CA Breast may locally spread to all of the following muscles except
What is the best management for a human bite?
ESWL is contraindicated in which of the following stones -
Surgery for undescended testis is recommended at what age?
What is the optimal timing for administering antibiotic prophylaxis before surgery?
Which of the following is NOT a feature of membranous urethral injury?
A high-riding prostate is indicative of which injury?
Prostate cancer that is limited to the capsule and not the urethra would be staged as -
What is the primary treatment for early-stage non-small cell lung cancer?
What is the typical absorption duration of Polydioxanone sutures?
NEET-PG 2015 - Surgery NEET-PG Practice Questions and MCQs
Question 41: CA Breast may locally spread to all of the following muscles except
- A. Latissimus Dorsi (Correct Answer)
- B. Pectoralis Minor
- C. Serratus Anterior
- D. Pectoralis Major
Explanation: ***Latissimus Dorsi*** - The **latissimus dorsi** muscle is located on the posterior aspect of the trunk and arm, significantly deeper and further away from the breast tissue compared to other surrounding muscles. - Direct local invasion of breast cancer to the latissimus dorsi is rare and typically requires extensive tumor growth or metastasis to more distant sites before affecting this muscle. *Pectoralis Minor* - The **pectoralis minor** muscle lies directly beneath the pectoralis major and is in close proximity to the deeper aspects of the breast tissue. - Tumors that invade the **deep fascia** of the breast can directly extend into this muscle. *Serratus Anterior* - The **serratus anterior** muscle is located on the lateral wall of the thorax, forming part of the chest wall beneath the breast. - **Aggressive breast cancers**, particularly those in the outer quadrants, can invade the fascial planes covering this muscle. *Pectoralis Major* - The **pectoralis major** forms the anterior wall of the axilla and lies directly beneath the majority of the breast tissue. - It is one of the most common muscles to be affected by **direct local invasion** from breast cancer due to its anatomical proximity.
Question 42: What is the best management for a human bite?
- A. Ampicillin plus sulbactam (Correct Answer)
- B. Clindamycin plus TMP-SMX
- C. Fluoroquinolone
- D. Doxycycline
Explanation: ***Ampicillin plus sulbactam*** - This combination is effective against the common **aerobic and anaerobic bacteria** found in human bite wounds, including **Eikenella corrodens** and oral streptococci. - The sulbactam component provides **beta-lactamase inhibition**, which is crucial as many oral bacteria produce these enzymes, rendering ampicillin alone ineffective. *Clindamycin plus TMP-SMX* - While clindamycin covers many anaerobes, it has **poor activity against Eikenella corrodens**, a key pathogen in human bites. - **TMP-SMX (trimethoprim-sulfamethoxazole)** also lacks reliable coverage against many oral anaerobes and Eikenella. *Fluoroquinolone* - **Fluoroquinolones** generally have good Gram-negative coverage but often possess **limited activity against oral anaerobes and streptococci** relevant to human bites. - There is a **growing concern for resistance** with fluoroquinolone monotherapy in these types of infections. *Doxycycline* - Doxycycline has a broad spectrum but is **not the first-line choice for human bites** due to inconsistent activity against common oral anaerobes and Eikenella corrodens. - It may be considered in specific cases, but **empiric coverage needs to be broader** for initial management of these **polymicrobial infections**.
Question 43: ESWL is contraindicated in which of the following stones -
- A. Urate stones
- B. Phosphate stones
- C. Oxalate Stones
- D. Cystine stones (Correct Answer)
Explanation: ***Cysteine stones*** - **Cystine stones** are very dense and hard, making them resistant to fragmentation by the shock waves generated during **Extracorporeal Shock Wave Lithotripsy (ESWL)**. - Due to their resistance to fragmentation, ESWL is generally ineffective for cystine stones, and other treatments like **ureteroscopy** or **percutaneous nephrolithotomy (PCNL)** are often preferred. *Oxalate Stones* - **Calcium oxalate stones** are generally **amenable to ESWL** as they are effectively fragmented by shock waves. - They are the **most common type of kidney stone** and often respond well to lithotripsy. *Urate stones* - **Uric acid stones** are typically **radiolucent** but are often **well-fragmented by ESWL**. - Their non-calcium composition does not hinder the effectiveness of shock waves. *Phosphate stones* - **Struvite (magnesium ammonium phosphate) stones** and **calcium phosphate stones** generally respond well to ESWL. - While sometimes large and branched (**staghorn calculi**), the individual components are susceptible to shock wave fragmentation, though multiple sessions or adjunctive therapies might be needed.
Question 44: Surgery for undescended testis is recommended at what age?
- A. 36 months
- B. 12 months (Correct Answer)
- C. 24 months
- D. 6 months
Explanation: ***12 months*** - **Orchiopexy** for undescended testes is generally recommended around **12 months of age** to optimize fertility and reduce cancer risk. - This timing is within the ideal surgical window of **6-18 months**, balancing the allowance for potential spontaneous descent (which rarely occurs after 6 months) with minimizing germ cell damage. - Most pediatric surgeons prefer operating around **12 months** as it provides optimal outcomes. *6 months* - While **6 months is within the acceptable surgical window** (6-18 months), most surgeons prefer waiting closer to 12 months. - Operating at 6 months is not incorrect, but waiting a few more months allows for logistical planning and ensures any late spontaneous descent has occurred. - The key is to operate **before 18 months** to preserve fertility potential. *24 months* - Delaying surgery until 24 months (2 years) **exceeds the recommended window** and increases the risk of germ cell damage and potential future infertility. - While still beneficial compared to no surgery, the ideal timing for preserving fertility and minimizing malignancy risk has passed. *36 months* - Surgery at 36 months (3 years) is considered a **significant delay** and carries higher risks for long-term complications, including reduced fertility potential and increased risk of testicular cancer. - The benefits of early intervention are largely diminished by this age, though orchiopexy is still indicated to reduce cancer risk and for cosmetic/psychological reasons.
Question 45: What is the optimal timing for administering antibiotic prophylaxis before surgery?
- A. Immediately before induction of anesthesia
- B. 30-60 minutes before incision (Correct Answer)
- C. 2-3 hours before surgery
- D. Immediately after surgery
Explanation: ***30-60 minutes before incision*** - This is the **optimal timing** recommended by WHO, CDC, and major surgical guidelines for most commonly used prophylactic antibiotics (cefazolin, cefuroxime). - Ensures **peak tissue and serum concentrations** are achieved at the time of incision, providing maximum protection against surgical site infections. - Based on **pharmacokinetic principles**: the antibiotic must be present at bactericidal concentrations in tissues when bacterial contamination occurs. - Studies show this timing significantly reduces surgical site infection rates compared to other timings. *Immediately before induction of anesthesia* - While acceptable in some protocols, this may be too early if there is a delay between induction and incision. - Could result in **declining antibiotic levels** by the time the incision is made, especially for antibiotics with shorter half-lives. *2-3 hours before surgery* - This is **too early** for most antibiotics. - Tissue levels may have already **declined below therapeutic concentrations** by the time of incision. - Does not provide adequate protection during the critical period of bacterial contamination. *Immediately after surgery* - This is **treatment, not prophylaxis**. - Offers **no preventive benefit** against intraoperative contamination. - By this time, bacteria introduced during surgery have already adhered to tissues and begun forming biofilms.
Question 46: Which of the following is NOT a feature of membranous urethral injury?
- A. blood at the meatus
- B. Retention of urine
- C. Pelvic fracture
- D. Perineal butterfly hematoma (Correct Answer)
Explanation: ***Perineal butterfly hematoma*** - A **perineal butterfly hematoma** is more characteristic of an injury to the **anterior urethra**, specifically the bulbar urethra, often caused by a straddle injury. - It occurs due to the extravasation of blood into the subcutaneous tissue of the perineum, outlining the shape of a butterfly. *blood at the meatus* - **Blood at the meatus** is a classic sign of urethral injury, regardless of the segment (anterior or posterior). - It indicates disruption of the urethral mucosa and bleeding from the damaged blood vessels. *Retention of urine* - **Retention of urine** can occur due to either a complete or partial urethral transection, preventing normal urine flow. - The inability to void can lead to bladder distension and is a significant symptom in assessing urethral trauma severity. *Pelvic fracture* - **Pelvic fractures** are frequently associated with **membranous urethral injuries** because the membranous urethra is fixed within the pelvic ring. - Shear forces from pelvic trauma can cause the prostatomembranous junction to avulse.
Question 47: A high-riding prostate is indicative of which injury?
- A. Extraperitoneal Bladder rupture
- B. Intraperitoneal Bladder Rupture
- C. Membranous Urethral Injury (Correct Answer)
- D. Bulbar Urethral Injury
Explanation: ***Membranous Urethral Injury*** - A **high-riding prostate** is a classic sign of **membranous urethral injury**, often resulting from **pelvic fractures**. - The disruption of the **urethra** above the perineal membrane causes the prostate to be displaced superiorly and appear "high." *Extraperitoneal Bladder rupture* - This typically occurs with **pelvic fractures** and involves urine leaking into the **retropubic space**. - While associated with pelvic trauma, it does not directly cause a high-riding prostate; the bladder itself may be ruptured, but the relative position of the prostate is not significantly altered. *Intraperitoneal Bladder Rupture* - This type of rupture usually results from a direct blow to a **full bladder** and involves urine extravasating into the **peritoneal cavity**. - It does not cause a high-riding prostate, as the injury is to the dome of the bladder, not the structures supporting the prostate. *Bulbar Urethral Injury* - A **bulbar urethral injury** usually results from a **straddle injury** and is located in the anterior urethra. - This type of injury does not affect the anatomical position of the prostate, which is posterior and superior to the bulbar urethra.
Question 48: Prostate cancer that is limited to the capsule and not the urethra would be staged as -
- A. T1
- B. T2 (Correct Answer)
- C. T3
- D. T0
Explanation: ***T2*** - A T2 stage indicates that the prostate cancer is **confined within the prostate capsule**, meaning it has not spread beyond the outer layer of the prostate gland. - While it is not limited to the urethra, the key defining characteristic of T2 is **capsular confinement**, which is described in the question. *T1* - T1 stage prostate cancer is typically **non-palpable** on digital rectal exam (DRE) and not visible on imaging. - It is often found incidentally, for example, during a **transurethral resection of the prostate (TURP)** for benign prostatic hyperplasia. *T3* - A T3 stage indicates that the prostate cancer has **extended beyond the prostate capsule**, but has not metastasized to distant sites. - This typically involves invasion into the **seminal vesicles** or other periprostatic tissues. *T0* - T0 means there is **no evidence of primary tumor**, which is not consistent with a diagnosed prostate cancer. - This staging is used when there is no measurable tumor.
Question 49: What is the primary treatment for early-stage non-small cell lung cancer?
- A. Radiotherapy
- B. Surgical resection (Correct Answer)
- C. Surgical resection with adjuvant chemotherapy
- D. Immunotherapy
Explanation: ***Surgical resection*** - **Surgical resection** (lobectomy or segmentectomy with lymph node dissection) is the **primary and definitive treatment** for early-stage non-small cell lung cancer (Stage I-II). - For **Stage IA disease**, surgery alone provides excellent outcomes with 5-year survival rates of 70-90%, and adjuvant chemotherapy is generally **not indicated**. - For **Stage IB-II**, surgery remains primary, with adjuvant chemotherapy considered selectively based on tumor size (>4 cm), poor differentiation, vascular invasion, or other high-risk features. - Complete surgical resection offers the **best chance of cure** for resectable early-stage NSCLC. *Surgical resection with adjuvant chemotherapy* - While this combination is important for **select early-stage cases** (high-risk Stage IB, Stage II-IIIA), it is **not the universal primary treatment** for all early-stage disease. - Adjuvant chemotherapy is an **addition** to surgery in specific scenarios, not part of the primary treatment for the majority of early-stage (especially Stage IA) patients. - Current guidelines recommend risk stratification before adding adjuvant therapy. *Radiotherapy* - **Radiotherapy** (stereotactic body radiotherapy/SBRT) is reserved for **medically inoperable** patients or those who refuse surgery. - It is not the primary treatment when the patient is a **surgical candidate**. - May be used as adjuvant therapy in patients with positive margins or N2 disease. *Immunotherapy* - **Immunotherapy** has emerging roles in neoadjuvant/adjuvant settings for resectable NSCLC (recent trials showing benefit). - However, it is **not established as primary monotherapy** for early resectable disease. - More commonly used in advanced/metastatic NSCLC or as part of combination regimens in clinical trial settings for early disease.
Question 50: What is the typical absorption duration of Polydioxanone sutures?
- A. 4 weeks
- B. 6 weeks
- C. 2 weeks
- D. 6 months (Correct Answer)
Explanation: ***Correct: 6 months*** - **Polydioxanone (PDS) sutures** are known for their **prolonged absorption time**, typically ranging from 180 to 210 days, or approximately 6 months. - This characteristic makes PDS sutures suitable for tissues requiring **extended support** during the healing process. - PDS retains approximately **50% tensile strength at 4 weeks** and **25% at 6 weeks**, with complete absorption occurring over 6-7 months. *Incorrect: 2 weeks* - An absorption duration of 2 weeks is characteristic of **rapidly absorbing sutures**, such as **chromic gut** or **fast-absorbing synthetic sutures**, which are used for tissues that heal quickly or require minimal support. - PDS sutures offer much longer tensile strength retention and absorption than this brief period. *Incorrect: 4 weeks* - A 4-week absorption time is considerably shorter than that of PDS sutures. This duration might be seen with some **intermediate-absorbing sutures**, but not with the long-lasting PDS. - Sutures absorbed in this timeframe would not provide sufficient support for tissues where PDS is typically indicated. *Incorrect: 6 weeks* - While longer than 2 or 4 weeks, 6 weeks (approximately 42 days) is still much shorter than the typical absorption profile of PDS sutures. - Sutures like **Vicryl Rapide** might fall into this absorption range, but PDS is designed for applications needing several months of support.