INI-CET 2021 - Surgery PYQs Practice Questions

Q: Which among the following is not used in post laryngectomy rehabilitation?

Tracheostomy tube. ***Tracheostomy tube*** - Following total laryngectomy, the **trachea is permanently diverted** to form a permanent stoma in the neck for breathing. - In the context of **post-laryngectomy rehabilitation**, the focus is on **voice restoration** methods rather than airway management devices. - While laryngectomy tubes or stoma buttons may be used temporarily for **stoma care** (preventing stenosis, maintaining patency), traditional **tracheostomy tubes are not part of voice rehabilitation** protocols. - The patient breathes directly through the permanent stoma, and rehabilitation centers on restoring communication ability. *Esophageal speech* - **Esophageal speech** is a voice rehabilitation method where air is injected into the esophagus and then expelled, vibrating the pharyngoesophageal segment to produce sound. - It requires no external devices, only extensive training, and can provide functional voice for communication. - This is one of the **three main voice restoration options** after laryngectomy. *Tracheoesophageal puncture* - **Tracheoesophageal puncture (TEP)** with voice prosthesis is the **gold standard** for voice rehabilitation post-laryngectomy. - A small fistula is created between trachea and esophagus, and a one-way valve (voice prosthesis) is inserted. - Air from the lungs is diverted through the prosthesis into the esophagus, vibrating the pharyngoesophageal segment to produce speech. - Provides the **most natural-sounding voice** among rehabilitation options. *Electrolarynx* - An **electrolarynx** is an external, battery-operated device held against the neck or placed intraorally that generates vibrations. - The vibrations are articulated by the mouth and tongue to produce speech. - Provides **immediate communication** post-laryngectomy, though the voice quality is mechanical or robotic. [Practice more Surgery PYQs on OnCourse]

Q: Which of the following findings appear late in compartment syndrome?

Pulselessness. ***Pulselessness*** - **Pulselessness** is a very late and ominous sign in compartment syndrome, indicating severe arterial compromise that has progressed beyond simple venous and lymphatic outflow obstruction. - Its presence suggests **irreversible tissue damage** has likely already occurred due to prolonged ischemia. *Paralysis* - **Paralysis** is a late sign, indicating significant nerve ischemia and damage due to sustained pressure within the compartment. - While it's a serious finding, it typically appears before pulselessness, as nerves are sensitive to ischemia but arteries are more resistant to complete occlusion until very high pressures are reached. *Pain on passive stretch* - **Pain on passive stretch** is considered one of the earliest and most reliable clinical signs of early compartment syndrome. - It results from the stretching of ischemic muscle fibers within the confined compartment. *Pallor* - **Pallor** (skin paleness) is also a relatively late sign, occurring when capillary perfusion is significantly reduced due to rising intracompartmental pressure. - It usually manifests when the pressure is high enough to restrict blood flow but often precedes the complete absence of pulses. [Practice more Surgery PYQs on OnCourse]

Q: A 12-year-old presented with fever and difficulty swallowing. He had swelling in the marked region and was advised to undergo tonsillectomy. Post-surgery the gauze continued to soak with blood. Which of the following vessels must have been injured?

Paratonsillar vein. ***Paratonsillar vein*** - The **paratonsillar vein**, also known as the **external palatine vein**, is the major vein draining the palatine tonsil and usually the primary source of **post-tonsillectomy hemorrhage**. - Its superficial location and tendency to be large and thin-walled make it particularly vulnerable to injury during **tonsillectomy**, leading to persistent bleeding. *Ascending pharyngeal artery* - The ascending pharyngeal artery contributes to the blood supply of the tonsil, but it is a **deep-seated artery** that is less frequently injured during tonsillectomy compared to the paratonsillar vein. - While its injury could lead to significant bleeding, it's not the most common vascular source of hemorrhage in this context. *Tonsillar branch of facial artery* - The **tonsillar branch of the facial artery** is a significant arterial supply to the tonsil. However, arterial bleeding is typically more pulsatile and rapid, whereas persistent soaking of gauze suggests venous bleeding. - While injury to this artery can occur, the **paratonsillar vein** is a more common source of persistent oozing hemorrhage post-tonsillectomy. *Retromandibular vein* - The **retromandibular vein** is located posterior to the mandible and is not directly associated with the tonsillar bed. - Injury to this vein during a **tonsillectomy** is highly unlikely due to its anatomical position. [Practice more Surgery PYQs on OnCourse]

Q: A 55-year-old female patient presented with a $4 \times 3 \mathrm{~cm}$ lump in the right upper outer quadrant, with no axillary lymph node involvement. Mammography revealed BIRADS 4b staging. She underwent breast conservation surgery, and the final HPE report showed high nuclear-grade DCIS with necrosis and 10 mm margin clearance. What is the further management?

Adjuvant radiotherapy. ***Adjuvant radiotherapy*** - For **high-grade DCIS** with necrosis after breast conservation surgery, adjuvant radiotherapy significantly reduces the risk of **local recurrence** (by approximately 50%). - Even with adequate margin clearance (10 mm), radiotherapy is recommended to treat **potential residual microscopic disease** elsewhere in the breast tissue. - This is the **standard of care** for high-grade DCIS post-BCS, particularly when necrosis is present. *Follow up 6 monthly for 2 years and then yearly follow up* - While regular follow-up is essential for all breast cancer patients, it is **not sufficient alone** for high-grade DCIS treated with breast conservation. - **Adjuvant radiotherapy** is necessary to reduce recurrence risk before initiating the follow-up schedule. *Trastuzumab therapy* - **Trastuzumab** is specifically indicated for **HER2-positive invasive breast cancer**. - The patient has **DCIS**, which is **non-invasive (in situ)**, making trastuzumab inappropriate. - There is no role for targeted therapy in DCIS management. *Adjuvant chemotherapy* - **Adjuvant chemotherapy** is generally reserved for **invasive breast cancers**, especially those with high-risk features like lymph node involvement or aggressive tumor biology. - For **DCIS**, even high-grade with necrosis, chemotherapy is **not indicated** as it provides no proven benefit for non-invasive disease. [Practice more Surgery PYQs on OnCourse]

Q: You are suturing a laceration in the ER using the interrupted suturing technique. What is the angle of needle placement?

90 degrees. ***90 degrees*** - Placing the needle at a **90-degree angle** to the skin surface ensures that the suture comes out perpendicular to the skin edge, creating an **eversion of the wound edges**. - This perpendicular entry allows for an equal amount of tissue to be grasped on both sides of the wound, promoting proper **wound approximation** and healing. *80 degrees* - An 80-degree angle, while close, would not provide the ideal **perpendicular entry** needed to properly evert the wound edges. - This slight deviation from 90 degrees could lead to less precise **tissue approximation** and potentially an inverted wound edge. *70 degrees* - A 70-degree angle is too shallow and would result in the suture entering the wound more tangentially, leading to **inverted wound edges**. - **Inverted wound edges** hinder optimal healing and can result in a less aesthetically pleasing scar. *60 degrees* - A 60-degree angle is significantly too shallow, which would cause the suture to be placed too superficially and horizontally, resulting in **poor wound edge eversion**. - This angle would make it difficult to adequately appose the deeper dermal layers, compromising **tensile strength** and increasing the risk of scar formation. [Practice more Surgery PYQs on OnCourse]

Question 1

Which among the following is not used in post laryngectomy rehabilitation?

Accepted Answer

Tracheostomy tube

Answer

Esophageal speech

Answer

Tracheoesophageal puncture

Answer

Electrolarynx

Question 2

Which of the following findings appear late in compartment syndrome?

Accepted Answer

Pulselessness

Answer

Paralysis

Answer

Pain on passive stretch

Answer

Pallor

Question 3

A 12-year-old presented with fever and difficulty swallowing. He had swelling in the marked region and was advised to undergo tonsillectomy. Post-surgery the gauze continued to soak with blood. Which of the following vessels must have been injured?

Accepted Answer

Paratonsillar vein

Answer

Ascending pharyngeal artery

Answer

Tonsillar branch of facial artery

Answer

Retromandibular vein

Question 4

A 55-year-old female patient presented with a $4 	imes 3 \mathrm{~cm}$ lump in the right upper outer quadrant, with no axillary lymph node involvement. Mammography revealed BIRADS 4b staging. She underwent breast conservation surgery, and the final HPE report showed high nuclear-grade DCIS with necrosis and 10 mm margin clearance. What is the further management?

Accepted Answer

Adjuvant radiotherapy

Answer

Follow up 6 monthly for 2 years and then yearly follow up

Answer

Trastuzumab therapy

Answer

Adjuvant chemotherapy

Question 5

You are suturing a laceration in the ER using the interrupted suturing technique. What is the angle of needle placement?

Accepted Answer

90 degrees

Answer

80 degrees

Answer

70 degrees

Answer

60 degrees

Question 6

A 26 year old male patient was brought to the emergency department with abdominal pain and obstipation for 3 days. He gives a history of bull gore to the abdomen 3 days back. His chest X-ray is given below. What is the probable diagnosis?

Accepted Answer

Hollow viscus perforation

Answer

Hemothorax

Answer

Pneumothorax

Answer

Intestinal obstruction

Question 7

A 50 year old male patient came to the outpatient department with complaints of hematuria. A 2 x 2 cm bladder mass is seen which is low grade transitional cell carcinoma. Which among the following is the ideal management?

Accepted Answer

Transurethral resection of the tumour

Answer

Resection with ileal conduit

Answer

Partial cystectomy with bladder reconstruction

Answer

Neoadjuvant chemotherapy

INI-CET 2021 — Surgery