Cystic neoplasm of pancreas

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Q) A 60-year-old woman is found to have a 3.2 cm pancreatic cystic lesion on MRI. EUS shows internal echogenic material within the cyst cavity. To accurately determine whether this represents mural nodules rather than intraluminal debris, which of the following is the most definitive diagnostic approach?
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Ulcerogenic cause of hypergastrinemia

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Free MCQ with CSS Toggle
Q) A 42-year-old male presents with multiple recurrent duodenal ulcers, abdominal pain, and chronic diarrhea. Fasting serum gastrin levels are >1000 pg/mL. Which of the following is the most likely ulcerogenic cause of hypergastrinemia?
✅ Answer: B. Zollinger–Ellison syndrome

🔍 Explanation:
Zollinger–Ellison syndrome (ZES) is caused by a gastrinoma (a gastrin-secreting tumor), typically located in the pancreas or duodenum.

It leads to massive hypergastrinemia, increased gastric acid secretion, and multiple, recurrent, or atypical peptic ulcers.

Diarrhea and steatorrhea are common due to acid inactivation of pancreatic enzymes.

Other Options:
A. Atrophic gastritis:
Leads to hypochlorhydria/achlorhydria with secondary hypergastrinemia, but non-ulcerogenic (low acid state).

C. Chronic PPI use:
Causes compensatory hypergastrinemia due to acid suppression, but again non-ulcerogenic unless stopped abruptly in predisposed individuals.

D. Helicobacter pylori infection:
May increase gastrin levels mildly, but ulcers are primarily due to mucosal damage and inflammation, not from gastrin hypersecretion.

🧠 Key Point: Zollinger–Ellison syndrome is the only ulcerogenic cause of hypergastrinemia. Fasting gastrin >1000 pg/mL with low gastric pH is diagnostic.

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Flaps in Plastic Surgery

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Q: A 48-year-old male undergoes excision of a chronic pilonidal sinus with a rhomboid-shaped defect over the sacrococcygeal region. The reconstructive plan involves a local flap designed adjacent to the defect, where the flap is transposed into the primary defect and the donor site is closed primarily. The flap follows the lines of minimal skin tension and relies on subdermal vascular supply without a named artery. What is the correct classification of this flap?

A. Rotation flap
B. Axial pattern transposition flap
C. Random pattern transposition flap
D. Advancement fasciocutaneous flap

Pericardial Injury

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Q: A 25-year-old male presents after a stab wound to the left 5th intercostal space at the midclavicular line.

He is hypotensive, tachycardic, and confused. eFAST reveals pericardial fluid. What is the next best step in management?

A. Pericardiocentesis
B. Emergency thoracotomy
C. CT angiography of the chest
D. Chest tube insertion

Sucking chest wound

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Q: A 30-year-old male presents to the emergency department after a stab wound to the right chest.

On examination, there is a 4 cm open wound in the 5th intercostal space anteriorly, with a sucking sound during inspiration, decreased breath sounds on the right, and respiratory distress.

What is the next best step in management?

# Theme NEET SS Mocktest 1

A) Immediately close the wound with an airtight dressing
B) Insert a chest tube on the same side and then close the wound
C) Intubate and initiate positive pressure ventilation
D) Apply a three-sided occlusive dressing to the wound
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TIPS

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Q: A 60-year-old man with cirrhosis presents with refractory ascites requiring frequent large-volume paracentesis. He is evaluated for TIPS placement. Which of the following findings would be the strongest contraindication to proceeding with the procedure?

A) Serum bilirubin of 3.5 mg/dL
B) MELD score of 18
C) Right heart catheterization showing mean pulmonary artery pressure of 55 mmHg
D) History of prior hepatic encephalopathy controlled on lactulose

Suturing Techniques

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Q: During a surgical skills assessment, you are asked to perform a hand-sewn intestinal anastomosis using a continuous, inverting suture that enters the bowel lumen.

Which of the following suture techniques best fits this description?

#Theme from INI CET GI Mock test

A) Lembert suture
B) Cushing suture
C) Gambee suture
D) Connell suture

Malignancy risk in Stem cells

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Q: Risk of malignancy is highest with which stem cells?

# Bailey Chapter 4

a) Somatic cells
b) SSc
c) Fetal cells
d) All
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Secondary hemorrhage after necrosectomy

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Q: A patient develops a delayed hemorrhage 3 weeks after an open necrosectomy. Which of the following best describes the pathophysiology of this complication?

# Pancreas INI CET MCQs

A) Coagulopathy from systemic inflammatory response
B) Arterial pseudoaneurysm formation and rupture
C) Disseminated intravascular coagulation (DIC)
D) Portal hypertension due to splenic vein thrombosis
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Gall bladder stone with obstruction

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A 65-year-old male presents with abdominal pain, vomiting, and a history of multiple episodes of cholecystitis. X ray image is given below.

What is the most likely diagnosis?

Gall stone and intesinal obstruction

A. Acute cholecystitis
B. Gallstone ileus
C. Small bowel volvulus
D. Duodenal perforation

 

 

Answer: B. Gallstone ileus

Explanation:
Rigler's Triad consists of pneumobilia, small bowel obstruction, and an ectopic gallstone, which is diagnostic of gallstone ileus. This condition occurs when a gallstone enters the bowel through a biliary-enteric fistula, leading to mechanical obstruction.

A large gallstone (>2.5 cm) erodes through the gallbladder wall, creating a cholecysto-enteric fistula (most commonly into the duodenum).

The stone enters the bowel and may cause obstruction, most often at the ileocecal valve due to its narrow lumen.

The presence of air in the biliary tree (pneumobilia) results from communication between the biliary and intestinal tracts.