Free Questions

Free MCQs in Surgery

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.

Meld score uses and drawbacks

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Q. All are true about Na-MELD except :

a) It corelates with cirrhosis
b)Range of sodium value  is 125-137
c)It relates to vasoconstriction
d) Used for allocation in DDLT patients

Ans c

 MELD was originally developed to predict three-month mortality following transjugular intrahepatic portosystemic shunt (TIPS) placement and was derived using data from a population of 231 patients with cirrhosis who underwent elective TIPS placement.

Range of MELD score is 6-40

MELD Score = 10 x (0.957 x Ln(serum creatinine mg/dL) + 0.378 x Ln(serum bilirubin  mg/dL) + 1.120 x Ln(INR) + 0.643 )

For candidates with an initial MELD score greater than 11, the MELD score is then re-calculated as follows:
MELDNa = MELD(i) + 1.32*(137-Na) - [0.033*MELD(i)*(137-Na)]

  • Sodium values less than 125 mmol/L will be set to 125, and values greater than 137 mmol/L will be set to 137.

It is used for allocation in DDLT to assess wait list mortality

MELD score has also proved to be an effective predictor of outcome in other situations, such as

  1. Patients with cirrhosis going for surgery and patients with fulminant hepatic failure or alcoholic hepatitis.
  2. The MELD score does have limitations in situations where the INR or creatinine may be elevated due to reasons other than liver disease, and its implementation for organ allocation purposes does not take into consideration several conditions that benefit from liver transplantation.

Smoking treatment

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Q) Smoking cessation- Not a  first line drug option ?

a) Clonidine 

b) Nicotine replacement (patches)

c) Varenicline

d)  Bupropion

Ans A) clonidine

NRT ,  varenicline (Chantix), and bupropion (Zyban) are the three principal firstline pharmacotherapies recommended for use either alone or in combination 

Clonidine and nortriptyline—as second-line pharmacotherapies for tobacco dependence typically used when a smoker cannot use first-line medications due to either contraindications or lack of effectiveness.

Ref Devita

Fong Score

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Q. 56 year ls male is diagnosed with ca rectum and multiple liver metastasis . Which of the following is not a Poor risk factor according to Fong score

a) Node +
 b) Disease free interval more than 1 yr
c) 2 Liver Mets

d) Single metastasis 6 cm

Ans b 

Fong score is for Survival after treatment for metastatic colorectal cancer to the liver. It includes 5 variables for which score is alloted to each point

Nodal status of primary

Disease-free interval from the primary to discovery of the liver metastases of <12 months

Number of tumors >1,

Preoperative CEA level >200 ng/ml, and

Size of the largest tumor >5 cm

 

Steroid Refractory Ulcerative colitis

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Q) Not used in steroid refractory severe Ulcerative Colitis ( AIIMS 2020 Nov) 

a) Infliximab
b) Azathioprine
c) Cyclosporine
d) Surgery

Ans b- Azathioprine

Cyclosporine is  immunomodulator indicated for second-line therapy in the case of severe, steroid refractory ulcerative colitis. Treatment is usually initiated after 3 to 5 days of failed steroid response

Tacrolimus is appropriate as second-line therapy in patients with severely active ulcerative colitis unresponsive to steroids.

The use of various anti–tumor necrosis factor-α  (TNF-α) monoclonal antibodies ( infliximab)  is well supported in the case of
severe ulcerative colitis refractory to steroids. 

Indication Surgery crohn disease

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Q. Most common indication of surgery in Crohn's disease (#AIIMS GI )    (# Jejunum MCQS) 
a) Fistula
b) intractability
c) abscess
d) obstruction

Ans d Obstruction

Confusion between failure of medical therapy or obstruction as the ans. I have checked Bailey sabiston and Shackelford

2 books mention obstruction on top whereas one mentions failure of medical therapy. However with the improvement of medical management in the past decade, obstruction can be the ans

Crohn’s disease will require surgery at some time durin the course of their illness. Approximately 70% of patients will
require surgical resection within 15 years after diagnosis.

Indications for surgery include failure of medical treatment, bowel obstruction, and fistula or abscess formation. Most patients can
be treated with elective surgery,

CDH 1 gene

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Q) CDH 1 gene is associated with which cancer

a) Breast

b) Colon

c) Prostate

d) Renal

ANs a

CDH 1 is with gastric and lobular breast cancer

The CDH1 gene is responsible for  making a protein called epithelial cadherin or E-cadherin.

Germline mutation in the CDH1 gene encoding E-cadherin is  shown to be associated with hereditary diffuse gastric cancer. Also RHOA gene is also associated with Ca stomach

Prophylactic total gastrectomy should be considered in patients with these mutations

Renal cancer is mainly associated with VHL gene

Gene mutation associated with CDH 

E Cadherin is involved in

a) Cell Adhesion

b) Cell maturation

c) Managing intracellular chemical signals

d) It acts as a tumor suppressor protein

Colon Lymphoma

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Q) True about lymphoma of the colon?

a) More common in females

b) Most common in 3rd and 4th decade

c) Most common site is caecum

d) T cells are most commonly involved

Surgery Questions on Colon

MCQs in Rectum

Ans c

Lymphoma is uncommon in the colon/rectum occurring in 0.4% of patients; intestinal lymphoma and can present anywhere between the
second and eighth decades of life.

Most of these lesions are intermediate to high-grade B-cell lymphomas.

Affected men outnumber women about 1.5:1 

The majority of colorectal lymphomas are found in the cecum or ascending colon. More than 70% of colorectal lymphomas are proximal to the hepatic flexure. 

Colon Lymphoma Pathology Outlines 

Extranodal Marginal Zone B-Cell Lymphoma

ENMZL, formerly known as marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma)

Low-grade lymphoma involving cells that arise from the marginal zone surrounding lymphoid follicles.

23%–48% of all primary GI NHLs, second only to DLBCL in most series

ENMZLs are heterogeneous lymphomas, often containing monocytoid-like cells, plasma cells, and scattered large cells intermixed with marginal zone cells.

There are small cells with irregular cleaved nuclei and a moderate amount of clear cytoplasm

DLBCL

Microscopic Appearance  diffuse sheets of large lymphoid cells infiltrate the lamina propria and submucosa, with frequent obliteration of the muscularis propria and ulceration of the overlying mucosa.

Irregular nuclei, prominent nucleoli, and basophilic cytoplasm and are more than twice as large as normal lymphocytes.

Other less common type is  Mantle cell lymphoma

Our Recommendations

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, 10th Edition

Yttrium 90

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Q ) Which of the following statement regarding yttrium 90 is incorrect: ( From Gen onco Surgery Q 21-40) 
a. Used for brachytherapy
b. Is a pure beta emitter with range of 1 cm
c. Most commonly used for treatment of ca prostate
d. Used in treatment of both primary and metastatic liver cancer through hepatic artery embolization

Answer: ) C ref devita page 212.

Iodine 125 and pallidium 103 are commonly used for prostate.

All other choices are true

Colon Lymphoma

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Q) A 55-year-old male patient presents with chronic abdominal pain, weight loss, and intermittent diarrhea. Colonoscopy reveals a mass in the cecum, and biopsy confirms colonic lymphoma. Which of the following statements is most likely true regarding this condition?

A) Colonic lymphoma is predominantly of T-cell origin
B) It is more common in females
C) The cecum is the most common site of involvement
D) It typically presents in the 3rd and 4th decades of life

C) The cecum is the most common site of involvement

Explanation:

Colonic lymphoma is a rare form of lymphoma that primarily affects the gastrointestinal tract. Among the options provided:

  • A) Colonic lymphoma is predominantly of T-cell origin: This is incorrect. Colonic lymphoma is most commonly of B-cell origin, particularly extranodal marginal zone lymphoma (MALT lymphoma), rather than T-cell lymphoma.
  • B) It is more common in females: This is also incorrect. Colonic lymphoma does not have a strong gender predilection. The incidence is more balanced between males and females.
  • C) The cecum is the most common site of involvement: This is correct. The cecum is the most frequent site of involvement in colonic lymphoma, especially for extranodal B-cell lymphoma, such as MALT lymphoma. It tends to present as a mass-like lesion, often causing symptoms such as abdominal pain and weight loss.
  • D) It typically presents in the 3rd and 4th decades of life: This is incorrect. Colonic lymphoma is more commonly diagnosed in older adults, typically over the age of 50. It is relatively rare in younger individuals.