AIPGMEE 2016 MCQ Surgery

A 62-year-old man undergoes total thyroidectomy for a left
thyroid nodule. On preoperative ultrasound, malignant calcifications
were noted. FNA was consistent with a follicular neoplasm.
Final pathologic evaluation reveals follicular carcinoma
with an insular component. With regard to his overall prognosis,
which of the following statements is not true?
A. Insular thyroid cancer carries a worse prognosis than do
other subtypes of WDTC.
B. Patients with insular thyroid cancer should routinely
undergo prophylactic central neck dissection.
C. The insular component subtypes of follicular carcinoma
demonstrate poor uptake of radioactive iodine.
D. Disease-free survival is shorter in patients with insular
thyroid cancer than in those with stage-matched follicular
and papillary thyroid cancer.
E. The death rate is higher in patients with insular thyroid
cancer.
A N S W E R : B
Follicular or papillary thyroid cancers with an
insular component have a far worse prognosis than do those with
other subtypes of WDTC. Most notably, these patients have a
higher rate of extrathyroidal extension and distant metastases.
Disease-free survival is shorter, and there is a higher rate of tumorrelated
deaths. Additionally, these tumors tend to exhibit poor
radioactive iodine uptake when compared with other WDTC types.
Because of its aggressive biology, some clinicians consider the
insular component subtype a separate entity from classic papillary
or follicular carcinomas that do not have this feature. Despite their
more aggressive nature, no studies to date have shown that patients
with insular thyroid cancer should undergo prophylactic central
neck dissection.

AIPGMEE 2016 MCQ Urology

The ureteric bud, arising from a bend in the mesonephric duct, pushes into the metanephric blastema, inducing the development of the permanent kidney in the:
(a) 5th gestational week
(b) 8th gestational week
(c) 10th gestational week
(d) 12th gestational week


Answer: (a) Early development of the permanent kidney occurs during the 5th gestational week when the ureteric bud meets up with the metanephric mass. By the 6th week the kidney has ascended above
the umbilical arteries and by the 8th week the center of the kidney has reached its permanent
level just below the adrenal gland (making (b) incorrect). The fetal kidney will start to secrete
urine by the 10th gestational week (making (c) incorrect). From the 6th to 20th gestational
weeks, the major calices subdivide into the 12 generations of caliceal formation (making (d) incorrect).

AIGMEE 2016 mcq Radiology

Which one of the following structures is present in the wall of the secondary lobule?
A. Pulmonary artery
B. Terminal bronchiole
C. Bronchial artery
D. Pulmonary vein
Rationale:
A: Incorrect.
B: Incorrect.
C: Bronchial artery originates from the aorta or intercostal arteries. They travel from the pulmonary hila to the level of the terminal bronchioles within the peribronchovascular interstitium.
D: The secondary pulmonary lobule is a hexagonal shaped structure measuring about 1-2.5 cm. The wall (interlobular septa) of the lobule contains connective tissue, pulmonary vein and lymphatics. The central portion of the lobule contains pulmonary artery and terminal bronchiole.

AIPGMEE 2016 MCQ Surgery

Which of the following statements regarding Hürthle cell carcinoma
is false?
A. It represents a subtype of follicular thyroid cancer.
B. Hürthle cell carcinoma accounts for 3% of all thyroid
malignancies.
C. It is more likely than follicular cancer to be multifocal.
D. It demonstrates poor radioactive iodine uptake.
E. Lymph node dissection is indicated for all patients.


COMMENTS: Hürthle cell carcinoma is considered a subtype
of follicular carcinoma and, similarly, is characterized by vascular
or capsular invasion. Of all thyroid malignancies, Hürthle cell
cancers account for about 3%. Different from follicular carcinoma,
Hürthle cell cancers are more often multifocal and bilateral, have
a higher rate of local nodal metastases, and demonstrate poor
radioactive iodine uptake. In part because of these features, Hürthle
cell carcinomas have also been associated with higher mortality
than follicular cancers. Previous radiation exposure has been correlated
with an increase in bilateralism and multicentricity of
Hürthle cell neoplasms, as well as an increased incidence of contralateral
non–Hürthle cell malignant thyroid lesions. The 10-year
survival rate of patients with Hürthle cell carcinoma is 70%.
Approximately 10% to 20% of patients have lymph node metastasis
when initially seen.
A N S W E R : E

AIPGMEE 2016 MCQ Microbiology

Quelling phenomenon is seen in:
a) Pneumococcus
b) Streptococcous
c) Staphylococcus
d) Hemophilus
Ans A
Streptococcus pneumoniae Quellung (capsular swelling) reaction can be used to demonstrate the presence of a specific capsular type of the bacterium.

AIPGMEE 2016 MCQ Surgery

Which of the following is true in the pathogenesis of chronic pancreatitis?

A. There is accumulation of damaging lipid granules in pancreatic stellate cells.

B. Chronic alcohol use decreases protein content of pancreatic secretions.

C. There is disorientation of acinar cell secretory function.

D. There is migration of ductal cells into the acini.

Ans-C

Among the hypothesized pathophysiologic mechanisms in chronic pancreatitis, the secretion of pancreatic enzyme precursors is altered such that the enzymes are secreted at the basolateral membrane
of the acinar cells rather than at the apical location. This secretion in turn causes local damage and
acinar cell necrosis. Pancreatic secretions in chronic pancreatitis are protein rich and lack adequate
bicarbonate, causing increased viscosity and obstruction of the ducts. Stellate cells become activated,
lose their lipid granules, and propagate a fibrotic response. Pancreatic ductal cells may also
be damaged and exhibit degrees of metaplasia and fibrosis.