Friday, February 20, 2009

51 - wounds, tissue repair and scars mcqs - 3

21q: the following statement about keloid is true ?

a. they do not extend into normal skin
b. local recurrence is common after excision
c. they often undergo malignant change
d. they are more common in whites than in blacks

answer: b .

22q: fibroblast in healing wound is derived from ?

a. local mesenchyme
b. epithelium
c. endothelium
d. vascular fibrosis

answer: a . local mesenchyme .

23q: in the healing of a clean wound the maximum immediate strength of the wound is reached by ?

a. 2-3 days
b. 4-7 days
c. 10-12 days
d. 13-18 days

answer: d . 13-18 days .

24q: degloving injury is ?

a. surgeon made wound
b. lacerated wound
c. avulsion injury
d. blunt injury
e. abrasive wound

answer: c . avulsion injury .

25q: a clean incised wound heals by ?

a. primary intention
b. secondary intention
c. excessive scarring
d. none

answer: a . primary intention .

26q: in treatment of hand injuries , the greatest priority is ?

a. repair of tendons
b. restoration of skin cover
c. repair of nerves
d. repair of blood vessels

answer: b .

27q: during the surgical procedure ?

a. tendons should be repaired before nerves
b. nerves should be repaired before tendons
c. tendons should not be repaired at the same time
d. none

answer: b .

28q: limb salvage primarily depends on ?

a. vascular injury
b. skin cover
c. bone injury
d. nerve injury

answer: a . vascular injury .

29q: the vitamin which has inhibitory effect on wound healing ?

a. vitamin A
b. vitamin E
c. vitamin C
d. vitamin B Complex

answer: b . vitamin E .

30q: the tensile strength of the wound starts and increases after ?

a. immediate suture of wound
b. 3 to 4 days
c. 7 to 10 days
d. 6 months

answer: b . 3 to 4 days .

50 - wounds, tissue repar and scars mcqs - 2

11q: the tensile strength of wound reaches that of normal tissue by ?

a. 6 weeks
b. 2 months
c. 4 months
d. 6 months
e. never

answer: e . never .

12q: the worst position for scars is ?

a. back
b. shoulder
c. sternum
d. abdomen

answer: c . sternum .

13q: the best scars are seen in ?

a. infants
b. children
c. adults
d. very old people

answer: d . very old people .

14q: patient has a lacerated untidy wound of the leg and attended the casualty after 2 hours .his wound should be ?

a. sutured immediately
b. debrided and sutured immediately
c. debrided and sutured secondarily
d. cleaned and dressed

answer: b . debrided and sutured immediately .

15q: the following are required for wound healing ?

a. zinc
b. copper
c. vitamin C
d. calcium

answer: all are necessary .

16q: when is the maximum collagen content of wound tissue ?

a. between third and fifth day
b. between 6th and 17th day
c. between 17th and 21st day
d. none

answer: c . between 17th and 21st day .

17q: if suture marks are to be avoided , skin sutures should be removed by ?

a. 72 hours
b. 1 week
c. 2 weeks
d. 3 weeks

answer: b . 1 week .

18q: what is true about keloids ?

a. it appears immediately after surgery
b. it appears a few days after surgery
c. it is limited in its distribution
d. it is common in old people

answer: b . it appears a few days after surgery .

19q: a patient with grossly contaminated wound presents 12 hours after an accident . his wound should be managed by ?

a. through cleaning and primary repair
b. through cleaning with debridement of all dead and devitalized tissue without primary closure
c. primary closure over a drain
d. covering the defect with split skin graft after cleaning

answer: b .

20q: delayed wound healing is seen in all except ?

a. malignancy
b. hypertension
c. diabetes
d. infection

answer: b . hypertension .

49 - wounds, tissue repair and scars mcqs - 1

1q: which one of the following is used as preservative for packing catgut suture ?

a. isopropyl alcohol
b. colloidal iodine
c. glutaraldehyde
d. hydrogen peroxide

answer: a . isopropyl alcohol .

2q: most common site of hypertrophic keloid ?

a. face
b. leg
c. pre sternal area
d. arm

answer: c . presternal area .

3q: first line treatment for keloid is ?

a. intralesional injection of keloid
b. local steroid
c. radiotherapy
d. wide excision

answer: a . intralesional injection of steroid .

4q: drug used for intralesional injection of keloid ?

a. prednisolone
b. triamcinolone
c. androgen
d. hydrocortisone

answer: b . triamcinolone .

5q: in an open injury during toileting and debridement , muscle viability is detected by ?

a. colour of muscle
b. muscle size
c. muscle function
d. muscle contractility
e. punctuate bleeding spots on cut edge

answer: a , d , e .

6q: prevention of wound infection is done by ?

a. preoperative shaving
b. preoperative antibiotic therapy
c. monofilament suture
d. wound opposition

answer: b , c, d are true . pre operative shaving just before surgery is preventive not the day before .

7q: the best skin graft for an open wound is ?

a. isograft
b. homograft
c. allograft
d. autograft

answer: d . autograft .

8q: regarding antibiotics true is ?

a. no prophylaxis for clean contaminated surgery
b. no prophylaxis for gastric ulcer surgery
c. prophylaxis for colorectal surgery
d. local irrigation with antibiotics contraindicated when systemic antibiotics are given

answer: c .

9q: keloid scar is made up of ?

a. dense collagen
b. loose fibrous tissue
c. granulomatous tissue
d. loose areolar tissue

answer: a . dense collagen .

10q: primary closure of incised wound must be done with in ?

a. 2 hours
b. 4 hours
c. 6 hours
d. 12 hours
e. 16 hours

answer: c . 6 hours .

Thursday, February 12, 2009

48 - oral cavity surgery mcqs - part 5

41q: all are true about cancrum oris except ?


  1. associated with malnutrition and vitamin deficiency
  2. follows chronic infection
  3. involves jaw
  4. treatment is excision and skin grafting with tubed pedicle graft


answer: all the statements are actually true but the answer of exclusion is most probably “ b “  follows chronic infection .


42q: cancrum oris – true statements ?


  1. associated with malnutrition
  2. inflammatory swelling
  3. associated with vitamin deficiency
  4. treatment is excision and skin grafting


answer: all are true .


43q: all are true about carcinoma palate except ?


  1. slow growing
  2. bilateral lymphatic spread
  3. adenocarcinoma
  4. presents with pain


answer: d . presents with pain . carcinoma palate usually gives no symptoms except painless irregularity on the palate felt by tongue .


A few important points about carcinoma palate :


  1. slow growing tumor
  2. remains superficial for prolonged periods before extending into the periosteum
  3. it usually presents as superficial ulcer with rolled out edges
  4. it usually gives no symptoms except painless irregularity on the palate felt by the tongue
  5. lymphatic metastasis is not common , but may spread to submandibular and upper jugular node .
  6. small tumors are resected along with the underlying bone
  7. large tumors are treated with maxillectomy
  8. adjuvant radiotherapy is given for advanced lesions
  9. bilateral lymphatic spread is common in tumors of head and neck like lower lip, supraglottis and soft palate .


44q: treatment of state T3N1 of carcinoma maxilla is ?


  1. radiation therapy only
  2. chemotherapy only
  3. surgery and radiation
  4. chemotherapy and radiation


answer: c . carcinoma maxilla is of two types . squamous cell carcinoma and adenocarcinoma . surgery and radiation is the treatment of choice for any stage of carcinoma maxilla .

                                    adenocarcinoma of maxilla is unresponsive to radiation and so surgery is the only option .


45q: gum tumor with 2 contralateral mobile lymphnodes in cheek come under ?


  1. T3N2M0
  2. T2N2M0
  3. T4N2M0
  4. T3N3M0


Answer: a . T3 N2 M0 . if only one node is involved with less than or equal to 6 cms size above the supraclavicular foss ,then it is N1 . if bilateral metastasis in lymph nodes with less than or equal to 6cms size above the supraclavicular fossa, then it is N2. if the size of metastasis is greater than 6cms to supraclavicular fossa then it is N3 . no other surrounding structures involved so it is T3 and not T4 .


46q: a patient with cheek cancer has a tumor of 2.5 cm located close to and involving the lower alveolus . a single mobile homolateral lymphnode measuring 6 cm is palpable . the TNM staging is ?


Answer: T4 N1 M0. notice that the alveoli involved so it is T4 . as one lymphnode is involved measuring 6 cms , it is N2 .


47q: patient with T3 N2a M0 lower alveolar carcinoma requires ?


    1. surgery
    2. surgery and radiotherapy
    3. radiotherapy
    4. chemotherapy


answer: a . surgery .

47 - oral cavity surgery mcqs - part 4

31q: commonest site of carcinoma tongue is ?


  1. dorsum
  2. ventral aspects
  3. anterior 2/3 rd lateral aspect
  4. tip


answer: c . anterior 2/3 or middle 1/3 rd .


32q: in the reconstruction following excision or previously irradiated cheek , the flap will be ?


  1. local tongue
  2. cervical
  3. forehead
  4. pectoralis major myocutaneous


answer: d . pectoralis major myocutaneous .


33q: true statements about oral cancer is / are ?


  1. most common in buccal mucosa
  2. metastasis is uncommon
  3. respond to radiotherapy
  4. surgery done
  5. syphilis and dental irritation predisposes


answer: b, c , d , e . cancer involving the buccal mucosa is the most common type of oral cancer in India but the most common type of oral cancer in the world is lip cancer .


34q: commonest site of carcinoma tongue ?


  1. apical
  2. lateral borders
  3. dorsum
  4. posterior one third
  5. faucio lingual


answer: b . lateral borders .


35q: which is not true of carcinoma tongue ?


  1. lateral border involved
  2. cervical lymph node involvement
  3. commonly adenocarcinoma
  4. tobacco chewing is a risk factor


answer: c . carcinoma of tongue is most commonly squamous cell carcinoma and not adenocarcinoma .


the most common sites of squamous cell carcinoma are :


  1. skin
  2. head and neck tumor
  3. carcinoma oesophagus
  4. carcinoma cervix
  5. carcinoma bladder


36q: trismus in oral cancer patients is severe in those treated with ?


  1. surgery and radiotherapy
  2. chemotherapy alone
  3. surgery alone
  4. not related to treatment


answer: a . surgery and radiotherapy .


37q: which of the following statements are true about carcinoma tongue ?


  1. occurs most commonly on the lateral border of the middle third of the tongue
  2. metastasize readily to cervical lymph nodes
  3. is usually radiosensitive
  4. treated surgically – should include homolateral neck dissection except for small lesions
  5. all of the above


answer: e . all the above statements are true .


38q: a patient with carcinoma tongue is found to have lymph nodes in the lower neck. The treatment of choice for the lymph nodes is ?


  1. lower cervical neck dissection
  2. suprahyoid neck dissection
  3. teleradiotherapy
  4. radical neck dissection


answer: d . radical neck dissection .


39q: an old man who is edentulous developed squamous cell carcinoma in buccal mucosa that has infiltrated to the alveolus . following is not indicated in the treatment ?


  1. radiotherapy
  2. segmental mandibulectomy
  3. marginal mandibulectomy involving removal of the outer table only
  4. marginal mandibulectomy involving removal of upper half of mandible


answer: c . in marginal mandibulectomy inner table of the mandible is removed and not the outer table . whenever squamous cell carcinoma of the oral cavity involve the mandible mandibulectomy becomes necessary.

                                          Mandibulectomy is of two types . segmental mandibulectomy and marginal mandibulectomy . marginal mandibulectomy is done when the tumor lies within one centimeter of the mandible or abuts the periosteum without evidence of direct bony invasion . if the tumor is greater than one centimeter and has direct bony invasion , then segmental mandibulectomy is done .


40q: a 80 year old patient presents with a midline tumor of the lower jaw , involving the alveolar margin . he is edentulous . what is the treatment of choice ?


  1. hemimandibulectomy
  2. commando operation
  3. segmental mandibulectomy
  4. marginal mandibulectomy


answer: c . segmental mandibulectomy . hemimandibulectomy cannot be done because it is a midline tumor .

46 - oral cavity surgery mcqs - part 3

21q: which of the following statements best represents ludwig’s angina ?


  1. a type of coronary artery spasm
  2. an infection of the cellular tissues around submandibular gland
  3. oesophageal spasm
  4. retropharyngeal infection


answer: b . an infection of the cellular tissues around submandibular gland .


22q: treatment of choice for carcinoma of lip less than one centimeter ?


  1. radiation
  2. chemotherapy
  3. excision
  4. radiation and chemotherapy


answer: c . excision .


23q: carcinoma of tongue less than 2 centimeters is treated by ?


  1. excision
  2. radiotherapy
  3. chemotherapy
  4. excision and radiotherapy
  5. excision and chemotherapy


answer: a . excision .


24q: a patient presented with a 1 X 1.5 cms growth on the lateral border of the tongue. The treatment indicated would be ?


  1. laser ablation
  2. interstitial brachytherapy
  3. external beam radiotherapy
  4. chemotherapy


answer: b . interstitial brachytherapy .  when u are asked about the management of carcinoma of tongue first observe the size of the tumor , if the size of the tumor is less than 1 cms surgical excision with wide margins is the treatment of choice .

                                                 if the size of the tumor is greater than 1 cm , then radiotherapy is the treatment of choice .

                                                 radiotherapy is of two types , that is interstitial brachytherapy and teletherapy . if the cancer of tongue involves anterior part of the tongue , then interstitial brachytherapy is the treatment of choice and if the cancer involves the posterior part of the tongue then teletherapy is the treatment of choice .


25q: tina , a 32 year old female from rural background presented with a history of chronic tobacco chewing since 14 year of age . now she has difficulty in opening her mouth. On oral examination no ulcers are seen . most probable diagnosis  ?


  1. submucous oral fibrosis
  2. carcinoma of buccal mucosa
  3. TM joint arthritis
  4. Trigeminal nerve paralysis


Answer: a . submucous oral fibrosis .


26q: metastasis of carcinoma buccal mucosa goes to ?


  1. regional lymph node
  2. liver
  3. heart
  4. brain


answer: a . regional lymph node .


27q: all of the following predisposes to oral cancer except ?


  1. erythroplakia
  2. leukoplakia
  3. submucosal fibrosis
  4. lichen planus


answer: d . lichen planus .


28q: all of the following predispose to squamous cell carcinoma except ?


  1. lichen planus of mouth
  2. bowen’s disease
  3. inverted papilloma of nose
  4. chronic irritation or oral mucosa of jagged teeth


answer: a . lichen planus of mouth .


the predisposing factors for squamous cell carcinoma of oral cavity :


  1. leukoplakia
  2. erythroplakia
  3. chronic hyperplastic candidiasis
  4. oral submucosal fibrosis
  5. syphilitic glossitis
  6. sideropenic dysphagia
  7. long standing dental ulcer (chronic irritation or oral  mucosa by jagged teeth)


29q: impacted wisdom teeth may produce referred pain via ?


  1. lingual nerve
  2. facial nerve
  3. branch of the auriculo temporal nerve
  4. none


answer: c . branch of the auriculo temporal nerve .


30q: not a carcinogenic for cancer of head and neck ?


  1. alcohol
  2. smoking
  3. tobacco
  4. unflourinated water


answer: d . unflourinated water .


45 - oral cavity surgery mcqs - part 2

11q: a 60 year old man presents with an ulcer on lateral margin of tongue also complaints of ear pain , most probable diagnosis ?


  1. dental ulcer
  2. carcinomatous ulcer
  3. tuberculous ulcer
  4. syphilitic ulcer


answer: b . carcinomatous ulcer. The clue in the question is the site of the ulcer and the age of the patient with pain reference . the most common site of carcinoma of tongue is the anterior 2/3 rd or middle 1/3 rd of the tongue .


12q: anatomical structure injured in excision of ranula ?


  1. lingual vein
  2. lingual artery
  3. submandibular duct
  4. parotid duct


answer: c . submandibular duct .


13q: areas of carcinoma of oral mucosa can be identified by staining with ?


  1. 1% zinc chloride
  2. 2% silver nitrate
  3. Gentian violet
  4. 2 % toluidene blue


Answer: d . 2 % toluidene blue .


14q: radiographic finding of floating teeth can be seen in ?


  1. ectodermal dysplasias
  2. cleidocranial dysplasias
  3. osteoporosis
  4. histiocytosis – X


answer: d . histiocytosis – X .


15q: dentigerous cyst arises from ?


  1. an unerupted tooth
  2. apex of an infected tooth
  3. nasopalatine cysts
  4. solitary bone cysts
  5. multi locular keratocytes


answer: a . an unerupted tooth .


16q: the commonest pre-malignant condition of oral cancer is ?


  1. leukoplakia
  2. apthous ulcer
  3. lichen planus
  4. erythro-leukoplakia


answer: a . leukoplakia .


17q: multiple painful ulcers on tongue are seen in all except ?


  1. apthous ulcers
  2. tuberculous ulcers
  3. herpes ulcers
  4. carcinomatous ulcers


answer: d . carcinomatous ulcers are normally painless in the early stages , but in advanced cases due to involvement of surrounding structures they become painful .


18q: predisposing factors for development of oral carcinoma is ?


  1. smoking
  2. alcohol
  3. syphilis
  4. all the above


answer: d . all the above .


19q: a full thickness loss of middle one third of the upper lip is best reconstructed by?


  1. nasolabial flap
  2. cheek flap
  3. abbey flap
  4. estlander flap


answer: c,d . abbey-estlander flap is most commonly used in the reconstruction of the upper lip .


20q: which of the following best represents ranula ?


  1. a type of epulis
  2. a thyroglossal cyst
  3. cystic swelling in the floor of mouth
  4. forked uvula


answer: c . cystic swelling in the floor of mouth .

44 - oral cavity surgery mcqs - part 1

1q: epulis arises from ?


  1. enamel
  2. root of teeth
  3. gingiva
  4. pulp


answer:  c. gingiva or gum .


2q: the commonest site of oral cancer among Indian population is ?


  1. tongue
  2. floor of the mouth
  3. alveobuccal complex
  4. lip


answer: c . alveobuccal complex . the most common type of oral cancer in India is buccal mucosa ( 38 % ) followed by anterior tongue secondly ( 16 %) and thirdly lower alveolus ( 15.7 % ) . so when the percentages of buccal mucosa and lower alveolus are combined it is alveobuccal complex ( 53.7 % ) that is the most common type of oral cancer in India .

                                                    worldwide the most common type of oral cancer is the carcinoma of the lip and secondly carcinoma of the tongue .


3q: a patient has small, oval  multiple ulcers in oral cavity with red erythematous margins . the diagnosis is ?


  1. carcinoma
  2. apthous ulcer
  3. tubercular ulcer
  4. syphilitic ulcer


answer: b . apthous ulcers .


4q: the premalignant condition with the highest probability of progression to malignancy ?


  1. dysplasia
  2. hyperplasia
  3. leukoplakia
  4. erythroplakia


answer: d . erythroplakia . the malignant potential of erythroplakia is 17 times higher than leukoplakia .


5q: in carcinoma cheek what is the best drug for single drug chemotherapy ?


  1. vincristine
  2. cyclophosphamide
  3. cisplatin
  4. daunorubicin


answer: c . cisplatin . CISPLATIN is the best drug for single drug chemotherapy in the treatment of carcinoma cheek .


6q: painless ulcer of the tongue is due to ?


  1. dyspepsia
  2. syphilis
  3. tuberculosis
  4. none


answer: b . syphilis .


7q: most common type of oral cancer ?


  1. lip
  2. cheek
  3. tongue
  4. palate


answer: a . lip . when it is not mentioned in the question about a specific country , assume that it is the most common occurrence in the world and so the answer here is the most common type of oral cancer in the world is lip .


8q: commonest cancer of the oral cavity ?


  1. adenocarcinoma
  2. melanoma
  3. sarcoma
  4. squamous cell carcinoma


answer: d . squamous cell carcinoma . most of the cancers of the head and neck are of the squamous cell type .


9q: what is ranula ?


  1. retention cyst of sublingual gland
  2. retention cyst of submandibular gland
  3. extravasation cyst of sublingual gland
  4. extravasation cyst of submandibular gland


answer: a . retention cyst of sublingual gland .


10q: the most frequent tooth to be impacted is ?


  1. lower third molar
  2. lower canine
  3. upper third molar
  4. upper premolar


answer: a . lower third molar . the second most common type of tooth to be impacted is upper third molar and thirdly the maxillary canine .

Thursday, February 5, 2009

43 - parathyroid and adrenal surgery mcqs - 4

25q: commonest cause of cushing's syndrome is ?

a. adrenal adenoma
b. carcinoma
c. hyperplasia
d. atrophy

answer: c . hyperplasia

26q: a known patient with renal stone disease developed pathological fractures along with abdominal pain and certain psychiatric symptoms. he should be suffering from ?

a. polycystic kidney
b. renal tubular acidosis
c. hyperparathyroidism
d. paget's disease of bone

answer: c . hyperparathyroidism .

27q: which of the following is not seen in neuroblastoma ?

a. diarrhoea
b. proptosis
c. splenomegaly
d. bone involvement

answer: c . splenomegaly .

28q: in pheochromocytoma the urine will contain ?

a. VMA
c. both
d. none

answer: a . VMA only .

29q: which of the following is a false statement about pheochromocytoma ?

a. 10 % are bilateral
b. arises from chromaffin cells
c. extra adrenal tumor - increase in nor adrenaline levels
d. increased VMA levels in urine

answer: i sense that all of them are correct . ( if u dont agree post in comments with explanation ).

30q: opsoclonus - myoclonus is a phenomenon seen in ?

a. wilm's tumor
b. neuroblastoma
c. meningioma
d. cortical tuberculoma

answer: b . neuroblastoma .

31q: hypocalcemia is a feature of all of the following except ?

a. chronic renal failure
b. hypoparathyroidism
c. pseudo hypoparathyroidism
d. total thyroidectomy

answer: all the 4 options given above can cause hypocalcemia .

32q: hypertension is seen in all except ?

a. adrenal tumors
b. pheochromocytoma
c. conn's syndrome
d. neuroblastoma

answer: actually all cause hypertension . ( if u think otherwise please post in comments ) .

42 - parathyroid and adrenal surgery mcqs - 3

17q: most common symptom of pheochromocytoma ?

a. palpitation
b. headache
c. sweating
d. dyspnoea

answer : b . headache . the most common symptom is hypertension followed by headache and sweating and palpitation .

18q: hypoparathyroidism occurs as a result of ?

a. idiopathic atrophy of parathyroids
b. following surgery
c. thyroiditis with secondary atrophy of parathyroids
d. all the above

answer: a and b are true . i have no idea about the option c .

19q: hypocalcemia in immediate post operative period following excision of parathyroid adenoma is due to ?

a. stress
b. increased uptake of bones
c. hypercalcuria
d. increased calcitonin

answer: b . increased uptake of bones . this is otherwise called hungry bone syndrome .

20q: in parathyroid crisis with sudden elevations of calcium over 16 mg/dl . the treatment consists of ?

a. intravenous vitamin D
b. parathyroidectomy for removal of adenoma
c. thyrocalcitonin
d. intravenous bicarbonate
e. all of the above

answer: b and c are true .

21q: hyperparathyroidism is characterised by the following except ?

a. generalised osteoporosis
b. renal calculi
c. hypercalcemia
d. osteosclerosis

answer: d .osteosclerosis .

22q: palpation on the costovertebral angle produces pain and tenderness in acute adrenal insufficiency . this is ?

a. rotch's sign
b. rossolimo's sign
c. rogoff's sign
d. osler's sign

answer: c . rogoff's sign .

23q: a patient has hypocalcemia which was the result of a surgical complication . which operation could it possibly have been ?

a. nephrectomy
b. thyroidectomy
c. gastrectomy
d. vocal cord tumor biopsy

answer: b . thyroidectomy .

24q: the symptoms of hyperparathyroidism include ?

a. constipation and muscle weakness
b. anorexia and weight loss
c. polydypsia and polyuria
d. all the above

answer: d . all the above .

41 - parathyroid and adrenal surgery mcqs - 2

9q: which of the following is a good prognostic factor for neuroblastomas ?

a. N-myc amplification
b. RAS oncogene
c. hyperdiploidy
d. translocations

answer: c . hyperdiploidy . if the age of the baby is less than or equal to one year at the time of presentation then it is a good prognostic factor , but if the age is greater than 1 year then it is a bad prognostic sign for neuroblastomas. stage 1,2A,2B,4S are all favourable prognosis. stage 3 , 4 are bad prognostic factors. evidence of schwannian stroma and gangliocytic differentiation is a good prognostic sign and absence of it is a bad prognostic sign. presence of intratumoral calcification is a good prognostic sign.

10q: a 35 year old woman has had recurrent episodes of headache and sweating . her mother had renal calculi and died of thyroid cancer. physical observation revealed a thyroid nodule and ipsilateral enlarged cervical lymphnodes. before performing thyroid surgery the woman's physician should order ?

a. thyroid scan
b. estimation of hydroxy indole acetic acid in urine
c. estimation of urinary metanephrines, VMA and catecholamines .
d. estimation of TSH and TRH levels in serum

answer: c . estimation of urinary metanephrines, VMA and catecholamines .

11q: a 20 year old male presents with chronic constipation ,headache and palpitations. on examination he had marfanoid habitus , neuromas of tongue, medullated corneal nerve fibers and nodule of 2 x 2 cm size in the left lobe of thyroid . this patient is a case of ?

a. sporadic medullary carcinoma of thyroid
b. familial medullary carcinoma of thyroid

answer: MEN II B also called as sipple syndrome . hirschsprung's disease and amyloidosis are features of MEN II A also called wermer syndrome .

12q: MEN II A includes all except ?

a. ganglioneuromas
b. cutaneous lichen amyloids
c. mutation in RET in chromosome 10
d. parathyroid adenoma
e. adrenal adenoma

answer: a . ganglioneuromas are a feature of MEN II B .

13q: true about MEN 1 ?

a. increased VMA in urine
b. increased calcitonin
c. hypergastrinemia
d. hyperprolactinemia
e. increased calcium

answer: c , d , e . hyperprolactinemia results due to parathyroid adenoma. hypergastrinemia results due to pancreatic carcinoma or islet cell hyperplasia . increased calcium results because of hyperparathyroidism which causes increase in parathormone levels that increase the serum calcium .

14q: young female presents with hypertension with VMA greater than 14 mg/day associated with ?

a. medullary carcinoma of thyroid
b. von hippel lindau disease
c. sturge weber syndrome
d. grave's disease
e. neurofibromatosis

answer: a, b , c, e . pheochromocytoma can be an associated feature of medullary carcinoma of thyroid or von hippel lindau disease or sturge weber syndrome or neurofibromatosis .

15q: most common cause of hyperparathyroidism ?

a. single adenoma
b. multiple adenomas
c. single gland hyperplasia
d. multiple gland hyperplasia

answer: a . single adenoma .

16q: most common cause of hypercalcemic crisis ?

a. parathyroid adenoma
b. parathyroid hyperplasia
c. carcinoma breast
d. paget's disease

answer: c . carcinoma breast . malignant tumors are the most common cause of hypercalcemic crisis of which breast carcinoma is the common cause .
pituitary adenoma is the most common cause of hypercalcemia .

40 - parathyroid and adrenal surgery mcqs - 1

1q: primary hyperparathyroidism is caused by ?

a. parathyroid hyperplasia
b. adenosis
c. MEN 1
d. thyrotoxicosis
e. CRF

answer: a , b and c .

2q: parathyroid adenoma most commonly involves which of the following sites ?

a. thyroid substance
b. superior parathyroid lobe
c. inferior parathyroid lobe
d. in the mediastinum

answer: c . inferior parathyroid lobe .

3q: features to differentiate parathyroid adenoma from hyperplasia would include which of the following ?

a. presence of excess chief cells
b. high levels of parathormone
c. infiltration of capsule
d. identifying hyperplasia of all 4 glands at surgery in parathyroid hyperplasia

answer: d .

4q: treatment for parathyroid hyperplasia is ?

a. removal of all four glands
b. calcium
c. removal of 3 and half glands
d. enlarged glands to be removed

answer: c . removal of 3 and half glands .

5q: in case of parathyroid adenoma treatment is ?

a. calcitonin and steroid
b. removal of adenoma
c. total parathyroidectomy and implantation in arm
d. total parathyroidectomy

answer: b . removal of adenoma .

6q: during bilateral adrenalectomy , intraoperative dose of hydrocortisone should be given after ?

a. opening the abdomen
b. ligation of left adrenal vein
c. ligation of right adrenal vein
d. excision of both adrenal glands

answer: d . after excision of both adrenal glands .

7q: rani , a 75 year old woman presents with post myocardial infarction after 6 weeks with mild CHF . there was past H/O neck surgery for parathyroid adenoma
5 years ago , EKG shows slow atrial fibrillation . serum calcium is 13 mg/L and urinary calcium is 300 mg/24 hr . on examination there is small mass in the paratracheal position behind the right clavicle . appropriate management at this time will be ?

a. repeat neck surgery
b. treatment with technetium - 99
c. observation and repeat serum calcium in 2 months
d. ultrasound guided alcohol injection into the mass

answer: d . ultrasound guided alcohol injection into the mass .

8q: Mrs.Neena noted an abdominal mass on the left side of her 6 month old child , which showed calcification near the left kidney. what will be the cause ?

a. leukemia
b. neuroblastoma
c. renal cell carcinoma
d. lymphoma

answer: b . neuroblastoma . this is the most common solid tumor of the infants and also the most common tumor of new borns .

39 - urinary tract mcqs - part 3

15q: urinary cytology is a useful screening test for the diagnosis of ?

a. renal cell carcinoma
b. wilm's tumor
c. urothelial carcinoma
d. carcinoma prostate

answer: c . urothelial carcinoma .

16q: urinary tract infection exists when the bacterial count in one milliliter of midstream specimen of urine is ?

a. 100
b. 1000
c. 10000
d. 100000 or over

answer: d . 100000 or one lakh or over .

17q: what is isotope renogram ?

a. study of renin mechanism
b. contrast study of kidneys , ureter and bladder
c. utilised in mapping the anatomy of the kidneys
d. graphic representation of the radioactivity of the kidneys

answer: d . graphic representation of the radioactivity of the kidneys .

18q: on exertion urine stream increases in ?

a. prostate enlargement
b. marion's disease
c. posterior urethral valve
d. urethral stricture

answer: d . urethral stricture .

19q: low and fixed specific gravity of urine is seen in ?

a. diabetes mellitus
b. diabetes insipidus
c. chronic renal failure
d. acute glomerulonephritis

answer: c . chronic renal failure .

20q: what is the cause of post micturition dribbling ?

a. detrusor overactivity
b. dribbling decreases in case of urethral stricture
c. collection of urine in U shaped curve of bulb of penis
d. neurogenic bladder

answer: c . collection of urine in U shaped curve of bulb of penis

21q: the most reliable urine specimen is obtained by ?

a. urethral catheterization
b. catheter aspiration
c. midstream voiding
d. suprapubic aspiration

answer: d . suprapubic aspiration .

22q: Jack stone calculi is seen in which anatomic part ?

a. prostate
b. kidney
c. ureter
d. bladder

answer: d . bladder .

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