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Free MCQs in Surgery

Fuel for colonocytes

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MCQ on Primary Fuel for Colonocytes
Q) Primary fuel for colonocytes is
✅ Answer: C. Butyrate

🔍 Explanation:
Butyrate is the primary fuel for colonocytes. It is a short-chain fatty acid (SCFA) produced by the colonic flora when fermenting complex carbohydrates. The colonic epithelium and luminal bacteria form a crucial symbiotic relationship where bacteria produce butyrate, which provides essential nutrition to the colonocytes.

- **Antibiotics** disrupt this balance by reducing bacteria, leading to less butyrate, which negatively affects colonocyte function, often causing diarrhea.

🧠 Key Point: Butyrate, not glucose or lactate, is the key fuel for colonocytes, and its production relies on gut bacteria.

📘 Reference: NEET SS 2022 Paper

Lymphatic Spread carcinoma Prostate

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MCQ on Most Common Lymph Node Involved in Prostate Carcinoma
Q) Most common lymph node involved in carcinoma prostate is
✅ Answer: A. Obturator

🔍 Explanation:
The most common lymph node involved in **prostate carcinoma** is the **obturator lymph node**.

Lymphatic spread may occur via lymphatic vessels that pass to the **obturator fossa**, along the sides of the rectum to the lymph nodes near the **internal iliac vein** and in the hollow of the sacrum.

Additionally, lymphatics pass over the **seminal vesicles** and follow the **vas deferens** for a short distance to drain into the **external iliac lymph nodes**.

From the retroperitoneal lymph nodes, the **mediastinal nodes** and occasionally the **supraclavicular nodes** may become implicated.

🧠 Key Point: **Obturator lymph nodes** are the first to be affected in prostate cancer due to the nature of lymphatic drainage from the prostate.

📘 Reference: NEET SS 2022 Paper

Small Bowel Adenocarcinoma & its Risk Factors

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Small Bowel Adenocarcinoma MCQ
Q) Which of the following is not a risk factor / least associated with small bowel adenocarcinoma?
a) Familial adenomatous polyposis (FAP)
b) Hereditary nonpolyposis colorectal cancer
c) Peutz-Jeghers syndrome
d) Juvenile polyposis coli
Correct Answer: d) Juvenile polyposis coli
Explanation: Juvenile Polyposis Coli is least associated with small bowel adenocarcinoma. Risk factors for Small Bowel Adenocarcinoma: 1. Hereditary polyps: - Familial adenomatous polyposis (FAP) - Hereditary nonpolyposis colorectal cancer - Peutz-Jeghers syndrome 2. Inflammatory and metabolic: - Crohn disease - Gluten-sensitive enteropathy (celiac sprue) - Prior peptic ulcer disease - Cystic fibrosis - Biliary diversion (e.g., previous cholecystectomy) 3. Lifestyle: - Smoking - Heavy alcohol use (>80 g/day ethanol) - Red meat/salted food intake 4. Genetic: - Kras - 5q (APC gene) - 17q (p53 gene) - 18q - DPC4 - SMAD4 - MSI-H (Microsatellite Instability-High)

Virchow’s triad

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Virchow's Triad MCQ
Q) Which of the following does not form a part of Virchow's triad?
a) Endothelial damage
b) Slow blood flow
c) Platelet defects
d) Hypercoagulable state
Correct Answer: c) Platelet defects
Explanation: Virchow triad (venous stasis, endothelial injury, and hypercoagulability) describes the factors contributing to venous clot formation and thromboembolism. Platelet defects are associated with arterial thrombosis and not venous. Virchow is known as "the father of modern pathology" and founder of social medicine. --- Virchow’s Triad: Unraveling the Factors Behind Thrombosis 1. Endothelial Damage: Endothelial cells line blood vessels. When injured, they expose tissue factor, initiating clot formation. Seen in atherosclerosis, sepsis, trauma. 2. Abnormal Blood Flow: Stasis or turbulence promotes clotting. Causes include prolonged immobilization, atrial fibrillation, varicose veins. 3. Hypercoagulability: A state of increased clotting tendency. Causes: • Oral contraceptives, obesity, pregnancy • Inherited mutations (e.g. factor V Leiden) • Smoking, malignancy Most thrombi result from a combination of the above factors. Recognizing the triad aids in prevention and diagnosis of thromboembolic disease.

Antigen Presenting cells

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Q) Most potent cells that present antigen and are distributed throughout the lymphoid and nonlymphoid tissues of the body are?

✅ Answer: A. Dendritic cells

🔍 Explanation:
Dendritic cells are specialized macrophages and are considered professional antigen presenting cells (APCs). They are the most potent APCs in the body, distributed widely in both lymphoid and non-lymphoid tissues.

🧠 NK cells are large granular lymphocytes involved in innate immunity. They have cytolytic functions but are not classified as APCs.

🧠 Macrophages and monocytes can present antigens but are less efficient compared to dendritic cells.

📘 Recommended for Surgeons: Get Surgery Essentials

Paclitaxel group drugs

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MCQ on Group of Drug Paclitaxel Belongs To
Q) Which group of drug paclitaxel belongs to?
✅ Answer: A. Drugs which interfere with mitosis

🔍 Explanation:
Paclitaxel is a drug that interferes with mitosis. It belongs to the class of drugs that interfere with mitosis.

- Paclitaxel works by stabilizing microtubules and preventing their disassembly, thereby inhibiting cell division.
- Vincristine is also in the same group but it interferes with the formation of microtubules (spindle poison).

- Antimetabolites include drugs like 5-FU, Methotrexate, and Gemcitabine, which interfere with DNA synthesis.
- Drugs that directly damage DNA include Mitomycin, Cisplatin, Oxaliplatin, and Doxorubicin.
- Receptor tyrosine kinase inhibitors include drugs like Imatinib and Gefitinib.

🧠 Key Point: Paclitaxel is primarily classified as a drug that interferes with mitosis, making it a mitotic inhibitor.

📘 Reference: SRB’s Manual of Surgery

Trace elements deficiency

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MCQ on Trace Element Deficiency
Q) Which of the following trace elements deficiency causes impaired glucose tolerance, anemia, neutropenia, and leukopenia?
✅ Answer: B. Copper

🔍 Explanation:
Copper deficiency is associated with impaired glucose tolerance, anemia, neutropenia, leukopenia, and changes in skin and hair pigmentation.
Copper also plays a crucial role in collagen and elastin synthesis, scavenges free radicals, and is linked to fatal arrhythmias in its deficiency.

- **Zinc deficiency** causes growth retardation, immune dysfunction, and delayed wound healing but is not typically linked to significant neutropenia.
- **Molybdenum deficiency** is rare and linked to metabolic disorders but not hematological abnormalities.
- **Selenium deficiency** leads to cardiomyopathy (Keshan disease) and myopathy, but not neutropenia or leukopenia.

🧠 Key Point: Copper plays a vital role in multiple metabolic processes, and its deficiency can cause a range of hematological and metabolic abnormalities.

📘 Reference: MCQs on Nutrition and Perioperative Management

Necrotising Infections

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MCQ on Necrotizing Infections
Q) Least common Signs or symptoms of necrotising infections is
✅ Answer: D. Fever

🔍 Explanation:
**Fever is usually absent** in necrotizing infections.

Indicators of Necrotizing Infections include:
- **Severe and Unusual Pain**: Patients often report intense pain disproportionate to the visible injury.
- **Swelling Beyond the Redness**: Edema extends past the erythema, signaling deeper tissue involvement.
- **Presence of Crepitus**: A crackling sound or sensation beneath the skin caused by gas-producing bacteria.
- **Formation of Blisters**: Skin blisters indicate significant tissue damage.
- **Dishwater-like Drainage**: The infected site may discharge greyish, watery fluid, resembling dishwater.
- **Discoloration of Skin**: Pink or orange staining in the skin indicates infection severity.
- **Localized Skin Necrosis**: Late-stage gangrene may develop in the skin.

**Systemic Complications** may include shock, coagulopathy, and multi-organ failure as the infection advances.

🧠 Key Point: While fever is a hallmark of most infections, it is often notably absent in necrotizing infections, which can be a distinguishing factor.

📘 Reference: MCQs on Infections (Bailey and Sabiston)

Adenoid Cystic Tumors

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MCQ on Adenoid Cystic Tumor of the Hard Palate
Q) All are true for adenoid cystic tumor of the hard palate except:
✅ Answer: C. Lymph node metastasis

🔍 Explanation:
**Adenoid cystic carcinoma** is a rare tumor arising from the minor salivary glands, with the **palate** being the most common site.
- **Perineural invasion** is common and leads to the spread of the tumor along nerves.
- **Lung metastasis** is also frequent, with distant metastasis occurring via the bloodstream, often affecting the lungs and bones.
- The tumor is **uncapsulated** and infiltrative, which often leads to **local recurrence**.
- **Lymph node metastasis** is **uncommon**, with an incidence that is low.
- Direct extension of the tumor to the base of the skull may lead to severe complications and death.

🧠 Key Point: The most important distinguishing feature of adenoid cystic carcinoma is its tendency for **perineural invasion** and **lung metastasis**, but it rarely metastasizes to the lymph nodes.

📘 Reference: [NCBI Article](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633292/)

MCQ on General onco

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MCQ on Mechanisms of Cancer Cells Invasion
Q) Which is not a mechanism of cancer cells invasion?
✅ Answer: D. Extracellular matrix dissolution is due to physical factors

🔍 Explanation:
Cancer cells secrete collagenases and proteases that chemically dissolve extracellular boundaries to facilitate invasion.
The three main mechanisms by which cancer cells invade are:
- **Dissolution of Extracellular Matrix**: Cancer cells secrete enzymes like matrix metalloproteinases (MMPs) that break down the extracellular matrix, allowing for tissue penetration.
- **Acquisition of Mobility**: Cancer cells undergo changes in their adhesion properties and cytoskeleton, which allows them to move through tissues.
- **Rise in Interstitial Pressure**: Although this may affect fluid dynamics, it is a consequence of tumor growth, not a direct invasion mechanism.

🧠 Key Point: The dissolution of the extracellular matrix is a chemical process, not due to physical factors like pressure.