Facial nerve pointers

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Q: What is the most consistent anatomical landmark of the facial nerve?

A) Anterior border of the posterior belly of the digastric muscle.
B) Posterior border of the posterior belly of the digastric muscle.
C) Superior border of the posterior belly of the digastric muscle.
D) Inferior border of the posterior belly of the digastric muscle.

Ivor Lewis Esophagectomy leak

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Q) After Ivor Lewis esophagectomy, on postoperative day 5 (POD 5), bile is seen in the chest tube.

The patient presents with a heart rate of 120 bpm, a temperature of 101°F, and blood pressure of 100/70 mmHg. What is the next appropriate step in management?

  • a) Stenting
  • b) Colonic replacement of gastric conduit
  • c) IV antibiotics
  • d) Conduit excision and esophageal diversion
Correct Answer: d) Conduit excision and esophageal diversion

In patients who develop a completely necrotic conduit post-esophagectomy, the risk of sepsis is high. These patients often require urgent surgical intervention. Upon confirming conduit necrosis, the conduit must be resected, and the patient should undergo diversion, which includes:

  • End esophagostomy
  • Venting gastrostomy
  • Feeding jejunostomy

It is crucial to maintain as much length of the remaining esophagus as possible to facilitate future reconstructive procedures.

Key Points:

  • Postoperative Day 5: Critical time for monitoring complications after esophagectomy.
  • Symptoms of Concern: Tachycardia, fever, and hypotension may indicate sepsis or other complications.
  • Surgical Intervention: Timely recognition and management are vital for patient outcomes.

For further reading, refer to Schakelford’s Surgical Anatomy of the Gastrointestinal Tract, page 477.

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Bone tumors

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Q) A 16 year old boy presents with severe groin pain after kicking a football. Imaging confirms a pelvic fracture. A previous pelvic x-ray performed 2 weeks ago shows a lytic lesion with 'onion type' periosteal reaction. What is the lesion?

Question from theme of Test 14

  • a) Giant cell tumor
  • b) Ewing's
  • c) Osteosarcoma
  • d) Osteomalacia
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Pancoast tumor

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Pancoast tumor
Q) 50 year old male with NSCL carcinoma of upper right lung which infiltrates the brachial plexus. What will be the management?

Lung and Thorax MCQs
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Giant cell tumor femur

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Q) A 22-year-old woman presents with a giant cell tumor (GCT) of the distal femur. Appropriate treatment would be:

A. Curettage and debridement
B. Amputation
C. Radiation
D. Preoperative chemotherapy, resection, and adjuvant chemotherapy
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Cystic lesion of pancreas

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Q) A 53-year-old woman is found to have an incidental pancreatic lesion on abdominal imaging. CT scan reveals a microcystic mass with a central stellate scar located in the body of the pancreas. Cyst fluid analysis demonstrates low viscosity, and low levels of CEA, CA 19-9, and amylase. Which of the following is the most likely diagnosis?

A. Serous cystic lesion
B. Mucinous cystic lesion
C. Intraductal pancreatic mucinous neoplasm
D. Pseudocyst
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Lung cancer

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Q) A 73 year male, old heavy smoker presents with haemoptysis.

On examination he is cachectic and shows evidence of clubbing. Imaging shows a main bronchial tumour with massive mediastinal lymphadenopathy together with widespread visceral metastases.

Which of the following variant is likely in him?

(Theme from mock test 12-24)
a) Adenocarcinoma
b) Small cell lung cancer
c) Large cell lung cancer
d) Squamous cell carcinoma

Mediastinal mass

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Q) A 25-year-old man presents to the emergency center with complaints of vague chest discomfort. Patient is noted to have a large anterior mediastinal mass. The alpha-fetoprotein levels are markedly elevated. What is the likely diagnosis?

A. Non seminomatous germ cell tumor
B. Seminoma
C. Thymoma
D. Lymphoma
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Graft loss after kidney transplant

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Q) After kidney transplant highest graft loss is seen in which condition?

a) Hemolytic uremic Syndrome

b) Ig A nephropathy

c) MPGN type 2

d) Systemic lupus