Cancer lower rectum

Q) False statement about management of cancer rectum

a) Relative to ERUS, pelvic MRI is more accurate in its ability to detect lymph node involvement 

b) Rectal cancers located in the upper third of the rectum are exempt from neoadjuvant treatment.

c)  TME is typically performed 2-3 weeks after completion of CRT before fibrosis develop

d) ERAS  include early mobilization, transition to oral pain control, and resumption of oral food intake

Carcinoma GB epidemiology

Q) Not true about GB malignancy

A. 80 percent of porcelain gall bladder predispose to malignancy

B. Untreated advanced  CA GB  median survival is 2-5 months

C. Stippled calcification of mucosa has higher risk of malignancy than diffuse intramural calcification

D. More than 75 percent of CA gall bladder has history of cholelithiasis


Ans a 

69% to 86% of patients with gallbladder cancer have a personal history of gallstone disease.

The presence of an abnormal pancreaticobiliary duct junction, thought to promote chronic biliary inflammation, has been associated with both choledochal cyst disease and gallbladder cancer.

In porcelain gallbladder, risk of ca gb due to chronic inflammation and calcification of the gallbladder wall, was once estimated to be as high as 61%; however, more contemporary analyses suggest that the correct figure is more likely between 7% and 25%

Ref Shackelford 8th page 1323

Role Of PET Scan in CA Stomach

Q) What is not true about the role of PET Scan in staging of Ca Stomach?

a) 50% of Carcinoma stomach are PET avid

b) Response to Neoadjuvant therapy is  usually seen on PET in 2 weeks

c) PET response correlates with survival 

d) Sensitivity of PET is same for all kinds of histopath tumors

Skin grafting

Q)In preop evaluation before placing skin graft over wounded area…bacterial colony count must be less than
a) 10000
b) 100000
c) 1000000
d) 10000000

ans b)  10 raise to the power 5

Prerequisites for skin grafting:
The recipient site should be assessed for potential bacterial load, blood supply,
presence of devitalized tissue, and exposed vital structures.
Donor site availability
Perform recipient site tissue culture if history or concern for infection (counts <105
CFU/g tissue for most pathogens required before grafting).
Presence of group a beta heamolytic streptococci is absolute contraindication for
skin grafting


Highly selective vagotomy

Q) False about highly selective vagotomy
a) Highly selective vagotomy divides the vagus nerves supplying the acid-producing portion of the stomach
b) Incidence of postoperative complications is lower.
c) The criminal nerve of Grassi should be severed
d) Crow's feet nerves are severed till below the GE junction


 Ans -d

HSV only divides the last part of the nerves which supply the part of stomach which produces acid
Acnt and post nerves of Latarjet are found and their terminal branches are severed from 7 cm proximal to the pylorus to 5 cm above the GE junction
Motor function of the stomach is not affected
Criminal nerve of grassi is branch of posterior vagus. It should be sought and cut
Ref sab 2oth page 1206