NEET 2018 Questions 6-10
Q1-5
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
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