Q) What is the most suitable treatment option for non muscle-invasive bladder cancer with the risk of recurrences?
A)Cystectomy
B)Intravesical chemotherapy
C)Transurethral resection and adjuvant intravesical chemotherapy
D)Palliative therapy
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.
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
Q ) 3.5cm mass in nasopharynx extending to left nasal cavity with 4.5cm size LN in supraclavicular area.
staging,
a.T1N1
B.T1N3
C.T2N1
D.T2N3
Q) Choledochal cyst III, treatment (MCH GI 2019)
A) Partial hepatic resection
B) Choledochojejunostomy
C) Transduodenal excision
D) Endoscopic drainage
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
Q) What is not true regarding Sugiura's procedure for Portal Hypertension
a
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.
Q. Greatest inaccuracy regarding T stage for Carcinoma esophagus in EUS is for
d) T4 tumor
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
d) Pancreatic YY
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