UPSC-CMS 2021 - Surgery PYQs Practice Questions

Q: Which of the following are types of wound healing? 1. Primary Intention 2. Secondary Intention 3. Tertiary Intention 4. Quaternary Intention

1, 2 and 3. ***1, 2 and 3*** - These options correctly identify the three recognized types of **wound healing** in surgical practice. - **Primary intention (healing by first intention)**: Clean wounds with approximated edges, minimal tissue loss, heals with minimal scarring (e.g., surgical incisions). - **Secondary intention (healing by second intention)**: Wounds with significant tissue loss that heal by granulation tissue formation, wound contraction, and epithelialization (e.g., pressure ulcers, large traumatic wounds). - **Tertiary intention (delayed primary closure)**: Contaminated wounds initially left open for 3-5 days, then closed after infection risk decreases. *1, 2 and 4* - This option incorrectly includes **"Quaternary Intention,"** which is **not a recognized classification** in wound healing. - Only primary, secondary, and tertiary intention are standard types described in surgical textbooks. *2, 3 and 4* - This option omits **"Primary Intention,"** the most common type of wound healing for clean surgical incisions. - It also incorrectly includes "Quaternary Intention," which does not exist in wound healing classification. *1, 3 and 4* - This option omits **"Secondary Intention,"** a crucial healing process for wounds with substantial tissue loss that cannot be primarily closed. - "Quaternary Intention" is not a valid wound healing type and represents a distractor in this question. [Practice more Surgery PYQs on OnCourse]

Q: A 60 year old lady underwent total abdominal hysterectomy. On the 3rd post operative day she suddenly became breathless while returning from washroom. Her blood pressure recorded was 80/50 mm of Hg. The most probable diagnosis is

Thromboembolism. ***Thromboembolism*** - Sudden onset **breathlessness** and **hypotension** in a postoperative patient are classic signs of a **pulmonary embolism (PE)**, a severe form of thromboembolism. - Surgical procedures, especially pelvic surgeries like hysterectomy, are **risk factors** for deep vein thrombosis (DVT) which can lead to PE. *Postural hypotension* - While it can cause lightheadedness or dizziness upon standing, it typically doesn't present as sudden, severe **breathlessness** and sustained **hypotension**. - Its onset is directly related to a change in position, and the patient's symptoms are more severe than usually seen with postural changes. *Transient ischaemic attack* - A TIA involves **neurological deficits** such as weakness, speech disturbance, or visual changes, which are temporary. - It does not present with sudden **breathlessness** or profound **hypotension**. *Secondary haemorrhage* - This would typically manifest as signs of **blood loss**, such as fresh bleeding from the surgical site or distended abdomen, along with features of hypovolemic shock. - While hypotension would be present, the primary symptom would not be sudden **breathlessness**. [Practice more Surgery PYQs on OnCourse]

Q: A 52 year old female underwent MRM (Modified Radical Mastectomy). After few years, she developed lymphedema of the ipsilateral arm. Which of the following malignancies can develop in her arm?

Lymphangiosarcoma. ***Lymphangiosarcoma*** - This is a rare, aggressive **vascular tumor** that can develop in chronically lymphedematous limbs, particularly after **mastectomy** for breast cancer. - The chronic lymphatic obstruction and inflammation are thought to be predisposing factors, leading to the condition known as **Stewart-Treves syndrome**. *Malignant Melanoma* - This cancer arises from **melanocytes** in the skin and is primarily associated with UV radiation exposure or existing nevi, not chronic lymphedema. - While it can occur anywhere on the body, there is no direct causal link between modified radical mastectomy and the development of melanoma in the arm. *Lymphoma* - Lymphoma is a cancer of the **lymphocytes** within the lymphatic system, typically presenting as swollen lymph nodes or B-symptoms. - Although lymphedema involves the lymphatic system, it generally predisposes to angiosarcoma rather than lymphoma in this specific clinical context. *Malignant fibrous histiocytoma* - This is a type of **soft tissue sarcoma** that can occur in various locations, but it is not specifically linked to chronic lymphedema following mastectomy. - While its etiology can be complex, it does not have the well-established association with chronic lymphedema that lymphangiosarcoma does. [Practice more Surgery PYQs on OnCourse]

Q: A gentleman of 60 years presented with a brawny swelling of the submandibular region with inflammatory edema of mouth and putrid halitosis. Most likely he is suffering from

Ludwig's angina. ***Ludwig's angina*** - This is a **rapidly progressive cellulitis** of the submandibular, sublingual, and submental spaces, commonly originating from **odontogenic infections**. - The classic presentation includes **brawny edema** (firm, woody induration) of the submandibular region, inflammatory edema of the mouth, and **putrid halitosis** indicative of an anaerobic infection. *Acute lymphadenitis* - This involves inflammation of the lymph nodes, typically characterized by **tender, enlarged nodes**. - While it can be associated with infection, it usually does not present with the diffuse, *brawny* swelling of the floor of the mouth and submandibular area as described, nor the severe systemic symptoms often linked to Ludwig's angina. *Tubercular adenitis* - This is a **chronic granulomatous inflammation** of lymph nodes, typically presenting as slowly enlarging, **non-tender masses**. - It does not cause acute, rapidly spreading cellulitis or *brawny* edema with severe halitosis, which are hallmark features of Ludwig's angina. *Chronic lymphadenitis* - This refers to persistent or recurrent inflammation of lymph nodes, often due to protracted infection or inflammatory processes. - It usually manifests as **enlarged, firm, sometimes mobile lymph nodes**, but does not involve the acute, diffuse, and rapidly spreading *brawny* edema characteristic of a severe fascial space infection like Ludwig's angina. [Practice more Surgery PYQs on OnCourse]

Q: A 25 year old female patient with previous history of neck irradiation presents with thyroid swelling for last 6 months. The patient is clinically euthyroid. On examination, the right lobe of thyroid gland is enlarged with presence of ipsilateral cervical lymphadenopathy. The most probable clinical diagnosis in this patient is

Papillary carcinoma thyroid. ***Papillary carcinoma thyroid*** - A history of **neck irradiation** is a significant risk factor for **papillary thyroid carcinoma**. - **Cervical lymphadenopathy** is a common presentation, as papillary carcinoma frequently metastasizes to regional lymph nodes, and the patient is **euthyroid**. *Lymphoma* - While neck mass and lymphadenopathy can occur with lymphoma, a history of **previous neck irradiation** is a stronger predisposing factor for thyroid carcinoma, and **thyroid lymphoma** often presents with a rapidly enlarging goiter or compressive symptoms. - Though irradiation can increase the risk of some lymphomas, it's a more direct and strong risk factor for thyroid cancer in the setting of thyroid swelling. *Medullary carcinoma thyroid* - **Medullary thyroid carcinoma** typically arises from **parafollicular C cells** and is often associated with elevated **calcitonin levels** and may be familial (e.g., MEN 2 syndromes), which are not mentioned. - While it can present with lymphadenopathy, the history of irradiation points more strongly towards papillary carcinoma. *Follicular carcinoma thyroid* - **Follicular carcinoma** is less commonly associated with a history of **neck irradiation** compared to papillary carcinoma and tends to metastasize hematogenously rather than primarily to regional lymph nodes. - It often presents as a solitary nodule, and while lymph node involvement can occur, it's less characteristic than in papillary carcinoma. [Practice more Surgery PYQs on OnCourse]

Question 1

Which of the following are types of wound healing?

1. Primary Intention
2. Secondary Intention
3. Tertiary Intention
4. Quaternary Intention

Accepted Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 3 and 4

Question 2

A 60 year old lady underwent total abdominal hysterectomy. On the 3rd post operative day she suddenly became breathless while returning from washroom. Her blood pressure recorded was 80/50 mm of Hg. The most probable diagnosis is

Accepted Answer

Thromboembolism

Answer

Postural hypotension

Answer

Transient ischaemic attack

Answer

Secondary haemorrhage

Question 3

A 52 year old female underwent MRM (Modified Radical Mastectomy). After few years, she developed lymphedema of the ipsilateral arm. Which of the following malignancies can develop in her arm?

Accepted Answer

Lymphangiosarcoma

Answer

Malignant Melanoma

Answer

Lymphoma

Answer

Malignant fibrous histiocytoma

Question 4

A gentleman of 60 years presented with a brawny swelling of the submandibular region with inflammatory edema of mouth and putrid halitosis. Most likely he is suffering from

Accepted Answer

Ludwig's angina

Answer

Acute lymphadenitis

Answer

Tubercular adenitis

Answer

Chronic lymphadenitis

Question 5

A 25 year old female patient with previous history of neck irradiation presents with thyroid swelling for last 6 months. The patient is clinically euthyroid. On examination, the right lobe of thyroid gland is enlarged with presence of ipsilateral cervical lymphadenopathy. The most probable clinical diagnosis in this patient is

Accepted Answer

Papillary carcinoma thyroid

Answer

Lymphoma

Answer

Medullary carcinoma thyroid

Answer

Follicular carcinoma thyroid

Question 6

An infant presented in the surgical OPD with complaints of a unilateral swelling in the neck. The swelling was soft, cystic, partially compressible and brilliantly transilluminant. The most probable diagnosis is

Accepted Answer

Cystic Hygroma

Answer

Branchial fistula

Answer

Branchial cyst

Answer

Thyroglossal cyst

Question 7

A 43 year old woman presented with serous discharge from a single duct of the nipple of her right breast which was sent for evaluation. She is unlikely to be suffering from

Accepted Answer

Fibrocystic disease

Answer

Intraductal Papilloma

Answer

Carcinoma

Answer

Duct Ectasia

Question 8

Which of the following is NOT a classical symptom of acute appendicitis ?

Accepted Answer

Constipation

Answer

Periumbilical colic

Answer

Anorexia

Answer

Nausea

Question 9

Which of the following statements with regard to Enteric perforation are correct?

1. Salmonella typhi is the causative organism for Enteric fever
2. Enteric perforation characteristically occurs during the third week of illness
3. Typhoid ulcers are placed transversely to the long axis of the gut
4. Terminal ileum is the most common site for enteric perforation

Accepted Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 3

Question 10

A 35 year old male patient with enteric fever presents to the emergency with sudden onset of generalised abdominal pain, abdominal distension, nausea, vomiting and constipation for last 48 hours. On examination, patient is dehydrated with PR = 110/min and BP = 100/60 mm Hg. There is generalised tenderness, rebound tenderness present and board like rigidity on per abdomen examination. The most likely complication of enteric fever in this patient is

Accepted Answer

Small bowel perforation

Answer

Cholecystitis

Answer

Small bowel enteritis

Answer

Small bowel obstruction

UPSC-CMS 2021 — Surgery