NEET SS 23 Test 7 - Surgery Superspeciality MCQS

Topics

Spleen and Adrenal from Sabiston , General Surgery Bailey chapters 16, BUrns from Schwartz

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1. Q) What is the blood loss in class III shock

10%

30%

35%

45%

2. Q) Most common indication for spelnectomy in haematological disorders?

G6PD deficiency

Sickle cell anemia

Hereditary spherocytosis

ITP

3. Q) MOst common tumor involving the spleen is ?

Hamartoma

Angiosarcoma

Lymphoma

All are same

4. Q) Chemical burns , Which agent is known to cause Hypocalcemia?

Formic acid

Hydrofluric acid

Lye

Sulphuric acid

5. Q) WHat is seen in electrical burn injuries?

Rhabdomyolysis

Compartment Syndrome

ECG changes

All

6. Q) Pathology tissue analysis without fixation is required for ?

Quantification of iron

Vascular invasion

Neural spread assesment

Cut margin assessment

7. Q) Not an Adjunct which has been shown to decrease fluid requirement in Burns patient?

Ascorbic acid

Plasmapharesis

Arginine

All the above

8. Q) 40 year old male with large mass in the Right Flank. There are features of cushing syndrome and evaluation shows Right adrenal irregular mass. What is the treatment of Adrenocortical carcinoma

a) chemotherapy

b) Upfront surgery

c) Neoadjuvant chemotherapy

d) Radiotherapy

9. Q) Most common cause for splenic abscess is ?

Haematogenous

Perinephritis

Infective colitis local spread

Pancreatitis

10. Q) Accessory spleen is not seen at

Left testis

left mesocolon

Mesentary

Seen in all

11. Q) A 34 year old male has blunt trauma abdomen with splenic Parenchymal laceration involving segmental or hilar vessels producing >25% devascularization. What grade is it

Grade II

Grade III

Grade IV

Grade V

12. Q) Advantage of cytology over histopathology sample is ?

Wider area is sampled

MOre invasive

Expensive

Takes time

13. Q) What is true regarding calculation of burn size area?

The “rule of nines” is a sophisticated and quick way of estimating burn size

For smaller or odd-shaped burns, the “rule
of the nine is useful”

Lund and Browder chart are less effective than rule of nines

Superficial or
first-degree burns should not be included when calculating burn
size

14. Q) Which topical cream can be used in eschar?

Silver nitrate

Mafenide acetate

polymyxin

Bacitracin

15. Q) 50 year old female with hypertension. She is diagnosed as a case of Pheochromocytoma. What is not true about the perioperative management?

Start alpha blocker 10 days before surgery

Dose of alpha blockers is increased to achieve normal rate and BP

Preop conditioning lasts for 2 weeks

All are true

16. Q) WHich of the following is not correct regarding blood supply of spleen?

Magistral type of splenic artery variation gives off branches near the hilum

Marginal type of variation is more common than distributive

Short gastric artery originates from splenic artery

Splenic artery origin is from coeliac trunk

17. Q) Least common site of metastasis for malignant pheochromocytoma?

Axial skeleton

Brain

Liver

Lung

18. Q) A 30 year old man is trapped in a house fire and sustains 30% partial and full thickness burns to his torso and limbs.
Three days following admission he has a brisk haematemesis. Which of the following is the most likely explanation for
this event?

A. Dieulafoy lesion

B. Curlings ulcers

C. Mallory Weiss tear

D. Depletion of platelets

19. Q) A 50 year old lady is admitted with recurrent episodes of non-specific abdominal pain. CT scan was performed. This demonstrates a
1.5cm nodule in the right adrenal gland. This is associated with a lipid rich core. Urinary VMA is within normal limits.
Other hormonal studies are normal. Diagnosis?

A) Benign incidental adenoma

B) Malignant adrenal adenoma

C) Metastatic lesion

d) Pheochrmocytoma

20. Q) Which of the following is not true for OPSI

OPSI is typically caused by
polysaccharideencapsulated organisms

Most of OPSI occur within six months

Mortality of OPSI is 40,%

Risk is highest In splenectomy for Thalassemia major

21. Q) True about burn wound management is?

Silver sulphadizene- High allergic reaction

Siver sulphadizene used as prophylaxis and not treatment

silver sulphadizene has metabolic complications

Silver sulphadiazene is used a 2%

22. Q) Not true about D/D of incidentally discovered adrenal mass?

a) If patient has h/o any malignancy most of them turn out to be metastatic

b) If no h/o malignancy most of them are non functioning

c) Most important for determining malignancy in incidentaloma is hormone secreting status

All are true

23. Q) WHich hereditary syndrome/gene is not implicated with pheochrmocytoma?

RET

NF1

MAX

P53

24. Q) True about grafting in burn wounds is?

Large burn areas use full thickness graft

Neck and face use meshed grafts

Meshed grafts provide drainage of collection and prevent graft loss

All are correct

25. Q) Risk of infection is most in which type of tissue sample?

Frozen section

Cytology

Histopathology

ALL CARRY EQUAL RISK

26. Q) 55-year-old male smoker with no previous medical history comes with abdominal pain CT shows a 2.5-cm left adrenal mass What is the next step in the management ?

Mri

Fnac

Biochemical work up

Observation for 6 months

27. Q) 40 year old male undergoes adrenalectomy for pheochromocytoma

In the post op period he complains of sweating and headache several hours following his operation. His blood pressure is 130/65 mmHg, heart rate is 85 beats/min, and respiratory rate is 12 breaths/min. What is the most likely cause of his symptoms?

Bleeding

Dehydration

Hypoglycemia

Narcotic overdose

28. Q) 48year-old patient presents after being burned in a house fire.

The patient has circumferential burns around both legs, the anterior torso and abdomen, and the circumferential left arm.

Additionally, the patient has painful erythema involving the circumferential right arm. What is this patient’s %TBSA?

63%

75%

42%

48%

29. Q) True statement about splenic cyst is?

True cyst form 10% of all spleen cysts

Pain is the most common presentation of true cysts of spleen

75% of the spleen appears to be sufficient to protect against pneumococcal
pneumonia.

Pseudocyst of spleen are lined by epithelium

30. Q) Which is not a cause of thrombocytopenia?

Alcohol

Pregnancy

Heparin

HBV infection

31. Q) Which of the following statements about paraganglia is correct?

A. Paraganglia are neuroendocrine cells associated only with the sympathetic nervous system.

B. Paragangliomas (PGLs) are neoplasms of adrenal paraganglia exclusively.

C. The organ of Zuckerkandl is a cluster of sympathetic paraganglia located near the aortic bifurcation.

D. Glomus tumors arise from sympathetic ganglia only.

32. Q) Which statement relating to phaeochromocytoma is untrue?

They are tumours of chromaffin cells in the adrenal medulla.

When located in an extra adrenal location have a higher incidence of malignancy.

May be associated with an elevated urinary VMA.

Up to 40% may have a blood pressure within the normal range.

33. Which of the following statements about tachycardia in shock is correct?

A. Tachycardia is always present in shock, regardless of the patient’s medical history.

B. Patients on β-blockers or those with implanted pacemakers may exhibit an inability to mount tachycardia during shock.

C. A pulse rate of 80 beats per minute in a young adult who normally has a pulse rate of 50 is considered normal

D. Penetrating trauma typically results in tachycardia, even if there is little blood loss.

34. Q) A 28-year-old pregnant woman, at 18 weeks gestation, presents to the emergency department with severe headaches, palpitations, and episodes of high blood pressure that have been difficult to control. She reports intermittent sweating and anxiety. Her obstetric history is otherwise unremarkable, and she has no known history of hypertension before pregnancy.

On examination, her blood pressure is noted to be 180/100 mmHg, with a pulse rate of 110 beats per minute. Laboratory tests reveal elevated plasma metanephrines, and an ultrasound suggests an adrenal mass.

Question: Based on this scenario, what is the recommended management approach?

A. Initiate antihypertensive therapy and plan for delivery as soon as fetal viability is achieved.

B. Perform adrenalectomy in the second trimester to manage the adrenal mass.

C. Schedule adrenalectomy immediately regardless of the gestational age.

D. Monitor the patient without intervention until postpartum.

35. What is the primary role of plasma free metanephrine testing in the diagnosis of pheochromocytoma?

A. To confirm a diagnosis of pheochromocytoma with high specificity.

B. To exclude pheochromocytoma when the test result is negative.

C. To identify all hypertensive individuals who may have pheochromocytoma.

D. To avoid false positives by minimizing interference from medications.

36. A 36-year-old woman presents with pheochromocytoma. Her family history is significant for multiple relatives with adrenal and paraganglionic tumors. Genetic testing reveals a succinate dehydrogenase B (SDHB) mutation. What is the recommended management approach for this patient?

A. Perform a total adrenalectomy on the affected adrenal gland to reduce the risk of recurrence.

B. No additional workup is necessary, as the diagnosis of pheochromocytoma is confirmed.

C. Consider a cortical-sparing adrenalectomy to preserve adrenal function, due to her familial risk.

D. Avoid genetic counseling, as the SDHB mutation is already identified.

37. Q) Which of the following best explains the immune dysfunction observed in patients following a severe burn injury?

There is a relative deficiency in macrophage production due to the presence of endotoxins, which impairs immune responses.

Neutrophils are hyperactive and overly efficient in responding to infections, which increases the risk of bacterial infections.

C. T lymphocytes and B lymphocytes are highly activated, increasing the risk of autoimmune diseases.

D. Neutrophil function is enhanced in the initial phase, improving chemotaxis and phagocytosis.

38. Which of the following statements regarding full-thickness burns is correct?

Full-thickness burns are characterized by a painless, hard, leathery eschar that may appear black, white, or cherry red, depending on the temperature of the source.

Full-thickness burns always involve the superficial fat but do not extend into deeper structures such as muscle or bone.

These burns can heal without the need for autologous skin grafting, as they regenerate primarily through the remaining dermal keratinocytes.

Full-thickness burns involve only the epidermis and dermis and heal primarily through scar formation without the need for grafting.

39. Q) The Berkow formula is used to calculate burn size in children. Which of the following is the most accurate description of the formula’s approach to estimating total body surface area (TBSA) for pediatric burn patients?

A) It assigns fixed percentages to specific body regions, similar to the Rule of Nines, but is tailored to children’s proportions.

B) It provides a universal percentage for each body part that remains constant throughout childhood and adulthood.

C) It uses a growth factor to adjust the surface area for children under the age of 5, but does not account for age-based changes beyond this point.

D) It is based on an algorithm that takes into account the child’s weight, height, and age to more accurately estimate TBSA burned.

40. A 58-year-old male undergoes a laparoscopic cholecystectomy for symptomatic gallstones. On postoperative day 3, he develops a bile leak confirmed by imaging and undergoes endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and biliary stent placement. According to the Clavien-Dindo classification, what grade of complication does this event correspond to?

A. Grade I

B. Grade II

C. Grade IIIa

D. Grade IIIb

41. A 45-year-old female undergoes an emergency laparotomy for a perforated duodenal ulcer with purulent peritoneal contamination. According to the surgical wound classification, how should this wound be categorized?

A. Clean

B. Clean-contaminated

C. Contaminated

D. Dirty/Infected

42. Which of the following statements is true regarding the management of patients with adrenal tumours undergoing surgery?

A) Adequate α-blockade preoperatively guarantees no risk of blood pressure changes during surgery.

B) Central venous catheter and invasive arterial monitoring are unnecessary in these patients.

C) A sudden drop in blood pressure may occur when the adrenal vein is ligated

D) Postoperative hypotension can be corrected solely by the infusion of large volumes of fluid, without the need for vasopressor agents.

43. Q) Which of the following is NOT associated with adrenocortical carcinoma (ACC)?

A) Multiple endocrine neoplasia type 1 (MEN 1)

B) Familial adenomatous polyposis

C) Lynch syndrome

D) Down syndrome

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