Paralytic ileus is a type of:
Indication of Coronary artery bypass grafting (CABG) is:
Which one of the following regarding abdominal pediatric surgery is correct?
Allen's test is used in cardiac surgery for:
In a lateral facial wound, if facial nerve injury is suspected, it should be:
Mallory-Weiss tear causing haematemesis is seen over:
Sleeve Gastrectomy done for Morbid obesity is a:
Pre-operative Nutrition Screening in a patient with morbid obesity planned for Gastric Bypass includes all EXCEPT:
In postoperative care the long term risks after Bariatric Surgery include all EXCEPT:
Hilton's method of Incision and drainage of abscess has the advantage of:
UPSC-CMS 2018 - Surgery UPSC-CMS Practice Questions and MCQs
Question 11: Paralytic ileus is a type of:
- A. Inflammatory obstruction
- B. Drug induced obstruction
- C. Adynamic obstruction (Correct Answer)
- D. Dynamic obstruction
Explanation: ***Adynamic obstruction*** - **Paralytic ileus** is characterized by the absence of normal peristaltic movement of the bowel, leading to a functional or **adynamic obstruction** without a physical blockage. - This condition often results from factors like **abdominal surgery**, electrolyte imbalances, or certain medications, which disrupt neural control over intestinal motility. *Inflammatory obstruction* - An **inflammatory obstruction** implies a physical blockage or narrowing of the bowel lumen due to inflammation, such as in **Crohn's disease** or diverticulitis. - While inflammation can contribute to ileus, the primary mechanism of paralytic ileus is a lack of motility, not a physical inflammatory mass blocking the lumen. *Drug-induced obstruction* - While certain drugs, such as **opioids** or **anticholinergics**, can *cause* paralytic ileus by reducing gut motility, the term "drug-induced obstruction" is typically used when the drug directly creates a physical obstruction. - In the context of ileus, drugs induce a *functional* impairment rather than a physical **luminal blockage**. *Dynamic obstruction* - **Dynamic obstruction** refers to a *physical blockage* of the bowel, such as a **volvulus**, **intussusception**, or an **hernia**, where the bowel is actively trying to overcome the obstruction (hence "dynamic"). - In contrast, paralytic ileus involves a *lack* of active bowel movement, classifying it as an adynamic, rather than dynamic, obstruction.
Question 12: Indication of Coronary artery bypass grafting (CABG) is:
- A. More than 70% stenosis of proximal left anterior interventricular artery
- B. More than 50% stenosis of critical left main stem
- C. Deranged Stress Echocardiography report
- D. Triple vessel disease (Correct Answer)
Explanation: ***Triple vessel disease*** - **Triple vessel disease** (significant stenosis in all three major coronary arteries: LAD, LCx, and RCA) is a **Class I indication for CABG** with the highest level of evidence. - CABG provides **superior long-term outcomes** compared to PCI in triple vessel disease, with better survival rates, reduced need for repeat revascularization, and more complete revascularization. - This is particularly true in patients with **diabetes** or **reduced LV function**. *More than 70% stenosis of proximal left anterior interventricular artery* - While **proximal LAD stenosis >70%** can be treated with CABG (Class IIa indication), it is often managed successfully with **PCI** (drug-eluting stents). - The choice between CABG and PCI for isolated proximal LAD disease depends on anatomy, patient comorbidities, and surgical risk factors. *More than 50% stenosis of critical left main stem* - **Left main coronary artery stenosis >50%** is actually a **Class I indication for CABG** per ACC/AHA and ESC/EACTS guidelines. - However, in the context of this question comparing multiple scenarios, **triple vessel disease** represents a more universally accepted and broader indication with the strongest evidence base for CABG superiority over PCI. - Modern guidelines do allow PCI for selected left main cases (low SYNTAX score, ostial/shaft lesions), whereas triple vessel disease more consistently favors CABG. *Deranged Stress Echocardiography report* - A **positive stress echocardiography** indicates inducible myocardial ischemia but is a **diagnostic finding**, not a specific indication for the revascularization method. - Further evaluation with **coronary angiography** is required to determine the anatomical extent of CAD and guide the choice between CABG, PCI, or medical management.
Question 13: Which one of the following regarding abdominal pediatric surgery is correct?
- A. Transverse abdominal incision is always used
- B. Bowel must be always anastomosed in double layer
- C. Skin over abdomen can never be closed with subcuticular sutures
- D. Incision can be closed with absorbable suture (Correct Answer)
Explanation: ***Incision can be closed with absorbable suture*** - **Absorbable sutures** are commonly used in pediatric abdominal surgery for closing deeper layers and sometimes skin, as they degrade over time and do not require removal. - This is particularly beneficial in children to avoid the trauma and discomfort of suture removal and to promote good cosmetic outcomes. *Transverse abdominal incision is always used* - While **transverse incisions** are often preferred in pediatric abdominal surgery for their good cosmetic results and lower incidence of incisional hernias, they are not *always* used. - Other incisions, such as **vertical midline incisions**, may be utilized depending on the surgical exposure required, the specific pathology, or the surgeon's preference. *Bowel must be always anastomosed in double layer* - **Bowel anastomoses** in pediatric surgery can be performed using either a **single-layer** or **double-layer** technique. - The choice depends on surgeon preference, the specific bowel segment involved, and the patient's condition, with both methods demonstrating comparable outcomes in many situations. *Skin over abdomen can never be closed with subcuticular sutures* - **Subcuticular sutures** are frequently used for skin closure in pediatric abdominal surgery, especially for their excellent cosmetic results and to avoid external suture removal. - This technique places the suture material under the skin surface, minimizing scarring and being well-suited for a child's healing skin.
Question 14: Allen's test is used in cardiac surgery for:
- A. To select finger prick for blood glucose estimation
- B. To check warmth of hands
- C. When radial artery harvest is planned (Correct Answer)
- D. For evaluation of AV fistula
Explanation: ***When radial artery harvest is planned*** - **Allen's test** is performed to assess the patency of the **ulnar artery** and ensure adequate collateral circulation to the hand before harvesting the radial artery. - A positive test (indicating good collateral flow) is crucial to prevent **hand ischemia** if the radial artery is removed. *To select finger prick for blood glucose estimation* - Finger prick sites for **blood glucose estimation** are chosen based on adequate capillary blood flow and patient comfort, not by Allen's test. - Allen's test is specifically for evaluating **arterial patency** and collateral circulation, which is irrelevant for routine fingersticks. *To check warmth of hands* - Checking the **warmth of hands** is a basic clinical assessment for peripheral perfusion but does not involve Allen's test. - Allen's test is a dynamic test of **vascular competence**, not a static thermal assessment. *For evaluation of AV fistula* - **AV fistula evaluation** involves assessing patency, thrill, and bruit, and is typically done using physical examination and Doppler ultrasound. - Allen's test is not used for this purpose, as it assesses **collateral arterial flow** to a digit, not the patency of an arteriovenous connection.
Question 15: In a lateral facial wound, if facial nerve injury is suspected, it should be:
- A. Left alone
- B. Secondary repair using microscope gives best result
- C. Skin and subcutaneous flaps to be raised to cover the cut ends
- D. Primary repair should be attempted (Correct Answer)
Explanation: ***Primary repair should be attempted*** - **Early surgical repair** of facial nerve injuries, ideally within the first 72 hours, offers the best chance for **functional recovery**. - **Primary repair** involves direct reapproximation and meticulous suturing of the severed nerve ends under magnification. *Left alone* - Leaving a suspected facial nerve injury untreated can lead to **permanent facial paralysis** and significant functional and aesthetic deficits. - The facial nerve has a limited capacity for spontaneous regeneration, especially after a **complete transection**. *Secondary repair using microscope gives best result* - While microscopic techniques are crucial for nerve repair, **secondary repair** (performed weeks or months after the injury) generally yields poorer outcomes compared to primary repair. - **Scar tissue formation** and **nerve end retraction** make secondary repair more challenging and less effective. *Skin and subcutaneous flaps to be raised to cover the cut ends* - This approach addresses wound closure but **does not repair the underlying nerve injury**, leading to persistent motor deficits. - Covering the nerve ends without repair would still result in **facial paralysis** as the nerve fibers cannot reconnect across the gap.
Question 16: Mallory-Weiss tear causing haematemesis is seen over:
- A. Oesophagus
- B. Gastroesophageal junction (Correct Answer)
- C. Anterior wall of stomach
- D. Fundus of stomach
Explanation: ***Gastroesophageal junction*** - Mallory-Weiss tears are **linear mucosal lacerations** typically located at the **gastroesophageal junction**, where the esophagus meets the stomach. - These tears are caused by sudden increases in **intra-abdominal pressure**, often due to forceful retching or vomiting, leading to bleeding. *Oesophagus* - While located close, Mallory-Weiss tears are specifically at the **junction**, not generally throughout the esophageal body. - **Esophageal varices** are a more common cause of hematemesis originating from the esophagus itself, distinct from Mallory-Weiss tears. *Anterior wall of stomach* - Tears in the anterior wall of the stomach are less common and typically associated with other conditions like **ulcers** or **trauma**, not the characteristic forceful vomiting seen in Mallory-Weiss syndrome. - The unique anatomical stress at the **gastroesophageal junction** during retching makes it the preferred site for Mallory-Weiss lacerations. *Fundus of stomach* - Tears in the fundus are rare in the context of Mallory-Weiss syndrome; the fundus is usually affected by other conditions such as **gastric ulcers** or **gastric varices**. - The biomechanical forces that cause Mallory-Weiss tears are concentrated where the **esophageal and gastric mucosa meet**, not primarily in the fundus.
Question 17: Sleeve Gastrectomy done for Morbid obesity is a:
- A. Restrictive procedure (Correct Answer)
- B. Mildly restrictive and mainly malabsorptive
- C. Reversible procedure
- D. Malabsorptive procedure only
Explanation: ***Restrictive procedure (Correct Answer)*** - A **sleeve gastrectomy** involves removing a large portion of the stomach (approximately 75-80%), leaving a banana-shaped "sleeve," which significantly **reduces stomach volume**. - This reduction in volume **restricts** the amount of food a patient can consume at one time, leading to early satiety and weight loss. - It is classified as a **purely restrictive** bariatric procedure. *Mildly restrictive and mainly malabsorptive* - While there is some malabsorption due to faster gastric emptying, the primary mechanism of weight loss in sleeve gastrectomy is **restriction**, not malabsorption. - Procedures like **Roux-en-Y gastric bypass** are considered both restrictive and malabsorptive. *Reversible procedure* - Sleeve gastrectomy involves the **irreversible removal** of a significant part of the stomach. - Unlike devices like the **adjustable gastric band**, it cannot be undone or reversed. *Malabsorptive procedure only* - Sleeve gastrectomy does not significantly alter the **intestinal tract** to cause malabsorption. - Procedures that are primarily **malabsorptive**, such as **biliopancreatic diversion with duodenal switch**, involve bypassing large sections of the small intestine.
Question 18: Pre-operative Nutrition Screening in a patient with morbid obesity planned for Gastric Bypass includes all EXCEPT:
- A. Serum Insulin (Correct Answer)
- B. Serum Vitamin B12
- C. Serum Calcium
- D. Serum Magnesium
Explanation: ***Serum Insulin*** - While relevant to **diabetes** and metabolic health, routine **pre-operative insulin screening** is not standard for gastric bypass. - Nutritional screening focuses on identifying and correcting deficiencies that could complicate surgery or post-operative recovery. *Serum Vitamin B12* - Patients undergoing **gastric bypass** are at high risk for **Vitamin B12 deficiency** due to altered absorption in the bypassed stomach and small intestine. - Pre-operative screening is essential to identify and replete deficiencies to prevent post-operative neurological complications. *Serum Calcium* - **Malabsorption of calcium** is a known risk after gastric bypass due to changes in the digestive tract. - Pre-operative **calcium levels** are crucial for bone health assessment and to guide supplementation strategies. *Serum Magnesium* - **Magnesium deficiency** can occur post-gastric bypass due to malabsorption. - Pre-operative screening helps to identify existing deficiencies, which can impact cardiac function and neuromuscular health.
Question 19: In postoperative care the long term risks after Bariatric Surgery include all EXCEPT:
- A. Vitamin and Micronutrient depletion syndromes
- B. Weight regain
- C. Deep Vein Thrombosis (Correct Answer)
- D. Protein Calorie Malnutrition
Explanation: ***Deep Vein Thrombosis*** - Deep Vein Thrombosis (DVT) is a significant **short-term (early) complication** of bariatric surgery, primarily in the **immediate postoperative period**, due to immobility and hypercoagulability. - While prophylaxis is crucial, DVT is not typically considered a **long-term risk** that persists for years after surgery. *Vitamin and Micronutrient depletion syndromes* - Bariatric surgery procedures, especially those involving malabsorption (e.g., Roux-en-Y gastric bypass), can lead to chronic deficiencies in **fat-soluble vitamins (A, D, E, K)**, **B12**, **iron**, and **calcium** due to altered absorption. - These depletion syndromes are a well-documented **long-term risk** requiring lifelong supplementation and monitoring. *Weight regain* - Despite initial significant weight loss, a substantial number of patients experience some degree of **weight regain** in the long term, typically peaking 2-5 years post-surgery. - This is a common and critical **long-term risk** that often necessitates ongoing lifestyle modifications and monitoring. *Protein Calorie Malnutrition* - Certain bariatric procedures (e.g., biliopancreatic diversion with duodenal switch) can lead to severe **malabsorption of protein and calories**, resulting in protein-calorie malnutrition (PCM). - PCM is a serious and persistent **long-term risk** that requires careful dietary management and sometimes additional medical interventions.
Question 20: Hilton's method of Incision and drainage of abscess has the advantage of:
- A. Avoids injury to underlying vessels and nerves (Correct Answer)
- B. Complete drainage of pus
- C. Heals without scar
- D. Provides irrigation
Explanation: ***Avoids injury to underlying vessels and nerves*** - Hilton's method involves blunt dissection with an artery forceps once the skin incision is made, allowing the surgeon to **feel important structures** and push them aside. - This technique is particularly useful in areas with **numerous neurovascular bundles**, such as the axilla or neck, minimizing the risk of iatrogenic damage. *Complete drainage of pus* - While Hilton's method facilitates drainage, it doesn't inherently guarantee **complete drainage** more than other proper incision and drainage techniques. - The effectiveness of drainage primarily depends on the **size and location of the incision** relative to the abscess cavity. *Heals without scar* - Any surgical incision, including those made using Hilton's method, will result in some degree of **scar formation**. - The method prioritizes safety over cosmetic outcomes, and the nature of the scar depends on **wound healing** and **surgical closure**. *Provides irrigation* - Irrigation is a separate step often performed after the incision and drainage to **flush out debris** and reduce bacterial load. - Hilton's method itself is a technique for making the incision and gaining access to the abscess, not for **intraoperative irrigation**.