1. Achalasia is a rare dismotility disorder of the esophagus thought to be due to the loss or destruction of ganglion cells in the myenteric plexus. In a patient with achalasia manometry revealed incomplete LES relaxation, aperistalsis, and elevated LES resting pressure (<26mmHg.) Esophagogastroscopy showed narrowing one centimeter proximal to the gastroesophageal junction. Which of the following modality of treatment is indicated ?
a) Continue Proton pump inhibitor therapy with repeat endoscopy in 8 weeks
b) Esophageal pneumatic dilatation followed by surgical myotomy if symptoms of continue
c) Calcium channel blocker therapy
d) Repeated endoscopic esophageal dilatation

2. Extracorporeal knotting can be used for laparoscopic closure of all of the following structures except?
a) Base of the appendix
b) Cystic duct at the time of cholecystectomy
c) Crural repair at the time of fundoplication
d) Repair of duodenal perforation

3. When tissues are under tension, which of the following knot would be more effective?
a) Intracorporeal square knot
b) Intracorporeal interrupted suture
c) Tumble square knot
d) Intracorporeal continuous suture

4. Patient has medical necessity for obesity laparoscopic surgery if BMI is:
Greater than 25
Greater than 40
Patient is depressed because she does not fit into her clothes
none of the above

5. At the time of performing a diagnostic laparoscopy for chronic right lower quadrant pain in a 45 year old female the only findings are some filmy adhesions to the right tube. The appendix is inspected and appears normal. What should you do?
Adhesiolysis and appendectomy since 15% of normal appearing appendices have pathology
Nothing since there appears to be no definitive source of pain
Only appendectomy
Only adhesiolysis

Thank you! Visit again tomorrow for more fresh questions.