FCPS MCQS OF SURGERY

Q1.False statement  regarding  acute necrotizing pancreatitis is ?

a)  It accounts for 10-15% of all cases of acute   pancreatitis

b) Necrotizing Pancreatitis involves both pancreatic parenchyma and surrounding tissues or sometimes

    either one

c) Peripancreatic involvement means severe disease as comapred to pancreatic parenchyma alone

d) Radioloical diagnosis of necrotizing pancreatitis is difficult in the 1st week

Q2. Which of the following statement is not true for ideal hepaticojejunostomy

a) The anastomosis should be tension free

b) All the suture knoys should  be on the  outside of bile duct

c) Mucosal contact must exist between  the mucosa of the bowel and bile duct

d) Anastomosis done with single layer  absorbable sutures

Q3. Barrett's esophagus is a premalignant condition.

Which of  the following statement is false regarding

Barrett's esophagus

a) Barrett's mucosa predisposes to Squamous cell carcinoma of esophagus

b) Risk of Cancer is 0.5% per year

c) Prevalence of Barrett's esophagus in general  population is  2-7%

d) Intestinal type of mucosa  with goblet cells is the most  common histopathological finding

Q4. A 45 year old lady presents to the HepatoBiliary

Clinic with a  large 3 cm stone in the neck of gall bladder

eroding into the Common Bile duct (CBD) effacing about

50% of its diameter. Patient  has been counselled  about

surgery and is willing for the same.What would be the most

appropriate  surgery for this patient?

a) Cholecystectomy, removal of stone and primary repair of CBD over a T tube

b) Radical Cholecystectomy

c) Cholecystectomy and use of a flap of Gall Bladder to repair the defect in CBD

d) Cholecystectomy and Roux en Y Hepaticojejunostomy

Q5. A 50 year old presents with vague persistent abdominal pain. CT Scan of the abdomen reveals a duodenal diverticulum. Which of the

statements is true regarding duodenal diverticulum.

a) The overall incidence of duodenal diverticulum is 7-20% and about 10%  of these require surgery.

b) Most of the duodenal diverticula are symtomatic and perforation is the most common complication

c) Surgery should be avoided and carried out only in case of complications  like perforation, uncontrooled hemorrahge, persistent biliary or pancreatic symptoms

d) Juxta vaterian diverticulum is the easiest to manage

answers

1) c

Pancreatic necrosis occurs in 10-20% of all cases of Acute pancreatitis and commonly involve both pancreatic parenchyma and peri pancreatic tissue.Involvement of pancreatic parenchyma heralds a disease more severe in intensity than involvement of peripancreatic tissue alone.

2) b

Ideal Hepaticojejunostomy should be tension free with mucosal approximation and done using single layer absorbale suture

All though it is desired that the suture knot should be outside but absorbale suture are bein used , in the posterior layer knots may be place on the inside of the lumen

3) a

Barrett's esophagus is associated with adenocarcinoma and not squmaous cell carcinoma. Metaplasia occurs most commonly because of GERD and the normal esopheal lining is replaced by columnar cells

These columnar cells can be (i) Junctional cells (ii) Gastric cells and (iii) Intestinal Type of cells

Prsence of intestinal type of cells with prsence of goblet cells is the sine quo non of Barrett's esophagus

All other options are true.

4d

This patient has typical feature of Mirizzi's syndrome named after the Pablo Mirizzi.

It is a rare condition in which stone gets impacted in the neck of Gall Bladder. The stone compresses the CBD externally or can lead to fistula formation with the CBD.

Patients generally present with pain abdomen, jaundice and fever.

The Csendes classification of Mirizzi syndrome  is

Type 1: external compression of the common bile duct

Type 2: a cholecystobiliary fistula is present involving less than one third the circumference of the bile duct

Type 3: a fistula is present involving up to two thirds the circumference of the bile duct

Type 4: a fistula is present with complete destruction of the wall of the bile duct

Mirizzi Syndrome Treatment

Type 1 - Mirizzi syndrome  treatment is fundus first cholecytectomy or partial cholecystectomy

  For Type 2 to 4 the best treatment would be cholecystectomy and Roux en Y hepaticojejunostomy. A flap of gall bladder may sometimes be used if it appears healthy.