Burns management

Q) A 45 year old male sustains 30% burns on both legs and anterior abdominal wall.  There was  mild inhalation  injury associated with it. He initially responded well to treatment with IV fluids, Inj Tramadol and enteral feeding.

Three days after the treatment he is having slight tachypnea (30/min) pulse 110/min and BP 98/60. His temp is 97degree F and some areas of partial thickness have converted into full thickness. He is currently on Inj Magnamycin. His platelets are 70ooo, TLC is 17000 and sugar is 200 mg%. What is the next step in management?

a) Continue same management

b) Upgrade the antibiotic and send a fresh culture from skin

c) Treat it as carbon monoxide poisoning

d) Manage in lines of Acute Tubular Necrosis

Answer for premium members

Burns management involves critical care, intensive phase and rehabilitation. Loss of skin and eschar formation predispose individuals to gram positive, gram negative and fungal infections.

 

Duodenal atresia

Question on Duodenal atresia was asked in AIIMS 2017 in April

Q) An infant presents with duodenal atresia. Which of the following is true about this condition?

a) It is the most common GI atresia

b) It presents soon after birth with non bilious vomiting

c) Pre natal detection of duodenal atresia is common

d) Gastro jejunostomy is the procedure of choice to bypass the obstruction

Answer (free) 

C- Commonly detected in the pre natal ultrasound

Duodenal atresia is seen in 1:5000 live births and most common atresia is jejunoileal (1in 2000). It is associated with lot of other congenital malformations like Down's,  prematurity, biliary atresia etc.

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Billroth 2 surgery

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

  1. Retained antrum syndrome
  2. Afferent loop obstruction
  3. Duodenal stump leak (1-3%)

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Electrolytes

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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