Q) Absolute contraindication for left lobe LDLT is
A. Trifurcation of the portal vein
B. Bifurcation of portal vein in the right lobe of the liver
C. Aberrant right hepatic artery
D. Right Posterior duct draining into left hepatic duct
Free Questions
Free MCQs in Surgery
Retained antrum syndrome
Q. True about retained antrum syndrome after gastrectomy are all except?
Correct Answer
c) Technetium labelled food is not helpful in diagnosing this condition
Explanation
After billroth II gastrectomy, if a cuff of gastric mucosa remains with duodenum, this entity is called as retained antrum syndrome. This cuff of gastric mucosa is cut off from the proximal stomach and inhibitory effect of hormones such as VIP (Vasoactive Intestinal Peptide) leading to a persistent hypergastrinemic state. ALso this gastric mucosa is continuously bathed by the alkaline contents of duodenum , which further increases the acid formation.
Both Basal and maximal gastric acid outputs increase but it is not as high as seen in zollinger ellison syndrome. Typically less than 1000 pg/ml
This condition can present as recurrent and persistent ulcerations. Technetium scanning is the diagnostic modality of choice. Treatment is re do surgery and antral excision.
Technetium pertechnate imaging has a sensitivity of 73% and specificity of 100%
Teaching Points
- Retained antrum syndrome occurs due to incomplete antrectomy, commonly after Billroth II gastrectomy.
- Loss of inhibitory hormonal control leads to persistent hypergastrinemia.
- Serum gastrin levels are elevated but usually <1000 pg/ml.
- Presents with recurrent or refractory peptic ulcer disease.
- Technetium pertechnate scan is the investigation of choice.
- Definitive treatment is redo surgery with excision of retained antrum.
More about retained antrum syndrome
Association of Carcinoma Esophagus
Q) Adenocarcinoma of esophagus is associated with which of the following? ( #All Esophagus MCQS)
a) Achalasia cardia
b) Barrett's disease
c) Human Papilloma virus (HPV)
d) Alcohol use
Esophagus Length
Length of Esophagus – MCQ for Surgery Exams
Q) Length of Esophagus is
A) 20 cm
B) 25 cm
C) 30–35 cm
D) 40 cm
GCS
Q. Best predictor in Glascow coma scale (GCS)
A. Eye opening
B. Motor response
C. Verbal response
D. All
Ans ) B, Motor response
In the Glasgow Coma Scale (GCS), motor response is considered the best predictor of patient outcomes, especially in assessing the severity of brain injury. This is because motor response correlates strongly with neurological function and brainstem activity, providing a more reliable indicator of the patient's level of consciousness and prognosis.
Why Other Choices Are Incorrect:
- A. Eye Opening:
Eye opening is important but is less specific as a predictor because it can be influenced by factors like sedation, drugs, or environmental stimulation. It is useful for initial assessment but not as accurate in determining long-term outcomes. - C. Verbal Response:
Verbal response can be influenced by factors like intubation, sedation, or pre-existing conditions affecting speech. It is less reliable in predicting outcomes in patients with severe head injuries, especially when they are unable to speak due to other medical interventions. - D. All:
While all components of the GCS are valuable in assessing consciousness, motor response alone has been shown to be the strongest predictor of outcome, making it the primary focus when assessing prognosis in severe head injuries.
Spinal cord injury
Q) Out of the following, which patient requires spinal immobilization the most?
✅ Answer: A. 22-year-old female involved in a high-speed motor vehicle collision with back pain
🔍 Explanation:
Spinal immobilization is most indicated when there's a high-risk mechanism of injury with suggestive symptoms, such as midline spinal pain or neurological signs.
A involves a high-energy mechanism (MVC) and reported back pain, which is a clear indication for spinal immobilization per NEXUS and Canadian C-spine rules.
B has a lower-risk mechanism and no symptoms; thus, spinal immobilization is generally not needed.
C – Gunshot wounds may or may not need spinal immobilization depending on location and neurological findings; not always indicated unless spinal structures are involved.
D – Isolated abdominal trauma is not an indication for spinal immobilization unless there’s evidence of spinal involvement.
⚡ Mechanism of Injury:
• Blunt trauma – Direct impingement, ischemia, compression or bleeding
• Penetrating trauma – Laceration of spinal cord
🩻 Chance fracture: A transverse fracture of all vertebral elements.
🩺 Management:
1. Complete immobilisation
2. Management of associated neurogenic shock (due to loss of sympathetic tone) with vasopressors and fluids
📘 Recommended Reading: Get Surgery Essentials
🔍 Explanation:
Spinal immobilization is most indicated when there's a high-risk mechanism of injury with suggestive symptoms, such as midline spinal pain or neurological signs.
A involves a high-energy mechanism (MVC) and reported back pain, which is a clear indication for spinal immobilization per NEXUS and Canadian C-spine rules.
B has a lower-risk mechanism and no symptoms; thus, spinal immobilization is generally not needed.
C – Gunshot wounds may or may not need spinal immobilization depending on location and neurological findings; not always indicated unless spinal structures are involved.
D – Isolated abdominal trauma is not an indication for spinal immobilization unless there’s evidence of spinal involvement.
⚡ Mechanism of Injury:
• Blunt trauma – Direct impingement, ischemia, compression or bleeding
• Penetrating trauma – Laceration of spinal cord
🩻 Chance fracture: A transverse fracture of all vertebral elements.
🩺 Management:
1. Complete immobilisation
2. Management of associated neurogenic shock (due to loss of sympathetic tone) with vasopressors and fluids
📘 Recommended Reading: Get Surgery Essentials
Harmonic Scalpel
Q. Harmonic scalpel frequency of vibration is ?
A. 20000-50000
B. 50000-80000
C. 80000-100000
D. >100000
Tropical Pancreatitis
Q) All are true about tropical pancreatitis except?
a. Associated with Tapioca.
b. Patients have large stones with fibrosis.
c. It is Pre Cancerous
d. Onset of disease at 50 years
Answer Free
Lymphatic right adrenal
Q) Lymphatic drainage of Right adrenal gland is to
a) Para aortic group
b) Inter Aortocaval
c) Pre aortic
d) Para Caval
Correct Answer: d) Para-caval for right and Para aortic for left
Small lymphatic channels from both cortex and medulla drain into the hilum, from where larger calibre lymphatic emerge to drain directly into the lateral group of para-aortic lymph nodes.
- Right side adrenal → Para-caval
- Left side adrenal → Para-aortic
Arterial supply:
- Superior adrenal artery (from inferior phrenic artery)
- Middle adrenal artery (from abdominal aorta)
- Inferior adrenal artery (from renal artery)
Venous drainage:
- Left adrenal vein → Left renal vein
- Right adrenal vein → IVC
Understanding lymphatic, arterial and venous drainage of the adrenal gland is critical in adrenalectomy and adrenal trauma surgery.
Isotonic fluid
Q) Isotonic fluid solution is
Answer: C – Ringer lactate
Ringer lactate and Normal saline are isotonic fluids. They are useful in replacing GI losses. Ringer lactate has a bit of potassium as well.
Ringer Lactate (Correct Answer):
Ringer lactate is an isotonic solution, meaning its osmolarity (around 273 mOsm/L) is close to that of human blood (around 275–295 mOsm/L). This solution contains electrolytes like sodium, potassium, calcium, and chloride, helping maintain fluid and electrolyte balance. It's commonly used for fluid replacement in surgical and trauma patients.
A. Half Normal Saline (0.45% NaCl):
Half normal saline is a hypotonic solution (~154 mOsm/L), which draws water into cells and may cause swelling—unsuitable for isotonic fluid replacement.
B. 1/5th Normal Saline (0.18% NaCl):
This is also hypotonic (~77 mOsm/L), risking excessive fluid entering cells and causing edema—unsuitable as an isotonic option.
D. Dextrose in Normal Saline (D5NS):
D5NS is hypertonic due to added dextrose, increasing osmolarity above blood levels, which can lead to water exiting cells and potential dehydration.
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