AIIMS MCQ

GI SUrgery MCQs from AIIMS over the years

Severe Acute Pancreatitis

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Q)  Ideal time for CECT in severe acute pancreatitis is
A. After 72 hours
B. After 48 hours
C. 24 hours
D. At admission

Answer for premium members

Mild acute pancreatitis 

  1. enlargement of the pancreas with loss of definition of the borders of the pancreas. 
  2.  Thickening of the right or left anterior pararenal fascia 

Severe Acute pancreatitis 

 Main determinant of clinical outcome is the degree of systemic organ disturbance, particularly during the early hours and days after admission to hospital

More than half of all deaths in AP occur within the first 2 weeks of illness  and are usually a consequence
of multiple organ failure

The revised Atlanta Classification 
3  grades of severity of pancreatitis:

Mild AP—characterized by the absence of organ failure or local
complications

Moderately severe AP—defined by...................read on 

 

Appendix

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Q) Least common position of appendix is
a) Retroileal
b) Retroceacal
c) Postileal
d) Pelvic

Cholangiocarcinoma

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Q) Cholangiocarcinoma type IIIB bismuth Corlette bilirubin 10, left portal vein and hepatic artery
involved. Best approach is
A. Preoperative left biliary drainage followed by resection
B. Preoperative right biliary drainage followed by resection
C. Left portal vein embolisation followed by resection
D. Palliative drainage

Answer 

Retained antrum syndrome

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Q) True about retained antrum syndrome after gastrectomy  are all except? ( # MCQ in  Stomach 11-15) 

a) It is a persistent hypergastrinemic state

b) It is only seen after Billroth II Gastrectomy

c) Technetium labelled food is not helpful in diagnosing this condition

d) Serum gastrin is usually less than 1000 pg/ml

Answer c

 After billroth II gastrectomy, if a cuff of gastric mucosa remains with duodenum, this entity is called as retained antrum syndrome. This cuff of gastric mucosa is cut off from the proximal stomach and inhibitory effect of hormones such as VIP (Vasoactive Intestinal Peptide)  leading to a persistent hypergastrinemic state. ALso this gastric mucosa is continuously bathed by the alkaline contents of duodenum , which further increases the acid formation.

Both Basal and maximal gastric acid outputs increase but it is not as high as seen in zollinger ellison syndrome. Typically less than 1000 pg/ml

This condition can present as recurrent and persistent ulcerations. Technetium scanning is the diagnostic modality of choice. Treatment is re do surgery and antral excision.

Technetium pertechnate imaging has a sensitivity of 73% and specificity of 100%

More about retained antrum syndrome

Anal canal

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 Q  True about anal canal anatomy are all except
a) Columns of morgagni above dentate line
b) Resting anal canal Pressure 5 – 20 mm Hg
c) Muscles are tubular with inner layer supplied by autonomic nerves

d) Contains columnar, transitional and squamous epithelium

Answer

Hepatic blood flow

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Q. All are true regarding hepatic blood flow except
A. Liver has dual blood supply from portal vein and hepatic artery
B. 70% of liver oxygen comes from the hepatic artery
C. 70-80% of blood supply to the liver is from portal vein

d) Liver receives 25% of cardiac output

Answer for premium

The explanation discusses how much blood and oxygen goes through portal vein and hepatic artery to the liver

What is hepatic artery buffer response??

 

Liver trauma

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Q) All are true for blunt hepatic trauma except
A. Grade V liver injuries are associated with vascular avulsion
B. Hepatic packing is an expeditious method to control bleeding in blunt hepatic trauma
C. After damage control Surgery and hepatic packing, abdominal compartment syndrome can happen in immediate postoperative period
D. Post conservative management, in the 3rd week anemia MC occurs due to subcapsular
hematoma rupture

Answer

anatomy of esophagus

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Q Which of the following is true about anatomy of esophagus?
A. Oesophageal hiatus is superior to aortic hiatus
B. Thoracic duct crosses esophagus at T3-T4level at the level of azygos vein arch
C. Laimer triangle is superior to the Killians triangle
D. In the mediastinum right vagus runs anteriorly and left vagus runs posteriorly

Answer

Post op chyle leak

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Q. Which of the following statements about postoperative chyle leak following esophagectomy is true?

A. Prophylactic intraoperative thoracic duct ligation reduces the risk of chyle leak
B. Conservative management results in spontaneous resolution in nearly all cases within 3 weeks
C. Surgical management requires transthoracic thoracic duct ligation exclusively
D. Conservative treatment includes antibiotics and enteral nutrition only

Answer