b) Type I choledochal cyst is the most common type
c) Type III is also called as choledochocele
d) Type II choledochal cyst is diverticular disease
71 a
Original classification of choledochal cysts was given by Alonso Lej and later modified by Todani.
Type I most common and and is fusiform dilatation
Type II saccular diverticulum
Type III dilatation in the intramural duodenum also called choledochocele
Type IV
IVa Both intrahepatic and extrahepatic biliary tree
IV b Multiple extrahepatic biliary
Type V - Caroli disease
Intrahepatic ducts only can be single or multiple
Ref Sabiston page 1510
Q72 ) How should you transport amputated finger?
a) Plastic bag with wet ice inside
b) Plastic bag with wet ice outside
c) Plastic bag with dry ice outside
d) Over sterile gauge
72 ) b
Amputated finger should be clean of debris and it should be carefully wrapped in a sterile towel or gauge which is moistened with ringer lactate to prevent desiccation. It is placed in a plastic bag and transported in an insulated bag with ice outside at a temp of 4 degree celcius
Direct contact of ice with the finger should not happen.
Q73 ) According to Siewert classification tumors at GE junction are
a) Type I
b) Type II
c) Type III
d) Type IV
73) b
Type I Lower (centre located within between 1-5cm above the anatomic OGJ)
Type II Real GE junction (within 1cm above and 2cm below the OGJ)
Type III (2-5cm below OGJ)
This classification has only 3 subtypes
According to the Siewert-Stein classification,
Type I tumour 25% approx
Type II - Most common 49%
Type III was present in 25%
This classification helps in deciding the operative management and unified pre op classification
Types of Surgery
Type I cancer--depending of the size of the tumour--distal 2/3 oesophagectomy with the resection of the proximal lesser curve of the stomach or total gastrectomy or THE
In patients with types II and III cancers total gastrectomy
Q 74) In LYMPHEDEMA STOCKING class A pressure is ? a. 20 -30mmHg b. 30-40 mmHg c. 40-50 mmHg d. 50-60
Ans 74) a
Compression garments are the mainstay of management for lymphedema. It provides compression with a high resting pressure and can follow the contour of the limb as the swelling reduces.
Pressure should be graduated from bottom above, 100 % at ankle, 70% knee, 50% thigh and 40% groin
Ankle brachial pressure index has to be serially followed to prevent too tight bandaging. Initially when the swelling is too much non elastic compression is used and later compression in maintenance phase.
The British System (classes I: 14–17 mmHg; II: 18–24 mmHg; III: 25–35 mmHg)
International (USA) (classes I: 20–30 mmHg; II: 30–40 mmHg; III: 40–50 mmHg; IV 50–60 mmHg)
Ans Bailey page 936
Q75) Starburst appearance is seen in
a) Mucinous cystic neoplasm
b) Serous cystic neoplasm
c) IPMN
d) Pseudocyst of pancreas
75) b
Serous cystic neoplasm
CT scan in SCN show starburst appearance in 20% of cases in which there is central calcification with radiating septa.
They are large well circumscribed masses, and on microscopy they appear as multiple lobulated small cysts which are glycogen rich.
Their most common position is head of pancreas and present with pain, abdominal mass and weight loss and obstructive jaundice.
