Type III Hiatal Hernia MCQ for NEET SS | mcqsurgery.com
What is a Type III esophageal (hiatal) hernia?
Correct Answer
c) Combination of sliding and paraesophageal hernia
Explanation
Hiatal hernias are classified based on the position of the gastroesophageal junction and stomach.
Type I involves upward displacement of the GEJ into the thorax.
Type II has a normally positioned GEJ with part of the stomach herniating alongside the esophagus.
Type III is a mixed hernia where both the GEJ and stomach herniate into the thoracic cavity.
Option (d) is more consistent with a giant paraesophageal hernia (Type IV).
Teaching Points
Type I is the most common and associated with GERD
Type III is a mixed hernia involving GEJ and stomach
Type II and III have higher risk of volvulus and strangulation
Large hernias with most of the stomach in chest are Type IV
Hepatic Hemangioma Management MCQ for NEET SS | mcqsurgery.com
A 38-year-old woman is found to have a 12-cm hepatic hemangioma. Which statement regarding management is true?
Correct Answer
d) If surgery is planned, peripherally located hemangiomas should be enucleated
Explanation
Hepatic hemangiomas are the most common benign tumors of the liver and are usually detected incidentally.
Management depends on symptoms, complications, and diagnostic certainty, not size alone.
Size and surgery:
Lesion size alone, even when greater than 10 cm (giant hemangioma), is not an indication for surgery if the patient is asymptomatic.
Oral contraceptives and pregnancy:
Although estrogen exposure may cause hemangioma enlargement, there is no strong evidence that oral contraceptive pills or pregnancy significantly increase the risk of rupture. Routine avoidance is not recommended.
Role of arterial embolization:
Arterial embolization is not performed routinely. It is reserved for:
Symptomatic patients unfit for surgery
Acute bleeding
Preoperative reduction of tumor vascularity
Surgical technique:
When surgery is indicated (symptoms, complications, or diagnostic uncertainty), enucleation is preferred for peripherally located hemangiomas because it:
Preserves maximum liver parenchyma
Results in less blood loss
Has lower morbidity compared to formal hepatic resection
Teaching Points
Hepatic hemangioma is the most common benign liver tumor
Size alone is not an indication for surgery
Most asymptomatic hemangiomas require only observation
Enucleation is preferred over resection when surgery is needed
Embolization is reserved for selected symptomatic or high-risk cases
Q ) A 25 year old male brought to the hospital after being involved in a road traffic accident that occurred 50 minutes ago. His initial BP at the scene of accident was 80/40 mm HG with a pulse rate of 120/min.
The paramedics administered 2 litres of normal saline in the ambulance and in the emergency department his BP is 110/70 with a pulse rate of 90/min.
He has tenderness in Left upper quadrant abdomen and USG reveals perisplenic fluid. Next step is to : (#See more trauma MCQS)
a) Take him for exploratory laparotomy
b) Shift him to ICU and observe
c) Do a CT scan of the abdomen
d) Put in a laparoscope and assess
Answer c
This Patient has a splenic injury due to blunt trauma abdomen. The immediate management depends on grade of splenic injury and response to IV Fluids. This patient is hemodynamically stable after IV fluids and immediate laparotomy is not needed.
Direct shifting to ICU is also not the right choice because CT is required first and for more severe injuries patient can go to OT
Hirschsprung’s Disease MCQ for NEET SS | mcqsurgery.com
Which of the following is a FALSE statement regarding Hirschsprung’s disease?
Correct Answer
a) Male and female have equal incidence
Explanation
Hirschsprung’s disease is a congenital disorder characterized by absence of ganglion cells in the distal bowel, leading to functional intestinal obstruction.
Sex distribution:
Hirschsprung’s disease shows a clear male predominance.
The male-to-female ratio is approximately 4:1 in short-segment disease.
Therefore, equal incidence in males and females is false.
Extent of disease:
Total colonic aganglionosis occurs in about 5–10% of patients, making option (b) true.
Postoperative outcome:
Following pull-through surgery, bowel dysfunction is common.
Constipation is the most frequent long-term problem, so option (c) is true.
Genetic associations:
Hirschsprung’s disease is associated with chromosomal anomalies.
Down syndrome is seen in approximately 2–10% of cases, making option (d) true.
Teaching Points
Hirschsprung’s disease has a strong male predominance
Total colonic aganglionosis occurs in about 5–10% of cases
Constipation is the most common long-term complication after surgery
Down syndrome is the most common genetic association
Enterocolitis is the most feared complication, especially in infants
Q) Which of the following is true about screening in hepatocellular carcinoma (HCC Cancer)
a) Alpha feto protein should be done 6 monthly
b) Ultrasound abdomen should be done 6 monthly
c) Candidates for liver transplant should be screened every 3 months
d) Nodules more than 2 cm should be followed up more regularly
Answer b
Cirrhosis is prone for development of HCC. Screening has to be stringent. Earlier ultrasound of liver and alpha feto protein were both used for screening
In 2009 Marrero et al demonstrated the suboptimal accuracy of AFP and after that it has been removed from the screening protocol and now only ultrasound is being done.
The screening recommendation is not for those patients with severe associated conditions and with advanced liver disease who are already considered for transplant. So there is no screening for those who are already listed. Nodules more than 1 cm are highly suspicious where as in nodules less than 1 cm only 40% will be malignant.
