Q ) Endovenous Laser Ablation (EVLA) of varicose veins is best suited for those :
a) With needle phobia
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.
Q) A young 18 years old unrestrained car driver has an head on collision with a truck and becomes unconscious. He is intubated on the site of accident and resuscitated with IV fluids. He is brought to the emergency in a state of shock,( BP 90/60 and pulse 120/min) but opens eyes on commands. On examination he does not have pallor but neck veins are distended.
There are no signs suggestive of head or spine injury. Xray chest reveals normal cardiac chambers, no free gas and mild pleural effusion on left with no evidence of fracture ribs.
What will be the next step of management
a) Resuscitation and simultaneous CT thorax
b) Resuscitation and simultaneous Echo cardiography
Q) IN RTOG trial for ductal carcinoma in situ (DCIS) favourable tumor was defined as
a) <3,5 cm in size and 2mm free resection margin
b) <2.5 cm and 2mm margin
c) <3 cm size and 3 mm margin
d) <2.5 cm size and 3 mm margin
Answer - Free answers to surgery mcqs
Ductal carcinoma in situ is a pre invasive state in which the cancer cells have not breached the epithelial membrane. It can develop into cancer in 20%.
Simple mastectomy is the standard of care but many centers now consider it over treatment.
Van Nuys system uses
Age of the patient
type of DCIS
presence of microcalcification
On mammography this is seen as clustered clustered calcification
Treatment options are
Breast conserving therapy (Lumpectomy +radiation and hormonal)
More recently, Eastern Cooperative Oncology Group investigators reported the frst result of a relatively large prospective single-arm study of surgery with negative margins of at least 3 mm without radiation therapy for patients with favorable subsets of DCIS.
Patients with low-grade or intermediate-grade DCIS measuring 2.5 cm or smaller had a 5-year rate of ipsilateral breast recurrence of only 6.1%. In contrast, patients with high-grade disease had a much higher 5-year ipsilateral breast recurrence rate of 15.3%.