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Ulcerogenic cause of hypergastrinemia

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Q) A 42-year-old male presents with multiple recurrent duodenal ulcers, abdominal pain, and chronic diarrhea. Fasting serum gastrin levels are >1000 pg/mL. Which of the following is the most likely ulcerogenic cause of hypergastrinemia?

A. Atrophic gastritis
B. Zollinger–Ellison syndrome
C. Chronic proton pump inhibitor use
D. Helicobacter pylori infection

Ans b

B. Zollinger–Ellison syndrome

Explanation:

  • Zollinger–Ellison syndrome (ZES) is caused by a gastrinoma (a gastrin-secreting tumor), typically located in the pancreas or duodenum.

  • It leads to massive hypergastrinemia, increased gastric acid secretion, and multiple, recurrent, or atypical peptic ulcers.

  • Diarrhea and steatorrhea are common due to acid inactivation of pancreatic enzymes.

🔍 Other Options:

  • A. Atrophic gastritis:

    • Leads to hypochlorhydria/achlorhydria with secondary hypergastrinemia, but non-ulcerogenic (low acid state).

  • C. Chronic PPI use:

    • Causes compensatory hypergastrinemia due to acid suppression, but again non-ulcerogenic unless stopped abruptly in predisposed individuals.

  • D. Helicobacter pylori infection:

    • May increase gastrin levels mildly, but ulcers are primarily due to mucosal damage and inflammation, not from gastrin hypersecretion.

🧠 Key Point:

Zollinger–Ellison syndrome is the only ulcerogenic cause of hypergastrinemia.
Fasting gastrin >1000 pg/mL with low gastric pH is diagnostic.

Flaps in Plastic Surgery

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Q) A 48-year-old male undergoes excision of a chronic pilonidal sinus with a rhomboid-shaped defect over the sacrococcygeal region.

The reconstructive plan involves a local flap designed adjacent to the defect, where the flap is transposed into the primary defect and the donor site is closed primarily.

The flap follows the lines of minimal skin tension and relies on subdermal vascular supply without a named artery. What is the correct classification of this flap?

A. Rotation flap
B. Axial pattern transposition flap
C. Random pattern transposition flap
D. Advancement fasciocutaneous flap

Pericardial Injury

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Q) A 25-year-old male presents after a stab wound to the left 5th intercostal space at the midclavicular line.

He is hypotensive, tachycardic, and confused. eFAST reveals pericardial fluid. What is the next best step in management?

A. Pericardiocentesis
B. Emergency thoracotomy
C. CT angiography of the chest
D. Chest tube insertion

Sucking chest wound

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Q) A 30-year-old male presents to the emergency department after a stab wound to the right chest.

On examination, there is a 4 cm open wound in the 5th intercostal space anteriorly, with a sucking sound during inspiration, decreased breath sounds on the right, and respiratory distress.

What is the next best step in management? # Theme neet ss mocktest 1

A. Immediately close the wound with an airtight dressing
B. Insert a chest tube on the same side and then close the wound
C. Intubate and initiate positive pressure ventilation
D. Apply a three-sided occlusive dressing to the wound

Answer D. Apply a three-sided occlusive dressing to the wound

This is a classic presentation of an open pneumothorax, also known as a sucking chest wound. When the chest wound is ≥2–3 cm (or ≥2/3 the diameter of the trachea), air preferentially enters through the chest wall defect instead of the trachea, impairing ventilation.

Management steps:

  1. Initial step: Apply a three-sided occlusive dressing — this allows air to escape during exhalation but prevents air from entering during inhalation, avoiding tension pneumothorax.

  2. Definitive step: Place a chest tube (thoracostomy) on the same side before fully sealing the wound.

A is incorrect because a fully sealed dressing without a chest tube can cause tension pneumothorax.
B is correct only after the initial temporary occlusive dressing is applied.
C may be needed later but not before securing the wound.

TIPS

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Q) A 60-year-old man with cirrhosis presents with refractory ascites requiring frequent large-volume paracentesis. He is evaluated for TIPS placement. Which of the following findings would be the strongest contraindication to proceeding with the procedure?

A) Serum bilirubin of 3.5 mg/dL
B) MELD score of 18
C) Right heart catheterization showing mean pulmonary artery pressure of 55 mmHg
D) History of prior hepatic encephalopathy controlled on lactulose

#Theme from INI CET GI Mock test Liver

Correct Answer:

C) Right heart catheterization showing mean pulmonary artery pressure of 55 mmHg

Explanation:

  • A mean pulmonary artery pressure >45 mmHg is a contraindication to TIPS due to the risk of worsening right heart failure.

  • Bilirubin up to 3.5 and a MELD score <25 are relative risks but not absolute contraindications.

  • Prior controlled hepatic encephalopathy is not a strict contraindication, though the risk of recurrence post-TIPS is higher.

  • TIPS is often used in patients with refractory ascites when medical management fails.

Suturing Techniques

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Q) During a surgical skills assessment, you are asked to perform a hand-sewn intestinal anastomosis using a continuous, inverting suture that enters the bowel lumen.

Which of the following suture techniques best fits this description?

#Theme from INI CET GI Mock test

A. Lembert suture
B. Cushing suture
C. Gambee suture
D. Connell suture

Correct Answer: D. Connell suture

The Connell suture is a continuous, inverting, full-thickness suture technique. It is unique because:

  • The needle enters the bowel lumen, passing through the mucosa.

  • It is run parallel to the incision line.

  • It achieves inversion of the bowel edge, which promotes serosal healing but intraluminal suture exposure is a drawback.

  • Historically used for the inner layer of two-layer bowel anastomoses.

Comparison with Other Options:

A. Lembert suture

  • Seromuscular only, avoids the mucosa

  • Interrupted or continuous

  • Inverting, but does not enter lumen

B. Cushing suture

  • Continuous, inverting

  • Parallel to incision

  • Penetrates submucosa but not mucosa (no lumen entry)

C. Gambee suture

  • Interrupted, inverting

  • Passes through a small portion of mucosa

  • Designed to minimize mucosal eversion and reduce luminal exposure

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