Hypovolemic Shock

Q) Which of the following is the correct physiological change during hypovolemic shock?

A)Increased cardiac output.

B)Decreased vascular resistance.

C)Decreased venous pressure.

D)Increased venous saturation.

Healing by Primary Intention

Q)What is the false regarding the healing by  primary intention?

A)Wound edges opposed.

B)Normal healing.

C)Usually done for dirty wounds

D)Minimal scar.

Answer-C(bailey-25)

Primary intention,

Healing by primary intention is also known as healing by the first intention this occurs when there is an opposition of the wound edges

Secondary Intention

Healing occurs when the wound edges are not opposed immediately, which may be necessary for contaminated or untidy wounds.

Primary intention,

  • Would edges opposed
  • Normal healing.
  • Minimal scar.

Secondary intention,

  • Would leave open.
  • Heals by granulation, contraction and epithelialisation.
  • Increased inflammation and proliferation.
  • Poor scar.

Abdominal Aortic Aneurysm (USMLE)

Abdominal Aortic Aneurysm (AAA) 

Splenic artery Aneurysm                         General Surgery                                   Free Questions                                           


Age - 60 years

Sex - Male

Who are at risk - Smokers, Hypertension 

Specific Questions - Associated with Ehler Danlos and MArfan Syndrome - So common in families Read More ...

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