Grades of Splenic Injury – Image based Question

Q) 45 year old male with road side accident and fracture of 3 ribs on left side. CT scan of the abdomen is shown below. Out of the five grades of splenic injury What is the grade  in him ?

Splenic Injury grades

 

 

 

 

 

 

 

a) Grade II

b) Grade III

c) Grade IV

d) Grade V 

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Ans b Grade III

Grade 1
Subcapsular haematoma <10% of surface area
Parenchymal laceration <1 cm depth Capsular tear
Grade 2
Subcapsular haematoma 10–50% of surface area; Intraparenchymal haematoma <5 cm
Parenchymal laceration 1–3 cm
Grade 3
Subcapsular haematoma >50% surface area; ruptured subcapsular or intraparenchymal haematoma ≥5 cm Parenchymal laceration >3 cm depth
Grade 4
Any injury in the presence of a splenic vascular
injury or active bleeding confned within the splenic
capsule
Parenchymal laceration involving segmental or hilar
vessels producing >25% devascularisation
Grade 5
Any injury in the presence of splenic vascular injurya
with active bleeding extending beyond the spleen
into the peritoneum – shattered spleen
Vascular injury is defined as a pseudoaneurysm or arteriovenous fistula and appears as a focal collection of vascular contrast that decreases in attenuation with delayed imaging.
Active bleeding from a vascular injury presents as vascular contrast, focal or diffuse, that
increases in size or attenuation in the delayed phase
Bailey 1224 

natural history breast cancer

Q. True about breast cancer is?

a) Doubling time of breast tumor is 1 month

b) Skip metastasis in level iii lymph nodes is common

c) Lungs are commonly involved by direct invasion

d) Dimpling of skin is due to shortening of cooper's ligaments

Ans

Trauma

Q) a 50 year old man with road side accident and injuries on right chest and femoral fracture, He is conscious,  BP is 80/60 , Pulse 104/min, and chest expansion is reduced. JVP is not raised and heart sounds are normal. Respiratory rate is 22/min

What does he have

a) Left heart failure

b) Fat Embolism

c) Pneumothorax

d) Fluid loss

Clinical Paediatric surgery Question

Q.  A 6 months old baby is brought to the emergency with continuous crying and drawing his legs up for 1 day. He has vomiting and passage of bloody stools. On examination a lump is found in right hypochondrium. What is the best clinical diagnoses?

Choices and Answer for Premium 

 

Ureteral injuries

Q) A 24 year old male suffers low velocity gun shot wound in lower abdomen. On exploration there is a 1 cm segment loss of left ureter above the pelvic brim. Best management is :

a) Ureterocystostomy

b) Uretero ureterostomy

c) Ureterostomy

d) Ligation of ureter 

Esophagus perforation

Q) A 45 year old man who has been drinking regularly for the past 15 years vomits after a large meal and complains of severe chest pain. Cardiac cause is ruled out and boerhavve's syndrome is suspected. Which of the following is not true about this condition

a) Gastrograffin tests will confirm the diagnosis

b) Perforation is most common in the left lower end

c) Exploration and full thickness suturing of perforation should be done

d) This condition has a high morbidity and mortality if not diagnosed at time

Answer for premium members  - Discussion on Boerhaave's syndrome

Reno vascular hypertension

Q) Which of the following is true about reno vascular hypertension

a) Seen in young age group

b) Both kidneys are of same size

c) It is familial

d) Diuretics will control the hypertension

a

Renal artery occlusion creates ischemia of the kidney which releases renin. Hypereninemia leads to secondary hypertension. This further leads to conversion of angiotensin I to angiotensin II and vasocontriction and eventually release of aldosterone.

It is a disease of young adults and children

Size of the kidneys vary and diuretics do not control hypertension because the mechanism is high renin secretion which is unresponsive to diuretics.

 

Peritonitis

Q) True statement regarding peritonitis is 

a) Raised serum amylase is only seen in pancreatitis

b) Rectal examination is better diagnostic of appendicitis than per abdominal examination

c) Ultrasound has diagnostic accuracy of 90% for diagnosing acute appendictis

d) Catarrhal appendicitis mostly leads to gangrene of appendix and perforation

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