AIIMS 2022 GI Surgery Questions

Recall and past papers AIIMS GI Surgery 2022


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) Appleby procedure, what is resected?

a) Coeliac artery ( CA)

b) CA plus SMA

c) CA plus PHA

d) CA plus Right hepatic artery

Ans  a) Coeliac artery

Resection of the celiac axis was first described by Canadian surgeon Lyon H. Appleby in 1953 as a feasible surgical option for locally advanced gastric cancer . He described preliminary clamping of the CHA to confirm sufficient palpable pulsatility of the proper hepatic artery perfused through the GDA, followed by an en bloc resection the celiac artery, stomach, tail of the pancreas, and spleen.

Appleby's original surgical technique was later modified and adapted for treatment of cases of PDAC that were previously considered locally advanced and unresectable because of extensive tumor contact with the celiac artery or CHA



Bile duct and GB

Q) Which of the following indicates Unresectable Gall bladder Ca:

a) T4 lesion

b) Retropancreatic LN

c) Solitary segment 3 liver mets

d) Right hepatic artery involvement

Ans a

T4 lesions are considered unresectable as it involves common hepatic artery or main portal vein

Solitary segment 3 is hematogenous and considered metastatic but can be resected

Because surgical intervention provides the only potential for cure or prolongation of life, radical resection should be considered for adequate operative candidates.
Radical resection in the setting of T3 and T4 lesions includes at least segments IVB and V but more often requires a central hepatectomy, including all of segments IV, V, and VIII.
To achieve R0 margin status in large tumors, a right trisegmentectomy may be required. Direct extension of tumor into adjacent structures such as the hepatic flexure is not a contraindication
to resection as long as negative margins can be obtained and
all disease resected.


Trauma

Q) Mangled bilateral extremities, with RTA First step is

a) Cervical spine stabilization

b) Activate MTP

c) Crystalloid 1-2L

4.

Ans a

First step remains management of ABCDE, cervical spine stabalization is correct


General Surgery 

Q) 14 yo female Child with normal voiding along with dribbling of urine 

a) Ectopic ureter

b) Ureterocele

c) VUR

d) Congenital megaureter

Ans a

In females, the ectopic ureter opens either into the urethra below the sphincter  or into the vagina.

A female who voids normally but who has dribbled urine for as long as she can remember is typical of the patient with an ectopic ureter.

In the male, the opening of the ureter is above the external urethral sphincter so the patient is continent.

 

Q ) What should be done to prevent refeeding syndrome in a 70yr old on TPN

a) Infuse amino acids and  lipids separately

b) Slowly increase calorie

c) Avoid lipid tpn

d) Slow infusion of tpn

Ans b

Treatment involves matching intakes with requirements and assiduously avoiding overfeeding. Calorie
delivery should be increased slowly and vitamins administered regularly.

Bailey page 288


Q) IN Small bowel syndrome what is not seen

a) Low gastric acid secretion

b) Diarrhea

c) Steatorrhea

d) Vitamin B12 deficiency

Ans a

Gastric acid hypersecretion is there

Other metabolic abnormalities

Deficiencies in vitamin B12,
bile salts, magnesium. Fluid
and nutrient malabsorption

Ref SKF page 922

 


Colon 

Q) In right hemicolectomy what is not ligated ?

a) Right branch of middle colic

b) Left branch of middle colic

c) Ileocolic

d) Right colic

Ans b

The blood supply to the right colon is via the superior mesenteric artery (SMA) that branches off the abdominal aorta anteriorly at the lower pole of L1.

The SMA gives off two main branches supplying the right colon that are the right colic and middle colic arteries. Another branch supplies the terminal ileum and caecum called the ileocolic artery

Left branch of middle colic not ligated in Right hemicolectomy


Q) Fong’s protocol in colorectal cancer, which is not a poor risk factor?

a) Metachronous CRC

b) 2 lesions

c) Lymph node positive primary

d) disease-free interval from the primary to discovery of the liver metastases of <6  months

Ans d

The clinical risk score proposed by Fong in 1999  is based

on two imaging factors (number and size of metastases)

and three oncological parameters (disease-free interval, CEA, node-positive primary tumor)

The five clinical criteria—nodal status of primary, disease-free interval from the primary to discovery of the liver metastases of <12 months, number of tumors >1, preoperative CEA level >200 ng/ml, and size of the largest tumor >5 cm—were chosen as criteria for a clinical risk score

Aim  of the score was to predict the long-term outcome of over 1000 patients operated on for hepatic metastases from colorectal cancer.


Esophagus

Q) Not True regarding Vagus preserving esophagectomy

a) Highly selective vagotomy done

b) Done for T1a T1b

c) Colonic interposition graft used

d) Less incidence of diarrhea  and dumping

Ans B

Surgical Technique

Through an upper midline abdominal incision, the right and left vagal nerves are identified, circled with a tape, and retracted to the right. A limited, highly selective proximal gastric vagotomy is performed along the cephalad 4 cm of the lesser curve. The stomach is divided with a GIA stapler just below the gastroesophageal junction. The colon is prepared to provide an interposed segment. Gastric pull up can also be done

 

Stripping of  the branches of the esophageal plexus off the longitudinal muscle of the esophagus, preserving the esophageal plexus along with the proximal vagal nerves and the distal vagal nerve trunks

The previously prepared interposed portion of the transverse colon is passed behind the stomach and up through the mediastinal tunnel into the neck. An end-to-end anastomosis is performed to the cervical esophagus using a single-layer technique. The colon is pulled taut and secured to the left crus with four or five interrupted suture

 

Absolute contraindications for a vagal-sparing esophagectomy are the need for a lymphadenectomy because sparing the vagus nerves precludes a lymph node dis-section, and prior vagal transection or evidence of gastric dysfunction,

T1b is submucosa invasion so Vagal sparing not done here


Spleen

Q) What is best management  of patient With splenic injury.  Haemodynamically stable

CT Scan  suggestive of  6cm laceration inferior border?

A. Conservative

B. Emergent laparotomy with spleen packing

C Splenectomy

d) Sub emergent laparotomy with splenorrhaphy

Ans A

Conservative

 

 

error: Content is protected !!