Download - Abdomen
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MCQ
• Short story = clinical vignette
• One line question
• 5 options= distractors
• One will be correct
• Blue print
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Blue print
• 10 basics = trauma• 10 H&N• 10 Breast• 10 hernia, etc• 10 jaundice, abdomen• 10 abdomen• 10 colo-rectal• 10 Ped surgery• 5 vascular• 5 Thoracic• 10 Plastic surgery
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Jaundice (J+)
• Surgical √
–Itching
–Clay colored stool
–Se Alkaline Phosphatase –Direct bilirubin –Total Bilirubin
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J+
• GB Soft
• A 45 y old male presents to OPD with jaundice, clay colored stools, itching. On examination, soft gall bladder is palpable. Total and direct bilirubin is raised.
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A 45 y old male presents to OPD with jaundice, clay colored stools, itching. On examination, soft gall bladder is palpable. Total and direct bilirubin is raised.• Which of the following is the likely
diagnosis?
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Distractors
1. CA gall bladder
2. CBD stone
3. Hilar cholangiocarcinoma
4. CA head of pancreas
5. Biliary agenesis
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J+
• GB Not palpable
• No pain
=
• Hilar Cholangiocarcinoma (Klatskin’s tumor)
• Intra-hepatic
• Congenital
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J+
• 2 months age
• GB Not palpable
• No pain =
• Intra-hepatic
• = Biliary agenesis= Kasai operation
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J+
• GB not palpable
• Pain +
• CBD stone
• Inv MRCP
• Rx ERCP
• GB not palpable
• Pain –
• Hilar Cholangiocarcinoma
• Inv MRCP
• Rx Excision + H-J• (Hepatico-jejunostomy)
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J+
• Hard liver- smooth
• = Primary Carcinoma of Liver
• Inv =AFP, CT scan, MRA
• FNAC is CONTRAINDICATED
• Rx = Surgery= Resection
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J+
• Liver Hard- nodular
• = Secondaries in Liver
• Inv = search for primary= P0
• FNAC Liver (if PT is N)
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J+
• Pain +• Fever += Charcot’s triad=Surgical emergency= IV fluids, antibiotics►Later, when stabilized, Inv MRCP ; Rx ERCP
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RIF mass : DD
1. Appendicular2. CA Caecum3. Ileo-caecal TB4. Crohn’s5. Actinomycosis6. Carcinoid7. Amoeboma8. LN mass
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RIF mass : DD
• Appendicular• CA Caecum• Ileo-caecal TB• Crohn’s• Actnomycosis• Carcinoid• Amoeboma• LN mass•
• Undescended testis• Ectopic kidney• In F= TO Mass• Aneurysm of Iliac Art• Bone tumour