Splenic Artery Aneurysm

Q)Splenic artery aneurysm is seen in 

a) Proximal 1/3rd of splenic artery

b) Proximal 2/3 of splenic artery

c) Middle 1/3 of splenic artery

d) Distal 1/3 of splenic artery

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Electrolytes

Q) A 50 year old male undergoes pancreatectomy for Carcinoma head of pancreas. His pre op Hb was 9.2g% and during surgery he received 5 units of PRBC. In the post op period on the 2nd day he develops ECG changes. Work up is done for Myocardial Ischemia which is negative. What is the most common  cause of ECG changes here

a) Hyponatremia

b) Hyperkalemia

c) Hypokalemia

d) Hypercalcemia

Free Answer  b, Hyperkalemia

Transfusion of high volume of  PRBC especially stored blood leads to hyperkalemia. In the setting of pancreatectomy in an already anemic patient, if massive blood transfusion is given, chances of hyperkalemia  are there.

The ECG changes of Hyperkalemia are tall T waves, shortened QT interval and ST segment depression

 

Retroperitoneal Sarcoma

Q) Which of the following about retroperitoneal sarcoma is true?

a) Angiosarcoma is the most common retroperitoneal sarcoma

b) Most common presentation is pain abdomen

c) Lymph node resection should be done even if no lymph nodes are seen on imaging (CT and MRI)

d) Radiation causes retroperitoneal sarcoma at an average of 10 years after exposure

Answer for all 

Retroperitoneal Sarcoma on CT

 d) Radiation is a known risk factor which causes this condition mostly 10 years after exposure.

Other pre disposing conditions include 

  1. Von Recklinghausen's disease
  2. Li- Fraumeni's disease
  3. Hereditary Retinoblastomas

Most common retroperitoneal sarcomas are liposarcoma and leiomyosarcoma. 
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Gastrinoma

Q) Regarding gastrinoma what is true?

a) All gastrinomas express SRS receptors

b) In 30 % of cases gastrinomas are not localized intra operatively

c) Levels of serum  gastrin more than 100pg/ml are strongly suggestive of gastrinoma

d) Angiography with secretin stimulation is required in all cases for localization of gastrinoma

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Amoebic Liver abscess

Q) True about presentation of amoebic liver abscess?

a) 60-70% patients with amoebic liver abscess have diarrhoea

b) Jaundice is seen in 50% of these patients

c) Rupture of liver abscess in the peritoneum is seen in 10% cases

d) More complications of amoebic liver abscess occurs in acute presentation

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Carcinoid Appendix

 A 40 year old male is  undergoing appendicectomy for acute appendictis.  During surgery a 3 cm mass is found in the body of appendix. Frozen section of the mass reveals carcinoid tumor. Which of the following is true

a) Appendicectomy should be completed followed by radiotherapy to the bed

b) Right hemicolectomy should be done

c) There is 50% chance of developing carcinoid syndrome in this case

d)  Carcinoid syndrome occurs only if there is liver metastasis

Answer for basic members (Register Free) 

Q. A 45 year old male has severe coughing followed by sudden Bilateral pain in lower abdomen. At the same time he develops a swelling in the mid line, lower abdomen which does not change in size on raising the leg muscles. What has really happened?

a) Ruptured aortic aneurysm

b) Obturator hernia

c) Spigelian Hernia

d) Rectus sheath hematoma

Answer

Dumping Syndrome

Q) Which of the following is true about dumping syndrome

a) Somatostatin analogues are effective in controlling symptoms

b) Symptoms always include flushing and tachycardia 

c) Diarrhea is always part of dumping syndrome

d) Part of treatment includes combining solids with liquids in frequent small meals

Answer Premium only

Contraindication of liver transplantation

Q)Contraindications of liver transplantation have changed over the years. Which is an absolute contraindication of  liver transplantation

a) Previous breast cancer

b) Portal vein thrombosis

c) Active tuberculosis

d) Active substance abuse

Answer

d

 

Previous history of breast cancer if completely treated is not an contraindication of liver transplant. Portal vein thrombosis was earlier considered a relative contraindication but almost all series have shown similar results in patients with PVT than patients without PVT.

IN portal vein thrombosis, inflow to the new liver can me taken in many ways

a) thrombectomy

b) Jump grafts from Superior mesenteric vein 

c) Anastomosis have been done from big collaterals

Active tuberculosis can be managed after transplant. Modified ATT regimens without INH and Rifampicin are being  used.  Any kind of active substance abuse alcohol,  drugs etc are absolute contraindications for liver transplant because the disease will recur.

Nutrient Absorption

Q) What is true regarding absorption of nutrients from small intestine?

a) Bile salt is required for absorption of Vitamin B12

b) Parathyroid hormone increases calcium absorption

c) Triglycerides are synthesized by intestinal epithelial cells before being released in portal circulation

d)  Iron deficient individual can absorb 80% of dietary iron

Answer

b

Calcium absorption is due to Vitamin D and Parathyroid hormone. Bile salt is required for absorption of fat soluble vitamins like Vitamin A, D, E& K

Vitamin B12 requires intrinsic factor. Triglyceride absorption occurs in the form of Free fatty acids and monoglycerides.

Only 20% iron is absorbed by iron deficient individuals

 

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Appendicitis in Pregnacy

Q) Which of the following statement is true about appendicitis in pregnancy?

a) Typical symptoms of appendicitis  are seen in more than 90% of patients.

b) 50% cases of appendicitis occur in 2nd trimester

c) Rate of negative explorations remain low based on clinical presentation alone

d) The sensitivity and specificity of ultrasound diagnosis remain the same in appendicitis in pregnancy

Answer b

Appendicitis  the most common non obstetric emergency in pregnancy. The diagnosis is difficult because the symptoms of pain abdomen, nausea, vomiting, anorexia, raised TLC are common in pregnancy. Appendicitis has a typical presentation in only 50% to 60% cases.

If untreated preterm labor and even fetal loss can occur due to the complications.

Based on clinical presentation alone, the incidence of negative exploration is as high as 25-50%

Ultrasound with graded compression is still a good imaging option but has lower sensitivity and specificity than in normal clinical situation. If ultrasound is equivocal the next best option is MRI which is safe.

Ref Sabiston 20th edition