NEET-PG 2013 - Surgery Practice Questions

Q: All of the following are causes of hemobilia, EXCEPT:

Hepatitis. ***Hepatitis*** - **Hepatitis** is an inflammation of the liver, typically caused by viral infections, alcohol, or autoimmune processes. While it can lead to liver damage and dysfunction, it does not typically cause **hemobilia**. - **Hemobilia** involves bleeding into the biliary tree, which is usually a result of vascular-biliary fistula formation; hepatitis primarily affects liver parenchymal cells and does not directly result in this type of bleeding. *Trauma to Abdomen* - **Abdominal trauma**, especially liver injuries, can lead to **vascular-biliary fistulae** or direct bleeding into the bile ducts, causing **hemobilia**. - Blunt or penetrating trauma can damage the liver parenchyma and blood vessels, allowing blood to enter the biliary system. *Malignancy* - **Malignant tumors** of the liver or biliary tract (e.g., **cholangiocarcinoma**, **hepatocellular carcinoma**) can erode into blood vessels and bile ducts, leading to **hemobilia**. - The growth of these tumors can rupture fragile vessels within the tumor or adjacent to it, causing blood to leak into the biliary tree. *Rupture of hepatic artery aneurysm* - A ruptured **hepatic artery aneurysm** is a significant and direct cause of **hemobilia**. - The forceful bleeding from the artery can breach the wall of an adjacent bile duct, creating a **fistula** and allowing arterial blood to enter the biliary system.

Q: In which of the following conditions is ERCP not indicated?

Proximal cholangiocarcinoma. ***Proximal cholangiocarcinoma*** - For **proximal/hilar cholangiocarcinoma** (Klatskin tumors at the **hepatic hilum**), **PTBD (Percutaneous Transhepatic Biliary Drainage)** is generally preferred over ERCP for biliary drainage. - The **high location** of these tumors makes endoscopic access difficult, with lower success rates and higher risk of complications like **cholangitis** and incomplete drainage. - **ERCP may fail** to adequately drain both hepatic ducts in bifurcation tumors, making PTBD the more reliable first-line approach. *Hepatic porta tumor* - **Hepatic porta tumors** involving the bile ducts are anatomically similar to **proximal cholangiocarcinoma**. - While ERCP can occasionally be attempted for porta hepatis lesions, **PTBD is often preferred** for high biliary obstructions due to better access to intrahepatic ducts. - The distinction is subtle, but **proximal cholangiocarcinoma** specifically refers to Klatskin tumors where ERCP has the **highest failure rate** and PTBD is most strongly preferred. *Distal CBD tumor* - **ERCP is the preferred modality** for **distal CBD tumors** to provide **biliary drainage**, tissue sampling (biopsy), and stent placement to relieve obstruction. - Direct endoscopic access to the distal common bile duct makes ERCP highly effective for diagnosis and palliation in this region. *Gallstone pancreatitis* - **ERCP is indicated** in **gallstone pancreatitis** when there is evidence of **cholangitis** or persistent **biliary obstruction** (e.g., rising liver enzymes, imaging showing retained stone in the CBD). - It allows for **therapeutic removal of impacted stones** from the common bile duct, preventing further pancreatic inflammation and complications.

Q: Which of the following is an example of a clean surgery?

Hernia surgery. ***Hernia surgery*** - **Clean surgeries** involve no entry into hollow viscera (e.g., gastrointestinal, genitourinary, or respiratory tract) and are characterized by **no inflammation** or infection. Hernia repair typically fits this description. - The risk of **surgical site infection** (SSI) is usually less than 2% in clean cases, making it a benchmark for surgical infection control. *Gastric surgery* - This involves entry into the **gastrointestinal tract**, which is considered a **contaminated** or **clean-contaminated** procedure due to the presence of bacteria. - The risk of infection is higher than in clean surgeries, often requiring prophylactic antibiotics. *Cholecystectomy* - This procedure involves the **gallbladder**, which is part of the biliary system, often considered a **clean-contaminated** wound if bile spills or if there's no evidence of active infection. - If performed for **acute cholecystitis** (inflammation/infection), it would be classified as **contaminated** or **dirty**. *Rectal surgery* - This involves the **rectum**, which is part of the lower **gastrointestinal tract** and contains a high bacterial load. - Procedures involving the rectum are classified as **contaminated** or **dirty** due to the high risk of bacterial contamination.

Q: Among the following single parameters, malnutrition in surgical patients is best assessed by:

Mid arm circumference. ***Mid arm circumference*** - **Mid-arm circumference (MAC)** is considered a reliable and easily measurable single parameter for assessing malnutrition, as it reflects both **muscle mass** and **subcutaneous fat**. - It is particularly useful in surgical patients where rapid and practical assessment of nutritional status is needed. *Serum albumin* - While **serum albumin** reflects visceral protein status, its levels can be significantly affected by **hydration status**, inflammation, and liver disease, making it less specific for malnutrition in acute surgical settings. - Due to its **long half-life**, serum albumin may not accurately reflect recent changes in nutritional status. *Hb level* - **Hemoglobin (Hb) levels** primarily assess anemia, which can be caused by various factors beyond malnutrition, such as blood loss or chronic disease. - Anemia does not directly measure or reflect overall protein-energy malnutrition. *Triceps skin fold thickness* - **Triceps skin fold thickness (TSFT)** measures subcutaneous fat stores but does not provide information about lean muscle mass or overall protein status. - Its measurement can be less accurate due to inter-observer variability and may not reflect comprehensive malnutrition as well as MAC.

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

Deep vein thrombosis. ***Deep vein thrombosis*** - **Surgery in varicose veins is absolutely contraindicated in the presence of DVT** (both acute and chronic) - In **acute DVT**, the deep venous system is already compromised, and removing superficial veins could further impair venous return and worsen the thrombotic state - In **chronic DVT with post-thrombotic syndrome**, the deep veins may be occluded or heavily damaged, and the superficial varicosities often serve as **crucial collateral vessels** to maintain venous drainage—their removal would be detrimental - Surgery should only be considered after complete resolution of acute DVT and adequate anticoagulation *Multiple incompetent perforators* - **NOT a contraindication**—incompetent perforators are actually a common indication for surgical treatment - Incompetent perforators contribute to venous insufficiency and recurrent varicose veins - Can be addressed surgically with **subfascial endoscopic perforator surgery (SEPS)** or endovenous ablation techniques - Their presence often indicates need for more comprehensive treatment alongside superficial venous surgery *Varicose veins with leg ulcer* - **NOT a contraindication**—venous leg ulcers are actually an **indication for varicose vein surgery** - Leg ulcers result from chronic venous hypertension due to venous insufficiency - Surgical treatment (saphenous vein ablation, ligation and stripping, or sclerotherapy) reduces venous hypertension and improves venous drainage - Surgery promotes ulcer healing and prevents recurrence when combined with appropriate wound care *None of the above* - Incorrect because **Deep Vein Thrombosis (DVT) is a well-established contraindication** to varicose vein surgery

Q: Commonest site of carcinoma tongue -

Lateral borders. ***Lateral borders*** - The **lateral borders** of the tongue are the most common site for squamous cell carcinoma due to chronic irritation from teeth, dental appliances, and exposure to carcinogens. - This area is subjected to considerable mechanical stress and chemical exposure, making it more susceptible to malignant transformation. *Apical* - While the apex (tip) of the tongue can be affected, it is **less common** compared to the lateral borders. - Tumors in this location may present earlier due to their prominent position, but incidence rates are lower. *Dorsum* - The **dorsum** (top surface) of the tongue is covered by papillae which provide some protective barrier, making it a **less frequent site** for carcinoma. - Carcinomas on the dorsum are often associated with other risk factors like syphilis or immunosuppression. *Posterior 1/3* - Carcinomas of the **posterior one-third** (base of the tongue) are often associated with **Human Papillomavirus (HPV)** infection. - These are typically harder to detect early due to their location and may present with different symptoms such as dysphagia or referred otalgia, but they are not the most common overall site.

Q: Most common anomaly of upper urogenital tract is -

Uretero pelvic junction stenosis. ***Uretero pelvic junction stenosis*** - **Ureteropelvic junction (UPJ) obstruction** is the most common cause of **antenatally detected hydronephrosis**, making it the most frequent anomaly of the upper urogenital tract. - It results from an intrinsic or extrinsic narrowing at the junction of the **renal pelvis** and the **ureter**, impeding urine flow. *Ectopic urethral opening* - This anomaly involves the **urethral opening** being in an abnormal location, such as **hypospadias** or **epispadias** in males, or into the vagina in females. - While relatively common, it is an anomaly of the **lower urogenital tract**, specifically the urethra, not the upper tract. *Ureterocele* - A ureterocele is a **cystic dilation** of the distal part of the ureter as it enters the bladder. - While it can be associated with varying degrees of **upper tract obstruction**, it is not as common as UPJ stenosis. *Ectopic ureter* - An ectopic ureter involves a ureter that drains into an abnormal location other than the **trigone of the bladder**. - This condition is less common than UPJ stenosis and is often associated with a **duplex collecting system**.

Q: All are true about carcinoma penis except which of the following?

Spreads by blood borne metastasis. ***Spreads by blood borne metastasis*** - Carcinoma penis typically spreads initially via the **lymphatic system** to inguinal lymph nodes. - **Hematogenous spread** is a late event and generally rare, with the most common sites being the lung, liver, and bone. *Leads to erosion of artery* - Local advancement of penile carcinoma can lead to **erosion of penile arteries**, which can cause significant morbidity including bleeding and functional compromise. - This local tissue destruction is a characteristic feature of advanced, uncontrolled penile cancer. *Slowly progressive* - Carcinoma penis is generally a **slowly progressive** malignancy, allowing for early detection and intervention if patients seek medical attention promptly. - The slow growth rate contributes to the fact that many patients present with localized or regionally advanced disease before distant metastases occur. *Most common type is squamous cell carcinoma* - Approximately 95% of penile cancers are **squamous cell carcinomas (SCCs)**, arising from the epithelial cells of the glans or foreskin. - Other rare types include melanoma, basal cell carcinoma, and sarcomas, but SCC vastly predominates.

Q: Young male with history of trauma having left sided testis swollen and erythematous. Other side normal. What is the diagnosis?

Hematoma. ***Hematoma*** - A history of **trauma** leading to a **swollen and erythematous testis** is highly indicative of a testicular hematoma. Trauma can cause bleeding within the scrotal sac, leading to the observed symptoms. - A hematoma is a localized collection of **blood outside of blood vessels**, which in this case, results from the injury to the testis or surrounding structures. *Torsion* - Testicular torsion typically presents with **sudden, severe pain** and swelling, and can be associated with absent **cremasteric reflex**. While swelling is present, the clear history of trauma points away from spontaneous torsion. - Torsion is an **emergency** caused by the twisting of the spermatic cord, which **cuts off blood supply** to the testis, and usually lacks a direct antecedent trauma. *Carcinoma* - Testicular carcinoma usually presents as a **painless, firm mass** within the testis. Pain can occur if there is hemorrhage within the tumor or rapid growth. - While it can cause swelling, the acute onset and direct association with trauma make carcinoma less likely, as it is a **slowly progressive** condition. *Hernia* - An inguinal hernia typically presents as a **groin bulge** that can extend into the scrotum, and usually reduces with manipulation or lying down. It is often associated with a cough or strain. - While a hernia can cause scrotal swelling, the primary presentation is usually a reducible mass, and the direct link to trauma with associated erythema is not typical for a simple hernia.

Q: May-Thurner or Cockett syndrome involves:

Left iliac vein compression. ***Correct: Left iliac vein compression*** - May-Thurner syndrome, also known as Cockett syndrome, specifically describes the **compression of the left common iliac vein** by the overlying right common iliac artery. - This anatomical compression can lead to **venous outflow obstruction**, increasing the risk of deep vein thrombosis (DVT) in the left leg. *Incorrect: Internal iliac artery obstruction* - This condition involves an artery and is unrelated to May-Thurner syndrome, which is a **venous compression disorder**. - Obstruction of the internal iliac artery would typically cause symptoms of **pelvic ischemia** or erectile dysfunction, not venous DVT. *Incorrect: Common iliac artery obstruction* - Obstruction of the common iliac artery is an **arterial occlusion** that would cause peripheral artery disease symptoms in the leg, such as claudication or rest pain. - It does not involve the compression of a vein by an artery, which is characteristic of May-Thurner syndrome. *Incorrect: Internal iliac vein obstruction* - While this is a venous issue, May-Thurner syndrome specifically involves the **common iliac vein**, not the internal iliac vein. - Obstruction of the internal iliac vein would typically present with symptoms related to pelvic venous congestion, distinct from the left lower extremity DVT associated with May-Thurner syndrome.

Question 1

All of the following are causes of hemobilia, EXCEPT:

Accepted Answer

Hepatitis

Answer

Trauma to Abdomen

Answer

Rupture of hepatic artery aneurysm

Answer

Malignancy

Question 2

In which of the following conditions is ERCP not indicated?

Accepted Answer

Proximal cholangiocarcinoma

Answer

Distal CBD tumor

Answer

Hepatic porta tumor

Answer

Gall stone pancreatitis

Question 3

Which of the following is an example of a clean surgery?

Accepted Answer

Hernia surgery

Answer

Cholecystectomy

Answer

Rectal surgery

Answer

Gastric surgery

Question 4

Among the following single parameters, malnutrition in surgical patients is best assessed by:

Accepted Answer

Mid arm circumference

Answer

Triceps skin fold thickness

Answer

Hb level

Answer

Serum albumin

Question 5

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 6

Commonest site of carcinoma tongue -

Accepted Answer

Lateral borders

Answer

Apical

Answer

Dorsum

Answer

Posterior 1/3

Question 7

Most common anomaly of upper urogenital tract is -

Accepted Answer

Uretero pelvic junction stenosis

Answer

Ureterocele

Answer

Ectopic ureter

Answer

Ectopic urethral opening

Question 8

All are true about carcinoma penis except which of the following?

Accepted Answer

Spreads by blood borne metastasis

Answer

Leads to erosion of artery

Answer

Slowly progressive

Answer

Most common type is squamous cell carcinoma

Question 9

Young male with history of trauma having left sided testis swollen and erythematous. Other side normal. What is the diagnosis?

Accepted Answer

Hematoma

Answer

Carcinoma

Answer

Hernia

Answer

Torsion

Question 10

May-Thurner or Cockett syndrome involves:

Accepted Answer

Left iliac vein compression

Answer

Internal iliac artery obstruction

Answer

Common iliac artery obstruction

Answer

Internal iliac vein obstruction

NEET-PG 2013 — Surgery