NEET-PG 2013 - Surgery PYQs Practice Questions

Q: Test to differentiate between psychological and organic erectile dysfunction is:

Nocturnal penile tumescence. ***Nocturnal penile tumescence*** - **Nocturnal penile tumescence (NPT)** testing measures the occurrence and quality of **erections during sleep**. - Healthy men experience erections during REM sleep; their presence suggests a **psychological cause** for erectile dysfunction as the neural pathways for erection are intact. *Pharmacologically induced penile erection therapy* - This involves injecting **vasodilating agents** directly into the penis to induce an erection. - While it can confirm the capacity for erection, it does not differentiate between psychological and organic causes since both types of ED can respond to direct pharmacological intervention. *Sildenafil induced erection* - Sildenafil (Viagra) is a **PDE5 inhibitor** that works by enhancing the effects of nitric oxide during sexual stimulation. - An erection induced by sildenafil can occur in both psychological and organic ED as long as there is some capacity for vasodilation, thus it does not differentiate the underlying cause. *Squeeze technique* - The **squeeze technique** is a behavioral therapy used to treat **premature ejaculation**, not erectile dysfunction. - It involves stopping stimulation at the point of impending ejaculation and applying pressure to the penis to reduce arousal. [Practice more Surgery PYQs on OnCourse]

Q: In which of the following conditions is protein catabolism MOST increased?

Burns. ***Burns*** - Severe burns lead to a profound **hypermetabolic state** with the highest increase in **protein catabolism** among all the options listed. - The extensive tissue damage triggers massive breakdown of muscle protein to provide amino acids for **wound healing**, **acute phase protein synthesis**, and **immune response**. - Burns can increase metabolic rate by **100-200%**, with protein catabolism far exceeding that of other stress conditions. *Starvation* - While starvation initially increases protein catabolism, the body adapts within days by shifting towards **ketone body utilization** to spare protein. - After adaptation, protein breakdown decreases to **20-30 grams per day** to preserve lean body mass. - The goal is survival through metabolic adaptation, not tissue repair. *Surgery* - Major surgery induces a **stress response** that increases protein catabolism, but it is typically less severe and shorter-lived than burns. - The degree of catabolism is proportional to the **magnitude of surgical trauma** and usually resolves within days. - Protein catabolism increases by **50-75%** in major surgery compared to **100-200%** in severe burns. *Fever* - Fever increases basal metabolic rate by approximately **13% per degree Celsius** rise in body temperature. - While metabolism is elevated, protein catabolism is **modest** compared to the massive tissue destruction and repair demands of severe burns. - The increase is primarily in energy expenditure, not protein breakdown. [Practice more Surgery PYQs on OnCourse]

Q: Which condition typically presents with irregular, hard palpable masses in the breast?

Invasive ductal carcinoma. ***Paget's disease*** - Paget's disease of the breast leads to **palpable abnormalities** such as skin changes and underlying mass formation [1]. - Often presents with **nipple discharge** and alterations in the areola, indicating an underlying malignancy [2]. *Non comedo DCIS* - Non comedo ductal carcinoma in situ (DCIS) typically presents with **microscopic changes** and lacks palpable masses. - Frequently asymptomatic and may not cause any **significant clinical findings** or changes in the breast. *None* - This option suggests the absence of a related condition, which does not address the query about a type of DCIS causing a **palpable abnormality**. - In the context of DCIS, there are sure conditions (like Paget's) that **do cause palpable changes**. *Comedocarcinoma* - This type of DCIS is characterized by **necrosis and calcifications**, rather than a palpable mass. - While potentially aggressive, it usually does not present with noticeable **palpable abnormalities** like Paget's disease. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1061-1062. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 456-457. [Practice more Surgery PYQs on OnCourse]

Q: Which levels of cervical lymph nodes are included in a modified radical neck dissection?

I-V. ***I-V*** - A modified radical neck dissection typically removes lymph nodes from levels **I through V**, along with preservation of one or more non-lymphatic structures (sternocleidomastoid muscle, internal jugular vein, or spinal accessory nerve). - This extensive dissection addresses potential metastasis to these node groups from head and neck cancers, crucial for adequate oncologic clearance while aiming for functional preservation. *I-III* - This limited dissection would likely be insufficient for many head and neck cancers, as spread often extends beyond level III. - It would miss potential metastases in the lower jugular and posterior triangle nodes, increasing the risk of recurrence. *I-IV* - This dissection omits **level V**, which includes the posterior triangle nodes, a common site for metastatic spread, especially for cancers of the oropharynx, hypopharynx, and thyroid. - Excluding level V would be considered an incomplete radical or modified radical neck dissection in many clinical scenarios. *II-VI* - This option incorrectly excludes lymph nodes at **level I** (submental and submandibular nodes), which are critical draining sites for many oral cavity cancers. - Including level VI (anterior compartment nodes) is typically part of a central compartment neck dissection, often performed for thyroid cancer, but is usually not part of a standard modified radical neck dissection for other head and neck primaries unless specifically indicated. [Practice more Surgery PYQs on OnCourse]

Q: Most common organ involved in air blast injury is?

Ear drum. ***Ear drum*** - The **tympanic membrane (eardrum)** is highly sensitive to changes in pressure, making it the most vulnerable and frequently injured organ during **air blast events**. - Its delicate structure can easily rupture due to the sudden, immense pressure wave. *Stomach* - While blast injuries can affect the gastrointestinal tract, causing conditions like **bowel perforation**, the stomach is less commonly and directly impacted than the eardrum. - Gastrointestinal injury usually results from a combination of **blast waves** and secondary effects like **fragmentation**. *Eye* - Eye injuries from blasts often involve **foreign bodies**, **ocular trauma**, or **thermal burns**, but direct **barotrauma** to the eye itself is less common than eardrum rupture. - The eye is somewhat protected by the bony orbit, offering a degree of shielding from direct blast effects. *Lung* - **Blast lung injury** is a serious, life-threatening condition involving pulmonary contusions, hemorrhage, and rupture of alveoli. - While significant, it is generally considered less frequent than eardrum perforation in overall blast injury cases. [Practice more Surgery PYQs on OnCourse]

Question 1

Test to differentiate between psychological and organic erectile dysfunction is:

Accepted Answer

Nocturnal penile tumescence

Answer

Pharmacologically induced penile erection therapy

Answer

Sildenafil induced erection

Answer

Squeeze technique

Question 2

In which of the following conditions is protein catabolism MOST increased?

Accepted Answer

Burns

Answer

Surgery

Answer

Starvation

Answer

Fever

Question 3

Which condition typically presents with irregular, hard palpable masses in the breast?

Accepted Answer

Invasive ductal carcinoma

Answer

Non comedo DCIS

Answer

Fibroadenoma

Answer

Comedocarcinoma

Question 4

Which levels of cervical lymph nodes are included in a modified radical neck dissection?

Accepted Answer

I-V

Answer

I-IV

Answer

I-III

Answer

II-VI

Question 5

Most common organ involved in air blast injury is?

Accepted Answer

Ear drum

Answer

Stomach

Answer

Eye

Answer

Lung

Question 6

What does the acronym NSABP represent in the context of cancer research?

Accepted Answer

National Surgical Adjuvant Breast and Bowel Project

Answer

National surgical adjuvant for brain and breast

Answer

National surgical adjuvant for bowel and brain

Answer

National surgical adjuvant for breast project

Question 7

What is the preferred palliative surgical procedure for rectal prolapse in elderly patients who are unfit for more invasive surgery?

Accepted Answer

Thiersch's operation

Answer

Delorme's procedure

Answer

Wells' procedure

Answer

Low anterior resection

Question 8

Most common site for anal fissure is

Accepted Answer

6 O'clock

Answer

3 O'clock

Answer

2 O'clock

Answer

10 O'clock

Question 9

Surgery in varicose veins is NOT attempted in the presence of which of the following?

Accepted Answer

Deep vein thrombosis

Answer

Multiple incompetent perforators

Answer

Varicose veins with leg ulcer

Answer

None of the above

Question 10

Commonest site of carcinoma tongue -

Accepted Answer

Lateral borders

Answer

Apical

Answer

Dorsum

Answer

Posterior 1/3

NEET-PG 2013 — Surgery