Anal malformation

Q) Newborn with abdominal distension on day 2, not passed meconium. There is absent anal orifice. WHat is the next step? # NEET SS 22 

a) Cross table X ray

b) Invertogram

c) Anoplasty

d) Sigmoid colostomy

Ans a) Cross table X ray

1st step in such cases Rule out congenital abnormalities of spine, sacrum , kidney heart etc

2nd step Cross table x ray  If it shows Perineal fistula do ANoplasty, If x ray shows rectal gas below coccyx do PSA RP with or without colostomy, If it shows gas above coccyx with associated defects do colostomy

Table 67.14 Sabiston 

 

Stage II Empyema

Q) Empyema stage II management is ? # NEET SS 22

a) VATs

b) Decortication Open

c) IV antibiotics

d) Antibiotics and drainage

Ans d

ANtibiotics and drainage

60 years ago, The American Thoracic Society first described the evolution of empyema as a continuous process that subdivides into three stages.

Exudative stage -

initial bacterial infection causes an acute inflammatory response between the pulmonary parenchyma and visceral pleural.

This exudative fluid is usually free-flowing, resolves with appropriate antibiotic treatment, and does not warrant any invasive drainage.

Fibrinopurulent and Loculated stage II)  In the absence of appropriate treatment, the effusion can become complicated via deposition of fibrin clots and membranes resulting in isolated collections of fluid in the pleural space

.At this stage, bacteriology usually becomes positive, and the effusion warrants antimicrobials and drainage.

Chronic Organizational stage - if not drained, fibroblasts coalesce to form a thick pleural peel between the visceral and parietal pleura. This peel can ultimately encase the underlying lung parenchyma and can complicate the clinical course via inhibition of adequate gas exchange, trapped lung or chronic forms of empyema.

Hepatic adenoma

Q Which of the following statement about hepatic adenoma is CORRECT?

a) It is more common in males

b) Ct shows a central stellate scar

c) Associated with cirrhotic liver

d) Risk of rupture and fatal hemorrhage is present 

Giving a clinical scenario of Hepatic Adenoma 

A 37 year old lady presents with right upper quadrant pain and nausea. She is otherwise well and her only medical therapy is the oral contraceptive pill which she has taken for many years with no ill effects. Her liver function tests and serum alpha feto protein are normal. An ultrasound examination demonstrates a 4cm non encapsulated lesion in the right lobe of the liver which has a mixed echogenicity and heterogeneous texture.

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