Facial nerve

Q) Not a branch of facial nerve?

a) Greater auricular nerve

b) Post Auricular nerve

c) Nerve to Chorda tympani

d) Nerve to Stapedius

Ans a

The posterior auricular nerve arises from the facial nerve close to the stylomastoid foramen.

The great auricular nerve (or greater auricular nerve) originates from the cervical plexus, composed of branches of spinal nerves C2 and C3. 

The chorda tympani is a nerve that arises from the mastoid segment of the facial nerve

The nerve to stapedius arises from the facial nerve to supply the stapedius muscle.

Primary Hyperparathyroidism

Q) Which is not a feature of primary hyperthyroidism?

a) Increase Parathormone

b) Increase Calcium

c) Decreased phosphate

d) Dystrophic calcification

Ans d 

Clinical features of Hyperparathyroidism are

  1. Subperiosteal bone erosions
  2. Primary Hyperthyroidism  is defined as hypercalcaemia in the presence of an unsuppressed and therefore relatively, or absolutely, elevated PTH level. Elevated calcium and elevated PTH are important  in diagnosis of PTH
  3. The presence of kidney stones remains the most common clinical manifestation of symptomatic PHPT.
  4. It is associated with a low serum phosphate in the setting of normal creatinine and vitamin D levels

Ref Bailey and Love Page 826

 Some useful questions can be bought here  MCQs and EMQs in Surgery: A Bailey & Love Revision Guide, Second Edition 

Some uncommon disorders associated with hyperparathyroidism include

peptic ulcers, pancreatitis, and bone disease

central nervous system symptoms 


Causes of Primary Hyperparathyroidism are

  1. Parathyroid Adenoma -75% (can be localised by Sestamibi scanning)

Management of primary hyperparathyroidism

Patients with symptomatic primary hyperparathyroidism as manifested by kidney stones, renal dysfunction, or osteoporosis should undergo parathyroidectomy.

If the patient is asymptomatic and detected to have high parathyroid levels then surgery is done only if

  1. age is less than 50
  2. very high excretion of calcium in urine
  3. low creatinine clearance
  4. kidney stones
  5. high serum calcium

 

Paraneoplastic syndrome in HCC

Q) Paraneoplastic Syndrome in HCC which also occurs in End stage liver disease

a) Hypercholesteremia

b) Hypoglycemia

c) Hypercalcemia

d) Carcinoid

Ans -  b

Hypoglycemia (also seen in end stage liver disease) 

Erythrocytosis

Hypercalcemia

Dysfibrogenimea

Carcinoid Syndrome

Thyroxin binding globulinincreases

Porphyria cutanea tarda

Gynecomastia, testicular atrophy, early puberty

Carcinoma GB epidemiology

Q) Not true about GB malignancy

A. 80 percent of porcelain gall bladder predispose to malignancy

B. Untreated advanced  CA GB  median survival is 2-5 months

C. Stippled calcification of mucosa has higher risk of malignancy than diffuse intramural calcification

D. More than 75 percent of CA gall bladder has history of cholelithiasis

 

Ans a 

69% to 86% of patients with gallbladder cancer have a personal history of gallstone disease.

The presence of an abnormal pancreaticobiliary duct junction, thought to promote chronic biliary inflammation, has been associated with both choledochal cyst disease and gallbladder cancer.

In porcelain gallbladder, risk of ca gb due to chronic inflammation and calcification of the gallbladder wall, was once estimated to be as high as 61%; however, more contemporary analyses suggest that the correct figure is more likely between 7% and 25%

Ref Shackelford 8th page 1323