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Moya Moya disease

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Q) In Moya Moya disease which of the following is true

a) It is a disease of geriatric age group

b) Occurs due to the occlusion of vertebral artery

c) There is presence of smoke puff sign on angiography

d) It is a neurological disease due to deficiency of Vitamin B

Answer 

 

Lymph node in oral cancer

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Q) Correct about N staging in oral carcinoma

a) N1 ipsilateral more than 6 cm

b) N2a ipsilateral single node between 3-6 cm

c) N2b is Multiple ipsilateral more than 6 cm

d) N2c is Bilateral more than 6 cm

Answer is b

N2a ipsilateral between 3-6 cm

Cervical lymph nodes are divided into (i) Submandibular (II) Upper jugular, (iii) Middle  jugular (iv) Lower jugular and (v) Posterior triangle

Cancer of oral cavity and lips mainly go to lymph nodes I, II, and III

Tongue skip metastasis to level III and IV is common 

Oropharynx - II, III, IV and contralateral

TNM Staging


NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 : Metastasis in a single ipsilateral lymph node <3 cm in greatest dimension
N2a:  Metastasis in a single ipsilateral lymph node >3 cm but not more than 6 cm
N2b:  Metastasis in multiple ipsilateral lymph nodes, none >6 cm in greatest dimension
N2c : Metastasis in bilateral or contralateral lymph nodes, none >6 cm in greatest dimension
N3 Metastasis in any lymph node >6 cm

Ref: Bailey 709

Colon cancer surveillnace

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Q) CEA surveillance in normal person whose father and brother had colon cancer is helpful in 

a) CEA is highly sensitive in picking up the diagnosis of colon cancer

b) HIGH preoperative CEA is predictive of unresectability in colon cancer

c) Increase in CEA after surgery is indicative of tumor recurrence

d) CEA is present in normal colonic mucosa

Answer for premium members

Thyroid Questions

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Q) Which of the following thyroid cancers do not take up radio active iodine

a) Medullary carcinoma thyroid

b) Papillary  carcinoma

c) Follicular carcinoma

d) Hurthle cell carcinoma

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a - Medullary carcinoma

Medullary carcinoma of the thyroid is a tumor that arises from the C cells ie the parafollicular cells and not from cells of thyroid follicles.

These are not TSH dependent and hence do not take up radioactive iodine

Hurthle cell carcinoma is a variation of follicular carcinoma only.

In these tumors lymph node involvement is about 60%

Bailey page 769

Barrett esophagus

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Q . Barrett's esophagus is a premalignant condition. Which of  the following statement is false regarding Barrett's esophagus

 a) Barrett's mucosa predisposes to Squamous cell carcinoma of esophagus

b) Risk of Cancer is 0.5% per year

c) Prevalence of Barrett's esophagus in general  population is  2-7%

d) Intestinal type of mucosa  with goblet cells is the most  common histopathological finding

Answer for Premium members

Site of Insulinoma

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Premium MCQ - Insulinoma Site
Q) Most common site of insulinoma is
a) Head of Pancreas
b) Body of Pancreas
c) Tail of Pancreas
d) All equal

Peritonitis

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Q) True statement regarding peritonitis is 

a) Raised serum amylase is only seen in pancreatitis

b) Rectal examination is better diagnostic of appendicitis than per abdominal examination

c) Ultrasound has diagnostic accuracy of 90% for diagnosing acute appendictis

d) Catarrhal appendicitis mostly leads to gangrene of appendix and perforation

Endovenous Laser Ablation of varicose veins

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Q) Endovenous Laser Ablation (EVLA) of varicose veins is best suited for patients:

A. With needle phobia
B. With thrombophlebitis
C. With excessive tortuosity of the vein
D. With primary varicose veins

Ans d

EVLA is thermal ablation of varicose veins in which laser  fiber is inserted in the lumen and ablation is done from inside. It is a good modality for primary and recurrent varicose veins and work in both long and short segments.

This treatment is not effective in cases where there is needle phobia or the veins are having excessive tortuousity or thrombophlebitis. This procedure is done under ultrasound guidance and  wire is passed from the superficial to the deep veins.

Tumescent means swollen or distended, typically due to the infiltration of fluid.

  • It refers to the injection of a large volume of dilute local anesthetic solution (usually lidocaine with epinephrine and saline) into subcutaneous tissue.

  • This causes the tissue to swell or become turgid (tumescent).

In procedures like endovenous thermal ablation:

Tumescent solution:

  • Compresses the vein to improve contact with the ablation device.

  • Separates the vein from surrounding structures (like nerves or skin).

  • Acts as a thermal insulator (heat sink) to prevent collateral damage.

Tumescent local anesthesia also helps

  • A. Needle phobia – EVLA requires multiple needle sticks (tumescent anesthesia), making this option inappropriate.

  • B. Thrombophlebitis – Active inflammation or thrombosis is a relative contraindication to EVLA.

  • C. Excess tortuosity – Makes catheter navigation difficult; EVLA is less suitable.

  • D. Primary varicose veins – Ideal candidates, especially with straight vein anatomy and valvular incompetence.