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) Fowler Stephen Surgery is done for
c) Exstrophy of bladder
Answer Free for all
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.
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)
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
Q. Hyergastrinemia occurs in all except
c)Brunner gland adenoma
Answer for premium members
Q) Most sensitive investigation for Gastrinoma ?
b) Selective angiography
Answer for premium only
Q) Which of the following is tumoricidal?
a. 1 percent cetrimide.
Q) Newest treatment for anal incontinence?
a. Sacral nerve stimulation
b. Artificial sphincter.
c. Repair of sphincter
d. Gluteus maximus graft
Sacral nerve stimulation is the newest modality in treatment for anal incontinence. In it electrodes are placed via the sacral foramina. The nerve supply of anal sphincter is similar to lower extremity so their stimulation can lead to contraction of various foot muscles.
Others are all older methods
Shackelford page 1779
Q) Post cholecystectomy injury which is true
a) Bile duct leak occurs in 1%
b) After open cholecystectomy bile duct injury occurs in 0.5 to 1 %
c) Most common cause of bile duct injury is cystic stump blow out and duct of luschka injury
d) Type E injury is clipping of CBD by mistake
Premium members answer
Q) Non hereditary polyp in colon
a) Peutz Jeghers Syndrome
d) Cronkhite Canada
Q) LASER used in CA urinary bladder
a) Carbon dioxide
b. Nd yag
c. Holmium yag
Q. Regarding percutaneous cholecystostomy A/E
a. Technical success in 90 – 98 % of cases
b. Indicated in Grade II cholecystitis with significant pericholecystic inflammation & GOO
c. Indicated in Gr III cholecystitis with significant comorbidity
d. In Grade III cholecystitis with biliary peritonitis, PCC results in significant improvement
Q ) Modified Nissen's Fundoplication
a) 2700 anterior wrap around esophagus
b) 2400 wrap
c) 3600 wrap over > 52 Fr for 1 – 2 cm
d) 600 wrap over 42 Fr for 4 cm
Nissen fundoplication is complete 360 degree but has high incidence of gas bloat. To counter this modification done to wrap over 52 F tube for 1-2 cm
Belsey - Left thoracotomy, mobilization of distal esophagus and stomach, hiatus opened from above, fundus is brought 270 degrees around distal esophagus. Then the whole assembly is brought down and crura is repaired.
Hill procedure - No fundoplication is done
Toupet is anterior fundoplication either 240 degree or 270 degree.