In testicular torsion, within what time frame should surgery be performed to save the viability of the testis?
Young male with history of trauma having left sided testis swollen and erythematous. Other side normal. What is the diagnosis?
Head & face burn in infant accounts for what percentage of total body surface area?
What is the preferred method for removing a foreign body from the lung in children?
Most common anomaly of upper urogenital tract is -
In which one of the following conditions is gas under the diaphragm typically seen?
Which of the following statements about Grisel syndrome is false?
Most common site for anal fissure is
A 55-year-old male presents with a history of dysphagia with vomiting of undigested food throughout the day, weight loss, and appears emaciated and dehydrated. No mass is palpable per abdomen. After appropriate diagnostic workup reveals a benign esophageal stricture, the most appropriate definitive management is:
Which of the following is an example of a clean surgery?
NEET-PG 2013 - Surgery NEET-PG Practice Questions and MCQs
Question 41: In testicular torsion, within what time frame should surgery be performed to save the viability of the testis?
- A. 6 hr (Correct Answer)
- B. 12 hr
- C. 24 hr
- D. 1 week
Explanation: ***6 hr*** - Testicular viability is highest when **detorsion** occurs within **6 hours** of symptom onset. - Delay beyond this timeframe significantly increases the risk of **testicular ischemia** and necrosis. *12 hr* - While some viability may remain, the probability of **testicular salvage** decreases substantially after 6 hours. - Testicular function, including **sperm production**, is often compromised even if the testis is saved. *24 hr* - Beyond 12-24 hours, the likelihood of **testicular viability** is very low, and **orchiectomy** (testicle removal) is often necessary. - Prolonged ischemia leads to irreversible **tissue damage** and infarction. *1 week* - After one week, the testis is almost certainly non-viable due to **prolonged ischemia** and necrosis. - This delay would invariably result in the need for **orchiectomy**.
Question 42: Young male with history of trauma having left sided testis swollen and erythematous. Other side normal. What is the diagnosis?
- A. Carcinoma
- B. Hernia
- C. Hematoma (Correct Answer)
- D. Torsion
Explanation: ***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.
Question 43: Head & face burn in infant accounts for what percentage of total body surface area?
- A. 15%
- B. 18% (Correct Answer)
- C. 12%
- D. 32%
Explanation: ***18%*** - In infants, the **Rule of Nines** is modified due to their proportionally larger head and smaller lower extremities compared to adults. - The head and face in an infant account for a larger percentage of the **total body surface area (TBSA)**, specifically 18%. *15%* - This percentage is inaccurate for an infant's head and face when calculating **TBSA** using the modified Rule of Nines. - While some areas might be 15% in adults, an infant's head is proportionally larger. *12%* - This percentage significantly **underestimates** the body surface area of an infant's head and face. - Using this value would lead to an incorrect assessment of **burn size** and potential under-resuscitation. *32%* - This percentage far **overestimates** the surface area of an infant's head and face. - Such a high value would result in an incorrect assessment of **burn severity** and potentially lead to over-resuscitation.
Question 44: What is the preferred method for removing a foreign body from the lung in children?
- A. Rigid bronchoscopy (Correct Answer)
- B. Chest x-ray
- C. Flexible endoscopy
- D. Direct laryngoscopy
Explanation: ***Rigid bronchoscopy*** - **Rigid bronchoscopy** is the preferred method for removing foreign bodies from the lung in children due to its ability to provide better air control, magnified viewing, and larger working channels for robust grasping tools. - It allows for complete ventilation control and isolation of the airway, which is crucial in children where airway obstruction can rapidly lead to respiratory compromise. *Chest x-ray* - A **chest x-ray** is a diagnostic tool used to identify the presence and location of a foreign body, but it is not a method for removal. - Many foreign bodies, especially non-radiopaque ones like food, may not be visible on an x-ray, making it unreliable for definitive diagnosis of presence or absence. *Flexible endoscopy* - While **flexible bronchoscopy** can be used for foreign body removal in some adults or specific situations, it is generally less effective and carries higher risks in children, especially for larger or lodged objects. - Its smaller working channels and less stable airway control make it less suitable for urgent and complete removal in the pediatric population. *Direct laryngoscopy* - **Direct laryngoscopy** is used to visualize the larynx and vocal cords, primarily to remove foreign bodies from the upper airway or intubate, but not typically for removal of foreign bodies lodged deep within the main bronchi or lungs. - It does not offer direct access or visualization of the lower bronchial tree where most aspirated foreign bodies in children tend to lodge.
Question 45: Most common anomaly of upper urogenital tract is -
- A. Uretero pelvic junction stenosis (Correct Answer)
- B. Ureterocele
- C. Ectopic ureter
- D. Ectopic urethral opening
Explanation: ***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**.
Question 46: In which one of the following conditions is gas under the diaphragm typically seen?
- A. Perforated duodenal ulcer (Correct Answer)
- B. Typhoid perforation
- C. After laparotomy
- D. Spontaneous rupture of oesophagus
Explanation: ***Perforated duodenal ulcer*** - A perforated duodenal ulcer creates a communication between the **lumen of the duodenum and the peritoneal cavity**, allowing air from the gastrointestinal tract to escape. - This free air, being lighter, rises and collects under the **diaphragm**, visible as **pneumoperitoneum** on an upright chest X-ray. - This is the **classic and most typical** presentation taught in medical education for gas under the diaphragm. - Occurs in approximately **70-75% of cases** of peptic ulcer perforation. *Typhoid perforation* - Typhoid perforation (typically affecting the **terminal ileum**) also causes pneumoperitoneum and can show gas under the diaphragm. - However, it is **less commonly encountered** in routine practice compared to peptic ulcer perforation in most settings. - The question asks for the **"typically seen"** condition, which refers to the classic teaching example: perforated duodenal ulcer. *After laparotomy* - It is normal to see a small amount of **residual intra-abdominal gas** for a few days to a week after a laparotomy, which can collect under the diaphragm. - However, this is a **post-surgical finding** and not a pathological condition leading to gas under the diaphragm in the same acute, diagnostic sense as a perforation. - Not the answer when considering pathological causes. *Spontaneous rupture of oesophagus* - Spontaneous oesophageal rupture (Boerhaave syndrome) leads to leakage of oesophageal contents into the **mediastinum or pleural cavity**, not the peritoneal cavity. - Presents with **mediastinal emphysema** (Hamman's sign) and pleural effusion rather than pneumoperitoneum. - **Subdiaphragmatic free air** indicative of pneumoperitoneum is not typically seen.
Question 47: Which of the following statements about Grisel syndrome is false?
- A. It can occur after adenoidectomy.
- B. It involves inflammation of cervical spine ligaments.
- C. A neurosurgeon is never needed. (Correct Answer)
- D. Conservative treatment is the first-line approach in most cases.
Explanation: ***A neurosurgeon is never needed.*** - This statement is false because severe cases of **Grisel syndrome** may require surgical intervention, necessitating consultation with a **neurosurgeon**. - Surgical management, such as **cervical fusion**, may be indicated in cases of irreducible subluxation or neurological compromise. *It can occur after adenoidectomy.* - This statement is true; **Grisel syndrome** is a rare complication that may occur following **adenoidectomy** or other head and neck surgeries. - The postulated mechanism involves inflammation spreading from the pharynx to the alar and transverse ligaments, leading to **atlantoaxial subluxation**. *It involves inflammation of cervical spine ligaments.* - This statement is true; **Grisel syndrome** is characterized by non-traumatic **atlantoaxial subluxation** resulting from inflammatory laxity of the cervical ligaments. - Specifically, the **transverse and alar ligaments** become inflamed and weakened, leading to instability between the atlas (C1) and axis (C2). *Conservative treatment is the first-line approach in most cases.* - This statement is true; initial management of **Grisel syndrome** typically involves conservative measures such as **neck immobilization**, pain control, and muscle relaxants. - Early diagnosis and conservative treatment are crucial to prevent progression and potential neurological complications.
Question 48: Most common site for anal fissure is
- A. 3 O'clock
- B. 6 O'clock (Correct Answer)
- C. 2 O'clock
- D. 10 O'clock
Explanation: ***6 O'clock*** - The **posterior midline (6 o'clock position)** is the most common site for anal fissures, accounting for approximately **90% of all cases**. - This location is prone to tearing due to relatively **poor blood supply** and increased **mechanical stress** during defecation. - The posterior midline is the least supported part of the anal canal by the external anal sphincter. - **Note**: The **anterior midline (12 o'clock position)** is the second most common site, occurring in **10-25% of women** but rarely in men. *3 O'clock* - The **3 o'clock position (right lateral)** is an infrequent site for anal fissures. - Fissures in this location, especially if *lateral*, may suggest an underlying systemic disease such as **Crohn's disease**, **tuberculosis**, **HIV**, or **malignancy**. - Atypical fissures warrant thorough investigation. *2 O'clock* - The **2 o'clock position (anterior-lateral)** is not typically associated with anal fissures. - Similar to other atypical sites, a fissure here warrants investigation for secondary causes. - Consider inflammatory bowel disease or other pathological conditions. *10 O'clock* - The **10 o'clock position (left lateral)** is also a less common site for anal fissures compared to the posterior midline. - Fissures in lateral positions should raise suspicion for other conditions, such as **inflammatory bowel disease**, **tuberculosis**, **HIV**, or **malignancy**.
Question 49: A 55-year-old male presents with a history of dysphagia with vomiting of undigested food throughout the day, weight loss, and appears emaciated and dehydrated. No mass is palpable per abdomen. After appropriate diagnostic workup reveals a benign esophageal stricture, the most appropriate definitive management is:
- A. IV normal saline
- B. pH monitoring
- C. IV total parenteral nutrition
- D. Endoscopic dilation (Correct Answer)
Explanation: ***Endoscopic dilation (preferred treatment)*** - **Endoscopic dilation** directly addresses the underlying problem of the **benign esophageal stricture** by widening the narrowed esophagus, which is crucial for relieving dysphagia and improving nutritional intake. - Given the patient's severe symptoms like **weight loss**, **emaciation**, and **dehydration**, dilation allows for symptom relief and subsequent rehydration and nutritional support. *IV total parenteral nutrition* - While TPN provides nutrition, it does not resolve the **mechanical obstruction** caused by the stricture and carries risks such as infection and metabolic complications. - It's typically reserved for situations where enteral feeding is not possible or adequate after addressing the obstruction. *IV normal saline* - **IV normal saline** would help address the immediate **dehydration**, but it does not treat the underlying cause of the patient's symptoms (the esophageal stricture). - This is a supportive measure, not the primary management strategy for the stricture itself. *pH monitoring* - **pH monitoring** is used to diagnose and assess gastroesophageal reflux disease (**GERD**), which can sometimes cause strictures. - However, in a patient with a confirmed benign esophageal stricture and severe obstructive symptoms, addressing the stricture mechanically (dilation) takes precedence over diagnostic testing for reflux.
Question 50: Which of the following is an example of a clean surgery?
- A. Hernia surgery (Correct Answer)
- B. Cholecystectomy
- C. Rectal surgery
- D. Gastric surgery
Explanation: ***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.