a) Ureteral obstruction
b) Entero vesical fistula
d) Recto uretheral fistula
Q) True about management of hemangioma liver
a) All hemangioma more than 10 cm should be resected
b) OCPs and pregnancy should be avoided in young females as there is risk of rupture
c) Arterial embolization should be routinely done in large hemangiomas
d) If surgery is decided hemangioma located at the periphery should be enucleated
Q) What is true regarding complications of billroth 2 surgery?
a) It has less complications than billroth 1 surgery
b) Recurrent ulceration is more common in the afferent limb as compared to efferent limb.
c) Afferent loop obstruction is more common after billroth 2 surgery
d) Billroth I operation is preferred in scarred duodenum
Answer c -
In billroth 2 surgery, afferent limb obstruction is more common
In surgery for benign gastric ulcers, billroth I reconstruction is the preferred choice. Billroth II surgery has problems of
- Retained antrum syndrome
- Afferent loop obstruction
- Duodenal stump leak (1-3%)
Q) Splenic artery aneurysm is seen in
a) Proximal 1/3rd of splenic artery
b) Proximal 2/3 of splenic artery
c) Middle 1/3 of splenic artery
d) Distal 1/3 of splenic artery
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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
b) Intrahepatic cholangiocarcinoma (IHCC)
IHCC - Mass forming type- have gradual central enhancement and variable delayed enhancement on portal phase
Q) Which of the following histological varieties of IPMN is associated with low grade dysplasia
a) Intestinal type
b) Oncocytic type
c) Pancreaticobiliary type
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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 :
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
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
Q) False statement about Hirchsprung's disease is:
a) Male and Female have equal incidence
b) In approximately 8% of the patients entire colon is affected
c) After surgery constipation is the most common problem
d) Down syndrome can be seen in up to 3-5% patients
Hirchsprung's disease is a developmental disorder characterized by absence of ganglion cells in both Auerbach's and Meissner's plexus and males are more frequently affected than females
Absence of these ganglion cells lead to a very tight anal sphincter with resultant constipation.
This aganglionosis which is similar to Achalasia cardia begins at anorectal junction and involves rectosigmoid in 80% and entire colon in 8% of cases.
Various surgical options like Duhamel, Swenson and Soave procedures can be done and in all constipation is a common problem
Down's syndrome is associated in 5%
Ref: Sabiston 20th edition page 1876
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
In a cirrhotic liver, hcc cancer can develop any time and a stringent screening protocols have to be followed for early detection and timely treatment. Earlier ultrasound of liver and alpha feto protein were both used as tumor markers. However 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 Read More ...