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:
Chvostek sign could be seen after -
Reactionary Hemorrhage occurs due to?
Claudication due to femoropopliteal incompetence is primarily seen in
Which of the following is the correct management of abdominal compartment syndrome?
What is the treatment of choice in desmoid tumors?
Which of the following neck dissections is considered the most conservative?
Supraomohyoid dissection is a type of?
ESWL is contraindicated in which of the following stones -
NEET-PG 2015 - Surgery NEET-PG Practice Questions and MCQs
Question 51: 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 52: 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.
Question 53: Chvostek sign could be seen after -
- A. Total Thyroidectomy (Correct Answer)
- B. Subtotal Thyroidectomy
- C. Heller's Cardiomyotomy
- D. Gastrojejunostomy
Explanation: ***Total Thyroidectomy*** - A total thyroidectomy involves the removal of the entire thyroid gland, which can inadvertently lead to the removal or damage of the **parathyroid glands** as well. - Damage to the parathyroid glands causes **hypoparathyroidism**, leading to **hypocalcemia**, which is characterized by neuromuscular excitability manifesting as a **Chvostek sign**. *Subtotal Thyroidectomy* - In a subtotal thyroidectomy, only a portion of the thyroid gland is removed, leaving some functional parathyroid tissue intact. - This procedure usually preserves enough parathyroid function to prevent severe **hypocalcemia** and the manifestation of a Chvostek sign. *Heller's Cardiomyotomy* - Heller's cardiomyotomy is a surgical procedure performed to treat **achalasia**, involving the cutting of muscle fibers in the esophagus. - This procedure does not involve the neck region or the parathyroid glands and therefore has no direct association with calcium regulation or the **Chvostek sign**. *Gastrojejunostomy* - A gastrojejunostomy is a surgical procedure that creates a bypass between the stomach and the jejunum, typically performed for conditions like gastric outlet obstruction or as part of bariatric surgery. - This operation is limited to the abdominal cavity and has no direct impact on calcium metabolism or the parathyroid glands that would elicit a **Chvostek sign**.
Question 54: Reactionary Hemorrhage occurs due to?
- A. Infection
- B. Damage to a blood vessel
- C. Pressure necrosis
- D. Dislodgement of clot (Correct Answer)
Explanation: ***Dislodgement of clot*** - **Reactionary hemorrhage** occurs within the first 24 hours post-surgery as the initial **vasoconstriction** and **blood pressure drop** from anesthesia resolve. - As blood pressure normalizes and peripheral vessels dilate, a **clot** that formed in a previously bleeding vessel becomes dislodged, leading to bleeding. *Infection* - **Infection** can cause secondary hemorrhage, but this typically occurs later, usually several days to weeks after surgery, due to tissue necrosis and erosion of blood vessels. - It is not the primary mechanism for hemorrhage occurring within the first 24 hours. *Damage to a blood vessel* - **Damage to a blood vessel** during surgery is a cause of primary hemorrhage, which occurs during or immediately after the procedure. - While it initiates the potential for bleeding, reactionary hemorrhage specifically refers to bleeding that resumes due to changes in patient physiology post-operatively, rather than ongoing vessel damage. *Pressure necrosis* - **Pressure necrosis** refers to tissue death due to sustained external pressure, often leading to skin breakdown or deep tissue injury. - It does not directly cause reactionary hemorrhage, although necrotic tissue could potentially contribute to later secondary hemorrhage if a vessel erodes.
Question 55: Claudication due to femoropopliteal incompetence is primarily seen in
- A. Thigh
- B. Calf (Correct Answer)
- C. Buttocks
- D. Feet
Explanation: ***Calf*** - **Femoropopliteal incompetence** refers to insufficiency in the superficial femoral and popliteal arteries. Blockage in these arteries typically results in **claudication** symptoms downstream from the obstruction. - The **calf muscles** receive their blood supply via these arteries and are therefore the primary site of pain due to inadequate blood flow during exertion, manifesting as claudication. *Thigh* - Claudication in the **thigh** is usually associated with more proximal arterial obstructions in the **aortoiliac system** or common femoral artery. - While thigh muscles are located upstream from the calf, pain would indicate a blockage higher up than the femoropopliteal segment. *Buttocks* - **Buttock claudication** points to very proximal arterial disease, specifically involving the **internal iliac arteries** or the distal aorta (**Leriche syndrome**). - This is even further upstream than the femoropopliteal arteries and would involve more significant and widespread circulatory compromise. *Feet* - While the **feet** can experience pain due to arterial insufficiency, particularly with severe disease or at rest, isolated foot claudication is less common. - **Claudication** specifically points to muscle ischemia during activity, and the robust musculature of the calf makes it the primary site when femoropopliteal arteries are involved.
Question 56: Which of the following is the correct management of abdominal compartment syndrome?
- A. Antihypertensives
- B. Urgent Fasciotomy
- C. Wait and monitor for 24 hours
- D. Urgent decompressive laparotomy (Correct Answer)
Explanation: ***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.
Question 57: What is the treatment of choice in desmoid tumors?
- A. Irradiation
- B. Wide excision (Correct Answer)
- C. Local excision
- D. Local excision following radiation
Explanation: ***Wide excision*** - For **desmoid tumors**, **complete surgical resection with clear margins** is the primary treatment of choice due to their infiltrative nature and high recurrence rates. - This approach aims to minimize local recurrence and prevent tumor progression, which can impact adjacent structures. *Irradiation* - **Radiation therapy** is typically reserved as an **adjuvant** treatment after surgery or for unresectable tumors, not as a primary standalone treatment. - While it can help reduce recurrence rates, it carries risks of **secondary malignancies** and local tissue damage. *Local excision* - **Local excision** alone is insufficient for desmoid tumors due to their **infiltrative growth pattern** and high propensity for **local recurrence** if positive margins remain. - It often leads to incomplete removal, necessitating further intervention and increasing the risk of tumor progression. *Local excision following radiation* - Combining local excision with initial radiation is not the preferred sequence; **wide surgical excision** is typically performed first. - Radiation might be considered preoperatively in specific cases to **reduce tumor size** or postoperatively for **positive margins**, but starting with local excision after initial radiation is not the standard primary management.
Question 58: Which of the following neck dissections is considered the most conservative?
- A. Supraomohyoid neck dissection (Correct Answer)
- B. Radical neck dissection
- C. Modified radical neck dissection
- D. All options are conservative.
Explanation: ***Supraomohyoid neck dissection*** - This dissection is highly **selective**, removing only lymph nodes from **levels I, II, and III**, which are the most superficial and anterior groups in the neck. - It preserves the **internal jugular vein**, spinal accessory nerve, and sternocleidomastoid muscle, minimizing functional and cosmetic morbidity. *Radical neck dissection* - This is the **most extensive** neck dissection, involving the removal of all lymph node levels (I-V), the **internal jugular vein**, the **spinal accessory nerve**, and the **sternocleidomastoid muscle**. - It is reserved for advanced cancers with extensive nodal involvement due to its significant associated morbidity and functional deficits. *Modified radical neck dissection* - This dissection removes lymph nodes in levels I-V but **spares at least one non-lymphatic structure**, such as the spinal accessory nerve, internal jugular vein, or sternocleidomastoid muscle. - While less radical than a full radical neck dissection, it is still more extensive than a supraomohyoid dissection as it targets a broader range of lymph node levels. *All options are conservative.* - This statement is incorrect because **radical neck dissection** is by definition the most extensive and least conservative surgical approach to neck nodal disease. - The different types of neck dissections represent a spectrum of extensiveness, with supraomohyoid being the most selective and conservative.
Question 59: Supraomohyoid dissection is a type of?
- A. Selective neck dissection (Correct Answer)
- B. Modified radical neck dissection
- C. Radical neck dissection
- D. Posterolateral dissection
Explanation: ***Selective neck dissection*** - **Supraomohyoid dissection** specifically refers to a type of selective neck dissection, characterized by the removal of lymph node levels **I, II, and III**. - This procedure is commonly performed for early-stage oral cavity cancers due to their typical lymphatic spread patterns. *Modified radical neck dissection* - This dissection preserves one or more **non-lymphatic structures** (e.g., sternocleidomastoid muscle, internal jugular vein, spinal accessory nerve) that are typically removed in a radical neck dissection. - It involves a broader range of lymph node levels (typically **I-V**) compared to a supraomohyoid dissection. *Radical neck dissection* - This is a more extensive procedure involving the removal of all lymph node groups (levels **I-V**), along with the **sternocleidomastoid muscle**, **internal jugular vein**, and **spinal accessory nerve**. - It is reserved for advanced neck disease due to its significant morbidity. *Posterolateral dissection* - **Posterolateral neck dissection** is a term not commonly used within the standard classification of neck dissections (radical, modified radical, selective). - Lymphatic dissection is typically categorized based on anatomical levels rather than a general directional term like posterolateral.
Question 60: 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.