Among pathological lead points, the commonest cause of intussusception is -
What is the most important presenting feature of periampullary carcinoma?
What is the best marker to assess prognosis after surgery for colon carcinoma?
All of the following are surgical options in the management of esophageal carcinoma except -
Which of the following statements about heart transplantation is false?
What is the most common cause of lateral aberrant thyroid tissue?
A child presented with blunt abdominal trauma, the first investigation to be done is -
Vacuum assisted closure is contraindicated in which of the following conditions -
Which of the following statements is true regarding cystic hygroma?
The size threshold at which the risk of rupture of an abdominal aortic aneurysm significantly increases is:
NEET-PG 2015 - Surgery NEET-PG Practice Questions and MCQs
Question 31: Among pathological lead points, the commonest cause of intussusception is -
- A. Submucous lipoma
- B. Meckel's diverticulum (Correct Answer)
- C. Polyp
- D. Hypertrophy of submucous peyer's patches
Explanation: ***Meckel's diverticulum*** - Among **pathological lead points** specifically, **Meckel's diverticulum** is the most common cause of intussusception. - It is a true congenital diverticulum that can act as a lead point when it becomes inverted, inflamed, or has associated ectopic tissue or tumors. - While overall intussusception in children is mostly idiopathic, when a **pathological lesion** is identified, Meckel's diverticulum is the leading cause. - Seen in approximately 2% of the population, it follows the "rule of 2s" and is the most frequent anatomical abnormality causing pathological intussusception in pediatric patients. *Hypertrophy of submucous Peyer's patches* - **Peyer's patch hypertrophy** is the most common cause of intussusception **overall** in children (90% of cases), typically following viral infections. - However, this represents **idiopathic intussusception**, not a true pathological lead point, as no discrete anatomical lesion is identified. - The question specifically asks for pathological lead points, which excludes this idiopathic mechanism. *Submucous lipoma* - A **submucous lipoma** can serve as a pathological lead point for intussusception, but is much rarer. - More commonly seen in adults rather than children. - While it is a true pathological lesion, it is less frequent than Meckel's diverticulum as a lead point. *Polyp* - **Polyps** (adenomatous, hamartomatous, or inflammatory) can act as pathological lead points. - More common in adults and in specific syndromes (e.g., Peutz-Jeghers syndrome). - Less frequent than Meckel's diverticulum among pathological causes in the pediatric population.
Question 32: What is the most important presenting feature of periampullary carcinoma?
- A. Jaundice (Correct Answer)
- B. Abdominal Pain
- C. Unintentional Weight Loss
- D. Palpable Abdominal Mass
Explanation: ***Jaundice*** - **Painless obstructive jaundice** is the hallmark symptom, occurring early due to the tumor's proximity to the common bile duct. - The obstruction of bile flow leads to the accumulation of **bilirubin**, causing yellow discoloration of the skin and eyes. *Abdominal Pain* - While **abdominal pain** can occur, it is often a later symptom and is less specific than jaundice for early diagnosis. - Pain typically arises from tumor growth, invasion of surrounding structures, or pancreatic involvement. *Unintentional Weight Loss* - **Unintentional weight loss** is a common constitutional symptom of many advanced malignancies, including periampullary carcinoma. - However, it usually manifests at a later stage and is not the initial, specific presenting feature that prompts investigation. *Palpable Abdominal Mass* - A **palpable abdominal mass** is rare in early periampullary carcinoma, as these tumors are typically small and deeply seated. - Its presence usually indicates advanced disease with significant tumor burden or metastasis.
Question 33: What is the best marker to assess prognosis after surgery for colon carcinoma?
- A. CA 19-9
- B. CA-125
- C. Alpha fetoprotein
- D. CEA (Correct Answer)
Explanation: ***CEA*** - Carcinoembryonic antigen (**CEA**) is a well-established tumor marker for monitoring colorectal cancer post-surgery and assessing prognosis [1]. - Elevated **CEA levels** after surgery may indicate recurrence or residual disease, making it valuable in follow-up care [1]. *CA 19-9* - Primarily associated with **pancreatic** and **biliary tract cancers**, and not specific for colon carcinoma. - While it may elevate in some gastrointestinal malignancies, it is not the best indicator for prognosis after colon cancer surgery. *Alpha fetoprotein* - Mostly used for monitoring **hepatocellular carcinoma** and germ cell tumors, not colorectal malignancies. - Elevated levels are not typically correlated with prognosis in colon cancer patients. *CA-125* - Mainly utilized as a tumor marker for **ovarian cancer** and some other malignancies, not specifically for colon carcinoma. - Its use in colorectal cancer prognosis is limited and lacks relevance in this context. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 253-254.
Question 34: All of the following are surgical options in the management of esophageal carcinoma except -
- A. Ivor Lewis Approach
- B. McKeown's Approach
- C. Transhiatal removal
- D. Sistrunk operation (Correct Answer)
Explanation: ***Sistrunk operation*** - The **Sistrunk operation** is a surgical procedure specifically designed for the removal of a **thyroglossal duct cyst**, not for esophageal carcinoma. - This procedure involves excising the cyst along with the central portion of the hyoid bone and the tract leading to the foramen cecum to prevent recurrence. *Ivor Lewis Approach* - The **Ivor Lewis approach** is a common and established surgical technique for **esophagectomy**, involving both abdominal and right thoracic incisions for tumor resection and reconstruction. - It is often used for tumors in the mid to distal esophagus. *Mckeown's Approach* - The **McKeown's approach** is another well-known surgical technique for **esophagectomy**, typically used for more proximal esophageal tumors. - This involves three incisions: abdominal, right thoracic, and cervical, allowing for extensive lymphadenectomy. *Transhiatal removal* - **Transhiatal esophagectomy** is a surgical option for esophageal cancer that involves abdominal and cervical incisions without a thoracic incision. - This approach is often favored in patients with significant comorbidities who may not tolerate a full thoracotomy.
Question 35: Which of the following statements about heart transplantation is false?
- A. High pulmonary arterial resistance is a contraindication
- B. It is only orthotopic and not heterotopic (Correct Answer)
- C. Immunosuppression is started preoperatively
- D. A beating heart cadaver/donor is not always needed.
Explanation: ***It is only orthotopic and not heterotopic*** - This statement is **FALSE**, making it the correct answer to this question asking for the false statement. - While **orthotopic transplantation** (replacing the recipient's heart with the donor heart in its normal anatomical position) is the overwhelmingly predominant method, **heterotopic transplantation** (leaving the recipient's heart in place and implanting the donor heart as an auxiliary "piggyback" pump) has been performed as an alternative technique. - Heterotopic transplantation, though rarely used in modern practice, was described and performed in select cases, particularly when the donor heart is undersized or when severe pulmonary hypertension is present. Therefore, the claim that heart transplantation is "only orthotopic" is incorrect. *Immunosuppression is started preoperatively* - This statement is **TRUE**. - **Immunosuppressive therapy** is typically initiated intraoperatively or in some protocols may begin preoperatively to prevent hyperacute and acute rejection. - Induction immunosuppression aims to suppress the recipient's immune response before it can react to the transplanted organ, improving early graft survival. *High pulmonary arterial resistance is a contraindication* - This statement is **TRUE**. - **Fixed pulmonary hypertension** with elevated pulmonary vascular resistance (PVR >4-5 Wood units or transpulmonary gradient >15 mmHg unresponsive to vasodilators) is a **contraindication** for isolated heart transplantation. - The donor right ventricle may not be able to pump against high pulmonary pressures, leading to acute right heart failure. - Such patients may require combined heart-lung transplantation or medical optimization to reduce pulmonary vascular resistance before transplantation can be considered. *A beating heart cadaver/donor is not always needed* - This statement is considered **TRUE**, though with important caveats. - Traditionally, heart transplantation has relied almost exclusively on **beating-heart donors** (brain-dead donors with maintained cardiac function) to ensure organ viability. - The statement acknowledges that in rare circumstances or with advanced preservation techniques, the absolute requirement for a beating heart might be questioned, though in practical terms beating-heart donation remains the standard for heart transplantation.
Question 36: What is the most common cause of lateral aberrant thyroid tissue?
- A. Ectopic thyroid tissue due to developmental anomalies
- B. Thyroid tissue in the mediastinum
- C. Metastatic thyroid carcinoma (Correct Answer)
- D. Lingual thyroid
Explanation: ***Metastatic thyroid carcinoma*** - **Metastatic papillary thyroid carcinoma** to cervical lymph nodes is the most common cause of lateral aberrant thyroid tissue - The term "lateral aberrant thyroid" is a **historical misnomer** that has been abandoned in modern thyroid surgery - What was previously thought to be ectopic thyroid tissue in lateral neck nodes is virtually always **metastatic disease** - Papillary thyroid carcinoma commonly metastasizes to **regional lymph nodes**, which then contain thyroid follicular cells - This represents **lymph node metastases**, not developmental ectopia *Ectopic thyroid tissue due to developmental anomalies* - True developmental ectopia of thyroid tissue in the **lateral neck is extremely rare to nonexistent** - The thyroid gland originates from the **foramen cecum in the midline** and descends along the thyroglossal duct - Developmental ectopic thyroid occurs in **midline structures** (lingual thyroid, thyroglossal duct remnants), not laterally - The concept of "lateral aberrant thyroid" as a developmental anomaly has been **disproven** *Thyroid tissue in the mediastinum* - Mediastinal thyroid tissue represents **substernal or retrosternal goiter** that has descended into the chest - This describes a different anatomical location (mediastinum vs. lateral neck) - Not related to lateral cervical masses *Lingual thyroid* - Lingual thyroid is ectopic thyroid tissue located at the **base of the tongue** - This is a **midline structure**, not a lateral neck finding - Represents failure of thyroid descent during embryological development
Question 37: A child presented with blunt abdominal trauma, the first investigation to be done is -
- A. USG (Correct Answer)
- B. CT Scan
- C. Complete Hemogram
- D. Abdominal X-ray
Explanation: ***USG*** - An **ultrasound (USG)** is the **first-line imaging investigation** for blunt abdominal trauma in children due to its **non-invasive nature**, lack of radiation exposure, and rapid bedside availability. - **FAST (Focused Assessment with Sonography for Trauma)** effectively identifies the presence of **free fluid** (indicating internal bleeding/hemoperitoneum) and can assess solid organ injuries, particularly the **spleen and liver**. - It is the **preferred initial investigation in hemodynamically stable pediatric patients**. *CT Scan* - A **CT scan** is more sensitive and provides detailed anatomical information but involves significant **radiation exposure**, which is a major concern in children. - It is usually reserved for cases where USG is inconclusive, there is a **high clinical suspicion of severe injury**, or when determining the need for surgical intervention in hemodynamically stable patients. *Complete Hemogram* - A **complete hemogram** assesses blood components like hemoglobin and hematocrit, which are crucial for evaluating blood loss, but it is a **laboratory test, not an imaging investigation**. - While important for initial assessment and serial monitoring, it doesn't provide immediate information about the **location, type, or extent of internal abdominal injuries**. *Abdominal X-ray* - An **abdominal X-ray** has limited utility in blunt abdominal trauma as it is primarily useful for detecting **hollow viscus perforation (free air)** or bony fractures. - It does not effectively visualize soft tissue injuries, fluid collections, or solid organ damage, making it unsuitable as the primary diagnostic tool in blunt abdominal trauma.
Question 38: Vacuum assisted closure is contraindicated in which of the following conditions -
- A. Chronic osteomyelitis
- B. Large amount of necrotic tissue with eschar (Correct Answer)
- C. Abdominal wound
- D. Surgical wound dehiscence
Explanation: ***Large amount of necrotic tissue with eschar*** - The presence of a large amount of **necrotic tissue** and **eschar** is a contraindication for VAC therapy because it prevents effective contact between the foam and viable tissue, impairing wound healing. - Eschar acts as a physical barrier, trapping bacteria and hindering the proper function of negative pressure by preventing uniform pressure distribution and fluid removal from the wound bed. *Chronic osteomyelitis* - While chronic osteomyelitis can be challenging, VAC therapy can sometimes be used as an **adjunctive treatment** after surgical debridement to manage the wound and promote granulation tissue formation. - It helps in controlling infection and closing the wound by removing exudates, reducing edema, and improving blood flow. *Abdominal wound* - VAC therapy is commonly used for **abdominal wounds**, especially after damage control surgery or in cases of open abdomen management. - It facilitates closure by promoting granulation, reducing edema, and protecting the abdominal contents. *Surgical wound dehiscence* - **Surgical wound dehiscence** is a common indication for VAC therapy, as it helps to manage the open wound, promote granulation tissue, and prepare the wound for eventual secondary closure or grafting. - VAC therapy reduces surgical site infections, removes exudates, and enhances tissue perfusion, leading to better wound healing outcomes.
Question 39: Which of the following statements is true regarding cystic hygroma?
- A. Non transilluminant
- B. Develops from jugular lymphatic sequestration (Correct Answer)
- C. Lined by endothelial cells
- D. All of the options
Explanation: ***Develops from jugular lymphatic sequestration*** - **Cystic hygromas** are congenital **lymphatic malformations** that primarily occur in the neck - They arise from the abnormal budding or sequestration of the **jugular lymph sacs** during embryonic development, leading to the formation of dilated lymphatic channels that fail to connect with the venous system - This is the **most specific and characteristic** feature of cystic hygroma pathogenesis *Non transilluminant* - This statement is **incorrect**; cystic hygromas are typically **transilluminant** because they are fluid-filled sacs - The cystic nature of the lesion allows light to pass through, which is a classic diagnostic feature on clinical examination *Lined by endothelial cells* - While this statement is technically true (lymphatic endothelial cells are a type of endothelial cell), it is **not the most specific answer** - This feature is shared with all vascular and lymphatic structures, making it less distinctive for cystic hygromas - The key distinguishing feature is their **embryological origin** from jugular lymphatic sequestration, not just their endothelial lining *All of the options* - This option is **incorrect** because not all statements are true or most appropriate - Only the statement about jugular lymphatic sequestration represents the most specific and correct answer
Question 40: The size threshold at which the risk of rupture of an abdominal aortic aneurysm significantly increases is:
- A. 5.5 cm (Correct Answer)
- B. 6 cm
- C. 6.5 cm
- D. 7 cm
Explanation: ***5.5 cm*** - An abdominal aortic aneurysm (AAA) 5.5 cm or larger is typically the threshold for considering **elective surgical repair** due to significantly increased **rupture risk**. - For aneurysms smaller than this, the risk of surgery often outweighs the risk of rupture, making watchful waiting with surveillance more appropriate. *6 cm* - While a 6 cm AAA certainly has a very high risk of rupture, the generally accepted guideline for intervention begins at **5.5 cm** for most patients. - Delaying intervention until 6 cm could unnecessarily expose the patient to a higher risk of rupture. *6.5 cm* - An AAA of 6.5 cm carries an extremely high risk of rupture, and intervention would be strongly indicated. - This size is well past the standard **5.5 cm threshold** recommended for elective repair. *7 cm* - A 7 cm AAA is associated with a **critical and very high risk of rupture**, making immediate intervention imperative. - This size is significantly beyond the established guideline for considering elective repair, which is 5.5 cm.