Hyperbaric oxygen

 Hyperbaric oxygen therapy in radiation proctitis all are true except
A. Indicated in acute radiation proctitis but not in subacute or chronic radiation proctitis
B. Oxygen increases the growth of residual tumor and hence tumor should be completely
C. Complications include Parkinsonism, barotrauma
D. Usually 30-40 sessions are required for treatment

Answer free for all


Hyperbaric oxygen overcomes chronic tissue hypoxia in radiation damaged tissues and with repeated sessions induces growth of regenerative tissue, capillaries, and epithelium. Successful therapy may take multiple sessions.
 18 to 60 treatments

Ref Shackelford page 2211

HBO treatments for hypoxic wounds are usually delivered at 1.9 to 2.5 atm

for sessions of 90 to 120 minutes each. Treatments are given once daily, five to six times per week and should be given as an adjunct to surgical or medical therapies. Clinical evidence of wound improvement should be noted after 15 to 20 treatments. Read More ...

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


Answer is free for all 


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  Read More ...

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

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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Contraindication of Left lobe liver transplant

Q) Absolute contraindication for left lobe LDLT is
A. Trifurcation of the portal vein
B. Bifurcation of portal vein in the right lobe of the liver
C. Aberrant right hepatic artery
D. Right Posterior duct draining into left hepatic duct


Trifurcation of portal vein is not a contraindication of  left lobe liver transplant  as we will get a single portal vein on the left side

9k= Contraindication of Left lobe liver transplant
Portal vein

Bifurcation of portal vein in right lobe does not matter because we are leaving the right lobe behind

Again right aberrant artery does not matter because that segment is left behind

Right post duct draining into left duct gives rise to two ducts on the left or a single duct which is quite high.

C3-4-FF3 Contraindication of Left lobe liver transplant
Right posterior duct to left






Retained antrum syndrome

Q) True about retained antrum syndrome after gastrectomy  are all except

a) It is a persistent hypergastrinemic state

b) It is only seen after Billroth II Gastrectomy

c) Technetium labelled food is not helpful in diagnosing this condition

d) Serum gastrin is usually less than 1000 pg/ml

Answer c

 After billroth II gastrectomy, if a cuff of gastric mucosa remains with duodenum, this entity is called as retained antrum syndrome. This cuff of gastric mucosa is cut off from the proximal stomach and inhibitory effect of hormones such as VIP (Vasoactive Intestinal Peptide)  leading to a persistent hypergastrinemic state. ALso this gastric mucosa is continuously bathed by the alkaline contents of duodenum , which further increases the acid formation.

Both Basal and maximal gastric acid outputs increase but it is not as high as seen in zollinger ellison syndrome. Typically less than 1000 pg/ml

This condition can present as recurrent and persistent ulcerations. Technetium scanning is the diagnostic modality of choice. Treatment is re do surgery and antral excision.

Technetium pertechnate imaging has a sensitivity of 73% and specificity of 100%

More about retained antrum syndrome


Q) Regarding minimal access cholecystectomy all are true except?

a) NOTES can be done transvaginally and transgastrically

b) Transgastric route is preferred

c) SILS is done through single port with multiple instruments avoiding multiple ports

d) SILS has difficulty with triangulation and retraction

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Answer is B

Natural  orifice  transluminal  endoscopic  surgery (NOTES),  which  uses  natural  orifices  (transgastric, colonic,  urethral,  vagina)  to  introduce  an  endoscope,  has been  reported  since  early  2000  as  a  less  invasive  approach to  laparoscopy.  The  first  human  NOTES  transvaginal  cholecystectomy  was  reported  in  2007,  and  later  the  report  of a  hybrid  combination  of  flexible  scope  by  a  transvaginal approach  in  combination  with  an  umbilical  needle  or port  for  laparoscopic  instruments  for  retraction,  dissection,  or  clips  application.  This  hybrid  technique  allowed for  a  quicker  and  safer  procedure;  the  present  deficiency is  in  the  proper  endoscopic  instrumentation. For  the  trans vaginal  approach,  a  Foley  catheter is  placed,  a  dissection  is  performed  in  the  posterior vaginal  cul-de-sac  to  allow  a  port  placement,  and  when the  case  is  over,  the  closure  is  easier  than  a  transgastric or  transcolonic  approach,  which  continues  to  be  an  issue.


Association of Carcinoma Esophagus

Q) Adenocarcinoma of esophagus is associated with which of the following? (DNB 2018)

a) Achalasia cardia

b) Barrett's disease

c) Human Papilloma virus (HPV)

d) Alcohol use

Answer - b

Association of carcinoma esophagus is with a number of risk factors. Both squamous cell carcinoma and adenocarcinoma of esophagus have different etiologies

Risk factors for Adenocarcinoma are                                                        Risk factor for Squamous cell carcinoma are

  1. Tobacco                                                                                                   1. Alcohol
  2. GERD                                                                                                       2. tobacco 
  3. Obesity                                                                                                     3. Achalasia
  4. Barrett                                                                                                      4. Caustic injury of esophagus
  5. H/o previous radiation for breast cancer                                         5. Previous radiation of CA breast                

                                                                                                                             6. H/o head and neck cancer

                                                                                                                             7. Plummer vinson and tylosisassociation-of-carcinoma-esophagus-1-300x239 Association of Carcinoma Esophagus


Esophagus Length DNB 2018

Q) Length of Esophagus

 A. 20cm
B. 25cm
C. 30-35cm
D. 40cm


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

Ref Shackelford page 10


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 


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
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 


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


1 Complete immobilisation

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

Sabiston page 420


Tropical Pancreatitis

Q) All are true about tropical pancreatitis except?

a. Associated with Tapioca.
b. Patients have  large stones with fibrosis.
c. It is Pre Cancerous

d) Onset of disease at 50 years 

  Free. See here for answers to other  questions and this question

Answer -d )Onset is at young age

Tropical pancreatitis

is an  idiopathic disease which begins in teens.  It has a high association with diabetes and Pancreatic duct calculi. It is common in South India, Asia, Africa and central America.





Hydrocarbons exposure

It is associated with SPINK 1 mutation

It is pre cancerous

IPSG data shows the cumulative risk of Pancreatic Cancer  in patients with Chronic Pancreatitis  (predominantly of alcoholic aetiology) was reported as 1.8 % and 4 % at 10 and 20 years respectively. This risk was reported to be independent of age, sex and type of pancreatitis.

The link between CP and PC is clearer in certain subtypes of CP like tropical pancreatitis and hereditary pancreatitis.

 Augustine et al. reported a 8.3 % incidence of pancreatic cancer in patients with tropical pancreatitis, which is much higher than western figures.


Pancreatic Cancer in Chronic Pancreatitis

Clinical Picture of tropical pancreatitis

a child, adolescent or young adult , recurrent upper abdominal pain, diabetes mellitus,  malnutrition, nutrient deficiencies, nutritional edema, cyanotic hue of the lips, parotid enlargement and pancreatic calculi on plain abdominal X ray  

Ref https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1742869/pdf/v079p00606.pdf