Which of the following statements about heart transplantation is false?
What is the most common cause of lateral aberrant thyroid tissue?
A child presented with blunt abdominal trauma, the first investigation to be done is -
Vacuum assisted closure is contraindicated in which of the following conditions -
Which of the following statements is true regarding cystic hygroma?
The size threshold at which the risk of rupture of an abdominal aortic aneurysm significantly increases is:
Chvostek sign could be seen after -
Reactionary Hemorrhage occurs due to?
Claudication due to femoropopliteal incompetence is primarily seen in
Which of the following is the correct management of abdominal compartment syndrome?
NEET-PG 2015 - Surgery NEET-PG Practice Questions and MCQs
Question 41: Which of the following statements about heart transplantation is false?
- A. High pulmonary arterial resistance is a contraindication
- B. It is only orthotopic and not heterotopic (Correct Answer)
- C. Immunosuppression is started preoperatively
- D. A beating heart cadaver/donor is not always needed.
Explanation: ***It is only orthotopic and not heterotopic*** - This statement is **FALSE**, making it the correct answer to this question asking for the false statement. - While **orthotopic transplantation** (replacing the recipient's heart with the donor heart in its normal anatomical position) is the overwhelmingly predominant method, **heterotopic transplantation** (leaving the recipient's heart in place and implanting the donor heart as an auxiliary "piggyback" pump) has been performed as an alternative technique. - Heterotopic transplantation, though rarely used in modern practice, was described and performed in select cases, particularly when the donor heart is undersized or when severe pulmonary hypertension is present. Therefore, the claim that heart transplantation is "only orthotopic" is incorrect. *Immunosuppression is started preoperatively* - This statement is **TRUE**. - **Immunosuppressive therapy** is typically initiated intraoperatively or in some protocols may begin preoperatively to prevent hyperacute and acute rejection. - Induction immunosuppression aims to suppress the recipient's immune response before it can react to the transplanted organ, improving early graft survival. *High pulmonary arterial resistance is a contraindication* - This statement is **TRUE**. - **Fixed pulmonary hypertension** with elevated pulmonary vascular resistance (PVR >4-5 Wood units or transpulmonary gradient >15 mmHg unresponsive to vasodilators) is a **contraindication** for isolated heart transplantation. - The donor right ventricle may not be able to pump against high pulmonary pressures, leading to acute right heart failure. - Such patients may require combined heart-lung transplantation or medical optimization to reduce pulmonary vascular resistance before transplantation can be considered. *A beating heart cadaver/donor is not always needed* - This statement is considered **TRUE**, though with important caveats. - Traditionally, heart transplantation has relied almost exclusively on **beating-heart donors** (brain-dead donors with maintained cardiac function) to ensure organ viability. - The statement acknowledges that in rare circumstances or with advanced preservation techniques, the absolute requirement for a beating heart might be questioned, though in practical terms beating-heart donation remains the standard for heart transplantation.
Question 42: What is the most common cause of lateral aberrant thyroid tissue?
- A. Ectopic thyroid tissue due to developmental anomalies
- B. Thyroid tissue in the mediastinum
- C. Metastatic thyroid carcinoma (Correct Answer)
- D. Lingual thyroid
Explanation: ***Metastatic thyroid carcinoma*** - **Metastatic papillary thyroid carcinoma** to cervical lymph nodes is the most common cause of lateral aberrant thyroid tissue - The term "lateral aberrant thyroid" is a **historical misnomer** that has been abandoned in modern thyroid surgery - What was previously thought to be ectopic thyroid tissue in lateral neck nodes is virtually always **metastatic disease** - Papillary thyroid carcinoma commonly metastasizes to **regional lymph nodes**, which then contain thyroid follicular cells - This represents **lymph node metastases**, not developmental ectopia *Ectopic thyroid tissue due to developmental anomalies* - True developmental ectopia of thyroid tissue in the **lateral neck is extremely rare to nonexistent** - The thyroid gland originates from the **foramen cecum in the midline** and descends along the thyroglossal duct - Developmental ectopic thyroid occurs in **midline structures** (lingual thyroid, thyroglossal duct remnants), not laterally - The concept of "lateral aberrant thyroid" as a developmental anomaly has been **disproven** *Thyroid tissue in the mediastinum* - Mediastinal thyroid tissue represents **substernal or retrosternal goiter** that has descended into the chest - This describes a different anatomical location (mediastinum vs. lateral neck) - Not related to lateral cervical masses *Lingual thyroid* - Lingual thyroid is ectopic thyroid tissue located at the **base of the tongue** - This is a **midline structure**, not a lateral neck finding - Represents failure of thyroid descent during embryological development
Question 43: A child presented with blunt abdominal trauma, the first investigation to be done is -
- A. USG (Correct Answer)
- B. CT Scan
- C. Complete Hemogram
- D. Abdominal X-ray
Explanation: ***USG*** - An **ultrasound (USG)** is the **first-line imaging investigation** for blunt abdominal trauma in children due to its **non-invasive nature**, lack of radiation exposure, and rapid bedside availability. - **FAST (Focused Assessment with Sonography for Trauma)** effectively identifies the presence of **free fluid** (indicating internal bleeding/hemoperitoneum) and can assess solid organ injuries, particularly the **spleen and liver**. - It is the **preferred initial investigation in hemodynamically stable pediatric patients**. *CT Scan* - A **CT scan** is more sensitive and provides detailed anatomical information but involves significant **radiation exposure**, which is a major concern in children. - It is usually reserved for cases where USG is inconclusive, there is a **high clinical suspicion of severe injury**, or when determining the need for surgical intervention in hemodynamically stable patients. *Complete Hemogram* - A **complete hemogram** assesses blood components like hemoglobin and hematocrit, which are crucial for evaluating blood loss, but it is a **laboratory test, not an imaging investigation**. - While important for initial assessment and serial monitoring, it doesn't provide immediate information about the **location, type, or extent of internal abdominal injuries**. *Abdominal X-ray* - An **abdominal X-ray** has limited utility in blunt abdominal trauma as it is primarily useful for detecting **hollow viscus perforation (free air)** or bony fractures. - It does not effectively visualize soft tissue injuries, fluid collections, or solid organ damage, making it unsuitable as the primary diagnostic tool in blunt abdominal trauma.
Question 44: Vacuum assisted closure is contraindicated in which of the following conditions -
- A. Chronic osteomyelitis
- B. Large amount of necrotic tissue with eschar (Correct Answer)
- C. Abdominal wound
- D. Surgical wound dehiscence
Explanation: ***Large amount of necrotic tissue with eschar*** - The presence of a large amount of **necrotic tissue** and **eschar** is a contraindication for VAC therapy because it prevents effective contact between the foam and viable tissue, impairing wound healing. - Eschar acts as a physical barrier, trapping bacteria and hindering the proper function of negative pressure by preventing uniform pressure distribution and fluid removal from the wound bed. *Chronic osteomyelitis* - While chronic osteomyelitis can be challenging, VAC therapy can sometimes be used as an **adjunctive treatment** after surgical debridement to manage the wound and promote granulation tissue formation. - It helps in controlling infection and closing the wound by removing exudates, reducing edema, and improving blood flow. *Abdominal wound* - VAC therapy is commonly used for **abdominal wounds**, especially after damage control surgery or in cases of open abdomen management. - It facilitates closure by promoting granulation, reducing edema, and protecting the abdominal contents. *Surgical wound dehiscence* - **Surgical wound dehiscence** is a common indication for VAC therapy, as it helps to manage the open wound, promote granulation tissue, and prepare the wound for eventual secondary closure or grafting. - VAC therapy reduces surgical site infections, removes exudates, and enhances tissue perfusion, leading to better wound healing outcomes.
Question 45: Which of the following statements is true regarding cystic hygroma?
- A. Non transilluminant
- B. Develops from jugular lymphatic sequestration (Correct Answer)
- C. Lined by endothelial cells
- D. All of the options
Explanation: ***Develops from jugular lymphatic sequestration*** - **Cystic hygromas** are congenital **lymphatic malformations** that primarily occur in the neck - They arise from the abnormal budding or sequestration of the **jugular lymph sacs** during embryonic development, leading to the formation of dilated lymphatic channels that fail to connect with the venous system - This is the **most specific and characteristic** feature of cystic hygroma pathogenesis *Non transilluminant* - This statement is **incorrect**; cystic hygromas are typically **transilluminant** because they are fluid-filled sacs - The cystic nature of the lesion allows light to pass through, which is a classic diagnostic feature on clinical examination *Lined by endothelial cells* - While this statement is technically true (lymphatic endothelial cells are a type of endothelial cell), it is **not the most specific answer** - This feature is shared with all vascular and lymphatic structures, making it less distinctive for cystic hygromas - The key distinguishing feature is their **embryological origin** from jugular lymphatic sequestration, not just their endothelial lining *All of the options* - This option is **incorrect** because not all statements are true or most appropriate - Only the statement about jugular lymphatic sequestration represents the most specific and correct answer
Question 46: The size threshold at which the risk of rupture of an abdominal aortic aneurysm significantly increases is:
- A. 5.5 cm (Correct Answer)
- B. 6 cm
- C. 6.5 cm
- D. 7 cm
Explanation: ***5.5 cm*** - An abdominal aortic aneurysm (AAA) 5.5 cm or larger is typically the threshold for considering **elective surgical repair** due to significantly increased **rupture risk**. - For aneurysms smaller than this, the risk of surgery often outweighs the risk of rupture, making watchful waiting with surveillance more appropriate. *6 cm* - While a 6 cm AAA certainly has a very high risk of rupture, the generally accepted guideline for intervention begins at **5.5 cm** for most patients. - Delaying intervention until 6 cm could unnecessarily expose the patient to a higher risk of rupture. *6.5 cm* - An AAA of 6.5 cm carries an extremely high risk of rupture, and intervention would be strongly indicated. - This size is well past the standard **5.5 cm threshold** recommended for elective repair. *7 cm* - A 7 cm AAA is associated with a **critical and very high risk of rupture**, making immediate intervention imperative. - This size is significantly beyond the established guideline for considering elective repair, which is 5.5 cm.
Question 47: Chvostek sign could be seen after -
- A. Total Thyroidectomy (Correct Answer)
- B. Subtotal Thyroidectomy
- C. Heller's Cardiomyotomy
- D. Gastrojejunostomy
Explanation: ***Total Thyroidectomy*** - A total thyroidectomy involves the removal of the entire thyroid gland, which can inadvertently lead to the removal or damage of the **parathyroid glands** as well. - Damage to the parathyroid glands causes **hypoparathyroidism**, leading to **hypocalcemia**, which is characterized by neuromuscular excitability manifesting as a **Chvostek sign**. *Subtotal Thyroidectomy* - In a subtotal thyroidectomy, only a portion of the thyroid gland is removed, leaving some functional parathyroid tissue intact. - This procedure usually preserves enough parathyroid function to prevent severe **hypocalcemia** and the manifestation of a Chvostek sign. *Heller's Cardiomyotomy* - Heller's cardiomyotomy is a surgical procedure performed to treat **achalasia**, involving the cutting of muscle fibers in the esophagus. - This procedure does not involve the neck region or the parathyroid glands and therefore has no direct association with calcium regulation or the **Chvostek sign**. *Gastrojejunostomy* - A gastrojejunostomy is a surgical procedure that creates a bypass between the stomach and the jejunum, typically performed for conditions like gastric outlet obstruction or as part of bariatric surgery. - This operation is limited to the abdominal cavity and has no direct impact on calcium metabolism or the parathyroid glands that would elicit a **Chvostek sign**.
Question 48: Reactionary Hemorrhage occurs due to?
- A. Infection
- B. Damage to a blood vessel
- C. Pressure necrosis
- D. Dislodgement of clot (Correct Answer)
Explanation: ***Dislodgement of clot*** - **Reactionary hemorrhage** occurs within the first 24 hours post-surgery as the initial **vasoconstriction** and **blood pressure drop** from anesthesia resolve. - As blood pressure normalizes and peripheral vessels dilate, a **clot** that formed in a previously bleeding vessel becomes dislodged, leading to bleeding. *Infection* - **Infection** can cause secondary hemorrhage, but this typically occurs later, usually several days to weeks after surgery, due to tissue necrosis and erosion of blood vessels. - It is not the primary mechanism for hemorrhage occurring within the first 24 hours. *Damage to a blood vessel* - **Damage to a blood vessel** during surgery is a cause of primary hemorrhage, which occurs during or immediately after the procedure. - While it initiates the potential for bleeding, reactionary hemorrhage specifically refers to bleeding that resumes due to changes in patient physiology post-operatively, rather than ongoing vessel damage. *Pressure necrosis* - **Pressure necrosis** refers to tissue death due to sustained external pressure, often leading to skin breakdown or deep tissue injury. - It does not directly cause reactionary hemorrhage, although necrotic tissue could potentially contribute to later secondary hemorrhage if a vessel erodes.
Question 49: Claudication due to femoropopliteal incompetence is primarily seen in
- A. Thigh
- B. Calf (Correct Answer)
- C. Buttocks
- D. Feet
Explanation: ***Calf*** - **Femoropopliteal incompetence** refers to insufficiency in the superficial femoral and popliteal arteries. Blockage in these arteries typically results in **claudication** symptoms downstream from the obstruction. - The **calf muscles** receive their blood supply via these arteries and are therefore the primary site of pain due to inadequate blood flow during exertion, manifesting as claudication. *Thigh* - Claudication in the **thigh** is usually associated with more proximal arterial obstructions in the **aortoiliac system** or common femoral artery. - While thigh muscles are located upstream from the calf, pain would indicate a blockage higher up than the femoropopliteal segment. *Buttocks* - **Buttock claudication** points to very proximal arterial disease, specifically involving the **internal iliac arteries** or the distal aorta (**Leriche syndrome**). - This is even further upstream than the femoropopliteal arteries and would involve more significant and widespread circulatory compromise. *Feet* - While the **feet** can experience pain due to arterial insufficiency, particularly with severe disease or at rest, isolated foot claudication is less common. - **Claudication** specifically points to muscle ischemia during activity, and the robust musculature of the calf makes it the primary site when femoropopliteal arteries are involved.
Question 50: Which of the following is the correct management of abdominal compartment syndrome?
- A. Antihypertensives
- B. Urgent Fasciotomy
- C. Wait and monitor for 24 hours
- D. Urgent decompressive laparotomy (Correct Answer)
Explanation: ***Urgent decompressive laparotomy*** - The definitive treatment for abdominal compartment syndrome (ACS) is **urgent surgical decompression** via **decompressive laparotomy**. - This involves opening the abdominal fascia to immediately **reduce intra-abdominal pressure (IAP)**, typically indicated when IAP >20 mmHg with new organ dysfunction. - Decompression is crucial to prevent irreversible organ damage, restore perfusion to compressed organs, and improve ventilation. - The abdomen is often left open temporarily with negative pressure wound therapy until the patient stabilizes. *Antihypertensives* - Antihypertensives may manage systemic hypertension but do not address the **elevated intra-abdominal pressure** that is the primary pathology in ACS. - This approach is insufficient and could worsen **organ perfusion** by reducing the perfusion pressure gradient (MAP - IAP) to already compressed abdominal organs. - ACS requires mechanical decompression, not pharmacological blood pressure management. *Urgent Fasciotomy* - Fasciotomy is the correct treatment for **extremity compartment syndrome** (e.g., leg, forearm), where it relieves pressure within muscle compartments. - It is anatomically inappropriate for **abdominal compartment syndrome**, which requires opening the abdominal cavity, not limb fascial compartments. - This represents a fundamental misunderstanding of the anatomical site requiring decompression. *Wait and monitor for 24 hours* - ACS is a **surgical emergency** that can rapidly progress to multiorgan failure, acute kidney injury, respiratory failure, and cardiovascular collapse. - Delaying intervention by 24 hours would likely result in **irreversible organ damage** and significantly increased mortality. - Once diagnosed (IAP >20 mmHg with organ dysfunction), urgent decompression is mandatory.