Surgical Diagnostics Flashcards
A 62 year old male underwent a lymph node biopsy of the neck. If this is due to lymphoma, result of immunostaining of the specimen would likely be: A) (+) LCA, (+) cytokeratin B) (-) LCA, (-) cytokeratin C) (+) LCA, (-) cytokeratin D) (-) LCA, (+) cytokeratin
C) (+) LCA, (-) cytokeratin
LCA or CD45 - positive in lymphoma
Cytokeratin - positive in epithelial tumors, negative in non-epithelial tumors
A 44 year old woman has a left level III cervical lymph node. Excision biopsy revealed metastatic squamous cell carcinoma. Head, chest and abdominal CT scans are all negative. Upper airway and upper GI endoscopic examinations are both negative. Next step should be:
A) Colonoscopy
B) Bronchoscopy
C) Random blind punch biopsies of the nasopharynx
D) Immunostaining of the specimen
C) Random blind punch biopsies of the nasopharynx
SCC –> chemoRT
A 56 year old male has multiple enlarged tumors in the retroperitoneal and posterior mediastinal region as documented by CT scan studies. He has fever and body weakness. The biggest retroperitoneal tumor is 6 cm and is not abutting any major vascular structure or organ. It looks resectable. Next step:
A) Determine alkaline phosphatase level
B) Request for blood alpha-fetoprotein and HCG C) Perform a percutaneous CT scan guided needle biopsy of the most accessible tumor
D) Do debulking surgery to minimize tumor load
C) Perform a percutaneous CT scan guided needle biopsy of the most accessible tumor
If lymphoma, do chemoRT
A patient presents with hypercalcemia. What is most useful modality to detect the lesion? A) CT scan of the whole abdomen B) Renal ultrasonography C) Sestamibi scan D) PET CT scan
C) Sestamibi scan
A 55 year old female presented with a palpable mass 5 cm from the anal verge. Next step:
A) Barium enema
B) Colonoscopy and possible endorectal ultrasonography
C) Virtual colonoscopy
D) Proctosigmoidoscopy
B) Colonoscopy and possible endorectal ultrasonography
56 year old female patient presented with microcalcifications in the right breast with a BIRADS 5 reading. It was seen in mammography and not in ultrasound. Next step:
A) Mammotome assisted excision
B) Stereotactic biopsy under general anesthesia
C) Mammographic needle localization biopsy
D) Mammographic guided core needle biopsy
C) Mammographic needle localization biopsy
If the result of the biopsy of a 0.5 cm breast mass is cancer, what will you request to be done to the specimen:
A) ER and Progesterone status; Her2neu
B) ER and Progesterone status
C) Her2neu
D) S phase and DNA ploidy
B) ER and progesterone status
Her2neu cannot be detected in tumors less than 1 cm.
A patient has a suspicious melanoma-looking 2 cm lesion in the right forearm. The next procedure should be:
A) Wide excision with a 3 cm margin of skin with reconstruction
B) Wide excision with a 3 cm margin and resection of the underlying muscles with reconstruction
C) Sentinel lymph node biopsy
D) Full thickness incisional biopsy
D) Full thickness incisional biopsy
True statement on total mesorectal excision:
A) The circumferential resection margin is an important predictor of local and distant recurrence as well as the survival of patients.
B) Lympazurin dye is applied to the specimen before fixing it with formalin.
C) The minimum number of lymph nodes to be harvested for rectal cancer according to AJCC and American College of Pathologists is 8. 12 X
D) It is the treatment of choice for a 1 cm anal cancer.
A) The circumferential resection margin is an important predictor of local and distant recurrence as well as the survival of patients.
A 55 year old male was diagnosed with a 1.5 cm papillary thyroid cancer by fine needle biopsy. Work-ups should include:
A) Liver ultrasonography
B) Bone scan
C) Serum calcium
D) Chest x ray
D) Chest x ray
Most common metastasis is lung metastasis
The best diagnostic modality to detect distant metastasis from a cutaneous melanoma of the thigh is:
A) Ultrasonography of whole abdomen and pelvic region
B) Bone scan
C) PET-CT Scan
D) Sentinel node biopsy using technetium and lymphazurin
C) PET-CT Scan
By ultrasonography, a 44 year old man has a 7 cm pancreatic tail tumor involving the spleen. There are multiple enlarged lymph nodes near the spleen. CA 19-9 is very high. What will you do next?
A. En-bloc resection of the tail of the pancreas and spleen with lymph node dissection
B. CT scan of the chest
C. Endoscopic ultrasound
D. En-bloc resection of the tail of the pancreas and spleen with lymph node dissection, chemotherapy and radiation treatment
B. CT scan of the chest
A 55-year male was noted to have a 7 cm squamous cell carcinoma of the left parotid gland by frozen section. What will be your next step after total parotidectomy?
A. Offer 5-FU-based chemotherapy for the patient
B. Chest CT-scan
C. Supraomohyoid lymph node dissection/sampling
D. bone scan
C. Supraomohyoid lymph node dissection/sampling
A 55 year old male patient underwent total thyroidectomy 20 years ago for a 3 cm follicular carcinoma of the left lobe. He now presents with a 3 cm nodule in the left parietal bone underlying the scalp. What is the best next procedure of choice? A. Incision biopsy of the mass B. Excision biopsy of the mass C. MRI of the head D. Observation
C. MRI of the head
A 65-year old woman by CT scan has multiple midline retroperitoneal masses. The size range from 2-9 centimeters in widest dimension. There is associated enlarged para-aortic lymph nodes. Best procedure of choice is:
A. Angiography
B. Bone scan
C. Request for CEA
D. Percutaneous core needle aspiration biopsy
D. Percutaneous core needle aspiration biopsy
