Colonoscopic stenting in Colon cancer

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Q) . Not a risk factor in colonoscopic stenting in colonic cancer causing obstruction
A. Short stricture of length <10 cm
B. Extrinsic compression
C. Treatment with bevacizumab
D. Strictures and obstructions at multiple levels

Answer

Bleeding on Clopidogrel

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Q)  Patient on Clopidogrel has  Intraop bleeding  Which component will you transfuse to control it? ( #NEET 2018)

a) Platelets
b) FFP
c) Cryoprecipitate

d) PRBC

Ans ) A, platelets

Patients on clopidogrel who are actively bleeding and undergoing major surgery may require almost continuous infusion of platelets during the course of the procedure. Arginine vasopressin or its analogues (DDAVP) have also been used in this patient group

Platelet shelf life is 5 days and stored at temp of -24

Bailey 27th page 

 

Complete mesocolic excision

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Q) All are true regarding complete mesocolic  excision except

a) Hohenberger et al introduced it
b) It is based on ligation of central artery
c) Increases yield of lymph nodes and has decreased recurrence
d) Line of resection is below Toldt's fasica
Answer

Gastric pullup

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Q 35) Not a step in Gastric pull up mobilization?

a) Lesser sac entering

b) Posterior mobilization of the duodenum

c) dilatation of hiatus

d) ligation of lesser curve vessels
Answer 35

Stomach is the best esophageal substitute. It has a single anastomosis, consistent blood supply and is durable

Disadvantage is reflux in the long term.

Check the answer to the question on gastric pull up in the answer

Caustic Injury to esophagus

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Q ) False regarding Caustic injury to Esophagus

a) Gastric lavage not done as it increases the chances of more injury

b) Neutralising  agents not given as it produces more injury than preventing it

c) Milk and albumin not given as it causes more damage

d) Activated charcoal not given as it doesn’t effectively absorb alkali

Check one more question on caustic injuries to esophagus here


Answer 

In  caustic injuries to the esophagus, early decisions have to be taken. The involvement of surgeon should be done early and patient should be placed under close monitoring.

Blind nasogastric and orogastric tubes should not be inserted and initially CT of chest and abdomen with contrast should be done to guide the subsequent procedures. Read on

 

Fasciotomy

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Q) True about fasciotomy of the lower limb

a) Fasciotomy should be done when distal pulses are absent

b) If there are no clinical signs and compartment pressure is more than 30 mm Hg, fasciotomy should be done

c) Multiple small incisions should be given on the leg

d) Crush injuries that manifest late, fasciotomy is preferred

Answer for premium members

Pressure sore

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Q) Pressure sore, grade II is (NEET 2017) 

a) Partial thickness skin loss, epidermis and dermis are involved

b) Full thickness skin loss, involving subcutaneous tissue but not underlying fascia

 

Bile duct injuries in cholecystectomy

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Q True about Bile duct injuries in cholecystectomy

a) Only 15% are recognized at the time of surgery

b)Routine  Operative cholangiography  definitely reduces the incidence of bile duct injury

c) In incomplete obstruction of bile duct,  jaundice occurs early

d) Surgical outcome depends on timing of surgery

Answer for premium members

After cholecystectomy complications can occur in 15%. Identification and management of bile duct injuries is very important. This question and subsequent discussion has been routinely asked in many exams

Gall Bladder adenoma

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Q)  Not an indication of cholecystectomy in gall bladder adenoma?

a) Size more than 1 cm

b) Associated gall stones

c) Age more than 60 years

d) More than 3 in number

Answer 

Siewert

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  1. Q) False regarding CA Esophagus

    a) Siewert I treated as Esophageal cancer

    b) Siewert III treated as Gastric cancer

    c) Siewert II treated as Esophageal cancer or Merindino surgery

    d) Proximal margin in Esophagus is determined routinely to alter the management

    Answer