UPSC-CMS 2023 - Surgery Practice Questions

Q: Consider the following statements in respect of congenital hypertrophic pyloric stenosis: 1. The condition is more common in males. 2. The investigation of choice is ultrasonography. 3. Hypertrophy is maximal in the pre pyloric region. 4. Projectile vomiting is seen in this condition. Which of the statements given above are correct?

1, 2 and 4 only. ***1, 2 and 4 only*** - **Statement 1 is CORRECT**: Congenital hypertrophic pyloric stenosis (CHPS) is more common in males with a male-to-female ratio of approximately 4-5:1. - **Statement 2 is CORRECT**: Ultrasonography is the investigation of choice for CHPS, being non-invasive and accurate in measuring pyloric muscle thickness (>3 mm) and pyloric length (>15 mm). - **Statement 3 is INCORRECT**: The hypertrophy is maximal in the **pyloric muscle** (circular muscle layer of the pylorus), NOT in the pre-pyloric region. This is a key anatomical distinction. - **Statement 4 is CORRECT**: Projectile non-bilious vomiting typically occurring 30-60 minutes after feeding is the hallmark clinical presentation of CHPS. *3 only* - Incorrect because statement 3 is false (hypertrophy is in the pylorus, not pre-pyloric region), while statements 1, 2, and 4 are all true. *2, 3 and 4 only* - Incorrect because it includes statement 3, which is false. The maximal hypertrophy occurs in the **pyloric canal**, not the pre-pyloric region. *1 and 2 only* - Incomplete as it omits statement 4 about projectile vomiting, which is a cardinal feature of CHPS and is definitely correct.

Q: Consider the following statements : Branchial cysts : 1. are associated with tracks passing between the carotid bifurcation. 2. usually present in early adulthood. 3. occur along the lower one-third of the anterior border of the sternocleidomastoid muscle. 4. develop from the vestigial remnants of the fourth branchial cleft. Which of the statements given above are correct?

1, 2 and 3 only. ***1, 2 and 3 only*** - **Branchial cysts** (specifically **second branchial cleft cysts**) are frequently associated with a **sinus tract** that passes between the **internal and external carotid arteries** (carotid bifurcation) and opens into the tonsillar fossa. - They commonly present in **late childhood or early adulthood** as a slowly enlarging, painless mass, often located along the **anterior border of the sternocleidomastoid muscle**, typically at the junction of the upper two-thirds and lower one-third of the neck. *2, 3 and 4 only* - This option incorrectly states that branchial cysts develop from the **fourth branchial cleft**. Most common branchial cysts are derived from the **second branchial cleft** (accounting for >90% of cases). - While statements 2 and 3 are correct regarding presentation and location, the origin from the fourth branchial cleft is generally not applicable to the most prevalent type of branchial cyst. *1, 2, 3 and 4* - This option includes the incorrect statement that branchial cysts typically originate from the **fourth branchial cleft**. The vast majority (over 90-95%) of branchial cleft anomalies arise from the **second branchial cleft**. - While all other statements (1, 2, and 3) are characteristic of second branchial cleft cysts, the inclusion of the fourth branchial cleft origin makes this option incorrect. *1 and 2 only* - This option correctly identifies the association with tracks passing through the carotid bifurcation and presentation in early adulthood. - However, it omits the correct statement that branchial cysts typically occur along the **lower one-third of the anterior border of the sternocleidomastoid muscle**, which is a key anatomical location and an important clinical finding for diagnosis.

Q: A 25-year-old gentleman complains of dragging pain in the scrotum. The examination reveals the scrotum full of bag of worms which disappear on lying down. The usual first line option for relief is :

Surgical varicocelectomy (ligation of testicular veins). ***Surgical varicocelectomy (ligation of testicular veins)*** - The "bag of worms" sensation that disappears on lying down is **pathognomonic for varicocele**, representing dilated pampiniform plexus veins - **Varicocelectomy** (surgical ligation of the internal spermatic/testicular veins) is the **gold standard first-line treatment** for symptomatic varicoceles causing pain or infertility - Common approaches include **open (Palomo or Ivanissevich technique)**, **laparoscopic**, or **microscopic subinguinal** varicocelectomy with success rates of 90-95% - The procedure involves **ligation** (tying off) the dilated veins, not excision of the entire pampiniform plexus *Radio frequency ablation of testicular veins* - **Radiofrequency ablation** is not a standard treatment modality for varicoceles - The testicular veins are not amenable to standard RFA techniques used for other venous insufficiencies - This is **not considered a first-line option** in clinical practice *Percutaneous embolization of gonadal veins* - **Percutaneous embolization** is an alternative **minimally invasive first-line treatment** option for symptomatic varicoceles, particularly in resource-rich settings - Success rates are comparable to surgery (90-95%) with potentially lower complication rates and faster recovery - However, in the context of **traditional Indian surgical practice** and most PG examinations, **surgical varicocelectomy remains the conventional first-line answer** - Embolization involves retrograde catheterization and occlusion of the testicular vein with coils or sclerosants *Laparoscopic excision of affected testes* - **Orchiectomy** (testicular excision) is completely inappropriate for varicocele management - This radical procedure is reserved for **testicular malignancy**, severe trauma with non-viable testis, or torsion with necrosis - **Never a treatment option** for simple symptomatic varicocele

Q: A malnourished 60-year-old man underwent emergency surgery for Strangulated Sigmoid Volvulus. After resection of the sigmoid colon, a colostomy was fashioned. The postoperative period was stormy and he developed a painful calf swelling in right lower limb. The most probable diagnosis is :

Deep vein thrombosis. ***Deep vein thrombosis*** - Postoperative patients, especially those undergoing **abdominal surgery** and those with **malnutrition**, are at high risk for **deep vein thrombosis (DVT)** due to Virchow's triad (venous stasis, endothelial injury, hypercoagulability). - A **painful calf swelling** is a classic symptom of DVT, indicating clot formation within the deep veins of the leg. *Myocardial failure due to fluid overload* - While fluid overload can occur post-surgery, it typically leads to **generalized edema**, shortness of breath, and signs of cardiac dysfunction, not isolated painful calf swelling. - The primary presentation here is a localized, painful swelling, which is less consistent with systemic cardiac issues. *Oedema of renal failure* - **Renal failure** can cause **edema**, but it tends to be **pitting, bilateral, and generalized**, often affecting the ankles and sacral areas. - It would not typically present as a painful, unilateral calf swelling without other signs of kidney dysfunction. *Hypoproteinaemia* - **Hypoproteinaemia**, common in **malnourished** individuals, can cause **generalized non-pitting edema** due to decreased oncotic pressure, not specifically a painful calf swelling. - It would manifest as widespread edema rather than a localized, painful swelling indicative of a thrombotic event.

Q: Which of the following are components of "Klippel-Trenaunay syndrome" ? 1. Cutaneous Naevus 2. Subcutaneous Lipomas 3. Varicose veins 4. Soft tissue hypertrophy Select the correct answer using the code given below :

1, 3 and 4. ***1, 3 and 4*** - Klippel-Trenaunay syndrome is characterized by a triad of **capillary malformations (cutaneous naevus)**, **venous malformations (varicose veins)**, and **limb overgrowth (soft tissue hypertrophy)**. - These features are typically present at birth and often affect a single limb or a region of the body. *1, 2 and 3* - This option incorrectly includes **subcutaneous lipomas** as a core component of Klippel-Trenaunay syndrome, which are not typically associated with the condition. - While capillary malformations and varicose veins are characteristic, the inclusion of lipomas makes this option incorrect. *2, 3 and 4* - This option incorrectly includes **subcutaneous lipomas** and omits the essential feature of **cutaneous naevus (capillary malformation)**. - The absence of cutaneous naevus, a hallmark of the syndrome, makes this selection inaccurate. *1, 2 and 4* - This option incorrectly includes **subcutaneous lipomas** and omits **varicose veins**, a key component of the syndrome. - The presence of capillary malformations and soft tissue hypertrophy are correct, but the missing varicose veins and incorrect inclusion of lipomas render this option incorrect.

Q: Which of the following statements regarding Thyroglossal duct are correct ? 1. It is situated in midline of neck. 2. It moves upwards on swallowing but not on tongue protrusion. 3. It is treated with Sistrunk operation. 4. It may be the only functioning thyroid tissue in the body. Select the correct answer using the code given below :

1, 3 and 4. ***1, 3 and 4*** - The **thyroglossal duct** is embryological remnant located in the **midline of the neck** and often presents as a cyst. - The **Sistrunk operation** is the definitive surgical treatment for **thyroglossal duct cysts**, involving removal of the cyst, the midline portion of the hyoid bone, and the tract to the foramen cecum. - In some cases, a **thyroglossal duct cyst** may harbor the patient's only functional **thyroid tissue**, making preoperative imaging crucial to avoid inadvertently causing hypothyroidism. *1, 2 and 3* - This option incorrectly states that the thyroglossal duct moves upwards only on swallowing and not on **tongue protrusion**. - In fact, its connection to the foramen cecum at the base of the tongue means it **elevates with tongue protrusion** as well as swallowing. *2, 3 and 4* - This option incorrectly states that the **thyroglossal duct** moves upwards only on swallowing and not on **tongue protrusion**. - The **midline location** (statement 1) is a key characteristic of thyroglossal duct remnants and is correctly included in the comprehensive correct option. *1, 2 and 4* - This option incorrectly claims that the thyroglossal duct moves upwards only on swallowing and not on **tongue protrusion**. - It also omits the **Sistrunk operation** (statement 3), which is the standard surgical treatment for **thyroglossal duct cysts**.

Q: "Collar-stud" abscess is seen in :

Tuberculosis. ***Tuberculosis*** - A "**collar-stud**" abscess is a classic presentation of **tuberculous lymphadenitis**, particularly in the neck. - This type of abscess forms when pus from an infected deep lymph node erodes through the deep fascia but is contained by the superficial fascia, creating a dumbbell or "collar-stud" shape. *Lymphomatous degeneration* - **Lymphomatous degeneration** refers to the transformation of a benign lymphoid process into lymphoma. - While lymph nodes are involved, it typically presents as **lymphadenopathy** (enlargement of lymph nodes) and does not characteristically form an abscess with this specific morphology. *Pseudomonas infection* - **Pseudomonas infections** can cause abscesses, especially in immunocompromised individuals or associated with contaminated wounds or medical devices. - However, they do not specifically form a "**collar-stud**" abscess, which is a hallmark of tuberculous infection of lymph nodes. *Streptococcal infection* - **Streptococcal infections** frequently cause cellulitis, erysipelas, and various forms of abscesses, such as peritonsillar or skin abscesses. - While streptococci can cause **suppurative lymphadenitis**, they do not typically produce the distinctive "**collar-stud**" morphology seen in tuberculosis.

Question 1

Consider the following statements in respect of congenital hypertrophic pyloric stenosis:

1. The condition is more common in males.

2. The investigation of choice is ultrasonography.

3. Hypertrophy is maximal in the pre pyloric region.

4. Projectile vomiting is seen in this condition.
Which of the statements given above are correct?

Accepted Answer

1, 2 and 4 only

Answer

3 only

Answer

2, 3 and 4 only

Answer

1 and 2 only

Question 2

The following statements regarding Meckel's diverticulum in adults are true except

Accepted Answer

It usually presents on the mesenteric border of small intestine

Answer

Bleeding is a common complication

Answer

Incidental removal is often recommended in younger patients with risk factors

Answer

It is a remnant of omphalomesenteric duct

Question 3

Consider the following statements :

Branchial cysts :

1. are associated with tracks passing between the carotid bifurcation.
2. usually present in early adulthood.
3. occur along the lower one-third of the anterior border of the sternocleidomastoid muscle.
4. develop from the vestigial remnants of the fourth branchial cleft.

Which of the statements given above are correct?

Accepted Answer

1, 2 and 3 only

Answer

2, 3 and 4 only

Answer

1, 2, 3 and 4

Answer

1 and 2 only

Question 4

Regarding laparoscopic cholecystectomy, which of the following statements is correct?

Accepted Answer

It is associated with higher rate of bile duct injuries than open cholecystectomy

Answer

It is primarily done for cholecystitis in the third trimester of pregnancy

Answer

It is safer than open cholecystectomy in patients with cardiorespiratory disease

Answer

It is contraindicated in acute cholecystitis

Question 5

A 5-year-old male child comes with a left sided scrotal swelling which has no cough impulse and does not reduce on compression or lying down but the parents give a definite history that swelling is absent in the morning and comes by in the evening. The best treatment is :

Accepted Answer

Herniotomy

Answer

Eversion of sac

Answer

To leave it alone (masterly inactivity)

Answer

Hernioplasty

Question 6

A 25-year-old gentleman complains of dragging pain in the scrotum. The examination reveals the scrotum full of bag of worms which disappear on lying down. The usual first line option for relief is :

Accepted Answer

Surgical varicocelectomy (ligation of testicular veins)

Answer

Radio frequency ablation of testicular veins

Answer

Percutaneous embolization of gonadal veins

Answer

Laparoscopic excision of affected testes

Question 7

A malnourished 60-year-old man underwent emergency surgery for Strangulated Sigmoid Volvulus. After resection of the sigmoid colon, a colostomy was fashioned. The postoperative period was stormy and he developed a painful calf swelling in right lower limb. The most probable diagnosis is :

Accepted Answer

Deep vein thrombosis

Answer

Myocardial failure due to fluid overload

Answer

Oedema of renal failure

Answer

Hypoproteinaemia

Question 8

Which of the following are components of "Klippel-Trenaunay syndrome" ?

1. Cutaneous Naevus
2. Subcutaneous Lipomas
3. Varicose veins
4. Soft tissue hypertrophy

Select the correct answer using the code given below :

Accepted Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Question 9

Which of the following statements regarding Thyroglossal duct are correct ?

1. It is situated in midline of neck.
2. It moves upwards on swallowing but not on tongue protrusion.
3. It is treated with Sistrunk operation.
4. It may be the only functioning thyroid tissue in the body.

Select the correct answer using the code given below :

Accepted Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Question 10

"Collar-stud" abscess is seen in :

Accepted Answer

Tuberculosis

Answer

Lymphomatous degeneration

Answer

Pseudomonas infection

Answer

Streptococcal infection

UPSC-CMS 2023 — Surgery