Chronic Pancreatitis MCQs

Radiopaque stones are: Calcium oxalate, calcium phosphate, triple phosphate, cystine stones. Radiolucent stones are: Uric acid, xanthine stones. Uric acid stones can be visualized by helical CT. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 318, Pg: 2370.

Metabolic effects Vomiting hydrochloric acid results in hypochloremic alkalosis . Initially the sodium and potassium may be relatively normal; however, as dehydration progresses, more profound metabolic abnormalities arise, partly related to renal dysfunction. Initially, the urine has a low chloride and high bicarbonate content , reflecting the primary metabolic abnormality. With time the patient becomes progressively hyponatremic and more profoundly dehydrated. Because of the dehydration , sodium is retained and potassium and hydrogen ions are excreted . This results in the urine becoming paradoxically acidic and hypokalaemia ensues . Alkalosis leads to a lowering in the circulating ionized calcium, and tetany can occur.

The history given here is suggestive of buerger's disease The next investigation is to do DUPLEX scan to know the distal blood flow in lower limbs. This major non-invasive technique uses B-mode ultrasound to provide an image of vessels IOC for atherosclerotic diseases is DIGITAL SUBSTARCTION ANGIOGRAPHY (DSA)

The key aspects of assessing a patient with suspected chronic liver disease or complications of portal hypertension are the following - Diagnosis of the underlying liver disease Estimation of functional hepatic reserve - helps to determine whether definitive (e.g., hepatic transplantation) or palliative (e.g., endoscopic variceal ligation or a shunt procedure) treatment is indicated Definition of portal venous anatomy and hepatic hemodynamic evaluation Identification of the site of upper gastrointestinal hemorrhage , if present. Reference : Sabinston Textbook of Surgery 21st Edition, SECTION X ABDOMEN, Chapter 54, The Liver Pg: 1445.

Explanation: The Los Angeles (LA) classification grades reflux esophagitis (endoscopic mucosal breaks). Achalasia is classified by high-resolution manometry using the Chicago classification (types I-III). So LA classification does not apply to achalasia Explanation of other options: Chronic pancreatitis (Option A)- M-ANNHEIM : the M-ANNHEIM classification (pronounced "Mannheim") is an accepted classification and scoring system for chronic pancreatitis (etiology, stage, severity). So this pairing is essentially correct (note the common spelling M-ANNHEIM). Colonoscopy - Boston score (Option C) : the Boston Bowel Preparation Scale is used to grade bowel prep quality for colonoscopy. Parathyroid resection - Miami criteria (Option D) : t he Miami intraoperative PTH criteria (drop of >50% from baseline at 10 min) guides adequacy of parathyroidectomy.

Long cold ischemic time is a risk factor. Chronic rejection usually occurs after the first 6 months. All types of transplants are susceptible to chronic rejection, and it is the major cause of allograft failure. Interestingly, the liver is more resistant than other organs to the destructive effects of chronic rejection. The risk factors for chronic rejection of a kidney transplant are: Previous episodes of acute rejection Poor HLA match Long cold ischaemia time Cytomegalovirus (CMV) infection Raised blood lipids Inadequate immunosuppression (including poor compliance) The single most important risk factor for chronic rejection after kidney transplantation is acute rejection (with vascular inflammation) and recurrent episodes of acute rejection . Reference : Bailey & Love's short practice of surgery 27th Edition, Chapter 82, Transplantation, Pg: 1536.

Bevacizumab is effective against VEGF receptors . Erlotinib, cetuximab are effective against EGFR receptors. Ibrutinib is effective against bruton’s tyrosine kinase receptors. Used in the management of chronic lymphocytic leukemia. Reference: Schwartz 11 th edition page 343

Rest pain As disease progression occurs the claudication distance decreases and perfusion to the leg may be so severely compromised that anaerobic respiration occurs even at rest , typically affecting the foot and/or calf. The pain is exacerbated by lying down or elevation of the foot because of the loss of gravitational effects on the perfusion pressure in the foot. The patient characteristically describes pain that is worse at night and may be lessened by hanging the foot out of bed or by sleeping in a chair (effects of gravity restored). Even the pressure of bedclothes on the foot may exacerbate the pain.