General Surgery

NEET, DNB questions from general surgery

Dumping Syndrome

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Q) Late dumping syndrome is due to 

a) Excessive release of insulin

b) Food bolus in jejunum

c) Release of serotonin

d) Local enteric reflexes

Answer

a, Excessive release of Insulin 

Dumping syndrome are most common after billroth II gastrectomy followed by BI and Truncal vagotomy and gastro jejunostomy.

Dumping can occur 30 mins after food, (early dumping) or 2 hours after eating (late dumping). Early dumping has GI symptoms such as nausea, vomiting, epigastric fullness, diarrhea and abdominal pain.

Early dumping occurs due to rapid emptying of chyme in jejunum. This hyperosmolar fluid draws water from extracellular compartment to the lumen of small intestine causing intestinal distension and autonomic changes.Serotonin, bradykinin-like substances, neurotensin, and enteroglucagon are involved in early dumping.

Late dumping syndrome  has more cardiovascular symptoms such as palpitations, light headedness, dizziness, tachycardia, diaphoresis, flushing and blurred vision.

It occurs due to delivery of carbohydrates into jejunum, their absorption causes hyperglycemia and insulin release. Excessive insulin release leads to development of symptoms.

Treatment 

  1. Diet - Avoid carbohydrates, frequent small meals of protein and fat and separate liquids from solids
  2. surgery Conversion to Roux en Y

Ref Sabiston 1212

 

Carbon Monoxide poisoning

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Q. Carbon monoxide poisoning true is 

a)  It is having 10 times more affinity than oxygen
b) 60 percent is not deadly.
c) . Concentration above 10% are dangerous and need observation
d)  Concentration above 10% are dangerous and need treatment with pure oxygen for more than 24 hours

d

Option A: Affinity of CO for Hb is 200-250 times that of oxygen. It causes a conformational change in Hb molecule and reduces affinity of Hb for O2, shifting the oxyhemoglobin dissociation curve to the left.

Option B: Concentrations less than 10% are usually asymptomatic. Concentrations >60% are fatal. Arterial carboxyhemoglobin level must be obtained because pulse oximetry can be falsely elevated.

Option C: Concentrations above 10 per cent are dangerous and need treatment with pure oxygen for more than 24 hours. Administration of 100% O2 reduces the half-life of CO from 250 minutes in room air to 40 to 60 minutes on 100% oxygen.

Compartment syndrome of limb

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Compartment Syndrome of Limb – Free Surgery MCQ

Q) All are true about compartment syndrome of limb except?

a) Diagnosis is unlikely if pulse is felt distally
b) There is pain on passive stretching of the limb
c) Pain is out of proportion to the signs
d) Muscles of calf and forearm are commonly involved