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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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

Answer

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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USMLE Trauma

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

Answer c

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

Paget disease of the breast

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

Answer

c

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.