Free Questions

Free MCQs in Surgery

Colon Lymphoma

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Q) A 55-year-old male patient presents with chronic abdominal pain, weight loss, and intermittent diarrhea. Colonoscopy reveals a mass in the cecum, and biopsy confirms colonic lymphoma. Which of the following statements is most likely true regarding this condition?

A) Colonic lymphoma is predominantly of T-cell origin
B) It is more common in females
C) The cecum is the most common site of involvement
D) It typically presents in the 3rd and 4th decades of life

C) The cecum is the most common site of involvement

Explanation:

Colonic lymphoma is a rare form of lymphoma that primarily affects the gastrointestinal tract. Among the options provided:

  • A) Colonic lymphoma is predominantly of T-cell origin: This is incorrect. Colonic lymphoma is most commonly of B-cell origin, particularly extranodal marginal zone lymphoma (MALT lymphoma), rather than T-cell lymphoma.
  • B) It is more common in females: This is also incorrect. Colonic lymphoma does not have a strong gender predilection. The incidence is more balanced between males and females.
  • C) The cecum is the most common site of involvement: This is correct. The cecum is the most frequent site of involvement in colonic lymphoma, especially for extranodal B-cell lymphoma, such as MALT lymphoma. It tends to present as a mass-like lesion, often causing symptoms such as abdominal pain and weight loss.
  • D) It typically presents in the 3rd and 4th decades of life: This is incorrect. Colonic lymphoma is more commonly diagnosed in older adults, typically over the age of 50. It is relatively rare in younger individuals.

Peptic Ulcer Location

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Q) False statement about location of peptic ulcer?

a) Type 1 is on greater curvature

b) Type 2 is gastric body and duodenal

c) Pauchet procedure is for type IV

d) Type Iv is high on lesser curvature

Ans 16) a

TYPE             LOCATION                             ACID LEVEL
I                   Lesser curve at incisura         Low to normal
II               Gastric body with duodenal ulcer Increased
III                      Prepyloric                           Increased
IV                   High on lesser curve               Normal
V                        Anywhere                            Normal,

Anti rejection drugs

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Q) Anti Rejection medicine which also prevents tumor recurrence? MCH Questions ...

a) M tor inhibitors

b) IL2 blockers

c) Steroids

d) Azathioprine

Ans a) mtor inhibitors 

One Question is always asked about anti rejection medicines, Salient points i am enumerating

  1. Three drug regimen is classic includes IL2 blocker, Mycophenolate and steroids which are tapered . IL 2 blocker  Tacrolimus is used more than Cyclosporine ( cyclosporine less used now). IL2 blocker side effects are hirsutism, hyperkalemia, gum hypertrophy etc) 
  2. Mycophenolate is preferred over azathioprine . Both cause fall in cell lines
  3. Steroids have many side effects like weight gain, cataract, infections and are used in tapering dose

M-tor inhibitors are sirolimus and Everolimus which are used when transplant is done for HCC, IT has anti tumor action.

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Paget disease of Breast

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Q) True regarding Paget's disease of the breast?
A. Seen in 5-10% Carcinoma  breast
B. 50-60% associated with underlying mass
C. Treated by MRM always

d) Radiotherapy is the treatment of choice

Ans b

50% have underlying mass 

Paget disease accounts for 1% or less of breast malignancies. It is characterized clinically by nipple erythema and irritation with associated pruritus and may progress to crusting and ulceration. ( Sabiston page 860)

Paget disease is a condition of the nipple that is commonly associated with an underlying breast cancer  More than 95% of patients with Paget disease have an underlying breast carcinoma. Paget disease may be accompanied by a palpable mass in slightly more than 50% of Epidermal layer of skin is involved. Clinically, dermatitis occurs that may appear eczematoid and moist or dry and psoriatic.

Treatment of Paget disease

(i) mastectomy with axillary staging 

(ii) wide local excision of the nipple and areola to achieve clear margins, axillary staging, and radiation therapy. 

Prognosis Carcinoma thyroid

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Q) Not an important prognostic factor in Carcinoma thyroid (JIPMER)  ?
A. Age
B. Completeness of resection
C. Multicentricity
D. Extra thyroid extension

Ans c

In thyroid carcinoma, important prognostic factors include age (younger patients tend to have a better prognosis), completeness of resection (as complete removal of the tumor affects outcomes), and extra-thyroid extension (invasion beyond the thyroid worsens prognosis). However, multicentricity (the presence of multiple tumor foci within the thyroid) is generally not considered a major prognostic factor.

Most of the papillary carcinoma are multicentric any way

 

As per AGES And AMES criteria.

HIgh risk - Male. Age more than 40 years, Size more than 4 cm, Capsular or extra thyroid extension, Regional or distant metastasis and poor differentiation

Low Risk - Well differentiated less than 2 cm. Age benefit is extended to 50 yrs in women

 

IN younger patients (<45 years old), the presence of lymph node metastases had no effect on the excellent overall survival, but the presence of lymph node metastases increased the risk of death by 46% in patients older than 45

The presence of lymph node metastasis in patients with contained intrathyroidal primary papillary carcinoma also does not affect
long-term survival.

If there is gross or microscopic extension of a primary PTC through the thyroid capsule, a poor prognosis and
possibly a higher rate of lymph node metastasis may be anticipated.

Axilla management in CA breast

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Q) 47 year old premenopausal lady with a 3X 3cm left breast lump with IDC grade III, TNBC.

On examination, there is a  single subcentimetric mobile soft mobile ipsilateral  axillary LN palpable.  Usg nodes no loss of hilum.  Management of axilla?

a) SLND

b) ALND

c) Radiotherapy only

d) No treatment

Ans a

Selective lymph node dissection

ACOSOG Z0011 trial 0  (stages I and II) in patients who undergo breast conservation therapy, axillary lymph node dissection does not improve locoregional control or survival.

This trial has demonstrated the safety of limiting axillary surgery to the SLNB without performing formal axillary dissection for sentinel node positivity.

This  avoids of the  morbidity of the axillary dissection.

If node is  positive the patient should receive adjuvant chemotherapy and radiation therapy.

Round cell tumors

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Q) 12 yr old girl fever diaphyseal femur mass . It is a  Round cell tumor. PAS+VE diastase
sensitive .  AIIMS onco 2020 

A. Ewing's sarcoma 
B. Osteosarcoma
C. Chondroblastoma
D. Chondrosarcoma

Ans a) Ewing

On the basis of round cell pattern tumor classification is 

  1. Diffuse round cell pattern

    1. Ewing's sarcoma

    2. Primitive neuroectodermal tumor (PNET)

    3. Merkel cell carcinoma

    4. Embryonal rhabdomyosarcoma (ERMS)

    5. Small cell carcinoma

    6. Lymphoma

    7. Leukemic infiltrate.

  2. Septate or lobulated round cell pattern

    1. Small round cells are divided by fibrous/fibrovascular septate

    2. Ewing's sarcoma

    3. Alveolar rhabdomyosarcoma (ARMS).

According to size of round cell

  1. Small round cell – Squamous cell carcinoma, PNET, Ewing's sarcoma, melanoma, rhabdomyosarcoma (RMS), Langerhans cell disease, lymphoma, adenocarcinoma, neuroendocrine carcinoma, Merkel cell carcinoma, olfactory neuroblastoma

  2. Large round cell – Squamous cell carcinoma, adenocarcinoma, melanoma, RMS, lymphoid tumors, paraganglioma.

Loss of cell Surface antigen

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Q) Loss of cell surface antigen is a feature of 
A. CIS
B. NO RELATION WITH GRADE
C. LOW GRADE TUMOR
D. HIGH GRADE TUMOR

Ans d High grade

The ABO(H) blood group system consists of terminal oligosaccharide antigens carried by glycoproteins or glycolipids in hematopoietic or epithelial cells 

Their biosynthesis is presumed to be controlled by the ABO(H), Se, H, Le, and X blood group genes .

These antigens are present on normal bladder epithelium of secretor individuals but not on some low-grade and early-stage papillary urothelial carcinomas 

Moreover, initially expressing tumours lose these cell surface antigens upon local recurrence, progression to invasion or metastization 

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