UPSC-CMS 2014 - Surgery PYQs Practice Questions

Q: Indications of TURP for Benign Prostatic Hyperplasia (BPH) include: 1. Urinary flow rate of less than 10 mL/second 2. Residual volume of urine >100 mL 3. Serum level of prostatic specific antigen >10 ng/mL 4. Trabeculated Urinary bladder Select the correct answer using the code given below:

1, 2 and 4. ***1, 2 and 4*** - Urinary flow rate ** 100 mL**, and the presence of a **trabeculated bladder** (indicating chronic bladder outlet obstruction) are all relevant indications for considering TURP in BPH. - These findings collectively suggest significant **obstruction** and potential complications of BPH that may warrant surgical intervention. *2, 3 and 4* - This option incorrectly includes a **PSA level > 10 ng/mL** as an indication for TURP, which is primarily a marker for **prostate cancer screening** and not a direct surgical indication for BPH. - While an elevated PSA might prompt further investigation (e.g., biopsy), it doesn't alone necessitate TURP for BPH symptoms. *1, 2 and 3* - This option also incorrectly includes **PSA level > 10 ng/mL** as an indication for TURP. - The other two points (low flow rate and high residual volume) are appropriate indications, but the inclusion of PSA makes this option incorrect. *1, 3 and 4* - This option includes **PSA level > 10 ng/mL** as an indication for TURP, which is incorrect. - Additionally, it omits **residual urine volume > 100 mL**, which is a significant indicator of obstruction and a common reason for considering TURP. [Practice more Surgery PYQs on OnCourse]

Q: Tongue fixation in a patient with carcinoma tongue is staged as

T4. ***T4*** - **Tongue fixation** in carcinoma of the tongue indicates advanced local disease classified as **T4a stage** according to AJCC TNM staging. - This finding suggests invasion of **extrinsic tongue muscles**, which causes loss of tongue mobility and represents moderately advanced local disease. - T4a tumors invade through cortical bone, involve the inferior alveolar nerve, floor of mouth, or skin of face, or in the case of tongue, involve deep extrinsic muscles causing fixation. *T1* - **T1 tumors** are small lesions measuring **≤2 cm** in greatest dimension with **depth of invasion (DOI) ≤5 mm**. - They are superficial without invasion of deep structures or causing any functional impairment like tongue fixation. *T2* - **T2 tumors** measure **≤2 cm with DOI >5 mm and ≤10 mm**, OR **>2 cm but ≤4 cm with DOI ≤10 mm**. - While larger than T1, they do not involve deep extrinsic muscles or cause tongue fixation. *T3* - **T3 tumors** are defined as tumors **>4 cm** OR **any tumor with DOI >10 mm**. - Although T3 indicates larger tumor size and deeper invasion, **tongue fixation** specifically indicates T4a stage due to involvement of extrinsic tongue musculature. [Practice more Surgery PYQs on OnCourse]

Q: Which of the following are contraindications to salvaging accidentally injured spleen during operation? 1. Labile blood pressure 2. Presence of intraperitoneal infection 3. Pre-existing splenic disease 4. Age below 50 years Select the correct answer using the code given below:

1, 2 and 3. ***1, 2 and 3*** - **Labile blood pressure** (1) indicates ongoing hemodynamic instability, making splenic salvage risky due to the potential for further hemorrhage and the need for immediate control. - **Presence of intraperitoneal infection** (2) makes splenic salvage dangerous as the injured spleen provides a niche for bacterial proliferation, increasing the risk of abscess formation and sepsis. - **Pre-existing splenic disease** (3) such as lymphoma or significant architectural changes, can compromise the spleen's integrity and function, making successful and safe salvage unlikely. *1, 3 and 4* - This option incorrectly includes age below 50 years as a contraindication. **Age below 50 years** (4) is generally not a contraindication to splenic salvage; in fact, younger patients, especially children, often have a greater imperative for splenic preservation due to higher risks of **overwhelming post-splenectomy infection (OPSI)**. - While choices 1 and 3 are correct contraindications, choice 4 is not. *2, 3 and 4* - This option incorrectly includes age below 50 years as a contraindication. **Labile blood pressure** (1) is a critical contraindication but is omitted. - Choices 2 and 3 are valid contraindications, but excluding the crucial factor of hemodynamic instability makes this option incomplete. *1, 2 and 4* - This option correctly identifies **labile blood pressure** (1) and **intraperitoneal infection** (2) as contraindications but incorrectly includes **age below 50 years** (4). - It also omits **pre-existing splenic disease** (3), which is another significant reason to avoid salvage. [Practice more Surgery PYQs on OnCourse]

Q: Treatment of choice for annular pancreas is

Duodenoduodenostomy. ***Duodenoduodenostomy*** - This procedure bypasses the **annular pancreatic constriction** by creating an anastomosis between two healthy segments of the **duodenum**, restoring normal flow. - It's preferred because it avoids manipulation or resection of the pancreatic tissue itself, which can lead to complications such as **pancreatitis** or **fistula formation**. *Resection* - Direct resection of the **annular pancreas** is generally avoided due to the high risk of **pancreatitis**, **fistulae**, and injury to the **biliary duct** or **main pancreatic duct**. - The abnormal pancreatic tissue is often intimately associated with the **duodenal wall**, making its complete removal difficult and dangerous. *Pyloromyotomy* - This procedure involves incising the muscle layer of the **pylorus** and is typically used for conditions like **pyloric stenosis**. - It does not address the obstruction caused by an annular pancreas around the **duodenum**. *Gastrojejunostomy* - This procedure involves creating a connection between the **stomach** and the **jejunum** to bypass a distal duodenal or pyloric obstruction. - While it can relieve gastric outlet obstruction, it does not directly address the obstruction in the **proximal duodenum** caused by an **annular pancreas**. [Practice more Surgery PYQs on OnCourse]

Question 1

Indications of TURP for Benign Prostatic Hyperplasia (BPH) include:

1. Urinary flow rate of less than 10 mL/second
2. Residual volume of urine >100 mL
3. Serum level of prostatic specific antigen >10 ng/mL
4. Trabeculated Urinary bladder

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Answer

1, 3 and 4

Question 2

Tongue fixation in a patient with carcinoma tongue is staged as

Accepted Answer

T4

Answer

T1

Answer

T2

Answer

T3

Question 3

The following procedures are recommended for palliation in a patient with obstructive jaundice due to unresectable carcinoma of head of pancreas except:

Accepted Answer

Choledochoduodenostomy, gastrojejunostomy with pancreaticojejunostomy

Answer

Cholecystojejunostomy with jejunojejunostomy with gastrojejunostomy

Answer

Hepaticojejunostomy with gastrojejunostomy

Answer

Choledochoduodenostomy with gastrojejunostomy

Question 4

Which of the following are contraindications to salvaging accidentally injured spleen during operation?

1. Labile blood pressure
2. Presence of intraperitoneal infection
3. Pre-existing splenic disease
4. Age below 50 years

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 4

Question 5

Treatment of choice for annular pancreas is

Accepted Answer

Duodenoduodenostomy

Answer

Resection

Answer

Pyloromyotomy

Answer

Gastrojejunostomy

Question 6

In a patient of gastric outlet obstruction nutritional support is best delivered by:

Accepted Answer

Jejunostomy

Answer

Enteral nutrition by Ryles tube

Answer

Gastrostomy

Answer

Parenteral nutrition

Question 7

The following nerves are blocked for repairing inguinal hernia by local anaesthetic except:

Accepted Answer

Femoral

Answer

Ilio-inguinal

Answer

Genito-femoral

Answer

Ilio-hypogastric

Question 8

Traumatic haemothorax is best managed by:

Accepted Answer

Intercostal tube drainage

Answer

Use of streptokinase

Answer

Open drainage

Answer

Aspiration of blood from pleural cavity

Question 9

Which of the following statements about mesh skin grafts is not correct?

Accepted Answer

They contract to the same degree as a grafted sheet of skin.

Answer

They allow egress of fluid collections under the graft.

Answer

They permit coverage of large areas.

Answer

They “take” satisfactorily on granulating bed.

Question 10

The following operative procedure can result in neurogenic voiding dysfunction except:

Accepted Answer

Ureterolithotomy

Answer

Radical hysterectomy

Answer

Abdominoperineal resection

Answer

Retroperitoneal lymph node dissection

UPSC-CMS 2014 — Surgery