Boerhaave Syndrome- Barotrauma of esophagus

Q) Correct statement about Boerhaave syndrome is
A. May present with peritonitis
B. Forceful vomiting against open glottis
C. MOst common in upper 1/3 rd of esophagus
D. Most are managed conservatively

Answer for premium 

Esophagus Length DNB 2018

Q) Length of Esophagus

 A. 20cm
B. 25cm
C. 30-35cm
D. 40cm


Answer

29) b

The esophageal length is anatomically defined as the distance between the cricoid cartilage and the gastric
orifice. It ranges in adults from 22 to 28 cm (24
± 5 SD), 3 to 6 cm of which are located in the abdomen.

The shortest distance between the cricoid cartilage and the celiac axis is the orthotopic route in the posterior mediastinum, being 30 cm. The retrosternal (32 cm) and the subcutaneous route (34 cm) proved to be
longer

Ref Shackelford page 10

Ludwig’s Angina

Q Cause of mortality in Ludwig’s angina
A. Asphyxia
B. Pneumothorax
C. Hemorrhage
D. Sepsis

Answer

Ludwig's angina is an inflammatory  condition of the neck which is due to 

  1. Streptococcal infection
  2. Anaerobic infection
  3. Infection of malignancy in the neck

Read on ......

 

Melanoma

 Q) Pigmented lesion suspicious melanoma of size 1cm with ulceration and features of ABCD,
next step
A. Wide Local Excision  with 1cm margin
B. Excision biopsy with 1-2mm margin
C. Punch biopsy at the edge of the lesion
D. Incisional biopsy

Answer in Q 44 

Pediatric liver transplant

Q  ) Most common indication for Pediatric liver transplant (DNB SS) 
A. Biliary atresia
B. Metabolic diseases
C. Alagille syndrome
D. HCV

Free answer 

Biliay atresia

MOst common cause or liver transplant in children. Presents as persistent jaundice after birth. Etiology is not clear

Findings include absent extrahepatic ducts and gallbladder. Biopsy is diagnostic

GCS

Q. Best predictor in the GCS

A. Eye opening
B. Motor response
C. Verbal response
D. All


23) B, Motor response

Motor score is the best predictor of neurological outcome.

The m component of the GCS,  is not only linearly related to survival, but preserves almost all the predictive power of the GCS 

BAiley

Spinal cord injury

Q) Out of the following which will require Spinal immobilization most?
a. 22 yr Female had a high-speed motor vehicle collision who complains of backpain and no
numbness
b.16 yr male jumped from 6ft landed on both foot denies back pain and weakness
C. Gunshot injury
D. Abdominal injury

Answer is free 

a) 

Spinal cord injuries are a common cause of morbidity and expenditure. Mortality is associated with cervical injuries but not lower spinal cord injuries.

Motor vehicle accidents are the most common cause and gunshot injuries the least common for spinal cord injuries.

Mechanism of injury 

  1. Blunt trauma - Direct impingement, Ischemia, compression or bleeding 
  2. Penetrating - Laceration of spinal cord

Chance fracture - is a type of spinal cord fracture in which there is transverse fracture of all vertebral elements

Management

1 Complete immobilisation

2. Management of associated neurogenic shock ( due to loss of sympathetic tone) with vasopressors  and fluids

Sabiston page 420