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Next Exam: DNB SS December 2017.
Q Least useful investigation in a pt with recurrent LGI bleed, multiple upper and lower GI endoscopies negative
b) Double balloon enteroscopy
c) Capsule endoscopy
d) Push endoscopy
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Investigations in lower GI bleed should be specific and less time consuming
Small bowel enteroclysis, which uses a tube to infuse barium, methylcellulose, and air directly into the small bowel, yields better images than simple small bowel follow-through. Because the yield has been reported to be very low and the test is poorly tolerated, it is now rarely used.
Capsule endoscopy uses a small capsule with a video camera. capsule endoscopy is an excellent tool for the patient who is hemodynamically stable but continues to bleed, with reported success rates as high as 90% in identifying a small bowel pathology.
The hemodynamically stable patient should undergo small bowel enteroscopy. Usually performed with a pediatric colonoscope, it is referred to as push endoscopy. It can reach about 50 to 70 cm past the ligament of Treitz in most cases and permits endoscopic management of some lesions. Overall, push enteroscopy is successful in 40% of patients .
Double-balloon endoscopy is another technique gaining in popularity. Although technically difficult, this approach is capable of providing a complete examination of the small bowel. In expert hands, double-balloon enteroscopy can identify a bleeding source in 77% of cases with occult bleeding, with the yield increasing to over 85% if the endoscopy is per-formed within 1 month of an overt bleeding episode.The advantage of this technique is that as well as visualization, biopsies can be performed and therapeutic interventions undertaken.
To conclude investigations in lower GI bleed have to be specific and have high sensitivity also.
Q) Most common content of Morgagni hernia is :
b. Small intestine.
c. Transverse colon.
Foramen of morgagni is a congenital diaphramatic defect along with Bochdalek.
Morgagni was an italian anatomist
a) After weight loss it resolves symptoms of venous ulcers due to stasis
b) Symptoms of pseudo tumor cerebri are resolved
c) Heartburn is alleviated immediately
d) Protein malnutrition is a very common problem
d Protein malnutrition is common in Biliopancreatic division and duodenal switch.
Essential components of successful Roux en Y gastric bypass are
Q) False statement about emergency airway management
a) Cricothyroidotomy is preferred
b. Skin incision is vertical.
c. Membrane incision is vertical
d. Airway is prepared before cricothyroidotomy
Q) Most common radiolucent renal stone .
a. Calcium oxalate .
b. Calcium phosphate
c. Triple phosphate
d. Uric acid
Q) Treatment of tetany due to hypocalcemia is ?
a. Oral calcium
b. Injectable 10 percent calcium gluconate
c) Parathyroid injections
d) Vitamin D
b) Rt gastroepiploic
c) Rt gastric
d) Sup Pancreaticoduodenal
Discuss blood supply of 1st part of duodenum, and course of all arteries mentioned in choices.
a) NPO, TPN
b) Enteral feeding with medium chain
c) Re explore and suture the defect
Once the diagnosis is made, one should ensure the pleural space is completely evacuated; if needed, drainage is done by a chest tube or a radiologically directed catheter placement.
Feedings are stopped and total parenteral nutrition (TPN) is started. The amount of chest tube output is then monitored for several days in order to make a decision about the possible need for reoperation. Small leaks can seal with nonoperative therapy. Large initial daily outputs (typically greater than 1 L/day) often fail nonoperative therapy and require reoperation. An absolute amount of drainage for prediction of failure is unknown and one should consider also if there is a gradual reduction in daily output to continue with conservative therapy.
If the drainage is less than 500 mL per day and slowly decreasing, continued conservative therapy is frequently successful. Continued volumes more than 1 L after 2 days of TPN is a good indication of the need for reoperation. In general, it is better to be more rather than less aggressive in returning to the operation theater with a chylothorax. It was more common after THE and was associated with longer intensive care unit (ICU) and hospital stays. There was no difference in mortality between those with and without a chylothorax.
Patients with initial drainage exceeding 2 L within 2 days of starting conservative treatment all required reoperation.
a) Continue same management
b) Upgrade the antibiotic and send a fresh culture from skin
c) Treat it as carbon monoxide poisoning
d) Manage in lines of Acute Tubular Necrosis
Burns management involves critical care, intensive phase and rehabilitation. Loss of skin and eschar formation predispose individuals to gram positive, gram negative and fungal infections.
a) CE2 cyst with multiple daughter cysts
b) Large 10 cm cyst situated peripherally
c) Infected cyst
d) 6 cm asymptomatic cyst
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