Surgery MCQ
Q1. 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
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Q2. 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

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Q3.  Which of the following statement is true for epiphrenic diverticulum
a) Surgery or Endoscopic Intervention is required in almost all cases at detection
b) Most of these diverticulum of esophagus are primary
c) Most of the epiphrenic diverticula are on the right
d) These are also known as traction or mid esophageal divertcula

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Q 4. Not true about CEA (Carcino Embryonic antigen) in Carcinoma Colon





a)  It is a useful screening test in Carcinoma colon
b) Slight elevation of CEA  can occur in certain benign diseases.
c) CEA is useful as a prognostic marker in Cancer of Colon
d) Preoperative CEA value is a predictor of survival in Carcinoma Colon
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Q5. Which of the following statement is not true for ideal hepaticojejunostomy

a) The anastomosis should be tension free
b) All the suture knots should  be on the  outside of bile duct
c) Mucosal contact must exist between  the mucosa of the bowel and bile duct
d) Anastomosis done with single layer  absorbable sutures
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1) 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



2)c
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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3) c
Epiphrenic diverticulum is a lower esophageal diverticulum with in 10 cm of gastro esopheal junction (GEJ) Most of these diverticula are secondary and false  due to associated motor disease such as Diffuse esophageal spasm (DES) or Achlasia. (Read more about Achlasia Cardia here) Unlike the middle esophageal divertula these are not traction diverticula. These are most commonly seen on the right side.
Most of these are asymptomatic and treatment is required only if they cause chest pain (due to DES) or regurgitaion or aspiration.

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   4) a
   CEA  is an oncofetal protein that is normally present during fetal life but can be present in low concentrations in healthy adults. Structurally, it is a           glycoprotein with a molecular weight of 200 kDa. It is  not useful as a screening test because of its low sensitivity in early-stage disease.
   It can be increased in several benign diseases such as rheumatoid arthritis, cystic diseases of kidneys, COPD, cirrhosis.
  It is useful as a follow up investigation after colonic resection because increasing levels correlate with the stage of the disease and similarly preop values correlate with the severity of the disease
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5) b
Ideal Hepaticojejunostomy should be tension free with mucosal approximation and done using single layer absorbale suture
All though it is desired that the suture knot should be outside but absorbale suture are being used , in the posterior layer knots may be place on the inside of the lumen

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