NEET-PG 2012 - Surgery Practice Questions

Q: What is the standard intercostal space used for hepatic biopsy?

9th. ***Correct Option: 9th*** - The **9th intercostal space** in the mid-axillary line is the standard and most commonly used entry point for percutaneous liver biopsy. - This location provides safe access to the **right lobe of the liver** while avoiding injury to the **pleura** and **lungs** superiorly and minimizing risk to the **kidney** and other abdominal organs inferiorly. - At this level, the liver is sufficiently large and the approach avoids the pleural reflection, which typically descends to the 8th-9th intercostal space. - Standard surgical textbooks (Sabiston, Schwartz) recommend the **8th-10th intercostal space**, with the 9th being most frequently used. *Incorrect Option: 5th* - The **5th intercostal space** is far too high for liver biopsy and would result in puncturing the **lung** or **pleura**, causing **pneumothorax** or hemothorax. - This space is well above the liver margin and is not suitable for hepatic access. *Incorrect Option: 7th* - While the **7th intercostal space** may occasionally be mentioned, it is generally considered **too high** for routine percutaneous liver biopsy. - This level carries increased risk of **pleural injury** as the pleural reflection may extend to this level, especially during deep inspiration. - It is not the standard or preferred approach in current surgical practice. *Incorrect Option: 11th* - The **11th intercostal space** is too low and significantly increases the risk of injuring the **right kidney** or entering the peritoneal cavity with potential injury to bowel or other abdominal structures. - This space is below the optimal liver access zone and is not recommended for routine liver biopsy.

Q: Which of the following is not considered a contraindication for pancreaticoduodenectomy?

Portal vein involvement. ***Portal vein involvement*** - While extensive portal vein invasion can make the procedure challenging, **segmental portal vein involvement without complete occlusion or direct invasion of the superior mesenteric artery** is often considered resectable with venous reconstruction and is not an absolute contraindication. - Advancements in surgical techniques and patient selection criteria allow for **safe resection and reconstruction of the portal vein** in carefully chosen cases, improving outcomes for patients who would otherwise be deemed inoperable. *Metastasis* - The presence of **distant metastases** (e.g., to the liver, peritoneum, or lungs) unequivocally indicates **Stage IV disease** and is an absolute contraindication to pancreaticoduodenectomy, as the surgery would not offer a curative benefit. - In such cases, systemic chemotherapy or palliative care is the more appropriate treatment approach, as resection would not alter the overall prognosis. *Stage III CA head of pancreas* - **Stage III carcinoma of the head of the pancreas** often implies **locally advanced disease** that involves major peripancreatic vessels, such as the superior mesenteric artery or celiac axis. - This level of extensive vascular involvement typically renders the tumor **unresectable**, making pancreaticoduodenectomy surgically unfeasible and a contraindication. *Extensive invasion of superior mesenteric vein* - **Extensive involvement of the superior mesenteric vein (SMV)**, particularly if it completely occludes the lumen or involves a long segment making reconstruction impossible, is generally considered a contraindication to pancreaticoduodenectomy. - While limited SMV involvement with reconstructive options might be resectable, **extensive, unreconstructable invasion** signifies locally advanced disease beyond surgical cure.

Q: Road traffic accident (RTA) with multiple fractures - initial treatment would be:

Airway management. ***Airway management*** - In trauma, **establishing and maintaining a patent airway** is the absolute priority, as compromised breathing can lead to rapid deterioration and death. - The **ABCs (Airway, Breathing, Circulation)** of trauma care dictate that airway intervention precedes other life-saving measures. *Management of shock* - While crucial, **managing shock (C)** follows **airway (A)** and **breathing (B)** in the primary survey of trauma care. - Addressing profound shock without a patent airway can be ineffective and leads to irreversible damage. *Splinting of limbs* - **Splinting fractures** is important for pain control, preventing further injury, and minimizing blood loss in open fractures, but it is not an immediate life-saving intervention. - This falls under the **secondary survey** or definitive management, after life-threatening issues have been addressed. *Cervical spine protection* - **Cervical spine protection** is essential in trauma to prevent further neurological injury and is performed simultaneously with airway management (often with in-line stabilization). - However, a patent airway is the **most immediate life-sustaining intervention** if the airway is compromised.

Q: What type of burn is characterized by flash burn, tenderness, redness, and pain?

First degree burn. ***First degree burn*** - Characterized by **tenderness**, **redness**, and **pain** without blistering. - Involves only the **epidermis**, typically from a **flash burn** or brief contact with a hot object. *Scalded burn* - A type of burn caused by **hot liquid or steam**, not a characteristic of a specific burn depth. - Can be superficial or deep, depending on the **temperature** and **duration of exposure**. *Second degree burn* - Involves the **epidermis and dermis**, presenting with **blisters**, severe pain, and sometimes a wet, weeping appearance. - Often heals with scarring, unlike first-degree burns. *Fourth degree burn* - The most severe type of burn, extending through **all layers of skin** into underlying **muscle**, **tendons**, or **bone**. - Often appears charred or black, and victims may feel little pain due to extensive nerve damage.

Q: Circumcision is contraindicated in

Hypospadias. ***Hypospadias*** - In **hypospadias**, the **urethral opening** is located on the underside of the penis, and the foreskin is **essential** for **reconstructive surgery** (urethroplasty) to correct the defect. - Removing the foreskin via circumcision would eliminate this vital tissue, making surgical repair extremely difficult or impossible. - This is the **most absolute contraindication** to circumcision in pediatric urology. *Balanitis* - **Balanitis** is inflammation of the glans penis, often due to poor hygiene or infection. - Circumcision is actually a **treatment** for recurrent balanitis, not a contraindication. - It represents an **indication** for circumcision, not a contraindication. *Paraphimosis* - **Paraphimosis** is a urological emergency where the retracted foreskin becomes trapped behind the glans, causing vascular compromise. - Immediate management involves manual reduction or dorsal slit procedure. - Once the acute condition is resolved, elective circumcision can be performed to prevent recurrence—**not a contraindication**. *Exstrophy of bladder* - **Bladder exstrophy** is a severe congenital anomaly involving the epispadias-exstrophy complex, where the bladder is exposed outside the body. - The foreskin is typically **preserved for penile reconstruction** during complex staged repairs. - While this is also considered a **contraindication to circumcision** in most cases, **hypospadias** remains the **classic and most absolute contraindication** taught in medical education and is the expected answer for this question.

Q: Diversion of urine is best done at

Ileum. ***Ileum*** - The **ileum** is the most commonly used segment for urinary diversion due to its **mobility**, adequate vascular supply, and low complication rates. - Its relatively **low absorptive capacity** for electrolytes, particularly urea and ammonia, minimizes metabolic disturbances. *Jejunum* - The **jejunum** has a high absorptive capacity, which can lead to significant **electrolyte imbalances** (e.g., hypochloremic, hypokalemic metabolic acidosis) when urine is diverted into it. - It is also more prone to **stomal stenosis** and bowel obstruction compared to the ileum. *Colon* - While the colon can be used, particularly in continent diversions, it has a **thicker wall** and can be less mobile, making surgical creation of a conduit more challenging. - Similar to the jejunum, it has a **higher absorptive capacity** than the ileum, which can lead to electrolyte disturbances. *Caecum* - The **caecum** is a possible site for continent urinary diversions (e.g., cecal pouch), but it is not typically used for simple incontinent conduits due to its **anatomical position** and surgical complexity. - Its use often requires additional procedures to ensure continence and prevent reflux.

Q: Most common congenital diaphragmatic hernia is:

Bochdalek hernia. ***Bochdalek hernia*** - This is the most common type of **congenital diaphragmatic hernia (CDH)**, accounting for approximately **95% of all CDH cases**. - It occurs due to a defect in the **posterolateral diaphragm** (pleuroperitoneal membrane), typically on the **left side**. - Presents in neonates with respiratory distress due to herniation of abdominal contents into the thorax. *Morgagni hernia* - This is a rare type of **congenital diaphragmatic hernia**, occurring through the **anterior retrosternal diaphragm** (foramen of Morgagni). - Accounts for only **2-5% of all CDH cases**, usually on the right side. - Often asymptomatic and diagnosed incidentally in adults. *Paraesophageal hernia* - This is an **acquired hiatal hernia** where part of the stomach herniates alongside the esophagus through the esophageal hiatus. - While **hiatal hernias are the most common diaphragmatic hernias overall**, they are **not congenital** and therefore not the answer to this question. - Seen commonly in older adults. *None of the options* - Incorrect, as **Bochdalek hernia** is definitively the most common congenital diaphragmatic hernia.

Q: Which of the following is NOT a standard component of the triple test for breast cancer detection?

Breast self examination. ***Breast self examination*** - While **breast self-examination (BSE)** is important for **personal awareness** and **early detection**, it is not considered a standard component of the diagnostic "triple test" for breast cancer, which aims for definitive diagnosis. - The traditional triple test comprises **clinical examination**, **imaging** (mammography/ultrasound), and **pathological assessment** (FNAC/biopsy). *USG/ mammography* - **Mammography** and **ultrasonography (USG)** are crucial imaging modalities and an integral part of the **triple test**, providing detailed anatomical information about breast lesions. - They help characterize masses detected clinically and guide biopsy procedures, contributing significantly to diagnosis. *FNAC/ trucut biopsy* - **Fine needle aspiration cytology (FNAC)** and **tru-cut biopsy** are essential for **histopathological diagnosis**, confirming malignancy and determining tumor characteristics. - This is the third component of the triple test, providing a definitive cellular or tissue diagnosis. *Clinical examination* - A **thorough clinical breast examination** by a healthcare professional is the first step in the triple test, identifying palpable masses or other suspicious signs. - It involves **inspection** and **palpation** to assess breast tissue and lymph nodes.

Q: Which of the following statements about keloids is true?

Local recurrence is common after excision.. ***Local recurrence is common after excision*** - Keloids are characterized by an overgrowth of **scar tissue** that extends beyond the original wound boundaries. - Due to their aggressive fibrous nature and growth factors, **surgical excision alone often leads to recurrence**, sometimes even larger than the original keloid [1]. *They undergo malignant transformation frequently* - Keloids are **benign fibrous growths** and do **not typically undergo malignant transformation**. - While they can be cosmetically distressing and cause symptoms like itching or pain, they are not a precursor to cancer. *They occur equally across all ethnic groups* - Keloids show a significant **predisposition in individuals with darker skin pigmentation**, including those of African, Asian, and Hispanic descent [1]. - This suggests a **genetic component** influencing their occurrence, which is not equally distributed across all ethnic groups [1]. *They remain confined to the original wound boundaries* - This statement describes **hypertrophic scars**, not keloids. - Keloids are specifically defined by their tendency to **grow beyond the margins** of the original injury, invading surrounding healthy skin [1].

Question 1

What is the standard intercostal space used for hepatic biopsy?

Accepted Answer

9th

Answer

5th

Answer

7th

Answer

11th

Question 2

Which of the following is not considered a contraindication for pancreaticoduodenectomy?

Accepted Answer

Portal vein involvement

Answer

Metastasis

Answer

Extensive invasion of superior mesenteric vein

Answer

Stage III CA head of pancreas

Question 3

Road traffic accident (RTA) with multiple fractures - initial treatment would be:

Accepted Answer

Airway management

Answer

Management of shock

Answer

Splinting of limbs

Answer

Cervical spine protection

Question 4

What type of burn is characterized by flash burn, tenderness, redness, and pain?

Accepted Answer

First degree burn

Answer

Scalded burn

Answer

Second degree burn

Answer

Fourth degree burn

Question 5

Circumcision is contraindicated in

Accepted Answer

Hypospadias

Answer

Paraphimosis

Answer

Exostrophy of bladder

Answer

Balanitis

Question 6

Diversion of urine is best done at

Accepted Answer

Ileum

Answer

Jejunum

Answer

Colon

Answer

Caecum

Question 7

Most common congenital diaphragmatic hernia is:

Accepted Answer

Bochdalek hernia

Answer

Morgagni hernia

Answer

None of the options

Answer

Paraesophageal hernia

Question 8

Which of the following is NOT a standard component of the triple test for breast cancer detection?

Accepted Answer

Breast self examination

Answer

USG/ mammography

Answer

Clinical examination

Answer

FNAC/ trucut biopsy

Question 9

Which of the following statements about keloids is true?

Accepted Answer

Local recurrence is common after excision.

Answer

They undergo malignant transformation frequently.

Answer

They occur equally across all ethnic groups.

Answer

They remain confined to the original wound boundaries.

Question 10

In the initial management of a hemodynamically unstable polytrauma patient, what is the recommended initial crystalloid bolus dose of Ringer's lactate for assessment and stabilization?

Accepted Answer

1000 ml Ringer's lactate bolus, then regulated by clinical indicators

Answer

2000 ml Ringer's lactate bolus

Answer

250 ml Ringer's lactate bolus

Answer

500 ml Ringer's lactate bolus, then regulated by clinical indicators

NEET-PG 2012 — Surgery