Metabolic & Bariatric Surgery MCQs

Explanation: In the immediate postoperative period, patients often develop hyperkalaemia or normal potassium levels due to tissue breakdown, acidosis and decreased renal excretion. Hypokalaemia is not typically seen . Normal metabolic changes in the immediate postoperative period include: Negative nitrogen balance due to catabolic stress hormones (Option A) Glucose intolerance due to increased cortisol, catecholamines and insulin resistance (Option C) Hyponatremia due to ADH surge and water retention (Option D) Potassium tends to be normal or high , not low, because of increased catabolism, acidemia and reduced renal clearance

The factors determining organ function after transplantation include - A] Donor characteristics - Extremes of age Presence of pre-existing damage in transplanted organ Haemodynamic and metabolic instability B] Procurement-related factors - Warm ischaemic time Type of preservation solution Cold ischaemic time C] Recipient-related factors - Technical factors relating to implantation Haemodynamic and metabolic stability Immunological factors Presence of drugs that impair transplant function Reference : Bailey & Love's short practice of surgery 27th Edition, Chapter 82, Transplantation, Pg: 1549.

The metabolic effects of the thyroid hormones are due to unbound free T4 and T3 (0.03% and 0.3% of the total circulating hormones, respectively). T3 is the more important physiological hormone and is also produced in the periphery by conversion from T4. T3 is quick acting (within a few hours), whereas T4 acts more slowly (4-14 days). Reference : Bailey & Love's short practice of surgery, chapter: 55, Edition: 28 th , Pg: 852

Explanation: Iron deficiency is the most common nutritional deficiency following Roux-en-Y gastric bypass (RYGB). This occurs due to two main reasons: Bypass of the Duodenum: The primary site of iron absorption is bypassed. Reduced Gastric Acid: The new gastric pouch produces little acid, and iron requires an acidic environment for conversion into its absorbable ferrous (Fe2+) form. This often leads to iron-deficiency anemia, presenting as fatigue and pallor. Copper and zinc deficiencies may occur but are less common than iron deficiency, while calcium deficiency is frequent due to reduced intake and vitamin D malabsorption, yet iron deficiency remains the most common. (Options B,C and D ruled out) Key Takeaways: Iron deficiency is the most prevalent micronutrient deficiency after gastric bypass. Lifelong supplementation and monitoring are required after bariatric surgery.

Option A : After 12 hours of fast plasma insulin level falls and glucagon level rise which Facilitates conversion of liver glycogen into glucose. Option B : After more than 24 hours of fasting, Gluconeogenesis started from Amino acids particularly glutamine and alanine. Option C : After 48-72 hours not a week, central nervous system may adapt to using ketone bodies as their primary fuel source. Option D : Glycogen also exist in muscle but cannot be utilized directly. Muscle Glycogen is converted to lactate which is then exported to liver where It is converted to glucose. Reference: Bailey & Love's short practice of surgery, chapter: 25, Edition: 28th, Pg: 329

In the majority, the cause is hyperplasia of Peyer’s patches (lymphoid tissue), which may be secondary to a viral infection. In 10% of children, there is a pathological lead point, such as a Meckel’s diverticulum, enteric duplication cyst or even a small bowel lymphoma. Such cases are more likely in children over the age of 2 years and in those with recurrent intussusception. Classically, a previously healthy infant presents with colicky pain and vomiting (milk then bile). Between episodes, the child initially appears well. Later, they may pass a ‘redcurrant jelly’ stool. Clinical signs include dehydration, abdominal distension and a palpable sausage-shaped mass in the right upper quadrant. Rectal examination may reveal blood or rarely the apex of the intussusceptum. Reference: Bailey and love’s short practice of surgery, 27 th edition, Page –129

At the renal hilum, The first structure encountered (i.e. the uppermost) is the renal vein Then the renal artery Lastly the renal pelvis . Reference : Bailey & Love's short practice of surgery 27 th Edition, Chapter 76, The Kidney and Ureter, Pg: 1399.

In Patey's mastectomy, the breast and associated structures are dissected en bloc and the excised mass is composed of - Whole breast tissue Skin over the breast tissue Nipple areola complex Fat, fascia and lymph nodes of the axilla. The pectoralis minor muscle is either divided or retracted to gain access to the upper two-thirds of the axilla. The axillary vein and nerves to the serratus anterior and latissimus dorsi should be preserved . Reference : Bailey & Love's short practice of surgery, chapter: 58, Edition: 28 th , Pg: 935