DNB 71-80 (GI)

DNB General Surgery 1-10 



21-30 Neurosurgery (in progress)





Q71) Duplication of the intestine associated with
A. Heterotopic mucosa 
B. Smooth muscle component 
C. Associated with spinal / vertebral defects
D. All are correct

Q 72) Choledochocele is type
A. 2
B. 3
C. 4
D. 5

Q73) . WDHA syndrome is associated with 
A. VIPoma
B. Somatostatinoma
C. Glucagonoma
D. Gastrinoma

Q74)  DVT, Depression, Dermatitis, Diarrhoea seen in
A. Glucagonoma
B. VIPoma
C. Somatostatinoma
D. Gastrinoma

Q 75) Which of the following is a type of Familial Adenomatous Polyposis 
A. Gardner syndrome
C. Juvenille polyps
D. Hamartomatous polyp

Q 76) Perineal procedure in rectal prolapse
A. Delorme
B. Ripstein
C. Resection rectopexy
D. Frykman Goldberg procedure

Q77 ) Intussusception in children
A. Mc type is Ileocolic
B. Mc type is colo colic
C. Entering tube is intususcepiens
D. Contrast enema is not useful

Q78 ) A type of Selective shunt for portal hypertension is
A. PSRS (Proximal spleno renal shunt) 
B. Warren shunt
C. SSPCS (Side to side portocaval shunt) 
D. Mesocaval

Q 79) Hereditary diffuse Gastric carcinoma is associated with which  breast cancer
A. Ductal carcinoma NOS subtype
B. Lobular carcinoma
D. Metaplastic carcinoma

Q 80. Malignant hydatid disease is caused by
A. E. Granulosus
B. E. oligartus
C. E. vogeli
D. E. multilocularis

71) d

Duplications of alimentary tract are rare and most are on mesenteric side. Normally they are lined by alimentary tract mucosa but can have heterotopic mucosa.

They can also be associated with spinal anomalies.  They present in early childhood with obstruction, hemorrhage, intussusception or perforation. They can even go on to become malignant (especially rectal) 

Excision is the treatment

Ref BAiley page 

72) b

Classification of choledochal cysts (CC).

Type I cysts are fusiform dilatations of the common bile duct (CBD). (75%) 

Type II cysts are true diverticula of the CBD  (2%) 

type III CC (choledochoceles) are intraduodenal dilations of the common channel. (1-4%)

Type IVA CC consist of multiple intrahepatic and extrahepatic biliary dilatations, while type IVB CC have extra-hepatic biliary dilatation with a normal intrahepatic biliary tree. (15%) 

Type V CC, or Caroli's disease, consist of cystic dilation of the intrahepatic biliary tree. (10%)

Type V CCs are thought to arise from ductal plate malformation and be associated with polycystic kidney disease, an autosomal recessive inherited condition associated with mutation in PKD1 gene 

When type V CCs are accompanied with congenital hepatic fibrosis, it is termed Caroli's syndrome

Management o Choledochal cyst

1. Type I and IV CC management consists of complete extrahepatic bile duct cyst excision down to the level of communication with the pancreatic duct, cholecystectomy, and restoration of bilioenteric continuity

2. Type II and III CC are associated with an extremely low risk of malignant transformation. Diverticulectomy of type II CC followed by primary CBD closure at the diverticulum neck.

 Small choledochoceles- endoscopic sphincterotomy.

Transduodenal excision for large choledochoceles with associated complications such as gastric outlet obstruction or pancreatitis

3. Type V (Caroli's disease) management consists of liver resection or orthotopic liver transplant 

73) a

VIP (Vasoactive Intestinal Peptide) is found in brain, Antral G cells, pancreatic neurons and D cells in pancreas.

Components of WDHA are watery diarrhea, hypokalemia, Achlorhydria

Sabiston 965

74) a

Glucagonoma is characterised  with Diabetes,  Dermatitis, DVT, Depression. Also associated is weight loss and vitamin deficiency.

Skin lesions- Necrolytic migrating erythema, appear before other symptoms and are often misdiagnosed. These are because of amino acid deficiency and go away after Iv amino acids

Ref Sabiston 957 

75) A

FAP has phenotype variations. This means there can be many extraintestinal manifestations.

Gardner syndrome- FAP + Osteoma skull + Desmoid mesentery +  Periampullary tumors

Associated with FAP are also   thyroid papillary tumors, medulloblastomas (turcot) , hypertrophic gastric fundic polyps, and congenital hypertrophy of the retinal pigmented epithelium of the iris (CHRPE)

2. PJS (Peutz Zeghers Syndrome) - Small polyps through out the intestine especially small intestine associated with pigmented lesions of skin and genital tumors, This entity is dift from FAP and has increased risk of pancreatic and

GI malignancies.

3. Juvenile polyps-

76) a

Delorme - Perineal procedure in which there is rectal mucosectomy with muscular plication

Frykman Goldberg - Transabdominal posterior rectopexy with resection of the redundant left colon .

Ripstein - Trans abdominal proctopexy

Resection rectopexy- Trans abbdominal 

Thierech- Perineal wire plasty

Altmeier- Perineal Proctosigmoidectomy and levatoroplasty

Ref Sabiston 

77) a

Intussusception is classified according to the site of the intussusceptum and intussuscipiens. In children, more than 80% are ileocolic, beginning several centimetres proximal to the ileocaecal valve with their apex found in the ascending or transverse colon.

Classically, a previously healthy infant presents with colicky pain and vomiting (milk then bile). Between episodes,
the child initially appears well. Later, they may pass a ‘redcurrant jelly’ stool

Bailey 129

78) b

Selective shunts only decompress gastroesophageal varices and maintain portal hypertension and flow to the liver

Warren shunt or DSRS is a selective shunt which decompresses esophageal and gastric varices by connecting the splenic vein into the left renal vein. With portal azygous disconnection by ligation of the left and right gastric veins, and interruption of the gastroepiploic arcade, portal hypertension is preserved. Key elements in this procedure are mobilization of the splenic flexure of the colon, mobilization of the pancreas from the superior mesenteric vessels to the hilum of the spleen, adequate dissection of the splenic vein to prevent distortion when it is brought down for anastomosis to the left renal vein.


79) b

Germline CDH1 mutations confer a high lifetime risk of developing diffuse gastric (DGC) and lobular breast cancer (LBC)

The updated guidelines include revised CDH1 testing criteria (taking into account first-degree and second-degree relatives):

(1) families with two or more patients with gastric cancer at any age, one confirmed DGC;

(2) individuals with DGC before the age of 40 and

(3) families with diagnoses of both DGC and LBC (one diagnosis before the age of 50).

Additionally, CDH1 testing could be considered in patients with bilateral or familial LBC before the age of 50, patients with DGC and cleft lip/palate, and those with precursor lesions for signet ring cell carcinoma. Given the high mortality associated with invasive disease, prophylactic total gastrectomy at a centre of expertise is advised for individuals with pathogenic CDH1 mutations. Breast cancer surveillance with annual breast MRI starting at age 30 for women with a CDH1 mutation is recommended.