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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Inflammatory Carcinoma breast

Q) In terms of cure best results in inflammatory carcinoma breast  are seen with-

a) Surgery alone

b) Chemotherapy

c) Radiotherapy

d) All of the above

Surgery MCQ PDF - Free Answer

d) 

Inflammatory carcinoma of the breast is a rare aggressive tumor that blocks the sub dermal lymphatics as a result of which cutaneous edema is common . Differentiating it from a breast abscess is important and biopsy is diagnostic. It is also responsible to peau d orange

Treatment is multidisciplinary and involves, chemotherapy followed by surgery followed by radiotherapy.

 

 

 

Parenteral nutrition

Q) IV fluid of choice to increases calories to provide parenteral nutrition  by peripheral route is:

a) DNS

b) Lipid Emulsions

c) Arginine in DNS

d) 25% dextrose

Answer (FREE)  b

Lipid Emulsions can be given by peripheral route. They are the highest source of energy and calories.  25% dextrose, although a good source of energy has high concentration of glucose which can cause thrombophelebitis.

DNS will provide just basic calories and will not cause any increase in calorie intake.

Addition of arginine, which is an amino acid will not increase the energy intake.

 

 

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.

 

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