NEET-PG 2013 - Surgery Practice Questions

Q: Best prognostic factor for head injury is:

Glasgow coma scale. ***Glasgow coma scale*** - The **Glasgow Coma Scale (GCS)** is a standardized tool used to assess the level of consciousness in head injury patients, providing an objective measure of neurological function. - A **lower GCS score** correlates with a greater severity of injury and poorer prognosis, making it the most reliable predictor of outcome. *Age* - While age can influence recovery, with **older patients generally having worse outcomes** due to less neural plasticity and pre-existing comorbidities, it is not the single best prognostic factor. - Younger patients often have better recovery potential, but their prognosis is still heavily dependent on the immediate severity of the brain injury. *Mode of injury* - The mode of injury (e.g., blunt trauma, penetrating injury) provides information about the mechanism and potential **types of injury**, but does not directly quantify the severity of brain damage or predict long-term outcomes as precisely as GCS. - While **high-impact injuries** tend to be more severe, the actual neurological deficit measured by GCS is a better indicator of prognosis. *CT* - **CT scans** are crucial for identifying specific neurological injuries like hemorrhage, edema, or fractures, which can guide immediate management. - However, the findings on a CT scan do not solely determine prognosis; a patient with a relatively normal CT can still have a poor outcome if their **GCS is low**, indicating widespread neuronal dysfunction not always visible on imaging.

Q: May-Thurner or Cockett syndrome involves:

Left iliac vein compression. ***Correct: Left iliac vein compression*** - May-Thurner syndrome, also known as Cockett syndrome, specifically describes the **compression of the left common iliac vein** by the overlying right common iliac artery. - This anatomical compression can lead to **venous outflow obstruction**, increasing the risk of deep vein thrombosis (DVT) in the left leg. *Incorrect: Internal iliac artery obstruction* - This condition involves an artery and is unrelated to May-Thurner syndrome, which is a **venous compression disorder**. - Obstruction of the internal iliac artery would typically cause symptoms of **pelvic ischemia** or erectile dysfunction, not venous DVT. *Incorrect: Common iliac artery obstruction* - Obstruction of the common iliac artery is an **arterial occlusion** that would cause peripheral artery disease symptoms in the leg, such as claudication or rest pain. - It does not involve the compression of a vein by an artery, which is characteristic of May-Thurner syndrome. *Incorrect: Internal iliac vein obstruction* - While this is a venous issue, May-Thurner syndrome specifically involves the **common iliac vein**, not the internal iliac vein. - Obstruction of the internal iliac vein would typically present with symptoms related to pelvic venous congestion, distinct from the left lower extremity DVT associated with May-Thurner syndrome.

Q: Surgery in varicose veins is NOT attempted in the presence of which of the following?

Deep vein thrombosis. ***Deep vein thrombosis*** - **Surgery in varicose veins is absolutely contraindicated in the presence of DVT** (both acute and chronic) - In **acute DVT**, the deep venous system is already compromised, and removing superficial veins could further impair venous return and worsen the thrombotic state - In **chronic DVT with post-thrombotic syndrome**, the deep veins may be occluded or heavily damaged, and the superficial varicosities often serve as **crucial collateral vessels** to maintain venous drainage—their removal would be detrimental - Surgery should only be considered after complete resolution of acute DVT and adequate anticoagulation *Multiple incompetent perforators* - **NOT a contraindication**—incompetent perforators are actually a common indication for surgical treatment - Incompetent perforators contribute to venous insufficiency and recurrent varicose veins - Can be addressed surgically with **subfascial endoscopic perforator surgery (SEPS)** or endovenous ablation techniques - Their presence often indicates need for more comprehensive treatment alongside superficial venous surgery *Varicose veins with leg ulcer* - **NOT a contraindication**—venous leg ulcers are actually an **indication for varicose vein surgery** - Leg ulcers result from chronic venous hypertension due to venous insufficiency - Surgical treatment (saphenous vein ablation, ligation and stripping, or sclerotherapy) reduces venous hypertension and improves venous drainage - Surgery promotes ulcer healing and prevents recurrence when combined with appropriate wound care *None of the above* - Incorrect because **Deep Vein Thrombosis (DVT) is a well-established contraindication** to varicose vein surgery

Q: Among the following, intraoperative sentinel lymph node detection in axilla can be done using

Isosulfan blue dye. ***Correct Option: Isosulfan blue dye*** - **Isosulfan blue dye** is a vital dye used for **intraoperative visual identification** of sentinel lymph nodes in the axilla during breast cancer surgery - The dye is injected near the tumor site and **preferentially concentrates in lymphatic channels**, allowing the surgeon to visually trace the lymphatic drainage to the **first lymph node(s)** (sentinel nodes) receiving lymph flow - The sentinel nodes appear **blue-stained** and can be identified and excised for biopsy to determine lymph node status - **Alternative methods** include radioactive tracers like **Technetium-99m** or a combination of both (dual mapping technique) *Incorrect Option: Mammography* - Mammography is an **X-ray imaging technique** used for breast cancer screening and diagnosis to detect tumors and calcifications - It is a **pre-operative diagnostic tool**, not used for intraoperative sentinel lymph node detection - Cannot visualize or track lymphatic flow during surgery *Incorrect Option: MRI* - MRI (Magnetic Resonance Imaging) provides detailed anatomical assessment and staging of breast cancer pre-operatively - It is a **static imaging modality** that cannot be used for real-time intraoperative sentinel lymph node detection - Does not visualize lymphatic drainage or dye uptake during surgery *Incorrect Option: CT* - CT scans (Computed Tomography) provide cross-sectional images useful for assessing tumor size and metastatic spread - Not employed for **intraoperative sentinel lymph node detection** - Cannot track real-time lymphatic flow with dyes during surgery

Q: Which of the following statements is true about Marjolin's ulcer?

All of the options. ***All of the options*** - Marjolin's ulcer is a **malignant transformation** that occurs in chronic wounds and scars, which tend to be **long-standing**. - It most commonly leads to the development of **squamous cell carcinoma (SCC)**, and these lesions are generally **slow-growing**. *Squamous cell carcinoma develops* - This statement is true; the most common histological type of malignancy arising in a Marjolin's ulcer is **squamous cell carcinoma (SCC)**. - Less frequently, **basal cell carcinoma** or other sarcomas can also arise, but **SCC** is the predominant form. - The SCC arising in Marjolin's ulcer tends to be **more aggressive** than conventional SCC, with higher rates of **local invasion** and **metastasis**. *Slow growing lesion* - This statement is true; Marjolin's ulcer lesions typically exhibit a **slow growth rate** over an extended period. - This characteristic often contributes to delayed diagnosis, as patients may initially dismiss the changes as non-malignant wound complications. - The latency period can range from **years to decades** after the initial injury. *Develops in long standing scar* - This statement is true; Marjolin's ulcer is defined by its development in areas of **chronic inflammation**, such as **burn scars**, **pressure sores**, **venous stasis ulcers**, and other non-healing wounds. - The latency period for malignant transformation in such scars can range from years to decades, indicating a **long-standing** nature. - **Burn scars** are the most common site, accounting for the majority of cases.

Q: In which of the following conditions is neurosurgery not indicated?

Diffuse axonal injury (DAI). ***Diffuse axonal injury (DAI)*** - Neurosurgery is generally **not indicated** for diffuse axonal injury because the primary damage involves widespread shearing of axons throughout the white matter, rather than a focal, surgically accessible lesion. - Management of DAI is primarily **supportive**, focusing on managing intracranial pressure and optimizing cerebral perfusion, as there is no specific surgical intervention to reverse the axonal damage. *Subdural hematoma (SDH)* - Surgical intervention, such as a **craniotomy** or **burr hole drainage**, is often indicated for acute or subacute subdural hematomas, especially when they are large, causing mass effect, or leading to neurological deterioration. - The goal of surgery is to **evacuate the blood clot** and relieve pressure on the brain. *Epidural hematoma (EDH)* - **Epidural hematomas** are typically surgical emergencies that require urgent craniotomy for evacuation of the hematoma to relieve pressure on the brain. - This is due to their rapid development and tendency to cause significant **mass effect** and brain herniation. *Intracerebral hemorrhage* - Neurosurgery may be indicated for certain types of **intracerebral hemorrhage (ICH)**, particularly those that are superficial, large, causing significant mass effect, or located in a surgically accessible area. - The decision for surgery often depends on the **size and location of the bleed**, the patient's neurological status, and the risk of further deterioration.

Q: What is the method of reduction for an inguinal hernia?

Taxis. ***Taxis*** - **Taxis** is the manual reduction of a hernia by applying gentle, sustained pressure to gently guide the herniated contents back into the abdominal cavity. - This technique is typically used for **reducible hernias** to prevent complications like strangulation. *Kugel maneuver* - The **Kugel patch** is a device used in the surgical repair of inguinal hernias, not a method of manual reduction. - It involves a **preperitoneal mesh** placed during an open repair to reinforce the weakened abdominal wall. *Macvay procedure* - The **McVay repair** (also known as Cooper's ligament repair) is a surgical technique for inguinal hernias. - It involves suturing the **conjoint tendon** to Cooper's ligament for a strong repair, not a manual reduction. *Stopa's technique* - "Stopa's technique" is not a recognized medical term or a standard method for hernia reduction or repair. - This option appears to be a **distractor** and does not correspond to any established medical procedure for hernias.

Q: What is the treatment of choice for squamous cell anal cancer?

Chemoradiotherapy. ***Chemoradiotherapy*** - **Chemoradiotherapy** is the standard and most effective treatment for squamous cell anal cancer, offering high rates of **tumor control** and **anal sphincter preservation**. - This combined approach uses both **radiation** and **chemotherapy** (typically 5-fluorouracil and mitomycin-C) to enhance tumor cell killing and reduce recurrence. *Laser ablation* - **Laser ablation** is a minimally invasive technique generally reserved for very small, early-stage **superficial tumors** or **intraepithelial neoplasia**, not for invasive squamous cell anal cancer. - It does not address potential **lymph node involvement** or deliver the comprehensive treatment required for most anal cancers. *Abdominoperineal resection* - **Abdominoperineal resection (APR)** involves the surgical removal of the anus, rectum, and part of the sigmoid colon, leading to a permanent **colostomy**. - This is considered a **salvage therapy** for recurrent disease or for patients who have failed chemoradiotherapy, not a primary treatment. *Cisplatin-based chemotherapy* - While **cisplatin** can be used as a component of chemotherapy regimens for some cancers, it is not the primary single-agent or cornerstone chemotherapy for **squamous cell anal cancer**. - The standard chemotherapy regimen typically includes **5-fluorouracil** and **mitomycin-C** in combination with radiation.

Q: Which of the following is the best combination of clinical features of intestinal obstruction?

Abdominal distension and vomiting. ***Abdominal distension and vomiting*** - This combination represents **two of the cardinal clinical features** of intestinal obstruction from the classic tetrad (pain, vomiting, distension, constipation). - **Abdominal distension** occurs due to accumulation of gas and fluid proximal to the obstruction. - **Vomiting** occurs as the body attempts to expel contents that cannot pass through the blocked intestine. - The **combination** makes this the most specific and complete answer among the given options. *Vomiting* - While vomiting is indeed a prominent clinical feature of intestinal obstruction, it can occur in numerous other conditions (gastroenteritis, metabolic disorders, CNS pathology). - **Isolated vomiting lacks specificity** for diagnosing intestinal obstruction. *Fluid level in X-ray > 4* - This refers to **multiple air-fluid levels** seen on erect abdominal X-ray, which is a **radiologic/diagnostic finding**, not a clinical feature. - Clinical features are symptoms and signs (what the patient experiences or what is observed on examination), whereas X-ray findings are **investigative/imaging findings**. *Abdominal distension* - While abdominal distension is a key clinical feature of intestinal obstruction, it can also occur in other conditions (ascites, pregnancy, obesity, bowel perforation). - **Isolated distension lacks specificity** compared to the combination with vomiting.

Q: What is the treatment of choice for medullary carcinoma of the thyroid?

Total thyroidectomy. ***Total thyroidectomy*** - This is the **treatment of choice for medullary thyroid carcinoma (MTC)** due to its multifocal nature and high propensity for lymph node metastasis - **Complete surgical resection** (often with central compartment neck dissection) provides the best chance for cure by removing all thyroid tissue and involved lymph nodes - MTC arises from **parafollicular C cells** (calcitonin-producing cells) and frequently involves both lobes, making total thyroidectomy essential *Partial thyroidectomy* - This procedure removes only a portion of the thyroid gland, which is **insufficient for MTC** given its tendency for multifocality and bilateral involvement - Leaves residual thyroid tissue that could harbor undetected disease or develop future recurrences - Does not adequately address the aggressive nature of MTC *I-131 ablation* - **Radioactive iodine therapy** is effective for differentiated thyroid cancers (papillary and follicular) that take up iodine - MTC originates from **parafollicular C cells that do not concentrate iodine**, making I-131 ablation completely ineffective - This is a key distinguishing feature of MTC from other thyroid malignancies *Hemithyroidectomy* - This procedure removes only one thyroid lobe, which is **inadequate for MTC** - Risks leaving behind primary tumor in the contralateral lobe or occult bilateral disease - Fails to address the multifocal nature of MTC, particularly in hereditary cases (MEN 2A, MEN 2B, familial MTC)

Question 1

Best prognostic factor for head injury is:

Accepted Answer

Glasgow coma scale

Answer

Age

Answer

Mode of injury

Answer

CT

Question 2

May-Thurner or Cockett syndrome involves:

Accepted Answer

Left iliac vein compression

Answer

Internal iliac artery obstruction

Answer

Common iliac artery obstruction

Answer

Internal iliac vein obstruction

Question 3

Surgery in varicose veins is NOT attempted in the presence of which of the following?

Accepted Answer

Deep vein thrombosis

Answer

Multiple incompetent perforators

Answer

Varicose veins with leg ulcer

Answer

None of the above

Question 4

Among the following, intraoperative sentinel lymph node detection in axilla can be done using

Accepted Answer

Isosulfan blue dye

Answer

Mammography

Answer

MRI

Answer

CT

Question 5

Which of the following statements is true about Marjolin's ulcer?

Accepted Answer

All of the options

Answer

Squamous cell carcinoma develops

Answer

Slow growing lesion

Answer

Develops in long standing scar

Question 6

In which of the following conditions is neurosurgery not indicated?

Accepted Answer

Diffuse axonal injury (DAI)

Answer

Subdural hematoma (SDH)

Answer

Epidural hematoma (EDH)

Answer

Intracerebral hemorrhage

Question 7

What is the method of reduction for an inguinal hernia?

Accepted Answer

Taxis

Answer

Stopa's technique

Answer

Kugel patch

Answer

McVay procedure

Question 8

What is the treatment of choice for squamous cell anal cancer?

Accepted Answer

Chemoradiotherapy

Answer

Laser ablation

Answer

Abdominoperineal resection

Answer

Cisplatin-based chemotherapy

Question 9

Which of the following is the best combination of clinical features of intestinal obstruction?

Accepted Answer

Abdominal distension and vomiting

Answer

Vomiting

Answer

Fluid level in X-ray > 4

Answer

Abdominal distension

Question 10

What is the treatment of choice for medullary carcinoma of the thyroid?

Accepted Answer

Total thyroidectomy

Answer

I-131 ablation

Answer

Partial thyroidectomy

Answer

Hemithyroidectomy

NEET-PG 2013 — Surgery