NEET-PG 2025 — Surgery
8 Previous Year Questions with Answers & Explanations
What is correct regarding this suture?
A 56-year-old man presents with the following pathology shown in the image, which of the following is correct?
A 3-year-old child was brought to OPD with complaint of dysuria and ballooning on micturition and examination as given below, what is the diagnosis?
A 30-year-old female was brought to the emergency room after a fire. On examination, full-thickness burns and deep partial-thickness burns were present involving the lower limb circumferentially. A procedure was performed to relieve vascular compromise. Identify the procedure?
Identify the fistula according to Park's classification?
After a building collapse, a patient presents with airway obstruction and mouth filled with concrete debris. BP is 90/60 mmHg, HR 105/min. A cricothyrotomy is performed. Which of the following statements regarding this procedure is true?
Identify the knot?
A 43-year-old female presents to OPD due to changes in breast and a lump in breast as given below. What is the diagnosis?
NEET-PG 2025 - Surgery NEET-PG Practice Questions and MCQs
Question 1: What is correct regarding this suture?
- A. Collagen derived
- B. Non absorbable
- C. Monofilament (Correct Answer)
- D. Braided multifilament
Explanation: ***Monofilament*** - **Monofilament** sutures consist of a single strand, which minimizes tissue drag and reduces the risk of harboring **bacteria** and subsequent wound infection. - This structure is typical for materials like **Prolene** (Polypropylene) and **Nylon**, prized for their low friction and use in delicate or contaminated fields. *Non absorbable* - This describes the **fate** of the suture (remaining permanently in the body) but not its structure; non-absorbable sutures can be either **monofilament** (e.g., Nylon) or multifilament (e.g., Silk). - While many important sutures are non-absorbable, it is a property independent of whether the suture is single-stranded. *Braided multifilament* - This refers to sutures made of multiple intertwined strands, which is the structural opposite of a **monofilament**. - Multifilament sutures typically offer better knot security but have increased tissue drag and potential for **capillarity** (wicking action). *Collagen derived* - This refers to the material source, specifically **catgut** (made from sheep or cow intestine), which is an absorbable natural material. - Catgut is absorbable and rapidly loses its tensile strength; 'monofilament' describes the physical form and is not exclusive to this biologic material.
Question 2: A 56-year-old man presents with the following pathology shown in the image, which of the following is correct?
- A. Sclerotherapy is the best treatment
- B. Telangiectasia is rare
- C. No possibility of venous ulcer
- D. Lipodermatosclerosis/eczema can occur (Correct Answer)
Explanation: ***Lipodermatosclerosis/eczema can occurs*** - The image suggests features of **chronic venous insufficiency (CVI)**, including skin discoloration (hyperpigmentation/hemosiderin deposition) and induration, which are classic features leading to **lipodermatosclerosis** and **venous eczema** (C4 changes in CEAP classification). - Lipodermatosclerosis involves inflammation and fibrosis of the skin and subcutaneous fat in the gaiter area due to prolonged **venous hypertension**. *Sclerotherapy is the best treatment* - Sclerotherapy is typically indicated for **small varicose veins** or **telangiectasias**. - For CVI causing advanced skin changes (like lipodermatosclerosis), the best initial treatment is usually **compression therapy** and addressing the source of reflux (e.g., endovenous ablation). *Telangiectasia is rare* - **Telangiectasias** (spider veins) are very common in patients with CVI and often represent the earliest visible sign of **venous disease** (C1 in CEAP classification). - The presence of more advanced skin changes (like those shown) indicates significant venous hypertension, often accompanied by microcirculatory changes including telangiectasia. *No possibility of venous ulcer* - The changes seen (hyperpigmentation and probable underlying induration/atrophy) are stages C4/C5 of the CEAP classification, which are **immediate precursors** to or associated with **venous leg ulcers** (C6). - Venous hypertension is the underlying cause for both the skin changes and the development of **venous ulcers**, making the possibility very real in this patient.
Question 3: A 3-year-old child was brought to OPD with complaint of dysuria and ballooning on micturition and examination as given below, what is the diagnosis?
- A. Recurrent balanoposthitis
- B. Balanitis xerotica obliterans
- C. Recurrent urinary tract infections
- D. True phimosis (Correct Answer)
Explanation: ***True phimosis*** - The image shows a severely narrowed, pinhole-like preputial opening, coupled with **dysuria** and **ballooning on micturition**, which are hallmark symptoms of symptomatic or **pathological phimosis**. - **Ballooning** occurs because the tight foreskin traps urine before it can exit, confirming significant distal urinary outflow obstruction. *Balanitis xerotica obliterans* - Although BXO is a leading cause of pathological phimosis, this diagnosis is reserved for cases showing characteristic **sclerotic, white, atrophic skin changes** around the meatus, which are absent in the image. - BXO typically develops secondary to a chronic inflammatory process and is often considered when the phimosis is **acquired** rather than purely developmental. *Recurrent balanoposthitis* - Balanoposthitis is an inflammation of the glans and prepuce, typically presenting with **erythema, swelling, and discharge**. - While repeated episodes can lead to **scarring and acquired phimosis**, the primary and most concerning diagnosis here is the resulting anatomical obstruction (phimosis) that is causing symptoms. *Recurrent urinary tract infections* - **Recurrent UTIs** are a potential complication of significant true phimosis, resulting from urine stasis and poor hygiene. - However, the symptoms described, especially **ballooning on micturition**, directly indicate the presence of urethral **outflow obstruction**, which is the diagnosis.
Question 4: A 30-year-old female was brought to the emergency room after a fire. On examination, full-thickness burns and deep partial-thickness burns were present involving the lower limb circumferentially. A procedure was performed to relieve vascular compromise. Identify the procedure?
- A. Debridement
- B. Escharotomy (Correct Answer)
- C. Early skin grafting
- D. Excised to healthy tissue
Explanation: ***Escharotomy*** - Performed for **full-thickness (circumferential)** burns to relieve pressure caused by the rigid, constricting **eschar** (necrotic tissue). - Indicated when there are signs of **compartment syndrome** or impaired distal circulation (e.g., absent pulses, cyanosis) in the affected limb. *Debridement* - Involves removing dead, contaminated, or foreign material from a wound to promote healing. - While necessary for complex burns, simply debridement does not address the acute vascular compromise caused by circumferential full-thickness burns. *Excised to healthy tissue* - Refers to **tangential** or **fascial excision** of the burn wound, an operative procedure typically done under general anesthesia for definitive wound management. - This is performed later for wound bed preparation, not an immediate, bedside procedure to restore circulation and prevent limb loss like **escharotomy**. *Early skin grafting* - The definitive procedure used to close the wound after it is excised and prepared. - Cannot be performed until severe vascular constriction is relieved and the wound bed is adequately prepared, making it a later step in management.
Question 5: Identify the fistula according to Park's classification?
- A. Extra-sphincteric
- B. Trans-sphincteric high
- C. Supra-sphincteric
- D. Intersphincteric (Correct Answer)
Explanation: ***Intersphincteric*** - This type of fistula tract is confined entirely to the space **between the internal and external anal sphincters**, as clearly depicted in the image. - It represents the **most common** variety of anal fistula, accounting for about 70% of cases in Park's classification. *Supra-sphincteric* - A supra-sphincteric fistula passes through the intersphincteric space, hooks **above the puborectalis muscle**, and then descends through the ischiorectal fossa. - The illustrated tract does not traverse cephalad to the **external anal sphincter** or the puborectalis muscle. *Extra-sphincteric* - This rare type runs **outside both the internal and external anal sphincters** and often penetrates the levator ani muscle to connect the rectum to the perianal skin. - The tract shown is contained **within the muscle planes** of the anal canal, ruling out an extra-sphincteric course. *Trans-sphincteric high* - Trans-sphincteric fistulas pass **through the external anal sphincter** (usually involving the lower or middle third) to reach the ischiorectal fossa. - The depicted track runs strictly **between** the internal and external layers without crossing the external sphincter.
Question 6: After a building collapse, a patient presents with airway obstruction and mouth filled with concrete debris. BP is 90/60 mmHg, HR 105/min. A cricothyrotomy is performed. Which of the following statements regarding this procedure is true?
- A. It provides adequate ventilation for up to 6 hours
- B. It can be safely used for prolonged airway management without further intervention
- C. It must be followed by a formal tracheostomy (Correct Answer)
- D. It allows for removal of large foreign bodies from the airway
Explanation: ***It must be followed by a formal tracheostomy*** - The procedure performed is an emergency surgical airway, likely a **cricothyrotomy**, which is a life-saving but temporary measure used when **endotracheal intubation** is impossible. - Due to the high risk of long-term complications, especially **subglottic stenosis** and cricoid cartilage damage, it requires prompt conversion (typically within 48-72 hours) to a more permanent airway using a **formal tracheostomy**. *It provides adequate ventilation for up to 6 hours* - While it provides adequate immediate ventilation, 6 hours is not a safety cut-off; the decision to convert is driven by the risk of **laryngeal damage** and scarring with delayed action. - The primary goal of cricothyrotomy is **immediate stability**, not providing a specific period of ventilation. *It allows for removal of large foreign bodies from the airway* - The procedure bypasses the upper airway obstruction by inserting a tube through the **cricothyroid membrane** (below the vocal cords). - It does **not** facilitate the removal of large foreign bodies or concrete debris, which would require specialized tools like **bronchoscopy** or direct laryngoscopy. *It can be safely used for prolonged airway management without further intervention* - This statement is false, as prolonged use (>72 hours) of a cricothyrotomy is highly associated with localized complications, including vocal cord dysfunction and life-threatening **subglottic stenosis**. - A cricothyrotomy is only intended as a **bridge** until a definitive airway (tracheostomy) can be established in a controlled environment.
Question 7: Identify the knot?
- A. Double Knot
- B. Reef knot
- C. Surgeon's knot (Correct Answer)
- D. Granny's knot
Explanation: ***Surgeon's knot*** - The image displays the characteristic first throw of a **Surgeon's knot**, which involves looping the suture end twice (a **double throw** or double twist) instead of once. - This double throw is designed to increase friction, preventing slippage when securing vascular pedicles or tissues under **high tension** before completing the knot with a second single throw. *Granny's knot* - A **Granny's knot** is formed by two consecutive throws made in the same direction, meaning the second throw does not reverse the first. - This design causes the knot to lie obliquely, making it inherently weak and prone to **slipping** or untying, especially under tension. *Reef knot* - Also known as a **Square knot**, a Reef knot consists of two consecutive throws made in **opposite directions** (e.g., right-over-left followed by left-over-right). - It is a secure knot when used correctly, but it uses only a single twist for the first throw, unlike the double twist shown in the image. *Double Knot* - "Double knot" is a generalized or imprecise term; while a Surgeon's knot involves a double twist, this term does not precisely describe the unique **structure and function** of the knot shown. - The image specifically illustrates the deliberate **two consecutive wraps** in the first throw, which precisely defines the specialized technique of the Surgeon's knot.
Question 8: A 43-year-old female presents to OPD due to changes in breast and a lump in breast as given below. What is the diagnosis?
- A. T4d (Correct Answer)
- B. T3
- C. T1c
- D. T4a
Explanation: ### ***T4d*** - The image displays characteristic findings of **Inflammatory Breast Cancer** (IBC), including **erythema** (redness), **edema**, and **peau d'orange** (orange peel appearance) involving more than one-third of the skin of the breast. - According to the **AJCC TNM Staging** system (8th edition), T4d specifically denotes a tumor size equivalent to Inflammatory Breast Cancer, regardless of the actual tumor dimension or nodal status. ### *T4a* - T4a describes a tumor of any size with direct extension to the **chest wall** (ribs, intercostal muscles, or serratus anterior muscle) but **not** including the pectoralis muscle. - The primary feature in the image is **skin involvement** (**edema** and **erythema**), **not** direct extension to the underlying chest wall structures, which is why this is not T4a. ### *T1c* - T1c describes an invasive carcinoma where the maximum tumor dimension is **greater than 10 mm but less than or equal to 20 mm**. - This staging category is based on the size of the primary tumor mass and does not account for the extensive skin changes (**inflammatory signs**) visible in the image, which immediately mandate a T4 classification. ### *T3* - T3 describes an invasive carcinoma where the maximum tumor dimension is **greater than 50 mm**. - While the tumor size might be large, the presence of **Inflammatory breast symptoms** (**erythema**, **edema**, **peau d'orange**) overrides tumor size for T staging, escalating the stage to **T4d**.