NEET-PG 2015 - Surgery PYQs Practice Questions

Q: In case of polytrauma with multiple injuries to the chest, neck, and abdomen, what is the highest priority intervention?

Stabilization of the airway. ***Stabilization of the airway*** - Maintaining a **patent airway** is the absolute first priority in any trauma patient (following the **ABCDE approach**), as inadequate oxygenation and ventilation can rapidly lead to irreversible brain damage and death. - In a patient with injuries to the chest, neck, and abdomen, the airway is particularly vulnerable to compromise from direct trauma, swelling, or aspiration. *Vasopressors* - Vasopressors are used to support blood pressure in cases of **hypotensive shock**, but establishing adequate ventilation and oxygenation (airway, breathing) must precede circulatory support. - Administering vasopressors without a patent airway and efficient breathing will not be effective and can be detrimental. *Assessing disability* - Assessing disability (neurological status) is part of the **D** in the **ABCDE approach**, which comes after addressing airway, breathing, and circulation. - While important, it is not the highest priority intervention as an immediate threat to life takes precedence. *Stabilization of the cervical spine* - While crucial in trauma (especially with neck injuries) to prevent further neurological damage, **cervical spine stabilization** is often performed concurrently or immediately after airway assessment and control, under the **"A" for Airway with cervical spine protection** principle. - However, establishing a patent airway without moving the neck (if possible) still takes absolute priority over full stabilization, as a blocked airway is an immediate life threat. [Practice more Surgery PYQs on OnCourse]

Q: Which of the following statements is true about branchial cysts?

They mostly arise from the second branchial cleft.. ***They mostly arise from the second branchial cleft.*** - **Second branchial cleft cysts** are the most common type, accounting for approximately **95%** of all branchial anomalies. - They typically present as a smooth, fluctuant mass along the **anterior border of the sternocleidomastoid muscle** at the junction of the upper and middle third of the neck. - These cysts result from **incomplete obliteration** of the second branchial cleft during embryonic development. *Branchial cysts are more common in males than females.* - Branchial cysts have **no significant sex predilection**, affecting males and females with roughly equal frequency. - The overall incidence is relatively rare, with most cases presenting in late childhood or early adulthood. *Surgical intervention is not always necessary.* - **Complete surgical excision** is the **definitive treatment** and is strongly recommended for all branchial cysts. - Indications for surgery include: prevention of **recurrent infections**, risk of **abscess formation**, elimination of cosmetic concerns, and removal due to potential (though rare) **malignant transformation**. - While very small asymptomatic cysts may occasionally be observed, this carries significant risk of future complications, making surgery the standard of care in clinical practice. *They can cause dysphagia and hoarseness if infected.* - While an **infected branchial cyst** causes local inflammatory signs (pain, swelling, warmth, erythema), it **rarely causes dysphagia or hoarseness** unless exceptionally large. - These symptoms would require the cyst to compress the **pharynx** (dysphagia) or involve the **recurrent laryngeal nerve** (hoarseness), which is uncommon even with infection. - The primary presentation of infected cysts includes **tender neck mass** with overlying skin changes and possible **abscess formation**. [Practice more Surgery PYQs on OnCourse]

Q: Amount of blood loss in Stage I of hemorrhagic shock is -

<15%. ***<15%*** - Stage I (Class I) hemorrhagic shock is characterized by **minimal blood loss of up to 15%** of total blood volume (up to 750 mL in a 70 kg adult). - This is the **universally accepted ATLS definition** for Class I hemorrhage. - At this level, compensatory mechanisms maintain normal vital signs with minimal clinical manifestations. - Patients typically show minimal or no symptoms, with possible mild tachycardia only. * 100 bpm), tachypnea, and decreased pulse pressure, but blood pressure remains normal. - This is too broad to specifically define Stage I. * 120 bpm), altered mental status, and decreased urine output. - This is far beyond the compensated Stage I definition. [Practice more Surgery PYQs on OnCourse]

Q: Which solid organ is considered to have the lowest risk of rejection during transplantation?

Liver. ***Liver*** - The liver has a unique immunologic environment, often referred to as **immunologic privilege**, which contributes to its lower rates of rejection compared to other transplanted solid organs. - It produces various **immunosuppressive factors** and has a high capacity for regeneration and repair, adapting more readily to the recipient's immune system. - The liver's **dual blood supply** (hepatic artery and portal vein) and tolerogenic properties make it the most immunologically privileged solid organ. *Pancreas* - **Pancreas transplantation** carries a high risk of rejection, with rejection rates significantly higher than liver transplantation. - Pancreatic tissue is highly **immunogenic** due to its endocrine and exocrine functions, requiring aggressive immunosuppression. - Often transplanted with kidney in diabetic patients, and rejection episodes are common. *Kidney* - Kidney transplantation is common, but it carries a significant risk of both **acute and chronic rejection**, requiring lifelong immunosuppression. - The kidney expresses various **MHC antigens** that are readily recognized by the recipient's immune system, making it more immunogenic than the liver. *Heart* - **Heart transplantation** is associated with a high risk of rejection due to the rich vascularity and immunogenicity of cardiac tissue. - It often requires aggressive immunosuppressive regimens to prevent both **acute cellular rejection** and **antibody-mediated rejection**. [Practice more Surgery PYQs on OnCourse]

Q: Solution currently used for liver preservation for transplantation is?

University of Wisconsin (UW) solution. ***University of Wisconsin (UW) solution*** - The **University of Wisconsin (UW) solution** is widely considered the gold standard for **organ preservation**, particularly for liver transplantation, due to its superior ability to extend cold ischemia time. - It contains a unique blend of components, including **lactobionate, raffinose, and hydroxyethyl starch**, which help to minimize cellular swelling, prevent free radical injury, and maintain cellular integrity during cold storage. *IGL-1 solution* - **IGL-1** is a more recent preservation solution designed to be used with **machine perfusion** systems. - While showing promise, it is **not yet as universally adopted** as UW solution for static cold storage of livers. *Ross Marshall Citrate solution* - The **Ross Marshall Citrate solution** was an older solution primarily used for **kidney preservation**. - It has been largely **superseded by newer solutions** with improved efficacy for liver and other organ preservation. *Kyoto ET solution* - **Kyoto ET solution** is another preservation solution primarily used in **Japan**, particularly for **kidney and pancreas preservation**. - While effective for those organs, it is **not the most commonly used** or preferred solution for liver preservation globally. [Practice more Surgery PYQs on OnCourse]

Question 1

In case of polytrauma with multiple injuries to the chest, neck, and abdomen, what is the highest priority intervention?

Accepted Answer

Stabilization of the airway

Answer

Vasopressors

Answer

Assessing disability

Answer

Stabilization of the cervical spine

Question 2

Which of the following statements is true about branchial cysts?

Accepted Answer

They mostly arise from the second branchial cleft.

Answer

Branchial cysts are more common in males than females.

Answer

Surgical intervention is not always necessary.

Answer

They can cause dysphagia and hoarseness if infected.

Question 3

Amount of blood loss in Stage I of hemorrhagic shock is -

Accepted Answer

<15%

Answer

<10%

Answer

<30%

Answer

<40%

Question 4

Which solid organ is considered to have the lowest risk of rejection during transplantation?

Accepted Answer

Liver

Answer

Pancreas

Answer

Kidney

Answer

Heart

Question 5

Solution currently used for liver preservation for transplantation is?

Accepted Answer

University of Wisconsin (UW) solution

Answer

IGL-1 solution

Answer

Ross Marshall Citrate solution

Answer

Kyoto ET solution

Question 6

All of the following are indications for tracheostomy except ?

Accepted Answer

Superior laryngeal nerve palsy

Answer

Coma after head injury

Answer

Maxillofacial injury

Answer

Bilateral abductor palsy

Question 7

Which of the following cancers do not present with cervical lymph node involvement?

Accepted Answer

Glottic Cancer

Answer

Papillary thyroid cancer

Answer

Oral cancer

Answer

Subglottic Cancer

Question 8

Which of the following statements is MOST accurate regarding Zenker diverticulum?

Accepted Answer

It is a pulsion diverticulum

Answer

It is between superior and middle constrictor

Answer

It projects posteriorly

Answer

It is commonly seen in older adults

Question 9

A patient involved in an accident presents with unconsciousness. Upon physical examination, there is unilateral pupillary dilatation. What is the most likely cause of this finding?

Accepted Answer

Uncal herniation

Answer

Tonsillar herniation

Answer

Cingulate herniation

Answer

Transcalvarial herniation

Question 10

What is the best management for a human bite?

Accepted Answer

Ampicillin plus sulbactam

Answer

Clindamycin plus TMP-SMX

Answer

Fluoroquinolone

Answer

Doxycycline

NEET-PG 2015 — Surgery