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.

 

Q. A 45 year old male has severe coughing followed by sudden Bilateral pain in lower abdomen. At the same time he develops a swelling in the mid line, lower abdomen which does not change in size on raising the leg muscles. What has really happened?

a) Ruptured aortic aneurysm

b) Obturator hernia

c) Spigelian Hernia

d) Rectus sheath hematoma

Answer

GI Bleed

Q )  A 59 year old male alcoholic male presents with history of upper GI bleed of 1 day duration. During the day he has had three episodes of bleeding each time about 150 ml. Blood is fresh and not associated with retching. He has a history of long standing alcohol intake. What will be the most likely cause of GI bleed

a) Mallory weiss tear

b) Esophageal varices

c) Gastric ulcer

d) Esophagitis

Answer for premium

USMLE Trauma

Q ) A 25 year old male brought to the hospital  after being involved in a road traffic accident that occurred 50 minutes ago. His  initial BP at the scene of accident was  80/40 mm HG with a pulse rate of 120/min.

The paramedics administered 2 litres of normal saline in the ambulance and in the emergency department his BP is 110/70 with a pulse rate of 90/min.

He has tenderness in Left upper quadrant abdomen and USG reveals perisplenic fluid. Next step is to :

a) Take him for exploratory laparotomy

b) Shift him to ICU and observe

c) Do a CT scan of the abdomen

d) Put in a laparoscope and assess

Answer c

This Patient has a splenic injury due to blunt trauma abdomen.The  immediate management  depends on grade of splenic  injury  and response to IV Fluids. This patient is hemodynamically stable after IV fluids  and immediate laparotomy is not needed.

Direct shifting to ICU is also not the right choice because CT is required first and for more severe injuries patient can go to OT

Laparoscopy has no role in splenic injuries

Paget disease of the breast

Q) A 60 year old lady, mother of 2 presents with rash and color change in the left areola of 3 months duration. She is diagnosed with Paget disease of the breast. What is true regarding this condition

a) Cancer is a distant possibility

b) Surgical therapy fails to cure Paget's disease of breast

c) Nipple biopsy is diagnostic

d) It is associated with paget's disease of bone

Answer

c

Paget's disease of the breast is invasive carcinoma which grows along the ducts into nipple and areola. Diagnosis is made by nipple biopsy. The lesion presents with eczematous rash which is persistent.

On histology swollen paget cells are seen. Surgical therapy is curative and this pathology is unrelated to paget's disease of the bone.

USMLE Liver

Q) A 50 year old lady with right renal cell carcinoma presents with acute pain in right upper abdomen. She has acute tenderness in right upper abdomen with palpable edge of liver.
She is afebrile and has normal liver functions and normal TLC. CECT Abdomen shows extensive web of collterals in the liver. What is the next step in management.
Portal Cavernoma
                          Portal Cavernoma
 
a) Cholecystectomy
b) Beta blockers
c) Tissue plasminogen activator followed with anticoagulation
d) ERCP and stenting
Answer for premium only