a) Ureteral obstruction
b) Entero vesical fistula
d) Recto uretheral fistula
Q) A 37 year old lady with history of oral contraceptives undergoes a CT scan for pain lower abdomen which also revealed a solitary 6 cm lesion in segment VI of liver. Triple phase Ct scan shows a lesion which enhances in the arterial phase more at the margins and in the venous phase it moves towards the center. This lesion is :
a) Focal Nodular Hyperplasia
c) Hepatic Adenoma
d) Hepatocellular carcinoma
Answer is C
Hepatic Adenoma is benign neoplasms of the liver. They are associated with
Androgen containing steroids
Type I and III glycogen storage diseases
They are diagnosed on the basis of CT scans. Diagnostic features of CT Scan for hepatic adenoma are
Non contrast- Heterogenous hypodense mass with areas of hemorrhage and necrosis
Arterial phase shows rapid filling at the periphery then progressing to the center
Hepatocellular carccinoma shows - Rapid arterial filling with wash off in the portal venous phase
Hemangioma- Peripheral nodular enhancement
FNH- Central scar
Rf: Shackelford page 1564
Q) Not true about recurrent pyogenic cholangitis :
a) Mostly there are intrahepatic strictures with involvement of the left side duct
b) It can present as choledochoduodenal fistula
c) Complete biliary obstruction can lead to marked jaundice and pruritis
d) MRCP and other other cholangiography can be diagnostic
In recurrent pyogenic cholangitis (RPC) complete obstruction does not occur and jaundice and pruritis is not marked. RPC is a disease commonly seen in young Asians (also known as oriental cholangiohepatitis) which leads to multiple strictures in extra or intrahepatic ducts.
Association with Ascaris lumbricoides and Clonorchis sinensis has been noted.
It can present as choledocholithiasis with stricture, choledochoduodenal fistula, acute pancreatitis, secondary biliary cirrhosis and can lead to cholangiocarcinoma.
MRCP can be diagnostic and is preferred because of its non invasive nature.
Q) Which of the following is true about giant gastric ulcer?
a) 70-80% of these ulcers are malignant
b) By definition giant gastric ulcer is more than 1.5 cm in size
c) Medical therapy can heal 80% of such ulcers
d) They are more common on the greater curvature and invade surrounding organs like spleen, liver etc
Answer for premium members
a) Paraesophageal hiatus hernia
b) Sliding hiatus hernia
c) Both sliding and paraesophageal hernia
d) Large part of stomach in the mediastinum with pylorus near the esophageal hiatus
Hiatal hernias are protrusion of stomach through a defect in the esophageal hiatus into the mediastinum.
They are of two types
- Sliding - GE junction migrates to the mediastinum and rests superior to the diaphragm.
- Paraesophgaeal - Part of stomach migrates through the esophageal hiatus into the mediastinum with GE junction remaining at its normal position.
- There are IV types of hiatal hernia
Q) A 45 year old male sustains 30% burns on both legs and anterior abdominal wall. There was mild inhalation injury associated with it. He initially responded well to treatment with IV fluids, Inj Tramadol and enteral feeding.
Three days after the treatment he is having slight tachypnea (30/min) pulse 110/min and BP 98/60. His temp is 97degree F and some areas of partial thickness have converted into full thickness. He is currently on Inj Magnamycin. His platelets are 70ooo, TLC is 17000 and sugar is 200 mg%. What is the next step in management?
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.