NEET-PG 2015 - Surgery Practice Questions

Q: Which of the following neck dissections is considered the most conservative?

Supraomohyoid neck dissection. ***Supraomohyoid neck dissection*** - This dissection is highly **selective**, removing only lymph nodes from **levels I, II, and III**, which are the most superficial and anterior groups in the neck. - It preserves the **internal jugular vein**, spinal accessory nerve, and sternocleidomastoid muscle, minimizing functional and cosmetic morbidity. *Radical neck dissection* - This is the **most extensive** neck dissection, involving the removal of all lymph node levels (I-V), the **internal jugular vein**, the **spinal accessory nerve**, and the **sternocleidomastoid muscle**. - It is reserved for advanced cancers with extensive nodal involvement due to its significant associated morbidity and functional deficits. *Modified radical neck dissection* - This dissection removes lymph nodes in levels I-V but **spares at least one non-lymphatic structure**, such as the spinal accessory nerve, internal jugular vein, or sternocleidomastoid muscle. - While less radical than a full radical neck dissection, it is still more extensive than a supraomohyoid dissection as it targets a broader range of lymph node levels. *All options are conservative.* - This statement is incorrect because **radical neck dissection** is by definition the most extensive and least conservative surgical approach to neck nodal disease. - The different types of neck dissections represent a spectrum of extensiveness, with supraomohyoid being the most selective and conservative.

Q: All of the following are surgical options in the management of esophageal carcinoma except -

Sistrunk operation. ***Sistrunk operation*** - The **Sistrunk operation** is a surgical procedure specifically designed for the removal of a **thyroglossal duct cyst**, not for esophageal carcinoma. - This procedure involves excising the cyst along with the central portion of the hyoid bone and the tract leading to the foramen cecum to prevent recurrence. *Ivor Lewis Approach* - The **Ivor Lewis approach** is a common and established surgical technique for **esophagectomy**, involving both abdominal and right thoracic incisions for tumor resection and reconstruction. - It is often used for tumors in the mid to distal esophagus. *Mckeown's Approach* - The **McKeown's approach** is another well-known surgical technique for **esophagectomy**, typically used for more proximal esophageal tumors. - This involves three incisions: abdominal, right thoracic, and cervical, allowing for extensive lymphadenectomy. *Transhiatal removal* - **Transhiatal esophagectomy** is a surgical option for esophageal cancer that involves abdominal and cervical incisions without a thoracic incision. - This approach is often favored in patients with significant comorbidities who may not tolerate a full thoracotomy.

Q: Which of the following is NOT a principle of negative pressure wound therapy?

Clearance of infection. ***Clearance of infection*** - While negative pressure wound therapy (NPWT) can help manage heavily colonized wounds by removing exudate and reducing bacterial burden, it is **not a primary treatment for active infection**. - **Systemic antibiotics** or local antiseptics are required to truly clear an infection, as NPWT alone cannot eliminate deep-seated pathogens. *Stabilization of wound environment* - NPWT helps to **stabilize the wound bed** by holding it in place, protecting it from external contamination and mechanical stress. - This creates an optimal environment for **wound healing** by preventing disruption of newly formed granulation tissue. *Macrodeformation of the wound* - The negative pressure applied to the wound surface causes the wound edges to be drawn together, leading to **macrodeformation**. - This effect reduces wound size and promotes **epithelialization** and **wound contraction**. *Decreased edema* - NPWT actively removes **excess interstitial fluid** and exudate from the wound bed, leading to a significant reduction in edema. - This reduction in swelling improves **perfusion** to the wound tissues and promotes better healing.

Q: A 25 year old male is receiving conservative management for an appendicular mass since 3 days now presents with a rising pulse rate, tachycardia and fever. The mode of management must be -

Proceed to laparotomy and appendicectomy. ***Proceed to laparotomy and appendicectomy*** - A **rising pulse rate, tachycardia, and fever** indicate **worsening sepsis** or **perforation** of the appendicular mass, necessitating urgent surgical intervention. - Continuing conservative management in the face of these signs carries a high risk of **morbidity and mortality** from peritonitis or widespread sepsis. *Continue Ochsner Sherren regimen with close monitoring* - The Ochsner Sherren regimen is a **conservative approach** for a stable appendicular mass, which is no longer the case with signs of deterioration. - **Clinical worsening** (tachycardia, rising fever, increased pulse) signifies failure of conservative management and requires a shift to surgical intervention. *Continue conservative management* - Continuing conservative management despite **signs of deterioration** (rising pulse, tachycardia, fever) would lead to further progression of the disease and potential life-threatening complications. - These symptoms suggest that the infection is **not contained** and is likely spreading, indicating the need for immediate surgical treatment. *Intravenous antibiotics* - While intravenous antibiotics are part of the initial conservative management, they are **insufficient** alone for an appendicular mass showing signs of deterioration. - The worsening clinical picture suggests a **failed antibiotic response** or a more severe underlying issue (e.g., abscess rupture) that requires surgical drainage or removal.

Q: A 65 year old male presents with CA prostate. The tumour is limited to the capsule and it is palpable on PR examination. The patient is diagnosed as stage T2a. What is the most appropriate treatment option?

Surgical removal of the prostate (Radical prostatectomy). ***Surgical removal of the prostate (Radical prostatectomy)*** - **Radical prostatectomy** is the **definitive treatment of choice** for **localized prostate cancer (T2a)** in patients with **good life expectancy (>10 years)**. - For a **65-year-old patient** with tumor confined to the prostate, **surgical removal offers excellent disease control** and potential cure. - This is the **preferred option** when the patient is **medically fit for surgery** and has adequate life expectancy. *External beam radiation therapy* - **External beam radiation therapy (EBRT)** is also an effective treatment for **localized T2a prostate cancer** with comparable long-term survival outcomes. - However, **radical prostatectomy is generally preferred** in younger, healthier patients as it: - Provides definitive pathological staging - Allows for immediate assessment of surgical margins - Preserves radiation as a salvage option if needed - EBRT is better suited for patients who are **not surgical candidates** due to comorbidities or patient preference. *Active surveillance* - **Active surveillance** is appropriate for **very low-risk prostate cancer** (T1c, PSA <10, Gleason ≤6). - For **T2a disease** (palpable tumor), the risk of progression is significant, making active surveillance **not the most appropriate first-line option**. - Would be considered only in patients with limited life expectancy or significant comorbidities. *Androgen deprivation therapy (ADT)* - **ADT** is used for **advanced, locally advanced, or metastatic prostate cancer** to reduce testosterone and slow tumor growth. - It is **not curative** and not appropriate as **monotherapy for localized T2a disease**. - May be used as adjuvant therapy with radiation in higher-risk cases, but not as primary treatment alone.

Q: All of the following may lead to gall bladder carcinoma except which of the following?

Echinococcus Granulosus Infection. ***Echinococcus Granulosus Infection*** - Echinococcus granulosus is primarily associated with **hydatid cyst formation**, not directly linked to gallbladder carcinoma. - This infection typically affects the **liver** rather than inducing malignant transformation in the gallbladder. *Typhoid carriers* - Chronic infection with **Salmonella typhi** in carriers can cause **gallbladder inflammation** and is a risk factor for gallbladder cancer. - Typhoid carriers retain the bacteria in the gallbladder, leading to chronic irritation and potentially malignant changes. *Gall Bladder Polyps* - Certain types of gallbladder polyps, especially those larger than **1 cm**, have a significant risk of undergoing malignant transformation. - They are associated with **chronic inflammation** and may progress to cancer if not monitored. *Exposure to carcinogens like nitrosamine* - Nitrosamines are known **carcinogens** that can induce protein modifications leading to DNA damage, contributing to gallbladder cancer. - Long-term exposure to such chemicals can result in **cellular mutations** in the gallbladder epithelial lining.

Q: All of the following are true about Nissen Fundoplication except which of the following?

Reinforcement is done only in the posterior half. ***Reinforcement is done only in the posterior half*** - This statement is incorrect because the **Nissen fundoplication** typically involves a **360-degree wrap** of the gastric fundus around the lower esophagus. - A 360-degree wrap provides complete reinforcement to prevent reflux, unlike a partial wrap which might be used in other procedures but not a standard Nissen. *It is done for GERD* - **Nissen fundoplication** is a common surgical procedure performed to treat severe **Gastroesophageal Reflux Disease (GERD)** that is refractory to medical management. - The procedure aims to strengthen the **lower esophageal sphincter (LES)** and prevent the reflux of stomach contents into the esophagus. *Upper part of stomach is plicated around the lower esophagus* - Specifically, the **fundus** (upper part) of the stomach is wrapped around the distal esophagus to create a functional valve. - This wrap helps to reinforce the LES and prevent stomach acid from flowing back up into the esophagus. *It is done for paraesophageal hiatus hernia* - **Nissen fundoplication** is often performed concurrently with the repair of a **hiatal hernia**, especially a **paraesophageal hernia**, to anchor the stomach in its correct anatomical position and prevent recurrence. - Repair of the hernia alone may not be sufficient to prevent reflux, making the fundoplication an important additional step.

Q: Where does spontaneous esophageal rupture (Boerhaave syndrome) most commonly occur?

Above the diaphragmatic aperture. ***Above the diaphragmatic aperture*** - Boerhaave syndrome, or spontaneous esophageal rupture, most commonly occurs in the **distal esophagus**, just above the diaphragmatic aperture. - This region is particularly susceptible due to increased **intraluminal pressure** during forceful vomiting, combined with a lack of muscular support and a thinner esophageal wall. - The rupture typically occurs in the **left posterolateral wall** of the lower third of the esophagus, approximately **2-5 cm above the gastroesophageal junction**. *Below the diaphragmatic aperture* - Ruptures below the diaphragmatic aperture are less common in Boerhaave syndrome, as the **lower esophageal sphincter** and surrounding diaphragmatic crura provide more support. - While other forms of esophageal injury can occur here, a spontaneous rupture due to vomiting is less typical in this location. *Pharyngoesophageal junction* - Ruptures at the pharyngoesophageal junction are known as **Zenker's diverticulum ruptures** or other types of perforation, typically not Boerhaave syndrome. - This area is prone to tears from instrumentation or foreign bodies but not usually from the extreme pressure of forceful vomiting (which affects the distal esophagus more). *At the crossing of the arch of aorta* - The mid-esophagus at the level of the aortic arch is not a common site for Boerhaave syndrome. - Although the esophagus is constricted here, the primary stress during forceful vomiting is concentrated in the **distal esophagus**.

Q: What is the treatment of choice in desmoid tumors?

Wide excision. ***Wide excision*** - For **desmoid tumors**, **complete surgical resection with clear margins** is the primary treatment of choice due to their infiltrative nature and high recurrence rates. - This approach aims to minimize local recurrence and prevent tumor progression, which can impact adjacent structures. *Irradiation* - **Radiation therapy** is typically reserved as an **adjuvant** treatment after surgery or for unresectable tumors, not as a primary standalone treatment. - While it can help reduce recurrence rates, it carries risks of **secondary malignancies** and local tissue damage. *Local excision* - **Local excision** alone is insufficient for desmoid tumors due to their **infiltrative growth pattern** and high propensity for **local recurrence** if positive margins remain. - It often leads to incomplete removal, necessitating further intervention and increasing the risk of tumor progression. *Local excision following radiation* - Combining local excision with initial radiation is not the preferred sequence; **wide surgical excision** is typically performed first. - Radiation might be considered preoperatively in specific cases to **reduce tumor size** or postoperatively for **positive margins**, but starting with local excision after initial radiation is not the standard primary management.

Question 1

Which of the following neck dissections is considered the most conservative?

Accepted Answer

Supraomohyoid neck dissection

Answer

Radical neck dissection

Answer

Modified radical neck dissection

Answer

All options are conservative.

Question 2

All of the following are surgical options in the management of esophageal carcinoma except -

Accepted Answer

Sistrunk operation

Answer

Ivor Lewis Approach

Answer

McKeown's Approach

Answer

Transhiatal removal

Question 3

Which of the following is NOT a principle of negative pressure wound therapy?

Accepted Answer

Clearance of infection

Answer

Macrodeformation of the wound

Answer

Decreased edema

Answer

Stabilization of wound environment

Question 4

A 25 year old male is receiving conservative management for an appendicular mass since 3 days now presents with a rising pulse rate, tachycardia and fever. The mode of management must be -

Accepted Answer

Proceed to laparotomy and appendicectomy

Answer

Intravenous antibiotics

Answer

Continue Ochsner Sherren regimen with close monitoring

Answer

Continue conservative management

Question 5

A 65 year old male presents with CA prostate. The tumour is limited to the capsule and it is palpable on PR examination. The patient is diagnosed as stage T2a. What is the most appropriate treatment option?

Accepted Answer

Surgical removal of the prostate (Radical prostatectomy)

Answer

External beam radiation therapy

Answer

Androgen deprivation therapy (ADT)

Answer

Active surveillance

Question 6

Which of the following statements about heart transplantation is false?

Accepted Answer

It is only orthotopic and not heterotopic

Answer

High pulmonary arterial resistance is a contraindication

Answer

Immunosuppression is started preoperatively

Answer

A beating heart cadaver/donor is not always needed.

Question 7

All of the following may lead to gall bladder carcinoma except which of the following?

Accepted Answer

Echinococcus Granulosus Infection

Answer

Gall Bladder Polyps

Answer

Typhoid carriers

Answer

Exposure to carcinogens like nitrosamine

Question 8

All of the following are true about Nissen Fundoplication except which of the following?

Accepted Answer

Reinforcement is done only in the posterior half

Answer

It is done for GERD

Answer

Upper part of stomach is plicated around the lower esophagus

Answer

It is done for paraesophageal hiatus hernia

Question 9

Where does spontaneous esophageal rupture (Boerhaave syndrome) most commonly occur?

Accepted Answer

Above the diaphragmatic aperture

Answer

Below the diaphragmatic aperture

Answer

Pharyngoesophageal junction

Answer

At the crossing of the arch of aorta

Question 10

What is the treatment of choice in desmoid tumors?

Accepted Answer

Wide excision

Answer

Irradiation

Answer

Local excision

Answer

Local excision following radiation

NEET-PG 2015 — Surgery