DFT - NEET PG - 18/10/2025 - SURGERY MINI TEST

The definitive anatomical position of a horseshoe kidney is typically at the L3-L5 vertebral level, lower than the normal T12-L3 position. This is a direct consequence of a specific embryological interaction during fetal development. Which structure physically prevents the normal cephalad migration of the fused renal mass?

• Inferior mesenteric artery

• Celiac trunk

• Bifurcation of the abdominal aorta

• Median sacral artery

Answer explanation

 During embryological ascent from the pelvis, the fused renal isthmus of a horseshoe kidney gets caught under the root of the inferior mesenteric artery, arresting its further migration to the normal anatomical location.

A patient presents with a persistent, velvety red plaque on the glans penis. A biopsy reveals squamous cell carcinoma in situ. What is the specific clinical diagnosis?

• Erythroplasia of Queyrat

• Bowen's disease

• Leukoplakia

• Balanitis xerotica obliterans

Answer explanation

Erythroplasia of Queyrat is the specific term for squamous cell carcinoma in situ presenting as a red, velvety plaque on the glans or prepuce.

A pediatric patient with a palpable, non-tender abdominal mass undergoes an MRI, which reveals a large, heterogeneous renal tumor. An incidental finding noted on the scan is the fusion of the lower renal poles anterior to the aorta. This congenital anomaly is most significantly associated with an increased risk of which specific malignancy?

• Wilms tumor (Nephroblastoma)

• Renal cell carcinoma

• Transitional cell carcinoma

• Angiomyolipoma

Answer explanation

 Horseshoe kidney has a well-established association with an increased incidence of Wilms tumor, making it the most likely malignancy in this pediatric context.

During a planned open repair of an infrarenal abdominal aortic aneurysm, the surgeon encounters a fibrous-parenchymal isthmus connecting the kidneys across the midline, lying directly over the aorta. Mobilization of this structure is critical. Which vessel, typically responsible for arresting the ascent of this renal anomaly, must be carefully identified and preserved just superior to the isthmus?

• Inferior mesenteric artery

• Superior mesenteric artery

• Celiac trunk

• Median sacral artery

Answer explanation

 The horseshoe kidney's ascent is halted by the root of the inferior mesenteric artery (IMA). Therefore, in surgery, the IMA is found immediately superior to the renal isthmus.

An abdominal ultrasound, performed for non-specific symptoms, reveals medially deviated lower renal poles with inconclusive visualization of a possible isthmus due to overlying bowel gas. The patient is otherwise clinically stable with normal renal function tests. To achieve definitive anatomical delineation of the renal parenchyma, collecting systems, and aberrant vasculature, which imaging modality is the investigation of choice?

• CECT of the abdomen

• Intravenous Urogram (IVU)

• MAG3 renal scintigraphy

• Antegrade pyelography

Answer explanation

CECT provides unparalleled anatomical detail, making it the gold standard for confirming a horseshoe kidney and defining its parenchymal isthmus, complex arterial supply, and venous drainage, which is crucial for clinical management.

An individual undergoes an intravenous urogram for evaluation of recurrent urinary tract infections. The resulting images show that the vertical axes of the kidneys are reversed, with the lower poles positioned closer to the midline than the upper poles. The pelvicalyceal systems are malrotated, and the lower calyces point medially. What is the definitive diagnosis?

• Horseshoe kidney

• Crossed fused renal ectopia

• Pelvic kidney

• Medullary sponge kidney

Answer explanation

This classic triad on IVU abnormal vertical axis, malrotation, and medial orientation of lower calyces is pathognomonic for a horseshoe kidney.

A 32-year-old male presents for a routine health check-up and is found to have a blood pressure of 150/95 mmHg. He mentions that his father died from a "kidney problem" requiring dialysis. On examination, both kidneys feel enlarged and nodular on deep palpation. An ultrasound confirms the presence of numerous bilateral renal cysts. In addition to managing his hypertension, which of the following extra-renal manifestations is the most crucial to screen for due to its potential for catastrophic outcomes?

• Intracranial berry aneurysm

• Multiple hepatic cysts

• Mitral valve prolapse

• Bronchogenic cysts

Answer explanation

 Intracranial berry aneurysms are found in 5–10% of ADPKD patients and their rupture can cause a devastating subarachnoid hemorrhage. Screening is often considered, especially in patients with a positive family history of aneurysm or high-risk professions.

A 28-year-old male presents with dysuria and a mild urethral discharge. Urine routine microscopy reveals 20-25 pus cells/hpf, but the standard urine culture shows no bacterial growth after 48 hours. A Gram stain of the discharge is also negative for organisms. Apart from Mycobacterium tuberculosis, which organism is a common cause of this presentation?

• Chlamydia trachomatis

• Escherichia coli

• Staphylococcus saprophyticus

• Candida albicans

Answer explanation

Chlamydia trachomatis is an obligate intracellular bacterium that causes non-gonococcal urethritis. It will not grow on standard culture media, classically presenting as sterile pyuria.

A patient undergoing treatment for genitourinary tuberculosis develops persistent flank pain and recurrent secondary bacterial infections localized to the right kidney. An isotope renogram confirms negligible function in the right kidney, and a CT scan reveals extensive calcification and parenchymal destruction consistent with autonephrectomy. What is the most appropriate surgical intervention?

• Simple nephrectomy

• Percutaneous nephrostomy drainage

• Ureteric stent placement

• Partial nephrectomy

Answer explanation

A non-functioning, symptomatic, and destroyed kidney ("putty kidney") due to tuberculosis is a source of pain and infection, necessitating its removal via simple nephrectomy.

During follow-up for renal tuberculosis, a patient's CT urogram demonstrates resolution of renal parenchymal inflammation but reveals a short, dense stricture at the vesicoureteric junction, causing significant hydroureteronephrosis of a still-functioning kidney. Which surgical procedure offers the best long-term outcome?

• Ureteroneocystostomy

• Endoscopic balloon dilation

• Boari flap reconstruction

• Ileal ureter replacement

Answer explanation

For a short stricture at the vesicoureteric junction, excising the diseased segment and directly reimplanting the ureter into the bladder (ureteroneocystostomy) is the standard, definitive treatment.