UPSC-CMS 2024 - Surgery PYQs Practice Questions

Q: 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.

1, 2 and 4. ***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. [Practice more Surgery PYQs on OnCourse]

Q: A 48-year-old smoker presents to the OPD with complaints of cramping pain in both the calves on walking to about 100-150 metres. The pain is relieved on taking rest for about 2-3 minutes and the patient is able to walk for some more distance again before the pain appears. This presentation is suggestive of

intermittent claudication. ***intermittent claudication*** - The classic presentation of **cramping pain in the calves** that occurs with exertion, particularly walking a specific distance, and is **relieved by rest** within a few minutes, is highly characteristic of **intermittent claudication** [1]. - This condition is a hallmark symptom of **peripheral artery disease (PAD)**, where narrowed arteries reduce blood flow to the limbs, and is exacerbated by risk factors such as **smoking** [1]. *osteoarthritis of the knee* - While osteoarthritis causes pain with activity, it typically describes a **mechanical joint pain worsened by movement** and often associated with stiffness, crepitus, and swelling [2]. - The pain from osteoarthritis is usually **localized to the joint** and less likely to be described as cramping in the calves or to have such a clear, immediate resolution with rest as seen in claudication [2]. *muscular fatigue* - Muscular fatigue can cause pain and discomfort with exertion, but it typically does not present with the **consistent, reproducible pattern** of pain onset at a specific distance and rapid relief with a short rest as described. - Fatigue-related pain is generally more diffuse and gradually improves with prolonged rest, rather than the quick resolution characteristic of claudication. *neurogenic claudication* - Neurogenic claudication also causes **leg pain with walking** but is typically associated with **spinal stenosis** and is often described as numbness, tingling, or weakness, rather than pure cramping. - Crucially, neurogenic claudication is often relieved by **bending forward or sitting**, rather than just standing still, and is less directly tied to the specific walking distance that defines intermittent claudication. [Practice more Surgery PYQs on OnCourse]

Q: 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

thyroglossal cyst with only functioning thyroid tissue. ***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. [Practice more Surgery PYQs on OnCourse]

Q: 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?

Edge biopsy of the lesion. ***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. [Practice more Surgery PYQs on OnCourse]

Q: 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?

Malignant transformation. ***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. [Practice more Surgery PYQs on OnCourse]

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.

Accepted Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Question 2

A 48-year-old smoker presents to the OPD with complaints of cramping pain in both the calves on walking to about 100-150 metres. The pain is relieved on taking rest for about 2-3 minutes and the patient is able to walk for some more distance again before the pain appears. This presentation is suggestive of

Accepted Answer

intermittent claudication

Answer

osteoarthritis of the knee

Answer

muscular fatigue

Answer

neurogenic claudication

Question 3

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

Accepted Answer

thyroglossal cyst with only functioning thyroid tissue

Answer

solitary thyroid nodule

Answer

thyroglossal cyst

Answer

lateral aberrant thyroid

Question 4

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?

Accepted Answer

Edge biopsy of the lesion

Answer

Oral antifungal treatment

Answer

Local topical cauterization

Answer

Oral vitamin C supplementation

Question 5

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?

Accepted Answer

Malignant transformation

Answer

Myxomatous transformation

Answer

Haemorrhage

Answer

Cystic degeneration

Question 6

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.

Accepted Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 3 and 4

Question 7

Which of the following are local complications of acute pancreatitis?

1. Pseudocyst
2. Pleural effusion
3. Ileus
4. Acute fluid collection

Select the correct answer using the code given below.

Accepted Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 3

Question 8

Which one of the following statements is correct about mesenteric cysts?

Accepted Answer

It presents most commonly as a painless abdominal swelling.

Answer

It is more common in males as compared to females.

Answer

It occurs most commonly in children less than 18 years of age.

Answer

Percutaneous aspiration with injection of sclerosant is the preferred treatment option.

Question 9

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.

Accepted Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Answer

1, 3 and 4

Question 10

What is the most common cause of perforation of the oesophagus?

Accepted Answer

Iatrogenic injury

Answer

Barotrauma

Answer

Malignancy

Answer

Mediastinitis

UPSC-CMS 2024 — Surgery