Q) True about Marjolin's ulcer
a) lymphatic spread is common
b) They are painful
c) Aggressive and fast growing tumors
d) Squamous cell carcinoma is the most common type
Q ) In trauma what is the ratio of PRBC: FFP to be transfused?
When there is requirement of more than 6 units of PRBC, FFP and other blood products are required. Read on ....
Ref Sabiston 72
Q) Which of the following is Not a risk factor for pouchitis post IPAA in ULcerative colitis
B ) NSAIDs use post op
C) Elderly patients
D) UC with extra intestinal manifestation
Pouchitis is the complication of Ileal Pouch Anal Anastomosis (IPAA) for Ulcerative colitis. The incidence of pochitis for the same proedure for familial Adenomatous polyposis is less than 10% but for ulcerative colitis can go as high as 50%.
Risk factors for development of pouchitis are
- Previous extra intestinal manifestations of IBD especially arthritis
- ANCA positive cases of UC
- NOD2insC positive patients
- Smoking prevents the development of puchitis after IPAA in ulcerative colitis.
5. Other reported factors that may associate with pouchitis include extent of UC, thrombocytosis,and PPI use with NSAId
Q ) Which of the following group of lymph nodes do lymphatics of the colon first drain to?
c) Nodes along SMA/IMA
d) Para aortic
Answer to 37
Lymphatics first drain to epicolic group along the bowel wall
Then paracolic group along the marginal artery
Intermediate group along the named vessels SMA/IMA
Finally to par aortic
Colon and upper 2/5 of rectum --- Para aortic
Lower 1/5 of rectum and anal canal - Superficial inguinal lymph nodes
Q) True about Focal nodular hyperplasia of liver
a) Central scar is seen in all cases
b) In doubt FNAC is mostly diagnostic
c) They should be resected in view of malignant transformation
d) Asymptomatic patients with typical radiologic features do not require treatment
Q) False regarding Bariatric surgery
a) VBG produces less weight loss when compared to RYGB
b) Jejuno-ileal by-pass not done nowadays.
c) Dumping is due to non- compliance of dietary advice
d) LAGB requires once a 4-6wk follow up
Q) True about suturing technique in vascular anastomosis
a) Anastomosis may not be completely water tight
b) To prevent intimal injury needle should be moved from with in to out
c) 4-0 suture is preferred for aorta
d) Any bio degradable suture which is monofilament can be used
Vessels should always be sewn with the needle moving from within to without on the downstream edge of the vessel to avoid creating an intimal flap and to fix any atherosclerotic plaque.
Tip of the needle should be at right angle to the intima and curve of the needle should be followed
Distal clamp is released first
Non absorbable sutures should be used
2-0 should be used for aorta 4-0 for femoral and 6-0 for popliteal
Only non absorbable monofilament sutures are used in vascular anastomosis
Bailey 27 page 99
Q) All are true about annular pancreas except ( AIIMS GI Surgery Question bank)
a) They are mostly asymptomatic
b) It has equal incidence in children and adults
c) Treatment of choice is duodenojejunostomy
d) Associated with Down's syndrome
d) All are indications for splenectomy