Type III Hiatal Hernia MCQ for NEET SS | mcqsurgery.com
What is a Type III esophageal (hiatal) hernia?
Correct Answer
c) Combination of sliding and paraesophageal hernia
Explanation
Hiatal hernias are classified based on the position of the gastroesophageal junction and stomach.
Type I involves upward displacement of the GEJ into the thorax.
Type II has a normally positioned GEJ with part of the stomach herniating alongside the esophagus.
Type III is a mixed hernia where both the GEJ and stomach herniate into the thoracic cavity.
Option (d) is more consistent with a giant paraesophageal hernia (Type IV).
Teaching Points
Type I is the most common and associated with GERD
Type III is a mixed hernia involving GEJ and stomach
Type II and III have higher risk of volvulus and strangulation
Large hernias with most of the stomach in chest are Type IV
Hepatic Hemangioma Management MCQ for NEET SS | mcqsurgery.com
A 38-year-old woman is found to have a 12-cm hepatic hemangioma. Which statement regarding management is true?
Correct Answer
d) If surgery is planned, peripherally located hemangiomas should be enucleated
Explanation
Hepatic hemangiomas are the most common benign tumors of the liver and are usually detected incidentally.
Management depends on symptoms, complications, and diagnostic certainty, not size alone.
Size and surgery:
Lesion size alone, even when greater than 10 cm (giant hemangioma), is not an indication for surgery if the patient is asymptomatic.
Oral contraceptives and pregnancy:
Although estrogen exposure may cause hemangioma enlargement, there is no strong evidence that oral contraceptive pills or pregnancy significantly increase the risk of rupture. Routine avoidance is not recommended.
Role of arterial embolization:
Arterial embolization is not performed routinely. It is reserved for:
Symptomatic patients unfit for surgery
Acute bleeding
Preoperative reduction of tumor vascularity
Surgical technique:
When surgery is indicated (symptoms, complications, or diagnostic uncertainty), enucleation is preferred for peripherally located hemangiomas because it:
Preserves maximum liver parenchyma
Results in less blood loss
Has lower morbidity compared to formal hepatic resection
Teaching Points
Hepatic hemangioma is the most common benign liver tumor
Size alone is not an indication for surgery
Most asymptomatic hemangiomas require only observation
Enucleation is preferred over resection when surgery is needed
Embolization is reserved for selected symptomatic or high-risk cases
Hirschsprung’s Disease MCQ for NEET SS | mcqsurgery.com
Which of the following is a FALSE statement regarding Hirschsprung’s disease?
Correct Answer
a) Male and female have equal incidence
Explanation
Hirschsprung’s disease is a congenital disorder characterized by absence of ganglion cells in the distal bowel, leading to functional intestinal obstruction.
Sex distribution:
Hirschsprung’s disease shows a clear male predominance.
The male-to-female ratio is approximately 4:1 in short-segment disease.
Therefore, equal incidence in males and females is false.
Extent of disease:
Total colonic aganglionosis occurs in about 5–10% of patients, making option (b) true.
Postoperative outcome:
Following pull-through surgery, bowel dysfunction is common.
Constipation is the most frequent long-term problem, so option (c) is true.
Genetic associations:
Hirschsprung’s disease is associated with chromosomal anomalies.
Down syndrome is seen in approximately 2–10% of cases, making option (d) true.
Teaching Points
Hirschsprung’s disease has a strong male predominance
Total colonic aganglionosis occurs in about 5–10% of cases
Constipation is the most common long-term complication after surgery
Down syndrome is the most common genetic association
Enterocolitis is the most feared complication, especially in infants
Q) Which of the following is true about screening in hepatocellular carcinoma (HCC Cancer)
a) Alpha feto protein should be done 6 monthly
b) Ultrasound abdomen should be done 6 monthly
c) Candidates for liver transplant should be screened every 3 months
d) Nodules more than 2 cm should be followed up more regularly
Answer b
Cirrhosis is prone for development of HCC. Screening has to be stringent. Earlier ultrasound of liver and alpha feto protein were both used for screening
In 2009 Marrero et al demonstrated the suboptimal accuracy of AFP and after that it has been removed from the screening protocol and now only ultrasound is being done.
The screening recommendation is not for those patients with severe associated conditions and with advanced liver disease who are already considered for transplant. So there is no screening for those who are already listed. Nodules more than 1 cm are highly suspicious where as in nodules less than 1 cm only 40% will be malignant.
Q) Which statement is not true about recurrent pyogenic cholangitis :
a) Mostly there are intrahepatic strictures with involvement of the left side duct
b) It can present as choledocho duodenal fistula
c) There is complete biliary obstruction which leads to marked jaundice and pruritis
d) MRCP and other other cholangiography can be diagnostic
Answer c
In recurrent pyogenic cholangitis (RPC) complete obstruction does not occur and jaundice and pruritis is not marked.
RPC is a disease commonly seen in young Asians (also known as oriental cholangiohepatitis) which leads to multiple strictures in extra or intrahepatic ducts.
Men and women are equally affected, and, historically, the disease strikes at an early age (20–40 years) in patients from lower socioeconomic classes.
Cause for recurrent pyogenic cholangitis
Association with Ascaris lumbricoides and Clonorchis sinensis has been noted.
Stones and strictures
Clinical Presentation of Recurrent pyogenic Cholangitis
It can present as choledocholithiasis with stricture, choledochoduodenal fistula, acute pancreatitis, secondary biliary cirrhosis and can lead to cholangiocarcinoma.
Radiology for Recurrent Pyogenic Cholangitis
MRCP can be diagnostic and is preferred because of its non invasive nature.
Surgical treatment
Goal is to clear the biliary tree and to bypass or resect the strictures
Beger Procedure in Chronic Pancreatitis | Surgery MCQ
Q: True about Beger procedure for chronic pancreatitis
# Theme NEET SS Pancreas MCQ
a) Posterior branch of gastro duodenal artery is preserved.
b) Beger procedure is a pancreatic head mass resection that can be done for small pancreatic tumors.
c) Intra pancreatic, choledochal and ampullary structures are removed.
d) Neck of the pancreas is not transected
🆓 This is a free MCQ — click below to view the answer.
✅ Correct Answer: a) Posterior branch of GDA is preserved
Beger procedure for chronic pancreatitis is mostly done in Europe. Hans Beger in 1972 in Germany introduced this for chronic pancreatitis with inflammatory head mass. This is a complex procedure which removes head of the pancreas but leaves duodenum, a thin rim of pancreas around the medial aspect of duodenum and intrapancreatic bile duct intact.
The difference from similar Frey's procedure is that in Beger procedure neck of the pancreas is transacted whereas in Frey, neck of the pancreas is not cut.
This procedure is not recommended if there is suspicion of carcinoma head of pancreas and Whipple is the procedure for that. For small tumors it can be used.
Posterior branch of GDA is preserved in Beger Procedure.
Reconstruction is at two places: Distal pancreas and rim of the pancreas at medial side of duodenum.
