Gastrointestinal Surgery Practice Questions

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.

Q: A wide mouth Meckel's diverticulum is found incidentally during laparotomy. What is the recommended treatment?

Leave as is. **Explanation:** The management of an incidentally discovered Meckel’s diverticulum (MD) remains a classic debate in surgery, but current consensus for NEET-PG follows the principle of **conservative management** for asymptomatic, wide-mouthed diverticula. **Why "Leave as is" is correct:** A **wide-mouthed** diverticulum is at very low risk for complications like diverticulitis or obstruction because intestinal contents can flow freely in and out, preventing stasis. In adults, the risk of developing complications from an asymptomatic MD is approximately 4–6%, whereas the risk of postoperative complications (adhesions, leak) from an unnecessary resection is often higher. Therefore, if the diverticulum is asymptomatic, wide-based, and feels soft (no palpable ectopic tissue), it should be left alone. **Why other options are incorrect:** * **A & C (Resection/Ligation):** Simple diverticulectomy or ligation is reserved for symptomatic cases (like diverticulitis) or high-risk incidental cases (narrow base, long length >2cm, or presence of palpable nodules). * **D (Resection with ileum):** Formal wedge resection or segmental ileal resection is mandatory only if there is **bleeding** (to ensure the ectopic gastric mucosa in the adjacent ileum is removed) or if the base is inflamed/gangrenous. **High-Yield Clinical Pearls for NEET-PG:** 1. **Rule of 2s:** 2% population, 2 inches long, 2 feet from ileocecal valve, 2% symptomatic, 2 types of ectopic tissue (Gastric > Pancreatic). 2. **Most common presentation:** Painless lower GI bleed in children; Intestinal obstruction in adults. 3. **Incidental Resection Criteria:** Resect if the patient is 2cm long, has a narrow neck, or feels thickened (suggesting ectopic mucosa). 4. **Technetium-99m Pertechnetate scan:** The investigation of choice for bleeding MD (detects ectopic gastric mucosa).

Q: Paralytic ileus is characterized by which of the following findings, except?

Loops of intestine are not seen due to loss of peristalsis. **Explanation:** Paralytic ileus is a state of functional intestinal obstruction where there is a failure of peristalsis without a mechanical blockage. **1. Why Option D is the Correct Answer (The Exception):** In paralytic ileus, the loops of the intestine are **clearly visible** on imaging (X-ray or CT). Because peristalsis has ceased, the bowel becomes distended with gas and fluid. These dilated, gas-filled loops are a hallmark radiological finding. The statement that "loops are not seen" is factually incorrect, making it the right choice for an "except" question. **2. Analysis of Incorrect Options:** * **Option A (No bowel sounds):** Since there is a global absence of peristaltic activity (aperistalsis), auscultation typically reveals a "silent abdomen." This is a classic clinical feature. * **Option B (No passage of flatus):** Because the functional movement of the gut has stopped, gas and feces cannot be propelled distally, leading to absolute constipation and failure to pass flatus. * **Option C (Gas-filled loops with fluid levels):** On an erect abdominal X-ray, paralytic ileus shows generalized dilatation of both the small and large bowel. Multiple air-fluid levels are seen at the same height in the same loop (unlike the "step-ladder" pattern of mechanical obstruction). **3. Clinical Pearls for NEET-PG:** * **Most common cause:** Post-operative state (Physiological ileus). Normal recovery: Small bowel (0–24h) > Stomach (24–48h) > Colon (48–72h). * **Electrolyte Imbalance:** Hypokalemia is the most common metabolic cause of paralytic ileus. * **Radiology:** Characterized by "Gas in the Rectum" (often absent in complete mechanical obstruction). * **Management:** Usually conservative (NPO, IV fluids, nasogastric decompression, and correction of electrolytes). Avoid opioids as they worsen the condition.

Q: A 50-year-old woman presented with bilateral solid ovarian tumors, ascites, and an ulcerative growth in the pyloric region of the stomach. What is the most likely diagnosis?

Gastric adenocarcinoma. ### Explanation The clinical presentation described is a classic case of **Krukenberg Tumor**, which refers to a metastatic signet-ring cell carcinoma of the ovary, most commonly originating from a primary site in the **stomach (Gastric Adenocarcinoma)**. **Why Gastric Adenocarcinoma is correct:** In this patient, the "ulcerative growth in the pyloric region" represents the primary malignancy. Krukenberg tumors are characterized by **bilateral, solid ovarian enlargement** resulting from retrograde lymphatic spread or transcoelomic seeding. While the colon, breast, and appendix can also be primary sites, the stomach is the most frequent source (approx. 70% of cases). The presence of ascites further suggests peritoneal dissemination. **Why the other options are incorrect:** * **Ovarian malignancy:** While the patient has ovarian tumors, the presence of a gastric pyloric mass indicates that the ovarian involvement is secondary (metastatic) rather than primary. * **Uterine malignancy:** Uterine cancers typically spread to pelvic lymph nodes or the lungs; they do not commonly present with a primary gastric mass and bilateral solid ovarian tumors. * **Duodenal adenocarcinoma:** This is significantly rarer than gastric cancer and is not the classic primary site associated with the eponymous Krukenberg tumor. **Clinical Pearls for NEET-PG:** * **Histology:** Look for **Signet-ring cells** (mucin-filled cytoplasm displacing the nucleus to the periphery). * **Route of spread:** Most commonly believed to be **retrograde lymphatic spread**, though transcoelomic seeding occurs. * **Sister Mary Joseph Nodule:** Another sign of gastric metastasis, presenting as a palpable nodule at the umbilicus. * **Virchow’s Node:** Left supraclavicular lymphadenopathy, often the first sign of hidden gastric malignancy.

Question 1

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 2

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 3

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 4

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 5

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 6

The most common complication of vagotomy is:

Accepted Answer

Diarrhea

Answer

Dryness of mouth

Answer

Tachycardia

Answer

Bleaching

Question 7

A wide mouth Meckel's diverticulum is found incidentally during laparotomy. What is the recommended treatment?

Accepted Answer

Leave as is

Answer

Resection of the diverticulum

Answer

Ligate at the base

Answer

Resection with a portion of the ileum

Question 8

Paralytic ileus is characterized by which of the following findings, except?

Accepted Answer

Loops of intestine are not seen due to loss of peristalsis

Answer

No bowel sounds on auscultation

Answer

No passage of flatus

Answer

Gas-filled loops of intestine with multiple fluid levels

Question 9

Which of the following features characterize acute intestinal obstruction?

Accepted Answer

In colonic obstruction, distension is more common than vomiting.

Answer

Vomiting is common in duodenal obstruction.

Answer

Pain after each attack of vomiting is characteristic of ileal obstruction.

Answer

Colicky pain changing to steady pain indicates strangulation.

Question 10

A 50-year-old woman presented with bilateral solid ovarian tumors, ascites, and an ulcerative growth in the pyloric region of the stomach. What is the most likely diagnosis?

Accepted Answer

Gastric adenocarcinoma

Answer

Ovarian malignancy

Answer

Uterine malignancy

Answer

Duodenal adenocarcinoma

Gastrointestinal Surgery — MCQs

Gastrointestinal Surgery — MCQs

On this page

Practice by Chapter

Want unlimited practice?