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

                                                                             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 signReported incidence, percent
Centripetal obesity79 to 97
Facial plethora50 to 94
Glucose intolerance39 to 90
Weakness, proximal myopathy29 to 90
Hypertension74 to 87
Psychological changes31 to 86
Easy bruisability23 to 84
Hirsutism64 to 81
Oligomenorrhea or amenorrhea55 to 80
Impotence55 to 80
Acne, oily skin26 to 80
Abdominal striae51 to 71
Ankle edema28 to 60
Backache, vertebral collapse, fracture40 to 50
Polydipsia, polyuria25 to 44
Renal calculi15 to 19
Hyperpigmentation4 to 16
Headache0 to 47
Exophthalmos0 to 33
Tinea versicolor infection0 to 30
Abdominal pain0 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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