MedicoNotebook

0 Eosinophilia with Lung involvement

MCQ 142

Q. Lungs are always involved in which of the following ?

a. Churg-strauss disease

b. Classic PAN

c. Both

d. None

ANSWER:

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

1 Tracheoesophageal fistula

Tracheoesophageal fistula

Male
Common with down's syndrome
Polyhydroamnios (in 50% cases)

Presentation :

1st - Child drooling saliva
Aspiration and choking with breast feed

Investigation of choice : Pass Nasogastric tube and take X-Ray image.

VACTERL Association :

V - Vertebral anomalies
A - Anal atresia
C - Cardiovascular anomalies (PDA , VSD , TOF)
TE - Tracheoesophageal fistula
R - Renal (Kidney) anomalies
L - Limb defects (Radial hypoplasia)

Treatment :
Surgery - RIGHT postero-lateral thoracotomy with ligation of fistula and end to end anastomosis.
If very sick child - Do feeding gastrostomy

Q. Why RIGHT postero-lateral approach ?
Ans : Because aorta is Left of oesophagus in upper and middle 1/3rd.

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

0 Caval opening of diaphragm

MCQ 141

Q. Which of the following passes through caval opening of diaphragm ?

a. Right phrenic nerve

b. Left phrenic nerve

c. Azygous vein

d. Thoracic duct

ANSWER:

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

0 Hiatus hernia

Hiatus hernia

Investigation :
Barium meal ( IOC ) , in trendelenburg position

Treatment :

Conservative - PPI for GERD

Surgery -

1. Fundoplication

Nissen's - 360 degree
Belsey - < 270 degree
Toupet - 180 degree

2. Hill's repair : Make angle of "His" acute by stitching lower oesophagus to median arcuate ligament.

3. Collis gastroplasty - Surgery for short oesophagus ( because of fibrosis )

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel