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
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) Management of occult breast cancer with N1 lymph nodes:
a) Modified radical mastectomy (MRM) with axillary dissection
b) MRM with radiotherapy to axilla
c) Only axillary dissection with radiotherapy and chemotherapy to axilla
d) Simple mastectomy with chemotherapy
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Q) Not true about GIST?
a) It is more common in females
b) They are mesodermal in origin
c) More than 5 cm are malignant
d) They can occur anywhere in the GI tract
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Q) Which of the following is true about phyllodes tumor?
a) It has a fast spread and is locally invasive
b) It is benign proliferative in ANDI
c) Mammography is diagnostic
d) Young patients less than 20 years old are more commonly involved
answer for Premium members only-
Discuss about Phyllodes tumor and their malignant potential.
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%
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
Q ) Endovenous Laser Ablation (EVLA) of varicose veins is best suited for those :
a) With needle phobia
c) Excess tortuousity
d) Primary varicose veins
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
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
Q) IN RTOG trial for ductal carcinoma in situ (DCIS) favourable tumor was defined as
a) <3,5 cm in size and 2mm free resection margin
b) <2.5 cm and 2mm margin
c) <3 cm size and 3 mm margin
d) <2.5 cm size and 3 mm margin
Answer - Free answers to surgery mcqs
Ductal carcinoma in situ is a pre invasive state in which the cancer cells have not breached the epithelial membrane. It can develop into cancer in 20%.
Simple mastectomy is the standard of care but many centers now consider it over treatment.
Van Nuys system uses
- Age of the patient
- type of DCIS
- presence of microcalcification
- resection margin
On mammography this is seen as clustered clustered calcification
Treatment options are
- Breast conserving therapy (Lumpectomy +radiation and hormonal)
More recently, Eastern Cooperative Oncology Group investigators reported the frst result of a relatively large prospective single-arm study of surgery with negative margins of at least 3 mm without radiation therapy for patients with favorable subsets of DCIS.
Patients with low-grade or intermediate-grade DCIS measuring 2.5 cm or smaller had a 5-year rate of ipsilateral breast recurrence of only 6.1%. In contrast, patients with high-grade disease had a much higher 5-year ipsilateral breast recurrence rate of 15.3%.
REF : Sabiston 853
Q) A 68 year old man undergoes repair of infra renal aortic aneurysm. On 2nd POD he has abdominal pain, bloody diarrhea and tachycardia. BP is 120/70. Abdomen is mildly distended and tender especially in the left lower quadrant.
How will you proceed
a) Send stool for clostridium and spores
b) CT Abdomen
c) Exploratory laparotomy
d) Higher antibiotics
Answer for premium - Discuss the complications of Surgery for aortic aneurysm