NEET-PG 2012 - Surgery Practice Questions

Q: How much length is increased in Z-plasty when it is done at 60 degrees?

75%. ***75%*** - A **60-degree Z-plasty** lengthens the central limb by approximately **75%** of its original length. This configuration provides a balance between length gain and flap viability. - The greater the angle of the Z-plasty limbs, the greater the theoretical lengthening, but also the larger the flaps and the increased risk of complications. *25%* - A **30-degree Z-plasty** typically provides about **25% lengthening** of the central limb. This angle offers less lengthening but is useful for smaller scars or when skin mobility is limited. - While it provides some lengthening, it falls significantly short of the length achieved with a 60-degree Z-plasty. *50%* - A **45-degree Z-plasty** generally results in approximately **50% lengthening**. This is an intermediate option, providing moderate lengthening. - This option does not match the significant lengthening associated with the larger 60-degree angle. *100%* - To achieve approximately **100% length gain**, larger angles such as **75 or 90-degree Z-plasty** might be considered. However, these angles are less commonly used due to increased flap size and tension at the base. - A standard 60-degree Z-plasty does not provide a 100% increase in length.

Q: Which of the following is NOT a standard component of the triple test for breast cancer detection?

Breast self examination. ***Breast self examination*** - While **breast self-examination (BSE)** is important for **personal awareness** and **early detection**, it is not considered a standard component of the diagnostic "triple test" for breast cancer, which aims for definitive diagnosis. - The traditional triple test comprises **clinical examination**, **imaging** (mammography/ultrasound), and **pathological assessment** (FNAC/biopsy). *USG/ mammography* - **Mammography** and **ultrasonography (USG)** are crucial imaging modalities and an integral part of the **triple test**, providing detailed anatomical information about breast lesions. - They help characterize masses detected clinically and guide biopsy procedures, contributing significantly to diagnosis. *FNAC/ trucut biopsy* - **Fine needle aspiration cytology (FNAC)** and **tru-cut biopsy** are essential for **histopathological diagnosis**, confirming malignancy and determining tumor characteristics. - This is the third component of the triple test, providing a definitive cellular or tissue diagnosis. *Clinical examination* - A **thorough clinical breast examination** by a healthcare professional is the first step in the triple test, identifying palpable masses or other suspicious signs. - It involves **inspection** and **palpation** to assess breast tissue and lymph nodes.

Q: In the context of inflammatory breast cancer, what is the TNM stage associated with the peau d'orange appearance?

T4b. ***T4b*** * The **TNM staging system** classifies T4b specifically for inflammatory breast cancer, which is characterized by the presence of **peau d'orange** (edema) of the skin of the breast. * This T stage also encompasses **ulceration of the skin** of the breast or satellite nodules confined to the same breast. *T4a* * T4a describes an **extension to the chest wall**, which includes the ribs, intercostal muscles, and serratus anterior muscle, but **not** the pectoralis muscle, which is generally not considered part of the chest wall for this classification. * This stage does **not** include the characteristic skin changes associated with inflammatory breast cancer. *T3* * T3 describes a tumor with a **size greater than 5 cm** in its greatest dimension, without direct extension to the chest wall or skin involvement. * This stage is based solely on tumor size and **does not account for the skin changes** like peau d'orange. *T2* * T2 describes a tumor with a **size greater than 2 cm but not more than 5 cm** in its greatest dimension. * Similar to T3, this stage is also based on tumor size and **does not include any skin involvement** or inflammatory features.

Q: What is the primary condition treated by the Kasai operation?

Biliary atresia. ***Biliary atresia*** - The **Kasai operation**, or **hepatoportoenterostomy**, is the primary surgical treatment for **biliary atresia**, a condition where the bile ducts are blocked or absent. - The procedure aims to establish bile flow from the liver to the small intestine to prevent liver damage. *Choledochal cyst* - A **choledochal cyst** is a congenital dilation of the bile ducts and is typically treated by surgical excision of the cyst and a **Roux-en-Y hepaticojejunostomy**. - While it involves the biliary system, it is a distinct condition from biliary atresia and requires a different surgical approach. *Hepatocellular carcinoma* - **Hepatocellular carcinoma** is a primary liver cancer, and its treatment options range from **surgical resection** and **transplantation** to **chemotherapy** and **radiation**, which are distinctly different from the Kasai operation. - The Kasai operation is not used for malignant conditions of the liver or bile ducts. *Primary biliary cirrhosis* - **Primary biliary cirrhosis** is a chronic autoimmune disease affecting the small bile ducts within the liver, causing progressive cholestasis. - Its management is primarily medical, focusing on symptom control and preventing disease progression with drugs like **ursodeoxycholic acid**, and surgery is not a primary treatment.

Q: Which of the following hernias has the highest risk of strangulation?

Spigelian. ***Spigelian*** - **Spigelian hernias** occur through a defect in the **Spigelian aponeurosis** (between the semilunar line and lateral border of rectus abdominis), typically inferior to the arcuate line. - They have a **high risk of strangulation (20-25%)** due to their **narrow fascial defect** and tendency to become incarcerated through the layers of the abdominal wall. - The hernia often becomes **interparietal** (between muscle layers), making it difficult to detect clinically, which increases the risk of delayed presentation and strangulation. *Indirect* - **Indirect inguinal hernias** pass through the **deep inguinal ring** and follow the inguinal canal, potentially entering the scrotum. - While they do have a narrow neck that can cause strangulation, their **strangulation risk is moderate (~10-15%)**, lower than Spigelian hernias. - They are the most common type of hernia but not the highest risk for strangulation among these options. *Direct* - **Direct inguinal hernias** protrude through **Hesselbach's triangle** in the posterior wall of the inguinal canal. - They have a **broad-based neck**, making strangulation relatively uncommon (~5%). - The wider defect allows easier reduction and less constriction of contents. *Incisional* - **Incisional hernias** develop at previous surgical incision sites due to fascial weakness or inadequate healing. - While they can incarcerate, they typically have a **wider neck** and **lower strangulation risk** compared to Spigelian or indirect inguinal hernias. - Risk varies with defect size, but generally not the highest among common hernia types.

Q: What is the treatment of choice for anal carcinoma?

Chemoradiation. ***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.

Q: A 10 cm tumor is found on the anterior surface of the thigh. What is the most appropriate procedure to obtain a diagnosis?

Incision biopsy. ***Incision biopsy*** - An **incision biopsy** is most appropriate for a large tumor (10 cm) to obtain a tissue diagnosis without performing a potentially morbid or disfiguring complete excision upfront. - It involves removing a representative section of the tumor for histopathological analysis, providing adequate tissue for diagnosis, grading, and subtyping. - This allows definitive treatment planning based on confirmed histopathology. *Excision biopsy* - **Excision biopsy** is generally reserved for smaller tumors (typically <3-5 cm) that can be completely resected with acceptable cosmetic and functional outcomes. - Excision of a 10 cm tumor on the thigh would be a significant surgical procedure, potentially causing substantial morbidity, without a prior definitive diagnosis. - Could compromise subsequent definitive surgery if margins are inadequate. *FNAC* - **FNAC (Fine Needle Aspiration Cytology)** provides only cytological diagnosis, which is insufficient for definitive diagnosis, grading, and subtyping of soft tissue tumors, especially sarcomas. - It misses crucial architectural features and tissue patterns needed for accurate classification. - May yield inadequate or non-diagnostic samples from large heterogeneous tumors. *USG* - **USG (Ultrasound)** is an imaging modality, not a tissue diagnosis procedure. - While useful for characterizing mass features (size, location, vascularity, solid vs cystic), it cannot provide histopathological diagnosis. - The question specifically asks for a procedure to "obtain a diagnosis," which requires tissue sampling for microscopic examination.

Q: What is the most common complication of a felon?

Osteomyelitis. ***Osteomyelitis*** - A **felon** is a severe infection of the **distal pulp space** of the fingertip, which has numerous fibrous septa. - The tightly compartmentalized nature of this space can lead to increased pressure, compromising blood supply and facilitating the spread of infection to the underlying **phalanx bone**, causing **osteomyelitis**. *Subungual hematoma* - A **subungual hematoma** is a collection of blood under the nail, usually resulting from direct trauma. - It is not a complication of an infection like a felon, but rather a separate traumatic injury. *Infective arthritis* - **Infective arthritis** involves the joint space, typically resulting from direct inoculation, hematogenous spread, or spread from adjacent soft tissue infection. - While possible, it is less common for a felon to directly spread to the **distal interphalangeal joint** compared to the more immediate risk of bone involvement. *No complications* - A **felon** is a serious infection that, if left untreated, almost always leads to complications due to the unique anatomy of the fingertip pulp space. - The high pressure within the compartments of the distal pulp makes it prone to necrosis and spread of infection to adjacent structures.

Q: The term 'raspberry tumor' is most commonly associated with which of the following conditions?

Umbilical granuloma. ***Umbilical granuloma*** - An **umbilical granuloma** is a common condition in newborns, presenting as a soft, red, moist growth at the umbilicus after the umbilical cord detaches. - Its characteristic appearance, resembling a small red berry, has led to the descriptive term "**raspberry tumor**." *Umbilical fistula* - An **umbilical fistula** is an abnormal connection that can occur between the intestine or bladder and the umbilicus, leading to the discharge of stool or urine from the umbilicus. - It does not present as a fleshy, raspberry-like growth, but rather as an opening with discharge. *Meckel’s diverticulum* - **Meckel's diverticulum** is a remnant of the **vitelline duct**, typically found on the anti-mesenteric border of the ileum, and is a congenital anomaly of the small intestine. - It is an internal structure and does not manifest externally at the umbilicus as a "raspberry tumor." *Umbilical adenoma* - An **umbilical adenoma** is a rare tumor of the umbilicus, often a remnant of the **vitelline duct** or **urachus**, which can present as a reddish mass. - While it can be a reddish mass, the specific term "raspberry tumor" is not commonly associated with umbilical adenoma but rather with umbilical granuloma due to its very distinct granular appearance.

Q: What is the first step to be taken in the management of a cervical spine injury?

Immobilization of spine. ***Immobilization of spine*** - In the context of **isolated cervical spine injury management**, **spinal immobilization** is the primary intervention to prevent further neurological damage. - This is typically achieved using a **cervical collar** and **backboard** to maintain in-line spinal stabilization. - **Note**: In actual trauma scenarios following **ATLS protocols**, airway management and cervical spine immobilization occur **simultaneously** as the first priority (Airway with C-spine protection). *Turn head* - **Turning the head** is absolutely contraindicated as it can exacerbate a cervical spine injury, leading to further compression or damage to the **spinal cord**. - Maintaining a **neutral, in-line position** is critical to avoid neurological deterioration. *Maintain airway* - In comprehensive trauma management per **ATLS guidelines**, **airway management with simultaneous cervical spine protection** is the first priority in the ABC sequence. - Airway is maintained using methods that do not compromise spinal stability, such as a **jaw thrust maneuver** or **endotracheal intubation with manual in-line stabilization**. - The distinction here is that this question focuses on the specific step for **spinal injury management** rather than overall trauma priorities. *None of the options* - This option is incorrect because **immobilization of the spine** is a definitive priority in managing a suspected cervical spine injury. - Both spinal immobilization and airway management are critical interventions that should occur together in actual practice.

Question 1

How much length is increased in Z-plasty when it is done at 60 degrees?

Accepted Answer

75%

Answer

50%

Answer

25%

Answer

100%

Question 2

Which of the following is NOT a standard component of the triple test for breast cancer detection?

Accepted Answer

Breast self examination

Answer

USG/ mammography

Answer

Clinical examination

Answer

FNAC/ trucut biopsy

Question 3

In the context of inflammatory breast cancer, what is the TNM stage associated with the peau d'orange appearance?

Accepted Answer

T4b

Answer

T4a

Answer

T3

Answer

T2

Question 4

What is the primary condition treated by the Kasai operation?

Accepted Answer

Biliary atresia

Answer

Choledochal cyst

Answer

Hepatocellular carcinoma

Answer

Primary biliary cirrhosis

Question 5

Which of the following hernias has the highest risk of strangulation?

Accepted Answer

Spigelian

Answer

Indirect

Answer

Direct

Answer

Incisional

Question 6

What is the treatment of choice for anal carcinoma?

Accepted Answer

Chemoradiation

Answer

Chemotherapy alone

Answer

APR combined with radiotherapy

Answer

All of the options

Question 7

A 10 cm tumor is found on the anterior surface of the thigh. What is the most appropriate procedure to obtain a diagnosis?

Accepted Answer

Incision biopsy

Answer

Excision biopsy

Answer

FNAC

Answer

USG

Question 8

What is the most common complication of a felon?

Accepted Answer

Osteomyelitis

Answer

Subungual hematoma

Answer

Infective arthritis

Answer

No complications

Question 9

The term 'raspberry tumor' is most commonly associated with which of the following conditions?

Accepted Answer

Umbilical granuloma

Answer

Umbilical fistula

Answer

Meckel’s diverticulum

Answer

Umbilical adenoma

Question 10

What is the first step to be taken in the management of a cervical spine injury?

Accepted Answer

Immobilization of spine

Answer

Turn head

Answer

None of the options

Answer

Maintain airway

NEET-PG 2012 — Surgery