Weber-Ferguson approach is used for?
Fatal exsanguination occurs most commonly in
Tensile strength of a wound becomes normal after:
Sistrunk operation is for:
NEET-PG 2013 - Surgery NEET-PG Practice Questions and MCQs
Question 61: Weber-Ferguson approach is used for?
- A. Maxillectomy (Correct Answer)
- B. Mastoidectomy
- C. Myringoplasty
- D. Mandibulectomy
Explanation: ***Maxillectomy*** - The **Weber-Ferguson approach**, also known as the **lateral rhinotomy approach**, is a standard surgical incision used to access the midface, particularly for procedures involving the maxilla. - It provides excellent exposure for **maxillectomy**, which is the surgical removal of part or all of the maxilla, often performed for tumors of the maxillary sinus or hard palate. *Mastoidectomy* - This procedure involves the surgical removal of diseased mastoid air cells, typically performed for chronic otitis media or cholesteatoma. - The surgical approaches for mastoidectomy usually involve incisions behind the ear (**postauricular** or **endaural**), not the Weber-Ferguson incision. *Myringoplasty* - Myringoplasty is a surgical repair of a perforated eardrum (tympanic membrane). - This procedure is typically performed through the ear canal (**transcanal approach**) or a small incision behind the ear, and does not require a large facial incision like the Weber-Ferguson. *Mandibulectomy* - Mandibulectomy involves the surgical removal of part or all of the mandible (jawbone), often for malignant tumors. - Approaches for mandibulectomy typically involve **transoral**, **submandibular**, or **lip-splitting incisions**, which are distinct from the Weber-Ferguson approach and designed for lower facial access.
Question 62: Fatal exsanguination occurs most commonly in
- A. Closed fracture of the femoral shaft
- B. Partial transection of an artery (Correct Answer)
- C. Complete transection of an artery
- D. Open fracture of the femur and tibia
Explanation: ***Partial transection of an artery*** - A **partially transected artery** is the most dangerous scenario for fatal exsanguination - The vessel walls **cannot retract or undergo effective vasospasm** because they remain tethered - The torn opening remains patent, allowing **continuous and profuse bleeding** - This is a classic surgical principle: **partial arterial injuries bleed more than complete transections** - Without prompt surgical control, this leads to rapid and fatal exsanguination *Complete transection of an artery* - When an artery is completely transected, the vessel ends **retract and go into spasm** - This natural hemostatic mechanism significantly **reduces immediate blood loss** - While still serious and requiring urgent treatment, complete transection is **less likely to cause fatal exsanguination** than partial transection - The retraction and spasm provide temporary hemostasis until definitive repair *Open fracture of the femur and tibia* - Can cause significant bleeding from muscle, soft tissue, and bone - However, the bleeding is typically **not from major arterial injury** unless vessels are directly damaged - Usually controllable with **tourniquets, pressure dressings, and splinting** - Less likely to cause immediate fatal exsanguination compared to major arterial injury *Closed fracture of the femoral shaft* - Can result in substantial internal blood loss (up to **1-1.5 liters** into the thigh compartment) - May cause **hypovolemic shock** requiring transfusion - However, the closed space provides some tamponade effect - Rarely causes immediate **fatal exsanguination** unless associated with other major injuries
Question 63: Tensile strength of a wound becomes normal after:
- A. Never (Correct Answer)
- B. 6 months
- C. 4 months
- D. 6 weeks
Explanation: ***Never*** - A healed wound, even after complete maturation, only achieves about **80% of the original tissue's tensile strength** - The process of scar formation involves the realignment of collagen fibers and increased cross-linking, but it can **never perfectly replicate** the pre-injury tissue architecture and strength - This is a fundamental principle of wound healing - scar tissue is structurally different from normal tissue *6 months* - By 6 months, a wound's tensile strength has typically reached its **maximum potential** of approximately 80%, but this is still less than 100% of the original tissue's strength - This period marks the end of the significant remodeling phase, where collagen fibers are reorganized and strengthened *4 months* - At 4 months, the wound is still undergoing substantial **remodeling and strengthening**, achieving approximately 70-80% of eventual tensile strength - While considerable strength is gained by this time, further improvements continue for several more months *6 weeks* - At 6 weeks, the wound has achieved about **50-70% of its eventual tensile strength** - This stage is characterized by increased collagen deposition and cross-linking, making the wound clinically strong, but it is far from its maximum or normal strength
Question 64: Sistrunk operation is for:
- A. Thyroglossal fistula
- B. Branchial fistula
- C. Thyroglossal cyst (Correct Answer)
- D. Branchial cyst
Explanation: ***Thyroglossal cyst*** - The **Sistrunk operation** is the definitive surgical procedure for the removal of a **thyroglossal duct cyst**. - This procedure involves excising the cyst along with the central portion of the **hyoid bone** and a core of muscle from the posterior aspect of the hyoid to the foramen cecum to prevent recurrence. *Thyroglossal fistula* - A **thyroglossal fistula** is a complication of a thyroglossal cyst that has ruptured or been surgically incised, leading to a persistent tract to the skin. - While a Sistrunk operation may be performed for a fistula, it is primarily indicated for the *cyst* itself to prevent both recurrence of the cyst and subsequent fistula formation. *Branchial fistula* - A **branchial fistula** is a congenital anomaly resulting from incomplete closure of the branchial arches during embryonic development, leading to an abnormal tract between the neck and the pharynx or skin. - Surgical excision of a branchial fistula is a different procedure from the Sistrunk operation, as its anatomical location and developmental origin are distinct from those of a thyroglossal cyst. *Branchial cyst* - A **branchial cyst** is a congenital neck mass arising from remnants of the branchial arches, typically presenting as a painless, soft, movable lump in the lateral neck. - While also a congenital neck cyst requiring surgical excision, the surgical approach for a branchial cyst does not involve the hyoid bone in the same manner as the Sistrunk operation due to its different embryological origin and location.