Facial nerve pointers

Q) The most consistent anatomical landmark of the facial nerve is the
A. Anterior border of the posterior belly of the digastric muscle.
B. Posterior border of the posterior belly of the digastric muscle.
C. Superior border of the posterior belly of the digastric muscle.
D. Inferior border of the posterior belly of the digastric muscle

Ans c

Facial nerve identification:

  •  Posterior belly of the digastric
  • Mastoid tip
  • Tragal pointer
  • Tympanomastoid suture line are key anatomical landmarks.
  • The nerve lies 2 to 4 mm inferior to the tympanomastoid suture line. The most consistent intraoperative landmark is the superior aspect of the posterior belly
    of the digastric.

Ivor Lewis Esophagectomy leak

Q) After Ivor Lewis esophagectomy, on POD 5 , bile is seen in chest tube. Patient's heart rate is 120,  temp is 101 degree F, BP is 100/70. What will be the next step?

a) Stenting

b) Colonic replacement of gastric conduit

c) IV antibiotics 

d) Conduit excision and  Esophageal diversion

Ans  d

Patients with a completely necrotic conduit are most often septic and brought to the operating room for emergent exploration.

If conduit necrosis is confirmed,   then the conduit must be resected and the patient
should be diverted with an end esophagostomy, venting gastrostomy, and feeding jejunostomy. Care should be
taken to maintain the longest possible length of remaining
esophagus to facilitate future reconstruction

Schakelford page 477


 

Bone tumors

Q) A 16 year old boy presents with severe groin pain after kicking a football. Imaging confirms a pelvic fracture. A previous pelvic x-ray performed 2 weeks ago shows a lytic lesion with 'onion type' periosteal reaction. What is the lesion?

a) Giant cell tumor

b) Ewing's 

c) Osteosarcoma

d) Osteomalacia

Question  from theme of test 14 

 

Pancoast tumor

Q) 50 year old male with NSCL carcinoma of upper Rt lung which infiltrates the brachial plexus. WHat will be the managament? 

Lung and Thorax MCQS

a) Surgical resection

b) CCRT and resection

c) CCRT and access for response

d) Neoadjuvant and resection

Cystic lesion of pancreas

Q) A 48-year-old female presents with an incidental imaging finding of a microcystic pancreatic lesion with a stellate scar. Cyst fluid analysis reveals low viscosity, CEA, CA 19-9, and amylase. These findings are most consistent with:
A. Serous cystic lesion
B. Mucinous cystic lesion
C. Intraductal pancreatic mucinous neoplasm
D. Pseudocyst

Lung cancer

Q) A 73 year male,  old heavy smoker presents with haemoptysis. On examination he is cachectic and shows evidence of clubbing. Imaging shows a main bronchial tumour with massive mediastinal lymphadenopathy together with widespread visceral metastases. Which of the following variant is likely in him? ( Theme from mock test 12- 24) 

a)  Adenocarcinoma
B.  Small cell lung cancer
C. Large cell lung cancer
D. Squamous cell carcinoma

Ans  b

 Small cell lung cancer
Small cell carcinoma is associated with disseminated disease at presentation in the majority of cases. Most cases occur in the main airways and paraneoplastic features are common

Adenocarcinomas are the most common tumour type present in never smokers. They are usually located at the periphery.

Squamous cell carcinomas are reported to be more slow growing and are typically centrally located

Mediastinal mass

Q) A 25-year-old man presents to the emergency center with complaints of vague chest  discomfort.  patient is noted to have a large anterior mediastinal mass. The alpha.-fetoprotein levels are markedly elevated. What is the likely diagnosis? ( Theme of next mock test ) 
A. Non seminomatous germ cell tumor
B. Seminoma
C. Thymoma
D. Lymphoma