INI-CET 2025 — Surgery

13 Questions — Page 2 of 2

Q11

A 65-year-old patient undergoes colonoscopy for altered bowel habits. A 6 cm colonic mass is biopsied and histopathology shows adenocarcinoma confined to the mucosa with no lymph node or distant metastasis. What is the most appropriate TNM stage of this tumor?

Q12

A patient has burns involving the face, both upper limbs and front of the chest. What is the percentage of burns involved?

Q13

Cleft lip primary muscle repair is required in which of the following muscles?

INI-CET 2025 - Surgery INI-CET Practice Questions and MCQs

Question 11: A 65-year-old patient undergoes colonoscopy for altered bowel habits. A 6 cm colonic mass is biopsied and histopathology shows adenocarcinoma confined to the mucosa with no lymph node or distant metastasis. What is the most appropriate TNM stage of this tumor?

A. Stage 0 (Correct Answer)
B. Stage II
C. Stage III
D. Stage I

Explanation: ***Stage 0*** - In the TNM staging system for colorectal cancer, a tumor that is **confined to the mucosa** (Carcinoma in situ) is classified as **Tis**. - Stage 0 is specifically defined by the staging combination **Tis, N0, M0**, indicating tumor confined to the mucosa with no nodal involvement (N0) or distant metastasis (M0). *Incorrect: Stage I* - Stage I encompasses tumors that invade the **submucosa (T1)** or the **muscularis propria (T2)**, provided there is no lymph node or distant spread (N0, M0). - Since this tumor is confined only to the mucosa (Tis), it has not met the criteria for T1 or T2 required for Stage I. *Incorrect: Stage II* - Stage II refers to tumors with deeper wall penetration, classified as **T3** (invasion through muscularis propria into subserosa) or **T4** (invasion into adjacent structures or peritoneum). - Although Stage II also requires N0 and M0, the depth of invasion (T3 or T4) far exceeds the mucosal confinement (Tis) seen in this patient. *Incorrect: Stage III* - Stage III is defined by the presence of **regional lymph node metastasis** (N1 or N2), regardless of the depth of the primary tumor (Any T). - The case description explicitly states **no lymph node or distant metastasis**, ruling out any N staging higher than N0.

Question 12: A patient has burns involving the face, both upper limbs and front of the chest. What is the percentage of burns involved?

A. 30 to 37 (Correct Answer)
B. 25 to 48
C. 27 to 30
D. 38 to 42

Explanation: ***Correct: 30 to 37*** - This percentage is derived using the **Rule of Nines** for adults: Face (part of Head) = 4.5%, Both Upper Limbs (9% each) = 18%, and Front of Chest (part of Anterior Trunk) = 9%. Total = 4.5 + 18 + 9 = **31.5%**. - The Rule of Nines is a quick method for estimating the total body surface area burned (TBSA) in adults, assigning 9% to major body sections (or multiples thereof). *Incorrect: 27 to 30* - This range is too low; the precise calculation according to the Rule of Nines is **31.5%**, which falls outside and above this range. - This would underestimate the burn area and potentially lead to inadequate fluid resuscitation. *Incorrect: 38 to 42* - This range is too high; it would imply involvement of additional surface area beyond what is described. - 36% would cover the entire head (9%), both upper limbs (18%), and the entire anterior trunk (18%), which is more than just the front of the chest. *Incorrect: 25 to 48* - While the calculated value (31.5%) falls within this excessively wide range, it is an unnecessarily broad estimation and not clinically useful. - The most precise option provided is **30 to 37**, which appropriately contains the calculated value of 31.5%.

Question 13: Cleft lip primary muscle repair is required in which of the following muscles?

A. Levator palpebrae superioris
B. Orbicularis oris (Correct Answer)
C. Orbicularis oculi
D. Masseter

Explanation: ***Orbicularis oris*** - The **orbicularis oris** muscle forms the main sphincter of the mouth and is interrupted in a cleft lip. Repair involves meticulous anatomical realignment of this muscle for correct function and appearance. - Dysfunction of this muscle in unrepaired cleft lip leads to **vermilion deficiency**, **cupid's bow distortion**, and poor feeding/speech. *Orbicularis oculi* - This muscle surrounds the eye and is responsible for blinking and closing the eyelid; it is not primarily affected in a standard cleft lip. - Though part of the facial musculature, its involvement is secondary, mainly due to potential nerve injury during extensive **craniofacial procedures**, not cleft lip repair. *Levator palpebrae superioris* - This muscle elevates the upper eyelid and is innervated by the **oculomotor nerve (CN III)**. It is not involved in cleft lip pathology or repair. - Its function is essential for vision, and damage results in **ptosis**, a concern unrelated to primary lip closure. *Masseter* - The masseter is a powerful muscle of mastication, innervated by the **trigeminal nerve (CN V)**. It is located in the cheek and is not part of the required functional repair for a cleft lip. - Its primary role is in **jaw closure (chewing)**, and its integrity is preserved during standard cleft lip repair procedures.