Free Questions

Free MCQs in Surgery

Compartment syndrome of limb

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Compartment Syndrome of Limb – Free Surgery MCQ

Q) All are true about compartment syndrome of limb except?

a) Diagnosis is unlikely if pulse is felt distally
b) There is pain on passive stretching of the limb
c) Pain is out of proportion to the signs
d) Muscles of calf and forearm are commonly involved

Strongest layer of the intestine

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Strongest Layer of Intestine MCQ - Surgery Exam Preparation
Q) Which is the strongest layer of the intestine?
a) Mucosa
b) Submucosa
c) Muscularis propria
d) Muscularis mucosa

Answer:

b) Submucosa is the strongest and most important layer for intestinal anastomosis. It has fibroblasts that will ultimately release collagen and hold the anastomosis together. This layer should be fully incorporated in the anastomosis.

Inverted vs everted anastomosis of intestine debate has been long going on, but now many prefer inverted because mucosa is exposed to mucosa and eventually degrades, joining the two submucosa layers together to cause healing by primary intention.

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Free questions on esophagus: www.mcqsurgery.com/esophagus

Borrmann’s classification for ca stomach

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Q) According to Borrmann's Classification of Ca stomach Type II is?

a) Fungating

b) Polypoid

c) Ulcerative

d) Infiltrative

Borrmann’s pathologic classification of gastric cancer is  based on gross appearance.

Developed in 1926

Gastric carcinoma is divided into 5 types according to this classification

Read on >>>

Ans  c

Ulcerative with elevated borders

Borrmann’s classification is for advanced gastric tumors. 

It is useful to distinguish between advanced and early gastric tumors because in advanced tumors neo adjuvant therapy improves over all survival.

The gross appearance of advanced gastric carcinomas can be divided into

Type I for polypoid growth or fungating 

Type II for Ulcerated with elevated borders

Type III for ulcerating with invasion of wall

Type IV for diffusely infiltrating growth which is also referred to as linitis plastica 

Type V can not be classified

 

Endocrine cells of pancreas

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Q) Delta cells in the pancreas secrete

a) Insulin

b) Glucagon

c) Somatostatin

d) Secretin

Answer d

Somatostatin

Endocrine pancreas
Endocrine cells of pancreas

Pancreas- Endocrine functions

Beta cells form 65-80% of pancreatic endocrine cells and produce insulin

Alpha cells 12-20% and produce glucagon

Delta cells 3-10% and produce somatostatin

PP cells - Pancreatic polypeptide 1%

Somatostatin is an inhibitory hormone and inhibits most of the things

Thyroid Questions

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Q) Which of the following thyroid cancers do not take up radio active iodine

a) Medullary carcinoma thyroid

b) Papillary  carcinoma

c) Follicular carcinoma

d) Hurthle cell carcinoma

Neet onco 2020
 Drugs in onco 

a - Medullary carcinoma

Medullary carcinoma of the thyroid is a tumor that arises from the C cells ie the parafollicular cells and not from cells of thyroid follicles.

These are not TSH dependent and hence do not take up radioactive iodine

Hurthle cell carcinoma is a variation of follicular carcinoma only.

In these tumors lymph node involvement is about 60%

Bailey page 769

Endovenous Laser Ablation of varicose veins

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Q) Endovenous Laser Ablation (EVLA) of varicose veins is best suited for patients:

A. With needle phobia
B. With thrombophlebitis
C. With excessive tortuosity of the vein
D. With primary varicose veins

Ans d

EVLA is thermal ablation of varicose veins in which laser  fiber is inserted in the lumen and ablation is done from inside. It is a good modality for primary and recurrent varicose veins and work in both long and short segments.

This treatment is not effective in cases where there is needle phobia or the veins are having excessive tortuousity or thrombophlebitis. This procedure is done under ultrasound guidance and  wire is passed from the superficial to the deep veins.

Tumescent means swollen or distended, typically due to the infiltration of fluid.

  • It refers to the injection of a large volume of dilute local anesthetic solution (usually lidocaine with epinephrine and saline) into subcutaneous tissue.

  • This causes the tissue to swell or become turgid (tumescent).

In procedures like endovenous thermal ablation:

Tumescent solution:

  • Compresses the vein to improve contact with the ablation device.

  • Separates the vein from surrounding structures (like nerves or skin).

  • Acts as a thermal insulator (heat sink) to prevent collateral damage.

Tumescent local anesthesia also helps

  • A. Needle phobia – EVLA requires multiple needle sticks (tumescent anesthesia), making this option inappropriate.

  • B. Thrombophlebitis – Active inflammation or thrombosis is a relative contraindication to EVLA.

  • C. Excess tortuosity – Makes catheter navigation difficult; EVLA is less suitable.

  • D. Primary varicose veins – Ideal candidates, especially with straight vein anatomy and valvular incompetence.

 

Atrial Septal Defect

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Most Common Type of ASD MCQ for NEET SS | mcqsurgery.com

Most common type of atrial septal defect (ASD) is:

Correct Answer

B) Ostium secundum

Explanation

Atrial septal defects are classified according to their anatomical location within the atrial septum.

  • Ostium secundum ASD:
    Located at the region of the fossa ovalis. It accounts for approximately 70–75% of all atrial septal defects, making it the most common type.
  • Ostium primum ASD:
    Less common. Typically associated with atrioventricular septal defects and endocardial cushion defects.
  • Sinus venosus ASD:
    Relatively rare. Commonly associated with partial anomalous pulmonary venous return.
  • Comparison:
    Since ostium secundum defects are far more frequent than other types, option (D) is incorrect.

Teaching Points

  • Ostium secundum ASD is the most common type (≈70–75%)
  • Located at the fossa ovalis
  • Ostium primum ASD is associated with AV canal defects
  • Sinus venosus ASD is commonly associated with anomalous pulmonary venous return
  • Fixed split S2 is a classic clinical finding in ASD
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Whipple’s triad

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Q) Whipple's triad is seen in which pathological condition?

a) Insulinoma

b) Glucagonoma

c) VIPOma

d) Somatostatinoma

 

Answer 

a) Insulinoma

Whipple's triad is seen in pancreatic insulinoma and consists of 

a) Symptoms of hypoglycemia

b) Fasting sugar less than 50 mg%

c) Relief of symptoms with administration of dextrose solution

Other Points

  • Insulinoma is the most common functioning pancreatic neuroendocrine tumor
  • Symptoms are present for many years before diagnosis
  • Weight gain is common
  • Distribution of insulinomas is equal in body head and tail
  • Average size of insulinoma is 1-1.5 cm

Symptoms of Insulinoma

The neuroglycopenic symptoms of insulinoma included confusion, visual change, and unusual behavior

Sympathoadrenal symptoms may include palpitations, diaphoresis, and tremulousness.

Whipple's triad is just a part of Insulinoma and is not pathognomic of it. This entity may also be seen in other hyperinsulinemic conditions.

For endogenous Insulinoma, following tests are done

Proinsulin above 5.0 pmol/L

insulin above 3.0 pmol/L,

C-peptide above 0.2 nmol/L

all demonstrate endogenous hyperinsulinemia

In Memoriam: Allen O. Whipple, M.D

Inversion of nipple

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Q) Simple nipple inversion is seen in?

a) Duct ectasia

b) Puberty

c) Peri ductal fibrosis

d) Carcinoma breast

Answer of this question is free. Click the link for more similar questions for MCH preparation

Ans is b

Inversion of nipple  is  seen in a lot of conditions, both benign and malignant.

Common causes are 

Benign causes of Nipple inversion

  1. Duct ectasia
  2.  After breast Surgery
  3. Fat necrosis
  4. Mondor disease
  5. Chronic peri ductal mastitis

Malignancy

  1. Carcinoma breast 

Rapid unilateral development of inversion of nipple is a dangerous sign and warrants further diagnosis. Further circumferential retraction is also sign of carcinoma.

Simple nipple inversion occurring at puberty  or retracted nipple is of unknown cause and is bilateral in 25%. Mostly No treatment is required for this and condition resolves spontaneously during pregnancy and lactation.

Suction pumps and cosmetic surgery can also help.

Inversion of nipple associated with malignancy may be with or without the presence of lump. Associated discharge from the nipple can point to the diagnosis.

Duct ectasia - slit like retraction of nipple . ALso seen in duct ectasia is green, black or blood stained discharge from nipple

 

 

Ref - Bailey 801

Grading of benign nipple inversions for management

In grade I, the nipple is easily pulled out manually and maintains its projection quite well.  It has minimal fibrosis  thus, manual traction and a single, buried purse-string suture are enough for the correction.

Grade II (majority)  the nipples can be pulled out but cannot maintain projection and tend to go back again. These nipples are thought to have moderate fibrosis beneath the nipple.

In grade III, to which the least number of inverted-nipple cases belong, the nipple can hardly be pulled out manually. Severe fibrosis made it impossible to reach optimal release of the fibrotic band with the preservation of the ducts.

Ref https://www.ncbi.nlm.nih.gov/pubmed/10654681

 

Our Recommendations of surgery Books

BEST TEXTBOOKS FOR GENERAL SURGERY

Bailey & Love’s Short Practice of Surgery, 27th Edition

Sabiston’s Textbook of Surgery

Schwartz’s Principles Of Surgery

SRB’S Manual Of Surgery

BEST BOOKS FOR OPERATIVE SURGERY

Operative Techniques in Surgery by Michael W. Mulholland et al

Chassin’s Operative Strategy in General Surgery

Farquharson’s Textbook of Operative General Surgery

Q)  Is nipple inversion a sign of breast cancer?

A) Not always but above the danger signs and symptoms are listed