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Esophagus Perforation

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Q) Elderly healthy male with impacted denture. Removed endoscopically. Pt developed fever, dyspnoea and respiratory distress over 24 hrs. X-ray revealed Lt hydrothorax and mediastinal emphysema.

a) ICD and NG feeds

b) ICD and TPN

c) Cervical esophagectomy, FJ, debridement, ICD

d) Debridement, primary repair with buttress and ICD

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Management of GERD

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Q. 40 yr old lady with symptoms of GERD. Endoscopy shows hiatus hernia. Symptoms controlled with PPI. Next step

a) Leave alone

b) Manometry with Ph study

c) Ba swallow with Manometry

d) Ba swallow with Ph study

Answer

Fowler Stephen Surgery

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Q) Fowler Stephen Surgery is done for 

a) Epispadias

b) Hypospadias

c) Exstrophy of bladder

d) Cryptorchidism

Answer Free for all 

d) Cryptorchidism

 

Cryptorchidism - Fowler stephens surgery means division of short testicular vessels to mobilise the testis

The testicular blood supply is then dependent on collaterals from the vasal artery.

Surgeries for Epispadias are - 

Exstrophy 

1. MSRE- Modern stage repair of Exstrophy includes bladder closure, pelvic osteotomies followed by epispadis repair and uretheroplasty at 12-18 months

 Young-Dees-Leadbetter repair- Bladder neck reconstruction for exstrophy

 Kelly repair (RSTM) Radical soft tissue mobilization

2.  Complete primary repair for classic bladder exstrophy (CPRE) 

 

 

 

Primary Graft non function

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Q) Causes of primary graft non function are A/E

a) Recipient with renal failure

b) Microsteatosis > 60%

c) Cold ischaemia time > 12hrs

d) Non heart beating donor

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Discuss the causes of PNF-Primary non function of liver

Treatment of anal incontinence

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Q) Newest treatment for anal incontinence?
a. Sacral nerve stimulation
b. Artificial sphincter.
c. Repair of sphincter
d. Gluteus maximus graft

More Questions 

Answer a)

Sacral nerve stimulation is the newest modality in treatment for anal incontinence. In it electrodes are placed via the sacral foramina. The nerve supply of anal sphincter is similar to lower extremity so their stimulation can lead to contraction of various foot muscles.

Others are all older methods

Shackelford page 1779

Post cholecystectomy injury

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Q   Post cholecystectomy Injury, which is true?

a.       Bile duct leak in approx 1%

b.      Open cholecystectomy bile duct injury 0.5 to 1 %

c.       Most common cause of bile leak is cystic stump blowout and duct of lushka injury

d.      Type E injury is due to clipping of CBD by mistake