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Free MCQs in Surgery

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Axillary lymph node dissection in ca breast

Q: Which of the following statements is most accurate regarding axillary lymph node dissection (ALND) in breast cancer staging?

a) Level I and level II ALND requires the removal of at least 10 lymph nodes for accurate staging, and level III nodes should always be included in the dissection, regardless of the presence of gross disease in levels I and II.
b) The axillary dissection should include tissue from levels I and II, with a focus on the area inferior to the axillary vein, extending laterally to the latissimus dorsi muscle and medially to the pectoralis minor muscle, when there is no gross disease in level II nodes.
c) Level III nodes should be dissected in all cases of breast cancer for accurate staging, as they are always involved in metastatic spread.
d) Level I and level II ALND can be skipped in cases of clinically negative axilla, as there is no need for lymph node evaluation in the absence of suspicion of metastasis.
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Constipation in Childhood – Most Likely Diagnosis MCQ for INI CET, NEET SS, and Pediatric Surgery Exams

Q) A 4-year-old child presents with a history of infrequent, hard stools associated with painful defecation.

There is no history of vomiting, fever, or blood in the stool. On examination, there is a palpable fecal mass in the left lower abdomen, and the anal tone is normal.

What is the most likely diagnosis?
# Theme from Mock test 32

  • A) Hirschsprung disease
  • B) Functional constipation
  • C) Intussusception
  • D) Anal fissure

Breast cancer TNBC

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Q: Which of the following patients with operable breast cancer is the most appropriate candidate for preoperative systemic therapy?

A) A patient with ER-positive, HER2-negative breast cancer with a 1 cm tumor and clinically node-negative disease who desires breast conservation
B) A patient with HER2-positive breast cancer with a 3 cm primary tumor and clinically node-positive disease
C) A patient with triple-negative breast cancer with a 1 cm tumor and clinically node-negative disease who prefers mastectomy
D) A patient with ER-positive, HER2-positive breast cancer with a 1.5 cm tumor and no lymph node involvement
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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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