AIIMS GI 2020

Anti rejection drugs

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Q) Anti Rejection medicine which also prevents tumor recurrence? MCH Questions ...

a) M tor inhibitors

b) IL2 blockers

c) Steroids

d) Azathioprine

Ans a) mtor inhibitors 

One Question is always asked about anti rejection medicines, Salient points i am enumerating

  1. Three drug regimen is classic includes IL2 blocker, Mycophenolate and steroids which are tapered . IL 2 blocker  Tacrolimus is used more than Cyclosporine ( cyclosporine less used now). IL2 blocker side effects are hirsutism, hyperkalemia, gum hypertrophy etc) 
  2. Mycophenolate is preferred over azathioprine . Both cause fall in cell lines
  3. Steroids have many side effects like weight gain, cataract, infections and are used in tapering dose

M-tor inhibitors are sirolimus and Everolimus which are used when transplant is done for HCC, IT has anti tumor action.

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Intra Op Ultrasound vs Lap Ultrasound

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Q) Which is true regarding comparison of Lap intra op Ultrasound with traditional Intra op Ultrasound in liver surgery?

a) It is more sensitive

b) It is more specific

c) More time consuming

d) Anatomy better delineated with IOUS

Ans c

The procedure can be time consuming in patients with dense adhesions.

Sensitivity and Specificity are same

Anatomy seen equally with both

IUS has been shown to successfully locate insulinomas in 85% of cases. When combined with intraoperative palpation, the detection rate can be in the 95 to 100% range. IUS was shown to detect 83% of gastrinomas in one series, including 100% of intrapancreatic lesions.

 

Handsewn IPAA vs stapled anastomosis

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Q Handsewn IPAA vs Stapled anastomosis which is the wrong statement?
a. More stricture rate in hand sewn anastomosis
b. More leak is seen in hand sewn anastomosis
c. More pouchitis in hand sewn
d. More incidence of Small bowel obstruction in hand sewn anastomosis

 

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