NEET Pattern Questions

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

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.

 

Ductal carcinoma in situ

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Q) IN RTOG trial for ductal carcinoma in situ (DCIS) favourable tumor was defined as

a) <3,5 cm in size and 2mm free resection margin

b) <2.5 cm and 2mm margin

c) <3 cm size and 3 mm margin

d) <2.5 cm size and 3 mm margin

Answer - Free answers to surgery mcqs
d

Ductal carcinoma in situ is a pre invasive state in which the cancer cells have not breached the epithelial membrane. It can develop into cancer in 20%.

Simple mastectomy is the standard of care but many centers now consider it over treatment.

Van Nuys system uses

  1. Age of the patient
  2. type of DCIS
  3. presence of microcalcification
  4. Size
  5. resection margin

On mammography this is seen as clustered clustered calcification

Treatment options are 

  1. Mastectomy
  2. Breast conserving therapy (Lumpectomy +radiation and hormonal)

More recently, Eastern Cooperative Oncology Group investigators reported the frst result of a relatively large prospective single-arm study of surgery with negative margins of at least 3 mm without radiation therapy for patients with favorable subsets of DCIS.

 Patients with low-grade or intermediate-grade DCIS measuring 2.5 cm or smaller had a 5-year rate of ipsilateral breast recurrence of only 6.1%. In contrast, patients with high-grade disease had a much higher 5-year ipsilateral breast recurrence rate of 15.3%.

REF : Sabiston 853

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334775/

 

Atrial Septal Defect

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Q) Most common type of Atrial Septal Defect (ASD) is:

A. Ostium Primum
B. Ostium Secundum
C. Sinus Venosus
D. All are equal

 

ASDs
■ Common defects
Ostium secundum: fossa ovalis defect (approximately 70 per cent of ASDs)
Ostium primum: atrioventricular septal defect (approx imately 20 per cent of ASDs)
Sinus venosus defect: often associated with anomalous pulmonary venous drainage (approximately 10 per cent of ASDs)
Patent foramen ovale: common in isolation, usually no left-to-right shunt (not strictly an ASD)

 Rarer defects
Inferior vena cava defects: a low sinus venosus defect and may allow shunting of blood into the left atrium
Coronary sinus septal defect: also known as unroofed coronary sinus with the left superior vena cava draining to the left atrium as part of a more complex lesion