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

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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
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