High yield surgery 1 MCQ for KU final year MBBS
Nipple discharge
Blood stained nipple discharge is seen in? ductal papilloma
Green discharge is most commonly seen with? Duct ectasia
A 25 years old female complains of discharge of blood from a single duct in her breast. The most appropriate treatment is: (question is asking tx of blood stained nipple discharge )? microdochectomy
A 25 years old lady presents with spontaneous nipple discharge of 3-months duration. On examination the discharge is bloody and from a single duct. The following statements about management of this patient are true except:
- Ultrasound can be a useful investigation
- Radical duct excision is the operation of choice
- Galactogram though useful is not essential
- Majority of blood stained nipple discharges are due to papillomas or other benign condition
Ca breast Ix
Best diagnostic method for breast lump is: biopsy
A 45-years old woman presents with a hard and mobile lump in the breast. Next investigation is: mammography
A female patient present with a hard mobile lump in her right breast. Which investigation would be most helpful in making the diagnosis :
a.FNAC
c. Excision biopsy
b. Needle biopsy
d. Mammography
Investigation of choice for high risk breast cancer in female is: MRI
Gold standard investigation for screening of breast carcinoma in patients with breast implant: MRI
60-year-old lady comes with blood stained discharge from the nipple with family history of breast cancer. Next best STEP FOR HER MRI
Best investigation to differentiate scar from recurrence after mastectomy done for carcinoma breast: PET SCAN All of the following are indications for MRI in breast carcinoma except:
a.microcalcification
b.Breast-implant patients
c.High-risk cases d.Lobular carcinoma in situ
What is the sensitivity of axillary ultrasound in identifying axillary metastases in clinically node negative carcinoma breast? 55-60%
Mammography
Most sensitive imaging for ductal carcinoma in situ
0.1cGy/study is used (remember its cGy not Gy only )
BIRADS : Breast Imaging Reporting and Data System read Benign vs malignant
Popcorn calcification : Fibroadenoma (benign lesion)
What is the age of routine screening mammography? 40yrs BIRADS score 4 suggests: sus malignancy
BIRADS score 5 is: highly suggestive of malignancy
Risk of malignancy in BIRADS II: 0-2%
Which of the following is seen in carcinoma breast?
a. Powdery calcification b. Popcorn calcification
c. nodular calcification d. Pleomorphic calcification
Ca breast risk factors
Which of the following is a predisposing factor for carcinoma of breast?
Epithelial hyperplasia or Hyperplasia atypical
(Any hyperplasia tick that if you get confused )
Gail model of risk assessment is used for: ca breast
Ovarian breast and prostate is associated with BRCA so they are genetic potential Least risk of CA breast is seen in:
a. BRCA-1 b. c. Li-Fraumeni syndrome d. Ataxia telangiectasia
BRCA-1 gene is associated with: Ductal carcinoma
Type of fibroadenosis most likely to undergo malignant change is: b. Epitheliosis Fibrocystic change IS BENIGN SO don’t go into malignancy
BRCA -1 IS chromosome 17 while BRCA-2 is 13
All of the following are true about tumors associated with BRCA-1 except: hormone receptor positive
Ca breast
comedo growth pattern is seen? Ductal ca in situ
lobular carcinoma breast have good prognosis multicentric bilateral(so if 1 is affected check both breast )
histology in infiltrating lobular breast carcinoma: Single file pattern Most common presentation of lobular carcinoma breast is: breast mass
Carcinoma breast is most commonly seen in which quadrant upper outer so least common in lower and inner Histological variety of breast carcinoma with best prognosis is: tubular >colloid
Worst prognosis : inflammatory breast ca
‘Peau-d-orange’ appearance of the mammary skin is due to: Lymphatic permeation
Which is the most conspicuous sign in breast cancer? Peau-d’orange
Most common site of metastasis from breast carcinoma: lumbar vertebra (if not in option tick bone)
‘Peau-d-orange’ is due to: Blockage of subdermal lymphatics Nipple inversion occurs due to involvement of: subareolar duct
Dimpling in carcinoma breast is due to: Subdermal lymphangitis
Post mastectomy complication : lymphedema can go into angiosarcoma/lymphosarcoma
Thyrotoxicosis
Thyroid storm after operation is due to: Inadequate control of hyperthyroidism(thyrotoxicosis not thyroiditis, so it only occurs in thryrotoxicosis stuff ) Which of the following is the agent of choice for treating thyrotoxicosis during pregnancy ? Carbimazole
features of thyrotoxicosis Soft non-ejection systolic murmur Irregularly, irregular pulse and Scratching sound in systole Dancing carotid
The best marker to diagnose thyroid related disorder is: TSH
The occurrence of hypothyroidism following administration of supplemental iodine to subjects with endemic iodine to subjects with endemic iodine deficiency goiter is
known as: WolF-ChaikoFF effect
Treatment of thyroid storm except : Propranolol, Radioactive iodine, Hydrocortisone, Lugol’s iodine
All of the following conditions are associated with hyper- thyroidism, except: . Hashimoto’s thyroiditis ,Toxic multinodular goiter, struma ovary Reduction of size and vascularity prior to thyroidectomy is done by: iodides
Which of the following is a symptom of hypothyroidism? Hairloss
Graves dis is common in female
Treatment of thyrotoxicosis can lead to hypothyroidism
Gall bladder
All of the following are essential for formation of gallstones except /Bile stasis /Crystallization /NucleationL/ithogenic bile Cholesterol gallstones are made up of Crystalline cholesterol monohydrate
All are true about pigmented stones except: Seen in cholangiohepatitis b. Secondary CBD stones c. Primary CBD stones d. More common in Asians
-False about brown pigmented stones:Associated with disorders of biliary motility and associated bacterial infection /More common in Caucasians /Soft and earthy in texture /High content of cholesterol and calcium palmitate
-Lithogenic bile has the following properties:Bile and cholesterol ratio
7. Gallbladder stone formation is infuenced by all except Clofibrate therapy /Hyper alimentation /Primary biliary cirrhosis /Hypercholesterolemia Incidence of gallstone is high in: a. Partial hepatectomy b. Jejunal resection c. Ileal resection d Subtotal gastrectomy
True statement about gallstones are all except: Lithogenic bile is required for stone formation /May be associated with carcinoma gallbladder /Associated with diabetes mellitus /More common in males between 30–40 years of age
Which among the following does not lead to pigment gallstones? a. TPN b. c. Hemolytic anemia c Clonorchis sinensis d. Alcoholic cirrhosis
True about gallstones: More common in females /Gallstones, hiatus hernia/CBD stones form Saints triad /Limey bile precipitated /Lithotripsy always done
All are component of Saint’s triad except: a. Renal stones b. Hiatus hernia c. Diverticulosis of colon d. Gallstones Commonest type of gallstone is: Mixed
Percentage of gallstones which are radiopaque: a. 10%b. 20% c. 30% d. 40%
A gallstone gets impacted most commonly in which part of common bile duct? Ampulla of vater
Gallstones do not contain: a. Oxalate c. Phosphate b. Cholesterol d. Carbonate True color of cholesterol stone is: pale yellow
Calculous cholecystitis is associated with all of the following except diabetes Investigation of choice in acute cholecystitis: USG
Mercedes Benz sign or Seagull sign is seen in: gallstone
Graham Cole test refers to: Oral cholecystography (iopanoic acid is used)
Initial investigation of choice for biliary obstruction: USG
Investigation for assessing proper functioning of biliary function is HIDA scan (no USG) Ursodeoxycholic acid is a: Gallstone dissolving drug
Regarding stones in gallbladder the following are true except: Mixed stones are common in the west /In Saint’s triad diverticulosis of colon and hiatus hernia coexist /Is a risk factor in the development of GB carcinoma /90% of GB stones are radiopaque /A mucocele of GB is caused by a stone impacted in the Hartmann’s pouch
Which of the following is a contraindication for medical management ? Radiopaque
Type II Mirizzi’s syndrome: Erosion of up to two-third circumference of common duct Mirizzi’s syndrome is GB stone compressing common hepatic duct .
Sentinel node of gallbladder is: lymph node of Lund
The procedure of choice for elective removal of CBD stones for most patients is: endoscopic papillotomy
The Reynold’s pentad of fever, jaundice, right upper quadrant pain, septic shock and mental status change is typical of: Cholangitis
What is the treatment of choice for recurrent CBD stones with multiple strictures in common bile duct? Hepaticojejunostomy / Cutaneous hepaticojejunostomy /Cholecystectomy /ERCP and sphincterotomy
Charcot’s triad: Fever, abdominal pain, jaundice
A patient of post-cholecystectomy biliary stricture has undergone an ERCP three days ago. Following this, she has developed acute cholangitis. The most likely organism is: e.coli
What is more appropriate for diagnosis of CBD stones? ERCP
Best treatment modality for common bile duct stone is: Endoscopic sphincterotomy
(IF CBD stone go for endoscopic removal if you are confused , likely to be answer )
Study risk factor mc cause billiard stuff>alcohol L-Asperaginase Splenectomy
Which of the following does not cause an increase in serum amylase . Pancreatitis c. Renal failure b. Carcinoma lung d. Cardiac failure
Which of the following is most diagnostic investigation for acute pancreatitis ? Serum lipase Which of the following types of pancreatitis has the best prognosis?gallstone induced pancreatitis Gasless abdomen in X-ray is a sign of Acute pancreatitis
Most common causes of death due to acute pancreatitis: infection
Renal calculi
Renal calculi associated with proteus infection: triple phosphate
nephrolithiasis occurs with the toxicity of: Indinavir
Staghorn calculus is made of Phosphate
Stone formed in alkaline urine is: calcium phosphate(if @CCU then acidic=calcium oxalate cysteine and uric acid) Potent producer of urease is: proteus (any infection related to renal tick proteus which is likely to be answer ) Struvite stone is caused by which metal? Calcium magnesium and phosphate
Locate the renal stone with pain radiating to medial side of thigh and perineum due to slipping of stone in males: at pelvic brim (iliohypogastric nerve) Triad of renal colic, swelling in loin which disappears after passing urine is called: Dietl’s crisis (intermittent hydronephrosis)
Ureteric colic due to stone is caused by: Increased peristalsis of ureter to overcome the obstruction
Commonest presentation of bilateral ureteric stones: pain
Treatment of choice of ureteric colic is: diclofenac
Steinstrasse is: Ureteric obstruction due to fragments in ureter
Which one of the following is radiolucent stone? a. Calcium oxalate b. Cystine c. Uric acid d. Phosphate
Which of the following statements about the Holmium: YAG laser is incorrect?
It has a wavelength of 2100 nm /Its use for uric acid stones has caused deaths due to
generation of cyanide /It is effective against the hardest urinary stones /It can even cut the wire of stone baskets
Percentage of renal stones which are radio opaque: 90%
45-year-old male shows calcification on the right side of his abdomen in an AP view. In lateral view the calcification is seen to overlie the spine. Most likely diagnosis is: renal stone Which of the following advises is not given to a 35 years old female patient with recurrent renal stone? Restrict calcium intake
Hematogenous is mc route
The most sensitive imaging modality to detect early renal tuberculosis is Intravenous urography
Earliest sign of renal tuberculosis on IVP: Moth eaten calyx
Sterile pyuria is consistent finding
Earliest and often the only presentation of TB kidney is: increased frequency Golf-hole” ureter is seen in: renal TB
Genitourinary TB in a male patient presents with: Microscopic hematuria
In a patient of genitourinary tuberculosis, IVP was done. What is the name of the sign seen in the image?thimble bladder
BPH
Benign prostatic hyperplasia first develops in the: Periurethral transition zone
. In BPH most common lobe involved is: Median Which is the earliest symptom? Frequency
Which of the following lasers is used for treatment of benign prostatic hyperplasia as well as urinary calculi? Ho: YAG laser Mx: is terazocin +finesteride if MI is there then only terazocin
Indication for surgery in benign prostatic hypertrophy are all except: a. Prostatism c. Hemorrhage b. Chronic retention d. Enlarged prostate
Which of the following drug can decrease the size of prostate? Finasteride
TUR SYNDROME/WATER RETENTION/DILUTIOAL HPONATREMIA /WATER INTOXICATION IS SAME
Which of the following substances is not used as an irrigant during transurethral resection of the prostate? 1.5%GYLCERINE
Ca prostate
Most common site of development of carcinoma of prostate is: Peripheral zone PSA(prostate specific antigen ) is serum marker
Serum acid phosphatase is increased
DRE+ PSA is most sensitive screening (if you have to chose DRE and PSA then go for PSA)
Secondary deposits form prostatic carcinoma is commonest in: bone
Normal level of PSA in males is: <4ng/ml
Gleason score: is for prostate ca
Osteoblastic metastasis commonly arise from: prostate (breast is osteoblastic and osteolytic ) Treatment for metastatic CA Prostate: GnRH analogue
Ketoconazole action in prostate carcinoma is: androgen ablation
Urethra and penis
Circumcision is contraindicated in: Hypospadias
Most common congenital anomaly of urethra: Hypospadias
Commonest hypospadias is: Glandular
The best time for surgery of hypospadias is: 6–10 months of age (before 1 year)
Name of surgery in hypospadias: Dennis-Brown
PARAPHIMOSIS The condition occurred due to the doctor forgeting to replace the retracted prepuce
treatment is manual reduction
Length of the male urethra: 20cm female is 4cm
surgery 1 mcq
Testis
Best time for surgery of undescended testis is: 6 months of age Incidence of undescended testis in normal new born: 3%
Most common tumors in undescended testis: Seminoma Stephen Fowler surgery is done for: undescended testis
Best investigation for undescended testis(also called anorchia) in 1-year-old child is: laparoscopy Incompletely descended testis is commonest on: right side
In cryptorchidism, hallmark histological changes appear in testis at: 4 months
Testis does not descend beyond: 1 year
Most common site of ectopic testis: Superficial inguinal pouch
Torsion of testis has to be treated within: immediately
In testicular torsion, surgery within how much time can save viability of testis? 6hrs All the following statements are true regarding torsion of testis except:
Most common between 10 and 25 years of age/Prompt exploration and twisting snd fixation is the only way to save the torted testis /Anatomical abnormality is unilateral and contalateral testis should not be fixed/Inversion of testis is the most common predisposing cause
Bag of worm like sensation is felt in: Varicocele
Chinese lantern on transillumination seen in: epididymal cyst
Spermatoceles are most commonly found at: Head of epididymis
Congenital hydrocele is best treated by: Herniotomy
Positive Prehn’s sign is: Elevation of testis reduces pain of acute epididymitis (SOMETIMES only orchitis is given don’t get confused)
