What is the most common site for carcinoid tumor?
Best approach for emergency thoracotomy in acute thoracic trauma is
Indication for sentinel node biopsy is:
Which one of the following is used as a preservative for packing catgut suture?
Most common site for anal fissure is
Sentinel lymph node biopsy in carcinoma breast is done if -
Among the following single parameters, malnutrition in surgical patients is best assessed by:
Which of the following stages of Breast Cancer corresponds to the following features: a breast mass of 6 x 3 cm, ipsilateral supraclavicular lymph node involvement, and distant metastasis that cannot be assessed?
Treatment for ileal obstruction due to roundworm infestation is
Which of the following is an example of a clean surgery?
NEET-PG 2013 - Surgery NEET-PG Practice Questions and MCQs
Question 11: What is the most common site for carcinoid tumor?
- A. Lung
- B. Ileum (Correct Answer)
- C. Esophagus
- D. Appendix
Explanation: ***Ileum*** - The **ileum** is the most common site for carcinoid tumors, accounting for nearly **50%** of cases [1]. - Carcinoid tumors arise from **neuroendocrine cells** in the gastrointestinal tract, with the ileum being particularly common due to its abundant neuroendocrine tissue [1]. *Appendix* - While carcinoid tumors can occur in the **appendix**, they represent a smaller proportion compared to those found in the ileum. - Typical carcinoid tumors in the appendix are often **asymptomatic** and usually detected incidentally. *Lung* - Though lung carcinoids exist, they represent a different classification of carcinoid tumors, primarily occurring in the **bronchial tree** [2]. - They are less common than those in the gastrointestinal tract, particularly the ileum. *Esophagus* - Carcinoid tumors are rare in the **esophagus** and typically have different presentations compared to gastrointestinal carcinoids. - The esophagus is not a common site for carcinoid tumors, which are primarily found in the intestinal tract. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 780-781. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 727.
Question 12: Best approach for emergency thoracotomy in acute thoracic trauma is
- A. Midline sternotomy
- B. Parasternal thoracotomy
- C. Anterolateral thoracotomy (Correct Answer)
- D. Posterolateral thoracotomy
Explanation: ***Anterolateral thoracotomy*** - Provides **rapid access** to the chest cavity for emergent situations, such as **cardiac tamponade** or **massive hemorrhage**, which are common in thoracic trauma. - Allows assessment and management of injuries to the **heart, great vessels, and lungs** with minimal repositioning in a critically ill patient. *Midline sternotomy* - Primarily used for **cardiac surgery**, offering excellent exposure to the mediastinum but is less ideal for general thoracic trauma with potential lateral injuries. - Takes **longer to perform** than an anterolateral approach and may not be suitable in an emergent, unstable trauma setting. *Parasternal thoracotomy* - Offers more limited access compared to other approaches, typically used for specific, localized procedures near the sternum. - Does not provide the **broad exposure** needed to manage the diverse and potentially widespread injuries seen in severe thoracic trauma. *Posterolateral thoracotomy* - Provides excellent exposure to the **posterior mediastinum, spine, and descending aorta**, but requires the patient to be in the lateral decubitus position. - Repositioning a severely injured trauma patient for this approach is often **impractical and time-consuming**, making it unsuitable for initial resuscitation.
Question 13: Indication for sentinel node biopsy is:
- A. Palpable axillary lymph node
- B. Metastasis
- C. Mass > 5 cm
- D. Non-palpable axillary lymph node (Correct Answer)
Explanation: ***Non-palpable axillary lymph node*** - **Sentinel lymph node biopsy (SLNB)** is indicated when there is no clinical evidence of axillary lymph node involvement, meaning the nodes are **non-palpable**. - Its purpose is to identify micrometastases that would not be detectable by physical examination, staging the cancer more accurately and guiding further treatment. *Palpable axillary lymph node* - A **palpable axillary lymph node** suggests macroscopic nodal involvement, usually requiring a fine needle aspiration (FNA) or core needle biopsy for diagnosis. - If positive, these patients typically proceed directly to **axillary lymph node dissection (ALND)** rather than SLNB. *Mass > 5 cm* - The size of the primary tumor (e.g., > 5 cm) is a factor in staging but does not, in itself, preclude or indicate SLNB. - While larger tumors have a higher risk of nodal involvement, the decision for SLNB still hinges on the clinical status of the axilla (palpable vs. non-palpable nodes). *Metastasis* - If **distant metastasis** is confirmed, the focus shifts to palliative care and systemic treatment, making a regional staging procedure like SLNB less relevant or unnecessary. - SLNB is used for staging early-stage cancer to detect regional spread, not when widespread disease is already established.
Question 14: Which one of the following is used as a preservative for packing catgut suture?
- A. Colloidal iodine
- B. Glutaraldehyde
- C. Isopropyl alcohol (Correct Answer)
- D. Hydrogen peroxide
Explanation: ***Isopropyl alcohol*** - **Isopropyl alcohol** is commonly used as a preservative for **catgut sutures** due to its antiseptic and denaturing properties that prevent microbial growth and maintain the integrity of the biologic material. - It helps to keep the suture sterile and prevents degradation by enzymes or bacteria during storage. *Colloidal iodine* - **Colloidal iodine** is an antiseptic, but it is not typically used as a preservative for **catgut sutures**; it is more often used for skin preparation or wound disinfection. - Its reactivity and potential to stain or alter **suture material** make it less suitable for long-term preservation within the packaging. *Glutaraldehyde* - **Glutaraldehyde** is a potent disinfectant and sterilant, but it is generally too harsh for preserving **catgut sutures**; it can cause significant cross-linking and denaturation of proteins. - It is more commonly used for sterilizing heat-sensitive medical instruments like **endoscopes**, rather than for preserving **suture materials**. *Hydrogen peroxide* - **Hydrogen peroxide** is an oxidizing agent used as an antiseptic to clean wounds or as a sterilant, but it is not suitable for preserving **catgut sutures**. - Its oxidative action could degrade the **collagenous material** of the suture, compromising its strength and absorption properties.
Question 15: Most common site for anal fissure is
- A. 3 O'clock
- B. 6 O'clock (Correct Answer)
- C. 2 O'clock
- D. 10 O'clock
Explanation: ***6 O'clock*** - The **posterior midline (6 o'clock position)** is the most common site for anal fissures, accounting for approximately **90% of all cases**. - This location is prone to tearing due to relatively **poor blood supply** and increased **mechanical stress** during defecation. - The posterior midline is the least supported part of the anal canal by the external anal sphincter. - **Note**: The **anterior midline (12 o'clock position)** is the second most common site, occurring in **10-25% of women** but rarely in men. *3 O'clock* - The **3 o'clock position (right lateral)** is an infrequent site for anal fissures. - Fissures in this location, especially if *lateral*, may suggest an underlying systemic disease such as **Crohn's disease**, **tuberculosis**, **HIV**, or **malignancy**. - Atypical fissures warrant thorough investigation. *2 O'clock* - The **2 o'clock position (anterior-lateral)** is not typically associated with anal fissures. - Similar to other atypical sites, a fissure here warrants investigation for secondary causes. - Consider inflammatory bowel disease or other pathological conditions. *10 O'clock* - The **10 o'clock position (left lateral)** is also a less common site for anal fissures compared to the posterior midline. - Fissures in lateral positions should raise suspicion for other conditions, such as **inflammatory bowel disease**, **tuberculosis**, **HIV**, or **malignancy**.
Question 16: Sentinel lymph node biopsy in carcinoma breast is done if -
- A. LN palpable
- B. Breast lump with palpable axillary node
- C. Metastatic CA breast
- D. Breast mass but no lymph node palpable (Correct Answer)
Explanation: ***Breast mass but no lymph node palpable*** - Sentinel lymph node biopsy is primarily performed in patients with **clinically negative axillae** (no palpable lymph nodes) to assess for microscopic metastatic disease. - The goal is to avoid full axillary lymph node dissection if the sentinel nodes are negative, thus reducing the risk of **lymphedema** and other complications. *LN palpable* - If a lymph node is palpable, it is often considered **clinically suspicious** and may warrant a direct fine-needle aspiration (FNA) or core biopsy rather than a sentinel node biopsy. - A positive biopsy from a palpable node would typically lead directly to an **axillary lymph node dissection** or neoadjuvant therapy, as the sentinel node procedure offers less benefit in this scenario. *Breast lump with palpable axillary node* - Similar to a palpable LN, a **palpable axillary node** in the presence of a breast lump suggests established nodal involvement. - In such cases, **sentinel lymph node biopsy** is often not the initial step; rather, direct biopsy of the palpable node or upfront axillary dissection (sometimes after neoadjuvant treatment) is considered. *Metastatic CA breast* - In **metastatic breast cancer** (stage IV disease), the focus shifts to systemic treatment, and axillary lymph node dissection, including sentinel node biopsy, is generally not indicated for staging purposes. - The primary goal is palliative care or controlling systemic disease, not regional lymph node staging.
Question 17: Among the following single parameters, malnutrition in surgical patients is best assessed by:
- A. Mid arm circumference (Correct Answer)
- B. Triceps skin fold thickness
- C. Hb level
- D. Serum albumin
Explanation: ***Mid arm circumference*** - **Mid-arm circumference (MAC)** is considered a reliable and easily measurable single parameter for assessing malnutrition, as it reflects both **muscle mass** and **subcutaneous fat**. - It is particularly useful in surgical patients where rapid and practical assessment of nutritional status is needed. *Serum albumin* - While **serum albumin** reflects visceral protein status, its levels can be significantly affected by **hydration status**, inflammation, and liver disease, making it less specific for malnutrition in acute surgical settings. - Due to its **long half-life**, serum albumin may not accurately reflect recent changes in nutritional status. *Hb level* - **Hemoglobin (Hb) levels** primarily assess anemia, which can be caused by various factors beyond malnutrition, such as blood loss or chronic disease. - Anemia does not directly measure or reflect overall protein-energy malnutrition. *Triceps skin fold thickness* - **Triceps skin fold thickness (TSFT)** measures subcutaneous fat stores but does not provide information about lean muscle mass or overall protein status. - Its measurement can be less accurate due to inter-observer variability and may not reflect comprehensive malnutrition as well as MAC.
Question 18: Which of the following stages of Breast Cancer corresponds to the following features: a breast mass of 6 x 3 cm, ipsilateral supraclavicular lymph node involvement, and distant metastasis that cannot be assessed?
- A. T4 N3 MX
- B. T4 N1 M1
- C. T4 N0 M0
- D. T3 N3c MX (Correct Answer)
Explanation: ***T3 N3c MX*** - A **breast mass of 6 x 3 cm** indicates a T3 tumor (tumor size > 5 cm). - **Ipsilateral supraclavicular lymph node involvement** is classified as N3c disease. **Distant metastasis that cannot be assessed** is denoted by MX. *T4 N3 MX* - A **T4 classification** is reserved for tumors with direct extension to the chest wall or skin, or inflammatory breast cancer, which is not mentioned here. - While N3c and MX are correct for the nodal and metastatic status, the T stage is inaccurate based on the provided tumor size. *T4 N1 M1* - A **T4 classification** is incorrect as the mass size alone (6 x 3 cm) does not meet T4 criteria. - **N1** denotes involvement of 1-3 axillary lymph nodes, which is less extensive than supraclavicular involvement (N3c). **M1** indicates confirmed distant metastasis, but the question states it "cannot be assessed" (MX). *T4 N0 M0* - **T4** is incorrect, as this stage is for direct chest wall/skin involvement or inflammatory breast cancer. - **N0** signifies no regional lymph node metastasis, contradicting the presence of supraclavicular lymph node involvement. **M0** indicates no distant metastasis, whereas the question specifies it cannot be assessed (MX).
Question 19: Treatment for ileal obstruction due to roundworm infestation is
- A. Resection with end to end anastomosis
- B. Resection with side to side anastomosis
- C. Enterotomy, removal of worms and primary closure (Correct Answer)
- D. Diversion
Explanation: ***Enterotomy, removal of worms and primary closure*** - For **ileal obstruction** by **roundworms**, **surgical intervention** involves opening the affected bowel segment (**enterotomy**), carefully extracting the worm bolus, and then closing the incision primarily. - This approach is favored because the bowel itself is usually **healthy**, and the obstruction is purely mechanical from the worms. *Resection with end to end anastomosis* - This aggressive approach of **resecting** part of the bowel is generally **unnecessary** and **risky** when the bowel is otherwise healthy and viable, as is typical in roundworm obstruction. - It carries risks of **anastomotic leakage** and **short gut syndrome** if repeated resections are needed, making simple worm removal a preferable option. *Resection with side to side anastomosis* - Similar to end-to-end anastomosis, **resection** of the bowel is generally avoided unless there is **irreversible damage** or **ischemia** to the bowel, which is not the primary pathology in uncomplicated roundworm obstruction. - This method is more complex and less optimal than simply removing the obstruction, given the typically *healthy* nature of the bowel wall. *Diversion* - **Diversion** procedures, such as **stoma formation**, are generally reserved for situations with **perforation**, **gross contamination**, or complex obstructions where primary repair is considered unsafe or impossible. - In a straightforward ileal obstruction due to worms, the goal is to resolve the obstruction with minimal intervention to preserve bowel continuity.
Question 20: Which of the following is an example of a clean surgery?
- A. Hernia surgery (Correct Answer)
- B. Cholecystectomy
- C. Rectal surgery
- D. Gastric surgery
Explanation: ***Hernia surgery*** - **Clean surgeries** involve no entry into hollow viscera (e.g., gastrointestinal, genitourinary, or respiratory tract) and are characterized by **no inflammation** or infection. Hernia repair typically fits this description. - The risk of **surgical site infection** (SSI) is usually less than 2% in clean cases, making it a benchmark for surgical infection control. *Gastric surgery* - This involves entry into the **gastrointestinal tract**, which is considered a **contaminated** or **clean-contaminated** procedure due to the presence of bacteria. - The risk of infection is higher than in clean surgeries, often requiring prophylactic antibiotics. *Cholecystectomy* - This procedure involves the **gallbladder**, which is part of the biliary system, often considered a **clean-contaminated** wound if bile spills or if there's no evidence of active infection. - If performed for **acute cholecystitis** (inflammation/infection), it would be classified as **contaminated** or **dirty**. *Rectal surgery* - This involves the **rectum**, which is part of the lower **gastrointestinal tract** and contains a high bacterial load. - Procedures involving the rectum are classified as **contaminated** or **dirty** due to the high risk of bacterial contamination.