UPSC-CMS 2023 - Surgery Practice Questions

Q: 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?

1, 2 and 3 only. ***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.

Q: 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 :

Surgical varicocelectomy (ligation of testicular veins). ***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

Q: 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 :

Deep vein thrombosis. ***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.

Q: 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 :

1, 3 and 4. ***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**.

Q: The best cosmetic result following breast reconstruction is achieved with :

Transverse rectus abdominis myocutaneous flap. ***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.

Q: 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:

1, 2 and 3. ***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.

Q: A Sengstaken-Blakemore tube is used for the management of :

Variceal bleeding. ***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.

Q: 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 :

Subphrenic abscess. ***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.

Question 1

The following statements regarding Meckel's diverticulum in adults are true except

Accepted Answer

It usually presents on the mesenteric border of small intestine

Answer

Bleeding is a common complication

Answer

Incidental removal is often recommended in younger patients with risk factors

Answer

It is a remnant of omphalomesenteric duct

Question 2

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?

Accepted Answer

1, 2 and 3 only

Answer

2, 3 and 4 only

Answer

1, 2, 3 and 4

Answer

1 and 2 only

Question 3

Regarding laparoscopic cholecystectomy, which of the following statements is correct?

Accepted Answer

It is associated with higher rate of bile duct injuries than open cholecystectomy

Answer

It is primarily done for cholecystitis in the third trimester of pregnancy

Answer

It is safer than open cholecystectomy in patients with cardiorespiratory disease

Answer

It is contraindicated in acute cholecystitis

Question 4

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 :

Accepted Answer

Surgical varicocelectomy (ligation of testicular veins)

Answer

Radio frequency ablation of testicular veins

Answer

Percutaneous embolization of gonadal veins

Answer

Laparoscopic excision of affected testes

Question 5

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 :

Accepted Answer

Deep vein thrombosis

Answer

Myocardial failure due to fluid overload

Answer

Oedema of renal failure

Answer

Hypoproteinaemia

Question 6

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 :

Accepted Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Question 7

The best cosmetic result following breast reconstruction is achieved with :

Accepted Answer

Transverse rectus abdominis myocutaneous flap

Answer

Latissimus dorsi flap

Answer

Silicone gel implant with reconstruction

Answer

Acellular dermal matrix flap

Question 8

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:

Accepted Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 4

Question 9

A Sengstaken-Blakemore tube is used for the management of :

Accepted Answer

Variceal bleeding

Answer

Corrosive poisoning

Answer

Tension pneumothorax

Answer

Asphyxia

Question 10

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 :

Accepted Answer

Subphrenic abscess

Answer

Right lobe liver abscess

Answer

Surgical site infection

Answer

Postoperative peritonitis

UPSC-CMS 2023 — Surgery