1
University of Medicine, Magway
Department of Surgery
Final Part II (6/2017) Group B
Completion Examination
Section (A)
Multiple Choice Questions
All Questions are to be answered.
Minus system not carried over.
Time Allowed - 3 hours for both Section A and B Date 29-12-2017
1. A fracture is said to be
A. Closed if the overlying skin laceration has been sutured
B. Simple, when there is a single fracture line
C. Comminuted if there has been associated damage to adjacent nerves or vessels
D. A fatigue fracture if it occurs through a diseased bone
E. Pathological if it occurs through a bony metastasis
2. Acute osteomyelitis;
A. Occurs at epiphysis of the long bone.
B. Is due to direct inoculation of the bacteria.
C. Is due to blood borne bacteria.
D. Should be treated by draining the pus from medullary cavity by drilling.
E. Can be diagnosed by clinical means.
3. Hypovolaemia is associated with
A. tachycardia
B. uraemia
C. decrease urinary sodium excretion
D. hypotension
E. increased urine output
4. In the management of cardiac arrest
A. airway must be patent
B. resuscitation should be started only when an assistant is present
C. endotracheal tube may be inserted
D. ECG should be done
E. pulse should be checked by palpating the radial artery
5. Regarding supracondylar fracture of the humerus-
A. it is typically a fracture of the elderly
B. it is caused by a fall onto the outstretched hand with the elbow straight
C. the distal fragment is usually displaced anteriorly
D. the deformity causes kinking of the radial artery
E. its recognized complications include mal-union and compartment syndrome
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6. A fistula will persist if
A. a foreign body is present
B. tuberculosis is present
C. the wall becomes lined with epithelium
D. there is unrelieved obstruction proximal to the fistula
E. intervening abscess cavity is present
7. Metabolic alkalosis
A. is most commonly due to repeated vomiting with gastric outlet obstruction
B. is sometimes manifested with tetany
C. may give rise to polyuria
D. is usually accompanied by hyperkalaemia
E. is usually associated with intracellular alkalosis
8. Which of the following regarding use of tourniquet are true?
A. The theatre nurse has overall responsibility in its use
B. Distal neurovascular status must be checked before and after its use
C. The tourniquet must be placed as proximally as possible
D. The tourniquet must be placed snugly enough so as not to slide during the operation
E. Always note the time of application and removal
9. Regarding incompatible blood transfusion
A. It is usually due to human error
B. It may present with pain in the loins
C. transfusion must be slowed
D. urine output must be monitored
E. dialysis may be necessary
10. Flail chest injury
A. Occurs when several adjacent ribs are fractured in two places
B. Results in paradoxical movement
C. Causes a left to right shunt
D. Requires endotracheal intubation in severe cases
E. Is in itself not an indication for tracheostomy
11. The orthopaedic emergencies are
A. Open fracture
B. Acute septic arthritis
C. Dislocations
D. Chronic osteomyelitis
E. All of the above
12. Tidy wounds
A. Are inflicted by sharp instruments
B. Contain devitalized tissue
C. Do not involve tendon and vascular injuries
D. Are usually associated with fracture
E. Can be sutured primarily
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13. Factors which predispose to wound infection include
A. Impaired blood supply
B. Development of wound haematoma
C. The presence of devitalized tissue in the wound
D. Antibiotic administration during surgery
E. Foreign material in wound
14. The metabolic response to injury is characterised by
A. Reducing core temperature
B. Conservation of sodium and water
C. Mobilizing glucose from fat and protein stores
D. Maintaining body weight
E. Enhancing immune function
15. Carcinomas: -
A. Originate from connective tissues.
B. Invade surrounding tissues.
C. Blood borne metastases occur very early.
D. May present as ulcerating irregular mass.
E. Possess a capsule.
16. Secondary haemorrhage occurs
A. At the time of surgery
B. When there is slipping of ligatures
C. When the wound gets infected
D. When under running sutures are not applied
E. Within 10 to 14 days after surgery
17. Massive blood transfusion may be complicated by
A. Hyperkalaemia
B. Hypercalcaemia
C. Hepatic coma
D. Leucopenia
E. Coagulopathy
18. Empyema thoracis: -
A. Is an accumulation of pus in the lung
B. Can follow pneumothorax
C. With the unknown aetiology is called empyema necessitatus
D. Is not related to pulmonary tuberculosis
E. Can be treated by thoracotomy and decortications
19. Wet gangrene;
A. Is caused by diabetes mellitus.
B. Is caused by thromboangitis obliterans.
C. Has well demarcated line.
D. Can be caused by embolism arising from dislodgement of thrombus due to cardiac arrhythmia.
E. Is treated by provisional amputation.
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20. Necrotising fascitis: -
A Is synonymous with synergistic spreading gangrene
B Is caused by clostridial infection
C
D Is associated with diabetes insipidus
E Requires aggressive wide excision
21. Carbuncle: -
A. Commonly occurs in cheek.
B. Is infection of hair follicle
C. Is usually associated with diabetes mellitus.
D. Needs surgical intervention.
E. Is one example of infective gangrene
22. Post-operative pyrexia is seen in: -
A. Major operations only.
B. Lung collapse.
C. Urinary tract infection.
D. Sub-diaphragmatic abscess.
E. Deep vein thrombosis
23. Regarding sterilization
A. It is the process which destroys micro-organisms except bacterial spore
B. Autoclave is medical device which sterilizes instruments by steam under pressure
C. Sterilization by ethylene oxide is recommended for ventilator or respiratory equipment
D. Sterilization by hot air oven can be used for substances such as rubber and plastics
E. Sterilization by irradiation is an industrial process
24. Wound dehiscence
A. Usually occurs in transverse wounds
B. May occur because of anastomotic leakage
C. Happens more in diabetic patient
D. Can develop incisional hernia
E. Occurs more often in smokers
25. Surgical filter
A. Is a process for surgical case management
B. Means investigations for surgical patient
C. Is a mental work for provisional diagnosis
D. Is applied after history taking from surgical patient
E. Is only used by surgeons
26. Hypertrophic scars
A. are not familial
B. are race related
C. are common in children
D. are related to tension
E. remain within wound
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27. The prevention of hospital acquired infection can be made by
A. Adopting the infection control policy
B. Routine use of broad spectrum antibiotics
C. Proper sterilization and disinfection procedures
D. Proper and regular hand washing
E. Promoting the natural resistance of the attendants
28. The criteria of ideal surgical incision includes
A. Small incision
B. Rapid access
C. Better cosmesis
D. Limited exposure
E. Safe and strong wound
29. Lipoma
A. Is a benign tumour of adult fat cells
B. Is known as universal tumour
C. Never changes into malignancy
D. Cannot occur in intestine
E. Can occur in spermatic cord
30. The following drugs should be discontinued prior to surgery: -
A. Warfarin
B. Aspirin
C. Nifidipine
D. Corticosteroids
E. Thiazide diuretics
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ANSWER KEYS
Section A - Multiple Choice Questions Date 29-12-2017
1. B E
2. C D E
3. A B C D
4. A C D
5. E
6. A B C E
7. A B C
8. B C D E
9. A B D E
10. A B D
11. A B C
12. A E
13. A B C E
14. B C
15. B D
16. C E
17. A C E
18. B E
19. A D E
20. A E
21. C D E
22. B C D E
23. B E
24. B C D E
25. C
26. A C D E
27. A C D
28. B C E
29. A B E
30. A B
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University of Medicine Magway
Department of Surgery
Final Part II (6/2017) Group 2
Completion test
Section (B)
Date 29-12-2017
Answer all Questions
Answer Question 1 Book I
2 Book II
3 to 7 Book III
1. Describe the management of open fracture.
2. Describe the management of carcinoma of the middle third of oesophagus.
3. Describe the pathophysiology and management of septic shock in a patient with duodenal ulcer
perforation.
4. Describe the causes and management of mastalgia.
5. What are the cardinal features of intestinal obstruction? Describe the management of intestinal
obstruction due to rectosigmoid junction.
6. Define the strangulated inguinal hernia. Describe the management of strangulated inguinal
hernia.
7. Describe the management of a 30 years old man chronic smoker presenting with intermittent
claudication and gangrene of right big toe.
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DEPARTMENT OF SURGERY
UNIVERSITY OF MEDICINE , MAGWAY
FINAL PART II MBBS (6/2017) 2nd BATCH COMPLETION TEST
SECTION A MCQ DATE: 4.4.18
Time allowed: 3 hours for both section A and B
1. Regarding gas gangrene
a. It is due to Clostridium botulinum infection
b. Clostridial species are gram-negative spore forming anaerobes
c. The clinical features are due to the release of protein endotoxin
d. Gas is invariably present in the muscle compartments
e. Surgical debridement and antibiotics are an essential part of treatment
2. Anatomy of the inguinal canal
a. The internal ring lies midway between the symphysis pubis and anterior superior iliac
spine
b. The internal ring lies medial to the inferior epigastric vessels
c. The external oblique aponeurosis forms the anterior wall
d. The inguinal ligament forms the inferior boundary
e. The conjoint tendon forms the lateral part of the posterior wall
3. Intussusception
a. Is most common in children from 6 to 12 years
b. Presents with colicky abdominal pain, rectal bleeding and an abdominal mass
c. 10% of cases present with diarrhea & vomiting simulating gastroenteritis
d. Hydrostatic reduction can be attempted if there is no shock or peritonitis
e. a Mec
4. Regarding thyrotoxicosis
a.
b. Secondary thyrotoxicosis must be treated by radioactive iodine.
c. Thyroid antibodies are found in toxic adenoma.
d. Thyroid crisis can occur during operation for toxic multinodular goiter.
e. Surgery has no role for primary thyrotoxicosis.
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5. The functions of a tracheostomy are to
a. bypass an upper airway obstruction
b. increase the anatomical dead space
c. increase airway resistance
d. protect against aspiration
e. allow frequent airway suction
6. Regarding early breast cancer
a. Breast conserving surgery is the treatment of choice
b. Lobular carcinoma is the commonest histological type
c. Adjuvant chemotherapy is not always necessary in young patient
d. Lymphovascular invasion is a bad prognostic signs
e. Sentinal node negative cases should be treated by axillary clearance
7.
a. affects both upper limbs and lower limbs
b. is also known as thromboangiitis obliterans
c. mainly affects small and medium sized arteries
d. lumbar sympathectomy may improve skin blood flow.
e. Is treated by femoropopliteal bypass.
8. In the management of acute osteomyelitis
a. three separate venepunctures on the same occasion are made to obtain blood culture
b. X-ray changes(i.e.) lifting of ther periosteum are seen immediately
c. antibiotics should not be given until the results of culture and sensitivity are known
d. pus, if its presence is suspected clinically, should be drained by operation
e. operation is carried out with the limb exsanguinated
9. Solitary thyroid nodules
a. are more prevalent in men
b. in adult population, more than 50% are malignant
c. More than 50% of scintigraphically cold nodules are malignant
d. Malignant risk of a hot nodule is negligible
e. Should be removed surgically in almost all patients
10. Regarding crystalloid solutions
a. One liter of normal saline contains 154 mmol of sodium and chloride
b. One Liter of dextrose saline will provide 154 mmol of sodium
c. 2 grams of KCl is equal to 57 mmol of the salt
d. onate
e. The daily requirement of K for a 40 Kg women is sbout 40 mmol
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11. Regarding stones in the gallbladder
a. Cholesterol stones are most common stones in Asia
b. Pigment stones are associated with haemolytic anaemia
c. are a risk factor for the development of gallbladder carcinoma
d. 10% of gallstones are radio-opaque.
e.
12. Peptic ulceration
a. H. pylori is a gram-positive bacillus
b. Chronic duodenal ulcer is more common than gastric ulcer
c. Z-E syndrome is associated with gastric hyposecretion
d. Proton pump inhibitors will heal 85-95% of duodenal ulcers in 8 weeks
e. Triple therapy can eradicate H. pylori in 80% of patients in one week.
13. Regarding post-operative complications
a. Paralytic ileus is typically seen within first 12 hours after surgery.
b. Wound infection rate is approximately 10%
c. Post-operative infection is usually due to haemolytic streptococci.
d. Clostridium difficile is usually the cause of antibiotic enterocolitis.
e. Oral vancomycin is acceptable treatment for pseudomembranous enterocolitis.
14. Regarding oesophageal carcinoma
a. Achalacia is a predisposing factor
b. Typically present with progressive dysphagia
c. Carcinoma in upper third is treated by Ivor Lewis operation
d. Endoscopic mucosectomy can be used for treatment of T1 tumours.
e. Oesophageal stenting is a curative procedure.
15. An osteosarcoma
a. tends to occur in metaphyseal region of a long bone
b. is restricted to persons in second and third decades
c. does not destroy normal bones but rather grows on the surface
d. spreads to the regional lymph nodes at an early stage
e. should be confirmed by needle biopsy
16. Treatment of an abscess include
a. very high dose of antibiotics
b. incision & drainage
c. aspiration using 21gauge needle
d. enucleation
e. wide excision
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17. Treatment of superficial burn include
a. irrigation with sterile water
b. early split-skin grafting
c. early intravenous antibiotics
d. fluid & electrolyte therapy if area is large
e. escharotomy
18. Massive blood transfusion may be complicated by
a. Hyperkalaemia
b. Hypocalcaemia
c. ARDS
d. Hypothermia
e. Coagulopathy
19. The following malignant tumours commonly metastasize to bone
a. Ca Prostate
b. Ca Lung
c. Ca Breast
d. Renal cell carcinoma
e. Follicular carcinoma of thyroid
20. The radiological signs possible in splenic rupture are
a. Displacement of fundal gas to the left
b. Pronounced visibility of psoas shadow
c. Elevation of the left hemidiaphragm
d. Localized ileus at the left hypochondrial region
e. Fracture of one or more ribs on the left side
21. Ureteric calculi
a. usually present with ureteric colic
b. often results from urinary tract infection
c. Frequently cause haematuria
d. is not usually radio-opaque
e. producing ureteric colic should be removed surgically.
22. A fistula will persist if
a. foreign body is present in it
b. tuberculosis is present
c. the wall becomes lined with epithelium
d. there is unrelieved obstruction proximal to the fistula
e. intervening abscess cavity is present.
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23. Regarding minimally invasive surgery
a. It has minimal somatic and psychological trauma
b. It is less disfiguring to the patient
c. It has reduced bile duct injury compared to open cholecystectomy
d. It provides less wound related complication
e. It has less postoperative pain
24. Which of the following complications can occur with total parenteral nutrition?
a. Hyperglycaemia
b. Hyperlipidaemia
c. Hypophosphataemia
d. Abnormalities of the liver function tests
e. Primary metabolic alkalosis
25. The following solutions are called crystalloids
a. Dextrose water
b. 6HES
c.
d. Normal saline
e. Dextran 110
26. Recognized association with carcinoma stomach include
a. H pylori
b. Blood group O
c. Pernicious anaemia
d. Linitis plastica
e. Volvulus of the stomach
27. Guidelines for the diagnosis of brain death include:
a. The presence of bilateral pinpoint pupils
b. No corneal reflex present
c. The absence of any effect of sedative drugs
d. The agreement of two consultant surgeons
e.
28. Causes of hypokalaemia are
a.
b. Chronic renal failure
c. Villous adenoma of rectum
d. Adrenocortical insufficiency
e. External fistulae of GI tract
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29. Patients with major burns are complicated by:
a. lcers
b. Cardiogenic shock
c. Hypovolaemic shock
d. Haemolysis.
e. Renal failure.
30. Unilateral hydronephrosis
a. It may have incomplete urethral obstruction
b. It may have an aberrant renal artery
c.
d. It may be due to ureteric injury during pelvic operation
e. It may be due to ureteric calculi
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ANSWER GRID FOR MCQ (2nd BATCH) 4.4.18
1. DE
2. ACD
3. BCDE
4. AD
5. A
6. D
7. ABCD
8. ADE
9. D
10. ABDE
11. BCDE
12. BDE
13. BDE
14. ABDE
15. ACD
16. B
17. AD
18. ABCDE
19. ALL TRUE
20. CDE
21. ABC
22. ABCE
23. ABDE
24. ABCD
25. ACD
26. ACD
27. BCDE
28. ACE
29. ACDE
30. BCDE
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DEPARTMENT OF SURGERY
UNIVERSITY OF MEDICINE , MAGWAY
FINAL PART II MBBS (6/2017) 2nd BATCH COMPLETION TEST
SECTION B MSQ DATE: 4.4.18
Time allowed: 3 hours for both section A and B
1. Describe the mechanism, clinical features, investigation and management of extradural
haematoma.
2. What are the causes of haematuria. Describe the investigation and management of haematuria.
3. Describe the management of 60 kg man with 36 % burns.
4. Define solitary thyroid nodule. What are the causes of solitary thyroid nodule? Describe the
management of 20 years old man with solitary thyroid nodules.
5. Describe the fluid and electrolyte changes of gastric outlet obstruction. Describe briefly the
management of 70 years old man with gastric outlet obstruction due to carcinoma of stomach.
6. Define acute pancreatitis. What are the causes of acute pancreatitis. Describe the management
of severe acute pancreatitis.
7. Add notes on
(a) Informed consent
(b) Triple assessment for carcinoma of breast
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DEPARTMENT OF SURGERY
UNIVERSITY OF MEDICINE , MAGWAY
FINAL PART II MBBS (6/2017) GROUP - D COMPLETION TEST
SECTION A MCQ DATE: 6.7.18
Time allowed: 3 hours for both section A and B
1. acute osteomyelitis
A. Presents in children with toxaemia, fever and unwillingness to move the limb
B. X-rays are normal for up to 1 week so are of no value in making an early diagnosis
C. WBC and CRP are usually raised
D. Early diagnosis is treated with high-dose i.v. antibiotics
E. Can be diagnosed by prescence of sequestrum on X-ray
2. regarding hypovolaemic shock
A. high cardiac output is an associated feature
B. vascular resistance is high
C. venous pressure is low
D. mixed venous saturation is high
E. base deficit is low
3. the followings are direct results of increased intracranial pressure
A. Reduced perfusion pressure.
B. Headache, vomiting and reduced conscious level.
C. Tonsillar herniation.
D. Loss of cerebral autoregulation.
E. Displacement of CSF and venous blood from the cranium.
4. causes of ischaemic leg ulcers are
A. Thromboangitis obliterans
B. rheumatoid arthritis
C. neuropathic ulcer
D. neoplastic ulcer
E. venous ulcer
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5. wound dehiscence
A. usually occurs in transverse abdominal wounds
B. poor surgical technique is one of the causes
C. occurs most commonly in young asthmatics
D. occurs most frequently in senile patients
E. occurs more often in smokers
6. concerning acute paronychia
A. it is a sub-cuticular infection
B. if pus forms, it tends to spread under the nail
C. antibiotics do not abort an early infection
D. operation using a bloodless field is not necessary
E. the best treatment is to avulse the whole nail
7. stomas
A. May be colostomy or ileostomy
B. Are temporary or permanent
C. Temporary or defunctioning stomas are usually fashioned as end stomas
D. An ileostomy is flush
E. colostomy effluent is usually solid
8. causes of solitary thyroid nodule include:
A. papillary carcinoma
B. follicular adenoma
C. dorminant nodule of multinodulat goiter
D.
E. thyroglossal cyst
9. Breast conserving surgery
A. Can be done in all types of early carcinoma
B. Has the same survival rate as total mastectomy and axillary clearance
C. Has high local recurrence rate
D. Is relatively contraindicated in carcinoma breast with lymphovascular invasion in
histology
E.
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10. acute pancreatitis can caused by
A. ERCP
B. Hyperthyroidism
C. Hyperparathyroidism
D. Azathioprine
E. Trauma
11. treatment of ascites in chronic liver disease
A. salt addition
B. diuretics
C. abdominal paracentesis
D. peritoneo-venous shunt
E. liver resection
12. complications of major burn include
A. myoglobinuria
B. hyperglycaemia
C. hyponatraemia
D. sepsis
E. acute tubular necrosis
13. flail chest
A. is common is premature infants
B. leads to ventilatory failure if the involving segment is large
C. causes paradoxical breathing
D. is best treated by the reconstruction of the chest wall
E. is usually painless
14. regarding testicular tumours
A. common in 20-30 year of age
B. seminoma is commonest
C.
D. teratoma mainly spread by haematogenous route
E. undescended testis can change into seminoma
15. liver biopsy can be
A. performed safely on any person
B. performed by using a Menghini Needle
C. reliable as a means of detecting tumour
D. carried out via the epigastrium
E. profitably combined with peritoneoscopy
19
16. pancreatic pseudocyst
A. is a retention cyst
B. usually arises in lesser peritoneal sac
C. is usually complicated by spontaneous rupture
D. is usually treated by surgical drain
E. usually follows abdominal or surgical trauma
17. carbuncle
A. is an infection of a sweat gland
B. is associated with diabetes mellitus
C. rarely needs surgical intervention
D. is an example of infective gangrene
E. commonly occurs in the back
18. high risks factors for deep vein thrombosis include
A. pregnancy
B. pelvic surgery
C. diabetes mellitus
D. malignancy
E. hypertension
19. ureteric stone
A. can be asymptomatic
B. stone larger than 2 cm can be treated with laparoscopic ureterolithotomy
C. ureteroscopic lithotripsy is one treatment option for stone less than 2 cm
D. bilateral ureteric stones can lead to end stage renal disease or severe chronic renal
failure
E. if there are bilateral ureteric stones, the stone in a better function side should be
operated first
20. colorectal carcinoma
A. is common in western countries
B. rectosigmoid region is the commonest site
C. associated with colonic polyp
D. surgery is the mainstay of treatment
E. sphincter saving surgery could not be done if tumour lies below peritoneal reflection
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21. splenic rupture can be treated by
A. conservative measures
B. splenorrhaphy
C. topical application of fibrin glue
D. splenectomy
E. segmental resection
22. bleeding oesophageal varices
A. are due to extra-hepatic causes in most cases
B. can usually be controlled long term with Sengstaken tube
C. usually present in the first decade
D. usually associated with ascites
E. should be treated with hypertonic saline infusion
23. the followings are features of thyrotoxicosis
A. weight gain
B. palpitation
C. proximal myopathy
D. increase skin pigmentation
E. pretibial myxoedema
24. Regarding rectal cancer
A. it often arises in metaplastic polyps
B. rectum is the commonest site of colorectal tumours
C. a cancer in the upper 1/3 of the rectum is appropriately managed by AP resection
D. local recurrence of rectal cancer can be reduced by a total mesorectal excision
E. chemotherapy is of proven benefit in Duke's A. tumours
25. Aetiology of carcinoma oesophagus include
A. Achalacia
B. corrosive stricture of oesophagus
C.
D. mediastinal goiter
E. vitamin deficiency
21
26. post-operative hypotension may be due to
A. sepsis
B. dopamine
C. hypovolaemia
D. hypoxia
E. pain
27. massive blood transfusion can cause
A. Hyperkalaemia
B. Hypercalcaemia
C. Hepatic coma
D. Leucopenia
E. Coagulopathy
28. anal fissure
A. usually occurs anterior in the midline
B. may be associated with sentinel skin tags
D. can be managed by anal stretching
E. can cause pruritus ani
29. features of obstructed jaundice are
A. marked increase alkaline phosphatase
B. marked increase in liver enzymes such as AST, ALT
C. clay coloured stool
D. dilated biliary tree on ultrasonic examination
E. presence of HBsAg
30. incisional hernias are related to
A. obesity
B. use of non-absorbable suture
C. wound infection
D. failure of surgical technique
E. contaminated wound
22
MCQ Key for Final Part II Completion Test
1.ABCD 16.B
2.BC 17. BDE
3.D 18.ABCD
4.AB 19. ABCDE
5.BDE 20.ABCD
6.AB 21. ABCDE
7. ABE 22.D
8.ABC 23. BCDE
9.CD 24.BD
10. ACDE 25. ABCE
11. CDE 26. ACD
12.ABCDE 27. ACE
13. BC 28. BCDE
14.ABDE 29. ACD
15.BDE 30. ACDE
23
DEPARTMENT OF SURGERY
UNIVERSITY OF MEDICINE, MAGWAY
FINAL PART II MBBS (6/2017) GROUP- D COMPLETION TEST
SECTION B MSQ DATE: 6.7.18
Time allowed: 3 hours for both section A and B
1. Define minimal access surgery. Enumerate the types of minimal access surgery. Describe
the advantages and disadvantages of minimal access surgery.
2. Define and classify open fracture. Describe the management of open fracture tibia.
3. Describe the aetiology, pathogenesis, clinical features and management of severe tetanus.
4. What is locally advanced breast cancer? Describe the management of 40 years old
premenopausal lady with locally advanced carcinoma of the breast.
5. Define massive blood transfusion. Describe the complications of blood transfusion in
surgical practice.
6. Describe the management of 70 years old lady with carcinoma of recto-sigmoid junction
presenting with acute on chronic intestinal obstruction.
7. What is flail chest? What are the lethal six and hidden six in chest injury. Describe the
management of a flail chest involving multiple rib fractures with hypoxaemia using ATLS
guidelines.
