Electrolytes

Q) A 50 year old male undergoes pancreatectomy for Carcinoma head of pancreas. His pre op Hb was 9.2g% and during surgery he received 5 units of PRBC. In the post op period on the 2nd day he develops ECG changes. Work up is done for Myocardial Ischemia which is negative. What is the most common  cause of ECG changes here

a) Hyponatremia

b) Hyperkalemia

 

Gastrinoma

Q) Regarding gastrinoma what is true?

a) All gastrinomas express SRS receptors

b) In 30 % of cases gastrinomas are not localized intra operatively

c) Levels of serum  gastrin more than 100pg/ml are strongly suggestive of gastrinoma

d) Angiography with secretin stimulation is required in all cases for localization of gastrinoma

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Amoebic Liver abscess

Q) True about presentation of amoebic liver abscess?

a) 60-70% patients with amoebic liver abscess have diarrhoea

b) Jaundice is seen in 50% of these patients

c) Rupture of liver abscess in the peritoneum is seen in 10% cases

d) More complications of amoebic liver abscess occurs in acute presentation

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Carcinoid Appendix

 A 40 year old male is  undergoing appendicectomy for acute appendictis.  During surgery a 3 cm mass is found in the body of appendix. Frozen section of the mass reveals carcinoid tumor. Which of the following is true

a) Appendicectomy should be completed followed by radiotherapy to the bed

b) Right hemicolectomy should be done

c) There is 50% chance of developing carcinoid syndrome in this case

d)  Carcinoid syndrome occurs only if there is liver metastasis

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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

Dumping Syndrome

Q) Which of the following is true about dumping syndrome

a) Somatostatin analogues are effective in controlling symptoms

b) Symptoms always include flushing and tachycardia 

c) Diarrhea is always part of dumping syndrome

d) Part of treatment includes combining solids with liquids in frequent small meals

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Contraindication of liver transplantation

Q)Contraindications of liver transplantation have changed over the years. Which is an absolute contraindication of  liver transplantation

a) Previous breast cancer

b) Portal vein thrombosis

c) Active tuberculosis

d) Active substance abuse

d

Previous history of breast cancer if completely treated is not an contraindication of liver transplant. Portal vein thrombosis was earlier considered a relative contraindication but almost all series have shown similar results in patients with PVT than patients without PVT.

IN portal vein thrombosis, inflow to the new liver can me taken in many ways

a) thrombectomy

b) Jump grafts from Superior mesenteric vein 

c) Anastomosis have been done from big collaterals

Active tuberculosis can be managed after transplant.

Modified ATT regimens without INH and Rifampicin are being  used.  Any kind of active substance abuse alcohol,  drugs etc are absolute contraindications for liver transplant because the disease will recur.