GENERAL SURGERY (NEET-SS) (INI-SS)

📢 INI-CET May '24: Champions Exam Approaching!

Exam Dates: From 17th to 21st April

Follows latest exam pattern - 4 sections, 50 questions, 45 min each

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#53. Explanation


(E) A number of breast cancer risk factors have been identified. These include family history, benign breast disease with atypical epithelial hyperplasia, alcohol consumption, and HRT. The most common and clinically useful risk factors are age and female gender. In most patients (70%) with breast cancer, however, no other major risk factor can be identified


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#53. A 56-year-old woman presents to the clinic for routine health screening. Her concern is the development of breast cancer. She has no current breast-related complaints. Past history is pertinent for fibrocystic changes with atypical ductal hyperplasia and a single fibroadenoma, both diagnosed by open biopsy 5 years ago. She smokes one pack per day and drinks one can of beer daily. Family history is positive for breast cancer in her mother, diagnosed at the age of 85. Current medications include a cholesterol-lowering agent, an antihypertensive, and HRT, which she has taken for 5 years. Physical examination is unremarkable. Mammograms show dense breasts, decreasing the accuracy of the study, but no suspicious findings were noted. Which of the following is the most common risk factor in evaluating women for breast cancer?

#52. Explanation


A) (C) A new mass in a woman of this age group must be fully evaluated to rule out carcinoma. Though biopsy by fine needle, core needle, or open biopsy will be required to determine the etiology of the mass, they should not be performed until all necessary breast imaging studies have been performed. Imaging should include diagnostic mammography and possibly sonography to determine whether the mass is solid or cystic. An appropriate type of biopsy can be chosen (i.e., FNA for cystic lesions or core biopsy for solid lesions). Imaging should not be delayed, although the patient should discontinue HRT until the etiology of the mass is determined.


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#52. A 56-year-old woman presents to the physician’s office with complaints of a new left breast mass. She denies any pain, nipple discharge, or skin dimpling. She has a prior history of breast cysts 5 years ago, treated by aspiration at that time. Her last mammogram was at age 53. Past history is pertinent for a 30 pack-year smoking history, prior total abdominal hysterectomy-bilateral salpingo-oophorectomy (TAH-BSO) at age 54 for leiomyomas, and current use of hormone replacement therapy (HRT). Family history is negative for breast disease. Examination reveals a firm, well-defined, mobile, 1.5-cm nodule in the upper outer quadrant of the left breast without any regional lymphadenopathy. Which of the following is the most appropriate next step in management?

DIRECTIONS (Questions #52 through #113): Each of the numbered items or incomplete statements in this section is followed by answers or by completions of the statement. Select the ONE lettered answer or completion that is BEST in each case.

#51. Explanation

(I) Pancreatitis may be the cause of jaundice by different mechanisms, resulting in compression of the common bile duct (CBD). Acute pancreatitis may cause edema of the head with resultant compression of the CBD; pancreatitis may lead to a pseudocyst in the head with compression of the duct; and chronic pancreatitis may lead to dense scarring around the duct
with a resultant stricture. The clinical scenario of an alcohol abuser with acute abdominal pain; nausea; vomiting; jaundice; and a tender, palpable epigastric mass is most consistent with acute pancreatitis with CBD obstruction attributable to a pseudocyst.


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#51. A 54-year-old man presents to the emergency department on transfer from another hospital at the request of the family. He was admitted to the outside hospital 2 weeks ago with abdominal pain, nausea, vomiting, and fever. He was treated with antibiotics, NG tube decompression, and TPN without significant improvement. He developed jaundice 2 days ago. His past history is pertinent for a 40 pack-year smoking history, chronic alcohol abuse, and diabetes. Examination reveals a
mildly jaundiced patient with vital signs of temperature 100°F, pulse rate 95/min, and BP 110/60 mmHg. Cardiac examination is unremarkable, lung examination reveals decreased breath sounds at the bases bilaterally, and abdominal examination reveals fullness in the epigastrium with tenderness and voluntary guarding.

#50. Explanation

(G) Liver dysfunction resulting in jaundice may be a manifestation of advanced metastatic disease to the liver. In a patient with a known malignancy at high risk for metastases (i.e., deeply invasive and ulcerative melanoma), metastatic disease must be considered in the evaluation of the jaundiced patient. Hepatomegaly found on abdominal examination is supportive of advanced metastatic disease


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#50. A 65-year-old man presents to the physician’s office with complaints of abdominal discomfort and jaundice for the past 3 weeks. Past history is pertinent for 30 pack-year smoking history, occasional alcohol intake, and a 5.5-mm ulcerating melanoma removed from his back 21 /2 years ago. Examination reveals a mildly jaundiced patient with normal vital signs and a slightly distended abdomen with mild right upper quadrant tenderness and significant hepatomegaly.

#49. Explanation

(C) Common duct stones (choledocholithiasis) may be the cause of acute bile duct obstruction without warning, resulting in jaundice, pain, and sepsis. The sepsis maymanifest as fever, hypotension, and altered mental status.


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#48. Explanation

(F) Pancreatic carcinoma occurs in the head of the gland in 75% of cases. About 75% of the patients with carcinoma in the head of the pancreas present with obstructive jaundice, weight loss, and, in the presence of advanced disease,abdominal pain

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#49. A 75-year-old woman is brought to the emergency department from the nursing home for jaundice and mental confusion. The nursing home notes state that she has become less responsive and has developed jaundice over the last 2 weeks. Past history is pertinent for hypertension, diabetes, and prior colon resection for cancer at age 55. Examination reveals mild jaundice with vital signs of temperature 101.5°F, pulse rate 110/min, and BP 100/60 mmHg. She does not respond to verbal commands, but withdraws to pain. Abdominal examination reveals tenderness in the epigastrium and right upper quadrant

#48. A 75-year-old man is brought to the emergency department by his family for evaluation of jaundice. He complains of pruritus of 2 weeks’ duration and a recent 10-lb weight loss. On examination, he is deeply jaundiced and has a nontender, globular mass in the right upper quadrant of the abdomen that moves with respiration.