NEET-PG 2015 - Surgery Practice Questions

Q: What is the best management for a human bite?

Ampicillin plus sulbactam. ***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**.

Q: A high-riding prostate is indicative of which injury?

Membranous Urethral Injury. ***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.

Q: Under what guidelines is treatment started for a patient presenting with appendicular mass on a CT scan?

Ochsner Sherren Regimen. ***Ochsner Sherren Regimen*** - The **Ochsner Sherren regimen** is a conservative management approach specifically used for patients presenting with an **appendicular mass** (a palpable mass formed by the inflamed appendix, omentum, and small bowel loops). - This regimen involves **nil by mouth**, **intravenous fluids**, **antibiotics**, and **analgesia**, with close observation to allow the inflammation to subside before potential interval appendectomy. *Conservative management and discharge* - While the Ochsner Sherren regimen is a form of conservative management, simply stating "conservative management and discharge" is incomplete and potentially dangerous for a patient with an **appendicular mass**. - **Discharge** is not appropriate without a period of observation and specific medical interventions like antibiotics, as there's a risk of abscess formation or perforation. *Kocher's Regimen* - **Kocher's regimen** is not a recognized treatment protocol for an appendicular mass. - The term "Kocher" is more commonly associated with a **surgical incision** (Kocher incision for cholecystectomy) or a **maneuver** (Kocher maneuver for duodenal mobilization). *Immediate Laparotomy* - **Immediate laparotomy** is generally contraindicated in the presence of a well-formed **appendicular mass**. - Operating on a friable, inflamed mass can disrupt the natural containment, leading to widespread peritonitis and increased morbidity. The Ochsner Sherren regimen aims to cool down the inflammation first.

Q: Supraomohyoid dissection is a type of?

Selective neck dissection. ***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.

Q: Treatment of choice for mucinous carcinoma of the gall bladder in the early stage is -

Simple cholecystectomy. ***Simple cholecystectomy*** - For **early-stage (T1a) mucinous carcinoma of the gallbladder**, **simple cholecystectomy** is the treatment of choice - T1a disease (tumor confined to mucosa) has an excellent prognosis with **5-year survival >90%** after simple cholecystectomy alone - Extended resection offers **no survival benefit** for T1a disease and increases surgical morbidity - If incidentally discovered post-cholecystectomy with negative margins, no further surgery is needed *Extended cholecystectomy* - **Extended cholecystectomy** (cholecystectomy + liver segments IVb/V resection + portal lymphadenectomy) is indicated for **T2 or higher stage** disease (tumor invading muscularis propria or beyond) - This is **not** the treatment for early-stage disease as it increases morbidity without survival benefit - Reserved for more advanced tumors with deeper invasion *Cholecystectomy with wedge resection of liver* - This describes a component of extended cholecystectomy and is similarly indicated for **T2+ disease**, not early-stage - Wedge resection aims to achieve negative margins when tumor extends beyond the gallbladder wall - Not appropriate for early-stage mucinous carcinoma confined to mucosa *Chemotherapy only* - **Chemotherapy alone** is not curative for early-stage gallbladder carcinoma - Surgery remains the primary curative treatment for resectable disease - Chemotherapy is reserved for advanced, metastatic, or unresectable disease as palliative treatment

Q: In which of the following surgeries is monopolar cautery preferred over bipolar cautery?

Surgery of the Hip. ***Surgery of the Hip*** - **Monopolar cautery** is preferred in surgeries like hip surgery where a larger area needs to be coagulated, as it provides a wider field of effect and can be more efficient for **deep tissue coagulation**. - Its mechanism relies on the current passing through the patient to a large **dispersive electrode (grounding pad)**, making it suitable for extensive tissue work. *Hand Surgery* - In **hand surgery**, delicate structures like nerves and tendons are abundant, making **bipolar cautery** safer due to its localized current flow and reduced risk of inadvertent thermal spread. - **Bipolar cautery** limits the current to a small area between the two prongs of the instrument, thus minimizing damage to surrounding tissues. *Surgery around Penis* - **Bipolar cautery** is generally preferred in sensitive areas like the penis, due to its localized effect and reduced risk of thermal injury to adjacent delicate structures. - The avoidance of current passing through the body to a grounding pad in **bipolar modality** is especially important in areas with potential for nerve damage or scarring. *Surgery around the face* - Surgically around the face often involves delicate tissues and structures where **bipolar cautery** is favored to prevent widespread thermal damage and minimize scarring or nerve injury. - The confined current path of **bipolar cautery** makes it ideal for precision work in cosmetic or reconstructive facial surgery.

Q: Reactionary Hemorrhage occurs due to?

Dislodgement of clot. ***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.

Q: An Incisional wound heals by

Primary Healing. ***Primary Healing*** - An **incisional wound** is typically a clean, sharply incised wound with **minimal tissue loss** and edges that can be approximated. - **Primary healing** (or first intention) occurs when the wound edges are surgically closed, leading to rapid healing with minimal scarring. *Secondary Healing* - This type of healing occurs in wounds with **significant tissue loss** or infection, where the edges cannot be approximated. - The wound must heal by **granulation tissue formation** and **wound contraction**, resulting in a larger scar. *Epithelialization* - **Epithelialization** is a vital process in all types of wound healing, where epithelial cells migrate to cover the wound surface. - However, it describes a *process* rather than a *mode* of overall wound healing for a closed incisional wound. *Delayed primary Healing* - **Delayed primary healing** (or tertiary intention) involves leaving a wound open for a period (e.g., to control infection or edema) before closing it surgically. - This approach is not typical for a clean incisional wound but is used in cases where primary closure is initially unsafe.

Q: A patient presents with abdominal pain. On physical examination there was abdominal guarding and tenderness. A plain erect chest X-ray reveals air under diaphragm. Probable diagnosis is

Perforated abdominal viscus. ***Perforated abdominal viscus*** - The presence of **abdominal guarding** and **tenderness** indicates peritoneal irritation, while **air under the diaphragm** on an erect chest X-ray (**pneumoperitoneum**) is a classic sign of a perforated hollow abdominal organ. - This combination strongly suggests a **perforated abdominal viscus**, such as a **perforated peptic ulcer** or perforated diverticulitis, leading to the leakage of air and intestinal contents into the peritoneal cavity. *Acute myocardial infarction* - Acute myocardial infarction primarily presents with **chest pain**, radiation to the arm/jaw, and shortness of breath, not typically severe abdominal pain with guarding. - While it can cause some epigastric discomfort, it would not explain the **pneumoperitoneum** seen on the chest X-ray. *Aortic dissection* - Aortic dissection typically causes **sudden, severe tearing chest or back pain**, often radiating to the back. - There is no direct link between aortic dissection and **air under the diaphragm** unless there's a co-existing, unrelated issue, which is not suggested by the primary symptoms. *None of the options* - Given the clear clinical and radiological findings of **pneumoperitoneum** and **peritoneal signs**, a perforated abdominal viscus is the most fitting diagnosis among the choices provided. - This option is incorrect as there is a highly probable diagnosis among the given choices.

Question 1

What is the best management for a human bite?

Accepted Answer

Ampicillin plus sulbactam

Answer

Clindamycin plus TMP-SMX

Answer

Fluoroquinolone

Answer

Doxycycline

Question 2

A high-riding prostate is indicative of which injury?

Accepted Answer

Membranous Urethral Injury

Answer

Extraperitoneal Bladder rupture

Answer

Intraperitoneal Bladder Rupture

Answer

Bulbar Urethral Injury

Question 3

Under what guidelines is treatment started for a patient presenting with appendicular mass on a CT scan?

Accepted Answer

Ochsner Sherren Regimen

Answer

Conservative management and discharge

Answer

Kocher's Regimen

Answer

Immediate Laparotomy

Question 4

Supraomohyoid dissection is a type of?

Accepted Answer

Selective neck dissection

Answer

Modified radical neck dissection

Answer

Radical neck dissection

Answer

Posterolateral dissection

Question 5

Treatment of choice for mucinous carcinoma of the gall bladder in the early stage is -

Accepted Answer

Simple cholecystectomy

Answer

Extended cholecystectomy

Answer

Cholecystectomy with wedge resection of liver

Answer

Chemotherapy only

Question 6

A 55 year old woman presented with history of recurrent episodes of right upper abdominal pain for the last one year. She presented to emergency with history of jaundice and fever for 2 days. On examination, the patient appeared toxic and had a blood pressure of 100/60 mmHg. She was started on intravenous antibiotics. Ultrasound of the abdomen showed presence of stones in the common bile duct. What would be the best treatment option for her -

Accepted Answer

Endoscopic Retrograde Cholangiopancreatography (ERCP) and bile duct stone extraction

Answer

Open bile duct surgery for stone removal

Answer

Lithotripsy for bile duct stones

Answer

Laparoscopic cholecystectomy (gallbladder removal)

Question 7

In which of the following surgeries is monopolar cautery preferred over bipolar cautery?

Accepted Answer

Surgery of the Hip

Answer

Surgery around Penis

Answer

Hand Surgery

Answer

Surgery around the face

Question 8

Reactionary Hemorrhage occurs due to?

Accepted Answer

Dislodgement of clot

Answer

Infection

Answer

Damage to a blood vessel

Answer

Pressure necrosis

Question 9

An Incisional wound heals by

Accepted Answer

Primary Healing

Answer

Secondary Healing

Answer

Epithelialization

Answer

Delayed primary Healing

Question 10

A patient presents with abdominal pain. On physical examination there was abdominal guarding and tenderness. A plain erect chest X-ray reveals air under diaphragm. Probable diagnosis is

Accepted Answer

Perforated abdominal viscus

Answer

Acute myocardial infarction

Answer

Aortic dissection

Answer

None of the options

NEET-PG 2015 — Surgery