Gastrointestinal surgery: umbilical metastasis: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Gastrointestinal surgery: umbilical metastasis

Sample item

A 62-year-old woman with weight loss and ascites has a hard, irregular 2 cm nodule at the umbilicus. CT shows a thickened gastric wall with omental caking. What is the umbilical nodule most likely to be?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. A metastatic deposit from an intra-abdominal cancer

A hard umbilical nodule in a patient with an intra-abdominal malignancy is a Sister Mary Joseph nodule, a metastasis reaching the umbilicus through the lymphatics, the falciform ligament or the remnants of the umbilical vein. The commonest primaries are stomach, ovary, pancreas and colon, and the finding signals advanced disease.

Option by option

  • A. A metastatic deposit from an intra-abdominal cancer (correct)

    Correct. This is a Sister Mary Joseph nodule from a gastric or other abdominal primary.

  • B. A deposit of umbilical endometriosis

    Umbilical endometriosis causes cyclical pain and bleeding in a premenopausal woman and would not coexist with gastric wall thickening.

  • C. An incarcerated paraumbilical hernia

    A hernia is a reducible or tender bulge with a cough impulse, and it does not explain the gastric mass and omental caking.

  • D. A urachal remnant cyst

    A urachal remnant cyst is a midline cystic swelling below the umbilicus, usually in children or young adults.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is A, A metastatic deposit from an intra-abdominal cancer. A hard umbilical nodule in a patient with an intra-abdominal malignancy is a Sister Mary Joseph nodule, a metastasis reaching the umbilicus through the lymphatics, the falciform ligament or the remnants of the umbilical vein.

Why is "A deposit of umbilical endometriosis" not the answer?

Umbilical endometriosis causes cyclical pain and bleeding in a premenopausal woman and would not coexist with gastric wall thickening.

Why is "An incarcerated paraumbilical hernia" not the answer?

A hernia is a reducible or tender bulge with a cough impulse, and it does not explain the gastric mass and omental caking.

Why is "A urachal remnant cyst" not the answer?

A urachal remnant cyst is a midline cystic swelling below the umbilicus, usually in children or young adults.

What concept does this question test?

It tests Gastrointestinal surgery: umbilical metastasis in General Surgery. The commonest primaries are stomach, ovary, pancreas and colon, and the finding signals advanced disease.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastrointestinal surgery: umbilical metastasis?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.