Free Questions

Free MCQs in Surgery

Malignant features of salivary gland tumors

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Q) 54 year old lady with long standing swelling right side of cheek. What is not a clinical feature of malignant conversion of salivary gland tumor?

a) Pain 

b) Facial nerve weakness

c) Swelling

d) Cervical lymph node swelling

Ans a

Clinical features of high-grade malignant salivary tumours include

1. facial nerve weakness

2. rapid enlargement of the swelling; 

3. induration and/or ulceration of the overlying skin;

4. cervical node enlargement.

Ref Bailey 27th page 783

Most of these tumors are painless

More Questions Head and Neck onco 

Lymph nodes in neck

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Q) Most common site for lymph node spread is ? (head and neck Onco) 

a) Tongue

b) Lip

c) NAsopharynx

d) Glottis

Ans c

 Primary sites within the pharynx (i.e., nasopharynx, oropharynx, and hypopharynx) and supraglottic larynx  are particularly high risk.

The oral cavity has an intermediate risk,

whereas the glottic larynx, nasal cavity, and paranasal sinuses are low risk. Other predictors of risk of metastases are higher T stage and thickness (in case of oral cavity cancers).

Bladder Cancer

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Q) What is the most suitable treatment option for non muscle-invasive bladder cancer with the risk of recurrences?

A)Cystectomy

B)Intravesical chemotherapy

C)Transurethral resection and adjuvant intravesical chemotherapy

D)Palliative therapy

Answer-C(Schwartz-1654)

Patients with non–muscle-invasive bladder cancer (confined to the bladder mucosa or submucosa) can be managed with transurethral resection alone and adjuvant intravesical (instilled into the bladder) chemotherapy/immunotherapy.

The use of these intravesical agents is critical since patients with non–muscle-invasive bladder cancer are at risk for tumour recurrence and progression.

 

Uro Onco MCQS

Sugiura Procedure

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Q)   What is not true regarding Sugiura's procedure for Portal Hypertension ?

a)  It is a transesophageal variceal ligation

b) Splenectomy is done

c) Vagotomy is done 
d) Pyloroplasty is done
Sugiura procedure is the non shunting procedure for EV bleeding, which was first proposed by Sugiura and Futagawa in 1973 []. However, because of its complexity and high postoperative morbidity and mortality, this procedure has not been widely accepted in Western countries 

a

Non shunt operations are done for bleeding esophageal varices in emergency for poor risk patients when sclerotherapy or other conservative methods fail.
Sugiura's is a devascularization procedure described in 1973
It has two parts
Thoracic and abdominal which may be simultaneous or staged.
The Left posterolateral thoracotomy is done.
The longitudinal periesophageal azygous collateral veins and thoracic vagus is preserved. 
The esophagus is transected at level of diaphragm. This completely  devascularizes the esophagus.
The cut mucosa and anterior muscle layer is approximated.
Then the abdominal approach is done and abdominal esophagus, cardia of stomach is devascularized. Short gastric vessels are ligated, selective vagotomy is done, pyloroplasty is done, splenectomy completes the procedure.
Transgastric varix ligation was done previous to this procedure as described by Tanner  but not transesophageal. Hence 'a' is the answer.
The modified Sugiura procedure can be performed through a one-stage transabdominal approach via the midline incision or extension of a left subcostal incision with the exposure of an L shape.
The procedure starts with splenectomy for improvement of the exposure followed by gastric and esophageal devascularization and finally the esophageal transaction using a mechanical stapler through a short gastrotomy.
The Sugiura operation contains five componential procedures and esophagogastric devascularization is the only remaining part in the many different versions of the modified Sugiura operation.
Schakelford pancreas pg 383.

Prognostic factor for carcinoma esophagus

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Q. Most important prognostic factor for carcinoma esophagus is
 
a) Cellular differentiation                                 b) Depth of  esophagus involvement
 

c) Length of  esophagus involvement            d)   Age of the patient

B
Most important is depth of involvement of wall  of esophagus and lymph node involvement of the surrounding esophageal tissue.
 Length of esophagus involvement is not that important because esophagus has extensive submucosal lymph supply and for complete cure 10 cm excision margin would mean removal of almost total esophagus.

Summary of Key Prognostic Factors:

Factor Prognostic Impact
Depth of invasion Most important
Lymph node involvement Highly significant
Distant metastasis Very poor prognosis
Cellular differentiation Moderate significance
Tumor length and location Lesser importance
Patient age/health Indirectly affects prognosis
Treatment response Useful for tailoring therapy