Gastrointestinal Surgery Practice Questions

Q: Which nerve marked as $X$ is shown in the image given below? (Recent NEET Pattern 2016-17)

Criminal nerve of Grassi. ***Correct: Criminal nerve of Grassi*** - The image shows the **vagal innervation to the stomach**. The nerve marked 'X' is a **posterior gastric nerve** branch that innervates the **fundus** and is often referred to as the criminal nerve of Grassi due to its implication in **recurrent ulceration if not transected during vagotomy**. - This nerve is part of the **posterior vagal trunk** and specifically innervates the posterior aspect of the fundus and body of the stomach. Its omission during a vagotomy can lead to continued acid secretion. *Incorrect: Nerve of Laterjet* - The nerve of Laterjet refers to the **anterior and posterior gastric nerves** that run along the **lesser curvature** of the stomach. - These nerves primarily innervate the **body and antrum** of the stomach and control acid secretion from the parietal cells. *Incorrect: Crow's feet* - "Crow's feet" refers to the **pyloric branches** of the anterior and posterior nerves of Laterjet, which ramify around the **pylorus**. - These are distinguished from the nerve of Grassi which supplies the fundus. *Incorrect: Celiac trunk* - The celiac trunk is an **artery**, not a nerve. It is a major visceral branch of the aorta that supplies blood to the foregut structures, including the stomach, liver, and spleen. - It does not represent neural innervation as depicted in the image.

Q: All of the following conditions are visible in the image except: (Recent NEET Pattern 2016-17)

Left sided femoral hernia. ***Left sided femoral hernia*** - This is the **correct answer** because a left-sided femoral hernia is **NOT visible in the image**. - The image shows bilateral inguinal hernias, with bulges located **above the inguinal ligament**, characteristic of inguinal hernias. - A **femoral hernia** would present as a bulge **below the inguinal ligament**, inferior and lateral to the pubic tubercle, which is **not depicted on the left side**. *Right sided femoral hernia* - This option is also not visible in the image, but since only one answer can be marked correct, the question focuses on the left side. - The prominent right-sided bulge is located **above the inguinal ligament**, characteristic of an **inguinal hernia**, not a femoral hernia. - A femoral hernia would appear in the upper thigh region, which is not shown on the right. *Right sided inguinal hernia* - This condition **IS visible in the image** as a large, prominent bulge in the right groin region. - The bulge is located in the anatomic area of the **inguinal canal**, superior to the inguinal ligament, consistent with a **right-sided inguinal hernia**. *Left sided inguinal hernia* - This condition **IS visible in the image** as a smaller but distinct bulge in the left groin region. - The bulge is in the characteristic location for an **inguinal hernia** above the inguinal ligament on the left side.

Q: A multiparous female presents with the condition shown in the image. This condition can be managed by: (Recent NEET Pattern 2016-17)

McEvedy repair. ***McEvedy repair*** - The image shows a **femoral hernia**, characterized by a bulge below the **inguinal ligament** and lateral to the **pubic tubercle**, commonly seen in multiparous females. The **McEvedy repair** (high approach) is specifically designed for femoral hernias, particularly when **strangulated**, as it allows better assessment of **bowel viability**. - This approach involves an incision extending above the inguinal ligament, providing superior access to the **femoral canal** and allowing for reduction and repair from above, which is ideal for the anatomical location shown. *Bassini repair* - This is a traditional **inguinal hernia repair** method where the **transversus abdominis muscle**, **transversalis fascia**, and **conjoint tendon** are sutured to the inguinal ligament. - It is primarily used for **inguinal hernias**, not femoral hernias, and would not provide adequate access or repair for the condition shown below the inguinal ligament. *Hunters repair* - This term does not correspond to a recognized standard surgical repair technique for hernias and may be a **misnomer** or outdated eponym. - Standard hernia repair names typically refer to specific anatomical repairs like **Shouldice**, **Lichtenstein**, or **McEvedy**, making this option incorrect. *Shouldice repair* - The Shouldice repair is a **tension-based tissue repair** of an **inguinal hernia** that involves **four layers of fascia** being approximated with continuous sutures (not to be confused with the tension-free Lichtenstein mesh repair). - It is specifically designed for **inguinal hernias** and is not suitable for the repair of a **femoral hernia**, which requires a different anatomical approach below the inguinal ligament.

Q: Which hernia repair procedure is shown in the image? (Recent NEET Pattern 2016-17)

Lichtenstein repair. ***Lichtenstein repair*** - The image clearly displays a **mesh patch** being used to reinforce the posterior wall of the inguinal canal, which is the hallmark of a **tension-free Lichtenstein repair**. - This technique is widely considered the **gold standard** for **inguinal hernia repair** due to its low recurrence rates and reduced postoperative pain. *Bassini herniorrhaphy* - **Bassini's repair** is a **tissue-based repair** that involves suturing the conjoined tendon and transversalis fascia to the inguinal ligament. - This method does **not use mesh** and is associated with higher tension and recurrence rates compared to mesh-based repairs. *Shouldice repair* - The **Shouldice repair** is another **tissue-based repair** from Canada, renowned for its strong, multilayered closure of the posterior wall of the inguinal canal. - It involves **four layers of suture repair** of the transversalis fascia and conjoined tendon, without the use of synthetic mesh as seen in the image. *Lord's procedure* - **Lord's procedure** is a historical method for **inguinal hernia repair** that primarily involved placing a small, tightly rolled mesh plug into the internal ring. - It is **not commonly used today** and does not involve the broad, flat mesh placement depicted in the image to reinforce the entire posterior wall.

Q: A 25-year-old male presents with inguinal swelling. He had surgery for acute abdomen 2 years ago but could not tell the reason behind it. Trauma to which structure during the surgery conducted 2 years ago would have resulted in this inguinal swelling?

Ilioinguinal nerve. ***Ilioinguinal nerve*** - Damage to the ilioinguinal nerve during abdominal surgery, especially an appendectomy, can lead to muscle weakness in the anterior abdominal wall. - This weakness predisposes the patient to the formation of an **inguinal hernia**, which manifests as an inguinal swelling. *Spermatic cord* - Trauma to the spermatic cord could lead to **testicular atrophy**, pain, or issues with fertility due to vascular or ductal damage. - It is not directly associated with the development of an inguinal hernia as a primary consequence of isolated trauma during non-hernia repairs. *Genital branch of genitofemoral nerve* - Injury to the genital branch of the genitofemoral nerve primarily affects the **cremasteric reflex** and sensation in the scrotum/inner thigh. - While it can cause sensory disturbances, it does not directly lead to weakness of the abdominal wall sufficient to cause an inguinal hernia. *Pampiniform plexus* - The pampiniform venous plexus is involved in regulating testicular temperature. Injury primarily causes a **hydrocele** or **varicocele** due to impaired venous drainage. - It would not cause an inguinal hernia, which involves protrusion of abdominal contents through a weakened abdominal wall.

Q: Contents of the inguinal hernia sac are displayed intraoperatively and appendix is seen at 7 o'clock. What is the diagnosis?

Amyand hernia. ***Amyand hernia*** - An **Amyand hernia** is a rare type of inguinal hernia that contains the **vermiform appendix** within the hernia sac. - The discovery of the appendix, as shown in the image, within an inguinal hernia sac definitively identifies this as an Amyand hernia. *Richter hernia* - A **Richter's hernia** occurs when only a portion of the circumference of the bowel wall becomes incarcerated in the hernia sac. - It does not specifically involve the appendix and is characterized by the potential for **strangulation without obstruction**. *Pantaloons hernia* - A **pantaloons hernia** (or saddlebag hernia) is a combined direct and indirect inguinal hernia, with the inferior epigastric vessels located between the two sacs. - It describes the anatomical configuration of the hernia sacs rather than the contents within them. *Maydl's hernia* - **Maydl's hernia** (or W-hernia) occurs when two loops of bowel are contained within the hernia sac, with a connecting loop lying within the abdominal cavity. - This type of hernia is particularly dangerous due to the high risk of **strangulation of the intervening loop** of bowel.

Q: All the following statements regarding this film representing esophagus are true except:

Serosal layer prevents local spread. ***Serosal layer prevents local spread*** - The esophagus does **not have a serosal layer** like other parts of the gastrointestinal tract (e.g., stomach, intestines). - Its outer layer is the **adventitia**, which is a loose connective tissue and offers little barrier to the local spread of esophageal cancer, allowing for earlier mediastinal invasion. *Squamous cell usually affects the upper two-thirds* - **Squamous cell carcinoma** (SCC) of the esophagus typically arises in the **proximal and middle esophagus**, which are lined by squamous epithelium. - This is consistent with the general understanding of SCC etiology, often linked to smoking and alcohol. *Adenocarcinoma usually affects the lower-third* - **Adenocarcinoma** of the esophagus commonly occurs in the **distal esophagus**, often arising from **Barrett's esophagus**. - Barrett's esophagus is a metaplastic change where the normal squamous epithelium is replaced by columnar epithelium, strongly associated with chronic gastroesophageal reflux disease (GERD). *Lymph node involvement is a bad prognostic factor* - The presence of **lymph node metastases** indicates that the cancer has spread beyond the primary tumor site and is a significant indicator of **advanced disease**. - This typically leads to a **worse prognosis** and influences treatment decisions, often requiring systemic therapy in addition to local treatments.

Q: A 35-year-old patient presents with a painless swelling at the umbilicus that has been gradually increasing in size over the past 6 months. The swelling increases on coughing and straining. On examination, there is a reducible bulge at the umbilicus. What is the likely diagnosis?

Umbilical hernia. ***Umbilical hernia*** - The image clearly displays a bulge at the **umbilicus**, which is characteristic of an umbilical hernia. - This type of hernia occurs when abdominal contents protrude through a weakness in the **umbilical ring**. - The clinical presentation of a **reducible swelling that increases with coughing** is pathognomonic of a hernia. - Umbilical hernias are common in adults and are associated with increased intra-abdominal pressure. *Epigastric hernia* - An epigastric hernia occurs in the **midline** between the **xiphoid process** and the umbilicus. - The location of the bulge in the image is specifically at the umbilicus, not superior to it. - These typically present as small, often tender nodules in the epigastric region. *Spigelian hernia* - A Spigelian hernia protrudes through the **Spigelian fascia**, which is lateral to the rectus abdominis muscle, typically at the **arcuate line**. - This location is **lateral**, distinct from the periumbilical region shown in the image. - These are rare and often difficult to palpate due to their interparietal nature. *Paraumbilical hernia* - A paraumbilical hernia occurs **adjacent to the umbilicus** through the linea alba, rather than directly through the umbilical ring. - While close in location, the image shows a hernia **directly at the umbilicus**, not beside it. - Paraumbilical hernias are more common in adults, while true umbilical hernias through the ring can occur in both children and adults.

Q: A 30-year-old patient presents with abdominal pain, fever, nausea, vomiting and respiratory distress. On admission BP=80/40 mm Hg and pulse rate is 120 BPM. The following CXR was performed. What is the immediate management? (AIIMS May 2016)

IV fluids and antibiotics followed by laparotomy. ***IV fluids and antibiotics followed by laparotomy*** - The imaging shows **free air under the diaphragm** (pneumoperitoneum), confirming a perforated viscus. The patient is also in **septic shock** (low blood pressure, high heart rate, fever, abdominal pain), requiring immediate resuscitation with **IV fluids and broad-spectrum antibiotics** to stabilize before surgery. - While definitive management is surgical, **resuscitation** must precede laparotomy in an unstable patient to improve outcomes from septic shock. *Immediate laparotomy* - Performing an immediate laparotomy without prior resuscitation in a patient with **septic shock** (BP 80/40, HR 120) significantly increases surgical risk and mortality. - The patient's **hemodynamic instability** must be addressed first to withstand the stress of surgery. *Intravenous fluids* - While critical for initial resuscitation in septic shock, **IV fluids alone** are insufficient as the definitive management for a perforated viscus. - The source of sepsis (perforation) must be addressed surgically, and **antibiotics** are essential to combat the infection. *Intravenous potassium* - There is no indication in the clinical presentation or image for **intravenous potassium administration**. - This intervention is used for treating **hypokalemia**, which is not mentioned as a concern here, and does not address the underlying pathology.

Q: Which is correct about hematemesis (upper GI bleeding) in this patient?

Rockall scoring is used for risk stratification. ***Rockall scoring is used for risk stratification*** - The image shows a patient with significant **hematemesis**, indicating an upper gastrointestinal bleed. The **Rockall score** is a validated tool used to assess the risk of rebleeding and mortality in patients with upper GI bleeding. - This scoring system considers factors such as **age**, **shock**, **comorbidity**, and endoscopic findings to guide management. *Most common is variceal bleeding* - While variceal bleeding is a serious cause of upper GI hemorrhage, **peptic ulcer disease** (gastric or duodenal ulcers) is the most common cause of non-variceal upper GI bleeding, accounting for 40-50% of cases. - Variceal bleeding is common in patients with **portal hypertension**, often due to liver cirrhosis. *Occurs only if bleeding occurs proximal to ampulla of Vater* - **Hematemesis** (vomiting blood) specifically indicates bleeding **proximal to the ligament of Treitz**, which is superior to the ampulla of Vater. - Bleeding from the small intestine distal to the ligament of Treitz or the colon typically results in **melena** or **hematochezia**, not hematemesis. *MC management is endoscopic banding* - **Endoscopic banding** is the primary treatment for **esophageal variceal bleeding**. - For non-variceal bleeding, such as from **peptic ulcers**, the most common endoscopic management is **epinephrine injection** followed by **thermal coagulation** or **clip placement**.

Question 1

Which nerve marked as $X$ is shown in the image given below? (Recent NEET Pattern 2016-17)

Accepted Answer

Criminal nerve of Grassi

Answer

Nerve of Laterjet

Answer

Crow's feet

Answer

Celiac trunk

Question 2

All of the following conditions are visible in the image except: (Recent NEET Pattern 2016-17)

Accepted Answer

Left sided femoral hernia

Answer

Right sided femoral hernia

Answer

Right sided inguinal hernia

Answer

Left sided inguinal hernia

Question 3

A multiparous female presents with the condition shown in the image. This condition can be managed by: (Recent NEET Pattern 2016-17)

Accepted Answer

McEvedy repair

Answer

Bassini repair

Answer

Hunters repair

Answer

Shouldice repair

Question 4

Which hernia repair procedure is shown in the image? (Recent NEET Pattern 2016-17)

Accepted Answer

Lichtenstein repair

Answer

Bassini herniorrhaphy

Answer

Shouldice repair

Answer

Lord's procedure

Question 5

A 25-year-old male presents with inguinal swelling. He had surgery for acute abdomen 2 years ago but could not tell the reason behind it. Trauma to which structure during the surgery conducted 2 years ago would have resulted in this inguinal swelling?

Accepted Answer

Ilioinguinal nerve

Answer

Spermatic cord

Answer

Genital branch of genitofemoral nerve

Answer

Pampiniform plexus

Question 6

Contents of the inguinal hernia sac are displayed intraoperatively and appendix is seen at 7 o'clock. What is the diagnosis?

Accepted Answer

Amyand hernia

Answer

Richter hernia

Answer

Pantaloons hernia

Answer

Maydl's hernia

Question 7

All the following statements regarding this film representing esophagus are true except:

Accepted Answer

Serosal layer prevents local spread

Answer

Squamous cell usually affects the upper two-thirds

Answer

Adenocarcinoma usually affects the lower-third

Answer

Lymph node involvement is a bad prognostic factor

Question 8

A 35-year-old patient presents with a painless swelling at the umbilicus that has been gradually increasing in size over the past 6 months. The swelling increases on coughing and straining. On examination, there is a reducible bulge at the umbilicus. What is the likely diagnosis?

Accepted Answer

Umbilical hernia

Answer

Epigastric hernia

Answer

Spigelian hernia

Answer

Paraumbilical hernia

Question 9

A 30-year-old patient presents with abdominal pain, fever, nausea, vomiting and respiratory distress. On admission BP=80/40 mm Hg and pulse rate is 120 BPM. The following CXR was performed. What is the immediate management? (AIIMS May 2016)

Accepted Answer

IV fluids and antibiotics followed by laparotomy

Answer

Immediate laparotomy

Answer

Intravenous fluids

Answer

Intravenous potassium

Question 10

Which is correct about hematemesis (upper GI bleeding) in this patient?

Accepted Answer

Rockall scoring is used for risk stratification

Answer

Most common is variceal bleeding

Answer

Occurs only if bleeding occurs proximal to ligament of Treitz

Answer

MC management is endoscopic banding

Gastrointestinal Surgery — MCQs

Gastrointestinal Surgery — MCQs

On this page

Practice by Chapter

Want unlimited practice?