A patient with suspected head injury is brought to the emergency following road traffic accident. At the time of examination, patient is conscious with GCS 14/15 and stable vitals. There is bleeding from right ear and CSF leak from nose. Bruising is present behind the right ear. The most probable clinical diagnosis in this patient is
Q12
Which of the following are correct about ectopic ureters?
1. They are more common in males
2. They drain the upper pole of the kidney
3. They are associated with duplex ureter
4. They may cause incontinence
Q13
A patient of road traffic accident presents to the emergency with increasing restlessness and difficulty in breathing. The respiratory rate is 26 breaths/minute; there are distended neck veins; trachea is deviated to the right side with hyper-resonant note and absence of breath sounds on the left side. Which of the following statements are correct?
1. The most probable clinical diagnosis is left tension pneumothorax
2. Immediate chest decompression using wide bore cannula in left 2nd intercostal space is to be done
3. Immediate chest X-ray should be done to confirm the clinical diagnosis
4. Definitive chest tube insertion in left fifth intercostal space should be done
Q14
Untidy wounds are characterised by which of the following?
1. Crushed or avulsed tissues
2. Contaminated wound
3. Devitalised tissue
4. No loss of tissue
UPSC-CMS 2021 - Surgery UPSC-CMS Practice Questions and MCQs
Question 11: A patient with suspected head injury is brought to the emergency following road traffic accident. At the time of examination, patient is conscious with GCS 14/15 and stable vitals. There is bleeding from right ear and CSF leak from nose. Bruising is present behind the right ear. The most probable clinical diagnosis in this patient is
A. Extradural haematoma
B. Fracture of the base of skull (Correct Answer)
C. Cerebral concussion
D. Traumatic subarachnoid haemorrhage
Explanation: ***Fracture of the base of skull***
- The combination of **bleeding from the ear (otorrhagia)**, **CSF leak from the nose (rhinorrhea)**, and **bruising behind the ear (Battle's sign)** are classic indicators of a **basilar skull fracture**.
- These signs suggest a breach in the bone separating the brain from the external environment, often involving the **temporal bone** or the **anterior cranial fossa**.
*Extradural haematoma*
- This typically presents with a **lucid interval** followed by rapid neurological deterioration due to arterial bleeding, which is not suggested by the stable GCS of 14/15.
- While it can be associated with skull fractures, the specific signs of **CSF leak** and **Battle's sign** point more directly to a basilar fracture.
*Cerebral concussion*
- A concussion involves a transient disturbance of brain function without macrostructural damage, characterized by symptoms like confusion, dizziness, and memory problems.
- It does not involve **CSF leaks**, **otorrhagia**, or **Battle's sign**, which are indicative of a more severe structural injury.
*Traumatic subarachnoid haemorrhage*
- This involves bleeding into the **subarachnoid space**, typically causing a **sudden severe headache**, nuchal rigidity, and altered consciousness.
- It does not directly explain **otorrhagia**, **rhinorrhea**, or **Battle's sign**, which are specific to a breach in the skull base.
Question 12: Which of the following are correct about ectopic ureters?
1. They are more common in males
2. They drain the upper pole of the kidney
3. They are associated with duplex ureter
4. They may cause incontinence
A. 1, 3 and 4
B. 1, 2 and 3
C. 2, 3 and 4 (Correct Answer)
D. 1, 2 and 4
Explanation: ***2, 3 and 4***
- Ectopic ureters primarily drain the **upper pole** of a **duplicated kidney** and are nearly always associated with some degree of renal dysplasia.
- They are commonly associated with **duplex ureters** and can cause **incontinence**, especially in females, as they often bypass the bladder sphincter.
*1, 3 and 4*
- This option is incorrect because ectopic ureters are **more common in females** than males, particularly symptomatic cases involving incontinence.
- While they are associated with duplex ureters and incontinence, the statement about being more common in males is inaccurate.
*1, 2 and 3*
- This option is incorrect because ectopic ureters are **more prevalent in females** and are a significant cause of continuous urinary incontinence in this population.
- While they drain the upper pole and are associated with duplex ureters, the claim of being more common in males is false.
*1, 2 and 4*
- This option is incorrect as ectopic ureters are typically found more often in **females** and are a recognized cause of **incontinence** in affected individuals.
- Although they drain the upper pole and may cause incontinence, the assertion that they are more common in males is inaccurate.
Question 13: A patient of road traffic accident presents to the emergency with increasing restlessness and difficulty in breathing. The respiratory rate is 26 breaths/minute; there are distended neck veins; trachea is deviated to the right side with hyper-resonant note and absence of breath sounds on the left side. Which of the following statements are correct?
1. The most probable clinical diagnosis is left tension pneumothorax
2. Immediate chest decompression using wide bore cannula in left 2nd intercostal space is to be done
3. Immediate chest X-ray should be done to confirm the clinical diagnosis
4. Definitive chest tube insertion in left fifth intercostal space should be done
A. 2, 3 and 4
B. 1, 2 and 4 (Correct Answer)
C. 1, 2 and 3
D. 1, 3 and 4
Explanation: ***1, 2 and 4***
- The clinical presentation with **increasing restlessness**, **difficulty in breathing**, **distended neck veins**, **tracheal deviation away from the affected side** (to the right for a left-sided collection), **hyper-resonant note**, and **absent breath sounds on the left** is pathognomonic for **left tension pneumothorax** (Statement 1 is correct).
- **Immediate needle decompression** with a wide-bore cannula in the **2nd intercostal space** along the mid-clavicular line on the affected side is a **life-saving intervention** that must be performed immediately (Statement 2 is correct).
- After needle decompression, **definitive chest tube insertion** in the **5th intercostal space** (mid-axillary line) should be performed (Statement 4 is correct).
- Statement 3 is **incorrect** because tension pneumothorax is a **clinical diagnosis** requiring immediate treatment without delaying for imaging, which could be fatal.
*2, 3 and 4*
- This combination is incorrect because Statement 3 is wrong.
- **Immediate chest X-ray should NOT be done** for suspected tension pneumothorax as it is a **clinical emergency** requiring immediate decompression without delay for imaging.
- Statement 1 (the correct diagnosis) is also missing from this option.
*1, 2 and 3*
- This combination is incorrect because Statement 3 is wrong.
- **Delaying treatment to obtain imaging** can be **fatal** due to cardiovascular collapse from mediastinal shift and impaired venous return.
- Statement 4 (definitive chest tube insertion) is also missing from this option.
*1, 3 and 4*
- This combination is incorrect because Statement 3 is wrong.
- The diagnosis is **clinical**, and treatment (needle decompression - Statement 2) should be initiated immediately to prevent hemodynamic compromise and death.
- Statement 2 (immediate needle decompression) is also missing from this option.
Question 14: Untidy wounds are characterised by which of the following?
1. Crushed or avulsed tissues
2. Contaminated wound
3. Devitalised tissue
4. No loss of tissue
A. 1, 2, 3 and 4
B. 1, 2 and 4
C. 1, 2 and 3 (Correct Answer)
D. 2, 3 and 4
Explanation: ***1, 2 and 3***
- **Untidy wounds**, often resulting from high-energy trauma, are defined by the presence of **crushed or avulsed tissues**, **contamination**, and **devitalized tissue**.
- These characteristics make the wound more complex to manage and prone to complications like infection.
*1, 2, 3 and 4*
- This option incorrectly includes "no loss of tissue" (option 4) as a characteristic of untidy wounds. **Untidy wounds** frequently involve **tissue loss**, making this statement contradictory to their definition.
- The presence of **crushed or avulsed tissues** inherently suggests some degree of tissue damage or loss.
*1, 2 and 4*
- This option incorrectly states that "no loss of tissue" is a characteristic of untidy wounds. In reality, **untidy wounds** are often associated with significant **tissue destruction and loss**.
- **Crushed and avulsed tissues** are direct indicators of tissue damage and potential loss.
*2, 3 and 4*
- This option incorrectly omits "crushed or avulsed tissues" (option 1), which is a cardinal feature of untidy wounds. It also incorrectly includes "no loss of tissue" (option 4).
- While **contamination** and **devitalized tissue** are hallmarks of untidy wounds, the absence of crushed/avulsed tissue and the idea of no tissue loss are inaccurate.