NEET-PG 2019 - Surgery PYQs Practice Questions

Q: Parathyroid autoimplantation takes place in which muscle?

Brachioradialis. ***Brachioradialis*** - The **brachioradialis muscle** in the forearm is the preferred site for parathyroid autoimplantation due to its accessibility and favorable blood supply. - This muscle allows for easy **monitoring of parathyroid graft function** and re-exploration if necessary. *Sternocleidomastoid* - While located in the neck, the **sternocleidomastoid muscle** is generally not used for parathyroid autoimplantation due to potential cosmetic concerns and the risk of damage to vital neck structures. - Its proximity to the original parathyroid glands could make it difficult to differentiate native tissue from implanted grafts if future surgery is required. *Triceps* - The **triceps muscle** in the upper arm is a large muscle, but it is not typically chosen for parathyroid autoimplantation. - It is less accessible for routine examination and potential re-exploration compared to the brachial region. *Sartorius* - The **sartorius muscle** is located in the thigh and is not used for parathyroid autoimplantation. - Its distant location from the head and neck region would make monitoring and re-exploration of the graft impractical. [Practice more Surgery PYQs on OnCourse]

Q: A patient presented with a history of diplopia and restricted eye movements. What is the most likely diagnosis based on the clinical and CT images?

Blowout fracture. ***Blowout fracture*** - The CT image shows a **fracture of the orbital floor**, with associated **herniation of orbital contents** (fat and inferior rectus muscle) into the maxillary sinus. - This type of fracture commonly causes **diplopia** (due to muscle entrapment) and **restricted eye movements**. *Le Fort fracture* - Le Fort fractures involve the **midface and maxilla** as a whole, typically causing widespread facial instability. - They are classified into three types (I, II, III), none of which are exclusively characterized by an isolated orbital floor fracture with muscle entrapment. *Maxillary fracture* - While an orbital floor fracture involves the maxilla, a "maxillary fracture" is a broad term and does not specifically describe the characteristic features of **orbital content prolapse** and their resulting symptoms. - Isolated maxillary fractures might not cause diplopia or restricted eye movements unless they directly involve the orbit. *Zygomatic fracture* - A zygomatic fracture (either isolated or as part of a zygomaticomaxillary complex fracture) primarily affects the **cheekbone**. - While it can involve the orbital rim, it typically presents with **facial asymmetry**, **numbness** in the infraorbital nerve distribution, and sometimes **trismus**, rather than isolated muscle entrapment causing diplopia, as seen in the image. [Practice more Surgery PYQs on OnCourse]

Q: What type of knot is depicted in the image?

Granny knot. ***Granny knot*** - The image shows a knot where the two half-knots are tied in the **same direction** (left over right, then left over right again, or vice versa), causing it to be unstable and slip. - This instability makes it less secure than a reef knot, as the two end pieces emerge parallel but on opposite sides of the loop. - The granny knot is an **insecure knot** that should be avoided in surgery as it can spontaneously untie. *Surgeon's knot* - A surgeon's knot involves an **extra throw** (double wrap) around the first loop to increase friction and make it more secure, which is not depicted here. - It is typically used to ensure that the first throw holds tension while the second throw is being tied. *Reef knot* - A reef knot (or square knot) is formed by tying two half-knots in **opposite directions** (left over right, then right over left), which creates a flat, stable, and secure knot. - In a reef knot, the two end pieces emerge parallel and on the same side of the loop, unlike the granny knot. *Half hitch* - A half hitch is a simple overhand knot around a standing part of the rope, used as a single throw or in combination with other knots. - It is not the same as the double-throw configuration shown in the image. [Practice more Surgery PYQs on OnCourse]

Q: What is the most likely diagnosis for the parotid mass with mixed consistency shown in the image?

Pleomorphic adenoma. ***Pleomorphic adenoma*** - The **mixed consistency** of the parotid mass indicates a **benign tumor**, predominantly of epithelial and mesenchymal origin, typical of pleomorphic adenomas. - This type of tumor is usually **pain-free** and can exhibit a **soft** and **firm** texture on examination [1]. *Sebaceous cyst* - Typically presents as a **smooth, fluctuant nodule** and usually has a **firm consistency** rather than mixed. - Generally not seen as a parotid mass; usually found on the skin in areas with sebaceous glands. *Dermoid cyst* - Generally presents as a **well-defined, soft, and mobile mass**, not commonly associated with mixed consistency. - Often contains **keratin** and has a more homogenous consistency rather than the mixed characteristics of pleomorphic adenoma. *All* - As not all options are suitable for the description of a **mixed consistency parotid mass**, this option is incorrect. - Only **pleomorphic adenoma** aligns with the specific clinical presentation detailed in the question [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 751-753. [Practice more Surgery PYQs on OnCourse]

Q: CEAP score indicates-

Venous disorder. ***Venous disorder*** - The **CEAP classification** is a widely recognized system used to categorize and describe chronic venous disorders. The acronym stands for **Clinical, Etiological, Anatomical, and Pathophysiological** factors. - It provides a standardized framework for clinicians to classify the severity and characteristics of **venous disease**, ranging from spider veins to active ulcers. *Atrial disorders* - **Atrial disorders** refer to conditions affecting the atria of the heart, such as **atrial fibrillation** or **atrial flutter**. - These are cardiovascular conditions distinct from venous disorders, which involve the veins (blood vessels returning blood to the heart). *Neurological disorder* - A **neurological disorder** is a condition affecting the **nervous system**, including the brain, spinal cord, and nerves. - The CEAP classification is specifically designed for vascular conditions and has no direct relevance to neurological diseases. *Trauma disorder* - A **trauma disorder** is a condition resulting from a **physically or psychologically traumatic event**. - While trauma can sometimes lead to venous issues (e.g., deep vein thrombosis from immobilization), the CEAP score itself is a classification system for chronic venous disease, not for traumatic conditions in general. [Practice more Surgery PYQs on OnCourse]

Question 1

Parathyroid autoimplantation takes place in which muscle?

Accepted Answer

Brachioradialis

Answer

Triceps

Answer

Sartorius

Answer

Sternocleidomastoid

Question 2

A patient presented with a history of diplopia and restricted eye movements. What is the most likely diagnosis based on the clinical and CT images?

Accepted Answer

Blowout fracture

Answer

Le Fort fracture

Answer

Maxillary fracture

Answer

Zygomatic fracture

Question 3

What type of knot is depicted in the image?

Accepted Answer

Granny knot

Answer

Half hitch

Answer

Surgeon’s knot

Answer

Reef knot

Question 4

What is the most likely diagnosis for the parotid mass with mixed consistency shown in the image?

Accepted Answer

Pleomorphic adenoma

Answer

Sebaceous cyst

Answer

Dermoid cyst

Answer

None of the options

Question 5

CEAP score indicates-

Accepted Answer

Venous disorder

Answer

Atrial disorders

Answer

Trauma disorder

Answer

Neurological disorder

Question 6

Identify the surgical instrument based on its characteristics: a small, triangular blade used for precise incisions.

Accepted Answer

Blade no. 11

Answer

Blade no. 15

Answer

Blade no. 10

Answer

Blade no. 12

Question 7

Degloving injury involves separation of:-

Accepted Answer

Skin + Fascia + Subcutaneous tissue

Answer

Skin

Answer

Everything above from bone

Answer

Skin + Subcutaneous tissue

Question 8

All of the following statements are true about Frey's Syndrome except

Accepted Answer

Sympathetic nerve involvement is the primary cause

Answer

Less chances with enucleation than parotidectomy

Answer

Gustatory sweating

Answer

Aberrant misdirection of parasympathetic fibers of auriculotemporal nerve

Question 9

Most commonly used approach for retrosternal goitre:-

Accepted Answer

Transcervical

Answer

Transthoracic second intercostal space

Answer

Axillary approach

Answer

Trans-sternal through anterior mediastinum

Question 10

Which of the following best describes a degloving injury?

Accepted Answer

Separation of skin, subcutaneous tissue, and fascia with tendon exposure

Answer

Separation of only the skin layer

Answer

Separation of skin and subcutaneous tissue without fascia involvement

Answer

Exposure of tendons without skin and fascia separation

NEET-PG 2019 — Surgery