NEET-PG 2015 - Surgery Practice Questions

Q: A 45-year-old male is diagnosed with carcinoma of the penis. Which lymph nodes should the surgeon primarily consider for potential metastasis?

Inguinal lymph nodes (located in the groin region). ***Inguinal lymph nodes (located in the groin region)*** - The lymphatic drainage of the penis primarily bypasses the internal nodal basins and drains directly to the **superficial and deep inguinal lymph nodes**. - Metastasis to these nodes is the **most common initial spread** in penile carcinoma, making them the primary targets for surgical evaluation and dissection. *Para-aortic lymph nodes (located near the aorta)* - These nodes are typically involved in more advanced or widespread metastatic disease, following initial spread to the pelvic nodes. - They are not considered the primary draining lymph nodes for penile carcinoma. *External iliac lymph nodes (located along the external iliac vessels)* - While part of the pelvic lymph node chain, the external iliac nodes are usually involved after metastasis to the inguinal nodes, or in cases of direct invasion of the pelvic floor. - They are not the first echelon of lymphatic drainage for the penis. *Internal iliac lymph nodes (located along the internal iliac vessels)* - These nodes are involved in lymphatic drainage from organs like the bladder, prostate, and rectum. - The lymphatic drainage of the penis primarily bypasses these nodes for initial metastasis.

Q: A 22 year old woman comes with a non progressive mass in the left breast since 6 months. There are no associated symptoms. Examination shows a mobile mass not attached to the overlying skin or underlying tissue. The possible diagnosis is

Fibroadenoma. ***Fibroadenoma*** - This is the most common benign breast tumor in young women, typically presenting as a **mobile, non-tender, firm mass** with no attachment to surrounding tissues. - The history of a **non-progressive mass** over six months in a 22-year-old woman is highly characteristic of a fibroadenoma. *Cystasarcoma Phylloides* - While it can present as a mobile mass, phyllodes tumors tend to grow **rapidly** and can reach a large size, which contradicts the "non-progressive" nature of the mass described. - Phyllodes tumors often have a **leaf-like architectural pattern** histologically and can be benign, borderline, or malignant. *Scirrhous Carcinoma* - This is a type of invasive ductal carcinoma that typically presents as a **hard, irregular, fixed mass** that is often attached to the skin or underlying tissue, unlike the mobile mass described here. - It is common in older women and often associated with **skin dimpling** or nipple retraction. *Fibroadenosis* - This refers to a group of benign breast changes, often presenting with generalized **lumpiness, pain, or tenderness** that fluctuates with the menstrual cycle, rather than a discrete, solitary mass. - It usually presents as **multiple, diffuse nodules** rather than a single, well-defined mass.

Q: Which of the following statements about Gallbladder carcinoma is true?

Gallstones may be a predisposing factor. ***Gallstones may be a predisposing factor*** - The chronic inflammation and irritation caused by **gallstones (cholelithiasis)** are considered major risk factors for the development of gallbladder carcinoma. - Approximately 70-90% of patients with gallbladder carcinoma also have **cholelithiasis**, suggesting a strong association. *Carries a good prognosis* - Gallbladder carcinoma generally has a **poor prognosis** due to its asymptomatic nature in early stages and aggressive local invasion. - Most cases are diagnosed at an advanced stage, leading to a **low 5-year survival rate**. *Commonly squamous cell carcinoma* - The vast majority of gallbladder carcinomas are **adenocarcinomas** (around 90%), arising from the glandular epithelium. - **Squamous cell carcinoma** is rare, accounting for only a small percentage of cases. *Jaundice is rare* - **Jaundice** is a common symptom in advanced gallbladder carcinoma, often indicating obstruction of the biliary ducts. - It arises when the tumor invades or compresses the **common bile duct**, leading to bilirubin backup.

Q: Most common site for Cystic Hygroma is -

Lower third of neck. ***Lower third of neck*** - **Cystic hygromas** (also known as **lymphatic malformations**) most commonly occur in the **posterior triangle of the neck**, which is located in the lower lateral aspect of the neck [1]. - Approximately **75-80%** of cystic hygromas are found in the neck region, with the **posterior triangle** being the predominant site. - The **posterior jugular lymph sac** fails to connect properly with the venous system during embryonic development, leading to these cystic malformations in this characteristic location [1]. - The posterior triangle encompasses the lower lateral neck, making "lower third of neck" an acceptable description of this most common site. *Overlying the parotid gland* - While lymphatic malformations can occur in the parotid region, this represents only about **10-15%** of cases. - This is a less common site compared to the posterior triangle of the neck. - Lesions in this area might raise concern for other parotid pathologies like **pleomorphic adenoma** or **hemangioma**. *Along the Zygomatic Prominence* - This is an unusual location for a cystic hygroma, as the lymphatic drainage and embryonic development in this area are not typically associated with these malformations. - Lesions here might suggest different developmental or neoplastic etiologies such as **dermoid cysts** or **vascular malformations**. *Post auricular* - The post-auricular region is not a common site for cystic hygromas. - Swelling in this area could be due to other conditions like **mastoiditis**, **lymphadenopathy**, or **sebaceous cysts**.

Q: Which of the following is resected in Whipple's operation, except?

Neck of pancreas. ***Neck of pancreas*** - In a **Whipple procedure** (pancreaticoduodenectomy), the **neck of the pancreas** is the site of transection (division), not resection. - The pancreas is divided at the neck, and the remaining **body and tail** are preserved and anastomosed to the jejunum for pancreatic drainage. *Duodenum* - The **entire duodenum** is resected during a Whipple operation as it shares intimate anatomical relations with the pancreatic head. - Complete duodenal removal is necessary to achieve adequate **oncological margins** and remove all associated lymphatic drainage. *Head of pancreas* - The **head of the pancreas** is the primary structure resected in a Whipple procedure. - This resection is typically performed for **pancreatic adenocarcinoma** or **periampullary tumors** requiring en bloc removal. *Common bile duct* - The **distal common bile duct** is resected as part of the specimen to ensure complete tumor excision. - The remaining **proximal bile duct** is reconstructed via **hepaticojejunostomy** to restore biliary drainage.

Q: A 54 year old woman is diagnosed as having carcinoma of the renal pelvis of size less than 4 cm without any metastasis. The best treatment option is

Radical Nephroureterectomy. ***Radical Nephroureterectomy*** - Carcinoma of the **renal pelvis** is a type of upper tract urothelial carcinoma (UTUC). Because of the multifocal nature and higher risk of recurrence of UTUC, **radical nephroureterectomy** (which includes removal of the kidney, ureter, and bladder cuff) is the standard treatment, even for smaller tumors. - Unlike renal cell carcinoma, partial nephrectomy is generally not recommended for renal pelvis carcinomas due to the risk of leaving behind residual disease in the ureter or bladder cuff. *Partial nephrectomy* - This is generally reserved for small, localized **renal cell carcinomas**, especially when kidney function preservation is a concern (e.g., solitary kidney, bilateral tumors). - For **renal pelvis carcinomas**, partial nephrectomy is associated with a higher risk of local recurrence because of the potential for tumor spread within the ureter and multifocal disease. *Chemotherapy and immunotherapy* - **Chemotherapy** (often cisplatin-based) might be used as neoadjuvant or adjuvant therapy for locally advanced or high-risk UTUC, or for metastatic disease. It is not the primary curative treatment for localized disease. - **Immunotherapy** is typically reserved for advanced or metastatic urothelial carcinoma that has progressed after chemotherapy. *Palliative Radiotherapy* - **Radiotherapy** has a limited role in the primary curative treatment of renal pelvis carcinoma. - It is mainly used in a **palliative setting** for symptom control (e.g., bone metastases, local pain) in advanced or metastatic disease, not for localized, resectable tumors.

Q: Which of the following statements about Hirschsprung disease is incorrect?

The non-peristaltic affected segment is dilated. ***The non-peristaltic affected segment is dilated*** - In Hirschsprung disease, the **aganglionic segment** is typically **constricted** and **narrow**, not dilated, due to continuous contraction without relaxation. - The healthy colon proximal to the affected segment becomes dilated due to the obstruction caused by the constricted, aganglionic segment. *Absence of Ganglion cells in the involved segment* - This statement is **correct**. Hirschsprung disease is fundamentally characterized by the **absence of intramural ganglion cells** (Meissner and Auerbach plexuses) in a segment of the distal colon. - This aganglionosis results in a failure of relaxation and normal peristalsis in the affected bowel segment. *Swenson, Duhamel, and Soave are surgical procedures for this condition* - This statement is **correct**. These are the classic and most common **pull-through surgical procedures** used to treat Hirschsprung disease. - They involve resecting the aganglionic segment and pulling the normal, ganglionated bowel down to the anus. *Mainly presents in infancy* - This statement is **correct**. Hirschsprung disease is primarily a **congenital condition** and is typically diagnosed in newborns and infants. - Common presenting symptoms include **failure to pass meconium** within the first 24-48 hours of life, abdominal distension, and bilious vomiting.

Q: A 45-year-old male presenting with penile cancer extending up to the glans penis is treated with which of the following surgical options?

Partial penectomy with a 2 cm margin. ***Partial penectomy with a 2 cm margin*** - For **penile cancer** confined to the glans, **partial penectomy** is the standard surgical approach to achieve local control while preserving penile length. - Historically, a **2 cm tumor-free margin** was recommended as the standard of care (reflected in older guidelines and exam questions). - **Modern evidence** suggests that narrower margins of **5-8 mm** are oncologically safe with comparable local control rates, but the **2 cm margin** was the traditional teaching and remains the expected answer for this question context. *Simple circumcision* - **Simple circumcision** is indicated for benign conditions like **phimosis** or **premalignant lesions** (carcinoma in situ), not for invasive cancer. - It does not provide adequate oncological clearance for **invasive penile cancer** and carries a high risk of **local recurrence**. *Partial penectomy with a 4 cm margin* - A **4 cm margin** is excessively radical and would result in unnecessary loss of penile length and function. - Even by historical standards, this exceeds the recommended **2 cm margin** and would cause significant functional and psychological morbidity. *Partial penectomy with inguinal lymph node dissection* - **Inguinal lymph node dissection** is indicated when there is **clinical or radiological evidence of lymph node metastasis** or high-risk pathological features. - Without evidence of nodal involvement, routine prophylactic lymphadenectomy is not performed due to significant morbidity (lymphedema, wound complications). - The question does not specify nodal involvement, making this option unnecessarily aggressive.

Q: What is the most common cause of lateral aberrant thyroid tissue?

Metastatic thyroid carcinoma. ***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 1

A 45-year-old male is diagnosed with carcinoma of the penis. Which lymph nodes should the surgeon primarily consider for potential metastasis?

Accepted Answer

Inguinal lymph nodes (located in the groin region)

Answer

Para-aortic lymph nodes (located near the aorta)

Answer

External iliac lymph nodes (located along the external iliac vessels)

Answer

Internal iliac lymph nodes (located along the internal iliac vessels)

Question 2

A 22 year old woman comes with a non progressive mass in the left breast since 6 months. There are no associated symptoms. Examination shows a mobile mass not attached to the overlying skin or underlying tissue. The possible diagnosis is

Accepted Answer

Fibroadenoma

Answer

Cystasarcoma Phylloides

Answer

Scirrhous Carcinoma

Answer

Fibroadenosis

Question 3

Which of the following statements about Gallbladder carcinoma is true?

Accepted Answer

Gallstones may be a predisposing factor

Answer

Carries a good prognosis

Answer

Commonly squamous cell carcinoma

Answer

Jaundice is rare

Question 4

Most common site for Cystic Hygroma is -

Accepted Answer

Lower third of neck

Answer

Overlying the parotid gland

Answer

Along the Zygomatic Prominence

Answer

Post auricular

Question 5

Which of the following is resected in Whipple's operation, except?

Accepted Answer

Neck of pancreas

Answer

Duodenum

Answer

Head of pancreas

Answer

Common bile duct

Question 6

A 54 year old woman is diagnosed as having carcinoma of the renal pelvis of size less than 4 cm without any metastasis. The best treatment option is

Accepted Answer

Radical Nephroureterectomy

Answer

Palliative Radiotherapy

Answer

Chemotherapy and immunotherapy

Answer

Partial nephrectomy

Question 7

Which of the following statements about Hirschsprung disease is incorrect?

Accepted Answer

The non-peristaltic affected segment is dilated

Answer

Absence of ganglion cells in the involved segment

Answer

Mainly presents in infancy

Answer

Swenson, Duhamel, and Soave are surgical procedures for this condition

Question 8

Which of the following statements accurately describes a subtotal thyroidectomy?

Accepted Answer

Removal of 1 lobe with isthmus and the second lobe partially

Answer

Removal of one lobe and isthmus

Answer

Removal of both lobes leaving behind 6-8 grams of tissue

Answer

Removal of entire thyroid with cervical lymphnodes

Question 9

A 45-year-old male presenting with penile cancer extending up to the glans penis is treated with which of the following surgical options?

Accepted Answer

Partial penectomy with a 2 cm margin

Answer

Simple circumcision

Answer

Partial penectomy with a 4 cm margin

Answer

Partial penectomy with inguinal lymph node dissection

Question 10

What is the most common cause of lateral aberrant thyroid tissue?

Accepted Answer

Metastatic thyroid carcinoma

Answer

Ectopic thyroid tissue due to developmental anomalies

Answer

Thyroid tissue in the mediastinum

Answer

Lingual thyroid

NEET-PG 2015 — Surgery