AIIMS 2016

Whipple Proceudre steps

AIIMS Endocrine MCH entrance exam 2016-2017 questions

Exact choices are given only when remembered

AIIMS  Breast and Endocrine MCH  questions

Q1) 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.

Toboggan in thyroid
Toboggan

                                                                             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

 

Q2) 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.

See the results of this trial here

Q3) Milan trial radical mastectomy Vs MRM

Q4) 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 o Breast Surgery

Q5) One of the following is not seen in Cushing syndrome

a) High Blood sugar

b) Pretibial myxedema

c) Moon facies

d) striae

Answer b         Pretibial Myxedema

Symptoms and signs of Cushing's syndrome
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

Q6) Functional incidentaloma

Ans

  • 10-15% of incidentalomas are functional ie secrete a hormone
  • Excessive gluco corticoid secretion is the most common - Subclinical Cushing
  • Pheochromocytoma
  • Hyperaldosteronoma
  • All should undergo  adrenalectomy

Q7) 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.

Q8) 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

Questions 9-20 (Premium)

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