UPSC-CMS 2016 - Surgery Practice Questions

Q: In a case of obstructed hernia, strangulation is suggested by which of the following? 1. Presence of shock 2. Pain is never completely absent 3. Localised tenderness is associated with rebound tenderness 4. Pain persists despite conservative management 5. An external hernia becomes tense, tender, irreducible, with recent increase in size Select the correct answer using the code given below:

1, 2, 3, 4 and 5. ***1, 2, 3, 4 and 5*** - All listed options (presence of **shock**, persistent pain, **localized and rebound tenderness**, failure of conservative management, and a **tense, tender, irreducible hernia** with recent size increase) are classic indicators of **hernia strangulation**. - **Strangulation** is a surgical emergency where the blood supply to the herniated tissue is compromised, leading to **ischemia** and potential **necrosis**, requiring immediate intervention. *1, 2, 4 and 5 only* - This option incorrectly omits **localized tenderness associated with rebound tenderness**, which is a crucial sign of peritoneal irritation and impending or established strangulation. - While other signs are accurate, the absence of this specific finding makes the option incomplete for a comprehensive understanding of strangulation. *1, 2, 3, 4 only* - This option misses the critical clinical sign of an **external hernia becoming tense, tender, irreducible, with a recent increase in size**, which is a direct and often visible sign of strangulation. - The physical examination findings of the hernia itself are paramount in diagnosing strangulation. *1, 3 and 5 only* - This option omits two significant indicators: **pain is never completely absent** (implying continuous, severe pain) and **pain persists despite conservative management**. - Continuous pain and refractoriness to treatment highlight the progressive and severe nature of strangulation.

Q: Which one of the following structures is not removed during a classical radical neck dissection?

Trapezius. ***Trapezius*** - The **trapezius muscle** is consistently spared (not removed) in a classical radical neck dissection, although it becomes non-functional due to sacrifice of its motor nerve supply. - While the muscle remains anatomically in place, removal of the **accessory nerve** leads to denervation of the trapezius, causing severe shoulder dysfunction including **shoulder drop** and inability to abduct the arm past 90 degrees. *Accessory nerve* - The **accessory nerve (cranial nerve XI)** is sacrificed in a classical radical neck dissection to ensure complete removal of lymphatic tissue and metastatic disease. - Its removal results in **denervation and paralysis of the trapezius muscle**, leading to shoulder weakness, shoulder drop, and limited shoulder abduction. - The accessory nerve also innervates the sternocleidomastoid, though this muscle is removed in the procedure. *Sternocleidomastoid* - The **sternocleidomastoid muscle** is removed in a classical radical neck dissection for oncological clearance, as lymph nodes closely associated with it can harbor metastatic disease. - Its removal contributes to cosmetic defect and can affect neck contour and mobility. *Internal jugular vein* - The **internal jugular vein** is resected during a classical radical neck dissection to achieve en bloc removal of lymphatic tissue in levels II, III, and IV, which often contain metastatic disease. - Its removal can lead to **venous congestion** in the head and neck initially, although collateral circulation through the external jugular and vertebral venous systems usually develops over time.

Q: Mousseau-Barbin Tube (M.B.Tube) is used for:

Advanced cancer oesophagus. ***Advanced cancer oesophagus*** - The **Mousseau-Barbin tube** is a type of **endoscopic stent** used for palliative management of **dysphagia** caused by advanced **oesophageal cancer**. - It provides a lumen through obstructed oesophageal segments, allowing patients to swallow food and liquids more easily. *Advanced cancer oropharynx* - While dysphagia can be a symptom of oropharyngeal cancer, the Mousseau-Barbin tube is specifically designed for placement within the **oesophagus**. - Management for advanced oropharyngeal cancer often involves other interventions like **radiotherapy**, **chemotherapy**, or **surgical resection**. *All of these* - This option is incorrect because the Mousseau-Barbin tube has a specific application for the **oesophagus**. - It is not routinely used for cancers of the oropharynx or stomach due to differences in anatomical location and disease progression. *Advanced cancer stomach* - Advanced stomach cancer, particularly in the distal stomach, would not typically benefit from an oesophageal stent. - Gastric outlet obstruction can occur, but specific **gastric stents** or **surgical bypasses** are used for this.

Q: Consider the following statements: 1. Carbon dioxide is the safest gas for creating pneumoperitoneum in operative laparoscopy. 2. Laparoscopic sterilization is not recommended during the period of immediate postpartum. Which of the statements given above is/are correct?

Both 1 and 2. ***Both 1 and 2*** - **Carbon dioxide (CO2)** is the safest gas for creating pneumoperitoneum due to its **rapid absorption** and **excretion** by the body, minimizing the risk of gas embolism and tissue toxicity. - Laparoscopic sterilization is generally **not recommended during the immediate postpartum period** (first 6-8 weeks) due to the **enlarged uterus**, increased vascularity, and altered anatomy, which elevate the risk of complications such as hemorrhage and organ perforation. *1 only* - While carbon dioxide is indeed the safest gas for pneumoperitoneum, this option is incorrect because the second statement regarding postpartum sterilization is also accurate. - Selecting this option would imply that statement 2 is false, which is not the case. *Neither 1 nor 2* - This option is incorrect because both statements are clinically accurate and accepted practices in operative laparoscopy and postpartum care. - Both statements reflect standard surgical and obstetric guidelines. *2 only* - This option is incorrect because, in addition to the second statement being true, the first statement (regarding the safety of CO2 for pneumoperitoneum) is also correct. - Choosing this option would suggest that CO2 is not the safest gas, which contradicts established medical practice.

Q: Which of the following suture materials has the least tissue reaction?

Stainless steel. ***Stainless steel*** - **Stainless steel** is a **monofilament** suture with the **lowest tissue reactivity** due to its inert nature. - It is often used in situations requiring maximal strength and minimal biological interaction, such as abdominal wall closure or orthopedic procedures. *Silk* - **Silk** is a **multifilament, natural, non-absorbable** suture and is known for its **moderate tissue reactivity** due to its braided structure and organic origin. - While it provides good knot security, its reactivity makes it unsuitable for areas where minimal foreign body reaction is paramount. *Cotton / Linen* - **Cotton and linen** sutures are **natural, multifilament, non-absorbable** materials that exhibit significant **tissue reactivity**. - Their fibrous nature can lead to considerable inflammatory response and are rarely used in modern surgical practice. *Chromic catgut* - **Chromic catgut** is a **natural, absorbable** suture treated with chromium salts to prolong its absorption time, but it still triggers a **significant inflammatory response** as it is absorbed by enzymatic digestion. - Its high tissue reactivity makes it less ideal for situations requiring minimal foreign body reaction compared to synthetic or metallic sutures.

Question 1

In a case of obstructed hernia, strangulation is suggested by which of the following?

1. Presence of shock
2. Pain is never completely absent
3. Localised tenderness is associated with rebound tenderness
4. Pain persists despite conservative management
5. An external hernia becomes tense, tender, irreducible, with recent increase in size

Select the correct answer using the code given below:

Accepted Answer

1, 2, 3, 4 and 5

Answer

1, 2, 4 and 5 only

Answer

1, 2, 3, 4 only

Answer

1, 3 and 5 only

Question 2

Which one of the following structures is not removed during a classical radical neck dissection?

Accepted Answer

Trapezius

Answer

Accessory nerve

Answer

Sternocleidomastoid

Answer

Internal jugular vein

Question 3

Mousseau-Barbin Tube (M.B.Tube) is used for:

Accepted Answer

Advanced cancer oesophagus

Answer

Advanced cancer oropharynx

Answer

All of these

Answer

Advanced cancer stomach

Question 4

Consider the following statements:

1. Carbon dioxide is the safest gas for creating pneumoperitoneum in operative laparoscopy.
2. Laparoscopic sterilization is not recommended during the period of immediate postpartum. Which of the statements given above is/are correct?

Accepted Answer

Both 1 and 2

Answer

1 only

Answer

Neither 1 nor 2

Answer

2 only

Question 5

Which of the following suture materials has the least tissue reaction?

Accepted Answer

Stainless steel

Answer

Silk

Answer

Cotton / Linen

Answer

Chromic catgut

UPSC-CMS 2016 — Surgery