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Anal malformation

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MCQ on Newborn with Abdominal Distension
Q) Newborn with abdominal distension on day 2, not passed meconium. There is absent anal orifice. What is the next step? # NEET SS 22
✅ Answer: A. Cross table X ray

🔍 Explanation:
The first step in such cases is to rule out congenital abnormalities of the spine, sacrum, kidneys, and heart.

- The second step is a Cross-table X-ray. If the X-ray shows perineal fistula, perform Anoplasty.
- If the X-ray shows rectal gas below the coccyx, perform a PSARP (Posterior Sagittal Anorectoplasty) with or without a colostomy.
- If the X-ray shows gas above the coccyx with associated defects, perform a colostomy.

🧠 Key Point: Cross-table X-ray is crucial to determine the presence of rectal gas and other associated defects, guiding the next step in management.

📘 Reference: Table 67.14 Sabiston

Hepatic adenoma

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Q Which of the following statement about hepatic adenoma is CORRECT?

a) It is more common in males

b) Ct shows a central stellate scar

c) Associated with cirrhotic liver

d) Risk of rupture and fatal hemorrhage is present 

Giving a clinical scenario of Hepatic Adenoma 

A 37 year old lady presents with right upper quadrant pain and nausea. She is otherwise well and her only medical therapy is the oral contraceptive pill which she has taken for many years with no ill effects. Her liver function tests and serum alpha feto protein are normal. An ultrasound examination demonstrates a 4cm non encapsulated lesion in the right lobe of the liver which has a mixed echogenicity and heterogeneous texture.

Colon Diverticulitis

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Q) A  65 year old lady presents with colon diverticulitis. ON CT Scan  She has colonic wall thickening and phlegmon .

Which grade of diverticulitis is it??   # NEET SS 23 MOck tests

a) Grade 0

b) grade I a

c) Grade I b

d) Grade ii

Spontaneous Pneumothorax

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Q) 15 year old boy, with Spontaneous pneumothorax. He is dyspneic with increased RR

Next best step

a) Vats and pleurodesis

b) Needle aspiration

c) Tube thoracostomy

d) Any of the above

Ans c

Primary spontaneous pneumothorax occurs in young patients without significant lung disease, whereas secondary spontaneous pneumothorax occurs in patients with COPD.

The most common cause of primary spontaneous pneumothorax is rupture of small apical blebs. Tube thoracostomy with water seal drainage is the usual first-line treatment of a moderate-to-large pneumothorax in a patient with a first-time occurrence.

Fuel for colonocytes

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MCQ on Primary Fuel for Colonocytes
Q) Primary fuel for colonocytes is
✅ Answer: C. Butyrate

🔍 Explanation:
Butyrate is the primary fuel for colonocytes. It is a short-chain fatty acid (SCFA) produced by the colonic flora when fermenting complex carbohydrates. The colonic epithelium and luminal bacteria form a crucial symbiotic relationship where bacteria produce butyrate, which provides essential nutrition to the colonocytes.

- **Antibiotics** disrupt this balance by reducing bacteria, leading to less butyrate, which negatively affects colonocyte function, often causing diarrhea.

🧠 Key Point: Butyrate, not glucose or lactate, is the key fuel for colonocytes, and its production relies on gut bacteria.

📘 Reference: NEET SS 2022 Paper