General Surgery Question Bank

Read the General Surgery Question Bank sample questions

1. 1.The three findings in achalasia are:

   • A.Decreased LES resting pressure, increased LES relaxation decreased esophageal peristaltic activity.
   • B.Decreased LES resting pressure, increased LES relaxation decreased esophageal peristaltic activity.
   • C.Increased LES resting pressure, decreased LES relaxation decreased esophageal peristaltic activity.Correct
   • D.Decreased LES resting pressure, increased LES relaxation decreased esophageal peristaltic activity.

   Why: Achalasia results from degeneration of the myenteric (Auerbach) plexus, producing the classic triad of an elevated (increased) lower esophageal sphincter resting pressure, failure of the LES to relax with swallowing, and absent/decreased esophageal body peristalsis. This causes functional obstruction with progressive dysphagia to solids and liquids.

2. 2.Esophageal precancerous conditions are:

   • A.Cricopharyngeal dysphagia, epiphrenic diverticulum, achalasia.
   • B.Achalasia , hiatus hernia, Zenker's diverticulum.
   • C.Chemical burns of the esophagus, achalasia, Barrett's esophagus.Correct
   • D.Barretts esophagus, hiatus hernia, achalasia.

   Why: Recognized esophageal premalignant conditions include long-standing achalasia, lye/chemical (corrosive) burn strictures, and Barrett's esophagus. Each carries chronic mucosal injury and increased risk of squamous (achalasia, caustic burns) or adenocarcinoma (Barrett's).

3. 3.Acidic pH in the lower esophagus should not exceed:

   • A.1 hour daily.
   • B.2 hours daily.
   • C.1.5 hours daily.Correct
   • D.2.5 hours daily.

   Why: On 24-hour pH monitoring, physiologic acid exposure (pH <4) in the distal esophagus should not exceed roughly 1.5 hours of the day (about 4-5% of total time). Exceeding this threshold defines pathologic gastroesophageal reflux.

4. 4.An anti reflux procedure may be unsuccessful because of:

   • A.Gastric outlet obstruction not previously identified.Correct
   • B.Well-dilated previous stricture.
   • C.Decreased saliva production.
   • D.Transthoracic fundoplasty.

   Why: A common cause of failed antireflux surgery is an unrecognized distal obstruction such as gastric outlet obstruction, which raises intragastric pressure and overcomes the repair. Identifying and correcting outlet obstruction (e.g., from peptic disease) before fundoplication is essential.

5. 5.The most common etiology of esophageal perforations is:

   • A.Spontaneous rupture (Boerhaave's syndrome).
   • B.Instrumental perforation.Correct
   • C.Foreign bodies in esophagus.
   • D.Barrett's esophagus.

   Why: Iatrogenic instrumental perforation (during endoscopy, dilation, or intubation) is the most common cause of esophageal perforation, exceeding spontaneous (Boerhaave) rupture and foreign-body injury. The cervical/cricopharyngeal area is the most frequent site during rigid endoscopy.

6. 6.Esophageal carcinoma confined to the esophagus is best treated by:

   • A.Laser debulking.
   • B.Prosthetic tube insertion.
   • C.Local resection.
   • D.Subtotal esophagectomy.Correct

   Why: For carcinoma confined to the esophagus, subtotal esophagectomy offers the only realistic chance of cure by removing the tumor with adequate margins and regional nodes. Laser debulking, stenting, and local resection are palliative or inadequate for oncologic clearance.

7. 7.Middle-third esophageal carcinoma confined to the esophagus may be approached via:

   • A.a) Right chest.
   • B.b) Abdomen and right chest.
   • C.c) Abdomen and neck.
   • D.d) Both b and c.Correct

   Why: A middle-third esophageal carcinoma can be resected via an Ivor-Lewis approach (abdomen and right chest) or a transhiatal approach (abdomen and neck); both provide access for esophagectomy and reconstruction. Therefore both b and c are correct.

8. 8.Cricopharyngeal dysphagia is associated with all but

   • A.lack of coordination between contraction of the inferior constrictor of the pharynx and relaxation of the cricopharyngeus.Correct
   • B.GE reflux.
   • C.Development of Zenker's diverticulum.
   • D.Decreased primary peristaltic waves.

   Why: Cricopharyngeal (oropharyngeal) dysphagia is associated with discoordination of the inferior constrictor and cricopharyngeus, Zenker diverticulum formation, and reduced primary peristaltic waves. GE reflux is not a feature of cricopharyngeal dysfunction, so it is the exception. [REVIEW: keyed answer may be incorrect — the stem lists incoordination as a hallmark feature, so GE reflux (b) is the better 'all but' answer rather than (a)].

9. 9.Esophageal tertiary waves are prevalent in:

   • A.Esophageal carcinoma.
   • B.Hiatus hernia.
   • C.Diffuse esophageal spasm.Correct
   • D.Scleroderma.

   Why: Tertiary (non-propulsive, simultaneous) esophageal contractions are characteristic of diffuse esophageal spasm, producing the 'corkscrew' appearance on barium swallow and intermittent chest pain/dysphagia.

10. 10.Which of the following is the primary stimulus for gastric somatostatin release

    • A.Distension of the stomach
    • B.Release of acetylcholine by the vagus
    • C.Acidification of the antrumCorrect
    • D.Release of cholecystokinin

    Why: Antral acidification (low luminal pH) is the principal physiologic stimulus for D-cell somatostatin release. Somatostatin then inhibits gastrin release in a negative-feedback loop that limits further acid secretion.