AIIMS/ NEET-PG 2017: Surgery MCQs 21-30

Q-21. Best treatment of cystic hygroma
a) Radiotherapy
b) Sclero-therapy
c) Surgical excision
d) Chemotherapy

Answer: Surgical excision
Explanation:
Cystic hygroma or lymph-angioma is benign multi-lobular, multi-nodular cystic mass lines by endothelium cells.
Medical treatment of CH consists of the administration of sclerosing agents, such as OK-432 (A lyophilized mixture of Streptococcus pyogenes and penicillin G potassium), bleomycin and doxycycline.
The mainstay of treatment of cystic hygroma is surgical excision.

Q-22. Most common type of hypospadias
a) Glandular
b) Penile
c) Scrotal
d) Perineal

Answer: Glandular
Explanation:
Hypospadias is a common birth defect of the penis where the urethra (the tube that carries urine from the bladder to outside of the body) is not at the tip of the penis.
Classification of hypospadias is done by the position of the urethral opening. The types of hypospadias include:
Distal or glandular: most common form when opening is found near the head of the penis
Mid shaft: when opening is found in the middle to the lower shaft of the penis
Peno-scrotal: When opening is on the scrotum
Perineal: when opening is behind the scrotal sac. These are the most severe forms of hypospadias.

Q-23. A person with ‘Inappropriate speech’ evaluated by the ‘Glasgow coma scale’ will have a verbal score of
a) 4
b) 3
c) 2
d) 1

Answer: 3
Explanation:
Glasgow coma scale: Verbal response and score
Oriented and converses: 5
Disoriented/ confused and converses: 4
Inappropriate words: 3
Incomprehensible words: 2
No response: 1

Q-24. During on emergency thoracotomy, the incision is made >1 cm lateral to sternal margin to preserve
a) Inter-costal artery
b) Superior epigastric artery
c) Internal mammary artery
d) Inter-costal vein

Answer: Internal mammary artery
Explanation:
Internal mammary artery descends along the internal surface of anterior part of rib case approximately 1-2 cm lateral to the margin of sternum.

Q-25. A 10 year-old boy presented with cervical lymphadenopathy. Needle biopsy from the nodes revealed secondaries from papillary carcinoma of thyroid. The child underwent complete removal of tumor near total thyroidectomy and radical neck dissection. What should be the immediate next line of management?
a) Start thyroxine suppression therapy
b) Iodine 131 whole body scan to assess extent of disease
c) Bone scan to evaluate secondaries
d) CECT scan to assess any residual disease.

Answer: Start thyroxine suppression therapy
Explanation:

Q-26. Which of the following vessels is most commonly involved in a hemorrhage from duodenal ulcers?
a) Inferior vena Cava
b) Gastro-duodenal artery
c) Superior mesenteric artery
d) Inferior pancreatico-duodenal artery

Answer: Gastro-duodenal artery
Explanation:
Bleeding ulcers in the duodenum are usually located on posterior surface of the duodenal bulb.
As the ulcer penetrates the gastro-duodenal artery is exposed and may become eroded.

Q-27. A 30 year old presented with massive hematemesis. A 2×2 cm ulcer was visualized on upper GI endoscopy on the posterior aspect of 1st part of duodenum. The bleeding vessel was visualized but bleeding could not be controlled endoscopically. Blood transfusion was administered and patient was planned for surgery. His blood pressure was recorded as 90/70 and pulse rate was 110 with Hb of 9 gm % at the time of surgery. Which of the following would be the best surgical management?
a) Antrectomy with ligation of left gastric artery
b) Duodenotomy, ligation of bleeding vessels with postoperative PPI
c) Duodenotomy, ligation of bleeding vessels, truncal vagotomy with postoperative pyloroplasty
d) Duodenotomy ligation of bleeding vessels, highly selective vagotomy

Answer: Duodenotomy, ligation of bleeding vessels with postoperative PPI
Explanation:
Management of bleeding duodenal ulcers in an unstable patient:
Duodenotomy
+
Ligation of bleeding vessels
+
Postoperative PPI
+
Anti H. pylori therapy

Q-28. All of the following statements about carcinoid tumors are true except
a) It is the most common malignant tumor of the small intestine
b) Extensive involvement of small intestine is associated with higher probability of lung metastasis
c) 5 Years survival for carcinoid tumors is > 60%
d) Appendiceal carcinoids are more common in females

Answer: It is the most common malignant tumor of the small intestine
Explanation:
Adenocarcinoma is the most common malignant tumor of the small intestine
Appendiceal carcinoids are more common in females.

Q-29. A 30 year-old male presents with complete rectal prolapse, which of the following procedures is associated with lowest risk of recurrence
a) Delorme’s procedure
b) Thiersch procedure
c) Abdominal rectopexy
d) Altemeier’s procedure

Answer: Abdominal rectopexy
Explanation:
Abdominal rectopexy is the procedure of choice for complete rectal prolapse.
Abdominal rectopexy is associated with least recurrence rates and carries the highest likely-hood to restore continence.

Q-30. The diagnostic method of choice for Hirschprung disease is
a) Rectal biopsy
b) Manometry
c) Contrast enema
d) MRI

Answer: Rectal biopsy
Explanation:
During normal fetal development, cells from the neural crest migrate into the large intestine (colon) to form the networks of nerves called Auerbach’s plexus and Meissner’s plexus. In Hirschsprug’s disease, the migration is not complete and part of the colon lacks these nerve bodies that regulate the activity of the colon.
Diagnostic techniques involve ano-rectal manometry, barium enema, and rectal biopsy.
The suction rectal biopsy is considered the current international gold standard in the diagnosis of Hirschsprug’s disease.
A histologic examination of the tissue would show a lack of ganglionic nerve cells.