Q81) In trauma what is the ratio of PRBC: FFP to be transfused?
a) 1:1
b) 1:2
c) 1:3
d) 1:4
Correct Answer: a) 1:1
When there is requirement of more than 6 units of PRBC, FFP and other blood products are required. FFP and platelets should be transfused first and then PRBC. For every 7–12 Units of PRBC, ideally 6 units of FFP and one unit of platelets should be given.
Q) What is not a management option in Abdominal compartment syndrome?
a) Drainage of Intra abdominal collections
b) Muscle relaxation
c) Mesh closure
d) High PEEP
Ans d)
Intra Abdominal Hypertension leads to Abdominal Compartment syndrome.
The decision to intervene surgically is not based on IAH alone but rather on the presence of organ dysfunction in association with IAH. Few patients with a pressure of 12 mm Hg have any organ dysfunction, whereas IAP greater than 15 to 20 mm Hg is significant in every patient
With grade III IAH, decompression may be considered when the abdomen is tense and signs of extreme ventilatory dysfunction and oliguria develop. In grade IV IAH, with signs of ventilator and renal failure, decompression is indicated
Measures to lower IAH are implemented are
• Drainage of intra-abdominal fluid collections
• Muscle relaxation Avoid primary closure of the incision—laparotomy or mesh, Bogota bag, biologic mesh, or vacuum-assisted closure.
Q) Patient on Clopidogrel has Intraop bleeding Which component will you transfuse to control it? ( #NEET 2018)
a) Platelets
b) FFP
c) Cryoprecipitate
d) PRBC
Ans ) A, platelets
Patients on clopidogrel who are actively bleeding and undergoing major surgery may require almost continuous infusion of platelets during the course of the procedure. Arginine vasopressin or its analogues (DDAVP) have also been used in this patient group
Platelet shelf life is 5 days and stored at temp of -24
Q) Which of the following statements regarding bariatric surgery is false?
a) Vertical banded gastroplasty (VBG) produces less weight loss compared to Roux-en-Y gastric bypass (RYGB) b) Jejunoileal bypass is no longer commonly performed c) Dumping syndrome occurs primarily due to non-compliance with dietary advice d) Laparoscopic adjustable gastric banding (LAGB) requires follow-up only once every 4–6 weeks
c
Dumping is due to the surgery and unrelated to diet
Calorie restriction is responsible for long term weight loss and its beneficial effects such as control of diabetes, dyslipidemia, hypertension and other metabolic abnormalities.
Restrictive procedures are LSG and LAGB which decrease the appetite and induce early satiety.
The RYGB (ROUX en Y gastric bypass ) is a malabsorptive procedure with long term sustained weight loss.
Mechanism of weight loss after bariatric surgery
Ghrelin is orexigenic gut hormone, which increases appetite. After food intake ghrelin levels fall and appetite decreases.
After restrictive surgery such as LYGB and LSG, ghrelin levels fall and appetite decreases.
Vertical Banded Gastroplasty (VBG)
This procedure has been abandoned in favor of other operations because of poor long-term weight loss, a high rate of late stenosis of the gastric outlet, and a tendency for patients to adopt a highcalorie liquid diet, thereby leading to regain of weight. Choice a is correct
Jejuno ileal bypass has many side effects because of malabsorbtion and liver cirrhosis ( See above) Choice b is true
Visit - evaluate oral intake, food tolerance, and wound healing and to determine whether appropriate restriction has resulted from placement of the non inflated band.
Subsequent visits, usually scheduled monthly to bimonthly in the beginning and then less frequently, involve counseling with a nutritionist and evaluation of weight loss and the need for band adjustment.
A goal of 1 to 2 lb/wk is ideal
d is correct
Dumping is both late and early and unrelated to dietary advise