Esophagus perforation

Q) A 45 year old man who has been drinking regularly for the past 15 years vomits after a large meal and complains of severe chest pain. Cardiac cause is ruled out and boerhavve's syndrome is suspected. Which of the following is not true about this condition

a) Gastrograffin tests will confirm the diagnosis

b) Perforation is most common in the left lower end

c) Exploration and full thickness suturing of perforation should be done

d) This condition has a high morbidity and mortality if not diagnosed at time

Answer for premium members  - Discussion on Boerhaave's syndrome

Reno vascular hypertension

Q) Which of the following is true about reno vascular hypertension

a) Seen in young age group

b) Both kidneys are of same size

c) It is familial

d) Diuretics will control the hypertension

Answer for free

a

Renal artery occlusion creates ischemia of the kidney which releases renin. Hypereninemia leads to secondary hypertension. This further leads to conversion of angiotensin I to angiotensin II and vasocontriction and eventually release of aldosterone.

It is a disease of young adults and children

Size of the kidneys vary and diuretics do not control hypertension because the mechanism is high renin secretion which is unresponsive to diuretics.

 

Colon Bleeding

Q) True statement about  colonic bleeding:

a) Bleeding from diverticulitis is severe and often requires interventional procedures to stop it

b) In colitis risk of brisk bleeding is less and diarrhea is absent

c) In haemaorrhoids haemodynamic compromise is rare

d) Bleeding from angiodysplasia is always slight and managed endoscopically

Answer

Peritonitis

Q) True statement regarding peritonitis is 

a) Raised serum amylase is only seen in pancreatitis

b) Rectal examination is better diagnostic of appendicitis than per abdominal examination

c) Ultrasound has diagnostic accuracy of 90% for diagnosing acute appendictis

d) Catarrhal appendicitis mostly leads to gangrene of appendix and perforation

Answer for premium members http://www.mcqsurgery.com/appendix

 

Complications of Surgery of Aortic aneurysm

Q) A 68 year old man undergoes repair of infra renal aortic aneurysm. On 2nd POD he has abdominal pain, bloody diarrhea and tachycardia. BP is 120/70. Abdomen is mildly distended and tender especially in the left lower quadrant.

How will you proceed

a) Send stool for clostridium and spores

b) CT Abdomen

c) Exploratory laparotomy

d) Higher antibiotics

Answer for premium - Discuss the complications of Surgery for aortic aneurysm

Retroperitonuem tumor

Q) A 42 year old lady undergoes exploration for a retroperitoneum mass. In OT it is suspected that this is a liposarcoma. Which of the following is  not true about liposarcoma?

a) Liposarcoma is the most common variant of sarcomas

b) They have a  pseudocapsule

c) They can grow quite large before producing symptoms

d) They are locally invasive and do not metastatize

Answer  Free

 

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