Natural Killer cells

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Q) What are natural killer cells?

a) Multinuclear monocytes

b) Special macrophages

c) Antigen presenting cells

d) Large granular lymphocytes

Ans d

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

Ref: https://study.com/academy/lesson/natural-killer-cells-definition-functions-quiz.html

       Sabiston 20th page 601

Bilobed grafts

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Q Bi lobed graft is  used in which reconstruction

a. Nose.
b. Eyelid.
c. Cheek.

d) Lips

Answer

Clinical Paediatric surgery Question

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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?

a) Intussusception

b) Gastrochisis

c) Hirshprung disease

d) Intestinal atresia

Answer 

Z plasty

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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

Answer 

Tetrology of Fallot

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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

Answer

Fontan Procedure

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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

24) d

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
  • Sinus rhythm
  • 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.

Investigations in lower GI Bleed

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Q Least useful investigation in a pt with recurrent LGI bleed, multiple upper and lower GI endoscopies negative

a) BMFT

b) Double balloon enteroscopy

c) Capsule endoscopy

d) Push endoscopy

Answer

Free for all

A

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.

Sabiston

Foramen of Morgagni

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Q) Most common content of Morgagni hernia is :

a) Stomach.
b. Small intestine.
c. Transverse colon.

d) Liver

Foramen of morgagni is a congenital diaphramatic defect along with Bochdalek.

Morgagni was an italian anatomist