Month: May 2017

Inflammatory Carcinoma breast

Inflammatory Carcinoma breast

Q) In terms of cure best results in inflammatory carcinoma breast  are seen with-

a) Surgery alone

b) Chemotherapy

c) Radiotherapy

d) All of the above

Surgery MCQ PDF - Free Answer

d) 

Inflammatory carcinoma of the breast is a rare aggressive tumor that blocks the sub dermal lymphatics as a result of which cutaneous edema is common . Differentiating it from a breast abscess is important and biopsy is diagnostic. It is also responsible to peau d orange

Treatment is multidisciplinary and involves, chemotherapy followed by surgery followed by radiotherapy.

 

 

 

Inversion of nipple

Inversion of nipple

Q) Simple nipple inversion is seen in?

a) Duct ectasia

b) Puberty

c) Peri ductal fibrosis

d) Carcinoma breast

Answer free

b

Inversion of nipple  is  seen in a lot of conditions, both benign and malignant. Common causes are 

  1. Duct ectasia
  2.  After breast Surgery
  3. Fat necrosis
  4. Mondor disease
  5. Chronic peri ductal mastitis
  6. Carcinoma breast 

Rapid unilateral development of inversion of nipple is a dangerous sign and warrants further diagnosis. Further circumferential retraction is also sign of carcinoma.

Simple nipple inversion occurring at puberty  or retracted nipple is of unknown cause and is bilateral in 25%. Mostly No treatment is required for this and condition resolves spontaneously during pregnancy and lactation.

Suction pumps and cosmetic surgery can also help.

Inversion of nipple associated with malignancy may be with or without the presence of lump. Associated discharge from the nipple can point to the diagnosis.

Ref - Bailey 801

Grading of benign nipple inversions for management

In grade I, the nipple is easily pulled out manually and maintains its projection quite well.  It has minimal fibrosis  thus, manual traction and a single, buried purse-string suture are enough for the correction.

Grade II (majority)  the nipples can be pulled out but cannot maintain projection and tend to go back again. These nipples are thought to have moderate fibrosis beneath the nipple.

In grade III, to which the least number of inverted-nipple cases belong, the nipple can hardly be pulled out manually. Severe fibrosis made it impossible to reach optimal release of the fibrotic band with the preservation of the ducts.

Ref https://www.ncbi.nlm.nih.gov/pubmed/10654681

 

 

Surgical Gastro NEET type Exam Questions

Surgical Gastro NEET type Exam Questions

Q) Type II gastric ulcer as described by Johnson  is 

a) Pre pyloric

b) Ulcer on body of stomach combined with duodenum

c) High on lesser curvature

d) Ulcer near the antrum

The answer to this question asked in 2016 exam is free. It has been there on the site for the last 6 years.

Answer b

 

Q) Which of the following liver resections have the least chances of bleeding?

a) Previous history of TACE

b) A patient with splenomegaly

c) The patient with Platelet count 25000

d) Patient with grade III esophageal varices

Answer

Imatinib resistant GIST

Imatinib resistant GIST

  Q. Which of the following is not an option for Imatinib resistant GIST

    a) Increase the dose to 800 mg/day

    b) Sunitinib

    c) Chemotherapy with Cisplatin

    d) Radiofrequency Abalation

   Answer 

Complications of liver transplant

Complications of liver transplant

Q) True about liver transplant

a) Portal vein thrombosis is more common than Hepatic Artery thrombosis

b) Bile leak though common is not a significant problem

c) Any bleeding in post op period, patient should be taken to OT

d) Acute liver rejection is seen in 5-10% cases

Answer for members

Caustic injuries to esophagus

Caustic injuries to esophagus

Q) Which of the following is not true about reconstruction in caustic injuries to esophagus

a) Caustic injuries to esophagus have 1000 times more risk of developing malignancy

b) Right colon replacement is definately better than left colon

c) The only indication for elective surgery is refractory strictures and possibility of malignancy

d) Most of the surgeons prefer bypass over resection of esophagus

Premium Answer

Significance of MELD Scoring in Liver Transplant

Significance of MELD Scoring in Liver Transplant

Q) The significance of MELD Scoring in Liver transplant is :

a) Less ill patients are given more priority in liver transplant

b) Set threshold for patients who are too ill to undergo transplant.

c) To access  mortality in the waiting list.

d) To list patients in cadaveric deceased donor program

Answer Free 

d

MELD score takes into account  three factors. Bilirubin, INR and creatinine. Recently MELD Na is also included. Model for end stage Liver Disease (MELD) was initially developed to evaluate three months prognosis in patients undergoing TIPS. 
It ranges from 6 (3 months survival = 90%) to 40 (3 months survival =7%).

In countries where DDLT is more common MELD Score is used to allot grafts to people in the cadaveric list. More severe is the MELD, earlier is the allotment of cadaveric graft.

Sicker patients are given priority

Living Donor liver transplant

Living Donor liver transplant

Q) Living donor liver transplant (LDLT) is done in centers where cadaveric donations are few. Which of the following is true about it?

a) Only right lobe of the donor can be used

b) Only left lobe can be used

c) In LDLT bile leak is more than cadaveric donor

d) Small for size liver is defined as liver size less than 0.5% of recipient BSA

Answer

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