Q) What are natural killer cells?
a) Multinuclear monocytes
b) Special macrophages
c) Antibody presenting cells
d) Large granular lymphocytes?
Answer is free
Large granular lymphocytes
Natural killer cells are a part of lymphocytes called "null cells" These are large granular lymphocytes and the 1st line of defence against viruses and bacteria
They belong to null cells as they do not rely on specific match or memory.
They control both tumor and microbial spread in the body.
Unlike T cells ( which mature in thymus), natural killer cells develop in bone marrow. They identify the viruses and other harmful cells by lack of major histocompatibility complexes (MHC)
Antigen presenting cells are B cells
T cells are direct cyto toxic cells
Sabiston 20th page 601
Q) All are premalignant in carcinoma GB except
a. PSC ,
b. Porcelain GB
c. Multiple 2 cm stones.
d. Choledochal cyst
Q) Paradoxical breathing is seen in
a) Poland syndrome
b) Flail chest
c) Pectus excavatum
d) Pectus carinatum
Answer for premium members
Q14. A 6 months old baby is brought to the emergency with continuous crying and drawing his legs up for 1 day. He has vomiting and passage of bloody stools. On examination a lump is found in right hypochondrium. What is the best clinical diagnoses?
c) Hirshprung disease
d) Intestinal atresia
Q) True about Z plasty.
a. 3 limbs equal with 45 degree.
b. 3limbs equal 60 degree.
c. All limbs equal with 45 degree
d. All limbs equal with 60 degree
Q Autopsy finding in a patient who dies of Tetrology of Fallot is
a) Brachiocephalic vein draining into the left renal vein
b) Inferior vena cava (IVC) draining to the superior mesenteric vein
c) Atrial Septal Defect (ASD)
d) Decreased vascularity of the lung field
Q 24 Contraindication of Fontan procedure?
a) 20 year old male
b) Severe MR
c) Right pulmonary artery stenosis
d) Left ventricular end diastolic pressure of 20 mm Hg
Fontan procedure is for tricuspid atresia and is done when there is low pulmonary vascular resistance. For the same reason it is not done in neonates.
In Tricuspid atresia, venous blood does not go to right ventricle and there is mixing of venous and arterial blood in aorta which leads to decreased oxygenation.
Most infants with tricuspid atresia have restrictive pulmonary blood flow. To improve systemic oxygentaion they undergo modified Blalock-Taussig shunt, which is a small polytetrafluoroethylene (PTFE) graft to connect the subclavian artery and a pulmonary artery.
Criteria for Fontan procedure are
Age older than 4 years
Normal systemic venous return
Normal right atrial volume
Mean pulmonary artery pressure less than 15 mm
Pulmonary arteriolar resistance less than 4 Wood units/m 2
Pulmonary artery–aorta ratio more than 0.75
Left ventricular ejection fraction more than 0.60
Current absolute contraindications are a pulmonary vascular resistance above 4 Wood units/m2, severe hypoplasia of the pulmonary arteries, and severe diastolic dysfunction of the left ventricle.
Q Least useful investigation in a pt with recurrent LGI bleed, multiple upper and lower GI endoscopies negative
b) Double balloon enteroscopy
c) Capsule endoscopy
d) Push endoscopy
Free for all
Investigations in lower GI bleed should be specific and less time consuming
Small bowel enteroclysis, which uses a tube to infuse barium, methylcellulose, and air directly into the small bowel, yields better images than simple small bowel follow-through. Because the yield has been reported to be very low and the test is poorly tolerated, it is now rarely used.
Capsule endoscopy uses a small capsule with a video camera. capsule endoscopy is an excellent tool for the patient who is hemodynamically stable but continues to bleed, with reported success rates as high as 90% in identifying a small bowel pathology.
The hemodynamically stable patient should undergo small bowel enteroscopy. Usually performed with a pediatric colonoscope, it is referred to as push endoscopy. It can reach about 50 to 70 cm past the ligament of Treitz in most cases and permits endoscopic management of some lesions. Overall, push enteroscopy is successful in 40% of patients .
Double-balloon endoscopy is another technique gaining in popularity. Although technically difficult, this approach is capable of providing a complete examination of the small bowel. In expert hands, double-balloon enteroscopy can identify a bleeding source in 77% of cases with occult bleeding, with the yield increasing to over 85% if the endoscopy is per-formed within 1 month of an overt bleeding episode.The advantage of this technique is that as well as visualization, biopsies can be performed and therapeutic interventions undertaken.
To conclude investigations in lower GI bleed have to be specific and have high sensitivity also.
Q) Most common content of Morgagni hernia is :
b. Small intestine.
c. Transverse colon.
Answer is here
Foramen of morgagni is a congenital diaphramatic defect along with Bochdalek.
Morgagni was an italian anatomist