Repeated Medical PG Question- 09

#SURGERY (AIIMS-PG)

Q- A female in her twenties presents with complaints of abdominal pain, abdominal distention, and vomiting. On examination, she was found to have alopecia and crepitus in the epigastrium. What is your diagnosis?

       A. Trichobezoar

       B. Carcinoma pyloric antrum

       C. Intestinal tuberculosis

       D. Rectus sheath hematoma

Answer is A. Trichobezoar

 Rapunzel's syndrome(named after the captive maiden in the Grimm's fairy tale) refers to severe cases of trichobezoar that extend from the stomach into the small bowel and may even reach the caecum.

▪️Gastric bezoars may obstruct the stomach and cause gastric ulceration.

▪️It is a hair-ball commonly seen in the stomach of females with psychiatric illness, who swallow hair regularly.

▪️The most common presenting signs are abdominal pain, nausea and vomiting, obstruction, and peritonitis. Less commonly, patients have presented with weight loss, anorexia, hematemesis, and intussusception. 

▪️Barium outlines and often penetrates the mass, showing a filling defect in the stomach, which often has a mottled appearance.

Clinical Feature:

▪️Epigastric pain, early satiety

▪️Haematemesis

▪️Features of gastritis

▪️Loss of appetite

▪️Perforation

▪️Epigastric mass

Q- Which one of the following statements is not true regarding surgical blades?

A. Number 11 blade is also known as a stab blade and is used for incision & drainage

B. Belly of the blade is the sharpest portion of the blade

C. A right handed surgeon while making an incision should go from his right to his left

D. Surgical blades should ideally be passed in a kidney tray during surgery

Answer is C. . A right handed surgeon while making an incision should go from his right to his left

                       Surgical blades

🔹No. 10 used for skin ( it looks similar to no. 15 but larger in size)

🔹No. 11 is sharpest pointed known as stab blade , used for incision of abscess

🔹No. 12 used for suture removal

🔹Belly of blade is sharpest portion of blade

🔹No. 15 most commonly used for intraoral ,used to make incision around teeth through soft tissue.

🔹 While making an incision surgeon should go from his right to left( distal to proximal)

Q- A 40-year old lady presents with large left parietal convexity meningioma with perilesional edema. She is scheduled for surgery the next day. A senior neurosurgeon asks a junior resident to write the pre-op notes for the lady. Which of the following pre-op notes written by him is wrong

       A. Anti-epileptic treatment

       B. Wash head with shampoo

       C. Antibiotic sensitivity

       D. Stop steroids

Answer is D. Stop steroids

Perilesional edema or vasogenic edema responds to steroids thus lowering the intracranial pressure. Therefore steroids are to be continued and morning dose has to be taken.