Tetrology of Fallot

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Q Autopsy finding  in a patient who dies of Tetrology of Fallot is

a)  Brachiocephalic vein draining into the left renal vein
b)  Inferior vena cava (IVC) draining to the superior mesenteric vein
c)  Atrial Septal Defect (ASD)
d) Decreased vascularity of the lung field

Answer

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.

Investigations in lower GI Bleed

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Lower GI Bleed MCQ
Q) Least useful investigation in a patient with recurrent Lower GI bleed, multiple upper and lower GI endoscopies negative?
a) BMFT
b) Double balloon enteroscopy
c) Capsule endoscopy
d) Push endoscopy

Answer: a) BMFT

Investigations in lower GI bleed should be specific and less time consuming.

Small bowel enteroclysis (BMFT), which uses barium and contrast infusion, has a very low yield and is poorly tolerated, hence rarely used.

Capsule endoscopy is excellent for stable patients, with success rates up to 90% in detecting small bowel pathology.
Push enteroscopy can reach 50–70 cm beyond the ligament of Treitz and permits both diagnosis and therapy; success ~40%.
Double-balloon enteroscopy provides complete small bowel evaluation and allows biopsy and therapy, with yield 77–85%.

Therefore, BMFT is the least useful investigation.

Foramen of Morgagni

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Premium Surgery MCQ | mcqsurgery.com
Q) Most common content of Morgagni hernia is :
a) Stomach
b) Small intestine
c) Transverse colon
d) Liver
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Hypocalcemia

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Q)  Treatment of tetany due to hypocalcemia is ?
a. Oral calcium

b. Injectable 10 percent calcium gluconate

c) Parathyroid injections

d) Vitamin D 

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Blood supply duodenum

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Q) Supraduodenal artery of Wilkie is a branch of

a) GDA

b) Rt gastroepiploic

c) Rt gastric

d) Sup Pancreaticoduodenal

Ans For Premium 

Discuss blood supply of 1st part of duodenum, and course of all arteries mentioned in choices.

Esophagus Perforation

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Q) Elderly healthy male with impacted denture. Removed endoscopically. Pt developed fever, dyspnoea and respiratory distress over 24 hrs. X-ray revealed Lt hydrothorax and mediastinal emphysema.

a) ICD and NG feeds

b) ICD and TPN

c) Cervical esophagectomy, FJ, debridement, ICD

d) Debridement, primary repair with buttress and ICD

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