AIIMS MCQ

GI SUrgery MCQs from AIIMS over the years

Acute diverticulitis

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Q) False regarding the management of Acute Diverticulitis, Sigmoid colon inflammation and Fat stranding in CT ?

a) Outpatient treatment in most cases

b) Do a colonoscopy after the resolution of acute symptoms

c) Elective Colectomy to be done

d) IV antibiotics to be started`

The pathogenesis of acute diverticulitis is often attributed to the obstruction of diverticula by fecaliths, leading to increased intraluminal pressure, bacterial overgrowth, and subsequent inflammation or perforation

Answer Free  c

Sigmoid diverticulitis can be complicated and uncomplicated

Complicated means diverticulum associated with abscess, perforation, obstruction, fistula 

This question is about an uncomplicated acute diverticulitis 

It can be managed in outpatient setting

It requires IV antibiotics and diet modification

After resolution of symptoms, colonoscopy is to be done after 6 weeks to rule out the presence of other diverticula and neoplasm

Colectomy is not required in all cases. Current recommendations suggest that the decision for surgery should be individualized, taking into consideration the frequency and severity of recurrences. The patient’s overall medical condition and comorbidities should also be included in the analysis

Questions on colon

Acute diverticulitis

SMA syndrome

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Q True in SMA syndrome

  1. Causes Medial Arcuate Ligament syndrome
  2. Causes nut cracker syndrome
  3. Low AM distance and Narrow AM angle <25 degree is sensitive finding
  4. It can be treated by releasing the DJ and keeping duodenum to the right of the artery

Answer 

 

Hyperbaric oxygen therapy for Radiation Proctitis

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Q)  A 60 year old male is contemplating hyperbaric oxygen therapy for  radiation proctitis. Which of the following is not true regarding this?

A. Indicated in acute radiation proctitis but not in subacute or chronic radiation proctitis
B. Oxygen increases the growth of residual tumor and hence tumor should be completely
resected
C. Complications include Parkinsonism, barotrauma
D. Usually 30-40 sessions are required for treatment

Ans  a

This statement is not true because hyperbaric oxygen therapy (HBOT) is not only indicated in acute radiation proctitis but can also be beneficial in subacute and chronic radiation proctitis. Studies have shown that HBOT can promote healing in chronic radiation injuries as well.

Hyperbaric oxygen overcomes chronic tissue hypoxia in radiation damaged tissues and with repeated sessions induces growth of regenerative tissue, capillaries, and epithelium. Successful therapy may take multiple sessions. 18 to 60 treatments

HBO treatments for hypoxic wounds are usually delivered at 1.9 to 2.5 atm for sessions of 90 to 120 minutes each. Treatments are given once daily, five to six times per week and should be given as an adjunct to surgical or medical therapies. Clinical evidence of wound improvement should be noted after 15 to 20 treatments.

Complications of HBO therapy are caused by changes in atmospheric pressure and elevated PO2. Middle ear barotrauma, ranging from tympanic membrane hyperemia to eardrum perforation, is the most common complication.

Pneumothorax  brain oxygen toxicity, manifested by convulsions
resembling grand mal seizures; oxygen lung toxicity, resulting from damage from oxygen free radicals to lung parenchyma and airways and ranging from tracheobronchitis to full-blown respiratory distress syndrome; and transient myopia.

Absolute contraindications to HBO therapy are

(1) uncontrolled pneumothorax

(2) current or recent treatment with bleomycin or doxorubicin (potential aggravation of cardiac and pulmonary
toxicity), and

(3) treatment with disulfiram (increases risk of developing oxygen toxicity).

More questions on rectum

 

Gastric Lymphoma

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Q) Gastric Lymphomas false is 

a) The optimal treatment for lymphomas unresponsive to initial H. pylori antibiotic treatment remains unclear and includes the chemotherapy, radiotherapy, surgical resection, etc

b) Almost all MALT-lymphoma may regress with conventional H. pylori treatment. 

c) Need for surgery in lymphoma is mainly for its complication

d) Risk of perforation is over estimated in the literature

Answer

Familial Adenomatous polyposis

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Q. All are true about adenomatous polyposis syndrome except? ( Repeated in NOV INI SS) 
A. 25% do not have family history
B. Attenuated FAP has less than 100 polyps and delayed onset (50-55 yrs)
C. More than 20 rectal polyps have to be operated as there is high risk of Carcinoma
D. Attenuated FAP don’t have extracolonic manifestations and carry APC mutation

Ans d

Attenuated FAP is a phenotypically distinct variant of FAP in which

(1) affected individuals have fewer than 100 adenomas

(2) the polyps are more proximally distributed in the colon, and

(3) the onset of colorectal cancer is about 15 years later than in patients with FAP.

Germline mutations in the APC gene are found in 80% to 90% of patients with classic FAP and in 10% to 30% of patients with AFAP.

About 25% of patients with FAP have a de novo mutation and thus have no family history.

Attenuated FAP is a milder form of classic familial adenomatous polyposis (FAP) and is characterized by fewer colon polyps (an average of 30) and a delay in the development of colon cancer (average age 50 to 55 years) (True)

 AFAP is caused by mutations in the APC gene and is inherited in an autosomal dominant manner. 

Mutations responsible for this variant occur in the extreme upstream or downstream
portions of the APC gene.

Sabiston 21 page 1368

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GIST stomach

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Q) Antral GIST 1cm incidentally found on UGIE. True regarding its management
a) Surgical resection 
b) Endoscopic resection
c) Resection required if  EUS suggests irregular border with cystic spaces
d) Endoscopic surveillance, if size >2cm then resect

 

Ans 

c

GIST more than 2 cm should undergo resection. Management of GIST less than 2 cm  is dependent on weather high risk features are present on EUS. 

The high risk features are 

1. Irrgeular margins

2. Heterogenous architecture

3. Ulcers

Management of low risk GIST less than 2 cm is  surveillance every 6 months

 

 

 

Pancreatic protocol CT

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Q) All are true about pancreatic protocol CT except (#AIIMS ) 

a) > 90% of un resect able lesions  are picked up by CT

b) It is a dual phase CT with cuts taken at 40 secs and 70 secs

c) Liver metastasis are  detected in early arterial phase

d) All are true

Ans c

Pancreatic protocol CT involves  imaging  at  the  pancreatic  phase (i.e.,  approximately  45  seconds  after  contrast  administration)  and  at  the  portal  venous  phase  (i.e.,  approximately 70  seconds  after  contrast  administration).

It is useful for detection of adenocarcinoma of pancreas. 

Metastatic lesions are seen in  the  portal  venous  phase,  because  the  lesions  are  not  typically  well  vascularized.

 Arterial  phase images  are  principally  used  to  distinguish  metastatic  disease from  benign  vascular  lesions,  such  as  hemangiomas,  or  to  better define  the  arterial  anatomy  of  the  liver.

Non contrast phase used for

Evaluation  of  pancreatic calcifications  and  allows  localization  of  the  precise  levels  for imaging  on  the  post contrast  study. 

Early arterial phase 

Evaluation  of  pancreatic  vasculature  without  interference  from  venous  opacification. 

Late Arterial Phase

 Distinguish pancreatic  neoplasms  from  adjacent  normal   pancreatic  tissue It  also  is useful  to  evaluate  hypervascular  liver  metastases  as  seen  in patients  with  neuroendocrine  tumors   of  the  pancreas. 

Portal Phase

Evaluate  for  hypovascular  liver  metastases 

Ref Blumgart 

The dedicated pancreas protocol uses 750 to 1000 mL of oral water as a negative contrast agent administered before the examination, to aid distinction of enhanced vessels from the
gastrointestinal tract

Blumgart page 345

Free Answer

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