Gastrointestinal Surgery Practice Questions

Q: Which of the following is NOT a classical symptom of acute appendicitis ?

Constipation. ***Constipation*** - While patients with appendicitis may experience altered bowel habits, **constipation is not a classic or defining symptom**; **diarrhea** can even be present. - The primary symptoms relate to inflammation and irritation of the appendix, not typically leading to significant constipation. *Periumbilical colic* - This is a very common early symptom, often described as a **vague, dull pain around the umbilicus** as the appendix initially becomes inflamed. - The pain later **migrates to the right lower quadrant** as the inflammation localizes to the parietal peritoneum. *Anorexia* - **Loss of appetite** is a highly characteristic and almost universal symptom in patients with acute appendicitis. - It often precedes the onset of abdominal pain and is considered a significant diagnostic indicator. *Nausea* - **Nausea and vomiting** are very common symptoms, often following the onset of abdominal pain. - These gastrointestinal symptoms are due to the visceral irritation caused by the inflamed appendix.

Q: Which one of the following is given a score of two in Alvarado score?

Leukocytosis. ***Leukocytosis*** - A **leukocyte count greater than 10,000/mm³** (leukocytosis) is assigned a score of **two points** in the Alvarado score. [2] - This parameter reflects the systemic inflammatory response often associated with acute appendicitis. [1] *Anorexia* - **Anorexia**, or loss of appetite, is a common symptom in acute appendicitis but is only assigned **one point** in the Alvarado score. - It is a non-specific symptom that can be present in numerous conditions. *Pyrexia* - **Pyrexia** (fever) is another indicator of inflammation, but in the Alvarado score, a **fever of 37.3°C or higher** is given only **one point**. - This symptom, while important, does not carry the same weight as a significant elevation in white blood cell count. *Rebound tenderness* - **Rebound tenderness** is a sign of peritoneal irritation and is given **one point** in the Alvarado score. [1] - While strongly correlated with appendicitis, it is a clinical finding rather than a laboratory marker.

Q: An air fluid level with dilated oesophagus and “bird beak” appearance in a barium swallow is diagnostic of:

Achalasia cardia. ***Achalasia cardia*** - The classic radiographic features of achalasia on a barium swallow include a **dilated esophagus** with proximal food retention (leading to an **air-fluid level**) and a characteristic narrowing at the gastroesophageal junction, creating a **"bird-beak" appearance**. - This appearance is due to the failure of the lower esophageal sphincter to relax during swallowing, combined with absent esophageal peristalsis. *Carcinoma oesophagus* - Oesophageal carcinoma typically presents as an **irregular, constricting lesion** or a **filling defect** on barium swallow, often with mucosal irregularity or shelf-like margins, rather than a smooth "bird beak." - While it can cause dysphagia and possibly proximal dilation, the specific "bird beak" morphology is not characteristic of cancer. *Barrett's oesophagus* - Barrett's esophagus is a histological diagnosis involving **metaplastic changes** in the esophageal lining, usually due to chronic GERD. - It does not have a distinct radiographic appearance on barium swallow, though it might be associated with reflux changes or **ulcerations**, but not a "bird beak" sign. *Hiatus hernia* - Hiatus hernias are characterized by the **protrusion of a portion of the stomach into the chest cavity** through the esophageal hiatus of the diaphragm. - On a barium swallow, this appears as an **accumulation of barium above the diaphragm**, often with a wide opening at the esophagogastric junction, which is distinct from the narrowed "bird beak" of achalasia.

Q: Which one of the following statements is not correct regarding trichobezoar ( hair balls)?

It is usually associated with pyloric stenosis.. ***It is usually associated with pyloric stenosis.*** - **Trichobezoars** are generally not associated with **pyloric stenosis**. The two conditions have distinct etiologies and pathophysiologies. - While both can present with gastric outlet obstruction symptoms, the presence of a hairball does not imply an underlying congenital or acquired narrowing of the pylorus. *It is associated usually with psychiatric illness.* - **Trichobezoars** are highly associated with **trichophagia** (compulsive hair eating), which is often a symptom of underlying psychiatric conditions like **trichotillomania** or **pica**. - These conditions involve an irresistible urge to pull out one's hair and/or consume non-nutritive substances, including hair. *It is more common in females.* - **Trichobezoars** are indeed more commonly found in **females**, especially young females [1]. - This increased prevalence is often linked to the higher incidence of **trichotillomania** and **trichophagia** in females. *It is more common in young.* - **Trichobezoars** are observed more frequently in **children and adolescents**, particularly among young girls [1]. - The behaviors of **trichotillomania** and **trichophagia** often develop during childhood or early adolescence [1].

Q: Match List-I with List-II and select the correct answer using the code given below the Lists: **List-I (Procedure)** A. Highly selective vagotomy B. Vagotomy with gastrojejunostomy C. Subtotal gastrectomy D. Nissen's fundoplication **List-II (Complication)** 1. Metabolic bone disease 2. Post-prandial gas bloat 3. Lesser curve necrosis 4. Diarrhea **Code:**

A→3 B→4 C→1 D→2. ***A→3 B→4 C→1 D→2*** - **Highly selective vagotomy** involves careful dissection along the **lesser curve** of the stomach, which can lead to **lesser curve necrosis** due to devascularization during the procedure. - **Vagotomy with gastrojejunostomy** disrupts vagal innervation leading to altered gut motility and bacterial overgrowth, causing **diarrhea** as a common complication. - **Subtotal gastrectomy** removes significant gastric tissue affecting absorption of **calcium** and **vitamin D**, leading to **metabolic bone disease**. - **Nissen's fundoplication** creates a 360° wrap that can cause inability to belch and **post-prandial gas bloat** syndrome. *A→2 B→4 C→1 D→3* - Incorrectly associates **highly selective vagotomy** with gas bloat, which is primarily seen with **fundoplication procedures**. - Mismatches **Nissen's fundoplication** with lesser curve necrosis, when lesser curve necrosis specifically occurs during **vagotomy procedures**. *A→2 B→1 C→4 D→3* - Wrongly links **vagotomy with gastrojejunostomy** to metabolic bone disease, which is characteristic of **gastric resection procedures**. - Incorrectly associates **subtotal gastrectomy** with diarrhea as primary complication rather than the more specific **metabolic bone disease**. *A→3 B→1 C→4 D→2* - Mismatches **vagotomy with gastrojejunostomy** with metabolic bone disease, when this complication is specific to **gastric resection**. - Incorrectly links **subtotal gastrectomy** with diarrhea instead of its more characteristic long-term complication of **metabolic bone disease**.

Q: The following nerves are blocked for repairing inguinal hernia by local anaesthetic except:

Femoral. ***Femoral*** - The **femoral nerve** primarily innervates the anterior thigh muscles and provides sensory supply to the anterior thigh and medial leg; its block is not typically required for **inguinal hernia repair**. - Blocking the femoral nerve would primarily affect **motor function** of the quadriceps and sensation in the distribution of the saphenous nerve, which is not the surgical field for an inguinal hernia. *Ilio-inguinal* - The **ilio-inguinal nerve** provides sensation to the inguinal region, scrotum/labia majora, and the medial aspect of the thigh, making its block essential for anesthesia during **inguinal hernia repair**. - It lies in the **inguinal canal** and is typically targeted with local anesthetic to cover the incision site and surgical area. *Genito femoral* - The **genitofemoral nerve** has both genital and femoral branches, providing sensation to the scrotum/labia majora and a small area of the femoral triangle, respectively, and is therefore often included in an **inguinal block**. - Its blockade helps to cover the sensory innervation of the **spermatic cord** and a portion of the inguinal region, contributing to effective pain control. *Ilio-hypogastric* - The **ilio-hypogastric nerve** provides sensory innervation to the suprapubic and gluteal regions, and its blockade is important for covering the **upper part of the surgical incision** for an inguinal hernia repair. - It runs parallel to the ilio-inguinal nerve and is often blocked concurrently to ensure **comprehensive analgesia** of the abdominal wall.

Q: In a patient of gastric outlet obstruction nutritional support is best delivered by:

Jejunostomy. ***Jejunostomy*** - In **gastric outlet obstruction**, the stomach cannot empty properly, making gastric feeding routes (like Ryles tube or gastrostomy) ineffective. - A **jejunostomy** allows direct delivery of **enteral nutrition** into the jejunum, bypassing the obstructed stomach and duodenum. *Enteral nutrition by Ryles tube* - A **Ryles tube** delivers nutrition into the stomach, which is obstructed in this condition, leading to **stasis** and **vomiting**. - This method would be ineffective and potentially dangerous due to the inability of gastric contents to pass beyond the obstruction. *Gastrostomy* - A **gastrostomy** involves placing a tube directly into the stomach, which is still part of the obstructed system. - Feeding via gastrostomy would lead to accumulation of feed in the stomach, mimicking the issues with oral feeding or a Ryles tube. *Parenteral nutrition* - **Parenteral nutrition** is a viable option for nutritional support but is generally considered a second-line therapy after **enteral routes** fail or are contraindicated. - **Enteral feeding**, when possible (as with jejunostomy), is preferred due to lower cost, reduced risk of infection, and better maintenance of gut integrity.

Q: Which one of the following is the investigation of choice in a patient with haematemesis?

Flexible upper gastrointestinal endoscopy. ***Flexible upper gastrointestinal endoscopy*** - This is the **investigation of choice** for haematemesis as it allows for direct visualization of the upper gastrointestinal tract to identify the source of bleeding [1]. - It also enables **therapeutic intervention**, such as injection sclerotherapy, banding, or clip application, to stop the bleeding [1]. *Contrast enhanced CT scan* - A CT scan is generally **not the primary investigation** for acute haematemesis because it offers less diagnostic accuracy for mucosal lesions and cannot provide therapeutic intervention [1]. - While it can identify large bleeds or structural abnormalities, it is **less sensitive for smaller bleeds** or subtle mucosal abnormalities compared to endoscopy. *Barium meal for stomach and duodenum* - A barium meal is **contraindicated in acute gastrointestinal bleeding** as the barium can obscure endoscopic views and interfere with subsequent attempts at endoscopy or angiography [1]. - It provides **limited diagnostic information** about the active bleeding site and offers no therapeutic capabilities. *Selective left gastric angiography* - Angiography is typically reserved for cases of **severe, persistent bleeding** where endoscopy has failed to locate or control the bleed. - It is an **invasive procedure** with potential complications and is not indicated as the initial diagnostic investigation.

Q: Mousseau-Barbin Tube (M.B.Tube) is used for:

Advanced cancer oesophagus. ***Advanced cancer oesophagus*** - The **Mousseau-Barbin tube** is a type of **endoscopic stent** used for palliative management of **dysphagia** caused by advanced **oesophageal cancer**. - It provides a lumen through obstructed oesophageal segments, allowing patients to swallow food and liquids more easily. *Advanced cancer oropharynx* - While dysphagia can be a symptom of oropharyngeal cancer, the Mousseau-Barbin tube is specifically designed for placement within the **oesophagus**. - Management for advanced oropharyngeal cancer often involves other interventions like **radiotherapy**, **chemotherapy**, or **surgical resection**. *All of these* - This option is incorrect because the Mousseau-Barbin tube has a specific application for the **oesophagus**. - It is not routinely used for cancers of the oropharynx or stomach due to differences in anatomical location and disease progression. *Advanced cancer stomach* - Advanced stomach cancer, particularly in the distal stomach, would not typically benefit from an oesophageal stent. - Gastric outlet obstruction can occur, but specific **gastric stents** or **surgical bypasses** are used for this.

Question 1

Which of the following is NOT a classical symptom of acute appendicitis ?

Accepted Answer

Constipation

Answer

Periumbilical colic

Answer

Anorexia

Answer

Nausea

Question 2

Which one of the following is given a score of two in Alvarado score?

Accepted Answer

Leukocytosis

Answer

Anorexia

Answer

Pyrexia

Answer

Rebound tenderness

Question 3

An air fluid level with dilated oesophagus and “bird beak” appearance in a barium swallow is diagnostic of:

Accepted Answer

Achalasia cardia

Answer

Carcinoma oesophagus

Answer

Barrett's oesophagus

Answer

Hiatus hernia

Question 4

Which one of the following statements is not correct regarding trichobezoar ( hair balls)?

Accepted Answer

It is usually associated with pyloric stenosis.

Answer

It is associated usually with psychiatric illness.

Answer

It is more common in females.

Answer

It is more common in young.

Question 5

What is the treatment of choice in a patient with Crohn’s disease, where inflamed appendix was found on exploration?

Accepted Answer

Ileo–colic resection and anastomosis

Answer

Appendectomy

Answer

Closing the abdomen and starting medical treatment

Answer

Right hemicolectomy

Question 6

Match List-I with List-II and select the correct answer using the code given below the Lists:

**List-I (Procedure)**
A. Highly selective vagotomy
B. Vagotomy with gastrojejunostomy
C. Subtotal gastrectomy
D. Nissen's fundoplication

**List-II (Complication)**
1. Metabolic bone disease
2. Post-prandial gas bloat
3. Lesser curve necrosis
4. Diarrhea

**Code:**

Accepted Answer

A→3  B→4  C→1  D→2

Answer

A→3  B→1  C→4  D→2

Answer

A→2  B→1  C→4  D→3

Answer

A→2  B→4  C→1  D→3

Question 7

The following nerves are blocked for repairing inguinal hernia by local anaesthetic except:

Accepted Answer

Femoral

Answer

Ilio-inguinal

Answer

Genito-femoral

Answer

Ilio-hypogastric

Question 8

In a patient of gastric outlet obstruction nutritional support is best delivered by:

Accepted Answer

Jejunostomy

Answer

Enteral nutrition by Ryles tube

Answer

Gastrostomy

Answer

Parenteral nutrition

Question 9

Which one of the following is the investigation of choice in a patient with haematemesis?

Accepted Answer

Flexible upper gastrointestinal endoscopy

Answer

Contrast enhanced CT scan

Answer

Barium meal for stomach and duodenum

Answer

Selective left gastric angiography

Question 10

Mousseau-Barbin Tube (M.B.Tube) is used for:

Accepted Answer

Advanced cancer oesophagus

Answer

Advanced cancer oropharynx

Answer

All of these

Answer

Advanced cancer stomach

Gastrointestinal Surgery — MCQs

Gastrointestinal Surgery — MCQs

On this page

Practice by Chapter

Want unlimited practice?