Zones in Hand injury

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Q) What is the zone of injury due to glass cut on distal phalanx of middle finger, flexor aspect?

Zone I

Zone II

Zone III

Zone IV

Bariatric surgery in special circumstances

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Q) WHich bariatric surgery procedure is preferred in patients who can not comply with frequent follow ups? # Theme from MOck test 5 on 13.10.24

a) Roux en Y Bypass

b) BPD

c) Duodenal switch

d) Sleeve gastrectomy

 

Facial nerve pointers

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Q) The most consistent anatomical landmark of the facial nerve is the
A. Anterior border of the posterior belly of the digastric muscle.
B. Posterior border of the posterior belly of the digastric muscle.
C. Superior border of the posterior belly of the digastric muscle.
D. Inferior border of the posterior belly of the digastric muscle

Ans c

Facial nerve identification:

  •  Posterior belly of the digastric
  • Mastoid tip
  • Tragal pointer
  • Tympanomastoid suture line are key anatomical landmarks.
  • The nerve lies 2 to 4 mm inferior to the tympanomastoid suture line. The most consistent intraoperative landmark is the superior aspect of the posterior belly
    of the digastric.
  1. Tragal “Pointer” (of Conley):
    • Imagine the tragal cartilage—the little bump in front of your ear. Well, the facial nerve lies approximately 1 cm deep and slightly anterior and inferior to this “pointer.” As you dissect the tragal cartilage from the parotid fascia, it takes on a bluntly pointed shape—hence the name. This unassuming landmark is vital for safe surgery.
  2. Tendon of Posterior Belly of Digastric Muscle:
    • Picture the posterior belly of the digastric muscle attaching to the mastoid bone. The facial nerve lies about 1 cm deep to this attachment. During surgery, gently separate the tail of the parotid gland from the sternocleidomastoid muscle and uncover this hidden treasure.
  3. Tympanomastoid Suture/Fissure:
    • Deep within the temporal bone, where the mastoid meets the vaginal portion of the tympanic ring (fancy, right?), lies the facial nerve. It’s about 6-8 mm deep to this suture. Think of it as the nerve’s secret hideout.
  4. Styloid Process:
    • Lateral to the styloid process, you’re getting warmer! The facial nerve hangs out nearby. It’s like a VIP lounge for nerves.

Ivor Lewis Esophagectomy leak

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Q) After Ivor Lewis esophagectomy, on POD 5 , bile is seen in chest tube. Patient's heart rate is 120,  temp is 101 degree F, BP is 100/70. What will be the next step?

a) Stenting

b) Colonic replacement of gastric conduit

c) IV antibiotics 

d) Conduit excision and  Esophageal diversion

Ans  d

Patients with a completely necrotic conduit are most often septic and brought to the operating room for emergent exploration.

If conduit necrosis is confirmed,   then the conduit must be resected and the patient
should be diverted with an end esophagostomy, venting gastrostomy, and feeding jejunostomy.

Care should be taken to maintain the longest possible length of remaining
esophagus to facilitate future reconstruction

Schakelford page 477

 

Bone tumors

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Q) A 16 year old boy presents with severe groin pain after kicking a football. Imaging confirms a pelvic fracture. A previous pelvic x-ray performed 2 weeks ago shows a lytic lesion with 'onion type' periosteal reaction. What is the lesion?

a) Giant cell tumor

b) Ewing's 

c) Osteosarcoma

d) Osteomalacia

Question  from theme of test 14 

 

Pancoast tumor

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Q) 50 year old male with NSCL carcinoma of upper Rt lung which infiltrates the brachial plexus. WHat will be the managament? 

Lung and Thorax MCQS

a) Surgical resection

b) CCRT and resection

c) CCRT and access for response

d) Neoadjuvant and resection

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