Surgical Medicine Quiz

Barrett's esophagus without dysplasia requires endoscopic surveillance every 3-5 years. Don't do it every six months!

The lower esophageal sphincter (LES) should have a pressure of 10mmHg when relaxed and 0mmHg when a food bolus is present.

A minimum of 2-3 cm of intra-abdominal esophagus is needed for hiatal hernia repair.

A Collis gastroplasty can be used to increase the length of the esophagus if it's too short.

Patients undergoing an anatomic pulmonary lobectomy need a pre-operative FEV1 of at least 60%. If it's lower, they need a minimum predicted postoperative FEV1 of 35-40% and a DLCO greater than 60%.

A condition that occurs after Roux-en-Y gastric bypass surgery, characterized by a decrease in mean corpuscular volume (MCV), leading to microcytic anemia due to iron deficiency.

A type of cancer that originates from the interstitial cells of Cajal and is most commonly found in the stomach, followed by the small bowel.

A syndrome that develops after Billroth II surgery due to an excessively long afferent loop, characterized by megaloblastic anemia, but NOT microcytic anemia.

Stress Ulcer Prophylaxis with proton pump inhibitor is indicated for patients with traumatic brain injury (TBI) (GCS ≤ 10 or inability to obey commands) or traumatic spinal cord injury, mechanical ventilation > 48 hours, severe burn injury (≥ 20% body surface area), or coagulopathy (INR > 1.5, PTT > 2 times the control value, platelets < 50,000/mm³).

Endoscopic mucosal resection (EMR) or surgical mucosal dissection (SMD) is considered for early gastric cancer with 20 polyps or if the polyps are > 1 cm. It is also recommended to withdraw proton pump inhibitor medications in these cases.

Bland spindle cells with elongated nuclei are a hallmark of GIST (Gastrointestinal Stromal Tumors).

The right gastroepiploic artery should be preserved during esophagectomy if you plan to use the stomach for reconstruction.

Large ulcers along the greater curvature of the stomach require biopsy from both the edge and the core.

The stomach secretes approximately 1500 milliliters of fluid within 24 hours.

Mitosis count > 5/50 high-power field and size > 5 cm are strong indicators of malignant potential in GIST.

Electrolyte correction is the most effective intervention for post-operative ileus.

Small bowel motility returns within hours, gastric motility within 24-48 hours, and colonic motility within 48-72 hours after abdominal surgery.

Celiac disease is a risk factor for small bowel T-cell lymphoma, which is characterized by monotonous anaplastic cells expressing T-cell markers like CD3 and CD7.

A tumor arising from neuroendocrine cells, often releasing hormones such as chromogranin A and pancreastatin.

A protein secreted by neuroendocrine cells, often elevated in NETs.

A fragment of Chromogranin A, also often elevated in NETs.

A common side effect of octreotide treatment for NETs, caused by the inhibition of CCK, which leads to increased cholesterol in bile.

A technique used to visualize and sample liver lesions, particularly helpful for NETs.

The parasite that causes hydatid cysts in the liver, potentially leading to serious complications.

The most common cause of liver cirrhosis globally.

A procedure to create a connection between the portal vein and the hepatic vein, used for severe portal hypertension.

Cholecystokinin is the most potent stimulator of pancreatic enzyme secretion, while secretin stimulates fluid and bicarbonate secretion.

Acidification of the duodenum (pH < 4.5) triggers the release of secretin from specialized cells in the duodenal mucosa, which then stimulates pancreatic duct cells to secrete pancreatic fluid and bicarbonate.

CT-guided drainage is more effective for a uniloculated fluid collection, while splenectomy is the preferred treatment approach for multiloculated splenic abscesses.

A right hemicolectomy is indicated for appendiceal neuroendocrine tumors larger than 2 cm, those involving the appendiceal base, or those between 1 and 2 cm with certain characteristics like lymphovascular invasion, positive/uncertain margin, higher proliferation rate, or mixed histology.

Sphincterotomy is the surgical option for persistent anal fissures, not fissurectomy.

R0 resection is the first-line treatment for intrahepatic cholangiocarcinoma without metastasis, but neoadjuvant chemotherapy is not proven to be beneficial. Patients are ineligible for resection if they have metastatic disease, including lymph node metastasis beyond the porta hepatis.

Hyperchromasia, increased mitotic activity, and pseudostratification of Lieberkühn crypts in the liver are suggestive of metastatic colorectal cancer.

Nucleation of sterol monohydrate aggregates is the primary cause of gallstone formation.

A multiloculated, hypodense liver lesion on CT strongly suggests a pyogenic liver abscess.

Resection of the paracellular carcinoma is contraindicated when the main portal vein is involved.

Acute myeloid leukemia (AML) is a recognised risk factor for acalculous cholecystitis.

Fungal hepatic abscess should be treated with percutaneous drainage and antifungal agents like caspofungin or micafungin. Amphotericin B is not the preferred treatment.

The step-up approach is preferred for necrotizing pancreatitis, delaying operative intervention for at least 4-6 weeks. Drain placement should be considered before video-assisted debridement.