Q) 40 year old lady was on anti thyroid medications which she stopped for 2 weeks. She presented in emergency with high grade fever and hypotension. ( Thyroid Storm) What is not a part of further management?
Thyroid or non thyroid surgery in untreated thyrotoxicosis
Trauma in patients with untreated thyrotoxicosis.
Amiodarone
Iodinated contrast agents
RAI therapy
Management is
Beta blockers
Oxygen and hemodynamic support
IV Lugol iodine
PTU
Corticosteroids
The symptoms of thyroid storm are more intense and severe than typical hyperthyroidism symptoms. They can include severe fever, rapid and irregular heartbeat (tachycardia), elevated blood pressure, restlessness, confusion, agitation, tremors, excessive sweating, nausea, vomiting, diarrhea, dehydration, and in severe cases, even delirium, seizures, and coma.
Q) 45 year old male with road side accident and fracture of 3 ribs on left side. CT scan of the abdomen is shown below. Out of the five grades of splenic injury What is the grade in him ?
Subcapsular haematoma <10% of surface area
Parenchymal laceration <1 cm depth Capsular tear
Grade 2
Subcapsular haematoma 10–50% of surface area; Intraparenchymal haematoma <5 cm
Parenchymal laceration 1–3 cm
Grade 3
Subcapsular haematoma >50% surface area; ruptured subcapsular or intraparenchymal haematoma ≥5 cm Parenchymal laceration >3 cm depth
Grade 4
Any injury in the presence of a splenic vascular
injury or active bleeding confned within the splenic
capsule
Parenchymal laceration involving segmental or hilar
vessels producing >25% devascularisation
Grade 5
Any injury in the presence of splenic vascular injurya
with active bleeding extending beyond the spleen
into the peritoneum – shattered spleen
Vascular injury is defined as a pseudoaneurysm or arteriovenous fistula and appears as a focal collection of vascular contrast that decreases in attenuation with delayed imaging.
Active bleeding from a vascular injury presents as vascular contrast, focal or diffuse, that
increases in size or attenuation in the delayed phase
Pulmonary complications 57% with TTE 27% with THE ( SKF 409)
Anastomotic leak 16% TTE and 14% THE ( not significant) subclinical leak slightly more in THE
Option D is correct
Cardiac complications, Vocal cord paralysis , wound infection, chyle leak are all more with TTE
Blackmon et al. published a propensity-matched analysis comparing outcomes between side-to-side stapled anastomosis, end-to-end circular stapled anastomosis, and handsewn,
with no significant difference in leak rate noted. ( SKF page 475)
For patients with disease confned to the thyroid, total thyroidectomy is recommended to remove all C cells with elective dissection of the central neck nodes. If there is evidence of nodal metastases, gross
disease should be remove
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