Reno vascular hypertension

Q) Which of the following is true about reno vascular hypertension

a) Seen in young age group

b) Both kidneys are of same size

c) It is familial

d) Diuretics will control the hypertension

Answer for free


Renal artery occlusion creates ischemia of the kidney which releases renin. Hypereninemia leads to secondary hypertension. This further leads to conversion of angiotensin I to angiotensin II and vasocontriction and eventually release of aldosterone.

It is a disease of young adults and children

Size of the kidneys vary and diuretics do not control hypertension because the mechanism is high renin secretion which is unresponsive to diuretics.


Lymph node in oral cancer

Q) Correct about N staging in oral carcinoma

a) N1 ipsilateral more than 6 cm

b) N2a ipsilateral single node between 3-6 cm

c) N2b is Multiple ipsilateral more than 6 cm

d) N2c is Bilateral more than 6 cm

Answer is b

N2a ipsilateral between 3-6 cm

Cervical lymph nodes are divided into (i) Submandibular (II) Upper jugular, (iii) Middle  jugular (iv) Lower jugular and (v) Posterior triangle

Cancer of oral cavity and lips mainly go to lymph nodes I, II, and III

Tongue skip metastasis to level III and IV is common 

Oropharynx - II, III, IV and contralateral

TNM Staging

NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 : Metastasis in a single ipsilateral lymph node <3 cm in greatest dimension
N2a:  Metastasis in a single ipsilateral lymph node >3 cm but not more than 6 cm
N2b:  Metastasis in multiple ipsilateral lymph nodes, none >6 cm in greatest dimension
N2c : Metastasis in bilateral or contralateral lymph nodes, none >6 cm in greatest dimension
N3 Metastasis in any lymph node >6 cm

Ref: Bailey 709

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


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


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