Pancreatic protocol CT

Q) All are true about pancreatic protocol CT except (AIIMS 2012) 

a) > 90% unresectable lesions picked up by CT

b) Dual phase CT with cuts taken at 40 secs and 70 secs

c) Liver metastasis detected in early arterial phase

d)

Answer is free for all 

c

Pancreatic protocol CT involves  imaging  at  the  pancreatic  phase (i.e.,  approximately  45  seconds  after  contrast  administration)  and  at  the  portal  venous  phase  (i.e.,  approximately 70  seconds  after  contrast  administration). It is useful for detection of adenocarcinoma of pancreas. 

Metastatic lesions are seen in  the  portal  venous  phase,  because  the  lesions  are  not  typically  well  vascularized.

  Arterial  phase images  are  principally  used  to  distinguish  metastatic  disease from  benign  vascular  lesions,  such  as  hemangiomas,  or  to  better define  the  arterial  anatomy  of  the  liver.

Non contrast phase used for 

Evaluation  of  pancreatic calcifications  and  allows  localization  of  the  precise  levels  for imaging  on  the  post contrast  study. 

Early arterial phase 

Evaluation  of  pancreatic  vasculature  without  interference  from  venous  opacification. 

Late Arterial Phase

 Distinguish pancreatic  neoplasms  from  adjacent  normal   pancreatic  tissue It  also  is useful  to  evaluate  hypervascular  liver  metastases  as  seen  in patients  with  neuroendocrine  tumors   of  the  pancreas. 

Portal Phase

Evaluate  for  hypovascular  liver  metastases 

Ref Blumgart 

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Pancreatic trauma                                           Pancreas Q 26-30 (Work in progress) 


 

 

UTI Sample

Q) Best specimen for culture in UTI
A. Midstream urine at anytime
B. Midstream urine at early morning
C. First voided sample
D. Any urine sample

Answer 

a

In males- midstream urine sample 

 

Duodenal injury

Q . Duodenal injury management false

a) Circumferential skeletonization is required

b) All duodenal repairs require some form of drainage

c) All hematomas near the pancreas requires exploration to check for serosal integrity

d) Most common location is the second portion

Answer 

Malignancy in UC

Q. All are true regarding malignancy in UC except
A. Increased risk with pancolitis and increased duration
B. Screening for malignancy should start 8-10 yrs after onset of symptoms
C. Poorly differentiated
D. Surveillance should start as soon as remission occurs to pick up missed colon cancer

Answer is D

Explanation here 

Disinfectants in Surgery

Q) All are true about disinfectants in surgery  except
A. Povidone iodine needs to dry up prior to its action
B. Alcohol disinfectants act against all organisms except clostridium difficile
C. Single dose of first generation cephalosporin should be givens prophylaxis for vascular
procedures and bladder catheterisation
D. Chlorhexidine is bactericidal, viricidal, fungicidal, and has rapid onset of action and persistent
duration.


Answer d

Povidone-iodine solution is used for surgical site preparation, it must be allowed to dry for microbicidal effect. 

Chlorhexidine is  a phenol which is  used in concentrations of 0.5% to 4.0% alone or in lower concentrations in combination with an alcohol as a skin antiseptic. ....

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CEA

Q True regarding CEA is  (AIIMS 2017 , JIPMER 2016) 

a) Low specificity

b) Falls after 1 week of surgery to baseline

c) Preoperative high value is good prognostic marker

d) Follow up, first test of CEA in 8-10 days followed by weekly tests thereafter

Another question on CEA can be seen here

Answer 

Physiology of biliary obstruction

Q) Infection in obstructive jaundice all are true except

a) There is loosening of hepatic tight junctions and cholangiovenous reflux

b) IgM production from liver cells decreased

c) Reduced bacteriostatic & bactericidal action due to decreased bile salts in bowel

Answer 

In  patients  with  long-standing  obstruction,  intrahepatic bile ductule  proliferation occurs with an increase in the length and tortuosity of the canaliculi. The  biliary  system  normally  has  a  low  pressure  (5  to  10  cm H2O);  however,  in  the  setting  of  complete  or  partial  biliary obstruction,  biliary  pressure  can  approach  30  cm  H2O. 

Read on........

Semen analysis

Q )  Fructose absence in semen analysis suggests
A. B/L vas deferens obstruction
B. Ejaculatory duct obstruction
C. Testicular failure
D. Prostatic urethral obstruction

Answer