UPSC-CMS 2025 - Surgery PYQs Practice Questions

Q: A 56-year-old male came with acute onset breathlessness and found to have pneumothorax. The resident doctor decided to insert an intercostal drain. Which one of the following sites is suitable for such a procedure?

Triangle of safety. ***Triangle of safety*** - The **triangle of safety** is the universally accepted site for safe **intercostal drain (chest tube)** insertion to treat **pneumothorax**. - Its boundaries help avoid injury to vital organs; it is bordered by the **anterior border of the latissimus dorsi**, the **lateral border of the pectoralis major**, and the **fifth intercostal space**. *Petit's triangle* - This anatomical landmark, also known as the **lumbar triangle**, is located in the **lumbar region** of the back. - It defines a weaker area in the abdominal wall and is a common site for **lumbar hernias**, not chest tube insertion for pneumothorax. *Hesselbach's triangle* - This triangle is located in the **groin region** and is an important anatomical landmark for **inguinal hernias**. - It is bordered by the inferior epigastric vessels, the lateral border of the rectus abdominis, and the inguinal ligament, and is entirely unrelated to chest procedures. *Triangle of auscultation* - The **triangle of auscultation** is a small region of the back, bordered by the **latissimus dorsi**, **trapezius**, and **medial border of the scapula**. - It is a thinner area of musculature, making it an ideal location for **listening to breath sounds** with a stethoscope, but it is not used for invasive procedures like chest tube insertion. [Practice more Surgery PYQs on OnCourse]

Q: Consider the following : I. Diabetes II. Hypertension III. Renal failure IV. Jaundice Which of the above are the risk factors for post-operative wound dehiscence?

I, III and IV. ***I, III and IV*** - **Diabetes** impairs wound healing through microvascular complications, neuropathy, and increased infection risk. - **Renal failure** (III) leads to uremia, malnutrition, and impaired collagen synthesis, all of which compromise wound integrity. - **Jaundice** (IV) is associated with impaired collagen synthesis, reduced fibroblast activity, and increased risk of infection, contributing to poor wound healing. *II, III and IV* - **Hypertension** (II) alone is not a direct risk factor for post-operative wound dehiscence; its complications (e.g., end-organ damage) might indirectly affect healing. - **Renal failure** (III) and **jaundice** (IV) are indeed significant risk factors, but the exclusion of diabetes makes this option incomplete. *I, II and III* - While **diabetes** (I) and **renal failure** (III) are major risk factors, **hypertension** (II) in isolation does not directly cause wound dehiscance. - This option incorrectly omits **jaundice** (IV), which is a known independent risk factor for impaired wound healing. *I, II and IV* - **Diabetes** (I) and **jaundice** (IV) are strong risk factors, but **hypertension** (II) does not directly contribute. - This option incorrectly excludes **renal failure** (III), which is a significant predisposing factor for wound dehiscence. [Practice more Surgery PYQs on OnCourse]

Q: Which of the following statements are correct regarding sutures in surgery? I. Barbed sutures have the advantage of eliminating the need for knots. II. Vertical mattress sutures help in eversion of wound edges. III. Aberdeen knot is used for continuous suturing. IV. Silk is preferred for subcuticular suturing. Select the answer using the code given below :

I, II and III. ***I, II and III*** - **I. Barbed sutures** have unidirectional or bidirectional barbs that grip tissue, negating the need for traditional knots to secure the suture line. This property can significantly **reduce operating time** and the volume of foreign material left in the wound. - **II. Vertical mattress sutures** are designed to achieve precise wound edge approximation and eversion, which are crucial for optimal healing and cosmesis, particularly in areas under tension or for thick skin. - **III. The Aberdeen knot** is a slip knot technique specifically designed to secure the end of a **continuous suture line** efficiently and reliably. It provides a flat, secure knot that minimizes bulk and is less prone to loosening. *I, II and IV* - While statements I and II are correct, statement IV is incorrect. **Silk is a braided, non-absorbable multifilament suture** that can cause significant tissue reaction. - It is generally not preferred for subcuticular suturing due to its increased risk of infection, visibility, and foreign body reaction compared to monofilament, absorbable sutures. *II, III and IV* - Statements II and III are correct, but statement IV is incorrect. **Silk is avoided for subcuticular closure** due to its inflammatory properties and potential for suture extrusion or sinus formation. - Subcuticular sutures typically use **absorbable monofilament sutures** (e.g., poliglecaprone 25 or polydioxanone) to minimize tissue reaction and achieve good cosmetic results. *I, III and IV* - Statements I and III are correct regarding barbed sutures and the Aberdeen knot, respectively. However, statement IV is incorrect because **silk suture is a non-absorbable, braided material that is highly reactive and not suitable for subcuticular placement**, where monofilament absorbable sutures are preferred for minimal tissue reaction and good cosmesis. [Practice more Surgery PYQs on OnCourse]

Q: Which of the following about Minimal Access Surgery are correct? I. Decreased intraoperative heat loss II. Improved visualization III. Increased chances of herniation IV. Improved mobility Select the answer using the code given below :

I, II and IV. ***I, II and IV (Correct Answer)*** **Statement I - Decreased intraoperative heat loss:** Correct. MAS involves smaller incisions with reduced exposure of internal organs to the operating room environment, resulting in significantly less heat loss compared to open surgery. **Statement II - Improved visualization:** Correct. Endoscopic cameras provide magnified, high-definition, and well-illuminated views of the surgical field, offering superior visualization compared to the naked eye in open procedures. **Statement IV - Improved mobility:** Correct. Patients experience faster post-operative recovery with less pain and earlier return to normal activities due to minimal tissue trauma from smaller incisions. **Statement III - Increased chances of herniation:** This statement is **INCORRECT** and is the key reason why options containing it are wrong. MAS typically results in *decreased* risk of incisional hernias due to smaller access points. While trocar-site hernias can occur, they are less common than the large incisional hernias seen in open surgery when proper fascial closure techniques are employed. *I, III and IV* - Incorrect because Statement III (increased herniation) is false. MAS reduces, not increases, herniation risk. *I, II and III* - Incorrect because Statement III (increased herniation) is false. Properly performed MAS has lower incisional hernia rates than open surgery. *II, III and IV* - Incorrect because Statement III (increased herniation) is false. Smaller incisions in MAS lead to reduced hernia formation compared to traditional open approaches. [Practice more Surgery PYQs on OnCourse]

Q: Which of the following are the techniques commonly used to close the raw area after excision of a pilonidal sinus in order to avoid a midline wound? I. Limberg procedure II. Y-V plasty III. Z-plasty IV. Karydakis procedure Select the correct answer using the code given below :

I, II and IV. ***I, II and IV*** - The **Limberg procedure** (rhomboid flap) and **Karydakis flap** are the most widely established plastic surgical techniques used to close the defect after pilonidal sinus excision. - These techniques aim to **flatten the natal cleft** and move the scar away from the midline, reducing tension and recurrence rates. - **Y-V plasty** is less commonly used specifically for pilonidal sinus compared to Limberg and Karydakis procedures, though it can be employed for tissue advancement in selected cases. - This combination excludes Z-plasty, which is not a primary technique for pilonidal sinus closure. *II, III and IV* - While **Karydakis procedure** is indeed a standard technique, this option incorrectly includes **Z-plasty**, which is generally used for **scar revision** or releasing contractures rather than primary closure of large excisional defects. - It also excludes the **Limberg flap**, which is one of the most commonly used techniques worldwide for pilonidal sinus surgery. *I, III and IV* - This option incorrectly includes **Z-plasty** while excluding **Y-V plasty**. - Z-plasty is not a primary technique for closing pilonidal sinus defects as it doesn't provide adequate tissue coverage for large excisions. - The **Limberg and Karydakis procedures** are the mainstay techniques from this list. *I, II and III* - This combination incorrectly includes **Z-plasty** as a primary technique for closing the excisional defect. - It omits the **Karydakis procedure**, which is one of the most widely recognized and effective flaps for pilonidal disease with excellent outcomes. - The Karydakis flap specifically focuses on **modifying the natal cleft contour** and displacing the incision laterally for better healing and lower recurrence rates. [Practice more Surgery PYQs on OnCourse]

Question 1

A 56-year-old male came with acute onset breathlessness and found to have pneumothorax. The resident doctor decided to insert an intercostal drain. Which one of the following sites is suitable for such a procedure?

Accepted Answer

Triangle of safety

Answer

Petit's triangle

Answer

Hesselbach's triangle

Answer

Triangle of auscultation

Question 2

Consider the following :
I. Diabetes
II. Hypertension
III. Renal failure
IV. Jaundice

Which of the above are the risk factors for post-operative wound dehiscence?

Accepted Answer

I, III and IV

Answer

II, III and IV

Answer

I, II and III

Answer

I, II and IV

Question 3

Which of the following statements are correct regarding sutures in surgery?
I. Barbed sutures have the advantage of eliminating the need for knots.
II. Vertical mattress sutures help in eversion of wound edges.
III. Aberdeen knot is used for continuous suturing.
IV. Silk is preferred for subcuticular suturing.

Select the answer using the code given below :

Accepted Answer

I, II and III

Answer

I, II and IV

Answer

II, III and IV

Answer

I, III and IV

Question 4

Which of the following about Minimal Access Surgery are correct?
I. Decreased intraoperative heat loss
II. Improved visualization
III. Increased chances of herniation
IV. Improved mobility

Select the answer using the code given below :

Accepted Answer

I, II and IV

Answer

I, III and IV

Answer

I, II and III

Answer

II, III and IV

Question 5

Which of the following are the techniques commonly used to close the raw area after excision of a pilonidal sinus in order to avoid a midline wound?
I. Limberg procedure
II. Y-V plasty
III. Z-plasty
IV. Karydakis procedure

Select the correct answer using the code given below :

Accepted Answer

I, II and IV

Answer

II, III and IV

Answer

I, III and IV

Answer

I, II and III

Question 6

A 45-year-old lady presents with history of a painless lump in the right breast since 1 month. On examination, the lump is hard, 3 x 4 cm in size in the upper outer quadrant and is not fixed to the skin or the underlying structures. The axilla reveals firm mobile lymph nodes (level I). Rest of systemic examination is normal. The clinical stage of this disease is :

Accepted Answer

cT₂ N₁ Mₓ

Answer

cT₃ N₁ Mₓ

Answer

cT₁ N₁ Mₓ

Answer

cT₃ N₂ Mₓ

Question 7

Resection of which part of intestine does not significantly affect fluid and electrolyte balance?

Accepted Answer

Distal jejunum

Answer

Ileum

Answer

Proximal jejunum

Answer

Colon

Question 8

Which one of the following is correct regarding splenic artery aneurysm?

Accepted Answer

It is most commonly located in the middle third of the splenic artery.

Answer

It is generally multiple in number.

Answer

It is caused due to blunt trauma to the abdomen.

Answer

It is twice as common in men.

Question 9

Which of the following statements are correct regarding primary survey/management of traumatic head injury patient?
I. Ensure adequate oxygenation and circulation
II. Exclude hypoglycaemia
III. Check for mechanism of injury
IV. Check pupil size and response

Select the answer using the code given below :

Accepted Answer

I, II and IV

Answer

II, III and IV

Answer

I, III and IV

Answer

I, II and III

Question 10

Which of the following statements are correct regarding ABCDE of trauma care ?
I. A stands for Airway with cervical spine protection
II. B stands for Breathing and ventilation
III. C stands for Control of massive external haemorrhage
IV. D stands for Disability (Neurological status)
Select the answer using the code given below :

Accepted Answer

I, II and IV

Answer

I, II and III

Answer

II, III and IV

Answer

I, III and IV

UPSC-CMS 2025 — Surgery