Tuesday, October 6, 2009

59 - Surgery mock test 3

Q1. Which of the following is not a congenital abnormality associated with Juvenile polyps ?

a) Malrotation
b) Meckel's diverticulum
c) Macrocephaly
d) Mesenteric lymphangioma

Q2. In Lynch syndrome which malignancy does not occur?

a) Bronchus
b) Ovary
c) Endometrium
d) Sebaceous Carcinoma

Q3. Which of the following is not true for malignancy of Familial Adenomatous Polyposis

a) Adrenals
b) Thyroid
c) Astrocytomas
d) Hepatoblastomas

Q4. What is not true for HNPCC

a) It is the most common hereditary colorectal cancer syndrome in USA
b) It is associated with MMR
c) It is associated with APC mutation
d) It is associated with carcinoma colon and extraintestinal cancers

Q5. Which of the following is not fermented by colonic bacteria

a) Lignin
b) Pectin
c) Cellulose

Q6. True about Ulcerative Colitis with malignancy
a) It has a better prognosis
b) Is related to disease activity
c) Is related to duration of ulcerative colitis
d) Malignancy is more in anorectal ulcerative colitis

Q7. In ulcerative coilitis with toxic megacolon lowest rcurrence is seen in
a) Complete proctocolectomy and Brook's ileostomy
b) Ileo rectal anastomoses
c) kock's pouch
d) Ileo anal pull through procedure

Q8) All are precancerous for carcinoma colon except

a. crohn's disease
b. Bile acids
c. Fats
d. carotene

Answers :

In Familial Juvenile polyposis there are associated abnormalities in 20% of cases which include:

*Cardiac lesions
*Mesenteric lymphangioma
*Meckel's Diverticulum
Ref: Sabiston 17 th page 1452 .

2. a
Lynch Syndrome is associated with cancers of :

-Endometrium and ovary
-Stomach and small intestine
-Renal pelvis and ureters
-Sebaceous carcinoma
Ref: Sabiston 17th page 1452.

3. c
FAP is associated with malignancy of colon.

Rare tumors associated with it are :
Ref:Sabiston 17th page 1452

4. c
HNPCC is associated with mutations of MMR (Mismatch Repair) genes and not APC gene which is mutated in FAP.
Sabistion 17th 1453

5. a
*Lignin is a non carbohydrate component of plants which is not fermented by colonic bacteria. It attracts water producing bulk.
*Lignin is used to treat constipation.
*Cellulose is partly fermented
*Pectin is completely fermented and used to treat diarrhea.

6 .c
-Carcinoma of the colon afflicts patients with ulcerative colitis 7 to 30 times more frequently than it does the general population.
-The risk of colon cancer in ulcerative colitis is related to two factors:
(1) duration of the colitis, and
(2) extent of colonic involvement.

-The risk of colon cancer for patients who have had the disease less than 10 years is low, but this risk steadily increases. The cancer risk for patients who have had disease activity for 10 to 20 years is 23 times that of the general population, while a disease duration of more than 20 years is associated with a cancer risk 32 times greater than that of the general population. The extent of colonic involvement in colitis also influences the risk of cancer. The incidence of cancer when ulcerative colitis is limited to the rectum or to the left side of the colon is much lower than when ulcerative colitis involves the entire colon.

The colonic malignancy associated with ulcerative colitis is generally an adenocarcinoma evenly scattered throughout the colon. The adenocarcinoma is often flatter than cancers in the general population and has fewer overhanging margins. It is generally considered extremely aggressive.

7. a
-Total proctocolectomy with brooke's ileostomy removes almost all of the diseased segment.
-IRA and IPAA leave behind rectal mucosa which may or may not be diseased

8) d
Carotene, Vit C and Calcium reduce the risk of colonic malignancy

58 - Risk factors for Oesophageal Carcinoma

Factors Associated with Pathogenesis of Esophageal Cancer

Squamous Cell Cancer
Alcohol consumption

Hot beverages

N-nitroso compounds (e.g., pickled vegetables)

Betel nut chewing

Maté drinking

Deficiencies of green vegetables and vitamins

Low socioeconomic class

Fungal toxin or virus

History of radiation to the mediastinum
Lye corrosive stricture

History of aerodigestive malignancy

Plummer-Vinson syndrome



Gastroesophageal reflux

Barrett's esophagus


*Observe that Adenocarcinoma is associated with only 5 of all the factors listed above. They are Barrett's esophagus, GERD, Obesity, Smoking and radiation to the mediastinum.
*Squamous cell cancer of esophagus is not associated with Obesity, GERD and Barrett's esophagus.
*The most common location of squamous cell carcinoma of esophagus is the middle and lower third of esophagus.
*The most common location of adenocarcinoma of esophagus is the lower third of the esophagus.
*The most common type of esophageal carcinoma in WEST is adenocarcinoma, which is on the rise recently.
*The most common type of esophageal carcinoma in INDIA and ASIA is squamous cell carcinoma. (reasons being less incidence of GERD, obesity and barrett's esophagus in asian population when compared to the west and high incidence of H.PYLORI, which is thought to be protective against adenocarcinoma; in asian population. )

Monday, October 5, 2009

57 - Surgery mock test 2

Q1. What is not true regarding caustic injuries to the esophagus?

a) Acid injury causes coagulative necrosis
b) Alkali injury causes liquifactive necrosis
c) Acid burns of esophagus are more destructive than alkali burns
d) Endoscopy should be done urgently

Q2. Which of the following dyes are not used in chromoendoscopy?

a) Potassium Iodide
b) Congo Red
c) Methylene blue
d) Cresyl Violet

Q3. Which of the following is not an indication for surgery in GERD?
a) Young Age with symptoms controlled on proton pump inhibitors.
b) Progressive respiratory symptoms
c) Barrett's oesophagus
d) Hiatus hernia with symptoms controlled on medicines

Q 4. Which of the following conditions in GERD have the worst response after Surgery, (Fundoplication)?
a) Atypical GERD symptoms
b) Patients who achieve symptomatic pain relief with PPIs
c) Classical GERD symptoms
d) Positive 24 hr ph study


1. c
Injury by acids produce coagulative necrosis and form a barrier to prevent further damage. Liquifactive necrosis is produced by Alkali. Injury by alkali agents is more harmful than acids. Endoscopy is recommended early to stage the inujry. Endoscopy should be avoided from 4-14 days as this is the time when is esophagus is more prone for perforations.
Schakelford surgery of alimentary canal Volume 6th Section 1 page 541

2. b
In Chromoendoscopy various dyes are used to identify the cells lining the oesophagus. These dyes stain the cells that absorb them or they accumulate in the mucosal crevices to enhance the architectural framework.
*Congo red is not used in endoscopy. I t is a dye that was used to test for the completeness of vagotomy.
*Potassium Iodide -- absorbed by squamous epithelium and stains it brown. It identifies early neoplasm
*Methylene blue absorbed by intestinal type of cells
*Cresyl violet stains columnar cells purple.

3. d
22-50% of patients with Gastroesophageal disease (GERD) develop complications. The aim of management in these patients is to identify those who require surgery for definitive management
These include
i) Anatomical and physiological markers of severe disease like defective lower oesophageal sphincter, poor peristalsis, large hiatal hernia and bile reflux
ii) Severe erosive esophagitis
iii) Barrett's oesophagus
iv) young age
v) Progressive respiratory symptoms

Hiatus hernia is seen in upto 80% of patients with GERD and mere presence of hernia is no indication for surgery.

4. a
The best response to ANTIREFLUX SURGERY eg Nissen's fundoplication is seen when there is demonstrable acid reflux from the stomach to the oesophagus (most commonly due to deficient lower oesophageal sphincter).
98% response can be seen who have symptomatic relief with PPI s (acid reduction), typical symptoms of GERD such as heartburn, regurgitation and dysphagia and positive 24 hr ph monitoring studies. Patients with atypical GERD symptoms such as asthma, chough, wheeze etc are benefited less after Fundoplication.

56 - Surgery mock test 1

1)Most common benign mesenchymal tumor of the stomach...
a) Polypoid adenoma
b) Leiomyoma
c) Glomus tumor
d) Lipoma

2) All the following are risk factors of CA- Colon except.........
a) Crohn's disease
b) Ulcerative Colitis
c) Adenomatous Polyp
d) Juvenile Polyposis

3) Which of the following is a locally aggressive soft tissue tumor?
a) Rhabdomyoma
b) Angiosarcoma
c) Round tissue liposarcoma
d) Fibromatosis

4) In a patient with A/C gastric dilatation , initial evaluation & treatment should include all these except.............
a) Insertion of intravenous catheter
b) Insertion of nasogastric tube
c) Administration of metaclopramide to increase the rate of gastric emptying
d) Insertion of Foley's catheter

5) A patient presents with a small fast growing lesion on the upper extremity & comments that it has been present since 2 weeks . Likely diagnosis is...
a) Sq cell CA
b) Keratoachanthoma
c) Basal cell CA
d) Junctional Nevus

6) The least painful surgical approach to heart & lungs is:
a) Median sternotomy
b) Postero lateral Thoracotomy
c) Anterolateral Thoracotomy
d) Transverse sternal splitting Thoracotomy

7) All the following about BPH are true except:
a) Decreased force & caliber of the urinary stream is the usual presenting feature
b) Increase in PSA levels is one of the diagnostics features
c) Dynamic uro flowmetry is one of the diagnostic modalities.
d) Incidence is age related

8) An elderly lady has been admitted with features of anemia weakness ,weight loss & a palpable mass per abdomen . She has CA:Colon. The most likely anatomical site is...............
a) Rectum
b) Sigmoid colon
c) transverse colon
d) left colon

9) A 28year old man presents with a single descended testis & a 6 cms solid mass seen by CT. The most likely diagnosis is:
a) Metastatic prostate cancer
b) Teratoma
c) Hyper plastic cryporchid testis
d) Seminoma

10) The initial therapy of documented DVT in a post operative case is :
a) Subcutaneous heparin therapy
b) IV heparin therapy
c) Anti Thrombosis therapy with urokinase
d) aspirin therapy

11) Out of the following locations of intra cranial hemorrhage , surgery is most useful in :
a) Putamen hemorrhage
b) Thalamic hemorrhage
c) Cerebellar hemorrhage
d) Pontine hemorrhage

12) Which of the following statements regarding AV fistula are true?
a) Blood volume is decreased
b) Cardiac output is increased
c) Heart rate is decreased
d) Peripheral vascular resistance is decreased

13) A 35 year old lady is diagnosed to have Medullary CA of rt breast with TNM staging of T2 N1 M0 . The current recommended treatment is :
a) Multimodality therapy consisting of surgery , radiotherapy & chemotherapy .
b) Modified radical mastectomy
c) Simple mastectomy with radiotherapy
d) Combination therapy

14) A 5 year old boy has a midline swelling of neck that moves with deglutition & is located below the hyoid bone . The mass is likely to be......
a) Branchial cleft cyst
b) cystic hygroma
c) Teratoma
d) Thyroglossal duct cyst.

15) A 40year old lady comes to the OPD after noticing a lump in her breast . Physical examination revels a 3 cms , firm irregular mass on the lateral aspect of the rt breast with dimpling of the overlying skin . A subsequent biopsy revels chronic inflammatory necrotic adipose tissue with saponification , with areas of calcification . Diagnosis will be...
a) Chomedo CA
b) Fat necrosis
c) Duct ectasia
d) Granulomatous mastitis

16) The most acceptable method of treatment of esophageal perforation during endoscopy, which is associated with a leak into pleural space is :
a) Observation alone
b) Observation + antibiotics
c) Insertion of left chest tube
d) Drainage & surgical repair of the injury

17) In TNM classification of lung CA N2 nodes includes all the following except?
a) Paratrachial nodes
b) Subcarinal nodes
c) Nodes in the inferior pulmonary ligaments
d) Inter lobar nodes

18) Regarding primary Sclerosing Cholengitis all the following are true except...
a) USG is often normal
b) ERCP is the preferred approach
c) Cholangiogram appearance may mimic diffuse form of Cholangio CA
d) Affects only intra hepatic ducts

19) The most important anomaly in the urethra & bladder that leads to stress incontinence is ......
a) Loss of estrogen in menopausal period
b) Loss of urethral sphincter
c) Prolapse Uterus
d) Loss of posterior Urethrovesicle angle

20) On radiograph of chest , a double shadow behind the heart ,signs of aspiration pneumonia , & absence of air in the stomach is suggestive of
a) Aneurism of aorta
b) Achalasia
c) Ca esophagus
d) Peptic ulcer of stomach


Question 1=b
Question 2=d
Question 3=d
Question 4=d
Question 5=b
Question 6=a
Question 7=b
Question 8=b
Question 9=d
Question 10=b
Question 11=b
Question 12=d
Question 13=a
Question 14=d
Question 15=b
Question 16=d
Question 17=d
Question 18=d
Question 19=d
Question 20=b

Subscribe Now: Feed

You are visitor number

Visitors currently online