INI-CET 2025 - Surgery Practice Questions

Q: A 25-year-old male presents with pain starting from the umbilicus moving to the right iliac fossa, associated with fever, nausea, and tenderness in the right iliac fossa. His WBC count is 14,000/cmm. What is the Alvarado score?

7. The **Alvarado Score** (MANTRELS) is a clinical scoring system used to diagnose **Acute Appendicitis**. It is a high-yield topic for NEET-PG/INI-CET as it helps determine the need for observation, imaging, or surgery. ### **Calculation for this Patient:** The score is calculated based on the **MANTRELS** mnemonic: 1. **M**igration of pain to RIF: **1 point** (Present) 2. **A**norexia: 1 point (Not mentioned) 3. **N**ausea/Vomiting: **1 point** (Present) 4. **T**enderness in RIF: **2 points** (Present) 5. **R**ebound tenderness: 1 point (Not mentioned) 6. **E**levated temperature (>37.3°C): **1 point** (Present/Fever) 7. **L**eukocytosis (>10,000/cmm): **2 points** (Present: 14,000) 8. **S**hift to the left (Neutrophilia): 1 point (Not mentioned) **Total Score: 1 + 1 + 2 + 1 + 2 = 7** --- ### **Why the other options are incorrect:** * **Options A (6) and C (5):** These scores underestimate the weightage of **RIF Tenderness** and **Leukocytosis**, which are the only two parameters that carry **2 points** each. * **Option B (4):** A score of 4 or less makes appendicitis unlikely, whereas this patient presents with classic "textbook" symptoms and significant leukocytosis. --- ### **Clinical Pearls for INI-CET:** * **Interpretation:** * **5–6:** Possible (Equivocal); observation/CT scan recommended. * **7–8:** Probable; surgery usually indicated. * **9–10:** Very probable; immediate appendectomy. * **Modified Alvarado Score:** Excludes "Shift to the left" (Total score out of 9). * **Most common symptom:** Anorexia (often the first sign). * **Most common sign:** Tenderness at **McBurney’s point**. * **Pediatric Alternative:** The **Pediatric Appendicitis Score (PAS)** is often preferred for children.

Q: A 65-year-old patient undergoes colonoscopy for altered bowel habits. A 6 cm colonic mass is biopsied and histopathology shows adenocarcinoma confined to the mucosa with no lymph node or distant metastasis. What is the most appropriate TNM stage of this tumor?

Stage 0. ### **Explanation** The correct answer is **Stage 0**. #### **1. Why Stage 0 is Correct** In the TNM staging of colorectal cancer, the depth of invasion is the primary determinant of the 'T' stage. * **Carcinoma in situ (Tis):** This is defined as cancer cells confined to the **mucosa** (epithelium or lamina propria) without extension through the **muscularis mucosae** into the submucosa. * Because the colonic mucosa lacks lymphatic channels (which begin in the submucosa), tumors confined to the mucosa have essentially **zero risk of regional lymph node metastasis**. * According to the AJCC staging system, **Tis N0 M0** is classified as **Stage 0**. #### **2. Why Other Options are Incorrect** * **Stage I (T1-T2 N0 M0):** Requires invasion into the **submucosa** (T1) or the **muscularis propria** (T2). * **Stage II (T3-T4 N0 M0):** Occurs when the tumor invades through the muscularis propria into the subserosa (T3) or perforates the visceral peritoneum/invades adjacent organs (T4), but without nodal involvement. * **Stage III (Any T, N1-N2 M0):** This stage is defined by the presence of **regional lymph node metastasis**, regardless of the depth of T invasion. #### **3. High-Yield Clinical Pearls for INI-CET** * **The "No Lymphatics" Rule:** Unlike the stomach or esophagus, the colonic lamina propria has no lymphatic vessels. Therefore, "intramucosal carcinoma" in the colon is biologically equivalent to carcinoma in situ. * **Management:** Most Stage 0 lesions can be managed via **endoscopic mucosal resection (EMR)** or polypectomy rather than formal colectomy, provided margins are clear. * **TNM Staging Quick Recall:** * **T1:** Submucosa * **T2:** Muscularis propria * **T3:** Subserosa/Pericolonic fat * **T4:** Perforation of serosa or invasion of other organs.

Q: Multiple lytic lesions on skull are seen in which thyroid carcinoma?

Follicular carcinoma. ***Follicular carcinoma*** - Follicular thyroid carcinoma (FTC) classically spreads hematogenously to distant sites, most commonly the **bone (skull, spine, pelvis)** and lungs. - Bone metastases, especially in the skull, are typically **lytic** and may present as solitary or multiple lesions with a characteristic **"cannonball" appearance** on imaging if involving the lungs. ***Papillary carcinoma thyroid*** - Papillary thyroid carcinoma (PTC) predominantly spreads locally via **lymphatics** to regional neck lymph nodes, rarely causing distant metastases early in the disease course. - Distant metastases, when they occur, are usually to the lungs (small micronodules) and are less common as lytic skull lesions compared to FTC. ***Hurthle cell carcinoma*** - Hurthle cell carcinoma (a variant of follicular carcinoma) also has a high propensity for **hematogenous spread** to bone and lung. - While it can cause lytic bone lesions, it is best classified under the broader category of follicular carcinoma for its metastatic pattern, but FTC is the most common association for lytic skull lesions among the choices. ***Thyroid lymphoma*** - Thyroid lymphoma is rare and usually presents as a **rapidly enlarging thyroid mass** in an older patient, often associated with a background of Hashimoto's thyroiditis. - It typically causes diffuse thyroid involvement and local invasion into the neck structures; distant metastases, especially lytic skull lesions, are highly **uncommon**.

Q: Cleft lip primary muscle repair is required in which of the following muscles?

Orbicularis oris. ***Orbicularis oris*** - The **orbicularis oris** muscle forms the main sphincter of the mouth and is interrupted in a cleft lip. Repair involves meticulous anatomical realignment of this muscle for correct function and appearance. - Dysfunction of this muscle in unrepaired cleft lip leads to **vermilion deficiency**, **cupid's bow distortion**, and poor feeding/speech. *Orbicularis oculi* - This muscle surrounds the eye and is responsible for blinking and closing the eyelid; it is not primarily affected in a standard cleft lip. - Though part of the facial musculature, its involvement is secondary, mainly due to potential nerve injury during extensive **craniofacial procedures**, not cleft lip repair. *Levator palpebrae superioris* - This muscle elevates the upper eyelid and is innervated by the **oculomotor nerve (CN III)**. It is not involved in cleft lip pathology or repair. - Its function is essential for vision, and damage results in **ptosis**, a concern unrelated to primary lip closure. *Masseter* - The masseter is a powerful muscle of mastication, innervated by the **trigeminal nerve (CN V)**. It is located in the cheek and is not part of the required functional repair for a cleft lip. - Its primary role is in **jaw closure (chewing)**, and its integrity is preserved during standard cleft lip repair procedures.

Question 1

A 25-year-old male presents with pain starting from the umbilicus moving to the right iliac fossa, associated with fever, nausea, and tenderness in the right iliac fossa. His WBC count is 14,000/cmm. What is the Alvarado score?

Accepted Answer

7

Answer

6

Answer

4

Answer

5

Question 2

A 40-year-old male with head injury presents with respiratory distress and absent breath sounds on the right. GCS is 8/15. What is the most immediate next step in management?

Accepted Answer

Secure airway

Answer

Contrast-enhanced CT (CECT)

Answer

Oxygen by nasal prongs

Answer

Intercostal chest drain (ICD)

Question 3

A 65-year-old patient undergoes colonoscopy for altered bowel habits. A 6 cm colonic mass is biopsied and histopathology shows adenocarcinoma confined to the mucosa with no lymph node or distant metastasis. What is the most appropriate TNM stage of this tumor?

Accepted Answer

Stage 0

Answer

Stage II

Answer

Stage III

Answer

Stage I

Question 4

According to the Muir-Barclay formula, which of the following is considered the best colloid for volume replacement?

Accepted Answer

Albumin

Answer

Fresh Frozen Plasma (FFP)

Answer

Packed Red Blood Cells (PRBC)

Answer

Dextran 40

Question 5

A patient has burns involving the face, both upper limbs and front of the chest. What is the percentage of burns involved?

Accepted Answer

30 to 37

Answer

25 to 48

Answer

27 to 30

Answer

38 to 42

Question 6

Multiple lytic lesions on skull are seen in which thyroid carcinoma?

Accepted Answer

Follicular carcinoma

Answer

Thyroid lymphoma

Answer

Papillary carcinoma thyroid

Answer

Hurthle cell carcinoma

Question 7

Cleft lip primary muscle repair is required in which of the following muscles?

Accepted Answer

Orbicularis oris

Answer

Levator palpebrae superioris

Answer

Orbicularis oculi

Answer

Masseter

INI-CET 2025 — Surgery