NEET-PG 2020 - Surgery Practice Questions

Q: A middle-aged man presented with a swelling over the neck since childhood. The swelling is irregular and involves large nerves and their branches. Most probable diagnosis is:

Plexiform neurofibroma. ***Plexiform neurofibroma*** - This condition presents as an **irregular swelling** evident since childhood, which is characteristic of the slow growth associated with **plexiform neurofibromas**. - Its involvement of **large nerves and their branches** is a hallmark feature, distinguishing it from other neck masses. *Toxic nodular goitre* - This would present primarily as a **thyroid swelling** and is typically associated with symptoms of **hyperthyroidism**, which are not mentioned. - It does not involve **peripheral nerves** in the manner described. *Lymphangioma* - Lymphangiomas are **benign lymphatic malformations** that typically present as soft, compressible masses. - While they can occur in the neck and be present from childhood, they do not specifically involve or originate from **nerve branches**. *Vasculitis* - Vasculitis is an **inflammation of blood vessels**, which can cause a variety of symptoms including pain, skin lesions, and organ dysfunction. - It does not present as a localized, irregular neck swelling involving **nerve branches** with a history since childhood.

Q: Management of RCC less than 4 cm in size:

Partial nephrectomy. ***Correct: Partial nephrectomy*** - For **renal cell carcinoma (RCC) less than 4 cm (T1a)**, partial nephrectomy is the **gold standard** as it offers equivalent oncological outcomes to radical nephrectomy while preserving renal function. - This approach minimizes the risk of **chronic kidney disease** and its associated complications without compromising cancer control for appropriately selected smaller tumors. - **Nephron-sparing surgery** is now the preferred approach per EAU and AUA guidelines for small renal masses. *Incorrect: Surgery followed by chemotherapy* - While surgery is the primary treatment, **adjuvant chemotherapy** is generally **not effective** for localized RCC and is not routinely recommended for small tumors. - Systemic therapies are typically reserved for **advanced or metastatic RCC**, or in specific clinical trials. *Incorrect: Radical nephrectomy* - This involves removing the entire kidney, which is typically reserved for **larger tumors (T1b and above)**, centrally located tumors, or those with significant renal parenchymal involvement. - For tumors under 4 cm, radical nephrectomy leads to **unnecessary loss of renal function** compared to partial nephrectomy. *Incorrect: Chemotherapy* - **RCC is notoriously chemoresistant**, meaning traditional chemotherapy drugs have very limited efficacy in treating this cancer. - Chemotherapy alone is **not a primary treatment modality** for localized RCC due to its poor response rates in this cancer type.

Q: In the primary survey, which of the following is not included?

CECT to look for bleeding. ***CECT to look for bleeding*** - A **CECT scan** is a detailed imaging study that is performed during the **secondary survey**, not during the primary survey. - The primary survey focuses on the immediate **ABCDE assessment** (Airway, Breathing, Circulation, Disability, Exposure) to identify and treat immediately life-threatening conditions. - While identifying bleeding is critical, detailed imaging like CECT is done only after initial stabilization is achieved in the primary survey. *ABC* - **Airway, Breathing, and Circulation (ABC)** are the fundamental first three components of the primary survey. - These represent the immediate priorities for life support in trauma management according to ATLS guidelines. - Ensuring a patent airway, adequate breathing, and circulatory stability are critical first steps. *Exposure of the whole body* - **Exposure** (the "E" in ABCDE) is an essential part of the primary survey. - Complete exposure allows full assessment for injuries and prevents missing critical external wounds. - This step also involves maintaining **thermoregulation** to prevent hypothermia. *Recording BP* - **Recording blood pressure** is a crucial part of assessing circulation (the "C") during the primary survey. - It helps quickly evaluate hemodynamic status and identify potential signs of shock or internal bleeding. - Vital signs monitoring is integral to the initial trauma assessment.

Question 1

A middle-aged man presented with a swelling over the neck since childhood. The swelling is irregular and involves large nerves and their branches. Most probable diagnosis is:

Accepted Answer

Plexiform neurofibroma

Answer

Toxic nodular goitre

Answer

Lymphangioma

Answer

Vasculitis

Question 2

Management of RCC less than 4 cm in size:

Accepted Answer

Partial nephrectomy

Answer

Surgery followed by chemotherapy

Answer

Radical nephrectomy

Answer

Chemotherapy

Question 3

In the primary survey, which of the following is not included?

Accepted Answer

CECT to look for bleeding

Answer

ABC

Answer

Exposure of the whole body

Answer

Recording BP

NEET-PG 2020 — Surgery