Bladder Cancer

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Q) What is the most suitable treatment option for non muscle-invasive bladder cancer with the risk of recurrences?


B)Intravesical chemotherapy

C)Transurethral resection and adjuvant intravesical chemotherapy

D)Palliative therapy


Patients with non–muscle-invasive bladder cancer (confined to the bladder mucosa or submucosa) can be managed with transurethral resection alone and adjuvant intravesical (instilled into the bladder) chemotherapy/immunotherapy.

The use of these intravesical agents is critical since patients with non–muscle-invasive bladder cancer are at risk for tumour recurrence and progression.


Uro Onco MCQS

Squamous cell carcinoma

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Q) What is the correct regarding squamous cell carcinoma? (For oncosurgery skin MCQs see here)

A)Chronic healing wound is a risk factor.

B)Bowen's disease does not have a risk of malignant transformation.

C)In situ disease present as slightly pink or skin coloured raised plaques.

D)Imiquimod is not used as a treatment option.

Biliary stricture in Chronic pancreatitis

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Q ) Biliary stricture in chronic pancreatitis. True Statement is 
a) Endoscopy is primary treatment
b) Mostly asymptomatic
c) Stricture is because of proximity to head of pancreas
d) Malignancy must always be ruled out

TNM Nasopharyngeal Carcinoma

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Q ) 3.5cm mass in nasopharynx extending to left nasal cavity with 4.5cm size LN in supraclavicular area.






Type III Choledochal cyst

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Q) Choledochal cyst III, treatment (MCH GI 2019) 

A) Partial hepatic resection
B) Choledochojejunostomy

C) Transduodenal excision
D) Endoscopic drainage


Esophagus duplication cyst

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Q) False statement about esophagus duplication cyst

a) Cystic form is most common  which does not  communicate with the lumen

b) Adults are mostly asymptomatic

c) Malignnat transformation is rare

d) Most commonly seen in middle 1/3 of esophagus


Sugiura Procedure

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Q)   What is not true regarding Sugiura's procedure for Portal Hypertension

a)  It is a transesophageal variceal ligation
b) Splenectomy is done
c) Vagotomy
d) Pyloroplasty
Sugiura procedure is the nonshunting procedure for EV bleeding, which was first proposed by Sugiura and Futagawa in 1973 []. However, because of its complexity and high postoperative morbidity and mortality, this procedure has not been widely accepted in Western countries 


Non shunt operations are done for bleeding esophageal varices in emergency for poor risk patients when sclerotherapy or other conservative methods fail.
Sugiura's is a devascularization procedure described in 1973, It has two parts
Thoracic and abdominal which may be simultaneous or staged. The Left posterolateral thoracotomy is done. The longitudinal periesophageal azygous collateral veins and thoracic vagus is preserved.  The esophagus is transected at level of diaphragm. This completely  devascularizes the esophagus. The cut mucosa and anterior muscle layer is approximated.
Then the abdominal approach is done and abdominal esophagus, cardia of stomach is devascularized. Short gastric vessels are ligated, selective vagatomy is done, pyloroplasty is done, splenectomy completes the procedure.
Transgastric varix ligation was done previous to this procedure as described by Tanner  but not transesophageal. Hence 'a' is the answer.
The modified Sugiura procedure can be performed through a one-stage transabdominal approach via the midline incision or extension of a left subcostal incision with the exposure of an L shape.
The procedure starts with splenectomy for improvement of the exposure followed by gastric and esophageal devascularization and finally the esophageal transaction using a mechanical stapler through a short gastrotomy.
The Sugiura operation contains five componential procedures and esophagogastric devascularization is the only remaining part in the many different versions of the modified Sugiura operation.
Schakelford pancreas pg 383.

prognostic factor for carcinoma esophagus

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Q. Most important prognostic factor for carcinoma esophagus is
a) Cellular differentiation                                 b) Depth of  esophagus involvement

c) length of  esophagus involvement            d)   age of the patient


Most important is depth of involvement of wall  of esophagus and lymph node involvement of the surrounding esophageal tissue.
 Length of esophagus involvement is not that important because esophagus has extensive submucosal lymph supply and for complete cure 10 cm excision margin would mean removal of almost total esophagus.

EUS In CA esophagus Staging

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Q. Greatest inaccuracy regarding T stage for Carcinoma esophagus in EUS is for

a) T1 tumor
b) T2 tumor
c) T3 tumor

d) T4 tumor

Chicago classification of Achalasia

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Here I am discussing the Chicago classification and its clinical significance


This is based on high resolution manometry (HRM) 

Manometry evaluates the swallowing response, and weather the LES sphincter relaxation is absent or incomplete.

There are three types of Achalasia and all have incomplete LES relaxation

Type I - Body - Aperistalsis  and no pressurization

Type II Body - aperistalsis and panesophageal pressurization 

Type III - Spastic contractions and distal contractility integral (DCI) over 450 mm HG

 Type 2 achalasia had the best positive response to treatment, and type 3 the least favorable response to treatment.

The best initial treatment option for types 1 and 2 are conservative measures such as pneumatic dilatation and surgical myotomy,

while type 3 achalasia appears to respond better to initial treatment with peroral endoscopic myomectomy

Hormones released from duodenum

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 Q. Which of the following hormones are not released in duodenum?
a) Gastrin
b) Motilin
c) Somatostatin

d) Pancreatic YY

4. d
Peptide YY is released from ileum.

Gastrin - G cells stomach
Motilin- M cells from duodenum and jejunum
Somatostatin - D cells in pancreas, stomach and duodenum

Somatostain is an inhibitory hormone and inhibits most of the things

Secretin is released by acid in the duodenum and stimulates pancreatic fluid and bicarbonate secretion, leading to neutralization of acidic chyme in the intestine. Secretin also inhibits gastric acid secretion  and intestinal motility. LES pressure is decreased by Secretin, CCK, Somatostatin and VIP