Gastrointestinal Surgery Practice Questions

Q: All of the following are true about achalasia cardia except?

Decreased lower esophageal sphincter tone. **Explanation:** Achalasia cardia is a primary esophageal motility disorder characterized by the failure of the Lower Esophageal Sphincter (LES) to relax and the absence of esophageal peristalsis. **Why Option C is the Correct Answer (The False Statement):** In achalasia, there is **increased (hypertensive) resting LES pressure** (typically >30 mmHg) and, more importantly, **incomplete relaxation** of the LES upon swallowing. This is due to the degeneration of inhibitory nitrergic neurons in the myenteric (Auerbach’s) plexus. Therefore, "decreased tone" is physiologically incorrect. **Analysis of Other Options:** * **Option A (Bird beak appearance):** This is the classic radiological finding on a barium swallow. The dilated proximal esophagus tapers down to a narrow distal segment (the non-relaxing LES), resembling a bird’s beak or rat’s tail. * **Option B (Absent air bubble):** On a plain chest X-ray, the absence of the gastric air bubble (magenblase) is a high-yield sign. Since the LES does not open properly, air cannot enter the stomach. * **Option C (Absent peristalsis):** This is a hallmark manometric finding. The esophageal body shows aperistalsis or low-amplitude simultaneous contractions because of the destruction of the ganglionic cells. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Esophageal Manometry (shows incomplete LES relaxation and aperistalsis). * **Most Common Symptom:** Dysphagia to both solids and liquids (often starting simultaneously). * **Heller’s Myotomy:** The surgical treatment of choice, usually performed with a partial fundoplication (Dor or Toupet) to prevent reflux. * **Chagas Disease:** A common secondary cause of achalasia (caused by *Trypanosoma cruzi*). * **Sigmoid Esophagus:** The term used for the advanced, massively dilated, and tortuous esophagus seen in long-standing cases.

Q: What is true about mesenteric cysts?

Moves perpendicular to the line of attachment. Mesenteric cysts are rare intra-abdominal tumors located between the leaves of the mesentery [1]. Understanding their clinical presentation and pathology is crucial for NEET-PG. **1. Why Option A is Correct:** The hallmark clinical sign of a mesenteric cyst is its **mobility**. Because the cyst is attached to the mesentery (which runs from the left second lumbar vertebra to the right sacroiliac joint), it can be moved freely in a plane **perpendicular to the line of mesenteric attachment** (transverse mobility) [1]. It has restricted mobility along the longitudinal axis of the attachment. **2. Why the other options are Incorrect:** * **Option B:** The most common type is the **Chylolymphatic cyst**, followed by enterogenous cysts. Teratomatous cysts are rare. * **Option C:** Chylolymphatic cysts are thin-walled and **share a common blood supply** with the adjacent loop of the bowel. This makes simple enucleation difficult without compromising the bowel's vascularity. * **Option D:** The treatment of choice is **enucleation** (simple excision). Resection of the adjacent bowel is **not** required for all cysts; it is only indicated if the cyst is large, involves the bowel wall, or shares an inseparable blood supply (common in chylolymphatic or enterogenous types). **Clinical Pearls for NEET-PG:** * **Tillaux’s Sign:** A zone of resonance (tympanitic) all around the cyst with a dull note over the center, which is characteristic of mesenteric cysts [1]. * **Most common site:** Mesentery of the **ileum** (60%). * **Imaging:** Ultrasound is the initial investigation; CT/MRI is used for surgical planning. * **Differential Diagnosis:** Ovarian cyst (moves side-to-side but usually has a pelvic origin) [2].

Q: Which of the following presents as a symptom of pelvic abscess?

Mucoid diarrhea. **Explanation:** A pelvic abscess typically occurs as a complication of appendicitis, pelvic inflammatory disease, or post-operative leakage. The correct answer is **Mucoid diarrhea** due to the anatomical proximity of the abscess to the rectum. **Why Mucoid Diarrhea is Correct:** The pelvic abscess rests in the Rectovesical pouch (in men) or the Pouch of Douglas (in women), directly abutting the anterior wall of the rectum. The inflammatory mass causes **biochemical and mechanical irritation** of the rectal mucosa. This irritation leads to: 1. **Tenesmus:** A constant, painful urge to defecate. 2. **Mucus Hypersecretion:** The irritated rectal lining produces excess mucus, which is passed as "spurious diarrhea" or mucoid stools. **Analysis of Incorrect Options:** * **A. Pain in the perineum:** While pelvic pathology can cause referred pain, it is not a classic diagnostic symptom of a localized pelvic abscess compared to rectal symptoms. * **C. Abdominal distension & D. Vomiting:** These are features of generalized peritonitis or intestinal obstruction. A pelvic abscess is a **localized** collection; unless it ruptures or causes a secondary paralytic ileus, these systemic obstructive symptoms are less characteristic than localized rectal irritation. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Contrast-Enhanced CT (CECT) of the abdomen and pelvis. * **Classic Physical Sign:** On **Digital Rectal Examination (DRE)**, one finds a tender, boggy swelling on the anterior rectal wall. * **Treatment:** Surgical drainage is required. This is often done via the route where the abscess is "pointing"—most commonly **transrectal drainage** (proctotomy) or transvaginal drainage (colpotomy). * **Mnemonic:** Remember the "Pelvic 3": **P**ain (suprapubic), **P**us (collection), and **P**oop (mucoid diarrhea/tenesmus).

Q: Which of the following is not an approach for inguinal hernia repair?

Lotheissen. ### Explanation The correct answer is **B. Lotheissen**. **Why Lotheissen is the correct answer:** The **Lotheissen procedure** is a surgical approach specifically designed for **femoral hernia** repair, not inguinal hernia. It involves a supra-inguinal approach where the transversalis fascia is opened to access the femoral canal from above. While it utilizes the same regional anatomy, its primary objective is the closure of the femoral ring. **Analysis of Incorrect Options:** * **Bassini’s Repair:** A classic "tissue-based" (non-mesh) repair for inguinal hernias. It involves suturing the conjoint tendon (internal oblique and transversus abdominis) to the inguinal ligament. * **Lichtenstein’s Repair:** The current **gold standard** for inguinal hernia surgery. It is a "tension-free" repair using a synthetic mesh to reinforce the posterior wall of the inguinal canal. * **Desarda Repair:** A modern non-mesh technique where a strip of the external oblique aponeurosis is used to reinforce the posterior wall. It is an alternative for patients who cannot afford or tolerate mesh. **High-Yield Clinical Pearls for NEET-PG:** * **McVay’s Repair:** A procedure that can address **both** inguinal and femoral hernias by suturing the conjoint tendon to Cooper’s ligament. * **Shouldice Repair:** The most effective non-mesh (tissue) repair with the lowest recurrence rate; it involves a four-layer imbrication of the transversalis fascia. * **Nerve Injury:** The **ilioinguinal nerve** is the most commonly injured nerve during open inguinal hernia repair, leading to numbness over the scrotum/labia and medial thigh. * **Gold Standard:** Lichtenstein (Open) and TEP/TAPP (Laparoscopic) are the preferred modern approaches.

Q: Which of the following is NOT true about dumping syndrome?

Least common with trunkal vagotomy. **Dumping Syndrome** (also known as **post-cibal syndrome**) occurs when gastric reservoir function is lost or bypassed, leading to the rapid delivery of hyperosmolar chyme into the small intestine. ### **Explanation of Options** * **Option B (Correct Answer):** This statement is **false**. Dumping syndrome is actually **most common** with Truncal Vagotomy (TV) when combined with a drainage procedure like Pyloroplasty or Gastrojejunostomy. TV destroys the receptive relaxation of the stomach and the drainage procedure destroys the pyloric sphincter mechanism, maximizing accelerated emptying. It is *least* common with Highly Selective Vagotomy (HSV), which preserves the pyloric antral pump. * **Option A:** This is **true**. Dumping syndrome is synonymous with post-cibal syndrome, as symptoms occur specifically after food intake. * **Option C:** This is **true**. The core pathophysiology is the loss of the pyloric "gatekeeper" mechanism, leading to **accelerated gastric emptying**. * **Option D:** This is **true**. **Octreotide** (a somatostatin analogue) is the most effective medical treatment. It inhibits the release of insulin and GI hormones (like serotonin and VIP) and slows gastric emptying. ### **Clinical Pearls for NEET-PG** 1. **Early Dumping (75%):** Occurs 15–30 mins after meals. Due to hyperosmolar load causing fluid shift into the bowel lumen (distension) and release of vasoactive substances. Symptoms: Palpitations, tachycardia, diarrhea. 2. **Late Dumping (25%):** Occurs 1–3 hours after meals. Due to a rapid rise in blood glucose leading to an **insulin overshoot**, resulting in **reactive hypoglycemia**. 3. **Management:** * **Dietary:** Small, frequent, dry meals; high protein/low carb; avoid liquids during meals. * **Surgical:** If medical management fails, Roux-en-Y gastrojejunostomy is the preferred reconstructive procedure to slow emptying.

Q: What is the most common complication of a sliding hernia?

Esophagitis due to continuous reflux. **Explanation:** **Sliding Hiatal Hernia (Type I)** is the most common type of hiatal hernia (95%). In this condition, the gastroesophageal (GE) junction and a portion of the gastric cardia "slide" upward into the posterior mediastinum through the esophageal hiatus. 1. **Why Option A is correct:** The primary clinical significance of a sliding hernia is the disruption of the **anti-reflux mechanism**. The displacement of the Lower Esophageal Sphincter (LES) into the chest results in the loss of the abdominal pressure gradient and the acute angle of His. This leads to chronic Gastroesophageal Reflux Disease (GERD). **Esophagitis** is the most frequent complication resulting from this continuous acid reflux. 2. **Why other options are incorrect:** * **Pneumonia:** While aspiration pneumonia can occur due to severe reflux, it is a secondary consequence and less common than direct mucosal inflammation (esophagitis). * **Hemorrhage and Perforation:** These are classic complications of **Paraesophageal Hernias (Type II)**. In Type II hernias, the GE junction remains fixed, but the fundus herniates, leading to risks of incarceration, strangulation, volvulus, and ischemic ulceration (Cameron ulcers), which can bleed or perforate. **High-Yield Clinical Pearls for NEET-PG:** * **Most common type of Hiatal Hernia:** Sliding Hernia (Type I). * **Most common symptom:** Heartburn/Regurgitation (GERD). * **Indication for Surgery:** Sliding hernias are managed medically unless refractory to treatment. Paraesophageal hernias often require surgery due to the risk of strangulation. * **Schatzki Ring:** A mucosal ring often found at the squamocolumnar junction in patients with sliding hernias.

Question 1

In percutaneous endoscopic gastrostomy (PEG), which of the following is not used?

Accepted Answer

Retraction method

Answer

Push technique

Answer

Pull technique

Answer

Introducer technique

Question 2

All of the following are true about achalasia cardia except?

Accepted Answer

Decreased lower esophageal sphincter tone

Answer

Bird beak appearance on barium swallow

Answer

Absent air bubble in the stomach on X-ray

Answer

Absent peristalsis in the body of the esophagus

Question 3

What is true about mesenteric cysts?

Accepted Answer

Moves perpendicular to the line of attachment

Answer

Teratomatous is the most common type

Answer

Chylolymphatic cyst has a separate blood supply

Answer

Surgical removal of bowel along with the cyst is the treatment of choice for all cysts

Question 4

Which of the following presents as a symptom of pelvic abscess?

Accepted Answer

Mucoid diarrhea

Answer

Pain in the perineum

Answer

Abdominal distension

Answer

Vomiting

Question 5

Which of the following findings indicates the least chance of re-bleeding after hematemesis episodes?

Accepted Answer

Clean based ulcer

Answer

Adherent clot on ulcer

Answer

Gastric ulcer with arteriovenous malformation

Answer

Visible bleeding vessel

Question 6

Which of the following is not an approach for inguinal hernia repair?

Accepted Answer

Lotheissen

Answer

Bassini's

Answer

Lichtenstein's

Answer

Desarda

Question 7

Which ascitic fluid analysis finding is suggestive of gut perforation?

Accepted Answer

ALP > 240 and CEA > 5

Answer

LDH > 600 and Sugar < 50

Answer

Total count > 15,000

Answer

E.coli positive ascitic fluid culture

Question 8

Which of the following is NOT true about dumping syndrome?

Accepted Answer

Least common with trunkal vagotomy

Answer

Also called post-cibal syndrome

Answer

Occurs due to accelerated gastric emptying

Answer

Octreotide may be useful

Question 9

What is true about the hyperplastic type of tuberculosis?

Accepted Answer

Pulled up caecum

Answer

Swallowed infected sputum is the cause

Answer

Highly virulent compared to ulcerative type

Answer

Serosa studded with tubercles

Question 10

What is the most common complication of a sliding hernia?

Accepted Answer

Esophagitis due to continuous reflux

Answer

Pneumonia

Answer

Hemorrhage

Answer

Perforation

Gastrointestinal Surgery — MCQs

Gastrointestinal Surgery — MCQs

On this page

Practice by Chapter

Want unlimited practice?