NEET Pattern Questions

Whipple’s triad

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Q) Whipple's triad is seen in which pathological condition?

a) Insulinoma

b) Glucagonoma

c) VIPOma

d) Somatostatinoma

 

Answer 

a) Insulinoma

Whipple's triad is seen in pancreatic insulinoma and consists of 

a) Symptoms of hypoglycemia

b) Fasting sugar less than 50 mg%

c) Relief of symptoms with administration of dextrose solution

Other Points

  • Insulinoma is the most common functioning pancreatic neuroendocrine tumor
  • Symptoms are present for many years before diagnosis
  • Weight gain is common
  • Distribution of insulinomas is equal in body head and tail
  • Average size of insulinoma is 1-1.5 cm

Symptoms of Insulinoma

The neuroglycopenic symptoms of insulinoma included confusion, visual change, and unusual behavior

Sympathoadrenal symptoms may include palpitations, diaphoresis, and tremulousness.

Whipple's triad is just a part of Insulinoma and is not pathognomic of it. This entity may also be seen in other hyperinsulinemic conditions.

For endogenous Insulinoma, following tests are done

Proinsulin above 5.0 pmol/L

insulin above 3.0 pmol/L,

C-peptide above 0.2 nmol/L

all demonstrate endogenous hyperinsulinemia

In Memoriam: Allen O. Whipple, M.D

Inversion of nipple

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Q) Simple nipple inversion is seen in?

a) Duct ectasia

b) Puberty

c) Peri ductal fibrosis

d) Carcinoma breast

Answer of this question is free. Click the link for more similar questions for MCH preparation

Ans is b

Inversion of nipple  is  seen in a lot of conditions, both benign and malignant.

Common causes are 

Benign causes of Nipple inversion

  1. Duct ectasia
  2.  After breast Surgery
  3. Fat necrosis
  4. Mondor disease
  5. Chronic peri ductal mastitis

Malignancy

  1. Carcinoma breast 

Rapid unilateral development of inversion of nipple is a dangerous sign and warrants further diagnosis. Further circumferential retraction is also sign of carcinoma.

Simple nipple inversion occurring at puberty  or retracted nipple is of unknown cause and is bilateral in 25%. Mostly No treatment is required for this and condition resolves spontaneously during pregnancy and lactation.

Suction pumps and cosmetic surgery can also help.

Inversion of nipple associated with malignancy may be with or without the presence of lump. Associated discharge from the nipple can point to the diagnosis.

Duct ectasia - slit like retraction of nipple . ALso seen in duct ectasia is green, black or blood stained discharge from nipple

 

 

Ref - Bailey 801

Grading of benign nipple inversions for management

In grade I, the nipple is easily pulled out manually and maintains its projection quite well.  It has minimal fibrosis  thus, manual traction and a single, buried purse-string suture are enough for the correction.

Grade II (majority)  the nipples can be pulled out but cannot maintain projection and tend to go back again. These nipples are thought to have moderate fibrosis beneath the nipple.

In grade III, to which the least number of inverted-nipple cases belong, the nipple can hardly be pulled out manually. Severe fibrosis made it impossible to reach optimal release of the fibrotic band with the preservation of the ducts.

Ref https://www.ncbi.nlm.nih.gov/pubmed/10654681

 

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Q)  Is nipple inversion a sign of breast cancer?

A) Not always but above the danger signs and symptoms are listed

 

Complications of liver transplant

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Q) True about liver transplant complications 

a) Portal vein thrombosis is more common than Hepatic Artery thrombosis

b) Bile leak though common is not a significant problem in most

c) Any bleeding in post op period, patient should be taken to OT

d) Acute liver rejection is seen in 5-10% cases

 

Significance of MELD Scoring in Liver Transplant

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Q) The significance of MELD Scoring in Liver transplant is :

a) Less ill patients are given more priority in liver transplant

b) Set threshold for patients who are too ill to undergo transplant.

c) To access  mortality in the waiting list.

d) To list patients in cadaveric deceased donor program

d

MELD score takes into account  three factors. Bilirubin, INR and creatinine. Recently MELD Na is also included. Model for end stage Liver Disease (MELD) was initially developed to evaluate three months prognosis in patients undergoing TIPS. 
It ranges from 6 (3 months survival = 90%) to 40 (3 months survival =7%).

In countries where DDLT is more common MELD Score is used to allot grafts to people in the cadaveric list. More severe is the MELD, earlier is the allotment of cadaveric graft.

Sicker patients are given priority

 

Living Donor liver transplant

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Q) Living donor liver transplant (LDLT) is done in centers where cadaveric donations are few. Which of the following is true about it?

a) Only right lobe of the donor can be used

b) Only left lobe can be used

c) In LDLT bile leak is more than cadaveric donor

d) Small for size liver is defined as liver size less than 0.5% of recipient BSA

Answer

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