AIIMS GI 2020

Fong Score

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Q. 56 year ls male is diagnosed with ca rectum and multiple liver metastasis . Which of the following is not a Poor risk factor according to Fong score

a) Node +
 b) Disease free interval more than 1 yr
c) 2 Liver Mets

d) Single metastasis 6 cm

Ans b 

Fong score is for Survival after treatment for metastatic colorectal cancer to the liver. It includes 5 variables for which score is alloted to each point

Nodal status of primary

Disease-free interval from the primary to discovery of the liver metastases of <12 months

Number of tumors >1,

Preoperative CEA level >200 ng/ml, and

Size of the largest tumor >5 cm

 

Steroid Refractory Ulcerative colitis

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Q) Not used in steroid refractory severe Ulcerative Colitis ( AIIMS 2020 Nov) 

a) Infliximab
b) Azathioprine
c) Cyclosporine
d) Surgery

Ans b- Azathioprine

Cyclosporine is  immunomodulator indicated for second-line therapy in the case of severe, steroid refractory ulcerative colitis. Treatment is usually initiated after 3 to 5 days of failed steroid response

Tacrolimus is appropriate as second-line therapy in patients with severely active ulcerative colitis unresponsive to steroids.

The use of various anti–tumor necrosis factor-α  (TNF-α) monoclonal antibodies ( infliximab)  is well supported in the case of
severe ulcerative colitis refractory to steroids. 

Indication Surgery crohn disease

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Q. Most common indication of surgery in Crohn's disease (#AIIMS GI )    (# Jejunum MCQS) 
a) Fistula
b) intractability
c) abscess
d) obstruction

Ans d Obstruction

Confusion between failure of medical therapy or obstruction as the ans. I have checked Bailey sabiston and Shackelford

2 books mention obstruction on top whereas one mentions failure of medical therapy. However with the improvement of medical management in the past decade, obstruction can be the ans

Crohn’s disease will require surgery at some time durin the course of their illness. Approximately 70% of patients will
require surgical resection within 15 years after diagnosis.

Indications for surgery include failure of medical treatment, bowel obstruction, and fistula or abscess formation. Most patients can
be treated with elective surgery,