AIIMS MCQ

GI SUrgery MCQs from AIIMS over the years

ELAPE (Extra Levator Abdomino perineal Excision)

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Q) What is not true about  extra levator Abdomino Perineal Resection (APE) (AIIMS 2019) 

a) Anal canal dissected from levator

b) Patient  in prone jack knife position

c) Specimen is resected en block with sacrum

d) Entire levator is resected along with mesorectum

chemodectoma

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Q) Paraganglionoma and chemodectoma is seen in (AIIMS onco) 

a) Carotid space

b) Prevertebral space

c) Parapharyngeal Space

d) Masticator space

Zenker’s divertculum

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Q) Incorrect statement about zenker's diverticulum (AIIMS GI)

a) More common in the elderly on the left side

b) Barium swallow is diagnostic

c) Diverticulopexy means fixation of diverticulum to prevertebral fascia

d) Dohlman Procedure is for large sized diverticuli

Facial nerve

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Q) Not a branch of facial nerve?

a) Greater auricular nerve

b) Post Auricular nerve

c) Nerve to Chorda tympani

d) Nerve to Stapedius

Ans a

The posterior auricular nerve arises from the facial nerve close to the stylomastoid foramen.

The great auricular nerve (or greater auricular nerve) originates from the cervical plexus, composed of branches of spinal nerves C2 and C3. 

The chorda tympani is a nerve that arises from the mastoid segment of the facial nerve

The nerve to stapedius arises from the facial nerve to supply the stapedius muscle.

Primary Hyperparathyroidism

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Q) Which is not a feature of primary hyperparathyroidism?

a) Increase Parathormone

b) Increase Calcium

c) Decreased phosphate

d) Dystrophic calcification

Ans d 

Clinical features of Hyperparathyroidism are

  1. Subperiosteal bone erosions
  2. Primary Hyperthyroidism  is defined as hypercalcaemia in the presence of an unsuppressed and therefore relatively, or absolutely, elevated PTH level. Elevated calcium and elevated PTH are important  in diagnosis of PTH
  3. The presence of kidney stones remains the most common clinical manifestation of symptomatic PHPT.
  4. It is associated with a low serum phosphate in the setting of normal creatinine and vitamin D levels

Ref Bailey and Love Page 826

 Some useful questions can be bought here  MCQs and EMQs in Surgery: A Bailey & Love Revision Guide, Second Edition 

Some uncommon disorders associated with hyperparathyroidism include

peptic ulcers, pancreatitis, and bone disease

central nervous system symptoms 

Causes of Primary Hyperparathyroidism are

  1. Parathyroid Adenoma -75% (can be localised by Sestamibi scanning)

Management of primary hyperparathyroidism

Patients with symptomatic primary hyperparathyroidism as manifested by kidney stones, renal dysfunction, or osteoporosis should undergo parathyroidectomy.

If the patient is asymptomatic and detected to have high parathyroid levels then surgery is done only if

  1. age is less than 50
  2. very high excretion of calcium in urine
  3. low creatinine clearance
  4. kidney stones
  5. high serum calcium

 

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