Thursday, February 5, 2009

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 .

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