CDH 1 mutation

Q ) Hereditary diffuse Gastric carcinoma is associated with which  breast cancer
A. Ductal carcinoma NOS subtype
B. Lobular carcinoma
C. DCIS
D. Metaplastic carcinoma

Answer for Q 79

Majority of Gastric Cancers are sporadic,

1–3% of GCs arise as a result of inherited cancer predisposition syndromes.

 Li-Fraumeni syndrome, Lynch syndrome, Peutz-Jeghers syndrome, hereditary breast and ovarian cancer,MUTYH-associated adenomatous polyposis (MAP), familial adenomatous polyposis,  juvenile polyposis syndrome and PTENhamartoma tumour syndrome (Cowden syndrome).

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Selective Shunt

Q) A type of Selective shunt for portal hypertension is
A. PSRS (Proximal spleno renal shunt) 
B. Warren shunt
C. SSPCS (Side to side portocaval shunt) 
D. Mesocaval
 shunt

Answer  Q 78

Surgical decompression can be achieved with total or partial portal systemic shunts or by selection variceal decompression.

 Total shunts divert all the portal flow to the systemic circulation. Partial shunts maintain some portal flow to the liver. Selective shunts only decompress gastroesophageal varices and maintain portal hypertension and flow to the liver. Read on for answer...

Severe Acute Pancreatitis

Q)  Ideal time for CECT in severe acute pancreatitis is
A. After 72 hours
B. After 48 hours
C. 24 hours
D. At admission

Answer for premium members

Mild acute pancreatitis 

  1. enlargement of the pancreas with loss of definition of the borders of the pancreas. 
  2.  Thickening of the right or left anterior pararenal fascia 

Severe Acute pancreatitis 

 Main determinant of clinical outcome is the degree of systemic organ disturbance, particularly during the early hours and days after admission to hospital

More than half of all deaths in AP occur within the first 2 weeks of illness  and are usually a consequence
of multiple organ failure

The revised Atlanta Classification 
3  grades of severity of pancreatitis:

Mild AP—characterized by the absence of organ failure or local
complications

Moderately severe AP—defined by...................read on 

 

Cholangiocarcinoma

Q) Cholangiocarcinoma type IIIB bismuth Corlette bilirubin 10, left portal vein and hepatic artery
involved. Best approach is
A. Preoperative left biliary drainage followed by resection
B. Preoperative right biliary drainage followed by resection
C. Left portal vein embolisation followed by resection
D. Palliative drainage

Answer 

Retained antrum syndrome

Q) True about retained antrum syndrome after gastrectomy  are all except

a) It is a persistent hypergastrinemic state

b) It is only seen after Billroth II Gastrectomy

c) Technetium labelled food is not helpful in diagnosing this condition

d) Serum gastrin is usually less than 1000 pg/ml


Answer c

 After billroth II gastrectomy, if a cuff of gastric mucosa remains with duodenum, this entity is called as retained antrum syndrome. This cuff of gastric mucosa is cut off from the proximal stomach and inhibitory effect of hormones such as VIP (Vasoactive Intestinal Peptide)  leading to a persistent hypergastrinemic state. ALso this gastric mucosa is continuously bathed by the alkaline contents of duodenum , which further increases the acid formation.

Both Basal and maximal gastric acid outputs increase but it is not as high as seen in zollinger ellison syndrome. Typically less than 1000 pg/ml

This condition can present as recurrent and persistent ulcerations. Technetium scanning is the diagnostic modality of choice. Treatment is re do surgery and antral excision.

Technetium pertechnate imaging has a sensitivity of 73% and specificity of 100%

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