UPSC-CMS 2022 - Surgery PYQs Practice Questions

Q: The most common metabolic abnormality associated with gastric outlet obstruction is

hypochloraemic alkalosis. ***Hypochloraemic alkalosis*** - Gastric outlet obstruction leads to **persistent vomiting of gastric contents**, rich in **hydrochloric acid (HCl)**. - The loss of HCl causes a decrease in plasma chloride (**hypochloraemia**) and an increase in bicarbonate, leading to **metabolic alkalosis**. - This is the **classic metabolic abnormality** seen in pyloric stenosis and other causes of gastric outlet obstruction. *Hyperchloraemic alkalosis* - This is an incorrect combination of electrolyte and acid-base disturbances; hyperchloraemia typically accompanies **acidosis**, not alkalosis. - Hyperchloraemic alkalosis would imply an excess of chloride and base, which does not result from the vomiting of acidic gastric contents. *Hypochloraemic acidosis* - Hypochloraemia can occur with acidosis (e.g., from severe diarrhea with bicarbonate loss), but the primary acid-base disturbance in gastric outlet obstruction is **alkalosis** due to hydrogen ion loss. - Vomiting primarily causes a loss of acid, leading to an increase in blood pH, not a decrease. *Hyperchloraemic acidosis* - This condition is often seen in situations like **renal tubular acidosis** or with the administration of large amounts of **saline solutions**, where chloride intake is high and bicarbonate is lost or diluted. - It specifically does not occur with the loss of highly acidic gastric contents, which would decrease chloride levels and increase pH. [Practice more Surgery PYQs on OnCourse]

Q: Which of the following is the PRIMARY factor that predisposes to the development of incisional hernia?

Postoperative wound infection. ***Postoperative wound infection*** - **Postoperative wound infection** is the **PRIMARY and most important modifiable risk factor** for incisional hernia development, increasing the risk by **2-4 fold**. - Infection causes **tissue necrosis**, **fascial disruption**, and **impaired collagen synthesis**, directly compromising the structural integrity of the wound closure. - The inflammatory response and proteolytic enzymes released during infection destroy newly formed collagen and prevent proper fascial healing. - This is consistently cited in major surgical textbooks (Sabiston, Schwartz) as the leading preventable cause of incisional hernias. *Malnutrition* - While malnutrition impairs wound healing by reducing collagen synthesis and tissue strength, it acts as a **background predisposing factor** rather than the primary cause [1]. - Protein deficiency affects overall tissue quality but typically requires additional factors (like infection) to result in hernia formation [1]. - Nutritional optimization is important perioperatively but is less directly causative than acute wound complications. *Immunocompromised patient* - Immunocompromise increases susceptibility to infection and impairs healing, but it is an indirect risk factor [1]. - The mechanism primarily operates through **increased infection risk** rather than being an independent primary cause [1]. *Non-absorbable suture material* - Suture material choice affects long-term stability and may influence chronic pain or foreign body reactions. - Current evidence shows **continuous non-absorbable sutures** are actually preferred for fascial closure to reduce hernia risk [1]. - This is a technical consideration but not a primary predisposing factor compared to wound complications. [Practice more Surgery PYQs on OnCourse]

Q: Triaging is done to prioritize the treatment in case of trauma and the patients are colour coded. The yellow colour code signifies

urgent. ***urgent*** - The **yellow (urgent)** code indicates that the patient requires medical attention within a few hours, but their condition is not immediately life-threatening. - These patients are stable enough to wait for treatment after more critical patients have been addressed but still need significant care soon. *non-urgent* - **Green (non-urgent)** code is for patients with minor injuries or conditions that can wait for extended periods for treatment. - They typically have stable vital signs and minimal risk of deterioration. *immediate* - **Red (immediate)** code signifies patients with life-threatening injuries or conditions requiring immediate intervention to save life or limb. - These are the highest priority patients who need attention within minutes. *unsalvageable* - **Black (unsalvageable/deceased)** code is for patients who are either deceased or have injuries so severe that survival is unlikely even with immediate medical intervention. - These patients are given palliative care if alive, or their bodies are managed if deceased. [Practice more Surgery PYQs on OnCourse]

Question 1

Which of the following vital structures in the axilla should always be preserved in modified radical mastectomy?

Accepted Answer

Axillary vein

Answer

Intercostobrachial nerves

Answer

Nerve to serratus anterior

Answer

Nerve to latissimus dorsi

Question 2

The most common metabolic abnormality associated with gastric outlet obstruction is

Accepted Answer

hypochloraemic alkalosis

Answer

hyperchloraemic alkalosis

Answer

hypochloraemic acidosis

Answer

hyperchloraemic acidosis

Question 3

Which of the following is the PRIMARY factor that predisposes to the development of incisional hernia?

Accepted Answer

Postoperative wound infection

Answer

Immunocompromised patient

Answer

Malnutrition

Answer

Non-absorbable suture material

Question 4

Which of the following statements regarding a patient of liver trauma are correct?

1. Liver is the most common organ injured following abdominal trauma.
2. Surgical exploration (laparotomy) is required in haemodynamically unstable patients and patients with free intraperitoneal fluid on FAST.
3. Contrast enhanced CT abdomen should be done in haemodynamically stable patients.
4. Blunt injuries have a higher mortality as compared to penetrating injuries.

Accepted Answer

3. Contrast enhanced CT abdomen should be done in haemodynamically stable patients.

Answer

1. Liver is the most common organ injured following abdominal trauma.

Answer

2. Surgical exploration (laparotomy) is required in haemodynamically unstable patients and patients with free intraperitoneal fluid on FAST.

Answer

4. Blunt injuries have a higher mortality as compared to penetrating injuries.

Question 5

Triaging is done to prioritize the treatment in case of trauma and the patients are colour coded. The yellow colour code signifies

Accepted Answer

urgent

Answer

non-urgent

Answer

immediate

Answer

unsalvageable

Question 6

Hypotension in an unconscious head injury patient is most commonly due to

Accepted Answer

associated injuries of abdomen or chest

Answer

intracerebral haemorrhage

Answer

extradural haemorrhage

Answer

pontine haemorrhage

Question 7

Preoperative investigations done prior to surgery depend upon which of the following?

1. Type of surgery
2. Patient origin
3. Patient comorbidities
4. Experience of surgeon

Accepted Answer

1. Type of surgery

Answer

4. Experience of surgeon

Answer

2. Patient origin

Answer

3. Patient comorbidities

Question 8

Which of the following is NOT included in Grade II acute cholecystitis as per 'Tokyo Consensus Guidelines for Severity'?

1. Elevated white cell count (> 18000/mm3)
2. Renal dysfunction
3. Duration > 72 hours
4. Marked local inflammation

Accepted Answer

2. Renal dysfunction

Answer

4. Marked local inflammation

Answer

3. Duration > 72 hours

Answer

1. Elevated white cell count (> 18000/mm3)

Question 9

Which of the following is the FIRST step in triple assessment of breast lumps?

1. Clinical assessment
2. Radiological assessment
3. Histopathological assessment
4. Sentinel lymph node biopsy

Accepted Answer

Clinical assessment

Answer

Radiological assessment

Answer

Sentinel lymph node biopsy

Answer

Histopathological assessment

Question 10

Which of the following is the MOST reliable intraoperative feature of viable small bowel?

1. Visible peristalsis
2. Flabby intestinal musculature
3. Shiny appearance of small bowel wall
4. Visible pulsation in the mesenteric artery

Accepted Answer

1. Visible peristalsis

Answer

3. Shiny appearance of small bowel wall

Answer

2. Flabby intestinal musculature

Answer

4. Visible pulsation in the mesenteric artery

UPSC-CMS 2022 — Surgery