NEET-PG 2012 - Surgery Practice Questions

Q: What does the term 'gastrotomy' refer to?

Making an incision into the stomach. ***Making an incision into the stomach*** - The suffix **-otomy** specifically refers to the **surgical creation of an incision** or a cutting open of an organ or structure. - In this context, **gastr-** refers to the **stomach**, thus "gastrotomy" means cutting into the stomach. *Closing the stomach after tube insertion* - While a gastrotomy might precede tube insertion, "closing" the stomach is distinct and typically part of the **wound closure** rather than the incision itself. - The term for surgical closure is generally **-rrhaphy**, not -otomy. *Removing a part of the stomach* - The surgical removal of a part of an organ is indicated by the suffix **-ectomy**, such as in **gastrectomy**. - Gastrotomy only implies making an incision, not the resection of tissue. *Resecting the upper part of the stomach* - This describes a **partial gastrectomy** or **fundectomy**, which involves the removal of tissue. - Gastrotomy is a simpler procedure involving only an incision, without tissue removal.

Q: Ogilvie's syndrome most commonly involves

Cecum and right hemicolon. ***Cecum and right hemicolon*** - Ogilvie's syndrome, also known as acute colonic pseudo-obstruction, primarily affects the **large bowel**. - It most commonly presents with significant dilation of the **cecum and right hemicolon** due to impaired autonomic innervation *Stomach* - The stomach is not typically involved in Ogilvie's syndrome. Conditions affecting the stomach might include **gastroparesis** or **pyloric obstruction**, which have different pathophysiologies. - Ogilvie's syndrome is a disorder of **colonic motility**, not gastric motility. *Gallbladder* - The gallbladder is an organ of the **biliary system** and is not directly affected by Ogilvie's syndrome. - Conditions like **cholecystitis** or **cholelithiasis** involve the gallbladder but are unrelated to acute colonic pseudo-obstruction. *Small intestine* - While pseudo-obstruction can sometimes affect the small intestine (chronic intestinal pseudo-obstruction), Ogilvie's syndrome specifically refers to **acute colonic pseudo-obstruction**. - **Small bowel obstruction** caused by mechanical blockages is a distinct condition with different diagnostic features and management.

Q: What is the most common abdominal surgical procedure for complete rectal prolapse?

Rectopexy. ***Rectopexy*** - **Rectopexy** is the most common abdominal surgical procedure for full-thickness rectal prolapse - It involves fixing the rectum to the sacral promontory or presacral fascia (with sutures or mesh) to prevent prolapse - Various modifications exist including suture rectopexy, mesh rectopexy, ventral rectopexy, and resection rectopexy - **Abdominal approach** is preferred in fit patients with better long-term outcomes compared to perineal procedures *Rectal mucosal stapling* - This procedure refers to **stapled hemorrhoidopexy (PPH)** or **STARR procedure** - Primarily used for **internal mucosal prolapse** and hemorrhoids, not full-thickness external rectal prolapse - Involves excising redundant rectal mucosa using circular staplers - Does not address the full-thickness prolapse or provide proper fixation *Placation/wiring* - **Thiersch wiring** is a historical perineal procedure involving placement of a wire or suture around the anus to narrow the anal canal - Now largely abandoned due to high recurrence rates and complications - **Plication** refers to folding tissue but is not a standalone procedure name for rectal prolapse - This terminology is not standard in modern colorectal surgery *Mucosal resection* - Refers to **Delorme's procedure**, a perineal approach involving mucosal sleeve resection with underlying muscle plication - Used in elderly or high-risk patients who cannot tolerate abdominal surgery - Associated with higher recurrence rates compared to abdominal rectopexy - Does not provide the same level of fixation as abdominal procedures

Q: In the Bismuth-Corlette classification, which type involves the hepatic duct confluence WITHOUT extension into secondary intrahepatic ducts?

Type II. ***Type II*** - This classification specifically describes **cholangiocarcinomas** located at the **hepatic duct confluence** without extension into secondary intrahepatic ducts. - **Type II tumors** involve the hepatic duct confluence but **do not extend** into the right or left secondary intrahepatic ducts. - This is the defining feature that distinguishes Type II from Type III variants. *Type I* - **Type I tumors** are located at least **2 cm distal to the hepatic duct bifurcation**. - This type involves the **common hepatic duct** and **spares the confluence** completely. - Does not meet the criteria of involving the confluence. *Type IIIa* - **Type IIIa tumors** involve the **hepatic duct confluence** with extension into the **right secondary intrahepatic ducts**. - This represents extension **beyond** the confluence, unlike Type II. - The extension into secondary ducts is the key differentiating feature. *Type IIIb* - **Type IIIb tumors** involve the **hepatic duct confluence** with extension into the **left secondary intrahepatic ducts**. - This represents extension **beyond** the confluence, unlike Type II. - The extension pattern differs from Type IIIa by involving the left rather than right system.

Q: In the context of blunt trauma affecting the entire body, what is the estimated daily nitrogen loss in grams due to protein metabolism?

Approximately 35 grams. ***Approximately 35 grams*** - In **severe trauma**, such as blunt trauma affecting the entire body, the body undergoes a significant stress response leading to marked **protein catabolism**. Approximately **35 grams of nitrogen** can be lost daily under such conditions. - This represents a highly catabolic state where muscle protein is broken down to provide amino acids for energy and synthesis of acute-phase proteins, impacting overall nitrogen balance. *Approximately 45 grams* - While severe trauma does lead to substantial nitrogen loss, **45 grams** would typically indicate an even more extreme or prolonged catabolic state, which is less common in the initial stages of post-trauma protein metabolism than 35 grams. - Such a high nitrogen loss might be seen in very extensive burns or sepsis, which are different clinical contexts. *Approximately 55 grams* - A daily nitrogen loss of **55 grams** is beyond what is commonly observed even in severe, whole-body blunt trauma. This level of catabolism would likely be unsustainable or indicative of a rare, super-catabolic condition. - This magnitude of protein breakdown would lead to rapid and severe muscle wasting and organ dysfunction if sustained. *Approximately 65 grams* - Losing **65 grams of nitrogen** per day is an exceptionally high rate of protein catabolism, rarely, if ever, observed in blunt trauma alone. - This level of protein breakdown would represent a profound and life-threatening metabolic derangement, far exceeding typical post-trauma responses.

Q: In Congenital Diaphragmatic Hernia (CDH), the most commonly associated anomaly affects the

Congenital heart defects. ***Congenital heart defects*** - **Congenital diaphragmatic hernia (CDH)** is frequently associated with other congenital anomalies. - **Cardiac malformations** are the most common co-occurring defects, affecting a significant proportion of CDH patients. *Anomalies of the urinary tract* - While **urogenital anomalies** can occur with CDH, they are less prevalent than congenital heart defects. - These typically include conditions like **renal agenesis** or **hydronephrosis**. *Anomalies of the skull* - **Skull anomalies** are not a primary or common association with congenital diaphragmatic hernia. - Genetic syndromes associated with both CDH and skull anomalies are relatively rare. *Craniofacial anomalies* - **Craniofacial anomalies**, such as **cleft lip/palate**, can occur with CDH but are less common than cardiac anomalies. - These are often seen within the context of specific genetic syndromes.

Q: What is a felon or whitlow?

Terminal pulp space infection. ***Terminal pulp space infection*** - A **felon**, also known as a **whitlow**, is a **closed-space infection** of the **digital pulp** of the fingertip, distal to the distal interphalangeal joint. - This area contains numerous fibrous septa that create multiple small compartments, which, when infected, can lead to increased pressure, severe pain, and potential **ischemic necrosis** of the bone. *Infection of the ulnar bursa* - An infection of the **ulnar bursa** involves the synovial sheath surrounding the flexor tendons of the medial three and a half digits, extending into the palm. - This condition is often referred to as **ulnar bursitis** or **tenosynovitis** and presents with distinct clinical signs, such as swelling in the palm and along the little finger, known as Kanavel's signs. *Infection of the radial bursa* - An infection of the **radial bursa** affects the synovial sheath around the flexor pollicis longus tendon of the thumb. - This condition is known as **radial bursitis** or **thenar space infection** and typically presents with swelling and tenderness confined to the thumb and thenar eminence. *Midpalmar space infection* - A **midpalmar space infection** occurs in the deep fascial space of the palm, located between the flexor tendons and the interosseous muscles. - This infection presents as diffuse swelling and tenderness in the central palm, often with pain on passive extension of the fingers, but does not involve the fingertip pulp directly.

Q: Spigelian hernia is

Through lateral border of rectus abdominis. ***Through lateral border of rectus abdominis*** - A **Spigelian hernia** protrudes through the **Spigelian aponeurosis**, which is the aponeurosis of the transversus abdominis muscle, primarily located along the **lateral border of the rectus abdominis muscle**. - Its typical location is often at the **semilunar line**, making it a challenging diagnosis due to its intermittent presentation and potential for strangulation. *Through linea alba* - A hernia through the **linea alba** (midline fibrous structure) is known as an **epigastric hernia** if above the umbilicus, or an **umbilical hernia** if at the umbilicus. - These are distinct from Spigelian hernias which are lateral to the rectus sheath. *Through lateral wall of inguinal canal* - This description typically refers to an **indirect inguinal hernia**, where the contents pass through the **deep inguinal ring**. - This type of hernia travels through the entire inguinal canal and emerges through the superficial ring. *Through medial wall of inguinal canal* - This would describe a **direct inguinal hernia**, which protrudes directly through the posterior wall of the inguinal canal, specifically through **Hesselbach's triangle**. - This is medial to the inferior epigastric vessels, while Spigelian hernias are more superior and lateral.

Q: In a patient with acute cholecystitis, referred pain to the shoulder is known as

Boas' sign. ***Boas' sign*** - **Boas' sign** refers to the presence of hyperesthesia below the right scapula, which can also manifest as referred pain to the **right shoulder** or back [1]. - This symptom in acute cholecystitis is due to the **irritation** of the **phrenic nerve**, which shares sensory pathways with the shoulder region. *Murphy's sign* - **Murphy's sign** is elicited by asking the patient to exhale, then placing the examiner's hand below the costal margin on the right mid-clavicular line, and then asking the patient to inhale deeply [1]. - A positive sign is indicated by a sudden cessation of inspiration due to pain, which is specific for **acute cholecystitis** and not referred shoulder pain [1]. *Gray Turner sign* - The **Gray Turner sign** involves ecchymosis or discoloration of the flanks. - It is a severe indicator of **retroperitoneal hemorrhage**, often associated with acute pancreatitis, not cholecystitis [2]. *Cullen's sign* - **Cullen's sign** presents as periumbilical ecchymosis or discoloration around the navel. - This sign is also indicative of **retroperitoneal hemorrhage**, typically seen in serious conditions like ruptured ectopic pregnancy or acute pancreatitis.

Q: What is the type of Intussusception that is most frequently observed?

Ileocolic type. ***Ileocolic type*** - This is the **most common form of intussusception**, accounting for approximately 75% to 90% of cases, especially in children. - It occurs when the **ileum telescopes into the colon** at the ileocecal valve. *Ileoileal type* - This type involves the **invagination of one part of the ileum into another part of the ileum**. - While it can occur, it is **less common than ileocolic intussusception** and is more often associated with a pathological lead point in older children and adults. *Colo-colic type* - This involves the **telescoping of one segment of the colon into another segment of the colon**. - It is **rare in children** and, when present, is almost always associated with a pathological lead point, such as a polyp or tumor, primarily in adults. *Caeco-colic type* - This type occurs when the **cecum telescopes into the ascending colon**. - It is also a **relatively uncommon form of intussusception** compared to the ileocolic type.

Question 1

What does the term 'gastrotomy' refer to?

Accepted Answer

Making an incision into the stomach

Answer

Closing the stomach after tube insertion

Answer

Removing a part of the stomach

Answer

Resecting the upper part of the stomach

Question 2

Ogilvie's syndrome most commonly involves

Accepted Answer

Cecum and right hemicolon

Answer

Stomach

Answer

Gallbladder

Answer

Small intestine

Question 3

What is the most common abdominal surgical procedure for complete rectal prolapse?

Accepted Answer

Rectopexy

Answer

Rectal mucosal stapling

Answer

Placation/wiring

Answer

Mucosal resection

Question 4

In the Bismuth-Corlette classification, which type involves the hepatic duct confluence WITHOUT extension into secondary intrahepatic ducts?

Accepted Answer

Type II

Answer

Type IIIb

Answer

Type I

Answer

Type IV

Answer

Type IIIa

Answer

Type III

Question 5

In the context of blunt trauma affecting the entire body, what is the estimated daily nitrogen loss in grams due to protein metabolism?

Accepted Answer

Approximately 35 grams

Answer

Approximately 45 grams

Answer

Approximately 55 grams

Answer

Approximately 65 grams

Question 6

In Congenital Diaphragmatic Hernia (CDH), the most commonly associated anomaly affects the

Accepted Answer

Congenital heart defects

Answer

Anomalies of the urinary tract

Answer

Anomalies of the skull

Answer

Craniofacial anomalies

Question 7

What is a felon or whitlow?

Accepted Answer

Terminal pulp space infection

Answer

Infection of the ulnar bursa

Answer

Infection of the radial bursa

Answer

Midpalmar space infection

Question 8

Spigelian hernia is

Accepted Answer

Through lateral border of rectus abdominis

Answer

Through linea alba

Answer

Through lateral wall of inguinal canal

Answer

Through medial wall of inguinal canal

Question 9

In a patient with acute cholecystitis, referred pain to the shoulder is known as

Accepted Answer

Boas' sign

Answer

Murphy's sign

Answer

Gray Turner sign

Answer

Cullen's sign

Question 10

What is the type of Intussusception that is most frequently observed?

Accepted Answer

Ileocolic type

Answer

Ileoileal type

Answer

Colo-colic type

Answer

Caeco-colic type

NEET-PG 2012 — Surgery