NEET-PG 2023 - Surgery Practice Questions

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: A swelling behind the ear suggests fracture of:

Temporal bone. ***Temporal bone*** - Swelling behind the ear is a classic sign of **temporal bone fracture**, particularly involving the **mastoid portion**, which creates the characteristic **Battle's sign** (post-auricular ecchymosis and swelling). - Temporal bone fractures often accompany **basilar skull fractures** and may present with additional signs like **hemotympanum**, **CSF otorrhea**, or **facial nerve palsy**. *Orbital floor fracture* - **Orbital floor fractures** cause periorbital swelling, **diplopia** (especially on upward gaze), and **enophthalmos**, all localized to the **orbital region**. - These fractures do not involve structures behind the ear and would not cause **post-auricular swelling**. *Condylar fracture* - **Condylar fractures** typically cause **pre-auricular swelling** and pain, especially with jaw movement, as the condyle is located in front of the ear. - The swelling is anterior to the ear canal, not posterior, and is often accompanied by **trismus** and **malocclusion**. *Zygomatic complex* - **Zygomatic complex fractures** cause swelling and ecchymosis around the **cheekbone** and lateral orbital rim, not behind the ear. - These fractures may also cause **infraorbital numbness** due to infraorbital nerve involvement and **trismus** from coronoid process impingement.

Q: When resuscitating a patient in shock which of the following is not an adequate parameter to predict end point of resuscitation?

Blood pressure. ***Blood pressure*** - While essential for initial assessment and guiding treatment, **blood pressure** can be maintained within normal limits even in significant shock states due to compensatory mechanisms [1]. - Blood pressure alone does not reflect **tissue perfusion** or cellular oxygenation, which are the true endpoints of resuscitation [1]. *Mixed venous oxygen saturation* - **Mixed venous oxygen saturation (SvO2)** reflects the balance between oxygen delivery and consumption, providing insight into global tissue oxygenation. - A low SvO2 indicates inadequate oxygen delivery relative to demand, making it a valuable target for guiding resuscitation. *Base deficit* - **Base deficit** is a measure of metabolic acidosis and reflects the severity of tissue hypoperfusion and anaerobic metabolism. - Normalization of base deficit indicates correction of metabolic derangements and improved tissue perfusion. *Lactate* - **Lactate** is a product of anaerobic metabolism, which occurs when tissues are not adequately perfused or oxygenated. - Elevated lactate levels indicate tissue hypoperfusion, and serial measurements are crucial for monitoring the effectiveness of resuscitation and predicting outcomes.

Question 1

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 2

A swelling behind the ear suggests fracture of:

Accepted Answer

Temporal bone

Answer

Zygomatic complex

Answer

Condylar fracture

Answer

Orbital floor fracture

Question 3

When resuscitating a patient in shock which of the following is not an adequate parameter to predict end point of resuscitation?

Accepted Answer

Blood pressure

Answer

Mixed venous oxygen saturation

Answer

Base deficit

Answer

Lactate

NEET-PG 2023 — Surgery