135.IN A MALE AFTER LAPROSCOPIC CHOLECYSTECTOMY CARCINOMA GALL BLADDER STAGE Ia WAS DETECTED ON HISTOPATH. WHAT IS THE NEXT APPROPRIAT MANAGEMENT? A. CONSERVATIVE AND FOLLOW UP B. RADICAL PORTAL LYMPHADENECTOMY C. RADIOTHERAPY D.
136. BOUNDARY OF TRIANGLE OF DOM ARE FORMED BY ALL EXCEPT? A. PERITONEAL FOLD REFLECTION B. COOPERS LIGAMENT C. TESTICULAR VESSELS D. VAS DEFRENS
137.MOST COMMON SITE OF CURLINGS ULCER IN A BURNS PATIENT IS? A. DUODENUM B. ILEUM C. COLON D. OESOPHAGUS
138.MOST COMMON SITE OF PERIPHERAL ANEURYSM? A. FEMORAL A. B. POPLITEAL A C. BRACHIAL A D. RADIAL A
139. THE CHILDRENHOSPITAL OF EASTERN ONTARIO PAIN SCALE(CHEOPS) FOR RATING POST OPERATIVE PAIN IN CHILDREN INCLUDES A/E? A. CRY B. TOUCH C. TORSO D. OXYGEN SATURATION
140. A MAN COMES TO EMERGENCY WITH STEB INJURY TO LEFT FLANK.HE HAS STABLE VITALS WHAT WOULD BE THE NEXT STEP IN MANAGEMENT? A. CECT B. CELIOTOMY/SCOPY C. DIAGNOSTIC PERITONEAL LAVAGE D. LAPAROTOMY
141. RECURRENT GIST IS DIAGNOSED BY? A. PET SCAN B. MIBG C. MRI D. USG
142. NICOLADONI’S SIGN IS ALSO KNOWN AS? A. BRANHAMS SIGN B. MURRAY SIGN C. D. FREI SIGN
143.NOT A COMPLICATION OF TOTAL PARENTERAL NUTRITION? A. CONGESTIVE CARDIAC FAILURE B. METABOLIC BONE DISEASE C. ESSENTIAL FATTY ACID DEFICIENCY D.HYPOPHOSPHATEMIA
144. SURGERY NOT DONE IN MORBID OBESITY? A. ILEAL TRANSPOSITION B. PANCREATICO BILIARY DIVERSION C. SLEEVE GASTRECTOMY D. GASTRIC BYPASS
145.A PERSON WITH MULTIPLE INJURIES DEVELOPS FEVER TACHYCARDIA TACHYPNEA AND A PERIUMBILICAL RASH. DIAGNOSIS IS? A. FAT EMBOLISM B. PULMONARY EMBOLISM C. D.
146. GLOMUS TUMOUR IS SEEN IN? A.PITUITARY B. ADRENAL C. LIVER D. FINGER
147. HUNTERIAN LIGATURE IS USED IN? A. VARICOSE VEIN B. POPLITEAL ANEURYSM C. AV MALFORMATION D. LIMB ISCHEMIA
148.TREATMENT OF MEDULLARY CARCINOMA THYROID? A. SURGERY ALONE B. RADIOIODINE ABLATION C. SURGERY AND RADIOTHERAPY D. CHEMO AND RADIATION
149.IN A PATIENT OF CARCINOMA BREAST SUPRACLAVICULAR LYMPH NODES ARE POSITIVE FOR METASTASIS.STAGE IS? A.II B. IIIb C. IIIc D. IV
150.BEST TEST TO DIAGNOSE GERD AND QUANTIFY ACID OUTPUT IS? A. ESOPHAGOGRAM B. ENDOSCOPY C. 24 hour PH MONITORING D. MANOMETRY
151.VIRCHOWS TRIAD INCLUDES A/E? A. INJURY TO VEIN B. VENOUS THROMBOSIS C. VENOUS STASIS D. HYPERCOAGULABILITY OF BLOOD
152.A 25 YEAR MALE PRESENTED WITH PAIN ABDOMEN, ON USG MIXED ECHOGENICITY WAS FOUND AT LEFT RENAL HILUM AND A MULTIFOCAL NECROTIC MASS IS DETECTED.PROBABLE DIAGNOSIS IS? A. METASTATIC GERM CELL TUMOUR B. TRANSITIONAL CELL CARCINOMA C. LYMPHOMA D. METASTATIC MALIGNANT MELANOMA
153.MOST COMMON SITE OF CHOLANGIO CARINOMA? A. DISTAL BILIARY TREE B. HILUM C. INTRAHEPATIC BILIARY DUCT D. MULTIFOCAL
154.TRUE ABOUT GLEASONS STAGING? A. SCORE FROM 1-10 B. HIGH SCORE IS ASSOCIATED WITH BAD PROGNOSIS C. HELPS IN GRADING OF TUMOUR D. HELPS DECEIDE TREATMENT MODALITY
155.MOST COMMON CAUSE OF ACUTE MESENTRIC ISCHEMIA? A. THROMBOSIS B. EMBOLISM C.NON OCCLUSIVE MESENTRIC ISCHEMIA D.
156.A WOMAN NOTICED MASS ON BREAST WITH BLOODY DISCHARGE. HISTOPATH REVEALED DUCT ECTASIA.TREATMENT IS? A. MICRODOCHECTOMY B. LOBECTOMY C. RADICAL DUCT EXCISION D. SIMPLE MASTECTOMY
case : A 32-year-old man with diabetic nephropathy undergoes an uneventful renal transplant from his sister (two-haplotype match). His immunosuppressive regimen includes azathioprine, steroids, and cyclosporine. For each development in the postoperative period, select the most appropriate next step.
a. Begin gancyclovir b. Administer steroid boost c. Withhold steroids d. Decrease cyclosporine e. Increase cyclosporine f. Decrease azathioprine g. Obtain renal ultrasound h. Begin broad-spectrum antibiotics i. Administer filgrastim (Neupogen) j. Administer FK50
question 1:
On postoperative day 3 the patient is doing well, but you notice on his routine laboratory tests that his white blood cell count is 2.0. (SELECT 1 STEP)
question 2:
The patient’s WBC count gradually returns to normal, but on postoperative day 7 he develops a fever of 39.44°C (103°F) and a nonproductive cough. A chest xray reveals diffuse interstitial infiltrates, and a “buffy coat” is positive for viral inclusions. (SELECT 1 STEP)
question 3:
The patient recovers from the above illness and is discharged home on postoperative day 18. At 3-mo follow-up he is doing well, but you notice that his creatinine is 2.8 mg/dL. He has no fever, his graft is not tender, and his renal ultrasound is normal. (SELECT 1 STEP)
question 4:
Six months following his transplant, the patient begins to develop fever, malaise, and pain of the right lower quadrant. Upon palpation, the graft is tender. Chest xray and urine and blood cultures are normal. Renal ultrasound shows an edematous graft. (SELECT 1 STEP)
The answers are question 1-f, question 2-a, question 3-d, question 4-b.
(Greenfield,2/e, pp 577–581.) Routine postoperative immunosuppression for a renal transplant recipient includes cyclosporine, azathioprine, and steroids. Cyclosporine is nephrotoxic and is frequently withheld in the postoperative period until the creatinine returns to normal following transplantation. Transplants,Immunology,and Oncology Answers 151 Azathioprine has bone marrow toxicity as its major side effect and both WBC and platelet counts need to be monitored in the immediate posttransplant period. The patient’s decrease in WBCs is secondary to azathioprine toxicity, and the most appropriate step is to decrease the dose of azathioprine. Viral infections are a serious cause of morbidity following transplantation. A “buffy coat” is the supernatant of a centrifuged blood sample that contains the WBCs. Viral cultures from this supernatant as well as localization of inclusion bodies can identify transplant patients infected with cytomegalovirus (CMV). This patient has CMV pneumonitis and needs to be treated with high-dose gancyclovir. An elevation in creatinine at 3-mo follow-up can be secondary to rejection, anastomotic problems, urologic complications, infection, or nephrotoxicity of various medications. With a normal ultrasound, no fever, and no graft tenderness, the most likely cause is cyclosporine-induced nephrotoxicity and the most appropriate step is a reduction in the cyclosporine dose. Finally, at 6 mo with graft tenderness, fever, and an edematous kidney on ultrasound, rejection must be suspected. Negative cultures make infection unlikely, and a steroid boost is appropriate. Addition of monoclonal antibodies to CD3 (OKT3) or pooled antibodies against lymphocytes (ALG) is also appropriate in the treatment of a first
