UPSC-CMS 2014 - Surgery Practice Questions

Q: The following operative procedure can result in neurogenic voiding dysfunction except:

Ureterolithotomy. **Ureterolithotomy** - This procedure involves removing kidney stones from the **ureter** and generally does not involve dissection near the pelvic nerves responsible for bladder function. - It is a **localized procedure** that avoids the extensive pelvic dissection associated with damage to the **autonomic nerves controlling voiding**. *Radical hysterectomy* - This procedure involves the removal of the **uterus, cervix, parametrium, and a portion of the vagina**, which frequently necessitates extensive dissection in the pelvic area. - The dissection can injure the **pelvic plexus nerves**, leading to neurogenic bladder dysfunction. *Abdominoperineal resection* - This surgery involves removing the **rectum and anus**, requiring extensive dissection through the pelvic floor. - This procedure carries a significant risk of damaging the **inferior hypogastric plexus and sacral nerves**, which are crucial for bladder control. *Retroperitoneal lymph node dissection* - This procedure involves dissecting lymph nodes in the **retroperitoneal space**, especially in cases of testicular cancer. - While primarily affecting ejaculation, extensive or misplaced dissection can also impact the **sympathetic and parasympathetic efferent nerves originating from the pelvic plexus** that contribute to bladder function.

Q: Match List-I with List-II and select the correct answer using the code given below the Lists: **List-I (Procedure)** A. Highly selective vagotomy B. Vagotomy with gastrojejunostomy C. Subtotal gastrectomy D. Nissen's fundoplication **List-II (Complication)** 1. Metabolic bone disease 2. Post-prandial gas bloat 3. Lesser curve necrosis 4. Diarrhea **Code:**

A→3 B→4 C→1 D→2. ***A→3 B→4 C→1 D→2*** - **Highly selective vagotomy** involves careful dissection along the **lesser curve** of the stomach, which can lead to **lesser curve necrosis** due to devascularization during the procedure. - **Vagotomy with gastrojejunostomy** disrupts vagal innervation leading to altered gut motility and bacterial overgrowth, causing **diarrhea** as a common complication. - **Subtotal gastrectomy** removes significant gastric tissue affecting absorption of **calcium** and **vitamin D**, leading to **metabolic bone disease**. - **Nissen's fundoplication** creates a 360° wrap that can cause inability to belch and **post-prandial gas bloat** syndrome. *A→2 B→4 C→1 D→3* - Incorrectly associates **highly selective vagotomy** with gas bloat, which is primarily seen with **fundoplication procedures**. - Mismatches **Nissen's fundoplication** with lesser curve necrosis, when lesser curve necrosis specifically occurs during **vagotomy procedures**. *A→2 B→1 C→4 D→3* - Wrongly links **vagotomy with gastrojejunostomy** to metabolic bone disease, which is characteristic of **gastric resection procedures**. - Incorrectly associates **subtotal gastrectomy** with diarrhea as primary complication rather than the more specific **metabolic bone disease**. *A→3 B→1 C→4 D→2* - Mismatches **vagotomy with gastrojejunostomy** with metabolic bone disease, when this complication is specific to **gastric resection**. - Incorrectly links **subtotal gastrectomy** with diarrhea instead of its more characteristic long-term complication of **metabolic bone disease**.

Q: Optimum age for surgery for a child with cleft lip is:

3 - 6 months. ***3 - 6 months*** - This age range allows the infant to **grow sufficiently** and gain weight, which is important for tolerating anesthesia and surgery. - It's also early enough to minimize the development of **feeding difficulties** and **speech problems** often associated with unrepaired cleft lips. *4 weeks* - At 4 weeks, infants are generally considered too young and **fragile** for cleft lip repair due to their small size and immature physiological systems. - The risk of **anesthesia-related complications** and surgical stress is higher in very young infants. *4 - 6 weeks* - Similar to 4 weeks, this period is still too early for optimal surgical outcomes, as the infant's facial structures are still developing and they may not have reached an adequate weight. - Waiting a few more months allows for better **wound healing** and reduces the overall risks associated with the procedure. *6 - 18 months* - While cleft lip repair can be done during this period, it's generally considered **later than optimal** for isolated cleft lip. - Delaying surgery beyond 6 months can increase the likelihood of developing **feeding and speech issues**, as well as potential psycho-social impacts.

Q: An electrical contact burn is considered to be:

Full thickness burn. ***Full thickness burn*** - Electrical contact burns are characterized by **high heat** generated at the point of contact, leading to **deep tissue destruction** that extends through the entire dermis and often into subcutaneous fat, muscle, or bone - The current pathway through the body causes additional damage internally, but the contact point itself typically reflects a **third-degree (full thickness) injury** due to intense localized heat - Entry and exit wounds from electrical burns characteristically show **charred, dry tissue** with central necrosis *Superficial partial thickness burn* - This type of burn involves only the **epidermis and superficial portion of the dermis**, typically presenting with blistering and redness - Electrical burns, especially contact burns, rarely result in such shallow injury due to the **intense and deep nature** of the energy transfer - The high voltage and current density at contact points cause damage far beyond superficial layers *Superficial scalding with blisters* - **Scald burns** are caused by hot liquids or steam and are typically **superficial or superficial partial thickness** - An electrical contact burn is distinct in its mechanism (electrical current) and the **severity of tissue damage** it causes, which extends far beyond the superficial layers - The mechanism of injury is fundamentally different from thermal scalding *Deep partial thickness burn* - Deep partial thickness burns extend into the **deeper dermis**, causing fluid-filled blisters and often mottled or waxy white areas - While electrical burns can involve deeper structures, the direct point of contact in an electrical contact burn usually causes damage that is **full thickness or beyond**, going past just the deep dermis - The concentrated heat and current flow at entry/exit sites result in complete destruction of all skin layers

Q: A 52 year old male patient comes with history of rectal bleeding, alteration in bowel habits and tenesmus. The ideal investigation would be:

Colonoscopy. ***Colonoscopy*** - **Colonoscopy** is the gold standard for investigating symptoms like rectal bleeding, altered bowel habits, and tenesmus, as it allows for direct visualization of the entire colon and rectum. - It enables **biopsy of suspicious lesions** for histopathological diagnosis, which is crucial for confirming conditions like colorectal cancer or inflammatory bowel disease. *Contrast-enhanced CT scan* - A **contrast-enhanced CT scan** is primarily used for **staging known malignancies** and assessing for distant metastases, not as a primary diagnostic tool for initial symptoms. - While it can identify large masses, it might miss smaller lesions and does not allow for tissue biopsy. *Fecal occult blood test* - A **fecal occult blood test** screens for blood in the stool, which indicates gastrointestinal bleeding but does not pinpoint the source or cause. - It has **low sensitivity and specificity** for diagnosing underlying conditions like colorectal cancer or inflammatory bowel disease and is mainly a screening tool. *Ultrasonogram* - An **ultrasonogram** is generally not effective for evaluating the colon and rectum due to bowel gas interference. - It is more commonly used for investigating abdominal organs like the liver, gallbladder, and kidneys, or for pelvic pathology, but not the primary investigation for these colorectal symptoms.

Q: The following are features of hypovolemic shock except:

Bradycardia. ***Bradycardia*** - Hypovolemic shock typically causes **tachycardia** (increased heart rate) as a compensatory mechanism to maintain cardiac output in the face of reduced blood volume [1]. - **Bradycardia** is generally not a feature of hypovolemic shock unless there are confounding factors or severe terminal stages. *Acidosis* - **Lactic acidosis** is a common feature of hypovolemic shock due to tissue hypoperfusion causing anaerobic metabolism [2]. - Reduced blood flow leads to inadequate oxygen delivery, forcing cells to produce lactic acid. *Oliguria* - **Oliguria** (decreased urine output) occurs in hypovolemic shock as the kidneys attempt to conserve fluid due to reduced renal perfusion. - The body prioritizes blood flow to vital organs, leading to decreased kidney function and urine production. *Low Blood Pressure* - **Hypotension** (low blood pressure) is a hallmark of shock, including hypovolemic shock, resulting from a significant reduction in circulating blood volume [1]. - The decrease in blood volume directly reduces venous return, stroke volume, and ultimately, systemic blood pressure.

Q: A 45 year old man sustains trauma in a road traffic accident and develops engorgement of neck veins, pallor, rapid pulse rate, and chest pain. What is the most likely diagnosis?

Cardiac tamponade. ***Cardiac tamponade*** - The classic triad of **Beck's triad** (engorged neck veins, muffled heart sounds, and hypotension) along with **tachycardia** and **pallor** in a trauma setting is highly indicative of cardiac tamponade [1]. - **Chest pain** due to pressure on the heart and surrounding structures further supports this diagnosis. *Haemothorax* - While blunt trauma can cause **haemothorax**, it typically presents with **diminished or absent breath sounds** on the affected side and **respiratory distress**, not prominently with engorged neck veins unless it's very large and significantly compromises venous return. - The primary sign would be **hypotension** and **tachycardia** from hypovolemia, but without the JVD. *Pulmonary laceration* - A pulmonary laceration would primarily cause **pneumothorax** or **haemothorax**, leading to signs like **dyspnea**, **chest pain**, and potentially **subcutaneous emphysema**. - **Engorged neck veins** are not a primary feature unless the resulting pneumothorax is tension type, which would also present with tracheal deviation. *Rupture of spleen* - A ruptured spleen causes **internal bleeding** (hypovolemic shock) presenting as **abdominal pain**, **left upper quadrant tenderness**, **tachycardia**, and **hypotension**. - **Engorged neck veins** are not a characteristic symptom of splenic rupture because it is a source of blood loss leading to hypovolemia.

Q: Which one of the following statements is not correct regarding trichobezoar ( hair balls)?

It is usually associated with pyloric stenosis.. ***It is usually associated with pyloric stenosis.*** - **Trichobezoars** are generally not associated with **pyloric stenosis**. The two conditions have distinct etiologies and pathophysiologies. - While both can present with gastric outlet obstruction symptoms, the presence of a hairball does not imply an underlying congenital or acquired narrowing of the pylorus. *It is associated usually with psychiatric illness.* - **Trichobezoars** are highly associated with **trichophagia** (compulsive hair eating), which is often a symptom of underlying psychiatric conditions like **trichotillomania** or **pica**. - These conditions involve an irresistible urge to pull out one's hair and/or consume non-nutritive substances, including hair. *It is more common in females.* - **Trichobezoars** are indeed more commonly found in **females**, especially young females [1]. - This increased prevalence is often linked to the higher incidence of **trichotillomania** and **trichophagia** in females. *It is more common in young.* - **Trichobezoars** are observed more frequently in **children and adolescents**, particularly among young girls [1]. - The behaviors of **trichotillomania** and **trichophagia** often develop during childhood or early adolescence [1].

Question 1

Which of the following statements about mesh skin grafts is not correct?

Accepted Answer

They contract to the same degree as a grafted sheet of skin.

Answer

They allow egress of fluid collections under the graft.

Answer

They permit coverage of large areas.

Answer

They “take” satisfactorily on granulating bed.

Question 2

The following operative procedure can result in neurogenic voiding dysfunction except:

Accepted Answer

Ureterolithotomy

Answer

Radical hysterectomy

Answer

Abdominoperineal resection

Answer

Retroperitoneal lymph node dissection

Question 3

Match List-I with List-II and select the correct answer using the code given below the Lists:

**List-I (Procedure)**
A. Highly selective vagotomy
B. Vagotomy with gastrojejunostomy
C. Subtotal gastrectomy
D. Nissen's fundoplication

**List-II (Complication)**
1. Metabolic bone disease
2. Post-prandial gas bloat
3. Lesser curve necrosis
4. Diarrhea

**Code:**

Accepted Answer

A→3  B→4  C→1  D→2

Answer

A→3  B→1  C→4  D→2

Answer

A→2  B→1  C→4  D→3

Answer

A→2  B→4  C→1  D→3

Question 4

Optimum age for surgery for a child with cleft lip is:

Accepted Answer

3 - 6 months

Answer

4 weeks

Answer

4 - 6 weeks

Answer

6 - 18 months

Question 5

An electrical contact burn is considered to be:

Accepted Answer

Full thickness burn

Answer

Superficial partial thickness burn

Answer

Superficial scalding with blisters

Answer

Deep partial thickness burn

Question 6

A 52 year old male patient comes with history of rectal bleeding, alteration in bowel habits and tenesmus. The ideal investigation would be:

Accepted Answer

Colonoscopy

Answer

Contrast-enhanced CT scan

Answer

Fecal occult blood test

Answer

Ultrasonogram

Question 7

What is the treatment of choice in a patient with Crohn’s disease, where inflamed appendix was found on exploration?

Accepted Answer

Ileo–colic resection and anastomosis

Answer

Appendectomy

Answer

Closing the abdomen and starting medical treatment

Answer

Right hemicolectomy

Question 8

The following are features of hypovolemic shock except:

Accepted Answer

Bradycardia

Answer

Acidosis

Answer

Oliguria

Answer

Low Blood Pressure

Question 9

A 45 year old man sustains trauma in a road traffic accident and develops engorgement of neck veins, pallor, rapid pulse rate, and chest pain. What is the most likely diagnosis?

Accepted Answer

Cardiac tamponade

Answer

Haemothorax

Answer

Pulmonary laceration

Answer

Rupture of spleen

Question 10

Which one of the following statements is not correct regarding trichobezoar ( hair balls)?

Accepted Answer

It is usually associated with pyloric stenosis.

Answer

It is associated usually with psychiatric illness.

Answer

It is more common in females.

Answer

It is more common in young.

UPSC-CMS 2014 — Surgery