Papillary Thyroid carcinoma

Q) A 30-year-old female is diagnosed with papillary thyroid carcinoma (PTC) following a fine-needle aspiration biopsy. Ultrasound shows a 1.8 cm solid nodule in the left thyroid lobe, and the ultrasound reveals no evidence of cervical lymphadenopathy. The patient's medical history is unremarkable, and she has no family history of thyroid cancer. According to the NCCN guidelines, which of the following management strategies is MOST appropriate for this patient?

A. Total thyroidectomy, as the tumor size exceeds 1 cm and there is a risk of contralateral disease.

B. Lobectomy with careful monitoring, as there is no extrathyroidal extension or lymph node involvement, and the tumor size is less than 2 cm.

C. Active surveillance with regular follow-up and ultrasound monitoring, given the tumor size and absence of aggressive features.

D. Lobectomy followed by radioactive iodine ablation to reduce the risk of recurrence.

 

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Breast cancer TNBC

Q) Which of the following patients with operable breast cancer is the most appropriate candidate for preoperative systemic therapy?


A) A patient with ER-positive, HER2-negative breast cancer with a 1 cm tumor and clinically node-negative disease who desires breast conservation

B) A patient with HER2-positive breast cancer with a 3 cm primary tumor and clinically node-positive disease

C) A patient with triple-negative breast cancer with a 1 cm tumor and clinically node-negative disease who prefers mastectomy

D) A patient with ER-positive, HER2-positive breast cancer with a 1.5 cm tumor and no lymph node involvement

Correct Answer: B) A patient with HER2-positive breast cancer with a 3 cm primary tumor and clinically node-positive disease

Preoperative systemic therapy is generally recommended for:

  1. HER2-positive or triple-negative breast cancer when the tumor is ≥cT2 (≥2 cm) or clinically node-positive (cN1).
  2. Patients with a large tumor relative to breast size who desire breast-conserving surgery.
  3. Patients with clinically node-positive disease (cN+) who may achieve node-negative (cN0) status with systemic therapy.

Option B meets these criteria with both HER2-positive disease and clinically node-positive status, making the patient an ideal candidate for preoperative systemic therapy.

Choice A: A patient with ER-positive, HER2-negative breast cancer with a 1 cm tumor and clinically node-negative disease who desires breast conservation
  • Explanation: This patient has an ER-positive, HER2-negative tumor that is small (1 cm) and clinically node-negative. These characteristics indicate a low risk of aggressive disease, and preoperative systemic therapy is typically not necessary for small, low-risk tumors. In this case, surgery would likely be the primary treatment option, followed by adjuvant therapy if needed.

Choice C: A patient with triple-negative breast cancer with a 1 cm tumor and clinically node-negative disease who prefers mastectomy

  • Explanation: Although this patient has triple-negative breast cancer (TNBC), the tumor size is only 1 cm and clinically node-negative. Preoperative systemic therapy is generally reserved for larger tumors (≥cT2) or node-positive disease in TNBC cases to improve outcomes or allow breast conservation. In this scenario, with a small, node-negative tumor, the preferred approach might be surgery first, as systemic therapy may not offer substantial additional benefits.

Choice D: A patient with ER-positive, HER2-positive breast cancer with a 1.5 cm tumor and no lymph node involvement

  • Explanation: This patient has HER2-positive breast cancer, but the tumor size is only 1.5 cm, which is below the ≥cT2 threshold for recommending preoperative systemic therapy. Additionally, the absence of lymph node involvement (cN0) indicates a lower burden of disease. While HER2-positive patients often benefit from systemic therapy, a neoadjuvant (preoperative) approach may not be necessary unless the tumor or nodal status meets certain thresholds (≥cT2 or ≥cN1).

The Final Sprint: 120 days to Transform Your MCH NEET SS Aspirations Into Reality

DEMO TEST Surgery MCQS

How to Prepare for NEET SS 2025: A Friendly Guide

You've come a long way in your preparation, and now it's time to give it your all. The next 120 days can define your success in the MCH NEET SS exam. Here’s how to make the most of this crucial period:

1. Get Familiar with the Exam Pattern

Before jumping into studying, it’s crucial to know what the exam looks like. NEET SS has multiple-choice questions (MCQs), with negative marking for wrong answers (so guesswork isn’t always your friend). You’ll have 3.5 hours to tackle questions focused on your chosen super-specialty, and most questions are from the postgraduate curriculum. Understanding the structure helps you plan how to approach your studies.

Read more

Anticoagulation in valve surgery

Q) IN which operative valve procedure, lifelong anticoagulation is required. 

# Theme from mock test on 13.10.24 ( Plastic and cardiac) 

a) Valve Repair

b) Mechanical valve  replacement

c) Biological valve stentless

d) Biological valve homogenous

Zones in Hand injury

Q) What is the zone of injury due to glass cut on distal phalanx of middle finger, flexor aspect?

Zone I

Zone II

Zone III

Zone IV

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