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NOTES

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Q) Regarding minimal access cholecystectomy all are true except?

a) NOTES can be done transvaginally and transgastrically

b) Transgastric route is preferred

c) SILS is done through single port with multiple instruments avoiding multiple ports

d) SILS has difficulty with triangulation and retraction

Answer is B

Natural  orifice  transluminal  endoscopic  surgery (NOTES),  which  uses  natural  orifices  (transgastric, colonic,  urethral,  vagina)  to  introduce  an  endoscope,  has been  reported  since  early  2000  as  a  less  invasive  approach to  laparoscopy. 

The  first  human  NOTES  transvaginal  cholecystectomy  was  reported  in  2007,  and  later  the  report  of a  hybrid  combination  of  flexible  scope  by  a  transvaginal approach  in  combination  with  an  umbilical  needle  or port  for  laparoscopic  instruments  for  retraction,  dissection,  or  clips  application. 

This  hybrid  technique  allowed for  a  quicker  and  safer  procedure;  the  present  deficiency is  in  the  proper  endoscopic  instrumentation. For  the  trans vaginal  approach,  a  Foley  catheter is  placed,  a  dissection  is  performed  in  the  posterior vaginal  cul-de-sac  to  allow  a  port  placement,  and  when the  case  is  over,  the  closure  is  easier  than  a  transgastric or  transcolonic  approach,  which  continues  to  be  an  issue.

Shackelford

Association of Carcinoma Esophagus

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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

Answer - b

Association of carcinoma esophagus is with a number of risk factors. Both squamous cell carcinoma and adenocarcinoma of esophagus have different etiologies

Risk factors for Adenocarcinoma are                                                Risk factor for SCC 

  1. Tobacco                                                                                                   1. Alcohol
  2. GERD                                                                                                       2. tobacco 
  3. Obesity                                                                                                     3. Achalasia
  4. Barrett                                                                                                      4. Caustic injury of esophagus
  5. H/o previous radiation for breast cancer                                         5. Previous radiation of CA breast                

                                                                                                                             6. H/o head and neck cancer

                                                                                                                             7. Plummer vinson and tylosis

 

Achalasia is associated with both Adenocarcinoma and SCC ( Table 35.2 - Shackelford) 

Esophagus Length

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Length of Esophagus – Surgery MCQ with Answer

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

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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:

  1. 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.
  2. 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.
  3. 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

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Spinal Immobilization MCQ | Free NEET SS Surgery Question
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

Harmonic Scalpel

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Q. Harmonic  scalpel frequency of vibration is ?
A. 20000-50000
B. 50000-80000
C. 80000-100000
D. >100000

Ans a

The harmonic scalpel transduces high-frequency ultrasonic energy through a metallic jaw to generate mechanical vibration. It has an active and an inactive blade When in contact with tissue, the vibration of a single blade against a static blade results in vaporization and coagulation.

Harmonic scalpel also called ultrasonic scalpel cuts through tissues and causes coagulation by protein denaturation caused by vibrating force. As compared to electro cautrey harmonic scalpel

  1. takes longer time 
  2. produces less smoke
  3. Cause less tissue edema, swelling

Tropical Pancreatitis

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Free MCQ - 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

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Lymphatic Drainage of Right Adrenal Gland | Adrenal Surgery MCQ

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.

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Isotonic fluid

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NEET SS Surgery MCQ – Isotonic Fluid (Free)
Q) Isotonic fluid solution is
  • A. Half normal saline
  • B. 1/5th normal saline
  • C. Ringer lactate
  • D. Dextrose in Normal saline

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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Vascular ring

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True Vascular Ring MCQ | NEET SS Surgery

True Vascular Ring - NEET SS Surgery MCQ

Q) Which is a true vascular ring?
a) Pulmonary artery sling
b) Double aortic arch
c) Cervical aortic arch
d) Origin of subclavian artery from descending aorta

Correct Answer: b) Double aortic arch

Double aortic arch is a classic example of a true vascular ring. It forms a complete ring around the trachea and esophagus, leading to compressive symptoms such as stridor, wheezing, or feeding difficulties.

Pulmonary artery sling is not a vascular ring. It is a congenital anomaly where the left pulmonary artery arises from the right pulmonary artery and passes between the trachea and esophagus but does not form a complete ring.

Cervical aortic arch is a rare anomaly and does not form a true vascular ring.

Aberrant origin of subclavian artery (e.g., aberrant right subclavian artery from the descending aorta) is considered a partial ring and usually causes less significant symptoms compared to true vascular rings.

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