NEET-PG 2015 Practice Questions

Q: Which of the following statements about the bare area of the liver is false?

It is circular in shape. ***It is circular in shape*** - The bare area of the liver is **triangular** in shape, bordered by the reflections of the **coronary ligaments** and the inferior vena cava. [1] - Its shape is dictated by the anatomical arrangement of these peritoneal folds, making it distinctly non-circular. *Infection can spread from the abdominal to thoracic cavity at this area* - This statement is true because the bare area is the only part of the liver not covered by **peritoneum**, allowing direct contact between the liver and the diaphragm. [1] - This anatomical arrangement facilitates the spread of infections, like **subphrenic abscesses**, from the abdominal cavity to the posterior mediastinum and pleural cavity. [2] *It is not a site of portocaval anastomosis* - This statement is true; there is **no direct portosystemic shunt** at the bare area of the liver that becomes significant in portal hypertension. - While small veins connect the liver capsule to the diaphragm, these do not represent major portocaval anastomoses like those found at the gastroesophageal junction or rectum. *Formed by the reflections of coronary ligaments* - This statement is true; the bare area is specifically demarcated by the points where the **anterior and posterior layers of the coronary ligament** diverge, leaving a triangular region of the liver directly apposed to the diaphragm. [1] - The **coronary ligaments** are reflections of the peritoneum from the diaphragm onto the superior surface of the liver.

Q: Which of the following statements about hypernephroma is true?

Not radiosensitive. ***Radiosensitive*** - Hypernephroma, or renal cell carcinoma, is typically resistant to **radiation therapy**, making this statement false. - It is generally treated with **surgery** and targeted therapies rather than radiation. *Usually adenocarcinoma* - Hypernephroma is indeed a type of **adenocarcinoma**, as it originates from the renal tubular epithelium [1]. - It is the most common form of **kidney cancer**, supporting this as a true statement. *May present with rapidly developing varicocele* - Rapidly developing **varicocele** can occur due to **renal vein obstruction** associated with renal tumors [2], so this statement is true. - Varicocele is a recognized clinical feature in renal cell carcinoma due to its anatomical relationships. *Arise from cortex usually from pre existing adenoma* - Hypernephroma does arise from the **renal cortex**, often from pre-existing renal adenomas or other lesions. - This establishes its origin, making the statement accurate. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 959-961. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 492-493.

Q: A 45-year-old male is diagnosed with carcinoma of the penis. Which lymph nodes should the surgeon primarily consider for potential metastasis?

Inguinal lymph nodes (located in the groin region). ***Inguinal lymph nodes (located in the groin region)*** - The lymphatic drainage of the penis primarily bypasses the internal nodal basins and drains directly to the **superficial and deep inguinal lymph nodes**. - Metastasis to these nodes is the **most common initial spread** in penile carcinoma, making them the primary targets for surgical evaluation and dissection. *Para-aortic lymph nodes (located near the aorta)* - These nodes are typically involved in more advanced or widespread metastatic disease, following initial spread to the pelvic nodes. - They are not considered the primary draining lymph nodes for penile carcinoma. *External iliac lymph nodes (located along the external iliac vessels)* - While part of the pelvic lymph node chain, the external iliac nodes are usually involved after metastasis to the inguinal nodes, or in cases of direct invasion of the pelvic floor. - They are not the first echelon of lymphatic drainage for the penis. *Internal iliac lymph nodes (located along the internal iliac vessels)* - These nodes are involved in lymphatic drainage from organs like the bladder, prostate, and rectum. - The lymphatic drainage of the penis primarily bypasses these nodes for initial metastasis.

Q: A 45-year-old male presenting with penile cancer extending up to the glans penis is treated with which of the following surgical options?

Partial penectomy with a 2 cm margin. ***Partial penectomy with a 2 cm margin*** - For **penile cancer** confined to the glans, **partial penectomy** is the standard surgical approach to achieve local control while preserving penile length. - Historically, a **2 cm tumor-free margin** was recommended as the standard of care (reflected in older guidelines and exam questions). - **Modern evidence** suggests that narrower margins of **5-8 mm** are oncologically safe with comparable local control rates, but the **2 cm margin** was the traditional teaching and remains the expected answer for this question context. *Simple circumcision* - **Simple circumcision** is indicated for benign conditions like **phimosis** or **premalignant lesions** (carcinoma in situ), not for invasive cancer. - It does not provide adequate oncological clearance for **invasive penile cancer** and carries a high risk of **local recurrence**. *Partial penectomy with a 4 cm margin* - A **4 cm margin** is excessively radical and would result in unnecessary loss of penile length and function. - Even by historical standards, this exceeds the recommended **2 cm margin** and would cause significant functional and psychological morbidity. *Partial penectomy with inguinal lymph node dissection* - **Inguinal lymph node dissection** is indicated when there is **clinical or radiological evidence of lymph node metastasis** or high-risk pathological features. - Without evidence of nodal involvement, routine prophylactic lymphadenectomy is not performed due to significant morbidity (lymphedema, wound complications). - The question does not specify nodal involvement, making this option unnecessarily aggressive.

Q: A young male presents with a testicular mass on the right side. The AFP is elevated while the HCG is normal. The most appropriate next step is

Orchidectomy. ***Radical Inguinal Orchidectomy*** - In a patient who already presents with a **testicular mass** and **elevated AFP** (suggesting non-seminomatous germ cell tumor), the most appropriate next step is **radical inguinal orchidectomy**. - This procedure is both **diagnostic and therapeutic**, providing tissue for histopathological confirmation while removing the primary tumor. - The standard management sequence is: clinical examination → scrotal USG → tumor markers → **orchidectomy** → staging imaging → further treatment based on histology and stage. - Since the mass is already identified and tumor markers are done, proceeding directly to orchidectomy is appropriate. *USG* - Scrotal **ultrasound** is typically the **first imaging modality** when a testicular mass is suspected or palpated. - However, in this scenario, the mass is already clinically identified and tumor markers (AFP) have been measured, suggesting that initial workup including USG has likely been completed. - USG would have been the appropriate answer if the question asked for the "first investigation" before tumor markers were done. *Biopsy* - Direct **biopsy** of a testicular mass is **contraindicated** due to the high risk of tumor cell spillage along the needle tract, which can alter staging and worsen prognosis. - Testicular cancer is diagnosed via **radical inguinal orchidectomy**, not biopsy. *Wait and Watch* - A **wait and watch** approach is inappropriate and dangerous in the presence of a **testicular mass with elevated AFP**, which strongly suggests malignancy (non-seminomatous germ cell tumor). - Delayed treatment can lead to disease progression, metastasis, and poorer outcomes.

Q: All of the following are true about Nissen Fundoplication except which of the following?

Reinforcement is done only in the posterior half. ***Reinforcement is done only in the posterior half*** - This statement is incorrect because the **Nissen fundoplication** typically involves a **360-degree wrap** of the gastric fundus around the lower esophagus. - A 360-degree wrap provides complete reinforcement to prevent reflux, unlike a partial wrap which might be used in other procedures but not a standard Nissen. *It is done for GERD* - **Nissen fundoplication** is a common surgical procedure performed to treat severe **Gastroesophageal Reflux Disease (GERD)** that is refractory to medical management. - The procedure aims to strengthen the **lower esophageal sphincter (LES)** and prevent the reflux of stomach contents into the esophagus. *Upper part of stomach is plicated around the lower esophagus* - Specifically, the **fundus** (upper part) of the stomach is wrapped around the distal esophagus to create a functional valve. - This wrap helps to reinforce the LES and prevent stomach acid from flowing back up into the esophagus. *It is done for paraesophageal hiatus hernia* - **Nissen fundoplication** is often performed concurrently with the repair of a **hiatal hernia**, especially a **paraesophageal hernia**, to anchor the stomach in its correct anatomical position and prevent recurrence. - Repair of the hernia alone may not be sufficient to prevent reflux, making the fundoplication an important additional step.

Q: In which of the following surgeries is monopolar cautery preferred over bipolar cautery?

Surgery of the Hip. ***Surgery of the Hip*** - **Monopolar cautery** is preferred in surgeries like hip surgery where a larger area needs to be coagulated, as it provides a wider field of effect and can be more efficient for **deep tissue coagulation**. - Its mechanism relies on the current passing through the patient to a large **dispersive electrode (grounding pad)**, making it suitable for extensive tissue work. *Hand Surgery* - In **hand surgery**, delicate structures like nerves and tendons are abundant, making **bipolar cautery** safer due to its localized current flow and reduced risk of inadvertent thermal spread. - **Bipolar cautery** limits the current to a small area between the two prongs of the instrument, thus minimizing damage to surrounding tissues. *Surgery around Penis* - **Bipolar cautery** is generally preferred in sensitive areas like the penis, due to its localized effect and reduced risk of thermal injury to adjacent delicate structures. - The avoidance of current passing through the body to a grounding pad in **bipolar modality** is especially important in areas with potential for nerve damage or scarring. *Surgery around the face* - Surgically around the face often involves delicate tissues and structures where **bipolar cautery** is favored to prevent widespread thermal damage and minimize scarring or nerve injury. - The confined current path of **bipolar cautery** makes it ideal for precision work in cosmetic or reconstructive facial surgery.

Q: What is the primary treatment for early-stage non-small cell lung cancer?

Surgical resection. ***Surgical resection*** - **Surgical resection** (lobectomy or segmentectomy with lymph node dissection) is the **primary and definitive treatment** for early-stage non-small cell lung cancer (Stage I-II). - For **Stage IA disease**, surgery alone provides excellent outcomes with 5-year survival rates of 70-90%, and adjuvant chemotherapy is generally **not indicated**. - For **Stage IB-II**, surgery remains primary, with adjuvant chemotherapy considered selectively based on tumor size (>4 cm), poor differentiation, vascular invasion, or other high-risk features. - Complete surgical resection offers the **best chance of cure** for resectable early-stage NSCLC. *Surgical resection with adjuvant chemotherapy* - While this combination is important for **select early-stage cases** (high-risk Stage IB, Stage II-IIIA), it is **not the universal primary treatment** for all early-stage disease. - Adjuvant chemotherapy is an **addition** to surgery in specific scenarios, not part of the primary treatment for the majority of early-stage (especially Stage IA) patients. - Current guidelines recommend risk stratification before adding adjuvant therapy. *Radiotherapy* - **Radiotherapy** (stereotactic body radiotherapy/SBRT) is reserved for **medically inoperable** patients or those who refuse surgery. - It is not the primary treatment when the patient is a **surgical candidate**. - May be used as adjuvant therapy in patients with positive margins or N2 disease. *Immunotherapy* - **Immunotherapy** has emerging roles in neoadjuvant/adjuvant settings for resectable NSCLC (recent trials showing benefit). - However, it is **not established as primary monotherapy** for early resectable disease. - More commonly used in advanced/metastatic NSCLC or as part of combination regimens in clinical trial settings for early disease.

Q: All of the following statements about Gastrointestinal carcinoid tumors are true, Except:

Rectum is spared. ***Rectum is spared*** - This statement is **incorrect**; carcinoid tumors can occur in the rectum, which is often **affected** by such tumors. - It is more accurate to say that carcinoid tumors arise in various gastrointestinal locations, including the **rectum** itself. *Small intestine and appendix account for almost 60% of all gastrointestinal carcinoid* - This statement is **true**; small intestine and appendix are indeed significant sites for carcinoid tumors, together accounting for nearly **60% of cases**. - These locations are particularly prominent due to the number of neuroendocrine cells found in these areas of the **gastrointestinal tract** [1][2]. *5 year survival for carcinoid tumors is >60%* - This statement is **true**, as many patients with localized carcinoid tumors exhibit a **5-year survival rate** greater than 60%. - Survival rates vary depending on the tumor's stage and location, but overall, they tend to have a favorable prognosis when diagnosed early. *Appendicial carcinoids are more common in females than males* - This statement is **true**; studies indicate that appendiceal carcinoids are indeed more frequently diagnosed in **females** compared to males [2]. - This differentiation is one of the notable epidemiological trends observed with carcinoid tumors.

Q: What is the typical absorption duration of Polydioxanone sutures?

6 months. ***Correct: 6 months*** - **Polydioxanone (PDS) sutures** are known for their **prolonged absorption time**, typically ranging from 180 to 210 days, or approximately 6 months. - This characteristic makes PDS sutures suitable for tissues requiring **extended support** during the healing process. - PDS retains approximately **50% tensile strength at 4 weeks** and **25% at 6 weeks**, with complete absorption occurring over 6-7 months. *Incorrect: 2 weeks* - An absorption duration of 2 weeks is characteristic of **rapidly absorbing sutures**, such as **chromic gut** or **fast-absorbing synthetic sutures**, which are used for tissues that heal quickly or require minimal support. - PDS sutures offer much longer tensile strength retention and absorption than this brief period. *Incorrect: 4 weeks* - A 4-week absorption time is considerably shorter than that of PDS sutures. This duration might be seen with some **intermediate-absorbing sutures**, but not with the long-lasting PDS. - Sutures absorbed in this timeframe would not provide sufficient support for tissues where PDS is typically indicated. *Incorrect: 6 weeks* - While longer than 2 or 4 weeks, 6 weeks (approximately 42 days) is still much shorter than the typical absorption profile of PDS sutures. - Sutures like **Vicryl Rapide** might fall into this absorption range, but PDS is designed for applications needing several months of support.

Question 1

Which of the following statements about the bare area of the liver is false?

Accepted Answer

It is circular in shape

Answer

It is not a site of portocaval anastomosis

Answer

Formed by the reflections of coronary ligaments

Answer

Infection can spread from the abdominal to thoracic cavity at this area

Question 2

Which of the following statements about hypernephroma is true?

Accepted Answer

Not radiosensitive

Answer

May present with rapidly developing varicocele

Answer

Usually an adenocarcinoma

Answer

Arises from the cortex, usually from a pre-existing adenoma

Question 3

A 45-year-old male is diagnosed with carcinoma of the penis. Which lymph nodes should the surgeon primarily consider for potential metastasis?

Accepted Answer

Inguinal lymph nodes (located in the groin region)

Answer

Para-aortic lymph nodes (located near the aorta)

Answer

External iliac lymph nodes (located along the external iliac vessels)

Answer

Internal iliac lymph nodes (located along the internal iliac vessels)

Question 4

A 45-year-old male presenting with penile cancer extending up to the glans penis is treated with which of the following surgical options?

Accepted Answer

Partial penectomy with a 2 cm margin

Answer

Simple circumcision

Answer

Partial penectomy with a 4 cm margin

Answer

Partial penectomy with inguinal lymph node dissection

Question 5

A young male presents with a testicular mass on the right side. The AFP is elevated while the HCG is normal. The most appropriate next step is

Accepted Answer

Orchidectomy

Answer

Biopsy

Answer

USG

Answer

Wait and Watch

Question 6

All of the following are true about Nissen Fundoplication except which of the following?

Accepted Answer

Reinforcement is done only in the posterior half

Answer

It is done for GERD

Answer

Upper part of stomach is plicated around the lower esophagus

Answer

It is done for paraesophageal hiatus hernia

Question 7

In which of the following surgeries is monopolar cautery preferred over bipolar cautery?

Accepted Answer

Surgery of the Hip

Answer

Surgery around Penis

Answer

Hand Surgery

Answer

Surgery around the face

Question 8

What is the primary treatment for early-stage non-small cell lung cancer?

Accepted Answer

Surgical resection

Answer

Radiotherapy

Answer

Surgical resection with adjuvant chemotherapy

Answer

Immunotherapy

Question 9

All of the following statements about Gastrointestinal carcinoid tumors are true, Except:

Accepted Answer

Rectum is spared

Answer

Small intestine and appendix account for almost 60% of all gastrointestinal carcinoid

Answer

Appendicial carcinoids are more common in females than males

Answer

5 year survival for carcinoid tumors is >60%

Question 10

What is the typical absorption duration of Polydioxanone sutures?

Accepted Answer

6 months

Answer

4 weeks

Answer

6 weeks

Answer

2 weeks

NEET-PG 2015

Anatomy

Pathology

Surgery