Free Questions

Free MCQs in Surgery

Facial nerve pointers

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Q: What is the most consistent anatomical landmark of the facial nerve?

A) Anterior border of the posterior belly of the digastric muscle.
B) Posterior border of the posterior belly of the digastric muscle.
C) Superior border of the posterior belly of the digastric muscle.
D) Inferior border of the posterior belly of the digastric muscle.

Ivor Lewis Esophagectomy leak

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Q) After Ivor Lewis esophagectomy, on postoperative day 5 (POD 5), bile is seen in the chest tube.

The patient presents with a heart rate of 120 bpm, a temperature of 101°F, and blood pressure of 100/70 mmHg. What is the next appropriate step in management?

  • a) Stenting
  • b) Colonic replacement of gastric conduit
  • c) IV antibiotics
  • d) Conduit excision and esophageal diversion
Correct Answer: d) Conduit excision and esophageal diversion

In patients who develop a completely necrotic conduit post-esophagectomy, the risk of sepsis is high. These patients often require urgent surgical intervention. Upon confirming conduit necrosis, the conduit must be resected, and the patient should undergo diversion, which includes:

  • End esophagostomy
  • Venting gastrostomy
  • Feeding jejunostomy

It is crucial to maintain as much length of the remaining esophagus as possible to facilitate future reconstructive procedures.

Key Points:

  • Postoperative Day 5: Critical time for monitoring complications after esophagectomy.
  • Symptoms of Concern: Tachycardia, fever, and hypotension may indicate sepsis or other complications.
  • Surgical Intervention: Timely recognition and management are vital for patient outcomes.

For further reading, refer to Schakelford’s Surgical Anatomy of the Gastrointestinal Tract, page 477.

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Lung cancer

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Q) A 73 year male, old heavy smoker presents with haemoptysis.

On examination he is cachectic and shows evidence of clubbing. Imaging shows a main bronchial tumour with massive mediastinal lymphadenopathy together with widespread visceral metastases.

Which of the following variant is likely in him?

(Theme from mock test 12-24)
a) Adenocarcinoma
b) Small cell lung cancer
c) Large cell lung cancer
d) Squamous cell carcinoma

Thyroid storm

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Q) 40 year old lady was on anti thyroid medications which she stopped for 2 weeks.

She presented in emergency with high grade fever and hypotension (Thyroid Storm).

What is not a part of further management?
a) Oxygen
b) Beta blockers
c) Radio active Iodine
d) Lugol's iodine

Grades of Splenic Injury – Image based Question

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Q) 45 year old male with road side accident and fracture of 3 ribs on left side.

CT scan of the abdomen is shown below. Out of the five grades of splenic injury What is the grade  in him ?

Splenic Injury grades

 

 

 

 

 

a) Grade II

b) Grade III

c) Grade IV

d) Grade V 

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Take the free image based mock test 

Ans b Grade III

Grade 1
Subcapsular haematoma <10% of surface area
Parenchymal laceration <1 cm depth Capsular tear
Grade 2
Subcapsular haematoma 10–50% of surface area; Intraparenchymal haematoma <5 cm
Parenchymal laceration 1–3 cm
Grade 3
Subcapsular haematoma >50% surface area; ruptured subcapsular or intraparenchymal haematoma ≥5 cm Parenchymal laceration >3 cm depth
Grade 4
Any injury in the presence of a splenic vascular
injury or active bleeding confned within the splenic
capsule
Parenchymal laceration involving segmental or hilar
vessels producing >25% devascularisation
Grade 5
Any injury in the presence of splenic vascular injurya
with active bleeding extending beyond the spleen
into the peritoneum – shattered spleen
Vascular injury is defined as a pseudoaneurysm or arteriovenous fistula and appears as a focal collection of vascular contrast that decreases in attenuation with delayed imaging.
Active bleeding from a vascular injury presents as vascular contrast, focal or diffuse, that
increases in size or attenuation in the delayed phase

THE vs TTE

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Esophagus Surgery
Esophagus Mock Test 1
Q) Trans Hiatal Esophagectomy (THE) vs Trans Thoracic Esophagectomy (TTE) – which is not true?
(Question asked in all AIIMS and INI exams since 2017)
a) Leak rates are more with TTE
b) Pulmonary complication is more with TTE
c) Side to side stapler anastomosis has less leaks than open two layer suturing
d) THE can be done through minimally invasive surgery
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Ulcerative colitis Surgery in Young female

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Ulcerative Colitis Surgery Choice
#AIIMS 2022 April
Q) Which surgery would be preferred to be done in young unmarried female with steroid refractory Ulcerative colitis and 15 bloody bowel movements per day?
a) TPC with IPAA
b) TPC with EI (end ileostomy)
c) TAC with EI (end ileostomy)
d) TAC with IRA (Ileo rectal anastomosis)
Ans b

The risk of infertility following IPAA was estimated to be approximately 50% compared with 15% among medically treated patients.

Given these data, many surgeons advocate for a three-stage procedure in which subtotal colectomy with end ileostomy is performed and IPAA is deferred until childbearing is completed.
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Medullary thyroid cancer – Management

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Thyroid MCQ
Q) 42 year old Male patient with 1 cm nodule in Right side of Thyroid.

Biopsy shows medullary carcinoma. No neck nodes are seen on USG. What is the management?
a) Total thyroidectomy
b) Total thyroidectomy with central node dissection
c) Total thyroidectomy with lateral and central neck dissection
d) Right hemithyroidectomy
Thyroid MCQs Thyroid Mock test 1 Thyroid Mock test 2 Thyroid 3
Answer

Carcinoma Breast and Pregnancy

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MCQ on Breast Cancer Management in Pregnancy
Q) A 30-year-old female in the 2nd trimester of pregnancy has a 2 cm breast carcinoma with no axillary lymph nodes. What should be the management?
✅ Answer: D. Lumpectomy + axillary dissection + chemo

🔍 Explanation:
In this case, lumpectomy followed by axillary dissection and chemotherapy is the preferred management.

- Axillary dissection is ideally done after Sentinel Lymph Node Biopsy (SLNB) - Radiotherapy can be given after the termination of pregnancy if necessary. - Hormonal therapy can also be started after pregnancy if required. - There is no need to terminate the pregnancy unless absolutely necessary, as modern treatments can be administered with careful planning.

🧠 Key Point: **Axillary dissection** and **chemotherapy** are preferred, with the option for hormonal therapy after pregnancy.

📘 Reference: NEET SS 2022 Paper

Anal malformation

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MCQ on Newborn with Abdominal Distension
Q) Newborn with abdominal distension on day 2, not passed meconium. There is absent anal orifice. What is the next step? # NEET SS 22
✅ Answer: A. Cross table X ray

🔍 Explanation:
The first step in such cases is to rule out congenital abnormalities of the spine, sacrum, kidneys, and heart.

- The second step is a Cross-table X-ray. If the X-ray shows perineal fistula, perform Anoplasty.
- If the X-ray shows rectal gas below the coccyx, perform a PSARP (Posterior Sagittal Anorectoplasty) with or without a colostomy.
- If the X-ray shows gas above the coccyx with associated defects, perform a colostomy.

🧠 Key Point: Cross-table X-ray is crucial to determine the presence of rectal gas and other associated defects, guiding the next step in management.

📘 Reference: Table 67.14 Sabiston