Q91) Newest treatment for anal incontinence?
a. Sacral nerve stimulation
b. Artificial sphincter.
c. Repair of sphincter
d. Gluteus maximus graft
Q 92) Which of the following is tumoricidal?
a. 1 percent cetrimide.
Q93) Treatment of hypocalcemia tetany
a. Oral calcium
b. Injectable 10 percent calcium gluconate
c) PTH injections
d) vitamin D
Q94 ) False statement about emergency airway management
a) Cricothyroidotomy is preferred
b. Skin incision is vertical.
c. Membrane incision is vertical
d. Airway is prepared before cricothyroidotomy
Q95 ) Allen's test is done for
a) Patency of ulnar and radial artery
b) Scalene muscle test in thoracic outlet syndrome
c) Hyperabduction test
d) Patency of Subclavian artery
Q96) Most common content of Morgagni foramen
b. Small intestine.
c. Transverse colon.
Q97 ) True about Z plasty.
a. 3 limbs equal with 45 degree.
b. 3limbs equal 60 degree.
c. All limbs equal with 45 degree
d. All limbs equal with 60 degree
Q 98 Bi lobed graft is used in which reconstruction
Q99) Paradoxical breathing is seen in
a) Poland syndrome
b) Flail chest
c) Pectus excavatum
d) Pectus carinatum
Q100) All are premalignant in carcinoma GB except
a. PSC ,
b. Porceline GB
c. Multiple 2 cm stones.
d. Choledochal cyst
Sacral nerve stimulation is the newest modality in treatment for anal incontinence. In it electrodes are placed via the sacral foramina. The nerve supply of anal sphincter is similar to lower extremity so their stimulation can lead to contraction of various foot muscles.
Others are all older methods
Shackelford page 1779
Cetrimide 1% is mix of ammonium salts that have anti cancer activity. It inhibits H+ ATP synthatase inhibiting proliferation.
After rectal tumor resection, lumen is irrigated with 1% cetrimide
Saline/Hypertonic saline has no anticancer activity
Other two are tumoigenic
Symptoms of hypocalcemia include neuromuscular irritability, with perioral and extremity numbness that may progress to carpopedal spasm and tetany.
Classic signs include Trousseau and Chvostek's signs.
- Asymptomatic outpatients can be supplemented orally (1-3 g/day)
- Symptomatic patients need to be monitored and treated.If symptoms are mild, large doses of oral calcium are often adequate (especially in the postparathyroidectomy patient).
- Severely symptomatic patients should be repleted with IV calcium until symptoms resolve and an appropriate oral regimen is tolerated. Doses of 100-300 mg of elemental calcium (10 mL of calcium gluconate contains 90 mg elemental calcium; 10 mL of calcium chloride contains 272 mg elemental calcium) in 50-100 mL of 5% dextrose in water (D5W) should be given over 5-10 minutes. This dosage raises the ionized level to 0.5-1.5 mmol and should last 1-2 hours (medscape)
Ref : NMS 5th edition
Ans 94) d
Emergency cricothyroidotomy is done when tracheostomy is difficult or time consuming. Skin incision is vertical from inferior border of thyroid cartilage to suprasternal notch
Membranous incision is also vertical at the level of 2nd, 3rd and 4th ring.
There is no time for airway preparation.
Allen's test is done to assess patency of ulnar artery when radial artery harvest is planned as a conduit in CABG.
Patient makes a fist while the doctor compresses both ulnar and radial arteries
Hand is relaxed and ulnar artery is released. The time taken for redness to return is seen.
If colour returns in upto 7 secs, ulnar artery is patent and radial artery graft can be harvested
Other two tests are for thoracic outlet syndrome.
Ref Bailey pg 829
here are two congenital sites where abdominal viscera can herniate into the chest leading to respiratory distress
• The foramen of Morgagni. A hernia in the anterior part of the diaphragm with a defect between the sternal and costal attachments. The most commonly involved viscus is the transverse colon.
The foramen of Bochdalek. Through the dome of the diaphragm posteriorly.
Ref BAiley 871
Z plasty is a technique of scar revision. It is a transposition flap in which both rotation and advancement is done.
It is particularly useful for a scar that crosses relaxed skin tension lines. The thickness of the flap should be carefully decided and ideally should be below the subdermal plexus and subcutaneous fatty tissue.
In this technique the incisions are designed to create a Z shape with the central limb aligned with the part of the scar that needs lengthening or re-aligning. The traditional 60° angle Z-plasty will give a theoretical lengthening of the central limb of 75%.
Bilobed flap is double transposition flap used in skin defects of face. It was first used for nasal tip defects.
Commonly used for
- Ala: Nose-cheek flap
- Dorsum: Front-glabellar flap, bilobed flap, and sliding flap (lateral region)
Tip: Frontal island flap and bilobed flap
Flail chest is defined as fracture of three or more ribs at two or more places. It is associated with paradoxical breathing and pulmonary contusion . It can be life threatening.
The paradox is that on inspiration the loose segment of chest wall is displaced inwards. Because of pain and lung contusion hypoxia develops rapidly .
Treatment is oxygen administration and analgesia.
In Pectus excavatum - sternum is depressed with dish shaped deformity of ribs on both sides. It does not cause respiratory problems
In Pectus carinatum (pigeon chest) Sternum is elevated above the level of ribs and again most people are asymptomatic
Ref Bailey : 872
c Multiple 2 cm stones
Presence of gallstones is considered to be the primary risk factor, and larger stones (>3 cm)
carry an increased risk of cancer development.
Other risk factors include entities that may also cause inﬂammation in the gallbladder wall, such as APBJ, choledochal cysts, and PSC.
Porcelain gallbladder, and carries a risk of cancer development, as does the presence of a gallbladder polyp larger than 10 mm.
Sabiston page 1513