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CEA

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True regarding CEA is 

  1. Low specificity
  2. Falls after 1 week of surgery to baseline
  3. Preoperative high value is good prognostic marker
  4. Follow up, first test of CEA in 8-10 days followed by weekly tests thereafter

Answer after Q 20

Pediatric liver transplant

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Q) Most common indication for Pediatric liver transplant (DNB SS) 
A. Biliary atresia
B. Metabolic diseases
C. Alagille syndrome
D. HCV

Free answer 

a 

Biliay atresia

MOst common cause or liver transplant in children.

Presents as persistent jaundice after birth. Etiology is not clear

Findings include absent extrahepatic ducts and gallbladder.

Biopsy is diagnostic

Dieulafoy lesion

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Q) Dieulafoy lesion which is false? (AIIMS 2018)

A. Most of the bleed cannot be visualised due to small mucosal defect lies over large arterial bleed.
B. Large 1-3 mm artery in the submucosa is the source
C. MC in the greater curvature
D. Found within 6 cm from GEJ

Switch in Dextraposition of great vessels

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Q . Factors that preclude the use of a single-stage arterial  switch reconstruction of dextrotransposition of the great vessels include:
A. Age older than 6 weeks with a left ventricular pressure of less than 50% of systemic pressure.
B. Dynamic left ventricular outflow tract obstruction.
C. Intramural coronary artery anatomy.
D. Subpulmonary VSD.

Answer for premium 

Anti Rejection drugs

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Q) Most nephrotoxic drug is 

A. Cyclosporine
B. Sirolimus
C. Azathioprine
D. Steroids

Answer

These are immunosuppressants used after solid organ transplants. These drugs have a lot of side effects.

Answer is here  

 

Parkland formula

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Q )  During fluid resuscitation in a burns patient using Parkland’s formula, volume of fluid given in first 8 hours is ?
A. 50%
B. 25 % 
C. 75 % 
D. 100 % 

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Ans a

The modified Parkland formula

TBSA% burn × weight (kg) × 4 = volume in mL
The first half is given in 8 hours and the second over 16 hours to complete the 24-hour resuscitation time frame.

Developed by Dr. Charles Baxter in the 1960s at the Parkland Memorial Hospital in Texas, this formula serves as a cornerstone in determining the initial fluid requirements to stabilize burn victims during the crucial early hours following injury.

Although the Parkland Formula offers a valuable framework for fluid resuscitation, it's important to note that individual patient variability, coexisting injuries, and evolving clinical conditions necessitate close monitoring and adjustment of the resuscitation plan. Over-resuscitation can lead to complications such as pulmonary edema, while under-resuscitation can result in inadequate tissue perfusion and organ failure.

Bailey 28th  671

Truncus arteriosus

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Q ) Which of the following statements about truncus  arteriosus is false?
A. Most infants do well without operations until late childhood.
B. Cyanosis is a late feature
C. Most infants present with congestive heart failure.
D. Repair requires a conduit from right ventricle to pulmonary arteries.

Answer 

In Truncus arteriosus there is a single arterial trunk arising from the ventricles, with single dysplastic valve with

semilunar leaflets and a subvalvular VSD..

Untreated, most infants  do not survive beyond 6 months. Cyanosis is usually not present early, because mixing
mainly occurs at VSD level and the arterial oxygen saturation is generally greater than  85%, but............Read on 

Diverticulitis

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Q ) Hincheys grade III Diverticulitis. Management most likely to follow more interventions after an index operation is

a) Laparoscopic irrigation and exploration

b) Sigmoid Colectomy+Hartman’s

c) Primary repair with omental patch and peritoneal toilette

d )Sigmoid Colectomy with colorectal anastomosis and diverting ileostomy

Grade III diverticulitis is generalized peritonitis.

Answer for premium Q 10 

Warfarin

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Q Warfarin sodium acts by
A. Inhibits carboxylation of  Factor VII, IX, X 
B. Factor X a inhibition
C. Thrombin inhibitor and X a inhibition
D. IX, XI, XII, factor and thrombin inhibition