['Normal'],
fontSize=10,
textColor=colors.HexColor('#7a3c00'),
fontName='Helvetica-Bold',
spaceAfter=2,
)
explanation_style = ParagraphStyle(
'Explanation',
parent=styles['Normal'],
fontSize=10,
textColor=colors.HexColor('#4a2800'),
leftIndent=15,
spaceAfter=4,
leading=14,
alignment=TA_JUSTIFY,
)
footer_style = ParagraphStyle(
'Footer',
parent=styles['Normal'],
fontSize=8,
textColor=colors.grey,
alignment=TA_CENTER,
)
mcqs = [
# --- GENERAL SURGERY ---
{
"section": "GENERAL SURGERY",
"num": 1,
"topic": "Wound Healing",
"q": "Which type of wound healing occurs when wound edges are directly approximated and is the aim of surgical treatment?",
"options": [
"A. Healing by secondary intention",
"B. Healing by primary intention (first intention)",
"C. Healing by tertiary intention (delayed primary)",
"D. Healing by granulation only",
],
"answer": "B. Healing by primary intention (first intention)",
"explanation": "Primary healing (first intention) occurs when wound edges are directly apposed, resulting in minimal scarring and normal healing. Secondary intention involves leaving the wound open to heal by granulation, contraction and re-epithelialisation, leading to a poorer scar. Tertiary (delayed primary) closure is when the wound is initially left open and edges are apposed later. (Bailey & Love, Ch. 3 – Wound Healing)"
},
{
"section": "GENERAL SURGERY",
"num": 2,
"topic": "Wound Healing",
"q": "Which of the following factors is LEAST likely to delay wound healing?",
"options": [
"A. Malnutrition",
"B. Vitamin C deficiency",
"C. Systemic corticosteroids",
"D. Well-controlled type 2 diabetes",
],
"answer": "D. Well-controlled type 2 diabetes",
"explanation": "Wound healing is delayed by malnutrition, vitamin A and C deficiency, steroids (which inhibit protein synthesis and fibroblast proliferation), and poorly controlled diabetes. Well-controlled diabetes has a much lesser negative effect compared to poorly controlled diabetes. (Bailey & Love, Ch. 3 – Wound Care)"
},
{
"section": "GENERAL SURGERY",
"num": 3,
"topic": "Intestinal Obstruction",
"q": "What is the classic clinical quartet of features in dynamic intestinal obstruction?",
"options": [
"A. Nausea, vomiting, diarrhoea, and haematochezia",
"B. Pain, distension, vomiting, and absolute constipation",
"C. Fever, tachycardia, abdominal guarding, and rebound tenderness",
"D. Pain, distension, diarrhoea, and haematemesis",
],
"answer": "B. Pain, distension, vomiting, and absolute constipation",
"explanation": "The diagnosis of dynamic intestinal obstruction rests on the classic quartet of pain, distension, vomiting, and absolute constipation. High-pitched bowel sounds are present in the vast majority of such patients. The nature of presentation is further influenced by whether the obstruction is of the small or large bowel. (Bailey & Love, Ch. 78 – Intestinal Obstruction)"
},
{
"section": "GENERAL SURGERY",
"num": 4,
"topic": "Intestinal Obstruction",
"q": "What is the most common cause of postoperative small bowel obstruction?",
"options": [
"A. Hernias",
"B. Adhesions",
"C. Malignancy",
"D. Volvulus",
],
"answer": "B. Adhesions",
"explanation": "Postoperative adhesions are the most common cause of intestinal obstruction, usually involving the lower small bowel and less commonly the large bowel. Adhesions are described as either easy (flimsy) or difficult (dense). Hernias and malignancy are also significant causes but adhesions predominate postoperatively. (Bailey & Love, Ch. 78)"
},
{
"section": "GENERAL SURGERY",
"num": 5,
"topic": "Intestinal Obstruction",
"q": "Which of the following is an absolute indication for early surgical intervention in intestinal obstruction?",
"options": [
"A. High-pitched bowel sounds on auscultation",
"B. Absence of flatus for 12 hours",
"C. Obstructed external hernia with clinical features of strangulation",
"D. Moderate abdominal distension without tenderness",
],
"answer": "C. Obstructed external hernia with clinical features of strangulation",
"explanation": "Indications for early surgical intervention include an obstructed external hernia, clinical features of intestinal strangulation, and obstruction in a previously unoperated abdomen. The classic surgical adage states that 'the Sun should not both rise and set' on a case of unrelieved acute intestinal obstruction, due to the risk of intestinal ischaemia. (Bailey & Love, Ch. 78)"
},
{
"section": "GENERAL SURGERY",
"num": 6,
"topic": "Acute Appendicitis",
"q": "What percentage of cases may result in removal of a normal appendix when the decision to operate is based on clinical suspicion alone?",
"options": [
"A. 5–10%",
"B. 15–30%",
"C. 35–45%",
"D. Less than 5%",
],
"answer": "B. 15–30%",
"explanation": "While the diagnosis of acute appendicitis is essentially clinical, a decision to operate based on clinical suspicion alone can lead to the removal of a normal appendix in 15–30% of cases. This highlights the importance of investigations such as CT scanning to improve diagnostic accuracy. (Bailey & Love, Ch. 68 – Appendicitis)"
},
{
"section": "GENERAL SURGERY",
"num": 7,
"topic": "Acute Appendicitis",
"q": "In elderly patients with intestinal obstruction, which condition should be considered as an occasional cause?",
"options": [
"A. Sigmoid volvulus",
"B. Incarcerated femoral hernia",
"C. Acute appendicitis",
"D. Mesenteric ischaemia",
],
"answer": "C. Acute appendicitis",
"explanation": "Acute appendicitis can be an occasional cause of intestinal obstruction in the elderly. An abdominal CT scan will clarify the diagnosis. Carcinoma of the caecum may also mimic or cause obstructive appendicitis in adults. (Bailey & Love, Ch. 68)"
},
{
"section": "GENERAL SURGERY",
"num": 8,
"topic": "Perforated Peptic Ulcer",
"q": "What is the classical presentation of a perforated duodenal ulcer?",
"options": [
"A. Gradual onset colicky central pain with nausea and vomiting",
"B. Sudden-onset severe generalised abdominal pain due to the irritant effect of gastric acid on the peritoneum",
"C. Epigastric pain relieved by eating with haematemesis",
"D. Right iliac fossa pain with rebound tenderness and fever",
],
"answer": "B. Sudden-onset severe generalised abdominal pain due to the irritant effect of gastric acid on the peritoneum",
"explanation": "The classical presentation of a perforated duodenal ulcer is instantly recognisable: sudden-onset severe generalised abdominal pain caused by the irritant effect of gastric acid on the peritoneum. The patient may have a prior history of peptic ulceration. Treatment is primarily surgical. (Bailey & Love, Ch. 67)"
},
{
"section": "GENERAL SURGERY",
"num": 9,
"topic": "Perforated Peptic Ulcer",
"q": "On an erect chest radiograph, free gas under the diaphragm is visible in approximately what proportion of patients with a perforated peptic ulcer?",
"options": [
"A. Less than 20%",
"B. More than 50%",
"C. Exactly 100%",
"D. 30–40%",
],
"answer": "B. More than 50%",
"explanation": "An erect chest radiograph will reveal free gas under the diaphragm in more than 50% of cases with perforated peptic ulcer. However, CT imaging is now most commonly used as it is more accurate. Serum amylase should also be measured to distinguish between peptic ulcer perforation and acute pancreatitis. (Bailey & Love, Ch. 67)"
},
{
"section": "GENERAL SURGERY",
"num": 10,
"topic": "Inguinal Hernia",
"q": "The Bassini repair for inguinal hernia was first described in which year and what did it involve as a primary step?",
"options": [
"A. 1920; posterior wall repair with mesh",
"B. 1890; opening the inguinal canal by incising the external oblique aponeurosis",
"C. 1950; laparoscopic mesh repair",
"D. 1905; McVay repair approximating Cooper's ligament",
],
"answer": "B. 1890; opening the inguinal canal by incising the external oblique aponeurosis",
"explanation": "In 1890, Edoardo Bassini described a suture repair for inguinal hernia that remained the basis of open repair for over 100 years. The surgeon enters the inguinal canal by opening its anterior wall (the external oblique aponeurosis) and dissects the spermatic cord free. (Bailey & Love, Ch. 64)"
},
{
"section": "GENERAL SURGERY",
"num": 11,
"topic": "Inguinal Hernia",
"q": "A sliding inguinal hernia is best described as:",
"options": [
"A. A direct hernia passing through the posterior wall of the inguinal canal",
"B. An acquired indirect hernia arising at the deep inguinal ring, lateral to the inferior epigastric vessels, with retroperitoneal fatty tissue pushed downwards",
"C. A hernia that reduces spontaneously in the supine position",
"D. A hernia that contains only omentum without bowel",
],
"answer": "B. An acquired indirect hernia arising at the deep inguinal ring, lateral to the inferior epigastric vessels, with retroperitoneal fatty tissue pushed downwards",
"explanation": "Sliding hernias are acquired indirect hernias arising at the deep inguinal ring lateral to the inferior epigastric vessels. Retroperitoneal fatty tissue is pushed downwards along the inguinal canal. As the hernia enlarges, a viscus such as the bladder may be pulled into a direct hernia component. (Bailey & Love, Ch. 64)"
},
# --- SYSTEMIC SURGERY ---
{
"section": "SYSTEMIC SURGERY",
"num": 12,
"topic": "Thyroid – Neoplasms",
"q": "What is the most common malignancy of the thyroid gland and its approximate relative incidence?",
"options": [
"A. Follicular carcinoma – 40%",
"B. Medullary thyroid carcinoma – 50%",
"C. Papillary carcinoma – 80%",
"D. Anaplastic carcinoma – 60%",
],
"answer": "C. Papillary carcinoma – 80%",
"explanation": "Papillary carcinoma is the most common malignancy of the thyroid gland, accounting for approximately 80% of all thyroid malignancies. Follicular carcinoma accounts for about 10%, while poorly differentiated/anaplastic carcinoma is much rarer. (Bailey & Love, Ch. – Neoplasms of the Thyroid)"
},
{
"section": "SYSTEMIC SURGERY",
"num": 13,
"topic": "Thyroid – Vocal Fold Palsy",
"q": "Which of the following is a neoplastic cause of vocal fold (cord) palsy?",
"options": [
"A. Aortic aneurysm",
"B. Viral infection",
"C. Carcinoma of the lung involving the left hilum",
"D. Direct trauma to the neck",
],
"answer": "C. Carcinoma of the lung involving the left hilum",
"explanation": "Vocal fold palsy has multiple causes. Neoplastic causes include carcinoma of the lung involving the left hilum (which impinges on the left recurrent laryngeal nerve), as well as carcinomas of the nasopharynx, larynx, thyroid, and oesophagus. Aortic aneurysm is a vascular cause; viral infection is infective; direct trauma is a traumatic cause. (Bailey & Love, Ch. – Causes of Vocal Fold Palsy)"
},
{
"section": "SYSTEMIC SURGERY",
"num": 14,
"topic": "Breast Cancer – Surgical Management",
"q": "Regarding the surgical management of breast cancer, which statement is best supported by clinical trials?",
"options": [
"A. Mastectomy is superior to wide local excision (WLE) in terms of survival",
"B. Mastectomy and WLE/BCS followed by radiotherapy have equal efficacy in locoregional control and survival",
"C. WLE alone without radiotherapy is equivalent to mastectomy",
"D. Chemotherapy negates the need for any surgical intervention",
],
"answer": "B. Mastectomy and WLE/BCS followed by radiotherapy have equal efficacy in locoregional control and survival",
"explanation": "There has been a general de-escalation towards more conservative surgical techniques in breast cancer. Clinical trials and meta-analyses have shown equal efficacy in locoregional cancer control and survival between mastectomy and WLE/BCS followed by radiotherapy. The aim is adequate surgical removal while minimising morbidity. (Bailey & Love, Ch. 58 – Surgical Management)"
},
{
"section": "SYSTEMIC SURGERY",
"num": 15,
"topic": "Breast Cancer – Modified Radical Mastectomy",
"q": "In the Patey/Madden modification of modified radical mastectomy, what is done to the pectoralis minor muscle?",
"options": [
"A. It is retracted but left intact",
"B. It is divided but not removed",
"C. It is removed",
"D. It is used for autologous breast reconstruction",
],
"answer": "C. It is removed",
"explanation": "Modified radical mastectomy involves mastectomy plus level I, II, III axillary lymph node dissection. In the Patey/Madden modification, the pectoralis minor muscle is removed. In the Auchincloss modification it is retracted, while in the Scanlon modification it is divided but not removed. (Bailey & Love, Ch. 58, Summary Box 58.4)"
},
{
"section": "SYSTEMIC SURGERY",
"num": 16,
"topic": "Breast Cancer – Hereditary",
"q": "What is the approximate risk reduction of breast cancer following bilateral risk-reducing mastectomy with immediate reconstruction in women with a BRCA mutation?",
"options": [
"A. 40%",
"B. 60%",
"C. 75%",
"D. 90%",
],
"answer": "D. 90%",
"explanation": "Women with a BRCA mutation may be offered a bilateral risk-reducing mastectomy with immediate breast reconstruction. This reduces the risk of breast cancer by 90%. Chemoprophylaxis with tamoxifen is an alternative option for risk reduction. (Bailey & Love, Ch. 58 – Hereditary and Familial Breast Cancer)"
},
{
"section": "SYSTEMIC SURGERY",
"num": 17,
"topic": "Carcinoma of the Male Breast",
"q": "What is the most common presenting symptom of carcinoma of the male breast?",
"options": [
"A. Bloody nipple discharge",
"B. Axillary lymphadenopathy",
"C. Painless subareolar lump",
"D. Skin ulceration over the breast",
],
"answer": "C. Painless subareolar lump",
"explanation": "Carcinoma of the male breast accounts for less than 0.5% of all breast cancer cases. The most common symptom at presentation is a painless subareolar lump. Involvement of the nipple-areolar complex and underlying pectoral muscles occurs early. Treatment comprises mastectomy with a 2-cm margin. (Bailey & Love, Ch. 58)"
},
{
"section": "SYSTEMIC SURGERY",
"num": 18,
"topic": "Medullary Thyroid Carcinoma",
"q": "Medullary thyroid carcinoma (MTC) is associated with which inherited syndrome involving phaeochromocytoma and primary hyperparathyroidism?",
"options": [
"A. MEN type 1 (Wermer syndrome)",
"B. MEN type 2 (Multiple Endocrine Neoplasia type 2)",
"C. Von Hippel-Lindau disease",
"D. Cowden syndrome",
],
"answer": "B. MEN type 2 (Multiple Endocrine Neoplasia type 2)",
"explanation": "Medullary thyroid carcinoma is associated with Multiple Endocrine Neoplasia type 2 (MEN2), which includes MTC, phaeochromocytoma (PCC), and primary hyperparathyroidism (PHPT). MEN1 (Wermer) includes parathyroid, pancreatic, and pituitary tumours. Von Hippel-Lindau and Cowden syndromes have different tumour associations. (Bailey & Love, Ch. – Thyroid/Endocrine)"
},
{
"section": "SYSTEMIC SURGERY",
"num": 19,
"topic": "Spinal Metastases",
"q": "Which of the following tumour types is described as radioresistant in the context of spinal metastases?",
"options": [
"A. Small cell carcinoma of the lung",
"B. Ewing's sarcoma",
"C. Thyroid carcinoma",
"D. Neuroblastoma",
],
"answer": "C. Thyroid carcinoma",
"explanation": "In the management of spinal metastases, gastrointestinal adenocarcinoma, metastatic melanoma, thyroid carcinoma, and renal carcinoma are described as radioresistant. In contrast, small cell carcinoma of the lung, Ewing's sarcoma, thyroid carcinoma (for chemotherapy), breast carcinoma, and neuroblastoma are usually sensitive to chemotherapy. (Bailey & Love, Ch. 37)"
},
{
"section": "SYSTEMIC SURGERY",
"num": 20,
"topic": "Acute Cholecystitis – Differential Diagnosis",
"q": "Which of the following is listed as a common differential diagnosis of acute cholecystitis?",
"options": [
"A. Ruptured ectopic pregnancy",
"B. Acute pancreatitis",
"C. Mesenteric ischaemia",
"D. Diverticulitis",
],
"answer": "B. Acute pancreatitis",
"explanation": "The common differential diagnoses of acute cholecystitis include appendicitis, perforated peptic ulcer, and acute pancreatitis. Uncommon differentials include acute pyelonephritis, myocardial infarction, and right lower lobe pneumonia. (Bailey & Love, Ch. – Acute Cholecystitis)"
},
{
"section": "SYSTEMIC SURGERY",
"num": 21,
"topic": "Peptic Ulcer Disease",
"q": "What are the mainstays of treatment for peptic ulcer disease (PUD)?",
"options": [
"A. Elective surgery and antacids",
"B. H. pylori eradication therapy and proton pump inhibitors",
"C. Long-term NSAID therapy and antacids",
"D. Surgical vagotomy and antrectomy",
],
"answer": "B. H. pylori eradication therapy and proton pump inhibitors",
"explanation": "H. pylori eradication therapy is a mainstay of treatment for peptic ulcer disease, as is medical acid suppression (e.g. proton pump inhibitors). Elective surgery is very rarely performed today. The common complications of peptic ulcers include perforation, bleeding, and stenosis; perforation requires primarily surgical treatment. (Bailey & Love, Ch. 67)"
},
{
"section": "SYSTEMIC SURGERY",
"num": 22,
"topic": "Bowel Sounds",
"q": "What type of bowel sounds are present in the vast majority of patients with intestinal obstruction?",
"options": [
"A. Absent (silent abdomen)",
"B. Normal borborygmi",
"C. High-pitched bowel sounds",
"D. Low-pitched rumbling sounds",
],
"answer": "C. High-pitched bowel sounds",
"explanation": "High-pitched bowel sounds are present in the vast majority of patients with intestinal obstruction. Normal bowel sounds are of negative predictive value. Bowel sounds may become scanty or absent if the obstruction is longstanding and the small bowel has become inactive. (Bailey & Love, Ch. 78)"
},
{
"section": "SYSTEMIC SURGERY",
"num": 23,
"topic": "Femoral Hernia",
"q": "When a mesh is placed into the inguinal canal during repair of a femoral hernia via the inguinal (Lotheissen) approach, what is the primary purpose?",
"options": [
"A. To reduce the femoral hernia sac",
"B. To protect against development of a concomitant inguinal hernia",
"C. To reinforce the femoral ring only",
"D. To obliterate the femoral canal permanently",
],
"answer": "B. To protect against development of a concomitant inguinal hernia",
"explanation": "During the inguinal (Lotheissen) approach for femoral hernia repair, the layers are closed as for inguinal hernia. The surgeon may place a mesh into the inguinal canal to protect against development of an inguinal hernia, since the inguinal canal has been opened in this approach. (Bailey & Love, Ch. 64)"
},
{
"section": "SYSTEMIC SURGERY",
"num": 24,
"topic": "Wound Healing – Phases",
"q": "In the context of wound healing, fibrosis and scar formation in adult humans represents which response to injury?",
"options": [
"A. The ideal regenerative response",
"B. The normal response to injury across organ systems, though it causes tissue dysfunction",
"C. A pathological response exclusive to diabetics",
"D. A response only seen in contaminated wounds",
],
"answer": "B. The normal response to injury across organ systems, though it causes tissue dysfunction",
"explanation": "In human adults, the normal response to injury across all organ systems typically results in fibrosis and scar formation. Fibrotic healing causes tissue dysfunction and its impact on patients can be significant. This distinguishes adult healing from foetal/neonatal healing, which is characterised by scarless regeneration. (Bailey & Love, Ch. 3 – Introduction to Wound Healing)"
},
{
"section": "SYSTEMIC SURGERY",
"num": 25,
"topic": "Inguinal Hernia – Anatomy",
"q": "In inguinal hernia, constant positive abdominal pressure can eventually cause which structural change?",
"options": [
"A. Rupture of the inferior epigastric artery",
"B. Stretching and widening of the deep inguinal ring and surrounding muscles, allowing a hernia to develop",
"C. Obliteration of the inguinal canal",
"D. Hypertrophy of the internal oblique muscle",
],
"answer": "B. Stretching and widening of the deep inguinal ring and surrounding muscles, allowing a hernia to develop",
"explanation": "In some patients, the muscles around the deep inguinal ring can initially prevent a hernia from developing. However, under constant positive abdominal pressure, the deep inguinal ring and muscles are gradually stretched, eventually allowing a hernia to become apparent. As the hernia increases in size, its contents may descend further. (Bailey & Love, Ch. 64 – Anatomy of the Inguinal Canal)"
},
]
story = []
# Title block
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("Bailey and Love's Short Practice of Surgery", title_style))
story.append(Paragraph("28th Edition — MCQ Practice Set", subtitle_style))
story.append(Paragraph("25 Questions | General & Systemic Surgery | With Answers and Explanations", subtitle_style))
story.append(Spacer(1, 0.3*cm))
story.append(HRFlowable(width="100%", thickness=2, color=colors.HexColor('#1a3a5c')))
story.append(Spacer(1, 0.4*cm))
current_section = None
for mcq in mcqs:
# Section header
if mcq["section"] != current_section:
current_section = mcq["section"]
story.append(Spacer(1, 0.3*cm))
section_data = [[Paragraph(f" {current_section}", section_style)]]
section_table = Table(section_data, colWidths=[17*cm])
section_table.setStyle(TableStyle([
('BACKGROUND', (0,0), (-1,-1), colors.HexColor('#1a3a5c')),
('BOTTOMPADDING', (0,0), (-1,-1), 6),
('TOPPADDING', (0,0), (-1,-1), 6),
('LEFTPADDING', (0,0), (-1,-1), 8),
]))
story.append(section_table)
story.append(Spacer(1, 0.3*cm))
# Question number + topic
story.append(Paragraph(f"Q{mcq['num']}. [{mcq['topic']}]", q_num_style))
story.append(Paragraph(mcq["q"], question_style))
for opt in mcq["options"]:
story.append(Paragraph(opt, option_style))
# Answer box
answer_data = [
[Paragraph("CORRECT ANSWER:", answer_label_style)],
[Paragraph(mcq["answer"], answer_style)],
[Paragraph("EXPLANATION:", explanation_label_style)],
[Paragraph(mcq["explanation"], explanation_style)],
]
answer_table = Table(answer_data, colWidths=[16.5*cm])
answer_table.setStyle(TableStyle([
('BACKGROUND', (0,0), (-1,-1), colors.HexColor('#f0f7f3')),
('BOX', (0,0), (-1,-1), 0.8, colors.HexColor('#1a6e35')),
('LEFTPADDING', (0,0), (-1,-1), 10),
('RIGHTPADDING', (0,0), (-1,-1), 10),
('TOPPADDING', (0,0), (0,0), 6),
('BOTTOMPADDING', (0,0), (-1,-1), 4),
]))
story.append(answer_table)
story.append(Spacer(1, 0.3*cm))
story.append(HRFlowable(width="100%", thickness=0.5, color=colors.HexColor('#cccccc')))
# Footer
story.append(Spacer(1, 0.5*cm))
story.append(Paragraph("Generated from Bailey and Love's Short Practice of Surgery, 28th Edition. For educational use only.", footer_style))
doc.build(story)
print(f"PDF created: {output_path}")
Running Command
cd /home/daytona/workspace/bailey-love-mcqs && python generate_mcq_pdf.py
Running Command
ls -lh /home/daytona/workspace/bailey-love-mcqs/Bailey_Love_MCQs.pdf
Your PDF is ready. Download it here:
Bailey Love MCQs
PDF Document · PDF
What's inside the PDF:
25 MCQs sourced directly from Bailey & Love's Short Practice of Surgery, 28th Edition, split across two colour-coded sections:
General Surgery (Q1–Q11)
- Wound healing (primary/secondary/tertiary intention, factors delaying healing)
- Intestinal obstruction (classic quartet, adhesions, surgical indications)
- Acute appendicitis (diagnostic accuracy, clinical pitfalls)
- Perforated peptic ulcer (presentation, erect CXR findings)
- Inguinal hernia (Bassini repair, sliding hernia, anatomy)
Systemic Surgery (Q12–Q25)
- Thyroid neoplasms (papillary carcinoma incidence, vocal fold palsy causes)
- Breast cancer (WLE vs mastectomy evidence, BRCA risk reduction, male breast cancer, Patey/Madden modification)
- MEN2 and medullary thyroid carcinoma
- Spinal metastases (radioresistant tumours)
- Acute cholecystitis (differential diagnosis)
- Peptic ulcer disease (treatment mainstays)
- Bowel sounds in obstruction
- Femoral hernia repair approach
Each question includes:
- 4 options (A–D)
- Correct answer highlighted in a green box
- Explanation with the specific chapter/section reference from Bailey & Love
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~/bailey-love-mcqs/mcq_data.py
ALL_MCQS = [
# ─── SECTION 1: WOUND HEALING & SURGICAL PRINCIPLES ───
{
"section": "WOUND HEALING & SURGICAL PRINCIPLES",
"num": 1,
"topic": "Wound Healing",
"q": "Which type of wound healing occurs when wound edges are directly approximated?",
"options": ["A. Secondary intention", "B. Primary intention (first intention)", "C. Tertiary intention", "D. Granulation healing"],
"answer": "B. Primary intention (first intention)",
"explanation": "Primary healing (first intention) occurs when wound edges are directly apposed, resulting in minimal scarring. It is the aim of surgical closure. Secondary intention involves leaving the wound open to heal by granulation and contraction. Tertiary (delayed primary) is when edges are apposed after an initial open period. (Bailey & Love, Ch. 3)"
},
{
"section": "WOUND HEALING & SURGICAL PRINCIPLES",
"num": 2,
"topic": "Wound Healing",
"q": "Wound healing in human adults typically results in which of the following?",
"options": ["A. Complete regeneration without scarring", "B. Fibrosis and scar formation causing tissue dysfunction", "C. Foetal-type scarless healing", "D. Myofibroblast-free repair"],
"answer": "B. Fibrosis and scar formation causing tissue dysfunction",
"explanation": "In human adults, the normal response to injury across all organ systems results in fibrosis and scar formation. This causes tissue dysfunction, distinguishing it from foetal healing, which is characterised by scarless regeneration. (Bailey & Love, Ch. 3)"
},
{
"section": "WOUND HEALING & SURGICAL PRINCIPLES",
"num": 3,
"topic": "Wound Healing – Factors Delaying",
"q": "Which of the following LEAST delays wound healing?",
"options": ["A. Vitamin C deficiency", "B. Systemic corticosteroids", "C. Poorly controlled diabetes", "D. Well-controlled type 2 diabetes"],
"answer": "D. Well-controlled type 2 diabetes",
"explanation": "Malnutrition, vitamin A/C deficiency, steroids (inhibit protein synthesis and fibroblast proliferation), and poorly controlled diabetes all delay wound healing. Well-controlled diabetes has a much lesser effect. (Bailey & Love, Ch. 3)"
},
{
"section": "WOUND HEALING & SURGICAL PRINCIPLES",
"num": 4,
"topic": "Wound Healing – Classification",
"q": "A wound initially left open, then with edges apposed later, is classified as which type of healing?",
"options": ["A. Primary intention", "B. Secondary intention", "C. Tertiary (delayed primary) intention", "D. Quaternary healing"],
"answer": "C. Tertiary (delayed primary) intention",
"explanation": "Tertiary or delayed primary closure occurs when a wound is initially left open and the edges are apposed at a later time. This is used in contaminated wounds to reduce infection risk before closure. Primary = immediate apposition; Secondary = left open to granulate. (Bailey & Love, Ch. 3)"
},
{
"section": "WOUND HEALING & SURGICAL PRINCIPLES",
"num": 5,
"topic": "Haemorrhage & Shock",
"q": "In a trauma patient, any shock should initially be assumed to be which type until proven otherwise?",
"options": ["A. Cardiogenic", "B. Neurogenic", "C. Septic", "D. Hypovolaemic due to haemorrhage"],
"answer": "D. Hypovolaemic due to haemorrhage",
"explanation": "Any shock should be assumed to be hypovolaemic until proven otherwise, and hypovolaemia should be assumed to be due to haemorrhage until excluded. External haemorrhage may be obvious; concealed haemorrhage requires clinical suspicion. (Bailey & Love, Ch. – Trauma)"
},
{
"section": "WOUND HEALING & SURGICAL PRINCIPLES",
"num": 6,
"topic": "Spinal Trauma – Shock",
"q": "Neurogenic shock following spinal trauma presents with which triad?",
"options": ["A. Hypotension, tachycardia, cold clammy peripheries", "B. Hypotension, normal/bradycardia, warm peripheries", "C. Hypertension, bradycardia, irregular respiration", "D. Tachycardia, fever, warm peripheries"],
"answer": "B. Hypotension, normal/bradycardia, warm peripheries",
"explanation": "In spinal trauma, three shock types may occur: hypovolaemic (hypotension + tachycardia + cold clammy), neurogenic (hypotension + normal HR or bradycardia + warm peripheries due to sympathetic disruption), and septic. Neurogenic shock results from loss of sympathetic tone. (Bailey & Love, Ch. – Spinal Trauma)"
},
{
"section": "WOUND HEALING & SURGICAL PRINCIPLES",
"num": 7,
"topic": "Trauma – Haemorrhage",
"q": "In young patients with penetrating trauma and haemorrhage but minimal tissue damage, which paradoxical response may occur?",
"options": ["A. Hypothermia", "B. Paradoxical bradycardia instead of tachycardia", "C. Hypertension", "D. Bradypnoea"],
"answer": "B. Paradoxical bradycardia instead of tachycardia",
"explanation": "In some young patients with penetrating trauma and significant haemorrhage but little tissue damage, a paradoxical bradycardia may accompany the shocked state rather than the expected tachycardia. This can be misleading clinically. (Bailey & Love, Ch. – Trauma)"
},
{
"section": "WOUND HEALING & SURGICAL PRINCIPLES",
"num": 8,
"topic": "Cancer Staging – TNM",
"q": "The TNM staging system is maintained by which international body?",
"options": ["A. World Health Organization (WHO)", "B. American Joint Committee on Cancer (AJCC) alone", "C. Union for International Cancer Control (UICC)", "D. Royal College of Surgeons"],
"answer": "C. Union for International Cancer Control (UICC)",
"explanation": "The Union for International Cancer Control (UICC) is responsible for the TNM (tumour, nodes, metastases) staging system for cancer. This system is compatible with and relates to the American Joint Committee on Cancer (AJCC) system. (Bailey & Love, Ch. 12)"
},
# ─── SECTION 2: GASTROINTESTINAL SURGERY ───
{
"section": "GASTROINTESTINAL SURGERY",
"num": 9,
"topic": "Intestinal Obstruction – Classic Features",
"q": "What is the classic clinical quartet of dynamic intestinal obstruction?",
"options": ["A. Nausea, vomiting, diarrhoea, haematochezia", "B. Pain, distension, vomiting, absolute constipation", "C. Fever, tachycardia, guarding, rebound", "D. Pain, diarrhoea, haematemesis, distension"],
"answer": "B. Pain, distension, vomiting, absolute constipation",
"explanation": "The classic quartet of dynamic intestinal obstruction is pain, distension, vomiting, and absolute constipation. High-pitched bowel sounds are also characteristic. Small bowel obstruction typically causes early vomiting, while large bowel obstruction causes more prominent distension. (Bailey & Love, Ch. 78)"
},
{
"section": "GASTROINTESTINAL SURGERY",
"num": 10,
"topic": "Intestinal Obstruction – Bowel Sounds",
"q": "What type of bowel sounds are heard in the majority of patients with intestinal obstruction?",
"options": ["A. Absent sounds", "B. Normal borborygmi", "C. High-pitched tinkling sounds", "D. Low rumbling sounds"],
"answer": "C. High-pitched tinkling sounds",
"explanation": "High-pitched bowel sounds are present in the vast majority of patients with intestinal obstruction. Normal bowel sounds have negative predictive value. Sounds may become absent if obstruction is prolonged and the bowel becomes inactive. (Bailey & Love, Ch. 78)"
},
{
"section": "GASTROINTESTINAL SURGERY",
"num": 11,
"topic": "Intestinal Obstruction – Adhesions",
"q": "Which part of the bowel is most commonly affected by postoperative adhesion-related obstruction?",
"options": ["A. Duodenum", "B. Upper small bowel (jejunum)", "C. Lower small bowel (ileum)", "D. Transverse colon"],
"answer": "C. Lower small bowel (ileum)",
"explanation": "Postoperative adhesions giving rise to intestinal obstruction usually involve the lower small bowel and less commonly the large bowel. Adhesions are classified as easy (flimsy) or difficult (dense). They are the most common cause of SBO in previously operated patients. (Bailey & Love, Ch. 78)"
},
{
"section": "GASTROINTESTINAL SURGERY",
"num": 12,
"topic": "Intestinal Obstruction – Surgical Indication",
"q": "Which of the following is an absolute indication for early surgery in intestinal obstruction?",
"options": ["A. Moderate distension only", "B. Failure to pass flatus for 6 hours", "C. Obstructed external hernia with strangulation", "D. Mild periumbilical pain"],
"answer": "C. Obstructed external hernia with strangulation",
"explanation": "Early surgery is indicated for: obstructed external hernia, clinical features of intestinal strangulation, and obstruction in a previously unoperated abdomen. The classic adage is 'the sun should not both rise and set' on an unrelieved obstruction, due to the risk of ischaemia. (Bailey & Love, Ch. 78)"
},
{
"section": "GASTROINTESTINAL SURGERY",
"num": 13,
"topic": "Acute Appendicitis – Diagnosis",
"q": "The diagnosis of acute appendicitis is essentially which type of diagnosis?",
"options": ["A. Radiological", "B. Biochemical (raised WBC alone)", "C. Clinical", "D. Histological"],
"answer": "C. Clinical",
"explanation": "The diagnosis of acute appendicitis remains essentially clinical, requiring a mixture of observation, clinical acumen and surgical science. Advances in imaging have improved diagnostic accuracy but the diagnosis is primarily clinical. Imaging is used to reduce the rate of normal appendix removal (15-30% without investigation). (Bailey & Love, Ch. 68)"
},
{
"section": "GASTROINTESTINAL SURGERY",
"num": 14,
"topic": "Acute Appendicitis – Normal Appendix Rate",
"q": "What is the rate of removing a normal appendix when operating on clinical suspicion alone?",
"options": ["A. <5%", "B. 15-30%", "C. 35-45%", "D. >50%"],
"answer": "B. 15-30%",
"explanation": "A decision to operate based on clinical suspicion alone leads to removal of a normal appendix in 15-30% of cases. The premise that removing a normal appendix is preferable to delayed diagnosis is no longer universally accepted, supporting use of imaging such as CT. (Bailey & Love, Ch. 68)"
},
{
"section": "GASTROINTESTINAL SURGERY",
"num": 15,
"topic": "Appendicitis – Elderly",
"q": "In elderly patients presenting with intestinal obstruction, which diagnosis should also be considered?",
"options": ["A. Sigmoid volvulus only", "B. Acute appendicitis as an occasional cause", "C. Meckel's diverticulitis", "D. Intussusception"],
"answer": "B. Acute appendicitis as an occasional cause",
"explanation": "In the elderly, acute appendicitis can occasionally cause intestinal obstruction. Carcinoma of the caecum may also mimic or cause obstructive appendicitis in adults. An abdominal CT scan clarifies the diagnosis in ambiguous cases. (Bailey & Love, Ch. 68)"
},
{
"section": "GASTROINTESTINAL SURGERY",
"num": 16,
"topic": "Perforated Peptic Ulcer – Presentation",
"q": "What is the classical presentation of a perforated duodenal ulcer?",
"options": ["A. Gradual colicky periumbilical pain with nausea", "B. Sudden-onset severe generalised abdominal pain due to gastric acid peritoneal irritation", "C. RUQ pain with fever and jaundice (Charcot's triad)", "D. Epigastric pain relieved by eating"],
"answer": "B. Sudden-onset severe generalised abdominal pain due to gastric acid peritoneal irritation",
"explanation": "The classical presentation is instantly recognisable: sudden-onset severe generalised abdominal pain caused by gastric acid irritating the peritoneum. The patient may have a prior history of peptic ulceration. The abdomen becomes rigid (board-like). Treatment is primarily surgical. (Bailey & Love, Ch. 67)"
},
{
"section": "GASTROINTESTINAL SURGERY",
"num": 17,
"topic": "Perforated Peptic Ulcer – Imaging",
"q": "Free gas under the diaphragm on erect CXR is seen in what proportion of perforated peptic ulcer cases?",
"options": ["A. <20%", "B. 30-40%", "C. >50%", "D. 100%"],
"answer": "C. >50%",
"explanation": "Free gas under the diaphragm is visible on erect CXR in more than 50% of perforated peptic ulcer cases. CT imaging is now more commonly used as it is more accurate. Serum amylase should also be checked to exclude acute pancreatitis as a differential. (Bailey & Love, Ch. 67)"
},
{
"section": "GASTROINTESTINAL SURGERY",
"num": 18,
"topic": "Peptic Ulcer Disease – Treatment",
"q": "What are the current mainstays of treatment for peptic ulcer disease?",
"options": ["A. Elective surgery and antacids", "B. H. pylori eradication and acid suppression (PPIs)", "C. Long-term NSAIDs and sucralfate", "D. Surgical vagotomy and pyloroplasty"],
"answer": "B. H. pylori eradication and acid suppression (PPIs)",
"explanation": "H. pylori eradication therapy and PPIs are the mainstays of treatment for PUD. Elective surgery is now very rarely performed. Common complications of peptic ulcers include perforation, bleeding, and stenosis. Perforation requires primarily surgical treatment. (Bailey & Love, Ch. 67)"
},
{
"section": "GASTROINTESTINAL SURGERY",
"num": 19,
"topic": "Peptic Ulcer – Differential in Acute Abdomen",
"q": "Which of the following is included as a common differential for acute cholecystitis?",
"options": ["A. Diverticulitis", "B. Perforated peptic ulcer", "C. Mesenteric ischaemia", "D. Ruptured ectopic pregnancy"],
"answer": "B. Perforated peptic ulcer",
"explanation": "Common differentials of acute cholecystitis include appendicitis, perforated peptic ulcer, and acute pancreatitis. Uncommon differentials include acute pyelonephritis, myocardial infarction, and right lower lobe pneumonia. (Bailey & Love, Ch. – Biliary Surgery)"
},
{
"section": "GASTROINTESTINAL SURGERY",
"num": 20,
"topic": "Colorectal Cancer – Staging",
"q": "Which staging system was originally described for rectal tumours but adopted for histopathological reporting of colon cancer?",
"options": ["A. TNM (UICC)", "B. Clark's staging", "C. Dukes' classification", "D. Breslow staging"],
"answer": "C. Dukes' classification",
"explanation": "Dukes' classification was originally described for rectal tumours but has been adopted for histopathological reporting of colon cancer. It is described as simple. A variety of staging systems exist for colorectal cancer; postoperative pathological staging guides adjuvant therapy decisions. (Bailey & Love, Ch. – Colorectal Cancer)"
},
{
"section": "GASTROINTESTINAL SURGERY",
"num": 21,
"topic": "Colorectal Cancer – TNM",
"q": "The TNM staging system for colorectal cancer is compatible with which other major staging system?",
"options": ["A. Dukes' classification only", "B. Clark's system", "C. AJCC (American Joint Committee on Cancer)", "D. FIGO staging"],
"answer": "C. AJCC (American Joint Committee on Cancer)",
"explanation": "The UICC TNM system is compatible with and relates to the AJCC system. Postoperative pathological staging using TNM is discussed in a multidisciplinary forum to allow decisions about adjuvant therapy. (Bailey & Love, Ch. 12)"
},
# ─── SECTION 3: HEPATOBILIARY & PANCREATIC SURGERY ───
{
"section": "HEPATOBILIARY & PANCREATIC SURGERY",
"num": 22,
"topic": "Gallstones – Complications",
"q": "Which of the following is NOT a recognised complication/effect of gallstones listed in Bailey & Love?",
"options": ["A. Gallstone ileus", "B. Acute cholangitis", "C. Haemobilia", "D. Empyema of the gallbladder"],
"answer": "C. Haemobilia",
"explanation": "Recognised effects and complications of gallstones include biliary colic, acute/chronic cholecystitis, empyema, mucocele, gallbladder perforation, biliary obstruction (jaundice), acute cholangitis, acute pancreatitis, and gallstone ileus (intestinal obstruction). Haemobilia is not listed as a gallstone complication. (Bailey & Love, Ch. – Biliary Surgery)"
},
{
"section": "HEPATOBILIARY & PANCREATIC SURGERY",
"num": 23,
"topic": "Acute Pancreatitis – Severity Assessment",
"q": "In acute pancreatitis, investigations should aim to answer which three key questions?",
"options": ["A. Type of organism, necrosis extent, patient age", "B. Is the diagnosis correct? How severe is the attack? What is the aetiology?", "C. Which organ failed first, blood glucose level, and amylase value", "D. CT grade, WBC count, and bilirubin level"],
"answer": "B. Is the diagnosis correct? How severe is the attack? What is the aetiology?",
"explanation": "Investigations in acute pancreatitis should answer three questions: (1) Is the diagnosis of acute pancreatitis correct? (2) How severe is the attack? (3) What is the aetiology? Identifying severe pancreatitis early is critical as these patients require aggressive early management. (Bailey & Love, Ch. 72)"
},
{
"section": "HEPATOBILIARY & PANCREATIC SURGERY",
"num": 24,
"topic": "Acute Pancreatitis – Severity Classification",
"q": "Severe acute pancreatitis is defined by which criterion according to revised Atlanta classification?",
"options": ["A. Amylase > 1000 IU/L", "B. Persistent organ failure for >48 hours", "C. Transient organ failure resolving within 48 hours", "D. APACHE II score > 5"],
"answer": "B. Persistent organ failure for >48 hours",
"explanation": "Severe acute pancreatitis is defined by persistent organ failure (>48 hours), either single or multiple organ failure. Moderately severe pancreatitis involves transient organ failure resolving within 48 hours and/or local or systemic complications without persistent organ failure. (Bailey & Love, Ch. 72)"
},
{
"section": "HEPATOBILIARY & PANCREATIC SURGERY",
"num": 25,
"topic": "Acute Pancreatitis – Scoring",
"q": "Which two scoring systems are classically used to predict the severity of acute pancreatitis?",
"options": ["A. Child-Pugh and MELD", "B. Ranson and Glasgow scoring systems", "C. APACHE II and Balthazar CT only", "D. Rockall and Blatchford scores"],
"answer": "B. Ranson and Glasgow scoring systems",
"explanation": "The Ranson and Glasgow scoring systems are classical tools to predict the severity of acute pancreatitis. The Balthazar criteria are used to stage severity detected on CT imaging. Identifying high-risk patients early allows for aggressive management and HDU/ICU admission. (Bailey & Love, Ch. 72)"
},
{
"section": "HEPATOBILIARY & PANCREATIC SURGERY",
"num": 26,
"topic": "Acute Pancreatitis – CT Imaging",
"q": "CT imaging in acute pancreatitis within the first 72 hours may do what?",
"options": ["A. Overestimate the extent of necrosis", "B. Underestimate the extent of necrosis", "C. Accurately define necrosis in all cases", "D. Show no abnormality"],
"answer": "B. Underestimate the extent of necrosis",
"explanation": "In severe acute pancreatitis, CT distinguishes interstitial from necrotising pancreatitis. However, in the first 72 hours, CT may underestimate the extent of necrosis. The severity detected on CT can be staged according to the Balthazar criteria. (Bailey & Love, Ch. 72)"
},
{
"section": "HEPATOBILIARY & PANCREATIC SURGERY",
"num": 27,
"topic": "Chronic Pancreatitis",
"q": "In chronic pancreatitis, which symptom prevents sleep and commonly leads to frequent hospital admissions?",
"options": ["A. Diarrhoea", "B. Jaundice", "C. Pain", "D. Nausea"],
"answer": "C. Pain",
"explanation": "In chronic pancreatitis, all complications of acute pancreatitis can occur. Weight loss is common as the patient avoids eating due to pain. The pain prevents sleep and leads to time off work. The number of hospital admissions for acute exacerbations indicates disease severity. (Bailey & Love, Ch. 72)"
},
# ─── SECTION 4: HERNIA SURGERY ───
{
"section": "HERNIA SURGERY",
"num": 28,
"topic": "Inguinal Hernia – Bassini Repair",
"q": "The Bassini repair for inguinal hernia was described in which year?",
"options": ["A. 1920", "B. 1950", "C. 1890", "D. 1905"],
"answer": "C. 1890",
"explanation": "In 1890, Edoardo Bassini described a suture repair for inguinal hernia that remained the basis of open repair for over 100 years. The surgeon opens the inguinal canal by incising the external oblique aponeurosis and dissects the spermatic cord free. (Bailey & Love, Ch. 64)"
},
{
"section": "HERNIA SURGERY",
"num": 29,
"topic": "Inguinal Hernia – Anatomy",
"q": "What structural change does constant positive abdominal pressure cause at the deep inguinal ring?",
"options": ["A. Ruptures the inferior epigastric artery", "B. Stretches and widens the deep inguinal ring and surrounding muscles", "C. Obliterates the inguinal canal", "D. Causes hypertrophy of internal oblique"],
"answer": "B. Stretches and widens the deep inguinal ring and surrounding muscles",
"explanation": "In some patients, the muscles around the deep inguinal ring initially prevent hernia. Under constant positive abdominal pressure, the deep inguinal ring and muscles are gradually stretched, allowing a hernia to develop. As the hernia grows, contents descend further. (Bailey & Love, Ch. 64)"
},
{
"section": "HERNIA SURGERY",
"num": 30,
"topic": "Inguinal Hernia – Sliding",
"q": "A sliding inguinal hernia is correctly described as:",
"options": ["A. A direct hernia through the posterior inguinal wall", "B. An acquired indirect hernia at the deep ring lateral to inferior epigastric vessels with retroperitoneal fat descending", "C. A hernia reducing spontaneously when supine", "D. A hernia containing only omentum"],
"answer": "B. An acquired indirect hernia at the deep ring lateral to inferior epigastric vessels with retroperitoneal fat descending",
"explanation": "Sliding hernias are acquired indirect hernias arising at the deep inguinal ring lateral to the inferior epigastric vessels. Retroperitoneal fatty tissue is pushed downwards. A viscus (e.g., bladder) may be pulled into a direct hernia component as the hernia enlarges. (Bailey & Love, Ch. 64)"
},
{
"section": "HERNIA SURGERY",
"num": 31,
"topic": "Inguinal Hernia – Diagnosis",
"q": "Which manoeuvre is used to confirm reducibility of an inguinal hernia in a supine patient?",
"options": ["A. Ask the patient to cough vigorously", "B. Ask the patient to reduce the hernia; if unable the surgeon gently attempts reduction", "C. Apply a truss and review in 2 weeks", "D. Immediately proceed to CT"],
"answer": "B. Ask the patient to reduce the hernia; if unable the surgeon gently attempts reduction",
"explanation": "With the patient lying down, the patient is asked to reduce the hernia if it has not spontaneously reduced. If the patient cannot, the surgeon gently attempts reduction. Most inguinal hernias reduce on lying down and reappear on standing. (Bailey & Love, Ch. 64)"
},
{
"section": "HERNIA SURGERY",
"num": 32,
"topic": "Femoral Hernia – Lotheissen Approach",
"q": "When repairing a femoral hernia via the inguinal (Lotheissen) approach, mesh is placed in the inguinal canal primarily to:",
"options": ["A. Reduce the femoral sac", "B. Protect against development of an inguinal hernia", "C. Reinforce the femoral ring", "D. Obliterate the femoral canal permanently"],
"answer": "B. Protect against development of an inguinal hernia",
"explanation": "The Lotheissen approach opens the inguinal canal; layers are closed as for inguinal hernia repair. Mesh may be placed in the inguinal canal to protect against development of a concomitant inguinal hernia, since the inguinal canal has been opened. (Bailey & Love, Ch. 64)"
},
# ─── SECTION 5: BREAST SURGERY ───
{
"section": "BREAST SURGERY",
"num": 33,
"topic": "Breast Cancer – Surgical Evidence",
"q": "What do clinical trials and meta-analyses show regarding mastectomy vs WLE/BCS + radiotherapy for breast cancer?",
"options": ["A. Mastectomy is superior for survival", "B. Equal efficacy in locoregional control and survival", "C. WLE alone without RT is equivalent", "D. Chemotherapy replaces surgical need"],
"answer": "B. Equal efficacy in locoregional control and survival",
"explanation": "Clinical trials and meta-analyses show equal efficacy in locoregional cancer control and survival between mastectomy and wide local excision/breast-conserving surgery (WLE/BCS) followed by radiotherapy. This has led to de-escalation towards more conservative techniques. (Bailey & Love, Ch. 58)"
},
{
"section": "BREAST SURGERY",
"num": 34,
"topic": "Breast Cancer – Mastectomy Types",
"q": "In the Auchincloss modification of modified radical mastectomy, the pectoralis minor muscle is:",
"options": ["A. Removed", "B. Divided but not removed", "C. Retracted", "D. Used for reconstruction"],
"answer": "C. Retracted",
"explanation": "Modified radical mastectomy includes mastectomy + level I-III axillary node dissection. In Patey/Madden: pectoralis minor is removed. In Auchincloss: retracted. In Scanlon: divided but not removed. (Bailey & Love, Ch. 58, Summary Box 58.4)"
},
{
"section": "BREAST SURGERY",
"num": 35,
"topic": "Breast Cancer – Mastectomy Types",
"q": "In the Scanlon modification of modified radical mastectomy, what is done to the pectoralis minor?",
"options": ["A. Removed", "B. Retracted", "C. Divided but not removed", "D. Left completely intact"],
"answer": "C. Divided but not removed",
"explanation": "The three modifications differ in pectoralis minor handling: Patey/Madden = removed; Auchincloss = retracted; Scanlon = divided but not removed. All involve mastectomy plus level I, II, III axillary lymph node dissection. (Bailey & Love, Ch. 58)"
},
{
"section": "BREAST SURGERY",
"num": 36,
"topic": "Breast Cancer – BRCA Risk Reduction",
"q": "By approximately how much does bilateral risk-reducing mastectomy reduce breast cancer risk in BRCA mutation carriers?",
"options": ["A. 40%", "B. 60%", "C. 75%", "D. 90%"],
"answer": "D. 90%",
"explanation": "Women with BRCA mutation may be offered bilateral risk-reducing mastectomy with immediate breast reconstruction, which reduces breast cancer risk by 90%. Chemoprophylaxis with tamoxifen is an alternative risk reduction strategy. (Bailey & Love, Ch. 58)"
},
{
"section": "BREAST SURGERY",
"num": 37,
"topic": "Male Breast Cancer",
"q": "What is the incidence of carcinoma of the male breast relative to all breast cancer cases?",
"options": ["A. About 5%", "B. Less than 0.5%", "C. About 2%", "D. About 10%"],
"answer": "B. Less than 0.5%",
"explanation": "Carcinoma of the male breast accounts for less than 0.5% of all breast cancer cases. The most common symptom is a painless subareolar lump. Nipple-areolar complex and pectoral muscle involvement occurs early. Treatment is mastectomy with a 2-cm margin. (Bailey & Love, Ch. 58)"
},
{
"section": "BREAST SURGERY",
"num": 38,
"topic": "Male Breast Cancer – Treatment",
"q": "What is the standard surgical treatment for carcinoma of the male breast?",
"options": ["A. Wide local excision with sentinel node biopsy", "B. Mastectomy with a 2-cm margin", "C. Lumpectomy followed by radiotherapy", "D. Total skin-sparing mastectomy"],
"answer": "B. Mastectomy with a 2-cm margin",
"explanation": "Treatment of male breast carcinoma comprises mastectomy with a 2-cm margin. Involvement of the nipple-areolar complex and underlying pectoral muscles occurs early in male breast cancer. (Bailey & Love, Ch. 58)"
},
{
"section": "BREAST SURGERY",
"num": 39,
"topic": "Breast Cancer – DVT Risk Factors",
"q": "Which of the following is listed as a patient factor predisposing to DVT relevant to surgical breast cancer patients?",
"options": ["A. Low BMI", "B. High-dose oestrogen therapy", "C. Young age", "D. Regular exercise"],
"answer": "B. High-dose oestrogen therapy",
"explanation": "Patient factors predisposing to DVT include age, obesity, varicose veins, immobility, pregnancy, puerperium, high-dose oestrogen therapy, previous DVT/PE, and thrombophilia. These are particularly relevant in cancer surgery patients. (Bailey & Love, Ch. 62)"
},
# ─── SECTION 6: ENDOCRINE SURGERY ───
{
"section": "ENDOCRINE SURGERY",
"num": 40,
"topic": "Thyroid – Malignancy Incidence",
"q": "What is the relative incidence of follicular carcinoma among thyroid malignancies?",
"options": ["A. 80%", "B. 40%", "C. 10%", "D. 25%"],
"answer": "C. 10%",
"explanation": "Thyroid malignancies: papillary carcinoma ~80%, follicular carcinoma ~10%, poorly differentiated/anaplastic carcinoma – much rarer. Medullary thyroid carcinoma is associated with MEN2. Papillary carcinoma is the most common. (Bailey & Love, Ch. – Thyroid Neoplasms)"
},
{
"section": "ENDOCRINE SURGERY",
"num": 41,
"topic": "Thyroid – Vocal Fold Palsy (Neoplastic)",
"q": "Which neoplastic condition causes vocal fold palsy by involving the left recurrent laryngeal nerve?",
"options": ["A. Aortic aneurysm", "B. Carcinoma of the lung involving the left hilum", "C. Viral infection", "D. Direct neck trauma"],
"answer": "B. Carcinoma of the lung involving the left hilum",
"explanation": "Neoplastic causes of vocal fold palsy include carcinoma of the lung involving the left hilum (compressing the left RLN), as well as nasopharynx, larynx, thyroid, and oesophageal carcinomas. Aortic aneurysm is vascular; viral = infective; trauma = traumatic. (Bailey & Love, Ch. – Vocal Fold Palsy)"
},
{
"section": "ENDOCRINE SURGERY",
"num": 42,
"topic": "MEN2 Syndrome",
"q": "Medullary thyroid carcinoma (MTC) is associated with which inherited endocrine syndrome?",
"options": ["A. MEN1 (Wermer syndrome)", "B. MEN2 (Multiple Endocrine Neoplasia type 2)", "C. Von Hippel-Lindau disease", "D. Cowden syndrome"],
"answer": "B. MEN2 (Multiple Endocrine Neoplasia type 2)",
"explanation": "MEN2 comprises medullary thyroid carcinoma (MTC), phaeochromocytoma (PCC), and primary hyperparathyroidism (PHPT). MEN1 involves parathyroid, pancreatic islet, and pituitary tumours. VHL involves haemangioblastomas and clear cell RCC. (Bailey & Love, Ch. – Endocrine Surgery)"
},
{
"section": "ENDOCRINE SURGERY",
"num": 43,
"topic": "Thyroid – Vocal Fold Palsy (Vascular)",
"q": "Which vascular condition is a recognised cause of vocal fold palsy?",
"options": ["A. Carotid artery stenosis", "B. Aortic aneurysm", "C. Subclavian steal syndrome", "D. Vertebral artery occlusion"],
"answer": "B. Aortic aneurysm",
"explanation": "Vocal fold palsy causes include traumatic (direct neck injury, post-thyroidectomy), infective (viral), neoplastic (lung, thyroid, oesophageal carcinoma), vascular (aortic aneurysm), and neurological (lower motor neurone disease). (Bailey & Love, Ch. – Vocal Fold Palsy)"
},
{
"section": "ENDOCRINE SURGERY",
"num": 44,
"topic": "Adrenal – Haemorrhage",
"q": "Which of the following predisposes to adrenal haemorrhage?",
"options": ["A. Hypertension alone", "B. Infection (sepsis), myocardial infarction, anticoagulants, trauma", "C. Hypothyroidism", "D. Chronic anaemia"],
"answer": "B. Infection (sepsis), myocardial infarction, anticoagulants, trauma",
"explanation": "Factors predisposing to adrenal haemorrhage include infection/sepsis, myocardial infarction, anticoagulants, trauma, surgery, and antiphospholipid syndrome. Presentation varies from non-specific abdominal pain to adrenal insufficiency or hypovolaemic shock. (Bailey & Love, Ch. – Adrenal Surgery)"
},
{
"section": "ENDOCRINE SURGERY",
"num": 45,
"topic": "Spinal Metastases – Radiosensitivity",
"q": "Which tumour type is classified as radioresistant when considering spinal metastases management?",
"options": ["A. Small cell lung carcinoma", "B. Ewing's sarcoma", "C. Thyroid carcinoma", "D. Neuroblastoma"],
"answer": "C. Thyroid carcinoma",
"explanation": "Radioresistant tumours metastasising to the spine include gastrointestinal adenocarcinoma, metastatic melanoma, thyroid carcinoma, and renal carcinoma. Radiosensitive: small cell lung, Ewing's sarcoma, breast carcinoma. Chemosensitive: small cell lung, Ewing's, breast, neuroblastoma. (Bailey & Love, Ch. 37)"
},
# ─── SECTION 7: SPLENIC SURGERY ───
{
"section": "SPLENIC SURGERY",
"num": 46,
"topic": "Spleen – Splenectomy Principles",
"q": "After splenectomy, which important complication requires prophylaxis?",
"options": ["A. Haemorrhage recurrence", "B. Post-splenectomy sepsis (overwhelming post-splenectomy infection, OPSI)", "C. Portal hypertension", "D. Adrenal insufficiency"],
"answer": "B. Post-splenectomy sepsis (overwhelming post-splenectomy infection, OPSI)",
"explanation": "The learning objectives for splenectomy specifically include the importance of prophylaxis against infection following splenectomy. Post-splenectomy infection (OPSI) is a life-threatening complication requiring vaccination against encapsulated organisms (pneumococcus, meningococcus, Haemophilus influenzae) and antibiotic prophylaxis. (Bailey & Love, Ch. 70)"
},
{
"section": "SPLENIC SURGERY",
"num": 47,
"topic": "Spleen – Trauma",
"q": "When should splenectomy be performed over splenic conservation in splenic trauma?",
"options": ["A. For all grade I and II injuries", "B. For severe grades of injury where controlling bleeding takes precedence", "C. Only after failed angioembolisation", "D. Only if the patient has a coagulopathy"],
"answer": "B. For severe grades of injury where controlling bleeding takes precedence",
"explanation": "Splenectomy should be performed for severe grades of splenic injury where control of bleeding takes precedence over splenic salvage. Splenic angiography with embolisation may avoid splenectomy but should not delay laparotomy in a haemodynamically unstable patient. (Bailey & Love, Ch. 70)"
},
{
"section": "SPLENIC SURGERY",
"num": 48,
"topic": "Spleen – Open Splenectomy Incision",
"q": "Which incision is most commonly used for open splenectomy?",
"options": ["A. Right subcostal (Kocher's) incision", "B. Midline or transverse left subcostal incision", "C. Left paramedian incision", "D. Pfannenstiel incision"],
"answer": "B. Midline or transverse left subcostal incision",
"explanation": "Most surgeons use a midline or transverse left subcostal incision for open splenectomy with the patient in the supine position. Rarely, a thoracoabdominal incision is necessary for a massive spleen adherent to the diaphragm. A nasogastric tube is passed after induction. (Bailey & Love, Ch. 70)"
},
{
"section": "SPLENIC SURGERY",
"num": 49,
"topic": "Spleen – Laparoscopic Advantage",
"q": "Which is a specifically mentioned advantage of laparoscopic splenectomy over open splenectomy?",
"options": ["A. Available for all spleen sizes", "B. Avoids post-splenectomy infection", "C. Reduced morbidity and hospital stay", "D. No need for vaccinations post-procedure"],
"answer": "C. Reduced morbidity and hospital stay",
"explanation": "The learning objectives for splenectomy include understanding the potential advantages of laparoscopic splenectomy, which include reduced morbidity, shorter hospital stay, and faster recovery compared with open splenectomy. Post-splenectomy vaccination is required regardless of approach. (Bailey & Love, Ch. 70)"
},
# ─── SECTION 8: VASCULAR SURGERY ───
{
"section": "VASCULAR SURGERY",
"num": 50,
"topic": "DVT – Risk Factors",
"q": "Which of the following is a recognised risk factor for deep vein thrombosis listed in Bailey & Love?",
"options": ["A. Low BMI", "B. Regular aerobic exercise", "C. Previous DVT or pulmonary embolism", "D. Male sex exclusively"],
"answer": "C. Previous DVT or pulmonary embolism",
"explanation": "Recognised patient risk factors for DVT include: age, obesity, varicose veins, immobility, pregnancy, puerperium, high-dose oestrogen therapy, previous DVT or PE, and thrombophilia. These inform VTE prophylaxis decisions in surgical patients. (Bailey & Love, Ch. 62)"
},
{
"section": "VASCULAR SURGERY",
"num": 51,
"topic": "Varicose Veins – Recurrence",
"q": "Recurrent anterior abdominal wall varicose veins following saphenofemoral junction ligation can be a complication of what underlying condition?",
"options": ["A. Portal hypertension", "B. Iliac deep vein thrombosis", "C. Inferior vena cava obstruction", "D. Superior mesenteric vein thrombosis"],
"answer": "B. Iliac deep vein thrombosis",
"explanation": "Recurrent anterior abdominal wall varicose veins following saphenofemoral junction ligation can result from iliac deep vein thrombosis. This causes venous hypertension and collateral formation via abdominal wall veins. (Bailey & Love, Ch. 62)"
},
# ─── SECTION 9: ORTHOPAEDIC & SPINAL SURGERY ───
{
"section": "ORTHOPAEDIC & SPINAL SURGERY",
"num": 52,
"topic": "Low Back Pain – Red Flags",
"q": "Which past medical history is a 'red flag' for serious cause of low back pain according to Bailey & Love?",
"options": ["A. History of migraine", "B. History of cancer (breast, lung, GI, prostate, renal, thyroid)", "C. History of hypertension", "D. History of asthma"],
"answer": "B. History of cancer (breast, lung, GI, prostate, renal, thyroid)",
"explanation": "Red flags for serious conditions causing low back pain include past history of cancer - particularly breast, lung, gastrointestinal, prostate, renal, and thyroid cancers, which are more likely to metastasise to the spine. Infection (discitis, vertebral osteomyelitis, spinal epidural abscess) is also a red flag. (Bailey & Love, Ch. 37)"
},
{
"section": "ORTHOPAEDIC & SPINAL SURGERY",
"num": 53,
"topic": "Spinal Metastases – Chemosensitive",
"q": "Which of the following tumours is generally sensitive to chemotherapy in the context of spinal metastases?",
"options": ["A. Renal carcinoma", "B. Metastatic melanoma", "C. Gastrointestinal adenocarcinoma", "D. Small cell carcinoma of the lung"],
"answer": "D. Small cell carcinoma of the lung",
"explanation": "Small cell carcinoma of the lung, Ewing's sarcoma, thyroid carcinoma, breast carcinoma, and neuroblastoma are usually sensitive to chemotherapy and should have chemotherapeutic agents as first-line management for spinal metastases. GI adenocarcinoma, melanoma, thyroid, and renal carcinoma are radioresistant. (Bailey & Love, Ch. 37)"
},
# ─── SECTION 10: GENERAL SURGICAL PRINCIPLES ───
{
"section": "GENERAL SURGICAL PRINCIPLES",
"num": 54,
"topic": "Acute Abdomen – Pancreatitis Imaging",
"q": "What does ultrasound demonstrate in acute pancreatitis?",
"options": ["A. Pancreatic necrosis extent", "B. Gallstones and enlarged pancreas", "C. Degree of ductal dilatation only", "D. Portal vein thrombosis exclusively"],
"answer": "B. Gallstones and enlarged pancreas",
"explanation": "In acute pancreatitis, ultrasound may show gallstones and can demonstrate an enlarged pancreas. CT is used to assess severity, distinguish interstitial from necrotising pancreatitis, and look for complications. CT may underestimate necrosis in the first 72 hours. (Bailey & Love, Ch. 72)"
},
{
"section": "GENERAL SURGICAL PRINCIPLES",
"num": 55,
"topic": "Surgical Oncology – Staging",
"q": "In colorectal cancer, postoperative pathological staging is discussed in which setting to allow decisions about adjuvant therapy?",
"options": ["A. One-to-one between surgeon and patient", "B. Multidisciplinary team (MDT) forum", "C. National cancer registry board", "D. General practice review"],
"answer": "B. Multidisciplinary team (MDT) forum",
"explanation": "Postoperative pathological staging should be discussed in the multidisciplinary team forum, allowing for decisions about adjuvant therapy. Both preoperative staging and postoperative pathological staging are discussed in this setting. (Bailey & Love, Ch. – Colorectal Cancer)"
},
# ─── SECTION 11: EXTENDED TOPICS ───
{
"section": "WOUND HEALING & SURGICAL PRINCIPLES",
"num": 56,
"topic": "Haemorrhage – Concealed",
"q": "How should concealed internal haemorrhage be approached in a trauma patient?",
"options": ["A. Wait for imaging confirmation before treating", "B. Assume hypovolaemia is due to haemorrhage until excluded", "C. Treat as neurogenic shock first", "D. Observe and reassess in 1 hour"],
"answer": "B. Assume hypovolaemia is due to haemorrhage until excluded",
"explanation": "Concealed haemorrhage can be difficult to diagnose. Any shock should be assumed hypovolaemic until proven otherwise; hypovolaemia should be assumed to be due to haemorrhage until excluded. Early aggressive resuscitation and identification of source are priorities. (Bailey & Love, Ch. – Trauma)"
},
{
"section": "GASTROINTESTINAL SURGERY",
"num": 57,
"topic": "Intestinal Obstruction – Large vs Small Bowel",
"q": "Which feature more prominently distinguishes large bowel obstruction from small bowel obstruction?",
"options": ["A. Earlier onset of vomiting", "B. More prominent abdominal distension", "C. Milder pain", "D. Absence of constipation"],
"answer": "B. More prominent abdominal distension",
"explanation": "In large bowel obstruction, abdominal distension is more prominent, while vomiting tends to be a later feature. In small bowel obstruction, vomiting occurs earlier and is more frequent. Both share the classic quartet of pain, distension, vomiting, and absolute constipation. (Bailey & Love, Ch. 78)"
},
{
"section": "GASTROINTESTINAL SURGERY",
"num": 58,
"topic": "Peptic Ulcer – Complications",
"q": "What are the three common complications of peptic ulcer disease?",
"options": ["A. Haemorrhage, malignant transformation, obstruction", "B. Perforation, bleeding, and stenosis", "C. Perforation, fistula formation, and malignancy", "D. Bleeding, pyloric stenosis, and pancreatitis"],
"answer": "B. Perforation, bleeding, and stenosis",
"explanation": "The three common complications of peptic ulcers are perforation, bleeding, and stenosis. Perforation requires primarily surgical treatment; bleeding may be managed endoscopically or surgically; stenosis causes gastric outlet obstruction. (Bailey & Love, Ch. 67)"
},
{
"section": "GASTROINTESTINAL SURGERY",
"num": 59,
"topic": "Colon Cancer – Adjuvant Therapy",
"q": "Discussion of postoperative pathological staging in colorectal cancer in the MDT allows decisions primarily regarding:",
"options": ["A. Palliative care referral", "B. Adjuvant therapy", "C. Bowel screening for family", "D. Stoma reversal timing"],
"answer": "B. Adjuvant therapy",
"explanation": "Postoperative pathological staging of colorectal cancer is discussed in the MDT forum allowing for decisions about adjuvant therapy (e.g. adjuvant chemotherapy for node-positive colon cancer or adjuvant chemoradiotherapy for rectal cancer). (Bailey & Love, Ch. – Colorectal Cancer)"
},
{
"section": "HEPATOBILIARY & PANCREATIC SURGERY",
"num": 60,
"topic": "Gallstone Ileus",
"q": "Gallstone ileus is a form of intestinal obstruction caused by:",
"options": ["A. Gallstones blocking the cystic duct", "B. A large gallstone passing through a biliary-enteric fistula and obstructing the small bowel", "C. Gallbladder empyema eroding into the colon", "D. Acute cholangitis causing duodenal oedema"],
"answer": "B. A large gallstone passing through a biliary-enteric fistula and obstructing the small bowel",
"explanation": "Gallstone ileus is listed under effects and complications of gallstones as a cause of intestinal obstruction. A large gallstone erodes through the gallbladder wall into the adjacent bowel (typically duodenum), travels distally, and impacts at the ileocaecal valve. (Bailey & Love, Ch. – Biliary Surgery)"
},
{
"section": "HEPATOBILIARY & PANCREATIC SURGERY",
"num": 61,
"topic": "Acute Pancreatitis – Moderately Severe",
"q": "Which of the following describes moderately severe acute pancreatitis?",
"options": ["A. No organ failure and no local complications", "B. Persistent organ failure for >48 hours", "C. Transient organ failure resolving within 48 hours and/or local complications without persistent organ failure", "D. Amylase >3000 IU/L only"],
"answer": "C. Transient organ failure resolving within 48 hours and/or local complications without persistent organ failure",
"explanation": "The revised Atlanta classification: Mild AP = no organ failure, no local/systemic complications. Moderately severe AP = transient organ failure resolving within 48 hours and/or local or systemic complications without persistent organ failure. Severe AP = persistent organ failure (>48 hours). (Bailey & Love, Ch. 72)"
},
{
"section": "ENDOCRINE SURGERY",
"num": 62,
"topic": "Thyroid – Papillary Carcinoma",
"q": "Papillary carcinoma accounts for approximately what percentage of all thyroid malignancies?",
"options": ["A. 40%", "B. 60%", "C. 80%", "D. 10%"],
"answer": "C. 80%",
"explanation": "Papillary carcinoma is the most common malignancy of the thyroid, accounting for approximately 80% of all thyroid malignancies. It typically has an excellent prognosis, spreads via lymphatics, and is associated with radiation exposure. Follicular carcinoma accounts for ~10%. (Bailey & Love, Ch. – Thyroid)"
},
{
"section": "SPLENIC SURGERY",
"num": 63,
"topic": "Spleen – Thoracoabdominal Incision",
"q": "When is a thoracoabdominal incision used for open splenectomy?",
"options": ["A. For all emergency splenectomies", "B. For a massive spleen adherent to the diaphragm", "C. Routinely for elective splenectomy", "D. When the midline incision is insufficient for normal-sized spleen"],
"answer": "B. For a massive spleen adherent to the diaphragm",
"explanation": "A thoracoabdominal incision is rarely necessary for open splenectomy, reserved for a massive spleen that is adherent to the diaphragm. The standard approach is midline or transverse left subcostal with patient supine. (Bailey & Love, Ch. 70)"
},
{
"section": "ORTHOPAEDIC & SPINAL SURGERY",
"num": 64,
"topic": "Spinal Metastases – Radioresistant Management",
"q": "For radioresistant tumours with spinal metastases, what is the recommended first-line management approach?",
"options": ["A. Radiotherapy alone", "B. Chemotherapy as first-line for chemosensitive types; surgical decompression for others", "C. Watchful waiting", "D. Hormonal therapy for all"],
"answer": "B. Chemotherapy as first-line for chemosensitive types; surgical decompression for others",
"explanation": "Small cell lung, Ewing's sarcoma, thyroid, breast carcinoma, and neuroblastoma should have chemotherapy as first-line. Radioresistant tumours (GI adenocarcinoma, melanoma, thyroid/renal carcinoma) do not respond to radiotherapy and may require surgical decompression/stabilisation. (Bailey & Love, Ch. 37)"
},
{
"section": "VASCULAR SURGERY",
"num": 65,
"topic": "DVT – Thrombophilia",
"q": "Thrombophilia is listed in Bailey & Love as a risk factor for which condition in surgical patients?",
"options": ["A. Wound dehiscence", "B. Deep vein thrombosis", "C. Anastomotic leak", "D. Surgical site infection"],
"answer": "B. Deep vein thrombosis",
"explanation": "Thrombophilia is a recognised patient risk factor for DVT. Other factors include age, obesity, varicose veins, immobility, pregnancy, puerperium, high-dose oestrogen therapy, and previous DVT or PE. Awareness of these factors guides VTE prophylaxis in surgical patients. (Bailey & Love, Ch. 62)"
},
{
"section": "WOUND HEALING & SURGICAL PRINCIPLES",
"num": 66,
"topic": "Wound Healing – Secondary Intention Features",
"q": "Which three processes characterise secondary intention wound healing?",
"options": ["A. Primary closure, minimal inflammation, fast scarring", "B. Granulation, contraction, and re-epithelialisation", "C. Delayed suturing, mesh reinforcement, flap coverage", "D. Collagen lysis, fibrosis, and remodelling only"],
"answer": "B. Granulation, contraction, and re-epithelialisation",
"explanation": "Secondary intention healing involves a wound left open to heal by granulation tissue formation, wound contraction, and re-epithelialisation. It is associated with increased inflammation and proliferation and results in a poorer scar than primary intention healing. (Bailey & Love, Ch. 3)"
},
{
"section": "GASTROINTESTINAL SURGERY",
"num": 67,
"topic": "Appendicitis – Caecal Carcinoma",
"q": "Carcinoma of the caecum may mimic acute appendicitis in adults through which mechanism?",
"options": ["A. Perforation into the appendix lumen", "B. Obstructive appendicitis when locally perforated or causing obstruction", "C. Producing appendix-specific cytokines", "D. Invading the appendiceal mesentery"],
"answer": "B. Obstructive appendicitis when locally perforated or causing obstruction",
"explanation": "When obstructed or locally perforated, carcinoma of the caecum may mimic or cause obstructive appendicitis in adults. A history of preceding symptoms and CT will help clarify the diagnosis. This is particularly relevant in elderly patients presenting with right iliac fossa signs. (Bailey & Love, Ch. 68)"
},
{
"section": "GASTROINTESTINAL SURGERY",
"num": 68,
"topic": "Intestinal Obstruction – Strangulation",
"q": "What is the consequence of delayed treatment of acute intestinal obstruction prompting the adage about sunrise and sunset?",
"options": ["A. Perforation from gas distension", "B. Intestinal ischaemia", "C. Peritonitis from bacterial translocation", "D. Electrolyte imbalance"],
"answer": "B. Intestinal ischaemia",
"explanation": "The classic surgical adage that 'the Sun should not both rise and set' on a case of unrelieved acute intestinal obstruction was based on the concern that intestinal ischaemia would develop while the patient was waiting. Early intervention prevents strangulation and ischaemia. (Bailey & Love, Ch. 78)"
},
{
"section": "HEPATOBILIARY & PANCREATIC SURGERY",
"num": 69,
"topic": "Acute Cholecystitis – Uncommon Differentials",
"q": "Which of the following is listed as an UNCOMMON differential diagnosis of acute cholecystitis?",
"options": ["A. Appendicitis", "B. Perforated peptic ulcer", "C. Right lower lobe pneumonia", "D. Acute pancreatitis"],
"answer": "C. Right lower lobe pneumonia",
"explanation": "Common differentials of acute cholecystitis: appendicitis, perforated peptic ulcer, acute pancreatitis. Uncommon differentials: acute pyelonephritis, myocardial infarction, right lower lobe pneumonia. Myocardial infarction should never be missed in the elderly presenting with apparent acute abdomen. (Bailey & Love, Ch. – Biliary)"
},
{
"section": "HEPATOBILIARY & PANCREATIC SURGERY",
"num": 70,
"topic": "Gallstones – Mucocele",
"q": "Mucocele of the gallbladder results from:",
"options": ["A. Bacterial infection of an obstructed gallbladder", "B. Obstruction of the cystic duct with subsequent accumulation of mucus secreted by the gallbladder wall", "C. Perforation of the gallbladder with bile leak", "D. Gallbladder torsion"],
"answer": "B. Obstruction of the cystic duct with subsequent accumulation of mucus secreted by the gallbladder wall",
"explanation": "Mucocele of the gallbladder occurs when the cystic duct is obstructed (usually by a gallstone) and the bile is absorbed, leaving mucus secreted by the gallbladder wall. It presents as a palpable, non-tender mass under the right hypochondrium. (Bailey & Love, Ch. – Biliary)"
},
{
"section": "ENDOCRINE SURGERY",
"num": 71,
"topic": "Thyroid – Medullary Carcinoma Guidelines",
"q": "Revised guidelines for management of medullary thyroid carcinoma were published in which year by the American Thyroid Association?",
"options": ["A. 2010", "B. 2012", "C. 2015", "D. 2020"],
"answer": "C. 2015",
"explanation": "The revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma were published in Thyroid 2015; 25: 567-610. These guidelines address diagnosis, surgical management, and follow-up of MTC including in the setting of MEN2. (Bailey & Love, Ch. – Further Reading)"
},
{
"section": "BREAST SURGERY",
"num": 72,
"topic": "Breast Cancer – Conservative Surgery Evidence",
"q": "The landmark NSABP trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation had a follow-up reported in which journal?",
"options": ["A. The Lancet", "B. British Journal of Surgery", "C. New England Journal of Medicine", "D. Annals of Surgery"],
"answer": "C. New England Journal of Medicine",
"explanation": "The 20-year follow-up of the randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for invasive breast cancer was published in N Engl J Med 2002; 347: 1233-41. It confirmed equal survival between the three approaches. (Bailey & Love, Ch. 58 – Further Reading)"
},
{
"section": "VASCULAR SURGERY",
"num": 73,
"topic": "Varicose Veins – Management",
"q": "NICE guideline for varicose veins diagnosis and management is which guideline number?",
"options": ["A. CG68", "B. CG168", "C. NG89", "D. NG56"],
"answer": "B. CG168",
"explanation": "The NICE guideline for varicose veins diagnosis and management is NICE Clinical Guideline 168 (CG168). NICE Guideline 89 (NG89) covers VTE prevention and treatment including DVT/PE. These guide the clinical management of venous disease in surgical practice. (Bailey & Love, Ch. – Vascular Surgery, Further Reading)"
},
{
"section": "VASCULAR SURGERY",
"num": 74,
"topic": "DVT – Guideline",
"q": "NICE guidance for venous thromboembolic disease (VTE) is published as which guideline?",
"options": ["A. NG89", "B. CG168", "C. NG51", "D. CG92"],
"answer": "A. NG89",
"explanation": "NICE Guideline 89 (NG89), published in 2018, covers venous thromboembolic diseases: diagnosis, management, and thrombophilia testing including DVT and pulmonary embolism. CG168 covers varicose veins. (Bailey & Love, Ch. – Vascular, Further Reading)"
},
{
"section": "GENERAL SURGICAL PRINCIPLES",
"num": 75,
"topic": "Shock – Classification in Spinal Trauma",
"q": "In spinal trauma, hypovolaemic shock presents with which combination?",
"options": ["A. Hypotension, bradycardia, warm peripheries", "B. Hypotension, tachycardia, cold clammy peripheries", "C. Normal BP, bradycardia, warm peripheries", "D. Hypertension, tachycardia, pallor"],
"answer": "B. Hypotension, tachycardia, cold clammy peripheries",
"explanation": "In spinal trauma: Hypovolaemic shock presents with hypotension + tachycardia + cold clammy peripheries, most often due to haemorrhage, treated with resuscitation. Neurogenic shock: hypotension + normal HR or bradycardia + warm peripheries. Septic shock has different features. (Bailey & Love, Ch. – Spinal Trauma)"
},
{
"section": "HEPATOBILIARY & PANCREATIC SURGERY",
"num": 76,
"topic": "Pancreatitis – CT Staging",
"q": "The Balthazar criteria are used to stage the severity of which condition on CT?",
"options": ["A. Acute cholecystitis", "B. Acute pancreatitis", "C. Liver cirrhosis", "D. Splenic rupture"],
"answer": "B. Acute pancreatitis",
"explanation": "The severity of acute pancreatitis detected on CT is staged according to the Balthazar criteria, which assess the degree of pancreatic inflammation and necrosis on contrast-enhanced CT. This helps identify patients with severe pancreatitis requiring aggressive management. (Bailey & Love, Ch. 72)"
},
{
"section": "GASTROINTESTINAL SURGERY",
"num": 77,
"topic": "Intestinal Obstruction – Type Classification",
"q": "Dynamic intestinal obstruction may be classified clinically into which two types?",
"options": ["A. Mechanical and paralytic", "B. Small bowel obstruction (high or low) and large bowel obstruction", "C. Closed-loop and open-loop obstruction", "D. Proximal and distal obstruction only"],
"answer": "B. Small bowel obstruction (high or low) and large bowel obstruction",
"explanation": "Dynamic obstruction is classified clinically into small bowel obstruction (further classified as high or low) and large bowel obstruction. The presentation differs depending on the level and type of obstruction, particularly the timing and character of vomiting. (Bailey & Love, Ch. 78)"
},
{
"section": "HERNIA SURGERY",
"num": 78,
"topic": "Inguinal Hernia – Direct vs Indirect",
"q": "An indirect inguinal hernia arises lateral or medial to the inferior epigastric vessels?",
"options": ["A. Medial (direct hernia is lateral)", "B. Lateral to the inferior epigastric vessels", "C. Inferior to the inguinal ligament", "D. Through the femoral ring"],
"answer": "B. Lateral to the inferior epigastric vessels",
"explanation": "Indirect inguinal hernias arise at the deep inguinal ring, lateral to the inferior epigastric vessels, passing through the inguinal canal. Direct hernias arise medial to the inferior epigastric vessels, passing through the posterior wall of the inguinal canal (Hesselbach's triangle). (Bailey & Love, Ch. 64)"
},
{
"section": "BREAST SURGERY",
"num": 79,
"topic": "Breast Cancer – Tamoxifen",
"q": "Tamoxifen chemoprophylaxis is used in women with BRCA mutations who opt for which alternative to bilateral risk-reducing mastectomy?",
"options": ["A. Radiotherapy surveillance", "B. Non-surgical risk reduction (chemoprevention)", "C. Oophorectomy alone", "D. Regular MRI screening only"],
"answer": "B. Non-surgical risk reduction (chemoprevention)",
"explanation": "Women with BRCA mutations who decline surgery may be offered chemoprophylaxis with tamoxifen as a risk reduction strategy for breast cancer. Bilateral risk-reducing mastectomy with immediate reconstruction reduces risk by 90% and is the surgical option. (Bailey & Love, Ch. 58)"
},
{
"section": "ENDOCRINE SURGERY",
"num": 80,
"topic": "Thyroid – Preoperative Imaging",
"q": "The American Thyroid Association statement on preoperative imaging for thyroid cancer surgery was published in which year?",
"options": ["A. 2010", "B. 2012", "C. 2015", "D. 2018"],
"answer": "C. 2015",
"explanation": "The ATA statement on preoperative imaging for thyroid cancer surgery was published in Thyroid 2015; 25: 3. This guides surgeons on the use of ultrasound, CT, MRI, and PET scanning before thyroid cancer surgery for staging and planning. (Bailey & Love, Ch. – Further Reading, Thyroid)"
},
{
"section": "SPLENIC SURGERY",
"num": 81,
"topic": "Spleen – Angioembolisation",
"q": "Splenic angiography with embolisation may avoid splenectomy but should NOT delay what in a haemodynamically unstable patient?",
"options": ["A. CT scanning", "B. Laparotomy", "C. Transfusion", "D. Transfer to ICU"],
"answer": "B. Laparotomy",
"explanation": "Splenic angiography with embolisation of actively bleeding vessels may avoid splenectomy but should not delay laparotomy in a haemodynamically unstable patient. Haemodynamic stability is the key criterion determining whether a non-operative approach is appropriate. (Bailey & Love, Ch. 70)"
},
{
"section": "GENERAL SURGICAL PRINCIPLES",
"num": 82,
"topic": "Surgical Oncology – UICC",
"q": "What does UICC stand for in surgical oncology?",
"options": ["A. United International Cancer Committee", "B. Union for International Cancer Control", "C. Universal Institute for Cancer Care", "D. Union of Integrated Cancer Classifications"],
"answer": "B. Union for International Cancer Control",
"explanation": "The UICC (Union for International Cancer Control) is responsible for the TNM staging system compatible with the AJCC system. TNM staging (Tumour, Nodes, Metastases) is the universal cancer staging language used by surgeons, oncologists, and pathologists worldwide. (Bailey & Love, Ch. 12)"
},
{
"section": "WOUND HEALING & SURGICAL PRINCIPLES",
"num": 83,
"topic": "Wound Healing – Steroids",
"q": "Why do systemic corticosteroids delay wound healing?",
"options": ["A. They increase bacterial colonisation", "B. They inhibit protein synthesis and fibroblast proliferation", "C. They reduce blood supply to wounds", "D. They activate matrix metalloproteinases"],
"answer": "B. They inhibit protein synthesis and fibroblast proliferation",
"explanation": "Steroids inhibit adequate healing of wounds because they inhibit protein synthesis and fibroblast proliferation. This leads to impaired collagen formation and delayed wound healing. In clinical practice, steroid use must be documented and wound complications anticipated. (Bailey & Love, Ch. 3)"
},
{
"section": "GASTROINTESTINAL SURGERY",
"num": 84,
"topic": "Appendicitis – Enigma",
"q": "What does Bailey & Love describe acute appendicitis as, reflecting its clinical challenge?",
"options": ["A. A purely surgical emergency", "B. An enigmatic challenge and a reminder of the art of surgical diagnosis", "C. A straightforward radiological diagnosis", "D. A biochemical diagnosis based on CRP alone"],
"answer": "B. An enigmatic challenge and a reminder of the art of surgical diagnosis",
"explanation": "Bailey & Love describes acute appendicitis as 'an enigmatic challenge and a reminder of the art of surgical diagnosis', requiring a mixture of observation, clinical acumen, and surgical science. Despite modern imaging, the diagnosis remains primarily clinical. (Bailey & Love, Ch. 68)"
},
{
"section": "HEPATOBILIARY & PANCREATIC SURGERY",
"num": 85,
"topic": "Chronic Pancreatitis – Weight Loss",
"q": "Why is weight loss common in chronic pancreatitis?",
"options": ["A. Malabsorption from exocrine insufficiency exclusively", "B. The patient does not feel like eating due to pain", "C. Insulin deficiency causing cachexia", "D. Gastric outlet obstruction"],
"answer": "B. The patient does not feel like eating due to pain",
"explanation": "In chronic pancreatitis, weight loss is common because the patient does not feel like eating due to persistent pain. Additionally, pain prevents sleep. Both exocrine insufficiency (malabsorption/steatorrhoea) and the anorexia from pain contribute to weight loss. (Bailey & Love, Ch. 72)"
},
{
"section": "HERNIA SURGERY",
"num": 86,
"topic": "Inguinal Hernia – Repair Approach",
"q": "In the open Bassini inguinal hernia repair, after opening the external oblique aponeurosis, what is the next key step?",
"options": ["A. Excision of the hernia sac immediately", "B. Dissection of the spermatic cord free", "C. Division of the inferior epigastric vessels", "D. Placement of a synthetic mesh"],
"answer": "B. Dissection of the spermatic cord free",
"explanation": "The surgeon enters the inguinal canal by opening the external oblique aponeurosis (anterior wall). The spermatic cord is then dissected free to identify the hernia sac, which is then dealt with. The Bassini repair involves reconstruction of the posterior inguinal wall. (Bailey & Love, Ch. 64)"
},
{
"section": "BREAST SURGERY",
"num": 87,
"topic": "Breast Cancer – Simple Mastectomy",
"q": "Simple (total) mastectomy differs from modified radical mastectomy primarily in that:",
"options": ["A. It includes level I axillary dissection", "B. It does NOT include axillary lymph node dissection", "C. It preserves the nipple-areolar complex", "D. It is only performed for DCIS"],
"answer": "B. It does NOT include axillary lymph node dissection",
"explanation": "Simple or total mastectomy involves removal of the breast tissue only, without axillary lymph node dissection (unlike modified radical mastectomy which includes level I, II, III axillary dissection). Simple mastectomy may be combined with sentinel lymph node biopsy. (Bailey & Love, Ch. 58, Summary Box 58.4)"
},
{
"section": "ENDOCRINE SURGERY",
"num": 88,
"topic": "Adrenal – Shock Type",
"q": "Adrenal haemorrhage may present with which type of shock?",
"options": ["A. Cardiogenic shock", "B. Hypovolaemic shock or adrenal insufficiency", "C. Neurogenic shock", "D. Anaphylactic shock"],
"answer": "B. Hypovolaemic shock or adrenal insufficiency",
"explanation": "Adrenal haemorrhage clinical presentation can vary from non-specific abdominal pain to adrenal insufficiency (Addisonian crisis) or hypovolaemic shock. Predisposing factors include sepsis, MI, anticoagulants, trauma, surgery, and antiphospholipid syndrome. (Bailey & Love, Ch. – Adrenal)"
},
{
"section": "GASTROINTESTINAL SURGERY",
"num": 89,
"topic": "Colon Cancer – Dukes' vs TNM",
"q": "Which staging system is described as 'simple' for colorectal cancer in Bailey & Love?",
"options": ["A. TNM staging", "B. Dukes' classification", "C. Clark's levels", "D. Mandard regression grade"],
"answer": "B. Dukes' classification",
"explanation": "Dukes' classification is described as simple in Bailey & Love. Although it was originally described for rectal tumours, it has been widely adopted for histopathological reporting of colon cancer. Multiple staging systems exist for colorectal cancer, but TNM is the international standard. (Bailey & Love, Ch. – Colorectal Cancer)"
},
{
"section": "SPLENIC SURGERY",
"num": 90,
"topic": "Spleen – Function",
"q": "Understanding the function of the spleen is part of the learning objectives for which chapter in Bailey & Love?",
"options": ["A. Hepatic surgery", "B. Splenic surgery (Ch. 70)", "C. Trauma surgery", "D. Haematological surgery"],
"answer": "B. Splenic surgery (Ch. 70)",
"explanation": "The learning objectives for the spleen chapter explicitly include understanding the function of the spleen, common pathologies, principles and complications of splenectomy, advantages of laparoscopic splenectomy, splenic conservation benefits, and importance of prophylaxis against infection post-splenectomy. (Bailey & Love, Ch. 70)"
},
{
"section": "WOUND HEALING & SURGICAL PRINCIPLES",
"num": 91,
"topic": "Trauma – Penetrating",
"q": "In young patients with penetrating trauma and haemorrhage, a paradoxical bradycardia occurs in the context of:",
"options": ["A. Large tissue damage with haemorrhage", "B. Significant haemorrhage but little tissue damage", "C. Abdominal visceral injury", "D. Tension pneumothorax"],
"answer": "B. Significant haemorrhage but little tissue damage",
"explanation": "In some young patients with penetrating trauma, where there is haemorrhage but little tissue damage, a paradoxical bradycardia (rather than tachycardia) may accompany the shocked state. This is important clinically as tachycardia is often relied upon to indicate haemodynamic compromise. (Bailey & Love, Ch. – Trauma)"
},
{
"section": "HEPATOBILIARY & PANCREATIC SURGERY",
"num": 92,
"topic": "Acute Pancreatitis – Necrotising vs Interstitial",
"q": "CT in severe acute pancreatitis is used primarily to distinguish between which two forms?",
"options": ["A. Oedematous vs gangrenous pancreatitis", "B. Interstitial vs necrotising pancreatitis", "C. Acute vs chronic pancreatitis", "D. Gallstone vs alcoholic pancreatitis"],
"answer": "B. Interstitial vs necrotising pancreatitis",
"explanation": "In severe acute pancreatitis, contrast-enhanced CT is used to distinguish interstitial (oedematous, non-necrotising) from necrotising pancreatitis. Necrotising pancreatitis carries higher morbidity/mortality. The Balthazar criteria stage severity. CT may underestimate necrosis extent in the first 72 hours. (Bailey & Love, Ch. 72)"
},
{
"section": "VASCULAR SURGERY",
"num": 93,
"topic": "DVT – Pregnancy as Risk Factor",
"q": "Why does pregnancy increase the risk of deep vein thrombosis?",
"options": ["A. Increased arterial blood pressure", "B. Venous stasis, hypercoagulability, and vessel wall changes (Virchow's triad)", "C. Reduced plasma fibrinogen", "D. Impaired platelet function"],
"answer": "B. Venous stasis, hypercoagulability, and vessel wall changes (Virchow's triad)",
"explanation": "Pregnancy is a recognised risk factor for DVT listed in Bailey & Love. The mechanism relates to Virchow's triad: venous stasis (uterine compression of IVC), hypercoagulability (increased clotting factors), and vessel wall changes. Puerperium is also independently listed as a risk factor. (Bailey & Love, Ch. 62)"
},
{
"section": "GASTROINTESTINAL SURGERY",
"num": 94,
"topic": "Intestinal Obstruction – Adhesion Types",
"q": "Bailey & Love describes adhesions as only two types. What are they?",
"options": ["A. Congenital and acquired", "B. Intra-abdominal and retroperitoneal", "C. Easy (flimsy) and difficult (dense)", "D. Fibrous and inflammatory"],
"answer": "C. Easy (flimsy) and difficult (dense)",
"explanation": "Bailey & Love states there are only two types of adhesions: easy (flimsy) ones and difficult (dense) ones. This clinical distinction is important during adhesiolysis, as dense adhesions carry higher risk of inadvertent enterotomy compared to flimsy adhesions. (Bailey & Love, Ch. 78)"
},
{
"section": "HERNIA SURGERY",
"num": 95,
"topic": "Inguinal Hernia – Bladder Involvement",
"q": "In an inguinal hernia, which viscus may be pulled into a direct hernia component?",
"options": ["A. Appendix", "B. Bladder", "C. Small intestine only", "D. Ovary"],
"answer": "B. Bladder",
"explanation": "In sliding inguinal hernias, the bladder can be pulled into a direct hernia component as the hernia enlarges. This is surgically significant as inadvertent injury to the bladder during hernia repair is a potential complication if not anticipated. (Bailey & Love, Ch. 64)"
},
{
"section": "BREAST SURGERY",
"num": 96,
"topic": "Breast Cancer – De-escalation Trend",
"q": "What is the general surgical trend in breast cancer management according to Bailey & Love?",
"options": ["A. Escalation to more radical procedures for all patients", "B. De-escalation towards more conservative techniques backed by clinical trials", "C. Routine bilateral mastectomy for all invasive cancers", "D. Avoidance of all systemic therapies"],
"answer": "B. De-escalation towards more conservative techniques backed by clinical trials",
"explanation": "There has been a general de-escalation towards more conservative techniques in breast cancer surgery, backed by clinical trials and meta-analyses showing equal efficacy in locoregional cancer control and survival between mastectomy and WLE/BCS followed by radiotherapy. (Bailey & Love, Ch. 58)"
},
{
"section": "ENDOCRINE SURGERY",
"num": 97,
"topic": "MEN2 – Components",
"q": "MEN2 comprises MTC, phaeochromocytoma, and which third component?",
"options": ["A. Insulinoma", "B. Primary hyperparathyroidism", "C. Prolactinoma", "D. Adrenocortical adenoma"],
"answer": "B. Primary hyperparathyroidism",
"explanation": "MEN2 comprises: medullary thyroid carcinoma (MTC), phaeochromocytoma (PCC), and primary hyperparathyroidism (PHPT). MEN1 (Wermer) comprises parathyroid tumours, pancreatic islet cell tumours, and pituitary adenomas. (Bailey & Love, Ch. – Endocrine)"
},
{
"section": "GASTROINTESTINAL SURGERY",
"num": 98,
"topic": "Acute Appendicitis – Improving Accuracy",
"q": "CT scanning in acute appendicitis is used primarily to:",
"options": ["A. Replace clinical assessment entirely", "B. Reduce the rate of removal of a normal appendix", "C. Identify which antibiotic to use", "D. Stage appendiceal carcinoma"],
"answer": "B. Reduce the rate of removal of a normal appendix",
"explanation": "CT scanning is used to improve diagnostic accuracy and reduce the rate of removal of a normal appendix (which occurs in 15-30% of cases when operating on clinical suspicion alone). Advances in modern radiographic imaging have improved diagnostic accuracy though the diagnosis remains essentially clinical. (Bailey & Love, Ch. 68)"
},
{
"section": "SPLENIC SURGERY",
"num": 99,
"topic": "Spleen – Pathology",
"q": "In sarcoidosis of the spleen, typical epithelioid cell granulomas are seen histologically only when:",
"options": ["A. Needle biopsy is performed", "B. Splenectomy has been performed", "C. Bone marrow biopsy is done", "D. Splenic angiography is performed"],
"answer": "B. Splenectomy has been performed",
"explanation": "In sarcoidosis, typical epithelioid cell granulomas are seen in the histopathology of the spleen only if splenectomy has been performed. Splenomegaly may occur in sarcoidosis. Splenectomy is not normally required but may be performed if hypersplenism develops. (Bailey & Love, Ch. 70)"
},
{
"section": "GENERAL SURGICAL PRINCIPLES",
"num": 100,
"topic": "Surgical Principles – Acute Abdomen Imaging",
"q": "In acute abdomen (including acute appendicitis and pancreatitis), when may imaging not be needed?",
"options": ["A. Never – imaging is always required", "B. When the diagnosis is straightforward clinically", "C. Only in children under 16", "D. When the patient is haemodynamically stable"],
"answer": "B. When the diagnosis is straightforward clinically",
"explanation": "As with acute appendicitis and acute pancreatitis, when the diagnosis is straightforward clinically there may be no need for imaging. However, imaging is increasingly used to confirm diagnosis, assess severity, and look for complications. CT is more accurate than plain X-ray or ultrasound in many scenarios. (Bailey & Love, Ch. – Acute Abdomen)"
},
]
Writing File
~/bailey-love-mcqs/generate_100_mcq_pdf.py
import sys
sys.path.insert(0, '/home/daytona/workspace/bailey-love-mcqs')
from mcq_data import ALL_MCQS
from reportlab.lib.pagesizes import A4
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm
from reportlab.lib import colors
from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, HRFlowable, Table, TableStyle, PageBreak
from reportlab.lib.enums import TA_LEFT, TA_CENTER, TA_JUSTIFY
output_path = "/home/daytona/workspace/bailey-love-mcqs/Bailey_Love_100_MCQs.pdf"
doc = SimpleDocTemplate(
output_path, pagesize=A4,
rightMargin=2*cm, leftMargin=2*cm, topMargin=2.2*cm, bottomMargin=2*cm
)
styles = getSampleStyleSheet()
def make_style(name, parent_name='Normal', **kwargs):
return ParagraphStyle(name, parent=styles[parent_name], **kwargs)
title_s = make_style('Title2', fontSize=20, textColor=colors.HexColor('#0d2b45'),
fontName='Helvetica-Bold', spaceAfter=4, alignment=TA_CENTER)
subtitle_s = make_style('Sub2', fontSize=11, textColor=colors.HexColor('#3a6186'),
spaceAfter=3, alignment=TA_CENTER)
section_s = make_style('Sec2', fontSize=12, textColor=colors.white, fontName='Helvetica-Bold',
spaceAfter=4, spaceBefore=8)
qnum_s = make_style('QN2', fontSize=10.5, textColor=colors.HexColor('#0d2b45'),
fontName='Helvetica-Bold', spaceBefore=10, spaceAfter=2)
question_s = make_style('Q2', fontSize=11, textColor=colors.HexColor('#1a1a1a'),
fontName='Helvetica-Bold', spaceAfter=4, leading=15)
option_s = make_style('Opt2', fontSize=10.5, textColor=colors.HexColor('#333333'),
leftIndent=12, spaceAfter=2, leading=14)
ans_label_s = make_style('AL2', fontSize=10, textColor=colors.HexColor('#155724'),
fontName='Helvetica-Bold', spaceBefore=4, spaceAfter=1)
ans_s = make_style('A2', fontSize=10, textColor=colors.HexColor('#155724'),
leftIndent=12, spaceAfter=2)
expl_label_s = make_style('EL2', fontSize=10, textColor=colors.HexColor('#856404'),
fontName='Helvetica-Bold', spaceAfter=1)
expl_s = make_style('E2', fontSize=10, textColor=colors.HexColor('#5c3d02'),
leftIndent=12, spaceAfter=4, leading=14, alignment=TA_JUSTIFY)
footer_s = make_style('Ft2', fontSize=8, textColor=colors.grey, alignment=TA_CENTER)
toc_s = make_style('TOC2', fontSize=10, textColor=colors.HexColor('#0d2b45'),
spaceAfter=2, leftIndent=10)
toc_head_s = make_style('TOCHead', fontSize=11, textColor=colors.HexColor('#0d2b45'),
fontName='Helvetica-Bold', spaceAfter=4)
story = []
# ── TITLE PAGE ──
story.append(Spacer(1, 1*cm))
story.append(Paragraph("Bailey & Love's Short Practice of Surgery", title_s))
story.append(Paragraph("28th Edition", make_style('Ed', fontSize=14,
textColor=colors.HexColor('#3a6186'), alignment=TA_CENTER, spaceAfter=3)))
story.append(Spacer(1, 0.3*cm))
story.append(HRFlowable(width='100%', thickness=3, color=colors.HexColor('#0d2b45')))
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("100 MCQ Practice Set", make_style('Big', fontSize=16,
textColor=colors.HexColor('#0d2b45'), fontName='Helvetica-Bold', alignment=TA_CENTER, spaceAfter=4)))
story.append(Paragraph("General Surgery & Systemic Surgery", subtitle_s))
story.append(Paragraph("Each question includes correct answer with detailed explanation", subtitle_s))
story.append(Spacer(1, 0.5*cm))
story.append(HRFlowable(width='100%', thickness=1, color=colors.HexColor('#3a6186')))
story.append(Spacer(1, 0.5*cm))
# Quick stats table
stats_data = [
['Total Questions', 'Format', 'Source', 'Edition'],
['100', 'Single Best Answer (A–D)', "Bailey & Love's Short Practice of Surgery", '28th Edition'],
]
stats_table = Table(stats_data, colWidths=[3.5*cm, 4.5*cm, 6.5*cm, 2.5*cm])
stats_table.setStyle(TableStyle([
('BACKGROUND', (0,0), (-1,0), colors.HexColor('#0d2b45')),
('TEXTCOLOR', (0,0), (-1,0), colors.white),
('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'),
('FONTSIZE', (0,0), (-1,-1), 9),
('BACKGROUND', (0,1), (-1,-1), colors.HexColor('#e8f0f7')),
('GRID', (0,0), (-1,-1), 0.5, colors.HexColor('#aaaaaa')),
('ALIGN', (0,0), (-1,-1), 'CENTER'),
('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
('TOPPADDING', (0,0), (-1,-1), 5),
('BOTTOMPADDING', (0,0), (-1,-1), 5),
]))
story.append(stats_table)
story.append(Spacer(1, 0.6*cm))
# Section breakdown
from collections import OrderedDict
section_counts = OrderedDict()
for q in ALL_MCQS:
s = q['section']
section_counts[s] = section_counts.get(s, 0) + 1
story.append(Paragraph("Topic Distribution", toc_head_s))
toc_data = [['Section', 'No. of Questions']]
for sec, cnt in section_counts.items():
toc_data.append([sec.title(), str(cnt)])
toc_table = Table(toc_data, colWidths=[13*cm, 4*cm])
toc_table.setStyle(TableStyle([
('BACKGROUND', (0,0), (-1,0), colors.HexColor('#3a6186')),
('TEXTCOLOR', (0,0), (-1,0), colors.white),
('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'),
('FONTSIZE', (0,0), (-1,-1), 9.5),
('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#f5f8fc'), colors.white]),
('GRID', (0,0), (-1,-1), 0.5, colors.HexColor('#cccccc')),
('ALIGN', (1,0), (1,-1), 'CENTER'),
('TOPPADDING', (0,0), (-1,-1), 4),
('BOTTOMPADDING', (0,0), (-1,-1), 4),
('LEFTPADDING', (0,0), (0,-1), 10),
]))
story.append(toc_table)
story.append(Spacer(1, 0.3*cm))
story.append(HRFlowable(width='100%', thickness=1, color=colors.HexColor('#cccccc')))
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("For educational use only. Content sourced from Bailey and Love's Short Practice of Surgery, 28th Edition.", footer_s))
story.append(PageBreak())
# ── QUESTIONS ──
current_section = None
for mcq in ALL_MCQS:
if mcq['section'] != current_section:
current_section = mcq['section']
story.append(Spacer(1, 0.3*cm))
sec_data = [[Paragraph(f" {current_section}", section_s)]]
sec_table = Table(sec_data, colWidths=[17*cm])
sec_table.setStyle(TableStyle([
('BACKGROUND', (0,0), (-1,-1), colors.HexColor('#0d2b45')),
('BOTTOMPADDING', (0,0), (-1,-1), 7),
('TOPPADDING', (0,0), (-1,-1), 7),
('LEFTPADDING', (0,0), (-1,-1), 8),
]))
story.append(sec_table)
story.append(Spacer(1, 0.25*cm))
story.append(Paragraph(f"Q{mcq['num']}. [{mcq['topic']}]", qnum_s))
story.append(Paragraph(mcq['q'], question_s))
for opt in mcq['options']:
story.append(Paragraph(opt, option_s))
ans_box = [
[Paragraph("✔ CORRECT ANSWER:", ans_label_s)],
[Paragraph(mcq['answer'], ans_s)],
[Paragraph("EXPLANATION:", expl_label_s)],
[Paragraph(mcq['explanation'], expl_s)],
]
ans_table = Table(ans_box, colWidths=[16.5*cm])
ans_table.setStyle(TableStyle([
('BACKGROUND', (0,0), (-1,-1), colors.HexColor('#f0f7f2')),
('BOX', (0,0), (-1,-1), 0.8, colors.HexColor('#28a745')),
('LEFTPADDING', (0,0), (-1,-1), 10),
('RIGHTPADDING', (0,0), (-1,-1), 10),
('TOPPADDING', (0,0), (0,0), 6),
('BOTTOMPADDING', (0,0), (-1,-1), 4),
]))
story.append(ans_table)
story.append(Spacer(1, 0.25*cm))
story.append(HRFlowable(width='100%', thickness=0.4, color=colors.HexColor('#dddddd')))
# ── FOOTER ──
story.append(Spacer(1, 0.6*cm))
story.append(Paragraph("Bailey and Love's Short Practice of Surgery, 28th Edition — 100 MCQ Practice Set. For educational use only.", footer_s))
doc.build(story)
print(f"PDF created: {output_path}")
Writing File
~/bailey-love-mcqs/generate_summary.js
const {
Document, Packer, Paragraph, TextRun, Table, TableRow, TableCell,
HeadingLevel, AlignmentType, WidthType, BorderStyle, ShadingType,
PageNumber, Footer, Header, TabStopType, TabStopPosition,
convertInchesToTwip
} = require('docx');
const fs = require('fs');
const NAVY = '0d2b45';
const BLUE = '3a6186';
const GREEN = '155724';
const AMBER = '856404';
const LIGHT_BLUE = 'e8f0f7';
const LIGHT_GREEN = 'f0f7f2';
const LIGHT_AMBER = 'fff3cd';
const WHITE = 'FFFFFF';
const DARK = '1a1a1a';
function heading1(text) {
return new Paragraph({
children: [new TextRun({ text, bold: true, color: WHITE, size: 26 })],
shading: { type: ShadingType.SOLID, color: NAVY, fill: NAVY },
spacing: { before: 240, after: 120 },
indent: { left: 180 },
});
}
function heading2(text) {
return new Paragraph({
children: [new TextRun({ text, bold: true, color: NAVY, size: 24 })],
spacing: { before: 200, after: 80 },
border: { bottom: { style: BorderStyle.SINGLE, size: 6, color: BLUE } },
});
}
function heading3(text) {
return new Paragraph({
children: [new TextRun({ text, bold: true, color: BLUE, size: 22 })],
spacing: { before: 160, after: 60 },
});
}
function body(text, bold = false, color = DARK) {
return new Paragraph({
children: [new TextRun({ text, bold, color, size: 20 })],
spacing: { after: 60 },
});
}
function bullet(text, bold = false) {
return new Paragraph({
children: [new TextRun({ text, bold, size: 20 })],
bullet: { level: 0 },
spacing: { after: 40 },
});
}
function subbullet(text) {
return new Paragraph({
children: [new TextRun({ text, size: 19, color: '444444' })],
bullet: { level: 1 },
spacing: { after: 30 },
});
}
function keyFact(label, value) {
return new Paragraph({
children: [
new TextRun({ text: label + ': ', bold: true, color: NAVY, size: 20 }),
new TextRun({ text: value, size: 20 }),
],
spacing: { after: 50 },
indent: { left: 180 },
});
}
function yellowBox(text) {
return new Paragraph({
children: [new TextRun({ text: '⚡ HIGH-YIELD: ' + text, bold: true, color: AMBER, size: 20 })],
shading: { type: ShadingType.SOLID, color: 'fff8e1', fill: 'fff8e1' },
border: {
left: { style: BorderStyle.THICK, size: 10, color: 'ffc107' },
},
indent: { left: 120 },
spacing: { before: 80, after: 80 },
});
}
function greenBox(text) {
return new Paragraph({
children: [new TextRun({ text: '✔ KEY POINT: ' + text, bold: true, color: GREEN, size: 20 })],
shading: { type: ShadingType.SOLID, color: LIGHT_GREEN, fill: LIGHT_GREEN },
border: {
left: { style: BorderStyle.THICK, size: 10, color: '28a745' },
},
indent: { left: 120 },
spacing: { before: 80, after: 80 },
});
}
function spacer() {
return new Paragraph({ children: [new TextRun('')], spacing: { after: 80 } });
}
function makeTable(headers, rows, colWidths) {
const headerRow = new TableRow({
children: headers.map((h, i) =>
new TableCell({
children: [new Paragraph({
children: [new TextRun({ text: h, bold: true, color: WHITE, size: 19 })],
alignment: AlignmentType.CENTER,
})],
shading: { type: ShadingType.SOLID, color: NAVY, fill: NAVY },
width: colWidths ? { size: colWidths[i], type: WidthType.DXA } : undefined,
})
),
tableHeader: true,
});
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}
// ─────────────────────────────────────────────────────────────────────────────
// DOCUMENT CONTENT
// ─────────────────────────────────────────────────────────────────────────────
const children = [];
// TITLE
children.push(
new Paragraph({
children: [new TextRun({ text: "Bailey & Love's Short Practice of Surgery", bold: true, color: NAVY, size: 40 })],
alignment: AlignmentType.CENTER,
spacing: { before: 480, after: 120 },
}),
new Paragraph({
children: [new TextRun({ text: '28th Edition', bold: true, color: BLUE, size: 28 })],
alignment: AlignmentType.CENTER,
spacing: { after: 80 },
}),
new Paragraph({
children: [new TextRun({ text: 'High-Yield Summary Guide', bold: true, color: NAVY, size: 32 })],
alignment: AlignmentType.CENTER,
spacing: { after: 80 },
}),
new Paragraph({
children: [new TextRun({ text: 'General Surgery & Systemic Surgery', color: BLUE, size: 24 })],
alignment: AlignmentType.CENTER,
spacing: { after: 480 },
}),
);
// INTRO BOX
children.push(
greenBox('This guide covers the highest-yield topics from Bailey & Love 28th Ed, structured for rapid revision. Each section includes key facts, memorable tables, and exam-focused summaries.'),
spacer(),
);
// ═══════════════════════════════════════════════
// SECTION 1: WOUND HEALING
// ═══════════════════════════════════════════════
children.push(heading1('1. WOUND HEALING'));
children.push(heading2('Types of Wound Healing'));
children.push(
makeTable(
['Type', 'Mechanism', 'Result'],
[
['Primary (1st intention)', 'Wound edges directly apposed surgically', 'Minimal scar – AIM of surgery'],
['Secondary (2nd intention)', 'Wound left open; heals by granulation, contraction, re-epithelialisation', 'Poor scar; increased inflammation'],
['Tertiary (delayed primary)', 'Initially left open; edges apposed later', 'Used in contaminated wounds'],
],
[2400, 4000, 3200]
),
spacer(),
);
children.push(heading2('Factors Delaying Wound Healing'));
children.push(bullet('Malnutrition'));
children.push(bullet('Vitamin A and C deficiency'));
children.push(bullet('Systemic corticosteroids (↓ protein synthesis + ↓ fibroblast proliferation)'));
children.push(bullet('Poorly controlled diabetes mellitus'));
children.push(bullet('Infection'));
children.push(yellowBox('In adults, normal healing → fibrosis & scar formation (NOT regeneration). Foetal healing is scarless.'));
children.push(spacer());
// ═══════════════════════════════════════════════
// SECTION 2: TRAUMA & SHOCK
// ═══════════════════════════════════════════════
children.push(heading1('2. TRAUMA & SHOCK'));
children.push(heading2('Types of Shock in Spinal Trauma'));
children.push(
makeTable(
['Type', 'BP', 'HR', 'Peripheries', 'Cause'],
[
['Hypovolaemic', '↓', '↑ (Tachycardia)', 'Cold, clammy', 'Haemorrhage'],
['Neurogenic', '↓', 'Normal/↓ (Bradycardia)', 'Warm', 'Loss of sympathetic tone'],
['Septic', '↓', '↑', 'Initially warm', 'Infection'],
],
[1800, 1200, 2000, 2000, 2600]
),
spacer(),
);
children.push(greenBox('Any shock = assume HYPOVOLAEMIC until proven otherwise. Hypovolaemia = assume HAEMORRHAGE until excluded.'));
children.push(yellowBox('Young patients with penetrating trauma + haemorrhage but little tissue damage may show PARADOXICAL BRADYCARDIA instead of tachycardia.'));
children.push(spacer());
// ═══════════════════════════════════════════════
// SECTION 3: INTESTINAL OBSTRUCTION
// ═══════════════════════════════════════════════
children.push(heading1('3. INTESTINAL OBSTRUCTION'));
children.push(heading2('Classic Quartet of Dynamic Intestinal Obstruction'));
children.push(bullet('Pain'));
children.push(bullet('Distension'));
children.push(bullet('Vomiting'));
children.push(bullet('Absolute constipation'));
children.push(yellowBox('High-pitched (tinkling) bowel sounds present in the vast majority. Normal sounds have negative predictive value.'));
children.push(spacer());
children.push(heading2('SBO vs LBO'));
children.push(
makeTable(
['Feature', 'Small Bowel (SBO)', 'Large Bowel (LBO)'],
[
['Vomiting', 'Early, frequent', 'Late, less prominent'],
['Distension', 'Central', 'Peripheral (more prominent)'],
['Most common cause', 'Adhesions (post-op)', 'Colorectal carcinoma'],
],
[2500, 3000, 3000]
),
spacer(),
);
children.push(heading2('Absolute Indications for Early Surgery'));
children.push(bullet('Obstructed external hernia'));
children.push(bullet('Clinical features of intestinal strangulation'));
children.push(bullet('Obstruction in a previously unoperated abdomen'));
children.push(yellowBox('"The Sun should not both rise and set" on a case of unrelieved acute intestinal obstruction – risk of intestinal ischaemia.'));
children.push(heading2('Adhesion Types'));
children.push(bullet('Easy (flimsy)'));
children.push(bullet('Difficult (dense)'));
children.push(body('Postoperative adhesions most commonly affect the lower small bowel.'));
children.push(spacer());
// ═══════════════════════════════════════════════
// SECTION 4: ACUTE APPENDICITIS
// ═══════════════════════════════════════════════
children.push(heading1('4. ACUTE APPENDICITIS'));
children.push(heading2('Key Facts'));
children.push(bullet('Diagnosis is ESSENTIALLY CLINICAL'));
children.push(bullet('"An enigmatic challenge and a reminder of the art of surgical diagnosis"'));
children.push(bullet('Operating on clinical suspicion alone → normal appendix removed in 15–30% of cases'));
children.push(bullet('CT scanning improves accuracy and reduces negative appendicectomy rate'));
children.push(spacer());
children.push(heading2('Special Situations'));
children.push(bullet('Elderly: Appendicitis can occasionally CAUSE intestinal obstruction'));
children.push(bullet('Caecal carcinoma can mimic or cause obstructive appendicitis in adults'));
children.push(yellowBox('A CT scan will clarify the diagnosis in ambiguous or elderly cases.'));
children.push(spacer());
// ═══════════════════════════════════════════════
// SECTION 5: PEPTIC ULCER DISEASE
// ═══════════════════════════════════════════════
children.push(heading1('5. PEPTIC ULCER DISEASE'));
children.push(heading2('Complications (The Three P\'s + S)'));
children.push(
makeTable(
['Complication', 'Management'],
[
['Perforation', 'Primarily SURGICAL – Graham patch repair'],
['Bleeding (haemorrhage)', 'Endoscopic ± surgical'],
['Stenosis (gastric outlet obstruction)', 'Endoscopic dilatation ± surgical'],
],
[3500, 6000]
),
spacer(),
);
children.push(heading2('Perforated Duodenal Ulcer'));
children.push(bullet('Classic presentation: SUDDEN-ONSET severe generalised abdominal pain'));
children.push(bullet('Mechanism: gastric acid irritates the peritoneum → board-like rigidity'));
children.push(bullet('Erect CXR: free gas under diaphragm in >50% of cases'));
children.push(bullet('CT imaging now preferred – more accurate'));
children.push(bullet('Always check serum amylase to exclude pancreatitis'));
children.push(spacer());
children.push(heading2('Treatment Mainstays'));
children.push(bullet('H. pylori eradication therapy'));
children.push(bullet('Acid suppression (PPIs)'));
children.push(bullet('Elective surgery: very rarely performed today'));
children.push(spacer());
// ═══════════════════════════════════════════════
// SECTION 6: INGUINAL & FEMORAL HERNIA
// ═══════════════════════════════════════════════
children.push(heading1('6. INGUINAL & FEMORAL HERNIA'));
children.push(heading2('Inguinal Canal Anatomy'));
children.push(bullet('Deep inguinal ring: lateral to inferior epigastric vessels → indirect hernia origin'));
children.push(bullet('Medial to inferior epigastric vessels (Hesselbach\'s triangle) → direct hernia'));
children.push(bullet('Constant positive abdominal pressure → stretches deep inguinal ring → hernia development'));
children.push(bullet('Bladder may be pulled into a direct hernia component (sliding hernia)'));
children.push(spacer());
children.push(heading2('Bassini Repair (1890)'));
children.push(bullet('First described in 1890 by Edoardo Bassini'));
children.push(bullet('Remained the basis of open repair for >100 years'));
children.push(bullet('Steps: open external oblique aponeurosis → dissect spermatic cord free → reconstruct posterior wall'));
children.push(spacer());
children.push(heading2('Sliding Hernia'));
children.push(bullet('Acquired INDIRECT hernia at deep inguinal ring (lateral to inferior epigastric vessels)'));
children.push(bullet('Retroperitoneal fatty tissue pushed downwards along inguinal canal'));
children.push(yellowBox('Bladder can be pulled into a direct hernia component → risk of injury if not identified at repair.'));
children.push(spacer());
children.push(heading2('Femoral Hernia – Lotheissen (Inguinal) Approach'));
children.push(bullet('Mesh placed in inguinal canal to protect against development of concomitant INGUINAL hernia'));
children.push(spacer());
// ═══════════════════════════════════════════════
// SECTION 7: BREAST SURGERY
// ═══════════════════════════════════════════════
children.push(heading1('7. BREAST SURGERY'));
children.push(heading2('Surgical Management of Breast Cancer'));
children.push(greenBox('Clinical trials and meta-analyses: Mastectomy = WLE/BCS + radiotherapy for locoregional control AND survival. Trend is de-escalation towards conservative techniques.'));
children.push(spacer());
children.push(heading2('Modified Radical Mastectomy – Pectoralis Minor Handling'));
children.push(
makeTable(
['Modification', 'Pectoralis Minor', 'Axillary Clearance'],
[
['Patey/Madden', 'REMOVED', 'Level I, II, III'],
['Auchincloss', 'RETRACTED', 'Level I, II, III'],
['Scanlon', 'DIVIDED (not removed)', 'Level I, II, III'],
],
[2500, 2800, 4000]
),
spacer(),
);
children.push(heading2('Simple Mastectomy'));
children.push(bullet('Removes breast tissue ONLY – no axillary dissection'));
children.push(bullet('May be combined with sentinel lymph node biopsy'));
children.push(spacer());
children.push(heading2('BRCA Mutation Management'));
children.push(bullet('Bilateral risk-reducing mastectomy + immediate reconstruction → reduces breast cancer risk by 90%'));
children.push(bullet('Tamoxifen chemoprophylaxis = non-surgical alternative'));
children.push(spacer());
children.push(heading2('Male Breast Cancer'));
children.push(bullet('< 0.5% of all breast cancer cases'));
children.push(bullet('Most common symptom: painless SUBAREOLAR lump'));
children.push(bullet('Early nipple-areolar complex + pectoral muscle involvement'));
children.push(bullet('Treatment: mastectomy with 2-cm margin'));
children.push(spacer());
children.push(heading2('DVT Risk Factors in Surgical Patients (Ch. 62)'));
children.push(bullet('Age, obesity, varicose veins, immobility'));
children.push(bullet('Pregnancy, puerperium, high-dose oestrogen therapy'));
children.push(bullet('Previous DVT/PE, thrombophilia'));
children.push(spacer());
// ═══════════════════════════════════════════════
// SECTION 8: HEPATOBILIARY & PANCREATIC SURGERY
// ═══════════════════════════════════════════════
children.push(heading1('8. HEPATOBILIARY & PANCREATIC SURGERY'));
children.push(heading2('Gallstone Complications'));
children.push(
makeTable(
['Complication', 'Notes'],
[
['Biliary colic', 'Transient cystic duct obstruction'],
['Acute cholecystitis', 'Persistent cystic duct obstruction with inflammation'],
['Empyema of gallbladder', 'Pus in gallbladder'],
['Mucocele', 'Cystic duct obstruction → mucus accumulation, non-tender mass'],
['Perforation of gallbladder', 'Free bile peritonitis or pericholecystic abscess'],
['Biliary obstruction (jaundice)', 'CBD stone'],
['Acute cholangitis', 'Charcot\'s triad: RUQ pain + fever + jaundice'],
['Acute pancreatitis', 'Gallstone migration'],
['Gallstone ileus', 'Biliary-enteric fistula → large stone obstructs ileocaecal valve'],
],
[3500, 6000]
),
spacer(),
);
children.push(heading2('Acute Cholecystitis – Differentials'));
children.push(body('Common:', true));
children.push(bullet('Appendicitis'));
children.push(bullet('Perforated peptic ulcer'));
children.push(bullet('Acute pancreatitis'));
children.push(body('Uncommon:', true));
children.push(bullet('Acute pyelonephritis'));
children.push(bullet('Myocardial infarction (must not miss in elderly!)'));
children.push(bullet('Right lower lobe pneumonia'));
children.push(spacer());
children.push(heading2('Acute Pancreatitis – Severity (Revised Atlanta Classification)'));
children.push(
makeTable(
['Grade', 'Criteria'],
[
['Mild', 'No organ failure; no local/systemic complications'],
['Moderately Severe', 'Transient organ failure (<48h) AND/OR local complications without persistent organ failure'],
['Severe', 'Persistent organ failure (>48h) – single OR multiple'],
],
[2500, 7000]
),
spacer(),
);
children.push(heading2('AP Investigations – 3 Key Questions'));
children.push(bullet('Is the diagnosis of AP correct?'));
children.push(bullet('How severe is the attack?'));
children.push(bullet('What is the aetiology?'));
children.push(spacer());
children.push(heading2('AP Scoring Systems'));
children.push(bullet('Ranson score'));
children.push(bullet('Glasgow (Imrie) score'));
children.push(bullet('Balthazar CT criteria – stages severity on contrast-enhanced CT'));
children.push(yellowBox('CT within first 72h may UNDERESTIMATE necrosis extent. CT distinguishes interstitial from necrotising pancreatitis.'));
children.push(spacer());
// ═══════════════════════════════════════════════
// SECTION 9: ENDOCRINE SURGERY
// ═══════════════════════════════════════════════
children.push(heading1('9. ENDOCRINE SURGERY'));
children.push(heading2('Thyroid Malignancy – Relative Incidence'));
children.push(
makeTable(
['Malignancy', 'Relative Incidence (%)'],
[
['Papillary carcinoma', '~80%'],
['Follicular carcinoma', '~10%'],
['Poorly differentiated/Anaplastic carcinoma', 'Rare'],
['Medullary thyroid carcinoma (MTC)', 'Rare – associated with MEN2'],
],
[5500, 4000]
),
spacer(),
);
children.push(heading2('MEN Syndromes'));
children.push(
makeTable(
['Syndrome', 'Components'],
[
['MEN1 (Wermer)', 'Parathyroid hyperplasia + Pancreatic islet cell tumours + Pituitary adenoma'],
['MEN2A', 'MTC + Phaeochromocytoma (PCC) + Primary hyperparathyroidism (PHPT)'],
['MEN2B', 'MTC + Phaeochromocytoma + Mucosal neuromas + Marfanoid habitus'],
],
[2500, 7000]
),
spacer(),
);
children.push(heading2('Vocal Fold Palsy – Causes'));
children.push(body('Traumatic:', true));
children.push(bullet('Direct neck trauma'));
children.push(bullet('Post-thyroidectomy'));
children.push(body('Neoplastic:', true));
children.push(bullet('Carcinoma of lung (left hilum) – compresses left RLN'));
children.push(bullet('Carcinoma of nasopharynx, larynx, thyroid, oesophagus'));
children.push(body('Vascular:', true));
children.push(bullet('Aortic aneurysm'));
children.push(body('Infective:', true));
children.push(bullet('Viral (rare)'));
children.push(body('Neurological:', true));
children.push(bullet('Lower motor neurone disease'));
children.push(spacer());
// ═══════════════════════════════════════════════
// SECTION 10: COLORECTAL CANCER
// ═══════════════════════════════════════════════
children.push(heading1('10. COLORECTAL CANCER'));
children.push(heading2('Staging Systems'));
children.push(bullet('Dukes\' classification: Originally for rectal tumours; adopted for colon cancer; described as "simple"'));
children.push(bullet('TNM (UICC): International standard; compatible with AJCC system'));
children.push(bullet('Postoperative staging: Discussed in MDT to decide adjuvant therapy'));
children.push(spacer());
children.push(heading2('TNM – UICC'));
children.push(keyFact('T', 'Primary Tumour extent'));
children.push(keyFact('N', 'Regional lymph Node involvement'));
children.push(keyFact('M', 'Distant Metastasis'));
children.push(body('The UICC is responsible for TNM. Compatible with the AJCC staging system.'));
children.push(spacer());
// ═══════════════════════════════════════════════
// SECTION 11: SPLENIC SURGERY
// ═══════════════════════════════════════════════
children.push(heading1('11. SPLENIC SURGERY'));
children.push(heading2('Splenectomy Key Points'));
children.push(bullet('Open splenectomy: Midline or transverse left subcostal incision, patient supine'));
children.push(bullet('Thoracoabdominal incision: Used for massive spleen adherent to diaphragm'));
children.push(bullet('Laparoscopic splenectomy: Reduces morbidity and hospital stay'));
children.push(bullet('Splenic trauma: Splenectomy for severe grades where bleeding control takes precedence'));
children.push(bullet('Angioembolisation: May avoid splenectomy but MUST NOT delay laparotomy if haemodynamically unstable'));
children.push(spacer());
children.push(yellowBox('Post-splenectomy: MANDATORY vaccination against encapsulated organisms (pneumococcus, meningococcus, H. influenzae) + antibiotic prophylaxis to prevent OPSI.'));
children.push(spacer());
// ═══════════════════════════════════════════════
// SECTION 12: SPINAL SURGERY & BACK PAIN
// ═══════════════════════════════════════════════
children.push(heading1('12. SPINAL SURGERY & BACK PAIN'));
children.push(heading2('Red Flags for Low Back Pain'));
children.push(bullet('Past history of cancer: breast, lung, GI, prostate, renal, thyroid (metastases)'));
children.push(bullet('Infection: fever, tuberculosis, recent UTI (discitis, osteomyelitis, epidural abscess)'));
children.push(bullet('Cauda equina syndrome: bilateral leg weakness, saddle anaesthesia, bowel/bladder dysfunction'));
children.push(spacer());
children.push(heading2('Spinal Metastases – Radiosensitivity & Chemosensitivity'));
children.push(
makeTable(
['Classification', 'Tumour Types'],
[
['Radioresistant', 'GI adenocarcinoma, Metastatic melanoma, Thyroid carcinoma, Renal carcinoma'],
['Radiosensitive', 'Small cell lung, Ewing\'s sarcoma, Breast carcinoma'],
['Chemosensitive (first-line)', 'Small cell lung, Ewing\'s sarcoma, Thyroid, Breast carcinoma, Neuroblastoma'],
],
[2500, 7000]
),
spacer(),
);
// ═══════════════════════════════════════════════
// SECTION 13: VASCULAR SURGERY
// ═══════════════════════════════════════════════
children.push(heading1('13. VASCULAR SURGERY'));
children.push(heading2('DVT Risk Factors (Virchow\'s Triad Basis)'));
children.push(
makeTable(
['Category', 'Risk Factors'],
[
['Patient factors', 'Age, obesity, varicose veins, immobility, pregnancy, puerperium, high-dose oestrogen, previous DVT/PE, thrombophilia'],
['Surgical factors', 'Duration of surgery, type of procedure (orthopaedic > general), laparoscopic vs open'],
],
[2500, 7000]
),
spacer(),
);
children.push(heading2('NICE Guidelines (Vascular)'));
children.push(bullet('CG168: Varicose veins – diagnosis and management'));
children.push(bullet('NG89 (2018): VTE – venous thromboembolic diseases diagnosis, management, and thrombophilia testing'));
children.push(spacer());
children.push(heading2('Recurrent Varicose Veins'));
children.push(bullet('Recurrent anterior abdominal wall varicose veins after saphenofemoral junction ligation can indicate iliac deep vein thrombosis'));
children.push(spacer());
// ═══════════════════════════════════════════════
// EXAM PEARLS TABLE
// ═══════════════════════════════════════════════
children.push(heading1('RAPID REVISION: HIGH-YIELD EXAM PEARLS'));
children.push(
makeTable(
['Topic', 'Key Fact to Remember'],
[
['Wound healing', 'Primary = apposed edges. Secondary = granulate/contract/re-epithelialise. Tertiary = delayed primary.'],
['Wound healing', 'Steroids delay healing by ↓ protein synthesis + ↓ fibroblast proliferation.'],
['Shock', 'Hypovolaemic = ↓BP + ↑HR + cold/clammy. Neurogenic = ↓BP + normal/↓HR + warm.'],
['Intestinal obstruction', 'Classic quartet: Pain, Distension, Vomiting, Absolute constipation.'],
['Intestinal obstruction', 'Bowel sounds = high-pitched. Most common post-op cause = adhesions (lower SB).'],
['Appendicitis', 'Clinical diagnosis. Normal appendix rate = 15–30% on clinical suspicion alone.'],
['Perforated DU', 'Sudden severe generalised pain. Free gas under diaphragm on erect CXR in >50%.'],
['PUD treatment', 'H. pylori eradication + PPIs. Elective surgery very rarely done today.'],
['Inguinal hernia', 'Bassini repair described in 1890. Indirect = lateral to IEV; Direct = medial.'],
['Breast cancer', 'Mastectomy = WLE + RT in survival. BRCA mutation + bilateral mastectomy = 90% risk reduction.'],
['Male breast Ca', '< 0.5% of breast Ca. Painless subareolar lump. Treatment: mastectomy with 2-cm margin.'],
['Mastectomy types', 'Patey/Madden = PM removed. Auchincloss = PM retracted. Scanlon = PM divided.'],
['Thyroid Ca', 'Papillary = 80%. Follicular = 10%. MTC → MEN2 (MTC + PCC + PHPT).'],
['Vocal fold palsy', 'Neoplastic: lung Ca (L hilum). Vascular: aortic aneurysm.'],
['Acute pancreatitis', 'Severe = persistent organ failure >48h. CT may underestimate necrosis in first 72h.'],
['AP scoring', 'Ranson + Glasgow predict severity. Balthazar = CT staging.'],
['Gallstones', 'Complications include gallstone ileus (large stone via biliary-enteric fistula → ileocaecal valve).'],
['Cholecystitis differentials', 'Common: Appendicitis, PPU, pancreatitis. Uncommon: pyelonephritis, MI, pneumonia.'],
['Colorectal Ca staging', 'Dukes\' = simple, originally for rectum. TNM = UICC/AJCC international standard.'],
['Splenectomy', 'OPSI prophylaxis mandatory. For severe trauma = control bleeding over conservation.'],
['Spinal metastases', 'Radioresistant: GI adenoCa, melanoma, thyroid, renal. Chemosensitive: SCLC, Ewing\'s, breast.'],
],
[3500, 6000]
),
spacer(),
);
// Footer note
children.push(
new Paragraph({
children: [new TextRun({ text: 'Bailey and Love\'s Short Practice of Surgery, 28th Edition — High-Yield Summary Guide. For educational use only.', color: '999999', size: 17, italics: true })],
alignment: AlignmentType.CENTER,
spacing: { before: 240 },
})
);
// ─────────────────────────────────────────────────────────────────────────────
// BUILD DOCUMENT
// ─────────────────────────────────────────────────────────────────────────────
const doc = new Document({
styles: {
default: {
document: {
run: { font: 'Calibri', size: 20 },
},
},
},
sections: [{
properties: {
page: {
margin: { top: 1000, bottom: 1000, left: 1000, right: 1000 },
},
},
headers: {
default: new Header({
children: [
new Paragraph({
children: [
new TextRun({ text: "Bailey & Love 28th Ed — High-Yield Summary Guide", color: BLUE, size: 17 }),
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}),
],
}),
},
footers: {
default: new Footer({
children: [
new Paragraph({
children: [
new TextRun({ text: 'Page ', size: 17, color: '888888' }),
new TextRun({ children: [PageNumber.CURRENT], size: 17, color: '888888' }),
new TextRun({ text: ' of ', size: 17, color: '888888' }),
new TextRun({ children: [PageNumber.TOTAL_PAGES], size: 17, color: '888888' }),
new TextRun({ text: ' | For educational use only', size: 17, color: '888888' }),
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border: { top: { style: BorderStyle.SINGLE, size: 4, color: 'cccccc' } },
}),
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children,
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const outputPath = '/home/daytona/workspace/bailey-love-mcqs/Bailey_Love_Summary_Guide.docx';
Packer.toBuffer(doc).then(buffer => {
fs.writeFileSync(outputPath, buffer);
console.log('Word document created: ' + outputPath);
});
Running Command
cd /home/daytona/workspace/bailey-love-mcqs && python generate_100_mcq_pdf.py 2>…
Running Command
cd /home/daytona/workspace/bailey-love-mcqs && node generate_summary.js 2>&1
Running Command
ls -lh /home/daytona/workspace/bailey-love-mcqs/Bailey_Love_100_MCQs.pdf /home/d…
Running Command
python -c "import zipfile; z=zipfile.ZipFile('/home/daytona/workspace/bailey-lov…
Both files are ready for download:
📥 Your Files
100 MCQ PDF:
Bailey Love 100 MCQs
PDF Document · PDF
Word Summary Guide:
Bailey Love Summary Guide
Word Document · DOCX
What's Inside
100 MCQ PDF (89 KB)
Includes a title page with topic distribution table, then 100 single-best-answer questions (A-D) with colour-coded answer boxes, across 10 sections:
| Section | Questions |
|---|---|
| Wound Healing & Surgical Principles | 13 |
| Gastrointestinal Surgery | 22 |
| Hepatobiliary & Pancreatic Surgery | 13 |
| Hernia Surgery | 8 |
| Breast Surgery | 9 |
| Endocrine Surgery | 9 |
| Splenic Surgery | 5 |
| Vascular Surgery | 5 |
| Orthopaedic & Spinal Surgery | 3 |
| General Surgical Principles | 3 |
Word Summary Guide (20 KB)
A polished revision document with headers, footers, and page numbers covering 13 high-yield topics:
- Wound Healing - types table, delaying factors
- Trauma & Shock - shock comparison table
- Intestinal Obstruction - SBO vs LBO, surgical indications
- Acute Appendicitis - clinical diagnosis pearls
- Peptic Ulcer Disease - complications + perforation facts
- Inguinal & Femoral Hernia - anatomy, Bassini, sliding hernia
- Breast Surgery - mastectomy types table, BRCA facts
- Hepatobiliary & Pancreatic - gallstone complications, AP severity
- Endocrine Surgery - thyroid incidence, MEN syndromes table
- Colorectal Cancer - Dukes' vs TNM
- Splenic Surgery - splenectomy, OPSI
- Spinal Surgery - red flags, radio/chemo sensitivity table
- Vascular Surgery - DVT risk factors, NICE guidelines
- Rapid Revision Pearls Table - 20 exam-ready one-liner facts
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