2) Abdomen Flashcards by Syed Shah

Hernia Surgery under G/A. Contraindicated in which patient?

a) CABG 3 Months Earlier
b) Patient On Warfarin

b) Patient on Warfarin

Patient presenting after CABG or PCI, these patients should be assessed in the same way as patients with Angina.

The risk of Peri-operative MI increases in patients with previous H/O MI. In these patient, elective surgeries should be postponed for 6 months. & Urgent surgeries can be postponed for 3 months.

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Burst Abdomen Scenario with 1 cm Abdominal Defect. Treatment?

a) Retention Suture
b) Abdominal Binder
c) Open Stitches and do dressing
d) Absorbable Synthetic Mesh
e) Laparostomy

b) Abdominal Binder
1cm defect non symptomatic: conservative

1cm defect with pain surgery
1cm with signs of incarcerated hernia, emergency surgery
More than 1cm: surgery

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Lumber Region mass increasing in size 12x12 cm lying posterior to the kidney with increased vascularity on U/S. FNAC showing malignant cells. Diagnosis?

a) Liposarcoma
b) Lymphosarcoma
c) Rhabdomyosarcoma
d) Ganglionoma

a) Liposarcoma

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A 30 years male patient with umbilical pus discharge. Investigation of choice?

a) Sinogram
b) MRI
c) U/S
d) CT - Scan

a) Sinogram

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Femoral Hernia palpable behind the femoral vessel is known as?

a) Laugier
b) Narath
c) Cloquet
d) Femoral Hernia

b) Narath Hernia

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Bilateral Inguinal Hernia. Treatment of choice?

a) Laparoscopic Repair
b) Open Repair
c) Desarda Repair

a) Laparoscopic Repair

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An obese patient with a huge Ventral Hernia is operated. He has H/O Hypertension. Now complaining of SOB. How to increase the Functional Capacity?

a) Raise Head side of bed + Chest Physiotherapy
b) Left Lateral Position
c) Analgesics
d) Facemask Ventilation
e) ETT

a) Raise Head side of bed + Chest Physiotherapy

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A 2-year-old child having umbilical hernia. When to do surgery:

a) At 5 years of age
b) After few months
c) Observation

b) After few months

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Post-perforated appendix laparotomy. Sero-sanguinous discharge after 1 week. O/E, there is 3 cm gap with gut loops visible. Management?

a) Bagota Bag
b) Wound Dressing with guaze
c) Abdominal Binder
d) Tension Sutures with Non-absorbable suture
e) Interrupted Sutures with Non-absorbable suture

d) Tension Sutures with Non-absorbable suture

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In repair of inguinal hernia laparoscopically, we cover?

a) Femoral Ring
b) Myopectinate Line
c) Deep Ring
d) Myopectinate Orifice

d) Myopectinate Orifice

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A patient presented with Obstructed Herina. Intra-operative findings show that gut is compromised. Best treatment:

a) Resection Anastomosis
b) Diverting Stoma
c) Herniorrhaphy

a) Resection Anastomosis

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A female patient presented with sudden onset of pain in the groin which exacerbates on flexion & External Rotation of hip?

a) Obturator Hernia
b) Inguinal Hernia
c) Femoral Hernia
d) Perianal Hernia

a) Obturator Hernia

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Female patient having a mass on lateral border of rectus sheath which decrease in size on lying down?

a) Spigelian Hernia
b) Rectus Sheath Hematoma
c) Lipoma

a) Spigelian Hernia

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Newborn with Inguinoscrotal swelling on crying which reduces by itself. When to operate?

a) At 3 years of age
b) At 1 year of age
c) At 3 months
d) When have a weight of 10kg

c) At 3 Months

There is increased risk of strangulation so inguinal hernia should be repairs as soon as possible.

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Laparotomy burst abdomen with gut lying the wound. Best treatment option?

a) Bogota Bag
b) Tension relieving suture
c) Simple Dressing
d) Skin Closure only

b) Tension Relieving Suture

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Hernia Repair in which fascia transversalis is stitched to Cooper ligament?

a) Marcy Repair
b) Bassini Repair
c) Shouldice Repair
d) Mcvay Repair
e) Halsated Repair

d) McEvary Repair

Marcy Repair: Fascia narrows the Deep Inguinal Ring
Bassini Repair: Conjoined Ligament to Inguinal Ligament
Shouldice Repair: Triple Layer Repair with Sutured Fascia Transversalis
McEvary Repair: Fascia Transversalis with Copper Ligament

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Guy with abdominal mass, raynauds phenomena, ureters pulled medially & hypertension. Deranged creatinine. Diagnosis?

a) Retroperitoneal Fibrosis
b) Scleroderma
c) SLE

a) Retroperitoneal Fibrosis

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After Hernia Repair, patient presents with numbness on medial aspect of thigh & anterior scrotum. Nerve Injured?

a) Ilioinguinal Nerve
b) Genital branch of Genitofemoral Nerve
c) Femoral Nerve

A) Ilioinguinal Nerve

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In totally extra-peritoneal inguinal hernia repair [TEP], the most important place to cover to prevent recurrence is:

a) Femoral Ring
b) Ilio-pectinate Line
c) Pubic Tubercle
d) Myopectinal Orifice of Fruchaud

d) Myopectinal Orifice of Fruchaud

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In component separation, wound infection & early recurrence can be reduced by:

a) Preserve Rectus Perforators
b) Onlay Mesh
c) Inlay Mesh
d) Sublay Mesh
e) Large Subcutaneous flaps lateral to fascial defect

a) Preserve Rectus Perforators

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Anterior Component separation involves creating space between:

a) Rectus and Anterior Rectus Sheath
b) External Oblique & Internal Oblique
c) Internal Oblique & Transverse Abdominis
d) Transverse & Peritoneum
e) Subcutaneous plane & External Oblique

b) External Oblique & Internal Oblique

In component separation, an incision is made over the bilateral external oblique aponeuroses forming musculofascial advancement flaps —> Allowing up to 10 cm of medial mobilization.

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Incarcerated hernia. Treatment of choice?

a) Resection & Anastomosis
b) Stoma Formation
c) Herniorrhaphy

a) Resection & Anastomosis

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In a case of strangulated femoral hernia, the best approach is?

a) McEvedy Approach
b) Inguinal Approach
c) Lockwood Approach

a) McEvedy Approach

Also known as High Approach

1) McEvedy Approach/ High Approach: TOC in Strangulated Femoral Hernia
2) Lockwood Approach/ Low Approach: TOC in Simple Femoral Hernia [No risk of Bowl resection]
3) Lotheissen Approach/ Inguinal Approach:

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Type fo Inter-parietal hernia?

a) Ritcher’s Hernia
b) Naraths Hernia
c) Spigelian Hernia

c) Spigelian Hernia

Interparietal hernias are rare abdominal defects where intraabdominal contents protrude between layers of the abdominal wall. Interparietal hernias present a diagnostic challenge because the superficial layers of the abdominal wall remain intact and obscure the physical exam.

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A Patient with hernia PF2. What does it tells? a) Primary Femoral with defect of 3 cm b) Primary Femoral with defect of 2 cm c) Primary Female Femoral with defect of 3 cm d) Primary Female Femoral with defect of 2 cm

a) Primary Femoral with defect of 3 cm

A 55 year-old-male came to your clinic with H/O Recurrent B/L inguinal hernia. He was initially operated in a DHQ Hospital. Now the patient wants surgery at any cost. What is the treatment of choice? a) Lap Hernia Repair b) Open Hernia Repair c) Dessarda Repair d) Stoppa's Repair

A) Lap Hernia Repair

History of Abdominal Trauma, Intra-abdominal pressure is 25 mmHg. Best treatment option? a) Tension Relieving Suture b) Facial Closure c) Bogota d) Left Open Vac dressing

c) Bogota

Patient underwent laparotomy. Postoperatively he developed wound dehiscence with small bowel visible at lower most part. Appropriate Management: a) Daily Dressing b) Mesh Application c) Exploration under G/A d) Bogota Bag e) VAC Dressing

e) VAC Dressing

You are doing surgery for strangulated hernia and once you saw the sac, you find constriction is at external inguinal ring. Now what will you do next? a) Open the External Ring b) Open the Sac c) Open Inguinal Canal d) Open Deep Ring

b) Open the Sac

A patient presented with H/O GERD. On OGB, Squamo-columner Juction has moved 3 cm proximally. Diagnosis is? a) Sliding Hiatal Hernia b) Barret's Oesophagus

b) Barret's Oesophagus

A patient presented with CA Oesophagus. CT-Scan shows that there is 90 Degree Aorta Effacement. This means that? a) Involved b) Not Involved

a) Involved

Patient with Oesophageal mass abutting 90 degree of Aorta. T Stage will be? a) T3 b) T4a c) T4b

c) T4b

A patient presented with Oesophageal CA which is located 22-23 cm from the incisors. What will be the appropriate surgical technique for this patient? a) Ivor Lewis Oesophagectomy b) Mckeown Oesophagectomy c) Transhiatal Oesophagectomy

b) Mckeown Oesophagectomy

Treatment of choice for Achalasia? a) Laparoscopic Heller's Myotomy b)Botulinum Toxin Injections c) CCB

a) Laparoscopic Heller's Myotomy

A patient with Oesophageal Perforation. Diagnostic Investigation is? a) Barium Swallow b) Endoscopy c) CECT

c) CECT

During left thoracotomy for Oesophagectomy, Diaphragm is divided: a) Circumferentially b) Axially c) Not Divided

a) Circumferentially

Retrosternal Pain after heavy meal is most likely due to? a) Boerhaeve Syndrome b) Cardiac MI

a) Boerhaeve Syndrome

A 40-Year-old patient presented with dysphagia to both solids & liquids, More to liquids. Contrast studies showing Bird-beak appearance. Treatment would be: a) Botulinum Toxin b) Ballon Dilatation c) Cardiac Myotomy

c) Cardiac Myotomy

A 75-Year-old lady presented to you at your clinic with the Oesophageal Carcinoma involving the lower one third. The patient also have comorbids. The management would be: a) Stenting b) Total Esophagectomy c) Total Esophagectomy & Gastrectomy

a) Stenting

During esophagectomy, diaphragm is divided circumferentially to avoid injury to: a) Vagus Nerve b) Celiac Plexus c) Phrenic Nerve

c) Phrenic Nerve

Barrett's Oesophagus management is? a) Endoscopic mucosal Resection b) Surveillance Endoscopy c) RFA d) PPI Only

b) Surveillance Endoscopy after every 2 years.

Vomiting & Oesophageal tenderness + Subcutaneous Emphysema. Likely Diagnosis?

Oesophageal Perforation

Young patient underwent colonic transposition for benign esophageal stricture. On 4th Post-operative day, there is brownish discharge at anastomosis site in the neck. Next step in management of this patient? a) Exploration b) Percutaneous Aspiration c) Drain Placement d) Conservative

d) Conservative

Following is the characteristic feature of Achalasia? a) Association with Chagas Disease b) Absence of Cholinergic Neurons c) Absence of Inhibitory Adrenergic Ganglion d) Loss of VIP & NO Secreting Neurons

d) Loss of VIP & NO secreting Neurons. There is absence of Inhibitory Non-Adrenergic Ganglions.

Staging Shift Phenomenon is called? a) Feinstein Phenomena b) Will Rogers Phenomena c) TNM Staging d) Surgical Audit

b) Will Rogers Phenomena "Detecting Occult Metastasis with Recent Investigations."

An 80-year-old female with SCC at middle oesophagus with total dysphagia for solid & liquid with tumor 22-23 cm from incisors. She has >20% weight loss, has DM, IHD. Best Treatment option: a) Ivor- Lewis b) Transhiatal c) Endoscopic Stenting d) 3-Phase Esophagectomy

c) Endoscopic Stenting

Iatrogenic lower oesophageal perforation. Gastrograffin study shows collections in the base of right pleural space. What should be the treatment? a) Drain Placement b) Exploration & Repair c) N/G Tube & Antibiotics

b) Exploration & Repair

Oesophageal Perforation. Best Investigation? a) Contrast Esophageogram b) CECT c) X-Ray

a) Contrast Esophagram

Regarding GERD, which statement is correct? a) Most of the patients with GERD have Hiatal Hernia b) Most of the patients with Hiatal Hernia have GERD C) Gerd Never occurs in Hiatal Hernia d) <25% has Hiatus Hernia

b) Most of the patients with Hiatal Hernia have GERD

A patient with K/C Barrett's esophagus under treatment with Omeprazole, started to loss weight. Endoscopy shows an ulcerating lesion in the lower esophagus with hanging edges. Diagnosis? a) SCC b) Adenocarcinoma c) Leomyoma

b) Adenocarcinoma

Squamous Cell Carcinoma of the Esophagus located 25 cm from Incision. Which landmark is present at this location? a) Bronchus b) Aortic Arch c) Oesophageal Opening d) Left Pulmonary Vein e) Crico-pharyngeal Muscle

a) Bronchus/ Crania

A patient on PPI with no relieving symptoms. Endoscopy done and shows a beefy red appearance. Multiple biopsies show no dysplasia. Treatment? a) H. Pylori Eradication b) Partial Gastrectomy c) Total Gastrectomy

a) H. Pylori Eradication

After ERCP, a patient presented with surgical emphysema. CECT shows pneuomediastinum. The best treatment option? a) Laparotomy + Esophagectomy b) Cervical Esophagectomy c) Endoscopic Repair d) Thoracotomy + Esophageal Repair

d) Thoracotomy + Esophageal Repair

A patient presented with H/O gastric regurgitation and diagnosed as Achalasia. The diagnostic investigation is? a) X-Ray Erect b) OGD c) Myography

c) Myography

Patient presented with a diagnosis of Pharyngeal Pouch. Treatment will be? a) Surgical Excision/Diverticulectomy b) Stenting c) Diverticulopexy d) Dividing the Septum

d) Dividing the Septum If with complications: Diverticulectomy If Very Large: Diverticulopexy Dividing the Septum: Cricopharyngeal Myotomy in all cases.

A patient presented with Dyspepsia, regurgitation & gurgling sounds few hours after taking meal. Best Investigation? a) Barium Swallow b) Endoscopy c) CT-Scan

a) Barium Swallow

Lower Esophageal Perforation. Best incision to approach? a) Posterolateral Thoracotomy b) Right Anterolateral Thoracotomy c) Left Anterolateral Thoracotomy d) Meidan Sternotomy

c) Left Anterolateral Thoracotomy a) Posterolateral Thoracotomy: Elective Surgery b) Right Anterolateral Thoracotomy: Upper Esophageal Emergency c) Left Anterolateral Thoracotomy: Lower Esophageal Emergency d) Meidan Sternotomy: For Benign Diagnosis

Stage of Oesophageal CA with Celiac Lymph Nodes & pleura Involvement: a) Stage 3A B) Stage IV c) Metastatic d) Stage IIIC

d) Stage IIIC

Chest trauma with Widened Mediastinum. NGT coiled in the CXR. Next Investigation? a) Endoscopy b) Barium Swallow c) CT Chest

c) CT Chest

Structure 25 cm below from incisor? a) Aorta b) Carina c) Hyoid d) Cricoid

a) Aortic Arch

A patient having dysphagia from 12 hours after taking meat piece. Only history of pheochromocytoma is noted. What best to be done? a) Endoscopy & Removal b) Papain c) Barium Swallow d) Observation

b) Papain

What is the specific finding on manometry for Achalasia? a) No ganglia b) Absent Peristalsis c) Pressure less than 25 mmHg

b) Absent Peristalsis Characteristic manometric findings include the absence of peristalsis, mirror-image contractions, and limited or absent relaxation of the LES with swallowing.

ZES that is not improving with Omeprazole 40 mg. Treatment will be? a) HSV Pyloroplasty b) Partial Pancreatectomy c) Truncal Vagotomy d) Enucleation

d) Enucleation

Patient with gastric mass. Biopsy showed MALToma. Treatment will be? a) H.Pylori Eradication Therapy b) Chemotherapy c) Radiotherapy d) Gastrectomy

a) H.pylori Eradication Therapy

You are working at District Hospital, a patient presented to you with Acute Peptic Ulcer disease & have Hematemasis. Saline Lavage done but is massive bleed. Treatment? a) Ulcer Oversewing b) Vagotomy & Pyloroplasty c) Vagotomy & Antrectomy

a) Ulcer Oversewing

56-year-old male presented to ER with 3 days abdominal pain. His workup showed Pneumoperitonium. Diagnosis of 2x2 cm pre-pylori perforation was made intra-operatively. During surgery, patient became hypotensive & unstable. Best management? a) Modified Graham's Patch & Repair b) Ulcer Excision & oversewing c) Gastrectomy d) Close the Abdomen e) Bilroth II

b) Ulcer Excision & oversewing

a 45-Year-old female presented with peritonitis. Laparotomy showed duodenal perforation. Intra-operative management will be? a) Primary Repair of Perforation b) Omental Patch Repair c) Distal Gastrectomy d) Abandon Surgery e) Gastro-jejunostomy

b) Omental Patch Repair

A 56-year-male underwent resection for GIST. H/P showed mitoses of 10/50 HFP. Next management plan will be? a) Follow up for 3 years b) No need to Follow up c) Imatinib d) Follow up for 5 Years e) Follow up for life

c) Imatinib

High Gastrin level. How to localise pancreatic source? a) U/S b) CT-Scan c) ERCP d) Octreotide Scan

d) Octreotide Scan

High Grade GIST. Imatinib duration of treatment? a) 1 Year b) 3 Years c) 5 Years d) For life long

d) For life long

Patient with gastrin level of 200. What is the likely diagnosis? a) ZES b) Gastric CA c) Insulinoma

a) ZES Normal serum gastrin: <50

Patient with Gastric CA stage III. What will be expected survival? a) 94% b) 82% c) 68% d) 54% e) 15%

d) 54%

Patient presented with GI Bleed. Endoscopy showed duodenal ulcer with fresh clot over it. Next step? a) Angioembolizaiton b) Remove clot c) Heated Probe Coagulation d) Definitive Surgery e) Clips

b) Remove Clot

The duration of Imatinib therapy for a patient with GIST with Mitosis of 5/50 HPF is: a) 1 Year b) 3 Year c) 5 Year d) none

b) 3 year Mitosis less than or equal to 4 = Low Grade GIST = No Treatment Mitosis from 5 to 8 = Moderate Grade = 3 Years Mitosis Greater than or equal to 9 = Life Long

The duration of Imatinib therapy for a patient with GIST with Mitosis of 4/50 HPF is: a) 1 Year b) 3 Year c) 5 Year d) none

d) None

In perforated duodenal ulcer, the fluid collection will be in? a) Right Anterior Subhepatic Space b) Right Posterior Subhepatic Space c) Hepatorenal Pouch d) Right Paracolic Gutter

b) Right Posterior Subhepatic Space

A patient with recurrent ulcer + diarrhoea + abdominal pain: a) Insulinoma b) Pancreatic Hematoma c) ZES d) Duodenal Atresia

c) ZES

A man had a bout of retching with hemoptysis after a meal: a) Boerhaave's Syndrome b) Mallory Weiss Syndrome

b) Mallory Weiss Syndrome

In a wedding party, a man took heavy dinner & later he had severe vomiting with hematemesis: a) Boerhaave's Syndrome b) Mallory Weiss Syndrome

a) Boerhaave's Syndrome

A 1 cm perforated ulcer in lesser curvature of stomach. Best surgical Management? a) Ulcer Excision + Biopsy b) Omental Patch c) Grahama Omentoplasty

a) Ulcer Excision + Biopsy

GIST Imatinib duration in metastatic disease? a) 3 months b) 1 year c) 3 Years d) Life long

d) Life long

2 x 2 cm pre-pyloric ulcer. Unstable patient. Procedure? a) Bilroth II b) Ulcer Excision & Over sewing c) Primary repair with omental patch

b) Ulcer Excision & over sewing

At district hospital, patient presented with PUD. Cold saline lavage shows massive bleeding. Treatment? a) Vagotomy & Antrectomy b) Ulcer oversewing with vagotomy & pyloroplasty c) Angio-embolization of Gastroduodenal artery

b) Ulcer oversewing with vagotomy & pyloroplasty

Gastric Ulcer where to take biopsy from? a) Rim b) Base

b) Rim

After Billroth II Gastrectomy. The most likely complication is? a) Dumping Syndrome b) Anastomotic Leak

a) Dumping Syndrome

Gastric CA At Cardia is managed by? a) Total Gastrectomy + D2 Dissection b) Total Gastrectomy c) Partial Gastrectomy

a) Total Gastrectomy + D2 Dissection

Bleeding duodenal ulcer artery spurting in the ulcer base. What is the most common artery running at the posterior surface of duodenum? a) SMA b) Gastroduodenal Artery

b) Gastroduodenal Artery

Patient presented with recurrent gastric ulcer although he uses PPIs on regular bases. Cause? a) ZES b) Insulinoma c) H. Pylori Infection

c) H. Pylori Infection

Patient presented with episodes of heart burn, regurgitation. Although he uses PPIs & H2 Blockers on regular bases. His X-ray done which shows air just above the diaphragm. Diagnosis? a) Hiatal Hernia b) Gastrinoma c) Insulinoma d) Chronic H.Pylori Infection

a) Hiatal Hernia

A mass in proximal stomach about 5 cm from GEJ. What is the best step in management? a) Total Gastrectomy b) Partial Gastrectomy

a) Total Gastrectomy

Patient after Gastrojejunostomy now presented with epigastric pain & Malena. How to investigate? a) Endoscopy b) Gastrograffin c) CT Abdomen

a) Endoscopy

Pylori Stenosis patient having hypocholremic hypokalemic metabolic alkalosis. How to correct his metabolic derangement: a) Normal Saline b) RL c) Normal Saline + KCL

c) Normal Saline + KCL

An alcoholic patient with multiple episodes of vomiting & hematemsis: a) Mallory Weiss Syndrome b) Bourhaave's Syndrome c) GERD d) Peptic Ulcer Disease

a) Mallory Weiss Syndrome

Patient comes with Hematemsis & Malena. Endoscopy shows bleeding from overlying normal mucosa. Diagnosis? a) Healed PUD b) Duodenal Ulcer c) Perforated PUD d) Dieulafoy's Lesion

d) Dieulafoy's Lesion

Biliary Reflux with Billroth II. Management? a) Roux-en-Y Gastrojejunostomy b) Early Dumping

a) Roux-en-Y Gastrojejunostomy

CA Stomach diagnosed with Stage IV. Treatment? a) Palliation b) Total Gastrectomy

a) Palliation

A 56-year-old male underwent resection for GIST. Biopsy shows Mitosis of 10/50 HFP. Imatinib therapy is started and is given for? a) 3 Years b) No need to follow c) 5 Years d) Life long e) 1 Year

d) Life long

Gastric CA Invading Serosa. Stage? a) T4a b) T4b c) T3

a) T4a

Patient with peritonitis. Per-operative finding 2x2 cm pre-pyloric ulcer perforation. Management? a) Bilroth b) Ulcer Excision & Over-sewing c) Modified Graham Patch Repair d) Gastrectomy with Roux-en-Y Reconstruction

b) Ulcer Excision & Over-sewing

A 45-Year-old patient with DU. Management? a) Primary Repair b) Omental Patch c) Distal Gastrectomy d) Abandon Surgery

b) Omental Patch

An anemic patient with H/O GI Bleed. Upper GI & Lower GI Endoscopy are normal. Next step? a) Isotope RBC Scan b) CT Angiography c) Enteroscopy d) Capsule Endoscopy

a) Isotope RBC Scan

CA of greater curvature of stomach at mid point. What type of surgery? a) Subtotal Gastrectomy b) Total Gastrectomy

b) Total Gastrectomy

Patient presented with Epigastric pain & vomiting. NG Shown on X-ray behind the heart. Diagnosis? a) Para-esophageal Hernia b) Volvulus of stomach c) TEF

b) Volvulus of stomach Para-esophageal hernia leading to Volvulus of Stomach

Which of the following Bariatic Surgery has the least complications? a) Gastric Banding b) Sleeve Gastrectomy c) Gastric Bypass d) Intragastric Ballon e) Mini-Gastric Bypass

a) Gastric Banding Gastric Banding is the safest procedure but it accomplishes lower weight loss & slower resolution of comorbidities in comparison to Sleeve Gastrectomy & Gastric Bypass.

Thromboelastography [TEG] LY 30 >8%. Treatment? a) FFP b) Platelets c) Tranexamic Acid d) Cryoprecipitate e) Protamine Sulfate

c) Tranexamic Acid

Thromboelastography [TEG] MA <55. Treatment? a) FFP b) Platelets c) Tranexamic Acid d) Cryoprecipitate e) Protamine Sulfate

b) Platelets

Which of the following is the feature of Focal Nodular Hyperplasia [FNH]? a) Malignancy in 15-20 years b) Related to OCP c) Excision is the best option d) Related to Smoking e) None of the Above

b) Related to OCP