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Most common cause of death in acute pancreatitis

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Q. Most Common Cause of death in early acute Pancreatitis is ( Free Questions on Pancreas) 
 a) Renal Failure
b) Cardiac failure
c) Respiratory Failure
d) Uncontrolled Coagulopathy

Ans

c
Respiratory failure is the cause of death in the early phase (7 days). The pulmonary manifestations of pancreatitis include atelectasis and acute lung injury where as infective complications are the cause of death in late phase.

Rupture of Urinary Bladder

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Q) Rupture of Urinary Bladder : False statement is 

a) Associated with perineal hematoma

b) Emergency laparotomy is required in most cases

c) Investigation of choice is IVP

d) Blunt urinary bladder trauma is associated with pelvic fractures

Answer c

Both b and c are wrong but the question was like this only.

Rupture of urinary bladder is mostly extraperitoneal (80%) but can also be intraperitoneal (20%). Intra peritoneal rupture is usually when injury occurs in a full distended bladder. Haematuria may or may not be present.

Perineal injuries may be seen in most cases

Associated uretheral injury may be common.

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Ameloblastoma

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Q) Which of the following is true about ameloblastoma 

a) It is seen in children below 5 years

b) It is the most common odontogenic tumor

c) Mandible is the most common site 

d) It is highly malignant

Ans 

c Mandible is the most common site

It is the 2nd  most common odontogenic tumor. It is locally invasive and can cause severe deformity. It is seen in middle age group and not children.

Mandible is the most common site of origin seen in 80% cases. It is slow growing  but it remains locally aggressive with high rates of recurrence.

Given the choices above, c  is the most probable one.

Ameloblastoma is a benign, slow growing, locally invasive odontogenic tumor. It is the second most common odontogenic neoplasm. It accounts for 11% of all odontogenic tumors.

Ref:  http://atlasgeneticsoncology.org/Tumors/AmeloblastomID5945.html

Hemodynamic changes after pedicular clamping of Portal structures

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Q) 33 year old male is undergoing resection of right lobe of liver Which of the following hemodynamic  happens during pedicular clamping in liver transaction? 

a) Systemic vascular resistance decreases by 20%

b) Mean arterial pressure decreases

c) Cardiac index decreases by 10%

d) Preload to the heart increases

c-  Cardiac index decreases by 10%

Portal triad clamping is done to decrease blood loss during hepatic transaction. With the advancement in techniques in donor resection in living donor liver transplants, many centers are shifting away from this but in most centers this is still practiced.

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Conduits of Esophagus

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Q) What is true regarding gastric conduits to be used as esophagus replacement?

a) The right gastric and gastro epiploic arteries can be safely divided to bring stomach to the neck

b) For malignant diseases stomach is the most reliable conduit

c) Stomach has the least incidence of developing reflux esophagitis

d) For benign esophageal strictures stomach is the conduit of choice

Hepatic Adenoma

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Q) A 37 year old lady with history of oral contraceptives undergoes a CT scan for pain lower abdomen which also revealed a solitary 6 cm lesion in segment VI of liver.  Triple phase  Ct scan shows a lesion which  enhances in the arterial phase more at the margins and in the venous phase it moves towards the center. This lesion is :

a) Focal Nodular Hyperplasia

b) Haemangioma

c) Hepatic Adenoma

d) Hepatocellular carcinoma

Answer is C

Hepatic Adenoma is benign neoplasms of the liver. They are associated with 

  1. OCP use
  2. Androgen containing steroids
  3. Type I and III glycogen storage diseases

They are diagnosed on the basis of CT scans. Diagnostic features of CT Scan for hepatic adenoma are

  1. Non contrast- Heterogenous hypodense mass with areas of hemorrhage and necrosis
  2. Arterial phase shows rapid filling at the periphery then progressing to the center

Hepatocellular carccinoma shows - Rapid arterial filling with wash off in the portal venous phase

Hemangioma- Peripheral nodular enhancement

FNH- Central scar

Rf: Shackelford page 1564