NEET SS Surgery Questions
NEET SS (2018)
Q1) What is false regarding a keloid?
a) Keloids contain type IV collagen on HPE
b) They extend beyond the boundaries of the incision
c) Keloids are common on the trunk and face
d) Most of them are refractory to medical and surgical treatment
Q2. True statement about pre operative skin preparation
a) Hair removal should be done with razors
b) Pre operative shaving should be done 1 hour prior to surgery
c) One application of alcoholic antiseptic is adequate
d) Use of incision drapes has reduced Surgical site infection rates drastically
Q3, Not a facial node
d) Infra orbital
Q4 ) Which is the strongest layer of the intestine?
c) Muscularis propria
d) Muscularis mucosa
Q5) Which is false about crystalloid solutions?
A. NS has Sodium 154 meq/l
B. NS has Chloride 154 mEq/l
C. RL contains Lactate but doesn’t contain calcium
D. RL contains sodium potassium calcium and lactate
Q . Restrictive strategy of transfusion in acute GI bleed all are true except?
A. Should be started at a hemoglobin < 7 g/dl
B. Will not alter the risk of rebleed
C. Child A and B patients had significantly lower morbidity
Characterstics of keloids
- Extend beyond the boundaries of scar
- They do not regress with time and are refractory to treatment
- Common in dark colored people and occur above the clavicle, upper trunk and face
- Keloids can not be prevented
- They contain disorganised Type I and Type III collagen
Ref Sabiston 20th page 142
Prevention of SSI is key to successful surgery.
One application of alcoholic antiseptic reduces bacterial count by 95% and is enough. Adequate time should be given to it to dry.
Shaving should be done just before the surgery
Razors should not be used for hair removal. Clippers should be used.
Ref: Bailey Page 62
Submucosa is the strongest and most important layer for intestinal anastomosis. It has fibroblasts that will ultimately release collagen and hold the anastomosis together. This layer should be fully incorporated in the anastomosis.
Inverted Vs everted anastomosis of intestine debate has been log going on but now many prefer inverted because mucosa is exposed to mucosa and eventually degrades joining the two submuoca together to cause healing by primary intention.
REF Schakelford: page 923
Lactated Ringer's is composed of sodium chloride 6 g/L, sodium lactate 3.1 g/L, potassium chloride 0.3 g/L, and calcium chloride 0.2 g/L.
Lactated Ringer's contains ions of sodium 130 mEq/L, potassium 4 mEq/L, calcium 2.7 mEq/L, chloride 109 mEq/L, and lactate 28 mEq/L.
Lactated Ringer's has an osmolarity of 273 mOsmol/L, pH of 6.5, and caloric content of 9 kcal/L.
MIsc answer b)
this Question is from this trial-- https://www.nejm.org/doi/full/10.1056/nejmoa1211801
Transfusion Strategies for Acute Upper Gastrointestinal Bleeding
The probability of survival was slightly higher with the restrictive strategy than with the liberal strategy in the subgroup of patients who had bleeding associated with a peptic ulcer (hazard ratio, 0.70; 95% CI, 0.26 to 1.25) and was significantly higher in the subgroup of patients with cirrhosis and Child–Pugh class A or B disease (hazard ratio, 0.30; 95% CI, 0.11 to 0.85), but not in those with cirrhosis and Child–Pugh class C disease
In the restrictive-strategy group, the hemoglobin threshold for transfusion was 7 g per deciliter, with a target range for the post-transfusion hemoglobin level of 7 to 9 g per deciliter.In the liberal-strategy group, the hemoglobin threshold for transfusion was 9 g per deciliter, with a target range for the post-transfusion hemoglobin level of 9 to 11 g per deciliter.
Mortality at 45 days was significantly lower in the restrictive-strategy group than in the liberal-strategy group: 5% (23 patients) as compared with 9% (41 patients) (P=0.02)