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Next Exam: DNB SS December 2017.
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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Q) Elderly healthy male with impacted denture. Removed endoscopically. Pt developed fever, dyspnoea and respiratory distress over 24 hrs. X-ray revealed Lt hydrothorax and mediastinal emphysema.
a) ICD and NG feeds
b) ICD and TPN
c) Cervical esophagectomy, FJ, debridement, ICD
d) Debridement, primary repair with buttress and ICD
Q. 40 yr old lady with symptoms of GERD. Endoscopy shows hiatus hernia. Symptoms controlled with PPI. Next step
a) Leave alone
b) Manometry with Ph study
c) Ba swallow with Manometry
d) Ba swallow with Ph study
Q) Degloving injury is one which involves stripping of
b) Skin, Subcutaneous fat
c) Skin, Subcutaneous fat and underlying fascia
d) All soft tissue upto bones
Q) Which of the following is tumoricidal?
a. 1 percent cetrimide.
Q) Fowler Stephen Surgery is done for
c) Exstrophy of bladder
Answer Free for all
Surgeries for Epispadias are -
1. MSRE- Modern stage repair of Exstrophy includes bladder closure, pelvic osteotomies followed by epispadis repair and uretheroplasty at 12-18 months
Young-Dees-Leadbetter repair- Bladder neck reconstruction for exstrophy
Kelly repair (RSTM) Radical soft tissue mobilization
2. Complete primary repair for classic bladder exstrophy (CPRE)
Cryptorchidism - Fowler stephens surgery means division of short testicular vessels to mobilise the testis
The testicular blood supply is then dependent on collaterals from the vasal artery.
Q) Causes of primary graft non function are A/E
a) Recipient with renal failure
b) Microsteatosis > 60%
c) Cold ischaemia time > 12hrs
d) Non heart beating donor
Discuss the causes of PNF-Primary non function of liver