General Surgery

Highly selective vagotomy

August 11, 2019August 11, 2019 admin

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

July 19, 2019 admin

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

Tumor lysis syndrome

July 7, 2019July 7, 2019 admin

Q)Tumor lysis syndrome which is not seen

a. hyperkalemia

b hypocalcemia

c. hypophosphatemia

d. hyperuricemia

Ans is c

Tumor lysis syndrome releases, various intracellular metabolites such as uric acid, potassium and phosphorous which overwhelm the excretory capacities of the kidney.

The metabolic anomalies are

Hyperuricemia

Hyperkalemia

Hyperphosphatemeia

Hypocalcemia

It mostly occurs in poorly differentiated leukemias and lymphomas

Electrolytes

July 2, 2019 admin

Q) Chovstek sign with normal calcium seen in
a) Hypomagnesemia
b) Hypermagnesemia
c) Hyperphosphatemia

d) Hypokalemia

Pulmonary embolism

June 3, 2019June 3, 2019 admin

Q) Indication of IVC Filter in a 40 year old male

A. Recurrent thromboembolism despite adequate anticoagulation

B. Deep venous thrombosis in a patient well controlled by anticoagulation

C. Presence of DVT

D. All of the above

Internal Potassium balance

May 28, 2019 admin

Q) If ph >7.4, How much does plasma potassium concentration change for every 0.1 unit increase of the extracellular pH ?

a) Potassium decrease by 0.3meq/l

b) K+ increase by 0.3 meq/l

c) Potassium decrease by 1.5 meq/l

d) K+increase by 1.5 meq/l

Free answer

Acid-base disturbances cause potassium to shift into and out of cells. This is called internal potassium balance and was discovered in 1956. In alkalosis (increase in ph,) K+ falls and in Acidosis potassium concentration will increase. For every 0.1 fall in ph, K+ increases by 0.3-0.6 meql/l

Metabolic acidosis- in a plasma potassium concentration that is elevated in relation to total body stores.

Ref