NEET-PG 2024 - Surgery PYQs Practice Questions

Q: A hypertensive patient presents with excruciating chest pain and unequal radial pulses. Which of the following is the correct management for this patient?

Emergency surgical repair. ***Emergency surgical repair*** - The combination of **excruciating chest pain**, a history of **hypertension**, and **unequal radial pulses** is highly suggestive of an **acute aortic dissection**. - **Unequal radial pulses** indicate involvement of the **ascending aorta** (Type A dissection), affecting the brachiocephalic or subclavian arteries that branch proximally from the aortic arch. - **Type A aortic dissections**, involving the ascending aorta, are life-threatening emergencies requiring immediate **surgical repair** to prevent rupture, cardiac tamponade, aortic regurgitation, and organ malperfusion. *BP control and monitoring* - While **blood pressure control** is a crucial initial step in managing aortic dissection to reduce shear stress on the aorta and prevent propagation, it is insufficient as the primary treatment for an **ascending (Type A) aortic dissection**. - Continuous monitoring is necessary but cannot resolve a progressing dissection that poses an immediate threat to life. - Medical management alone is reserved for **uncomplicated Type B dissections**. *Stenting* - **Endovascular stenting** (thoracic endovascular aortic repair, TEVAR) is primarily used for **Type B aortic dissections** (involving the descending aorta) in stable patients or those with complicated features. - It is generally not the first-line treatment for **Type A dissections** due to the anatomical challenges and urgent need for surgical repair in this location. *Balloon dilatation* - **Balloon dilatation** or angioplasty is a procedure used to open narrowed arteries, typically in the context of atherosclerotic disease (e.g., coronary artery disease or peripheral artery disease). - It has no role in the management of an **aortic dissection**, which involves a tear in the aortic wall rather than a simple narrowing. [Practice more Surgery PYQs on OnCourse]

Q: A 78-year-old immobile patient presents with a pressure ulcer on the sacral area, as shown in the image below. How would you grade this bedsore?

Stage 4. *Stage 1* - A Stage 1 pressure ulcer is characterized by **non-blanchable erythema** of intact skin, typically over a bony prominence. - There is no break in the skin, which is not what is visible in the image. *Stage 2* - A Stage 2 pressure ulcer involves **partial-thickness skin loss** presenting as a shallow open ulcer with a red-pink wound bed, without slough or bruising. - The depth and tissue involvement shown in the image are far more extensive than a Stage 2 ulcer. *Stage 3* - A Stage 3 pressure ulcer involves **full-thickness tissue loss** where subcutaneous fat may be visible, but bone, tendon, or muscle are not exposed. - The visible structures in the image suggest involvement beyond the subcutaneous fat layer, distinguishing it from a Stage 3 ulcer. ***Stage 4*** - The image shows **full-thickness tissue loss** with visible **bone, tendon, or muscle**, indicating a Stage 4 pressure ulcer. - There is also evidence of **slough and eschar** in the wound bed, which is consistent with severe tissue damage extending beyond the subcutaneous fat. - This is the **correct answer** as the exposed deeper structures are pathognomonic for Stage 4. [Practice more Surgery PYQs on OnCourse]

Q: A 12-year-old child presents to the OPD with a complaint of scrotal pain and a history of trauma 6 hours ago. On surgical exploration, the following finding is observed. What is the most likely diagnosis?

Testicular torsion with gangrene. ***Testicular torsion with gangrene*** - The combination of **scrotal pain**, history of **trauma**, and the image showing a **dark, necrotic testicle** (implying gangrene) is highly indicative of testicular torsion that has progressed to tissue death due to prolonged ischemia. - Testicular torsion is an emergency where the **spermatic cord** twists, cutting off blood supply; after 6 hours, especially following trauma, the risk of non-viability and gangrene is very high. *Torsion of testicular appendages with gangrene* - While torsion of appendages (e.g., appendix testis) can cause acute scrotal pain, it typically results in a **"blue dot sign"** and is usually a **less severe condition** than testicular torsion. - It would not typically lead to the extensive necrotic appearance of the entire testicle as suggested by the scenario, and surgical exploration revealing gangrene usually points to the whole testis being affected. *Gangrene* - While gangrene is present, this option is **incomplete** as it does not specify the underlying cause, which is critical for diagnosis and treatment. - The context of acute scrotal pain and trauma points to a specific etiology, namely torsion. *Hematoma* - A hematoma would present as a **blood collection**, potentially causing swelling and discoloration, but usually **not the black, necrotic changes** indicative of gangrene from ischemia. - While trauma could cause a hematoma, the description of gangrene points to a more severe vascular compromise. [Practice more Surgery PYQs on OnCourse]

Q: The image shows a Negative Pressure Wound Therapy (NPWT) dressing applied to a patient's wound. What is the ideal negative pressure range commonly used for NPWT to promote wound healing?

-125 mm Hg. ***-125 mm Hg*** - **Negative Pressure Wound Therapy (NPWT)** uses controlled subatmospheric (negative) pressure to promote wound healing. - The most commonly used pressure setting is **-125 mm Hg**, which has been extensively validated in clinical studies. - This pressure level effectively promotes granulation tissue formation, reduces edema, removes exudate, and increases blood flow to the wound bed. - **-75 to -125 mm Hg** is the typical therapeutic range, with -125 mm Hg being the standard setting for most wound types. *60-80 mm Hg* - This represents **positive pressure**, not negative pressure used in NPWT. - NPWT requires subatmospheric (below atmospheric) pressure, denoted by the negative sign. - Positive pressures in this range would be used in compression therapy for venous insufficiency, not vacuum-assisted wound closure. *130 mm Hg* - This is a **positive pressure** value and does not apply to NPWT. - NPWT uses negative (suction) pressure, not positive compression. - If interpreted as -130 mm Hg, this would be at the higher end and might increase patient discomfort without additional benefit over -125 mm Hg. *80-100 mm Hg* - These are **positive pressure** values not used in NPWT. - NPWT specifically requires negative pressure (vacuum/suction) to work effectively. - This range would be excessively high even for compression therapy and inappropriate for NPWT. [Practice more Surgery PYQs on OnCourse]

Q: Which of these is the STRONGEST indication for giving adjuvant treatment in oral malignancy after resection and Modified Radical Neck Dissection (MRND)?

Extranodal extension. ***Extranodal extension*** - **Extranodal extension (ENE)** is the strongest adverse pathological feature (APF) indicating the highest risk of recurrence and significantly impacting prognosis. - ENE is associated with increased likelihood of regional and distant metastasis. - The presence of ENE mandates **adjuvant concurrent chemoradiotherapy** (not radiotherapy alone), as landmark trials (EORTC 22931, RTOG 9501) demonstrated survival benefit with combined modality treatment. - ENE and positive surgical margins are the two most critical features requiring intensified adjuvant therapy. *Multiple lymph node metastasis* - Multiple positive lymph nodes (≥2 nodes) indicate high risk of recurrence and warrant **adjuvant radiotherapy**. - While this is a significant adverse feature, it does not mandate chemoradiotherapy unless accompanied by ENE or positive margins. - Considered a high-risk feature but not as strong an indication as ENE. *T3 tumor* - T3 tumor indicates significant local invasion but is a clinical staging parameter, not a pathological adverse feature. - The decision for adjuvant therapy depends primarily on pathological findings (margins, lymph node status, ENE) rather than T-stage alone. - T3 status without adverse pathological features may not require adjuvant treatment after complete resection. *Close margin* - Close margin (tumor within 1-5 mm of resected edge) is a high-risk feature warranting **adjuvant radiotherapy** due to increased local recurrence risk. - However, it is less critical than ENE in terms of overall survival and regional control. - A **positive margin** (<1 mm or tumor at ink) would be equivalent to ENE as an indication for chemoradiotherapy, but a close margin typically requires radiotherapy alone. [Practice more Surgery PYQs on OnCourse]

Question 1

A hypertensive patient presents with excruciating chest pain and unequal radial pulses. Which of the following is the correct management for this patient?

Accepted Answer

Emergency surgical repair

Answer

BP control and monitoring

Answer

Stenting

Answer

Balloon dilatation

Question 2

A 78-year-old immobile patient presents with a pressure ulcer on the sacral area, as shown in the image below. How would you grade this bedsore?

Accepted Answer

Stage 4

Answer

Stage 1

Answer

Stage 2

Answer

Stage 3

Question 3

A 12-year-old child presents to the OPD with a complaint of scrotal pain and a history of trauma 6 hours ago. On surgical exploration, the following finding is observed. What is the most likely diagnosis?

Accepted Answer

Testicular torsion with gangrene

Answer

Torsion of testicular appendages with gangrene

Answer

Gangrene

Answer

Hematoma

Question 4

The image shows a Negative Pressure Wound Therapy (NPWT) dressing applied to a patient's wound. What is the ideal negative pressure range commonly used for NPWT to promote wound healing?

Accepted Answer

-125 mm Hg

Answer

60-80 mm Hg

Answer

130 mm Hg

Answer

80-100 mm Hg

Question 5

Which of these is the STRONGEST indication for giving adjuvant treatment in oral malignancy after resection and Modified Radical Neck Dissection (MRND)?

Accepted Answer

Extranodal extension

Answer

Multiple lymph node metastasis

Answer

T3 tumor

Answer

Close margin

Question 6

A patient presents to the OPD with a right-sided ulcerated breast lesion. Radiological imaging shows liver metastasis, as seen in the provided ultrasound image. What is the most appropriate management?

Accepted Answer

Neoadjuvant chemotherapy followed by surgery

Answer

Simple mastectomy

Answer

Modified Radical Mastectomy (MRM)

Answer

Radical mastectomy

Question 7

Identify the instrument shown in the image.

Accepted Answer

Ureteroscope

Answer

Nephroscope

Answer

Cystoscope

Answer

Laparoscope

Question 8

What type of graft or dressing is used to cover the post-burn wound shown in the image?

Accepted Answer

Split thickness skin graft

Answer

Full thickness skin graft

Answer

VAC dressing

Answer

Normal saline dressing

Question 9

A jeep driver presents with pain in the gluteal region along with swelling and pus discharge for the past 6 months. What is the most likely diagnosis?

Accepted Answer

Pilonidal sinus

Answer

Fistula in ano

Answer

Fissure in ano

Answer

Gluteal abscess

Question 10

A child presents to the OPD with the finding shown in the image. When should the first surgical repair be performed?

Accepted Answer

3 months

Answer

6 months

Answer

12 months

Answer

18 months

NEET-PG 2024 — Surgery