NEET Pattern Questions

Post op pancreatic fistula

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Q) Regarding postoperative pancreatic fistula (POPF), which of the following is TRUE?
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Tumor lysis syndrome

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Q)Tumor lysis  syndrome which is not seen? (# Electrolytes MCQ) 

a. Hyperkalemia

b Hypocalcemia

c. Hypophosphatemia

d. Hyperuricemia

Ans is c

This syndrome  releases, various intracellular  metabolites such as uric acid, potassium and phosphorous which overwhelm the excretory capacities of the kidney.

The metabolic anomalies are

Hyperuricemia

Hyperkalemia

Hyperphosphatemeia

Hypocalcemia

It mostly occurs in poorly differentiated leukemias and lymphomas

Other facts

Tumor Lysis Syndrome Tumor lysis syndrome (TLS) is a life-threatening condition that can occur when cancer cells die. As the cells die, they release their contents into the bloodstream, which can lead to a number of complications.

TLS is most likely to occur in people with rapidly growing cancers, such as leukemia, lymphoma, and multiple myeloma. It can also occur in people with solid tumors, such as breast cancer, lung cancer, and pancreatic cancer.

 

Budd chiari syndrome

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Q  BCS true is

a) Hepatic venography needed for diagnosis

b) Triad of pain hepatomegaly and jaundice

c) Mesocaval graft thrombosis precludes liver transplant

d) In IVC  stenosis, splenorenal shunt can be used

Electrolytes

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Q) Chovstek sign with normal calcium seen in
a) Hypomagnesemia
b) Hypermagnesemia
c) Hyperphosphatemia

d) Hypokalemia

 

Internal Potassium balance

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Q) If ph >7.4, How much does plasma potassium concentration change for every 0.1 unit increase of the extracellular pH ?

a) Potassium decrease by 0.3meq/l

b) K+ increase by 0.3 meq/l

c) Potassium decrease by 1.5 meq/l

d) K+increase by 1.5 meq/l

Free answer

a

Acid-base disturbances cause potassium to shift into and out of cells. This is called internal potassium balance and was discovered in 1956.

In alkalosis (increase in ph,) K+ falls and in Acidosis potassium concentration will increase. For every 0.1 fall in ph, K+ increases by 0.3-0.6 meql/l

Metabolic acidosis- in a plasma potassium concentration that is elevated in relation to total body stores. 

Ref 

 

Intra Abdominal pressure

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Q) Which of the following is not true about Intra abdominal pressure (IAP) 

a) Normal Intra abdominal pressure in most people is less than 5 mmHg

b) After non complicated surgery  IAP remains less than 5mm Hg

c) IAH (Intra abdominal hypertension) is IAP more than 12 mmHG

d) ACS is IAP more than 20 mm Hg

Question on Management of Abdominal Compartment Syndrome

Allograft Rejection

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Q) Which of the following is false regarding HLA in graft rejection? 

a) HLA (Human leucocyte antigen) is the most common cause of graft rejection

b) They mainly serve as antigen recognition unit

c) HLA also serve as effector cells 

d) They are highly polymorphic

Corrosive Stricture esophagus

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Q) Which modality has no part in management of corrosive injury of esophagus? 

a) Repeated Endoscopies routinely

b) Esophagectomy in some cases

c) Early emergency surgery routinely

d) Steroid use routinely

Corrosive stricture esophagus mcqs

C

In corrosive injury of the esophagus, routine early emergency surgery is generally not indicated. The primary approach involves stabilization, assessing the extent of injury, and supportive care. Surgery is reserved for specific complications, such as perforation or severe necrosis.

Other than the need for emergency surgery for bleeding or perforation, elective oesophageal resection should be deferred for at least 3 months until the fibrotic phase has been established.

Oesophageal replacement is usually required for very long or multiple strictures. Resection can be difficult because of perioesophageal inflammation in these patients.

Regular endoscopic examinations are the best way to assess stricture development .

Significant stricture formation occurs in about 50% of patients with extensive mucosal damageo Corrosives can cause significant pharyngolaryngeal oedema

In unusual circumstances, e.g. with extensive necrosis after corrosive ingestion, emergency oesophagectomy may be necessary.

Questions on Esophagus 

Alkali and acidic injuries to the esophagus, both leading causes of corrosive stricture of the esophagus, differ in their effects due to distinct chemical reactions with tissue.

 Mechanism of Injury

  • Alkali Injuries: Ingested alkalis (e.g., drain cleaners) cause liquefactive necrosis, where tissue rapidly breaks down. This process allows alkalis to penetrate deep into the esophageal layers, often causing severe, widespread injury that extends to adjacent tissues. As a result, alkali injuries frequently lead to extensive scarring and stricture formation over time, significantly impacting the esophageal lumen.
  • Acidic Injuries: Acids like hydrochloric acid cause coagulative necrosis, resulting in protein denaturation and an eschar formation. This eschar limits acid penetration depth, typically causing more superficial injury compared to alkalis. However, mucosal damage can still be severe, leading to ulceration and potential esophageal stricture over time, especially if the injury affects the lower esophagus.

Association of carcinoma pancreas

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Q) Least common association of Carcinoma Pancreas is with 

a) Smoking

b) Male gender

c) Obesity

d) Lynch Syndrome

Severe Pancreatitis – Scoring

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Q) Not a consistent feature of  severe acute pancreatitis 

a) Persistent organ failure

b) CRP more than 150 mg/dl at 48 hours

c) Single organ failure

d) LDH >350 U /L

Another question on severe pancreatitis