Medullary thyroid cancer – Management

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Thyroid MCQ
Q) 42 year old Male patient with 1 cm nodule in Right side of Thyroid.

Biopsy shows medullary carcinoma. No neck nodes are seen on USG. What is the management?
a) Total thyroidectomy
b) Total thyroidectomy with central node dissection
c) Total thyroidectomy with lateral and central neck dissection
d) Right hemithyroidectomy
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Answer

Carcinoma Breast and Pregnancy

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MCQ on Breast Cancer Management in Pregnancy
Q) A 30-year-old female in the 2nd trimester of pregnancy has a 2 cm breast carcinoma with no axillary lymph nodes. What should be the management?
✅ Answer: D. Lumpectomy + axillary dissection + chemo

🔍 Explanation:
In this case, lumpectomy followed by axillary dissection and chemotherapy is the preferred management.

- Axillary dissection is ideally done after Sentinel Lymph Node Biopsy (SLNB) - Radiotherapy can be given after the termination of pregnancy if necessary. - Hormonal therapy can also be started after pregnancy if required. - There is no need to terminate the pregnancy unless absolutely necessary, as modern treatments can be administered with careful planning.

🧠 Key Point: **Axillary dissection** and **chemotherapy** are preferred, with the option for hormonal therapy after pregnancy.

📘 Reference: NEET SS 2022 Paper

Anal malformation

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MCQ on Newborn with Abdominal Distension
Q) Newborn with abdominal distension on day 2, not passed meconium. There is absent anal orifice. What is the next step? # NEET SS 22
✅ Answer: A. Cross table X ray

🔍 Explanation:
The first step in such cases is to rule out congenital abnormalities of the spine, sacrum, kidneys, and heart.

- The second step is a Cross-table X-ray. If the X-ray shows perineal fistula, perform Anoplasty.
- If the X-ray shows rectal gas below the coccyx, perform a PSARP (Posterior Sagittal Anorectoplasty) with or without a colostomy.
- If the X-ray shows gas above the coccyx with associated defects, perform a colostomy.

🧠 Key Point: Cross-table X-ray is crucial to determine the presence of rectal gas and other associated defects, guiding the next step in management.

📘 Reference: Table 67.14 Sabiston