Q 6) A 50 year old male with Crohn disease of ileum had intestinal obstruction. He underwent resection and anastomosis of ileum. 10 days later he arrived in ER with 1l bilious leak from the drains. He is managed with antibiotics, TPN and nil per oral regime. 4 days later his ABG is ph 7.24, PO2 98, PCO2 40 and anion gap of 10.
What is the most likely cause of this ABG
a) Renal failure
b) Diabetic ketoacidosis
c) Hypovolemia
d) Small bowel fistula
6) d- Small bowel fistula
This patient has a high output fistula with normal anion gap (10-15). The patient has metabolic acidosis with normal anion gap which happens with loss of bicarbonates (Pancreatic fistula, diarrhea, small bowel fistula) or gain of chlorides (excessive Saline infusion)
Q7) Which of the following is not associated with peptic ulcer disease
a. Zollinger Ellsion syndrome
b. Primary hyperparathyroidism
c. Cirrhosis
d. Pernicious Anemia
7) d
Pernicous anemia has achlorhydria in which the chances of ulcer formation are rare.
Peptic ulcer is associated with a host of conditions.
It includes
Infection
Helicobacter pylori
HSV
CMV
Helicobacter heilmannii
Other rare infections: TB, syphilis, mucormycosis, etc
Hormonal or mediator-induced, including acid hypersecretory states
Gastrinoma (Zollinger-Ellison syndrome)
Systemic mastocytosis
Basophilia in myeloproliferative disease
Antral G cell hyperfunction (existence independent of H. pylori is debatable)
Drug exposure
NSAIDs and aspirin including low dose aspirin
Bisphosphonates (probably when combined with NSAIDs)
Clopidogrel (when combined with NSAIDs or in high risk subjects)
Corticosteroids (when combined with NSAIDs)
Sirolimus
Spironolactone (probable, no data with NSAID cotherapy)
Mycophenolate mofetil
Potassium chloride
Chemotherapy (eg, hepatic infusion with 5-fluorouracil)
Post surgical
Antral exclusion
Post-gastric bypass
Vascular insufficiency including crack cocaine use
Comorbid ulcers associated with decompensated chronic disease or acute multisystem failure
Stress intensive care unit ulcers
Cirrhosis
Organ transplantation
Renal failure
Chronic obstructive pulmonary disease (secondary to smoking)
Q8) Which of the following is associated with metabolic alkalosis
a) Gain in fixed acid
b) Loss of base
c) Rise in base excess
d) Hyperkalemia
8) c
Increase in base excess is associated with metabolic alkalosis.
Metabolic alkalosis is associated with loss of fixed acids and hypokalemia. Classic example is vomiting in pyloric stenosis.
Q9) True about reactionary haemorrhage after cholecystectomy
a) It commonly occurs with in 24 hours after surgery
b) It is caused due to infection
c) Mostly because of sloughing of tissues
d) It is more common than primary haemorrhage
9) A
Reactionary hemorrhage is less common than primary hemorrhage and is most commonly due to dislodgement of clot or over aggressive resuscitation. It is not due to infections
It can be due to the slippage of knots or sutures. Most of the times re exploration has to be carried out
