Q) In terms of cure best results in inflammatory carcinoma breast are seen with-
a) Surgery alone
d) All of the above
Surgery MCQ PDF - Free Answer
Inflammatory carcinoma of the breast is a rare aggressive tumor that blocks the sub dermal lymphatics as a result of which cutaneous edema is common . Differentiating it from a breast abscess is important and biopsy is diagnostic. It is also responsible to peau d orange
Treatment is multidisciplinary and involves, chemotherapy followed by surgery followed by radiotherapy.
Q) Simple nipple inversion is seen in?
a) Duct ectasia
c) Peri ductal fibrosis
d) Carcinoma breast
Inversion of nipple is seen in a lot of conditions, both benign and malignant. Common causes are
- Duct ectasia
- After breast Surgery
- Fat necrosis
- Mondor disease
- Chronic peri ductal mastitis
- 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.
Q) Popcorn calcification in breast is seen in which condition
b) Periductal fibrosis
c) Carcinoma breast
d) Duct ectasia
Free answer to Surgery MCQs
Here is the explanation.
Q) Type II gastric ulcer as described by Johnson is
a) Pre pyloric
b) Ulcer on body of stomach combined with duodenum
c) High on lesser curvature
d) Ulcer near the antrum
The answer to this question asked in 2016 exam is free. It has been there on the site for the last 6 years.
Q) Which of the following liver resections have the least chances of bleeding?
a) Previous history of TACE
b) A patient with splenomegaly
c) The patient with Platelet count 25000
d) Patient with grade III esophageal varices
Q) True about liver transplant
a) Portal vein thrombosis is more common than Hepatic Artery thrombosis
b) Bile leak though common is not a significant problem
c) Any bleeding in post op period, patient should be taken to OT
d) Acute liver rejection is seen in 5-10% cases
Answer for members
Q) The significance of MELD Scoring in Liver transplant is :
a) Less ill patients are given more priority in liver transplant
b) Set threshold for patients who are too ill to undergo transplant.
c) To access mortality in the waiting list.
d) To list patients in cadaveric deceased donor program
MELD score takes into account three factors. Bilirubin, INR and creatinine. Recently MELD Na is also included. Model for end stage Liver Disease (MELD) was initially developed to evaluate three months prognosis in patients undergoing TIPS.
It ranges from 6 (3 months survival = 90%) to 40 (3 months survival =7%).
In countries where DDLT is more common MELD Score is used to allot grafts to people in the cadaveric list. More severe is the MELD, earlier is the allotment of cadaveric graft.
Sicker patients are given priority