Uncategorized Archives - Page 2 of 51 - Dr Chaitanya Joshi, MD

3 Set Loksewa Past Question Collection of Medical Officer (MBBS)

GASTRIC OUTLET OBSTRUCTION (GOO) Note Complete

~~Table of Contents(toc)~~

GASTRIC OUTLET OBSTRUCTION (GOO)

Definition

Partial or complete obstruction of the distal stomach, pylorus, or proximal duodenum, preventing normal gastric emptying into the duodenum.

Etiology

A. Congenital causes

Infantile hypertrophic pyloric stenosis (most common in infants)
Duodenal atresia
Annular pancreas
Preduodenal portal vein
Gastric/duodenal webs or membranes

B. Acquired causes

1. Benign causes

Peptic ulcer disease (most common in adults)
Chronic pancreatitis (fibrosis, pseudocyst compression)
Postoperative adhesions or anastomotic strictures
Ingestion of corrosives
Gallstone impaction (Bouveret syndrome)
Crohn’s disease
Tuberculosis (gastroduodenal)

2. Malignant causes

Carcinoma of the stomach (antral carcinoma)
Carcinoma of the pancreas (head region)
Duodenal carcinoma
Lymphoma involving pylorus

Pathophysiology

Obstruction → gastric stasis → accumulation of food, fluid, and secretions → gastric dilatation
Persistent vomiting → loss of H⁺, Cl⁻, K⁺ → hypochloremic, hypokalemic metabolic alkalosis
Dehydration → hypovolemia → renal compensation (paradoxical aciduria)

Clinical Features

Symptoms

Vomiting – projectile, non-bilious, of undigested food; may be late after meals
Fullness / bloating / early satiety
Epigastric pain (relieved by vomiting)
Weight loss and dehydration
Constipation and reduced urine output

Signs

Visible gastric peristalsis (from left to right across epigastrium)
Succussion splash (sloshing sound >6 hrs after meal)
Epigastric distension
Signs of dehydration: sunken eyes, dry tongue, hypotension
Palpable lump (in carcinoma or hypertrophic pyloric stenosis)

Investigations

Laboratory

Electrolyte imbalance: ↓Na⁺, ↓K⁺, ↓Cl⁻, ↑HCO₃⁻ (metabolic alkalosis)
Hemoconcentration (↑Hct)
Renal function tests – elevated urea/creatinine due to dehydration

Imaging

Plain X-ray abdomen:

Greatly distended stomach with fluid level, no gas beyond pylorus

goo plain x ray

Barium meal:

Delayed gastric emptying, “string sign” (narrow pylorus), or “beak-like narrowing”

GOO barium x ray

Endoscopy:

Visualize site of obstruction; exclude malignancy; can take biopsy

CT scan:
- Defines cause and extrinsic compression (pancreatic malignancy, pseudocyst)

Management

1. Initial (Stabilization)

Nil per oral (NPO)
Nasogastric decompression
IV fluids – correct dehydration and electrolyte imbalance
Correct metabolic alkalosis
Proton pump inhibitors / H₂ blockers
Nutritional support

2. Definitive treatment

a. Benign causes:

Peptic ulcer-related:
- Endoscopic balloon dilatation (first-line if fibrosis mild)
- Surgery if refractory:
  - Truncal vagotomy + antrectomy (Billroth I/II)
  - Gastrojejunostomy
Hypertrophic pyloric stenosis:
- Ramstedt’s pyloromyotomy
Chronic pancreatitis / pseudocyst:
- Treat underlying cause or cyst drainage

b. Malignant causes:

Resectable:
- Subtotal/total gastrectomy or pancreaticoduodenectomy (depending on origin)
Unresectable:
- Palliative gastrojejunostomy or endoscopic stenting

Complications

Severe dehydration and shock
Metabolic alkalosis with paradoxical aciduria
Aspiration pneumonia
Nutritional deficiencies
Gastric perforation (rare, late stage)

Summary Table

Feature	Benign	Malignant
Onset	Gradual	Rapid
Vomiting	Large, non-bilious, food particles	Small, may contain altered blood
Pain	Relieved by vomiting	Persistent
Visible peristalsis	Prominent	Often absent
Weight loss	Moderate	Marked
Endoscopy finding	Scarring, ulcer	Mass, irregular ulcer

Diploma in OTTM license examination model question

DIPLOMA IN OTTM – 50 MCQs

~~Table of Contents(toc)~~

operation theatre technology MCQs

Anatomy & Physiology

The largest organ in the human body is:
A) Liver
B) Skin
C) Brain
D) Lungs
The functional unit of the kidney is:
A) Nephron
B) Alveolus
C) Glomerulus
D) Bowman’s capsule
Which artery supplies the heart muscle?
A) Pulmonary artery
B) Coronary artery
C) Carotid artery
D) Subclavian artery
The normal range of adult respiratory rate is:
A) 8–10/min
B) 12–20/min
C) 22–28/min
D) 30–40/min
Which cranial nerve controls the diaphragm?
A) Vagus nerve
B) Phrenic nerve
C) Hypoglossal nerve
D) Trigeminal nerve
The total number of bones in adult human body is:
A) 204
B) 206
C) 208
D) 210
The largest gland in the human body is:
A) Pancreas
B) Liver
C) Thyroid
D) Adrenal
Gas exchange occurs in:
A) Trachea
B) Bronchi
C) Alveoli
D) Pleura
The hormone insulin is secreted by:
A) Adrenal cortex
B) Pancreas (Islets of Langerhans)
C) Pituitary
D) Thyroid
Which part of the brain controls balance and coordination?
A) Cerebrum
B) Cerebellum
C) Medulla
D) Pons

Microbiology & Infection Control

Autoclaving is done at:
A) 100°C for 15 min
B) 121°C for 15 min at 15 psi
C) 134°C for 5 min at 30 psi
D) 160°C for 1 hour
Bacteria are best stained by:
A) Gram stain
B) Ziehl-Neelsen stain
C) Wright’s stain
D) Leishman stain
The causative organism of gas gangrene is:
A) Staphylococcus aureus
B) Clostridium perfringens
C) Streptococcus pyogenes
D) Pseudomonas aeruginosa
The universal precaution includes all EXCEPT:
A) Wearing gloves
B) Recapping needles
C) Mask use
D) Handwashing
The most effective disinfectant for HIV virus is:
A) Phenol
B) Alcohol
C) Sodium hypochlorite
D) Lysol
The ideal temperature for storing blood is:
A) 0°C
B) 1–6°C
C) 10°C
D) Room temperature
Asepsis means:
A) Presence of microorganisms
B) Absence of pathogenic microorganisms
C) Infection
D) Sterility failure
The process of killing all microorganisms including spores is:
A) Disinfection
B) Sterilization
C) Pasteurization
D) Antisepsis
Which of the following is a spore-forming bacteria?
A) E. coli
B) Clostridium
C) Klebsiella
D) Neisseria
The standard concentration of formalin used for fumigation is:
A) 20%
B) 30%
C) 40%
D) 10%

OT Techniques & Sterilization

The sterile area in OT includes:
A) Scrub area
B) Operation table
C) Corridor
D) Changing room
Ethylene oxide sterilization is used for:
A) Linen
B) Rubber and plastic items
C) Glassware
D) Instruments
Instruments are arranged on:
A) Mayo table
B) Instrument trolley
C) Both A and B
D) Floor table
The position used for perineal surgeries is:
A) Supine
B) Lithotomy
C) Trendelenburg
D) Prone
The function of suction machine in OT is:
A) To provide oxygen
B) To remove blood and secretions
C) To monitor BP
D) To sterilize instruments
The blue zone in OT indicates:
A) Clean area
B) Sterile zone
C) Dirty area
D) Store
Drapes used in surgery should be:
A) Waterproof
B) Cotton
C) Plastic
D) Wool
The ideal air pressure in OT is:
A) Positive pressure
B) Negative pressure
C) Neutral
D) Variable
The most important step before scrubbing is:
A) Wearing gown
B) Wearing mask and cap
C) Touching sterile field
D) None
Scrubbing time for hands is:
A) 30 seconds
B) 1 minute
C) 3–5 minutes
D) 10 minutes

Anaesthesia & Surgery Basics

Local anesthesia acts by:
A) Blocking motor nerves
B) Blocking sensory nerves
C) Depressing CNS
D) Inducing sleep
Spinal anesthesia is given at the level of:
A) L1–L2
B) L3–L4
C) T10–T11
D) L5–S1
The color of oxygen cylinder is:
A) Black with white shoulder
B) Blue
C) Black with green shoulder
D) Green
The anesthetic agent causing malignant hyperthermia is:
A) Halothane
B) Ether
C) Succinylcholine
D) Nitrous oxide
The antidote for morphine overdose is:
A) Naloxone
B) Atropine
C) Neostigmine
D) Diazepam
The commonest complication of spinal anesthesia is:
A) Vomiting
B) Headache
C) Fever
D) Infection
Pulse oximeter measures:
A) Blood pressure
B) Heart rate
C) Oxygen saturation
D) CO₂ level
The color code for nitrous oxide cylinder is:
A) Black with white shoulder
B) Blue
C) White
D) Green
Minimum alveolar concentration (MAC) is related to:
A) Potency of inhaled anesthetic
B) Toxicity
C) Cost
D) Blood solubility
The safest muscle relaxant in renal failure is:
A) Vecuronium
B) Pancuronium
C) Atracurium
D) Rocuronium

Surgical Instruments & Procedures

Mosquito forceps are used for:
A) Holding skin
B) Clamping small blood vessels
C) Cutting sutures
D) Grasping tissue
The instrument used to hold bowel is:
A) Allis forceps
B) Babcock forceps
C) Kocher forceps
D) Artery forceps
The suture material absorbed by the body is:
A) Silk
B) Catgut
C) Nylon
D) Prolene
The size of needle used for IM injection in adult is:
A) 18G
B) 20G
C) 21G
D) 23G
The normal adult blood volume is approximately:
A) 2 L
B) 3 L
C) 5 L
D) 7 L
The instrument used to retract abdominal wall is:
A) Langenbeck retractor
B) Balfour retractor
C) Doyen retractor
D) Volkmann retractor
“Swab count” is done to prevent:
A) Hypotension
B) Retained foreign body
C) Hypoxia
D) Bleeding
Surgical asepsis is maintained by:
A) Sterile gloves
B) Clean apron
C) Hand wash only
D) Changing shoes
The first step in wound management is:
A) Suturing
B) Cleaning and debridement
C) Dressing
D) Bandaging
Postoperative infection usually occurs within:
A) 6 hours
B) 24 hours
C) 48–72 hours
D) 1 week

ANSWER KEY (1–50)

1–B
2–A
3–B
4–B
5–B
6–B
7–B
8–C
9–B
10–B
11–B
12–A
13–B
14–B
15–C
16–B
17–B
18–B
19–B
20–C
21–B
22–B
23–C
24–B
25–B
26–B
27–A
28–A
29–B
30–C
31–B
32–B
33–A
34–C
35–A
36–B
37–C
38–B
39–A
40–C
41–B
42–B
43–B
44–C
45–C
46–B
47–B
48–A
49–B
50–C

Remember these 3 types now: Do you know Breast milk types?

Types of Breast Milk: Colostrum, Foremilk, and Hindmilk

1. Colostrum

Definition: The first milk secreted during the initial 2–4 days after delivery.
Appearance: Thick, yellowish, sticky fluid.
Volume: Small in quantity (about 30–100 mL/day).
Composition:
- High in proteins, especially immunoglobulin A (IgA) and lactoferrin.
- Low in fat and lactose.
- Rich in vitamins A, E, and K, and leukocytes.
Functions / Importance:
- Provides passive immunity and protects against infections (especially GI and respiratory).
- Acts as a natural laxative, promoting early meconium passage and decreasing risk of neonatal jaundice.
- Helps in gut maturation and colonization by beneficial bacteria.

2. Foremilk

Definition: The milk secreted at the beginning of a feeding session.
Appearance: Thin, watery, bluish-white.
Composition:
- High in lactose, water, and proteins.
- Low in fat and calories.
Function:
- Quenches the baby’s thirst.
- Provides hydration and quick energy through lactose.
Clinical Relevance:
- Excessive foremilk intake (without adequate hindmilk) may cause lactose overload → symptoms like colic, gas, and loose stools.

3. Hindmilk

Definition: The milk secreted towards the end of feeding.
Appearance: Creamy, thick, and whiter due to higher fat content.
Composition:
- High in fat and calories.
- Relatively low in lactose.
Function:
- Provides satiety and helps in weight gain.
- Supplies essential fatty acids for brain development and energy.
Practical Point:
- Mothers should be advised to empty one breast fully before switching to the other to ensure the baby receives enough hindmilk.

Summary Table

Type	Time of Secretion	Appearance	Major Component	Function
Colostrum	0–4 days postpartum	Yellow, thick	Proteins, IgA	Immunity, meconium passage
Foremilk	Early in each feed	Watery, bluish	Lactose, water	Hydration, energy
Hindmilk	Later in each feed	Creamy, white	Fat	Satiety, growth

You must know these dangerous causes of Black Tongue!

Table of Contents(toc)

🦷 What Causes Black Tongue?

(Understanding the Causes, Symptoms, and Prevention)

A black tongue can look alarming — but in most cases, it’s harmless and temporary. Medically known as “black hairy tongue” (lingua villosa nigra), this condition occurs when tiny projections on the tongue (called papillae) become elongated and trap debris, bacteria, or yeast, causing discoloration.

Let’s explore the causes, symptoms, and what you can do about it.

black hairy tongue

🧬 What Actually Happens?

The surface of your tongue is covered with small bumps called filiform papillae. Normally, these shed continuously.
However, when this natural process slows down, dead cells accumulate, allowing bacteria, fungi, food pigments, or even tobacco to get trapped.
This buildup gives the tongue a black, brown, or dark furry appearance.

⚠️ Common Causes of Black Tongue

1. Poor Oral Hygiene

Not brushing or scraping the tongue regularly is the most common cause.
Dead cells and bacteria accumulate, leading to discoloration.

2. Smoking and Tobacco Use

Nicotine and tar in tobacco products stain the tongue and alter its normal surface, promoting bacterial growth.

3. Excessive Coffee or Tea

Dark beverages contain chromogens — substances that stain teeth and tongue alike.

4. Antibiotics or Medications

Certain drugs (like tetracyclines, bismuth-containing medicines such as Pepto-Bismol, or long-term antibiotics) can alter oral flora and cause dark discoloration.

5. Dry Mouth (Xerostomia)

Reduced saliva allows dead cells and bacteria to build up.
This is common in people who breathe through their mouth, use mouthwashes with peroxide, or take anticholinergic drugs.

6. Candida (Fungal Overgrowth)

Sometimes, fungal infection (oral thrush) coexists with black hairy tongue, worsening discoloration.

7. Dietary Factors

Soft diets with little chewing may fail to mechanically clean the tongue.
Similarly, diets low in roughage may promote papillae overgrowth.

8. Mouthwash Overuse

Ironically, some antiseptic or oxidizing mouthwashes (containing peroxide or menthol) can irritate the tongue and promote papillary elongation.

causes of black tongue

👅 Symptoms

Black, brown, green, or yellow discoloration on the tongue
Hair-like or furry surface texture
Bad breath (halitosis)
Altered taste or metallic taste
Gagging sensation in severe cases

🔍 Diagnosis

A doctor or dentist can usually diagnose black hairy tongue just by examining your mouth.
No special tests are needed unless a fungal or bacterial infection is suspected.

🩺 Treatment and Management

The good news — it’s reversible with proper oral hygiene!

✅ Steps to Treat and Prevent:

Brush the tongue twice daily using a soft toothbrush or tongue scraper.
Maintain good oral hygiene — regular brushing, flossing, and dental visits.
Stop smoking or chewing tobacco.
Reduce coffee, tea, and alcohol intake.
Stay hydrated to prevent dry mouth.
Avoid irritating mouthwashes — use mild, alcohol-free ones.
If caused by medication, consult your doctor before stopping it — they may suggest an alternative.
In persistent cases, antifungal or keratolytic treatments may be prescribed.

🚫 When to See a Doctor

Seek medical advice if:

The discoloration does not improve within 1–2 weeks of good oral hygiene
You have pain, swelling, or bleeding
You notice white patches, ulcers, or difficulty swallowing

These could indicate other conditions such as oral candidiasis, leukoplakia, or precancerous lesions that need medical attention.

Key Takeaway

A black tongue is usually harmless — it’s your mouth’s way of saying, “I need better cleaning!”

By maintaining simple oral hygiene habits and avoiding staining substances, you can keep your tongue healthy, pink, and fresh.

Newborn examination form Summary!

NEWBORN EXAMINATION FORM Continue reading Newborn examination form Summary!

Note on Anaphylaxis

Note on anaphylaxis

How to store breast milk for future use?

1. Purpose

Proper storage of expressed breast milk (EBM) helps preserve its nutritional and immunological properties for later feeding when the mother is away.

2. Containers for Storage

Use clean, sterilized glass or BPA-free plastic containers with tight-fitting lids.
Breast milk storage bags (food-grade, pre-sterilized) are convenient for freezing.
Avoid ordinary plastic bottles or disposable liners.

3. Labeling

Each container should be labeled with:
Date and time of expression
Baby’s name (if used in hospital or daycare)

4. Storage Guidelines

Location	Temperature	Duration	Remarks
Room temperature	Up to 25°C (77°F)	4–6 hours	Keep in a cool, clean area away from direct sunlight
Refrigerator (back portion)	2–4°C (35–40°F)	Up to 72 hours (3 days)	Do not store in refrigerator door due to temperature fluctuation
Freezer (separate door)	–18°C or lower	Up to 3–6 months	Keep in small portions; leave space for expansion
Deep freezer	–20°C	Up to 6–12 months	Best for long-term storage
Insulated cooler box with ice packs	~15°C	Up to 24 hours	For temporary transport or travel

5. Thawing and Warming

Thaw in refrigerator overnight or by placing the container in warm water (<37°C).
Do not microwave or boil — destroys antibodies and nutrients.
Swirl gently (do not shake) to mix separated fat layers.
Once thawed, use within 24 hours and do not refreeze.

6. Hygiene

Wash hands before expressing or handling milk.
Use clean pump parts and containers for each session.
Avoid touching the inside of lids or bottles.

7. Key Points

Always use oldest milk first (“first in, first out”).
Discard leftover milk from feeding bottle after use.
Observe for odor or curdling — discard if spoiled.

Summary:

Safe breast milk storage requires hygienic handling, correct temperature, and appropriate duration. Properly stored milk retains most of its nutritional, immunological, and protective properties, ensuring safe feeding for infants when direct breastfeeding isn’t possible.