Google Readertag:google.com,2005:reader/user/12076197357837598901/label/surgery questionsjohny2011-07-09T08:03:46Ztag:google.com,2005:reader/item/046b0800ce3e9f7f2011-07-09T08:03:46Z2011-07-09T08:03:46Z <p><a href="http://feedads.g.doubleclick.net/~a/QKS92wBxNTbECP3QquWdowm7yTk/0/da"><img src="http://feedads.g.doubleclick.net/~a/QKS92wBxNTbECP3QquWdowm7yTk/0/di" border="0" ismap="true"></img></a><br/> <a href="http://feedads.g.doubleclick.net/~a/QKS92wBxNTbECP3QquWdowm7yTk/1/da"><img src="http://feedads.g.doubleclick.net/~a/QKS92wBxNTbECP3QquWdowm7yTk/1/di" border="0" ismap="true"></img></a></p><div style="width:562px;height:326px;overflow:hidden"> <div> <div><font color="#3366ff"><b>Q1 Not a distinguishing feature of diverticulitis from carcinoma colon on barium enema examination</b></font></div> <div align="justify">a) Gradual transition from normal to diseased segment</div> <div>b) Intact mucosa in the abnormal segment</div> <div>c) Short involved segment</div> <div>d) A mass deforming the colon but with intact mucosa</div> <div><br></div> <div><font color="#3366ff"><b>Q2.Which of the following is not an angiographic sign of ectasia of colon</b></font></div> <div>a)  Densely opacified dilated tortuous slowly emptying intramural vein</div> <div>b)  A discrete vascular tuft</div> <div>c)  Early filling vein</div> <div>d) Rapidly emptying intra mural vein</div></div></div> <div style="width:562px;height:1230px;overflow:hidden"> <div> <div><font color="#3366ff"><b>Q3 Which of the following investigation is of least value in a case of fecal incontonence</b></font></div> <div align="justify">a) Anal Manometry</div> <div>b) Per rectal finger examination</div> <div>c) Pudendal Nerve Terminal Motor Latency (PNTML)</div> <div>d) Endoanal ultrasound</div> <div><font color="#000000"><br></font></div> <div><font color="#3366ff"><b>Q4. What is obstructed defaecation syndrome</b></font></div> <div><font color="#000000">a) Failure of Puborectalis and external sphincter to relax</font></div> <div><font color="#000000">b) Internal intussusception of rectum</font></div> <div><font color="#000000">c) Sigmoidocele</font></div> <div><font color="#000000">d) Descending Perineum Syndrome</font></div> <div><font color="#000000"><br></font></div> <div><font color="#3366ff"><br></font></div> <div><font color="#3366ff">Q5. Which of the following is not true for </font><a title="Laparoscopic surgery of Colon" href="http://www.mcqsurgery.com/lapcolon.html">Laparoscopic Colorectal surgery</a></div> <div><font color="#000000">a) It is associated with increased operative time</font></div> <div><font color="#000000">b) It improves qulaity of life</font></div> <div><font color="#000000">c) Lap colorectal surgery is associated with shorter ileus time and shorter hospital stay</font></div> <div><font color="#000000">d) There is increased chance of port site recurrence in laparoscopic colorectal surgery done for malignancy</font></div> <div><font color="#000000"><br></font></div> <div><font color="#000000"><br></font></div> <div><font color="#000000">                                        Answers</font></div> <div><font color="#000000"><br></font></div> <div><font color="#000000"><br></font></div> <div><font color="#000000" face="Tahoma">1. c</font></div> <div><font color="#000000" face="Tahoma">Diverticulitis of colon and carcinoma colon can coexist. The distinguishing features of diverticulitis from carcinoma colon on barium examination are</font></div> <div><font color="#000000" face="Tahoma">Gradual tapering, intact mucosa and long segment involvement (more than 6 cm), not a short segment</font></div> <div><font color="#ff0000" face="Tahoma">Ref- Schakelford Surgery of Alimentary canal  pg 2015</font></div> <div><font color="#000000" face="Tahoma"><br></font></div> <div><font color="#000000">2) d</font></div> <div><font color="#000000">Ectasia of colon is the most common cause of lower GI bleed after the age of 60. Ectasia represents age related degeneration of the intramural veins entering the muscularis of colon. They are most common in the caecum and right colon.Most common angiographic finding is dilated tortuous slowly filling vein. </font></div> <div><font color="#000000">They do noy fill rapidly</font></div> <div><font color="#000000">3. c</font></div> <div><font color="#000000">Ideally all the tests are required and should be done in the work up of an incontinent patient. These patients should undergo a through history aqnd clinical examination. Per rectal examination should look for scars of previous surgeries, loss of anal tone and changes consistent with inflamatory bowel diseases or neoplasm</font></div> <div><font color="#000000">Anal manometry is essential because it gives an idea of resting anal canal pressure and maximum squeeze pressure. Also it tells about the Rectoanal inhibitory Response (RAIR). This response is abolished in diseases such as Hirshprung's.</font></div> <div><font color="#000000">Endoanal Ultrasound is essential for mapping of the sphincters, The muscle loss in obstetric injuries can be documented and these are the patients in whom the muscular repairs are more likely to succed</font></div> <div><font color="#000000">PNTML depends on  various things such as skill of the operator and body habitus of the patient. Also the density od nerve fibres in that area have a say rather than the speed of conduction. PNTML can help prognosticate patients who will be unlikely to benefit from surgical intervention as the problem is more neurological</font></div> <div><font color="#000000"><u>ALL the above tests should be done but if given a choice in these four PNTML is of least benefit.</u></font></div> <div><font color="#000000"><br></font></div> <div><font color="#000000">4. a</font></div> <div><font color="#000000">When there is excessive straining to overcome the functional obstruction caused by failure of external sphincter and pubo rectalis to relax this condition is called Obstructive defaecation</font></div> <div><font color="#000000">Descending perineal syndrome is Obstructed defaecation + Loose pelvic floor and organ prolapse</font></div> <div><font color="#000000">The diagnostic modalities for this condition are</font></div> <div><font color="#000000">1. Anal manometry and EMG (Electromyography) for paradoxical sphincter contraction</font></div> <div><font color="#000000">2. Balloon expulsion test</font></div> <div><font color="#000000">3. Defaecography</font></div> <div><font color="#000000"><br></font></div> <div><font color="#000000">Treatment of obstructed defaecation is</font></div> <div><font color="#000000">Medical</font></div> <div><font color="#000000">Biofeedback</font></div> <div><font color="#000000">Surgery has a limited role as this is more of a functional problem</font></div> <div><font color="#000000"><br></font></div> <div><font color="#000000">5.d</font></div> <div><font color="#000000">Several recent trials in </font><a title="Laparoscpopic Colon surgery" href="http://www.mcqsurgery.com/lapcolon.html">laparoscopic colorectal surgery  </a><font color="#000000">have shown beyond doubt that it is assciated with all the benefits of laparoscopy with no compromise in oncological results</font></div> <div><font color="#000000">Some trials in mid 1990s showed there was increased risk of port site recurrence but now this issue has been laid to rest in the three large multi institution studies</font></div> 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