Lymph nodes in neck

Q) Most common site for lymph node spread is ? (head and neck Onco) 

a) Tongue

b) Lip

c) NAsopharynx

d) Glottis

Ans c

 Primary sites within the pharynx (i.e., nasopharynx, oropharynx, and hypopharynx) and supraglottic larynx  are particularly high risk.

The oral cavity has an intermediate risk,

whereas the glottic larynx, nasal cavity, and paranasal sinuses are low risk. Other predictors of risk of metastases are higher T stage and thickness (in case of oral cavity cancers).

Bladder Cancer

Q) What is the most suitable treatment option for non muscle-invasive bladder cancer with the risk of recurrences?

A)Cystectomy

B)Intravesical chemotherapy

C)Transurethral resection and adjuvant intravesical chemotherapy

D)Palliative therapy

Answer-C(Schwartz-1654)

Patients with non–muscle-invasive bladder cancer (confined to the bladder mucosa or submucosa) can be managed with transurethral resection alone and adjuvant intravesical (instilled into the bladder) chemotherapy/immunotherapy.

The use of these intravesical agents is critical since patients with non–muscle-invasive bladder cancer are at risk for tumour recurrence and progression.

 

Uro Onco MCQS

prognostic factor for carcinoma esophagus

Q. Most important prognostic factor for carcinoma esophagus is
 
a) Cellular differentiation                                 b) Depth of  esophagus involvement
 

c) length of  esophagus involvement            d)   age of the patient

Questions

b
Most important is depth of involvement of wall  of esophagus and lymph node involvement of the surrounding esophageal tissue.
 Length of esophagus involvement is not that important because esophagus has extensive submucosal lymph supply and for complete cure 10 cm excision margin would mean removal of almost total esophagus.

Hormones released from duodenum

 Q. Which of the following hormones are not released in duodenum?
a) Gastrin
b) Motilin
c) Somatostatin

d) Pancreatic YY

4. d
Peptide YY is released from ileum.

Gastrin - G cells stomach
Motilin- M cells from duodenum and jejunum
Somatostatin - D cells in pancreas, stomach and duodenum

Somatostain is an inhibitory hormone and inhibits most of the things

Secretin is released by acid in the duodenum and stimulates pancreatic fluid and bicarbonate secretion, leading to neutralization of acidic chyme in the intestine. Secretin also inhibits gastric acid secretion  and intestinal motility. LES pressure is decreased by Secretin, CCK, Somatostatin and VIP

 

Bevacizumab

Q) Not true about use of Bevacizumab (Free Ans) (Onco AIIMS) 

a) It is a humanized monoclonal antibody against VEGF A

b)  Bevacizumab is a first-line treatment in  metastatic nonsquamous non-small cell lung cancer. 

c) Bevacizumab is a first-line or second-line therapy for metastatic colorectal cancer

d) Its major advantage is that it has replaced combination chemotherapy

 Ans d)  It is used in combination with other drugs

a) is true

Bevacizumab is a first-line treatment in combination with carboplatin and paclitaxel for recurrent, locally advanced, unresectable, or metastatic nonsquamous non-small cell lung cancer. 

Bevacizumab is a first-line or second-line therapy for metastatic colorectal cancer when used in combination with fluorouracil (FU)-based chemotherapy regimens. 

OTher FDA approved indications of Bevacizumab are 

Cervical cancer, Metastatic RCC, Glioblastoma, Ovarian cancer

IT is always used with other drugs which are specific for the disease

AN important side effect is GI bleed and GI perforations

 

 

Staging Anal Cancer

Q  ) In Anal Carcinoma  involvement of external iliac group of lymph nodes
a. Stage II
b. Stage III a
c. Stage III b

d) M1

Ans c, IIIb

Primary tumor (T)

  • TX: primary tumor cannot be assessed
  • T0: no evidence of primary tumor
  • Tis: carcinoma in situ (Bowen disease, high-grade squamous intraepithelial lesion [HSIL], anal intraepithelial neoplasia II-III (AIN II-III)
  • T1: tumor 2 cm or less in greatest dimension
  • T2: tumor >2 cm but <5 cm in greatest dimension
  • T3: tumor >5 cm in greatest dimension
  • T4: tumor of any size invades adjacent organ(s), e.g. vagina, urethra, bladder (note that direct invasion of the rectal wall, perirectal skin, subcutaneous tissue, or the sphincter muscle(s) is not classified as T4)
Regional lymph nodes (N)
  • Nx: regional lymph nodes cannot be assessed
  • N0: no regional lymph node metastasis
  • N1: metastasis in regional lymph nodes
  • N1a: metastases in inguinal, mesorectal, and/or internal iliac lymph nodes
  • N1b: metastases in external iliac lymph nodes
  • N1c: metastases in external iliac and in inguinal, mesorectal, and/or internal iliac lymph nodes
Distant metastasis (M)
  • Mx: distant metastasis cannot be assessed
  • M0: no distant metastasis
  • M1: distant metastasis

Involvement of para-aortic or more distant lymph nodes is considered M1

Stage 0 Tis N0 M0
Stage I T1 N0 M0
Stage II T2, T3 N0 M0
Stage IIIA T1, T2, T3 N1 M0
T4 N0 M0
Stage IIIB T4 N1 M0
Any      T N2, N3 M0
Stage IV Any T Any N M1

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Healing by Primary Intention

Q)What is the false regarding the healing by  primary intention?

A)Wound edges opposed.

B)Normal healing.

C)Usually done for dirty wounds

D)Minimal scar.

Answer-C(bailey-25)

Primary intention,

Healing by primary intention is also known as healing by the first intention this occurs when there is an opposition of the wound edges

Secondary Intention

Healing occurs when the wound edges are not opposed immediately, which may be necessary for contaminated or untidy wounds.

Primary intention,

  • Would edges opposed
  • Normal healing.
  • Minimal scar.

Secondary intention,

  • Would leave open.
  • Heals by granulation, contraction and epithelialisation.
  • Increased inflammation and proliferation.
  • Poor scar.

Intestinal TB

Q) False about intestinal TB
1. Hyperplastic variety has colonic strictures
2. Raised markers,anaemia,positive sputum culture point towards diagnosis
3. BMFT shows pulled up cecum
4. IFN gamma assay

Ans A) STRICTURES ARE OF SMALL BOWEL

There are two types Of Intestinal TB

Ulcerative type - Transverse ulcers with undermined edges, Serosa of bowel is studded with tubercles. It is a severe form of disease

Hyperplastic - Hyperplasia and thickening of terminal ileum. Narrowing of lumen., Stricture and fibrosis occues of terminal ileum

There are raised inflamatory markers and anemia

Interferon gamma is for subclinical infection

BMFT shows subhepatic caecum

Bailey page 80