July 2019 – Surgery Questions – SuperSpeciality MCQs

Juvenile Polyposis Coli

Q) In juvenile polyposis coli, all true except

a) SMAD 4 mutation
b) No risk of cancer
c) Polyps most common in ileum
d) Autosomal Dominant with high penetrance

Q) which of the following statement is false with respect to most common type of TEF(tracheoesophageal fistula)?
A) type C with female predominance
B )proximal blind pouch ends one or two vertebral bodies from distal TEF
C) distal TEF is located 1cm above Carina
D) polhydraminos is often with isolated proximal atresia.

Post Whipple’s Bleeding

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Q) Post whipples on pod4 patient presented with fever, tachycardia and pain, usg showed collection, which was drained percutaneously. on pod 10 there is frank blood of 100ml in drain, next line of management

a. Ct angiography

b. Emergency laparotomy

c. flush the drain with noradrenaline
d. Observe

Ans a

This is extraluminal bleed on 10th POD following most likely a pancreatic fistula. Clinical condition is mentioned for day 4 which is because of pancreatic leak. A pancreatic fistula can cause vascular pseudo aneurysm so answer is A CT angiography

Early extraluminal PPH requires reexploration.

Intraluminal bleeding may manifest as extraluminal if there is associated anastomotic breakdown,and this may be amenable to angiographic intervention when involving the pancreaticojejunostomy.

Patients present with septic complications and/or a sentinel bleed. Radiographic embolization has become a more successful modality, with up to 80% success,13 but is limited by the initially intermittent nature of the bleeding

Exploration - if patient is not stable
Ref SKF page 1241

Acute Gastric dilatation

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Q) Not true about acute gastric dilatation (AGD)

a) AGD is encountered most often as a postoperative complication in abdominal surgery

b)Also seen in other disorders, such as anorexia and bulimia nervosa, psychogenic polyphagia, trauma, diabetes mellitus

c) When intragastric pressure from gastric distension exceeds 20 cm H2O gastric necrosis starts

d) clinical features are pain abdomen and effortless vomiting

VON Hipple

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Q)Von Hippel Lindau (VHL) causes all except
1. breast cancer
2. pancreas cancer
3. renal
4. hemangioma of cerebellum

Surgical Management of Zenker’s diverticulum

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Q) What is not true about management of Zenker's diverticulum

a) Both endoscopic and surgical repair give equivalent results

b) In complete diverticulectomy, myotomy is not necessary

c) If diverticulum is less than 2 cm, myotomy is sufficient

d) In diverticulopexy suture the diverticulum to the posterior pharynx as opposed to the prevertebral fascia

Similar Question on zenker's diverticulum here

Post op pancreatic fistula

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Q About post operative pancreatic fistula, true is

a) 65-85% after pancreatic surgery

b) Amylase more than 3 times serum level

c) All cases of POPF for distal pancreatectomy needs revision exploration..

d) Majority needs re exploration

Ans

Tumor lysis syndrome

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Q)Tumor lysis syndrome which is not seen

a. hyperkalemia

b hypocalcemia

c. hypophosphatemia

d. hyperuricemia

Ans is c

Tumor lysis syndrome releases, various intracellular metabolites such as uric acid, potassium and phosphorous which overwhelm the excretory capacities of the kidney.

The metabolic anomalies are

Hyperuricemia

Hyperkalemia

Hyperphosphatemeia

Hypocalcemia

It mostly occurs in poorly differentiated leukemias and lymphomas