NEET-PG 2013 - Surgery Practice Questions

Q: What is the treatment of choice for medullary carcinoma of the thyroid?

Total thyroidectomy. ***Total thyroidectomy*** - This is the **treatment of choice for medullary thyroid carcinoma (MTC)** due to its multifocal nature and high propensity for lymph node metastasis - **Complete surgical resection** (often with central compartment neck dissection) provides the best chance for cure by removing all thyroid tissue and involved lymph nodes - MTC arises from **parafollicular C cells** (calcitonin-producing cells) and frequently involves both lobes, making total thyroidectomy essential *Partial thyroidectomy* - This procedure removes only a portion of the thyroid gland, which is **insufficient for MTC** given its tendency for multifocality and bilateral involvement - Leaves residual thyroid tissue that could harbor undetected disease or develop future recurrences - Does not adequately address the aggressive nature of MTC *I-131 ablation* - **Radioactive iodine therapy** is effective for differentiated thyroid cancers (papillary and follicular) that take up iodine - MTC originates from **parafollicular C cells that do not concentrate iodine**, making I-131 ablation completely ineffective - This is a key distinguishing feature of MTC from other thyroid malignancies *Hemithyroidectomy* - This procedure removes only one thyroid lobe, which is **inadequate for MTC** - Risks leaving behind primary tumor in the contralateral lobe or occult bilateral disease - Fails to address the multifocal nature of MTC, particularly in hereditary cases (MEN 2A, MEN 2B, familial MTC)

Q: In which condition is the Prehn sign typically positive?

Acute epididymitis. ***Acute epididymitis*** - **Prehn sign** is positive when lifting the scrotal sac alleviates pain, as it reduces pressure on the inflamed epididymis. - This sign is commonly used to differentiate **epididymitis** from **testicular torsion**, where pain typically worsens or remains unchanged with elevation. *Chronic epididymitis* - While potentially painful, **chronic epididymitis** usually presents with persistent, dull pain that is less likely to be acutely relieved by scrotal elevation. - The **Prehn sign** is primarily a diagnostic tool for **acute inflammatory conditions** of the epididymis. *Testicular torsion* - In **testicular torsion**, the pain is often sudden, severe, and typically **not relieved** by elevating the testicle; in fact, it may worsen. - This condition is a **surgical emergency** where blood flow to the testicle is compromised. *Acute scrotal pain due to other causes* - Other causes of **acute scrotal pain**, such as **trauma** or **incarcerated hernias**, generally do not exhibit a positive Prehn sign. - The **Prehn sign** is quite specific to the **inflammatory process** of epididymitis affecting pain perception.

Q: Which of the following conditions is not typically treated with a simple mastectomy?

Fibroadenoma. ***Fibroadenoma*** - A **fibroadenoma** is a **benign tumor** of the breast that typically does not require a mastectomy for treatment. - Treatment usually involves **observation**, **excision**, or **cryoablation**, depending on size, symptoms, and patient preference. *Paget's disease* - **Paget's disease of the breast** is a rare form of breast cancer that affects the nipple and areola, and is typically associated with an underlying **ductal carcinoma in situ** (DCIS) or **invasive breast cancer**. - Due to the presence of malignancy and its superficial spread, **mastectomy** (simple or modified radical) is often the recommended treatment, especially for extensive disease. *Cystosarcoma phyllodes* - Formerly known as **phyllodes tumor**, this is a rare **stromal tumor** of the breast that can be benign, borderline, or malignant. - Due to its potential for local recurrence and, in malignant cases, metastasis, **wide local excision with clear margins** is crucial, and a **simple mastectomy** may be necessary for large or recurrent tumors to achieve adequate margin control. *None of the options* - This option is incorrect because fibroadenoma is a condition not typically treated with a simple mastectomy, unlike Paget's disease and cystosarcoma phyllodes.

Q: Commonest site of carcinoma tongue -

Lateral borders. ***Lateral borders*** - The **lateral borders** of the tongue are the most common site for squamous cell carcinoma due to chronic irritation from teeth, dental appliances, and exposure to carcinogens. - This area is subjected to considerable mechanical stress and chemical exposure, making it more susceptible to malignant transformation. *Apical* - While the apex (tip) of the tongue can be affected, it is **less common** compared to the lateral borders. - Tumors in this location may present earlier due to their prominent position, but incidence rates are lower. *Dorsum* - The **dorsum** (top surface) of the tongue is covered by papillae which provide some protective barrier, making it a **less frequent site** for carcinoma. - Carcinomas on the dorsum are often associated with other risk factors like syphilis or immunosuppression. *Posterior 1/3* - Carcinomas of the **posterior one-third** (base of the tongue) are often associated with **Human Papillomavirus (HPV)** infection. - These are typically harder to detect early due to their location and may present with different symptoms such as dysphagia or referred otalgia, but they are not the most common overall site.

Q: In which of the following conditions is ERCP not indicated?

Proximal cholangiocarcinoma. ***Proximal cholangiocarcinoma*** - For **proximal/hilar cholangiocarcinoma** (Klatskin tumors at the **hepatic hilum**), **PTBD (Percutaneous Transhepatic Biliary Drainage)** is generally preferred over ERCP for biliary drainage. - The **high location** of these tumors makes endoscopic access difficult, with lower success rates and higher risk of complications like **cholangitis** and incomplete drainage. - **ERCP may fail** to adequately drain both hepatic ducts in bifurcation tumors, making PTBD the more reliable first-line approach. *Hepatic porta tumor* - **Hepatic porta tumors** involving the bile ducts are anatomically similar to **proximal cholangiocarcinoma**. - While ERCP can occasionally be attempted for porta hepatis lesions, **PTBD is often preferred** for high biliary obstructions due to better access to intrahepatic ducts. - The distinction is subtle, but **proximal cholangiocarcinoma** specifically refers to Klatskin tumors where ERCP has the **highest failure rate** and PTBD is most strongly preferred. *Distal CBD tumor* - **ERCP is the preferred modality** for **distal CBD tumors** to provide **biliary drainage**, tissue sampling (biopsy), and stent placement to relieve obstruction. - Direct endoscopic access to the distal common bile duct makes ERCP highly effective for diagnosis and palliation in this region. *Gallstone pancreatitis* - **ERCP is indicated** in **gallstone pancreatitis** when there is evidence of **cholangitis** or persistent **biliary obstruction** (e.g., rising liver enzymes, imaging showing retained stone in the CBD). - It allows for **therapeutic removal of impacted stones** from the common bile duct, preventing further pancreatic inflammation and complications.

Q: In testicular torsion, within what time frame should surgery be performed to save the viability of the testis?

6 hr. ***6 hr*** - Testicular viability is highest when **detorsion** occurs within **6 hours** of symptom onset. - Delay beyond this timeframe significantly increases the risk of **testicular ischemia** and necrosis. *12 hr* - While some viability may remain, the probability of **testicular salvage** decreases substantially after 6 hours. - Testicular function, including **sperm production**, is often compromised even if the testis is saved. *24 hr* - Beyond 12-24 hours, the likelihood of **testicular viability** is very low, and **orchiectomy** (testicle removal) is often necessary. - Prolonged ischemia leads to irreversible **tissue damage** and infarction. *1 week* - After one week, the testis is almost certainly non-viable due to **prolonged ischemia** and necrosis. - This delay would invariably result in the need for **orchiectomy**.

Q: Head & face burn in infant accounts for what percentage of total body surface area?

18%. ***18%*** - In infants, the **Rule of Nines** is modified due to their proportionally larger head and smaller lower extremities compared to adults. - The head and face in an infant account for a larger percentage of the **total body surface area (TBSA)**, specifically 18%. *15%* - This percentage is inaccurate for an infant's head and face when calculating **TBSA** using the modified Rule of Nines. - While some areas might be 15% in adults, an infant's head is proportionally larger. *12%* - This percentage significantly **underestimates** the body surface area of an infant's head and face. - Using this value would lead to an incorrect assessment of **burn size** and potential under-resuscitation. *32%* - This percentage far **overestimates** the surface area of an infant's head and face. - Such a high value would result in an incorrect assessment of **burn severity** and potentially lead to over-resuscitation.

Q: What is the preferred method for removing a foreign body from the lung in children?

Rigid bronchoscopy. ***Rigid bronchoscopy*** - **Rigid bronchoscopy** is the preferred method for removing foreign bodies from the lung in children due to its ability to provide better air control, magnified viewing, and larger working channels for robust grasping tools. - It allows for complete ventilation control and isolation of the airway, which is crucial in children where airway obstruction can rapidly lead to respiratory compromise. *Chest x-ray* - A **chest x-ray** is a diagnostic tool used to identify the presence and location of a foreign body, but it is not a method for removal. - Many foreign bodies, especially non-radiopaque ones like food, may not be visible on an x-ray, making it unreliable for definitive diagnosis of presence or absence. *Flexible endoscopy* - While **flexible bronchoscopy** can be used for foreign body removal in some adults or specific situations, it is generally less effective and carries higher risks in children, especially for larger or lodged objects. - Its smaller working channels and less stable airway control make it less suitable for urgent and complete removal in the pediatric population. *Direct laryngoscopy* - **Direct laryngoscopy** is used to visualize the larynx and vocal cords, primarily to remove foreign bodies from the upper airway or intubate, but not typically for removal of foreign bodies lodged deep within the main bronchi or lungs. - It does not offer direct access or visualization of the lower bronchial tree where most aspirated foreign bodies in children tend to lodge.

Q: Most common anomaly of upper urogenital tract is -

Uretero pelvic junction stenosis. ***Uretero pelvic junction stenosis*** - **Ureteropelvic junction (UPJ) obstruction** is the most common cause of **antenatally detected hydronephrosis**, making it the most frequent anomaly of the upper urogenital tract. - It results from an intrinsic or extrinsic narrowing at the junction of the **renal pelvis** and the **ureter**, impeding urine flow. *Ectopic urethral opening* - This anomaly involves the **urethral opening** being in an abnormal location, such as **hypospadias** or **epispadias** in males, or into the vagina in females. - While relatively common, it is an anomaly of the **lower urogenital tract**, specifically the urethra, not the upper tract. *Ureterocele* - A ureterocele is a **cystic dilation** of the distal part of the ureter as it enters the bladder. - While it can be associated with varying degrees of **upper tract obstruction**, it is not as common as UPJ stenosis. *Ectopic ureter* - An ectopic ureter involves a ureter that drains into an abnormal location other than the **trigone of the bladder**. - This condition is less common than UPJ stenosis and is often associated with a **duplex collecting system**.

Q: In which one of the following conditions is gas under the diaphragm typically seen?

Perforated duodenal ulcer. ***Perforated duodenal ulcer*** - A perforated duodenal ulcer creates a communication between the **lumen of the duodenum and the peritoneal cavity**, allowing air from the gastrointestinal tract to escape. - This free air, being lighter, rises and collects under the **diaphragm**, visible as **pneumoperitoneum** on an upright chest X-ray. - This is the **classic and most typical** presentation taught in medical education for gas under the diaphragm. - Occurs in approximately **70-75% of cases** of peptic ulcer perforation. *Typhoid perforation* - Typhoid perforation (typically affecting the **terminal ileum**) also causes pneumoperitoneum and can show gas under the diaphragm. - However, it is **less commonly encountered** in routine practice compared to peptic ulcer perforation in most settings. - The question asks for the **"typically seen"** condition, which refers to the classic teaching example: perforated duodenal ulcer. *After laparotomy* - It is normal to see a small amount of **residual intra-abdominal gas** for a few days to a week after a laparotomy, which can collect under the diaphragm. - However, this is a **post-surgical finding** and not a pathological condition leading to gas under the diaphragm in the same acute, diagnostic sense as a perforation. - Not the answer when considering pathological causes. *Spontaneous rupture of oesophagus* - Spontaneous oesophageal rupture (Boerhaave syndrome) leads to leakage of oesophageal contents into the **mediastinum or pleural cavity**, not the peritoneal cavity. - Presents with **mediastinal emphysema** (Hamman's sign) and pleural effusion rather than pneumoperitoneum. - **Subdiaphragmatic free air** indicative of pneumoperitoneum is not typically seen.

Question 1

What is the treatment of choice for medullary carcinoma of the thyroid?

Accepted Answer

Total thyroidectomy

Answer

I-131 ablation

Answer

Partial thyroidectomy

Answer

Hemithyroidectomy

Question 2

In which condition is the Prehn sign typically positive?

Accepted Answer

Acute epididymitis

Answer

Chronic epididymitis

Answer

Testicular torsion

Answer

Acute scrotal pain due to other causes

Question 3

Which of the following conditions is not typically treated with a simple mastectomy?

Accepted Answer

Fibroadenoma

Answer

Paget's disease

Answer

Cystosarcoma phyllodes

Answer

None of the options

Question 4

Commonest site of carcinoma tongue -

Accepted Answer

Lateral borders

Answer

Apical

Answer

Dorsum

Answer

Posterior 1/3

Question 5

In which of the following conditions is ERCP not indicated?

Accepted Answer

Proximal cholangiocarcinoma

Answer

Distal CBD tumor

Answer

Hepatic porta tumor

Answer

Gall stone pancreatitis

Question 6

In testicular torsion, within what time frame should surgery be performed to save the viability of the testis?

Accepted Answer

6 hr

Answer

12 hr

Answer

24 hr

Answer

1 week

Question 7

Head & face burn in infant accounts for what percentage of total body surface area?

Accepted Answer

18%

Answer

15%

Answer

12%

Answer

32%

Question 8

What is the preferred method for removing a foreign body from the lung in children?

Accepted Answer

Rigid bronchoscopy

Answer

Chest x-ray

Answer

Flexible endoscopy

Answer

Direct laryngoscopy

Question 9

Most common anomaly of upper urogenital tract is -

Accepted Answer

Uretero pelvic junction stenosis

Answer

Ureterocele

Answer

Ectopic ureter

Answer

Ectopic urethral opening

Question 10

In which one of the following conditions is gas under the diaphragm typically seen?

Accepted Answer

Perforated duodenal ulcer

Answer

Typhoid perforation

Answer

After laparotomy

Answer

Spontaneous rupture of oesophagus

NEET-PG 2013 — Surgery