Medullary thyroid cancer – Management

Q) Male patient with 1 cm nodule in Right side of Thyroid. Biopsy shows medullary carcinoma. No neck nodes are seen on USG. What is the management

a) Total thyroidectomy

b) Total thyroidectomy with central node dissection

c) Total thyroidectomy with lateral and central neck dissection

d) Right hemithyroidectomy

Thyroid MCQs 

NEET SS 22

Ans b 

For patients with disease confned to the thyroid, total thyroidectomy is recommended to remove all C cells with elective dissection of the central neck nodes. If there is evidence of nodal metastases, gross
disease should be remove

Bailey 28th page 831

 

Carcinoma Breast and Pregnancy

Q) 30 year old female in 2nd trimester of pregnancy has a 2 cm Ca breast with no axillary lymph node What should be the management?

a) Terminate Pregnancy and MRM

b) Wait till completion of pregnancy and MRM

c) Lumpectomy plus chemo

d) Lumpectomy + axillary dissection + chemo

Breast

Neet SS 22 paper

Ans d

Lumpectomy plus axillary dissection + chemo

Axillary dissection is ideally after SLNB

Radiotherapy can be given after termination of pregnancy

Hormonal therapy is also given after pregnancy if required

No need to terminate pregnancy

Bailey 28th page 942

Anal malformation

Q) Newborn with abdominal distension on day 2, not passed meconium. There is absent anal orifice. WHat is the next step? # NEET SS 22 

a) Cross table X ray

b) Invertogram

c) Anoplasty

d) Sigmoid colostomy

Ans a) Cross table X ray

1st step in such cases Rule out congenital abnormalities of spine, sacrum , kidney heart etc

2nd step Cross table x ray  If it shows Perineal fistula do ANoplasty, If x ray shows rectal gas below coccyx do PSA RP with or without colostomy, If it shows gas above coccyx with associated defects do colostomy

Table 67.14 Sabiston 

 

Fuel for colonocytes

Q) Primary fuel for colonocytes is 

a) Glucose

b) Lactate

c) Butyrate

d) Fats

Ans c ) Butyrate

Butyrate For the fermentable complex carbohydrates available, colonic flora produce short-chain fatty acids (SCFAs).

Butyrate, an SCFA, is the principal source of nutrition for the colonocyte.
Mammalian cells do not produce butyrate, the colonic epithelium and luminal bacteria form an essential and elegant symbiotic relationship.

Antibiotics disrupt this cohabitation—decreased bacteria leads to less butyrate, which, in turn, negatively affects colonocyte function leading to diarrhea.

Lymphatic Spread carcinoma Prostate

Q) Most common lymph node involved in carcinoma prostate is
a. Obturator
b. Iliac
c. Periprostatic
d. Perivesical

a ✅

Lymphatic spread may occur (1) via lymphatic vessels passing to the obturator fossa or along the sides of the rectum to the lymph nodes beside the internal iliac vein and in the hollow
of the sacrum

Also lymphatics that pass over the seminal vesicles and follow the vas deferens for a short distance to
drain into the external iliac lymph nodes.

From retroperitoneal lymph nodes, the mediastinal nodes and occasionally the supraclavicular nodes may become implicated.

Bailey page 1468

Small Bowel Adenocarcinoma & its Risk Factors

Q) Which of the following is not a risk factor/ least associated with small bowel adenocarcinoma ?

a) Familial adenomatous polyposis (FAP)

b) Hereditary nonpolyposis colorectal cancer

c) Peutz-Jeghers syndrome

d) Juvenile polyposis coli


MOre Questions on Small Bowel Q 1-5

 

Ans

d

Juvenile Polyposis Coli is least associated with small bowel adenocarcinoma

Risk factors for Small bowel Adenocarcinoma are 

  1. Hereditary polyps - familial adenomatous polyposis (FAP), hereditary nonpolyposis
    colorectal cancer, Peutz-Jeghers syndrome

2.  Crohn disease, gluten-sensitive enteropathy (i.e., celiac sprue), prior peptic ulcer disease, cystic fibrosis, and biliary diversion (i.e., previous cholecystectomy).

3. Lifestyle

Smoking, heavy alcohol consumption (>80 g/day of ethanol), and consumption of red meat or salted food

4. Genetic -

Kras,  5q (APC gene), 17q (p53 gene), and 18q  and DPC4 , SMAD 4, MSI H

Sabiston page 1274

 

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