NEET-PG 2012 - Surgery PYQs Practice Questions

Q: Indications for emergency thoracotomy are all of the following except:

Tension pneumothorax. ***Tension pneumothorax*** - While a life-threatening condition, a **tension pneumothorax** is initially managed with **needle decompression** or **chest tube insertion**, not an immediate emergency thoracotomy. - Emergency thoracotomy is reserved for situations requiring direct repair or control of massive bleeding that cannot be addressed by less invasive means. *Major tracheobronchial injuries* - These injuries can lead to severe **airway obstruction**, **massive air leak**, and **hemorrhage**, necessitating direct surgical repair via emergency thoracotomy. - Prompt surgical intervention is crucial to restore airway integrity and prevent life-threatening respiratory collapse. *Cardiac tamponade* - **Cardiac tamponade** can be caused by penetrating or blunt trauma, leading to circulatory collapse due to compression of the heart. - While initial management may involve pericardiocentesis, persistent or rapidly recurring tamponade, especially after trauma, often requires an **emergency thoracotomy** for direct repair of cardiac injury and evacuation of blood. *Penetrating injuries to anterior chest* - **Penetrating anterior chest injuries** carry a high risk of damage to vital structures such as the heart, great vessels, and major airways. - These injuries often result in rapid **hemodynamic instability**, severe hemorrhage, or cardiac arrest, making emergency thoracotomy essential for direct exploration and definitive repair. [Practice more Surgery PYQs on OnCourse]

Q: What is the appropriate treatment for an incidentally detected appendicular carcinoid tumor measuring 2.5 cm?

Right hemicolectomy. ***Right hemicolectomy*** - An appendiceal carcinoid tumor **larger than 2 cm** (or with **mesoappendix invasion, positive margins, or high-grade features**) warrants a right hemicolectomy due to a significantly higher risk of lymph node metastasis (20-30%). - This 2.5 cm tumor clearly exceeds the 2 cm threshold, making right hemicolectomy the standard of care. - This procedure ensures adequate oncological margins and removal of regional lymph nodes, which is crucial for complete treatment. *Limited resection of the right colon* - This option is insufficient for an appendiceal carcinoid of this size, as it may not remove all regional lymph nodes or provide adequate oncological margins. - Limited resection lacks the systematic lymphadenectomy required for tumors exceeding 2 cm. *Total colectomy* - This is an **overly aggressive** and unnecessary procedure for an isolated appendiceal carcinoid tumor, even one of this size. - Total colectomy is typically reserved for diffuse colonic involvement, multifocal tumors, or specific genetic syndromes, which is not indicated here. *Appendicectomy* - An appendicectomy alone is only appropriate for very small appendiceal carcinoid tumors, typically **less than 1 cm** in size, with negative margins and without evidence of mesoappendix invasion or aggressive features. - For a 2.5 cm tumor, the risk of regional lymph node involvement (20-30%) is too high for appendicectomy to be considered adequate oncological treatment. [Practice more Surgery PYQs on OnCourse]

Q: Which of the following is an acquired condition?

Mastitis. ***Mastitis*** - **Mastitis** is an **inflammatory condition** of the breast, often caused by bacterial infection, particularly common during **lactation** [1]. - It is an **acquired condition** as it develops after birth due to external or internal factors, not present at birth. *Polymastia (supernumerary breasts)* - **Polymastia** is a **congenital condition** where additional breast tissue develops along the **milk line**. - This condition is present at birth and results from *embryological development anomalies*, not acquired later in life. *Polythelia (extra nipples)* - **Polythelia** refers to the presence of **accessory nipples** along the embryonic milk line and is a **congenital anomaly**. - Like polymastia, it is present from birth due to *developmental errors* and is not an acquired condition. *Amastia (absence of breast tissue)* - **Amastia** is a rare **congenital anomaly** characterized by the complete absence of breast tissue, nipple, and areola. - It is a **birth defect**, meaning it is present from birth and not an acquired condition. [Practice more Surgery PYQs on OnCourse]

Q: IVC filter is used in the following situations except -

As primary treatment for acute DVT. ***As primary treatment for acute DVT*** - The **primary treatment** for **acute deep vein thrombosis (DVT)** is **anticoagulation therapy** (heparin, warfarin, or DOACs) to prevent clot propagation and embolization. - An **IVC filter** is **NOT primary therapy**—it is reserved for specific situations and does not treat the underlying thrombosis. - **Indications for IVC filter include:** - Absolute **contraindication to anticoagulation** (active bleeding, recent hemorrhagic stroke) - **Recurrent PE despite adequate anticoagulation** - Complications from anticoagulation therapy - Therefore, using IVC filter as primary treatment for acute DVT is **incorrect and not indicated**. *Negligible size of emboli* - While IVC filters trap **large emboli**, the concept of "negligible size emboli" is not a standard clinical consideration for filter placement. - IVC filters are indicated based on **risk of PE** and **contraindications to anticoagulation**, not based on emboli size assessment. *To reduce symptoms* - **IVC filters** do not reduce symptoms of DVT such as pain, swelling, or discomfort. - They function as a **mechanical barrier** to prevent emboli from reaching pulmonary circulation. - Symptom management requires anticoagulation, compression therapy, and leg elevation. *To prevent progress of native blood vessel disease* - IVC filters do not influence progression of underlying **vascular disease** such as atherosclerosis or chronic venous insufficiency. - Their sole function is **mechanical prevention of PE**, not disease modification. [Practice more Surgery PYQs on OnCourse]

Q: What is the most common site of gastrointestinal stromal tumors (GISTs)?

Stomach. Stomach - The stomach is the most common site for gastrointestinal stromal tumors (GISTs), accounting for approximately 60-70% of cases. - GISTs in the stomach often present with symptoms like abdominal pain or bleeding and are associated with mutations in the KIT gene. Ileum - Although GISTs can occur in the ileum, they are far less common than those found in the stomach, representing about 10-15% of cases [1]. - GISTs in the ileum tend to present differently, often with intestinal obstruction or pain [1]. Esophagus - Esophageal GISTs are rare and account for only about 5% of GIST cases, making them an uncommon location. - Symptoms are usually related to dysphagia or chest pain, not typical for GISTs arising from more common sites. Colon - Although GISTs can occur in the colon, their frequency is much lower compared to the stomach and represents a small percentage of cases. - Clinical features in colonic GISTs can mimic other colorectal tumors, often causing obstruction or bleeding rather than classic GIST symptoms. [Practice more Surgery PYQs on OnCourse]

Question 1

Indications for emergency thoracotomy are all of the following except:

Accepted Answer

Tension pneumothorax

Answer

Cardiac tamponade

Answer

Major tracheobronchial injuries

Answer

Penetrating injuries to anterior chest

Question 2

What is the appropriate treatment for an incidentally detected appendicular carcinoid tumor measuring 2.5 cm?

Accepted Answer

Right hemicolectomy

Answer

Limited resection of the right colon

Answer

Total colectomy

Answer

Appendicectomy

Question 3

Which of the following is an acquired condition?

Accepted Answer

Mastitis

Answer

Polymastia (supernumerary breasts)

Answer

Polythelia (extra nipples)

Answer

Amastia (absence of breast tissue)

Question 4

IVC filter is used in the following situations except -

Accepted Answer

As primary treatment for acute DVT

Answer

To reduce symptoms

Answer

Negligible size of emboli

Answer

To prevent progress of native blood vessel disease

Question 5

What is the most common site of gastrointestinal stromal tumors (GISTs)?

Accepted Answer

Stomach

Answer

Ileum

Answer

Esophagus

Answer

Colon

Question 6

Which of the following statements about desmoid tumors is incorrect?

Accepted Answer

Highly radiosensitive

Answer

Show infiltrative growth pattern

Answer

Often seen below the umbilicus

Answer

More common in women

Question 7

All of the following are risk factors for carcinoma of the gallbladder, EXCEPT -

Accepted Answer

Oral contraceptives

Answer

Adenomatous gall bladder polyps

Answer

Choledochal cysts

Answer

Typhoid carriers

Question 8

What is the first aid treatment for acid contact with the skin?

Accepted Answer

Wash with copious amounts of water

Answer

Wash with strong alkali

Answer

Refer to higher centre

Answer

Wash with mild alkali agent

Question 9

Which of the following actions is NOT recommended when dealing with a patient who has been bitten by a snake?

Accepted Answer

Local incision

Answer

Reassurance

Answer

Immobilization of the affected limb

Answer

Clean with soap and water

Question 10

What is a felon or whitlow?

Accepted Answer

Terminal pulp space infection

Answer

Infection of the ulnar bursa

Answer

Infection of the radial bursa

Answer

Midpalmar space infection

NEET-PG 2012 — Surgery