Barrett esophagus

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Q . Barrett's esophagus is a premalignant condition. Which of  the following statement is false regarding Barrett's esophagus

 a) Barrett's mucosa predisposes to Squamous cell carcinoma of esophagus

b) Risk of Cancer is 0.5% per year

c) Prevalence of Barrett's esophagus in general  population is  2-7%

d) Intestinal type of mucosa  with goblet cells is the most  common histopathological finding

Answer for Premium members

Site of Insulinoma

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Premium MCQ - Insulinoma Site
Q) Most common site of insulinoma is
a) Head of Pancreas
b) Body of Pancreas
c) Tail of Pancreas
d) All equal

Peritonitis

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Q) True statement regarding peritonitis is 

a) Raised serum amylase is only seen in pancreatitis

b) Rectal examination is better diagnostic of appendicitis than per abdominal examination

c) Ultrasound has diagnostic accuracy of 90% for diagnosing acute appendictis

d) Catarrhal appendicitis mostly leads to gangrene of appendix and perforation

Endovenous Laser Ablation of varicose veins

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Q) Endovenous Laser Ablation (EVLA) of varicose veins is best suited for patients:

A. With needle phobia
B. With thrombophlebitis
C. With excessive tortuosity of the vein
D. With primary varicose veins

Ans d

EVLA is thermal ablation of varicose veins in which laser  fiber is inserted in the lumen and ablation is done from inside. It is a good modality for primary and recurrent varicose veins and work in both long and short segments.

This treatment is not effective in cases where there is needle phobia or the veins are having excessive tortuousity or thrombophlebitis. This procedure is done under ultrasound guidance and  wire is passed from the superficial to the deep veins.

Tumescent means swollen or distended, typically due to the infiltration of fluid.

  • It refers to the injection of a large volume of dilute local anesthetic solution (usually lidocaine with epinephrine and saline) into subcutaneous tissue.

  • This causes the tissue to swell or become turgid (tumescent).

In procedures like endovenous thermal ablation:

Tumescent solution:

  • Compresses the vein to improve contact with the ablation device.

  • Separates the vein from surrounding structures (like nerves or skin).

  • Acts as a thermal insulator (heat sink) to prevent collateral damage.

Tumescent local anesthesia also helps

  • A. Needle phobia – EVLA requires multiple needle sticks (tumescent anesthesia), making this option inappropriate.

  • B. Thrombophlebitis – Active inflammation or thrombosis is a relative contraindication to EVLA.

  • C. Excess tortuosity – Makes catheter navigation difficult; EVLA is less suitable.

  • D. Primary varicose veins – Ideal candidates, especially with straight vein anatomy and valvular incompetence.

 

High speed injury

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Q) A young 18 years old unrestrained car driver has an head on collision with a truck and becomes unconscious. He is intubated on the site of accident and resuscitated with IV fluids. He is brought to the emergency in a state of shock,( BP 90/60 and pulse 120/min) but opens eyes on commands. On examination he does not have  pallor but neck veins are distended.

There are no signs suggestive of head or spine injury. Xray chest reveals normal cardiac chambers, no free gas and mild pleural effusion on left with no evidence of fracture ribs.

What will be the next step of management

a) Resuscitation and simultaneous CT thorax

b) Resuscitation and simultaneous Echo cardiography

c) Exploratory laparotomy

d) Chest tube drainage left side

Similar Questions -

Ductal carcinoma in situ

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Q) IN RTOG trial for ductal carcinoma in situ (DCIS) favourable tumor was defined as

a) <3,5 cm in size and 2mm free resection margin

b) <2.5 cm and 2mm margin

c) <3 cm size and 3 mm margin

d) <2.5 cm size and 3 mm margin

Answer - Free answers to surgery mcqs
d

Ductal carcinoma in situ is a pre invasive state in which the cancer cells have not breached the epithelial membrane. It can develop into cancer in 20%.

Simple mastectomy is the standard of care but many centers now consider it over treatment.

Van Nuys system uses

  1. Age of the patient
  2. type of DCIS
  3. presence of microcalcification
  4. Size
  5. resection margin

On mammography this is seen as clustered clustered calcification

Treatment options are 

  1. Mastectomy
  2. Breast conserving therapy (Lumpectomy +radiation and hormonal)

More recently, Eastern Cooperative Oncology Group investigators reported the frst result of a relatively large prospective single-arm study of surgery with negative margins of at least 3 mm without radiation therapy for patients with favorable subsets of DCIS.

 Patients with low-grade or intermediate-grade DCIS measuring 2.5 cm or smaller had a 5-year rate of ipsilateral breast recurrence of only 6.1%. In contrast, patients with high-grade disease had a much higher 5-year ipsilateral breast recurrence rate of 15.3%.

REF : Sabiston 853

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334775/

 

Complications of Surgery of Aortic aneurysm

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Q) A 68 year old man undergoes repair of infra renal aortic aneurysm. On 2nd POD he has abdominal pain, bloody diarrhea and tachycardia. BP is 120/70. Abdomen is mildly distended and tender especially in the left lower quadrant.

How will you proceed

a) Send stool for clostridium and spores

b) CT Abdomen

c) Exploratory laparotomy

d) Higher antibiotics

Ans b 

Get a contrast CT Abdomen as bowel ischemia is a likely diagnosis 

Incidence of bowel ischemia after repair of aortic aneurysm is around 2-6%. It is because of loss of inferior mesenteric artery artery at the time of surgery and inadequate colonic collaterals. 

Spores and clostridium difficle diarrhea occurs after prolonged antibiotic use. Also there is no bloody diarrhea in it.

Exploratory laparotomy will be required after CT Shows full thickness gangrene and not before

Antibiotic escalation will not help at this stage.