A 2-year-old girl had her cleft palate repaired at 11 months. Her mother now reports that she does not respond well to sounds, and examination shows dull, retracted tympanic membranes on both sides. Which mechanism best explains this?

Poor tensor veli palatini action on the Eustachian tube

Damage to the cochlea during palate surgery

Recurrent nasal regurgitation into the middle ear

Absence of the stapedius reflex from facial palsy

A newborn in the special newborn care unit has a small, receding lower jaw, a U-shaped cleft of the soft palate, and episodes of noisy breathing, chest retractions and desaturation, worse when lying on his back. What is the most appropriate first step to manage his airway?

Nurse the baby prone or on the side

Early palate repair in the first week

Mandibular distraction osteogenesis

A 50-year-old man had an excision biopsy of a changing mole on his thigh. Histology shows nodular melanoma with a Breslow thickness of 1.8 mm, without ulceration and with clear margins. There are no palpable groin nodes and staging scans are clear. What is the most appropriate next step?

Wide local excision (1-2 cm margin) with sentinel node biopsy

Wide local excision with a 5 cm margin alone

Observation, as the biopsy margins are clear

Elective inguinal block dissection

A 9-year-old girl, born to parents who are first cousins, has had severe sunburn after brief sun exposure since infancy, with freckling and dry skin on her face. She now has two basal cell carcinomas and a squamous cell carcinoma on her face. Which mechanism underlies her condition?

Defective nucleotide excision repair

Defective homologous recombination

Loss of the p53 checkpoint at birth

Surgical oncology, plastic and paediatric surgery

18 NEET-PG practice questions on Surgical oncology, plastic and paediatric surgery, part of General Surgery. The first 18 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 · Medium
A 2-year-old girl had her cleft palate repaired at 11 months. Her mother now reports that she does not respond well to sounds, and examination shows dull, retracted tympanic membranes on both sides. Which mechanism best explains this?
1. ADamage to the cochlea during palate surgery
2. BRecurrent nasal regurgitation into the middle ear
3. CPoor tensor veli palatini action on the Eustachian tube
4. DAbsence of the stapedius reflex from facial palsy
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Answer: C · Poor tensor veli palatini action on the Eustachian tube
In cleft palate, the tensor veli palatini and levator veli palatini are abnormally inserted, so the tensor cannot open the Eustachian tube properly. The middle ear is poorly ventilated, causing otitis media with effusion and conductive hearing loss in most children with cleft palate, and this can persist after repair. Hearing assessment is part of routine cleft care, and grommets are inserted when hearing loss is significant. Unrecognised hearing loss adds to speech delay.
- A: Palate surgery does not touch the cochlea; this hearing loss is conductive.
- B: Nasal regurgitation affects feeding and speech, not middle ear ventilation directly.
- D: The stapedius reflex has nothing to do with middle ear effusion.
Question 2 · Hard
A newborn in the special newborn care unit has a small, receding lower jaw, a U-shaped cleft of the soft palate, and episodes of noisy breathing, chest retractions and desaturation, worse when lying on his back. What is the most appropriate first step to manage his airway?
1. AImmediate tracheostomy
2. BEarly palate repair in the first week
3. CMandibular distraction osteogenesis
4. DNurse the baby prone or on the side
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Answer: D · Nurse the baby prone or on the side
Micrognathia, glossoptosis (the tongue falling back) and a U-shaped cleft palate form the Pierre Robin sequence. The small jaw lets the tongue fall back and block the pharynx, especially when supine. The first step is prone or lateral positioning; if this fails, a nasopharyngeal airway is used, and only persistent obstruction needs mandibular distraction, tongue-lip adhesion or tracheostomy. The jaw often grows enough over the first year for the airway to improve, and the palate is repaired later in the usual way.
- A: Tracheostomy is a last resort after simpler measures fail.
- B: Palate repair does not relieve tongue-based airway obstruction.
- C: Distraction is reserved for obstruction that persists despite simpler measures.
Question 3 · Medium
A mother in rural Odisha brings her plump 7-month-old son to the CHC: since morning he has had intermittent spells of inconsolable crying with knees pulled to the chest, is limp and pale in between, has vomited twice and has just passed a jelly-like red stool. A firm curved mass lies under the right costal margin. Which investigation is preferred to confirm the diagnosis?
1. APlain X-ray of the abdomen
2. BUltrasound of the abdomen
3. CDiagnostic laparoscopy
4. DCT scan of the abdomen
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Answer: B · Ultrasound of the abdomen
Episodic colicky pain with pulling up of the legs, lethargy, vomiting, 'red currant jelly' stool and a sausage-shaped mass in an infant of 6 months to 2 years is intussusception, most often ileocolic. Ultrasound is the investigation of choice: it shows a target or doughnut sign in cross-section and a pseudokidney sign in long section, with high accuracy and no radiation. A plain film may be normal early. Confirmed cases without peritonitis go on to image-guided enema reduction.
- A: A plain film is often normal early and cannot confirm the diagnosis.
- C: Laparoscopy is invasive and not a first diagnostic step.
- D: CT adds radiation and is not needed in a typical infant.
Question 4 · Hard
A 50-year-old man had an excision biopsy of a changing mole on his thigh. Histology shows nodular melanoma with a Breslow thickness of 1.8 mm, without ulceration and with clear margins. There are no palpable groin nodes and staging scans are clear. What is the most appropriate next step?
1. AWide local excision with a 5 cm margin alone
2. BObservation, as the biopsy margins are clear
3. CWide local excision (1-2 cm margin) with sentinel node biopsy
4. DElective inguinal block dissection
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Answer: C · Wide local excision (1-2 cm margin) with sentinel node biopsy
An excision biopsy is diagnostic; definitive treatment is a wide local excision whose margin depends on Breslow thickness: about 1 cm for tumours up to 1 mm, 1-2 cm for 1-2 mm, and 2 cm for thicker tumours. For a melanoma of 1.8 mm with clinically negative nodes, sentinel lymph node biopsy is recommended at the time of wide excision, because it stages the regional nodes and guides adjuvant therapy. Old 5 cm margins gave no survival benefit. Elective node dissection without nodal disease has been replaced by sentinel biopsy.
- A: 5 cm margins add morbidity without improving survival and miss nodal staging.
- B: A clear excision biopsy margin is not an adequate oncological margin.
- D: Block dissection is for proven nodal disease, not clinically negative nodes.
Question 5 · Medium
A 9-year-old girl, born to parents who are first cousins, has had severe sunburn after brief sun exposure since infancy, with freckling and dry skin on her face. She now has two basal cell carcinomas and a squamous cell carcinoma on her face. Which mechanism underlies her condition?
1. ADefective homologous recombination
2. BDefective nucleotide excision repair
3. CDefective mismatch repair
4. DLoss of the p53 checkpoint at birth
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Answer: B · Defective nucleotide excision repair
Extreme sun sensitivity from infancy, freckling and multiple skin cancers in childhood, with parental consanguinity (autosomal recessive), is xeroderma pigmentosum. The defect is in nucleotide excision repair, which removes UV-induced pyrimidine (thymine) dimers; unrepaired dimers cause mutations and skin cancers, including melanoma, at a young age. Strict sun protection, regular skin surveillance and early excision of tumours are the mainstay. Eye and neurological problems can also occur.
- A: Homologous recombination defects (BRCA) cause breast and ovarian cancer.
- C: Mismatch repair defects cause Lynch syndrome (colon and endometrial cancer).
- D: Inherited p53 loss is Li-Fraumeni syndrome, with sarcomas and breast cancers.
Question 6 · Easy
A 3-month-old boy with a complete unilateral cleft lip is admitted to the plastic surgery ward for lip repair. Which operation is most widely used for this repair?
1. AAbbe flap
2. BMillard rotation-advancement
3. CFurlow double Z-plasty
4. DVon Langenbeck palatoplasty
Answer and explanation in LearnFree account
Question 7 · Medium
A 58-year-old man from Kerala has an irregular black patch on the sole of his left heel, 2.5 cm across with uneven borders, that has slowly enlarged over 2 years. A dark streak has also appeared under the nail of the left great toe. Which subtype of melanoma is most likely?
1. ALentigo maligna melanoma
2. BNodular melanoma
3. CAcral lentiginous melanoma
4. DSuperficial spreading melanoma
Answer and explanation in LearnFree account
Question 8 · Medium
A 10-month-old girl with intussusception confirmed on ultrasound has been unwell for 14 hours. After IV fluids she is alert, pulse is 132/min, the abdomen is soft without guarding, and there is no free air on X-ray. What is the treatment of choice?
1. ALaparotomy with manual reduction
2. BNasogastric decompression and observation
3. CEmergency laparotomy and resection
4. DPneumatic or hydrostatic enema reduction
Answer and explanation in LearnFree account
Question 9 · Medium
A newborn in the labour room has a unilateral cleft of the upper lip lateral to the philtrum; the palate is intact. The paediatrician explains the cause to the parents. Failure of fusion of which embryonic structures produces this defect?
1. ATwo lateral palatine shelves
2. BTwo mandibular prominences
3. CMedial and lateral nasal prominences
4. DMaxillary prominence and medial nasal prominence
Answer and explanation in LearnFree account
Question 10 · Easy
A 70-year-old farmer from Rajasthan has a slow-growing ulcer near the inner canthus of the left eye for 3 years. It has a rolled, pearly edge with fine telangiectasia over it, and no lymph nodes are palpable. What is the most likely diagnosis?
1. AKeratoacanthoma
2. BBasal cell carcinoma
3. CAmelanotic melanoma
4. DSquamous cell carcinoma
Answer and explanation in LearnFree account
Question 11 · Easy
A 5-week-old first-born boy has had non-bilious, projectile vomiting after every feed for 6 days and is hungry right after vomiting. A firm, olive-sized mass is felt in the epigastrium during a test feed. Which investigation confirms the diagnosis?
1. AUltrasound of the abdomen
2. BUpper GI endoscopy
3. CBarium meal
4. DPlain X-ray of the abdomen
Answer and explanation in LearnFree account
Question 12 · Medium
A 5-week-old boy is admitted with suspected infantile hypertrophic pyloric stenosis. The surgical resident lists four statements: 1. A firm olive-shaped mass may be felt in the epigastrium or right upper quadrant. 2. Hypochloraemic metabolic alkalosis is the typical biochemical finding. 3. The vomiting is typically bile-stained. 4. Serum potassium is typically raised. Which statements are correct?
1. A1 and 2 only
2. B1, 2, 3 and 4
3. C1, 2 and 4 only
4. D2 and 3 only
Answer and explanation in LearnFree account
Question 13 · Medium
A 62-year-old woman has a 1.5 cm nodular basal cell carcinoma in the right nasolabial fold, with poorly defined edges on dermoscopy. The plastic surgeon wants the highest cure rate while sparing as much normal tissue as possible. Which treatment is best?
1. ATopical imiquimod
2. BCurettage and electrodesiccation
3. CRadiotherapy alone
4. DMohs micrographic surgery
Answer and explanation in LearnFree account
Question 14 · Medium
A 4-week-old boy with projectile vomiting for a week is admitted to the paediatric surgery ward. He is lethargic and dry. Which blood gas and electrolyte pattern is expected?
1. AHyperkalaemic metabolic acidosis
2. BHypochloraemic, hypokalaemic metabolic alkalosis
3. CHigh anion gap metabolic acidosis
4. DHyperchloraemic normal anion gap acidosis
Answer and explanation in LearnFree account
Question 15 · Medium
A 72-year-old retired schoolteacher has a lesion on her cheek; the dermatology resident lists four statements about basal cell carcinoma: 1. It commonly spreads to regional lymph nodes. 2. It is the commonest skin cancer. 3. Histology shows nests of basaloid cells with peripheral palisading. 4. It occurs mostly on sun-exposed skin of the head and neck. Which statements are correct?
1. A2 and 4 only
2. B2, 3 and 4 only
3. C1, 3 and 4 only
4. D1, 2, 3 and 4
Answer and explanation in LearnFree account
Question 16 · Hard
A 14-month-old boy is brought to the district hospital after 2 days of colicky pain, bilious vomiting and blood-stained stools. He is drowsy, pulse 176/min, capillary refill 5 seconds, with a distended, rigid, tender abdomen. Ultrasound shows an ileocolic intussusception with free fluid. After IV fluid boluses, what is the definitive management?
1. ALaparotomy, with resection if the bowel is not viable
2. BPneumatic enema reduction under fluoroscopy
3. CRepeat ultrasound after 6 hours
4. DHydrostatic enema under ultrasound guidance
Answer and explanation in LearnFree account
Question 17 · Hard
A 6-week-old boy with ultrasound-confirmed hypertrophic pyloric stenosis is admitted after 8 days of vomiting. He is lethargic with sunken eyes and a capillary refill of 3 seconds. Serum sodium is 131 mmol/L, potassium 2.8 mmol/L, chloride 84 mmol/L and bicarbonate 36 mmol/L. What is the most appropriate next step?
1. AIV sodium bicarbonate to correct the acidosis
2. BEmergency Ramstedt pyloromyotomy tonight
3. CIV 0.9% saline with dextrose and potassium, then pyloromyotomy
4. DOral rehydration solution and early feeding
Answer and explanation in LearnFree account
Question 18 · Easy
A 45-year-old man has a wide local excision of a pigmented lesion on the back; histology shows a superficial spreading melanoma. Which single feature of the primary tumour is the most important predictor of outcome when nodes are not involved?
1. ADiameter of the lesion
2. BBreslow thickness
3. CClark level
4. DDegree of pigmentation
Answer and explanation in LearnFree account

Surgical oncology, plastic and paediatric surgery

A 2-year-old girl had her cleft palate repaired at 11 months. Her mother now reports that she does not respond well to sounds, and examination shows dull, retracted tympanic membranes on both sides. Which mechanism best explains this?

A newborn in the special newborn care unit has a small, receding lower jaw, a U-shaped cleft of the soft palate, and episodes of noisy breathing, chest retractions and desaturation, worse when lying on his back. What is the most appropriate first step to manage his airway?

A 50-year-old man had an excision biopsy of a changing mole on his thigh. Histology shows nodular melanoma with a Breslow thickness of 1.8 mm, without ulceration and with clear margins. There are no palpable groin nodes and staging scans are clear. What is the most appropriate next step?

A 9-year-old girl, born to parents who are first cousins, has had severe sunburn after brief sun exposure since infancy, with freckling and dry skin on her face. She now has two basal cell carcinomas and a squamous cell carcinoma on her face. Which mechanism underlies her condition?

A 3-month-old boy with a complete unilateral cleft lip is admitted to the plastic surgery ward for lip repair. Which operation is most widely used for this repair?

A 58-year-old man from Kerala has an irregular black patch on the sole of his left heel, 2.5 cm across with uneven borders, that has slowly enlarged over 2 years. A dark streak has also appeared under the nail of the left great toe. Which subtype of melanoma is most likely?

A 10-month-old girl with intussusception confirmed on ultrasound has been unwell for 14 hours. After IV fluids she is alert, pulse is 132/min, the abdomen is soft without guarding, and there is no free air on X-ray. What is the treatment of choice?

A newborn in the labour room has a unilateral cleft of the upper lip lateral to the philtrum; the palate is intact. The paediatrician explains the cause to the parents. Failure of fusion of which embryonic structures produces this defect?

A 70-year-old farmer from Rajasthan has a slow-growing ulcer near the inner canthus of the left eye for 3 years. It has a rolled, pearly edge with fine telangiectasia over it, and no lymph nodes are palpable. What is the most likely diagnosis?

A 5-week-old first-born boy has had non-bilious, projectile vomiting after every feed for 6 days and is hungry right after vomiting. A firm, olive-sized mass is felt in the epigastrium during a test feed. Which investigation confirms the diagnosis?

A 62-year-old woman has a 1.5 cm nodular basal cell carcinoma in the right nasolabial fold, with poorly defined edges on dermoscopy. The plastic surgeon wants the highest cure rate while sparing as much normal tissue as possible. Which treatment is best?

A 4-week-old boy with projectile vomiting for a week is admitted to the paediatric surgery ward. He is lethargic and dry. Which blood gas and electrolyte pattern is expected?

A 45-year-old man has a wide local excision of a pigmented lesion on the back; histology shows a superficial spreading melanoma. Which single feature of the primary tumour is the most important predictor of outcome when nodes are not involved?