UPSC-CMS 2012 — Surgery
17 Previous Year Questions with Answers & Explanations
The term "debridement of the wound" refers to
Which of the following statements is true regarding wound contracture ?
The scolicidal agents used in the surgery of a hydatid cyst include all of the following except
Which one of the following is an example of a chemodectoma ?
The following are the indications for carrying out a sympathectomy except
In which one of the following is Branham's sign positive?
The structures removed in radical neck dissection include: 1. Sternocleidomastoid muscle 2. Submandibular gland 3. Internal jugular vein 4. Accessory nerve
The inflammatory breast carcinoma is staged as
Splenectomy is indicated in all of the following conditions, except
Which one of the following statements is true regarding "injection sclerotherapy" for haemorrhoids ?
UPSC-CMS 2012 - Surgery UPSC-CMS Practice Questions and MCQs
Question 1: The term "debridement of the wound" refers to
- A. Irrigation and cleaning of the wound
- B. Laying open all layers of the wound and excision of the devitalized tissue (Correct Answer)
- C. Closure of wound in layers
- D. Clean excision of at least 1 mm of skin from the edge of the wound
Explanation: ***Laying open all layers of the wound and excision of the devitalized tissue*** - **Debridement** specifically involves surgically removing **necrotic (devitalized)** or infected tissue from a wound to promote healing. - This process often requires **laying open all layers** to ensure complete removal of contaminated or dead tissue. *Irrigation and cleaning of the wound* - While **irrigation and cleaning** are components of wound care, they are considered primary steps in **wound prep** and are not synonymous with the complete surgical removal of devitalized tissue. - This option describes a more superficial cleaning rather than the definitive removal of non-viable tissue. *Closure of wound in layers* - **Wound closure in layers** is a step performed *after* debridement and cleaning, as part of the reconstructive phase of wound management. - This refers to the technique used to approximate tissues and is not part of the tissue removal process itself. *Clean excision of at least 1 mm of skin from the edge of the wound* - This describes **wound excision** or **surgical de-epithelialization** which may be performed for specific wound conditions or cosmetic purposes, but not primarily to remove devitalized tissue from the wound bed. - The focus here is on healthy tissue at the wound margins, not the non-viable tissue within the wound.
Question 2: Which of the following statements is true regarding wound contracture ?
- A. Bacterial colonization of a wound slows the process of contraction
- B. It may account for a 40% decrease in the size of a wound
- C. It is a primary process affecting the closure of sutured wounds
- D. It is the function of specialised fibroblasts that contain actin myofilaments (Correct Answer)
Explanation: ***It is the function of specialised fibroblasts that contain actin myofilaments*** - Wound contracture is primarily mediated by **myofibroblasts**, which are specialized fibroblasts containing **actin myofilaments**. - These cells exert contractile force, pulling the wound edges together to reduce wound size. *Bacterial colonization of a wound slows the process of contraction* - **Bacterial colonization** and infection typically **impair** or **delay** wound healing, including contracture, due to inflammation and tissue damage. - A healthy, sterile wound environment encourages optimal contraction. *It may account for a 40% decrease in the size of a wound* - Wound contracture can lead to a much greater reduction in wound size, often exceeding **40%**, with some studies suggesting up to **90%** for full-thickness wounds. - The extent of contracture depends on the size, location, and depth of the wound. *It is a primary process affecting the closure of sutured wounds* - Wound contracture is a more significant mechanism for **secondary intention healing** (wounds left open to heal by granulation and epithelialization). - For **sutured wounds (primary intention)**, closure is primarily achieved by direct apposition and sealing of the wound edges; contracture plays a minor role.
Question 3: The scolicidal agents used in the surgery of a hydatid cyst include all of the following except
- A. 15% glutaraldehyde (Correct Answer)
- B. Absolute alcohol
- C. 0.5% silver nitrate
- D. 20% (hypertonic) saline
Explanation: ***15% glutaraldehyde*** - **15% glutaraldehyde** is NOT a standard scolicidal agent used during hydatid cyst surgery. - While glutaraldehyde is an effective disinfectant and sterilizing agent, it is **not routinely used as a scolicidal agent** in hydatid cyst surgery. - It is **highly toxic to tissues** and can cause severe local damage, making it unsuitable for intraoperative use in the peritoneal cavity. - Standard scolicidal agents are safer and more established for this specific purpose. *Absolute alcohol* - **Absolute alcohol (95-100% ethanol)** is an effective scolicidal agent used in hydatid cyst surgery. - It kills protoscolices rapidly and has documented efficacy in preventing **secondary hydatidosis**. - While it can be irritating to tissues, it is still employed clinically with appropriate precautions to minimize spillage. *0.5% silver nitrate* - **0.5% silver nitrate** solution is an effective scolicidal agent that causes disruption of the scolex membranes. - It has been shown to kill scolices and reduce the risk of **secondary hydatidosis**. - It is one of the established agents used in hydatid cyst surgery. *20% (hypertonic) saline* - **Hypertonic saline (20%)** is the **most widely used** scolicidal agent due to its osmotic effect, which causes scolices to rupture. - It is **relatively safe** and highly effective, making it the preferred choice in most surgical protocols. - Spillage should still be minimized to avoid complications like hypernatremia or electrolyte imbalance.
Question 4: Which one of the following is an example of a chemodectoma ?
- A. Cock's peculiar tumour
- B. Cystosarcoma phylloides
- C. Keratoacanthoma
- D. Carotid body tumour (Correct Answer)
Explanation: ***Carotid body tumour*** - A **carotid body tumour** is a rare, usually benign, neuroendocrine tumour that arises from the **chemoreceptor cells (paraganglia)** of the carotid body. - These tumours are also known as **paragangliomas** and are classic examples of chemodectomas. *Cock's peculiar tumour* - **Cock's peculiar tumour** is a historical term for a **sebaceous cyst** that has undergone inflammation and potential infection, often presenting as a chronic, indurated lesion. - It is a benign adnexal tumour of the skin and does not arise from chemoreceptor cells. *Cystosarcoma phylloides* - **Cystosarcoma phylloides** (Phyllodes tumour) is a rare fibroepithelial tumour of the breast, characterized by both epithelial and stromal components arranged in leaf-like patterns. - It varies in its malignant potential but is distinct from neuroendocrine tumours. *Keratoacanthoma* - A **keratoacanthoma** is a rapidly growing, usually benign, cutaneous tumour that mimics squamous cell carcinoma. - It originates from the hair follicle epithelium and is characterized by a central keratin plug, not neuroendocrine tissue.
Question 5: The following are the indications for carrying out a sympathectomy except
- A. Causalgia
- B. Hyperhidrosis
- C. Venous ulcer of leg (Correct Answer)
- D. Raynaud's disease
Explanation: ***Venous ulcer of leg*** - Sympathectomy aims to reduce **vasoconstriction** and improve blood flow, but venous ulcers are primarily caused by **venous insufficiency** and stasis, not arterial spasm. - While improved microcirculation might be a minor benefit, it is not a primary indication for sympathectomy, as the underlying problem is venous, requiring different treatments like compression and elevation. *Causalgia* - **Causalgia (Complex Regional Pain Syndrome type II)** is characterized by severe burning pain, hyperalgesia, and allodynia, often with vasomotor dysfunction. - Sympathectomy can relieve the pain by interrupting the **sympathetic efferent nerves** that contribute to the pain and vasomotor changes. *Hyperhidrosis* - **Hyperhidrosis** is a condition of excessive sweating, mostly localized to the hands, feet, or axillae. - Sympathectomy, particularly **endoscopic thoracic sympathectomy (ETS)**, is an effective treatment for severe localized hyperhidrosis by disrupting the sympathetic nerve supply to the sweat glands. *Raynaud's disease* - **Raynaud's disease** involves episodic digital ischemia due to exaggerated vasoconstriction of peripheral arteries, often triggered by cold or stress. - Sympathectomy can reduce the frequency and severity of vasospastic attacks by interrupting the **vasoconstrictor sympathetic fibers** to the affected digits.
Question 6: In which one of the following is Branham's sign positive?
- A. Arterial stenosis
- B. Arteriovenous fistula (Correct Answer)
- C. Deep vein thrombosis
- D. Arterial aneurysm
Explanation: ***Arteriovenous fistula*** - **Branham's sign**, also known as Nicoladoni-Branham's sign, is characterized by a **sudden decrease in heart rate** upon compression of an arteriovenous fistula. - This occurs because *compression of the fistula increases systemic vascular resistance, leading to improved venous return and a reflex bradycardia* via vagal stimulation. *Arterial stenosis* - **Arterial stenosis** involves narrowing of an artery and does not typically present with Branham's sign. - While it may cause a **bruit** or **reduced pulse**, compressing the stenotic vessel would not lead to an immediate change in heart rate. *Deep vein thrombosis* - **Deep vein thrombosis (DVT)** is a blood clot in a deep vein, causing pain and swelling, but it is not associated with Branham's sign. - Compression in the area of a DVT would likely worsen pain or dislodge the clot, not alter heart rate in this manner. *Arterial aneurysm* - An **arterial aneurysm** is a localized bulging of an artery wall, which can pulsate but generally does not elicit Branham's sign upon compression. - Compressing an aneurysm could be dangerous and would not result in the reflex bradycardia seen with an arteriovenous fistula.
Question 7: The structures removed in radical neck dissection include: 1. Sternocleidomastoid muscle 2. Submandibular gland 3. Internal jugular vein 4. Accessory nerve
- A. 1 and 2 only
- B. 1 and 3 only
- C. 2 and 4 only
- D. 1, 2, 3 and 4 (Correct Answer)
Explanation: ***1, 2, 3 and 4*** - A **radical neck dissection** involves the removal of the **sternocleidomastoid muscle**, **internal jugular vein**, and **spinal accessory nerve (cranial nerve XI)**, along with all cervical lymph node groups from levels I to V, and the submandibular gland. - This extensive procedure is designed to achieve complete tumor clearance, particularly in cases of advanced head and neck cancers with suspected or confirmed nodal metastases. *1 and 2 only* - This option is incomplete as a radical neck dissection targets more structures than just the **sternocleidomastoid muscle** and **submandibular gland**. - While these two structures are removed, the procedure also extensively addresses major neurovascular structures and lymph nodes to ensure comprehensive cancer eradication. *1 and 3 only* - This option is incomplete because a radical neck dissection also involves the removal of the **submandibular gland** and the **accessory nerve**, in addition to the sternocleidomastoid muscle and internal jugular vein. - The goal is to clear all potential pathways of cancer spread in the neck. *2 and 4 only* - This option is incorrect as it omits other key structures removed in a radical neck dissection, such as the **sternocleidomastoid muscle** and the **internal jugular vein**. - These structures are critical components of the surgical field to adequately remove all affected tissues.
Question 8: The inflammatory breast carcinoma is staged as
- A. T4d (Correct Answer)
- B. T4c
- C. T1a
- D. T1b
Explanation: ***T4d*** - **Inflammatory breast carcinoma** is by definition a **T4d tumor** in the TNM staging system, regardless of tumor size. - This designation reflects the aggressive nature and characteristic features of erythema and edema involving a substantial portion of the breast. *T4c* - **T4c** refers to either **T4a** (chest wall invasion) and **T4b** (ulceration, edema, or skin nodules) combined. - While these can be features of advanced breast cancer, they do not specifically define inflammatory breast carcinoma. *T1a* - **T1a** describes a tumor size of **greater than 0.5 cm but not more than 1 cm** in greatest dimension. - Inflammatory breast carcinoma is not staged based on tumor size in this manner due to its diffuse nature. *T1b* - **T1b** describes a tumor size of **greater than 1 cm but not more than 2 cm** in greatest dimension. - Inflammatory breast carcinoma is characterized by diffuse involvement of the breast skin and does not fit into typical size-based T categories like T1b.
Question 9: Splenectomy is indicated in all of the following conditions, except
- A. Hydatid cyst of the spleen (Correct Answer)
- B. Hereditary spherocytosis
- C. Idiopathic thrombocytopenic purpura
- D. Myelofibrosis
Explanation: ***Hydatid cyst of the spleen*** - **Splenectomy** is generally **NOT indicated** as first-line treatment for uncomplicated **hydatid cysts** of the spleen. - The primary concern is the **risk of spillage of cyst contents**, which can lead to **anaphylactic shock** or **disseminated echinococcosis** (secondary hydatid disease). - **Conservative organ-preserving approaches** are strongly preferred, including **PAIR** (Puncture, Aspiration, Injection, Reaspiration, and Drainage) or **pericystectomy** (removing cyst with its pericyst while preserving spleen). - Splenectomy may only be considered in complicated cases (rupture, secondary infection, or inability to preserve spleen tissue), but it is NOT a routine indication. *Hereditary spherocytosis* - **Splenectomy** is the **definitive treatment** for **hereditary spherocytosis** to reduce hemolysis and alleviate symptoms like anemia, jaundice, and splenomegaly. - The spleen is the primary site of destruction of the abnormally shaped red blood cells, so its removal significantly prolongs red blood cell lifespan. - Typically performed after age 5-6 years to reduce infection risk. *Idiopathic thrombocytopenic purpura* - **Splenectomy** is indicated in cases of **chronic refractory ITP** that do not respond to medical therapy (e.g., corticosteroids, IVIG, rituximab). - The spleen is the primary site of **platelet destruction** and **autoantibody production** against platelets in ITP. - Splenectomy achieves remission in approximately 60-70% of patients with chronic ITP. *Myelofibrosis* - **Splenectomy** may be indicated in **myelofibrosis** for severe, symptomatic **splenomegaly** causing debilitating pain, early satiety, cachexia, or mechanical complications. - Also indicated for refractory cytopenias requiring frequent transfusions or severe portal hypertension. - It can alleviate pressure symptoms and reduce the metabolic demands of a massively enlarged spleen, improving quality of life.
Question 10: Which one of the following statements is true regarding "injection sclerotherapy" for haemorrhoids ?
- A. Injection of sclerosant is made above the dentate line (pectinate line) (Correct Answer)
- B. Sclerotherapy is the treatment of choice for the prolapsed haemorrhoids
- C. In patients with haemorrhoids at 3 o'clock, 7 o'clock and 11 o'clock positions, the injection is made in the sitting position
- D. Sclerotherapy is the ideal treatment for acute external haemorrhoids
Explanation: ***Injection of sclerosant is made above the dentate line (pectinate line)*** - Sclerotherapy involves injecting a **sclerosing agent** into the submucosa of internal hemorrhoids, specifically where they are **rich in blood vessels** and above the **pain-sensitive dentate line** to minimize discomfort. - Injecting above the dentate line helps to **avoid pain receptors** and induce fibrosis, which reduces blood flow and shrinks the hemorrhoid. *Sclerotherapy is the treatment of choice for the prolapsed haemorrhoids* - **Sclerotherapy** is generally effective for **Grade I and II internal hemorrhoids** that bleed but may not prolapse or prolapse only minimally. - For **prolapsed hemorrhoids (Grade III and IV)**, band ligation, excisional hemorrhoidectomy, or other surgical interventions are typically more effective. *In patients with haemorrhoids at 3 o'clock, 7 o'clock and 11 o'clock positions, the injection is made in the sitting position* - Injections for hemorrhoids are typically performed in the **left lateral (Sims') position** or **lithotomy position**, which provides optimal exposure and patient comfort. - The **sitting position** is not used for this procedure due to poor access and difficulty in maintaining a stable posture for the injection. *Sclerotherapy is the ideal treatment for acute external haemorrhoids* - **Sclerotherapy** is contraindicated for **external hemorrhoids** because they lie below the dentate line and are highly sensitive to pain. - Acute external hemorrhoids, especially if thrombosed, are usually managed with **excision of the thrombus** or conservative measures, not sclerotherapy.