DMA's SURGERY PG Q&A 15-12-2017
Published on Dec. 15, 2017, 5:44 p.m.

 

1. In a patient suspected of having a pancreatic pseudo cyst, the finding that suggests a cystadenoma is

 

(A) Calcification within the cyst

 

(B) Generalized weakness

 

(C) Severe anorexia

 

(D) Vague abdominal discomfort

 

2. The most common cause of Budd Chiari syndrome is

 

(A). Hepatic vein valve              

 

(B). PNH

 

(C). IVC web                             

 

(D). SLE

 

3. Ulcerative colitis is commonly associated with the following except:

 

(A). Toxic megacolon   

 

(B). Perforation

 

(C). Massive bleeding   

 

(D). Stricture of the colon

 

4. Treatment of squamous cell carcinoma of anal canal is:

 

(A) Cisplatin based chemotherapy followed by radical radiotherapy

 

(B) Abdomino perineal resection

 

(C) Radical radiotherapy

 

(D) Radical radiotherapy followed by mitomycin-c based chemotherapy.

 

5. Intestine get strangulated most commonly in which space

 

(A). Omental bursa                    

 

(B).Paraduodenal space

 

(C). Rectouterine space            

 

(D). Subphrenic

 

6. A plain abdominal X-ray in a patient with a sigmoid volvulus will show a distended bowel loop with its apex in

 

(A). Right iliac fossa                 

 

(B). Left iliac fossa

 

(C). Lt. hypochondrium             

 

(D). Rt. Hypochondrium

 

7. Abdominal symptoms mimicking acute peritonitis have been associated with the administration of

 

(A) Dihydrostreptomycin 

 

(B) Ethambutol

 

(C) Isoniazid                   

 

(D) Para-aminosalicylic acid

 

8. Organ last to recover in paralytic ileus is

 

(A). Stomach                

 

(B). Large intestine

 

(C). Small intestine       

 

(D). Rectum and anal canal

 

9. True regarding Familial adenomatous polyposis are all the following except

           

(A). 100% chances of malignancy over a period of time

 

(B). Adenomatous polyps occur in colon

 

(C). Equal incidence in males and females

 

(D). Total colectomy early in childhood is the treatment of choice.

 

10. Triple diagnostic technique is used in which of the following condition?

 

(A). Peptic ulcer                       

 

(B). Breast mass

 

(C). Piles                      

 

(D). Obstructive jaundice

 

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1. Ans. (A). (Calcification within the cyst

The other symptoms can develop with either a pancreatic pseudocyst or a cystadenoma but calcification within the sac on radiologic examination is unusual with a pseudocyst. Whenever a patient with a pseudocyst under¬goes operation. the lining of the cyst should be inspected and biopsied to rule out an adenoma or an adenocarcinoma.    

2. Ans. (B). PNH

Budd Chiari syndrome
1    Results from occlusion of hepatic vein or inferior Vena cava.
2    The most common cause is thrombosis of hepatic vein often in setting of polycythemia rubra vera, myeloproliferative syndrome, PNH, OCP or hypercoagulable states.   
3    It may also results from invasion of IVC by tumor.
4    Idiopathic membranous obstruction of IVC is the most common cause of this syndrome in Japan & some other countries.
5    Hepatic venography or liver biopsy showing centrilobular congestion and sinusoidal dilation in absence of right sided heart failure establish diagnosis.
6    Characteristic appearance in CT scan - large congested liver (early stage) or small cirrhotic liver in which these is gross enlargement of segment I (the caudate lobe)  

3. Ans. (D). Stricture of the colon

•    Stricture is uncommon in ulcerative colitis as inflammation is limited to mucosa and superficial submucosa.
•    If stricture present in ulcerative colitis it should be considered as malignant until proven otherwise.
Complication of ulcerative colitis
Acute - Toxic dilatation
Perforation  
Haemorrhage
Chronic
Cancer
Extra colic manifestations.

4. Ans. (A). Cisplatin based chemotherapy followed by radical radiotherapy

•    Cancers of the anal canal can be divided into those affecting the anal margin (distal to the dentate line) and those affecting the anal canal (proximal to the dentate line).
•    Treatment of Anal Epidermoid or Squamous cell Ca.
o    Epidermoid Ca of anal margin is treated in similar way to the squamous cell ca of the skin in other locations because adequate surgical margins can usually be achieved without resecting the anal sphincter  wide local excision is adequate.
o    Epidermoid cancer occurring in the anal canal cannot be excised locally without destroying the sphincter so the first line therapy is  chemotherapy followed by Radiation therapy (Chemoradiation).
o    More than 80% are cured by chemoradiation. If any residual tumor is left behind after chemoradiation  an abdominoperineal excision is performed.
o    Chemotherapy used is combination of 5FU (5-fluorouracil) and mitomycin.
o    Other agents which can be used are a combination of bleomycin, cisplatin, doxorubicin.

5. Ans. (B). Paraduodenal space

    
•    Paraduodenal hernia are the most common congenital internal hernia Q.
•    It accounts for 25-50% of congenital internal hernia.
•    It results from abnormal rotation of midgut during embryonic development and can be divided into two sub type i.e. left and right paraduodenal hernia.

6. Ans. (D). Right hypochondrium

Plain X-ray abdomen finding in Sigmoid Volvulus
1. Characteristic bent inner tube or coffee bean appearance with Q convexity of loop lying in the right upper quadrant (opposite to the site of obstruction)
2. Contrast study (Gastrografin enema) - bird beak appearance i.e Q. narrowing at the site of volvulus. Q

7. Ans. (C). Isoniazid

In an acutely ill individual, it is important to know what drugs the patient is receiving. Isoniazid or erythromycin estolate may produce symptoms mimicking acute peritonitis. may produce striking thickening of the visceral peritoneum with small bowel obstruction, and a palpable abdominal mass.

8. Ans. (B). Large intestine

The return of normal motility following laparotomy has characteristic sequence
* Small intestine within - 24 hour
* Gastric motility 48 hours
* Colonic motility 3-5days
Thus colon is last to recover after paralytic ileus. Q

9. Ans. (D). Total colectomy early in childhood is the treatment of choice.

•    Flexible sigmoidoscopy (Proctosigmoidoscopy) recommended from 10-15 year of age annually
•    Upper GI endoscopy every 1 to 3 year from 25 to 35 year.
Once the polyps are detected surgery should be performed.

10. And. (B). Breast mass

Solid lesions that are persistent, recurrent, complex, or bloody cysts require mammography and biopsy, although in selected patients the so-called triple diagnostic techniques (palpation, mammography, aspiration) can be used to avoid biopsy.