UPSC-CMS 2013 - Surgery PYQs Practice Questions

Q: The surgical complications of typhoid fever include all of the following except :

Acute pancreatitis. ***Acute pancreatitis*** - While typhoid fever can rarely involve the pancreas, **acute pancreatitis** is **not** considered a typical *surgical complication* of typhoid fever. - Pancreatic involvement, when it occurs, is generally mild and does not require surgical intervention. - This is the correct answer as it is NOT a recognized surgical complication. *Splenic abscess* - **Splenic abscess** is a rare but recognized complication of typhoid fever, resulting from hematogenous spread. - When present, it may require **percutaneous drainage** or **splenectomy** due to the risk of rupture. - Note: More common splenic manifestation is splenomegaly, not abscess. *Acute cholecystitis* - **Acute cholecystitis** is a well-recognized surgical complication of typhoid fever. - The gallbladder can serve as a chronic reservoir for **Salmonella Typhi**, leading to inflammation and stone formation. - This may require **cholecystectomy** in severe or recurrent cases. *Perforation peritonitis* - **Intestinal perforation**, particularly of the **terminal ileum**, is the **most common and serious** surgical complication of typhoid fever. - Occurs in approximately **1-3%** of cases, typically in the 2nd-3rd week of illness. - This leads to **peritonitis**, a life-threatening condition requiring **urgent laparotomy and surgical repair**. [Practice more Surgery PYQs on OnCourse]

Q: Treatment of choice for acute femoral artery embolism is :

Immediate embolectomy. ***Immediate embolectomy*** - **Acute femoral artery embolism** is a medical emergency that requires prompt intervention to restore blood flow and prevent limb ischemia. - **Early surgical embolectomy** is the treatment of choice to physically remove the clot and immediately re-establish perfusion. *Warfarin* - **Warfarin** is an anticoagulant used for *long-term prevention* of future embolic events, but it is not effective for acute clot removal. - Its therapeutic effect is delayed, making it unsuitable for the immediate treatment of an acute embolism. *Embolectomy after rest for few days* - Delaying embolectomy for several days would lead to **irreversible tissue damage** and potential limb loss due to prolonged ischemia. - Time is critical in acute arterial occlusions, and immediate intervention is paramount. *Heparin* - **Heparin** is an anticoagulant used to *prevent further clot propagation* and reduce the risk of re-embolization. - While it can be initiated as an adjunct, it does not dissolve the existing embolus quickly enough to be the sole treatment for an acute limb-threatening obstruction. [Practice more Surgery PYQs on OnCourse]

Q: The most common early sign of increasing intracranial pressure in the victim of head injury is :

Change of level of consciousness. ***Change of level of consciousness*** - A **deterioration in the level of consciousness** is often the earliest and most sensitive indicator of increasing intracranial pressure (ICP) following a head injury. - This change can manifest as **confusion, lethargy, drowsiness, or difficulty arousing** the patient. *Contralateral pupillary dilation* - **Contralateral pupillary dilation** typically occurs later in the progression of increased ICP, often indicating brainstem compression. - This sign suggests a more advanced and severe stage of brain herniation. *Ipsilateral pupillary dilatation* - **Ipsilateral pupillary dilation** is a classic sign of **uncal herniation**, which occurs as increased ICP pushes the temporal lobe. - While a critical sign, it is generally not the earliest indicator and suggests significant mass effect on the oculomotor nerve. *Hemiparesis* - **Hemiparesis**, or weakness on one side of the body, is a **focal neurological deficit** that can result from direct brain injury or compression. - It usually appears later than changes in the level of consciousness and may not be the initial symptom of rising ICP, especially if the pressure increase is diffuse. [Practice more Surgery PYQs on OnCourse]

Q: Surgical treatment for a 40-years old lady with 3 x 3 cm. papillary carcinoma thyroid with level III enlarged lymph nodes is :

Total thyroidectomy with functional neck dissection. ***Total thyroidectomy with functional neck dissection*** - For **papillary thyroid carcinoma** with **level III lymph node involvement**, the standard approach is **total thyroidectomy** with **therapeutic lateral neck dissection** (functional/modified radical neck dissection). - **Level III nodes** are part of the **lateral compartment** (levels II-IV), requiring formal **compartment-oriented dissection** rather than selective node excision for adequate oncological clearance. *Total thyroidectomy with excision of involved nodes* - **"Excision of involved nodes"** is not standard terminology in thyroid surgery and **"berry-picking"** individual nodes is generally not recommended for therapeutic purposes. - **Compartment-oriented dissection** is preferred over selective node removal as it provides better oncological outcomes and staging accuracy. *Total thyroidectomy with radical neck dissection* - **Radical neck dissection** involves removal of cervical lymph node levels I-V along with the **sternocleidomastoid muscle**, **internal jugular vein**, and **spinal accessory nerve**. - This extensive procedure is reserved for cases with **extensive extranodal extension** or when these structures are directly involved, causing significant morbidity. *Total thyroidectomy with post-operative radio-iodine ablation* - **Radioiodine ablation** is an **adjuvant therapy** used after thyroidectomy to destroy remaining thyroid tissue and microscopic disease. - This option doesn't address the **surgical management** of enlarged lymph nodes, which is specifically what the question asks about. [Practice more Surgery PYQs on OnCourse]

Question 1

A 25-year-old patient has 5 x 5 cm amoebic abscess in right lobe of liver. He is febrile and has pain in right hypochondrium. His primary management would include:

Accepted Answer

Ultra-sound guided placement of pigtail catheter

Answer

Laparotomy and drainage

Answer

Administration of antibiotic and observation

Answer

Ultra-sound guided aspiration

Question 2

The surgical complications of typhoid fever include all of the following except :

Accepted Answer

Acute pancreatitis

Answer

Splenic abscess

Answer

Acute cholecystitis

Answer

Perforation peritonitis

Question 3

Treatment of choice for acute femoral artery embolism is :

Accepted Answer

Immediate embolectomy

Answer

Warfarin

Answer

Embolectomy after rest for few days

Answer

Heparin

Question 4

The most common early sign of increasing intracranial pressure in the victim of head injury is :

Accepted Answer

Change of level of consciousness

Answer

Contralateral pupillary dilation

Answer

Ipsilateral pupillary dilatation

Answer

Hemiparesis

Question 5

Surgical treatment for a 40-years old lady with 3 x 3 cm. papillary carcinoma thyroid with level III enlarged lymph nodes is :

Accepted Answer

Total thyroidectomy with functional neck dissection

Answer

Total thyroidectomy with radical neck dissection

Answer

Total thyroidectomy with post-operative radio-iodine ablation

Answer

Total thyroidectomy with excision of involved nodes

Question 6

Splenectomy is best indicated for :

Accepted Answer

Hereditary spherocytosis

Answer

Cirrhosis liver with portal hypertension

Answer

Sickle cell disease

Answer

Gaucher's disease

Question 7

A retained stone in CBD (common bile duct) diagnosed by T-tube cholangiogram is best treated by :

Accepted Answer

Endoscopic papillotomy

Answer

Re-exploration of common bile duct

Answer

Extra corporeal shock wave lithotripsy

Answer

Dissolution therapy

Question 8

All of the following statements regarding gallstones are true except :

Accepted Answer

They are mostly radio opaque

Answer

They can cause intestinal obstruction

Answer

They can lead to acute cholangitis by slipping into the common bile duct

Answer

Mixed stones are the commonest type

Question 9

A 65-year-old patient presents with obstructive jaundice and 15 kg weight loss. An ultrasound shows a 4 cm mass in the head of the pancreas with dilated bile ducts. Further work up includes a helical CT scan. The study shows several lesions consistent with metastasis in the right and left lobes of the liver and encasement of gastroduodenal artery. The most appropriate treatment would be:

Accepted Answer

Endoscopic stenting of bile duct

Answer

Total pancreatectomy

Answer

Biliary and gastric bypass

Answer

Pancreaticoduodenectomy (Whipple procedure)

Question 10

Laparoscopic instruments are best sterilized by :

Accepted Answer

Autoclaving

Answer

Ethylene oxide

Answer

Hot air oven

Answer

2% Glutaraldehyde

UPSC-CMS 2013 — Surgery