DBMCI eGurukul OFFICIAL

Answer2810. #EXPLANATION Flail chest: ⦁ Occurs when several adjacent ribs are fractured in two places either on one side of the chest or either side of the sternum, the flat segment moves paradoxically, that is, inwards during inspiration and outwards during expiration (Paradoxical respiration). ⦁ Net result is poor oxygenation from injury to the underlying lung parenchyma and paradoxical movement of the flail segment. ⦁ If the segment is small and not embarrassing respiration local control of chest pain with good analgesia and regular blood gas analysis until the flail segment stabilizes. ⦁ In more severe cases endotracheal intubation with positive pressure ventilation for up to 3 weeks, until the fracture becomes less mobile. Ans. B. (IPPV with oral intubation)

Answer2809. #EXPLANATION ⦁ All the choices in the given question can present with chest pain especially GERD can present with epigastric discomfort. ⦁ But none other than MI and pericarditis present with ECG changes ⦁ ECG changes in the given question are ST elevation Inferior leads which is typical of inferior wall MI. Ans. D. Inferior wall myocardial infarction

Answer2808. #EXPLANATION Unsafe CSOM (atticoantral type) involves the posterosuperior part of middle ear cleft (attic, antrum, posterior tympanum and mastoid) and is associated with cholesteatoma, which, because of its bone eroding properties, causes risk of serious complications for this reason, the disease is also called unsafe or dangerous type. Surgical treatment is the mainstay in the management. Primary aim is to remove the disease and render the ear safe, and second in priority is to preserve the hearing but never at the cost of primary aim. Two types of surgical procedures are done to deal with cholesteatoma: ⦁ Canal wall down procedures and ⦁ Canal wall up procedures. Ans. D. Tympano-mastoid exploration

Answer2806. #EXPLANATION Pelvic hematocele - may follow an instrumental delivery, a paracervical or pudendal block anaesthesia, vigorous ironing of the lower vagina and perineum during delivery or even rarely after a normal delivery. Retroverted gravid uterus - causes urinary retention at 12 weeks of gestations. ⦁ The patients treated with infertility most likely the incidence of ectopic pregnancy is much higher presents with amenorrhoea (75%), Abdominal pain (95%), vaginal bleeding, retention of urine ⦁ Retention of urine - In a subacute variety of ectopic pregnancy, the blood collects in pouch of Douglas to form a pelvic haematocele, this haematocele forms an irregular mass of differing consistency due to a mixture of clot and blood, and bulges forwards, displacing the cervix against the bladder and leading to retention of urine ⦁ Cervical fibroid [929-W- Myomas in the cervix or lower uterine segment may obstruct labour and may be confused with the fetal head. Ans. C. Pelvic haematocele

Answer2807. #EXPLANATION ⦁ Moderate leukocytosis is characteristic of acute appendicitis, but a white blood count of 22,000/mm3 suggests either appendiceal rupture or some other diagnosis. ⦁ When an inflamed appendix lies posteriorly near the ureter, other white blood cells or red blood cells may be found in the urinary sediment. ⦁ Other studies are not usually required to establish a diagnosis of acute appendicitis. If an abdominal x-ray is done, a fecalith may be seen in the right lower quadrant, or nonspecific ileus may be present. ⦁ However, it is not unusual for the study to be entirely normal. Similarly, ultrasound examination mayor may not identify an inflammatory right lower quadrant mass. Ans. D. White blood count 22,000/mm3