Which statement is false regarding Hirschsprung’s disease?

Hirschsprung’s disease does not have equal incidence in males and females. It shows a strong male predominance, especially in short-segment disease.

Z-plasty is an example of which type of surgical flap?

Correct Answer: Transposition flap. Z-plasty is a type of transposition flap where triangular flaps are rearranged to reorient and lengthen a scar or contracted tissue.

Mass forming lesion Liver

2020-12-252017-01-19 by admin

Q) A 55 year old male presents with obstructive jaundice. Ultrasound evaluation reveals a

hyperechoic 4 cm mass in segment VI of liver with peripheral duct dilatation.

CT abdomen shows a hypodense mass with delayed enhancement in portal pahse.

What is the most likely diagnosis

a) Hepatocellular carcinoma

b) Intrahepatic cholangiocarcinoma

c) Metastatic Adenocarcinoma

d) Carcinoid

b) Intrahepatic cholangiocarcinoma (IHCC)

IHCC - Mass forming type- have gradual central enhancement and variable delayed enhancement on portal phase

Hepatocellular carcinoma present ....Premium content at Questions on Bile ducts Q16-20

Ulcerative colitis and Crohn’s disease

2020-12-202017-01-08 by admin

Q) All of the following are seen in both ulcerative colitis and crohn's disease except

a) Aphthous ulcer

b) Pseudo polyp

c) Rectal disease

d) Obstructive symptoms

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

Hirchsprung’s disease

2026-01-282017-01-06 by admin

Hirschsprung’s Disease MCQ for NEET SS | mcqsurgery.com

Which of the following is a FALSE statement regarding Hirschsprung’s disease?

a) Male and female have equal incidence b) In approximately 8% of patients, the entire colon is affected c) After surgery, constipation is the most common long-term problem d) Down syndrome can be seen in up to 3–5% of patients

Free Answer & Explanation

Correct Answer

a) Male and female have equal incidence

Explanation

Hirschsprung’s disease is a congenital disorder characterized by absence of ganglion cells in the distal bowel, leading to functional intestinal obstruction.

Sex distribution:
Hirschsprung’s disease shows a clear male predominance. The male-to-female ratio is approximately 4:1 in short-segment disease. Therefore, equal incidence in males and females is false.
Extent of disease:
Total colonic aganglionosis occurs in about 5–10% of patients, making option (b) true.
Postoperative outcome:
Following pull-through surgery, bowel dysfunction is common. Constipation is the most frequent long-term problem, so option (c) is true.
Genetic associations:
Hirschsprung’s disease is associated with chromosomal anomalies. Down syndrome is seen in approximately 2–10% of cases, making option (d) true.

Teaching Points

Hirschsprung’s disease has a strong male predominance
Total colonic aganglionosis occurs in about 5–10% of cases
Constipation is the most common long-term complication after surgery
Down syndrome is the most common genetic association
Enterocolitis is the most feared complication, especially in infants

Free Questions Mock Tests Join Premium Surgery Course

HCC Cancer

2020-12-122017-01-05 by admin

Q) Which of the following is true about screening in hepatocellular carcinoma (HCC Cancer)

a) Alpha feto protein should be done 6 monthly

b) Ultrasound abdomen should be done 6 monthly

c) Candidates for liver transplant should be screened every 3 months

d) Nodules more than 2 cm should be followed up more regularly

Answer b

Cirrhosis is prone for development of HCC. Screening has to be stringent. Earlier ultrasound of liver and alpha feto protein were both used for screening

In 2009 Marrero et al demonstrated the suboptimal accuracy of AFP and after that it has been removed from the screening protocol and now only ultrasound is being done.

The screening recommendation is not for those patients with severe associated conditions and with advanced liver disease who are already considered for transplant. So there is no screening for those who are already listed. Nodules more than 1 cm are highly suspicious where as in nodules less than 1 cm only 40% will be malignant.

Ref: blumgart 6th edition

Mass in Right lower quadrant

2019-10-022016-12-29 by admin

Q) A 55 year old lady presents with vague pain in right lower abdomen. Physical examination reveals a well defined mass there which is non tender and freely mobile. It is non pulsatile as well. What is the most likely possibility?

a) Appendicular mass

b) Mesenteric cyst

c) Perforated tubo ovarian mass

d) Meckel's diverticulum

Answer

Mesenteric cysts are uncommon lesions found in this age group. It typically presents as a freely mobile mass which moves perpendicular to small blwel axis. It is painless as well.

Appendicular mass will have a preceding history of pain abdomen

Similarly perforated tubo ovarian mass will also have a history of pain

Meckel's diverticulum does not present as this kind of mass

gastricbypass.surgery

EUS criteria of malignant lymph node

2024-06-122016-12-17 by admin

Q) One of the following is not a criteria of malignancy in lymph node on EUS

a) Size more than 1 cm

b) Prominent intranodal vasculature

c) Sharp well defined borders

d) Hypoechoic

Q) Which statement is not true about recurrent pyogenic cholangitis :

a) Mostly there are intrahepatic strictures with involvement of the left side duct

b) It can present as choledocho duodenal fistula

c) There is complete biliary obstruction which leads to marked jaundice and pruritis

d) MRCP and other other cholangiography can be diagnostic

Answer c

In recurrent pyogenic cholangitis (RPC) complete obstruction does not occur and jaundice and pruritis is not marked.

RPC is a disease commonly seen in young Asians (also known as oriental cholangiohepatitis) which leads to multiple strictures in extra or intrahepatic ducts.

Men and women are equally affected, and, historically, the disease strikes at an early age (20–40 years) in patients from lower socioeconomic classes.

Cause for recurrent pyogenic cholangitis

Association with Ascaris lumbricoides and Clonorchis sinensis has been noted.

Stones and strictures

Clinical Presentation of Recurrent pyogenic Cholangitis

It can present as choledocholithiasis with stricture, choledochoduodenal fistula, acute pancreatitis, secondary biliary cirrhosis and can lead to cholangiocarcinoma.

Radiology for Recurrent Pyogenic Cholangitis

MRCP can be diagnostic and is preferred because of its non invasive nature.

Surgical treatment

Goal is to clear the biliary tree and to bypass or resect the strictures

Options are

CBD exploration

Hepaticojejunostomy

Partial liver resections