Pouchitis in chronic ulcerative colitis

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Q. In patients undergoing restorative proctocolectomy for chronic ulcerative colitis, which of the following statements regarding pouchitis is TRUE?

a) More common in females
b) Positively associated with smoking
c) Associated with primary sclerosing cholangitis
d) Associated with p-ANCA positivity

Show Answer & Explanation

Correct Answer: c) Associated with primary sclerosing cholangitis

True is association with PSC

Incidence of pouchitis after restorative proctocolectomy is 16-48%. It increases over time.

Risk of pouchitis is more after surgery for Chronic Ulcerative colitis (CUC) than FAP.

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Spinal cord injury

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Spinal Immobilization MCQ | Free NEET SS Surgery Question
Q) Out of the following, which patient requires spinal immobilization the most?
✅ Answer: A. 22-year-old female involved in a high-speed motor vehicle collision with back pain

🔍 Explanation:
Spinal immobilization is most indicated when there's a high-risk mechanism of injury with suggestive symptoms, such as midline spinal pain or neurological signs.

A involves a high-energy mechanism (MVC) and reported back pain, which is a clear indication for spinal immobilization per NEXUS and Canadian C-spine rules.

B has a lower-risk mechanism and no symptoms; thus, spinal immobilization is generally not needed.

C – Gunshot wounds may or may not need spinal immobilization depending on location and neurological findings; not always indicated unless spinal structures are involved.

D – Isolated abdominal trauma is not an indication for spinal immobilization unless there’s evidence of spinal involvement.

⚡ Mechanism of Injury:
• Blunt trauma – Direct impingement, ischemia, compression or bleeding
• Penetrating trauma – Laceration of spinal cord

🩻 Chance fracture: A transverse fracture of all vertebral elements.

🩺 Management:
1. Complete immobilisation
2. Management of associated neurogenic shock (due to loss of sympathetic tone) with vasopressors and fluids

📘 Recommended Reading: Get Surgery Essentials

Obscure occult Gi bleed

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Q Not true about Obscure occult GI bleed

a) RBC scintigraphy scan has high accuracy

b) Capsule endoscopy can not be done in obstruction

c) Mesenteric Angiography is best for angiodysplasia

d) Intraoperative enteroscopy should be the last resort

 

Crohn Extraintestinal manifestations

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Q) Extra intestinal manifestation of Ulcerative Colitis  not cured by surgery

a) PSC

b) Sacro ileitis

c) Episcleritis

d) Erythema nodosum

Questions on colon 21-30

Ans ) a PSC 

Arthritis,  ankylosing  spondylitis,  erythema  nodosum,  and  pyoderma  gangrenosum  typically  improve  or  completely  resolve after  colectomy.

PSC  occurs  in  5%  to  8%  of  patients  with  ulcerative  colitis. 

HLA-B8  or HLA-DR3  haplotype  are  10  times  more  likely  to  develop  PSC. 

The  risk  for  colon  cancer   in these  patients  is  up  to  five  times  greater   than  in  patients  with ulcerative  colitis  alone.  These  tumors  are  more  likely  to  arise proximal  to  the  splenic  flexure . Colectomy  has  no  effect  on  the course  of  PSC.

 

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Pudendal nerve terminal latency

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Q .PNTL prolonged in all the following except

a) Traumatic injury to anal sphincter

b) Prolonged labor

c) Long standing Rectal prolapse

d) Straining

Answer for premium members (Q4) 

The nerve latency is measured by an electrode which is worn on the finger. It stimulates the pudendal nerve and calculates the conduction time to the anal sphincter