INICET Surgery Previous Year Questions (2018–2026)

The correct answer is A is correct and B is incorrect.

Statement A is true: for any scrotal swelling you must examine the inguinal region and confirm whether you can get above the swelling. If you cannot, the lump is likely an inguinoscrotal hernia descending through the external ring rather than a primary scrotal lesion. Statement B is false: the testis develops as a retroperitoneal organ and then descends, so its lymphatics follow the testicular vessels up to the para-aortic (lumbar) lymph nodes at the level of L2. It is the skin of the scrotum, not the testis, that drains to the superficial inguinal lymph nodes.

This distinction is clinically vital: a testicular tumour spreads first to para-aortic nodes, so a normal groin examination does not exclude nodal metastasis, whereas a carcinoma of the scrotal skin does spread to the inguinal nodes.

Incorrect Options:

• Both are correct: wrong, because the testis drains to para-aortic, not superficial inguinal, nodes.
• A is incorrect and B is correct: reverses the truth - A is true and B is false.
• Both are incorrect: wrong, because examining the inguinal region for a scrotal swelling is mandatory.

High-Yield Facts:

• The testis drains to para-aortic (lumbar) nodes at L2.
• The scrotal skin drains to superficial inguinal nodes.
• For any scrotal swelling, check whether you can get above it.
• A testicular tumour spreads first to para-aortic nodes, not the groin.

Figure: The testis drains to the para-aortic (lumbar) lymph glands shown along the aorta, reflecting its retroperitoneal origin - not to the inguinal nodes.

The correct answer is Grade 4.

The ISUP/WHO prognostic grade group system maps the Gleason score onto five groups. Grade Group 1 is Gleason 6 or less, Grade Group 2 is 3+4=7, Grade Group 3 is 4+3=7, Grade Group 4 is Gleason 8 (whether 4+4, 3+5 or 5+3), and Grade Group 5 is Gleason 9 to 10. A Gleason score of 8 (4+4) therefore corresponds to Grade Group 4, a high-risk, poorly differentiated cancer.

Note the deliberate split of Gleason 7: a primary pattern 4 (4+3) carries a worse prognosis than 3+4, so the two are separated into Grade Groups 3 and 2 respectively. This prognostic separation is the main reason the grade group system was introduced.

Incorrect Options:

• Grade 2: corresponds to Gleason 3+4=7, not 8.
• Grade 3: corresponds to Gleason 4+3=7, a different score.
• Grade 5: reserved for Gleason 9 and 10, the most aggressive tumours.

High-Yield Facts:

• Grade Group 4 = Gleason 8 (4+4, 3+5 or 5+3).
• Grade Group 1 = Gleason 6 or less, and Grade Group 5 = Gleason 9 to 10.
• Gleason 7 splits into GG2 (3+4) and GG3 (4+3).
• Gleason patterns run from 1 (well differentiated) to 5 (anaplastic).

Figure: Gleason patterns 1 to 5. A score of 8 means two pattern-4 components (4+4), placing the tumour in Grade Group 4.

The correct answer is 1-d, 2-c, 3-b, 4-a.

Each condition has a classic investigation of choice. A pancreatic pseudocyst is best assessed by contrast-enhanced CT (d), which shows the cyst wall, size, ductal communication and surrounding anatomy. Obstructive jaundice is mapped non-invasively by MRCP (c), the preferred test for the level and cause of biliary obstruction. A solitary thyroid nodule is evaluated by FNAC (b), the single best test to separate benign from malignant nodules. Prostate carcinoma is increasingly staged with PSMA-PET (a), which detects nodal and metastatic disease with high sensitivity.

Only the combination 1-d, 2-c, 3-b, 4-a links every condition to its correct modality. The other combinations swap at least one pair, for example assigning CT to the thyroid nodule or FNAC to the pseudocyst.

Incorrect Options:

• 1-c, 2-d, 3-a, 4-b: wrongly gives MRCP to the pseudocyst and PSMA-PET to the thyroid nodule.
• 1-d, 2-b, 3-a, 4-c: FNAC does not assess obstructive jaundice, and MRCP is not used for prostate cancer.
• 1-c, 2-b, 3-a, 4-d: mismatches nearly every pair, including CT for prostate carcinoma.

High-Yield Facts:

• CT is the investigation of choice for a pancreatic pseudocyst.
• MRCP is the non-invasive test of choice for obstructive jaundice.
• FNAC is the best test for a solitary thyroid nodule.
• PSMA-PET is used to stage prostate carcinoma.

Figure: MRCP showing biliary calculi - MRCP is the non-invasive investigation of choice for obstructive jaundice, defining the level and cause of obstruction.