NEET-PG 2015 - Surgery Practice Questions

Q: Which of the following is the correct management of abdominal compartment syndrome?

Urgent decompressive laparotomy. ***Urgent decompressive laparotomy*** - The definitive treatment for abdominal compartment syndrome (ACS) is **urgent surgical decompression** via **decompressive laparotomy**. - This involves opening the abdominal fascia to immediately **reduce intra-abdominal pressure (IAP)**, typically indicated when IAP >20 mmHg with new organ dysfunction. - Decompression is crucial to prevent irreversible organ damage, restore perfusion to compressed organs, and improve ventilation. - The abdomen is often left open temporarily with negative pressure wound therapy until the patient stabilizes. *Antihypertensives* - Antihypertensives may manage systemic hypertension but do not address the **elevated intra-abdominal pressure** that is the primary pathology in ACS. - This approach is insufficient and could worsen **organ perfusion** by reducing the perfusion pressure gradient (MAP - IAP) to already compressed abdominal organs. - ACS requires mechanical decompression, not pharmacological blood pressure management. *Urgent Fasciotomy* - Fasciotomy is the correct treatment for **extremity compartment syndrome** (e.g., leg, forearm), where it relieves pressure within muscle compartments. - It is anatomically inappropriate for **abdominal compartment syndrome**, which requires opening the abdominal cavity, not limb fascial compartments. - This represents a fundamental misunderstanding of the anatomical site requiring decompression. *Wait and monitor for 24 hours* - ACS is a **surgical emergency** that can rapidly progress to multiorgan failure, acute kidney injury, respiratory failure, and cardiovascular collapse. - Delaying intervention by 24 hours would likely result in **irreversible organ damage** and significantly increased mortality. - Once diagnosed (IAP >20 mmHg with organ dysfunction), urgent decompression is mandatory.

Q: Which of the following urethral anomalies is the most common?

Hypospadias. ***Hypospadias*** - **Hypospadias** is the most common urethral anomaly, occurring when the **urethral opening** is located on the underside of the penis rather than at the tip. - Its prevalence ranges from approximately **1 in 150 to 1 in 300 live male births**, making it significantly more frequent than other urethral malformations. *Pinhole meatus* - A **pinhole meatus** refers to an abnormally small urethral opening. - While it can be a component or consequence of other anomalies, it is **less common as a standalone finding** compared to hypospadias. *Epispadias* - **Epispadias** is a rare anomaly where the urethra opens on the **dorsal (top) aspect** of the penis. - Its incidence is much lower than hypospadias, estimated at **1 in 100,000 to 1 in 500,000 live births**. *Stricture of the urethra* - A **urethral stricture** is a narrowing of the urethra, often due to **scar tissue** from inflammation, trauma, or infection. - Although it can present at any age, it is more commonly an **acquired condition** rather than a congenital anomaly like hypospadias or epispadias.

Q: A 60-year-old male presented with jaundice, pale stools, dark urine, and a mass in the epigastric region. Which of the following diagnoses is least likely to be the cause of these symptoms?

Chronic Cholecystitis. ***Chronic Cholecystitis*** - While chronic cholecystitis can cause epigastric pain, it rarely presents with **jaundice**, **pale stools**, and **dark urine** because it typically does not obstruct the common bile duct. - The presence of a palpable **epigastric mass** is also not a common feature of chronic cholecystitis. *Biliary Cancer* - **Biliary cancer**, particularly choledochal cancer, can cause **obstructive jaundice**, leading to **pale stools** (lack of bilirubin) and **dark urine** (conjugated bilirubin in urine). - A mass in the **epigastric region** could represent an enlarged gallbladder due to distal obstruction (Courvoisier's sign) or the tumor itself. *Periampullary Cancer* - **Periampullary cancers**, which arise near the ampulla of Vater, characteristically cause **obstructive jaundice**, presenting with **pale stools** and **dark urine**. - A mass in the **epigastric region** might be the tumor or a dilated gallbladder due to bile duct obstruction. *Pancreatic cancer* - **Pancreatic head cancer** frequently obstructs the common bile duct, resulting in **jaundice**, **pale stools**, and **dark urine**. - An **epigastric mass** can be the palpable tumor itself or an enlarged, distended gallbladder.

Q: The Grayhack shunt is established between which of the following?

Corpora cavernosa and saphenous vein. ***Corpora cavernosa and saphenous vein*** - The **Grayhack shunt** is a proximal **cavernosal-venous shunt** that connects the corpus cavernosum to the **great saphenous vein**. - This procedure surgically manages **refractory priapism** by diverting blood away from the trapped penile cavernosal spaces into the systemic venous circulation. - It is performed when distal and proximal corporeal shunts have failed. *Corpora cavernosa and dorsal vein* - This describes the **Barry shunt**, which connects the corpus cavernosum to the **deep dorsal vein**. - The Al-Ghorab shunt (sometimes confused) is actually a **distal corporo-glanular shunt** involving open excision of glans tissue — not a dorsal vein shunt. *Corpora cavernosa and glans* - This describes **distal cavernosal-glanular shunts** such as the **Winter shunt** (percutaneous needle) or **Ebbehoj shunt** (scalpel incision), which create a communication between the corpus cavernosum and the glans penis. - These are **first-line** surgical options for priapism but are distinct from the proximal Grayhack shunt. *Corpora cavernosa and corpora spongiosa* - This describes the **Quackels shunt**, a **proximal cavernosal-spongiosal shunt** connecting the corpora cavernosa to the corpus spongiosum. - Also used for refractory priapism, but anatomically and surgically distinct from the Grayhack (cavernosal-venous) shunt.

Q: Vacuum assisted closure is contraindicated in which of the following conditions -

Large amount of necrotic tissue with eschar. ***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.

Q: Which of the following stages of lip carcinoma does not have nodal involvement?

T3N0. ***T3N0*** - The **'N' classification** in the TNM staging system refers to **nodal involvement**. A stage with **'N0' indicates no regional lymph node metastasis**. - A **T3 lesion** signifies a large primary tumor, but if it's accompanied by **N0**, it means there's no evidence of spread to the lymph nodes. *T2N1* - The **'N1' classification** indicates the presence of **regional lymph node metastasis**, specifically in a **single ipsilateral lymph node** that is 3 cm or less in its greatest dimension. - This stage therefore **does have nodal involvement**, contradicting the premise of the question. *T2N2* - The **'N2' classification** signifies more advanced regional lymph node metastasis, such as a **single ipsilateral lymph node** greater than 3 cm but not more than 6 cm. - It could also refer to **multiple ipsilateral lymph nodes**, none greater than 6 cm, or bilateral/contralateral lymph nodes, none greater than 6 cm. In all these cases, **nodal involvement is present**. *T1N1* - Similar to T2N1, the **'N1' component** in T1N1 indicates the presence of **regional lymph node metastasis** in a single ipsilateral lymph node of 3 cm or less. - Therefore, this stage **does involve nodal spread**, despite having a smaller primary tumor (T1).

Q: What is the most important presenting feature of periampullary carcinoma?

Jaundice. ***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.

Q: A child presented with blunt abdominal trauma, the first investigation to be done is -

USG. ***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.

Q: What is the appropriate management for a patient with a carcinoid tumor of the appendix larger than 2 cm?

Right hemicolectomy. ***Right hemicolectomy*** - Carcinoid tumors of the appendix larger than **2 cm** are considered at high risk for **lymph node metastasis** and recurrence. - A **right hemicolectomy** provides adequate margins and allows for lymph node dissection, which is essential for staging and definitive treatment in such cases. *Appendicectomy* - An **appendicectomy** alone is typically sufficient for carcinoid tumors of the appendix that are **less than 1 cm** and localized to the tip. - For larger tumors, appendicectomy carries an unacceptably high risk of **incomplete resection** and metastatic disease. *Appendicectomy + abdominal CT scan* - While an **abdominal CT scan** is useful for assessing local spread and distant metastases, it does not address the need for a more extensive surgical resection for a **large primary tumor**. - A simple **appendicectomy** in this scenario would be inadequate as definitive treatment. *Appendicectomy + 24 hrs urinary HIAA* - **24-hour urinary 5-hydroxyindoleacetic acid (5-HIAA)** is a biomarker used to detect and monitor **carcinoid syndrome**, which occurs in a minority of patients with carcinoid tumors. - Measuring 5-HIAA is primarily for assessing systemic symptoms rather than determining the primary surgical management of the **tumor size**.

Q: Which type of surgical suture is known to cause the most tissue reaction?

Silk. ***Silk*** - Silk is a **natural, braided, non-absorbable suture** that is known to elicit a significant **inflammatory reaction** due to its natural protein composition and braided structure. - While it was historically used for its good handling properties, its high tissue reactivity makes it less ideal for situations where minimal scarring or inflammation is desired. - **Silk causes the most tissue reaction** among commonly used sutures. *Plain Catgut* - Plain catgut is a **natural, absorbable suture** derived from purified collagen of animal intestines, causing a moderate to high tissue reaction. - However, its absorption by enzymatic hydrolysis is relatively rapid, limiting the duration of the inflammatory response compared to non-absorbable natural materials like silk. *Polydiaxonone* - Polydiaxonone (PDS) is a **synthetic, monofilament, absorbable suture** known for causing a relatively **low tissue reaction**. - Its slow absorption profile and monofilament structure contribute to its minimal inflammatory response, making it suitable for tissues requiring prolonged support. *Chromic Catgut* - Chromic catgut is a treated form of plain catgut that has been coated with chromium salts, which prolong its absorption time and reduce its tissue reactivity compared to plain catgut. - Although it is still a natural, absorbable suture, its tissue reaction is **less than both plain catgut and silk**, but greater than synthetic monofilament sutures like PDS.

Question 1

Which of the following is the correct management of abdominal compartment syndrome?

Accepted Answer

Urgent decompressive laparotomy

Answer

Antihypertensives

Answer

Urgent Fasciotomy

Answer

Wait and monitor for 24 hours

Question 2

Which of the following urethral anomalies is the most common?

Accepted Answer

Hypospadias

Answer

Pinhole meatus

Answer

Epispadias

Answer

Stricture of the urethra

Question 3

A 60-year-old male presented with jaundice, pale stools, dark urine, and a mass in the epigastric region. Which of the following diagnoses is least likely to be the cause of these symptoms?

Accepted Answer

Chronic Cholecystitis

Answer

Biliary Cancer

Answer

Periampullary Cancer

Answer

Pancreatic Cancer

Question 4

The Grayhack shunt is established between which of the following?

Accepted Answer

Corpora cavernosa and saphenous vein

Answer

Corpora cavernosa and dorsal vein

Answer

Corpora cavernosa and glans

Answer

Corpora cavernosa and corpora spongiosa

Question 5

Vacuum assisted closure is contraindicated in which of the following conditions -

Accepted Answer

Large amount of necrotic tissue with eschar

Answer

Chronic osteomyelitis

Answer

Abdominal wound

Answer

Surgical wound dehiscence

Question 6

Which of the following stages of lip carcinoma does not have nodal involvement?

Accepted Answer

T3N0

Answer

T2N1

Answer

T2N2

Answer

T1N1

Question 7

What is the most important presenting feature of periampullary carcinoma?

Accepted Answer

Jaundice

Answer

Abdominal Pain

Answer

Unintentional Weight Loss

Answer

Palpable Abdominal Mass

Question 8

A child presented with blunt abdominal trauma, the first investigation to be done is -

Accepted Answer

USG

Answer

CT Scan

Answer

Complete Hemogram

Answer

Abdominal X-ray

Question 9

What is the appropriate management for a patient with a carcinoid tumor of the appendix larger than 2 cm?

Accepted Answer

Right hemicolectomy

Answer

Appendicectomy

Answer

Appendicectomy + abdominal CT scan

Answer

Appendicectomy + 24 hrs urinary HIAA

Question 10

Which type of surgical suture is known to cause the most tissue reaction?

Accepted Answer

Silk

Answer

Plain Catgut

Answer

Polydiaxonone

Answer

Chromic catgut

NEET-PG 2015 — Surgery