In Congenital Diaphragmatic Hernia (CDH), the most commonly associated anomaly affects the
Volkmann's contracture: which artery is involved in this condition?
What is the type of Intussusception that is most frequently observed?
A female patient who underwent surgery for abdominal intestinal perforation presents on the 5th postoperative day with serous discharge and a gap in the wound. What is the most likely diagnosis?
Road traffic accident (RTA) with multiple fractures - initial treatment would be:
What type of burn is characterized by flash burn, tenderness, redness, and pain?
Which muscle flap is commonly used for autologous breast reconstruction after mastectomy?
Which condition is commonly associated with complications arising from phimosis?
In the initial management of a hemodynamically unstable polytrauma patient, what is the recommended initial crystalloid bolus dose of Ringer's lactate for assessment and stabilization?
Most common congenital diaphragmatic hernia is:
NEET-PG 2012 - Surgery NEET-PG Practice Questions and MCQs
Question 21: In Congenital Diaphragmatic Hernia (CDH), the most commonly associated anomaly affects the
- A. Congenital heart defects (Correct Answer)
- B. Anomalies of the urinary tract
- C. Anomalies of the skull
- D. Craniofacial anomalies
Explanation: ***Congenital heart defects*** - **Congenital diaphragmatic hernia (CDH)** is frequently associated with other congenital anomalies. - **Cardiac malformations** are the most common co-occurring defects, affecting a significant proportion of CDH patients. *Anomalies of the urinary tract* - While **urogenital anomalies** can occur with CDH, they are less prevalent than congenital heart defects. - These typically include conditions like **renal agenesis** or **hydronephrosis**. *Anomalies of the skull* - **Skull anomalies** are not a primary or common association with congenital diaphragmatic hernia. - Genetic syndromes associated with both CDH and skull anomalies are relatively rare. *Craniofacial anomalies* - **Craniofacial anomalies**, such as **cleft lip/palate**, can occur with CDH but are less common than cardiac anomalies. - These are often seen within the context of specific genetic syndromes.
Question 22: Volkmann's contracture: which artery is involved in this condition?
- A. Radial
- B. Ulnar
- C. Brachial artery (Correct Answer)
- D. Anterior interosseous artery
Explanation: ***Brachial artery*** - **Volkmann's contracture** is an ischemic contracture of the forearm muscles, classically caused by injury or compression of the **brachial artery** - The most common cause is **supracondylar fracture of the humerus** in children, which can damage or compress the brachial artery - Brachial artery injury → **forearm ischemia** → **compartment syndrome** in the anterior (flexor) compartment → muscle necrosis → **ischemic contracture** - The **brachial artery** is the main arterial supply to the forearm, and its compromise leads to the widespread ischemia necessary for Volkmann's contracture - **Clinical features**: Flexion deformity of the wrist and fingers, claw hand, sensory loss in the distribution of median and ulnar nerves *Anterior interosseous artery* - The **anterior interosseous artery** is a branch of the common interosseous artery (from the ulnar artery) that supplies deep forearm muscles - While it contributes to forearm circulation, **isolated injury** to this smaller branch vessel does not typically cause the extensive ischemia required for Volkmann's contracture - The primary vascular pathology in Volkmann's contracture involves the **main arterial trunk** (brachial artery), not its distal branches *Radial* - The **radial artery** is one of the two terminal branches of the brachial artery in the forearm - It primarily supplies the **lateral compartment** and contributes to hand circulation - Isolated radial artery injury does not cause Volkmann's contracture, as the ulnar artery provides collateral circulation - The pathology requires compromise of the **main arterial supply** proximal to the forearm *Ulnar* - The **ulnar artery** is the other terminal branch of the brachial artery - It supplies the **medial forearm** and hand - Similar to radial artery, isolated ulnar artery injury has collateral compensation from the radial artery - Volkmann's contracture requires **proximal arterial compromise** (brachial artery level) affecting the entire forearm blood supply
Question 23: What is the type of Intussusception that is most frequently observed?
- A. Ileocolic type (Correct Answer)
- B. Ileoileal type
- C. Colo-colic type
- D. Caeco-colic type
Explanation: ***Ileocolic type*** - This is the **most common form of intussusception**, accounting for approximately 75% to 90% of cases, especially in children. - It occurs when the **ileum telescopes into the colon** at the ileocecal valve. *Ileoileal type* - This type involves the **invagination of one part of the ileum into another part of the ileum**. - While it can occur, it is **less common than ileocolic intussusception** and is more often associated with a pathological lead point in older children and adults. *Colo-colic type* - This involves the **telescoping of one segment of the colon into another segment of the colon**. - It is **rare in children** and, when present, is almost always associated with a pathological lead point, such as a polyp or tumor, primarily in adults. *Caeco-colic type* - This type occurs when the **cecum telescopes into the ascending colon**. - It is also a **relatively uncommon form of intussusception** compared to the ileocolic type.
Question 24: A female patient who underwent surgery for abdominal intestinal perforation presents on the 5th postoperative day with serous discharge and a gap in the wound. What is the most likely diagnosis?
- A. Wound dehiscence (Correct Answer)
- B. Enterocutaneous fistula
- C. Peritonitis
- D. Seroma
Explanation: ***Wound dehiscence*** - This is the most likely diagnosis given the presentation of **serous discharge** and a **gap in the wound** on the 5th postoperative day. - **Abdominal intestinal perforation** surgery is a risk factor, and the timing is consistent with **fascial dehiscence**, which can lead to evisceration if left untreated. *Enterocutaneous fistula* - This involves a connection between the **bowel lumen** and the **skin surface**, typically discharging enteric contents (e.g., bile, stool), not just serous fluid. - While a possibility in complicated abdominal surgeries, the description of a "gap in the wound" and serous discharge is more indicative of a **structural failure** of the wound. *Seroma* - A seroma is a collection of **serous fluid** under the skin flap or surgical incision, presenting as a **fluctuant swelling**, but it typically does not involve a "gap in the wound." - It would not usually present with a wound **disruption** that exposes underlying tissue; instead, it's an intact pocket of fluid. *Peritonitis* - This is an **inflammation of the peritoneum**, usually caused by infection, and presents with **severe abdominal pain**, fever, and diffuse tenderness, which are not mentioned here. - While an intestinal perforation would initially cause peritonitis, the current presentation focuses on the **wound site** rather than systemic or diffuse abdominal symptoms.
Question 25: Road traffic accident (RTA) with multiple fractures - initial treatment would be:
- A. Management of shock
- B. Splinting of limbs
- C. Airway management (Correct Answer)
- D. Cervical spine protection
Explanation: ***Airway management*** - In trauma, **establishing and maintaining a patent airway** is the absolute priority, as compromised breathing can lead to rapid deterioration and death. - The **ABCs (Airway, Breathing, Circulation)** of trauma care dictate that airway intervention precedes other life-saving measures. *Management of shock* - While crucial, **managing shock (C)** follows **airway (A)** and **breathing (B)** in the primary survey of trauma care. - Addressing profound shock without a patent airway can be ineffective and leads to irreversible damage. *Splinting of limbs* - **Splinting fractures** is important for pain control, preventing further injury, and minimizing blood loss in open fractures, but it is not an immediate life-saving intervention. - This falls under the **secondary survey** or definitive management, after life-threatening issues have been addressed. *Cervical spine protection* - **Cervical spine protection** is essential in trauma to prevent further neurological injury and is performed simultaneously with airway management (often with in-line stabilization). - However, a patent airway is the **most immediate life-sustaining intervention** if the airway is compromised.
Question 26: What type of burn is characterized by flash burn, tenderness, redness, and pain?
- A. Scalded burn
- B. First degree burn (Correct Answer)
- C. Second degree burn
- D. Fourth degree burn
Explanation: ***First degree burn*** - Characterized by **tenderness**, **redness**, and **pain** without blistering. - Involves only the **epidermis**, typically from a **flash burn** or brief contact with a hot object. *Scalded burn* - A type of burn caused by **hot liquid or steam**, not a characteristic of a specific burn depth. - Can be superficial or deep, depending on the **temperature** and **duration of exposure**. *Second degree burn* - Involves the **epidermis and dermis**, presenting with **blisters**, severe pain, and sometimes a wet, weeping appearance. - Often heals with scarring, unlike first-degree burns. *Fourth degree burn* - The most severe type of burn, extending through **all layers of skin** into underlying **muscle**, **tendons**, or **bone**. - Often appears charred or black, and victims may feel little pain due to extensive nerve damage.
Question 27: Which muscle flap is commonly used for autologous breast reconstruction after mastectomy?
- A. Deltopectoral
- B. Serratus anterior
- C. Trapezius
- D. Latissimus dorsi (Correct Answer)
Explanation: ***Latissimus dorsi*** - The **latissimus dorsi** muscle is commonly used in **autologous breast reconstruction** due to its rich blood supply and ample tissue volume which can be transferred as a **pedicled flap** to the chest. - This flap includes muscle, skin, and subcutaneous fat, providing a good aesthetic outcome for **breast mound reconstruction** after mastectomy. *Deltopectoral* - The **deltopectoral flap** is primarily used for **head and neck reconstruction**, specifically for oral cavity and pharyngeal defects. - It involves muscle and skin from the **chest and shoulder region**, but its size and location make it less suitable for comprehensive breast reconstruction. *Serratus anterior* - The **serratus anterior** muscle is occasionally used as a **free flap** for small soft tissue defects, but it is not typically the first choice for large-volume breast reconstruction. - Its primary role is in **shoulder movement** and it does not provide sufficient tissue bulk for a complete breast mound. *Trapezius* - The **trapezius flap** is more commonly employed in **head and neck reconstruction** or for covering defects in the posterior shoulder region. - While it offers a good blood supply, its bulk and orientation are not ideal for **breast reconstruction**, which requires a more anterior and hemispheric shape.
Question 28: Which condition is commonly associated with complications arising from phimosis?
- A. Inability to retract the foreskin
- B. Inflammation of the glans and foreskin (Correct Answer)
- C. Urethral opening on the underside of the penis
- D. Narrowing of the urethral opening
Explanation: ***Inflammation of the glans and foreskin*** - **Phimosis** (the inability to retract the foreskin) can lead to poor hygiene under the foreskin, creating an environment for bacterial or fungal growth. - This often results in **balanitis** (inflammation of the glans) or **balanoposthitis** (inflammation of both the glans and foreskin) due to retained secretions and microorganisms. *Inability to retract the foreskin* - This is the **definition** of phimosis, not a complication arising from it. - While it is the primary characteristic, it directly describes the condition itself rather than a subsequent problem. *Urethral opening on the underside of the penis* - This condition is known as **hypospadias**, a congenital anomaly of the urethra. - Hypospadias is a developmental issue and is unrelated to phimosis or its complications. *Narrowing of the urethral opening* - This condition is called **meatal stenosis** and refers to the narrowing of the external opening of the urethra. - While it can cause urinary symptoms, it is a distinct condition and not a direct complication of phimosis, although severe phimosis might indirectly impact urinary hygiene.
Question 29: In the initial management of a hemodynamically unstable polytrauma patient, what is the recommended initial crystalloid bolus dose of Ringer's lactate for assessment and stabilization?
- A. 2000 ml Ringer's lactate bolus
- B. 1000 ml Ringer's lactate bolus, then regulated by clinical indicators (Correct Answer)
- C. 250 ml Ringer's lactate bolus
- D. 500 ml Ringer's lactate bolus, then regulated by clinical indicators
Explanation: ***1000 ml Ringer's lactate bolus, then regulated by clinical indicators*** - For **hemodynamically unstable** polytrauma patients, the initial recommended crystalloid bolus is typically **1 liter (1000 mL)** of Ringer's lactate. - This initial bolus allows for rapid assessment of the patient's response and guides subsequent fluid management based on **clinical indicators** such as blood pressure, heart rate, and urine output, avoiding over-resuscitation. *2000 ml Ringer's lactate bolus* - A **2000 ml bolus** is generally considered too large for an initial dose in trauma, as it can lead to **dilutional coagulopathy**, worsening hemorrhage, and **abnormal fluid shifts**, especially in cases where definitive hemorrhage control is not yet achieved. - Excessive fluid administration can lead to complications such as **abdominal compartment syndrome** and **acute respiratory distress syndrome (ARDS)**. *250 ml Ringer's lactate bolus* - A **250 ml bolus** is generally too small to effectively address **hemodynamic instability** in a polytrauma patient, offering insufficient volume to significantly improve circulation or organ perfusion. - While small boluses might be used in specific situations (e.g., small children or patients with cardiac comorbidities), this dose is not adequate for initial resuscitation in a severely unstable adult trauma patient. *500 ml Ringer's lactate bolus, then regulated by clinical indicators* - While **500 mL** is a common bolus size in other medical settings, it may be insufficient for the initial resuscitation of a **hemodynamically unstable adult polytrauma patient**. - Current trauma guidelines often recommend a larger initial bolus (e.g., 1000 mL) to gain a more immediate and measurable hemodynamic response for assessment.
Question 30: Most common congenital diaphragmatic hernia is:
- A. Bochdalek hernia (Correct Answer)
- B. Morgagni hernia
- C. None of the options
- D. Paraesophageal hernia
Explanation: ***Bochdalek hernia*** - This is the most common type of **congenital diaphragmatic hernia (CDH)**, accounting for approximately **95% of all CDH cases**. - It occurs due to a defect in the **posterolateral diaphragm** (pleuroperitoneal membrane), typically on the **left side**. - Presents in neonates with respiratory distress due to herniation of abdominal contents into the thorax. *Morgagni hernia* - This is a rare type of **congenital diaphragmatic hernia**, occurring through the **anterior retrosternal diaphragm** (foramen of Morgagni). - Accounts for only **2-5% of all CDH cases**, usually on the right side. - Often asymptomatic and diagnosed incidentally in adults. *Paraesophageal hernia* - This is an **acquired hiatal hernia** where part of the stomach herniates alongside the esophagus through the esophageal hiatus. - While **hiatal hernias are the most common diaphragmatic hernias overall**, they are **not congenital** and therefore not the answer to this question. - Seen commonly in older adults. *None of the options* - Incorrect, as **Bochdalek hernia** is definitively the most common congenital diaphragmatic hernia.