NEET-PG 2024 Practice Questions

Q: In the intraoperative image of congenital hernia repair, the structure marked by the red arrow is identified as which of the following?

Testicular vein. ***Testicular vein*** - The **testicular vein** is clearly visible within the **spermatic cord** structures, which are typically identified and often dissected during congenital hernia repair. - Its position coursing with the testicular artery and vas deferens is consistent with its anatomical location within the inguinal canal. *Femoral vein* - The **femoral vein** lies more inferiorly and medially within the femoral canal, distinct from the inguinal canal contents visualized in this image. - Identification of the femoral vein would be in the context of a femoral hernia repair, not typically a congenital (indirect inguinal) hernia. *Obturator vein* - The **obturator vein** is located deep within the pelvis, accompanying the obturator nerve and artery through the obturator foramen. - It is not typically encountered or visible during a standard open or laparoscopic inguinal hernia repair. *Inferior epigastric vein* - The **inferior epigastric vein** runs superiorly and medially, forming the medial border of the **inguinal triangle (Hesselbach's triangle)**. - While it's an important landmark in hernia repair (differentiating direct vs. indirect hernias), its anatomical position and trajectory are distinct from the structure indicated by the arrow, which is part of the spermatic cord.

Q: A patient presents to the OPD with recurrent diarrhea, abdominal pain, and foul-smelling stools. The colonoscopy reveals the following findings. What is the most likely diagnosis?

Pseudomembranous colitis. ***Pseudomembranous colitis*** - The image clearly shows **yellowish-white plaques or pseudomembranes** scattered over the inflamed colonic mucosa, which are characteristic endoscopic findings of **pseudomembranous colitis**. - The clinical symptoms of **recurrent diarrhea**, **abdominal pain**, and **foul-smelling stools** are consistent with this diagnosis, often caused by *Clostridioides difficile* infection. *FAP (Familial Adenomatous Polyposis)* - FAP is characterized by hundreds to thousands of **adenomatous polyps** throughout the colon, usually **smaller and more uniform** in appearance than the pseudomembranes seen here. - While it can cause diarrhea and abdominal pain, the endoscopic appearance of discrete polyps rather than diffuse pseudomembranes differentiates it from the image shown. *Ulcerative colitis* - Ulcerative colitis typically presents with **continuous inflammation** of the colon, often involving **ulcerations, friability, and loss of haustra**, without the distinct pseudomembranes. - Symptoms usually include **bloody diarrhea** and tenesmus, which differ from the foul-smelling stools mentioned. *Acute gastritis* - Acute gastritis is an inflammation of the **stomach lining**, not the colon, and would not be diagnosed via colonoscopy. - Symptoms are usually upper GI-related, such as **epigastric pain, nausea, and vomiting**, not recurrent diarrhea and foul-smelling stools.

Q: Surgery was performed as shown in the image below. What is the name of the procedure?

Chopart amputation. ***Chopart amputation*** - The image shows a disarticulation through the **talonavicular and calcaneocuboid joints**, which defines a **Chopart amputation**. - This procedure removes the distal foot while preserving the **calcaneus and talus**, forming a stump that allows for some ankle motion. *Below knee amputation* - A below-knee amputation involves transection of the tibia and fibula, preserving the knee joint, which is much more proximal than shown in the image. - This type of amputation removes a significant portion of the lower leg, with the foot entirely removed, unlike the partial foot amputation depicted. *Above knee amputation* - An above-knee amputation involves disarticulation or transection through the femur, completely removing the lower leg and knee joint. - This is a much more extensive amputation than what is illustrated, which is confined to the foot. *Lisfranc amputation* - A Lisfranc amputation is a disarticulation through the **tarsometatarsal joints**, removing the metatarsals and phalanges but preserving the tarsal bones. - The image clearly shows the incision more proximally, at the midtarsal level, specifically through the talonavicular and calcaneocuboid joints, not the tarsometatarsal joints.

Q: What type of graft or dressing is used to cover the post-burn wound shown in the image?

Split thickness skin graft. ***Split thickness skin graft*** - The image shows a **meshed pattern** on the skin graft, which is characteristic of a **split-thickness skin graft** that has been expanded to cover a larger area. - This type of graft consists of the epidermis and a portion of the dermis, making it more flexible and able to **"take" more reliably** on various wound beds, commonly used for burn wounds. *Full thickness skin graft* - A **full-thickness skin graft** includes the entire epidermis and dermis and typically does not have a meshed appearance. - They are used for smaller defects where cosmesis is a priority, but have a **lower take rate** than split-thickness grafts, making them less suitable for large burn wounds. *VAC dressing* - A **VAC (Vacuum-Assisted Closure) dressing** is a system that applies negative pressure to a wound to promote healing and is not a skin graft itself. - It involves a foam or gauze dressing sealed with an adhesive film, connected to a vacuum pump, which is not what is depicted in the image. *Normal saline dressing* - A **normal saline dressing** is a simple wet-to-dry or wet-to-wet dressing for wound care, involving gauze soaked in normal saline. - This is a basic wound management technique and does not involve grafting or have the characteristic meshed appearance seen in the image.

Q: A jeep driver presents with pain in the gluteal region along with swelling and pus discharge for the past 6 months. What is the most likely diagnosis?

Pilonidal sinus. ***Pilonidal sinus*** - This is the classic presentation of **pilonidal sinus disease**, historically known as **"Jeep disease"** due to its high incidence in military personnel during WWII who sat for prolonged periods in jeeps - The **occupational clue "jeep driver"** is pathognomonic for pilonidal sinus, as prolonged sitting causes friction and pressure in the **sacrococcygeal/natal cleft region** - Presents with **chronic pain, swelling, and intermittent pus discharge** in the gluteal region, typically over weeks to months - Risk factors include: prolonged sitting, friction, deep natal cleft, obesity, and excessive body hair - The **chronic 6-month duration** with ongoing discharge is characteristic of pilonidal sinus with secondary infection, not an acute abscess *Gluteal abscess* - While this can cause pain, swelling, and pus discharge, it typically presents **acutely** (days to weeks, not 6 months) - Does not have the specific **occupational association with prolonged sitting** (jeep driver) - Would be expected to either resolve with drainage/antibiotics or progress to sepsis, not persist chronically for 6 months - Lacks the classic "Jeep disease" eponym *Fistula in ano* - This involves an abnormal tract between the **anal canal and perianal skin** - Discharge would be localized **perianally**, close to the anus, not in the broader gluteal/sacrococcygeal region - Does not have the jeep driver occupational association *Fissure in ano* - A **tear in the anal canal lining** causing severe pain during defecation with **bright red bleeding** - Does not present with swelling or chronic pus discharge - Pain is characteristically related to bowel movements, not constant

Q: A child presents to the OPD with the finding shown in the image. When should the first surgical repair be performed?

3 months. ***3 months*** - Surgical repair of **cleft lip** is typically performed around **3 months of age** based on current practice guidelines. - The traditional **"Rule of 10s"** (10 weeks old, 10 pounds weight, 10 g/dL hemoglobin) has evolved to **3-6 months** as the optimal timing window, with **3 months** being most common. - Early repair helps with **feeding difficulties**, improves cosmesis, and facilitates normal **parent-infant bonding** while optimizing surgical outcomes. *6 months* - While 6 months is within the acceptable range for cleft lip repair, **3 months is preferred** as the optimal timing in most centers. - Delaying repair to 6 months may impact feeding mechanics and parental bonding, though outcomes remain good. - This timing is **earlier** than the recommended window for **cleft palate repair** (9-18 months). *12 months* - **Cleft palate repair** is typically performed around **9-18 months of age**, with 12 months being a common target to optimize speech development. - Performing **cleft lip repair** at 12 months is significantly **delayed** and would miss the benefits of earlier intervention for feeding, cosmesis, and bonding. *18 months* - 18 months is at the **upper limit** for **cleft palate repair** to minimize speech development issues. - This age is **too late** for the first surgical repair of a cleft lip, which should be performed in early infancy (3-6 months).

Q: How does a skin graft receive nutrition on day 3 after transplantation?

Inosculation. ***Inosculation*** - **Inosculation** is the process where host capillaries directly connect with the graft's existing vessels (or newly formed ones) around day 2-3 post-transplantation. - This establishes blood flow and is the primary mechanism for **nutrient delivery** and waste removal by day 3. *Imbibition* - **Imbibition** is the initial phase (first 24-48 hours) where the graft passively absorbs nutrients from the recipient bed through diffusion. - While essential for initial survival, it is typically insufficient for sustained graft viability by day 3. *Neovascularization* - **Neovascularization** involves the formation of entirely new blood vessels into the graft, a process that typically begins after inosculation and continues for several days to weeks. - On day 3, while *initiation* of new vessel formation may be occurring, the main nutritional support is primarily from established connections through inosculation. *A & B* - While **imbibition** plays a role in the initial survival of the graft, by day 3, **inosculation** is the dominant and more effective mechanism for nutrient supply. - Therefore, selecting both A and B would be incorrect as imbibition's role diminishes significantly as inosculation progresses.

Q: A patient presents with constant chest pain, and the radiological finding is as shown in the image. What is the most appropriate management?

Surgical management. ***Surgical management*** - The chest X-ray shows a **widened mediastinum** and abnormal aortic contour, highly suggestive of **aortic dissection involving the ascending aorta (Type A)**. - **Type A aortic dissection** (involving the ascending aorta) is a **surgical emergency** requiring immediate operative repair to prevent life-threatening complications such as cardiac tamponade, acute aortic regurgitation, or rupture. - The constant chest pain with these radiological findings indicates urgent surgical intervention is the definitive management. *Vasodilator* - Vasodilators **alone** should never be used in aortic dissection as they can increase aortic wall shear stress and propagate the dissection. - They must always be preceded by beta-blockade to prevent reflex tachycardia. - Vasodilators do not address the structural defect requiring surgical correction in Type A dissection. *Beta blocker* - Beta-blockers are essential for **initial medical stabilization** to reduce heart rate (target <60 bpm) and blood pressure, thereby decreasing aortic wall stress (dP/dt). - However, in **Type A dissection**, beta-blockers alone do not address the structural defect and are used as a bridge to emergency surgery, not as definitive treatment. - For Type B dissections (descending aorta), medical management with beta-blockers may be definitive in uncomplicated cases. *Beta blocker plus vasodilator* - This combination represents optimal **medical management** for blood pressure and heart rate control in aortic dissection. - In **Type B (descending) aortic dissections**, this is often the definitive treatment for uncomplicated cases. - However, in **Type A dissections** (as indicated by the widened mediastinum suggesting ascending aortic involvement), this serves only as initial stabilization before **mandatory surgical repair**, not as definitive therapy. - Surgery cannot be delayed in Type A dissection due to high mortality risk (1-2% per hour).

Q: Identify the procedure shown in the image, which is performed in a patient with recurrent GERD.

Nissen fundoplication. ***Nissen fundoplication*** - The image clearly depicts the **fundus of the stomach** being wrapped completely around the lower esophagus and sutured in place, which is the hallmark of a **360-degree Nissen fundoplication**. - This procedure aims to strengthen the **lower esophageal sphincter (LES)** to prevent reflux in patients with recurrent GERD. *Partial gastrectomy* - This procedure involves the **surgical removal of a portion of the stomach** and is typically performed for conditions like gastric cancer or severe ulcers, not primarily for GERD. - The image shows the stomach intact and being wrapped, not resected. *Esophageal banding* - Esophageal banding is a procedure used to treat **esophageal varices** by placing elastic bands around dilated veins, not a surgical intervention for GERD that alters stomach anatomy. - The image shows a gastric maneuver, not banding of the esophagus. *Toupet fundoplication* - A Toupet fundoplication involves a **partial (270-degree) wrap** of the fundus around the esophagus, leaving a small portion unwrapped. - The image distinctly illustrates a **complete 360-degree wrap**, distinguishing it from a Toupet fundoplication.

Question 1

In the intraoperative image of congenital hernia repair, the structure marked by the red arrow is identified as which of the following?

Accepted Answer

Testicular vein

Answer

Femoral vein

Answer

Obturator vein

Answer

Inferior epigastric vein

Question 2

A patient presents to the OPD with recurrent diarrhea, abdominal pain, and foul-smelling stools. The colonoscopy reveals the following findings. What is the most likely diagnosis?

Accepted Answer

Pseudomembranous colitis

Answer

FAP (Familial Adenomatous Polyposis)

Answer

Ulcerative colitis

Answer

Acute gastritis

Question 3

Surgery was performed as shown in the image below. What is the name of the procedure?

Accepted Answer

Chopart amputation

Answer

Below knee amputation

Answer

Above knee amputation

Answer

Lisfranc amputation

Question 4

What type of graft or dressing is used to cover the post-burn wound shown in the image?

Accepted Answer

Split thickness skin graft

Answer

Full thickness skin graft

Answer

VAC dressing

Answer

Normal saline dressing

Question 5

A jeep driver presents with pain in the gluteal region along with swelling and pus discharge for the past 6 months. What is the most likely diagnosis?

Accepted Answer

Pilonidal sinus

Answer

Fistula in ano

Answer

Fissure in ano

Answer

Gluteal abscess

Question 6

A child presents to the OPD with the finding shown in the image. When should the first surgical repair be performed?

Accepted Answer

3 months

Answer

6 months

Answer

12 months

Answer

18 months

Question 7

An elderly patient presents with a non-healing ulcerative lesion on the lower lip, as shown in the image. The lesion has been gradually enlarging over the past few months. Suspecting squamous cell carcinoma (SCC), what is the most appropriate method to obtain a biopsy for definitive diagnosis?

Accepted Answer

Incisional

Answer

Excisional

Answer

Deep tissue biopsy

Answer

Superficial biopsy from the border with normal tissue

Question 8

How does a skin graft receive nutrition on day 3 after transplantation?

Accepted Answer

Inosculation

Answer

Imbibition

Answer

Neovascularization

Answer

A & B

Question 9

A patient presents with constant chest pain, and the radiological finding is as shown in the image. What is the most appropriate management?

Accepted Answer

Surgical management

Answer

Vasodilator

Answer

Beta blocker

Answer

Beta blocker plus vasodilator

Question 10

Identify the procedure shown in the image, which is performed in a patient with recurrent GERD.

Accepted Answer

Nissen fundoplication

Answer

Partial gastrectomy

Answer

Esophageal banding

Answer

Toupet fundoplication

NEET-PG 2024

Anatomy

Internal Medicine

Orthopaedics

Surgery