AIIMS 2022 April GI Surgery Questions

Recall and past papers AIIMS GI Surgery 2022 Novemeber

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Pancreas

Q) Highest risk for pancreatic cancer is with?

a) Peutz jeghers

b) Hereditary pancreatitis

c) FAMMM

d) All equal

Ans a) PJS

STK11 Peutz-Jeghers syndrome Mutation results in >100-fold increase in risk of PDAC

PRSS1 Familial pancreatitis Mutation results in chronic pancreatitis and 40% lifetime risk of PDAC

Individuals with hereditary pancreatitis have a greater than 50-fold increase in their risk for development of pancreatic cancer compared with unaffected individuals

Familial atypical mole and multiple melanoma syndrome (CDKN2A gene mutation). CDKN2A encodes protein p16, which normally inhibits cell proliferation by binding to cyclin-dependent
kinases (CDKs). - 20 times

Sabiston page 1553


Q) LEEPP protocol in adenocarcinoma pancreas consists of 

a) NACT protocol

b) ACT protocol

c) RT protocol

d)  HPE examination

Ans d

In 2006, Verbeke et al. introduced a standardized histopathologic protocol . By applying this rigorous standardized protocol (Leeds Pathology Protocol, LEEPP), which involves axial specimen slicing, multicolor margin staining, and extensive tissue sampling


Q) Carcinoma  pancreas on imaging. True

a) Hypodense  on CT

b) Pet avid

c) Isointense on MRI T1

d) Hyperechoic on EUS

Ans

a

CT They enhance poorly compared to adjacent normal pancreatic tissue and thus appear hypodense on arterial phase scans in 75-90% of cases, but may become isodense on delayed scans

Signal characteristics include:

  • T1: hypointense cf. normal pancreas 5
  • T1 FS: hypointense cf. normal pancreas 5
  • T1 + C (Gd): slower enhancement than the normal pancreas, therefore dynamic injection with fat saturation with arterial phase imaging is ideal

USG

Findings are non-specific and include:

  • hypoechoic mass


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