NEET-PG 2020 - Surgery PYQs Practice Questions

Q: What is the appropriate management for a male patient who presents to the hospital with abdominal pain from cholecystitis and is incidentally detected with an asymptomatic abdominal aortic aneurysm?

Monitor till size reaches 55 mm. ***Monitor till size reaches 55 mm*** - For **asymptomatic abdominal aortic aneurysms (AAAs)** in male patients, elective repair is generally recommended when the aneurysm reaches 5.5 cm (55 mm) in diameter. - This size balances the risk of rupture against the risks associated with surgery. *Immediate surgery* - Immediate surgery is reserved for patients with a **symptomatic** or **ruptured AAA**, indicated by severe abdominal pain, hypotension, and a pulsatile mass. - An incidentally detected, asymptomatic AAA typically does not warrant emergency surgical intervention. *Monitor till size reaches 45 mm* - A 45 mm aneurysm in a male patient is typically managed with **regular surveillance** rather than immediate intervention. - The risk of rupture at this size is generally considered low enough to avoid the risks of elective surgery. *USG monitoring till size of the aneurysm reaches 70 mm* - Monitoring an AAA until it reaches 70 mm (7 cm) is **not safe practice** due to a significantly increased risk of rupture as the aneurysm grows beyond 5.5 cm. - Guidelines recommend intervention at 5.5 cm to prevent life-threatening rupture. [Practice more Surgery PYQs on OnCourse]

Q: A person reports 4 hours after having a clean wound without laceration. He had taken TT 10 years before. The next step in management is:

Single-dose TT. ***Single-dose TT*** - For a **clean wound** when the last **tetanus toxoid (TT)** was given **10 years ago**, a **booster dose** is indicated as the protective immunity duration is **10 years**. - **TT provides immunity for 10 years** for clean wounds; at the 10-year mark, the protective window has elapsed and requires a booster. *No need for any vaccine* - This would be correct only if the last TT dose was given **<10 years ago** (within the protective window). - At exactly **10 years**, the immunity has waned and a **booster is required** for continued protection against tetanus. *Full course Tetanus vaccine to be given* - A **complete primary series (3 doses)** is only indicated for patients who are **unimmunized** or have **unknown vaccination history**. - This patient has documented **prior TT immunization**, so only a **single booster dose** is needed, not a full course. *Full dose TT with TIG* - **Tetanus Immunoglobulin (TIG)** is reserved for **high-risk scenarios**: tetanus-prone wounds in patients with **inadequate immunization** (<3 doses) or **unknown vaccination status**. - For a **clean wound** with documented prior immunization, **TIG is unnecessary** and represents over-treatment. [Practice more Surgery PYQs on OnCourse]

Q: In a patient with parathyroid adenoma, how do we confirm the removal of the correct gland after surgery?

50% reduction in PTH after 10 minutes. ***50% reduction in PTH after 10 minutes*** - Intraoperative **PTH monitoring** is crucial for confirming complete removal of hyperfunctioning parathyroid tissue during parathyroidectomy. - A successful surgery is indicated by a **≥50% drop** in PTH levels from the baseline (pre-excision) or highest post-excision level within **10 minutes** of gland removal. *25% reduction in PTH after 10 minutes* - A **25% reduction** in PTH after 10 minutes is generally considered **insufficient** to confirm successful removal of the hyperfunctioning gland. - This level of reduction may suggest incomplete removal or the presence of additional hypersecreting tissue. *25% reduction in PTH after 5 minutes* - While an initial drop may be observed, a **25% reduction after only 5 minutes** without further significant decline by 10 minutes is often not indicative of successful surgery. - The standard MIBI-scan-guided protocol or the Miami criteria require a more substantial and sustained drop. *50% reduction in PTH after 5 minutes* - A rapid and significant **50% reduction after 5 minutes** of excision is a good sign but the gold standard for intraoperative PTH monitoring typically requires the **10-minute post-excision** sample to confirm the sustained drop. - The **Miami Criteria**, a widely accepted protocol, uses the 10-minute post-excision time point as a critical determinant. [Practice more Surgery PYQs on OnCourse]

Q: Which of the following is not a component of the Thoracoscore?

Expected complications post-surgery. ***Expected complications post-surgery*** - While patient risk assessment tools aim to predict surgical outcomes, the **Thoracoscore** specifically calculates risk based on present patient characteristics and surgical plan, not based on a list of expected complications. - Expected complications are a *result* of the risk score, not an input into its calculation. *ASA classifications* - The **American Society of Anesthesiologists (ASA) Physical Status Classification System** is a crucial component of the Thoracoscore, reflecting the patient's overall health status and comorbidity burden. - A higher ASA classification indicates greater surgical risk and contributes to the Thoracoscore calculation. *Surgery priorities* - **Surgery priority** (e.g., elective, urgent, emergency) is an important factor in the Thoracoscore, as urgent or emergent surgeries are associated with higher risk. - This parameter helps categorize the immediacy and complexity of the surgical intervention. *Performance status* - The patient's **performance status**, often assessed using scales like the Eastern Cooperative Oncology Group (ECOG) or Karnofsky, is a significant predictor of surgical outcome and is included in the Thoracoscore. - A lower performance status (indicating poorer functional capacity) increases the calculated surgical risk. [Practice more Surgery PYQs on OnCourse]

Question 1

What is the appropriate management for a male patient who presents to the hospital with abdominal pain from cholecystitis and is incidentally detected with an asymptomatic abdominal aortic aneurysm?

Accepted Answer

Monitor till size reaches 55 mm

Answer

Immediate surgery

Answer

Monitor till size reaches 45 mm

Answer

USG monitoring till size of the aneurysm reaches 70 mm

Question 2

A person reports 4 hours after having a clean wound without laceration. He had taken TT 10 years before. The next step in management is:

Accepted Answer

Single-dose TT

Answer

No need for any vaccine

Answer

Full course Tetanus vaccine to be given

Answer

Full dose TT with TIG

Question 3

A 68-year-old asymptomatic male is found to have an abdominal aortic aneurysm (AAA) measuring 4.5 cm on routine ultrasound screening. What is the most appropriate management?

Accepted Answer

Monitor regularly and consider surgery if size reaches 55mm or symptomatic

Answer

Ultrasound monitoring until size exceeds 70mm

Answer

No treatment unless symptomatic

Answer

Immediate surgical repair for all diagnosed aneurysms regardless of size

Question 4

In a patient with parathyroid adenoma, how do we confirm the removal of the correct gland after surgery?

Accepted Answer

50% reduction in PTH after 10 minutes

Answer

25% reduction in PTH after 10 minutes

Answer

25% reduction in PTH after 5 minutes

Answer

50% reduction in PTH after 5 minutes

Question 5

Which of the following is not a component of the Thoracoscore?

Accepted Answer

Expected complications post-surgery

Answer

Surgery priorities

Answer

ASA classifications

Answer

Performance status

Question 6

A middle-aged man presents with a swelling in the neck that has been present since childhood. The swelling has a bag or worm-like appearance and features a central black spot. Based on this description, what is the most likely diagnosis?

Accepted Answer

Plexiform neurofibroma

Answer

Cirsoid aneurysm

Answer

Varicocele

Answer

Lymphangioma

Question 7

Which flap is commonly used in breast reconstruction?

Accepted Answer

DIEP based on deep inferior epigastric perforator vessels

Answer

Gluteal flap based on superior gluteal artery

Answer

Latissimus dorsi flap based on thoracodorsal artery

Answer

TRAM based on transverse rectus abdominis muscle

Question 8

A pregnant female had meconium-stained liquor and underwent emergency LSCS. A few days later, her condition deteriorated, and an ultrasound showed edematous bowels. What is the most likely cause of her condition?

Accepted Answer

Paralytic ileus

Answer

Adhesive intestinal obstruction

Answer

Intra-abdominal abscess

Answer

Intestinal perforation

Question 9

Which statement about retrosternal goiter is correct?

Accepted Answer

CT chest is recommended for evaluation of retrosternal goiter.

Answer

Surgery should be avoided in all cases.

Answer

All patients require surgical intervention.

Answer

Blood supply primarily comes from the thyroid arteries.

Question 10

A patient after a heavy meal and episode of forceful vomiting presents with severe epigastric pain. On examination, there is tenderness and rigidity in the upper abdomen. X-ray shows pneumomediastinum. What is the most likely cause?

Accepted Answer

Spontaneous rupture of the esophagus

Answer

Penetrating injury to the esophagus

Answer

Perforation of a peptic ulcer

Answer

Rupture of an emphysematous bulla

NEET-PG 2020 — Surgery