Month: January 2017
Q Most common urological complication in Crohn’s disease is
a) Ureteral obstruction
b) Entero vesical fistula
c) Pyonephrosis
d) Recto uretheral fistula
Hemangioma Liver
Q) True about management of hemangioma liver
a) All hemangioma more than 10 cm should be resected
b) OCPs and pregnancy should be avoided in young females as there is risk of rupture
c) Arterial embolization should be routinely done in large hemangiomas
d) If surgery is decided hemangioma located at the periphery should be enucleated
Answer d
Explanation for premium members
Billroth 2 surgery
Q) What is true regarding complications of billroth 2 surgery?
a) It has less complications than billroth 1 surgery
b) Recurrent ulceration is more common in the afferent limb as compared to efferent limb.
c) Afferent loop obstruction is more common after billroth 2 surgery
d) Billroth I operation is preferred in scarred duodenum
Answer c -
In billroth 2 surgery, afferent limb obstruction is more common
In surgery for benign gastric ulcers, billroth I reconstruction is the preferred choice. Billroth II surgery has problems of
- Retained antrum syndrome
- Afferent loop obstruction
- Duodenal stump leak (1-3%)
Splenic artery aneurysm
Q) Splenic artery aneurysm is seen in
a) Proximal 1/3rd of splenic artery
b) Proximal 2/3 of splenic artery
c) Middle 1/3 of splenic artery
d) Distal 1/3 of splenic artery
Answer Premium members
Mass forming lesion Liver
Q) A 55 year old male presents with obstructive jaundice. Ultrasound evaluation reveals a
hyperechoic 4 cm mass in segment VI of liver with peripheral duct dilatation.
CT abdomen shows a hypodense mass with delayed enhancement in portal pahse.
What is the most likely diagnosis
a) Hepatocellular carcinoma
b) Intrahepatic cholangiocarcinoma
c) Metastatic Adenocarcinoma
d) Carcinoid
Answer
b) Intrahepatic cholangiocarcinoma (IHCC)
IHCC - Mass forming type- have gradual central enhancement and variable delayed enhancement on portal phase
Hepatocellular carcinoma present ....Premium content at Questions on Bile ducts Q16-20
IPMN Adnenocarcinoma Pancreas
Q) Which of the following histological varieties of IPMN is associated with low grade dysplasia
a) Intestinal type
b) Oncocytic type
c) Pancreaticobiliary type
d) Gastric
Answer Premium member
Ulcerative colitis and Crohn’s disease
Q) All of the following are seen in both ulcerative colitis and crohn's disease except
a) Aphthous ulcer
b) Pseudo polyp
c) Rectal disease
d) Obstructive symptoms
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
Hirchsprung’s disease
Q) False statement about Hirchsprung's disease is:
a) Male and Female have equal incidence
b) In approximately 8% of the patients entire colon is affected
c) After surgery constipation is the most common problem
d) Down syndrome can be seen in up to 3-5% patients
Answer
a
Hirchsprung's disease is a developmental disorder characterized by absence of ganglion cells in both Auerbach's and Meissner's plexus and males are more frequently affected than females
Absence of these ganglion cells lead to a very tight anal sphincter with resultant constipation.
This aganglionosis which is similar to Achalasia cardia begins at anorectal junction and involves rectosigmoid in 80% and entire colon in 8% of cases.
Various surgical options like Duhamel, Swenson and Soave procedures can be done and in all constipation is a common problem
Down's syndrome is associated in 5%
Ref: Sabiston 20th edition page 1876