UPSC-CMS 2018 - Surgery Practice Questions

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

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 2

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 3

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 4

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 5

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 6

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 — Surgery