UPSC-CMS 2018 Practice Questions

Q: Which one of the following bones is affected in Keinbock's disease?

Lunate bone. ***Lunate bone*** - Kienbock's disease is an **avascular necrosis** of the **lunate bone** in the wrist, leading to its collapse and fragmentation over time. - This condition is often associated with repetitive trauma, negative ulnar variance, and altered blood supply to the lunate. *Capitellum of the humerus* - Avascular necrosis of the capitellum is known as **Panner's disease**, which is distinct from Kienbock's disease. - Panner's disease primarily affects children and adolescents, often due to repetitive throwing or overhead activities. *Metatarsal* - Avascular necrosis of the metatarsal heads is seen in conditions like **Freiberg's disease**, which typically affects the second metatarsal. - This condition presents with forefoot pain and differs significantly in location and affected bone from Kienbock's disease. *Navicular bone* - Avascular necrosis of the tarsal navicular bone is referred to as **Kohler's disease**, predominantly appearing in young children. - This condition affects the foot and is not related to the wrist pathologies seen in Kienbock's disease.

Q: In postoperative care the long term risks after Bariatric Surgery include all EXCEPT:

Deep Vein Thrombosis. ***Deep Vein Thrombosis*** - Deep Vein Thrombosis (DVT) is a significant **short-term (early) complication** of bariatric surgery, primarily in the **immediate postoperative period**, due to immobility and hypercoagulability. - While prophylaxis is crucial, DVT is not typically considered a **long-term risk** that persists for years after surgery. *Vitamin and Micronutrient depletion syndromes* - Bariatric surgery procedures, especially those involving malabsorption (e.g., Roux-en-Y gastric bypass), can lead to chronic deficiencies in **fat-soluble vitamins (A, D, E, K)**, **B12**, **iron**, and **calcium** due to altered absorption. - These depletion syndromes are a well-documented **long-term risk** requiring lifelong supplementation and monitoring. *Weight regain* - Despite initial significant weight loss, a substantial number of patients experience some degree of **weight regain** in the long term, typically peaking 2-5 years post-surgery. - This is a common and critical **long-term risk** that often necessitates ongoing lifestyle modifications and monitoring. *Protein Calorie Malnutrition* - Certain bariatric procedures (e.g., biliopancreatic diversion with duodenal switch) can lead to severe **malabsorption of protein and calories**, resulting in protein-calorie malnutrition (PCM). - PCM is a serious and persistent **long-term risk** that requires careful dietary management and sometimes additional medical interventions.

Q: Hilton's method of Incision and drainage of abscess has the advantage of:

Avoids injury to underlying vessels and nerves. ***Avoids injury to underlying vessels and nerves*** - Hilton's method involves blunt dissection with an artery forceps once the skin incision is made, allowing the surgeon to **feel important structures** and push them aside. - This technique is particularly useful in areas with **numerous neurovascular bundles**, such as the axilla or neck, minimizing the risk of iatrogenic damage. *Complete drainage of pus* - While Hilton's method facilitates drainage, it doesn't inherently guarantee **complete drainage** more than other proper incision and drainage techniques. - The effectiveness of drainage primarily depends on the **size and location of the incision** relative to the abscess cavity. *Heals without scar* - Any surgical incision, including those made using Hilton's method, will result in some degree of **scar formation**. - The method prioritizes safety over cosmetic outcomes, and the nature of the scar depends on **wound healing** and **surgical closure**. *Provides irrigation* - Irrigation is a separate step often performed after the incision and drainage to **flush out debris** and reduce bacterial load. - Hilton's method itself is a technique for making the incision and gaining access to the abscess, not for **intraoperative irrigation**.

Q: Indications of computed tomography after head injury include all EXCEPT:

Mild head injury in a 50 year old man. ***Mild head injury in a 50-year-old man*** - This is not an absolute indication for CT scanning after head injury, especially if the patient is **neurologically intact** (GCS 15) and has no other high-risk features. - While age **> 65 years** is considered a risk factor in some guidelines (Canadian CT Head Rule), age 50 alone does not warrant CT in mild head injury (GCS 13-15) without additional warning signs. - CT would be indicated if this patient had **other risk factors** such as loss of consciousness, amnesia, vomiting, anticoagulation use, or dangerous mechanism of injury. *Open depressed fracture* - This is a **high-risk feature** indicating a severe head injury and potential for **intracranial injury** or infection, requiring immediate imaging. - CT is essential to assess the extent of **bone depression**, foreign bodies, and associated brain injury. *Glasgow Coma Scale 30 minutes* - **Post-traumatic amnesia (PTA)** lasting longer than 30 minutes is a recognized risk factor for **intracranial injury**, even in patients with otherwise normal GCS scores. - It indicates a more significant impact on brain function and warrants a CT scan to rule out **structural lesions** per NICE and Canadian CT Head Rules.

Q: Sengstaken-Blakemore tube is used to control bleeding in:

Bleeding varices. ***Bleeding varices*** - The **Sengstaken-Blakemore tube** is specifically designed with gastric and esophageal balloons to apply direct pressure and tamponade actively bleeding **esophageal** or **gastric varices**. - This device is a temporary measure used to control life-threatening hemorrhage from varices secondary to **portal hypertension** when endoscopic therapies are unsuccessful or unavailable. *Duodenal ulcer bleed* - Bleeding from a duodenal ulcer is typically managed with **endoscopic intervention** (e.g., clipping, injection, cautery) or **surgical repair**. - A Sengstaken-Blakemore tube is not suitable for controlling duodenal bleeds as it cannot reach or apply pressure to the bleeding site in the **duodenum**. *Renal trauma* - Renal trauma causes bleeding within or around the **kidney**, which is usually managed conservatively, with embolization of bleeding vessels, or surgically (e.g., nephrectomy). - The Sengstaken-Blakemore tube is an **upper gastrointestinal device** and has no role in managing bleeding from renal injuries. *Splenic injury in portal hypertension* - Splenic injury with bleeding in the context of portal hypertension typically requires **splenectomy** or **splenic artery embolization**. - While portal hypertension can be a contributing factor, the tube is not designed to control bleeding originating from a **damaged spleen**.

Q: Which one of the following regarding management of acute wounds is NOT true?

Clamps should be used to stop all bleeding vessels. ***Clamps should be used to stop all bleeding vessels*** - While **hemostasis** is crucial, using clamps on *all* bleeding vessels, especially small ones, is generally discouraged as it can cause **tissue damage** and may not be necessary for effective bleeding control in many acute wound settings. - The primary initial goal is to achieve **hemostasis** safely, often through direct pressure, elevation, and pressure dressings, before more invasive measures. *Wounds should be examined, taking into consideration site and structures damaged* - A thorough examination is fundamental to identify the **extent of the injury**, including potential damage to underlying structures like nerves, tendons, vessels, or joints. - This assessment guides the appropriate cleaning, debridement, and repair strategies to optimize **healing and function**. *Bleeding wounds should be elevated and a pressure pad applied* - **Elevation** helps reduce hydrostatic pressure, thereby decreasing blood flow to the injured area. - Applying **direct pressure** with a pressure pad is the most immediate and effective method for controlling venous and capillary bleeding, and often arterial bleeding as well. *The whole patient should be examined according to ATLS principles* - The **Advanced Trauma Life Support (ATLS)** principles prioritize a systematic approach to trauma care, starting with the primary survey (ABCDE) to identify and manage life-threatening injuries. - This ensures that hidden or more critical injuries are not missed amidst the focus on the visible wound, maintaining a **holistic view** of the patient's condition.

Question 1

Which one of the following bones is affected in Keinbock's disease?

Accepted Answer

Lunate bone

Answer

Capitellum of the humerus

Answer

Metatarsal

Answer

Navicular bone

Question 2

In postoperative care the long term risks after Bariatric Surgery include all EXCEPT:

Accepted Answer

Deep Vein Thrombosis

Answer

Vitamin and Micronutrient depletion syndromes

Answer

Weight regain

Answer

Protein Calorie Malnutrition

Question 3

Hilton's method of Incision and drainage of abscess has the advantage of:

Accepted Answer

Avoids injury to underlying vessels and nerves

Answer

Complete drainage of pus

Answer

Heals without scar

Answer

Provides irrigation

Question 4

Indications of computed tomography after head injury include all EXCEPT:

Accepted Answer

Mild head injury in a 50 year old man

Answer

Open depressed fracture

Answer

Glasgow Coma Scale < 13 at any point

Answer

Amnesia > 30 minutes

Question 5

Mondor’s disease is:

Accepted Answer

Thrombophlebitis of superficial veins of the breast and anterior chest wall

Answer

Named after the scientist who first coined the term “Actinomycosis of Breast”

Answer

Other name for tuberculosis of breast

Answer

Rare type of chronic intramammary abscess

Question 6

Sengstaken-Blakemore tube is used to control bleeding in:

Accepted Answer

Bleeding varices

Answer

Duodenal ulcer bleed

Answer

Renal trauma

Answer

Splenic injury in portal hypertension

Question 7

Which one of the following regarding Pancreatic effusion is correct?

Accepted Answer

Percutaneous drainage under image guidance is indicated for symptomatic effusions

Answer

Pancreatic stenting is to be done

Answer

Free fluid collection in Pleural cavity

Answer

Never associated with abdominal collection

Question 8

Which one of the following regarding management of acute wounds is NOT true?

Accepted Answer

Clamps should be used to stop all bleeding vessels

Answer

Wounds should be examined, taking into consideration site and structures damaged

Answer

Bleeding wounds should be elevated and a pressure pad applied

Answer

The whole patient should be examined according to ATLS principles

Question 9

Risk Scoring System which can be used postoperatively is:

Accepted Answer

POSSUM 
Physiologic and Operative Severity Score for Enumeration of Mortality and Morbidity

Answer

ASA 
American Society of Anaesthesiologist

Answer

MET 
Metabolic Equivalent Task

Answer

RCRI 
Revised Cardiac Risk Index

UPSC-CMS 2018

Orthopaedics

Surgery