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Gastric ulcer

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Q) Gastric ulcer type III is located in? (DNB 2018) 
A. Lesser curvature
B. Body of stomach
C. Prepyloric
D. GE junction

Answer This Question was already discussed in 2009. Here is the link

Choledochal cyst

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 Q) False  about choledochal cysts ? (AIIMS GI 2018) 
A. Upto 90% is associated with APBJ
B. 30% are associated with chronic pancreatitis
C. Most common association in adults is cholecystolithiasis
D. Malignancy risk is eliminated by cyst excision

Answer  Q 22

Switch in Dextraposition of great vessels

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Q . Factors that preclude the use of a single-stage arterial  switch reconstruction of dextrotransposition of the great vessels include:
A. Age older than 6 weeks with a left ventricular pressure of less than 50% of systemic pressure.
B. Dynamic left ventricular outflow tract obstruction.
C. Intramural coronary artery anatomy.
D. Subpulmonary VSD.

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Anti Rejection drugs

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Q) Most nephrotoxic drug is 

A. Cyclosporine
B. Sirolimus
C. Azathioprine
D. Steroids

Answer

These are immunosuppressants used after solid organ transplants. These drugs have a lot of side effects.

Answer is here  

 

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

Diverticulitis

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Q ) Hincheys grade III Diverticulitis. Management most likely to follow more interventions after an index operation is

a) Laparoscopic irrigation and exploration

b) Sigmoid Colectomy+Hartman’s

c) Primary repair with omental patch and peritoneal toilette

d )Sigmoid Colectomy with colorectal anastomosis and diverting ileostomy

Grade III diverticulitis is generalized peritonitis.

Answer for premium Q 10 

Fontan Procedure

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Q 24 Contraindication of Fontan procedure?

a) 20 year old male

b) Severe MR

c) Right pulmonary artery stenosis

d) Left ventricular end diastolic pressure of 20 mm Hg

24) d

Fontan procedure is for tricuspid atresia and is done when there is low pulmonary vascular resistance. For the same reason it is not done in neonates. 

In Tricuspid atresia, venous blood does not go to right ventricle and there is mixing of venous and arterial blood in aorta which leads to decreased oxygenation.

Most infants with tricuspid atresia have restrictive pulmonary blood flow.  To improve systemic oxygentaion they undergo modified Blalock-Taussig shunt, which is a small polytetrafluoroethylene (PTFE) graft to connect the subclavian artery and a pulmonary artery.

Criteria for Fontan procedure are 

  • Age older than 4 years
  • Sinus rhythm
  • Normal systemic venous return
  • Normal right atrial volume
  • Mean pulmonary artery pressure less than 15 mm 
  • Pulmonary arteriolar resistance less than 4 Wood units/m 2
  • Pulmonary artery–aorta ratio more than 0.75
  • Left ventricular ejection fraction more than 0.60

Current absolute contraindications are a pulmonary vascular resistance above 4 Wood units/m2, severe hypoplasia of the pulmonary arteries, and severe diastolic dysfunction of the left ventricle.

Clinical question

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Q) A 68-year-old woman complains of  Intestinal obstruction. Xrays reveal fluid levels and air in the biliary tree. What is the likely cause?
(A) Choledochal cyst
(B) Gallstone ileus
(C) Obstructed hernia
(D) Previous choledochoduodenostomy

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