UPSC-CMS 2009 - Surgery PYQs Practice Questions

Q: Which of the following is a scoring system for severity of wound infection, and is particularly useful for surveillance and research ?

Southampton grading system. ***Southampton grading system*** - The **Southampton grading system** is specifically designed for the **severity of wound infection**, offering a clear framework for classification based on clinical signs. - Its utility in **surveillance and research** stems from its structured and reproducible assessment, allowing for consistent data collection on wound healing and infection rates. *Apgar score* - The **Apgar score** is a rapid assessment of a **newborn's health** immediately after birth, evaluating heart rate, respiratory effort, muscle tone, reflex irritability, and color. - It is not used for assessing wound infection severity. *Glasgow scoring system* - The **Glasgow Coma Scale (GCS)** is used to assess the **level of consciousness** in a person following a brain injury, comprising eye opening, verbal, and motor responses. - It is not relevant to wound infection assessment. *ASA classification* - The **American Society of Anesthesiologists (ASA) Physical Status Classification System** is used to assess a patient's **overall health before surgery**, providing an indication of anesthetic risk. - It is not used for evaluating wound infection. [Practice more Surgery PYQs on OnCourse]

Q: Which one of the following is not a correct statement with reference to locally advanced carcinoma breast ?

Radical Mastectomy is the treatment of choice. *Patients are staged as T3 or T4 with any N, without distant metastasis (M0)* - **Locally advanced breast cancer (LABC)** is correctly defined as tumors that are **T3 or T4** or involve regional lymph nodes (**any N**) without distant metastasis (**M0**). - This statement is **correct** regarding LABC staging criteria. *It constitutes the bulk of patients of carcinoma breast in India* - This statement is **correct**. In India, approximately **50-60% of breast cancer patients present with locally advanced disease** at the time of diagnosis. - This is in stark contrast to Western countries where LABC represents less than 10% of cases. - The high prevalence is attributed to lack of screening programs, delayed presentation, limited awareness, and socioeconomic factors. *Neoadjuvant chemotherapy downgrades the disease* - This statement is **correct**. **Neoadjuvant chemotherapy (NACT)** is a cornerstone of LABC management. - NACT aims to **downstage** the tumor, making it more amenable to surgical resection and increasing the feasibility of breast-conserving surgery. - It also provides early treatment of micrometastases and serves as an in vivo test of tumor chemosensitivity. ***Radical Mastectomy is the treatment of choice*** - This statement is **INCORRECT** and is the correct answer to this negation question. - **Radical mastectomy (Halsted mastectomy)** involving removal of breast, pectoral muscles, and axillary nodes is **no longer the standard treatment** for LABC. - Modern treatment involves a **multimodal approach**: neoadjuvant chemotherapy followed by **modified radical mastectomy (MRM)** or breast-conserving surgery with radiation therapy. - MRM preserves the pectoral muscles, providing better functional and cosmetic outcomes while maintaining oncological safety. [Practice more Surgery PYQs on OnCourse]

Q: Consider the following statements regarding splenectomy : 1. It corrects anemia in congenital hereditary spherocytosis. 2. Postponed until the age of 4 years if possible. 3. Polyvalent pneumococcal vaccine to be administered to all before the surgery. Which of the statements given above are correct ?

1, 2 and 3. ***1, 2 and 3*** - **Splenectomy** is a definitive treatment for **hereditary spherocytosis**, as it removes the primary site of red blood cell destruction, thereby correcting the **anemia**. - Delaying splenectomy until after **4 years of age** reduces the risk of **overwhelming post-splenectomy infection (OPSI)**, allowing the child's immune system to mature. *Note: This reflects 2009 guidelines when this question was set. Current guidelines recommend postponing splenectomy until 5-6 years or even older (6-9 years) to further minimize OPSI risk.* - **Vaccination** against encapsulated bacteria like **Streptococcus pneumoniae** (using a polyvalent vaccine) is crucial before splenectomy to prevent severe infections, as the spleen plays a vital role in clearing these pathogens. *1 and 3 only* - This option is incorrect because it omits the important recommendation to **postpone splenectomy** until the child is older, which is a key part of managing hereditary spherocytosis in children. *2 and 3 only* - This option is incorrect because it fails to acknowledge that **splenectomy effectively corrects the anemia** in congenital hereditary spherocytosis by eliminating the site of premature red blood cell destruction, which is a primary indication for the procedure. *1 and 2 only* - This option is incorrect because it overlooks the critical need for **vaccination** against encapsulated bacteria **before splenectomy** to protect against life-threatening infections, a standard and essential practice. [Practice more Surgery PYQs on OnCourse]

Question 1

Which of the following is a scoring system for severity of wound infection, and is particularly useful for surveillance and research ?

Accepted Answer

Southampton grading system

Answer

Apgar score

Answer

Glasgow scoring system

Answer

ASA classification

Question 2

Which one of the following statements is correct in case of squamous cell carcinoma of the lip?

Accepted Answer

Lesion often arises in the areas of persistent hyperkeratosis

Answer

Lymph node metastases occur early

Answer

Radiotherapy is considered inappropriate treatment for these lesions

Answer

More than 90 per cent of cases occur on the upper lip

Question 3

Which one of the following is not a correct statement with reference to locally advanced carcinoma breast ?

Accepted Answer

Radical Mastectomy is the treatment of choice

Answer

Patients are staged as T3 or T4 with any N, without distant metastasis (M0)

Answer

It constitutes the bulk of patients of carcinoma breast in India

Answer

Neoadjuvant chemotherapy downgrades the disease

Question 4

Consider the following statements regarding splenectomy :

1. It corrects anemia in congenital hereditary spherocytosis.
2. Postponed until the age of 4 years if possible.
3. Polyvalent pneumococcal vaccine to be administered to all before the surgery. Which of the statements given above are correct ?

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

2 and 3 only

Answer

1 and 2 only

Question 5

A young patient develops high grade fever with chills and rigors, mild jaundice and acute pain in the upper abdomen following cholecystectomy. On examination she was jaundiced, toxic, haemodynamically stable and having vague fullness upper abdomen. What is the most probable diagnosis ?

Accepted Answer

Localised collection of bile in peritoneal cavity

Answer

Duodenal injury

Answer

Acute Pancreatitis

Answer

Iatrogenic ligation of common bile duct

Question 6

Consider the following with reference to the management of portal hypertension :

1. Infusion of vasopressin
2. General resuscitation
3. Devascularisation procedure
4. Endoscopic sclerotherapy What is the appropriate sequence in the line of management in the event of massive variceal bleeding in portal hypertension ?

Accepted Answer

2, 1, 4, 3

Answer

3, 2, 1, 4

Answer

1, 4, 2, 3

Answer

4, 2, 1, 3

Question 7

A 50 year old diabetic patient with asymptomatic gallstone (> 3 cm) will be best treated by

Accepted Answer

Early surgery

Answer

Bile-salt treatment

Answer

Waiting till it becomes symptomatic

Answer

ESWL

Question 8

Which of the following is not an indication for surgical intervention in acute pancreatitis?

Accepted Answer

Acute fluid collection

Answer

Diagnostic dilemma

Answer

Pancreatic abscess

Answer

Infected pancreatic necrosis

Question 9

The most common intraperitoneal abscess following peritonitis is

Accepted Answer

Pelvic

Answer

Paracolic

Answer

Subphrenic

Answer

Interloop

Question 10

The following statements are correct about burst abdomen (abdominal dehiscence) except

Accepted Answer

Second dehiscence is very common

Answer

Manage with nasogastric aspiration and intravenous fluids

Answer

Cover the wound with sterile towel and perform emergency surgery

Answer

Peak incidence is between 6th and 8th post operative day

UPSC-CMS 2009 — Surgery