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Amoebic Liver abscess

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Q) Not true about amoebic liver abscess

a) Most common liver enzyme elevated is ALT
b) Metronidazole and luminal amebicide needed in all cases
c) In peritonitis due to amoebiasis perforation of colon are less than perforation of liver
d) 5% to 15% of patients with ALA may be resistant to metronidazole

 

Answer
The cecum is the most common site of amebic colitis, and the right lobe of the liver is more commonly affected because of drainage
of the right portal branch from the right side of the colon. The condition usually starts as diffuse amebic hepatitis; liver cells
undergo liquefactive necrosis

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Colon cancer genetics

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 False in Colo Rectal Cancer  pathogenesis

a) APC mutation FOR Aberrant crytpt foci formation

b) KRAS for ACF to Early Adenom

c) DCC for Intermediate to Late Adenoma

d) P53 for Large Adenoma to CRC

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Acute mesenteric ischemia

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Q)  All are  findings in acute mesenteric ischemia findings except?

a) Slow filling intramural vein

b) Spasm of arterial arcade / distal vessels

c) String of sausages/beaded appearance

d) Dilated and ring enhancement of SMV in CT

Answer 

 

Acute diverticulitis

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Q) False regarding the management of Acute Diverticulitis, Sigmoid colon inflammation and Fat stranding in CT ?

a) Outpatient treatment in most cases

b) Do a colonoscopy after the resolution of acute symptoms

c) Elective Colectomy to be done

d) IV antibiotics to be started`

The pathogenesis of acute diverticulitis is often attributed to the obstruction of diverticula by fecaliths, leading to increased intraluminal pressure, bacterial overgrowth, and subsequent inflammation or perforation

Answer Free  c

Sigmoid diverticulitis can be complicated and uncomplicated

Complicated means diverticulum associated with abscess, perforation, obstruction, fistula 

This question is about an uncomplicated acute diverticulitis 

It can be managed in outpatient setting

It requires IV antibiotics and diet modification

After resolution of symptoms, colonoscopy is to be done after 6 weeks to rule out the presence of other diverticula and neoplasm

Colectomy is not required in all cases. Current recommendations suggest that the decision for surgery should be individualized, taking into consideration the frequency and severity of recurrences. The patient’s overall medical condition and comorbidities should also be included in the analysis

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Acute diverticulitis

SMA syndrome

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Q True in SMA syndrome

  1. Causes Medial Arcuate Ligament syndrome
  2. Causes nut cracker syndrome
  3. Low AM distance and Narrow AM angle <25 degree is sensitive finding
  4. It can be treated by releasing the DJ and keeping duodenum to the right of the artery

Answer 

 

GIST Stomach

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Q ) Antral GIST 1cm incidentally found on UGIE. True regarding its management

a) Surgical resection resection of GIST (More questions on GIST here) 

b) Endoscopic resection

c) Resection required if EUS suggests irregular border with cystic spaces

d) Endoscopic surveillance, if size >2cm then resect

Answer ( You need to be a premium member to see this) 

GIST are usually found in the stomach (40% to 60%), small intestine (30%), and colon (15%). Clinically they appear  in patients older than 50 years.

They generally have an equal male-to-female ratio or a slight male predominance.

They are rarely associated with familial syndromes such as GISTparaganglioma syndrome (Carney triad), neurofibromatosis 1, and von Hippel-Lindau disease, but most develop de novo. 

natural history breast cancer

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Q. True about breast cancer is?

a) Doubling time of breast tumor is 1 month

b) Skip metastasis in level iii lymph nodes is common

c) Lungs are commonly involved by direct invasion

d) Dimpling of skin is due to shortening of cooper's ligaments

Ans

Hyperbaric oxygen therapy for Radiation Proctitis

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Q)  A 60 year old male is contemplating hyperbaric oxygen therapy for  radiation proctitis. Which of the following is not true regarding this?

A. Indicated in acute radiation proctitis but not in subacute or chronic radiation proctitis
B. Oxygen increases the growth of residual tumor and hence tumor should be completely
resected
C. Complications include Parkinsonism, barotrauma
D. Usually 30-40 sessions are required for treatment

Ans  a

This statement is not true because hyperbaric oxygen therapy (HBOT) is not only indicated in acute radiation proctitis but can also be beneficial in subacute and chronic radiation proctitis. Studies have shown that HBOT can promote healing in chronic radiation injuries as well.

Hyperbaric oxygen overcomes chronic tissue hypoxia in radiation damaged tissues and with repeated sessions induces growth of regenerative tissue, capillaries, and epithelium. Successful therapy may take multiple sessions. 18 to 60 treatments

HBO treatments for hypoxic wounds are usually delivered at 1.9 to 2.5 atm for sessions of 90 to 120 minutes each. Treatments are given once daily, five to six times per week and should be given as an adjunct to surgical or medical therapies. Clinical evidence of wound improvement should be noted after 15 to 20 treatments.

Complications of HBO therapy are caused by changes in atmospheric pressure and elevated PO2. Middle ear barotrauma, ranging from tympanic membrane hyperemia to eardrum perforation, is the most common complication.

Pneumothorax  brain oxygen toxicity, manifested by convulsions
resembling grand mal seizures; oxygen lung toxicity, resulting from damage from oxygen free radicals to lung parenchyma and airways and ranging from tracheobronchitis to full-blown respiratory distress syndrome; and transient myopia.

Absolute contraindications to HBO therapy are

(1) uncontrolled pneumothorax

(2) current or recent treatment with bleomycin or doxorubicin (potential aggravation of cardiac and pulmonary
toxicity), and

(3) treatment with disulfiram (increases risk of developing oxygen toxicity).

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