Tuesday, November 24, 2009

320 - PGI Chanigarh November 2009 MCQs with answers - part 8

36q: Which of the following is seen in severe preeclampsia ?
b)severe oedema
d)Diastolic bp mmore than 110
e)Systolic bp more than 150

37q: True about Boerrhave's syndrome ?
a)present with hemoptysis
b)shows transmucosal rupture
c)shows cyanosis & decreased conciousness
d)mucosal repair

38q: Pathognomic pathologial finding in HIV infection?
b)neurofibrillary tangles
c)giant cells
d)lewi bodies

39q: True about senile amyloidosis
b)beta amyloid
c)AA amyloid
d)Heart failure is predominant presentation

40q: which is seen in zygomatic fracture?
a. Swelling cheek
b. Severe malocclusion
c. Epistaxis
d. Infraorbital nerve damage
e. ?????????


Anonymous said...

qu36 seen in preeclampsia:answer is a,b,c,d...systolic bp shud b more than 170mm hg

quasimod said...

Boerhaave's syndrome - complete TRANSMURAL (not transmucosal) rupture of Lower esophagus

represents 10-15% traumatic esophageal ruptures
(most common or >85% are due to iatrogenic causes)

Hemoptysis is uncommon/not a typical feature in Boerhaave's as compared to Mallory Weiss syndrome

Mackler triad defines the classic presentation of Boerhaave syndrome. It consists of vomiting, lower thoracic pain, and subcutaneous emphysema.

# Other classic findings include tachypnea and abdominal rigidity.

# Tachycardia, diaphoresis, fever, and hypotension are common, particularly as the illness progresses. However, these findings are nonspecific.

# Unusual findings may include the following:

* Peripheral cyanosis
* Hoarseness of voice due to recurrent laryngeal nerve involvement
* Tracheal and mediastinal shift
* Cervical vein distention
* Proptosis

# Pneumomediastinum is a very important finding.

* It may cause a crackling sound upon chest auscultation, known as the Hamman crunch.
* The crunch typically is heard coincident with each heartbeat and may be mistaken for a pericardial friction rub.
* This is present in 20% of patients.

Conservative (nonsurgical) management might be appropriate ONLY in following cases

* The esophageal disruption should be well contained in the mediastinum.
* The cavity should be well drained back into the esophagus.
* Few symptoms should be present.
* Evidence of clinical sepsis should be minimal.

Conservative management consists of the following:

* Intravenous fluids should be instituted.
* Antibiotics: Imipenem/cilastatin (Primaxin) offers good broad-spectrum coverage.
* Nasogastric suction should be applied.
* Keep the patient NPO.
* Adequate drainage with tube thoracostomy or formal thoracotomy is vital.
* Early use of nutritional supplementation: Evidence suggests that for hastening recovery, a jejunostomy tube feeding may be favored over hyperalimentation.

Most physicians advocate surgical intervention if the diagnosis is made within the first 24 hours after perforation

# Direct repair of the rupture and adequate drainage of the mediastinum and pleural cavity provide the best survival rates.
# A left thoracotomy is the preferred approach.

An omental flap may be used to support the primary closure

the use of plastic-covered self-expanding metallic stents.6,7

* They are considered acceptable alternatives only when all other interventional options have been exhausted. Their use in nonmalignant disease is highly controversial because they cannot be removed without considerable risks or not at all.
* The use of stents in Boerhaave syndrome is recommended for cases that involve extreme delays in diagnosis or a failure of conservative.

From the above, the answer is derived to be ONLY C as correct.

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