UPSC-CMS 2016 - Surgery PYQs Practice Questions

Q: Which of the following statements is not correct regarding sebaceous cyst?

Treatment is incision and drainage. ***Treatment is incision and drainage*** - The standard treatment for a sebaceous cyst (more accurately an **epidermoid cyst** or **pilar cyst**) is **surgical excision** of the entire cyst wall to prevent recurrence. - **Incision and drainage** only provides temporary relief by emptying the contents but leaves the cyst wall intact, leading to a high chance of the cyst refilling. *Found on hairy areas of the body* - This statement is generally correct as sebaceous cysts often arise from hair follicles and are common in **hair-bearing areas** like the scalp, face, neck, and trunk. - They occur due to the accumulation of **sebum** and keratin within a blocked or damaged sebaceous gland or hair follicle. *Not found on palms and soles* - This statement is correct because **palms and soles** generally **lack sebaceous glands** and hair follicles, hence sebaceous cysts are typically not found in these locations. - Cysts found in these areas are more likely to be **ganglion cysts** or other types of epidermal inclusion cysts. *It has a punctum* - This statement is often correct; many sebaceous cysts (especially epidermoid cysts) have a visible **central punctum** which represents the occluded pore from which the cyst originated. - This punctum is a **key diagnostic feature** and can sometimes exude a cheesy, foul-smelling material. [Practice more Surgery PYQs on OnCourse]

Q: Tumours of anterior mediastinum include the following except:

Schwannoma. ***Schwannoma*** - **Schwannomas** (neurilemmomas) are typically found in the **posterior mediastinum**, arising from **peripheral nerves** or nerve roots. - They are usually benign and grow slowly, presenting with symptoms due to compression of surrounding structures. *Lymphoma* - **Lymphoma** is a common tumor of the **anterior mediastinum**, often presenting as an **anterior mediastinal mass**. - Both Hodgkin and non-Hodgkin lymphomas can involve mediastinal lymph nodes. *Germ cell tumour* - **Germ cell tumors**, including **teratomas** and **seminomas**, frequently occur in the **anterior mediastinum**. - They arise from ectopic germ cell rests that migrate aberrantly during embryonic development. *Thymoma* - **Thymomas** are the most common primary tumor of the **anterior mediastinum**, originating from the **thymus gland**. - They are often associated with **myasthenia gravis** and other paraneoplastic syndromes. [Practice more Surgery PYQs on OnCourse]

Q: In India, the commonest cause of unilateral lymphoedema of lower limb is:

Filariasis. ***Filariasis (Correct Answer)*** - **Filariasis**, particularly caused by *Wuchereria bancrofti*, is endemic in many parts of India and is the leading cause of **secondary lymphedema** worldwide. - The parasitic worms block the lymphatic vessels, leading to chronic swelling, thickening of the skin, and can cause grotesque enlargement of limbs, often unilaterally. - In India, filariasis accounts for the vast majority of acquired unilateral lower limb lymphedema cases. *Tubercular lymphadenopathy (Incorrect)* - While **tubercular lymphadenopathy** is common in India, it primarily causes swelling of lymph nodes, often in the neck or axilla. - It typically does not lead to diffuse, unilateral lymphedema of the entire lower limb. *Carcinoma of penis (Incorrect)* - **Carcinoma of the penis** can cause inguinal lymph node metastasis, which might lead to lymphedema if the nodes are extensively involved or surgically removed. - However, it is not the most common cause of unilateral lower limb lymphedema in the general population of India. *Lymphoedema tarda (Incorrect)* - **Lymphedema tarda** is a form of primary lymphedema that typically presents after the age of 35, often without an identifiable cause. - While it can occur in India, it is a congenital or developmental disorder of the lymphatic system and is far less common than filariasis as a cause of acquired lymphedema. [Practice more Surgery PYQs on OnCourse]

Q: Nottingham prognostic Index is used for:

Cancer breast. ***Cancer breast*** - The **Nottingham Prognostic Index (NPI)** is a well-established tool used specifically for assessing the prognosis of **early invasive breast cancer**. - It combines three key pathological features: **tumor size**, **lymph node status**, and **histological grade**, to provide a prognostic score. *Cancer stomach* - Prognostic indices for gastric cancer typically involve factors like **tumor depth (T stage)**, **lymph node involvement (N stage)**, **metastasis (M stage)**, and **histological type**. - The NPI is not validated or used for gastric cancer. *Cancer colon* - Prognosis in colorectal cancer is primarily determined by the **Dukes' staging system** or the **TNM staging system**, which consider tumor invasion depth, lymph node spread, and distant metastasis. - The NPI is not applicable to colorectal cancer. *Cancer lung* - Lung cancer prognosis depends heavily on the **TNM staging system**, differentiating between **non-small cell lung cancer** and **small cell lung cancer**, and considering factors like tumor size, nodal involvement, and metastases. - There is no role for the NPI in assessing lung cancer prognosis. [Practice more Surgery PYQs on OnCourse]

Q: In gallstone ileus, obstruction most frequently occurs at:

Terminal ileum. ***Terminal ileum*** - In gallstone ileus, the **terminal ileum** (particularly at the **ileocecal valve region**) is the most common site of obstruction, accounting for **60-70%** of cases. - This occurs because the terminal ileum is the **narrowest portion of the small bowel**, creating a natural anatomical bottleneck where large gallstones become impacted. - The **ileocecal valve** represents the point of transition from small to large bowel, and its relatively fixed position and narrow caliber make it the classic site of obstruction. *Proximal ileum* - While gallstones can cause obstruction in the proximal or mid-ileum, this is **less frequent** than terminal ileum obstruction. - The proximal ileum has a relatively wider lumen compared to the terminal ileum, allowing larger stones to pass through more easily. *Jejunum* - The **jejunum** has the widest lumen of the small bowel, making obstruction at this site uncommon. - Gallstones typically pass through the jejunum without causing impaction. *Duodenum* - Duodenal obstruction by a gallstone is called **Bouveret's syndrome** and represents a rare variant (1-4% of gallstone ileus cases). - This occurs when a large stone impacts in the duodenal bulb or pylorus after eroding through a cholecystoduodenal fistula. [Practice more Surgery PYQs on OnCourse]

Question 1

Which of the following statements is not correct regarding sebaceous cyst?

Accepted Answer

Treatment is incision and drainage

Answer

Found on hairy areas of the body

Answer

Not found on palms and soles

Answer

It has a punctum

Question 2

Tumours of anterior mediastinum include the following except:

Accepted Answer

Schwannoma

Answer

Lymphoma

Answer

Germ cell tumour

Answer

Thymoma

Question 3

In India, the commonest cause of unilateral lymphoedema of lower limb is:

Accepted Answer

Filariasis

Answer

Tubercular lymphadenopathy

Answer

Carcinoma of penis

Answer

Lymphoedema tarda

Question 4

Nottingham prognostic Index is used for:

Accepted Answer

Cancer breast

Answer

Cancer stomach

Answer

Cancer colon

Answer

Cancer lung

Question 5

In gallstone ileus, obstruction most frequently occurs at:

Accepted Answer

Terminal ileum

Answer

Jejunum

Answer

Duodenum

Answer

Proximal ileum

Question 6

The following conditions are associated with high incidence of pigment gallstones except:

Accepted Answer

Prosthetic heart valve

Answer

Cirrhosis

Answer

Thalassemia

Answer

Ileal disease

Question 7

The most common complication of pancreas divisum is:

Accepted Answer

Recurrent acute pancreatitis

Answer

Obstructive jaundice

Answer

Peptic ulcer

Answer

Duodenal obstruction

Question 8

The commonest major surgical complication following Whipple procedure is:

Accepted Answer

Disruption of pancreatic anastomosis

Answer

Disruption of gastric anastomosis

Answer

Biliary peritonitis

Answer

GI bleeding

Question 9

A 60 year old male presents with bleeding per rectum. Proctoscopy reveals 2nd degree hemorrhoids. The treatment of choice is:

Accepted Answer

Banding

Answer

Cryotherapy

Answer

Sclerotherapy

Answer

Surgery

Question 10

Hyperchloremic acidosis is a common complication of:

Accepted Answer

Ureterosigmoidostomy

Answer

Ileostomy

Answer

Vomiting

Answer

Diarrhoea

UPSC-CMS 2016 — Surgery