NEET-PG 2012 — Surgery

Q: Indications for emergency thoracotomy are all of the following except:

Tension pneumothorax. ***Tension pneumothorax*** - While a life-threatening condition, a **tension pneumothorax** is initially managed with **needle decompression** or **chest tube insertion**, not an immediate emergency thoracotomy. - Emergency thoracotomy is reserved for situations requiring direct repair or control of massive bleeding that cannot be addressed by less invasive means. *Major tracheobronchial injuries* - These injuries can lead to severe **airway obstruction**, **massive air leak**, and **hemorrhage**, necessitating direct surgical repair via emergency thoracotomy. - Prompt surgical intervention is crucial to restore airway integrity and prevent life-threatening respiratory collapse. *Cardiac tamponade* - **Cardiac tamponade** can be caused by penetrating or blunt trauma, leading to circulatory collapse due to compression of the heart. - While initial management may involve pericardiocentesis, persistent or rapidly recurring tamponade, especially after trauma, often requires an **emergency thoracotomy** for direct repair of cardiac injury and evacuation of blood. *Penetrating injuries to anterior chest* - **Penetrating anterior chest injuries** carry a high risk of damage to vital structures such as the heart, great vessels, and major airways. - These injuries often result in rapid **hemodynamic instability**, severe hemorrhage, or cardiac arrest, making emergency thoracotomy essential for direct exploration and definitive repair. [Practice more Surgery PYQs on OnCourse]

Q: IVC filter is used in the following situations except -

As primary treatment for acute DVT. ***As primary treatment for acute DVT*** - The **primary treatment** for **acute deep vein thrombosis (DVT)** is **anticoagulation therapy** (heparin, warfarin, or DOACs) to prevent clot propagation and embolization. - An **IVC filter** is **NOT primary therapy**—it is reserved for specific situations and does not treat the underlying thrombosis. - **Indications for IVC filter include:** - Absolute **contraindication to anticoagulation** (active bleeding, recent hemorrhagic stroke) - **Recurrent PE despite adequate anticoagulation** - Complications from anticoagulation therapy - Therefore, using IVC filter as primary treatment for acute DVT is **incorrect and not indicated**. *Negligible size of emboli* - While IVC filters trap **large emboli**, the concept of "negligible size emboli" is not a standard clinical consideration for filter placement. - IVC filters are indicated based on **risk of PE** and **contraindications to anticoagulation**, not based on emboli size assessment. *To reduce symptoms* - **IVC filters** do not reduce symptoms of DVT such as pain, swelling, or discomfort. - They function as a **mechanical barrier** to prevent emboli from reaching pulmonary circulation. - Symptom management requires anticoagulation, compression therapy, and leg elevation. *To prevent progress of native blood vessel disease* - IVC filters do not influence progression of underlying **vascular disease** such as atherosclerosis or chronic venous insufficiency. - Their sole function is **mechanical prevention of PE**, not disease modification. [Practice more Surgery PYQs on OnCourse]

Q: What is the appropriate treatment for an incidentally detected appendicular carcinoid tumor measuring 2.5 cm?

Right hemicolectomy. ***Right hemicolectomy*** - An appendiceal carcinoid tumor **larger than 2 cm** (or with **mesoappendix invasion, positive margins, or high-grade features**) warrants a right hemicolectomy due to a significantly higher risk of lymph node metastasis (20-30%). - This 2.5 cm tumor clearly exceeds the 2 cm threshold, making right hemicolectomy the standard of care. - This procedure ensures adequate oncological margins and removal of regional lymph nodes, which is crucial for complete treatment. *Limited resection of the right colon* - This option is insufficient for an appendiceal carcinoid of this size, as it may not remove all regional lymph nodes or provide adequate oncological margins. - Limited resection lacks the systematic lymphadenectomy required for tumors exceeding 2 cm. *Total colectomy* - This is an **overly aggressive** and unnecessary procedure for an isolated appendiceal carcinoid tumor, even one of this size. - Total colectomy is typically reserved for diffuse colonic involvement, multifocal tumors, or specific genetic syndromes, which is not indicated here. *Appendicectomy* - An appendicectomy alone is only appropriate for very small appendiceal carcinoid tumors, typically **less than 1 cm** in size, with negative margins and without evidence of mesoappendix invasion or aggressive features. - For a 2.5 cm tumor, the risk of regional lymph node involvement (20-30%) is too high for appendicectomy to be considered adequate oncological treatment. [Practice more Surgery PYQs on OnCourse]

Q: During incision and drainage of ischiorectal abscess, which nerve is most likely to be injured?

Inferior rectal nerve. ***Inferior rectal nerve*** - The **inferior rectal nerve** innervates the **external anal sphincter** and the skin around the anus, making it vulnerable during an incision and drainage of an **ischiorectal abscess** due to its anatomical proximity. - Injury to this nerve can lead to **fecal incontinence** or altered sensation in the perianal region. *Superior rectal nerve* - The **superior rectal nerve** is primarily involved in the innervation of the **rectum** and is not directly located in the area of an **ischiorectal abscess**. - This nerve supplies the smooth muscle of the rectum and is not anatomically vulnerable during incision and drainage of an abscess in the ischiorectal fossa. *Superior gluteal nerve* - The **superior gluteal nerve** supplies the **gluteus medius**, **gluteus minimus**, and **tensor fasciae latae muscles**, which are typically located much more superior and lateral to an **ischiorectal abscess**. - Damage to this nerve causes a characteristic **Trendelenburg gait**, which is unrelated to perianal surgery. *Inferior gluteal nerve* - The **inferior gluteal nerve** innervates the **gluteus maximus muscle**, which is also located more superiorly and laterally relative to the **ischiorectal fossa**. - Injury to this nerve would primarily affect hip extension and is not a common complication of **ischiorectal abscess** drainage. [Practice more Surgery PYQs on OnCourse]

Q: What is the first aid treatment for acid contact with the skin?

Wash with copious amounts of water. ***Wash with copious amounts of water*** - The primary first aid for acid contact with the skin is immediate and prolonged **irrigation with copious amounts of water**. This helps to dilute the acid and wash away residual chemicals, minimizing tissue damage. - Flushing should continue for at least **20-30 minutes** or until medical help arrives, even if the pain subsides, to ensure thorough removal of the corrosive agent. *Wash with strong alkali* - Using a strong alkali to neutralize an acid burn can lead to an **exothermic reaction**, generating significant heat and causing further tissue damage. - This approach carries a high risk of worsening the chemical burn and should be strictly avoided. *Refer to higher centre* - While referral to a higher center may be necessary for severe burns, it is not the **immediate first aid step**. Delaying initial management to seek advanced care can worsen the burn. - **Immediate irrigation** is crucial to prevent further chemical injury and should precede any transfer decisions. *Wash with mild alkali agent* - Similar to strong alkalis, even a mild alkali agent can cause an **exothermic reaction** when mixed with acid on the skin, potentially increasing tissue damage rather than mitigating it. - The most effective and safest approach is **dilution with water**, not neutralization with bases. [Practice more Surgery PYQs on OnCourse]

47 Previous Year Questions with Answers & Explanations

Questions

Indications for emergency thoracotomy are all of the following except:

IVC filter is used in the following situations except -

What is the appropriate treatment for an incidentally detected appendicular carcinoid tumor measuring 2.5 cm?

During incision and drainage of ischiorectal abscess, which nerve is most likely to be injured?

What is the first aid treatment for acid contact with the skin?

Which of the following actions is NOT recommended when dealing with a patient who has been bitten by a snake?

What is the treatment of choice for anal carcinoma?

What does the term 'gastrotomy' refer to?

Circumcision is contraindicated in

Q10

Diversion of urine is best done at

NEET-PG 2012 - Surgery NEET-PG Practice Questions and MCQs

Question 1: Indications for emergency thoracotomy are all of the following except:

A. Cardiac tamponade
B. Tension pneumothorax (Correct Answer)
C. Major tracheobronchial injuries
D. Penetrating injuries to anterior chest

Explanation: ***Tension pneumothorax*** - While a life-threatening condition, a **tension pneumothorax** is initially managed with **needle decompression** or **chest tube insertion**, not an immediate emergency thoracotomy. - Emergency thoracotomy is reserved for situations requiring direct repair or control of massive bleeding that cannot be addressed by less invasive means. *Major tracheobronchial injuries* - These injuries can lead to severe **airway obstruction**, **massive air leak**, and **hemorrhage**, necessitating direct surgical repair via emergency thoracotomy. - Prompt surgical intervention is crucial to restore airway integrity and prevent life-threatening respiratory collapse. *Cardiac tamponade* - **Cardiac tamponade** can be caused by penetrating or blunt trauma, leading to circulatory collapse due to compression of the heart. - While initial management may involve pericardiocentesis, persistent or rapidly recurring tamponade, especially after trauma, often requires an **emergency thoracotomy** for direct repair of cardiac injury and evacuation of blood. *Penetrating injuries to anterior chest* - **Penetrating anterior chest injuries** carry a high risk of damage to vital structures such as the heart, great vessels, and major airways. - These injuries often result in rapid **hemodynamic instability**, severe hemorrhage, or cardiac arrest, making emergency thoracotomy essential for direct exploration and definitive repair.

Question 2: IVC filter is used in the following situations except -

A. To reduce symptoms
B. As primary treatment for acute DVT (Correct Answer)
C. Negligible size of emboli
D. To prevent progress of native blood vessel disease

Explanation: ***As primary treatment for acute DVT*** - The **primary treatment** for **acute deep vein thrombosis (DVT)** is **anticoagulation therapy** (heparin, warfarin, or DOACs) to prevent clot propagation and embolization. - An **IVC filter** is **NOT primary therapy**—it is reserved for specific situations and does not treat the underlying thrombosis. - **Indications for IVC filter include:** - Absolute **contraindication to anticoagulation** (active bleeding, recent hemorrhagic stroke) - **Recurrent PE despite adequate anticoagulation** - Complications from anticoagulation therapy - Therefore, using IVC filter as primary treatment for acute DVT is **incorrect and not indicated**. *Negligible size of emboli* - While IVC filters trap **large emboli**, the concept of "negligible size emboli" is not a standard clinical consideration for filter placement. - IVC filters are indicated based on **risk of PE** and **contraindications to anticoagulation**, not based on emboli size assessment. *To reduce symptoms* - **IVC filters** do not reduce symptoms of DVT such as pain, swelling, or discomfort. - They function as a **mechanical barrier** to prevent emboli from reaching pulmonary circulation. - Symptom management requires anticoagulation, compression therapy, and leg elevation. *To prevent progress of native blood vessel disease* - IVC filters do not influence progression of underlying **vascular disease** such as atherosclerosis or chronic venous insufficiency. - Their sole function is **mechanical prevention of PE**, not disease modification.

Question 3: What is the appropriate treatment for an incidentally detected appendicular carcinoid tumor measuring 2.5 cm?

A. Right hemicolectomy (Correct Answer)
B. Limited resection of the right colon
C. Total colectomy
D. Appendicectomy

Explanation: ***Right hemicolectomy*** - An appendiceal carcinoid tumor **larger than 2 cm** (or with **mesoappendix invasion, positive margins, or high-grade features**) warrants a right hemicolectomy due to a significantly higher risk of lymph node metastasis (20-30%). - This 2.5 cm tumor clearly exceeds the 2 cm threshold, making right hemicolectomy the standard of care. - This procedure ensures adequate oncological margins and removal of regional lymph nodes, which is crucial for complete treatment. *Limited resection of the right colon* - This option is insufficient for an appendiceal carcinoid of this size, as it may not remove all regional lymph nodes or provide adequate oncological margins. - Limited resection lacks the systematic lymphadenectomy required for tumors exceeding 2 cm. *Total colectomy* - This is an **overly aggressive** and unnecessary procedure for an isolated appendiceal carcinoid tumor, even one of this size. - Total colectomy is typically reserved for diffuse colonic involvement, multifocal tumors, or specific genetic syndromes, which is not indicated here. *Appendicectomy* - An appendicectomy alone is only appropriate for very small appendiceal carcinoid tumors, typically **less than 1 cm** in size, with negative margins and without evidence of mesoappendix invasion or aggressive features. - For a 2.5 cm tumor, the risk of regional lymph node involvement (20-30%) is too high for appendicectomy to be considered adequate oncological treatment.

Question 4: During incision and drainage of ischiorectal abscess, which nerve is most likely to be injured?

A. Superior rectal nerve
B. Inferior rectal nerve (Correct Answer)
C. Superior gluteal nerve
D. Inferior gluteal nerve

Explanation: ***Inferior rectal nerve*** - The **inferior rectal nerve** innervates the **external anal sphincter** and the skin around the anus, making it vulnerable during an incision and drainage of an **ischiorectal abscess** due to its anatomical proximity. - Injury to this nerve can lead to **fecal incontinence** or altered sensation in the perianal region. *Superior rectal nerve* - The **superior rectal nerve** is primarily involved in the innervation of the **rectum** and is not directly located in the area of an **ischiorectal abscess**. - This nerve supplies the smooth muscle of the rectum and is not anatomically vulnerable during incision and drainage of an abscess in the ischiorectal fossa. *Superior gluteal nerve* - The **superior gluteal nerve** supplies the **gluteus medius**, **gluteus minimus**, and **tensor fasciae latae muscles**, which are typically located much more superior and lateral to an **ischiorectal abscess**. - Damage to this nerve causes a characteristic **Trendelenburg gait**, which is unrelated to perianal surgery. *Inferior gluteal nerve* - The **inferior gluteal nerve** innervates the **gluteus maximus muscle**, which is also located more superiorly and laterally relative to the **ischiorectal fossa**. - Injury to this nerve would primarily affect hip extension and is not a common complication of **ischiorectal abscess** drainage.

Question 5: What is the first aid treatment for acid contact with the skin?

A. Wash with strong alkali
B. Wash with copious amounts of water (Correct Answer)
C. Refer to higher centre
D. Wash with mild alkali agent

Explanation: ***Wash with copious amounts of water*** - The primary first aid for acid contact with the skin is immediate and prolonged **irrigation with copious amounts of water**. This helps to dilute the acid and wash away residual chemicals, minimizing tissue damage. - Flushing should continue for at least **20-30 minutes** or until medical help arrives, even if the pain subsides, to ensure thorough removal of the corrosive agent. *Wash with strong alkali* - Using a strong alkali to neutralize an acid burn can lead to an **exothermic reaction**, generating significant heat and causing further tissue damage. - This approach carries a high risk of worsening the chemical burn and should be strictly avoided. *Refer to higher centre* - While referral to a higher center may be necessary for severe burns, it is not the **immediate first aid step**. Delaying initial management to seek advanced care can worsen the burn. - **Immediate irrigation** is crucial to prevent further chemical injury and should precede any transfer decisions. *Wash with mild alkali agent* - Similar to strong alkalis, even a mild alkali agent can cause an **exothermic reaction** when mixed with acid on the skin, potentially increasing tissue damage rather than mitigating it. - The most effective and safest approach is **dilution with water**, not neutralization with bases.

Question 6: Which of the following actions is NOT recommended when dealing with a patient who has been bitten by a snake?

A. Reassurance
B. Immobilization of the affected limb
C. Clean with soap and water
D. Local incision (Correct Answer)

Explanation: ***Local incision*** - Making an incision at the bite site can **worsen tissue damage**, increase the risk of infection, and does not effectively remove venom. - This practice is **outdated** and potentially harmful, as venom spreads rapidly through the lymphatic system rather than being localized in a way that incision can help. - **Local incision is NOT recommended** and is a contraindicated first-aid measure. *Immobilization of the affected limb* - Immobilizing the bitten limb helps **slow the spread of venom** through the lymphatic system. - This is a **recommended first-aid measure**, especially for neurotoxic snakebites, and should be done by keeping the limb at or below heart level. - Proper immobilization involves splinting the limb without restricting blood flow. *Reassurance* - Overt fear and anxiety can lead to symptoms like **tachycardia** and **hypertension**, which can exacerbate the effects of the venom. - **Calming the patient** helps reduce the physiological stress response, which is crucial as panic can worsen the clinical picture. - Reassurance is a **recommended supportive measure**. *Clean with soap and water* - Cleaning the wound helps remove surface venom and **reduce the risk of secondary bacterial infection**. - This is a **recommended basic first-aid measure** that promotes wound hygiene without interfering with venom management.

Question 7: What is the treatment of choice for anal carcinoma?

A. Chemotherapy alone
B. APR combined with radiotherapy
C. Chemoradiation (Correct Answer)
D. All of the options

Explanation: ***Chemoradiation*** - This combined modality is the **standard of care** for most anal carcinomas, achieving high cure rates while preserving sphincter function. - The combination of **chemotherapy** (e.g., 5-fluorouracil and mitomycin C) and **external beam radiation** works synergistically to destroy cancer cells. *Chemotherapy alone* - **Chemotherapy alone** is generally insufficient as a primary treatment for anal carcinoma. - It is often used in combination with radiation or for **metastatic disease**, but not as a monotherapy for curative intent in localized disease. *APR combined with radiotherapy* - **Abdominoperineal resection (APR)** combined with radiotherapy is typically reserved for **recurrent** or **persistent anal carcinoma** after failed chemoradiation, or for very advanced tumors. - APR is a highly morbid surgery leading to a **permanent colostomy**, and primary chemoradiation aims to avoid this outcome. *All of the options* - As **chemoradiation** is the preferred first-line treatment and other options are either inadequate or reserved for specific situations, stating "all of the options" is incorrect. - The treatment strategy for anal carcinoma involves a nuanced approach, prioritizing **organ preservation** with effective cancer control.

Question 8: What does the term 'gastrotomy' refer to?

A. Closing the stomach after tube insertion
B. Making an incision into the stomach (Correct Answer)
C. Removing a part of the stomach
D. Resecting the upper part of the stomach

Explanation: ***Making an incision into the stomach*** - The suffix **-otomy** specifically refers to the **surgical creation of an incision** or a cutting open of an organ or structure. - In this context, **gastr-** refers to the **stomach**, thus "gastrotomy" means cutting into the stomach. *Closing the stomach after tube insertion* - While a gastrotomy might precede tube insertion, "closing" the stomach is distinct and typically part of the **wound closure** rather than the incision itself. - The term for surgical closure is generally **-rrhaphy**, not -otomy. *Removing a part of the stomach* - The surgical removal of a part of an organ is indicated by the suffix **-ectomy**, such as in **gastrectomy**. - Gastrotomy only implies making an incision, not the resection of tissue. *Resecting the upper part of the stomach* - This describes a **partial gastrectomy** or **fundectomy**, which involves the removal of tissue. - Gastrotomy is a simpler procedure involving only an incision, without tissue removal.

Question 9: Circumcision is contraindicated in

A. Paraphimosis
B. Exostrophy of bladder
C. Balanitis
D. Hypospadias (Correct Answer)

Explanation: ***Hypospadias*** - In **hypospadias**, the **urethral opening** is located on the underside of the penis, and the foreskin is **essential** for **reconstructive surgery** (urethroplasty) to correct the defect. - Removing the foreskin via circumcision would eliminate this vital tissue, making surgical repair extremely difficult or impossible. - This is the **most absolute contraindication** to circumcision in pediatric urology. *Balanitis* - **Balanitis** is inflammation of the glans penis, often due to poor hygiene or infection. - Circumcision is actually a **treatment** for recurrent balanitis, not a contraindication. - It represents an **indication** for circumcision, not a contraindication. *Paraphimosis* - **Paraphimosis** is a urological emergency where the retracted foreskin becomes trapped behind the glans, causing vascular compromise. - Immediate management involves manual reduction or dorsal slit procedure. - Once the acute condition is resolved, elective circumcision can be performed to prevent recurrence—**not a contraindication**. *Exstrophy of bladder* - **Bladder exstrophy** is a severe congenital anomaly involving the epispadias-exstrophy complex, where the bladder is exposed outside the body. - The foreskin is typically **preserved for penile reconstruction** during complex staged repairs. - While this is also considered a **contraindication to circumcision** in most cases, **hypospadias** remains the **classic and most absolute contraindication** taught in medical education and is the expected answer for this question.

Question 10: Diversion of urine is best done at

A. Jejunum
B. Colon
C. Ileum (Correct Answer)
D. Caecum

Explanation: ***Ileum*** - The **ileum** is the most commonly used segment for urinary diversion due to its **mobility**, adequate vascular supply, and low complication rates. - Its relatively **low absorptive capacity** for electrolytes, particularly urea and ammonia, minimizes metabolic disturbances. *Jejunum* - The **jejunum** has a high absorptive capacity, which can lead to significant **electrolyte imbalances** (e.g., hypochloremic, hypokalemic metabolic acidosis) when urine is diverted into it. - It is also more prone to **stomal stenosis** and bowel obstruction compared to the ileum. *Colon* - While the colon can be used, particularly in continent diversions, it has a **thicker wall** and can be less mobile, making surgical creation of a conduit more challenging. - Similar to the jejunum, it has a **higher absorptive capacity** than the ileum, which can lead to electrolyte disturbances. *Caecum* - The **caecum** is a possible site for continent urinary diversions (e.g., cecal pouch), but it is not typically used for simple incontinent conduits due to its **anatomical position** and surgical complexity. - Its use often requires additional procedures to ensure continence and prevent reflux.