Parotid tumors (AIIMS ONCO 2019)

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Q7. 70 year old smoker, with right parotid swelling, histopath- lymphocytic  stroma with oncocytes and proteinaceous background. What is the diagnosis?

a) Oncocytoma

b) Warthin tumor

c) Pleomorphic adenoma

d) Mucoepidermoid

Paraneoplastic syndrome in HCC

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Q) Paraneoplastic Syndrome in HCC which also occurs in End stage liver disease ?

a) Hypercholesteremia

b) Hypoglycemia

c) Hypercalcemia

d) Carcinoid

Ans -  b

Hypoglycemia (also seen in end stage liver disease) 

Erythrocytosis

Hypercalcemia

Dysfibrogenimea

Carcinoid Syndrome

Thyroxin binding globulinincreases

Porphyria cutanea tarda

Gynecomastia, testicular atrophy, early puberty

Enteropathy in T cell lymphoma

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Q. Not true about enteropathy in T cell lymphoma
a) It is an  variant of intestinal lymphoma mainly in jejunum and ileum
b) Associated with coeliac disease
c) Perforation is frequently seen with ETL (Enteropathy T cell lymphoma)
d) This type of lymphoma is commonly seen
Ans. d
Enteropathy T cell lymphoma is an unusual variant of intestinal lymphoma. It is associated with celiac disease and responds to gluten free diet. It has a higher rate of perforations because of circumferential ulcers. It is commonly seen in jejunum and ileum
Ref- Schakelford Surgery of Alimentary canal  pg 1205
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Duodenal Adenocarcinoma

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Q) Which of the following is not true about duodenal adenocarcinoma

a) Adenocarcinoma is the most common malignancy affecting duodenum

b) Most of the patients with duodenal adenoacarcinoma have a palpable mass

c) Surgery is the main stay of management

d) GOO is the most common presentation

A day at the office

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Biliary fistula in Hydatid cyst liver

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Q) Which is not true in terms of biliary fistula in  hydatid cyst liver

a) Cyst diameter more than 10 cm is a predictor of intrabiliary rupture

b) Minor communications are revealed by post op bile leak

c) Major biliary communication is fistula more than 5 mm or communication in the bile duct

d) Major biliary communication is seen in 15-20%

Response to chemotherapy in Carcinoma Esophagus

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Q) A patient with carcinoma lower 1/3 of esophagus, receives chemo Radiotherapy and dysphagia shows complete response. What is the next step in management

a) Reassure

b) Follow with CT scan every  6 months 

c) Esophagectomy

d) EUS to look for residual disease

 Ans c

Clinical trials and meta‐analyses have shown that a CRT + surgery regimen could significantly improve the survival of locally advanced esophageal carcinoma patients compared to surgery alone

Endoscopic biopsy, endoscopic ultrasonography, MRI (at various sequences), and PET‐CT all had shortcomings for evaluating cCR and the therapeutic effect of nCRT. 

 

Timing of cholecystectomy in biliary pancreatitis

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Q) What is true regarding timing of cholecystectomy in biliary pancreatitis ?

a) Cholecystectomy should be done before discharge in severe pancreatitis to prevent recurrent attacks

b) Cholecystectomy should be done in same admission as pancreatitis when severe disease is excluded

c) Early cholecystectomy has been shown to have more complications than interval cholecystectomy

d) Early cholecystectomy increases technical complications

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Questions on Bile ducts?

 Ans b

"Poncho trial " answers this question of timing of cholecystectomy in biliary pancreatitis 

Early cholecystectomy (just before discharge, when the patient has recovered and severe disease excluded), compared to interval cholecystectomy, effectively reduces---

  1. The rate of recurrent gallstone-related complications in patients with mild biliary pancreatitis,
  2. low added risk of complications.

Evidence on the timing of cholecystectomy in severe pancreatitis is scarce. Cholecystectomy is recommended after all signs of pancreatic necrosis have been resolved or if they persist more than 6 weeks

  • Cholecystectomy during the same admission is recommended for patients with mild biliary pancreatitis to prevent recurrent attacks.
  • In cases of severe pancreatitis, surgery is generally delayed until the inflammation subsides.
  • Studies have shown that early cholecystectomy during the same admission for mild to moderate biliary pancreatitis does not increase complications compared to delayed or interval cholecystectomy.

Surgeons OT dress

Pancreatic necrosis

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Q) Pancreatic necrosis all are true except
a) Sterile pancreatic necrosis may be managed conservatively in most of the cases
b) Infected Pancreatic Necrosis  is managed by surgery at 2 weeks
c) Minimal access techniques have given better results than open necrosectomy
d)WOPN may be drained by either a transgastric or, less commonly, a transdoudenal route.