FMGE 2018 - Surgery Practice Questions

Q: Marjolin's ulcer is:-

Squamous cell carcinoma from scar. ***Squamous cell carcinoma from scar*** - A Marjolin's ulcer is a rare but aggressive form of squamous cell carcinoma (SCC) that arises in areas of previously traumatized, chronically inflamed, or scarred skin. - Common sites include burn scars, chronic osteomyelitis tracts, pressure ulcers, and venous ulcers. - Typically has a long latency period (average 30-35 years after initial injury). - Characterized by higher rates of local recurrence and metastasis compared to conventional SCC. *Adenoma of scar* - An adenoma is a benign tumor of glandular origin and is not typically associated with scar tissue or malignant transformation in this context. - The malignancy arising in a scar is usually carcinoma, not adenoma. *Amoebic ulcer* - An amoebic ulcer is caused by the parasite *Entamoeba histolytica* and typically affects the colon, presenting as dysentery. - It is not a type of malignant transformation within a pre-existing scar. *Tubercular ulcer* - A tubercular ulcer is a manifestation of tuberculosis, often affecting the skin or mucous membranes and caused by *Mycobacterium tuberculosis*. - This is an infectious process and not a malignant transformation of scar tissue.

Q: Dye for Sentinel Lymph Node Biopsy is injected in which of the following sites?

Areola. ***Areola*** - The **areola** is the primary site for injecting dye in sentinel lymph node biopsy because it is rich in **lymphatic vessels** that directly drain into the regional lymph nodes. - This method ensures the dye follows the natural lymphatic drainage pathway, accurately identifying the **first lymph node** to receive drainage from the tumor. *Nipple* - While the nipple is part of the breast, it has a less dense network of **lymphatic vessels** compared to the areola. - Injection directly into the nipple may not consistently identify the sentinel lymph node as effectively as periareolar or intratumoral injections. *Axilla* - The **axilla** contains the regional lymph nodes that are the *target* for identification, not the site of dye injection. - Injecting dye directly into the axilla would bypass the lymphatic drainage from the tumor, making the biopsy ineffective. *Tail of spence* - The **tail of Spence** is an extension of breast tissue into the axilla, and while it contains breast tissue, it is not the most optimal or primary site for dye injection. - The lymphatic drainage from the tail of Spence would still rely on the broader lymphatic network, which is best accessed via the central breast regions like the areola.

Q: Which of the following is not done in carcinoma esophagus?

pH - metry/monitoring. ***pH - metry/monitoring*** - **pH metry/monitoring** is primarily used to diagnose **gastroesophageal reflux disease (GERD)**, which is not a direct diagnostic tool for esophageal carcinoma itself. - While GERD is a risk factor for **Barrett's esophagus** and subsequently adenocarcinoma of the esophagus, pH monitoring does not directly identify or stage the cancer. *CT chest* - **CT (Computed Tomography) chest** is routinely performed in esophageal carcinoma to assess the **local extent** of the tumor and identify potential **lymph node involvement** or **metastasis** to other organs. - It is crucial for **staging** the disease and guiding treatment decisions such as resectability. *PET scan* - A **PET (Positron Emission Tomography) scan** is highly useful for detecting **distant metastases** and identifying **occult disease** not visible on CT, especially in cases of suspected advanced esophageal carcinoma. - It helps in **accurate staging** and avoiding futile surgery in patients with metastatic disease. *Biopsy* - **Biopsy**, typically performed during endoscopy, is the **gold standard** for confirming the diagnosis of esophageal carcinoma by obtaining tissue for **histopathological examination**. - It identifies the cell type (e.g., adenocarcinoma, squamous cell carcinoma) and grade of the tumor, which is essential for treatment planning.

Q: A 35-year-old lady who presented with a 6-month painless fluctuant, non-transilluminant swelling with a thin watery discharge. Clinical diagnosis is?

TB. ***TB*** - **Tuberculosis (TB)** lymphadenopathy often presents as a **painless, fluctuant, non-transilluminant cervical swelling** (scrofula) with possible **thin, watery discharge** from a sinus tract [1]. - The 6-month duration indicates a **chronic process**, consistent with the indolent nature of TB infection [1]. *Brachial cyst* - A **branchial cleft cyst** typically presents as a **smooth, movable, and sometimes fluctuant neck mass**, but it is usually **transilluminant** unless infected. - While it can discharge, the fluid is often mucoid, and the discharge is less commonly described as thin and watery; also it typically develops during childhood or early adulthood. *Secondaries* - **Metastatic lymph nodes (secondaries)** are generally **firm, non-fluctuant, and non-tender**, and do not typically discharge thin watery fluid unless there is necrosis or ulceration of the overlying skin. - The absence of associated primary malignancy symptoms also makes this less likely. *Lymphoma* - **Lymphoma** presents as often **painless rubbery, firm, and non-fluctuant lymph node enlargement**, and discharge is not a typical feature unless there is skin involvement or ulceration in advanced stages. - The described fluctuance and watery discharge are not characteristic of simple lymphoma.

Question 1

Marjolin's ulcer is:-

Accepted Answer

Squamous cell carcinoma from scar

Answer

Adenoma of scar

Answer

Amoebic ulcer

Answer

Tubercular ulcer

Question 2

Dye for Sentinel Lymph Node Biopsy is injected in which of the following sites?

Accepted Answer

Areola

Answer

Nipple

Answer

Axilla

Answer

Tail of spence

Question 3

Which of the following is not done in carcinoma esophagus?

Accepted Answer

pH - metry/monitoring

Answer

CT chest

Answer

PET scan

Answer

Biopsy

Question 4

A 35-year-old lady who presented with a 6-month painless fluctuant, non-transilluminant swelling with a thin watery discharge. Clinical diagnosis is?

Accepted Answer

TB

Answer

Brachial cyst

Answer

Secondaries

Answer

Lymphoma

FMGE 2018 — Surgery