Facial nerve

Q) Not a branch of facial nerve?

a) Greater auricular nerve

b) Post Auricular nerve

c) Nerve to Chorda tympani

d) Nerve to Stapedius

Ans a

The posterior auricular nerve arises from the facial nerve close to the stylomastoid foramen.

The great auricular nerve (or greater auricular nerve) originates from the cervical plexus, composed of branches of spinal nerves C2 and C3. 

The chorda tympani is a nerve that arises from the mastoid segment of the facial nerve

The nerve to stapedius arises from the facial nerve to supply the stapedius muscle.

Primary Hyperparathyroidism

Q) Which is not a feature of primary hyperthyroidism?

a) Increase Parathormone

b) Increase Calcium

c) Decreased phosphate

d) Dystrophic calcification

Ans d 

Clinical features of Hyperparathyroidism are

  1. Subperiosteal bone erosions
  2. Primary Hyperthyroidism  is defined as hypercalcaemia in the presence of an unsuppressed and therefore relatively, or absolutely, elevated PTH level. Elevated calcium and elevated PTH are important  in diagnosis of PTH
  3. The presence of kidney stones remains the most common clinical manifestation of symptomatic PHPT.
  4. It is associated with a low serum phosphate in the setting of normal creatinine and vitamin D levels

Ref Bailey and Love Page 826

 Some useful questions can be bought here  MCQs and EMQs in Surgery: A Bailey & Love Revision Guide, Second Edition 

Some uncommon disorders associated with hyperparathyroidism include

peptic ulcers, pancreatitis, and bone disease

central nervous system symptoms 


Causes of Primary Hyperparathyroidism are

  1. Parathyroid Adenoma -75% (can be localised by Sestamibi scanning)

Management of primary hyperparathyroidism

Patients with symptomatic primary hyperparathyroidism as manifested by kidney stones, renal dysfunction, or osteoporosis should undergo parathyroidectomy.

If the patient is asymptomatic and detected to have high parathyroid levels then surgery is done only if

  1. age is less than 50
  2. very high excretion of calcium in urine
  3. low creatinine clearance
  4. kidney stones
  5. high serum calcium

 

Afferent loop syndrome

Q) Not true about afferent loop syndrome

a) It can  occur after either partial or total gastrectomy with Billroth ii reconstruction or roux en y gastrojejunostomy

b) Acute obstruction is more common than chronic

c)  Weight loss and anemia are common. 

d) Bacterial overgrowth in  afferent limb causes  malabsorption of fat and other nutrients, such as vitamin B12 or iron. 

Role Of PET Scan in CA Stomach

Q) What is not true about the role of PET Scan in staging of Ca Stomach?

a) 50% of Carcinoma stomach are PET avid

b) Response to Neoadjuvant therapy is  usually seen on PET in 2 weeks

c) PET response correlates with survival 

d) Sensitivity of PET is same for all kinds of histopath tumors

Highly selective vagotomy

Q) False about highly selective vagotomy
a) Highly selective vagotomy divides the vagus nerves supplying the acid-producing portion of the stomach
b) Incidence of postoperative complications is lower.
c) The criminal nerve of Grassi should be severed
d) Crow's feet nerves are severed till below the GE junction

 

 Ans -d

HSV only divides the last part of the nerves which supply the part of stomach which produces acid
Acnt and post nerves of Latarjet are found and their terminal branches are severed from 7 cm proximal to the pylorus to 5 cm above the GE junction
Motor function of the stomach is not affected
Criminal nerve of grassi is branch of posterior vagus. It should be sought and cut
Ref sab 2oth page 1206

Acute Gastric dilatation

Q) Not true about acute gastric dilatation (AGD) 

a) AGD is encountered most often as a postoperative complication in abdominal surgery 

b)Also seen in other  disorders, such as anorexia and bulimia nervosa, psychogenic polyphagia, trauma, diabetes mellitus 

c) When intragastric pressure from gastric distension exceeds 20 cm H2O gastric necrosis starts

d)  clinical features are pain abdomen and effortless vomiting