UPSC-CMS 2018 - Surgery PYQs Practice Questions

Q: All of the following statements are correct about vasectomy EXCEPT:

It increases the incidence of testicular cancer. ***It increases the incidence of testicular cancer*** - Research has consistently shown **no causal link** between vasectomy and an increased risk of testicular cancer. - The reported incidence of testicular cancer in men who have undergone vasectomy is similar to that in the general population. *No Scalpel Vasectomy (NSV) was first developed in China.* - The **no-scalpel vasectomy (NSV)** technique was indeed developed in China by Dr. Li Shunqiang in 1974. - This method involves a smaller puncture incision rather than a traditional scalpel incision, leading to fewer complications. *It is less time consuming than tubectomy* - Vasectomy is generally a **simpler, less invasive, and quicker procedure** than tubectomy (female sterilization). - Tubectomy often requires general anesthesia and a more complex surgical approach, making it more time-consuming overall. *Addition contraception should be used for 3 months after vasectomy* - It takes approximately **3 months or 20 ejaculations** for all residual sperm to be cleared from the reproductive tract after a vasectomy. - Therefore, additional contraception is crucial during this period until a **sperm analysis (semen analysis)** confirms azoospermia (absence of sperm). [Practice more Surgery PYQs on OnCourse]

Q: Following are the factors for increased risk of wound infection EXCEPT:

Good blood supply. ***Good blood supply*** - A **robust blood supply** is crucial for wound healing as it delivers **oxygen, nutrients, and immune cells** to the injured site, actively preventing infection. - Good perfusion means that the tissues can effectively **clear bacteria** and support the local immune response, thereby **decreasing the risk** of wound infection. *Metabolic diseases (diabetes, uraemia)* - **Diabetes** impairs wound healing through mechanisms like **peripheral neuropathy**, **vasculopathy**, and compromised immune function, greatly increasing infection risk. - **Uraemia** in kidney failure leads to a buildup of toxins that can **suppress the immune system** and impair cellular function, making patients more susceptible to infections. *Immunosuppression* - **Immunosuppression**, whether due to chronic illness, medications (e.g., corticosteroids), or immunodeficiency, significantly **weakens the body's defense mechanisms**. - A compromised immune system is less able to **identify, target, and eliminate invading pathogens**, leading to a higher incidence of wound infections. *Malnutrition* - **Malnutrition**, particularly deficiencies in protein, vitamin C, and zinc, can severely **impair collagen synthesis**, immune function, and overall tissue repair. - Inadequate nutritional status hinders the body's ability to **mount an effective immune response** and regenerate tissues, creating an environment ripe for infection. [Practice more Surgery PYQs on OnCourse]

Q: A 22 year old young man came with history of occasional bleeding per rectum. On colonoscopy, numerous sessile polyps were seen in descending and sigmoid colon. On family history his elder brother was operated for thyroid malignancy. The young man should be advised:

Prophylactic panproctocolectomy. ***Prophylactic panproctocolectomy*** - This patient presents with multiple sessile polyps in the descending and sigmoid colon, along with a family history of **thyroid malignancy** in his brother. This constellation of findings is highly suggestive of **Familial Adenomatous Polyposis (FAP)**, specifically **Gardner syndrome**, which is a variant of FAP associated with extracolonic manifestations like thyroid tumors. - Due to the high risk of **colorectal cancer** development in FAP (nearly 100% by age 40 without intervention), **prophylactic panproctocolectomy** is the recommended treatment to prevent progression to malignancy. *Prophylactic anterior resection* - An anterior resection typically involves removing only a segment of the colon, which would be insufficient for a patient with FAP, as polyps can develop throughout the entire colon and rectum. - This procedure would leave a significant portion of the colon at risk for **neoplastic transformation**, necessitating further surgeries or intense surveillance. *Surveillance colonoscopy every 6 months* - While surveillance is crucial in risk assessment, for diagnosed FAP, particularly with symptomatic polyps and a family history suggestive of a syndrome, surveillance alone is inadequate due to the **high and inevitable risk of cancer**. - Delaying definitive surgical intervention would expose the patient to a very high probability of developing **colorectal carcinoma**. *Colonoscopic removal of all polyps* - Given the presence of **numerous sessile polyps**, endoscopic polypectomy would be impractical, incomplete, and would likely miss microscopic or nascent lesions. - This approach offers only temporary management and does not address the underlying genetic predisposition to continuous polyp formation and high malignancy risk. [Practice more Surgery PYQs on OnCourse]

Q: Gastric conduit after oesophageal resection is based upon:

Right Gastroepiploic artery. ***Right Gastroepiploic artery*** - The **right gastroepiploic artery** is the primary arterial supply preserved when fashioning a gastric conduit for esophageal replacement. - This artery provides the main blood supply to the **greater curvature of the stomach**, which forms the basis of the conduit, ensuring its viability. *Short gastric vessels and Vasa brevia* - The **short gastric vessels** are typically ligated and divided during gastric conduit creation to mobilize the stomach for upward transposition. - These vessels supply the fundus and upper part of the greater curvature, which are often either resected or lose their primary blood supply, making them unsuitable as the sole basis for the conduit. *Left gastric artery* - The **left gastric artery** is usually ligated during oesophageal resection to facilitate gastric mobilization and conduit creation. - It supplies the lesser curvature and upper part of the stomach, but its division is necessary to free the stomach for transposition into the chest or neck. *Right gastric artery* - The **right gastric artery** supplies the lesser curvature of the stomach and is often ligated or preserved with care, but it is not the primary vessel relied upon for the blood supply of the gastric conduit. - Its contribution to the overall conduit's blood supply is secondary to the robust flow from the right gastroepiploic artery. [Practice more Surgery PYQs on OnCourse]

Q: A 70 year old male having comorbidities presents with benign appearing parotid tumour. The best option is:

Superficial Parotidectomy. ***Superficial Parotidectomy*** - This is the **standard surgical treatment** for benign parotid tumors, even in elderly patients with comorbidities, as it offers the best balance of **low recurrence risk** and **preservation of facial nerve function**. - The procedure removes the superficial lobe of the parotid gland, where most benign tumors are located, and allows for **intraoperative facial nerve monitoring**. *Tumour enucleation* - This procedure has a **higher risk of tumor recurrence** as it does not remove a cuff of healthy tissue around the tumor. - It also has a greater chance of **facial nerve injury** due to the lack of clear dissection planes. *Radio therapy* - Radiotherapy is generally reserved for **malignant parotid tumors** or as an adjuvant therapy after incomplete resection of high-grade malignancies. - It carries risks of **xerostomia**, radiation-induced fibrosis, and potential secondary malignancies, making it less suitable for benign conditions. *Aspiration biopsy confirmation* - While an aspiration biopsy (Fine Needle Aspiration Cytology, FNAC) is crucial for **preoperative diagnosis**, it is not a treatment option. - It helps in planning the definitive surgical approach but does not address the tumor itself. [Practice more Surgery PYQs on OnCourse]

Question 1

All of the following statements are correct about vasectomy EXCEPT:

Accepted Answer

It increases the incidence of testicular cancer

Answer

No Scalpel Vasectomy (NSV) was first developed in China.

Answer

It is less time consuming than tubectomy

Answer

Additional contraception should be used for 3 months after vasectomy

Question 2

Following are the factors for increased risk of wound infection EXCEPT:

Accepted Answer

Good blood supply

Answer

Metabolic diseases (diabetes, uraemia)

Answer

Immunosuppression

Answer

Malnutrition

Question 3

A 22 year old young man came with history of occasional bleeding per rectum. On colonoscopy, numerous sessile polyps were seen in descending and sigmoid colon. On family history his elder brother was operated for thyroid malignancy. The young man should be advised:

Accepted Answer

Prophylactic panproctocolectomy

Answer

Prophylactic anterior resection

Answer

Surveillance colonoscopy every 6 months

Answer

Colonoscopic removal of all polyps

Question 4

Gastric conduit after oesophageal resection is based upon:

Accepted Answer

Right Gastroepiploic artery

Answer

Short gastric vessels and Vasa brevia

Answer

Left gastric artery

Answer

Right gastric artery

Question 5

A 70 year old male having comorbidities presents with benign appearing parotid tumour. The best option is:

Accepted Answer

Superficial Parotidectomy

Answer

Tumour enucleation

Answer

Radio therapy

Answer

Aspiration biopsy confirmation

Question 6

Mainstay of an accurate diagnosis of pancreatic injury following blunt abdominal trauma is:

Accepted Answer

Computed Tomogram

Answer

USG abdomen

Answer

MRI abdomen

Answer

Diagnostic peritoneal lavage

Question 7

Pancreatic pseudocysts developing complications are best managed by?

Accepted Answer

Surgery

Answer

Conservative treatment

Answer

Radiologically guided interventions

Answer

External drainage

Question 8

Which one of the following regarding absorbable meshes is NOT true?

Accepted Answer

They show very good results as collagen deposition is maximum

Answer

They are made of polyglycolic acid fibre

Answer

They are used to buttress sutured repair

Answer

They are used in temporary abdominal wall closure

Question 9

Which one of the following is NOT a surgical modality for management of femoral hernia?

Accepted Answer

The canal ring narrowing operation (Lytle’s)

Answer

Lotheissen's (Inguinal) operation

Answer

The low approach (Lockwood)

Answer

The high approach (Mc Evedy)

Question 10

“Triangle of Doom” dissected and seen during Laparoscopic inguinal hernia repair is bounded by all EXCEPT:

Accepted Answer

Peritoneal fold

Answer

Vas deferens

Answer

Gonadal vessels

Answer

Cord structures

UPSC-CMS 2018 — Surgery