INI SS December 2021 GI Surgery

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Recall Questions from INI SS 2021 In November


Q1.) True regarding organ transplantation act 2011
a) only solid organs included
b) Neurologist mandatory for declaring
C) Includes grandparents, grandchildren, spouse, siblings
D) original act passed in 1995

Ans c

Original act passed in 1994

Solid organs and tissues are involved

Neurologist is not mandatory for diagnosis


 

Esophagus

Q ) In pharyngo esophageal corrosive injury which is false

a) Permanent tracheostomy may be required

b) Patient can have difficulty in swallowing despite a good conduit

c) Laryngoscopy should be used

d) Colon is always used a conduit

Q2 Which of the following is false regarding musculature of esophagus and pharynx?

a) Pharynx has single consecutive layer of muscles, esophagus has 2 layers of muscles.

b. Below Carina both layers of esophageal musculature have smooth muscles components only.

c. The point of transition of circular muscle proximally is known as Laimer area

d.  Collar of Helvetius is Circular muscle to Oblique muscle on greater curvature of stomach


Q3. Suspected esophageal leak after TTE on day 5, anastomoses is in thorax, Which of the following is true?

a) Gastrografin is better for localizing leak than barium

b) Initial contrast study should be gastrografin

c) Barium has risk of aspiration and pneumonia

d)

Ans b

In thorax, barium extravasation can lead to mediastinal, pleural, or abdominal contamination and is avoided.  Gastrografin is the initial study. If negative, can proceed with barium study.

Water-soluble contrast has  the potential to induce a severe chemical pneumonitis if aspirated into the lung
parenchyma. ( c is wrong)

Barium is better study to localize leaks because of thick contrast

Gastrografin has a higher false-negative rate—extravasating in only 50% to 80% of cases of esophageal perforation

ref Shackelford 527

Colon

Q) Which of the following is false  for attenuated FAP ?

a) Decreased extra hepatic presentations

b) Incidence of Desmoid increase in 3'  end mutations

c) Age of presentation is 33-44 yrs

d) If more than 20 rectal polyps are present risk of malignancy increases

Ans is c

It has fewer extracolonic manifestations, option a is true

Extracolonic manifestations include gastric fundic gland polyps, gastric adenomas, duodenal adenomas, and periampullary tumors.

Desmoids in FAP/AFAP have mutations at 3' end of APC gene so b us true

Age of presentation is 55 yrs

Risk of CRC is 80% . It is 100% with classical FAP , option d is correct


Q) Which is worst option for bleeding stomach ulcer on upper lesser curvature
A. Csendes
B. Kelling Medlender
C. Total gastrectomy
D. Pauchet

Ans d kelling Madlener

A high gastric ulcer may be treated by excision, or the ulcer may be retained and healing encouraged by other means.

If the ulcer is retained there is a small but definite risk of malignancy. Neither gastric drainage, nor the Kelling–Madlener operation, nor vagotomy and pyloroplasty ensures healing in a high gastric ulcer.

Ref  link here 

• Pauchet procedure advised for ulcers 5 cm below the cardia.

• Csendes is a procedure which is done for ulcers within 2cm of cardia, near total
gastrectomy done.

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