Surgery MCQs with answers Part 4:

1.Breast cancer poor prognosis factors are all except
1.Estrogen receptor positive
2. Her 2 status
3. Stage / grade
4. Lymph node status
5. Size
Please contribute to the discussion by posting the answer with references and pointing out any errors in the question!

2.The tumor, which may occur in the residual breast or overlying skin following wide local excision and radiotherapy for mammary carcinoma, is:
A. Leiomyosarcoma
B. Squamous cell carcinoma
C. Basal cell carcinoma
D. Angiosarcoma
Correct answer : D. Angiosarcoma
Angiosarcoma can occur as a late complication following breast conservation surgery.

3.In which of the following types of breast carcinoma, would you consider biopsy of opposite breast?
A. Adenocarcinoma-poorly differentiated
B. Medullary carcinoma
C. Lobular carcinoma
D. Comedo carcinoma
Correct answer : C. Lobular carcinoma
Lobular carcinoma has higher incidence of bilaterality compared to other carcinomas

4.The most important prognostic factor in breast carcinoma is:
A. Histological grade of the tumor
B. Stage of the tumor at the time of diagnosis
C. Status of estrogen and progesterone receptors
D. Over expression of p53 tumour suppressor gene
Correct answer : B. Stage of the tumor at the time of diagnosis

5.Which of the following statements is true of primary grade IV-V vesicoureteric reflux in young children?
a) Renal scarring usually begins in the midpolar regions
b) Postnatal scarring may occur even in the absence of urinary tract infections
c) Long term outcome is comparable in patients treated with either antibiotic prophylaxis or surgery
d) Oral amoxicillin is the antibiotic of choice for prophylaxis
Correct answer : b) Postnatal scarring may occur even in the absence of urinary tract infections

Renal scarring usually begins in the polar regions
Long term outcome is better with surgery
Co-trimoxazole is the drug …

6.The defective migration of neural crest cells results in;
a) Congenital megacolon
b) Albinism
c) Adrenogenital hypoplasia
d) Dentinogenesis imperfecta
Correct answer : a) Congenital megacolon and b) Albinism
Conditions caused by defective migration of neural crest cells:

Congenital megacolon
Albinism
Neurocristopathies
Melanoma
Oropharyngeal teratoma

7.A 45-year-old gentleman has undergone truncal vagotomy and pyloroplasty for bleeding duodenal ulcer seven years ago. Now he has intractable recurrent symptoms of peptic ulcer. All of the following suggest the diagnosis of Zollinger Ellison syndrome, except:
a) Basal acid output of 15 meq/hour
b) Serum gastrin value of 500 pg/ml
c) Ulcers in proximal jejunum and lower end of esophagus
d) Serum gastrin value of 200 pg/ml with secretin stimulation
Correct answer : d) Serum gastrin value of 200 pg/ml with secretin stimulation
Diagnosis of ZES requires a rise of 200 pg/ml or more in …

8.Which one of the following statements is incorrect in regard to stones in the gallbladder?
a) Pigment stones are due to increased excretion of conjugated bilirubin
b) Are considered a risk factor for the development of gallbladder carcinoma
c) 10% of gallstones are radio-opaque
d) A mucocele of the gallbladder is caused by a stone impacted in Hartman’s pouch
Correct answer : d) A mucocele of the gallbladder is caused by a stone impacted in Hartman’s pouch
Mucocele of gallbladder is caused by stone impaction in the neck of gall bladder or in the cystic duct.

9.One of the following is not correct in papillary carcinoma of thyroid:
a) Can be reliably diagnosed using fine needle aspiration cytology
b) Always unifocal
c) Typically spreads to the cervical lymph nodes
d) Requires a a total thyroidectomy for large tumours
Correct answer :
b) Always unifocal
Papillary carcinoma is usually mulitifocal. Lymphatic spread occurs to cervical lymph nodes. (Hematogenous spread occurs in case of follicular carcinoma.)

10.In which of the following conditions acquired (secondary) megacolon is seen?
a) Fissure in-ano
b) Complete absence of parasympathetic ganglion cells
c) Absence of sympathetic ganglion cells
d) Rectal malignancy
Correct answer :
d) Rectal malignancy
Absence of ganglion cells result in congenital megacolon. Fissure in ano causes anal sphincter spasm, but does not result in megacolon. Rectal malignancies cause luminal obstruction leading to development of megacolon.