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Surgery Questions

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Gastrectomy Margins

Provided a negative-margin resection can be obtained with a subtotal gastrectomy, and provided it is not a linitis plastica situation (ie, diffuse infiltrating poorly differentiated cancer eliciting a leather-bottle stomach), routine total gastrectomy is to be avoided. The 2010 Japanese treatment guidelines, and the 2011 English version, call for a proximal margin of 3 cm from gross disease for localized well-circumscribed Borrmann I or II tumors, and a margin of at least 5 cm for other tumors. Total gastrectomy is performed whenever necessary to meet these requirements. Total gastrectomy should also be performed for cases of linitis plastica.

 

Amoebic Liver abscess

Q) True about presentation of amoebic liver abscess?

a) 60-70% patients with amoebic liver abscess have diarrhoea

b) Jaundice is seen in 50% of these patients

c) Rupture of liver abscess in the peritoneum is seen in 10% cases

d) More complications of amoebic liver abscess occurs in acute presentation

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Carcinoid Appendix

 A 40 year old male is  undergoing appendicectomy for acute appendictis.  During surgery a 3 cm mass is found in the body of appendix. Frozen section of the mass reveals carcinoid tumor. Which of the following is true

a) Appendicectomy should be completed followed by radiotherapy to the bed

b) Right hemicolectomy should be done

c) There is 50% chance of developing carcinoid syndrome in this case

d)  Carcinoid syndrome occurs only if there is liver metastasis

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Q. A 45 year old male has severe coughing followed by sudden Bilateral pain in lower abdomen. At the same time he develops a swelling in the mid line, lower abdomen which does not change in size on raising the leg muscles. What has really happened?

a) Ruptured aortic aneurysm

b) Obturator hernia

c) Spigelian Hernia

d) Rectus sheath hematoma

Answer

Weight loss surgery

Q) Which  of the following statement about Roux en Y gastric bypass is not true?

a) After weight loss it resolves symptoms of venous ulcers due to stasis

b) Symptoms of pseudo tumor cerebri are resolved

c) Heartburn is alleviated immediately

d) Protein malnutrition is a very common problem

 

Answer 

d Protein malnutrition is common in Biliopancreatic division and duodenal switch.

Essential components of successful Roux en Y gastric bypass are 

  1. Small Gastric pouch (15-20ml) made from cardia of stomach
  2. Keep the length of roux limb at around 75 cm
  3. Division of gastric pouch from distal end of stomach

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Mass in Right lower quadrant

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

b

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
  • Dumping Syndrome

    Q) Which of the following is true about dumping syndrome

    a) Somatostatin analogues are effective in controlling symptoms

    b) Symptoms always include flushing and tachycardia 

    c) Diarrhea is always part of dumping syndrome

    d) Part of treatment includes combining solids with liquids in frequent small meals

    Answer Premium only