Miscellaneous Questions from DNB
Q17 ) Capsule endoscopy false is
A. Sedation is not required
B. Accurate localisation possible
C. Not suitable for patients with stricture
D. Can visualise entire small bowel
Q18) Fascial compartments of leg
A. Anterior, lateral, Superficial and deep posterior
B. Anterior, posterior, medial
C. Medial, lateral posterior
D. Anterior, medial, lateral
Q19) Penetrating injury to the abdomen, with BP 84/60, Pulse 116/min, what is the next best step in management?
b) CT Abdomen with contrast
c) Ultrasound abdomen
d) Take to OT
Q 20)Management of isolated liver injury in children commonly is
c) Intervention and embolization of bleeding vessel
d) Liver packing
A 17) B
Capsule endoscopy has a sensitivity of detecting occult GI bleed in 60-70% cases. Its advantages are that it is painless and easy to do in centers that have the technology to do it. No sedation is required and it visualizes the whole bowel. It is painless and preferable.
Its disadvantages are that it is not accurate and does not accurately tells the bleeding point. Can not be done in strictures and those who can not swallow. Sometimes the batteries dies and studies are incomplete
Ref Bailey Page 205
The bones in the lower leg, interosseous membranes, and fascia divide the lower leg into four compartments.
Anterior compartment: between the deep fascia and the interosseous membrane, with the
tibia medially and the fibula laterally.It has the deep peroneal nerve and the anterior tibial vessels.
Lateral compartment: lies between the deep fascia, peroneal surface of the fibula and the
anterior and posterior intermuscular septa. superficial peroneal nerve.
The posterior compartment is divided into deep and superficial compartments. The deep
posterior compartment contains tibial nerve.
The superficial posterior compartment contains and the medial sural cutaneous nerve.
19 ) d.
Penetrating injury to the abdomen with shock, patient should be taken directly for the laparotomy. In case of penetrating injury abdomen, with shock, peritonitis and evisceration, patient should be taken for laparotomy.
Otherwise patient should go for local wound exploration, and serial physical examination. If there is hemodynamic instability, patient should then go for exploration.
CT or DPL should be considered in case of significant decrease in hemoglobin (<3g/dl) or leukocytosis.
Ref : sabiston 20th edition
20 ) a
In hemodynamically stable children with isolated liver injury, conservative management should be done. Isolated liver injury means only parenchymal injury without involving hepatic vein, IVC, portal vein or hepatic artery.
Intervention should be done if there is hemodynamic instability, deteriorating clinical findings, blood requirement of 40ml/kg/day
In well equipped centres, angiography and embolisation of bleeding vessels can be done otherwise surgery is the standard of care.
Ref Sabiston page 1896