MCH 2018 Q 6-10

NEET 2018 Questions 6-10


 11-20 (general)

Q6. Not seen in ulcerative colitis?

a) Anal fistula

b) Association with primary sclerosing cholangitis

c) Superficial epithelial involvement

d) Backwash ilieitis

Q7. Least common complication of Meckel diverticulum

a) Bleeding

b) Obstruction

c) Neoplasm

d) Obstruction

Q8) Hinchey classification is for 

a) Diverticulitis complicated by obstruction

b) Simple diverticulitis

c) Diverticulitis complicated by perforation

d) Diverticulum of colon

Q9. Most common type of anal fistula is 

a) Intersphincteric

b) Transsphincteric

c) Supra sphincteric

d) Extra sphincteric

Q10) In Carcinoid appendix, False  statement is

a) It is the most common tumor of the appendix

b) Less than 1% of the overall  appendectomy specimens have carcinoid tumor

c) Size of the lesion is a good predictor of  malignant behavior

d)  Mostly carcinoid appendix are seen in the base of appendix

Answer to 10

A 6 ) a

Anal fistula is more common in Crohn's disease.

2-3 questions might come from the table below


Gross Appearance              UC                Crohn
Thickened wall                             0                     4+
Thickened mesentery                 0                      3+
Serosal fat wrapping                  0                      4+
Segmental disease                      0                      4
Microscopic Appearance
Transmural                                 0                       4+
Lymphoid aggregates               0                        4+
Granulomas                                0                        3
Clinical Features
Bleeding per rectum                 3+                        1+
Diarrhea                                      3+                        3+
Obstructive symptoms              1+                        3+
Anal or perianal disease          Rare                    4+
Risk for cancer                          2+                           3+
Small bowel disease                 0                           4+
Colonoscopic Features
Distribution                     Continuous         Discontinuous
Rectal disease                       4
+                             1+
Friability                                4+                             1+
Aphthous ulcers                    0                                4+
Deep longitudinal ulcers     0                               4+
Cobblestoning                       0                                 4

Ref Sabiston page 1339 

7) c Neoplasm

The most common clinical presentation of Meckel’s diverticulum is gastrointestinal bleeding, which occurs in 25% to 50% of patients who present with complications

intestinal obstruction occur as a result of a volvulus of the small bowel around a diverticulum associated with a fibrotic band attached to the abdominal wall, intussusception, or, rarely, incarceration of the diverticulum in an inguinal hernia (Littre hernia)

Diverticulitis accounts for 10% to 20% of symptomatic presentations.

Neoplasms can also occur in a Meckel’s diverticulum, with NET as the most common malignant neoplasm (77%). Other histologic types include adenocarcinoma (11%), which generally originates from the gastric mucosa, and GIST (10%) and lymphoma (1%).

Sabiston -1285

8 c

The Hinchey classification is commonly used to describe
the severity of diverticular disease complicated by perforation
and is an additional tool that may be used to guide overall management:

Stage I: Small, confined pericolonic or mesenteric abscess

Stage II: Larger, walled-off pelvic abscess

Stage III: Generalized purulent peritonitis

Stage IV: Generalized fecal peritonitis

Hinchey stages I and II can often be managed with administration of antibiotics and percutaneous drainage, if technically feasible

Sabiston page 1333 - 20th 

9) a

According to  Park's classification

Intersphincteric fistulae (45%) do not cross the external sphincter. Most commonly they run directly from the internal to the external openings across the distal internal sphincter

Trans-sphincteric fistulae (40%) have a primary track that crosses both internal and external sphincters (the latter at a variable level) and which then passes through the ischiorectal fossa to reach the skin of the buttock.

Supra sphincteric and Extra sphincteric are rare

Bailey page 1364

10) d

Carcinoid appendix are the most common tumors of the appendix and seen in upto 0.3-0.9% of appendectomy specimen.

They are well circumscribed lesions seen near the distal part of appendix. 

Size of the lesion corresponds with metastatic potential as well as malignant behavior.

Carcinoids smaller than 1 cm are typically thought to behave in a benign manner and are cured with
appendectomy. Carcinoids larger than 2 cm are treated more
aggressively, however.

Sabiston page 1308