NEET SS 25 Surgery Recall

Correct Answer: C. Placement of double-J stent and repair

Explanation:
When a partial ureteric injury is recognized intra-operatively, immediate repair over a ureteric stent is the treatment of choice. Early recognition allows preservation of renal function, promotes healing, and prevents urinoma, fistula, or stricture formation.

Teaching Points:
• Intra-operative recognition → immediate repair
• Partial injuries → stent ± primary repair
• Delayed recognition increases stricture and fistula risk
• Always confirm ureteric integrity during pelvic surgery

Correct Answer: D. Two-stage Fowler–Stephens orchidopexy with 6-month gap

Explanation:
High intra-abdominal testes with short spermatic vessels cannot be mobilized safely in one stage. The Fowler–Stephens technique relies on collateral blood supply from the deferential and cremasteric arteries after division of testicular vessels. A 6-month interval allows adequate neovascularization and significantly reduces testicular atrophy.

Teaching Points:
• Gold standard for high intra-abdominal testis = two-stage Fowler–Stephens
• Optimal gap = 6 months (not 3 months)
• Success rate ≈ 85–90%
• Orchiectomy reserved for post-pubertal or severely atrophic testis

Correct Answer: B. Partial nephrectomy

Explanation:
A renal mass <4 cm is classified as T1a RCC. Nephron-sparing surgery provides equivalent oncologic outcomes while preserving long-term renal function. Radical nephrectomy is avoided unless partial nephrectomy is not technically feasible.

Teaching Points:
• RCC <4 cm = T1a
• Treatment of choice = partial nephrectomy
• Radical nephrectomy → higher CKD risk
• Ablation / surveillance reserved for unfit patients

Correct Answer: B. BEP × 3 cycles

Explanation:
BEP (Bleomycin, Etoposide, Cisplatin) is the standard first-line regimen for metastatic NSGCT with good-risk features. Number of cycles is determined by IGCCCG risk stratification.

Teaching Points:
• Good-risk NSGCT → BEP × 3
• Intermediate / poor risk → BEP × 4
• VIP used if bleomycin contraindicated

Correct Answer: D. Midline laparotomy

Explanation:
In a hemodynamically unstable trauma patient, the priority is rapid access and vascular control, not organ-specific exposure. A midline laparotomy: Is the fastest incision to enter the abdomen Provides access to all four quadrants Allows proximal vascular control (infrarenal or supraceliac aorta) Permits assessment and control of associated intra-abdominal injuries In renal hilar injuries, early control of the renal pedicle or even supraceliac aortic control may be lifesaving. This is best achieved through a midline incision. Subcostal, flank, or chevron incisions are elective, organ-specific approaches and are inappropriate in unstable trauma.

Teaching Points:
• Unstable abdominal trauma → midline laparotomy
• Renal hilar injury → priority is vascular control
• Flank / subcostal incisions are elective

Correct Answer: C. Direct visual internal urethrotomy (DVIU)

Explanation:
For a first-presentation, short (<1–2 cm), single anterior urethral stricture, DVIU is the preferred initial treatment.

Teaching Points:
• Short anterior stricture → DVIU first
• Repeated DVIU → poor long-term outcome
• Recurrent / long strictures → urethroplasty

Correct Answer: D. Retrograde urethrogram

Explanation:
RUG is the gold-standard initial investigation in suspected urethral injury and must be done before catheterization.

Teaching Points:
• Blood at meatus = urethral injury until proven otherwise
• Never pass Foley before RUG

Correct Answer: C. Suprapubic cystostomy

Explanation:
Once urethral injury is confirmed, urethral catheterization is contraindicated. Urinary diversion via suprapubic cystostomy is the safest immediate step.

Teaching Points:
• Confirmed urethral injury → SPC
• Definitive repair is delayed

Correct Answer: C

Explanation:
Non-functional adrenal incidentalomas are managed based on size, hormonal activity, and imaging characteristics. Lesions <4 cm that are non-functional and show benign radiologic features carry a very low risk of malignancy. Surgery is therefore not routinely indicated, and conservative follow-up is appropriate.

Teaching Points:
• Adrenal incidentaloma assessment depends on size, function, and imaging
• <4 cm + non-functional + benign imaging → observe
• ≥4–6 cm or suspicious features → consider surgery
• Follow-up: repeat imaging at 6–12 months, hormonal evaluation annually up to 5 years