Q) Paradoxical breathing is seen in
a) Poland syndrome
b) Flail chest
c) Pectus excavatum
d) Pectus carinatum
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Clinical Paediatric surgery Question
Q. A 6 months old baby is brought to the emergency with continuous crying and drawing his legs up for 1 day. He has vomiting and passage of bloody stools. On examination a lump is found in right hypochondrium. What is the best clinical diagnoses?
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Tetrology of Fallot
Q Autopsy finding in a patient who dies of Tetrology of Fallot is
a) Brachiocephalic vein draining into the left renal vein
b) Inferior vena cava (IVC) draining to the superior mesenteric vein
c) Atrial Septal Defect (ASD)
d) Decreased vascularity of the lung field
Fontan Procedure
Q 24 Contraindication of Fontan procedure?
a) 20 year old male
b) Severe MR
c) Right pulmonary artery stenosis
d) Left ventricular end diastolic pressure of 20 mm Hg
24) d
Fontan procedure is for tricuspid atresia and is done when there is low pulmonary vascular resistance. For the same reason it is not done in neonates.
In Tricuspid atresia, venous blood does not go to right ventricle and there is mixing of venous and arterial blood in aorta which leads to decreased oxygenation.
Most infants with tricuspid atresia have restrictive pulmonary blood flow. To improve systemic oxygentaion they undergo modified Blalock-Taussig shunt, which is a small polytetrafluoroethylene (PTFE) graft to connect the subclavian artery and a pulmonary artery.
Criteria for Fontan procedure are
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Age older than 4 years
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Sinus rhythm
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Normal systemic venous return
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Normal right atrial volume
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Mean pulmonary artery pressure less than 15 mm
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Pulmonary arteriolar resistance less than 4 Wood units/m 2
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Pulmonary artery–aorta ratio more than 0.75
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Left ventricular ejection fraction more than 0.60
Current absolute contraindications are a pulmonary vascular resistance above 4 Wood units/m2, severe hypoplasia of the pulmonary arteries, and severe diastolic dysfunction of the left ventricle.
Investigations in lower GI Bleed
Q) Least useful investigation in a patient with recurrent Lower GI bleed, multiple upper and lower GI endoscopies negative?
a) BMFT
b) Double balloon enteroscopy
c) Capsule endoscopy
d) Push endoscopy
Answer: a) BMFT
Investigations in lower GI bleed should be specific and less time consuming.
Small bowel enteroclysis (BMFT), which uses barium and contrast infusion, has a very low yield and is poorly tolerated, hence rarely used.
Capsule endoscopy is excellent for stable patients, with success rates up to 90% in detecting small bowel pathology.
Push enteroscopy can reach 50–70 cm beyond the ligament of Treitz and permits both diagnosis and therapy; success ~40%.
Double-balloon enteroscopy provides complete small bowel evaluation and allows biopsy and therapy, with yield 77–85%.
Therefore, BMFT is the least useful investigation.
Foramen of Morgagni
Q) Most common content of Morgagni hernia is :
a) Stomach
b) Small intestine
c) Transverse colon
d) Liver
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Allen test
Q) Allen's test is done for
a) Patency of ulnar and radial artery
b) Scalene muscle test in thoracic outlet syndrome
c) Hyperabduction test
d) Patency of Subclavian artery
Discuss the uses of allen's test and where it is used, how it is done
Emergency airway management
Q) False statement about emergency airway management
a) Cricothyroidotomy is preferred
b. Skin incision is vertical.
c. Membrane incision is vertical
d. Airway is prepared before cricothyroidotomy