Cardiac Question

Q  Structures which may be injured in mitral valve replacement are all except
 A) Circumflex coronary artery
B) Right coronary  artery
C) Aortic valve
D) AV node

Conduits of Esophagus

Q) What is true regarding gastric conduits to be used as esophagus replacement?

a) The right gastric and gastro epiploic arteries can be safely divided to bring stomach to the neck

b) For malignant diseases stomach is the most reliable conduit

c) Stomach has the least incidence of developing reflux esophagitis

d) For benign esophageal strictures stomach is the conduit of choice

Answer for premium members only

Hepatic Adenoma

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

b) Haemangioma

c) Hepatic Adenoma

d) Hepatocellular carcinoma

Answer is C

Hepatic Adenoma is benign neoplasms of the liver. They are associated with 

  1. OCP use

  2. Androgen containing steroids

  3. 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

  1. Non contrast- Heterogenous hypodense mass with areas of hemorrhage and necrosis

  2. 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

 

Giant Gastric ulcer

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

 

Burns management

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

Answer for premium members

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.

 

Duodenal atresia

Question on Duodenal atresia was asked in AIIMS 2017 in April

Q) An infant presents with duodenal atresia. Which of the following is true about this condition?

a) It is the most common GI atresia

b) It presents soon after birth with non bilious vomiting

c) Pre natal detection of duodenal atresia is common

d) Gastro jejunostomy is the procedure of choice to bypass the obstruction

Answer (free) 

C-

Commonly detected in the pre natal ultrasound

Duodenal atresia is seen in 1:5000 live births and most common atresia is jejunoileal (1in 2000). It is associated with lot of other congenital malformations like Down's,  prematurity, biliary atresia etc.

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Bleeding Peptic ulcer

Q) In a patient with a bleeding peptic ulcer, endoscopy is done. Which of the following findings on endoscopy predicts the highest rate of re bleed?

a) Non bleeding vessel

b) Adherent clot

c) Flat pigmented spot

d) Clean base ulcer

Free Answer . Click here for stomach MCQs

a) Non bleeding vessel IIA - Out of the choices given

Bleeding peptic ulcer is mostly from the posterior surface of the lesion and can be sometimes lethal

Forrest classification is used to grade the risk of re bleeding in peptic ulcers.

According to the stigmata of recent bleed, the chances of re bleed increase.

Forrest Classification

Ia - Active Spurting

Ib-  Active oozing

IIa Non bleeding vessel             50% chance of rebleed

IIB Adherent clot

IIC Flat Pigmented spot

III Clean based ulcer

Sabiston 12o3 20th edition

 

 

Primary Thyroid Lymphoma

Q) Which of the following statement is true regarding primary thyroid lymphoma?

a) Goiter grows at a slow pace

b) Hashimoto thyroiditis is a pre existing condition for thyroid lymphoma

c) "B" symptoms are common

d) MALT lymphoma is the commonest

Answer for Premium members See Question no.10

Parenteral nutrition

Q) IV fluid of choice to increases calories to provide parenteral nutrition  by peripheral route is:

a) DNS

b) Lipid Emulsions

c) Arginine in DNS

d) 25% dextrose

Answer (FREE)  b

Lipid Emulsions can be given by peripheral route. They are the highest source of energy and calories.  25% dextrose, although a good source of energy has high concentration of glucose which can cause thrombophelebitis.

DNS will provide just basic calories and will not cause any increase in calorie intake.

Addition of arginine, which is an amino acid will not increase the energy intake.