The following statements regarding Meckel's diverticulum in adults are true except
Consider the following statements : Branchial cysts : 1. are associated with tracks passing between the carotid bifurcation. 2. usually present in early adulthood. 3. occur along the lower one-third of the anterior border of the sternocleidomastoid muscle. 4. develop from the vestigial remnants of the fourth branchial cleft. Which of the statements given above are correct?
Regarding laparoscopic cholecystectomy, which of the following statements is correct?
A 25-year-old gentleman complains of dragging pain in the scrotum. The examination reveals the scrotum full of bag of worms which disappear on lying down. The usual first line option for relief is :
A malnourished 60-year-old man underwent emergency surgery for Strangulated Sigmoid Volvulus. After resection of the sigmoid colon, a colostomy was fashioned. The postoperative period was stormy and he developed a painful calf swelling in right lower limb. The most probable diagnosis is :
Which of the following statements regarding Thyroglossal duct are correct ? 1. It is situated in midline of neck. 2. It moves upwards on swallowing but not on tongue protrusion. 3. It is treated with Sistrunk operation. 4. It may be the only functioning thyroid tissue in the body. Select the correct answer using the code given below :
The best cosmetic result following breast reconstruction is achieved with :
While managing oesophageal perforations, which of the following factors favour non-operative management? 1. Perforation by a flexible endoscope 2. Contained perforation without free communication 3. Perforation with a small septic load 4. Perforation of the abdominal oesophagus Select the correct answer using the code given below:
A Sengstaken-Blakemore tube is used for the management of :
A young 28-year-old male was operated for duodenal ulcer perforation peritonitis. After having recovered well for five days, he developed high fever with chills and symptoms of toxemia. He developed right shoulder tip pain and intractable hiccoughs. The most likely diagnosis is :
UPSC-CMS 2023 - Surgery UPSC-CMS Practice Questions and MCQs
Question 11: The following statements regarding Meckel's diverticulum in adults are true except
- A. It usually presents on the mesenteric border of small intestine (Correct Answer)
- B. Bleeding is a common complication
- C. Incidental removal is often recommended in younger patients with risk factors
- D. It is a remnant of omphalomesenteric duct
Explanation: ***It usually presents on the mesenteric border of small intestine*** - Meckel's diverticulum is a **true diverticulum** arising from the **anti-mesenteric border** of the ileum, typically 2 feet from the ileocecal valve. - Its mesenteric positioning would be highly atypical and contradict its embryological origin as a remnant of the **vitelline duct**. - This statement is **FALSE** - it arises from the anti-mesenteric border, making it the correct answer to this "except" question. *Bleeding is a common complication* - **Bleeding** is indeed a common complication in adults, often due to **ectopic gastric mucosa** (present in ~50% of cases) within the diverticulum causing ulceration. - This complication can manifest as **painless rectal bleeding**. - This statement is **TRUE**. *Incidental removal is often recommended in younger patients with risk factors* - Current evidence-based guidelines recommend **selective removal** based on risk factors including age <50 years, palpable abnormalities (thickening, nodularity), narrow neck, length >2cm, or presence of bands. - In younger patients with risk factors, the lifetime risk of complications justifies prophylactic removal. - In older adults or those without risk factors, the morbidity of resection may outweigh the lifetime risk of complications. - This statement is **TRUE**. *It is a remnant of omphalomesenteric duct* - Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, representing a persistent portion of the **embryonic vitelline (omphalomesenteric) duct**. - This duct normally connects the fetal midgut to the yolk sac and should completely regress by the 7th week of gestation. - This statement is **TRUE**.
Question 12: Consider the following statements : Branchial cysts : 1. are associated with tracks passing between the carotid bifurcation. 2. usually present in early adulthood. 3. occur along the lower one-third of the anterior border of the sternocleidomastoid muscle. 4. develop from the vestigial remnants of the fourth branchial cleft. Which of the statements given above are correct?
- A. 2, 3 and 4 only
- B. 1, 2, 3 and 4
- C. 1, 2 and 3 only (Correct Answer)
- D. 1 and 2 only
Explanation: ***1, 2 and 3 only*** - **Branchial cysts** (specifically **second branchial cleft cysts**) are frequently associated with a **sinus tract** that passes between the **internal and external carotid arteries** (carotid bifurcation) and opens into the tonsillar fossa. - They commonly present in **late childhood or early adulthood** as a slowly enlarging, painless mass, often located along the **anterior border of the sternocleidomastoid muscle**, typically at the junction of the upper two-thirds and lower one-third of the neck. *2, 3 and 4 only* - This option incorrectly states that branchial cysts develop from the **fourth branchial cleft**. Most common branchial cysts are derived from the **second branchial cleft** (accounting for >90% of cases). - While statements 2 and 3 are correct regarding presentation and location, the origin from the fourth branchial cleft is generally not applicable to the most prevalent type of branchial cyst. *1, 2, 3 and 4* - This option includes the incorrect statement that branchial cysts typically originate from the **fourth branchial cleft**. The vast majority (over 90-95%) of branchial cleft anomalies arise from the **second branchial cleft**. - While all other statements (1, 2, and 3) are characteristic of second branchial cleft cysts, the inclusion of the fourth branchial cleft origin makes this option incorrect. *1 and 2 only* - This option correctly identifies the association with tracks passing through the carotid bifurcation and presentation in early adulthood. - However, it omits the correct statement that branchial cysts typically occur along the **lower one-third of the anterior border of the sternocleidomastoid muscle**, which is a key anatomical location and an important clinical finding for diagnosis.
Question 13: Regarding laparoscopic cholecystectomy, which of the following statements is correct?
- A. It is primarily done for cholecystitis in the third trimester of pregnancy
- B. It is associated with higher rate of bile duct injuries than open cholecystectomy (Correct Answer)
- C. It is safer than open cholecystectomy in patients with cardiorespiratory disease
- D. It is contraindicated in acute cholecystitis
Explanation: ***It is associated with higher rate of bile duct injuries than open cholecystectomy*** - **Historically**, laparoscopic cholecystectomy has been associated with a **higher rate of bile duct injuries** (0.4-0.6%) compared to open cholecystectomy (0.1-0.2%), particularly during the **learning curve period** in the 1990s. - Contributing factors include **limited visualization**, **altered anatomy** in acute inflammation, **reliance on 2D imaging**, and **misidentification of anatomic structures**. - Bile duct injuries, such as **common bile duct (CBD) laceration** or **transection**, can lead to significant morbidity. - **Note**: With increased surgeon experience and adoption of the **critical view of safety** technique, these rates have decreased, though the risk remains slightly higher than open surgery in some studies. *It is primarily done for cholecystitis in the third trimester of pregnancy* - **Laparoscopic cholecystectomy** during pregnancy is generally considered safe for symptomatic **gallstone disease**, with the **second trimester** being the optimal time for surgery. - In the **third trimester**, surgical considerations like **increased uterine size**, technical difficulty, and **fetal well-being** make laparoscopic surgery more challenging, and it is usually **deferred until after delivery** unless an emergency. - The primary indication for **cholecystectomy** is symptomatic gallstones or complications like **acute cholecystitis**, not specifically third trimester pregnancy. *It is safer than open cholecystectomy in patients with cardiorespiratory disease* - While **laparoscopic cholecystectomy** is generally associated with **less postoperative pain**, **reduced pulmonary complications**, and **faster recovery**, it involves **pneumoperitoneum** (CO2 insufflation), which increases intra-abdominal pressure. - **Pneumoperitoneum** can cause **decreased venous return**, **increased systemic vascular resistance**, **hypercarbia**, and **decreased lung compliance**, which may stress patients with severe **cardiorespiratory disease**. - The safety profile depends on individual patient factors, severity of cardiorespiratory disease, and anesthetic management. In many cases, the benefits of minimally invasive surgery outweigh the risks, but careful patient selection is essential. *It is contraindicated in acute cholecystitis* - This is **incorrect**. **Laparoscopic cholecystectomy** is the **gold standard treatment** for acute cholecystitis. - **Early laparoscopic cholecystectomy** (within **72 hours** of symptom onset) is preferred as it reduces complications, shortens hospital stay, and has better outcomes compared to delayed surgery. - Acute cholecystitis is an **indication**, not a **contraindication** for laparoscopic approach.
Question 14: A 25-year-old gentleman complains of dragging pain in the scrotum. The examination reveals the scrotum full of bag of worms which disappear on lying down. The usual first line option for relief is :
- A. Surgical varicocelectomy (ligation of testicular veins) (Correct Answer)
- B. Radio frequency ablation of testicular veins
- C. Percutaneous embolization of gonadal veins
- D. Laparoscopic excision of affected testes
Explanation: ***Surgical varicocelectomy (ligation of testicular veins)*** - The "bag of worms" sensation that disappears on lying down is **pathognomonic for varicocele**, representing dilated pampiniform plexus veins - **Varicocelectomy** (surgical ligation of the internal spermatic/testicular veins) is the **gold standard first-line treatment** for symptomatic varicoceles causing pain or infertility - Common approaches include **open (Palomo or Ivanissevich technique)**, **laparoscopic**, or **microscopic subinguinal** varicocelectomy with success rates of 90-95% - The procedure involves **ligation** (tying off) the dilated veins, not excision of the entire pampiniform plexus *Radio frequency ablation of testicular veins* - **Radiofrequency ablation** is not a standard treatment modality for varicoceles - The testicular veins are not amenable to standard RFA techniques used for other venous insufficiencies - This is **not considered a first-line option** in clinical practice *Percutaneous embolization of gonadal veins* - **Percutaneous embolization** is an alternative **minimally invasive first-line treatment** option for symptomatic varicoceles, particularly in resource-rich settings - Success rates are comparable to surgery (90-95%) with potentially lower complication rates and faster recovery - However, in the context of **traditional Indian surgical practice** and most PG examinations, **surgical varicocelectomy remains the conventional first-line answer** - Embolization involves retrograde catheterization and occlusion of the testicular vein with coils or sclerosants *Laparoscopic excision of affected testes* - **Orchiectomy** (testicular excision) is completely inappropriate for varicocele management - This radical procedure is reserved for **testicular malignancy**, severe trauma with non-viable testis, or torsion with necrosis - **Never a treatment option** for simple symptomatic varicocele
Question 15: A malnourished 60-year-old man underwent emergency surgery for Strangulated Sigmoid Volvulus. After resection of the sigmoid colon, a colostomy was fashioned. The postoperative period was stormy and he developed a painful calf swelling in right lower limb. The most probable diagnosis is :
- A. Myocardial failure due to fluid overload
- B. Deep vein thrombosis (Correct Answer)
- C. Oedema of renal failure
- D. Hypoproteinaemia
Explanation: ***Deep vein thrombosis*** - Postoperative patients, especially those undergoing **abdominal surgery** and those with **malnutrition**, are at high risk for **deep vein thrombosis (DVT)** due to Virchow's triad (venous stasis, endothelial injury, hypercoagulability). - A **painful calf swelling** is a classic symptom of DVT, indicating clot formation within the deep veins of the leg. *Myocardial failure due to fluid overload* - While fluid overload can occur post-surgery, it typically leads to **generalized edema**, shortness of breath, and signs of cardiac dysfunction, not isolated painful calf swelling. - The primary presentation here is a localized, painful swelling, which is less consistent with systemic cardiac issues. *Oedema of renal failure* - **Renal failure** can cause **edema**, but it tends to be **pitting, bilateral, and generalized**, often affecting the ankles and sacral areas. - It would not typically present as a painful, unilateral calf swelling without other signs of kidney dysfunction. *Hypoproteinaemia* - **Hypoproteinaemia**, common in **malnourished** individuals, can cause **generalized non-pitting edema** due to decreased oncotic pressure, not specifically a painful calf swelling. - It would manifest as widespread edema rather than a localized, painful swelling indicative of a thrombotic event.
Question 16: Which of the following statements regarding Thyroglossal duct are correct ? 1. It is situated in midline of neck. 2. It moves upwards on swallowing but not on tongue protrusion. 3. It is treated with Sistrunk operation. 4. It may be the only functioning thyroid tissue in the body. Select the correct answer using the code given below :
- A. 1, 3 and 4 (Correct Answer)
- B. 1, 2 and 3
- C. 2, 3 and 4
- D. 1, 2 and 4
Explanation: ***1, 3 and 4*** - The **thyroglossal duct** is embryological remnant located in the **midline of the neck** and often presents as a cyst. - The **Sistrunk operation** is the definitive surgical treatment for **thyroglossal duct cysts**, involving removal of the cyst, the midline portion of the hyoid bone, and the tract to the foramen cecum. - In some cases, a **thyroglossal duct cyst** may harbor the patient's only functional **thyroid tissue**, making preoperative imaging crucial to avoid inadvertently causing hypothyroidism. *1, 2 and 3* - This option incorrectly states that the thyroglossal duct moves upwards only on swallowing and not on **tongue protrusion**. - In fact, its connection to the foramen cecum at the base of the tongue means it **elevates with tongue protrusion** as well as swallowing. *2, 3 and 4* - This option incorrectly states that the **thyroglossal duct** moves upwards only on swallowing and not on **tongue protrusion**. - The **midline location** (statement 1) is a key characteristic of thyroglossal duct remnants and is correctly included in the comprehensive correct option. *1, 2 and 4* - This option incorrectly claims that the thyroglossal duct moves upwards only on swallowing and not on **tongue protrusion**. - It also omits the **Sistrunk operation** (statement 3), which is the standard surgical treatment for **thyroglossal duct cysts**.
Question 17: The best cosmetic result following breast reconstruction is achieved with :
- A. Latissimus dorsi flap
- B. Silicone gel implant with reconstruction
- C. Acellular dermal matrix flap
- D. Transverse rectus abdominis myocutaneous flap (Correct Answer)
Explanation: ***Transverse rectus abdominis myocutaneous flap*** - The **TRAM flap** offers excellent aesthetic outcomes by utilizing the patient's own **abdominal tissue**, providing a natural look and feel that mimics breast tissue. - This method results in a soft, pliable breast mound with good long-term stability and can provide a **simultaneous abdominoplasty** effect. *Latissimus dorsi flap* - While a viable option, the **latissimus dorsi flap** is typically smaller and may require an **implant** to achieve adequate breast volume, potentially leading to a less natural result than a TRAM flap. - It uses tissue from the back, which can leave a noticeable scar and may cause **weakness in the shoulder** or back. *Silicone gel implant with reconstruction* - Implants can provide good cosmetic results but carry risks such as **capsular contracture**, rupture, and the need for future revisions, which can affect long-term satisfaction. - They do not offer the same **natural feel or warmth** as autologous tissue reconstruction, as the reconstructed breast is not made of living tissue. *Acellular dermal matrix flap* - **Acellular dermal matrix (ADM)** is often used as an adjunct in implant-based reconstruction to support and reinforce the breast tissue, rather than as a primary reconstructive flap for optimal cosmetic results. - While it aids in tissue expansion and support, it does not provide the **volume or natural contour** that an autologous flap like the TRAM can achieve on its own.
Question 18: While managing oesophageal perforations, which of the following factors favour non-operative management? 1. Perforation by a flexible endoscope 2. Contained perforation without free communication 3. Perforation with a small septic load 4. Perforation of the abdominal oesophagus Select the correct answer using the code given below:
- A. 1, 3 and 4
- B. 2, 3 and 4
- C. 1, 2 and 3 (Correct Answer)
- D. 1, 2 and 4
Explanation: ***1, 2 and 3*** - **Perforation by a flexible endoscope** often results in smaller, less destructive perforations due to the instrument's flexibility, making non-operative management feasible if other favorable conditions are met. - **Contained perforation without free communication** implies that the leak is localized and not actively spreading into surrounding tissues, reducing the risk of widespread mediastinitis or peritonitis. - **Perforation with a small septic load** indicates minimal contamination, which simplifies management and improves the chances of successful non-operative treatment through antibiotics and supportive care. *1, 3 and 4* - This option correctly identifies factors 1 and 3, but **perforation of the abdominal esophagus** is generally treated surgically due to the high risk of widespread peritonitis and severe sepsis. - While smaller perforations are more manageable, the anatomical location in the abdominal cavity predisposes to rapid and severe contamination. *2, 3 and 4* - This option correctly includes factors 2 and 3 that favor non-operative management but incorrectly suggests that **perforation of the abdominal esophagus** is managed non-operatively. - The high risk of peritonitis from an abdominal oesophageal perforation often necessitates surgical intervention to prevent severe complications. *1, 2 and 4* - This option correctly identifies factors 1 and 2 but mistakenly includes **perforation of the abdominal esophagus** as a factor favoring non-operative management. - Abdominal oesophageal perforations are high-risk situations generally requiring early surgical repair to prevent life-threatening complications.
Question 19: A Sengstaken-Blakemore tube is used for the management of :
- A. Corrosive poisoning
- B. Variceal bleeding (Correct Answer)
- C. Tension pneumothorax
- D. Asphyxia
Explanation: ***Variceal bleeding*** - A **Sengstaken-Blakemore tube** is specifically designed with gastric and esophageal balloons to apply direct pressure and tamponade **bleeding esophageal varices**, a common complication of portal hypertension. - It is utilized as a temporary measure to control severe hemorrhage when endoscopic interventions fail or are unavailable. *Corrosive poisoning* - Management of corrosive poisoning focuses on **supportive care**, pain management, and preventing further injury; a Sengstaken-Blakemore tube is not indicated. - Using such a tube could potentially worsen esophageal damage or perforation in corrosive injuries. *Tension pneumothorax* - A tension pneumothorax is a **thoracic emergency** requiring immediate **needle decompression** or chest tube insertion. - A Sengstaken-Blakemore tube is an upper gastrointestinal device and has no role in managing pulmonary conditions. *Asphyxia* - Asphyxia involves a lack of oxygen and is managed by establishing an **open airway**, providing ventilation, and addressing the underlying cause. - A Sengstaken-Blakemore tube is irrelevant to the treatment of asphyxia.
Question 20: A young 28-year-old male was operated for duodenal ulcer perforation peritonitis. After having recovered well for five days, he developed high fever with chills and symptoms of toxemia. He developed right shoulder tip pain and intractable hiccoughs. The most likely diagnosis is :
- A. Subphrenic abscess (Correct Answer)
- B. Right lobe liver abscess
- C. Surgical site infection
- D. Postoperative peritonitis
Explanation: ***Subphrenic abscess*** - The development of **high fever with chills**, **toxemia**, **right shoulder tip pain**, and **intractable hiccups** following a duodenal ulcer perforation repair strongly suggests a subphrenic abscess. - **Diaphragmatic irritation** by the abscess causes referred shoulder pain (due to phrenic nerve irritation) and hiccups. *Right lobe liver abscess* - While a liver abscess can cause fever and chills, **shoulder tip pain** and **hiccups** are less typical compared to a subphrenic abscess, unless the abscess is very superficial and irritating the diaphragm. - A liver abscess often presents with **right upper quadrant pain** and hepatomegaly, which are not mentioned. *Surgical site infection* - A surgical site infection would typically manifest with **localized pain**, **redness**, **swelling**, and possibly **pus discharge** at the incision site, rather than referred shoulder pain or intractable hiccups. - While it can cause fever and toxemia, the specific constellation of symptoms points away from a superficial wound infection. *Postoperative peritonitis* - Postoperative peritonitis would present with more generalized **abdominal pain**, **distension**, **tenderness**, and potentially signs of evolving **sepsis** or **organ dysfunction**. - While it can cause fever and toxemia, the distinct symptoms of **shoulder tip pain** and **hiccups** are less characteristic of diffuse peritonitis.