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?
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?
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
- 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?
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
- 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
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.
25. Which one of the following soft tissue sarcomas frequently metastasizes to lymph nodes?
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
Correct answer : C. Altered mental status
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)