UPSC-CMS 2023 - Surgery PYQs Practice Questions

Q: Tidy wounds inflicted by sharp instruments and containing no devitalised tissues are expected to heal by

Primary healing. ***Primary healing*** - This mode of healing occurs in **clean, surgically incised, or sharply cut wounds** with minimal tissue loss and edges that can be approximated. - Features include minimal scarring and rapid re-epithelialization without granulation tissue formation. *Skin grafting* - This is a surgical procedure used to cover large wounds where **primary closure is not possible** or to repair areas with significant tissue loss. - It involves transplanting skin from one area of the body to another, not a natural healing process for tidy wounds. *Secondary healing* - This occurs in wounds with **significant tissue loss, infection, or edges that cannot be approximated**, requiring the formation of granulation tissue to fill the defect. - It results in a larger scar and takes longer to heal compared to primary healing. *Formation of contracture* - **Wound contracture** is a process that occurs during secondary healing, where myofibroblasts pull the wound edges together, leading to a reduction in wound size. - While it's a part of the healing process for certain wounds, it is not the primary mode of healing for tidy, sharp wounds and can lead to functional impairment if severe. [Practice more Surgery PYQs on OnCourse]

Q: A patient has a 6-cm breast tumor with mobile, clinically positive, ipsilateral axillary lymph nodes and no evidence of distant metastasis. The stage of the breast cancer is

Stage IIIa. ***Stage IIIa*** - A **6-cm tumor (T3)** with **mobile, clinically positive ipsilateral axillary lymph nodes (N1)** and **no distant metastasis (M0)** classifies as **T3N1M0 = Stage IIIA** according to AJCC TNM staging. - Stage IIIA includes **T3N1M0** among other combinations, representing locally advanced breast cancer with significant tumor burden and regional nodal involvement. *Stage IIb* - Stage IIB is classified as **T2N1M0** (2-5 cm tumor with mobile axillary nodes) or **T3N0M0** (>5 cm tumor with no nodal involvement). - This patient has **T3N1M0**, which exceeds Stage IIB criteria due to the combination of large tumor size and positive lymph nodes. *Stage I* - Stage I involves **small tumors (T1, ≤2 cm)** with **no lymph node involvement (N0)** or only micrometastases. - The **6-cm tumor size** and **clinically evident axillary lymph node involvement** far exceed Stage I parameters. *Stage IIIb* - Stage IIIB requires **T4 disease** with chest wall invasion, skin involvement (ulceration, satellite nodules), or inflammatory breast cancer features. - This case shows **T3 disease** without signs of **locally advanced features** like chest wall fixation or skin changes. [Practice more Surgery PYQs on OnCourse]

Q: A 40-year old alcoholic male complains of acute pain in the epigastrium associated with vomiting for the last 10 days. On clinical examination, he is found to have a mass in the epigastrium. The most likely diagnosis is

Pancreatic pseudocyst. **Pancreatic pseudocyst** - The presence of an **epigastric mass** in an **alcoholic male** with acute epigastric pain and vomiting for 10 days is highly suggestive of a pancreatic pseudocyst, which commonly develops after **acute pancreatitis**. - Pseudocysts are collections of **pancreatic fluid** encased by a non-epithelial inflammatory wall, often presenting as a palpable mass within days to weeks after an acute episode. - The **alcoholic history** and **acute presentation** strongly support this diagnosis. *Carcinoma of head of the pancreas* - While pancreatic carcinoma can cause epigastric pain, **vomiting** and an **acute course** over 10 days are less typical. - It is usually associated with **weight loss**, **jaundice** (if the head is involved), and a more insidious onset. *Perforated peptic ulcer with sub-hepatic abscess* - A perforated peptic ulcer presents with **sudden, severe epigastric pain** that rapidly worsens, often with signs of **peritonitis** and acute abdomen. - A sub-hepatic abscess would typically be accompanied by **fever**, **leukocytosis**, and signs of sepsis. *Hepatoma in left lobe of liver* - A hepatoma would usually present with a **liver mass**, potentially **jaundice**, weight loss, and abnormal liver function tests, rather than an acute onset of severe epigastric pain and vomiting. - The mass would typically be felt in the **right upper quadrant** or epigastrium, but the clinical picture does not align with an acute pancreatic process. [Practice more Surgery PYQs on OnCourse]

Q: In acute pancreatitis, surgery is indicated in which one of the following conditions?

Infected pancreatic necrosis. ***Infected pancreatic necrosis*** - **Infected pancreatic necrosis** is a severe complication of acute pancreatitis requiring surgical or percutaneous debridement (necrosectomy) to remove infected tissue and prevent sepsis. - The presence of infection in necrotic tissue significantly increases morbidity and mortality, making intervention crucial. *Acute pseudocyst* - An acute pseudocyst is usually managed conservatively and only requires intervention if it is **symptomatic**, rapidly expanding, or becomes infected. - Surgical drainage is typically reserved for large, symptomatic, or complicated pseudocysts that persist beyond 6 weeks. *Acute fluid collection* - **Acute fluid collections** are generally self-limiting and resolve without intervention. - They are typically asymptomatic and represent an early stage of fluid accumulation, often preceding pseudocyst formation. *Sterile pancreatic necrosis* - **Sterile pancreatic necrosis** is usually managed with supportive care, as surgical intervention in the absence of infection does not improve outcomes and may increase complications. - The key distinction is the absence of infection—surgery is indicated only when necrosis becomes infected. [Practice more Surgery PYQs on OnCourse]

Q: The most common site of skeletal metastases in carcinoma of the breast is

Thoracic vertebrae. ***Thoracic vertebrae*** - The **thoracic spine** accounts for **68-80%** of all spinal metastases in breast cancer due to direct venous drainage via **Batson's venous plexus** through the **azygos vein** and **intercostal veins**. - The **valveless nature** of Batson's plexus allows **retrograde seeding** of tumor cells, making thoracic vertebrae the primary target for skeletal metastases. *Skull* - While skull metastases can occur in breast cancer, they represent a **less frequent site** compared to the axial skeleton, particularly thoracic vertebrae. - Skull involvement typically presents as **lytic lesions** and may cause neurological symptoms, but occurs in a minority of cases. *Pelvis* - The pelvis is indeed a common site for bone metastases in breast cancer, but it is **secondary** to thoracic vertebral involvement. - Pelvic metastases can cause **pathological fractures** and hip pain, but represent a smaller percentage of initial skeletal spread. *Lumbar vertebrae* - Lumbar spine involvement occurs in only **16-22%** of spinal metastases, significantly **less frequent** than thoracic vertebrae. - This distinction is crucial for exam purposes as lumbar involvement is often confused with thoracic, but the **anatomical drainage pattern** clearly favors thoracic spread. [Practice more Surgery PYQs on OnCourse]

Question 1

Tidy wounds inflicted by sharp instruments and containing no devitalised tissues are expected to heal by

Accepted Answer

Primary healing

Answer

Skin grafting

Answer

Secondary healing

Answer

Formation of contracture

Question 2

A patient has a 6-cm breast tumor with mobile, clinically positive, ipsilateral axillary lymph nodes and no evidence of distant metastasis. The stage of the breast cancer is

Accepted Answer

Stage IIIa

Answer

Stage IIIb

Answer

Stage I

Answer

Stage IIb

Question 3

A 40-year old alcoholic male complains of acute pain in the epigastrium associated with vomiting for the last 10 days. On clinical examination, he is found to have a mass in the epigastrium. The most likely diagnosis is

Accepted Answer

Pancreatic pseudocyst

Answer

Carcinoma of head of the pancreas

Answer

Perforated peptic ulcer with sub-hepatic abscess

Answer

Hepatoma in left lobe of liver

Question 4

In acute pancreatitis, surgery is indicated in which one of the following conditions?

Accepted Answer

Infected pancreatic necrosis

Answer

Acute pseudocyst

Answer

Acute fluid collection

Answer

Sterile pancreatic necrosis

Question 5

The most common site of skeletal metastases in carcinoma of the breast is

Accepted Answer

Thoracic vertebrae

Answer

Skull

Answer

Pelvis

Answer

Lumbar vertebrae

Question 6

Consider the following findings with reference to a diagnostic peritoneal lavage (DPL) in a case of abdominal trauma :

1. 10 ml of gross blood on aspiration
2. W.B.C. count more than 500/cu mm
3. Amylase level more than 175 IU/dL
4. R.B.C. count more than 100,000/cu mm The criteria for a positive DPL are :

Accepted Answer

1, 2, 3 and 4

Answer

1 and 2 only

Answer

3 and 4 only

Answer

1, 2 and 3 only

Question 7

Following radical surgery for the carcinoma of breast, reconstruction of the breast can be performed by using the following procedures except

Accepted Answer

Deltopectoral flap

Answer

Silicone implants

Answer

Transversus abdominis muscle flap (TRAM flap)

Answer

Latissimus dorsi flap (LD flap)

Question 8

A Wolfe graft is a

Accepted Answer

Large full thickness skin graft

Answer

Partial thickness skin graft

Answer

Pinch skin graft

Answer

Pedicle graft

Question 9

The indications for surgery in patients with pulmonary tuberculosis include all of the following except

Accepted Answer

AFB positive sputum with normal chest CT scan

Answer

Drug-resistant chronic tuberculous abscess

Answer

Severe life-threatening haemoptysis

Answer

Aspergilloma within a tuberculous cavity with recurrent haemoptysis

Question 10

In a patient with stage T1 (tumor invading lamina propria) transitional cell carcinoma of the urinary bladder, the recommended treatment is

Accepted Answer

Trans urethral resection of bladder tumour (TURBT)

Answer

Radiation therapy

Answer

Systemic chemotherapy

Answer

Radical cystectomy

UPSC-CMS 2023 — Surgery