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Nutritional Screening

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NRS-2002 Nutritional Screening MCQ | mcqsurgery.com
Q) According to NRS-2002, which patient needs nutritional intervention?
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Debakey Classification

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Aortic Dissection – DeBakey Classification MCQ

Clinical Scenario: A 52-year-old hypertensive male presents with sudden retrosternal chest pain radiating to the back. CT angiography reveals dissection confined to the ascending aorta without involvement of the arch or descending thoracic aorta.

Which DeBakey classification does this correspond to?

A. Type I
B. Type II
C. Type IIIa
D. Type IIIb

AFP & Embryomal cell carcinoma of Testis

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AFP in Pure Embryonal Cell Carcinoma MCQ | mcqsurgery.com
Q) Which of the following statements about alpha-fetoprotein (AFP) in pure embryonal cell carcinoma is most accurate?
✅ Answer: c) AFP is elevated in 50-80% of cases of pure embryonal cell carcinoma.

🔍 Explanation:
Alpha-fetoprotein (AFP) is a **tumor marker** commonly elevated in **non-seminomatous germ cell tumors** (NSGCTs), which includes **embryonal cell carcinoma**. AFP levels are elevated in approximately **50-80%** of cases of **pure embryonal carcinoma**, and this elevation is associated with the **yolk sac tumor component** that is often seen within these tumors.
  • AFP is a **glycoprotein** produced by the fetal liver and yolk sac, and its levels are typically **low in adults**.
  • It is elevated in conditions like **liver cancer**, **germ cell tumors**, and **yolk sac tumors** (which may be seen with embryonal carcinoma).
  • In **seminomas**, AFP is **usually normal**, and they are typically not associated with AFP elevation.
  • Correct interpretation of AFP levels is important for **diagnosis**, **monitoring treatment response**, and **detecting recurrence** in **germ cell tumors**.
Misinterpreting AFP levels can lead to **incorrect staging** or **diagnosis** of testicular cancers.
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GCS Intubated patient

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Multiple MCQs Example | mcqsurgery.com
Q1) What is the maximum possible GCS score for an intubated patient?
Show Answer & Explanation
✅ Answer: c) 11T

🔍 Explanation: In intubated patients, verbal cannot be assessed (T). Max score = Eye 4 + Motor 6 = 10, written as 11T. Explanation and Teaching Points: Intubated patients cannot be assessed for the verbal response, which is replaced by “T”. The verbal component (maximum 5) is omitted, so the best total becomes Eye (4) + Motor (6) = 10, and the notation “T” is added, making it 11T. Regular reassessment (every 30 minutes) is crucial to detect changes in neurological status.

EUS in carcinoma esophagus

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Esophageal Wall Layers EUS MCQ | mcqsurgery.com
Q) A 60-year-old patient undergoes EUS for staging of an early esophageal tumor. Regarding the echogenic layers of the esophageal wall, which of the following statements is INCORRECT?
✅ Answer: c) The fourth hyperechoic layer represents the muscularis propria (incorrect — the fourth layer is hypoechoic and corresponds to muscularis propria).

🔍 Explanation:
EUS shows 5 layers of the esophageal wall:
  • 1. Hyperechoic – superficial mucosa/water interface
  • 2. Hypoechoic – deep mucosa
  • 3. Hyperechoic – submucosa
  • 4. Hypoechoic – muscularis propria
  • 5. Hyperechoic – adventitia
Correct identification is critical for T-staging of esophageal cancer. Misidentifying layer 4 may lead to incorrect staging and management errors. Radial echoendoscopes provide optimal visualization of all layers.
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Post gastrectomy management

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Q) A 60-year-old woman presents with chronic postprandial epigastric pain, nausea, and bilious vomiting. She had a Billroth II gastrectomy 8 years ago. Despite medical therapy with proton pump inhibitors, sucralfate, and cholestyramine, her symptoms persist. Endoscopy and biopsy confirm ongoing bile reflux gastritis with reactive gastropathy. She is nutritionally declining and has poor quality of life.

What is the most appropriate next step in management?

A. Increase the dose of cholestyramine
B. Add prokinetic therapy (e.g., metoclopramide)
C. Perform total gastrectomy with esophagojejunostomy
D. Convert Billroth II to a Roux-en-Y gastrojejunostomy
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Shock

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Q) A 25-year-old male is brought to the emergency department after a high-speed motorbike accident. He is conscious but reports inability to move his lower limbs. On examination his blood pressure is 75/40 mmHg, pulse 48/min, skin warm and dry. There is flaccid paralysis of both lower limbs and decreased sensation below the level of the umbilicus. Jugular venous pressure is low.

What is the most likely diagnosis?

A. Hypovolemic shock due to occult intra-abdominal bleed
B. Neurogenic shock due to spinal cord injury
C. Cardiogenic shock due to blunt cardiac contusion
D. Septic shock due to aspiration pneumonia
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Retinoblastoma

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Q) Retinoblastoma, the most common ocular malignancy of childhood, has the following features. Which statement is TRUE?

a) It is always unilateral and sporadic
b) Bilateral disease occurs in about one-third of cases
c) It is inherited in an autosomal recessive fashion
d) It is caused by mutation of the p53 gene on chromosome 17

Esophagectomy Chyle leak

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Premium MCQ - Chylothorax Management after Esophagectomy
Q) A 66-year-old male undergoes TTE. After esophagectomy, ICD output is 1000 ml chyle on 5th postoperative day. What should be the next step in management?
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