Q 11) A 59 year old male alcoholic male presents with history of upper GI bleed of 1 day duration. During the day he has had three episodes of bleeding each time about 150 ml. Blood is fresh and not associated with retching. He has a history of long standing alcohol intake. What will be the most likely cause of GI bleed
a) Mallory weiss tear
b) Esophageal varices
c) Gastric ulcer
Q 12 ) 75 year old man complains of obstipation for 2 days. He has taken laxatives but continues to have worsening pain and distension associated with vomiting. He underwent b/l knee replacement 2 weeks back. He was on Inj fentanyl for pain control. He is on antihypertensives and lipid lowering agents for the past 15 years.
On examination he is afebrile, oriented, pulse rate of 100 min/, BP 120/60 and abdomen is distended with mild tenderness. There are no signs of peritonitis, bowel sounds are sluggish.
TLC is 6,500, and potassium is 3.2 . All other blood tests are normal. X ray abdomen and CT abdomen shows dilated large bowel loops and oral contrast upto splenic flexure.
What is the probable diagnosis
a) Ischemic colitis
b) CMV colitis
c) Colonic Pseudoobstruction
d) Caecal volvulus
Q13) A 68 year old man undergoes repair of infra renal aortic aneurysm. On 2nd POD he has abdominal pain, bloody diarrhea and tachycardia. BP is 120/70. Abdomen is mildly distended and tender especially in the left lower quadrant.
How will you proceed
a) Send stool for clostridium and spores
b) CT Abdomen
c) Exploratory laparotomy
d) Higher antibiotics
Q14) A young 18 years old unrestrained car driver has an head on collision with a truck and becomes unconscious. He is intubated on the site of accident and resuscitated with IV fluids. He is brought to the emergency in a state of shock,( BP 90/60 and pulse 120/min) but opens eyes on commands. On examination he does not have pallor but neck veins are distended.
There are no signs suggestive of head or spine injury. Xray chest reveals normal cardiac chambers, no free gas and mild pleural effusion on left with no evidence of fracture ribs.
What will be the next step of management
a) Resuscitation and simultaneous CT thorax
b) Resuscitation and simultaneous Echo cardiography
c) Exploratory laparotomy
d) Chest tube drainage left side
Q15. A 38 year old male patient has symptoms suggestive of ulcer disease. Endoscopy shows 3 ulcers in proximal jejunum ranging in size from 0.5 to 1.5 cm. Biopsy is taken which is benign and a course of antibiotics is given for H. Pylori. The ulcers and symptoms are persistent What should you do next?
a) Repeat Biopsy
b) Change the antibiotic
c) CT abdomen
d) Serum gastrin