NEET-PG 2013 - Surgery Practice Questions

Q: Head & face burn in infant accounts for what percentage of total body surface area?

18%. ***18%*** - In infants, the **Rule of Nines** is modified due to their proportionally larger head and smaller lower extremities compared to adults. - The head and face in an infant account for a larger percentage of the **total body surface area (TBSA)**, specifically 18%. *15%* - This percentage is inaccurate for an infant's head and face when calculating **TBSA** using the modified Rule of Nines. - While some areas might be 15% in adults, an infant's head is proportionally larger. *12%* - This percentage significantly **underestimates** the body surface area of an infant's head and face. - Using this value would lead to an incorrect assessment of **burn size** and potential under-resuscitation. *32%* - This percentage far **overestimates** the surface area of an infant's head and face. - Such a high value would result in an incorrect assessment of **burn severity** and potentially lead to over-resuscitation.

Q: Most common anomaly of upper urogenital tract is -

Uretero pelvic junction stenosis. ***Uretero pelvic junction stenosis*** - **Ureteropelvic junction (UPJ) obstruction** is the most common cause of **antenatally detected hydronephrosis**, making it the most frequent anomaly of the upper urogenital tract. - It results from an intrinsic or extrinsic narrowing at the junction of the **renal pelvis** and the **ureter**, impeding urine flow. *Ectopic urethral opening* - This anomaly involves the **urethral opening** being in an abnormal location, such as **hypospadias** or **epispadias** in males, or into the vagina in females. - While relatively common, it is an anomaly of the **lower urogenital tract**, specifically the urethra, not the upper tract. *Ureterocele* - A ureterocele is a **cystic dilation** of the distal part of the ureter as it enters the bladder. - While it can be associated with varying degrees of **upper tract obstruction**, it is not as common as UPJ stenosis. *Ectopic ureter* - An ectopic ureter involves a ureter that drains into an abnormal location other than the **trigone of the bladder**. - This condition is less common than UPJ stenosis and is often associated with a **duplex collecting system**.

Q: In which one of the following conditions is gas under the diaphragm typically seen?

Perforated duodenal ulcer. ***Perforated duodenal ulcer*** - A perforated duodenal ulcer creates a communication between the **lumen of the duodenum and the peritoneal cavity**, allowing air from the gastrointestinal tract to escape. - This free air, being lighter, rises and collects under the **diaphragm**, visible as **pneumoperitoneum** on an upright chest X-ray. - This is the **classic and most typical** presentation taught in medical education for gas under the diaphragm. - Occurs in approximately **70-75% of cases** of peptic ulcer perforation. *Typhoid perforation* - Typhoid perforation (typically affecting the **terminal ileum**) also causes pneumoperitoneum and can show gas under the diaphragm. - However, it is **less commonly encountered** in routine practice compared to peptic ulcer perforation in most settings. - The question asks for the **"typically seen"** condition, which refers to the classic teaching example: perforated duodenal ulcer. *After laparotomy* - It is normal to see a small amount of **residual intra-abdominal gas** for a few days to a week after a laparotomy, which can collect under the diaphragm. - However, this is a **post-surgical finding** and not a pathological condition leading to gas under the diaphragm in the same acute, diagnostic sense as a perforation. - Not the answer when considering pathological causes. *Spontaneous rupture of oesophagus* - Spontaneous oesophageal rupture (Boerhaave syndrome) leads to leakage of oesophageal contents into the **mediastinum or pleural cavity**, not the peritoneal cavity. - Presents with **mediastinal emphysema** (Hamman's sign) and pleural effusion rather than pneumoperitoneum. - **Subdiaphragmatic free air** indicative of pneumoperitoneum is not typically seen.

Q: Commonest site of carcinoma tongue -

Lateral borders. ***Lateral borders*** - The **lateral borders** of the tongue are the most common site for squamous cell carcinoma due to chronic irritation from teeth, dental appliances, and exposure to carcinogens. - This area is subjected to considerable mechanical stress and chemical exposure, making it more susceptible to malignant transformation. *Apical* - While the apex (tip) of the tongue can be affected, it is **less common** compared to the lateral borders. - Tumors in this location may present earlier due to their prominent position, but incidence rates are lower. *Dorsum* - The **dorsum** (top surface) of the tongue is covered by papillae which provide some protective barrier, making it a **less frequent site** for carcinoma. - Carcinomas on the dorsum are often associated with other risk factors like syphilis or immunosuppression. *Posterior 1/3* - Carcinomas of the **posterior one-third** (base of the tongue) are often associated with **Human Papillomavirus (HPV)** infection. - These are typically harder to detect early due to their location and may present with different symptoms such as dysphagia or referred otalgia, but they are not the most common overall site.

Q: Which of the following conditions is not typically treated with a simple mastectomy?

Fibroadenoma. ***Fibroadenoma*** - A **fibroadenoma** is a **benign tumor** of the breast that typically does not require a mastectomy for treatment. - Treatment usually involves **observation**, **excision**, or **cryoablation**, depending on size, symptoms, and patient preference. *Paget's disease* - **Paget's disease of the breast** is a rare form of breast cancer that affects the nipple and areola, and is typically associated with an underlying **ductal carcinoma in situ** (DCIS) or **invasive breast cancer**. - Due to the presence of malignancy and its superficial spread, **mastectomy** (simple or modified radical) is often the recommended treatment, especially for extensive disease. *Cystosarcoma phyllodes* - Formerly known as **phyllodes tumor**, this is a rare **stromal tumor** of the breast that can be benign, borderline, or malignant. - Due to its potential for local recurrence and, in malignant cases, metastasis, **wide local excision with clear margins** is crucial, and a **simple mastectomy** may be necessary for large or recurrent tumors to achieve adequate margin control. *None of the options* - This option is incorrect because fibroadenoma is a condition not typically treated with a simple mastectomy, unlike Paget's disease and cystosarcoma phyllodes.

Q: Best approach for emergency thoracotomy in acute thoracic trauma is

Anterolateral thoracotomy. ***Anterolateral thoracotomy*** - Provides **rapid access** to the chest cavity for emergent situations, such as **cardiac tamponade** or **massive hemorrhage**, which are common in thoracic trauma. - Allows assessment and management of injuries to the **heart, great vessels, and lungs** with minimal repositioning in a critically ill patient. *Midline sternotomy* - Primarily used for **cardiac surgery**, offering excellent exposure to the mediastinum but is less ideal for general thoracic trauma with potential lateral injuries. - Takes **longer to perform** than an anterolateral approach and may not be suitable in an emergent, unstable trauma setting. *Parasternal thoracotomy* - Offers more limited access compared to other approaches, typically used for specific, localized procedures near the sternum. - Does not provide the **broad exposure** needed to manage the diverse and potentially widespread injuries seen in severe thoracic trauma. *Posterolateral thoracotomy* - Provides excellent exposure to the **posterior mediastinum, spine, and descending aorta**, but requires the patient to be in the lateral decubitus position. - Repositioning a severely injured trauma patient for this approach is often **impractical and time-consuming**, making it unsuitable for initial resuscitation.

Q: Primary treatment for localized malignant melanoma is

Wide excision. ***Wide excision*** - This is the **primary treatment** for localized malignant melanoma, aiming to completely remove the tumor along with a surrounding margin of healthy tissue to reduce recurrence risk. - The excisional margin width depends on the **Breslow depth** (tumor thickness). *Radiotherapy* - Not the primary treatment for localized melanoma, as melanoma cells are often **radioresistant**. - It may be used as **adjuvant therapy** for local control in cases of positive margins or nodal involvement, or for palliative care in metastatic disease. *Excision* - While excision is part of the treatment, the term **"wide excision"** specifically implies removing a sufficient margin of healthy tissue around the tumor. - Simple excision without appropriate margins is generally inadequate for malignant melanoma and carries a **high risk of local recurrence**. *Chemotherapy* - It is generally **not the first-line treatment** for localized melanoma due to limited efficacy and significant side effects. - Chemotherapy agents are typically reserved for **advanced or metastatic melanoma** and are often replaced by targeted therapies or immunotherapy in modern practice.

Q: All are true about carcinoma penis except which of the following?

Spreads by blood borne metastasis. ***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 1

Head & face burn in infant accounts for what percentage of total body surface area?

Accepted Answer

18%

Answer

15%

Answer

12%

Answer

32%

Question 2

Most common anomaly of upper urogenital tract is -

Accepted Answer

Uretero pelvic junction stenosis

Answer

Ureterocele

Answer

Ectopic ureter

Answer

Ectopic urethral opening

Question 3

In which one of the following conditions is gas under the diaphragm typically seen?

Accepted Answer

Perforated duodenal ulcer

Answer

Typhoid perforation

Answer

After laparotomy

Answer

Spontaneous rupture of oesophagus

Question 4

Which fracture pattern is classified as a Le Fort I fracture?

Accepted Answer

Horizontal fracture of the maxilla separating teeth from upper jaw

Answer

Pyramidal fracture involving maxilla and nasal bones

Answer

Complete craniofacial separation involving the upper face

Answer

Isolated nasal bone fracture

Question 5

Commonest site of carcinoma tongue -

Accepted Answer

Lateral borders

Answer

Apical

Answer

Dorsum

Answer

Posterior 1/3

Question 6

Which of the following conditions is not typically treated with a simple mastectomy?

Accepted Answer

Fibroadenoma

Answer

Paget's disease

Answer

Cystosarcoma phyllodes

Answer

None of the options

Question 7

What causes Frey's syndrome?

Accepted Answer

Aberrant regeneration of parasympathetic fibers from the auriculotemporal nerve to sweat glands.

Answer

Facial nerve damage.

Answer

Greater auricular nerve involvement.

Answer

None of the options

Question 8

Best approach for emergency thoracotomy in acute thoracic trauma is

Accepted Answer

Anterolateral thoracotomy

Answer

Midline sternotomy

Answer

Parasternal thoracotomy

Answer

Posterolateral thoracotomy

Question 9

Primary treatment for localized malignant melanoma is

Accepted Answer

Wide excision

Answer

Radiotherapy

Answer

Excision

Answer

Chemotherapy

Question 10

All are true about carcinoma penis except which of the following?

Accepted Answer

Spreads by blood borne metastasis

Answer

Leads to erosion of artery

Answer

Slowly progressive

Answer

Most common type is squamous cell carcinoma

NEET-PG 2013 — Surgery