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
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
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
d) Radiation is a known risk factor which causes this condition mostly 10 years after exposure.
Other pre disposing conditions include
- Von Recklinghausen's disease
- Li- Fraumeni's disease
- Hereditary Retinoblastomas
Most common retroperitoneal sarcomas are liposarcoma and leiomyosarcoma.
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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
Q) What is true regarding complications of billroth 2 surgery?
a) It has less complications than billroth 1 surgery
b) Recurrent ulceration is more common in the afferent limb as compared to efferent limb.
c) Afferent loop obstruction is more common after billroth 2 surgery
d) Billroth I operation is preferred in scarred duodenum
Answer c -
In billroth 2 surgery, afferent limb obstruction is more common
In surgery for benign gastric ulcers, billroth I reconstruction is the preferred choice. Billroth II surgery has problems of
- Retained antrum syndrome
- Afferent loop obstruction
- Duodenal stump leak (1-3%)
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Q ) A 25 year old male brought to the hospital after being involved in a road traffic accident that occurred 50 minutes ago. His initial BP at the scene of accident was 80/40 mm HG with a pulse rate of 120/min.
The paramedics administered 2 litres of normal saline in the ambulance and in the emergency department his BP is 110/70 with a pulse rate of 90/min.
He has tenderness in Left upper quadrant abdomen and USG reveals perisplenic fluid. Next step is to :
a) Take him for exploratory laparotomy
b) Shift him to ICU and observe
c) Do a CT scan of the abdomen
d) Put in a laparoscope and assess
This Patient has a splenic injury due to blunt trauma abdomen.The immediate management depends on grade of splenic injury and response to IV Fluids. This patient is hemodynamically stable after IV fluids and immediate laparotomy is not needed.
Direct shifting to ICU is also not the right choice because CT is required first and for more severe injuries patient can go to OT
Laparoscopy has no role in splenic injuries
Q) A 60 year old lady, mother of 2 presents with rash and color change in the left areola of 3 months duration. She is diagnosed with Paget disease of the breast. What is true regarding this condition
a) Cancer is a distant possibility
b) Surgical therapy fails to cure Paget's disease of breast
c) Nipple biopsy is diagnostic
d) It is associated with paget's disease of bone
Paget's disease of the breast is invasive carcinoma which grows along the ducts into nipple and areola. Diagnosis is made by nipple biopsy. The lesion presents with eczematous rash which is persistent.
On histology swollen paget cells are seen. Surgical therapy is curative and this pathology is unrelated to paget's disease of the bone.
Q) Screening for colorectal tumors should be started at
a) 20 years if there is family history of FAP
b) 15 years if there is family history of HNPCC
c) 8 years after the onset of pancolitis in Ulcerative colitis
d) 10 years after onset of left sided colitis in ulcertaive colitis
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