UPSC-CMS 2019 - Surgery PYQs Practice Questions

Q: All of the following are risk factors for an increased risk of wound infection EXCEPT:

Hypertension. ***Hypertension*** - **Hypertension** itself is not a direct risk factor for wound infection, unlike conditions that impair immunity, tissue perfusion, or healing. - While uncontrolled hypertension can contribute to broader cardiovascular issues, it does not inherently increase the likelihood of **bacterial contamination** or **impaired immune response** in a wound. *Cancer* - Patients with **cancer** often have compromised immune systems due to the disease itself or as a result of treatments like **chemotherapy** or **radiation**, increasing susceptibility to infections. - **Malnutrition** and overall debilitation associated with advanced cancer can also impair wound healing and immune function. *Jaundice* - **Jaundice** (hyperbilirubinemia) is associated with impaired immune function, particularly a reduction in phagocytic activity and cellular immunity, making patients more prone to infections. - High bilirubin levels can also interfere with **collagen synthesis** and wound tensile strength, contributing to delayed healing and increased infection risk. *Obesity* - **Obesity** is a significant risk factor for wound infection due to poor vascularity of adipose tissue, which leads to reduced oxygen delivery and antibiotic penetration to the wound site. - The presence of large skin folds can also create a **moist environment** conducive to bacterial growth, and increased tension on wound edges can impair healing. [Practice more Surgery PYQs on OnCourse]

Q: Gentleman of 56 years underwent laparoscopic left hemicolectomy for diagnosed left colonic carcinoma. Histopathology revealed the tumour to be invading submucosa and muscularis propria. Among the 16 regional lymph nodes harvested, 2 were positive for malignant deposits. His staging as per AJCC will be:

T2, N1, M0. ***T2, N1, M0*** - The tumor invades the **muscularis propria** but not through it, which is classified as **T2** in the AJCC staging for colorectal cancer. - The presence of **2 positive regional lymph nodes** (out of 16 harvested) is classified as **N1** disease. **M0** indicates no distant metastasis. *T2, N1, M1* - While the **T2** and **N1** classifications are correct for this case, **M1** signifies the presence of **distant metastasis**, which is not indicated in the provided information. - The staging is based on the **available pathological findings only**, which do not mention any distant spread. *T1, N1, M0* - **T1** classification indicates that the tumor invades the **submucosa** but not the muscularis propria, which contradicts the information that the tumor invaded the **muscularis propria**. - Although **N1** and **M0** are consistent with the provided information regarding lymph nodes and distant metastasis, the **T-stage is incorrect**. *T1, N0, M0* - **T1** is incorrect as the tumor invaded the **muscularis propria**. - **N0** is incorrect as there were **2 positive regional lymph nodes** which indicates nodal involvement. [Practice more Surgery PYQs on OnCourse]

Q: Indications for carotid endarterectomy in symptomatic patients are all of the following EXCEPT:

Persistent hypertension. ***Persistent hypertension*** - **Hypertension** is a **risk factor** for carotid artery disease but is not a direct indication for carotid endarterectomy in symptomatic patients. - Carotid endarterectomy aims to treat **carotid stenosis** causing neurological symptoms, not to manage blood pressure. *Hemianopia* - **Hemianopia** is a **visual field defect** that can be caused by cerebral ischemia resulting from carotid artery stenosis, making it a neurological symptom indicating potential benefit from endarterectomy. - It suggests that the **carotid artery** is supplying an area of the brain that could be at risk for stroke. *Dysphasia* - **Dysphasia** (difficulty with speech) is a classic **neurological symptom** of cerebral ischemia, often associated with carotid artery stenosis affecting the dominant hemisphere. - This symptom strongly indicates that the patient's **carotid disease** is causing clinically significant effects, warranting consideration of endarterectomy. *Monocular blindness* - **Amaurosis fugax**, or transient monocular blindness, is a **transient ischemic attack (TIA)** symptom caused by emboli from the carotid artery reaching the retinal artery. - It is a significant **warning sign** of impending stroke and is a strong indication for carotid endarterectomy in symptomatic patients with appropriate stenosis. [Practice more Surgery PYQs on OnCourse]

Q: A policeman of 45 years presented with Lipodermatosclerosis over lower medial aspect of left leg, along with a healed venous ulcer. As per the CEAP (Clinical-etiology-anatomy-pathophysiology) classification his clinical classification will be:

C5. **C5 (healed venous ulcer)** - The CEAP classification for **C5** indicates the presence of a **healed venous ulcer**, which matches the patient's presentation of a healed ulcer. - The associated **lipodermatosclerosis** is a skin change often preceding or accompanying venous ulcers. *C4b (lipodermatosclerosis, atrophie blanche)* - **C4b** represents **lipodermatosclerosis** and **atrophie blanche**, which are skin changes due to chronic venous insufficiency. - While the patient has lipodermatosclerosis, the presence of a *healed ulcer* further elevates the classification to C5, as it signifies a more advanced stage of venous disease. *C6 (active venous ulcer)* - **C6** denotes an **active, open venous ulcer**. - The patient's ulcer is explicitly stated as "healed," making C6 an incorrect classification. *C4a (pigmentation or eczema)* - **C4a** refers to skin changes such as **pigmentation** or **venous eczema**. - While the patient might have some pigmentation associated with lipodermatosclerosis, the presence of a *healed ulcer* indicates a more severe clinical stage than C4a. [Practice more Surgery PYQs on OnCourse]

Q: What is true about the management of a corrosive injury of oesophagus?

Early skilled endoscopy is a must. ***Early skilled endoscopy is a must*** - **Early endoscopy** within 12-24 hours is crucial to assess the extent and depth of corrosive injury - Helps determine severity (Grade I-III burns) and guide further management - Identifies patients needing aggressive treatment vs. conservative management - **Contraindicated** only in suspected perforation or severe respiratory distress *Broad spectrum antibiotics should be started as soon as possible* - **Prophylactic antibiotics are NOT routinely recommended** for corrosive injuries - Risk of promoting antibiotic resistance without proven benefit - Antibiotics indicated only when signs of infection present: **fever, leukocytosis, or suspected perforation** *Immediate surgery with oesophagectomy is advisable* - **Immediate oesophagectomy is NOT standard management** - Reserved for severe complications: **perforation, extensive necrosis, mediastinitis, or uncontrolled bleeding** - Most patients initially managed conservatively with supportive care - Surgery considered only if conservative measures fail *Immediate NG tube insertion and gastric lavage should be performed* - **Both are CONTRAINDICATED** in corrosive ingestions - **Gastric lavage** can induce vomiting, causing re-exposure of esophagus and risking perforation - **NG tube insertion** can traumatize damaged esophageal mucosa and cause perforation - Management focuses on NBM (nil by mouth), fluid resuscitation, and pain control [Practice more Surgery PYQs on OnCourse]

Question 1

All of the following are risk factors for an increased risk of wound infection EXCEPT:

Accepted Answer

Hypertension

Answer

Cancer

Answer

Jaundice

Answer

Obesity

Question 2

Gentleman of 56 years underwent laparoscopic left hemicolectomy for diagnosed left colonic carcinoma. Histopathology revealed the tumour to be invading submucosa and muscularis propria. Among the 16 regional lymph nodes harvested, 2 were positive for malignant deposits. His staging as per AJCC will be:

Accepted Answer

T2, N1, M0

Answer

T2, N1, M1

Answer

T1, N1, M0

Answer

T1, N0, M0

Question 3

Indications for carotid endarterectomy in symptomatic patients are all of the following EXCEPT:

Accepted Answer

Persistent hypertension

Answer

Hemianopia

Answer

Dysphasia

Answer

Monocular blindness

Question 4

A policeman of 45 years presented with Lipodermatosclerosis over lower medial aspect of left leg, along with a healed venous ulcer. As per the CEAP (Clinical-etiology-anatomy-pathophysiology) classification his clinical classification will be:

Accepted Answer

C5

Answer

C4b

Answer

C6

Answer

C4a

Question 5

What is true about the management of a corrosive injury of oesophagus?

Accepted Answer

Early skilled endoscopy is a must

Answer

Broad spectrum antibiotics should be started as soon as possible

Answer

Immediate surgery with oesophagectomy is advisable

Answer

Immediate NG tube insertion and gastric lavage should be performed

Question 6

A 48 year old male with the history of chronic duodenal ulcer presented in surgical emergency with the complaints of sudden severe pain in the abdomen. At presentation: Pulse = 120/m, BP = 90/60 mm of Hg Abdomen: Tenderness (+), Rigidity (+), Guarding (+) Respiratory Rate: 20/m X-ray: Gas under right dome of diaphragm The probable diagnosis is:

Accepted Answer

Perforation Peritonitis

Answer

Acute appendicitis

Answer

Acute Pancreatitis

Answer

Acute Myocardial infarction

Question 7

A young sports person presented in surgical emergency with the complaints of severe pain in the groin area, extending into the scrotum and upper thigh. The pain is debilitating and he is not able to exercise. On examination there is tenderness in the region of Inguinal canal and pubic tubercle. He is probably suffering from:

Accepted Answer

Sportsman hernia

Answer

Inguinal hernia

Answer

Femoral hernia

Answer

Varicocele

Question 8

Ventral hernia includes all EXCEPT:

Accepted Answer

Inguinal hernia

Answer

Umbilical hernia

Answer

Epigastric hernia

Answer

Para-umbilical hernia

Question 9

Diaphragmatic injury is suspected in a 50 year old gentleman with history of blunt abdominal trauma, having a normal chest X-ray. He is best managed by:

Accepted Answer

Diagnostic laparoscopy

Answer

CECT abdomen

Answer

Diagnostic peritoneal lavage and proceed

Answer

Upper GI contrast study

Question 10

Urinary bladder can be injured in all of the following operations EXCEPT:

Accepted Answer

Inguinal hernia repair

Answer

Surgery for rectum

Answer

Inguinal lymph node dissection

Answer

Hysterectomy

UPSC-CMS 2019 — Surgery