Gastrointestinal Surgery Practice Questions

Q: Which of the following is a manifestation of carcinoma of the stomach?

All of the above. **Explanation:** Carcinoma of the stomach is known for its propensity to present with various paraneoplastic syndromes and signs of distant metastasis due to its aggressive nature and late clinical presentation. * **Troisier’s Sign (Option A):** This refers to the clinical finding of a palpable, hard, non-tender left supraclavicular lymph node (**Virchow’s node**). It indicates the spread of abdominal malignancy (most commonly gastric cancer) via the thoracic duct. * **Trousseau’s Syndrome (Option B):** This is a paraneoplastic manifestation characterized by **migratory thrombophlebitis**. It occurs due to the release of procoagulants (like mucin) from the adenocarcinoma, leading to recurrent blood clots in superficial veins at various sites. * **Irish Node (Option C):** This refers to the enlargement of the **left anterior axillary lymph node**, signifying lymphatic spread from a gastric malignancy. Since all three clinical features are recognized manifestations of advanced or metastatic gastric carcinoma, **Option D (All of the above)** is the correct answer. **High-Yield Clinical Pearls for NEET-PG:** * **Sister Mary Joseph’s Nodule:** Palpable nodule at the umbilicus due to metastasis (most common in gastric, ovarian, or pancreatic cancer). * **Krukenberg Tumor:** Metastasis to the ovaries (classically showing signet ring cells). * **Blumer’s Shelf:** A shelf-like palpable mass in the rectovesical or rectouterine pouch (Pouch of Douglas) on rectal examination, indicating peritoneal drop metastasis. * **Acanthosis Nigricans:** A sudden, diffuse onset of velvety hyperpigmentation (especially in axilla) can be a paraneoplastic sign of gastric adenocarcinoma.

Q: All of the following statements about Esophageal carcinoma are true, EXCEPT:

Pernicious anemia is a risk factor. **Explanation:** **1. Why Pernicious Anemia is the Correct Answer (The Exception):** Pernicious anemia is an autoimmune condition characterized by vitamin B12 deficiency due to a lack of intrinsic factor. It is a well-established risk factor for **Gastric Adenocarcinoma** and **Gastric Carcinoid tumors**, but it has **no clinical association with Esophageal Carcinoma**. Therefore, statement D is the false statement. **2. Analysis of Incorrect Options:** * **A. More common in Men:** True. Both Squamous Cell Carcinoma (SCC) and Adenocarcinoma show a strong male predilection (often cited as a 3:1 to 4:1 ratio). * **B. Adenocarcinoma is on the rise:** True. While SCC remains the most common type worldwide, the incidence of Adenocarcinoma is rapidly increasing in Western countries and urban India, primarily due to the rising prevalence of obesity and GERD (leading to Barrett’s Esophagus). * **C. Most common in the elderly:** True. Esophageal cancer is a disease of aging, with the peak incidence typically occurring in the 6th and 7th decades of life. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Globally, the middle third (SCC); for Adenocarcinoma, it is the lower third. * **Risk Factors for SCC:** Smoking, Alcohol, Achalasia Cardia, Tylosis (100% risk), Plummer-Vinson Syndrome, and Lye ingestion. * **Risk Factors for Adenocarcinoma:** GERD, Barrett’s Esophagus (metaplasia), Obesity, and Smoking. * **Investigation of Choice:** Upper GI Endoscopy (UGIE) with biopsy. * **Staging:** Endoscopic Ultrasound (EUS) is the most accurate for 'T' and 'N' staging.

Q: A 50-year-old man presented with severe vomiting and chest pain after consuming alcohol and a heavy dinner, leading to collapse. Chest X-ray revealed hydropneumothorax. What is the likely diagnosis?

Boerhaave syndrome. **Explanation:** The clinical presentation of severe vomiting followed by sudden chest pain and collapse, combined with the radiological finding of **hydropneumothorax**, is a classic description of **Boerhaave syndrome**. **1. Why Boerhaave Syndrome is correct:** Boerhaave syndrome is a **spontaneous full-thickness transmural perforation** of the esophagus. It typically occurs due to a sudden rise in intra-abdominal pressure (e.g., forceful vomiting or retching against a closed glottis). The perforation most commonly occurs in the **left posterolateral aspect of the distal esophagus** (2-3 cm above the gastroesophageal junction). The leakage of gastric contents and air into the pleural space leads to chemical pleuritis and hydropneumothorax. **2. Why other options are incorrect:** * **Mallory-Weiss syndrome:** This involves a **mucosal/submucosal tear** (not transmural) at the gastroesophageal junction. It presents with hematemesis but does not cause perforation or hydropneumothorax. * **Ruptured duodenal ulcer:** While it causes sudden abdominal pain and pneumoperitoneum (air under the diaphragm), it does not typically present with hydropneumothorax or severe chest pain. * **Myocardial infarction:** While it presents with chest pain and collapse, it would not explain the presence of air or fluid in the pleural cavity (hydropneumothorax). **High-Yield Clinical Pearls for NEET-PG:** * **Mackler’s Triad:** Vomiting, chest pain, and subcutaneous emphysema (pathognomonic but seen in only 25% of cases). * **Diagnosis:** Gastrografin (water-soluble contrast) swallow is the initial investigation of choice. * **Chest X-ray:** May show the **V-sign of Naclerio** (translucent streaks of air behind the heart). * **Management:** Surgical emergency requiring primary repair and mediastinal drainage if diagnosed within 24 hours.

Q: All of the following are indications for surgery in a case of duodenal ulcer EXCEPT?

Typical periodicity. **Explanation:** The management of duodenal ulcers (DU) has shifted significantly toward medical therapy due to the efficacy of Proton Pump Inhibitors (PPIs) and *H. pylori* eradication. Surgery is now reserved primarily for **complications** rather than the disease itself. **Why "Typical Periodicity" is the correct answer:** Typical periodicity refers to the classic symptomatic pattern of duodenal ulcers (pain-food-relief-pain), occurring in clusters over weeks followed by pain-free intervals. This is a **clinical feature** of uncomplicated DU, which is managed medically. It is not an indication for surgical intervention. **Analysis of Incorrect Options (Indications for Surgery):** * **Acute Perforation (Option A):** This is a surgical emergency. The standard treatment is an emergency laparotomy/laparoscopy with a Graham’s omental patch repair. * **Pyloric Stenosis (Option B):** This represents gastric outlet obstruction (GOO) due to chronic scarring. It is a mechanical complication that requires surgical correction (e.g., Truncated Vagotomy and Gastrojejunostomy or Pyloroplasty). * **Massive Haemorrhage (Option C):** While most bleeds are managed endoscopically, surgery (e.g., underrunning the bleeder) is indicated if there is hemodynamic instability despite resuscitation or failure of endoscopic intervention. **NEET-PG High-Yield Pearls:** * **Most common complication of DU:** Hemorrhage. * **Most common site of perforation:** Anterior wall of the first part of the duodenum (D1). * **Most common site of bleeding:** Posterior wall of D1 (erosion into the Gastroduodenal Artery). * **Intractability:** Failure of medical management (after 6–12 weeks of therapy) is also a surgical indication, though rare today.

Question 1

Which of the following is a manifestation of carcinoma of the stomach?

Accepted Answer

All of the above

Answer

Troisier's sign

Answer

Trousseau's syndrome

Answer

Irish node

Question 2

Regarding abdominal cocoon, all statements are true except?

Accepted Answer

Associated with liver fibrosis.

Answer

Common in young girls.

Answer

Fibrosis of the small bowel and stomach.

Answer

Chronic peritonitis is seen.

Question 3

All of the following statements about Esophageal carcinoma are true, EXCEPT:

Accepted Answer

Pernicious anemia is a risk factor

Answer

More common in Men

Answer

Adenocarcinoma is on the rise

Answer

Most common in the elderly

Question 4

During appendectomy, if the base of the appendix is noticed to be inflamed, what is the further line of treatment?

Accepted Answer

No burying of the stump

Answer

No appendicectomy

Answer

Hemicolectomy

Answer

Cecal resection

Question 5

Retractile mesenteritis may be seen in which of the following conditions?

Accepted Answer

Ormond's disease

Answer

Gardner's syndrome

Answer

Turner's syndrome

Answer

Down's syndrome

Question 6

A thirty-year-old male presents to the Emergency Department with symptoms of epigastric pain radiating to the back that wakes him up at night and is relieved by consuming food. He gives a history of similar pain in the past which was diagnosed as a perforated duodenal ulcer and treated with omental patch surgery on two occasions. Pain before and after surgery has been controlled with proton pump inhibitors and analgesics. What is the likely diagnosis on this occasion?

Accepted Answer

Duodenal ulcer

Answer

Gastric ulcer

Answer

Atrophic gastritis

Answer

Chronic pancreatitis

Question 7

A 50-year-old man presented with severe vomiting and chest pain after consuming alcohol and a heavy dinner, leading to collapse. Chest X-ray revealed hydropneumothorax. What is the likely diagnosis?

Accepted Answer

Boerhaave syndrome

Answer

Mallory-Weiss syndrome

Answer

Ruptured duodenal ulcer

Answer

Myocardial infarction

Question 8

Which of the following is NOT typically seen following massive resection of the small bowel?

Accepted Answer

Hypogastrinemia

Answer

Vitamin B12 deficiency

Answer

Malabsorption

Answer

Oxalate stone formation

Question 9

All of the following are indications for surgery in a case of duodenal ulcer EXCEPT?

Accepted Answer

Typical periodicity

Answer

Acute perforation of ulcer

Answer

Pyloric stenosis

Answer

Massive haemorrhage

Question 10

The most common complication of vagotomy is:

Accepted Answer

Diarrhea

Answer

Dryness of mouth

Answer

Tachycardia

Answer

Bleaching

Gastrointestinal Surgery — MCQs

Gastrointestinal Surgery — MCQs

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