Free Questions

Free MCQs in Surgery

Differential diagnosis of mass in right iliac fossa

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Q) Patient with generalized ill health and pyrexia has a mass in the right iliac fossa with a history of blood-stained mucoid diarrheia? Most common etiology in this case would be ? 

a) Carcinoma

b) TB

c) Amoeboma

d) Lymphoma

More questions on general surgery tropical infections

Ans  c ✅

Amoeboma is partially treated amoebic infection of the caecum

It mostly presents as a mass in RIF and causes confusion with malignancy.

Such a patient is highly unlikely to have a carcinoma because altered bowel habit is not a feature of right-sided colonic carcinoma.

Ref Bailey page 58

Vascular occlusion ( MCQ with free answer)

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Q) During hepatic resection, there was excessive bleeding and Pringle's maneuvre was performed. What is false about vascular occlusion for hepatic surgery?

A. Portal triad clamping along with clamping of supra hepatic and infra hepatic IVC allows adequate bleeding control
B. Prolonged intermittent clamping is usually used in longer surgeries
C. Portal triad clamping can be done for 60 minutes under normothermia
D. Liver tolerates vascular clamping well

Ans b is false, Short intermittent clamping is better

Hepatic vascular exclusion (HVE) combines total inflow and outflow vascular occlusion of the liver. Total isolation of the liver
from the systemic circulation is intended during resection of large tumors adjacent to or involving the major hepatic veins
and/or the IVC.  ( BG 1619)

Intermittent inflow occlusion (Pringle, 1908) to control blood flow to the remnant, usually maintaining inflow occlusion for
periods of 15 minutes, interspersed by 5 minute periods of relief to allow perfusion of the remnant and decompression of
the bowel.

The superiority of intermittent inflow occlusion versus continuous or total occlusion is now widely accepted

According to the Cochrane database, in elective resection, intermittent portal triad clamping seems better than continuous clamping, especially in patients with diseased parenchyma. Therefore, intermittent triad clamping could be recommended as the “gold
standard” method of clamping

Clamps are applied for up to 60 minutes in patients with normal liver ( BG 1619)

c)  is true A number of studies have

established that ≤ 90 min of complete PTC is safe in normal livers. Nonetheless, many surgeons will not clamp the inflow continuously for > 45 min because of concern about occult liver damage and most resections can be accomplished within this time frame.

d) is true Although the liver is relatively resistant to periods of warm ischaemia, it is vulnerable to anoxic conditions and may be more severely vulnerable if it has been chronically damaged by either cirrhosis or chemotherapy.

ALPSS

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Free MCQ with CSS Toggle
Q) ALPSS all are true except?
✅ Answer: a) ALPPS should be considered in every patient in whom PVE or the classic two-stage approach is not feasible or has failed.

🔍 Explanation:
The limits for safe hepatic resections are usually considered from 20% to 40%, depending on the quality of liver parenchyma (fibrosis, steatosis, chemotherapy-related liver injury).

The lower limit for FLRV is set at 20% in patients with normal livers, 30% to 35% in patients with chemotherapy-related liver injury, and 40% in patients with chronic liver disease.

Cut-off values for proceeding to stage 2, usually after 7 to 14 days, are sFLR greater than 30% (BWR > 0.5%) or 40% (BWR > 0.8%) depending on parenchymal quality. (Ref BG page 1665)

Currently, CRLM is the most promising indication, especially for bilobar involvement.

In hilar cholangiocarcinoma, it is a relative contraindication as the mortality and morbidity are high.

Post op pulmonary complications

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Q) What does not decrease post op pulmonary complications?

  a) Smoking cessation

b) Epidural Anesthesia

c) Nasogastric tube

d) Preop and post op Spirometry

Free Questions

 Questions on Gen Surgery Peri op care

Ans c) Routine Naso gastric tube placement

Postop pulmonary complications occur in approximately 6% of patients after major abdominal operations and

It includes pneumonia/infection, respiratory failure requiring prolonged ventilation, exacerbation of chronic obstructive pulmonary disease (COPD), and lobar/parenchymal collapse with or without associated effusion.

More recently, standard patient care protocols (e.g., Cough) have been developed to decrease the risk of pulmonary complications, which include incentive spirometry, coughing and deep breathing, oral care (brushing teeth and using mouthwash), elevating the head of bed,
and getting out of bed three times a day.

Multimodal pain contro and judicious use of regional analgesia (e.g., thoracic epidurals) may
also help to prevent pulmonary complications in surgical patients.
Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice

Ref Sabiston 21 page 247

Surgery for Gastric volvulus

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Q)   Which is not an operative approach in  in gastric volvulus? ( Click for  more Questions on Stomach) 

a) Tanner

b) Opolzsr

c) Grey Ghimmenton

d) Gavrilu

Ans  d ) Gavrilu

Gavrilu is  trans-abdominal myotomy and antireflux procedure using a flap of greater curvature of stomach to be sutured over esophageal mucosa through a left subcostal incision

Division of gastro colic ligament and gastropexy is tanner

Splitting the meso colon and doing a gastropexy is grey ghimelton

Fundo antral gastrogastrostomy - opolzsr
Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice

Extra 

There are two main types of gastric volvulus:

  1. Organo-axial volvulus: In this type, the stomach twists along its long axis, causing the stomach to rotate excessively. This type is often associated with conditions that result in an elongated stomach, such as diaphragmatic hernias or paraesophageal hernias.
  2. Mesentero-axial volvulus: This type involves the stomach twisting around its mesentery, a fold of tissue that connects the stomach to other organs. It is less common than organo-axial volvulus and can be associated with conditions that cause the stomach to be in an abnormally mobile position.

Endocrine cells of Pancreas

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Q  Which is wrongly matched ( Free Questions) (#AIIMS 2021 GI Recall) 

a) Alpha cell - pancreatic poly peptide

b) Beta cell - insulin

c) Epsilon cell - ghrelin

d) Delta cell -  somatostatin

Ans a, ALpha cells

Alpha cells secrete glucagon

Pancreatic polypeptide is from F cells which form 15% of islet mass and are seen in Head and Uncinate process of Pancreas

Also alpha cells are the first cells to develop in the lineage
Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice

REf Sabiston 21st edition page 943

 

Sarcoma with early lymph node spread

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Soft Tissue Sarcoma MCQ – Early Lymph Node Metastasis – NEET SS
Q) Soft tissue sarcoma with early lymph node metastasis is:
✅ Correct Answer: d) All of the above

🔍 Explanation:
- Most soft tissue sarcomas spread hematogenously.
- However, certain sarcomas are known for early lymph node metastasis including:
✅ **Angiosarcoma** – High lymphatic spread
✅ **Pleomorphic sarcoma** (Undifferentiated pleomorphic sarcoma, formerly MFH)
✅ **Epithelioid sarcoma, rhabdomyosarcoma, clear cell sarcoma** – also associated with LN spread

📚 Early LN spread is a known exception pattern in STS and has prognostic implications.

👉 Explore more Liver and Oncology MCQs

Fibrolamellar HCC

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Fibrolamellar HCC MCQ – Liver Tumors – NEET SS Surgery
Q) Fibrolamellar HCC is associated with? ( #NEET Onco Questions 2020)
✅ Correct Answer: a) Young age

🔍 Explanation:
- Fibrolamellar Hepatocellular Carcinoma typically affects younger patients without underlying cirrhosis.
- It is often well-demarcated, encapsulated, and contains a central fibrotic scar.
- Prognosis is better than classic HCC due to higher resectability, absence of chronic liver disease, and a more indolent behavior.
- Long-term survival can be expected in ~50–75% of patients.
- However, lymph node metastasis **can occur**, and when present, is associated with poorer outcomes.

👉 Explore more Liver MCQs

Crohn Disease Pathology

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Q) Which of the following is not characteristic of Crohn Disease  : * (From AIIMS 2020 November GI)  

a) Granular mucosa
b) Transmural involvement
c) Skip lesions
d) Giant cell granuloma

Ans a ) Granular Mucosa- This is a feature of ulcerative colitis ( Table 49-7 Sabiston 20) 

The typical gross appearance of ulcerative colitis is hyperemic mucosa.

Friable and granular mucosa is common in more severe cases, and ulceration may not be readily evident. ( Saby 1340) 

IN Crohn disease - Microscopically, there are focal areas of chronic inflammation involving all layers of the intestinal wall with lymphoid
aggregates. Non-caseating giant cell granulomas are found in 60% of patients and when present clearly allow a confident diagnosis of CD.

( Bailey 1242) 

 

Gastrinoma diagnosis

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Q) Gastrinoma false is (AIIMS GI 2020) 
a) Fasting serum gastrin levels are  1000 g/ml
b) Duodenotomy should be done in all cases
c) Diarrhea most common symptom
d) SRS can localize 80% cases

Ans  )  c -

Duodenotomy detects 25% to 30% of tumors not seen on preoperative imaging.

Gastrin  levels higher than 1000 pg/mL are strongly suggestive of gastrinoma, provided that the patient demonstrated increased gastric acid  secretion ( gastric secretion ph should be less than 2) 

Most common is abdominal pain ( 75%) In 10% to 20% of patients, diarrhea is the only symptom

 Saby page 954) 

SRS should be performed because almost all gastrinomas express somatostatin receptors.