BREAST (MCQS)

1)Causes of gynecomastia: -idiopathic (most common) -LCF (liver cell failure) -leprosy -hormonal (teratoma of the testes, ectopic hormonal production in bronchial carcinoma) -Klinefelter's $ 2)Breast cancer in males: -1 % of all cases of breast cancer -gynecomastia is a PDF -excess estrogen (exogenous or endogenous) -worse prognosis than female breast cancer 3)Lymphatic obstn. In advanced breast cancer leads to: -Peau d'orange -edema of the arm -lymphangiosarcoma "Stuart Treve's $" 4)Adjuvant chemotherapy for breast cancer: -better combination -TTT of choice for metastais except bone>>>Radio -Main line of TTT for inflammatory cancer 5)Radiotherapy>>> -doesn't improve the overall survival but prevents the local recurrence -,if axillary clearance not applied .but can be given with axillary sampling -TTT of choice for palliation of the bone metastasis 6)Benefits of Tamoxifen in breast cancer: -reduces the recurrence -can halt the progression of metastatic breast cancer -reduces the risk of cancer in the other breast -helps to prevent osteoporosis -can lower the cholesterol level & decreases the risk of myocardial infarction 7)TTT of axillary LNs doen't influence survival!! 8)In management of early breast cancer: -Adjuvant tamoxifen improves survival in both pre- & post menopausal patients for both ER +ve & ER ve >>>decreases the malignancy in the other site!!

-mastectomy have the same survival rate as the BCT (Breast conservative therapy) ,but they only differ in their indications! - Adjuvant chemotherapy reduces the mortality by 30 % 9)LCIS: -multifocal,multi-centeric & bilateral mostly -can transform to both invasive ductal or invasive lobular carcinoma -the only method of detection is accidental in a biopsy indicated for other indication! -options for TTT>>>the best is : follow up.others:Hormonal (Tamoxifen),bilateral SC mastectomy!! 10)DCIS: --15-20 % of screen detected breast cancers -axillary LN metastasis in 1 % of the cases (wrong Diagnosis from the start) 11)-Greenish discharge>>>fibroadenosis -blood stained>>>mostly duct papilloma,less commonly carcinoma or duct ectasia!! 12)Axillary LNs receive>>>75 % of lymph drainage of the breast 13)Milk lines: -derived from the ectoderm -common to all mammals -2 % -6 % of the females have accessory breast -extend from axilla to inguinal regions! 14)Lobular carcinoma in situ>>>most dangerous risk factor for breast cancer (RR 10) 15)DCIS tranforms into invasive within 2 years!! 16)Most common type of Ductal carcinoma>>>NOS (75 %) 17)Mondor's disease: thrombophlebitis of the superf. Veins of the breast & ant. Chest wall for unknown etiology!! 18)Cystosarcoma phylloides>>>must perform the probe test to diff. from the fungating carcinoma 19)Duct papilloma: -may also present with serous discharge -may turn malignant -But single lesion isn't pre-malignant!!

-TTT:microdochectomy 20)Fibro-adenosis>>>cyclic mastalgia,most frequent disorder of the breast,esp. in the child bearing period!! -Not pre-malignant except if associated with: papillomatosis-atypical epitheliosis! 21)Duct ectasia: -in smokers -breast lump -Creamy nipple discharge -most common cause of nipple discharge -TTT: macrodochectomy (major duct excision) -Not pre-cancerous 22)Breast abscess: Staphylococcus aureus! 23)Sarcoma of the breast: -spindle cell sarcoma -Blood spread -TTT: simple mastectomy followed by radiotherapy! 24)In breast cancer, the pathogonomic signs are: -skin nodules -Cancer en Cuirasse 25)Most common presentation of invasive carcinoma>>>painless mass! 26)The cest indicator for micrometastasis is>>>infilteration of the breast LNs

THYROID (MCQS)
1)It develops from>>>4th pharyngeal pouch, C-cells from>>>the ultimo-branchial body!! Weight>>>20-25gms| 2)Thyroid tests>>>No SINGLE test is conclusive 3)Simple goiter develops as a result of>>>dietary def. of iodine mainly! 4)Goiterogens>>>vegetables (brassica family), PAS & Ca++, thyocynates & perchlorates, Carbimazole & thiouracil!! 5)Multinodular goiter>>>is 1 of the forms of a clinically solitary nodule!!!!! 6)Cold nodules>>>under active nodules>>>> 10 % malignant warm nodules>>>active hot nodules>>>over active>>>100 % toxic & benign 7)thyroid scan is most useful for>>>toxic adenoma of the thyroid 8)Retrosternal goiter>>>rarely causes RLN paralysis 9)In Paediatric Grave's,surgery is preferred because>>>radioactive iodine is potentially carcinogenic, anti-thyroid drugs have side effects, radioactive iodine causes late myxedema!! 10)TTT in pregrancy: -mainly anti-thyroid (in the 1st & 3rd trimesters) -given in the lowest possible doses -PTU is the drug of choice>>>less placental transfer>>>may cause foetal hypothyroidism -Radioactive iodine is absolutely # in pregrancy! 11)Propranolol>>>doesn't block the production of thyroxine!! While PTU & Carbimazole take about 3-4 weeks for their effect to appear (half life of T3>>few hours,T4>>>10-14 days) 12)type of radiation used>>>Beta-rays with half life 56 days & little damage to the surrounding tissue (I 131) hypothyroidism 13)Surgeries>>>Total is better than subtotal 14)Refractory Hge is common due to: from either the thyroid artery or remenant thyroid tissue! -slippage of ligature from the sup. Thyroid artery -bleeding thyroid veins

-It's imp. To open the wound in ward to relieve tension 15)Any stress>>>Crises (preventable)>>>best TTT is: BB (Propranolol) & Ice bath for hyperpyrexia!! 16)All types of biopsies are histological except FNAC>>>cytological!& it's the best!!But not reliable to diff. follicular adnoma & adenocarcinoma! 17)Advantages of TTT of Papillary carcinoma with Total thyroidectomy: -possibility to use radioactive iodine postoperative to identify the metastasis (No normal thyroid tissue) -ability to use thyroglobin as a marker -lower recurrence rate!! -but higher risk for hypoparathyroidism 19)Mediastinal LN involvement is common with>>>medullary carcinoma 20)ligature of STA>>>injury to ELN (Ext, br. Of SLN) , ITA>>>RLN 21)In Grave's,all of the following are raised>>>T4, PBI (protein bounding iodine), thyrois stimulating anti-bodies 22)in papillary carcinoma>>>you can hear bruit over the thyroid, psammoma bodies,mainly lymphatic spread,multi-centeric 23)TSH causes: -activiation of the thyroid follicles -increased iodide trapping in thyroid follicles -increased thyroglobin synthesis -increases release of T3 & T4 24)Hashimoto>>>diffuse enlargement of the thyroid gland in a middle age female!! 25)90 % of thyroxine released from the thyroid is>>>T4 26)De-Quervain's=Viral= subacute throiditis>>>pain is the main presenting symptom, uptake of the gland is depressed!! TTT>>>Prednisolone 10-20 mg/d for 7 days 27)Riedle's>>>Extension of the fibrous tissue byound the thyroid capsule,FNAC is a must,sever pressure symptoms,TTT: high dose steroids 28)Medullary carcinoma>>>mostly sporadic,MEN type II,lymphatic spread in 50-60 %>>>mediastinal & cervical,blood>>>liver,diarrhea, calcitonine is the tumor marker!! 29)Follicular>>>blood>>>skull>>pulsating,osteolytic,painful!!

30)anaplastic>>>direct spread! 31)most imp. Etiology for malignancy>>>Ext. irradiation 32)TNG & retrosternal>>>the only TTT is surgical after preparation with inderal!! 33)True exophthalmos occurs in 70 % of the cases of Grave's!! 34)injury of RLN Unilateral 1)complete: hoarsness 2)partial: mild dyspnea on exertion 2)Partial: failure of abd.>>>sever dyspnea & stridor!! 35)pressure symptoms in SMNG commonly affect>>>trachea, then>>IJV -risk of malignancy>>>25 % -risk of toxic changes>>>25 % 36)thyroglossal fistula>>>acquired & NEVER ONGENITAL cyst>>>columnar epith., contains lymphoid tissue, most commonly>>>infrahyoid, age: 5-7 ys>>>neck U/S 37)Pendered $>>>SMNG, deafness, mental retardation !!due to: Peroxidase def. 38)lingual thyoid>>>must be removed & give replacement therapy even if it's the only thyroid tissue!! But median ectopic>>>don't remove if it's the only thyroid tissue!! Bilateral 1)complete: failure of abd. & add. >>>loss of voice>>mild dyspnea

VASCULAR (MCQS)
Venous MCQs 1-P. in superf. Veins in leg during standing:80 mmHg & during Ex. It falls 2-The best surgery for VV:division or ligation at sites of communication from deep to superf. System (stripping of LSV in thigh only>>>1st step is Trendlenberg's) 3-Best TTT for lipodermatosclerosis or thrombophlebitis: Systemic anti-inflammatory & ext. compression + ambulation in thrombophlebitis) 4-The most reliable sign in DVT>>>swelling 5-The most common cause of fatal Pulmonary embolism: iliac vein thrombosis 6-Pulmonary embolism is best diagnosed by: spiral CT, while ABG is abnormal in only 50 % 7- Venous ulcers: 80 % of the leg ulcers

Lymphatic MCQs -lymphedema predominately affects females -Congenita & praecox are genetically predisposed -Recurrent Staph. Infection is common -Millroy's>>>familial lymphedema

Arterial MCQs:
1-Night cramps>>>in VV.>>>>sudeen cramping pain in the calf muscles that awakens the patient from sleep 2-The A/B index in a diabetic patient may be falsely high due to>>>calcification of leg arteries 3-Rupture is rare in popliteal artery aneurysm 4- 30 % of the patients with popliteal aneurysm have associated aortic aneurysm>>>ask for abd. aneurysm 10 % of patients with abd. Aneurysm have associated popliteal aneurysm 50 % >>>associated with the other site 5-Graft used in aorto-iliac bypass>>>Dacron 6-for Fem-pop>>>Autogenous vein graft 7-lumbar sympathectomy>>>L1>>>retrograde ejaculation 8-Adson's maneuver>>thoracic outlet>>+ve if>>>disappearing pulse 9-Seldinger needle>>>for arteriography 10-Intra-arterial thrombolysis is best achieved with>>>Pulse spray tPA

11-In fat embolism,fat arise from>>>chylomicrons 12-Moist gangrene occurs with: venous & arterial occlusion, embolism, DM 13-Bowel strangulation is an example for>>>Moist gangrene! 14-In subclavian Steal $>>>blood is drawn from>>Vertebral artery 15-Most common presentation of thoracic outlet $>>>> nervous??? 16-Raynaud's disease: -abnormal sensitivity to skin vss. To cold!! -characteristic pallor of the hands after cold stimulationfollowed by blue,then red colour changes!!! 17-PTA: -for short segment stenosis -higher bleeding complication rate than angiography -dissection of the artery can occur -arterial thrombosis may occur 18-Raynaud's phenomenon occurs with:SLE, thromangitis Obliterans (Buerger's), Occupational (vibrating tools), Drugs( ergotamine), thoracic outlet $ 19-In arterial injuries: -systemic heparinization should be avoided in patients with multiple injuries esp. the CNS trauma -venous repair is postponed till the patient is hemodynamically stable!!But proximal extremities veins are repaired whenever technically possible to avoid the sequela of venous occlusion!! -Reversed saphenous vein from an uninjured lower extremity is the 1st choice for interpositioning graft! -Direct approach through the site of injury is usually avoided for fear to cause Hge or injury to nearby nerve!