Meld score uses and drawbacks

Q. All are true about Na-MELD except :

a) It corelates with cirrhosis
b)Range of sodium value  is 125-137
c)It relates to vasoconstriction
d) Used for allocation in DDLT patients

Ans c

 MELD was originally developed to predict three-month mortality following transjugular intrahepatic portosystemic shunt (TIPS) placement and was derived using data from a population of 231 patients with cirrhosis who underwent elective TIPS placement.

Range of MELD score is 6-40

MELD Score = 10 x (0.957 x Ln(serum creatinine mg/dL) + 0.378 x Ln(serum bilirubin  mg/dL) + 1.120 x Ln(INR) + 0.643 )

For candidates with an initial MELD score greater than 11, the MELD score is then re-calculated as follows:
MELDNa = MELD(i) + 1.32*(137-Na) - [0.033*MELD(i)*(137-Na)]

  • Sodium values less than 125 mmol/L will be set to 125, and values greater than 137 mmol/L will be set to 137.

It is used for allocation in DDLT to assess wait list mortality

MELD score has also proved to be an effective predictor of outcome in other situations, such as

  1. Patients with cirrhosis going for surgery and patients with fulminant hepatic failure or alcoholic hepatitis.
  2. The MELD score does have limitations in situations where the INR or creatinine may be elevated due to reasons other than liver disease, and its implementation for organ allocation purposes does not take into consideration several conditions that benefit from liver transplantation.

Smoking treatment

Q) Smoking cessation- Not a  first line drug option ?

a) Clonidine 

b) Nicotine replacement (patches)

c) Varenicline

d)  Bupropion

Ans A) clonidine

NRT ,  varenicline (Chantix), and bupropion (Zyban) are the three principal firstline pharmacotherapies recommended for use either alone or in combination 

Clonidine and nortriptyline—as second-line pharmacotherapies for tobacco dependence typically used when a smoker cannot use first-line medications due to either contraindications or lack of effectiveness.

Ref Devita

Fong Score

Q.Not a Poor risk factor according to Fong score
a) Node +
 b) Disease free interval more than 1 yr
c) 2 Liver Mets

d) Single metastasis 6 cm

Ans b 

Fong score is for Survival after treatment for metastatic colorectal cancer to the liver. It includes 5 variables for which score is alloted to each point

Nodal status of primary

Disease-free interval from the primary to discovery of the liver metastases of <12 months

Number of tumors >1,

Preoperative CEA level >200 ng/ml, and

Size of the largest tumor >5 cm

Steroid Refractory Ulcerative colitis

Q) Not used in steroid refractory severe Ulcerative Colitis ( AIIMS 2020 Nov) 

a) Infliximab
b) Azathioprine
c) Cyclosporine
d) Surgery

Ans b- Azathioprine

Cyclosporine is  immunomodulator indicated for second-line therapy in the case of severe, steroid refractory ulcerative colitis. Treatment is usually initiated after 3 to 5 days of failed steroid response

Tacrolimus is appropriate as second-line therapy in patients with severely active ulcerative colitis unresponsive to steroids.

The use of various anti–tumor necrosis factor-α  (TNF-α) monoclonal antibodies ( infliximab)  is well supported in the case of
severe ulcerative colitis refractory to steroids. 

Indication Surgery crohn disease


Q. Most common indication of surgery in Crohn's disease (#AIIMS GI )    (# Jejunum MCQS) 
a) Fistula
b) intractability
c) abscess
d) obstruction

Ans d Obstruction

Confusion between failure of medical therapy or obstruction as the ans. I have checked Bailey sabiston and Shackelford

2 books mention obstruction on top whereas one mentions failure of medical therapy. However with the improvement of medical management in the past decade, obstruction can be the ans

Crohn’s disease will require surgery at some time durin the course of their illness. Approximately 70% of patients will
require surgical resection within 15 years after diagnosis.

Indications for surgery include failure of medical treatment, bowel obstruction, and fistula or abscess formation. Most patients can
be treated with elective surgery,

CDH 1 gene

Q) CDH 1 gene is associated with which cancer

a) Breast

b) Colon

c) Prostate

d) Renal

ANs a CDH 1 is with gastric and lobular breast cancer

Germline mutation in the CDH1 gene encoding E-cadherin was shown to be associated with hereditary diffuse gastric cancer. Prophylactic total gastrectomy should be considered in patients with these mutations

Renal mainly associated with VHL