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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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Body response to Trauma

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Q) A 28-year-old male is brought to the ED after a road traffic accident with polytrauma. He undergoes emergency laparotomy for splenic injury. On postoperative day 1, he develops fever (38.7°C), tachycardia (120/min), leukocytosis (18,000/µL), and hypotension requiring fluids. Blood and urine cultures are negative. No evidence of pneumonia is seen on chest X-ray.

Which of the following best explains his condition?
✅ Answer: B. Sterile systemic inflammatory response due to DAMP release

🔍 Explanation:
Trauma and major surgery cause tissue necrosis, ischemia, and cellular injury. Intracellular molecules such as HMGB1, mitochondrial DNA, ATP, uric acid, and heat shock proteins are released and act as DAMPs (damage-associated molecular patterns).

These activate innate immune receptors like Toll-like receptors and inflammasomes (e.g., NLRP3), triggering a robust inflammatory response even in the absence of infection. This explains sterile SIRS, which can mimic sepsis but with negative cultures.

🧠 Key Point: DAMP-driven sterile inflammation is common after trauma, burns, pancreatitis, and ischemia-reperfusion injuries. It must be differentiated from infection-driven SIRS (PAMP-mediated sepsis).
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Ulcerogenic cause of hypergastrinemia

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Free MCQ with CSS Toggle
Q) A 42-year-old male presents with multiple recurrent duodenal ulcers, abdominal pain, and chronic diarrhea. Fasting serum gastrin levels are >1000 pg/mL. Which of the following is the most likely ulcerogenic cause of hypergastrinemia?
✅ Answer: B. Zollinger–Ellison syndrome

🔍 Explanation:
Zollinger–Ellison syndrome (ZES) is caused by a gastrinoma (a gastrin-secreting tumor), typically located in the pancreas or duodenum.

It leads to massive hypergastrinemia, increased gastric acid secretion, and multiple, recurrent, or atypical peptic ulcers.

Diarrhea and steatorrhea are common due to acid inactivation of pancreatic enzymes.

Other Options:
A. Atrophic gastritis:
Leads to hypochlorhydria/achlorhydria with secondary hypergastrinemia, but non-ulcerogenic (low acid state).

C. Chronic PPI use:
Causes compensatory hypergastrinemia due to acid suppression, but again non-ulcerogenic unless stopped abruptly in predisposed individuals.

D. Helicobacter pylori infection:
May increase gastrin levels mildly, but ulcers are primarily due to mucosal damage and inflammation, not from gastrin hypersecretion.

🧠 Key Point: Zollinger–Ellison syndrome is the only ulcerogenic cause of hypergastrinemia. Fasting gastrin >1000 pg/mL with low gastric pH is diagnostic.

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Sucking chest wound

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Q: A 30-year-old male presents to the emergency department after a stab wound to the right chest.

On examination, there is a 4 cm open wound in the 5th intercostal space anteriorly, with a sucking sound during inspiration, decreased breath sounds on the right, and respiratory distress.

What is the next best step in management?

# Theme NEET SS Mocktest 1

A) Immediately close the wound with an airtight dressing
B) Insert a chest tube on the same side and then close the wound
C) Intubate and initiate positive pressure ventilation
D) Apply a three-sided occlusive dressing to the wound
🆓 This is a free MCQ — click below to view the answer.
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Suturing Techniques

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Q: During a surgical skills assessment, you are asked to perform a hand-sewn intestinal anastomosis using a continuous, inverting suture that enters the bowel lumen.

Which of the following suture techniques best fits this description?

#Theme from INI CET GI Mock test

A) Lembert suture
B) Cushing suture
C) Gambee suture
D) Connell suture

Gall bladder stone with obstruction

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A 65-year-old male presents with abdominal pain, vomiting, and a history of multiple episodes of cholecystitis. X ray image is given below.

What is the most likely diagnosis?

Gall stone and intesinal obstruction

A. Acute cholecystitis
B. Gallstone ileus
C. Small bowel volvulus
D. Duodenal perforation

 

 

Answer: B. Gallstone ileus

Explanation:
Rigler's Triad consists of pneumobilia, small bowel obstruction, and an ectopic gallstone, which is diagnostic of gallstone ileus. This condition occurs when a gallstone enters the bowel through a biliary-enteric fistula, leading to mechanical obstruction.

A large gallstone (>2.5 cm) erodes through the gallbladder wall, creating a cholecysto-enteric fistula (most commonly into the duodenum).

The stone enters the bowel and may cause obstruction, most often at the ileocecal valve due to its narrow lumen.

The presence of air in the biliary tree (pneumobilia) results from communication between the biliary and intestinal tracts.

Surgery Instrument

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Q) Identify the instrument

 

 

 

 

 

 

 

a) Craniotome

b) Hudson Brace

c) Humby's knife

d) CUSA

Ans b

The Hudson brace is a manually operated surgical drill used in neurosurgery and orthopedic procedures. It consists of a hand-cranked mechanism with interchangeable drill bits for trephination or skull perforation.

Puzzle people by Thomas Starzl

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Axillary lymph node dissection in ca breast

Q: Which of the following statements is most accurate regarding axillary lymph node dissection (ALND) in breast cancer staging?

a) Level I and level II ALND requires the removal of at least 10 lymph nodes for accurate staging, and level III nodes should always be included in the dissection, regardless of the presence of gross disease in levels I and II.
b) The axillary dissection should include tissue from levels I and II, with a focus on the area inferior to the axillary vein, extending laterally to the latissimus dorsi muscle and medially to the pectoralis minor muscle, when there is no gross disease in level II nodes.
c) Level III nodes should be dissected in all cases of breast cancer for accurate staging, as they are always involved in metastatic spread.
d) Level I and level II ALND can be skipped in cases of clinically negative axilla, as there is no need for lymph node evaluation in the absence of suspicion of metastasis.
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Constipation in Childhood – Most Likely Diagnosis MCQ for INI CET, NEET SS, and Pediatric Surgery Exams

Q) A 4-year-old child presents with a history of infrequent, hard stools associated with painful defecation.

There is no history of vomiting, fever, or blood in the stool. On examination, there is a palpable fecal mass in the left lower abdomen, and the anal tone is normal.

What is the most likely diagnosis?
# Theme from Mock test 32

  • A) Hirschsprung disease
  • B) Functional constipation
  • C) Intussusception
  • D) Anal fissure

Breast cancer TNBC

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Q: Which of the following patients with operable breast cancer is the most appropriate candidate for preoperative systemic therapy?

A) A patient with ER-positive, HER2-negative breast cancer with a 1 cm tumor and clinically node-negative disease who desires breast conservation
B) A patient with HER2-positive breast cancer with a 3 cm primary tumor and clinically node-positive disease
C) A patient with triple-negative breast cancer with a 1 cm tumor and clinically node-negative disease who prefers mastectomy
D) A patient with ER-positive, HER2-positive breast cancer with a 1.5 cm tumor and no lymph node involvement
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