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

Metastatic NET

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Q) Girl with pain upper abdomen.  CT Abdomen shows  4 X 5 cm mass in segment V  and thickening in ileocecal region. Liver Biopsy shows NET. Next line of management:?

Immunosuppression

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Q) False regarding immunosuppresant medicines ?

a. MMF is a reversible inhibitor of IMD-DH
b. Both Cyclosporine  and tacrolimus inhibit NF-KB and its downstream effects
c. Everolimus acts on FKBP12To inhibit Calcineurin activity
d. ALG are more used in pancreas transplant

Ectopic pancreas

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Q) Not a site of ectopic pancreas
a. Esophagus
b. GB
c. Liver
d. Jejunum

Loss of cell Surface antigen

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Q) Loss of cell surface antigen is a feature of 
A. CIS
B. NO RELATION WITH GRADE
C. LOW GRADE TUMOR
D. HIGH GRADE TUMOR

Ans d High grade

The ABO(H) blood group system consists of terminal oligosaccharide antigens carried by glycoproteins or glycolipids in hematopoietic or epithelial cells 

Their biosynthesis is presumed to be controlled by the ABO(H), Se, H, Le, and X blood group genes .

These antigens are present on normal bladder epithelium of secretor individuals but not on some low-grade and early-stage papillary urothelial carcinomas 

Moreover, initially expressing tumours lose these cell surface antigens upon local recurrence, progression to invasion or metastization 

D 2 gastrectomy

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Q) D2 gastrectomy false statement is ? ( AIIMS 2021) 
a. No benefit in Overall Survival ( OS) 

b. Better Disease free Survival ( DFS) 
c. Recommended to take stomach, omentum, retro peritoneum en masse
d. Can remove spleen or pancreas if involved