Episodes of headache, palpitations and sweating with BP of 210/120 mmHg during attacks occur in a young accountant. Which is the best initial biochemical test?

Plasma aldosterone to renin ratio

Which haematological disease is the most common indication for elective splenectomy?

Refractory immune thrombocytopenia

Hereditary spherocytosis in a 2-year-old

Iron deficiency with splenomegaly

Genetic testing for a RET mutation is done in a family after a lady is found to have a calcitonin-secreting thyroid nodule. Her plasma metanephrines are five times the upper limit, and CT shows a 3 cm right adrenal mass. Serum calcium is mildly raised with a raised PTH. Her neck ultrasound shows a 2 cm nodule with a few central nodes. The endocrine surgeon plans all her operations under one admission if possible, and the anaesthetist asks which tumour must be dealt with first. What is the correct order?

Adrenalectomy first, after alpha-blockade, then thyroid surgery

All three procedures together without preparation

Parathyroidectomy first, then the other two

Total thyroidectomy first, then adrenalectomy

Neurosurgery, spleen, adrenal and transplant surgery

52 NEET-PG practice questions on Neurosurgery, spleen, adrenal and transplant surgery, part of General Surgery. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Hard
In the emergency department, a man with a known, untreated non-functioning pituitary macroadenoma develops a sudden, severe headache, vomiting and blurred vision. He is drowsy but rousable; BP is 86/54 mmHg. Visual acuity has fallen in both eyes and he has a right third nerve palsy. Plain CT shows a haemorrhagic sellar mass. Serum sodium is 128 mmol/L (normal 135-145) and glucose 68 mg/dL. He had never been started on any hormone replacement. The neurosurgeon is on the way. What should be given first?
1. AIV 3% saline bolus
2. BOral cabergoline
3. CIV hydrocortisone
4. DIV mannitol
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Answer: C · IV hydrocortisone
Sudden headache, visual loss and ophthalmoplegia with a haemorrhagic sellar mass is pituitary apoplexy. Acute ACTH deficiency causes hypotension, hypoglycaemia and hyponatraemia, so the first step is IV hydrocortisone (100 mg, then continued). Once he is stable, urgent trans-sphenoidal decompression is considered because of the falling acuity and reduced consciousness. Key point: Pituitary apoplexy: give IV hydrocortisone first, then decide on urgent surgical decompression.
- A: Hyponatraemia here is from cortisol deficiency and corrects with hydrocortisone.
- B: Cabergoline is for prolactinoma and does not treat apoplexy.
- D: Mannitol does not address the cortisol deficiency that threatens life.
Question 2 · Easy
Episodes of headache, palpitations and sweating with BP of 210/120 mmHg during attacks occur in a young accountant. Which is the best initial biochemical test?
1. APlasma aldosterone to renin ratio
2. BSerum cortisol at midnight
3. CSerum chromogranin B
4. DPlasma free metanephrines
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Answer: D · Plasma free metanephrines
Paroxysmal headache, palpitations and sweating with severe hypertension suggest phaeochromocytoma. Plasma free metanephrines (or 24-hour urinary fractionated metanephrines) are the recommended first test because the tumour converts catecholamines to metanephrines continuously, giving very high sensitivity. Imaging is done only after biochemical confirmation. Key point: Screen for phaeochromocytoma with plasma free or urinary fractionated metanephrines, then image.
- A: The aldosterone-renin ratio screens for primary aldosteronism.
- B: Midnight cortisol is a test for Cushing syndrome.
- C: Chromogranin is a non-specific neuroendocrine marker, not the first test.
Question 3 · Medium
Which haematological disease is the most common indication for elective splenectomy?
1. ARefractory immune thrombocytopenia
2. BHereditary spherocytosis in a 2-year-old
3. CBeta-thalassaemia trait
4. DIron deficiency with splenomegaly
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Answer: A · Refractory immune thrombocytopenia
Immune thrombocytopenia that fails or relapses after steroids, IVIG and second-line drugs is the most common indication for elective splenectomy; about two-thirds achieve a lasting remission. The spleen is the main site of both antiplatelet antibody production and platelet destruction. Splenectomy for hereditary spherocytosis is deferred until about 6 years of age because of OPSI risk. Key point: Refractory ITP is the commonest indication for elective splenectomy.
- B: Splenectomy for spherocytosis is delayed until later childhood.
- C: Thalassaemia trait needs no treatment, let alone splenectomy.
- D: Iron deficiency is not an indication for splenectomy.
Question 4 · Hard
Genetic testing for a RET mutation is done in a family after a lady is found to have a calcitonin-secreting thyroid nodule. Her plasma metanephrines are five times the upper limit, and CT shows a 3 cm right adrenal mass. Serum calcium is mildly raised with a raised PTH. Her neck ultrasound shows a 2 cm nodule with a few central nodes. The endocrine surgeon plans all her operations under one admission if possible, and the anaesthetist asks which tumour must be dealt with first. What is the correct order?
1. AAll three procedures together without preparation
2. BAdrenalectomy first, after alpha-blockade, then thyroid surgery
3. CParathyroidectomy first, then the other two
4. DTotal thyroidectomy first, then adrenalectomy
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Answer: B · Adrenalectomy first, after alpha-blockade, then thyroid surgery
Medullary thyroid carcinoma, phaeochromocytoma and hyperparathyroidism with a RET mutation is MEN 2A. An untreated phaeochromocytoma can cause a fatal hypertensive crisis during any anaesthetic, so it is removed first after alpha-blockade. Total thyroidectomy with central neck dissection, along with parathyroid surgery, follows. Key point: In MEN 2, remove the phaeochromocytoma first (after alpha-blockade), then operate on the thyroid.
- A: Operating without alpha-blockade is dangerous.
- C: Parathyroid surgery first carries the same anaesthetic risk from the phaeochromocytoma.
- D: Thyroid surgery with an untreated phaeochromocytoma risks a hypertensive crisis.
Question 5 · Easy
Under the Transplantation of Human Organs and Tissues Act, a living kidney donor who is not a near relative of the recipient needs approval from which body?
1. ADistrict Magistrate
2. BState Medical Council
3. CAuthorisation Committee
4. DLocal police station
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Answer: C · Authorisation Committee
THOA allows living donation by near relatives, and donation by anyone else (for example out of affection or attachment) only with approval of an Authorisation Committee. The committee checks that there is no commercial dealing and that consent is free and informed. Buying or selling organs is a punishable offence. Key point: Under THOA, a non-near-relative living donation needs Authorisation Committee approval.
- A: The District Magistrate has no approving role under THOA.
- B: The State Medical Council regulates doctors' registration, not individual donations.
- D: The police have no role in approving donations.
Question 6 · Medium
During testing for brain-stem death in the ICU of a man after a massive intracerebral bleed, all brainstem reflexes are absent and the apnoea test shows no breathing effort. The nurse notes that his knee jerks are present and his toes withdraw when the sole is scratched. What is the correct interpretation?
1. AThey mean sedative drugs are still acting
2. BThey indicate seizures, so an EEG is mandatory
3. CThey prove brainstem function, so testing must stop
4. DSpinal reflexes; certification can proceed
Answer and explanation in LearnFree account
Question 7 · Medium
Peripheral smear report of a patient: target cells, small round purple nuclear remnants inside many red cells, occasional nucleated red cells, and a platelet count of 6.2 lakh/microL (normal 1.5-4.5 lakh). What does this picture most likely indicate?
1. AIron deficiency anaemia
2. BA previous splenectomy
3. CAcute lead poisoning
4. DMegaloblastic anaemia
Answer and explanation in LearnFree account
Question 8 · Medium
On the third week of treatment for tuberculous meningitis, a labourer becomes drowsy. CT shows enlargement of all four ventricles with thick enhancing exudate in the basal cisterns. What is the most likely mechanism of his hydrocephalus?
1. AVenous sinus thrombosis raising venous pressure
2. BObstruction of the cerebral aqueduct by a tuberculoma
3. CExcess CSF production by the choroid plexus
4. DBlock to CSF flow in the basal cisterns
Answer and explanation in LearnFree account
Question 9 · Medium
MRI brain of a bank clerk with 6 weeks of headache and personality change shows an irregular, ring-enhancing mass with central necrosis crossing the corpus callosum into both frontal lobes. Stereotactic biopsy shows pseudopalisading necrosis and microvascular proliferation; IDH is wild type. After maximal safe resection, what is the standard further treatment?
1. AWhole-brain radiotherapy alone
2. BFocal radiotherapy with temozolomide
3. CObservation with MRI every 3 months
4. DHigh-dose methotrexate chemotherapy
Answer and explanation in LearnFree account
Question 10 · Hard
In the ICU, a young man certified brain-stem dead after a road accident is being kept on the ventilator while his family consents to organ donation. Over 4 hours his urine output rises to 600 mL/h of dilute urine. Serum sodium has risen from 142 to 156 mmol/L (normal 135-145), urine osmolality is 110 mOsm/kg, and BP is 88/52 mmHg. Central venous pressure is low and the chest X-ray is clear. The retrieval team is 6 hours away. Besides fluid replacement, what is the best drug to give?
1. AVasopressin infusion
2. BIV furosemide
3. CIV hydrocortisone only
4. DIV 3% saline
Answer and explanation in LearnFree account
Question 11 · Medium
After laparoscopic left adrenalectomy for a cortisol-secreting adenoma causing Cushing syndrome, the patient feels weak and nauseated on the second day with BP 92/60 mmHg. Why does this happen, and what must she receive?
1. ASuppressed right adrenal; steroid replacement
2. BHypoglycaemia from anaesthesia; IV dextrose only
3. CRight adrenal infarction; urgent re-exploration
4. DLoss of aldosterone; fludrocortisone only
Answer and explanation in LearnFree account
Question 12 · Medium
MRI of a college student with chronic headaches and papilloedema shows dilated lateral and third ventricles with a normal-sized fourth ventricle and a narrowed cerebral aqueduct, with no mass. What is the preferred operation?
1. AVentriculoatrial shunt insertion
2. BEndoscopic third ventriculostomy
3. CLumboperitoneal shunt insertion
4. DChoroid plexus coagulation
Answer and explanation in LearnFree account
Question 13 · Medium
CT and MRI of a schoolboy with morning headaches and an unsteady gait show a cerebellar hemisphere cyst with a brightly enhancing mural nodule. The nodule is excised, and biopsy shows a biphasic tumour with Rosenthal fibres and eosinophilic granular bodies. What is the most likely diagnosis?
1. AMedulloblastoma
2. BPilocytic astrocytoma
3. CFourth ventricular ependymoma
4. DCerebellar haemangioblastoma
Answer and explanation in LearnFree account
Question 14 · Medium
Consider these patterns of chronic rejection: 1. Kidney: transplant glomerulopathy with interstitial fibrosis. 2. Liver: vanishing bile duct syndrome. 3. Lung: bronchiolitis obliterans. 4. Heart: acute fibrinoid necrosis of the coronary arteries. Which pairs are correct?
1. A2, 3 and 4 only
2. B1, 2 and 3 only
3. C1 and 2 only
4. D1, 2, 3 and 4
Answer and explanation in LearnFree account
Question 15 · Medium
After lifting a heavy sack, a porter has severe low back pain with pain down both legs. Twelve hours later he cannot pass urine, and there is numbness around the anus and perineum. Ankle jerks are absent on both sides. What is the most appropriate next step?
1. ABed rest and analgesics for one week
2. BNerve conduction studies
3. CPlain X-ray of the lumbar spine
4. DEmergency MRI of the lumbosacral spine
Answer and explanation in LearnFree account
Question 16 · Easy
In metastatic spinal cord compression, which is the most common level involved and the usual first symptom?
1. ALumbar spine; leg weakness
2. BCervical spine; neck stiffness
3. CThoracic spine; urinary retention
4. DThoracic spine; back pain
Answer and explanation in LearnFree account
Question 17 · Easy
In a standard renal transplant, where is the donor kidney placed and to which artery is its renal artery joined?
1. APelvis; internal pudendal artery
2. BRenal bed; native renal artery
3. CIliac fossa; external iliac artery
4. DLumbar region; abdominal aorta
Answer and explanation in LearnFree account
Question 18 · Easy
Over a year, a retired railway guard has developed a broad-based, magnetic gait, urinary urgency with incontinence and forgetfulness. CT shows enlarged lateral ventricles out of proportion to sulcal widening. Lumbar puncture opening pressure is 14 cm of water (normal 6-20). What is the diagnosis?
1. AAlzheimer disease
2. BParkinson disease
3. CNormal pressure hydrocephalus
4. DVascular dementia
Answer and explanation in LearnFree account
Question 19 · Medium
A man with poorly controlled diabetes has had fever, severe localised thoracic back pain with tenderness over T7 for a week, and now weakness of both legs. ESR and CRP are high, and MRI shows a ring-enhancing dorsal epidural collection compressing the cord. Which organism is most likely?
1. AMycobacterium tuberculosis
2. BStreptococcus pyogenes
3. CEscherichia coli
4. DStaphylococcus aureus
Answer and explanation in LearnFree account
Question 20 · Hard
CT done for renal colic in a normotensive man aged 48 shows an incidental 2.5 cm, homogeneous, smooth left adrenal mass with an unenhanced attenuation of 8 Hounsfield units. He has no features of hormone excess, his serum potassium is normal, an overnight 1 mg dexamethasone suppression test gives a morning cortisol of 1.2 microgram/dL (normal suppression under 1.8), and plasma metanephrines are normal. He has no history of malignancy. He is worried about cancer and asks for the mass to be removed or scanned every year. What is the best advice?
1. ALaparoscopic left adrenalectomy
2. BCT-guided biopsy of the mass
3. CRepeat CT every 6 months for 2 years
4. DNo surgery and no further imaging
Answer and explanation in LearnFree account
Question 21 · Medium
A man with known prostate cancer on hormone therapy reports a new band-like thoracic back pain worse at night and mild leg heaviness for 2 days. Reflexes are brisk in the legs. Dexamethasone has been given. Which investigation should be done, and how urgently?
1. AX-ray of the thoracic spine next week
2. BWhole-spine MRI within 24 hours
3. CBone scan within 2 weeks
4. DCT of the thoracic spine only
Answer and explanation in LearnFree account
Question 22 · Hard
In the casualty after a motorbike fall, a college student has left upper abdominal pain and left lower rib fractures. After 1 litre of crystalloid his pulse settles from 118 to 92/min and BP from 94/60 to 118/76 mmHg, and it stays stable. FAST shows fluid in the left upper quadrant. Contrast CT shows a grade III splenic laceration with a contrast blush and a moderate haemoperitoneum; no other injury is seen. He has no peritonism and no other injury on examination. The centre has interventional radiology on site. What is the best management?
1. AEmergency laparotomy and splenectomy
2. BSplenic angioembolisation with close monitoring
3. CLaparoscopic partial splenectomy
4. DObservation alone without intervention
Answer and explanation in LearnFree account
Question 23 · Medium
About adrenal surgery: 1. Laparoscopic adrenalectomy is the standard approach for benign functional adrenal tumours. 2. The left adrenal vein drains into the left renal vein. 3. The right adrenal vein drains into the right renal vein. 4. A large tumour suspected to be adrenocortical carcinoma is best removed by open surgery. Which statements are correct?
1. A1, 2 and 4 only
2. B2 and 3 only
3. C1, 2 and 3 only
4. D1, 2, 3 and 4
Answer and explanation in LearnFree account
Question 24 · Easy
What is the most common primary malignant brain tumour in adults?
1. APrimary CNS lymphoma
2. BMeningioma
3. COligodendroglioma
4. DGlioblastoma
Answer and explanation in LearnFree account
Question 25 · Hard
MRI of a woman with breast cancer shows a single metastatic deposit at T8 compressing the cord, with a collapsed vertebral body and kyphotic deformity. She has had progressive leg weakness for 36 hours but can still walk with help. There is no other visceral or brain disease, and her oncologist expects survival well beyond a year. Dexamethasone 16 mg has been given. The radiation oncologist offers a short course of radiotherapy alone. What is the best definitive treatment?
1. AShort-course radiotherapy alone to T8
2. BSystemic chemotherapy alone
3. CHigh-dose steroids and observation
4. DSurgical decompression and fixation, then radiotherapy
Answer and explanation in LearnFree account

27 more Neurosurgery, spleen, adrenal and transplant surgery questions

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Neurosurgery, spleen, adrenal and transplant surgery

Episodes of headache, palpitations and sweating with BP of 210/120 mmHg during attacks occur in a young accountant. Which is the best initial biochemical test?

Which haematological disease is the most common indication for elective splenectomy?

Under the Transplantation of Human Organs and Tissues Act, a living kidney donor who is not a near relative of the recipient needs approval from which body?

Peripheral smear report of a patient: target cells, small round purple nuclear remnants inside many red cells, occasional nucleated red cells, and a platelet count of 6.2 lakh/microL (normal 1.5-4.5 lakh). What does this picture most likely indicate?

On the third week of treatment for tuberculous meningitis, a labourer becomes drowsy. CT shows enlargement of all four ventricles with thick enhancing exudate in the basal cisterns. What is the most likely mechanism of his hydrocephalus?

After laparoscopic left adrenalectomy for a cortisol-secreting adenoma causing Cushing syndrome, the patient feels weak and nauseated on the second day with BP 92/60 mmHg. Why does this happen, and what must she receive?

MRI of a college student with chronic headaches and papilloedema shows dilated lateral and third ventricles with a normal-sized fourth ventricle and a narrowed cerebral aqueduct, with no mass. What is the preferred operation?

CT and MRI of a schoolboy with morning headaches and an unsteady gait show a cerebellar hemisphere cyst with a brightly enhancing mural nodule. The nodule is excised, and biopsy shows a biphasic tumour with Rosenthal fibres and eosinophilic granular bodies. What is the most likely diagnosis?

Consider these patterns of chronic rejection: 1. Kidney: transplant glomerulopathy with interstitial fibrosis. 2. Liver: vanishing bile duct syndrome. 3. Lung: bronchiolitis obliterans. 4. Heart: acute fibrinoid necrosis of the coronary arteries. Which pairs are correct?

After lifting a heavy sack, a porter has severe low back pain with pain down both legs. Twelve hours later he cannot pass urine, and there is numbness around the anus and perineum. Ankle jerks are absent on both sides. What is the most appropriate next step?

In metastatic spinal cord compression, which is the most common level involved and the usual first symptom?

In a standard renal transplant, where is the donor kidney placed and to which artery is its renal artery joined?

Over a year, a retired railway guard has developed a broad-based, magnetic gait, urinary urgency with incontinence and forgetfulness. CT shows enlarged lateral ventricles out of proportion to sulcal widening. Lumbar puncture opening pressure is 14 cm of water (normal 6-20). What is the diagnosis?

A man with poorly controlled diabetes has had fever, severe localised thoracic back pain with tenderness over T7 for a week, and now weakness of both legs. ESR and CRP are high, and MRI shows a ring-enhancing dorsal epidural collection compressing the cord. Which organism is most likely?

A man with known prostate cancer on hormone therapy reports a new band-like thoracic back pain worse at night and mild leg heaviness for 2 days. Reflexes are brisk in the legs. Dexamethasone has been given. Which investigation should be done, and how urgently?

What is the most common primary malignant brain tumour in adults?