Blood Supply esophagus

Q) Thoracic esophagus blood supply (DNB 2018) 
A. Inferior thyroid
B. Aorta and bronchial artery
C. Inferior phrenic 

D. Left Gastric

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Choledochal cyst

 Q) False  about choledochal cysts ? (AIIMS GI 2018) 
A. Upto 90% is associated with APBJ
B. 30% are associated with chronic pancreatitis
C. Most common association in adults is cholecystolithiasis
D. Malignancy risk is eliminated by cyst excision

Answer  Q 22

Switch in Dextraposition of great vessels

Q . Factors that preclude the use of a single-stage arterial  switch reconstruction of dextrotransposition of the great vessels include:
A. Age older than 6 weeks with a left ventricular pressure of less than 50% of systemic pressure.
B. Dynamic left ventricular outflow tract obstruction.
C. Intramural coronary artery anatomy.
D. Subpulmonary VSD.

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Anti Rejection drugs

Q) Most nephrotoxic drug is 

A. Cyclosporine
B. Sirolimus
C. Azathioprine
D. Steroids

Answer

These are immunosuppressants used after solid organ transplants. These drugs have a lot of side effects.

Answer is here  

 

Parkland formula

Q 32)  During fluid resuscitation in a burns patient using Parkland’s formula, volume of fluid given
in first 8 hrs
A. 50%
B. 25
C. 75
D. 100

Answer 

 

Diverticulitis

Q ) Hincheys grade III Diverticulitis. Management most likely to follow more interventions after an index operation is

a) Laparoscopic irrigation and exploration

b) Sigmoid Colectomy+Hartman’s

c) Primary repair with omental patch and peritoneal toilette

d )Sigmoid Colectomy with colorectal anastomosis and diverting ileostomy

Grade III diverticulitis is generalized peritonitis.

Answer for premium Q 10 

Glucagonoma

Q) All are true about Glucagonoma except

a) Usually seen  in middle age and elderly

b) Usually > 5cm at presentation

c) Skin lesions preceed tumor detection by 6-8yrs

d) Often associated with ketoacidosis


Glucaonoma is an endocrine tumor characterized by increased levels of serum glucaogon. It is seen in the age group ............... Read on   (Question 8) 

For other questions on endocrine tumors

Duodenal injury

Q) Duodenal injury management false

a ) Circumferential skeletonization is required

b ) All duodenal repairs require some form of drainage

c) All hematomas near the pancreas requires exploration to check for serosal integrity

d) Most common location is the second portion

 

Colon Volvulus

Q) Regarding colonic volvulus all are true except

a) Sigmoid volvulus without gangrene – colonoscopic decompression is the trt of choice

b) Caecal bascule has high chance of gangrene due to torsion of mesentry

c) Splenic flexure volvulus has better prognosis than transverse colon volvulus

d) Recurrence rate after detorsion of cecal volvulus is 10-20%

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Fontan Procedure

Q 24 Contraindication of Fontan procedure?

a) 20 year old male

b) Severe MR

c) Right pulmonary artery stenosis

d) Left ventricular end diastolic pressure of 20 mm Hg

24) d

Fontan procedure is for tricuspid atresia and is done when there is low pulmonary vascular resistance. For the same reason it is not done in neonates. 

In Tricuspid atresia, venous blood does not go to right ventricle and there is mixing of venous and arterial blood in aorta which leads to decreased oxygenation.

Most infants with tricuspid atresia have restrictive pulmonary blood flow.  To improve systemic oxygentaion they undergo modified Blalock-Taussig shunt, which is a small polytetrafluoroethylene (PTFE) graft to connect the subclavian artery and a pulmonary artery.

Criteria for Fontan procedure are 

  • Age older than 4 years
  • Sinus rhythm
  • Normal systemic venous return
  • Normal right atrial volume
  • Mean pulmonary artery pressure less than 15 mm 
  • Pulmonary arteriolar resistance less than 4 Wood units/m 2
  • Pulmonary artery–aorta ratio more than 0.75
  • Left ventricular ejection fraction more than 0.60

Current absolute contraindications are a pulmonary vascular resistance above 4 Wood units/m2, severe hypoplasia of the pulmonary arteries, and severe diastolic dysfunction of the left ventricle.