UPSC-CMS 2021 - Surgery Practice Questions

Q: A 45 year old female patient presents with a painless firm abdominal swelling of size 10 x 8 cm near the umbilicus. The swelling is reducible and shows no fixation to deeper structures. The most probable clinical diagnosis in this patient is

Umbilical hernia. ***Umbilical hernia*** - An **umbilical hernia** presents as a swelling near the umbilicus, is often **painless**, and tends to be **reducible**, especially in adults where it can be acquired. - The patient's age and the location and characteristics of the swelling (painless, firm, reducible, unfixed near the umbilicus) are highly consistent with an umbilical hernia, which commonly affects middle-aged women. *Incisional hernia* - An **incisional hernia** develops at the site of a previous surgical incision, which is not mentioned in the patient's history. - While it can be reducible, its location near the umbilicus without a history of abdominal surgery makes it less likely than an umbilical hernia. *Inguinal hernia* - An **inguinal hernia** occurs in the **groin region**, above the inguinal ligament, and not typically near the umbilicus. - While also often **reducible**, its anatomical location differentiates it from the described swelling. *Femoral hernia* - A **femoral hernia** presents as a swelling in the **upper thigh**, inferior to the inguinal ligament, and is more common in women. - The described swelling's location near the umbilicus rules out a femoral hernia.

Q: In Pringle Manoeuvre, clamping includes which of the following? 1. Common Bile Duct 2. Hepatic artery 3. Portal vein 4. Inferior Vena Cava

1, 2 and 3. ***1, 2 and 3*** - The **Pringle maneuver** involves clamping structures within the **hepatoduodenal ligament** to temporarily control bleeding from the liver. - The three main structures within the hepatoduodenal ligament that are clamped are the **hepatic artery**, the **portal vein**, and the **common bile duct**. *2, 3 and 4* - This option incorrectly includes the **inferior vena cava (IVC)**, which is not part of the hepatoduodenal ligament and therefore not clamped during a standard Pringle maneuver. - Clamping the IVC would lead to severe hemodynamic instability and is not a part of this routine surgical maneuver. *1, 3 and 4* - This option incorrectly includes the **inferior vena cava (IVC)**, which is not clamped during the Pringle maneuver. - It also omits the **hepatic artery**, a major blood supply to the liver, which must be clamped along with the portal vein to effectively reduce hepatic blood flow. *1, 2 and 4* - This option incorrectly includes the **inferior vena cava (IVC)**, which is located posterior to the liver and not within the hepatoduodenal ligament. - It also omits the **portal vein**, which contributes to the majority of the liver's blood supply and is crucial to occlude during the Pringle maneuver to control bleeding effectively.

Q: A patient with suspected head injury is brought to the emergency following road traffic accident. At the time of examination, patient is conscious with GCS 14/15 and stable vitals. There is bleeding from right ear and CSF leak from nose. Bruising is present behind the right ear. The most probable clinical diagnosis in this patient is

Fracture of the base of skull. ***Fracture of the base of skull*** - The combination of **bleeding from the ear (otorrhagia)**, **CSF leak from the nose (rhinorrhea)**, and **bruising behind the ear (Battle's sign)** are classic indicators of a **basilar skull fracture**. - These signs suggest a breach in the bone separating the brain from the external environment, often involving the **temporal bone** or the **anterior cranial fossa**. *Extradural haematoma* - This typically presents with a **lucid interval** followed by rapid neurological deterioration due to arterial bleeding, which is not suggested by the stable GCS of 14/15. - While it can be associated with skull fractures, the specific signs of **CSF leak** and **Battle's sign** point more directly to a basilar fracture. *Cerebral concussion* - A concussion involves a transient disturbance of brain function without macrostructural damage, characterized by symptoms like confusion, dizziness, and memory problems. - It does not involve **CSF leaks**, **otorrhagia**, or **Battle's sign**, which are indicative of a more severe structural injury. *Traumatic subarachnoid haemorrhage* - This involves bleeding into the **subarachnoid space**, typically causing a **sudden severe headache**, nuchal rigidity, and altered consciousness. - It does not directly explain **otorrhagia**, **rhinorrhea**, or **Battle's sign**, which are specific to a breach in the skull base.

Q: Which of the following are correct about ectopic ureters? 1. They are more common in males 2. They drain the upper pole of the kidney 3. They are associated with duplex ureter 4. They may cause incontinence

2, 3 and 4. ***2, 3 and 4*** - Ectopic ureters primarily drain the **upper pole** of a **duplicated kidney** and are nearly always associated with some degree of renal dysplasia. - They are commonly associated with **duplex ureters** and can cause **incontinence**, especially in females, as they often bypass the bladder sphincter. *1, 3 and 4* - This option is incorrect because ectopic ureters are **more common in females** than males, particularly symptomatic cases involving incontinence. - While they are associated with duplex ureters and incontinence, the statement about being more common in males is inaccurate. *1, 2 and 3* - This option is incorrect because ectopic ureters are **more prevalent in females** and are a significant cause of continuous urinary incontinence in this population. - While they drain the upper pole and are associated with duplex ureters, the claim of being more common in males is false. *1, 2 and 4* - This option is incorrect as ectopic ureters are typically found more often in **females** and are a recognized cause of **incontinence** in affected individuals. - Although they drain the upper pole and may cause incontinence, the assertion that they are more common in males is inaccurate.

Q: A patient of road traffic accident presents to the emergency with increasing restlessness and difficulty in breathing. The respiratory rate is 26 breaths/minute; there are distended neck veins; trachea is deviated to the right side with hyper-resonant note and absence of breath sounds on the left side. Which of the following statements are correct? 1. The most probable clinical diagnosis is left tension pneumothorax 2. Immediate chest decompression using wide bore cannula in left 2nd intercostal space is to be done 3. Immediate chest X-ray should be done to confirm the clinical diagnosis 4. Definitive chest tube insertion in left fifth intercostal space should be done

1, 2 and 4. ***1, 2 and 4*** - The clinical presentation with **increasing restlessness**, **difficulty in breathing**, **distended neck veins**, **tracheal deviation away from the affected side** (to the right for a left-sided collection), **hyper-resonant note**, and **absent breath sounds on the left** is pathognomonic for **left tension pneumothorax** (Statement 1 is correct). - **Immediate needle decompression** with a wide-bore cannula in the **2nd intercostal space** along the mid-clavicular line on the affected side is a **life-saving intervention** that must be performed immediately (Statement 2 is correct). - After needle decompression, **definitive chest tube insertion** in the **5th intercostal space** (mid-axillary line) should be performed (Statement 4 is correct). - Statement 3 is **incorrect** because tension pneumothorax is a **clinical diagnosis** requiring immediate treatment without delaying for imaging, which could be fatal. *2, 3 and 4* - This combination is incorrect because Statement 3 is wrong. - **Immediate chest X-ray should NOT be done** for suspected tension pneumothorax as it is a **clinical emergency** requiring immediate decompression without delay for imaging. - Statement 1 (the correct diagnosis) is also missing from this option. *1, 2 and 3* - This combination is incorrect because Statement 3 is wrong. - **Delaying treatment to obtain imaging** can be **fatal** due to cardiovascular collapse from mediastinal shift and impaired venous return. - Statement 4 (definitive chest tube insertion) is also missing from this option. *1, 3 and 4* - This combination is incorrect because Statement 3 is wrong. - The diagnosis is **clinical**, and treatment (needle decompression - Statement 2) should be initiated immediately to prevent hemodynamic compromise and death. - Statement 2 (immediate needle decompression) is also missing from this option.

Q: Which of the following statements regarding the composition of common crystalloid solutions is correct ?

Normal saline contains 154 mEq/L of Na+. ***Normal saline contains 154 mEq/L of Na+*** - Normal saline (0.9% NaCl) contains **154 mEq/L of both Na+ and Cl-**, making this statement factually correct. - This makes normal saline **hypernatremic and hyperchloremic** compared to plasma (which has ~140 mEq/L Na+ and ~103 mEq/L Cl-). - Normal saline is useful for correcting **hyponatremia** and for significant volume expansion, but large volumes can cause **hyperchloremic metabolic acidosis**. *Hartmann's solution contains 140 mEq/L of Na+* - Hartmann's solution (Lactated Ringer's) actually contains approximately **130 mEq/L of Na+**, not 140 mEq/L. - The sodium content is designed to be closer to that of **plasma**, making it a more physiologically balanced solution. *Hartmann's solution contains 120 mEq/L of Cl-* - Hartmann's solution contains approximately **109-110 mEq/L of Cl-**, not 120 mEq/L. - This **lower chloride content** compared to normal saline, along with the presence of lactate (28 mEq/L), contributes to a reduced risk of hyperchloremic metabolic acidosis. - The lactate is metabolized to bicarbonate, providing a mild alkalinizing effect. *Normal saline contains 140 mEq/L of Cl-* - Normal saline contains **154 mEq/L of Cl-**, not 140 mEq/L. - Its high chloride content can lead to **hyperchloremic metabolic acidosis** with large-volume administration.

Q: Which of the following are correct about ectopic ureters? 1. They are more common in males 2. They drain the upper pole of kidney 3. They are associated with duplex ureter 4. They may cause incontinence

2, 3 and 4. ***2, 3 and 4*** - **Statement 2 is correct:** Ectopic ureters in duplex systems typically drain the **upper pole moiety** of the kidney (Weigert-Meyer rule) - **Statement 3 is correct:** Ectopic ureters are most commonly associated with **complete ureteral duplication** (duplex collecting system) - **Statement 4 is correct:** Ectopic ureters can cause **continuous urinary incontinence**, especially in females when insertion is below the sphincter mechanism (vagina, urethra, vestibule) - **Statement 1 is incorrect:** Ectopic ureters are **more common in females** (approximately 80% of cases), not males *1, 2 and 4* - Incorrectly includes statement 1 - ectopic ureters are **more common in females**, not males *1, 2 and 3* - Incorrectly includes statement 1 - ectopic ureters are **more common in females**, not males - Missing statement 4, which is correct - ectopic ureters **do cause incontinence** *1, 2, 3 and 4* - Incorrectly includes statement 1 - ectopic ureters are **more common in females**, not males

Q: Untidy wounds are characterised by which of the following? 1. Crushed or avulsed tissues 2. Contaminated wound 3. Devitalised tissue 4. No loss of tissue

1, 2 and 3. ***1, 2 and 3*** - **Untidy wounds**, often resulting from high-energy trauma, are defined by the presence of **crushed or avulsed tissues**, **contamination**, and **devitalized tissue**. - These characteristics make the wound more complex to manage and prone to complications like infection. *1, 2, 3 and 4* - This option incorrectly includes "no loss of tissue" (option 4) as a characteristic of untidy wounds. **Untidy wounds** frequently involve **tissue loss**, making this statement contradictory to their definition. - The presence of **crushed or avulsed tissues** inherently suggests some degree of tissue damage or loss. *1, 2 and 4* - This option incorrectly states that "no loss of tissue" is a characteristic of untidy wounds. In reality, **untidy wounds** are often associated with significant **tissue destruction and loss**. - **Crushed and avulsed tissues** are direct indicators of tissue damage and potential loss. *2, 3 and 4* - This option incorrectly omits "crushed or avulsed tissues" (option 1), which is a cardinal feature of untidy wounds. It also incorrectly includes "no loss of tissue" (option 4). - While **contamination** and **devitalized tissue** are hallmarks of untidy wounds, the absence of crushed/avulsed tissue and the idea of no tissue loss are inaccurate.

Q: Which one of the following statements regarding the composition of common crystalloid solutions is correct ?

Hartmann’s solution contains 111 meq/L of Cl. ***Hartmann’s solution contains 111 meq/L of Cl*** - **Hartmann's solution** (Lactated Ringer's) typically contains **111 mmol/L** (or meq/L) of chloride. - Its electrolyte composition aims to mimic plasma more closely than normal saline, with **lower chloride content** to reduce the risk of hyperchloremic acidosis. *Hartmann’s solution contains 111 meq/L of Na* - Hartmann's solution contains approximately **130 meq/L of Na**, not 111 meq/L. - The sodium concentration is higher than 111 meq/L to maintain **isotonicity** and match plasma osmolality. *Normal saline contains 130 meq/L of Cl* - **Normal saline (0.9% NaCl)** contains **154 meq/L of Cl**, which is significantly higher than 130 meq/L. - Its high chloride content can lead to **hyperchloremic metabolic acidosis** if administered in large volumes. *Normal saline contains 100 meq/L of Na* - **Normal saline (0.9% NaCl)** contains **154 meq/L of Na**, not 100 meq/L [1]. - This higher sodium concentration contributes to its **isotonicity** with plasma [1].

Question 1

A 45 year old female patient presents with a painless firm abdominal swelling of size 10 x 8 cm near the umbilicus. The swelling is reducible and shows no fixation to deeper structures. The most probable clinical diagnosis in this patient is

Accepted Answer

Umbilical hernia

Answer

Incisional hernia

Answer

Inguinal hernia

Answer

Femoral hernia

Question 2

In Pringle Manoeuvre, clamping includes which of the following?

1. Common Bile Duct
2. Hepatic artery
3. Portal vein
4. Inferior Vena Cava

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 4

Question 3

A patient with suspected head injury is brought to the emergency following road traffic accident. At the time of examination, patient is conscious with GCS 14/15 and stable vitals. There is bleeding from right ear and CSF leak from nose. Bruising is present behind the right ear. The most probable clinical diagnosis in this patient is

Accepted Answer

Fracture of the base of skull

Answer

Extradural haematoma

Answer

Cerebral concussion

Answer

Traumatic subarachnoid haemorrhage

Question 4

Which of the following are correct about ectopic ureters?

1. They are more common in males
2. They drain the upper pole of the kidney
3. They are associated with duplex ureter
4. They may cause incontinence

Accepted Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Question 5

A patient of road traffic accident presents to the emergency with increasing restlessness and difficulty in breathing. The respiratory rate is 26 breaths/minute; there are distended neck veins; trachea is deviated to the right side with hyper-resonant note and absence of breath sounds on the left side. Which of the following statements are correct?

1. The most probable clinical diagnosis is left tension pneumothorax

2. Immediate chest decompression using wide bore cannula in left 2nd intercostal space is to be done

3. Immediate chest X-ray should be done to confirm the clinical diagnosis

4. Definitive chest tube insertion in left fifth intercostal space should be done

Accepted Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Answer

1, 3 and 4

Question 6

Which of the following statements regarding the composition of common crystalloid solutions is correct ?

Accepted Answer

Normal saline contains 154 mEq/L of Na+

Answer

Hartmann's solution contains 120 mEq/L of Cl-

Answer

Hartmann's solution contains 140 mEq/L of Na+

Answer

Normal saline contains 140 mEq/L of Cl-

Question 7

Which of the following are correct about ectopic ureters?

1. They are more common in males
2. They drain the upper pole of kidney
3. They are associated with duplex ureter
4. They may cause incontinence

Accepted Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

1, 2, 3 and 4

Question 8

Untidy wounds are characterised by which of the following?

1. Crushed or avulsed tissues
2. Contaminated wound
3. Devitalised tissue
4. No loss of tissue

Accepted Answer

1, 2 and 3

Answer

1, 2, 3 and 4

Answer

1, 2 and 4

Answer

2, 3 and 4

Question 9

Which one of the following statements regarding the composition of common crystalloid solutions is correct ?

Accepted Answer

Hartmann’s solution contains 111 meq/L of Cl

Answer

Hartmann’s solution contains 111 meq/L of Na

Answer

Normal saline contains 130 meq/L of Cl

Answer

Normal saline contains 100 meq/L of Na

UPSC-CMS 2021 — Surgery