Exam points

EUS in carcinoma esophagus

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Esophageal Wall Layers EUS MCQ | mcqsurgery.com
Q) A 60-year-old patient undergoes EUS for staging of an early esophageal tumor. Regarding the echogenic layers of the esophageal wall, which of the following statements is INCORRECT?
✅ Answer: c) The fourth hyperechoic layer represents the muscularis propria (incorrect — the fourth layer is hypoechoic and corresponds to muscularis propria).

🔍 Explanation:
EUS shows 5 layers of the esophageal wall:
  • 1. Hyperechoic – superficial mucosa/water interface
  • 2. Hypoechoic – deep mucosa
  • 3. Hyperechoic – submucosa
  • 4. Hypoechoic – muscularis propria
  • 5. Hyperechoic – adventitia
Correct identification is critical for T-staging of esophageal cancer. Misidentifying layer 4 may lead to incorrect staging and management errors. Radial echoendoscopes provide optimal visualization of all layers.
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Anal malformation

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MCQ on Newborn with Abdominal Distension
Q) Newborn with abdominal distension on day 2, not passed meconium. There is absent anal orifice. What is the next step? # NEET SS 22
✅ Answer: A. Cross table X ray

🔍 Explanation:
The first step in such cases is to rule out congenital abnormalities of the spine, sacrum, kidneys, and heart.

- The second step is a Cross-table X-ray. If the X-ray shows perineal fistula, perform Anoplasty.
- If the X-ray shows rectal gas below the coccyx, perform a PSARP (Posterior Sagittal Anorectoplasty) with or without a colostomy.
- If the X-ray shows gas above the coccyx with associated defects, perform a colostomy.

🧠 Key Point: Cross-table X-ray is crucial to determine the presence of rectal gas and other associated defects, guiding the next step in management.

📘 Reference: Table 67.14 Sabiston

Crohn Disease Pathology

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Q) Which of the following is not characteristic of Crohn Disease  : * (From AIIMS 2020 November GI)  

a) Granular mucosa
b) Transmural involvement
c) Skip lesions
d) Giant cell granuloma

Ans a ) Granular Mucosa- This is a feature of ulcerative colitis ( Table 49-7 Sabiston 20) 

The typical gross appearance of ulcerative colitis is hyperemic mucosa.

Friable and granular mucosa is common in more severe cases, and ulceration may not be readily evident. ( Saby 1340) 

IN Crohn disease - Microscopically, there are focal areas of chronic inflammation involving all layers of the intestinal wall with lymphoid
aggregates. Non-caseating giant cell granulomas are found in 60% of patients and when present clearly allow a confident diagnosis of CD.

( Bailey 1242) 

 

Malignant features of salivary gland tumors

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Q) 54 year old lady with long standing swelling right side of cheek. What is not a clinical feature of malignant conversion of salivary gland tumor?

a) Pain 

b) Facial nerve weakness

c) Swelling

d) Cervical lymph node swelling

Ans a

Clinical features of high-grade malignant salivary tumours include

1. facial nerve weakness

2. rapid enlargement of the swelling; 

3. induration and/or ulceration of the overlying skin;

4. cervical node enlargement.

Ref Bailey 27th page 783

Most of these tumors are painless

More Questions Head and Neck onco 

Abdominal Aortic Aneurysm (USMLE)

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Abdominal Aortic Aneurysm (AAA) 

Splenic artery Aneurysm                         General Surgery                                   Free Questions                                           

Age - 60 years

Sex - Male

Who are at risk - Smokers, Hypertension 

Specific Questions - Associated with Ehler Danlos and MArfan Syndrome - So common in families

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