UPSC-CMS 2020 - Surgery PYQs Practice Questions

Q: Indications for fasciotomy in compartment syndrome include all EXCEPT:

Palpable distal pulses. ***Palpable distal pulses*** - The presence of **palpable distal pulses is NOT an indication for fasciotomy** and does not rule out compartment syndrome. - **Vascular compromise is a late sign** in compartment syndrome - pulses often remain palpable even with significant nerve and muscle ischemia. - Fasciotomy decisions should be based on **clinical signs** (pain, sensory changes) and **pressure measurements**, not the presence of pulses. - This is the correct answer because it is NOT an indication for the procedure. *Compartment pressure > 30 mm Hg* - **Absolute indication for fasciotomy** when compartment pressure exceeds 30 mmHg, or when the **delta pressure** (diastolic BP minus compartment pressure) is less than 30 mmHg. - This pressure level impairs capillary perfusion and leads to tissue ischemia. *Distal sensory disturbance* - **Early and reliable indication** for fasciotomy showing nerve ischemia. - Paresthesia or numbness in the distribution of nerves running through the affected compartment indicates neurological compromise from elevated intracompartmental pressure. *Pain on passive movement of affected muscles* - **Most sensitive and earliest clinical sign** of compartment syndrome (part of "the 6 P's"). - Pain on passive stretch is typically **out of proportion to the injury** and indicates underlying muscle ischemia. - This is a clear indication for fasciotomy. [Practice more Surgery PYQs on OnCourse]

Q: Which one of the following statements is NOT correct regarding Necrotising Soft Tissue infections?

They are monomicrobial in nature. ***They are monomicrobial in nature*** - Necrotizing soft tissue infections (NSTIs) are predominantly **polymicrobial**, involving a mix of aerobic and anaerobic bacteria. - While some cases can be monomicrobial (e.g., due to *Streptococcus pyogenes* or *Clostridium perfringens*), the statement that they *are* monomicrobial is generally false. *Treatment consists of wide local excision and appropriate antibiotics* - This statement is **correct**. **Aggressive surgical debridement** (wide local excision) to remove all necrotic tissue is the cornerstone of treatment for NSTIs. - **Broad-spectrum antibiotics** are also essential to cover the polymicrobial nature of these infections, but they are insufficient without surgical intervention. *Tissue biopsy is required for culture and diagnosis* - This statement is **correct**. While the diagnosis is primarily clinical, **tissue biopsy** for gram stain, culture, and histopathology is crucial for identifying the causative organisms and guiding definitive antibiotic therapy. - This helps differentiate NSTIs from other severe soft tissue infections and improves treatment accuracy. *Crepitus, skin blistering and focal skin gangrene are typical presenting features* - This statement is **correct**. These are classic signs of advanced necrotizing soft tissue infections. - **Crepitus** indicates gas production by bacteria, **skin blistering** (bullae) suggests dermal involvement, and **focal skin gangrene** is a direct sign of tissue necrosis, all pointing to the severity and rapid progression of NSTIs. [Practice more Surgery PYQs on OnCourse]

Q: Which type of surgery is laparoscopic cholecystectomy classified as?

Clean contaminated. ***Clean contaminated*** - This classification applies to surgeries that involve a **viscus** (e.g., gallbladder, gastrointestinal tract, respiratory tract) but with **no unusual contamination** encountered. - While the gallbladder contains bile, which harbors bacteria, in an uncomplicated laparoscopic cholecystectomy, spillage is controlled, and there's no pre-existing infection. *Dirty* - This category is reserved for procedures performed in the presence of **established infection**, such as an abdominal abscess or perforated viscus with gross spillage. - There is evidence of **pus** or a **perforated hollow viscus** encountered during the operation. *Contaminated* - This classification is used when there is a **major break in sterile technique** or a significant spillage from the gastrointestinal contents or infected bile. - It also includes procedures where **acute, non-purulent inflammation** is encountered, or an open, traumatic wound is less than 4 hours old. *Clean* - These are procedures in which there is **no inflammation**, the gastrointestinal, genitourinary, or respiratory tracts are **not entered**, and there is no break in aseptic technique. - Examples include breast biopsies, hernia repairs without bowel resection, and thyroidectomies. [Practice more Surgery PYQs on OnCourse]

Q: A 50-year old lady underwent uneventful bariatric surgery for morbid obesity. On the third post operative day, she develops breathlessness and pulmonary embolism is suspected. The next investigation to confirm the diagnosis will be:

CT pulmonary angiography. ***CT pulmonary angiography*** - **CT pulmonary angiography (CTPA)** is the **gold standard** for diagnosing pulmonary embolism due to its high sensitivity and specificity in visualizing pulmonary arteries. - It rapidly provides detailed images of the pulmonary vasculature, allowing for the direct visualization of **thrombi** within the vessels. *MR angiography* - **MR angiography (MRA)** can be used for diagnosing pulmonary embolism but is generally less available and often takes longer than CTPA. - It is usually reserved for patients with contraindications to CT, such as **renal impairment** or **iodine allergy**, which are not indicated in this case. *Echocardiography* - **Echocardiography** can help assess the **right ventricular strain** caused by pulmonary embolism, but it is not diagnostic for the embolism itself. - It is more useful in evaluating the **hemodynamic impact** of the PE and ruling out other cardiac causes of breathlessness. *Duplex venography* - **Duplex venography** (or ultrasound of the lower extremities) is used to detect **deep vein thrombosis (DVT)** in the legs. - While DVT is a common cause of pulmonary embolism, this investigation does not directly visualize the embolism in the **pulmonary arteries**. [Practice more Surgery PYQs on OnCourse]

Q: A patient operated for a parotid gland tumour developed symptoms of sweating and erythema (flushing) over the region of surgical excision while eating. The probable diagnosis is:

Frey's syndrome. ***Frey's syndrome*** - **Frey's syndrome**, also known as auriculotemporal syndrome, is characterized by gustatory sweating and flushing in the preauricular or temporal region during mastication (eating). - This occurs due to aberrant regeneration of damaged postganglionic parasympathetic fibers that previously supplied the parotid gland. These fibers mistakenly reinnervate sweat glands and blood vessels in the skin, leading to sweating and flushing when salivary stimulation occurs. *Sialadenitis* - **Sialadenitis** is inflammation of a salivary gland, typically presenting with pain, swelling, and sometimes fever, and is not directly linked to sweating while eating. - It is usually caused by infection or obstruction, and its symptoms would not be localized to the surgical excision site with flushing and sweating upon eating. *Parotid gland fistula* - A **parotid gland fistula** involves the leakage of saliva through an opening in the skin, which would manifest as continuous or intermittent salivary drainage, not sweating and flushing. - This condition is a direct communication between the parotid duct or gland parenchyma and the skin surface. *Chronic wound infection* - A **chronic wound infection** would present with persistent pain, redness, warmth, swelling, and possibly purulent discharge at the surgical site. - Sweating and flushing specifically triggered by eating are not characteristic symptoms of a wound infection. [Practice more Surgery PYQs on OnCourse]

Question 1

Indications for fasciotomy in compartment syndrome include all EXCEPT:

Accepted Answer

Palpable distal pulses

Answer

Compartment pressure > 30 mm Hg

Answer

Distal sensory disturbance

Answer

Pain on passive movement of affected muscles

Question 2

Which one of the following statements is NOT correct regarding Necrotising Soft Tissue infections?

Accepted Answer

They are monomicrobial in nature

Answer

Treatment consists of wide local excision and appropriate antibiotics

Answer

Tissue biopsy is required for culture and diagnosis

Answer

Crepitus, skin blistering and focal skin gangrene are typical presenting features

Question 3

Which type of surgery is laparoscopic cholecystectomy classified as?

Accepted Answer

Clean contaminated

Answer

Dirty

Answer

Contaminated

Answer

Clean

Question 4

A 50-year old lady underwent uneventful bariatric surgery for morbid obesity. On the third post operative day, she develops breathlessness and pulmonary embolism is suspected. The next investigation to confirm the diagnosis will be:

Accepted Answer

CT pulmonary angiography

Answer

MR angiography

Answer

Echocardiography

Answer

Duplex venography

Question 5

A patient operated for a parotid gland tumour developed symptoms of sweating and erythema (flushing) over the region of surgical excision while eating. The probable diagnosis is:

Accepted Answer

Frey's syndrome

Answer

Sialadenitis

Answer

Parotid gland fistula

Answer

Chronic wound infection

Question 6

All of the following are sequelae of peptic ulcer surgery EXCEPT:

Accepted Answer

Increased appetite

Answer

Dumping syndrome

Answer

Bilious vomiting

Answer

Diarrhoea

Question 7

'Swiss cheese defects' are seen during laparoscopic repair of:

Accepted Answer

Inguinal hernia

Answer

Ventral hernia

Answer

Obturator hernia

Answer

Femoral hernia

Question 8

Valentino's syndrome is:

Accepted Answer

Pain in right iliac fossa in perforated peptic ulcer

Answer

Pain over left shoulder in left hypochondriac collection

Answer

Pain on per-vaginal examination in pelvic abscess

Answer

Pain over left groin in perirenal collection

Question 9

Structure not forming boundaries of the "Triangle of doom" seen during laparoscopic inguinal hernia surgery dissection is:

Accepted Answer

Inferior epigastric artery

Answer

Spermatic cord vessels

Answer

Vas deferens

Answer

Peritoneum

Question 10

Left Internal Mammary Artery (LIMA) has become the conduit of choice for Left Anterior Descending (LAD) artery during coronary artery bypass grafting because:

Accepted Answer

Long term patency rates are superior (>90% at 10 years)

Answer

Atherosclerosis is never seen in this vessel

Answer

It is very easy to harvest

Answer

It is close to LAD

UPSC-CMS 2020 — Surgery