Handsewn IPAA vs stapled anastomosis

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Q Handsewn IPAA vs Stapled anastomosis which is the wrong statement?
a. More stricture rate in hand sewn anastomosis
b. More leak is seen in hand sewn anastomosis
c. More pouchitis in hand sewn
d. More incidence of Small bowel obstruction in hand sewn anastomosis

 

Esophagus Lymphatics

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Q) Esophageal lymphatic- False is 
a. Lymphatics above tracheal bifurcation drain to sub-carinal, and mainly upwards 
b. EUS can access and samples many stations

c. 40 percent submucosal lymphatic drain to thoracic duct
d. T1a nd T2a  has similar lymph node inolvement

Chylous Ascites

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Q) Which of the following is least likey mechanism of formation of chylous ascites

a) Obstruction of existing lymphatics with exudation of chyle

b) Chyle leak from lymph vessels due to injured retroperitoneal vessels

c) Mega lymphatics exudation which are present in the wall of retroperitoneum

d) Recurrent chronic pancreatitis

Aclaculus choelcystitis

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Q)  True about acalculous cholecystitis is:

a) Mortality more than that of calculus cholecystitis

b) GB rupture chances are more

c) Immediate cholecystectomy is the treatment of choice

d) Only A & B are correct

 A12) d

The disease  process  is  generally  more  fulminant  than  that  of  calculous cholecystitis  and  may  progress  to  gangrene  and  perforation  of  the gallbladder.

Treatment  of  acalculous  cholecystitis  is  similar  to  that  of  calculous  cholecystitis,  with  cholecystectomy  being  therapeutic. Given  the  substantial  inflammation  and  high  risk  of  gallbladder gangrene,  an  open  procedure  is  generally  preferred.

However, many  of  these  patients  are  critically  ill  and  would  not  tolerate  the physiologic  insult  of  a  laparotomy,  explaining  why  the  mortality rate  of  cholecystectomy  for  acalculous  cholecystitis  is  up  to  40%. Accordingly,  percutaneous  drainage  of  the  distended  and  inflamed gallbladder  is  carried  out  in  patients  unable  to  tolerate  a  laparotomy.

Approximately  90% of  patients  will  improve  with  percutaneous  drainage,  and  the  tube  can  eventually  be  removed.  If  follow-up  imaging  continues to  demonstrate  no  stones,  interval  cholecystectomy  is  generally unnecessary.

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Round cell tumors

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Q) 12 yr old girl fever diaphyseal femur mass . It is a  Round cell tumor. PAS+VE diastase
sensitive .  AIIMS onco 2020 

A. Ewing's sarcoma 
B. Osteosarcoma
C. Chondroblastoma
D. Chondrosarcoma

Ans a) Ewing

On the basis of round cell pattern tumor classification is 

  1. Diffuse round cell pattern

    1. Ewing's sarcoma

    2. Primitive neuroectodermal tumor (PNET)

    3. Merkel cell carcinoma

    4. Embryonal rhabdomyosarcoma (ERMS)

    5. Small cell carcinoma

    6. Lymphoma

    7. Leukemic infiltrate.

  2. Septate or lobulated round cell pattern

    1. Small round cells are divided by fibrous/fibrovascular septate

    2. Ewing's sarcoma

    3. Alveolar rhabdomyosarcoma (ARMS).

According to size of round cell

  1. Small round cell – Squamous cell carcinoma, PNET, Ewing's sarcoma, melanoma, rhabdomyosarcoma (RMS), Langerhans cell disease, lymphoma, adenocarcinoma, neuroendocrine carcinoma, Merkel cell carcinoma, olfactory neuroblastoma

  2. Large round cell – Squamous cell carcinoma, adenocarcinoma, melanoma, RMS, lymphoid tumors, paraganglioma.

CT colonogrpahy

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Q) Which of the following is not an indication of CT colography

a) Obstructed growth to look for  synchronous lesions
b. Can’t do colonoscopy
c. High risk pt with suspicion of ca colon

d)   50 year old with Average risk