UPSC-CMS 2024 — Surgery
14 Previous Year Questions with Answers & Explanations
Which of the following are risk factors for wound infection? 1. Malnutrition 2. Poor perfusion 3. Antibodies 4. Foreign body material Select the correct answer using the code given below.
A midline neck swelling just below the hyoid bone and managed by Sistrunk's operation leads to postoperative need for thyroxine replacement. The most likely diagnosis is
A 40-year-old smoker presents with soreness of tongue since last 2 months. On examination, it is found that the oral hygiene is poor and there is a white plaque over the lateral border of the tongue. What is the next step in the management of this patient?
A 60-year-old lady presents with a recent onset increase in a long standing swelling on the front of the neck. The swelling, which was small, had been present since last 30 years, but has now increased to more than twice the size in the last 2 months. On examination, the swelling is firm to hard in consistency and moves with deglutition. What is the most likely cause of this clinical presentation?
Which among the following are complications of liver trauma? 1. Liver abscess 2. Biliary fistula 3. Portal thrombosis 4. Liver failure Select the correct answer using the code given below.
Which one of the following statements is correct about mesenteric cysts?
Which of the following are features of umbilical hernia in adults? 1. Patients are commonly overweight with a thinned and attenuated midline raphe. 2. Most patients are asymptomatic or present with a painless swelling. 3. Men are affected more than women. 4. Hernia repair can be done by the technique described by Mayo. Select the correct answer using the code given below.
What is the most common cause of perforation of the oesophagus?
Which of the following are stages of damage control surgery? 1. Patient selection 2. Control of haemorrhage 3. Resuscitation in ICU 4. Preventive surgery Select the correct answer using the code given below.
Extracorporeal Shock Wave Lithotripsy (ESWL) is most commonly used for the treatment of
UPSC-CMS 2024 - Surgery UPSC-CMS Practice Questions and MCQs
Question 1: Which of the following are risk factors for wound infection? 1. Malnutrition 2. Poor perfusion 3. Antibodies 4. Foreign body material Select the correct answer using the code given below.
- A. 1, 3 and 4
- B. 1, 2 and 4 (Correct Answer)
- C. 2, 3 and 4
- D. 1, 2 and 3
Explanation: ***Correct: 1, 2 and 4*** The risk factors for wound infection include: - **Malnutrition** impairs the immune system and wound healing processes, making the patient more susceptible to infection - **Poor perfusion** (reduced blood supply) leads to decreased oxygen and nutrient delivery to the wound, hindering healing and immune cell function - **Foreign body material** within the wound creates a nidus for bacterial colonization and protects bacteria from immune defenses and antibiotics Antibodies are part of the body's immune defense system and **protect against infection** rather than being a risk factor for it. *Incorrect: 1, 3 and 4* While malnutrition (1) and foreign bodies (4) are risk factors, antibodies (3) are part of the immune defense and protect against infection, not increase its risk. *Incorrect: 2, 3 and 4* Poor perfusion (2) and foreign bodies (4) are risk factors, but antibodies (3) are protective components of the immune system. *Incorrect: 1, 2 and 3* Malnutrition (1) and poor perfusion (2) are significant risk factors, but antibodies (3) are a component of the host's defense mechanism against infection, not a risk factor.
Question 2: A midline neck swelling just below the hyoid bone and managed by Sistrunk's operation leads to postoperative need for thyroxine replacement. The most likely diagnosis is
- A. solitary thyroid nodule
- B. thyroglossal cyst with only functioning thyroid tissue (Correct Answer)
- C. thyroglossal cyst
- D. lateral aberrant thyroid
Explanation: ***thyroglossal cyst with only functioning thyroid tissue*** - A midline neck swelling below the hyoid bone is characteristic of a **thyroglossal cyst**. The need for **thyroxine replacement** post-Sistrunk's operation indicates that this cyst contained the patient's **only functioning thyroid tissue**. - In such rare cases, the body's entire thyroid gland develops abnormally within the thyroglossal duct, explaining the subsequent **hypothyroidism** after its removal. *solitary thyroid nodule* - A **solitary thyroid nodule** is typically located within the thyroid gland itself, which is lower in the neck than "just below the hyoid bone." - Simple removal of a solitary benign thyroid nodule would not, on its own, necessitate **thyroxine replacement** unless a total thyroidectomy was performed for other reasons, or the patient had underlying thyroid dysfunction. *thyroglossal cyst* - While a **thyroglossal cyst** fits the description of a midline neck swelling below the hyoid, simply diagnosing it as a cyst doesn't explain the need for **thyroxine replacement**. - Most thyroglossal cysts are benign and contain no functional thyroid tissue, so their removal via a Sistrunk's operation does not typically lead to **hypothyroidism**. *lateral aberrant thyroid* - **Lateral aberrant thyroid tissue** is typically found in the lateral neck, often associated with a branchial cleft anomaly, not in the midline below the hyoid bone. - While it can contain functional thyroid tissue, its location and the specific context of a Sistrunk's operation pointing to a midline anomaly make this diagnosis less likely.
Question 3: A 40-year-old smoker presents with soreness of tongue since last 2 months. On examination, it is found that the oral hygiene is poor and there is a white plaque over the lateral border of the tongue. What is the next step in the management of this patient?
- A. Edge biopsy of the lesion (Correct Answer)
- B. Oral antifungal treatment
- C. Local topical cauterization
- D. Oral vitamin C supplementation
Explanation: ***Edge biopsy of the lesion*** - The patient's presentation with a **white plaque** on the lateral border of the tongue, coupled with **poor oral hygiene** and a history of **smoking**, raises high suspicion for **oral potentially malignant disorders**, including **leukoplakia** or early **squamous cell carcinoma**. - An **edge biopsy** is the most appropriate next step to obtain a definitive histological diagnosis, which is crucial for determining the correct management strategy and ruling out malignancy. - The lateral border of the tongue is a **high-risk site** for oral cancer, and any persistent lesion in a smoker warrants tissue diagnosis. *Oral antifungal treatment* - This would be indicated if the white plaque were consistent with **oral candidiasis (thrush)**, which typically presents as **scrapable** white patches with a cottage cheese-like appearance. - Given the patient's significant risk factors (smoking, 2-month duration) and the location (lateral tongue border), empirical antifungal treatment without a definitive diagnosis would inappropriately delay management if the lesion is precancerous or cancerous. *Local topical cauterization* - **Cauterization** is contraindicated for undiagnosed oral lesions, especially those suspected of having malignant potential, as it could obscure the true histology and destroy tissue needed for diagnosis. - This method is only suitable for small, confirmed benign lesions or for hemostasis, never as a diagnostic or first-line approach. *Oral vitamin C supplementation* - While **vitamin C** supports overall health and tissue repair, there is no evidence it would resolve a suspicious white plaque on the tongue, especially one with potential malignant transformation. - Delaying proper diagnostic evaluation with supplementation alone could lead to progression of a serious underlying condition such as oral cancer.
Question 4: A 60-year-old lady presents with a recent onset increase in a long standing swelling on the front of the neck. The swelling, which was small, had been present since last 30 years, but has now increased to more than twice the size in the last 2 months. On examination, the swelling is firm to hard in consistency and moves with deglutition. What is the most likely cause of this clinical presentation?
- A. Myxomatous transformation
- B. Haemorrhage
- C. Cystic degeneration
- D. Malignant transformation (Correct Answer)
Explanation: ***Malignant transformation*** - A long-standing **benign thyroid swelling** (like a nodular goiter or adenoma) in an older patient that suddenly and rapidly increases in size, becomes firm/hard, and is associated with new symptoms suggests **malignant transformation**. - Additionally, factors like age over 60, female sex and change in consistency are concerning for **thyroid carcinoma**. *Myxomatous transformation* - This typically refers to the accumulation of **mucinous material** and is not a common or principal cause of rapid, significant enlargement and hardening in a long-standing thyroid swelling. - It does not explain the **rapid increase in size** and **firm consistency** described. *Haemorrhage* - While hemorrhage into a thyroid nodule can cause a **sudden increase in size** and pain, it usually presents as an acutely painful, tender swelling, and the consistency might be tense but not typically described as "firm to hard." - The rapid change in size over **two months** is more suggestive of cellular proliferation rather than a resolving bleed. *Cystic degeneration* - Cystic degeneration can explain some fluctuation in size over time, but a **rapid increase to more than twice the size** within two months, especially accompanied by a **firm to hard consistency**, is not characteristic of simple cystic change. - Cysts are typically softer or fluctuant on palpation, not firm and hard.
Question 5: Which among the following are complications of liver trauma? 1. Liver abscess 2. Biliary fistula 3. Portal thrombosis 4. Liver failure Select the correct answer using the code given below.
- A. 1, 2 and 4 (Correct Answer)
- B. 1, 2 and 3
- C. 2, 3 and 4
- D. 1, 3 and 4
Explanation: ***1, 2 and 4*** - **Liver abscess** is a well-recognized complication resulting from infected devitalized tissue, hematoma, or bile contamination following liver trauma. - **Biliary fistula** is a common complication occurring when bile leaks from damaged intrahepatic or extrahepatic bile ducts, potentially forming external fistulas or bilomas. - **Liver failure** may result from extensive parenchymal damage, massive blood loss causing hepatic ischemia, coagulopathy, and metabolic derangements. - These three represent the **most common and clinically significant** complications of liver trauma encountered in clinical practice. *1, 2 and 3* - While **portal thrombosis** can theoretically occur after portal vein injury in liver trauma, it is a **rare complication** compared to liver abscess, biliary fistula, and liver failure. - This option incorrectly prioritizes portal thrombosis over the more common and clinically significant complication of liver failure. *2, 3 and 4* - This option incorrectly omits **liver abscess**, which is one of the most important delayed complications of liver trauma. - Abscess formation from infected hematomas or devitalized tissue is far more commonly encountered than portal thrombosis. *1, 3 and 4* - This option incorrectly omits **biliary fistula**, which is one of the most frequent complications of liver trauma. - Bile duct injury with subsequent bile leakage occurs in a significant proportion of liver trauma cases, making biliary fistula more clinically relevant than portal thrombosis.
Question 6: Which one of the following statements is correct about mesenteric cysts?
- A. It presents most commonly as a painless abdominal swelling. (Correct Answer)
- B. It is more common in males as compared to females.
- C. It occurs most commonly in children less than 18 years of age.
- D. Percutaneous aspiration with injection of sclerosant is the preferred treatment option.
Explanation: ***It presents most commonly as a painless abdominal swelling.*** - **Mesenteric cysts** typically manifest as a **slowly growing**, **asymptomatic abdominal mass**, which is often discovered incidentally or due to mild pressure symptoms. - Their **painless nature** and gradual enlargement contribute to this common presentation. *Percutaneous aspiration with injection of sclerosant is the preferred treatment option.* - **Simple aspiration** or sclerotherapy of mesenteric cysts is generally **contraindicated** due to the high risk of recurrence and potential for complications like infection or rupture. - The **preferred treatment** for mesenteric cysts is surgical excision to prevent recurrence and complications. *It is more common in males as compared to females.* - While rare overall, mesenteric cysts are **more prevalent in females** than males, although the exact reason for this disparity is not fully understood. - Some studies suggest a **female-to-male ratio** of approximately 2:1. *It occurs most commonly in children less than 18 years of age.* - Mesenteric cysts can occur at any age, but they are **more common in adults**, with the highest incidence typically reported in the third to fifth decades of life. - Although they can be found in children, this is **not the most common age group** for presentation.
Question 7: Which of the following are features of umbilical hernia in adults? 1. Patients are commonly overweight with a thinned and attenuated midline raphe. 2. Most patients are asymptomatic or present with a painless swelling. 3. Men are affected more than women. 4. Hernia repair can be done by the technique described by Mayo. Select the correct answer using the code given below.
- A. 2, 3 and 4
- B. 1, 2 and 3
- C. 1, 3 and 4
- D. 1, 2 and 4 (Correct Answer)
Explanation: ***1, 2 and 4*** - **Overweight patients** often have increased intra-abdominal pressure and weakened abdominal walls, contributing to the development of an umbilical hernia and a **thinned midline raphe**. - **Most adult umbilical hernias are asymptomatic** or present as painless swellings; patients typically notice a bulge that may increase with coughing or straining. Pain usually indicates **complications** such as incarceration or strangulation. - The **Mayo repair** is a classic technique specifically designed for umbilical hernias, involving the overlapping of the rectus sheath for a strong repair. *2, 3 and 4* - While patients are often **asymptomatic** (statement 2 correct) and the **Mayo repair** is standard (statement 4 correct), statement 3 is incorrect; **women are more commonly affected** by umbilical hernias than men. *1, 2 and 3* - Patients are commonly **overweight** (statement 1 correct) and often **asymptomatic** (statement 2 correct), but statement 3 is incorrect as umbilical hernias are seen **more often in women** than men. *1, 3 and 4* - Patients are commonly **overweight** (statement 1 correct) and the **Mayo repair** is a recognized technique (statement 4 correct), but statement 3 is incorrect because **women are more affected** than men. Statement 2 is also correct as most patients are asymptomatic.
Question 8: What is the most common cause of perforation of the oesophagus?
- A. Barotrauma
- B. Malignancy
- C. Mediastinitis
- D. Iatrogenic injury (Correct Answer)
Explanation: ***Correct: Iatrogenic injury*** - **Iatrogenic injuries** are the most common cause of esophageal perforation, accounting for **50-75%** of all cases. - Most commonly occur during **endoscopic procedures** (upper GI endoscopy, esophageal dilation, biopsy, bougie dilation, pneumatic dilation for achalasia, sclerotherapy). - Other iatrogenic causes include **nasogastric tube insertion**, esophageal stent placement, and intraoperative injuries during thoracic or cervical surgery. - The incidence has increased with the widespread use of therapeutic endoscopy. *Incorrect: Barotrauma* - **Boerhaave syndrome** (spontaneous esophageal rupture from forceful vomiting) is the most common cause of *spontaneous* perforation. - Accounts for only **15-20%** of all esophageal perforations. - Typically occurs after severe vomiting, retching, or Valsalva maneuver causing sudden increase in intra-esophageal pressure. - Most commonly involves the **left posterolateral wall of the lower esophagus**, 3-6 cm above the gastroesophageal junction. *Incorrect: Malignancy* - Esophageal tumors (carcinoma, lymphoma) can **erode through the esophageal wall** leading to perforation. - However, this is a **rare complication** and accounts for a small percentage of perforations. - More commonly, perforation in malignancy occurs during endoscopic intervention rather than spontaneous erosion. *Incorrect: Mediastinitis* - **Mediastinitis** is a **consequence** of esophageal perforation, not a cause. - Results from leakage of esophageal contents (saliva, gastric acid, food particles) into the mediastinum. - Leads to severe infection with high mortality if not promptly treated with antibiotics, drainage, and surgical repair.
Question 9: Which of the following are stages of damage control surgery? 1. Patient selection 2. Control of haemorrhage 3. Resuscitation in ICU 4. Preventive surgery Select the correct answer using the code given below.
- A. 1, 3 and 4
- B. 1, 2 and 4
- C. 2, 3 and 4
- D. 1, 2 and 3 (Correct Answer)
Explanation: ***1, 2 and 3*** - **Damage control surgery** (DCS) is a multi-stage approach for critically injured patients, involving initial stabilization, followed by definitive repair. - The stages include **patient selection** (for those who would benefit), **initial hemorrhage and contamination control**, and subsequent **resuscitation in the ICU** before a final operation. *1, 3 and 4* - This option incorrectly includes **preventive surgery** as a stage of damage control surgery. - While patient selection and ICU resuscitation are crucial, preventive surgery is not a distinct stage within the standard damage control protocol, which focuses on immediate life-saving measures and delayed definitive repair. *1, 2 and 4* - This option incorrectly includes **preventive surgery** and omits **resuscitation in the ICU**, which is a critical phase of damage control. - After initial surgical control of bleeding and contamination, the patient undergoes aggressive resuscitation and optimization in the ICU before the next surgical stage. *2, 3 and 4* - This option omits **patient selection**, which is the crucial first step in determining who is a candidate for damage control surgery. - It also incorrectly includes **preventive surgery**, as outlined previously.
Question 10: Extracorporeal Shock Wave Lithotripsy (ESWL) is most commonly used for the treatment of
- A. urinary tract stones (Correct Answer)
- B. gallbladder stones
- C. abdominal stony-hard tumour
- D. salivary gland stones
Explanation: ***Urinary tract stones*** - **Extracorporeal Shock Wave Lithotripsy (ESWL)** is a non-invasive procedure primarily used to break down **kidney stones** and **ureteral stones** into smaller fragments. - The shock waves are generated outside the body and focused on the stone, allowing the fragments to be passed naturally in the urine. *Gallbladder stones* - **Gallbladder stones (cholelithiasis)** are typically treated with **cholecystectomy** (surgical removal of the gallbladder) or medications for dissolution, not ESWL. - While some research has explored ESWL for gallbladder stones, it is not the most common or preferred treatment due to high recurrence rates and limited efficacy. *Abdominal stony-hard tumour* - ESWL is designed to fragment **calcifications or stones**, not cellular masses or tumors. - Abdominal tumors, regardless of their consistency, require **biopsy for diagnosis** and subsequent treatment such as surgery, chemotherapy, or radiation, specialized based on pathophysiology. *Salivary gland stones* - **Sialolithiasis** (salivary gland stones) can sometimes be treated with **lithotripsy**, but this typically involves specific techniques like **endoscopic lithotripsy** or **interventional removal**, distinct from the general application of ESWL for urinary stones. - The most common treatments for salivary gland stones focus on hydration, massage, and, if necessary, surgical removal of the stone or gland.