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Q) Risk of malignancy is highest with which stem cells. # Bailey Chapter 4

#Theme from INI CET GI Mock test

a) Somatic cells

b) SSc

c) Fetal cells

d) All

Q) A patient develops a delayed hemorrhage 3 weeks after an open necrosectomy. Which of the following best describes the pathophysiology of this complication?

# Pancreas INI CET MCQs

A) Coagulopathy from systemic inflammatory response
B) Arterial pseudoaneurysm formation and rupture
C) Disseminated intravascular coagulation (DIC)
D) Portal hypertension due to splenic vein thrombosis

A 65-year-old male presents with abdominal pain, vomiting, and a history of multiple episodes of cholecystitis. X ray image is given below.

What is the most likely diagnosis?

Gall stone and intesinal obstruction

A. Acute cholecystitis
B. Gallstone ileus
C. Small bowel volvulus
D. Duodenal perforation

Answer: B. Gallstone ileus

Explanation:
Rigler's Triad consists of pneumobilia, small bowel obstruction, and an ectopic gallstone, which is diagnostic of gallstone ileus. This condition occurs when a gallstone enters the bowel through a biliary-enteric fistula, leading to mechanical obstruction.

A large gallstone (>2.5 cm) erodes through the gallbladder wall, creating a cholecysto-enteric fistula (most commonly into the duodenum).

The stone enters the bowel and may cause obstruction, most often at the ileocecal valve due to its narrow lumen.

The presence of air in the biliary tree (pneumobilia) results from communication between the biliary and intestinal tracts.

Q) Identify the instrument

a) Craniotome

b) Hudson Brace

c) Humby's knife

d) CUSA

Ans b

The Hudson brace is a manually operated surgical drill used in neurosurgery and orthopedic procedures. It consists of a hand-cranked mechanism with interchangeable drill bits for trephination or skull perforation.

Q ) A 68-year-old male with severe mitral regurgitation due to a prolapsed mitral valve is being evaluated for a MitraClip® procedure. Which of the following is a known limitation of the MitraClip® treatment?

A) It has a high risk of causing permanent heart valve failure.

B) Long-term durability of the device is uncertain, and its effectiveness may decline over time.

C) The MitraClip® is associated with increased risk of severe aortic stenosis.

D) The procedure is recommended for all patients with moderate to severe mitral regurgitation, regardless of surgical risk.

Q) The sensitivity and specificity of sestamibi for parathyroid localization are reported to be 79% and 90%, respectively. Which of the following best describes a potential source of false positives in sestamibi imaging? Theme from mock test on 16.2.25 #parathyroid

A) Parathyroid adenomas in patients with hyperparathyroidism
B) Thyroid nodules with high oxyphilic content, such as Hürthle cell nodules
C) Low mitochondrial content in thyroid tissues
D) Parathyroid glands in normal positions

Q) Which of the following is the primary reason why serology is not recommended for evaluating H. pylori treatment success? Q from next INI GI MOck test # Stomach

A) Serological tests are less sensitive than stool antigen and urea breath tests.
B) Antibody levels can remain elevated for months to years after infection is eradicated.
C) Serological tests lack the ability to detect IgG antibodies accurately.
D) Serology tests have a specificity of less than 50%.

Q) Which of the following statements is most accurate regarding axillary lymph node dissection (ALND) in breast cancer staging?

a) Level I and level II ALND requires the removal of at least 10 lymph nodes for accurate staging, and level III nodes should always be included in the dissection, regardless of the presence of gross disease in levels I and II.

b) The axillary dissection should include tissue from levels I and II, with a focus on the area inferior to the axillary vein, extending laterally to the latissimus dorsi muscle and medially to the pectoralis minor muscle, when there is no gross disease in level II nodes.

c) Level III nodes should be dissected in all cases of breast cancer for accurate staging, as they are always involved in metastatic spread.

d) Level I and level II ALND can be skipped in cases of clinically negative axilla, as there is no need for lymph node evaluation in the absence of suspicion of metastasis

Ans b) The axillary dissection should include tissue from levels I and II, with a focus on the area inferior to the axillary vein, extending laterally to the latissimus dorsi muscle and medially to the pectoralis minor muscle, when there is no gross disease in level II nodes.

In breast cancer surgery, axillary lymph node dissection (ALND) is used to evaluate the extent of cancer spread to the lymph nodes and to help stage the disease. The following key points should be noted:

Why Option b is correct:

Level I and II ALND are typically performed when there is a need to stage the axilla, and it is crucial to remove lymph nodes from these levels to accurately assess the presence of metastatic cancer. The dissection should focus on the tissue inferior to the axillary vein, from the latissimus dorsi muscle laterally to the medial border of the pectoralis minor muscle. This area corresponds to the levels I and II nodes.
If there is no gross disease detected in the level II nodes, further dissection into level III nodes is generally not needed. This ensures a more selective approach, avoiding unnecessary complications associated with dissection of more extensive lymph node regions.

Why the other options are incorrect:

Option a): While 10 lymph nodes are often considered the minimum number for accurate staging, level III nodes should not always be included in ALND unless there is gross disease detected in levels I and II. Dissecting level III nodes in the absence of disease is not routine practice due to the increased risk of complications.
Option c): Level III nodes are not routinely dissected in all cases. They are only considered when there is gross disease in level I and II nodes. This step is generally reserved for cases where there is clinically evident disease, as level III nodes are more challenging to access and carry a higher risk of complications.
Option d): In cases of clinically negative axilla, ALND may not be necessary, but for accurate staging and treatment decisions, lymph node evaluation (such as with sentinel lymph node biopsy or ALND) is still important. Skipping the dissection entirely without any evaluation is not appropriate, as there may be microscopic disease in the axillary nodes that could influence prognosis and treatment planning.