In seat belt syndrome the most common site of bleeding is from :
A 47-year-old man comes to Surgery OPD with history of recurrent episodes of UTI. He gives history of the urine being frothy and occasionally having bubbles. The probable diagnosis is :
A patient with head injury with a Glasgow Coma Scale of 10 is classified as :
Which of the following are the common complications associated with enteral nutrition in postoperative patients ? 1. Tube malposition, displacement 2. Diarrhoea, constipation 3. Predisposition to systemic sepsis 4. Electrolytic imbalance Select the correct answer using the code given below :
UPSC-CMS 2023 - Surgery UPSC-CMS Practice Questions and MCQs
Question 21: In seat belt syndrome the most common site of bleeding is from :
- A. Bowel
- B. Spleen
- C. Liver
- D. Mesentery (Correct Answer)
Explanation: ***Mesentery*** - In **seat belt syndrome**, the **mesentery** is the **most common site of bleeding** due to the unique mechanism of injury. - Sudden deceleration causes **shearing forces** at fixed points where the small bowel and mesentery are compressed against the posterior abdominal wall and spine by the lap belt. - This results in **mesenteric tears**, **hematomas**, and **vascular injuries** (mesenteric vessels are particularly vulnerable), leading to significant intra-abdominal hemorrhage. - **Mesenteric injury** occurs in approximately **20-30%** of seat belt syndrome cases, making it the predominant source of bleeding. *Bowel* - While **bowel injuries** (perforation, transection, intramural hematoma) do occur in seat belt syndrome and are clinically significant, they are typically **second in frequency** to mesenteric injuries. - Bowel perforation occurs in about 15-20% of cases and may present with delayed symptoms. - The bowel injury often occurs in conjunction with mesenteric tears due to the same deceleration mechanism. *Spleen* - Splenic injury is less commonly associated with the specific compression mechanism of seat belt syndrome. - The spleen is more typically injured in direct blunt trauma to the left upper quadrant from side impacts or direct blows. - Not the characteristic injury pattern seen with lap belt restraint. *Liver* - Liver injuries are more often associated with direct forceful impacts to the right upper quadrant or generalized severe blunt abdominal trauma. - The typical seat belt mechanism with lap belt compression does not preferentially injure the liver. - Less common in the classical seat belt syndrome presentation.
Question 22: A 47-year-old man comes to Surgery OPD with history of recurrent episodes of UTI. He gives history of the urine being frothy and occasionally having bubbles. The probable diagnosis is :
- A. Tubercular cystitis
- B. Colovesical fistula (Correct Answer)
- C. Urethrocutaneous fistula
- D. Anaerobic bacterial infection
Explanation: ***Colovesical fistula*** - The presence of **pneumaturia (gas/bubbles in urine)** and **frothy urine** is pathognomonic of colovesical fistula, indicating abnormal communication between the colon and bladder with gas passage from bowel to bladder. - **Recurrent UTIs** occur in >50% of cases due to constant contamination of the bladder with fecal bacteria. - Other features include **fecaluria** (fecal matter in urine) - though less common than pneumaturia. - Most commonly caused by diverticular disease (65%), followed by colorectal cancer and Crohn's disease. *Tubercular cystitis* - While it can cause recurrent UTIs and bladder irritation, it does not typically present with **pneumaturia** or frothy urine. - Presents with sterile pyuria, dysuria, hematuria, and frequency. - Diagnosis requires identification of *Mycobacterium tuberculosis* in urine culture or bladder biopsy. *Urethrocutaneous fistula* - This involves an abnormal communication between the urethra and the skin, leading to urine leakage onto the skin surface. - Does not cause gas to enter the bladder or result in **pneumaturia**. - May cause recurrent UTIs if fistula leads to inadequate bladder emptying, but not the presenting features. *Anaerobic bacterial infection* - Although anaerobic bacteria can cause UTIs, they do not produce sufficient gas to cause **pneumaturia** without an underlying anatomical defect. - **Pneumaturia** is a mechanical sign indicating an abnormal connection with a gas-containing organ (colon), not merely infection.
Question 23: A patient with head injury with a Glasgow Coma Scale of 10 is classified as :
- A. Moderate injury (Correct Answer)
- B. Mild injury
- C. Severe injury
- D. Minor injury
Explanation: ***Moderate injury*** - A Glasgow Coma Scale (GCS) score between **9 and 12** is classified as a **moderate head injury**. - Patients in this range often present with initial loss of consciousness, post-traumatic amnesia, or neurological deficits. *Mild injury* - A **mild head injury** is characterized by a GCS score of **13-15**. - These patients typically have a brief or no loss of consciousness and may experience symptoms like headache or dizziness. *Severe injury* - A **severe head injury** is indicated by a GCS score of **3-8**. - Patients with severe head injuries are often comatose and require urgent medical intervention. *Minor injury* - "Minor injury" is not a standard medical classification for head trauma based on the GCS. - The closest GCS classification would be for **mild head injury**.
Question 24: Which of the following are the common complications associated with enteral nutrition in postoperative patients ? 1. Tube malposition, displacement 2. Diarrhoea, constipation 3. Predisposition to systemic sepsis 4. Electrolytic imbalance Select the correct answer using the code given below :
- A. 1, 2 and 4
- B. 1, 3 and 4
- C. 2, 3 and 4
- D. 1, 2 and 3 (Correct Answer)
Explanation: ***1, 2 and 3*** - **Tube malposition/displacement** is a common mechanical complication (10-15% incidence), which can lead to ineffective feeding or aspiration into the respiratory tract. - **Diarrhoea and constipation** are frequent gastrointestinal complications (10-20% incidence), occurring due to formula intolerance, rapid infusion rates, or altered gut motility in postoperative patients. - **Predisposition to systemic sepsis**: While enteral nutrition itself has lower infection risk than parenteral nutrition, complications like **aspiration pneumonia** (from tube malposition), **contaminated formula**, and **prolonged ileus** can predispose to severe infections and sepsis in postoperative patients. This is particularly relevant when enteral feeding is improperly managed. *1, 2 and 4* - This combination includes **electrolyte imbalances** (hypokalemia, hypophosphatemia, hypomagnesemia), which are indeed common metabolic complications requiring monitoring. - However, in the context of postoperative patients, the infection risk (sepsis) from aspiration and feeding-related complications is considered a more significant acute complication than electrolyte disturbances, which are generally manageable with proper monitoring and formula adjustment. *1, 3 and 4* - This option incorrectly excludes **diarrhoea and constipation**, which are among the **most common complications** of enteral nutrition, occurring in 10-20% of patients. - GI complications are a primary reason for enteral feeding intolerance and cannot be omitted. *2, 3 and 4* - This option incorrectly omits **tube malposition/displacement**, which is the most important **mechanical complication** directly related to the enteral feeding method. - Without proper tube placement verification, feeding cannot be safely administered, making this a critical complication to recognize.