Q) Which is true regarding comparison of Lap intra op Ultrasound with traditional Intra op Ultrasound in liver surgery?
a) It is more sensitive
b) It is more specific
c) More time consuming
d) Anatomy better delineated with IOUS
The procedure can be time consuming in patients with dense adhesions.
Sensitivity and Specificity are same
Anatomy seen equally with both
IUS has been shown to successfully locate insulinomas in 85% of cases. When combined with intraoperative palpation, the detection rate can be in the 95 to 100% range. IUS was shown to detect 83% of gastrinomas in one series, including 100% of intrapancreatic lesions.
Q) MEN 2A also known as A. Sipple syndrome B. Wermer syndrome
C) Werner syndrome
Sipple and Steiner described the association of thyroid cancer with pheochromocytoma and hyperparathyroidism, respectively
Bailey says MTC combined with phaeochromocytoma alone is called Sipple’s syndrome (page 856)
MEN2A is characterized by MTC, pheochromocytoma (50%) and hyperparathyroidism (25%).
Associated with mutations in codon 634 in the RET proto-oncogene.
Wermer- MEN 1 is characterised by the triad of tumours in the anterior pituitary gland, mostly presenting as prolactinomas or non-functioning tumours, hyperplasia of the parathyroids causing primary hyperparathyroidism (pHPT) and pancreaticoduodenal endocrine tumours (PETs)
Q) Not an important prognostic factor in Carcinoma thyroid (JIPMER) A. Age B. Completeness of resection C. Multicentricity D. Extra thyroid extension
MOst of the papillary carcinoma are multicentric any way
As per AGES And AMES criteria.
HIgh risk - Male. Age more than 40 years, Size more than 4 cm, Capsular or extra thyroid extension, Regional or distant metastasis and poor differentiation
Low Risk - Well differentiated less than 2 cm. Age benefit is extended to 50 yrs in women
Ref ( Sabiston page page 903)
IN younger patients (<45 years old), the presence of lymph node metastases had no effect on the excellent overall survival, but the presence of lymph node metastases increased the risk of death by 46% in patients older than 45
The presence of lymph node metastasis in patients with contained intrathyroidal primary papillary carcinoma also does not affect long-term survival.
If there is gross or microscopic extension of a primary PTC through the thyroid capsule, a poor prognosis and possibly a higher rate of lymph node metastasis may be anticipated.