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
Which of the following is NOT a principle of negative pressure wound therapy?
Where does spontaneous esophageal rupture (Boerhaave syndrome) most commonly occur?
Which of the following is resected in Whipple's operation, except?
CA Breast may locally spread to all of the following muscles except
A 45-year-old female underwent a modified radical mastectomy with axillary clearance for breast cancer. Post-surgery, she is unable to lift her arm above her head. Which nerve is most likely to be injured?
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
RPLND and Chemotherapy may be used in management of?
The Grayhack shunt is established between which of the following?
Which of the following statements about undescended testis is true?
NEET-PG 2015 - Surgery NEET-PG Practice Questions and MCQs
Question 61: 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
- A. Palliative Radiotherapy
- B. Chemotherapy and immunotherapy
- C. Partial nephrectomy
- D. Radical Nephroureterectomy (Correct Answer)
Explanation: ***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.
Question 62: Which of the following is NOT a principle of negative pressure wound therapy?
- A. Macrodeformation of the wound
- B. Decreased edema
- C. Stabilization of wound environment
- D. Clearance of infection (Correct Answer)
Explanation: ***Clearance of infection*** - While negative pressure wound therapy (NPWT) can help manage heavily colonized wounds by removing exudate and reducing bacterial burden, it is **not a primary treatment for active infection**. - **Systemic antibiotics** or local antiseptics are required to truly clear an infection, as NPWT alone cannot eliminate deep-seated pathogens. *Stabilization of wound environment* - NPWT helps to **stabilize the wound bed** by holding it in place, protecting it from external contamination and mechanical stress. - This creates an optimal environment for **wound healing** by preventing disruption of newly formed granulation tissue. *Macrodeformation of the wound* - The negative pressure applied to the wound surface causes the wound edges to be drawn together, leading to **macrodeformation**. - This effect reduces wound size and promotes **epithelialization** and **wound contraction**. *Decreased edema* - NPWT actively removes **excess interstitial fluid** and exudate from the wound bed, leading to a significant reduction in edema. - This reduction in swelling improves **perfusion** to the wound tissues and promotes better healing.
Question 63: Where does spontaneous esophageal rupture (Boerhaave syndrome) most commonly occur?
- A. Below the diaphragmatic aperture
- B. Pharyngoesophageal junction
- C. At the crossing of the arch of aorta
- D. Above the diaphragmatic aperture (Correct Answer)
Explanation: ***Above the diaphragmatic aperture*** - Boerhaave syndrome, or spontaneous esophageal rupture, most commonly occurs in the **distal esophagus**, just above the diaphragmatic aperture. - This region is particularly susceptible due to increased **intraluminal pressure** during forceful vomiting, combined with a lack of muscular support and a thinner esophageal wall. - The rupture typically occurs in the **left posterolateral wall** of the lower third of the esophagus, approximately **2-5 cm above the gastroesophageal junction**. *Below the diaphragmatic aperture* - Ruptures below the diaphragmatic aperture are less common in Boerhaave syndrome, as the **lower esophageal sphincter** and surrounding diaphragmatic crura provide more support. - While other forms of esophageal injury can occur here, a spontaneous rupture due to vomiting is less typical in this location. *Pharyngoesophageal junction* - Ruptures at the pharyngoesophageal junction are known as **Zenker's diverticulum ruptures** or other types of perforation, typically not Boerhaave syndrome. - This area is prone to tears from instrumentation or foreign bodies but not usually from the extreme pressure of forceful vomiting (which affects the distal esophagus more). *At the crossing of the arch of aorta* - The mid-esophagus at the level of the aortic arch is not a common site for Boerhaave syndrome. - Although the esophagus is constricted here, the primary stress during forceful vomiting is concentrated in the **distal esophagus**.
Question 64: Which of the following is resected in Whipple's operation, except?
- A. Duodenum
- B. Head of pancreas
- C. Neck of pancreas (Correct Answer)
- D. Common bile duct
Explanation: ***Neck of pancreas*** - In a **Whipple procedure** (pancreaticoduodenectomy), the **neck of the pancreas** is the site of transection (division), not resection. - The **head of the pancreas** (distal to the neck) is removed, while the **body and tail** (proximal to the neck) are preserved. - The transected surface at the neck is anastomosed to the jejunum to maintain pancreatic drainage. *Duodenum* - The **entire duodenum** is resected during a Whipple operation. - This is necessary because the **head of the pancreas** is intimately involved with the duodenum, sharing blood supply and lymphatic drainage. *Head of pancreas* - The **head of the pancreas** is the primary target for resection in a Whipple procedure. - This is typically performed for **malignancies** (pancreatic or periampullary tumors) or severe inflammatory conditions affecting this region. *Common bile duct* - The **distal common bile duct** is resected as part of the specimen to ensure complete tumor excision with adequate margins. - The remaining **proximal common bile duct** is then anastomosed to the jejunum (hepaticojejunostomy).
Question 65: 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 66: A 45-year-old female underwent a modified radical mastectomy with axillary clearance for breast cancer. Post-surgery, she is unable to lift her arm above her head. Which nerve is most likely to be injured?
- A. Intercostobrachial nerve
- B. Nerve to latissimus Dorsi
- C. Lateral Pectoral nerve
- D. Long thoracic nerve of Bell (Correct Answer)
Explanation: ***Long thoracic nerve of Bell*** - Injury to the **long thoracic nerve** (nerve to the serratus anterior) leads to **paralysis of the serratus anterior muscle**. - This muscle is crucial for **upward rotation and protraction of the scapula**, which is essential for arm elevation above the head and preventing **'winging' of the scapula**. *Intercostobrachial nerve* - Injury to the **intercostobrachial nerve** typically causes **sensory loss** or numbness in the medial upper arm. - It does not primarily affect motor function or the ability to lift the arm. *Nerve to latissimus Dorsi* - The **thoracodorsal nerve** innervates the **latissimus dorsi muscle**, which is involved in adduction, extension, and internal rotation of the arm. - Injury to this nerve would impair these movements but not directly prevent arm elevation above the head. *Lateral Pectoral nerve* - The **lateral pectoral nerve** supplies the **pectoralis major muscle**, primarily its clavicular head. - Injury would weaken adduction and flexion of the arm, but the inability to lift the arm above the head strongly points to serratus anterior dysfunction.
Question 67: 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
- A. Fibroadenoma (Correct Answer)
- B. Cystasarcoma Phylloides
- C. Scirrhous Carcinoma
- D. Fibroadenosis
Explanation: ***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.
Question 68: RPLND and Chemotherapy may be used in management of?
- A. Non-seminomatous germ cell tumors of the testis (Correct Answer)
- B. Non-germ cell tumors
- C. Seminomatous germ cell tumors
- D. Lymphoma of the testis
Explanation: ***Non-seminomatous germ cell tumors of the testis*** - **Retroperitoneal lymph node dissection (RPLND)** and **chemotherapy** are key components in the management of non-seminomatous germ cell tumors (NSGCTs), especially for metastatic disease or after initial orchidectomy. - The combination therapy addresses both local nodal involvement (RPLND) and widespread micrometastases (chemotherapy), which are common in NSGCTs. *Non-germ cell tumors* - This is a broad category, and while some non-germ cell testicular tumors may require surgery or chemotherapy, **RPLND** is not a standard part of their management in the same way it is for germ cell tumors. - The specific treatment depends on the tumor type (e.g., Leydig cell tumor, Sertoli cell tumor), stage, and histology, and often involves less aggressive approaches. *Seminomatous germ cell tumors* - **Seminomas** are highly radiosensitive and often respond well to **radiation therapy**, particularly for localized disease or retroperitoneal nodal involvement. - While chemotherapy is used for metastatic seminoma, **RPLND** is generally not indicated for seminomas due to their radiosensitivity and different metastatic patterns compared to NSGCTs. *Lymphoma of the testis* - Testicular lymphoma is a type of **non-Hodgkin lymphoma** and is primarily managed with systemic **chemotherapy** (e.g., R-CHOP) and sometimes radiation therapy. - **RPLND** is not a standard treatment modality for testicular lymphoma, as it is a systemic disease requiring systemic treatment, not local surgical excision of retroperitoneal nodes.
Question 69: The Grayhack shunt is established between which of the following?
- A. Corpora cavernosa and dorsal vein
- B. Corpora cavernosa and saphenous vein (Correct Answer)
- C. Corpora cavernosa and glans
- D. Corpora cavernosa and corpora spongiosa
Explanation: ***Corpora cavernosa and saphenous vein*** - The **Grayhack shunt** is a type of **cavernosal-venous shunt**, specifically connecting the corpus cavernosum to the saphenous vein. - This procedure is typically performed to surgically manage **priapism** by diverting blood from the trapped penile cavernosal spaces. *Corpora cavernosa and dorsal vein* - While other **cavernosal-venous shunts** can be created between the corpora cavernosa and the dorsal vein (e.g., Al-Ghorab shunt), the Grayhack shunt specifically involves the **saphenous vein**. - The dorsal vein approach is usually considered for more distal shunts. *Corpora cavernosa and glans* - This describes a **distal cavernosal-glanular shunt** (e.g., Winter or Ebbehoj), which involves creating a communication between the corpus cavernosum and the glans penis to relieve priapism. - The Grayhack shunt is a more **proximal** and **cavernosal-venous** type of shunt. *Corpora cavernosa and corpora spongiosa* - This describes a **cavernosal-spongiosal shunt**, such as the Quackels shunt, where connection is made between the corpora cavernosa and the corpus spongiosum. - This type of shunt is also used for priapism but is distinct from the cavernosal-venous Grayhack shunt.
Question 70: Which of the following statements about undescended testis is true?
- A. Hormonal therapy is effective
- B. More common on the right side
- C. Increased risk of malignancy (Correct Answer)
- D. Secondary sexual characteristics are universally normal
Explanation: ***Increased risk of malignancy*** - Undescended testis is associated with a **3 to 14 times increased risk** of testicular malignancy, particularly **seminoma**. - The risk remains elevated even after orchiopexy, though the procedure allows for **easier surveillance and examination**. - This is one of the **most important clinical features** of cryptorchidism and a key reason for early surgical correction. - Even a **corrected cryptorchid testis** maintains higher cancer risk compared to normally descended testes. *Secondary sexual characteristics are universally normal* - In **unilateral cryptorchidism** (90% of cases), the normally descended contralateral testis produces **adequate testosterone** for normal secondary sexual development. - However, in **bilateral cryptorchidism** or if the descended testis is functionally impaired, **testosterone deficiency** can occur, leading to delayed or abnormal sexual development. - Therefore, secondary sexual characteristics are **not universally normal** in all cases of undescended testis. *Hormonal therapy is effective* - Hormonal therapy with **hCG (human chorionic gonadotropin)** or **GnRH (gonadotropin-releasing hormone)** has **limited and inconsistent effectiveness**. - Success rates are generally **low** (10-30%), particularly for truly undescended testes (as opposed to retractile testes). - **Orchiopexy** (surgical correction) remains the **definitive treatment**, ideally performed between **6-18 months of age** to optimize fertility potential. *More common on the right side* - Undescended testis is actually **slightly more common on the left side** (~55-60%) than the right (~40-45%). - **Bilateral cryptorchidism** occurs in approximately 10-20% of cases. - There is no significant right-sided predilection.