INI-CET 2026 - Surgery PYQs Practice Questions

Q: Which of the following electrolyte or metabolic abnormalities is NOT a component of the lethal triad associated with massive blood transfusion?

Hyponatremia. ***Hyponatremia*** - While electrolyte imbalances can occur during massive blood transfusion due to citrated blood products, hyponatremia is not a primary component of the classic **lethal triad**. - The lethal triad specifically refers to the interrelated pathophysiological processes that exacerbate **hemorrhagic shock** and mortality in trauma patients. *Acidosis* - **Metabolic acidosis** is a key pillar of the lethal triad, often resulting from poor tissue perfusion, anaerobic metabolism, and shock. - It contributes to coagulopathy by inhibiting the activity of **clotting factors**, thereby worsening bleeding. *Hypothermia* - **Hypothermia** significantly disrupts the enzymatic reactions of the **coagulation cascade**, making it a critical component of the lethal triad. - It is frequently caused by blood loss, fluid resuscitation with un-warmed fluids, and exposure in the trauma bay. *Coagulopathy* - **Coagulopathy** of trauma is characterized by decreased clotting factor activity, platelet dysfunction, and hyperfibrinolysis. - It is intrinsically linked to the other two components, as acidosis and hypothermia both directly inhibit **hemostasis**. [Practice more Surgery PYQs on OnCourse]

Q: A patient with a thyroid nodule undergoes FNAC, which yields a result suggestive of follicular carcinoma. What is the most appropriate next step in management?

Hemithyroidectomy. ***Hemithyroidectomy*** - Fine-needle aspiration cytology (FNAC) cannot distinguish between **follicular adenoma** (benign) and **follicular carcinoma** (malignant) because the distinction requires histopathologic evidence of **capsular or vascular invasion**. - Therefore, a **hemithyroidectomy** (lobectomy) is the standard initial management to obtain a definitive tissue diagnosis while offering potential curative treatment if the lesion is benign or minimally invasive. *Total thyroidectomy* - This is not the initial procedure of choice because the majority of **follicular neoplasms** are eventually diagnosed as benign **adenomas**. - Total thyroidectomy is reserved for cases where histopathology confirms **invasive follicular carcinoma** or if there is clinical evidence of extensive multifocal disease. *Radioactive iodine therapy* - This therapy is used postoperatively for **differentiated thyroid cancer** (follicular or papillary) to ablate residual thyroid tissue or treat metastases, not as a primary management for a nodule. - It is never indicated when the diagnosis remains uncertain based solely on **FNAC** findings. *Repeat FNAC* - Repeating the FNAC is not helpful because it would likely yield the same **indeterminate result** (follicular neoplasm) and cannot evaluate for **invasion**. - Delaying surgical excision in a patient with a [Practice more Surgery PYQs on OnCourse]

Q: Match each of the following clinical conditions with its most appropriate diagnostic investigation: Clinical Condition Investigation A. Pancreatic pseudocyst 1. FNAC B. Thyroid nodule 2. MRCP C. Prostate cancer 3. PET scan D. Obstructive jaundice 4. CT scan Which of the following is the correct match?

A-4, B-1, C-3, D-2. ***A-4, B-1, C-3, D-2*** - **Pancreatic pseudocysts** are typically evaluated and characterized using **CT scanning (A-4)**, which provides excellent visualization of the collection and its relationship to surrounding structures. - **Thyroid nodules** are best evaluated for malignancy risk using fine-needle aspiration cytology (**FNAC**) (**B-1**), which remains the **gold standard** for diagnosis. - **Prostate cancer** staging or evaluation of recurrence/metastasis increasingly utilizes **PSMA-PET scanning (C-3)** for high sensitivity and specificity in detecting nodal or distant spread. - **Obstructive jaundice** requires detailed imaging of the biliary tree to determine the cause of obstruction, for which **magnetic resonance cholangiopancreatography (MRCP) (D-2)** is the investigation of choice. *A-3, B-1, C-4, D-2* - While **MRCP (D-2)** is correctly identified for obstructive jaundice, this option incorrectly pairs the **pancreatic pseudocyst** with a **PET scan (A-3)**, which is not the primary diagnostic modality for fluid collections. - It also mismatches **prostate cancer** with a **CT scan (C-4)** as the primary investigation, which is less sensitive than specialized functional imaging like PET for detecting small metastases. *A-2, B-1, C-4, D-3* - This option incorrectly identifies the diagnostic test for **obstructive jaundice** as a **PET scan (D-3)** rather than **MRCP**. - It also suggests a **CT scan (C-4)** for prostate cancer, which is inferior to **PET/MRI** imaging protocols for staging and disease assessment. *A-4, B-2, C-3, D-1* - This option incorrectly assigns **MRCP (B-2)** to the **thyroid**; MRCP is used for biliary anatomy, whereas **FNAC** is specific for thyroid nodules. - It incorrectly suggests **FNAC (D-1)** for the workup of **obstructive jaundice**, as FNAC is not a diagnostic tool for biliary anatomy or stone disease. [Practice more Surgery PYQs on OnCourse]

Q: On defecography, a rectocele is considered clinically significant when there is anterior bulging of the rectal wall into the posterior vaginal wall measuring more than:

2 cm. ***2 cm*** - A rectocele is defined as an anterior bulging of the rectal wall into the posterior vaginal wall, and it is considered clinically significant on **defecography** when this protrusion exceeds **2 cm**. - While smaller protrusions may be seen on imaging, they are often asymptomatic and do not require surgical intervention unless the patient presents with specific symptoms like **obstructed defecation**. *1 cm* - A rectocele measuring **1 cm** is typically considered to be within the range of physiologic or normal findings on defecography. - Many asymptomatic women show minimal bulging of this size, so it does not meet the criteria for **clinical significance** or surgical correction. *3 cm* - Although a **3 cm** rectocele would certainly fit the criteria for a clinically significant finding, it is not the minimum threshold for that clinical diagnosis. - Using a higher threshold would result in missing diagnosis and potentially undertreating patients who have symptomatic outlet obstruction related to a **2 cm** rectocele. *4 cm* - A **4 cm** rectocele is a large defect, but setting the diagnostic threshold this high would be inaccurate. - Clinical guidelines use the **2 cm** cutoff to balance diagnostic sensitivity with the correlation of patient-reported symptoms like **rectal digitation**. [Practice more Surgery PYQs on OnCourse]

Q: During laparoscopic inguinal hernia repair, what is the minimum distance of dissection required below the inguinal ligament to adequately expose the myopectineal orifice?

2 cm. ***2 cm*** - Dissection at least 2 cm below the **inguinal ligament** is essential to fully expose the **myopectineal orifice** (MPO), ensuring that the inferior border of the mesh can extend well below the **Cooper's ligament**. - This margin is critical to prevent **recurrence**, as it provides adequate coverage of the inferior space where direct or indirect hernias may originate. *0.5 cm* - This distance is insufficient for safe and effective **mesh placement**, as it fails to cover the entire **myopectineal orifice**. - Inadequate dissection at the inferior aspect risks leaving a gap through which a primary or recurrent hernia can easily develop. *1 cm* - While slightly broader than 0.5 cm, 1 cm of dissection usually proves inadequate to expose **Cooper's ligament** sufficiently for proper mesh fixation. - Most surgical guidelines emphasize a more generous inferior dissection to ensure the **mesh** lies flat and covers the potential hernial spaces. *4 cm* - Dissecting 4 cm below the **inguinal ligament** is excessive and increases the risk of injury to structures such as the **femoral vessels** and **obturator nerve**. - Excessive dissection beyond the required 2 cm creates unnecessary space that may lead to **seroma formation** or injury to neurovascular bundles below the **pubic ramus**. [Practice more Surgery PYQs on OnCourse]

Question 1

Which of the following electrolyte or metabolic abnormalities is NOT a component of the lethal
triad associated with massive blood transfusion?

Accepted Answer

Hyponatremia

Answer

Acidosis

Answer

Hypothermia

Answer

Coagulopathy

Question 2

A patient with a thyroid nodule undergoes FNAC, which yields a result suggestive of follicular
carcinoma. What is the most appropriate next step in management?

Accepted Answer

Hemithyroidectomy

Answer

Total thyroidectomy

Answer

Radioactive iodine therapy

Answer

Repeat FNAC

Question 3

Match each of the following clinical conditions with its most appropriate diagnostic
investigation:

Clinical Condition Investigation

A. Pancreatic pseudocyst 1. FNAC

B. Thyroid nodule 2. MRCP

C. Prostate cancer 3. PET scan

D. Obstructive jaundice 4. CT scan

Which of the following is the correct match?

Accepted Answer

A-4, B-1, C-3, D-2

Answer

A-3, B-1, C-4, D-2

Answer

A-2, B-1, C-4, D-3

Answer

A-4, B-2, C-3, D-1

Question 4

On defecography, a rectocele is considered clinically significant when there is anterior bulging
of the rectal wall into the posterior vaginal wall measuring more than:

Accepted Answer

2 cm

Answer

1 cm

Answer

3 cm

Answer

4 cm

Question 5

During laparoscopic inguinal hernia repair, what is the minimum distance of dissection required
below the inguinal ligament to adequately expose the myopectineal orifice?

Accepted Answer

2 cm

Answer

0.5 cm

Answer

1 cm

Answer

4 cm

Question 6

A trauma patient is evaluated using the GCS. The patient localizes to painful stimuli, produces
incoherent sounds, and opens eyes only in response to pain. What is the total GCS score?

Accepted Answer

9

Answer

6

Answer

7

Answer

8

Question 7

According to the American Association for the Surgery of Trauma (AAST) colon injury grading
scale, how is a colonic laceration involving more than 50% of the bowel wall circumference without
complete transection classified?

Accepted Answer

Grade III

Answer

Grade II

Answer

Grade IV

Answer

Grade V

Question 8

A 60-year-old patient presents with pruritus and obstructive jaundice. Physical examination
reveals a palpable, non-tender gallbladder. What is the most likely diagnosis?

Accepted Answer

Carcinoma of the head of the pancreas

Answer

Choledocholithiasis

Answer

Cholangiocarcinoma

Answer

Gallbladder carcinoma

Question 9

What is the fundamental surgical principle underlying TME in the operative management of
rectal cancer?

Accepted Answer

En bloc removal of the entire mesorectum as a single intact unit

Answer

Excision of only the peritumoral fat surrounding the tumor

Answer

Routine resection of the pelvic autonomic nerves

Answer

Ligation of the internal iliac artery

Question 10

According to ATLS guidelines, which of the following represents the correct sequence of steps
in primary trauma management?

Steps:
a. Airway management with cervical spine protection
b. Circulation with hemorrhage control
c. Disability assessment
d. Catastrophic bleeding control
Which sequence is correct?

Accepted Answer

d → a → b → c

Answer

a → b → c → d

Answer

b → a → d → c

Answer

d → b → a → c

INI-CET 2026 — Surgery