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Surgery Trauma MCQ

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Q ) A 25 year old male brought to the hospital  after being involved in a road traffic accident that occurred 50 minutes ago. His  initial BP at the scene of accident was  80/40 mm HG with a pulse rate of 120/min.

The paramedics administered 2 litres of normal saline in the ambulance and in the emergency department his BP is 110/70 with a pulse rate of 90/min.

He has tenderness in Left upper quadrant abdomen and USG reveals perisplenic fluid. Next step is to :  (#See more trauma MCQS) 

a) Take him for exploratory laparotomy

b) Shift him to ICU and observe

c) Do a CT scan of the abdomen

d) Put in a laparoscope and assess

Answer c

This Patient has a splenic injury due to blunt trauma abdomen. The  immediate management  depends on grade of splenic  injury  and response to IV Fluids. This patient is hemodynamically stable after IV fluids  and immediate laparotomy is not needed.

Direct shifting to ICU is also not the right choice because CT is required first and for more severe injuries patient can go to OT

Laparoscopy has no role in splenic injuries

Hirchsprung’s disease

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Q) False statement about Hirchsprung's disease is:

a) Male and Female have equal incidence

b) In approximately 8% of the patients entire colon is affected

c) After surgery constipation is the most common problem

d) Down syndrome can be seen in up to 3-5% patients 

HCC Cancer

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Q) Which of the following is true about screening in hepatocellular carcinoma (HCC Cancer) 

a) Alpha feto protein should be done 6 monthly

b) Ultrasound abdomen should be done 6 monthly

c) Candidates for liver transplant should be screened every 3 months

d) Nodules more than 2 cm should be followed up  more regularly

Answer b

Cirrhosis is prone for development of HCC. Screening has to be stringent.  Earlier ultrasound of liver and alpha feto protein were both used for screening

In 2009 Marrero et al demonstrated the suboptimal accuracy of AFP and after that it has been removed from the screening protocol and now only ultrasound is being done.

The screening recommendation is not for those patients with severe associated conditions and with advanced liver disease who are already considered for  transplant. So there is no screening for those who are already listed. Nodules more than 1 cm are highly suspicious where as in nodules less than 1 cm only 40% will be malignant.

Ref: blumgart 6th edition