Gastrointestinal surgery: haemorrhoids grading: 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: haemorrhoids grading

Sample item

A 45-year-old man has bright red bleeding after defecation and a lump that comes down on straining and has to be pushed back in by hand. Proctoscopy confirms internal piles. Which grade is this?

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

The answer and the reasoning

D. Grade III (third degree)

In the Goligher classification, grade III piles prolapse and need manual replacement. Grade I bleed without prolapse, grade II prolapse and reduce spontaneously, and grade IV stay permanently prolapsed. Grade III disease that fails banding is treated by haemorrhoidectomy.

Option by option

  • A. Grade II (second degree)

    Grade II piles prolapse on straining but go back by themselves.

  • B. Grade I (first degree)

    Grade I piles never come outside the anal canal.

  • C. Grade IV (fourth degree)

    Grade IV piles remain outside and cannot be reduced.

  • D. Grade III (third degree) (correct)

    Correct. Prolapse that needs manual replacement defines third-degree piles.

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 D, Grade III (third degree). In the Goligher classification, grade III piles prolapse and need manual replacement.

Why is "Grade II (second degree)" not the answer?

Grade II piles prolapse on straining but go back by themselves.

Why is "Grade I (first degree)" not the answer?

Grade I piles never come outside the anal canal.

Why is "Grade IV (fourth degree)" not the answer?

Grade IV piles remain outside and cannot be reduced.

What concept does this question test?

It tests Gastrointestinal surgery: haemorrhoids grading in General Surgery. Grade I bleed without prolapse, grade II prolapse and reduce spontaneously, and grade IV stay permanently prolapsed. Grade III disease that fails banding is treated by haemorrhoidectomy.

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: haemorrhoids grading?

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.