Which of the following is an example of a clean surgery?
Best approach for emergency thoracotomy in acute thoracic trauma is
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?
Which type of fracture is most likely to cause exsanguinating blood loss?
What is considered a poor prognostic indicator in Pott's paraplegia?
Pulled up cecum is seen in which condition?
Periorbital ecchymosis without direct orbital trauma (raccoon eyes) is most commonly associated with injury to:
NEET-PG 2013 - Surgery NEET-PG Practice Questions and MCQs
Question 51: 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 52: Best approach for emergency thoracotomy in acute thoracic trauma is
- A. Midline sternotomy
- B. Parasternal thoracotomy
- C. Anterolateral thoracotomy (Correct Answer)
- D. Posterolateral thoracotomy
Explanation: ***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.
Question 53: 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 54: 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 55: 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 56: 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 57: Which type of fracture is most likely to cause exsanguinating blood loss?
- A. Closed tibial fracture
- B. Open femoral fracture (Correct Answer)
- C. Open humeral fracture
- D. Closed humeral fracture
Explanation: ***Open femoral fracture*** - An **open femoral fracture** involves both a break in the **femur** (the largest bone in the body, which houses significant marrow and has an extensive blood supply) and a break in the skin, allowing for direct external bleeding. - The **femur** can bleed up to **1-2 liters internally** even in a closed fracture, and an **open fracture** compounds this risk with direct external blood loss, leading to rapid exsanguination. *Closed tibial fracture* - A **closed tibial fracture** does not involve a break in the skin, so external bleeding is not a primary concern. - While there can be internal bleeding, the **tibia** is smaller than the femur and generally causes less significant blood loss (typically **250-500 mL**) compared to a femoral fracture. *Open humeral fracture* - An **open humeral fracture** involves exposure of the bone to the outside, but the **humerus** is a smaller bone with less marrow volume and blood supply compared to the femur. - While bleeding can be significant, especially if major vessels like the **brachial artery** are damaged, the overall potential for rapid, life-threatening **exsanguination** is less than with a femoral fracture. *Closed humeral fracture* - A **closed humeral fracture** does not involve a break in the skin, limiting blood loss to internal bleeding within the arm. - The **humerus** is a relatively smaller bone and, in a closed fracture, the surrounding tissues can tamponade some of the bleeding, making exsanguinating hemorrhage unlikely.
Question 58: What is considered a poor prognostic indicator in Pott's paraplegia?
- A. Healed disease
- B. Chronic disease
- C. Rapid progression of neurological deficits (Correct Answer)
- D. Active disease
Explanation: ***Rapid progression of neurological deficits*** - **Rapid progression** implies severe spinal cord damage occurring quickly, which is less likely to fully recover even with treatment. - This indicates a more aggressive disease process or significant compression that can lead to irreversible neurological impairment. *Healed disease* - **Healed disease** (even if paraplegia existed previously) indicates that the infection is resolved and the destructive process has stopped, allowing for potential neurological recovery or stability. - While residual neurological deficits might remain, the absence of active inflammation improves the long-term prognosis compared to ongoing damage. *Chronic disease* - **Chronic disease** in the context of Pott's paraplegia often refers to established deficits after a prolonged course, but it doesn't necessarily imply ongoing active deterioration. - The chronicity itself, without rapid progression, suggests a more stable state where the damage has already occurred, and further deterioration might be slow or absent. *Active disease* - **Active disease** means the infection is still present and causing bone destruction, which is a concern. - However, if the neurological deficits are not rapidly progressing, there is still a window for treatment to stop the disease and potentially allow for some recovery, distinguishing it from an acute, rapidly deteriorating situation.
Question 59: Pulled up cecum is seen in which condition?
- A. Cecal carcinoma
- B. Intussusception
- C. Colon carcinoma
- D. Ileocecal tuberculosis (TB) (Correct Answer)
Explanation: ***Ileocecal tuberculosis (TB)*** - **Ileocecal tuberculosis** commonly causes **fibrosis** and stricture formation in the ileocecal region, which can lead to the **retraction or pulling up of the cecum**. - This "pulled-up cecum" is a characteristic radiographic finding, often associated with a **patulous ileocecal valve** and inflammatory changes. *Cecal carcinoma* - While cecal carcinoma can cause a mass and involve the cecum, it does not typically lead to a "pulled-up" appearance. - Carcinoma usually presents as a **filling defect** or an **obstructing lesion** rather than retraction. *Intussusception* - **Intussusception** involves the telescoping of one part of the intestine into another, usually presenting as a **target sign** on imaging. - This condition does not cause a *pulled-up cecum*; instead, it involves the distal segment invaginating into the proximal segment. *Colon carcinoma* - **Colon carcinoma** can manifest as an **apple-core lesion** or an obstructing mass, but like cecal carcinoma, it generally does not cause the cecum to be pulled upwards. - The pathology is primarily one of **luminal narrowing** or mass obstruction.
Question 60: Periorbital ecchymosis without direct orbital trauma (raccoon eyes) is most commonly associated with injury to:
- A. Base of skull (Correct Answer)
- B. Pinna
- C. Scalp
- D. Eye
Explanation: ***Base of skull*** - **Periorbital ecchymosis** (raccoon eyes) is a classic sign of a **basilar skull fracture**, particularly one involving the **anterior cranial fossa**. - The fracture allows blood to leak from the cranial cavity and track along fascial planes into the periorbital soft tissues. - The key feature is that ecchymosis occurs **without direct trauma to the orbit or eye**, indicating the primary injury is to the **skull base**. - Often associated with CSF rhinorrhea and requires CT imaging for diagnosis. *Eye* - The question specifically states the ecchymosis occurs "**without direct orbital trauma**," meaning the eye/orbit is NOT the site of injury. - The eye region is where the sign **manifests** (blood tracks to this area), but it is not the site of the underlying injury. - Direct eye trauma would cause immediate localized periorbital swelling, not the delayed bilateral "raccoon eyes" pattern. *Pinna* - Pinna (ear) injury can be associated with head trauma, and Battle's sign (retroauricular ecchymosis) indicates temporal bone fracture. - However, pinna injury does not cause periorbital ecchymosis; these are separate findings. *Scalp* - Scalp injuries cause localized bleeding and swelling at the impact site. - While scalp trauma may accompany basilar skull fracture, the scalp itself is not the source of periorbital ecchymosis. - Blood from scalp wounds tracks superficially, not into deep fascial planes leading to the orbits.