FNH _ Focal Nodular hyperplasia

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Q) Which of the following statements about focal nodular hyperplasia (FNH) of the liver is true?

a) A central scar is present in all cases
b) Fine-needle aspiration cytology (FNAC) is usually diagnostic in doubtful cases
c) Resection is recommended due to risk of malignant transformation
d) Asymptomatic patients with typical radiologic features usually do not require treatment

d) Asymptomatic patients with typical radiologic features usually do not require treatment

  • Focal Nodular Hyperplasia (FNH) is a benign liver lesion, often found incidentally.

  • a) Central scar is present in all cases – Incorrect. While a central stellate scar is characteristic of FNH, it is not present in all cases (seen in ~50-70% on imaging).

  • b) FNAC is usually diagnostic – Incorrect. FNAC often provides inconclusive results in FNH. Histological diagnosis requires tissue architecture, which FNAC can't reliably provide.

  • c) Resection is recommended due to risk of malignant transformation – Incorrect. FNH has no malignant potential and rarely causes complications. Surgery is not routinely recommended unless symptomatic or diagnosis is uncertain.

  • d) Asymptomatic patients with typical radiologic features usually do not require treatment – Correct. FNH with typical imaging features (especially on MRI with hepatobiliary contrast agents) does not require biopsy or surgical intervention.

Bariatric Surgery

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Q) Which of the following statements regarding bariatric surgery is false?

a) Vertical banded gastroplasty (VBG) produces less weight loss compared to Roux-en-Y gastric bypass (RYGB)
b) Jejunoileal bypass is no longer commonly performed
c) Dumping syndrome occurs primarily due to non-compliance with dietary advice
d) Laparoscopic adjustable gastric banding (LAGB) requires follow-up only once every 4–6 weeks

c
Dumping is due to the surgery and unrelated to diet
Calorie restriction is responsible for long term weight loss and its beneficial effects such as control of diabetes, dyslipidemia, hypertension and other metabolic abnormalities.
Restrictive procedures are LSG and  LAGB  which decrease the appetite and induce early satiety.           
The RYGB (ROUX en Y  gastric bypass ) is  a malabsorptive procedure  with long term sustained weight loss.
Mechanism of weight loss after bariatric surgery
Ghrelin is orexigenic gut hormone, which increases appetite. After food intake ghrelin levels fall and appetite decreases.

After restrictive surgery such as LYGB and LSG, ghrelin levels fall and appetite decreases.

Vertical Banded Gastroplasty (VBG)
 This procedure has been abandoned in favor of other operations because of poor long-term weight loss, a high rate of late stenosis of the gastric outlet, and a tendency for patients to adopt a highcalorie liquid diet, thereby leading to regain of weight. Choice a is correct

Jejuno ileal bypass has many side effects because of malabsorbtion and liver cirrhosis ( See above)  Choice b is true

Visit -  evaluate oral intake, food tolerance, and wound healing and to determine whether appropriate restriction has resulted from placement of the non inflated band.
Subsequent visits, usually scheduled monthly to bimonthly in the beginning and then less frequently, involve counseling with a nutritionist and evaluation of weight loss and the need for band adjustment.
A goal of 1 to 2 lb/wk is ideal
d is correct
Dumping is both late and early and unrelated to dietary advise

Carcinoid appendix

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Q) In Carcinoid appendix, False  statement is

a) It is the most common tumor of the appendix

b) Less than 1% of the overall  appendectomy specimens have carcinoid tumor

c) Size of the lesion is a good predictor of  malignant behavior

d)  Mostly carcinoid appendix are seen in the base of appendix

Answer

 

Roux stasis

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Q) True about Roux stasis syndrome

a) Dilated Roux limb present

b) Can be prevented by inter positioning 20 cm jejunum between stomach n duodenum

c) Delayed gastric emptying of solids

d) It is not related to the size of gastric remnant

Answer

Non obstructive mesenteric ischemia

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Q) Not true about Non Obstructive Mesenteric Ischeamia (NOMI)

a) Occurs due to treatment with vasopressors

b) Occurs in cardiac shock

c) Can occur in Burns

d) Hypercoagulable state maybe responsible for NOMI

Answer

Renal cell carcinoma

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Q) False about Renal cell carcinoma is

a) More common in males

b) Associated with von hippel lindau syndrome

c) Always require radical nephrectomy

d) Has paraneoplastic manifestaions

Answer

c

Renal cell carcinoma is more common in males

Genetic

loss of heterozygosity in chromosome 3p

B/l RCC is associated with VHL syndrome

Paraneoplastic of RCC

Anemia, hypettension, erythrocytosis.

Radical nephrectomy is the gold standard but not always necessary and partial nephrectomies in selected cases give good clearance