Hemangioma Liver

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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 Ans)d Whatever the size there is no role of resection for asymptomatic hemangioma. Risk of rupture is very small and therefore there is no rationale for stopping OCPS, pregnancy or physical activities.  Arterial embolization, which may be considered for temporary control of hemorrhage has limited success and is occasionally associated with morbidity In symptomatic hemangioma liver resection is the treatment of choice, in peripheral tumors enucleation and in centrally placed tumors, formal resection should be done REf Blumgart Surgery of liver 6th edition  

Splenic artery aneurysm

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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

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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

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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

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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 Answer for premium only

USMLE Trauma

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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