Pouchitis Disease severity index

Q) Pouchitis disease activity index includes all except (AIIMS 2019)

a) Fever
b) Malaise
c) Fecal urgency
d) Bleeding PR

Pouchitis is commonly asked in AIIMS and JIPMER MCH exams. Previous year questions are here and here

Ans b ) Malaise, Clinical data includes Frequency, urgency and rectal bleed

Summary of the PAS

	Range
I. Clinical
1. Stool frequency	(0, 2, 4, 6)
2. Fecal urgency	(0, 3)
3. Rectal bleeding	(0, 3)
Maximal clinical subscore: 12
II. Endoscopic findings
1. Oedema	(0, 1)
2. Granularity	(0, 1)
3. Friability	(0, 1, 2)
4. Erythema	(0, 2, 3)
5. Mucosal flattening	(0, 2)
6. Ulcerations/erosions	(0, 2, 3)
Maximal endoscopic subscore: 12
III. Histological Acute inflammation
1. Polymorphonuclear infiltration	(0, 1, 2, 3)
2. Ulcerations/erosions	(0, 1, 2, 3)
Chronic inflammation
1. Mononuclear infiltration	(0, 1, 2, 3)
2. Villous atrophy	(0, 1, 2, 3)
Maximal (total) histological subscore: 12
Maximal total PAS: 36

Cells Involved in Wound healing

Q) The cells or cell components central to wound healing are:
A. B cells

B. T cells

C. Leukocytes

D. Macrophages

Q) Which of the following is the correct physiological change during hypovolemic shock?

A)Increased cardiac output.

B)Decreased vascular resistance.

C)Decreased venous pressure.

D)Increased venous saturation.

Q) Creeping resection is done for?

a) IPMN

b) PSEUDOCYST Pancreas

c) SCN ( Serous Cystic neoplasm)

d) MCN ( Mucinous Cystic Neoplasm)

Q)What is the false regarding the healing by primary intention?

A)Wound edges opposed.

B)Normal healing.

C)Usually done for dirty wounds

D)Minimal scar.

Answer-C(bailey-25)

Primary intention,

Healing by primary intention is also known as healing by the first intention this occurs when there is an opposition of the wound edges

Secondary Intention

Healing occurs when the wound edges are not opposed immediately, which may be necessary for contaminated or untidy wounds.

Primary intention,

Secondary intention,

Old age and no history of pancreatitis, it is cystic neoplasm of pancreas
Most common is SCN followed by MCN and IPMN
OLd patient with dilated duct, cystic neoplasm is IPMN
The most important point of differentiation in cystic neoplasms is whether the epithelium is serous or mucinous.
All mucinous cystic lesions should be resected; lesions < 2 cm remain controversial.
Mucinous neoplasm in middle aged female, body and tail of pancreas
Creeping Resection is for IPMN Intraoperative frozen sectionsin the management of IPMNs. If margins are positive for adenoma or borderline atypia with minimal cytoarchitectural atypia and gastric/foveolar-type epithelium, no further resection is required. If instead they are positive for invasive carcinoma, carcinoma in situ, or borderline atypia exhibiting florid papilla formation, further resection is warranted, if feasible.In such instances, further “creeping” resection toward the head for a tail lesion, or toward the tail for a head or uncinate process lesion, can often be sufficient.