USMLE type Questions

Q1. During exploratory laparotomy of blunt trauma abdomen, after splenectomy, a retroperitoneal haematoma is found over the pancreas. The haematoma is explored and pancreas is seen transected over the vertebral bodies. What will be the next step in management?

a) Sump drainage

b) Distal pancreatectomy

c) Whipple's surgery

d) Pancreaticojejunostomy

Q2. Which testicular cancer cell type is extremely radiosensitive?

a) Embryonal carcinoma

b) Yolk Sac tumor

c) Seminoma

d) Choriocarcinoma

Q3. What physiological change occurs after Carbon dioxide pneumoperitoneum?

a) Decreased pulmonary compliance

b) Metabolic alkalosis

c) Increase in Cardiac output

d) Decrease in Mean arterial pressure

Q 4. Not true about CEA (Carcino Embryonic antigen) in Carcinoma Colon

a) It is a useful screening test

b) Slight elevation of CEA can occur in certain benign diseases.

c) CEA is useful as a prognostic marker in Cancer of Colon

d) Preoperative CEA value is a predictor of survival in Carcinoma Colon

Q5 . A 10 year old girl complains of limping. She has pain in the right leg and fatigue for months.

Physical examination shows multiple bruises on the body with cervical and axillary lymphadenopathy

and hepatosplenomegaly. A blood smear shows excessive lymphocytes.

What is the next step?

a) Bone marrow biopsy

b) Liver biopsy

c) Recommend a diet rich in Vitamin C

d) Serum heterophile antibodies test

Q6. A 70 year old male undergoes colonic resection for tumor. 24 hours later his urine output is 10 ml/hr. Na138, K 6meq/l, Cl 100 meq/l and HCo3 14meq/l. This metabolic abnormality is consistent with

a) Distension of abdomen

b) Peaked T wavec) Narrow QRS d) J wave e) Cardiac arrest in systole

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Answers

1) b Distal pancreatectomy

Since pancreas is transacted over the vertebral bodies, head of pancreas is preserved and there is sufficient tissue to carry out the endocrine and exocrine functions so distal pancreatectomy is recommended.

Whipple is done for trauma of head of pancreas

Sump drainage is useful when there is limited injury and duct of pancreas is not transected

Pancreaticojejunostomy in this setting will not be of much benefit because the tissue will be soft and friable and there will be chances of anastomotic leak.

2)c Seminoma

Seminoma are radiosensitive where as all others are resistant to radiotherapy and sensitive to chemotherapy.

3) a

Decrease in pulmonary compliance occurs due to increase in intra abdonial pressure and diaphragmatic elevation.

Co2 retention causes acidosis and not alkalosis

Cardiac output decreases

Mean arterial pressure increases

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4) a

CEA is an oncofetal protein that is normally present during fetal life but can be present in low concentrations in healthy adults. Structurally, it is a glycoprotein with a molecular weight of 200 kDa. It is not useful as a screening test because of its low sensitivity in early-stage disease.

It can be increased in several benign diseases such as rheumatoid arthritis, cystic diseases of kidneys, COPD, cirrhosis.

It is useful as a follow up investigation after colonic resection because increasing levels correlate with the stage of the disease and similarly preop values correlate with the severity of the disease

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5) a

Bone pain, easy bruisability and fatigue in a child with hepatosplenomegaly suggests malignancy which is confirmed by the presence of blast cells on peripheral smears.Most common leukemia in a child is ALL (Acute lymphocytic leukemia)

Bone marrow biopsy is the next appropriate step

Liver biopsy will not help keeping in mind the blood picture

Vitamin C deficiency does cause easy bruising but does not fill in the over all picture

Serum heterophile antibody test is done in cases of Infectious mononucleosis which causes lymphadenopathy but is not required here.

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6. b

This patient has low urine output with hyperkalemia which is manifested with tall T waves.

Abdominal distension is seen with hypokalemia

ECG in this seeting will show wide QRS and not narrow

In Hyperkalemia cardiac arresr occurs in diastole

J wave is seen in hypothermia