Robotic Surgery — MCQs

10 questions

Stereotactic Radiosurgery is a form of –

Which of the following is not a component of damage control surgery?

The disadvantage of Marshall-Marchetti-Krantz procedure compared with other surgical alternatives for treatment of stress urinary incontinence includes

Which of the following is NOT a surgical landmark for parotid surgery?

Which of the following is the platinum-based chemotherapeutic agent used as first-line treatment for ovarian carcinoma?

Incision used in the endomeatal approach to the ear?

A 55-year-old male, known smoker, complains of calf pain while walking. He experiences calf pain while walking but can continue walking with effort. Which grade of claudication does this patient fall under?

Discectomy can be performed using:

What is the treatment for most cases of blunt trauma to the kidney?

Q10

Which hernia repair procedure is shown in the image? (Recent NEET Pattern 2016-17)

Robotic Surgery Indian Medical PG Practice Questions and MCQs

Question 1: Stereotactic Radiosurgery is a form of –

A. Radioiodine therapy
B. Cryosurgery
C. Robotic Surgery
D. Radiotherapy (Correct Answer)

Explanation: ***Radiotherapy*** - **Stereotactic radiosurgery** is a highly precise form of **radiotherapy** that delivers a single high dose or multiple fractionated high doses of radiation to a specific target area. - It uses focused **radiation beams** to treat tumors or other lesions, often as an alternative to conventional surgery, by causing damage to the DNA of target cells. *Radioiodine therapy* - **Radioiodine therapy** primarily uses **iodine-131** to treat thyroid conditions like hyperthyroidism or thyroid cancer. - This involves the patient ingesting a radioactive isotope, unlike the external radiation beams used in radiosurgery. *Cryo Surgery* - **Cryosurgery** involves the use of **extreme cold** to destroy abnormal tissues. - It is a physical method of tissue destruction and does not involve radiation. *Robotic Surgery* - **Robotic surgery** utilizes robotic systems to assist in performing surgical procedures, enhancing precision, and control for the surgeon. - This is a mode of performing traditional surgery and does not involve radiation as its primary therapeutic agent.

Question 2: Which of the following is not a component of damage control surgery?

A. Control of contamination
B. Control of hemorrhage
C. Definitive repair (Correct Answer)
D. Temporary closure

Explanation: ***Definitive repair*** - **Damage control surgery** is a staged approach for severely injured patients, prioritizing stabilization over complete repair. - **Definitive repair** is the goal of the final stage, after the patient's physiological status has improved, not an initial component. *Control of contamination* - This is a crucial early step in damage control surgery to prevent **sepsis** and further physiological deterioration. - It involves measures like **bowel repair** or diversion, and thorough abdominal lavage. *Control of hemorrhage* - This is the **primary immediate goal** of damage control surgery, often achieved through packing or temporary shunts. - Uncontrolled bleeding leads to the **lethal triad** of coagulopathy, hypothermia, and acidosis. *Temporary closure* - After addressing immediate life-threatening issues, the abdomen or other body cavity is temporarily closed to prevent **abdominal compartment syndrome**. - This allows time for patient resuscitation and correction of physiological derangements before definitive repair.

Question 3: The disadvantage of Marshall-Marchetti-Krantz procedure compared with other surgical alternatives for treatment of stress urinary incontinence includes

A. Increased incidence of urinary tract infections
B. Urinary retention
C. High failure rate
D. Osteitis pubis (Correct Answer)

Explanation: ***Osteitis pubis*** - **Osteitis pubis** is a known, though rare, complication specifically associated with the Marshall-Marchetti-Krantz (MMK) procedure due to the sutures placed in the periosteum of the pubic symphysis, leading to inflammation. - This complication presents as **groin pain** and tenderness over the symphysis pubis, and it is less common with modern sling procedures or colposuspension techniques. *Increased incidence of urinary tract infections* - While **urinary tract infections (UTIs)** can occur after any pelvic surgery, there is no evidence to suggest that the MMK procedure specifically carries a higher incidence compared to other stress urinary incontinence (SUI) surgeries. - Post-surgical catheterization and manipulation can increase UTI risk universally regardless of the specific surgical approach. *Urinary retention* - **Urinary retention** is a potential complication of many SUI surgeries, including MMK, due to over-correction or urethral obstruction. - However, newer procedures like mid-urethral slings have also been associated with significant rates of transient or persistent urinary retention, suggesting it's not a unique disadvantage of MMK. *High failure rate* - The **failure rate** of MMK, while debated and variable across studies, is generally comparable to or sometimes better than some older SUI procedures. - Modern tension-free vaginal tape (TVT) and other sling procedures have often superseded MMK due to less invasiveness or similar efficacy, not necessarily a universally higher failure rate of MMK.

Question 4: Which of the following is NOT a surgical landmark for parotid surgery?

A. Tragal pointer
B. Digastric posterior belly
C. Inferior belly of omohyoid (Correct Answer)
D. Stylomastoid foramen

Explanation: ***Inferior belly of omohyoid*** - The **inferior belly of the omohyoid** muscle is located in the anterior triangle of the neck and is not anatomically relevant to parotid gland surgery. - Its position is too medial and inferior to serve as a reliable landmark for the facial nerve or the parotid gland itself. *Tragal pointer* - The **tragal pointer** is a crucial and easily palpable landmark for locating the main trunk of the facial nerve during parotidectomy. - The facial nerve typically emerges approximately 1 cm deep and inferior to the tragal pointer. *Digastric posterior belly* - The **posterior belly of the digastric muscle** courses anteriorly and inferiorly to the entry point of the facial nerve into the parotid gland. - Following this muscle provides a reliable anatomical guide to identify the facial nerve, as the nerve often crosses superficial to it. *Stylomastoid foramen* - The **stylomastoid foramen** is the exit point of the facial nerve from the skull, located between the styloid and mastoid processes. - Identifying this foramen allows for direct localization of the facial nerve trunk as it emerges to enter the parotid gland.

Question 5: Which of the following is the platinum-based chemotherapeutic agent used as first-line treatment for ovarian carcinoma?

A. Cyclophosphamide
B. Methotrexate
C. Cisplatin (Correct Answer)
D. Dacarbazine

Explanation: ***Cisplatin*** - **Cisplatin** is a platinum-based chemotherapy drug that forms **DNA cross-links**, inhibiting DNA synthesis and leading to the death of rapidly dividing cells, making it highly effective against **ovarian carcinoma**. - It is a cornerstone of chemotherapy regimens for ovarian cancer, often used in combination with other agents such as paclitaxel. *Methotrexate* - **Methotrexate** is an **antimetabolite** that inhibits dihydrofolate reductase, thereby interfering with DNA synthesis. - While it is used in various cancers like leukemia, lymphoma, and some solid tumors (e.g., breast cancer, gestational trophoblastic disease), it is **not a primary recommended drug for ovarian carcinoma**. *Cyclophosphamide* - **Cyclophosphamide** is an **alkylating agent** that causes DNA damage, leading to cell death. - It is used in many cancers, including lymphoma, breast cancer, and some leukemias, but it is **not a first-line or primary agent for ovarian carcinoma** in contemporary treatment guidelines. *Dacarbazine* - **Dacarbazine** is an **alkylating agent** primarily used in the treatment of **malignant melanoma** and Hodgkin lymphoma. - It is **not indicated for the treatment of ovarian carcinoma**.

Question 6: Incision used in the endomeatal approach to the ear?

A. Rosen's incision (Correct Answer)
B. Wilde's incision
C. Lempert I incision
D. Lempert II incision

Explanation: ***Rosen's incision*** - **Rosen's incision** is a common incision used in the **endomeatal approach** to the ear, typically for procedures like **stapedectomy**. - It involves an incision in the **posterior meatal wall**, allowing excellent access to the middle ear structures. *Wilde's incision* - **Wilde's incision** is a **postauricular incision** used for draining subperiosteal abscesses associated with acute **mastoiditis**. - It is not used for an endomeatal approach to the middle ear. *Lempert I incision* - **Lempert I incision** (also known as a **Lempert flap**) is a **tympanomeatal flap** elevated for accessing the middle ear, often in tympanoplasty. - While it provides access to the middle ear, it's a flap rather than a distinct incision name like Rosen's for the overall approach. *Lempert II incision* - **Lempert II incision** generally refers to an extension of the **Lempert I flap**, used for wider exposure in more complex middle ear surgeries. - It is also a flap design rather than the primary incision name for the endomeatal approach.

Question 7: A 55-year-old male, known smoker, complains of calf pain while walking. He experiences calf pain while walking but can continue walking with effort. Which grade of claudication does this patient fall under?

A. Grade I (Mild claudication)
B. Grade II (Moderate claudication) (Correct Answer)
C. Grade III (Severe claudication)
D. Grade IV (Ischemic rest pain)

Explanation: ***Grade II (Moderate claudication)*** - **Grade II claudication** is characterized by **intermittent claudication** where the patient experiences pain while walking but can **continue walking with effort**. - This level of claudication reflects a moderate degree of peripheral arterial disease, where blood flow is sufficiently compromised to cause pain with exertion but not severe enough to force immediate cessation of activity. - The patient in this scenario can continue ambulation despite discomfort, which is the defining feature of this grade. *Grade I (Mild claudication)* - **Grade I claudication** involves discomfort or pain that the patient can **tolerate without significantly altering their gait or pace**. - In this stage, the pain is minimal, and the patient may perceive it as a dull ache or mild fatigue rather than true pain. - Walking can continue without significant effort or limitation. *Grade III (Severe claudication)* - **Grade III claudication** is marked by pain that is **severe enough to stop the patient from walking within a short distance** (typically less than 200 meters). - The pain forces the patient to rest and recover before they can resume walking. - This represents significant functional limitation in daily activities. *Grade IV (Ischemic rest pain)* - **Grade IV**, also known as **critical limb ischemia**, involves **pain even at rest**, especially in the feet or toes, often worsening at night when the limb is elevated. - This stage indicates severe arterial obstruction and is frequently associated with **ulcers, non-healing wounds, or gangrene**. - This represents advanced peripheral arterial disease requiring urgent intervention. **Note:** This grading system is a simplified clinical classification. The standard medical classifications for peripheral arterial disease are the **Fontaine classification** (Stages I-IV) and **Rutherford classification** (Categories 0-6).

Question 8: Discectomy can be performed using:

A. Open surgery
B. Microdiscectomy
C. Endoscopic approach
D. All of the options (Correct Answer)

Explanation: ***All of the options*** - **Discectomy** can be performed through various surgical approaches, including open surgery, minimally invasive techniques using a microscope, and endoscopic procedures. - The choice of method depends on factors such as the **location and size of the disc herniation**, patient anatomy, and surgeon’s preference and expertise. *Open surgery* - This involves a larger incision to directly visualize and access the spinal structures and remove the **herniated disc material**. - While effective, it typically involves more muscle dissection, leading to increased **postoperative pain** and a longer recovery time compared to minimally invasive approaches. *Microscope* - **Microdiscectomy** uses a surgical microscope to provide magnified visualization of the surgical field through a smaller incision. - This minimally invasive approach reduces tissue dissection, leading to less pain, smaller scars, and **faster recovery** than traditional open surgery. *Endoscope* - **Endoscopic discectomy** utilizes a small camera (endoscope) inserted through a tiny incision, allowing the surgeon to view the surgical area on a monitor. - This is a highly minimally invasive technique that typically results in even **less tissue damage** and a quicker return to normal activities compared to microdiscectomy.

Question 9: What is the treatment for most cases of blunt trauma to the kidney?

A. Conservative (Correct Answer)
B. Nephrectomy
C. Nephrotomy
D. Nephroplexy

Explanation: ***Conservative*** - The majority of kidney injuries resulting from **blunt trauma** are low-grade (Grades I-III) and can be successfully managed with **conservative (non-operative) methods**. - This typically involves bed rest, careful monitoring of vital signs and urine output, hydration, and serial imaging to ensure stability and healing of the kidney. *Nephrectomy* - **Nephrectomy** (surgical removal of the kidney) is generally reserved for severe, high-grade kidney injuries (Grades IV-V) that are life-threatening or cannot be controlled by other means. - Indications include uncontrollable hemorrhage, extensive renal parenchymal destruction, or a non-viable kidney. *Nephrotomy* - **Nephrotomy** is an incision into the kidney, often performed for stone removal or to drain an abscess, but it is not a primary treatment for blunt traumatic kidney injury. - While surgical repair (nephrorrhaphy) may sometimes be indicated for high-grade injuries to preserve the kidney, a simple nephrotomy is not the standard approach. *Nephroplexy* - **Nephroplexy** is a surgical procedure to fix a prolapsed or "floating" kidney (nephroptosis), which is an entirely different condition from traumatic injury. - This procedure aims to secure the kidney in its normal anatomical position and is not indicated for kidney trauma.

Question 10: Which hernia repair procedure is shown in the image? (Recent NEET Pattern 2016-17)

A. Lichtenstein repair (Correct Answer)
B. Bassini herniorrhaphy
C. Shouldice repair
D. Lord's procedure

Explanation: ***Lichtenstein repair*** - The image clearly displays a **mesh patch** being used to reinforce the posterior wall of the inguinal canal, which is the hallmark of a **tension-free Lichtenstein repair**. - This technique is widely considered the **gold standard** for **inguinal hernia repair** due to its low recurrence rates and reduced postoperative pain. *Bassini herniorrhaphy* - **Bassini's repair** is a **tissue-based repair** that involves suturing the conjoined tendon and transversalis fascia to the inguinal ligament. - This method does **not use mesh** and is associated with higher tension and recurrence rates compared to mesh-based repairs. *Shouldice repair* - The **Shouldice repair** is another **tissue-based repair** from Canada, renowned for its strong, multilayered closure of the posterior wall of the inguinal canal. - It involves **four layers of suture repair** of the transversalis fascia and conjoined tendon, without the use of synthetic mesh as seen in the image. *Lord's procedure* - **Lord's procedure** is a historical method for **inguinal hernia repair** that primarily involved placing a small, tightly rolled mesh plug into the internal ring. - It is **not commonly used today** and does not involve the broad, flat mesh placement depicted in the image to reinforce the entire posterior wall.

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