OPSI

Q) True about OPSI

a) OPSI is over estimated and not seen 2 years after splenectomy

b) Focus of infection is always in the lung or abdomen

c)  Despite antibiotics and intensive care, the mortality rate is between 50% and 70% for full blown OPSI

d) H. influenza is the most common organism

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Stomach Physiology

Q) Regarding the microscopic anatomy of stomach, false statement is ?

a) Parietal cells are abundant in the body of stomach and secrete H+

b) Chief cells produce pepsinogen I and II

c) G cells are abundant in gastric antrum

d) ECL cells are abundant in antrum 

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Intra op cholangio

Q) All of the following are indications for performing intra op cholangiography except:

A. Pain around the day of surgery
B. Anomalous biliary anatomy
C. Suspicious findings on ERCP
D. Abnormal hepatic function panel

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Duodenal adenoma in FAP

Q) Surgery in FAP patient after colectomy for ampullary adenoma Stage IV
a)Classic Whipple
b) Pancreas preserving duodenectomy
c) Transduodenal excision
d) endoscopic excision


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b) 

Duodenal cancers are the third most common (10%) cause of death in FAP after CRC and desmoid disease.

Duodenal adenomas  100% incidence

 tendency to progress to cancer.

The severity of duodenal adenomatosis predicts the chances of duodenal cancer,  Spigelman staging system that is based on

adenoma number, size, and histology

Patients with stage 0 disease (no adenomas) can be surveyed again in 5 years.

Stage I patients can be surveyed in 3 years;

stage II in 1 year;

stage III in 6 months

and stage IV is an indication to consider surgery. 36 % progress to cancer- Surgery is pancreas preserving duodenectomy

A Whipple is indicated for a duodenal cancer that is definitively operable

Duodenal adenomas can be treated by snare polypectomy or by transduodenal polypectomy. Ampullary adenomas can be treated by endoscopic mucosal resection or surgical ampullectomy

Ref schakelford page 1968

MCN

Q) All about MCN of pancreas are true except?
1.Presence of eggshell calcification in CT is suggestive  of malignancy
2.cyst fluid analysis can diagnose accurately in 80%
3.invasive MCN is very aggressive with 30%  5YR Survival compared to adeno carcinoma
4. If MCN is non invasive, surgery  is curative

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