What causes Frey's syndrome?
What imaging study is typically required before endoscopic sinus surgery?
Which fracture pattern is classified as a Le Fort I fracture?
Which of the following conditions is least likely to cause bilateral recurrent laryngeal nerve palsy?
Sentinel lymph node biopsy in carcinoma breast is done if -
Which of the following is an example of a clean surgery?
Most common site for anal fissure is
A 40-year-old male with gastroesophageal reflux disease (GERD) is found to have Barrett's esophagus with low-grade dysplasia on endoscopy. What is the most appropriate initial pharmacological treatment for this condition?
All are true about carcinoma penis except which of the following?
The most common cause of acquired AV fistula is:
NEET-PG 2013 - Surgery NEET-PG Practice Questions and MCQs
Question 11: What causes Frey's syndrome?
- A. Facial nerve damage.
- B. Greater auricular nerve involvement.
- C. Aberrant regeneration of parasympathetic fibers from the auriculotemporal nerve to sweat glands. (Correct Answer)
- D. None of the options
Explanation: ***Aberrant regeneration of parasympathetic fibers from the auriculotemporal nerve to sweat glands.*** - Frey's syndrome, or **gustatory sweating**, occurs due to aberrant regeneration after parotid surgery or trauma where parasympathetic secretomotor fibers meant for the **parotid gland** (carried by the auriculotemporal nerve) incorrectly reinnervate **sweat glands and blood vessels** in the overlying skin. - This misdirection leads to **sweating and flushing** over the parotid region in response to gustatory stimuli (eating, thinking about food). - The auriculotemporal nerve is a branch of the **mandibular division of the trigeminal nerve (V3)** that carries parasympathetic fibers to the parotid gland. *Greater auricular nerve involvement.* - The greater auricular nerve is a sensory nerve (from C2-C3) that provides sensation to the **external ear** and skin over the parotid region. - Damage to this nerve causes **numbness** in its distribution, not gustatory sweating. *Facial nerve damage.* - The facial nerve (CN VII) primarily controls **muscles of facial expression** and provides taste sensation from the anterior two-thirds of the tongue. - Damage leads to **facial paralysis**, not Frey's syndrome. *None of the options* - Incorrect, as the first option accurately describes the underlying cause of Frey's syndrome.
Question 12: What imaging study is typically required before endoscopic sinus surgery?
- A. MRI of paranasal sinus
- B. CT of PNS (Correct Answer)
- C. Acoustic tests
- D. Mucociliary clearing testing
Explanation: ***CT of PNS*** - A **CT scan of the paranasal sinuses** is crucial prior to endoscopic sinus surgery for detailed anatomical mapping. - It helps identify **key anatomical landmarks**, variations, and the extent of disease, minimizing surgical risks. *MRI of paranasal sinus* - **MRI** is generally reserved for evaluating **soft tissue abnormalities**, such as tumors, fungal infections, or intracranial extension. - It provides less detail regarding **bony anatomy** and is not the primary imaging modality for surgical planning in routine cases. *Mucociliary clearing testing* - **Mucociliary clearing tests** assess the function of the **mucociliary escalator** in the nasal cavity and sinuses. - These tests are primarily diagnostic for conditions like **primary ciliary dyskinesia** and do not provide anatomical detail for surgical guidance. *Acoustic tests* - **Acoustic tests** are typically used to assess **hearing function** in the ear. - They have **no relevance** to the anatomical evaluation of the paranasal sinuses or planning for endoscopic sinus surgery.
Question 13: Which fracture pattern is classified as a Le Fort I fracture?
- A. Pyramidal fracture involving maxilla and nasal bones
- B. Complete craniofacial separation involving the upper face
- C. Isolated nasal bone fracture
- D. Horizontal fracture of the maxilla separating teeth from upper jaw (Correct Answer)
Explanation: **Horizontal fracture of the maxilla separating teeth from upper jaw** - A **Le Fort I fracture** is a **horizontal fracture** that detaches the entire **maxillary arch**, including the **palate** and **alveolar process**, from the rest of the facial skeleton. - This fracture line typically extends **above the level of the nasal floor** and involves the **pterygoid plates**. *Pyramidal fracture involving maxilla and nasal bones* - This description corresponds to a **Le Fort II fracture**, which is a **pyramidal fracture** involving the **nasal bones**, **medial walls of the orbits**, and the **maxilla**. - It creates a central fragment that includes the **nasal bridge** and part of the maxilla, separating it from the frontal bone. *Complete craniofacial separation involving the upper face* - This refers to a **Le Fort III fracture**, also known as **craniofacial disjunction**. - It involves the separation of the entire **midfacial skeleton** from the **cranial base**, often extending through the **zygomaticofrontal sutures** and **nasofrontal sutures**. *Isolated nasal bone fracture* - An **isolated nasal bone fracture** involves only the nasal bones and does not extend into the maxilla or other facial structures. - It is a much more **localized injury** compared to any of the Le Fort fracture patterns.
Question 14: Which of the following conditions is least likely to cause bilateral recurrent laryngeal nerve palsy?
- A. Thyroid carcinoma
- B. Lymphadenopathy
- C. Thyroid surgery
- D. Aortic aneurysm (Correct Answer)
Explanation: ***Aortic aneurysm*** - An aortic aneurysm, especially of the ascending aorta, is **less likely to cause bilateral recurrent laryngeal nerve palsy** because the left recurrent laryngeal nerve typically hooks under the aortic arch, while the right nerve hooks under the subclavian artery. - For **bilateral involvement**, two separate and simultaneous lesions affecting both nerves would be required at different anatomical locations with this etiology, making it a rare cause. *Thyroid carcinoma* - An aggressive **thyroid carcinoma** can directly invade or compress the recurrent laryngeal nerves (RLNs) due to their proximity to the thyroid gland. - If the carcinoma is extensive or multifocal, it can lead to **bilateral involvement** by affecting both nerves. *Lymphadenopathy* - Significant **cervical or mediastinal lymphadenopathy** (e.g., due to metastatic disease or lymphoma) can compress or encase both recurrent laryngeal nerves. - This proximity allows for potential **bilateral compression or damage** to the nerves as they ascend in the tracheoesophageal grooves. *Thyroid surgery* - **Thyroidectomy** is a common cause of recurrent laryngeal nerve injury due to the nerves' close anatomical relationship with the thyroid gland. - **Bilateral recurrent laryngeal nerve palsy** can occur if both nerves are damaged during dissection, often due to surgical misidentification, thermal injury, or traction.
Question 15: Sentinel lymph node biopsy in carcinoma breast is done if -
- A. LN palpable
- B. Breast lump with palpable axillary node
- C. Metastatic CA breast
- D. Breast mass but no lymph node palpable (Correct Answer)
Explanation: ***Breast mass but no lymph node palpable*** - Sentinel lymph node biopsy is primarily performed in patients with **clinically negative axillae** (no palpable lymph nodes) to assess for microscopic metastatic disease. - The goal is to avoid full axillary lymph node dissection if the sentinel nodes are negative, thus reducing the risk of **lymphedema** and other complications. *LN palpable* - If a lymph node is palpable, it is often considered **clinically suspicious** and may warrant a direct fine-needle aspiration (FNA) or core biopsy rather than a sentinel node biopsy. - A positive biopsy from a palpable node would typically lead directly to an **axillary lymph node dissection** or neoadjuvant therapy, as the sentinel node procedure offers less benefit in this scenario. *Breast lump with palpable axillary node* - Similar to a palpable LN, a **palpable axillary node** in the presence of a breast lump suggests established nodal involvement. - In such cases, **sentinel lymph node biopsy** is often not the initial step; rather, direct biopsy of the palpable node or upfront axillary dissection (sometimes after neoadjuvant treatment) is considered. *Metastatic CA breast* - In **metastatic breast cancer** (stage IV disease), the focus shifts to systemic treatment, and axillary lymph node dissection, including sentinel node biopsy, is generally not indicated for staging purposes. - The primary goal is palliative care or controlling systemic disease, not regional lymph node staging.
Question 16: Which of the following is an example of a clean surgery?
- A. Hernia surgery (Correct Answer)
- B. Cholecystectomy
- C. Rectal surgery
- D. Gastric surgery
Explanation: ***Hernia surgery*** - **Clean surgeries** involve no entry into hollow viscera (e.g., gastrointestinal, genitourinary, or respiratory tract) and are characterized by **no inflammation** or infection. Hernia repair typically fits this description. - The risk of **surgical site infection** (SSI) is usually less than 2% in clean cases, making it a benchmark for surgical infection control. *Gastric surgery* - This involves entry into the **gastrointestinal tract**, which is considered a **contaminated** or **clean-contaminated** procedure due to the presence of bacteria. - The risk of infection is higher than in clean surgeries, often requiring prophylactic antibiotics. *Cholecystectomy* - This procedure involves the **gallbladder**, which is part of the biliary system, often considered a **clean-contaminated** wound if bile spills or if there's no evidence of active infection. - If performed for **acute cholecystitis** (inflammation/infection), it would be classified as **contaminated** or **dirty**. *Rectal surgery* - This involves the **rectum**, which is part of the lower **gastrointestinal tract** and contains a high bacterial load. - Procedures involving the rectum are classified as **contaminated** or **dirty** due to the high risk of bacterial contamination.
Question 17: Most common site for anal fissure is
- A. 3 O'clock
- B. 6 O'clock (Correct Answer)
- C. 2 O'clock
- D. 10 O'clock
Explanation: ***6 O'clock*** - The **posterior midline (6 o'clock position)** is the most common site for anal fissures, accounting for approximately **90% of all cases**. - This location is prone to tearing due to relatively **poor blood supply** and increased **mechanical stress** during defecation. - The posterior midline is the least supported part of the anal canal by the external anal sphincter. - **Note**: The **anterior midline (12 o'clock position)** is the second most common site, occurring in **10-25% of women** but rarely in men. *3 O'clock* - The **3 o'clock position (right lateral)** is an infrequent site for anal fissures. - Fissures in this location, especially if *lateral*, may suggest an underlying systemic disease such as **Crohn's disease**, **tuberculosis**, **HIV**, or **malignancy**. - Atypical fissures warrant thorough investigation. *2 O'clock* - The **2 o'clock position (anterior-lateral)** is not typically associated with anal fissures. - Similar to other atypical sites, a fissure here warrants investigation for secondary causes. - Consider inflammatory bowel disease or other pathological conditions. *10 O'clock* - The **10 o'clock position (left lateral)** is also a less common site for anal fissures compared to the posterior midline. - Fissures in lateral positions should raise suspicion for other conditions, such as **inflammatory bowel disease**, **tuberculosis**, **HIV**, or **malignancy**.
Question 18: A 40-year-old male with gastroesophageal reflux disease (GERD) is found to have Barrett's esophagus with low-grade dysplasia on endoscopy. What is the most appropriate initial pharmacological treatment for this condition?
- A. Fundoplication
- B. Esophageal resection
- C. PPI (Correct Answer)
- D. Diet modification
Explanation: ***PPI*** - In patients with **GERD** and **low-grade dysplasia**, high-dose **proton pump inhibitors (PPIs)** are the initial treatment of choice to suppress acid reflux. - Continuous acid suppression can help in the regression of dysplasia and prevent its progression to higher grades. *Fundoplication* - **Fundoplication** is a surgical procedure to treat severe GERD, but it is not the primary initial treatment for low-grade dysplasia. - It might be considered if medical therapy with PPIs fails or if there are significant anatomical defects. *Esophageal resection* - **Esophageal resection** is a major surgical procedure typically reserved for **high-grade dysplasia** or **esophageal adenocarcinoma**. - It is an overly aggressive and unnecessary intervention for initial management of low-grade dysplasia. *Diet modification* - **Diet modification** is an important adjunctive therapy for GERD symptoms and overall gastric health. - However, it is generally insufficient as a standalone initial treatment for documented **low-grade dysplasia** without concurrent pharmacotherapy.
Question 19: All are true about carcinoma penis except which of the following?
- A. Leads to erosion of artery
- B. Spreads by blood borne metastasis (Correct Answer)
- C. Slowly progressive
- D. Most common type is squamous cell carcinoma
Explanation: ***Spreads by blood borne metastasis*** - Carcinoma penis typically spreads initially via the **lymphatic system** to inguinal lymph nodes. - **Hematogenous spread** is a late event and generally rare, with the most common sites being the lung, liver, and bone. *Leads to erosion of artery* - Local advancement of penile carcinoma can lead to **erosion of penile arteries**, which can cause significant morbidity including bleeding and functional compromise. - This local tissue destruction is a characteristic feature of advanced, uncontrolled penile cancer. *Slowly progressive* - Carcinoma penis is generally a **slowly progressive** malignancy, allowing for early detection and intervention if patients seek medical attention promptly. - The slow growth rate contributes to the fact that many patients present with localized or regionally advanced disease before distant metastases occur. *Most common type is squamous cell carcinoma* - Approximately 95% of penile cancers are **squamous cell carcinomas (SCCs)**, arising from the epithelial cells of the glans or foreskin. - Other rare types include melanoma, basal cell carcinoma, and sarcomas, but SCC vastly predominates.
Question 20: The most common cause of acquired AV fistula is:
- A. Bacterial infection
- B. Fungal infection
- C. Blunt trauma
- D. Penetrating trauma (Correct Answer)
Explanation: ***Penetrating trauma*** - **Penetrating trauma** is the most common cause of **acquired AV fistulas** due to direct injury to adjacent artery and vein. - This type of injury can result from causes like **gunshot wounds, stab wounds, or iatrogenic procedures** (e.g., catheterizations). *Bacterial infection* - While infections can cause vascular damage, they are **not the most common cause** of acquired AV fistulas. - Infections like **endocarditis** or localized abscesses can lead to vascular erosion, but this is less frequent than trauma. *Fungal infection* - **Fungal infections** are a much rarer cause of vascular damage leading to AV fistulas compared to bacterial infections or trauma. - They typically occur in immunocompromised individuals or in specific settings, not as a common cause of acquired AV fistulas. *Blunt trauma* - **Blunt trauma** can cause vascular injury, but it is **less likely to directly create an AV fistula** compared to penetrating trauma. - Blunt force is more commonly associated with vessel rupture, dissection, or pseudoaneurysm formation, rather than a direct connection between an artery and a vein.