Lymphoma Head and NECk

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Q) Lymphoma of the head and neck - False statement is 
A. Hodgkin’s disease is common in the oropharynx.
B. Most are of the B-cell type .
C. FNAC of neck lymph nodes is now mandatory.
D. For disseminated non-Hodgkin’s lymphoma, systemic chemotherapy is preferred.

Soft tissue sarcoma with lymph node

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Q) Which of the following soft tissue sarcoma  (STS) associated with least lymph node metastasis:-
A. Fibrosarcoma
C. Epitheloid sarcoma
D. Rhabdomyosarcoma


Uncomplicated Diverticulitis

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Q). 45 yr old Known case of diverticular disease, presents with left lower abdominal pain , on CT sigmoid wall thickening with fat stranding. All of the following can be done except
a) Admit and iv antibiotic
b) Colonoscopy after resolution
c) Elective colectomy after resolution
d) Out patient oral antibiotic

Meld score uses and drawbacks

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Q. All are true about Na-MELD except :

a) It corelates with cirrhosis
b)Range of sodium value  is 125-137
c)It relates to vasoconstriction
d) Used for allocation in DDLT patients

Ans c

 MELD was originally developed to predict three-month mortality following transjugular intrahepatic portosystemic shunt (TIPS) placement and was derived using data from a population of 231 patients with cirrhosis who underwent elective TIPS placement.

Range of MELD score is 6-40

MELD Score = 10 x (0.957 x Ln(serum creatinine mg/dL) + 0.378 x Ln(serum bilirubin  mg/dL) + 1.120 x Ln(INR) + 0.643 )

For candidates with an initial MELD score greater than 11, the MELD score is then re-calculated as follows:
MELDNa = MELD(i) + 1.32*(137-Na) - [0.033*MELD(i)*(137-Na)]

  • Sodium values less than 125 mmol/L will be set to 125, and values greater than 137 mmol/L will be set to 137.

It is used for allocation in DDLT to assess wait list mortality

MELD score has also proved to be an effective predictor of outcome in other situations, such as

  1. Patients with cirrhosis going for surgery and patients with fulminant hepatic failure or alcoholic hepatitis.
  2. The MELD score does have limitations in situations where the INR or creatinine may be elevated due to reasons other than liver disease, and its implementation for organ allocation purposes does not take into consideration several conditions that benefit from liver transplantation.

ICG retention liver

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Q) Regarding  ICG clearance rate . Which is false..
a) It assess total  liver function

b) Heterogenous uptake in liver may lead to false negative result
c) Measures blood supply 
d) ICG clearance Measured non invasively via spectrophotometry

GIST Surgery

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Q).GIST  wrong statement is?

a)Margin 1-2 cm is required
b) R1 eis  worse prognosis
c) Lap is for safe for lesions > 5 cm
d)Lymphadenectomy not done

GB polyp

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Q)  Not an indication of cholecystectomy in gall bladder polyp?

a) Size more than 1 cm

b) Associated gall stones

c) Age more than 50 years

d) More than 3 in number

Ans d) No relation with number

The only polypoid lesions that have malignant potential and are associated with a significant rate of harboring
malignancy are adenomatous polyps

The most consistent predictors are single polyps, size greater than 1 cm, and age older than 50

BG 796

Smoking treatment

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Q) Smoking cessation- Not a  first line drug option ?

a) Clonidine 

b) Nicotine replacement (patches)

c) Varenicline

d)  Bupropion

Ans A) clonidine

NRT ,  varenicline (Chantix), and bupropion (Zyban) are the three principal firstline pharmacotherapies recommended for use either alone or in combination 

Clonidine and nortriptyline—as second-line pharmacotherapies for tobacco dependence typically used when a smoker cannot use first-line medications due to either contraindications or lack of effectiveness.

Ref Devita

Carcinoid Lung

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Q) All are true about pulmonary carcinoid except?

a) Atypical carcinoid is more common

b) Surgery is done with curative intent

c) Atypical carcinoids are peripheral

d) Typical carcinoids have lymph node metastasis and require lymphadenectomy

Endoscopic Resection of Stomach cancer

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Q.  Not an Extended Criteria for Endoscopic resection of gastric cancer?

a) Less than 3 cm irrespective of ulceration
b) Limited Sm1 leison
c) Submucosal invasion 2 cm in size

d) submucosal invasion 3.5 cm in size

Hyperthyroidism in Pregnancy

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Q) Which of the following is true for hyperthyroidism in Pregnancy

A) Surgery done in 2nd trimester

B) Beta blockers are contraindicated

C) All antithyroid drugs are contraindicated

D) Radioactive iodine (RAI) is treatment of choice