Distributive Shock

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Q) What is not seen in Distributive Shock?

a) High central venous pressure

b) High Cardiac output

c) High Base deficit

d) High Mixed Venous Saturation

MCQs on Shock and Body Response 

Ans a 

In Distributive shock Systemic vascular resistance and venous pressure are low ( because of vasodilation)

All other parameters are high

Distributive Shock Symptoms

Vasodilation

Warm peripheries

Hypotension

Causes of Distributive Shock are

  1. Anaphylaxis
  2. High spinal cord injury
  3. Septic shock
  4. Toxic Shock Syndrome
  5. The distributive shock from adrenal insufficiency occurs due to decreased alpha-1 receptor expression on arterioles secondary to cortisol deficiency, which results in vasodilation. This is seen in patients on chronic steroids that are stopped suddenly.

 

Thyroid storm

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Q) 40 year old lady was on anti thyroid medications which she stopped for 2 weeks.

She presented in emergency with high grade fever and hypotension (Thyroid Storm).

What is not a part of further management?
a) Oxygen
b) Beta blockers
c) Radio active Iodine
d) Lugol's iodine

Staging in Adenocarcinoma lung

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Q) Patient with 2cm lung nodule, biopsy proven adenocarcinoma. CT shows hilar lymph node 1.5cm and left pleural effusion. Pleural fluid cytology is positive for malignant cells. What is the stage?

A. T1N1M0
B. T1N2M1
C. T4N1M0
D. T1N1M1
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8 important CTVS/cardiology signs asked in exams

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8 CTVS signs on imaging

Expect 2-3 questions on cardiology signs asked in MCH exams 

I am listing the 8 most common 

  1. Egg on String sign - Transposition of great arteries
  2. Snowman Sign - TAPVC ( Total Anomalous pulmonary venous return) 

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Grades of Splenic Injury – Image based Question

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Q) 45 year old male with road side accident and fracture of 3 ribs on left side.

CT scan of the abdomen is shown below. Out of the five grades of splenic injury What is the grade  in him ?

Splenic Injury grades

 

 

 

 

 

a) Grade II

b) Grade III

c) Grade IV

d) Grade V 

Take the practice MCQ tests  ( Some are free). Others are for Premium Members

Take the free image based mock test 

Ans b Grade III

Grade 1
Subcapsular haematoma <10% of surface area
Parenchymal laceration <1 cm depth Capsular tear
Grade 2
Subcapsular haematoma 10–50% of surface area; Intraparenchymal haematoma <5 cm
Parenchymal laceration 1–3 cm
Grade 3
Subcapsular haematoma >50% surface area; ruptured subcapsular or intraparenchymal haematoma ≥5 cm Parenchymal laceration >3 cm depth
Grade 4
Any injury in the presence of a splenic vascular
injury or active bleeding confned within the splenic
capsule
Parenchymal laceration involving segmental or hilar
vessels producing >25% devascularisation
Grade 5
Any injury in the presence of splenic vascular injurya
with active bleeding extending beyond the spleen
into the peritoneum – shattered spleen
Vascular injury is defined as a pseudoaneurysm or arteriovenous fistula and appears as a focal collection of vascular contrast that decreases in attenuation with delayed imaging.
Active bleeding from a vascular injury presents as vascular contrast, focal or diffuse, that
increases in size or attenuation in the delayed phase

THE vs TTE

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Esophagus Surgery
Esophagus Mock Test 1
Q) Trans Hiatal Esophagectomy (THE) vs Trans Thoracic Esophagectomy (TTE) – which is not true?
(Question asked in all AIIMS and INI exams since 2017)
a) Leak rates are more with TTE
b) Pulmonary complication is more with TTE
c) Side to side stapler anastomosis has less leaks than open two layer suturing
d) THE can be done through minimally invasive surgery
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Hereditary pancreatic cancers

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Hereditary pancreatic cancers questions is asked many times in NEET SS and GI and onco Surgery CET 

Please understand the difference between x% lifetime risk of pancreatic cancer and x fold increase in risk as compared to normal population

  1. PRSS & SPINK 1 - Familial pancreatitis 40% lifetime increase . 50 fold increase as compared to Normal
  2. STK 11 - Peutz Jeghers - 100 fold increase in Pancreatic cancer . Also associated with lung, ovarian, breast, uterine, and testicular cancers
  3.  CFTR - cystic fibrosis - 30 fold increase
  4. Familial atypical mole and multiple melanoma syndrome (CDKN2A gene mutation). CDKN2A - 20 fold increase
  5.  BRCA 2 - 10 fold increase
  6. Lynch Syndrome  ( MLH) ( MSH) - 8 fold increase
  7. FAP APC gene - 4 fold