Q) In terms of cure best results in inflammatory carcinoma breast are seen with-
a) Surgery alone
b) Chemotherapy
c) Radiotherapy
d) All of the above
Ans wer
d)
Inflammatory carcinoma of the breast is a rare aggressive tumor that blocks the sub dermal lymphatics as a result of which cutaneous edema is common . Differentiating it from a breast abscess is important and biopsy is diagnostic. It is also responsible to peau d orange
Treatment is multidisciplinary and involves, chemotherapy followed by surgery followed by radiotherapy.
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.
Q) Popcorn calcification in breast is seen in which condition
a) Fibroadenoma
b) Periductal fibrosis
c) Carcinoma breast
d) Duct ectasia
Free answer to Surgery MCQs
a
Calcifications associated with fibroadenomas have been termed popcorn calcifications because of their large size and dense, coarse appearance. Calcifications in fibroadenomas usually begin at the periphery and then involve the central portion of the fibroadenoma.
Q) Type II gastric ulcer as described by Johnson is
a) Pre pyloric
b) Ulcer on body of stomach combined with duodenum
c) High on lesser curvature
d) Ulcer near the antrum
Answer b
Type II gastric ulcers, as described by Johnson, refer to:
b) Ulcer on body of stomach combined with duodenum
Type II ulcers are characterized by the presence of both gastric ulcers and duodenal ulcers.
In Johnson’s classification of peptic ulcers, Type II gastric ulcers are those that occur in both the stomach and the duodenum simultaneously. Here are the details:
Location: The gastric ulcer typically occurs in the body of the stomach, usually on the lesser curvature, while the duodenal ulcer is found in the first part of the duodenum.
Pathophysiology: This type of ulcer is associated with increased gastric acid secretion, which contributes to the development of both gastric and duodenal ulcers. The co-occurrence is often due to the same underlying factors like Helicobacter pylori infection or hyperacidity.
Q) A 28-year-old man with a history of accidental caustic ingestion in childhood presents with long-standing progressive dysphagia. He has undergone multiple endoscopic dilatations with only temporary relief. Contrast study shows a long-segment esophageal stricture. He is being planned for definitive surgical reconstruction. Which of the following statements regarding reconstruction after caustic esophageal injury is NOT true?
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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.
