Indication for sentinel node biopsy is:
Which one of the following is used as a preservative for packing catgut suture?
Which of the following nerves is commonly damaged during McBurney's incision?
The most common cause of acquired AV fistula is:
Which of the following is a component of the Alvarado score?
What is the preferred palliative surgical procedure for rectal prolapse in elderly patients who are unfit for more invasive surgery?
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?
Sentinel lymph node biopsy in carcinoma breast is done if -
Which of the following is a contraindication to breast conservation surgery?
Best prognostic factor for head injury is:
NEET-PG 2013 - Surgery NEET-PG Practice Questions and MCQs
Question 31: 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 32: 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 33: Which of the following nerves is commonly damaged during McBurney's incision?
- A. Subcostal nerve
- B. Iliohypogastric nerve (Correct Answer)
- C. 11th thoracic nerve
- D. 10th thoracic nerve
Explanation: ***Iliohypogastric nerve*** - The **iliohypogastric nerve** is most commonly injured during **McBurney's incision** due to its superficial position and transverse course at the level of the incision. - Damage can lead to **numbness** or altered sensation in the suprapubic region, and sometimes **weakness of the lower abdominal wall**. *Subcostal nerve* - The **subcostal nerve** (T12) runs inferior to the 12th rib and is generally superior to the typical site of a McBurney's incision. - Injury to this nerve is less common during this procedure compared to the iliohypogastric and ilioinguinal nerves. *10th thoracic nerve* - The **10th thoracic nerve** (T10) provides sensation around the umbilicus. - While it contributes to innervation of the abdominal wall, its location is typically well above the area of a standard McBurney's incision, making injury unlikely. *11th thoracic nerve* - The **11th thoracic nerve** (T11) innervates the abdominal wall and is located superior to the typical incision site for appendectomy. - Injury to T11 during a McBurney's incision is uncommon as the nerve's course lies cephalad to the surgical field.
Question 34: The most common cause of acquired AV fistula is:
- A. Bacterial infection
- B. Fungal infection
- C. Blunt trauma
- D. Penetrating trauma (Correct Answer)
Explanation: ***Penetrating trauma*** - **Penetrating trauma** is the most common cause of **acquired AV fistulas** due to direct injury to adjacent artery and vein. - This type of injury can result from causes like **gunshot wounds, stab wounds, or iatrogenic procedures** (e.g., catheterizations). *Bacterial infection* - While infections can cause vascular damage, they are **not the most common cause** of acquired AV fistulas. - Infections like **endocarditis** or localized abscesses can lead to vascular erosion, but this is less frequent than trauma. *Fungal infection* - **Fungal infections** are a much rarer cause of vascular damage leading to AV fistulas compared to bacterial infections or trauma. - They typically occur in immunocompromised individuals or in specific settings, not as a common cause of acquired AV fistulas. *Blunt trauma* - **Blunt trauma** can cause vascular injury, but it is **less likely to directly create an AV fistula** compared to penetrating trauma. - Blunt force is more commonly associated with vessel rupture, dissection, or pseudoaneurysm formation, rather than a direct connection between an artery and a vein.
Question 35: Which of the following is a component of the Alvarado score?
- A. Leucopenia
- B. Diarrhea
- C. Periumbilical pain
- D. Loss of appetite (Correct Answer)
Explanation: ***Loss of appetite*** - **Anorexia** (loss of appetite) is a key symptom considered in the Alvarado score, contributing 1 point to the total. - This symptom is often one of the **earliest indicators** of acute appendicitis. *Leucopenia* - The Alvarado score uses **leukocytosis** (elevated white blood cell count greater than 10,000/mm³), not leucopenia, as a component. - **Leucopenia** (decreased white blood cell count) is generally not indicative of acute appendicitis. *Diarrhea* - While diarrhea can sometimes accompany appendicitis, it is **not a specific component** of the Alvarado score. - The score focuses on classic appendicitis symptoms like **migratory and right lower quadrant pain**. *Periumbilical pain* - The Alvarado score specifically considers **migratory pain to the right iliac fossa** (RLQ tenderness) as a component, not just periumbilical pain. - Although pain often starts periumbilically, the score emphasizes the **subsequent migration** of pain.
Question 36: What is the preferred palliative surgical procedure for rectal prolapse in elderly patients who are unfit for more invasive surgery?
- A. Delorme's procedure
- B. Wells' procedure
- C. Thiersch's operation (Correct Answer)
- D. Low anterior resection
Explanation: ***Thiersch's operation*** - **Thiersch's operation** is a perineal procedure involving the placement of a **circum-anal cerclage** (a non-absorbable suture) around the anal canal to prevent external prolapse. - It is preferred in elderly or frail patients due to its **minimal invasiveness**, low operative risk, and suitability for local or regional anesthesia as a palliative measure for symptoms. *Delorme's procedure* - **Delorme's procedure** is a perineal approach that involves the **mucosal stripping** of the prolapsed rectum, plication of the muscularis, and re-anastomosis. - While less invasive than abdominal approaches, it is more complex than Thiersch's and may still carry higher operative risks for very frail patients. *Wells' procedure* - **Wells' procedure** (rectopexy via an abdominal approach) involves **mobilization of the rectum** and its fixation to the sacrum, often with a mesh. - This is a more invasive abdominal procedure with a higher operative risk, making it unsuitable for elderly patients unfit for major surgery. *Low anterior resection* - **Low anterior resection** is a major abdominal procedure primarily used for rectal cancer or severe inflammatory bowel disease, involving the **surgical removal of a segment of the rectum**. - It is a highly invasive procedure with significant morbidity and mortality, making it inappropriate for the palliative management of rectal prolapse in frail elderly patients.
Question 37: 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 38: 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 39: Which of the following is a contraindication to breast conservation surgery?
- A. Presence of multicentric tumors (Correct Answer)
- B. Involvement of axillary lymph nodes
- C. Tumor size greater than 4 cm
- D. Presence of diffuse microcalcifications
Explanation: ***Presence of multicentric tumors*** - **Multicentric tumors** are defined as two or more discrete tumors in different quadrants of the breast, which cannot be removed with a single lumpectomy. - This condition is a contraindication for breast conservation surgery (BCS) because complete removal of all tumor foci while maintaining an acceptable cosmetic outcome is highly unlikely. *Involvement of axillary lymph nodes* - **Axillary lymph node involvement** is an important prognostic factor in breast cancer and influences adjuvant therapy decisions, but it is not a direct contraindication to BCS. - Patients with positive nodes often undergo axillary dissection or sentinel lymph node biopsy, followed by radiation and/or systemic therapy, which can be combined with BCS. *Tumor size greater than 4 cm* - While larger tumor size (e.g., >4-5 cm) can make achieving negative surgical margins and a good cosmetic outcome more challenging with BCS, it is not an absolute contraindication. - **Neoadjuvant chemotherapy** can often downstage larger tumors, making BCS a viable option for many patients. *Presence of diffuse microcalcifications* - **Diffuse microcalcifications** can sometimes indicate extensive ductal carcinoma in situ (**DCIS**) or invasive lobular carcinoma with a widespread component. - However, if the microcalcifications represent a single focus of disease that can be entirely excised with negative margins, BCS may still be an option, especially if guided by stereotactic biopsy and imaging.
Question 40: Best prognostic factor for head injury is:
- A. Glasgow coma scale (Correct Answer)
- B. Age
- C. Mode of injury
- D. CT
Explanation: ***Glasgow coma scale*** - The **Glasgow Coma Scale (GCS)** is a standardized tool used to assess the level of consciousness in head injury patients, providing an objective measure of neurological function. - A **lower GCS score** correlates with a greater severity of injury and poorer prognosis, making it the most reliable predictor of outcome. *Age* - While age can influence recovery, with **older patients generally having worse outcomes** due to less neural plasticity and pre-existing comorbidities, it is not the single best prognostic factor. - Younger patients often have better recovery potential, but their prognosis is still heavily dependent on the immediate severity of the brain injury. *Mode of injury* - The mode of injury (e.g., blunt trauma, penetrating injury) provides information about the mechanism and potential **types of injury**, but does not directly quantify the severity of brain damage or predict long-term outcomes as precisely as GCS. - While **high-impact injuries** tend to be more severe, the actual neurological deficit measured by GCS is a better indicator of prognosis. *CT* - **CT scans** are crucial for identifying specific neurological injuries like hemorrhage, edema, or fractures, which can guide immediate management. - However, the findings on a CT scan do not solely determine prognosis; a patient with a relatively normal CT can still have a poor outcome if their **GCS is low**, indicating widespread neuronal dysfunction not always visible on imaging.