Intra Op Ultrasound vs Lap Ultrasound

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

Ans c

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.

 

MEN 2A

Q)  MEN 2A also known as
A. Sipple syndrome
B. Wermer syndrome

C) Werner syndrome

Ans a

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)

Patients with MEN 2B do not develop pHPT

Prognosis Carcinoma thyroid

Q) Not an important prognostic factor in Carcinoma thyroid (JIPMER) 
A. Age
B. Completeness of resection
C. Multicentricity
D. Extra thyroid extension

Ans c

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.

Axilla management in CA breast

Q) 47 year old premenopausal lady with a 3X 3cm left breast lump with IDC grade III, TNBC.

On examination, there is a  single subcentimetric mobile soft mobile ipsilateral  axillary LN palpable.

Usg nodes no loss of hilum.  Management of axilla? Ans is free

a) SlND

b) ALND

c) Radiotherapy only

d) No treatment

Ans a

Selective lymph node dissection

ACOSOG Z0011 trial 0  (stages I and II) in patients who undergo breast conservation therapy, axillary lymph node dissection does not improve locoregional controlor survival.

This trial has demonstrated the safety of limiting axillary surgery to the SLNB without performing formal axillary dissection for sentinel node positivity.

This  avoids of the  morbidity of the axillary dissection.

If nodes positive the patient should receive adjuvant chemotherapy and radiation therapy.