INI-CET 2024 - Surgery PYQs Practice Questions

Q: During thyroidectomy, which nerve, if damaged, can cause a hoarse voice?

Recurrent laryngeal; loops under aorta/subclavian. ***Recurrent laryngeal; loops under aorta/subclavian*** - The **recurrent laryngeal nerve (RLN)** innervates most of the intrinsic muscles of the larynx, including the **posterior crico-arytenoid muscle**, which is responsible for abducting the vocal cords. - Damage to the RLN during thyroidectomy can lead to **vocal cord paralysis**, resulting in a hoarse voice, stridor, or aspiration. *Superior laryngeal; with superior thyroid artery* - The **superior laryngeal nerve (SLN)** branches into external and internal laryngeal nerves. The **external laryngeal nerve** runs with the **superior thyroid artery** and innervates the **cricothyroid muscle**, which is responsible for tensioning the vocal cords. - Damage to the SLN can cause subtle changes in voice pitch and reduced vocal range but typically does not cause hoarseness or vocal cord paralysis, which is more characteristic of RLN injury. *Glossopharyngeal; along posterior thyroid* - The **glossopharyngeal nerve (CN IX)** provides sensory innervation to the posterior third of the tongue, tonsils, pharynx, and middle ear, and motor innervation to the stylopharyngeus muscle. - It is not directly related to vocal cord function or hoarseness as a result of thyroid surgery. *Hypoglossal; inferior to thyroid* - The **hypoglossal nerve (CN XII)** innervates all extrinsic and intrinsic muscles of the tongue, controlling tongue movement. - Damage to the hypoglossal nerve would affect speech articulation and swallowing but not directly cause hoarseness or vocal cord paralysis. [Practice more Surgery PYQs on OnCourse]

Q: A 55-year-old man has a history of difficulty swallowing and frequent choking while eating. A barium swallow shows a posterior pharyngeal diverticulum. What is the most likely diagnosis?

Zenker's diverticulum. ***Zenker's diverticulum*** - A **Zenker's diverticulum** is a **pseudodiverticulum** that occurs due to herniation of the pharyngeal mucosa at Killian's triangle, often causing dysphagia and regurgitation in older adults. - The **barium swallow** revealing a **posterior pharyngeal diverticulum** is a classic finding for Zenker's, and the symptoms of difficulty swallowing and choking are consistent with food lodging in the pouch. *Esophageal stricture* - An **esophageal stricture** is a narrowing of the esophagus, which would cause difficulty swallowing (dysphagia), but typically wouldn't lead to a **posterior pharyngeal diverticulum** on barium swallow. - While strictures can cause choking, the primary finding described in the barium swallow points away from a simple stricture. *GERD* - **Gastroesophageal reflux disease (GERD)** can cause dysphagia due to **esophagitis** or stricture formation, but it is not typically associated with a **posterior pharyngeal diverticulum**. - The main symptoms of GERD include **heartburn** and acid regurgitation, though atypical symptoms exist, the diverticulum is not characteristic. *Achalasia* - **Achalasia** is a motility disorder characterized by impaired relaxation of the **lower esophageal sphincter** and loss of peristalsis in the esophageal body, leading to dysphagia and regurgitation. - A barium swallow in achalasia typically shows a **dilated esophagus** with a "bird's beak" appearance at the LES, not a posterior pharyngeal diverticulum. [Practice more Surgery PYQs on OnCourse]

Q: Patients requiring immediate life-threatening care are categorized under which of the following triage?

Red. ***Red*** - The **red tag** is assigned to patients with immediate, life-threatening injuries or illnesses who have a high probability of survival with prompt medical intervention. - This category signifies that the patient needs **critical care** and immediate transport to a medical facility to stabilize their condition. *Black* - The **black tag** is reserved for patients who are deceased or whose injuries are so severe that survival is unlikely, even with extensive medical care. - This category indicates that resources should be allocated to those with a higher chance of survival. *Yellow* - The **yellow tag** is for patients with significant injuries that require medical attention but are not immediately life-threatening. - These patients can usually wait for a few hours before receiving definitive treatment. *Green* - The **green tag** is for patients with minor injuries or illnesses that are not life-threatening and who can often care for themselves or wait for medical attention for several hours. - They are considered the "walking wounded" and usually require minimal medical intervention. [Practice more Surgery PYQs on OnCourse]

Q: Which of the following is not done in the primary survey of trauma?

NCCT head. ***NCCT head*** - A **Non-Contrast CT (NCCT) head** is typically performed during the **secondary survey** once the patient is hemodynamically stable and life-threatening conditions have been addressed. - The primary survey focuses on immediate **life-saving interventions** for airway, breathing, circulation, disability, and exposure. *Intubation* - **Intubation** is a critical intervention during the primary survey, specifically under the **'A' (Airway)** component, to establish and secure a patent airway in a compromised patient. - Failure to establish an airway can rapidly lead to **hypoxia** and death. *ICD drainage* - **Intercostal drain (ICD) drainage** is an urgent intervention in the primary survey, falling under **'B' (Breathing)**, to manage conditions like **tension pneumothorax** or massive hemothorax. - These conditions can severely compromise ventilation and circulation, requiring immediate relief. *CXR* - A **Chest X-ray (CXR)** is a rapid and essential diagnostic tool in the primary survey, also under **'B' (Breathing)**, to identify life-threatening thoracic injuries such as pneumothorax, hemothorax, or mediastinal shift. - It provides quick information crucial for immediate management decisions. [Practice more Surgery PYQs on OnCourse]

Question 1

A 40-year-old male with a head injury presents with a GCS of 8, BP of 90/60, and HR of 120. A CT scan shows an epidural hematoma. What are the immediate management priorities?

Accepted Answer

Intubation and ventilation

Answer

Administer mannitol for intracranial pressure management

Answer

Perform immediate craniotomy

Answer

Administer intravenous fluids and monitor vital signs

Question 2

During thyroidectomy, which nerve, if damaged, can cause a hoarse voice?

Accepted Answer

Recurrent laryngeal; loops under aorta/subclavian

Answer

Superior laryngeal; with superior thyroid artery

Answer

Glossopharyngeal; along posterior thyroid

Answer

Hypoglossal; inferior to thyroid

Question 3

A 55-year-old man has a history of difficulty swallowing and frequent choking while eating. A barium swallow shows a posterior pharyngeal diverticulum. What is the most likely diagnosis?

Accepted Answer

Zenker's diverticulum

Answer

Esophageal stricture

Answer

GERD

Answer

Achalasia

Question 4

Patients requiring immediate life-threatening care are categorized under which of the following triage?

Accepted Answer

Red

Answer

Black

Answer

Yellow

Answer

Green

Question 5

Which of the following is not done in the primary survey of trauma?

Accepted Answer

NCCT head

Answer

Intubation

Answer

ICD drainage

Answer

CXR

Question 6

Case of trauma in a patient with an unknown blood group. Patient is unstable and requires urgent blood transfusion. Which type of blood should be transfused?

Accepted Answer

O-

Answer

AB+

Answer

O+

Answer

A+

Question 7

A 55-year-old male patient presents to the clinic with left lower lip weakness following a recent parotid gland surgery. Considering the surgical history and current symptoms, what is the most likely site of the lesion causing this patient's condition?

Accepted Answer

Marginal mandibular branch of the facial nerve

Answer

Main trunk of facial nerve

Answer

Temporal branch of facial nerve

Answer

Parotid duct

Question 8

Lower lip paralysis after a parotidectomy is most likely due to injury to which structure?

Accepted Answer

Marginal mandibular branch of the facial nerve

Answer

Buccal branch of the facial nerve

Answer

Cervical branch of the facial nerve

Answer

Temporal branch of the facial nerve

Question 9

A 25-year-old male college student presents to emergency after road traffic accident. Patient is in state of shock and breath sounds are decreased on the side of chest trauma (left side). Normal heart sounds, no elevated JVP and dull note on percussion. What is the diagnosis?

Accepted Answer

Massive Hemothorax

Answer

Cardiac tamponade

Answer

Flail chest

Answer

Tension pneumothorax

Question 10

Arrange the following according to good outcome
a - zone of stasis
 b - zone of coagulation
 c - zone of hyperemia

Accepted Answer

c > a > b

Answer

a > b > c

Answer

a > c > b

Answer

a = c > b

INI-CET 2024 — Surgery