Q According to WHO-IWGE ultrasonographic classification for Hydatid cyst, inactive cysts belong to which group a) Group I b) Group 2 c) Group 3 d) Group 4
WHO Informal Working Group on Echinococcosis (WHO-IWGE) classification
Group 1: Active group – cysts larger than 2 cm and often fertile. Group 2: Transition group – cysts starting to degenerate and entering a transitional stage because of host resistance or treatment, but may contain viable protoscolices. Group 3: Inactive group – degenerated, partially or totally calcified cysts; unlikely to contain viable protoscolices.
Q) Which is not a feature of primary hyperparathyroidism?
a) Increase Parathormone
b) Increase Calcium
c) Decreased phosphate
d) Dystrophic calcification
Answer – Free
Answer: d) Dystrophic calcification
Explanation: Clinical features of primary hyperparathyroidism include subperiosteal bone resorption, increased serum calcium, decreased phosphate levels, and elevated PTH. Dystrophic calcification is not typically seen in this condition.
Primary hyperparathyroidism is most commonly caused by parathyroid adenoma (75%) and can be localized using sestamibi scan. Kidney stones are the most frequent symptomatic manifestation. It is defined by hypercalcemia with inappropriately normal or elevated PTH.
Associated disorders: peptic ulcers, pancreatitis, bone disease, and CNS symptoms.
Indications for surgery in asymptomatic patients include:
Age < 50 years
High urinary calcium excretion
Low creatinine clearance
Kidney stones
Very high serum calcium
Reference: Bailey and Love, 27th Edition, Page 826
"Poncho trial " answers this question of timing of cholecystectomy in biliary pancreatitis
Early cholecystectomy (just before discharge, when the patient has recovered and severe disease excluded), compared to interval cholecystectomy, effectively reduces---
The rate of recurrent gallstone-related complications in patients with mild biliary pancreatitis,
low added risk of complications.
Evidence on the timing of cholecystectomy in severe pancreatitis is scarce. Cholecystectomy is recommended after all signs of pancreatic necrosis have been resolved or if they persist more than 6 weeks
Cholecystectomy during the same admission is recommended for patients with mild biliary pancreatitis to prevent recurrent attacks.
In cases of severe pancreatitis, surgery is generally delayed until the inflammation subsides.
Studies have shown that early cholecystectomy during the same admission for mild to moderate biliary pancreatitis does not increase complications compared to delayed or interval cholecystectomy.
Q) In preop evaluation before placing skin graft over wounded area…bacterial colony count must be less than
a) 10000 b) 100000 c) 1000000 d) 10000000
ans b) 10 raise to the power 5
In advanced surgical practice, the bacterial colony count is a critical factor when considering the placement of a skin graft over a wounded area. The threshold for bacterial contamination in the wound is typically 100,000 colony-forming units (CFU) per gram of tissue. If the bacterial count exceeds this limit, the risk of postoperative infection, graft failure, and delayed healing increases significantly.
This threshold is based on several key factors:
Wound infection: A bacterial count above 100,000 CFU per gram is associated with a high risk of wound infection, which can lead to graft failure.
Graft survival: A sterile or minimally contaminated wound is crucial for graft take. Any significant bacterial load can compromise the graft's survival due to the impaired healing environment.
Prerequisites for skin grafting: The recipient site should be assessed for potential bacterial load, blood supply, presence of devitalized tissue, and exposed vital structures. Donor site availability Perform recipient site tissue culture if history or concern for infection (counts <100000 CFU/g tissue for most pathogens required before grafting).
Presence of group a beta heamolytic streptococci is absolute contraindication for skin grafting [/bg_collapse]
