Practice Paper of NEET PG: Important Questions of Surgery

Surgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance, or sometimes for some other reason.

The Important Questions of Surgery for NEET PG exam:

1. Abdominal approach is used in?
A. Thiersch operation
B. Delorme’s operation
C. Altemier’s procedure
D. Ripstein’s operation

Correct answer : D. Ripstein’s operation

  • Ripstein’s operation is the abdominal approach for rectal prolapse.
  • The abdominal approach is recommended in patients with complete rectal prolapse who are otherwise in good health.
  • In Ripstein’s operation, the rectosigmoid junction is hitched up to the front of the sacrum using a teflon sling.

 

2. Most common type of teratoma of the testis is?
A. Teratoma differentiated
B. Malignant teratoma intermediate
C. Malignant teratoma anaplastic
D. Malignant teratoma trophoblastic

Correct answer : B. Malignant teratoma intermediate

Histology of teratoma

  • Teratoma arises from totipotent cells in the rete testis.
  • Histologically it is classified into 4 types:
    • Teratoma differentiated
    • Malignant teratoma intermediate
    • Malignant teratoma anaplastic
    • Malignant teratoma trophoblastic
  • The most common type is malignant teratoma intermediate.
  • It contains malignant and incompletely differentiated components.

 

3. Which of the following is true regarding hereditary pancreatitis?
A. Autosomal recessive disorder
B. Has 80% penetrance
C. Accounts for about 30% of cases of chronic pancreatitis
D. IgG4 concentrations are elevated

Correct answer : B. Has 80% penetrance

CT scan of chronic pancreatitis. Calcification is visible.

  • Hereditary pancreatitis is an autosomal dominant disorder.
  • It has 80% penetrance.
  • It is associated with mutations in the cationic trypsinogen gene located on chromosome 7.
  • IgG4 concentrations are elevated in autoimmune pancreatitis.

4. Stemmer’s sign is due to?
A. Lipodystrophy
B. Retroperitoneal fibrosis
C. Subcutaneous fibrosis
D. Deep vein thrombosis

Stemmer’s sign in lymphoedema

Correct answer : C. Subcutaneous fibrosis

  • Stemmer’s sign is seen in lymphoedema.
  • Skin on the dorsum of the toes cannot be pinched due to subcutaneous fibrosis.
  • This is called Stemmer’s sign.

 

5. Lymphangiosarcoma was originally described in?
A. Stewart-Treves’ syndrome
B. Klippel-Trenaunay’s syndrome
C. Milroy’s disease
D. Meig’s disease

Correct answer : A. Stewart-Treves’ syndrome

  • Lymphangiosarcoma was originally described in Stewart-Treves’ syndrome(post mastectomy lymphoedema).
  • It affects about 0.5% of patients.
  • Stewart and Treves reported this in a joint paper in 1948.
  • Milroy’s disease is familial lymphoedema type 1.
  • Meig’s disease is familial lymphoedema type 2.

 

6. Which is not true regarding Schatzki’s ring?
A. Seen at squamocolumnar junction
B. Associated with reflux disease
C. Circular ring in the proximal oesophagus
D. Respond to dilatation

Correct answer: C. Circular ring in the proximal oesophagus

Schatzki’s ring – endoscopic view

  • Schatzki’s ring is a circular ring seen in the distal oesophagus.
  • It is usually present at the squamocolumnar junction.
  • It is strongly associated with reflux disease.
  • It maybe associated with dysphagia and respond to dilatation along with medical anti-reflux therapy.

Schatzki’s ring – Barium swallow

 

7. All are true regarding Caroli’s disease except?
A. Intrahepatic stone formation
B. Biliary stasis
C. Commonly presents with ascites
D. Malignant change can occur

Correct answer : C. Commonly presents with ascites

CT scan of cholangiocarcinoma. Malignant change can occur in Caroli’s disease.

  • Caroli’s disease is congenital dilatation of the intrahepatic biliary tree.
  • This disease is complicated by presence of intrahepatic stone formation.
  • Patients can present with abdominal pain or sepsis.
  • Biliary stasis with stone formation can lead to biliary sepsis.
  • Malignant change in the ductal system can lead to cholangiocarcinoma.

 

8. Which of the following is true regarding type III neuroendocrine tumour of the stomach?
A. Most frequent neuroendocrine tumour of the stomach
B. Serum gastrin is normal
C. High grade malignant tumour
D. Endoscopic resection is the treatment of choice

Correct answer: B. Serum gastrin is normal

Histology of neuroendocrine tumour (small intestine)

  • Neuroendocrine tumours of the stomach are rare tumours which comprise about 5% of all neuroendocrine tumours of the gastrointestinal tract.
  • The most frequent neuroendocrine tumour of the stomach is type I tumour.
  • Type III tumours are low grade malignant differentiated tumours.
  • Serum gastrin is normal.
  • The common symptom is upper gastrointestinal bleeding.
  • Gastrectomy, lymph node resection and resection of liver metastases is the treatment of choice.

 

9. Migratory necrolytic skin rash is seen in?
A. ACTHoma
B. VIPoma
C. Glucagonoma
D. Somatostatinoma

Correct answer : C. Glucagonoma

  • Glucagonoma is a neuroendocrine tumour of the pancreas.
  • It can present with migratory necrolytic skin rash.
  • Other symptoms include glossitis, stomatitis and angular cheilitis.
  • Diabetes, severe weight loss and diarrhoea can also occur.

 

10. The mechanism of action of everolimus is?
A. Blocks IL-2 gene transcription
B. Blocks IL-2 receptor signal transduction
C. Blockade of T cells
D. Prevents lymphocyte proliferation

Correct answer : B. Blocks IL-2 receptor signal transduction

Everolimus – molecular structure

  • Everolimus is an immunosuppressive agent used in organ transplantation.
  • It acts by blocking IL-2 receptor signal transduction.
  • It inhibits an intracellular kinase called mammalian target of rapamycin (mTOR).
  • This in turn interferes with intracellular signalling from the IL-2 receptor and arrest T cell division in the G1 phase.

 

11. Delayed obstruction of urinary tract after TURP is most commonly caused by?
A. Bladder neck stenosis
B. Penoscrotal stricture
C. Bulbar stricture
D. Membranous urethral stricture

Correct answer : A. Bladder neck stenosis

TURP resection specimen showing nodular hyperplasia

Most common cause of delayed obstruction of urinary tract after Transurethral Resection of Prostate (TURP) is bladder neck stenosis.

Late complications of TURP include:

  • Urethral stricture (3.8%)
  • Bladder neck stenosis (4%)
  • Stress incontinence (2.2%)
  • Sexual dysfunction: retrograde ejaculation (65-70%) and erectile dysfunction (6%).
  • Penoscrotal stricture, Bulbar stricture, Membranous urethral stricture and Submeatal strictures are subtypes of urethral strictures.
  • Urethral stricture can be treated by end to end urethroplasty.
  • Bladder neck stenosis can be corrected by endoscopic incision.

12. True regarding obstructive azoospermia is?
A. Increased FSH and LH
B. Increased FSH and normal LH
C. Normal FSH and increased LH
D. Normal FSH and LH

Correct answer : D. Normal FSH and LH

OBSTRUCTIVE AZOOSPERMIA

  • In this condition, azoospermia occurs secondary to a bilateral obstruction in the vas deferens or epididymis,
  • Sperm cells are produced, but not ejaculated,
  • Most common cause of obstructive azoospermia is vasectomy,
  • Other causes include congenital absence of vas deferens and obstruction secondary to infection,
  • The levels of FSH, LH and testosterone are normal,
  • Testicular volume is usually normal,
  • Treatment is by surgical removal of the obstruction / extraction of sperm from the testis.

 

13. Areas involved in posterior cerebral artery infarct are all except?
A. Thalamus
B. Temporal lobe
C. Anterior cortex
D. Choroid plexus

Correct answer : C. Anterior cortex

 

Blood supply of brain – Anterior cerebral artery (blue), middle cerebral artery (red) & posterior cerebral artery (yellow).

AREAS INVOLVED IN POSTERIOR CEREBRAL ARTERY INFARCT

  • Occipital lobe
  • Infero-medial temporal lobe
  • Postero-inferior parietal lobe
  • Large parts of thalamus
  • Midbrain
  • Posterior part of choroid plexus

 

14. A patient presents to the emergency department with an abdominal trauma with signs of shock and peritonitis. Airway and breathing were checked. 2 large bore cannulas were inserted to secure IV access. What is the next step in the management of this patient?

A. Immediate exploratory laparotomy with general anaesthesia
B. Focused Assessment with Sonography in Trauma (FAST)
C. Laparoscopic visualisation of the injury
D. Watch and wait

Correct answer : A. Immediate exploratory laparotomy with general anaesthesia

MANAGEMENT OF A CASE OF ABDOMINAL TRAUMA

  • Maintenance of airway, breathing and circulation is the first priority
  • The patient should be intubated in case of airway block
  • If the breathing is compromised, the patient should be ventilated with a high fraction of inspired oxygen
  • Large bore IV cannulas should be inserted and IV fluids should be administered
  • In case of external bleeding, direct pressure should be applied to control it
  • Spinal immobilisation should be done in cases with suspected spinal cord injury

Indications for laparotomy in blunt trauma abdomen

  • Hemodynamically unstable patients with shock
  • Signs of peritonitis
  • Progressive deterioration of the patient’s status
  • Identification of hemoperitoneum after Focused Assessment with Sonography in Trauma (FAST) or Diagnostic Peritoneal Lavage (DPL)

Non surgical management

  • If the patent is hemodynamically stable, further investigations like CT scan can be done to visualise the site of injury

 

15. Which of the following is not a component of Total Parenteral Nutrition?

A. Amino acids
B. Fats
C. Vitamins
D. Fiber

Correct answer : D. Fiber

COMPONENTS OF TOTAL PARENTERAL NUTRITION

  • Total parenteral nutrition should provide both energy and other essential nutrients.
  • Carbohydrates, lipids and amino acids provide energy.
  • The other essential nutrients to be included are: minerals, vitamins and water.
  • Dietary fiber is required only in case of enteral nutrition. It is not given as a part of parenteral nutrition.

16. Most common splenic cyst is?

A. Dermoid cyst

B. Hydatid cyst

C. Pseudocyst

D. Lymphangioma

Correct answer : B. Hydatid cyst

Hydatid cyst (caused by Echinococcus) is the most common type of splenic cyst.

 

17. Surgery for correction of cryptorchidism is best done before?

A. 1 month of age

B. 6 months of age

C. 1 year of age

D. 2 years of age

Correct answer : C. 1 year of age

Surgical orchidopexy should be done if spontaneous descent has not occurred by 1 year of age.

 

18. Commonest site of urethral carcinoma in males is?A. Prostatic urethra

B. Penile urethra

C. Bulbomembranous urethra

D. Navicular fossa

Correct answer : C. Bulbomembranous urethra

Commonest site of urethral carcinoma in males is Bulbomembranous urethra. It constitutes about 60% of the cases. Penile urethra is involved in 30% and prostatic urethra is involved in 10%.

 

19. The commonest cause of abdominal aortic aneurysm is?

A. Trauma

B. Syphilis

C. Vasculitis

D. Atherosclerosis

Correct answer : D. Atherosclerosis

90% of all abdominal aortic aneurysms greater than 4 cm are caused by atherosclerotic disease.

 

20. First autologous renal transplantation was performed by?

A. Hardy

B. Higgins

C. Studor

D. Kavosis

Correct answer : A. Hardy

First autologous renal transplantation was done by Hardy in the year 1963.

21. Lord’s plication is used in the treatment of ?

A. Hydrocele

B. Inguinal hernia

C. Testicular malignancy

D. Varicocele

Correct answer : A. Hydrocele

  • Lord’s plication is a surgical procedure used for the treatment of hydrocele
  • The hydrocele fluid is drained and the redundant sac is plicated
  • It is used for treatment of small and medium sized hydroceles

22. Which of the following structures are connected by Grayhack shunt?

A. Corpora cavernosa and saphenous vein

B. Corpora cavernosa and dorsal vein

C. Corpora cavernosa and corpus spongiosum

D. Corpora cavernosa and glans

Correct answer : A. Corpora cavernosa and saphenous vein

  • Grayhack shunt connects the corpora cavernosa with the saphenous vein
  • It is used for the treatment of ischaemic priapism

 

23. Which of the following conditions is associated with multiple cutaneous sebaceous adenomas?

A. Turcot’s syndrome

B. Cowden syndrome

C. Gardner’s syndrome

D. Muir Torre syndrome

Correct answer : D. Muir Torre syndrome

Multiple cutaneous sebaceous adenomas are seen in Muir Torre syndrome.

24. Which of the following renal calculi is seen associated with proteus infection?

A. Calcium Oxalate

B. Triple Phosphate

C. Xanthine

D. Uric Acid

Correct answer : B. Triple Phosphate

High ammonia concentration leads to the formation of triple phosphate stones. This arises when urine is infected with urea splitting organisms like Proteus.

 

25. Which one of the following soft tissue sarcomas frequently metastasizes to lymph nodes?
A. Fibrosarcoma
B. Osteosarcoma
C. Embryonal Rhabdomyosarcoma
D. Alveolar soft part sarcoma

Correct answer : C. Embryonal Rhabdomyosarcoma

Rhabdomyosarcoma is a soft tissue sarcoma which frequently metastasizes to lymph nodes.

 

26. The earliest manifestation of increased intracranial pressure following head injury is:
A. Ipsilateral pupillary dilatation
B. Contralateral pupillary dilatation
C. Altered mental status
D. Hemiparesis

Correct answer : C. Altered mental status

27. The following statements regarding finasteride are true except:A. It is used in the medical treatment of benign Prostatic hypertrophy (BPH)
B. Impotence is well documented after its use
C. It blocks the conversion of dihydrotestosterone to testosterone
D. It is a 5-alpha reductase inhibitor

Correct answer : C. It blocks the conversion of dihydrotestosterone to testosterone

Finasteride blocks the conversion of testosterone to dihydrotestosterone!

28. According to the Glasgow Coma Scale (GCS), a verbal score of 1 indicates:
A. No response
B. Inappropriate words
C. Incomprehensible sounds
D. Disoriented response

Correct answer : A. No response

GCS verbal score:

  1. No response
  2. Incomprehensible sounds
  3. Inappropriate words
  4. Disorriented and converses
  5. Oriented and converses

 

29. Which of the following is the most troublesome source of bleeding during a radical retropubic prostatectomy?
A. Dorsal venous complex
B. Inferior vesical pedicle
C. Superior vesical pedicle
D. Seminal vesicular artery

Correct answer : A. Dorsal venous complex

Dorsal venous complex passes over the prostate. It is the most troublesome source of bleeding during a prostatectomy.

 

30. Sclerotherapy is ideal for treatment of
A. External hemorrhoids
B. Internal hemorrhoids
C. Prolapsed hemorrhoids
D. Strangulated hemorrhoids

Correct answer : B. Internal hemorrhoids

Sclerotherapy is ideal for treatment of internal haemorrhoids. (first degree with bleeding and early second degree haemorrhoids)

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