Polyps and Colorectal Carcinoma MCQs

Periodic Fever with Aphthous Stomatitis , pharyngitis and cervical adenitis presents with clock like periodicity. It is the Most common autoinflammatory syndrome in children. Reference : Harrison's Principles of Internal Medicine, 21 st ed, Ch; 369 Pg: 2843

Hypercalciuria is the most common identifiable cause of calcium kidney stone disease. The commonest type of renal stone is Calcium Oxalate. Currently there is no normal or cut off to define hypercalciuria. High calcium along with high urine oxalate and low urinary citrate cause Calcium oxalate stones. Pharmacological management of Calcium Oxalate stones Thiazide diuretics, usually Chlorthalidone, along with sodium restriction. Sodium restriction, if not followed will not lead to the desired effect on calcium. The other significant causes are hyperoxaluria, hyperuricosuria, low urinary volume, and hypocitraturia. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 318, Pg: 2372.

Streptococcus bovis bacteremia and endocarditis have been strongly associated with colorectal neoplasia. Patient identified to have S. bovis endocarditis should be evaluated for the presence of colorectal polyps or cancer. Penicillin G is the treatment of choice for S. bovis endocarditis typically given for 4 weeks. Staphylococcus aureus is the most commonly isolated organism from endocarditis occurring in IV drug abusers, which preferentially affects the tricuspid valve. Reference : Harrison's Principles of Internal Medicine 21 st edition Page 1023-25

Varices are ubiquitous in patients with portal hypertension irrespective of the etiology and usually present with an acute, large-volume haematemesis associated with a high morbidity and significant mortality. The lower esophagus is the most common site and the diagnosis should be suspected in a patient known to have cirrhosis, but confirmation of the source is required following initial resuscitation. Variceal hemorrhage is a medical emergency and failure to control variceal bleeding with current medical management occurs in 10-20% of cases. The most common cause of death in these patients are HEMORRHAGIC SHOCK -> HYPOVOLEMIC SHOCK Patients with massive hemorrhage should be admitted to an intensive therapy unit, venous access obtained through two large-bore peripheral cannulae and resuscitation commenced, ideally with blood.

The aim of EDT is to perform: Internal cardiac massage; Control of haemorrhage from injury to the heart or lung; Control of intrathoracic haemorrhage from other sources; Control of massive air leak; Clamping of the thoracic aorta to preserve the blood supply to the heart and brain, and cutting off the arterial supply distally, in a moribund patient with a major distal penetrating injury. Reference : Bailey & Love's short practice of surgery, chapter: 29, Edition: 28th, Pg: 378

In certain situations, EDT is considered futile: CPR in the absence of endotracheal intubation for more than 5 minutes; CPR for more than 10 minutes (despite endotracheal intubation); Blunt trauma when there have been no signs of life at the scene Reference : Bailey & Love's short practice of surgery, chapter: 29, Edition: 28th, Pg: 378

All symptomatic patients should be offered surgery. An expert panel recently published recommendations on which asymptomatic patients should be considered for surgical intervention (Bilezikian et al., 2014). When criteria have been met and where a single adenoma has been identified by radiological means, a minimally invasive parathyroidectomy may be offered. Conversely, where there is discordant imaging or where imaging fails to identify any parathyroid abnormalities, then a bilateral neck exploration and three and a half-gland parathyroidectomy or a four- gland parathyroidectomy and autotransplantation should be performed. Reference : Bailey & Love's short practice of surgery 28 th Edition, CHAPTER 56, The parathyroid glands, Pg:879.

Renal transplantation remains the only definite treatment for secondary hyperparathyroidism . Other therapies are a bridge to this or aim to provide symptom relief. Standard management includes replacement of calcium and vitamin D and the reduction of phosphate levels by the use of phosphate binders. Treatment of this disease changed radically with the introduction of calcimimetic drugs, such as cinacalcet. Calcimimetics alter the set point of the CaR, thereby reducing the constant stimulation of the parathyroid glands and lowering the PTH level. Reference : Bailey & Love's short practice of surgery 28 th Edition, CHAPTER 56, The parathyroid glands, Pg:885.