Correct Answer A
Gall stone
REF: Sutton's textbook of radiology, Th edition, volume 1 page 713 Mercedes Benz sign/Seagull sign/Crow feet sign: Gall bladder stone if radiopaque has a stellate faceted appearance with gas containing fissures on the plain radiograph and is called as Mercedes Benz sign/Seagull sign or Crow feet sign
Correct Answer - A It is characterized clinically by medullary thyroid carcinoma (MTC) pheochromocytoma, and hyperparathyroidism. Approximately 70- 95% of individuals with MEN 2A develop MTC, 50% develop pheochromocytoma, and 15-30% develop hyperparathyroidism
Ref: Bailey and Love's Short Practice of Surgery, 24th Edition, Page 802; Harissons Internal Medicine, 18th Edition, Chapter 351
Correct Answer -D
Postoperative adhesions REF: Bailey & Love 25th edition page 1188, http:/lemedicine.medscape.comlarticle/774140overview "The most common cause of small-bowel obstruction (SBO) is postsurgical adhesions"
The most common causes of intestinal obstruction in adults are: Intestinal adhesions - bands of fibrous tissue in the abdominal cavity that can form after abdominal or pelvic surgery
In children, the most common cause of intestinal obstruction is telescoping of the intestine (intussusception).
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Correct Answer - C
Ans. is c i.e., Develops from jugular lymphatic sequestration
Cystic hygroma
Cystic hygroma is a swelling usually occuring in the lower third of the neck
It is most commonly seen in posterior triangle of the neck, but may also occur in axilla, groin & mediastinum
It results due to sequestration of a portion of the jugular lymph sac
from the lymphatic system.
It usually manifests in the neonate or in early infancy (occasionally
present at birth) The swelling is soft and partially compressible and invariably increases in size when the child coughs or cries.
The characteristic that distinguishes it from all other neck swellings is that it is brilliantly translucent.
...The cysts are filled with clear
lymph and are lined by endothelium.
Mostly these are multiple cysts but occasionally they can be
unilocular.
It may show spontaneous regression.
Treatment [Ref.: Sabiston 18/e p2053; Schwartz 9/e p1415]
There are two methods of
treatment: Surgical excision &
Sclerotherapy
Sabiston writes- "Complete surgical excision is the preferredtreatment; however, this may be impossible because of the hygroma
infiltrating within and around important neurovascular structures.
.
Because hygromas are not neoplastic tumors, radical resection with removal of major blood vessels and nerves is not indicated.
.Injection of sclerosing agents such as bleomycin or the derivative of
Streptococcus pvogenes OK-432 have also been reported to be
effective in the management of cystic hygromas. Intracystic injection of sclerosants appears to be most effective for macrocystic
hygromas, as opposed to the microcystic variety."
"The modern management of most cystic hygromas includes the
combination of surgical excision and image-guided sclerotherapy."-
Schwartz
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Correct Answer - A
Answer- A. Biliary atresia
Kasai operation is also known as hepatoportoenterostomy.
Biliary atresia is currently MC indication for pediatric liver
transplantation.
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Correct Answer - C
Answer- C. Varicose veins
Important causes of gangrene
Diabetes
PVD (Buerger's disease)
Trauma
Obesity
Atherosclerosis
Raynaud's disease
Frostibite
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Correct Answer - D
Ans. D: Ureterocele
The term ureterocele denotes a cystic ballooning of the distal end of the ureter.
This type of ureterocele is also termed orthotopic, since it
arises from a ureter with a normal insertion into the trigone.
An intravesical ureterocele results from the prolapse of the mucosa
of the terminal segment of the ureter through the ureterovesical
orifice into the bladder.
This prolapsed ureteral mucosa carries with it a portion of the
continuous sheet of the bladder mucosa around the orifice.
The prolapsed segment thus has a wall that consists of a thin layer of
muscle and collagen interposed between the bladder uroepithelium
and the ureter uroepithelium.
Since the terminal ureteral orifice is usually narrowed and partially
obstructed, and since there is no muscle support for the double
mucosal walls of the prolapsed segment, it dilates.
This dilated segment fills with urine and protrudes into the bladder.
On excretory urography, cobra head sign is classically seen with an
intravesical ureterocele.
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Correct Answer - D
Ans. is 'd' i.e., Spontaneous rupture of oesophagus
Chilaiditi's syndrome : Condition characterised by inter position of
small or large bowel between liver and right diaphragm.
Radiologically it gives gas under diaphragm.
Iatrogenic pneumoperitoneum : Certain procedure like peritoneal
dialysis, Iatrogenically air pushed before putting PD cannula to avoid
injury of viscera in such case gas under diaphragm can be seen.
All cases when intestine or viscera preforat we can get gas under
diaphragm.
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Correct Answer - D
Answer- D. 80
Routine use of noncontast CT Scan has completely revolutionized to
imaging evaluation of renal stone disease, nearly completely
replacing plain radigrpahs and X urography for diagnosis of acute
ureteral obstruction by renal stones.
Nephrolithiasis refers to the presence of calculi in the renal collecting system.
Nearly 10 % of the population will form a renal stone in their lifetime.
Sufficient calcium oxalate and phosphate is present in 80 % of the renal calculi for them to be radio-opaque on the plain radiographs.
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Correct Answer -C Ulcerated sebaceous cyst [Ref. Love & Bailey 23/e page 173, 595; Das text book of Surgery3/e p81] Repeat from May 04 . Cock's peculiar tumour is a sebaceous cyst linked growth that can resemble a squamous cell carcinoma The proliferating cyst is usually solitary, but it often arises from a simple trichilemmal cysts in the hair follicle epithelium.
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Correct Answer - A
Both acute and chronic rejection may result in hypertension. The former causes acute fluid retention and plugging of peritubular capillaries with inflammatory cells. This may progress to intimal swelling and medial necrosis and eventuate in ischemia secondary to endothelial proliferation and obliteration of small vessels. Chronic rejection, thought to be related to protracted humoral injury, results in obliteration of capillaries via the development of intimal hyperplasia. Cyclosporine has a vasoconstrictive effect which, through activation of the renin-angiotensin system, may lead to hypertension. RTAS is responsible for hypertension in 4% to 12% of renal allograft recipients. It responds well to percutaneous angioplasty. A careful trial of angiotensin-converting enzyme inhibitors may be diagnostic of RTAS. Recurrent disease such as membranoproliferative glomerulonephritis and focal glomerular sclerosis may result in significant hypertension in renal allograft rejections.
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Correct Answer - A
Ans. A. Amiodarone
V-Fib or VF is the most common rhythm that occurs immediately
after cardiac arrest. In this rhythm, the heart beats with rapid, erratic
electrical impulses.
Treatment:
Shock / Defibrillation: every 2 minutes in a single one shock,
successive, shockable increments
200 joules - Followed by immediate CPR for 2 minutes / give and
circulate a drug(s)
300 joules - Followed by immediate CPR for 2 minutes / give and
circulate a drug(s)
360 joules - Followed by immediate CPR for 2 minutes / give and
circulate a drug(s)
Drugs :
Give Epinephrine 1mg of a 1:10,000 solu,on every 3 to 5 minutes
[No Limit]
Give either:
Amiodarone [if not contraindicated, can be given 2x]: 300mg first
dose / 150mg second dose at 3 to
Lidocaine: First dose: 1mg/kg or 1.5 mg/kg. Can repeat it at half the
original dose up to a total of 3 mg/kg [Second and remaining doses
are given at either 0.5mg/kg or 0.75mg/kg depending on your star,ng dosage.]
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Correct Answer - D
Answer- D
Historically, the most common site of gastrointestinal (GI) carcinoid
tumors was the appendix.
Currently, however, the most common site of carcinoids in the GI tract is the small intestine (30%), followed by the rectum (19.6%).
In most studies, the appendix is only the third most common site of GI carcinoids, and in some studies, it is the fourth most common.
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Correct Answer - C
Ans. is c) i.e. depth of penetration of bowel walls
Schwartz writes
"Regional lymph node involvement is the most common form of
spread of colorectal carcinoma and usually preceeds distant metastasis or the development of carcinomatosis.
the T stage (depth of invasion) is the single most significant predictor of lymph node spread."
From the above given lines 'depth of penetration of bowel wall'
appears to be predictor of distant metastases as well.
CEA level is a marker for recurrance of colorectal ca after surgical resection.
Though its preoperative levels has some prognostic significance, it is
not a predictor for distant metastasis.
CEA level is used to follow up post operative cases of colorectal
cancer, for early detection of recurrence
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