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High-Yield GIT, Hepatobiliary and Pancreatic Surgery Questions

Feb 8, 2024

High-Yield GIT, Hepatobiliary and Pancreatic Surgery Questions

Preparing for the NEET SS exam can feel like navigating a maze, but fear not! We have got the perfect strategy to help you gauge your readiness by giving you a sneak peek into the exam format.

Dive into the NEET SS high-yield questions to gain insight into what to expect. Get started by practicing the questions below, boost your confidence and fine tune your NEET SS Surgery preparation

  1. A 37-year-old male presents to the surgical outpatient department due to dysphagia for solids for 2 months. Investigations reveal disorganised primary peristalsis in the lower half of the esophagus. The brainstem controls primary peristalsis via vagal fibres and neurotransmitters. Which neurotransmitter is not released by inhibitory postganglionic fibres in controlling primary peristalsis?
  1. Acetylcholine
  2. Adenosine triphosphate (ATP)
  3. Nitric oxide (NO)
  4. Vasoactive intestinal peptide (VIP)
  1. A 52-year-old man with a history of gastroesophageal reflux disease for the last 8 years comes to the clinic. Endoscopy of the lower third of the oesophagus is shown in the image below. Which of the following is the most likely diagnosis in this patient based on the endoscopic finding?
Barrett’s oesophagus
  1. Hiatal hernia
  2. Barrett’s oesophagus
  3. Oesophageal stricture
  4. Oesophageal varices

3. A 38-year-old female presents with a complaint of dysphagia for a few weeks that began with liquids but now she is having difficulty swallowing solids too. She also complained of regurgitation of food and weight loss. Achalasia is suspected in this patient. Which of the following investigation will confirm the diagnosis in this patient?

  1. Manometry
  2. Endoscopy
  3. 24- hour PH monitoring
  4. CT scan

4. A young female who is a known case of bulimia nervosa presents to the emergency department with complaints of hematemesis and severe upper abdominal and chest pain that started after a severe episode of vomiting 1 hour ago. X-ray reveals air in the mediastinum.

Boerhaave’s syndrome

What is the most likely diagnosis?

  1. Mallory-Weiss syndrome
  2. Peptic ulcer disease
  3. Boerhaave’s syndrome
  4. Oesophagal varices

5. A 35-year-old male presents to the emergency department after drinking detergent with suicidal intentions. Endoscopy reveals transmural ulceration with extensive necrosis in the proximal oesophagus. What is the corrosive oesophagal injury grade according to the Zargar classification scheme?

  1. Grade 4
  2. Grade 3A
  3. Grade 3B
  4. Grade 2B

6. A 61-year-old man presents to the outpatient department with post-prandial chest pain and difficulty swallowing solid foods for 15 days. A barium swallow reveals a part of the gastric fundus herniating parallel to the oesophagus. A diagnosis of paraoesophageal hernia is made and he is scheduled for laparoscopic surgery. Which of the following factors is associated with an increased risk of complications following para esophageal hernia repair?

  1. Large hiatal hernia size
  2. Male gender
  3. History of GERD
  4. Laparoscopic approach

7. A 56-year-old man presents to the surgery department with complaints of hoarseness of voice associated with difficulty swallowing for the last four months. He consumes 5 to 6 units of alcohol per day. He also reports a weight loss of 4 kilograms over the last three months. His upper GI endoscopy reveals a mass in the middle third of the Oesophagus, He underwent esophagectomy, and the histology specimen shows microscopically negative margins. What is the type of resection done in this patient?

  1. R0 resection
  2. R1 resection
  3. R2 resection
  4. R1 and R2 resection

8. A 38-year-old man comes into the clinic complaining of dysphagia and odynophagia that have been bothering him for the previous week. He claims that after eating, his chest begins to burn more intensely. He denies having ever experienced heartburn or acid reflux. Physical examination is unremarkable. Non-reflux oesophagitis is suspected. Which of the following pathophysiology best describes his symptoms?

1. Decreased lower oesophageal sphincter pressure

2. Increased acid secretion by the gastric parietal cells

3. Impaired oesophageal motility

4. Hypersensitivity of the oesophageal mucosa

9. A 72-year-old man presents with on-and-off difficulty in swallowing for the past 2 years, which is accompanied by an uncomfortable sensation of “food sticking in the throat”. The patient also complains of a non-productive cough which is especially worse at night after a large dinner. He has also noticed a foul odour to his breath despite taking oral hygiene measures. He does not smoke or drink alcohol. His blood pressure is 130/80 mmHg, and his pulse is 90/min. The systemic examination is unremarkable and the patient has a BMI of 22 kg/m2. The patient is at the greatest risk of mortality from developing which of the following complications? 

1. Aspiration pneumonia

2. Hoarseness of voice

3. Oesophageal perforation

4. Squamous cell carcinoma

10. A 30-year-old female presented to the emergency department with complaints of severe chest and epigastric pain and hypersalivation after intake of a drain cleaner. She is clinically unstable. Which of the following is the most appropriate next-best management step for this patient?

1. Chest x-ray

2. Endoscopy

3. Surgical management

4. Airway evaluation and fluids administration

11. A 25-year-old woman is an avid marathon runner who complains of upper abdominal pain during her runs. She also reports that the pain subsides when she stops running and resumes after she starts running again. What region of the stomach is most likely the source of her pain?

1. Fundus

2. Body

3. Antrum

4. Pylorus

12. A 66-year-old man who has a major medical history of melanoma, peptic ulcer disease, and hypertension arrives in the emergency department with an abrupt onset of severe (9 of 10) left upper quadrant stomach discomfort. The patient says he has neither nausea nor vomiting but adds that he has lost his appetite even though it has been more than 6 hours since his last meal. The back and left shoulder are also affected, and the discomfort has been getting worse over time. He is breathing quickly while remaining still as he lies on the bed with his legs lifted to his chest. His body temperature is 37.9°C (100.2 °F), his blood pressure is 152/88 mm Hg, his pulse is 94/min, and his respiration rate is 18/min. Physical inspection reveals a very tender, rigid, and distended abdomen with enhanced tympany. The sounds of the bowels were inaudible. The other portions of the physical examination are not relevant. Relevant laboratory results include:

  •  WBC 14,000/mm3
  •  Haemoglobin 13.2 g/dL
  •  Platelets 303,000/mm3
  •  Direct bilirubin: 0.2 mg/dL
  •  Total bilirubin: 0.9 mg/dL
  •  Amylase 210 U/L
  •  Lipase 20 U/L (normal 0–160 U/L)
  •  [laboratory specific])
  •  Aspartate transaminase 33 U/L
  •  Alanine transaminase 30 U/L

Which of the subsequent diagnoses is more likely?

  1. Cholecystitis
  2. Hepatitis
  3. Pancreatitis
  4. Perforated peptic ulcer

13. A 45-year-old male presents with recurrent episodes of peptic ulcers, severe abdominal pain, and gastrointestinal bleeding. Upper gastrointestinal endoscopy reveals multiple hyperplastic polyps in the gastric mucosa. Laboratory investigations show elevated serum gastrin levels and low gastric pH. Imaging studies localize a gastrinoma in the duodenal wall. Based on the clinical presentation and laboratory findings, which Type of gastric neuroendocrine tumour (g-NET) is most likely present in this patient?

1. Type I

2. Type II

3. Type III

4. Type IV

14. A 55-year-old male with a history of alcohol abuse presents to the emergency department with complaints of vomitus with blood after a night of heavy drinking. The patient reports severe abdominal pain, multiple episodes of vomiting, and severe retching. On physical Examination, the patient appears pale and tachycardic. What are the most likely diagnosis and diagnostic tools for this patient?

1. Acute gastritis - No investigation needed at first

2. Gastrointestinal bleeding – Sigmoidoscopy

3. Mallory Weiss tear - Upper gastrointestinal endoscopy

4. Peptic ulcer disease - Abdominal ultrasound

15. A 53-year-old male presents to the emergency department with epigastric pain, generalised abdominal discomfort, and worsening abdominal distension for two days associated with retching but denies any vomiting or fever. A nasogastric tube is inserted for gastric decompression, and an X-ray of the abdomen reveals a distended stomach with a coiled nasogastric tube in the oesophagus, as shown: 

Gastric Volvulus

16. A 68-year-old male presents to the physician with abdominal pain, nausea, and bilious vomiting. He had a history of gastrectomy for gastric cancer a year ago. Physical examination reveals tenderness in the mild epigastric region. Endoscopy reveals red, beefy, and friable mucosa. Which of the following is the most likely diagnosis in this patient?

1. Peptic ulcer disease

2. Dumping syndrome

3. Afferent loop syndrome

4. Alkaline reflux gastritis

17.  A 35-year-old female presents to the surgical outpatient department due to epigastric pain for 2 weeks. She has had a history of gastritis for 10 years which has become unresponsive to proton-pump inhibitors (PPIs). Elective upper endoscopy reveals an ulcerated lesion with an underlying mass in the distal part of the stomach. A biopsy of the lesion shows smooth muscle cells. Which of the following syndrome is not associated with this patient’s condition?

  1. Neurofibromatosis 1
  2. Von-Hippel Lindau disease
  3. Carney-Stratakis syndrome
  4. Tuberous sclerosis

18. A 55-year-old man presents to the clinic with complaints of epigastric pain and unintentional weight loss over the past few months. He reports feeling full quickly during meals and occasional vomiting. The patient denies any history of gastrointestinal bleeding, melena, or hematochezia. On physical examination, there is mild tenderness in the epigastric region, but no palpable masses or lymphadenopathy are appreciated. Laboratory studies reveal mild anaemia with haemoglobin of 11.8 g/dL (reference range 13.5-17.5 g/dL).What is the most likely diagnosis of this patient’s underlying condition?

1. Gastric adenocarcinoma

2. Gastric lymphoma

3. Gastric neuroendocrine tumour

4. Gastric stromal tumour

19. A 32-year-old woman presents to the emergency department with severe abdominal pain of sudden onset and fever. She describes the pain as constant, sharp, and located in the right lower quadrant. She denies any vaginal bleeding. Her last menstrual period was 5 weeks ago, and she had a positive home pregnancy test 2 weeks ago. On physical examination, her vital signs are stable, and she has rebound tenderness and guarding in the right lower quadrant. Pelvic examination reveals no cervical motion tenderness or adnexal masses. Which of the following is the most likely diagnosis?

  1. Ectopic pregnancy
  2. Appendicitis
  3. Ovarian torsion
  4. Ovarian cyst rupture

20. A 40-year-old female presents to her primary care physician with complaints of abdominal discomfort, changes in bowel habits, and weight loss. A CT scan of the abdomen and pelvis reveals a 3 cm mass in the appendix involving the muscularis propria. Biopsy confirms adenocarcinoma of the appendix. Further workup, including a PET scan, shows no evidence of metastasis. The patient has undergone a right hemicolectomy; what is the most appropriate adjuvant therapy for this patient?

1. Observation

2. Chemotherapy

3. Radiation therapy

4. Chemotherapy and radiation therapy

21. A 35-year-old female presented with complaints of oral lesions, as shown below. She has had them for the past four months. Physical examination showed multiple lipomas on both forearms and arms. Further assessment showed the presence of both macrocephaly and duodenal polyps on upper gastrointestinal endoscopy. A colonoscopy with biopsy detected multiple hamartomatous polyps. What will be the most likely diagnosis based on clinical findings?

PTEN Hamartoma Syndrome

1. PTEN Hamartoma Syndrome

2. Lynch Syndrome

3. Peutz-Jeghers Syndrome

4. Familial adenomatous polyposis

22. A 65-year-old female is diagnosed with advanced-stage anal cancer and has undergone surgery to remove the tumour. She is now considering adjuvant therapy options to reduce the risk of recurrence. Which radiation therapy options would be the most appropriate for this patient?

1. Intensity-modulated radiation therapy (IMRT)

2. 3-D conformal radiation therapy (3D-CRT)

3. Stereotactic body radiation therapy (SBRT)

4. External beam radiation therapy (EBRT)

23. A 67-year-man has presented to the surgical outpatient department with complaints of tenesmus and per-rectal bleeding for three months. There was considerable weight loss as well. Which of the following is the best diagnostic modality for the diagnosis of colorectal cancer?

1. Double-contrast barium enema

2. Spiral CT-scan

3. Ultrasonography of abdomen

4. Colonoscopy 

24. A 43-year-old male presents in the surgical outpatient department for a normal checkup. A week earlier, he had received a previous diagnosis of right-sided colon cancer. Additionally, he reports that ovarian and colorectal cancer runs in his family. An anomaly in the MSH2 gene leads to the prompt ordering of genetic testing, which reveals the verified diagnosis of hereditary non-polyposis colorectal cancer (HNPCC). What is the fundamental role of this gene in the diagnosis of the patient described above?

1. Signal Transduction

2. Apoptosis Regulation

3. Regulatory GTPase

4. DNA mismatch repair

Hope you found this blog helpful for your GIT, Hepatobiliary and Pancreatic Surgery preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.

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