General Surgery

NEET, DNB questions from general surgery

CEA

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Q True regarding CEA is  (AIIMS 2017 , JIPMER 2016) 

a) Low specificity

b) Falls after 1 week of surgery to baseline

c) Preoperative high value is good prognostic marker

d) Follow up, first test of CEA in 8-10 days followed by weekly tests thereafter

Another question on CEA can be seen here

Answer 

Restrictive blood transfusion

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Q) Restrictive strategy of transfusion in acute GI bleed  all are true except?

A. Should be started at a hemoglobin < 7 g/dl
B. Will not alter the risk of rebleed
C. Child A and B patients had significantly lower risk of gi bleed

d) None of the above

 

CDH 1 mutation

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Q ) Hereditary diffuse Gastric carcinoma is associated with which  breast cancer
A. Ductal carcinoma NOS subtype
B. Lobular carcinoma
C. DCIS
D. Metaplastic carcinoma

Answer for Q 79

Majority of Gastric Cancers are sporadic,

1–3% of GCs arise as a result of inherited cancer predisposition syndromes.

 Li-Fraumeni syndrome, Lynch syndrome, Peutz-Jeghers syndrome, hereditary breast and ovarian cancer,MUTYH-associated adenomatous polyposis (MAP), familial adenomatous polyposis,  juvenile polyposis syndrome and PTENhamartoma tumour syndrome (Cowden syndrome).

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Retained antrum syndrome

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Retained Antrum Syndrome MCQ | Post Gastrectomy Complications | NEET SS
Q. True about retained antrum syndrome after gastrectomy are all except?
a) It is a persistent hypergastrinemic state
b) It is only seen after Billroth II gastrectomy
c) Technetium labelled food is not helpful in diagnosing this condition
d) Serum gastrin is usually less than 1000 pg/ml
Correct Answer

c) Technetium labelled food is not helpful in diagnosing this condition

Explanation

After billroth II gastrectomy, if a cuff of gastric mucosa remains with duodenum, this entity is called as retained antrum syndrome. This cuff of gastric mucosa is cut off from the proximal stomach and inhibitory effect of hormones such as VIP (Vasoactive Intestinal Peptide) leading to a persistent hypergastrinemic state. ALso this gastric mucosa is continuously bathed by the alkaline contents of duodenum , which further increases the acid formation.

Both Basal and maximal gastric acid outputs increase but it is not as high as seen in zollinger ellison syndrome. Typically less than 1000 pg/ml

This condition can present as recurrent and persistent ulcerations. Technetium scanning is the diagnostic modality of choice. Treatment is re do surgery and antral excision.

Technetium pertechnate imaging has a sensitivity of 73% and specificity of 100%

Teaching Points
  • Retained antrum syndrome occurs due to incomplete antrectomy, commonly after Billroth II gastrectomy.
  • Loss of inhibitory hormonal control leads to persistent hypergastrinemia.
  • Serum gastrin levels are elevated but usually <1000 pg/ml.
  • Presents with recurrent or refractory peptic ulcer disease.
  • Technetium pertechnate scan is the investigation of choice.
  • Definitive treatment is redo surgery with excision of retained antrum.

More about retained antrum syndrome

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Ludwig’s Angina

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Q Cause of mortality in Ludwig’s angina
A. Asphyxia
B. Pneumothorax
C. Hemorrhage
D. Sepsis

Answer

Ludwig's angina is an inflammatory  condition of the neck which is due to 

  1. Streptococcal infection
  2. Anaerobic infection
  3. Infection of malignancy in the neck

Read on ......

 

Dieulafoy lesion

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Q) Dieulafoy lesion which is false? (AIIMS 2018)

A. Most of the bleed cannot be visualised due to small mucosal defect lies over large arterial bleed.
B. Large 1-3 mm artery in the submucosa is the source
C. MC in the greater curvature
D. Found within 6 cm from GEJ