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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

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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

Neet onco 2020
 Drugs in onco 

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

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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.

 

High speed injury

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Q) A young 18 years old unrestrained car driver has an head on collision with a truck and becomes unconscious. He is intubated on the site of accident and resuscitated with IV fluids. He is brought to the emergency in a state of shock,( BP 90/60 and pulse 120/min) but opens eyes on commands. On examination he does not have  pallor but neck veins are distended.

There are no signs suggestive of head or spine injury. Xray chest reveals normal cardiac chambers, no free gas and mild pleural effusion on left with no evidence of fracture ribs.

What will be the next step of management

a) Resuscitation and simultaneous CT thorax

b) Resuscitation and simultaneous Echo cardiography

c) Exploratory laparotomy

d) Chest tube drainage left side

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Ductal carcinoma in situ

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RTOG 9804 Trial MCQ – Good-Risk DCIS Criteria

📘 Theme: Breast Surgery – DCIS (NEET SS / MCh / FMAS High Yield)

Clinical Breast Surgery MCQ

According to the RTOG 9804 trial, which of the following criteria defined a favourable (good-risk) ductal carcinoma in situ (DCIS)?

A. Less than 3.5 cm in size with a 2 mm free resection margin
B. Less than 2.5 cm in size with a 2 mm free resection margin
C. Less than 3 cm in size with a 3 mm free resection margin
D. Less than 2.5 cm in size with a 3 mm free resection margin

Answer: D. Less than 2.5 cm in size with a 3 mm free resection margin

Explanation

The RTOG 9804 trial evaluated radiotherapy in patients with good-risk DCIS treated with breast-conserving surgery. Eligible patients had low- or intermediate-grade DCIS measuring ≤2.5 cm with surgical margins of at least 3 mm. These criteria were used to define favourable DCIS.

Why other options are incorrect

  • A: Tumour size criterion was not 3.5 cm.
  • B: A 2 mm margin did not meet the RTOG 9804 eligibility requirement.
  • C: The size cutoff was ≤2.5 cm, not 3 cm.

High-yield teaching points

  • RTOG 9804 enrolled patients with "good-risk" DCIS.
  • Eligibility required DCIS ≤2.5 cm and margins ≥3 mm.
  • The study demonstrated a reduction in ipsilateral breast recurrence with radiotherapy.
  • RTOG 9804 is frequently cited when discussing omission of radiotherapy in selected low-risk DCIS patients.

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