a) It corelates with cirrhosis b)Range of sodium value is 125-137 c)It relates to vasoconstriction d) Used for allocation in DDLT patients
Ans c
MELD was originally developed to predict three-month mortality following transjugular intrahepatic portosystemic shunt (TIPS) placement and was derived using data from a population of 231 patients with cirrhosis who underwent elective TIPS placement.
Range of MELD score is 6-40
MELD Score = 10 x (0.957 x Ln(serum creatinine mg/dL) + 0.378 x Ln(serum bilirubin mg/dL) + 1.120 x Ln(INR) + 0.643 )
For candidates with an initial MELD score greater than 11, the MELD score is then re-calculated as follows: MELDNa = MELD(i) + 1.32*(137-Na) - [0.033*MELD(i)*(137-Na)]
Sodium values less than 125 mmol/L will be set to 125, and values greater than 137 mmol/L will be set to 137.
It is used for allocation in DDLT to assess wait list mortality
MELD score has also proved to be an effective predictor of outcome in other situations, such as
Patients with cirrhosis going for surgery and patients with fulminant hepatic failure or alcoholic hepatitis.
The MELD score does have limitations in situations where the INR or creatinine may be elevated due to reasons other than liver disease, and its implementation for organ allocation purposes does not take into consideration several conditions that benefit from liver transplantation.
Q) Smoking cessation- Not a first line drug option ?
a) Clonidine
b) Nicotine replacement (patches)
c) Varenicline
d) Bupropion
Ans A) clonidine
NRT , varenicline (Chantix), and bupropion (Zyban) are the three principal firstline pharmacotherapies recommended for use either alone or in combination
Clonidine and nortriptyline—as second-line pharmacotherapies for tobacco dependence typically used when a smoker cannot use first-line medications due to either contraindications or lack of effectiveness.
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
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.
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,
The CDH1 gene is responsible for making a protein called epithelial cadherin or E-cadherin.
Germline mutation in the CDH1 gene encoding E-cadherin is shown to be associated with hereditary diffuse gastric cancer. Also RHOA gene is also associated with Ca stomach
Prophylactic total gastrectomy should be considered in patients with these mutations
Lymphoma is uncommon in the colon/rectum occurring in 0.4% of patients; intestinal lymphoma and can present anywhere between the second and eighth decades of life.
Most of these lesions are intermediate to high-grade B-cell lymphomas.
Affected men outnumber women about 1.5:1
The majority of colorectal lymphomas are found in the cecum or ascending colon. More than 70% of colorectal lymphomas are proximal to the hepatic flexure.
Colon Lymphoma Pathology Outlines
Extranodal Marginal Zone B-Cell Lymphoma
ENMZL, formerly known as marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma)
Low-grade lymphoma involving cells that arise from the marginal zone surrounding lymphoid follicles.
23%–48% of all primary GI NHLs, second only to DLBCL in most series
ENMZLs are heterogeneous lymphomas, often containing monocytoid-like cells, plasma cells, and scattered large cells intermixed with marginal zone cells.
There are small cells with irregular cleaved nuclei and a moderate amount of clear cytoplasm
DLBCL
Microscopic Appearance diffuse sheets of large lymphoid cells infiltrate the lamina propria and submucosa, with frequent obliteration of the muscularis propria and ulceration of the overlying mucosa.
Irregular nuclei, prominent nucleoli, and basophilic cytoplasm and are more than twice as large as normal lymphocytes.
Q ) Which of the following statement regarding yttrium 90 is incorrect: ( From Gen onco Surgery Q 21-40) a. Used for brachytherapy b. Is a pure beta emitter with range of 1 cm c. Most commonly used for treatment of ca prostate d. Used in treatment of both primary and metastatic liver cancer through hepatic artery embolization
Answer: ) C ref devita page 212.
Iodine 125 and pallidium 103 are commonly used for prostate.
Q) A 55-year-old male patient presents with chronic abdominal pain, weight loss, and intermittent diarrhea. Colonoscopy reveals a mass in the cecum, and biopsy confirms colonic lymphoma. Which of the following statements is most likely true regarding this condition?
A) Colonic lymphoma is predominantly of T-cell origin B) It is more common in females C) The cecum is the most common site of involvement D) It typically presents in the 3rd and 4th decades of life
C) The cecum is the most common site of involvement
Explanation:
Colonic lymphoma is a rare form of lymphoma that primarily affects the gastrointestinal tract. Among the options provided:
A) Colonic lymphoma is predominantly of T-cell origin: This is incorrect. Colonic lymphoma is most commonly of B-cell origin, particularly extranodal marginal zone lymphoma (MALT lymphoma), rather than T-cell lymphoma.
B) It is more common in females: This is also incorrect. Colonic lymphoma does not have a strong gender predilection. The incidence is more balanced between males and females.
C) The cecum is the most common site of involvement: This is correct. The cecum is the most frequent site of involvement in colonic lymphoma, especially for extranodal B-cell lymphoma, such as MALT lymphoma. It tends to present as a mass-like lesion, often causing symptoms such as abdominal pain and weight loss.
D) It typically presents in the 3rd and 4th decades of life: This is incorrect. Colonic lymphoma is more commonly diagnosed in older adults, typically over the age of 50. It is relatively rare in younger individuals.
Q) False statement about location of peptic ulcer?
a) Type 1 is on greater curvature
b) Type 2 is gastric body and duodenal
c) Pauchet procedure is for type IV
d) Type Iv is high on lesser curvature
Ans 16) a
TYPE LOCATION ACID LEVEL
I Lesser curve at incisura Low to normal
II Gastric body with duodenal ulcer Increased
III Prepyloric Increased
IV High on lesser curve Normal
V Anywhere Normal,