MRCS1

Q1.) A 42 year old lady undergoes exploration for a retroperitoneum mass. In OT it is suspected that this is a liposarcoma. Which of the following is  not true about liposarcoma?

a) Liposarcoma is the most common variant of sarcomas

b) They have a  pseudocapsule

c) They can grow quite large before producing symptoms

d) They are locally invasive and do not metastatize


Q2) A 40 year old male undergoes reversal of loop ileostomy. Surgery was uneventful with minimum adhesiolysis. He is discharged on 7th POD but comes back on 12th POD with features of colicky pain abdomen, vomiting , obstipation. On examination he is anxious, HR is 106/min, BP is 120/70 and he has tenderness and swelling at the previous colostomy site.

The probable diagnosis is 

a) Adhesive intestinal obstruction

b) Anastomotic leak 

c) Incisional hernia obstruction

d) Ileus


Q3) A 45 year old male with carcinoma head of pancreas, complains of stickiness of stools and difficulty in digestion. Which of the following enzyme deficiency does he have?

a) Amylase

b) Protease

c) Lipase

d) Elastase


Ans 1) d

Retroperitoneal Sarcoma constitue 1-2% of all solid tumors and 10-20% of all sarcomas are retroperitoneal.

The most common type of sarcomas are different in different series. Bailey says liposarcoma is most common where as some series say MFH (Malignant fibrous histiocytoma). These lesions tend to have a pseudocapsule and that should be completely removed. These tumors can achieve a large size in retroperitoneum before producing symptoms.

Pain and fullness in abdomen are common symptoms

Surgery is the mainstay of treatment.Cell type has no implications on prognosis and survival

They frequently have pulmonary metastasis

Ref Bailey 986


2. c

From the question it is clear that this is a case of intestinal obstruction.Tender swelling at the previous site gives hint that this is an obstructed hernia at the site of previous ileostomy.

It could have been adhesive but the tell tale sign is at the site of previous colostomy

It is not an anastomotic leak because that would manifest early and not after 10th day

Ileus does not have pain 


3. c

This patient has steatorrhoea (pale sticky bulky stools) which is due to the deficiency of lipase. Lipase is responsible for breakdown of fats into fatty acids and triglycerides and its deficiency leads to foul smelling bulky stools.


 

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