Surgery MCQ
Q1. True statement about gastric varices is
a) Incidence of bleeding in gastric varices is very high (60-70%)
b) Successful eradication of esophageal varices eradicates gastric varices in most cases
c) Isolated splenic vein thrombosis is the commonest cause of gastric varices
d) Gastric varices should be sclerosed at the earliest oppurtunity

Q2 Which of the following is not an anatomic problem associated with rectal prolapse
a) Diastasis of Levator ani
b) Redundant  sigmoid colon
c) Patulous anal sphincter
d) Shallow Cul de sac

Q3. Which of the following statements is not  true about esophageal atresia? (USMLE- Question)
a) It leads to excessive salivation and /or choking spells when 1st feed is attempted
b) It is associated with VACTER anomalies
c) X ray shows absent gas in the abdomen
d) Primary surgical repair is preferred.

Q4.What is true about splenic abscess is:

a) Most of the abscess in spleen occur through local spread such as from kidneys, colon
b) Unilocular splenic abscess has a high mortality rate more than 50%
c) Splenomegaly is typically seen in splenic abscess
d) In one third of adults splenic abscess is multilocular
Q5. What is not true regarding Cholangiocarcinoma?

a) Intrahepatic cholangiocarcinoma is the least common type anatomically
b) Primary resection is the main treatment
c) Liver Transplant is the main treatment
d) A multidisciplinary team should evaluate and manage all patients of cholangiocarcinoma

1) b
Most common cause of gastric varices is portal hypertension followed by splenic vein thrombosis. Gastric varices  are of two types 1.
Gastroesophageal varices and 2. Isolated Gastric varices (IGV) .
IGV are further subclassified into Type 1. Fundic gastric varices in the fundus  and Type 2 Ectopic,  anywhere in the stomach except fundus.
Incidence of bleeding in gastric varices is 3-30% and not 70%. If the cause of gastric varices is portal hypertension, eradication of esophageal varices leads to  eradication of gastric varices also. other treatment options are banding, glue, TIPS and liver transplant.Sclerotherapy is not preferred because of ulcer formation which can cause recurrent bleeding.

Patients with rectal prolapse have specific anatomic and physiologic characterstics. The anatomic characterstics include deep and not shallow pelvic cul de sac along with patulous anal sphincter, redundant sigmoid colon, diastasis of levator ani and loss of sacral attachments.

Esophgeal atresia is commonly associated with VACTER defects (Vertebral, Anal, cardiac, Tracheobronchial, esophagus, radial). It is associated with choking and excessive salivation on attempting 1st feed. Nasogastric tube is seen to be coiled up in upper chest on Xrays. It 

4) d
Haematogenous route is the most common route for acquiring splenic abscess (70%). Risk factors inculde polycythemia vera, malignancies, IV drugs etc. Unilocular splenic abscess has mortality rates of 15-20% and multiloculated abscess about 80%. Typical symptoms are fever, pain abdomen, pleuritic chest pain. Splenomegaly is uncommon.
In 1/3rd adults abscess is multilocular.
Read more about questions on spleen here

Perihilar Cholangiocarcinoma also known as Klatskin tumor is the most common type of cholangiocarcinoma followed by lower end cholangiocarcinoma. Intra hepatic cholangiocarcinoma is the least common.

Complete surgical resection to negative margins is the only hope for long-term survival;
highly selected patients with unresectable tumors or underlying liver disease such as primary
sclerosing cholangitis may be considered for liver transplant. Not all patients are considered for liver transplant. To read more about liver transplant see here,
A multidisciplinary team comprising of surgeon, gastroenterologist, oncologists, radian oncologists should evaluate the patient along with support staff

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