Perforation during Lap cholecytectomy

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Q.     Regarding Lap Cholecystectomy false  is  (AIIMS) 

a.       GB perforation occurs in 40%

b.      Perforation occurs at time of dissection from GB bed

c.       10 – 30 % incidence of missed stones in peritoneal cavity

d.      Missed stones seldom cause any problem in the future

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

Squamous cell carcinoma

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Q) What is the correct regarding squamous cell carcinoma? (For oncosurgery skin MCQs see here)

A)Chronic healing wound is a risk factor.

B)Bowen's disease does not have a risk of malignant transformation.

C)In situ disease present as slightly pink or skin coloured raised plaques.

D)Imiquimod is not used as a treatment option.

TNM Nasopharyngeal Carcinoma

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Nasopharyngeal Carcinoma TNM Staging MCQ | NEET SS Surgery
HEAD AND NECK SURGERY MCQ | NEET SS

Nasopharyngeal Carcinoma: TNM Staging

A 3.5 cm mass is identified in the nasopharynx, extending into the left nasal cavity. Imaging also reveals a 4.5 cm lymph node in the supraclavicular region. What is the correct TNM staging of this nasopharyngeal carcinoma?

A. T1N1
B. T1N3
C. T2N1
D. T2N3

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Nasopharyngeal Carcinoma TNM Staging: Important Exam Notes

Nasopharyngeal carcinoma is staged using the TNM system, which assesses the primary tumour (T), regional lymph nodes (N) and distant metastasis (M). Correct staging requires assessment of the anatomical extent of the primary lesion and the size, location and distribution of involved nodes.

Primary tumour classification

  • T1: Tumour confined to the nasopharynx or extending into the nasal cavity and/or oropharynx without parapharyngeal extension.
  • T2: Parapharyngeal extension and/or involvement of adjacent soft tissues.
  • T3: Involvement of skull base bone, cervical vertebrae, pterygoid structures or paranasal sinuses.
  • T4: Intracranial or cranial nerve involvement, orbital extension, hypopharyngeal involvement, parotid involvement or extensive soft-tissue disease.

Regional lymph node classification

Nodal staging considers the anatomical level of the involved nodes, their laterality, size and extension relative to defined anatomical landmarks. A 4.5 cm node does not qualify as N3 on size alone. The location must be assessed against the applicable staging criteria.

Important examination pearl

Extension into the nasal cavity alone is compatible with T1 disease. Do not upgrade to T2 without the relevant additional anatomical extension. Likewise, a description of a supraclavicular node should be interpreted using its precise anatomical location rather than its label alone.

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Esophagus duplication cyst

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Q) False statement about esophagus duplication cyst

a) Cystic form is most common  which does not  communicate with the lumen

b) Adults are mostly asymptomatic

c) Malignnat transformation is rare

d) Most commonly seen in middle 1/3 of esophagus

 

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.