The Tamilnadu Dr MGR Medical University
Third (Final) M.B.B.S. Degree Examination
(August 2006) question paper withsolutionsDr T Balasubramanian
Tamilnadu Dr. MGR MedicalUniversity
Third (Final) M.B.B.S. Degree Examination
(August 2006)
Time: Three hours
Answer all questions
I. Write Essay:
1. Describe the clinical features, diagnosis and management of cancer oesophagus. (15 marks)Patients with cancer oesophagus manifest with:a.Difficulty in swallowingb. Painful swallowing.Usually dysphagia is the most common symptom. Initially dysphagia is pronounced for solidfood. Fluids and semisolid diet are better tolerated.c. These patients manifest with excessive loss of weight which could be due to:Difficulty in swallowingReduced appetite due to malignancy.d. Heart burns – These patients characteristically complain of burning pain in the midline of thechest. This type of pain progressively gets worse and is made still worse by the act of swallowing.e. Voice change – This is usually due to involvement of recurrent laryngeal nerves causing paralysisof vocal folds. Right recurrent laryngeal nerve is commonly involved in these patients. Duringearly stages these patients may have varying degrees of aspiration. Sometimes aspiration may besevere enough to cause aspiration pneumonitis.f. Disruption of peristalsis – The sheer bulk of tumor present intraluminally within the oesophagusmay cause disruption of normal peristalsis. This could cause nausea, vomiting and foodregurgitation.g. Haematemesis – If the tumor is friable it can cause intraluminal bleeding leading on tohematemesis.h. Compression symptoms – Increasing bulk of oesophageal mass can cause compression of localstructures. It can cause compression to trachea leading on to upper airway obstruction. Another area of compression is at the level of superior vena cava causing superior vena caval syndrome.Erosion of trachea may lead to troublesome tracheo oesophageal fistula.Drtbalu's otolaryngology online
Symptoms caused by superior vena cava syndrome include:1. Dyspnoea2. Swelling of the face / upper extremities3. Headache4. Orthopnoea5. Nasal stuffiness6. Light headednessSymptoms caused by metastatic lesions:Hepatic metastasis can lead to jaundice, ascitis.Lung metastasis could cause shortness of breath, pleural effusion.Diagnosis:Radiology:Barium swallow / meal can reveal occlusal mass in the oesophagus.CT scan imaging will reveal the extent of the lesion, compression to adjacent structures if any.Metastatic lesions can also be identified by performing CT scan.PET scans can be used to identify and ascertain whether the lesion is active and metabolicallyactive.Upper GI endoscopy:This is the standard in the diagnosis of oesophageal cancer. It helps in identifying the exactlocation of the lesion, biopsying the lesion. The location of the tumor is generally measured fromthe incisor.Histopathology:This offers the final diagnosis. Adenocarcinoma is common in the lower oesophagus whilesquamous cell carcinoma is prevalent in the upper third of oesophagus.Management:The ideal management modality is determined by:Drtbalu's otolaryngology online
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Tamilnadu Dr MGR University MBBS Prefinal ENT August 2006 question paper with solution
The Tamilnadu Dr MGR Medical University MBBS Prefinal ENT August 2006 question paper with solution
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