UPSC-CMS 2010 - Surgery PYQs Practice Questions

Q: The percutaneous PAIR therapy used in the treatment of uncomplicated hepatic hydatid cyst can be associated with the following complications, except

bradycardia. ***bradycardia*** - **Bradycardia is not a recognized primary complication** of percutaneous aspiration, injection, and re-aspiration (PAIR) therapy for hydatid cysts. - While bradycardia can occur as a **vasovagal response during any invasive procedure**, it is not specifically listed among the complications of PAIR therapy in standard medical literature. - The typical cardiovascular manifestation of anaphylaxis (a known PAIR complication) is **tachycardia**, not bradycardia. *hypotension* - **Hypotension** is a well-documented complication of PAIR therapy, occurring due to **anaphylactic reaction** from leakage of antigenic hydatid fluid into the circulation. - It can also result from **intra-abdominal hemorrhage** if a major vessel is inadvertently punctured during the procedure. *vomiting* - **Vomiting** can occur as part of a **systemic allergic reaction or anaphylaxis** triggered by the release of hydatid cyst contents. - It may also be a manifestation of peritoneal irritation if cyst contents leak into the peritoneal cavity. *anaphylaxis* - **Anaphylaxis** is the most feared and well-documented complication of PAIR therapy, caused by the release of **highly antigenic hydatid cyst fluid** (containing protoscolices and hydatid antigens) into the host's system. - This severe Type I hypersensitivity reaction can manifest with **hypotension, tachycardia, bronchospasm, urticaria, angioedema**, and in severe cases, cardiovascular collapse. - Prophylactic antihistamines and corticosteroids are often administered to minimize this risk. [Practice more Surgery PYQs on OnCourse]

Q: Trendelenburg's operation is done for

primary varicose veins. ***primary varicose veins*** - **Trendelenburg's operation** is the classical surgical procedure for **primary varicose veins of the lower limb** - It involves **high ligation of the long saphenous vein** at the saphenofemoral junction - Named after Friedrich Trendelenburg (1844-1924), this was historically the standard treatment for varicose veins - Modern variations include **flush ligation** and stripping of the saphenous vein - Now often replaced by minimally invasive techniques like **endovenous laser ablation (EVLA)** and **radiofrequency ablation (RFA)** *varicocele* - **Varicocele** is treated by operations like **Ivanissevich procedure**, **Palomo's operation**, or **laparoscopic varicocelectomy** - These involve ligation of the **testicular/gonadal veins**, not the saphenous vein - There is no established surgical technique for varicocele called "Trendelenburg's operation" - The confusion may arise from Trendelenburg's contributions to various surgical fields *deep vein thrombosis with varicose veins* - **Deep vein thrombosis (DVT)** is an acute condition requiring **anticoagulation therapy**, not surgical intervention like Trendelenburg's operation - Management focuses on preventing **pulmonary embolism** and post-thrombotic syndrome - Varicose veins may coexist but are addressed separately after DVT treatment *arteriovenous fistula* - **Arteriovenous fistula** represents an abnormal connection between artery and vein - Treatment involves **surgical repair**, **embolization**, or observation depending on etiology - This is unrelated to Trendelenburg's operation for venous insufficiency [Practice more Surgery PYQs on OnCourse]

Q: Which of the following does not alter the T stage in breast cancer?

Nipple retraction. ***Nipple retraction*** - Nipple retraction, while a significant clinical sign that can indicate an underlying malignancy, does **not alter the T stage** (tumor size and extent) of breast cancer. - It is considered a local sign of tumor proximity or involvement but does not classify the tumor into a T4 category according to AJCC TNM staging. - Nipple retraction may be seen with various T stages and is **not a criterion for upstaging**. *Pectoral muscle involvement* - **Important note**: Involvement of the **pectoralis muscle alone does NOT alter T stage** according to current AJCC TNM classification. - Only **chest wall involvement** (ribs, intercostal muscles, serratus anterior) qualifies as **T4b**. - This is a common point of confusion, but pectoralis muscle is **not considered chest wall** for staging purposes. *Skin ulceration* - **Skin ulceration** directly reflects tumor invasion through the skin of the breast. - This finding is a criterion for classifying the tumor as **T4b**, indicating advanced local disease. - Clearly **alters the T stage** regardless of tumor size. *Peau d'orange* - **Peau d'orange** (orange peel appearance) is caused by obstruction of dermal lymphatics by tumor cells, leading to **skin edema**. - This sign is a criterion for classifying the tumor as **T4b** (edema of the skin including peau d'orange). - Clearly **alters the T stage** and indicates advanced local disease. [Practice more Surgery PYQs on OnCourse]

Q: What is the most common hernia in females?

Inguinal hernia. ***Inguinal hernia*** - **Inguinal hernias** are the most common type of hernia in females, accounting for approximately **70% of all hernias** in women. - While less common in females than males, inguinal hernias still represent the majority of hernias in the female population. - They occur through the **inguinal canal** and can be either indirect (through the deep inguinal ring) or direct (through Hesselbach's triangle). - Present as a **bulge in the groin** above the inguinal ligament. *Femoral hernia* - **Femoral hernias** are the second most common hernia in females, accounting for approximately 30% of hernias in women. - They have a **higher female-to-male ratio** compared to inguinal hernias (femoral hernias are more common in women than men relatively). - Occur through the **femoral canal** below the inguinal ligament, medial to the femoral vein. - Higher risk of **strangulation** due to the rigid boundaries of the femoral ring. - This option is incorrect because despite being relatively more common in females than males, femoral hernias are still **less common than inguinal hernias** in the female population overall. *Spigelian hernia* - A rare type of hernia occurring through the **Spigelian aponeurosis**, lateral to the rectus abdominis muscle. - Not specifically more common in females and represents a small fraction of all hernias. *Obturator hernia* - A very rare hernia passing through the **obturator foramen**. - More common in elderly, thin females but still extremely rare overall. - May present with **Howship-Romberg sign** (inner thigh pain on hip extension/rotation) due to obturator nerve compression. [Practice more Surgery PYQs on OnCourse]

Question 1

In carcinoma breast, adjuvant radiotherapy is indicated after modified radical mastectomy in all of the following, except

Accepted Answer

ER, PR hormone receptor negative tumour

Answer

more than four positive axillary lymph nodes

Answer

positive margins

Answer

tumour size more than 5 cm

Question 2

The percutaneous PAIR therapy used in the treatment of uncomplicated hepatic hydatid cyst can be associated with the following complications, except

Accepted Answer

bradycardia

Answer

hypotension

Answer

vomiting

Answer

anaphylaxis

Question 3

Trendelenburg's operation is done for

Accepted Answer

primary varicose veins

Answer

deep vein thrombosis with varicose veins

Answer

varicocele

Answer

arteriovenous fistula

Question 4

Which of the following does not alter the T stage in breast cancer?

Accepted Answer

Nipple retraction

Answer

Pectoral muscle involvement

Answer

Skin ulceration

Answer

Peau d'orange

Question 5

What is the most common hernia in females?

Accepted Answer

Inguinal hernia

Answer

Femoral hernia

Answer

Obturator hernia

Answer

Spigelian hernia

Question 6

Dumping syndrome can occur after

Accepted Answer

Billroth-II operation

Answer

Whipple's operation

Answer

Nissen fundoplication

Answer

Heller's operation

Question 7

With reference to Le Fort I fracture, consider the following statements :

1. Fracture line separates alveolus and palate from the facial skeleton.

2. Fracture line passes from the pyriform aperture.

3. Fracture line runs posteriorly to include pterygoid plates.

4. Fracture line passes through orbit.
Which of the statements given above are correct?

Accepted Answer

1, 2 and 3

Answer

1 and 2 only

Answer

2, 3 and 4

Answer

1 and 3 only

Question 8

Consider the following conditions in blunt trauma of the chest :
1. Flail chest
2. Drainage of 1 litre of blood from the chest tube
3. Cardiac tamponade
4. Rupture of oesophagus
Which of the above are the indications of emergency thoracotomy?

Accepted Answer

2, 3 and 4 only

Answer

2 and 4 only

Answer

1, 2, 3 and 4

Answer

1, 2 and 3 only

Question 9

A man falls astride a penetrating object. He develops retention of urine, perineal hematoma and bleeding from urinary meatus. The nature of injury would be

Accepted Answer

rupture of bulbar urethra

Answer

intraperitoneal rupture of bladder

Answer

rupture of membranous urethra

Answer

extraperitoneal rupture of bladder

Question 10

Renal carcinoma with solitary lung secondary is best treated by

Accepted Answer

surgery

Answer

chemotherapy

Answer

immunotherapy

Answer

radiotherapy

UPSC-CMS 2010 — Surgery