Surgery Superspeciality MCQS – Page 124

Hirchsprung’s disease

2020-12-182017-01-06 by admin

Q) False statement about Hirchsprung's disease is:

a) Male and Female have equal incidence

b) In approximately 8% of the patients entire colon is affected

c) After surgery constipation is the most common problem

d) Down syndrome can be seen in up to 3-5% patients

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Answer

Hirchsprung's disease is a developmental disorder characterized by absence of ganglion cells in both Auerbach's and Meissner's plexus and males are more frequently affected than females

Absence of these ganglion cells lead to a very tight anal sphincter with resultant constipation.

This aganglionosis which is similar to Achalasia cardia begins at anorectal junction and involves rectosigmoid in 80% and entire colon in 8% of cases.

Various surgical options like Duhamel, Swenson and Soave procedures can be done and in all constipation is a common problem

Down's syndrome is associated in 5%

Ref: Sabiston 20th edition page 1876

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HCC Cancer

2020-12-122017-01-05 by admin

Q) Which of the following is true about screening in hepatocellular carcinoma (HCC Cancer)

a) Alpha feto protein should be done 6 monthly

b) Ultrasound abdomen should be done 6 monthly

c) Candidates for liver transplant should be screened every 3 months

d) Nodules more than 2 cm should be followed up more regularly

Answer b

Cirrhosis is prone for development of HCC. Screening has to be stringent. Earlier ultrasound of liver and alpha feto protein were both used for screening

In 2009 Marrero et al demonstrated the suboptimal accuracy of AFP and after that it has been removed from the screening protocol and now only ultrasound is being done.

The screening recommendation is not for those patients with severe associated conditions and with advanced liver disease who are already considered for transplant. So there is no screening for those who are already listed. Nodules more than 1 cm are highly suspicious where as in nodules less than 1 cm only 40% will be malignant.

Ref: blumgart 6th edition

Mass in Right lower quadrant

2019-10-022016-12-29 by admin

Q) A 55 year old lady presents with vague pain in right lower abdomen. Physical examination reveals a well defined mass there which is non tender and freely mobile. It is non pulsatile as well. What is the most likely possibility?

a) Appendicular mass

b) Mesenteric cyst

c) Perforated tubo ovarian mass

d) Meckel's diverticulum

Answer

Mesenteric cysts are uncommon lesions found in this age group. It typically presents as a freely mobile mass which moves perpendicular to small blwel axis. It is painless as well.

Appendicular mass will have a preceding history of pain abdomen

Similarly perforated tubo ovarian mass will also have a history of pain

Meckel's diverticulum does not present as this kind of mass

gastricbypass.surgery

EUS criteria of malignant lymph node

2024-06-122016-12-17 by admin

Q) One of the following is not a criteria of malignancy in lymph node on EUS

a) Size more than 1 cm

b) Prominent intranodal vasculature

c) Sharp well defined borders

d) Hypoechoic

Q) Which statement is not true about recurrent pyogenic cholangitis :

a) Mostly there are intrahepatic strictures with involvement of the left side duct

b) It can present as choledocho duodenal fistula

c) There is complete biliary obstruction which leads to marked jaundice and pruritis

d) MRCP and other other cholangiography can be diagnostic

Answer c

In recurrent pyogenic cholangitis (RPC) complete obstruction does not occur and jaundice and pruritis is not marked.

RPC is a disease commonly seen in young Asians (also known as oriental cholangiohepatitis) which leads to multiple strictures in extra or intrahepatic ducts.

Men and women are equally affected, and, historically, the disease strikes at an early age (20–40 years) in patients from lower socioeconomic classes. ( Sabiston 21st edition page 1461)

Cause for recurrent pyogenic cholangitis

Association with Ascaris lumbricoides and Clonorchis sinensis has been noted.

Stones and strictures

Clinical Presentation of Recurrent pyogenic Cholangitis

It can present as choledocholithiasis with stricture, choledochoduodenal fistula, acute pancreatitis, secondary biliary cirrhosis and can lead to cholangiocarcinoma.

Radiology for Recurrent Pyogenic Cholangitis

MRCP can be diagnostic and is preferred because of its non invasive nature.

Surgical treatment

Goal is to clear the biliary tree and to bypass or resect the strictures

Options are

CBD exploration

Hepaticojejunostomy

Partial liver resections