AIIMS MCQ

GI SUrgery MCQs from AIIMS over the years

Obscure occult Gi bleed

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Q Not true about Obscure occult GI bleed

a) RBC scintigraphy scan has high accuracy

b) Capsule endoscopy can not be done in obstruction

c) Mesenteric Angiography is best for angiodysplasia

d) Intraoperative enteroscopy should be the last resort

 

Crohn Extraintestinal manifestations

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Q) Extra intestinal manifestation of Ulcerative Colitis  not cured by surgery

a) PSC

b) Sacro ileitis

c) Episcleritis

d) Erythema nodosum

Questions on colon 21-30

Ans ) a PSC 

Arthritis,  ankylosing  spondylitis,  erythema  nodosum,  and  pyoderma  gangrenosum  typically  improve  or  completely  resolve after  colectomy.

PSC  occurs  in  5%  to  8%  of  patients  with  ulcerative  colitis. 

HLA-B8  or HLA-DR3  haplotype  are  10  times  more  likely  to  develop  PSC. 

The  risk  for  colon  cancer   in these  patients  is  up  to  five  times  greater   than  in  patients  with ulcerative  colitis  alone.  These  tumors  are  more  likely  to  arise proximal  to  the  splenic  flexure . Colectomy  has  no  effect  on  the course  of  PSC.

 

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Pudendal nerve terminal latency

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Q .PNTL prolonged in all the following except

a) Traumatic injury to anal sphincter

b) Prolonged labor

c) Long standing Rectal prolapse

d) Straining

Answer for premium members (Q4) 

The nerve latency is measured by an electrode which is worn on the finger. It stimulates the pudendal nerve and calculates the conduction time to the anal sphincter

ERCP in pancreatitis

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Q) All are true about ERCP in pancreatitis except

a) Not useful in patient with multiple strictures and stones

b) Ductal stenting associated with changes of c/c pancreatitis in 50%

c) In pts with pancreas divisum minor duct sphincterotomy causes significant pain relief irrespective of size of duct

d) Pain relief with endoscopic intervention occurs irrespective of relief of ductal pressure/ decrease in duct size

Answer for premium members  ( Please log in to see) 

Pancreatic  ductal  obstruction  by  fibrotic  stenoses  and/or  calculi are  the  most  frequent  indications  for  endoscopic  therapy.

Multiple strictures and stones are not amenable for endoscopic therapy ....................

Heterotropic pancreas

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Q ) True about heterotropic pancreas is

a) Most common site for heterotropic pancreas is stomach.

 

 

 

Duodenal injury

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Q) Duodenal injury management false

a ) Circumferential skeletonization is required

b ) All duodenal repairs require some form of drainage

c) All hematomas near the pancreas requires exploration to check for serosal integrity

d) Most common location is the second portion

 

Spontaneous fistula closure

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Q) Which of the following is an Adverse factor hindering  spontaneous fistula closure:

a) Tract <1cm

b)Transferrin > 200

c) Location in esophagus

d) First surgery done in the same institution

 

a) Tract less than 1 cm

Spontaneous fistula closure

Short-turnover  protein (prealbumin,  retinol-binding  protein,  transferrin)  levels should  be  measured  at  least  weekly  to  assess  the  adequacy of  protein  delivery. An  ongoing  catabolic  state  will adversely  affect  short-turnover  protein  levels,  even  with maximal  protein  delivery.

Failure  of  an  enterocutaneous  fistula  to  close  spontaneously  is associated with acronym FRIENDS): 

the  presence  of  a foreign  body  within  the  tract  or  adjacent  to  it,  previous radiation  exposure  of  the  site,  ongoing  inflammation (most  commonly  from  Crohn  disease)  or  infection  that contributes  to  a  catabolic  state,  epithelialization  of  the fistula  tract  (particularly  if  the  fistula  tract  is  less  than 2  cm  long),  neoplasm,  distal  intestinal  obstruction,  and  pharmacologic  doses  of  steroids. 

Fistulas  associated  with  a concurrent  pancreatic  fistula  also  have  a  low  rate  of  spontaneous  closure,  as  do  those  occurring  in  the  presence  of  malnutrition  or  adjacent  infection.

In general,  anatomic  locations  that  are  favorable  for  closure  are  the  oropharynx,  esophagus,  duodenal  stump,  pancreas,  biliary  tree,  and  jejunum.