Gastric lymphoma

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Q ) Treatment of Primary Gastric Lymphoma is 

a) Surgery

b) chemotherapy

c) Radiotherapy

d) Both chemo and radiotherapy

Unknown primary neck

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Q) Submandibular node without any apparent primary, next step should be

a) Tripple endoscopy

b) PET CT Head, Neck and thorax

c) Laryngoscopy

d) Chest X ray

 

Haemorrhoidectomy

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Q) 57 year old male come to the surgery clinic with bleeding PR. He is diagnosed with Haemarrhoids . What is  not an indication of haemorrhoidectomy 

a) Persistent Second degree haemorrhoid 5 days after sclerotherapy

b) 3rd degree haemorrhoid

c) Fibrosed  haemorrhoid

d)  Interno-external haemorrhoids when the external haemorrhoid is well defined.

Ans a

Haemorrhoids can persist for 10 days after sclerotherapy

The indications for haemorrhoidectomy include:

● third- and fourth-degree haemorrhoids;

● second-degree haemorrhoids that have not been cured by non-operative treatments;

● fibrosed haemorrhoids;

● interno-external haemorrhoids when the external haemorrhoid is well defined.

Four degrees of haemorrhoids ●●

First degree – bleed only, no prolapse ●●

Second degree – prolapse but reduce spontaneously ●●

Third degree – prolapse and have to be manually reduced ●●

Fourth degree – permanently prolapsed

MCQS on Rectum

OPSI

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Q) True about OPSI is 

a) OPSI is over estimated and not seen 2 years after splenectomy

b) Focus of infection is always in the lung or abdomen

c)  Despite antibiotics and intensive care, the mortality rate is between 50% and 70% for full blown OPSI

d) H. influenza is the most common organism

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Stomach Physiology

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Q) Regarding the microscopic anatomy of stomach, false statement is ?

a) Parietal cells are abundant in the body of stomach and secrete H+

b) Chief cells produce pepsinogen I and II

c) G cells are abundant in gastric antrum

d) ECL cells are abundant in antrum 

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Intussusception in childhood

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Q) Most common intussusception in children is

a) Ileocolic

b) Ileoileal

c) Ileoileocolic

d) Colocolic

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Intra op cholangio

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Q) All of the following are indications for performing intra op cholangiography except:

A. Pain around the day of surgery
B. Anomalous biliary anatomy
C. Suspicious findings on ERCP
D. Abnormal hepatic function panel

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Duodenal adenoma in FAP

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Q) What is the Surgery in FAP patient after colectomy for ampullary adenoma Stage IV

a)Classic Whipple
b) Pancreas preserving duodenectomy
c) Transduodenal excision
d) endoscopic excision

Answer is free for all

b) 

Duodenal cancers are the third most common (10%) cause of death in FAP after CRC and desmoid disease.

Duodenal adenomas  100% incidence

 tendency to progress to cancer.

The severity of duodenal adenomatosis predicts the chances of duodenal cancer,  Spigelman staging system that is based on

adenoma number, size, and histology

Patients with stage 0 disease (no adenomas) can be surveyed again in 5 years.

Stage I patients can be surveyed in 3 years;

stage II in 1 year;

stage III in 6 months

and stage IV is an indication to consider surgery. 36 % progress to cancer- Surgery is pancreas preserving duodenectomy

A Whipple is indicated for a duodenal cancer that is definitively operable

Duodenal adenomas can be treated by snare polypectomy or by transduodenal polypectomy. Ampullary adenomas can be treated by endoscopic mucosal resection or surgical ampullectomy

Ref schakelford page 1968

Polyposis syndrome

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Q) Polyposis associated with least risk of colon cancer
a) Familial juvenile polyposis
b) Peutz Jeghers syndrome
c) Cowden syndrome
d) Cronkite Canada syndrome

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