General Surgery

NEET, DNB questions from general surgery

Burns management

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Q) A 45 year old male sustains 30% burns on both legs and anterior abdominal wall.  There was  mild inhalation  injury associated with it. He initially responded well to treatment with IV fluids, Inj Tramadol and enteral feeding.

Three days after the treatment he is having slight tachypnea (30/min) pulse 110/min and BP 98/60. His temp is 97degree F and some areas of partial thickness have converted into full thickness. He is currently on Inj Magnamycin. His platelets are 70ooo, TLC is 17000 and sugar is 200 mg%. What is the next step in management?

a) Continue same management

b) Upgrade the antibiotic and send a fresh culture from skin

c) Treat it as carbon monoxide poisoning

d) Manage in lines of Acute Tubular Necrosis

Answer for premium members

Burns management involves critical care, intensive phase and rehabilitation. Loss of skin and eschar formation predispose individuals to gram positive, gram negative and fungal infections.

 

Bleeding Peptic ulcer

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Q) In a 55 year old male  with a bleeding peptic ulcer, endoscopy is done. Which of the following findings on endoscopy predicts the highest rate of re bleed?

a) Non bleeding vessel

b) Adherent clot

c) Flat pigmented spot

d) Clean base ulcer

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Free Answer 

Answer a

a) Non bleeding vessel IIA - Out of the choices given

Bleeding peptic ulcer is mostly from the posterior surface of the lesion and can be sometimes lethal

Forrest classification is used to grade the risk of re bleeding in peptic ulcers.

According to the stigmata of recent bleed, the chances of re bleed increase.

Endoscopic appearance of bleeding peptic ulcer classification

 Forrest Classification

Ia - Active Spurting                   Highest 90% chance of acute bleeding peptic ulcer ICD 10

Ib-  Active oozing

IIa Non bleeding vessel             50% chance of re bleed

IIB Adherent clot

IIC Flat Pigmented spot

III Clean based ulcer

Sabiston 1154 21th edition

Q) How to treat a bleeding peptic ulcer? Bleeding gastric ulcer management?

Steps to manage a bleeding peptic ulcer

  1. Secure two large bore IV lines for fluid and blood products. Evaluate for coagulopathy
  2. Simultaneous evaluation for source of bleeding and history. Important causes to rule out are chronic liver disease, NSAID use etc
  3.  Simultaneous IV PPI infusion
  4. Endoscopic control  of bleeding peptic ulcer- Thermal coagulation, hemoclips, Adrenaline injections etc
  5. Operative procedure For  Duodenum bleed - Longitudanally opening the anterior wall of duodenum and 3 point suture ligation
  6. For Gatric ulcer bleeding - depends on the site of ulcer and might require Antrectomy/Partial gastrectomy

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

 

Electrolytes

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Q) A 50 year old male undergoes pancreatectomy for Carcinoma head of pancreas. His pre op Hb was 9.2g% and during surgery he received 5 units of PRBC. In the post op period on the 2nd day he develops ECG changes. Work up is done for Myocardial Ischemia which is negative. What is the most common  cause of ECG changes here

a) Hyponatremia

b) Hyperkalemia

 

Gastrinoma

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Q) Regarding gastrinoma what is true? ( # Questions on Endocrine Surgery) 

a) All gastrinomas express SRS receptors

b) In 30 % of cases gastrinomas are not localized intra operatively

c) Levels of serum  gastrin more than 100pg/ml are strongly suggestive of gastrinoma

d) Angiography with secretin stimulation is required in all cases for localization of gastrinoma

 

Dumping Syndrome

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Q) Which of the following is true about dumping syndrome

a) Somatostatin analogues are effective in controlling symptoms

b) Symptoms always include flushing and tachycardia 

c) Diarrhea is always part of dumping syndrome

d) Part of treatment includes combining solids with liquids in frequent small meals

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Lymph node stations in Carcinoma stomach

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Q) In gastric cancer, lymph node station 12 corresponds to 

a) Common hepatic

b) Hepatoduodenal

c) Retropancreatic

d) Superior Mesenteric

Ans b

In gastric cancer, lymph node station 12 corresponds to the hepatoduodenal ligament lymph nodes.  These nodes are specifically located along the hepatoduodenal ligament and are further subdivided into groups based on their anatomical relationship: along the hepatic artery (12a), along the bile duct (12b), and behind the portal vein (12p)

Complications of Billroth II surgery

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Billroth 1 and 2
Complications of Billroth II Surgery – Free MCQ | mcqsurgery.com

Complications of Billroth II – Free MCQ (GI Surgery)

High-yield stomach surgery question for NEET SS & GI Surgery preparation. Use the Answer Free button to reveal the explanation.

Q) What is true regarding complications of Billroth II surgery?

a) It has less complications than Billroth I surgery
b) Recurrent ulceration is more common in the afferent limb as compared to efferent limb.
c) Afferent loop obstruction is more common after Billroth II  surgery
d) Billroth I  operation is preferred in scarred duodenum

Answer c -

In Billroth II surgery, afferent limb obstruction is more common

In Billroth I reconstruction The remnant is anastomosed  to the duodenum

In Billroth II duodenum stump is closed and stomach is anastomosed to the jejunum limb

Advantages of Billroth I

  • More Physiological as normal GI continuity is maintained
  • No problem of afferent and efferent limb
  • Future procedures like endoscopy and ERCP can be done
  • Reduced chance of gastric carcinoma in remnant stomach as compared to Billroth 2  ( SKF page 682) 

In surgery for benign gastric ulcers, Billroth I reconstruction is the preferred choice.

Billroth II surgery has problems of

  • Retained antrum syndrome
  • Afferent loop obstruction
  • Duodenal stump leak (1-3%

Billroth 2 surgery is done when there is

1. Inadequate mobility of the duodenum

2. Scarring of duodenum

Complications of gastric surgery
Complications of gastrectomy

  • Nutritional and weight loss - Iron deficiency, Copper deficiency, Vit B12 , Anemia
  • Delayed gastric emptying
  • Roux statsis- Seen in roux en y loops-  Pain, nausea, vomiting, abdominal bloating
  • Cholelithiasis-  Higher incidence in roux en y reconstruction as compared to B1 and B 2 gastrectomy
  • Recurrent ulceration

Complications of Billroth 2 surgery

  • Dumping syndrome Dumping symptoms have been reported in up to 70% of Billroth II patients and up to 75% of patients after RYGBP for obesity.
  • Afferent loop obstruction - It can be minimized by keeping the length of afferent loop less than 20 cm and using a retrocloic approach.
  • Bile reflux gastritis - More common with billroth I and billroth 2 surgery, incidence is decreasing after the use roux en y anastomosis
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Tags: Billroth I, Billroth II, Afferent loop obstruction, Stomach Surgery MCQ, NEET SS GI Surgery

Surgery Trauma MCQ

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Q ) A 25 year old male brought to the hospital  after being involved in a road traffic accident that occurred 50 minutes ago. His  initial BP at the scene of accident was  80/40 mm HG with a pulse rate of 120/min.

The paramedics administered 2 litres of normal saline in the ambulance and in the emergency department his BP is 110/70 with a pulse rate of 90/min.

He has tenderness in Left upper quadrant abdomen and USG reveals perisplenic fluid. Next step is to :  (#See more trauma MCQS) 

a) Take him for exploratory laparotomy

b) Shift him to ICU and observe

c) Do a CT scan of the abdomen

d) Put in a laparoscope and assess

Answer c

This Patient has a splenic injury due to blunt trauma abdomen. The  immediate management  depends on grade of splenic  injury  and response to IV Fluids. This patient is hemodynamically stable after IV fluids  and immediate laparotomy is not needed.

Direct shifting to ICU is also not the right choice because CT is required first and for more severe injuries patient can go to OT

Laparoscopy has no role in splenic injuries