UPSC-CMS 2024 - Surgery Practice Questions

Q: Which of the following are correct for herniation via foramen of Morgagni? 1. It occurs posteriorly in chest. 2. Transverse colon is the commonest content. 3. Defect is between sternal and costal attachments. 4. It is a type of congenital hernia. Select the answer using the code given below.

2, 3 and 4. ***2, 3 and 4*** - The **foramen of Morgagni** hernia (also known as a parasternal or retrosternal hernia) is a type of **congenital diaphragmatic hernia (CDH)** - statement 4 is **correct**. - The defect is located in the **anterior diaphragm**, specifically between the **sternal and costal attachments** - statement 3 is **correct**. - The **transverse colon** is indeed a common content (most common visceral organ), though omentum is actually the most frequent overall content - statement 2 is considered **correct** in clinical practice. - Statement 1 is **incorrect** as Morgagni hernias occur **anteriorly**, not posteriorly. *1, 3 and 4* - This option incorrectly includes statement 1, which claims the herniation occurs **posteriorly** in the chest. - **Morgagni hernias** are **anterior** diaphragmatic defects (parasternal location). - Posterior diaphragmatic hernias are **Bochdalek hernias**, not Morgagni hernias. *1, 2 and 4* - This option is incorrect because statement 1 states the hernia occurs **posteriorly**, which is wrong. - **Morgagni hernias** are located in the **anterior diaphragm** between sternal and costal attachments. - While statements 2 and 4 are correct, the inclusion of statement 1 makes this option incorrect. *1, 2 and 3* - This option is incorrect because statement 1 claims the hernia occurs **posteriorly**, which is inaccurate. - **Morgagni hernias** are **anterior** defects, representing only 2-3% of congenital diaphragmatic hernias. - The key distinguishing feature is the anterior parasternal location, not posterior.

Q: A 30-year-old road traffic accident victim is being taken up for emergency laparotomy for haemoperitoneum and suspected multiorgan trauma. Which one of the following will be an indication for performing damage control surgery?

Acidosis with pH < 7.32. ***Acidosis with pH < 7.32*** - This represents **severe metabolic acidosis** and is a specific, measurable component of the **"lethal triad"** (acidosis, hypothermia, coagulopathy) that mandates damage control surgery. - pH < 7.32 (or < 7.2 in some protocols) is a **defined threshold** that indicates severe physiological derangement requiring abbreviated surgery. - Severe acidosis impairs **cardiac contractility**, **enzyme function**, and **coagulation cascade**, making prolonged definitive repair dangerous. - This specific laboratory value provides clear, objective criteria for the surgical decision. *Blood pressure < 100 mm Hg* - While **hypotension** indicates shock and requires aggressive resuscitation, blood pressure < 100 mmHg alone is not a specific criterion for damage control surgery. - Damage control is indicated by the **lethal triad** components, not by blood pressure thresholds alone. - Many trauma patients with BP 1.5, PT > 16-19 seconds, platelets < 50,000) that would make it a definitive, measurable criterion. - In contrast to the specific pH threshold given in option A, "coagulopathy" as stated here is less precise for decision-making. *Hypothermia < 36 °C* - While hypothermia is the third component of the "lethal triad," the typical threshold for damage control surgery is **core temperature < 35°C** (or < 34°C in most trauma protocols). - Hypothermia < 36°C represents only **mild hypothermia** and is not generally considered an absolute indication for abbreviated surgery. - More severe hypothermia (< 34-35°C) would be required to trigger damage control protocols.

Q: A 30-year-old motorbike rider is brought to the emergency with history of a road traffic accident and altered consciousness. On secondary survey, the doctor notices presence of a bruise over the left mastoid process. The finding indicates

fracture of the skull base. ***fracture of the skull base*** - A bruise over the mastoid process, known as **Battle's sign**, is a classic indicator of a **basilar skull fracture**. It signifies extravasation of blood from fracture lines in the skull base, typically involving the **temporal bone**. - This sign develops several hours to days after the injury as blood tracks subcutaneously, indicating severe trauma given the patient's altered consciousness. *injury to the external auditory meatus* - While head trauma can cause injury to the **external auditory meatus (EAM)**, a bruise over the mastoid process specifically points to deeper bone involvement, not just the EAM. - Injuries to the EAM might present with bleeding from the ear canal or local pain, but a mastoid bruise suggests a more extensive underlying fracture. *fracture of mastoid process* - Although Battle's sign is located on the mastoid process, it primarily indicates a fracture of the **skull base** (often involving the temporal bone, which includes the mastoid). - A fracture limited to the mastoid process itself might not necessarily cause the characteristic diffuse bruising pattern associated with Battle's sign, which results from blood tracking from deeper structures. *soft tissue injury to the neck* - A bruise over the mastoid process is anatomically distinct from the neck and does not directly indicate a **soft tissue injury to the neck**. - While neck injuries can accompany head trauma, Battle's sign is specific to a **cranial fracture**.

Q: A surgeon is about to start a laparoscopic procedure on a patient. The floor nurse asks the surgeon about the identity of the patient, site of the procedure to be performed and any anticipated critical events during the surgery. These questions are a part of the

WHO surgical safety checklist. **WHO surgical safety checklist** - The questions about patient identity, procedure site, and anticipated critical events are key components of the **"Sign In"** and **"Time Out"** sections of the **WHO Surgical Safety Checklist**. - This checklist is designed to improve **patient safety** by ensuring communication and adherence to essential steps before, during, and after surgery, thereby reducing surgical errors. *nurses safety checklist* - While nurses play a crucial role in patient safety, there isn't a universally recognized "nurses safety checklist" that specifically encompasses these exact comprehensive surgical verification steps. - The comprehensive framework described, with its specific questions, aligns more closely with the broader, interdisciplinary **WHO Surgical Safety Checklist**. *universal precautions checklist* - **Universal precautions** focus on preventing the transmission of bloodborne pathogens and other infectious agents by treating all bodily fluids as potentially infectious. - This checklist primarily addresses **infection control** measures and does not cover patient identification, surgical site verification, or critical event anticipation. *MCI patient safety checklist* - A "MCI patient safety checklist" is not a widely recognized or standardized medical safety protocol. - The scenario describes a standard, internationally adopted set of safety checks specifically for surgical procedures, which is the **WHO Surgical Safety Checklist**.

Question 1

Which of the following are correct for herniation via foramen of Morgagni?

1. It occurs posteriorly in chest.
2. Transverse colon is the commonest content.
3. Defect is between sternal and costal attachments.
4. It is a type of congenital hernia. Select the answer using the code given below.

Accepted Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Question 2

A 30-year-old road traffic accident victim is being taken up for emergency laparotomy for haemoperitoneum and suspected multiorgan trauma. Which one of the following will be an indication for performing damage control surgery?

Accepted Answer

Acidosis with pH < 7.32

Answer

Blood pressure < 100 mm Hg

Answer

Coagulopathy

Answer

Hypothermia < 36 °C

Question 3

A 30-year-old motorbike rider is brought to the emergency with history of a road traffic accident and altered consciousness. On secondary survey, the doctor notices presence of a bruise over the left mastoid process. The finding indicates

Accepted Answer

fracture of the skull base

Answer

injury to the external auditory meatus

Answer

fracture of mastoid process

Answer

soft tissue injury to the neck

Question 4

A surgeon is about to start a laparoscopic procedure on a patient. The floor nurse asks the surgeon about the identity of the patient, site of the procedure to be performed and any anticipated critical events during the surgery. These questions are a part of the

Accepted Answer

WHO surgical safety checklist

Answer

nurses safety checklist

Answer

universal precautions checklist

Answer

MCI patient safety checklist

UPSC-CMS 2024 — Surgery