Category: Free Questions

Free MCQs in Surgery

BISAP Score In Pancreatitis

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Q) All are components in BISAP score except?

a) Age more than 60 years

b) WBC more than 16000

c) GCS <15

d) BUN > 25 mg/dl

Ans

)b

The Bedside Index of Severity in Acute Pancreatitis  BISAP is a more-recent score than the older Ranson's Criteria. It predicts mortality risk in pancreatitis with fewer variables than Ranson's.

It does not require data points from 48 hours into a patient's hospital admission.

It includes

BUN > 25 mg/dL (8.9 mmol/L) :
Abnormal mental status with a Glasgow coma score < 15 :
Evidence of SIRS :
> 60 years old :
Pleural effusion :

Complications of Meckel’s diverticulum

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Q. Least common complication of Meckel's diverticulum (NEET 2018) 

a) Bleeding

b) Obstruction

c) Neoplasm

d) Obstruction

Answer is free 
7) c Neoplasm

The most common clinical presentation of Meckel’s diverticulum is gastrointestinal bleeding, which occurs in 25% to 50% of patients who present with complications

intestinal obstruction occur as a result of a volvulus of the small bowel around a diverticulum associated with a fibrotic band attached to the abdominal wall, intussusception, or, rarely, incarceration of the diverticulum in an inguinal hernia (Littre hernia)

Diverticulitis accounts for 10% to 20% of symptomatic presentations.

Neoplasms can also occur in a Meckel’s diverticulum, with NET as the most common malignant neoplasm (77%). Other histologic types include adenocarcinoma (11%), which generally originates from the gastric mucosa, and GIST (10%) and lymphoma (1%).

Sabiston -1285

Acute diverticulitis

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Q) False regarding the management of Acute Diverticulitis. Sigmoid colon inflammation and Fat stranding in CT with initiation of IV antibiotics,

a) Outpatient treatment

b) Do a colonoscopy after the resolution of acute symptoms

c) Elective Colectomy to be done

d) IV antibiotics

Answer Free  c

Sigmoid diverticulitis can be complicated and uncomplicated

Complicated means diverticulum associated with abscess, perforation, obstruction, fistula 

This question is about an uncomplicated acute diverticulitis 

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Hyperbaric oxygen

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 Hyperbaric oxygen therapy in radiation proctitis all are true except
A. Indicated in acute radiation proctitis but not in subacute or chronic radiation proctitis
B. Oxygen increases the growth of residual tumor and hence tumor should be completely
resected
C. Complications include Parkinsonism, barotrauma
D. Usually 30-40 sessions are required for treatment

Answer free for all

a

Hyperbaric oxygen overcomes chronic tissue hypoxia in radiation damaged tissues and with repeated sessions induces growth of regenerative tissue, capillaries, and epithelium. Successful therapy may take multiple sessions.
 18 to 60 treatments

Ref Shackelford page 2211

HBO treatments for hypoxic wounds are usually delivered at 1.9 to 2.5 atm

for sessions of 90 to 120 minutes each. Treatments are given once daily, five to six times per week and should be given as an adjunct to surgical or medical therapies. Clinical evidence of wound improvement should be noted after 15 to 20 treatments. Read More ...

Pancreatic protocol CT

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Q) All are true about pancreatic protocol CT except (AIIMS 2012) 

a) > 90% unresectable lesions picked up by CT

b) Dual phase CT with cuts taken at 40 secs and 70 secs

c) Liver metastasis detected in early arterial phase

d)

Answer is free for all 

c

Pancreatic protocol CT involves  imaging  at  the  pancreatic  phase (i.e.,  approximately  45  seconds  after  contrast  administration)  and  at  the  portal  venous  phase  (i.e.,  approximately 70  seconds  after  contrast  administration). It is useful for detection of adenocarcinoma of pancreas. 

Metastatic lesions are seen in  the  portal  venous  phase,  because  the  lesions  are  not  typically  well  vascularized.

  Arterial  phase images  are  principally  used  to  distinguish  metastatic  disease from  benign  vascular  lesions,  such  as  hemangiomas,  or  to  better define  the  arterial  anatomy  of  the  liver.

Non contrast phase used for  Read More ...

Disinfectants in Surgery

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Q) All are true about disinfectants in surgery  except
A. Povidone iodine needs to dry up prior to its action
B. Alcohol disinfectants act against all organisms except clostridium difficile
C. Single dose of first generation cephalosporin should be givens prophylaxis for vascular
procedures and bladder catheterisation
D. Chlorhexidine is bactericidal, viricidal, fungicidal, and has rapid onset of action and persistent
duration.

Answer d

Povidone-iodine solution is used for surgical site preparation, it must be allowed to dry for microbicidal effect. 

Chlorhexidine is  a phenol which is  used in concentrations of 0.5% to 4.0% alone or in lower concentrations in combination with an alcohol as a skin antiseptic. ....

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Contraindication of Left lobe liver transplant

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Q) Absolute contraindication for left lobe LDLT is
A. Trifurcation of the portal vein
B. Bifurcation of portal vein in the right lobe of the liver
C. Aberrant right hepatic artery
D. Right Posterior duct draining into left hepatic duct

ANSWER d

Trifurcation of portal vein is not a contraindication of  left lobe liver transplant  as we will get a single portal vein on the left side

Portal vein trifurcation
Portal vein

Bifurcation of portal vein in right lobe does not matter because we are leaving the right lobe behind

Again right aberrant artery does not matter because that segment is left behind

Right post duct draining into left duct gives rise to two ducts on the left or a single duct which is quite high.

Right posterior duct to left