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.

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