NEET-PG 2019 - Surgery Practice Questions

Q: What is the name of this triangle?

Gastrinoma triangle. ***Gastrinoma triangle*** - The **gastrinoma triangle** is a region in the abdomen where **gastrinomas** (tumors producing gastrin) are most commonly found. - This anatomical area is bordered by the **cystic duct**, the **second and third portions of the duodenum**, and the **neck and body of the pancreas**. *Cholecystohepatic triangle* - This is also known as **Calot's triangle**, which is not the correct option for gastrinomas. - It is defined by the **cystic duct**, the **common hepatic duct**, and the **inferior border of the liver**. *Doom's triangle* - **"Triangle of Doom"** (or Dôme's triangle) is an anatomical landmark in **laparoscopic inguinal hernia repair**. - It is bounded by the **vas deferens medially** and the **testicular vessels laterally**, containing the **external iliac vessels** which must be avoided during surgery. - This is distinct from the gastrinoma triangle. *Calot's triangle* - **Calot's triangle** is an important anatomical landmark in gallbladder surgery, used to identify structures like the **cystic artery**. - It is distinct from the gastrinoma triangle, as its boundaries relate to the gallbladder and hepatic duct, not the pancreas or duodenum in the context of gastrinomas.

Q: Most commonly used approach for retrosternal goitre:-

Transcervical. ***Transcervical*** - The transcervical approach is the **most common and preferred method** for resecting retrosternal goitres, as the majority can be delivered through the **thoracic inlet**. - This approach minimizes morbidity and avoids the need for a **sternotomy** in most cases. *Transthoracic second intercostal space* - This approach is typically reserved for **mediastinal masses** or procedures requiring direct access to the **pleural cavity**, which is generally not necessary for retrosternal goitres. - It would involve a more invasive incision than typically required for a goitre that can be delivered transcervically. *Axillary approach* - The axillary approach is primarily used for **lymph node dissection** in breast cancer or for certain **thoracoscopic procedures**, not for accessing the thyroid gland for retrosternal goitre removal. - Its anatomical location does not provide adequate exposure to the **cervical and mediastinal structures** involved in a retrosternal goitre. *Trans-sternal through anterior mediastinum* - A trans-sternal approach (sternotomy) is a **major surgical procedure** typically reserved for very large, irreducible retrosternal goitres that have significant **mediastinal extension** or are adherent to surrounding structures. - It is avoided whenever possible due to increased morbidity and longer recovery compared to the transcervical approach, making it less commonly used overall.

Q: A patient presents with a gradually progressive, painless mass persisting for 10 years. The mass is firm to nodular and shows variable consistency within different areas of the swelling. What is the most probable diagnosis?

Pleomorphic adenoma. ***Pleomorphic adenoma*** - A **gradually progressive**, **painless mass** that has been present for 10 years, with a **firm to nodular** consistency and variability at different sites, is highly characteristic of a pleomorphic adenoma. - This benign tumor of salivary glands is known for its **slow growth** and **variable histological composition**, leading to its characteristic consistency. *Dermoid cyst* - Dermoid cysts are typically **present from birth** or early childhood and tend to be **soft and doughy** in consistency, rather than firm or nodular with variable consistency. - While painless, their growth pattern and texture differ from the described mass. *Malignancy* - A mass that has been present for **10 years** and is still described as **gradually progressive** but painless is less likely to be a malignancy, as most malignant tumors tend to grow more rapidly and often present with pain or other symptoms over such a long period. - Malignancies usually demonstrate a more infiltrative and aggressive growth pattern. *Sebaceous cyst* - A sebaceous cyst (epidermoid cyst) typically presents as a **smooth, movable, dome-shaped lump** and contains a cheesy, malodorous material, which is not consistent with a firm to nodular mass with varying consistency. - While they can be long-standing and painless, their characteristic feel and contents are different.

Q: Cushing ulcers are:-

Stress ulcers in head injury. ***Stress ulcers in head injury*** - **Cushing ulcers** are acute **gastric or duodenal ulcers** that develop after a severe **head injury** or other central nervous system trauma. - The pathophysiology involves **vagal overstimulation** due to increased intracranial pressure, leading to hypersecretion of **gastric acid** and reduced mucosal blood flow. *Stress ulcers in hiatus hernia* - A **hiatus hernia** is a condition where part of the stomach protrudes through the diaphragm into the chest cavity, which can predispose to reflux and esophagitis. - While patients with hiatus hernia might develop ulcers, these are not specifically termed Cushing ulcers, and the primary cause is mechanical or reflux-related, not neurological. *Stress ulcers in burns* - **Stress ulcers** that occur in burn patients are known as **Curling ulcers**, not Cushing ulcers. - These are typically caused by **hypovolemia, vasoconstriction**, and **ischemia** of the gastrointestinal mucosa due to significant fluid loss and systemic inflammatory response. *Stress ulcers in depression* - **Depression** is a mood disorder that can influence gastrointestinal function through the **gut-brain axis**, potentially affecting motility and visceral hypersensitivity. - However, depression is not directly associated with the formation of acute stress ulcers like Cushing ulcers, which are primarily linked to severe CNS injury.

Q: A 40 years old male was brought emergency with severe abdominal pain. On examination, pulse rate was 112/minute and systolic BP was 80 mmHg. Chest x-ray is given below. What is the most appropriate management?

Exploratory laparotomy. ***Exploratory laparotomy*** - The chest x-ray shows **pneumoperitoneum (air under the diaphragm)**, which, combined with severe abdominal pain, tachycardia, and hypotension (signs of **septic shock**), is highly indicative of a **perforated viscus**. - **Emergency exploratory laparotomy** is the definitive treatment to identify and repair the perforation, control contamination, and prevent further deterioration. *Saline wash of stomach* - This procedure is typically used for gastric lavage in cases of **poisoning or drug overdose**, or to clear the stomach in preparation for endoscopy. - It does not address a viscus perforation or the widespread abdominal contamination and systemic septic response seen in this patient. *Intercostal tube drainage* - **Intercostal tube drainage** (chest tube placement) is used to drain air (pneumothorax) or fluid (pleural effusion, hemothorax, empyema) from the pleural space, not the abdominal cavity. - While there is air visible on the x-ray, it is **subdiaphragmatic (pneumoperitoneum)**, not within the pleural space, and thus a chest tube would be ineffective and inappropriate. *IV antibiotics* - **Intravenous antibiotics** are crucial for managing sepsis associated with a perforated viscus and should be administered promptly. - However, antibiotics alone are **not sufficient** to treat the underlying mechanical problem of a perforation, which requires surgical repair to prevent ongoing bacterial contamination and sepsis.

Q: Identify this instrument which is used for harvesting graft from a healthy area in split skin grafting:

Humby's knife. ***Humby's knife*** - The image shown is a **Humby's knife**, which is a type of **hand-held dermatome** used for harvesting split-thickness skin grafts. - It utilizes an adjustable roller to control the thickness of the graft. *Brown's dermatome* - **Brown's dermatome** (also known as a **drum dermatome**) is a mechanical, hand-held, electrically-powered dermatome. - It uses an oscillating blade and is more precise for very thin grafts but is not the instrument pictured. *Catlin amputating knife* - A **Catlin amputating knife** is a long, narrow knife primarily used for **amputations**, designed for cutting through tissue and muscle, not for skin grafting. - It has a distinct shape and purpose different from the instrument in the image. *Silver's knife* - **Silver's knife** is another type of blade used in surgery, often associated with a specific cutting technique or for specialized tissue dissection. - It is not a dermatome used for harvesting large split-thickness skin grafts.

Q: The following image shows

Encephalocele. ***Encephalocele*** - The image shows a **protrusion (sac) on the scalp** of a child, suggesting a congenital defect where brain tissue and/or meninges herniate through a defect in the skull. This is characteristic of an **encephalocele**. - **Encephaloceles** often present as a skin-covered or membranous sac, typically found along the midline of the skull, as depicted in the image. *Dermoid cyst* - A dermoid cyst is a **benign tumor** that contains mature skin structures like hair follicles and sebaceous glands. - While they can occur on the scalp, they are typically **smaller, firmer, and do not communicate with the intracranial cavity**, unlike the large, soft-appearing protrusion in the image. *Sebaceous cyst* - A sebaceous cyst, or epidermoid cyst, is a **closed sac under the skin** filled with keratin and fatty material. - These are generally **firm, mobile, and do not represent a herniation of intracranial contents**, making them unlikely given the size and appearance of the lesion. *Neurofibroma* - A neurofibroma is a **benign tumor of nerve sheath cells** that can manifest as a skin lesion or subcutaneous nodule. - While they can vary in size, they usually appear as soft, fleshy growths and are **not associated with a skull defect or herniation of brain tissue**, which is the defining feature of the lesion shown.

Question 1

What is the name of this triangle?

Accepted Answer

Gastrinoma triangle

Answer

Cholecystohepatic triangle

Answer

Doom's triangle

Answer

Calot's triangle

Question 2

Most commonly used approach for retrosternal goitre:-

Accepted Answer

Transcervical

Answer

Transthoracic second intercostal space

Answer

Axillary approach

Answer

Trans-sternal through anterior mediastinum

Question 3

Which of the following best describes a degloving injury?

Accepted Answer

Separation of skin, subcutaneous tissue, and fascia with tendon exposure

Answer

Separation of only the skin layer

Answer

Separation of skin and subcutaneous tissue without fascia involvement

Answer

Exposure of tendons without skin and fascia separation

Question 4

A patient presents with a gradually progressive, painless mass persisting for 10 years. The mass is firm to nodular and shows variable consistency within different areas of the swelling. What is the most probable diagnosis?

Accepted Answer

Pleomorphic adenoma

Answer

Dermoid cyst

Answer

Malignancy

Answer

Sebaceous cyst

Question 5

Cushing ulcers are:-

Accepted Answer

Stress ulcers in head injury

Answer

Stress ulcers in hiatus hernia

Answer

Stress ulcers in burns

Answer

Stress ulcers in depression

Question 6

A 40 years old male was brought emergency with severe abdominal pain. On examination, pulse rate was 112/minute and systolic BP was 80 mmHg. Chest x-ray is given below. What is the most appropriate management?

Accepted Answer

Exploratory laparotomy

Answer

Saline wash of stomach

Answer

Intercostal tube drainage

Answer

IV antibiotics

Question 7

Which of the following is true about tenosynovitis of the finger?

Accepted Answer

Tenosynovitis of little finger will spread to thumb rather than ring finger.

Answer

Treatment is conservative.

Answer

Fingers held in mild extension / Extension deformity at the involved fingers.

Answer

With involvement of little finger the infection can spread to the ring finger.

Question 8

Identify this instrument which is used for harvesting graft from a healthy area in split skin grafting:

Accepted Answer

Humby's knife

Answer

Brown's dermatome

Answer

Catlin amputating knife

Answer

Silver's knife

Question 9

The following image shows

Accepted Answer

Encephalocele

Answer

Dermoid cyst

Answer

Sebaceous cyst

Answer

Neurofibroma

NEET-PG 2019 — Surgery