NEET-PG 2021 - Surgery PYQs Practice Questions

Q: A 35-year-old male presents with posterior epistaxis. Conservative management including nasal packing to stop the bleeding was unsuccessful. What is the next step in the management of this patient?

Endoscopic sphenopalatine artery ligation. ***Endoscopic sphenopalatine artery ligation*** - **Sphenopalatine artery ligation** is the most common surgical intervention for **posterior epistaxis** that is refractory to conservative management (e.g., nasal packing). - It is highly effective because the sphenopalatine artery is the major blood supply to the **posterior nasal cavity**. *Internal carotid artery (ICA) ligation* - **ICA ligation** is rarely performed for epistaxis due to the risk of **neurological complications**, such as stroke. - The ICA primarily supplies the brain, and its contribution to nasal bleeding is indirect and not typically the primary source. *Maxillary artery ligation* - The **maxillary artery** is the parent artery of the sphenopalatine artery, but ligating it more proximally carries a higher risk of complications and is less precise. - Due to the deep anatomical location, this approach is more invasive and technically challenging than sphenopalatine artery ligation. *External carotid artery (ECA) ligation* - **ECA ligation** is a more proximal and less selective procedure than sphenopalatine artery ligation, meaning other vessels may be ligated unnecessarily. - While it can reduce blood flow, it may not be as effective as direct sphenopalatine artery ligation for controlling severe posterior epistaxis, as collateral blood flow can still occur. [Practice more Surgery PYQs on OnCourse]

Q: Which of the following is a common topical use of the medicine shown in the image?

Post-adenoidectomy to control bleeding. ***Post-adenoidectomy to control bleeding*** - The image shows **Neo-Synephrine (phenylephrine)**, a potent **alpha-adrenergic agonist** that causes **vasoconstriction**. - Its vasoconstrictive properties make it useful topically to reduce **bleeding** during and after surgical procedures like **adenoidectomy**. *Rhino cerebral mucormycosis* - This is a serious fungal infection requiring systemic antifungal therapy, often **amphotericin B**. Topical phenylephrine has no role in treating the infection itself. - While bleeding might be a symptom of mucormycosis, phenylephrine would only offer temporary symptomatic relief, not address the underlying fungal pathology. *Inlay type I myringoplasty* - Myringoplasty is a surgical procedure to repair a perforated eardrum. Topical phenylephrine is not indicated for this procedure. - The primary goal of this surgery is to reconstruct the **tympanic membrane**, and phenylephrine would not contribute to tissue healing or graft integration. *Subglottic stenosis* - This condition involves narrowing of the airway below the vocal cords, often requiring surgical intervention or corticosteroids. - Phenylephrine is a decongestant and vasoconstrictor, and as such, it does not have a therapeutic role in resolving the **fibrotic narrowing** characteristic of subglottic stenosis. [Practice more Surgery PYQs on OnCourse]

Q: A child who underwent a tonsillectomy started bleeding while lying in the ward post-operatively. Which of the following is the most appropriate management step?

Take to OT, remove the clot & re-ligation. ***Take to OT, remove the clot & re-ligation*** - **Post-tonsillectomy bleeding** is a surgical emergency requiring immediate intervention to prevent airway compromise and significant blood loss. - The most definitive management involves returning to the **operating theatre** for direct visualization, removal of any obstructing clots, and **re-ligation** of the bleeding vessel. *Conservative management* - **Conservative management** is generally insufficient for significant post-tonsillectomy bleeding, as it does not address the source of hemorrhage and can lead to severe complications. - While minor oozing might be observed, active bleeding often indicates a larger vessel injury that requires **surgical hemostasis**. *Take to OT & pressure packing* - While **pressure packing** can temporarily slow bleeding, it is not a definitive long-term solution as it does not directly identify and treat the bleeding vessel. - Furthermore, pharyngeal packing in a child carries a risk of **airway obstruction** and aspiration, making it less suitable than direct re-ligation. *Cautery* - **Cautery** is a method of hemostasis, but it is typically performed in the operating theatre under direct vision, often after clot removal. - It is not a stand-alone initial management step in the ward for active bleeding without proper surgical assessment and preparation. [Practice more Surgery PYQs on OnCourse]

Q: What surgery is shown here in the image?

Thiersch wiring. ***Thiersch wiring*** - The image clearly depicts a **suture or wire** placed circumferentially around the anus to reduce its caliber, which is the hallmark of a **Thiersch procedure**. - This technique is used to treat **anal incontinence** by constricting the anal opening and improving sphincter function. *Hemorrhoidectomy* - This procedure involves the **surgical removal of hemorrhoids** and the images do not show any identifiable hemorrhoidal tissue being excised. - While bleeding and prolapse can be associated with hemorrhoids, the depicted technique with circumferential wiring is not used for their removal. *Altemeier operation* - The Altemeier operation is a type of **perineal rectosigmoidectomy** for rectal prolapse that involves resecting the prolapsed segment of the rectum. - The image does not illustrate resection of rectal tissue; instead, it shows a constricting device around the anus. *Wells procedure* - The Wells procedure, or **rectopexy**, involves anchoring the rectum to the sacrum to correct rectal prolapse. - This procedure typically involves an abdominal approach and fixation techniques, which are not represented in the illustration. [Practice more Surgery PYQs on OnCourse]

Q: A patient presents with upper limb swelling after undergoing a modified radical mastectomy (MRM). What is the most likely cause?

Upper limb Lymphedema. ***Upper limb Lymphedema*** - **Lymphedema** is a common complication after **modified radical mastectomy (MRM)** due to the removal of axillary lymph nodes and subsequent disruption of lymphatic drainage pathways. - This disruption leads to an accumulation of lymphatic fluid in the interstitial tissues, causing **swelling** in the ipsilateral upper limb. *Angiosarcoma* - **Angiosarcoma** (Stewart-Treves syndrome) is a very rare, aggressive tumor that can occur in the chronic lymphedematous limb after mastectomy. - It presents as multiple **violaceous nodules or plaques** in the affected limb, which is not described as the initial finding. *Recurrence* - **Recurrence** of breast cancer in the axilla or chest wall could cause swelling, but it would typically involve a palpable mass, skin changes, or pain, which are not mentioned as the primary symptom. - While recurrence can lead to lymphatic obstruction, **lymphedema** is a more direct and common post-operative complication. *Metastasis* - **Metastasis** to the axillary or supraclavicular lymph nodes could cause lymphatic obstruction and swelling. - However, lymphedema from direct surgical disruption of lymphatics is a more immediate and common cause of upper limb swelling following MRM, especially without other signs of widespread disease. [Practice more Surgery PYQs on OnCourse]

Question 1

A 35-year-old male presents with posterior epistaxis. Conservative management including nasal packing to stop the bleeding was unsuccessful. What is the next step in the management of this patient?

Accepted Answer

Endoscopic sphenopalatine artery ligation

Answer

Internal carotid artery (ICA) ligation

Answer

Maxillary artery ligation

Answer

External carotid artery (ECA) ligation

Question 2

Which of the following is a common topical use of the medicine shown in the image?

Accepted Answer

Post-adenoidectomy to control bleeding

Answer

Rhino cerebral mucormycosis

Answer

Inlay type I myringoplasty

Answer

Subglottic stenosis

Question 3

A child who underwent a tonsillectomy started bleeding while lying in the ward post-operatively. Which of the following is the most appropriate management step?

Accepted Answer

Take to OT, remove the clot & re-ligation

Answer

Conservative management

Answer

Take to OT & pressure packing

Answer

Cautery

Question 4

What surgery is shown here in the image?

Accepted Answer

Thiersch wiring

Answer

Hemorrhoidectomy

Answer

Altemeier operation

Answer

Wells procedure

Question 5

A patient presents with upper limb swelling after undergoing a modified radical mastectomy (MRM). What is the most likely cause?

Accepted Answer

Upper limb Lymphedema

Answer

Angiosarcoma

Answer

Recurrence

Answer

Metastasis

Question 6

Which of the following is the most commonly performed repair for a direct inguinal hernia?

Accepted Answer

Lichtenstein repair

Answer

Bassini's repair

Answer

Herniotomy

Answer

All of the options

Question 7

A patient presents with breathlessness and decreased air entry into the right lung following a road traffic accident (RTA) and is hypotensive. What is the next step in management?

Accepted Answer

Needle insertion at 2nd ICS in midclavicular line (MCL)

Answer

Wide bore needle decompression

Answer

Needle insertion at 5th ICS in mid-axillary line

Answer

Fluid resuscitation using wide bore cannula

Question 8

After a total thyroidectomy, the surgeon is unable to extubate the patient, who shows cyanosis and respiratory distress. What is the most likely cause of the inability to extubate?

Accepted Answer

Bilateral recurrent laryngeal nerve palsy

Answer

Unilateral recurrent laryngeal nerve palsy

Answer

Superior laryngeal nerve palsy

Answer

Hemorrhage

Question 9

Asymptomatic varicose veins would fall under which category of the CEAP classification system?

Accepted Answer

C2 (Varicose veins)

Answer

C1 (Telangiectasias or reticular veins)

Answer

C3 (Edema)

Answer

C4 (Skin changes)

Question 10

Which nerve is most commonly injured during submandibular gland surgery?

Accepted Answer

Marginal mandibular branch of facial nerve

Answer

Lingual nerve

Answer

Mylohyoid nerve

Answer

Hypoglossal nerve

NEET-PG 2021 — Surgery