UPSC-CMS 2013 - Surgery Practice Questions

Q: The treatment of choice for congenital hypertrophic pyloric stenosis is :

Ramstedt's operation. ***Ramsted's operation*** - **Ramstedt pyloromyotomy** is the definitive surgical treatment for **congenital hypertrophic pyloric stenosis**. - This procedure involves a longitudinal incision through the serosa and muscular layers of the hypertrophied pylorus, stopping short of the mucosa, to relieve the obstruction. *Duodenojejunostomy* - This procedure involves connecting the **duodenum to the jejunum**, typically performed to bypass an obstruction or resection in the distal duodenum or pancreas. - It is not indicated for **pyloric stenosis**, which is an obstruction at the gastric outlet. *Heller's operation* - Also known as **Heller myotomy**, this procedure is used to treat **achalasia**, a disorder affecting the esophagus. - It involves cutting the muscle fibers of the lower esophageal sphincter to facilitate food passage into the stomach, which is unrelated to **pyloric hypertrophy**. *Gastrojejunostomy* - This surgical procedure creates a connection between the **stomach and the jejunum**, bypassing the duodenum. - It is typically performed for conditions like **duodenal obstruction** or distal gastric tumors, not for primary pyloric muscle hypertrophy.

Q: Consider the following statements in respect of prostatic carcinoma : 1. Most originate from peripheral zone 2. Prostatic needle biopsy is better performed under trans rectal ultrasound 3. Prostate specific antigen is the specific test 4. L.H.R.H. analogues are used as medical treatment for metastatic disease Which of the statements given above is/are correct ?

1, 2 and 4. ***1, 2 and 4*** - **Most prostatic carcinomas originate from the peripheral zone** (approximately 70%), making this statement correct. This zone is palpable on digital rectal examination. - **Prostatic needle biopsy is indeed better performed under transrectal ultrasound (TRUS) guidance**, which allows for targeted and accurate sampling of suspicious areas. - **LHRH (Luteinizing Hormone-Releasing Hormone) analogues are a cornerstone of medical treatment for metastatic prostate cancer** as they suppress testosterone production, which fuels tumor growth. *1 and 3* - While statement 1 is correct (most prostate cancers originate from the peripheral zone), **prostate-specific antigen (PSA) is not a specific test** for prostate cancer. - **Elevated PSA can be caused by various conditions** such as benign prostatic hyperplasia (BPH), prostatitis, and even normal aging, making it a marker for prostate health rather than a definitive diagnostic test for cancer. *1 and 2 only* - Statements 1 and 2 are correct individually, but this option **incorrectly excludes statement 4**, which is also correct regarding the use of LHRH analogues in metastatic disease. - Therefore, this option is incomplete as it misses a true statement about prostate cancer management. *2, 3 and 4* - This option is incorrect because **statement 3 regarding PSA being a specific test is false**. - While PSA is used for screening and monitoring, its lack of specificity means it cannot definitively diagnose cancer.

Q: Regarding varicocele, all of the following are true except :

Varicosity of cremasteric veins. ***Varicosity of cremasteric veins*** - A varicocele is specifically the **dilation of the pampiniform plexus** of testicular veins, not the cremasteric veins. - The cremasteric veins are a separate venous system, and their varicosity is not what defines a varicocele. *May lead to infertility* - Varicoceles can **impair spermatogenesis** due to increased scrotal temperature and reflux of adrenal/renal metabolites, leading to reduced sperm count and motility. - This is a well-established complication and a common cause of **male factor infertility**. *Left side is affected usually* - The left side is more commonly affected because the **left testicular vein drains into the left renal vein** at a perpendicular angle, leading to higher hydrostatic pressure and a longer course. - The right testicular vein drains directly into the inferior vena cava (IVC) at an acute angle, which is less prone to reflux and dilation. *Feels like a bag of worms* - The characteristic palpation of a varicocele is described as a **"bag of worms"** due to the palpable dilated and tortuous veins within the pampiniform plexus. - This sensation is a key diagnostic clinical finding on physical examination.

Q: The most frequent complication of fracture pelvis is injury to :

membranous urethra. ***membranous urethra*** - The membranous (posterior) urethra is the **most frequently injured genitourinary structure** in pelvic fractures, occurring in **10-20% of major pelvic fractures** in males. - It is particularly vulnerable due to its **relatively fixed position** between the urogenital diaphragm and prostate, making it susceptible to shearing forces during anteroposterior compression or straddle-type injuries. - **Associated with pubic rami fractures and diastasis of the pubic symphysis** - the "pie in the sky" bladder sign on cystography suggests associated posterior urethral injury. - Clinical signs include **blood at the urethral meatus, high-riding prostate, and inability to void**. *urinary bladder* - Bladder injury occurs in approximately **5-10% of pelvic fractures**, making it less common than posterior urethral injuries. - Can present as **intraperitoneal rupture** (dome injury from increased intravesical pressure) or **extraperitoneal rupture** (base injury from bone fragments). - More common with pubic rami fractures, but still **less frequent than urethral injury overall**. *penile urethra* - Injury to the penile (anterior) urethra is **rarely associated with pelvic fractures** as it is mobile and not in direct proximity to pelvic bones. - More commonly injured by **straddle injuries, instrumentation, or direct penile trauma**. *rectum* - Rectal injury is a **rare complication** occurring in less than 1-5% of pelvic fractures. - Typically seen with **open pelvic fractures, open-book fractures with severe displacement**, or penetrating injuries where sharp bone fragments lacerate the rectum. - Much less common than genitourinary injuries.

Q: Burns involving the head and neck region are particularly dangerous because :

There may be thermal damage to the respiratory passage. ***There may be thermal damage to the respiratory passage*** - Burns to the **head and neck** often indicate exposure to heat or flame around the face, increasing the risk of inhaling hot air, smoke, or toxic fumes. - This can lead to **thermal damage** to the upper and lower **respiratory passages**, causing edema, airway obstruction, and acute respiratory distress. *Face is a very vascular area* - While the face is indeed **vascular**, this property primarily impacts **healing time** (often faster due to good blood supply) and the potential for swelling, but does not inherently make burns in this region "particularly dangerous" in the immediate, life-threatening sense compared to airway compromise. - The vascularity itself doesn't directly cause a unique danger that surpasses the risk of **airway obstruction** or systemic complications. *Renal failure is more frequent* - **Acute renal failure** can be a complication of severe burns due to hypovolemia, rhabdomyolysis, or sepsis, but it is not specific to burns of the head and neck region. - It is a systemic complication related to the overall burn severity and total body surface area (TBSA) involved, rather than the specific anatomical location of the burn. *Blood loss may be more severe* - Significant **blood loss** is not typically a direct primary concern in burn injuries unless there are associated trauma or very deep burns to highly vascular areas. - While fluid shifts in burns can be massive, initial blood loss is not the defining factor that makes head and neck burns particularly dangerous from a life-threatening perspective.

Q: Which method of vasectomy has the highest failure rate ?

Open ended vasectomy with granulation formation. ***Open ended vasectomy with granulation formation*** - This method involves either leaving the testicular end of the **vas deferens** open or allowing the formation of a **sperm granuloma**, which is believed to reduce post-vasectomy pain and congestion. - However, this approach carries a higher risk of **recanalization** and failure because sperm can potentially find a pathway through the granuloma or the open end, leading to unintended pregnancy. *Use of hemoclips with 1-4 cm gap after cutting proximal and distal ends* - The use of **hemoclips** with a significant gap (1-4 cm) between the clipped ends of the vas deferens is a common and generally effective method. - While failure is possible due to clip displacement or recanalization, the gap and mechanical obstruction provided by the clips make it more reliable than open-ended techniques. *Cutting and ligating vas to occlude the proximal and distal lumen* - **Cutting and ligating** both the proximal and distal ends of the vas deferens creates a clear physical barrier, preventing sperm transport. - This method is considered highly effective as it involves both severance and occlusion, significantly reducing the chance of recanalization. *Cutting the vas and turning the ends backwards and ligating with suture material* - This technique, often referred to as **fascial interposition** or burying the ends, involves cutting the vas, turning one or both ends back, and ligating them into the fascial sheath. - This creates an additional anatomical barrier, further separating the cut ends and making recanalization much more difficult, thus offering a very high success rate.

Question 1

A 32 year-old male patient presents in casualty department with history of RTA one hour back; on examination is found that BP is 90/50 mm Hg, pulse rate 110 beats per minute, with fracture left lower ribs, and generalized distension of abdomen with guarding and rigidity. He also complained of pain on the tip of the left shoulder. As a casualty Medical Officer you must exclude which one of the following clinical conditions on the primary basis ?

Accepted Answer

Splenic rupture

Answer

Cardiac tamponade

Answer

Rupture left lobe of liver

Answer

Intestinal perforation

Question 2

The treatment of choice for congenital hypertrophic pyloric stenosis is :

Accepted Answer

Ramstedt's operation

Answer

Duodenojejunostomy

Answer

Heller's operation

Answer

Gastrojejunostomy

Question 3

Consider the following statements in respect of prostatic carcinoma :

1. Most originate from peripheral zone
2. Prostatic needle biopsy is better performed under trans rectal ultrasound
3. Prostate specific antigen is the specific test
4. L.H.R.H. analogues are used as medical treatment for metastatic disease Which of the statements given above is/are correct ?

Accepted Answer

1, 2 and 4

Answer

1 and 3

Answer

1 and 2 only

Answer

2, 3 and 4

Question 4

Regarding varicocele, all of the following are true except :

Accepted Answer

Varicosity of cremasteric veins

Answer

May lead to infertility

Answer

Left side is affected usually

Answer

Feels like a bag of worms

Question 5

The most frequent complication of fracture pelvis is injury to :

Accepted Answer

membranous urethra

Answer

penile urethra

Answer

rectum

Answer

urinary bladder

Question 6

Burns involving the head and neck region are particularly dangerous because :

Accepted Answer

There may be thermal damage to the respiratory passage

Answer

Face is a very vascular area

Answer

Renal failure is more frequent

Answer

Blood loss may be more severe

Question 7

Which method of vasectomy has the highest failure rate ?

Accepted Answer

Open ended vasectomy with granulation formation

Answer

Use of hemoclips with 1-4 cm gap after cutting proximal and distal ends

Answer

Cutting and ligating vas to occlude the proximal and distal lumen

Answer

Cutting the vas and turning the ends backwards and ligating with suture material

UPSC-CMS 2013 — Surgery