Repeated Medical PG Question- 14

Q- A 60-year-old lady comes with blood stained discharge from the nipple with family history of breast cancer. Next best step for her will be?

          A. Ductoscopy

          B. Sonomammogram

          C. Nipple discharge cytology

          D. MRI

Answer is D. MRI.

 ▪️The next best step for her (high-risk female) will be MRI for the screening of breast cancer.

▪️Given the history, she is high- risk female - MRI for a screening of breast cancer.

▪️There is a current interest in the use of MRI to screen the breasts of high-risk women and of women with newly diagnosed breast cancer.

▪️In the first case, women who have a strong family history of breast cancer or who carry known genetic mutations require screening at an early age, but the mammographic evaluation is limited because of the increased breast density in younger women.

▪️In the second case, an MRI study of the contralateral breast in women with known breast cancer has shown a contralateral breast cancer in 5.7% of these women.

Indications for Breast MRI:

1. Lobular carcinoma: Difficult to detect and measure by conventional method because of multifocal and infiltrating growth pattern.

2. Staging of primary breast cancer.

3. Occult primary tumor with malignant axillary lymphadenopathy and normal mammogram and breast USG.

4. Screen younger women with high familial risk of breast cancer.

5. Assessing the integrity of breast implant.

Q- A 42 year old male patient presented with mild abdominal pain, mild constipation with a feeling of incomplete evacuation and mucus in stools for the past 4 years. On examination, tenderness is present in left iliac fossa. The most likely diagnosis is?

        A. Carcinoma colon

        B. Diverticular disease of the colon

        C. Irritable bowel syndrome

        D. Ulcerative colitis

Answer is B. Diverticular disease of the colon

Diverticulitis is the result of inflammation (perforation) of colonic diverticulum.

Clinical Features

• Mild cases: Distension, flatulence and a sensation of heaviness in the lower abdomen.

• Emergency: Persistent lower abdominal pain, usually in the left iliac fossa, with or without peritonitis, could be caused by diverticulitis.

• Fever, malaise and leukocytosis can differentiate diverticulitis from painful diverticulosis.

• The sigmoid colon is often palpable, tender and thickened.

• Any urinary symptoms may herald the formation of a vesicocolic fistula, which leads to pneumaturia (flatus in the urine) and even feces in the urine (fecaluria).

Q-  A driver wearing seat belt applied brake suddenly to avoid a collision. Which of the following body parts is most likely to be injured?

             A. Spleen

             B. Liver

             C. Mesentery

             D. Abdominal aorta

Answer is C. Mesentery

 

🔸Most common organ injured in seat belt injury is Mesentery.

🔸If a car accident occurs when a seatbelt is worn, sudden deceleration can result in a torn mesentery

🔸Blunt trauma to the abdomen by seatbelt injury may compress the pancreas over the vertebral column and result in pancreaticoduodenal injury.

🔸If there is any bruising of the abdominal wall, or even marks of clothing impressed into the skin, laparotomy may be indicated.