UPSC-CMS 2017 - Surgery PYQs Practice Questions

Q: An eight year old male child complains of severe pain in right testis. The most probable diagnosis is

Torsion of right testis. ***Torsion of right testis*** - **Testicular torsion** typically presents with sudden onset **severe unilateral testicular pain** in pre-pubertal boys, as described. - This condition is an emergency requiring prompt surgical intervention to preserve testicular viability, making it the most probable diagnosis for severe pain in a child's testis. *Acute epididymo-orchitis* - While causing testicular pain, **epididymo-orchitis** typically has a more gradual onset and is often associated with symptoms like **fever** and **dysuria**, which are not mentioned. - It usually occurs in older adolescents or adults and is less common in an 8-year-old without predisposing factors like a urinary tract infection. *Strangulated Inguinal hernia* - A **strangulated inguinal hernia** would present with an acutely painful, irreducible groin or scrotal swelling, often accompanied by signs of **bowel obstruction**. - While it can cause pain radiating to the testis, primary severe testicular pain without a palpable groin mass points away from this diagnosis. *Undescended testis* - An **undescended testis** (cryptorchidism) is a condition where the testis has not descended into the scrotum; it typically presents as an empty scrotum or a palpable mass in the inguinal canal. - It is usually **painless** unless undergoing torsion or developing malignancy, and severe acute pain as the primary symptom would be unusual for an uncomplicated undescended testis. [Practice more Surgery PYQs on OnCourse]

Q: Which one of the following statements is NOT correct regarding Gastroschisis?

It is a ruptured exomphalos. ***It is a ruptured exomphalos*** - This statement is incorrect because **gastroschisis** and **exomphalos (omphalocele)** are distinct congenital abdominal wall defects, and gastroschisis is not a ruptured form of exomphalos. - Gastroschisis involves a **full-thickness abdominal wall defect** with direct extrusion of bowel, while exomphalos involves herniation of abdominal contents into the base of the umbilical cord, covered by a membrane. *Gut has herniated through a defect to right of umbilicus* - Gastroschisis is typically characterized by a **paraumbilical defect**, almost always located to the **right of the umbilical cord**. - This anatomical location is a key differentiator from exomphalos, where the defect is at the central umbilical ring. *Normally limited to midgut* - The herniated contents in gastroschisis are predominantly the **small bowel (midgut)**, though other organs like the large bowel, stomach, or liver can occasionally be involved. - The limited involvement of other organs is a differentiating factor from an exomphalos, which can contain a wider array of abdominal viscera. *There is no covering membrane* - A defining feature of gastroschisis is the **absence of a peritoneal sac or covering membrane** over the herniated intestines. - This lack of protection exposes the bowel to amniotic fluid, leading to inflammation and a thickened, matted appearance of the bowel loops. [Practice more Surgery PYQs on OnCourse]

Q: Heineke‐Mikulicz operation is done for:

Pyloric stenosis. ***Pyloric stenosis*** - The Heineke-Mikulicz pyloroplasty is a surgical procedure specifically designed to relieve obstruction in cases of **pyloric stenosis**. - This operation involves a **longitudinal incision** of the pylorus followed by a **transverse closure**, effectively widening the pyloric channel. *Ureteric stricture* - Ureteric strictures are typically treated with procedures like **ureteroplasty** (e.g., using a Foley Y-V plasty for ureteropelvic junction obstruction) or ureteral stenting, not the Heineke-Mikulicz operation. - The Heineke-Mikulicz technique is not anatomically or functionally suitable for the repair of a ureter, which is a muscular tube with distinct functions. *Urethral stricture* - Urethral strictures are managed by **urethroplasty**, which includes various techniques such as excision and primary anastomosis, or augmentation using grafts (e.g., buccal mucosa). - The Heineke-Mikulicz technique is not employed for the treatment of urethral strictures, which have different anatomical and surgical considerations. *Stricture common bile duct* - Common bile duct strictures are usually treated with procedures like **choledochoduodenostomy** or **choledochojejunostomy** (bile duct bypass) or endoscopic techniques like balloon dilation and stent placement. - The Heineke-Mikulicz operation is a pyloroplasty that is not applicable to the common bile duct, given its different anatomical location and physiological role. [Practice more Surgery PYQs on OnCourse]

Q: A 32 year old female underwent laparoscopic cholecystectomy which was difficult. On her second post operative day, she develops jaundice. Her LFT parameters show serum bilirubin 6.8 mg/dL; direct bilirubin 5.6 and indirect bilirubin 1.2 mg/dL; and serum alkaline phosphatase 1226 IU/L. She is most likely suffering from obstructive jaundice due to:

Bile duct injury. ***Bile duct injury*** - The patient developed jaundice two days after a "difficult" laparoscopic cholecystectomy, which is a common context for **iatrogenic bile duct injury**. - The lab results show **predominantly direct (conjugated) hyperbilirubinemia** and a significantly **elevated alkaline phosphatase**, highly indicative of extrahepatic **obstructive jaundice**. *Hepatocellular carcinoma* - This is unlikely given the **acute onset of jaundice** two days post-surgery; hepatocellular carcinoma typically presents with a more ** insidious onset** and features of chronic liver disease. - While it can cause obstructive jaundice, it is usually due to large masses compressing bile ducts or tumor thrombus in the portal vein, which doesn't fit the immediate postoperative timing. *Carcinoma gallbladder* - Gallbladder carcinoma can cause obstructive jaundice by invading or compressing the bile ducts, but it usually presents with more **chronic symptoms** and is rare in a 32-year-old. - The acute onset immediately following surgery makes an **iatrogenic cause** much more probable than a newly diagnosed cancer. *Carcinoma head of pancreas* - Pancreatic head carcinoma causes **obstructive jaundice** by compressing the common bile duct, but similar to other cancers, it presents more chronically with **weight loss**, **abdominal pain**, and potentially **pancreatitis**. - An acute presentation **post-cholecystectomy** in a young patient is not typical for this diagnosis. [Practice more Surgery PYQs on OnCourse]

Q: A 23-year-old male riding his motorcycle meets with a road accident. He is tachypnoeic with HR 110/min and BP 112/74 mmHg. On examination, he appears pale and has tenderness over the left side of chest with dullness to percussion. There is slight mediastinal shift to the opposite side. Abdominal examination is unremarkable. Most probably he is suffering from:

Haemothorax. **Haemothorax** - **Dullness to percussion** on the left side of the chest, combined with symptoms of **hypovolemia** (pale, HR 110/min, BP 112/74 mmHg), strongly suggests blood accumulation in the pleural space. - **Slight mediastinal shift** to the opposite side is consistent with a large volume of blood pushing the mediastinum, though it's typically more pronounced in tension pneumothorax. *Tension pneumothorax* - Characterized by **hyperresonance** to percussion, not dullness, as air accumulates in the pleural space. - Would present with marked **tracheal deviation**, **severe respiratory distress**, and often severe hypotension due to impaired cardiac output. *Subcutaneous emphysema* - Identified by **crepitus** (crackling sensation) on palpation due to air in the subcutaneous tissues. - While it can be associated with chest trauma, it does not explain the dullness to percussion or the systemic signs of blood loss. *Tracheal rupture* - Typically presents with **severe subcutaneous emphysema**, **dyspnea**, **hoarseness**, and possibly a **pneumomediastinum**. - Does not directly cause dullness to percussion in the pleural space or explain the significant signs of blood loss. [Practice more Surgery PYQs on OnCourse]

Question 1

An eight year old male child complains of severe pain in right testis. The most probable diagnosis is

Accepted Answer

Torsion of right testis

Answer

Acute epididymo-orchitis

Answer

Strangulated Inguinal hernia

Answer

Undescended testis

Question 2

Which one of the following statements is NOT correct regarding Gastroschisis?

Accepted Answer

It is a ruptured exomphalos

Answer

Gut has herniated through a defect to right of umbilicus

Answer

Normally limited to midgut

Answer

There is no covering membrane

Question 3

Heineke‐Mikulicz operation is done for:

Accepted Answer

Pyloric stenosis

Answer

Ureteric stricture

Answer

Urethral stricture

Answer

Stricture common bile duct

Question 4

A 32 year old female underwent laparoscopic cholecystectomy which was difficult. On her second post operative day, she develops jaundice. Her LFT parameters show serum bilirubin 6.8 mg/dL; direct bilirubin 5.6 and indirect bilirubin 1.2 mg/dL; and serum alkaline phosphatase 1226 IU/L. She is most likely suffering from obstructive jaundice due to:

Accepted Answer

Bile duct injury

Answer

Hepatocellular carcinoma

Answer

Carcinoma gallbladder

Answer

Carcinoma head of pancreas

Question 5

A 23-year-old male riding his motorcycle meets with a road accident. He is tachypnoeic with HR 110/min and BP 112/74 mmHg. On examination, he appears pale and has tenderness over the left side of chest with dullness to percussion. There is slight mediastinal shift to the opposite side. Abdominal examination is unremarkable. Most probably he is suffering from:

Accepted Answer

Haemothorax

Answer

Tension pneumothorax

Answer

Subcutaneous emphysema

Answer

Tracheal rupture

Question 6

Mondor’s disease is

Accepted Answer

Thrombophlebitis of superficial veins of breast

Answer

Multiple breast cysts

Answer

Eczema of nipple and areola

Answer

Lymphangitis of mammary lymphatics

Question 7

Anderson‐Hynes operation is performed for:

Accepted Answer

Pelvi-ureteric junction obstruction

Answer

Pseudo-pancreatic cyst

Answer

Achalasia cardia

Answer

Pyloric stenosis

Question 8

Which one of the following is the most important selection criteria for obesity surgery?

Accepted Answer

BMI > 40

Answer

BMI 35 without any co-morbid disease

Answer

BMI 30 with co-morbid disease

Answer

BMI 30

Question 9

A 45 year old underwent surgery for rectal prolapse. At present, he complains of sexual dysfunction which is probably due to the injury of:

Accepted Answer

Pelvic autonomic nerves

Answer

Urinary bladder

Answer

Rectum

Answer

Inferior mesenteric artery

Question 10

A 40 year old man, with a history of a reducible left groin swelling of two years, comes with severe pain over left groin. The swelling is now non-reducible and is very tender to touch. The most probable treatment plan for this patient would be:

Accepted Answer

Prepare for emergency surgery

Answer

Hot fomentation of groin area

Answer

Oral antibiotics

Answer

Continue conservative management

UPSC-CMS 2017 — Surgery