Ans1- Alexander Fleming.

Ans2- In 1928, Alexander Fleming observed that a mold, Penicillium notatum, had contaminated a culture of Staphylococcus aureus, and that the mold had inhibited the bacteria's growth, leading to the discovery of penicillin.

Accidental Discovery:
While working at St. Mary's Hospital in London, Fleming was studying influenza when he noticed that a petri dish containing Staphylococcus aureus cultures had been accidentally contaminated with mold.

Observation:
He observed that the mold, identified as Penicillium notatum, had created a clear, bacteria-free zone around itself on the culture plate.

Further Investigation:
Fleming investigated the phenomenon and discovered that the mold was secreting a substance that inhibited bacterial growth, which he named "penicillin".

Significance:
Penicillin became the world's first antibiotic, revolutionizing the treatment of bacterial infections and saving countless lives.

Ans1- There are multiple dilated loops of small bowel secondary to small bowel obstruction. There is mild mural thickening in the right lower quadrant, suggestive of early ischaemia.

An abrupt transition is seen in the terminal ileum due to a 30 mm gallstone – a gallstone ileus.

Pneumobilia is present, this is secondary to a cholecystoduodenal fistula.

Ans2- Gallstone ileus is an uncommon but potentially serious cause of small bowel obstruction.

The main therapeutic goal is relief of intestinal obstruction by extraction of the gallstone.

Current surgical options are simple enterolithotomy (as in this case); enterolithotomy, cholecystectomy and fistula closure (one-stage procedure) or enterolithotomy with cholecystectomy performed later as a two-stage procedure. Enterolithotomy is the most common surgical procedure performed.

Ans1- Right pneumothorax for which ICD was attempted.

Ans2- ICD malpositioned in subcutaneous tissue.

ETT is virtually at the level of the carina and should be withdrawn. Nasogastric tube is in the stomach.

Left intercostal catheter at tip is against the mediastinum and left Pneumocath tip is projected over the heart.

Small bilateral pneumothoraces are present together with multiple bilateral rib fractures.

No right sided intercostal catheter is seen.

Elevated left hemidiaphragm.

This is a Xray of patient who had Esophagectomy and gastric pull-up performed on the same day earlier.

CXR was done to assess position of central venous catheter, chest drains, and endotracheal tube.

Double lumen endotracheal tube should not be misdiagnosed as ET being malpositioned.

Ans.1- Arthur C Guyton.

Ans.2- His research which include more than 600 papers and 40 books led to understanding of most of the cardiovascular disorders like Hypertension, heart failure and others.

He pioneered the concepts of CO, venous return, interstitial fluid pressure, fluid volumes, blood flow auto regulation, renal pressure natriuresis and long term blood pressure regulation.

Ans.3- Textbook of Medical physiology. It’s the best selling physiology textbook in world translated into 15 languages.

Unlike most major textbooks, the first eight editions of the book were written entirely by Dr Guyton which is unprecedented in any medical text.

Ans.- Multiple bilateral rib fractures seen laterally and right subcutaneous emphysema including gas tracking in the right pectoralis muscle.

Bilateral intercostal catheters have been inserted.

The patient is intubated with the endotracheal tube tip almost at the level of the carina. This should be pulled back a few centimetres for ideal positioning.

While the superior mediastinum appears widened and the aortic knuckle is poorly seen this does not necessarily imply mediastinal haematoma as the patient is supine and significantly rotated.

There is however the suggestion of left apical pleural capping which can be a feature of aortic injury.

Subsequent CT revealed a normal mediastinum and small volume extra-pleural haematoma at the lung apices due to first rib fractures.