Free Questions

Free MCQs in Surgery

Highly selective vagotomy

by
Q) False about highly selective vagotomy? ( # Gastric Surgery MCQS)  (# Questions on Esophagus) 
a) Highly selective vagotomy divides the vagus nerves supplying the acid-producing portion of the stomach
b) Incidence of postoperative complications is lower.
c) The criminal nerve of Grassi should be severed

d) Crow's feet nerves are severed till below the GE junction

This Question discusses the concept of criminal nerve of Grassi and features of HSV

Ans -d

Highly Selective Vagotomy (HSV)  only divides the last part of the nerves which supply the part of stomach which produces acid.
Anterior  and posterior  nerves of Latarjet are found and their terminal branches are severed from 7 cm proximal to the pylorus to 5 cm above the GE junction
Motor function of the stomach is not affected
Criminal nerve of Grassi is branch of posterior Vagus. It should be sought and cut. This nerve derives its name from the common mistake done during vagotomy. This nerve is often missed and responsible for recurrence of symptoms of Peptic ulcer disease.

 

Criminal Nerve of Grassi is 1st branch of posterior vagus
Criminal Nerve of Grassi is from posterior vagus
MOre 

Vagus Nerve branches 

  • Anterior trunk: Gives
Branch to liver GB and Bile duct and goes along the lesser curvature as the anterior nerve of Latarjet

  • Posterior Trunk:

    Sends branches to the celiac plexus and continues along the posterior aspect of the lesser curvature as the posterior nerve of Latarjet.
    • Criminal Nerve of Grassi: The first branch of the posterior trunk, innervates the gastric fundus. Failure to divide this nerve during an acid-reducing surgery can lead to recurrent ulcers
    • Crows Foot: The most distal branches of the anterior and posterior trunks and provides innervation to the antro-pyloric region. These branches are spared in a highly selective vagotomy (HSV)
    • Parasympathetics are vagally mediated using acetylcholine as the primary neurotransmitter

Question on Dumping Syndrome

Post Whipple’s Bleeding

by
Free MCQ
Q) A 50-year-old male undergoes Whipple pancreaticoduodenectomy. On post-op day 4, he develops fever, tachycardia, and pain. Ultrasound shows a collection in the lesser sac, which is drained percutaneously. On post-op day 10, 100 ml of frank blood is noted in the drain. What is the next best step?
✅ Correct Answer: a. CT angiography

🔍 Explanation:
This is an extraluminal bleed on the 10th POD, likely due to a pancreatic fistula. The earlier POD 4 symptoms indicate a leak, which can lead to pseudoaneurysm formation. CT angiography is crucial to identify the bleeding source and evaluate for vascular injury or pseudoaneurysm, which may be amenable to embolization.

- Emergency laparotomy is reserved for unstable patients or failed embolization.
- Flushing the drain or observation are inappropriate and potentially harmful in the setting of active bleeding.

🔗 For more MCQs on the pancreas, visit: www.mcqsurgery.com/pancreas

Tumor lysis syndrome

by

Q)Tumor lysis  syndrome which is not seen? (# Electrolytes MCQ) 

a. Hyperkalemia

b Hypocalcemia

c. Hypophosphatemia

d. Hyperuricemia

Ans is c

This syndrome  releases, various intracellular  metabolites such as uric acid, potassium and phosphorous which overwhelm the excretory capacities of the kidney.

The metabolic anomalies are

Hyperuricemia

Hyperkalemia

Hyperphosphatemeia

Hypocalcemia

It mostly occurs in poorly differentiated leukemias and lymphomas

Other facts

Tumor Lysis Syndrome Tumor lysis syndrome (TLS) is a life-threatening condition that can occur when cancer cells die. As the cells die, they release their contents into the bloodstream, which can lead to a number of complications.

TLS is most likely to occur in people with rapidly growing cancers, such as leukemia, lymphoma, and multiple myeloma. It can also occur in people with solid tumors, such as breast cancer, lung cancer, and pancreatic cancer.

 

Corrosive Stricture esophagus

by

Q) Which modality has no part in management of corrosive injury of esophagus? 

a) Repeated Endoscopies routinely

b) Esophagectomy in some cases

c) Early emergency surgery routinely

d) Steroid use routinely

Corrosive stricture esophagus mcqs

C

In corrosive injury of the esophagus, routine early emergency surgery is generally not indicated. The primary approach involves stabilization, assessing the extent of injury, and supportive care. Surgery is reserved for specific complications, such as perforation or severe necrosis.

Other than the need for emergency surgery for bleeding or perforation, elective oesophageal resection should be deferred for at least 3 months until the fibrotic phase has been established.

Oesophageal replacement is usually required for very long or multiple strictures. Resection can be difficult because of perioesophageal inflammation in these patients.

Regular endoscopic examinations are the best way to assess stricture development .

Significant stricture formation occurs in about 50% of patients with extensive mucosal damageo Corrosives can cause significant pharyngolaryngeal oedema

In unusual circumstances, e.g. with extensive necrosis after corrosive ingestion, emergency oesophagectomy may be necessary.

Questions on Esophagus 

Alkali and acidic injuries to the esophagus, both leading causes of corrosive stricture of the esophagus, differ in their effects due to distinct chemical reactions with tissue.

 Mechanism of Injury

  • Alkali Injuries: Ingested alkalis (e.g., drain cleaners) cause liquefactive necrosis, where tissue rapidly breaks down. This process allows alkalis to penetrate deep into the esophageal layers, often causing severe, widespread injury that extends to adjacent tissues. As a result, alkali injuries frequently lead to extensive scarring and stricture formation over time, significantly impacting the esophageal lumen.
  • Acidic Injuries: Acids like hydrochloric acid cause coagulative necrosis, resulting in protein denaturation and an eschar formation. This eschar limits acid penetration depth, typically causing more superficial injury compared to alkalis. However, mucosal damage can still be severe, leading to ulceration and potential esophageal stricture over time, especially if the injury affects the lower esophagus.

Haemorrhoidectomy

by

Q) 57 year old male come to the surgery clinic with bleeding PR. He is diagnosed with Haemarrhoids . What is  not an indication of haemorrhoidectomy 

a) Persistent Second degree haemorrhoid 5 days after sclerotherapy

b) 3rd degree haemorrhoid

c) Fibrosed  haemorrhoid

d)  Interno-external haemorrhoids when the external haemorrhoid is well defined.

Ans a

Haemorrhoids can persist for 10 days after sclerotherapy

The indications for haemorrhoidectomy include:

● third- and fourth-degree haemorrhoids;

● second-degree haemorrhoids that have not been cured by non-operative treatments;

● fibrosed haemorrhoids;

● interno-external haemorrhoids when the external haemorrhoid is well defined.

Four degrees of haemorrhoids ●●

First degree – bleed only, no prolapse ●●

Second degree – prolapse but reduce spontaneously ●●

Third degree – prolapse and have to be manually reduced ●●

Fourth degree – permanently prolapsed

MCQS on Rectum