Surgery Questions

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Thyroid Questions

Q) Which of the following thyroid cancers do not take up radio active iodine

a) Medullary carcinoma thyroid

b) Papillary  carcinoma

c) Follicular carcinoma

d) Hurthle cell carcinoma

Free Answer

a - Medullary carcinoma

Medullary carcinoma of the thyroid is a tumor that arises from the C cells ie the parafollicular cells and not from cells of thyroid follicles.

These are not TSH dependent and hence do not take up radioactive iodine

Hurthle cell carcinoma is a variation of follicular carcinoma only.

In these tumors lymph node involvement is about 60%

Bailey page 769

 

Q . Barrett's esophagus is a premalignant condition. Which of  the following statement is false regarding Barrett's esophagus

 a) Barrett's mucosa predisposes to Squamous cell carcinoma of esophagus

b) Risk of Cancer is 0.5% per year

c) Prevalence of Barrett's esophagus in general  population is  2-7%

d) Intestinal type of mucosa  with goblet cells is the most  common histopathological finding

Answer for Premium members

Peritonitis

Q) True statement regarding peritonitis is 

a) Raised serum amylase is only seen in pancreatitis

b) Rectal examination is better diagnostic of appendicitis than per abdominal examination

c) Ultrasound has diagnostic accuracy of 90% for diagnosing acute appendictis

d) Catarrhal appendicitis mostly leads to gangrene of appendix and perforation

Answer for premium members http://www.mcqsurgery.com/appendix

 

Endovenous Laser Ablation of varicose veins

Q )  Endovenous Laser Ablation (EVLA)  of  varicose veins is best suited for those :

a) With needle phobia

b) Thrombophlebitis

c) Excess tortuousity

d) Primary varicose veins

Answer

EVLA is thermal ablation of varicose veins in which laser  fibre is inserted in the lumen and ablation is done from inside. It is a good modality for primary and recurrent varicose veins and work in both long and short segments.

This treatment is not effective in cases where there is needle phobia or the veins are having excessive tortuousity or thrombophlebitis. This procedure is done under ultrasound guidance and  wire is passed from the superficial to the deep veins.

Tumescent local anesthesia also helps

Ref Bailey: Page 909

Traction diverticula

traction diverticulum esophagus

Q) What is true about traction diverticula of the esophagus?

a) It is a common diverticulum at the lower end of esophagus

b)Most  of these diverticula are symptomatic and require surgery

c) Mediastinal fibrosis is a common etiologial factor

d) They are most common on the left side

 

Answer 

c) Mediastinal fibrosis

Most of the traction diverticula are in mid esophagus on the right side. The common etiological factors are mediastinal infections, tuberculosis, mediastinal fibrosis and histoplasmosis.

These are true traction diverticula and have all the walls of esophagus.

They are mostly discovered incidentally during the workup of other diseases. Most of these are asymptomatic but can present with dysphagia, chest pain and regurgitation.

 

High speed injury

Q14) A young 18 years old unrestrained car driver has an head on collision with a truck and becomes unconscious. He is intubated on the site of accident and resuscitated with IV fluids. He is brought to the emergency in a state of shock,( BP 90/60 and pulse 120/min) but opens eyes on commands. On examination he does not have  pallor but neck veins are distended.

There are no signs suggestive of head or spine injury. Xray chest reveals normal cardiac chambers, no free gas and mild pleural effusion on left with no evidence of fracture ribs.

What will be the next step of management

a) Resuscitation and simultaneous CT thorax

b) Resuscitation and simultaneous Echo cardiography

c) Exploratory laparotomy

d) Chest tube drainage left side

Answer for Premium - Type of injuries in high speed accidents and points to look at