NEET-PG 2012 - Surgery Practice Questions

Q: Best gas used for creating pneumoperitoneum at laparoscopy is:

CO2. ***CO2*** - **Carbon dioxide** is rapidly absorbed and expelled by the respiratory system, minimizing the risk of **gas embolism**. - It is **non-flammable**, which is crucial in a surgical environment where electrosurgical devices are often used. - CO2 is **highly soluble in blood**, allowing rapid clearance if venous absorption occurs. *N2* - **Nitrogen** is not ideal for pneumoperitoneum as its poor solubility in blood leads to a significant risk of **gas embolism**. - **Increased nitrogen pockets** can create complications that make it a poor choice. *O2* - **Oxygen** poses a significant **fire hazard** in the presence of electrosurgical instruments. - It **supports combustion**, making the surgical field dangerous when using electrocautery or laser devices. *N2O* - **Nitrous oxide** supports **combustion**, making it unsafe for use with electrosurgical devices. - It can also diffuse into **bowel loops**, causing distension and obstructing visibility, which is undesirable during laparoscopy.

Q: The term 'raspberry tumor' is most commonly associated with which of the following conditions?

Umbilical granuloma. ***Umbilical granuloma*** - An **umbilical granuloma** is a common condition in newborns, presenting as a soft, red, moist growth at the umbilicus after the umbilical cord detaches. - Its characteristic appearance, resembling a small red berry, has led to the descriptive term "**raspberry tumor**." *Umbilical fistula* - An **umbilical fistula** is an abnormal connection that can occur between the intestine or bladder and the umbilicus, leading to the discharge of stool or urine from the umbilicus. - It does not present as a fleshy, raspberry-like growth, but rather as an opening with discharge. *Meckel’s diverticulum* - **Meckel's diverticulum** is a remnant of the **vitelline duct**, typically found on the anti-mesenteric border of the ileum, and is a congenital anomaly of the small intestine. - It is an internal structure and does not manifest externally at the umbilicus as a "raspberry tumor." *Umbilical adenoma* - An **umbilical adenoma** is a rare tumor of the umbilicus, often a remnant of the **vitelline duct** or **urachus**, which can present as a reddish mass. - While it can be a reddish mass, the specific term "raspberry tumor" is not commonly associated with umbilical adenoma but rather with umbilical granuloma due to its very distinct granular appearance.

Q: The appearance described as an inverted champagne bottle is associated with which condition?

Lipodermatosclerosis. ***Lipodermatosclerosis*** - This condition presents with a characteristic "inverted champagne bottle" appearance, where the **ankle area is narrow** and the **calf area above it is wider** due to fibrotic changes and fat atrophy. - It's a severe manifestation of **chronic venous insufficiency**, characterized by **skin hardening**, pigmentation, and inflammation, often preceding venous ulceration. *Varicose veins (enlarged, twisted veins)* - While associated with **venous insufficiency**, varicose veins themselves are **dilated, tortuous superficial veins**, and do not typically cause the generalized lower leg shape change described. - They may cause swelling and discomfort but do not directly lead to the **fibrotic narrowing** seen in an "inverted champagne bottle" leg. *Deep vein thrombosis (DVT) (acute venous obstruction)* - DVT is an **acute condition** involving a **blood clot in a deep vein**, leading to sudden onset pain, swelling, and redness. - It does not cause the **chronic skin changes** and **fibrotic reshaping** of the calf and ankle that characterize lipodermatosclerosis. *Venous ulceration (open sores due to venous insufficiency)* - Venous ulcers are **open sores** that occur in severe chronic venous insufficiency, often found above the medial malleolus. - While they are a complication of the underlying venous disease that can also cause lipodermatosclerosis, the ulceration itself is a **skin lesion**, not the **overall inverted champagne bottle shape** of the leg.

Q: A 10 cm tumor is found on the anterior surface of the thigh. What is the most appropriate procedure to obtain a diagnosis?

Incision biopsy. ***Incision biopsy*** - An **incision biopsy** is most appropriate for a large tumor (10 cm) to obtain a tissue diagnosis without performing a potentially morbid or disfiguring complete excision upfront. - It involves removing a representative section of the tumor for histopathological analysis, providing adequate tissue for diagnosis, grading, and subtyping. - This allows definitive treatment planning based on confirmed histopathology. *Excision biopsy* - **Excision biopsy** is generally reserved for smaller tumors (typically <3-5 cm) that can be completely resected with acceptable cosmetic and functional outcomes. - Excision of a 10 cm tumor on the thigh would be a significant surgical procedure, potentially causing substantial morbidity, without a prior definitive diagnosis. - Could compromise subsequent definitive surgery if margins are inadequate. *FNAC* - **FNAC (Fine Needle Aspiration Cytology)** provides only cytological diagnosis, which is insufficient for definitive diagnosis, grading, and subtyping of soft tissue tumors, especially sarcomas. - It misses crucial architectural features and tissue patterns needed for accurate classification. - May yield inadequate or non-diagnostic samples from large heterogeneous tumors. *USG* - **USG (Ultrasound)** is an imaging modality, not a tissue diagnosis procedure. - While useful for characterizing mass features (size, location, vascularity, solid vs cystic), it cannot provide histopathological diagnosis. - The question specifically asks for a procedure to "obtain a diagnosis," which requires tissue sampling for microscopic examination.

Q: Which of the following is a common consequence of gastrectomy?

Iron deficiency. ***Iron deficiency*** - Gastrectomy often leads to **achlorhydria** or hypochlorhydria, reducing the conversion of **ferric iron** (Fe3+) to its more absorbable ferrous form (Fe2+). - Additionally, bypassing the duodenum, a primary site of iron absorption, further contributes to **iron malabsorption**. *Calcium deficiency* - While gastrectomy can contribute to calcium malabsorption due to reduced gastric acidity and faster transit, **iron deficiency** is typically a more direct and common initial consequence. - **Vitamin D deficiency**, often co-occurring with gastrectomy, is a more direct cause of **calcium malabsorption**. *Steatorrhoea* - **Steatorrhoea** (fat malabsorption) is more commonly associated with conditions affecting the **pancreas** or **small intestine** (e.g., celiac disease, chronic pancreatitis) rather than primarily gastrectomy unless there is significant bile salt malabsorption or rapid gastric emptying affecting nutrient mixing. - Although rapid transit post-gastrectomy can sometimes impair fat digestion, it's not the most common direct consequence compared to iron deficiency. *Fluid loss* - **Fluid loss** is usually an acute post-surgical complication or related to conditions causing vomiting or diarrhea, and not a common long-term consequence of gastrectomy itself. - While **dumping syndrome** can occur after gastrectomy, causing osmotic fluid shifts into the intestine, generalized chronic fluid loss is not a primary recognized long-term sequela.

Q: What is the type of Intussusception that is most frequently observed?

Ileocolic type. ***Ileocolic type*** - This is the **most common form of intussusception**, accounting for approximately 75% to 90% of cases, especially in children. - It occurs when the **ileum telescopes into the colon** at the ileocecal valve. *Ileoileal type* - This type involves the **invagination of one part of the ileum into another part of the ileum**. - While it can occur, it is **less common than ileocolic intussusception** and is more often associated with a pathological lead point in older children and adults. *Colo-colic type* - This involves the **telescoping of one segment of the colon into another segment of the colon**. - It is **rare in children** and, when present, is almost always associated with a pathological lead point, such as a polyp or tumor, primarily in adults. *Caeco-colic type* - This type occurs when the **cecum telescopes into the ascending colon**. - It is also a **relatively uncommon form of intussusception** compared to the ileocolic type.

Q: In the context of inflammatory breast cancer, what is the TNM stage associated with the peau d'orange appearance?

T4b. ***T4b*** * The **TNM staging system** classifies T4b specifically for inflammatory breast cancer, which is characterized by the presence of **peau d'orange** (edema) of the skin of the breast. * This T stage also encompasses **ulceration of the skin** of the breast or satellite nodules confined to the same breast. *T4a* * T4a describes an **extension to the chest wall**, which includes the ribs, intercostal muscles, and serratus anterior muscle, but **not** the pectoralis muscle, which is generally not considered part of the chest wall for this classification. * This stage does **not** include the characteristic skin changes associated with inflammatory breast cancer. *T3* * T3 describes a tumor with a **size greater than 5 cm** in its greatest dimension, without direct extension to the chest wall or skin involvement. * This stage is based solely on tumor size and **does not account for the skin changes** like peau d'orange. *T2* * T2 describes a tumor with a **size greater than 2 cm but not more than 5 cm** in its greatest dimension. * Similar to T3, this stage is also based on tumor size and **does not include any skin involvement** or inflammatory features.

Q: What is the first-line intervention for acute symptomatic hydroureter with ureteral obstruction requiring urgent decompression?

Endoscopic ureteral stenting. ***Endoscopic ureteral stenting*** - **Endoscopic ureteral stenting** is the primary intervention for **acute symptomatic ureteral obstruction** requiring urgent decompression when the obstruction causes **hydroureter**. - This minimally invasive procedure provides immediate drainage from the kidney to the bladder, preventing further renal damage, managing pain, and relieving obstruction. - **Indications for urgent stenting** include: infected hydronephrosis, impaired renal function, intractable pain, solitary kidney with obstruction, or bilateral obstruction. - Alternative to stenting is **percutaneous nephrostomy**, particularly when retrograde stent placement fails or in infected systems. *Antibiotic prophylaxis alone* - While antibiotics are essential when infection complicates obstruction (pyonephrosis), **antibiotics alone cannot relieve the mechanical obstruction**. - The physical blockage must be addressed to prevent progressive renal damage and sepsis. *Immediate ureterolithotomy* - **Open ureterolithotomy** is a definitive surgical treatment but is **not first-line** for acute obstruction. - It is more invasive and typically reserved for failed endoscopic management, large impacted stones, or anatomical abnormalities preventing endoscopic access. - Modern approach favors initial decompression followed by definitive treatment (ureteroscopy, ESWL, or surgery). *Urinary alkalization* - **Urinary alkalization** may help dissolve **uric acid stones** over time but does not provide immediate relief of acute obstruction. - This is an adjunctive measure for specific stone types, not an emergency intervention for symptomatic hydroureter.

Q: Which of the following hernias has the highest risk of strangulation?

Spigelian. ***Spigelian*** - **Spigelian hernias** occur through a defect in the **Spigelian aponeurosis** (between the semilunar line and lateral border of rectus abdominis), typically inferior to the arcuate line. - They have a **high risk of strangulation (20-25%)** due to their **narrow fascial defect** and tendency to become incarcerated through the layers of the abdominal wall. - The hernia often becomes **interparietal** (between muscle layers), making it difficult to detect clinically, which increases the risk of delayed presentation and strangulation. *Indirect* - **Indirect inguinal hernias** pass through the **deep inguinal ring** and follow the inguinal canal, potentially entering the scrotum. - While they do have a narrow neck that can cause strangulation, their **strangulation risk is moderate (~10-15%)**, lower than Spigelian hernias. - They are the most common type of hernia but not the highest risk for strangulation among these options. *Direct* - **Direct inguinal hernias** protrude through **Hesselbach's triangle** in the posterior wall of the inguinal canal. - They have a **broad-based neck**, making strangulation relatively uncommon (~5%). - The wider defect allows easier reduction and less constriction of contents. *Incisional* - **Incisional hernias** develop at previous surgical incision sites due to fascial weakness or inadequate healing. - While they can incarcerate, they typically have a **wider neck** and **lower strangulation risk** compared to Spigelian or indirect inguinal hernias. - Risk varies with defect size, but generally not the highest among common hernia types.

Q: What is the first step to be taken in the management of a cervical spine injury?

Immobilization of spine. ***Immobilization of spine*** - In the context of **isolated cervical spine injury management**, **spinal immobilization** is the primary intervention to prevent further neurological damage. - This is typically achieved using a **cervical collar** and **backboard** to maintain in-line spinal stabilization. - **Note**: In actual trauma scenarios following **ATLS protocols**, airway management and cervical spine immobilization occur **simultaneously** as the first priority (Airway with C-spine protection). *Turn head* - **Turning the head** is absolutely contraindicated as it can exacerbate a cervical spine injury, leading to further compression or damage to the **spinal cord**. - Maintaining a **neutral, in-line position** is critical to avoid neurological deterioration. *Maintain airway* - In comprehensive trauma management per **ATLS guidelines**, **airway management with simultaneous cervical spine protection** is the first priority in the ABC sequence. - Airway is maintained using methods that do not compromise spinal stability, such as a **jaw thrust maneuver** or **endotracheal intubation with manual in-line stabilization**. - The distinction here is that this question focuses on the specific step for **spinal injury management** rather than overall trauma priorities. *None of the options* - This option is incorrect because **immobilization of the spine** is a definitive priority in managing a suspected cervical spine injury. - Both spinal immobilization and airway management are critical interventions that should occur together in actual practice.

Question 1

Best gas used for creating pneumoperitoneum at laparoscopy is:

Accepted Answer

CO2

Answer

N2

Answer

N2O

Answer

O2

Question 2

The term 'raspberry tumor' is most commonly associated with which of the following conditions?

Accepted Answer

Umbilical granuloma

Answer

Umbilical fistula

Answer

Meckel’s diverticulum

Answer

Umbilical adenoma

Question 3

The appearance described as an inverted champagne bottle is associated with which condition?

Accepted Answer

Lipodermatosclerosis

Answer

Varicose veins

Answer

Deep vein thrombosis

Answer

Venous ulceration

Question 4

A 10 cm tumor is found on the anterior surface of the thigh. What is the most appropriate procedure to obtain a diagnosis?

Accepted Answer

Incision biopsy

Answer

Excision biopsy

Answer

FNAC

Answer

USG

Question 5

Which of the following is a common consequence of gastrectomy?

Accepted Answer

Iron deficiency

Answer

Calcium deficiency

Answer

Steatorrhoea

Answer

Fluid loss

Question 6

What is the type of Intussusception that is most frequently observed?

Accepted Answer

Ileocolic type

Answer

Ileoileal type

Answer

Colo-colic type

Answer

Caeco-colic type

Question 7

In the context of inflammatory breast cancer, what is the TNM stage associated with the peau d'orange appearance?

Accepted Answer

T4b

Answer

T4a

Answer

T3

Answer

T2

Question 8

What is the first-line intervention for acute symptomatic hydroureter with ureteral obstruction requiring urgent decompression?

Accepted Answer

Endoscopic ureteral stenting

Answer

Antibiotic prophylaxis alone

Answer

Immediate ureterolithotomy

Answer

Urinary alkalization

Question 9

Which of the following hernias has the highest risk of strangulation?

Accepted Answer

Spigelian

Answer

Indirect

Answer

Direct

Answer

Incisional

Question 10

What is the first step to be taken in the management of a cervical spine injury?

Accepted Answer

Immobilization of spine

Answer

Turn head

Answer

None of the options

Answer

Maintain airway

NEET-PG 2012 — Surgery