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NEET-PG 2013 — Surgery

Q: Fatal exsanguination occurs most commonly in

Partial transection of an artery. ***Partial transection of an artery*** - A **partially transected artery** is the most dangerous scenario for fatal exsanguination - The vessel walls **cannot retract or undergo effective vasospasm** because they remain tethered - The torn opening remains patent, allowing **continuous and profuse bleeding** - This is a classic surgical principle: **partial arterial injuries bleed more than complete transections** - Without prompt surgical control, this leads to rapid and fatal exsanguination *Complete transection of an artery* - When an artery is completely transected, the vessel ends **retract and go into spasm** - This natural hemostatic mechanism significantly **reduces immediate blood loss** - While still serious and requiring urgent treatment, complete transection is **less likely to cause fatal exsanguination** than partial transection - The retraction and spasm provide temporary hemostasis until definitive repair *Open fracture of the femur and tibia* - Can cause significant bleeding from muscle, soft tissue, and bone - However, the bleeding is typically **not from major arterial injury** unless vessels are directly damaged - Usually controllable with **tourniquets, pressure dressings, and splinting** - Less likely to cause immediate fatal exsanguination compared to major arterial injury *Closed fracture of the femoral shaft* - Can result in substantial internal blood loss (up to **1-1.5 liters** into the thigh compartment) - May cause **hypovolemic shock** requiring transfusion - However, the closed space provides some tamponade effect - Rarely causes immediate **fatal exsanguination** unless associated with other major injuries

Q: Sistrunk operation is for:

Thyroglossal cyst. ***Thyroglossal cyst*** - The **Sistrunk operation** is the definitive surgical procedure for the removal of a **thyroglossal duct cyst**. - This procedure involves excising the cyst along with the central portion of the **hyoid bone** and a core of muscle from the posterior aspect of the hyoid to the foramen cecum to prevent recurrence. *Thyroglossal fistula* - A **thyroglossal fistula** is a complication of a thyroglossal cyst that has ruptured or been surgically incised, leading to a persistent tract to the skin. - While a Sistrunk operation may be performed for a fistula, it is primarily indicated for the *cyst* itself to prevent both recurrence of the cyst and subsequent fistula formation. *Branchial fistula* - A **branchial fistula** is a congenital anomaly resulting from incomplete closure of the branchial arches during embryonic development, leading to an abnormal tract between the neck and the pharynx or skin. - Surgical excision of a branchial fistula is a different procedure from the Sistrunk operation, as its anatomical location and developmental origin are distinct from those of a thyroglossal cyst. *Branchial cyst* - A **branchial cyst** is a congenital neck mass arising from remnants of the branchial arches, typically presenting as a painless, soft, movable lump in the lateral neck. - While also a congenital neck cyst requiring surgical excision, the surgical approach for a branchial cyst does not involve the hyoid bone in the same manner as the Sistrunk operation due to its different embryological origin and location.

52 Questions — Page 6 of 6

Q51

Fatal exsanguination occurs most commonly in

Q52

Sistrunk operation is for: