NEET-PG 2012 - Surgery Practice Questions

Q: Hirschsprung disease is confirmed by ?

Rectal biopsy. ***Rectal biopsy*** - A **rectal biopsy** is the most definitive diagnostic test for Hirschsprung disease, revealing the absence of **ganglion cells** in the submucosal and myenteric plexuses. - This procedure involves taking a small tissue sample from the rectum, which is then examined under a microscope for characteristic histological changes. *Per/Rectal examination* - A **per/rectal examination** may reveal an empty rectum followed by a gush of stool and gas upon withdrawal of the finger, which is suggestive but not diagnostic. - It is a **clinical finding** that prompts further investigation but does not provide histological confirmation of aganglionosis. *Rectal manometry* - **Rectal manometry** measures pressures within the rectum and can detect the absence of the **rectoanal inhibitory reflex** (RAIR), a hallmark of Hirschsprung disease. - While highly sensitive, it is a **physiological test** indicating functional abnormalities, but it does not provide the definitive histological diagnosis of aganglionosis. *X-ray abdomen* - An **X-ray of the abdomen** may show dilated loops of bowel proximal to a narrowed, aganglionic segment, indicating intestinal obstruction. - This imaging study is useful for **initial assessment** and identifying signs of obstruction, but it is not specific for Hirschsprung disease and cannot confirm the absence of ganglion cells.

Q: What is the most common complication of a felon?

Osteomyelitis. ***Osteomyelitis*** - A **felon** is a severe infection of the **distal pulp space** of the fingertip, which has numerous fibrous septa. - The tightly compartmentalized nature of this space can lead to increased pressure, compromising blood supply and facilitating the spread of infection to the underlying **phalanx bone**, causing **osteomyelitis**. *Subungual hematoma* - A **subungual hematoma** is a collection of blood under the nail, usually resulting from direct trauma. - It is not a complication of an infection like a felon, but rather a separate traumatic injury. *Infective arthritis* - **Infective arthritis** involves the joint space, typically resulting from direct inoculation, hematogenous spread, or spread from adjacent soft tissue infection. - While possible, it is less common for a felon to directly spread to the **distal interphalangeal joint** compared to the more immediate risk of bone involvement. *No complications* - A **felon** is a serious infection that, if left untreated, almost always leads to complications due to the unique anatomy of the fingertip pulp space. - The high pressure within the compartments of the distal pulp makes it prone to necrosis and spread of infection to adjacent structures.

Q: What is the first step to be taken in the management of a cervical spine injury?

Immobilization of spine. ***Immobilization of spine*** - In the context of **isolated cervical spine injury management**, **spinal immobilization** is the primary intervention to prevent further neurological damage. - This is typically achieved using a **cervical collar** and **backboard** to maintain in-line spinal stabilization. - **Note**: In actual trauma scenarios following **ATLS protocols**, airway management and cervical spine immobilization occur **simultaneously** as the first priority (Airway with C-spine protection). *Turn head* - **Turning the head** is absolutely contraindicated as it can exacerbate a cervical spine injury, leading to further compression or damage to the **spinal cord**. - Maintaining a **neutral, in-line position** is critical to avoid neurological deterioration. *Maintain airway* - In comprehensive trauma management per **ATLS guidelines**, **airway management with simultaneous cervical spine protection** is the first priority in the ABC sequence. - Airway is maintained using methods that do not compromise spinal stability, such as a **jaw thrust maneuver** or **endotracheal intubation with manual in-line stabilization**. - The distinction here is that this question focuses on the specific step for **spinal injury management** rather than overall trauma priorities. *None of the options* - This option is incorrect because **immobilization of the spine** is a definitive priority in managing a suspected cervical spine injury. - Both spinal immobilization and airway management are critical interventions that should occur together in actual practice.

Q: Road traffic accident (RTA) with multiple fractures - initial treatment would be:

Airway management. ***Airway management*** - In trauma, **establishing and maintaining a patent airway** is the absolute priority, as compromised breathing can lead to rapid deterioration and death. - The **ABCs (Airway, Breathing, Circulation)** of trauma care dictate that airway intervention precedes other life-saving measures. *Management of shock* - While crucial, **managing shock (C)** follows **airway (A)** and **breathing (B)** in the primary survey of trauma care. - Addressing profound shock without a patent airway can be ineffective and leads to irreversible damage. *Splinting of limbs* - **Splinting fractures** is important for pain control, preventing further injury, and minimizing blood loss in open fractures, but it is not an immediate life-saving intervention. - This falls under the **secondary survey** or definitive management, after life-threatening issues have been addressed. *Cervical spine protection* - **Cervical spine protection** is essential in trauma to prevent further neurological injury and is performed simultaneously with airway management (often with in-line stabilization). - However, a patent airway is the **most immediate life-sustaining intervention** if the airway is compromised.

Q: What type of burn is characterized by flash burn, tenderness, redness, and pain?

First degree burn. ***First degree burn*** - Characterized by **tenderness**, **redness**, and **pain** without blistering. - Involves only the **epidermis**, typically from a **flash burn** or brief contact with a hot object. *Scalded burn* - A type of burn caused by **hot liquid or steam**, not a characteristic of a specific burn depth. - Can be superficial or deep, depending on the **temperature** and **duration of exposure**. *Second degree burn* - Involves the **epidermis and dermis**, presenting with **blisters**, severe pain, and sometimes a wet, weeping appearance. - Often heals with scarring, unlike first-degree burns. *Fourth degree burn* - The most severe type of burn, extending through **all layers of skin** into underlying **muscle**, **tendons**, or **bone**. - Often appears charred or black, and victims may feel little pain due to extensive nerve damage.

Q: Which muscle flap is commonly used for autologous breast reconstruction after mastectomy?

Latissimus dorsi. ***Latissimus dorsi*** - The **latissimus dorsi** muscle is commonly used in **autologous breast reconstruction** due to its rich blood supply and ample tissue volume which can be transferred as a **pedicled flap** to the chest. - This flap includes muscle, skin, and subcutaneous fat, providing a good aesthetic outcome for **breast mound reconstruction** after mastectomy. *Deltopectoral* - The **deltopectoral flap** is primarily used for **head and neck reconstruction**, specifically for oral cavity and pharyngeal defects. - It involves muscle and skin from the **chest and shoulder region**, but its size and location make it less suitable for comprehensive breast reconstruction. *Serratus anterior* - The **serratus anterior** muscle is occasionally used as a **free flap** for small soft tissue defects, but it is not typically the first choice for large-volume breast reconstruction. - Its primary role is in **shoulder movement** and it does not provide sufficient tissue bulk for a complete breast mound. *Trapezius* - The **trapezius flap** is more commonly employed in **head and neck reconstruction** or for covering defects in the posterior shoulder region. - While it offers a good blood supply, its bulk and orientation are not ideal for **breast reconstruction**, which requires a more anterior and hemispheric shape.

Q: Periorbital ecchymosis without direct orbital trauma (raccoon eyes) is most commonly associated with injury to:

Base of skull. ***Base of skull*** - **Periorbital ecchymosis** (raccoon eyes) is a classic sign of a **basilar skull fracture**, particularly one involving the **anterior cranial fossa**. - The fracture allows blood to leak from the cranial cavity and track along fascial planes into the periorbital soft tissues. - The key feature is that ecchymosis occurs **without direct trauma to the orbit or eye**, indicating the primary injury is to the **skull base**. - Often associated with CSF rhinorrhea and requires CT imaging for diagnosis. *Eye* - The question specifically states the ecchymosis occurs "**without direct orbital trauma**," meaning the eye/orbit is NOT the site of injury. - The eye region is where the sign **manifests** (blood tracks to this area), but it is not the site of the underlying injury. - Direct eye trauma would cause immediate localized periorbital swelling, not the delayed bilateral "raccoon eyes" pattern. *Pinna* - Pinna (ear) injury can be associated with head trauma, and Battle's sign (retroauricular ecchymosis) indicates temporal bone fracture. - However, pinna injury does not cause periorbital ecchymosis; these are separate findings. *Scalp* - Scalp injuries cause localized bleeding and swelling at the impact site. - While scalp trauma may accompany basilar skull fracture, the scalp itself is not the source of periorbital ecchymosis. - Blood from scalp wounds tracks superficially, not into deep fascial planes leading to the orbits.

Question 1

Hirschsprung disease is confirmed by ?

Accepted Answer

Rectal biopsy

Answer

Per/Rectal examination

Answer

Rectal manometry

Answer

X-ray abdomen

Question 2

What is the most common complication of a felon?

Accepted Answer

Osteomyelitis

Answer

Subungual hematoma

Answer

Infective arthritis

Answer

No complications

Question 3

What is the first step to be taken in the management of a cervical spine injury?

Accepted Answer

Immobilization of spine

Answer

Turn head

Answer

None of the options

Answer

Maintain airway

Question 4

Road traffic accident (RTA) with multiple fractures - initial treatment would be:

Accepted Answer

Airway management

Answer

Management of shock

Answer

Splinting of limbs

Answer

Cervical spine protection

Question 5

What type of burn is characterized by flash burn, tenderness, redness, and pain?

Accepted Answer

First degree burn

Answer

Scalded burn

Answer

Second degree burn

Answer

Fourth degree burn

Question 6

Which muscle flap is commonly used for autologous breast reconstruction after mastectomy?

Accepted Answer

Latissimus dorsi

Answer

Deltopectoral

Answer

Serratus anterior

Answer

Trapezius

Question 7

Periorbital ecchymosis without direct orbital trauma (raccoon eyes) is most commonly associated with injury to:

Accepted Answer

Base of skull

Answer

Pinna

Answer

Scalp

Answer

Eye

NEET-PG 2012 — Surgery