AIIMS MCH entrance exam 2016-2017 questions
Questions from Breast and Endocrine surgery
Q) Toboggan technique is used in
A) Substernal goitre.
It is a technique employed to prevent injury to recurrent laryngeal nerve during manipulation. Toboggan is a sled like transport used in snow.
Main operative issues
- Isthmus of the thyroid is liberated 1st. It is separated from the anterior part of trachea and transected.
- Middle thyroid vein and superior pole vessels are then divided
- Recurrent laryngeal nerve is identified at its entry into the larynx
- Dissection continues between the nerve and posterior part of thyroid from top to bottom
Q) ACOZOG Z0011 trial
A)It is a prospective, randomized, multicenter trial that compared the survival and locoregional recurrence rates after complete axillary lymph node dissection (ALND) versus sentinel node biopsy (SNB) alone in women with a positive sentinel node in an effort to avoid the complications associated with ALND.
Q) Milan trial radical mastectomy Vs MRM
Q) Structure preserved in modified radical mastectomy
A) Nerve of bell
B) Thoracodorsal vein
C) Lateral thoracic vein
Answer All three have to be preserved.
An excellent account of MRM Can be seen here
Questions on Breast Surgery
Q) One of the following is not seen in Cushing syndrome
a) High Blood sugar
b) Pretibial myxedema
c) Moon facies
Answer b Pretibial Myxedema
|Symptom or sign||Reported incidence, percent|
|Centripetal obesity||79 to 97|
|Facial plethora||50 to 94|
|Glucose intolerance||39 to 90|
|Weakness, proximal myopathy||29 to 90|
|Hypertension||74 to 87|
|Psychological changes||31 to 86|
|Easy bruisability||23 to 84|
|Hirsutism||64 to 81|
|Oligomenorrhea or amenorrhea||55 to 80|
|Impotence||55 to 80|
|Acne, oily skin||26 to 80|
|Abdominal striae||51 to 71|
|Ankle edema||28 to 60|
|Backache, vertebral collapse, fracture||40 to 50|
|Polydipsia, polyuria||25 to 44|
|Renal calculi||15 to 19|
|Hyperpigmentation||4 to 16|
|Headache||0 to 47|
|Exophthalmos||0 to 33|
|Tinea versicolor infection||0 to 30|
|Abdominal pain||0 to 21|
Q) Functional incidentaloma
- 10-15% of incidentalomas are functional ie secrete a hormone
- Excessive gluco corticoid secretion is the most common - Subclinical Cushing
- All should undergo adrenalectomy
Q) Codon directed surgery in thyroid cancer is done for
a) Well differentiated adenocarcinoma
b) Anaplastic carcinoma
C) Medullary carcinoms
Answer C ) Medullary Carcinoma.
In MEN 2B, codon directed ret mutations are identified and prophylactic thyroidectomy is carried out.
Q) Sentinel lymph node biopsy in breast
Summary on sentinel lymph node biopsy
- Lymphatic mapping is based upon the concept that one or more nodes are the first to be involved with metastatic disease within a given lymph node basin. If these sentinel lymph nodes are not involved, the entire basin should be free of tumor.
- Clinically if there are no lymphnodes in axilla, sentinel lymph node biopsy can help prevent unnecessary axillary lymph node dissections
- No role in node positive axilla