General Surgery

NEET, DNB questions from general surgery

Dieulafoy lesion

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Q) Dieulafoy lesion which is false? (AIIMS 2018)

A. Most of the bleed cannot be visualised due to small mucosal defect lies over large arterial bleed.
B. Large 1-3 mm artery in the submucosa is the source
C. MC in the greater curvature
D. Found within 6 cm from GEJ

Parkland formula

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Q )  During fluid resuscitation in a burns patient using Parkland’s formula, volume of fluid given in first 8 hours is ?
A. 50%
B. 25 % 
C. 75 % 
D. 100 % 

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Ans a

The modified Parkland formula

TBSA% burn × weight (kg) × 4 = volume in mL
The first half is given in 8 hours and the second over 16 hours to complete the 24-hour resuscitation time frame.

Developed by Dr. Charles Baxter in the 1960s at the Parkland Memorial Hospital in Texas, this formula serves as a cornerstone in determining the initial fluid requirements to stabilize burn victims during the crucial early hours following injury.

Although the Parkland Formula offers a valuable framework for fluid resuscitation, it's important to note that individual patient variability, coexisting injuries, and evolving clinical conditions necessitate close monitoring and adjustment of the resuscitation plan. Over-resuscitation can lead to complications such as pulmonary edema, while under-resuscitation can result in inadequate tissue perfusion and organ failure.

Bailey 28th  671

Warfarin

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Q Warfarin sodium acts by
A. Inhibits carboxylation of  Factor VII, IX, X 
B. Factor X a inhibition
C. Thrombin inhibitor and X a inhibition
D. IX, XI, XII, factor and thrombin inhibition

Spinal cord injury

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Spinal Immobilization MCQ | Free NEET SS Surgery Question
Q) Out of the following, which patient requires spinal immobilization the most?
✅ Answer: A. 22-year-old female involved in a high-speed motor vehicle collision with back pain

🔍 Explanation:
Spinal immobilization is most indicated when there's a high-risk mechanism of injury with suggestive symptoms, such as midline spinal pain or neurological signs.

A involves a high-energy mechanism (MVC) and reported back pain, which is a clear indication for spinal immobilization per NEXUS and Canadian C-spine rules.

B has a lower-risk mechanism and no symptoms; thus, spinal immobilization is generally not needed.

C – Gunshot wounds may or may not need spinal immobilization depending on location and neurological findings; not always indicated unless spinal structures are involved.

D – Isolated abdominal trauma is not an indication for spinal immobilization unless there’s evidence of spinal involvement.

⚡ Mechanism of Injury:
• Blunt trauma – Direct impingement, ischemia, compression or bleeding
• Penetrating trauma – Laceration of spinal cord

🩻 Chance fracture: A transverse fracture of all vertebral elements.

🩺 Management:
1. Complete immobilisation
2. Management of associated neurogenic shock (due to loss of sympathetic tone) with vasopressors and fluids

📘 Recommended Reading: Get Surgery Essentials

Obscure occult Gi bleed

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Q Not true about Obscure occult GI bleed

a) RBC scintigraphy scan has high accuracy

b) Capsule endoscopy can not be done in obstruction

c) Mesenteric Angiography is best for angiodysplasia

d) Intraoperative enteroscopy should be the last resort

 

Harmonic Scalpel

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Q. Harmonic  scalpel frequency of vibration is ?
A. 20000-50000
B. 50000-80000
C. 80000-100000
D. >100000

Ans a

The harmonic scalpel transduces high-frequency ultrasonic energy through a metallic jaw to generate mechanical vibration. It has an active and an inactive blade When in contact with tissue, the vibration of a single blade against a static blade results in vaporization and coagulation.

Harmonic scalpel also called ultrasonic scalpel cuts through tissues and causes coagulation by protein denaturation caused by vibrating force. As compared to electro cautrey harmonic scalpel

  1. takes longer time 
  2. produces less smoke
  3. Cause less tissue edema, swelling