MCH SS 2021 GI Surgery

MCH 2021 ( Jan 22) GI Surgery Similar  Questions and explanations


1st three questions are free to evaluate, Rest will be seen if you are signed in as a premium member


Q) Lymph node not removed in whipple's?

a) Retropancreatic
b) Celiac
c) Suprapyloric

d) Inferior pancreatico duodenal

 

Ans b

The extent of standard lymphadenectomy of pancreatic head carcinomas includes the LNs station involved in two main routes of LN metastases: from the head of the pancreas to the common hepatic artery (CHA) then celiac axis and from the head of the pancreas to the superior mesenteric artery (SMA)

Standard lymphadenectomy.

No. 5 Supra pyloric lymph nodes;

No. 6 infra pyloric lymph nodes

No. 8a lymph nodes in the anterosuperior group along the common hepatic artery

No. 12b lymph nodes along the bile duct; No. 12c (located next to 12b), lymph nodes around the cystic duct;

No. 13a lymph nodes on the posterior aspect of the superior portion of the head of the pancreas;

No. 13b lymph nodes on the posterior aspect of the inferior portion of the head of the pancreas;

No. 14a-b lymph nodes along right side of superior mesenteric artery

No. 17a lymph nodes on the anterior surface of the superior portion of the head of the pancreas;

No. 17b lymph nodes on the anterior surface of the inferior portion of the head of the pancreas.

Extended lymphadenectomy.

No. 8p lymph nodes in the posterior group along the common hepatic artery;

No. 12a lymph nodes along the hepatic artery;

No. 12p lymph nodes along the portal vein;

No. 14c-d lymph nodes along the left side of superior mesenteric artery;

No. 16 lymph nodes around the abdominal aorta besides standard range of lymph node dissection.

https://www.frontiersin.org/articles/10.3389/fonc.2020.01343/full

 


Q) Young Male around 20 with severe chest pain and dysphagia with small hiatus hernia most probable diagnosis?

a) Achalasia cardia
b) Hypertensive LES
c) Nutcracker esophagus
d) DES

 

Ans b

Hypertensive lower esophageal sphincter (LES) is an uncommon manometric abnormality found in patients with dysphagia and chest pain, and is sometimes associated with gastroesophageal reflux disease (GERD)

Achalasia does not have chest pain

DES has chest pain but seen in older females preferably

Nutcracker esophagus  is seen in patients of all ages, with equal gender predilection and is the most
common of all esophageal hypermotility disorders. Like DES patients have chest pain and dysphagia.

REF https://pubmed.ncbi.nlm.nih.gov/14675708/

 


Q3) 45  year old lady asymptomatic, routine USG check up detected to have 5X 6 cm cystic lesion in  segment V of liver. CT Scan picture

Cystic lesion liver

a) Biliary cystadenoma

b) Hydatid cyst liver

c) Amoebic liver abscess

d) Cystic degeneration of Malignancy

 

Ans a

Biliary cyst adenoma are mostly seen in the age group asked in the question. Most of them are asymptomatic

While 10% of reported BCT originate in the extrahepatic biliary tree, the overwhelming majority arises from the intrahepatic biliary system

CT of Biliary cyst adenoma At CT, BCAs are a fluid attenuating cystic mass with a soft tissue attenuating rim, internal septa, and possibly capsular calcifications and mural nodularity.

D/d is

Hydatid cyst - In this question age and sex is pointer to biliary cyst adenoma

Simple cyst

Liver abscess ( excluded in this question ) as patient is asymptomatic


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