Free Questions

Free MCQs in Surgery

THE vs TTE

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Q) Trans Hiatal Esophagectomy ( THE)  vs Trans Thoracic Esophagectomy ( TTE)   which is not true? ( Question asked in all AIIMS and INI exams since 2017) 

a) Leak rates are more with TTE 

b) Pulmonary complication is more with TTE

c) Side to side stapler anastomosis has less leaks than open two layer suturing

d) THE can be done through minimally invasive surgery

Esophagus Mock test  1

Esophagus Mock test 2 

Ans c

Pulmonary complications  are 57% with TTE 27% with  THE  ( SKF 409)

Anastomotic leak 16% TTE and 14% THE ( not significant) subclinical leak slightly more in THE

Option D is correct

Cardiac complications, Vocal cord paralysis , wound infection, chyle leak are all more with TTE

Blackmon et al. published a propensity-matched analysis comparing outcomes between side-to-side stapled anastomosis, end-to-end circular stapled anastomosis, and handsewn,
with no significant difference in leak rate noted.  ( SKF page 475)

SKF page 409

Ulcerative colitis Surgery in Young female

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Q) Which surgery would be preferred to be done in young unmarried  female with steroid refractory Ulcerative colitis  and 15 bloody bowel movements per day?

a) TPC with IPAA

b) TPC with EI ( end ileostomy) 

c) TAC with EI ( end ileostomy) 

d) TAC with IRA ( Ileo rectal anastomosis)

#AIIMS 2022 April 

Colon

Ans b

The risk of infertility following IPAA was estimated to be approximately 50% compared with 15% among medically treated patients.
Given these data, many surgeons advocate for a three-stage procedure in which subtotal colectomy with end ileostomy is performed and IPAA is deferred until childbearing is
completed.
SKF 8th page 1936

Medullary thyroid cancer – Management

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Q) 42 year old Male patient with 1 cm nodule in Right side of Thyroid. Biopsy shows medullary carcinoma. No neck nodes are seen on USG. What is the management

a) Total thyroidectomy

b) Total thyroidectomy with central node dissection

c) Total thyroidectomy with lateral and central neck dissection

d) Right hemithyroidectomy

Thyroid MCQs 

Thyroid Mock test 1 

Thyroid Mock test 2 

Thyroid 3 

Ans b 

Medullary thyroid carcinoma is associated with a risk of nodal involvement, even if neck nodes are not visible on ultrasound. A total thyroidectomy is recommended to remove the affected thyroid tissue, and central neck dissection is indicated to address potential lymphatic spread.

Total thyroidectomy

  • While a total thyroidectomy is necessary for medullary thyroid carcinoma (MTC) to remove the entire gland, it does not include the assessment and potential removal of central lymph nodes, which can harbor metastases. Given the risk of lymphatic spread with MTC, central node dissection is recommended.

c) Total thyroidectomy with lateral and central neck dissection

  • This option is more extensive than typically required for a 1 cm medullary carcinoma without evidence of lymph node involvement. While MTC can spread to lateral nodes, the primary recommendation is to start with central node dissection unless there are clinical signs or imaging suggesting lateral node involvement. A more conservative approach is often favored unless there's clear evidence of lateral disease.

d) Right hemithyroidectomy

  • A hemithyroidectomy would only remove half of the thyroid gland and is inadequate for managing MTC. Since MTC can be bilateral and has the potential for multifocality, a total thyroidectomy is the standard of care to ensure complete removal of the cancerous tissue.

Carcinoma Breast and Pregnancy

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Q) 30 year old female in 2nd trimester of pregnancy has a 2 cm Ca breast with no axillary lymph node What should be the management?

a) Terminate Pregnancy and MRM

b) Wait till completion of pregnancy and MRM

c) Lumpectomy plus chemo

d) Lumpectomy + axillary dissection + chemo

Breast

Neet SS 22 paper

Ans d

Lumpectomy plus axillary dissection + chemo

Axillary dissection is ideally done  after SLNB

Radiotherapy can be given after termination of pregnancy

Hormonal therapy is also given after pregnancy if required

No need to terminate pregnancy

Anal malformation

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Q) Newborn with abdominal distension on day 2, not passed meconium. There is absent anal orifice. WHat is the next step? # NEET SS 22 

a) Cross table X ray

b) Invertogram

c) Anoplasty

d) Sigmoid colostomy

Ans a) Cross table X ray

1st step in such cases Rule out congenital abnormalities of spine, sacrum , kidney heart etc

2nd step Cross table x ray  If it shows Perineal fistula do ANoplasty, If x ray shows rectal gas below coccyx do PSA RP with or without colostomy, If it shows gas above coccyx with associated defects do colostomy

Table 67.14 Sabiston 

 

Fuel for colonocytes

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Q) Primary fuel for colonocytes is 

a) Glucose

b) Lactate

c) Butyrate

d) Fats

Ans c ) Butyrate

Butyrate For the fermentable complex carbohydrates available, colonic flora produce short-chain fatty acids (SCFAs).

Butyrate, an SCFA, is the principal source of nutrition for the colonocyte.
Mammalian cells do not produce butyrate, the colonic epithelium and luminal bacteria form an essential and elegant symbiotic relationship.

Antibiotics disrupt this cohabitation—decreased bacteria leads to less butyrate, which, in turn, negatively affects colonocyte function leading to diarrhea.

Lymphatic Spread carcinoma Prostate

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Q) Most common lymph node involved in carcinoma prostate is
a. Obturator
b. Iliac
c. Periprostatic
d. Perivesical

a ✅

Lymphatic spread may occur (1) via lymphatic vessels passing to the obturator fossa or along the sides of the rectum to the lymph nodes beside the internal iliac vein and in the hollow
of the sacrum

Also lymphatics that pass over the seminal vesicles and follow the vas deferens for a short distance to
drain into the external iliac lymph nodes.

From retroperitoneal lymph nodes, the mediastinal nodes and occasionally the supraclavicular nodes may become implicated.

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