NEET PG Question Bank

The three most common objective measures of surgical risk in cirrhotic patients are the Child-Turcotte-Pugh (CTP) score, the MELD score, and residual liver volume.

The Child-Turcotte-Pugh (CTP) score was originally developed to evaluate the risk of portocaval shunt procedures performed for portal hypertension and is subsequently useful in predicting surgical risks of other intra-abdominal operations on cirrhotic patients.

Ref: Sabiston Textbook of Surgery 21st Ed - Page 198

Half-circle needles are commonly utilised in the gastrointestinal tract,

J-shaped needles, quarter-circle needles, and compound curvature needles are used in special situations such as the laparoscopic port site closure, eye, and oral cavity, respectively.

Ref: Bailey and Love 28th Ed - Page 107

Option A :

PTH is secreted in response to low serum calcium or high serum magnesium levels

Option B :

The active circulating molecule has a half-life of approximately 3–5 minutes in patients with normal renal function.

The half-life of PTH is 3 to 5 minutes, although it can vary from 1 to 21 minutes (Sabiston)

Option C :

Calcitonin, which is synthesised by the parafollicular C cells of the thyroid gland, acts as the physiological antagonist to PTH.

Option D :

The PTH-mediated renal effects to maintain calcium homeostasis are rapid, taking minutes to hours, compared to the skeletal effects, which take hours to days

Ref: Bailey & Love 28^th Ed – Page 874

Sabiston Textbook of Surgery 21^st Ed – Page 925

Modified Makuuchi incision - also called inverted L incision - used for Liver surgeries ( Transplant /resection)

Makuuchi incision - J-shaped incision - used for liver surgeries

Gibson incision - used for renal transplant ( Recent question)

Mercedes Benz incision - Used for HPB surgeries

N.B.: Incisions are very high yield!

Posterior Urethral Valve

• PUVs are membranous folds that obstruct the lumen of the posterior urethra, affecting about 1 in 4000 live-born boys.
• Girls are not affected.
• About one-third are identified antenatally with bilateral hydronephrosis, a dilated bladder, and a dilated posterior urethra, which, on imaging, looks like a keyhole.
• In severe cases, there is oligohydramnios and lung hypoplasia.
• Postnatal presentations include urinary tract infections, bladder distension, and voiding dysfunction.

Option B: The diagnosis is confirmed on a voiding cystourethrogram, which shows a dilated posterior urethra with a thick-walled bladder

Image-  Lateral view showing a dilated posterior urethra (A) and trabeculated bladder (B) due to posterior urethral valves (C), seen on a voiding cystourethrogram.

Option A: Ultrasonography looks for hydronephrosis and a thickened bladder.

Option C: IVU is not very useful for PUV

Option D: Renal function can be assessed with routine blood tests and glomerular filtration rate or a DMSA scan. MAG3 is frequently used in PUJO

Ref: Bailey and Love 28th Ed - Page 281/282

Miami protocol - Intra op identification of parathyroid.

Edmonston protocol - pancreas transplantation( Islets)

Bastion / Afghan protocol is to reduce radiation exposure in trauma screening

Bailey writes, “Abdominal and pelvic CT should be single-volume dual-contrast to minimise radiation exposure using the Camp Bastion or Afghan protocol.”

Ref: Bailey and Love 28th Ed - Page 275

The Mickey Mouse sign is said to represent the normal anatomy of the common femoral artery, common femoral vein, and great saphenous vein on ultrasound at the level just inferior to the inguinal crease

Ref: Bailey and Love 28th Ed - Page 1032

The Thoracic Surgery Scoring System (Thoracoscore) is the most widely used model to assess the risk of operative mortality in thoracic patients.

Risk is calculated based on nine variables

• Age,
• Sex,
• American Society of Anesthesiologists score,
• Performance status,
• Dyspnoea score,
• Priority of surgery,
• Extent of surgery,
• Malignant diagnosis and
• Composite comorbidity score.

It is currently the most robust model available to estimate the risk of death when considering patients for thoracic surgery.

Ref: Bailey and Love 28th Ed - Page 975

Postoperative complications of surgery for Zenker diverticulum include fistula formation, abscess, hematoma, recurrent nerve paralysis, difficulties in phonation, and Horner syndrome. The incidence of the first two can be reduced by performing a diverticulopexy rather than a diverticulectomy.

The absence of a suture line lessens the chance of a postoperative leak

The security of this staple line and the effectiveness of the myotomy may be tested before hospital discharge with a water-soluble contrast esophagogram

Reference:

Bailey and Love 28th Ed - Page 1127

Schwartz Textbook of Surgery 11th Ed - Page 1053