----Surgery MCQs
Q11. Regarding the location of gastric ulcers which is true

a) Type I ulcers are the most common
b) type II ulcers are located with in 2 cm of pylorus
c) Type III ulcers are associated with duodenal ulcers
d) Type IV ulcers have the least morbidity

Q12. Which of the following is not true for Menetrier's disease
a) It is a premalignant condition of the stomach
b) It is characterized by massive gastric folds in the antrum
c) Hypoproteinemia, Achlorhydria and excessive mucus production are common
d) Associated with CMV infection in children and H Pylori in adults

Q13. Treatment of Type III Carcinoid tumor of the Stomach is
a) Endoscopic Biopsy and excision
b) Gastrectomy with oncological margins
c) Gastrectomy with complete lymph node clearance
d) Endoscopy and fulgration followed by somatostatin

Q14 .Which of the following is not true about gastric lymphomas?

a) Stomach is the most common organ in the Gastro intestinal  system
which is involved in  Lymphoma
b) Peak incidence of lymphomas is seen in 6th-7th decade
c) Endoscopy usually reveals gastritis like picture or gastric ulcer.
d) MALT lymphoma is the commonest variety.

Q15. Which is false for GIST of stomach
a) It is the same as leiomyoma and leomyosarcoma as described previously.
b) origin is from mucosa from the interstitial cells of Cajal
c) Associated with C-Kit Mutation
d) Imatinab is a new effective drug for adjuvant therapy.


11. a
Type 1 gastric ulcers are most common, accounting for about 60% to 70% of the total.
They are located on the lesser curvature at or proximal to the incisura, near the junction
of the oxyntic and antral mucosa.
Type 2 gastric ulcers (~15%) occur in the same location as the type 1 lesion but are associated
with either active or chronic duodenal ulcer disease.
Type 3 gastric ulcers (20%) are typically located within 2 cm of the pylorus (pyloric channel ulcer).
Type IV gastric ulcer is located in the proximal stomach or in the gastric cardia

12.  b
Menetrier's disease is a rare condition of the stomach characterized
by large hypertrophic mucosal folds in the body and fundus of stomach and
not antrum. Achlorhydria, Hypochlorhydria with Protein loss is
commonly seen in this condition. The exact causeof this disease is
not known but it is associated with CMV infection in children and
H Pylori in adults

13. c

Carcinoid stomach is of 4 types. Type I is small and diffuse associated with hypergastrinemia. Type II is also diffuse and it is associated with MEN Syndromes. Type III is the most malignant type. It is not associated with hypergastrinemia. It is large and solitary. Its management is same as that of adenocarcinoma stomach.  Endoscopic resection is viable when tumor is less than 2 cm, above muscularis mucosa and less than 6 in number

Ref Yeo: Shackelford's Surgery of the Alimentary Tract, 7th ed.

Sabiston 17th page 1303

14. d
Diffuse B cell lymphoma is the commonest variety (55%) followed by MALT 
The stomach is the most common site for lymphomas in the gastrointestinal system. However, primary gastric lymphoma is still relatively uncommon, accounting for less than 15% of gastric malignancies and 2% of lymphomas.
Endoscopy rarely reveals a mass lesion and stomach is the most commonly involved organ

Gastric sarcomas arise from mesenchymal components of the gastric wall and constitute about 3% of all gastric malignancies
GISTs were previously classified as leiomyomas or leiomyosarcomas. Histologically, they appear to arise from the muscularis propria and most likely originate from the cells of Cajal.
Kit is a transmembrane tyrosine kinase receptor,The Kit protein is detected by immunohistochemistry and can reliably distinguish GISTs from true smooth muscle neoplasms.
Imatinib mesylate (formerly ST1517, now Glivic/Gleevec) is a competitive inhibitor of certain tyrosine kinases, including the kinases associated with the transmembrane receptor Kit and platelet-derived growth factor receptors. Initial studies showed encouraging results, with 54% of patients exhibiting at least a partial response

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