Role Of PET Scan in CA Stomach

Q) What is not true about the role of PET Scan in staging of Ca Stomach?

a) 50% of Carcinoma stomach are PET avid

b) Response to Neoadjuvant therapy is  usually seen on PET in 2 weeks

c) PET response correlates with survival 

d) Sensitivity of PET is same for all kinds of histopath tumors

Skin grafting

Q)In preop evaluation before placing skin graft over wounded area…bacterial colony count must be less than
a) 10000
b) 100000
c) 1000000
d) 10000000

ans b)  10 raise to the power 5

Prerequisites for skin grafting:
The recipient site should be assessed for potential bacterial load, blood supply,
presence of devitalized tissue, and exposed vital structures.
Donor site availability
Perform recipient site tissue culture if history or concern for infection (counts <105
CFU/g tissue for most pathogens required before grafting).
Presence of group a beta heamolytic streptococci is absolute contraindication for
skin grafting
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Black Esophagus

Q) The black esophagus most commonly presents as

a) Chest pain

b) Hematemesis

c) Incidental

d) None

Highly selective vagotomy

Q) False about highly selective vagotomy
a) Highly selective vagotomy divides the vagus nerves supplying the acid-producing portion of the stomach
b) Incidence of postoperative complications is lower.
c) The criminal nerve of Grassi should be severed
d) Crow's feet nerves are severed till below the GE junction

Ans -d

Highly Selective Vagotomy (HSV)  only divides the last part of the nerves which supply the part of stomach which produces acid
Anterior  and posterior  nerves of Latarjet are found and their terminal branches are severed from 7 cm proximal to the pylorus to 5 cm above the GE junction
Motor function of the stomach is not affected
Criminal nerve of grassi is branch of posterior vagus. It should be sought and cut
Ref sab 2oth page 1206
Criminal Nerve of Grassi is 1st branch of posterior vagus
Criminal Nerve of Grassi is from posterior vagus
MOre 

Vagus Nerve branches 

  • Anterior trunk: Gives
Branch to liver GB and Bile duct and goes along the lesser curvature as the anterior nerve of Latarjet
  • Posterior Trunk:

    Sends branches to the celiac plexus and continues along the posterior aspect of the lesser curvature as the posterior nerve of Latarjet.
    • Criminal Nerve of Grassi: The first branch of the posterior trunk, innervates the gastric fundus. Failure to divide this nerve during an acid-reducing surgery can lead to recurrent ulcers
    • Crows Foot: The most distal branches of the anterior and posterior trunks and provides innervation to the antro-pyloric region. These branches are spared in a highly selective vagotomy (HSV)
    • Parasympathetics are vagally mediated using acetylcholine as the primary neurotransmitter

Caustic injury esophagus

Q)  True statement about caustic injury esophagus :

A. NG tube is inserted to allow enteral nutrition.

B. Gastric conduit is preferred for esophageal reconstruction

C. Early dilatation to prevent stricture formation is not recommended

D. Contrast esophagogram is performed in the initial 48 hours to characterise the extent of injury and detect perforation

Inverted papilloma

Q)Most common site of inverted papilloma
A. Maxillary sinus
B. Ethmoid sinus
C. Lateral nasal wall
D. Maxillary + ethmoid sinus

Achalasia pressures

Q All are true about achalasia except

A. Type 1 Achalasia is characterised by 100% failed contractions (DCI<100) and no esophageal pressurisation

B. Type 3 Achalasia has premature contractions in atleast 20% swallows

C. IEM (Ineffective esophageal motility) is characterised by >20% ineffective swallows (DCI<450)

D. Patients with type 2 achalasia have the best response to therapy