Surgical Oncology Principles Practice Questions

Q: What is the most likely diagnosis based on the image provided? The patient had a snake bite at this site 5 years ago.

Marjolin's ulcer. ***Marjolin's ulcer*** - This is a **squamous cell carcinoma** developing in a chronic wound, burn scar, or chronic inflammatory lesion, often after a long latent period (like the 5 years post-snake bite). The image shows a **fungating, ulcerative lesion** consistent with a malignant transformation in a chronic wound. - The history of a **snake bite 5 years ago** indicates a pre-existing chronic wound site, making Marjolin's ulcer the most probable diagnosis for a subsequent malignant change. *Bazin's ulcer* - Bazin's ulcer, also known as **erythema induratum**, is a chronic, recurrent panniculitis typically affecting the calves of young to middle-aged women. - It is associated with **tuberculosis**, presenting as tender, subcutaneous nodules that can ulcerate, which doesn't match the image or history. *Martorell's ulcer* - This is a form of **ischemic ulcer** caused by severe, uncontrolled hypertension, leading to microangiopathy and skin necrosis, usually on the anterior and lateral aspects of the lower leg. - While it presents as a painful ulcer, it is not typically associated with chronic trauma or previous wounds like a snake bite and lacks the fungating appearance shown. *Meleney's ulcer* - Meleney's ulcer, or **progressive bacterial synergistic gangrene**, is a rare, severe skin infection characterized by painful, undermined ulcers with a necrotic center. - It usually develops post-surgery or trauma and involves a synergistic bacterial infection, which is not suggested by the chronic nature (5 years) or the appearance of the lesion in the image.

Q: What technique has been depicted in the image shown below?

Sentinel lymph node biopsy. ***Sentinel lymph node biopsy*** - The image shows a **skin incision in the axilla**, which is the typical site for accessing **axillary lymph nodes for biopsy**. - A surgical instrument is poised to enter the incision, consistent with the procedure for **identifying and removing the sentinel lymph node**. *Brachytherapy* - This involves placing **radioactive sources** inside or next to the area requiring treatment, usually for cancer. - The image does not depict any radioactive sources or the specialized equipment used for brachytherapy. *USG* - **Ultrasonography (USG)** uses sound waves to create images of internal body structures. - The image shows a surgical incision and instrument, not an ultrasound transducer or screen. *Lateral pectoral nerve block* - A **nerve block** involves injecting an anesthetic close to a nerve to relieve pain or numb an area. - While it involves an injection, the image shows an incision in the axillary region, which is typically for surgical access, not solely for nerve block administration.

Q: After undergoing surgery, for carcinoma of colon, a patient developed single liver metastasis of 2 cm. What would be the next treatment?

Resection. ***Resection*** - For a **single, resectable liver metastasis** from colorectal carcinoma, surgical **resection offers the best chance of cure** and is the gold standard of treatment. - The size of the metastasis (2 cm) is well within the criteria for surgical removal, and the absence of multiple lesions or widespread disease makes it a prime candidate for curative surgery. *Radio frequency ablation* - **RFA** is typically considered for patients with **unresectable liver metastases** or those who are not surgical candidates. - While it can be effective for small lesions, it is generally preferred when resection is not possible due to factors like lesion location (e.g. adjacent to major vessels), patient comorbidities, or multiple lesions. *Chemo-radiation* - **Chemoradiation** is more commonly used in the treatment of the **primary colorectal cancer** itself, especially in locally advanced rectal cancer, or for palliative purposes in metastatic disease. - It is **not the primary curative treatment** for an isolated, resectable liver metastasis. *Acetic acid injection* - **Acetic acid injection** is a form of **chemical ablation** and is sometimes used for small liver tumors, particularly hepatocellular carcinoma. - It is generally considered **less effective and less predictable** than RFA or surgical resection for colorectal liver metastases and is not the preferred treatment for a resectable lesion.

Q: A 35-year-old HIV-positive woman (CD4 count 180/μL, on HAART) develops extensive perianal condyloma acuminata resistant to conventional treatments. HPV typing shows type 16. What is the most appropriate management approach?

Wide surgical excision with histopathological examination. ***Wide surgical excision with histopathological examination*** - This is the most appropriate management due to the **extensive, treatment-resistant perianal condyloma acuminata** in an **HIV-positive patient with HPV type 16**, which carries a higher risk of **malignant transformation**. - **Surgical excision** allows for complete removal of the lesions and provides tissue for **histopathological examination** to rule out **dysplasia or squamous cell carcinoma**. *HPV vaccination* - While important for prevention, **HPV vaccination** is generally less effective as a primary treatment for **established, extensive lesions**, especially with existing infection. - It primarily aims to prevent new infections and may have some benefit in preventing recurrence, but it won't resolve the current burden of disease. *Interferon therapy* - **Interferon therapy** can be used for severe, recurrent, or difficult-to-treat warts, but its efficacy is variable and generally considered a **second-line or adjunctive treatment**. - Given the patient's **immunosuppressed status** and **resistance to conventional treatments**, a more definitive approach is needed. *Continue conservative management with topical imiquimod* - The patient has already demonstrated **resistance to conventional treatments**, suggesting that continued topical therapy with **imiquimod** is unlikely to be effective. - In an HIV-positive individual with **extensive lesions and high-risk HPV type 16**, waiting for a response to conservative therapy could delay definitive management and potentially increase the **risk of malignant progression**.

Q: Which of the following cancers are correctly matched with the criteria for the minimum number of lymph nodes required for pathological staging? A. CA stomach -10 B. CA colon -12 C. CA gall bladder -6 D. CA breast -15

B,C. ***B,C (Correct Answer)*** - **Colorectal cancer (B)** requires a minimum of **12 lymph nodes** for adequate pathological staging - **correctly matched** ✅ - **Gallbladder cancer (C)** requires at least **6 lymph nodes** for proper staging - **correctly matched** ✅ - These are the only two correctly matched pairs in the question - Adequate lymph node retrieval is essential to prevent **understaging** and ensure accurate prognostic assessment *A,B,C (Incorrect)* - While B and C are correct, **gastric cancer (A)** requires a minimum of **15 lymph nodes**, not 10 - The inclusion of A makes this combination incorrect *A,B,C,D (Incorrect)* - **Gastric cancer (A)** requires **15 lymph nodes**, not 10 - **incorrectly matched** - **Breast cancer (D)** requires a minimum of **10 lymph nodes**, not 15 - **incorrectly matched** - Only B and C are correctly matched *A,C,D (Incorrect)* - **Gastric cancer (A)** requires **15 lymph nodes**, not 10 - **incorrectly matched** - **Breast cancer (D)** requires **10 lymph nodes**, not 15 - **incorrectly matched** - C is correct, but A and D are both incorrectly matched

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: What is the most common anterior mediastinal tumor?

Thymoma. ***Thymoma*** - **Thymomas** are the most common primary tumor of the **anterior mediastinum** in adults. - They originate from the epithelial cells of the **thymus gland**, which is located in the anterior mediastinum. *Bronchogenic cyst* - **Bronchogenic cysts** are typically found in the **middle mediastinum**, although they can occasionally occur in the anterior or posterior mediastinum. - They are congenital anomalies resulting from abnormal budding of the **tracheobronchial tree**. *Neurofibroma* - **Neurofibromas** are nerve sheath tumors that typically occur in the **posterior mediastinum**, arising from spinal nerves. - They are often associated with **neurofibromatosis type 1**. *Pericardial cyst* - **Pericardial cysts** are benign, fluid-filled sacs most commonly found in the **middle mediastinum**, specifically in the cardiophrenic angle. - They are usually asymptomatic and are often discovered incidentally.

Q: NOT an indication for surgery in a Ventricular septal defect

Eisenmenger's Syndrome. ***Eisenmenger's Syndrome*** - This condition represents **irreversible pulmonary hypertension** due to long-standing, high-volume, high-pressure shunting, leading to a reversal of the shunt (right-to-left). - In **Eisenmenger's syndrome**, the benefits of VSD closure are outweighed by the risks, as closing the defect can acutely increase **pulmonary vascular resistance (PVR)** and right ventricular overload, leading to fatal outcomes. *Suck- Rest-Suck cycle while feeding* - This symptom indicates significant **heart failure** and **poor feeding** in an infant, often due to a large VSD causing increased pulmonary blood flow and work of breathing. - It is a clear sign of clinical compromise and is generally an **indication for surgical intervention** to improve feeding and reduce symptoms. *Pulmonary: Systemic blood flow > 2:1* - A pulmonary to systemic blood flow ratio (Qp:Qs) greater than 2:1 signifies a **large left-to-right shunt** through the VSD, leading to significant volume overload in the pulmonary circulation. - This degree of shunting is a strong **indication for surgery** to prevent the development of pulmonary hypertension and right ventricular dysfunction. *Hepatomegaly* - **Hepatomegaly** (enlarged liver) in the context of a VSD often suggests **right-sided heart failure**, a common complication of large left-to-right shunts and increased pulmonary vascular resistance. - It is a clinical sign of significant cardiac dysfunction and typically indicates the need for **surgical repair** to alleviate the underlying cardiac load.

Question 1

What is the most likely diagnosis based on the image provided? The patient had a snake bite at this site 5 years ago.

Accepted Answer

Marjolin's ulcer

Answer

Bazin's ulcer

Answer

Martorell's ulcer

Answer

Meleney's ulcer

Question 2

What technique has been depicted in the image shown below?

Accepted Answer

Sentinel lymph node biopsy

Answer

Brachytherapy

Answer

USG

Answer

Lateral pectoral nerve block

Question 3

After undergoing surgery, for carcinoma of colon, a patient developed single liver metastasis of 2 cm. What would be the next treatment?

Accepted Answer

Resection

Answer

Radio frequency ablation

Answer

Chemo-radiation

Answer

Acetic acid injection

Question 4

A 35-year-old HIV-positive woman (CD4 count 180/μL, on HAART) develops extensive perianal condyloma acuminata resistant to conventional treatments. HPV typing shows type 16. What is the most appropriate management approach?

Accepted Answer

Wide surgical excision with histopathological examination

Answer

HPV vaccination

Answer

Interferon therapy

Answer

Continue conservative management with topical imiquimod

Question 5

A 50-year-old alcoholic patient presents with a history of waxing and waning jaundice for the past 2 months. His CT examination reveals dilatation of the common bile duct and pancreatic duct. What is the most probable diagnosis in the patient?

Accepted Answer

Periampullary carcinoma

Answer

Common bile duct stone

Answer

Head of the pancreas carcinoma

Answer

Cholangiocarcinoma

Question 6

Which of the following cancers are correctly matched with the criteria for the minimum number of lymph nodes required for pathological staging?
A. CA stomach -10
B. CA colon -12
C. CA gall bladder -6
D. CA breast -15

Accepted Answer

B,C

Answer

A,B,C

Answer

A,B,C,D

Answer

A,C,D

Question 7

Marjolin's ulcer is:-

Accepted Answer

Squamous cell carcinoma from scar

Answer

Adenoma of scar

Answer

Amoebic ulcer

Answer

Tubercular ulcer

Question 8

What is the most common anterior mediastinal tumor?

Accepted Answer

Thymoma

Answer

Bronchogenic cyst

Answer

Neurofibroma

Answer

Pericardial cyst

Question 9

NOT an indication for surgery in a Ventricular septal defect

Accepted Answer

Eisenmenger's Syndrome

Answer

Suck- Rest-Suck cycle while feeding

Answer

Pulmonary: Systemic blood flow > 2:1

Answer

Hepatomegaly

Question 10

Intraoperative radiation therapy (IORT) is most commonly used in which of the following cancers?

Accepted Answer

Ca Pancreas

Answer

Ca Thyroid

Answer

Ca Cervix

Answer

Ca Breast

Surgical Oncology Principles — MCQs

Surgical Oncology Principles — MCQs

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