NEET-PG 2024 - Surgery Practice Questions

Q: A patient presents with an umbilical mass, which was previously reducible but has now become irreducible with discharge coming out, as shown in the image. What is the most appropriate management?

Umbilical excision with mesh hernioplasty. ***Umbilical excision with mesh hernioplasty*** - The presence of an **irreducible umbilical mass with discharge** indicates a complicated umbilical hernia, likely with **incarceration, strangulation, or infection**. - Management requires **excision of compromised tissue** (umbilicus and surrounding necrotic/infected skin) followed by **hernia defect repair**. - **Mesh hernioplasty** provides strong, durable reinforcement and prevents recurrence. - **Note:** In heavily contaminated fields, primary tissue repair or biologic mesh may be preferred over synthetic mesh, or staged repair may be considered. However, if contamination is minimal after debridement, mesh repair can be performed in the same setting. *Umbilical excision* - While **excision of the compromised umbilical skin and necrotic tissue** is necessary due to the discharge (suggesting infection or necrosis), **excision alone does not address the underlying hernia defect**. - Simply excising the umbilicus without repairing the hernia would lead to **persistent hernia or recurrence**. *Mesh hernioplasty* - A mesh hernioplasty alone is appropriate for **uncomplicated, reducible umbilical hernias** to reinforce the abdominal wall. - However, it **does not account for the irreducibility and skin changes/discharge**, which necessitate **excision of potentially infected or necrotic tissue** first. - Placing mesh without addressing the compromised tissue would risk ongoing infection and mesh complications. *Conservative* - **Conservative management** is reserved for **asymptomatic, reducible umbilical hernias** in adults (especially if small) or for infants where spontaneous closure can occur. - An **irreducible mass with discharge** signifies an **acute surgical emergency** (incarceration, strangulation, or infection) requiring **urgent surgical intervention**, not observation.

Question 1

Which of the following procedures would be difficult to perform based on the given Chest X-ray?

Accepted Answer

Tracheostomy

Answer

Laryngeal mask airway insertion

Answer

Ryle's tube insertion

Answer

Intubation

Question 2

A patient presents with an umbilical mass, which was previously reducible but has now become irreducible with discharge coming out, as shown in the image. What is the most appropriate management?

Accepted Answer

Umbilical excision with mesh hernioplasty

Answer

Umbilical excision

Answer

Mesh hernioplasty

Answer

Conservative

NEET-PG 2024 — Surgery