INI-CET 2022 - Surgery PYQs Practice Questions

Q: Identify the given bone marrow biopsy instrument

Jamshidi needle. ***Jamshidi needle*** - The image displays a **Jamshidi needle**, characterized by its **tapered, beveled tip** designed to facilitate entry into the bone and procure an intact core of bone marrow. - This needle is widely considered the **gold standard** for bone marrow biopsy due to its effectiveness in obtaining high-quality trephine samples. *Salah needle* - A Salah needle is primarily used for **bone marrow aspiration**, not typically for a trephine biopsy, and it has a different design meant for aspirating liquid marrow. - It features a **shorter, sturdier design** with a sharp bevel, optimized for safely extracting marrow fluid. *Tru-cut needle* - The Tru-cut needle is primarily designed for obtaining **soft tissue biopsies** (e.g., liver, kidney, prostate) and is not typically used for bone marrow biopsies. - Its mechanism involves an inner cutting stylet and an outer cutting cannula, which is unsuitable for penetrating dense bone and retrieving a bone core. *Vim Silverman needle* - The Vim Silverman needle is also designed for **soft tissue biopsies**, similar to the Tru-cut, and not specifically for bone marrow. - It utilizes a split needle design to capture tissue, which is not appropriate for obtaining a solid bone marrow core. [Practice more Surgery PYQs on OnCourse]

Q: Which of these is the most life-threatening injury that can be identified by assessing the breathing component of the patient?

Tension pneumothorax. ***Tension pneumothorax*** - A tension pneumothorax is a **life-threatening condition** identified during the breathing assessment, as it severely impairs ventilation and causes **hemodynamic instability** by compressing major vessels. - Key signs include absent breath sounds on the affected side, **tracheal deviation**, and **hypotension** due to mediastinal shift. *Blunt cardiac injury* - While serious, blunt cardiac injury is typically identified during the **circulation assessment**, with signs like arrhythmias, hypotension, or cardiac tamponade. - Its direct impact on breathing is less immediate compared to a tension pneumothorax. *Cervical spine injury* - A cervical spine injury can affect breathing if it involves the **phrenic nerve** (C3-C5), leading to respiratory paralysis, but this is assessed during the **disability component** or secondary survey for neurological deficits. - It does not directly cause an acute, life-threatening compromise of lung function discernible primarily through a breathing assessment like a tension pneumothorax. *Laryngotracheal injury* - A laryngotracheal injury primarily affects the **airway component** (A in ABCDE), leading to immediate obstruction or stridor. - While critical, it is distinct from problems with the lungs' ability to expand or perform gas exchange, which are assessed under breathing. [Practice more Surgery PYQs on OnCourse]

Q: A 32-year-old female patient with Graves' disease with eye signs and enlarged thyroid planned for a total thyroidectomy. What can be given in the preoperative period to reduce intraoperative bleeding in the patient?

Potassium iodide. ***Potassium iodide*** - **Potassium iodide** (e.g., Lugol's solution) is given preoperatively to patients with Graves' disease undergoing thyroidectomy because it **decreases the vascularity** of the thyroid gland, thereby reducing intraoperative bleeding. - It also helps to **block the release of thyroid hormones** from the thyroid gland, stabilizing the patient's thyroid function. *Propylthiouracil* - **Propylthiouracil (PTU)** is an **antithyroid drug** that prevents the synthesis of thyroid hormones by inhibiting the organification of iodine and the coupling of iodotyrosines. - Although it helps to achieve a **euthyroid state** before surgery, it does not directly reduce the vascularity of the thyroid gland to decrease intraoperative bleeding. *Betamethasone* - **Betamethasone** is a corticosteroid used for its **anti-inflammatory** and immunosuppressive effects. - It is not typically used preoperatively in Graves' disease to reduce thyroid vascularity or bleeding; its primary role might be in managing severe **ophthalmopathy** or thyroid storm, not surgical bleeding. *Propranolol* - **Propranolol** is a **beta-blocker** used to control the adrenergic symptoms of hyperthyroidism, such as **tachycardia**, palpitations, and tremors. - While it helps to achieve a more stable cardiac state for surgery, it does not directly impact the **vascularity** of the thyroid gland or reduce surgical bleeding. [Practice more Surgery PYQs on OnCourse]

Q: What is the correct sequence of management in a patient who presents to the casualty with an RTA? 1. Cervical spine stabilization 2. Intubation 3. IV cannulation 4. CECT

1,2,3,4. ***1,2,3,4*** - This sequence follows the **ATLS (Advanced Trauma Life Support)** protocol, prioritizing immediate life threats in order. - **Cervical spine stabilization** is the **first action upon patient contact** to prevent secondary neurological injury in any trauma patient. - **Airway management (intubation)** is then performed **with maintained in-line c-spine stabilization** - these occur nearly simultaneously but c-spine protection is instituted first. - **IV cannulation (circulation)** follows to establish vascular access for resuscitation and medications. - **CECT (imaging)** is performed last, once the patient is stabilized after addressing immediate life threats. - This follows the **ATLS Primary Survey: Airway (with c-spine protection) → Breathing → Circulation → Disability → Exposure**. *2,1,4,3* - This incorrectly places intubation **before** cervical spine stabilization is initiated. - In ATLS, **c-spine protection must be applied immediately upon patient contact** before any airway manipulation. - Delaying IV cannulation until after CECT is inappropriate as circulatory access is critical for early resuscitation. *1,3,2,4* - While this correctly starts with cervical spine stabilization, it incorrectly places **IV cannulation before intubation**. - In the ATLS primary survey, **Airway comes before Circulation** - securing the airway takes priority over establishing IV access. - This sequence could delay critical airway management in a patient with respiratory compromise. *2,1,3,4* - This sequence places **intubation before cervical spine stabilization**, which violates ATLS principles. - **C-spine stabilization must be the first action** upon approaching any trauma patient to prevent secondary spinal cord injury. - While intubation with in-line stabilization is possible, the c-spine protection must be instituted first, not after beginning airway manipulation. [Practice more Surgery PYQs on OnCourse]

Q: A patient presents with pneumothorax on chest x-ray. Which of the following is NOT a boundary of the triangle of safety for intercostal chest drain (ICD) insertion?

Mid - clavicular line. ***Mid-clavicular line*** - The **mid-clavicular line** is **NOT** a boundary of the triangle of safety; it is a vertical reference line located centrally on the thorax. - The triangle of safety is located in the **mid-axillary region**, not at the mid-clavicular line. - The mid-clavicular line is used for other procedures but is **anterior to the safe zone** for ICD insertion. *Base of axilla* - The **base of the axilla** forms the **superior boundary** of the triangle of safety. - This boundary is typically at the level of the **5th intercostal space** (nipple level in males). - It helps guide ICD insertion away from the **brachial plexus** and axillary vessels. *Lateral border of latissimus dorsi* - The **lateral border of the latissimus dorsi muscle** forms the **posterior boundary** of the triangle of safety. - This landmark ensures the insertion is anterior to major back muscles and avoids injury to the long thoracic nerve. *Lateral edge of pectoralis major* - The **lateral edge of the pectoralis major muscle** forms the **anterior boundary** of the triangle of safety. - This ensures the ICD is inserted lateral to the pectoral muscle, avoiding breast tissue and superficial vessels. [Practice more Surgery PYQs on OnCourse]

Question 1

Identify the given bone marrow biopsy instrument

Accepted Answer

Jamshidi needle

Answer

Salah needle

Answer

Tru-cut needle

Answer

Vim Silverman needle

Question 2

Which of these is the most life-threatening injury that can be identified by assessing the breathing component of the patient?

Accepted Answer

Tension pneumothorax

Answer

Blunt cardiac injury

Answer

Cervical spine injury

Answer

Laryngotracheal injury

Question 3

A 32-year-old female patient with Graves' disease with eye signs and enlarged thyroid planned for a total thyroidectomy. What can be given in the preoperative period to reduce intraoperative bleeding in the patient?

Accepted Answer

Potassium iodide

Answer

Propylthiouracil

Answer

Betamethasone

Answer

Propranolol

Question 4

What is the correct sequence of management in a patient who presents to the casualty with an RTA?

1. Cervical spine stabilization
2. Intubation
3. IV cannulation
4. CECT

Accepted Answer

1,2,3,4

Answer

2,1,4,3

Answer

1,3,2,4

Answer

2,1,3,4

Question 5

A patient presents with pneumothorax on chest x-ray. Which of the following is NOT a boundary of the triangle of safety for intercostal chest drain (ICD) insertion?

Accepted Answer

Mid - clavicular line

Answer

Base of axilla

Answer

Lateral border of latissimus dorsi

Answer

Lateral edge of pectoralis major

Question 6

Which of the following cancers are correctly matched with the criteria for the minimum number of lymph nodes required for pathological staging?
A. CA stomach -10
B. CA colon -12
C. CA gall bladder -6
D. CA breast -15

Accepted Answer

B,C

Answer

A,B,C

Answer

A,B,C,D

Answer

A,C,D

Question 7

All the following are true about acute cholecystitis, except

Accepted Answer

Preferential visualization of gall bladder in HIDA scan

Answer

Gall bladder thickness >3 mm on USG

Answer

Murphy's sign positive

Answer

Leukocytosis

Question 8

Which of the following is not a relative contraindication for breast conservative surgery?

Accepted Answer

Small tumor size (<3cm)

Answer

Multicentric disease

Answer

Previous radiation to breast

Answer

Large tumor size

Question 9

Which of the following is not a perineal approach for the condition shown in the image?

Accepted Answer

Ripstein's procedure

Answer

Delorme's procedure

Answer

Altemeier's procedure

Answer

Thiersch's procedure

Question 10

A 50-year-old alcoholic patient presents with a history of waxing and waning jaundice for the past 2 months. His CT examination reveals dilatation of the common bile duct and pancreatic duct. What is the most probable diagnosis in the patient?

Accepted Answer

Periampullary carcinoma

Answer

Common bile duct stone

Answer

Head of the pancreas carcinoma

Answer

Cholangiocarcinoma

INI-CET 2022 — Surgery