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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Gastrectomy Margins

Provided a negative-margin resection can be obtained with a subtotal gastrectomy, and provided it is not a linitis plastica situation (ie, diffuse infiltrating poorly differentiated cancer eliciting a leather-bottle stomach), routine total gastrectomy is to be avoided. The 2010 Japanese treatment guidelines, and the 2011 English version, call for a proximal margin of 3 cm from gross disease for localized well-circumscribed Borrmann I or II tumors, and a margin of at least 5 cm for other tumors. Total gastrectomy is performed whenever necessary to meet these requirements. Total gastrectomy should also be performed for cases of linitis plastica.


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

Ans for premium Members

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