NEET-PG 2013 - Surgery Practice Questions

Q: Young male with history of trauma having left sided testis swollen and erythematous. Other side normal. What is the diagnosis?

Hematoma. ***Hematoma*** - A history of **trauma** leading to a **swollen and erythematous testis** is highly indicative of a testicular hematoma. Trauma can cause bleeding within the scrotal sac, leading to the observed symptoms. - A hematoma is a localized collection of **blood outside of blood vessels**, which in this case, results from the injury to the testis or surrounding structures. *Torsion* - Testicular torsion typically presents with **sudden, severe pain** and swelling, and can be associated with absent **cremasteric reflex**. While swelling is present, the clear history of trauma points away from spontaneous torsion. - Torsion is an **emergency** caused by the twisting of the spermatic cord, which **cuts off blood supply** to the testis, and usually lacks a direct antecedent trauma. *Carcinoma* - Testicular carcinoma usually presents as a **painless, firm mass** within the testis. Pain can occur if there is hemorrhage within the tumor or rapid growth. - While it can cause swelling, the acute onset and direct association with trauma make carcinoma less likely, as it is a **slowly progressive** condition. *Hernia* - An inguinal hernia typically presents as a **groin bulge** that can extend into the scrotum, and usually reduces with manipulation or lying down. It is often associated with a cough or strain. - While a hernia can cause scrotal swelling, the primary presentation is usually a reducible mass, and the direct link to trauma with associated erythema is not typical for a simple hernia.

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.

Q: Which of the following statements about Grisel syndrome is false?

A neurosurgeon is never needed.. ***A neurosurgeon is never needed.*** - This statement is false because severe cases of **Grisel syndrome** may require surgical intervention, necessitating consultation with a **neurosurgeon**. - Surgical management, such as **cervical fusion**, may be indicated in cases of irreducible subluxation or neurological compromise. *It can occur after adenoidectomy.* - This statement is true; **Grisel syndrome** is a rare complication that may occur following **adenoidectomy** or other head and neck surgeries. - The postulated mechanism involves inflammation spreading from the pharynx to the alar and transverse ligaments, leading to **atlantoaxial subluxation**. *It involves inflammation of cervical spine ligaments.* - This statement is true; **Grisel syndrome** is characterized by non-traumatic **atlantoaxial subluxation** resulting from inflammatory laxity of the cervical ligaments. - Specifically, the **transverse and alar ligaments** become inflamed and weakened, leading to instability between the atlas (C1) and axis (C2). *Conservative treatment is the first-line approach in most cases.* - This statement is true; initial management of **Grisel syndrome** typically involves conservative measures such as **neck immobilization**, pain control, and muscle relaxants. - Early diagnosis and conservative treatment are crucial to prevent progression and potential neurological complications.

Q: What is considered a poor prognostic indicator in Pott's paraplegia?

Rapid progression of neurological deficits. ***Rapid progression of neurological deficits*** - **Rapid progression** implies severe spinal cord damage occurring quickly, which is less likely to fully recover even with treatment. - This indicates a more aggressive disease process or significant compression that can lead to irreversible neurological impairment. *Healed disease* - **Healed disease** (even if paraplegia existed previously) indicates that the infection is resolved and the destructive process has stopped, allowing for potential neurological recovery or stability. - While residual neurological deficits might remain, the absence of active inflammation improves the long-term prognosis compared to ongoing damage. *Chronic disease* - **Chronic disease** in the context of Pott's paraplegia often refers to established deficits after a prolonged course, but it doesn't necessarily imply ongoing active deterioration. - The chronicity itself, without rapid progression, suggests a more stable state where the damage has already occurred, and further deterioration might be slow or absent. *Active disease* - **Active disease** means the infection is still present and causing bone destruction, which is a concern. - However, if the neurological deficits are not rapidly progressing, there is still a window for treatment to stop the disease and potentially allow for some recovery, distinguishing it from an acute, rapidly deteriorating situation.

Q: Which type of fracture is most likely to cause exsanguinating blood loss?

Open femoral fracture. ***Open femoral fracture*** - An **open femoral fracture** involves both a break in the **femur** (the largest bone in the body, which houses significant marrow and has an extensive blood supply) and a break in the skin, allowing for direct external bleeding. - The **femur** can bleed up to **1-2 liters internally** even in a closed fracture, and an **open fracture** compounds this risk with direct external blood loss, leading to rapid exsanguination. *Closed tibial fracture* - A **closed tibial fracture** does not involve a break in the skin, so external bleeding is not a primary concern. - While there can be internal bleeding, the **tibia** is smaller than the femur and generally causes less significant blood loss (typically **250-500 mL**) compared to a femoral fracture. *Open humeral fracture* - An **open humeral fracture** involves exposure of the bone to the outside, but the **humerus** is a smaller bone with less marrow volume and blood supply compared to the femur. - While bleeding can be significant, especially if major vessels like the **brachial artery** are damaged, the overall potential for rapid, life-threatening **exsanguination** is less than with a femoral fracture. *Closed humeral fracture* - A **closed humeral fracture** does not involve a break in the skin, limiting blood loss to internal bleeding within the arm. - The **humerus** is a relatively smaller bone and, in a closed fracture, the surrounding tissues can tamponade some of the bleeding, making exsanguinating hemorrhage unlikely.

Q: Pulled up cecum is seen in which condition?

Ileocecal tuberculosis (TB). ***Ileocecal tuberculosis (TB)*** - **Ileocecal tuberculosis** commonly causes **fibrosis** and stricture formation in the ileocecal region, which can lead to the **retraction or pulling up of the cecum**. - This "pulled-up cecum" is a characteristic radiographic finding, often associated with a **patulous ileocecal valve** and inflammatory changes. *Cecal carcinoma* - While cecal carcinoma can cause a mass and involve the cecum, it does not typically lead to a "pulled-up" appearance. - Carcinoma usually presents as a **filling defect** or an **obstructing lesion** rather than retraction. *Intussusception* - **Intussusception** involves the telescoping of one part of the intestine into another, usually presenting as a **target sign** on imaging. - This condition does not cause a *pulled-up cecum*; instead, it involves the distal segment invaginating into the proximal segment. *Colon carcinoma* - **Colon carcinoma** can manifest as an **apple-core lesion** or an obstructing mass, but like cecal carcinoma, it generally does not cause the cecum to be pulled upwards. - The pathology is primarily one of **luminal narrowing** or mass obstruction.

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

Young male with history of trauma having left sided testis swollen and erythematous. Other side normal. What is the diagnosis?

Accepted Answer

Hematoma

Answer

Carcinoma

Answer

Hernia

Answer

Torsion

Question 2

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

Accepted Answer

18%

Answer

15%

Answer

12%

Answer

32%

Question 3

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 4

Most common anomaly of upper urogenital tract is -

Accepted Answer

Uretero pelvic junction stenosis

Answer

Ureterocele

Answer

Ectopic ureter

Answer

Ectopic urethral opening

Question 5

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

Question 6

Which of the following statements about Grisel syndrome is false?

Accepted Answer

A neurosurgeon is never needed.

Answer

It can occur after adenoidectomy.

Answer

It involves inflammation of cervical spine ligaments.

Answer

Conservative treatment is the first-line approach in most cases.

Question 7

What is considered a poor prognostic indicator in Pott's paraplegia?

Accepted Answer

Rapid progression of neurological deficits

Answer

Healed disease

Answer

Chronic disease

Answer

Active disease

Question 8

Which type of fracture is most likely to cause exsanguinating blood loss?

Accepted Answer

Open femoral fracture

Answer

Closed tibial fracture

Answer

Open humeral fracture

Answer

Closed humeral fracture

Question 9

Pulled up cecum is seen in which condition?

Accepted Answer

Ileocecal tuberculosis (TB)

Answer

Cecal carcinoma

Answer

Intussusception

Answer

Colon carcinoma

Question 10

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 2013 — Surgery