Pre op Management of carcinoma head of pancreas

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Q ) 45 year old patient with jaundice and itching diagnosed with adenocarcinoma of carcinoma head of pancreas with ECOG 1 , total  bilirubin  10mg% , s calcium  6.3 , sgot sgpt deranged. What is management
a) Whipple
b) Stenting whiple
c) Triple bypass
d) Biopsy stenting Chemo

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.