Malignant chest wall tumors

Q  Most common malignant chest wall tumor
A. Chondrosarcoma
B. Osteosarcoma
C. Synovial sarcoma
D. Rhabdomyosarcoma

Answer to Q 46

Most common tumors of the chest wall are secondaries from elsewhere. The most common malignant tumor of chest wall is .......

Ref Sabiston page 1602

 

Priapism

Q) What is the cause of priapism in a patient with trauma

a) Penile rupture

b) Dorsal vein of penis thrombosis

c) Spinal cord injury

d) Sickle cell anemia

Answer 

Most common cause of priapism is sickle cell anemia, but in the setting of trauma....

Read on  Q 86

Tropical Pancreatitis

Q) All are true about tropical pancreatitis except?

a. Associated with Tapioca.
b. Patients have  large stones with fibrosis.
c. Cancerous

d) Onset of disease at 50 years 


Answer d - Free. See here for other questions and this question

Onset 50 years

Tropical pancreatitis is an  idiopathic disease which begins in teens.  It has a high association with diabetes and Pancreatic duct calculi. It is common in South India, Asia, Africa and central America

Etiology 

Malnutrition 

Cassava

Hydrocarbons exposure

These patients have increased risk of cancer

It is associated with SPINK 1 mutation

Ref https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1742869/pdf/v079p00606.pdf

 

Lymphatic right adrenal

Q) Lymphatic drainage of Right adrenal gland is to 
a. Para aortic group
b. Inter Aortocaval
c. Pre aortic.
d. Para Caval

Answer free 

a)  Para-aortic lymph node.

Small lymphatic channels from both cortex and medulla drain into  the hilum, from where larger calibre lymphatic emerge to drain directly into the lateral group of  para-aortic lymph nodes

  • arterial supply is via three adrenal arteries 
    • superior adrenal artery (from inferior phrenic artery)
    • middle adrenal artery (from abdominal aorta)
    • inferior adrenal artery (from renal artery)
  • venous drainage 
    • adrenal veins emerge from the hilum and drain to different veins depending on the side:
      • left adrenal vein drains to the left renal vein
      • right adrenal gland drains to the IVC

( Grays anatomy)

Blood Supply SA Node

Q) SA Node is supplied by which artery

a) Right coronary

b) Left coronary

c) Left circumflex

d) Anterior interventricular


Coronary arteries originate from ascending aorta, above the aortic valves from the aortic sinuses. Right coronary artery passes between the right atrial appendage and pulmonary trunk in the atrio ventricular septum and continues as .......................

Premium members read on 

 

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