Indication Surgery crohn disease

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Q. Most common indication of surgery in Crohn's disease (#AIIMS GI )    (# Jejunum MCQS) 
a) Fistula
b) intractability
c) abscess
d) obstruction

Ans d Obstruction

Confusion between failure of medical therapy or obstruction as the ans. I have checked Bailey sabiston and Shackelford

2 books mention obstruction on top whereas one mentions failure of medical therapy. However with the improvement of medical management in the past decade, obstruction can be the ans

Crohn’s disease will require surgery at some time durin the course of their illness. Approximately 70% of patients will
require surgical resection within 15 years after diagnosis.

Indications for surgery include failure of medical treatment, bowel obstruction, and fistula or abscess formation. Most patients can
be treated with elective surgery,

CDH 1 gene

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Q) CDH 1 gene is associated with which cancer

a) Breast

b) Colon

c) Prostate

d) Renal

ANs a CDH 1 is with gastric and lobular breast cancer

Germline mutation in the CDH1 gene encoding E-cadherin was shown to be associated with hereditary diffuse gastric cancer. Prophylactic total gastrectomy should be considered in patients with these mutations

Renal mainly associated with VHL

Colon Lymphoma

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Q) True about lymphoma of the colon

a) MOre common in females

b) Most common in 3rd and 4th decade

c) Most common site is caecum

d) T cells are most commonly involved

Ans c

Lymphoma is uncommon in the colon/rectum occurring in 0.4% of patients; intestinal lymphoma and can present anywhere between the
second and eighth decades of life.

Most of these lesions are intermediate to high-grade B-cell lymphomas.

Affected men outnumber women about 1.5:1 

The majority of colorectal lymphomas are found in the cecum or ascending colon. More than 70% of colorectal lymphomas are proximal to the hepatic flexure. 

 

Yttrium 90

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Q ) Which of the following statement regarding yttrium 90 is incorrect: ( From Gen onco Surgery Q 21-40) 
a. Used for brachytherapy
b. Is a pure beta emitter with range of 1 cm
c. Most commonly used for treatment of ca prostate
d. Used in treatment of both primary and metastatic liver cancer through hepatic artery embolization

Answer: 21) C ref devita page 212.

Iodine 125 and pallidium 103 are commonly used for prostate.

All other choices are true

Peptic Ulcer Location

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Q) False statement about location of peptic ulcer?

a) Type 1 is on greater curvature

b) Type 2 is gastric body and duodenal

c) Pauchet procedure is for type IV

d) Type Iv is high on lesser curvature

Ans 16) a

TYPE             LOCATION                             ACID LEVEL
I                   Lesser curve at incisura         Low to normal
II               Gastric body with duodenal ulcer Increased
III                      Prepyloric                           Increased
IV                   High on lesser curve               Normal
V                        Anywhere                            Normal,

Anti rejection drugs

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Q) Anti Rejection medicine which also prevents tumor recurrence? MCH Questions ...

a) M tor inhibitors

b) IL2 blockers

c) Steroids

d) Azathioprine

Ans a) mtor inhibitors 

One Question is always asked about anti rejection medicines, Salient points i am enumerating

  1. Three drug regimen is classic includes IL2 blocker, Mycophenolate and steroids which are tapered . IL 2 blocker  Tacrolimus is used more than Cyclosporine ( cyclosporine less used now). IL2 blocker side effects are hirsutism, hyperkalemia, gum hypertrophy etc) 
  2. Mycophenolate is preferred over azathioprine . Both cause fall in cell lines
  3. Steroids have many side effects like weight gain, cataract, infections and are used in tapering dose

M-tor inhibitors are sirolimus and Everolimus which are used when transplant is done for HCC, IT has anti tumor action.

Paget disease of Breast

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Q) True regarding Paget's disease of the breast
A. Seen in 5-10% Carcinoma  breast
B. 50-60% associated with underlying mass
C. Treated by MRM always

d) Radiotherapy is the treatment of choice

Ans b 50% have underlying mass 

Paget disease accounts for 1% or less of breast malignancies. It is characterized clinically by nipple erythema and irritation with
associated pruritus and may progress to crusting and ulceration. ( Sabiston page 860)

Paget disease is a condition of the nipple that is commonly associated with an underlying breast cancer  More than 95% of patients with Paget disease have an underlying breast carcinoma. Paget disease may be accompanied by a palpable mass in slightly more than 50% of Epidermal layer of skin is involved. Clinically, dermatitis occurs that may appear eczematoid and moist or dry and psoriatic.

Treatment of Paget disease

(i) mastectomy with axillary staging 

(ii) wide local excision of the nipple and areola to achieve clear margins, axillary staging, and radiation therapy. 

Prognosis Carcinoma thyroid

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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.